Ambulance Traffic Crashes in Japan: Characteristics of Casualties and Efforts to Improve Ambulance Safety.

BACKGROUND: An ambulance traffic crash not only leads to injuries among emergency medical service (EMS) professionals but also injures patients or their companions during transportation. We aimed to describe the incidence of ambulance crashes, seating location, seatbelt use for casualties (ie, both fatal and nonfatal injuries), ambulance safety efforts, and to identify factors affecting the number of ambulance crashes in Japan. METHODS: We conducted a nationwide survey of all fire departments in Japan. The survey queried each fire department about the number of ambulance crashes between January 1, 2017, and December 31, 2019, the number of casualties, their locations, and seatbelt usage. Additionally, the survey collected information on fire department characteristics, including the number of ambulance dispatches, and their safety efforts including emergency vehicle operation training and seatbelt policies. We used regression methods including a zero-inflated negative binomial model to identify factors associated with the number of crashes. RESULTS: Among the 726 fire departments in Japan, 553 (76.2%) responded to the survey, reporting a total of 11,901,210 ambulance dispatches with 1,659 ambulance crashes (13.9 for every 100,000 ambulance dispatches) that resulted in a total of 130 casualties during the 3-year study period (1.1 in every 100,000 dispatches). Among the rear cabin occupants, seatbelt use was limited for both EMS professionals (n = 3/29, 10.3%) and patients/companions (n = 3/26, 11.5%). Only 46.7% of the fire departments had an internal policy regarding seatbelt use. About three-fourths of fire departments (76.3%) conducted emergency vehicle operation training internally. The output of the regression model revealed that fire departments that conduct internal emergency vehicle operation training had fewer ambulance crashes compared to those that do not (odds of being an excessive zero -2.20, 95% CI: -3.6 to -0.8). CONCLUSION: Two-thirds of fire departments experienced at least one crash during the study period. The majority of rear cabin occupants who were injured in ambulance crashes were not wearing a seatbelt. Although efforts to ascertain seatbelt compliance were limited, Japanese fire departments have attempted a variety of methods to reduce ambulance crashes including internal emergency vehicle operation training, which was associated with fewer ambulance crashes.

Crash rates of convertible cars.

OBJECTIVE: Convertible cars have existed since among the first automobiles, and the lack of substantial roof structure creates some safety concerns. Though crash tests have demonstrated that convertibles can resist excessive intrusion in front and side crashes and that strong A-pillars and roll bars can help maintain survival space in rollovers, little work has been done examining the real-world crash experience of these vehicles. The objective of this study was to compare the crash experience of recent convertibles with nonconvertible versions of the same cars using the most recent crash data. METHODS: Crash and exposure data were obtained from the U.S. Department of Transportation and IHS Markit, respectively. Rates of driver deaths and police-reported crash involvements were compared for 1- to 5-year-old convertible cars and their nonconvertible versions during 2014-2018. Exposure measures included registered vehicle years (RVY) and vehicle miles traveled (VMT). These rates were compared using the standardized mortality ratio to account for possible differences in exposure distribution. Crash circumstances (e.g., point of impact, rollover, ejection) and behavioral outcomes (e.g., speeding, alcohol impairment, seat belt use) were compared for drivers killed in crashes. RESULTS: Convertibles had lower driver death rates and police-reported crash involvement rates on the basis of both RVY and VMT. However, the differences in driver death rates were not statistically significant. Driver deaths per 10 billion VMT were 11% lower for convertibles, and driver involvement in police-reported crashes per 10 million VMT was 6% lower. On average, convertibles were driven 1,595 fewer miles per year than the nonconvertible versions of these cars. Among fatally injured drivers, convertibles had slightly higher rates of ejection, and behavioral differences were minimal. The number of rollovers was small and their rate did not substantially differ between convertibles and their nonconvertible versions. CONCLUSIONS: Safety concerns associated with convertibles' retractable roof structures were not supported by the results of this study.

Female kinematics and muscle responses in lane change and lane change with braking maneuvers.

