Nonconformities in real-world fatal crashes--electronic stability control and seat belt reminders.

OBJECTIVE: Many new safety systems are entering the market. Vision Zero is a safety strategy aiming at the elimination of fatalities and impairing injuries by the use of a holistic model for safe traffic to develop a safe system. The aim of this article is to analyze fatalities in modern cars with respect to the Vision Zero model with special respect to electronic stability control (ESC) systems and modern seat belt reminders (SBRs). The model is used to identify and understand cases where cars with ESC systems lost control and where occupants were unbelted in a seat with seat belt reminders under normal driving conditions. METHODS: The model for safe traffic was used to analyze in-depth studies of fatal crashes with respect to seat belt use and loss of control. Vehicles from 2003 and later in crashes from January 2004 to mid-2010 were analyzed. The data were analyzed case by case. Cars that were equipped with ESC systems and lost control and occupants not using the seat belt in a seat with a seat belt reminder were considered as nonconformities. A total of 138 fatal crashes involving 152 fatally injured occupants were analyzed. RESULTS: Cars with ESC systems had fewer loss-of-control-relevant cases than cars without ESC systems. Thirteen percent of the ESC-equipped vehicles had loss-of-control-relevant crashes and 36 percent of the cars without ESC systems had loss-of-control-relevant crashes. The analysis indicates that only one car of the 9 equipped with ESC that lost control did it on a road surface with relevant friction when driving within the speed restriction of the road. In seats with seat belt reminders that are in accordance with the European New Car Assessment Programme's (Euro NCAP) protocol, 93 percent of the occupants were using a seat belt. In seats without reminders this number was 74 percent. CONCLUSIONS: This study shows that ESC systems result in a very significant reduction in fatal crashes, especially under normal driving conditions. Under extreme driving conditions such as speeding or extremely low friction (snow or on the side of the road), ESC systems can fail in keeping the car under control. Seat belt reminders result in higher seat belt use rates but the level of unbelted occupants is higher than roadside studies have indicated. The holistic Vision Zero approach helped in the analysis by identifying nonconformities and putting these into the safe systems perspective.

A holistic approach for assessing traffic safety in the United Arab Emirates.

Traffic accident and fatality rates can be utilized as indicators of traffic safety, but cannot reflect the overall status of traffic safety in a country. This paper uses a holistic perspective approach to investigate traffic safety in the United Arab Emirates (UAE). Initially, 12 potential items were selected to investigate the issue of traffic safety in the country. The investigation included data collection and analyses from official police reports, survey among road-users and interview of traffic safety experts. Based on data analysis and interpretation, the main factors affecting traffic safety in the UAE along with their level of deficiency were identified. The study revealed that the main factors contributing to traffic safety in the UAE are driving behaviour, awareness, education and training, infrastructure, vehicle, law enforcement, coordination and quality of resources. Among these factors, a major deficiency was found in the "driving behaviour", a minor deficiency in "vehicle safety", and a moderate deficiency in the others. Based on the deficiency level of the factors recommendations were proposed to improve the status of traffic safety in the country.

A noncontiguous 2-level spinal injury in a young female driver due to a 3-point seat belt restraint.

OBJECTIVES: The purpose of this case is to describe noncontiguous fracture and dislocations of the thoracolumbosacral spine in a 23-year-old female driver with a 3-point seat belt restraint. CLINICAL FEATURES: A 23-year-old woman presented to us after a motor vehicle accident while driving with a 3-point seat belt restraint. She was neurologically intact except for loss of motor function in the distribution of the L5 nerve root in the right lower limb. Computed tomography and magnetic resonance imaging showed fracture and dislocation of T3 with considerable retrolisthesis and complete anterolisthesis of L5 over the sacrum. INTERVENTION AND OUTCOME: Both fractures were reduced and fixed with bone graft and instrumentation. She was discharged a month later without any further neurologic deterioration. CONCLUSIONS: To our knowledge, this case is the first report in the literature of a seat belt safety restraint causing 2 noncontiguous fracture dislocations of the spine. Although the consensus is that seat belts can prevent most spine injuries, this case shows that the seat belt can be a contributor to spine injury. It shows that the shoulder-lap restraint can act as 2 fulcrums at the upper and lower bands causing 2 separate fracture dislocations. A thorough radiologic evaluation of the spine with respect to the clinical findings is mandatory in seat belt-restrained road traffic accidents cases.

Oil workers and seat-belt wearing behaviour: the northern Alberta context.

