Prevalence of adverse childhood experiences (ACE) in the Czech Republic.

A cross-sectional survey was undertaken to estimate the prevalence of child maltreatment and adverse childhood experiences in the Czech Republic, as data on these is scarce. The survey was conducted among 1760 randomly selected students from five Czech universities. Participants filled in the adverse childhood experiences survey instrument. The results showed that the prevalence of child maltreatment and other adverse childhood experiences is high: emotional abuse was reported by 20.7%, physical abuse by 17.1%, sexual abuse by 6.4%, and physical neglect by 8.0%. Household dysfunction was also high, with household street drug use reported by 4.9%, alcohol misuse by 15.3%, mental disorder by 13.4%, parental violence by 22.1% and parental separation by 23%. Thirty-eight per cent had not experienced any adverse childhood experience, while 9.9% reported experiencing four or more types of adverse childhood experiences. There was a significant association between adverse childhood experiences and health-harming behaviours such as suicide attempt, drug use, risky sexual behaviour and tobacco use. The findings suggest that there is a need to invest in prevention programmes.

Life course health consequences and associated annual costs of adverse childhood experiences across Europe and North America: a systematic review and meta-analysis.

BACKGROUND: An increasing number of studies are identifying associations between adverse childhood experiences (ACEs) and ill health throughout the life course. We aimed to calculate the proportions of major risk factors for and causes of ill health that are attributable to one or multiple types of ACE and the associated financial costs. METHODS: In this systematic review and meta-analysis, we searched for studies in which risk data in individuals with ACEs were compared with these data in those without ACEs. We searched six electronic databases (MEDLINE, CINAHL, PsycINFO, Applied Social Sciences Index and Abstracts, Criminal Justice Databases, and the Education Resources Information Center) for quantitative studies published between Jan 1, 1990, and July 11, 2018, that reported risks of health-related behaviours and causes of ill health in adults that were associated with cumulative measures of ACEs (ie, number of ACEs). We included studies in adults in populations that did not have a high risk of ACEs, that had sample sizes of at least 1000 people, and that provided ACE prevalence data. We calculated the pooled RR for risk factors (harmful alcohol use, illicit drug use, smoking, and obesity) and causes of ill health (cancer, diabetes, cardiovascular disease, respiratory disease, anxiety, and depression) associated with ACEs. RRs were used to estimate the population-attributable fractions (PAFs) of risk attributable to ACEs and the disability-adjusted life-years (DALYs) and financial costs associated with ACEs. This study was prospectively registered in PROSPERO (CRD42018090356). FINDINGS: Of 4387 unique articles found following our initial search, after review of the titles (and abstracts, when the title was relevant), we assessed 880 (20%) full-text articles. We considered 221 (25%) full-text articles for inclusion, of which 23 (10%) articles met all selection criteria for our meta-analysis. We found a pooled prevalence of 23·5% of individuals (95% CI 18·7-28·5) with one ACE and 18·7% (14·7-23·2) with two or more ACEs in Europe (from ten studies) and of 23·4% of individuals (22·0-24·8) with one ACE and 35·0% (31·6-38·4) with two or more ACEs in north America (from nine studies). Illicit drug use had the highest PAFs associated with ACEs of all the risk factors assessed in both regions (34·1% in Europe; 41·1% in north America). In both regions, PAFs of causes of ill health were highest for mental illness outcomes: ACEs were attributed to about 30% of cases of anxiety and 40% of cases of depression in north America and more than a quarter of both conditions in Europe. Costs of cardiovascular disease attributable to ACEs were substantially higher than for most other causes of ill health because of higher DALYs for this condition. Total annual costs attributable to ACEs were estimated to be US$581 billion in Europe and $748 billion in north America. More than 75% of these costs arose in individuals with two or more ACEs. INTERPRETATION: Millions of adults across Europe and north America live with a legacy of ACEs. Our findings suggest that a 10% reduction in ACE prevalence could equate to annual savings of 3 million DALYs or $105 billion. Programmes to prevent ACEs and moderate their effects are available. Rebalancing expenditure towards ensuring safe and nurturing childhoods would be economically beneficial and relieve pressures on health-care systems. FUNDING: World Health Organization Regional Office for Europe.

Impact of Adverse Childhood Experiences on Alcohol Use in Emerging Adults in Montenegro and Romania.

