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.     

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.     

Seat Belt Use in States and Territories with Primary and Secondary Laws -- United States, 2006

Problem

Motor-vehicle crashes are a leading cause of death in the United States. In the event of a crash, seat belts are highly effective in preventing serious injury and death.

Methods

Data from the 2006 Behavioral Risk Factor Surveillance System were used to calculate prevalence of seat belt use by state and territory and by type of state seat belt law (primary vs. secondary enforcement).

Results

In 2006, seat belt use among adults ranged from 58.3% to 91.9% in the states and territories. Seat belt use was 86.0% in states and territories with primary enforcement laws and 75.9% in states with secondary enforcement laws.

Discussion

Seat belt use continues to increase in the United States. Primary enforcement laws remain a more effective strategy than secondary enforcement laws in getting motor-vehicle occupants to wear their seat belts.     

Taxi driver seat belt wearing in Nanjing, China

Objective

To determine and validate patterns of seat belt use and attitudes of taxi drivers on wearing a seat belt following national and provincial seat belt legislation in 2004-2005. Design: Roadside daylight seat belt observation and interview survey methods were used, as well as observations from inside taxis during routine trips and a taxi driver focus group. The setting was Nanjing, Jiangsu Province, PR China in April of 2006 and 2007.

Main outcome measures

Prevalence of seat belt use and attitudes to wearing a seat belt were determined, as were vehicle and driver characteristics, and comparisons with other motor-vehicle driver's seat belt use and attitudes.

Results

Taxi drivers interviewed were predominantly male and aged 30-39 years. They spent more hours per week in their vehicles and had more driving experience than other drivers. Over half (56.2%) of taxi drivers interviewed reported that they always wore seat belts, while observation of taxi drivers showed lower wearing rates (i.e., roadside observation was 43.8%, and observation from inside taxis was 36.2%). Belt tampering was a practice of 12-15% of taxi drivers. “Fine avoidance, safety, high speed and long trips” were given as important reasons for wearing and “feeling trapped and uncomfortable” for not wearing. Seat belt reminder signs in taxis were common (82.6% of taxis), but did not appear to impact on driver seat belt use.

Conclusion

The four research methods found taxi drivers to have consistently low “correct wearing” rates.

Impact on industry

As in several other countries, taxi drivers are particularly resistant to seat belt use. Innovative strategies, including occupational health and safety approaches, may be required to achieve increased levels of seat belt use.     

Implied-consent laws: A review of the literature and examination of current problems and related statutes

Problem

A substantial proportion of drivers arrested for DUI refuse the BAC test, thereby reducing the likelihood that they will be convicted and potentially increasing the number of high-risk multiple offenders contributing to alcohol-related crashes.

Method

This paper reviews the information on the current status of implied-consent laws (which impose a sanction on offenders who refuse the BAC test) in the 50 states and the other relevant traffic safety laws and policies that may influence state refusal rates.

Results

Although there appears to be only a weak relationship between state refusal rates and crash rates, there is strong evidence that BAC test refusals significantly compromise the arrest, prosecution, and sentencing of DUI suspects and the overall enforcement of DUI laws in the United States.

Discussion

Laws and policies that may reduce the number of refusals are discussed.

Impact on industry

Alcohol-related crash injuries are an important cost problem for U.S. industry because of property damage from crashes, crash injuries to employees that raise health costs, or the reduction of time on the job resulting from a highway injury.     

Reality and risk of contact-type head injuries related to bicycle-mounted child seats

Objective

The authors have treated numerous children who have been injured by falling from bicycle-mounted child seats. Despite the greatly increased use of such seats, the understanding of their risk and the importance of helmet use remains alarmingly poor. The objective of this study was to confirm the risk of bicycle-mounted child seats and to evaluate the efficacy of helmets, seat belts, and back seat height in terms of preventing or mitigating contact-type head impacts that occur in falls from bicycle-mounted child seats.

Materials and methods

Biometrical dummy tests were performed to examine contact-type head injuries in falls from stationary bicycles. A bicycle with an anthropometric test dummy placed in a bicycle-mounted child seat was tipped over. Each test was repeated three times and three-dimensional acceleration was measured using accelerometer. Head Injury Criteria (HIC) were calculated and the respective influences of a helmet, a seat belt, and increased height of the back of the seat on such impacts were evaluated.

Results

Only helmets unequivocally lowered maximal acceleration and/or HIC values with statistical significance. The seat belt lowered HIC values as long as it was used with the high-back seat. Only when the dummy wore a helmet sitting in a high-back seat did the HIC show less than the threshold of 570 for three-year-old children. The HIC showed the lowest score of 161.5 when the dummy wore both a helmet and a seat belt sitting in a high-back seat.

