Emotional Stress and Traffic Accidents

Impact of COVID-19 pandemic on road traffic injuries in Iran: An interrupted time-series analysis

INTRODUCTION

Globally, the COVID-19 pandemic has affected the number of road accidents and deaths caused by them. The present study aimed to identify the effect of this epidemic on traffic accidents and their casualties in Iran.

METHODS

In this study, Interrupted Time Series Analysis (ITSA) was used in a semi-experimental design to measure the impact of the restrictive policies of COVID-19 on road accidents. Data were collected retrospectively from the Iran Red Crescent Society data set for 31 provinces from March 2017 to February 2022. The information related to the number of road accidents, injuries, deaths, and deaths in the hospital was collected. The Newey-West method is used for estimation. Statistical analyses were carried out using R software version 3.6.1.

RESULTS

Since February 2020 in Iran, the reduction in the number of road accidents and the number of injuries and deaths in these accidents was significant at 5% but the reduction of deaths in the scene and hospital was significant at 10%. In general, for all variables, the reduction trend was established only in the first months, and then it had an upward trend.

CONCLUSION

In the early months of the COVID-19 epidemic in Iran, the number of road accidents and their casualties decreased. Policies restricting traffic, quarantine, and fines for violators can be reasons for changing people's behavior and travel patterns and also lead to a reduction in traffic accidents and fatalities. Such studies can explain the importance of the policies in changing behavioural patterns and can be used as a guide in future policies.

Adult attention-deficit/hyperactivity disorder traits in healthy adults associated with brain volumetric data identify precuneus involvement in traffic crashes

This large-scale study including 2548 healthy adults with no clinical attention-deficit/hyperactivity disorder (ADHD) diagnosis intended to clarify the complex relationships between cerebral grey matter volumes (GMVs), ADHD traits, and driving safety behaviours. Path analysis of magnetic resonance imaging (MRI) results and questionnaires about ADHD traits and traffic crashes over the past decade revealed significant correlations of ADHD traits with different brain regions relevant to different cognitive functions. The left precuneus responsible for visuospatial cognition was the sole region correlated with all ADHD trait categories, suggesting it plays an important role in understanding driving safety and traffic crashes. For the first time, a strong relationship was found among regional GMVs, ADHD traits, and real-life traffic crashes. These insights into the complex interplay may inform the development of an effective intervention with MRI examination to prevent traffic crashes. Large-scale brain volumetric data may further open social applications of behaviour science and neuroimaging.

Individual prediction of motor vehicle accidents for patients with epilepsy

The objective of the study was to design a clinically useful tool to predict the risk of seizure-related motor vehicle accidents (MVAs) for people with epilepsy (PWE). Participants were patients who visited our epilepsy center in West China Hospital from October 2012 to October 2019 and were divided into a primary cohort and a validation cohort. Ultimately, we included 525 patients in the primary cohort and 86 patients in the validation cohort. Proportional hazard regression was performed to measure the prognostic factors of car accidents. The outcome was used to create a nomogram model. The final model had 7 factors, with a C-index of 0.85 (95% CI, 0.80-0.91), to predict the possibility of non-MVA for PWE. For the validation cohort, the C-index was 0.83 (95% CI, 0.72-0.95). This nomogram model can offer more individualized advice to PWE who are still driving by estimating the risk of car accidents.

COVID-19, lockdowns and motor vehicle collisions: empirical evidence from Greece

Reduced mobility during COVID-19 lockdowns means not only fewer vehicles at risk of collision, but also an opportunity to speed on empty streets. The objective of this paper is to examine the impact of the first wave of the pandemic and the first lockdown on motor vehicle collisions (MVCs) and associated injuries and deaths in Greece. Using monthly data at the regional unit level, I provide descriptive evidence and subsequently follow a difference-in-differences econometric approach, comparing trends in 2020 with those of the previous 5 years while controlling for unemployment and petrol prices. I found a steep decline in collisions, injuries and deaths compared with what would have been otherwise expected. In March and April 2020, there were about 1226 fewer collisions, 72 fewer deaths, 40 fewer serious injuries and 1426 fewer minor injuries compared with what would have been expected in the absence of the pandemic.

The association between demographic characteristics, personality, and mental health of bus drivers in China: A structural equation model

BACKGROUND

The psychological status of drivers is related to adverse driving behaviors. Although there are several studies on the mental health and traffic accidents among bus drivers, related studies on the association between mental health and individual characteristics are scarce.

METHODS

Our report is on a cross-sectional study of bus drivers that took place between October 2014 and May 2016. A total of 596 bus drivers who worked for transportation companies and underwent occupational physical examinations at The Guangxi Zhuang Autonomous Region workers' Hospital during the study period were included. Demographic characteristics were collected by a self-designed demographic questionnaire. The Eysenck Personality Questionnaire (EPQ) and the Symptom Checklist 90-Revised (SCL-90-R) were used to evaluate the personality and mental health of bus drivers, and the results of the scales were compared with Chinese norms. The structural equation model was used to analyze the correlation among demographic characteristics, personality characteristics, and mental health.

RESULTS

Except for the lie dimension, the average scores of the driver's personality dimension were higher than the Chinese norm, and the means of somatization and phobia scores of bus drivers were also higher; obsessions-compulsions, interpersonal sensitivity, and depression scores were lower than those for the Chinese norms. The structural equations modeling revealed that the total effects coefficient of demographic characteristics on mental health was 0.68, and that of personality was 0.60. There were direct influences between demographic characteristics and personality characteristics, demographic characteristics and mental health, and personality characteristics and mental health; the standardized path coefficients were 0.60, 0.50, and 0.30, respectively. Smoking, drinking, and neuroticism were the main factors affecting the mental health of bus drivers; and the standardized path coefficients were 0.56, 0.54, and 0.90 respectively.