BACKGROUND: Aiming at generating evidence for formulating targeted and cost-effective public health interventions for the effective control of alcohol use (AU) in emerging adults in South Eastern Europe. The study's objective was to assess if alcohol users experience adverse childhood experiences (ACE) more often than non-users, and to identify which ACE victims are the most vulnerable to AU. METHODS: The data was collected in 2010-2012 in two cross-sectional studies conducted in university settings in Montenegro and Romania (overall response rate 89.1%). In the present study, 3,283 students were included. The international ACE Study Questionnaires were used as a base for study instruments for collecting information on ACEs, health behaviours, and socio-economic factors. The association between AU and individual ACEs, adjusted to background factors, was assessed by using logistic regression. RESULTS: From the child maltreatment group, three ACEs were included in the final model as statistically significantly associated with AU, all of them from physical neglect/abuse types: frequently being hit so hard to have marks or being injured (OR=1.68; p=0.012), frequently being spanked (OR=1.38; p=0.012), and frequently having no person to take to the doctor if necessary (OR=0.58; p=0.031). From the household dysfunction group, two ACEs were included in the final model: exposure to mental health problems in the household (OR=2.85; p<0.001), and living with a problematic drinker/alcoholic (OR=1.51; p=0.019). CONCLUSIONS: The effect of exposure to ACEs on AU persists into emerging adulthood. This should be considered when developing cost-effective response to AU burden through targeted interventions, in particular in settings with scarce resources.

Adverse childhood experiences, childhood relationships and associated substance use and mental health in young Europeans.

BACKGROUND: Adverse childhood experiences (ACEs) can increase risks of health-harming behaviours and poor health throughout life. While increases in risk may be affected by resilience resources such as supportive childhood relationships, to date few studies have explored these effects. METHODS: We combined data from cross-sectional ACE studies among young adults (n = 14 661) in educational institutions in 10 European countries. Nine ACE types, childhood relationships and six health outcomes (early alcohol initiation, problem alcohol use, smoking, drug use, therapy, suicide attempt) were explored. Multivariate modelling estimated relationships between ACE counts, supportive childhood relationships and health outcomes. RESULTS: Almost half (46.2%) of participants reported ≥1 ACE and 5.6% reported ≥4 ACEs. Risks of all outcomes increased with ACE count. In individuals with ≥4 ACEs (vs. 0 ACEs), adjusted odds ratios ranged from 2.01 (95% CIs: 1.70-2.38) for smoking to 17.68 (95% CIs: 12.93-24.17) for suicide attempt. Supportive childhood relationships were independently associated with moderating risks of smoking, problem alcohol use, therapy and suicide attempt. In those with ≥4 ACEs, adjusted proportions reporting suicide attempt reduced from 23% with low supportive childhood relationships to 13% with higher support. Equivalent reductions were 25% to 20% for therapy, 23% to 17% for problem drinking and 34% to 32% for smoking. CONCLUSIONS: ACEs are strongly associated with substance use and mental illness. Harmful relationships are moderated by resilience factors such as supportive childhood relationships. Whilst ACEs continue to affect many children, better prevention measures and interventions that enhance resilience to the life-long impacts of toxic childhood stress are required.

The prevalence of elder abuse in institutional settings: a systematic review and meta-analysis.

Background: A recent study has shown that close to one in six older adults have experienced elder abuse in a community setting in the past year. It is thought that abuse in institutions is just as prevalent. Few systematic evidence of the scale of the problem exists in elder care facilities. The aim of this review is to conduct a systematic review and meta-analysis of the problem in institutional settings and to provide estimates of the prevalence of elder abuse in the past 12 months. Methods: Fourteen academic databases and other online platforms were systematically searched for studies on elder abuse. Additionally, 26 experts in the field were consulted to identify further studies. All studies were screened for inclusion criteria by two independent reviewers. Data were extracted, and meta-analysis was conducted. Self-reported data from older residents and staff were considered separately. Results: Nine studies met the inclusion criteria from an initial of 55 studies identified for review. Overall abuse estimates, based on staff reports, suggest that 64.2% of staff admitted to elder abuse in the past year. There were insufficient studies to calculate an overall prevalence estimate based on self-reported data from older residents. Prevalence estimates for abuse subtypes reported by older residents were highest for psychological abuse (33.4%), followed by physical (14.1%), financial (13.8%), neglect (11.6%), and sexual abuse (1.9%). Conclusions: The prevalence of elder abuse in institutions is high. Global action to improve surveillance and monitoring of institutional elder abuse is vital to inform policy action to prevent elder abuse.

