Risk and Protective Factors for Injury in Adult Front- and Rear-Seated Motor Vehicle Occupants in New York State.

Although seatbelt use is known to reduce motor vehicle occupant crash injury and death, rear-seated adult occupants are less likely to use restraints. This study examines risk and protective factors associated with injury severity in front- and rear-seated adults involved in a motor vehicle crash in New York State. The Crash Outcome Data Evaluation System (CODES) (2016-2017) was used to examine injury severity in front- and rear-seated occupants aged 18 years or older (N = 958,704) involved in a motor vehicle crash. CODES uses probabilistic linkage of New York State hospitalization, emergency department, and police and motorist crash reports. Multivariable logistic regression models with MI analyze employed SAS 9.4. Odds ratios are reported as OR with 95% CI. The mortality rate was approximately 1.5 times higher for rear-seated than front-seated occupants (136.60 vs. 92.45 per 100,000), with rear-seated occupants more frequently unrestrained than front-seated occupants (15.28% vs. 1.70%, p < 0.0001). In adjusted analyses that did not include restraint status, serious injury/death was higher in rear-seated compared to front-seated occupants (OR:1.272, 1.146-1.412), but lower once restraint use was added (OR: 0.851, 0.771-0.939). Unrestrained rear-seated occupants exhibited higher serious injury/death than restrained front-seated occupants. Unrestrained teens aged 18-19 years old exhibit mortality per 100,000 occupants that is more similar to that of the oldest two age groups than to other young and middle-aged adults. Speeding, a drinking driver, and older vehicles were among the independent predictors of serious injury/death. Unrestrained rear-seated adult occupants exhibit higher severe injury/death than restrained front-seated occupants. When restrained, rear-seated occupants are less likely to be seriously injured than restrained front-seated occupants.

Fatal Motor Vehicle Crashes in Upstate and Long Island New York: The Impact of High Visibility Seat Belt Enforcement on Multiple Risky Driving Behaviors.

Despite an observed daytime front-seat seat belt use that exceeds 90%, nearly half of motor vehicle occupants who die in New York State (NYS) each year are not wearing a seat belt. Crash outcomes were examined by occupant, vehicle, environmental and traffic enforcement patterns related to the annual Click It or Ticket high visibility seat belt enforcement campaign. Three periods of enforcement were examined: pre-enforcement, peri-enforcement (during/immediately after), and post-enforcement. Of the 14.4 million traffic citations, 713,990 (5.0%) were seat belt violations. Relative risk with 95% CI was assessed using deaths from the Fatality Analysis Reporting System (FARS) and SAS Glimmix 9.4 software. Mortality was lower peri-enforcement (32.9%) compared to pre- (40.9%) or post-enforcement (37.1%) (p < 0.001) and tended to be elevated in low enforcement response areas (43.6%). Fatalities were 30% lower (0.7, 95% CI 0.6−0.9) during peri-enforcement in models adjusted for demographics, law coverage, enforcement response, rural, weekend, impairment, speeding, and vehicle type. Adjusted mortality was higher in rural (1.9, 1.6−2.6), alcohol-involved (1.8, 1.4−2.9), and speeding-involved (2.0, 1.7−2.5) crashes. Peri-enforcement alcohol- and speed-involved fatalities tended to be lower in restrained, unrestrained and occupants missing belt status. The finding of lower mortality in both belted and unbelted occupant's peri-enforcement­in the context of fewer fatal speed and alcohol-involved crashes­suggests that the mechanism(s) through which high visibility seat belt enforcement lowers mortality is through impacting multiple risky driving behaviors.

Motor Vehicle Crash and Hospital Charges in Front- and Rear-Seated Restrained and Unrestrained Adult Motor Vehicle Occupants.

