An observational study of child safety seat use in an international safe community: Tehran,Iran

Objective: Despite strong evidence of the effectiveness of child safety seats in reducing injuries, the use of these devices in some communities is still rare. The purpose of this study was to determine the prevalence of child safety seat use and the factors influencing its use in the safe community of Tehran.

Methods: This roadside observational study was conducted in 2015 and 2,178 personal cars with a child under 12 years aboard were observed on Tehran's streets in regard to use of child safety seats. Other variables such as the gender of the driver, driver's age group, type of street, region of municipality, time of day, and day of the week were also collected.

Results: Prevalence of child safety seat use was 4.3% and was significantly higher among women drivers, on freeways, and in municipal regions 1, 4, and 7.

Conclusions: The prevalence of child safety seat use in Tehran as a most populous member of the international safe community was very low and most children commuted in insecure situations in the vehicle. Therefore, it is proposed that plans should be made to increase the use of child safety seats in international safe communities.     

Teaching infant car seat installation via interactive visual presence: An experimental trial

Objective: A large portion of child restraint systems (car seats) are installed incorrectly, especially when first-time parents install infant car seats. Expert instruction greatly improves the accuracy of car seat installation but is labor intensive and difficult to obtain for many parents. This study was designed to evaluate the efficacy of 3 ways of communicating instructions for proper car seat installation: phone conversation; HelpLightning, a mobile application (app) that offers virtual interactive presence permitting both verbal and interactive (telestration) visual communication; and the manufacturer's user manual.

Methods: A sample of 39 young adults of child-bearing age who had no previous experience installing car seats were recruited and randomly assigned to install an infant car seat using guidance from one of those 3 communication sources.

Results: Both the phone and interactive app were more effective means to facilitate accurate car seat installation compared to the user manual. There was a trend for the app to offer superior communication compared to the phone, but that difference was not significant in most assessments. The phone and app groups also installed the car seat more efficiently and perceived the communication to be more effective and their installation to be more accurate than those in the user manual group.

Conclusions: Interactive communication may help parents install car seats more accurately than using the manufacturer's manual alone. This was an initial study with a modestly sized sample; if results are replicated in future research, there may be reason to consider centralized “call centers” that provide verbal and/or interactive visual instruction from remote locations to parents installing car seats, paralleling the model of centralized Poison Control centers in the United States.     

Fatally injured drivers in Norway 2005–2015—Trends in substance use and crash characteristics

Objective: Norway introduced a “Vision Zero” strategy in 2001, using multiple approaches, aiming toward a future in which no one will be killed or seriously injured in road traffic crashes (RTCs). Official statistics show that the number of fatally injured road users has declined substantially from 341 deaths in 2000 to 117 in 2015. In-depth crash investigations of all fatal RTCs started in Norway in 2005. The aim of this study was to investigate whether fatal crash characteristics, vehicle safety features, and prevalence of drugs and/or alcohol among fatally injured drivers and riders has changed during 2005–2015, accompanying the reduction in road fatalities.

Methods: Data on all car/van drivers and motorcycle/moped riders fatally injured in RTCs during 2005–2015 were extracted from Norwegian road traffic crash registries and combined with forensic toxicology data.

Results: The proportion of cars and motorcycles with antilock braking systems and cars with electronic stability control, increased significantly during the study period. The prevalence of nonuse of seat belts/helmets and speeding declined among both fatally injured drivers and riders. In addition, the prevalence of alcohol declined, though no significant change in the total prevalence of other substances was noted.

Conclusion: The observed changes toward more safety installations in cars and motorcycles and lower prevalence of driver-related risk factors like alcohol use, speeding, and nonuse of seat belts/helmets among fatally injured drivers/riders may have contributed to the decrease in road traffic deaths.     

A simulator study of driving behavior and mental workload in mixed-use arterial road environments

Objectives: Mixed-use urban environments, such as arterial roads with adjacent commercial land uses, represent crash locations with the highest risk. These locations are often characterized by high volumes of motor vehicle traffic, on-street parking, and interactions with multiple road user groups such as pedestrians, cyclists, and public transportation. The objective of this study was to investigate previously identified crash risk factors for mixed-use urban environments and assess how parking occupancy, center medians, and cyclist volume influence performance and workload in a driving simulator study.

