Schizophrenia, antipsychotic treatment adherence and driver responsibility for motor vehicle crash: a population-based retrospective study in British Columbia, Canada

OBJECTIVE

To examine the relationship between schizophrenia, antipsychotic medication adherence and driver responsibility for motor vehicle crash.

DESIGN

Retrospective observational cohort study using 20 years of population-based administrative health and driving data.

SETTING

British Columbia, Canada.

PARTICIPANTS

Licensed drivers who were involved in a police-attended motor vehicle crash in British Columbia over a 17-year study interval (2000-16).

EXPOSURES

Incident schizophrenia was identified using hospitalisation and physician services data. Antipsychotic adherence was estimated using prescription fill data to calculate the 'medication possession ratio' (MPR) in the 30 days prior to crash.

PRIMARY OUTCOME MEASURES

We deemed drivers 'responsible' or 'non-responsible' for their crash by applying a validated scoring tool to police-reported crash data. We used logistic regression to evaluate the association between crash responsibility and exposures of interest.

RESULTS

Our cohort included 808 432 drivers involved in a police-attended crash and for whom crash responsibility could be established. In total, 1689 of the 2551 drivers with schizophrenia and 432 430 of the 805 881 drivers without schizophrenia were deemed responsible for their crash, corresponding to a significant association between schizophrenia and crash responsibility (66.2% vs 53.7%; adjusted OR (aOR), 1.67; 95% CI, 1.53 to 1.82; p<0.001). The magnitude of this association was modest relative to established crash risk factors (eg, learner license, age ≥65 years, impairment at time of crash). Among the 1833 drivers with schizophrenia, near-optimal antipsychotic adherence (MPR ≥0.8) in the 30 days prior to crash was not associated with lower crash responsibility (aOR, 1.04; 95% CI, 0.83 to 1.30; p=0.55).

CONCLUSIONS

Crash-involved drivers with schizophrenia are more likely to be responsible for their crash, but the magnitude of risk is similar to socially acceptable risk factors such as older age or possession of a learner license. Contemporary driving restrictions for individuals with schizophrenia appear to adequately mitigate road risks, suggesting more stringent driving restrictions are not warranted.

Distracted on duty: A theory-based exploration of influences leading to mobile phone distracted riding among food delivery workers

Using mobile phones while riding is a form of distracted riding that significantly elevates crash risk. Regrettably, the factors contributing to mobile phone use while riding (MPUWR) among food delivery riders remain under-researched. Addressing this literature gap, the current study employs the Job Demands-Resources (JD-R) model and various socio-economic factors to examine the determinants of MPUWR. The research incorporates data from 558 delivery workers in Hanoi and Ho Chi Minh City, Vietnam. The study utilizes two analytical methods to empirically test the hypotheses, considering non-linear relationships between variables: Partial Least Square Structural Equation Modelling (PLS-SEM) and Artificial Neural Network (ANN). The results reveal mixed impacts of factors connected to job resources. Although social support appears to deter MPUWR, work autonomy and rewards seemingly encourage it. Furthermore, a predisposition towards risk-taking behaviour significantly impacts the frequency of mobile phone usage among delivery riders. Interestingly, riders with higher incomes and those who have previously been fined by the police exhibit more frequent mobile phone use. The findings of this study present valuable insights into the crucial factors to be addressed when designing interventions aimed at reducing phone use among food delivery riders.

Do comparative judgements affect the perceived relevance of mobile phone road safety campaigns?

OBJECTIVE

Given the prevalence of illegal mobile phone use while driving and reliance upon messaging campaigns in deterring the behavior, there is a need to explore to what extent comparative judgements may influence desired outcomes of such campaigns. This exploratory study investigated (a) the perceived relevance and influence of different mobile phone road safety campaigns within a sample of Queensland motorists who reported using their mobile phone while driving and (b) if these varied depending on whether participants believed that their crash risk whilst using a phone was higher (comparative pessimism), lower (comparative optimism) or similar to the same-age and sex driver.

METHODS

A total of 350 licensed drivers residing within Queensland (Australia) were included in this study, of which 200 reported using their hand-held phone on some occasion. Participation involved completing a 20-25 min online anonymous survey, which included viewing three mobile phone road safety campaigns (injury-based, sanction-based and humor) and responding to questions about the perceived relevance and impact of each campaign.

RESULTS

A total of 64 (32%) participants displayed comparative optimism, 50 displayed similar judgements (25%) and 86 (43%) exhibited comparative pessimism. First, it was found that the injury-based campaign was perceived to be significantly more relevant than the humor campaign. Second, whilst the relevance of each campaign did not vary as a function of group membership, the campaigns were significantly less relevant to those displaying comparative optimism relative to those with similar judgements and comparative pessimism. Finally, the injury-based campaign was perceived to be significantly more influential than the other campaigns. However, overall, participants displaying comparative optimism believed that they would be less influenced by the campaigns compared to those with comparative pessimism.

CONCLUSIONS

Although preliminary, these findings suggest that low perceptions of risk may dilute or extinguish the desired behavioral outcomes of mobile phone road safety campaigns. Nonetheless, experimental research is needed to examine these effects directly.

Syncope While Driving and the Risk of a Subsequent Motor Vehicle Crash

STUDY OBJECTIVE

Syncope that occurs while driving can result in a motor vehicle crash. Whether individuals with a prior syncope-related crash exhibit an exceptional risk of subsequent crash remains uncertain.

METHODS

We performed a population-based retrospective observational study of patients diagnosed with 'syncope and collapse' at any of 6 emergency departments in British Columbia, Canada (2010 to 2015). Data were obtained from chart abstraction, administrative health records, insurance claims and police crash reports. We compared crash-free survival among individuals with crash-associated syncope (a crash and an emergency visit for syncope on the same date) to that among controls with syncope alone (no crash on date of emergency visit for syncope).

RESULTS

In the year following their index emergency visit, 13 of 63 drivers with crash-associated syncope and 852 of 9,160 controls with syncope alone experienced a subsequent crash as a driver (crash risk 21% versus 9%). After accounting for censoring and potential confounders, crash-associated syncope was not associated with a significant increase in the risk of subsequent crash (adjusted hazard ratio [aHR] 1.38, 95% confidence interval [CI] 0.78 to 2.47). Individuals with crash-associated syncope were 31-fold more likely to have physician driving advice documented during their index visit (prevalence ratio 31.0, 95% CI, 21.3 to 45.1). In the subgroup without documented driving advice, crash-associated syncope was associated with a significant increase in subsequent crash risk (aHR 1.88, 95% CI 1.06 to 3.36).

CONCLUSIONS

Crash risk after crash-associated syncope appears similar to crash risk after syncope alone.

Personality, perceptions and behavior: A study of speeding amongst drivers in Victoria, Australia

INTRODUCTION

Road crashes present a serious public health issue. Many people are seriously or fatally injured every year in avoidable crashes. While these crashes can have multiple contributing factors, including road design and condition, vehicle design and condition, the environment and human error, the performance of illegal driving behavior, including speeding, may also play a role. The current study aimed to examine the mediating influence that four potential deterrents (perceptions towards enforcement, crash risk, social norms and disapproval, and negative personal/emotional affect) have between the Big Five personality traits (conscientiousness; extraversion; agreeableness; neuroticism; openness) and expectations to speed.

