Factors associated with motorcycle traffic crash fatalities among active duty U.S. Army personnel

Objective: Research on factors associated with motorcycle fatalities among active duty U.S. Army personnel is limited. This analysis describes motorcycle crash–related injuries from 1995 through 2014 and assesses the effect of alcohol use and helmet use on the risk of fatal injury among active duty U.S. Army motorcycle operators involved in a traffic crash, controlling for other factors shown to be potentially associated with fatality in this population.

Methods: Demographics, crash information, and injury data were obtained from safety reports maintained in the Army Safety Management Information System. Traffic crashes were defined as crashes occurring on a paved public or private roadway or parking area, including those on a U.S. Army installation. Analysis was limited to motorcycle operators. Odds ratios (ORs) and 95% confidence intervals (95% CIs) from a multivariable analysis estimated the effect of alcohol use and helmet use on the risk of a fatal injury given a crash occurred, controlling for operator and crash characteristics.

Results: Of the 2,852 motorcycle traffic crashes, most involved men (97%), operators aged 20–29 years of age (60%), and operators who wore helmets (95%) and did not use alcohol (92%). Two thirds of reported crashes resulted in injuries requiring a lost workday; 17% resulted in fatality. Controlling for operator and crash characteristics, motorcycle traffic crashes involving operators who had used alcohol had a 3.1 times higher odds of fatality than those who did not use alcohol (OR =3.14; 95% CI, 2.17–4.53). Operators who did not wear a helmet had 1.9 times higher odds of fatality than those who did wear a helmet (OR =1.89; 95% CI, 1.24–2.89).

Conclusions: Among U.S. Army motorcycle operators, alcohol use and not wearing a helmet increased the odds of fatality, given that a crash occurred, and additional modifiable risk factors were identified. Results will help inform U.S. Army motorcycle policies and training.     

Prevalence of alcohol impairment and odds of a driver injury or fatality in on-road farm equipment crashes

Objective: The objective of this article was to estimate the prevalence of alcohol impairment in crashes involving farm equipment on public roadways and the effect of alcohol impairment on the odds of crash injury or fatality.

Methods: On-road farm equipment crashes were collected from 4 Great Plains state departments of transportation during 2005–2010. Alcohol impairment was defined as an involved driver having blood alcohol content of ≥0.08 g/100 ml or a finding of alcohol impairment as a driver contributing circumstance recorded on the police crash report. Injury or fatality was categorized as (a) no injury (no and possible injury combined), (b) injury (nonincapacitating or incapacitating injury), and (c) fatality. Hierarchical multivariable logistic regression modeling, clustered on crash, was used to estimate the odds of an injury/fatality in crashes involving an alcohol-impaired driver.

Results: During the 5 years under study, 3.1% (61 of 1971) of on-road farm equipment crashes involved an alcohol-impaired driver. One in 20 (5.6%) injury crashes and 1 in 6 (17.8%) fatality crashes involved an alcohol-impaired driver. The non-farm equipment driver was significantly more likely to be alcohol impaired than the farm equipment driver (2.4% versus 1.1% respectively, P = .0012). After controlling for covariates, crashes involving an alcohol-impaired driver had 4.10 (95% confidence interval [CI], 2.30–7.28) times the odds of an injury or fatality. In addition, the non-farm vehicle driver was at 2.28 (95% CI, 1.92–2.71) times higher odds of an injury or fatality than the farm vehicle driver. No differences in rurality of the crash site were found in the multivariable model.

Conclusion: On-road farm equipment crashes involving alcohol result in greater odds of an injury or fatality. The risk of injury or fatality is higher among the non-farm equipment vehicle drivers who are also more likely to be alcohol impaired. Further studies are needed to measure the impact of alcohol impairment in on-road farm equipment crashes.     

