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Goel R, Tiwari G, Varghese M, Bhalla K, Agrawal G, Saini G, Jha A, John D, Saran A, White H, Mohan D. Effectiveness of road safety interventions: An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1367. [PMID: 38188231 PMCID: PMC10765170 DOI: 10.1002/cl2.1367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Background Road Traffic injuries (RTI) are among the top ten leading causes of death in the world resulting in 1.35 million deaths every year, about 93% of which occur in low- and middle-income countries (LMICs). Despite several global resolutions to reduce traffic injuries, they have continued to grow in many countries. Many high-income countries have successfully reduced RTI by using a public health approach and implementing evidence-based interventions. As many LMICs develop their highway infrastructure, adopting a similar scientific approach towards road safety is crucial. The evidence also needs to be evaluated to assess external validity because measures that have worked in high-income countries may not translate equally well to other contexts. An evidence gap map for RTI is the first step towards understanding what evidence is available, from where, and the key gaps in knowledge. Objectives The objective of this evidence gap map (EGM) is to identify existing evidence from all effectiveness studies and systematic reviews related to road safety interventions. In addition, the EGM identifies gaps in evidence where new primary studies and systematic reviews could add value. This will help direct future research and discussions based on systematic evidence towards the approaches and interventions which are most effective in the road safety sector. This could enable the generation of evidence for informing policy at global, regional or national levels. Search Methods The EGM includes systematic reviews and impact evaluations assessing the effect of interventions for RTI reported in academic databases, organization websites, and grey literature sources. The studies were searched up to December 2019. Selection Criteria The interventions were divided into five broad categories: (a) human factors (e.g., enforcement or road user education), (b) road design, infrastructure and traffic control, (c) legal and institutional framework, (d) post-crash pre-hospital care, and (e) vehicle factors (except car design for occupant protection) and protective devices. Included studies reported two primary outcomes: fatal crashes and non-fatal injury crashes; and four intermediate outcomes: change in use of seat belts, change in use of helmets, change in speed, and change in alcohol/drug use. Studies were excluded if they did not report injury or fatality as one of the outcomes. Data Collection and Analysis The EGM is presented in the form of a matrix with two primary dimensions: interventions (rows) and outcomes (columns). Additional dimensions are country income groups, region, quality level for systematic reviews, type of study design used (e.g., case-control), type of road user studied (e.g., pedestrian, cyclists), age groups, and road type. The EGM is available online where the matrix of interventions and outcomes can be filtered by one or more dimensions. The webpage includes a bibliography of the selected studies and titles and abstracts available for preview. Quality appraisal for systematic reviews was conducted using a critical appraisal tool for systematic reviews, AMSTAR 2. Main Results The EGM identified 1859 studies of which 322 were systematic reviews, 7 were protocol studies and 1530 were impact evaluations. Some studies included more than one intervention, outcome, study method, or study region. The studies were distributed among intervention categories as: human factors (n = 771), road design, infrastructure and traffic control (n = 661), legal and institutional framework (n = 424), post-crash pre-hospital care (n = 118) and vehicle factors and protective devices (n = 111). Fatal crashes as outcomes were reported in 1414 records and non-fatal injury crashes in 1252 records. Among the four intermediate outcomes, speed was most commonly reported (n = 298) followed by alcohol (n = 206), use of seatbelts (n = 167), and use of helmets (n = 66). Ninety-six percent of the studies were reported from high-income countries (HIC), 4.5% from upper-middle-income countries, and only 1.4% from lower-middle and low-income countries. There were 25 systematic reviews of high quality, 4 of moderate quality, and 293 of low quality. Authors' Conclusions The EGM shows that the distribution of available road safety evidence is skewed across the world. A vast majority of the literature is from HICs. In contrast, only a small fraction of the literature reports on the many LMICs that are fast expanding their road infrastructure, experiencing rapid changes in traffic patterns, and witnessing growth in road injuries. This bias in literature explains why many interventions that are of high importance in the context of LMICs remain poorly studied. Besides, many interventions that have been tested only in HICs may not work equally effectively in LMICs. Another important finding was that a large majority of systematic reviews are of low quality. The scarcity of evidence on many important interventions and lack of good quality evidence-synthesis have significant implications for future road safety research and practice in LMICs. The EGM presented here will help identify priority areas for researchers, while directing practitioners and policy makers towards proven interventions.
