Alcohol consumption,helmet use and head trauma in cycling collisions in Germany

Cycling, being easy, inexpensive and healthy, is becoming one of the most popular means of transport. Cyclists, however, are among the most vulnerable road users in traffic collisions.     

Trends in helmet use and head injuries in San Diego County: the effect of bicycle helmet legislation

The purpose of this study is to evaluate the effect of California's bicycle helmet law on bicycle-related head injuries in San Diego County with a year 2000 population of approximately 3 million people. The study design is an ecological trend design based on observational data from a Trauma Registry. Outcome measures include helmet use compliance, site/severity of injury and abbreviated injury scale (AIS). There were 1116 bicycle trauma patients recorded in the San Diego County Trauma Registry between 1992 and 1996. The percentages of pre-law and post-law helmet use were 13.2 and 31.7%, respectively. Over the whole study period, the overall helmet use increased by an average of 43% per year with an averaged 84% rate increase in helmet use among children. Only 16.1% of patients with serious head injury used helmets, compared to 28.2% in those who did not have serious head injury. The odds ratio of helmet use against serious head injuries is 0.43 (95% CI 0.28-0.66) after adjusting for age, ethnicity and time. The p-values for comparing pre- and post-legislation serious head injury rates are p=0.764, 0.4 and 0.194 for the overall, adult and child populations, respectively. Helmet legislation increased helmet use in the targeted child population and the effect was carried over to the adult population. Helmet use has a protective effect against serious head injury. Probably due to several of its limitations, the current study did not confirm that helmet legislation alone significantly reduced head injury rates in San Diego County during the study period.     

Barriers to, and factors associated, with observed motorcycle helmet use in Vietnam

This study investigated barriers to, and factors associated with, observed motorcycle helmet use among motorcyclists in Hai Duong Province, Vietnam. The findings highlighted an array of factors associated with observed helmet use namely, support for universal helmet legislation and a positive attitude towards what might be perceived as negative attributes of helmet use such as inconvenience and discomfort in hot weather. As well, older age (greater than 25 years in age), riding on a compulsory road, being a driver, trips of greater than 10 km, higher levels of education (having a university degree and higher) were found to be key determinants of helmet use. Despite over 95% of motorcyclists disagreeing with the statement that wearing a helmet does not reduce the severity of head injury in a crash, most motorcyclists believed that helmets did not need to be worn for a short trip. Overall, only 23% of motorcyclists were observed wearing a helmet. The authors conclude that efforts to increase helmet use need to focus on the necessity for universal helmet legislation in association with identifying solutions to reduce the negative attitudes towards helmet use.     

The association of age, sex and helmet use with the risk of death for occupants of two-wheeled motor vehicles involved in traffic crashes in Spain

Background

This study was designed to separate the association of age, sex and helmet use with the risk of death for occupants of two-wheeled motor vehicles (TWMV) involved in crashes into its two theoretical components: severity of the crash and occupant resilience.

Methods

We analyzed the retrospective cohort comprising all 48 016 pairs of drivers and passengers aged 14 years or more in TWMV involved in crashes with victims in Spain from 1993 to 2007 recorded in the Spanish traffic crash registry. The outcome (death or survival), age, sex and helmet use was known for both occupants. Adjusted relative risks (RR) for the association of age, sex and helmet with the risk of death were calculated with Poisson regression models.

Results

Each 1-year increase in age was related with a 3% increase in the risk of death related with lower resilience. The severity-dependent RR of death was 1.84 for male sex and 0.86 for non-helmet use, and the resilience-dependent RR was 0.72 and 2.53, respectively.

Conclusions

The direction and magnitude of the association between age, sex and helmet use and the risk of death of an occupant of a TWMV involved in a crash changed depending on which component of risk was considered: crash severity or occupant resilience. Specifically, female sex and non-helmet use seemed to be associated with crashes of lower severity, but together with increased age they were also related with lower resilience to the energy released in the crash, and therefore with a higher risk of death after adjustment for crash severity. This should be taken into account when assessing the association of individual factors with the risk of death after a crash.     