Land-traffic crash leading to passenger vehicle submersion,drowning and other fatal injuries: A 44-year study based on records from the Finnish Crash Data Institute

Background: Land motor traffic crash (LMTC) -related drownings are an overlooked and preventable cause of injury death. The aim of this study was to analyze the profile of water-related LMTCs involving passenger cars and leading to drowning and fatal injuries in Finland, 1972 through 2015. Materials and methods: The database of the Finnish Crash Data Institute (FCDI) that gathers detailed information on fatal traffic accidents provided records on all LMTCs leading to drowning during the study period and, from 2002 to 2015, on all water-related LMTCs, regardless of the cause of death. For each crash, we considered variables on circumstances, vehicle, and fatality profiles. Results: During the study period, the FCDI investigated 225 water-related LMTCs resulting in 285 fatalities. The majority of crashes involved passenger cars (124), and the cause of death was mostly drowning (167). Only 61 (36.5%) fatalities suffered some–generally mild–injuries. The crashes frequently occurred during fall or summer (63.7%), in a river or ditch (60.5%), and resulted in complete vehicle’s submersion (53.7 %). Half of the crashes occurred in adverse weather conditions and in over 40% of the cases, the driver had exceeded the speed limit. Among drivers, 77 (68.8%) tested positive for alcohol (mean BAC 1.8%). Conclusion: Multidisciplinary investigations of LMTCs have a much higher potential than do exclusive police and medico-legal investigations. The risk factors of water-related LMTCs are similar to those of other traffic crashes. However, generally the fatal event in water-related LMTC is not the crash itself, but drowning. The paucity of severe physical injuries suggests that victims’ functional capacity is usually preserved during vehicle submersion. Practical Applications: In water-related LMTCs, expansion of safety measures is warranted from general traffic-injury prevention to prevention of drowning, including development of safety features for submerged vehicles and simple self-rescue protocols to escape from a sinking vehicle.     

Investigating traffic fatality trends and restraint use among rear-seat passengers in the United States, 2000–2016

Introduction: Motor-vehicle crash is one of the leading causes of unintentional injury death in the United States. Previous studies focused on fatalities among drivers and front-seat passengers, with a limited number of studies examining rear-seat passenger fatalities. The objectives of this study were to assess trends in rear-seat passenger motor-vehicle fatalities in the United States from 2000 to 2016 and to identify demographic factors associated with being unrestrained among fatally injured rear-seat passengers. Methods: Rear-seat passenger fatality data were obtained from the Fatality Analysis Reporting System (FARS) database. The fatality rate ratios for overall rear-seat passengers and for different age and sex groups were determined by comparing fatality rates in 2000 and 2016 using random effects models. Risk ratios of being unrestrained for age and sex groups were obtained using general estimating equations. Results: Compared to 2000, the overall rear-seat passenger fatality rate in 2016 decreased by 44% (95% confidence interval [CI]: 39–49%). In particular, the fatality rate among rear-seat passengers decreased more in males than females, and passengers aged 14–19 years experienced a larger decline than all other age groups. Fatally injured male rear-seat passengers had a higher risk of being unrestrained (adjusted risk ratio: 1.06, 95% CI: 1.04–1.07) than their female counterparts, and both youngest (≤13 years) and oldest (65–85 years) passengers were less likely to be unrestrained than those aged 20–64 years. Conclusions: Overall, fatality rates among rear-seat passengers have declined, with differential degrees of improvement by age and sex. Practical Applications: Continued restraint use enforcement campaigns targeted at teenagers and males would further preserve them from fatal injuries and improve traffic safety for the overall population.     

Characteristics of rear-end crashes involving passenger vehicles with automatic emergency braking

Abstract

Objectives: Automatic emergency braking (AEB) is a proven effective countermeasure for preventing front-to-rear crashes, but it has not yet fully lived up to its estimated potential. This study identified the types of rear-end crashes in which striking vehicles with AEB are overrepresented to determine whether the system is more effective in some situations than in others, so that additional opportunities for increasing AEB effectiveness might be explored.

Methods: Rear-end crash involvements were extracted from 23?U.S. states during 2009–2016 for striking passenger vehicles with and without AEB among models where the system was optional. Logistic regression was used to examine the odds that rear-end crashes with various characteristics involved a striking vehicle with AEB, controlling for driver and vehicle features.

