Fatality Analysis Reporting System Data Research Articles

State cannabis laws and cannabis positivity among fatally injured drivers

BackgroundAs of November 8, 2023, 24 states and the District of Columbia have legalized cannabis for both recreational and medical use (RMCL-states), 14 states have legalized cannabis for medical use only (MCL-states) and 12 states have no comprehensive cannabis legislation (NoCL-states). As more states legalize cannabis for recreational use, it is critical to understand the impact of such policies on driving safety.MethodsUsing the 2019 and 2020 Fatality Analysis Reporting System data, we performed multivariable logistic regression modeling to explore the association between state level legalization status and cannabis positivity using toxicological testing data for 14,079 fatally injured drivers. We performed a sensitivity analysis by including multiply imputed toxicological testing data for the 14,876 eligible drivers with missing toxicological testing data.ResultsOverall, 4702 (33.4%) of the 14,079 fatally injured drivers tested positive for cannabis use. The prevalence of cannabis positivity was 30.7% in NoCL-states, 32.8% in MCL-states, and 38.2% in RMCL-states (p < 0.001). Compared to drivers fatally injured in NoCL-states, the adjusted odds ratios of testing positive for cannabis were 1.09 (95% confidence interval: 0.99, 1.19) for those fatally injured in MCL-states and 1.54 (95% confidence interval: 1.34, 1.77) for those fatally injured in RMCL-states. Sensitivity analysis yielded similar results.ConclusionsOver one-third of fatally injured drivers tested positive for cannabis use. Drivers fatally injured in states with laws permitting recreational use of cannabis were significantly more likely to test positive for cannabis use than those in states without such laws. State medical cannabis laws had little impact on the odds of cannabis positivity among fatally injured drivers.

Urban and Rural Child Deaths from Motor Vehicle Crashes: United States, 2015-2019

The objective of the study was to examine child deaths in motor vehicle crashes by rurality, restraint use, and state child passenger restraint laws. 2015-2019 Fatality Analysis Reporting System data were analyzed to determine deaths and rates by passenger and crash characteristics. Optimal restraint use was defined using age and the type of the restraint according to child passenger safety recommendations. Death rates per 100 000 population were highest for non-Hispanic Black (1.96; [1.84, 2.07]) and American Indian or Alaska Native children (2.67; [2.14, 3.20]) and lowest for Asian or Pacific Islander children (0.57; [0.47, 0.67]). Death rates increased with rurality with the lowest rate (0.88; [0.84, 0.92]) in the most urban counties and the highest rate (4.47; [3.88, 5.06]) in the most rural counties. Children who were not optimally restrained had higher deaths rates than optimally restrained children (0.84; [0.81, 0.87] vs 0.44; [0.42, 0.46], respectively). The death rate was higher in counties where states only required child passenger restraint use for passengers aged ≤6years (1.64; [1.50, 1.78]) than that in those requiring child passenger restraint use for passengers aged ≤7 or ≤8 years (1.06; [1.01, 1.12]). Proper restraint use and extending the ages covered by child passenger restraint laws reduce the risk for child crash deaths. Additionally, racial and geographic disparities in crash deaths were identified, especially among Black and Hispanic children in rural areas. Decision makers can consider extending the ages covered by child passenger restraint laws until at least age 9 to increase proper child restraint use and reduce crash injuries and deaths.

Increased motor vehicle fatalities Tuesday through Thursday during the US Thanksgiving holiday (1980-2018).

Traffic crashes remain a leading cause of death in the United States; holidays are known to have increased travel and traffic fatalities. Our purpose was to determine which days during Thanksgiving had the highest crash fatality risk compared to non-holiday periods. Using time series and binomial approximations, we analyzed Fatality Analysis Reporting System data (1980–2018) with a Monday-Sunday holiday and matching comparisons the weeks before and after. Fatalities included 31,263 during the holiday, 30,361 the previous week, and 29,399 the following week. Deadliest days during the holiday were Saturday (16.7% of fatalities) and Wednesday (16.0%), but odds of a traffic fatality (vs. non-holiday) were highest Wednesday [odds ratio (OR) 1.35, 95% confidence interval (CI) 1.29–1.40], Thanksgiving (OR 1.18, 95% CI 1.13–1.23), and Tuesday (OR 1.12, 95% CI 1.06–1.17). The 35 excess holiday fatalities per year may have limited practical significance considering increased holiday travel.

Older Driver Crash Involvement and Fatalities, by Age and Sex, 2000-2017.

