Uber and Metropolitan Traffic Fatalities in the United States

Investigating the Implications of Sexual Assaults with Ride-Sharing: A Call for Research

Sexual assault rates are increasing with ride-shares. Sexual violence data are often underestimated due to sexual violence cases going unreported and can lead to negative health outcomes. There is no research on the phenomenon of sexual assaults among ride-share users. This manuscript investigates sexual assaults from two ride-share companies and the policies/procedures in place to prevent sexual assaults. The data from two ride-share companies' previous Safety Reports were compared to see an increase in sexual assaults. The researchers looked at policies and regulations that ride-share companies have to prevent sexual assault. There is a call for research to investigate more in-depth the sexual assaults that have occurred including demographic data, geographic location, global positioning system failure, and the effectiveness of the criminal background checks.

Globalization, platform work, and wellbeing-a comparative study of Uber drivers in three cities: London, Helsinki, and St Petersburg

BACKGROUND

Globalization of platform work has become a challenge for wider social and employment relations and wellbeing of workers, yet on-location work remains governed also by local regulatory context. Understanding common challenges across countries and potential for regulatory measures is essential to enhance health and wellbeing of those who work in platform economy. Our comparative study on platform work analyzed concerns of Uber drivers in three cities with a different regulatory and policy context.

METHODS

Drawing from current understanding on employment and precarity as social determinants of health we gathered comparative documentary and contextual data on regulatory environment complemented with key informant views of regulators, trade unions, and platform corporations (N = 26) to provide insight on the wider regulatory and policy environment. We used thematic semi-structured interviews to examine concerns of Uber drivers in Helsinki, St Petersburg, and London (N = 60). We then analysed the driver interviews to identify common and divergent concerns across countries.

RESULTS

Our results indicate that worsening of working conditions is not inevitable and for drivers the terms of employment is a social determinant of health. Drivers compensated declining pay with longer working hours. Algorithmic surveillance as such was of less concern to drivers than power differences in relation to terms of work.

CONCLUSIONS

Our results show scope for regulation of platform work especially for on-location work concerning pay, working hours, social security obligations, and practices of dismissal.

Are ride-hailing services safer than taxis? A multivariate spatial approach with accommodation of exposure uncertainty

Despite many research efforts on ride-hailing services and taxis, limited studies have compared the safety performance of the two modes. A major challenge is the need for reliable mode-specific exposure data to model their safety outcomes. Moreover, crash frequencies of the two modes by injury severities tend to be spatially and inherently correlated. To fully address these issues, this study proposes a novel multivariate conditional autoregressive model considering measurement errors in mode-specific exposures (MVCARME). More specially, a classical measurement error structure accommodates the uncertainty of estimated mode-specific exposures, and a multivariate spatial specification is adopted to capture potential spatial and inherent correlations. The model estimation is accelerated by an integrated nest Laplace approximation method. The census tracts in the city of Chicago are set as the spatial analysis unit. The mode-specific exposures (vehicle-mile-traveled) in each census tract are estimated by trip assignments using ride-hailing and taxi trip data in 2019. The modeling results indicate that both ride-hailing crashes and taxi crashes are positively associated with transportation factors (e.g., vehicle-mile-traveled, mode-specific vehicle-mile-traveled, and traffic signal numbers), land use factors (i.e., number of educational and alcohol-related sites), and demographic factors (e.g., median household income, transit ratio, and walk ratio). By comparison, the proposed model outperforms the others (i.e., negative binomial models and multivariate conditional autoregressive model) by yielding the lowest deviance information criterion (DIC), Watanabe-Akaike information criterion (WAIC), mean absolute error (MAE), and root-mean-square error (RMSE). According to the results of t-tests, ride-hailing services are found to be prone to a higher risk of minor injury crashes compared with taxis, despite no significant difference between the risks of severe injury crashes. Methodologically, this study adds a robust safety evaluation approach for comparing crash risks of different modes to the literature. At the same time, practically, it provides researchers, practitioners, and policy-makers insights into the safety management of various mobility alternatives.

Uber use after alcohol consumption among car/motorcycle drivers in ten Brazilian capitals

OBJECTIVE

This study aimed to measure the proportion of Uber use instead of drinking and driving in ten Brazilian capitals, in 2019.

METHODS

A cross-sectional survey was developed in ten Brazilian capitals. Data were collected in agglomeration points (AP) and sobriety checkpoints (SC). Based on responses to a standardized questionnaire, the proportion of drivers who used Uber instead of drinking and driving was measured for total sample of each methodology and stratified by municipality, age group, gender, education level, and type of vehicle. Fisher's exact test was used to make comparisons between the strata.

RESULTS

A total of 8,864 drivers were interviewed. The most used means of transport to replace driving after drinking alcohol was the Uber system (AP: 54.6%; 95%CI: 51.2-58.0. SC: 58.6%; 95%CI: 55.2-61.9). Most of these users were aged from 18 to 29 years, women, with at least one higher education degree. According to the AP methodology, the highest magnitude of this indicator was found in Vitória (ES) (71.0%; 95%CI: 63.5-77.5), whereas the lowest was observed in Teresina (PI) (33.1%; 95%CI: 22.7-45.5). According to the SC methodology, the highest magnitude of the indicator was also found in Vitória (ES) (78.3%; 95%CI: 68.8-85.5), whereas the lowest was observed in Boa Vista (RR) (36.6%; 95%CI: 26.8-47.7).

CONCLUSION

In Brazilian capitals, the study showed higher proportions of Uber use instead of drinking and driving. This type of scientific evidence on factors associated with road traffic injuries presents the potential to guide public health interventions.

Do ridesharing transportation services alleviate traffic crashes? A time series analysis

OBJECTIVES

On-demand ridesharing services are suggested to provide several benefits, such as improving accessibility and mobility, reducing drive-alone trips and greenhouse gas emissions. However, the impacts of these services on traffic crashes are not completely clear. This paper investigates the availability of Via- an on-demand ridesharing service in Arlington, TX, to identify the effects of this service on traffic crashes. We hypothesize that the launch of Via would result in more shared rides, fewer drive-alone trips and fewer traffic crashes.

METHODS

We implement an Interrupted Time Series Analysis (ITSA) approach to study the impact of Via service availability on traffic crashes using weekly counts of all traffic crashes, the number of injuries, and serious injuries that occurred in Arlington from 2014 to 2021.

RESULTS

The results show a statistically significant reduction in the weekly number of total crashes and total injuries but do not show any significant impact on the number of serious injuries. Shared Autonomous Vehicles have the potential to reduce traffic crashes caused by driver's fault.

CONCLUSIONS

This study reveals the potential impacts ridesharing services can have on traffic crashes and injuries in a mid-sized city. The results of this study can help decision and policymakers to understand the full potential of ridesharing services that can contribute to making relevant decisions toward creating sustainable and safer transportation systems in cities.