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Affiliation(s)
- Rahul Goel
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | - Geetam Tiwari
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | | | - Kavi Bhalla
- Department of Public Health SciencesUniversity of ChicagoChicagoIllinoisUSA
| | - Girish Agrawal
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | | | - Abhaya Jha
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | - Denny John
- Faculty of Life and Allied Health SciencesM S Ramaiah University of Applied Sciences, BangaloreKarnatakaIndia
| | | | | | - Dinesh Mohan
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
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Fone D, Morgan J, Fry R, Rodgers S, Orford S, Farewell D, Dunstan F, White J, Sivarajasingam V, Trefan L, Brennan I, Lee S, Shiode N, Weightman A, Webster C, Lyons R. Change in alcohol outlet density and alcohol-related harm to population health (CHALICE): a comprehensive record-linked database study in Wales. PUBLIC HEALTH RESEARCH 2016. [DOI: 10.3310/phr04030] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundExcess alcohol consumption has serious adverse effects on health and results in violence-related harm.ObjectiveThis study investigated the impact of change in community alcohol availability on alcohol consumption and alcohol-related harms to health, assessing the effect of population migration and small-area deprivation.DesignA natural experiment of change in alcohol outlet density between 2006 and 2011 measured at census Lower Layer Super Output Area level using observational record-linked data.SettingWales, UK; population of 2.5 million aged ≥ 16 years.Outcome measuresAlcohol consumption, alcohol-related hospital admissions, accident and emergency (A&E) department attendances from midnight to 06.00 and violent crime against the person.Data sourcesLicensing Act 2003 [Great Britain.Licensing Act 2003. London: The Stationery Office; 2003. URL:www.legislation.gov.uk/ukpga/2003/17/contents(accessed 8 June 2015)] data on alcohol outlets held by the 22 local authorities in Wales, alcohol consumption data from annual Welsh Health Surveys 2008–12, hospital admission data 2006–11 from the Patient Episode Database for Wales (PEDW) and A&E attendance data 2009–11 were anonymously record linked to the Welsh Demographic Service age–sex register within the Secure Anonymised Information Linkage Databank. A final data source was recorded crime 2008–11 from the four police forces in Wales.MethodsOutlet density was estimated (1) as the number of outlets per capita for the 2006 static population and the per quarterly updated population to assess the impact of population migration and (2) using new methods of network analysis of distances between each household and alcohol outlets within 10 minutes of walking and driving. Alcohol availability was measured by three variables: (1) the previous quarterly value; (2) positive and negative change over the preceding five quarters; and (3) volatility, a measure of absolute quarterly changes during the preceding five quarters. Longitudinal statistical analysis used multilevel Poisson models of consumption and Geographically Weighted Regression (GWR) spatial models of binge drinking, Cox regression models of hospital admissions and A&E attendance and GWR models of violent crime against the person, each as a function of alcohol availability adjusting for confounding variables. The impact on health inequalities was investigated by stratifying models within quintiles of the Welsh Index of Multiple Deprivation.ResultsThe main finding was that change in walking outlet density was associated with alcohol-related harms: consumption, hospital admissions and violent crime against the person each tracked the quarterly changes in outlet density. Alcohol-related A&E attendances were not clinically coded and the association was less conclusive. In general, social deprivation was strongly associated with the outcome measures but did not substantially modify the associations between the outcomes and alcohol availability. We found no evidence for an important effect of population migration.LimitationsLimitations included the absence of any standardised methods of alcohol outlet data collation, processing and validation, and incomplete data on on-sales and off-sales. We were dependent on the quality of clinical coding and administrative records and could not identify alcohol-related attendances in the A&E data set.ConclusionThis complex interdisciplinary study found that important alcohol-related harms were associated with change in alcohol outlet density. Future work recommendations include defining a research standard for recording outlet data and classification of outlet type, the methodological development of residence-based density measures and a health economic analysis of model-predicted harms.FundingThe National Institute for Health Research Public Health Research programme. Additional technical and computing support was provided by the Farr Institute at Swansea University, made possible by the following grant:Centre for the Improvement of Population Health through E-records Research (CIPHER) and Farr Institute capital enhancement. CIPHER and the Farr Institute are funded by Arthritis Research UK, the British Heart Foundation, Cancer Research UK, the Chief Scientist Office (Scottish Government Health Directorates), the Economic and Social Research Council, the Engineering and Physical Sciences Research Council, the Medical Research Council, the National Institute for Health Research, the National Institute for Social Care and Health Research (Welsh Government) and the Wellcome Trust (grant reference MR/K006525/1).
