Major Traffic Safety Reform and Road Traffic Injuries Among Low-Income New York Residents, 2009-2021.

Objectives. To evaluate the effects of a comprehensive traffic safety policy-New York City's (NYC's) 2014 Vision Zero-on the health of Medicaid enrollees. Methods. We conducted difference-in-differences analyses using individual-level New York Medicaid data to measure traffic injuries and expenditures from 2009 to 2021, comparing NYC to surrounding counties without traffic reforms (n = 65 585 568 person-years). Results. After Vision Zero, injury rates among NYC Medicaid enrollees diverged from those of surrounding counties, with a net impact of 77.5 fewer injuries per 100 000 person-years annually (95% confidence interval = -97.4, -57.6). We observed marked reductions in severe injuries (brain injury, hospitalizations) and savings of $90.8 million in Medicaid expenditures over the first 5 years. Effects were largest among Black residents. Impacts were reversed during the COVID-19 period. Conclusions. Vision Zero resulted in substantial protection for socioeconomically disadvantaged populations known to face heightened risk of injury, but the policy's effectiveness decreased during the pandemic period. Public Health Implications. Many cities have recently launched Vision Zero policies and others plan to do so. This research adds to the evidence on how and in what circumstances comprehensive traffic policies protect public health. (Am J Public Health. 2024;114(6):633-641. https://doi.org/10.2105/AJPH.2024.307617).

The development of a road safety policy index and its application in evaluating the effects of road safety policy.

The paper presents an exploratory study of a road safety policy index developed for Norway. The index consists of ten road safety measures for which data on their use from 1980 to 2021 are available. The ten measures were combined into an index which had an initial value of 50 in 1980 and increased to a value of 185 in 2021. To assess the application of the index in evaluating the effects of road safety policy, negative binomial regression models and multivariate time series models were developed for traffic fatalities, fatalities and serious injuries, and all injuries. The coefficient for the policy index was negative, indicating the road safety policy has contributed to reducing the number of fatalities and injuries. The size of this contribution can be estimated by means of at least three estimators that do not always produce identical values. There is little doubt about the sign of the relationship: a stronger road safety policy (as indicated by index values) is associated with a larger decline in fatalities and injuries. A precise quantification is, however, not possible. Different estimators of effect, all of which can be regarded as plausible, yield different results.

Injury risk curves to guide safe speed limits on Swedish roads using German crash data supplemented with estimated non-injury crashes.

Vision Zero postulates that no one should be killed or seriously injured in road traffic; therefore, it is necessary to define evidence-based speed limits to mitigate impact severity. The overall aims to guide the definition of safe speeds limits by establishing relations between impact speed and the risk of at-least-moderate (MAIS2+) and at-least-severe (MAIS3+) injuries for car occupants in frontal and side crashes in Sweden. As Swedish in-depth data are unavailable, the first objective was to assess the applicability of German In-depth Accident Study (GIDAS) data to Sweden. The second was to create unconditional injury risk curves (risk of injury given involvement in any crash), rather than risk curves conditional on the GIDAS sampling criterion of suspected-injury crashes. Thirdly, we compared the unconditional and conditional risk curves to quantify the practical implications of this methodological choice. Finally, we provide an example to demonstrate how injury risk curves facilitate the definition of safe, evidence-based speed limits in Sweden. Characteristics important for the injury outcome were similar between GIDAS and Swedish data; therefore, the injury risk curves using German GIDAS data are applicable to Sweden. The regression models yielded the following results for unconditional injury risk curves: 10 % MAIS2+ at 25 km/h impact speed for frontal head-on crashes, 20 km/h for frontal car-to-object crashes, 55 km/h in far-side crashes, and 45 km/h in near-side crashes. A 10 % MAIS3+ risk was reached between 70 and 75 km/h for all crash types. Conditional injury risk curves gave substantially different results; the 10 % MAIS3+ risk in near-side crashes was 140 km/h, twice the unconditional value. For example, if a 10 % MAIS3+ risk was acceptable, treating remaining uncertainty conservatively, assuming compliance with speed limits and that Automated Emergency Braking takes 20 km/h of the travel speed before impact in longitudinal traffic, the safe speed limit for car occupants on most Swedish roads would be 80 km/h and 60 km/h in intersections.

