Comparing estimates of road traffic deaths and non-fatal road traffic injuries in Cambodia.

INTRODUCTION: Timely, accurate and detailed information about traffic injuries are essential for managing national road safety programmes. However, there is considerable under-reporting in official statistics of many low and middle-income countries (LMICs) and large discrepancies between estimates from the Global Burden of Disease (GBD) study and WHO's Global Health Estimates (GHE). We compared all sources of epidemiological information on traffic injuries in Cambodia to guide efforts to improve traffic injury statistics. METHODS: We estimated the incidence of traffic deaths and injuries and household ownership of motor vehicles in Cambodia from nationally representative surveys and censuses. We compared findings with GDB and GHE estimates. RESULTS: We identified seven sources for estimating traffic deaths and three for non-fatal injuries that are not included as data sources in GBD and GHE models. These sources and models suggest a fairly consistent estimate of approximately 3100 deaths annually, about 50% higher than official statistics, likely because most hospital deaths are not recorded. Surveys strongly suggest that the vehicle fleet is dominated by motorcycles, which is not consistent with GBD estimates that suggest similar numbers of motorcyclist and vehicle occupant deaths. Estimates of non-fatal injuries from health surveys were about 7.5 times official statistics and 1.5 times GBD estimates. CONCLUSION: Including local epidemiological data sources from LMICs can help reduce uncertainty in estimates from global statistical models and build trust in estimates among local stakeholders. Such analysis should be used as a benchmark to assess and strengthen the completeness of reporting of the national surveillance system.

Availability of population-level data sources for tracking the incidence of deaths and injuries from road traffic crashes in low-income and middle-income countries.

INTRODUCTION: Tracking progress towards Sustainable Development Goal (SDG) 3·6 of reducing traffic deaths and serious injuries poses a measurement challenge in most low-income and middle-income countries (LMICs) due to large discrepancies between reported official statistics and estimates from global health measurement studies. We assess the extent to which national population censuses and health surveys can fill the information gaps. METHODS: We reviewed questionnaires for nationally representative surveys and censuses conducted since 2000 in LMICs. We identified sources that provide estimates of household ownership of vehicles, incidence of traffic deaths and non-fatal injuries, and prevalence of disability. RESULTS: We identified 802 data sources from 132 LMICs. Sub-Saharan African countries accounted for 43% of all measurements. The number of measurements since 2000 was high, with 97% of the current global LMIC population having at least one measurement for vehicle ownership, 77% for deaths, 90% for non-fatal injuries and 50% for disability due to traffic injuries. Recent data (since 2010) on traffic injuries were available from far fewer countries (deaths: 21 countries; non-fatal injuries: 62 and disability: 12). However, there were many more countries with recent data on less-specific questions about unintentional or all injuries (deaths: 41 countries, non-fatal: 87, disability: 32). CONCLUSION: Traffic injuries are substantially underreported in official statistics of most LMICs. National surveys and censuses provide a viable alternative information source, but despite a large increase in their use to monitor SDGs, traffic injury measurements have not increased. We show that relatively small modifications and additions to questions in forthcoming surveys can provide countries with a way to benchmark their existing surveillance systems and result in a substantial increase in data for tracking road traffic injuries globally.

The effects of training impulse control on simulated driving.

There is growing interest in young driver training that addresses age-related factors, including incompletely developed impulse control. Two studies investigated whether training of response inhibition can reduce risky simulated driving in young drivers (aged 16-24 years). Each study manipulated aspects of response inhibition training then assessed transfer of training using simulated driving measures including speeding, risky passing, and compliance with traffic controls. Study 1 (n = 65) used a Go/No-go task, Stop Signal Task and a Collision Detection Task. Designed to promote engagement, learning, and transfer, training tasks were driving-relevant and adaptive (i.e. difficulty increased as performance improved), included performance feedback, and were distributed over five days. Control participants completed matching "filler" tasks. Performance on trained tasks improved with training, but there was no significant improvement in simulated driving. Study 2 enhanced response inhibition training using Go/No-go and SST tasks, with clearer performance feedback, and 10 days of training. Control participants completed testing only, in order to avoid any possibility of training response inhibition in the filler tasks. Again performance on trained tasks improved, but there was no evidence of transfer of training to simulated driving. These findings suggest that although training of sufficient interest and duration can improve response inhibition task performance, a training schedule that is likely to be acceptable to the public does not result in improvements in simulated driving. Further research is needed to investigate whether response inhibition training can improve risky driving in the context of real-world motivations for risky driving.