Motorcycle helmet use and the risk of head,neck, and fatal injury: Revisiting the Hurt Study

Most studies find strong evidence that motorcycle helmets protect against injury, but a small number of controversial studies have reported a positive association between helmet use and neck injury. The most commonly cited paper is that of Goldstein (1986). Goldstein obtained and reanalyzed data from the Hurt Study, a prospective, on-scene investigation of 900 motorcycle collisions in the city of Los Angeles. The Goldstein results have been adopted by the anti-helmet community to justify resistance to compulsory motorcycle helmet use on the grounds that helmets may cause neck injuries due to their mass. In the current study, we replicated Goldstein’s models to understand how he obtained his unexpected results, and we then applied modern statistical methods to estimate the association of motorcycle helmet use with head injury, fatal injury, and neck injury among collision-involved motorcyclists. We found Goldstein’s analysis to be critically flawed due to improper data imputation, modeling of extremely sparse data, and misinterpretation of model coefficients. Our new analysis showed that motorcycle helmets were associated with markedly lower risk of head injury (RR 0.40, 95% CI 0.31–0.52) and fatal injury (RR 0.44, 95% CI 0.26–0.74) and with moderately lower but statistically significant risk of neck injury (RR 0.63, 95% CI 0.40–0.99), after controlling for multiple potential confounders.     

A review of risk factors and patterns of motorcycle injuries

Per vehicle mile traveled, motorcycle riders have a 34-fold higher risk of death in a crash than people driving other types of motor vehicles. While lower-extremity injuries most commonly occur in all motorcycle crashes, head injuries are most frequent in fatal crashes. Helmets and helmet use laws have been shown to be effective in reducing head injuries and deaths from motorcycle crashes. Alcohol is the major contributing factor to fatal crashes. Enforcement of legal limits on the blood alcohol concentration is effective in reducing motorcycle deaths, while some alcohol-related interventions such as a minimal legal drinking age, increased alcohol excise taxes, and responsible beverage service specifically for motorcycle riders have not been examined. Other modifiable protective or risk factors comprise inexperience and driver training, conspicuity and daytime headlight laws, motorcycle licensure and ownership, riding speed, and risk-taking behaviors. Features of motorcycle use and potentially effective prevention programs for motorcycle crash injuries in developing countries are discussed. Finally, recommendations for future motorcycle-injury research are made.     

A cross-sectional observational study of helmet use among motorcyclists in Wa,Ghana

Motorcyclists’ injuries and fatalities are a major public health concern in many developing countries including Ghana. This study therefore aimed to investigate the prevalence of helmet use among motorcyclists in Wa, Ghana. The method used involved a cross-sectional roadside observation at 12 randomly selected sites within and outside the CBD of Wa. A total of 14,467 motorcyclists made up of 11,360 riders and 3107 pillion riders were observed during the study period. Most observed riders (86.5%) and pillion riders (61.7%) were males. The overall prevalence of helmet use among the observed motorcyclists was 36.9% (95% CI: 36.1–37.7). Helmet use for riders was 45.8% (95% CI: 44.8–46.7) whilst that for pillion riders was 3.7% (95 CI: 3.0–4.4). Based on logistic regression analysis, higher helmet wearing rates were found to be significantly associated with female gender, weekdays, morning periods and at locations within the CBD. Riders at locations outside the CBD were about 7 times less likely to wear a helmet than riders within the CBD (48.9% compared to 42.3%; χ²₍₁₎ = 49.526; p < 0.001). The study concluded that despite the existence of a national helmet legislation that mandates the use of helmets by both riders and pillion riders on all roads in Ghana, helmet use is generally low in Wa. This suggests that all stakeholders in road safety should jointly intensify education on helmet use and pursue rigorous enforcement on all road types especially at locations outside the CBD to improve helmet use in Wa.     

