Evidence-based policy on road safety: the effect of the demerit points system on seat belt use and health outcomes

OBJECTIVE: To assess the effect of a demerit points system, introduced in Italy in July 2003, on the prevalence of seat belt use (intermediate outcome) and the number of road traffic deaths and injuries (health outcomes). DESIGN: Pre- and post-intervention regional observational study for seat belt investigation (April 2003, October 2004); national time-series analysis of road traffic deaths and injuries between 1999 and 2004 for health outcomes. SETTING: Veneto region, Italy. PARTICIPANTS: 19,551 drivers, 19,057 front passengers and 8,123 rear passengers estimated to be aged over 11 years were included in the investigation into seat belt use. 38,154 fatalities and 1,938,550 injured subjects were examined for the time-series analysis. INTERVENTIONS: Demerit points system. MAIN OUTCOME MEASURES: The proportions of drivers and front and rear passengers observed to be using seat belts before and after the intervention; estimates of lives and injuries saved through the implementation of a penalty points system. RESULTS: The demerit points system was followed by an increase in observed seat belt use of 51.8% (95% confidence interval 48.7% to 54.9%) among drivers, of 42.3% (95% confidence interval 39.2% to 45.5%) among front passengers and of 120.7% (95% confidence interval 99.4% to 144.3%) among rear passengers. It is estimated that 1,545 (95% confidence interval 1387 to 1703; p<0.0001) deaths and 91,772 (95% confidence interval 67,762 to 115,783; p<0.0001) injuries were prevented in the 18 months after the introduction of the legislation, i.e. an 18% reduction (1545/8570) in fatalities and a 19% reduction (91,772/473,048) in injuries. CONCLUSIONS: The demerit points system is effective both in encouraging drivers and passengers to adhere to the law and in terms of health outcomes, substantially contributing to road safety.     

Risk factors for injuries caused by traffic accidents and the impact of an intervention on the road

OBJECTIVE: To evaluate the effect of interventions at a highway, in the occurrence and severity of injuries by traffic accidents. METHOD: It was made a comparative analysis of two cross-sectional studies in 1994 and 1996. RESULTS: In 1994 the rate was 7.96 accidents/ 100,000 vehicles and in 1996 8.49 / 100,000 vehicles. The increase was not significant (p>0.05). The rate of injured drivers in 1994 was of 2.10 / 100,000 vehicles and of 1.35 / 100,000 vehicles in 1996, which was a significant decrease (p<0.000). The self-report of use of seat belt (63.46% versus 76.6%), the small vehicles involved in accidents (7.9% versus 37.7%), nocturnal schedule (23.7% versus 31.8%) and in Mexico-Cuernavaca direction (45% versus 66.7%), were more frequent in 1996 (p<0.05). The risk of injury, using a logistic regression model, between drivers exposed to the interventions (1996) and those that were not exposed (1994) adjusted by: age, speed, use of seat belt, alcohol intake and external cause, showed a protective effect of the interventions at the highway (OR 0.42 CI95% 0.27-0.66). CONCLUSION: There is an evident need of multisectorial approaches in the study and evaluation of the interventions in the field of the traffic accidents. The present research is a clear example of the repercussions over health of interventions developed by the transportation sector at the highway.     

Predictors of seat-belt use among school-aged children in two low-income Hispanic communities

OBJECTIVES: To examine the prevalence of seat belt use among school-aged children in low-income Hispanic communities. METHODS: We conducted unobtrusive observations of school-aged children (aged 5 to 12 years) traveling to and from nine elementary schools in two communities. We documented vehicle type, and belted status and seating position of children, driver, and other passengers. Results are presented as percentages with 95% confidence intervals (CIs). RESULTS: We observed 3651 children, of which restraint use could be determined for 2741. Overall, 29% of children were using seat belts. By seating location, 58% were in the front seat with 40% belted, and 42% were in the back seat with 14% belted. Children were most likely to be restrained when traveling in the front seat (40.0%, CI=37.6-42.5); traveling with a belted driver (42.4%, CI=40.0-44.8); or traveling without additional passengers (40.3%, CI=37.0-43.7) CONCLUSIONS: Seat belt use among children from this study population was below the national average and was alarmingly low among children in the back seat. While traveling, being belted in the back seat provides the most protection in a collision. Prevention efforts need to be based on an understanding of the barriers to restraint use for children traveling in the back seat.     

