Road safety in China: Analysis of current challenges

Introduction

China has the world's largest population, and is the second largest automobile market. China's economy is booming, resulting in a rapid increase in both the road infrastructure and access to private vehicles. Along with economic growth, the ownership of motorized vehicles has almost quadrupled in the past 10 years, from 42.2 million in 1997 to 159.7 million in 2007. However, at the same time, China also has a very high number of road fatalities compared to other countries, with about 100,000 reported fatalities each year.

Method

This study analyzes the Chinese road-fatality situation to identify areas in which the total harm caused by crashes can be substantially and readily reduced. It provides a comprehensive analysis of the current road-fatality situation in China using conventional indices and the likely future trends.

Results

Four areas were identified in which countermeasures have the most potential to substantially reduce fatalities in China: pedestrians and other non-motorists, nighttime driving, vehicle passengers, and motorcycles.

Conclusion

While China faces unprecedented road safety issues, this report identifies major areas in which there are opportunities to greatly reduce total harm.     

Trends and characteristics of animal-vehicle collisions in the United States

Introduction

Since 1990, fatal animal-vehicle collisions (AVCs) in the United States have more than doubled. This paper examines annual AVC trends in the United States over a 19-year period, seasonal and diurnal patterns of AVC risk, the geographic distribution of crash risk by state, and the association between posted speed limit and AVC crash risk in darkness.

Method

AVCs were compiled from the Fatality Analysis Reporting System (FARS) and the General Estimates System (GES) for the years 1990-2008 to examine annual crash trends for fatal and nonfatal crashes. Seasonal trends for fatal AVCs were examined with the aggregated FARS dataset; seasonal trends for fatal and nonfatal AVCs were also examined by aggregating four years of Michigan crash data. State-by-state distributions of fatal AVCs were also described with the aggregated FARS dataset. Finally, the relationship between posted speed limit and the odds that a fatal or nonfatal AVC occurred in darkness were examined with logistic regressions using the aggregated FARS and Michigan datasets.

Results

Between 1990 and 2008, fatal AVCs increased by 104% and by 1.3 crashes per trillion vehicle miles travelled per year. Although not all AVCs involve deer, daily and seasonal AVC crash trends follow the general activity pattern of deer populations, consistent with prior reports. The odds that a fatal AVC occurred in darkness were also found to increase by 2.3% for each mile-per-hour increase in speed; a similar, albeit smaller, effect was also observed in the aggregated Michigan dataset, among nonfatal crashes.

Conclusion

AVCs represent a small but increasing share of crashes in the United States. Seasonal and daily variation in the pattern of AVCs seem to follow variation in deer exposure and ambient light level. Finally, the relative risk that a fatal and nonfatal AVC occurred in darkness is influenced by posted speed limit, suggesting that a driver's limited forward vision at night plays a role in AVCs, as it does in pedestrian collisions.

Impact on Industry

The association between speed limit and crash risk in darkness suggests that AVC risk might be reduced with countermeasures that improve a driver's forward view of the road.     

A national evaluation of the nighttime and passenger restriction components of graduated driver licensing

Introduction

The high crash rate of youthful novice drivers has been recognized for half a century. Over the last decade, graduated driver licensing (GDL) systems, which extend the period of supervised driving and limit the novice's exposure to higher-risk conditions (such as nighttime driving), have effectively reduced crash involvements of novice drivers.

Method

This study used data from the Fatality Analysis Reporting System (FARS) and the implementation dates of GDL laws in a state-by-year panel study to evaluate the effectiveness of two key elements of GDL laws: nighttime restrictions and passenger limitations.

Results

Nighttime restrictions were found to reduce 16- and 17-year-old driver involvements in nighttime fatal crashes by an estimated 10% and 16- and 17-year-old drinking drivers in nighttime fatal crashes by 13%. Passenger restrictions were found to reduce 16- and 17-year-old driver involvements in fatal crashes with teen passengers by an estimated 9%.