Thrill and adventure seeking as a modifier of the relationship of perceived risk with risky driving among young drivers.

Risky driving contributes to road trauma, a leading cause of mortality among young people. Health-relevant behaviour models suggest a negative relationship between risky driving and perceived risk of its outcomes. However, high sensation seekers may value the "thrill" of the risk, and positive associations between sensation seeking and risky driving have been observed. This is the first study to examine whether aspects of sensation seeking modify the relationship between perceived risk and risky driving. Young drivers in metropolitan Sydney and rural New South Wales [NSW] (n=797) completed a survey relating to one of the four risky driving behaviours (speeding, drink-driving, driving while fatigued, and failing to wear a seatbelt). Results suggest that the Thrill and Adventure Seeking subscale of Zuckerman's (1994) Sensation Seeking Scale moderate the relationship of perceived risk with risky driving - indicating a negative relationship for low-scores, but not high-scorers, on the TAS subscale. Thus, road safety campaigns that emphasize the riskiness of a particular behaviour may be of limited benefit to thrill and adventure seekers.

The effectiveness of audio-tactile lane-marking in reducing various types of crash: a review of evidence, template for evaluation, and preliminary findings from Australia.

Audio-tactile lane-marking (ATLM) is designed to alert inattentive drivers when they deviate from their lane. Most commonly used previously to mark the edges of divided freeways, it is increasingly used to mark the edge and/or centre of two-lane undivided roads. We present a detailed review of ATLM evaluations to demonstrate that although both edge- and centreline ATLM appear to be effective, evaluations have been flawed insofar as they have (1) often not controlled adequately for variations due to extraneous factors known to affect crash incidence; (2) often focussed on total crashes, or on inattention-related crashes, and failed to address the possibility that ATLM increases some crash-types (particularly crashes involving two-wheeled vehicles, out-of-control crashes, or crashes on the opposite side of the lane to which the ATLM is installed); (3) almost always related to the milled-in "rumble strips" employed in the US rather than the raised profile lane-marking (PLM) that is employed in Australia. The present Empirical Bayes analysis aimed to evaluate PLM by comparing treated and untreated sections of the same roads both before and after the date of treatment in terms a range of crash types (some separately for roads with only edgeline-PLM, with only centreline-PLM, and with both edgeline- and centreline-PLM). Although some of the above issues could not be addressed due to insufficient data, the analysis provides a useful template for future researchers. The results provide evidence that both edgeline and centreline (alone or in combination) reduce targeted (same-side) crashes. Although there is no evidence that edgeline and centreline alone increase opposite side crashes, only edgeline and centreline together produced a net reduction in total crashes. Thus, the present results suggest that installing PLM on both edgeline and centreline is preferable to installing either alone.

Beliefs and behaviours relevant to the road safety effects of profile lane-marking.

Audio-tactile lane-marking (ATLM) is designed to alert inattentive drivers when they deviate from their lane, and appears to reduce crashes. Research into cognitive-behavioural mechanisms underlying, or possibly undermining, the efficacy of ATLM, is limited. We surveyed 775 randomly selected drivers (42% female, up to 75+ years) regarding the profile line-marking (PLM) employed in Australia (and in some European countries). Respondents perceived advantages of PLM in terms of lane-keeping and visibility. Respondents reported avoiding edge-line PLM, so that it may result in driving too close to untreated centre-line. Findings generally allayed concerns, on the basis of risk homeostasis theory, that PLM may increase risky driving. Perceived efficacy of PLM was not associated with increased drink-driving or speeding, but was associated with increased driving while fatigued. Findings suggest that the efficacy of PLM may be increased by employing PLM on both edge- and centre-lines, by exaggerating the audio-tactile effects of PLM that cause drivers to avoid it, and by discouraging the belief that it is safe to drive while fatigued when PLM is present.

An implicit non-self-report measure of attitudes to speeding: development and validation.

Speeding is a major contributor to road trauma and attitudes toward speeding are hypothesised to be a key determinant of the behaviour. Attitudinal research is limited by reliance on self-report measures and the attendant possibility of reporting biases. The Implicit Association Test (IAT) aims to measure attitudes without reliance on self-report, by assessing the association between a target-concept and an evaluation, in terms of reaction time for compatible versus non-compatible pairings. The present research aimed to develop and evaluate an IAT to measure attitudes to speeding. Forty-five licensed drivers completed the speed-related IAT, and drove a driving simulator. Participants also completed a questionnaire that assessed self-reported attitudes to speeding, and several variables theoretically related to attitudes, including speeding behaviour. Observed IAT results suggested that attitudes toward speeding are negative, and were generally consistent with results derived from the simulated driving and self-reported behaviours, beliefs, and attitudes. Thus, the speed-related IAT appears to be a valid measure of attitudes toward speeding, which might be used to measure attitudes in road safety research without reliance on self-report.

