Road traffic crash circumstances and consequences among young unlicensed drivers: a Swedish cohort study on socioeconomic disparities

Association of age and severe injury in young motorcycle riders: A cross-sectional study from Karachi, Pakistan

INTRODUCTION

The burden imposed by motorcyclist deaths and injuries is high in low- and middle-income countries. Many injured motorcycle riders in these settings are underage. The aim of this study was to assess the association between age and severe injury in young motorcycle riders.

METHODS

We analysed road traffic injury surveillance data from the emergency rooms of five hospitals in Karachi from 2007 to 2015. We used logistic regression to assess the association of motorcycle riders' age, categorised as underage (13-17 years), early licensing age (18-19 years) and late licensing age (20-24 years), with severe injury, defined as an Injury Severity Score (ISS) ≥ 16.

RESULTS

The study sample included 45,366 motorcycle riders. There were 10115 (22.3%) motorcycle riders aged 13-17 years, 9899 (21.8%) aged 18-19 years and 25352 (55.9%) aged 20-24 years. Almost all were male (99%). Being aged 13-17 years (adjusted odds ratio 1.25; 95% CI 1.11, 1.42) and 18-19 years (adjusted odds ratio 1.26; 95% CI 1.10, 1.43) were associated with higher odds of severe injury compared with being aged 20-24 years.

CONCLUSION

Motorcycle riders who presented to the hospital with injuries after road traffic crashes and were aged 13-17 years and 18-19 years had significantly higher odds of severe injury than those aged 20-24 years.

Crash involvement among unlicensed 17 year old drivers before and after licensing at 17 was allowed

Unlicensed driving among youth is associated with increased crash risk, and partly motivated by a wish to learn to drive. In this paper we examine whether crash involvement among 17-year-old unlicensed drivers changed after post-licence accompanied driving from the age of 17 was allowed in Denmark in 2017. The study includes police-registered crashes occurring three years before and three years after the change (2014-2019). Results show an increase in crash involvement among 17-year-olds and a small increase in crash involvement among unlicensed 17-year-olds, if population size is taken into account, but no differences in the crash and person characteristics before and after the change. Being male, speeding, and impairment at the time of the crash predicted unlicensed crash involvement. A latent class clustering analysis (LCCA) identified seven clusters of crashes involving an unlicensed 17-year-old. The cluster characteristics reveal different patterns in the associated factors such as females and parked vehicles being more likely to be included in C1, alcohol impaired in C2 and drug impaired in C7. Brief crash descriptions provided by the police indicate that driving with extra motives such as showing-off or pleasure are prevalent in all clusters. Results confirm, that unlicensed crash involvement among 17-year olds is associated with risk-taking behaviours such as speeding, impaired driving, showing-off, and the car being pursued by the police. However, unfortunate manoeuvres and loss of control of the vehicle possibly related to poor driving skills are also associated with the crashes. Crash characteristics such as impairment by alcohol and drugs indicate that unlicensed crash involvement is a distinct safety challenge associated with health risk behaviours rather than a transport related need for a driver's license. Additional studies exploring the motivations and circumstances associated with unlicensed driving among 17-year olds are needed along with measures to prevent car access among unlicensed youth..

Is driving without a valid license associated with an increased risk of causing a road crash?

The aim of this study was to estimate the association between each cause of driving without a valid license (DWVL) and the risk of causing a road crash, considering driver, vehicle and environmental factors. A case-control study based on data from the Spanish Register of Road Accidents with Victims was carried out between 2014 and 2017. Cases included 28,620 drivers of moving private cars, vans and off-road vehicles involved in single crashes plus 50,100 drivers deemed responsible for clean collisions (i.e. those in which only one driver was labeled as responsible). In accordance with the quasi-induce exposure approach, drivers not responsible for clean collisions comprised the control group (N = 51,656). Logistic and multinomial regression models were used to estimate crude and adjusted Odds Ratios or Relative Risk Ratios between each reason for DWVL and the risk of being a case of all, single and multi-vehicle collisions. A significant association was found between all reasons for DWVL and the risk of causing a road crash. This association was particularly high for drivers with a suspended license and drivers who had never obtained a license. In these subgroups of drivers, the proportion of the relationship explained by high-risk driving behaviors is high. Our results support the need for applying continued strategies to identify and control these subgroups of drivers.

