Associations between smoke-free vehicle legislation and childhood admissions to hospital for asthma in Scotland: an interrupted time-series analysis of whole-population data.

BACKGROUND: In Scotland, childhood admissions to hospital for asthma fell from March, 2006, after legislation was introduced to prohibit smoking in public places. In December, 2016, new Scottish legislation banned smoking in vehicles containing a child. We aimed to determine whether the introduction of this new legislation produced additional benefits. METHODS: We obtained data on all asthma emergency admissions to hospitals in Scotland between 2000 and 2018 for individuals younger than 16 years. We used interrupted time-series analyses to study changes in monthly incidence of asthma emergency admissions to hospital per 100 000 children after the introduction of smoke-free vehicle legislation, taking into account previous smoke-free interventions. We did subgroup analyses according to age and area deprivation, using the Scottish Index of Multiple Deprivation, and repeated the analyses for a control condition, gastroenteritis, and other respiratory conditions. FINDINGS: Of the 32 342 emergency admissions to hospital for asthma among children younger than 16 years over the 19-year study period (Jan 1, 2000, to Dec 31, 2018), 13 954 (43%) were among children younger than 5 years and 18 388 (57%) were among children aged 5-15 years. After the introduction of smoke-free vehicle legislation, there was a non-significant decline in the slope for monthly emergency admissions to hospital for asthma among children younger than 16 years (-1·21%, 95% CI -2·64 to 0·23) relative to the underlying trend in hospital admissions for childhood asthma. However, children younger than 5 years had a significant decline in the slope for monthly asthma admissions (-1·49%, -2·69 to -0·27) over and above the underlying trend among children in this age group (equivalent to six fewer hospitalisations per year), but no such decline was seen in children aged 5-15 years. Monthly admissions to hospital for asthma fell significantly among children living in the most affluent areas (-2·27%, -4·41 to -0·07) but not among those living in the most deprived areas. We found no change in admissions to hospital for gastroenteritis or other respiratory conditions after the introduction of the smoke-free vehicle legislation. INTERPRETATION: Although legislation banning smoking in vehicles did not affect hospital admissions for severe asthma among children overall or in the older age group, this legislation was associated with a reduction in severe asthma exacerbations requiring hospital admission among preschool children, over and above the underlying trend and previous interventions designed to reduce exposure to second-hand smoke. Similar legislation prohibiting smoking in vehicles that contain children should be adopted in other countries. FUNDING: None.

Increasing evacuation flow through school bus emergency roof hatches.

Emergency escape roof hatches are used to evacuate school buses in rolled-over orientations. In the United States, the minimum opening size of a roof hatch is defined by Federal Motor Vehicle Safety Standard (FMVSS) no. 217. With the prevalence of rising obesity rates among children, the minimum roof hatch opening size may not be large enough to accommodate larger passengers. Post-accident conditions such as injuries, disorientation, and exit obstructions may also prevent unobstructed passage for egress within acceptable time limits. The purpose of this study was to redesign and fabricate a roof hatch with a larger opening and evaluate its egress characteristics for a range of typical school bus passengers. The larger roof hatch opening allows greater evacuation flow rates, and is almost functionally equivalent to the evacuation flow rate of the front door on an upright school bus.

Fine-Grained Spatiotemporal Analysis of the Impact of Restricting Factories, Motor Vehicles, and Fireworks on Air Pollution.

