Effect of enhanced seat belt reminders on driver fatality risk

Objective

Enhanced seat belt reminders in automobiles have been shown to increase belt use rates by approximately 3 percentage points. The objective of this study was to estimate the effect of enhanced seat belt reminders on driver fatality risk.

Method

Data included all passenger vehicle driver deaths and vehicle registration counts in the United States for calendar years 2000-2007. Driver fatality rates per vehicle registration per year were compared for otherwise identical vehicle models with and without enhanced seat belt reminders.

Results

Driver fatality rates were 6% lower for vehicles with enhanced seat belt reminders compared with vehicles without enhanced belt reminders. After adjusting for vehicle age differences, the estimated effect of enhanced belt reminders on driver fatality risk ranged from a 9% reduction for General Motors vehicles to a 2% increase for Honda vehicles. Combining all manufacturers, enhanced belt reminders reduced fatality risk by approximately 2%. Although not statistically significant, the 2% reduction in fatality risk agrees with what should be expected from a 3 percentage point increase in seat belt use rates.

Conclusions

Enhanced seat belt reminders have raised driver belt use rates and reduced fatality rates, but more aggressive systems may be needed for some drivers. It can be inferred that nonfatal injury rates also have been reduced.

Impact on Industry

Manufacturers should be encouraged to put enhanced seat belt reminders on all vehicles as soon as possible.     

Prioritizing prevention opportunities in the Washington State construction industry, 2003-2007

Objective

This study compares construction industry groups in Washington State by injury severity and cost, and ranks industry groups according to potential for prevention.

Methods

All Washington State workers' compensation compensable claims with date of injury between 2003 and 2007 were classified into North American Industrial Classification System (NAICS) industry groups. Claims were then aggregated by injury type and industry groups were ranked according to a prevention index (PI). The PI is the average of the rank orders of the claim count and the claim incidence rate. A lower PI indicates a higher need for prevention activities. The severity rate was calculated as the number of days of time loss per 10,000 full-time equivalents (FTEs).

Results

For all injury types, construction industry groups occupy 7 of the top 15 PI ranks in Washington State. The severity rate among construction industry groups was twice that for non-construction groups for all injury types. Foundation, structure, and building exterior contractors (NAICS 2381) ranked highest in prevention potential and severity among construction industry groups for most common injury types including falls from elevation, fall on same level, struck by/against, and musculo-skeletal disorders of the neck, back, and upper extremity (WMSDs). Median claim costs by injury type were generally higher among construction industry groups.

Conclusions

The construction industry in Washington State has a high severity rate and potential for prevention. The methods used for characterizing these industry groups can be adapted for comparison within and between other industries and states.

Impact on Industry

These data can be used by industry groups and employers to identify higher cost and higher severity injury types. Knowledge about the relative frequencies and costs associated with different injury types will help employers and construction industry associations make better informed decisions about where prevention efforts are most needed and may have the greatest impact. The results of this study can also be used by industry stakeholders to cooperatively focus on high cost and high severity injuries and explore best practices, interventions, and solutions as demonstrated by efforts to prevent musculoskeletal disorders in masonry (Entzel, Albers, & Welch, 2007). Initiating construction industry groups to focus on high cost and high severity injuries may also help prevent other types of injuries.     

Hepatitis B virus infection among health care workers in Public Teaching Hospitals in Khartoum State, Sudan

Background

Hepatitis B virus (HBV) infection is a global public health problem. It is estimated that there are more than 300 million HBV carriers in the world.

Aim

The study aimed to examine the sero-prevalence of hepatitis B virus (HBV) markers among health care workers (HCWs) in Public Teaching Hospitals in Khartoum State, in the year 2004.

Methods

The study is an observational, cross sectional, facility-based study. It was conducted on stratified two-stage cluster random sample of 843 subjects. The study followed non-parametric statistical methods, using Z-test for single proportion.

Results

Among the 843 subjects tested for all HBV markers (Anti-HBc, HBsAg, HBsAb, and HBeAg), the prevalence of Anti-HBc, HBsAg, HBsAb, and HBeAg was found to be 57% (CI 95%:53-60%), 6% (CI 95%:4.0-8.0%), 37% (CI 95%:34-40%) and 9% (CI 95%:7-11%) respectively. P < 0.05.