There are reports that historically higher mortality observed for front- compared to rear-seated adult motor vehicle (MV) occupants has narrowed. Vast improvements have been made in strengthening laws and restraint use in front-, but not rear-seated occupants suggesting there may be value in expanding the science on rear-seat safety. METHODS: A linked 2016-2017 hospital and MV crash data set, the Crash Outcomes Data Evaluation System (CODES), was used to compare characteristics of front-seated (n = 115,939) and rear-seated (n = 5729) adults aged 18 years and older involved in a MV crash in New York State (NYS). A primary enforced seat belt law existed for front-seated, but not rear-seated occupants. Statistical analysis employed SAS 9.4. RESULTS: Compared to front-seated occupants, those rear-seated were more likely to be unrestrained (21.2% vs. 4.3%, p < 0.0001) and to have more moderate-to-severe injury/death (11.9% vs. 11.3%, p < 0.0001). Compared to restrained rear-seated occupants, unrestrained rear-seated occupants had higher moderate-to-severe injury/death (21.5% vs. 7.5%, p < 0.0001) and 4-fold higher hospitalization. More than 95% of ejections were unrestrained and had 7-fold higher medical charges. Unrestrained occupants' hospital stays were longer, charges and societal financial costs higher. CONCLUSIONS: These findings extend the science of rear-seat safety in seriously injured rear-seated occupants, document increased medical charges and support the need to educate consumers and policy makers on the health and financial risks of adults riding unrestrained in the rear seat. The lack of restraint use in adult rear-seated motor vehicle occupants consumes scarce health care dollars for treatment of this serious, but largely preventable injury.

Using Crash Outcome Data Evaluation System (CODES) to examine injury in front vs. rear-seated infants and children involved in a motor vehicle crash in New York State.

BACKGROUND: In New York State (NYS), motor vehicle (MV) injury to child passengers is a leading cause of hospitalization and emergency department (ED) visits in children aged 0-12 years. NYS laws require appropriate child restraints for ages 0-7 years and safety belts for ages 8 and up while traveling in a private passenger vehicle, but do not specify a seating position. METHODS: Factors associated with injury in front-seated (n = 11,212) compared to rear-seated (n = 93,092) passengers aged 0-12 years were examined by age groups 0-3, 4-7 and 8-12 years using the 2012-2014 NYS Crash Outcome Data Evaluation System (CODES). CODES consists of Department of Motor Vehicle (DMV) crash reports linked to ED visits and hospitalizations. The front seat was row 1 and the rear rows 2-3. Vehicle towed from scene and air bag deployed were proxies for crash severity. Injury was dichotomized based on Maximum Abbreviated Injury Severity (MAIS) scores greater than zero. Multivariable logistic regression (odds ratios (OR) with 95% CI) was used to examine factors predictive of injury for the total population and for each age group. RESULTS: Front-seated children had more frequent injury than those rear-seated (8.46% vs. 4.92%, p < 0.0001). Children in child restraints experienced fewer medically-treated injuries compared to seat belted or unrestrained children (3.80, 6.50 and 13.62%, p < 0.0001 respectively). A higher proportion of children traveling with an unrestrained vs. restrained driver experienced injury (14.50% vs 5.26%, p < 0.0001). After controlling for crash severity, multivariable adjusted predictors of injury for children aged 0-12 years included riding in the front seat (1.20, 1.10-1.31), being unrestrained vs. child restraint (2.13, 1.73-2.62), being restrained in a seat belt vs. child restraint (1.20, 1.11-1.31), and traveling in a car vs. other vehicle type (1.21, 1.14-1.28). Similarly, protective factors included traveling with a restrained driver (0.61, 0.50-0.75), a driver aged < 25 years (0.91, 0.82-0.99), being an occupant of a later vehicle model year 2005-2008 (0.68, 0.53-0.89) or 2009-2015 (0.55, 0.42-0.71) compared to older model years (1970-1993). CONCLUSIONS: Compared to front-seated children, rear-seated children and children in age-appropriate restraints had lower adjusted odds of medically-treated injury.

Marijuana use in U.S. teen drivers: a comparison of a road-side survey of reported use and fluid tests for tetrahydrocannabinol (THC).

