Understanding and Improving Arterial Roads to Support Public Health and Transportation Goals.

Arterials are types of roads designed to carry high volumes of motorized traffic. They are an integral part of transportation systems worldwide and exposure to them is ubiquitous, especially in urban areas. Arterials provide access to diverse commercial and cultural resources, which can positively influence community health by supporting social cohesion as well as economic and cultural opportunities. They can negatively influence health via safety issues, noise, air pollution, and lack of economic development. The aims of public health and transportation partially overlap; efforts to improve arterials can meet goals of both professions. Two trends in arterial design show promise. First, transportation professionals increasingly define the performance of arterials via metrics accounting for pedestrians, cyclists, transit riders, and nearby residents in addition to motor vehicle users. Second, applying traffic engineering and design can generate safety, air quality, and livability benefits, but we need evidence to support these interventions. We describe the importance of arterials (including exposures, health behaviors, effects on equity, and resulting health outcomes) and make the case for public health collaborations with the transportation sector.

Are rural places less safe for motorists? Definitions of urban and rural to understand road safety disparities.

The objectives of the study are to understand road safety within the context of regional development processes and to assess how urban-rural categories represent differences in motor vehicle occupant fatality risk. We analysed 2015 motor vehicle occupant deaths in Wisconsin from 2010 to 2014, using three definitions of urban-rural continua and negative binomial regression to adjust for population density, travel exposure and the proportion of teen residents. Rural-Urban Commuting Area codes, Beale codes and the Census definition of urban and rural places do not explain differences in urban and rural transportation fatality rates when controlling for population density. Although it is widely believed that rural places are uniquely dangerous for motorised travel, this understanding may be an artefact of inaccurate constructs. Instead, population density is a more helpful way to represent transportation hazards across different types of settlement patterns, including commuter suburbs and exurbs.

Social and Environmental Characteristics Associated With Older Drivers' Use of Non-driving Transportation Modes.

Objective: We examined associations between older drivers' social and environmental characteristics and odds of using non-driving transportation modes. Methods: Using 2015 National Health and Aging Trends Study data for community-dwelling drivers (n = 5102), we estimated logistic regression models of associations between social characteristics, environmental characteristics, and odds of using non-driving transportation modes three years later. Results: Drivers had 20% increase in odds of getting rides three years later for each additional confidante (adjusted odds ratio [aOR] = 1.20, 95% confidence interval [CI]: 1.11-1.30). Drivers living in more walkable neighborhoods were more likely to walk to get places (National Walkability Index [NWI] score of 18 vs. 2 aOR = 1.71, 95% CI: 1.02-2.90) and take public transit three years later (NWI 18 vs. 2 aOR = 7.47, 95% CI: 1.69-33.0). Discussion: Identifying modifiable social and environmental characteristics can inform future interventions supporting older adults' health during the transition to non-driving.

Getting Rides From Others As a Coping Mechanism in the Transition to Non-Driving.

OBJECTIVES: To characterize the effect of the actual and potential ability to get rides from others on older adults' driving reduction at 3-year follow-up in the United States. METHODS: We analyzed National Health and Aging Trends Study data from community-dwelling drivers in 2015 (unweighted n = 5,102). We used weighted logistic regression models to estimate whether getting rides from others in 2015 was associated with older adults increasing the number of driving behaviors they avoided, decreasing the frequency with which they drove, or not driving at 3-year follow-up after adjusting for biopsychosocial variables. We also measured presence of social network members living nearby including household and non-household members and estimated associated odds of driving reduction at 3-year follow-up. RESULTS: Older adults who got rides from others in 2015 had greater odds of reporting no longer driving at 3-year follow-up compared to those who did not get rides (adjusted odds ratio [aOR] = 1.53, 95% confidence interval [CI]: 1.11-2.11). We found no statistically significant association between older adults living with others or having more nearby confidantes outside their household and their odds of reducing driving at 3-year follow-up. DISCUSSION: These findings suggest that getting rides from others plays an important role in the transition to non-driving for older adults. Future research should examine whether other aspects of social networks (e.g., type, quality, and closer proximity) might also be key modifiable coping factors for older adults transitioning to non-driving.

Traffic risks by travel mode in the metropolitan regions of Stockholm and San Francisco: a comparison of safety indicators.

According to commonly used measures of traffic safety, Sweden has one of the safest road transportation systems in the world, whereas the USA has relatively poor road safety performance. Although national comparisons are useful, they are problematical because they generalise across a diverse mix of travel environments (eg, urban and rural). This study used an array of traffic death rates to determine whether comparable urban regions in Sweden and California-Stockholm and San Francisco-have similar road safety performance for various types of road users. The study found that the Stockholm region is far safer than the San Francisco Bay area for pedestrians and bicyclists, even when comparing the regions' core cities, but may not be any safer for motor vehicle occupants. In addition, comparing traffic safety with traditional measures of exposure such as population and motor vehicle travel produced different results than measures that account for mode-specific exposure.

How do the definitions of urban and rural matter for transportation safety? Re-interpreting transportation fatalities as an outcome of regional development processes.

Urban and rural places are integrated through economic ties and population flows. Despite their integration, most studies of road safety dichotomize urban and rural places, and studies have consistently demonstrated that rural places are more dangerous for motorists than urban places. Our study investigates whether these findings are sensitive to the definition of urban and rural. We use three different definitions of urban-rural continua to quantify and compare motor vehicle occupant fatality rates per person-trip and person-mile for the state of Wisconsin. The three urban-rural continua are defined by: (1) popular impressions of urban, suburban, and rural places using a system from regional economics; (2) population density; and (3) the intensity of commute flows to core urbanized areas. In this analysis, the three definitions captured different people and places within each continuum level, highlighting rural heterogeneity. Despite this heterogeneity, the three definitions resulted in similar fatality rate gradients, suggesting a potentially latent "rural" characteristic. We then used field observations of urban-rural transects to refine the definitions. When accounting for the presence of higher-density towns and villages in rural places, we found that low-density urban places such as suburbs and exurbs have fatality rates more similar to those in rural places. These findings support the need to understand road safety within the context of regional development processes instead of urban-rural categories.

Revisiting exposure: fatal and non-fatal traffic injury risk across different populations of travelers in Wisconsin, 2001-2009.

Comparing the injury risk of different travel modes requires using a travel-based measure of exposure. In this study we quantify injury risk by travel mode, age, race/ethnicity, sex, and injury severity using three different travel-based exposure measures (person-trips, person-minutes of travel, and person-miles of travel) to learn how these metrics affect the characterization of risk across populations. We used a linked database of hospital and police records to identify non-fatal injuries (2001-2009), the Fatality Analysis Reporting System for fatalities (2001-2009), and the 2001 Wisconsin Add-On to the National Household Travel Survey for exposure measures. In Wisconsin, bicyclists and pedestrians have a moderately higher injury risk compared to motor vehicle occupants (adjusting for demographic factors), but the risk is much higher when exposure is measured in distance. Although the analysis did not control for socio-economic status (a likely confounder) it showed that American Indian and Black travelers in Wisconsin face higher transportation injury risk than White travelers (adjusting for sex and travel mode), across all three measures of exposure. Working with multiple metrics to form comprehensive injury risk profiles such as this one can inform decision making about how to prioritize investments in transportation injury prevention.