Unsafe riding practice among electric bikers in Suzhou, China: an observational study.

BACKGROUND: Electric bike (E-bike)-related deaths have been increasing rapidly in China and such injuries may be partly attributable to unsafe riding practice. OBJECTIVES: To describe potentially unsafe riding behaviours among electric bikers (E-bikers) and to investigate factors influencing these practices in China. METHODS: In September 2012, a cross-sectional observation study including a speed measurement component was conducted in Wuzhong (an urban district) and Zhangjiagang (a rural district) of Suzhou, Jiangsu Province, China. Hand-held radar speed metres were used to read travelling speeds of E-bikes and a pro forma observation checklist was used to collect data on road riding practice. Mixed-effect logistic regressions were used to calculate adjusted ORs and 95% CIs for the association between speeding, road rule violations and helmet use and their influencing factors. RESULTS: Among 800 E-bikes with a speed reading, 70.9% exceeded the designed speed limit of 20 km/h. Among a further 20 647 E-bikers observed, 38.3% did not comply with the road rules when entering intersections; and only 2.2% wore helmets. No regional variation was identified between urban and rural areas. Male E-bikers were associated with more speeding and road rule violations, whereas riding a pedal-equipped E-bike was associated with less road rule violations and less helmet use. CONCLUSIONS: Unsafe riding practices such as speeding, road rule violations and lack of helmet use were commonplace among E-bikers, especially among men. The study findings indicate that measures aimed at improving E-bike safety are required in China.

Epidemiological profile of hospitalised injuries among electric bicycle riders admitted to a rural hospital in Suzhou: a cross-sectional study.

Police reports indicate an increasing burden of electric bike (E-bike) casualties in China; however, hospitalised injury data have not been reported. The aim of the present work was to describe hospitalised injury patterns for E-bikers involved in road crashes and explore injury risk disparities among them. For the period October 2010 to April 2011, this cross-sectional study retrospectively collected information for hospitalised E-bikers involved in road crashes from hospital records, in Suzhou China, using the International Classification of Diseases, 10th revision (ICD-10) injury diagnosis codes. Injury nature and body region were further categorised using ICD-10 codes. Multivariate logistic regression was used to assess the risk of specific injury types. We found that hospitalised E-biker injuries (n=323) accounted for 57.2% of road traffic hospitalisations over the 6-month study period. The average age, length of stay and hospitalisation cost were 43.8 years, 10.0 days and ¥8229 (US$1286), respectively. Fractures and head injuries were common. The odds of traumatic brain injuries were significantly elevated for night-time E-bike crashes and incidents other than colliding with motor vehicles. These findings confirm E-bike injuries as an important population health problem and identify elevated injury odds in different E-biker groups. Future injury prevention initiatives should include encouraging helmet use among E-bikers.

Understanding on-road practices of electric bike riders: an observational study in a developed city of China.

Although millions of electric bikes (E-bikes) operate in China and many associated deaths and injuries have been reported, E-bikers' on-road practices are poorly characterized and few direct observational studies have been performed. This study aims to describe riding behaviors among E-bikers and to investigate factors influencing these practices to inform injury prevention. In March 2012, a cross-sectional observational study was conducted at 14 randomly selected intersections in Suzhou during a 7-day period. A pro-forma observation checklist was used to collect data on road riding practice. Adjusted Odds Ratios (OR) and 95% Confidence Intervals (CI) to assess the likelihood of specific riding practices among E-bikers were evaluated using mixed-effects logistic regression. Among 18,150 E-bikers observed, 37.6% rode E-bikes with cycling pedals, 86.0% of E-bikes were registered, 26.6% did not comply with the road rules, and 41.1% wore at least one safety item. The overall prevalence of carrying passengers, riding in a motor vehicle lane, running red lights, riding in opposite directions (i.e., facing oncoming traffic), mobile phone use, and helmet use were 12.4% (95%CI: 11.9-12.9%), 1.9% (95%CI: 1.7-2.1%), 4.8% (95%CI: 4.5-5.1%), 3.4% (95%CI: 3.1-3.7%), 0.4% (95%CI: 0.3-0.5%), and 9.0% (95%CI: 8.5-9.4%), respectively. Male E-bikers was associated with increased helmet use and riding in motor vehicle lanes, whereas riding a registered E-bike was associated with reduced likelihood of carrying passengers. This study demonstrates common road rule violations and low helmet use among E-bikers and supports the urgent need to develop additional regulations and behavioral interventions to improve safety practice among E-bikers in China.

Reorienting environmental health practice in Fiji: the potential in developing a National Environmental Health Action Plan.

Environmental health policy and practice is in transition with a traditional focus on health protection merging with an increased focus on health promotion. In Fiji, the role of environmental health practitioners in this process has been pivotal. Practitioners in Fiji believe that the importance of the practitioner's role should be reflected through contributions to policy development. The domination of the health agenda by those with a curative, bio-medical mindset, however, often limited this potential. The practitioners themselves, therefore, proposed and undertook the development of a National Environmental Health Action Plan (NEHAP). This in turn led to the adoption of the health promotion concept of 'healthy settings' in order to promote health in a culturally sensitive and locally relevant manner: 'Healthy Islands'. Following a participatory action research approach, this study explores the role that NEHAP development played in the reorientation of the environmental health profession in Fiji. The journey is told through the eyes of the authors who, together with practitioners from Fiji as well as agencies such as the WHO, participated in a collaborative long-term approach to change. The results show that practitioner's assertion of their right to a policy voice has not only been an initial step in their own recognition as professionals, it had also served to give them a platform for placing environmental health on the national agenda. 'Healthy Islands', in particular, has provided practitioners with the opportunity -to reorient their practice and begin to transform national policy.

National environmental health planning in Vietnam: flying some kites.

The link between environment and health has been well established, as has the need to develop strategies to manage the environment to protect health. The response of many governments to the emergence of environment as a leading concern of public health policy has been to fragment environment and health functions across many agencies, without effective coordination or communication systems, resulting in poor planning frameworks. There is a deepening awareness by many in government and international agencies of the need to develop 'national environmental health plans' (NEHAPS) to build and integrate environment and health policy and practice. To date, however, experience in the development of these and similar plans indicates that prescriptive 'top-down' approaches to plan development may yield limited success. This paper describes an ongoing project in Vietnam to develop a process for a national environmental health plan that provides a strong link between policies and practice, and utilizes a learning model for plan development. As environmental health is a new concept in Vietnam, significant attention has been given to the development of both national and local visions. The lessons learnt to date indicate that the use of a learning framework may provide a strong basis for the emergence of environmental health policy and its management. Facilitation of this process has required the use of a variety of change management tools and has placed an emphasis on using them in culturally sensitive ways. It is hoped that the emerging model, which gives environmental health its first expression at both national and provincial levels, will be of value to others undertaking similar policy and planning initiatives.