METHODS

A total of 5,108 drivers in Victoria, Australia completed an online survey in 2019. A mediated regression analysis was used to examine pathways in a conceptual model developed for the study.

RESULTS

The results showed that perceptions towards the four potential deterrents examined did mediate the relationship (either completely or partially) between personality and expectations to speed.

CONCLUSIONS

The results of this study suggest that if interventions to deter illegal driving behavior are to be successful, one factor that could be taken into account is the personality traits of drivers who may be at greatest risk of the performance of illegal driving behaviors.

Key factors associated with parents' illegal engagement with their smartphones while driving their children

This study aimed to examine the key factors associated with parents' and caregivers' illegal engagement with their smartphones while driving with their children aged 10 years and younger. Five hundred and ten participants completed an online survey (M = 40.4 years, SD = 6.9, Range = 20.0-69.0 years; Female: 79.2%). Most participants reported that they 'never' accessed social media, talked or composed a text on their smartphone (while handheld) while driving with their children (88.0%, 85.3%, and 80.0%, respectively). However, it was interesting to note that more than one-quarter of the sample reported that they had read a text message or used an app on their handheld smartphone while driving their children (36.3%, and 28.6%, respectively). The results of a logistic regression model showed that participants': age, severity of nomophobia (the fear of being without a mobile phone), and self-reported engagement in other risky driving behaviours (i.e., errors, violations) were significantly associated with illegal engagement with their smartphone while driving their child aged 10 years and younger. With the growing prevalence of mobile phone use and the impact of distraction due to child occupants, it is important to consider the compounded effect of these factors on driver performance, as well as the influence of driver risk-taking behaviour while engaging with smartphones and the consequences of this on children who observe this behaviour.

Analysis of Risky Riding Behavior Characteristics of the Related Road Traffic Injuries of Electric Bicycle Riders

Electric bicycle (EB) riders, being vulnerable road users (VRUs), are increasingly becoming victims of road traffic injuries (RTIs). This study aimed to determine the current status and epidemiological characteristics of RTIs among EB riders through a questionnaire survey and roadside observations in Shantou to provide a scientific basis for the prevention and control of electric bicycle road traffic injuries (ERTIs). A total of 2412 EB riders were surveyed, and 34,554 cyclists were observed in the study. To analyze the relationship between riding habits and injuries among EB riders, chi-square tests and multi-factor logistic regression models were employed. The findings reveal that the prevalence of ERTIs in Shantou was 4.81%, and the most affected group was children under 16 years old, accounting for 9.84%. Risky behavior was widespread among EB riders, such as the infrequent wearing of safety helmets, carrying people on EBs, riding on sidewalks, and listening to music with headphones while bicycling. Notably, over 90% of those who wore headphones while bicycling engaged in this risky behavior. The logistic regression analysis showed that honking the horn (odds ratio (OR): 2.009, 95% CI: 1.245-3.240), riding in reverse (OR: 4.210, 95% CI: 2.631-6.737), and continuing to ride after a fault was detected (OR: 2.010, 95% CI: 1.188-3.402) all significantly increased the risk of ERTIs (all p < 0.05). Risky riding behavior was significantly less observed at traffic intersections with traffic officers than at those without (all p < 0.001).

Syncope and subsequent traffic crash: A responsibility analysis

BACKGROUND

Physicians are often asked to counsel patients about driving safety after syncope, yet little empirical data guides such advice.

METHODS

We identified a population-based retrospective cohort of 9,507 individuals with a driver license who were discharged from any of six urban emergency departments (EDs) with a diagnosis of 'syncope and collapse'. We examined all police-reported crashes that involved a cohort member as a driver and occurred between 1 January 2010 and 31 December 2016. We categorized crash-involved drivers as 'responsible' or 'non-responsible' for their crash using detailed police-reported crash data and a validated responsibility scoring tool. We then used logistic regression to test the hypothesis that recent syncope was associated with driver responsibility for crash.

RESULTS

Over the 7-year study interval, cohort members were involved in 475 police-reported crashes: 210 drivers were deemed responsible and 133 drivers were deemed non-responsible for their crash; the 132 drivers deemed to have indeterminate responsibility were excluded from further analysis. An ED visit for syncope occurred in the three months leading up to crash in 11 crash-responsible drivers and in 5 crash-non-responsible drivers, suggesting that recent syncope was not associated with driver responsibility for crash (adjusted odds ratio, 1.31; 95%CI, 0.40-4.74; p = 0.67). However, all drivers with cardiac syncope were deemed responsible, precluding calculation of an odds ratio for this important subgroup.

CONCLUSIONS

Recent syncope was not significantly associated with driver responsibility for traffic crash. Clinicians and policymakers should consider these results when making fitness-to-drive recommendations after syncope.

Identifying distracted-driving events from on-road observations using a moving vehicle: A case study in New Jersey

Distracted driving is a major traffic safety concern in the USA. To observe and detect distracted-driving events, various methods (e.g., surveys, videos, and simulations) involving the collection of cross-sectional data from individual subjects have been used in the transportation field. In this study, we employed an unconventional approach of on-road observations using a moving vehicle to collect data on distracted-driving events for multiple subjects in New Jersey. A data-collection crew member continuously navigated selected corridors to record driver-distraction events. A GPS (Global Positioning System) tracker was used to timestamp and record the location of each incident. Two non-parametric tests (Mann-Whitney U test and Kruskal-Wallis test) were performed to identify the significance of the variations in distracted-driving behaviors due to changes in temporal variables (e.g., day of the week, season), the type of roadway, and the geometric properties of the roadway. The results indicated that cellphone use was the leading type of distraction. Additionally, "handheld phone use (phone to ear)," "fidgeting/grooming," "drinking/eating/smoking," and "talking to passengers" events were significantly affected by the time of day and the geometric properties of the roadway. The results of this study are expected to assist state and local agencies in promoting awareness of distracted driving with the aim of reducing the frequency and severity of distracted driving-related crashes.

Estimate of the magnitude of risky and protective behaviors associated with road traffic injuries in capitals participating in the Life in Traffic Project of Brazil

BACKGROUND

Brazil occupies the fifth position in the ranking of the highest mortality rates due to RTI in the world. With the objective of promoting traffic safety and consequently reducing deaths, Brazil created the Life in Traffic Project (LTP). The main goal of LTP is reducing 50% of RTI deaths, by promoting interventions to tackle risk factors, such as driving under the influence of alcohol and excessive and/or inappropriate speed. Thus, the aim of this study was to estimate the magnitude of risky and protective factors for RTI in capitals participating in the LTP in Brazil. We estimated these factors according to sociodemographic (age group, sex, education, race and, type of road user).

METHODS

A total of 5,922 car drivers and motorcyclists from 14 Brazilian capitals participating in the LTP were interviewed. Data collection was carried out in sobriety checkpoints at night and consisted of the administration of an interview and a breathalyzer test. Risky and protective behaviors associated with RTI were investigated. Covariates of the study were: age, sex, education, race and, type of road user. Poisson multiple regression analysis was used to assess the relationship between variables of interest.

