Ethical considerations for the design and implementation of child injury prevention interventions: the example of delivering and installing safety equipment into the home.

INTRODUCTION: Public health ethics is a growing field of academic interest but ethical discussion of injury prevention seems to have received limited attention. Interventions that promise to be effective are not necessarily-without explicit justification-'good' and 'right' interventions in every sense. This paper explores public health ethics in the context of child injury prevention with the objective to initiate interdisciplinary dialogue on the ethics of child safety interventions. METHOD: A framework of seven public health ethics principles (non-maleficence, health maximisation, beneficence, respect for autonomy, justice, efficiency and proportionality) were applied to an intervention to promote child safety in the home. RESULTS: Preventing child injury in the home is ethically challenging due to the requirement for the state to intervene in the private sphere. Non-maleficence and beneficence are difficult to judge within this intervention as these are likely to be highly dependent on the nature of intervention delivery, in particular, the quality of communication. Respect for autonomy is challenged by an intervention occurring in the home. The socioeconomic gradient in child injury risk is an important factor but a nuanced approach could help to avoid exacerbating inequalities or stigmatisation. Equally, a nuanced approach may be necessary to accommodate the principles of proportionality and efficiency within the local context. CONCLUSION: We conclude that this intervention is justifiable from an ethical perspective but that this type of reflection loop is helpful to identify the impact of interventions beyond effectiveness.

Rollover Protective Structures, Worker Safety, and Cost-Effectiveness: New York, 2011-2017.

OBJECTIVES: To measure cost-effectiveness of an intervention to increase retrofitting of rollover protective structures (ROPS) on tractors. METHODS: Tractor overturns are the leading cause of farm fatalities. ROPS prevent these deaths. This study updates a 2011 cost-effectiveness assessment of a New York State intervention to increase use of ROPS. We subtracted intervention cost from the cost of injuries averted, then divided this figure by the number of averted injuries. We used related probabilities and costs of fatalities and injuries from published literature to calculate the program's cost-effectiveness. RESULTS: The total cost of the injuries averted from 2007 to 2017 was $6 018 742 versus a total program cost of $1 776 608. The one-time retrofit costs will continue to prevent injuries as long as the tractors are used, generating additional (projected) future savings of $12 136 512, $15 781 027, and $18 924 818 if retrofitted tractors remain in operation 15, 20, or 25 years after their retrofit. CONCLUSIONS: Social marketing was cost-effective for reducing injuries from tractor overturns. Public Health Implications. These results indicate that the intervention model is effective from both a public health and economic standpoint and should be expanded into other states.

Preventing deaths and injuries from house fires: a cost-benefit analysis of a community-based smoke alarm installation programme.

BACKGROUND: Operation Installation (OI), a community-based smoke alarm installation programme in Dallas, Texas, targets houses in high-risk urban census tracts. Residents of houses that received OI installation (or programme houses) had 68% fewer medically treated house fire injuries (non-fatal and fatal) compared with residents of non-programme houses over an average of 5.2 years of follow-up during an effectiveness evaluation conducted from 2001 to 2011. OBJECTIVE: To estimate the cost-benefit of OI. METHODS: A mathematical model incorporated programme cost and effectiveness data as directly observed in OI. The estimated cost per smoke alarm installed was based on a retrospective analysis of OI expenditures from administrative records, 2006-2011. Injury incidence assumptions for a population that had the OI programme compared with the same population without the OI programme was based on the previous OI effectiveness study, 2001-2011. Unit costs for medical care and lost productivity associated with fire injuries were from a national public database. RESULTS: From a combined payers' perspective limited to direct programme and medical costs, the estimated incremental cost per fire injury averted through the OI installation programme was $128,800 (2013 US$). When a conservative estimate of lost productivity among victims was included, the incremental cost per fire injury averted was negative, suggesting long-term cost savings from the programme. The OI programme from 2001 to 2011 resulted in an estimated net savings of $3.8 million, or a $3.21 return on investment for every dollar spent on the programme using a societal cost perspective. CONCLUSIONS: Community smoke alarm installation programmes could be cost-beneficial in high-fire-risk neighbourhoods.

Evaluation of the crash mitigation effect of low-speed automated emergency braking systems based on insurance claims data.