OBJECTIVES: Seat-belt wearing rates in the North reflect workers in the oil industry, necessitating sociocultural descriptions on the issue. The objective of this study was to describe how the social context influences oil workers' views of risk and seat-belt wearing behaviour in northern Alberta. STUDY DESIGN: The study design was qualitative research. Focus groups were held with oil workers in three northern Alberta locations. METHODS: Forty-five oil industry workers participated in 3 focus groups held in a different northern Alberta location, each consisting of 15 participants. Focus group discourse was centred on a series of questions that were clustered around the following themes: (1) propensity to take risks; (2) work patterns and workplace routines; (3) driving history and patterns; (4) self-disclosed seat-belt wearing behaviour; and (5) social relationships. RESULTS: Northern oil workers believe that taking safety risks is an essential characteristic of who they are and where they work. Employers demand consecutive number of hours on the job and offer attractive incentives for working overtime that encourages risk-taking. Risk-taking also appears in driving where workers take numerous risks to get home after they have worked 12-hour shifts for 14 consecutive days. Most are situational seat-belt wearers, buckling up in inclement weather, at the presence of numerous logging trucks and the threat of drunk and/or fatigued drivers. Without prompting, northern oil workers consider fatigued driving as the most dangerous driving risk they experience in the north. Nearly every respondent has experienced fatigued driving after completing his last work shift in a 14-day rotation. CONCLUSIONS: Seat-belt wearing initiatives for oil workers during off-work driving should be led by the oil industries. For example, they could support and encourage the police to increase their enforcement, lobby the government for higher penalties, punish their workers who are caught not wearing seat belts and collaborate with local communities to develop programs that will increase awareness of seat-belt wearing. Because workers described fatigued driving as the key risk in the North, oil industries should become engaged in interventions, with seat-belt wearing as a vital component of fatigued driving.

The effect of seat belt use on the cervical electromyogram response to whiplash-type impacts.

OBJECTIVE: The objective of this study was to determine the effect of a standard 3-point lap-and-shoulder seat belt and car seat on the electromyogram (EMG) response of the cervical muscles to increasing low-velocity impacts in comparison with that of a rigid seat and 5-point restraint. METHODS: Seventeen healthy volunteers were subjected to rear, frontal, right and left lateral and bilateral anterolateral, and posterolateral impacts with an acceleration varying from 4.4 to 16.8 m/s(2) while in a car seat with lap-and-shoulder seat belt. RESULTS: For rear-end impacts, whether straight on, right posterolateral, or left posterolateral, all muscles generated 50% or less of the maximal voluntary contraction (MVC) EMG. In straight-on rear impacts, the sternocleidomastoid was symmetrically the most active; however, in posterolateral impacts, the sternocleidomastoid contralateral to impact direction was more active than its counterpart. For a right lateral impact, at the highest acceleration, the left splenius capitis generated 47% of its MVC and the left trapezius did 46% of its MVC. In a left lateral impact, the right splenius capitis generated 48% of its MVC and the right trapezius did 57% of its MVC. In a straight-on frontal impact, the left trapezius generated 35% of its MVC and the right trapezius did 48% of its MVC. In a left anterolateral impact, the right splenius generated 60% of its MVC and the right trapezius did 66% of its MVC. Similarly, in a right anterolateral impact, the contralateral splenius muscle increased its activity to 52% of its MVC and the left trapezius was at 52% of its MVC. CONCLUSIONS: Compared with previously reported impact studies with a rigid seat and 5-point harness, the use of a 3-point lap-and-shoulder seat belt with a standard car seat did not appear to adversely affect cervical muscle response. In very-low-velocity and low-velocity impact experiments, seat belt and seat type may not significantly alter cervical EMG and kinematics.

Awareness of correct use of a seatbelt among pregnant women and health professionals: a multicentric survey.

A questionnaire survey was conducted to determine if pregnant women and healthcare professionals were aware of the correct use of a seatbelt and if advice was given. A total of 154 pregnant women and 56 health professionals were included in the study. A total of 115 (74.6 %) pregnant women wore seatbelts as drivers; 51 (33.1%) women were concerned about wearing the seatbelt in pregnancy; eight (14.2 %) received advice from health professionals. Incorrect positioning of a seatbelt was indicated by 67 (43.5 %) pregnant women and nine (16 %) health professionals. The majority of the doctors and community midwives advised women on seatbelt use only if asked. This study shows that almost half of pregnant women are ignorant of the correct use of a seatbelt, which puts them at risk for injuries. Well-informed prenatal care providers should substantially influence the practice among pregnant women through education.

Imagery and associations of adolescents reflected in their behaviour.

