Fatal Motor Vehicle Crashes Research Articles

Differences in rural and urban drivers’ attitudes and beliefs about seat belts

In the United States, a disproportionate number of motor vehicle crash fatalities occur in rural areas. While many factors likely contribute to the discrepancy between fatality rates in rural and urban areas, prior studies suggest that rural drivers may be more likely to engage in risky driving behaviors like seat belt non-use. Although having favorable attitudes or beliefs about seat belts increases the likelihood of wearing them, few studies have investigated the possibility that lower rates of seat belt use in rural areas may result from a greater prevalence of unfavorable seat belt attitudes and beliefs—one part of a distinct rural “traffic safety culture.” In the current study, we analyzed responses from the 2016 Motor Vehicle Occupant Safety Survey (MVOSS) to test the hypotheses that rural drivers are more likely than urban drivers to hold unfavorable attitudes and beliefs about seat belts, and that these unfavorable attitudes and beliefs predict lower self-reported seat belt use. We found that rural and urban drivers differed significantly on several seat belt attitudes and beliefs and that these differences persisted after controlling for possible demographic differences between rural and urban drivers. We also found that drivers who hold less favorable attitudes and beliefs were less likely to always wear their seat belts. However, even after accounting for demographic factors and differences in attitudes and beliefs, rural drivers continued to be less likely to report full-time seat belt use than urban drivers. Our findings suggest that rural drivers should be treated as a distinct market segment for seat belt messaging and public awareness campaigns, and that interventions designed to change the unfavorable attitudes and beliefs about seat belts held by rural drivers may help reduce the disparity between rural and urban traffic fatality rates.

An examination of the unintended consequences of the legalization of recreational marijuana on alcohol-related behaviors

ABSTRACT This paper focuses on the unintended consequences of the legalization of recreational marijuana within the state of Colorado. Toward this end, we examine the impact of our intervention series on tax revenue from the sale of all varieties of liquors (beer, wine, and spirits) and the number of fatal motor vehicle crashes involving alcohol. The results from the interrupted time series analyses indicate the legalization of recreational marijuana significantly increased tax revenue from alcohol sales and the number of fatal motor vehicle crashes involving alcohol. The implications of these findings for the evaluation of social policy are discussed.

Complications in bereavement following motor vehicle crash fatalities in a sample of young adults.

Complications in bereavement following motor vehicle crash fatalities in a sample of young adults.

Roadway features associated with elderly drivers in motor vehicle crashes.

As the number of older US drivers has increased over the past decades, so has the number of injuries, hospitalizations, and deaths from motor vehicle crashes (MVCs) involving elderly drivers. We seek to identify personal, environmental, and roadway features associated with increased crashes involving elderly drivers. We hypothesize that elderly drivers are more likely to be involved in MVCs at intersections with more complex signage and traffic flow. This is a retrospective observational study using 2015 to 2019 police traffic crash reports and a Department of Public Health database of built-environment variables from a single urban center. Demographics and environmental/road features were compared for vehicle-only MVCs involving elderly (≥65 years) and younger drivers. χ2 and nonparametric tests were used to analyze 36,168 drivers involved in MVCs. There were 2,575 (7.1%) elderly drivers involved in MVCs during the study period. Left turns and all-way stop signs were associated with increased crash risk among elderly drivers compared with younger drivers. Elderly-involved MVCs were less likely to occur at intersections with left-turn restrictions, traffic lights, only one-way streets, and bike lanes compared with MVCs with younger drivers. Elderly drivers were more likely to be involved in MVCs on weekdays, less often intoxicated at the time of the crash, and less frequently involved in fatal MVCs compared with younger drivers. However, elderly drivers were more frequently the at-fault party, especially after the age of 75 years. Updates to roadway features have potential to decrease injury and death from MVCs involving elderly adults. Left turn restrictions or other innovative safety treatments at all-way stops or where left turns are permitted may mitigate road crashes involving older adults. Education may increase awareness of higher-risk driving tasks such as turning left, and driving alternatives including public transportation/paratransit may offer alternate means to maintain activities of daily living. Prognostic/Epidemiological, level IV.