The impact of compulsory helmet legislation on cyclist head injuries in New South Wales,Australia: A response

This article responds to criticisms made in a rejoinder (Accident Analysis and Prevention 2012, 45: 107–109) questioning the validity of a study on the impact of mandatory helmet legislation (MHL) for cyclists in New South Wales, Australia. We systematically address the criticisms through clarification of our methods, extension of the original analysis and discussion of new evidence on the population-level effects of MHL. Extensions of our analysis confirm the original conclusions that MHL had a beneficial effect on head injury rates over and above background trends and changes in cycling participation. The ongoing debate around MHL draws attention away from important ways in which both safety and participation can be improved through investment in well-connected cycling infrastructure, fostering consideration between road users, and adequate legal protection for vulnerable road users. These are the essential elements for providing a cycling environment that encourages participation, with all its health, economic and environmental benefits, while maximising safety.     

Motorcycle helmet type and the risk of head injury and neck injury during motorcycle collisions in California

The use of novelty motorcycle helmets is often prompted by beliefs that wearing a standard helmet can contribute to neck injury during traffic collisions. The goal of this analysis was to examine the association between helmet type and neck injury risk and the association between helmet type and head injury. Data were collected during the investigation of motorcycle collisions of any injury severity by the California Highway Patrol (CHP) and 83 local law enforcement agencies in California between June 2012 and July 2013. We estimated head injury and neck injury risk ratios from data on 7051 collision-involved motorcyclists using log-binomial regression. Helmet type was strongly associated with head injury occurrence but was not associated with the occurrence of neck injury. Rider age, rider alcohol use, and motorcycle speed were strong, positive predictors of both head and neck injury. Interventions to improve motorcycle helmet choice and to counteract misplaced concerns surrounding neck injury risk are likely to lead to reductions in head injury, brain injury, and death.     

Gender and age distribution of occupational fatalities in Taiwan

This study analyzed fatal occupational injuries in Taiwan. One thousand eight hundred ninety work-related accident reports filed in the years 1996-1999 were extracted from the annual publication of the Council of Labor Affairs (CLA). These data were analyzed in terms of gender, age and work experience of the accident victim as well as accident type and the work-related source of injury to identify significant contributing factors. The CLA data showed that work-related falls were the leading cause of work-related fatalities in both male and female workers (38.2% of male victims and 39.2% of female victims). Gender differences were also noted in the accident type and age of the injured workers. Male workers had a significantly higher prevalence of fatal occupational injuries than female workers throughout the analyzed period (7.4 compared to 0.9 per 100,000 full-time workers). Young males aged 24 years or less had the highest rate of fatal occupational injuries. The finding that gender and age are major factors in occupational injuries is a significant finding in the field of occupational safety and may be helpful for developing accident prevention programs.     

Exploring motorcyclist injury severity in approach-turn collisions at T-junctions: focusing on the effects of driver's failure to yield and junction control measures

Research has suggested that motorcyclists involved in approach-turn crashes were much more injurious than any other crash-type. This paper investigates the determinants of motorcyclist injury severity resulting from such crash types that occurred at T-junctions, with emphasis on the effects of driver's failure to give way and various junction control measures. The ordered probit models of motorcyclist injury severity were estimated using the data extracted from the STATS19 accident injury database (1991-2004). Approach-turn collisions are categorised into two sub-crashes based on the manoeuvres motorcycles and vehicles were making prior to the collisions. The modelling results uncover several important determinants of injury severity: for example, injuries appeared to be greatest when an approaching motorcycle collided with a turning-right vehicle, and such effect was found to exacerbate injury severity when stop, give-way signs and markings controlled the junction. A turning-right driver that was identified to fail to yield to an approaching motorcyclist was also found to severely injure the motorcyclist. The findings of this study may offer guidelines for further research and provide some important preliminary evidence for the development of countermeasures that may help prevent the specific hazards from occurring.     

Drivers overtaking bicyclists: objective data on the effects of riding position, helmet use, vehicle type and apparent gender

A naturalistic experiment used an instrumented bicycle to gather proximity data from overtaking motorists. The relationship between rider position and overtaking proximity was the opposite to that generally believed, such that the further the rider was from the edge of the road, the closer vehicles passed. Additionally, wearing a bicycle helmet led to traffic getting significantly closer when overtaking. Professional drivers of large vehicles were particularly likely to leave narrow safety margins. Finally, when the (male) experimenter wore a long wig, so that he appeared female from behind, drivers left more space when passing. Overall, the results demonstrate that motorists exhibit behavioural sensitivity to aspects of a bicyclist's appearance during an encounter. In the light of previous research on drivers' attitudes to bicyclists, we suggest drivers approaching a bicyclist use physical appearance to judge the specific likelihood of the rider behaving predictably and alter their overtaking accordingly. However, the extent to which a bicyclist's moment-to-moment behaviour can be inferred from their appearance is questionable, and so the tendency for drivers to alter their passing proximity based on this appearance probably has implications for accident probability.     