BACKGROUND: Although the growth of state-level legalization of marijuana is aimed at increasing availability for adults and the chronically ill, one fear is that this trend may also increase accessibility in younger populations. The objectives of this study are to evaluate marijuana use in teen driver study participants and to compare their survey self-reported use with oral fluid and blood tests for psychoactive metabolites of tetrahydrocannabinol (THC). METHODS: The National Roadside Survey (NRS) of 2013-2014 was used to examine marijuana use in drivers aged 16-19 years. Of 11,100 drivers surveyed at 300 U.S. locations in 24 states, 718 were 16-19 years, and 666 (92.8%) provided oral fluid and/or blood. We examined weighted and unweighted data, but present unweighted findings. Kappa statistics, Chi square, and multivariable logistic regressions were used to assess agreement, associations and independent predictors of outcomes. RESULTS: More than one-quarter (203/718) of teen drivers reported either using marijuana in the last year or were THC positive. Overall incidence of a THC positive fluid test was 13.7%. In addition to 175 (27.3%) teen drivers who reported use in the last year, 28 (4.4%) who denied using in the past year, tested positive for THC. Of 45 teen drivers reporting use in the last 24 h, more than two-thirds (71.1%) were THC positive. Disagreement between the oral and blood test for 305 teen drivers who had both tests was 17 (5.6%), with a Kappa of 0.78 (95% CI 0.69-0.88). Of THC-positive drivers, nearly 20% started drinking alcohol by age 14 and more than 70% by age 16. Age, gender- and income-adjusted independent predictors of a positive THC test included survey completion during the school year (OR 3.2, 95% CI 1.6-6.2), survey-reported marijuana use in last year (OR 5.3, 95% CI 3.0-9.2), current smoker (OR 2.1, 95% CI 1.1-3.7), and alcohol consumption before age 16 (OR 2.3, 95% CI 1.1-3.7). CONCLUSIONS: Although specific THC thresholds for safe driving have not been established, taken in the context of teen crash statistics, THC documented impairments and rapidly relaxing marijuana laws, these findings suggest the need for increased vigilance and stepped-up surveillance in teen drivers.

Restraint use and injury in forward and rear-facing infants and toddlers involved in a fatal motor vehicle crash on a U. S. Roadway.

BACKGROUND: Use of appropriate child passenger safety restraints reduces injury in infants, with rear facing restraints favored over forward facing. In 2011, the American Academy of Pediatrics (AAP) began recommending that infants and children under the age of 2 years be restrained in a rear-facing seat installed in the vehicle's rear seat. This study examines the practice of rear-facing restraints pre- and post-AAP recommendations for children under 2 years. METHODS: Data from the Fatality Analysis Reporting System (FARS) from 2008 to 2015 were used to examine restraint status and injuries in rear-seated infants and toddlers aged 0 to less than 2 years involved in fatal collisions (n = 4966). Subpopulation analyses were conducted on 1557 children with seat facing direction recorded. Multivariable logistic regression was used to generate odds ratios (OR) with 95% confidence intervals (CI). Covariates considered for inclusion in the multivariable model included passenger characteristics (age, gender, seating position), driver characteristics (age, gender, seat belt status, alcohol status, drug status, previous traffic violations), vehicle characteristics (vehicle type), and crash-level characteristics (day/night, weekday/weekend, rush hour, expressway/surface street, urban/rural). RESULTS: Approximately 6.7% (330 of 4996) of infants and toddlers were unrestrained with mortality that was approximately triple that of restrained infants (40.0% vs 13.7%, P < 0.0001). In multivariable adjusted models, predictors of an infant being unrestrained included unrestrained driver (OR: 3.17, 95% CI: 2.38-4.21), driver aged less than 20 years (OR: 2.18, 95% CI: 1.42-3.34), driver alcohol use (OR: 2.21, 95% CI: 1.42-3.44), center-seated infant (OR: 1.55, 95% CI: 1.19-2.03) and weekday crash (OR: 1.52, 95% CI: 1.12-2.01). Of all rear-seated children whose restraint status were reported (4966), rear-facing restraint use increased from 5.0% to 23.2% between 2008 and 2015 (P < 0.0001). The odds of rear-facing restraint use increased after introduction of the AAP guideline among infants aged 0 to < 1 year old (OR: 2.12, 95% CI: 1.46-3.10) and among toddlers aged 1 to < 2 years old (OR: 1.97, 95% CI: 1.03-3.79). CONCLUSION: Trends in the use of rear-facing child restraints improved over the timeframe of this study, but remain low despite the introduction of AAP guidelines and the strengthening of child restraint laws.

