Suicide by crashing into a heavy vehicle: Focus on professional drivers using in-depth crash data

Objective: Road traffic suicides typically involve a passenger car driver crashing his or her vehicle into a heavy vehicle, because death is almost certain due to the large mass difference between these vehicles. For the same reason, heavy-vehicle drivers typically suffer minor injuries, if any, and have thus received little attention in the research literature. In this study, we focused on heavy-vehicle drivers who were involved as the second party in road suicides in Finland.

Methods: We analyzed 138 road suicides (2011–2016) involving a passenger car crashing into a heavy vehicle. We used in-depth road crash investigation data from the Finnish Crash Data Institute.

Results: The results showed that all but 2 crashes were head-on collisions. Almost 30% of truck drivers were injured, but only a few suffered serious injuries. More than a quarter reported sick leave following their crash. Injury insurance compensation to heavy-vehicle drivers was just above €9,000 on average. Material damage to heavy vehicles was significant, with average insurance compensation paid being €70,500. Three out of 4 truck drivers reported that drivers committing suicide acted abruptly and left them little opportunity for preventive action.

Conclusions: Suicides by crashing into heavy vehicles can have an impact on drivers’ well-being; however, it is difficult to see how heavy-vehicle drivers could avoid a suicide attempt involving their vehicle.     

Is there a link between motor vehicle collisions and being a cigarette smoker in Canada? Analysis of survey data from Ontario from 2002 to 2014

Objective: Although most research on drugs and driving has focused on the use of alcohol and cannabis, research that has been conducted on cigarette smoking and collisions has found that smokers have an increased collision involvement. Studies dating from 1967 through 2013 have shown a crude relative risk of about 1.5 among smokers compared to nonsmokers. In Canada, the association between smoking and collisions has not been recently investigated. Studies that have examined the association between smoking and collisions often did not control for all confounding factors, such as alcohol use and driving exposure, which have been associated with increased collision rates. Additionally, a number of these studies were examined in countries and at times when prevalence of smoking was much higher than is currently the case in Canada. The purpose of this research is to examine the association between self-reported current smoking and past-year collision involvement, controlling for confounding factors, in a large representative sample of adult drivers in Ontario, Canada, from 2002 and 2014.

Method: Data are based on the Centre for Addiction and Mental Health (CAMH) Monitor, an ongoing, rolling telephone survey of Ontario adults that provides epidemiological surveillance of indicators related to alcohol, tobacco, and other drug use, as well as physical and mental health. The survey uses random-digit-dialing methods via Computer-Assisted Telephone Interview, with response rates over 50%.

Results: Prevalence of self-reported collision involvement within the past year for 2002–2014 was 8.6% among those who currently smoke compared to 6.5% of nonsmokers. Logistic regression analysis, controlling for the potential confounding effects of sociodemographics, driving exposure measures, drinking frequency, and hazardous alcohol use, found that the overall odds for collision involvement in the preceding year among current smokers for 2002–2014 was 1.27 (95% confidence interval [CI], 1.06–1.53) times that of nonsmokers.

Conclusions: These findings indicate that despite a substantial reduction in overall prevalence of smoking in Canada, smokers still have a significantly increased odds of collision involvement, even when controlling for alcohol and exposure. Additionally, the results are consistent with the increased odds/risks of motor vehicle collisions found in other countries.     

Helmet retention system types as a risk factor to properly attach the chin strap

Objectives: This study aimed to determine the factors associated with the incorrect use of a helmet retention system (loose or open) and how often this happens.

Methods: This was an observational transversal study conducted in Curitiba, Brazil. Trained observers positioned at traffic lights collected information about the helmet fixation mode, the helmet model (full-face, open-face, modular, half), and the helmet retention system model (micrometric, double-D, fast-release). Additional data including position on the motorcycle, gender, and function of the motorcycle (as a work vehicle) were collected. The observers, collection site, and periods were randomly selected by lots.

Results: From a total of 3,050 motorcyclists, 1,807 (59.2%) had their helmets fastened correctly, 907 (29.7%) had the retention system fastened loosely, and in 336 (11.0%), the retention system was completely open. Increased odds of incorrect use were observed for the fast-release and double-D buckles compared to the micrometrics buckles, with a fixed odds ratio (OR) of 4.62 (95% confidence interval [CI], 3.89–5.51) and 3.54 (95% CI, 2.46–5.09), respectively (P <.0001). Full-face helmets had a higher chance of incorrect use (P <.0001), and passengers had a higher incidence of incorrect use of the helmet than drivers (P <.0001).