OBJECTIVE: The primary aim of this article is to extensively study female occupant kinematics and muscle activations in vehicle maneuvers potentially occurring in precrash situations and with different seat belt configurations. The secondary aim is to provide validation data for active human body models (AHBMs) of female occupants in representative precrash loading situations. METHODS: Front seat female passengers wearing a 3-point seat belt, with either standard or pre-pretensioning functionality, were subjected to multiple autonomously carried-out lane change and lane change with braking maneuvers while traveling at 73 km/h. This article quantifies the head center of gravity and T1 vertebra body (T1) linear and rotational displacements. This article also includes surface electromyography (EMG) data collected from 38 muscles in the neck, torso, and upper and lower extremities, all normalized by maximum voluntary contraction (MVC). The raw EMG data were filtered, rectified, and smoothed. Separate Wilcoxon signed-rank tests were performed on EMG onset and amplitude as well as peak displacements of head and T1 considering 2 paired samples with the belt configuration as an independent variable. RESULTS: Significantly smaller lateral and forward displacements for head and T1 were found with the pre-pretensioner belt versus the standard belt (P < .05). Averaged muscle activity, mainly in the neck, lumbar extensor, and abdominal muscles, increased up to 16% MVC immediately after the vehicle accelerated in the lateral direction. Muscles in the right and left sides of the body displayed differences in activation time and amplitude relative to the vehicle's lateral motion. For specific muscles, lane changes with the pre-pretensioner belt resulted in earlier muscle activation onsets and significantly smaller activation amplitudes compared to the standard belt (P < .05). CONCLUSIONS: The presented results from female passengers complement the previously published results from male passengers subjected to the same loading scenarios. The data provided in this article can be used for validation of AHBMs of female occupants in both sagittal and lateral loading scenarios potentially occurring prior to a crash. Additionally, our results show that a pre-pretensioner belt decreases muscle activation onset and amplitude as well as forward and lateral displacements of head and T1 compared to a standard belt, confirming previously published results.

Evaluating disparities in child occupant protection using a proportion-eliminated approach to mediation.

OBJECTIVE: While there are clear racial/ethnic disparities in child restraint system (CRS) use, to date no studies have identified mediators that quantitatively explain the relationship between race and CRS use. Therefore, the objective of this study was to provide an example of how a proportion-eliminated approach to mediation may be particularly useful in understanding the complex relationship between race and CRS use. METHODS: Sixty-two mothers with a child between 4-8 years old completed a survey and had their CRS use assessed by a Child Passenger Safety Technician using a structured assessment based on the 2018 American Academy of Pediatrics' Best Practice guidelines. Recruitment and data collection occurred in Birmingham, Alabama between June 2018 and January 2019. We used chi-squared tests, logistic regressions, and a proportion-eliminated approach to mediation to compare our variables of interest and to estimate the amount of the association between racial group membership and errors in restraint use that may be explained by sociodemographic, psychosocial, and parenting variables. RESULTS: Before mediation, Nonwhite mothers in this sample had a 7.38 greater odds of having an error in CRS use than White mothers. Mediation analyses indicated that being married and self-reported seatbelt use explained 47% and 35% of the effect of race on CRS use errors, respectively. CONCLUSION: A proportion-eliminated approach to mediation may be particularly useful in child passenger safety research aiming to inform the development of interventions tailored for racial minority populations.

Composite performance indicators for helmet and seat-belt enforcement as imprecise data.

OBJECTIVES: Composite road safety performance indicators (RSPIs) are useful tools in regional road safety planning. Among the indicators and data calculated by the World Health Organization (WHO), information on the effectiveness of law enforcement on various risk factors for road casualties were provided, which can be considered as qualitative indicators. The purpose of this study is to analyze the performance indicators related to the percentage of helmet and seat-belt use versus the qualitative enforcement scores attributed by WHO. METHODS: This analysis was performed for 30 member states of WHO and will show how and with what degree of efficiency the qualitative output of the enforcement score acts versus the input percentage of seat-belt and helmet use. The qualitative nature of the output index has led us to depart the traditional analysis of crisp numerical indicators related to road safety performance and to consider data as imprecise or fuzzy indices. In this study we used two methods including imprecise DEA-based CIs and fuzzy DEA-based CIs, respectively. RESULTS: Results show that the clear score achieved by the Imprecise DEA-based CI model is easy to interpret and use. Whereas, in the Fuzzy DEA-based CI model, the fuzzy indicator scores obtained based on the level of several probabilities are strong in capturing the uncertainties related to human behavior. CONCLUSIONS: Both RSPIs are applicable with slight differences that were in the order of countries and the ease of reading the results. We also found that each method has different strengths and that the FDEA-based CIs method is more accurate and more in line with the inputs than the IDEA-based CIs method.

