Seat Belt Laws Research Articles

Alcohol and marijuana use among young injured drivers in Arizona, 2008–2014

Objective: We examined alcohol and marijuana use among injured drivers aged 16–20 years evaluated at Arizona level 1 trauma centers during 2008–2014.Methods: Using data from the Arizona State Trauma Registry, we conducted a descriptive analysis of blood alcohol concentration (BAC) and qualitative test results (positive or negative) for delta-9-tetrahydrocannabinol (THC) by year of age, sex, race, ethnicity, injury severity, seat belt use, motorcycle helmet use, and type of vehicle driven. To explore compliance with Arizona’s motorcycle helmet law requiring helmet use for riders <18 years old, we examined helmet use by age.Results: Data on 5,069 injured young drivers were analyzed; the annual number of injured drivers declined by 41% during the 7-year study period. Among the 76% (n = 3,849) of drivers with BAC results, 19% tested positive, indicating that at least 15% of all drivers had positive BACs. Eighty-two percent of the BAC-positive drivers had BACs ≥0.08 g/dL, the illegal threshold for drivers aged ≥21 years. Among the 49% (n = 2,476) of drivers with THC results, 30% tested positive, indicating that at least 14% of all drivers were THC-positive. American Indians and blacks had the highest proportion of THC-tested drivers with positive THC results (38%). In addition, 28% of tested American Indians had positive results for both substances, more than twice the proportion seen in all other race or ethnic groups. Crude prevalence ratios suggested that drivers who tested positive for alcohol or THC were less likely than those who tested negative to wear a helmet or seat belt, further increasing their injury risk. Helmet use among motorcyclists was lower among 16- and 17-year-old riders compared to 18- to 20-year-olds, despite Arizona’s motorcycle helmet law requiring riders aged <18 years to wear a helmet.Conclusions: About 1 in 4 injured drivers aged 16–20 years tested positive for alcohol, THC, or both substances. Most drivers with positive BACs were legally intoxicated (BAC ≥0.08 g/dL). All substance-using young drivers in this study were candidates for substance abuse screening and possible referral to treatment. Broader enforcement of existing laws targeting underage access to alcohol and alcohol-impaired driving could further reduce injuries among young Arizona drivers. To further reduce crash-related injuries and fatalities among all road users, the state could consider implementing a primary enforcement seat belt law and a universal motorcycle helmet law.

Pattern of Maxillofacial Trauma in the Nigerian Population

Introduction: The pattern of trauma to the maxillofacial region differs in various parts of the world. Studies have shown that not only does it differ from one continent to the other, it differs from one country to another within the same continent and from one zone to another within the same country. These have been ascribed to the prevailing socioeconomic, cultural and environmental factors in the study area. It is important that patterns of maxillofacial injuries should be continuously evaluated so that efforts should be put in place to reduce the incidence. The aim of the present study is therefore to describe the patterns of maxillofacial injuries in the Nigerian literature.Methods: The MEDLINE was used to conduct a computerized literature search using for publications on maxillofacial trauma in Nigeria. For this search, the medical subject headings on "maxillofacial fractures" or "mandible fractures" or "middle-third fractures" or "facial fractures" or "zygoma fractures" were combined with "Nigeria". Also, the publications cited in these articles to look for additional important articles but were not found on MEDLINE were searched for.Results: Most of the studies were retrospective while the commonest geopolitical zone where studies were done was the South West region. The commonest cause of maxillofacial injuries was road traffic accident while the commonest age group was the 21-30 years.Conclusion: Road traffic accident is the commonest cause of maxillofacial injuries. It is therefore recommended that the appropriate authorities should enforce seat belt and helmet laws. The government should provide street lights, good roads, pedestrian bridges and traffic lights to reduce vehicular/vehicular and human/vehicular/human collisions.&#x0D; &#x0D; &#x0D;

Evaluating Seat Belt Use in Lebanon (1997-2017)

