Does the built environment affect when American teens become drivers? Evidence from the 2001 National Household Travel Survey

Problem

Motor vehicle crashes are the most common cause of death for American adolescents. However, the impact of where teens live on when they begin driving has not been studied.

Method

Data from the 2001 National Household Travel Survey were used to estimate the effect of residential density on the driver status of teens aged 16 to 19 years after matching on demographic characteristics.

Results

Controlling for demographic characteristics, 16 and 17 year old teens in high density neighborhoods had driver rates 15 percentage points below teens living in less dense areas (p < 0.001). The effect for 18 and 19 year olds was a 9 percentage point decrease (p < 0.001).

Summary

These results suggest teens living in less dense and more sprawling communities initiate driving at a younger age than comparable teens in compact areas, placing them at increased risk for crash related injuries. Impact on Industry: The role of environmental factors, such as neighborhood walkability and provision of transit, should be considered in young driver programs.     

Winter storm-related injuries in Oklahoma, January 2007

Introduction

A January 2007 ice storm occurred in Oklahoma, causing power outages and hazardous travel conditions. The objective of this investigation was to describe the nature of winter storm-related injuries among Oklahoma residents, to determine populations at risk, and to inform prevention-planning personnel.

Methods

Winter storm-related injuries were a temporarily reportable condition; all acute-care hospitals and the state medical examiner logged storm-related injuries and deaths during January 12 − 30, 2007. Medical records were retrospectively abstracted.Risk of injury was described by demographic group, injury type, and mechanism.

Results

Among 6,047 persons experiencing winter storm-related injuries, 74% were injured in falls, 13% in motor-vehicle collisions (MVCs), 8% while sledding, 1% by unintentional carbon monoxide poisoning, 1% in cleanup activities, and 3% by other mechanisms. Median age of injured persons was 39 years. Persons aged ≥ 40 years were 1.4 times more likely to experience falls as the cause of injury than those aged < 40 years, and falls were twice as likely as other mechanisms to cause fractures among persons aged ≥ 40 years. Injured persons aged < 40 years were 2.2 times more likely to experience MVC-related injuries, and 19 times more likely to experience sledding-related injuries than persons aged ≥ 40 years.

Conclusions

Younger persons were more likely injured in MVCs and sledding incidents, whereas older persons were more likely to experience falls and fractures.

Impact on industry

Prevention messages for winter storm-related injuries should target winter-driving safety tips to younger adults and precautions regarding falls to older adults.     

The contribution of traumatic brain injury to the medical and economic outcomes of motor vehicle-related injuries in Ohio

Objective

To describe traumatic brain injury (TBI) among injured roadway users. Aim 1 assessed the association of age, gender, alcohol/drug use, safety equipment use, type of roadway user, metropolitan area, and primary payer with motor vehicle-related TBI outcome. Aim 2 assessed the relationship of motor vehicle-related TBI and risk/protective factors with medical and economic outcomes.

Methods

Population-level hospital and trauma databases from the Ohio Hospital Association and Ohio Department of Public Safety, respectively, were probabilistically linked for 2003 through 2006. Injured roadway users (motor vehicle occupants, motorcyclists, bicyclists, pedestrians, and others) were assessed for TBI, ventilator use, intensive care unit (ICU) admission, injury severity score (ISS), need for rehabilitation, death, and total hospital charges.

Results

The odds of a motor vehicle-related TBI were greater among those not using safety equipment (OR = 1.56). The interactions of alcohol/drug use by gender and of alcohol/drug use by location were significant. Sustaining a TBI increased the odds of requiring ventilation (OR = 3.66), being admitted to the ICU (OR = 2.51), having a high ISS (OR = 4.24), requiring rehabilitation (OR = 2.22), or death (OR = 2.52). When compared with a non-TBI, total hospital charges increased by a factor of 1.35 for a TBI. Hospital charges were $46,441 on average for individuals who sustained a TBI, whereas mean hospital charges were $32,614 for patients with a non-TBI.

Conclusions

Among injured roadway users, individuals who sustain a TBI are more likely to require extensive medical care and have injuries resulting in death.

Impact on industry

Prevention strategies aimed at reducing alcohol use and increasing safety device use should be encouraged to reduce the burden of TBI.     

The effects of airbags and seatbelts on occupant injury in longitudinal barrier crashes

Introduction

Longitudinal barriers, such as guardrails, are designed to prevent a vehicle that leaves the roadway from impacting a more dangerous object while minimizing the risk of injury to the vehicle occupants. Current full-scale test procedures for these devices do not consider the effect of occupant restraints such as seatbelts and airbags. The purpose of this study was to determine the extent to which restraints are used or deployed in longitudinal barrier collisions and their subsequent effect on occupant injury.

