Crash risk factors for novice motorcycle riders.

BACKGROUND: Motorcycle riders have the highest injury and fatality rates among all road users. This research sought in-depth understanding of crash risk factors to help in developing targeted measures to reduce motorcycle crash injuries and fatalities. METHODS: We used interview data from a study of 2,399 novice motorcycle riders in Victoria, Australia from 2010 to 2012 linked with their police-recorded crash and offence data. The outcome measure was self and/or police reported crash. The association between potential risk factors and crashes was explored in multivariable logistic regression models. RESULTS: In the multivariable analysis, riders who reported being involved in three or more near crashes had 1.74 times (95% CI 1.11-2.74) higher odds of crashing compared to riders who reported no near-crash events, and riders who participated in a pre-learner course had 1.41 times higher odds of crashing (95% CI 1.07-1.87) compared with riders who did not attend a pre-learner course. Riders who had been involved in a crash before the study had 1.58 times (95% CI 1.14-2.19) higher odds of crashing during the study period compared with riders who were not involved in a crash. Each additional month of having held a license and learner permit decreased the odds of crashing by 2%, and each additional 1,000 km of riding before the study increased the odds of crashing by 2%. CONCLUSION: Measures of pre-learner training and riding experience were the strongest predictors of crashing in this cohort of novice motorcycle riders. At the time of the study there was no compulsory rider training to obtain a learner permit in Victoria and no on-road courses were available. It may be plausible that riders who voluntarily participated in an unregulated pre-learner course became or remained at high risk of crash after obtaining a rider license. We suggest systematically reviewing the safety benefits of voluntary versus mandatory pre-learner and learner courses and the potential need to include on-road components.

Randomized controlled trial of an early intervention programme for adolescent anxiety disorders.

OBJECTIVE: To assess the effectiveness of an indicated early intervention and prevention programme for anxiety disorders when conducted by school staff. METHOD: A total of 260 students in their first year of high school with self-reported anxiety symptoms >1 SD above the mean score of a normative sample were randomly allocated on the basis of their school to an intervention condition led by school staff or to a monitoring condition. RESULTS: There was little difference between conditions at the 2 year and 4 year follow up on self-reported symptoms, and no difference on diagnosis or health-care use. CONCLUSIONS: Outcomes associated with indicated prevention programmes led by school staff may not be as strong as those produced by specialist mental health staff. More work is needed to delineate models by which evidence-based treatments can be effectively used in schools.

Universal Motorcycle Helmet Laws to Reduce Injuries: A Community Guide Systematic Review.

CONTEXT: Motorcycle crashes account for a disproportionate number of motor vehicle deaths and injuries in the U.S. Motorcycle helmet use can lead to an estimated 42% reduction in risk for fatal injuries and a 69% reduction in risk for head injuries. However, helmet use in the U.S. has been declining and was at 60% in 2013. The current review examines the effectiveness of motorcycle helmet laws in increasing helmet use and reducing motorcycle-related deaths and injuries. EVIDENCE ACQUISITION: Databases relevant to health or transportation were searched from database inception to August 2012. Reference lists of reviews, reports, and gray literature were also searched. Analysis of the data was completed in 2014. EVIDENCE SYNTHESIS: A total of 60 U.S. studies qualified for inclusion in the review. Implementing universal helmet laws increased helmet use (median, 47 percentage points); reduced total deaths (median, -32%) and deaths per registered motorcycle (median, -29%); and reduced total injuries (median, -32%) and injuries per registered motorcycle (median, -24%). Repealing universal helmet laws decreased helmet use (median, -39 percentage points); increased total deaths (median, 42%) and deaths per registered motorcycle (median, 24%); and increased total injuries (median, 41%) and injuries per registered motorcycle (median, 8%). CONCLUSIONS: Universal helmet laws are effective in increasing motorcycle helmet use and reducing deaths and injuries. These laws are effective for motorcyclists of all ages, including younger operators and passengers who would have already been covered by partial helmet laws. Repealing universal helmet laws decreased helmet use and increased deaths and injuries.

Does an on-road motorcycle coaching program reduce crashes in novice riders? A randomised control trial.

OBJECTIVES: Motorcycle riding is increasing globally and confers a high risk of crash-related injury and death. There is community demand for investment in rider training programs but no high-quality evidence about its effectiveness in preventing crashes. This randomised trial of an on-road rider coaching program aimed to determine its effectiveness in reducing crashes in novice motorcycle riders. METHODS: Between May 2010 and October 2012, 2399 newly-licensed provisional riders were recruited in Victoria, Australia and completed a telephone interview before randomisation to intervention or control groups. Riders in the intervention group were offered an on-road motorcycle rider coaching program which involved pre-program activities, 4h riding and facilitated discussion in small groups with a riding coach. Outcome measures were collected for all participants via telephone interviews at 3 and 12 months after program delivery (or equivalent for controls), and via linkage to police-recorded crash and offence data. The primary outcome was a composite measure of police-recorded and self-reported crashes; secondary outcomes included traffic offences, near crashes, riding exposure, and riding behaviours and motivations. RESULTS: Follow-up was 89% at 3 months and 88% at 12 months; 60% of the intervention group completed the program. Intention-to-treat analyses conducted in 2014 indicated no effect on crash risk at 3 months (adjusted OR 0.90, 95% CI: 0.65-1.27) or 12 months (adjusted OR 1.00, 95% CI: 0.78-1.29). Riders in the intervention group reported increased riding exposure, speeding behaviours and rider confidence. CONCLUSIONS: There was no evidence that this on-road motorcycle rider coaching program reduced the risk of crash, and we found an increase in crash-related risk factors.

