Use of Involuntary Emergency Treatment by Physicians and Law Enforcement for Persons With High-Risk Drug Use or Alcohol Dependence

This cohort study evaluates the number of petitions for temporary involuntary commitment of individuals who pose a risk to themselves or others after implementation of a pilot program to streamline the process in Boston, Massachusetts.

Experiences of Court Clinicians Who Perform Civil Commitment Evaluations for Substance Use Disorders

Civil commitment for substance use disorders is an increasingly used intervention to mitigate the risks associated with severe substance use. Although court clinicians play a vital role in helping courts determine whether respondents meet statutory requirements for commitment, little is known about their experiences conducting these evaluations. In this pilot study, we surveyed all court clinicians who perform evaluations for civil commitment for substance use disorders in Massachusetts, a state with one of the highest rates of such commitments nationally. Court clinicians reported that these evaluations are most frequently ordered for individuals who use heroin and other opioids, alcohol, and cannabis. They reported a recent suicide attempt or drug overdose, intentional physical harm to another, use of dangerous weapon, and driving while intoxicated as the behaviors most likely to satisfy the statutory requirement of imminent risk. At the same time, many court clinicians consider a much broader range of behaviors as constituting imminent risk, and many reported having endorsed commitment on one or more occasions in the absence of statutory criteria being satisfied. These findings underscore the need for additional research on the performance of civil commitment evaluations for substance use disorder and standards for such evaluations.

Patient confidentiality, the duty to protect, and psychotherapeutic care: perspectives from the philosophy of ubuntu

This paper demonstrates how ubuntu relational philosophy may be used to ground beneficial coercive care without necessarily violating a patient's dignity. Specifically, it argues that ubuntu philosophy is a useful theory for developing necessary conditions for determining a patient's potential dangerousness; setting reasonable limits to the duty to protect; balancing the long-term good of providing unimpeded therapy for patients who need it with the short-term good of protecting at-risk parties; and advancing a framework for future case law and appropriate regulations in the care of psychotherapy patients. Issues regarding the decision to breach medical confidentiality in psychotherapeutic care are ultimately reserved for the courts. Professional assessment might be an important first step in this process, and court rulings govern most aspects of this assessment. However, current case law, especially in the United States, places an unreasonable expectation on psychotherapists to protect all at-risk parties or foresee that a patient intends to follow through on said threats. It has largely failed to guarantee psychotherapy patients unlimited access to care, while potentially inhibiting future honest communication between patients and health professionals and endangering the safety of others. Of these decisions, the two most prominent are the 1976 Tarasoff decision and the 2016 Volk decision. This paper argues for the possibility of grounding good laws in ubuntu African philosophy in a way that protects others from harm and ensures unimpeded access to care without necessarily breaching medical confidentiality.

Health Anxiety Predicts the Perceived Dangerousness of COVID-19 over and above Intrusive Illness-Related Thoughts, Contamination Symptoms, and State and Trait Negative Affect

This study sought to evaluate the specificity of health anxiety, relative to other forms of psychopathology, in perceptions of COVID-19 as dangerous. Measures of health anxiety, COVID-19 perceived dangerousness, negative affect, anxiety, depression, stress, contamination-related obsessions and compulsions, and intrusive illness-related thoughts were administered online to 742 community individuals during the Italian national lockdown. Results showed that, after controlling for demographic variables and other internalizing problems, health anxiety was the single most important factor associated with the perceived dangerousness of COVID-19. Moreover, a comparison between the current sample's scores on various symptom measures and scores from prepandemic Italian samples revealed that, whereas other internalizing symptoms increased by a large or very large magnitude during the pandemic, levels of health anxiety and negative affect increased by a medium amount. This result may indicate that health anxiety is relatively trait-like, increasing the likelihood that our correlational data support the model of health anxiety as a vulnerability rather than an outcome. Together, these results indicate that health anxiety may be a specific risk factor for COVID-related maladjustment and support the distinction of health anxiety from other psychological problems.

