Does the built environment affect when American teens become drivers? Evidence from the 2001 National Household Travel Survey

Problem

Motor vehicle crashes are the most common cause of death for American adolescents. However, the impact of where teens live on when they begin driving has not been studied.

Method

Data from the 2001 National Household Travel Survey were used to estimate the effect of residential density on the driver status of teens aged 16 to 19 years after matching on demographic characteristics.

Results

Controlling for demographic characteristics, 16 and 17 year old teens in high density neighborhoods had driver rates 15 percentage points below teens living in less dense areas (p < 0.001). The effect for 18 and 19 year olds was a 9 percentage point decrease (p < 0.001).

Summary

These results suggest teens living in less dense and more sprawling communities initiate driving at a younger age than comparable teens in compact areas, placing them at increased risk for crash related injuries. Impact on Industry: The role of environmental factors, such as neighborhood walkability and provision of transit, should be considered in young driver programs.     

Preferred modes of travel among older adults: What factors affect the choice to walk instead of drive?

Introduction

There are many factors that influence older adults' travel choices. This paper explores the associations between mode of travel choice for a short trip and older adults' personal characteristics.

Methods

This study included 406 drivers over the age of 64 who were enrolled in a large integrated health plan in the United States between 1991 and 2001. Bivariate analyses and generalized linear modeling were used to examine associations between choosing to walk or drive and respondents' self-reported general health, physical and functional abilities, and confidence in walking and driving.

Results

Having more confidence in their ability to walk versus drive increased an older adult's likelihood of walking to make a short trip by about 20% (PR = 1.22; 95% CI: 1.06-1.40), and walking for exercise increased the likelihood by about 50% (PR = 1.53; 95% CI = 1.22-1.91). Reporting fair or poor health decreased the likelihood of walking, as did cutting down on the amount of driving due to a physical problem.

Discussion

Factors affecting a person's decision to walk for exercise may not be the same as those that influence their decision to walk as a mode of travel. It is important to understand the barriers to walking for exercise and walking for travel to develop strategies to help older adults meet both their exercise and mobility needs. Impact on Industry: Increasing walking over driving among older adults may require programs that increase confidence in walking and encourage walking for exercise.     

Older driver retraining: An updated systematic review of evidence of effectiveness

Problem and Objective

The number of older drivers who might benefit from driver retraining is growing. A previous review on the effectiveness of older driver retraining included intervention studies up to 2004. The objective was to perform an updated systematic review of the effectiveness of older driver retraining for improving driving-related skills and reducing crash rates.

Method

Articles published from 2004-2008 were grouped according to the intervention provided and outcome studied. Randomized clinical trials (RCTs) were appraised using the Physiotherapy Evidence Database (PEDro) Scale and scored for quality according to their internal validity. Each intervention's effectiveness was then rated and assigned a level of evidence by combining pre- and post- 2004 findings.

Results

Three RCTs and one matched-pairs cohort design met the inclusion criteria. There is strong evidence (Level 1a) that education combined with on-road training improves driving performance and moderate evidence (Level 1b) that it improves knowledge. There is moderate evidence (Level 1b) that physical retraining improves driving performance. There is moderate evidence (Level 1b) that an educational intervention curriculum alone is not effective in reducing crashes.

Summary

The updated evidence on the effectiveness of retraining aimed at older drivers is sufficiently encouraging to merit assertive health promotion actions regarding intervention and program planning.

Impact on Industry

These positive findings warrant a comprehensive plan that has both behavioral and monetary incentives encouraging older driver participation in programs aimed at driver safety.     

A comparison of web-based and telephone surveys for assessing traffic safety concerns, beliefs, and behaviors

Introduction

The purpose of this investigation was to compare the results of a web-based and a telephone interview survey measuring driver concerns about a variety of traffic safety issues, their beliefs, and specific driving behaviors.

Method

State-wide, annual random digit-dial telephone surveys and web-based surveys were conducted in Maryland. A total of 1,700 drivers were surveyed by telephone and 6,806 took a web survey.

