Maryland Motor Vehicle Administration Research Articles

Association of Neighborhood Deprivation With Prostate Cancer and Immune Markers in African American and European American Men

Neighborhood variables may be factors in the excessive burden of prostate cancer among African American men. To examine associations between neighborhood deprivation, circulating immune-oncology markers, and prostate cancer among African American and European American men. A case-control study was conducted between January 1, 2005, and January 1, 2016. Participants included men with prostate cancer and age- and race-frequency-matched population controls. Participants were recruited at the Baltimore Veterans Affairs Medical Center and University of Maryland Medical Center; controls were obtained through the Maryland Motor Vehicle Administration database. National Death Index follow-up was performed through December 31, 2020, and data analysis was conducted from February 1, 2022, through October 31, 2022. 2000 Census-tract Neighborhood Deprivation Index as a standardized score. Primary outcomes included prostate cancer, all-cause mortality, and disease-specific mortality. Secondary outcomes included the National Comprehensive Cancer Network risk score and serum proteomes for 82 immune-oncology markers with pathway annotation. Participants included men with prostate cancer (n = 769: 405 African American, 364 European American men) and age- and race-frequency-matched population controls (n = 1023: 479 African American, 544 European American men). The median survival follow-up was 9.70 years (IQR, 5.77 years), with 219 deaths. Among 884 African American men, mean (SD) age at recruitment was 63.8 (7.6) years; mean (SD) age at recruitment among 908 European American men was 66.4 (8.1) years. In the multivariable logistic regression analysis with individual socioeconomic status adjustment, neighborhood deprivation was associated with 55% increased odds of prostate cancer among African American men (odds ratio [OR], 1.55; 95% CI, 1.33-1.81), but was not associated with the disease among European American men. Residing in the most-deprived vs least-deprived neighborhoods corresponded to 88% higher disease odds (OR, 1.88; 95% CI, 1.30-2.75) among all men and an approximate 3-fold increase among African American men (OR, 3.58; 95% CI, 1.72-7.45), but no association was noted among European American men. In Cox proportional hazard regression analyses, socioeconomic status-adjusted neighborhood deprivation was associated with an increased all-cause mortality only among African American men (hazard ratio [HR], 1.28; 95% CI, 1.08-1.53), whereas it was associated with metastatic disease and a 50% increased hazard of a prostate cancer-specific death among all men (HR, 1.50; 95% CI, 1.07-2.09). In analyses restricted to controls, neighborhood deprivation was associated with increased activity scores of serum proteome-defined chemotaxis, inflammation, and tumor immunity suppression. The findings of this study suggest that deprived neighborhood residency may increase the risk of African American men for prostate cancer and a related mortality, potentially through its association with systemic immune function and inflammation.

Driving concerns among older adults: Associations with driving skill, behaviors, and experiences

Objectives: The purpose of this investigation was to determine what older adults find most concerning about driving as they age and how these concerns are related to driving skill, behaviors, and experiences.Methods: In partnership with the Maryland Motor Vehicle Administration, a sample of 751 older adults ages 65 and older completed an online survey between October 2017 and May 2018. A content analysis was used to code open-ended responses about driver concerns, and multivariate logistic regression models were used to analyze the associations between driving concerns and driving skill, behavior, and experiences.Results: Eighty-four percent of participants reported at least one driving concern, with 44% concerned about others’ driving, 34% concerned about their own driving, and 24% concerned about driving conditions. The most frequently mentioned driving concerns were other drivers in general, driving at night, visual ability and awareness, and other drivers being aggressive or reckless. Being concerned with their own driving was significantly associated with decreased perceived driving skill and increased odds of experiencing negative driving experiences in the past year. Being concerned about others’ driving was associated with increased odds of wearing a seat belt (adjusted odds ratio [AOR] = 2.67; 95% confidence interval [CI], 1.02, 7.00), having high perceived driving skills in emergency situations (AOR = 1.56; 95% CI, 1.14, 2.12), and getting in a near crash or collision in the past year (AOR = 1.50; 95% CI, 1.04, 2.18).Conclusions: Older adult drivers are frequently concerned about their own driving as well as the driving of others. Implications for future research and health practice are discussed.