Aiming at improving the air quality and protecting public health, policies such as restricting factories, motor vehicles, and fireworks have been widely implemented. However, fine-grained spatiotemporal analysis of these policies' effectiveness is lacking. This paper collected the hourly meteorological and PM2.5 data for three typical emission scenarios in Hubei, Beijing-Tianjin-Hebei (BTH), and Yangtze River Delta (YRD). Then, this study simulated the PM2.5 concentration under the same meteorological conditions and different emission scenarios based on a reliable hourly spatiotemporal random forest model (R2 exceeded 0.84). Finally, we investigated the fine-grained spatiotemporal impact of restricting factories, vehicles, and fireworks on PM2.5 concentrations from the perspective of hours, days, regions, and land uses, excluding meteorological interference. On average, restricting factories and vehicles reduced the PM2.5 concentration at 02:00, 08:00, 14:00, and 20:00 by 18.57, 16.22, 25.00, and 19.07 µg/m3, respectively. Spatially, it had the highest and quickest impact on Hubei, with a 27.05 µg/m3 decrease of PM2.5 concentration and 17 day lag to begin to show significant decline. This was followed by YRD, which experienced a 23.52 µg/m3 decrease on average and a 23 day lag. BTH was the least susceptible; the PM2.5 concentration decreased by only 8.2 µg/m3. In addition, influenced by intensive human activities, the cultivated, urban, and rural lands experienced a larger decrease in PM2.5 concentration. These empirical results revealed that restricting factories, vehicles, and fireworks is effective in alleviating air pollution and the effect showed significant spatiotemporal heterogeneity. The policymakers should further investigate influential factors of hourly PM2.5 concentrations, combining with local geographical and social environment, and implement more effective and targeted policies to improve local air quality, especially for BTH and the air quality at morning and night.

Optimal-robust selection of a fuel surrogate for homogeneous charge compression ignition modeling.

Homogeneous Charge Compression Ignition (HCCI) combustion is a potential candidate for dealing with the stringent regulations on vehicle emissions while still providing very good energy efficiency. Despite the promising results obtained in preliminary studies, the lack of autoignition control has delayed its launch in the engine industry. In the development of the HCCI concept, the availability of reliable computer models has proved extremely valuable, due to their flexibility and lower cost compared with experiments using real engines. In order to obtain the best formulation of a fuel surrogate formulated with n-heptane, toluene and cyclohexane that efficiently estimate the autoignition behaviour, regression adjustments are made to the Root-Mean-Square Errors (RMSE) of experimental Starts of Combustion (SOC) from the modeled SOC. The canonical form of the Scheffé polynomials is widely used to fit the data from mixture experiments, however the experimenter might have only partial knowledge. In this paper we present the adaptation of the robust methodology for possibly misspecified blending model and an algorithm to obtain tailor-made optimal designs for mixture experiments, instead of using standard designs which are indiscriminately employed, to make good estimations of the parameters blending model. We maximize the determinant of the mean squared error matrix of the least square estimator over a realistic neighbourhood of the fitted regression mixture model. The maximized determinant is then minimized over the class of possible designs, yielding an optimal design. Thus, the computed desings are robust to the exact form of the true blending model. Standard mixture designs, as the simplex lattice, are around 25% efficient for estimation purposes compared with the designs obtained in this work when deviances from the considered model occur during the experiments. Once an optimal-robust design was selected (based on the level of certainty about model adequacy), we computed the optimal mixture that best reproduces the combustion property to be imitated. Optimal mixtures obtained when the considered model is inadequate agree with the results achieved in empirical studies, which validates the methodology proposed in this work.

Effectiveness of child restraint legislation to reduce motor vehicle related serious injuries and fatalities: A national interrupted time series analysis.

Children that are unrestrained while travelling in a motor vehicle are more vulnerable to serious injury and death. The greatest levels of crash protection are achieved when children use the most age or size appropriate form of restraint. In this study, we aimed to examine the effectiveness of the introduction of age-appropriate child restraint legislation on serious and fatal injury in five Australian states and territories. For this interrupted time series analysis, we used a segmented regression method to assess the association between the implementation of child-restraint legislation and motor-vehicle related serious injuries and fatalities using data obtained from transport authorities in each jurisdiction. We estimated the change in annual rates after the implementation of legislation with the number of motor-vehicle accidents resulting in fatalities or serious injuries as the outcome, and the total number of injuries (minor, serious and fatal) as an offset in the model. We identified 10882 motor-vehicle related crashes resulting in fatalities (n = 188), serious injuries (n = 1730) and minor injuries (n = 8964). In NSW and VIC, the rate ratio was statistically significant and positive, indicating an increase in the rate of serious injuries and fatalities in the period post-legislation compared to the period prior to legislation. In all other states and territories, we did not find a statistically significant effect of legislation Road safety programs incorporating interventions targeted at increasing awareness of optimal restraint practices, strengthened enforcement and measures to improve the affordability of restraints are needed to support legislation.