RESULTS

The prevalence of individuals with positive blood alcohol concentration (BAC) was 6.3% and who reported driving after drinking alcohol in the last 30 days was 9.1%. The others risky behaviors reported were: driving at excessive speed on roads of 50 km/h, using a cell phone for calls while driving, using a cell phone to send or read calls while driving, running a red light. Use of seatbelts and helmets showed prevalence above 96,0% Use of seatbelts showed prevalence of 98.6% among car drivers, and helmet use was described by 96.6% of motorcycle drivers. Most risky behaviors were more prevalent in younger age groups (except BAC measurement higher in older participants), in males (except for cell phone use), in participants with higher education level and without a driver's license.

CONCLUSION

Excessive speed and driving under the influence of alcohol, defined as priorities within the LTP, need more consistent interventions, as they still have considerable prevalence in the cities investigated. The factors described such as cell phone usage and passing red traffic lights should also need to be prioritized as a focus on promoting traffic safety.

Distraction impairs drivers of all ages: A cross-sectional analysis of fatal crashes in the United States

Objective: The objective of this study was to examine the association between distracted driving and crash responsibility across the whole age span after adjusting for several driver characteristics and the potential influence of alcohol and drugs.Methods: Using data from the Fatality Analysis Reporting System for the years 2010 to 2019, we estimated the association between distracted driving and crash responsibility in drivers (of passenger-type vehicles) aged 20 and older, with a confirmed blood alcohol concentration of zero, and who tested negative for drugs (n = 33,513). We operationalized crash responsibility as having one or more unsafe driving action (UDA) recorded.Results: In total, slightly under 9% of the drivers examined were coded as distracted. The most common UDA among distracted drivers was a failure to yield right of way (23.4% vs. 14.2% for non-distracted drivers). Driving distracted was associated with higher odds of an UDA for drivers of all ages (overall OR = 1.46, 95% CI = 1.24, 1.73).Conclusions: Distracted driving affects drivers of all ages. Given that distracted driving is highly preventable, we must increase our prevention efforts.

Analysis of distracted driving crashes in New Jersey using mixed logit model

INTRODUCTION

Distracted driving is a concern for traffic safety in the 21st century, and can be held responsible for the increasing propensity and severity of traffic crashes. With the advent of mobile technologies, distractions involving the use of cellphones while driving have emerged, and young drivers in particular are getting more and more engaged in these distractions. Texting or receiving phone calls while driving are offenses in most states, and they are punished with fiscal penalties. Awareness campaigns have also been arranged over recent decades across the United States in order to minimize crashes due to distracted driving. The severity of such crashes depends on driver behavior, which can also be affected by various factors like the geometric design of the roadway, lighting and environmental conditions, and temporal variables.

METHOD

In this study, we analyzed data on five years (2015-2019) of crashes involving cellphone use in New Jersey using a mixed logit model. As estimated model parameters can vary randomly across roadway segments in this approach, this allowed us to account for unobserved heterogeneities relating to roadway characteristics, environmental factors, and driver behavior. A pseudo-elasticity analysis was further employed to observe the sensitivity of the significant explanatory variables to crash severity.

RESULTS

We found that higher speed limits and a larger total number of vehicles involved both increased crash severity, while higher annual average daily traffic (AADT) levels and the presence of an urban road setting reduced it.

PRACTICAL APPLICATIONS

These findings will help decision-makers to comprehend what the significant contributing factors associated with crash injury severity due to distracted driving are, and how to implement necessary interventions to reduce this severity.

Versatile, but not focused, traffic offenders are more likely to be at fault for a fatal crash

INTRODUCTION

The aim of this study was to determine whether drivers who had received more traffic infringements were more likely to be at fault for the crash in which they were killed.

METHOD

The current dataset was derived from the crash and traffic history records provided by the Queensland Department of Transport and Main Roads and Coroner's Court for every driver, with available records, who was killed in a crash in Queensland, Australia, between 2011 and 2019 (N = 1,136). The most common traffic offenses in the current sample were speeding, disobeying road rules, driving under the influence of drugs and alcohol, and unlicensed driving. Logistic regression models were used to compute odds ratios for the number of overall offenses, the number of specific offense types, and for specific offending profiles that were derived from the literature. Age, gender, and crash type were each controlled for by entering them into the initial blocks of the regression models.

RESULTS

After accounting for the variance associated with age, gender, and crash type, only the overall number of offenses and the number of unlicensed driving offenses predicted a significant change in a drivers' likelihood of being at fault for the crash that killed them. Furthermore, drivers who were identified as having versatile (i.e., multiple offenses from different categories) or criminal-type offense profiles (i.e., offenses that were considered to approximate criminal offenses) were each significantly more likely to be at fault for a fatal crash.

PRACTICAL APPLICATIONS

This study provided an important contribution by demonstrating how a more nuanced approach to understanding how a driver's traffic history might be used to identify drivers who are more at risk of being involved in a crash (i.e., for which they were at fault). The implications of these findings are discussed with recommendations and consideration for future research.

Risk Factors for Road-Traffic Injuries Associated with E-Bike: Case-Control and Case-Crossover Study

The Electric Bike (EB) has become an ideal mode of transportation because of its simple operation, convenience, and because it is time saving, economical and environmentally friendly. However, electric bicycle road-traffic injuries (ERTIs) have become a road-traffic safety problem that needs to be solved urgently, bringing a huge burden to public health. In order to provide basic data and a theoretical basis for the prevention and control of ERTIs in Shantou, mixed research combining a case-control study and a case-crossover study was carried out to investigate the cycling behavior characteristics and injury status of EB riders in Shantou city, and to explore the influencing factors of ERTI. The case-control study selected the orthopedic inpatient departments of three general hospitals in Shantou. The case-crossover study was designed to assess the effect of brief exposure on the occurrence of ERTIs, in which each orthopedic inpatient serves as his or her own control. Univariable and multivariable logistic regressions were used to examine the associated factors of ERTIs. In the case-control study, multivariable analysis showed that chasing or playing when cycling, finding the vehicle breakdown but continuing cycling, not wearing the helmet, and retrograde cycling were risk factors of ERTIs. Compared with urban road sections, suburb and township road sections were more likely to result in ERTIs. Astigmatism was the protective factor of ERTI. The case-crossover study showed that answering the phone or making a call and not wearing a helmet while cycling increased the risk of ERTIs. Cycling in the motor-vehicle lane and cycling on the sidewalk were both protective factors. Therefore, the traffic management department should effectively implement the policy about wearing a helmet while cycling, increasing the helmet-wearing rate of EB cyclists, and resolutely eliminate illegal behaviors such as violating traffic lights and using mobile phones while cycling. Mixed lanes were high-incidence road sections of ERTIs. It was suggested that adding people-non-motor-vehicles/motor vehicles diversion and isolation facilities in the future to ensure smooth roads and safety would maximize the social economic and public health benefits of EB.

Risk of Accidents or Chronic Disorders From Improper Use of Mobile Phones: A Systematic Review and Meta-analysis

Background

Mobile phone use has brought convenience, but the long or improper use of mobile phones can cause harm to the human body.

Objective

We aimed to assess the impact of improper mobile phone use on the risks of accidents and chronic disorders.

Methods

We systematically searched in PubMed, EMBASE, Cochrane, and Web of Science databases for studies published prior to April 5, 2019; relevant reviews were also searched to identify additional studies. A random-effects model was used to calculate the overall pooled estimates.