Prevalence of mobile phone use while driving vehicles

OBJECTIVE: To estimate the prevalence of mobile telephone use while driving vehicles in the city of Lleida (Spain). METHODS: A random sample of 1536 cars passing through six intersections regulated by traffic lights in Lleida were selected (three with urban traffic and three with interurban traffic). Cyclists, motorcyclists and driving school cars were excluded. The variables studied were mobile telephone use, age, (18-40; 41-60; >61), sex, the presence of passengers, type of intersection (urban traffic/interurban traffic), day of the week (working day/weekend or holiday) and hour of the day (rush hour/non-rush hour). The prevalence of mobile telephone use was calculated in percentages with a 95% CI. The relationship among the dependent variable (mobile telephone use) and the other independent variables was studied using odds radios (OR) and 95% CI. RESULTS: A total of 1536 direct observations were made and mobile telephone use was detected in 50 drivers. The prevalence was 3.3 (95% CI, 2.4-4.3). The prevalence was higher in men (OR = 2.2; 95% CI, 1.0-5.7), in drivers aged more than 60 years old (OR = 2.2; 95% CI, 0.5-8,4) and in those aged 18-40 years old (OR =1.5; 95% CI, 0.8-3.0), in unaccompanied drivers (OR = 3.0; 95% CI, 1.5-6.3), in urban intersections (OR = 2.7; 95% CI, 1.2-5.9), on workdays (OR = 2.0; 95% CI, 0.9-4.4) and at the rush hour (OR =1.4; 95% CI, 0.8-2.4). CONCLUSIONS: The prevalence of mobile telephone use while driving vehicles can be considered high, because of the increase in car accidents. The profile of drivers using mobile telephones corresponds to men aged 18-40 years or more than 61 years, in urban intersections, without passengers, during workdays and at the rush hour. We recommend the implementation of measures to decrease the use of mobile telephones while driving.     

广州、南宁市汽车安全带佩戴状况调查

目的 调查广州、南宁市汽车安全带佩戴情况。方法 采用随机抽样的方法，按照3种不同类型的道路选取观察点，在4个不同时间段对目标车辆进行观察。结果 司机安全带正确佩戴率南宁市（63．8％）高于广州市（49．3％），而不正确佩戴率广州市（22．9％）高于南宁市（8．1％）；乘客安全带佩戴率广州市高于南宁市，包括正确佩戴率和不正确佩戴率；安全带佩戴率受道路类型、时间、性别和车型等的影响，正确佩戴率高速路高于其他道路、白天高于晚上、女性高于男性、小型汽车高于其他车型，不正确佩戴率工作151高于周末。结论 广州市男性出租车司机安全带不正确佩戴率高；两地区周末和晚上佩戴安全带率较低，应加大执法力度；加强宣传教育，提高司乘人员佩戴安全带的意识。     

合肥市出租车司乘人员安全带佩戴状况调查

目的 调查安徽省合肥市出租车司乘人员安全带的佩戴情况。方法 在合肥市区分别选择5个主干道和5个支路路段观察点,每个观察点于工作日、双休日各观察1d。自07:00～19:00连续12h的每1h时间段内,累计观察前排有乘客乘坐的出租车50车次,共观察12000车次。结果 合肥市出租车司机安全带正确、不正确佩戴率及未佩戴率分别为44.2%,3.4%,52.4%;前排乘客安全带的正确佩戴率及未佩戴率分别为0.5%和99.5%。司机安全带正确佩戴率工作日高于双休日,且自07:00～19:00呈增高-降低-增高-降低的变化趋势;上午10～11点、下午4～5点时间段较高,中午1点最低;主干道和支路路段上正确佩戴率差异无统计学意义;女司机正确佩戴率高于男司机。结论 合肥市出租车司乘人员安全带的佩戴率较低,应结合司机佩戴安全带的时间变化规律加强交通监管力度,同时要充分重视对前排乘客安全带使用的干预。     

