Socioeconomic differences and motorcycle injuries: age at risk and injury severity among young drivers. A Swedish nationwide cohort study

Monitoring day and dark traffic collisions in Toronto neighbourhoods with implications for injury reduction and Vision Zero initiatives: A spatial analysis approach

The City of Toronto adopted a Vision Zero strategy in 2016 that aims to eliminate deaths and serious injuries from vehicular collisions. The strategy includes policies to improve lighting to reduce collision risks, and past research has suggested lighting as a road safety factor. We apply Bayesian spatial analysis (including Poisson log-normal regression modelling, shared component spatial modelling, and Bayesian spatiotemporal modelling) to publicly available data on traffic collisions where persons are killed or seriously injured (KSI) based on Day/Dark conditions. We assess (1) links between KSI risk and socioeconomic and built environment factors, (2) spatial distributions of relative Day & Dark KSI risk, and (3) area-specific trends in space and time for Day-Dark KSI risk change across Toronto neighbourhoods. Our analysis does not find significant associations between socioeconomic/built environment factors and KSI risk, but we uncover neighbourhoods with heightened Dark KSI risk and pronounced Day-Dark KSI changes compared to Toronto's mean area trend. Findings highlight the need for increased policy attention for impacts of lighting on collisions and provide insight for focus regions for improved Vision Zero policy development.

Extreme environmental temperatures and motorcycle crashes: a time-series analysis

Extreme temperature could affect traffic crashes by influencing road safety, vehicle performance, and drivers' behavior and abilities. Studies evaluating the impacts of extreme temperatures on the risk of traffic crashes have mainly overlooked the potential role of vehicle air conditioners. The aim of this study, therefore, was to evaluate the effect of exposure to extreme cold and hot temperatures on seeking medical attention due to motorcycle crashes. The study was conducted in Iran by using medical attendance for motorcycle crashes from March 2011 to June 2017. Data on daily minimum, mean and maximum temperature (°C), relative humidity (%), wind velocity (km/h), and precipitation (mm/day) were collected. We developed semi-parametric generalized additive models following a quasi-Poisson distribution with the distributed nonlinear lag model to estimate the immediate and lagged associations (reported as relative risk [RR], and 95% confidence interval [CI]). Between March 2011 and June 2017, 36,079 medical attendances due to motorcycle road traffic crashes were recorded (15.8 ± 5.92 victims per day). In this time period, the recorded temperature ranged from -11.2 to 45.4 °C (average: 25.5 ± 11.0 °C). We found an increased risk of medical attendance for motorcycle crashes (based on maximum daily temperature) at both extremely cold (1st percentile) and hot (99th percentile) temperatures and also hot (75th percentile) temperatures, mainly during lags 0 to 3 days (e.g., RR: 1.12 [95% CI: 1.05: 1.20]; RR: 1.08 [95% CI: 1.01: 1.16]; RR: 1.20 [95% CI: 1.09: 1.32] at lag0 for extremely cold, hot, and extremely hot conditions, respectively). The risk estimates for extremely hot temperatures were larger than hot and extremely cold temperatures. We estimated that 11.01% (95% CI: 7.77:14.06) of the medical attendance for motorcycle crashes is estimated to be attributable to non-optimal temperature (using mean temperature as exposure variable). Our findings have important public health messaging, given the considerable burden associated with road traffic injury, particularly in low- and middle-income countries.

The neglected epidemic-Risk factors associated with road traffic injuries in Mozambique: Results of the 2016 INCOMAS study

In 2019, 93% of road traffic injury related mortality occurred in low- and middle-income countries, an estimated burden of 1.3 million deaths. This problem is growing; by 2030 road traffic injury will the seventh leading cause of death globally. This study both explores factors associated with RTIs in the central region of Mozambique, as well as pinpoints geographical "hotspots" of RTI incidence. A cross-sectional, population-level survey was carried out in two provinces (Sofala and Manica) of central Mozambique where, in addition to other variables, the number of road traffic injuries sustained by the household within the previous six months, was collected. Urbanicity, household ownership of a car or motorcycle, and socio-economic strata index were included in the analysis. We calculated the prevalence rate ratios using a generalized linear regression with a Poisson distribution, as well as the spatial prevalence rate ratio using an Integrated Nested Laplace Approximation. The survey included 3,038 households, with a mean of 6.29 (SD 0.06) individuals per household. The road traffic injury rate was 6.1% [95%CI 7.1%, 5.3%]. Urban residence was associated with a 47% decrease in rate of injury. Household motorbike ownership was associated with a 92% increase in the reported rate of road traffic injury. Higher socio-economic status households were associated with a 26% increase in the rate of road traffic injury. The rural and peri-urban areas near the "Beira corridor" (national road N6) have higher rates of road traffic injuries. In Mozambique, living in the rural areas near the "Beira corridor", higher household socio-economic strata, and motorbike ownership are risk factors for road traffic injury.

Association between employment status and sickness presenteeism among Korean employees: a cross-sectional study

Background

Sickness presenteeism (SP) indicates “going to work while being ill.” The importance of SP has only recently been investigated, and the association between SP and employment status has been inconsistent across studies. Therefore, we conducted this study to explore the association between SP and employment status by using presenteeism propensity (PP), which can reflect the individual decision-making process.