Results

Mobile phone users had a higher risk of accidents (relative risk [RR] 1.37, 95% CI 1.22 to 1.55). Long-term use of mobile phones increased accident risk relative to nonuse or short-term use (RR 2.10, 95% CI 1.63 to 2.70). Compared with nonuse, mobile phone use resulted in a higher risk for neoplasms (RR 1.07, 95% CI 1.01 to 1.14), eye diseases (RR 2.03, 95% CI 1.27 to 3.23), mental health disorders (RR 1.16, 95% CI 1.02 to 1.32), and headaches (RR 1.25, 95% CI 1.18 to 1.32); the pooled risk of other chronic disorders was 1.20 (95% CI 0.90 to 1.59). Subgroup analyses also confirmed the increased risk of accidents and chronic disorders.

Conclusions

Improper use of mobile phones can harm the human body. While enjoying the convenience brought by mobile phones, people have to use mobile phones properly and reasonably.

Mobile phone applications use while driving in Ukraine: Self-reported frequencies and psychosocial factors underpinning this risky behaviour

Despite the fact that mobile phones have been transformed over the last decade into information and communication hubs that are fundamental to modern life, there is little information on how this has impacted on mobile phone use while driving. The present study was conducted in Ukraine, where this risky behaviour remains a common driving practice, despite legislative bans. A total of 220 (male = 82%; mean age = 35.53; SD = 10.54) drivers completed an online survey assessing frequency of engaging in a range of mobile phone applications while driving. Four variables of the theory of planned behaviour (general attitude and intention towards phone use while driving, social norms towards mobile phone use, perceived behavioural control, the specific beliefs about being able to engage in distracting activities and drive safely), and type A behaviour pattern were also collected. The results showed that, during the last year, 65% of drivers had read a text message and 49% had written a text using mobile phone applications. Likewise, a substantial proportion of the sample reported using social media while driving, by checking (34%), sending or typing a post (25%) on social network applications. Hierarchical stepwise regressions showed that a positive attitude towards mobile phone use while driving and beliefs about being able to drive safely and write or read a text message were significantly associated with the mobile phone applications use while driving. No associations were found between the type A behaviour pattern and mobile phone applications use.

Mobile phone use among car drivers and motorcycle riders: The effect of problematic mobile phone use, attitudes, beliefs and perceived risk

Mobile phone use while driving presents significant risks, potentially leading to injury or death through distracted driving. Using a case study of Vietnam, this research aimed to understand the effect of problematic mobile phone use (also known as mobile phone addiction or compulsive mobile phone use), attitudes and beliefs, and perceived risk on the frequency of mobile phone use among motorcyclists and car drivers. A self-administered questionnaire was distributed to motorcyclists (n₁= 529) and car drivers (n₂= 328) using an online survey and face-to-face survey. The survey took around 20-min to complete and participants were entered into a lottery for supermarket vouchers. Of the motorcyclists, 42% of the sample (the highest proportion) was in the 18-25 age group while the 36-45 age group accounted for the highest proportion among car drivers (34.8%). Using structural equation modelling (SEM), key findings showed that each construct influenced mobile phone use, but in different ways for motorcycle riders and car drivers. Attitudes and beliefs had the largest effect on mobile phone use while riding among motorcyclists, with problematic mobile phone use having the smallest influence. In contrast, problematic mobile phone use had the largest effect on mobile phone use while driving a car, with attitudes and beliefs having the smallest effect. The findings of this study point to the need for tailored interventions involving a range of actors (policymakers, police enforcement, mental health professionals, advocacy groups and the wider community) to raise awareness, modify attitudes and increase risk perception associated with mobile phone use while driving/riding. This can be achieved thorough educational tools and road safety campaigns which are focused on reducing this risky driving behaviour. This includes customising road safety programs for individuals and groups affected by problematic mobile phone use such as targeted advertising.

Serious motor vehicle collisions involving young drivers on Norwegian roads 2013-2016: Speeding and driver-related errors are the main challenge

Objective: Motor vehicle collisions (MVCs) are a leading cause of death and acute disability among young adults worldwide. We performed a prospective study of young drivers involved in severe MVCs, investigating the critical events leading up to a collision with an emphasis on driver-related factors and collision culpability. Methods: A study was conducted in southeastern Norway of all drivers younger than 25 years who were involved in high-energy MVCs resulting in immediate hospitalization during 2013-2016. Collision investigators evaluated the exterior and interior of the motor vehicle (MV) within 24 h. Complementary information was obtained from interviews of collision victims, ambulance personnel and witnesses, from police reports, and medical records.Results: There were 145 young drivers included during a 3-year study period, representing an estimated incidence of 29 per 100,000 drivers with registered driving licenses. Ninety-two percent (133/145) were considered culpable of initiating the MVC, and only 2% of the critical factors preceding the collision were not related to the driver. There were 74% (108/145) males, the median MV (motor vehicle) age age was 14 years, and 86% (125/145) of the MVs were passenger cars. The MVCs predominantly occurred on rural roads (90%, 130/145). Among the culpable drivers, speeding behavior was the main predisposing factor in 80% (106/133) of the collisions. Driving at excessive speed was associated with single-vehicle collisions (87%, 74/85) and the presence of passengers (89%, 56/63). Compared to nonculpable drivers, culpable drivers were more often younger than 21years (66% vs 33%, p = 0.031), had obtained their license less than 2 years previously (68% vs 20%, p = 0.004), and were more likely to have been drinking or using drugs (27% vs 0%, p = 0.039). The overall rate of seatbelt use was 79% (114/145).Conclusion: The vast majority of injury-causing MVCs involving young drivers are initiated by those drivers. These incidents are characterized by male drivers with little driving experience who are operating old cars on rural roads at excessive speeds. Driving under the influence of alcohol or drugs is also not uncommon. These issues should be targeted in future preventive measures.

Near crash characteristics among risky drivers using the SHRP2 naturalistic driving study

PROBLEM

Previous research have focused extensively on crashes, however near crashes provide additional data on driver errors leading to critical events as well as evasive maneuvers employed to avoid crashes. The Strategic Highway Research Program 2 (SHRP2) Naturalistic Driving Study contains extensive data on real world driving and offers a reliable methodology to study near crashes. The current study utilized the SHRP2 database to compare the rate and characteristics associated with near crashes among risky drivers.

METHODS

A subset from the SHRP2 database consisting of 4,818 near crashes for teen (16-19 yrs), young adult (20-24 yrs), adult (35-54 yrs), and older (70+ yrs) drivers was used. Near crashes were classified into seven incident types: rear-end, road departure, intersection, head-on, side-swipe, pedestrian/cyclist, and animal. Near crash rates, incident type, secondary tasks, and evasive maneuvers were compared across age groups. For rear-end near crashes, near crash severity, max deceleration, and time-to-collision at braking were compared across age.

RESULTS

Near crash rates significantly decreased with increasing age (p < 0.05). Young drivers exhibited greater rear-end (p < 0.05) and road departure (p < 0.05) near crashes compared to adult and older drivers. Intersection near crashes were the most common incident type among older drivers. Evasive maneuver type did not significantly vary across age groups. Near crashes exhibited a longer time-to-collision at braking (p < 0.01) compared to crashes.

SUMMARY

These data demonstrate increased total near crash rates among young drivers relative to adult and older drivers. Prevalence of specific near crash types also differed across age groups. Timely execution of evasive maneuvers was a distinguishing factor between crashes or near crashes. Practical Applications: These data can be used to develop more targeted driver training programs and help OEMs optimize ADAS to address the most common errors exhibited by risky drivers.