Conclusions

These results confirm the effectiveness of these provisions in GDL systems. Impact on Public Health. States without the nighttime or passenger restrictions in their GDL law should strongly consider adopting them.

Impact on Industry

The results of this study indicate that nighttime restrictions and passenger limitations are very important components of any GDL law.     

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.     

The Long Beach/Fort Lauderdale relative risk study

Problem

The role of alcohol as a major factor in traffic crash causation has been firmly established. However, controversy remains as to the precise shape of the relative risk function and the BAC at which crash risk begins to increase.

Methods

This study used a case-control design in two locations: Long Beach, California, and Fort Lauderdale, Florida. Data were collected on 2,871 crashes of all severities and a matched control group of drivers selected from the same time, location, and direction of travel as the crash drivers. Of the 14,985 sample drivers, 81.3% of the crash drivers and 97.9% of the controls provided a valid BAC specimen.

Results

When adjusted for covariates and nonparticipation bias, increases in relative risk were observed at BACs of .04-.05, and the elevations in risk became very pronounced when BACs exceeded .10.

Discussion

The results provide strong support for .08 per se laws and for state policies that increase sanctions for BACs in excess of .15.

Impact on Industry

This study provides further precision on the deleterious effects of alcohol on driving and, by implication, on other complex tasks.     

Determinants of seat belt use: A regression analysis with FARS data corrected for self-selection

IntroductionWe develop a methodology to use FARS data as an alternative to NOPUS in estimating seat belt usage. The advantages of using FARS over NOPUS are that (i) FARS is broader because it contains more variables relevant for policy analysis, (ii) FARS allows for easy multivariate regression analysis, and finally, (iii) FARS data is more cost-effective.MethodologyWe apply a binary logit model in our analysis to determine the likelihood of seat belt usage given various occupant, vehicle, and built environment characteristics. Using FARS data, we derive coefficient estimates for categories such as vehicle occupants' age and night time seat belt use that observational surveys like NOPUS cannot easily provide.ResultsOur results indicate that policies should focus on passengers (as opposed to drivers), male and young vehicle occupants, and that law enforcement should focus on pick-up trucks, rural roads, and nights. We find evidence that primary seat belt laws are effective.ConclusionsAlthough this is primarily a methodological paper, we present and discuss our results in the context of public policy so that our findings are relevant for road safety practitioners, researchers, and policymakers.     

The impact of a standard enforcement safety belt law on fatalities and hospital charges in Ohio

Introduction

The purpose of this study was to analyze linked crash and hospital data to determine the effect that enactment of a standard enforcement safety belt law in Ohio would have on hospital charges and direct medical costs due to motor-vehicle crashes, focusing on the impact to the state's Medicaid system.

Method

The linkage and analysis was conducted as part of the Ohio Crash Outcome Data Evaluation System (CODES) program. Current safety belt usage in Ohio stands at 82% with its secondary enforcement safety belt law.

Results

Assuming an increase in usage to 92% through standard enforcement, over $15.3 million in medical costs to Medicaid for injuries that occur in a single year could be prevented over a 10-year period. Cumulative savings could reach more than $91.2 million during the 10-year period. In addition, 161 fatalities could have been prevented in one year had all unbelted occupants who sustained a fatal injury instead chosen to wear their safety belt.

Summary and Impact on Industry

Clearly, substantial progress can be made in reducing the number of deaths and injuries, as well as medical costs associated with motor-vehicle crashes, by strengthening safety belt laws and increasing safety belt usage in Ohio.     

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.     

Perceptions of personal vulnerability to workplace hazards in the Australian construction industry

Introduction

The importance of risk perception for workplace safety has been highlighted by the inclusion of risk appraisals in contemporary models of precautionary behavior at work. Optimism bias is the tendency to think that negative events are less likely to happen to oneself than to the average person, and is proposed to be related to the reduced use of precautions.