Mortality reduction with air bag and seat belt use in head-on passenger car collisions

To assess the efficacy of occupant protection systems, the authors measured the mortality reduction associated with air bag deployment and seat belt use for drivers involved in head-on passenger car collisions in the United States. They used a matched case-control design of all head-on collisions involving two passenger cars reported to the Fatality Analysis Reporting System in 1992-1997, and driver mortality differences between the paired crash vehicles for air bag deployment and seat belt use were measured with matched-pair odds ratios. Conditional logistic regression was used to adjust for multiple effects. There were 9,859 head-on collisions involving 19,718 passenger cars and drivers. Air bag deployment reduced mortality 63% (crude odds ratio (OR) = 0.37, 95% confidence interval (CI): 0.32, 0.42), while lap-shoulder belt use reduced mortality 72% (OR = 0.28, 95% CI: 0.25, 0.31). In a conditional logistic model that adjusted for vehicle (rollover, weight, age) and driver (age, sex) factors, air bags (OR = 0.71, 95% CI: 0.58, 0.87) and any combination of seat belts (OR = 0.25, 95% CI: 0.22, 0.29) were both associated with reduced mortality. Combined air bag and seat belt use reduced mortality by more than 80% (OR = 0.18, 95% CI: 0.13, 0.25). Thus, this study confirms the independent effect of air bags and seat belts in reducing mortality.     

Restraint use among northwest American Indian children traveling in motor vehicles

OBJECTIVES: We sought to estimate motor vehicle passenger restraint use among Northwest American Indian children 8 years old or younger and to determine factors associated with using proper (i.e., age and weight appropriate) passenger restraint systems. METHODS: We surveyed vehicles driven by members of 6 tribes in Idaho, Oregon, and Washington. Associations between proper restraint and child, driver, and vehicle characteristics were analyzed using logistic regression for clustered data. RESULTS: We observed 775 children traveling in 574 vehicles; 41% were unrestrained. Proper restraint ranged from 63% among infant seat-eligible children to 11% among booster seat-eligible children and was associated with younger child's age (odds ratio (OR) per year = 0.60; 95% confidence interval (CI) = 0.48, 0.75), seating location (OR front vs rear=0.27; 95% CI=0.16, 0.44), driver seat belt use (OR=2.39; 95% CI=1.51, 3.80), and relationship (OR for nonparent vs parent=0.28; 95% CI=0.14, 0.58). More than half of drivers felt children could use an adult seat belt earlier than recommended guidelines, and 63% did not correctly identify whether their tribe had child safety seat laws. CONCLUSIONS: Children in these communities are inadequately restrained. Restraint use was exceedingly low among booster-eligible children and children riding with unrestrained adults. Interventions emphasizing appropriate restraint use and enforcement of passenger safety laws could reduce the risk of injury or death in motor vehicle accidents.     

Traffic accidents in a metropolitan area in Brazil, 1991-2000

A time series study described the trend in motor vehicle accidents from 1991 to 2000, using data from the State Transit Department in Salvador, Bahia State, Brazil. Rates were calculated for total motor vehicle accidents, number of casualties, and standardized mortality based on population and number of vehicles, comparing two periods (1991-1994 and 1995-2000), before and after the adoption of safety measures including compulsory seat belt use and the new National Transit Code (NTC). Vehicle accident and casualty rates were high and showed little variation during the study period. The mortality rate decreased from 25.7/100,000 inhabitants in 1995 to 18.1/100,000 in 1998 and remained stable thereafter. The only significant difference (p < 0.001) was in the mean motor vehicle accident mortality rate before and after the intervention. The case fatality rate decreased from 10.7% (1995) to 7% (2000). Although still representing a major public health problem in this important metropolitan area, the decrease in motor vehicle accident mortality was possibly due to interventions in 1995 and expanded NTC measures in 1998. Greater efforts to change driver and pedestrian behavior could further decrease the high number of accidents and related mortality.     

The use of seat belts on British motorways.