Conclusion

Seroprevalence of all HBV markers (P < 0.05) was found to be significantly high, while the rate of immunity against HBV infection was low among health care workers In Public Teaching Hospitals in Khartoum State, Sudan.     

A Bayesian assessment of the effect of highway bypasses in Iowa on crashes and crash rate

Introduction

A common contention is that the construction of highway bypasses negatively impacts the economy of local communities by reducing pass-by traffic for businesses. However, as access to specific business' account records is limited, this impact is difficult to quantify. Another common contention is that bypasses contribute to a reduction in overall crashes in the community and in the surrounding areas. Even though a large number of bypasses have been constructed in the State of Iowa over the past several years, their actual impact in terms of traffic safety has not been quantified.

Objectives

This study seeks answers to the following questions: (a) Are bypasses in Iowa associated with a reduction in crash frequencies and crash rates on the bypassed highway? (b) Do bypasses in Iowa introduce a reduction of overall crash frequencies and rates or do they merely shift crashes from the highways through the communities to the bypasses with no significant overall reduction?

Method

We obtained crash information from the Iowa DOT at 19 sites on which a bypass was constructed sometime during the past 23 years. We also obtained the same information at six sites used as comparison sites on which no bypasses were constructed at least until 2005. We them employed a Bayesian approach to estimating the association between the construction of the bypass and crash rates, while also accounting for other factors.

Results

The construction of bypasses in Iowa is associated with a significant increase in traffic safety both on the main road through town and on the combined main road and bypass roadway.     

What is the potential of trauma registry data to be used for road traffic injury surveillance and informing road safety policy?

Introduction

Information from hospital trauma registries is increasingly being used to support injury surveillance efforts. This research examines the potential of using trauma registry data for road traffic injury surveillance for different types of road users in terms of both the information collected and how representative trauma data are compared to two population-based road traffic injury data collections.

Methods

The three data collections were assessed against recommended variables to be collected for injury surveillance purposes and the representativeness of the distribution of road traffic-related injury data from the trauma registry was compared to hospital admission and road traffic authority data collections.

Results

Data from the trauma registry was largely not representative of the distribution of age groups or activities compared to the two population-based collections, but was representative for gender for some road user groups to at least one population-based data collection.

Conclusions

Trauma data could be used to supplement information from population-based data collections to inform road safety efforts.

Impact on Industry

Road safety policy makers should be aware of the potential and the limitations of using trauma registry data for road traffic injury surveillance.     

The effects of airbags and seatbelts on occupant injury in longitudinal barrier crashes

Introduction

Longitudinal barriers, such as guardrails, are designed to prevent a vehicle that leaves the roadway from impacting a more dangerous object while minimizing the risk of injury to the vehicle occupants. Current full-scale test procedures for these devices do not consider the effect of occupant restraints such as seatbelts and airbags. The purpose of this study was to determine the extent to which restraints are used or deployed in longitudinal barrier collisions and their subsequent effect on occupant injury.

Methods

Binary logistic regression models were generated to predict occupant injury risk using data from the National Automotive Sampling System / Crashworthiness Data System from 1997 through 2007.

Results

In tow-away longitudinal barrier crashes, airbag deployment rates were 70% for airbag-equipped vehicles. Compared with unbelted occupants without an airbag available, seat belt restrained occupants with an airbag available had a dramatically decreased risk of receiving a serious (MAIS 3+) injury (odds-ratio (OR) = 0.03; 95% CI: 0.004-0.24). A similar decrease was observed among those restrained by seat belts, but without an airbag available (OR = 0.03; 95% CI: 0.001- 0.79). No significant differences in risk of serious injuries were observed between unbelted occupants with an airbag available compared with unbelted occupants without an airbag available (OR = 0.53; 95% CI = 0.10-2.68).

Impact on Industry

This study refutes the perception in the roadside safety community that airbags rarely deploy in frontal barrier crashes, and suggests that current longitudinal barrier occupant risk criteria may over-estimate injury potential for restrained occupants involved in a longitudinal barrier crash.     

What kinds of injuries do OSHA inspections prevent?

Objective

OSHA's enforcement program is one of the major public efforts to protect American workers. We examine both the scope of injury prevention that inspections can contribute and the types of standards that contribute the most.