Assessing the impact of the 2015 introduction of increased penalties and enhanced public awareness and enforcement activities on texting while driving among adults in Ontario, Canada

Objective: Texting while driving (TWD) is considered a particularly hazardous form of distracted driving. It is highly prevalent among young drivers, but fewer studies of TWD among adult drivers exist and these prevalence rates may approach those of younger drivers. The effectiveness of measures to prevent distracted driving, and TWD specifically, is unclear. On September 1, 2015, Ontario introduced increased penalties for distracted driving accompanied by public education programs to increase public awareness of the new regulations. Provincial police also introduced enhanced enforcement efforts. The current study examined self-reported TWD in a representative sample of Ontario adults before and after introduction of the new legislation and the enhanced public education and enforcement efforts.Methods: Data were based on telephone interviews with 1,846 respondents who reported having driven in the past year. Data were derived from the 2015-2016 cycles of the Centre for Addiction and Mental Health (CAMH) Monitor, an ongoing cross-sectional telephone survey of adults aged 18+ years in Ontario, Canada. A binary logistic regression analysis of TWD in the previous 30 days was conducted, adjusting for demographic characteristics (sex, age), driving exposure, and introduction of the legislation (before versus after).Results: The proportion of the sample reporting TWD declined significantly from 37.6% before the law was introduced to 24.2% after the law was introduced. The impact appeared to be most pronounced among drivers who reported TWD more frequently. Adjusted odds of TWD declined 42% following introduction of the legislation and associated enhanced public education and enforcement.Conclusions: These results identify a decrease in TWD following the introduction of enhanced penalties with corresponding public education and enforcement efforts, adding to the existing evaluative evidence base to inform transportation safety policy. These results also support the need to examine TWD and its determinants among all age groups.

Association Between Mobile Telephone Interruptions and Medication Administration Errors in a Pediatric Intensive Care Unit

IMPORTANCE

Incoming text messages and calls on nurses' mobile telephones may interrupt medication administration, but whether such interruptions are associated with errors has not been established.

OBJECTIVE

To assess whether a temporal association exists between mobile telephone interruptions and subsequent errors by pediatric intensive care unit (PICU) nurses during medication administration.

DESIGN, SETTING, AND PARTICIPANTS

A retrospective cohort study was performed using telecommunications and electronic health record data from a PICU in a children's hospital. Data were collected from August 1, 2016, through September 30, 2017. Participants included 257 nurses and the 3308 patients to whom they administered medications.

EXPOSURES

Primary exposures were incoming telephone calls and text messages received on the institutional mobile telephone assigned to the nurse in the 10 minutes leading up to a medication administration attempt. Secondary exposures were the nurse's PICU experience, work shift (day vs night), nurse to patient ratio, and level of patient care required.

MAIN OUTCOMES AND MEASURES

Primary outcome, errors during medication administration, was a composite of reported medication administration errors and bar code medication administration error alerts generated when nurses attempted to give medications without active orders for the patient whose bar code they scanned.

RESULTS

Participants included 257 nurses, of whom 168 (65.4%) had 6 months or more of PICU experience; and 3308 patients, of whom 1839 (55.6%) were male, 1539 (46.5%) were white, and 2880 (87.1%) were non-Hispanic. The overall rate of errors during 238 540 medication administration attempts was 3.1% (95% CI, 3.0%-3.3%) when nurses were uninterrupted by incoming telephone calls and 3.7% (95% CI, 3.4%-4.0%) when they were interrupted by such calls. During day shift, the odds ratios (ORs) for error when interrupted by calls (compared with uninterrupted) were 1.02 (95% CI, 0.92-1.13; P = .73) among nurses with 6 months or more of PICU experience and 1.22 (95% CI, 1.00-1.47; P = .046) among nurses with less than 6 months of experience. During night shift, the ORs for error when interrupted by calls were 1.35 (95% CI, 1.16-1.57; P < .001) among nurses with 6 months or more of PICU experience and 1.53 (95% CI, 1.16-2.03; P = .003) among nurses with less than 6 months of experience. Nurses administering medications to 1 or more patients receiving mechanical ventilation and arterial catheterization while caring for at least 1 other patient had an increased risk of error (OR, 1.21; 95% CI, 1.03-1.42; P = .02). Incoming text messages were not associated with error (OR, 0.97; 95% CI, 0.92-1.02; P = .22).

CONCLUSIONS AND RELEVANCE

This study's findings suggest that incoming telephone call interruptions may be temporally associated with medication administration errors among PICU nurses. Risk of error varied by shift, experience, nurse to patient ratio, and level of patient care required.

Driver and road characteristics associated with child pedestrian injuries

BACKGROUND

Child pedestrians make up a significant proportion of all road traffic deaths. Our primary objective was to examine the association of driver characteristics with child pedestrian injuries with a secondary objective to broadly describe the road characteristics surrounding these collisions.

METHODS

We included drivers involved in child (<18 years old) pedestrian motor-vehicle collisions (PMVCs) in Calgary and Edmonton, Alberta (2010-2015). These drivers were compared with not at fault (Alberta adaptation of a Canadian culpability scoring tool) drivers involved in vehicle-only collisions. The data were analyzed with unconditional logistic regression.

RESULTS

Seven hundred ninety-three drivers collided with 826 children. One quarter of child PMVC drivers were 40-54 years old (25.2%). Younger drivers, 16-24 (adjusted odds ratio [aOR] = 1.62, 95% CI: 1.27-2.09), and older drivers, ≥55 (aOR = 1.57, 95% CI: 1.24-1.99) were more likely to be involved in a child PMVC. Time of day between 06:01 - 09:00 (aOR = 1.46, 95% CI: 1.16-1.85) and 18:01 - 24:00 (aOR = 1.68, 95% CI: 1.30-2.17), no seatbelt use (aOR = 2.30, 95% CI: 1.09-4.85), having a child passenger in the vehicle (aOR = 2.15, 95% CI: 1.56-2.96), and impairment including 'had been drinking' (aOR = 7.70, 95% CI: 2.85-20.86) and 'fatigued/asleep/medical defect' (aOR = 27.15, 95% CI: 8.30-88.88) were also associated with being a driver involved in a child PMVC.

CONCLUSIONS

Age, time, impairment and distraction were risk factors for being a driver involved in a child PMVC. Because child PMVC driver characteristics differ from the general driver population, driver-based interventions are a rational additional means of preventing child PMVCs.

Acute sleep deprivation and culpable motor vehicle crash involvement

Study Objectives

To quantify the relationship between acute sleep deprivation and culpable involvement in motor vehicle crashes.

Methods

Participants were 6845 drivers involved in a representative sample of crashes investigated by the US Department of Transportation in years 2005-2007. A modified case-control study design was used to compare self-reported hours of sleep in the 24 hr before crashing between drivers deemed culpable versus nonculpable. Analyses controlled for fatigue-related, driver-related, and environmental factors. Specific errors that led to crashes were also examined.

