Adjusting vehicle secondary safety ratings to account for crash-avoidance technology fitment using real-world crash and injury data.

OBJECTIVES: Publicizing safety ratings of vehicles can motivate manufacturers to prioritize safety and help consumers choose safer vehicles, leading to safer fleets. The benefits of primary safety technologies that prevent crash occurrence are not currently incorporated in current ratings in a way that values their safety benefits consistently. We aimed to propose a method for assigning weights for each safety technology to account for established safety benefits using published effectiveness and prevalence from real-life data. METHODS: To illustrate this method, we present a worked example calculated using crash and injury data from Australia and New Zealand. The method proposed attenuates the weights for given safety technologies where two or more safety technologies fitted to the same vehicle are effective for the same types of crashes. RESULTS: In the worked example using Australasian data, large SUVs were estimated to have the largest safety increment from the fitment of all the technologies considered compared to vehicles without these primary safety technologies, with an almost 17% reduction in crash occurrence. Cars with all the technologies fitted had estimated average crash reduction of between 11% and 12%. CONCLUSIONS: Different market groups have different crash patterns, so the safety attributable to safety technology fitment differs at the market group level. This study presents an approach for providing a summary measure of crash avoidance according to the fitment of safety technologies. If this measure is combined with an estimate of secondary safety (whether derived from existing crash and injury data or from new car crash assessment programs), the combined estimate then represents the important elements of safety provided by the vehicle. The methods presented here form a rational basis for assigning safety ratings to represent the benefits of swiftly developing safety technologies.

Dietary Pattern Indicators among Healthy and Unhealthy Weight Adolescents Residing in Different Contexts across the Otago Region, New Zealand.

Reported obesity rates for adolescents in different urban and rural areas are inconsistent. We examined indicators of healthy and unhealthy dietary patterns among 1863 adolescents aged 13-18 years with a healthy or excess body weight attending 23 secondary schools in four different settlement types across the Otago region, New Zealand. An online survey included demographics and dietary behaviours. Height and weight were measured, and body mass index was calculated. New Zealand defined urban and rural settlement types were used. Home addresses determined a small area-level index of deprivation. Data were analysed using Chi-square tests and ANOVA. A logistic model was fitted to estimate adjusted odds ratios of excess weight. The proportion of adolescents with a healthy weight differed (p < 0.001) between the most (64.9%) and least (76.4%) deprived neighbourhood areas. There was only indicative evidence of differences between settlement types (p = 0.087). Sugar-sweetened beverage and fast-food consumption was more frequent in the most deprived areas (p < 0.001), and in urban versus rural settlements (p < 0.001). The most important associations with excess weight were area-level deprivation and ethnicity, but not settlement type. Prioritising socioeconomic factors irrespective of settlement type is necessary when developing interventions to improve dietary patterns and body weight status among adolescents.

The Impact of Transport on Population Health and Health Equity for Maori in Aotearoa New Zealand: A Prospective Burden of Disease Study.

BACKGROUND: The land transport system influences health via a range of pathways. This study aimed to quantify the amount and distribution of health loss caused by the current land transport system in Aotearoa New Zealand (NZ) through the pathways of road injury, air pollution and physical inactivity. METHODS: We used an existing multi-state life table model to estimate the long-term health impacts (in health-adjusted life years (HALYs)) and changes in health system costs of removing road injury and transport related air pollution and increasing physical activity to recommended levels through active transport. Health equity implications were estimated using relative changes in HALYs and life expectancy for Maori and non-Maori. RESULTS: If the NZ resident population alive in 2011 was exposed to no further air pollution from transport, had no road traffic injuries and achieved at least the recommended weekly amount of physical activity through walking and cycling from 2011 onwards, 1.28 (95% UI: 1.11-1.5) million HALYs would be gained and $7.7 (95% UI: 10.2 to 5.6) billion (2011 NZ Dollars) would be saved from the health system over the lifetime of this cohort. Maori would likely gain more healthy years per capita than non-Maori, which would translate to small but important reductions (2-3%) in the present gaps in life expectancy. CONCLUSION: The current transport system in NZ, like many other car-dominated transport systems, has substantial negative impacts on health, at a similar level to the effects of tobacco and obesity. Transport contributes to health inequity, as Maori bear greater shares of the negative health impacts. Creating a healthier transport system would bring substantial benefits for health, society and the economy.