Alcohol, illicit and non-illicit psychoactive drug use and road traffic injury in Thailand: A case-control study

The objective of this study was to determine the relationship between alcohol use, psychoactive drug use and road traffic injury (RTI). A case-control study was conducted among drivers in Bangkok, Thailand. Two hundred cases and 849 controls were enrolled between February and November 2006. Cases who sustained a RTI were matched with four controls recruited from petrol stations within a 1-km radius of the reported crash site of the case.A positive alcohol breath test (≥50 mg/dl), and positive tests for the presence of illicit (amphetamine, cocaine, marijuana) and non-illicit psychoactive drugs (antihistamine, benzodiazepine, antidepressants), using gas chromatography/mass spectrometry (GC/MS) were documented as primary measures.There were significantly higher odds of an alcohol breath test ≥50 mg/dl (adjusted odds ratio (OR) 63.6 (95% CI: 25.5-158.9)), illicit psychoactive drugs (adjusted OR 3.4 (95% CI: 1.7-6.6)) and non-illicit psychoactive drug (adjusted OR 3.1 (95% CI: 1.5-6.3)) among cases than controls.Even though driving under the influence of psychoactive drugs has been significantly linked to RTI, its contribution to road safety is much lower than driving under the influence of alcohol. With limited resources, the priority for RTI prevention should be given to control of driving under the influence of alcohol.     

The effects of health status, distress, alcohol and medicinal drug use on subsequent motor vehicle injuries

Objective

The purpose of this study was to examine the effects of health factors and substance use on subsequent motor vehicle collision (MVC) injuries of three different age groups, using the longitudinal dataset from the Canadian National Population Health Survey (NPHS) for the years 1994–2002.

Methods

Path analysis technique was used to determine the relations between MVC injury and four risk factors: binge drinking; health status; distress; and medication use. The three demographic variables, age at ‘baseline’, sex, and immigration status were added into the model as control variables. Three age groups were examined: young = 12–29.9; middle-aged = 30–59.9 and old = 60–85 years of age. The total sample size was 16,093.

Results

A lower percentage of males, older persons, immigrants, and non-binge drinkers reported a subsequent MVC injury, as did respondents reporting better health and lower distress scores. Medication use was associated with higher subsequent MVC injuries. Path analysis found that among younger individuals, the variable binge drinking, was the only significant risk factor associated with subsequent injuries. In contrast, among middle-aged individuals, the variable medication use, was the only statistically significant risk factor for subsequent injuries. No variables were significant risk factors of injuries for older individuals.

Conclusions

Various demographic and risk factors were found to influence injuries among a nationally representative sample of Canadians. Reported binge drinking among young individuals and medication use among middle-aged individuals were found to be risk factors for subsequent MVC injury. These findings support the need for continued focus on alcohol, drugs and traffic safety.     

Airbag effectiveness in preventing fatalities predicted according to type of crash, driver age, and blood alcohol concentration

The effectiveness of airbags was estimated in a recent paper by assuming that they do not affect ejection probability and protect only in frontal and near-frontal crashes; the impact-reducing effectiveness in such crashes was assumed equal to that of lap/shoulder belts. The effectiveness, estimated as 18%, thus depends on the distribution of crashes by direction of impact and the incidence of ejection. Ejection rates and impact directions are markedly different for single-car as compared to two-car crashes and as a function of driver age and alcohol use. This raises the possibility that the overall effectiveness estimate might reflect an average of higher effectiveness for drivers more likely to be responsible for crashes (youths, drunks, those involved in single-car crashes) and a lower effectiveness for those less likely to be responsible (non-youths, the sober, and those involved in two-car crashes). By using FARS data for 1975–1986 to distribute fatal crashes by impact direction under various conditions, airbag effectiveness was calculated under these same conditions. Although substantial dependencies on impact direction were found, the fraction of all fatalities that were frontals remained surprisingly constant. It is concluded that effectiveness does not depend much on driver age or alcohol consumption, but is greater for two-car crashes than for single-car crashes (21% compared to 16%)/.     

