Bicycle helmet wearing and the risk of head, face, and neck injury: a French case--control study based on a road trauma registry.

BACKGROUND: Previous case-control studies on bicycle helmet efficacy are mostly Anglo-Saxon, and based on data from the early 1990s when hard-shell helmets were common. METHODS: In France, the Rhône county (1.6 million inhabitants) is covered by a road trauma registry that includes emergency department visits, hospital admissions, and fatalities. Over the 1998-2008 period, 13,797 cyclist casualties were identified. The injuries sustained were coded using the Abbreviated Injury Scale (AIS) for injuries to the head (AIS1+ and AIS3+), face (AIS1+), or neck (AIS1+). The study uses a case-control design where the control group includes cyclists injured below the neck-that is, not injured in the region associated with the helmet. We first adjusted for age, gender, and type of crash, as in a previously published Cochrane review. Then we adjusted for injury severity based on non-head, face, or neck injury, and when relevant, for crash location: type of road, urban/rural area. RESULTS: The fully adjusted ORs of helmeted versus unhelmeted cyclists are: for AIS1+ head injuries, 0.69 (95% CI 0.59 to 0.81); for AIS3+ head injuries sustained in urban areas, 0.34 (95% CI 0.15 to 0.65), those sustained in rural areas, 0.07 (95% CI 0.02 to 0.23); for AIS1+ facial injuries, 0.72 (95% CI 0.62 to 0.83); and for AIS1+ neck injuries, 1.18 (95% CI 0.94 to 1.47). CONCLUSION: This study confirms the protective effect for head and facial injuries, even though soft-shell helmets have now become more common. The reduction of risk is greater for serious head injuries. The study is inconclusive about the risk for neck injuries.

Why drivers start drinking and driving--a prospective study over a 6-year period in the GAZEL cohort.

AIMS: To estimate the frequency with which a group of formerly safe drivers adopt driving while alcohol-intoxicated (DWI), and to determine the factors associated with DWI adoption. METHODS: Participants were current employees or recent retirees of the French national electricity and gas company. An annual cohort questionnaire that includes two questions about overall alcohol consumption is sent each year to participants. A Driving Behaviour and Road Safety (DBRS) questionnaire was administered in 2001, 2004 and 2007. Only drivers who participated in the 2001 survey received the 2004 and 2007 questionnaires. RESULTS: More than 462 participants ceased DWI between 2001 and 2007, while 511 adopted this behaviour for the first time. Multivariate analysis showed that the risk of adopting DWI was associated with male gender and with several changes over the preceding years: increased alcohol consumption, increased number of close friends, decreased number of close relatives and decreased attitudes in favour of strict enforcement/regulations. CONCLUSION: A large number of offenders stopped DWI between 2001 and 2007, concomitantly with an increased crackdown on road violations in France. But this success was compromised by the occurrence of new drunk drivers. Preventive strategies should target factors that facilitate DWI adoption-in particular, increased alcohol consumption and low acceptance of law enforcement initiatives.

The injury epidemiology of cyclists based on a road trauma registry.

BACKGROUND: Bicycle use has increased in some of France's major cities, mainly as a means of transport. Bicycle crashes need to be studied, preferably by type of cycling. Here we conduct a descriptive analysis. METHOD: A road trauma registry has been in use in France since 1996, in a large county around Lyon (the Rhône, population 1.6 million). It covers outpatients, inpatients and fatalities. All injuries are coded using the Abbreviated Injury Scale (AIS). Proxies were used to identify three types of cycling: learning = children (0-10 years old); sports cycling = teenagers and adults injured outside towns; cycling as means of transport = teenagers and adults injured in towns. The study is based on 13,684 cyclist casualties (1996-2008). RESULTS: The percentage of cyclists injured in a collision with a motor vehicle was 8% among children, 17% among teenagers and adults injured outside towns, and 31% among those injured in towns. The percentage of serious casualties (MAIS 3+) was 4.5% among children, 10.9% among adults injured outside towns and 7.2% among those injured in towns. Collisions with motor-vehicles lead to more internal injuries than bicycle-only crashes. CONCLUSION: The description indicates that cyclist type is associated with different crash and injury patterns. In particular, cyclists injured in towns (where cycling is increasing) are generally less severely injured than those injured outside towns for both types of crash (bicycle-only crashes and collisions with a motor vehicle). This is probably due to lower speeds in towns, for both cyclists and motor vehicles.