CONCLUSIONS

In this study, bus drivers were significantly more extroverted, psychotic, and neurotic than the general population; and they were more likely to suffer from somatization and phobia. The mental health of bus drivers was associated with some demographic and personality characteristics in the study. These findings provide a theoretical basis for the selection of bus drivers and intervention measures for drivers with high-risk driving tendencies, which is conducive to better guide road traffic safety construction and reduce the occurrence of road traffic injuries.

A copula-based approach for jointly modeling crash severity and number of vehicles involved in express bus crashes on expressways considering temporal stability of data

The consequences of crashes, including injury, loss of lives, and damage to properties, are further worsened when buses plying expressways are involved in the crash. Previous studies have separately analyzed crash severity in terms of monetary cost, injuries and loss of lives, and the size of crashes in terms of the number of vehicles involved. However, as both outcome variables are correlated, it is imperative to perform a combined analysis using an appropriate econometric model to achieve a better model fit. This study contributes to the literature by jointly exploring the factors influencing the severity and size of express bus-involved crashes that occur on expressways and characterizes the dependence between both outcome variables by employing a more plausible copula regression framework. Likelihood ratio tests were also conducted to investigate the temporal stability of the factors that affect both crash severity and size. Based on the goodness-of-fit statistics, the Frank copula model proved superior to the independent ordered probit model. The estimate of the underlying dependence between the outcome variables provided a better comprehension of the correlation between them. Temporal instability was detected for the individual parameters in the models and is attributed to the changing driving behavior due to the heightened road safety campaigns. The results suggest that traffic exposure measures are significantly associated with a higher propensity of observing increased bus crash severity and size. Insights into the factors influencing the size and severity of express bus crashes are discussed, and appropriate engineering, enforcement, and education-related countermeasures are proposed.

Socio-Demographic Determinants of Road Traffic Fatalities in Women of Reproductive Age in the Republic of Georgia: Evidence from the National Reproductive Age Mortality Study (2014)

Purpose

Globally and in the European region, the road traffic injuries (RTI) have emerged as a major public health and development problem, killing the most productive adult members of a population, including women. This study aimed to identify the key socio-demographic determinants of premature and avoidable RTI mortality in reproductive-aged women (15–49 years) in Georgia.

Materials and Methods

The study employed verbal autopsy data from the second national reproductive age mortality survey (RAMOS 2014). Univariate and multivariate logistic regression models were fitted using the Firth method to assess the crude and adjusted effects of each individual level socio-demographic factor on the odds of RTI-attributed death, with corresponding 95% confidence intervals (COR and AOR, 95% CI).

Results

Of 843 women aged 15–49 years, 78 (9.3%) were the victims of fatal traffic crashes. After multivariate adjustment, the odds of dying from RTI were significantly higher in women aged 15–29 years (AOR=7.73, 95% CI= 4.20 to 14.20), those being employed (AOR=2.11, 95% CI= 1.22 to 3.64) and the wealthiest (AOR=2.88, 95% CI= 1.44 to 5.77) compared, respectively, to their oldest (40–49 years), unemployed and poorest counterparts. Conversely, there were no statistically significant ethnic, marital, rural/urban, and educational disparities in women’s RTI fatalities. Overall, motorized four-wheeler occupants (78.2%), particularly passengers (71.8%), appeared to be the most common victims of fatal road injuries than pedestrians (20.5%). Alarmingly, the vast majority (85.9%) of any type of road users died instantly at the scene of collision, as compared to deaths en route to hospital (1.3%) or in hospital (11.5%).

Conclusion

Age, employment, and wealth status appeared to be the strong independent predictors of young women’s RTI mortality in Georgia. Future comprehensive research would be advantageous for further deciphering the differential impact of social determinants on traffic-induced fatalities, as a vital platform for evidence-based remedial actions on this predictable and preventable safety hazard.

Mental disorders and medical conditions associated with causing injury or death: A population-based study

The aim of the present study is to examine mental disorders and medical conditions associated with causing harm to another person in the general adult population. The sample (n=22,138) was drawn from a cross-sectional survey designed to characterize mental health needs in France. Twelve-month DSM-IV axis I mental disorders and medical conditions, and lifetime occurrence of potentially traumatic events were assessed with the Composite International Diagnostic Interview-SF Overall, 2% (n=430) of the sample reported having injured or killed someone. Causing harm was associated with male gender, lower education level, and being unemployed. The great majority (85%) of those who caused harm had experienced two or more additional potentially traumatic events. When adjusting for gender, employment status, education and number of events experienced, causing harm was associated with certain anxiety disorders, drug dependence and lifetime suicide attempt but not with major depression or post-traumatic stress disorder. Furthermore, causing harm was not associated with medical conditions in multivariate analyses. These results highlight the need for clinicians to be particularly attentive to the psychological burden that may be experienced by those who have harmed or killed someone.

Uncovering the behaviour of road accidents in urban areas

Different patterns in the incidence of road accidents are revealed when considering areas with increased levels of urbanization. To understand these patterns, road accident data from England and Wales is explored. In particular, the data are used to (i) generate time series for comparison of the incidence of road accidents in urban as opposed to rural areas, (ii) analyse the relationship between the number of road accidents and the population size of a set of urban areas, and (iii) model the likelihood of suffering an accident in an urban area and its dependence with population size. It is observed that minor and serious accidents are more frequent in urban areas, whereas fatal accidents are more likely in rural areas. It is also shown that, generally, the number of accidents in an urban area depends on population size superlinearly, with this superlinear behaviour becoming stronger for lower degrees of severity. Finally, given an accident in an urban area, the probability that the accident is fatal or serious decreases with population size and the probability that it is minor, increases sublinearly. These findings promote the question as to why such behaviours exist, the answer to which will lead to more sustainable urban policies.