A challenge to the assumed generalizability of prediction and countermeasure for risky driving: different factors predict different risky driving behaviors.

In road safety, it may be debated whether all risky behaviors are sufficiently similar to be explained by similar factors. The often assumed generalizability of the factors that influence risky driving behaviors has been inadequately tested. Study 1 (N=116) examined the role of demographic, personality and attitudinal factors in the prediction of a range of risky driving behaviors, for young drivers. Results illustrated that different driving behaviors were predicted by different factors (e.g., speeding was predicted by authority--rebellion, while drink driving was predicted by sensation seeking and optimism bias). Study 2 (N=127) examined the generalizability of these results to the general driving population. Study 1 results did not generalize. Predictive factors remained behavior-specific, but different predictor-behavior relationships were observed in the community sample. Overall, results suggest that future research and practice should focus on a multi-factor framework for specific risky driving behaviors, rather than assuming generalizability across behaviors and driving populations.

Misunderstanding of right-of-way rules at various pedestrian crossing types: observational study and survey.

Misunderstanding of right-of-way rules may contribute to pedestrian trauma, especially at crossings where pedestrian and traffic signals appear to give contradictory messages. Two thousand eight hundred and fifty-four pedestrians were observed crossing at signal-controlled intersections to compare attention to traffic for different combinations of pedestrian and traffic signals. In addition, a survey was conducted at signal-controlled intersections and nearby car parks in metropolitan and rural areas. Five hundred and seventy-four participants took the role of pedestrian or driver when responding to questions regarding beliefs about pedestrian right-of-way for a range of situations at signal-controlled crossings, zebra crossings, and unmarked sections of road (specifically: alone, with pedestrian refuge, or paved). Results suggest that at signal-controlled crossings pedestrian right-of-way is erroneously thought to be influenced by the pedestrian signal. Many respondents thought that a pedestrian refuge or paving gave a pedestrian right-of-way at an otherwise unmarked section of road. In many situations more than 20% of both drivers and pedestrians reported that they would take right-of-way. Pedestrian crossing types should be rationalised, and education should be provided regarding rules and responsibilities at available crossings.

Better the devil you know? High-risk individuals' anticipated psychological responses to genetic testing for melanoma susceptibility.

PURPOSE: The psychological consequences of genetic testing for mutations among individuals at increased risk of developing melanoma remain unexamined. The present study aimed to explore anticipated emotional, behavioral, cognitive, and familial responses to hypothetical genetic testing for melanoma susceptibility. METHODS: Forty semi-structured interviews were undertaken with affected (n=20) and unaffected (n=20) individuals at either high or average risk of developing melanoma due to family history. RESULTS: In-depth thematic analysis revealed that, in response to being identified as a mutation carrier, most participants with a family history anticipated calmly accepting their increased risk; either increasing precaution adoption or maintaining already vigilant behavioral practices; perceiving such information as important and valuable; and communicating genetic test results to family members, despite the acknowledgement of potential difficulties. In response to being identified as a non-carrier, the majority of participants expected to feel relieved; to maintain current precautionary health practices; to still perceive themselves at some risk of developing melanoma; and to be wary of the potential negative behavioral consequences of disclosing such information to family members. Women appeared more likely than men to acknowledge the potential for depression and worry following genetic testing. In contrast, more males than females expected to carry a gene mutation, and viewed their current preventive practices as optimum. CONCLUSION: Genetic testing for melanoma risk is likely to elicit a complex array of emotional, behavioral, cognitive, and familial responses for both testees and their family members, and these responses are likely to bear subtle differences for males and females.

The role of noise sensitivity in the noise-response relation: a comparison of three international airport studies.