Conclusion: An important risk factor related to the incorrect use of the helmet was the type of retention system. The helmet model and being a passenger had a secondary influence on incorrect use of helmets.     

Prevalence of alcohol impairment and odds of a driver injury or fatality in on-road farm equipment crashes

Objective: The objective of this article was to estimate the prevalence of alcohol impairment in crashes involving farm equipment on public roadways and the effect of alcohol impairment on the odds of crash injury or fatality.

Methods: On-road farm equipment crashes were collected from 4 Great Plains state departments of transportation during 2005–2010. Alcohol impairment was defined as an involved driver having blood alcohol content of ≥0.08 g/100 ml or a finding of alcohol impairment as a driver contributing circumstance recorded on the police crash report. Injury or fatality was categorized as (a) no injury (no and possible injury combined), (b) injury (nonincapacitating or incapacitating injury), and (c) fatality. Hierarchical multivariable logistic regression modeling, clustered on crash, was used to estimate the odds of an injury/fatality in crashes involving an alcohol-impaired driver.

Results: During the 5 years under study, 3.1% (61 of 1971) of on-road farm equipment crashes involved an alcohol-impaired driver. One in 20 (5.6%) injury crashes and 1 in 6 (17.8%) fatality crashes involved an alcohol-impaired driver. The non-farm equipment driver was significantly more likely to be alcohol impaired than the farm equipment driver (2.4% versus 1.1% respectively, P = .0012). After controlling for covariates, crashes involving an alcohol-impaired driver had 4.10 (95% confidence interval [CI], 2.30–7.28) times the odds of an injury or fatality. In addition, the non-farm vehicle driver was at 2.28 (95% CI, 1.92–2.71) times higher odds of an injury or fatality than the farm vehicle driver. No differences in rurality of the crash site were found in the multivariable model.

Conclusion: On-road farm equipment crashes involving alcohol result in greater odds of an injury or fatality. The risk of injury or fatality is higher among the non-farm equipment vehicle drivers who are also more likely to be alcohol impaired. Further studies are needed to measure the impact of alcohol impairment in on-road farm equipment crashes.     

Driving anger among motor vehicle drivers in China: A cross-sectional survey

Objective: Driving anger is a common emotion while driving and has been associated with traffic crashes. This study aimed to investigate situations that increase driving anger among Chinese drivers.

Methods: A cross-sectional study was conducted among 3,101 drivers in southern China. The translated version of the 33-item Driving Anger Scale (DAS) was used to measure driving anger. Data were collected by face-to-face interviews between June 2016 and September 2016.

Results: Confirmatory factor analysis showed that the fit of the original 6-factor model (discourtesy, traffic obstacles, hostile gestures, slow driving, illegal driving, and police presence) was satisfactory, after removing 2 items and allowing 5 error pairs to covary. The model showed satisfactory fit: goodness of fit index (GFI) = 0.90, incremental fit index (IFI) = 0.90, root mean square error of approximation (RMSEA) = 0.06, 90% confidence interval (CI) = 0.061–0.064. Driving anger among Chinese drivers was lower than that in some Western countries. Compared to older and experienced drivers, younger and new drivers were more likely to report driving anger. There was no difference in total reported driving anger between males and females. Additionally, the higher the driver’s anger level was, the more likely he or she was to have had a traffic crash.

Conclusion: Driving anger is a common emotion among Chinese drivers and has a strong correlation with aggressive driving behavior and traffic crashes.     

Road traffic crashes among farm vehicle drivers in southern China: A cross-sectional survey

Objective: The objective of this study was to identify the prevalence and potential risk factors of farm vehicle–related road traffic crashes among farm vehicle drivers in southern China.

Methods: A cross-sectional study was used to interview 1,422 farm vehicle drivers in southern China. Farm vehicle–related road traffic crashes that occurred from December 2013 to November 2014 were investigated. Data on farm vehicle–related road traffic crashes and related factors were collected by face-to-face interviews.