Methods

We linked Pennsylvania Department of Labor and Industry files for lost-time injuries and employment to calculate injury rates for 1998-2005 for all single-establishment manufacturing firms. We linked these to OSHA inspection records.

Results

Inspections with penalties did affect injury types unrelated to standards as well as those related. We also found again that citations for violations of the standard requiring personal protective equipment had the largest impact on preventing injuries.

Impact on Industry

Programs requiring protective equipment use deserve added attention from consultants and inspectors. In addition, some inspections spur managers to undertake safety measures that go beyond compliance with standards.     

Injury outcomes and costs for cross-median and median barrier crashes

Introduction

The objective of this research was to quantify the injury outcomes and develop reliable and comprehensive injury costs for cross-median crashes (CMC) and median barrier crashes (MBC).

Method

A three-step methodology was developed to quantify the crash costs for each crash severity and type. All CMC and MBC between 2001 and 2007 in Wisconsin were identified and used in this analysis. The Wisconsin CODES database provided comprehensive injury costs based on the injury types and severities suffered by participants in study crashes.

Results

As expected, multi-vehicle CMC result in more total injuries and more severe injuries than single-vehicle CMC. Injury costs for the same injury level on KABCO scale are different for different crash types. Injury costs for concrete MBC are 33% to 50% less than those of multi-vehicle CMC, while the injury costs of concrete MBC for lower severities (B and C) are similar to those of single-vehicle CMC for the same severities; but for incapacitating injuries the costs are 30% less. As expected, concrete MBC result in lower severities than CMC. The costs, by crash severity, vary significantly between different crash types. Concrete median barrier injury crashes are roughly 20% of multi-vehicle CMC costs and 50% of single-vehicle CMC costs.

Conclusions

Results indicate that using one set of crash costs for all crash types biases any evaluation. Therefore, it is recommended that crash-type-specific costs be used in applications such as development of median barrier warrant where specific types of crashes are considered (CMC and MBC).

Impact on industry

Using crash specific costs can lead to a more realistic benefit-cost analysis and enable better decision-making.     

Attitudes toward a primary seat belt law among adults in a rural state with a secondary seat belt law

Problem

Enforced primary seatbelt laws can reduce morbidity and mortality associated with motor-vehicle crashes. Constituent support is an important factor associated with legislator voting behavior toward injury prevention laws. Little is known about attitudes toward a primary seat belt law among adults in rural states without a primary seat belt law.

Methods

Data from the Behavioral Risk Factor Surveillance System (BRFSS) survey, a telephone survey of a representative sample of adults in Montana, were used to assess attitudes toward a primary seat belt law.

Results

Sixty-one percent of respondents supported a primary seat belt law. Using multiple logistic regression analyses, women (AOR 1.87; 95% CI 1.49-2.36), persons aged 65 years and older (1.45; 1.06-1.96), American Indians (2.71; 1.55-4.75), those with health insurance (1.51; 1.07-2.14), and those who reported always wearing their seat belt (4.05; 3.14-5.21) were more likely to support a primary seat belt law than respondents without these characteristics.

Conclusions

The majority of adults in a rural state support a primary seat belt law.     

Time trends and predictive factors for safety perceptions among incoming South Australian university students

Problem

Young workers are over-represented in injury statistics. In order to develop injury prevention strategies, this study investigated time trends and predictive factors relating to safety skills, confidence, and attitudes.

Method

Annual surveys were conducted from 2006-2009 among incoming students at the University of Adelaide. The questions addressed safety training, injury experience, and health and safety perceptions.

Results

Time trends in training, perceived safety skills, confidence, and attitudes were not significant. In terms of skills and confidence, the most important correlate was safety training outside of high school (odds ratio = 1.6), especially when repeated, assessed, or in face to face mode. Feeling strongly about safety issues was best predicted by injury experience (OR = 1.7) and gender.

Discussion

These results emphasize the value of assessed training, but they are also consistent with published U.S. data, indicating no improvement over time. It is suggested that there be a more integrated approach in safety education, involving schools and workplaces.

Impact on industry

By developing an understanding of student safety perceptions and experiences, this research aims to target strategies to reduce the excess injury rate for young workers. Workplaces should be more aware of the limitations of school-based safety education and a more integrated and evidence-based approach should be developed, involving schools and workplaces.     