Testing the Effectiveness of a Mixed-Method Pilot Intervention in Reducing Risky Driving Due to Aggression and Stress

The study aimed at testing the effectiveness of a mixed-method pilot intervention in reducing risky self-reported driving performance, upon addressing stress and aggression while driving. The study recruited individuals who had performed these behaviors during the year preceding the study and allocated them into an intervention (n = 10) and a control group (n = 30). A pre-and postintervention evaluation design was employed to explore changes in risky self-reported driving behaviors, 12 months after the intervention. The intervention involved 2 h of experiential instruction and 1 h of cognitive restructuring using a driving simulator and scenarios appropriate for the processing of driving stress, aggression, and risk. The intervention group displayed significant improvements in the scales of “Hazard Monitoring” (p = 0.037) and “Covered Violations” (p = 0.049) at the postintervention level. No statistically significant differences were identified in terms of self-reported driving performance between the intervention and the control group at postintervention level. Launching large-scale experimental surveys with broadened cognitive restructuring approaches seems important to deepen our understanding of the behavioral change processes and increase the effectiveness of future interventions.

Psychotic experiences and accidents, injuries, and poisonings among adults in the United States

Psychotic experiences (PEs) have been linked to an increased risk for accidents and injuries. However, this association remains little researched in many countries. To address this research gap, the current study used cross-sectional data from the United States to examine the association between PEs and accidents, injuries, and poisoning in a general population sample. Data were analyzed from 2274 individuals who completed the psychosis screen as part of the National Comorbidity Survey Replication (NCS-R). Information was obtained on PEs (hallucinations and delusions) and the experience of past 12-month accidents, injuries, and poisoning. Logistic regression analysis was used to examine the association while adjusting for demographic variables and common mental disorders (CMDs). In a fully adjusted model past 12-month PEs were associated with almost three times higher odds for reporting accidents, injuries, and poisoning (odds ratio [OR]: 2.97, 95% confidence interval [CI]: 1.13-7.74). The results of this study indicate that PEs are associated with higher odds for accidents and injuries among adults in the United States. Research is now needed to determine the direction of this association and the factors linked to it.

Endogenous commercial driver's traffic violations and freight truck-involved crashes on mainlines of expressway

Freight truck-involved crashes result in a high mortality rate and significantly impact logistic costs; therefore, many researchers have analyzed the causes of truck-involved traffic crashes. In the existing literature, it was found that truck-involved crashes are affected by factors such as road geometry, weather, driver and vehicle characteristics, and traffic volume based on a variety of statistical methodologies; however, the endogenous impact resulting from driver traffic violation has not been considered. The goal of the study is to discover the factors influencing freight vehicle crashes and develop more accurate crash probability estimation by explaining the endogenous driver traffic violations. To achieve the purpose of this study, we applied the two-stage residual inclusion (2SRI) approach, a methodology used in the nonlinear regression analysis model for capturing the endogeneity issue. This method improves the accuracy of the model by capturing the unobserved effects of driver traffic violations. From the results, traffic violations were identified to be influenced by the driver's physical condition, as well as driver and vehicle characteristics. Furthermore, variables of driver traffic violations such as improper passing, speeding, and safe distance violation were found to be endogenous in the probability model of freight truck crashes on expressway mainlines.

The relative risk of motor vehicle collision on cannabis celebration day in Great Britain

Cannabis celebration day, also known as "420 day", takes place at 4:20pm on April 20 every year. The objective of this paper is to study whether there is an increase in road traffic collisions in Great Britain on that day. We used daily car crash data resulting in death or injury from all 51 local police forces covering Great Britain over the period 2011-2015. We compared crashes from 4:20pm onwards on April 20 to control days on the same day of the week in the preceding and succeeding two weeks, using panel data econometric models. On the average cannabis celebration day in Britain, there were an additional 23 police-reported collisions compared to control days, corresponding to a 17.9% increase in the relative risk of collision.

An exploratory study of long-haul truck drivers' secondary tasks and reasons for performing them

Research on drivers has shown how certain visual-manual secondary tasks, unrelated to driving, increase the risk of being involved in crashes. The purpose of the study was to investigate (1) if long-haul truck drivers in Sweden engage in secondary tasks while driving, what tasks are performed and how frequently, (2) the drivers' self-perceived reason/s for performing them, and (3) if psychological factors might reveal reasons for their engaging in secondary tasks. The study comprised 13 long-haul truck drivers and was conducted through observations, interviews, and questionnaires. The drivers performed secondary tasks, such as work environment related "necessities" (e.g., getting food and/or beverages from the refrigerator/bag, eating, drinking, removing a jacket, face rubbing, and adjusting the seat), interacting with a mobile phone/in-truck technology, and doing administrative tasks. The long-haul truck drivers feel bored and use secondary tasks as a coping strategy to alleviate boredom/drowsiness, and for social interaction. The higher number of performed secondary tasks could be explained by lower age, shorter driver experience, less openness to experience, lower honesty-humility, lower perceived stress, lower workload, and by higher health-related quality of life. These explanatory results may serve as a starting point for further studies on large samples to develop a safer and healthier environment for long-haul truck drivers.

The short-term impact of economic uncertainty on motor vehicle collisions

Stress and anxiety lead to attention loss and sleep deprivation and may reduce driving performance, increasing the risk of motor vehicle collision. We used evidence from a natural experiment to examine whether daily changes in economic uncertainty, potentially leading to attention or sleep loss, are associated with collisions in Great Britain. Daily data from the economic policy uncertainty index, derived from analysis of daily UK newspapers, were linked to the daily number of motor vehicle collisions in Great Britain over the period 2005-2015, obtained from the Department for Transport. Exploiting daily variations in economic uncertainty, we used a GARCH approach to model daily rates of motor vehicle collisions as a function of economic uncertainty, controlling for month and day of the week, monthly unemployment rates and weekly unleaded petrol prices. A spike in the daily economic uncertainty index was associated with an immediate increase in the number of motor vehicle collisions. Results were robust to various sensitivity analyses. Overall, daily increases in economic uncertainty are associated with short-term spikes in motor vehicle collisions. Preventive and traffic control measures may need to increase during periods of economic uncertainty.