Introduction:The use of seat belts has made a significant contribution to the reduction of road traffic casualties, and the risk inherent with not wearing seat belts in all seats of a vehicle is now well-known worldwide. The use of seat belts has a major role in reducing fatal and nonfatal injuries in all types of motor-vehicles crashes.Aim:The aim of this study is to understand the reasons behind the variation in seat belt use over the past two decades in Lebanon. It analyzes the situation and suggests recommendations to improve seat belt use in Lebanon.Design:Nine observational studies had been conducted in Lebanon during the last two decades between 1997 and 2017, and one qualitative study was performed in 2017.Results:The results show a significant variation in the use of the seat belt. When enforcement efforts are in progress, seat belt use increases. While when there are no checkpoints and the enforcement of seat belt use is almost absent, a significant fall was noticed.Discussion:The results of this study proved the failure of the Lebanese government in saving hundreds of lives just by a simple measure of enforcing seat belt law. Although experiences from various countries prove that such laws usually have a long-lasting effect on seat belt use, Lebanon failed to pursue the successful implementation of this law due to security and political problems.Conclusion:During the past two decades, Lebanon witnessed continuous fluctuations in seat belt use. Outside few short enforcement campaigns, our observations showed lack in seat belt use. Our observations of seat belt use among drivers and front seat passengers showed a significant correlation between seat belt use and the enforcement of seat belt law.The greatest national benefits from seat belt use are obtained when wearing rates are very high. This can be achieved only through a sustained enforcement campaign alongside other seat belt wearing interventions such as publicity and education.

Road traffic injuries measures in the Eastern Mediterranean Region: findings from the Global Status Report on Road Safety - 2015.

:Background:The Eastern Mediterranean Region has the second highest road traffic fatality rate in the world. This article presents the epidemiology of road traffic injuries and the preventive measures in Eastern Mediterranean Region taken by the different World Health Organization member states compared to the rest of the world.Methods:This is a secondary data analysis addressing the Global Status Report on Road Safety published by the World Health Organization in 2015. Data are from 180 countries covering 6.97 billion people of the world’s population, of which 21 Eastern Mediterranean Region of World Health Organization member states with about 595 million population were included and were analyzed. From 22 countries in the region, 21 are presented and Syria has not reported any data on road traffic injuries.Results:Eastern Mediterranean Region member states contribute to 9.69% of all global fatal road traffic injuries (19.9 per 100 000 population compared to the same rate in the European region with 9.3), while these countries account for 7.4% of the world’s population and have about 5.6% of the world’s vehicles on their roads. More than 90% of the Eastern Mediterranean Region countries have passed mandatory seat-belt laws for both front-seat and rear-seat passengers and making helmet use obligatory; and only 27% have child restraint laws; half percent have an emergency room injury surveillance system. All countries have a national drink-driving law; and certain speed limits but there is no distinction between rural and urban areas, and the latter lack adequate speed restrictions.Conclusions:Although the Eastern Mediterranean Region member states have some important preventive measures recommended by World Health Organization, considerable efforts are still needed to optimize the enforcement of existing road safety laws. The maximum urban speed limit should be reduced in many countries. Sufficient attention should be paid to the needs of pedestrians, cyclists and motorcyclists, who together make up about 50% of Eastern Mediterranean Region road traffic deaths.

Decomposition analysis of the effects of vehicle safety technologies on the motor vehicle collision–related mortality rate from 1994 to 2015

Objective: Though the mortality rate for motor vehicle collisions (MVCs) has been decreasing since the 1960s with the advent of the first federal seat belt laws in 1968, MVC remains a leading cause of death for individuals aged 1 to 44 years. The purpose of this study is to examine the effects of frontal (FABs) and side airbags (SABs) and electronic stability control (ESC) on the components of the MVC mortality rate.Methods: The MVC mortality rate from 1994 to 2015 was separated into its components of exposure of vehicles, exposure of travel, collision density, injury incidence, and case fatality rate. Year was categorized on the availability of safety technology in vehicles: 1994–1997 (first-generation FABs mandated), 1998–2001 (sled-certified, second-generation FABs mandated), 2002–2006 (increasing prevalence of SABs and ESC), 2007–2011 (advanced airbags mandated), and 2012–2015 (ESC mandated, SAB in over 90% of vehicles, introduction of advanced safety systems). Relative contributions (RCs) of the components to changes in the MVC-related mortality rate were calculated as the absolute value of the component’s beta coefficient divided by the sum of the absolute values of all components’ beta coefficients. Negative binomial regression–estimated rate ratios (RRs) for the changes in the rate of each component by year category compared to the prior year category.Results: Significant decreases in the MVC mortality rate were observed for 2007–2011 and 2012–2015. The decrease in 2007–2011 was due in most part to an 18% decrease in the injury incidence (RR = 0.82, P < .0001, RC = 63%), though there was a noted contribution by the decrease in vehicle miles traveled (RR = 0.95, P < .0001, RC = 15%). The continued decrease in mortality in 2012–2015 was due is most part to the 10% decreased case fatality rate (RR = 0.90, P < .0001, RC = 66%) because there was no significant change in the vehicle miles traveled and injury incidence.Conclusions: The results of this study highlight the effects of vehicle safety technologies on the MVC-related mortality rate and can help direct prevention efforts. Through the study period, there was no meaningful contribution to decreases in the MVC-related mortality rate due to components related to exposure (i.e., vehicles per population and the rate of vehicle miles traveled), suggesting that prevention efforts at decreasing exposure prevalence would have little effect on the MVC-related mortality rate. Instead, prevention efforts should continue to focus on event-phase methods to decrease injury occurrence and mitigate injury severity during the collision.

