Traffic calming for the prevention of road traffic injuries: systematic review and meta-analysis

Effectiveness of road safety interventions: An evidence and gap map

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.

Unintentional injuries in children in the south of Iran, 2004-2019: a trend analysis of mortality rates

INTRODUCTION

Injury is one of the main causes of death and disability in the world. This study was designed to determine the trend of mortality rate and years of life lost (YLLs) due to unintentional injuries in children in southern Iran.

METHOD

In this cross-sectional study, we extracted all death reports due to unintentional injuries based on age, gender and the year of death based on International Classification of Diseases (ICD-10)from the Electronic Death Registration System. The YLL analysis due to premature death related to unintentional injuries was executed by the 2015 YLL template from the WHO using the Excel V.2016 software. To examine the trend of crude mortality rate and YLL rates for different years, joinpoint regression was used based on the log-linear model.

RESULTS

During the 16-year study period (2004-2019), 6590 deaths due to unintentional injuries in children aged 0-19 years have occurred. The total YLLs due to unintentional injuries were 138 482 in males and 53 168 in females. The three main causes of YLLs in our study were transportation injuries (67.37%), drowning (7.19%) and burns (6.70%). According to the joinpoint regression analysis, the 16-year trend of YLL rate due to premature mortality was decreasing; the annual per cent change was -5.2% (95% CI -6.5% to -3.9%, p<0.001) for males and -4.3% (95% CI -5.7% to -3.0%, p<0.001) for females.

CONCLUSION

Based on the findings of this study, the trend of mortality and YLL rate has been decreasing. Road traffic injuries were the most frequent injuries and the most common cause of death. Mortality rates fell by half. To improve child survival, injuries must now be recognised as a major child health problem, and to prevent deaths from injuries in children, early and preventive measures should be taken into account.

Road safety, health equity, and the built environment: perspectives of transport and injury prevention professionals in five Canadian municipalities

BACKGROUND

Concerns regarding health equity (HE) and the built environment (BE) are well established in the Canadian urban context. Transport and injury prevention professionals across sectors, such as transportation and public health, are involved in designing and implementing BE interventions that enhance the safety of vulnerable road users (VRUs). Results from a larger study examining barriers and facilitators to BE change are used to illustrate how transport and injury prevention professionals perceive HE concerns in their work in five Canadian municipalities. Broadening our understanding of how HE influences the professional BE change context is crucial when advocating for modifications that enhance the safety of equity-deserving VRUs and groups who experience marginalization.

METHODS

Interview and focus group data were gathered from transport and injury prevention professionals working in policy/decision-making, transport, police services, public health, non-profit organizations, schools/school boards, community associations, and private sectors across five Canadian urban municipalities: Vancouver, Calgary, Peel Region, Toronto, and Montréal. Data were analyzed using thematic analysis (TA) to illustrate how equity considerations were perceived and applied in participants' BE change work.

RESULTS

The results of this study illustrate transport and injury prevention professionals' awareness of the varying needs of VRUs, as well as the inadequacies of current BEs in the Canadian urban context and consultation processes utilized to guide change. Participants emphasized the importance of equitable community consultation strategies, as well as specific BE changes that would support the health and safety of VRUs. Overall, the results highlight how HE concerns inform transport and injury prevention professionals' BE change work in the Canadian urban context.

CONCLUSION

For professionals working in urban Canadian transport and injury prevention sectors HE concerns influenced their perspectives of the BE and BE change. These results illustrate a growing need for HE to guide BE change work and consultation processes. Further, these results contribute to ongoing efforts in the Canadian urban context to ensure that HE is at the forefront of BE policy change and decision-making, while promoting existing strategies to ensure that the BE, and related decision-making processes, are accessible and informed by a HE lens.

Macro-level literature analysis on pedestrian safety: Bibliometric overview, conceptual frames, and trends

Due to the high volume of documents in the pedestrian safety field, the current study conducts a systematic bibliometric analysis on the researches published before October 3, 2021, based on the science-mapping approach. Science mapping enables us to present a broad picture and comprehensive review of a significant number of documents using co-citation, bibliographic coupling, collaboration, and co-word analysis. To this end, a dataset of 6311 pedestrian safety papers was collected from the Web of Science Core Collection database. First, a descriptive analysis was carried out, covering whole yearly publications, most-cited papers, and most-productive authors, as well as sources, affiliations, and countries. In the next steps, science mapping was implemented to clarify the social, intellectual, and conceptual structures of pedestrian-safety research using the VOSviewer and Bibliometrix R-package tools. Remarkably, based on intellectual structure, pedestrian safety demonstrated an association with seven research areas: "Pedestrian crash frequency models", "Pedestrian injury severity crash models", "Traffic engineering measures in pedestrians' safety", "Global reports around pedestrian accident epidemiology", "Effect of age and gender on pedestrians' behavior", "Distraction of pedestrians", and "Pedestrian crowd dynamics and evacuation". Moreover, according to conceptual structure, five major research fronts were found to be relevant, namely "Collision avoidance and intelligent transportation systems (ITS)", "Epidemiological studies of pedestrian injury and prevention", "Pedestrian road crossing and behavioral factors", "Pedestrian flow simulation", and "Walkable environment and pedestrian safety". Finally, "autonomous vehicle", "pedestrian detection", and "collision avoidance" themes were identified as having the greatest centrality and development degrees in recent years.

Evidence From the Decade of Action for Road Safety: A Systematic Review of the Effectiveness of Interventions in Low and Middle-Income Countries

Objectives: To evaluate the effectiveness of road safety interventions in low and middle-income countries (LMICs), considering the principles of systems theory presented in the Global Plan for the Decade of Action for Road Safety.

Methods: We conducted a systematic review according to PRISMA guidelines. We searched for original research studies published during 2011–2019 in the following databases: Medline, Embase, PsycInfo, Scopus, Web of Science, Cochrane library, Global Health Library, ProQuest and TRID. We included studies conducted in LMICs, evaluating the effects of road traffic safety interventions and reporting health-related outcomes.

Results: Of 12,353 non-duplicate records, we included a total of 33 studies. Most interventions were related to legislation and enforcement (n = 18), leadership (n = 5) and speed management (n = 4). Overall, legislation and enforcement interventions appear to have the largest impact. Few studies were found for road infrastructure, vehicle safety standard and post crash response interventions.

Conclusion: Based on the currently available evidence, legislation and enforcement interventions appear most impactful in LMICs. However, many interventions remain understudied and more holistic approaches capturing the complexity of road transport systems seem desirable.

Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=197267, identifier CRD42020197267.

The neglected epidemic-Risk factors associated with road traffic injuries in Mozambique: Results of the 2016 INCOMAS study

In 2019, 93% of road traffic injury related mortality occurred in low- and middle-income countries, an estimated burden of 1.3 million deaths. This problem is growing; by 2030 road traffic injury will the seventh leading cause of death globally. This study both explores factors associated with RTIs in the central region of Mozambique, as well as pinpoints geographical "hotspots" of RTI incidence. A cross-sectional, population-level survey was carried out in two provinces (Sofala and Manica) of central Mozambique where, in addition to other variables, the number of road traffic injuries sustained by the household within the previous six months, was collected. Urbanicity, household ownership of a car or motorcycle, and socio-economic strata index were included in the analysis. We calculated the prevalence rate ratios using a generalized linear regression with a Poisson distribution, as well as the spatial prevalence rate ratio using an Integrated Nested Laplace Approximation. The survey included 3,038 households, with a mean of 6.29 (SD 0.06) individuals per household. The road traffic injury rate was 6.1% [95%CI 7.1%, 5.3%]. Urban residence was associated with a 47% decrease in rate of injury. Household motorbike ownership was associated with a 92% increase in the reported rate of road traffic injury. Higher socio-economic status households were associated with a 26% increase in the rate of road traffic injury. The rural and peri-urban areas near the "Beira corridor" (national road N6) have higher rates of road traffic injuries. In Mozambique, living in the rural areas near the "Beira corridor", higher household socio-economic strata, and motorbike ownership are risk factors for road traffic injury.