Evidence demonstrating the advantages of seat belts in improving safety of road travel is overwhelming and has resulted in government legislation. This study was performed to investigate compliance with this legislation by fast-moving traffic on British motorways, for which no previous data exists. Analysis of seat belt use by 2564 travellers in 1526 cars in October 1992 revealed the following rates of use: drivers 98%; front passengers 96%; rear seat passengers with available belts 53%. The overall low rate of rear seat restraint use was seen in all age groups except babies. When the study was repeated 8 months later, the rates of restraint amongst 3910 travellers in 1881 cars had not increased. In view of the continuing heavy death toll on British motorways and roads, there is an obvious need for measures to improve rear seat belt use. This would be most appropriately achieved by both enforcing and publicizing the current legislation.     

Causes and effects of road traffic accidents in Saudi Arabia

In Saudi Arabia the motor vehicle is the main means of transportation. Between 1971 and 1997; 564,762 people died or were injured in road traffic accidents, a figure equivalent to 3.5% of the total population in Saudi Arabia. During this period 66,914 people have died on the roads in Saudi Arabia due to road accidents, amounting to one person killed and four injured every hour. Over 65% of accidents occur because of vehicles travelling at excess speed and/or drivers disobeying traffic signals. Of deaths in Ministry of Health hospitals, 81% are due to road traffic accidents and 20% of their beds are occupied by traffic accidents victims. Also, 79.2% of patients admitted to Riyadh Armed Forces Hospital with spinal injuries has sustained their injuries as a result of a motor vehicle accident. We recommend compulsory use of safety seat belts in vehicles and the setting up of a new database to collect, store and analyse information relating to the road traffic accidents.     

Prevalencia de consumo de tabaco en vehículos privados

Objective

To determine the prevalence of smoking among drivers of private vehicles in the city of Lleida (Spain).

Methods

A random sample of 1600 cars passing through six intersections regulated by traffic lights were selected. The variables were age, sex, smoking driver, adult passengers, intersection (urban/interurban), day (working day/weekend), hour (morning/evening) and simultaneous smokers. We calculated the prevalence of smoking drivers and the corresponding odds ratios (ORs), adjusted for the potential confounding variables, as well as their 95% confidence intervals (95% CI).

Results

The prevalence was 6.0% (95% CI: 4.9-7.3) and was higher in men (6.4%), in the group aged 41 to 60 years (6.9%), and in unaccompanied drivers (6.5%). The probability of the driver smoking increased if there was a smoking passenger (aOR = 10.8; 95% CI: 3.6-32.5). The frequency of smoking drivers was higher on working days (aOR = 1.7; 95% CI: 1.0-2.8) and in the morning (aOR = 1.6; 95% CI: 1.0-2.4).

Conclusions

The prevalence of smoking drivers can be considered dangerously high. We recommend avoiding smoking while driving.     

宜兴市2010年机动车驾乘人员安全带佩戴现况及态度调查

目的 了解宜兴市驾乘人员安全带佩戴现况及态度.方法 在市区内选取4个观察点,在不同的时间段对出租车、小轿车、面包车和“皮卡”4种车型的司机和前排乘车人安全带的佩戴情况进行观察.同一时期对驾驶人员进行有关安全带佩戴态度问卷调查.结果 共观察12 473辆车辆和司机以及4 182名前排乘车人.其中司机安全带佩戴率为19.9％;乘车人安全带佩戴率为3.5％.问卷调查了1 073名驾乘人员,选择经常佩戴的51.7％,有时佩戴的25.4％,不佩戴22.9％;不佩戴的原因最多的是感到束缚、感到不舒服.认为最有效的措施是重金处罚、交通事故报道佩戴安全带者幸免于难.在调整了性别、车型等因素后,司机不佩戴安全带会增加前排乘车人不佩戴的风险(OR=8.26,P＜0.001).结论 目前该市驾乘人员司机和前排乘车人安全带的佩戴意识达到一定水平,但实际佩戴率还比较低,亟需加强管理.     

