Female involvement in U.S. nonfatal crashes under a three-level hierarchical crash model

Individual characteristics associated with road traffic collisions and healthcare seeking in low- and middle-income countries and territories

Incidence of road traffic collisions (RTCs), types of users involved, and healthcare requirement afterwards are essential information for efficient policy making. We analysed individual-level data from nationally representative surveys conducted in low- or middle-income countries (LMICs) between 2008-2019. We describe the weighted incidence of non-fatal RTC in the past 12 months, type of road user involved, and incidence of traffic injuries requiring medical attention. Multivariable logistic regressions were done to evaluate associated sociodemographic and economic characteristics, and alcohol use. Data were included from 90,790 individuals from 15 countries or territories. The non-fatal RTC incidence in participants aged 24-65 years was 5.2% (95% CI: 4.6-5.9), with significant differences dependent on country income status. Drivers, passengers, pedestrians and cyclists composed 37.2%, 40.3%, 11.3% and 11.2% of RTCs, respectively. The distribution of road user type varied with country income status, with divers increasing and cyclists decreasing with increasing country income status. Type of road users involved in RTCs also varied by the age and sex of the person involved, with a greater proportion of males than females involved as drivers, and a reverse pattern for pedestrians. In multivariable analysis, RTC incidence was associated with younger age, male sex, being single, and having achieved higher levels of education; there was no association with alcohol use. In a sensitivity analysis including respondents aged 18-64 years, results were similar, however, there was an association of RTC incidence with alcohol use. The incidence of injuries requiring medical attention was 1.8% (1.6-2.1). In multivariable analyses, requiring medical attention was associated with younger age, male sex, and higher wealth quintile. We found remarkable heterogeneity in RTC incidence, the type of road users involved, and the requirement for medical attention after injuries depending on country income status and socio-demographic characteristics. Targeted data-informed approaches are needed to prevent and manage RTCs.

Magnitude and factors associated with motor road traffic injuries in Brazil: Results from the National Health Survey, 2019

OBJECTIVE

To estimate the magnitude and factors associated with self-reported road traffic injuries (RTI) in Brazil.

METHODS

Cross-sectional study conducted using data from individuals aged 18 years or older, participants in the 2019 National Health Survey, a population-based conducted on 88,531 adult individuals in Brazil. Three indicators were analyzed: (i) Proportion (%) of individuals aged 18 years or older who were involved in RTI in the past 12 months; (ii) Proportion (%) of car drivers who were involved in RTI in the past 12 months; and (iii), Proportion (%) of motorcycle drivers who were involved in RTI in the past 12 months. In the inferential analysis, multiple Poisson regression was used to analyze the association between demographic and socioeconomic variables and RTI, stratified for the general population, population of car and motorcycle drivers.

RESULTS

The estimated prevalence of self-reported RTI in the past 12 months was 2.4%. The South, Southeast, Northeast, Central-West, and North regions of Brazil had prevalences of 2.0%, 2.1%, 2.7%, 3.2%, and 3.4%, respectively. The results also show that most developed regions (South and Southeast) showed the lowest prevalence's, the highest frequencies were observed in those with lower socioeconomic development levels (Central-West, North, and Northeast). The prevalence was also higher in the subgroup of motorcyclists when compared to car drivers. In the general sample, the Poisson model showed an association between male sex, younger age, low level of education, residing outside capitals and metropolitan regions, in the North, Northeast and South regions and the prevalence of RTI. In car drivers, similar associations were found, except for area of residence. In motorcycle drivers, young age, low level of education, living in urban areas were associated with increased prevalence of RTI.

CONCLUSION

The prevalence of RTI is still high within the country, with disparities between regions, affecting more motorcyclists, young people, males, individuals with low education, and residents of the countryside.

Are there sex differences in crash and crash-related injury between men and women? A 13-year cohort study of young drivers in Australia

BACKGROUND

Young men have long been known to be disproportionately impacted by road crash and crash-related injury compared to young women and older drivers. However, there is limited insight into how sex differences in crash and crash-related injury changes over time as men and women get older and gain more driving experience. To explore sex differences in crash and crash-related injury, we undertook a sex disaggregated analysis in a large longitudinal cohort of over 20,000 young drivers in New South Wales, Australia, for up to 13 years after they first attained their independent car driver licence.