An Investigation into Unsafe Behaviors and Traffic Accidents Involving Unlicensed Drivers: A Perspective for Alignment Measurement

Road traffic plays a vital role in countries’ economic growth and future development. However, traffic accidents are considered a major public health issue affecting humankind. Despite efforts by governments to improve traffic safety, the misalignment between the policy efforts and on-ground infringements, distractions and breaches reflect the regulatory failure. This paper uses the Bayesian network method to investigate unsafe behaviors and traffic accidents involving unlicensed drivers as a perspective for the regulatory alignment assessment. The findings suggest that: (1) unlicensed drivers are more likely to have unsafe driving behaviors; (2) the probability of being involved in a severe traffic accident increases when the drivers are unlicensed and decreases in the case of licensed drivers; (3) young drivers are noticeably more likely to engage in unsafe behaviors, usually leading to serious injuries and deaths, when their driving licenses are invalid; (4) women are more likely to engage in right-of-way violations and to have collisions with no serious injuries, contrary to unlicensed men drivers, who are involved in other types of traffic accidents resulting in serious injuries.

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

Purpose

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

Materials and Methods

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

Results

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

Conclusion

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

Driving violations and health promotion behaviors among undergraduate students: Self-report of on-road behavior

INTRODUCTION

The purposes of this study are to characterize Israeli undergraduate students' driving violations in the terms of problem behavior theory and to identify whether there is any relationship between driving violations and health risk behaviors, daring behaviors, excitement seeking, and health promotion behaviors.

METHODS

This study is based on a structured self-reported anonymous questionnaire distributed to undergraduate students in an academic institution. The sample included 533 undergraduate students (374 females and 159 males). The mean age was 23.4 (SD = 1.4, range = 5).

RESULTS

A higher prevalence of self-reported driving violations was found among males in comparison to females. All substance use measures were positively related to driving violations; for example, use of cigarettes (OR = 4.287, P <.001) and water pipes (odds ratio [OR] = 3.000, P <.001) as well as binge drinking (OR = 5.707, P <.001) and regular cannabis smoking (OR = 5.667, P <.001) raise the probability of committing rare driving violations. The strongest predictive factors for the frequent driving violations group were alcohol consumption-related variables: binge drinking (OR = 2.560, P <.01) and drunkenness (OR = 2.284, P <.05). Strong odd ratios were also found between the frequent driving violations group and selling or dealing drugs (12.143, P <.001), and stealing something valuable (13.680, P <.001). The strongest predicted variable for the rare driving violations group was physical confrontation due to verbal disagreement (3.439, P <.05) and the concept that selling or dealing drugs is socially acceptable (2.521, P <.05). The probability of executing rare driving violations was higher for subjects who reported intense physical workout regimens (OR = 1.638, P <.05).

CONCLUSIONS

Problem behavior theory succeeded in explaining health risk behavior and driving violations. This study shows that bachelors tend to be more involved in risk behaviors, such as substance use, excitement-seeking behaviors, and daring behaviors and are active physically and thus constitute a risk group for driving violations. As such, intervention resources should be directed toward this group.

Post-trauma morbidity, measured as sick leave, is substantial and influenced by factors unrelated to injury: a retrospective matched observational cohort study

BACKGROUND

Mortality as an endpoint has been the focus of trauma research whereas few studies investigate long-term outcomes in terms of morbidity. An adequate analysis of post-injury morbidity includes several dimensions, for this reason sick leave has been used as a proxy for morbidity in the current study. The aim of this retrospective matched observational cohort study was to investigate sick leave before and after trauma and factors associated with prolonged sick leave.

METHODS

Patients from a level one trauma centre 2005-2010 were matched in a 1:5 ratio with uninjured controls. By linkage to national registries, sick leave rates were compared. The association between potential risk factors and full-time sick leave at twelve months post injury, the primary end-point, was examined in trauma patients by logistic regression.

RESULTS

Four thousand seven hundred twelve patients and 25,013 controls aged 20-63 were included. Trauma patients had more sick leave both before and after trauma. Age, psychiatric disease, low level of education, serious injury, spinal injury, reduced consciousness at admission, discharge destination other than home, and hospital length of stay >7 days were all associated with the primary end-point. The strongest risk factor was sick leave before trauma; this was also noted in the most seriously injured patients.