Comparison of childhood household injuries and risk factors between urban and rural communities in Ghana: A cluster-randomized, population-based, survey to inform injury prevention research and programming

BACKGROUND

Childhood household injuries incur a major proportion of the global disease burden, particularly in low- and middle-income countries (LMICs). However, household injury hazards are differentially distributed across developed environments. Therefore, we aimed to compare incidence of childhood household injuries and prevalence of risk factors between communities in urban and rural Ghana to inform prevention initiatives.

METHODS

Data from urban and a rural cluster-randomized, population-based surveys of caregivers of children <5 years in Ghana were combined. In both studies, caregivers were interviewed about childhood injuries that occurred within the past 6 months and 200 meters of the home that resulted in missed school/work, hospitalization, and/or death. Sampling weights were applied, injuries and incidence rate ratios (IRRs) were described, and multi-level regression was used to identify and compare risk factors.

RESULTS

We sampled 200 urban and 357 rural households that represented 20,575 children in Asawase and 14,032 children in Amakom, Ghana, respectively. There were 143 and 351 injuries in our urban and rural samples, which equated to 594 and 542 injuries per 1,000 child-years, respectively (IRR 1.09, 95%CI 1.05-1.14). Toddler-aged children had the highest odds of injury both urban and rural communities (OR 3.77 vs 3.17, 95%CI 1.34-10.55 vs 1.86-5.42 compared to infants, respectively). Urban children were more commonly injured by falling (IRR 1.50, 95%CI 1.41-1.60), but less commonly injured by flame/hot substances (IRR 0.51, 95%CI 0.44-0.59), violence (IRR 0.41, 95%CI 0.36-0.48), or motor vehicle (IRR 0.50, 95%CI 0.39-0.63). Rural households that cooked outside of the home (OR 0.36, 95%CI 0.22-0.60) and that also supervised older children (OR 0.33, 95%CI 0.17-0.62) had lower odds of childhood injuries than those that did not.

CONCLUSIONS

Childhood injuries were similarly common in both urban and rural Ghana, but with different patterns of mechanisms and risk factors that must be taken into account when planning prevention strategies. However, the data suggest that several interventions could be effective, including: community-based, multi-strategy initiatives (e.g., home hazard reduction, provision of safety equipment, establishing community creches); traffic calming interventions in rural community clusters; and passive injury surveillance systems that collect data to inform violence and broader prevention strategies.

Roadway features associated with elderly drivers in motor vehicle crashes

BACKGROUND

As the number of older US drivers has increased over the past decades, so has the number of injuries, hospitalizations, and deaths from motor vehicle crashes (MVCs) involving elderly drivers. We seek to identify personal, environmental, and roadway features associated with increased crashes involving elderly drivers. We hypothesize that elderly drivers are more likely to be involved in MVCs at intersections with more complex signage and traffic flow.

METHODS

This is a retrospective observational study using 2015 to 2019 police traffic crash reports and a Department of Public Health database of built-environment variables from a single urban center. Demographics and environmental/road features were compared for vehicle-only MVCs involving elderly (≥65 years) and younger drivers. χ2 and nonparametric tests were used to analyze 36,168 drivers involved in MVCs.

RESULTS

There were 2,575 (7.1%) elderly drivers involved in MVCs during the study period. Left turns and all-way stop signs were associated with increased crash risk among elderly drivers compared with younger drivers. Elderly-involved MVCs were less likely to occur at intersections with left-turn restrictions, traffic lights, only one-way streets, and bike lanes compared with MVCs with younger drivers. Elderly drivers were more likely to be involved in MVCs on weekdays, less often intoxicated at the time of the crash, and less frequently involved in fatal MVCs compared with younger drivers. However, elderly drivers were more frequently the at-fault party, especially after the age of 75 years.

CONCLUSION

Updates to roadway features have potential to decrease injury and death from MVCs involving elderly adults. Left turn restrictions or other innovative safety treatments at all-way stops or where left turns are permitted may mitigate road crashes involving older adults. Education may increase awareness of higher-risk driving tasks such as turning left, and driving alternatives including public transportation/paratransit may offer alternate means to maintain activities of daily living.

LEVEL OF EVIDENCE

Prognostic/Epidemiological, level IV.

Exploring the Injury Severity Risk Factors in Fatal Crashes with Neural Network

A better understanding of circumstances contributing to the severity outcome of traffic crashes is an important goal of road safety studies. An in-depth crash injury severity analysis is vital for the proactive implementation of appropriate mitigation strategies. This study proposes an improved feed-forward neural network (FFNN) model for predicting injury severity associated with individual crashes using three years (2017–2019) of crash data collected along 15 rural highways in the Kingdom of Saudi Arabia (KSA). A total of 12,566 crashes were recorded during the study period with a binary injury severity outcome (fatal or non-fatal injury) for the variable to be predicted. FFNN architecture with back-propagation (BP) as a training algorithm, logistic as activation function, and six number of hidden neurons in the hidden layer yielded the best model performance. Results of model prediction for the test data were analyzed using different evaluation metrics such as overall accuracy, sensitivity, and specificity. Prediction results showed the adequacy and robust performance of the proposed method. A detailed sensitivity analysis of the optimized NN was also performed to show the impact and relative influence of different predictor variables on resulting crash injury severity. The sensitivity analysis results indicated that factors such as traffic volume, average travel speeds, weather conditions, on-site damage conditions, road and vehicle type, and involvement of pedestrians are the most sensitive variables. The methods applied in this study could be used in big data analysis of crash data, which can serve as a rapid-useful tool for policymakers to improve highway safety.

Risk factors associated with road traffic injuries at the prone-areas in Kampala city: a retrospective cross-sectional study

Background:

Road traffic injuries (RTIs) pose a disproportionate public health burden in the low and middle-income countries (LMICs) like Uganda, with 85% of all the fatalities and 90% of all disability-adjusted life years lost reported worldwide. Of all RTIs which are recorded in Uganda, 50% of cases happen in Kampala —the capital city of Uganda and the nearby cities. Identifying the RTI prone-areas and their associated risk factors can help to inform road safety and prevention measures aimed at reducing RTIs, particularly in emerging cities such as Kampala.

Methods:

This study was based on a retrospective cross-sectional design to analyze a five year (2011 – 2015) traffic crash data of the Uganda Police Force.

Results:

Accordingly, 60 RTI prone-areas were identified to exist across the Kampala. They were ranked as low and high risk areas; 41 and 19, respectively and with the majority of the latter based in the main city center. The bivariate analysis showed a significant association between identified prone-areas and population flow (OR: 4.89, P–value: 0.01) and traffic flow time (OR: 9.06, P–value: 0.01). On the other hand, the multivariate regression analysis only showed traffic flow time as the significant predictor (OR: 6.27, P–value: 0.02) at identified RTI prone-areas.

