Motor Vehicle Crash Deaths Research Articles

Geographic variation and trends in opioid-involved crash deaths in Maryland: 2006–2017

The objective of this study was to describe trends in the prevalence of opioids in driver fatalities and examine geographic variation in opioid-involved crashes at a county level. Using comprehensive toxicological data from the Office of the Chief Medical Examiner in Maryland, we examined the prevalence of opioids in all motor vehicle crash fatalities in Maryland between 2006–2017 and tested for trends to assess the statistical significance of changes in the prevalence of prescription opioids detected in these drivers over time. Opioid-involved crash deaths accounted for 10.0% of all driver deaths during the study period. The prevalence of opioids detected in fatally injured drivers increased from 8.3% in 2006 to 14.1% in 2017, (Z = −1.9, p < .05). The trends in opioid deaths do not follow broader trends in motor vehicle crash deaths; opioid-involved crashes appear to be increasing while overall motor vehicle crashes appear to be decreasing over the same period. To determine if the increase in opioid-involved crash deaths was the result of changes in pain management related to injuries sustained from the crash, we analyzed a subgroup of cases where death occurred at the scene of the crash. Within this group, there was no statistically significant increase in opioid-involved crashes during the study period. Opioid prevalence was higher in middle aged, and white drivers, and in crashes occurring in rural counties. Geographic distribution of opioid-involved crash deaths reflect broader patterns of opioid deaths overdose across the state. Irrespective of the timing of the deaths, of the drivers testing positive for opioids, 28% had elevated blood alcohol concentrations (‡ 0.01 g/dL), and 45% tested positive for other drugs.

Comparison of US County-Level Public Health Performance Rankings With County Cluster and National Rankings

Health departments can be grouped together based on sociodemographic characteristics of the population served. Comparisons within these groups can then help with monitoring and improving the health of their populations. To compare county-level percentile rankings on outcomes of smoking, motor vehicle crash deaths, and obesity within sociodemographic peer clusters vs nationwide rankings. This cross-sectional, population-based study of demographic and health data from the 2014 Behavioral Risk Factor Surveillance System and the 2016 Robert Wood Johnson Foundation County Health Rankings data set was conducted at 3139 of 3143 US counties and county-equivalents. Four locations were excluded due to incomplete data. Data analysis was conducted between January and August 2017. Random forest algorithms were used to identify sociodemographic characteristics most associated with the outcomes of interest. These characteristics were race and ethnicity, educational attainment, age, marital status, employment status, sex, and health insurance status. k-means clustering was used to cluster counties based on these sociodemographic characteristics and the percentage of the county classified as rural. County-level smoking prevalence, motor vehicle crash death rate, and obesity prevalence. County percentile rankings on the outcomes of interest were compared in the national context and the within-cluster context. A total of 318 856 967 individuals (mean [SD] individuals per county, 101 579.2 [326 315]; 161 911 910 women [50.8%]) were represented by the 3139 counties used in this analysis. Eight distinct sociodemographic clusters throughout the United States were found. Cluster-specific percentile rankings for both smoking prevalence and motor vehicle crash death rates improved more than 70 percentile points for several counties in the rural, American Indian cluster compared with the nationwide percentiles. Conversely, the young, urban, middle to high socioeconomic status cluster included counties with cluster-specific percentile rankings that declined by 60 percentile points or more compared with the nationwide rankings for all 3 outcomes of interest. Comparing county health outcomes on a nationwide or statewide basis fails to adequately account for sociodemographic context. Clustering counties by sociodemographic factors related to the outcome of interest allows a better understanding of other factors that may be shaping the prevalence of health outcomes. These groupings may also aid learning exchange.