Does the Implementation of Ride-Hailing Services Affect Urban Road Safety? The Experience of Madrid

In recent years, changes have occurred in consumption, ownership, and social relations, giving rise to new economic models in which technology enables new ways of connecting, creating, and sharing value. The nature of transport has transformed with the emergence of mobile applications, such as Uber and Cabify, which offer an alternative to the services traditionally provided by the taxi and chauffeur-driven hire vehicle (CDV) sectors. These services have developed within a context of market regulation of the taxi and CDV which are subject to considerable unjustified restrictions for entering and operating in the market, including the numerus clausus of licenses, the limited geographical scope of the license and, in the case of taxis, the regulation of prices as inflexible public rates. Bearing in mind the latest legislative changes affecting mostly the provision of the services of these platforms, this study analyzes whether the number of traffic accident victims has fallen since the introduction of these services in the city of Madrid using a Random Effects Negative Binominal model. The results show that the deployment of these platforms is associated with a reduction of 25% in the number of serious injuries and deaths.

Ride-Hailing and Road Traffic Crashes: A Critical Review

Ride-hailing businesses, including Uber and Lyft, have reshaped road traffic since they first began operating in the United States approximately a decade ago. It follows that ride-hailing may also alter the incidence and distribution of road traffic crash injuries and deaths. The available evidence relating ride-hailing to crashes is critically reviewed in this article. We present a theoretical model that synthesizes the hypothesized mechanisms, and we identify common methodological challenges and suggest priorities for future research. Mixed results have been reported for the overall incidence of road traffic crash injuries and deaths, likely due to heterogeneous impacts on vehicular traffic flow (e.g., increasing the volume of vehicles); on vehicle-, person-, and event-level characteristics (e.g., reducing alcohol-impaired driver crashes); on road-user types (e.g., increasing pedestrian crashes); and on environmental conditions (e.g., reducing crashes most substantially where public transit access is poorest). The lack of a well-developed theory of human mobility and methodological challenges that are common to many ecological studies impede exploration of these sources of moderation. Innovative solutions are required to explicate ride-hailing's heterogeneous impacts, to guide policy that can take advantage of the public health benefits of ride-hailing, and to ensure that research keeps pace with technological advances that continue to reshape road traffic use.

Alcohol-impaired driving among adults-USA, 2014-2018

INTRODUCTION

Alcohol-impaired driving (AID) crashes accounted for 10 511 deaths in the USA in 2018, or 29% of all motor vehicle-related crash deaths. This study describes self-reported AID in the USA during 2014, 2016 and 2018 and determines AID-related demographic and behavioural characteristics.

METHODS

Data were from the nationally representative Behavioral Risk Factor Surveillance System. Adults were asked 'During the past 30 days, how many times have you driven when you have had perhaps too much to drink?' AID prevalence, episode counts and rates per 1000 population were estimated using annualised individual AID episodes and weighted survey population estimates. Results were stratified by characteristics including gender, binge drinking, seatbelt use and healthcare engagement.

RESULTS

Nationally, 1.7% of adults engaged in AID during the preceding 30 days in 2014, 2.1% in 2016 and 1.7% in 2018. Estimated annual number of AID episodes varied across year (2014: 111 million, 2016: 186 million, 2018: 147 million) and represented 3.7 million, 4.9 million and 4.0 million adults, respectively. Corresponding yearly episode rates (95% CIs) were 452 (412-492) in 2014, 741 (676-806) in 2016 and 574 (491-657) in 2018 per 1000 population. Among those reporting AID in 2018, 80% were men, 86% reported binge drinking, 47% did not always use seatbelts and 60% saw physicians for routine check-ups within the past year.

CONCLUSIONS

Although AID episodes declined from 2016 to 2018, AID was still prevalent and more common among men and those who binge drink. Most reporting AID received routine healthcare. Proven AID-reducing strategies exist.

Differential impacts of ridesharing on alcohol-related crashes by socioeconomic municipalities: rate of technology adoption matters

BACKGROUND

An emergent group of studies have examined the extent under which ridesharing may decrease alcohol-related crashes in countries such as United States, United Kingdom, Brazil, and Chile. Virtually all existent studies have assumed that ridesharing is equally distributed across socioeconomic groups, potentially masking differences across them. We contribute to this literature by studying how socioeconomic status at the municipal level impacts Uber's effect on alcohol-related crashes.

METHODS

We use data provided by Chile's Road Safety Commission considering all alcohol-related crashes, and fatal and severe alcohol-related injuries that occurred between January 2013 and September 2013 (before Uber) and January and September 2014 (with Uber) in Santiago. We first apply spatial autocorrelation techniques to examine the level of spatial dependence between the location of alcohol-related crashes with and without Uber. We then apply random-effects meta-analysis to obtain risk ratios of alcohol-related crashes by considering socioeconomic municipality differences before and after the introduction of Uber.

RESULTS

In both analyses, we find that the first 9 months of Uber in Santiago is associated with significant rate ratio decreases (RR = 0.71 [95% Confidence Interval (C.I.) 0.56, 0.89]) in high socioeconomic municipalities in all alcohol-related crashes and null (RR = 1.10 [95% C.I. 0.97, 1.23]) increases in low socioeconomic municipalities. No concomitant associations were observed in fatal alcohol-related crashes regardless of the socioeconomic municipality group.

CONCLUSIONS

One interpretation for the decline in alcohol-related crashes in high socioeconomic municipalities is that Uber may be a substitute form of transport for those individuals who have access to credit cards, and thus, could afford to pay for this service at the time they have consumed alcohol. Slight increases of alcohol-related crashes in low socioeconomic municipalities should be studied further since this could be related to different phenomena such as increases in alcohol sales and consumption, less access to the provision of public transport services in these jurisdictions, or biases in police reports.

Self-Powered Respiration Monitoring Enabled By a Triboelectric Nanogenerator

In mammals, physiological respiration involves respiratory cycles of inhaled and exhaled breaths, which has traditionally been an underutilized resource potentially encompassing a wealth of physiologically relevant information as well as clues to potential diseases. Recently, triboelectric nanogenerators (TENGs) have been widely adopted for self-powered respiration monitoring owing to their compelling features, such as decent biocompatibility, wearing comfort, low-cost, and high sensitivity to respiration activities in the aspect of low frequency and slight amplitude body motions. Physiological respiration behaviors and exhaled chemical regents can be precisely and continuously monitored by TENG-based respiration sensors for personalized health care. This article presents an overview of TENG enabled self-powered respiration monitoring, with a focus on the working principle, sensing materials, functional structures, and related applications in both physical respiration motion detection and chemical breath analysis. Concepts and approaches for acquisition of physical information associated with respiratory rate and depth are covered in the first part. Then the sensing mechanism, theoretical modeling, and applications related to detection of chemicals released from breathing gases are systemically summarized. Finally, the opportunities and challenges of triboelectric effect enabled self-powered respiration monitoring are comprehensively discussed and criticized.

