Cannabis use among adolescents and young adults during the COVID-19 pandemic: A systematic review.

Background: A systematic review of the literature was performed to summarize cannabis use among adolescents and young adults during the COVID-19 pandemic. Special focus was given to the prevalence of cannabis use during COVID-19, as well as factors that may explain changes in cannabis consumption patterns. Methods: The protocol of this systematic review was registered. Articles from seven publication databases were searched in January 2022. The inclusion criteria for studies were as follows: 1) published in English; 2) study instruments needed to include items on COVID-19; 3) conducted after January 1st, 2020; 4) published in a peer-reviewed journal, dissertation, or thesis; 5) study population ≤25 years of age; 6) study designs were limited to observational analytical studies; 7) measured cannabis use. This review excluded other reviews, editorials, and conference abstracts that were not available as full text manuscripts. Independent review, risk of bias assessment, and data abstraction were performed by two authors. Results: Fifteen articles from the United States (n=11) and Canada (n=4) were included in this review. The findings of this review showed that the prevalence of cannabis use during the pandemic among adolescents and young adults were mixed. Some mental health symptoms, including depression and anxiety, were identified as the most commonly reported reasons for increased cannabis use during the pandemic. Conclusions: This review highlights the inconsistencies in the prevalence of cannabis use among adolescents and young adults during the pandemic. Therapeutic interventions for mental health and continued public health surveillance should be conducted to understand the long-term effects of cannabis use among adolescents and young adults.

Risk factors associated with driving after marijuana use among West Virginia college students during the COVID-19 pandemic.

OBJECTIVES: The purpose of this study was to assess sociodemographic and behavioral risk factors associated with driving after marijuana use (DAMU) among West Virginia college students. METHODS: Participants were recruited from West Virginia University between September and November 2022. The study sample was restricted to students who were ≥18 years of age; reported recently driving; possessed a current, valid driver's license from any US state; and were enrolled for at least one credit hour in the Fall 2022 semester. RESULTS: Among respondents (N = 772), 28.9% reported DAMU. Students who had a GPA of B (adjusted odds ratio [AOR]: 2.17, 95% confidence interval [CI]: 1.06-4.42), smoked or ingested marijuana in the past year (AOR: 26.51, 95% CI: 10.27-68.39), drove after drinking (AOR: 2.38, 95% CI: 1.18-4.79), and used both marijuana and alcohol concurrently and then drove (AOR: 10.39, 95% CI: 2.32-46.54) associated with DAMU. Individuals who felt the behavior was somewhat dangerous or not dangerous or thought their peers approved of DAMU showed significant associations with DAMU. CONCLUSIONS: As DAMU was prevalent, future interventions that raise awareness of the danger and potential consequences of DAMU may be needed to reduce this risky behavior on college campuses.

Characteristics of Fatal, Pedestrian-Involved, Motor Vehicle Crashes in West Virginia: A Cross-Sectional and Spatial Analysis.

Fatal, pedestrian-involved, motor vehicle collisions are increasing in the United States yet remain lower in rural states such as West Virginia. This study's purpose was to investigate the overall risk factors of pedestrian fatalities by rurality and sex in West Virginia. Data were obtained from the Fatality Analysis Reporting System. The fatality had to occur within West Virginia between 1 January 2009 and 31 December 2019. Risk factors of rural vs. urban and male vs. female crashes were determined using multivariable logistic regression models. Clustering of crash locations was analyzed using kernel density estimation and Ripley's K. Among the 254 fatalities, most victims were male (70%). Most crashes occurred at night (76%), on highways (73%), on level (71%), non-curved (84%), dry (82%) roads during fair weather conditions (82%). Nearly 34% of the victims tested positive for alcohol. Men were 2.5 times as likely to be hit in a rural area (OR = 2.5; 95% CI 1.2, 5.4), on curved roads, and 57% less likely (OR = 0.43; 95% CI 0.2, 0.9) to test positive for drugs compared to women. Crash characteristics, including location, were similar between the sexes. As many risk factors were modifiable behaviors, public health interventions to ensure pedestrian safety may be necessary.