Methods

The study population included employees participating in the 5th Korean Working Condition Survey. We analyzed data of only employees with at least one health event, which was calculated as the sum of SP and sickness absenteeism days. Employment status was grouped into 3 categories: stable employment, unstable employment (contract period ≥ 1 year), and unstable employment (contract period < 1 year). Survey-weighted logistic regression analysis was conducted to assess the association between employment status and PP (dichotomized as “≤ 0.5” and “> 0.5”).

Results

Unstable employees (contract period ≥ 1 year) had higher odds of PP than stable employees (odds ratio [OR]: 1.23, 95% confidence interval [CI]: 1.03–1.47), whereas unstable employees (contract period < 1 year) had lower odds of PP than stable employees (OR: 0.82, 95% CI: 0.71–0.96).

Conclusions

Employment status was associated with SP. Given the negative health impact of SP, social efforts, such as paid sick leave, are required to reduce SP and enhance the health status of unstable workers.

Crash risk factors for novice motorcycle riders

BACKGROUND

Motorcycle riders have the highest injury and fatality rates among all road users. This research sought in-depth understanding of crash risk factors to help in developing targeted measures to reduce motorcycle crash injuries and fatalities.

METHODS

We used interview data from a study of 2,399 novice motorcycle riders in Victoria, Australia from 2010 to 2012 linked with their police-recorded crash and offence data. The outcome measure was self and/or police reported crash. The association between potential risk factors and crashes was explored in multivariable logistic regression models.

RESULTS

In the multivariable analysis, riders who reported being involved in three or more near crashes had 1.74 times (95% CI 1.11-2.74) higher odds of crashing compared to riders who reported no near-crash events, and riders who participated in a pre-learner course had 1.41 times higher odds of crashing (95% CI 1.07-1.87) compared with riders who did not attend a pre-learner course. Riders who had been involved in a crash before the study had 1.58 times (95% CI 1.14-2.19) higher odds of crashing during the study period compared with riders who were not involved in a crash. Each additional month of having held a license and learner permit decreased the odds of crashing by 2%, and each additional 1,000 km of riding before the study increased the odds of crashing by 2%.

CONCLUSION

Measures of pre-learner training and riding experience were the strongest predictors of crashing in this cohort of novice motorcycle riders. At the time of the study there was no compulsory rider training to obtain a learner permit in Victoria and no on-road courses were available. It may be plausible that riders who voluntarily participated in an unregulated pre-learner course became or remained at high risk of crash after obtaining a rider license. We suggest systematically reviewing the safety benefits of voluntary versus mandatory pre-learner and learner courses and the potential need to include on-road components.

Different demographic and drinking profiles of motorcyclists and car drivers with the first-time offense of driving/riding under the influence of alcohol

BACKGROUND

Driving/riding under the influence (DUI) of alcohol is a major public concern worldwide. Only a few studies have distinguished DUI-related variables between motorcyclists and car drivers. This study examined the differences in demographic characteristics and drinking behaviors among first-time DUI offenders operating different transportation vehicles, and risk factors for frequent DUI (fDUI) among them.

METHODS

We conducted an anonymous survey for 561 first-time DUI offenders who attended a mandatory educational program. Participants self-administered questionnaires concerning alcohol drinking behaviors and DUI. We defined fDUI as at least two DUI behaviors per month based on self-reported information. Demographic and drinking characteristics were compared between DUI offenders, car drivers and motorcyclists. Logistic regression analysis was used to examine risk factors for fDUI.

RESULTS

Two-thirds of first-time DUI offenders were motorcyclists. Compared with car drivers, motorcyclists were younger and less educated, with a higher percentage of them being women and unmarried. Car drivers reported a higher rate of fDUI than motorcyclists (16.5% vs. 9.7%). Regression analysis revealed that binge drinkers had a higher fDUI risk in both groups. Regarding the drinking place prior to DUI behavior, workplace was significantly associated with fDUI in car drivers.

CONCLUSIONS

Distinct strategies may be required for motorcyclists and car drivers for DUI recidivism prevention, and drinking place interventions should also be considered.

Worldwide prevalence of alcohol in fatally injured motorcyclists: A meta-analysis

Objective: The aim of this study was to estimate the prevalence of alcohol in fatally injured motorcyclists and to determine the factors that are related to the prevalence worldwide. Methods: A systematic review was conducted using PubMed/Medline, ISI Web of Knowledge, and Google Scholar until 2018. Point prevalence with 95% confidence intervals was estimated. The variances of each study were calculated using by binomial distribution formula. Heterogeneity among the studies was tested using Cochran's Q test with a significance level less than .1. The index of changes attributed to heterogeneity (I²) was assessed. Regarding the heterogeneity of the studies, a random effects model was employed to combine the results of the studies. All statistical analyses were performed using STATA Ver. 11 using the meta-analysis commands. Results: Of 916 articles from 2011 to 2018, 12 studies were examined and analyzed based on inclusion criteria. The prevalence of alcohol in fatally injured motorcyclists was 0.30 (95% confidence interval [CI], 0.25-0.35). Subgroup analysis based on the type of country showed that the prevalence of alcohol in fatally injured motorcyclists in developing countries was 34% (95% CI, 0.18-0.49), which was higher than that in developed countries (29%; 95% CI, 0.24-0.33). In addition, the prevalence of alcohol among fatally injured motorcyclists aged 25-35 years was greater than that of other age groups (0.34; 95% CI, 0. 27-0.4). Conclusions: Motorcyclists dominated the picture of fatal crashes and deserve more attention by the public and government. With the proper planning and adoption of health policies, increasing prevalence and complications of the disease will be prevented.