METHODS

DRIVE Study survey data from 2003-04 were linked with police, hospital and deaths data up to 2016. Sex differences were analysed using cumulative incidence curves investigating time to first crash and in negative binominal regression models adjusted for driver demographics and crash risk factors.

RESULTS

After adjusting for demographics and driving exposure, compared with women, men had 1.25 (95% CI 1.18-1.33), 2.07 (1.75-2.45), 1.28 (95% CI 1.13-1.46), 1.32 (95% CI 1.17-1.50) and 1.59 (95% CI 1.43-1.78) times higher rates of any crash, single vehicle crash, crash on streets with a speed limit of 80 km/h or above, crash in wet conditions and crash in the dark, respectively. By contrast, men were less likely to be involved in crashes that resulted in hospitalisation compared to women 0.73 (95% CI 0.55-0.96).

CONCLUSIONS

Young men are at increased risk of crash, and this risk persists as they get older and gain more driving experience. Despite lower risk of crash, women are at higher risk of crash related injury requiring hospitalisation. These differences in men's and women's risk of crash and injury signal the need for better understanding of how sex and/or gender may contribute to risk of crash and injury across the life-course.

Alcohol- and speeding-related fatal crashes among novice drivers age 18-20 not fully licensed at the time of the crash

INTRODUCTION

Some teens may intentionally delay their driving licensure until age 18 or later, thereby skipping the learning and driver safety benefits provided by graduated driver licensing (GDL) programs. Delaying driving initiation could elevate teen crash risk once they begin driving. This study compares the prevalence of alcohol use and speeding among individuals aged 18-20 y/o who were not fully licensed drivers (NFLD) at the time of the fatal crash with that of their fully licensed counterparts (FLD).

MATERIALS AND METHODS

Data came from the 2010-2017 Fatality Analysis Reporting System (FARS). Census data were added to measure mean household income at drivers' zip code. Bivariate (chi-square) and logistic regressions were used to assess the likelihood young drivers were alcohol-positive and/or speeding at the time of the crash as a function of drivers' license status, demographic, socioeconomic, and the strength of GDL programs in the state.

RESULTS

Compared with females and White drivers age 18-20 y/o, males, Latino, and Black drivers were more likely to be NFLD at the time of the fatal crash (p < .0001). Living in zip codes with low median household income (p < .001) and the strength of GDL restrictions (p < .0001) were associated with individuals being NFLD at the time of the fatal crash. Alcohol-related fatal crashes were more prevalent among NFLD than FLD (p < .02).

CONCLUSIONS

The study provides indirect evidence suggesting that alcohol use may be more detrimental for NFLD than for FLD.

Risk of Injury and Mortality among Driver Victims Involved in Single-Vehicle Crashes in Taiwan: Comparisons between Vehicle Types

Vehicle-type specific injury severity has rarely been investigated mainly because of a lack of such information in hospital-based studies that normally exclude those who are severely injured and die on the scene. No study has been conducted either on driver characteristics in single vehicle crashes in Taiwan according to vehicle type. This was the first population-based study aiming to describe demographic characteristics in association with vehicle-specific rates of injury and fatality among driver victims involved in single-vehicle crashes in Taiwan. We presented sex and age-specific number and proportion of driver victims according to vehicle type. We calculated sex and age-specific rates of injury and fatality. Injury and fatality rates were also graphically presented. Bicycle and motorcycle rider victims generally had higher injury rates but lower fatality rates. However, older (45+) bicycle rider victims had greater fatality risk. By contrast, truck and car driver victims were generally associated with lower injury rates but with higher fatality rates. Elderly (65+ years) truck driver victims suffered from higher rates of injury and fatality. Male victims were found to have a higher fatality rate than female victims regardless of vehicle type. The vehicle-type-specific analyses of injury and fatality are considered useful in identifying single-vehicle crash victims at greater risks of injury and fatality.