Belief about seat belt use and seat belt wearing behavior among front and rear seat passengers in the United States

Introduction: Unrestrained drivers and passengers represent almost half of all passenger vehicle occupant deaths in the United States. The current study assessed the relationship between the belief about importance of seat belt use and the behavior of always wearing a seat belt. Method: Data from 2012 ConsumerStyles were analyzed separately for front and rear passenger seating positions. Multivariable regression models were constructed to identify the association between seat belt belief and behavior (i.e., always wears seat belt) among adults. Models controlled for type of state seat belt law (primary, secondary, or none). Results: Seat belt use was higher in front passenger seats (86.1%) than in rear passenger seats (61.6%). Similarly, belief that seat belt use was very important was higher in reference to the front passenger seat (84.2%) versus the rear passenger seat (70.5%). For the front passenger seat, belief was significantly associated with seat belt use in states with both primary enforcement laws (adjPR 1.64) and secondary enforcement laws (adjPR 2.77). For the rear passenger seat, belief was also significantly associated with seat belt use, and two 2-way interactions were observed (belief by sex, belief by region). Conclusions: Despite overall high rates of seat belt use in the United States, certain groups are less likely to buckle up than others. The study findings suggest that efforts to increase seat belt use among high-risk populations, such as those who live in states with secondary or no seat belt laws and those who ride in rear seats (which include people who utilize taxis or ride-hailing vehicles) could benefit from interventions designed to strengthen beliefs related to the benefits of seat belt use. Practical applications: Future research that uses a theoretical framework to better understand the relationship between beliefs and behavior may inform interventions to improve seat belt use.

The effect of verified pediatric trauma centers, state laws, and crash characteristics on time trends in adolescent motor vehicle fatalities, 1999-2015.

Motor vehicle crashes are a leading cause of adolescent death from trauma. A recent study found American College of Surgeons-verified pediatric trauma centers (vPTC) were inversely correlated with pediatric mortality, but the analysis was limited to a single year. This study assesses the contribution of vPTCs, crash characteristics, and state driver laws on 15- to 17-year-old motor vehicle crash mortality for all 50 states from 1999 to 2015. Prospective data on motor vehicle fatalities, crash characteristics, state driving laws, and American College of Surgeons-verified trauma centers were collected from publicly available sources for 50 US states from 1999 to 2015. A mixed fixed/random effects multivariate regression model was fitted to assess the relative contribution of crash characteristics, state laws, and vPTCs while controlling for state variation and time trends. The final regression model included driver and crash characteristics, verified trauma centers, and state laws. Camera laws ([B = -0.57 [p < 0.001]) were associated with a 57% decrease in the rate of change in adolescent crude fatalities. The lagged Level 1 vPTC crude rate (B = -0.12 [p < .001]) was protective and contributed independently to a 12% decline in the rate of change in teen fatalities over the time period. Seat belt laws (B = -0.15 [p < 0.001]), graduated driver's license passenger restrictions (B = -0.07[p < 0.001]), graduated driver's license learner permit period (B = -0.04 [p < 0.002]), nondeployed airbag (B = -0.003 [p < 0.001]), and Hispanic heritage (B = -0.003 [p < 0.05]) were protective. Increased risk of fatality was associated with minivan (B = 0.01 [p < 0.001]), speed > 90 mph (B = 0.004 [p < 0.001]), rural roads (B = 0.002 [p < 0.002], unknown seat belt compliance (B = 0.004 [p < 0.001]), and dry road surface (B = 0.005 [p < 0.001]). State camera laws during the study time frame are associated with a 57% decrease in the rate of change in adolescent crude fatalities; vPTCs during the study time period reduced overall rate of change in the crude fatality rate by 12%. State laws, restrictions on teenage passengers and longer learner's permit periods, and seat belt laws are associated with significant decreases in the crude teen mortality rate. Prospective study and prevention, level III.

