Examining racial bias as a potential factor in pedestrian crashes

The Built Environment and Pediatric Health

Buildings, parks, and roads are all elements of the "built environment," which can be described as the human-made structures that comprise the neighborhoods and communities where people live, work, learn, and recreate (https://www.epa.gov/smm/basic-information-about-built-environment). The design of communities where children and adolescents live, learn, and play has a profound impact on their health. Moreover, the policies and practices that determine community design and the built environment are a root cause of disparities in the social determinants of health that contribute to health inequity. An understanding of the links between the built environment and pediatric health will help to inform pediatricians' and other pediatric health professionals' care for patients and advocacy on their behalf. This technical report describes the range of pediatric physical and mental health conditions influenced by the built environment, as well as historical and persistent effects of the built environment on health disparities. The accompanying policy statement outlines community design solutions that can improve pediatric health and health equity, including opportunities for pediatricians and the health care sector to incorporate this knowledge in patient care, as well as to play a role in advancing a health-promoting built environment for all children and families.

Investigating the behavior of pedestrians and related factors in northern Iran in 2021

Among all road users, pedestrian behavior is most unpredictable, and our knowledge of pedestrian behavior and compliance in northern Iran is limited. The aim of the study was to determine the self-reporting behavior of pedestrians and related factors in northern Iran in 2021. This cross-sectional study's research tool included demographic characteristics, social characteristics, and a pedestrian behavior questionnaire (PBS - 43 questions). Data collection was randomly performed in 30 different passages around Rasht (a city in the north of Iran). We used the Poisson regression model and statistical software STATA version 15 for data analysis. With increasing age, pedestrians showed better crossing behavior (p < 0.001, β = 0.202), and the behavior of female pedestrians was better than that of male pedestrians (p < 0.001, β -4.79). As pedestrians, those with private jobs had worse crossing behavior than others (p < 0.045, β = 9.380), and those pedestrians who mentioned they were motorcyclists before had worse crossing behavior than others (p < 0.045, β = 9.380). The findings of this study can be used to establish pedestrian safety and preventative planning. In behavior change intervention programs, it is best to target young male pedestrians aiming to walk to their workplace, a private business. In addition, the behavior of pedestrians whose predominant means of transportation is the motorcycle must be corrected. It is necessary to conduct information campaigns and educational programs for pedestrians with common high-risk behaviors, especially errors and violations.

Pedestrian crash frequency: Unpacking the effects of contributing factors and racial disparities

In this paper, we unpack the magnitude effects of the determinants of pedestrian crashes using a multivariate analysis approach. We consider four sets of exogenous factors that characterize residential neighborhoods as well as potentially affect pedestrian crashes and the racial composition of such crashes: (1) crash risk exposure (CE) attributes, (2) cultural variables, (3) built environment (BE) features, and (4) sociodemographic (SD) factors. Our investigation uses pedestrian crash and related data from the City of Houston, Texas, which we analyze at the spatial Census Block Group (CBG) level. Our results indicate that social resistance considerations (that is, minorities resisting norms as they are perceived as being set by the majority group), density of transit stops, and road design considerations (in particular in and around areas with high land-use diversity) are the three strongest determinants of pedestrian crashes, particularly in CBGs with a majority of the resident population being Black. The findings of this study can enable policymakers and planners to develop more effective countermeasures and interventions to contain the growing number of pedestrian crashes in recent years, as well as racial disparities in pedestrian crashes. Importantly, transportation safety engineers need to work with social scientists and engage with community leaders to build trust before leaping into implementing planning countermeasures and interventions. Issues of social resistance, in particular, need to be kept in mind.

Hazards of Anti-Blackness in the United States

On February 26, 2012, a Black child, Trayvon Martin, was executed in Sanford, Florida. Seventeen months later his killer was found not guilty. This is but one example of the state's brazen disregard for Black life, rooted in the kidnapping and enslavement of Africans more than 400 years ago, and the ways in which they and their descendants were systematically tortured. Trayvon Martin's murder catalyzed the Black Lives Matter (BLM) movement, which names and resists deeply entrenched state violence and inequities against Black people in the U.S. In this manuscript we: (1) summarize examples of structural disregard for Black lives in the U.S.; (2) describe how this disregard is reflected in differential patterns of social inequities, morbidity, and mortality; and (3) discuss how we can better employ the BLM perspective to frame a more historicized understanding of patterns in population health and to envision ways to resist health inequities.