Results

Drivers who reported having slept for 6, 5, 4, and less than 4 hr in the 24 hr before crashing had 1.3 (95% confidence interval [CI] = 1.04 to 1.7), 1.9 (1.1 to 3.2), 2.9 (1.4 to 6.2), and 15.1 (4.2 to 54.4) times the odds, respectively, of having been culpable for their crashes, compared with drivers who reported 7-9 hr of sleep. Drivers who had slept less than 4 hr had 3.4 (95% CI = 2.1 to 5.6) times the increase in odds of culpable involvement in single-vehicle crashes compared with multiple-vehicle crashes. Recent change in sleep schedule, typically feeling drowsy upon waking, and driving for 3+ hr were also associated with culpability (all p ≤ 0.013). Assuming nonculpable drivers comprised a representative sample of all drivers present where crashes occurred, these odds ratios approximate incidence rate ratios for culpable crash involvement per unit of time driving.

Conclusions

Driving after having slept less than 7 hr in a 24 hr period is associated with elevated risk of culpable crash involvement. Risk is greatest for drivers who have slept less than 4 hr and is manifested disproportionately in single-vehicle crashes.

The Association between Mobile Phone Use and Severe Traffic Injuries: A Case-Control Study from Saudi Arabia

Road traffic injury (RTI) is the third leading cause of death in Saudi Arabia. Using a mobile phone when driving is associated with distracted driving, which may result in RTIs. Because of limited empirical data, we investigated the association between mobile phone use and RTI in injured patients and community controls in Riyadh. Cases were patients admitted to King Abdulaziz Medical City (KAMC) between October 2016 and March 2018 due to RTIs. During admission, mobile phone use at the time of the accident was investigated. The controls were drivers observed at various locations citywide. A logistic regression model was constructed to estimate the association between mobile phone use while driving and sustaining RTIs. We included 318 cases and 1700 controls. For the cases, using a mobile phone was associated with higher severity and prevalence of disability. In addition, using a mobile phone while driving is associated with 44% higher odds of incurring a severe RTI (p = 0.04). Mobile phone use while driving is prevalent in Riyadh and pose a significant threat of disability. In addition, the low prevalence of seatbelt use is alarming and requires significant improvement. Prevention programs may use these findings to educate the public and policymakers and to advocate for increased visibility of enforcement to reduce RTIs and improve population health.

Factors related to cell phone use while driving based on the Theory of Planned Behavior among university students in Kerman, Iran

Background:

There is a paucity of research examining the pattern of and factors that influence cell phone use while driving in Iran. This study aimed to report the prevalence of and factors related to cell phone use while driving based on the Theory of Planned Behavior, among a sample of college students in Iran.

Methods:

This cross-sectional study was conducted in Kerman, Iran, in 2016. Participants volunteered to participate after the study was advertised. We used the Texting While Driving questionnaire (TWD) based on the theory of planned behavior for data collection and used SPSS 22 to calculate linear regression and Pearson correlation coefficients.

Results:

Two hundred and fifty-seven (n=257) students completed the questionnaire. Participants were between the ages of 18 and 47 years; 54.4% were females; 52.1% were single; 47.1% were undergraduate students, and 47.9% did not work. There was a significant relationship between intention toward sending and reading text messages while driving and gender, attitude, subjective norm, Perceived Behavioral Control (PBC), and moral norm. Also, there was a significant relation between willingness to send and read text messages while driving and PBC, subjective norm, group norm, and moral norm. For intention, personal factors were involved, and willingness was affected by both personal factors and friend/peer groups.

Conclusions:

Texting while driving is prevalent among college students in Kerman; and intention and willingness to do this, is affected by several factors. Our findings suggest needs for the individual and peer- group training, and increasing awareness about the dangers of using cell phones while driving among this sample.

Adaptation of a Canadian culpability scoring tool to Alberta police traffic collision report data

Objective: The objective of this study was to adapt a previously validated Canadian Culpability Scoring Tool (CCST) to Alberta police report data. Methods: Police traffic collision reports from motor vehicle (MV) collisions in Calgary and Edmonton (Alberta, Canada) from 2010 to 2014 were used. Adaptation of the CCST was completed with input from personnel within Alberta Transportation, contributing to face and content validity. Two research assistants, given only the information necessary for scoring, evaluated 175 randomly selected MV-MV collisions. Interrater agreement was estimated using kappa (k) and reported with 95% confidence intervals (CIs). Discussion of disagreements between the research assistants and consultation from Alberta Transportation informed the algorithm used in the Alberta Motor Vehicle Collision Culpability Tool (AMVCCT). The AMVCCT was automated and applied to all motorists involved in collisions. Binary logistic regression was used to examine characteristics of the culpable and nonculpable drivers and their effects were reported using odds ratios (ORs) with 95% CIs. Results: Interrater agreement for the random sample was excellent (k = 0.95; 95% CI, 0.92-0.99). Of those drivers hospitalized, 1,130 (37.54%) were rated not culpable and 1,880 (62.46%) were rated culpable. The odds of being culpable were higher for males than for females (OR = 1.43; 95% CI, 1.23-1.66). The odds of being culpable were higher in those impaired by alcohol than those considered "apparently normal" (OR = 61.10; 95% CI, 22.66-164.75). The odds of being deemed culpable, when compared with drivers >54 years old, were higher for those <25 years old (OR = 1.72; 95% CI, 1.35-2.20) and lower for those in the 40- to 54-year-old age group (OR = 0.78; 95% CI, 0.63-0.96). Driving between 12 a.m. and 6 a.m. resulted in higher odds of being culpable compare with all other 6-h time blocks. Direction and statistical significance remained consistent when applying the tool to all MV collisions. Sensitivity analysis including the removal of single vehicle collisions did not affect the direction or statistical significance of the main results. Conclusions: The AMVCCT identified a culpable group that exhibited characteristics expected in drivers who are at fault in collisions. The age groups 25-39 and 40-54 demonstrated different results than the CCST. However, this is the only difference that exists in the findings of the AMVCCT compared to the CCST and could exist due to differences between the driving populations in Alberta and British Columbia. It is possible to adapt the CCST to provinces outside British Columbia and, in doing so, we can identify risk factors for collision contribution and not-at-fault drivers who represent the driving population.

Exploring the impact of "soft blocking" on smartphone usage of young drivers

Smartphone usage while driving, and particularly texting, are well recognized as a major road safety concern. This paper presents an attempt to evaluate the effect of countermeasures aimed at mitigating this usage. These countermeasures, which are automatically activated, may be considered "soft blockers": silencing and hiding notifications, as well as sending an automatic reply to the person trying to contact the driver. A naturalistic study was conducted with 167 young Israeli drivers, who installed a research-oriented smartphone app, which continuously monitored their smartphones usage while driving and, in addition, activated "soft blocking" in the study's intervention stage. The evaluation is based on measures which capture the number of times drivers "touch" their smartphone screens, and on the vehicle's speed when these screen-touches occur. The results, based on 6633 hours of driving logged on 23,019 trips, indicate that a reduction of approximately 20% was obtained in the average number of screen-touches during the intervention stage of the study; that is, in the experimental groups but also in the control group, which was merely monitored. In addition, when young drivers touched the screen, the vehicle was more likely not in motion. The current paper highlights the potential of "soft blockers", as well as the awareness of being monitored, for mitigating smartphone usage while driving.

Novel Smartphone-Based Measures of Cell Phone Use While Driving in a Sample of Newly Licensed Adolescent Drivers

BACKGROUND

Motor vehicle crashes are the leading cause of adolescent death. Cell phone use while driving is a contributor to adolescent motor vehicle crash risk. Objective and directly observable measures of cell phone use while driving are needed to implement interventions aimed at reducing cell phone-related crash risk.

