A longitudinal study of risk factors for motorcycle crashes among junior college students in Taiwan

A comparison of heat effects on road injury frequency between active travelers and motorized transportation users in six tropical and subtropical cities in Taiwan

Road traffic injuries (RTIs) pose significant public health threats, particularly for vulnerable road users such as pedestrians and cyclists. While recent studies have revealed adverse impacts of heat exposure on RTI frequency among motorized road users, a research gap persists in understanding these impacts on non-motorized road users, especially in tropical regions where their vulnerability can be heightened due to differential thermal exposure, adaptive capacity, and biological sensitivity. In this study, we compared associations between high temperatures and RTIs across four different crash-involved modes of transportation-pedestrians, cyclists, motorcyclists, and car drivers in Taiwan. Leveraging data on RTI records and temperature conditions in Taiwan's six municipalities from 2018 to 2022, we conducted a city-time-stratified case-crossover analysis. We employed distributed lag non-linear models with conditional Poisson regression models to estimate temperature-RTI associations for each mode of transportation, adjusting for various weather factors and unmeasured spatio-temporal patterns. Our findings reveal that individuals using exposed, open transportation modes (i.e., pedestrians, cyclists, and motorcyclists) exhibited higher relative risks of heat-induced RTIs than car drivers, with non-motorized mode users showing greater susceptibility compared to their motorized counterparts. These elevated risks can be attributed to the absence of built-in cooling systems in open travel modes and the increased exertional heat stress implied in active travel. Our study contributes novel insights to a global concern related to climate change, extending its impact to road safety, a health outcome rarely studied in the context of a changing climate. Our findings are thus important, especially for regions where rising temperatures regularly approach or exceed human physiological limits related to heat tolerance in the coming decades. Additionally, our findings hold significance in the existing urban health literature, particularly within the context of the emerging era of micromobility-a category of low-speed, non-enclosed, and lightweight vehicles increasingly integrated into urban activities worldwide.

High-power motorcycle accidents in Spain: a descriptive study

PURPOSE

In modern societies, motorcycle accidents have become a great problem for health systems worldwide. In Spain, the size and the power of the engine of 2-wheel vehicles determine the type of driving license and the age at which these vehicles can be used (mopeds and motorcycles, which at the same time can have a small or large engine capacity). The objective of the present study was to analyze and characterize low- and high-power motorcycle accidents in Spain, between 2014 and 2020, both included and compared these categories with each other.

METHODS

Retrospective, descriptive, and observational study of motorcycle and moped accidents in Spain between 2014 and 2020, both included.

RESULTS

The mortality of motorcycle accident riders in Spain is associated with males aged between 30 and 40 years old, with a high-power motorcycle, and an A or A1 driver's license, who is 6.7 times more likely to die in crossings and highways than a moped, while wearing a helmet, and if not, this increases to 4.89 times. During the COVID-19 pandemic, an increase in death at 24 h after a high-power motorcycle accident was observed, as compared with a large reduction in the total medical assistance provided in 2019-2020.

CONCLUSIONS

High-power motorcycles had higher scores in mortality and morbity rates than low-power ones, with a significant increase in mortality during the pandemic, even though number of accidents and medical assistance provided were drastically reduced.

Exploring the spatial relationship of e-bike and motorcycle crashes: Implications for risk reduction

INTRODUCTION

Electric bicycles, or e-bikes, have become very popular over the past decade. In order to reduce the risk of crashes, it is necessary to understand the contributing factors. While several researchers have examined these elements, few have considered the spatial heterogeneity between crashes and environmental variables, such as Points of Interest (POI). In addition, there is a scarcity of studies comparing the crash-related factors of e-bikes and motorcycles. Despite their differing speed and range capabilities, different POIs also tend to impact area/bandwidths differently because e-bikes cannot cover the same range that motorcycles can.

METHOD

In this study, we compared e-bike and motorcycle crashes at 11 different types of POIs in Taipei from 2016 to 2020. Since crashes are sparse events and easily affected by the Modifiable Areal Unit Problem (MAUP), Kernel Density Estimation (KDE) was employed to transform crash points (count data) to crash risk surfaces (continuous data). Additionally, an advanced variant of Geographical Weighted Regression (GWR), Multiscale Geographically Weighted Regression (MGWR) utilized to predict crash risk because each predictor is allowed to have a different bandwidth.

RESULTS

The results showed: (a) For e-bike crashes, the MGWR model outperformed the GWR and OLS models in terms of AIC values, while the MGWR and GWR performed similarly with regard to motorcycle crashes; (b) The analysis revealed e-bike and motorcycle crash risk to be associated with various types of POIs. E-bike crashes tended to occur more frequently in areas with more schools, supermarkets, intersections, and elderly people. Meanwhile, motorcycle crashes were more likely to occur in areas with a high number of restaurants and intersections. The search bandwidths of e-bikes are inconsistent and narrower than those of motorcycles.

Effects of risky bus driving behaviors on motorcyclists' and car drivers' traffic safety perceptions in mixed traffic flow

OBJECTIVE

This study investigates traffic safety perceptions of motorcyclists and car drivers toward risky bus driving behaviors (RBDBs) in mixed traffic flow (MTF).

METHODS

The study identified 10 RBDBs and employed images in a unique questionnaire survey. Further, permutation tests were employed to compare perceptions of motorcyclists in scenarios involving bus-motorcycle-car flow and bus-motorcycle flow and to compare their perceptions to those of car drivers'. Moreover, heteroskedastic generalized ordered logit regression models were utilized to predict traffic safety perceptions of motorcyclists and car drivers toward RBDBs.

RESULTS

High-speed bus driving is perceived as the most dangerous situation, while continuous flashing of lights at vehicles in front is perceived as the least dangerous. The permutation test revealed that motorcyclists tend to perceive RBDBs as less dangerous in bus-motorcycle flow than in mixed flow with cars, while car drivers consider them safer than motorcyclists. The regression model revealed that among the RBDBs, bus moving at high speeds, abruptly overtaking, abruptly changing lanes, and suddenly pulling over at bus stops are perceived as the most dangerous by motorcyclists and car drivers. The study also discusses the relationships between the socio-demographic characteristics of motorcyclists/car drivers and their safety perception toward RBDBs.

CONCLUSIONS

These findings could inform the development of interventions to reduce RBDBs and improve traffic safety for motorcyclists and car drivers.

Environmental Factors Associated with Severe Motorcycle Crash Injury in University Neighborhoods: A Multicenter Study in Taiwan

University neighborhoods in Taiwan have high-volume traffic, which may increase motorcyclists' risk of injury. However, few studies have analyzed the environmental factors affecting motorcycle crash injury severity in university neighborhoods. In this multicenter cross-sectional study, we explored the factors that increase the severity of such injuries, especially among young adults. We retrospectively connected hospital data to the Police Traffic Accident Dataset. Areas within 500 m of a university were considered university neighborhoods. We analyzed 4751 patients, including 513 with severe injury (injury severity score ≥ 8). Multivariate analysis revealed that female sex, age ≥ 45 years, drunk driving, early morning driving, flashing signals, and single-motorcycle crashes were risk factors for severe injury. Among patients aged 18-24 years, female sex, late-night and afternoon driving, and flashing signals were risk factors. Adverse weather did not increase the risk. Time to hospital was a protective factor, reflecting the effectiveness of urban emergency medical services. Lifestyle habits among young adults, such as drunk driving incidents and afternoon and late-night driving, were also explored. We discovered that understanding chaotic traffic in the early morning, flashing signals at the intersections, and roadside obstacles is key for mitigating injury severity from motorcycle crashes in university neighborhoods.

Investigating the Difference in Factors Contributing to the Likelihood of Motorcyclist Fatalities in Single Motorcycle and Multiple Vehicle Crashes

In order to better understand the factors affecting the likelihood of motorcyclists' fatal injuries, motorcycle-involved crashes were investigated based on the involvement of the following vehicles: single motorcycle (SM), multiple motorcycles (MM) and motorcycle versus vehicle (MV) crashes.