Results: Striking vehicles were significantly more likely to have AEB in crashes where the striking vehicle was turning relative to when it was moving straight (odds ratio [OR]?=?2.35; 95% confidence interval [CI], 1.76, 3.13); when the struck vehicle was turning (OR = 1.66; 95% CI, 1.25, 2.21) or changing lanes (OR = 2.05; 95% CI, 1.13, 3.72) relative to when it was slowing or stopped; when the struck vehicle was not a passenger vehicle or was a special use vehicle relative to a car (OR = 1.61; 95% CI, 1.01, 2.55); on snowy or icy roads relative to dry roads (OR = 1.83; 95% CI, 1.16, 2.86); or on roads with speed limits of 70+ mph relative to those with 40 to 45?mph speed limits (OR = 1.49; 95% CI, 1.10, 2.03). Overall, 25.3% of crashes where the striking vehicle had AEB had at least one of these overrepresented characteristics, compared with 15.9% of strikes by vehicles without AEB.

Conclusions: The typical rear-end crash occurs when 2 passenger vehicles are proceeding in line, on a dry road, and at lower speeds. Because atypical crash circumstances are overrepresented among rear-end crashes by striking vehicles with AEB, it appears that the system is doing a better job of preventing the more typical crash scenario. Consumer information testing programs of AEB use a test configuration that models the typical rear-end crash type. Testing programs promoting good AEB performance in crash circumstances where vehicles with AEB are overrepresented could guide future development of AEB systems that perform well in these additional rear-end collision scenarios.     

Road traffic crashes among farm vehicle drivers in southern China: A cross-sectional survey

Objective: The objective of this study was to identify the prevalence and potential risk factors of farm vehicle–related road traffic crashes among farm vehicle drivers in southern China.

Methods: A cross-sectional study was used to interview 1,422 farm vehicle drivers in southern China. Farm vehicle–related road traffic crashes that occurred from December 2013 to November 2014 were investigated. Data on farm vehicle–related road traffic crashes and related factors were collected by face-to-face interviews.

Results: The prevalence of farm vehicle–related road traffic crashes among the investigated drivers was 7.2%. Farm vehicle–related road traffic crashes were significantly associated with self-reported vision problem (adjusted odds ratio [AOR] = 6.48, 95% confidence interval [CI], 3.86–10.87), self-reported sleep disorders (AOR = 10.03, 95% CI, 6.28–15.99), self-reported stress (AOR = 20.47, 95% CI, 9.96–42.08), reported history of crashes (AOR = 5.40, 95% CI, 3.47–8.42), reported history of drunk driving (AOR = 5.07, 95% CI, 2.97–8.65), and reported history of fatigued driving (AOR = 5.72, 95% CI, 3.73–8.78). The number of road traffic crashes was highest in the daytime and during harvest season. In over 96% of farm vehicle–related road traffic crashes, drivers were believed to be responsible for the crash. Major crash-causing factors included improper driving, careless driving, violating of traffic signals or signs, and being in the wrong lane.

Conclusion: Findings of this study suggest that farm vehicle–related road traffic crashes have become a burgeoning public health problem in China. Programs need to be developed to prevent farm vehicle–related road traffic crashes in this emerging country.     

Assessment of medical care costs of injuries due to alcohol-related motor vehicle crashes

The purpose of this study was to estimate the total medical care costs of individuals injured in motor vehicle crashes and in crashes where alcohol was involved. Crashes were studied that involved 2,728 vehicle occupants and 191 pedestrians with injuries as reported in 1979 by the National Accident Sampling System, a probability sample of all motor vehicle crashes occurring in the united States. Medical care costs were assigned by using Abbreviated Injury Scale codes in accordance with other published research. Determination of alcohol involvement was based on crash characteristics. Results indicate that 20.2 % of medical care costs for motor vehicle crash injuries may be due to crashes where alcohol was involved. It was estimated that alcohol-related motor vehicle crashes cost between $434 million and $483 million in medical care alone in the United States in 1979.     