Maternal residence near municipal waste incinerators and the risk of urinary tract birth defects.

OBJECTIVES: Waste incineration releases a mixture of chemicals with high embryotoxic potential, including heavy metals and dioxins/furans, into the atmosphere. In a previous ecological study we found an association between the risk of urinary tract birth defects and residence in the vicinity of municipal solid waste incinerators (MSWIs). The objective of the present study was to specifically test this association. METHODS: A population-based case-control study compared 304 infants with urinary tract birth defects diagnosed in the Rhône-Alpes region (2001-2003) with a random sample of 226 population controls frequency-matched for infant sex and year and district of birth. Exposure to dioxins in early pregnancy at the place of residence, used as a tracer of the mixture released by 21 active waste incinerators, was predicted with second-generation Gaussian modelling (ADMS3 software). Other industrial emissions of dioxins, population density and neighbourhood deprivation were also assessed. Individual risk factors including consumption of local food were obtained by interviews with 62% of the case and all control families. RESULTS: Risk was increased for mothers exposed to dioxins above the median at the beginning of pregnancy (OR 2.95, 95% CI 1.47 to 5.92 for dioxin deposits). When only interviewed cases were considered, risk estimates decreased mainly because the non-interviewed cases were more likely to live in exposed residential environments (OR 2.05, 95% CI 0.92 to 4.57). The results suggest that consumption of local food modifies this risk. CONCLUSIONS: This study confirms our previous observation of a link between the risk of urinary tract birth defects and exposure to MSWI emissions in early pregnancy and illustrates the effect of participation bias on risk estimates of environmental health impacts.

Road casualties and changes in risky driving behavior in France between 2001 and 2004 among participants in the GAZEL cohort.

OBJECTIVES: We investigated behavioral changes in a large cohort of drivers to identify underlying causes of the decline in road casualties in France. METHODS: In 2001 and 2004, 11,240 participants used self-administered questionnaires to report attitudes toward road safety and driving behaviors. Injury road traffic collisions were recorded from 2001 to 2005 through the cohort's annual questionnaire. RESULTS: Between 2001 and 2004, speeding and cell phone use decreased concomitantly with a decrease in injury road traffic collision rates among participants. Reported driving while sleepy remained unchanged and driving while alcohol intoxicated was reported by a higher proportion in 2004 than in 2001. Decreases in speeding between 2001 and 2004 were strongly linked with positive attitudes toward road safety in 2001. CONCLUSIONS: In this cohort, speeding and using a cell phone while driving decreased over the 2001 to 2004 period concomitantly with increases in traffic law enforcement and a dramatic decline in road mortality in France. However, the deterrent effect of traffic enforcement policies may have been reduced by negative attitudes toward traffic safety and having had a history of traffic penalty cancellations.

Management of severely injured children in road accidents in France: impact of the acute care organization on the outcome.

OBJECTIVE: To examine the impact of acute care management on outcome in children severely injured in road accidents. DESIGN AND SETTING: Prospective follow-up study conducted in 12 French pediatric intensive care units over a 24-month period. PATIENTS: Excluding those in refractory shock or in brain death at admission, a total of 125 children aged <17 years admitted to the pediatric intensive care unit with severe trauma (Injury Severity Score > or =16) were included. RESULTS: Intracranial pressure (ICP) monitoring and admission into a trauma resuscitation room (TRR) were used as proxy markers for the center management aggressiveness. Centers which admitted to TRR and monitored ICP when indicated in >75% of cases were called aggressive centers. Children with an ICP monitoring indication admitted to a TRR and monitored, as well as those without an indication treated in a TRR, were judged appropriately managed. A poor outcome at pediatric intensive care unit discharge was defined as a difference between the baseline and discharge pediatric overall performance category above 3, or a hospital death. Children with traumatic brain injury appropriately managed in a less-aggressive center were more likely to have a poor outcome than those appropriately managed in an aggressive center (odds ratio 7.56, 95% confidence interval 1.5-38.4), after adjustment for severity, age, and type of road user. CONCLUSIONS: The management in a more aggressive center for children admitted to TRR and monitored for ICP, when indicated, is associated with a better outcome. This could be explained by a more extensive experience in trauma management.