Newer Model Years Are Associated with Reduced Risk of Motor Vehicle Crash Fatalities among Older Drivers

Older drivers are a growing and particularly vulnerable population. Advances in vehicle safety may reduce the risk of death in the event of a motor vehicle crash (MVC). Although previous studies have identified a relationship between increasing model years and decreased risk of death in MVC among adult drivers, this relationship has not been quantified among older drivers. The purpose of this study was to examine the relationship between vehicle model year and the risk of death among drivers aged 65 years and older who were involved in MVCs in the United States from 2010 to 2015. Data were from a census of all fatal MVCs and a representative sample of all police-reported crashes nationwide. Drivers were stratified into five age groups (65–69, 70–74, 75–79, 80–84, and 85+). Vehicles examined were cars, sport utility vehicles, pick-up trucks, and vans. Overall, older drivers driving vehicles older than model year 1990 were more than twice as likely to be killed in a crash as individuals driving vehicles of model years 2000 to 2009. Older drivers driving vehicles of model years 2010 and newer had 46% lower risk of MVC death than those driving vehicles of model year 2000 to 2009. The relationship between vehicle model year and risk of death in a crash varied by driver age and vehicle type, however, the same overall patterns were observed for all age groups and vehicle types examined. These findings suggest that older adults are responsive to improvements in vehicle safety.

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

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

An automated method to morph finite element whole-body human models with a wide range of stature and body shape for both men and women

Field data analyses have shown that small female, obese, and/or older occupants are at increased risks of death and serious injury in motor-vehicle crashes compared with mid-size young men. The current adult finite element (FE) human models represent occupants in the same three body sizes (large male, mid-size male, and small female) as those for the contemporary adult crash dummies. Further, the time needed to develop an FE human model using the traditional method is measured in months or even years. In the current study, an improved regional mesh morphing method based on landmark-based radial basis function (RBF) interpolation was developed to rapidly morph a mid-size male FE human model into different geometry targets. A total of 100 human models with a wide range of human attributes were generated. A pendulum chest impact condition was applied to each model as an initial assessment of the resulting variability in response. The morphed models demonstrated mesh quality similar to the baseline model. The peak impact forces and chest deflections in the chest pendulum impacts varied substantially with different models, supportive of consideration of population variation in evaluating the occupant injury risks. The method developed in this study will enable future safety design optimizations targeting at various vulnerable populations that cannot be considered with the current models.

Sociodemographic, Toxicological, and Lifestyle Characteristics of Seat Belt Users in a Nationally Representative Sample of US High School Students: Results from the 2015 Youth Risk Behavior Survey

Background Seat belts prevent death and serious injury in motor vehicle crashes (MVCs), but in 2015, 47% of drivers ages 15 to 19 who died in a crash were unrestrained. Attempts to increase teenage belt use have included high-visibility enforcement (e.g. primary seat belt laws and graduated driver licensing), but limited research exists regarding lifestyle behaviors associated with regular belt use among young drivers. The objective of this study is to explore the prevalence of healthy lifestyle behaviors associated with regular seat belt use among US high school students. Methods Data were used from the Centers for Disease Control and Prevention’s 2015 national Youth Risk Behavior Survey (YRBS), a nationally representative sample of US high school students. The YRBS assessed seat belt use as a passenger and other lifestyle behaviors during the 30 days before the survey, for 15,561 high school students. Seat belt use was coded into a dichotomous variable (regular/always v. irregular). Chi-square tests examined bivariate associations between regular seat belt use, demographic variables, and the prevalence of the following healthy lifestyle behaviors: hours of sleep, cigarette smoking, alcohol consumption, marijuana use, illegal prescription drug use, physical activity, and regular vegetable and water consumption. Results The prevalence of regular seat belt use during the 30 days before the survey was 61%. Regular belt use was more prevalent in males (χ2=3.97; degrees of freedom=1; p=.046), positively associated with age (χ2=43.82; df=6; p Conclusions High school students who reported regularly wearing their seat belts were mostly male, older, White, and had no alcohol or drug use. This study also suggests that a diverse range of healthy lifestyle behaviors are associated with a higher proportion of regular seat belt use. Encouraging healthy lifestyle behaviors in students, particularly those who drive, may positively influence traffic safety behaviors, including regular seat belt use.