Temporal factors in motor-vehicle crash deaths: Ten years later

ObjectiveTo assess trends in traffic fatalities on several temporal scales: year to year, by month, by day of week, and by time of day, to determine why some times correspond with higher rates of crash deaths, and to assess how these trends relate to age, the role of the deceased, and alcohol consumption.MethodTraffic fatalities were identified using the Fatality Analysis Reporting System (FARS) for 1998 through 2014 and assessed for their time of occurrence. Three days that, on average, contained particularly high numbers of crash deaths were then assessed in greater detail, considering the age of the deceased, role of the deceased (vehicle occupant, bicyclist, motorcyclist, or pedestrian), and the blood alcohol content of either the driver (for passenger vehicle occupants) or the deceased.ResultsAnnual crash fatality totals were much lower in 2014 than in 1998, but the decrease was not steady; a marked drop in crash deaths occurred after 2007 and continued until 2014. On average the most fatalities per day occurred in July and August (116 per day), followed closely by June, September, and October. During the week, the greatest number of fatalities on average occur on weekend days, and during the day the most fatalities tend to occur between the hours of 3 p.m. and 7 p.m. Holidays like Independence Day and New Year's Day show elevated crash fatalities, and a greater percentage of these crashes involved alcohol, when compared with adjacent days.ConclusionCertain days and times of year stand out as posing an elevated crash risk, and even with the decrease in average daily fatalities over the past decade, these days and times of year have remained consistent.Practical applicationThese results indicate focused areas for continued efforts to reduce fatal crashes.     

Driver mortality in frontal crashes: comparison of newer and older airbag designs

In 1997, the National Highway Traffic Safety Administration amended its requirements for frontal crash performance under Federal Motor Vehicle Safety Standard 208 to temporarily allow 30 mi/h (48 km/h) sled tests with unbelted dummies as an alternative to 30 mi/h head-on rigid-barrier vehicle tests. This change permitted automakers to reduce airbag inflation forces so that they would be less likely to injure occupants who are close to airbags when they first deploy. Most vehicle models were sled-certified starting in model year 1998. Airbag-related deaths have decreased since 1997; however, controversy persists about whether reduced inflation forces might be decreasing protection for some occupants in high-severity frontal crashes. To examine the effects of the regulatory changes, this study computed rate ratios (RR) and 95% confidence intervals (95% CI) for passenger vehicle driver deaths per vehicle registration during 2000-2002 at principal impact points of 12 o'clock for 1998-99 model year vehicles relative to 1997 models. Passenger vehicles included in the study had both driver and passenger front airbags, had the same essential designs during the 1997-1999 model years, and had been sled-certified for drivers throughout model years 1998 and 1999. An adjustment was made for the higher annual mileage of newer vehicles. Findings were that the effect of the regulatory change varied by vehicle type. For cars, sport utility vehicles, and minivans combined, there was an 11 percent decrease in fatality risk in frontal crashes after changing to sled certification (RR = 0.89; 95% CI = 0.82-0.96). Among pickups, however, estimated frontal fatality risk increased 35 percent (RR = 1.35; 95% CI = 1.12-1.62). For a broad range of frontal crashes (11, 12, and 1 o'clock combined), the results indicated a modest net benefit of the regulatory change across all vehicle types and driver characteristics. However, the contrary finding for pickups needs to be researched further.     