Child maltreatment prevention: a content analysis of European national policies.

Background: Child maltreatment is a major public health concern, which worsens inequalities and perpetuates social injustice through its far-reaching impacts on the health and development of children affected. The aim of this article was to provide a content analysis of the national policies presently used to address child maltreatment and provide an overview of prevention practices being employed in countries of the World Health Organization (WHO) European Region. This analysis will aid in identifying, which policy areas still require further work to prevent child maltreatment. Methods: Three search methods were employed to identify national policies on child maltreatment. A framework based on WHO guidelines for the development of policies was used to conduct a policy analysis of the identified national policies. Results: Two hundred and seventy-eight national policies were identified; of these, 68 met the inclusion criteria for further analysis representing 75% of the WHO Europe Region Member States. Whereas the majority of policies fulfilled most of the WHO criteria for effective policy-making, only 34% had a budget and 6% had quantified objectives. Plans to implement proven child maltreatment prevention interventions were high, with the exception of some countries where the health sector is in the lead. Conclusions: The key policy areas requiring improvement were quantifiable objectives and allocated defined budgets. Hospital-based and home-based child maltreatment interventions were also not widely planned for implementation. Encouraging progress is being made on national policy development to prevent child maltreatment. There are as of yet, several key areas, which warrant increased attention in future policy-making.

Identification of adverse childhood experiences strongly predicting suicidal behaviour among emerging adults in Montenegro and Romania: a new way to targeted cost-effective prevention.

INTRODUCTION: Aiming at generating evidence for cost-effective public health (PH) interventions for suicidal behaviour (SB) prevention in South Eastern Europe, the objective was to identify adverse childhood experiences (ACEs) most strongly predicting SB in emerging adults. METHODS: Survey data of 3283 students aged 18-29 from Montenegro and Romania were analysed by logistic regression. Based on estimation of risk-for-SB, the profiles with the highest values were identified. RESULTS: The SB odds were the highest in respondents, experienced a suicide attempt in the household (OR: 13.81; p < 0.001), and whose primary family was not complete, in particular in those with the foster family background (OR: 18.30; p = 0.001). CONCLUSIONS: Magnitude of impact on emerging adults' mental health vulnerability tends to vary considerably with individual ACEs. This should be considered carefully when developing cost-effective response to SB burden through PH interventions in particular at the times of financial crises and in scarce resources settings.

Survey of adverse childhood experiences and associated health-harming behaviours among Polish students

A cross-sectional survey was undertaken to estimate the prevalence of child maltreatment and other adverse childhood experiences, and their association with health-harming behaviours in Poland. The survey was conducted among 1760 randomly selected students from five purposefully selected Polish universities. Participants filled in the adverse childhood experiences survey instrument. The results showed that the prevalence of child maltreatment and other adverse childhood experiences was high: physical abuse was reported by 46%, emotional abuse by 42%, sexual abuse by 5% and emotional neglect by 25%. Household dysfunction was also high, with household street drug use reported by 3%, alcohol misuse by 21%, mental disorder by 19%, parental violence by 8% and household crime by 5%. Twenty-four per cent had not had any adverse childhood experience, while 19% reported that they had undergone four or more types of adverse childhood experiences. There was a significant association between adverse childhood experiences and health-harming behaviours such as suicide attempt, alcohol misuse, drug use, risky sexual behaviour and tobacco use. The findings suggest that there is a need to invest in prevention programming.

Experiențele adverse din copilărie și comportamentele asociate de risc pentru sănătate la studenţii din instituţiile de învăţământ superior din Republica Moldova

Studiul privind experien ele adverse din copilarie (EAC) a fost realizat pe un e antion de 1.534de studen i, cu vârstele cuprinse între 18  i 27 ani, înmatricula i în 14 institu ii de înva amântsuperior din Republica Moldova. Studen ii au completat un chestionar auto-raportat privindexpunerea la EAC, atât în aspect de maltratare a copilului, cât  i de disfunc ionalita i la nivel defamilie, în primii 18 ani de via a. Studiul demonstreaza ca pâna la împlinirea vârstei de 18 ani,majoritatea responden ilor (59,6%) s-ar fi confruntat cu unul sau mai multe episoade de EAC,iar 12,5% au raportat patru sau mai multe astfel de episoade. Cele mai frecvent raportate tipuride EAC au fost disciplinarea fizica (20,2%), abuzul emo ional (15,1%)  i neglijarea emo ionala(13%). Tipurile predominante de disfunc ii la nivel de familie au reprezentat divor ul sausepararea parin ilor (19,5%), prezen a unui membru al familiei cu probleme de abuz de alcool(14,9%)  i tratarea violenta a mamei în prezen a copilului (13,1%). A fost determinat un grad înalt de corelare între expunerea la EAC  i adoptarea unor comportamente de risc  i problemelor de sanatate. Riscul autovatamarii, consumul de alcool sau substan e psihotrope  i fumatul este considerabil mai mare la studen ii cu patru sau mai multe EAC. Studiul sugereaza necesitatea instituirii unor ac iuni intersectoriale pentru prevenirea maltratarii copiilor sau a altor EAC.