Conclusions

Riders in bicycle-mounted child seats definitely have higher risks of contact-type head injuries. In transporting a child on a bicycle-mounted child seat, parents must use both a child-bicycle helmet and a high-back child seat at least; a seat belt is highly recommended as long as it is used with the other safety devices.

Impact on Industry

The bicycle-mounted child seat should have a high enough back and an appropriate seat belt to protect the head of the child from a contact-type injury.     

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.     

Differences in urban and rural accident characteristics and medical service utilization for traffic fatalities in less-motorized societies

Introduction

Fatalities from traffic accidents in less-motorized societies are an important global issue. We aimed to characterize the geographic differences of fatalities in such societies to facilitate the development of targeted interventions.

Method

This study linked police reports, hospital data, and vital registration data from Taiwan with special reference to accident factors in pre-hospital deaths and medical care in hospital deaths.

Results

A higher percentage of pre-hospital deaths were observed following rural as compared to urban traffic accidents. The deaths due to rural accidents can be attributed to lower use of restraints (i.e., helmets or seat belts), lower percentage of motorcyclists, and more highway accidents. A higher percentage of victims in rural accidents were transported to distant medical centers rather than to local hospitals.

Conclusion

Specific interventions, such as intelligent emergency medical systems, campaigns for helmets and seat belt usage, enforcement of helmets and seat belt use, and speed control measures should be targeted to rural areas.

Impact on industry

Cooperation between the vehicle industry and emergency medical providers in rural traffic accident rescue teams may decrease the numbers of deaths in these regions.     

Factors associated with driving under the influence of alcohol

Objective: This study examined the risk factors of driving under the influence of alcohol (DUI) among drivers of specific vehicle categories (DSC). On the basis of this research, the variables related to DUI and involvement in traffic crashes were defined. The analysis was conducted for car drivers, bicyclists, motorcyclists, bus drivers, and truck drivers.

Method: The research sample included drivers involved in traffic crashes on the territory of Serbia in 2016 (60,666). Two types of analyses were conducted in this study. Logistic regression established the correlation between DUI and DSC and the The Technique for Order of Preference by Similarity to Ideal Solution (Multi-criteria decision making) method was applied to consider the scoring and explore the potential for the prevalence of DUI on the basis of 2 data sets (DUI and non DUI).

Results: The study results showed that driver error and male drivers were the 2 most significant risk factors for DUI, with the highest scores and potential for prevalence. The nonuse of restraint systems, driver experience, and driver age are the factors with a significant prediction of involvement in an accident and an insignificant prediction of DUI.

Conclusions: Following the development of the logistic prediction models for DUI drivers, testing of the model was conducted for 3 control driver groups: Car, motorcycle, and bicycle. The prediction model with a probability greater than 50% showed that 77% of car drivers were under the influence of alcohol. Similarly, the prediction percentage for motorcyclists and bicyclists amounted to 71 and 67%, respectively. The recommendation of the study is that drivers whose DUI probability is above 50% should be potentially suspected of DUI. The results of this study can help to understand the problem of DUI among specific driver categories and detect DUI drivers, with the aim of creating successful traffic safety policy.     

Poverty as a determinant of young drivers' fatal crash risks

Problem

U.S. teenaged and young-adult drivers' elevated rates of fatal traffic crash involvement typically are attributed to biological and developmental risk-taking associated with young age. However, young drivers differ from older ones along several sociodemographic dimensions, including higher poverty rates and greater concentration in poorer areas, which may contribute to their risks.

Method

Using Fatality Analysis Reporting System, Census, and Federal Highway Administration data for 1994-2007, bivariate and multivariate regression analyses were conducted of fatal motor-vehicle crash involvements per 100 million miles driven by driver age (16 through 74) and state along with 14 driver-, vehicle-, and state-level variables.

Results

Driver age was not a significant predictor of fatal crash risk once several factors associated with high poverty status (more occupants per vehicle, smaller vehicle size, older vehicle age, lower state per-capita income, lower state population density, more motor-vehicle driving, and lower education levels) were controlled. These risk factors were significantly associated with each other and with higher crash involvement among adult drivers as well.

Summary and Discussion

The strong association between fatal crash risk and environments of poverty as operationalized by substandard vehicle and driving conditions suggests a major overlooked traffic safety factor particularly affecting young drivers.     