What Are the Restraint Practices, Preferences, and Experiences When Australian Parents Travel with Their Children in a Rideshare Vehicle?

This study aimed to explore the preferences, experiences and restraint practices of Australian parents travelling with their children in rideshare vehicles. Six hundred and thirty-one participants completed an online survey (M = 39.2 years, SD = 10.5, Range = 18.0–70.0 years; Female: 63.4%). Most participants (59.1%) reported that they had not travelled in a rideshare vehicle with their youngest child (M = 7.2 years, SD = 5.2, Range = 0.0–17.0 years; Male: 54.2%). Participants who reported that they have travelled with their youngest child in a rideshare vehicle tended to: be younger, identify as male, have completed an Undergraduate or Postgraduate degree, reside in the Australian Capital Territory, earning a higher yearly household income, and were involved in an at-fault crash in the past two years. In addition, these participants were: less likely to have a ‘younger’ youngest child, less likely to ‘always’ wear a seatbelt while travelling in their private motor vehicle, and also less likely to ‘always’ restrain their child in an appropriate restraint while travelling in their private motor vehicle. Prohibitive reasons for not travelling in a rideshare vehicle included: cost (29.3%), concerns over driver safety (27.5%), concerns over travelling with children in a rideshare service (24.8%), or inconvenience (24.3%). Participants who reported that they had travelled in a rideshare vehicle with their youngest child reported lower rates of appropriate restraint use within the rideshare vehicle (57.3%) than when travelling in their private motor vehicle (85.6%). Reasons associated with inappropriate restraint use within the rideshare vehicle included: unavailability of a child restraint (39.6%), travelling a short distance (33.0%), were not required to use one in this situation (33.0%), or the parent did not have a restraint with them (26.4%). Given the increasing popularity of rideshare services in Australia, and globally, the urgent adaption of rideshare-specific policy, legislation, education, and design in relation to child restraint requirements is needed to ensure the safety of child occupants.

Association of Rideshare Use With Alcohol-Associated Motor Vehicle Crash Trauma

Question

By decreasing impaired driving, are rideshare services associated with changes in motor vehicle trauma rates?

Findings

This multicenter cohort study obtained hospital data at both major trauma centers in Houston, Texas; convictions for impaired driving from the Harris County, Texas, District Attorney’s office; and rideshare use data from Uber and Google for Houston. Rideshare volume had a significant negative correlation with the incidence of motor vehicle–associated trauma, and this was most evident in those younger than 30 years; a significant decrease in convictions for impaired driving was associated with the introduction of rideshare services.

Meaning

By using rideshares to avoid impaired driving, young people may aid in decreasing motor vehicle trauma.

Importance

Motor vehicle crashes (MVCs) are an important public health concern. Recent trends suggest that introducing rideshare services has decreased the incidence of MVCs. However, detailed analyses linking rideshare volume, convictions for impaired driving, and nonfatal MVC traumas remain inconclusive.

Objective

To determine if there is an association between rideshare use and MVC traumas and convictions for impaired driving in Houston, Texas.

Design, Setting, and Participants

This multicenter cohort study was conducted between January 2007 and November 2019 with hospital data from the Red Duke Trauma Institute within the Memorial Hermann Hospital–Texas Medical Center and Ben Taub General Hospital. Rideshare data from Uber and Google covered trips taken within Houston, Texas, from February 2014 (the date of deployment of Uber to Houston) to December 2018. Impaired driving convictions included all indictments made by the Harris County, Texas, District Attorney’s office from January 2007 to December 2018. All adults with MVC traumas evaluated at both centers in the study population (individuals >16 years with a mechanism of injury classified under “motor vehicle collision”) were included. Impaired driving incidents were included only if the final legal outcome was conviction.

Main Outcomes and Measures

The primary study outcomes were the incident rate ratios for hourly MVC traumas and daily impaired driving convictions.

Results

A total of 23 491 MVC traumas (involving patients with a mean [SD] age of 37.9 [17.8] years and 14 603 male individuals [62.1%]), 93 742 impaired driving convictions, and more than 24 million Uber rides were analyzed. Following the introduction of Uber in February 2014, MVC traumas decreased by 23.8% (from a mean [SD] of 0.26 [0.04] to 0.21 [0.06] trauma incidents per hour) during peak trauma periods (Friday and Saturday nights). The incident rate ratio of MVC traumas following Uber deployment was 0.33 (95% CI, 0.17-0.67) per 1000 indexed rides (P = .002). Furthermore, rideshare use was associated with a significant, geographically linked reduction in impaired driving convictions between January 2014 to December 2019 (incidence rate ratio, 0.76 [95% CI, 0.73-0.78]; P < .001).

Conclusions and Relevance

In this study, introducing rideshare services in the Houston metropolitan area was associated with significant reductions in MVC traumas and impaired driving convictions. Increased use of rideshares may be an effective means of reducing impaired driving and decreasing rate of MVC traumas.

Analysis of the Impact of Ride-Hailing Services on Motor Vehicles Crashes in Madrid

In most cities, discretionary passenger transport by car is predominantly supplied by taxi services. These services face competition from new digital platforms (UBER, Cabify, etc.) that connect users with the services offered by authorized drivers with a license for rented vehicles with drivers (VTC). However, very little is known about the impacts that these services produce in cities where they operate. So far, most studies on this issue have focused on cities of the United States of America, and they broadly found a positive impact in terms of road safety. Road safety has become one of the priority focuses for ensuring social welfare, to the point of being integrated into the Sustainable Development Goals as a primary value to achieve sustainable, safe and responsible mobility. Within this context, the objective of this paper is to analyze the impact of ride-hailing platforms on the frequency of traffic accidents with at least one fatally or seriously injured person in the municipality of Madrid from 2014 to 2018. To do this, a regression analysis has been carried out using a random effects negative binomial regression (RENB). The results of the model show that Uber and Cabify services are associated with a decrease in fatal and serious accidents in Madrid.

Do ridesharing services increase alcohol consumption?