In adolescent girls, by means of imagery and associations it was studied, which images and associations produce concepts expressing activities which, on the one hand, protect and promote health (exercises, use of seat belts, and condoms) and, on the other hand, represent a health risk (drinking beer and liquor, cigarette smoking, marijuana smoking and cocain use, and sexual intercourse) and how they influence the respondents' behaviour. Nursing school students were interviewed by means of a questionnaire published by the Oregon Research Institute, USA. The respondents gave a total number of 15,760 images for nine concepts. The associations for smoking cigarettes and cocain were evaluated only negatively although 35% respondents had smoked in the past six months. The associations for exercising were given mainly positive ratings and, in some cases, neutral ratings although the respondents mentioned low regular physical activities. Drinking liquor and the using of seat belts were evaluated positively, negatively and neutrally. Nearly three quarters of the respondents had consumed alcoholic drinks occasionally or frequently during the past six months. Drinking beer and smoking marijuana were associated with negative or neutral images. Sexual intercourse and condom use were prevailingly associated with positive images. Our results have shown that images and associations tend to contradict the adolescents' behaviour. However, the results can form a basis for a particular application in primary preventive programmes which should make use of and promote the development of desirable attitudes and behaviour.

Ergogenic supplements and health risk behaviors.

OBJECTIVE: Our goals were to determine the prevalence of ergogenic supplement use in a young healthy population and to examine the extent to which supplement use is associated with specific health risk behaviors. STUDY DESIGN: We performed a cross-sectional survey. POPULATION: Individuals entering military service for enlisted training were included. OUTCOMES MEASURED: We recorded previous use of any nutritional ergogenic supplements and self-reported health risk behaviors. RESULTS: Of 550 eligible participants, 499 completed the survey (91% response rate). Individuals who used ergogenic supplements were more likely to drink alcohol (adjusted odds ratio [AOR]=1.8; 95% confidence interval [CI], 1.1-3.1), more likely to drink heavily (AOR=2.4; 95% CI, 1.5-3.9), more likely to ride in a vehicle with someone who had been drinking (AOR=2.2; 95% CI, 1.3-3.6), more likely to drive after drinking (AOR=2.4; 95% CI, 1.3-4.4), and more likely to have been in a physical fight (AOR=1.9; 95% CI, 1.0-3.5), compared with those who had not used supplements. Men were more likely to use supplements than women (P <.001). There were no differences in patterns of supplement use according to age or body mass index. CONCLUSIONS: Our study indicates an association between individuals who use ergogenic nutritional supplements and specific health risk behaviors. This represents an important opportunity for preventive counseling.

Health Behaviors and Health Perception among medical and non-medical students

BACKGROUND: The interest of medicine was moved from disease treatment to disease prevention and health promotion. Especially, there has been marked increased interest in health promotion recently. Perception and health behaviors held or acquired during medical training can influence the acceptance and prevention strategies. This exploratory study surveyed medical and non-medical student to assess both preventive health behaviors and perception, to find relations of personal behaviors and corresponding perception. METHODS: This survey were conducted 140 medical students and 131 non-medical students in one big city. Data were obtained by self-reported questionnaire. Weschler survey was adapted to assess perception toward preventive behavior, and Fantastic lifestyle was adapt,ed to assess health behavior. RESULTS: Among the questionnaire of perception of preventive behavior, quitting cigarette smoking ranked highest frequency as very important in medical student. In non-medical student, use seat-belt is ranked highest frequency. Mean score of FANTASTIC lifestyle is 29.98 in medical student, 28.86 in non-medical. The result show significant relationship between st,udent-reported behavior and corresponding perception in 6 qestionnaire that is eat breakfast, moderate or no alcohol use, eliminate smoking, use seat belt, limit coffee, get seven hours sleep. CONCLUSIONS: In comparing medical and non-medical students, health perception and health behavior were no significant difference. Overall, the result indicated that the preponderance of respondents that is engaging in health behaviors are high in health perception.

Adolescent health-threatening and health-enhancing behaviors: a study of word association and imagery.