Method

Building on studies of optimism bias for workplace hazards using samples with heterogenous risk profiles, the current study aimed to investigate whether optimism bias is present in a sample of workers exposed to similar workplace hazards. 175 Australian construction workers completed a brief survey that asked them to rate the likelihood of common construction industry hazards occurring to them and to the average worker of the same age doing the same job. Significant levels of optimism bias were found for many hazards (including being electrocuted, being trapped in a confined space, falling from heights, and causing someone else to have an injury).

Results

Optimism bias was not related to perceived controllability, contrary to findings in other domains, yet consistent with findings of optimism bias for workplace hazards. Optimism bias was not found to be related to a reduction in safe work behaviors, though this may be due to difficulties in measuring safe or precautionary behavior, such as social desirability.

Impact on industry

That most workers think that hazards are less likely to happen to them than to the average worker presents a significant problem because it may ameliorate the efficacy of safety programs, yet constitutes a largely unexplored opportunity for improving workplace safety performance.     

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.     

Predicting driver drowsiness using vehicle measures: Recent insights and future challenges

Introduction

Driver drowsiness is a significant contributing factor to road crashes. One approach to tackling this issue is to develop technological countermeasures for detecting driver drowsiness, so that a driver can be warned before a crash occurs.

Method

The goal of this review is to assess, given the current state of knowledge, whether vehicle measures can be used to reliably predict drowsiness in real time.

Results

Several behavioral experiments have shown that drowsiness can have a serious impact on driving performance in controlled, experimental settings. However, most of those studies have investigated simple functions of performance (such as standard deviation of lane position) and results are often reported as averages across drivers, and across time.

Conclusions

Further research is necessary to examine more complex functions, as well as individual differences between drivers.

Impact on Industry

A successful countermeasure for predicting driver drowsiness will probably require the setting of multiple criteria, and the use of multiple measures.     

Validity of police-reported alcohol involvement in fatal motor carrier crashes in the United States between 1982 and 2005

Objective

To examine the validity of police-reported alcohol data for drivers involved in fatal motor carrier crashes.

Material and Methods

We determined the availability of blood alcohol concentration (BAC) and police-reported alcohol data on 157,702 drivers involved in fatal motor carrier crashes between 1982 - 2005 using Fatality Analysis and Reporting System (FARS) data. Drivers were categorized as motor carrier drivers if they operated a vehicle with a gross vehicle weight rating of greater than 26,000 pounds. Otherwise, they were classified as non motor carrier drivers. The sensitivity and specificity of police-reported alcohol involvement were estimated for both driver types.

Results

Of the 157,702 drivers, 18% had no alcohol information, 15% had BAC results, 42% had police-reported alcohol data, and 25% had both. Alcohol information varied significantly by driver, crash, and vehicle characteristics. For example, motor carrier drivers were significantly more likely (51%) to have BAC testing results compared to non motor carrier drivers (31%) (p < 0.001). The sensitivity of police-reported alcohol involvement for a BAC level ≥ 0.08 was 83% (95% CI 79%, 86%) for motor carrier drivers and 90% (95% CI 89%, 90%) for non motor carrier drivers. The specificity rates were 96% (95% CI 95%, 96%) and 91% (95% CI 90%, 91%), respectively.

Conclusions

The sensitivity and specificity of police-reported alcohol involvement are reasonably high for drivers involved in fatal motor carrier crashes. Further research is needed to determine the extent to which the accuracy of police-reported alcohol involvement may be overestimated because of verification bias.

Impact on the Industry

Based on the results of this study, the federal government should continue to work with states to strengthen their strategies to increase chemical testing of all drivers involved in fatal crashes.     

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.     

[Case Study] CityCenter and Cosmopolitan Construction Projects, Las Vegas, Nevada: Lessons learned from the use of multiple sources and mixed methods in a safety needs assessment

Problem

The present study describes a response to eight tragic deaths over an eighteen month times span on a fast track construction project on the largest commercial development project in U.S. history.

Methods

Four versions of a survey were distributed to workers, foremen, superintendents, and senior management. In addition to standard Likert-scale safety climate scale items, an open-ended item was included at the end of the survey.