The burden of road traffic accidents in a French Departement: the description of the injuries and recent changes.

BACKGROUND: A significant reduction in road traffic accidents has been observed since prevention measures were introduced by the French public authorities in 2002. The goals of this study are to describe the burden of road traffic accidents in a French Departement, and to identify changes if any between the periods 1997-2001 and 2002-2006 on the basis of the disability adjusted life years (DALY). METHODS: Years of lost life (YLL) and years lived with disability (YLD) were calculated for two periods using the mortality and incidence data in the Rhone Departement Registry of Road Traffic Accident Casualties. RESULTS: YLD and YLL that are related to road traffic accidents are at their maximum value between 15 and 24 years of age. For men, intracranial fractures and intracranial injuries dominate, and for women it is spinal cord injuries that account for highest rates of YLD. A reduction in the rates of YLL and YLD has been observed for both genders and all age groups between 1997-2001 and 2002-2006. CONCLUSION: The reduction in DALY between the two periods is explained both by the reduction in the number of fatalities and injuries but also by an increase in the age at which they occur.

Impact of retirement on risky driving behavior and attitudes towards road safety among a large cohort of French drivers (the GAZEL cohort).

OBJECTIVES: This study investigated changes in driving behavior and attitudes towards road safety, following retirement, in a large cohort of road users. METHODS: In 2001, 14 226 participants of the GAZEL cohort in France reported their attitudes towards road safety and driving behavior using a self-administered driving behavior and road safety questionnaire. In 2004, 82% of the group (N=11 706) responded to the same questionnaire. Two complementary logistic regression analyses were performed to assess the association of (i) retirement with change in safe driving behavior and attitudes towards road safety between 2001 and 2004 and (ii) time since retirement with risky driving behavior and negative attitudes towards road safety in 2001. RESULTS: Among the participants who were active in 2001 (N=3927), those retiring between 2001 and 2004 (66%) were more likely to have discontinued sleepy driving [adjusted odds ratio (aOR) 2.12, P<0.001] and phone use while driving (aOR 1.74, P=0.006) than those who remained professionally active. The second analysis showed that the likelihood of sleepy driving and phone use while driving decreased soon after retirement, whereas that of speedy driving decreased over a longer interval. Retirement had no influence on driving while intoxicated or attitudes towards road safety. CONCLUSIONS: The results suggest that any professional activity may account for some risky road behavior. As work-related road traffic accidents are responsible for one out of every four road casualties in France, the monitoring and prevention of sleepy driving and phoning while driving among workers should be further considered.

Tiring job and work related injury road crashes in the GAZEL cohort.

The objective was to describe at-work and commuting crashes occurring in a cohort of French employees and to investigate occupational risk factors. The subjects were employees of the French national electricity and gas companies, Electricité de France and Gaz de France (EDF-GDF), who volunteered to join a research cohort (the GAZEL cohort which included 20,625 participants in 1989). Only crashes with injuries were considered. Crashes for the periods 1989--2001 were recorded together with the type of journey (commuting, work, private), the type of road-user, self-estimated responsibility, and injuries sustained by the subject. Annual incidences for gender/age groups and socio-occupational groups were computed for each of the two types of work related crashes. Occupational risk factor analyses were conducted using a Cox proportional hazards regression model with time-dependent covariates adjusting for the main confounders. A total of 146,285 person years at work were observed. Two indicators of self-reported work fatigue were associated with the occurrence of at-work crashes: "nervously tiring work" for males (RR=1.6, 95% CI [1.1; 2.3]), sustained standing for females (RR=3.0, 95% CI [1.0; 8.4]), adjusting for health status, location of residence, type of family, transport mode and mileage. As regards crashes while commuting, a self-reported uncomfortable position at work was a risk factor among women (RR=1.9, 95% CI [1.1; 3.3]). On the other hand, these occupational factors were not linked to road crashes in private trips. Work related road crashes seem then to be a matter for a specific prevention. Preventing employees from becoming exhausted should be considered as the first way to initiate such a prevention.