Head injuries (TBI) to adults and children in motor vehicle crashes

ABSTRACTPurpose: This is a descriptive study. It determined the annual, national incidence of head injuries (traumatic brain injury, TBI) to adults and children in motor vehicle crashes. It evaluated NASS-CDS for exposure and incidence of various head injuries in towaway crashes. It evaluated 3 health databases for emergency department (ED) visits, hospitalizations, and deaths due to TBI in motor vehicle occupants.Methods: Four databases were evaluated using 1997–2010 data on adult (15+ years old) and child (0–14 years old) occupants in motor vehicle crashes: (1) NASS-CDS estimated the annual incidence of various head injuries and outcomes in towaway crashes, (2) National Hospital Ambulatory Medical Care Survey (NHAMCS)-estimated ED visits for TBI, (3) National Hospital Discharge Survey (NHDS) estimated hospitalizations for TBI, and (4) National Vital Statistics System (NVSS) estimated TBI deaths. The 4 databases provide annual national totals for TBI related injury and death in motor vehicle crashes based on differing definitions with TBI coded by the Abbreviated Injury Scale (AIS) in NASS-CDS and by International Classification of Diseases (ICD) in the health data.Results: Adults: NASS-CDS had 16,980 ± 2,411 (risk = 0.43 ± 0.06%) with severe head injury (AIS 4+) out of 3,930,543 exposed adults in towaway crashes annually. There were 49,881 ± 9,729 (risk = 1.27 ± 0.25%) hospitalized with AIS 2+ head injury, without death. There were 6,753 ± 882 (risk = 0.17 ± 0.02%) fatalities with a head injury cause. The public health data had 89,331 ± 6,870 ED visits, 33,598 ± 1,052 hospitalizations, and 6,682 ± 22 deaths with TBI. NASS-CDS estimated 48% more hospitalized with AIS 2+ head injury without death than NHDS occupants hospitalized with TBI. NASS-CDS estimated 29% more deaths with AIS 3+ head injury than NVSS occupant TBI deaths but only 1% more deaths with a head injury cause. Children: NASS-CDS had 1,453 ± 318 (risk = 0.32 ± 0.07%) with severe head injury (AIS 4+) out of 454,973 exposed children annually. There were 2,581 ± 683 (risk = 0.57 ± 0.15%) hospitalized with AIS 2+ head injury, without death. There were 466 ± 132 (risk = 0.10 ± 0.03%) fatalities with a head injury cause. The public health data had 19,251 ± 2,803 ED visits, 3,363 ± 255 hospitalizations, and 488 ± 6 deaths with TBI. NASS-CDS estimated 24% fewer hospitalized children with AIS 2+ head injury without death than NHDS hospitalization with TBI. NASS-CDS estimated 31% more deaths with AIS 3+ head injury than NVSS child deaths but 5% fewer deaths with a head injury cause.Conclusions: The annual national incidence of motor vehicle–related head injury (TBI) was estimated using 1997–2010 NASS-CDS from the Department of Transportation and NHAMCS (ED visits), NHDS (hospitalizations), and NVSS (deaths) from the Department of Health and Human Services. The transportation and health databases use different definitions and coding, which complicates direct comparisons. Future work is needed where ICD to AIS translators are used if comparisons of serious head injuries in NASS and health data sets are to be made.

Primary Enforcement of Mandatory Seat Belt Laws and Motor Vehicle Crash Deaths

Policies that allow directly citing motorists for seat belt non-use (primary enforcement) have been shown to reduce motor vehicle crash deaths relative to secondary enforcement, but the evidence base is dated and does not account for recent improvements in vehicle designs and road safety. The purpose of this study was to test whether recent upgrades to primary enforcement still reduce motor vehicle crash deaths. In 2016, researchers used motor vehicle crash death data from the Fatal Analysis Reporting System for 2000-2014 and calculated rates using both person- and exposure-based denominators. Researchers used a difference-in-differences design to estimate the effect of primary enforcement on death rates, and estimated negative binomial regression models, controlling for age, substance use involvement, fixed state characteristics, secular trends, state median household income, and other state-level traffic safety policies. Models adjusted only for crash characteristics and state-level covariates models showed a protective effect of primary enforcement (rate ratio, 0.88, 95% CI=0.77, 0.98; rate difference, -1.47 deaths per 100,000 population, 95% CI= -2.75, -0.19). After adjustment for fixed state characteristics and secular trends, there was no evidence of an effect of upgrading from secondary to primary enforcement in the whole population (rate ratio, 0.98, 95% CI=0.92, 1.04; rate difference, -0.22, 95% CI= -0.90, 0.46) or for any age group. Upgrading to primary enforcement no longer appears protective for motor vehicle crash death rates.