The effectiveness of introducing detection cameras on compliance with mobile phone and seatbelt laws: a before-after study among drivers in Riyadh, Saudi Arabia

BackgroundBecause Saudi Arabia (SA) has struggled with the burden of Road Traffic Injuries (RTIs) for decades, a new automated citations system was implemented in 2018 to improve compliance with seatbelt and mobile phone laws. Therefore, the purpose of this study is to evaluate the impact of the system on the prevalence of seatbelt and mobile phone use among drivers in Riyadh. This is an observational study conducted between 2017 and 2018. A Pre-Post evaluation was employed to determine the impact of a camera detection system on seatbelt and mobile phone use. Two research coordinators collected the observations at several highways and inner intersections around Riyadh (n = 3400). We evaluated differences in the prevalence of seatbelt and mobile phone use across the two time periods using a chi-2 test. In addition, we evaluated the association between the new intervention and traffic violation using a logistic regression model.ResultsThe overall seatbelt compliance increased significantly from 33.9% (95% CI = 31.7–36.2) to 75.8% (95% CI = 73.7–77.8; P < 0.01). In addition, mobile phone use declined significantly from 13.8% (95% CI = 12.2–15.5) to 9.8 (95% CI = 8.8–9.1; P < 0.01). We found the detection system to be associated with a significant increase in seatbelt use and also a significant decline in mobile phone use while driving. After implementing the intervention, drivers were 6.1 times (OR = 6.1, 95% CI = 5.2–7.0) more likely to wear seatbelts than before the technology went into effect. Similarly, drivers observed after implementing the cameras were 32% (OR = 0.68, 95% CI = 0.55,0.84) less likely to use mobile phones while driving than those seen prior to the intervention.ConclusionsThis study found a significant reduction in traffic violations following the implementation of a camera detection system in Riyadh. This positive impact is evidence for the role preventative structural strategies play to improve traffic safety and reduce RTI in SA. Therefore, these findings may facilitate further support for policymakers that public health interventions play a significant role to improve traffic safety. Seatbelt and mobile phone use while driving should continue to be monitored, and traffic police may evaluate whether increasing the fine is associated with a significant reduction in traffic violations and associated crashes.

Estimating the Effect of Standard Enforcement of a Rear Seat Belt Law for Rear Seat Fatality Prevention

Data were collected from the NHTSA’s Fatality Analysis Reporting System to analyze the link between primary enforcement of rear seat belt use and injury severity in fatal vehicle collisions. Specifically, this study predicted the amount of fatalities that may have been prevented had there been standard enforcement of a rear seat belt law in effect. Previous literature concludes that increasing seat belt use will decrease injury severity in collisions and the primary enforcement of seat belts laws will increase seat belt use by approximately 14%. This study recorded and compared the number of rear seat fatalities in states that did and did not have primary enforcement laws for rear seat occupants. The results indicated that, on average, for every properly restrained rear seat fatality there are 0.45 more rear seat fatalities in states without primary enforcement than states with primary enforcement. It also predicts that the states that do not practice standard seat belt enforcement could have seen approximately 772 to 1,032 fatalities prevented from 2011 to 2015, had there been primary rear seat belt enforcement. This corresponds to an estimated national crash cost savings of $8.6 billion, or $1.7 billion annually.

2448 - Toward Zero Road Death Vision Assessment the Role Auto-Dependency, Public Health, and Active Transportation Modes: 2nd Highest Scoring Abstract: Early career/Post-doctoral