The joint effect of personality traits and perceived stress on pedestrian behavior in a Chinese sample

While improper pedestrian behavior has become an important factor related to road traffic fatalities, especially in developing countries, the effects of personality traits and/or stress on pedestrian behavior have been rarely reported. The current study explored the joint effects of five personality traits (i.e., extraversion, openness, neuroticism, normlessness and altruism) and global perceived stress (measured with the Perceived Stress Scale-10) on pedestrian behavior (measured with the Pedestrian Behavior Scale) in 311 Chinese individuals. Results showed that altruism, neuroticism and openness significantly affected different pedestrian behavior dimensions, while global perceived stress also significantly and positively predicted positive behavior. Moreover, the effect of neuroticism on positive behavior was fully mediated by stress. Some explanations and implications are provided in the discussion section.

New opioid analgesic use and the risk of injurious single-vehicle crashes in drivers aged 50-80 years: A population-based matched case-control study

BACKGROUND

the increasing trend in opioid analgesic use among older drivers has raised concerns about their risk of being involved in car crashes.

AIM

to investigate if older drivers who started using opioid analgesics have a higher probability of being involved in injurious crashes.

METHODS

population-based matched case-control study. Data from population registers were merged using a personal identity number. Cases were drivers aged 50-80 years responsible for a single vehicle crash between 01.07.05 and 31.12.09 that led to at least one injured passenger (n = 4,445). Four controls were randomly matched to each case by sex, birth month/year, and residence area from persons holding a valid driving license who did not crash during the study period. New use was defined as at least one dispensation within 1-30 days prior to the crash, but none within the previous 31-180 days; frequent use when ≥3 dispensations were given within 0-180 days, with at least one within 31-180 days. Individuals using 1-2 non-opioid analgesic medications were used as reference category. Conditional logistic regression was used to estimate odds ratios (OR; 95% CI) adjusting for benzodiazepine use, co-morbidity, civil status and occupation.

RESULTS

adjusted odds for new use were two-fold that of drivers using 1-2 non-opioid analgesics medications (2.0; 1.6-2.5). For frequent use, adjusted odds were also increased regardless of number of dispensations (3-4 = 1.7; 1.3-2.1, 5-6 = 1.6; 1.2-2.3, and ≥7 = 1.7; 1.3-2.1).

CONCLUSION

new, but also frequent opioid analgesic use, resulted in an increased probability of single vehicle crashes. While more epidemiologic evidence is needed, patients could be advised to refrain from driving when using opioid analgesics.

Validation of the Driver Stress Inventory in China: Relationship with dangerous driving behaviors

Perceived stress while driving may affect how critical driving events are handled. The current study validates a Chinese version of the Driver Stress Inventory (DSI) and explores its correlation with dangerous driving behaviors and gender. A sample of 246 drivers completed the Chinese version of the DSI and the Driver Behavior Questionnaire (DBQ). We also evaluated specific sociodemographic variables and traffic violations (including speeding, violating traffic signs or markings, driving while intoxicated, running a red light, and incurring penalty points). A confirmatory factor analysis (CFA) verified the DSI's internal structure. The DSI was also validated using questionnaires related to the DBQ, self-reported traffic accidents and violations, and sociodemographic characteristics. First, all of the DSI dimensions were moderately or weakly correlated with the DBQ subscales. Second, aggression, hazard monitoring and fatigue were weakly correlated with minor accidents. Third, drivers who had sped and violated traffic signs during the previous three years reported higher aggression and thrill seeking, while drivers who had violated traffic signs or markings during the previous three years reported decreased hazard monitoring compared with non-offenders. Finally, there were significant gender differences in driver stress. The Chinese version of the DSI will be useful for classifying and diagnosing drivers who may be at an increased risk for stress reactions.

Risky driving among UK regular armed forces personnel: changes over time

OBJECTIVES

To compare the prevalence of self-reported risky driving in a sample of UK military personnel at 2 different time points (2004 and 2009), and to identify the incidence of new onset risky driving and possible determinants of becoming a new risky driver.

METHODS

Data were used from 2 phases of a military cohort study investigating the health and well-being of UK military personnel between 2004 and 2009. Participants were included if they were undertaking regular (rather than reserve) engagements, had completed both surveys and reported being a driver at both surveys. Univariable and multivariable logistic regression analyses were performed to examine the relationship between risky driving status and sociodemographic and military characteristics. Data analysis was conducted in 2011.

RESULTS

The prevalence of risky driving reduced from 18% to 14%, over an average of 3.3 years. The incidence of new onset risky driving was 7%. Predictors for becoming a new risky driver were: younger age, not being in a relationship at phase 2 and harmful alcohol use. Those deployed after 2007 were less likely to become risky drivers following deployment, compared with those deployed before 2007 (adjusted OR 0.62 (95% CI 0.40 to 0.95)).

CONCLUSIONS

The prevalence of becoming a risky driver appears to have reduced over time. This paper suggests a number of explanations for this reduction, including changes in the way that the UK military have dealt with road safety with the introduction of the road safety campaign (in 2007).