OBJECTIVE: The aim of the present study was to evaluate the crash mitigation performance of low-speed automated emergency braking collision avoidance technologies by examining crash rates, car damage, and personal injuries. METHOD: Insurance claims data were used to identify rear-end frontal collisions, the specific situations where the low-speed automated emergency braking system intervenes. We compared cars of the same model (Volvo V70) with and without the low-speed automated emergency braking system (AEB and no AEB, respectively). Distributions of spare parts required for car repair were analyzed to identify car damage, and crash severity was estimated by comparing the results with laboratory crash tests. Repair costs and occupant injuries were investigated for both the striking and the struck vehicle. RESULTS: Rear-end frontal collisions were reduced by 27% for cars with low-speed AEB compared to cars without the system. Those of low severity were reduced by 37%, though more severe crashes were not reduced. Accordingly, the number of injured occupants in vehicles struck by low-speed AEB cars was reduced in low-severity crashes. In offset crash configurations, the system was found to be less effective. CONCLUSIONS: This study adds important information about the safety performance of collision avoidance technologies, beyond the number of crashes avoided. By combining insurance claims data and information from spare parts used, the study demonstrates a mitigating effect of low-speed AEB in real-world traffic.

[Effective interventions to prevent child injuries: a review of the literature]. / Les interventions efficaces en prévention des accidents de la vie courante chez les enfants: une synthèse de littérature.

Child injuries represent an important public health problem. The aim of this paper is to review the current scientific knowledge on interventions designed to prevent child injuries. The current state of knowledge in this area was assessed by means of a specific method involving a review of literature reviews and a classification of health promotion interventions identified in these reviews (rapid reviews). We found a large number of effective or promising programmes devoted to the prevention of the most common child injuries: drowning, burns, falls, poisoning, electrocution, sports and leisure injuries. Some interventions are based on environmental measures, while others are educational or use law and regulatory processes. Some are primary prevention measures, others are secondary prevention measures, while others are multidimensional and can effectively reduce several types of injuries. For example, home safety education and provision of safety equipment, or home-based parenting interventions, can have an impact on injury rates. These findings present a number of limitations due to the marked diversity of the quality of the documents reviewed. It should also be stressed that interventions that are not listed in this article are not necessarily ineffective: they may simply lack a rigorous evaluation enabling them to be identified in our review.

From technological acceptability to appropriation by users: methodological steps for device assessment in road safety.

This article presents the methodology developed within the framework of the research project SARI (Automated Road Surveillance for Driver and Administrator Information). This methodology is based on the logic of action research. The article presents the different stages in the development of technological innovation addressing vehicle control loss when driving on a curve. The results observed in speed reduction illustrate that no matter how optimal an innovation may be technologically speaking, it is only as effective as it is acceptable from a user standpoint. This acceptability can only be obtained if the technology is developed by engineers in liaison with social science specialists.

Increases in ROPS pricing from 2006-2012 and the impact on ROPS demand.

In 2006, a social marketing campaign was developed to increase the installation of rollover protective structures (ROPS) on unprotected New York tractors. Using data gathered from the program's hotline, the impact of price increases on farmers' interest in ROPS is examined. Pricing data were obtained for all rigid ROPS kits commercially available in the U.S. since 2006. These data were stratified into two groups of ROPS suppliers: (1) tractor manufacturers that sell ROPS for their own tractors, referred to in this study as original equipment manufacturers (OEMs), and (2) aftermarket (AM) ROPS suppliers. The trend in price increases was contrasted with the change in the consumer price index (CPI), the probability of retrofitting within quintiles of cost was estimated, and the increase in ROPS prices over time was plotted The average price increase for a ROPS kit (excluding shipping and installation) over the six years of the study was 23.3% for OEM versus 60.5% for AM (p < 0.0001). Out-of-pocket expenses held steady for OEM versus a six-year increase of $203 for AM (p = 0.098). The probability of a farmer retrofitting dropped monotonically from 66.9% in the lowest ROPS cost quintile to 23% in the highest. If these trends continue, the proportion of inquiries resulting in a ROPS retrofit will fall below 20% by 2020 for AM ROPS. Based on other trends identified in the literature, it is reasonable to assume that decreases in ROPS installation are likely to affect the tractor owners who are most likely to need these safety devices.

An assessment of the safety effects of the French speed camera program.

This article presents the results of an evaluation of the speed camera program implemented in France in November 2003. The effects of this program on traffic casualties were estimated using interrupted time-series analyses. Various parametizations were attempted in order to capture changes in the constant and the slope of our traffic injury series. Results of the study reveal significant decreases in both fatal and non-fatal traffic injuries on the whole road network following deployment of the speed camera program. The fatality rate per 100,000 vehicles fell by 21% whereas the decrease in non-fatal traffic injuries displayed a decay function: a 26.2% reduction was recorded in the first month but dropped to 0.8% for the last observation of the series.

Pay as You Speed, ISA with incentives for not speeding: a case of test driver recruitment.