Testing the Confluence Model of the Association Between Pornography Use and Male Sexual Aggression: A Longitudinal Assessment in Two Independent Adolescent Samples from Croatia

According to confluence model theorizing, pornography use contributes to sexual violence, but only among men who are predisposed to sexual aggression. Support for this assertion is limited to cross-sectional research, which cannot speak to the temporal ordering of assumed causes and consequences. To address this issue, we employed generalized linear mixed modeling to determine whether hostile masculinity, impersonal sexuality, and pornography use, and their interactions, predicted change in the odds of subsequently reported sexual aggression in two independent panel samples of male Croatian adolescents (N₁ = 936 with 2808 observations; N₂ = 743 with 2972 observations). While we observed the link between hostile masculinity and self-reported sexual aggression in both panels, we found no evidence that impersonal sexuality and pornography use increased the odds of subsequently reporting sexual aggression-regardless of participants' predisposed risk. This study's findings are difficult to reconcile with the view that pornography use plays a causal role in male sexual violence.

(Re)construction identitaire et pratique infirmière en psychiatrie légale : réflexion critique sur les commissions d’examen

Introduction : The caritative impact of nursing care provided in forensic mental health settings is rarely questioned.Context : Caritative nursing care is indirectly regulated by the Review Board (RB), a para-judicial court which ensures public safety.Objective : This study presents a critical reflection on the political and social effects of the RB, forensic psychiatry hospitals and practices of forensic mental health nurses.Method : The reflection is centered on the concepts of biopower, degradation ceremonies, moral career and identity (re)construction.Results : ‘Therapeutic’ nursing practices are useful for disciplinary purposes in the forensic psychiatric hospital, insofar as they permit the identification and management of dangerous persons. However, the practices also fall within the biopolitical scope of the RB, since they assist the latter in ensuring public safety.Discussion : The forensic psychiatric environment can prove problematic for nurses, requiring a double allegiance, whereby their responsibilities to patients (consent and confidentiality) and to the institution (protection of the public) can lead to tension.Conclusion : The analytical framework of the study allows for a reassessment of other presumed processes in psychiatric environments, which nonetheless constitute just as many rituals of identity (re)construction.

Analysis on mental-insanity and cessation-of-dangerousness examinations in three Brazilian custodial institutions: a retrospective cross-sectional study

BACKGROUND

In Brazil, the right to healthcare and the incorporation of best scientific evidence in public health are universally guaranteed by law. However, the treatment offered to patients with mental disorders in custodial hospitals in this country has not been rigorously evaluated.

OBJECTIVES

To analyze the psychiatric diagnoses and treatments implemented in three Brazilian custodial institutions.

DESIGN AND SETTING

This was a retrospective, cross-sectional and descriptive study on patients held in custody in three Brazilian institutions, as judicially-determined safety measures due to their mental disorders, and the tools used in diagnoses and treatments. These institutions are in Rio de Janeiro and the Federal District.

METHODS

The data from medical and judicial records that were made available were assessed regarding the diagnoses that were made and the instruments that were used.

RESULTS

None of these inpatients were evaluated using validated tools, and only a few medical records presented clear descriptions of the cases. No patient with substance involvement had undergone laboratory toxicological assays. It was not possible to verify the adequacy of treatments because the procedures were inadequately described in the records.

CONCLUSIONS

No standardized protocols or instruments for diagnosing mental health disorders or assessing use of psychoactive substances had been applied among the inpatients at these custodial institutions in Rio de Janeiro and the Federal District. The treatments that were prescribed to these inpatients consisted mainly of drugs.

Myths of Mental Health: Revelations from the French System for the United States

Drawing on an analysis of the French mental health system, this essay examines four presumptions about mental health care dominant in the United States: (1) the required abolition of the hospital for psychiatric deinstitutionalization; (2) the substitutability of public and private financing; (3) the importance of a "dangerousness" criterion for involuntary commitment procedures; and (4) the need for an ever-expanding scope of care. These claims hold little weight when subjected to comparative scrutiny, and the essay closes by discussing the implications of these revelations for US mental health care policy and ethics.