Behavioral Factors as Predictors of Motor Vehicle Crashes in Young Drivers

Gains in reducing mortality and morbidity from motor vehicle crashes can be achieved by understanding the behavioral factors that contribute to the elevated risk of motor vehicle-related injury and death. This study investigates the incidence, along with the effect of driver and behavioral factors, on the likelihood of motor vehicle crashes. Seventeen year old newly licensed drivers (n = 1277) in Perth, Western Australia, were recruited and followed over the first 12 months of driving. Using Cox proportional hazard analysis, driver and behavioral factors were assessed to determine whether they predicted the likelihood of a crash in the first 12 months of driving. The crash incidence rate was higher for males (1R = 4.6/10,000 driving days) than females (IR = 3.9/10,000 driving days). Multivariate analysis indicated that drivers who reported to have driven daily prior to obtaining their learners permit (L-plates) were at an increased risk of motor vehicle crash. A twofold increase in motor vehicle crash was apparent among drivers considered to be confident-adventurous drivers compared to low to moderate levels of driver confidence-adventurousness (HR = 2.04, 95% CI = 1.29-3.21). The research indicates that a driver's perception of their confidence and adventurousness in the road environment plays a part in the causal pathway leading to a motor vehicle crash. This research points to the need for preventive strategies that focus not only on knowledge and skill acquisition, but also the driver's perception in preparing young people for our roads.     

Estimates of fatal chest and abdominal injury prevention in side-impact crashes

The analysis reported in this study shows that the current NHTSA estimates of potential fatality reductions from improved side-impact protection in passenger cars are unrealistically high. This study is based on recent statistical estimates of fatality prevention by eliminating ejection and mitigating interior impact, and on an analysis of the limits of crash protection in fatal side-impact accidents. Because many fatalities involve high impact speed and significant deformation of vehicle side structures, about 70% of the near-side occupant fatalities from chest and abdominal injury are unpreventable by practical design changes. This implies that 30% of current fatalities may be prevented. Estimates of fatality prevention were then made as a fraction of the effectiveness of airbags in frontal crashes. Assuming sideinterior changes that may produce 20% of frontal airbag effectiveness, which is 6% effectiveness and is roughly the same level of safety benefit achieved with the energy-absorbing steering system, 140 fatalities per year would be prevented in all types of side-impact crashes. This estimate is a realistic but formidable goal. It is in striking contrast with NHTSA projection of 1,185 fatality reductions with relatively straightforward design changes. Their projection exaggerates potential safety improvements.     

Underage drinking: frequency, consequences, and interventions

OBJECTIVES: To examine the frequency of underage drinking, driving after drinking and alcohol-related crashes, trends in these behaviors, and promising interventions. METHODS: We examined drinking and drinking- and-driving behaviors reported in the United States in the 2001 U.S. National Household Survey of Drug Abuse, the Centers for Disease Control and Prevention 2001 Youth Risk Behavior Survey, the 1992 National Longitudinal Alcohol Epidemiologic Study, and the 1999 National Survey of Drinking and Driving conducted for the National Highway Traffic Administration. We also examined the 1999 European School Survey Project on Alcohol and Other Drugs. Alcohol-related fatal crashes were examined from the U.S. Fatality Analysis Reporting System. Evaluation of interventions to reduce teenage drinking and driving after drinking were reviewed. RESULTS: In the United States, 19% of youth ages 12-20 consumed five or more drinks on an occasion in the past 30 days. Although European nations have lower legal drinking ages (16-18) than in the United States (21), similar proportions engage in underage drinking. In two-thirds of European countries, a greater percentage of 15-16 year-olds drank five or more drinks on an occasion in the past month than in the United States. In both the United States and Europe, the earlier people begin to drink, the greater the likelihood of developing alcohol dependence and other alcohol-related problems, including alcohol-related crash involvement, during adolescence and adult years. During the past 20 years alcohol-related traffic deaths among people younger than 21 have been cut in half in the United States, but progress has halted since 1995 and the problem is still large. Interventions shown by research to reduce alcohol-related crashes among youth include raising the legal drinking age to 21, zero tolerance laws, and some interventions that are family, school, or community based. CONCLUSIONS: Despite research showing that a variety of interventions can reduce underage drinking and alcohol-related crash fatalities, the frequency of these behaviors remains high and the average age of drinking initiation is declining in the United States. Efforts are needed to enhance publicized enforcement of underage drinking laws. Comprehensive community interventions that include enforcement of these laws also are needed.     