Psychological Constructs Related to Seat Belt Use: A Nationally Representative Survey Study

Seat belt use can significantly reduce fatalities in motor vehicle crashes (Kahane, 2000). Nevertheless, the current U.S. seat belt use rate of 89.6% (Enriquez & Pickrell, 2019) indicates that a relatively small but pervasive portion of the population does not wear seat belts on a full-time basis. Whereas much is known about the demographic predictors of seat belt use, far less is understood about psychological factors that predict individual proclivities toward using or not using a seat belt. In this study, we examined some of these potential psychological predictors. A probability-based web survey was conducted with 6,038 U.S. residents aged 16 or older who reported having driven or ridden in a car in the past year. We measured self-reported seat belt use and 18 psychological constructs and found that delay of gratification, life satisfaction, risk aversion, risk perception, and resistance to peer influence were positively associated with belt use. Impulsivity and social resistance orientation were negatively associated with belt use. Prior research has shown that psychological factors like delay of gratification, risk aversion/perception, and impulsivity predict other health behaviors (e.g., cigarette smoking, sunscreen use); our results extend this literature to seat belts and can aid the development of traffic safety programs targeted at non-users who—due to such factors—may be resistant to more traditional countermeasures such as legislation and enforcement.

Means restriction for the prevention of suicide on roads.

Road traffic suicides are common. However, due to the difficulty in distinguishing between motor vehicle crash fatalities and actual suicides, no official figures exist for this method of suicide. Restricting access to means is an important universal or population-based approach to suicide prevention with clear evidence of its effectiveness. However, the evidence with respect to means restriction for the prevention of suicide on roads is not well established. We conducted a systematic review to assess the impact of restrictions on the availability of, or access to, means of suicide on roads. To evaluate the effectiveness of interventions to restrict the availability of, or access to, means of suicide on roads. We searched the Cochrane Library, MEDLINE, Embase, PsycINFO, and the Transport Research International Documentation (TRID) Database from the date of database inception to March 2020.We conducted searches of the World Health Organization International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.govto identify unpublished and ongoing studies.We applied no date, language, or publication status restrictions to these searches. Eligible studies were randomised or quasi-randomised controlled trials, controlled intervention studies without randomisation, before-after studies, or studies using interrupted time series designs, which evaluated interventions to restrict the availability of, or access to, means of suicide on roads. Two review authors screened abstracts and full-text publications against the inclusion criteria. Two review authors planned to independently extract data and assess risk of bias of included studies. However, we identified no studies eligible for inclusion. We identified no studies that met the inclusion criteria for this review. This systematic review highlights the paucity of research around road traffic suicides and the need for future robust studies that aim to investigate the effectiveness of interventions to prevent suicide on roads. Suicide ascertainment is a key issue; therefore, clear objective criteria are necessary in order to scale up and study this method more accurately. In the absence of any substantial evidence, we advocate for more awareness on road traffic suicides and its inclusion in future government suicide prevention policies. Further research exploring effective measures, particularly those that do not require driver compliance, are also needed.

An examination of relationships between cannabis legalization and fatal motor vehicle and pedestrian-involved crashes

Objective While attention has been given to how legalization of recreational cannabis affects traffic crash rates, there was been limited research on how cannabis affects pedestrians involved in traffic crashes. This study examined the association between cannabis legalization (medical, recreational use, and recreational sales) and fatal motor vehicle crash rates (both pedestrian-involved and total fatal crashes). Methods We used crash data from the Fatality Analysis Reporting System (FARS) to calculate monthly rates of fatal motor vehicle crashes and fatal pedestrian-involved crashes per 100,000 people from 1991 to 2018. Changes in monthly crash rates in three states that had legalized cannabis (Colorado, Washington, and Oregon) were compared to matched control states using segmented regression with autoregressive terms. Results We found no significant differences in pedestrian-involved fatal motor vehicle crashes between legalized cannabis states and control states following medical or recreational cannabis legalization. Washington and Oregon saw immediate decreases in all fatal crashes (-4.15 and −6.60) following medical cannabis legalization. Colorado showed an increase in trend for all fatal crashes after recreational cannabis legalization and the beginning of sales (0.15 and 0.18 monthly fatal crashes per 100,000 people). Conclusions Overall findings do not suggest an elevated risk of total or pedestrian-involved fatal motor vehicle crashes associated with cannabis legalization.