Methods

Binary logistic regression models were generated to predict occupant injury risk using data from the National Automotive Sampling System / Crashworthiness Data System from 1997 through 2007.

Results

In tow-away longitudinal barrier crashes, airbag deployment rates were 70% for airbag-equipped vehicles. Compared with unbelted occupants without an airbag available, seat belt restrained occupants with an airbag available had a dramatically decreased risk of receiving a serious (MAIS 3+) injury (odds-ratio (OR) = 0.03; 95% CI: 0.004-0.24). A similar decrease was observed among those restrained by seat belts, but without an airbag available (OR = 0.03; 95% CI: 0.001- 0.79). No significant differences in risk of serious injuries were observed between unbelted occupants with an airbag available compared with unbelted occupants without an airbag available (OR = 0.53; 95% CI = 0.10-2.68).

Impact on Industry

This study refutes the perception in the roadside safety community that airbags rarely deploy in frontal barrier crashes, and suggests that current longitudinal barrier occupant risk criteria may over-estimate injury potential for restrained occupants involved in a longitudinal barrier crash.     

Bystander injury evaluation of children from midwestern agricultural operations

Background

With more than a million youth living on agricultural operations, it is important for parents to understand the consequences of bystander injuries that children experience in these environments. We identified the childhood injuries for bystander status and compared the severity of these injuries to the working children in the Regional Rural Injury Study-II (RRIS-II).

Methods

RRIS-II followed 16,546 children (∼ 85% of eligible) from rural communities in the Midwest for two six-month recall periods in 1999 and 2001. Demographic, injury, and exposure data were collected through comprehensive computer-assisted telephone interviews. Child injuries were cataloged using narrative scenarios into four categories: (a) directly work-related; (b) indirectly work-related; (c) non-working accomplice; and (d) non-working attendant; the latter three all being bystander categories. Poisson regression modeling was used to calculate rates of bystander injuries. Frequencies were used for comparison of severity measures.

Results

Among the 463 child injuries (aged < 20 yrs), 102 were bystander injuries. Of the bystander-related injuries, 14 were identified as indirectly work-related (working bystanders), 27 as non-working accomplice (passengers/tag-alongs), and 60 as non-working attendant (playing on the operation). The overall rate of bystander injuries was 6.4 per 1,000 people, 95% CI (5.0, 8.1). Males, compared with females, had more than twice the injury rate (8.7; 95% CI 6.4-11.8, and 3.9; 95% CI 2.7-5.7, per 1,000 people, respectively). Bystanders in this population had more severe injuries with 4% having life-threatening circumstances; of these, 4% of the accomplices and 2% of the attendants subsequently died.

Conclusions

Children who live or work on agricultural operations are vulnerable to many hazards. Therefore, this study examined child injuries and found a clear difference in the consequences of these injuries between working-related and bystanding-related injuries.

Impact on Industry

Unlike occupations such as construction and mining, where laws and organizations have been created for the protection of bystanders, agricultural bystanders have remained unprotected and have had to face the consequent injury and death outcomes. As public health professionals considering these risks, it is necessary that we work to develop more intervention studies and continue to propose suggestive guidelines for child safety in these environments so as to challenge family traditions and possibly spark public policies that will give further protection to this population.     

Children's behavioral traits and risk of injury: Analyses from a case-control study of agricultural households

Problem

Children on family agricultural operations have high risk of injury. The association between children's behavioral traits and their risk of injury is not well understood.

Method

Data from the Regional Rural Injury Study-II were used to assess behavioral risk factors for injury to children ages six to < 20 years. A total of 379 injury events (cases) and 1,562 randomly selected controls were identified. Adjusted odds ratios (OR) and 95% confidence intervals (CI), calculated using logistic regression, were used to estimate injury risk in reference to behavioral traits.

Results

Injury risks were greater for children with high levels of depressive symptoms (OR = 1.9, CI = 1.0-3.7) and aggression (OR = 1.6, CI = 0.9-2.7), and low levels of careful/cautious behavior (OR = 1.8, CI = 1.1-2.9). Children with low levels of self-regulation had reduced risks (OR = 0.4, CI = 0.2-0.8).

Discussion

Results suggest that children's behaviors affect their risk of agricultural injury. Additional research could elucidate mechanisms and inform interventions.

Impact on industry

The development of multifaceted, sustainable approaches for prevention is necessary for this unique population. These findings suggest a need for interventions that incorporate specific behavior-related risk factors in the context of family farms and ranches.     

“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.     