Short-term impacts of all-driver handheld cellphone bans on high-schoolers' texting while driving: quasi-experimental analyses of Illinois and Georgia.

Teen drivers are more likely than their older counterparts to engage in distracted driving. Many states prohibit cellphone use for teen drivers, but only prohibit texting for all drivers. Evidence that these laws have been effective is mixed. We hypothesize that recent policy changes in Georgia and Illinois from teen cellphone bans with all-driver texting bans to all-driver handheld phone bans yielded short-term reductions in teen texting while driving. We analyzed Youth Risk Behavior Surveys in Georgia, Illinois, and control states North Carolina and Michigan. We estimated the reduction in texting while driving associated with policy changes via difference-in-differences models. In Illinois, 45.4 % of high school drivers texted while driving in 2013. After a 2014 policy change to an all-driver handheld ban, the percentage decreased in 2015 to 41.8 %, and decreased further in 2017 to 37.7 %. The adjusted DID estimate comparing Illinois to Michigan from 2013 to 2017 was -8.3 % (95 % CI: -15.5 % 1.1 %; p-value = 0.025). In Georgia, the percentage decreased from 37.5 % before the law to 30.8 % after, and the adjusted DID estimate comparing Georgia to North Carolina was -10.8 % (95 % CI: -19.0 %, -2.5 %; p-value = 0.011) than in North Carolina. Results support all-driver handheld phone bans to improve traffic safety for high school drivers.

Risk Factors Associated With Driving After Marijuana Use Among US College Students During the COVID-19 Pandemic.

PURPOSE: To assess the sociodemographic and behavioral risk factors associated with driving after marijuana use among US college students. METHODS: A secondary analysis used the fall 2020 and spring 2021 American College Health Association- National College Health Assessment III and the dataset was restricted to college students ≥18 years of age who reported recent driving and marijuana use. Associations between risk factors and driving after marijuana use were estimated using multivariable logistic regression. RESULTS: A total of 29.9% (n = 4,947) of the respondents reported driving after marijuana use. Males (adjusted odds ratio [AOR]: 1.64, 95% confidence interval [CI]: 1.48-1.82), non-Hispanic Black (AOR: 1.32, 95% CI: 1.02-1.71), sexual minorities (AOR: 1.19, 95% CI: 1.07-1.31), individuals with an alcohol or substance use disorder (AOR: 1.44, 95% CI: 1.08-1.91), anxiety (AOR: 1.20, 95% CI: 1.06-1.36), higher suicidality (AOR: 1.18, 95% CI: 1.07-1.31), and those who also drank and drove (AOR: 3.18, 95% CI: 2.84-3.57) had a higher risk of driving after marijuana use. DISCUSSION: Future research should focus on increasing awareness of driving after marijuana use and prevention programs and/or strategies on college campuses regarding driving after marijuana use for these groups to reduce this risky behavior.

Support for distracted driving laws: An analysis of adolescent drivers from the Traffic Safety Culture Index from 2011 to 2017.

INTRODUCTION: Adolescent drivers are often the focus of traffic safety legislation as they are at increased risk for crash-related injury and death. However, the degree to which adolescents support distracted driving laws and factors contributing to their support are relatively unknown. Using a large, nationally weighted sample of adolescent drivers in the United States, we assessed if perceived threat from other road users' engagement in distracted driving, personal engagement in distracted driving behaviors, and the presence of state distracted driving laws was associated with support for distracted driving laws. METHODS: The sample included 3565 adolescents (aged 16-18) who participated in the Traffic Safety Culture Index survey from 2011 to 2017. A modified Poisson regression model with robust errors was fit to the weighted data to examine support for distracted driving laws. Models included age, gender, year, state distracted driving laws, personal engagement in distracted driving behavior, and perceived threat from other road users' engaging in distracted driving. RESULTS: Approximately 87% of adolescents supported a law against texting and emailing compared to 66% who supported a universal handheld cellphone law. Support for distracted driving legislation was associated with greater perceived threat of other road users engaging in distracted driving while accounting for personal engagement in distracted driving, state distracted driving laws, and developmental covariates. DISCUSSION: Greater understanding of the factors behind legislative support is needed. Public health interventions focused on effectively translating the risks of cellphone use while driving and effective policy will further improve the traffic safety culture.

