The relationship between age and driving attitudes and behaviors among older Americans.

BACKGROUND: Due to a decreasing birth rate and longer life expectancy, the proportion of Americans over the age of 65 is expected to rise in coming years. Drivers over 65 drive two billion miles yearly, a number that will increase. For that reason, it is imperative to understand their attitudes and perceptions. It is also important to understand whether drivers over 65 can be treated as one cohesive group, or if there are differences among them. METHODS: A web-enabled survey was conducted among Americans in the years 2011-2013. Responses from 1793 persons over 65 regarding attitudes towards driving behaviors, support for safety interventions, and engagement in unsafe behaviors were analyzed. Respondents were stratified by age: 65-69, 70-74, and 75 and older. Age groups were compared using logistic regression. Other potential explanatory factors were analyzed and controlled for. RESULTS: The three groups were similar on many outcomes. However, statistically significant differences were found between them with regard to perceptions on speeding and the support for speed cameras, among other outcomes. In nearly all cases, those 75 and older were the most "pro-safety." However, when adjusted for demographic characteristics other than age, a larger proportion of respondents 75 and older reported engaging in red light running and drowsy driving in the last 30 days, and the difference was statistically significant. CONCLUSION: Older drivers are strongly "pro-traffic safety." However, the finding that those 65-69 are less so is concerning. This is especially true if it is the result of a cohort effect instead of an age effect. The increase in certain behaviors among those 75 and older is also concerning; drivers over this age are more prone to fatal injury when involved in a motor vehicle crashes. This poses a public health issue as the 75and older population expands.

Driver licensing and reasons for delaying licensure among young adults ages 18-20, United States, 2012.

BACKGROUND: Motor vehicle crashes are the leading cause of death for teens and young adults in the United States. Graduated driver licensing (GDL) systems were designed to protect young novice drivers by limiting their exposure to specific risks while they gain experience driving. In the United States, most states' GDL systems only apply to new drivers younger than 18. Some experts suggest that GDL might encourage young people to wait until age 18 to obtain a license, to avoid GDL requirements, resulting in older teenagers having less driving experience and higher crash risk than they might have had without GDL. This study examined the prevalence and timing of licensure among young adults, and explored factors associated with delaying licensure among those not licensed before age 18. METHODS: An online questionnaire was completed by 1,039 persons aged 18-20 years, recruited from a representative panel of United States households. Main outcome measures were acquisition of driver's license (a) within 12 months of the state minimum age for licensure, (b) before age 18. Associations of timing of licensure with demographic characteristics were assessed using multivariable logistic regression. Respondents not licensed before age 18 were asked to rate the importance of various possible reasons for delaying licensure. RESULTS: 54% of respondents were licensed before age 18. Blacks (37%; adjusted Prevalence Ratio 0.67, 95% Confidence Interval 0.48-0.93) and Hispanics (29%; adjusted Prevalence Ratio 0.60, 95% Confidence Interval 0.45-0.81) were less likely than non-Hispanic whites (67%) to be licensed before age 18. Lower household income was independently associated with delayed licensure (P < .001). The most common self-reported reasons for not becoming licensed sooner were not having a car, being able to get around without driving, and costs associated with driving. CONCLUSIONS: There was little evidence that GDL is a major contributor to delayed licensure; however, a substantial minority of young people do not obtain a driver's license until age 18 or older and thus begin driving outside of the GDL system, which in most states only applies to new drivers younger than 18. More research is needed to investigate the safety of older novice drivers.

Teen driver risk in relation to age and number of passengers, United States, 2007-2010.