Results: The prevalence of farm vehicle–related road traffic crashes among the investigated drivers was 7.2%. Farm vehicle–related road traffic crashes were significantly associated with self-reported vision problem (adjusted odds ratio [AOR] = 6.48, 95% confidence interval [CI], 3.86–10.87), self-reported sleep disorders (AOR = 10.03, 95% CI, 6.28–15.99), self-reported stress (AOR = 20.47, 95% CI, 9.96–42.08), reported history of crashes (AOR = 5.40, 95% CI, 3.47–8.42), reported history of drunk driving (AOR = 5.07, 95% CI, 2.97–8.65), and reported history of fatigued driving (AOR = 5.72, 95% CI, 3.73–8.78). The number of road traffic crashes was highest in the daytime and during harvest season. In over 96% of farm vehicle–related road traffic crashes, drivers were believed to be responsible for the crash. Major crash-causing factors included improper driving, careless driving, violating of traffic signals or signs, and being in the wrong lane.

Conclusion: Findings of this study suggest that farm vehicle–related road traffic crashes have become a burgeoning public health problem in China. Programs need to be developed to prevent farm vehicle–related road traffic crashes in this emerging country.     

Driving while impaired by alcohol: An analysis of drink-drivers involved in UK collisions

Objective: Drink-driving represents a critical issue on international organizations’ agendas as one of the key behavioral risk factors in road traffic safety, alongside speed and nonuse of motorcycle helmets, seat belts, and child restraints. Changing road user behaviors regarding these 5 factors is a critical component in reducing road traffic injuries and casualties. The objective of this study is the identification of drivers who are more likely to contribute to crashes in the UK while impaired by alcohol to design targeted drink drive compliance campaigns.

Method: To profile drivers with the factor “impaired by alcohol” assigned in collisions, an extensive data set is used, including all reported injury collisions between 2011 and 2015 in the UK (police records), merged with the Experian Mosaic Database. A multilevel mixed-effects logistic regression is conducted, utilizing the hierarchical nature of the data (drivers within Mosaic types).

Results: Using multilevel mixed-effects logistic regression analysis, the finding is that some driver profiles are more likely to contribute to crashes and are assigned the contributory factor “impaired by alcohol.” Drink-related crashes are more common in some circumstances or for some crash-involved driver groups than others. For instance, alcohol-related crashes are more likely to occur on single carriageways and among males and 25- to 35-year-olds. Drink-drive-related crashes are found to be strongly associated with dark lighting conditions and, more specifically, with late night hours (the interval between 3:00 a.m. and 4:00 a.m. accounts for a third of the drink-drive-related collisions). Using the Experian Mosaic Database which divides the UK population into 66 types based on demographic, lifestyle, and behavior characteristics, the finding is that, among crash-involved drivers, some Mosaic types are significantly more likely (e.g., pocket pensions, dependent greys, streetwise singles) and others are significantly less likely (e.g., crowded kaleidoscope, cultural comfort, penthouse chic) to contribute to a drink-related crash.

Conclusions: The outcome is a more nuanced understanding of drivers contributing to drink-related crashes in the UK. The study concludes by discussing the implications for governments and other interested bodies for better targeting and delivery of public education campaigns and interventions.     

Impact of helmet use on traumatic brain injury from road traffic accidents in Cambodia

Objective: Rapid urbanization and motorization without corresponding increases in helmet usage have made traumatic brain injury due to road traffic accidents a major public health crisis in Cambodia. This analysis was conducted to quantify the impact of helmets on severity of injury, neurosurgical indication, and functional outcomes at discharge for motorcycle operators who required hospitalization for a traumatic brain injury following a road traffic accident in Cambodia.

Methods: The medical records of 491 motorcycle operators who presented to a major tertiary care center in Cambodia with traumatic brain injury were retrospectively analyzed using multivariate logistic regression.

Results: The most common injuries at presentation were contusions (47.0%), epidural hematomas (30.1%), subdural hematomas (27.9%), subarachnoid hemorrhages (12.4%), skull fractures (21.4%), and facial fractures (18.5%). Moderate-to-severe loss of consciousness was present in 36.3% of patients. Not wearing a helmet was associated with an odds ratio of 2.20 (95% confidence interval [CI], 1.15–4.22) for presenting with moderate to severe loss of consciousness compared to helmeted patients. Craniotomy or craniectomy was indicated for evacuation of hematoma in 20.0% of cases, and nonhelmeted patients had 3.21-fold higher odds of requiring neurosurgical intervention (95% CI, 1.25–8.27). Furthermore, lack of helmet usage was associated with 2.72-fold higher odds of discharge with functional deficits (95% CI, 1.14–6.49). In total, 30.1% of patients were discharged with severe functional deficits.