Gender differences in the effectiveness of public education messages aimed at smartphone use among young drivers

Objective: The main aim of this survey study was to evaluate the relative persuasiveness of three newly developed and piloted public education messages aimed at monitoring/reading social interactive technology on a smartphone among young male and female drivers. In accordance with the Step Approach to Message Design and Testing, the messages were evaluated on a number of outcome measures and also explored the influence of self-reported involvement in the target behavior.Methods: Participants (N = 152; 105 F) were aged 17 to 25 years (M_age = 20.14 years, SD = 2.35) and were randomly allocated to either an intervention (one of the three messages) or control (no message) condition. The messages in the intervention group were assessed on acceptance (i.e., behavioral intention and message effectiveness), rejection, and the third person effect (TPE) differential score (i.e., the message is perceived to be more effective for others than for themselves).Results: Hierarchical regression analyses found that, compared to males, females reported: a) lower intention to monitor/read social interactive technology on a smartphone while driving, b) lower rejection; and, c) lower TPE likelihood, irrespective of message.Conclusions: These findings suggest that young male drivers and young female drivers require different message content to be effective and support the importance of including multiple outcome measures to explain the messages' persuasive effects.

Sex differences in the association between impulsivity and driving under the influence of alcohol in young adults: The specific role of sensation seeking

INTRODUCTION

There is an outstanding need to identify predictors of driving under the influence of alcohol (DUI) among young adults, particularly women. Impulsivity, or the tendency to act without thinking, is a predictor of DUI, but the specific facets of impulsivity that predict DUI and their interaction with sex differences remain unclear. We aimed to investigate sex differences in the link between impulsivity facets and DUI. Moreover, we sought to replicate previous findings regarding sex differences on impulsivity, and associations between impulsivity facets and DUI.

METHOD

A total of 506 university students participated in the study (males, n = 128; females, n = 378). Participants completed measures of impulsivity (UPPS-P short version), alcohol use (AUDIT-C), frequency of DUI episodes and related perception of risk. The UPPS-P assesses five facets of impulsivity: sensation seeking, (lack of) premeditation and perseverance and positive and negative urgency.

RESULTS

Men showed higher sensation seeking and lack of perseverance, alcohol use and DUI frequency and lower risk perception than women. DUI frequency was negatively associated with perception of risk and positively associated with alcohol use and the five impulsivity facets. After controlling for alcohol use and risk perception, only lack of premeditation was associated with DUI frequency in the whole sample. Sensation seeking was positively associated with DUI frequency only in women.

DISCUSSION

The link between lack of premeditation and DUI suggest that pre-drinking planning strategies can contribute to prevent risky driving. In women, specific links between sensation seeking and DUI suggest the need for personality-tailored prevention strategies.

Effect of Road Safety Education on Road Risky Behaviors of Spanish Children and Adolescents: Findings from a National Study

Background: Road Safety Education (RSE) is widely known as a reliable determinant of the future results for what concerns health and welfare and as an undisputable factor which contributes to the social behavior of individuals and to their mid- and long-term road safety outcomes. However, its development has been relatively scarce in most countries, a fact which has contributed to letting matters as delicate as traffic crashes, largely explained by road misbehaviors, continue to be a prevalent problem, thus affecting the health of the community. Objective: The aim of this study was to describe the relationship between demographic and RSE-related variables and the self-reported road risky behavior of Spanish students. Methods: For this cross-sectional study, a representative sample of 4062 (51.5% males and 48.5% females) participants attending primary (47.5%), secondary (40.7%), and high school (11.7%) was gathered through a national survey on RSE and road behaviors. Results: A set of significant associations between demographic factors, RSE variables, and self-reported road behaviors was found. Furthermore, Structural Equation Modelling (SEM) allowed us to establish that age and observed misbehaviors (positively), and attitudes towards road safety and risk perception (negatively), have a direct link with the road risky behavior of children and young people. The knowledge of traffic rules was not a significant predictor of road behavior. Conclusions: The results of this study show that, together with demographic factors such as age, RSE-related variables have an effect on the road behavior of children and young people. They also suggest the need for strengthening actions to be implemented in road safety (Road Safety Education) at scholar and community levels.

