The use and safety of medications known to affect driving in Jordan: A cross-sectional study

Objectives: The aim of this study was to estimate the main driving-impairing medications used by drivers in Jordan, the reported frequency of medication side effects, the frequency of motor vehicle crashes (MVCs) while using driving-impairing medicines, as well as factors associated with MVCs.

Methods: A cross-sectional study involving 1,049 individuals (age 18–75 years) who are actively driving vehicles and taking at least one medication known to affect driving (anxiolytics, antidepressants, hypnotics, antiepileptics, opioids, sedating antihistamines, hypoglycemic agents, antihypertensives, central nervous system [CNS] stimulants, and herbals with CNS-related effects) was conducted in Amman, Jordan, over a period of 8 months (September 2013–May 2014) using a structured validated questionnaire.

Results: Sixty-three percent of participants noticed a link between a medicine taken and feeling sleepy and 57% stated that they experience at least one adverse effect other than sleepiness from their medication. About 22% of the participants reported having a MVC while on medication. Multiple logistic regression analysis showed that among the participants who reported having a crash while taking a driving-impairing medication, the odds ratios were significantly higher for the use of inhalant substance (odds ratio [OR] = 2.787, P = .014), having chronic conditions (OR = 1.869, P = .001), and use of antiepileptic medications (OR = 2.348, P = .008) and significantly lower for the use of antihypertensives (OR = 0.533, P = .008).

Conclusion: The study results show high prevalence of adverse effects of medications with potential for driving impairment, including involvement in MVCs. Our findings highlight the types of patient-related and medication-related factors associated with MVCs in Jordan, such as inhalant use, presence of chronic conditions, and use of antiepileptics.     

Motor Vehicle Crashes on Bridges and Countermeasure Opportunities

There are approximately 600,000 highway bridges in the United States. These structures differ from surface streets and highways in terms of their physical properties and operational characteristics, which in turn, affect the risk of motor-vehicle crashes and the kinds of crashes that occur. The purpose of this study was to identify motor-vehicle crash patterns and contributing factors to bridge crashes and related countermeasure opportunities on four urban bridges in the New York metropolitan area. A crash typology was developed using the narratives and diagrams in police crash reports in addition to standard police classifications of crashes. The final dataset contained records of 1,381 police-reported crashes. The four bridges studied had higher crash rates than their respective approach roads. Four major crash types accounted for approximately 90% of the bridge crashes. Primary collision factors are reviewed, and potential countermeasures are discussed.     

Characteristics of animal-related motor vehicle crashes in select National Park Service units—United States, 1990–2013

Objectives: Nationally, animal–motor vehicle crashes (AVCs) account for 4.4% of all types of motor vehicle crashes (MVCs). AVCs are a safety risk for drivers and animals and many National Park Service (NPS) units (e.g., national park, national monument, or national parkway) have known AVC risk factors, including rural locations and substantial animal densities. We sought to describe conditions and circumstances involving AVCs to guide traffic and wildlife management for prevention of AVCs in select NPS units.

Methods: We conducted an analysis using NPS law enforcement MVC data. An MVC is a collision involving an in-transit motor vehicle that occurred or began on a public roadway. An AVC is characterized as a collision between a motor vehicle and an animal. A non-AVC is a crash between a motor vehicle and any object other than an animal or noncollision event (e.g., rollover crash). The final data for analysis included 54,068 records from 51 NPS units during 1990–2013. Counts and proportions were calculated for categorical variables and medians and ranges were calculated for continuous variables. We used Pearson’s chi-square to compare circumstances of AVCs and non-AVCs. Data were compiled at the park regional level; NPS parks are assigned to 1 of 7 regions based on the park’s location.