Background One of the most significant costs associated with automobile travel in the US is the number of road accidents and fatalities that this type of transportation incurs. To control these costs, in 2015, the USDOT announced that “zero road deaths” is the official policy of the US federal government transportation safety. This policy envisions zero deaths as the ultimate road safety goal. To achieve this ambition, we need a consistent understanding of all potential determinants of road safety in the national level. Accordingly, this research provides a framework to investigate the impact of a wide range of variables on traffic fatality rates (defined as deaths per 100,000 people). We particularly examine the effect of auto-dependency indicators, public health factors, and active transportation modes on the road safety outcomes. Methods For this purpose, a previously developed conceptual framework has been used which classified road safety contributing factors into seven separate sets: exposure, travel behavior, socio-economics, infrastructure and urban form, safety policies, and mitigating factors such as health care. This framework is tested using series of panel data models. These models investigate both spatial and temporal variations in safety patterns for the fifty states, along with DC, using annual data from 1997 to 2014. A complimentary analysis is conducted to assess the impact of factors which just available for few years of analysis like walking and biking variables. Results The results of our panel models illustrate that two variables Vehicle Miles Traveled and Vehicles per Capita , representing the level of auto-dependency, have the strongest impact on traffic fatalities. The elasticity analysis reveals that a 10% increase in VMT per vehicle is associated with 8.6% increase in road fatalities. Likewise, a 10% increase in vehicle ownership rate results in a 8.0% increase in road fatalities. This is closely followed by Infant Mortality Rates, the proxy that we used to represent the public health care. The results of complimentary analysis show that states with higher urban density, more walking, and more cycling are associated with lower traffic fatality rates. Conclusions Our findings suggest that if additional progress is to be made in reducing traffic fatalities, emphasis needs to move beyond simply focusing on policies such as seat belt laws. This research provides an order of factors influencing road fatalities, this order can help American policy makers to provide a more efficient road map for progress towards zero road death target.

2440 - Analyzing Border to Border (B2B): Nationwide Campaign to Increase Seat Belt Use and Enforcement along State Borders

Each year, approximately 40,000 Americans die in traffic crashes and almost three million are injured. In 2016, with a 90 percent national seat belt use rate, seat belts prevented 14,668 fatalities. In 2010, the medical and work loss combined cost for occupant fatalities in motor vehicle crashes was over $12 billion. Sadly, many of these fatalities, injuries, and costs could have been prevented if the victims had been wearing seat belts or were properly restrained in child seats. In 2015, only 52% of those killed in motor vehicle crashes were restrained. Despite an overall increase in seat belt use over the past decade, traffic crashes are still the leading cause of unintentional injury-related death in the United States. Primary seat belt laws have proven to be effective in increasing state’s seat belt use rate. When States upgrade their laws from secondary to primary, significant increases in safety belt use are often observed. This report will look at the National Highway Traffic Safety Administration’s Border to Border initiative aimed at addressing seat belt non-use. Border to Border (B2B) is a one-day seat belt-awareness effort coordinated by participating State highway safety offices and their respective law enforcement liaisons. The goal is to reduce seat belt fatalities in their regions by implementing the Click It or Ticket (CIOT) campaign brand. The B2B program aims to increase law enforcement participation by coordinating highly visible seat belt enforcement and providing seat belt fact sheets for drivers at heavily traveled and highly visible areas along state borders. The B2B initiative encourages cross-jurisdiction collaboration, across State borders, which will help law enforcement officers enforce seat belt laws. Since its inception in 2014, Region 2 has spearheaded the B2B program. Due to its size and success this year, NHTSA national headquarters is organizing the effort for 2018, which will include a 4-hour enforcement crackdown on May 21. This report will outline the expansion of the B2B program to a nationwide level. It will discuss state participation; engagement of law enforcement agencies, citations issued, and earned media. In addition to the results, it will look at the overall strengths and challenges of the initiative to inform future programs that require cross state collaboration by law makers, law enforcement, and public health programs globally.

2448 - Toward Zero Road Death Vision Assessment the Role Auto-Dependency, Public Health, and Active Transportation Modes