The impact of driver age on lost life years for other road users in France: A population based study of crash-involved road users.

BACKGROUND: One of the concerns in road safety is the threat older drivers may pose to other road users. Using the rate of lost life years, the present study provides a public health approach to quantify this potential threat. METHODS: A total of 1570686 motorised vehicle drivers or motorcycle riders and 652246 non-drivers, i.e. vehicle passengers, pedestrians and cyclists involved in injury crashes in France between 1996 and 2004, were included in a population based cross-sectional study. Fatality rates and rate of lost life years for each crash-involved driver age class were calculated for the drivers themselves and for other road users. RESULTS: The study has shown a significant reduction in the rate of lost life years for crash-involved other road users (whether passengers, pedestrians, cyclists or opposing drivers) as driver age increases. Other road users lost half as many years of life when involved in crashes with drivers aged over 85 than with drivers under 65 (1.26 and 2.32 per 100 expected remaining life years, respectively). CONCLUSION: Our findings suggest that among road users involved in injury crashes, older drivers are less dangerous for the other road users. By attributing other road users' lost life years to each driver age, this study represents a new contribution to the debate about ageing and road safety.

Incidence and risk factors of severe traumatic brain injury resulting from road accidents: a population-based study.

A population-based study was carried out in 1996-2001 to provide the incidence and to identify the risk factors of severe traumatic brain injury (TBI) resulting from a road accident. The severe TBI was defined as an injury to the brain or the skull, excluding scalp injuries, with an abbreviated injury scale (AIS) severity score greater than 2. The severe TBI of 1238 patients were described. The annual incidence and mortality of severe TBI were, respectively, 13.7 per 100,000 and 5.3 per 100,000. The fatality rate increased from 20% in childhood to 71% over 75-year-old. Compared to restrained car occupants, the odds ratio for having a severe TBI was 18.1 (95% confidence interval, CI=12.8-25.5) for un-helmeted motorcyclists, 9.2 (95% CI=7.5-11.3) for pedestrians, 6.4 (95% CI=4.7-8.8) for un-helmeted cyclists, 3.9 (95% CI=3.1-4.8) for unrestrained car occupants and 2.8 (95% CI=2.2-3.5) for helmeted motorcyclists. Even after adjustment for several severity factors, male gender and age above 55 were both risk factors. Prevention programs aiming at improving the head protection should be promoted. The circumstances of the accident should be taken into account to predict a severe TBI.

The Decrease in Traumatic Brain Injury Epidemics Deriving from Road Traffic Collision Following Strengthened Legislative Measures in France.

