Deaths among drivers and right-front passengers in frontal collisions: redesigned air bags relative to first-generation air bags.

OBJECTIVE: After automakers were allowed the option of using sled tests for unbelted male dummies to certify the frontal crash performance of vehicles, most frontal air bags were depowered, starting in model year 1998, to reduce deaths and serious injuries arising from air bag deployments. Concern has been expressed that depowering air bags could compromise the protection of adult occupants. This study aimed to determine the effects of changes in air bag designs on risk of death among front-seat occupants. METHODS: Deaths among drivers and right-front passengers per involvement in frontal police-reported crashes during calendar years 1998-2004 were compared among vehicles with sled-certified air bags (model years 1998-2004) and first-generation air bags (model years 1994-97). Frontal crash deaths were identified from the Fatality Analysis Reporting System. National estimates of police-reported crashes were derived from the National Automotive Sampling System/General Estimates System. Sled certification status for model years 1998-2004 was ascertained from published federal data and a survey of automobile manufacturers. Passenger cars, pickup trucks, sport utility vehicles, and minivans were studied. Stratified analyses were done to compute risk ratios (RR) and 95% confidence intervals (95% CI) for driver and right-front passenger deaths by air bag generation and crash, vehicle, and driver characteristics. RESULTS: In frontal crashes, overall RRs were 0.89 for driver deaths (95% CI = 0.74-1.08) and 0.89 for right-front passenger deaths (95% CI = 0.74-1.07) in sled-certified vehicles compared with first-generation air bag-equipped vehicles. Child right-front passengers (ages 0-4, 5-9) in vehicles with sled-certified air bags had statistically significant reductions in risk of dying in frontal collisions, including a 65% reduced risk among ages 0-4 (RR = 0.35; 95% CI = 0.21-0.60). No differences in effects of sled-certified air bags were observed between drivers ages 15-59 and 60-74 in sled-certified vehicles, both of whom had RRs slightly below 0.90 (non-significant). Among occupants killed in sled-certified vehicles, police-reported belt use was somewhat higher than in first-generation vehicles. CONCLUSIONS: No differences in risk of frontal crash deaths were observed between adult occupants with sled-certified and first-generation air bags. Consistent with reports of decreases in air bag-related deaths, this study observed significant reductions in frontal deaths among child passengers seated in the right-front position in sled-certified vehicles. Higher restraint use rates among children in sled-certified vehicles and other vehicle design changes might have contributed partially to these reductions.

Using head-on collisions to compare risk of driver death by frontal air bag generation: a matched-pair cohort study.

US air bag regulations were changed in 1997 to allow tests of unbelted male dummies in vehicles mounted and accelerated on sleds, resulting in longer crash pulses than rigid-barrier crashes. This change facilitated depowering of frontal air bags and was intended to reduce air bag-induced deaths. Controversy ensued as to whether sled-certified air bags could increase adult fatality risk. A matched-pair cohort study of two-vehicle, head-on, fatal collisions between drivers involving first-generation versus sled-certified air bags during 1998-2005 was conducted by using Fatality Analysis Reporting System data. Sled certification was ascertained from public information and a survey of automakers. Conditional Poisson regression for matched-pair cohorts was used to estimate risk ratios adjusted for age, seat belt status, vehicle type, passenger car size, and model year for driver deaths in vehicles with sled-certified air bags versus first-generation air bags. For all passenger-vehicle pairs, the adjusted risk ratio was 0.87 (95% confidence interval: 0.77, 0.98). In head-on collisions involving only passenger cars, the adjusted risk ratio was 1.04 (95% confidence interval: 0.85, 1.29). Increased fatality risk for drivers with sled-certified air bags was not observed. A borderline significant interaction between vehicle type and air bag generation suggested that sled-certified air bags may have reduced the risk of dying in head-on collisions among drivers of pickup trucks.

Persuasion and licensure: a randomized controlled intervention trial to increase licensure rates among Maryland motorcycle owners.

OBJECTIVE: This study aimed to determine whether a persuasive educational intervention could increase licensure among motorcycle owners. Unlicensed motorcycle operators appear to be disproportionately involved in police-reported motorcycle crashes in Maryland, accounting for about 27% of motorcycle operators in police-reported crashes, although unlicensed owners comprise 17% of primary motorcycle owners. METHODS: A randomized controlled trial was conducted among unlicensed owners. Linking Maryland records of registered motorcycles with license files, 8,499 unlicensed owners who had no licensed co-owners were identified. Half were randomized to receive a persuasive educational mailing in early June 2005 from Maryland Motor Vehicle Administration (MVA). Motorcycle licenses can be attained by passing an accredited motorcycle training class or passing knowledge and skills tests administered by the state driver licensing agency. Licensure rates and motorcycle class enrollment were followed for 6 months post-intervention. RESULTS: As of December 16, 2005, 280 intervention group owners had obtained Class M motorcycle licenses and 158 had obtained Class R motorcycle learner's permits. The comparison group obtained 209 M licenses and 122 R permits. The overall success rate in the intervention group, defined as obtaining Class M or R, was 10.4% compared with 7.9% in the comparison group (licensure ratio (LR) = 1.33; 95% confidence interval (CI) = 1.16-1.52). The intervention was most successful among men, whose LR for obtaining M licenses was 1.45 (95% CI = 1.21-1.75). LRs were higher among owners ages 40-48 and 49+ receiving the intervention compared with younger groups. Motorcycle training class enrollment rates were higher in the intervention group, particularly among those taking a course for riders with intermediate skills (enrollment ratio = 2.24; 95% CI = 1.41-3.55). CONCLUSION: The intervention appeared to increase licensure, yet the licensure rate remained low among the intervention group. Potential risks and benefits of increasing the percentage of motorcyclists who are licensed need to be studied.