Conclusions: Helmets demonstrate a protective effect and may be an effective public health intervention to significantly reduce the burden of traumatic brain injury in Cambodia and other developing countries with increasing rates of motorization across the world.     

Risk of motor vehicle crash for older adults after receiving a traffic charge: A case–crossover study

Objective: After the age of 65, the number of motor vehicle crashes per mile driven increases. Traffic-related charges issued by law enforcement can help identify drivers who are at a higher risk of having a crash. This study examines the relationship between motor vehicle crashes and traffic-related charges among older adult drivers.

Methods: Iowa Department of Transportation crash data from 2011–2012 were linked with Iowa Court Information System data for moving violations that occurred during 2009–2012 for drivers over the age of 50. A time-stratified case–crossover design was used matching on time periods 1 year apart. Case exposure was defined as having a traffic-related charge 30 days before the crash. Control exposure was the same 30-day time period 1 year before the crash for each individual. Conditional logistic regression was used to analyze the self-matched pairs. Additional time periods of 31–60, 61–90, 91–120, 121–150, 151–180, and 181–210 days before the crash were also assessed.

Results: There were 38,171 adults at least 50 years of age with an Iowa driver's license who were involved in a crash in Iowa between 2011 and 2012. In addition, 13,129 adults over the age of 50 received a charge during 2009–2012. Relative to the control time period, experiencing a traffic-related charge in the 30-day time period before the crash increased the risk of a crash by 21% (odds ration [OR] = 1.21, 95% confidence interval [CI], 1.03–1.42) for all drivers included in the study. This crash risk was similar for adults aged 50–64 (OR = 1.20, 95% CI, 1.00–1.45) and adults 65 and older (OR = 1.24, 95% CI, 0.90–1.72). In the 30 days after receiving a traffic-related charge, the risk of a crash was also increased for crashes occurring in adverse weather (OR = 1.79, 95% CI, 1.12–2.84) or during night, dawn, or twilight (OR = 1.89, 95% CI, 1.31–2.72).

Conclusions: A traffic-related charge for an adult over the age of 50 indicates an increased risk of experiencing a crash in the 30 days following the charge. The risk for crashes occurring in adverse conditions or outside of daylight hours was also increased in the 30 days after receiving a traffic-related charge. The risk of experiencing a crash decreases as time passes after receiving a charge. Measures to restrict or increase driving safety during these conditions could help reduce the crash risk for older adults who receive a traffic-related charge.     

Trends and patterns in fatal US motorcycle crashes, 2000–2016

Objective: To investigate trends of motorcyclist fatalities and identify at-risk populations by motorcyclist demographics and crash characteristics.

Methods: We used the Fatality Analysis Reporting System (FARS) database (2000–2016) to track fatality rate trends, which were quantified by using Poisson mixed-effects regression models comparing 2000–2001 and 2007–2008, as well as 2009–2010 and 2015–2016.

Results: The overall fatality rate per 100,000 population increased from 2000 to 2016, defined by two trend lines—before and after the economic recession in 2008–2009. The overall fatality rate ratio between 2000–2001 and 2007–2008 was 1.60 [95% Confidence Interval (CI): 1.51–1.70], and between 2009–2010 and 2015–2016 was 1.09 (95% CI: 1.02–1.18). Fatality rates increased among all age groups, particularly for motorcyclists aged 60 and older. Those aged 18–29 had the highest fatality rates overall. Age-and-sex standardized state fatality rates were consistently highest in Wyoming, South Dakota, and South Carolina and lowest in Massachusetts, New York and New Jersey.

Conclusion: Motorcycle fatality rates increased overall and across all age groups between 2000 and 2016. Fatalities for the oldest riders showed the steadiest increasing trends. Results highlight the continued public health burden of motorcyclist fatalities and, by extension, the importance of improving motorcycle safety.     