The association between a statewide stay-at-home order and motor vehicle injury rates among population sub-groups in West Virginia.

OBJECTIVE: Little is known about the relationship between Stay-At-Home orders issued by state governments due to the COVID-19 pandemic and their impacts on motor vehicle-related injuries. The purpose of this study was to determine whether the presence of a Stay-At-Home order was associated with lower rates of motor vehicle-related injuries requiring emergency medical treatment among population sub-groups in West Virginia (i.e., males, females, 0-17, 18-25, 26-45, 46-65, ≥66 years old). METHODS: A Stay-At-Home order was in effect in West Virginia from March 23-May 4, 2020. Counts of individuals who incurred motor-vehicle-related injuries that required emergency medical treatment were obtained from the Centers for Disease Control and Prevention's National Syndromic Surveillance Program from January 1 thru September 6 of 2019 and 2020. Counts were obtained by week-year and by population sub-group in West Virginia. The presence of the Stay-At-Home order was binary coded by week. Negative binomial regression was used to assess the relationship between the presence of a Stay-At-Home and injury rates. 2019 population sub-group estimates were obtained from the United States Census Bureau and used as offsets in the models. Models were also adjusted for year and vehicle miles traveled by week-year. RESULTS: There were 23,418 motor-vehicle related injuries during the study period. The presence of the Stay-At-Home order was associated with 44% less injuries overall [Incident Rate Ratio (IRR)=0.56, 95% CI 0.48, 0.64]. Females experienced fewer injuries than males (IRR = 0.49 vs 0.63, respectively) and the number of injuries decreased with age (p-value 0.031) when comparing time periods when the Stay-At-Home was in effect compared to times when it was not. CONCLUSIONS: West Virginia's Stay-At-Home order was associated with lower motor-vehicle injury rates requiring medical treatment across all population sub-groups. Most population sub-groups likely altered their travel behaviors which resulted in lower motor-vehicle injury rates. These findings may inform future policies that impose emergency travel restrictions in populations.

The liberalization of fireworks legislation and its effects on firework-related injuries in West Virginia.

BACKGROUND: Fifteen states, including West Virginia, have liberalized their laws concerning fireworks possession and sale. Effective June 1, 2016, House Bill 2852 enabled all Class C fireworks to be sold within the state. The effects of this policy on fireworks-related injuries requiring immediate medical care are unknown. The purpose of this study was to determine whether this policy may have affected the fireworks-related injury rate and/or injury severity. METHODS: Data were collected from the electronic medical records of patients treated by West Virginia University Medicine between June 1, 2015-May 31, 2017. The pre and post law periods were defined as June 1, 2015-May 31, 2016 and June 1, 2016-May 31, 2017, respectively. Fireworks-related injuries were identified via International Classification of Disease Clinical Modification codes and by free text searches of the electronic medical records. The rate of injuries pre and post-legislation were compared by Exact Poisson Regression, while demographic characteristics and injury severity were compared via Fisher's Exact tests. RESULTS: 56 individuals were treated for fireworks-related injuries during the study period. The majority of patients were over 25 years of age (64%) and male (77%). Most of the injuries occurred within 7 days of a celebrated U.S. holiday (64%), and 28% were severe in nature. Age, sex, and injury severity did not significantly differ pre and post law passage. The injury rate per 100,000 patients was 39% higher after the law was enacted (p = 0.3475; incidence rate ratio 1.39, 95% Confidence Interval 0.74, 2.68). CONCLUSION: The law increasing access to Class C fireworks may have affected the injury rate, but not injury severity among treated patients. Effective, evidence-based, public health interventions applicable to all age groups may be warranted particularly around national holidays. This study may inform other states looking to amend their legislation.

Maternal characteristics associated with injury-related infant death in West Virginia, 2010-2014.