METHOD

Binary logit and mixed logit models that consider the heterogeneity of parameters were applied to identify the critical factors that increase the likelihood of motorcyclist fatality.

RESULTS

Mixed logit models were found to have better fitting performances. Factors that increase the likelihood of motorcyclist fatality include lanes separated by traffic islands, male motorcyclists, and riding with BAC values of less than the legally limited value. Collisions with trees or utility poles lead to the highest likelihood of fatality in SM crashes. The effects of curved roads, same-direction swipe crashes, youth, and unlicensed motorcyclists are only significant in the likelihood of fatality in SM crashes.

CONCLUSIONS

Motorcyclists tend to be killed if they collide with large engine-size motorcycles and vehicles, unlicensed motorcyclists, or drivers with speeding related or right-of-way violations with positive BAC values. Driving or riding should be prohibited for any amount of alcohol or for anyone with a positive BAC value. Law enforcement should focus on unlicensed, speeding motorcyclists and drivers, and those who violate the right of way or perform improper turns. Roadside objects and facilities should be checked for appropriate placement and be equipped with reflective devices or injury protection facilities.

Study on Instant Delivery Service Riders' Safety and Health by the Effects of Labour Intensity in China: A Mediation Analysis

The Instant Delivery Service (IDS) riders' overwork by “self-pressurisation” will not only reduce the level of their physical and mental health but also lose their lives in safety accidents caused by their fatigue riding. The purpose of this article is to examine whether there is overwork among IDS riders in big and medium cities in China? What's going on with them? Based on the Cobb-Douglas production function in the input-output theory, this study characterised the factors on IDS riders' safety and health associated with labour intensity. A mediating model with moderating effect was adopted to describe the mediation path for the 2,742 IDS riders who were surveyed. The results of moderating regression demonstrated that (1) 0.4655 is the total effect of labour intensity on the safety and health of IDS riders. (2) 0.3124 is the moderating effect that working hours make a greater impact on labour intensity. (3) The mediating effect of work pressure is the principal means of mediation both upstream and downstream.

An application of in-vehicle recording technologies to analyze injury severity in crashes between taxis and two-wheelers

Conventionally, the crash data used in traffic safety analysis have been collected by the police dispatched to the crash scene. Therefore, crash information inevitably includes errors that influence traffic safety analysis. Such errors can include the crash speed, crash time, crash location, and other crash characteristics. The advances in in-vehicle video recording (IVVR) technologies have recently enabled traffic safety professionals to use more accurate crash information based on crash data reconstruction methods. Although a few studies have been conducted to identify the factors affecting the crash injury severity using such detailed crash data, there was no effort to analyze the factors affecting the injury severity in crashes between taxis and two-wheelers (TWs), including bicycles and motorcycles. Therefore, this study analyzes the injury severity of TW riders in taxi-TW crashes with the accurate crash data collected by taxis equipped with IVVR devices in Incheon, Korea. Two hundred and forty-eight crash data from two years (2010-2011) were used to perform this objective. The factors affecting the injury severity to TW riders were identified based on a partial proportional odds model for these data. Seven variables were found to affect the injury severity significantly: crash speed, second collision, third collision, Delta-V, crashes that occurred with a non-helmeted motorcycle rider, crashes where the collision type was sideswipe, and crashes under rainy or snowy weather conditions. On the other hand, two variables regarding crashes, where the taxi driver behavior helped reduce visible and severe injuries, were changing lanes and the young TW riders (<18 years).

An analysis of the novice motorcyclist crashes in Taiwan

OBJECTIVE

Motorcycles comprised over 60% of motor vehicles in Taiwan. There were still many motorcycle crashes in Taiwan, especially among young riders. This study investigated the characteristics of novice motorcyclist crashes in Taiwan over the period January 2011 to December 2016. Various risk factors affecting the severity of novice motorcyclist crashes, such as the rider characteristics, licensing conditions, and the environment, were examined.

METHODS

To model the count data with multiple crash severities, several regression models were considered. The multinomial logit (MNL) model, ordered logit (OL) model, and partial proportional odds (PPO) model were chosen and investigated for the relationships between the severity of novice motorcyclist crashes and potential risk factors.

RESULTS

The results showed that the novice rider who was underage or unlicensed had a higher probability of a fatal crash. Male sex, helmet use, drinking, college student, frontal impact, urban or dry road, and daytime all played significant roles in novice motorcyclist crashes.

CONCLUSIONS

Taiwan traffic safety needs further policy adjustments and public education toward novice motorcycle crashes. Adequate driving training and providing a user-friendly environment for novice riders could help. Taiwan should consider graduated driver licensing systems for skill-building and riding supervision for new motorcyclists.

Investigation of factors contributing to injury severity in single vehicle motorcycle crashes in India

Single-vehicle crashes are of major concern in both developed as well as in Low Middle Income Countries due to the severity of injuries, particularly fatal accidents. In India, a significant proportion of crashes are single-vehicle crashes. The vehicles which are involved in accidents due to causes such as self skidding, hitting stationary objects, trees that are simply contributed by the drivers themselves are referred to as out-of-control single-vehicle crashes. The main objective of this study is to evaluate the risk factors associated with single-vehicle motorcycle collisions in Tamilnadu, India and identifies the unique characteristics and injury outcomes associated with these collisions. Crash dataset for the present study was prepared from the police-reported crashes for the past nine years that occurred within the state of Tamilnadu between 2009 and 2017. The identified contributory factors which influence injury severity include driver characteristics, crash-related factors, traffic-related factors, vehicle and environment-related factors. In this study, injury severity is classified into three categories, i.e. fatal, serious, and minor injuries. Since the outcome of the injury severity could be measured on an ordinal scale, a discrete ordered outcome model, an ordered logit model is applied. To summarise the results, thirteen of the studied factors are found to have a significant influence on the injury severity of drivers. Results show that the likelihood of fatal injuries increases in crashes where motorcyclists hit stationary fixed objects, hit trees, ran-off road, inclement weather conditions, urban areas. It is also found that winter season, north districts of Tamilnadu, single and two-lane roads, highways, village roads and, other district roads, daylight conditions, drivers who are younger and working-age group, overtaking from left, taking u-turn are associated with less likelihood of fatal crashes. To increase the overall safety of the roads, targeted countermeasures may be designed in light of injury severity of the drivers with respect to single-vehicle crashes also. This study provides useful insights for reducing injury severity in single-vehicle motorcycle crashes.

Risk Factors, Pattern and Outcome of Motorcycle-associated Head Injury in Sokoto: An Analysis of 184 Cases

Background Road traffic accident (RTA) is the eighth leading cause of death worldwide. Motorcycle-associated head injury is the leading cause of road traffic associated morbidity and mortality in developing countries. Even though the incidence and mortality of head injury from motor cycle crash is on the increase in developing countries, especially in the African continent, most of the studies published in the literature on this subject matter took place in the developed Western countries.

Materials and Methods This was a retrospective cross-sectional study of data from patients managed in our institution between December 2014 and November 2016.

Results One hundred and eighty-four patients were analyzed. None of the patients used safety helmet for protection. The mean age was 27.6 ± 17.2 years with male female ratio of 6.7:1. Lone crash by cyclists and collisions accounted for 66.8% and 33.1% of the cases, respectively. Passengers and riders comprised 75% of the patients, while 25% were vulnerable pedestrians. The most frequently abused substance by the patients was tramadol (65.52%). Severe head injury and pupillary abnormality were found in 23.9% and 45.5% of the patients, respectively. Cranial CT scan showed abnormalities in 40.2% of the patients. Surgery was done in 28.3% of the patients with mortality rate of 20.7%.

Conclusions The use of motorcycle as a mean of transportation has caused significant negative impact on the society. Young people, who constitute the workforce, are majorly affected, and this invariably leads to a serious economic burden on the concerned families and communities.

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.