Home modifications to prevent home fall injuries in houses with Maori occupants (MHIPI): a randomised controlled trial.

BACKGROUND: As with many Indigenous populations internationally, Maori in New Zealand suffer health inequity. We aimed to assess the rate of fall injuries at home with and without home modifications in houses with Maori occupants. METHODS: We did a single-blind randomised controlled trial in the Wellington and Taranaki regions of New Zealand and enrolled owner-occupied households with at least one Maori occupant. Only households who stated they intended to live at that address for the subsequent 3 years were eligible for participation. We randomly assigned (1:1) households to either the intervention group, who received home modifications (handrails for outside steps and internal stairs, grab rails for bathrooms, outside lighting, repairs to window catches, high-visibility and slip-resistant edging for outside steps, fixing of lifted edges of carpets and mats, non-slip bath mats, and slip-resistant surfacing for outside areas such as decks) immediately, or the control group, who received the modifications 3 years later. Data on home injuries were obtained from the Accident Compensation Corporation and coded by study team members, who were masked to study group allocation. The primary outcome was the rate of medically treated fall injuries at home per household per year, analysed according to intention to treat. This Maori Home Injury Prevention Intervention (MHIPI) trial is now completed, and is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12613000148774. FINDINGS: Between Sept 3, 2013, and Oct 1, 2014, 824 households were assessed for eligibility and 254 were enrolled, of which 126 (50%) were assigned to the intervention group and 128 (50%) were assigned to the control group. After adjustment for previous falls and geographical region, there was an estimated 31% reduction in the rate of fall injuries at home per year exposed to the intervention compared with households in the control group (adjusted relative rate 0·69 [95% CI 0·47-1·00]). INTERPRETATION: Low-cost home modifications and repairs can be an effective means to reduce injury disparities. The high prevalence of modifiable safety issues in Maori homes merits considerable policy and community effort. FUNDING: Health Research Council of New Zealand.

Evaluation of the effectiveness of vehicle roll stability control (RSC) for high center of gravity light passenger vehicles in Australasia.

OBJECTIVE: Rollover crashes, which occur when the vehicle's side or roof makes impact with the ground, present particularly serious injury risk. Higher rollover risk has been found for high riding vehicles - those with a relatively high center of gravity compared to the width of the wheel track. Electronic Stability Control (ESC), which automatically applies brakes to individual wheels and reduces engine power to help drivers regain control when traction is lost, has been shown to be effective in preventing a proportion of rollovers. A newer safety technology, Roll Stability Control (RSC), uses similar technology aimed specifically to reduce rollover risk. This study sought to estimate rollover crash rates associated with the fitment of RSC compared to non-fitment for high center of gravity (CG) light passenger vehicles using an induced exposure analysis. METHODS: Police-recorded Australasian crash data were studied for the years 2008-2017. A quasi-induced exposure analysis was restricted to vehicles already equipped with ESC as vehicles fitted with RSC always have ESC fitted. Rollover risk associated with RSC fitment was assessed, controlling for year of crash, speed limit at crash location, year of vehicle manufacture, vehicle market group, driver age, driver gender and jurisdiction identifier. RESULTS: The analysis found a statistically significant rollover risk ratio of 0.76 (95% CI 0.62-0.93), representing a 24% reduction in rollover risk, associated with RSC fitment for vehicles manufactured between 2008 and 2017. Analysis by particular market groups found significant risk ratio reductions for commercial utilities and large SUVs, but not for the other high CG market groups individually. CONCLUSIONS: These results suggest that RSC is a highly effective safety feature for high CG vehicles. Fleet data from Australia and New Zealand showed declining rates of RSC fitment over recent years for SUVs, meaning the potential road safety benefits of the technology are not being fully realized.