Conclusions:

The measures devised to mitigate RTI in an emerging city like Kampala should study thoroughly the patterns of traffic and population flow to help to optimize the use of available resources for effective road safety planning, injury prevention and sustainable transport systems.

The Associations between Outdoor Playtime, Screen-Viewing Time, and Environmental Factors in Chinese Young Children: The "Eat, Be Active and Sleep Well" Study

The purpose of this study is to identify regional differences in outdoor activity time and screen-viewing time of preschool children in urban and rural areas and to provide data on the environmental factors to identify modifiable determinants for each region. This cross-sectional study was conducted on 1772 out of 2790 children between the age of 3 to 6 years living in northern China, with their consent. A cross-sectional study was conducted among preschool children living in urban (n = 1114) and rural areas (n = 658) in northern China. To assess environmental factors, the International Physical Activity Questionnaire was used for neighborhood environments, and the questionnaire included three items each for the physical home environment and socio-cultural environment domains. We observed the associations between outdoor play for urban children and sidewalks in the neighborhood, paths for cycles, aesthetic qualities, and “motor vehicles. In addition, in rural areas, screen-viewing time and environmental factors were found to be positively correlated with traffic, limited place and method of outdoor play, and were negatively correlated with the importance of academics and need for company in outdoor play. This has important implications for the development of effective intervention programs for preschool children in China in the future.

Mapping global evidence on strategies and interventions in neurotrauma and road traffic collisions prevention: a scoping review

BACKGROUND

Neurotrauma is an important global health problem. The largest cause of neurotrauma worldwide is road traffic collisions (RTCs), particularly in low- and middle-income countries (LMICs). Neurotrauma and RTCs are preventable, and many preventative interventions have been implemented over the last decades, especially in high-income countries (HICs). However, it is uncertain if these strategies are applicable globally due to variations in environment, resources, population, culture and infrastructure. Given this issue, this scoping review aims to identify, quantify and describe the evidence on approaches in neurotrauma and RTCs prevention, and ascertain contextual factors that influence their implementation in LMICs and HICs.

METHODS

A systematic search was conducted using five electronic databases (MEDLINE, EMBASE, CINAHL, Global Health on EBSCO host, Cochrane Database of Systematic Reviews), grey literature databases, government and non-government websites, as well as bibliographic and citation searching of selected articles. The extracted data were presented using figures, tables, and accompanying narrative summaries. The results of this review were reported using the PRISMA Extension for Scoping Reviews (PRISMA-ScR).

RESULTS

A total of 411 publications met the inclusion criteria, including 349 primary studies and 62 reviews. More than 80% of the primary studies were from HICs and described all levels of neurotrauma prevention. Only 65 papers came from LMICs, which mostly described primary prevention, focussing on road safety. For the reviews, 41 papers (66.1%) reviewed primary, 18 tertiary (29.1%), and three secondary preventative approaches. Most of the primary papers in the reviews came from HICs (67.7%) with 5 reviews on only LMIC papers. Fifteen reviews (24.1%) included papers from both HICs and LMICs. Intervention settings ranged from nationwide to community-based but were not reported in 44 papers (10.8%), most of which were reviews. Contextual factors were described in 62 papers and varied depending on the interventions.

CONCLUSIONS

There is a large quantity of global evidence on strategies and interventions for neurotrauma and RTCs prevention. However, fewer papers were from LMICs, especially on secondary and tertiary prevention. More primary research needs to be done in these countries to determine what strategies and interventions exist and the applicability of HIC interventions in LMICs.

PROTOCOL: Effectiveness of road safety interventions: An evidence and gap map

The Decade of Action for Road Safety 2011-2020, officially proclaimed by the UN General Assembly in March 2010, sought to reduce morbidity and mortality due to road traffic injuries (RTI) significantly. While there is reasonable agreement internationally on safer designs of motor vehicles (except locally produced vehicles like three-wheeled scooter taxis, tuk-tuks, jeepneys, etc.), there is a lack of evidence based interventions in road and infrastructure design, police enforcement and post-crash care. Researchers in the field of traffic safety have been aware of the existence of counterintuitive results in their area of work for more than four decades. The fact that many interventions do not result in reductions in RTI is mainly because a large number of studies only measure intermediate outcomes like change in behaviour or knowledge and not the actual results in the field. The scope of this evidence and gap map (EGM) is to cover relevant studies in road safety sector from all countries and present the effectiveness of interventions in terms of mainly traffic crash injuries as its outcome. The interventions adopted in this EGM are classified into five broad categories: Human factors, vehicle factors and protective devices, road design, infrastructure and traffic control, post-crash pre-hospital care and legal and institutional framework. In order to come closer to accomplishing targets for road safety, it is important to allocate resources to promote interventions that are effective in achieving outcomes in the context of road safety. A mapping will provide a comprehensive overview of existing knowledge in the area of road safety and its effectiveness across the world. The map will guide programme managers to high quality evidence and inform targeted commissioning of future research.

Traumatic brain injury mortality among U.S. children and adolescents ages 0-19 years, 1999-2017

INTRODUCTION

To examine recent traumatic brain injury (TBI) mortality changes among Americans aged 0-19 years by sex, age, urbanicity, state, and intent/causes of injury.

METHOD

TBI mortality per 100,000 population and average annual percent changes (AAPCs), plus 95% confidence intervals (CIs) based on Joinpoint regression models.

RESULTS

Age-adjusted TBI mortality among Americans aged 0-19 years declined consistently, though at varying rates between 1999 and 2013 (AAPC = -4.8%, 95%CI: -6.3%, -3.2%), and then significantly increased from 4.42 per 100,000 population in 2013 to 5.17 per 100,000 population in 2017 (AAPC = 3.4%, 95% CI: 1.7%, 5.1%). During the study time period, boys, rural children, and youth aged 15-19 years had higher TBI mortality rates than girls, urban children, and younger children, respectively. TBI mortality from unintentional transport crashes decreased substantially in all age groups between 1999 and 2017, and especially from 1999 to 2010. TBI mortality from suicide increased significantly from 2008 to 2017 in the 10-14-year age group (AAPC = 14.6%, 95% CI: 12.6%, 16.6%) and from 2007 to 2017 in the 15-19-year age group (AAPC = 6.3%, 95% CI: 3.8%, 8.7%). Unintentional transport crashes were the leading cause of TBI-related mortality in 46 states in 1999, but by 2017, suicide became the first leading cause in 14 states.

CONCLUSIONS

Pediatric TBI mortality declined consistently between 1999 and 2013 and increased significantly from 2013 to 2017, driven primarily by the mortality decrease from unintentional transport crashes and increase in suicide mortality. The spectrum of leading causes of pediatric TBI mortality changed across age groups and over time from 1999 to 2017. Practical Applications: TBI mortality increases in the United States since 2013 are driven primarily by increasing suicide rates, a trend that merits the attention of policy-makers and injury researchers. Action should be taken to curb growing TBI mortality rates among adolescents aged 10-19 years.