Results

Telephone respondents were more likely to be female and older. Web respondents were more likely to be white and not Latino/Hispanic. After controlling for demographic differences, telephone survey respondents were more likely to be concerned about traffic safety. They were more likely to believe that sobriety checkpoints reduce drunk driving (OR = 2.18, 95% CI 1.94, 2.45), they would be ticketed for not wearing a seat belt (OR = 1.26, 95% CI 1.12, 1.43), and they would be stopped by the police if they drove after drinking too much (OR = 1.17, 95% CI 1.03, 1.32). They were less likely to report a variety of risky behaviors including using a cell phone while driving (OR = .54, 95% CI .48, .61) and driving 10+ mph over the speed limit (OR = .81, 95% CI .72, .91), but were more likely to report having been ticketed for a moving violation in the last month (OR = 2.22, 95% CI 1.70, 2.90). Suggestions are offered for overcoming potential sources of sampling bias.

Impact on Industry

Web-based surveys produce substantially different results than random-digit-dial telephone surveys, when used for public assessments of traffic safety concerns and behaviors.     

Enhancing older driver safety: A driving survey and evaluation of the CarFit program

Objective

To evaluate CarFit, an educational program designed to promote optimal alignment of driver with vehicle.

Methods

A driving activity survey was sent to 727 randomly selected participants living in retirement communities. Drivers (n = 195) were assigned randomly to CarFit intervention (n = 83, M age = 78.1) or Comparison (n = 112, M age = 79.6) groups. After 6 months, participants completed a post-test of driving activity and CarFit recommendations.

Results

Nonconsenting drivers were older and participated in fewer driving activities. CarFit participation was moderate (71%) with 86% of the participants receiving recommendations. 60% followed the recommendations at the 6-month re-evaluation). The CarFit (67.6%) and Comparison (59.3%) groups reported at least one type of self-regulation of driving activity at baseline. There was no significant change in the driving behaviors at the six-month follow-up.

Conclusion

CarFit was able to detect addressable opportunities that may contribute to the safety of older drivers.

Impact on industry

CarFit recommendations may need stronger reinforcement in order to be enacted by a participant.     

Children's behavioral traits and risk of injury: Analyses from a case-control study of agricultural households

Problem

Children on family agricultural operations have high risk of injury. The association between children's behavioral traits and their risk of injury is not well understood.

Method

Data from the Regional Rural Injury Study-II were used to assess behavioral risk factors for injury to children ages six to < 20 years. A total of 379 injury events (cases) and 1,562 randomly selected controls were identified. Adjusted odds ratios (OR) and 95% confidence intervals (CI), calculated using logistic regression, were used to estimate injury risk in reference to behavioral traits.

Results

Injury risks were greater for children with high levels of depressive symptoms (OR = 1.9, CI = 1.0-3.7) and aggression (OR = 1.6, CI = 0.9-2.7), and low levels of careful/cautious behavior (OR = 1.8, CI = 1.1-2.9). Children with low levels of self-regulation had reduced risks (OR = 0.4, CI = 0.2-0.8).

Discussion

Results suggest that children's behaviors affect their risk of agricultural injury. Additional research could elucidate mechanisms and inform interventions.

Impact on industry

The development of multifaceted, sustainable approaches for prevention is necessary for this unique population. These findings suggest a need for interventions that incorporate specific behavior-related risk factors in the context of family farms and ranches.     

Self-assessed driver competence among novice drivers - a comparison of driving test candidate assessments and examiner assessments in a Dutch and Finnish sample

Problem

This study examined novice drivers’ overconfidence by comparing their self-assessed driver competence with the assessments made by driving examiners.

Method

A Finnish (n = 2,739) and a Dutch sample (n = 239) of drivers license candidates assessed their driver competence in six areas and took the driving test.