Environmental burden of disease from unsafe and substandard housing, New Zealand, 2010-2017.

OBJECTIVE: To assess the burden of disease related to unsafe and substandard housing conditions in New Zealand from 2010 to 2017. METHODS: We focused on substandard housing conditions most relevant for New Zealand homes: crowding, cold, damp or mould, and injury hazards linked to falls. We estimated the population attributable fraction using existing estimates of the population exposed and exposure-response relationships of health disorders associated with each housing condition. We used government hospitalization data, no-fault accident insurance claims and mortality data to estimate the annual disease burden from the most severe cases, as well as the resulting costs to the public sector in New Zealand dollars (NZ$). Using value of a statistical life measures, we estimated the indirect cost of deaths. FINDINGS: We estimated that illnesses attributable to household crowding accounted for 806 nights in hospital annually; cold homes for 1834 hospital nights; and dampness and mould for 36 649 hospital nights. Home injury hazards resulted in 115 555 annual accident claims. We estimated that direct public sector costs attributable to these housing conditions were approximately NZ$ 141 million (100 million United States dollars, US$) annually. We also estimated a total of 229 deaths annually attributable to adverse housing and the costs to society from these deaths at around NZ$ 1 billion (US$ 715 million). CONCLUSION: Of the conditions assessed in this study, damp and mouldy housing accounted for a substantial proportion of the burden of disease in New Zealand. Improving people's living conditions could substantially reduce total hospitalization costs and potentially improve quality of life.

Volunteering in older adulthood is associated with activity engagement and cognitive functioning.

Introduction: Given evidence that activity engagement in older adulthood can have protective effects on the aging brain, we investigated the idea that volunteering in the community, which often encompasses social, cognitive, and physical activity, might benefit cognition. Method: Ninety-one retired 65- to 75-year-olds reported their sociodemographic characteristics, wellbeing, volunteering, and activity engagement. They also completed computerized cognitive tests that tapped specific functions known to decline disproportionately with age. Results: Volunteering at least monthly was associated with better working memory and more social and cognitive activity. Mediation analyses indicated that volunteering was indirectly related to switching performance via cognitive activity. However, the volunteering-working memory association did not depend on activity engagement, leaving the underpinning mechanisms unclear. Conclusions: These findings provide new insight into positive associations between older people's volunteering, activity engagement, and cognitive functioning. However, further work is needed to understand the mechanisms that drive volunteering-cognition links, and to establish causality.

Built environment changes and active transport to school among adolescents: BEATS Natural Experiment Study protocol.

INTRODUCTION: Natural experiments are considered a priority for examining causal associations between the built environment (BE) and physical activity (PA) because the randomised controlled trial design is rarely feasible. Few natural experiments have examined the effects of walking and cycling infrastructure on PA and active transport in adults, and none have examined the effects of such changes on PA and active transport to school among adolescents. We conducted the Built Environment and Active Transport to School (BEATS) Study in Dunedin city, New Zealand, in 2014-2017. Since 2014, on-road and off-road cycling infrastructure construction has occurred in some Dunedin neighbourhoods, including the neighbourhoods of 6 out of 12 secondary schools. Pedestrian-related infrastructure changes began in 2018. As an extension of the BEATS Study, the BEATS Natural Experiment (BEATS-NE) (2019-2022) will examine the effects of BE changes on adolescents' active transport to school in Dunedin, New Zealand. METHODS AND ANALYSIS: The BEATS-NE Study will employ contemporary ecological models for active transport that account for individual, social, environmental and policy factors. The published BEATS Study methodology (surveys, accelerometers, mapping, Geographic Information Science analysis and focus groups) and novel methods (environmental scan of school neighbourhoods and participatory mapping) will be used. A core component continues to be the community-based participatory approach with the sustained involvement of key stakeholders to generate locally relevant data, and facilitate knowledge translation into evidence-based policy and planning. ETHICS AND DISSEMINATION: The BEATS-NE Study has been approved by the University of Otago Ethics Committee (reference: 17/188). The results will be disseminated through scientific publications and symposia, and reports and presentations to stakeholders. TRIAL REGISTRATION NUMBER: ACTRN12619001335189.