Perceived value of a motorcycle training program: the influence of crash history and experience of the training.

OBJECTIVE: Evidence that rider training reduces motorcycle-related injuries or crashes is currently lacking. However, significant community demand for training persists, which in turn can influence policy. The present study aims to contribute to the understanding of this demand via two objectives: to (1) offer a method, namely, contingent valuation, to measure the value motorcyclists place on training and (2) examine determinants of such value. METHODS: Value was elicited through a willingness to question, using a bidding format, novice motorcyclists who were randomly assigned to groups either offered the training or not. RESULTS: The group that was offered and subsequently received training provided a lower mean perceived value of the training than the group that was not. Perceived value increased with rider age and decreased with training participation and near-crash experiences, controlling for bidding order, income, education, and experience of other training. CONCLUSION: This study demonstrates the utility of contingent valuation in quantifying the perceived value of training, as well as the modifiability of perceived value, with age, training participation, and near-crash experiences as key determinants. This indicates that research to determine ways to align the perceived value with evidence on training effectiveness is worthwhile in order to facilitate more appropriate and justified allocation of road safety resources. Potential options to explore and evaluate may include community education on evidence of training effectiveness as well as alternative measures with demonstrated effectiveness in reducing crash risks.

The use of self-report exposure measures among novice motorcyclists: appropriateness and best practice recommendations.

OBJECTIVES: While self-report methods to collect exposure information have large practical advantages in many research contexts, little research has specifically investigated the reliability and validity of motorcyclists' self-reported exposure. The present study aimed to examine the reliability and validity of different self-report exposure measures and to provide recommendations on best practice self-report riding exposure questions. METHODS: The reliability and validity of different self-report exposure measures were examined amongst novice motorcyclists through t-tests, Bland Altman plots, coefficients of variation, and correlations. RESULTS: The most valid and reliable data was provided when riding exposure was asked for the current average week rather than earlier and longer periods, and in units of time rather than distance or number of trips. The greater reliability of riding exposure found amongst commuting and rural riders compared to recreational and metropolitan riders respectively and at the second interview compared to the first suggests that factors such as riding purposes, geographical locations, and riding experience can contribute to measurement error. CONCLUSIONS: If self-reported odometer readings are used, questions on whether the respondents share their own bike or ride more than one bike, and a built-in process to ensure respondents report the exact odometer reading on their bike are recommended. It is recommended that self-report riding exposure questions ask about the hours of riding for the current average week, and data on riding purposes, locations, and experience are also collected.

Empirical investigation of two assumptions in the diagnosis of DSM-IV major depressive episode.

OBJECTIVE: The aim of the current study was to examine two major assumptions behind the DSM-IV diagnosis of major depressive episode (MDE): that depression represents a distinct category defined by a valid symptom threshold, and that each depressive symptom contributes equally to the diagnosis. METHODS: Data were from the Australian National Survey of Mental Health and Wellbeing. Participants consisted of a random population-based sample of 10 641 community volunteers, representing a response rate of 78%. DSM-IV diagnoses of MDE and other mental disorders were obtained using the Composite International Diagnostic Interview, version 2.0. Analyses were carried out on the subsample of respondents who endorsed either depressed mood or loss of interest (n =2137). Multivariate linear regression analyses examined the relationship between the number and type of symptoms and four independent measures of impairment. RESULTS: The relationship between the number of depressive symptoms and the four measures of impairment was purely linear. Three individual symptoms (sleep problems, energy loss, and psychomotor disturbance) were all independent predictors of three of the four measures of impairment. CONCLUSIONS: Counting symptoms alone is limited in guiding a clear diagnostic threshold. The differential impact of individual symptoms on impairment suggests that impairment levels may be more accurately estimated by weighting the particular symptoms endorsed.

Mental disorders in Australian prisoners: a comparison with a community sample.

BACKGROUND: The plight of those with mental health problems and the possible role of prisons in "warehousing" these individuals has received considerable media and political attention. Prisoners are generally excluded from community-based surveys and to date no studies have compared prisoners to the community. OBJECTIVE: The objective was to examine whether excess psychiatric morbidity exists in prisoners compared to the general community after adjusting for demographics. METHOD: Prison data were obtained from a consecutive sample of reception prisoners admitted into the state's correctional system in 2001 (n = 916). Community data were obtained from the 1997 Australian National Survey of Mental Health and Wellbeing (n = 8168). Mental health diagnoses were obtained using the Composite International Diagnostic Interview and a number of other screening measures. Weighting was used in calculating the 12-month prevalence estimates to control for demographic differences between the two samples. Logistic regression adjusting for age, sex and education was used to compare the prison and community samples. RESULTS: The 12-month prevalence of any psychiatric illness in the last year was 80% in prisoners and 31% in the community. Substantially more psychiatric morbidity was detected among prisoners than in the community group after accounting for demographic differences, particularly symptoms of psychosis (OR = 11.8, 95% CI 7.5-18.7), substance use disorders (OR = 11.4, 95% CI 9.7-13.6) and personality disorders (OR = 8.6, 95% CI 7.2-10.3). Mental functioning and disability score were worse for prisoners than the community except for physical health. CONCLUSIONS: This study found an overrepresentation of psychiatric morbidity in the prisoner population. Identifying the causes of this excess requires further investigation.