The effect of stress and personality on dangerous driving behavior among Chinese drivers

The relationship between stress and road safety has been studied for many years, but the effect of global stress and its joint effect with personality on driving behavior have received little attention in previous studies. This study aimed to elucidate the impact of global stress and various personality traits on driving behavior. 242 drivers completed the Perceived Stress Scale-10 (PSS-10), the Dula Dangerous Driving Index (DDDI), and several personality trait scales related to anger, sensation seeking, and altruism. The results showed that perceived stress and sensation seeking were significantly correlated with the four subcategories of dangerous driving behavior, namely, negative cognitive/emotional driving (NCED), aggressive driving (AD), risky driving (RD), and drunk driving (DD). Moreover, anger was positively correlated with negative cognitive/emotional driving, aggressive driving, and risky driving, and altruism was negatively correlated with aggressive driving and drunk driving. Hierarchical multiple regressions were applied to analyze the mediating effect of personality traits, and the results showed that anger mediated the relationship between stress and dangerous driving behavior and that this mediating role was especially strong for negative cognitive/emotional driving and aggressive driving. Collectively, the results showed that stress is an important factor that can affect people's driving behavior but that personality traits mediate the effect of stress on driving behavior. The findings from this study regarding the relationship among stress, anger, and dangerous driving behavior could be applied in the development of intervention programs for stress and anger management in order to improve drivers' ability to manage emotional thoughts and adjust their behavior on the road.

Greasy roads: the impact of bad financial news on road traffic accidents

We use evidence from a natural experiment in Greece to study the effect of the announcement of austerity measures on road traffic accidents (RTAs). We use daily RTA data from 2010 and 2011, during which a number of austerity measures were announced, including salary and pension cuts and an increase in direct and indirect taxes. We find that controlling for other factors potentially influencing RTAs, the number of RTAs increased significantly on the first two days following the announcements of austerity measures. We put forward some tentative suggestions for why this happens.

The role of marital status in the association between benzodiazepines, psychotropics and injurious road traffic crashes: a register-based nationwide study of senior drivers in Sweden

BACKGROUND

Among senior drivers, benzodiazepines (BZDs) have a documented effect on the risk of road traffic crashes (RTCs). It remains unclear however if BZDs play the same role when considering marital status. Therefore, we aimed to investigate the role of marital status in the association between BZD use and injurious RTCs among senior drivers.

METHODS

Matched case-control study based on five national Swedish registers (n = 154 225). Cases comprised the first non-alcohol-related injurious RTC sustained by drivers aged 50-80 years from July 2005 to December 2009 and controls included registered residents with a valid license who did not crash during that period. Four controls were matched to each case by sex, age and place of residence. Conditional logistic regression analysis for injurious RTC was performed with adjustment for occupation and number of medications. The main exposure was dispensation of BZDs, alone or in combination with other psychotropic medications, 1-30 days prior to the crash date stratified by marital status.

RESULTS

BZD use, alone or in combination with other psychotropic medications, increased the risk of being involved in an RTC (BZD only: adjusted OR: 1.26, 95% CI: 1.17-1.36; BZDs and other psychotropics: adjusted OR: 1.25, 95% CI: 1.12-1.41). Compared to married drivers, those divorced (1.48, 1.43-1.53) and widowed (1.54; 1.45-1.63) had higher adjusted ORs. Marital status modified the association between BZDs and RTCs, particularly among younger male drivers.

CONCLUSIONS

Both BZDs and marital status independently affect the risk for senior drivers to be involved in an RTC. However, marital status plays a role in the association between BZD use and RTCs and this may have implications for targeting risk populations for RTCs among senior drivers.

The relative impact of work-related stress, life stress and driving environment stress on driving outcomes

Previous research has shown the association between stress and crash involvement. The impact of stress on road safety may also be mediated by behaviours including cognitive lapses, errors, and intentional traffic violations. This study aimed to provide a further understanding of the impact that stress from different sources may have upon driving behaviour and road safety. It is asserted that both stress extraneous to the driving environment and stress directly elicited by driving must be considered part of a dynamic system that may have a negative impact on driving behaviours. Two hundred and forty-seven public sector employees from Queensland, Australia, completed self-report measures examining demographics, subjective work-related stress, daily hassles, and aspects of general mental health. Additionally, the Driver Behaviour Questionnaire (DBQ) and the Driver Stress Inventory (DSI) were administered. All participants drove for work purposes regularly, however the study did not specifically focus on full-time professional drivers. Confirmatory factor analysis of the predictor variables revealed three factors: DSI negative affect; DSI risk taking; and extraneous influences (daily hassles, work-related stress, and general mental health). Moderate intercorrelations were found between each of these factors confirming the 'spillover' effect. That is, driver stress is reciprocally related to stress in other domains including work and domestic life. Structural equation modelling (SEM) showed that the DSI negative affect factor influenced both lapses and errors, whereas the DSI risk-taking factor was the strongest influence on violations. The SEMs also confirmed that daily hassles extraneous to the driving environment may influence DBQ lapses and violations independently. Accordingly, interventions may be developed to increase driver awareness of the dangers of excessive emotional responses to both driving events and daily hassles (e.g. driving fast to 'blow off steam' after an argument). They may also train more effective strategies for self-regulation of emotion and coping when encountering stressful situations on the road.

Mortality from road traffic accidents in Switzerland: longitudinal and spatial analyses

Road traffic accidents (RTA) are an important cause of premature death. We examined socio-demographic and geographical determinants of RTA mortality in Switzerland by linking 2000 census data to RTA mortality records 2000-2005 (ICD-10 codes V00-V99). Data from 5.5 million residents aged 18-94 years, 1744 study areas, and 1620 RTA deaths were analyzed, including 978 deaths (60.4%) in motor vehicle occupants, 254 (15.7%) in motorcyclists, 107 (6.6%) in cyclists, and 259 (16.0%) in pedestrians. Weibull survival models and Bayesian methods were used to calculate hazard ratios (HR), and standardized mortality ratios (SMR) across study areas. Adjusted HR comparing women with men ranged from 0.04 (95% CI 0.02-0.07) in motorcyclists to 0.43 (95% CI 0.32-0.56) in pedestrians. There was a u-shaped relationship with age in motor vehicle occupants and motorcyclists. In cyclists and pedestrians, mortality increased after age 55 years. Mortality was higher in individuals with primary education (HR 1.53; 95% CI 1.29-1.81), and higher in single (HR 1.24; 95% CI 1.05-1.46), widowed (HR 1.31; 95% CI 1.05-1.65) and divorced individuals (HR 1.62; 95% CI 1.33-1.97), compared to persons with tertiary education or married persons. The association with education was particularly strong for pedestrians (HR 1.87; 95% CI 1.20-2.91). RTA mortality increased with decreasing population density of study areas for motor vehicle occupants (test for trend p<0.0001) and motorcyclists (p=0.0021) but not for cyclists (p=0.39) or pedestrians (p=0.29). SMR standardized for socio-demographic and geographical variables ranged from 82 to 190. Prevention efforts should aim to reduce inequities across socio-demographic and educational groups, and across geographical areas, with interventions targeted at high-risk groups and areas, and different traffic users, including pedestrians.