Social Differences in the Prevalence of Road Traffic Injuries among Pedestrians, and Vehicle and Motorcycle Users in Iran: Results of a National Multiple Indicator Demographic and Health Survey (IrMIDHS, 2010)

Background

Traffic injuries are considered as the most important health issues for different countries in the world, especially developing countries that are experiencing rapid social changes. The purpose of this study was to investigate the prevalence of road traffic injuries (RTIs) and its socioeconomic differences among road users in Iran as it is one of the countries with high rates of accidents in the world. The study population included all people in Iran. The target sample was 3,096 clusters consisting of 2,187 urban and 909 rural households.

Methods

Source of the raw data was the Iran's Multiple Indicator Demographic and Health Survey (IrMIDHS) 2010, which is a multi-stage stratified cluster-random cross-sectional study. The logistic regression has been performed for investigating the socioeconomic determinants which influence the RTIs among pedestrian, vehicle, and motorcycle users.

Results

The prevalence of RTIs is 13.8 (95% CI: 13.1, 14.5) per 1,000 people in the year leading up to the study. The injured groups included pedestrians (14.37%), vehicles (38.36%), motorcyclists (43.37%), and 3.9% of users injured with other vehicles. A total of 78.3% of the injured people underwent outpatient treatment or were hospitalized. The mean age in these three groups was significantly increased (27.9, 32.5, 33.4, respectively), and the proportion of men decreased (89.2, 75.2, and 60.6).

Conclusions

RTIs in Iran are higher than previous estimates due to consideration of non-hospitalized cases. Considering the high contribution of human factors in developing countries, these measures should prioritize vulnerable groups.

Examining the association between area level deprivation and vehicle collisions that result in injury

OBJECTIVE

The objective of this study was to examine the association between area level deprivation and vehicle collisions resulting in either property damage or injury.

METHODS

A multilevel observational study was conducted using the 2000 to 2010 Saskatchewan Traffic Accident Information System (TAIS) (n = 72,234) and 2006 Census data at the Dissemination Area level (n = 337) for the city of Saskatoon.

RESULTS

Total area level deprivation was associated with severity of traffic collisions, but the association varied based on time of day and road repair status. Collisions were more likely to result in injury from the most deprived (Q5) versus the least deprived quintile (Q1) at all times of day; the difference was greatest in the evening (OR 1.7, 95% CI 1.3 to 2.3). However, there was no other evidence of a monotonic increase in risk associated with area level deprivation. When there were faded markings or potholes, the odds of a collision involving injury were 2.6 (95% CI 1.5 to 4.4) times greater for the most deprived quintile compared to the least deprived quintile. There were no significant differences in the risk of injury between area level deprivation quintiles when road conditions were good.

CONCLUSION

While the association between area level deprivation and whether vehicle collisions result in injury in Saskatoon varies based on time of day and road repairs, under many circumstances the most deprived areas report more injuries from collisions compared to the least deprived.

Spatial Factors Affecting the Frequency of Pedestrian Traffic Crashes: A Systematic Review

Context

Considering the importance of pedestrian traffic crashes and the role of environmental factors in the frequency of crashes, this paper aimed to review the published evidence and synthesize the results of related studies for the associations between environmental factors and distribution of pedestrian-vehicular traffic crashes.

Evidence Acquisition

We searched all epidemiological studies from 1966 to 2015 in electronic databases. We found 2,828 studies. Only 15 observational studies out of these studies met the inclusion criteria of the study. The quality of the included studies was assessed using the strengthening the reporting of observational studies in epidemiology (STROBE) checklist.

Results

A review of the studies showed significant correlations between a large number of spatial variables including student population and the number of schools, population density, traffic volume, roadway density, socio-economic status, number of intersections, and the pedestrian volume and the dependent variable of the frequency of pedestrian traffic crashes. In the studies, some spatial factors that play an important role in determining the frequency of pedestrian traffic crashes, such as facilities for increasing the pedestrians’ safety were ignored.

Conclusions

It is proposed that the needed research be conducted at national and regional levels in coordination and cooperation with international organizations active in the field of traffic crashes in various parts of the world, especially in Asian, African and Latin American developing countries, where a greater proportion of pedestrian traffic crashes occur.

Epidemiological Patterns of Road Traffic Crashes During the Last Two Decades in Iran: A Review of the Literature from 1996 to 2014

Context

Despite considerable attention given to health statistics of road traffic crashes (RTCs), the epidemiological aspects of injuries resulting from RTCs are not fully understood in Iran and other developing countries. The aim of this review was to study the epidemiological pattern and issues arising due to RTCs in Iran.