Risk factors for being the at-fault driver: A case–control study

Objective: It is estimated that road traffic accidents are globally responsible for approximately 1.2 million deaths and 20 to 50 million injuries. About 70% of traffic incidences (TIs) occur in developing countries and among countries with high TI rates; Iran is the first. The aim of this study was to measure the association between being responsible for a traffic accident and some vehicle, human; and environmental related factors in Yasuj, a city with a high incidence of road traffic injuries and deaths in Iran.

Methods: This is a time-, date-, and place-matched case–control study conducted in 2015 using all traffic accidents registered and investigated by police during 2012. In total, 194 drivers were considered the at-fault driver in a traffic accident and the 194 drivers in the same collisions were included in the analysis.

Results: Based on the results from multivariate conditional logistic regression, significant associations between vehicle maneuver (OR_{Turn to right or left/Moving forward} = 11.10, 95% confidence interval [CI], 1.77–69.58, P = .01) and age (odds ratio [OR] = 1.11, 95% CI, 1.004–1.22, P = .04) and the chance of being an at-fault driver were found.

Conclusion: Driver behavior–related interventions including training and law enforcement seem to be more effective in reducing road traffic accidents in Iran.     

Factors associated with prehospital death among traffic accident patients in Osaka City,Japan: A population-based study

Objective: Although it is important to assess the factors associated with traffic accident fatalities to decrease them as a matter of public health, such factors have not been fully identified.

Methods: Using a large-scale data set of ambulance records in Osaka City, Japan, we retrospectively analyzed all traffic accident patients transported to hospitals by emergency medical service personnel from 2013 to 2014. In this study, prehospital death was defined as that occurring at the scene or in the emergency department immediately after hospital arrival. We assessed prehospital factors associated with prehospital death due to traffic accidents by logistic regression models.

Results: This study enrolled 28,903 emergency patients involved in traffic accidents, of whom 68 died prehospital. In a multivariate model, elderly patients aged ≥75 years (adjusted odds ratio [AOR] = 4.34; 95% confidence interval [CI], 2.29–8.23), nighttime (AOR = 2.75; 95% CI, 1.65–4.70), and type of injured person compared to bicyclists such as pedestrians (AOR = 9.58; 95% CI, 5.07–17.99), motorcyclists (AOR = 2.75; 95% CI, 1.21–6.24), and car occupants (AOR = 2.98; 95% CI, 1.39–6.40) were significantly associated with prehospital death due to traffic accidents. In addition, the AOR for automobile versus nonautomobile as the collision opponent was 4.76 (95% CI, 2.30–9.88).

Conclusions: In this population, the factors associated with prehospital death due to traffic accidents were elderly people, nighttime, and pedestrian as the type of patient. The proportion of prehospital deaths due to traffic accidents was also high when the collision component was an automobile.     

Driving under the influence of alcohol and drugs in the eastern part of Denmark in 2015 and 2016: Abuse patterns and trends

Objectives: The objective of this study was to examine the frequency of psychoactive drugs and alcohol in drivers under suspicion of driving under the influence of drugs and alcohol in 2015 and 2016 in the eastern part of Denmark. The trends in the number of traffic cases sent for drug analysis since 2000 and alcohol analysis since 2011 are also discussed.

Methods: Blood samples from drivers suspected of being under the influence of alcohol and/or medication and/or illicit drugs in 2015 and 2016 were investigated as requested by the police. The blood samples were screened for alcohol and/or tetrahydrocannabinol (THC) alone, for other drugs (covering all drugs, except THC, listed in the Danish list of narcotic drugs), or for THC and other drugs. Age and gender were also recorded. The number of drug traffic cases since 2000 and the number of alcohol cases since 2011 were extracted from our Laboratory Information Management System (LIMS).

Results: In total, 11,493 traffic cases were investigated. Alcohol and/or drugs exceeded the legal limit in 9,657 (84%) cases. Men constituted 95% of the drivers investigated for drugs and 88% of the alcohol cases. The drivers investigated for drugs consisted primarily of young men, whereas drivers investigated for alcohol were older.

The frequency was higher for positive alcohol cases above the legal limit (87%) than for drug cases (76%) above the fixed concentration limit. THC (67–69%) was the most frequently detected drug above the legal limit, followed by cocaine (27–28.5%), amphetamine (17%), and clonazepam (6–7%) in both years. Morphine (5.4%), included among the 5 most frequent drugs in 2015, was replaced by methadone (4.6%) in 2016. Few new psychoactive drugs (NPS) were detected.