Statistical estimation of fatal and serious injuries saved by iRAP protocols in 74 countries.

OBJECTIVE: Road traffic crashes cause 1.19 million deaths and millions more injuries annually. The persistently high burden has drawn attention from national and international stakeholders worldwide. Unsafe road infrastructure is one of the major risk factors for traffic safety, particularly in low- and middle-income countries. METHODS: Aiming to eliminate high-risk roads in all countries, the International Road Assessment Programme (iRAP) developed a robust and evidence-based approach to support country transportation agencies. RESULTS: Thus far, the iRAP protocols have been used to collect 1.8 million kilometers of Crash Risk Mapping and 1.5 million kilometers of Star Rating and FSI estimations in 128 countries. Deploying an observational before-and-after (or pre-post) study design, this report estimated the fatal and series injuries (FSI) saved through use of the iRAP protocols. The study is based on 441,753 kilometers of assessed roads from 1,039 projects in 74 countries. Our results show that the implementation of iRAP's proposed countermeasures saves about 159,936 FSI annually. Throughout the lifetime of the implemented countermeasures, a total of 3.2 million FSI could be saved. CONCLUSION: While quantifying the success of the iRAP protocols, our results suggest an opportunity to save many millions more lives on the roads through expanding iRAP implementation to more regions and countries.

The Injury Prevention Program to Reduce Early Childhood Injuries: A Cluster Randomized Trial.

BACKGROUND AND OBJECTIVES: The American Academy of Pediatrics designed The Injury Prevention Program (TIPP) in 1983 to help pediatricians prevent unintentional injuries, but TIPP's effectiveness has never been formally evaluated. We sought to evaluate the impact of TIPP on reported injuries in the first 2 years of life. METHODS: We conducted a stratified, cluster-randomized trial at 4 academic medical centers: 2 centers trained their pediatric residents and implemented TIPP screening and counseling materials at all well-child checks (WCCs) for ages 2 to 24 months, and 2 centers implemented obesity prevention. At each WCC, parents reported the number of child injuries since the previous WCC. Proportional odds logistic regression analyses with generalized estimating equation examined the extent to which the number of injuries reported were reduced at TIPP intervention sites compared with control sites, adjusting for baseline child, parent, and household factors. RESULTS: A total of 781 parent-infant dyads (349 TIPP; 432 control) were enrolled and had sufficient data to qualify for analyses: 51% Hispanic, 28% non-Hispanic Black, and 87% insured by Medicaid. Those at TIPP sites had significant reduction in the adjusted odds of reported injuries compared with non-TIPP sites throughout the follow-up (P = .005), with adjusted odds ratios (95% CI) of 0.77 (0.66-0.91), 0.60 (0.44-0.82), 0.32 (0.16-0.62), 0.26 (0.12-0.53), and 0.27 (0.14-0.52) at 4, 6, 12, 18, and 24 months, respectively. CONCLUSIONS: In this cluster-randomized trial with predominantly low-income, Hispanic, and non-Hispanic Black families, TIPP resulted in a significant reduction in parent-reported injuries. Our study provides evidence for implementing the American Academy of Pediatrics' TIPP in routine well-child care.

The immediate effects of vision-zero corridor upgrades on pedestrian crashes in New York: A before-and-after spatial point process approach.