BACKGROUND: Since 2002, France has been strengthening legislation on road traffic. This study is intended to evaluate the changes in Traumatic Brain Injury (TBI) incidence and mortality resulting from Road Traffic Collision (RTC) in the two 6-year periods before and after 2002. METHODS: We used a Registry of all RTC casualties in the Rhône Department of France. Each casualty was coded according to the Abbreviated Injury Scale (AIS). The study describes changes in demographic variables, TBI (AIS ≥ 2) incidence and mortality, other body lesions (AIS ≥ 3) associated with TBI, road user types, seatbelt and helmet wearing. FINDINGS: RTC casualty occurrences decreased by 21% (from 64,312 to 50,746) during the period after 2002. TBI occurrence accounted for 8.6% and 6.7% of all RTC in both periods. This corresponds to a reduction of TBI casualty incidence (-42%), which was much more pronounced than RTC casualty incidence (-25%) (p < 0.0001). Severe and critical TBI (AIS-4 and -5) incidences were reduced by half as much (-21%), compared to TBI incidence. TBI mortality rate (among population) and lethality (among TBI related to RTC casualties) decreased 56% and 23%, respectively. This reduction particularly affected car occupants and victims who deceased. TBI incidence decreased 43% in all 10-year age classes until 60 on average, this decrease declining with age in the period after 2002. After adjustment for age, sex, road user types, and severity of lesions at the head and other body regions, logistic regression analysis displayed a protective effect of the period following 2002, on the risk of death after RTC-related TBI. INTERPRETATION: The greater reductions in the incidence, severity and mortality of TBI when compared with the reduction of casualty incidence have mainly affected car users. These results should be attributable to the improvements in standards of care, primary safety of the car fleet and general road architecture safety. However, the increased reduction in the TBI epidemics in France, when compared to those observed in other developed countries for the same periods, suggests that the effects should be strongly attributable to changes in road user behaviour induced by law enforcement. The at-risk groups for TBI after RTC are now two-wheel users (motorized or not) and individuals over 60 years of age.

Pain and pain treatment were associated with traffic accident involvement in a cohort of middle-aged workers.

BACKGROUND AND OBJECTIVE: To assess the influence of medical conditions on road traffic accidents among a cohort of middle-aged workers and pensioners. STUDY DESIGN AND SETTING: A longitudinal study of 13,548 participants from a cohort study of French workers. Follow-up data covered the 1989-2000 period. Adjusted hazards ratios (HR(adj)) for serious accidents were computed by Cox's proportional hazards regression with time-dependent covariates adjusted for age, occupation, annual mileage in 2001, alcohol consumption, and number of reported health problems. RESULTS: Men who reported treated dental or gingival problems (HR(adj)=8.57, 95% confidence interval CI=2.70-27.2) and women who reported treated renal colic or kidney stones (HR(adj)=9.71, 95% CI=2.40-39.3) were much more likely to have a serious traffic accident. Treated glaucoma, hiatal hernia or gastric ulcers, and diabetes among women and treated cataract among men were also found to be associated with the risk of serious traffic accidents. CONCLUSIONS: This study raises the hypothesis that pain and pain treatment (singly or in combination) could increase the risk of road traffic accident and confirms that medical conditions traditionally found to be associated with traffic accident involvement of older drivers are also risk factors for middle-aged drivers.

Retrospective assessment of exposure to traffic air pollution using the ExTra index in the VESTA French epidemiological study.

This study applies a traffic exhaust air dispersion model (the ExTra index) to 403 children enrolled in a French multicentric case-control study, the VESTA study (Five [V] Epidemiological Studies on Transport and Asthma). The ExTra index (previously validated by our team) was used to assess lifelong average traffic-related air pollutant (TAP) concentrations (nitrogen oxides) children in the study were exposed to in front of their living places. ExTra index took into account traffic density, topographical parameters (building height, road and pavement width), weather conditions (wind direction and strength) and background pollution levels. Topographical and traffic data were collected, using a specific questionnaire for each home, school or nursery address, attended by children. The assessment of time-weighted NOx levels in front of the children's living places highlighted significant disparities: mean ExTra index values and share attributable to proximity traffic were, respectively, 70+/-42 and 14+/-22 microg/m3 NOx equivalent NO2 for the 403 children in our study. Not only would this diversity not have been revealed using urban background pollution data provided by air quality networks, it would have resulted in 40% of the children being misclassified with regard to their TAP exposure by underestimating it in half of the cases and overestimating it in the other half. Such errors of classification, which are highly prejudicial in epidemiology, argue strongly for the use of an index such as the ExTra, which enables TAP exposure to be reconstructed within the framework of retrospective or prospective epidemiological studies.

[Types and mechanisms of 54 cases of kidney trauma in car drivers injured by road accident]. / Nature et mécanismes de 54 traumatismes du rein chez des automobilistes victimes d'accidents de la circulation.