The number of traffic cases sent for drug analysis has increased more than 30-fold since 2000–2006, and the number of traffic cases submitted in 2016 for drug analysis was higher than the number for alcohol analysis; the latter has decreased since 2011.

Conclusion: Overall, alcohol was the most frequent compound detected above the legal limit in both years, followed by the well-known illicit drugs THC, cocaine, and amphetamine. NPS were seldom seen. One consequence of the increased focus on drugs in traffic has been an immense increase in drug traffic cases sent for analysis since 2006 in the eastern part of Denmark. Although this survey revealed only minimal changes compared to earlier investigations, surveys like this are invaluable for monitoring abuse patterns and trends in drugged and drunken driving.     

The role of drug and alcohol use and the risk of motor vehicle crashes in Shiraz,Iran, 2014: A case–crossover study

Background: Traffic accidents and traffic-related injuries and mortality have become a major public health concern in Iran. This study aimed to examine the role of drug and alcohol use in motor vehicle accidents in Iran.

Methods: This case–crossover study was conducted on 441 drivers who survived a road traffic crash and were taken to the emergency department of Shahid Rajaee trauma hospital in Shiraz, southern Iran. Data were collected using checklists that included demographic characteristics and drug and alcohol use prior to driving. Alcohol and drug use was identified through self-report, and cannabis, morphine, and methamphetamine urine tests were used to confirm drug abuse among drivers.

Results: In total 17.9% of drivers reported using drugs (cannabis, opium, or metamphetamine) and 8.84% of drivers reported consuming alcohol prior to the collision. The crude odds ratios (ORs) for having a crash for opium, cannabis, and metamphetamine were 1.94 (95% interval confidence [CI], 1.11–3.38), 2.37 (95% CI, 1.03–5.42), 5.5 (95% CI, 1.21–24.81), respectively, and for all drugs was 3.83 (95% CI, 2.28–6.43). The OR for alcohol was 3.5 (95% CI, 1.73–7.06) based on self-report.

Conclusion: Drug and alcohol use are increasing the risk of traffic crashes in Iran. Risk-reducing programs must be designed and implemented.     

Road traffic injuries among riders of electric bike/electric moped in southern China

Objective: Electric bike/moped-related road traffic injuries have become a burgeoning public health problem in China. The objective of this study was to identify the prevalence and potential risk factors of electric bike/moped-related road traffic injuries among electric bike/moped riders in southern China.

Methods: A cross-sectional study was used to interview 3,151 electric bike/moped riders in southern China. Electric bike/moped-related road traffic injuries that occurred from July 2014 to June 2015 were investigated. Data were collected by face-to-face interviews and analyzed between July 2015 and June 2017.

Results: The prevalence of electric bike/moped-related road traffic injuries among the investigated riders was 15.99%. Electric bike/moped-related road traffic injuries were significantly associated with category of electric bike (adjusted odds ratio [AOR] = 1.36, 95% confidence interval [CI], 1.01–1.82), self-reported confusion (AOR = 1.77, 95% CI, 1.13–2.78), history of crashes (AOR = 6.14, 95% CI, 4.68–8.07), running red lights (AOR = 3.57, 95% CI, 2.42–5.25), carrying children while riding (AOR = 1.96, 95% CI, 1.37–2.85), carrying adults while riding (AOR = 1.68, 95% CI, 1.23–2.28), riding in the motor lane (AOR = 2.42, 95% CI, 1.05–3.93), and riding in the wrong traffic direction (AOR = 1.63, 95% CI, 1.13–2.35). In over 77.58% of electric bike/moped-related road traffic crashes, riders were determined by the police to be responsible for the crash. Major crash-causing factors included violating traffic signals or signs, careless riding, speeding, and riding in the wrong lane.

Conclusion: Traffic safety related to electric bikes/moped is becoming more problematic with growing popularity compared with other 2-wheeled vehicles. Programs need to be developed to prevent electric bike/moped-related road traffic injuries in this emerging country.     

Driving anger expression in Germany—Validation of the Driving Anger Expression Inventory for German drivers

Objective: The main objective of this article is to examine whether the Driving Anger Expression Inventory (DAX) applies to German drivers because this scale has previously been given to drivers in many different countries.