Efficacies of roadway safety improvements across functional subclasses of rural two-lane highways

Introduction

Highway crash occurrence is a leading cause of unnatural deaths, and highway agencies continually seek to identify engineering measures to reduce crashes and to assess the efficacy of such measures. Most past studies on the effectiveness of roadway improvements in terms of crash reduction considered all rural two-lane sections as a single category of roads. However, it may be hypothesized that the differences in the mobility and accessibility characteristics that are reflected in (and due to) the different design standards between different functional subclasses in the rural two-lane highway system can lead to differences in efficacies of safety improvements at these subclasses. This paper investigates the efficacy of roadway improvements, in terms of crash reduction, at the various subclasses of rural two-lane highways.

Methods

An empirical analysis of safety performance at each of the three subclasses of rural two-lane highways was carried out using the negative binomial modeling technique. For each subclass, crash prediction models were developed separately for the three levels of crash severity: property-damage only, injury, and fatal/injury. The crash factors that were considered include lane width, shoulder width, pavement surface friction, pavement condition, and horizontal and vertical alignments. After having developed the safety performance functions, the effectiveness (in terms of the extent of crash reduction, for different levels of crash severity) of highway safety enhancements at each highway subclass were determined using the theoretical concepts established in past literature. These enhancements include widening lanes, widening shoulders, enhancing pavement surface friction, and improving the vertical or horizontal alignment.

Results and Conclusion

The study found that there is empirical evidence to justify the decomposition of the family of rural two-lane roads into its constituent subclasses for purposes of analyzing the effectiveness of safety enhancement projects and thus to avoid underestimation or overestimation of benefits of safety improvements at this class of highways.     

Winter storm-related injuries in Oklahoma, January 2007

Introduction

A January 2007 ice storm occurred in Oklahoma, causing power outages and hazardous travel conditions. The objective of this investigation was to describe the nature of winter storm-related injuries among Oklahoma residents, to determine populations at risk, and to inform prevention-planning personnel.

Methods

Winter storm-related injuries were a temporarily reportable condition; all acute-care hospitals and the state medical examiner logged storm-related injuries and deaths during January 12 − 30, 2007. Medical records were retrospectively abstracted.Risk of injury was described by demographic group, injury type, and mechanism.

Results

Among 6,047 persons experiencing winter storm-related injuries, 74% were injured in falls, 13% in motor-vehicle collisions (MVCs), 8% while sledding, 1% by unintentional carbon monoxide poisoning, 1% in cleanup activities, and 3% by other mechanisms. Median age of injured persons was 39 years. Persons aged ≥ 40 years were 1.4 times more likely to experience falls as the cause of injury than those aged < 40 years, and falls were twice as likely as other mechanisms to cause fractures among persons aged ≥ 40 years. Injured persons aged < 40 years were 2.2 times more likely to experience MVC-related injuries, and 19 times more likely to experience sledding-related injuries than persons aged ≥ 40 years.

Conclusions

Younger persons were more likely injured in MVCs and sledding incidents, whereas older persons were more likely to experience falls and fractures.

Impact on industry

Prevention messages for winter storm-related injuries should target winter-driving safety tips to younger adults and precautions regarding falls to older adults.     

Effects of in-vehicle monitoring on the driving behavior of teenagers

Objectives

The objective was to determine if teenage driving behavior improves when a monitoring and feedback device is installed in the teen's vehicle.

Methods

Vehicles of 85 teenage drivers were fit with a device that detected all instances of sudden braking/acceleration, speeding, and nonuse of seat belts. Drivers were assigned randomly to one of four research groups, differing in whether or not an alert sounded in the vehicle and whether or not parents were given access to websites containing notification records. Time trends in event rates per mile traveled were compared using Poisson regression.

Results

Seat belt use improved when violations were reported to the parent websites, and improved even more when in-vehicle alerts were activated. Consistent reductions in speeding were achieved only when teenagers received alerts about their speeding behavior, believed their speeding behavior would not be reported to parents if corrected, and when parents were being notified of such behavior by report cards.

Conclusions

Electronic monitoring of teenage drivers can reduce the incidence of risky behavior, especially seat belt nonuse. More complicated behavior is more difficult to change, however.