Gasoline prices and traffic safety in Mississippi

Problem

Limited literature suggests that gasoline prices have substantial effects on reducing fatal crashes. However, the literature focuses only on fatal crashes and does not examine the effects on all traffic crashes.

Methods

Mississippi traffic crash data from April 2004–December 2008 from the Mississippi Highway Patrol and regular-grade unleaded gasoline price data from the Energy Information Administration of the U.S. Department of Energy were used to investigate the effects of gasoline prices on traffic safety by age, gender, and race.

Results

Gasoline prices have both short-term and intermediate-term effects on reducing total traffic crashes and crashes of females, whites, and blacks. The intermediate-term effects are generally stronger than the short-term effects. Gasoline prices also have short-term effects on reducing crashes of younger drivers and intermediate-term effects on older drivers and male drivers.

Impact on Industry

Higher gasoline taxes reduce traffic crashes and may result in additional societal benefits.     

Drink driving deterrents and self-reported offending behaviours among a sample of Queensland motorists

Problem

The efficacy of drink driving (driving under the influence, DUI) countermeasures to deter motorists from driving over the legal limit is extremely important when considering the personal and economic impact the offending behavior has on the community. This paper reports on an examination of 780 Queensland motorists' perceptions of legal and non-legal sanctions and their deterrent impact on self-reported offending behavior. Method: The data were collected via a telephone survey of motorists recruited from a random sample of all listed telephone numbers in the state, adjusted according to district population figures. Results: The results indicated that there were a range of legal and non-legal factors that were significantly associated with self-reported DUI including: the perceived risk of apprehension and license loss (legal factors); and concerns relating to the possibility of being involved in a crash and hurting another person (non-legal factors). However, additional multivariate analyses indicated that while both legal and non-legal factors significantly predicted self-reported DUI, higher alcohol consumption levels and more favorable attitudes to the behavior also appear to increase the likelihood of DUI. Discussion: The paper will outline the direct implications of the research project such as the development and promotion of countermeasures that both effectively deter motorists and address pro-offending attitudes. Impact on industry: The findings also highlight that DUI remains a relatively common behaviour among some motoring groups and that there is a need to extend current levels of enforcement as well as adopt innovative strategies to enhance the impact of these operations on the offending behaviour.     

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.     

A note on the effectiveness of the house-arrest alternative for motivating DWI offenders to install ignition interlocks

Introduction

The effectiveness of ignition interlocks at reducing drunk driving has been limited by the ability of driving-while-intoxicated (DWI) offenders to avoid court orders to install the devices.

Methods

In a pilot program in New Mexico, four Santa Fe County judges imposed home confinement (via electronic monitoring bracelets) on offenders who claimed to have no car or no intention to drive. Interlock installation rates for Santa Fe County were compared with all other counties in New Mexico over a 2-year program and 2-year post-program period.

Results

During the two program years, 70% of the drivers convicted of DWI in Santa Fe County installed interlocks, compared to only 17% in the other counties, but when the program was terminated, the Santa Fe installation rate fell by 18.8 percentage points.

Summary

Mandating the alternative sanction of house arrest led to the highest reported interlock installation rate for DWI offenders.

Impact on Industry

Impaired driving is a substantial expense to employers, particularly when it bars driving that interferes with employment. Interlocks provide a method of protecting the public while permitting the offender to drive sober. This study was directed at increasing interlock use by DWI offenders.     

The impact of retail beverage service training and social host laws on adolescents' DUI rates in San Diego County,California

Introduction: Driving under the influence (DUI) citations are still a serious concern among drivers aged 16–20 years and have been shown to be related to increased risk of fatal and nonfatal crashes. A battery of laws and policies has been enacted to address this concern. Though numerous studies have evaluated these policies, there is still a need for comprehensive policy evaluations that take into account a variety of contextual factors. Previous effort by this research team examined the impact of 20 minimum legal drinking age–21 laws in the state of California, as they impacted alcohol-related crash rates among drivers under 21 years of age while at the same time accounting for alcohol and gas taxes, unemployment rates, sex distribution among drivers, and sobriety checkpoints. The current research seeks to expand this evaluation to the county level (San Diego County). More specifically, we evaluate the impact of measures subject to county control such as retail beverage service (RBS) laws and social host (SH) laws, as well as media coverage, city employment, alcohol outlet density, number of sworn officers, alcohol consumption, and taxation policies, to determine the most effective point of intervention for communities seeking to reduce underage DUI citations.