Road environment, crash type and hospitalisation of bicyclists and motorcyclists presented to emergency departments in Western Australia

Emergency presentations by bicyclists and motorcyclists are often the result from a fall or non-motor vehicle collision that occurred in off-road locations. Consequently, they are unlikely to be captured by police records. If the injury is not severe enough to warrant hospitalisation, they will also not be captured by the hospital admission system. To ascertain the nature and type of these crash events, a 6-month prospective study was undertaken of bicyclists and motorcyclists who presented to emergency departments in Perth, Western Australia, due to involvement in a crash or non-motor vehicle collision. Of the 330 eligible presentations, 151 bicyclists and 104 motorcyclists agreed to participate in a structured interview, representing a response rate of 77.3%. Among them, 120 (79%) bicyclists and 71 (68%) motorcyclists had a fall or non-motor vehicle collision, and many of the crashes (88 (58%) and 47 (45%), respectively) occurred off-road. Moreover, 26.5% of bicyclist and 62.5% of motorcyclist presentations led to hospital admissions. Multivariate logistic regression analysis further showed that the crash location and road type affected hospitalisation for both groups. Although, crashes occurring in rural areas contributed 14% of the events overall, their adjusted risk of hospitalisation increased five times when compared to metropolitan locations. Crash preventive measures targeting rural areas should be considered to further improve the safety of bicyclists and motorcyclists.     

The influence of alcohol, age and number of passengers on the night-time risk of driver fatal injury in New Zealand

Breath alcohol measurements and other data collected at randomly selected roadside sites were combined with data on fatally injured drivers in crashes occurring on the same weekdays and times (Friday and Saturday nights) at locations matched by the size of the nearest town. A logistic model was fitted to these data for the years 1995-2000 to estimate the effects of alcohol, driver's age and the influence of passengers carried on the risk of driver fatal injury in New Zealand. The estimated risks increased steeply with increasing blood alcohol concentration (BAC), closely following an exponential curve at levels below about 200mg/dl (i.e. 0.2%) and increasing less than exponentially thereon. The model fitted to data for drivers under 200mg/dl showed that risks at all BAC levels were statistically significantly higher for drivers aged under 20 (over five times) and for drivers aged 20-29 (three times) than for drivers aged 30 and over. Further, controlling for age and BAC level, driving with a single passenger was associated with approximately half the night-time risk of driver fatal injury relative to driving either solo or with two or more passengers. According to a recent travel survey, the types of passengers carried at the times of night and days of week studied appear to differ significantly from the types of passengers carried generally, which may lead to different passenger effects on driver behaviour. The high relative risk of teenage drivers means that they reach high risk levels commonly regarded as unacceptable in the field of road safety even at their current legal limit of 30mg/dl, particularly when more than one passenger is carried in the car.     

An epidemiological study of the risk of cycling in the dark: The role of visual perception,conspicuity and alcohol use

To curtail the rising numbers of cyclists seriously injured in road crashes, more insights are needed into the factors that contribute to these crashes. For instance, darkness is known to be associated with higher injury rates, but little is known about the relative influence of factors such as poor conspicuity, impaired perception and alcohol use among cyclists. To examine these factors, the present study analyzed the epidemiological crash data for three meteorological light conditions: daylight, late evening darkness and early morning darkness; for two crash types: crashes with (M-crashes) and without motorized traffic (NM-crashes); and for different age groups. The relative injury rates (injury risk per distance travelled in darkness corrected for daylight injury risks for each age group) confirmed findings from earlier studies that cycling in late evening darkness is associated with higher injury rates than cycling in daylight conditions. This is the case for both crash types with only small differences between the age groups suggesting that poor conspicuity (M-crashes) and impaired perception (NM-crashes) may play a role. In comparison to late evening darkness, relative injury rates in early morning darkness are much higher. This is the case for both crash types with large differences among the age groups, suggesting that in addition to the absence of daylight also age related risk factors are at play. Support for this hypothesis was found from the analyses of hospital records, showing that the proportion of seriously injured cyclists who have been drinking is highest in early morning darkness and has strongly increased over the last decades. These insights provide input for the selection of countermeasures such as improved lighting (both street and bicycle lights) and interventions targeting alcohol use among cyclists.     