Recent studies suggest ridesharing services, such as Uber and Lyft, may reduce instances of intoxicated driving. However, such services may reduce the costs, and thus increase the frequency and intensity, of drinking activity. To examine whether ridesharing affects alcohol consumption, we leverage spatial and temporal variation in the presence of Uber's taxi-like service, UberX, across the United States. Using self-reported measures of alcohol consumption in the past 30 days among individuals aged 21 to 64, we find that UberX is associated with a 3.6% increase in number of drinks per drinking day, a 2.7% increase in drinking days, a 5.4% increase in total drinks, a 4.3% increase in the maximum number of drinks in a single occasion, and a 1.3% increase in those who report drinking any alcohol. For certain groups, such as males, individuals aged 21-34, and students, UberX is associated with even larger increases in drinking. For example, among those aged 21-34, total drinks increase by 7.4% and binge drinking instances increase by 9.5%. We also find that the marginal impact of Uber on drinking is larger in areas that have weaker public transit. Using administrative employment data, we find that some of the additional alcohol consumption is occurring at bars. Specifically, we estimate that UberX is associated with a 3.5% increase in employment and a 3.7% increase in total earnings among workers at NAICS-designated "drinking places".

Associating ridesourcing with road safety outcomes: Insights from Austin, Texas

Improving road safety and setting targets for reducing traffic-related crashes and deaths are highlighted as part of the United Nations sustainable development goals and worldwide vision zero efforts. The advent of transportation network companies and ridesourcing expands mobility options in cities and may impact road safety outcomes. We analyze the effects of ridesourcing use on road crashes, injuries, fatalities, and driving while intoxicated (DWI) offenses in Travis County, Texas. Our approach leverages real-time ridesourcing volume to explain variation in road safety outcomes. Spatial panel data models with fixed-effects are deployed to examine whether the use of ridesourcing is significantly associated with road crashes and other safety metrics. Our results suggest that for a 10% increase in ridesourcing trips, we expect a 0.12% decrease in road crashes, a 0.25% decrease in road injuries, and a 0.36% decrease in DWI offenses in Travis County. On the other hand, ridesourcing use is not significantly associated with road fatalities. This study augments existing work because it moves beyond binary indicators of ridesourcing availability and analyzes crash and ridesourcing trips patterns within an urbanized area rather than their metropolitan-level variation. Contributions include developing a data-rich approach for assessing the impacts of ridesourcing use on the transportation system's safety, which may serve as a template for future analyses for other cities. Our findings provide feedback to policymakers by clarifying associations between ridesourcing use and traffic safety and uncover the potential to achieve safer mobility systems with transportation network companies.

The effect of the Safer at Home order on the frequency of DUI breath alcohol tests in Los Angeles County

With Los Angeles County having a population size of just over 10 million and an additional 471,000 people who commute into Los Angeles County for employment, many drivers are at risk of being injured or killed in an alcohol-impaired driving collision. On March 19, 2020, the County of Los Angeles issued the Safer at Home order as a result of the COVID-19 pandemic. This curtailed driving and decreased the number of breath alcohol tests that were conducted in Los Angeles County. The number of breath tests conducted in January-February of 2019 and 2020 and March-April of 2019 and 2020 were evaluated using Fisher's exact test and analysis of variance. There was a statistically significant decrease in the overall number of breath tests conducted in Los Angeles County in March-April of 2020. There was also a significant decrease in the number of collisions where DUI was a factor. Accounting for changes in traffic volumes, the number of breath tests per vehicle miles driven also decreased significantly. Since the Safer at Home order closed all non-essential services such as bars and restaurants, there is indirect data on the relative contribution of liquor-serving establishments, and to some extent large social gatherings, to the incidence of drunk driving. Taking into account traffic volume, it was determined that the odds of encountering an intoxicated driver decreased by approximately 23% during the Safer at Home period. This information could help policy-makers determine the likely effectiveness of various countermeasures to prevent drunk driving.

Ride-Hailing Services and Alcohol Consumption: Longitudinal Analysis

Background

Alcohol consumption is associated with a wide range of adverse health consequences and a leading cause of preventable deaths. Ride-hailing services such as Uber have been found to prevent alcohol-related motor vehicle fatalities. These services may, however, facilitate alcohol consumption generally and binge drinking in particular.

Objective

The goal of the research is to measure the impact of ride-hailing services on the extent and intensity of alcohol consumption. We allow these associations to depend on population density as the use of ride-hailing services varies across markets.

Methods

We exploit the phased rollout of the ride-hailing platform Uber using a difference-in-differences approach. We use this variation to measure changes in alcohol consumption among a local population following Uber’s entry. Data are drawn from Uber press releases to capture platform entry and the Behavioral Risk Factor Surveillance Systems (BRFSS) Annual Survey to measure alcohol consumption in 113 metropolitan areas. Models are estimated using fixed-effects Poisson regression. Pre- and postentry trends are used to validate this approach.

Results

Ride-hailing has no association with the extent of alcohol consumption in high (0.61 [95% CI –0.05% to 1.28%]) or low (0.61 [95% CI –0.05% to 1.28%]) density markets, but is associated with increases in the binge drinking rate in high-density markets (0.71 [95% CI 0.13% to 1.29%]). This corresponds to a 4% increase in binge drinking within a Metropolitan Statistical Area.

Conclusions

Ride-hailing services are associated with an increase in binge drinking, which has been associated with a wide array of adverse health outcomes. Drunk driving rates have fallen for more than a decade, while binge drinking continues to climb. Both trends may be accelerated by ride-hailing services. This suggests that health information messaging should increase emphasis on the direct dangers of alcohol consumption and binge drinking.

Correlation of ride sharing service availability and decreased alcohol-related motor vehicle collision incidence and fatality

BACKGROUND

Alcohol-related motor vehicle collisions (AR-MVCs) account for ~30% of all US traffic fatalities. Ride-sharing services (RSS) have existed since 2010, but few studies to date have investigated their impact on AR-MVCs. We hypothesized that the availability of RSS would be correlated with a decrease in AR-MVCs at an urban Level I trauma center.

METHODS

A retrospective chart review was conducted of all AR-MVC trauma activations at a Level I trauma center from 2012 to 2018. Additional data were gathered from regional governmental traffic and law enforcement databases, including crash incidence, fatalities, and demographics. Data were compared pre- and post-RSS and analyzed using an unpaired t test with p less than 0.05 considered significant.

RESULTS

There were 1,474 patients in AR-MVCs during the study period. There was a significant decrease in the annual average proportion of MVCs that were AR-MVCs pre- vs. post-RSS (39% vs. 29%, p = 0.02) as well as a decrease in the average annual incidence of fatal AR-MVCs (11.6 vs. 5, p = 0.02). Subset analysis showed a decrease in AR-MVC incidence in 18- to 29-year-olds (12.7% vs. 7.5%; p = 0.03), which was also demonstrated by data from a local law enforcement database. Availability of RSS was also correlated with a decreased proportion of nighttime AR-MVCs (14.7% vs. 7.6%, p = 0.03) and decreased number of driving while intoxicated (1198.0 ± 78.5 vs. 612.8 ± 137.6, p = <0.01).