Does psychological distress increase the risk for motor vehicle crashes in young people? findings from the DRIVE study

PURPOSE

Earlier research demonstrates increased and decreased risk of crash related to psychological distress; however, previous literature has almost entirely used retrospective study designs and has not been able to adequately control for important confounders such as exposure to driving, alcohol and drug use, or having had a previous crash. This study aimed to assess the relationship between psychological distress and risk of motor vehicle crashes.

METHODS

The DRIVE study is a prospective cohort study of 20,822 novice drivers aged 17-24 years in Australia. Information on risk factors for motor vehicle crash was collected through online questionnaire and subsequently linked to police-reported crashes. Poisson regression was used to analyze risk of various crash types by low, moderate, high, and very high levels of psychological distress, taking into account other known risk factors for crash.

RESULTS

Compared to the referent group with low or no distress, a protective effect against crash was observed for young people who reported a moderate amount of psychological distress in unadjusted (RR = .87; 95% CI = .76-1.00) and multivariable analyses (RR = .85; 95% CI = .74-.97). Severe psychological distress was not significantly associated with an increase or decrease in the risk of crash. Psychological distress was not significantly associated with an increased risk of single vehicle crash.

CONCLUSION

Earlier studies may have overestimated risk for motor vehicle crashes associated with psychological distress. This study found little convincing evidence to support a strong risk relationship for higher levels of distress and indeed found a modest protective association for low levels of distress.

Resets do not appear to increase the rate of adverse events or prolong relapse in voucher-based reinforcement therapy

Voucher-based reinforcement therapy (VBRT) is an efficacious contingency management intervention for substance use disorders that provides escalating voucher values to reinforce continuous abstinence and typically resets escalated values to the initial low level upon detection of drug use. The objective of this study involving 130 methadone-maintained outpatients receiving VBRT was to investigate whether resets (a) increase risk for adverse events (AEs) and (b) delay return to abstinence in relation to magnitude of voucher reset. Weeks following resets were examined for increased likelihood of AEs using a Poisson regression. A Cox proportional hazards model was used to determine if higher resets increased the number of days until a negative urine specimen. Results showed that resets did not increase the likelihood of AEs nor were higher resets related to an increased delay to abstinence. Research involving larger samples is needed to produce sufficient data directly addressing safety concerns of various treatment stakeholders.

Digit ratio (2D:4D) is associated with traffic violations for male frequent car drivers

Digit ratio (2D:4D) is a putative marker of prenatal hormone exposure. A lower digit ratio has been suggested as an index of higher testosterone relative to estrogen exposure during prenatal development. Digit ratio has been associated with a variety of psychological sex-dimorphic variables, including spatial orientation, aggression, or risk-taking behavior. The present study aimed to relate digit ratio to traffic violations for a male sample (N = 77) of frequent car drivers. Digit ratio was assessed via printout scans of the hand, and traffic offense behavior was assessed via self-reported penalty points as registered by the Central Register of Traffic Offenders in Germany. In addition, social desirability and sensation seeking were recorded. Results showed that digit ratio was inversely related to penalty point entries, suggesting more traffic violations for individuals with higher prenatal testosterone exposure. Sensation seeking was positively associated with traffic violations, but there was no relationship between sensation seeking and digit ratio, proposing additive effects of both variables. The results suggest that prenatal androgen exposure might be related to traffic violations for frequent car drivers.

The effects of health status, distress, alcohol and medicinal drug use on subsequent motor vehicle injuries

OBJECTIVE

The purpose of this study was to examine the effects of health factors and substance use on subsequent motor vehicle collision (MVC) injuries of three different age groups, using the longitudinal dataset from the Canadian National Population Health Survey (NPHS) for the years 1994-2002.

METHODS

Path analysis technique was used to determine the relations between MVC injury and four risk factors: binge drinking; health status; distress; and medication use. The three demographic variables, age at 'baseline', sex, and immigration status were added into the model as control variables. Three age groups were examined: young=12-29.9; middle-aged=30-59.9 and old=60-85 years of age. The total sample size was 16,093.

RESULTS

A lower percentage of males, older persons, immigrants, and non-binge drinkers reported a subsequent MVC injury, as did respondents reporting better health and lower distress scores. Medication use was associated with higher subsequent MVC injuries. Path analysis found that among younger individuals, the variable binge drinking, was the only significant risk factor associated with subsequent injuries. In contrast, among middle-aged individuals, the variable medication use, was the only statistically significant risk factor for subsequent injuries. No variables were significant risk factors of injuries for older individuals.

CONCLUSIONS

Various demographic and risk factors were found to influence injuries among a nationally representative sample of Canadians. Reported binge drinking among young individuals and medication use among middle-aged individuals were found to be risk factors for subsequent MVC injury. These findings support the need for continued focus on alcohol, drugs and traffic safety.