Geographical distribution of at fault drivers involved in fatal traffic collisions in Tehran, Iran

OBJECTIVES

According to Traffic Police, about 35% of deaths and more than 50% of injuries caused by traffic collision in the roads of Tehran are among drivers and car occupants. This study was conducted to determine areas with the highest number of traffic collisions and perform spatial analysis of traffic collisions involving drivers in Tehran during April 2014 to March 2017.

METHODS

The present study was a cross-sectional and descriptive-analytic research. In this study, all traffic collision that driver was accounted (100 percent or less) for crash occurrence which resulted in the death of at least one person (driver, pedestrian or passenger) were included in the analyses. Geographic information system software was used to show spatial distribution of events from zoning maps. Moran index was used in the mathematical analysis in order to determine the distribution pattern of the events from and Getis-Ord G statistics was applied to analyze the hot spots (high risk points).

RESULTS

A total number of 519 traffic collisions were investigated in this study. Moreover, 283 cases (54.5%) of the incidents took place in direct routes and 236 cases (45.5%) occurred at intersections. The most frequent events were in the region 4 (57 cases) and the least frequent events were reported in the region 10 (6 cases). Moran statistics show that the distribution of the studied events significantly follows the cluster pattern (p<0.001).

CONCLUSIONS

The northeastern and northwest margins of Tehran are the most prone areas for drivers involved with traffic collisions leading to death. Most traffic collisions leading to death take place at highways located at the entrance and exit points of Tehran and highways in regions 2 and 5.

Spatial analysis of driving accidents leading to deaths related to motorcyclists in Tehran

PURPOSE

Traffic accidents are one of the main causes of death and disability, causing annual deaths of 1.23 million and tens of millions injured people worldwide. Meanwhile, a significant proportion of the deaths and injuries caused by traffic accidents occur among motorcyclists. According to the world health organization's 2015 report, about 25% of deaths from traffic accidents occur in motorists. In Iran, a significant proportion of deaths and injuries result from traffic accidents among motorcyclists, especially in passages within the cities. According to traffic police, about 25% of deaths and 50% of injuries in traffic accidents of Tehran are reported among motorcyclists. Therefore, due to the importance of this issue, the spatial factors influencing the incidence of motorcycle-related accidents in Tehran were investigated using the geographic information system.

METHODS

The present work was a cross-sectional and descriptive analysis study. The data necessary for the study were extracted from Tehran traffic police as well as municipality databases. Zoning maps were used to display the distribution of events. In the analytical investigation, Moran index was used to determine the distribution pattern of the events, while Getis-Ord G * statistics were applied to analyze hot spots. To investigate the role of regional and environmental factors in the frequency of traffic accidents related to motorcyclists in geographic units (Tehran 22 districts), Poisson regression and negative binomial models were used. The geographically weighted regression (GWR) model was used to analyze the relationship between environmental factors and the location of these events. Statistical analyses were performed using SPSS, STATA, ARC-GIS and GWR software.

RESULTS

The southern and eastern margins of Tehran are the most vulnerable areas in terms of deaths related to traffic accidents of motorcyclists. Highways are considered the location of most traffic accidents which lead to death of motorcyclists. Getis-Ord General G * (p < 0.04) indicates that the distribution of high-risk points is statistically significant. The final model showed that in Tehran, the association of different variables including demographic characteristics, pathways network and type of land use with the number of accidents in geographic units was statistically significant. The spatial distribution of traffic accidents leading to deaths of motorcyclists in the center of Tehran varies considerably with changes in population density, length of highways, volume of traffic, and land use in different parts.

CONCLUSION

Most of the traffic accidents leading to deaths of motorcyclists occur in highways. Various environmental variables play a role in determining the distribution pattern of these types of events. Through proper traffic management, controlling environmental risk factors and training people the safety of motorcyclists in Tehran can be improved.

Analysis of the Relationship between Turning Signal Detection and Motorcycle Driver's Characteristics on Urban Roads; A Case Study

The investigations on the effectiveness of the turn signal in motorcyclists understanding of motorists’ potential intentions in potentially dangerous car–motorcycle interactions and on the relationships among some variables that could influence the perception of rear and front turn signal status are examined in this paper. The investigations have been based on data pooled from the answers of a survey of 136 motorcycle riders, with special regards to the correct detection of turning indicators. Experimental videos have been realized during in-situ simulations, both in urban and suburban areas, recording vehicular interactions in three-leg road intersections, able to potentially generate crash risks, through a 360-camera mounted on a motorcyclist’s helmet. The blinkers detection rate has been combined with other factors related to motorcyclist’s characteristics and test context (e.g., age, gender, location of the test site, presence of a car behind tester vehicles and if the motorcyclist are also habitual car or bicycle drivers) in a stepwise logistic regression that modelled the odds of detecting the turn signal turned on as a function of significant factors. Within the limits of the proposed methodology, the results highlight the low percentage of correct sighting of the turn indicators and confirm the existence of a relation between the detection of the turn indicators aspect and some of the variables considered (e.g., age, being habitual cyclist or car driver and the presence of a car occluding the views), suggesting the opportunity to further investigate the phenomenon through the use of ad-hoc simulations, in order to highlight connections among the factors that can influence the perception of turning indicators in potentially dangerous contexts for cars and motorcycles.

Safety Analysis of Motorcycle Crashes in Seoul Metropolitan Area, South Korea: An Application of Nonlinear Optimal Scaling Methods

This study identifies the critical factors that affect motorcycle crash severity based on Korean motorcycle crash data in 2009. Motorcyclists, the environment, roadways, other vehicles involved in the crashes, and traffic flow characteristics were used as variables for identifying critical factors. Multivariable statistical methods were used to analyze the data, including categorical principal components analysis (CatPCA) and nonlinear canonical correlation analysis (NLCCA). The results indicate that the following factors are the most critical in increasing motorcycle crash severity: age (motorcyclists in their teens and over fifty years old), motorcycle speed over 30 km/h, speed over 50 km/h for other vehicles involved in the crash, crashes with heavy vehicles such as buses and trucks, crashes on roadways less than six meters wide, crashes at curved sections, crashes at basic roadway segments without any speed control facilities, and head-on crashes. These findings are expected to serve as a valuable reference for formulating remedial policy measures to decrease the severity of motorcycle crashes on roadways in the Seoul metropolitan area of South Korea.

Crashes and Traffic Signal Violations Caused by Commercial Motorcycle Couriers

Background

Motorcycles are one of the important members of commercial transportation because of the convenient use during congested traffic conditions and the ease of parking in narrow streets. This study investigates the characteristics of crashes and traffic signal violations caused by motorcycle couriers.

Methods

From the national compensation data, this study analyzed the traffic crashes caused by 671 motorcycle couriers.

Results

Among 671 injured couriers, 50.6% were aged less than 40 years, 49.2% run in a small business of <5 employees, and 47.2% had work experience of <6 months. Motorcycle crashes occurred mainly due to "rider overturned alone" (67.5%), in the daytime (73.5%), or on cloudy or clear days (77.2%). However, the violation rate caused by motorcycle couriers was high in couriers in a small business of <5 employees (13.9%), with work experience of <6 months (13.9%), on cloudy or clear days (12.4%), on an intersection (29.8%), in the type of "crash with a vehicle" (31.2%), or in a death accident (35.7%).

Conclusion

The findings of this study can be used as a baseline in devising policies for preventing crashes of motorcycle couriers.