Using Rural⁻Urban Continuum Codes (RUCCS) to Examine Alcohol-Related Motor Vehicle Crash Injury and Enforcement in New York State.

Rural areas of New York State (NYS) have higher rates of alcohol-related motor vehicle (MV) crash injury than metropolitan areas. While alcohol-related injury has declined across the three geographic regions of NYS, disparities persist with rural areas having smaller declines. Our study aim was to examine factors associated with alcohol-related MV crashes in Upstate and Long Island using multi-sourced county-level data that included the Crash Outcome Data Evaluation System (CODES) with emergency department visits and hospitalizations, traffic citations, demographic, economic, transportation, alcohol outlets, and Rural-Urban Continuum Codes (RUCCS). A cross-sectional study design employed zero-truncated negative binominal regression models to assess relative risks (RR) with 95% confidence interval (CI). Counties (n = 57, 56,000 alcohol-related crashes over the 3 year study timeframe) were categorized by mean annual alcohol-related MV injuries per 100,000 population: low (24.7 ± 3.9), medium (33.9 ± 1.7) and high (46.1 ± 8.0) (p < 0.0001). In multivariable analyses, alcohol-related MV injury was elevated for non-adjacent, non-metropolitan counties (RR 2.5, 95% CI: 1.6-3.9) with higher citations for impaired driving showing a small, but significant protective effect. Less metropolitan areas had higher alcohol-related MV injury with inconsistent alcohol-related enforcement measures. In summary, higher alcohol-related MV injury rates in non-metropolitan counties demonstrated a dose-response relationship with proximity to a metropolitan area. These findings suggest areas where intervention efforts might be targeted to lower alcohol-related MV injury.

Factors Associated With Child Restraint Use in Motor Vehicle Crashes.

Motor vehicle crashes (MVCs) are a leading cause of death among children. Multivariable analyses of age-appropriate child restraint system (CRS) use in the "booster-aged" population are needed. The current study identified factors associated with age-appropriate CRS use in fatal MVCs for children 4 to 7 years old, using 2011 to 2015 data from the Fatality Analysis Reporting System. Of 929 MVC fatalities, 32% of fatally injured children were in an age-appropriate restraint. While age-appropriate CRS use was higher for 4-, 5-, and 6-year-olds relative to 7-year-olds (adjusted relative risk [aRR] = 2.57, 2.51, and 2.18, respectively; p < .01 for each comparison), black children (aRR = 0.62; p < .01) relative to white children, and drivers who had not used a lap-shoulder belt (aRR = 0.40; p < .01) relative to belted drivers were associated with lower levels of age-appropriate CRS use. Our findings underscore the continued importance of communicating best practice guidelines on CRSs to caregivers of young children.

The Power of Academic-Practitioner Collaboration to Enhance Science and Practice Integration: Injury and Violence Prevention Case Studies.

One of the most substantial challenges facing the field of injury and violence prevention is bridging the gap between scientific knowledge and its real-world application to achieve population-level impact. Much synergy is gained when academic and practice communities collaborate; however, a number of barriers prevent better integration of science and practice. This article presents 3 examples of academic-practitioner collaborations, their approaches to working together to address injury and violence issues, and emerging indications of the impact on integrating research and practice. The examples fall along the spectrum of engagement with nonacademic partners as coinvestigators and knowledge producers. They also highlight the benefits of academic-community partnerships and the engaged scholarship model under which Centers for Disease Control and Prevention-funded Injury Control Research Centers operate to address the research-to-practice and practice-to-research gap.

Fatal Pediatric Motor Vehicle Crashes on U.S. Native American Indian Lands Compared to Adjacent Non-Indian Lands: Restraint Use and Injury by Driver, Vehicle, Roadway and Crash Characteristics.