DISCUSSION

In this retrospective matched observational cohort study we found a significant long-term morbidity, measured as sick leave, among trauma patients. Compared to controls the difference was maximal early after trauma and sustained throughout the follow up period. In the logistic regression, factors associated with the traumatic injury as well as host factors increased the probability of not returning to work. Full sick leavemonth twelve post injury was strongly associated with pre-injury sick leave but also with age, psychiatric comorbidity, level of education, injury severity, spinal injury, low GCS at admission, length of stay at hospital and discharge to other destination than home.

CONCLUSIONS

Trauma patients suffer from significant long-term morbidity. The sustained post-trauma morbidity is largely influenced by factors not related to injury per se. These insights enable identification of patients at risk for prolonged sick leave after trauma.

The effect of socio-economic status on non-fatal outcome after injury: A systematic review

BACKGROUND

Over the past decades, the number of survivors of injuries has rapidly grown. It has become important to focus more on the determinants of non-fatal outcome. Although socio-economic status (SES) is considered to be a fundamental determinant of health in general, the role of SES as a determinant of non-fatal outcome after injury is largely unknown.

METHODS

An online search was conducted in November 2015 using Embase, Medline, Web of Science, Cinahl, Cochrane, Google scholar and PubMed. Studies examining the relation between SES and a physical or psychological outcome measure, or using SES as a confounder in a general trauma population were included. There were no restrictions regarding study design. The 'Quality in Prognostic Studies tool' was used to assess the methodological quality of the included studies.

RESULTS

The 24 included studies showed large variations in methodological quality. The number of participants ranged from 56 to 4639, and assessments of the measures ranged from immediately to 6year post-injury. Studies used a large number of variables as indicators of SES. Participant's educational level was used most frequently. The majority of the studies used a multivariable technique to analyse the relation between SES and non-fatal outcome after injury. All studies found a positive association (80% of studies significant, n=19) between increased SES and better non-fatal outcome after injury.

CONCLUSION

Although an adequate and valid measure of SES is lacking, the results of this review showed that SES is an important determinant of non-fatal outcome after injury. Future research should focus on the definition and measurement of SES and should further underpin the effect of SES on non-fatal outcome after injury.

Association between trauma and socioeconomic deprivation: a registry-based, Scotland-wide retrospective cohort study of 9,238 patients

Background

Trauma remains a leading cause of morbidity and mortality in the UK and throughout the world. Socioeconomic deprivation has been linked with many types of ill-health and previous studies have shown an association with injury in other parts of the world. The aim of this study was to investigate the association between socioeconomic deprivation and trauma incidence and case-fatality in Scotland.

Methods

The study included nine thousand two hundred and thirty eight patients attending Emergency Departments following trauma across Scotland in 2011-12. A retrospective cohort study was conducted using secondary data extracted from the national trauma registry. Postcode of residence was used to generate deciles using the Scottish Index of Multiple Deprivation. The incidence rate ratio (IRR) was calculated to allow comparison of incidence of trauma across SIMD deciles. For mortality, observed: expected ratios were obtained using observed mortality in the cohort and expected deaths using probability of survival based on Trauma and Injury Severity Score (TRISS) method.

Results

Compared with the most deprived decile, the least deprived had an incidence rate ratio (IRR) for all trauma of 0.43 (95 % CI 0.32–0.58, p < 0.001). The association was stronger for penetrating trauma (IRR 0.07, 95 % CI .01–0.56, p = 0.011). There was a significant interaction between age, gender and SIMD. For case fatality, multivariate logistic regression showed that, severity of trauma (ISS > 15) OR 18.11 (95 % CI 13.91 to 23.58) and type of injury (Penetrating versus blunt injury) OR 2.07 (95 % CI 1.15 to 3.72) remain as independent predictors of case fatality in this dataset.

Discussion

Our data shows a higher incidence of trauma amongst a socioeconomically deprived population, in keeping with other areas of the world. In our dataset, outcome, as measured by in-hospital mortality, does not appear to be associated with socioeconomic deprivation.

Conclusion

In Scotland, populations living in socioeconomically deprived areas have a higher incidence of trauma, especially penetrating trauma, requiring hospital attendance. Case fatality is associated with more severe trauma and penetrating trauma, but not socioeconomic deprivation.

Electronic supplementary material

The online version of this article (doi:10.1186/s13049-016-0275-7) contains supplementary material, which is available to authorized users.