The light is red: Uncertainty behaviours displayed by pedestrians during illegal road crossing

Road accidents involving pedestrians are a reality of urban life. Pedestrian risk is now well known and documented from the perspective of drivers. However, pedestrian behaviour plays a central role in road accidents, notably in terms of illegal road crossing at signalized intersections. This study focuses on pedestrians crossing illegally at a signal light, and specifically investigates uncertainty behaviour, also referred to as hesitation, which occurs when a pedestrian slows down or stops his/her crossing movement then (1) abandons the crossing by returning to the kerb or (2) accelerates to cross the road more quickly. We sought to understand the causes of this behaviour in France and Japan, two countries where interesting differences have already been demonstrated in the way pedestrians behave. The results show a longer period of uncertainty for pedestrians in Japan compared to France. Japanese pedestrians also hesitated longer when they were alone. This study demonstrates a tendency to speed up if there are a number of pedestrians already crossing the road, but abandoning behaviours were more frequently observed than acceleration. This study confirms that pedestrians may misevaluate the moment to cross and hesitate when they realise that they have made a mistake, thus increasing the risk of an accident. These results could help to find solutions that prevent illegal and dangerous road-crossing behaviours.

Mapping global evidence on strategies and interventions in neurotrauma and road traffic collisions prevention: a scoping review protocol

INTRODUCTION

Neurotrauma is an important global health problem. This 'silent epidemic' is a major cause of death and disability in adolescents and young adults, with significant societal and economic impacts. Globally, the largest cause of neurotrauma is road traffic collisions (RTCs). Neurotrauma and RTCs are largely preventable, and many preventative strategies and interventions have been established and implemented over the last decades, particularly in high-income countries. However, these approaches may not be applicable globally, due to variations in environment, resources, population, culture and infrastructure. This paper outlines the protocol for a scoping review, which seeks to map the evidence on strategies and interventions in neurotrauma and RTCs prevention globally, and to ascertain contextual factors that influence their implementation.

METHODS AND ANALYSIS

This scoping review will use the established methodology by Arksey and O'Malley. Eligible studies will be identified from five electronic databases (MEDLINE, EMBASE, CINAHL, Global Health/EBSCO and Cochrane Database of Systematic Reviews) and grey literature sources. We will also carry out bibliographical and citation searching of included studies. A two-stage selection process, which involves screening of titles and abstracts, followed by full-text screening, will be used to determine eligible studies which will undergo data abstraction using a customised, piloted data extraction sheet. The extracted data will be presented using evidence mapping and a narrative summary.

ETHICS AND DISSEMINATION

Ethical approval is not required for this scoping review, which is the first step in a multiphase public health research project on the global prevention of neurotrauma. The final review will be submitted for publication to a scientific journal, and results will be presented at appropriate conferences, workshops and meetings. Protocol registered on 5 April 2019 with Open Science Framework (https://osf.io/s4zk3/).

Estimating the avoidable burden and population attributable fraction of human risk factors of road traffic injuries in iran: application of penalization, bias reduction and sparse data analysis

The aim of this study was to prioritize human risk factors for preventive interventions by estimating the avoidable burden and population attributable fraction (PAF) of each risk factor using penalization and data augmentation method. To avoid the sparse data bias, Bayesian logistic regression via data augmentation methods, were used for multivariable analysis. Informative normal priors adopted from the studies were used for the studied human risk factors. Weakly informative log-f was used for the covariates. The population attributable fraction was calculated based on direct method. The comparative risk assessment methodology of the WHO was used to estimate the potential impact fraction for each risk factor. The most important human factors influencing the traffic-related deaths were overspeeding (OR = 9.6, 95% CI: 2.45-37.7), reckless overtaking (OR = 8.6, 95% CI: 1.82-40.7), and fatigue and drowsiness (OR = 6.7, 95% CI: 1.79-25). The total PAF for the all studied risk factors was about 56% (PAF = 0.567, 95% CI: 0.37-0.7). The greatest avoidable burden was related to fatigue and drowsiness, overspeeding, and not fastening seatbelt. By considering the high contribution of human risk factors in occurrence of fatal traffic injuries appropriate legislation and prevention programs for these risk factors would decrease half of such deaths.

Prevention of unintentional childhood injury: A review of study designs in the published literature 2013-2016

The purpose of this review was to examine the range and quality of published injury prevention research, based on study design. Stratified random selection of journals (based on the average annual number of injury prevention publications) was conducted using a published inventory. Hand searches for empirical research articles on unintentional injury prevention in children and youth (0–19 years) over the four-year period 2013 to 2016, inclusive were conducted. Of the 380 studies identified, the majority were descriptive (133, 35%) or observational (163, 43%), with more than three quarters of the published studies using a “hypothesis-generating” study design. Only 12 (3%) studies were randomized controlled trials, and of the 44 experimental studies, 19 (43%) did not include a comparison group. Transportation injuries predominated, knowledge/attitude/behaviour outcomes were common, and the most common intervention approach was education. The majority of publications were from high-income countries.

This review of injury prevention research in children and youth showed that descriptive studies predominate in the published literature, and hypothesis-testing study designs are relatively infrequent. The findings suggest a need for the injury field to support and promote rigorous analytic study designs. In other words, to enhance and strengthen the evidence base for injury prevention policy and practice, injury prevention researchers should consider a greater focus on determination of cause and effect and evaluation of the effectiveness of interventions, particularly engineering and legislative interventions.

The built environment and active transportation safety in children and youth: a study protocol

BACKGROUND

Active transportation, such as walking and biking, is a healthy way for children to explore their environment and develop independence. However, children can be injured while walking and biking. Many cities make changes to the built environment (e.g., traffic calming features, separated bike lanes) to keep people safe. There is some research on how effective these changes are in preventing adult pedestrians and bicyclists from getting hurt, but very little research has been done to show how safe various environments are for children and youth. Our research program will study how features of the built environment affect whether children travel (e.g., to school) using active modes, and whether certain features increase or decrease their likelihood of injury.

METHODS

First, we will use a cross-sectional study design to estimate associations between objectively measured built environment and objectively measured active transportation to school among child elementary students. We will examine the associations between objectively measured built environment and child and youth pedestrian-motor vehicle collisions (MVCs) and bicyclist-MVCs. We will also use these data to determine the space-time distribution of pedestrian-MVCs and bicyclist-MVCs. Second, we will use a case-crossover design to compare the built environment characteristics of the site where child and youth bicyclists sustain emergency department reported injuries and two randomly selected sites (control sites) along the bicyclist's route before the injury occurred. Third, to identify implementation strategies for built environment change at the municipal level to encourage active transportation we will conduct: 1) an environmental scan, 2) key informant interviews, 3) focus groups, and 4) a national survey to identify facilitators and barriers for implementing built environment change in municipalities. Finally, we will develop a built environment implementation toolkit to promote active transportation and prevent child pedestrian and bicyclist injuries.

DISCUSSION

This program of research will identify the built environment associated with active transportation safety and form an evidence base from which municipalities can draw information to support change. Our team's national scope will be invaluable in providing information regarding the variability in built environment characteristics and is vital to producing evidence-based recommendations that will increase safe active transportation.

Spatial distribution of roadway environment features related to child pedestrian safety by census tract income in Toronto, Canada

BACKGROUND

Investments in traffic calming infrastructure and other street design features can enhance pedestrian safety as well as contribute to the 'walkability' of neighbourhoods. Pedestrian-motor vehicle collisions (PMVCs) in urban areas, however, remain common and occur more frequently in lower income neighbourhoods. While risk and protective features of roadways related to PMVC have been identified, little research exists examining the distribution of roadway environment features. This study examined the relationship between roadway environment features related to child pedestrian safety and census tract income status in Toronto.

METHODS

Spatial cluster detection based on 2006 census tract data identified low-income and high-income census tract clusters in Toronto. Police-reported PMVC data involving children between the ages of 5 and 14 years were mapped using geographical information system. Also mapped were roadway environment features (densities of speed humps, crossing guards, local roads, one-way streets and missing sidewalks). Multivariate logistic regression was used to examine the relationship between roadway environment features (independent variables) and cluster income status (dependent variable), controlling for child census tract population.