Rear-seat occupant demographics in rear impacts: Analysis of NASS-CDS.

PURPOSE: This study analyzes field accidents to identify rear-occupant exposure and injury by crash types. Occupant demographics and injury were assessed by body region and crash severity to understand rear-occupant injury mechanisms in rear crashes. METHODS: The exposure and serious-to-fatal injury was determined by crash type for non-ejected second- and third- row occupants in 1994+ MY vehicles using 1994-2015 NASS-CDS. Selected occupant demographics and serious injury distributions were assessed over a range of delta V for rear crashes. RESULTS: Rear crashes accounted for 8.7% of exposed and 5.4% of serious-to-fatally injured rear-seat occupants. On average, rear-seat occupants were 14.3 ± 1.5 years old (median 10.3, 90th CI 0.08-29.6), weighed 44.7 ± 2.6 kg (median 44.4, 90th CI 7.9-81.7) and were 130.3 ± 4.1 cm tall (median 141.4, 90th CI 67.3-178.4). With serious injury, the average rear occupant was 18.1 ± 5.8 years old (median 13.1, 90th CI 0.0-47.2), weighed 42.6 ± 10.7 kg (median 31.4, 90th CI 7.0-82.4) and was 120.6 ± 15.4 cm tall (median 145.4, 90th CI 48.8-174.1). More than 72% of rear-seat occupants were in delta V less than 24 km/h. Less than 2% were in delta V 48 km/h or greater. The overall rate of serious-to-fatally injured (MAIS 3 + F) was 0.73% ± 0.37%. For serious-to-fatally injured rear-seat occupants, the average delta V was 37.4 ± 3.1 km/h (median 29.8, 90th CI 28.6-62.1). None were involved in delta Vs less than 24 km/h, about 78% were in a delta V between 24-48 km/h and 22% were in a delta V of 48 km/h or greater. Head and chest were most commonly injured, irrespective of crash severity. CONCLUSIONS: The height and weight of a 10-year old and 5th Hybrid III ATD are representative of the average rear-seat occupant involved in rear crashes based on NASS-CDS. Crash tests with a delta V of between 30 and 37 km/h represent the typical collision causing serious-to-fatal injury.

Effect of ABTS and conventional seats on occupant injury in rear impacts: Analysis of field and test data.

PURPOSE: This study addressed the potential effect of higher seat stiffness with ABTS (All-Belt-to-Seat) compared to conventional seats in rear impacts. It analyzed field accidents and sled tests over a wide range in delta V and estimated the change in number of injured occupants if front-seats were replaced with stiffer ABTS. METHODS: The rear-impact exposures and serious-to-fatal injury rates were determined for 15+ year old non-ejected drivers and right-front passengers in 1994+ model year vehicles using 1994-2015 NASS-CDS. More than 50 rear sled tests were analyzed using conventional and ABTS seats. An injury risk was calculated for selected ATD biomechanical responses. The results obtained with the ABTS and conventional seats were compared for matched tests based on head restraint position, ATD size and initial position and delta V. The change in risk was used to estimate the change in injury in the field by adjusting the injury rate by delta V. RESULTS: On average, front seat occupants were 39 years old, weighed 78 kg and were 171 cm tall. About 29.3% of serious-to-fatally injured (MAIS 3 + F) front seat occupants were involved in delta Vs less than 24 km/h and about 28.4% in a delta V of 48 km/h or greater. The average biomechanical response and injury risk in sled tests were higher with an ABTS seat than with a conventional seat. The average maximum injury risk was assessed by delta V groups for conventional and ABTS seats. The relative risk of ABTS to conventional seats was 1.34 in less than 16 km/h, 1.69 in 16-24 km/h, 1.65 in 24-32 km/h, 1.33 in 32-40 km/h, 5.77 in 40-48 km/h and 48.24 in the 56-64 km/h delta V category. The estimated relative risk was 11.90 in 48-56 km/h and 34.11 in 64+ km/h. The number of serious-to-fatally injured occupants was estimated to increase by up to 6.88-times if stiffer ABTS seats replaced conventional seats. CONCLUSIONS: The field data indicate that the 50th percentile male Hybrid III size is representative of an average occupant involved in rear crashes. ABTS seats used in this study are stiffer than conventional seats and increase ATD responses and injury risks over a wide range of crash severities.