Nonfatal bathroom injuries among persons aged ≥15 years--United States, 2008

Problem

Information about where nonfatal unintentional injuries occur is limited, but bathrooms commonly are believed to be a hazardous location.

Methods

Data from a nationally representative sample of hospital emergency departments (ED) was used to quantify and characterize nonfatal unintentional bathroom injuries among people aged ≥ 15 years.

Results

In 2008, an estimated 234,094 nonfatal bathroom injuries were treated in EDs. Most injuries (81.1%) were caused by falls and 37.3% of injuries occurred when bathing, showering, or getting out of the tub or shower. Both injury and hospitalization rates increased with age.

Summary

These results suggest that bathrooms tend to be most hazardous for persons in the oldest age groups.

Impact on Industry

Bathroom injuries among all household members might be reduced by increasing awareness about potentially hazardous activities in the bathroom combined with simple environmental changes such as adding grab bars inside and outside the tub or shower.     

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.     

The relationship between recruitment processes, familiarity, trust, perceived risk and safety

Introduction and Method

Participants′ perceptions of the safety-related aspects of their organization′s recruitment processes were examined, as were their perceptions of safety aspects associated with new recruits.

Results

One hundred and fifty-four professional fire fighters indicated the trust they held in the safety-related aspects of their organizations′ selection and pre-start training. Perceived trust in pre-start training was negatively correlated (r = -.24, p < .01) with the risk associated with new recruits, and positively correlated (r = .50, p < .01) with ratings of trust in recruits to immediately work safely. Furthermore, trust in recruits to immediately work safely was negatively correlated (r = -.21, p < .01) with crews′ safety behavior toward recruits.

Conclusions

These results are interpreted as particularly dangerous for workers, as new recruits lack familiarity with aspects of their new workplace that cannot be addressed by either selection or pre-start training, making them a risk.

Impact on Industry

Organizations should actively identify new recruits, and encourage existing team members not to immediately trust new recruits to work safely.     

Analysis of precipitation-related motor vehicle collision and injury risk using insurance and police record information for Winnipeg, Canada

Introduction

Police records are the most common source of data used to estimate motor-vehicle collision risks, understand causal or contributing factors, and evaluate the efficacy of interventions. The literature notes concerns about this information citing discrepancies between police reports and other sources of injury occurrence and severity data. The primary objective of the analysis was to assess the adequacy of police reports for an examination of weather-related injury collision risk.

Method

Analyses of relative risk were carried out using both police records and comprehensive insurance claim data for Winnipeg, Canada over the period 1999-2001.

Results and conclusions

Both data sets yielded very similar results—precipitation substantially increases the risk of injury collision (police records: RR 1.76, CI 1.55-2.00; insurance: RR 1.80, CI 1.62-1.99) and risk of injury (police records, RR 1.74, CI 1.55-1.96; insurance, RR 1.69, CI 1.55-1.85) relative to corresponding dry weather control periods. Both rainfall and snowfall were associated with large increases in collisions and injuries.

Impact on Industry

While relative risks are almost identical, over 64% more injury collisions and 74% more injuries were identified using the insurance data, which is an important difference for evaluating absolute risk and exposure.     

Hepatitis B virus infection among health care workers in Public Teaching Hospitals in Khartoum State, Sudan

Background

Hepatitis B virus (HBV) infection is a global public health problem. It is estimated that there are more than 300 million HBV carriers in the world.

Aim

The study aimed to examine the sero-prevalence of hepatitis B virus (HBV) markers among health care workers (HCWs) in Public Teaching Hospitals in Khartoum State, in the year 2004.

Methods

The study is an observational, cross sectional, facility-based study. It was conducted on stratified two-stage cluster random sample of 843 subjects. The study followed non-parametric statistical methods, using Z-test for single proportion.

Results

Among the 843 subjects tested for all HBV markers (Anti-HBc, HBsAg, HBsAb, and HBeAg), the prevalence of Anti-HBc, HBsAg, HBsAb, and HBeAg was found to be 57% (CI 95%:53-60%), 6% (CI 95%:4.0-8.0%), 37% (CI 95%:34-40%) and 9% (CI 95%:7-11%) respectively. P < 0.05.

Conclusion

Seroprevalence of all HBV markers (P < 0.05) was found to be significantly high, while the rate of immunity against HBV infection was low among health care workers In Public Teaching Hospitals in Khartoum State, Sudan.     

A comparison of web-based and telephone surveys for assessing traffic safety concerns, beliefs, and behaviors

Introduction

The purpose of this investigation was to compare the results of a web-based and a telephone interview survey measuring driver concerns about a variety of traffic safety issues, their beliefs, and specific driving behaviors.