OBJECTIVE: To provide updated estimates of the relationship between the number and ages of passengers present in a vehicle and the crash risk per mile driven of 16- and 17-year-old drivers. METHODS: Data on crashes that occurred in years 2007-2010 and data on the number of miles driven in years 2008-2009 were examined. Rates of crash involvement and driver death per mile driven were estimated for 16- and 17-year-old drivers with no passengers; with 1, 2, and 3 or more passengers younger than age 21 (and no older passengers); and with at least 1 passenger aged 35 or older. RESULTS: For 16- and 17-year-old drivers, having 1 passenger younger than age 21 (and no older passengers) was associated with 44 percent greater risk per mile driven of being killed in a crash, compared to having no passengers (relative risk [RR]: 1.44, 95% confidence interval [CI]: 1.01-2.04). Having 2 passengers younger than age 21 was associated with double the risk of being killed in a crash, compared to having no passengers (RR: 2.02, 95% CI: 1.36-2.99). Having 3 or more passengers younger than age 21 was associated with roughly quadruple the risk of being killed in a crash, compared to having no passengers (RR: 4.39, 95% CI: 1.45-13.31). The relative risk of being involved in any police-reported crash in the presence of young passengers followed a similar pattern; however, the differences in risks of being involved in any police-reported crash were smaller and were not statistically significant. Having at least 1 passenger aged 35 or older in the vehicle was associated with a 62 percent lower risk per mile driven of being killed in a crash (RR: 0.38, 95% CI: 0.24-0.60) and a 46 percent lower risk of being involved in any police-reported crash (RR: 0.54, 95% CI: 0.31-0.93) for 16- and 17-year-old drivers, compared to having no passengers. CONCLUSIONS: These results show that although the overall number of teen driver fatalities has decreased substantially over the past several years, carrying young passengers is still a significant risk factor for young drivers. In contrast, carrying adult passengers is associated with significantly lower risk of crash involvement.

Graduated driver licensing research, 2010-present.

This is the latest in a series of reviews of research on graduated driver licensing (GDL) published in the Journal of Safety Research, covering the period January 1, 2010-June 1, 2012 and works in progress. The intent is to keep researchers and policy makers current regarding the existing state of knowledge about GDL, and to identify information gaps and areas where clarification of research findings are needed. The recent research indicates that we continue to learn about ways to extend GDL benefits, but there remain important questions in need of further inquiry. In terms of impact on industry, the review provides guidance for the future GDL research agenda.

Physical examination is a poor screening test for abdominal-pelvic injury in adult blunt trauma patients.

BACKGROUND: To determine if physical examination can reliably detect or exclude abdominal or pelvic injury in adult trauma activation patients. METHODS: Trauma registry and medical record data were retrospectively reviewed for all adult blunt trauma patients with Glasgow coma scale score>8, from 6/30/05 to 12/31/06. Attending surgeons' dictated admission history and physical examination reports were individually reviewed. Patients' subjective reports of abdominal pain were recorded as present or absent. Exam findings of the lower ribs, abdomen, and pelvis were each separately recorded as positive or negative, and were compared with findings on a subsequent objective evaluation of the abdomen (OEA). "Clinically significant" injuries were defined as those that would change patient management. RESULTS: One thousand six hundred sixty-three patients were studied. Of patients with a negative abdominal exam, 10% had a positive OEA. When abdominal pain was absent, and exam of the lower ribs, abdomen, and pelvis was normal, OEA was positive in 7.6%, and 5.7% had a clinically significant injury. While a positive abdominal exam was predictive of a positive OEA (P<0.01), a negative exam, even when broadened (pain, lower ribs, abdomen, pelvis) did not exclude significant injuries. CONCLUSION: Ten percent of trauma activation patients with a negative abdominal exam have occult abdominal/pelvic injuries. Even when exam of the lower ribs, abdomen, and pelvis are all negative and abdominal pain is absent, 5.7% have occult injuries that would change management. OEA should be used liberally for adult blunt trauma activation patients regardless of physical exam findings, to avoid missing clinically significant injuries.

Preventing unintentional pediatric injuries at evacuation centers.

Injury to children 1 to 14 years of age is the leading cause of death worldwide. The US has made concerted efforts to reduce the injury death rate to children by 45%. Such success depends on a multifaceted strategy that requires local, community coalitions and effective customized solutions. During a natural disaster, the risk of injury for children increases with the movement to a "safe environment." Implementation of low cost, effective injury prevention has a salutary impact upon the lives of children and can reduce the risk of preventable unintentional injury during a natural disaster.

Geographic region, weather, pilot age, and air carrier crashes: a case-control study.