Methods: Thirty participants were recruited for the study. Participants completed 6 drives that presented different combinations of cyclist volume, median condition, and parking occupancy. Incorporated into the simulator drives was a secondary peripheral detection task (PDT) designed to measure mental workload. Participants provided subjective assessments of workload using the Rating Scale Mental Effort (RSME).

Results: Mean lateral lane position was found to significantly vary across the 3 independent variables of parking occupancy, cyclist volume, and median conditions. No significant changes were identified for mean speed across the conditions. Subjective and objective measures of workload identified changes due to the presence of cyclists with slower reaction times for the PDT task when cyclists were present.

Conclusion: The findings provide insight into the interaction of road design elements in mixed-use urban road environments and demonstrate that increasingly complex environments increase driver demand. This has important road design implications for mixed-use arterial roads, which are often characterized by complex interactions between multiple road user groups.     

Trends and patterns in fatal US motorcycle crashes, 2000–2016

Objective: To investigate trends of motorcyclist fatalities and identify at-risk populations by motorcyclist demographics and crash characteristics.

Methods: We used the Fatality Analysis Reporting System (FARS) database (2000–2016) to track fatality rate trends, which were quantified by using Poisson mixed-effects regression models comparing 2000–2001 and 2007–2008, as well as 2009–2010 and 2015–2016.

Results: The overall fatality rate per 100,000 population increased from 2000 to 2016, defined by two trend lines—before and after the economic recession in 2008–2009. The overall fatality rate ratio between 2000–2001 and 2007–2008 was 1.60 [95% Confidence Interval (CI): 1.51–1.70], and between 2009–2010 and 2015–2016 was 1.09 (95% CI: 1.02–1.18). Fatality rates increased among all age groups, particularly for motorcyclists aged 60 and older. Those aged 18–29 had the highest fatality rates overall. Age-and-sex standardized state fatality rates were consistently highest in Wyoming, South Dakota, and South Carolina and lowest in Massachusetts, New York and New Jersey.

Conclusion: Motorcycle fatality rates increased overall and across all age groups between 2000 and 2016. Fatalities for the oldest riders showed the steadiest increasing trends. Results highlight the continued public health burden of motorcyclist fatalities and, by extension, the importance of improving motorcycle safety.     

Seat strength in rear body block tests

Purpose: This study collected and analyzed available testing of motor vehicle seat strength in rearward loading by a body block simulating the torso of an occupant. The data were grouped by single recliner, dual recliner, and all belts to seat (ABTS) seats.

Methods: The strength of seats to rearward loading has been evaluated with body block testing from 1964 to 2008. The database of available tests includes 217 single recliner, 65 dual recliner, and 18 ABTS seats. The trends in seat strength were determined by linear regression and differences between seat types were evaluated by Student's t-test. The average peak moment and force supported by the seat was determined by decade of vehicle model year (MY).

Results: Single recliner seats were used in motor vehicles in the 1960s to 1970s. The average strength was 918 ± 224 Nm (n = 26) in the 1960s and 1,069 ± 293 Nm (n = 65) in the 1980s. There has been a gradual increase in strength over time. Dual recliner seats started to phase into vehicles in the late 1980s. By the 2000s, the average strength of single recliner seats increased to 1,501 ± 335 Nm (n = 14) and dual recliner seats to 2,302 ± 699 Nm (n = 26). Dual recliner seats are significantly stronger than single recliner seats for each decade of comparison (P < .001). The average strength of ABTS seats was 4,395 ± 1,185 in-lb for 1989–2004 MY seats (n = 18). ABTS seats are significantly stronger than single or dual recliner seats (P < .001). The trend in ABTS strength is decreasing with time and converging toward that of dual recliner seats.

Conclusions: Body block testing is an quantitative means of evaluating the strength of seats for occupant loading in rear impacts. There has been an increase in conventional seat strength over the past 50 years. By the 2000s, most seats are 1,700–3,400 Nm moment strength. However, the safety of a seat is more complex than its strength and depends on many other factors.     

Implications of head and neck restraint test repeatability for specification improvement

Objective: Since 2005, National Association for Stock Car Auto Racing, Incorporated (NASCAR) drivers have been required to use a head and neck restraint system (HNR) that complies with SFI Foundation, Inc. (SFI) 38.1. The primary purpose of the HNR is to control and limit injurious neck loads and head kinematics during frontal and frontal oblique impacts. The SFI 38.1 performance specification was implemented to establish a uniform test procedure and minimum standard for the evaluation of HNRs using dynamic sled testing. The purpose of this study was to evaluate the repeatability of the current SFI 38.1 test setup and explore the effects of a polyester seat belt restraint system.