There are large disparities in American Indian pediatric motor vehicle (MV) mortality with reports that several factors may contribute. The Fatality Analysis Reporting System for 2000-2014 was used to examine restraint use for occupants aged 0-19 years involved in fatal MV crashes on Indian lands (n = 1667) and non-Indian lands in adjacent states (n = 126,080). SAS GLIMMIX logistic regression with random effects was used to generate odds ratios (OR) with 95% confidence intervals (CI). Restraint use increased in both areas over the study period with restraint use on Indian lands being just over half that of non-Indian lands for drivers (36.8% vs. 67.8%, p < 0.0001) and for pediatric passengers (33.1% vs. 59.3%, p < 0.0001). Driver restraint was the strongest predictor of passenger restraint on both Indian and non-Indian lands exerting a stronger effect in ages 13-19 than in 0-12 year olds. Valid licensed driver was a significant predictor of restraint use in ages 0-12 years. Passengers in non-cars (SUVs, vans and pickup trucks) were less likely to be restrained. Restraint use improved over the study period in both areas, but disparities failed to narrow as restraint use remains lower and driver, vehicle and crash risk factors higher for MV mortality on Indian lands.

The Hidden Epidemic of Firearm Injury: Increasing Firearm Injury Rates During 2001-2013.

Investigating firearm injury trends over the past decade, we examined temporal trends overall and according to race/ethnicity and intent in fatal and nonfatal firearm injuries (FFIs and NFIs) in United States during 2001-2013. Counts of FFIs and estimated counts of NFIs were obtained from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System. Poisson regression was used to analyze overall and subgroup temporal trends and to estimate annual change per 100,000 persons (change). Total firearm injuries (n = 1,328,109) increased annually by 0.36 (Ptrend < 0.0001). FFIs remained constant (change = 0.02; Ptrend = 0.22) while NFIs increased (change = 0.35; Ptrend < 0.0001). Homicide FFIs declined (change = -0.05; Ptrend < 0.0001) while homicide NFIs increased (change = 0.43; Ptrend < 0.0001). Suicide FFIs increased (change = 0.07; Ptrend < 0.0001) while unintentional FFIs and NFIs declined (changes = -0.01 and -0.09, respectively; Ptrend < 0.0001 and 0.005). Among whites, FFIs (change = 0.15; Ptrend < 0.0001) and NFIs (change = 0.13; Ptrend < 0.0001) increased; among blacks, FFIs declined (change = -0.20; Ptrend < 0.0001). Among Hispanics, FFIs declined (change = -0.28; Ptrend < 0.0001) while NFIs increased (change = 0.55; Ptrend = 0.014). The endemic firearm-related injury rates during the first decade of the 21st century mask a shift from firearm deaths towards a rapid rise in nonfatal injuries.

Restraint use and risky driving behaviors across drug types and drug and alcohol combinations for drivers involved in a fatal motor vehicle collision on U.S. roadways.

BACKGROUND: While driving impaired is a well-recognized risk factor for motor vehicle (MV) crash, recent trends in recreational drug use and abuse may pose increased threats to occupant safety. This study examines mechanisms through which drug and/or alcohol combinations contribute to fatal MV crash. METHODS: The Fatality Analysis Reporting System (FARS) for 2008-2013 was used to examine drugs, alcohol, driver restraint use, driver violations/errors and other behaviors of drivers of passenger vehicles who were tested for both alcohol and drugs (n = 79,932). Statistical analysis was based on Chi-square tests and multivariable logistic regression. Associations of restraint use and other outcomes with alcohol and drug use were measured by estimated odds ratios (ORs) and 95 % confidence intervals (95 % CIs). RESULTS: More than half (54.8 %) of the study population were positive for drugs or alcohol at the time of crash. Approximately half of drivers were belted, but this varied from 67.1 % (unimpaired) to 33.0 % (drugs plus alcohol). Compared to the unimpaired, the odds of a driver being unbelted varied: alcohol and cannabis (OR 3.70, 95 % CI 3.44-3.97), alcohol only (3.50,3.36-3.65), stimulants (2.13,1.91-2.38), depressants (2.09,1.89-2.31), narcotics (1.84,1.67-2.02) and cannabis only (1.55,1.43-1.67). Compared to belted drivers, unbelted drivers were over 4 times more likely to die. Driving violations varied across drug/drug alcohol combinations. Speed-related violations were higher for drivers positive for stimulants, alcohol, cannabis, and cannabis plus alcohol, with a more than two fold increase for alcohol and cannabis (2.36, 2.05, 2.71). CONCLUSIONS: Mechanisms through which drugs, alcohol and substance combinations produce increased risks to occupant safety include lowered restraint use and increases in risky driving behaviors, including speeding, lane, passing, turning and signal/sign violations.