BACKGROUND: Information about risk factors of aviation crashes is crucial for developing effective intervention programs. Previous studies assessing factors associated with crash risk were conducted primarily in general aviation, air taxis, and commuter air carriers. METHODS: A matched case-control design was used to examine the associations of geographic region, basic weather condition, and pilot age with the risk of air carrier (14 CFR Part 121) crash involvement. Cases (N = 373) were air carrier crashes involving aircraft made by Boeing, McDonnell Douglas, and Airbus recorded in the National Transportation Safety Board's aviation crash database during 1983 through 2002, and controls (N = 746) were air carrier incidents involving aircraft of the same three makes selected at random from the Federal Aviation Administration's aviation incident database. Each case was matched with two controls on the calendar year when the index crash occurred. Conditional logistic regression was used for statistical analysis. RESULTS: With adjustment for basic weather condition, pilot age, and total flight time, the risk of air carrier crashes in Alaska was more than three times the risk for other regions ladjusted odds ratio (OR) 3.18, 95% confidence interval (CI) 1.35-7.49]. Instrument meteorological conditions were associated with an increased risk for air carrier crashes involving pilot error (adjusted OR 2.26, 95% CI 1.15-4.44) and a decreased risk for air carrier crashes without pilot error (adjusted OR 0.60, 95% CI 0.37-0.96). Neither pilot age nor total flight time were significantly associated with the risk of air carrier crashes. CONCLUSIONS: The excess risk of air carrier crashes in Alaska and the effect of adverse weather on pilot-error crashes underscore the importance of environmental hazards in flight safety.

Injury and side impact air bag deployment in near and far sided motor vehicle crashes, United States, 2000-2005.

BACKGROUND: Side impact crashes, the most lethal type, account for 26% of all motor vehicle crashes in the United States. The purpose of this study is to delineate side impact airbag (SIAB) deployment rates, injury rates, and analyze crash factors associated with SIAB deployment and occupant injury. METHODS: All passenger vehicles equipped with SIABs that were involved in a side impact crash were identified from the National Automotive Sampling System database. Crashes with multiple impacts, ejections, unbelted drivers or rollovers were excluded from the study. The outcome variables of interest were SIAB deployment and driver injury. SIAB deployment was compared in similar crashes to analyze the impact on driver's injury severity score. Other crash factors were also examined to analyze what role they play in SIAB deployment rates and injury rates, such as plane of contact, striking object and Delta-V. RESULTS: The data set for this study contained 247 drivers in near and far side crashes in vehicles with installed SIABs. Overall SIAB deployment was 43% in side impact crashes. A significant factor associated with both the SIAB deployment rate and the driver's injury rate was increased Delta-V. CONCLUSIONS: SIABs do not deploy consistently in crashes with a high Delta-V or with a lateral primary direction of force and a front plane of contact. In these two scenarios, further research is warranted on SIAB deployments. With SIAB deployment, it appears drivers are able to sustain a higher Delta-V impact without serious injury.

A methodology for the geometric standardization of vehicle hoods to compare real-world pedestrian crashes.

This paper describes a standardization method that allows injury researchers to directly compare pedestrian hood contact points across a variety of hood sizes and geometries. To standardize hood contact locations a new coordinate system was created at the geometric center of the hood. Standardizing hood contact locations was done by turning each coordinate location into a ratio of the entire length or width of the hood. The standardized pedestrian contact locations could then be compared for various hood sizes. The standardized hood was divided into a three-by-three grid to aggregate contact points into hood regions. Data was obtained from the National Highway Traffic Safety Administration's Pedestrian Crash Data Study from 1994 to 1998. To understand injury severity with respect to pedestrian hood contact location, the injuries were narrowed to the single most severe Abreviated Injury Scale injury to the pedestrian and hood location at which that injury was sustained. Of the 97 pedestrian/vehicle cases, pedestrians received 270 injuries from 141 unique hood contact locations. After standardization, 36%, 28%, 36% of all contact points were located on the left, center and right side of the hood respectively. Vertically, 26%, 45%, 28% of contacts occurred at the front, middle, and rear regions of the hood respectively. The middle passenger side of the hood contained the most number of AIS 3+ injuries. By using real-world crash data, engineers can make evidence based decisions to decease the severity of pedestrian injuries.