RESULTS

There were significantly fewer speed humps and local roads in low-income versus high-income clusters. Child PMVC rates were 5.4 times higher in low-income versus high-income clusters.

CONCLUSION

Socioeconomic inequities in the distribution of roadway environment features related to child pedestrian safety have policy and process implications related to the safety of child pedestrians in urban neighbourhoods.

Identifying developmental trajectories of worldwide road traffic accident death rates using a latent growth mixture modeling approach

Road Traffic Accidents (RTA) are a major worldwide public health problem. The aim of this study was to use the growth mixture model for clustering countries on the basis of the mortality rate patterns of RTAs from 2007 to 2013. We obtained the data on RTA death rates from World Health Organization reports and Human Development Index (HDI) of United Nations Development Programme reports for the years 2007, 2010 and 2013. Simple Latent Growth Models (LGM) in 181 countries were applied to estimate overall RTA mortality rate growth trajectories and the latent growth mixture modeling utilized to cluster them. According to non-linear LGM, the overall mortality rate of RTAs showed a decrease from 2007 to 2010 followed by an increase from 2010 to 2013. The HDI covariate had a significant negative and positive effect on intercept and slope of the LGM, respectively. The extracted mixture model appeared to have seven classes with different trends in RTA mortality rates. The worldwide countries were clustered into seven classes. Further studies on each of the seven classes are suggested to provide recommendations for reducing the mortality rate of the RTAs. Additionally, increasing HDI in some countries could have a significant effect on reducing the RTA death rates.

The effects of roadway and built environment characteristics on pedestrian fatality risk: A national assessment at the neighborhood scale

Characteristics of the transportation system and built environment contribute to pedestrian fatality risks, including vehicular traffic and land-use characteristics associated with higher pedestrian activity. We combined data from FHWA, NHTSA, EPA, and the Census Bureau and performed regression modeling to explore associations between transportation system and built environment characteristics and pedestrian fatalities between 2012 and 2016 at the Census tract scale across the United States. In urban tracts, we found especially strong associations between traffic on non-access-controlled principal arterial and minor arterial roadways and pedestrian fatalities (0.91 and 0.68 additional annual pedestrian fatalities per 100,000 persons per 10,000 VMT/mi² increase in traffic density, respectively). In both urban and rural tracts, we also found strong associations between employment density in the retail sector and pedestrian fatalities. Finally, we compared our model to the High Injury Network in Los Angeles, CA. Nearly half (43%) of observed fatalities were identified by both methods, while some fatalities were identified by only one (19% by our model and 23% by the High Injury Network). This work shows that traffic on certain roadway facility types and employment in certain sectors have especially strong associations with pedestrian fatality risk. More broadly, we illustrate how leveraging cross-disciplinary data in novel ways can support prospective, risk-based assessments of pedestrian fatality risks and support integrated and systemic approaches to transportation safety.

The effects of changes to the built environment on the mental health and well-being of adults: Systematic review

There is increasing interest in the influence of place on health, and the need to distinguish between environmental and individual level factors. For environmental-level factors, current evidence tends to show associations through cross-sectional and uncontrolled longitudinal analyses rather than through more robust study designs that can provide stronger causal evidence. We restricted this systematic review to randomised (or cluster) randomised controlled trials and controlled before-and-after studies of changes to the built environment. Date of search was December 2016. We identified 14 studies. No evidence was found of an effect on mental health from 'urban regeneration' and 'improving green infrastructure' studies. Beneficial effects on quality-of-life outcomes from 'improving green infrastructure' were found in two studies. One 'improving green infrastructure' study reported an improvement in social isolation. Risk-of-bias assessment indicated robust data from only four studies. Overall, evidence for the impact of built environment interventions on mental health and quality-of-life is weak. Future research requires more robust study designs and interdisciplinary research involving public health, planning and urban design experts.

Save LIVES technical package: 22 interventions that could make a difference

The Save LIVES: a road safety technical package was produced and launched in May 2017 by the WHO to support road safety decision makers and practitioners in their efforts to significantly reduce the number of road traffic deaths in their countries. This Special Feature explains the process used to develop the package and how and why the 22 interventions were included. It concludes by encouraging researchers and practitioners to tailor their road safety packages to their own realities by following five practical steps.

Bicycle Facilities That Address Safety, Crime, and Economic Development: Perceptions from Morelia, Mexico

México is a developing nation and, in the city of Morelia, the concept of the bicyclist as a road user appeared only recently in the Municipal Traffic Regulations. Perhaps the right bicycle infrastructure could address safety, crime, and economic development. To identify the best infrastructure, six groups in Morelia ranked and commented on pictures of bicycle environments that exist in bicycle-friendly nations. Perceptions about bike paths, but only those with impossible-to-be-driven-over solid barriers, were associated with safety from crashes, lowering crime, and contributing to economic development. Shared use paths were associated with lowering the probability of car/bike crashes but lacked the potential to deter crime and foster the local economy. Joint bus and bike lanes were associated with lower safety because of the unwillingness by Mexican bus drivers to be courteous to bicyclists. Gender differences about crash risk biking in the road with the cars (6 best/0 worst scenario) were statistically significant (1.4 for male versus 0.69 for female; p < 0.001). For crashes, crime, and economic development, perceptions about bicycle infrastructure were different in this developing nation perhaps because policy, institutional context, and policing (ticketing for unlawful parking) are not the same as in a developed nation. Countries such as Mexico should consider building cycle tracks with solid barriers to address safety, crime, and economic development.

Factors affecting the exposure, vulnerability and emergency medical service capacity for victims of road traffic incidents in Kampala Metropolitan Area: a Delphi study

BACKGROUND

The Kampala Metropolitan Area (KMA) is the fastest developing region in Uganda. Over recent years, this has placed exponential demand on the road sector, which consequently has contributed to rapid growth in motorized vehicles which, predisposes the region to a high risk of road traffic incidents (RTIs). A number of concerted road safety and post-crash management measures to respond to RTIs in the KMA in particular and Uganda as a whole have been undertaken. However, there is a need to greatly improve the measures by better identifying the factors influencing the exposure, vulnerability and emergency medical service (EMS) capacity for RTI victims. The present study seeks to investigate and reveal these factors.

METHODS

A Delphi technique employing a questionnaire and involving a multidisciplinary panel of experts was used in three rounds.

RESULTS

The ten (10) most important factors affecting the exposure, vulnerability and EMS capacity for victims of RTIs in the KMA were identified. Socio-cultural, infrastructure and road safety aspects were the factors most identified as affecting the exposure and vulnerability. The absence of a national EMS policy and post-crash care system, as well as the fact that many victims lack health insurance, were noted to be the factors adversely affecting the EMS capacity.

CONCLUSIONS

There exists is a real need to substantially reduce the burden of RTIs in KMA, with ultimate goal of saving lives that are being lost needlessly and reducing the impact of injuries and trauma and the economic losses associated with it. This study offers insights into the causes of RTIs and the most appropriate ways of responding to them especially with the establishment and empowerment of predefined and structured EMS systems.

Exploratory field trial of motorcycle autonomous emergency braking (MAEB): Considerations on the acceptability of unexpected automatic decelerations

OBJECTIVE

Autonomous emergency braking (AEB) acts to slow down a vehicle when an unavoidable impending collision is detected. In addition to documented benefits when applied to passenger cars, AEB has also shown potential when applied to motorcycles (MAEB). However, the feasibility of MAEB as practically applied to motorcycles in the real world is not well understood.