Perceived driving safety and estimated blood alcohol concentration (BAC) the morning after drinking amongst young Australians attending a music festival: a cross-sectional survey

Background

Alcohol-related motor vehicle crashes remain a significant and costly public health issue globally. Particularly young people are over-represented in these incidents. This study set out to explore the factors that influence individuals’ perceptions of their safety to drive, and the factors related to a change in intention to drive.

Methods

Four hundred nine young people aged 18–40 attending an Australian multi-day music festival completed a survey measuring demographics, alcohol use, amount of sleep obtained the previous night, intention to drive, number of passengers, perceived safety to drive, estimated BAC (measured in g/210 L) and change in intention to drive following a BAC measurement via breathalysers. Statistical analyses involved univariate tests of association and multivariate logistic regression.

Results

Only one in five participants felt they were completely safe to drive. Males self-rated as less safe to drive than females. Multivariate analyses showed that licence class, sleep hours, units of alcohol consumed in the past 24 h and estimated BAC had statistically significant associations with driving safety perception. Participants who slept for greater than seven hours the previous night were three times more likely to feel safe to drive than those who had less than five hours of sleep (OR 3.05 (95% CI 1.25, 7.45)). Forty-one percent of participants changed their intended time of driving after having their BAC measured with a breathalyser. There was a statistically significant association between changing the intention to drive to a later time with an increase in each extra passenger in a participant’s vehicle (OR 1.53 (95% CI 1.02, 2.30)).

Conclusions

Whilst concerning behaviours relating to high-risk alcohol consumption were found, the study uncovered promising findings about young peoples’ perceptions of their safety to drive, and their propensity to change their driving intention. The strong correlation between hours of sleep, estimated BAC, units of alcohol consumed and license class with perception of driving safety suggests an increased awareness among young people and promotion of these factors may potentially improve actual driver safety. The influence of number of passengers on intention to drive later is another important consideration for future road safety research or promotion.

Evaluating the impact of an injury prevention measure regarding different sociodemographic factors

BACKGROUND

Road traffic collisions (RTC) remain a major problem especially among young road users. Injury prevention measures and licensing systems have increasingly been developed to counteract some of the negative effects of RTCs in youth. The Prevent Alcohol and Risk Related Trauma in Youth (P.A.R.T.Y.) program is an injury prevention program that promotes prevention through reality education. In this study, the impact of the program on different sociodemographic subgroups of school students was analyzed. The aim was to find out which subgroups were influenced the most and how improvements to the program can be made.

METHODS

Evaluation was performed in a pre-post-intervention setting by means of a standardized questionnaire. The questionnaire contained three different sections with a total of 22 questions to identify students' responses regarding risk-behavior and risk-assessment. Evaluation was done at two different points on the same day (pre-and post-intervention). Data were analyzed with a focus on gender, age, residential area and level of education. Cronbach's alpha was used to check all questions for reliability. Data were analyzed using the t-test and the Wilcoxon signed-rank test with significance defined as p less than 0.05.

RESULTS

The study sample contains 193 students (range 14-17 years of age, 44% male). Female students show better results regarding risk-behavior and risk-awareness. The same applies to students of a higher educational level. And students ≥ 16 years showed significantly better results in all three sections compared to younger students.

CONCLUSIONS

Morbidity and mortality due to RTCs is a major problem in the group of young road users. Especially male road users between 14 and 17 years of age with a low educational level are at high risk to sustain road traffic injuries. Our results show that the P.A.R.T.Y. program has a stronger effect on young female students. Additionally, a significant effect was measured on students ≥ 16 years of age and on students with a higher educational level. Prevention measures need to be evaluated and further improved particularly in order to address the high-risk group of young, male road users with a lower educational status.