The long-term effects of the Vision-Zero (VZ) approach in Scandinavia are well documented. In contrast, information regarding the immediate effects of VZ at the starting phase upon gradual implementation is scarce. Taking New York City as the case study, we analyzed both the local and global effects of the Vision-Zero gradual implementation on pedestrian crashes in the early stage of implementation starting from 2014. The data analysis comprised 8,165 pedestrian injury crashes. Using location data, the crashes were matched to VZ infrastructure improvement location, start and completion dates. The experimental design included a treatment and two types of control conditions, and we controlled for well-known covariates including traffic exposure, land use, and risk-prone areas. We estimated a Geyer Saturation model and kernel density function for modeling the effect of Vision-Zero on crash intensity and dispersion two years before and after the implementation of Vision-Zero. The results reveal a significant global decrease of 6.1 % (p = 0.004) in pedestrian crash incidence in the treated sections compared with the control group two years after the treatment, and a greater dispersion of pedestrian injuries following the policy implementation.

Voices from the Ground: Community Perspectives on Preventing Unintentional Child Injuries in Low-Income Settings.

Unintentional injuries significantly contribute to mortality and morbidity among children under five, with higher prevalence in low- and middle-income countries (LMICs). Deprived communities in these regions face increased injury risks, yet there is limited research on child safety tailored to their unique challenges. To address this gap, we conducted focus group discussions in rural Uganda, involving parents, village health workers, community leaders, teachers, and maids. The objective was to understand community perceptions around child safety and determine what culturally and age-appropriate solutions may work to prevent child injuries. Analysis of discussions from ten focus groups revealed five main themes: injury causes, child development and behavior, adult behavior, environmental factors, and potential safety kit components. Common injuries included falls, burns, drowning, and poisoning, often linked to environmental hazards such as unsafe bunk beds and wet floors. Financial constraints and limited space emerged as cross-cutting issues. Participants suggested educational resources, first aid knowledge, and practical devices like solar lamps as potential solutions. The study presents invaluable insights into child safety in rural Ugandan homes, emphasizing the role of community awareness and engagement in designing effective, accessible interventions. It underscores the importance of context-specific strategies to prevent childhood injuries in similar resource-constrained environments.

Assessing the impact and implications of the revised Act on the Aggravated Punishment of Specific Crimes in preventing child traffic injuries in school zones in Korea: an interrupted time series analysis.

In 2019, a child's death in Korea led to legislation that imposed stricter penalties for school zone traffic violations. We assessed the impact of that legislation using 2017-2022 Traffic Accident Analysis System data. Adjusted analyses revealed a significant decline in severe injuries in school zones, decreasing from 11 cases to 8 cases per month (p=0.017). The legislation correlated with a reduced risk of all child traffic injuries (risk ratio, 0.987; 95% confidence interval, 0.977 to 0.997; p=0.002), indicating its efficacy in curbing accidents.

Investigating pedestrian-vehicle crashes on interstate highways: Applying random parameter binary logit model with heterogeneity in means.

In the U.S., the interstate highway system is categorized as a controlled-access or limited-access route, and it is unlawful for pedestrians to enter or cross this type of highway. However, pedestrian-vehicle crashes on the interstate highway system pose a distinctive safety concern. Most of these crashes involve 'unintended pedestrians', drivers who come out of their disabled vehicles, or due to the involvement in previous crashes on the interstate. Because these are not 'typical pedestrians', a separate investigation is required to better understand the pedestrian crash problem on interstate highways and identify the high-risk scenarios. This study explored 531 KABC (K = Fatal, A = Severe, B = Moderate, C = Complaint) pedestrian injury crashes on Louisiana interstate highways during the 2014-2018 period. Pedestrian injury severity was categorized into two levels: FS (fatal/severe) and IN (moderate/complaint). The random parameter binary logit with heterogeneity in means (RPBL-HM) model was utilized to address the unobserved heterogeneity (i.e., variations in the effect of crash contributing factors across the sample population) in the crash data. Some of the factors were found to increase the likelihood of pedestrian's FS injury in crashes on interstate highways, including pedestrian impairment, pedestrian action, weekend, driver aged 35-44 years, and spring season. The interaction of 'pedestrian impairment' and 'weekend' was found significant, suggesting that alcohol-involved pedestrians were more likely to be involved in FS crashes during weekends on the interstate. The obtained results can help the 'unintended pedestrians' about the crash scenarios on the interstate and reduce these unexpected incidents.

Relationships Between Alcohol Policies and Infant Morbidities and Injuries.