An optimization model to determine an appropriate budget for improving work zone safety

In order to keep up with demand, government agencies must maintain and rehabilitate roadways so the supply to the public is met. However, while maintaining and rehabilitating roadways, work zones are a major threat to both the safety of the drivers, as well as the workers. In the U.S., 799 people were killed in work zone crashes in 2017 which comprises 2.1% of total fatalities in motor vehicle crashes. It is therefore crucial to maximize the safety within the work zone while maintaining under a limited budget. The purpose of this study is to improve work zone safety within a limited budget most efficiently. This study will develop an optimization model to determine appropriate budget for improving work zone safety. The appropriate budget can be defined as the budget below which the rate of safety improvement per dollar spending is higher than the spending above the budget. The primary factors in the model included a wide range of safety countermeasures and the implementation costs. The model identified a best mix of safety countermeasures minimizing expected number of crashes based on the crash modification factors of the safety countermeasures within an appropriate budget. The appropriate budget was determined by conducting a sensitivity analysis. The developed methodology utilized a linear integer programming to identify the best mix of safety countermeasures. The methodology was implemented on a work zone project as a case study. The developed methodology will help engineers in making funding decisions to improve safety on work zones.

Emergency Response Times for Fatal Motor Vehicle Crashes, 1975–2017

Emergency response times are an important component of road safety outcomes. Research has shown that there are potential benefits from shortened response times in patient outcomes for motor vehicle crashes. While a safety analysis may identify a decrease in traffic fatalities, that decrease may be a result of improved road safety or it may simply reflect improved emergency response times. However, it is currently unclear how emergency response times have changed over the last few decades. With data from the Fatality Analysis Reporting System (FARS), we identify the national trend in emergency response times from 1975 through 2017. To control for changes in response time, we analyze crashes that resulted in an immediate death. Results suggest that emergency response times have improved by approximately 50% over this timeframe. Additionally, we analyze response time trends in three states (North Carolina, Georgia, and Louisiana) that had consistent data and large sample sizes, finding patterns similar to the national trend. Outcomes suggest higher response times in rural areas. High standard deviations of average response times observed from 2003 to 2008 indicate a need for improvement in data collection. Future work could aim to better understand and reduce response times specific to certain regions and understand the effect of the popularization of cell phone usage. Our findings have important implications for fatality-based traffic safety analyses. Improving response time could help continue the trend of reduced mortality rates caused by motor vehicle crashes in the United States.

Brain-based limitations in attention and secondary task engagement during high-fidelity driving simulation among young adults.

Distracted driving remains a leading factor in fatal motor vehicle crashes, particularly in young drivers. Due to ongoing neuromaturation, attention capabilities are changing and improving throughout young adulthood. Here, we sought to bridge neuroscience with driving simulation by evaluating the effects of driving on attention processing through a selective auditory attention task. Participants (18-25 years old) engaged in an auditory attention task during LOAD (driving a high-fidelity simulator) and No-LOAD conditions (sitting in the parked simulator). For the auditory task, participants responded to a target auditory tone in a target ear. The event-related potential components, collected from frontal and posterior regions, P2 and P3, were used to evaluate attention processing across LOAD and No-LOAD conditions for attended and unattended stimuli. Data from 24 participants were evaluated in repeated measures ANOVAs, considering interactions between load and attention conditions for the P2 and P3 components of the cortical region. We observed a significant difference between response to attended and unattended stimuli for posterior P2 and P3 responses at the frontal and posterior midline sites. Comparing LOAD and No-LOAD conditions, there was a significant difference for P2 response at the posterior site and P3 response at the frontal site. A significant interaction between load and attended stimuli was found for P3 response at the posterior site. These data document differences in neural processing of auditory stimuli during high-fidelity simulated driving versus sitting parked in the simulator. Findings suggest the cognitive load of driving affects auditory attention.