CONCLUSION

We found that the incidence of both total AR-MVCs and fatal AR-MVCs presenting to our trauma center decreased after the introduction of RSS. Ride-sharing services may play a role in preventing AR-MVCs. Further research is needed to correlate AR-MVC incidence with granular proprietary RSS usage data and to account for any confounding factors. Future studies may identify ways to better utilize RSS availability as a targeted intervention for certain demographic groups to prevent AR-MVCs.

LEVEL OF EVIDENCE

Therapeutic/Care Management, Level IV.

The effectiveness of alternative transportation programs in reducing impaired driving: A literature review and synthesis

INTRODUCTION

Studies have shown that approximately half of arrested intoxicated drivers had their last alcoholic drink at a licensed bar or restaurant. Current efforts to prevent intoxicated patrons from leaving licensed establishments and driving home have been only partially successful. Since a high proportion of drinkers drive to their drinking destination, promoting the use of alternative transportation (AT) - including safe ride shuttles, free or subsidized taxi and ridesharing services, voluntary or paid designated driver programs, and more accessible public transportation - is an important strategy for preventing impaired driving. The primary goal of this study was to review and synthesize the findings of research studies designed to test the effectiveness of AT programs in reducing alcohol-impaired driving. A secondary goal was to report if using AT has led to any unintended consequences, in particular greater alcohol consumption.

METHOD

We identified relevant academic articles, new articles, government reports, and other documents (English only) through the University of Chicago library, Google Scholar, and Google Search. We also included published articles recommended by peers. Key search terms included: alternative transportation; safe rides; designated driver; alcohol-impaired driving; alcohol consumption, cost effectiveness; and reduce drunk driving. Initially, we identified 168 potentially relevant sources, of which only 57 were academic articles. After a thorough review, we narrowed down the number of relevant articles to 125 including some background articles and government reports.

RESULTS

Some AT programs produced reductions in one or more of the following outcomes: (1) impaired driving; (2) impaired driving crashes; (3) driving under the influence (DUI) arrests; and (4) traffic crashes in general, but others were not shown to be effective. A few programs resulted in greater self-reported alcohol use, but there were no significant findings indicating that drinking when using AT led to an increase in alcohol-related harms such as public intoxication, assaults, or other alcohol-related crime. Of the studies that conducted a cost-benefit analysis, most showed that AT programs yielded a positive benefit, but these studies did not include a sufficient number of variables to be considered true cost-benefit analyses.

CONCLUSIONS

There is mixed evidence regarding the effectiveness of AT programs. Evaluations with more rigorous quasi-experimental and experimental designs are needed to identify which types of AT programs work best for different types of communities and target groups. Practical Applications: The literature review and synthesis revealed that the most successful AT programs typically have some of these attributes: (1) social acceptance; (2) high level of public awareness; (3) low cost; (4) year-round availability; (5) provide rides to and from drinking venues; (6) several sponsors that provide funding); (7) user convenience; and (8) perceived safety.

Ride hailing app use and drunk/drugged driving among young adult nightclub patrons

OBJECTIVE

Nightclub patrons who consume alcohol and drugs in these venues would appear to be an important population to target with on-demand ride hailing app (RHA) services to reduce drunk/drugged driving (DUI). The present study is an exploratory examination of RHA use to avoid DUI behavior, as well as the perceived barriers and benefits of such RHA use, among young adult nightclub patrons in Miami who use drugs.

METHODS

Completers of a 2011-2015 randomized controlled trial of brief interventions to reduce health risk behaviors among young adult nightclub patrons were recruited to participate in a single self-administered computer-assisted interview about health risks, driving behaviors, and RHA perceptions and use. Recruitment (N = 123) began in June 2016 and ended in July 2017. Bivariable logistic regression and ANOVA models examined group differences between: (a) those who had used an RHA to avoid DUI vs. not; and (b) those who used RHAs as their primary mode of transportation to nightclubs vs. not.

RESULTS

About half were female (52.8%); median age was 29; 59.4% Hispanic, 31.7% Black, 8.1% white, 0.8% other race/ethnicity. Recent alcohol and marijuana use were almost universally endorsed, and more than half reported recent use/misuse of cocaine (72.4%), MDMA (63.4%), and prescription benzodiazepines (62.6%) and opioids (56.9%). More than 80% reported driving under the influence of alcohol and/or drugs in the past 12 months, and 17.1% experienced a DUI arrest in the prior two years. Almost two-thirds (65.9%) of participants had used an on-demand RHA to avoid DUI, but self-driving or riding in another's car were the most common (76.4%) primary modes of transportation to clubs. RHAs were the primary mode of travel to clubs for 21 (17.1%) respondents. Participants whose friends strongly disapproved of DUI were more than twice as likely to have used RHAs for this reason compared to those who had not done so. Those reporting RHA use to avoid DUI were less likely than others to have driven under the influence in the past 12 months and were somewhat more likely to endorse DUI-related risks. Those who used alternate modes of transportation were more likely than those who used RHAs as their primary mode of transportation to clubs to endorse the expense of RHAs and the lack of RHA drivers near their favorite clubs as barriers to RHA use to travel to nightclubs.

CONCLUSIONS

This novel study among a high-risk population points to the potential for on-demand RHAs to reduce DUI behaviors and arrests among young adult nightclub patrons who consume alcohol and/or drugs in the context of the club experience. Our findings point to key educational, peer support, and structural targets for intervention to increase the use of RHAs among this population, specifically, club-based incentives for increasing RHA availability and affordability. Research is needed to fully elucidate the findings of this exploratory study, including potential differences in intervention approaches depending on the location-specific public transportation options.

The unknown denominator problem in population studies of disease frequency

Problems related to unknown or imprecisely measured populations at risk are common in epidemiologic studies of disease frequency. The size of the population at risk is typically conceptualized as a denominator to be used in combination with a count of disease cases (a numerator) to calculate incidence or prevalence. However, the size of the population at risk can take other epidemiologic properties in relation to an exposure of interest and the count outcome, including confounding, modification, and mediation. Using spatial ecological studies of injury incidence as an example, we identify and evaluate five approaches that researchers have used to address "unknown denominator problems": ignoring, controlling for a proxy, approximating, controlling by study design, and measuring the population at risk. We present a case example and recommendations for selecting a solution given the data and the hypothesized relationship between an exposure of interest, a count outcome, and the population at risk.

Efficacy and cost-effectiveness of subsidized ridesharing as a drunk driving intervention in Columbus, OH

BACKGROUND

No economic evaluations exist of free or subsidized ridesharing services designed to reduce impaired driving.

OBJECTIVES

To evaluate the effects and economics of a 17-weekend program that provided rideshare coupons good for free one-way or round trips to/from the hospitality zones in Columbus, Ohio, coupled with a modest increase in enforcement and a media campaign that used messaging about enforcement to promote usage.