A heterogeneity based case-control analysis of motorcyclist's injury crashes: Evidence from motorcycle crash causation study

The main objective of this study is to quantify how different "policy-sensitive" factors are associated with risk of motorcycle injury crashes, while controlling for rider-specific, psycho-physiological, and other observed/unobserved factors. The analysis utilizes data from a matched case-control design collected through the FHWA's Motorcycle Crash Causation Study. In particular, 351 cases (motorcyclists involved in injury crashes) are analyzed vis-à-vis similarly-at-risk 702 matched controls (motorcyclists not involved in crashes). Unlike traditional conditional estimation of relative risks, the paper presents heterogeneity based statistical analysis that accounts for the possibility of both within and between matched case-control variations. Overall, the correlations between key risk factors and injury crash propensity exhibit significant observed and unobserved heterogeneity. The results of best-fit random parameters logit model with heterogeneity-in-means show that riders with partial helmet coverage (U.S. DOT compliant helmets with partial coverage, least intrusive covering only the top half of the cranium) have a significantly lower risk of injury crash involvement. Lack of motorcycle rider conspicuity captured by dark (red) upper body clothing is associated with significantly higher injury crash risk (odds ratio 3.87, 95% CI: 1.63, 9.61). Importantly, a rider's motorcycle-oriented lower clothing (e.g., cannot easily get stuck in the machinery) significantly lowers the odds of injury crash involvement. Regarding the effectiveness of training, formal motorcycle driving training in recent years was associated with lower injury crash propensity. Finally, riders with less sleep prior to crash/interview exhibited 1.97 times higher odds of crash involvement compared to riders who had more than 5 h of sleep. Methodologically, the conclusion is that the correlations of several rider, exposure, apparel, and riding history related factors with crash risk are not homogeneous and in fact vary in magnitude as well as direction. The study results indicate the need to develop appropriate countermeasures, such as refresher motorcycle training courses, prevention of sleep-deprived/fatigued riding, and riding under the influence of alcohol and drugs.

Role of sensation seeking and attitudes as mediators between age of driver and risky driving of Powered Two Wheelers

INTRODUCTION

This study examines the effect of age of driver on risky driving of Powered Two-Wheelers (PTW) employing sensation seeking and safety attitudes as mediators.

METHODS

A survey was conducted with 1299 PTW drivers (1089 males and 210 females) within the age of 18 and 63years, living in the state of Kerala, India. The questionnaire consisted of 31 items to measure sensation seeking, safety attitude, and risky driving of the drivers.

RESULTS

Mediation models were examined using sensation seeking as mediator and secondly safety attitudes as mediators. The relationship between the driver's age and risky driving was fully mediated by all the three variables.

PRACTICAL APPLICATIONS

Results of this study suggest that safety strategies should be employed to reduce risky driving tendencies that could be achieved by shaping or adapting the mediators (reducing sensation seeking and enhancing safety attitudes). This goal could be reached by starting to educate children about this at an early stage when they are at school as well as by social learning and safety awareness campaigns.

The analysis of influence of individual and environmental factors on 2-wheeled users' injuries

OBJECTIVE

Powered 2-wheeled motor vehicles (PTWs) are one of the most vulnerable categories of road users. Bearing that fact in mind, we have researched the effects of individual and environmental factors on the severity and type of injuries of PTW users. The aim was to recognize the circumstances that cause these accidents and take some preventive actions that would improve the level of road safety for PTWs.

METHODS

In the period from 2001 to 2010, an analysis of 139 road accidents involving PTWs was made by the Faculty of Transport and Traffic Engineering in Belgrade. The effects of both individual (age, gender, etc.) and environmental factors (place of an accident, time of day, etc.) on the cause of accidents and severity and type of injuries of PTWs are reported in this article. Analyses of these effects were conducted using logistic regression, chi-square tests, and Pearson's correlation.

RESULTS

Factors such as categories of road users, pavement conditions, place of accident, age, and time of day have a statistically significant effect on PTW injuries, whereas other factors (gender, road type; that is, straight or curvy) do not. The article also defines the interdependence of the occurrence of particular injuries at certain speeds. The results show that if PTW users died of a head injury, these were usually concurrent with chest injuries, injuries to internal organs, and limb injuries.

CONCLUSIONS

It has been shown that there is a high degree of influence of individual factors on the occurrence of accidents involving 2-wheelers (PTWs/bicycles) but with no statistically significant relation. Establishing the existence of such conditionalities enables identifying and defining factors that have an impact on the occurrence of traffic accidents involving bicyclists or PTWs. Such a link between individual factors and the occurrence of accidents makes it possible for system managers to take appropriate actions aimed at certain categories of 2-wheelers in order to reduce casualties in a particular area. The analysis showed that most of the road factors do not have a statistically significant effect on either category of 2-wheeler. Namely, the logistic regression analysis showed that there is a statistically significant effect of the place of accident on the occurrence of accidents involving bicyclists.

Motorcycle injury among secondary school students in the Tiko municipality, Cameroon

Introduction

Injury from motorcycle is a considerable cause of disability and death in the world and especially in low and middle-income countries; it is one of the most serious public health problems. In Cameroon, motorcycle is commonly used for transportation particularly among students. The aim of this paper is to study the risk-factors of the motorcycle-related accidents and injuries among secondary school students’ in the Tiko municipality, Cameroon.

Methods

A cross sectional study was conducted in January 2012 on 391 students age 16-24 from public and private schools in the Tiko Municipality. Logistic regression was used to estimate the association between risk factors and injuries. A closed-ended and few open-ended questionnaire was used to collect data.

Results

The study showed that over 70% of students used motorcycles always or often. Few had undergone any formal training for driving a motorcycle. The vast majority reported not wearing protective gear while driving or riding a motorcycle. Usage of protective gear was particularly low among girls. Over 16% reported using a motorbike always or occasionally under the influence of alcohol or drugs. Over 58% of respondents reported having an accident and over 35% were injured when driving or riding a motorcycle. Those who lived at the Tiko-Douala road have three times higher probability to sustain accidents and injuries than students residing elsewhere (OR 3.19 (1.20-8.46).

Conclusion

It is deeply alarming that every second respondent in the study reported having been in an accident and every third motorcycle user was somehow injured. We therefore call for an immediate attention and a deeper investigation into the highlighted situation, particularly at Tiko-Douala road.

Motorcycle-related hospitalization of adolescents in a Level I trauma center in southern Taiwan: a cross-sectional study

BACKGROUND

The aim of this study was to investigate and compare the injury pattern, mechanisms, severity, and mortality of adolescents and adults hospitalized for treatment of trauma following motorcycle accidents in a Level I trauma center.

METHODS

Detailed data regarding patients aged 13-19 years (adolescents) and aged 30-50 years (adults) who had sustained trauma due to a motorcycle accident were retrieved from the Trauma Registry System between January 1, 2009 and December 31, 2012. The Pearson's chi-squared test, Fisher's exact test, or the independent Student's t-test were performed to compare the adolescent and adult motorcyclists and to compare the motorcycle drivers and motorcycle pillion.

RESULTS

Analysis of Abbreviated Injury Scale (AIS) scores revealed that the adolescent patients had sustained higher rates of facial, abdominal, and hepatic injury and of cranial, mandibular, and femoral fracture but lower rates of thorax and extremity injury; hemothorax; and rib, scapular, clavicle, and humeral fracture compared to the adults. No significant differences were found between the adolescents and adults regarding Injury Severity Score (ISS), New Injury Severity Score (NISS), Trauma-Injury Severity Score (TRISS), mortality, length of hospital stay, or intensive care unit (ICU) admission rate. A significantly greater percentage of adolescents compared to adults were found not to have worn a helmet. Motorcycle riders who had not worn a helmet were found to have a significantly lower first Glasgow Coma Scale (GCS) score, and a significantly higher percentage was found to present with unconscious status, head and neck injury, and cranial fracture compared to those who had worn a helmet.

CONCLUSION

Adolescent motorcycle riders comprise a major population of patients hospitalized for treatment of trauma. This population tends to present with a higher injury severity compared to other hospitalized trauma patients and a bodily injury pattern differing from that of adult motorcycle riders, indicating the need to emphasize use of protective equipment, especially helmets, to reduce their rate and severity of injury.