Although injury-related deaths have been documented among children and adult populations, insufficient attention has been directed towards injury-related infant deaths. The objective of this retrospective study was to investigate maternal and infant characteristics associated with injury-related infant deaths in West Virginia. Birth and infant mortality data for 2010-2014 were sourced from the West Virginia Bureau for Public Health, Charleston. Relative risk was calculated using log-binomial regression utilizing generalized estimating equations. Maternal characteristics associated with injury-related infant mortality in West Virginia were race/ethnicity ([Formula: see text] = 7.48, p = .03), and smoking during pregnancy ([Formula: see text], p < .00). Risk of a Black Non-Hispanic infant suffering an injury-related death was 4.0 (95% CL 1.7, 9.3) times that of infants of other races/ethnicities. Risk of an infant dying from an injury-related cause, if the mother smoked during pregnancy, was 2.9 (95% CL 1.6, 5.0) times the risk of such a death if maternal smoking status during pregnancy is unknown or no smoking, controlling for race/ethnicity. This study provides important information to public health stakeholders at both the state and local levels in designing interventions for partial reduction or prevention of injury-related infant mortality in West Virginia.

Cell phone use while driving laws and motor vehicle driver fatalities: differences in population subgroups and location.

PURPOSE: Research suggests that cell phone use while driving laws are associated with lower driver fatalities. This study seeks to determine whether this relationship is modified by driver age (16-24, 25-39, 40-59, ≥60), sex (male, female), race/ethnicity (white non-Hispanic, white Hispanic, black non-Hispanic, other), or rurality (rural, urban). METHODS: Fatality Analysis Reporting System data were merged with state legislation (2000-2014). The exposure was the type of legislation in effect. The outcome was non-alcohol-related driver fatalities by state-quarter-year. Incident rate ratios were estimated using generalized Poisson mixed regression for overdispersed count data with robust standard errors. RESULTS: Amongst 190,544 drivers, compared to periods without bans, universal hand-held calling bans were associated with 10% (adjusted incident rate ratio = 0.90, 95% confidence interval 0.84, 0.96) lower non-alcohol-related driver fatalities overall and up to 13% lower fatalities across all age groups and sexes but not for race/ethnicity or rurality. When comparing state-quarter-years with bans to those without, universal texting bans were not associated with lower fatalities overall or for any demographic group. CONCLUSIONS: The relationships between cell phone laws and non-alcohol-related driver fatalities are modified by driver demographics, particularly for universal hand-held bans. Universal hand-held calling bans may benefit more types of drivers compared to texting bans.

Risk Perceptions of Cellphone Use While Driving: Results from a Delphi Survey.

Cellphone use while driving has been recognized as a growing and important public health issue by the World Health Organization and U.S. Center for Disease Control and Prevention. Surveys typically collect data on overall texting while driving, but do not differentiate between various forms of cellphone use. This study sought to improve the survey indicators when monitoring cellphone use among young drivers. Experts and young drivers were recruited to propose behavioral indicators (cellphone use while driving behaviors) and consequential indicators (safety consequences of cellphone use while driving) in 2016. Subsequently, experts and young drivers selected the top indicators using the Delphi survey method. We enrolled 22 experts with published articles on cellphone use while driving nationally, and seven young drivers who were freshmen at a state university. Sending a text or e-mail on a handheld phone was picked as the top behavioral indicator by both groups. However, young drivers chose playing music on a handheld phone as the second most important behavioral indicator, which was overlooked by experts. Injury/death and collision were the top two consequential indicators. Experts and young drivers identified the important survey indicators to monitor cellphone use while driving.

Cellphone Legislation and Self-Reported Behaviors Among Subgroups of Adolescent U.S. Drivers.