Federal reporting of crash fatalities has limited age-by-sex stratification, but both age and sex are associated with driving reduction and cessation. We described older driver fatal crash involvement and fatalities using Fatality Analysis Reporting System data to calculate rates (per 100,000 licensed drivers, per 100,000 population) with age-by-sex stratifications. Nationally from 2000 through 2017, 110,422 drivers 65+ were involved in crashes resulting in at least one death within 30 days, and 67,843 of these older drivers died. Involvement and fatality rates per 100,000 licensed drivers in 2017 were lowest for females 65-69 (7.7 and 3.6, respectively) and highest for males age 85+ (34.3 and 25.5, respectively). Females had lower driver fatal crash involvement and fatality rates throughout the lifespan, even when rates generally decreased over time. Elaborating fatal crash trends and rates by age and sex helps to differentiate the public health burden of older driver crashes and fatalities.

A novel feature extraction model for traffic injury severity and its application to Fatality Analysis Reporting System data analysis.

The prevention of severe injuries during crashes has become one of the leading issues in traffic management and transportation safety. Identifying the impact factors that affect traffic injury severity is critical for reducing the occurrence of severe injuries. In this study, the Fatality Analysis Reporting System data are selected as the dataset for the analysis. An algorithm named improved Markov Blanket was proposed to extract the significant and common factors that affect crash injury severity from 29 variables related to driver characteristics, vehicle characteristics, accidents types, road condition, and environment characteristics. The Pearson correlation coefficient test is applied to verify the significant correlation between the selected factors and traffic injury severity. Two widely used classification algorithms (Bayesian networks and C4.5 decision tree) were employed to evaluate the performance of the proposed feature selection algorithm. The calculation result of the correlation coefficient, accuracy of classification, and classification error rate indicated that the improved Markov Blanket not only could extract the significant impact factors but could also improve the accuracy of classification. Meanwhile, the relationship between five selected factors (atmospheric condition, time of crash, alcohol test result, crash type, and driver's distraction) and traffic injury severity was also analyzed in this study. The results indicated that crashes occurred in bad weather condition (e.g. fog or worse), in night time, in drunk driving, in crash type of single driver, and in distracted driving, which are associated with more severe injuries.

Fatal crashes in the 5 years after recreational marijuana legalization in Colorado and Washington

Colorado and Washington legalized recreational marijuana in 2012, but the effects of legalization on motor vehicle crashes remains unknown. Using Fatality Analysis Reporting System data, we performed difference-in-differences (DD) analyses comparing changes in fatal crash rates in Washington, Colorado and nine control states with stable anti-marijuana laws or medical marijuana laws over the five years before and after recreational marijuana legalization. In separate analyses, we evaluated fatal crash rates before and after commercial marijuana dispensaries began operating in 2014. In the five years after legalization, fatal crash rates increased more in Colorado and Washington than would be expected had they continued to parallel crash rates in the control states (+1.2 crashes/billion vehicle miles traveled, CI: -0.6 to 2.1, p = 0.087), but not significantly so. The effect was more pronounced and statistically significant after the opening of commercial dispensaries (+1.8 crashes/billion vehicle miles traveled, CI: +0.4 to +3.7, p = 0.020). These data provide evidence of the need for policy strategies to mitigate increasing crash risks as more states legalize recreational marijuana.

Fatal side impact crash scenarios for rear seat and seat belt–restrained occupants from vulnerable populations

Objective: Previous studies have revealed vulnerability of school-age children and older adults in rear seats in motor vehicle crashes. Detailed information about crashes in which these fatalities occur could help improve vehicle and restraint design.Methods: Police accident reports were obtained for crashes from the Fatality Analysis Reporting System data set. Inclusion criteria were crashes in which there was at least one fatally injured restrained rear seat occupant between the ages of 6 and 12 or 55 and older in a passenger vehicle no older than 10 years at the time of the crash. Reports were reviewed for key crash data. Side impacts were selected for analysis.Results: Thirty-nine side impact crashes met the inclusion criteria, resulting in 46 fatalities of interest. Far-side or nondirect impact cases outnumbered near-side cases by 15–11 for juvenile occupants. Sixty-one percent of occupants were in vehicles with side airbags (SABs), all of which deployed for their position, although torso SABs were only present in 3 cases. Head injuries were present in all juvenile cases with injury data available and older occupants suffered equally from head and torso injuries. Impacts with pickup trucks and heavy trucks made up 31 and 22% of all cases, respectively. Three-quarters of cases were judged as survivable for the fatally injured occupant(s), and 5 of 7 cases deemed unsurvivable involved juvenile decedents. Further, of those deemed survivable, two-thirds had damage comparable in magnitude with the same vehicles in consumer information crash tests, evaluated by photo comparison.Conclusions: Older adults suffered thoracic injuries at a higher rate than older children—who suffered predominately head injuries—and most vehicles did not have torso SABs installed, which could have mitigated thoracic injuries. Side impacts in which younger occupants were killed were more severe than impacts that resulted in the death of an older occupant; however, vehicle damage and intrusion in many fatal impacts for both age cohorts appeared similar to that of consumer information testing. Large pickups and heavy vehicles were the striking vehicle in over half of all fatalities; vehicle designs and crash tests should continue to take this into consideration. This research highlights the need for continued work as the automotive safety community seeks to eliminate fatalities in motor vehicle crashes.