AIMS

To describe novel smartphone-based measures of cell phone use while driving in a sample of newly licensed male and female adolescent drivers.

METHODS

Newly licensed adolescents in Pennsylvania installed a windshield-mounted device that pairs with a smartphone application to collect data on cell phone use while driving over 2 weeks during June 2016-October 2016. Descriptive statistics, independent t tests, and Wilcoxin Mann-Whitney U test were used to characterize handheld cell phone use ("unlock") and call time while accounting for driving exposure.

RESULTS

Data from 16 adolescents (50% male) resulted in 5,624 miles in 705 trips, 964 cell phone unlocks, and 146.22 minutes of call time. Participants had a mean of 23.96 unlocks/100 miles ( SD = 22.97), 1.23 unlocks/trip ( SD = 0.96), and 4.87 unlocks/hour driven ( SD = 3.93). Males had significantly more unlocks/100 miles, unlocks at speed >25 mph/100 miles, unlocks/hour driven, and unlocks at speed > 25 mph/hour driven ( p < .05).

CONCLUSIONS

Smartphone-based applications are an innovative means by which to collect continuous data on cell phone use while driving that can be used to better understand and intervene on this frequent behavior in newly licensed adolescent drivers.

The driver-level crash risk associated with daily cellphone use and cellphone use while driving

This study examined the overall prevalence of cellphone use, including the rates of calls and texts both per day and hourly while driving, and assessed whether or not individual crash risk was correlated with cellphone use. The study used data from the Second Strategic Highway Research Program Naturalistic Driving Study (SHRP 2 NDS), which had more than 3500 participants who provided up to three years of driving data. Of these participants, 620 provided cellphone records, 564 of which included both call and text records. The prevalence of cellphone calls and texts per day was calculated. By overlaying the cellphone records with the SHRP 2 NDS data, we also evaluated the rates of calls and texts while driving by driver demographics. Crashes for these cellphone-using participants were also identified from the SHRP 2 NDS data. Negative binomial regression models were used to determine whether the crash rate was associated with cellphone use. Participants made an average of 27.1 texts and 7.3 calls per day. They averaged 1.6 texts and 1.2 calls per hour of driving. Cellphone use varied significantly by age, especially for texting. The texting rate for drivers aged 16-19 was 59.4 per day and 2.9 per hour of driving, four times higher than the 14.3 per day and 1.0 per hour for drivers 30-64 years old. The texting rate for drivers 20-29 years old was also high at 42.4 per day and 2.6 per hour of driving. Participants experienced 243 crashes in 216,231 h of driving. It was found that those who texted more often per day or per hour of driving had higher crash rates after adjusting for age and gender effects. The severe crash rate increases 0.58% for every additional text per day and all 8.3% for every text per hour of driving; overall crash rate increases 0.41% for every additional text per day and 6.46% for every text per hour of driving. The results show that cellphone texting and calling are quite common while driving. The texting rate for young drivers is substantially higher than for middle-aged and senior drivers. This study confirmed that those who text at a higher rate are associated with a higher crash risk.

The effects of age on crash risk associated with driver distraction

Background

Driver distraction is a major contributing factor to crashes, which are the leading cause of death for the US population under 35 years of age. The prevalence of secondary-task engagement and its impacts on distraction and crashes may vary substantially by driver age.

Methods

Driving performance and behaviour data were collected continuously using multiple cameras and sensors in situ for 3542 participant drivers recruited for up to 3 years for the Second Strategic Highway Research Program Naturalistic Driving Study. Secondary-task engagement at the onset of crashes and during normal driving segments was identified from videos. A case-cohort approach was used to estimate the crash odds ratios associated with, and the prevalence of, secondary tasks for four age groups: 16-20, 21-29, 30-64 and 65-98 years of age. Only severe crashes (property damage and higher severity) were included in the analysis.

Results

Secondary-task-induced distraction posed a consistently higher threat for drivers younger than 30 and above 65 when compared with middle-aged drivers, although senior drivers engaged in secondary tasks much less frequently than their younger counterparts. Secondary tasks with high visual-manual demand (e.g. visual-manual tasks performed on cell phones) affected drivers of all ages. Certain secondary tasks, such as operation of in-vehicle devices and talking/singing, increased the risk for only certain age groups.

Conclusions

Teenaged, young adult drivers and senior drivers are more adversely impacted by secondary-task engagement than middle-aged drivers. Visual-manual distractions impact drivers of all ages, whereas cognitive distraction may have a larger impact on young drivers.

Falling asleep at the wheel and distracted driving. The High-Risk Professional Drivers study

Background:

Sleepiness at the wheel and driving while engaged in other activities are well known risk factors for traffic accidents. This article estimates the prevalence of these factors among Italian Professional Drivers (PDs) and their impact on reported driving mistakes.

Methods:

A cross-sectional study was conducted using anonymous questionnaires. PDs (n=497) were divided into two groups: high-risk PDs (HiRis_PDs) (those who self-reported more than one incident during the last 3 years and/or more than one mistake during the past year) and non-HiRis_PDs (subjects who did not meet the above-mentioned inclusion criteria). Logistic regression analyses were performed to assess the association of self-reported sleepiness and/or risky driving behaviour with the condition of being a high-risk driver.

Results:

161 (32.4%) subjects were defined as HiRis_PDs. Forty-one percent of the interviewees experienced at least one episode per month of sudden-onset sleep at the wheel. Twenty-eight point two percent reported a regular use of a hand-held cell phone. Predictive factors for being HiRis_PDs were: at least one self-reported episode per month of falling asleep at the wheel [odds ratio (OR) 5, 95% confidence interval (CI) 3.21-7.80, P<0.001], driving while regularly engaged in other activities (mainly hand-held cell phone use) (OR 6.11, 95% CI 2.90-12.84, P<0.001), and young age (OR 0.96, OR 1 year of age increase, 95% CI 0.94-0.98, P=0.001).

Conclusions:

Focusing prevention efforts on recognizing sleepiness at the wheel and on avoiding other distracting activities while driving can reduce the possibility of driving errors on the road by about 5-6 times.

Distraction-related road traffic collisions

OBJECTIVES

We aimed to prospectively study distraction-related road traffic collision injuries, their contributory factors, severity, and outcome.

METHODS

Data were prospectively collected on all hospitalized road traffic collision trauma patients in Al-Ain City who were drivers at the collision time over one and half years. Driver's inattentive behaviors preceding the collision were collected by interviewing the admitted drivers.

RESULTS

There were 444 drivers, 330 of them were fully oriented patients, out of them only 44 (13%) were distracted. Nineteen (5.8%) drivers were distracted by using mobile phones, 12 (3.6%) were pre-occupied with deep thinking, six (1.8%) were talking with other passengers, four (1.2%) were picking things in the vehicle, and three (0.9%) were using entertainment systems. The maximum distraction occurred during the time of 6 am - 12 noon when the traffic was crowded. There were no significant differences between distracted and non-distracted drivers in demographical and physiological factors, injured regions, and outcomes.

CONCLUSION

Distraction of alert drivers causes 13% of road traffic collisions in Al-Ain city. About 40 percent of the distracted drivers involved in road traffic collisions (RTC) were using mobile phones. Our study supports the ban of use of cell phones while driving.