Evidence Acquisition

The scope of this study involves data from a broad range of published literature on RTCs in Iran. Data collection for this study was conducted by searching for keywords such as traffic accidents, traffic crashes, motorcycle accidents, motorcycle crashes, motorcycle injury, motor vehicle injury, motor vehicle crashes and motor vehicle accidents, Iran and Iranian in various databases such as Embase, PubMed, Google Scholar, Scopus, Magiran, Iranian scientific information database (SID) and IranMedex.

Results

This study comprised of 95 articles. It is evident from this review that a large number of severe RTCs occur due to collision of two or more vehicles and most of the victims are males aged between 30 and 39 years. Male pedestrian, drivers and passengers are more likely to be severely injured in comparison to females. One of the most prevalent causes of death among adults involved in the RTCs are head injuries and the majority of deaths occur prior to hospitalization. Mortality rates for RTCs are higher in summer, especially during midnight among all age groups. The most common individual and environmental risk factors associated with RTCs include lack of attention, getting trapped in the car, listening to music, fatigue and sleepiness, duration and distance and negligence of seatbelt usage while driving.

Conclusions

The findings of the current study will be beneficial in prevention of RTCs and its associated complications and hence will be vital for policy makers, health service managers and stakeholders.

[Traffic accidentability and risky driving behavior in young people in New Caledonia. Results of study Situation Sociale et Comportements de Santé des Jeunes en Nouvelle-Calédonie]

BACKGROUND

New Caledonia has one of the highest global rates of death from road accidents: 240 deaths per million inhabitants in 2011 with a majority of young people. However, research on driving behaviors has remained rare.

METHODS

A cross-sectional survey based on face-to-face questionnaire with 1400 male and female youth aged 16 to 25 was conducted in 2007. It was used to measure the frequency of accidents and to compute a score of driving behaviors and their associations with socio-demographic characteristics, lifestyles as well as other health behaviors. RESULTS - 

CONCLUSION

A total of 10.6% of boys and 6.5% of girls reported a car accident in the previous twelve months period. Among male participants risky driving behavior was associated with having a degree (ORa=2, 95% CI [1.1-3.8]), sport practices (ORa=3.7, 95% CI [1.9-7.05]), involvement in a fight in the last twelve months (ORa=2.2, 95% CI [1.4-3.4]) and precocity of cannabis use (ORa=1.8, 95% CI [1.2-2.8]). Youth living in couple and those with children presented with higher risk-taking scores. Among female participants, young age at cannabis initiation (ORa=3.1, 95% CI [1.5-6.4]) and at sexual debut (ORa=2.4, 95% CI [1.1-5.1]) were associated with driving risk-taking. Finally, younger age at first alcohol intoxication was associated with risky behavior on the road in both sexes. These results highlighted the multidimensional nature of risk-taking behaviors on the road and showed that they are part of, for boys and girls, a larger pattern of risky behaviors. Such results suggest to include behaviors on the road in a comprehensive approach of prevention.

Prevalence and risk factors of alcohol and substance abuse among motorcycle drivers in Fars province, Iran

PURPOSE

The aim of this present study is to investigate the prevalence of alcohol and substance abuse (ASA) and its relationship with other risky driving behaviors among motorcycle drivers.

METHODS

This is a cross sectional study which is performed at Shiraz city of Iran. Data from motorcycle drivers were collected using a standard questionnaire in eight major streets at different times of the day. The data includes consumption of alcohol and other substances two hours before driving and some of the risky behaviors during driving.

RESULTS

A total of 414 drivers with a mean ± SD age of (27.0 ± 9.3) years participated in the study. Alcohol or substance consumptions two hours before driving was significantly associated with risky driving behaviors such as using mobile phone during driving, poor maneuvering, and driving over the speed limit (both p < 0.001). It was also associated with carelessness about safety such as driving with technical defects (p < 0.001) and not wearing a crash helmet (p=0.008).

CONCLUSION

Screening for alcohol and substance consumption among motorcycle drivers is an efficient way to identify drivers that are at a greater risk for road traffic accidents.

Motorcycle riding under the influence of alcohol: results from the SARTRE-4 survey

Riding a motorcycle under the influence of alcohol is a dangerous activity, especially considering the high vulnerability of motorcyclists. The present research investigates the factors that affect the declared frequency of drink-riding among motorcyclists in Europe and explores regional differences. Data were collected from the SARTRE-4 (Social Attitudes to Road Traffic Risk in Europe) survey, which was conducted in 19 countries. A total sample of 4483 motorcyclists was interviewed by using a face-to-face questionnaire. The data were analyzed by means of multilevel ordered logit models. The results revealed significant regional differences (between Northern, Eastern and Southern European countries) in drink-riding frequencies in Europe. In general, declared drinking and riding were positively associated with gender (males), increased exposure, underestimation of risk, friends' behaviour, past accidents and alcohol ticket experience. On the other hand, it was negatively associated with underestimation of the amount of alcohol allowed before driving, and support for more severe penalties.