INTRODUCTION: Previous research has found that policies specifically focused on pregnant people's alcohol use are largely ineffective. Therefore, the purpose of this study is to analyze the relationships between general population policies regulating alcohol physical availability and outcomes related to pregnant people's alcohol use, specifically infant morbidities and injuries. METHODS: Outcome data were obtained from Merative MarketScan, a longitudinal commercial insurance claims data set. Policy data were obtained from the National Institute on Alcohol Abuse and Alcoholism's Alcohol Policy Information System, the National Alcohol Beverage Control Association, and Liquor Handbooks and merged using policies in effect during the estimated year of conception. Relationships between state-level policies regulating sites, days/hours, and government monopoly of liquor sales and infant morbidities and injuries were examined. Analyses used logistic regression with individual controls, fixed effects for state and year, state-specific time trends, and SEs clustered by state. The study analysis was conducted from 2021 to 2023. RESULTS: The analytic sample included 1,432,979 infant-birthing person pairs, specifically people aged 25-50 years who gave birth to a singleton between 2006 and 2019. A total of 3.1% of infants had a morbidity and 2.1% of infants had an injury. State government monopoly on liquor sales was associated with reduced odds of infant morbidities and injuries, whereas gas station liquor sales were associated with increased odds of infant morbidities and injuries. Allowing liquor sales after 10PM was associated with increased odds for infant injuries. No effect was found for allowing liquor sales in grocery stores or on Sundays. CONCLUSIONS: Findings suggest that limiting alcohol availability for the general population may help reduce adverse infant outcomes related to pregnant people's alcohol use.

Pedestrian injuries in the United States: Shifting injury patterns with the introduction of pedestrian protection into the passenger vehicle fleet.

OBJECTIVE: Between 2010 and 2020, an annual average of more than 70,000 pedestrians were injured in U.S. motor vehicle crashes. Pedestrian fatalities increased steadily over that period, outpacing increases in vehicle occupant fatalities. Strategies for reducing pedestrian injuries include pedestrian crash prevention and improved vehicle design for protection of pedestrians in the crashes that cannot be prevented. This study focuses on understanding trends in injuries sustained in U.S. pedestrian crashes to inform continuing efforts to improve pedestrian crash protection in passenger vehicles. METHODS: More than 160,000 adult pedestrians injured in motor vehicle crashes who were admitted to U.S. trauma centers between 2007 and 2016 were drawn from the National Trauma Data Bank (NTDB) Research Data Sets. The injuries in those cases were used to explore the shifting patterns of pedestrian injuries. RESULTS: The proportion of pedestrians with thorax injuries increased 3.0 percentage points to 30.7% of trauma center-admitted NTDB pedestrian cases over the 10 years studied, and the proportion with pelvis/hip injuries increased to 21.2%. The proportion of cases with head injuries fell to 48.6%, and the percentage of pedestrians with lower extremity injury (44%) did not change significantly over the 10 year period. Assessment of possible reasons for the shifts suggested that increasing numbers of sport utility vehicles, population increases among the oldest age groups, and improvements in pedestrian protection in U.S. passenger vehicles likely contributed to, but did not completely account for, the relative changes in injury frequency in each body region. CONCLUSIONS: More important than the reasons for the shifts in the relative frequency of injury to each body region are the conclusions that can be drawn regarding priorities for pedestrian protection research. Though head/face and lower extremity injuries remained the most frequently injured body regions in adult pedestrians admitted to NTDB trauma centers, the relative frequency of thorax and pelvis/hip injuries increased steadily, underlining the increasing importance of pedestrian protection research on these body regions.

Unraveling the differences in distracted driving injury severities in passenger car, sport utility vehicle, pickup truck, and minivan crashes.