Tiring job and work related injury road crashes in the GAZEL cohort

The objective was to describe at-work and commuting crashes occurring in a cohort of French employees and to investigate occupational risk factors. The subjects were employees of the French national electricity and gas companies, Electricité de France and Gaz de France (EDF-GDF), who volunteered to join a research cohort (the GAZEL cohort which included 20,625 participants in 1989). Only crashes with injuries were considered. Crashes for the periods 1989--2001 were recorded together with the type of journey (commuting, work, private), the type of road-user, self-estimated responsibility, and injuries sustained by the subject. Annual incidences for gender/age groups and socio-occupational groups were computed for each of the two types of work related crashes. Occupational risk factor analyses were conducted using a Cox proportional hazards regression model with time-dependent covariates adjusting for the main confounders. A total of 146,285 person years at work were observed. Two indicators of self-reported work fatigue were associated with the occurrence of at-work crashes: "nervously tiring work" for males (RR=1.6, 95% CI [1.1; 2.3]), sustained standing for females (RR=3.0, 95% CI [1.0; 8.4]), adjusting for health status, location of residence, type of family, transport mode and mileage. As regards crashes while commuting, a self-reported uncomfortable position at work was a risk factor among women (RR=1.9, 95% CI [1.1; 3.3]). On the other hand, these occupational factors were not linked to road crashes in private trips. Work related road crashes seem then to be a matter for a specific prevention. Preventing employees from becoming exhausted should be considered as the first way to initiate such a prevention.

Does personality predict mortality? Results from the GAZEL French prospective cohort study

BACKGROUND

Majority of studies on personality and physical health have focused on one or two isolated personality traits. We aim to test the independent association of 10 personality traits, from three major conceptual models, with all-cause and cause-specific mortality in the French GAZEL cohort.

METHODS

A total of 14,445 participants, aged 39-54 in 1993, completed the personality questionnaires composed of the Bortner Type-A scale, the Buss-Durkee Hostility Inventory (for total, neurotic and reactive hostility) and the Grossarth-Maticek-Eysenck Personality Stress Inventory that assesses six personality types [cancer-prone, coronary heart disease (CHD)-prone, ambivalent, healthy, rational, anti-social]. The association between personality traits and mortality, during a mean follow-up of 12.7 years, was assessed using the Relative Index of Inequality (RII) in Cox regression.

RESULTS

In models adjusted for age, sex, marital status and education, all-cause and cause-specific mortality were predicted by 'total hostility', its 'neurotic hostility' component as well as by 'CHD-prone', 'ambivalent' 'antisocial', and 'healthy' personality types. After mutually adjusting personality traits for each other, only high 'neurotic hostility' remained a robust predictor of excess mortality from all causes [RII = 2.62; 95% confidence interval (CI) = 1.68-4.09] and external causes (RII = 3.24; 95% CI = 1.03-10.18). 'CHD-prone' (RII = 2.23; 95% CI = 0.72-6.95) and 'anti-social' (RII = 2.13; 95% CI 0.61-6.58) personality types were associated with cardiovascular mortality and with mortality from external causes, respectively, but CIs were wider. Adjustment for potential behavioural mediators had only a modest effect on these associations.

CONCLUSIONS

Neurotic hostility, CHD-prone personality and anti-social personality were all predictive of mortality outcomes. Further research is required to determine the precise mechanisms that contribute to these associations.

Systematic screening for unsafe driving due to medical conditions: still debatable

Background

Assessing people's ability to drive has become a public health concern in most industrialized countries. Although age itself is not a predictive factor of an increased risk for dangerous driving, the prevalence of medical conditions that may impair driving increases with age. Because the implementation of a screening for unsafe driving due to medical conditions is a public health issue, its usefulness should be judged using standardised criteria already proposed for screening for chronic disease. The aim of this paper is to propose standardised criteria suitable to assess the scientific validity of screening for unsafe driving due to medical conditions, and identify potential issues to be clarified before screening can be implemented and effective.

Discussion

Using criteria developed for screening for chronic diseases and published studies on driving with medical conditions, we specify six criteria to judge the opportunity of screening for unsafe driving due to medical conditions. This adaptation was needed because of the complexity of the natural history of medical conditions and their potential consequences on driving and road safety. We then illustrate that published studies pleading for or against screening for unsafe driving due to medical conditions fail to provide the needed documentation. Individual criteria were mentioned in 3 to 72% of 36 papers pleading for or against screening. Quantitative estimates of relevant indicators were provided in at most 42% of papers, and some data, such as the definition of an appropriate unsafe driving period were never provided.

Summary

The standardised framework described in this paper provides a template for assessing the effectiveness (or lack of effectiveness) of proposed measures for screening for unsafe driving due to medical conditions. Even if most criteria were mentioned in the published literature pleading for or against such a screening, the failure to find quantitative and evidence-based estimates of relevant indicators provides useful insight for further research.

Road crash involvement and professional status: a prospective study using the French Gazel cohort

OBJECTIVES

To assess professional status (PS) differences in the risk of road crash involvement (RCI) (irrespective of crash severity), and to examine the underlying mechanism by evaluating the role of exposure to road risk (ERR).

METHOD

A total of 15,271 subjects selected from the French GAZEL cohort were studied. A proportional hazard model for recurrent events was used to calculate the relative risks (RR) of RCI associated with PS. The associations between RCI and PS were investigated by adjusting for ERR (kilometers travelled and risk behaviors on the road).

RESULTS

In all, 1890 RCI were reported. Managers have greater crude RCI risk than unskilled workers (male, RR=1.30; female, RR=1.44). This difference was no longer statistically significant when adjusting for factors describing the drivers' behaviors. Female managers' risks were also insignificant when adjusted for vehicle kilometers travelled (VKT). Managers seemed at lower risk of injury when involved in a crash.

CONCLUSION

Socially advantaged subjects have the greatest RCI risk. Qualitative and quantitative ERR factors explain these disparities. These results highlight the importance to focus on ERR when studying the effect of an individual characteristic on RCI. They also highlight the importance to analyse separately the "RCI" and the "susceptibility to injury".