Pilot error in air carrier accidents: does age matter?

INTRODUCTION: The relationship between pilot age and safety performance has been the subject of research and controversy since the "Age 60 Rule" became effective in 1960. This study aimed to examine age-related differences in the prevalence and patterns of pilot error in air carrier accidents. METHODS: Investigation reports from the National Transportation Safety Board for accidents involving Part 121 operations in the United States between 1983 and 2002 were reviewed to identify pilot error and other contributing factors. Accident circumstances and the presence and type of pilot error were analyzed in relation to pilot age using Chi-square tests. RESULTS: Of the 558 air carrier accidents studied, 25% resulted from turbulence, 21% from mechanical failure, 16% from taxiing events, 13% from loss of control at landing or takeoff, and 25% from other causes. Accidents involving older pilots were more likely to be caused by turbulence, whereas accidents involving younger pilots were more likely to be taxiing events. Pilot error was a contributing factor in 34%, 38%, 35%, and 34% of the accidents involving pilots ages 25-34 yr, 35-44 yr, 45-54 yr, and 55-59 yr, respectively (p = 0.87). The patterns of pilot error were similar across age groups. Overall, 26% of the pilot errors identified were inattentiveness, 22% flawed decisions, 22% mishandled aircraft kinetics, and 11% poor crew interactions. CONCLUSION: The prevalence and patterns of pilot error in air carrier accidents do not seem to change with pilot age. The lack of association between pilot age and error may be due to the "safe worker effect" resulting from the rigorous selection processes and certification standards for professional pilots.

EMS helicopter crashes: what influences fatal outcome?

STUDY OBJECTIVE: In recent years, air transport of patients has been associated with disproportionate increases in crashes and deaths. We identify factors related to fatal outcome in air medical helicopter crashes and suggest preventive measures. METHODS: This was a retrospective study using National Transportation Safety Board records for helicopter emergency medical services (EMS) crashes between January 1, 1983, and April 30, 2005. The main outcome measure was the percentage of air medical crashes resulting in 1 or more deaths. RESULTS: There were 182 helicopter EMS crashes during the 22.3-year study period; 39% were fatal. One hundred eighty-four occupants died: 45% of the 44 patients and 32% of the 513 crewmembers. Fifty-six percent of crashes in darkness were fatal compared with 24% of crashes not in darkness. Seventy-seven percent of crashes in instrument meteorological conditions were fatal compared with 31% in visual conditions. Thirty-nine percent of all deaths occurred in crashes with postcrash fires; 76% of crashes with postcrash fire were fatal compared with 29% of other crashes. Multivariate logistic regression revealed that controlling for other factors, the odds of fatal outcome was increased by postcrash fire (odds ratio [OR] 16.1; 95% confidence interval [CI] 5.0 to 51.5], bad weather (OR 8.0; 95% CI 2.4 to 26.0), and darkness (OR 3.2; 95% CI 1.3 to 7.9). CONCLUSION: Fatalities after helicopter EMS crashes are associated especially with postcrash fire and with crashes that occur in darkness or bad weather and can be addressed with improved crashworthiness and measures to reduce flights in hazardous conditions. Further studies will be necessary to determine which changes will decrease the fatal crash rate and which are cost effective.

Ground crew injuries and fatalities in U.S. commercial aviation, 1983-2004.

INTRODUCTION: Ground crew services are an essential part of airport operations. Injury hazards to ground crewmembers who are in close proximity to aircraft have not been well studied. The objective of this paper was to examine airport ground crew injuries and fatalities involving aircraft of commuter air carriers and major airlines. METHODS: Investigation reports for all ground crew injuries involving commuter and major airline aircraft that occurred at United States airports between 1983 and 2004 were obtained from the National Transportation Safety Board (NTSB) and analyzed to describe the immediate cause and pattern of injury occurrence. RESULTS: During the 22-yr study period, the NTSB recorded a total of 80 ground crew accidents involving landing, taxiing, or standing commercial airline aircraft, yielding an overall rate of 0.47 ground crew related accidents per 1 million aircraft departures. These accidents resulted in injuries to 98 ground crewmembers, including 21 fatalities. Two-thirds of the accidents took place as the aircraft was departing. Vehicular collisions with an aircraft made up 43% of accidents, 34% were caused by moving aircraft equipment such as propellers or nose gear, and 11% resulted from jet blasts or fires. CONCLUSIONS: intervention programs for airport ground personnel should emphasize the safe operation of the aircraft equipment and ground vehicles. Some of the injuries to ground crewmembers might be avoided through improved design of commonly used equipment.