Method: Eight sled tests were conducted using the SFI 38.1 sled test protocol with additional test setup constraints. Four 0° frontal tests and 4 30° right frontal (RF) oblique tests were conducted. The first 3 tests of each principal direction of force (PDOF) used nylon SFI 16.1 seat belt restraint assemblies. The fourth test of each PDOF used polyester SFI 16.6 seat belt restraint assemblies. A secondary data set (Lab B Data) was also supplied by the HNR manufacturer for further comparisons. The International Organization for Standardization (ISO) 18571 objective comparison method was used to quantify the repeatability of the anthropomorphic test device (ATD) resultant head, chest, and pelvis acceleration and upper neck axial force and flexion extension bending moment time histories across multiple tests.

Results: Two data sets generated using the SFI 38.1 test protocol exhibited large variations in mean ISO scores of ATD channels. The 8 tests conducted with additional setup constraints had significantly lower mean ISO score coefficients of variation (CVs). The Lab B tests conducted within the current specification but without the additional test setup constraints had larger mean ISO score standard deviation and CV for all comparisons. Specifically, tests with the additional setup constraints had average CVs of 3.3 and 2.9% for the 0° and 30° RF orientations, respectively. Lab B tests had average CVs of 22.9 and 24.5%, respectively. Polyester seat belt comparisons had CVs of 5.3 and 6.2% for the 0° and 30° RF orientations, respectively.

Conclusion: With the addition of common test setup constraints, which do not violate the specification, the SFI 38.1 test protocol produced a repeatable test process for determining performance capabilities of HNRs within a single sled lab. A limited study using polyester webbing seat belt assemblies versus the nylon material called for in SFI 38.1 indicates that the material likely has less effects on ATD upper neck axial force and flexion extension bending moment time histories than the test setup freedom currently available within the specification. The additional test setup constraints are discussed and were shown to improve ATD response repeatability for a given HNR.     

Impact of perceptual countermeasures on driving behavior at curves using driving simulator

Objective: The probability of crash occurrence on horizontal curves is 1.5 to 4 times higher than that on tangent sections. A majority of these crashes are associated with human errors. Therefore, human behavior in curves needs to be corrected.

Methodology: In this study, 2 different road marking treatments, optical circles and herringbone patterns, were used to influence driver behavior while entering a curve on a 2-lane rural road section. A driving simulator was used to perform the experiment. The simulated road sections are replicas of 2 real road sections in Flanders.

Results: Both treatments were found to reduce speed before entering the curve. However, speed reduction was more gradual when optical circles were used. A herringbone pattern had more influence on lateral position than optical circles by forcing drivers to maintain a safe distance from opposing traffic in the adjacent lane.

Conclusion: The study concluded that among other low-cost speed reduction methods, optical circles are effective tools to reduce speed and increase drivers’ attention. Moreover, a herringbone pattern can be used to reduce crashes on curves, mainly for head-on crashes where the main problem is inappropriate lateral position.     

A multinomial logit analysis of factors associated with severity of motorcycle crashes in Ghana

Objective: The objective of this study was to explore the factors affecting motorcycle crash severity in Ghana.

Methods: A retrospective analysis of motorcycle crash data between 2011 and 2015 was conducted using a motorcycle crash data set extracted from the National Road Traffic Crash Database at the Building and Road Research Institute (BRRI) in Ghana. Injury severity was classified into 4 categories: Fatal, hospitalized, injured, and damage only. A multinomial logit modeling framework was used to identify the possible determinants of motorcycle crash severity.

Results: During the study period, a total of 8,516 motorcycle crashes were recorded, of which 22.9% were classified as fatal, 42.1% were classified as hospitalized injuries, 29.4% were classified as slight injuries, and 5.6% were classified as damage-only crashes. The estimation results indicate that the following factors increase the probability of fatal injuries: At a junction; weekend; signage; poor road shoulder; village settlement; tarred and good road surface; and collision between motorcycle and heavy goods vehicle (HGV). Motorcycle crashes occurring during the daytime and on the weekend increases the probability of hospitalized injury. The results also suggest that motorcycle crashes occurring during the daytime, in curves or inclined portions of roads, or in unclear weather conditions decrease the probability of fatal injury.