Why is the rate of annual road fatalities increasing? A unit record analysis of New Zealand data (2010-2017).

INTRODUCTION: Recent increases in road crashes have reversed New Zealand's formerly declining crash rates to produce annual fatal and serious injury counts that are 49% higher than the lowest rates achieved in 2013. METHOD: We model twenty-one factors in fatal and serious injury crashes, four years before and after 2013 using logistic regression. Three major factors are significantly different in the period after 2013, when crash rates increased: (1) alcohol as a cause, (2) learner licence holders, and (3) a regional effect for Auckland. Newly defined speed zones are a more common setting for crashes in the period of upturn but there is no coinciding elevated likelihood of 'speed as a causal factor'. Three factors related to road safety were less common: aged under 25-years old, fatigue, and not wearing a seatbelt. RESULTS: Results are compared to rates of prosecutions for alcohol-related driving offences over this period. It is possible that New Zealand's successful road safety initiatives of the past have been undermined by reduced levels of enforcement and an unexpected outcome from the graduated driving licence system.

Study Protocol of a Randomized Controlled Trial of Home Modification to Prevent Home Fall Injuries in Houses with Maori Occupants.

Worldwide, injuries due to falls in the home impose a substantial burden and merit considerable effort to find effective prevention measures. The current study is one of very few randomized controlled trials that assess the effectiveness of home modification for preventing falls. It is the first carried out with a minority or indigenous community and focused on reducing inequities. Just over 250 households in Aotearoa, New Zealand, with Maori occupants were recruited in two strata, 150 from the Wellington region and 100 from the Taranaki region. These were randomly allocated to equally sized treatment and control groups within the respective regions, the treatment group receiving a package of home modifications designed to prevent falls at the start of the study, and the control group receiving the package at the end of the study. Injury data came from the Accident Compensation Corporation, a state-owned no-fault injury insurer. This provided coverage of virtually all unintentional injuries requiring medical treatment. Matched injury claims were made available for analysis once all identifying fields had been removed. These data will be pooled with data for Maori households from the already-conducted Home Injury Prevention Intervention (HIPI) study, which tested an identical intervention on the general population. In the analysis, the primary outcome measure will be fall injury rates over time, comparing treatment and control households, adjusting for the stratum and prior falls in the household. A secondary measure will be the rates of specific injuries, which are most likely to be prevented by the package of modifications tested. We anticipate that the findings will provide robust evidence for effective injury prevention measures that can reduce an important contributor to health inequities for indigenous populations such as the Maori.

Evaluating natural experiments to measure the co-benefits of urban policy interventions to reduce carbon emissions in New Zealand.

Finding effective policy interventions for addressing the Sustainable Development Goals, such as reducing carbon emissions (SDG 13), which can also enhance good health and wellbeing (SDG 3), is urgent. Many promising interactions occur between sustainable cities and communities (SDG 11), clean water and sanitation (SDG 6) and affordable and clean energy (SDG 7), which sit at the centre of integrated urban planning and regeneration. In this paper, we consider the framing and findings of four policies we have evaluated as natural experiments, all of which have important co-benefits, which were not always the focus of the initial policies. These policies are: the installation of cycleways and walkways in existing suburbs; a central government measure to recentralise employment after the 2011 Christchurch earthquakes; the streamlining of housing developments by reducing land-use regulation; and ongoing changes of policy about public housing investment. We show that having a clear understanding of the benefits of increased physical activity for health, for example, could accelerate the reduction of carbon emissions. Also, decisions about infrastructure, housing and job locations can generate health and environmental gains if supported by broader public transport investments. Cycling and walking are also more likely to substitute for short habitual car trips. Similarly, measuring the co-benefits of differential residential models, relating to land-use and renewable energy, provides a framework that can facilitate learning from policy interventions, enabling wider and potentially more rapid generalisation of policies, including those for climate change mitigation.