Toxicological evaluation of exhaust emissions from light-duty vehicles using different fuel alternatives in sub-freezing conditions.

BACKGROUND: Emissions from road traffic are under constant discussion since they pose a major threat to human health despite the increasingly strict emission targets and regulations. Although the new passenger car regulations have been very effective in reducing the particulate matter (PM) emissions, the aged car fleet in some EU countries remains a substantial source of PM emissions. Moreover, toxicity of PM emissions from multiple new types of bio-based fuels remain uncertain and different driving conditions such as the sub-zero running temperature has been shown to affect the emissions. Overall, the current literature and experimental knowledge on the toxicology of these PM emissions and conditions is scarce. METHODS: In the present study, we show that exhaust gas PM from newly regulated passenger cars fueled by different fuels at sub-zero temperatures, induce toxicological responses in vitro. We used exhaust gas volume-based PM doses to give us better insight on the real-life exposure and included one older diesel car to estimate the effect of the new emissions regulations. RESULTS: In cars compliant with the new regulations, gasoline (E10) displayed the highest PM concentrations and toxicological responses, while the higher ethanol blend (E85) resulted in slightly lower exhaust gas PM concentrations and notably lower toxicological responses in comparison. Engines powered by modern diesel and compressed natural gas (CNG) yielded the lowest PM concentrations and toxicological responses. CONCLUSIONS: The present study shows that toxicity of the exhaust gas PM varies depending on the fuels used. Additionally, concentration and toxicity of PM from an older diesel car were vastly higher, compared to contemporary vehicles, indicating the beneficial effects of the new emissions regulations.

The impact of state laws on motor vehicle fatality rates, 1999-2015.

BACKGROUND: Motor vehicle crash (MVC) fatalities have been declining while states passed various legislation targeting driver behaviors. This study assesses the impact of state laws on MVC fatality rates to determine which laws were effective. METHODS: Publically available data were collected on driver-related motor vehicle laws, law strengths, enactment years, and numbers of verified-trauma centers. Prospective data on crash characteristics and MVC fatalities 16 years or older from Fatality Analysis Reporting System 1999 to 2015 (n = 850) were obtained. Generalize Linear Autoregressive Modeling was used to assess the relative contribution of state laws to the crude MVC fatality rate while controlling for other factors. RESULTS: Lowering the minimum blood alcohol content (BAC) was associated with largest declines for all ages, especially the older cohorts: 16 years to 20 years (B = 0.23; p < 0.001), 21 years to 55 years (B = 1.7; p < 0.001); 56 years to 65 years (B = 3.2; p < 0.001); older than 65 years (B = 4.1; p < 0.001). Other driving under the influence laws were also significant. Per se BAC laws accompanying a reduced BAC further contributed to declines in crude fatality rates: 21 years to 55 years (B = -0.13; p < 0.001); older than 65 years (B = -0.17; p < 0.05). Driving under the influence laws enhancing the penalties, making revocation automatic, or targeting social hosts had mixed effects by age. Increased enforcement, mandatory education, vehicle impoundment, interlock devices, and underage alcohol laws showed no association with declining mortality rates. Red light camera and seatbelt laws were associated with declines in mortality rates for all ages except for older than 65 years cohort, but speed camera laws had no effect. Graduated Driver License laws were associated with declines for 16 years to 21 years (B = -0.06; p < 0.001) only. Laws targeting specific risks (elderly, motorcycles, marijuana) showed no effect on declining MVC mortality rates during the study period. CONCLUSION: States have passed a wide variety of laws with varying effectiveness. A few key laws, specifically laws lowering allowable BAC, implementing red light cameras, and mandating seatbelt use significantly reduced MVC mortality rates from 1999 to 2015. Simply adding more laws/penalties may not equate directly to lives saved. Continued research on state laws will better inform policy makers to meet evolving public health needs in the management of MVC fatalities. LEVEL OF EVIDENCE: Epidemiological, Level III.

Organ Procurement Organization Run Department of Motor Vehicle Registration and Drivers Licensing Offices Leads to Increased Organ Donor First Person Authorization Registrations.