Identifying Fatality Risk Factors for the Commercial Vehicle Driver Population

Commercial/large-truck fatal crash involvement by drivers of different age groups is a critical issue for the trucking industry. Escalating safety concerns related to these heavy vehicles serving the freight economy in the U.S. have an impact national freight reliability and economic growth. This study identifies major contributing factors leading to large-truck fatal crashes for four age groups of driver: &lt;30, 30–49, 50–65, and 65+. The analysis in this study is based on five years (2012–2016) of Fatality Analysis Reporting System data and provides an overall picture of risk factors in large-truck fatal crashes. In total, 30 variables were found to be significant in the logit models, indicating varying risks associated with large-truck drivers of these four age groups. Model results indicate different risk factors associated with driver characteristics, spatial and temporal characteristics, vehicle and vehicle maneuvering characteristics, and environmental conditions at the time of the crashes. Identifying the risk factors for different age groups of drivers is important so proper countermeasures can be implemented from the perspective of human factors (e.g., safe speed choice, fatigue), roadway engineering (e.g., design of roadside barriers, radius of ramps), enforcement (e.g., presence of law enforcement personnel at critical locations), and emergency medical attention in remote areas. Considering the aging of the truck driver population in the U.S. and around the world, the findings of this study are vital to understand better the importance of safety in relation to large-truck fatal crashes.

Effects of distance and rescue time to medical facilities on traffic mortality utilizing GIS

ABSTRACTAlthough supported by little scientific evidence, the concept of ‘golden hour,’ which claims that mortality for trauma patients rises significantly over rescue time, plays a vital role in the design of our current trauma system. Only the contrary results could be found by using Fatality Analysis Reporting System data from 2010 to 2012. The results of logistic regression showed that longer total time intervals were associated with lower traffic mortality, with an odds ratio (OR) of 0.993 per minute. Utilizing the closest facility solver in the Geographic Information System, the effect of ‘reverse causation’ and the difference between trauma centre and non-trauma centre on the time-mortality relationship were discussed. Furthermore, based on the Kentucky Collision Analysis for the Public data from 2010 to 2012, the results of logistic regression showed that the mortality increased with each additional mile to the trauma centre with an OR of 1.011 per mile.

Trends in Prescription Opioids Detected in Fatally Injured Drivers in 6 US States: 1995-2015.

To assess the time trends in prescription opioids detected in fatally injured drivers. We analyzed 1995 to 2015 Fatality Analysis Reporting System data from California, Hawaii, Illinois, New Hampshire, Rhode Island, and West Virginia of toxicological tests for drivers fatally injured within 1 hour of a crash (n = 36 729). We used the Cochran-Armitage test for trend to assess the statistical significance of changes in the prevalence of prescription opioids detected in these drivers over time. The prevalence of prescription opioids detected in fatally injured drivers increased from 1.0% (95% confidence interval [CI] = 0.5, 1.4) in 1995 to 7.2% (95% CI = 5.7, 8.8) in 2015 (Z = -9.04; P < .001). Prescription opioid prevalence was higher in female than in male drivers (4.4% vs 2.9%; P < .001). Of the drivers testing positive for prescription opioids, 30.0% had elevated blood alcohol concentrations (≥ 0.01 g/dL), and 66.9% tested positive for other drugs. The prevalence of prescription opioids detected in fatally injured drivers has increased in the past 2 decades. The need to assess the effect of increased prescription opioid use on traffic safety is urgent.