Distracted Driving Laws and Motor Vehicle Crash Fatalities

Motor vehicle crashes (MVCs) continue to be the leading cause of death in youth 16 to 24 years old in the United States. Distracted driving has been shown to increase the risk of MVCs in all drivers, particularly teenagers. We aimed to determine the association between fatal MVC rates involving 16- to 19-year-old drivers and state distracted driving laws. We conducted a retrospective time series analysis of fatal MVCs in the United States involving drivers and passengers 16 to 19 years old from 2007 to 2017 using the Fatality Analysis Reporting System. Multivariable negative binomial regression analysis was performed to compare MVC rates across states on the basis of different types and strengths of distracted driving laws. There were 38 215 drivers 16 to 19 years old involved in fatal MVCs from 2007 to 2017. Incidence of fatal MVCs was highest for 19-year-old drivers (27.2 out of 100 000 19-year-old persons) and lowest for 16-year-olds (10.7 out of 100 000). States with primarily enforced texting bans had lower MVC fatality rates overall involving 16- to 19-year-old drivers (adjusted incidence rate ratio: 0.71; 95% confidence interval: 0.67-0.76). Texting bans and handheld bans for all drivers were associated with decreased MVC fatalities in all age groups. In the United States, primarily enforced distracted driving laws are associated with a lower incidence of fatal MVCs involving 16- to 19-year-old drivers. Bans on all handheld device use and texting bans for all drivers are associated with the greatest decrease in fatal MVCs. Adoption of universal handheld cellphone bans in all states may reduce the incidence of distracted driving and decrease MVC fatalities.

The impact of state laws on motor vehicle fatality rates, 1999-2015.

Motor vehicle crash (MVC) fatalities have been declining while states passed various legislation targeting driver behaviors. This study assesses the impact of state laws on MVC fatality rates to determine which laws were effective. Publically available data were collected on driver-related motor vehicle laws, law strengths, enactment years, and numbers of verified-trauma centers. Prospective data on crash characteristics and MVC fatalities 16 years or older from Fatality Analysis Reporting System 1999 to 2015 (n = 850) were obtained. Generalize Linear Autoregressive Modeling was used to assess the relative contribution of state laws to the crude MVC fatality rate while controlling for other factors. Lowering the minimum blood alcohol content (BAC) was associated with largest declines for all ages, especially the older cohorts: 16 years to 20 years (B = 0.23; p < 0.001), 21 years to 55 years (B = 1.7; p < 0.001); 56 years to 65 years (B = 3.2; p < 0.001); older than 65 years (B = 4.1; p < 0.001). Other driving under the influence laws were also significant. Per se BAC laws accompanying a reduced BAC further contributed to declines in crude fatality rates: 21 years to 55 years (B = -0.13; p < 0.001); older than 65 years (B = -0.17; p < 0.05). Driving under the influence laws enhancing the penalties, making revocation automatic, or targeting social hosts had mixed effects by age. Increased enforcement, mandatory education, vehicle impoundment, interlock devices, and underage alcohol laws showed no association with declining mortality rates. Red light camera and seatbelt laws were associated with declines in mortality rates for all ages except for older than 65 years cohort, but speed camera laws had no effect. Graduated Driver License laws were associated with declines for 16 years to 21 years (B = -0.06; p < 0.001) only. Laws targeting specific risks (elderly, motorcycles, marijuana) showed no effect on declining MVC mortality rates during the study period. States have passed a wide variety of laws with varying effectiveness. A few key laws, specifically laws lowering allowable BAC, implementing red light cameras, and mandating seatbelt use significantly reduced MVC mortality rates from 1999 to 2015. Simply adding more laws/penalties may not equate directly to lives saved. Continued research on state laws will better inform policy makers to meet evolving public health needs in the management of MVC fatalities. Epidemiological, Level III.

Alcohol Policies and Motor Vehicle Crash Deaths Involving Blood Alcohol Concentrations Below 0.08%

Motor vehicle crashes are a leading cause of injury death in the U.S. Restrictive alcohol policies protect against crashes involving alcohol above the legal blood alcohol concentration of 0.08%. Characteristics of motor vehicle crash fatalities involving blood alcohol concentrations below the limit and their relationships to alcohol control policies have not been well characterized. Motor vehicle crash fatality data and crash and decedent characteristics from 2000 to 2015 came from the Fatality Analysis Reporting System and were analyzed in 2018-2019. Alcohol Policy Scale scores characterized alcohol policy environments by state-year. Generalized estimating equation alternating logistic regression models assessed these scores and the odds that a fatality involved alcohol below the legal threshold. Of 612,030 motor vehicle crash fatalities, 223,471 (37%) died in alcohol-involved crashes, of which 33,965 (15% of alcohol-involved fatalities or 6% of all fatalities) had a blood alcohol concentration <0.08%. A 10 percentage point increase in Alcohol Policy Scale score, approximating the interquartile range among states, was associated with reduced odds of fatalities involving alcohol <0.08% vs 0.00% (AOR=0.91, 95% CI=0.89, 0.93). These findings held across multiple subgroup analyses by decedent and crash characteristics. Similar results were found for odds of alcohol involvement <0.05% vs 0.00% (AOR=0.90, 95% CI=0.88, 0.93), and ≥0.05% but <0.08% vs <0.05% (AOR=0.93, 95% CI=0.89, 0.96). The number of lower blood alcohol concentration fatalities is substantial. States with more restrictive alcohol policies tend to have reduced odds of lower blood alcohol concentration motor vehicle crashes than states with weaker policies.