Vital Signs: Motor Vehicle Injury Prevention - United States and 19 Comparison Countries.

Each year >32,000 deaths and 2 million nonfatal injuries occur on U.S. roads. CDC analyzed 2000 and 2013 data compiled by the World Health Organization and the Organisation for Economic Co-operation and Development (OECD) to determine the number and rate of motor vehicle crash deaths in the United States and 19 other high-income OECD countries and analyzed estimated seat belt use and the percentage of deaths that involved alcohol-impaired driving or speeding, by country. In 2013, the United States motor vehicle crash death rate of 10.3 per 100,000 population had decreased 31% from the rate in 2000; among the 19 comparison countries, the rate had declined an average of 56% during this time. Among all 20 countries, the United States had the highest rate of crash deaths per 100,000 population (10.3); the highest rate of crash deaths per 10,000 registered vehicles (1.24), and the fifth highest rate of motor vehicle crash deaths per 100 million vehicle miles traveled (1.10). Among countries for which information on national seat belt use was available, the United States ranked 18th out of 20 for front seat use, and 13th out of 18 for rear seat use. Among 19 countries, the United States reported the second highest percentage of motor vehicle crash deaths involving alcohol-impaired driving (31%), and among 15, had the eighth highest percentage of crash deaths that involved speeding (29%). Motor vehicle injuries are predictable and preventable. Lower death rates in other high-income countries, as well as a high prevalence of risk factors in the United States, suggest that the United States can make more progress in reducing crash deaths. With a projected increase in U.S. crash deaths in 2015, the time is right to reassess U.S. progress and set new goals. By implementing effective strategies, including those that increase seat belt use and reduce alcohol-impaired driving and speeding, the United States can prevent thousands of motor vehicle crash-related injuries and deaths and hundreds of millions of dollars in direct medical costs every year.

P06 Varied Severity of Motor Vehicle Crash Injuries Using National Dataset in Taiwan

BackgroundInjuries by motor vehicle crashes remain the priority concern in the public-health. The aims of this study were to determine the distribution of varied severity of motor vehicle crash (MVC) injuries, and the time trend of MVC injuries by different car type between 2003 and 2010 in Taiwan. MethodsPooled data from Taiwan׳s National Traffic Accident Dataset, Taiwan׳s National Health Insurance Database, and National Register of Deaths for the year 2003 through 2010 were used. A total of 2,405,674 subjects involved in MVC events were included. The severity of MVC injuries were classified as emergency-visit only (ER-visit), hospitalization and death. Frequency counts, percentages and 95% confident interval were estimated for descriptive analyses. Mann-Kendall test was used to determine time trend of varied severity injuries by car types. ResultsIn 2010, the percentages of MVC subjects who were injured with ER-visit only, hospitalization, or death were 33.9%, 6.9% and 0.6% respectively. Vulnerable road users as cyclists and motorcyclists had highest probability of sever injury outcomes due to MVC rather than all other types of vehicle drivers. Compared with sedan drivers, cyclist had approximately 10 times more risk of ER-visit, 15 times more risk of hospitalization, 9 times more risk of death in MVC. Among motorcyclists, the risks of getting ER-visit, hospitalization, or death were 9, 11, 4 times higher than sedan drivers in MVC respectively. Over the period 2003 to 2010, the results of time trend test showed that the percentage of hospitalization or death among drivers of MVC had significantly decreased with years, however, the ER-visit utilization increased from 26.2% in 2003 to 34.0% in 2010. After stratification of car types, the ER-visit utilization among cyclist and motorcyclist of MVC remains significantly increased by years. ConclusionsThe evidences presented that the severity of MVC occurred from cyclists and motorcyclists is the major problems of motor vehicle crashes in Taiwan. Therefore, governments and health care providers to address on motorists and cyclist safety education, and to allocate an appropriate level of medical resources in order to effectively deal with different injury severity patterns.