The 2019 Conference on Health and Active Transportation: Research Needs and Opportunities

Active transportation (AT) is widely viewed as an important target for increasing participation in aerobic physical activity and improving health, while simultaneously addressing pollution and climate change through reductions in motor vehicular emissions. In recent years, progress in increasing AT has stalled in some countries and, furthermore, the coronavirus (COVID-19) pandemic has created new AT opportunities while also exposing the barriers and health inequities related to AT for some populations. This paper describes the results of the December 2019 Conference on Health and Active Transportation (CHAT) which brought together leaders from the transportation and health disciplines. Attendees charted a course for the future around three themes: Reflecting on Innovative Practices, Building Strategic Institutional Relationships, and Identifying Research Needs and Opportunities. This paper focuses on conclusions of the Research Needs and Opportunities theme. We present a conceptual model derived from the conference sessions that considers how economic and systems analysis, evaluation of emerging technologies and policies, efforts to address inclusivity, disparities and equity along with renewed attention to messaging and communication could contribute to overcoming barriers to development and use of AT infrastructure. Specific research gaps concerning these themes are presented. We further discuss the relevance of these themes considering the pandemic. Renewed efforts at research, dissemination and implementation are needed to achieve the potential health and environmental benefits of AT and to preserve positive changes associated with the pandemic while mitigating negative ones.

A joint probability model for pedestrian crashes at macroscopic level: Roles of environment, traffic, and population characteristics

Road safety is a major public health issue, with road crashes accounting for one-fourth of all documented injuries. In these crashes, pedestrians are more vulnerable to fatal and/or severe injuries than car occupants. Therefore, it is necessary to have a better understanding of the relationship between pedestrian crashes and possible influencing factors, including road environment, traffic conditions, and population characteristics. In conventional studies, separate prediction models were established for pedestrian crashes and other crash types, which could have ignored possible correlations among the different crash types. Additionally, these influencing factors can contribute to pedestrian crashes in two manners, i.e., contributing to crash occurrence and propensity of pedestrian involvement. Furthermore, extensive pedestrian count data were generally not available, affecting the estimation of pedestrian crash exposure. In this study, a joint probability model is adopted for the simultaneous modeling of crash occurrence and pedestrian involvement in crashes; effects of possible influencing factors, including land use, road networks, traffic flow, population demographics and socioeconomics, public transport facilities, and trip attraction attributes, are considered. Additionally, trip generation and pedestrian activity data, based on a comprehensive household travel survey, are used to determine pedestrian crash exposure. Markov chain Monte Carlo full Bayesian approach is then applied to estimate the parameters. Results indicate that crash occurrence is correlated to traffic flow, number of non-signalized intersections, and points of interest such as restaurants and hotels. By contrast, population age, ethnicity, education, household size, road density, and number of public transit stations could affect the propensity of pedestrian involvement in crashes. These findings indicate that better design and planning of built environments are necessary for safe and efficient access for pedestrians and for the long-term improvement of walkability in a high-density city such as Hong Kong.

Racial disparities in pedestrian-related injury hospitalizations in the United States

BACKGROUND

Racial/ethnic disparity has been documented in a wide variety of health outcomes, and environmental components are contributors. For example, food deserts have been tied to obesity rates. Pedestrian injuries are strongly tied to environmental factors, yet no studies have examined racial disparity in pedestrian injury rates. We examine a nationally-representative sample of pedestrian-related hospitalizations in the United States to identify differences in incidence, severity, and cost by race/ethnicity.

METHODS

Patients with ICD diagnosis E-codes for pedestrian injuries were drawn from the United States Nationwide Inpatient Sample (2009-2016). Rates were calculated using the United States Census. Descriptive statistics and generalized linear regression were used to examine characteristics (age, sex, severity of illness, mortality rates, hospital admissions, length of stay, total costs) associated with hospitalizations for pedestrian injuries.