Psychological Constructs Related to Seat Belt Use: A Nationally Representative Survey Study.

Seat belt use can significantly reduce fatalities in motor vehicle crashes (Kahane, 2000). Nevertheless, the current U.S. seat belt use rate of 89.6% (Enriquez & Pickrell, 2019) indicates that a relatively small but pervasive portion of the population does not wear seat belts on a full-time basis. Whereas much is known about the demographic predictors of seat belt use, far less is understood about psychological factors that predict individual proclivities toward using or not using a seat belt. In this study, we examined some of these potential psychological predictors. A probability-based web survey was conducted with 6,038 U.S. residents aged 16 or older who reported having driven or ridden in a car in the past year. We measured self-reported seat belt use and 18 psychological constructs and found that delay of gratification, life satisfaction, risk aversion, risk perception, and resistance to peer influence were positively associated with belt use. Impulsivity and social resistance orientation were negatively associated with belt use. Prior research has shown that psychological factors like delay of gratification, risk aversion/perception, and impulsivity predict other health behaviors (e.g., cigarette smoking, sunscreen use); our results extend this literature to seat belts and can aid the development of traffic safety programs targeted at non-users who-due to such factors-may be resistant to more traditional countermeasures such as legislation and enforcement.

Age-related differences in driving behaviors among non-professional drivers in Egypt.

PURPOSE: This study aimed to investigate whether young and old non-professional drivers in South Egypt have aberrant driving behaviors compared with their middle-aged counterparts. MATERIALS AND METHODS: In this cross-sectional study, a total of 1764 non-professional drivers aged ≥ 19 years, residing in Beni-Suef in South Egypt, and having ≥ one year of driving experience were randomly selected. All drivers were asked to fill out a self-administered questionnaire, including personal information, driving habits, and the Arabic version of the Driver Behavior Questionnaire which evaluates driving violations, errors, and lapses. RESULTS: This study included 560 young drivers (19-25 years), 850 middle-aged drivers (26-59 years), and 354 old drivers (≥ 60 years). Compared with middle-aged drivers, young drivers reported more non-use of the seatbelt, eating while driving, and driving while feeling drowsy. Old drivers, in contrast, showed more careful driving behaviors including fewer violations, errors, and lapses and less likelihood of driving while feeling sleepy. CONCLUSION: This study supports the conception that young drivers pose less careful driving habits. Initiating educational programs targeting young drivers to improve their driving habits and create a traffic safety culture in Egypt is highly warranted.

Risky driving behaviour in Abu Dhabi, United Arab Emirates: a cross-sectional, survey-based study.

BACKGROUND: Traffic collision fatality rates per mile travelled have declined in Abu Dhabi similar to many developed countries. Nevertheless, the rate is still significantly higher than the average of countries with similar GDP and socio-demographic indicators. The literature on the subject in the UAE is limited especially in the area of studying drivers behaviour. This study aims to find determinants of risky driving behaviours that precipitate having a road traffic collision (RTC) in the United Arab Emirates (UAE). METHODS: A cross-sectional, survey-based study was employed. Participants were 327 active drivers who were attending Abu Dhabi Ambulatory Health Care Services clinics. They were provided with a questionnaire consisting of demography, lifestyle history, medical history, driving history, and an RTC history. They were also given a driving behaviour questionnaire, a distracted driving survey, depression screening and anxiety screening. RESULTS: Novice drivers (less than 25 years old) were 42% of the sample and 79% were less than 35 years. Those who reported a history of an RTC constituted 39.8% of the sample; nearly half (47.1%) did not wear a seatbelt during the collision. High scores in the driving behaviour questionnaire and high distraction scores were evident in the sample. Most distraction-prone individuals were young (90.5% were less than 36 years old). High scores in the driving behaviour questionnaire were also associated with high distraction scores (p < 0.001). Respondents with high depression risk were more likely to be involved in the RTC. With each one-point increase in the driver's distraction score, the likelihood of a car crash being reported increased by 4.9%. CONCLUSION: Drivers in the UAE engage in risky behaviours and they are highly distracted. Some behaviours that contribute to severe and even fatal injuries in RTCs include failing to wear a seatbelt and being distracted. Younger people were more likely distracted, while older drivers were more likely to have higher depression scores. Depression is suggested as a determinant factor in risky driving. These findings are informative to other countries of similar socioeconomic status to the UAE and to researchers in this field in general.