METHODS

In this study we performed a field trial involving 16 riders on a test motorcycle subjected to automatic decelerations, thus simulating MAEB activation. The tests were conducted along a rectilinear path at nominal speed of 40 km/h and with mean deceleration of 0.15 g (15% of full braking) deployed at random times. Riders were also exposed to one final undeclared brake activation with the aim of providing genuinely unexpected automatic braking events.

RESULTS

Participants were consistently able to manage automatic decelerations of the vehicle with minor to moderate effort. Results of undeclared activations were consistent with those of standard runs.

CONCLUSIONS

This study demonstrated the feasibility of a moderate automatic deceleration in a scenario of motorcycle travelling in a straight path, supporting the notion that the application of AEB on motorcycles is practicable. Furthermore, the proposed field trial can be used as a reference for future regulation or consumer tests in order to address safety and acceptability of unexpected automatic decelerations on a motorcycle.

Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015

BACKGROUND

Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures.

METHODS

We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).

FINDINGS

Globally, life expectancy from birth increased from 61·7 years (95% uncertainty interval 61·4-61·9) in 1980 to 71·8 years (71·5-72·2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11·3 years (3·7-17·4), to 62·6 years (56·5-70·2). Total deaths increased by 4·1% (2·6-5·6) from 2005 to 2015, rising to 55·8 million (54·9 million to 56·6 million) in 2015, but age-standardised death rates fell by 17·0% (15·8-18·1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14·1% (12·6-16·0) to 39·8 million (39·2 million to 40·5 million) in 2015, whereas age-standardised rates decreased by 13·1% (11·9-14·3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42·1%, 39·1-44·6), malaria (43·1%, 34·7-51·8), neonatal preterm birth complications (29·8%, 24·8-34·9), and maternal disorders (29·1%, 19·3-37·1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death.

INTERPRETATION

At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems.

FUNDING

Bill & Melinda Gates Foundation.

Road traffic mortality in the Slovak Republic in 1996-2014

OBJECTIVE

Road traffic mortality takes an enormous toll in every society. Transport safety interventions play a crucial role in improving the situation. In the period 1996-2014 several road safety measures, including a complex new road traffic law in 2009, were implemented in the Slovak Republic, introducing stricter conditions for road users. The aim of this study is to describe and analyze the trends in road user mortality in the Slovak Republic in individual age groups by sex during the study period 1996-2014.

METHODS

Data on overall mortality in the Slovak Republic for the period 1996-2014 were obtained from the Statistical Office of the Slovak Republic. Mortality rates were age-adjusted to the European standard population. Joinpoint regression was used to assess the statistical significance of change in time trends of calculated standardized mortality rates.

RESULTS

Mortality rates of all types of road users as well as all age groups and both sexes in the Slovak Republic in the period 1996-2014 are decreasing. The male : female ratio decreased from 4:1 in 1996 to 2:1 in 2014. Motor vehicle users (other than motorcyclists) and pedestrians have the highest mortality rates among road user groups. Both of these groups show a significant decline in mortality rates over the study period. Within the age groups, people age 65 years and over have the highest mortality rates, followed by the age groups 25-64 and 15-24 years old. Joinpoint regression confirmed a steady, significant decline in all mortality rates over the study period. A statistically significant decrease in mortality rates in the last years of the study period was observed in the age group 25-64 and in male motorcycle users. Assessing the impact of the 2009 road traffic law, a drop was observed in the average standardized mortality rate of all road traffic users from 14.56 per 100,000 person years in the period 1996-2008 to 7.69 per 100,000 person years in the period 2009-2014. A similar drop in the average standardized mortality rate was observed in all individual road user groups.

CONCLUSIONS

The implementation of the new traffic regulations may have contributed significantly to the observed decrease in mortality rates of road users in the Slovak Republic. A significant decrease in mortality was observed in all population groups and in all groups of road users. The introduction of a new comprehensive road traffic law may have expedited the decrease of road fatalities, especially in the age group 25-64 years old. This type of evidence-based epidemiology data can be used for improved targeting of future public health measures for road traffic injury prevention.

An Epidemiological Study of Road Traffic Accidents in Guilan Province, Northern Iran in 2012

OBJECTIVE

To determine the epidemiological characteristics of the road traffic injuries (RTIs) in Guilan province, northern Iran.

METHODS

This study was a cross-sectional study which included all of RTIs admitted to medical centers of Guilan province (northern Iran) during 2012. ICD-10 was used as diagnostic criteria. Demographic variables also injury circumstance and in hospital variables such as length of stay, time of admission, type of surgery, ICU admission, final outcome and mechanism of injury, anatomical part of injury according to Abbreviated Injury Scale (AIS) classification were derives from records by trained research team. Descriptive data is reported. The predictors of mortality were also determined.

RESULTS

The prevalence of road traffic injuries in Guilan province was 31 in 10,000 populations. Of total 7671 accidents, 5976 (77.9%) were men and 1695 (22.1%) were women. Mean age of these victims was 33.3 ± 17.289 years (32.64±16.939 for men, 35.62±18.312 for women). Most of them (32.5%) were 20-29 years old. Motorcycle-car accidents had the highest frequency followed by car-car crashes and car accidents involving pedestrians. Most of the patients (85.9%) were hospitalized and 280 injured died (3.7%). Upper extremities were the most sites of injuries. Male sex, length of hospital stay, multiple injuries and increased age were associated with road traffic accident associated mortality.

CONCLUSION

RTIs cause enormous death and disability in this area and more road traffic preventive programs should be enforcement in these areas to reduce incidences RTI.

Predicting and analyzing the trend of traffic accidents deaths in Iran in 2014 and 2015

Background:

Predicting the trend in traffic accidents deaths and its analysis can be a useful tool for planning and policy-making, conducting interventions appropriate with death trend, and taking the necessary actions required for controlling and preventing future occurrences.

Objective:

Predicting and analyzing the trend of traffic accidents deaths in Iran in 2014 and 2015.

Settings and Design:

It was a cross-sectional study.

Materials and Methods:

All the information related to fatal traffic accidents available in the database of Iran Legal Medicine Organization from 2004 to the end of 2013 were used to determine the change points (multi-variable time series analysis). Using autoregressive integrated moving average (ARIMA) model, traffic accidents death rates were predicted for 2014 and 2015, and a comparison was made between this rate and the predicted value in order to determine the efficiency of the model.

Results:

From the results, the actual death rate in 2014 was almost similar to that recorded for this year, while in 2015 there was a decrease compared with the previous year (2014) for all the months. A maximum value of 41% was also predicted for the months of January and February, 2015.

Conclusion:

From the prediction and analysis of the death trends, proper application and continuous use of the intervention conducted in the previous years for road safety improvement, motor vehicle safety improvement, particularly training and culture-fostering interventions, as well as approval and execution of deterrent regulations for changing the organizational behaviors, can significantly decrease the loss caused by traffic accidents.

Healthy urban environments for children and young people: A systematic review of intervention studies

This systematic review collates, and presents as a narrative synthesis, evidence from interventions which included changes to the urban environment and reported at least one health behaviour or outcome for children and young people. Following a comprehensive search of six databases, 33 primary studies relating to 27 urban environment interventions were included. The majority of interventions related to active travel. Others included park and playground renovations, road traffic safety, and multi-component community-based initiatives. Public health evidence for effectiveness of such interventions is often weak because study designs tend to be opportunistic, non-randomised, use subjective outcome measures, and do not incorporate follow-up of study participants. However, there is some evidence of potential health benefits to children and young people from urban environment interventions relating to road safety and active travel, with evidence of promise for a multi-component obesity prevention initiative. Future research requires more robust study designs incorporating objective outcome measures.