Results

Safety climate perceptions differed by job level. Specifically, management perceived a more positive safety climate as compared to workers. Content analysis of the open-ended item was used to identify important safety and health concerns which might have been overlooked with the qualitative portion of the survey.

Discussion

The surveys were conducted to understand workforce issues of concern with the aim of improving site safety conditions. Such efforts can require minimal investment of resources and time and result in critical feedback for developing interventions affecting organizational structure, management processes, and communication.

Summary

The most important lesson learned was that gauging differences in perception about site safety can provide critical feedback at all levels of a construction organization.

Impact on the Industry

Implementation of multi-level organizational perception surveys can identify major safety issues of concern. Feedback, if acted upon, can potentially result in fewer injuries and fatal events.     

The effect of work hours on adverse events and errors in health care

Introduction

We studied the relationship between registered nurses' extended work duration with adverse events and errors, including needlestick injuries, work-related injuries, patient falls with injury, nosocomial infections, and medication errors.

Method

Using bivariate and multivariate logistic regression, this secondary analysis of 11,516 registered nurses examined nurse characteristics, work hours, and adverse events and errors.

Results

All of the adverse event and error variables were significantly related to working more than 40 hours in the average week. Medication errors and needlestick injuries had the strongest and most consistent relationships with the work hour and voluntary overtime variables.

Discussion

This study confirms prior findings that increased work hours raise the likelihood of adverse events and errors in healthcare, and further found the same relationship with voluntary overtime.

Impact on Industry

Legislation has focused on mandatory overtime; however, this study demonstrated that voluntary overtime could also negatively impact nurse and patient safety.     

Driving self-restriction in high-risk conditions: how do older drivers compare to others?

Introduction

Many older drivers self-restrict or avoid driving under high-risk conditions. Little is known about the onset of driving self-restrictions or how widespread self-restrictions are among drivers of all ages.

Methods

The Second Injury Control and Risk Survey (ICARIS-2) was a nationwide cross-sectional, list-assisted random-digit-dial telephone survey from 2001 to 2003. National prevalence estimates and weighted percentages of those reporting driving self-restrictions were calculated. Multivariable logistic regression was used to explore associations between specific self-restrictions and age group, adjusting for other personal characteristics.

Results

More than half of all drivers reported at least one driving self-restriction. The most commonly reported restriction was avoidance of driving in bad weather (47.5%), followed by at night (27.9%) and on highways or high-speed roads (19%). A greater percentage of young adult women (18-24 years) reported self-restricting in bad weather compared to women in other age groups, and the percentage of drivers self-restricting at night, in bad weather, and on highways or high-speed roads increased steeply after age 64. We found that women, those in low income groups, and those who had driven low annual mileage were more likely to self-restrict.

Conclusions

In addition to assessing self-restrictions among older drivers, a new finding from our study is that self-restrictions are also quite prevalent among younger age groups. Driving self-restrictions may be better understood as a spectrum across ages in which drivers’ reasons for restriction change.

Impact on industry

Future research on the ability of driving self-restrictions to reduce actual crash risk and prevent injuries is needed.     

“Safety is everyone's job:” The key to safety on a large university construction site

Problem

Construction risk management is challenging.

Method

We combined data on injuries, costs, and hours worked, obtained through a Rolling Owner-Controlled Insurance Program (ROCIP), with data from focus groups, interviews, and field observations, to prospectively study injuries and hazard control on a large university construction project.

Results

Lost-time injury rates (1.0/200,000 hours worked) were considerably lower than reported for the industry, and there were no serious falls from height. Safety was considered in the awarding of contracts and project timeline development; hazard management was iterative. A top-down management commitment to safety was clearly communicated to, and embraced by, workers throughout the site.

Discussion and Impact

A better understanding of how contracting relationships, workers' compensation, and liability insurance arrangements influence safety could shift risk management efforts from worker behaviors to a broader focus on how these programs and relationships affect incentives and disincentives for workplace safety and health.     

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.