A home-based approach to understanding seatbelt use in single-occupant vehicles in Tennessee: Application of a latent class binary logit model.

Although the enforcement of seatbelt use is considered to be an effective strategy in reducing road injuries and fatalities, lack of seatbelt use still accounts for a substantial proportion of fatal crashes in Tennessee, United States. This problem has raised the need to better understand factors influencing seatbelt use. These factors may arise from spatial/temporal characteristics of a driving location, type of vehicle, demographic and socioeconomic attributes of the vehicle occupants, driver behaviours, attitudes, and social norms. However, the above factors may not have the same effects on seatbelt use across different individuals. In addition, the behavioural factors are usually difficult to measure and may not always be readily available. Meanwhile, residential locations of vehicle occupants have been shown to be associated with their behavioural patterns and thus may serve as a proxy for behavioural factors. However, the suitability of geographic and residential locations of vehicle occupants to understand the seatbelt use behaviour is not known to date. This study aims to fill the above gaps by incorporating the residential location characteristics of vehicle occupants in addition to their demographics and crash characteristics into their seatbelt use while accounting for the varying effects of these factors on individual seatbelt use choices. To achieve this goal, empirical data are collected for vehicular crashes in Tennessee, United States, and the home addresses of vehicle occupants at the time of the crash are geocoded and linked with the census tract information. The resulting data is then used as explanatory variables in a latent class binary logit model to investigate the determinants of vehicle occupants' seatbelt use at the time of the crash. The latent class specification is employed to capture the unobserved heterogeneity in data. Results show that Tennessean drivers belong to two general categories-conformist and eccentric-with gender, vehicle type, and income per capita determining the likelihood of these categories. Overall, male drivers, younger drivers, and drivers who have consumed drugs are less likely to wear a seatbelt, whereas drivers who come from areas with higher population density, travel time, and income per capita are more likely to wear a seatbelt. In addition, driving during the day and in rainy weather are associated with an increased likelihood of seatbelt use. The findings of this study will help developing effective policies to increase seatbelt use rate and improve safety.

Transportation Risk Behaviors Among High School Students - Youth Risk Behavior Survey, United States, 2019.

Motor-vehicle crashes are a leading cause of death and nonfatal injury among U.S. adolescents, resulting in approximately 2,500 deaths and 300,000 nonfatal injuries each year. Risk for motor-vehicle crashes and resulting injuries and deaths varies, depending on such behaviors as seat belt use or impaired or distracted driving. Improved understanding of adolescents' transportation risk behaviors can guide prevention efforts. Therefore, data from the 2019 Youth Risk Behavior Survey were analyzed to determine prevalence of transportation risk behaviors, including not always wearing a seat belt, riding with a driver who had been drinking alcohol (riding with a drinking driver), driving after drinking alcohol, and texting or e-mailing while driving. Differences by student characteristics (age, sex, race/ethnicity, academic grades in school, and sexual identity) were calculated. Multivariable analyses controlling for student characteristics examined associations between risk behaviors. Approximately 43.1% of U.S. high school students did not always wear a seat belt and 16.7% rode with a drinking driver during the 30 days before the survey. Approximately 59.9% of students had driven a car during the 30 days before the survey. Among students who drove, 5.4% had driven after drinking alcohol and 39.0% had texted or e-mailed while driving. Prevalence of not always wearing a seat belt was higher among students who were younger, black, or had lower grades. Riding with a drinking driver was higher among Hispanic students or students with lower grades. Driving after drinking alcohol was higher among students who were older, male, Hispanic, or had lower grades. Texting while driving was higher among older students or white students. Few differences existed by sexual identity. Multivariable analyses revealed that students engaging in one transportation risk behavior were more likely to engage in other transportation risk behaviors. Traffic safety and public health professionals can use these findings to reduce transportation risk behaviors by selecting, implementing, and contextualizing the most appropriate and effective strategies for specific populations and for the environment.

Analysis of restraint use in pregnant versus non-pregnant populations involved in motor vehicle collisions.