PURPOSE: The relationship between cellphone use while driving legislation and self-reported adolescent driver behavior is poorly understood, especially across demographic subgroups. This study investigated the relationship between statewide cellphone legislation and cellphone use behaviors across adolescent driver subgroups, including age (16/17 vs. 18), sex, race/ethnicity (white non-Hispanic and others), and rurality (urban or rural). METHODS: Data from the 2011-2014 Traffic Safety Culture Index Surveys were combined with state legislation. The outcomes were self-reported texting and handheld cellphone conversations. The exposure was the presence of a texting or handheld cellphone ban applicable to all drivers (i.e., universal) in the drivers' state of residence. A multilevel, modified Poisson regression model was used to estimate the risk of engaging in these behaviors. RESULTS: Approximately 34% of respondents reported to have driven while conversing, and 37% texted and drove in the 30 days before the survey. Universal handheld calling bans were associated with lower occurrences of cellphone conversations across all groups except rural drivers. Overall, handheld cellphone bans were associated with 55% lower (adjusted risk ratio .45, 95% confidence interval .32-.63) occurrences of cellphone conversations. However, universal texting bans were not associated with fewer texting behaviors in any subgroup. CONCLUSIONS: Universal handheld calling bans may discourage adolescents from engaging in handheld phone conversations, whereas universal texting bans may not fully discourage texting behaviors. More interventional or educational work is necessary, particularly addressing texting while driving.

Hand-held cell phone use while driving legislation and observed driver behavior among population sub-groups in the United States.

BACKGROUND: Cell phone use behaviors are known to vary across demographic sub-groups and geographic locations. This study examined whether universal hand-held calling while driving bans were associated with lower road-side observed hand-held cell phone conversations across drivers of different ages (16-24, 25-59, ≥60 years), sexes, races (White, African American, or other), ruralities (suburban, rural, or urban), and regions (Northeast, Midwest, South, and West). METHODS: Data from the 2008-2013 National Occupant Protection Use Survey were merged with states' cell phone use while driving legislation. The exposure was presence of a universal hand-held cell phone ban at time of observation. Logistic regression was used to assess the odds of drivers having a hand-held cell phone conversation. Sub-groups differences were assessed using models with interaction terms. RESULTS: When universal hand-held cell phone bans were effective, hand-held cell phone conversations were lower across all driver demographic sub-groups and regions. Sub-group differences existed among the sexes (p-value, <0.0001) and regions (p-value, 0.0003). Compared to states without universal hand-held cell phone bans, the adjusted odds ratio (aOR) of a driver hand-held phone conversation was 0.34 [95% confidence interval (CI): 0.28, 0.41] for females versus 0.47 (CI 0.40, 0.55) for males and 0.31 (CI 0.25, 0.38) for drivers in Western states compared to 0.47 (CI 0.30, 0.72) in the Northeast and 0.50 (CI 0.38, 0.66) in the South. CONCLUSIONS: The presence of universal hand-held cell phone bans were associated lower hand-held cell phone conversations across all driver sub-groups and regions. Hand-held phone conversations were particularly lower among female drivers and those from Western states when these bans were in effect. Public health interventions concerning hand-held cell phone use while driving could reasonably target all drivers.

Fueled by an Epidemic: A Spatial Analysis of Opioid-Positive Drivers Fatally Injured in Motor Vehicle Collisions in West Virginia, 2011-2015.

Background: Narcotics usage is associated with an increased risk of motor vehicle collision and opioid overdose deaths are elevated in West Virginia compared to other states in the United States. This analysis sought to determine the prevalence of narcotics among drivers fatally injured in motor vehicle collisions in West Virginia and to determine if these collisions were clustered in areas of the state where opioid use/abuse is high. Methodology/Principal Findings: Fatal crash data from 2011-2015 were obtained from the Fatality Analysis Reporting System and the locations of the collisions were plotted with spatial software. Spatial analyses, including nearest neighbor indexes, heat maps and hot-spots, were conducted to determine if and where clusters of opioid-positive crashes existed. The results of the spatial analyses were visually compared to the rates of opioid overdose deaths by county, which served as a proxy of opioid use/abuse. Of the 486 drivers, 19% (n=94) tested positive for opioids. A clustering of opioid positive crashes was detected in the state overall (nearest neighbor index=0.89, p-value=0.055). Hot-spots were detected in the lower regions of the state, which overlapped counties with the highest rates of opioid overdose deaths, and cold-spots were detected in areas with lower opioid overdose death rates. Conclusions/Significance: Individuals using narcotics may still operate motor vehicles, which may pose a threat to all road users in West Virginia. Public health interventions, education, or enforcement may be needed in areas of high opioid use/abuse to raise awareness of driving under the influence of drugs.

The association between handheld phone bans and the prevalence of handheld phone conversations among young drivers in the United States.