PURPOSE: To examine the ways in which perceived risks and benefits relate to health-threatening and health-enhancing behaviors by adolescents. METHOD: The study used a word association methodology to explore adolescents' thoughts and affective feelings associated with five health-threatening behaviors (e.g., drinking beer, smoking cigarettes) and three health-enhancing behaviors (e.g., exercising, using a seat belt). RESULTS: Each behavior elicited a mix of positive and negative associations. Health-threatening behaviors had many positive associations in common, such as having fun, social facilitation, and physiological arousal. Health-enhancing behaviors had much less commonality in their positive associations. Patterns of negative associations were not highly similar across behaviors. The content and affective tone of the associations were closely linked to participation in health-threatening behaviors and health-enhancing behaviors. Participants in an activity were far more likely than nonparticipants to associate that activity with positive outcomes, concepts, and affect and less likely to produce outcomes, concepts, and affect and less likely to produce negative associations. CONCLUSIONS: The word association methodology provides a useful technique for exploring adolescents' cognitions and affective reactions with regard to health-related behaviors. The data provided by this method have implications for prevention and intervention programs, as well as for future research.

Behavioral risk factors in an Amish community.

A representative sample of 400 Amish adults residing in Holmes County, Ohio, was interviewed about certain health risk characteristics and behaviors, using the Behavioral Risk Factor Survey (BRFS). For purposes of comparison, a representative sample of 773 non-Amish adults responded to the same survey by telephone interviews. In general, the Amish report lower rates of alcohol and tobacco consumption than their non-Amish counterparts. The Amish are less likely to salt their food and are more likely to take vitamin supplements, but do not differ from non-Amish in the consumption of "health foods." Amish men and women are less likely to be trying to lose weight than their non-Amish counterparts. Further, the Amish are less likely to engage in leisure-time physical activity or in exercise associated with attempts to lose weight or deal with hypertension. Amish women are less likely to use seat belts than non-Amish women, whereas men in both groups appear rather similar. Although some differences could be influenced by response biases, many are supported by less systematic observations of Old Order Amish societies. The patterns of health behavior reflect characteristics of Amish culture and may be responsible for certain favorable mortality rates among the Amish population.

Design, characteristics, and usefulness of state-based behavioral risk factor surveillance: 1981-87.

Since 1981, the Centers for Disease Control has collaborated with State health departments and the District of Columbia to conduct random digit-dialed telephone surveys of adults concerning their health practices and behaviors. This State-based surveillance system, which yields data needed in planning, initiating, and supporting health promotion and disease prevention programs, is described in this paper. Standard methods and questionnaires were used to assess the prevalence of personal health practices and behaviors related to the leading causes of death, including seatbelt use, high blood pressure control, physical activity, weight control, cigarette smoking, alcohol use, drinking and driving, and preventive health practices. Between 1981 and 1983, 29 States (includes the District of Columbia) conducted one-time telephone surveys. Beginning in 1984, most States began collecting data continuously throughout the year, completing approximately 100 interviews per month (range 50-250), with an average of 1,200 completed interviews per year (range 600-3,000). The raw data were weighted to the age, race, and sex distribution for each State from the 1980 census data. This weighting accounts for the underrepresentation of men, whites, and younger persons (18-24 years) in the telephone surveys and, for many health practices, provides prevalence estimates comparable with estimates obtained from household surveys. Nearly all (86 percent) of the States distributed selected survey results to other State agencies, local health departments, voluntary organizations, hospitals, universities, State legislators, and the press. The majority (60 percent) of States used information from the surveys to set State health objectives, prepare State health planning documents, and plan a variety of programs concerning antismoking, the prevention of chronic diseases, and health promotion. Further, nearly two-thirds (65 percent) used results to support legislation, primarily related to the use of tobacco and seatbelts. Most of the States (84 percent) reported that alternative sources for such data (prevalence of behavioral risk factors) were unavailable. Currently in 1988, over 40 State health departments are conducting telephone surveys as part of the Behavioral Risk Factor Surveillance System. This system has proved to be (a) flexible--it provides data on emerging public health problems, such as smokeless tobacco use and AIDS, (b) timely--it provides results within a few months after the data are collected, and (c) affordable--it operates at a fraction of the cost of comparable statewide in-person surveys. The system enables State public health agencies to continue to plan,initiate, and guide statewide health promotion and disease prevention programs and monitor their progress over time.

Promoting the use of seat belts. Wessex Positive Health Team.

A six-month study into the effect of a substantial programme of integrated health education promoting the use of seat belts showed no major change in the rates for occupants of front seats, which remained around 35%. Though there were increases of up to 5% in the rates for wearing seat belts immediately after the multimedia campaigns which achieved high penetration, only those among women drivers were sustained. Of the methods used to disseminate information, television had the greatest impact on the community, followed by press reports and radio broadcasts. It is concluded that health education alone is insufficient to increase significantly the use of car seat belts. Britain should follow its European partners and pass legislation requiring front seat occupants to wear belts. As the recent experience in Australia shows, the benefits will be considerable in terms of reducing mortality, morbidity, and consequential expenditure.