In order to examine the role of noise sensitivity in response to environmental noise, this paper presents detailed comparisons of socio-acoustic studies conducted around international airports in Amsterdam, Sydney, and London. Earlier findings that noise sensitivity moderates the effect of noise on annoyance were examined to see if they could be replicated in each of the datasets, independent of the technique of measuring noise sensitivity. The relation between exposure to aircraft noise and noise annoyance was studied separately for groups of individuals with low, medium, and high noise sensitivity, with statistical adjustment for relevant confounders. Results support the previous findings that noise sensitivity is an independent predictor of annoyance and adds to the prediction of noise annoyance afforded by noise exposure level by up to 26% of explained variance. There is no evidence of a moderating effect, whereby the covariation between noise exposure level and annoyance is weak for people who score at the extreme high or low end of the sensitivity scale, and strong for people who score in the middle of the sensitivity scale. Generally, noise sensitivity appears to increase annoyance independently of the level of noise exposure after adjustment for relevant confounders. These findings were consistent across the three datasets.

Development of a Controlled Drinking Self-Efficacy Scale and appraising its relation to alcohol dependence.

There is no specific self-efficacy measure that has been developed primarily for problem drinkers seeking a moderation drinking goal. In this article, we report the factor structure of a 20-item Controlled Drinking Self-Efficacy Scale (CDSES; Sitharthan et al., 1996; Sitharthan et al., 1997). The results indicate that the CDSES is highly reliable, and the factor analysis using the full sample identified four factors: negative affect, positive mood/social context, frequency of drinking, and consumption quantity. A similar factor structure was obtained for the subsample of men. In contrast, only three factors emerged in the analysis of data on female participants. Compared to women, men had low self-efficacy to control their drinking in situations relating to positive mood/social context, and subjects with high alcohol dependence had low self-efficacy for situations relating to negative affect, social situations, and drinking less frequently. The CDSES can be a useful measure in treatment programs providing a moderation drinking goal.

The effects of uncontrollable, unpredictable aversive and appetitive events: similar effects warrant similar, but not identical, explanations?

Exposure to uncontrollable, unpredictable appetitive events produces a variety of cognitive debilitations and vegetative changes, as does exposure to uncontrollable, unpredictable aversive events. Similarities include impaired escape from aversive events, impaired discrimination, finicky consumption, analgesia, and body weight loss. However, in stark contrast, uncontrollable aversive stress causes reduced motor activity where as similar appetitive treatment does not; aversively induced debilitation is causally related to energy regulation, whereas the appetitively induced effects are not. Parallel mechanisms are suggested to explain these effects in terms of a revised anxiety account of the aversive effects, and a frustration account of the appetitive effects. Finally, factors likely to limit important research to resolve the many remaining issues are identified: negative presentation of animal research, political decision making, and ignorance and fear in committees which review the ethics of research.

Human response to environmental noise: the role of perceived control.

Negative impacts of noise exposure on health and performance may result in part from "learned helplessness," the syndrome of deficits typically produced by exposure to uncontrollable events. People may perceive environmental noise to be uncontrollable, and several effects of noise exposure appear to parallel "learned helplessness" deficits. In the present socioacoustic survey (N = 1,015), perceived control over aircraft noise correlated negatively with some effects of noise (though not others). Furthermore, these effects were better predicted by perceived control than by noise level. These observational data support the claim that "learned helplessness" contributes to the effects of noise exposure.

Effective Communication of Health Messages regarding Noise-Induced Health Effects.

Noise exposure in both residential and occupational settings produces a range of auditory and nonauditory health problems. Efforts of the relevant authorities to reduce these effects may be supplemented by the adoption of various self-protective behaviours by individuals. Unfortunately campaigns designed to encourage such self-protective behaviours are likely to meet with limited success. The present paper considers the shortcomings of such campaigns and offers prescriptions for improving them. Campaigns based on these prescriptions and on thorough research of the factors involved in health promotion generally, as well as those particular to each case, should significantly advance efforts toward individuals protecting themselves against the ill effects of noise exposure.

Noise sensitivity as a factor influencing human reaction to noise.

Reaction (annoyance, dissatisfaction) to noise is itself an important health effect, as well as possibly contributing to other putative health effects of noise. Thus, factors such as noise sensitivity, which influence reaction, are of considerable importance. However, noise sensitivity is rarely clearly defined. This paper offers a formal definition of noise sensitivity, and reviews evidence relating to it. Noise sensitivity has been measured in various ways, but may be measured most directly by assessing reaction to many noise situations (other than those involving the noise source(s) which are the focus of the particular study). When noise sensitivity is measured in this way, factor analysis consistently reveals that noise sensitivity is not a unitary concept. Rather, two distinct factors appear: one related to loud noises (road traffic, lawn mower), and the other related to quieter noise situations which are nonetheless distracting (rustling papers at the movies, people talking while watching television). More research is needed to address the relationships between these factors, reaction and other health effects.