PURPOSE: Fourteen US states and the District of Columbia have banned handheld phone use for all drivers. We examined whether such legislation was associated with reduced handheld phone conversations among drivers aged younger than 25 years. METHODS: Data from the 2008 to 2013 National Occupant Protection Use Survey were merged with states' legislation. The outcome was roadside-observed handheld phone conversation at stop signs or lights. Logistic regression was used. RESULTS: A total of 32,784 young drivers were observed. Relative to drivers who were observed in states without a universal handheld phone ban, the adjusted odds ratio of phone conversation was 0.42 (95% confidence interval, 0.33-0.53) for drivers who were observed in states with bans. The relative reduction in phone conversation was 46% (23%, 61%) for laws that were effective less than 1 year, 55% (32%, 70%) for 1-2 years, 63% (51%, 72%) for 2 years or more, relative to no laws. CONCLUSIONS: Universal handheld phone bans may be effective at reducing handheld phone use among young drivers.

Medication use and the risk of motor vehicle collisions among licensed drivers: A systematic review.

OBJECTIVES: Driving under the influence of prescription and over-the-counter medication is a growing public health concern. A systematic review of the literature was performed to investigate which specific medications were associated with increased risk of motor vehicle collision (MVC). METHODS: The a priori inclusion criteria were: (1) studies published from English-language sources on or after January 1, 1960, (2) licensed drivers 15 years of age and older, (3) peer-reviewed publications, master's theses, doctoral dissertations, and conference papers, (4) studies limited to randomized control trials, cohort studies, case-control studies, or case-control type studies (5) outcome measure reported for at least one specific medication, (6) outcome measure reported as the odds or risk of a motor vehicle collision. Fourteen databases were examined along with hand-searching. Independent, dual selection of studies and data abstraction was performed. RESULTS: Fifty-three medications were investigated by 27 studies included in the review. Fifteen (28.3%) were associated with an increased risk of MVC. These included Buprenorphine, Codeine, Dihydrocodeine, Methadone, Tramadol, Levocitirizine, Diazepam, Flunitrazepam, Flurazepam, Lorazepam, Temazepam, Triazolam, Carisoprodol, Zolpidem, and Zopiclone. CONCLUSIONS: Several medications were associated with an increased risk of MVC and decreased driving ability. The associations between specific medication use and the increased risk of MVC and/or affected driving ability are complex. Future research opportunities are plentiful and worthy of such investigation.

Who actually receives cell phone use while driving citations and how much are these laws enforced among states? A descriptive, cross-sectional study.

OBJECTIVES: While numerous cell phone use while driving laws have been passed among states, little information exists regarding who gets cited for these traffic infractions and how much these laws are enforced at the state-level within the USA. DESIGN: Cross-sectional, descriptive study. SETTING: 14 states and the District of Columbia. PARTICIPANTS: Those receiving cell phone use while driving citations within included states from 2007 to 2013. PRIMARY OUTCOME: Demographic characteristics of cited drivers were assessed. Rates of infractions per 100 000 licensed in-state drivers per year for various cell phone use while driving violations were calculated. RESULTS: Drivers were cited for hand-held use violations (n=2.5 million) more than texting (n=14 682) or young driver all cell phone bans (n=342). Among states that provided data for all traffic violations, cell phone use while driving citations comprised 1% of all written citations. Regardless of ban type, males (68.2%) were cited more frequently than females. Drivers 25-64 years of age (90.8%) were more likely to be cited for hand-held phone use. The average yearly rate of infractions per 100 000 licensed in-state drivers from 2010-2013 was 5.8 for texting bans, 2607 for hand-held bans, and 9954 for any traffic violation. CONCLUSIONS: Among cited drivers, age and sex differences existed by the type of ban violated. State-level enforcement appeared sparse. Due to the potential serious consequences of cell phone use while driving in the USA, more enforcement and targeted public safety campaigns are likely needed.

A comparison of self-reported seat belt usage among the Appalachian and non-Appalachian United States.