Characteristics of motorcyclists involved in accidents between motorcycles and automobiles

Introduction: traffic accidents are one of the main causes of death and disability, with motorcyclists representing the great majority of both the victims and the perpetrators. Objective: this work studied the characteristics of motorcyclists injured in accidents involving motorcycles and automobiles. Method: this study sought to interview 100 motorcyclists who had been injured in collisions between motorcycles and automobiles, and who were undergoing emergency hospital treatment in the region of Belo Horizonte, Brazil. The questionnaires included demographic information (age, gender, skin color, education level, profession) and questions about years of licensed driving practice, how often they would drive an automobile, how long they had had a motorcycle driver’s license, how often they would ride a motorcycle, the number of prior accidents involving a car, and the number of prior accidents not involving a car. Results: of the 100 consecutive accidents studied, 91 occurred with men and 9 with women, aged between 16 and 79 (m = 29 ± 11) years. Regarding their reason for using a motorcycle, 83% reported using it for transport, 7% for work, and 10% for leisure. Most of these accident victims had secondary or higher education (47%). Of the motorcyclists who held a car driver’s license, 68.3% drove the vehicle daily or weekly and held the license for more than one year. Sixty-seven percent of the accident victims used a motorcycle daily and had a motorcycle driver’s license for at least one year. Conclusion: among the motorcyclists injured, most were men aged 20 years or older, with complete secondary education, and experienced in driving both motorcycles and cars, indicating that recklessness while driving the motorcycle is the main cause of traffic accidents.

Peer influences on alcohol expectancies in early adolescence: a study of concurrent and prospective predictors in Taiwan

The effects of peers on three domains of alcohol expectancies through early adolescence were prospectively examined over 2 years. Information on pubertal development, parental drinking, peer characteristics, network structure, alcohol expectancies, and alcohol consumption was assessed in a three-wave longitudinal study of 779 6th graders (~12 years of age) randomly selected from northern Taiwan. Complex survey regression analyses, stratified by drinking experience in 6th grade, were performed to identify predictors of two positive (i.e., enhanced social behaviors and relaxation/tension reduction) and one negative alcohol expectancies (i.e., cognitive/behavioral deterioration) in 7th grade. The results showed that the effects of peer influence on adolescents' alcohol expectancies varied by prior drinking experiences and by expectancy domains. For the alcohol naive, recent exposure to peer drinking was significantly associated with positive and negative alcohol expectancies in grade 7, and this association was moderated by advanced pubertal development (ESBlate puberty: ßwt=0.55; ESBearly puberty: ßwt=-0.40; PRTRlate puberty: ßwt=0.01; PRTRearly puberty: ßwt=1.22; CBD late puberty: ßwt=-0.84; CBDearly puberty: ßwt=0.56). For the alcohol experienced, neither peer drinking nor pubertal development showed any significant links with alcohol expectancies. Occupying a bridge position was slightly linked with negative expectancy (ßwt=0.25). Concurrent drinking serves as a strong predictor for the endorsed alcohol expectancy in both groups, particularly for the domain of enhanced social behaviors. If these effects are confirmed, knowledge of the effect of interplay between peer factors and pubertal development on alcohol expectancies in early adolescence can provide effective targets in prevention programs.

Validation of the Chinese-language brief sensation seeking scale: implications for risky riding behaviors of parental motorcyclists and their child passengers

Motorcycles are the leading cause of road traffic deaths in the Western Pacific and Southeast Asia, where Mandarin Chinese is the most commonly used language. Sensation seeking (SS) is reported to correlate with many risky motor vehicle behaviors, and therefore a culture-adapted Chinese instrument is needed to assess this personality trait in Chinese-speaking motorcycling populations. The standard front and blinded-backward process was carried out to formulate the Chinese-language Brief Sensation Seeking Scale (C-BSSS). 193 parental motorcyclists who rode with their young children were interviewed concerning their SS levels, demographics, riding behaviors, and the driving/riding experiences. A random sample of 30 subjects was re-interviewed 1-2 weeks later to examine the test-retest reliability. Psychometric analyses revealed satisfactory item characteristics, internal consistency, intraobserver reliability, and interobserver reliability. Additionally, parental motorcyclists who had the following characteristics were more likely to be the high sensation seekers (SSers), including male, younger age, presenting risky motor vehicle behaviors of themselves (e.g., higher riding speeds, operating after drinking, using a mobile phone while operating, and receiving a traffic ticket), and carrying child passengers who demonstrated dangerous motorcycling behaviors (e.g., a younger age, non-helmeted, and overloaded). We conclude that the C-BSSS is a useful and reliable measure of SS for ethnic Chinese populations. This instrument may be helpful to develop the future prevention strategy of motorcycle injuries in Chinese parental motorcyclists and their young child passengers.

Burden of transportation injuries among children and adolescents of Fars province: analysis of Iran's 20-year trends

OBJECTIVES:

Transportation injuries are among the top ten causes of burden of disease in all age groups worldwide. The burden of transportation injuries among children and adolescents in Iran is higher than the world average and that of other developing countries. The aims of this study were to investigate the burden of transportation injuries in children and adolescents in the province of Fars in Iran from 2009 to 2013, and to report the burden of these kinds of injuries in children and adolescents in Iran from 1990 to 2010.

METHODS:

The number of deaths due to transportation injuries and the location of fatal injuries in the province of Fars in Iran from 2009 to 2013 were analyzed using data from the Fars Forensic Medicine Organization. The 20-year trend in the burden of transportation injuries in Iran was analyzed using data from the Institute for Health Metrics and Evaluation.

RESULTS:

Similarly to the long-term trend in Iran, the burden of transportation injuries among the male population of Fars province was generally higher than in females. Most fatal accident injuries occurred on roads (males: n=4151, 61.51%; females: n=1182, 65.95%) and in urban areas (males: n=1994, 29.54%; females: n=473, 26.40%).

CONCLUSIONS:

Considering that children and adolescents are high risk groups for transportation injuries, adopting an effective comprehensive multi-sectoral approach, including enacting and enforcing appropriate laws and regulations, developing general knowledge, and facilitating the availability of Personal protective equipment, could be helpful for reducing the burden of these injuries.

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.

Injury severity in delivery-motorcycle to vehicle crashes in the Seoul metropolitan area

More than 56% of motorcycles in Korea are used for the purpose of delivering parcels and food. Since such delivery requires quick service, most motorcyclists commit traffic violations while delivering, such as crossing the centerline, speeding, running a red light, and driving in the opposite direction down one-way streets. In addition, the fatality rate for motorcycle crashes is about 12% of the fatality rate for road traffic crashes, which is considered to be high, although motorcycle crashes account for only 5% of road traffic crashes in South Korea. Therefore, the objective of this study is to analyze the injury severity of vehicle-to-motorcycle crashes that have occurred during delivery. To examine the risk of different injury levels sustained under all crash types of vehicle-to-motorcycle, this study applied an ordered probit model. Based on the results, this study proposes policy implications to reduce the injury severity of vehicle-to-motorcycle crashes during delivery.

Factor complexity of crash occurrence: An empirical demonstration using boosted regression trees

Factor complexity is a characteristic of traffic crashes. This paper proposes a novel method, namely boosted regression trees (BRT), to investigate the complex and nonlinear relationships in high-variance traffic crash data. The Taiwanese 2004-2005 single-vehicle motorcycle crash data are used to demonstrate the utility of BRT. Traditional logistic regression and classification and regression tree (CART) models are also used to compare their estimation results and external validities. Both the in-sample cross-validation and out-of-sample validation results show that an increase in tree complexity provides improved, although declining, classification performance, indicating a limited factor complexity of single-vehicle motorcycle crashes. The effects of crucial variables including geographical, time, and sociodemographic factors explain some fatal crashes. Relatively unique fatal crashes are better approximated by interactive terms, especially combinations of behavioral factors. BRT models generally provide improved transferability than conventional logistic regression and CART models. This study also discusses the implications of the results for devising safety policies.

Modeling offenses among motorcyclists involved in crashes in Spain

In relative terms, Spanish motorcyclists are more likely to be involved in crashes than other drivers and this tendency is constantly increasing. The objective of this study is to identify the factors that are related to being an offender in motorcycle accidents. A binary logit model is used to differentiate between offender and non-offender motorcyclists. A motorcyclist was considered to be offender when s/he had committed at least one traffic offense at the moment previous to the crash. The analysis is based on the official accident database of the Spanish general directorate of traffic (DGT) for the 2003-2008 time period. A number of explanatory variables including motorcyclist characteristics and environmental factors have been evaluated. The results suggest that inexperienced, older females, not using helmets, absent-minded and non-fatigued riders are more likely to be offenders. Moreover, riding during the night, on weekends, for leisure purposes and along roads in perfect condition, mainly on curves, predict offenses among motorcyclists. The findings of this study are expected to be useful in developing traffic policy decisions in order to improve motorcyclist safety.