A review of powered-two-wheeler behaviour and safety

Powered-two-wheelers (PTWs) constitute a very vulnerable type of road users. The notable increase in their share in traffic and the high risk of severe accident occurrence raise the need for further research. However, current research on PTW safety is not as extensive as for other road users (passenger cars, etc.). Consequently, the objective of this research is to provide a critical review of research on Power-Two-Wheeler behaviour and safety with regard to data collection, methods of analysis and contributory factors, and discuss the needs for further research. Both macroscopic analyses (accident frequency, accident rates and severity) and microscopic analyses (PTW rider behaviour, interaction with other motorised traffic) are examined and discussed in this paper. The research gaps and the needs for future research are identified, discussed and put in a broad framework. When the interactions between behaviour, accident frequency/rates and severity are co-considered and co-investigated with the various contributory factors (riders, other users, road and traffic environment, vehicles), the accident and injury causes as well as the related solutions are better identified.

Analysis of factors associated with injury severity in crashes involving young New Zealand drivers

Young people are a risk to themselves and other road users, as motor vehicle crashes are the leading cause of their death. A thorough understanding of the most important factors associated with injury severity in crashes involving young drivers is important for designing well-targeted restrictive measures within youth-oriented road safety programs. The current study estimates discrete choice models of injury severity of crashes involving young drivers conditional on these crashes having occurred. The analysis examined a comprehensive set of single-vehicle and two-vehicle crashes involving at least one 15-24 year-old driver in New Zealand between 2002 and 2011 that resulted in minor, serious or fatal injuries. A mixed logit model accounting for heterogeneity and heteroscedasticity in the propensity to injury severity outcomes and for correlation between serious and fatal injuries proved a better fit than a binary and a generalized ordered logit. Results show that the young drivers' behavior, the presence of passengers and the involvement of vulnerable road users were the most relevant factors associated with higher injury severity in both single-vehicle and two-vehicle crashes. Seatbelt non-use, inexperience and alcohol use were the deadliest behavioral factors in single-vehicle crashes, while fatigue, reckless driving and seatbelt non-use were the deadliest factors in two-vehicle crashes. The presence of passengers in the young drivers' vehicle, and in particular a combination of males and females, dramatically increased the probability of serious and fatal injuries. The involvement of vulnerable road users, in particular on rural highways and open roads, considerably amplified the probability of higher crash injury severity.

Relationship between motorcyclists' attitudes, behavior, and other attributes with declared accident involvement in Europe

OBJECTIVE

The objective of this study is to investigate patterns of road safety attitudes and behaviors of motorcyclists in Europe on the basis of the results of the pan-European questionnaire-based survey SARTRE-4, carried out in late 2010 in 18 European countries and Israel. In addition, we attempt to explore the link between attitudes, behaviors, and other motorcyclist attributes with motorcyclist involvement in accidents in the past 3 years, in which someone, including the rider, was injured and received medical attention as stated in the motorcyclists' responses.

METHODS

The various components of motorcyclist attitudes and behaviors such as reasons for driving a motorcycle, driving while impaired, perceived risk factors, and risk-taking behavior were determined by means of a principal component analysis (PCA) on 38 variables contained in the survey. A binary logistic regression model was then applied in order to link the attitudes and the stated behavior with the declared involvement in past accidents.

RESULTS

The results revealed 8 components. Component 1 (driving while impaired and speeding accident factors), component 2 (motorcycle benefits), component 3 (perceived risk of maneuvers), component 4 (sensation seeking), component 5 (road, vehicle, and environmental risk factors), component 7 (no modal options), and component 8 (attitudes toward drinking and friends' drinking) are associated with stated preferences and attitudes, whereas component 6 (dangerous and angry behaviors) is associated with stated behavior. Moreover, it was found that motorcyclists who tend to have dangerous attitudes and behaviors as well as younger motorcyclists are more likely to have been involved in an accident. It was also showed that driving exposure is positively associated with increased probability of a past accident.

CONCLUSIONS

The findings of the study provide some insight into the association between attitudes, behaviors, and declared past accident involvement. Furthermore, the analysis of such large databases with the inclusion of many different countries constitutes a step for further research in the field of motorcyclists' behaviors and safety. Supplemental materials are available for this article. Go to the publisher's online edition of Traffic Injury Prevention to view the supplemental file.

Population based case-control study of serious non-fatal motorcycle crashes

Background

Motorcycle sales, registration and use are increasing in many countries. The epidemiological literature on risk factors for motorcycle injury is becoming outdated, due to changes in rider demography, licensing regulations, traffic mix and density, road environments, and motorcycle designs and technologies. Further, the potential contribution of road infrastructure and travel speed has not yet been examined.

Methods/design

A population based case–control study together with a nested case-crossover study is planned. Cases will be motorcycle riders who are injured but not killed in a motorcycle crash on a public road within 150 km radius of Melbourne, Australia, and admitted to one of the study hospitals. Controls will be motorcycle riders who ride through the crash site on the same type of day (weekday or weekend) within an hour of the crash time. Data on rider, bike, and trip characteristics will be collected from the participants by questionnaire. Data on crash site characteristics will be collected in a structured site inspection, and travel speed for the cases will be estimated from these data. Travel speed for the controls will be measured prior to recruitment with a radar traffic detection device as they ride through the crash site. Control sites for the case-crossover study will be selected 1 km upstream from the crash site and matched on either intersection status or road curvature (either straight or cornered). If the initial site selected does not match the case site on these characteristics, then the closest matching site on the case route will be selected. Conditional multivariate logistic regression models will be used to compare risk between the matched case and control riders and to examine associations between road infrastructure and road environment characteristics and crash occurrence. Interactions between type of site and speed will be tested to determine if site type is an effect modifier of the relationship between speed and crash risk. The relationship between rider factors and travel speed generally will be assessed by multivariate regression methods.