Adverse childhood experiences and health-risk behaviours in university students from the Republic of Moldova

This survey of adverse childhood experiences (ACEs) was undertaken with 1534 university students aged 18–27 years from 14 universities in the Republic of Moldova. Students completed a self-report questionnaire on whether they had experienced ACEs, defined as both child maltreatment and household dysfunction, during the first 18 years of their life. The study shows that most respondents (59.6%) encountered one or more ACEs during the first 18 years and 12.5% reported four or more.

The most frequently reported types of negative childhood events were corporal punishment (20.2%), emotional abuse (15.1%) and emotional neglect (13%). The most prevalent types of household dysfunction identified were in the form of parental divorce or separation (19.5%), the presence of a family member who abused alcohol (14.9%) and witnessing the mother being treated violently (13.1%).

The association between experiencing ACEs and adopting risky health behaviours was strong. The risks of self-harm, drug and alcohol use, and smoking increased substantially in students with four or more ACEs. The study suggests there is a need for intersectoral action to prevent child maltreatment and other ACEs from occurring.

Adverse childhood experiences and health-harming behaviours among students in Ukraine: report on survey results

The survey of adverse childhood experiences in Ukraine was conducted among a representative sample of the student population (N=1517) selected from colleges and universities at all levels of accreditation (I–IV). It aimed to determine the prevalence and risk factors of adverse childhood experiences (child abuse, neglect, household dysfunctions, peer and community violence) and investigate the interrelations between adverse childhood experiences and health-harming behaviours. Results showed high prevalence of child maltreatment (emotional neglect was experienced by 28%, physical neglect by 25%, physical abuse by 12%, emotional abuse by 10% and sexual abuse by 5%), household dysfunctions, and peer and community violence. Adverse childhood experiences were associated with increased odds of health-risk behaviours, especially suicide attempt, early smoking initiation, alcohol abuse, drug use and risky sexual behaviour. Stakeholders should take stock of the current situation, strengthen national policy and implement a coordinated intersectoral preventive and care response.

Травматизм: призыв к действиям в области общественного здравоохранения в странах Европы: обновленная информация, представленная на основе разработанных ВОЗ глобальных оценочных показателей здоровья за 2015 г.

Разработанные ВОЗ глобальные оценочные показатели здоровья свидетельствуют о том, что в 2015 г. в Европейском регионе ВОЗ (далее – Регион) травматизм и насилие стали причиной смерти 530 000 человек. По сравнению с 2000 г. наблюдается снижение смертности от этих причин на 29%. Травматизм составляет 5,7% от всех причин смерти, 9,4% от общего числа потерянных лет здоровой жизни и является самой распространенной причиной смерти среди людей в возрасте 5–49 лет. Тремя ведущими причинами смерти в результате травм являются насилие, направленное на себя (128 000), падения (94 000) и дорожно-транспортный травматизм (80 000). В Регионе наблюдается неравенство по показателям смертности в результате травм; показатель смертности среди мужчин в 2,5 раза выше по сравнению с показателем смертности среди женщин и в 1,7 раза выше в странах со средним уровнем дохода по сравнению со странами с высоким уровнем дохода. При анализе смертности во всех возрастных группах за период с 2000 г. наблюдается тенденция в сторону сокращения разрыва между странами со средним уровнем дохода и странами с высоким уровнем дохода. Тем не менее в возрастной группе до 15 лет различия в уровне смертности увеличились. Необходимо предпринять действия в области общественного здравоохранения для сокращения неравенства по показателям травматизма в Регионе