Driver licensing,motor-vehicle crashes,and moving violations among older adults

IntroductionDriving is important for well-being among older adults, but age-related conditions are associated with driving reduction or cessation and increased crash risk for older drivers. Our objectives were to describe population-based rates of older drivers’ licensing and per-driver rates of crashes and moving violations.Methods: We examined individual-level statewide driver licensing, crash, and traffic citation data among all New Jersey drivers aged ≥ 65 and a 35- to 54-year-old comparison group during 2010–2014. Rate ratios (RR) of crashes and moving violations were estimated using Poisson regression.Results: Overall, 86% of males and 71% of females aged ≥ 65 held a valid driver’s license. Older drivers had 27% lower per-driver crash rates than middle-aged drivers (RR: 0.73, 95% CI: 0.73, 0.74)—with appreciable differences by sex—but 40% higher fatal crash rates (RR: 1.40 [1.24, 1.58]). Moving violation rates among older drivers were 72% lower than middle-aged drivers (RR: 0.28 [0.28, 0.28]).Conclusion: The majority of older adults are licensed, with substantial variation by age and sex. Older drivers have higher rates of fatal crashes but lower rates of moving violations compared with middle-aged drivers.Practical applications: Future research is needed to understand the extent to which older adults drive and to identify opportunities to further reduce risk of crashes and resultant injuries among older adults.     

Crash risk factors for novice motorcycle riders

Background: Motorcycle riders have the highest injury and fatality rates among all road users. This research sought in-depth understanding of crash risk factors to help in developing targeted measures to reduce motorcycle crash injuries and fatalities. Methods: We used interview data from a study of 2,399 novice motorcycle riders in Victoria, Australia from 2010 to 2012 linked with their police-recorded crash and offence data. The outcome measure was self and/or police reported crash. The association between potential risk factors and crashes was explored in multivariable logistic regression models. Results: In the multivariable analysis, riders who reported being involved in three or more near crashes had 1.74 times (95% CI 1.11–2.74) higher odds of crashing compared to riders who reported no near-crash events, and riders who participated in a pre-learner course had 1.41 times higher odds of crashing (95% CI 1.07–1.87) compared with riders who did not attend a pre-learner course. Riders who had been involved in a crash before the study had 1.58 times (95% CI 1.14–2.19) higher odds of crashing during the study period compared with riders who were not involved in a crash. Each additional month of having held a license and learner permit decreased the odds of crashing by 2%, and each additional 1,000 km of riding before the study increased the odds of crashing by 2%. Conclusion: Measures of pre-learner training and riding experience were the strongest predictors of crashing in this cohort of novice motorcycle riders. At the time of the study there was no compulsory rider training to obtain a learner permit in Victoria and no on-road courses were available. It may be plausible that riders who voluntarily participated in an unregulated pre-learner course became or remained at high risk of crash after obtaining a rider license. We suggest systematically reviewing the safety benefits of voluntary versus mandatory pre-learner and learner courses and the potential need to include on-road components.     

Risk of motor vehicle crash for older adults after receiving a traffic charge: A case–crossover study

Objective: After the age of 65, the number of motor vehicle crashes per mile driven increases. Traffic-related charges issued by law enforcement can help identify drivers who are at a higher risk of having a crash. This study examines the relationship between motor vehicle crashes and traffic-related charges among older adult drivers.

Methods: Iowa Department of Transportation crash data from 2011–2012 were linked with Iowa Court Information System data for moving violations that occurred during 2009–2012 for drivers over the age of 50. A time-stratified case–crossover design was used matching on time periods 1 year apart. Case exposure was defined as having a traffic-related charge 30 days before the crash. Control exposure was the same 30-day time period 1 year before the crash for each individual. Conditional logistic regression was used to analyze the self-matched pairs. Additional time periods of 31–60, 61–90, 91–120, 121–150, 151–180, and 181–210 days before the crash were also assessed.