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.

Risk factors for injury accidents among moped and motorcycle riders

OBJECTIVE

To study and quantify the effect of factors related to the riders of powered two-wheelers on the risk of injury accident involvement.

METHODOLOGY

Based on national data held by the police from 1996 to 2005, we conducted a case-control study with responsibility for the accident as the event of interest. We estimated the odds ratios for accident responsibility. Making the hypothesis that the non-responsible riders in the study are representative of all the riders on the road, we thus identified risk factors for being responsible for injury accidents. The studied factors are age, gender, helmet wearing, alcohol consumption, validity of the subject's driving licence and for how long it has been held, the trip purpose and the presence of a passenger on the vehicle. Moped and motorcycle riders are analyzed separately, adjusting for the main characteristics of the accident.

RESULTS

For both moped and motorcycle riders, being male, not wearing a helmet, exceeding the legal limit for alcohol and travelling for leisure purposes increased the risk of accident involvement. The youngest and oldest users had a greater risk of accident involvement. The largest risk factor was alcohol, and we identified a dose-effect relationship between alcohol consumption and accident risk, with an estimated odds ratio of over 10 for motorcycle and moped riders with a BAC of 2 g/l or over. Among motorcycle users, riders without a licence had twice the risk of being involved in an accident than those holding a valid licence. However, the number of years the rider had held a licence reduced the risk of accident involvement. One difference between moped and motorcycle riders involved the presence of a passenger on the vehicle: while carrying a passenger increased the risk of being responsible for the accident among moped riders, it protected against this risk among motorcycle riders.

CONCLUSION

This analysis of responsibility has identified the major factors contributing to excess risk of injury accidents, some of which could be targeted by prevention programmes.

Beyond general behavioral theories: structural discrepancy in young motorcyclist's risky driving behavior and its policy implications

While many studies examine the mean score differences of psychological determinants between heterogeneous driver groups, this study reveals a structural discrepancy in a causal behavioral framework. Using young motorcyclists (ages 18-28) as subjects, this study investigates the various roles of key influential factors in determining risky driving behavior. Multi-group analysis of structural equation modeling shows that age and gender are two factors that can effectively distinguish heterogeneous driver groups exhibiting different decision-making mechanisms in shaping their risky driving behaviors. When encountering undesirable traffic conditions, road rage can immediately increase male motorcyclists' intentions to engage in risky driving behaviors; on the other hand, young female motorcyclists further calculate their perceived risk to determine whether to engage in risky driving behaviors. This result shows that there is a significant link between risk perception and traffic condition awareness for experienced drivers (ages 25-28), but not for younger drivers (ages 18-24). This finding shows that while well-developed theories such as planned behavior and risk homeostasis provide general frameworks to explain risky driving behavior, heterogeneous driver groups may exhibit structural discrepancies that reflect their various decision-making mechanisms. This suggests that, in addition to mean differences, understanding structural discrepancies among heterogeneous groups could help researchers identify effective intervention strategies.

Overview of critical risk factors in Power-Two-Wheeler safety

Power-Two-Wheelers (PTWs) constitute a vulnerable class of road users with increased frequency and severity of accidents. The present paper focuses of the PTW accident risk factors and reviews existing literature with regard to the PTW drivers' interactions with the automobile drivers, as well as interactions with infrastructure elements and weather conditions. Several critical risk factors are revealed with different levels of influence to PTW accident likelihood and severity. A broad classification based on the magnitude and the need for further research for each risk factor is proposed. The paper concludes by discussing the importance of dealing with accident configurations, the data quality and availability, methods implemented to model risk and exposure and risk identification which are critical for a thorough understanding of the determinants of PTW safety.

Road traffic related mortality in Vietnam: evidence for policy from a national sample mortality surveillance system

Background

Road traffic injuries (RTIs) are among the leading causes of mortality in Vietnam. However, mortality data collection systems in Vietnam in general and for RTIs in particular, remain inconsistent and incomplete. Underlying distributions of external causes and body injuries are not available from routine data collection systems or from studies till date. This paper presents characteristics, user type pattern, seasonal distribution, and causes of 1,061 deaths attributable to road crashes ascertained from a national sample mortality surveillance system in Vietnam over a two-year period (2008 and 2009).

Methods

A sample mortality surveillance system was designed for Vietnam, comprising 192 communes in 16 provinces, accounting for approximately 3% of the Vietnamese population. Deaths were identified from commune level data sources, and followed up by verbal autopsy (VA) based ascertainment of cause of death. Age-standardised mortality rates from RTIs were computed. VA questionnaires were analysed in depth to derive descriptive characteristics of RTI deaths in the sample.

Results

The age-standardized mortality rates from RTIs were 33.5 and 8.5 per 100,000 for males and females respectively. Majority of deaths were males (79%). Seventy three percent of all deaths were aged from 15 to 49 years and 58% were motorcycle users. As high as 80% of deaths occurred on the day of injury, 42% occurred prior to arrival at hospital, and a further 29% occurred on-site. Direct causes of death were identified for 446 deaths (42%) with head injuries being the most common cause attributable to road traffic injuries overall (79%) and to motorcycle crashes in particular (78%).

Conclusion

The VA method can provide a useful data source to analyse RTI mortality. The observed considerable mortality from head injuries among motorcycle users highlights the need to evaluate current practice and effectiveness of motorcycle helmet use in Vietnam. The high number of deaths occurring on-site or prior to hospital admission indicates a need for effective pre-hospital first aid services and timely access to emergency facilities. In the absence of standardised death certification, sustained efforts are needed to strengthen mortality surveillance sites supplemented by VA to support evidence based monitoring and control of RTI mortality.

Fatal accident distribution by age, gender and head injury, and death probability at accident scene in Mashhad, Iran, 2006-2009

Several studies have investigated road traffic deaths, but few have compared by road user type. Iran, with an estimated 44 road traffic deaths per 100,000 population in 2002 had higher road traffic deaths than any other country for which reliable estimates can be made. So, the present study was conducted on road death data and identified fatal accident distribution by age, gender and head injury as well as the influences of age and gender on deaths at accident scenes for all road user groups. Data used in this study are on fatal road accidents recorded by forensic medicine experts of the Khorasan Razavi province in Mashhad, the capital of the province, the second largest city and the largest place of pilgrimage, immigration and tourism in Iran. Chi-square test and odds ratio were used to identify the relation of death place with age and gender in 2495 fatal road accidents from 2006 to 2009. The t-test and analysis of variance were employed for continues variable, age, to compare males' and females' mean age for all road user categories. For two genders, all three groups of fatalities (pedestrian, motorcyclist and motor vehicle occupant) had a peak at the ages of 21-30. The youngest were male motorcyclists (mean age = 28). Old pedestrians were included in road deaths very much, too. Male/female overall ratio was 3.41 and the highest male/female ratio was related to motorcyclists (14). The overall ratio of head injury to other organ injuries (torso and underbody) was 2.51 and pedestrians had the largest amount of head injury (38.2%). Regarding death at accident scene, for all road users, gender did not have any significant relation with death at the scene (P-value > 0.1); on the contrary, age had significant relation (P-value < 0.05). Females were more vulnerable at accident scenes (male/female ratio at accident sense < 1). Pedestrians aged 21-30, motorcyclists 41-50 and motor vehicle occupants 31-40 died the most at accident scenes. Identifying the most endangered groups of road accident fatalities, which was conducted in this study, is invaluable for the appropriate design of prevention strategies and allocation of financial resources for each group of road user fatalities - since in developing nations, there are insufficient financial resources to traffic safety and we should consider superiorities, i.e. the most risky groups. Steps which may contribute to safety promotion for local conditions include suitable facilities for old pedestrians, a training course before obtaining motorcycle license for motorcyclists, informing young road users by provincial media about death risk of road users and improving management of the head-injured patients. Finally, suggestions for future researches were made.