Result and Discussion

In contrast to previous studies where drivers have assessed their skill in comparison to the average driver, a smaller proportion overestimated and a larger proportion made realistic self-assessments of their driver competence in the present study, where self-assessments were compared with examiner assessments. Between 40% and 50% of the candidates in both samples made realistic assessments and 30% to 40% overestimated their competence. The proportion of overestimation was greater in the Dutch than in the Finnish sample, which might be explained by greater possibilities for practicing self-assessment in the Finnish driver education system. Similar to other self-assessment studies that indicate that incompetence is related to overestimation, a larger proportion of candidates that failed the test overestimated their skill compared to those who passed. In contrast to other studies, males did not overestimate their skills more than females, and younger driver candidates were not more overconfident than older drivers.

Impact on traffic safety

Although a great proportion of the candidates made a realistic assessment of their own driver competence, overestimation is still a problem that needs to be dealt with. To improve the accuracy of novice drivers’ self-assessment, methods for self-assessment training should be developed and implemented in the driver licensing process.     

Social norms of accompanied young children and observed crossing behaviors

Introduction

Social norms for accompanied young children and crossing behaviors were examined in two studies conducted in an Ultra-Orthodox Jewish community in Israel.

Method

In Study 1, road behaviors of young children crossing with and without accompaniment and older children were observed, and the actual social norm for accompanied school children younger than 9-years-old was examined. In Study 2, the perceived norm of accompaniment was tested by questionnaires.

Results

Young children who crossed without accompaniment exhibited poorer crossing skills compared to older children and to young children crossing with accompaniment. In the four locations observed, the actual accompaniment rate ranged between 15%-60%. The perceived social norm for child accompaniment was lower than the actual norm.

Conclusions

The discussion refers to both theoretical issues and their practical implications.     

The contribution of traumatic brain injury to the medical and economic outcomes of motor vehicle-related injuries in Ohio

Objective

To describe traumatic brain injury (TBI) among injured roadway users. Aim 1 assessed the association of age, gender, alcohol/drug use, safety equipment use, type of roadway user, metropolitan area, and primary payer with motor vehicle-related TBI outcome. Aim 2 assessed the relationship of motor vehicle-related TBI and risk/protective factors with medical and economic outcomes.

Methods

Population-level hospital and trauma databases from the Ohio Hospital Association and Ohio Department of Public Safety, respectively, were probabilistically linked for 2003 through 2006. Injured roadway users (motor vehicle occupants, motorcyclists, bicyclists, pedestrians, and others) were assessed for TBI, ventilator use, intensive care unit (ICU) admission, injury severity score (ISS), need for rehabilitation, death, and total hospital charges.

Results

The odds of a motor vehicle-related TBI were greater among those not using safety equipment (OR = 1.56). The interactions of alcohol/drug use by gender and of alcohol/drug use by location were significant. Sustaining a TBI increased the odds of requiring ventilation (OR = 3.66), being admitted to the ICU (OR = 2.51), having a high ISS (OR = 4.24), requiring rehabilitation (OR = 2.22), or death (OR = 2.52). When compared with a non-TBI, total hospital charges increased by a factor of 1.35 for a TBI. Hospital charges were $46,441 on average for individuals who sustained a TBI, whereas mean hospital charges were $32,614 for patients with a non-TBI.

Conclusions

Among injured roadway users, individuals who sustain a TBI are more likely to require extensive medical care and have injuries resulting in death.

Impact on industry

Prevention strategies aimed at reducing alcohol use and increasing safety device use should be encouraged to reduce the burden of TBI.     

The relationship between recruitment processes, familiarity, trust, perceived risk and safety

Introduction and Method

Participants′ perceptions of the safety-related aspects of their organization′s recruitment processes were examined, as were their perceptions of safety aspects associated with new recruits.

Results

One hundred and fifty-four professional fire fighters indicated the trust they held in the safety-related aspects of their organizations′ selection and pre-start training. Perceived trust in pre-start training was negatively correlated (r = -.24, p < .01) with the risk associated with new recruits, and positively correlated (r = .50, p < .01) with ratings of trust in recruits to immediately work safely. Furthermore, trust in recruits to immediately work safely was negatively correlated (r = -.21, p < .01) with crews′ safety behavior toward recruits.