[Traffic accidentability and risky driving behavior in young people in New Caledonia. Results of study Situation Sociale et Comportements de Santé des Jeunes en Nouvelle-Calédonie]

BACKGROUND

New Caledonia has one of the highest global rates of death from road accidents: 240 deaths per million inhabitants in 2011 with a majority of young people. However, research on driving behaviors has remained rare.

METHODS

A cross-sectional survey based on face-to-face questionnaire with 1400 male and female youth aged 16 to 25 was conducted in 2007. It was used to measure the frequency of accidents and to compute a score of driving behaviors and their associations with socio-demographic characteristics, lifestyles as well as other health behaviors. RESULTS - 

CONCLUSION

A total of 10.6% of boys and 6.5% of girls reported a car accident in the previous twelve months period. Among male participants risky driving behavior was associated with having a degree (ORa=2, 95% CI [1.1-3.8]), sport practices (ORa=3.7, 95% CI [1.9-7.05]), involvement in a fight in the last twelve months (ORa=2.2, 95% CI [1.4-3.4]) and precocity of cannabis use (ORa=1.8, 95% CI [1.2-2.8]). Youth living in couple and those with children presented with higher risk-taking scores. Among female participants, young age at cannabis initiation (ORa=3.1, 95% CI [1.5-6.4]) and at sexual debut (ORa=2.4, 95% CI [1.1-5.1]) were associated with driving risk-taking. Finally, younger age at first alcohol intoxication was associated with risky behavior on the road in both sexes. These results highlighted the multidimensional nature of risk-taking behaviors on the road and showed that they are part of, for boys and girls, a larger pattern of risky behaviors. Such results suggest to include behaviors on the road in a comprehensive approach of prevention.

Prevalence, recovery patterns and predictors of quality of life and costs after non-fatal injury: the Brabant Injury Outcome Surveillance (BIOS) study

INTRODUCTION

Trauma is a major public health problem worldwide that leads to high medical and societal costs. Overall, improved understanding of the full spectrum of the societal impact and burden of injury is needed. The main purpose of the Brabant Injury Outcome Surveillance (BIOS) study is to provide insight into prevalence, predictors and recovery patterns of short-term and long-term health-related quality of life (HRQoL) and costs after injury.

MATERIALS AND METHODS

This is a prospective, observational, follow-up cohort study in which HRQoL, psychological, social and functional outcome, and costs after trauma will be assessed during 24 months follow-up within injured patients admitted in 1 of 10 hospitals in the county Noord-Brabant, the Netherlands. Data will be collected by self-reported questionnaires at 1 week (including preinjury assessment), and 1, 3, 6, 12 and 24 months after injury. If patients are not capable of filling out the questionnaires, proxies will be asked to participate. Also, information about mechanism and severity of injury, comorbidity and indirect and direct costs will be collected. Mixed models will be used to examine the course of HRQoL, functional and psychological outcome, costs over time and between different groups, and to identify predictors for poor or good outcome.

RELEVANCE

This study should make a substantial contribution to the international collaborative effort to assess the societal impact and burden of injuries more accurately. The BIOS results will also be used to develop an outcome prediction model for outcome evaluation including, besides the classic fatal, non-fatal outcome.

TRIAL REGISTRATION NUMBER

NCT02508675.

Disability related to road traffic crashes among adults in Spain

BACKGROUND

Road traffic accidents cause substantial morbidity and disease burden; few studies have examined their impact on disability.

OBJECTIVE

To estimate the magnitude and distribution of disability due to road traffic accidents according to socio-demographic variables, and its main socioeconomic and health determinants.

METHODS

A cross-sectional study was conducted in community-dwelling participants in the "2008 Spanish National Disability Survey", a representative sample of 91,846 households with 20,425 disabled persons older than 15 years; 443 had disability due to road traffic accidents.

RESULTS

The prevalence was 2.1 per 1000 inhabitants (95% CI:1.8-2.3), with no differences by sex. Risk was highest among persons aged 31 to 64 years, and onset of disability showed a sharp inflection point at age 16 years in both sexes. Odds ratios (ORs) were higher (OR=1.3; 95% CI:1.1- 1.7) for participants with secondary education than for those with the lowest educational levels and were lower (OR: 0.5; 95% CI:0.3-0.8) for participants with the highest household income levels than for those with lowest. Only 24% of disabled participants were gainfully employed. As compared to other sources of disability, traffic crashes caused greater disability in terms of mobility (OR=3.1;p<0.001), a greater need for health/social services (OR=1.5;p=0.003), and more problems with private transportation (OR=1.6;p<0.001), moving around outside the home (OR=1.6;p<0.001) and changes in economic activity (OR=2.4;p<0.001).