Conclusions: This study provides further empirical evidence to support motorcycle crash modeling research, which is lacking in developing countries. The ability to understand the various factors that influence motorcycle crash severity is a step forward in providing an appropriate basis upon which informed motorcycle crash policies can be developed. Particular attention should be given to the provision of road signage at junctions and speed humps and controlling traffic during the weekend. In addition, road maintenance should be carried out periodically to address motorcycle safety in Ghana.     

Effects of mobile phone use on driving performance in a multiresource workload scenario

Objective: This study explores the influence of mobile phone secondary tasks on driving from the perspective of visual, auditory, cognitive, and psychomotor (VACP) multiple resource theory, and it is anticipated to benefit the human-centered design of mobile phone use while driving.

Methods: The present study investigated 6 typical phone use scenarios while driving and analyzed the effects of phone use distractions on driving performance. Thirty-six participants were recruited to participate in this experiment. We abandoned traditional secondary tasks such as conversations or dialing, in which cognitive resources can become interference. Instead, we adopted an arrow secondary task and an n-back delayed digit recall task.

Results: The results show that all mobile phone use scenarios have a significant influence on driving performance, especially on lateral vehicle control. The visual plus psychomotor resource occupation scenario demonstrated the greatest deterioration of driving performance, and there was a significant deterioration of driving speed and steering wheel angle once the psychomotor resource was occupied.

Conclusions: Phone use distraction leads to visual, cognitive, and/or motor resource functional limitations and thus causes lane violations and traffic accidents.     

Behavioral influences on driver crash risks in Ghana: A qualitative study of commercial passenger drivers

Objectives: Though there is a growing body of literature on crash risks in the developed world, little is known about how well these models apply to motoring in developing countries, the context in which the majority of road traffic fatalities occur. This qualitative study explores factors perceived to influence crash risks for commercial drivers in Ghana.

Method: Twenty commercial drivers of varied ages and experience were sampled from 7 major lorry terminals in 3 regions (Greater Accra, Ashanti, and Volta) of Ghana. Data were collected through semistructured interviews.

Results: The participants identified some issues that are shared with drivers in the developed world, though moderated by the Ghanaian context. These included work pressures (e.g., fatigued driving), speeding, distracted driving, and inadequate vehicle maintenance. Other factors identified by participants are less frequently considered in research addressing driving behavior in developed countries. These included aggressive competition over passengers and corruption (e.g., improper licensing practices), among others.

Conclusion: The findings have implications for building a research base to support the development of road safety policy and interventions in developing countries.     

Rating child passenger safety laws relative to best practice recommendations for occupant protection

Background: State laws regarding child passenger protection vary substantially.

Objectives: The objective of this study was to develop a scoring system to rate child passenger safety laws relative to best practice recommendations for each age of child.

Methods: State child passenger safety and seat belt laws were retrieved from the LexisNexis database for the years 2002–2015. Text of the laws was reviewed and compared to current best practice recommendations for child occupant protection for each age of child.

Results: A 0–4 scale was developed to rate the strength of the state law relative to current best practice recommendations. A rating of 3 corresponds to a law that requires a restraint that is sufficient to meet best practice, and a rating of 4 is given to a law that specifies several options that would meet best practice. Scores of 0, 1, or 2 are given to laws requiring less than best practice to different degrees. The same scale is used for each age of child despite different restraint recommendations for each age. Legislation that receives a score of 3 requires rear-facing child restraints for children under age 2, forward-facing harnessed child restraints for children aged 2 to 4, booster seats for children 5 to 10, and primary enforcement of seat belt use in all positions for children aged 11–13. Legislation requiring use of a “child restraint system according to instructions” would receive a score of 1 for children under age 2 and a 2 for children aged 2–4 because it would allow premature use of a booster for children weighing more than 13.6 kg (30 lb).

Conclusions: The scoring system developed in this study can be used in mathematical models to predict how child passenger safety legislation affects child restraint practices.     

Identifying the crash characteristics on freeway segments based on different ramp influence areas

Objective: This study aimed to explore the relationship between crash types and different freeway segments and identify the factors contributing to crashes on different freeway segments. Unlike most of the previous studies on freeway segments, this study separately investigates basic freeway segments, single ramp influence segments, and multiple ramp influence segments.