Prediction of vehicle occupants injury at signalized intersections using real-time traffic and signal data

Intersections are among the most dangerous roadway facilities due to the existence of complex movements of traffic. Most of the previous intersection safety studies are conducted based on static and highly aggregated data such as average daily traffic and crash frequency. The aggregated data may result in unreliable findings because they are based on averages and might not necessarily represent the actual conditions at the time of the crash. This study uses real-time event-based detection records, and crash data to develop predictive models for the vehicle occupants' injury severity. The three-year (2017-2019) data were acquired from the arterial highways in the City of Tallahassee, Florida. Random Forest (RF) and eXtreme Gradient Boosting (XGBoost) classifiers were used to identify the important factors on the vehicle occupants' injury severity prediction. The performance comparison of the two classifiers revealed that the XGBoost has a higher balanced accuracy score than RF. Using the XGBoost classifier, five topmost influential factors on injury prediction were identified. The factors are the manner of the collision, through and right-turn traffic volume, arrival on red for through and right-turn traffic, split failure for through traffic, and delays for through and right-turn traffic. Moreover, the partial dependency plots of the influential variables are presented to reveal their impact on vehicle occupant injury prediction. The knowledge gained from this study will be useful in developing effective proactive countermeasures to mitigate intersection-related crash injuries in real-time.

[Self-harming behavior by patients admitted to forensic psychiatry]

BACKGROUND

Incidents of self-harm by forensic psychiatric patients usually have a large impact on all those involved and self-harming behavior is an important predictor for violence towards others during treatment.

AIM

To describe incidents of self-harm during the treatment of patients admitted to forensic psychiatry.

METHOD

All incidents of self-harm during treatment in a forensic psychiatric center that were registered between 2008 and 2019 were analyzed and coded with respect to severity with the MOAS+.

RESULTS

Between 2008 and 2019 299 incidents of self-harm were registered committed by 106 patients. Most of these incidents (87,6%) were classified as non-suicidal. Methods most often used were cutting themselves with glass, broken plates or mugs, a razor or knife and swallowing dangerous objects or liquids. There were ten cases of suicide, almost all by suffocation with a rope or belt. The majority of the incidents were coded as severe or extreme with the MOAS+. Female patients were overrepresented and they caused on average three times more incidents than male patients.

CONCLUSION

Incidents of self-harm happen regularly in forensic psychiatry and are usually severe. More research is needed into the impact on all those involved, motivations and triggers for self-harming behavior and effective treatment of it.

Texting while driving: A discrete choice experiment

Texting while driving is one of the most dangerous types of distracted driving and contributes to a large number of transportation incidents and fatalities each year. Drivers text while driving despite being aware of the risks. Although some factors related to the decision to text while driving have been elucidated, more remains to be investigated in order to better predict and prevent texting while driving. To study decision making involved in reading a text message while driving, we conducted a discrete choice experiment with 345 adult participants recruited from Amazon's Mechanical Turk. Participants were presented with multiple choice sets, each involving two different scenarios, and asked to choose the scenario in which they would be more likely to text while driving. The attributes of the scenarios were the relationship to the text-message sender, the road conditions, and the importance of the message. The attributes varied systematically across the choice sets. Participants were more likely to read a text message while driving if the sender of the message was a significant other, the message was perceived to be very important, and the participant was driving on rural roads. Discrete choice experiments offer a promising approach to studying decision making in drivers and other populations because they allow for an analysis of multiple factors simultaneously and the trade-offs among different choices.

How Do Mines Explode? Understanding Risk in European Mining Doctrine, 1803-1906

Historians of risk and disaster have paid little attention to coal mining-an industry characterized by extreme risks and disasters-even though coal mine operators were concerned with the causes of explosions throughout the nineteenth and early twentieth centuries. This article goes beyond nationally oriented mining scholarship on coal mine safety and regulations to examine one form of industrial risk: how did European researchers understand the role of coal dust in mine explosions. It describes the complex factors involved in applying science and technology methodologies to solve industrial risk in this dangerous sector. It traces European countries shifting after 1882 to new types of mine experimentation sponsored by the state and mine owners to better mimic real-life situations, while French mining researchers continued to defend work in laboratory settings. French researchers converged methodologically with their colleagues only after the French Courrières mine catastrophe in 1906.

True Threats, Self-Defense, and the Second Amendment

Does the Second Amendment protect those who threaten others by negligently or recklessly wielding firearms? What line separates constitutionally legitimate gun displays from threatening activities that can be legally proscribed? This article finds guidance in the First Amendment doctrine of true threats, which permits punishment of "statements where the speaker means to communicate a serious expression of an intent to commit an act of unlawful violence to a particular individual or group of individual." The Second Amendment, like the First, should not be read to protect those who threaten unlawful violence. And to the degree that the constitution requires a culpable mental state (mens rea) in such circumstances, the appropriate standard should be recklessness.