BACKGROUND: Traumatic injuries obtained by pregnant females in motor vehicle collisions present unique treatment challenges for trauma and orthopaedic surgeons. Understanding safety choices in this population can help physicians and public safety advocates in delivering effective and targeted safety messages. METHODS: A publicly available, de-identified national data set that documents crash information (NASS-CDS) was examined to identify cohorts of pregnant and non-pregnant vehicle occupants and regression analysis employed to identify factors associated with belt non-use. RESULTS: Pregnant women were found to have significantly lower rates of belt use compared to non-pregnant females (70.0% vs. 90.3%, Rao-Scott Sample Weighted Chi-Square p = 0.0265). Logistic regression identified younger age and sitting in the back seat as associated with lower rates of belt use. CONCLUSION: Pregnant women wear belts at significantly lower frequencies than non-pregnant women and youth and second row seating increase noncompliance rates. This work suggests the need for targeted intervention strategies to improve belt compliance.

State-level seat belt use in the United States, 2011-2016: Comparison of self-reported with observed use and use by fatally injured occupants.

INTRODUCTION: Despite 49 states and the District of Columbia having seat belt laws that permit either primary or secondary enforcement, nearly half of persons who die in passenger vehicle crashes in the United States are unbelted. Monitoring seat belt use is important for measuring the effectiveness of strategies to increase belt use. OBJECTIVE: Document self-reported seat belt use by state seat belt enforcement type and compare 2016 self-reported belt use with observed use and use among passenger vehicle occupant (PVO) fatalities. METHODS: We analyzed the Behavioral Risk Factor Surveillance System (BRFSS) self-reported seat belt use data during 2011-2016. The Pearson correlation coefficient (r) was used to compare the 2016 BRFSS state estimates with observed seat belt use from state-based surveys and with unrestrained PVO fatalities from the Fatality Analysis Reporting System. RESULTS: During 2011-2016, national self-reported seat belt use ranged from 86-88%. In 2016, national self-reported use (87%) lagged observed use (90%) by 3 percentage points. By state, the 2016 self-reported use ranged from 64% in South Dakota to 93% in California, Hawaii, and Oregon. Seat belt use averaged 7 percentage points higher in primary enforcement states (89%) than in secondary states (82%). Self-reported state estimates were strongly positively correlated with state observational estimates (r = 0.80) and strongly negatively correlated with the proportion of unrestrained PVO fatalities (r = -0.77). CONCLUSION: National self-reported seat belt use remained essentially stable during 2011-2016 at around 87%, but large variations existed across states. Practical Applications: If seat belt use in secondary enforcement states matched use in primary enforcement states for 2016, an additional 3.98 million adults would have been belted. Renewed attention to increasing seat belt use will be needed to reduce motor-vehicle fatalities. Self-reported and observational seat belt data complement one another and can aid in designing targeted and multifaceted interventions.

Investigating traffic fatality trends and restraint use among rear-seat passengers in the United States, 2000-2016.

INTRODUCTION: Motor-vehicle crash is one of the leading causes of unintentional injury death in the United States. Previous studies focused on fatalities among drivers and front-seat passengers, with a limited number of studies examining rear-seat passenger fatalities. The objectives of this study were to assess trends in rear-seat passenger motor-vehicle fatalities in the United States from 2000 to 2016 and to identify demographic factors associated with being unrestrained among fatally injured rear-seat passengers. METHODS: Rear-seat passenger fatality data were obtained from the Fatality Analysis Reporting System (FARS) database. The fatality rate ratios for overall rear-seat passengers and for different age and sex groups were determined by comparing fatality rates in 2000 and 2016 using random effects models. Risk ratios of being unrestrained for age and sex groups were obtained using general estimating equations. RESULTS: Compared to 2000, the overall rear-seat passenger fatality rate in 2016 decreased by 44% (95% confidence interval [CI]: 39-49%). In particular, the fatality rate among rear-seat passengers decreased more in males than females, and passengers aged 14-19 years experienced a larger decline than all other age groups. Fatally injured male rear-seat passengers had a higher risk of being unrestrained (adjusted risk ratio: 1.06, 95% CI: 1.04-1.07) than their female counterparts, and both youngest (≤13 years) and oldest (65-85 years) passengers were less likely to be unrestrained than those aged 20-64 years. CONCLUSIONS: Overall, fatality rates among rear-seat passengers have declined, with differential degrees of improvement by age and sex. Practical Applications: Continued restraint use enforcement campaigns targeted at teenagers and males would further preserve them from fatal injuries and improve traffic safety for the overall population.

