Structural Racism and Pedestrian Safety: Measuring the Association Between Historical Redlining and Contemporary Pedestrian Fatalities Across the United States, 2010‒2019.

Objectives. To examine the association between historical redlining and contemporary pedestrian fatalities across the United States. Methods. We analyzed 2010-2019 traffic fatality data, obtained from the Fatality Analysis Reporting System, for all US pedestrian fatalities linked by location of crash to 1930s Home Owners' Loan Corporation (HOLC) grades and current sociodemographic factors at the census tract level. We applied generalized estimating equation models to assess the relationship between the count of pedestrian fatalities and redlining. Results. In an adjusted multivariable analysis, tracts graded D ("Hazardous") had a 2.60 (95% confidence interval = 2.26, 2.99) incidence rate ratio (per residential population) of pedestrian fatalities compared with tracts graded A ("Best"). We found a significant dose‒response relationship: as grades worsened from A to D, rates of pedestrian fatalities increased. Conclusions. Historical redlining policy, initiated in the 1930s, has an impact on present-day transportation inequities in the United States. Public Health Implications. To reduce transportation inequities, understanding how structurally racist policies, past and present, have an impact on community-level investments in transportation and health is crucial. (Am J Public Health. 2023;113(4):420-428. https://doi.org/10.2105/AJPH.2022.307192).

Integrating complex systems science into road safety research and practice, part 1: review of formative concepts.

Many of our most persistent public health problems are complex problems. They arise from a web of factors that interact and change over time and may exhibit resistance to intervention efforts. The domain of systems science provides several tools to help injury prevention researchers and practitioners examine deep, complex and persistent problems and identify opportunities to intervene. Using the increase in pedestrian death rates as an example, we provide (1) an accessible overview of how complex systems science approaches can augment established injury prevention frameworks and (2) a straightforward example of how specific systems science tools can deepen understanding, with a goal of ultimately informing action.

Integrating complex systems science into road safety research and practice, Part 2: applying systems tools to the problem of increasing pedestrian death rates.

OBJECTIVES: To provide a specific example of how systems dynamics tools can increase understanding of stakeholder 'mental models' and generate robust systems-based hypotheses about the escalating problem of rising pedestrian death rates in the USA. METHODS: We designed and facilitated two group model building (GMB) workshops. Participants generated causal loop diagrams (CLDs) individually and in small groups to explore hypotheses concerning time-dynamic interacting factors underlying the increasing rates of pedestrian deaths. Using a grounded theory approach, research team members synthesised the structures and hypotheses into a single CLD. RESULTS: CLDs from the 41 participants indicated four core factors hypothesised to have a direct impact on pedestrian fatalities: pedestrian-vehicle crashes, vehicle speed at the time of the crash, vehicle size/dimensions and emergency response time. Participants diagrammed how actions and reactions impacted these proximal factors over time and led to ripple effects throughout a larger system to generate an increase in pedestrian deaths. Hypothesised contributing mechanisms fell within the following broad categories: community responses; research, policy and industry influence; potential unintended consequences of responses to pedestrian deaths; and the role of sprawl. CONCLUSIONS: This application of systems science tools suggested several strategies for advancing injury prevention research and practice. The project generated robust hypotheses and advanced stakeholder communication and depth of understanding and engagement in this key issue. The CLD and GMB process detailed in this study provides a concrete example of how systems tools can be adopted and applied to a transportation safety topic.

Systems thinking in the context of road safety: Can systems tools help us realize a true "Safe Systems" approach?

PURPOSE OF REVIEW: Road traffic injuries are one of the leading causes of death in the U.S. and globally. We introduce the Safe Systems approach as a promising paradigm for road safety practice and describe how systems thinking tools can help bridge the gap between the current status quo and a Safe Systems approach. RECENT FINDINGS: Systems thinking tools can help us align with a Safe Systems approach by identifying latent risks in the transportation system, examining factors that coalesce to produce high travel speeds and kinetic energy transfer, and supporting safety prioritization through goal alignment. SUMMARY: The Safe Systems approach represents a significant change in the way we have historically designed transportation systems; it puts safety at the forefront and calls for designing a system that accounts for human fallibility. Operationalizing holistic Safe Systems concepts may be difficult, but systems thinking tools can help. Systems thinking tools provide a common language for individuals from diverse disciplines and sectors to express their unique understanding of the interconnected factors shaping road safety problems and support discussions about potential solutions that align with a Safe Systems approach.

Selected characteristics and injury patterns by age group among pedestrians treated in North Carolina emergency departments.