CONCLUSIONS

The prevalence of disability due to road traffic accidents in Spain is lower than in other developed countries, with middle-aged and socio-economically underprivileged persons being the most affected. Disability due to road traffic accidents is related to a greater demand for social/health care support, problems of accessibility/commuting, and major changes in economic activity.

Socio-economic status and co-morbidity as risk factors for trauma

Clinical experience and previous studies indicate that low socioeconomic positions are overrepresented in trauma populations. The reason for this social variation in injury risk is likely to be multifactorial. Both individual and environmental sources of explanation are plausible to contribute. We investigated the impact of the influence of socioeconomic factors and co-morbidity on the risk of becoming a trauma victim in a case-control study including 7,382 trauma patients matched in a one to five ratio with controls matched by age-, gender- and municipality from a level 1 trauma centre. Data from the trauma cohort were linked to national registries. Associations between socioeconomic factors and co-morbidity were estimated by conditional logistic regression. The trauma patients had been treated for psychiatric, substance abuse and somatic diagnoses to a higher extent than the controls. In the conditional logistic regression analysis a low level of education and income as well as co-morbidity (divided into psychiatric, substance abuse and somatic diagnoses) were all independent risk factors for trauma. Analysing patients with an injury severity score >15 separately did not alter the results, except for somatic diagnoses not being a risk factor. Recent treatment for substance abuse significantly increased the risk for trauma. Low level of education and income as well as psychiatric, substance abuse and somatic co-morbidity were all independent risk factors for trauma. Active substance abuse strongly influenced the risk for trauma and had a time dependent pattern. These insights can facilitate future implementation of injury prevention strategies tailored to specific risk groups.

Dominant role of drivers' attitude in prevention of road traffic crashes: a study on knowledge, attitude, and practice of drivers in Iran

OBJECTIVE

Evaluating the relation between Iranian drivers' knowledge, attitude, and practice (KAP) regarding traffic regulations, and their deterministic effect on road traffic crashes (RTCs).

SETTING

Two cities of Tehran and Zahedan, Iran.

METHODS

A cross-sectional study was designed. Using a simplified cluster sampling design, 2200 motor vehicle drivers including 1200 in Tehran and 1000 in Zahedan were selected. Sixty locations in Tehran and 50 in Zahedan were chosen. In each pre-identified location, 20 adult drivers were approached consecutively. A questionnaire developed by researchers was filled by each participant. The questionnaire had four sections including items assessing the demographics, knowledge, attitude and practice of drivers toward traffic regulations. Logistic regression analysis was used to evaluate the relationship between the RTCs and KAP variables.

RESULTS

The study sample consisted of 619 (28.1%) occupational and 1580 (71.8%) private drivers. Among them, 86.4% were male. The median age was 33.6 ± 10.83. Drivers in Tehran and Zahedan had no significant differences between their mean scores of KAP items of the questionnaire. Higher knowledge, safer attitude, and safer practice were associated with a decreased number of RTC. After adjusting for possible confounders, increase of one standard deviation in attitude and practice scores (but not knowledge) resulted in 26.4% and 18.5% decrease in RTC, respectively. Finally, considering knowledge, attitude and practice of drivers in one model to assess their mutual effect, it was shown that only attitude is significantly associated with a decrease of RTC (OR=0.76, P=0.007).

CONCLUSION

Increase in attitude and practice accompanied with decreased number of RTCs in Iranian drivers. Specifically, drivers' attitude had the crucial effect. It is not knowledge and standard traffic education; rather it is how such education is registered as an attitude that translates what is being learned into actions. Without safer attitude, even safer self-reported practice will not result in lower RTCs.

Pre-licensed driving experience and car crash involvement during the learner and restricted, licence stages of graduated driver licensing: Findings from the New Zealand drivers study

OBJECTIVE

The aim of this study was to determine whether pre-licence driving experiences, that is driving before beginning the licensing process, increased or decreased crash risk as a car driver, during the learner or the restricted licence stages of the graduated driver licensing system (GDLS).