Methods: Nonlinear canonical correlation analysis (NLCCA) and proportionality test were used to identify the relationship between crash types and different freeway segments. The data sets for the different freeway segments accumulated for this study consist of 9,867 crash samples with complete information on all 22 chosen variables. A multinomial logit model (MNL) was used to estimate the influence of crash factors on different freeway segments.

Results: The results show that weaving and diverge overlap influence segments (WD) are more likely to have injury or fatal crashes; diverge and diverge overlap influence segments (DD) are more likely to have property damage–only (PDO) crashes; merge and merge overlap influence segments (MM) are more likely to have sideswipe crashes; and WD have non-sideswipe crashes; WD and weaving overlap influence segments (MW) are more likely to have rear end crashes; and MM segments are less likely to have hit object crashes. The contributing factors are identified by MNL and the results show that different traffic variables, environmental variables, vehicle variables, driver variables, and geometric variables significantly affected the likelihood of crashes on different freeway segments.

Conclusions: Investigation of crash types and factors contributing to crashes on different freeway segments is based on multiple ramp influence segments, which can promote a better understanding of the safety performance of various freeway segments.     

A clustering approach to integrate traffic safety in road maintenance prioritization

Objectives: We combine data on roads and crash characteristics to identify patterns in road traffic crashes with regard to road characteristics. We illustrate how combined analysis of data regarding road maintenance, maintenance costs, road characteristics, crash characteristics, and geographical location can enrich road maintenance prioritization from a traffic safety perspective.

Methods: The study is based on traffic crash data merged with road maintenance data and annual average daily traffic (AADT) collected in Denmark. We analyzed 3,964 crashes that occurred from 2010 to 2015. A latent class clustering (LCC) technique was used to identify crash clusters with different road and crash characteristics. The distribution of crash severity and estimated road maintenance costs for each cluster was found and cluster differences were compared using the chi-square test. Finally, a map matching procedure was used to identify the geographical distribution of the crashes in each cluster.

Results: Results showed that based on road maintenance levels there was no difference in the distribution of crash severity. The LCC technique revealed 11 crash clusters. Five clusters were characterized by crashes on roads with a poor maintenance level (levels 4 and 3). Only a few of these crashes included a vulnerable road user (VRU) but many occurred on roads without barriers. Four clusters included a large share of crashes on acceptably maintained roads (level 2). For these clusters only small variations in road characteristics were found, whereas the differences in crash characteristics were more dominant. The last 2 clusters included crashes that mainly occurred on new roads with no need for maintenance (level 1). Injury severity, estimated maintenance costs, and geographical location were found to be differently distributed for most of the clusters.

Conclusions: We find that focusing solely on road maintenance and crash severity does not provide clear guidance of how to prioritize between road maintenance efforts from a traffic safety perspective. However, when combined with geographical location and crash characteristics, a more nuanced picture appears that allows consideration of different target groups and perspectives.     

Parental awareness and perception for correct use of child restraint systems and airbags in Brazil

Objective: The objective of this study was to obtain information about the current knowledge and habits of parents who transport children in cars in Brazil.

Methods: A cross-sectional survey was conducted using specifically designed self-report questionnaires to parents of children attending a private pediatric office in a town in southwest Brazil. Data were collected regarding children's age, gender, height, and weight and possession of an automobile child restraint system (CRS), its type, frequency and adequacy of use, and reasons for not possessing or not using the devices. Parents were asked whether their cars were equipped with airbags and about the use of the restraints in seats with airbags.

Results: We interviewed parents of 293 children transported in cars who met the criteria for use of a CRS. Children were younger than 1 year in 15.3% of the cases, between 1 and 4 years in 38.6%, and older than 4 in 46.1%. Cars were equipped with CRS in 78.5% of the cases, but in only 58% of the cases was the device proper for child's age and adequately installed in the seat. Among owners of the devices, 84.3% reported that they always used it. Reasons for infrequency were forgetting the device at home or in another car (6.4%), the child disliking the device (3.2%), or the false impression that the child was grown enough not to use it (3.2%)l 87.1% did not justify why they did not always use the CRS. Considering type of CRS, correct installation of the seat, and frequency of use, only 44.4% of children under 1 year, 69.9% of those 1 to 4 years, and 52.6% over age 4 were protected. Only 28.6% of the parents knew that children should never be positioned in a seat with active airbags.