Predictors of motor vehicle collision injuries among a nationally representative sample of Canadians

OBJECTIVE

The purpose of this study was to examine predictors of subsequent motor vehicle collision injuries, with a particular focus on health-related variables, using the longitudinal dataset from the Canadian National Population Health Survey (NPHS) for the years 1994-2002.

METHODS

Multiple logistic regression analysis was used to determine the relations between motor vehicle collision injury and four risk factors: binge drinking, health status, distress, and medication use. Age and sex were included as control variables. The total sample size was 14,529.

RESULTS

A higher percentage of females and younger persons reported a motor vehicle collision injury. Binge drinkers, respondents with poor health, respondents with distress, and respondents reported using two or more medications reported a higher percentage of subsequent injuries. Logistic regression analysis found that persons with poorer health status and persons who used more medications had higher odds of motor vehicle injuries. Only one statistically significant interaction effect was found: alcohol bingeing and medication use.

CONCLUSIONS

Among a nationally representative sample of Canadians, various demographic and risk factors predict subsequent injuries. Given that this number represents a considerable economic burden, this study underscores the need for continued research and countermeasures on alcohol, drugs, and driving.

Attention-deficit/hyperactivity disorder (ADHD) and driving risk: a review of the literature and a methodological critique

This article examines the literature on attention-deficit/hyperactivity disorder (ADHD) and unintentional driving injury. This literature has emerged over the last decade as part of the burgeoning epidemic of road traffic death and injury, which is the number-one cause of death among young adults in North America. The available literature on observational outcome studies and experimental pharmacologic interventions is critically reviewed. A meta-analysis of behavioral outcomes and a review of effect size of pharmacologic studies are presented. Current data support the utility of stimulant medication in improving driving performance in younger ADHD drivers. A conceptual model of risk factors in young ADHD drivers is offered. The current state of screening instruments for identifying high-risk subjects within this clinical group is summarized along with a final section on emerging trends and future prospects for intervention.

Using self-reported data to assess the validity of driving simulation data

In this article, we use self-reported driving behaviors from a written questionnaire to assess the measurement validity of data derived from a driving simulation. The issue of validity concerns the extent to which measures from the experimental context map onto constructs of interest. Following a description of the experimental methods and setting, an argument for the face validity of the data is advanced. Convergent validity was assessed by regressing behaviors observed in thedriving simulatoron self-reported measures of driving behaviors. Significant relationships were found across six measures: accidents, speeding, velocity, passing, weaving between traffic, and behavior at stop signs. Concurrent validity was evaluated with an analysis of simulator accident involvement and attention deficit hyperactivity disorder status. Discriminant validity was assessed using a multitrait-multimethod matrix of simulator and questionnaire data. We concluded that although the relationship between self-reported behaviors and observed responses in the simulator falls short of perfect correspondence, the data collected from the driving simulator are valid measures of the behaviors of interest.

Road mobility and the risk of road traffic accident as a driver. The impact of medical conditions and life events

STUDY OBJECTIVE

We conducted a longitudinal investigation of the impact of self-reported life events and medical conditions on changes in road mobility on the wheel between 2000 and 2002 in order to assess whether these changes would affect the risk of road traffic accident (RTA).

METHODS

Data are from a cohort of workers and retirees from the French national gas and electricity companies (the Gazel cohort). In the present study, 10,483 participants were included (7843 men aged 51-61 years and 2640 women aged 46-61 years, in 2000). The link between mobility and the risk of RTA was approximated using data on RTA number during lifetime and reported mobility in 2000. We then compared changes in road mobility between 2000 and 2002 resulting from life events and medical conditions reported to have occurred in the year 2001 or changed when compared to year 2000. We also compared road mobilities in 2000 in order to assess any pre-existing differences before life events and medical conditions. This led to estimation of the effect of road mobility changes on the risk of RTA.

RESULTS

Changes in road mobility associated with life events and medical conditions were only found among men. These changes in road mobility were minimal. Ensuing changes in the risk of RTA were estimated to be small (odds-ratios ranged from 0.94 to 1.01). The only life events found to be associated with increased road mobility was an important purchase. Hospitalization, serious RTA, and retiring were associated with reduced road mobility. Concerning medical conditions, men who reported cataract, angina pectoris, diabetes, anxiety and stress, sleep disorder, and depression decreased their road mobility.

CONCLUSION

We found no or moderate changes in road mobility resulting from life events and medical conditions, suggesting that results from previous published studies that assessed the impact of life events or medical conditions on RTA were not jeopardized by improper adjustment for road mobility.

Does physical trauma lead to an increase in the risk of new onset widespread pain?

OBJECTIVE

To determine the rate of new onset of widespread pain after a traumatic event (motor vehicle crash).

METHODS

A prospective cohort study of persons registered with an insurance company who had or had not experienced a motor vehicle crash. All participants were sent a questionnaire to assess pre-crash (or for the non-crash group, prior) psychosocial factors and widespread pain. Participants reporting pre-crash (prior) widespread pain were excluded. At six months, participants were sent a follow up questionnaire to ascertain new prevalent widespread pain.

RESULTS

597 (51%) of participants returned a baseline questionnaire (465 crash and 132 non-crash). Among the cohort who had experienced a crash, the new onset rate of widespread pain six months later was low (8%), though in comparison with the non-crash group there was an increased risk (RR = 1.9 (95% CI, 0.8 to 4.8, adjusted for age and sex)); this was attenuated after adjustment for pre-crash (prior) psychological distress and somatic symptoms (RR = 1.4 (95% CI, 0.5 to 3.2)).

CONCLUSIONS

The findings suggest that a motor vehicle crash (as an example of a physically traumatic event) is unlikely to have a major impact on the new onset of widespread pain. Any observed relation may, in part, be explained by psychological distress.