2nd Highest Scoring Abstract: Early Career/Post-doctoral Background One of the most significant costs associated with automobile travel in the US is the number of road accidents and fatalities that this type of transportation incurs. To control these costs, in 2015, the USDOT announced that “zero road deaths” is the official policy of the US federal government transportation safety. This policy envisions zero deaths as the ultimate road safety goal. To achieve this ambition, we need a consistent understanding of all potential determinants of road safety in the national level. Accordingly, this research provides a framework to investigate the impact of a wide range of variables on traffic fatality rates (defined as deaths per 100,000 people). We particularly examine the effect of auto-dependency indicators, public health factors, and active transportation modes on the road safety outcomes. Methods For this purpose, a previously developed conceptual framework has been used which classified road safety contributing factors into seven separate sets: exposure, travel behavior, socio-economics, infrastructure and urban form, safety policies, and mitigating factors such as health care. This framework is tested using series of panel data models. These models investigate both spatial and temporal variations in safety patterns for the fifty states, along with DC, using annual data from 1997 to 2014. A complimentary analysis is conducted to assess the impact of factors which just available for few years of analysis like walking and biking variables. Results The results of our panel models illustrate that two variables Vehicle Miles Traveled and Vehicles per Capita , representing the level of auto-dependency, have the strongest impact on traffic fatalities. The elasticity analysis reveals that a 10% increase in VMT per vehicle is associated with 8.6% increase in road fatalities. Likewise, a 10% increase in vehicle ownership rate results in a 8.0% increase in road fatalities. This is closely followed by Infant Mortality Rates, the proxy that we used to represent the public health care. The results of complimentary analysis show that states with higher urban density, more walking, and more cycling are associated with lower traffic fatality rates. Conclusions Our findings suggest that if additional progress is to be made in reducing traffic fatalities, emphasis needs to move beyond simply focusing on policies such as seat belt laws. This research provides an order of factors influencing road fatalities, this order can help American policy makers to provide a more efficient road map for progress towards zero road death target.

The prevalence of seatbelt and mobile phone use among drivers in Riyadh, Saudi Arabia: An observational study

IntroductionRoad traffic injuries (RTIs) are the third leading cause of death in Saudi Arabia. Numerous factors may increase the likelihood of RTIs. The prevalence of risk factors associated with RTIs may vary due to several reasons. Because little is known about these risk factors locally, we examined the prevalence of mobile phone and seatbelt use and their association with spatial locations. MethodsThis is an observational study conducted at major highways and inner intersections throughout Riyadh, the country's capital. Two observers captured seatbelt and mobile phone use among drivers. Logistic regression models were constructed to examine the association between real estate prices and mobile phone or seatbelt use. Observations were categorized as taken place in an affluent neighborhood if the average price per square meter was above 2500 Saudi Riyal. ResultsA total of 1700 drivers were observed in 13 sites citywide. 13.8% of drivers were seen using mobile while driving and only a third of drivers (34%) were wearing seatbelts. Being at an affluent neighborhood was associated with close to three times higher odds of wearing seatbelts (OR = 2.7, 95% CI = 1.9–3.7) and also associated with 42% lower odds of mobile phone use among drivers (OR = 0.58, 95% CI = 0.36–0.92). DiscussionThis study found a high prevalence of traffic violations among drivers in Riyadh. Based on our estimate, 660,000 drivers are roaming the street during daytime while using their phones and they are less likely to wear seatbelts. Unfortunately, this estimate might contribute to increasing RTIs. Despite existing regulations, seatbelt use among drivers is significantly lower than in developed countries (i.e. USA 94%). ConclusionOur study found a high prevalence of traffic violations represented by lack of compliance with seatbelt and mobile phone use laws. These findings provide a basis for their underlying prevalence in SA. Practical applications: Public health prevention programs may use these findings to facilitate support to increasing investment in awareness campaigns and further enforcement by the traffic police to reduce RITs and improve population health.

The effectiveness of child restraint and seat belt legislation in reducing child injuries: The case of Serbia

ABSTRACTObjective: The objective of this study is to determine the short- and long-term impacts of Serbia's 2009 update of child restraint and seat belt legislation on the incidence of pediatric motor vehicle–related injury. With this new law, the use of child restraints in children age 0–3 became mandatory, and children 4–12 had to wear seat belts in the rear seats.Methods: A unique data set with assembled information from public institutions of the Republic of Serbia from January 2004 to December 2014 and analyses based on interrupted time series were carried out. Eight outcome variables were assessed: monthly rate of injured children for 2 age groups 0–3 and 4–12 per child population, number of registered motor vehicles, number of passengers transported, and number of passengers' kilometers traveled. Independent variables were short- and long-term impacts of Serbia's legislation update (June 2009). Data on injuries were obtained from Serbia's Road Traffic Safety Agency. Child population and other transport-related data were obtained from the Statistical Office of the Republic of Serbia. We excluded fatalities from the analysis.Results: In the first year of the updated legislation there was a reduction of 2.0% (confidence interval [CI], 0.1; 3.9) of injured children aged 0–3 and a reduction of 2.5% (CI, 0.6; 4.3) of injured children aged 4–12. Six years after enactment of the legislation, a significant reduction of 8.2% (CI, 3.5; 13.0) of injured children aged 4–12 was observed, but a nonsignificant reduction of 1.1% (CI, −5.8; 3.5) was found for injured children aged 0–3. By December 2014, 369 (CI, 186; 555) injuries among children aged 4–12 were avoided.Conclusions: The case of Serbia suggests that the new law was effective in reducing injuries among children aged 0–3 in the short term and injuries among children aged 4–12 in both the short term and long term. To understand these results, we suggest 2 hypotheses. First, low proper usage of child restraint and weak police enforcement were likely to explain the short-term effect among children aged 0–3. Second, access to seat belts in rear seats was probably a condition that facilitated the use of these devices among children aged 4–12, protecting them during the period of the study.