Conclusion: Considering appropriateness for age, correctness of installation (in the back seat in the correct orientation), and frequency of use, only 50.85% (149/293) of the children were reported as always protected with a CRS. Children between 1 and 4 years were more likely to always use a CRS in this Brazilian survey. We were also able to identify an important gap in the knowledge about airbags among parents. Further efforts are needed to correct those distortions.     

Spatial analysis of mortality rate of pedestrian accidents in Iran during 2012–2013

Objectives: Considering the high mortality rate of pedestrians in traffic accidents in Iran, the present study aimed to determine the high-risk and low-risk areas of accidents resulting in pedestrian deaths and the spatial analysis of their mortality rates.

Methods: This cross-sectional study included 4,371 deceased pedestrians reported by the Legal Medicine Organization in Iran from March 2012 to March 2013. For spatial analysis, the collected data were entered into ArcGIS software version 10.2 and a spatial map of the mortality rate was drawn according to the distribution of data in the provinces. Using this software, high-risk and low-risk areas were identified by calculating the spatial autocorrelation of the data. The Moran’s index of road accident patterns was surveyed and high-risk and low-risk points were identified using the local Getis index.

Results: The age-standardized incidence rate was 6.8 per 100,000. After analyzing the data using ArcGIS software, the local Moran’s index showed a cluster pattern with a high mortality rate in 3 provinces of Mazandaran, Gilan, and Qazvin. In identifying high-risk and low-risk points, the local Getis index showed 3 hot spots with a confidence interval of 99% in Qom, Qazvin, and Mazandaran and 5 hot spots with a 95% confidence interval in Markazi, Tehran, Zanjan, Gilan, and Golestan provinces.

Conclusions: According to the cluster pattern of accidents in the 3 provinces and the presence of hot spots in 9 provinces, it is necessary to identify factors that increase the risk of death in the study provinces in order to reduce the mortality rate among pedestrians due to traffic accidents. Therefore, to reduce the pedestrian mortality rate, especially in high-risk provinces, some studies need to be conducted to determine the risk factors in pedestrian mortality.     

High blood alcohol concentration associated with traumatic brain injury among traffic injury patients during New Year festivals in Thailand

Objective: Road traffic injury (RTI) is one of the most significant public health problems in Thailand, especially during New Year and Songkran (Thai traditional New Year) holidays, which have the highest traffic density during the entire year. Drunk driving was reported to be one of the leading causes of RTI in Thailand. This study aimed to investigate the prevalence of patients with high blood alcohol concentration (BAC) and the association of BAC and specific organ injury during New Year and Songkran (Thai traditional New Year) holidays.

Methods: A cross-sectional study was performed to analyze the database from the Thai Governmental Road Safety Evaluation Project. Patient data on RTIs were collected from 26 main provincial hospitals during the New Year Festival 2003 and 2004 and Songkran Festival in 2003. Patient characteristics, type of organ injured, and BAC levels were mainly analyzed.

Results: During those long holidays, 2,642 RTI patients were identified, among whom 1,341 patients had high BAC levels. High BAC levels were associated with motorcycle users, male sex, middle age, teenagers, being riders or drivers, and not using protective devices. Moreover, high BAC levels were associated with brain injury.

Conclusion: Excessive alcohol consumption and RTIs occurred on New Year and Songkran Festival in Thailand. Legislation should be strictly used during these long holidays to control driving under the influence of alcohol, particularly among motorcyclists.     

Evaluating the impact of criminalizing drunk driving on years of life lost due to road traffic deaths in one megacity,China

Objective: Road safety is an important public health issue worldwide. However, few studies have analyzed the association between criminalizing drunk driving and years of life lost (YLL) due to road traffic deaths (RTDs). Our study can provide useful information about this policy.

Methods: We used interrupted time-series analysis to find the changes in monthly YLL and RTD before and after law enforcement began using RTD data from 2008 to 2014 in Tianjin.

Results: After adjustment for seasonality, months, holidays, and the number of people in each district, criminalizing drunk driving was followed by a 11.1% (95% confidence interval [CI], 1.1–21.1%) reduction in risk of RTDs and a corresponding 778.1-year (95% CI, 200–1,355.1) reduction in monthly YLL. The reduction in YLL was especially significant among males, those aged 16–64 years old, and suburban residents.

Conclusions: This study highlights that the law can lead to a reduction in YLL due to RTDs in Tianjin, China. Large immediate public health benefits resulted from the new road traffic law in China. YLL provides a complementary measure for examining the effect of criminalization on drunk driving RTDs.