The Intelligent Speed Adaptation (ISA) project we describe in this article is based on Pay as You Drive principles. These principles assume that the ISA equipment informs a driver of the speed limit, warns the driver when speeding and calculates penalty points. Each penalty point entails the reduction of a 30% discount on the driver's car insurance premium, which therefore produced the name, Pay as You Speed. The ISA equipment consists of a GPS-based On Board Unit with a mobile phone connection to a web server. The project was planned for a three-year test period with 300 young car drivers, but it never succeeded in recruiting that number of drivers. After several design changes, the project eventually went forward with 153 test drivers of all ages. This number represents approximately one thousandth of all car owners in the proving ground of North Jutland in Denmark. Furthermore the project was terminated before its scheduled closing date. This article describes the project with an emphasis on recruitment efforts and the project's progress. We include a discussion of possible explanations for the failure to recruit volunteers for the project and reflect upon the general barriers to using ISA with ordinary drivers.

Pay as You Speed, ISA with incentive for not speeding: results and interpretation of speed data.

To simulate a market introduction of Intelligent Speed Adaptation (ISA) and to study the effect of a Pay as You Speed (PAYS) concept, a field trial with 153 drivers was conducted during 2007-2009. The participants drove under PAYS conditions for a shorter or a longer period. The PAYS concept consisted of informative ISA linked with economic incentive for not speeding, measured through automatic count of penalty points whenever the speed limit was exceeded. The full incentive was set to 30% of a participant's insurance premium. The participants were exposed to different treatments, with and without incentive crossed with informative ISA present or absent. The results showed that ISA is an efficient tool for reducing speeding particularly on rural roads. The analysis of speed data demonstrated that the proportion of distance driven above the speed where the ISA equipment responded (PDA) was a sensitive measure for reflecting the effect of ISA, whereas mean free flow speed and the 85th percentile speed, were less sensitive to ISA effects. The PDA increased a little over time but still remained at a low level; however, when ISA was turned off, the participants' speeding relapsed to the baseline level. Both informative ISA and incentive ISA reduced the PDA, but there was no statistically significant interaction. Informative reduced it more than the incentive.

How much benefit does Intelligent Speed Adaptation deliver: an analysis of its potential contribution to safety and environment.

The UK Intelligent Speed Adaptation (ISA) project produced a rich database with high-resolution data on driver behaviour covering a comprehensive range of road environment. The field trials provided vital information on driver behaviour in the presence of ISA. The purpose of this paper is to exploit the information gathered in the field trials to predict the impacts of various forms of ISA and to assess whether ISA is viable in terms of benefit-to-cost ratio. ISA is predicted to save up to 33% of accidents on urban roads, and to reduce CO(2) emissions by up to 5.8% on 70 mph roads. In order to investigate the long-term impacts of ISA, two hypothetical deployment scenarios were envisaged covering a 60-year appraisal period. The results indicate that ISA could deliver a very healthy benefit-to-cost ratio, ranging from 3.4 to 7.4, depending on the deployment scenarios. Under both deployment scenarios, ISA has recovered its implementation costs in less than 15 years. It can be concluded that implementation of ISA is clearly justified from a social cost and benefit perspective. Of the two deployment scenarios, the Market Driven one is substantially outperformed by the Authority Driven one. The benefits of ISA on fuel saving and emission reduction are real but not substantial, in comparison with the benefits on accident reduction; up to 98% of benefits are attributable to accident savings. Indeed, ISA is predicted to lead to a savings of 30% in fatal crashes and 25% in serious crashes over the 60-year period modelled.

Deal or no deal: can incentives encourage widespread adoption of intelligent speed adaptation devices?

Given the burden of injury, economic, environmental and social consequences associated with speeding, reducing road traffic speed remains a major priority. Intelligent speed adaptation (ISA) is a promising but controversial new in-vehicle system that provides drivers with support on the speed-control task. In order to model potential system uptake, this paper explores drivers' preferences for two different types of ISA given a number of alternative fiscal incentives and non-fiscal measures, using a stated preference approach. As would be expected with such a contentious issue, the analysis revealed the presence of significant variations in sensitivities and preferences in the sample. While a non-negligible part of the sample population has such strong opposition to ISA that no reasonable discounts or incentives would lead to them buying or accepting such a system, there is also a large part of the population that, if given the right incentives, would be willing or even keen to equip their vehicle with an ISA device.

Evaluation of New Zealand's bicycle helmet law.

The New Zealand helmet law (all ages) came into effect on 1 January 1994. It followed Australian helmet laws, introduced in 1990-1992. Pre-law (in 1990) cyclist deaths were nearly a quarter of pedestrians in number, but in 2006-09, the equivalent figure was near to 50% when adjusted for changes to hours cycled and walked. From 1988-91 to 2003-07, cyclists' overall injury rate per hour increased by 20%. Dr Hillman, from the UK's Policy Studies Institute, calculated that life years gained by cycling outweighed life years lost in accidents by 20 times. For the period 1989-1990 to 2006-2009, New Zealand survey data showed that average hours cycled per person reduced by 51%. This evaluation finds the helmet law has failed in aspects of promoting cycling, safety, health, accident compensation, environmental issues and civil liberties.