Burden of road traffic injuries related to delays in implementing safety belt laws in low- and lower-middle-income countries

ABSTRACTObjective: Delayed implementation of effective road safety policies must be considered when quantifying the avoidable part of the fatal and nonfatal injuries burden. We sought to assess the avoidable part of disability-adjusted life years (DALYs) lost due to road traffic injuries related to delays in implementing road safety laws in low- and lower-middle-income countries.Methods: We chose one country for each of the regions of the World Health Organization (WHO) and World Bank (WB) country income levels. We used freely available data sets (WHO, International Traffic Safety Data and Analysis Group, the WB). Delays in implementation were calculated until 2013, from the year mandatory use of safety belts by motor vehicle front seat occupants was first introduced worldwide. We used life expectancy tables and age groups as social values in the DALY calculation model. From the estimated total burden, avoidable DALYs were calculated using estimates of the effectiveness of seat belt laws on fatal and nonfatal injuries combined, as extracted from published international reviews of evidence.Results: From the reference year 1972, implementation delays varied from 27 years (Uzbekistan) to 41 years in Bolivia (no seat belt law as of 2013). During delays, total absolute numbers of DALYs lost due to road traffic injuries reached 8,462,099 in Nigeria, 7,203,570 in Morocco, 4,695,500 in Uzbekistan, 3,866,391 in Cambodia, 3,253,359 in Bolivia, and 3,128,721 in Sri Lanka. Using effectiveness estimates ranging from 3 to 20% reduction, the avoidable burden of road traffic injuries for car occupants was highest in Uzbekistan (avoidable part from 1.2 to 10.4%) and in Morocco (avoidable part from 1.5 to 12.3%). In countries where users of public transport and pedestrians were the most affected by the burden, the avoidable parts ranged from 0.5 to 4.4% (Nigeria) and from 0.5 to 3.4% (Bolivia). Burden of road traffic injuries mostly affected motorcyclists in Sri Lanka and Cambodia where the avoidable parts were less than 2% in both countries. In all selected countries, burden of traffic injuries mostly affected men (about 80%) as well as young people (15–34 years).Conclusions: Despite limited data availability in low- and middle-income countries, the avoidable part of the burden related to delayed intervention is measurable. These results can be used to convince countries to avoid delaying the provision of better protection to road users.

Child injury deaths linked with adult alcohol consumption: A time series analysis

ObjectiveThis paper aims to quantify the population-level associations between child injury deaths and adult (aged 15+ years) per capita alcohol consumption (PCC) and between child injury deaths and the impact of major alcohol and safety policy changes in Australia. MethodsAll child deaths due to external causes during 1910–2013, and child deaths due specifically to road crashes, assaults, suicide and other external causes, were obtained from the Australian Institute of Health and Welfare. Child (0–14 year) mortality rates were analysed in relation to PCC using an Autoregressive Integrated Moving Average model. ResultsA positive association between PCC and overall child external mortality was identified. The estimated coefficient was 0.326 (p = .002), indicating that a 10% decrease in PCC was associated with a 3.3% reduction in child injury mortality. A positive association was identified for road traffic and other child injury mortality, but not assault injuries. The introduction of compulsory seatbelt legislation in combination with random breath testing was associated with a reduction in overall injury and road traffic child mortality. Decreasing the legal drinking age was associated with an increase in the rate of other external-cause child mortality. ConclusionReducing PCC in Australia is likely to result in a small but significant reduction in the injury mortality rate of children aged 0–14 years.

Changing pattern and etiology of maxillofacial fractures during the civil uprising in Western Libya.