Results: AVCs accounted for 10.4% (5,643 of 54,068) of all MVCs from 51 NPS units. The Northeast (2,021 of 5,643; 35.8%) and Intermountain (1,180 of 5,643; 20.9%) regions had the largest percentage of the total AVC burden. November was the peak month for AVCs across all regions (881 of 5,643; 15.6%); however, seasonality varied by park geographic regions. The highest counts of AVCs were reported during fall for the National Capital, Northeast/Southeast, and Northeast regions; winter for the Southeast region; and summer for Intermountain and Pacific West regions.

Conclusions: AVCs represent a public health and wildlife safety concern for NPS units. AVCs in select NPS units were approximately 2-fold higher than the national percentage for AVCs. The peak season for AVCs varied by NPS region. Knowledge of region-specific seasonality patterns for AVCs can help NPS staff develop mitigation strategies for use primarily during peak AVC months. Improving AVC data collection might provide NPS with a more complete understanding of risk factors and seasonal trends for specific NPS units. By collecting information concerning the animal species hit, park managers can better understand the impacts of AVC to wildlife population health.     

Geo-spatial and log-linear analysis of pedestrian and bicyclist crashes involving school-aged children

PROBLEM: There is a growing concern with the safety of school-aged children. This study identifies the locations of pedestrian/bicyclist crashes involving school-aged children and examines the conditions when these crashes are more likely to occur. METHOD: The 5-year records of crashes in Orange County, Florida where school-aged children were involved were used. The spatial distribution of these crashes was investigated using the Geographic Information Systems (GIS) and the likelihoods of crash occurrence under different conditions were estimated using log-linear models. RESULTS: A majority of school-aged children crashes occurred in the areas near schools. Although elementary school children were generally very involved, middle and high school children were more involved in crashes, particularly on high-speed multi-lane roadways. Driver's age, gender, and alcohol use, pedestrian's/bicyclist's age, number of lanes, median type, speed limits, and speed ratio were also found to be correlated with the frequency of crashes. DISCUSSION: The result confirms that school-aged children are exposed to high crash risk near schools. High crash involvement of middle and high school children reflects that middle and high schools tend to be located near multi-lane high-speed roads. IMPACT ON INDUSTRY: The pedestrian's/bicyclist's demographic factors and geometric characteristics of the roads adjacent to schools associated with school children's crash involvement are of interest to school districts.     

Antilock Brake Systems and Risk of Different Types of Crashes in Traffic

While antilock braking systems (ABS) have been convincingly demonstrated to enhance test track braking performance, their effect on crash risk in actual driving remains less clear. This paper examines how ABS influences crash risk using mainly two published studies which used police-reported crashes. The published findings are augmented by including new data and additional results. All the work is based on seven General Motors (GM) passenger vehicles having ABS as standard equipment for 1992 models but not available for 1991 models. The ratio of crashes under an adverse condition (say, when the pavement is wet) to under a normal condition (say, when the pavement is dry) is compared for ABS and non-ABS vehicles. After correcting for such factors as model year effects not linked to ABS, the following associations between ABS and crash risk were found by averaging data from the five states Texas, Missouri, North Carolina, Pennsylvania and Indiana (the errors are one standard error): a (10 ± 3)% relative lower crash risk on wet roads compared to the corresponding comparison on dry roads; a (22 ± 11)% lower risk of a pedestrian crash compared to the risk of a non-pedestrian crash; a (39 ± 16)% increase in rollover crash risk compared to the risk of a non-rollover crash. Data from the same Ave states were used to examine two-vehicle rear-end collisions. Using the assumption that side-impact crashes estimate exposure, it was found that for wet roads ABS reduces the risk of crashing into a lead vehicle by (32 ± 8)%, but increases the risk of being struck in the rear by (30 ± 14)%. The results from this study and from all available reported studies are summarized in tabular form.     