European status report on preventing child maltreatment

Child maltreatment is a major public health problem, affecting at least 55 million children in the WHO European Region. The impact of abuse and/or neglect in childhood is detrimental to physical, psychological and reproductive health throughout the life-course, yet the high costs to society are avoidable. There are clear risk factors for maltreatment at the level of the individual, family, community and society. This status report documents the progress that has been made by Member States in implementing the WHO European child maltreatment prevention action plan 2015–2020 at its midpoint. The plan has a target of a 20% reduction in child maltreatment and homicides by 2020. Data were collected through a survey of government-appointed national data coordinators of 49 participating countries in the Region. Results show that good progress is being made overall towards achieving the objectives. Development of national policy for the prevention of child maltreatment has increased across the Region, with three quarters of countries reporting an action plan, but these must be informed by robust national data. Surveillance of child maltreatment remains inadequate in many countries, with information systems in low- and middle-income countries most in need of strengthening. Legislation to prevent maltreatment is widespread, but better enforcement is warranted. The implementation of child maltreatment prevention programmes, including home-visiting, parenting education, school and hospital-based initiatives, has accelerated, but evaluation of impact is needed. Child maltreatment is a societal issue that crosses sectoral boundaries, meaning a sustained, systematic, multidisciplinary and evidence-informed approach to prevention must remain a priority for governments

The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis.

BACKGROUND: A growing body of research identifies the harmful effects that adverse childhood experiences (ACEs; occurring during childhood or adolescence; eg, child maltreatment or exposure to domestic violence) have on health throughout life. Studies have quantified such effects for individual ACEs. However, ACEs frequently co-occur and no synthesis of findings from studies measuring the effect of multiple ACE types has been done. METHODS: In this systematic review and meta-analysis, we searched five electronic databases for cross-sectional, case-control, or cohort studies published up to May 6, 2016, reporting risks of health outcomes, consisting of substance use, sexual health, mental health, weight and physical exercise, violence, and physical health status and conditions, associated with multiple ACEs. We selected articles that presented risk estimates for individuals with at least four ACEs compared with those with none for outcomes with sufficient data for meta-analysis (at least four populations). Included studies also focused on adults aged at least 18 years with a sample size of at least 100. We excluded studies based on high-risk or clinical populations. We extracted data from published reports. We calculated pooled odds ratios (ORs) using a random-effects model. FINDINGS: Of 11 621 references identified by the search, 37 included studies provided risk estimates for 23 outcomes, with a total of 253 719 participants. Individuals with at least four ACEs were at increased risk of all health outcomes compared with individuals with no ACEs. Associations were weak or modest for physical inactivity, overweight or obesity, and diabetes (ORs of less than two); moderate for smoking, heavy alcohol use, poor self-rated health, cancer, heart disease, and respiratory disease (ORs of two to three), strong for sexual risk taking, mental ill health, and problematic alcohol use (ORs of more than three to six), and strongest for problematic drug use and interpersonal and self-directed violence (ORs of more than seven). We identified considerable heterogeneity (I2 of >75%) between estimates for almost half of the outcomes. INTERPRETATION: To have multiple ACEs is a major risk factor for many health conditions. The outcomes most strongly associated with multiple ACEs represent ACE risks for the next generation (eg, violence, mental illness, and substance use). To sustain improvements in public health requires a shift in focus to include prevention of ACEs, resilience building, and ACE-informed service provision. The Sustainable Development Goals provide a global platform to reduce ACEs and their life-course effect on health. FUNDING: Public Health Wales.

Worsening Inequalities in Child Injury Deaths in the WHO European Region.

This article compares the mortality data for injuries in children aged 0-14 years in the World Health Organization WHO European region as estimated by the WHO Global Health Estimates for 2000 and 2015. While the region has seen a decline in child mortality due to injuries over the years, inequality persists between the low- and middle-income countries and high-income countries in the region. The gap in child mortality due to unintentional injuries has widened over the years between these two socioeconomic regions, particularly in terms of road injuries. In contrast, mortality rate ratios due to intentional injuries have narrowed between 2000 and 2015. The low- and middle-income countries need to scale up their efforts in injury prevention by adopting stricter regulations and higher safety practices to narrow the East-West gap in unintentional injuries.

Injuries: a call for public health action in Europe: an update using the 2015 WHO global health estimates

The WHO global health estimates show that 530 000 deaths occurred in the WHO European Region due to injuries and violence in 2015. This represents a decline of 29% from 2000. Injuries account for 5.7% of all deaths and 9.4% of all disability-adjusted life-years lost, and are a leading cause of death in people aged 5–49 years. The three leading causes of injury deaths are self-directed violence (128 000), falls (94 000) and road traffic injuries (80 000). Inequalities in injury deaths exist in the Region, with mortality rates 2.5 times higher in males than in females and 1.7 times higher in middle-income compared to high-income countries. When all ages are considered, there has been a convergence in mortality since 2000 between middle-income and high-income countries, but the gap has widened for children under 15 years. Public health action is needed to reduce inequalities in injuries in the Region.