Developing a Measure of Traffic Calming Associated with Elementary School Students' Active Transport

The objective of this study is to develop a measure of traffic calming with nationally available GIS data from NAVTEQ and to validate the traffic calming index with the percentage of children reported by school administrators as walking or biking to school, using data from a nationally representative sample of elementary schools in 2006-2010. Specific models, with and without correlated errors, examined associations of objective GIS measures of the built environment, nationally available from NAVTEQ, with the latent construct of traffic calming. The best fit model for the latent traffic calming construct was determined to be a five factor model including objective measures of intersection density, count of medians/dividers, count of low mobility streets, count of roundabouts, and count of on-street parking availability, with no correlated errors among items. This construct also proved to be a good fit for the full measurement model when the outcome measure of percentage of students walking or biking to school was added to the model. The traffic calming measure was strongly, significantly, and positively correlated with the percentage of students reported as walking or biking to school. Applicability of results to public health and transportation policies and practices are discussed.

Trends of Mortality of Road Traffic Accidents in Fars Province, Southern Iran, 2004 - 2010

BACKGROUND

The aim of this study was to investigate the trends in mortality from road traffic accidents (RTA) in Fars Province, southern Iran.

METHODS

The Age and sex-standardized mortality rate attributed to RTA from 2004 to 2010 in Fars Province was calculated using world standard population. We also used linear regression and chi-squared tests.

RESULTS

Over the period of study (7 years), 12954 people died in RTA. The age- and sex-standardized mortality rate was 27 per 100,000. While the rate of death due to RTA had an incremental rate in age group 18-30 years and among women, it had a decreasing trend in age groups 35-45, under18 and among men.

CONCLUSION

An increase in mortality rate of RTA among people aged 18-30 yr and women need to be addressed by health policy makers and other involved sections.

Motor vehicle-pedestrian collisions and walking to school: the role of the built environment

OBJECTIVES

Initiatives to increase active school transportation are popular. However, increased walking to school could increase collision risk. The built environment is related to both pedestrian collision risk and walking to school. We examined the influence of the built environment on walking to school and child pedestrian collisions in Toronto, Canada.

METHODS

Police-reported pedestrian collision data from 2002 to 2011 for children ages 4 to 12, proportion of children walking to school, and built environment data were mapped onto school attendance boundaries. Collision rates were calculated by using 2006 census populations and modeled by using negative binomial regression.

RESULTS

There were 481 collisions with a mean collision rate of 7.4/10 000 children per year. The relationship between walking proportion and collision rate was not statistically significant after adjusting for population density and roadway design variables including multifamily dwelling density, traffic light, traffic calming and 1-way street density, school crossing guard presence, and school socioeconomic status.

CONCLUSIONS

Pedestrian collisions are more strongly associated with built environment features than with proportions walking. Road design features were related to higher collision rates and warrant further examination for their safety effects for children. Future policy designed to increase children's active transportation should be developed from evidence that more clearly addresses child pedestrian safety.

Safely active mobility for urban baby boomers: The role of neighborhood design

Many urban designers and researchers argue that walkable urban environments can encourage older residents' walking activities that benefit their physical health. However, walking also exposes older adults to safety risks, including due to traffic accidents. This study seeks to reveal the interactions between urban form and safety affecting urban baby boomers' walking behavior. Spatial analysis reveals traffic collision patterns in urban Boston neighborhoods, detecting hotspots around activity centers. Structural equation modeling, estimated on individual data collected from a mail-back survey and utilizing numerous measures of neighborhood urban form and accessibility, then attempts to reveal the causal, interacting relationships between neighborhood-level urban form, traffic crashes, and baby boomers' walking behavior. The analysis identifies significant effects of walkable urban forms (e.g., mixed use, well-connected streets, and good access to potential destinations) on older adults' walking. Yet, accessibility to retail, as well as traffic speed and volume, are positively associated with the traffic collision frequency. The results suggest more cautious approaches may be necessary for designing urban spaces for walkability and also call into question prescriptions based on the "safety in numbers" hypothesis.

How do motorcyclists manage mental tensions of risky riding?

BACKGROUND

Road traffic injuries, especially those involving motorcycles, are a particular concern in Iran. We aimed to identify the specific cognitive dissonances and consonances associated with risky riding among Iranian motorcyclists.

METHODS

This was a grounded theory qualitative study of male motorcyclists who were ≥ 18 and were living in one of the three cities of Tehran, Isfahan and Ahwaz. Thirty four (n = 34) motorcyclists participated in 19 in-depth interviews and 5 focus-groups between January 2007 and February 2008.

RESULTS

We identified four categories of motorcycle riders each endorsing a unique risk bias they employed to justify their risky ridings. The categories included: (1) Risk Managers who justified risky riding by doubting that it would result in negative outcomes if they are competent riders. (2) Risk Utilizers who justified risky riding as functional and practical that would enable them to handle daily chores and responsibilities more efficiently. (3) Risk Calculators who justified risky riding by believing that it will help them to avoid road crashes. (4) Risk Takers who justified risky riding by arguing that risky riding is thrilling and brings them peer recognition.

CONCLUSION

Our findings reveal different groups of motorcyclists according to their different rationalizations for risky riding. Road safety advocates can benefit from our findings by matching relevant and appropriate interventions and incentives to these specific groups.

Trends of fatal road traffic injuries in Iran (2004-2011)

Road traffic injuries (RTIs) leading to death need the most essential concern for low, middle and high income societies. Mortality rate due to traffic injuries is considerable in Iran particularly during the last decade along with the industrialization process. The present study considered the trend of traffic injuries leading to death in Iran for a period of seven-years which started from March 2004 to March 2011. The formal merged Iranian database provided by the Ministry of Roads, the Legal Medicine Organization, the Traffic Police (NAJA), and the Ministry of Health covering 146, 269 deaths due to traffic injuries between 2004 and 2011 was analyzed. The time series method was carried out to determine the death trends of RTIs in the whole country. The Poisson regression model was used to estimate the changes in the frequency of events over time adjusting for associated known risk factors. The SARIMA (0, 1, 1)×(0, 1, 1)12 model was used for fitting to the time series of death rate. The death rate due to RTIs in Iran has statistically declined from 38 in 2004 to 31 per 100,000 populations in 2011. Based on the number of vehicles, the mortality rate has also declined from 38 to 12 cases per 10,000 vehicles from 2004 to 2011 respectively. However, the mortality rate was increased from 51 to 65 cases per 1000 accidents from 2004 to March 2011 respectively. Despite minor variations in mortality trends of RTIs in Iran according to different criteria, an annual average of 21,000 deaths is considerable and needs serious attentions. Modification of traffic laws, enhancement of police controls, improving transport infrastructure, holding education courses for drivers and providing optimal healthcare services are recommended.

Methodological proposal for implementing an intervention to prevent pedestrian injuries, a multidisciplinary approach: the case of Cuernavaca, Morelos, Mexico

OBJECTIVE

To describe the process for implementing an intervention to prevent pedestrian injuries in Cuernavaca, Mexico, using a multidisciplinary and evidence-based approach.