Speed cameras in an urban setting: a cost-benefit analysis.

BACKGROUND: To perform a cost-benefit analysis of the installation of speed cameras on the beltways of Barcelona. METHODS: The analysis was performed from the society perspective over a 2-year period using a controlled before-and-after study design. The net benefit was calculated using, as benefits, the willingness to pay for the estimated number of people who avoided injury as a consequence of the intervention, subtracting costs and savings. Sensitivity analyses were performed using the maximum and minimum estimated number of people who avoided injury, assuming that there was a minimum of one death avoided, using the maximum value of a statistical life, assigning all implementation costs to the first year and assuming there was no time lost due to speed reduction. RESULTS: Base case results showed a net benefit of €6.8 million. Sensitivity analyses suggested that net benefits could range from €5.6 to €23.1 million over 2 years. CONCLUSIONS: The use of speed cameras in urban areas has a favourable economic impact even when assessed using conservative assumptions.

Race and ethnic differences in a multicenter study of home safety with vouchers redeemable for free safety devices.

BACKGROUND: Most injuries to infants occur at home and are known to have a modifiable component. Additional information on safety behaviors, practices, and device ownership could inform prevention programs aimed at reducing injury-related race and ethnic disparities. METHODS: This study is a secondary data analysis of race and ethnic differences in home safety using data collected by the Connecticut, Ohio, Pennsylvania, Minnesota, and New York sites of the Injury Free Coalition for Kids. Study participants were English- and Spanish-speaking parents/guardians of infants aged 4 months to 6 months. All participants received a voucher redeemable for free safety devices and educational materials. RESULTS: Five hundred forty-two study participants were 37.8% black, 41.7% Hispanic, 10.5% white, and 10.0% other race. Whites more frequently owned/had safety devices including cabinet latches (chi2 =28.9, p < 0.0001), drawer latches (chi2 =21.4, p < 0.0001), bath thermometers (chi2 =22.5, p < 0.0001), electric outlet covers (chi2 =15.9, p = 0.0004), and poison control number (chi 2=93.8, p < 0.0001). Practice of unsafe behaviors, such as stomach sleep position, was higher in blacks (29.3%) than whites (15.8%) or Hispanics (17.7%) (chi2 =11.8, p < 0.0083). Overall, 62.1% redeemed vouchers, but this varied significantly by ethnicity: blacks (42.2%), non-Hispanic whites (64.6%), and Hispanics (76.3%) (chi2 = 48.5, p < 0.0001). CONCLUSIONS: Compared with whites, both blacks and Hispanics were less likely to own a variety of safety devices at baseline, but Hispanics were more likely than blacks to redeem vouchers. This one shot voucher program was effective at increasing device ownership, but was not sufficient alone to achieve population saturation of safety devices.

Validation of simulated assessment of teen driver speed management on rural roads.

More US teens die from traffic crashes than from any other cause, with speed and rural roads major contributing factors. This study aimed to validate a high-fidelity simulator to explore these risks in an injury-free environment. Twenty-one newly-licensed 16-year-old males completed simulated and on-the-road drives of the same rural roads. Average free speeds on three road segments showed no systematic differences across segments. The majority of teens exhibited speeds in the simulator within 10% of those on-the-road. These findings validate the simulator for further research on teen driver free speeds on rural roads. Further analyses are needed to validate other performance measures.

Safety considerations for live electrical measurements.

Test instruments available today, when combined with safe work practices, offer troubleshooters many enhancements that make the measurement environment and the measurements themselves much easier and safer than ever before.

Predicting the effect of various ISA penetration grades on pedestrian safety by simulation.

Intelligent speed adaption (ISA) is one type of vehicle-based intelligent transportation systems (ITS), which warns and regulates driving speed according to the speed limits of the roads. Early field studies showed that ISA could reduce general mean speed levels and their variances in different road environments. This paper studies the effects of various ISA penetration grades on pedestrian safety in a single lane road. A microscopic traffic simulation tool, TPMA, was further developed and used to implement different ISA penetration grades. Momentary spot speed and traffic flow data are first logged in the traffic simulation for later prediction of pedestrian safety. Then a hypothetical vehicle-pedestrian collision model is extended from early researches in order to estimate two safety indicators: probability of collision, and risk of death. Finally, Monte Carlo method is applied iteratively to compute those safety indices. The computational result shows that raising ISA penetration in traffic flow will reduce both the probability of mid-block collision between vehicle and pedestrian and the risk of death in the collision accidents. Furthermore, the decrease of the risk of death will be more prominent than that of the collision probability according to this method.