Driving-while-intoxicated history as a risk marker for general aviation pilots.

The Federal Aviation Administration conducts background checking for driving-while-intoxicated (DWI) convictions on all pilots. This study examined the association between DWI history and crash risk in a cohort of 335,672 general aviation pilots. These pilots were followed up from 1994 to 2000 through the aviation crash surveillance system of the National Transportation Safety Board. At baseline, 3.4% of the pilots had a DWI history. DWI history was associated with a 43% increased risk of crash involvement (adjusted relative risk: 1.43; 95% confidence interval: 1.15-1.77). The population-attributable risk fraction for DWI history was estimated as 1.4%. In addition to DWI history, male gender, older age, and inexperience were associated with significantly increased risk of crash involvement. The results of this study support DWI history as a valid risk marker for general aviation pilots. The safety benefit of background checking for DWI history needs to be further evaluated.

Neighborhood characteristics and emergency department utilization.

OBJECTIVES: Neighborhood environments have been linked to the prevalence and incidence rates of a variety of diseases and injuries. This study assessed the relations between neighborhood demographic and socioeconomic characteristics and emergency department (ED) utilization. METHODS: Billing data for the calendar year 2000 for adult patients residing within a one-mile radius of the study ED were geo-coded based on home addresses and merged with neighborhood data from the U.S. Census Bureau. Annual ED visit rates per 100 population were computed for each census block within the study area and analyzed in relation to neighborhood characteristics. RESULTS: The study area consisted of 714 census blocks and 42,278 adult residents, with a total of 16,427 visits to the study ED. Annual ED visit rates increased from 17 visits per 100 population for neighborhoods where less than 50% of the population were African American to 51 visits per 100 population for neighborhoods where all residents were African American (p < 0.001). Annual ED visit rates decreased from 53% for neighborhoods where <20% of housing units were owner-occupied to 27% for neighborhoods with >45% owner-occupied housing units (p < 0.001). Multivariate linear regression modeling revealed that proportions of African American residents and owner-occupied housing units were significantly associated with ED utilization, independent of age and gender compositions and the distance between residence and the study ED. CONCLUSIONS: Even within a small geographic area, ED utilization may vary greatly by neighborhood characteristics. Neighborhood racial composition and housing tenure are independent predictors of ED visit rates in this urban community.

Age, flight experience, and risk of crash involvement in a cohort of professional pilots.

Federal aviation regulations prohibit airline pilots from flying beyond the age of 60 years. However, the relation between pilot age and flight safety has not been rigorously assessed using empirical data. From 1987 to 1997, the authors followed a cohort of 3,306 commuter air carrier and air taxi pilots who were aged 45-54 years in 1987. During the follow-up period, the pilots accumulated a total of 12.9 million flight hours and 66 aviation crashes, yielding a rate of 5.1 crashes per million pilot flight hours. Crash risk remained fairly stable as the pilots aged from their late forties to their late fifties. Flight experience, as measured by total flight time at baseline, showed a significant protective effect against the risk of crash involvement. With adjustment for age, pilots who had 5,000-9,999 hours of total flight time at baseline had a 57% lower risk of a crash than their less experienced counterparts (relative risk = 0.43, 95% confidence interval: 0.21, 0.87). The protective effect of flight experience leveled off after total flight time reached 10,000 hours. The lack of an association between pilot age and crash risk may reflect a strong "healthy worker effect" stemming from the rigorous medical standards and periodic physical examinations required for professional pilots.

Geographic patterns of pilot fatality rates in commuter and air taxi crashes.