BACKGROUND: More people who have personally consented to organ donation via first person authorization (FPA) registration before death become organ donors than those not personally consenting. The majority of registrations occur at state-specific department of motor vehicle (DMV) and licensing offices, where people register their vehicles and obtain driver's licenses. METHODS: One organ procurement organization (OPO) ran 3 DMV offices and implemented an intervention: a donor-centric approach, including employee education, office decoration with donation materials, and customer experience improvements. Data about registry enrollment was collected before and during the 4-year OPO licensing office contract. A linear mixed model and interrupted time series analyses were performed to evaluate whether the intervention improved rates of registration. RESULTS: Preintervention registry enrollment rates per month were 10%-50%. Having the offices run by an OPO was associated with more enrollments independent of the increasing trend of enrollment (P < 0.001). Also, the DMV office with the lowest preimplementation registration rates had an immediate increase in enrollments after the intervention leading to higher registration rates (P < 0.001). CONCLUSIONS: A donor-centric OPO-managed DMV experience increases FPA registration, especially at offices with low initial registration rates. However, even at the office with the highest percentage of FPA registrations, rates were only 65% at intervention conclusion. The transplant community should consider other opportunities for FPA registration.

Dealing with existing theory: national fatality rates, vehicle standards and personal safety.

In this paper we discuss some of the weaknesses in exiting theories and understandings behind road safety interventions and policy making. The paper deals with four main issues: road traffic fatality rates and per capita income of countries, vehicle crashworthiness standards, role of pedestrian and powered two-wheeler share in traffic on fatalities, and safety standards for vehicles other than cars. Recent data indicate that there may not be a strong relationship between income and road safety performance and it is possible for low and middle-income countries (LMIC) to decrease death rates at present income levels. Safer cars have had a major role in reducing fatality rates, but, gains in traffic safety in high income countries may be partly due to reducing exposure of vulnerable road users. Small lightweight vehicles (like tuk-tuks, three-wheeled scooter taxis) operating in many LMIC appear to have low fatality rates though they do not follow any crashworthiness standards. Very different crashworthiness standards need to be developed for low mass vehicles incapable of operating speeds greater than 50 km/h. LMIC may not be able to reduce fatality rates below about 7 per 100,000 population unless there are innovative developments in road design and all vehicle safety standards.

[Support to smoking regulation in private vehicles and public outdoor spaces]. / Apoyo a la regulación de fumar en el interior de vehículos privados y espacios públicos al aire libre.

OBJECTIVE: To know the support of tobacco regulation is a very important issue to advance in the tobacco control policies and reduce the passive exposure to tobacco. The aim of this study was to describe the attitudes towards forbidding smoking in private vehicles and public outdoor spaces. METHODS: This is a cross-sectional study of a representative sample (n=736) of the adult population (24+ years old) from Barcelona, Spain in 2013-2014. We calculated the percentages of individuals who had a favourable attitude towards smoking regulation in private vehicles and public outdoor spaces, their adjusted Odds ratios (aOR) and their 95% confidence intervals (95%CI) according to sex, age, educational level and smoking status through logistic regression. We used weighted data for all analyses in order to keep the representativeness of the population of Barcelona in 2013-2014. RESULTS: 61.7% of participants supported forbidding smoking in private vehicles and 89.5% supported forbidding it only in the presence of minors. The support to smoking regulation in public outdoor spaces varied from 42.5% to 84.7% in different settings. Smokers showed a less favourable attitude towards an extension of the smoking regulation to other settings: outdoor areas of university centres, outdoor areas of shopping centres and beaches and outdoor pools. CONCLUSIONS: A wide support exists to extend the smoking regulation to private vehicles, especially in the presence of children, and public outdoor spaces. This wide support could favour the extension of smoking regulation to these places to improve the population's health and to contribute to denormalise tobacco use among the population.