RESULTS

The annual average of pedestrian-related deaths exceeded 5000 per year and hospitalizations exceeded 47,000 admissions per year. The burden of injury from pedestrian-related hospitalizations was higher among Black, Hispanic, and Multiracial/Other groups in terms of admission rates, costs per capita, proportion of children injured, and length of stay compared to Whites and Asian or Pacific Islander race/ethnicities. Compared to Whites, hospital admission rates were 1.92 (95% CI: 1.89-1.94) and 1.20 (95% CI: 1.19-1.21) times higher for Multiracial/Other and Blacks, respectively. Costs per capita ($USD) were $6.30, $4.14, and $3.22 for Multiracial/Others, Blacks, and Hispanics, compared to $2.88 and $2.32 for Whites and Asian or Pacific Islanders. Proportion of lengths of stay exceeding one week were larger for Blacks (26.4%), Hispanics (22.6%), Asian or Pacific Islanders (23.1%), and Multiracial/Other (24.1%), compared to Whites (18.6%). Extreme and major loss of function proportions were also highest among Black (34.5%) and lowest among Whites (30.2%).

CONCLUSIONS

Results from this study show racial disparities in pedestrian injury hospitalization rates and outcomes, particularly among Black, Hispanic, and Multiracial/Other race/ethnicity groups and support population and system-level approaches to prevention. Access to transportation is an indicator for health disparity, and these results indicate that access to safe transportation also shows inequity by race/ethnicity.

Pediatric Pedestrian Facial Fracture Patterns and Management Following Motor Vehicle Collisions

PURPOSE

Pedestrian trauma due to motor vehicle crashes can be especially destructive to the pediatric population as the facial skeleton is immature and developing. Almost half of crashes resulting in pedestrian death involved alcohol consumption, and children are often victims of irresponsible driving. The objective of this study was to examine the prevalence of facial fractures in this patient population in order to analyze management strategies that optimize functional recovery.

METHODS

A retrospective chart review was performed for all facial fractures resulting from motor vehicle collisions with pedestrians in the pediatric population at a level 1 trauma center in an urban environment (University Hospital in Newark, NJ). Patient demographics were collected, as well as location of fractures, concomitant injuries, and surgical management strategies.

RESULTS

During the time period examined, 55 patients were identified as 18 years of age or younger and having sustained a facial fracture as the result of being struck by a motor vehicle. The mean age was 11.3 (range 1-18) years, with a male predominance of 69.0%. There were a total of 125 fractures identified on radiologic imaging via CT or X-ray. The most common fractures were those of the orbit (20.0%), mandible (19.2%), and nasal bone (10.4%). The mean Glasgow Coma Scale on arrival was 12.1 (range 4-15). Fifteen patients were intubated on, or prior to, arrival to the trauma bay. The most common concomitant injuries were intracranial hemorrhage, long bone fractures, and cervical spine fractures. The mean operative time was 216.9 (range 63-515) minutes. Surgery was required in 36 patients, with most undergoing open reduction and internal fixation with titanium plates and screws. Two patients required resorbable plates, and one required Medpor implants. The mean hospital length of stay was 9.9 (range 1-59) days. Two patients expired.

CONCLUSIONS

There is currently a dearth of literature regarding the management and patterns of injury for pediatric pedestrian injuries due to motor vehicle collisions. The impact of these injuries can be devastating with concomitant life-threatening complications, and may influence the future development of the facial skeleton after healing of the bone and soft tissue. The authors hope this study can provide insight and further investigation regarding prevention and management.

Estimated car cost as a predictor of driver yielding behaviors for pedestrians

INTRODUCTION

Pedestrian crashes are not equitably distributed; people of color and males are overburdened. The aim of this study was to examine if driver yielding behavior differed based on gender and skin color of the pedestrian, and the estimated car cost at two midblock crosswalks in the Las Vegas metropolitan area.

METHODS

One white and one black female and one white and one black male crossed the intersection in a similar, prescribed manner. Crossings were video recorded. Driver yielding behavior was documented. The cost of car was estimated by cross referencing manufacturing websites and averaging the high and low values of estimated private sale. Generalized linear mixed model was applied, nesting within crossing attempt and within streets.

RESULTS

Of 461 cars, 27.98% yielded to pedestrians. Cars yielded more frequently for females (31.33%) and whites (31.17%) compared to males (24.06%) and non-whites (24.78%). Cost of car was a significant predictor of driver yielding (OR = 0.97; p = 0.0307); odds of yielding decreased 3% per $1000 increase.