Discussion

In the context of the changing motorcycling environment, this study will provide evidence on contemporary risk factors for serious non-fatal motorcycle crashes.

Severity of motorcycle crashes in Calgary

Motorcycle riders would be more vulnerable in the event of a crash because of their lack of protection which would often result in them suffering more severe injuries than car drivers. This paper estimated three crash severity models to identify factors that contributed to increasing the severity of motorcycle involved crashes in the Canadian City of Calgary. We found that results from the ordered logit model, heterogeneous choice model and partially constrained generalized ordered logit model produced estimates that were very similar which attested to their robustness. Injury severity tended to increase in neighborhoods with loops and lollipops types of streets or involved right-angle and left-turn-across-path crashes, a truck, unsafe speed or alcohol use but tended to decrease if the crash occurred in parking lots or during winter, involved a van or male rider, or a rider following-too-closely to the vehicle in front.

Examination of factors determining fault in two-vehicle motorcycle crashes

Motorcycle crashes frequently involve a combination of high-risk behaviors by the motorcyclist or the other crash-involved driver. Such behaviors may include riding or driving without appropriate licensure or while under the influence of alcohol, as well as deciding not to use a safety device such as a helmet or safety belt. Given that these factors frequently occur in combination with one another, it is difficult to untangle the specific effects of individual factors leading up to the crash outcome. This study assesses how various rider-, driver-, and other crash-specific factors contribute to at-fault status in two-vehicle motorcycle crashes, as well as how these same factors affect the propensity for other high-risk behaviors. Furthermore, the interrelationships among fault status and these other behaviors are also examined using a multivariate probit model. This model is developed using police-reported crash data for the years 2006-2010 from the State of Ohio. The results show that younger motorcyclists are more likely to be at-fault in the event of a collision, as are riders who are under the influence of alcohol, riding without insurance, or not wearing a helmet. Similarly, motorcyclists were less likely to be at-fault when the other driver was of younger age or was driving under the influence of alcohol, without insurance, or not wearing their safety belt. Crash-involved parties who engaged in one high-risk behavior were more likely to engage in other such behaviors, as well, and this finding was consistent for both motorcyclists and drivers. The results of this study suggest that educational and enforcement strategies aimed at addressing any one of these behaviors are likely to have tangential impacts on the other behaviors, as well.

Acciphilia on the road: An analysis of severe collisions

INTRODUCTION

Although prior studies of road traffic accidents have found between-group differences in risk, little attention has been given to the encounter between drivers involved in severe collisions.

METHOD

The present study empirically evaluates two different possible causes of "social accidents," which are defined as collisions between two or more drivers where some faulty social interaction might be assumed, and which are the most prevalent cause of road injuries. The analyses use merged Israeli collision records from 1983 to 2004 with data from two national censuses, thus providing an unprecedented empirical basis to study the social foundations of car accidents. The data are used to adjudicate between two alternative hypotheses: the heterogeneity hypothesis (socially different drivers tend to collide) versus the homogeneity hypothesis (socially similar drivers tend to collide).

RESULTS

Multivariate analyses provide preliminary support for the latter hypothesis. Given an accident, there are more collisions among drivers from the same broad educational group, and the factors that influence this correlation are independent of geography. The paper thus leads to the idea that severe collisions reflect a sociological or ecological process that is akin to acciphilia.

IMPACT ON INDUSTRY

The preliminary findings suggest that variation between drivers may be preferable to similarity, since apparently there is a greater tendency toward collisions between similar drivers.

Deprived neighborhoods and risk of road trauma (incidence and severity) among under 25year-olds in the Rhône Département (France)

INTRODUCTION

Previous research has shown that there are inequalities with regard to traffic accident risk between different social categories. This study describes the influence of the type of residential municipality (with or without deprived urban areas, "ZUS, zones urbaines sensibles"), used as an indicator of contextual deprivation, on the incidence and severity of road trauma involving people of under 25years of age in the Rhône.

METHOD

Injury data were taken from The Rhône Road Trauma Registry. The study covers the 2004-2007 period, with 13,589 young casualties. The incidence of traffic injury of all severities were computed according to the type of municipality and the age, gender, and type of road user. The ratios of the incidences of deprived municipalities, compared with others were calculated. Subsequently the severity factors and incidences according to the severity level (ISS 1-8, ISS 9+) were studied.

RESULTS

For the main types of road users except motorized two-wheeler users, the incidences were higher in the deprived municipalities: the greatest difference was for pedestrians, where the incidences were almost twice those of other municipalities. This excess risk, constituting a health inequality topic rarely considered, was even greater in municipalities with two or three ZUSs. It was essentially observed for minor injuries among motorists, cyclists, and pedestrians.