METHODS

Web surveys of riders and intercept surveys of foot traffic in the hospitality zones yielded data on the reduction in driving after drinking and the change in alcohol consumption associated with coupon use. We estimated crash changes from trip data using national studies, then confirmed with an ARIMA analysis of monthly police crash reports. Costs and output data came from program and rideshare company records.

RESULTS

70.8% of 19,649 responding coupon redeemers said coupon use reduced the chance they would drive after drinking. An estimated 1 in 4,310 drink-driving trips results in an alcohol-attributable crash, so the coupons prevented an estimated 3.2 crashes. Consistent with that minimal change, the ARIMA analysis did not detect a drunk-driving crash reduction. Self-reports indicated alcohol consumption rose by an average of 0.4 drinks per coupon redeemer, possibly with an equal rise among people who rode with the redeemer. The program cost almost $650,000 and saved an estimated 1.8 years of healthy life. Across a range of discount rates and values for a year of healthy life, it cost $366,000 to $791,000 per year of healthy life saved. Its estimated benefit-cost ratio was between 0.31 and 0.59, meaning it cost far more than it saved.

CONCLUSIONS

Ridesharing, coupled with a media campaign and increased enforcement, was not a cost-effective drunk-driving intervention. Although it reduced drink-driving crashes and saved years of healthy life, those savings were modest and expensive. Moreover, the self-reported increase in participant drinking imposed countervailing risks. Even sensitivity analyses that potentially overestimate the benefits and underestimate the costs indicate a significant imbalance between program costs and savings. Any funding devoted to ridesharing would divert scarce resources from interventions with benefit-cost ratios above 1. Thus, our evaluation suggests that governments should not devote energy or resources to ridesharing programs if their primary objective is to reduce drink-driving or harmful alcohol use.

Ridehailing and alcohol-involved traffic fatalities in the United States: The average and heterogeneous association of uber

Ridehailing services such as Uber have been promoted as viable interventions for curbing alcohol-involved driving fatalities. However, evidence of ridehailing's impact has been mixed, with some studies finding no association but others finding either an increase or a decrease in fatalities. We contribute to this literature by examining more recent years of data, which capture a period during which Uber ridership has grown substantially and alcohol-involved fatalities have increased. Furthermore, we test whether the relationship between Uber availability and traffic fatalities depends on local characteristics. We employ multivariate regression models to test the association between Uber availability and total, alcohol-involved, and weekend and holiday-specific traffic fatalities in the 100 most populated metropolitan areas in the United States between 2009 and 2017. We find that Uber availability is not associated with changes in total, alcohol-involved, and weekend and holiday-specific traffic fatalities in aggregate, yet it is associated with increased traffic fatalities in urban, densely populated counties.

Examining the Heterogeneous Impact of Ride-Hailing Services on Public Transit Use

Practice or Policy Abstract

Assessing the impact of a local community subsidised rideshare programme on road traffic injuries: an evaluation of the Evesham Saving Lives programme

BACKGROUND

Alcohol-related vehicle crashes pose a significant challenge to public health in suburban communities. The Evesham Saving Lives programme operated between late 2015 and 2019 in two townships (Evesham and Voorhees) in New Jersey. The programme subsidised rideshare (eg, Uber) trips from bars and restaurants between the hours of 21:00 and 02:00 to prevent alcohol-related traffic injuries.

METHODS

This study used data from the New Jersey Department of Transportation to examine changes to rates of injury crashes between 2010 and 2018. We used an ecological difference-in-difference design with Bayesian conditional autoregressive Poisson models to compare rates of injury crashes between participating municipalities (n=2) and non-participating municipalities (n=75). Sensitivity analyses included comparison with a weighted synthetic control series.

RESULTS

The Evesham Saving Lives programme was associated with 18% fewer injury crashes overall (IRR=0.82, 95% credible interval (CrI): 0.76, 0.88). Reductions in crashes were estimated to be greatest at night (IRR=0.62, 95% CrI: 0.48, 0.79), with moderate reductions in the afternoon (IRR=0.80, 95% CrI: 0.72, 0.88). We estimate that around three lives were saved (95% CrI: 2, 5) and around 371 injuries were prevented (95% CrI: 204, 625), potentially making considerable savings in terms of medical and economic expenses.

CONCLUSIONS

These findings support the claim that improving the convenience and reducing the costs of alternative night-time transportation can prevent road traffic injuries. Future studies should aim to replicate these analyses in programmes that have been implemented in other suburban communities across the US.

Ridesharing and motor vehicle crashes: a spatial ecological case-crossover study of trip-level data

BACKGROUND

Ridesharing services (eg, Uber, Lyft) have facilitated over 11 billion trips worldwide since operations began in 2010, but the impacts of ridesharing on motor vehicle injury crashes are largely unknown.

- METHODS

This spatial ecological case-cross over used highly spatially and temporally resolved trip-level rideshare data and incident-level injury crash data for New York City (NYC) for 2017 and 2018. The space-time units of analysis were NYC taxi zone polygons partitioned into hours. For each taxi zone-hour we calculated counts of rideshare trip origins and rideshare trip destinations. Case units were taxi zone-hours in which any motor vehicle injury crash occurred, and matched control units were the same taxi zone from 1 week before (-168 hours) and 1 week after (+168 hours) the case unit. Conditional logistic regression models estimated the odds of observing a crash (separated into all injury crashes, motorist injury crashes, pedestrian injury crashes, cyclist injury crashes) relative to rideshare trip counts. Models controlled for taxi trips and other theoretically relevant covariates (eg, precipitation, holidays).

RESULTS

Each additional 100 rideshare trips originating within a taxi zone-hour was associated with 4.6% increased odds of observing any injury crash compared with the control taxi zone-hours (OR=1.046; 95% CI 1.032 to 1.060). Associations were detected for motorist injury and pedestrian injury crashes, but not cyclist injury crashes. Findings were substantively similar for analyses conducted using trip destinations as the exposure of interest.

CONCLUSIONS

Ridesharing contributes to increased injury burden due to motor vehicle crashes, particularly for motorist and pedestrian injury crashes at trip nodes.

State or market? How to effectively decrease alcohol-related crash fatalities and injuries

Background

It is estimated that more than 270 000 people die yearly in alcohol-related crashes globally. To tackle this burden, government interventions, such as laws which restrict blood alcohol concentration (BAC) levels and increase penalties for drunk drivers, have been implemented. The introduction of private-sector measures, such as ridesharing, is regarded as alternatives to reduce drunk driving and related sequelae. However, it is unclear whether state and private efforts complement each other to reduce this public health challenge.

Methods

We conducted interrupted time-series analyses using weekly alcohol-related traffic fatalities and injuries per 1 000 000 population in three urban conglomerates (Santiago, Valparaíso and Concepción) in Chile for the period 2010–2017. We selected cities in which two state interventions—the ‘zero tolerance law’ (ZTL), which decreased BAC, and the ‘Emilia law’ (EL), which increased penalties for drunk drivers—were implemented to decrease alcohol-related crashes, and where Uber ridesharing was launched.