Global burden of injuries attributable to alcohol consumption in 2004: a novel way of calculating the burden of injuries attributable to alcohol consumption

Background

Alcohol consumption is a major risk factor for injuries; however, international data on this burden are limited. This article presents new methods to quantify the burden of injuries attributable to alcohol consumption and quantifies the number of deaths, potential years of life lost (PYLL), and disability-adjusted life years (DALYs) lost from injuries attributable to alcohol consumption for 2004.

Methods

Data on drinking indicators were obtained from the Comparative Risk Assessment study. Data on mortality, PYLL, and DALYs for injuries were obtained from the World Health Organization. Alcohol-attributable fractions were calculated based on a new risk modeling methodology, which accounts for average and heavy drinking occasions. 95% confidence intervals (CIs) were calculated using a Monte Carlo simulation method.

Results

In 2004, 851,900 (95% CI: 419,400 to 1,282,500) deaths, 19,051,000 (95% CI: 9,767,000 to 28,243,000) PYLL, and 21,688,000 (95% CI: 11,097,000 to 32,385,000) DALYs for people 15 years and older were due to injuries attributable to alcohol consumption. With respect to the total number of deaths, harms to others were responsible for 15.1% of alcohol-attributable injury deaths, 14.5% of alcohol-attributable injury PYLL, and 11.35% of alcohol-attributable injury DALYs. The overall burden of injuries attributable to alcohol consumption corresponds to 17.3% of all injury deaths, 16.7% of all PYLL, and 13.6% of all DALYs caused by injuries, or 1.4% of all deaths, 2.0% of all PYLL, and 1.4% of all DALYs in 2004.

Conclusions

The novel methodology described in this article to calculate the burden of injuries attributable to alcohol consumption improves on previous methodology by more accurately calculating the burden of injuries attributable to one’s own drinking, and for the first time, calculates the burden of injuries attributable to the alcohol consumption of others. The burden of injuries attributable to alcohol consumption is large and is entirely avoidable, and policies and strategies to reduce it are recommended.

Comparison of two warning concepts of an intelligent Curve Warning system for motorcyclists in a simulator study

Curve crashes are a particular matter of concern regarding motorcycle riding safety. For this reason, an intelligent Curve Warning system has been designed that gives the riders support when negotiating a curve. The system has been tested in a simulator study carried out with 20 test riders. The subjects performed three rides: one without the system (baseline) and two experimental rides using a version of the Curve Warning system, one providing the warnings by a force feedback throttle and one by a haptic glove. The effects of the two system versions were evaluated both in terms of the simulated riding performance and the subjective assessment by the riders. A descriptive analysis of the riders' reactions to the warnings shows that the warnings provided by both system versions provoke an earlier and stronger adaptation of the motorcycle dynamics to the curve than when the riders do not use the system. Riding with the Curve Warning system with the haptic glove furthermore leads to a reduction of critical curve events. The riders' subjective workload level was not affected by the system use, whereas the Curve Warning system with the force feedback throttle required an increased attention. The comparison of the riders' opinions about the system reveals a preference of the Curve Warning system with the haptic glove. The better acceptance of this system version suggests a higher potential in the enhancement of riding safety.

Hazard perception of motorcyclists and car drivers

The current study compares hazard perception (HP) performance of 50 male drivers with and without a motorcycle license in order to generalize results. A video-based HP test, measuring reaction times to traffic scenes, was administered to these two groups of drivers. Participants with a motorcycle license performed better than participants without a motorcycle license. ANOVA indicated that learning improved linearly for participants with a motorcycle license but not for participants without a motorcycle license. No evidence that HP was predicted by age was found. HP scores for drivers who reported previous involvement in an accident were lower than for those who reported not being involved in an accident. The results are discussed in the context of sensitivity and response bias models.

Exposure to traffic and risk of hospitalization due to injuries

Research on the risk of motor vehicle injuries and their relationship with the amount of travel has been only partially analyzed. The few individual exposure assessments are related to very specific subsets of the driving and traveling populations. This study analyzes the relationship between kilometers traveled and hospitalization due to motor vehicle injuries. Twelve thousand three hundred and sixty nine Spanish university graduates from the Seguimiento Universidad de Navarra multipurpose cohort study were evaluated. They had not been hospitalized due to motor vehicle injuries at baseline and were followed up to eight years. Biannual questionnaires allowed for self-reporting of kilometers traveled in motor vehicles, together with incidence of hospitalization. Covariates in the Cox regression models included age and gender and baseline use of safety belt while driving, driving a vehicle with driver-side airbag, driving a motorcycle, and drinking and driving. There were 49,766 participant-years with an average yearly travel of 7,828 km per person-year. Thirty-six subjects reported a first hospitalization event during this time. The adjusted hazard ratio per additional kilometer traveled was 1.00005 (95% confidence interval 1.000013 to 1.000086). Even the smallest of reductions in the amount of kilometers traveled (from an average of 3,250 km per year to 1,000) has a statistically significant protective effect on the likelihood of sustaining hospitalization due to motor vehicle injury (aHR 0.9, 95% CI 0.78 to 0.98). In light of current policies aimed to reduce motorized traffic due to environmental concerns, it may be appropriate to consider the additional health benefit related to reductions in injuries.

Motorcycle injury severity in Barcelona: the role of vehicle type and congestion

OBJECTIVES

To determine factors affecting the severity of moped and motorcycle injuries in Barcelona--the city with the highest number of motorcycles per inhabitants in Europe--paying special attention to differences across vehicle type and to the role of congestion in a city that has promoted powered two-wheelers (PTWs) to alleviate traffic density.

METHOD

Drawing on Barcelona's local police census database on casualties (2002-2008), we use a parametric estimation based on an ordered multinomial logistic regression in order to identify factors affecting injury severity. We control for demographic characteristics, environment and traffic conditions, primary causes of accidents, and regulatory measures. Regressions distinguish PTW casualties from the rest of vehicles and present results for motorcycles and mopeds separately.

RESULTS

We confirm the higher vulnerability of PTW casualties-especially motorcycle casualties (OR 2.30)-and show that factors such as gender, excess speed, road width, and alcohol consumption do affect casualty severity. Regarding traffic conditions, we find that congestion diminishes the probability of suffering severe injuries, although its statistical significance only appears for motorcycle casualties (odds ratio [OR] 0.80), which are also more severe due to speed violations (OR 6.29).

CONCLUSIONS

We confirm the negative relationship between traffic flow (congestion) and injury severity of PTWs casualties. This is clearly identified, at least for motorcycle casualties, although moped casualties present similar impacts as well. As a result, alleviating congestion through PTWs promotion turns out to be a trade-off between congestion and safety that public officers must consider. The article also highlights the need of awareness campaigns and safety policies focused on specific groups of drivers. Attention should also be given to the enforcement of speed limits and alcohol restrictions in Barcelona.

Correlates of motorcycle helmet use among recent graduates of a motorcycle training course

Helmets significantly decrease morbidity and mortality from motorcycle crashes, but many areas of the world lack universal helmet laws. To educate motorcyclists in areas without helmet laws, more knowledge of motorcyclists' helmet beliefs is needed. A web-based survey was therefore designed to assess motorcyclists' attitudes, norms and behaviors towards helmets in a U.S. state with a limited helmet law. Of 445 survey respondents, 68.4% of respondents reported always wearing a helmet. The not-always-helmeted riders were more likely than the always-helmeted to be male; to bave less education; and to have a history of previous motorcycle crashes and injuries. Although both groups had taken rider training classes, fewer of the not-always-helmeted had learned how to ride in a class. The strongest correlates of being not-always-helmeted (vs. always-helmeted) were attitudes that helmets were not protective and impaired sight/hearing; and the normative belief that they would only wear helmets if forced by law. Because attitudes are often more easily changed than normative beliefs, education may increase helmet use. However, less than half of riders in this state with a mandatory education program learned how to ride from a rider education course, and 44% of non-helmeted said they would only wear a helmet if forced by law. Legislation may therefore be a more efficient and effective strategy than education to increase helmet use.