Association of habitual alcohol use on risk-taking behaviors while using a car: The Korean National Health and Nutrition Examination Survey 2009-2013.

BACKGROUND: Using the Alcohol Use Disorders Identification Test-Korean revised version (AUDIT-KR), we examined the association between habitual alcohol use and risk-taking behaviors among car users. METHODS: We used the data of 15,043 car users aged 20 years or older from the Korea National Health and Nutrition Examination Survey (KNHANES) conducted between 2009 and 2013. Multivariable logistic regression analysis was used to investigate the associations between alcohol use and risk-taking behaviors (i.e., driving under the influence of alcohol, riding in a car being driven under the influence, not wearing a seat belt while driving, not wearing a seat belt in the passenger seat), while adjusting for individual-level covariates. RESULTS: Compared to low-risk drinkers, high-risk drinkers (adjusted odds ratio [Adj.OR] 2.18, 95 % CI 1.96-2.42) and intermediate-risk drinkers (Adj.OR 1.39, 95 % CI 1.26-1.54) had higher odds of risk-taking behaviors while using a car. Stratifying by sociodemographic variables (i.e., sex, age, and region) led to differences in the relationship between alcohol-drinking level and risk-taking behaviors. Furthermore, alcohol-drinking level had significant positive associations with most of risk-taking behaviors, especially driving under the influence of alcohol and using a car with a drunken driver. CONCLUSION: Car users with high levels of alcohol consumption are more likely to be involved in risk-taking behaviors, especially in driving under the influence of alcohol. While causal relations cannot be established due to the nature of the cross-sectional design, it is possible that individuals' habitual alcohol consumption level can influence their risk-taking behaviors while using a car.

Health Risk Factors Among Miners, Oil and Gas Extraction Workers, Other Manual Labor Workers, and Nonmanual Labor Workers, BRFSS 2013-2017, 32 States.

Background: Analyzing health risk factors among current workers by industry and occupation (IO) provides information on disparities between worker groups, especially when comparing workers within manual labor occupations. Mining and oil and gas extraction (OGE) are unique industries with different work environments that could affect health risk factors. The study objective was to compare the prevalence of health risk factors of miners, OGE, other manual labor, and nonmanual labor workers. Methods: The Behavioral Risk Factor Surveillance System's IO module was analyzed for years 2013-2017 to compare prevalences of excessive alcohol use, smoking, smokeless tobacco use, seat belt use, inadequate sleep, and obesity among four worker groups. National Health Interview Survey IO codes were used to categorize miners, OGE, other manual labor, and nonmanual labor workers. Findings: Miners and OGE workers had higher prevalence estimates than both nonmanual and manual labor workers for all health risk factors except current smoking. Both miners and OGE workers were significantly more likely than other manual labor workers to report smokeless tobacco use and not always wearing seatbelts. Compared with other manual labor workers, OGE workers were significantly more likely to report obesity, and miners were significantly more likely to report inadequate sleep. Conclusion/Application to Practice: Prevalence of most health risk factors differed among miners, OGE, other manual labor, and nonmanual labor workers. These differences could lead to disparities in health outcomes. Occupational health professionals in mining and OGE can use this information to inform and target integrated wellness and health and safety programs.

The Impact of Seat Belt Use in Pregnancy on Injuries and Outcomes After Motor Vehicle Collisions.