Impact on Industry

Parent participation is key to successful behavioral modification, but it is yet to be determined how best to encourage such participation.     

Effect of a nurse back injury prevention intervention on the rate of injury compensation claims

Problem

This study evaluated the effect of introducing a No Lifting policy on back injuries to nurses, across an entire health care system.

Methods

Methods included: analysis of the data for all public health agencies in the Australian state of Victoria; compensation data from the Victorian Workcover Authority; data about workforce and program implementation from a retrospective survey of agencies; longitudinal analysis of standardized workers compensation claim rates for back injuries before, during and after the intervention.

Results

A statistically significant decline in back injury claim rates during implementation contrasted with no statistically significant trends within the periods before and after the intervention. A statistically significant reduction occurred in mean quarterly standard back injury claim incidence rates per 1,000 equivalent fulltime nursing staff (EFTNS), representing a 24% reduction in standard back injury claims/1000 EFTNS.

Discussion

Ergonomics principles encourage changing the work environment to suit the worker. This approach delivered a significant improvement in the immediate term.

Impact of industry

The substantial decline in back injury rates signifies a major improvement in the safety of a critical aspect of the work environment for nurses.     

Social desirability effects in driver behavior inventories

Problem

The use of lie scales to control for common method variance in driver behavior inventories has been very limited. Given that such questionnaires often use self-reported safety variables as criteria, and have social implications, the risk of artefactual associations is high.

Method

A questionnaire containing scales from several well known driver inventories that have been claimed to predict traffic accident involvement was distributed three times to a group of young drivers in a driver education program, as well as a random group twice. The Driver Impression Management scale (DIM) was used to control for socially desirable responding.

Results

For all behavior scales, the correlation with the DIM scale was substantial. If a scale correlated with self-reported crashes, the amount of predictive power was more than halved when social desirability was controlled for. Results were similar for both samples and all waves. The predictive power of the behavior scales was not increased when values were averaged over questionnaire waves, as should have been the case if the measurement and predictive power were valid. Results were similar for self-reported penalty points. The present results indicate that even the most well-known and accepted psychometric scales used in driver research are susceptible to social desirability bias.

Discussion

As social desirability is only one of a number of common method variance mechanisms that can create artefactual associations, and the great popularity of the self-report methodology, the problem for traffic research is grave.

Impact on industry

Organizations that fund traffic safety research need to re-evaluate their policies regarding what methods are acceptable. The use of self-reported independent and dependent variables can lead to directly misleading results, with negative effects on traffic safety.     

When may road fatalities start to decrease?

Introduction

The comparative analysis of macroscopic trends in road safety has been a popular research topic. The objective of this research is to propose a simple and, at the same time, reliable multiple regime model framework for international road safety comparisons, allowing for the identification of slope changes of personal risk curves and respective breakpoints.

Method

The trends of road traffic fatalities in several EU countries have been examined through the temporal evolution of elementary socioeconomic indicators, namely motorized vehicle fleet and population, at the country level.

Results

Piece-wise linear regression models have been fitted, using a methodology that allows the simultaneous estimation of all slopes and breakpoints. The number and location of breakpoints, as well as the slope of the connecting trends, vary among countries, thus indicating different road safety evolution patterns.

Impact on industry

Macroscopic analysis of road accident trends may be proved beneficial for the identification of best examples and the implementation of appropriate programmes and measures, which will lead to important benefits for the society and the economy through the reduction of road fatalities and injuries. Best performing countries and the related programmes and measures adopted may concern several safety improvements at the processes of the road, the vehicle and the insurance industries.

Conclusions

Lessons from the analysis of the past road safety patterns of developed countries provide some insight into the underlying process that relates motorization levels with personal risk and can prove to be beneficial for predicting the road safety evolution of developing countries that may have not yet reached the same breakpoints. Furthermore, the presented framework may serve as a basis to build more elaborate models, including more reliable exposure indicators (such as vehicle-km driven).     

Survival risk factors for fatal injured car and motorcycle drivers in single alcohol-related and alcohol-unrelated vehicle crashes

Introduction

A high percentage of drivers who die as a result of a single vehicle crash are under the influence of alcohol. We aimed to better understand the prevalence of these fatalities and the ratio of death to injuries based on various risk factors. We focused on alcohol-related and -unrelated single-vehicle crashes to investigate the influence of such risk factors on the time until death for car and motorcycle drivers.