Threshold Effects of Speed-Monitoring Devices on the Speeding Behavior of Drivers

This paper summarizes an evaluation of a speed-monitoring system that provides speed warning feedback to drivers enrolled in a voluntary program. The field study aimed to determine the effects of immediate feedback on drivers, especially chronic speeders. Drivers with at least three speeding violations in the past 3 years were recruited through the Maryland Motor Vehicle Administration. After a 2-week baseline period, the alert system was activated, and driving behavior was monitored for any changes for approximately 4 weeks. Subjects were monitored (silently) for a follow-up phase of 2 weeks. During the treatment phase, drivers received alerts when their speeds exceeded the posted speed limit by more than 8 mph. The findings are encouraging and suggest that verbal alerts are successful in producing short-term changes in driving behavior. Overall, the average proportion of speeding above the alert threshold declined significantly during the treatment phase, an indication that the alerts did have a deterring effect on speeding behavior. Once the alerts were silenced, there was evidence suggesting a sustained change in driving behavior for some participants. Although the proportion of speeding above the threshold was higher during the 2-week follow-up period than during the treatment phase, for some participants the follow-up speeds were lower than those recorded during the baseline phase. Although speeding was reduced during the treatment phase at speeds over the feedback threshold, much of this speeding appeared to have shifted down to just below the threshold. This finding raises an important question regarding optimal levels for setting thresholds for feedback on speeding behavior.

Using cognitive status to predict crash risk: Blazing new trails?

IntroductionA computer-based version of an established neuropsychological paper-and-pencil assessment tool, the Trail-Making Test, was applied with approximately 700 drivers aged 70 years and older in offices of the Maryland Motor Vehicle Administration. MethodThis was a volunteer sample that received a small compensation for study participation, with an assurance that their license status would not be affected by the results. Analyses revealed that the study sample was representative of Maryland older drivers with respect to age and indices of prior driving safety. The relationship between drivers' scores on the Trail-Making Test and prospective crash experience was analyzed using a new outcome measure that explicitly takes into account error responses as well as correct responses, the error-compensated completion time. ResultsFor the only reliable predictor of crash risk, Trail-Making Test Part B, this measure demonstrated a modest gain in specificity and was a more significant predictor of future safety risk than the simple time-to-completion measure. Impact on industryImproved specificity and the potential for autonomous test administration are particular advantages of this measure for use with large populations, in settings such as health care or driver licensing.

Older drivers and rapid deceleration events: Salisbury Eye Evaluation Driving Study

Drivers who rapidly change speed while driving may be more at risk for a crash. We sought to determine the relationship of demographic, vision, and cognitive variables with episodes of rapid decelerations during five days of normal driving in a cohort of older drivers. In the Salisbury Eye Evaluation Driving Study, 1425 older drivers aged 67–87 were recruited from the Maryland Motor Vehicle Administration's rolls for licensees in Salisbury, Maryland. Participants had several measures of vision tested: visual acuity, contrast sensitivity, visual fields, and the attentional visual field. Participants were also tested for various domains of cognitive function including executive function, attention, psychomotor speed, and visual search. A custom created driving monitoring system (DMS) was used to capture rapid deceleration events (RDEs), defined as at least 350milli-g deceleration, during a five day period of monitoring. The rate of RDE per mile driven was modeled using a negative binomial regression model with an offset of the logarithm of the number of miles driven. We found that 30% of older drivers had one or more RDE during a five day period, and of those, about 1/3 had four or more. The rate of RDE per mile driven was highest for those drivers driving <59 miles during the 5-day period of monitoring. However, older drivers with RDE's were more likely to have better scores in cognitive tests of psychomotor speed and visual search, and have faster brake reaction time. Further, greater average speed and maximum speed per driving segment was protective against RDE events. In conclusion, contrary to our hypothesis, older drivers who perform rapid decelerations tend to be more “fit”, with better measures of vision and cognition compared to those who do not have events of rapid deceleration.

The Maze Test: A significant predictor of older driver crash risk

A study sponsored by the National Highway Traffic Safety Administration performed functional assessments on approximately 700 drivers age 70 and older who presented for license renewal in urban, suburban, and rural offices of the Maryland Motor Vehicle Administration. This volunteer sample received a small compensation for study participation, with an assurance that their license status would not be affected by the results. A comparison with all older drivers who visited the same sites on the same days indicated that the study sample was representative of Maryland older drivers with respect to age and prior driving safety indices. Relationships between drivers’ scores on a computer touchscreen version of the Maze Test and prospective crash and serious moving violation experience were analyzed. Results identified specific mazes as highly significant predictors of future safety risk for older drivers, with a particular focus on non-intersection crashes. Study findings indicate that performance on Maze Tests was predictive of prospective crashes and may be useful, as a complement to other, established cognitive screening tools, in identifying at-risk older drivers.