Results

In Santiago, the ZTL was associated with a 29.1% decrease (95% CI 1.2 to 70.2), the EL with a 41.0% decrease (95% CI 5.5 to 93.2) and Uber with a non-significant 28.0% decrease (95% CI −6.4 to 78.5) in the level of weekly alcohol-related traffic fatalities and injuries per 1 000 000 population series. In Concepción, the EL was associated with a 28.9% reduction (95% CI 4.3 to 62.7) in the level of the same outcome. In Valparaíso, the ZTL had a −0.01 decrease (95% CI −0.02 to −0.00) in the trend of weekly alcohol-related crashes per 1 000 000 population series.

Conclusion

In Chile, concomitant decreases of alcohol-related crashes were observed after two state interventions were implemented but not with the introduction of Uber. Relationships between public policy interventions, ridesharing and motor vehicle alcohol-related crashes differ between cities and over time, which might reflect differences in specific local characteristics.

The potential effects of autonomous vehicles on alcohol consumption and drink-driving behaviours

INTRODUCTION

By removing the need for a driver, autonomous vehicles (AV) are expected to substantially reduce rates of drink-driving. However, this benefit may be accompanied by an unintended negative consequence in the form of greater overall alcohol consumption due to increased availability of affordable and convenient transport.

AIMS

To assess: (i) the extent to which drinkers may choose to use AVs after consuming alcohol; (ii) the extent to which drinkers may consume more alcohol if they are using an AV afterwards; and (iii) whether demographic, alcohol-related and AV-related factors are associated with the likelihood of engaging in these behaviours.

DESIGN AND METHODS

A total of 1334 Australians of legal driving age who consume alcohol completed an online survey. Two regression models were used to calculate whether the analysed respondent characteristics were associated with intentions to use AVs after drinking and to consume more alcohol if using an AV afterwards.

RESULTS

Around half of the respondents (49%) reported being likely to use an AV after consuming alcohol, and over one-third (37%) reported being likely to consume more alcohol if using an AV afterwards. Younger age, more frequent alcohol consumption, a positive attitude to AVs and a preference for using 'ride-share' AVs were associated with a greater likelihood of engaging in these behaviours.

DISCUSSION AND CONCLUSIONS

The results suggest that the introduction of AVs is likely to reduce drink-driving rates while facilitating greater participation in heavy episodic drinking. This will constitute a challenge to policymakers in their efforts to minimise alcohol-related harms.

The implications of ridehailing for risky driving and road accident injuries and fatalities

The nature of transportation has fundamentally transformed in recent years with the rise of ridehailing providers such as Uber. Yet, few studies have examined whether there is an association between ridehailing and rates of road accident injuries, and virtually all of the existing studies focus on the exceptional case of the United States. In this study, we exploit differences in the timing of the deployment of Uber across Britain to test the association between the advent of Uber's ridehailing services and rates of fatal and non-fatal road accidents. We find that the deployment of Uber in Great Britain is associated with a marginally significant reduction in the number of serious road accident injuries (e.g., fractures and internal injuries), although not the number of serious accidents. Slight injuries (e.g., sprains and bruises) declined outside of London after the rollout of Uber, but increased within London. We do not observe a statistically significant association between Uber and traffic fatalities. One interpretation for the decline in serious road injuries is that Uber may be a substitute form of transportation for risky drivers, including drink-drivers. However, ridehailing is also a substitute for public transit, particularly buses. The increase in the number of cars on the road may explain why slight injuries increased in London following Uber's rollout.

College students' use of transportation networking companies: An opportunity to decrease substance-impaired driving

Objective: To examine the use of transportation networking companies (TNCs) (eg, Uber) among substance-using students in rural and urban college settings. Participants: Students at two large state universities were randomly selected and screened for substance use. Participants reported use of TNCs generally and after substance use and whether TNC use was on or near campus or in other environments. Methods: Data were evaluated using chi-square test, t-tests, and Fisher's exact tests. Results: Most (85%) participants (n = 99, 61% response rate) had used a TNC. Among students who used TNCs on/near campus, 98% of rural students used them after substance use compared to 85% of urban students (p = .037). We did not detect differences in TNC use by gender or age. Conclusions: Results indicate that TNC use is common after college student substance use and may play a particularly important role in preventing impaired driving for rural campuses where existing transportation options are limited.

Did UberX reduce ambulance volume?

Ambulances are a vital part of emergency medical services. However, they come in single, high intervention form, which is at times unnecessary, resulting in excessive costs for patients and insurers. In this paper, we ask whether UberX's entry into a city caused substitution away from traditional ambulances for low-risk patients, reducing overall volume. Using a city-panel over-time and leverage that UberX enter markets sporadically over multiple years, we find that UberX entry reduced the per capita ambulance volume by at least 6.7%. Our result is robust to numerous specifications.

An overview of GeoAI applications in health and healthcare

The moulding together of artificial intelligence (AI) and the geographic/geographic information systems (GIS) dimension creates GeoAI. There is an emerging role for GeoAI in health and healthcare, as location is an integral part of both population and individual health. This article provides an overview of GeoAI technologies (methods, tools and software), and their current and potential applications in several disciplines within public health, precision medicine, and Internet of Things-powered smart healthy cities. The potential challenges currently facing GeoAI research and applications in health and healthcare are also briefly discussed.

Estimating effects of Uber ride-sharing service on road traffic-related deaths in South Africa: a quasi-experimental study

Background

Road traffic deaths are a substantial barrier to population health improvement in low-income and middle-income countries (LMICs). In South Africa, the road-traffic injury mortality (RTM) rate of 27 per 100 000 population is twice the global average, over 60% of which are alcohol-related. Recent US studies suggest the Uber ride-sharing service may reduce alcohol-related RTM, however RTM burden in the USA is relatively low and transport behaviours differ from LMICs.

Methods

Using certification data from all deaths occurring in South Africa in the years 2010–2014 (n=2 498 216), we investigated the relative change in weekly road traffic-related death counts between provinces which received Uber services (beginning in 2013) against those that did not using a difference-in-differences approach.

Results

Weekly road traffic-related deaths in provinces with Uber were lower following Uber introduction than in comparison provinces without Uber. The effect size was larger in the province which had Uber the longest (Gauteng) and among young adult males (aged 17–39 years). However, the absolute effects were very small (<2 deaths per year) and may coincide with seasonal variation.

Conclusions

Overall, findings did not support either an increase or large decrease in province-level road traffic-related deaths associated with Uber introduction to South Africa. More localised investigations in South Africa and other LMICs are needed.