Behavior and lifestyle characteristics of male Kuwaiti drivers

INTRODUCTION

The high traffic accident risk among young drivers is a well-known and well-documented fact in most countries. Lifestyle has proven to affect driving behavior as well as accident risk. This study covers the lifestyle component of the problems related to young male Kuwaiti drivers' accident risk.

METHODS

The purpose of the study is to measure the relationship between lifestyle and accident risk. Lifestyle is measured through a questionnaire, where 302 male Kuwaiti drivers (mean age=28 years; range 25-35 years) answer 39 questions related to behavioral and social factors, road conditions, police enforcement, and life satisfaction. They also report their involvement in accidents and traffic violations.

RESULTS

The questionnaire's validity and reliability (Cronbach's alpha=0.7) were achieved. Principal component analysis reduced the 39 items on the questionnaire to 5 factors. Inadequate police enforcement is strongly correlated (r=0.862) to accident risk and traffic violations and is thus considered the best predictor of traffic accidents in Kuwait.

IMPACT ON INDUSTRY

As driving-related incidents (on-the-job and off-the-job) are a significant source of fatalities and lost-work-days, the study points to the importance of considering cultural factors in the design of comprehensive safety programs for industry.

The more you drink, the harder you fall: a systematic review and meta-analysis of how acute alcohol consumption and injury or collision risk increase together

Alcohol consumption causes injury in a dose-response manner. The most common mode of sustaining an alcohol-attributable injury is from a single occasion of acute alcohol consumption, but much of the injury literature employs usual consumption habits to assess risk instead. An analysis of the acute dose-response relationship between alcohol and injury is warranted to generate single occasion- and dose-specific relative risks. A systematic literature review and meta-analysis was conducted to fill this gap. Linear and best-fit first-order model were used to model the data. Usual tests of heterogeneity and publication bias were run. Separate meta-analyses were run for motor vehicle and non-motor vehicle injuries, as well as case-control and case-crossover studies. The risk of injury increases non-linearly with increasing alcohol consumption. For motor vehicle accidents, the odds ratio increases by 1.24 (95% CI: 1.18-1.31) per 10-g in pure alcohol increase to 52.0 (95% CI: 34.50-78.28) at 120 g. For non-motor vehicle injury, the OR increases by 1.30 (95% CI: 1.26-1.34) to an OR of 24.2 at 140 g (95% CI: 16.2-36.2). Case-crossover studies of non-MVA injury result in overall higher risks than case-control studies and the per-drink increase in odds of injury was highest for intentional injury, at 1.38 (95% CI: 1.22-1.55). Efforts to reduce drinking both on an individual level and a population level are important. No level of consumption is safe when driving and less than 2 drinks per occasion should be encouraged to reduce the risk of injury.

Risk-taking behaviors among motorcyclists in middle east countries: a case of islamic republic of Iran

OBJECTIVE

Injuries caused by motor vehicle crashes in Middle Eastern countries are among the highest in the world. In Iran, road traffic crashes are the second most common cause of mortality. Particularly, motorcycle-related injuries among men are the second most common type of traffic-related crash in this country. This study used qualitative research methods to elicit and explore the personal experiences of Iranian motorcyclists in respect to factors that facilitate their engagement in risk-taking behaviors within the PRECEDE (predisposing, reinforcing, and enabling constructs in educational diagnosis, and evaluation) framework.

METHODS

Focus groups, in-depth interviews, and field observation were conducted among motorcyclists, pillion passengers, and police officers.

RESULTS

Our data show that being young and single, living in lower socioeconomic conditions, and suffering from poor physical health and daily stress influence risk-taking behaviors. Additionally, lack of defined traffic rules and regulations, the availability and accessibility of motorcycles among unlicensed underaged persons, the cost-effectiveness of motorcycle transportation, unsafe roads and a lack of special pathways for motorcycles, and aggressive car and van/truck drivers are among the enabling factors that provoke risk-taking behavior. Finally, the participants verified that the enjoyment of motorcycling reinforced their decision to continue engaging in risky behaviors, and being penalized for disobeying traffic laws prevented them from further risk-taking behaviors.

CONCLUSION

Enabling and reinforcing factors to reduce risk-taking behaviors among motorcyclist could include (1) promoting smart driving practices among motorcyclists; (2) training pediatricians and emergency physicians to deliver brief motivational interventions to their young patients to avoid risky behaviors while riding; (3) training traffic enforcement officers to appreciate the value of providing consistent law enforcement services; (4) enhancing local efforts to increase the number of pathways for motorcyclists and improve the condition of deteriorated roads; (5) revising legislation and policies in association with motorcycle ownership among underaged and unlicensed individuals; (6) limiting an excessive number of passengers (particularly children) and cargo on motorcycles; and (7) identifying solutions to reduce the negative attitudes of car drivers toward motorcyclists and increase systematic compliance of traffic laws by motorcyclists and car drivers.

Running away experience and psychoactive substance use among adolescents in Taiwan: multi-city street outreach survey

BACKGROUND

This study aimed to examine: 1) the relationship between being a runaway and the time since the first absconding event and adolescent substance use; 2) whether different kinds of psychoactive substances have a different temporal relationship to the first absconding event; and 3) whether the various reasons for the first absconding event are associated with different risks of substance use.

METHODS

Participants were drawn from the 2004-2006 nationwide outreach programs across 26 cities/towns in Taiwan. A total of 17,133 participants, age 12-18 years, who completed an anonymous questionnaire on their experience of running away and substances use and who were now living with their families, were included in the analysis.

RESULTS

The lifetime risk of tobacco, alcohol, betel nut, and illegal drug/inhalant use increased steadily from adolescents who had experienced a trial runaway episode (one time lasting <or= 1 day), to those with extended runaway experience (>or= 2 times or lasting > 1 day), when compared to those who had never ran away. Adolescents who had their first running away experience > 6 months previously had a greater risk of betel nut or illegal drug/inhalant use over the past 6-months than those with a similar experience within the last 6 months. Both alcohol and tobacco use were most frequently initiated before the first running away, whereas both betel nut and illegal drug/inhalant use were most frequently initiated after this event. When adolescents who were fleeing an unsatisfactory home life were compared to those who ran away for excitement, the risk of alcohol use was similar but the former tended to have a higher risk of tobacco, betel nut, and illegal drug/inhalant use.

CONCLUSIONS

More significant running away and a longer time since the first absconding experience were associated with more advanced substance involvement among adolescents now living in a family setting. Once adolescents had left home, they developed additional psychoactive substance problems, regardless of their reasons for running away. These findings have implications for caregivers, teachers, and healthcare workers when trying to prevent and/or intervening in adolescent substance use.

Applying Bayesian hierarchical models to examine motorcycle crashes at signalized intersections

Motorcycles are overrepresented in road traffic crashes and particularly vulnerable at signalized intersections. The objective of this study is to identify causal factors affecting the motorcycle crashes at both four-legged and T signalized intersections. Treating the data in time-series cross-section panels, this study explores different Hierarchical Poisson models and found that the model allowing autoregressive lag-1 dependence specification in the error term is the most suitable. Results show that the number of lanes at the four-legged signalized intersections significantly increases motorcycle crashes largely because of the higher exposure resulting from higher motorcycle accumulation at the stop line. Furthermore, the presence of a wide median and an uncontrolled left-turn lane at major roadways of four-legged intersections exacerbate this potential hazard. For T signalized intersections, the presence of exclusive right-turn lane at both major and minor roadways and an uncontrolled left-turn lane at major roadways increases motorcycle crashes. Motorcycle crashes increase on high-speed roadways because they are more vulnerable and less likely to react in time during conflicts. The presence of red light cameras reduces motorcycle crashes significantly for both four-legged and T intersections. With the red light camera, motorcycles are less exposed to conflicts because it is observed that they are more disciplined in queuing at the stop line and less likely to jump start at the start of green.