PURPOSE: Seat belts are known to effectively prevent death and serious injury among motorists involved in vehicular collisions. Limited research exists regarding seat belt usage in Appalachia. This study compares self-reported seat belt use in the Appalachian and non-Appalachian counties of the United States. METHODS: Data from 2012 Behavioral Risk Factor Surveillance System were used to calculate nationally representative estimates of consistent seat belt usage in each region. These estimates were stratified by age, sex, and rurality. Total and potential lives saved by seat belts were calculated for each region using 2012 Fatality Analysis Reporting System data. RESULTS: Of the 345,513 respondents (unweighted), Appalachians were 6% less likely than non-Appalachians to always wear a seat belt (relative risk = 0.94, 95% confidence interval, 0.93-0.95). Seat belt usage was consistently lower among Appalachians regardless of sex, age, or rurality. Only 68.1% of rural, Appalachian youth reported always wearing a seat belt. Seat belt usage was highest among non-Appalachian females residing in urban areas (92.5%). With 100% belt compliance, an additional 360 and 1712 potential lives could have been saved in Appalachia and non-Appalachia, respectively. CONCLUSIONS: Regional differences possibly influence seat belt usage. Therefore, public health interventions to increase seat belt usage in Appalachia are likely warranted.

Medication use and the risk of motor vehicle collision in West Virginia drivers 65 years of age and older: a case-crossover study.

BACKGROUND: The current generation of older adults reports a higher lifetime prevalence of prescription, over-the-counter, and recreational drug use. The purpose of this analysis is to characterize the drug usage and determine the risk of motor vehicle collision associated with individual medications in a population of drivers ≥ 65 years. METHODS: A case-crossover study was conducted at West Virginia University Healthcare's facilities using data obtained from the electronic health records (n = 611) of drivers ≥ 65 years admitted for medical treatment following a motor vehicle collision which occurred between Jan. 1, 2009 and June 30, 2014. Patients' medication usage 14 days before collision were matched and compared to their medication usage during four control periods prior to collision. Odds ratios were then calculated for the most prevalent individual medications and pharmaceutical sub-classes using conditional logistic regression. RESULTS: Analgesic, cardiovascular and gastrointestinal medicines were common. Few drivers tested positive for either licit or illicit drugs. Of those testing positive for drugs, benzodiazepines and opiates were prevalent. Drivers consuming Tramadol (adjusted OR 11.41; 95% CI 1.27, 102.15) were at a significantly increased risk of motor vehicle collision. CONCLUSIONS: Older adult drivers who have a prescription for this medication may need to be aware of the potential risk. Further research is necessary in a larger, more nationally representative population.

Characterization of drug and alcohol use among senior drivers fatally injured in U.S. motor vehicle collisions, 2008-2012.

OBJECTIVE: Adults 65 years of age and older comprise the fastest growing demographic in the United States. As substance use is projected to increase in this population, there is concern that more seniors will drive under the influence of impairing drugs. The purpose of this analysis was to characterize the drug and alcohol usage among senior drivers fatally injured (FI) in traffic collisions. METHODS: Data from the Fatality Analysis Reporting System were analyzed from 2008 to 2012. Commonly used classes and specific drugs were explored. Rates of drug use, multiple drugs, concomitant drug and alcohol use, and alcohol use alone were generated using Poisson regression with robust error variance estimation. Rates were compared to a reference population of FI middle-aged drivers (30 to 50 years old) using rate ratios. RESULTS: Drug use among FI senior drivers occurred in 20.0% of those tested. Among drug-positive FI senior drivers, narcotics and depressants were frequent. The prevalence of testing positive for any drug, multiple drugs, combined drug and alcohol, and alcohol use alone among FI seniors were 47% less (relative risk [RR] = 0.53, 95% confidence interval [CI], 0.47, 0.62), 59% less (RR = 0.41, 95% CI, 0.34, 0.51), 87% less (RR = 0.13, 95% CI, 0.09, 0.19), and 77% less (RR = 0.23, 95% CI, 0.19, 0.28), respectively, compared to FI middle-aged drivers. CONCLUSIONS: Though overall drug use is less common among FI senior drivers relative to FI middle-aged drivers, driving under the influence of drugs may be a relevant traffic safety concern in a portion of this population.