DISCUSSION

Driver yielding differed by cost of cars. Given previous findings, future research is needed to further examine gender and racial disparities in pedestrian crashes. Findings are significant for public health and pedestrian safety, especially given the upward trend in crash rates.

Crash risk, crash exposure, and the built environment: A conceptual review

This paper reviews the literature on the relationship between the built environment and roadway safety, with a focus on studies that analyse small geographical units, such as census tracts or travel analysis zones. We review different types of built environment measures to analyse if there are consistent relationships between such measures and crash frequency, finding that for many built environment variables there are mixed or contradictory correlations. We turn to the treatment of exposure, because built environment measures are often used, either explicitly or implicitly, as measures of exposure. We find that because exposure is often not adequately controlled for, correlations between built environment features and crash rates could be due to either higher levels of exposure or higher rates of crash risk per unit of exposure. Then, we identify various built environment variables as either more related to exposure, more related to risk, or ambiguous, and recommend further targeted research on those variables whose relationship is currently ambiguous.

The epidemiology of pedestrian fatalities and substance use in Georgia, United States, 2007-2016

Though U.S. motor vehicle crashes as a whole have decreased over the past few years, fatalities among vulnerable road users have increased. Pedestrian deaths rose nationally by 27% between 2007 and 2016 accounting for 16% of all motor vehicle fatalities. This increase continues to burden transportation specialists, public health professionals, and community stakeholders. Potential risk factors include characteristics of the built environment, distractions, and pedestrians' use of alcohol and drugs. Pedestrian deaths in Georgia, United States, increased 40% between 2014 and 2016 while drug overdose deaths have increased by 18% during the same period. Concurrent increases in mortality due to pedestrian fatalities and drug overdoses make Georgia a natural environment in which to describe the proximity of drugs among pedestrian fatalities, a topic largely overlooked by the literature. This study explores the epidemiology of pedestrian fatalities in Georgia over a 10-year period with an emphasis on reported substance use among cases. The study employed 10-year data from the Fatality Analysis Reporting System (FARS) administered by the National Highway Traffic Safety Administration. Descriptive methods were used to explore drug screens by person, place, and time. We also examined trends in total drug screens over the examination period. Between 2007 and 2016, 1781 pedestrian crashes were reported to FARS; the fatality rate for this period was 94.5%. Of these, most were male with Blacks and Whites equally represented. Ages 15-64 accounted for 81.1% of cases with most occurring in the Atlanta Metropolitan area. When adjusted for population, one finds higher rates in more rural areas of the state. Data revealed that testing for the presence of drugs occurred among half of reported cases. Of those testing positive, five drug categories emerged; stimulants (45.8%), cannabinoids (21.5%), narcotics (including opioids) (14.1%), depressants (12.1%), and "Other Drugs" (6.3%). Positive drug screens across all drug classifications increased by 178.1% between 2007 and 2016. These findings suggest the need for state-wide policies designed to promote more consistent screening among pedestrians involved in motor vehicle crashes as well as diligence in understanding the role played by drugs among this population. Additional investigation should be conducted to tease out the presence of category-specific drugs among pedestrians. Understanding the epidemiology of pedestrian fatalities in the state, especially in relation to substance use, serves as a first step toward implementing localized preventive efforts.

The Impact of Pedestrian Crossing Flags on Driver Yielding Behavior in Las Vegas, NV

Walking is the most affordable, accessible, and environmentally friendly method of transportation. However, the risk of pedestrian injury or death from motor vehicle crashes is significant, particularly in sprawling metropolitan areas. The purpose of this study was to examine the effect of pedestrian crossing flags (PCFs) on driver yielding behaviors. Participants crossed a marked, midblock crosswalk on a multilane road in Las Vegas, Nevada, with and without PCFs, to determine if there were differences in driver yielding behaviors (n = 160 crossings). Trained observers recorded (1) the number of vehicles that passed in the nearest lane without yielding while the pedestrian waited at the curb and (2) the number of vehicles that passed through the crosswalk while the pedestrian was in the same half of the roadway. ANOVA revealed that drivers were significantly less likely to pass through the crosswalk with the pedestrian in the roadway when they were carrying a PCF (M = 0.20; M = 0.06); drivers were more likely to yield to the pedestrian waiting to enter the roadway when they were carrying a PCF (M = 1.38; M = 0.95). Pedestrian crossing flags are a low-tech, low-cost intervention that may improve pedestrian safety at marked mid-block crosswalks. Future research should examine driver fade-out effects and more advanced pedestrian safety alternatives.