BACKGROUND: Geographic information systems are widely used in studies of diseases. However, their value for aviation safety research has not been adequately explored. PURPOSE: This study examined the geographic patterns of pilot fatality rates in commuter and air taxi operations. METHODS: Crash data recorded by the National Transportation Safety Board under FAR Part 135 were used to create a digital map of all crash sites in the continental United States between 1983 and 1998. Fatality rates in crashes were calculated and then interpolated to create a contoured map of rates. A test of significance was performed using Monte Carlo simulations. High-, medium-, and low-rate areas were then compared for pilot characteristics, airplane characteristics, and crash circumstance. RESULTS: Of the 1094 commuter and air taxi crashes studied, 25% resulted in a pilot fatality. A large geographic area with a pilot fatality rate of > or = 36% extended through portions of Michigan, Indiana, and Illinois. A relatively low fatality rate (< 15%) prevailed over an area extending from Texas to northwest Georgia. Crashes in high-rate areas were significantly more likely than crashes elsewhere to have occurred at night and during instrument meteorological conditions. CONCLUSION: The geographic analysis revealed a distinctive pattern of pilot fatality rates from Part 135 crashes. Factors underlying the geographic pattern should be investigated, with particular attention to the great geographic variability of terrain and weather phenomena between the north and south regions of the United States.

Influence of international emergency medicine opportunities on residency program selection.

OBJECTIVES: In the last several years, there has been increasing interest in international emergency medicine (IEM) programs. A number of residency programs offer or encourage international opportunities during residency. The purpose of this study was twofold: 1) to determine whether the availability of international opportunities during residency affected the ranking of emergency medicine (EM) residency programs by graduating medical students and 2) to determine whether prior international health experience among medical students influences interviewing and ranking of residency programs with international opportunities. METHODS: An eight-question survey measuring interest in IEM and its effect on ranking of programs was mailed to all 1,205 first-year EM residents from 122 accredited allopathic EM residency programs in the United States. International opportunities were defined as any program that offered an international elective during residency or had an IEM fellowship. Data were analyzed using descriptive statistics and chi-square tests. RESULTS: Of the 1,205 mailed surveys, 34% were returned by the first-year residents. Of all respondents, 281/408 (69%) interviewed at programs with international opportunities. Study findings revealed 62% (164/264) of the students who interviewed at programs with international opportunities considered the availability of international opportunities a positive factor in ranking residency programs. Analysis revealed that applicants with previous international health experience, 68% (104/152), were more likely to rank EM residency programs with international opportunities higher than those that did not. CONCLUSIONS: This study suggests that the availability of international opportunities during residency positively affected residency ranking. This relationship was stronger in medical students with prior international health experience.

Self-rated changes in cognition and piloting skills: a comparison of younger and older airline pilots.

BACKGROUND: The relationship of chronological age to self-rated changes in cognition has been studied extensively. However, the relationship of these changes to age-related changes in piloting skills is not well understood. OBJECTIVE: This study aims to determine whether airline pilots report age-related changes in cognitive abilities, and whether these changes are related to self-rated changes in piloting skills. METHODS: A total of 1310 airline pilots (28-59 yr, mean age = 45.5 yr; mean total flight time = 11,992 h) currently employed by a major U.S. commercial air carrier participated in the study. A 13-item Aviation Experience Survey (AES) was completed by each pilot, using 5-point Likert ratings and yes/no responses comparing current cognitive abilities (e.g., concentration, reaction speed) and piloting skills (e.g., piloting in adverse weather, decision making while flying) with those of 10 yr ago. RESULTS: Cognitive abilities and piloting skills were more likely to be rated as "better' or "much better" than 10 yr ago by pilots age 39 or under than by pilots in their 40s and 50s, who were more likely to rate their abilities and skills as "the same." Fewer than 20% of pilots in any age group rated their cognitive abilities or piloting skills as "worse" or "much worse" than 10 yr ago. Pilots who reported more anxiety or stress while flying reported more negative changes in abilities, skills, and health status regardless of age. CONCLUSIONS: Self-ratings of cognition and piloting skills vary by age, but older pilots are not more likely to report negative changes in their abilities and skills than younger pilots. Further research is needed to verify whether these self-appraisals reflect true changes in skills over time.