An Exploratory Study of the Relationship Between Socioeconomic Status and Motor Vehicle Safety Features

Objective: The purpose of this study was to assess the association between motor vehicle owners' socioeconomic status (SES) and the safety of their motor vehicles. Methods: Truncated vehicle identification numbers (VINs) were obtained from the Maryland Motor Vehicle Administration office. ZIP code–level income and educational data were assigned to each VIN. Software was used to identify safety-related vehicle characteristics including crash test rating, availability of electronic stability control and side impact air bags, age, and weight. Correlations and analyses of variance were performed to assess whether a ZIP code's median household income and educational level were associated with its proportion of registered vehicles with safety features. Results: For 13 of the 16 correlations performed, SES was significantly associated with the availability of vehicle safety features in a direction that favored upper-income individuals. Vehicle weight was not associated with income or education. When ZIP codes were divided into median household income quintiles, their mean proportions of safety features also differed significantly, in the same direction, for availability of electronic stability control, side impact air bags, vehicle age, and crash test ratings. Conclusions: Safer motor vehicles appear to be distributed along socioeconomic lines, with lower income groups experiencing more risk. This previously unidentified mechanism of disparity merits further study and the attention of policy makers.

Medical Review of Fitness to Drive in Older Drivers: The Maryland Experience

Background. Over the next several decades, both the number and percentage of older drivers will increase dramatically. Older age is inherently associated with medical conditions, particularly those involving cognition and vision, that can affect medical fitness to drive. Over a 60-year period, the Maryland Motor Vehicle Administration (MVA) in conjunction with its medical advisory board (MAB) has matured a comprehensive system to identify at-risk older drivers and to assess their medical fitness to drive. Methods. This paper describes the medical review process in general, and in particular for older drivers, that has evolved in the state of Maryland. The resources, philosophy and research underpinnings of its MAB review process are examined. Results. Studies of functional screening measures in older drivers indicate that older drivers at risk of being at-fault for future crashes can be identified. The feasibility of using such screening measures for drivers referred to the MVA has been confirmed by practical use for a period of seven years. Conclusions. It is possible to create a medical review process with a goal of “safe mobility for life” that supports preservation of the driving privilege among many older drivers.

Persuasion and Licensure: A Randomized Controlled Intervention Trial to Increase Licensure Rates among Maryland Motorcycle Owners

Objective. This study aimed to determine whether a persuasive educational intervention could increase licensure among motorcycle owners. Unlicensed motorcycle operators appear to be disproportionately involved in police-reported motorcycle crashes in Maryland, accounting for about 27% of motorcycle operators in police-reported crashes, although unlicensed owners comprise 17% of primary motorcycle owners. Methods. A randomized controlled trial was conducted among unlicensed owners. Linking Maryland records of registered motorcycles with license files, 8,499 unlicensed owners who had no licensed co-owners were identified. Half were randomized to receive a persuasive educational mailing in early June 2005 from Maryland Motor Vehicle Administration (MVA). Motorcycle licenses can be attained by passing an accredited motorcycle training class or passing knowledge and skills tests administered by the state driver licensing agency. Licensure rates and motorcycle class enrollment were followed for 6 months post-intervention. Results. As of December 16, 2005, 280 intervention group owners had obtained Class M motorcycle licenses and 158 had obtained Class R motorcycle learner's permits. The comparison group obtained 209 M licenses and 122 R permits. The overall success rate in the intervention group, defined as obtaining Class M or R, was 10.4% compared with 7.9% in the comparison group (licensure ratio (LR) = 1.33; 95% confidence interval (CI) = 1.16–1.52). The intervention was most successful among men, whose LR for obtaining M licenses was 1.45 (95% CI = 1.21–1.75). LRs were higher among owners ages 40–48 and 49+ receiving the intervention compared with younger groups. Motorcycle training class enrollment rates were higher in the intervention group, particularly among those taking a course for riders with intermediate skills (enrollment ratio = 2.24; 95% CI = 1.41–3.55). Conclusion. The intervention appeared to increase licensure, yet the licensure rate remained low among the intervention group. Potential risks and benefits of increasing the percentage of motorcyclists who are licensed need to be studied.