Methods: We applied German versions of the DAX, the Driving Anger Scale (DAS), and the State-Trait Anger Expression Inventory (STAXI) to a sample of 501 German drivers. We computed confirmatory factor analysis and principal axis factoring (PAF) analysis to examine the structure of driving anger expression in Germany. Finally, we related the drivers’ anger exp ression scores to their driving anger experiences and their general anger propensities to assess the validity of the DAX for German drivers.

Results: Results indicated that the DAX’s original factor structure does not apply to German drivers because the confirmatory factor analysis did not show a good model fit. An item analysis revealed that many DAX items had no meaningful variability. They were excluded from further analysis. The subsequent PAF analysis indicated that German drivers do not use personal physical aggression to express their driving anger. Instead, they reported unique preventive anger expression management behavior. In addition, their driving anger expressions were significantly related to their driving anger experiences and their general anger propensities indicated the validity of the refined DAX for German drivers.

Conclusions: We conclude that German drivers do not use strong behaviors to express their driving anger. Many statements of Deffenbacher et al.’s (Behav Res Ther. 40:717–737, 2002) original American questionnaire were not applicable for our sample of German drivers. These findings are in line with several other studies showing discrepancies in driving anger expression in various countries. Future investigations should examine the reasons for discrepancies in driving anger expression.     

Road accident fatality risks for “vulnerable” versus “protected” road users in northern Ghana

Background: Road traffic injuries (RTIs) are a serious epidemic that claims more than a million lives across the globe each year. The burden of RTIs is particularly pronounced in Africa and other low- and middle-income countries. The unfavorable disparity of the burden of road trauma in the world is largely attributable to unsafe vehicles, lack of appropriate road infrastructure, and the predominance of vulnerable road users (VRUs) in developing countries. However, little research exists in northern Ghana to highlight the scale and risk of death among road users.

Objective: The objective of this research was to establish the relative risk of death among road users in northern Ghana.

Methods: Crash data from police reports between 2007 and 2011 were analyzed for the Upper Regions of Ghana. Conditional probabilities and multivariable logistic regression techniques were used to report proportions and adjusted odds ratios (AORs), respectively.

Results: Generally, crashes in northern Ghana were extremely severe; that is, 35% of all injury related collisions were fatal. The proportion of fatal casualties ranged between 21% among victims of sideswipe collisions and 41% among pedestrians and victims of rear-end collisions. Though males were 6 times more likely to die than females overall, females were more likely to die as pedestrians (90% of all female casualty deaths) and males were more likely to die as riders/drivers (78% of all male casualty deaths). Pedestrians were 3 times more likely to die (odds ratio [OR] = 3.1; 95% confidence interval [CI], 2.4 to 4.1) compared with drivers/riders. Compared with drivers, the odds of death among cyclists was about 4 times higher (AOR = 3.6; 95% CI, 2.3 to 5.6) and about 2 times higher among motorcyclists (AOR = 1.6; 95% CI, 1.2 to 2.2). Compared with casualties aged between 30 and 59 years, children under 10 years and those aged 60 years and above were independently 2 times more likely to die in traffic collisions.

Conclusion: Provision of requisite road infrastructure is vital for the safety of VRUs in northern Ghana. Cycle paths and lanes (for cyclists) as well as sidewalks (for pedestrians) in particular will separate VRUs from motorists and improve their safety. Enforcement of traffic laws particularly regarding helmet use, speeding, and alcohol use will be beneficial. Introduction of the demerit points system in the enforcement of traffic regulations may have significant deterrent effects on road users who have the penchant for violating traffic regulations. Road safety education is also required to create responsible road users.     

Modeling crash injury severity by road feature to improve safety

Objective: The objective of this research is 2-fold: to (a) model and identify critical road features (or locations) based on crash injury severity and compare it with crash frequency and (b) model and identify drivers who are more likely to contribute to crashes by road feature.

Method: Crash data from 2011 to 2013 were obtained from the Highway Safety Information System (HSIS) for the state of North Carolina. Twenty-three different road features were considered, analyzed, and compared with each other as well as no road feature. A multinomial logit (MNL) model was developed and odds ratios were estimated to investigate the effect of road features on crash injury severity.