The association between legalization of cannabis use and traffic deaths in Uruguay.

While cannabis use has been found to impair motor vehicle driving, the association between cannabis legalization and motor vehicle fatalities is unclear. In Uruguay in December 2013, cannabis for recreational purposes was legalized. This study assessed the association between implementation of this law and changes in traffic fatality rates. Interrupted time-series analysis of traffic fatality rates of light motor vehicle drivers and motorcyclists in urban and rural settings. Changes are reported as step and trend effects against modeled trends in the absence of legalization. Uruguay, Montevideo and four rural provinces (Colonia, Florida, Río Negro and San José) from 1January 2012 to 31December 2017. Cases and measurement Weekly traffic fatalities of light motor vehicle drivers and motorcyclists per type of vehicle. Data were gathered from the National Road Safety Agency of Uruguay and the Ministry of Transport and Public Works, respectively. Cannabis legalization was associated with a 52.4% immediate increase [95% confidence interval (CI)=11.6, 93.3, P=0.012] in the light motor vehicle driver's fatality rate. However, no significant change in the motorcyclists' fatality rate was observed. In Montevideo the legislation was associated with an absolute increase in its light motor vehicle driver's fatality rate by 0.06 (95% CI=0.01, 0.11, P = 0.025), but no significant associations were observed in rural settings. In Uruguay, the 2013 legislation legalizing recreational cannabis consumption may have been associated with an increase in fatal motor vehicle crashes, particularly in light motor-vehicle drivers and urban settings.

Burden of disease from transportation noise and motor vehicle crashes: Analysis of data from Houston, Texas

BackgroundTransportation systems have an essential role in satisfying individuals’ needs for mobility and accessibility. Yet, they have been linked to several adverse health impacts, with a large, but modifiable, burden of disease. Among the several transportation-related health risk factors, this study focused on transportation-related noise as an emerging exposure whose burden of disease remains partially recognized. We compared premature deaths potentially attributable to transportation-related noise with deaths from motor vehicle crashes, a well-researched and widely recognized transportation risk factor. MethodWe employed a standard burden of disease assessment framework to quantify premature cardiovascular diseases mortality attributable to transportation-related (road and aviation) noise at the census tract level (n = 592) in Houston, Texas. The results were compared to motor vehicle crash fatalities, which are routinely observed and collected in the study area. We also investigated the distribution of premature deaths across the city and explored the relationship between household median income and premature deaths attributable to transportation-related noise. ResultsWe estimated 302 (95% CI: 185–427) premature deaths (adults 30–75 years old) attributable to transportation-related noise in Houston, compared to 330 fatalities from motor vehicle crashes (adults younger than 75 years old). Transportation-related noise and motor vehicle crashes were responsible for 1.7% and 1.9% of all-cause premature deaths in Houston, respectively. Households with lower median income had a higher risk of adverse exposure and premature deaths potentially attributable to transportation-related noise. A larger number of premature deaths was associated with living in the central business district and the vicinity of highways and airports. ConclusionThis study highlighted the significant contribution of transportation-related noise and motor vehicle crashes to premature deaths in the city of Houston. The analogy between the estimated premature deaths attributable to transportation-related noise and motor vehicle crashes showed that the health impacts of transportation-related noise were as significant as motor vehicle crashes. The estimated premature death rate attributable to transportation-related noise was also comparable to the death rate caused by suicide, influenza, or pneumonia in the US. There is an urgent need for imposing policies to reduce transportation noise emissions and human exposures and to equip health impact assessment tools with a noise burden of disease analysis function.