A comparison of self-reported seat belt usage among the Appalachian and non-Appalachian United States

PurposeSeat belts are known to effectively prevent death and serious injury among motorists involved in vehicular collisions. Limited research exists regarding seat belt usage in Appalachia. This study compares self-reported seat belt use in the Appalachian and non-Appalachian counties of the United States. MethodsData from 2012 Behavioral Risk Factor Surveillance System were used to calculate nationally representative estimates of consistent seat belt usage in each region. These estimates were stratified by age, sex, and rurality. Total and potential lives saved by seat belts were calculated for each region using 2012 Fatality Analysis Reporting System data. ResultsOf the 345,513 respondents (unweighted), Appalachians were 6% less likely than non-Appalachians to always wear a seat belt (relative risk = 0.94, 95% confidence interval, 0.93–0.95). Seat belt usage was consistently lower among Appalachians regardless of sex, age, or rurality. Only 68.1% of rural, Appalachian youth reported always wearing a seat belt. Seat belt usage was highest among non-Appalachian females residing in urban areas (92.5%). With 100% belt compliance, an additional 360 and 1712 potential lives could have been saved in Appalachia and non-Appalachia, respectively. ConclusionsRegional differences possibly influence seat belt usage. Therefore, public health interventions to increase seat belt usage in Appalachia are likely warranted.

Us Child Safety Seat Laws: Are They Effective, and Who Complies?

This paper assesses the effectiveness of child safety seat laws. These laws progressively increased the mandatory age up to which children must be restrained in safety seats in cars. We use US Fatality Analysis Reporting System (FARS) data from 1978 to 2011 and rich state-time level variation in the implementation of these child safety seat laws for children of different ages. Increasing age thresholds is effective in increasing the actual age of child safety seat use. Across the child age distribution, restraint rates increase by about 30ppt in the long-run when the minimum age increases. However, we cannot reject the null hypothesis that restraining older children in safety seats does not reduce their likelihood to die in fatal accidents. We estimate that parents of 8.6M young children are legal compliers. They compose an important target group for policymakers because these parents alter their parenting behavior when laws change.

Trends in Alabama teen driving death and injury.

Motor vehicle crashes (MVCs) are a leading cause of morbidity and mortality in teens. Alabama has been in the Top 5 states for MVC fatality rate among teens in the United States for several years. Twelve years of teen MVC deaths and injuries were evaluated. Our hypothesis is that the teen driving motor vehicle-related deaths and injuries have decreased related to legislative and community awareness activities. A retrospective analysis of Alabama teen MVC deaths and injury for the years 2000 to 2011 was conducted. MVC data were obtained from a Fatality Analysis Reporting System data set managed by the Center for Advanced Public Safety at the University of Alabama. A Lowess regression-scattergram analysis was used to identify period specific changes in deaths and injury over time. Statistical analysis was conducted using True Epistat 5.0 software. When the Lowess regression was applied, there was an obvious change in the trend line in 2007. To test that observation, we then compared medians in the pre-2007 and post-2007 periods, which validated our observation. Moreover, it provided a near-even number of observations for comparison. The Spearman rank correlation was used to test for correlation of deaths and injury over time. The Mann-Whitney U-test was used to evaluate median differences in deaths and injury comparing pre-2007 and post-2007 data. Alabama teen MVC deaths and injury demonstrated a significant negative correlation over the 12-year period (Rs for deaths and injury, -0.87 [p < 0.001] and -0.92 [p < 0.001], respectively). Lowess regression identified a notable decline in deaths and injury after the year 2006. Median deaths and injury for the pre-2007 period were significantly higher than the post-2007 period, (U = 35.0, p = 0.003). Alabama teen driver deaths and injury have decreased during the 12-year study period, most notably after 2006. Factors that may have contributed to this trend may include stricter laws for teen drivers (enacted in 2002 and updated in 2010), less teen driving because of a nationwide economic downturn, delayed licensing in teens, steady improvements in overall seat belt use, and heightened public awareness of risky behaviors in teen driving.

Child passenger deaths involving alcohol-impaired drivers.