Pedestrians under influence (PUI) crashes: Patterns from correspondence regression analysis

INTRODUCTION

Alcohol-related impairment is a key contributing factor in traffic crashes. However, only a few studies have focused on pedestrian impairment as a crash characteristic. In Louisiana, pedestrian fatalities have been increasing. From 2010 to 2016, the number of pedestrian fatalities increased by 62%. A total of 128 pedestrians were killed in traffic crashes in 2016, and 34.4% of those fatalities involved pedestrians under the influence (PUI) of drugs or alcohol. Furthermore, alcohol-PUI fatalities have increased by 120% from 2010 to 2016. There is a vital need to examine the key contributing attributes that are associated with a high number of PUI crashes.

METHOD

In this study, the research team analyzed Louisiana's traffic crash data from 2010 to 2016 by applying correspondence regression analysis to identify the key contributing attributes and association patterns based on PUI involved injury levels.

RESULTS

The findings identified five risk clusters: intersection crashes at business/industrial locations, mid-block crashes on undivided roadways at residential and business/residential locations, segment related crashes associated with a pedestrian standing in the road, open country crashes with no lighting at night, and pedestrian violation related crashes on divided roadways. The association maps identified several critical attributes that are more associated with fatal and severe PUI crashes. These attributes are dark to no lighting, open country roadways, and non-intersection locations. Practical Applications: The findings of this study may be used to help design effective mitigation strategies to reduce PUI crashes.

Psychiatric commitment under the criminal law in China: An empirical perspective

This article examines the legislation and practice of compulsory treatment in China. Part I traces the Chinese history of criminal commitment law, explains the research methodology, and highlights some general empirical findings. Part II provides a comprehensive empirical analysis of compulsory treatment law in China, it covers both substantial issues such as criteria of compulsory treatment and procedural issues such as the commitment hearing, enforcement, and discharge of compulsory treatment. It also explores the compulsory treatment law from the human rights protection perspective. Our primary objective is to present the empirical findings to enable the legislative and other involved government agencies to make informed decisions about the future evolution of Chinese law in this area.

[The psychiatrization and unpredictability of interpersonal violent behavior]

The relationship between mental illness and violent behavior is a complex phenomenon. Scientific literature indicates that the presence of a mental disorder, even severe, is not sufficient, alone, to predict or motivate violent behavior, which seems to be more associated with other intermediate variables. The phenomenon of psychiatrization of violent behavior can be defined, from a psychiatric-forensic point of view, as the prejudicial and erroneous attribution to mental illness as a causal factor in relation to violent behavior. This phenomenon has consequences in psychiatric clinical practice, but also at the level of social stigmatization, management of organizational and economic resources, and the judicial system. In this paper, clinical criticalities related to the psychiatrization of violent behavior will be analyzed, including the need to differentiate clinical etiology and legal causality, predictability and avoidability, protective clinical factors and clinical risk factors, the limits of categorical psychiatric diagnosis, the need for specific victimological information, the criticalities of pharmacotherapy. Some forensic criticalities will also be analyzed, including errors in clinical and forensic methodology (psychiatrization of the symptom, prejudicial contamination, diagnostic overshadowing, legal causalization of protective and risk factors, the use of categorical diagnosis in the forensic field, the psychiatrization of non-pathological human experiences, the criminalization of the subject with mental disorder). In conclusion, it is highlighted that an individual can have a psychic disorder, even severe, but this disorder is not necessarily in a causal relationship with violent behavior. The lack of a causal relationship makes predictability of violent behavior difficult, even impossible depending on the case, both in the general population and in individuals with psychiatric disorders.

Psychosocial risk factors in young offenders

Introduction:

Juvenile delinquency is a multi-causal social phenomenon, in which socio-cultural and economic, family and individual factors are interrelated. In young people with a greater number of associated risk factors, the measures seem to be insufficient, both in open and closed environments, since the rate of recidivism is higher.

Objective:

Identify the psychosocial risk factors that exist at intra and interpersonal level in juvenile offenders, as well as determine if these factors are interrelated.

Material and method:

A literature review of articles found in different databases was carried out. The articles containing the key words selected at the beginning of the study were reviewed, and of all of them, those that met the established inclusion requirements, which are date of publication and language, were included.