Conclusions

These results are interpreted as particularly dangerous for workers, as new recruits lack familiarity with aspects of their new workplace that cannot be addressed by either selection or pre-start training, making them a risk.

Impact on Industry

Organizations should actively identify new recruits, and encourage existing team members not to immediately trust new recruits to work safely.     

Results from a national survey of Crown prosecutors and defense counsel on impaired driving in Canada: A “System Improvements” perspective

Introduction

This article summarizes the main findings from a study designed to examine the legal process in Canada as it applies to alcohol-impaired driving from the point of view of Crown prosecutors and defense counsel, and to identify evidentiary or procedural factors that may impact the legal process, the rights of the accused, and interactions of all parts in the legal process.

Method

The data in this study were collected by means of a survey that was mailed out to the population of Crown prosecutors and defense counsel in Canada. In total, 765 prosecutors and 270 defense lawyers or an estimated 33% of all Canadian prosecutors and 15% of defense lawyers completed and returned the questionnaire. The "systems improvement" paradigm was used to interpret the findings and draw conclusions. Such an approach acknowledges the importance of the context in which countermeasures are implemented and delivered and the structures or entities used to deliver countermeasures to a designated target group.

Results

Results on type of charges and breath alcohol concentration, caseload, case outcomes, case preparation time, conviction rate at trial and overall conviction rate, reasons for acquittals and time to resolve cases are described.

Discussion

The findings from this national survey suggest that there are important challenges within the criminal justice system that impede the effective and efficient processing of impaired driving cases. Some of these challenges occur as a function of practices and policies, while others occur as a function of legislation.

Impact on industry

This study illustrates that a "system improvements" approach that acknowledges the importance of all elements of the criminal justice system and the interaction between those elements, can be beneficial in overcoming the alcohol-impaired driving problem.     

Tracking the prevalence of rollover protective structures on U.S. farm tractors: 1993, 2001, and 2004

Problem

Between 1992 and 2005, 1412 workers on farms died from tractor overturns. A Rollover Protective Structure (ROPS) is a proven intervention to reduce overturn deaths. However, farm characteristics that are associated with the adoption of ROPS are not well understood.

Methods

ROPS prevalence statistics were derived from National Institute for Occupational Safety and Health (NIOSH) surveys that tracked ROPS use on farms. Data were from the years 1993, 2001, and 2004.

Results

In 1993, 38% of tractors were equipped with ROPS. This increased to 51% by 2004. ROPS prevalence rates were higher on farms in the Southern region of the United States, on farms where the operator was 25-34 years old, and on farms with $100,000 or more of farm sales. Low ROPS prevalence rates were associated with farm operators 65 years old or older and with farms with less than $10,000 of farm product sales.

Summary

The increase in ROPS prevalence between 1993 and 2004 has not been sufficient to decrease the rate of tractor overturn deaths on farms. Incentive programs targeting older farm operators and low-income farm operations are suggested to increase ROPS use on tractors.

Impact on Industry

The study provides farm characteristics associated with low ROPS prevalence rates. The results can be used to target farms for future ROPS promotion activities.     

An experimental study on the effect of mobile phone conversation on drivers' reaction time in braking response

Introduction

This paper presents an experimental study in which the effect of three factors (distance between cars, mobile call duration, and time of driving (day or night)) on drivers' reaction time in braking response was investigated.

Methods

The experiment was performed in a real driving environment in which 27 male adults between the ages of 22 and 24 years participated. Three levels of the first two factors (i.e., distance between cars and call duration) and two levels of the last factor (i.e., time of driving) were selected to conduct the experimental study. A full factorial design of experiment with 18 treatment combinations and three replicates of each combination were used. Fifty-four trial runs were performed in a random manner and for each run drivers' reaction time in braking response was measured, which served the data for further analysis. Analysis of variance (ANOVA), interaction effect analysis, and various model adequacy tests were carried out using Design Expert software.