OBJETIVO: Conocer el apoyo a la regulación del consumo de tabaco es una pieza clave para avanzar en las políticas de control del tabaquismo y reducir la exposición pasiva al tabaco. El objetivo de este trabajo fue describir las actitudes hacia la prohibición de fumar en los vehículos privados y espacios públicos al aire libre. METODOS: studio transversal de una muestra representativa (n=736) de la población adulta (mayor de 24 años) de la ciudad de Barcelona, España, realizado en 2013-2014. Se calcularon el porcentaje de individuos que tenían una actitud favorable a la regulación del consumo de tabaco en el interior de vehículos privados y espacios públicos al aire libre, las Odds Ratio ajustadas (ORa) y sus intervalos de confianza al 95% (IC95%) según sexo, edad, nivel de estudios y estatus de consumo de tabaco mediante un modelo de regresión logística. Se utilizaron pesos de probabilidad inversa para mantener la representatividad de la población de Barcelona en 2013-2014. RESULTADOS: El 61,7% de los participantes estuvo a favor de la prohibición de fumar dentro de los vehículos privados y el 89,5% de prohibirlo sólo en presencia de menores. El apoyo a la regulación del consumo de tabaco en espacios exteriores varió entre 42,5% hasta 84,7% dependiendo del ambiente. Los fumadores mostraron una actitud menos favorable a la ampliación de la regulación a otros espacios: zonas exteriores de los centros universitarios, zonas exteriores de los centros comerciales y playas y piscinas descubiertas. CONCLUSIONES: Existe un amplio apoyo a la extensión de la regulación del consumo del tabaco en el interior de vehículos privados, especialmente en presencia de menores, y espacios públicos al aire libre. Este amplio apoyo podría favorecer la ampliación de la regulación del consumo de tabaco a estos espacios a fin de mejorar la salud de la población y al mismo tiempo contribuir a la desnormalización del consumo de tabaco entre la población.

Sharing the sidewalk: A case of E-scooter related pedestrian injury.

The popularity of rideshare electric scooters is due to their availability, accessibility, and low cost. The recent increase in electric scooter use has raised concerns regarding the safety of both riders and pedestrians. Previous studies characterize the incidence and pattern of injury for riders, but there is a lack of literature concerning electric scooters' impact on pedestrians. Pedestrians injured by electric scooters face potential financial burdens from hospitalization costs, medical interventions, taking time off from work, and rehabilitation therapies. Based on prior studies, pedestrians who are most prone to injuries sustained by pedestrian transportation include individuals with vision and/or hearing impairment, young children, the elderly, and people distracted by mobile devices. We present a case involving a sixty-year-old female pedestrian who presented to the emergency department with an acute lumbar compression fracture after a collision with an electric scooter. This study highlights the safety risks and incidence of injuries for pedestrians associated with electric scooters, which can help shape public policy to ensure the safety of both riders and pedestrians.

Illinois Department of Motor Vehicle Customers' Reasons for (Not) Registering as an Organ Donor.

CONTEXT: Organ donation campaigns are maximized when promotional messages address salient issues among the intended audience. A diverse sample (N = 1573) was recruited to identify the reasons for (not) registering as an organ donor. OBJECTIVE: Relying on an established coding scheme, an updated explanation for why individuals register (or not) as organ donors is provided. Moreover, registration trends with respect to race, biological sex, and age is presented. METHOD: Participants exiting Department of Motor Vehicle offices (N = 12) were surveyed to understand their reasons for registering and not registering as organ donors. RESULTS: Benefits of donation followed by prior registration, rational arguments, and personal experiences represented nearly 90% of the coded responses for registering. Conversely, negative beliefs, decisional uncertainty, perceived disqualification, no reason, general fear/disgust, and lack of opportunity constituted nearly 90% of the coded responses for not registering as an organ donor. Whites and Latinx individuals were more likely to register as organ donors compared to African Americans. Participants in the lower (18-24) and upper (65+) age brackets had the lowest donor registration rates. CONCLUSION: Promotional efforts should continue to target younger and older audience segments with information about organ donation as well as African Americans. Results from the current study suggest emphasizing the benefits of organ donation as well as overcoming negative beliefs, decisional uncertainty, and perceived disqualifications.

Are There Missed Opportunities to Maximize Organ Donation Registrations? An Examination of Driver's License Applications Across the United States.