METHOD

Study participants were 15-24 year old members of the New Zealand Drivers Study (NZDS) - a prospective cohort study of newly licensed car drivers. The interview stages of the NZDS are linked to, the three licensing stages of the GDLS: learner, restricted and full. Baseline demographic (age, ethnicity, residential location, deprivation), personality (impulsivity, sensation seeking, aggression) and, behavioural data, (including pre-licensed driving behaviour), were obtained at the learner licence interview. Data on distance driven and crashes that occurred at the learner licence and restricted licence stages, were reported at the restricted and full licence interviews, respectively. Crash data were also obtained from police traffic crash report files and this was combined with the self-reported crash data. The analysis of the learner licence stage crashes, when only supervised driving is allowed, was based on the participants who had passed the restricted licence test and undertaken the NZDS, restricted licence interview (n=2358). The analysis of the restricted licence stage crashes, when unsupervised driving is first allowed, was based on those who had passed the full licence test and completed the full licence interview (n=1428).

RESULTS

After controlling for a range of demographic, personality, behavioural variables and distance driven, Poisson regression showed that the only pre-licence driving behaviour that showed a consistent relationship with subsequent crashes was on-road car driving which was associated with an increased risk of being the driver in a car crash during the learner licence period.

CONCLUSION

This research showed that pre-licensed driving did not reduce crash risk among learner or restricted licensed drivers, and in some cases (such as on-road car driving) may have increased risk. Young people should be discouraged from the illegal behaviour of driving a car on-road before licensing.

Young unlicensed drivers and fatal road traffic crashes in the USA in the past decade. A neglected public health issue

It is unknown whether road traffic crashes (RTCs) involving young unlicensed drivers follow the downward trend of those involving licensed drivers. Our national register-based study from 2000 to 2011 indicates that the downward trend for young unlicensed drivers (<25 years) is significantly less pronounced. These drivers account for 10.7% to 11.5% of the fatal RTCs involving young drivers during that time period; this percentage is consistently higher in the Western and Southern states and has increased in recent years in the Midwest.

The socioeconomic inequality in traffic-related disability among Chinese adults: the application of concentration index

Traffic crashes have become the fifth leading cause of burden of diseases and injuries in China. More importantly, it may further aggravate the degree of health inequality among Chinese population, which is still under-investigated. Based on a nationally representative data, we calculated the concentration index (CI) to measure the socioeconomic inequality in traffic-related disability (TRD), and decomposed CI into potential sources of the inequality. Results show that more than 1.5 million Chinese adults were disabled by traffic crashes and the adults with financial disadvantage bear disproportionately heavier burden of TRD. Besides, strategies of reducing income inequality and protecting the safety of poor road users, are of great importance. Residence appears to counteract the socioeconomic inequality in TRD, however, it does not necessarily come to an optimistic conclusion. In addition to the worrying income gap between rural and urban areas, other possible mechanisms, e.g. the low level of post-crash medical resources in rural area, need further studies. China is one of the developing countries undergoing fast motorization and our findings could provide other countries in similar context with some insights about how to maintain socioeconomic equality in road safety.

Unlicensed driving and other related health risk behaviors: a study of Montana high school students

PURPOSE

Health risk behaviors tend to cluster in young people, not least among young drivers. Less is known about the health risk profile of young unlicensed drivers. This study investigates health risk behaviors among young unlicensed drivers compared to both their licensed and driving peers, and their non-driving peers.

METHODS

High school students participating in the Youth Risk Behavior Surveillance System in Montana (US) and age-eligible to have a driver's license were studied (n=5985), categorized according to their self-reported car driving and license practice (licensed driving, unlicensed driving, and non-driving). Ten health risk behaviors, of which four were related to car riding/driving, were considered. Multinomial logistic regression was used to compile sex-specific odds ratios (with 95% confidence intervals) of adopting those behaviors using licensed drivers as a reference and adjusting for age and race/ethnicity.

RESULTS

Health risk behaviors tended to be more common among unlicensed drivers than other groups, although some behaviors were prevalent in all groups (i.e., alcohol use and lack of seat belt use). As a consequence, for both male and female students, there was a significant association between unlicensed driving and most health risk behaviors, except for being involved in a physical fight and riding with a drinking driver among female students.