OBJECTIVE: The objective of this study was to describe pedestrian demographic characteristics, crash characteristics, selected health outcomes, and injury patterns by age using linked North Carolina (NC) crash-emergency department (ED) visit data for the period October 1, 2010, to September 30, 2015. METHODS: This was a descriptive epidemiologic study. To examine both crash and health outcomes, NC pedestrian crash records were linked to statewide NC ED visit records using hierarchical deterministic methods. Pearson chi-square tests were used to compare the frequencies of pedestrians treated in NC EDs by sex, race/ethnicity, crash location, rurality, estimated driver speed at impact, ambient light, hospitalization/death, location of injury, and nature of injury, stratified by the following age groups: 0-14, 15-24, 25-64, and ≥65 years. RESULTS: Most pedestrians treated in NC EDs were male (57.5%), except among adults ≥65 years old (47.5%). Over half of all injured pedestrians aged 0-14 (52.6%) and 15-24 (50.5%) years were Black/African American, and 70.8% of injured pedestrians ≥65 years were white. Among pedestrians aged 25-64 years, no single racial/ethnic group was the majority. Though most pedestrians were injured on trafficways (71.7%) and at speeds ≤35 mph (80.1%), adults ≥65 years were less likely to be involved in on-trafficway crashes (51.0%) and pedestrians aged 15-24 years were more likely to be involved in >35 mph crashes (22.9%) compared to other age groups. Most pedestrians were injured under daylight conditions (56.9%). Regarding selected health outcomes, the highest frequency of hospitalization/death was for pedestrians aged ≥65 years (26.3%), compared to those aged 0-14 years (18.8%) and 15-64 years (12.4%). In terms of location of injury, 0- to 14-year-olds had the highest proportion of head injuries (39.5%), and adults ≥65 years of age had the highest proportion of spinal column/vertebral column (12.6%) and upper extremity injuries (33.2%). For nature of injury, 0- to 14-year-olds had the highest proportion of traumatic brain injuries (11.4%) and superficial wounds and contusions (62.8%). Adults aged ≥65 years had the highest proportion of open wounds/amputations and fractures (16.1%). Adults aged 25-64 years had the highest proportion of strains/sprains/dislocations (18.7%). CONCLUSIONS: There were considerable differences in demographic characteristics, crash characteristics, frequency of hospitalization/death, and injury patterns by age group. It is important to design streets and implement transportation policies and programs that improve safety for all pedestrians.

Automated Vehicles and Pedestrian Safety: Exploring the Promise and Limits of Pedestrian Detection.

INTRODUCTION: U.S. pedestrian fatalities have risen recently, even as vehicles are equipped with increasingly sophisticated safety and crash avoidance technology. Many experts expect that advances in automated vehicle technology will reduce pedestrian fatalities substantially through eliminating crashes caused by human error. This paper investigates automated vehicles' potential for reducing pedestrian fatalities by analyzing nearly 5,000 pedestrian fatalities recorded in 2015 in the Fatality Analysis Reporting System, virtually reconstructing them under a hypothetical scenario that replaces involved vehicles with automated versions equipped with state-of-the-art (as of December 2017) sensor technology. METHODS: This research involved the following activities: (1) establish functional ranges of state-of-the-art pedestrian sensor technologies, (2) use data from the Fatality Analysis Reporting System to identify pedestrian fatalities recorded in each state in the U.S. and District of Columbia in 2015, and (3) assess the maximum numbers of pedestrian fatalities that could have been avoided had involved vehicles been replaced with autonomous versions equipped with the described sensors. The research was conducted from July to December 2017. RESULTS: Sensors' abilities to detect pedestrians in advance of fatal collisions vary from <30% to >90% of fatalities. Combining sensor technologies offers the greatest potential for eliminating fatalities, but may be unrealistically expensive. Furthermore, whereas initial deployment of automated vehicles will likely be restricted to freeways and select urban areas, non-freeway streets and rural settings account for a substantial share of pedestrian fatalities. CONCLUSIONS: Although technologies are being developed for automated vehicles to successfully detect pedestrians in advance of most fatal collisions, the current costs and operating conditions of those technologies substantially decrease the potential for automated vehicles to radically reduce pedestrian fatalities in the short term.

Effect of a community-based pedestrian injury prevention program on driver yielding behavior at marked crosswalks.

BACKGROUND: Few studies have comprehensively evaluated the effectiveness of multi-faceted interventions intended to improve pedestrian safety. "Watch for Me NC" is a multi-faceted, community-based pedestrian safety program that includes widespread media and public engagement in combination with enhanced law enforcement activities (i.e., police outreach and targeted pedestrian safety operations conducted at marked crosswalks) and low-cost engineering improvements at selected crossings. The purpose of this study was to estimate the effect of the law enforcement and engineering improvement components of the program on motor vehicle driver behavior, specifically in terms of increased driver yielding to pedestrians in marked crosswalks. METHODS: The study used a pre-post design with a control group, comparing crossing locations receiving enforcement and low-cost engineering treatments (enhanced locations) with locations that did not (standard locations) to examine changes in driver yielding over a 6-month period from 2013 to 2014. A total of 24,941 drivers were observed in 11,817 attempted crossing events at 16 crosswalks in five municipalities that were participating in the program. Observations of real pedestrians attempting to use the crosswalks ("naturalistic" crossing) were supplemented by observations of trained research staff attempting the same crossings following an established protocol ("staged" crossings). Generalized estimating equations (GEE) were used to model driver yielding rates, accounting for repeated observations at the crossing locations and controlling other factors that affect driver behavior in yielding to pedestrians in marked crosswalks. RESULTS: At crossings that did not receive enhancements (targeted police operations or low-cost engineering improvements), driver yielding rates did not change from before to after the Watch for Me NC program. However, yielding rates improved significantly (between 4 and 7 percentage points on average) at the enhanced locations. This was true for both naturalistic and staged crossings. CONCLUSIONS: This study provides evidence that enhanced enforcement and low-cost engineering improvements, as a part of a broader program involving community-based outreach, can increase driver yielding to pedestrians in marked crosswalks. These data are important for the staff and decision-makers involved in pedestrian safety programs to gain a better understanding of the different engineering and behavioral mechanisms that could be used to improve driver yielding rates.