INTRODUCTION: With 116 000 people waiting for transplants and 8000 patients dying annually on waiting lists, the United States has a considerable organ shortage. An insufficient number of Americans have registered to become organ donors when obtaining driver's licenses or ID cards. Across states, there is considerable variability in organ donor registration rates as well as driver's license applications. METHODS: The purpose of this project was to describe the variability in the phrasing of the organ donor registration question by state bureaus of motor vehicles as well as other application questions that might influence this decision. In particular, the frequency of states employing empirically supported messages to increase donor registrations was ascertained. The content and phrasing of 46 different driver's license applications was coded in regard to seeking organ donor registrations. FINDINGS: No states used the empirically supported strategies of reciprocity, descriptive norms, or loss/gain framing from the interdisciplinary field of behavioral economics. Twelve states used injunctive norms to signify social approval for organ donation. Many state applications had lengthy organ donation sections and health questions that could discourage donor registrations. DISCUSSION: There is an extremely low use of empirically supported messages to increase organ donation registrations in driver's license applications in the United States. Opportunities exist for thoughtful consideration of the wording of driver's license applications. States interested in exploring ways to increase donations could undertake controlled variation of applications to test the effects of message framing on registration rates.

An African American Perspective on Familial Notification of Becoming a Registered Organ Donor.

INTRODUCTION: Studies demonstrate that family notification is much less frequent in African Americans than in Caucasians. Familial notification of one's decision to become a registered organ donor (ROD) is important to ensure adherence to the decedent's donation decision and to disseminate prodonation attitudes. The purpose of this study was to explore the experiences of familial notification among recent African American RODs and to identify intervention strategies to overcome potential barriers to the notification process. METHODS/APPROACH: The study used a qualitative focus group approach. An inductive thematic analysis identified common categories and themes in the recorded and transcribed discussions. FINDINGS: The focus groups consisted of 50 African American participants who had recently visited Alabama Department of Motorized Vehicles and made the voluntary decision (yes or no) about becoming an organ donor. Three major themes describing the African American experiences with notifying their family members about their decision to become a ROD emerged. These themes were as follows: motivation for the notification, notification conversation, and promoting familial notification. Specific discussions centered upon the importance of and barriers to familial notification, information, and strategies needed for successful notification. Strategies identified were use of media and social networks to provide enhanced knowledge on the notification process and the importance of health-care, community-provided knowledge about the donation process. DISCUSSION: Findings from this study provide a framework for future interventions designed to assist African American RODs in notifying family members of their status.

Regulating particle number measurements from the tailpipe of light-duty vehicles: The next step?

Light-duty vehicle emission regulation in the European Union requires the dilution of the whole exhaust in a dilution tunnel with constant volume sampling prior to emission measurements. This methodology avoids measurement uncertainties associated with direct raw exhaust emission measurements from the tailpipe, such as exhaust flow determination, exhaust flow pressure pulsations, differences in the response time between exhaust flow and instrument signals, or their misalignment. Transfer tubes connecting the tailpipe to the dilution tunnel of different lengths, and mixing of the exhaust gas with the dilution air in the dilution tunnel may increase differences in measurements performed at different facilities. Recently, the light-duty vehicle regulation was complemented by on-road measurements with Portable Emissions Measurement Systems (PEMS). PEMS measurements are conducted from the vehicle tailpipe. Differences between tailpipe and full dilution tunnel measurements have not been adequately addressed so far. In this study we compare particle number emissions measured at the full dilution tunnel or directly at the tailpipe. The measurements covered solid particles with diameter larger than 23 nm, as required by the current regulation, but also solid particles larger than 10 nm, as recommended for future regulations. The studied vehicle technologies were diesel, gasoline, and compressed natural gas. The differences between tailpipe and dilution tunnel particle number emissions were found to be small (<15%) for both size ranges, with the exception of engine cold start (up to 35% in some cases). Theoretical estimates showed that agglomeration in the transfer line from the vehicle to the dilution tunnel might reduce particle concentrations by up to 17%. Exhaust flow rate determination and time misalignment of exhaust flow and particle concentration signals can introduce uncertainties of ±10% and ±5%, respectively, to the tailpipe measurements. The results suggest that tailpipe sampling is not only possible, but it can additionally give more representative ("real") emissions of the vehicle and should be considered in post Euro 6 regulations.