Results:

The results of all the studies analyzed confirm the idea that a greater number of psychosocial risk factors occur in young offenders than in normalized young people. There are factors related to a family that has inadequate socialization styles, even negligent ones, accentuated by very substandard economic situations that are usually present. Along with this, the consumption of substances is a variable that is repeated continuously in these young people; united to a group of deviant pairs, that favor the appearance of criminal behaviours.

Conclusion:

It is possible to identify the main psychosocial risk factors that occur in young offenders, and define an interrelation between these factors, but it is not linear nor can it be homogenized. More resources and prevention programs, as well as intervention, are needed at the individual, family and community levels.

Hazard Perception and Prediction test for walking, riding a bike and driving a car: "Understanding of the global traffic situation"

To "put oneself in the place of other road users" may improve understanding of the global traffic situation. It should be useful enabling drivers to anticipate and detect obstacles in time to prevent accidents to other road users, especially those most vulnerable. We created a pioneering Hazard Perception and Prediction test to explore this skill in different road users (pedestrians, cyclists and drivers), with videos recorded in naturalistic scenarios: walking, riding a bicycle and driving a car. There were 79 participants (30 pedestrians, 14 cyclists, 13 novice drivers and 22 experienced drivers). Sixty videos of hazardous traffic situations were presented, divided into 2 blocks of 30 videos each: 10 walking, 10 riding a bicycle, 10 driving a car. In each situation presented, we evaluated the performance of the participants carrying out the task of predicting the hazard and estimating the risk. In the second block, after they had carried out the task, we gave them feedback on their performance and let them see the whole video (i.e., checking what happened next). The results showed that the holistic test had acceptable psychometric properties (Cronbach's alpha = .846). The test was able to discriminate between the different conditions manipulated: a) between traffic hazards recorded from different perspectives: walking, riding a bicycle and driving a car; b) between participants with different user profiles: pedestrians, cyclists and drivers; c) between the two test blocks: the first evaluation only and the second combining evaluation with this complex intervention. We found modal bias effects in both Hazard Perception and Prediction; and in Risk Estimation.

Red-light running behavior of delivery-service E-cyclists based on survival analysis

OBJECTIVE

The primary objective of this study is to explore the red-light running behavior of delivery-service E-cyclists, including differences with regular E-cyclists and influencing factors.

METHODS

A total of 2173 E-cyclists in Shanghai were observed, with a mix of 51.8% regular E-cyclists and 48.2% delivery-service E-cyclists. Survival analysis was used to establish the model to resolve the issue of censored data of the waiting time of E-cyclists at an intersection. The Kaplan-Meier estimator was adopted to examine the significance of the difference between regular E-cyclists and delivery-service E-cyclists on red-light running behavior. A Cox proportional hazards model with six potential influencing factors was developed to estimate the red-light running probability of delivery-service E-cyclists.

RESULTS

The violation rate of the red-light running behavior is almost 40% higher for delivery-service E-cyclists when compared to that for regular E-cyclists. The results show four factors that increase the hazard rate of red-light violation for delivery-service E-cyclists: being male, visual search (i.e., head movement), waiting beyond the stop line, and existence of red-light running of other (E-)cyclists. Additionally, they show one factor decreases the hazard rate of red-light violation: group size.

CONCLUSIONS

Waiting position, violation of the law by other cyclists, and group size play an important role in red-right running behavior. The hazard rates of running red-light by delivery-service E-cyclists increased by 62% and 33% when they wait near motorized lanes and when other individuals violate traffic rules, respectively. The hazard rates reduced by 50% when there are more than five waiting cyclists.

Effects of peripheral transverse line markings on drivers' speed and headway choice and crash risk in car-following: A naturalistic observation study