Gender Effects in Young Road Users on Road Safety Attitudes, Behaviors and Risk Perception

In the present study, we investigated gender-related effects on road safety attitudes in 2681 young drivers (1458 males, 54.4%; aged 18-22) who filled out several scales assessing attitudes toward road safety issues, driving behavior in specific hypothetical situations, accident risk perception, and concerns about such a risk. We focused only on young drivers to better understand the role of gender in road safety attitudes in a period of life in which risky behaviors are widespread for males and females. Indeed, there is still no agreement as to the nature of these gender differences. According to some authors, the effects of gender on being involved in a crash due to driving skills are either non-existent or largely explained by differences in alcohol consumption. In our study, we found gender differences in road safety attitudes (i.e., "negative attitude toward traffic rules and risky driving"; "negative attitude toward drugs and alcohol" and "tolerance toward speeding") and in driver behavior (i.e., "errors in inattentive driving" and "driving violations"). This result is consistent in all drivers coming from nine different European countries. Our analyses yielded an important finding concerning risk perception. The results indicate that the level of risk perception during driving is the same for males and females. However, these two groups differ in the level of concern about this risk, with males being less concerned about the risk of a road accident. This suggests that the main difference between these two groups is not strictly related to judgment of the perceived risk probability but rather to the level of concern experienced about the consequences of the risk. This difference between risk perception and worry could explain differences in the frequency of car accidents in the two groups. The present findings may provide new insights for the development of gender-based prevention programs.

Temporal trends in motor vehicle fatalities in the United States, 1968 to 2010 - a joinpoint regression analysis

Background

In the past 40 years, a variety of factors might have impacted motor vehicle (MV) fatality trends in the US, including public health policies, engineering innovations, trauma care improvements, etc. These factors varied in their timing across states/localities, and many were targeted at particular population subgroups. In order to identify and quantify differential rates of change over time and differences in trend patterns between population subgroups, this study employed a novel analytic method to assess temporal trends in MV fatalities between 1968 and 2010, by age group and sex.

Methods

Cause-specific MV fatality data from traffic injuries between 1968 and 2010, based on death certificates filed in the 50 states, and DC were obtained from Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER). Long-term (1968 to 2010) and short-term (log-linear piecewise segments) trends in fatality rates were compared for males and females overall and in four separate age groups using joinpoint regression.

Results

MV fatalities declined on average by 2.4% per year in males and 2.2% per year in females between 1968 and 2010, with significant declines observed in all age groups and in both sexes. In males overall and those 25 to 64 years, sharp declines between 1968 and mid-to-late 1990s were followed by a stalling until the mid-2000s, but rates in females experienced a long-term steady decline of a lesser magnitude than males during this time. Trends in those aged <1 to 14 years and 15 to 24 years were mostly steady over time, but males had a larger decline than females in the latter age group between 1968 and the mid-2000s. In ages 65+, short-term trends were similar between sexes.

Conclusions

Despite significant long-term declines in MV fatalities, the application of Joinpoint Regression found that progress in young adult and middle-aged adult males stalled in recent decades and rates in males declined relatively more than in females in certain age groups. Future research is needed to establish the causes of these observed trends, including the potential role of contemporaneous MV-related policies and their repeal. Such research is needed in order to better inform the design and evaluation of future population interventions addressing MV fatalities nationally.

Electronic supplementary material

The online version of this article (doi:10.1186/s40621-015-0035-6) contains supplementary material, which is available to authorized users.

Risk of permanent medical impairment (RPMI) in car crashes correlated to age and gender

OBJECTIVE

As fatalities from car crashes decrease, focus on medical impairment following car crashes becomes more essential. This study assessed the risk of permanent medical impairment based on car occupant injuries. The aim was to study whether the risk of permanent medical impairment differs depending on age and gender.

METHODS

In total, 36,744 injured occupants in car crashes that occurred between 1995 and 2010 were included. All initial injuries (n = 61,440) were classified according to the Abbreviated Injury Scale (AIS) 2005. If a car occupant still had residual symptoms 3 years after a crash, the case was classed as a permanent medical impairment. In total, 5,144 injuries led to permanent medical impairment. The data were divided into different groups according to age and gender as well as levels of permanent impairment. The risk of permanent medical impairment was established for different body regions and injury severity levels, according to the AIS.