Side impact motor vehicle crashes: driver, passenger, vehicle and crash characteristics for fatally and nonfatally-injured rear-seated adults.

BACKGROUND: Most studies of rear-seated occupants have focused on or included pediatric occupants which may not translate to adults. This study examines passenger, driver, vehicle and crash characteristics for rear-seated adult occupants involved in side crashes. METHODS: The National Automotive Sampling System General Estimates System (NASS/GES) for calendar years 2011-2014 was used with accompanying weights to examine the occupant, vehicle and crash characteristics associated with injury in rear-seated adults (n = 395,504) involved in a side crash. A weighted subpopulation analysis includes occupants travelling in a vehicle with an IIHS safety rating (n = 39,208), which was used to control for vehicle safety. Statistical analysis used Chi-square tests and multilevel multivariable logistic regression. Unadjusted and adjusted odds ratios (ORs) are reported with 95 % confidence intervals (95 % CIs). RESULTS: Rear-seated occupants on the same side as the crash impact were more likely to be severely/fatally injured than occupants seated on the opposite side (Multivariable adjusted OR: 2.54, 95 % CI: 2.31-2.79), as were those in angle crashes (Multivariable adjusted OR: 10.85, 95 % CI: 9.24-12.73). Rear-seated occupants of belted drivers were 3.28 times more likely to be belted compared to rear-seated occupants of an unbelted driver. In a subpopulation analysis of all same-side crashes, unrestrained occupants were 5.96 times more likely to be severely/fatally injured compared to restrained occupants. CONCLUSION: Restraint use was protective for rear-seated adult occupants involved in side crashes, including those in same-side crashes. Angle and same-side crashes are associated with increased injury severity.

Child Restraint Use and Driver Screening in Fatal Crashes Involving Drugs and Alcohol.

BACKGROUND: There are reports that the incidence of alcohol-involved crashes has remained stable among fatally injured drivers while drug involvement has increased in recent years. METHODS: Data from the Fatality Analysis Reporting System (FARS) from 2010 to 2013 were used to examine drug and alcohol status of drivers (N = 10 864) of 4-wheeled passenger vehicles involved in a fatal crash while transporting a passenger aged 0 to 14 years (N = 17 179). Mixed effect multivariable logistic regression used SAS GLIMMIX to control for clustering. Odds ratios are reported with 95% confidence intervals (CIs). RESULTS: Only 28.9% of drivers were screened for both alcohol and drugs, and 56.7% were not tested for either. The total proportion of unrestrained child passengers increased nearly linearly by age. Findings ranged as high as 70% for 13- to 14-year-olds with drivers positive for drugs and alcohol. In multivariable adjusted models, inappropriate child seating with drivers who tested positive was as follows: alcohol, 1.30 (95% CI, 0.92-1.82); drugs, 1.54 (95% CI, 1.24-1.92); and for both drugs and alcohol, 1.88 (95% CI, 1.38-2.55). More than one-fourth were unrestrained with drivers positive for cannabis (27.7%). Overall mortality was approximately triple for unrestrained versus restrained (33.5% vs 11.5%; P < .0001) and was higher in front-seated than rear-seated passengers (40.7% vs 31.5%; P < .0001). CONCLUSIONS: Passengers were less likely to be appropriately seated and to be restrained when transported by a driver positive for drugs and alcohol, but this finding varied according to passenger age and drug/alcohol category.

Rear-seat seatbelt laws and restraint use in rear-seated teen passengers traveling in passenger vehicles involved in a fatal collision on a US roadway.