Results

The results of the study indicated that the most important factor affecting the drivers' reaction time in car braking response was the mobile call duration followed by the time of driving, with a high level of interaction between the two factors. It was also found that the distance between cars did not seem to have a significant effect on the reaction time in braking response. It is to be noted that these response times are expected to be higher under normal driving conditions where awareness of experimental environment is not present.

Impact on Industry

The findings of this study would help mobile phone industries in improving safety of mobile phone users in driving environment.     

Television news' coverage of motor-vehicle crashes

Problem

Traffic crashes are a major cause of injury and death. Although it has been argued that a skewed estimation of personal risks may be partly attributable to news representations of mortality causes, the manners in which traffic crashes are covered in the news have not received much attention in the literature.

Method

The current study used content analysis to examine the framing of traffic crashes in television news.

Results

The data indicated that Flemish television news does not report traffic crashes from a public health perspective and consequently it misses opportunities to inform the public on the causes and consequences of risk-taking in traffic.

Impact on industry

It is important that professionals are aware of these findings and stress contextual factors surrounding traffic crashes in their communication with journalists. This may lead to more accurate reports and a more accurate risk perception of viewers.     

Fatal crash trends for Australian young drivers 1997-2007: Geographic and socioeconomic differentials

Background

Little has been published on changes in young driver fatality rates over time. This paper examines differences in Australian young driver fatality rates over the last decade, examining important risk factors including place of residence and socioeconomic status (SES).

Methods

Young driver (17-25 years) police-recorded passenger vehicle crashes were extracted from New South Wales State records from 1997-2007. Rurality of residence and SES were classified into three levels based on drivers’ residential postcode: urban, regional, or rural; and high, moderate, or low SES areas. Geographic and SES disparities in trends of fatality rates were examined by the generalized linear model. Chi-square trend test was used to examine the distributions of posted speed limits, drinking driving, fatigue, seatbelt use, vehicle age, night-time driving, and the time from crash to death across rurality and socioeconomic status.

Results

Young driver fatality rate significantly decreased 5% per year (p < 0.05); however, stratified analyses (by rurality and by SES) showed that only the reduction among urban drivers was significant (average 5% decrease per year, p < 0.01). The higher relative risk of fatality for rural versus urban drivers, and for drivers of low versus high SES remained unchanged over the last decade. High posted speed limits, fatigue, drink driving and seatbelt non-use were significantly associated with rural fatalities, whereas high posted speed limit, fatigue, and driving an older vehicle were significantly related to low SES fatality.

Conclusion

The constant geographic and SES disparities in young driver fatality rates highlight safety inequities for those living in rural areas and those of low SES. Better targeted interventions are needed, including attention to behavioral risk factors and vehicle age.     

Using data linkage to assess the impact of motorized recreational vehicle-related injuries in Ohio

Problem

Motorized recreational vehicle (MRV)-related injuries can result in severe medical and financial consequences. The objective of this study was to describe the epidemiology, and clinical and financial impact of MRV-related injuries in Ohio.

Method

Probabilistically linked statewide Emergency Medical Services (EMS) and hospital (inpatient and emergency department) data for 2003 and 2004 were examined. Record pairs with a MRV-related E-code (E821-E823, E825) were included in this study.