Methods

We combined data from national police reports and a vital registration database in Taiwan. Survival analysis using Cox regression models was used to identify the risk factors of time until death.

Results

Overall, nearly 60% of car driver fatalities and 40% of motorcycle driver fatalities involved the consumption of alcohol. Survival analysis of single-vehicle crashes suggested that the traffic island separation between a car moving at a higher speed and motorcycle traffic resulted in a higher risk of death over time for motorcycle drivers who consumed alcohol. The factors attributed to a higher risk of death over time for motorcycle drivers were older age, crashing into trees, night-time driving, driving on curved roads, and driving on local roads. Driving without restraints and driving on roads with higher speed limits attributed to a higher risk of death over time for car drivers.

Conclusions

The factors that influence the risk of death over time in a motor-vehicle accident involving alcohol depended on different elements, which should each be considered when attempting to reduce this risk.

Impact on Industry

More efforts should be made to investigate the various risk factors in areas with large motorcycle populations.     

Disparities in the prevalence of smoke alarms in U.S. households: Conclusions drawn from published case studies

Introduction

Deaths from fires and burns are a leading cause of fatal home injury in the United States. Smoke alarms are one of the most effective interventions to prevent residential fire deaths. Nationwide, more than 95% of homes are estimated to have at least one smoke alarm. There is evidence that homes at highest risk of fire deaths lag behind national averages in smoke alarm use and maintenance.

Method

We compiled a comprehensive list of published studies that focus on smoke alarm prevalence in high-risk homes. Our findings show that there are substantial gaps in both smoke alarm presence and functional status between high-risk homes and national average estimates.

Conclusions

To save more lives, improved efforts are needed to reduce the disparity in smoke alarm prevalence and functional use in the United States.     

Needle stick and sharps injuries among health care workers in Gondar city, Ethiopia

Background

All employees in health care settings handling needles or other sharps are at risk for needle stick and sharps injuries (NSSIs). Health care workers in under developed countries are at greater risk of infection from blood borne pathogens because of the lack of safety devices and the high prevalence of these pathogens.

Objectives

The aim of this study was to assess the prevalence of NSSIs and associated factors among health care workers in government health institutions in Gondar city, Ethiopia.

Methods

Institution based cross sectional study was conducted from May-December, 2010. The study included 344 health care workers who were selected from the source population using simple random sampling technique. Data were collected through interviews using structured and pre-tested questionnaire and the collected data were entered and analyzed using SPSS version 16.0.

Results

The prevalence of NSSIs among health care workers in the preceding 12 months was 106 (30.8%), of which 58 (54.7%) was reported by females. Lack of training on occupational health and safety, working more than 48 h/week, dissatisfaction with work environment and work culture, greater than 10 years of work experience and having low and moderate perception of risk were found to be significantly associated with NSSIs.

Conclusion

The study found high prevalence of NSSIs among health care workers. Effective training, ongoing awareness on the risk of hazards, preventive measures such as engineering control, and post-exposure prophylaxis following NSSIs are essential to reduce the risk of such injuries.     

The accident-exposure association: self-reported versus recorded collisions

Problem

It has been claimed that exposure to risk of road traffic accidents (usually conceptualized as mileage) is curvilinearly associated with crashes (i.e., the increase in number of crashes decreases with increased mileage). However, this effect has been criticized as mainly an artifact of self-reported data.

Method

To test the proposition that self-reported accidents create part of the curvilinearity in data by under-reporting by high-accident drivers, self-reported and recorded collisions were plotted against hours of driving for bus drivers.

Results

It was found that the recorded data differed from self-reported information at the high end of exposure, and had a more linear association with the exposure measure as compared to the self-reported data, thus supporting the hypothesis.

Discussion

Part of the previously reported curvilinearity between accidents and exposure is apparently due to biased methods. Also, the interpretation of curvilinearity as an effect of exposure upon accidents was criticized as unfounded, as the causality may just as well go the other way. Impact on industry: The question of how exposure associates with crash involvement is far from resolved, and everyone who uses an exposure metric (mileage, time, induced) should be careful to investigate the exact properties of their variable before using it.