Simulating the dynamic effect of land use and transport policies on the health of populations.

We identified the features of a land use-transportation system that optimizes the health and well-being of the population. We developed a quantitative system dynamics model to represent relationships among land use, transport, economic development, and population health. Simulation experiments were conducted over a 10-year simulation period to compare the effect of different baseline conditions and land use-transport policies on the number of motor vehicle crash deaths and disability-adjusted life years lost. Optimal reduction in the public health burden attributable to land transport was demonstrated when transport safety risk reduction policies were combined with land use and transport polices that minimized reliance on individual motorized transport and maximized use of active transport modes. The model's results were particularly sensitive to the level of development that characterized each city at the start of the simulation period. Local, national, and international decision-makers are encouraged to address transport, land use, and health as an integrated whole to achieve the desired societal benefits of traffic safety, population health, and social equity.

Driver license renewal policies and fatal crash involvement rates of older drivers, United States, 1986-2011.

BackgroundOlder drivers experience elevated risk of motor vehicle crash involvement, injury, and death. Several states attempt to address these risks through driver license renewal policies; however, little is known about their effects.MethodsData from 46 U.S. states from years 1986–2011 were examined. Associations between driver licensing policies and population-based fatal crash involvement rates of drivers aged 55 years and older, in 5-year age groups, were estimated using population-averaged negative binomial regression. Estimates were adjusted for seasonality, time trends, other traffic safety laws, and economic factors. Ratios of relative risks (RRR), which compared changes in fatal crash involvement rates of older drivers associated with changes in licensing policies to corresponding changes in fatal crashes of drivers ages 40–54, were computed to account for other possible sources of confounding.ResultsMandatory in-person renewal was associated with a 31% reduction in the fatal crash involvement rates of drivers ages 85 and older (RRR: 0.69, 95% Confidence Interval [CI]: 0.48–0.97). When in-person renewal was not required, requiring drivers to pass a vision test was associated with a similar reduction for drivers ages 85+ (RRR: 0.64, 95% CI: 0.49–0.85). When in-person renewal was required, however, requiring a vision test was not associated with any additional reduction, nor was requiring a knowledge test or an on-road driving test. Requiring more frequent license renewal and requiring healthcare providers to report concerns about patients’ driving ability to licensing authorities were not associated with statistically significant reductions in fatal crash involvement rates of older drivers. No policy examined was found to have a significant impact on fatal crash involvement of drivers younger than 85.ConclusionsRequiring drivers to renew their license in person, or to pass a vision test if not renewing in person, was associated with significant reductions in population-based fatal crash involvement rates for drivers ages 85 and older. The study could not determine how these effects were achieved, for example by specifically removing unsafe older drivers from the driving population or by fostering premature driving cessation. Other policies examined were not found to reduce fatal crash involvement rates of older drivers.

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.

Seatbelt usage: is there an association with obesity?

Wearing a seatbelt can prevent motor vehicle crash deaths. While primary seatbelt laws are designed to encourage vehicle passengers to wear seatbelts by allowing law enforcement officers to issue tickets when passengers do not wear seatbelts, discomfort may discourage obese individuals from wearing a seatbelt. The objective of this study is to assess the association between state-level obesity and seatbelt usage rates in the US, and to examine the possible role played by seatbelt laws in these associations. The strength of the association between obesity rates, seatbelt usage, and primary seatbelt laws at the state level is investigated using data from 2006 to 2011. Linear regression analysis is employed. This model estimates that increasing the obesity rate by 1% in a state where a primary seatbelt law (by which law enforcement officers can issue a ticket when seatbelts are not worn) is in effect is associated with a 0.06% decrease in seatbelt usage. However the same percentage of increase in the obesity rate in a state where no primary seatbelt law is in effect is associated with a 0.55% decrease in seatbelt usage. The magnitude of the statistical association between state obesity rates and state-level seatbelt usage is related to the existence of a primary seatbelt law, such that obesity has less impact on seatbelt usage in states where primary seatbelt laws are in effect.