Frequency, causes and human impact of motor vehicle-related road traffic accident (RTA) in Lubumbashi, Democratic Republic of Congo

OBJECTIVES

Road traffic accident (RTA)-related trauma remains a public health issue. The aim of this study was to determine the frequency, causes and human impact of motor vehicle-related RTA in Lubumbashi, Democratic Republic of Congo.

METHODS

A prospective cross-sectional study was conducted in the first semester of the year 2015 in which 288 drivers (144 RTA-causing drivers and 144 control drivers who have been declared not guilty by road safety agents) involved in 144 motor vehicle-related RTA were interviewed, and only data on all RTA involving two motor vehicles with at least four wheels were recorded and analyzed.

RESULTS

Results showed a total of 144 RTA that involved two motor vehicles with four wheels occurring during the study period which affected 104 people, including 93 injury and 11 fatality cases. The mean age of RTA-causing drivers was 33.8 ± 7.4, whereas it was 35 ± 8.8 for control drivers. The majority of RTA-causing drivers (53.4 %) did not attend a driving school. Over speeding (32 %), distracted driving (22 %), overtaking (16 %) and careless driving/risky maneuver (15 %) and driving under the influence of alcohol (9 %) were the main causes of RTA occurrence. In addition, the absence of a valid driving license [aOR = 12.74 (±2.71); 95 % CI 3.877-41.916; p = 0.015], unfastened seat belt for the RTA-causing driver [aOR = 1.85 (±0.62); 95 % CI 1.306-6.661; p = 0.048] and presence of damages on RTA-causing vehicle [aOR = 33.56 (24.01); 95 % CI 1.429-78.352; p = 0.029] were associated with the occurrence of RTA-related fatality.

CONCLUSION

This study showed a relatively high frequency of RTA occurring in Lubumbashi and suggests the necessity to reinforce road traffic regulation.

Student motorcyclists' mobile phone use while driving in Vientiane, Laos

To investigate mobile phone use while driving among student motorcyclists in Laos, we conducted a school-based questionnaire survey in central Vientiane in May 2014. Of the 883 high school students who reported to drive motorcycles at least once a week, 40% have ever used phones while driving motorcycles in both sexes. Those phone users had longer driving exposures than non-users, with about half engaging in phone use while driving at least 2 days a week and 70% engaging for 1 min or longer on an average day. They reported not just talking on the phone while driving but operating the phone such as dialling and text-messaging. In some instances, phone use was reportedly involved in their past crash experiences. To formulate a sound policy on this emerging distracting behaviour among motorcyclists, its contribution to the occurrence of overall crashes among motorcyclists should be investigated.

Declining trends in injuries and ambulance calls for road traffic crashes in Bahrain post new traffic laws of 2015

Road traffic crashes (RTC) are of serious global health concern. To identify whether the number of ambulance calls, injuries, and deaths has declined after the implementation of the new traffic law (NTL) 2015 in Bahrain, de-identified administrative RTC data obtained from the tertiary care center, and the General Directorate of Traffic (GDT) of Bahrain were used. A quasi-experimental design was employed to trend the impact of the NTL on RTC and associated healthcare events. Bahrainis and non-Bahrainis who met with RTC, either in a vehicle or as a pedestrian, between February 8 and May 8 in 2013, 2014 (pre NTL), and 2015 (post NTL) were included in the study. Our results show a reduction in the number of ambulance calls from vehicular and pedestrian RTC victims. The ambulance calls from pedestrian RTC victims were <10% compared to the number of ambulance calls from vehicular RTC victims. There was a significant reduction in minor injuries post 2015, whereas no obvious difference was seen for serious injuries and deaths. A longer follow-up study to confirm the sustained decline in RTC, enforcing a zero tolerance policy toward traffic transgressions, and raising public awareness on the “critical four minutes” and “golden hour” is recommended.

Improving the Understanding of Psychological Factors Contributing to Horse-Related Accident and Injury: Context, Loss of Focus, Cognitive Errors and Rigidity

While the role of the horse in riding hazards is well recognised, little attention has been paid to the role of specific theoretical psychological processes of humans in contributing to and mitigating risk. The injury, mortality or compensation claim rates for participants in the horse-racing industry, veterinary medicine and equestrian disciplines provide compelling evidence for improving risk mitigation models. There is a paucity of theoretical principles regarding the risk of injury and mortality associated with human-horse interactions. In this paper we introduce and apply the four psychological principles of context, loss of focus, global cognitive style and the application of self as the frame of reference as a potential approach for assessing and managing human-horse risks. When these principles produce errors that are combined with a rigid self-referenced point, it becomes clear how rapidly risk emerges and how other people and animals may repeatedly become at risk over time. Here, with a focus on the thoroughbred racing industry, veterinary practice and equestrian disciplines, we review the merits of contextually applied strategies, an evolving reappraisal of risk, flexibility, and focused specifics of situations that may serve to modify human behaviour and mitigate risk.

Do as I say, not as I do: Distracted driving behavior of teens and their parents

INTRODUCTION

Driver distraction is an important contributor to crash risk. Teenage driver distraction can be influenced by the attitudes and behaviors of parents. This study examined teens' and their parents' engagement in distracting behavior while driving.

METHOD

Survey data were collected from a national sample of 403 parent-teen dyads using random-digit dialing telephone interviews.

RESULTS

Results demonstrated few parent or teen sex differences in distracting behavior engagement while driving, or in their perceptions of each others' behavior. Parents and teens' frequencies of distracting behavior engagement were positively correlated. Parents' and teens' perceptions of each others' distracting behavior engagement while driving exceeded their own selfreports. Finally, the likelihood that teens reported engaging in distracting behavior while driving was more strongly associated with their perceptions of their parents' distracting behavior than by parents' self reports of their own behavior.

CONCLUSIONS

These results suggest that parents' examples of driving behavior are an important influence on teen driving behavior, but potentially more important are teens' perceptions of their parents' behaviors.

Do we really need to use our smartphones while driving?

Smartphone usage while driving, a prominent type of driver distraction, has become a major concern in the area of road safety. Answers to an internet survey by 757 Israeli drivers who own smartphones were analyzed with focus on two main purposes: (1) to gain insights regarding patterns of smartphone usage while driving and its motivation, (2) to probe drivers' views on the perceived risk and the need to use smartphones while driving, as well as their willingness to use blocking apps that limit such usages. Phone calls and texting were found to be the most common usages while driving, hence, both were chosen to be further analyzed. 73% (N=551) of the respondents make phone calls while driving and almost half of them may be considered frequent callers as they admit to do it intensively while driving. As for texting, 35% of the respondents (N=256) text while driving and a quarter of them do so frequently. While phone calls were perceived to compromise safety by 34% of the users, texting was perceived to compromise safety by 84% of the users. However, we found that drivers place limitations on themselves as more than 70% avoid texting when they think they need to devote attention to driving. A logistic regression model indicates that perceived need and perceived safety are significant factors associated with being a frequent smartphone phone calls user, but only perceived need significantly predicts being a frequent texting user. Approximately half of all the respondents are willing to try an app which blocks smartphone usage while driving. The willingness to use such technology was found to be related primarily to perceived need. Less significant factors are work-related usage and perceived safety. Frequency of usage was not found to affect this willingness, indicating that it should not be a factor in designing and implementing interventions to limit smartphone usage while driving.