BACKGROUND: There is widespread belief that after childhood rear-seated motor vehicle occupants do not need to wear-seat seatbelts to travel safely. This belief is reflected in the fact that, in many states, teen passengers can ride legally unbelted in the rear seat of a passenger vehicle. METHODS: The Fatality Analysis Reporting System for 2010-2011 was used to examine factors associated with teen use of rear-seat seatbelts (n = 3,655) and with injury outcomes of belted and unbelted rear-seated teen passengers traveling in a passenger vehicle on a US roadway. Multilevel models controlled for nonindependence of cases using SAS Glimmix. Odds ratio (OR) is reported with 95% confidence interval (CI). RESULTS: Slightly more than half (50.8%) of rear-seated teens were restrained, but this declined linearly with age from 65.8% of 13- to 14-year-olds to 43.3% of 18- to 19-year-olds. Overall, 77.0% of rear-seat mortality occurred in unbelted teens. Passengers of belted drivers were more frequently belted (64.1% vs. 19.0%, χ = 586.2, p < 0.0001). Nearly one-fifth (18.5%) of rear-seated teens were ejected, with 95.8% of ejections in unrestrained teens. Presence of a rear-seat seatbelt law was associated with higher restraint use (55.9% vs. 40.0%, χ = 89.0, p < 0.0001). However, in adjusted multilevel, multivariable models, belt status varied by whether the seatbelt law was primary (OR, 1.60; 95% CI, 1.29-1.99) or secondary enforcement (OR, 1.33; 95% CI, 0.98-1.78). CONCLUSION: Presence of a primary enforced rear-seat seatbelt law was associated with significantly higher belt use. Ejection was associated with higher mortality and being unrestrained. More than three quarters of rear-seated teens who died were unrestrained. LEVEL OF EVIDENCE: Epidemiologic study, level III.

Graduated driver license compliant teens involved in fatal motor vehicle crashes.

BACKGROUND: Significant reductions in motor vehicle injury mortality have been reported for teen drivers after passage of graduated driver licensing (GDL), seat belt, and no tolerance alcohol and drug laws. Despite this, teen drivers remain a vulnerable population with elevated fatal crash involvement. This study examines driver, vehicle, and crash characteristics of GDL-compliant, belted, and unimpaired teen drivers with the goal of identifying areas where further improvements might be realized. METHODS: The Fatality Analysis Reporting System (FARS) for 2007 to 2009 was used to examine and classify driver violations/errors in compliant teen drivers (n = 1,571) of passenger vehicles involved in a fatal collision. Teens driving unbelted, non-GDL compliant, or impaired by alcohol or drugs were excluded. Statistical analysis used χ, Fisher's exact and multivariable logistic regression. Odds ratios are reported with 95% confidence intervals. Significance was defined as p < 0.05. RESULTS: Nearly one third (n = 1,571) of teen drivers involved in a fatal motor vehicle crash were GDL compliant, unimpaired, and belted. The majority held an intermediate GDL license (90.6%). Crash-related factors were identified for 63.1% of fatal crashes. Age- and sex-adjusted odds identified overcorrecting, speeding, lane errors, school morning crashes, distractions, and driving on slippery surfaces as having increased odds of fatality for the teen driver as well as newer vehicle models and heavier vehicle weight as protective. CONCLUSION: Among compliant drivers, weekday crashes before and after school and committing a driving violation at the time of crash were associated with increased risk of driver death and higher incidence of incapacitating injury in surviving drivers. LEVEL OF EVIDENCE: Therapeutic study, level V.

Factors associated with mortality in rear-seated adult passengers involved in fatal motor vehicle crashes on US roadways.

BACKGROUND: Recent efforts to pass rear seat belt laws for adults have been hampered by large gaps in the scientific literature. This study examines driver, vehicle, crash, and passenger characteristics associated with mortality in rear-seated adult passengers. METHODS: The Fatality Analysis Reporting System (FARS) 2010 to 2011 was used to examine motor vehicle occupant mortality in rear-seated adult passengers 18 years and older. Side crash vehicle safety ratings were assessed in a subset analysis of vehicles struck on the same side as the rear-seated passenger. Multilevel logistic regression models used SAS GLIMMIX. RESULTS: Of the 7,229 rear-seated adult passengers, 2,091 (28.9%) died. Multivariable predictors of increased mortality were advancing passenger age, younger driver age, excessive speed, ejection, being unbelted, rear impact, and same-side crash. Belt use was associated with a 67.0% reduction in total mortality. Despite this, belt wearing was low (48.1%) and differed by seating position, with less than one third of middle-seated passengers belted. Multivariable analysis showed mortality to be nearly three times higher in same-side crashes than other impact locations (odds ratio (OR) = 2.76, 2.22, 3.44). In a multivariable subpopulation analysis of same-side crashes, right-seated passengers had an increased mortality (52.7% vs. 43.2%, p < 0.01) compared to left-seated passengers (OR = 1.55, 1.02, 2.36). Vehicle side crash safety ratings, available for 27.7% (n = 172) of same-side crashes, were not predictive of mortality. CONCLUSIONS: Except for same-side crashes, seat belts were associated with significantly lowered mortality. Despite this, seat belt wearing was low and represents one of several areas where further improvements in mortality might be realized.