CONCLUSIONS

While the incidence increased among people less than 25years of age, the severity of road injuries was lower in deprived neighborhoods, contrary to what is suggested by other studies. This lower severity disappeared when taking into account the crash characteristics.

IMPACT ON INDUSTRY

The incidence of injuries as a pedestrian, cyclist or motorist is higher among young people living in deprived municipalities. These areas should therefore be the targets of dedicated education programs, as well as further investigations about urban planning.

Social inequalities in road traffic deaths at age 16-20 years among all 611,654 Norwegians born between 1967 and 1976: a multilevel analysis

Background

Road traffic injury is a major cause of death among youths.

Aims

To estimate mortality differences in family socioeconomic position (SEP) and municipal disadvantage level.

Methods

Data on all Norwegians born in 1967–76, gathered from national registries, were linked by a unique national identification number. The 611 654 participants were followed-up for 5 years from age 16 years. Parental education level, father's income level, and proportion of high-income earners in the municipality served as SEP indicators. Associations between SEP and road traffic deaths were analysed by multilevel Poisson regression.

Results

Road traffic deaths (n=676, rate 22.2 per 100 000 person-years) constituted a major cause of death, of which 91.9% were motor vehicle occupants. SEP distributions differed according to gender and type of motor vehicle crash (collision, non-collision). There was an inverse relationship between municipal proportions of high-income earners and mortality (population attributable fraction (PAF) 0.43, 95% CI 0.30 to 0.53) in all categories of gender-specific crash types. Family SEP gradients were not found except for male non-collision deaths, where increasing mortality was found in association with decreasing parental education level (PAF 0.94, 95% CI 0.59 to 0.99) and increasing paternal income (PAF 0.25, 95% CI 0.06 to 0.40).

Conclusion

The different SEP patterns for road traffic deaths across gender and motor vehicle crash type illustrate that heterogeneity of social inequalities in health can be found even within narrow age bands and for similar causes of death.

Youth motorcycle-related brain injury by state helmet law type: United States, 2005-2007

BACKGROUND AND OBJECTIVES

Twenty-seven states have youth-specific helmet laws even though such laws have been shown to decrease helmet use and increase youth mortality compared with all-age (universal) laws. Our goal was to quantify the impact of age-specific helmet laws on youth under age 20 hospitalized with traumatic brain injury (TBI).

METHODS

Our cross-sectional ecological group analysis compared TBI proportions among US states with different helmet laws. We examined the following null hypothesis: If age-specific helmet laws are as effective as universal laws, there will be no difference in the proportion of hospitalized young motorcycle riders with TBI in the respective states. The data are derived from the 2005 to 2007 State Inpatient Databases of the Healthcare Cost and Utilization Project. We examined data for 17 states with universal laws, 6 states with laws for ages <21, and 12 states with laws for children younger than 18 (9287 motorcycle injury discharges).

RESULTS

In states with a <21 law, serious TBI among youth was 38% higher than in universal-law states. Motorcycle riders aged 12 to 17 in 18 helmet-law states had a higher proportion of serious/severe TBI and higher average Abbreviated Injury Scores for head-region injuries than riders from universal-law states.

CONCLUSIONS

States with youth-specific laws had an increased risk of TBI that required hospitalization, serious and severe TBI, TBI-related disability, and in-hospital death among the youth they are supposed to protect. The only method known to keep motorcycle-helmet use high among youth is to adopt or maintain universal helmet laws.

Excess accident risk among residents of deprived areas

This study examines road risks among residents of deprived neighbourhoods covered by social policy compared with residents of other contiguous neighbourhoods that are socially more privileged. The data used are from accident reports filled in by the police. When these data are brought to the level of the population in the areas studied, the adjusted relative risk for those living in sensitive urban areas compared with those living in other areas is assessed at 1.366 (with a 95% confidence interval from 1.240 to 1.502). Distributions by age and gender are then studied. In the discussion, several hypotheses concerning behaviour, mobility and socio-spatial factors are discussed.

Who by accident? The social morphology of car accidents

Prior studies in the sociology of accidents have shown that different social groups have different rates of accident involvement. This study extends those studies by implementing Bourdieu's relational perspective of social space to systematically explore the homology between drivers' social characteristics and their involvement in specific types of motor vehicle accident. Using a large database that merges official Israeli road-accident records with socioeconomic data from two censuses, this research maps the social order of road accidents through multiple correspondence analysis. Extending prior studies, the results show that different social groups indeed tend to be involved in motor vehicle accidents of different types and severity. For example, we find that drivers from low socioeconomic backgrounds are overinvolved in severe accidents with fatal outcomes. The new findings reported here shed light on the social regularity of road accidents and expose new facets in the social organization of death.