Comparisons Among Health Behavior Surveys: Implications for the Design of Informatics Infrastructures that Support Comparative Effectiveness Research

Introduction:To address the electronic health data fragmentation that is a methodological limitation of comparative effectiveness research (CER), the Washington Heights Inwood Informatics Infrastructure for Comparative Effectiveness Research (WICER) project is creating a patient-centered research data warehouse (RDW) by linking electronic clinical data (ECD) from New York Presbyterian Hospital’s clinical data warehouse with ECD from ambulatory care, long-term care, and home health settings and the WICER community health survey (CHS). The purposes of the research were to identify areas of overlap between the WICER CHS and two other surveys that include health behavior data (the Behavioral Risk Factor Surveillance System (BRFSS) Survey and the New York City Community Health Survey (NYC CHS)) and to identify gaps in the current WICER RDW that have the potential to affect patient-centered CER.Methods:We compared items across the three surveys at the item and conceptual levels. We also compared WICER RDW (ECD and WICER CHS), BRFSS, and NYC CHS to the County Health Ranking framework.Results:We found that 22 percent of WICER items were exact matches with BRFSS and that there were no exact matches between WICER CHS and NYC CHS items not also contained in BRFSS.Conclusions:The results suggest that BRFSS and, to a lesser extent, NYC CHS have the potential to serve as population comparisons for WICER CHS for some health behavior-related data and thus may be particularly useful for considering the generalizability of CER study findings. Except for one measure related to health behavior (motor vehicle crash deaths), the WICER RDW’s comprehensive coverage supports the mortality, morbidity, and clinical care measures specified in the County Health Ranking framework but is deficient in terms of some socioeconomic factors and descriptions of the physical environment as captured in BRFSS. Linkage of these data in the WICER RDW through geocoding can potentially facilitate patient-centered CER that integrates important socioeconomic and physical environment influences on health outcomes. The research methods and findings may be relevant to others interested in either integrating health behavior data into RDWs to support patient-centered CER or conducting population-level comparisons.

Low rates of child restraint system use in cars may be due to fatalistic beliefs and other factors

Restraining children in cars has proven to save lives during car crashes. However, not all drivers of cars with children in them comply with the law regarding child restraint system (CRS) use. The aim of this study was to measure the rate of child and adult CRS use and to identify associations between fatalistic beliefs and CRS use among Arab children. A random sample of 380 Arab drivers transporting children 8 years and younger in Israel were interviewed after observing 835 children traveling in 400 vehicles. Proper restraint ranged from 41% among children aged one to three to 9% among booster seat-eligible children. In a logistic regression model driver seat belt use, fatalistic beliefs, knowledge regarding the law on CRS, number of children in the car, age and gender were associated with all the children being restrained in the car. Drivers with higher levels of fatalistic beliefs had a lower odds ratio of restraining their children in the car, after adjusting for the other confounding variables (OR = 0.80, CI = 0.65, 0.97). High levels of fatalism and low levels of knowledge in addition to other factors may inhibit Israeli Arab parents from restraining their children in cars. Therefore, children in these communities are at risk of injury or death in motor vehicle crashes and there is a need for tailored interventions specific for this population.

CURRENT EVIDENCE ON PUBLICISED SOBRIETY CHECKPOINT PROGRAMMES: ARE THEY STILL EFFECTIVE?

BackgroundAlcohol-impaired driving is a major contributor to motor vehicle crash deaths resulting in almost 270 000 deaths globally. In 2001, the Community Preventive Services Task Force recommended the use of...

The Decrease in the Unintentional Injury Mortality Disparity Between American Indians/Alaska Natives and Non–American Indians/Alaska Natives in New Mexico, 1980 to 2009