机动车驾驶员道路交通伤害危险因素的病例对照研究

目的：探讨道路伤害中机动车驾驶员的危险因素，为进一步开展交通道路伤害预防提供科学依据。方法：采用病例对照研究方法，通过面询方法收集事故驾驶员和非事故驾驶员的一般情况、睡眠状况、急性困倦、吸烟、饮酒、违章驾驶行为等情况。以SPSS11．5软件进行统计分析。结果：调查了150名事故驾驶员和174名非事故驾驶员。在控制了其他影响因素情况下，驾驶时因感觉/判断错误、疏忽大意、遇紧急情况措施不当和违章操作的OR值（95％CI）分别是137．51（15．773-1198．876）、72．82（18．980-279．344）、25．16（3．097-204．398）和13．27（1．976-89．146）；初中及以下教育程度的驾驶员发生事故的危险性是高中及以上教育程度驾驶员的2．76倍（95％CI：1．082-7．021）；实际驾龄〈5年的驾驶员发生事故的危险性是实际驾龄≥5年的驾驶员的3．04倍（95％CI：1．235-7．457）；驾驶时感觉/判断失误与每周驾驶时间存在交互作用，每周驾驶时间≥40h的驾驶员，因感觉秽4断错误而发生交通事故的危险性低于每周驾驶时间〈40h的驾驶员（OR=0．022，95％CI：0．001-0．371）。结论：驾驶时疏忽大意、感觉/判断错误、遇紧急事故措施不当、违章操作、初中及以下教育程度、实际驾龄短是道路交通伤害中机动车驾驶员的危险因素。     

The driver's role in fatal two-car crashes: a paired "case-control" study.

This population-based study examines drivers' characteristics associated with driving errors that resulted in fatal motor vehicle crashes. Routinely collected data from the Fatal Accident Reporting System were used to assess whether a driver initiated the crash (case) or was passively involved (control) in 6,506 two-car collisions (81% of 7,993 eligible events). A paired comparison of cases and controls avoided confounding by environmental factors, exposure to traffic, and differences in case fatality. The strongest predictor of crash initiation is alcohol (odds ratio (OR) = 11.5; 95% confidence interval (CI) 9.57-13.9). Odds ratios are elevated even at the lowest blood alcohol concentration levels and increase dramatically as alcohol levels rise. Drivers aged 40-49 years are least likely to initiate crashes; odds ratios rise in a U-shaped manner to 3.35 in teenagers (95% CI 2.72-4.13) and to 22.1 in drivers over 80 years (95% CI 14.2-34.5). Other risk factors for initiating a fatal crash are the following: not wearing a seat belt (OR = 1.54; 95% CI 1.35-1.75), driving without a valid driver's license (OR = 2.16; 95% CI 1.72-2.73), and having had a crash within the last year (OR = 1.21; 95% CI 1.07-1.38). Driving errors leading to fatal crashes do not occur at random, but are associated with specific driver characteristics. The risk factors for crash initiation among crash-involved drivers are similar to risk factors for crash involvement found in other studies. These findings suggest that driving errors often explain high rates of crash involvement, invite further use of crash initiation in traffic injury research, and underscore the value of population-based registries for analytic epidemiology.     

Differences in injury rates in child motor vehicle passengers in rural and urban areas in New South Wales, July 2000 to June 2004

OBJECTIVES: To investigate whether the pattern of hospitalised injuries in injured child motor vehicle passengers involved in traffic crashes differs in rural and urban residents of New South Wales (NSW). METHODS: This study compared injuries of hospitalised child motor vehicle passengers resident in rural areas with those from urban areas. The NSW Inpatient Statistics Collection (ISC), a population-based dataset, was used to select cases for the period of July 2000 to June 2004. The hospitalised injury rate was calculated according to urban/rural status using Poisson regression. Injury rate ratios (IRR) comparing rural and urban children were computed overall and for specific injury types. RESULTS: Overall, 1,286 children (aged 0-15 years) residing in NSW were identified from the NSW ISC internally linked datasets as being separated from hospital for injuries resulting from a motor vehicle crash. The overall hospitalised injury incidence rates for child motor vehicle passengers resident in rural and urban NSW areas were 46.75 (95% CI 36.63-59.66) and 20.13 (95% CI 17.94-22.58) per 100,000 children respectively. The rural/urban IRR for comparing the incidence of hospitalisation was significantly elevated (IRR=2.10, 95% CI 1.78-2.48). The IRR was also significantly elevated across most injury types. The largest risk disparity between rural and urban children was in 9-12 year-olds (IRR=2.33, 95% CI 1.73-3.13). CONCLUSION AND IMPLICATIONS: There is an elevated injury incidence rate in rural resident children, compared with their urban counterparts. This differential should be addressed in future road safety initiatives.     