RESULTS

The cervical spine was the body region that had the highest number of diagnoses, and occupants who sustained injuries to the upper and lower extremities had the highest risk of medical impairment for both genders. Females aged 60 and above had a higher risk of permanent medical impairment from fractures in the extremities compared to males in the same age group and younger females. Females aged 44 or younger had a higher risk of permanent medical impairment from whiplash-associated disorders (WAD) than males in the same age group. Minor and moderate injuries (AIS 1-2) had a higher risk of permanent medical impairment among older car occupants compared to younger ones.

CONCLUSIONS

Differences in long-term outcome were dependent on both gender and age. Differences between age groups were generally greater than between genders. The vast majority of permanent medical impairments resulted from diagnoses with a low risk of fatality. The results emphasize the impact of age and gender in long-term consequences from car crashes. They could be used when designing safety technology in cars as well as to improve health care by contributing to better allocation of rehabilitation resources following trauma.

Profile of women detected drink driving via Roadside Breath Testing (RBT) in Queensland, Australia, between 2000 and 2011

BACKGROUND

Drink driving among women is a growing problem in many motorised countries. While research has shown that male and female drink drivers differ on a number of characteristics, few studies have addressed the circumstances surrounding women's drink driving offences specifically.

AIM

To add to previous research by comparing apprehension characteristics among men and women and to extend the understanding of the female drink driving problem by investigating the drink driving characteristics that are unique to women.

RESULTS

The sample consisted of the 248,173 (21.5% women) drink drivers apprehended between 2000 and 2011 in Queensland, Australia. Gender comparisons showed that women were older, had lower levels of reoffending, and were more likely to be apprehended in Major Cities compared to men. Comparisons of age group and reoffending and non-reoffending among female drink drivers only revealed that higher BAC readings were more common among younger women. Moreover, a substantial minority (13.7%) of women aged 24 years or younger were apprehended with a BAC below 0.05%, reflecting a breach of the zero tolerance BAC for provisional licence holders in Australia. Older women were more likely to be charged with a 'failure to provide a test' offence as a result of refusing to provide a breath or blood sample, indicating that drink driving is associated high levels of stigma for this group. Reoffending occurred among 16.2% of the female drink drivers and these drivers were more likely than non-reoffending drivers to record a mid to high range BAC, to be aged 30-39 or below 21 years, and to be apprehended in Inner Regional or Remote locations.

CONCLUSION

Findings highlight the unique circumstances and divergent needs of female drink drivers compared to male drivers and for different groups of female drivers.

Child passengers killed in reckless and alcohol-related motor vehicle crashes

INTRODUCTION

About 20years ago, concern was raised about the dangers that children face when driven by drinking drivers in the United States. During the last decade, the pace of research on this topic subsided. Yet in 2010, every day three children younger than age 15 were killed, and 469 were injured in motor-vehicle crashes.

METHOD

The aim of this effort is to describe the status of the problem in the United States and suggest lines of research. From the Fatality Analysis Reporting System (FARS), we selected crashes in which a driver aged 21 or older was driving at least one child younger than age 15. We identified crashes that occurred at different times of the day in which the driver was speeding, ran a red light, or was alcohol positive. We described the drivers' demographics and examined how they relate to the different crash types.

RESULTS

We found that, although driving a child seems to protect against the studied forms of risky driving, such protection varies sharply depending upon the drivers' and children's demographics and the crash type. There is no clear reason to explain the drivers' decision to endanger the children that they drive. The percent of children killed in speeding-related and red-light running motor-vehicle crashes has remained relatively stable during the last decade. Future research must (a) examine the effectiveness of current child endangerment laws; (b) examine crashes other than fatal; and (c) be more targeted, looking at specific drivers' age and gender, specific children's ages, the time of the crash, and the type of crash.

PRACTICAL APPLICATIONS

Significant attention needs to be given towards improving state laws on child endangerment. Policymakers' reaction to this problem is tentative because of our limited understanding of the problem; therefore, further research is needed. With unfocused countermeasures and prevention efforts, we have been restricted in our ability to evaluate these responses. The findings of this report should be informative to policy makers.