We tracked the unintentional injury death disparity between American Indians/Alaska Natives and non-American Indians/Alaska Natives in New Mexico, 1980 to 2009. We calculated age-adjusted rates and rate ratios for unintentional injury deaths and their external causes among American Indians/Alaska Natives and non-American Indians/Alaska Natives. We tested trend significance with the Mann-Kendall test. The unintentional injury death rate ratio of American Indians/Alaska Natives to non-American Indians/Alaska Natives declined from 2.9 in 1980-1982 to 1.5 in 2007-2009. The rate among American Indians/Alaska Natives decreased 47.2% from 1980-1982 to 1995-1997. Among non-American Indians/Alaska Natives, the rate declined 25.3% from 1980-1982 to 1992-1994, then increased 31.9% from 1992-1994 to 2007-2009. The motor vehicle traffic and pedestrian death rates decreased 57.8% and 74.6%, respectively, among American Indians/Alaska Natives from 1980-1982 to 2007-2009. The unintentional injury death rate disparity decreased substantially from 1980-1982 to 2007-2009 largely because of the decrease in motor vehicle crash and pedestrian death rates among American Indians/Alaska Natives and the increase in the poisoning death rate among non-American Indians/Alaska Natives.

Suicide by Motor Vehicle “Accident” in Queensland

Objective: Around the world, a substantial proportion of motor vehicle crash deaths are recognized as “hidden” suicides. This project sought to progress understandings of drivers who used a motor vehicle to die by suicide in Queensland, Australia, during the period 1990 to 2007. Methods: Data for this study were derived from the Queensland Suicide Register and forensic crash investigation case records. Analysis focused on life circumstances and events preceding the death, physical and mental illnesses, past suicidality, and indication of suicide intent (e.g., suicide notes or statements). Results: Compared to cases using other methods, confirmed driver suicides were more likely to be males aged between 25 and 44 years who were employed at the time of death. A large proportion of driver suicides had consumed alcohol immediately prior to the crash and experienced a number of life events, including relationship conflict, legal or criminal issues, and financial problems. Conclusion: These exploratory results indicate the need to educate crash investigators about the characteristics of those who use a motor vehicle to die. Improving the information available on the mental and physical health and background life-related factors of crash victims can help coroners and researchers determine whether these deaths were intentional. Further investigation is needed in order to formulate intervention strategies for those who may be vulnerable to driver suicide.

Effects of Dram Shop Liability and Enhanced Overservice Law Enforcement Initiatives on Excessive Alcohol Consumption and Related Harms: Two Community Guide Systematic Reviews

Dram shop liability holds the owner or server(s) at a bar, restaurant, or other location where a patron, adult or underage, consumed his or her last alcoholic beverage responsible for harms subsequently inflicted by the patron on others. Liability in a state can be established by case law or statute. Overservice laws prohibit the sale of alcoholic beverages to intoxicated patrons drinking in on-premises retail alcohol outlets (i.e., premises where the alcohol is consumed where purchased); enhanced enforcement of these laws is intended to ensure compliance by premises personnel. Both of these interventions are ultimately designed to promote responsible beverage service by reducing sales to intoxicated patrons, underage youth, or both. This review assesses the effectiveness of dram shop liability and the enhanced enforcement of overservice laws for preventing excessive alcohol consumption and related harms. Studies assessing alcohol-related harms in states adopting dram shop laws were evaluated, as were studies assessing alcohol-related harms in regions with enhanced overservice enforcement. Methods previously developed for systematic reviews for the Guide to Community Preventive Services were used. Eleven studies assessed the association of state dram shop liability with various outcomes, including all-cause motor vehicle crash deaths, alcohol-related motor vehicle crash deaths (the most common outcome assessed in the studies reviewed), alcohol consumption, and other alcohol-related harms. There was a median reduction of 6.4% (range of values 3.7% to 11.3% reduction) in alcohol-related motor vehicle fatalities associated with the presence of dram shop liability in jurisdictions where premises are licensed. Other alcohol-related outcomes also showed a reduction. Only two studies assessed the effects of enhanced enforcement initiatives on alcohol-related outcomes; findings were inconsistent, some indicating benefit and others none. According to Community Guide rules of evidence, the number and consistency of findings indicate strong evidence of the effectiveness of dram shop laws in reducing alcohol-related harms. It will be important to assess the possible effects of legal modifications to dram shop proceedings, such as the imposition of statutes of limitation, increased evidentiary requirements, and caps on recoverable amounts. According to Community Guide rules of evidence, evidence is insufficient to determine the effectiveness of enhanced enforcement of overservice laws for preventing excessive alcohol consumption and related harms.