Graduated driver license nighttime compliance in U.S. teen drivers involved in fatal motor vehicle crashes.

BACKGROUND: Examination of teen driver compliance with graduated driver licensing (GDL) laws could be instrumental in identifying factors associated with persistently high motor vehicle mortality rates. METHODS: Fatality analysis reporting system (FARS) data from the years 2006 to 2009 were used in this nation-wide cross-sectional study of drivers covered by a state nighttime GDL law (n=3492). A new definition of weekend, based on the school night in relation to the teenage social landscape, redefined Friday night as a weekend night and Sunday night as a weekday/school night and compared it to previous weekend definitions. Multiple logistic regression was used to examine independent effects of demographic, behavioral, environmental, contextual, and other factors on compliance with nighttime GDL laws. All analyses were performed in Stata version 11. RESULTS: Given coverage under nighttime GDL laws, drivers aged 15-17 years were non-compliant in 14.9% of the fatal MVCs in which they were involved, and nearly one-fifth (18.8%) of all fatalities aged 15-17 years were associated with non-compliance. Mortality risk was 10% higher using a revised social (school night) versus traditional (Sat-Sun) weekend definitions. In multivariable analysis, drivers non-compliant with nighttime GDL laws were more likely to be drinking (OR=4.97, 3.85-6.40), unbelted (OR=1.58, 1.25-1.99), driving on the weekend (OR=1.82, 1.47-2.24), and killed (OR=1.31, 1.04-1.65). CONCLUSION: GDL non-compliance contributes to teen motor vehicle mortality. Legislative and enforcement efforts targeting non-school night driving, seatbelt nonuse and alcohol have potential to further reduce teen driving mortality.

Injury-related hospital admissions of military dependents compared with similarly aged nonmilitary insured infants, children, and adolescents.

BACKGROUND: Military deployment of one or both parents is associated with declines in school performance, behavioral difficulties, and increases in reported mental health conditions, but less is known regarding injury risks in pediatric military dependents. METHODS: Kid Health Care Cost and Utilization Project 2006 (KID) was used to identify military dependents aged 0.1 year to 17 years through expected insurance payer being CHAMPUS, Tricare, or CHAMPVA (n = 12,310) and similarly aged privately insured nonmilitary in CHAMPUS, Tricare, or CHAMPVA states (n = 730,065). Mental health diagnoses per 1,000 hospitalizations and mechanisms of injury per 1,000 injury-related hospitalizations are reported. Unweighted univariate analyses used Fisher's exact, χ(2), and analysis of variance tests for significance. Odds ratios are age and sex adjusted with 95% confidence intervals. RESULTS: Injury-related admissions were higher in military than in nonmilitary dependents (15.5% vs. 13.2%, p < 0.0001). Age- and sex-adjusted motor vehicle occupant and pedestrian injuries were significantly lower in all-age military dependents but not in age-stratified categories. Very young military dependents had higher all-cause injury admissions (p < 0.0001), drowning/near drowning (p < 0.0001), and intracranial injury (p < 0.0001) and showed a tendency toward higher suffocation (p = 0.055) and crushing injury (p = 0.065). Military adolescents and teenagers had higher suicide/suicide attempts (p = 0.0001) and poisonings from medicinal substances (p = 0.0001). Mental health diagnoses were significantly higher in every age category of military dependents. All-cause in-hospital mortality tended to be greater in military than in nonmilitary dependents (p = 0.052). CONCLUSION: This study suggests that military dependents are a vulnerable population with special needs and provides clues to areas where injury prevention professionals might begin to address their needs. LEVEL OF EVIDENCE: Prognostic/epidemiologic study, level II.