Effectiveness of the revision to FMVSS 301: FARS and NASS-CDS analysis of fatalities and severe injuries in rear impacts

PurposeThis study investigated the change in the fatality and severe injury risks in rear impacts with vehicle model years (MY) grouped prior to, during the phase-in and after the revision to FMVSS 301.MethodsFARS and NASS-CDS data were used to determine the injury risks of non-ejected occupants in light vehicles involving non-rollover, rear impacts. The data were analyzed by MY groups: 1996–2001, 2002–2007 and 2008+ to represent the years prior to, during the phase-in and post-revision phase-in of FMVSS 301. The 1996–2013 FARS data were analyzed for rear crashes defined by the initial crash direction (IMPACT1) and direction with most damage (IMPACT2) to the rear. Fatality risk was determined by the number of fatally injured occupants per all occupants with known injury status.The 1994–2013 NASS-CDS was analyzed for rear crashes defined by the damage area variable. The risk of severe injury (MAIS 4+F) was determined as the number of occupants with MAIS 4+F injury per all occupants with known injury status. The distribution of rear crashes was determined by impact location and crash severity. NASS-CDS electronic cases with 2008+ MY vehicles were analyzed to evaluate the vehicle and occupant performance.ResultsThe fatality risk was 20.6% in the 1996–2001, 17.3% in the 2002–2007 and 15.0% in the 2008+ MY vehicles using FARS with the initial crash direction variable (IMPACT1) to the rear. There was a 27.1% reduction in risk with post-FMVSS 301 vehicles 2008+ MY. The risk was 19.0%, 15.4% and 12.8% with the most damage variable (IMPACT2) to the rear. There was 32.8% reduction in risk with 2008+ MY vehicles.The NASS-CDS analysis showed that the risk of severe injury (MAIS 4+F) was 0.27 ± 0.05% for 1996–2001, 0.30 ± 0.13% for 2002–2007 and 0.08 ± 0.04% for 2008+ MY year vehicles. There was a 70.2% reduction in the risk for severe injury with 2008+ MY vehicles.The NASS-CDS case review of MAIS 4+F injury in rear impacts of 2008+ MY vehicles that comply with the revised FMVSS 301 indicated that the crashes were very severe and generally involved significant 2nd row intrusion.ConclusionsThe revision to FMVSS 301 has effectively reduced the risks for fatal and severe injury in vehicles compliant with the revision (2008+ MY). The reduction was 27.1–32.8% in fatality risk using FARS data and 70.2% in severe injury risk using the NASS-CDS when compared to vehicles prior to the phase-in of the revised FMVSS 301 (1996–2001 MY vehicles). It is not possible to parse the effects of other design changes in seats and restraint systems that also increased safety over the study years.     

The role of sensation seeking,perceived peer pressure,and harmful alcohol use in riding with an alcohol-impaired driver

Alcohol-related motor vehicle collisions have been the top of policy agenda for more than three decades in Korea. Despite implementation of various traffic safety measures, some drivers’ alcohol use and abuse has resulted in a high number of alcohol-impaired traffic fatalities every year. This paper presents the association of theoretical factors with behavior of riding with an alcohol-impaired driver (RAID) among all age groups in the Korean adult sample. The theoretical factors of the drivers are personality factor, socio-psychological factor, and alcohol-related behavioral risk factor. We utilized national survey data from 1007 respondents consisting of 703 males and 304 females aged 20–66 collected by Korean Institute of Criminology (KIC) to test our theorized model. Our results indicated that there were three major predictors of RAID involvement: sensation seeking propensity, perceived peer pressure, and frequent harmful drinking. Overall, prediction of RAID behavior by gender was mediated entirely through these predictors. The issue of males’ higher risk of RAID involvements was addressed for effective communication strategies such as campaigns.