The effectiveness of child restraint and seat belt legislation in reducing child injuries: The case of Serbia

OBJECTIVE

The objective of this study is to determine the short- and long-term impacts of Serbia's 2009 update of child restraint and seat belt legislation on the incidence of pediatric motor vehicle-related injury. With this new law, the use of child restraints in children age 0-3 became mandatory, and children 4-12 had to wear seat belts in the rear seats.

METHODS

A unique data set with assembled information from public institutions of the Republic of Serbia from January 2004 to December 2014 and analyses based on interrupted time series were carried out. Eight outcome variables were assessed: monthly rate of injured children for 2 age groups 0-3 and 4-12 per child population, number of registered motor vehicles, number of passengers transported, and number of passengers' kilometers traveled. Independent variables were short- and long-term impacts of Serbia's legislation update (June 2009). Data on injuries were obtained from Serbia's Road Traffic Safety Agency. Child population and other transport-related data were obtained from the Statistical Office of the Republic of Serbia. We excluded fatalities from the analysis.

RESULTS

In the first year of the updated legislation there was a reduction of 2.0% (confidence interval [CI], 0.1; 3.9) of injured children aged 0-3 and a reduction of 2.5% (CI, 0.6; 4.3) of injured children aged 4-12. Six years after enactment of the legislation, a significant reduction of 8.2% (CI, 3.5; 13.0) of injured children aged 4-12 was observed, but a nonsignificant reduction of 1.1% (CI, -5.8; 3.5) was found for injured children aged 0-3. By December 2014, 369 (CI, 186; 555) injuries among children aged 4-12 were avoided.

CONCLUSIONS

The case of Serbia suggests that the new law was effective in reducing injuries among children aged 0-3 in the short term and injuries among children aged 4-12 in both the short term and long term. To understand these results, we suggest 2 hypotheses. First, low proper usage of child restraint and weak police enforcement were likely to explain the short-term effect among children aged 0-3. Second, access to seat belts in rear seats was probably a condition that facilitated the use of these devices among children aged 4-12, protecting them during the period of the study.

Alcohol-impaired driving in US counties, 2002-2012

Background

Excessive alcohol consumption and alcohol-impaired driving remain significant public health problems, leading to considerable morbidity and mortality, particularly among younger populations.

Methods

Using data from the Behavioral Risk Factor Surveillance System (BRFSS), we employed a small areas modeling strategy to estimate the county-level annual prevalence of alcohol-impaired driving in every United States county for the years 2002 through 2012, the latest year in which county identifiers were publicly available.

Results

Alcohol-impaired driving episodes declined from 157.0 million in 2002 (prevalence 3.8%: 95% uncertainty interval [UI], 3.7%–4.0%) to 129.7 million in 2012 (prevalence 3.7%: 95% UI, 3.5%–3.8%), a 17.4% decline. There is considerable variation in the prevalence of alcohol-impaired driving at the county level, ranging from 2.0% in the Sitka City Borough of Alaska to 9.3% in Nance County, Nebraska. Clusters of increased alcohol-impaired driving were observed in Northern Wisconsin (Marinette, Florence, Forest, Vilas, Oneida, Iron counties), North Dakota (Cavalier, Pembina, Walsh, Ramsey, Nelson, Benson, Eddy counties) and Montana (Sheridan, Daniels, Roosevelt, Valley, Phillips, Petroleum, Garfield counties).

Conclusions

This study showed guarded progress with respect to the occurrence of alcohol-impaired driving episodes in the US from 2002 to 2012. Because these data rely on self-report, this likely represents an underestimate of the true prevalence of alcohol-impaired driving in the US. As the US continues to have several million episodes of alcohol-impaired driving each month, renewed efforts are needed to mitigate this high-risk health behavior.

Ridesharing and Motor Vehicle Crashes in 4 US Cities: An Interrupted Time-Series Analysis

Uber, the world's largest ridesharing company, has reportedly provided over 2 billion journeys globally since operations began in 2010; however, the impact on motor vehicle crashes is unclear. Theoretically, ridesharing could reduce alcohol-involved crashes in locations where other modes of transportation are less attractive than driving one's own vehicle while under the influence of alcohol. We conducted interrupted time-series analyses using weekly counts of injury crashes and the proportion that were alcohol-involved in 4 US cities (Las Vegas, Nevada; Reno, Nevada; Portland, Oregon; and San Antonio, Texas). We considered that a resumption of Uber operations after a temporary break would produce a more substantial change in ridership than an initial launch, so we selected cities where Uber launched, ceased, and then resumed operations (2013-2016). We hypothesized that Uber's resumption would be associated with fewer alcohol-involved crashes. Results partially supported this hypothesis. For example, in Portland, Uber's resumption was associated with a 61.8% reduction (95% confidence interval: 38.7, 86.4) in the alcohol-involved crash rate (an absolute decrease of 3.1 (95% confidence interval: 1.7, 4.4) alcohol-involved crashes per week); however, there was no concomitant change in all injury crashes. Relationships between ridesharing and motor vehicle crashes differ between cities over time and may depend on specific local characteristics.

Effectiveness of child restraints and booster legislation in Israel

Introduction

96 countries in the world have enacted child restraints and booster legislation (CRBL). Yet, findings regarding the effectiveness of CRBLs are mixed. The current study is the first to examine the association between Israel’s CRBL, implemented in November 2004, and the traffic injury and fatality rates among children aged 0–9 years. We extend on previous studies by accounting for risk exposure and by comparing populations of children affected by the legislation to those who were not.

Methods

We used an interrupted time series design of kilometre driven-based traffic injury rates for children aged 0–4 years and children aged 5–9 years using childred aged 10–14 years as a comparison group. We estimated the effects of Israel’s CRBL using monthly injury and fatality count data from the Israeli Central Bureau of Statistics. The sample includes all child vehicle occupants injured and killed in crashes in Israel between January 2003 and December 2011.

Results

Children aged 0–4 years experienced a 5.17% yearly reduction in traffic injury rate (incidence rate ratio (IRR): 0.94(95% CI 0.92 to 0.96); p=0.000), and the injury rate for children aged 5–9 years was associated with a 4.10% yearly reduction (IRR: 0.95(95% CI 0.93 to 0.98); p=0.001). The comprehensive CRBL implemented in Israel was associated with a 6.3% (95% CI −7.2% to5.5%; p=0.001) reduction in traffic injuries and fatalities for children aged 0–9 years.

Conclusion

This is the first study comparing traffic injury rates per kilometre driven for motor vehicle-occupant children before and after the implementation of the CRBL in Israel.

Clinical Action against Drunk Driving

In advance of a safety campaign on 17 March 2017, Donald Redelmeier and Allan Detsky call on physicians and clinical colleagues to reduce the chances that patients will drive drunk.