Damp mouldy housing and early childhood hospital admissions for acute respiratory infection: a case control study.

INTRODUCTION: A gap exists in the literature regarding dose-response associations of objectively assessed housing quality measures, particularly dampness and mould, with hospitalisation for acute respiratory infection (ARI) among children. METHODS: A prospective, unmatched case-control study was conducted in two paediatric wards and five general practice clinics in Wellington, New Zealand, over winter/spring 2011-2013. Children aged <2 years who were hospitalised for ARI (cases), and either seen in general practice with ARI not requiring admission or for routine immunisation (controls) were included in the study. Objective housing quality was assessed by independent building assessors, with the assessors blinded to outcome status, using the Respiratory Hazard Index (RHI), a 13-item scale of household quality factors, including an 8-item damp-mould subscale. The main outcome was case-control status. Adjusted ORs (aORs) of the association of housing quality measures with case-control status were estimated, along with the population attributable risk of eliminating dampness-mould on hospitalisation for ARI among New Zealand children. RESULTS: 188 cases and 454 controls were studied. Higher levels of RHI were associated with elevated odds of hospitalisation (OR 1.11/unit increase (95% CI 1.01 to 1.21)), which weakened after adjustment for season, housing tenure, socioeconomic status and crowding (aOR 1.04/unit increase (95% CI 0.94 to 1.15)). The damp-mould index had a significant, adjusted dose-response relationship with ARI admission (aOR 1.15/unit increase (95% CI 1.02 to 1.30)). By addressing these harmful housing exposures, the rate of admission for ARI would be reduced by 19% or 1700 fewer admissions annually. CONCLUSIONS: A dose-response relationship exists between housing quality measures, particularly dampness-mould, and young children's ARI hospitalisation rates. Initiatives to improve housing quality and to reduce dampness-mould would have a large impact on ARI hospitalisation.

Why don't owners improve their homes? Results from a survey following a housing warrant-of-fitness assessment for health and safety.

OBJECTIVE: To assess homeowners' intentions to make voluntary improvements to their homes following a warrant-of-fitness (WOF) assessment to highlight health and safety issues. METHODS: We recruited 83 homeowners, including nine landlords, in Taranaki, New Zealand, who agreed to have a WOF assessment carried out on their homes. We interviewed 40 of the homeowners to ascertain what improvements they planned to make, and barriers to improving their homes. RESULTS: Of the 83 properties, 76 (92%) failed the WOF. Of the 40 interview participants, 31 (76%) had addressed or planned to address at least one of the identified issues with the home. Participants were least likely to address identified issues with security stays on windows, and absence of ground vapour barrier. Reasons for not addressing identified issues included cost, and a belief that making the improvement would not benefit health and safety. CONCLUSIONS: Information about housing defects appears insufficient to encourage people to make improvements to their homes to meet a specified health and safety standard. Implications for public health: Better understanding of how particular housing defects pose a risk for health and safety, and provision of funding support in some cases, may encourage people to invest in safer, healthier homes.

Physical and spatial assessment of school neighbourhood built environments for active transport to school in adolescents from Dunedin (New Zealand).

Adolescent active transport to school (ATS) is influenced by demographic, social, environmental and policy factors. Yet, the relationship between school neighbourhood built environment (SN-BE) and adolescents' ATS remains largely unexplored. This observational study examined associations between observed, objectively-measured and perceived SN-BE features and adolescents' ATS in Dunedin (New Zealand). Adolescents' perception of safety of walking to school was the strongest correlate of ATS among adolescents living ≤ 2.25 km of school, whereas assessed micro- and macro-scale SN-BE features were not significantly correlated with ATS. Adolescents' perceptions of walking safety should be considered as a part of comprehensive efforts to encourage ATS.