Approximately 1 in 5 child passenger deaths in the United States involves an alcohol-impaired driver, most commonly the child's own driver. The objective of this study was to document recent trends and state-specific rates of these deaths. A descriptive analysis of 2001-2010 Fatality Analysis Reporting System data for child passengers aged <15 years killed in alcohol-impaired driving crashes. Driver impairment was defined as a blood alcohol concentration of ≥0.08 g/dL. During 2001-2010, 2344 children <15 years were killed in crashes involving at least 1 alcohol-impaired driver. Of these children, 1515 (65%) were riding with an impaired driver. Annual deaths among children riding with an alcohol-impaired driver decreased by 41% over the decade. Among the 37 states included in the state-level analysis, Texas (272) and California (135) had the most children killed while riding with an impaired driver and South Dakota (0.98) and New Mexico (0.86) had the highest annualized child passenger death rates (per 100 000 children). Most (61%) child passengers of impaired drivers were unrestrained at the time of the crash. One-third of the impaired drivers did not have a valid driver's license. Alcohol-impaired driving remains a substantial threat to the safety of child passengers in the United States, and typically involves children being driven by impaired drivers. This risk varies meaningfully among states. To make further progress, states and communities could consider increased use of effective interventions and efforts aimed specifically at protecting child passengers from impaired drivers.

Patterns of drug use in fatal crashes

To characterize drug prevalence among fatally injured drivers, identify significant associations (i.e. day of week, time of day, age, gender), and compare findings with those for alcohol. Descriptive and logistic mixed-model regression analyses of Fatality Analysis Reporting System data. US states with drug test results for >80% of fatally injured drivers, 1998-2010. Drivers killed in single-vehicle crashes on public roads who died at the scene of the crash (n = 16 942). Drug test results, blood alcohol concentration (BAC), gender, age and day and time of crash. Overall, 45.1% of fatally injured drivers tested positive for alcohol (39.9% BAC ≥ 0.08) and 25.9% for drugs. The most common drugs present were stimulants (7.2%) and cannabinols (7.1%), followed by 'other' drugs (4.1%), multiple drugs (4.1%), narcotics (2.1%) and depressants (1.5%). Drug-involved crashes occurred with relative uniformity throughout the day while alcohol-involved crashes were more common at night (P < 0.01). The odds of testing positive for drugs varied depending upon drug class, driver characteristics, time of day and the presence of alcohol. Fatal single-vehicle crashes involving drugs are less common than those involving alcohol and the characteristics of drug-involved crashes differ, depending upon drug class and whether alcohol is present. Concerns about drug-impaired driving should not detract from the current law enforcement focus on alcohol-impaired driving.

Role of Poverty in California Teenagers’ Fatal Traffic Crash Risk

Teenagers’ high rates of motor vehicle crashes, accounting for 40% of external deaths among 16-19 yearolds, have been ascribed largely to inherent “adolescent risk-taking” and developmental hazards. However, the fact that compared to adults 25 and older, teenagers are twice as likely to live in poverty and low-income areas, risk factors for many types of violent death, has not been assessed. This paper uses Fatality Analysis Reporting System data on 65,173 fatal motor vehicle crashes by drivers in California’s 35 most populous counties for 1994-2007 to analyze fatal crash involvements per 100 million miles driven by driver age, county, poverty status, and 15 other traffic safety-related variables. Fatal crash rates were substantially higher for every driver age group in poorer counties than in richer ones. Multivariate regression found socioeconomic factors, led by the low levels of licensing and high unemployment rates prevalent in low-income areas, were associated with nearly 60% of the variance in motor vehicle crash risks, compared to 3% associated with driver age. The strong association between fatal crash risk and poverty, especially for young drivers who are concentrated in high-poverty brackets and low-income areas, suggests that factors related to poorer environments constitute a major traffic safety risk requiring serious attention.

The Impact of Underage Drinking Laws on Alcohol‐Related Fatal Crashes of Young Drivers

This study used a pre- to post-design to evaluate the influence on drinking-and-driving fatal crashes of 6 laws directed at youth aged 20 and younger and 4 laws targeting all drivers. Data on the laws were drawn from the Alcohol Policy Information System data set (1998 to 2005), the Digests of State Alcohol Highway Safety Related Legislation (1983 to 2006), and the Westlaw database. The Fatality Analysis Reporting System data set (1982 to 2004) was used to assess the ratio of drinking to nondrinking drivers involved in fatal crashes [fatal crash incidence ratio (CIR)]. The data were analyzed using structural equation modeling techniques. Significant decreases in the underage fatal CIR were associated with presence of 4 of the laws targeting youth (possession, purchase, use and lose, and zero tolerance) and 3 of the laws targeting all drivers (0.08 blood alcohol concentration illegal per se law, secondary or upgrade to a primary seat belt law, and an administrative license revocation law). Beer consumption was associated with a significant increase in the underage fatal CIR. The direct effects of laws targeting drivers of all ages on adult drinking drivers aged 26 and older were similar but of a smaller magnitude compared to the findings for those aged 20 and younger. It is estimated that the 2 core underage drinking laws (purchase and possession) and the zero tolerance law are currently saving an estimated 732 lives per year controlling for other exposure factors. If all states adopted use and lose laws, an additional 165 lives could be saved annually. These results provide substantial support for the effectiveness of under age 21 drinking laws with 4 of the 6 laws examined having significant associations with reductions in underage drinking-and-driving fatal crashes. These findings point to the importance of key underage drinking and traffic safety laws in efforts to reduce underage drinking-driver crashes.