Views of US drivers about driving safety

Problem: To assess how drivers view dangers on the highway, what motivates them to drive safely, how they say they reduce their crash and injury risk, and how they rate their own driving skills. Results: Most drivers rated their skills as better than average. The biggest motivating factor for safe driving was concern for safety of others in their vehicle, followed by negative outcomes such as being in a crash, increased insurance costs, and fines. The greatest threats to their safety were thought to be other drivers' actions that increase crash risk such as alcohol impairment or running red lights. In terms of reducing crashes and injuries, drivers tended to focus on actions they could take such as driving defensively or using seat belts. There was less recognition of the role of vehicles and vehicle features in crash or injury prevention. Impact on research, practice, and policy: Knowing how drivers view themselves and others, their concerns, and their motivations and techniques for staying out of trouble on the roads provides insight into the difficulty of changing driving practices.     

Prediction of vehicle crashes by drivers' characteristics and past traffic violations in Korea using a zero-inflated negative binomial model

Aims: Traffic safety is a significant public health challenge, and vehicle crashes account for the majority of injuries. This study aims to identify whether drivers' characteristics and past traffic violations may predict vehicle crashes in Korea.

Methods: A total of 500,000 drivers were randomly selected from the 11.6 million driver records of the Ministry of Land, Transport and Maritime Affairs in Korea. Records of traffic crashes were obtained from the archives of the Korea Insurance Development Institute. After matching the past violation history for the period 2004–2005 with the number of crashes in year 2006, a total of 488,139 observations were used for the analysis. Zero-inflated negative binomial model was used to determine the incident risk ratio (IRR) of vehicle crashes by past violations of individual drivers. The included covariates were driver's age, gender, district of residence, vehicle choice, and driving experience.

Results: Drivers violating (1) a hit-and-run or drunk driving regulation at least once and (2) a signal, central line, or speed regulation more than once had a higher risk of a vehicle crash with respective IRRs of 1.06 and 1.15. Furthermore, female gender, a younger age, fewer years of driving experience, and middle-sized vehicles were all significantly associated with a higher likelihood of vehicle crashes.

Conclusions: Drivers' demographic characteristics and past traffic violations could predict vehicle crashes in Korea. Greater resources should be assigned to the provision of traffic safety education programs for the high-risk driver groups.     

Etiology of fatal thoracic aortic injuries: Secondary data analysis

Objectives: Motor vehicle crashes remain a leading cause of death in the United States (US). Thoracic aortic dissection due to blunt trauma remains a major injury mechanism, and up to 90% of these injuries result in death on the scene. The objective of this study is to understand the modern risk factors and etiology of fatal thoracic aortic injuries in the current US fleet.

Methods: Using a unique, linked, Fatality Analysis Reporting System (FARS) and Multiple Cause of Death (MCOD) database from 2000–2010, 144,169 drivers over 16 years of age who suffered fatal injuries were identified. The merged database provides an unparalleled fidelity for identifying thoracic aortic injuries due to motor vehicle accidents. Thoracic aortic injuries were defined by ICD-10 codes S250. Univariate and multivariate logistic regression models for presence of any thoracic aortic injuries were fitted. Age, gender, BMI weight categories, vehicle class, model year, crash type/direction, severity of crash damage, airbag deployment location, and seatbelt use, fatal injury codes, and location of injury were considered. Odds ratios (OR) and corresponding 95% confidence intervals (95%CI) are calculated.

Results: There were 2953 deaths (2.10%) related to thoracic aortic injuries that met the inclusion criteria. Nearside crashes were associated with an increased odds (OR = 1.42, 1.1-1.83), while rollover crashes (OR =.44,.29-.66) were associated with a reduced odds of fatal thoracic aortic injury. Using backward selection on the full multivariate model, the only significant model effects that remained were vehicle type, crash type, body region, and injury type.

Conclusions: The increased prevalence of fatal thoracic aortic injury in nearside crashes, increasing age, and vehicle type provide some insight into the current US fleet. Important factors, including model year, had significantly lower levels of the injury in univariate analysis, demonstrating the effect of safety improvements in newer model vehicles. Further study of this fatal injury is warranted, including comparisons of those who survive the injury.