A Time Series Analysis of Motor Vehicle Crash Fatalities in New York State

Motor vehicle crashes are happening almost every day and unfortunately, some of them occur with fatality injuries. This paper presents a time series analysis on the trend and pattern of motor vehicle crash fatalities by month, day and day of the week in New York State. In this analysis, a statistical methodology for the decomposition of time series is used. The Kolmogorov – Zurbenko filter is used for decomposition of the crash fatalities into the long and seasonal and short-term component. Long-term component showed a 2 % decreases trend annually and seasonal term suggested increases of crash fatalities during the summer and decreases during winter period. The results indicate that sudden changes on trend are related to recessions that have occurred in USA. Another risk factor for crash fatalities in New York may be due to day light savings time that reduces light and visibility for drivers.

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.

PRECIPITATION AND FATAL MOTOR VEHICLE CRASHES: Continental Analysis with High-Resolution Radar Data.

Precipitation, even at light intensity, contributes a significant risk of fatal motor vehicle crashes across the United States, at nearly all times of day, and in all seasons.

Tribal Transportation Specialists’ Priorities for Reservation Roadway Safety: Results of a National Survey

The focus of this study is roadway safety in American Indian tribal lands. American Indians’ motor vehicle crash fatality rate is the highest among all ethnic and racial groups in the United States. Roadway safety in tribal areas, where approximately 656 fatalities occur each year, is an important aspect of this problem. Following a review of crash statistics from recently published research, we present our empirical analysis of the expressed concerns of roadway safety managers with the most informed, direct knowledge of reservations and tribal areas. The data source is the 2016 Tribal Transportation Safety Data Survey, including 151 tribal government and 22 state government respondents. Qualitative methods were used to analyze their perceptions and priorities for roadway safety. We identified: 1) tribes’ and states’ highest priorities for roadway safety in tribal lands, and 2) their concerns about state government relationships relating to data quality, data sharing, and coordination. Tribes consistently named four concerns: road quality engineering and repair; reckless driving (speeding, impaired, distracted driving); seatbelt/car seat use; and pedestrian safety. Tribes and states both expressed a wish to improve their relationships, particularly relating to data quality and sharing, with both sides identifying the need for tribes to have more resources for data documentation and analysis. We conclude with recommendations to improve tribal roadway safety plans, strengthen data quality, create a common framework for identifying roads of interest to tribal governments and communities, and conduct additional research on pedestrian safety, emergency medical service response, roadway departures, and nonfatal crashes.

Prescription opioids, alcohol and fatal motor vehicle crashes: a population-based case-control study

BackgroundThe prevalence of prescription opioid use among drivers has increased markedly in the past two decades. The purpose of this study is to assess the associations of prescription opioid use and alcohol use with the risk of fatal crash involvement in US drivers.MethodsWe performed a population-based case-control study using toxicological testing data from two national data systems. Cases (n = 3606) were drivers involved in fatal motor vehicle crashes selected from the Fatality Analysis Reporting System and controls (n = 15,600) were drivers participating in the 2007 and 2013 National Roadside Surveys of Alcohol and Drug Use by Drivers. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) of fatal crash involvement associated with prescription opioid use with and without the presence of alcohol.ResultsOverall, cases were significantly more likely than controls to test positive for prescription opioids (5.0% vs. 3.7%, p < 0.001), alcohol (56.2% vs. 7.1%, p < 0.0001), and both substances (2.2% vs. 0.2%, p < 0.001). Relative to drivers testing negative for prescription opioids and alcohol, the adjusted ORs of fatal crash involvement were 1.72 (95% CI: 1.37, 2.17) for those testing positive for prescription opioids and negative for alcohol, 17.92 (95% CI: 16.19, 19.84) for those testing positive for alcohol and negative for prescription opioids, and 21.89 (95% CI: 14.38, 33.32) for those testing positive for both substances. The interaction effect on fatal crash risk of prescription opioid use and alcohol use was not statistically significant on either additive or multiplicative scale.ConclusionsPrescription opioid use is associated with a significantly increased risk of fatal crash involvement independently of alcohol use. Concurrent use of prescription opioids and alcohol is associated with a 21-fold increased risk of fatal crash involvement.