PURPOSE: To analyse the types, mechanisms and severity of kidney trauma in injured car drivers and the effects of the presence or absence of the safety belt on the renal lesions observed. MATERIAL AND METHODS: 64,325 road accident victims were reported between 1996 and 2002. Data collection was performed in 96 primary care departments, 160 inpatient departments and 11 convalescence centres. Among the 33,431 injured car drivers, 54 presented kidney trauma (0.16%). The AAST classification was used to analyse these cases of RESULTS: The 54 cases of kidney trauma was classified as grade I and II in 39 cases, grade III in 6 cases, grade IV in 5 case, and grade V in 4 cases. Nine patients died with a kidney lesion. This lesion was never isolated, as it was associated with rupture of the spleen in 8 cases, head injury in 6 cases and chest injury in 4 cases. The mechanism of these fatal accidents was a head-on collision in every case. CONCLUSION: Kidney trauma in the car drivers of our series was rare (0.160%) and benign (72% of grade I and II lesions). Patients with a kidney lesion who died always presented multiple injuries. Renal pedicle lesions are usually observed in car drivers not wearing a

Driving behaviors and on-duty road accidents: a French case-control study.

OBJECTIVES: A case-control study was carried out to identify driving behaviors associated with the risk of on-duty road accident and to compare driving behaviors according to the type of journey (on duty, commuting, and private) for on-duty road accident victims. METHODS: Cases were recruited from the Rhône Road Trauma Registry between January 2004 and October 2005 and were on duty at the time of the accident. Control subjects were recruited from the electoral rolls of the case subjects' constituencies of residence. Cases' and controls' driving behavior data were collected by self-administered questionnaire. A logistic regression was performed to identify behavioral risk factors for on-duty road accidents, taking into account age, sex, place of residence, road accident risk exposure, socio-occupational category, and type of road user. A second analysis focused specifically on the case subjects, comparing their self-assessed usual behaviors according to the type of journey. RESULTS: Significant factors for multivariate analysis of on-duty road accidents were female gender, history of on-duty road accidents during the previous 10 years, severe time pressure at work, and driving a vehicle not belonging to the driver. On-duty road accident victims reported behavioral risk factors more frequently in relation to driving for work than driving for private reasons or commuting: nonsystematic seat belt use, cell phone use at least once daily while driving, and history of accidents with injury during the previous 10 years. CONCLUSIONS: This study provides knowledge on behavioral risk factors for on-duty road accidents and differences in behavior according to the type of journey for subjects who have been on-duty road accident victims. These results will be useful for the design of on-duty road risk prevention.

Spinal cord injuries sustained in road crashes are not on the decrease in france: a study based on epidemiological trends.

Traumatic spinal cord injuries (SCI) are rare but extremely costly. In order to improve the modelling of inclusion criteria for studies of SCI it is necessary to determine what epidemiological trends affect SCI. Using the Rhone Registry, which contains all the casualties resulting from road crashes in the Rhône département of France and codes their injuries using the Abbreviated Injury Scale (AIS), we describe the epidemiological trends that affect spinal cord injury (SCI), major spinal trauma (MST) and severe injuries (AIS4+) to other body regions between two periods 1996-2001 and 2003-2008. Although there has been a marked decrease (35%) in the incidence of casualties after a road traffic crash, and reductions of 22% in the incidence of MST and 33% in that of severe injuries (AIS4+) (p<0.001), for SCI the incidence rate and number of casualties have remained surprisingly stable. In the second period, there was no change in the incidence of SCI resulting from road traffic crashes, nor in the associated fatality, mortality and survival rates. The incidence for car users was significantly lower in the second period. This contrasts with the incidences for motorcyclists and for the group including pedestrians and cyclists which were respectively 47% and 77% higher in the second period. The median age of the casualties, the age-adjusted incidence of SCI and the number of associated injuries were also higher in the second period. We have observed a marked reduction in the incidence of road trauma including the most severe injuries, but not SCI. The higher proportion of motorcyclists, the increase in the age of casualties and the greater presence of multiple injuries are new factors in the epidemiology of SCI after a road crash.