A Cost Benefit Analysis of an Active Travel Intervention with Health and Carbon Emission Reduction Benefits.

Active travel (walking and cycling) is beneficial for people’s health and has many co-benefits, such as reducing motor vehicle congestion and pollution in urban areas. There have been few robust evaluations of active travel, and very few studies have valued health and emissions outcomes. The ACTIVE before-and-after quasi-experimental study estimated the net benefits of health and other outcomes from New Zealand’s Model Communities Programme using an empirical analysis comparing two intervention cities with two control cities. The Programme funded investment in cycle paths, other walking and cycling facilities, cycle parking, ‘shared spaces’, media campaigns and events, such as ‘Share the Road’, and cycle-skills training. Using the modified Integrated Transport and Health Impacts Model, the Programme’s net economic benefits were estimated from the changes in use of active travel modes. Annual benefits for health in the intervention cities were estimated at 34.4 disability-adjusted life years (DALYs) and two lives saved due to reductions in cardiac disease, diabetes, cancer, and respiratory disease. Reductions in transport-related carbon emissions were also estimated and valued. Using a discount rate of 3.5%, the estimated benefit/cost ratio was 11:1 and was robust to sensitivity testing. It is concluded that when concerted investment is made in active travel in a city, there is likely to be a measurable, positive return on investment.

Health consequences of transport patterns in New Zealand's largest cities.

AIM: Transport is a well-known determinant of health, through physical activity, air pollution and injury pathways. New Zealand has a highly car-dominated transport system, but cities differ in the amounts of walking, cycling and public transport use, reflecting different urban planning priorities over time. METHODS: Using the Integrated Transport and Health Impacts Model, adapted for New Zealand, we quantified the likely changes in health and greenhouse emissions if Auckland, Hamilton, Tauranga, Christchurch and Dunedin Cities had the same mode share for cycling, walking, public transport and car use as Wellington City, which currently has the highest levels of sustainable travel. RESULTS: All cities modelled would have better health, due to a reduction in morbidity and mortality from injury and air pollution and through increased levels of physical activity, if their transport systems resembled Wellington's. Carbon emissions from light passenger transport would fall also. The magnitude of these effects varies considerably by city. CONCLUSION: Transport funding in recent decades that has prioritised private car use has had detrimental effects on the health of New Zealanders. New Zealand requires better accounting of and accountability for the health and carbon impacts of decisions on transport projects, at both local and national levels.

The extent of backover collisions internationally.

This study reports good consistency in international comparisons of the number and severity of backover crashes. More than half occurred to pedestrians aged 60 years and older. Children less than 9 years comprised 5% of these crashes with a similar percent aged 10 to 19 years. A significant 41% reduction in real-world backover crashes was found for Australian vehicles with reversing cameras. A range of driver and pedestrian maneuvers was found and 11 crash scenarios were identified in backover collisions. Mandating the fitting of reversing cameras to all vehicles and enhancements would likely enhance the safety of pedestrians in reversing maneuvers.

Physical Activity Prevalence and Correlates Among New Zealand Older Adults.

The aim of this study was to provide up-to-date information about physical activity (PA) levels in New Zealand older adults to inform the development and targeting of relevant health promotion initiatives. Nationally-representative survey (N = 1,468) data were analyzed to assess in people aged ≥ 60 years the prevalence of physical inactivity and meeting PA guidelines, differences between 2012 and 2014, and sociodemographic correlates. One-fifth (20.7%) of respondents were inactive; 46.2% met PA guidelines. Multivariate analyses revealed lower PA in 2014 versus 2012, and identified self-rated health and education as correlates of both PA measures. Age and socioeconomic deprivation were associated with physical inactivity only, while sex and employment were correlates of meeting PA guidelines. Low PA among older adults signals a need to promote PA engagement in that age group. This analysis aids effective intervention design by identifying specific segments of the older adult population that tailored health promotion initiatives should target.