Methods: Annual DUI citation data (2000 to 2013), RBS and SH policies, and city-wide demographic, economic, and environmental information were collected and applied to each of the 20 cities in San Diego County, California. A structural equation model was fit to estimate the relative contribution of the variables of interest to DUI citation rates.

Results: Alcohol consumption and alcohol outlet density both demonstrated a significant increase in DUI rates, whereas RBS laws, SH laws, alcohol tax rates, media clusters, gas tax rates, and unemployment rates demonstrated significant decreases in DUI rates.

Conclusions: At the county level, although RBS laws, SH laws, and media efforts were found to contribute to a significant reduction in DUI rates, the largest significant contributors to reducing DUI rates were alcohol and gas taxation rates. Policy makers interested in reducing DUI rates among teenagers should examine these variables within their specific communities and consider conducting community-specific research to determine the best way to do so. Future efforts should be made to develop models that represent specific communities who are interested in reducing DUI rates among drivers aged 16–20 years.     

High-risk behaviors while driving: A population-based study from Iran

Objective: Traffic injuries are becoming one of the most important challenges of public health systems. Because these injuries are mostly preventable, the aim of this study is to evaluate the four main high-risk behaviors while driving.

Methods: This cross-sectional study was conducted on a random sample from the population of Mashhad, Iran, in 2014. A checklist and a previously validated questionnaire for the transtheoretical stages of change model (TTM) were used for data collection. Statistical analyses were performed using SPSS 11.5 software with P <.05 statistically significant.

Results: Totally 431 individuals were included with a mean age of 30 ± 11.3 years. Forty-three percent (183) were male. The TTM model revealed that participants were mostly in pre-actional phases regarding not using a cell phone while driving (80%), fastening the driver's seat belt (66%), front seat belt (68%), and rear seat belt (85%) The penalty was a protective factor only for using cellphone (odd ratio [OR] = 0.82, 95% confidence interval [CI], 0.68–0.98). Lower education (OR = 0.12, 95% CI, 0.01–0.94) and male gender (OR = 0.35, 95% CI, 0.14–0.83) were indicative of lower rates of fastening the front and rear seat belts.

Conclusion: The stages of change model among study participants is a proper reflection of the effectiveness of the current policies. More serious actions regarding these high-risk behaviors should be considered in legislation.     

Correcting sample selection in FARS data to estimate seatbelt use

Introduction

In this paper, we show that FARS data can be a comparable alternative to observational NOPUS data in estimating seat belt use in the United States once we correct for sample selection bias.

Results

Based on assumptions of independence for seatbelt choice, we establish a lower and upper bound for seatbelt usage rates, and find that once we correct for sample selection bias, the seatbelt usage estimates from the corrected FARS emerge at least as a comparable alternative to NOPUS estimates.

Impact on Industry

This implies that researchers can use corrected FARS to complement NOPUS, thus being able to utilize the rich cross-sectional details available in FARS data to analyze various relevant research questions.     

Committing driving violations: An observational study comparing city, town and village

Introduction

This article compares observed driving behavior in a city, a town, and a village.

Method

Unobtrusive observations were made at intersections in each residential type. Five violation types were observed: (a) not wearing a seat belt (seat belt violation); (b) not using a safety seat for a child (safety seat violation for children); (c) not using a speaker while speaking on the phone (on-phone violation); (d) failing to comply with a ‘give way’ sign (‘give way’ sign violation); and (e) stopping in an undesignated area (undesignated stop violation). It was expected that in accordance with the anonymity hypothesis that the bigger residential areas' rate of traffic violations would be higher. The effects of the residential type, drivers' gender, and age were assessed using the multiple regression model. The stepwise method of evaluation was employed. The model converged on step 3 (Adjusted R square = 0.039). Residential type and gender contributed significantly to the model. Results: Consistent with prior research, male drivers committed more violations than female drivers. Chi-square analyses were used to test the distribution of violations by the settlement types. Overall, more drivers committed violations in the two small residential areas than in the city, with 30% of city drivers, 43% of town drivers, and 51% of village drivers committing at least one violation (χ2 (2) = 37.65, p < 0.001). Moreover, in the town and the village, a combination of one or more violations was committed more often than in the city (χ2 (1) = 34.645, p < 0.001). Accordingly, more drivers committed violations in the two small settlements (48.4%) than in the city (30.6%). Possible explanations for the observed results were provided in the Discussion section.

Impact on Industry

The conclusions of this paper are that drivers in small villages tend to disobey traffic laws. Therefore, efforts have to be made in companies to take this issue in consideration while running fleets in companies located in small places far from the center.     

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.