CONCLUSIONS

Young unlicensed drivers are more likely than licensed drivers to adopt several health risk behaviors both in car driving/riding or otherwise, in particular alcohol use and cigarette smoking. This challenges any simplistic approach as unlicensed driving in youth is not an isolated act suggesting public health and traffic safety initiatives.

Fatal crash involvement of unlicensed young drivers: county level differences according to material deprivation and urbanicity in the United States

OBJECTIVES

This study assessed the association between county level material deprivation and urbanization with fatal road traffic crashes involving young unlicensed drivers in the United States (US).

BACKGROUND

Road traffic crashes have been positively associated with area deprivation and low population density but thus far few studies have been concerned specifically with young drivers, especially those that are unlicensed.

METHODS

A county material deprivation index was derived from the Townsend Material Deprivation Index, with variables extracted from the US Census (2000). An urbanicity scale was adapted from the US Department of Agriculture's Rural-Urban Continuum Codes (2003). Data on fatal crashes involving a young unlicensed driver during a seven-year period (2000-2006; n=3059) were extracted from the Fatality Analysis Reporting System. The effect of deprivation and urbanicity on the odds of the occurrence of at least one fatal crash at the county level was modeled by conditional and unconditional logistic regression.

RESULTS

The conditional model found a positive association between material deprivation and a fatal crash involving a young unlicensed driver (OR=1.19, 95% CI 1.17, 1.21). The interaction between urbanicity and material deprivation was negatively associated in suburban counties for fatal crashes (OR=0.92, 95% CI 0.90, 0.95).

CONCLUSIONS

An association with material deprivation and the likelihood of a fatal crash involving a young unlicensed driver is a new finding. It can be used to inform specific county-level interventions and promote state licensing policies to provide equity in young people's mobility regardless of where they live.

Young and unlicensed: risky driving before entering the licensing system

OBJECTIVE

On-road driving before gaining a valid license (prelicense driving) represents a risk for all road users. Prelicense driving among young people who obtained a provisional license within an enhanced graduated driver licensing program in Queensland, Australia, was investigated.

METHODS

Recently licensed drivers (n = 1032) aged 17 to 19 years (M = 17.54) completed a survey exploring their driving experiences while on their learner's license. Six months later, 355 of these drivers completed the same survey exploring their experiences on their provisional (intermediate) license.

RESULTS

Twelve percent of participants reported prelicense driving. Prelicense drivers reported significantly more risky driving as learners and provisional drivers.

CONCLUSIONS

Prelicense drivers not only place themselves and other road users at risk at the time but also continue to do so through their subsequent risky driving. Prelicense driving should be discouraged, and parents should be encouraged to monitor car use and the driving behavior of their children.

Young unlicensed drivers and passenger safety restraint use in u.s. Fatal crashes: concern for risk spillover effect?

Young unlicensed drivers are more likely to be in fatal crashes and to engage in high-risk driving behaviors like impaired driving, speeding, and driving unrestrained. In a crash context, the influence of these high-risk behaviors may spillover to adversely affect passenger safety restraint use. We conducted an analysis of the Fatality Analysis Reporting System from years 1996-2008. Fatal crashes involving a driver aged 15-24 years and at least one passenger aged 15-24 years were included. Logistic regression with generalized estimating equations was undertaken to assess the effect of unlicensed driving on passenger restraint use. We controlled for established predictors of passenger restraint use including driver restraint use, gender, number of occupants, driver drinking, number of occupants, crash year, and crash location (rural vs. urban). 102,092 passengers were involved in fatal crashes during the time period with 64,803 unique drivers. 6,732 (10.51%) were never licensed drivers and 5,603 (8.8%) were drivers with suspended, revoked, or expired licenses. Rates of unlicensed driving ranged from 17.7% to 22.1% and increased over time. While passengers in fatal crashes averaged a mere 40.9% restraint use, passengers of never and invalidly licensed drivers had a further decreased odds of wearing a safety restraint (OR 0.73, 95% CI 0.69-0.77, p<0.001) and (OR 0.84, 95% CI 0.79-0.90, p<0.001). Unlicensed driving is involved in a disproportionate and increasing number of preventable crash fatalities and plays a detrimental role in the lifesaving safety behaviors of their passengers. Our findings highlight an alarming peer influence between unlicensed drivers and passengers, placing increased emphasis on the need to better understand and characterize this present and growing threat.