Rear-end crashes are closely related to car-following situation of vehicles. Speeding and insufficient headway are the major reasons as the drivers have not enough time to react to a sudden brake from the leading vehicle. Perceptual countermeasures, like speed reduction markings, are widely used in practice for accident prevention, and are verified with substantial effectiveness. However, compared with its practical application, the perceptual countermeasures are rarely analyzed in depth from the perspective of drivers' visual perception where the meaning of "perceptual" actually dwells. In addition, its effect on drivers' headway (distance) choice is almost ignored in previous research. Given this, the present study explored the effects of a certain type of perceptual treatment, i.e., the peripheral transverse line markings (PTLMs), on drivers' choice of speed and headway (distance) in car-following by a series of on-road experiments. In the on-road experiments, temporary line markings were installed on a real-world freeway in China to shape the PTLMs. The intersection angle (α) and the longitudinal spacing (λ) of the PTLMs were manipulated to attempt to associate the line markings with drivers' visual perception. Results of general and sectional relative differences of time headway (η_h, θ_h), speed (η_v, θ_v), and distance (η_d, θ_d) suggests that 1) the speed was reduced, the distance and time headway were increased significantly after the installation of PTLMs when compared with the original condition; 2) a larger intersection angle (α) and a smaller longitudinal spacing (λ) of PTLMs could lead to a greater variations in speed and headway (distance); in particular, the PTLMs in a form of α=150°, λ=2m resulted in 0.44 s increase in time headway, 1.33 m/s reduction in speed, and 4.07 m increase in distance in maximum; 3) the real-time crash risk variations under the influence of PTLMs were evaluated by two modified and extended surrogate safety indicators. The effects of PTLMs were discussed and explained considering the influences of optical illusion on lane width narrowing, edge rate on speed and "discontinuity effect" on distance, respectively. The findings of this study provide theoretical support for the perceptual countermeasures and suggest comparative advantages of PTLMs in dealing with rear-end crashes by intervening drivers' speed and headway choice.

The development and validation of video-based measures of drivers' following distance and gap acceptance behaviours

The distance at which drivers follow other vehicles has been found to be linked to crash risk. Tailgating (i.e. driving at an unsafe following distance) is both endemic and a leading cause of rear-end crashes. Similarly, drivers' decisions about when to merge with a stream of traffic are likely to influence crash risk. Consistent with this, it has been shown that crashes are more common at intersections where drivers more frequently have to slow for vehicles pulling out into insufficient gaps. Therefore, the development of reliable and valid measures of both of these driving behaviours would facilitate further crash prevention research. Given the problems associated with assessing these behaviours during real driving, we developed new video-based measures. In our new following distance measure, participants view videos shot from the perspective of a driver who is following another vehicle at a range of distances across a variety of traffic environments. On each trial, participants report their own minimum comfortable following distance relative to the following distance depicted in the video. In our new test of gap acceptance behaviour, participants view a series of video clips and indicate when they would pull out into the approaching stream of traffic shown in each clip. The two new measures each yielded reliable data, and we found that young drivers made riskier choices than older drivers for both following distance and gap acceptance. These age-related differences are consistent with those found in observational studies of real driving, supporting the proposal that the new tests could potentially be used as proxies for these crash-related driving behaviours in both lab-based research and large-scale online studies.

Effects of traffic enforcement cameras on macro-level traffic safety: A spatial modeling analysis considering interactions with roadway and Land use characteristics

Nowadays, intelligent transportation system (ITS) planning has been often integrated into transportation planning stage. As a component of ITS, traffic enforcement cameras have been found to reduce dangerous behaviors, such as red-light running and speeding. However, with limited resource, it is important to understand the effects of enforcement cameras on macro-level safety, so that traffic policy-makers can better allocate those resources to improve traffic safety from the planning stage. In this paper, we examined the effects of various traffic enforcement cameras on regional traffic crash risk, considering their interactions with roadway and land use characteristics. The Kunshan city in Suzhou, China was selected in this study and a spatial modeling analysis was applied. According to the modeling results, several conclusions can be drawn: 1. Interaction effects on regional injury/PDO crash risk were found between traffic enforcement cameras and roadway/land use factors; 2. Traffic enforcement cameras were found to be associated with decreased regional crash risk. Among them, red-light running and speeding cameras were associated with the reduction of injury/PDO crash frequency, which can be further enhanced when being installed in certain area (e.g. industrial, commercial, residential land use) and on certain roadways (e.g. major arterials, local roads). Illegal lane changing cameras were associated with the decrease in PDO crash frequency, while such effect on reducing injury crashes was only found as significant on major arterials; 3. The main effects of certain land use and roadway factors appeared to be mediated by traffic enforcement interaction terms. For example, the main effect of industrialized land use was found as insignificant, while the interaction term between industrial area and speeding cameras showed a significant effect of reducing injury/PDO crash frequency. Based on those findings, traffic enforcement cameras, as one of the major components of ITS, need to be carefully considered at the transportation planning stage. In general, this study provides valuable information for policy-makers and transportation planners to improve regional traffic safety, by properly allocating traffic enforcement resources.