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Affiliation(s)
- David Fone
- Farr Institute, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Jennifer Morgan
- Farr Institute, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Richard Fry
- Farr Institute, Swansea University Medical School, Swansea, UK
| | - Sarah Rodgers
- Farr Institute, Swansea University Medical School, Swansea, UK
| | - Scott Orford
- School of Geography and Planning, Cardiff University, Cardiff, UK
- Wales Institute of Social and Economic Research, Data and Methods (WISERD), Cardiff University, Cardiff, UK
| | - Daniel Farewell
- Farr Institute, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Frank Dunstan
- Farr Institute, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - James White
- Farr Institute, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, School of Medicine, Cardiff University, Cardiff, UK
| | - Vas Sivarajasingam
- Violence and Society Research Group, School of Dentistry, Cardiff University, Cardiff, UK
| | - Laszlo Trefan
- Farr Institute, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Iain Brennan
- Violence and Society Research Group, School of Dentistry, Cardiff University, Cardiff, UK
| | - Shin Lee
- School of Geography and Planning, Cardiff University, Cardiff, UK
| | - Narushige Shiode
- School of Geography and Planning, Cardiff University, Cardiff, UK
| | - Alison Weightman
- Specialist Unit for Research Evidence, University Library Service, Cardiff University, Cardiff, UK
| | - Chris Webster
- School of Geography and Planning, Cardiff University, Cardiff, UK
| | - Ronan Lyons
- Farr Institute, Swansea University Medical School, Swansea, UK
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Fone D, Dunstan F, White J, Webster C, Rodgers S, Lee S, Shiode N, Orford S, Weightman A, Brennan I, Sivarajasingam V, Morgan J, Fry R, Lyons R. Change in alcohol outlet density and alcohol-related harm to population health (CHALICE). BMC Public Health 2012; 12:428. [PMID: 22691534 PMCID: PMC3409073 DOI: 10.1186/1471-2458-12-428] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 06/12/2012] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Excess alcohol consumption has serious adverse effects on health and violence-related harm. In the UK around 37% of men and 29% of women drink to excess and 20% and 13% report binge drinking. The potential impact on population health from a reduction in consumption is considerable. One proposed method to reduce consumption is to reduce availability through controls on alcohol outlet density. In this study we investigate the impact of a change in the density of alcohol outlets on alcohol consumption and alcohol-related harms to health in the community. METHODS/DESIGN A natural experiment of the effect of change in outlet density between 2005-09, in Wales, UK; population 2.4 million aged 16 years and over. Data on outlets are held by the 22 local authorities in Wales under The Licensing Act 2003. The study outcomes are change in (1) alcohol consumption using data from annual Welsh Health Surveys, (2) alcohol-related hospital admissions using the Patient Episode Database for Wales, (3) Accident & Emergency department attendances between midnight-6am, and (4) alcohol-related violent crime against the person, using Police data. The data will be anonymously record-linked within the Secure Anonymised Information Linkage Databank at individual and 2001 Census Lower Super Output Area levels. New methods of network analysis will be used to estimate outlet density. Longitudinal statistical analysis will use (1) multilevel ordinal models of consumption and logistic models of admissions and Accident & Emergency attendance as a function of change in individual outlet exposure, adjusting for confounding variables, and (2) spatial models of the change in counts/rates of each outcome measure and outlet density. We will assess the impact on health inequalities and will correct for population migration. DISCUSSION This inter-disciplinary study requires expertise in epidemiology and public health, health informatics, medical statistics, geographical information science, and research into alcohol-related violence. Information governance requirements for the use of record-linked data have been approved together with formal data access agreements for the use of the Welsh Health Survey and Police data. The dissemination strategy will include policy makers in national and local government. Public engagement will be through the Clinical Research Collaboration-Cymru "Involving People" network, which will provide input into the implementation of the research.
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Affiliation(s)
- David Fone
- Institute of Primary Care & Public Health, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK
| | - Frank Dunstan
- Institute of Primary Care & Public Health, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK
| | - James White
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK
| | - Chris Webster
- School of City and Regional Planning, Cardiff University, Glamorgan Building, King Edward VII Avenue, Cardiff, CF10 3WA, UK
| | - Sarah Rodgers
- Health Information Research Unit, School of Medicine, Swansea University, Swansea, SA2 8PP, UK
| | - Shin Lee
- School of City and Regional Planning, Cardiff University, Glamorgan Building, King Edward VII Avenue, Cardiff, CF10 3WA, UK
| | - Narushige Shiode
- School of City and Regional Planning, Cardiff University, Glamorgan Building, King Edward VII Avenue, Cardiff, CF10 3WA, UK
| | - Scott Orford
- School of City and Regional Planning, Cardiff University, Glamorgan Building, King Edward VII Avenue, Cardiff, CF10 3WA, UK
- Wales Institute of Social and Economic Research, Data and Methods (WISERD), Cardiff University, 46 Park Place, Cardiff, CF10 3BB, UK
| | - Alison Weightman
- Support Unit for Research Evidence, Information Services, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK
| | - Iain Brennan
- Department of Social Sciences, University of Hull, Cottingham Road, Hull, HU6 7RX, UK
| | - Vas Sivarajasingam
- School of Dentistry, Cardiff University, Heath Park, Cardiff, CF14 4XY, UK
| | - Jennifer Morgan
- Institute of Primary Care & Public Health, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK
| | - Richard Fry
- Health Information Research Unit, School of Medicine, Swansea University, Swansea, SA2 8PP, UK
| | - Ronan Lyons
- Health Information Research Unit, School of Medicine, Swansea University, Swansea, SA2 8PP, UK
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Cohen D, Rabinovich L. Addressing the proximal causes of obesity: the relevance of alcohol control policies. Prev Chronic Dis 2012; 9:E94. [PMID: 22554409 PMCID: PMC3431955 DOI: 10.5888/pcd9.110274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Many policy measures to control the obesity epidemic assume that people consciously and rationally choose what and how much they eat and therefore focus on providing information and more access to healthier foods. In contrast, many regulations that do not assume people make rational choices have been successfully applied to control alcohol, a substance — like food — of which immoderate consumption leads to serious health problems. Alcohol-use control policies restrict where, when, and by whom alcohol can be purchased and used. Access, salience, and impulsive drinking behaviors are addressed with regulations including alcohol outlet density limits, constraints on retail displays of alcoholic beverages, and restrictions on drink “specials.” We discuss 5 regulations that are effective in reducing drinking and why they may be promising if applied to the obesity epidemic.