Results

There were 2,893 patients with MRV-related injuries, who had linked EMS and hospital records, resulting in more than $15 million in hospital charges and 1,921 inpatient days of hospitalization. The male-to-female ratio was nearly 4:1, and 19% were younger than 16. Almost 82% of cases were not wearing a helmet; there was a trend of decreasing helmet use with increasing age. Mean (SE) inpatient hospital charges and length of stay (LOS) were $22,218 ($1,290) and 3.8 (0.2) days, respectively. The mean (SE) Injury Severity Score (ISS) for inpatients was 9.2 (0.4). Individuals injured on a street/highway were 3.20 times more likely to sustain an ISS ≥ 16 (95% CI: 1.03, 9.88; p = 0.044) and 3.05 times more likely to sustain a traumatic brain injury (TBI) (95% CI: 1.17, 7.94; p = 0.024) than those who were injured at a place designated for sport or recreation. Children aged 12 to 15 and young adults aged 16 to 25 were 2.47 and 2.14 times more likely, respectively, to sustain a TBI than adults aged 36 or older (aged 12 to 15: 95% CI: 1.13, 5.38; p = 0.024; aged 16 to 25: 95% CI: 1.26, 3.64; p = 0.005). Higher ISS was associated with both higher total charges (p < 0.001) and longer LOS (p < 0.001).

Discussion

This study demonstrates that MRV-related injuries are an important public health problem in Ohio, with a substantial clinical and financial impact.

Impact on Industry

Enactment and enforcement of statewide MRV safety legislation and training of MRV users offer valuable opportunities to prevent these costly injuries.     

Nonfatal bathroom injuries among persons aged ≥15 years--United States, 2008

Problem

Information about where nonfatal unintentional injuries occur is limited, but bathrooms commonly are believed to be a hazardous location.

Methods

Data from a nationally representative sample of hospital emergency departments (ED) was used to quantify and characterize nonfatal unintentional bathroom injuries among people aged ≥ 15 years.

Results

In 2008, an estimated 234,094 nonfatal bathroom injuries were treated in EDs. Most injuries (81.1%) were caused by falls and 37.3% of injuries occurred when bathing, showering, or getting out of the tub or shower. Both injury and hospitalization rates increased with age.

Summary

These results suggest that bathrooms tend to be most hazardous for persons in the oldest age groups.

Impact on Industry

Bathroom injuries among all household members might be reduced by increasing awareness about potentially hazardous activities in the bathroom combined with simple environmental changes such as adding grab bars inside and outside the tub or shower.     

Occupational fatalities due to electrocutions in the construction industry

Introduction

Occupational fatalities due to contact with electricity account for approximately 9% of all deaths in the construction industry and is the fourth leading cause of death in this industry.

Method

Differences in the proportions of electrocutions in the construction industry are significantly different from other industries based upon the age of the worker and the source of the electricity.

Results

This study found that, in the construction industry, the proportion of occupational fatalities due to contact with electric current is significantly higher for workers in the 16 to 19 years old age group. Contact with overhead power lines occurred more frequently with younger workers, while contact with electric wiring, transformers, and related equipment was found to occur more frequently with older workers. The proportion of fatalities due to this event was also found to account for a significantly greater proportion of fatalities in the construction industry overall.

Impact on industry

The proportions of electrocution fatalities in the construction industry were found to be significantly higher for younger workers when compared to all other industries. Focusing prevention measures toward younger workers who work near overhead power lines could have a significant impact upon death rates. For older workers, the focus should be on those who work on or near transformers, electrical wiring, and components. Across the construction industry, implementation of effective lockout-tagout programs, and verification of energy isolation, can prevent approximately 125 fatalities per year in the construction industry.     

Pediatrician attitudes, knowledge, and practice behavior regarding teen driving safety

Problem

Each year about 4,000 teens ages 16-19 die on U.S. roads. Injury prevention counseling is recommended as a valuable and cost-effective part of routine health supervision. This study describes pediatrician knowledge and practice regarding teen driving safety.

Methods

A 31-item self-administered survey was mailed to pediatricians.

Results

160 of 392 pediatricians (41%) completed the survey. During a health supervision visit 93% of pediatricians reported discussing seat belt use, 89% impaired driving, 54% teen licensing laws, and 16% parent teen contract. Half reported having a teen in their practice killed in a crash.

Conclusions

A majority surveyed report discussing and counseling teens on first wave teen driver safety issues (seat belts, alcohol use), but most do not discuss graduated driver licensing laws or related issues. Impact on Industry: Broadly adopted, this inexpensive counseling approach, could lead to reductions in teen motorvehicle crash injuries.