BACKGROUND: Seat belt use during motor vehicle collisions (MVCs) has been shown to alter adults' intra-abdominal injury patterns, although the effect of seat belt use in pregnant women is unclear. The objective of this study was to determine the impact of seat belt use in pregnancy on injuries and outcomes after MVCs. METHODS: Patients injured by MVCs were identified from the National Trauma Data Bank (2007-2014). The exclusion criteria were transfer from an outside hospital, male or unspecified sex, missing restraint data, and nonchildbearing age. Demographics, clinical/injury data, pregnancy status, seat belt use, and outcomes were collected. Study groups were dichotomized by pregnancy status with subgroup analysis by seat belt use. Univariate/multivariate analyses compared outcomes and determined predictors of seat belt use. RESULTS: After exclusions, 162,964 women were included, of which 680 (<1%) were pregnant. Intra-abdominal injuries during pregnancy did not vary according to seat belt use (P > 0.05). Unrestrained pregnant women were more injured (Injury Severity Score: 13 versus 7, P < 0.001), more likely to need emergent operation (14% versus 10%, P < 0.001), and had a longer hospital stay (6 versus 4 d, P = 0.012) than restrained counterparts. On multivariate analysis among pregnant women, seat belt use was associated with age ≥25 y (odds ratio: 2.033, P = 0.001). The lack of restraint use was associated with the position in the passenger seat (odds ratio: 0.521, P = 0.001). CONCLUSIONS: Seat belt use in pregnancy does not alter abdominal injury patterns but is associated with lower injury severity, reduced need for emergent surgery, and shortened hospital stay. Public health interventions emphasizing the importance of seat belts could be focused on younger patients and vehicle passengers to reach the high-risk pregnant subset.

Prevalence of child passenger restraint use in Shantou, China from 2012 to 2017.

BACKGROUND: Child passenger safety is an important public health problem in China. This study aimed to examine the prevalence of child passenger restraint use while riding in a car in the city of Shantou in China from 2012 to 2017. METHODS: Three large-scale cross-sectional observational studies were conducted in 2012, 2015 and 2017, respectively. The observation sites included randomly selected hospitals, kindergartens, and primary and secondary schools. The outcome measures included the changes in percentages of seating position (e.g., front vs. rear), whether sitting on lap, and use of child restraint systems (CRS) or seat belts by year and by age group. Descriptive statistics, Chi-square tests and logistic regression were used to address the study aims. RESULTS: A total of 9858 commuting children aged 17 and younger were observed in passenger cars in Shantou, China during the study. The proportion of children aged 0-5 sitting on adult's lap decreased from 26.6% in 2012 to 24.6% in 2017, while the proportion of CRS use among the children sitting in the rear row increased among children aged 0-5 (from 0.7% in 2012 to 14.2% in 2017) and children aged 6-11 (from 0.7% in 2012 to 2.4% in 2017). Comparing children aged 0-11 in 2012, children in the same ages were less likely to sit in the front row in 2015 (OR = 0.42, 95%CI = 0.37, 0.48) and in 2017 (OR = 0.27, 95%CI = 0.23, 0.31). Children aged 0-11 were more likely to sit in the rear row with CRS use in 2015 (OR = 8.50, 95%CI = 5.44, 13.28) and in 2017 (OR = 10.95, 95%CI = 7.02, 17.08) comparing with children in the same ages in 2012. As for children aged 12-17, they were more likely to use seat belt in 2017 (OR = 1.40, 95%CI = 1.06, 1.85) compared with those children in 2012. CONCLUSIONS: While child passenger safety behaviors improved from 2012 to 2017 in Shantou, China, more efforts are needed to protect child passengers from injuries.

Exploring the role of delta-V in influencing occupant injury severities - A mediation analysis approach to motor vehicle collisions.

This study investigates the impact that delta-V, the relative change in vehicle velocity pre- and post-crash, has on the severity of motor vehicle collisions (MVCs). We study injury severity using two metrics for each occupant - the number of injuries suffered, and the probability of suffering a serious or worse (MAIS 3+) injury. We use a cross-sectional set of generally-representative MVC data between 2010 and 2015 as a basis for our research. Collision factors that influence the crash environment are combined with the injuries that were suffered in MVCs. The influence of delta-V is captured using a mediation analysis, whereby delta-V acts as the focal point between crash factors and injury outcome. The mediation approach adds to existing research by presenting a detailed view of the relationship between injury severity, delta-V and other collision factors. We find evidence of competitive mediation, wherein a collision factor's positive association with injury severity is offset by a negative association with delta-V. Neglecting to include delta-V in our study would have let the factor's association with injury severity go undiscovered. In addition, certain collision factors are found to be related to injury severity solely because of delta-V, while others are found to have a significant impact regardless of delta-V. Our results support the multitude of policy recommendations that promote seatbelt use and warn against alcohol-impaired driving, and support the proliferation of safety-enabled vehicles whose technology can mitigate the bodily damage associated with detrimental crash types.