Distracted driving poses a significant risk on the roadway users, with the level of distraction and crash outcomes varying depending on the type of vehicle. Drivers of passenger cars, sport utility vehicles (SUVs), pickup trucks, minivans experience distinct levels of distraction, leading to potential crashes. This study investigates into the severity of driver injuries resulting from distracted driving in these vehicle categories, shedding light on the variations in single-vehicle crashes. Focusing on single-vehicle crashes in Florida during 2019, involving passenger cars, SUVs, pickup trucks, and minivans caused by distracted driving, the study examines various distractions such as, electronic communication devices (cell phones), electronic devices (navigation systems, music players), internal and external disturbances, texting, and inattentive driving. To analyze the severity of injuries resulting from distracted driving in passenger cars, SUVs, pickup trucks, and minivans, the study employs random parameter multinomial logit models with heterogeneity in means and variances. The model estimates highlight thirty-five significant factors influencing the severity of driver injuries resulting from distracted driving. Notably, the impact of these factors varies significantly depending on the vehicle type (i.e., passenger cars, SUVs, pickup trucks, and minivans). While many explanatory variables are specific to each vehicle type, only one factor (restraint belt usage) is common across all vehicle types, with varying magnitudes in injury outcomes. The likelihood ratio tests indicate that injury severity must be analyzed and modeled separately for passenger cars, SUVs, pickup trucks, and minivans. Vehicle characteristics play a crucial role in driver distraction and crash outcomes. Analyzing a year of crash data, categorized by four vehicle types, has provided valuable insights into distracted driving patterns in passenger cars, SUVs, pickup trucks, and minivans, influencing potential prevention strategies. To combat against distracted driving effectively, priority should be given to driver education and training, roadway design, vehicle technology, enforcement, and automobile insurance. The automobile industry, especially for passenger cars, SUVs, pickup trucks, and minivans, should consider implementing advanced in-vehicle technologies tailored to the specific characteristics of each vehicle type (e.g., advanced driver assistance systems (ADAS)) to proactively prevent driver distraction. These proactive measures will contribute significantly to enhancing road safety and reducing the risks associated with distracted driving.

Education on Preventing Early Childhood Injuries Using a Video Game: The VirtualSafeHome Platform.

Poisonings and household injuries are frequent events among toddlers. We developed VirtualSafeHome (VSH)-a novel self-contained, Internet-based home-safety learning tool-to improve awareness of household hazards. Study aims were to investigate VSH usage characteristics. A prototype, screen-based VSH kitchen was built in Unity and delivered through the web using 3DVista and Wix. Players spot and click 21 embedded hazards. A unique feature is the ability to capture the "child's perspective" in identifying hazards. We recruited a convenience sample of adults in 2021-2022. Outcomes included number of hazards discovered, session duration, and pretest/posttest knowledge scores. Twenty-four adults identified a median 15.5 hazards; median playing time was 1022 seconds. Players reported satisfaction with ease of navigation and game features. Mean pretest/posttest knowledge scores rose from 2.0 to 2.79 (P < .035). A web-enabled video game can provide easily accessed, enjoyable training on home safety.

Overview of road traffic injuries among migrant workers in Guangzhou, China, from 2017 to 2021.

INTRODUCTION: There are many migrant workers in China's first-tier cities, but little is known about road safety. This paper systematically analysed road traffic injuries and risk factors among migrant workers in Guangzhou, China. METHODS: Road traffic crash data from 2017 to 2021 were obtained from the Guangzhou Public Security Traffic Management Integrated System. We plotted the crash network of road users in road traffic crashes and used logistic regression to analyse the risk factors for migrant workers of motorcycle and four-wheeled vehicle crashes. Moreover, the roles of migrant workers and control individuals as perpetrators in road traffic crashes were also analysed. RESULTS: Between 2017 and 2021, 76% of road traffic injuries were migrant workers in Guangzhou. Migrant workers who were motorcyclist drivers most commonly experienced road traffic injuries. Crashes between motorcyclists and car occupants were the most common. The illegal behaviours of migrant worker motorcyclists were closely related to casualties, with driving without a licence only and driving without a licence and drunk driving accounting for the greatest number. Migrant workers were responsible for many injuries of other road users. Motorcycle drivers have a higher proportion of drunk driving. DISCUSSION: Migrant workers play an important role in road traffic safety. They were both the leading source of road traffic injuries and the main perpetrators of road traffic crashes. Measures such as strict requirements for migrant workers to drive motorcycles with licences, prohibit drunk driving, greater publicity of road safety regulations, and combining compulsory education with punishment for illegal behaviours.