METHODOLOGY

This study included two phases with several stages. The first was an overall assessment of pedestrian mortality in Cuernavaca that included a comparison of pedestrian mortality between Cuernavaca and the rest of Morelos State (1998-2007), an analysis and geocoding of pedestrian injuries (2008-2009), and a description of techniques for selecting and analysing clustered events using road audits. The second phase focused on selecting an intervention through a review of the literature seeking the 'best evidence' adaptable to the local context and a methodological evaluation for implementation including techniques for cluster randomisation and for the evaluation of possible effects of the intervention.

RESULTS

Between 2008 and 2009, in Cuernavaca there were 620 pedestrian injury events: 59.4% were men, the mean age was 36.3 years, 70% occurred during daylight hours, 55% had mild severity and there were no differences by sex (p>0.05). We generated evidence, that when combined with the results from a systematic search of the literature, provided sufficient information for the implementation of a pedestrian injury prevention intervention.

CONCLUSIONS

A combination of strategies and disciplines makes it possible to comprehensively address this public health problem, allowing interventions to strengthen aspects of pedestrian safety while accounting for characteristics of the local context; the promotion of local measures, of low cost and high impact, with modifications to the road infrastructure, are more effective in addressing pedestrian vulnerabilities.

Fatality and injury severity of older adult motor vehicle collisions in orange county, california, 1998-2007

INTRODUCTION

Injuries and fatalities in adult drivers 18-65 years of age have decreased in recent years due to safer vehicles, enhanced medical policies, and implementation of injury prevention policies. However, adult drivers over 65 years of age are continuing to suffer from motor vehicle collision-related injuries and fatalities at a more constant rate. A number of physiological factors contribute to the deterioration in visual acuity, slower reaction speeds, and decreased awareness in older drivers. The objective of this study was to examine injury severity and fatality rates in older drivers compared to their younger counterparts in Orange County, California.

METHODS

This study used the Statewide Integrated Traffic Record System data for Orange County for the years 1998-2007. Drivers were categorized into 4 age groups: 25-64, 65-74, 75-84, and older than 85 years of age. Injury severity was assessed by the investigating officer.

RESULTS

Of the 197,814 drivers involved in motor vehicle collisions, 178,481 (90.2%) were in the 25-64 age group; 11,397 (5.8%) were 65-74; 6,592 (3.3%) were 75-84; and 1,344 drivers (0.7%) were over 85. Those aged 25-64 had the lowest fatality rate per 100,000 people, 2.5, whereas those 75-84 had the highest fatality rate, 4.9. The percent of crashes involving a left turn increased with age, and the percent that were stopped in the road decreases with age. Change in injury collision involvement ratio in the 3 younger age groups decreased by 26% to 32%, but decreased by 18% among drivers aged 85 years and older.

CONCLUSION

The decrease in collision fatalities was greater in the 25-64-year-old group compared to the older adult population. This disparity highlights the need for further injury prevention efforts for older drivers.

Road user behaviour changes following a self-explaining roads intervention

The self-explaining roads (SER) approach uses road designs that evoke correct expectations and driving behaviours from road users to create a safe and user-friendly road network. Following the implementation of an SER process and retrofitting of local and collector roads in a suburb within Auckland City, lower speeds on local roads and less variation in speed on both local and collector roads were achieved, along with a closer match between actual and perceived safe speeds. Preliminary analyses of crash data shows that the project has resulted in a 30% reduction crash numbers and an 86% reduction in crash costs per annum, since the road changes were completed. In order to further understand the outcomes from this project, a study was carried out to measure the effects of the SER intervention on the activity and behaviour of all road users. Video was collected over nine separate days, at nine different locations, both before and after SER construction. Road user behaviour categories were developed for all potential road users at different location types and then used to code the video data. Following SER construction, on local roads there was a relatively higher proportion of pedestrians, less uniformity in vehicle lane keeping and less indicating by motorists along with less through traffic, reflecting a more informal/low speed local road environment. Pedestrians were less constrained on local roads following SER construction, possibly reflecting a perceptually safer and more user-friendly environment. These behaviours were not generally evident on collector roads, a trend also shown by the previous study of speed changes. Given that one of the objectives of SER is to match road user behaviour with functionally different road categories, the road user behaviour differences demonstrated on different road types within the SER trial area provides further reinforcement of a successful SER trial.

Assessment of the status of prehospital care in 13 low- and middle-income countries

BACKGROUND

Injury and other medical emergencies are becoming increasingly common in low- and middle-income countries (LMICs). Many to most of the deaths from these conditions occur outside of hospitals, necessitating the development of prehospital care. Prehospital capabilities are inadequately developed to meet the growing needs for emergency care in most LMICs.

OBJECTIVE

In order to better plan for development of prehospital care globally, this study sought to better understand the current status of prehospital care in a wide range of LMICs.

METHODS

A survey was conducted of emergency medical services (EMS) leaders and other key informants in 13 LMICs in Africa, Asia, and Latin America. Questions addressed methods of transport to hospital, training and certification of EMS providers, organization and funding of EMS systems, public access to prehospital care, and barriers to EMS development.

RESULTS

Prehospital care capabilities varied significantly, but in general were less developed in low-income countries and in rural areas, where utilization of formal EMS was often very low. Commercial drivers, volunteers, and other bystanders provided a large proportion of prehospital transport and occasionally also provided first aid in many locations. Although taxes and mandatory motor vehicle insurance provided supplemental funds to EMS in 85% of the countries, the most frequently cited barriers to further development of prehospital care was inadequate funding (36% of barriers cited). The next most commonly cited barriers were lack of leadership within the system (18%) and lack of legislation setting standards (18%).

CONCLUSIONS

Expansion of prehospital care to currently underserved or unserved areas, especially in low-income countries and in rural areas, could make use of the already-existing networks of first responders, such as commercial drivers and laypersons. Efforts to increase their effectiveness, such as more widespread first-aid training, and better encompassing their efforts within formal EMS, are warranted. In terms of existing formal EMS, there is a need for increased and more regular funding, integration and coordination among existing services, and improved organization and leadership, as could be accomplished by making EMS administration and leadership a more desirable career path.

Preventing road injuries in children by applying feedback devices

OBJECTIVE

The objective of this article is to determine how to prevent road injuries in schoolchildren by reducing the prevalence of speeding.

METHODS

On a busy road in the neighborhood of a preschool and two secondary schools in Oberhaching (greater Munich, Germany), a board was mounted next to the road (visible to the drivers as well as the pedestrians). The board consisted of a picture of a smiling child. Underneath the picture, an LED display read "Thank you!" in green blinking letters when the speed limit was adhered to and "Slowly!" in red blinking letters when speeding was detected. The main outcome assessment was the number of drivers adhering to the speed limit in the experimental condition (i.e., facing the device) compared to the number in the control condition (on the same road within the same time period but traveling in the opposite direction; i.e., drivers not facing the device).

RESULTS

In the control condition 27.6 percent (230) of drivers adhered to the speed limit compared to 41.1 percent (427) of drivers in the experimental condition, χ(2) = 36.1, P < .0001. Only 12 drivers exceeded the speed limit by more than 20 km per hour in the experimental condition, whereas 34 drivers did so in the control condition, χ(2) = 9.6, P < .01.

DISCUSSION

The display is associated with a significantly lower percentage of speeding drivers but does not seem to be sufficient, because the majority of drivers still did not observe the speed limit in the presence of the display. Additional factors on how speed reduction can be achieved will be discussed in the light of future applications and possible modifications of the device.