Results: Among the many road features, underpass, end or beginning of a divided highway, and on-ramp terminal on crossroad are the top 3 critical road features. Intersection crashes are frequent but are not highly likely to result in severe injuries compared to critical road features. Roundabouts are least likely to result in both severe and moderate injuries. Female drivers are more likely to be involved in crashes at intersections (4-way and T) compared to male drivers. Adult drivers are more likely to be involved in crashes at underpasses. Older drivers are 1.6 times more likely to be involved in a crash at the end or beginning of a divided highway.

Conclusions: The findings from this research help to identify critical road features that need to be given priority. As an example, additional advanced warning signs and providing enlarged or highly retroreflective signs that grab the attention of older drivers may help in making locations such as end or beginning of a divided highway much safer. Educating drivers about the necessary skill sets required at critical road features in addition to engineering solutions may further help them adopt safe driving behaviors on the road.     

Marijuana use and driving in Washington State: Risk perceptions and behaviors before and after implementation of retail sales

Objective: Washington is among the first states to legalize recreational use of marijuana. This study examined marijuana use and risk perceptions before and after retail sales of recreational marijuana began in July 2014, the relationship between risk perceptions and marijuana use, and the relationship between self-reported marijuana use and drug test results.

Methods: Roadside surveys were conducted in 3 waves: June 2014, the month before retail sales of marijuana began; 5–6 months later (November–December 2014); and 1 year later (June 2015). A total of 2,355 drivers completed a marijuana questionnaire about their past and current marijuana use and perceived risks associated with driving after using marijuana. Data collection also included biological specimens (oral fluid and/or blood for marijuana testing and breath for alcohol testing). Drivers who tested positive for delta-9-tetrahydrocannabinol or 11-hydroxy-delta-9-tetrahydrocannabinol in oral fluid or blood were defined as THC-positive.

Results: The proportion of drivers who reported recent marijuana use was similar across the 3 surveys. However, the proportion of THC-positive daytime drivers increased from 8% before retail sales to 23% 6 months after retail sales; this proportion did not change among nighttime drivers (19 and 20%). Drivers’ perceived risk of impairment by marijuana and perceived risk of being arrested for marijuana-impaired driving were similar before and after retail sales. The odds of being THC-positive were 40% lower among drivers who perceived that marijuana was very likely to impair driving, compared to other drivers. Drivers’ perceived risk of being arrested for marijuana-impaired driving was not predictive of THC-positive driving.

Conclusions: The prevalence of daytime THC-positive drivers increased substantially a few months after retail sales of marijuana were legal. Daytime and nighttime prevalence of THC-positive drivers was similar after retail sales. This pattern differs from that typically found for alcohol use, which is consistently higher among drivers at nighttime, compared to daytime. Reports of marijuana use were not always consistent with drug test results, which suggests that comparisons of self-reported marijuana use before and after legalization could be biased. This study examined marijuana use and risk perceptions over the course of 1 year. However, law changes may influence cultural norms gradually over a longer period of time. Future studies should continue to monitor marijuana use over time, as well as identify ways to determine whether drivers are impaired by marijuana.     

Fatally injured drivers in Norway 2005–2015—Trends in substance use and crash characteristics

Objective: Norway introduced a “Vision Zero” strategy in 2001, using multiple approaches, aiming toward a future in which no one will be killed or seriously injured in road traffic crashes (RTCs). Official statistics show that the number of fatally injured road users has declined substantially from 341 deaths in 2000 to 117 in 2015. In-depth crash investigations of all fatal RTCs started in Norway in 2005. The aim of this study was to investigate whether fatal crash characteristics, vehicle safety features, and prevalence of drugs and/or alcohol among fatally injured drivers and riders has changed during 2005–2015, accompanying the reduction in road fatalities.

Methods: Data on all car/van drivers and motorcycle/moped riders fatally injured in RTCs during 2005–2015 were extracted from Norwegian road traffic crash registries and combined with forensic toxicology data.

Results: The proportion of cars and motorcycles with antilock braking systems and cars with electronic stability control, increased significantly during the study period. The prevalence of nonuse of seat belts/helmets and speeding declined among both fatally injured drivers and riders. In addition, the prevalence of alcohol declined, though no significant change in the total prevalence of other substances was noted.

Conclusion: The observed changes toward more safety installations in cars and motorcycles and lower prevalence of driver-related risk factors like alcohol use, speeding, and nonuse of seat belts/helmets among fatally injured drivers/riders may have contributed to the decrease in road traffic deaths.