农用车辆道路交通事故及危险因素分析

目的了解农用车辆道路交通事故的发生情况和危险因素, 为实施有效的干预措施提供科学依据。方法采用方便抽样方法对在江苏省宜兴市农机站进行年度审验工作的905名农用车辆驾驶员进行问卷调查, 询问并记录最近1年内驾驶农用车辆人员的道路交通伤害情况。结果905名农用车辆驾驶员中有83人最近1年内发生过交通事故, 事故发生率为9.2%;有车祸史驾驶员的事故发生率为23.3%, 高于无车祸史驾驶员的6.5%, 差异有统计学意义(x²=41.644, P=0.000);睡眠情况很好、较好、一般的驾驶员事故发生率分别为7.5%、11.8%、100.0%, 差异有统计学意义(P=0.001);农用车辆道路交通事故最多发生在7~9月份(43.4%)、白天(96.4%)、晴天(89.2%)、无道路交通防护路段(60.2%)、无交通信号路段(59.0%)、水泥路面(65.1%)、干燥路面(90.4%)、完好路面(88.0%)和普通路段(47.0%);人为因素、车辆因素和道路因素引起的农用车辆交通事故分别占92.8%、3.6%和3.6%, 差异有统计学意义(x²=63.186, P<0.001)。结论农用车辆道路交通事故发生主要与驾驶员、道路、环境因素有关, 其中因驾驶员的原因造成的事故数最多, 应重视对农用车辆驾驶员的教育和培训。     

南京市2005-2007年机动车驾乘人员安全带佩戴情况调查

目的 调查道路安全法或条例出台3年后南京市机动车驾乘人员安全佩戴情况.方法 在市区内选取4个观察点,在不同时间段对出租车、小轿车(8座以内)、厢式小货车和"皮卡"4种车型的司机和前排乘车人安全带的佩戴情况进行观察.结果 2005-2007年共观察35 256辆车辆和司机,以及15 772名前排乘车人.其中司机安全带佩戴率为49.9%,不佩戴率和假戴率分别为44.1%和4.6%;乘车人安全带佩戴率为9.1%,不佩戴率90.9%.在调整了性别、车型等因素后,3年来无论是司机还是前排乘车人安全带佩戴率均呈现下降趋势(P<0.01),司机不佩戴安全带会增加前排乘车人不佩戴的风险(OR=8.10,P<0.01).结论 现有法律或条例在司机和乘牟人佩戴安全带方面并无具体的规定,妨碍了法律或条例的有效执行.     

Pain and pain treatment were associated with traffic accident involvement in a cohort of middle-aged workers

BACKGROUND AND OBJECTIVE: To assess the influence of medical conditions on road traffic accidents among a cohort of middle-aged workers and pensioners. STUDY DESIGN AND SETTING: A longitudinal study of 13,548 participants from a cohort study of French workers. Follow-up data covered the 1989-2000 period. Adjusted hazards ratios (HR(adj)) for serious accidents were computed by Cox's proportional hazards regression with time-dependent covariates adjusted for age, occupation, annual mileage in 2001, alcohol consumption, and number of reported health problems. RESULTS: Men who reported treated dental or gingival problems (HR(adj)=8.57, 95% confidence interval CI=2.70-27.2) and women who reported treated renal colic or kidney stones (HR(adj)=9.71, 95% CI=2.40-39.3) were much more likely to have a serious traffic accident. Treated glaucoma, hiatal hernia or gastric ulcers, and diabetes among women and treated cataract among men were also found to be associated with the risk of serious traffic accidents. CONCLUSIONS: This study raises the hypothesis that pain and pain treatment (singly or in combination) could increase the risk of road traffic accident and confirms that medical conditions traditionally found to be associated with traffic accident involvement of older drivers are also risk factors for middle-aged drivers.