Outcome evaluation of the p drivers Program: Randomised controlled trial of a program to improve safe driving among novice drivers.

BACKGROUND: Globally, road traffic crashes are the leading cause of death for young adults. The P Drivers Project was a trial of a behavioural change program developed for, and targeted at, young Australian drivers in their initial months of solo driving when crash risk is at its highest. METHODS: In a parallel group randomised controlled trial, drivers (N = 35,109) were recruited within 100 days of obtaining their probationary licence (allowing them to drive unaccompanied) and randomised to an intervention or control group. The intervention was a 3 to 6-week multi-stage driving behaviour change program (P Drivers Program). Surveys were administered at three time points (pre-Program, approximately one month post-Program and at 12 months after). The outcome evaluation employed an on-treatment analysis comprising the 2,419 intervention and 2,810 control participants who completed all required activities, comparing self-reported crashes and police-reported casualty crashes (primary outcome), infringements, self-reported attitudes and behaviours (secondary outcomes) between groups. RESULTS: The P Drivers Program improved awareness of crash risk factors and intentions to drive more safely, relative to the controls; effects were maintained after 12-months. However, the Program did not reduce self-reported crashes or police-reported casualty crashes. In addition, self-reported violations, errors and risky driving behaviours increased in the intervention group compared to the control group as did recorded traffic infringements. This suggests that despite the Program increasing awareness of risky behaviour in novice drivers, behaviour did not improve. This reinforces the need to collect objective measures to accompany self-reported behaviour and intentions. CONCLUSIONS: The P Drivers Program was successful in improving attitudes toward driving safety but the negative impact on behaviour, lack of effect on crashes, and the large loss to follow-up fail to support the use of a post-licensing behaviour change program to improve novice driver behaviour and reduce crashes. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: 363,293 (ANZCTR, 2012).

Exposure factors of Victoria's active motorcycle fleet related to serious injury crash risk.

OBJECTIVE: The purpose of this study was to describe the nature and extent of current powered 2-wheeler (PTW) risk exposures in order to support future efforts to improve safety for this mode of transport. METHODS: A cross-sectional analysis of the control arm of a population-based case-control study was conducted. The control sample was selected from 204 sites on public roads within 150 km of the city of Melbourne that were locations of recent serious injury motorcycle crashes. Traffic observations and measurements at each site were sampled for a mean of 2 h on the same type of day (weekday, Saturday, or Sunday) and within 1 h of the crash time. Photographs of passing riders during this observation period recorded data relating to characteristics of PTWs, age of riders, travel speed of PTWs and all vehicles, time gaps between vehicles, visibility, and protective clothing use. RESULTS: Motorcycles and scooters represented 0.6% of all traffic (compared with 4% of all vehicle registrations). Riders were significantly more likely to have larger time gaps in front and behind when compared to other vehicles. The average travel speed of motorcycles was not significantly different than the traffic, but a significantly greater proportion were exceeding the speed limit when compared to other vehicles (6 vs. 3%, respectively). The age of registered owners of passing motorcycles was 42 years. Over half of riders were wearing dark clothing with no fluorescent or reflective surfaces. One third of motorcyclists had maximum coverage of motorcycle-specific protective clothing. CONCLUSIONS: A very low prevalence of motorcyclists combined with relatively higher rates of larger time gaps to other vehicles around motorcycles may help explain their overrepresentation in injury crashes where another vehicle fails to give way. An increased risk of injury in the event of a crash exists for a small but greater proportion of motorcyclists (compared to other vehicle types) who were exceeding the speed limit. An apparent shift toward older age of the active rider population may be reducing injury crash risk relative to exposure time. There is significant scope to improve the physical conspicuity of motorcyclists and the frequency of motorcycle specific protective clothing use. These results can be used to inform policy development and monitor progress of current and future road safety initiatives.

The crash reduction effectiveness of a network-wide traffic police deployment system.

Random Road Watch (RRW) is a traffic policing program in operation in Queensland, Australia. It differs from conventional traffic policing in that an explicit resource management technique is used which randomly schedules low levels of police enforcement in a manner intended to provide long-term, widespread coverage of a road network and hence maximise road safety benefits. Implementation of the program studied in Queensland covered 55% of total crashes within the state. This study aimed to measure the crash effects of the RRW program in Queensland. A quasi-experimental study design was used for the evaluation incorporating Poisson regression statistical analysis techniques. Analysis of the effects of the Queensland RRW program on crash frequency has shown the program to be effective overall. Estimated program effects were largest on fatal crashes, with an estimated reduction of 31%. Estimated aggregate program crash effects reduced with crash severity and increased with time after program introduction. Crash reductions in the third year after program introduction translated into savings, at state level, of some 12% of the state's crashes of all severities and some 15% of the state's fatal road crashes. Overall, the program produced a significant 11% reduction in total crashes in areas outside of metropolitan Brisbane. The opportunity-cost benefit/cost ratio for the program was estimated to be 55:1.