Parents’ Intended Limits on Adolescents Approaching Unsupervised Driving

The purpose of this study was to determine the extent to which parents intend to place driving limits on adolescents approaching unsupervised driving. A total of 658 parents and their 16-year-old adolescents were recruited from a local Maryland Motor Vehicle Administration site as adolescents successfully tested for provisional licenses. Parents completed written surveys about parent-adolescent relations and anticipated adolescent unsupervised driving. The results indicated that parents reported high levels of intended limits on adolescents’ unsupervised driving, especially for trip conditions (e.g., getting permission) when compared with risk conditions (e.g., at night). Almost one third of parents reported completing driving agreements. Overall, intended driving limits and completed driving agreements were more likely when parents reported high levels of parental monitoring (2 times more likely), discussion of driving rules (2 to 4 times more likely), risk perception (2 times more likely), and vehicle access (2 to 3 times more likely). Completed driving agreements were not related to intended driving limits.

MaryPODS revisited: Updated crash analysis and implications for screening program implementation

Problem: Due to the relative scarcity of crashes, there has consistently been a problem with analyses that use crashes as a criterion measure in their analyses. Method: Previous analyses of the relationships between functional capacity measures and at-fault crash involvement for older drivers as reported in the NHTSA Model Driver Screening and Evaluation Program Final Technical Report have been updated to include one additional year of driving experience. Eighteen new at-fault crashes involving drivers who previously had no crash involvement were recorded for the Maryland Motor Vehicle Administration (MVA) test sample during this interval. The method of odds ratio (OR) calculation was used to examine the relationships between functional status predictors and the most salient among the safety outcome measures identified in the Maryland research. Peak valid OR values for the prior and current analyses were contrasted, and the stability of candidate pass–fail cut-points for each predictor relative to values identified in the Final Technical Report was examined. Results: Results indicate that the predictive value of functional tests appears to decrease over time, particularly for the perceptual–cognitive measures. Impact on Industry: The impact of these findings on programs and policies is to underscore a need for periodic reevaluation, spaced at the shortest practical intervals but not more than 2 years apart, in order for functional capacity screening to be applied effectively by licensing authorities, health care professionals, and others to reduce personal risk and enhance public safety.

Assessing driving risk in older drivers presenting to the Maryland motor vehicle ad-ministration (MVA)

Assessing driving risk in older drivers presenting to the Maryland motor vehicle ad-ministration (MVA)

The Risk of Offending on Homicide Victimization: A Case Control Study

Little research has been done to examine the risk an individual's criminal offending has on subsequent lethal victimization. Theoretical explanations for this relationship stem from the lifestyle theory, which suggests that offenders are at risk of victimization because they frequently interact with other criminals, cannot rely on legal authorities for protection, or become the objects of retaliatory behavior. A sample of homicide victims and two samples of nonvictims from Prince George's County, Maryland, have been collected for a case control study. The nonvictim samples were drawn from Maryland Motor Vehicle Administration records. In various bi- and multivariate models, the results find strong support for the premise that previous offending increases the risk of homicide victimization.

Alcohol education and recidivism rates: The cognitive connection

This study assesses the effectiveness of the Maryland Motor Vehicle Administration's Alcohol Education Program, formerly Maryland's Alcohol Safety Action Project. In addition, this study shows how a relatively short program of alcohol education actuates a favorable change in attitude and a concomitant change in behavior among social drinkers, as compared with problem drinkers, charged with drunk driving. Subjects were classified as social drinkers or problem drinkers, then assigned to a control group or to one of five treatment modes, consisting of various educational formats. Recidivism (post- treatment drunk driving convictions) of 3637 subjects over a two- year period formed the basic data of the study. Statistical analysis of the data disclosed that the recidivism rates of social drinkers were significantly lower than the recidivism rates of problem drinkers, suggesting alcohol education programs have differential effectiveness as a function of drinker type. We reasoned that social drinkers involved in a drunk driving offense, unlike problem drinkers, experience high levels of cognitive dissonance. Spurred by dissonance, which intensified as the program progressed, social drinkers underwent a favorable change in attitude and a concomitant change in behavior. We reasoned further that, having assimilated their drinking pattern into their self-concept, problem drinkers experience lower levels of dissonance, too low to effectuate attitudinal or behavioral change.