Handbook on developing national action plans to prevent child maltreatment

Child maltreatment is a major public health problem that has a serious impact on the health and development of children. Reports estimate that at least 55 million children in Europe may experience maltreatment during childhood. It may have a significant negative effect on children’s developmental progress and result in dysfunction during their life-course. Preventing child maltreatment would therefore contribute to preventing a much broader range of difficulties in adult life and enhance children’s long-term social development and physical and mental well-being. The financial costs of maltreatment are high for society, warranting increased investment in preventive and therapeutic strategies from early childhood. The key message to policy-makers and members of civil society is that child maltreatment is not inevitable: it can be prevented by taking a multisectoral, multifactorial public health approach to prevention. This handbook sets out the steps that can be taken when developing an action plan to prevent child maltreatment. It is intended for use alongside other resources developed by the WHO Regional Office for Europe and has been developed to assist countries to implement the European child maltreatment prevention action plan 2015–2020.

Measuring and monitoring national prevalence of child maltreatment: a practical handbook

This handbook has been developed to support the creation of a surveillance system to measure and monitor child maltreatment prevalence across European countries. Implementation of a surveillance system will be an essential factor in realizing Investing in children, the European child maltreatment prevention action plan 2015–2020. It describes the processes involved in setting up child maltreatment surveillance systems and presents recommendations on issues such as selection of data collection method, sampling of respondents, choice of instrument to measure abuse and ethical considerations. The handbook suggests community-based surveys on prevalence as the most appropriate method in setting up a child maltreatment surveillance system and proposes the use of one of three established child maltreatment questionnaires, based on the results of a rapid systematic review of child abuse measures. The Short Child Maltreatment Questionnaire is introduced for countries needing a brief measure. Ideally, community-based surveys should be conducted with nationally representative samples of approximately 1500 students in each age group and administered via schools. The use of self-report methods – paper-based or tablet/mobile-phone self-administered questionnaires – is advised. Questions should capture previous-year and lifetime prevalence of child maltreatment. Monitoring prevalence rates over time requires surveys to be conducted at repeated time points. It is proposed that surveys be administered every four to seven years. Methods of data collection that do not involve children are presented for countries unable to conduct surveys with children. Finally, ethical considerations in conducting surveys on child maltreatment are discussed.

Европейские факты и Доклад о состоянии безопасности дорожного движения в мире 2015

В 2013 г. в Европейском регионе ВОЗ от травм, полученных в дорожно-транспортных происшествиях, погибли почти 85 000 человек. Хотя в сравнении с другими регионами ВОЗ этот региональный показатель смертности является наиболее низким (9,3 случая смерти на 100 000 населения), между европейскими странами наблюдаются значительные различия в уровнях дорожно-транспортной смертности. Для того чтобы к 2020 г. достичь заявленной цели общемирового сокращения дорожно-транспортной смертности на 50%, необходимы более систематические усилия. В настоящей публикации анализируются законы и практические действия в отношении основных факторов риска – например, введение ограничений скорости в зависимости от типа дороги, управление транспортным средством в состоянии алкогольного опьянения, использование ремней безопасности, мотоциклетных шлемов и детских удерживающих устройств – с точки зрения их эффективности в плане снижения риска травматизма. Анализ показывает, что многим странам необходимо совершенствовать свое законодательство и правоприменение в области безопасности дорожного движения с тем, чтобы защитить население, изменить поведение участников дорожного движения и сократить число дорожных аварий. Например, несмотря на то, что 95% населения Региона охвачено всеобъемлющим и соответствующим передовой практике законодательством в отношении ремней безопасности, лишь 47% населения должным образом защищены законами о скорости, 45% – законами об использовании шлемов, 33% – законами в отношении вождения в состоянии алкогольного опьянения, и 71% – законами об использовании детских удерживающих устройств. Можно добиться значительных результатов путем повышения безопасности транспортных средств, улучшения дорожной инфраструктуры и пропаганды использования физически активных видов передвижения, служащих альтернативой использованию автотранспорта. Для того чтобы защитить всех участников дорожного движения в Регионе, нужно соединить политические усилия с системными подходами.