Mandatory bicycle helmet use following a decade of helmet promotion in Victoria, Australia--an evaluation.

On July 1, 1990, a law requiring wearing of an approved safety helmet by all bicyclists (unless exempted) came into effect in Victoria, Australia. Some of the more important steps that paved the way for this important initiative (believed to be the first statewide legislation of its type in the world) are described, and the initiative's effects are analysed. There was an immediate increase in average helmet-wearing rates from 31% in March 1990 to 75% in March 1991, although teenagers continued to show lower rates than younger children and adults. The number of insurance claims from bicyclists killed or admitted to hospital after sustaining a head injury decreased by 48% and 70% in the first and second years after the law, respectively. Analysis of the injury data also showed a 23% and 28% reduction in the number of bicyclists killed or admitted to hospital who did not sustain head injuries in the first and second post-law years, respectively. For Melbourne, where regular annual surveys of helmet wearing have been conducted, it was possible to fit a logistic regression model that related the reduction in head injuries to increased helmet wearing. Surveys in Melbourne also indicated a 36% reduction in bicycle use by children during the first year of the law and an estimated increase in adult use of 44%.

The interaction between speed camera enforcement and speed-related mass media publicity in Victoria, Australia.

The objective was to measure the presence of any interaction between the effect of mobile covert speed camera enforcement and the effect of intensive mass media road safety publicity with speed-related themes. During 1999, the Victoria Police varied the levels of speed camera activity substantially in four Melbourne police districts according to a systematic plan. Camera hours were increased or reduced by 50% or 100% in respective districts for a month at a time, during months when speed-related publicity was present and during months when it was absent. Monthly frequencies of casualty crashes, and their severe injury outcome, in each district during 1996-2000 were analysed to test the effects of the enforcement, publicity and their interaction. Reductions in crash frequency were associated monotonically with increasing levels of speed camera ticketing, and there was a statistically significant 41% reduction in fatal crash outcome associated with very high camera activity. High publicity awareness was associated with 12% reduction in crash frequency. The interaction between the enforcement and publicity was not statistically significant.

Simultaneous back-projection of AIDS incidence data for two or more groups.

Back-projection of AIDS incidence data is useful for estimating characteristics of the HIV epidemic curve and forms a basis for projections of the AIDS epidemic curve. Its application to subgroups of the population is limited by its imprecision for groups with a small number of cases. Back-projection can be made more precise by pooling data from different groups and linking their HIV infection intensities by a model. Here we propose a method based on proportional infection intensities and study its performance with simulations and applications to AIDS in different States of Australia and haemophiliacs in the U.S.A. This method of simultaneous back-projection is shown to reduce substantially the width of confidence intervals for HIV infection intensities and for total numbers infected.

Assessing the extent of the Australian HIV epidemic from AIDS surveillance data.

Current knowledge about human immunodeficiency virus (HIV) disease is used to assess past and future trends in Australian HIV/AIDS (acquired immune deficiency syndrome) incidence, focusing on the precision with which such assessments can be made. The statistical method of back-projection is applied to reconstruct the past pattern of HIV incidence from surveillance data on AIDS incidence to June 1992. The results indicate that HIV incidence rose rapidly in the early 1980s to peak in 1983-1984, followed by a sharp decline. This finding is insensitive to plausible variations from the assumptions made, and is consistent with both success in preventive strategies and high levels of infection in a subgroup having a high probability of exposure. Cumulative HIV incidence to the end of 1987 is estimated with a 90 per cent confidence interval from 9,350 to 10,350. Estimation of the cumulative HIV incidence to June 1992 is less precise, with a 90 per cent confidence interval of 12,900 to 17,800. After adjustment for underreporting the incidence could be as high as 22,000, but only if recent infection rates, which cannot be quantified accurately, were very high. Based on data to June 1992, the estimated trend in AIDS incidence indicates 680 new cases in 1993, rising gradually to 695 in 1995. The estimated rate of increase in AIDS incidence over the recent past and near future is significantly less than that observed earlier in the epidemic. This is a consequence of both the earlier peak in HIV incidence and the effect of therapy.