20 Years of Research on Socioeconomic Inequality and Children's-Unintentional Injuries Understanding the Cause-Specific Evidence at Hand

Injuries are one of the major causes of both death and social inequalities in health in children. This paper reviews and reflects on two decades of empirical studies (1990 to 2009) published in the peer-reviewed medical and public health literature on socioeconomic disparities as regards the five main causes of childhood unintentional injuries (i.e., traffic, drowning, poisoning, burns, falls). Studies have been conducted at both area and individual levels, the bulk of which deal with road traffic, burn, and fall injuries. As a whole and for each injury cause separately, their results support the notion that low socioeconomic status is greatly detrimental to child safety but not in all instances and settings. In light of variations between causes and, within causes, between settings and countries, it is emphasized that the prevention of inequities in child safety requires not only that proximal risk factors of injuries be tackled but also remote and fundamental ones inherent to poverty.

Saving lives in road traffic-ethical aspects

Aim

This article aims at giving an overview of five ethical problem areas relating to traffic safety, thereby providing a general framework for analysing traffic safety from an ethical perspective and encouraging further discussion concerning problems, policies and technology in this area.

Subjects and methods

The problems presented in the article are criminalisation, paternalism, privacy, justice and responsibility, and the reasons for choosing these are the following. First, they are all important areas in moral philosophy. Second, they are fairly general and it should be possible to categorise more specific problems under these headings. Ethical aspects of road traffic have not received the philosophical attention they deserve. Every year, more than 1 million people die globally in traffic accidents, and 20 to 50 million people are injured. Ninety per cent of the road traffic fatalities occur in low- and middle-income countries, where it is a growing problem. Politics, economics, culture and technology affect the number of fatalities and injuries, and the measures used to combat deaths in traffic as well as the role of road traffic should be ethically scrutinised. The topics are analysed and discussed from a moral-philosophical perspective, and the discussion includes both theory and applications.

Results and conclusion

The author concludes with some thoughts on how the ethical discussion can be included in the public debate on how to save lives in road traffic. People in industrialised societies are so used to road traffic that it is almost seen as part of nature. Consequently, we do not acknowledge that we can introduce change and that we can affect the role we have given road traffic and cars. By acknowledging the ethical aspects of road traffic and illuminating the way the choices society makes are ethically charged, it becomes clear that there are alternative ways to design the road traffic system. The most important general conclusion is that discussion concerning these alternative ways of designing the system should be encouraged.

A review of risk factors and patterns of motorcycle injuries

Per vehicle mile traveled, motorcycle riders have a 34-fold higher risk of death in a crash than people driving other types of motor vehicles. While lower-extremity injuries most commonly occur in all motorcycle crashes, head injuries are most frequent in fatal crashes. Helmets and helmet use laws have been shown to be effective in reducing head injuries and deaths from motorcycle crashes. Alcohol is the major contributing factor to fatal crashes. Enforcement of legal limits on the blood alcohol concentration is effective in reducing motorcycle deaths, while some alcohol-related interventions such as a minimal legal drinking age, increased alcohol excise taxes, and responsible beverage service specifically for motorcycle riders have not been examined. Other modifiable protective or risk factors comprise inexperience and driver training, conspicuity and daytime headlight laws, motorcycle licensure and ownership, riding speed, and risk-taking behaviors. Features of motorcycle use and potentially effective prevention programs for motorcycle crash injuries in developing countries are discussed. Finally, recommendations for future motorcycle-injury research are made.

Inter-group differences in road-traffic crash involvement

This paper assesses group differences in severe and fatal road-traffic accidents by using a unique database that merges road-traffic records with the Israeli census data. The database traces, over a period of 9 years, a group of drivers that comprises 20% of the Israeli population and explores the probability of their being involved in an accident. This unique database enables the investigation of drivers' socioeconomic and demographic characteristics, while controlling for a variety of variables, such as estimated daily distance traveled and license type. Testing a previously published theoretical paper on the social bases of accidents, the findings expose significant group differences in estimated probabilities of being involved in severe and fatal accidents. For example, estimated probabilities of accident involvement are higher for males than for females, for non-Jewish drivers than for Jewish, and for drivers whose origins are in Africa and Asia than in America and Europe. Furthermore, the higher one's education and socioeconomic status, the lower is the probability of accident-involvement. The implications of the findings for developing road-safety programs and suggestions for future research are discussed.

Psychosocial factors associated with lifetime experience of serious unintentional injury in South Korea

PURPOSE

The purpose of this study was to determine the prevalence of lifetime unintentional-injury experience and evaluate the quality of life of unintentional-injury victims, to provide useful data for the development of interventions aimed at decreasing the incidence of unintentional injuries. DESIGN, SAMPLE, AND METHODS: This study utilized data obtained from cross-sectional surveys of 24,327 Korean individuals aged 19-65 years, performed using face-to-face interviews. Demographic characteristics, unintentional-injury experience, attributes of health behavior, and health-related quality of life (HRQoL) questions were included in the study instruments.

RESULTS

About 11.8% of the subjects had experienced an unintentional injury that required hospitalization at least once in their lifetime. Being older, being male, having less education and lower income, working in a blue-collar job, and being enrolled in medical aid programs were associated with increased likelihood of having an unintentional injury. Among the HRQoL and risk-taking behavior variables, limitations in daily activities, suicide ideation, and binge drinking were significantly associated with injury experience.

CONCLUSION

Public health efforts to prevent unintentional injuries should target high-risk populations such as males, those with low incomes and education levels, and binge drinkers. Efforts should also be made to enhance the HRQoL of injury victims.