Contextual deprivation, daily travel and road traffic injuries among the young in the Rhône Département (France).

This study investigated the effect of the socioeconomic level of the municipality of residence on personal injury road traffic accident risk among young persons of 10-24 years of age in the Rhône Département. This effect was assessed by comparing incidences of injuries (n=2792 casualties) on the basis of three denominators: the resident population of young people, the number of users of each mode and the distances covered by each mode. The results are presented for each type of road users (pedestrians, car passengers, car drivers, motorised two-wheeler riders, cyclists, public transport users). Young persons from deprived municipalities use motorised-two wheelers, bicycles and the car (as passengers and drivers) less frequently, they walk more and take public transports more often than those from other municipalities. When considering injury risk, motorised two wheeler injuries among adolescent males, for example, are significantly less frequent in deprived municipalities. But the motorised two-wheeler riders as well as car passengers from deprived municipalities are characterized by an excess injury risk, whether the selected denominator is the number of users or the kilometres travelled by this mode. For the first time in France, this study has enabled a comparison of the effects of a contextual socioeconomic indicator (the type of municipality of residence, deprived, or not) on daily travel practices and injury incidences among the population, among the users of each mode and per km of travel.

Deprived neighborhoods and risk of road trauma (incidence and severity) among under 25year-olds in the Rhône Département (France).

INTRODUCTION: Previous research has shown that there are inequalities with regard to traffic accident risk between different social categories. This study describes the influence of the type of residential municipality (with or without deprived urban areas, "ZUS, zones urbaines sensibles"), used as an indicator of contextual deprivation, on the incidence and severity of road trauma involving people of under 25years of age in the Rhône. METHOD: Injury data were taken from The Rhône Road Trauma Registry. The study covers the 2004-2007 period, with 13,589 young casualties. The incidence of traffic injury of all severities were computed according to the type of municipality and the age, gender, and type of road user. The ratios of the incidences of deprived municipalities, compared with others were calculated. Subsequently the severity factors and incidences according to the severity level (ISS 1-8, ISS 9+) were studied. RESULTS: For the main types of road users except motorized two-wheeler users, the incidences were higher in the deprived municipalities: the greatest difference was for pedestrians, where the incidences were almost twice those of other municipalities. This excess risk, constituting a health inequality topic rarely considered, was even greater in municipalities with two or three ZUSs. It was essentially observed for minor injuries among motorists, cyclists, and pedestrians. CONCLUSIONS: While the incidence increased among people less than 25years of age, the severity of road injuries was lower in deprived neighborhoods, contrary to what is suggested by other studies. This lower severity disappeared when taking into account the crash characteristics. IMPACT ON INDUSTRY: The incidence of injuries as a pedestrian, cyclist or motorist is higher among young people living in deprived municipalities. These areas should therefore be the targets of dedicated education programs, as well as further investigations about urban planning.

Self-reported road traffic violations in France and how they have changed since 1983.

GOALS: The goal was to gain a picture of current driver behaviour, and of the links between committed violations and accident history. It was also to identify how driver behaviour has changed over the last 20 years. METHODS: A questionnaire-based cross-sectional study of a sample of 1161 drivers about the frequency of violations and the perception of the dangers and penalties associated with them was used in 2005. Self-reported violations and mental representations were also compared to the results of Biecheler who used similar methods (Biecheler-Fretel, 1983). RESULTS, CONCLUSIONS: Road traffic violations are frequent in France, particularly among male drivers. Several violations are linked with history of accidents in our sample. Frequently or fairly frequently exceeding the speed limit by 10 km/h (a violation reported by almost 53% of our sample), increases accident occurrence by a factor of 1.4. Progress in drivers' behaviour has been slow and nonuniform, and appears in part to be related to safety campaigns that have been run (seat belts, alcohol). The results could inform future campaigns. In particular, a campaign on the use of indicators would seem worthwhile.