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Popova S, Giesbrecht N, Bekmuradov D, Patra J. Hours and Days of Sale and Density of Alcohol Outlets: Impacts on Alcohol Consumption and Damage: A Systematic Review. Alcohol Alcohol 2009; 44:500-16. [DOI: 10.1093/alcalc/agp054] [Citation(s) in RCA: 328] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Potential biases due to geocoding error in spatial analyses of official data. Health Place 2008; 15:562-567. [PMID: 19004662 DOI: 10.1016/j.healthplace.2008.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Revised: 08/28/2008] [Accepted: 09/17/2008] [Indexed: 11/20/2022]
Abstract
Geospatial methods have been used extensively to examine associations between alcohol outlet density and various harms; however, the literature offers too little methodological detail to assess possible geocoding biases in these studies. We used New Zealand liquor licensing and crime data to assess geocoding error. For the year with the best data, 69% of offences could be accurately mapped (91% of those in urban areas, 38% in rural areas). There was considerable urban-rural variation in the accuracy and specificity of location data. If similar error exists in other jurisdictions, previous findings may be biased. Greater consideration should be given to the effects of data quality in geospatial studies, and geocoding methods should be reported explicitly.
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McMillan GP, Lapham S. Effectiveness of bans and laws in reducing traffic deaths: legalized Sunday packaged alcohol sales and alcohol-related traffic crashes and crash fatalities in New Mexico. Am J Public Health 2006; 96:1944-8. [PMID: 17018830 PMCID: PMC1751802 DOI: 10.2105/ajph.2005.069153] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We determined the relative risk of alcohol-related motor vehicle accidents and fatalities after New Mexico lifted its ban on Sunday packaged alcohol sales. We extracted all alcohol-related crashes from New Mexico police reports for 3652 days between July 1, 1990, and June 30, 2000, and found a 29% increase in alcohol-related crashes and a 42% increase in alcohol-related crash fatalities on Sundays after the ban on Sunday packaged alcohol sales was lifted. There was an estimated excess of 543.1 alcohol-related crashes and 41.6 alcohol-related crash fatalities on Sundays after the ban was lifted. Repealing the ban on Sunday packaged alcohol sales introduced a public health and safety hazard in New Mexico.
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Affiliation(s)
- Garnett P McMillan
- Behavioral Health Research Center of the Southwest, Albuquerque, NM 87102, USA
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Abstract
AIMS This study examined the economic impact of the New Mexico legislative action closing drive-up liquor windows on the retail establishments that operated them. DESIGN A telephone survey was conducted 20 months after the closure seeking information and owners' opinions about how their outlets had changed since the closure and how this affected their business. In addition, 2 years of aggregated pre- and post-closure total gross receipts revenues were obtained from the New Mexico Taxation and Revenue Department, with convenience stores as a comparison group. FINDINGS Interviews were completed for 149 of 220 establishments. Over one-quarter of former drive-up liquor windows (28%) had been converted to 'step-in' sales, defined as an outside door where customers can stop and enter the premises while their car is running. Almost two-thirds (61%) of owners reported decreased annual gross revenues following closure, with a reported average 15% reduction in alcohol sales. This is consistent with findings of decreased gross receipts for operators of non-urban, but not urban, drive-up liquor windows compared to convenience store gross receipts. Almost three-quarters (72%) of those surveyed would re-open the drive-up window if the law were rescinded. CONCLUSION Over one-quarter of the drive-up owners converted to step-in alcohol sales that still allow a form of drive-up liquor sales. Despite this, the forced closure of New Mexico's drive-up liquor windows negatively impacted total sales and liquor sales revenues of establishments that operated them.
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Affiliation(s)
- Sandra C Lapham
- Behavioral Health Research Center of the Southwest, Albuquerque, New Mexico 87102, USA.
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