BackgroundThe purpose of the present study was to evaluate changing pattern in characteristics of maxillofacial fractures and concomitant injuries in Western Libya During revolution and to assess the association between mechanism of injury and fracture patterns.Material and MethodsA retrospective review of medical records and radiographs of 187 patients treated for maxillofacial fractures from January 2010 to December 2012 was performed, there were 326 fractures in 187 patients.ResultsThe male: female ratio was 6:1. Most fractures occurred in patients aged 11 to 40 years, and few injuries occurred in patients aged > 50 years. Most fractures occurred from motor vehicle accidents, and other most frequent causes included assault, gunshot, and fall injuries. Most maxillofacial fractures involved the mandible, zygomatic complex, or maxilla. Most mandibular fractures occurred at the parasymphysis, angle, or condyle. Associated injuries most frequently involved the head, chest, and extremities. Most patients were treated with open reduction (132 patients [71%]), and 26 patients (14%) were treated nonoperatively. There were 21 complications (11%).ConclusionsIn summary, motor vehicle accidents were the most frequent cause of maxillofacial fracture in western Libya, possibly because of the lack of seat belt legislation. Interpersonal violence was a less frequent cause of maxillofacial fracture, possibly because of the religious restriction on alcohol consumption. Key words:Tauma, mandible, zygomatic complex, maxilla, treatment, complications.

A mixed effects negative binomial analysis of road mortality determinants in Sub-Saharan African countries

This paper uses aggregate data for a panel of 23 Sub-Saharan African countries to explore the potential predictors of road traffic fatalities between 2001 and 2010. In addition to the Gross Domestic Product per capita, the set of covariates includes some demographic, safe driving behavior, health and infrastructure-related variables. Estimations from a mixed effects negative binomial regression suggest that the fraction of populations aged between 15 and 64 years, the size of the road network and seat belt laws significantly increase fatalities. However, populations of age 65 and above, hospital beds and physicians’ densities, and road audits significantly decrease these fatalities. Moreover, traffic fatalities are found to increase with the Gross Domestic Product per capita. The economic implications of this finding is not to lower the economic growth but to design policies and technologies that could prevent African countries from experiencing the same road tragedy observed in industrialized countries during their development process.

Social policy and crash fatalities: a multivariate time series analysis

ABSTRACTThis paper is concerned with changes over time in road safety. Most research, rooted in the deterrence hypothesis, focuses on the impact of reductions in the blood alcohol concentration (BAC) limits on crash-related fatalities. Our study, drawing on opportunity theories of social action, extends this research by examining the relative effects of safety innovations, exposure risk, and changes in BAC limits, on deaths resulting from motor vehicle accidents. The multivariate time series analyses indicate that the implementation of seatbelt legislation and the number of vehicle miles traveled directly affect, while the reduction of BAC limits indirectly affects, the number of crash-related fatalities. The implication of these findings for determining the optimal research design for assessing the impact of legislative initiatives on crash-related injuries and deaths are discussed.

Automobile-dependency as a barrier to vision zero, evidence from the states in the USA

With a traffic fatality rate of 10.6 per 100,000 as of 2013—more than triple that in the UK, the Netherlands, and Sweden—the United States has the worst traffic safety performance of all developed countries. Statewide variations are even more pronounced. North Dakota registers more than twice the national average and five times the rate of Massachusetts. We used panel models and annual data from 1997 to 2013 to capture the effect of seven separate sets of factors that influence traffic safety: exposure, travel behavior, socioeconomics, macroeconomics, safety policies, and mitigating factors such as health care. The results of our panel models and supplementary analysis of state effects show that two variables — Vehicle Miles Traveled and Vehicles per Capita—have the strongest impact on traffic fatality rates. This is closely followed by Infant Mortality Rates, the proxy that we used to represent the quality of health care. Policy levers such as Graduated Driver’s Licenses (GDL) have improved safety, but to a limited extent. We also found that states with higher urban density and more walking are associated with lower traffic fatality rates. Taken as a whole, our findings suggest that if additional progress is to be made in reducing traffic fatalities, emphasis needs to move beyond simply focusing on policies such as GDL and seat belt laws, which have already been adopted by almost all jurisdictions across the United States. We need to also consider factors that focus on the type of urban form that we are creating to ensure that we are fostering environments that encourage multi-modal transportation such as walking to reduce the VMT and Vehicles per Capita, the two strongest predictors of traffic fatalities.