Epidemiology of alcohol and drug screening among pedestrian fatalities in the United States, 2014-2016

Objective: U.S. pedestrian fatalities increased by 25% between 2010 and 2015. Risk factors include distractions, the built environment, urbanization, economic variables, and weather conditions. Of interest is the role of alcohol and drugs in premature death among pedestrians. This study sought to explore the prevalence of substance use screenings among pedestrian fatalities in the United States between 2014 and 2016. Methods: Data were collected from the Fatality Analysis Reporting System provided by the NHTSA. Pedestrian crash variables included demographics as well as information regarding alcohol or drug testing status. Frequency and cross-tabulation tables were constructed to assess the prevalence of screening by person, place, and time. Log-linear analyses were completed to explore age, race, and sex differences. A 3-year examination period was used to control for yearly fluctuations and to incorporate an increasing trend in cases. Results: Pedestrian fatalities accounted for 84% of all deaths among vulnerable road users during the examination period. Those most at risk were white males between the ages of 45 and 64. Over all states, 74.7% of fatalities were tested for alcohol and 67.1% were tested for drugs; further, 66.5% of cases were tested for both alcohol and drugs and 24.8% were tested for neither substance. Cases screened for both alcohol and drugs ranged from 2.9% in North Carolina to 95.7% in Nevada and those testing for neither substance ranged from a high of 68.9% in Indiana to a low of 1.1% in Maryland. Log-linear regression revealed significant differences in alcohol screening by age and race but not by sex. Differences in drug screening were not identified for any demographic variable. Fatalities tested for alcohol were significantly more likely to be tested for drugs; only 8.2% were screened solely for alcohol and 0.05% were screened for drugs alone. Conclusions: Preventive strategies become more important as pedestrian crashes and fatalities increase. Risk reduction in the form of policy change, alterations to the built environment, or interdisciplinary approaches to injury prevention is dependent upon best evidence supported in part by more deliberate and consistent screening.

Exploring the factors contribute to the injury severities of vulnerable roadway user involved crashes

The vehicle to pedestrian (V2P) applications will enable safety, mobility, and environmental advancements for the vulnerable roadway user (VRU) that current technologies are unable to provide. The present research aims to explore the use of random parameters in logit models to examine factors that significantly influence injury severity of VRU involved crashes. Two types of logit models, the mixed generalized ordered logit (MGOL) models and mixed logit models are proposed to provide insights on reducing injury severities of pedestrian and bicyclist involved crashes and benefit amending current V2P applications to address the special safety needs and challenges of these VRUs. Based on 9180 pedestrian involved crashes and 1402 bicyclist involved crashes from the Fatality Analysis Reporting System (FARS), the measure of injury severities - time-to-death is considered as the independent variables to capture a more comprehensive picture of events after a crash occurs. By comparing to the ordered logit models and the multinomial logit models, the effectiveness and appropriateness of the proposed models are verified through two perspectives - goodness of fit and predictive power. The modelling results show that the injury severity of VRU involved crashes is significantly associated with involved non-motorist characteristics (age and police reported alcohol involvement), involved motorist characteristics (drunk drivers, previous recorded crashes, number of occupants), involved vehicle characteristics (vehicle body type, vehicle model year, travel speed), roadway characteristics (interstate, junction, roadway profile), and environmental characteristics (light and weather condition). Among these significant factors, the number of occupants, vehicle body type, interstate, and junction result in random parameters, which capture and reflect the unobserved heterogeneity across sampled observations. The analyses of under-researched aspects of VRU involved crashes, that is time-to-death, help us develop a deeper understanding of the consequences of injury and ultimately health and social costs. The findings indicate that the proposed MGOL models and mixed logit models can account for the heterogeneity issues in crash data due to the unobserved factors. In addition, the injury severity models that incorporate the random parameter features can reveal new insights and have superior goodness of fit.