The Effectiveness of Child Restraint Systems for Children Aged 3 Years or Younger During Motor Vehicle Collisions: 1996 to 2005

We estimated the effectiveness of child restraints in preventing death during motor vehicle collisions among children 3 years or younger. We conducted a matched cohort study using Fatality Analysis Reporting System data from 1996 to 2005. We estimated death risk ratios using conditional Poisson regression, bootstrapping, multiple imputation, and a sensitivity analysis of misclassification bias. We examined possible effect modification by selected factors. The estimated death risk ratios comparing child safety seats with no restraint were 0.27 (95% confidence interval [CI] = 0.21, 0.34) for infants, 0.24 (95% CI = 0.19, 0.30) for children aged 1 year, 0.40 (95% CI = 0.32, 0.51) for those aged 2 years, and 0.41 (95% CI = 0.33, 0.52) for those aged 3 years. Estimated safety seat effectiveness was greater during rollover collisions, in rural environments, and in light trucks. We estimated seat belts to be as effective as safety seats in preventing death for children aged 2 and 3 years. Child safety seats are highly effective in reducing the risk of death during severe traffic collisions and generally outperform seat belts. Parents should be encouraged to use child safety seats in favor of seat belts.

Predictors of injury among younger and older adults in fatal motor vehicle crashes

With 2003 Fatality Analysis Reporting System data, we examined relationships among predictors of motor vehicle injury/fatality outcomes for younger (35–54 years) and older (65 years and older) drivers. Using the Precede-Proceed Model of Health Promotion as an organizing framework, we classified variables into person, vehicle and environment domains and conducted a multinomial logistic regression. Significant risk factors for older driver injuries were impact crashes at 1–3 o’clock (OR = 1.65; CI: 1.05–2.59), 7–9 o’clock angles (OR = 2.59; CI = 1.45–4.63), and driving with one passenger (OR = 2.25; CI: 1.58–3.20). Previous other motor vehicle convictions were significantly associated with reduced risk of injury (OR = 0.55; CI = 0.34–0.90). The 7–9 o’clock angle (OR = 3.06; CI: 1.83–5.12), and driving in daylight hours were risk factors for fatality among older drivers. Many risk factors (e.g., female gender, non-seatbelt use, rollover crashes, and vehicle body type), and protective factors (e.g., number of lanes and non-airbag deployment) were relevant for younger and older drivers. Findings showed relevant factors for drivers from both age groups, with some pointing to older adults, and set the stage for further research to develop injury and fatality prevention programs.

Using Head-on Collisions to Compare Risk of Driver Death by Frontal Air Bag Generation: A Matched-Pair Cohort Study

US air bag regulations were changed in 1997 to allow tests of unbelted male dummies in vehicles mounted and accelerated on sleds, resulting in longer crash pulses than rigid-barrier crashes. This change facilitated depowering of frontal air bags and was intended to reduce air bag-induced deaths. Controversy ensued as to whether sled-certified air bags could increase adult fatality risk. A matched-pair cohort study of two-vehicle, head-on, fatal collisions between drivers involving first-generation versus sled-certified air bags during 1998-2005 was conducted by using Fatality Analysis Reporting System data. Sled certification was ascertained from public information and a survey of automakers. Conditional Poisson regression for matched-pair cohorts was used to estimate risk ratios adjusted for age, seat belt status, vehicle type, passenger car size, and model year for driver deaths in vehicles with sled-certified air bags versus first-generation air bags. For all passenger-vehicle pairs, the adjusted risk ratio was 0.87 (95% confidence interval: 0.77, 0.98). In head-on collisions involving only passenger cars, the adjusted risk ratio was 1.04 (95% confidence interval: 0.85, 1.29). Increased fatality risk for drivers with sled-certified air bags was not observed. A borderline significant interaction between vehicle type and air bag generation suggested that sled-certified air bags may have reduced the risk of dying in head-on collisions among drivers of pickup trucks.