A correlated random parameters ordered probit approach to analyze the injury severity of bicycle-motor vehicle collisions at intersections.

Bicycle-motor vehicle (BMV) accidents hold paramount importance due to their substantial impact on public safety. Specifically, road intersections, being critical conflict points, demand focused attention to reduce BMV crashes effectively and mitigate their severity. The existing research on the severity analysis of these crashes appears to have certain gaps that warrant further contribution. To address the mentioned limitations, this study first integrates multiple pre-collision features of the bicycles and vehicles to classify crash types based on the mechanism of the crashes. Then, the correlated random parameters ordered probit (CRPOP) model is employed to examine the factors influencing injury severity among bicyclists involved in intersection BMV crashes in Pennsylvania from 2013 to 2018. To gain deeper insights, this study conducts a separate analysis of crash data from 3-leg intersections, 4-leg intersections, and their combined scenarios, followed by a comparative examination of the results. The findings revealed that the presented crash typing approach yields new insights regarding injury severity outcomes. Moreover, in addition to exhibiting a comparable statistical performance contrasting to the more restricted models, the CRPOP model identified hidden correlations between three random parameters. Furthermore, the study demonstrated that analyzing combined crash data from the two intersection types obscured certain factors that were found significantly influential in the injury outcomes through analyzing sub-grouped data. Consequently, it is recommended to implement tailored countermeasures for each type of intersection.

Trauma and sexual abuse in children-Epidemiology, challenges, management strategies and prevention in lower- and middle-income countries.

Trauma is rising as a cause of morbidity and mortality in lower- and middle-income countries (LMIC). This article describes the Epidemiology, Challenges, Management strategies and prevention of pediatric trauma in lower- and middle-income countries. The top five etiologies for non-intentional injuries leading to death are falls, road traffic injuries, burns, drowning and poisoning. The mortality rate in LMICs is twice that of High-Income Countries (HICs) irrespective of injury severity adjustment. The reasons for inadequate care include lack of facilities, transportation problems, lack of prehospital care, lack of resources and trained manpower to handle pediatric trauma. To overcome these challenges, attention to protocolized care and treatment adaptation based on resource availability is critical. Training in management of trauma helps to reduce the mortality and morbidity in pediatric polytrauma cases. There is also a need for more collaborative research to develop preventative measures to childhood trauma.

Study of AEB and active seat belt on driver injury in vehicle-vehicle frontal oblique crash.

The safety of vehicle occupants in oblique collision scenarios continues to pose challenges, even with the implementation of Automatic Emergency Braking (AEB) systems. While AEB reduces collision risks, studies indicate it may heighten injury risks for out-of-position (OOP) occupants. To counteract this issue, the integration of active seat belts in vehicles equipped with AEB systems is recommended. Firstly, this study established an oblique angle collision scenario post-AEB activation using data from the Chinese National Automobile Accident In-depth Investigation System (NAIS) database, analyzed through Prescan software. The dynamic response of the vehicle was examined. Following this, finite element (FE) models were validated to assess the effects of collision overlap rate, AEB braking strategy, and active seat belt pre-tensioning on occupant injuries and kinematics. Under specific collision conditions, the impact of the timing and amount of seat belt pre-tensioning, as well as airbag deployment timing on occupant injuries, was also explored. Findings revealed that a 75% collision overlap rate significantly increases driver injury risk. Active seat belts effectively mitigate injuries caused by OOP statuses during AEB interventions, with the lowest Weighted Injury Criterion (WIC) observed at a pre-tensioning time of 200 ms for active seat belts. The study further suggests that optimal results in reducing occupant injuries are achieved when active pre-tensioning seat belts are complemented by appropriately timed airbag deployment.