Method

State-wide, annual random digit-dial telephone surveys and web-based surveys were conducted in Maryland. A total of 1,700 drivers were surveyed by telephone and 6,806 took a web survey.

Results

Telephone respondents were more likely to be female and older. Web respondents were more likely to be white and not Latino/Hispanic. After controlling for demographic differences, telephone survey respondents were more likely to be concerned about traffic safety. They were more likely to believe that sobriety checkpoints reduce drunk driving (OR = 2.18, 95% CI 1.94, 2.45), they would be ticketed for not wearing a seat belt (OR = 1.26, 95% CI 1.12, 1.43), and they would be stopped by the police if they drove after drinking too much (OR = 1.17, 95% CI 1.03, 1.32). They were less likely to report a variety of risky behaviors including using a cell phone while driving (OR = .54, 95% CI .48, .61) and driving 10+ mph over the speed limit (OR = .81, 95% CI .72, .91), but were more likely to report having been ticketed for a moving violation in the last month (OR = 2.22, 95% CI 1.70, 2.90). Suggestions are offered for overcoming potential sources of sampling bias.

Impact on Industry

Web-based surveys produce substantially different results than random-digit-dial telephone surveys, when used for public assessments of traffic safety concerns and behaviors.     

Required hours of practice for learner drivers: A comparison between two Australian jurisdictions

Problem

This study considers whether requiring learner drivers to complete a set number of hours while on a learner license affects the amount of hours of supervised practice that they undertake. It compares the amount of practice that learners in Queensland and New South Wales report undertaking. At the time the study was conducted, learner drivers in New South Wales were required to complete 50 hours of supervised practice while those from Queensland were not.

Method

Participants were approached outside driver licensing centers after they had just completed their practical driving test to obtain their provisional (intermediate) license. Those agreeing to participate were interviewed over the phone later and asked a range of questions to obtain information including socio-demographic details and amount of supervised practice completed.

Results

There was a significant difference in the amount of practice that learners reported undertaking. Participants from New South Wales reported completing a significantly greater amount of practice (M = 73.3 hours, sd = 29.12 hours) on their learner license than those from Queensland (M = 64.1 hours, sd = 51.05 hours). However, the distribution of hours of practice among the Queensland participants was bimodal in nature. Participants from Queensland reported either completing much less or much more practice than the New South Wales average.

Summary

While it appears that the requirement that learner drivers complete a set number of hours may increase the average amount of hours of practice obtained, it may also serve to discourage drivers from obtaining additional practice, over and above the required hours.

Impact on Industry

The results of this study suggest that the implications of requiring learner drivers to complete a set number of hours of supervised practice are complex. In some cases, policy makers may inadvertently limit the amount of hours learners obtain to the mandated amount rather than encouraging them to obtain as much practice as possible.     

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.     

Continued progress in the prevention of nail gun injuries among apprentice carpenters: What will it take to see wider spread injury reductions?

Problem

Nail guns are a common source of acute, and potentially serious, injury in residential construction.

Method

Data on nail gun injuries, hours worked and hours of tool use were collected in 2008 from union apprentice carpenters (n = 464) through classroom surveys; this completed four years of serial cross-sectional data collection from apprentices. A predictive model of injury risk was constructed using Poisson regression.

Results

Injury rates declined 55% from baseline measures in 2005 with early training and increased use of tools with sequential actuation. Injury rates declined among users of tools with both actuation systems, but the rates of injury were consistently twice as high among those using tools with contact trip triggers.

Discussion and impact

Nail gun injuries can be reduced markedly through early training and use of tools with sequential actuation. These successful efforts need to be diffused broadly, including to the non-union sector.     

Testing safety commitment in organizations through interpretations of safety artifacts

Problem

Safety culture relates to injuries and safety incidents in organizations, but is difficult to asses and measure. We describe a preliminary test of assessing an organization's safety culture by examining employee interpretations of organizational safety artifacts (safety signs).

Method

We collected data in three organizations using a new safety culture assessment tool that we label the Safety Artifact Interpretation (SAI) scale; we then crossed these data with safety climate and leadership evaluations.

Results

SAI were interpreted by employees in accordance with two conceptually distinct themes that are salient in the literature on organizational safety culture: safety compliance and commitment to safety. A significant correlation exists between SAI scores and the organizational safety climate. A similar (though insignificant) relationship was observed between SAI scores and leadership ratings.

Impact on industry

Employee perceptions and interpretations of safety artifacts can facilitate assessments of safety culture and can ultimately lead to understanding of and improvements in the level of organizational 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.     

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.