Results: There were 38,171 adults at least 50 years of age with an Iowa driver's license who were involved in a crash in Iowa between 2011 and 2012. In addition, 13,129 adults over the age of 50 received a charge during 2009–2012. Relative to the control time period, experiencing a traffic-related charge in the 30-day time period before the crash increased the risk of a crash by 21% (odds ration [OR] = 1.21, 95% confidence interval [CI], 1.03–1.42) for all drivers included in the study. This crash risk was similar for adults aged 50–64 (OR = 1.20, 95% CI, 1.00–1.45) and adults 65 and older (OR = 1.24, 95% CI, 0.90–1.72). In the 30 days after receiving a traffic-related charge, the risk of a crash was also increased for crashes occurring in adverse weather (OR = 1.79, 95% CI, 1.12–2.84) or during night, dawn, or twilight (OR = 1.89, 95% CI, 1.31–2.72).

Conclusions: A traffic-related charge for an adult over the age of 50 indicates an increased risk of experiencing a crash in the 30 days following the charge. The risk for crashes occurring in adverse conditions or outside of daylight hours was also increased in the 30 days after receiving a traffic-related charge. The risk of experiencing a crash decreases as time passes after receiving a charge. Measures to restrict or increase driving safety during these conditions could help reduce the crash risk for older adults who receive a traffic-related charge.     

Emergency department visits vs. fatalities among substance-impaired underage youths involved in motor vehicle crashes

IntroductionEmergency department (ED) visits resulting from motor vehicle crashes (MVCs) among individuals younger than 21 impaired by alcohol and/or drugs have been less studied than MVC fatalities.MethodUsing data from 2004 to 2011, we compare the magnitude and pattern of national ED visit and mortality data for alcohol- and drug-impaired youths involved in MVCs.ResultsTemporal patterns of ED visits are similar to those of fatalities, but the two differ in magnitude. The ratio of ED visits to fatalities is 3.5:1; alcohol related events involvement dominates other drugs in both categories.DiscussionThe volume of injuries serious enough to warrant ED visits imposes significant health, social, and financial burdens. In ED visits, alcohol is the prime source of MVC morbidity burden; other drugs consistently contribute less.Practical applicationsThese incidents are persistent and require interventions aimed at multiple levels of prevention, including stricter corrective steps earlier in the impaired driving career to reduce subsequent incidents. ED visits for MVC injuries can be important “teachable moments.” Limitations of the study indicate the need for improved surveillance of underage substance-involved crashes.     

An application of a conditional logistic regression to study the effects of safety belts, principal impact points, and car weights on drivers' fatalities

In addition to experimental trials in automotive factories, there is a fundamental need to monitor real people involved in real motor vehicle collisions to determine the impact of automotive design characteristics on injury mortality. To aid in designing future safety features for drivers' seats, data from the Fatal Accident Reporting System (FARS) were used to assess the effects of safety belts, directions of crash impacts, age, sex, and car weights on motor vehicle injury fatalities. Furthermore, because the FARS includes only accidents in which there was at least one fatality, this paper introduces a multivariate approach — a logistic regression conditioned on each accident —to avoid the sampling biases inherent in the FARS. The resulting model is used to quantify the relations among the safety belts, the directions of crash impacts, and vehicle weights and their effects on fatalities. Recause the proposed approach allows researchers to study many important variables simultaneously and eliminates the biases resulting from many possible confounders, the estimates presented in this paper are considered to be more precise and more firmly established than earlier estimates. The new approach to analyzing the FARS data will also be useful for investigating the effects of other risk factors or automotive characteristics on crash fatalities.     

Preventing highway crashes by raising the legal minimum age for drinking: An empirical confirmation

In recent years there has been increased interest in reducing the massive social costs due to alcohol-related motor vehicle crashes. Raising the legal minimum age for purchase and consumption of alcohol beverages has been proposed as one way to reduce alcohol-related crashes among young drivers. Currently, many states are raising the legal age, in contrast to the trend towards lower legal drinking ages in the early 1970s. Recent studies of the effects of raising the drinking age are reviewed, and results from a controlled multiple time-series evaluation of the experience in Michigan are presented. Significant 11 to 28% reductions in alcohol-related crash involvements are shown to be attributable to the raised drinking age in Michigan. Suggestions for further research and discussion of policy implications are included.