Between Privilege and Oppression: An Intersectional Analysis of Active Transportation Experiences Among Washington D.C. Area Youth

The use of active transportation (AT), such as walking, cycling, or even public transit, as a means of transport offers an opportunity to increase youth physical activity and improve health. Despite the well-known benefits of AT, there are environmental and social variables that converge on the AT experiences of low-income youth and youth of color (YOC) that have yet to be fully uncovered. This study uses an intersectional framework, largely focusing on the race-gender-class trinity, to examine youth AT within a context of transportation inequity. Theoretically guided by the Ecological Model of Active Transportation, focus groups were completed with two groups of girls (15 participants) and two groups of boys (nine participants) ranging between the ages of 12–15 years who lived within the Washington D.C. area. This research found race, gender, and class to be inhibitors of AT for both boys and girls, but with more pronounced negative influences on girls.

Reducing traffic violations in minority localities: Designing a traffic enforcement program through a public participation process

The current study tests an innovative public participation process for designing and implementing a tailored traffic enforcement program in minority localities. The quasi-experiment used two matched pairs of randomly selected Israeli Arab localities, where one locality in each pair was randomly assigned to the experimental group and the other to the control group. The intervention's main features were the public participation process and implementation by police of the traffic enforcement program designed during the process. Systematic field observations on 12,236 vehicles in the four localities found a meaningful and significant reduction in traffic violations in the experimental localities following the intervention, while a small increase in violations was observed in the control localities. The most meaningful decline, indicating improvement in drivers' behavior, was in non-use of seatbelts and small children in the front seat. The study suggests that a public participation process which identifies local road traffic problems and "dark" hot spots (places where offenses and risky behavior recur but might not be known to the police), followed by implementing tailored solutions for these problems, can reduce traffic violations. Future research should aim to separate out the independent effects of the two phases (the public participation process and tailored enforcement).

Experiences of Discrimination Are Associated With Greater Resting Amygdala Activity and Functional Connectivity

BACKGROUND

Social discrimination, a type of psychological stressor, is associated with poorer physical and mental health outcomes, yet we have little understanding of how discrimination affects neural functions in marginalized populations. By contrast, the effects of psychological stress on neural functions are well documented, with evidence of significant effects on the amygdala-a neural region that is central to psychosocial functions. Accordingly, we conducted an examination of the relation between self-reported discrimination exposure and amygdala activity in a diverse sample of adults.

METHODS

Seventy-four adults (43% women; 72% African American; 23% Hispanic; 32% homosexual/bisexual) completed self-report ratings of discrimination exposure. Spontaneous amygdala activity and functional connectivity were assessed during resting-state functional magnetic resonance imaging.

RESULTS

Greater discrimination exposure was associated with higher levels of spontaneous amygdala activity. Increases in discrimination were also associated with stronger functional connectivity between the amygdala and several neural regions (e.g., anterior insula, putamen, caudate, anterior cingulate, medial frontal gyrus), with the most robust effects observed in the thalamus. These effects were independent of several demographic (e.g., race, ethnicity, sex) and psychological (e.g., current stress, depression, anxiety) factors.

CONCLUSIONS

Collectively, our findings provide the first evidence that social discrimination is independently associated with elevations in intrinsic amygdala activity and functional connectivity, thus revealing clear parallels between the neural substrates of discrimination and psychological stressors of other origins. Such results should spur future investigations of amygdala-based networks as potential etiological factors linking discrimination exposure to adverse physical and mental health outcomes.

Neighborhood Influences on Vehicle-Pedestrian Crash Severity

Socioeconomic factors are known to be contributing factors for vehicle-pedestrian crashes. Although several studies have examined the socioeconomic factors related to the location of the crashes, limited studies have considered the socioeconomic factors of the neighborhood where the road users live in vehicle-pedestrian crash modelling. This research aims to identify the socioeconomic factors related to both the neighborhoods where the road users live and where crashes occur that have an influence on vehicle-pedestrian crash severity. Data on vehicle-pedestrian crashes that occurred at mid-blocks in Melbourne, Australia, was analyzed. Neighborhood factors associated with road users' residents and location of crash were investigated using boosted regression tree (BRT). Furthermore, partial dependence plots were applied to illustrate the interactions between these factors. We found that socioeconomic factors accounted for 60% of the 20 top contributing factors to vehicle-pedestrian crashes. This research reveals that socioeconomic factors of the neighborhoods where the road users live and where the crashes occur are important in determining the severity of the crashes, with the former having a greater influence. Hence, road safety countermeasures, especially those focussing on the road users, should be targeted at these high-risk neighborhoods.