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-enforcement—in the context of fewer fatal speed and alcohol-involved crashes—suggests that the mechanism(s) through which high visibility seat belt enforcement lowers mortality is through impacting multiple risky driving behaviors.
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.
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).
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).
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.
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.
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.
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).
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).
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.
Epidemiologic study, level III.
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.
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.
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 (
= 115,939) and rear-seated (
= 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.
Compared to front-seated occupants, those rear-seated were more likely to be unrestrained (21.2% vs. 4.3%,
< 0.0001) and to have more moderate-to-severe injury/death (11.9% vs. 11.3%,
< 0.0001). Compared to restrained rear-seated occupants, unrestrained rear-seated occupants had higher moderate-to-severe injury/death (21.5% vs. 7.5%,
< 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.
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.
► Coverage by nighttime GDL at fatal crash was 90.1% of 15-year-olds, 84.4% of 16-year-olds and 29.5% of 17-year-olds. ► Total non-compliance with nighttime GDL laws was 14.9% at time of fatal motor ...vehicle crash. ► Nighttime non-compliance was 18.8% for crashes in which the driver died. ► Over one half of all nighttime GDL non-compliant crashes took place on Friday and Saturday nights. ► The new social definition of the weekend captured a 10% higher mortality rate compared to traditional weekend definitions.
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.
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.
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).
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.
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 (
= 1667) and non-Indian lands in adjacent states (
= 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%,
< 0.0001) and for pediatric passengers (33.1% vs. 59.3%,
< 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.
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.
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 (
= 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).
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%,
< 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 (
< 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).
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.
Mortality trends across modifiable injury mechanisms may reflect how well effective injury prevention efforts are penetrating high-risk populations. This study examined all-cause, unintentional, and ...intentional injury-related mortality in children who were aged 0 to 4 years for evidence of and to quantify racial disparities by injury mechanism.
Injury analyses used national vital statistics data from January 1, 1981, to December 31, 2003, that were available from the Centers for Disease Control and Prevention. Rate calculations and chi2 test for trends (Mantel extension) used data that were collapsed into 3-year intervals to produce cell sizes with stable estimates. Percentage change for mortality rate ratios used the earliest (1981-1983) and the latest (2001-2003) study period for black, American Indian/Alaskan Native, and Asian/Pacific Islander children, with white children as the comparison group.
All-cause injury rates declined during the study period, but current mortality ratios for all-cause injury remained higher in black and American Indian/Alaskan Native children and lower in Asian/Pacific Islander children compared with white children. Trend analyses within racial groups demonstrate significant improvements in all groups for unintentional but not intentional injury. Black and American Indian/Alaskan Native children had higher injury risk as a result of residential fire, suffocation, poisoning, falls, motor vehicle traffic, and firearms. Disparities narrowed for residential fire, pedestrian, and poisoning and widened for motor vehicle occupant, unspecified motor vehicle, and suffocation for black and American Indian/Alaskan Native children.
These findings identify injury areas in which disparities narrowed, improvement occurred with maintenance or widening of disparities, and little or no progress was evident. This study further suggests specific mechanisms whereby new strategies and approaches to address areas that are recalcitrant to improvement in absolute rates and/or narrowing of disparities are needed and where increased dissemination of proven efficacious injury prevention efforts to high-risk populations are indicated.
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