Bethany A. West

All-terrain vehicle-related nonfatal injuries among young riders in the United States, 2001-2010.

OBJECTIVE: To estimate the numbers and rates of all-terrain vehicle (ATV)–related nonfatal injuries among riders aged ≤15 years treated in hospital emergency departments (EDs) in the United States during 2001–2010. METHODS: National Electronic Injury Surveillance System–All Injury Program data for 2001–2010 were analyzed. Numbers and rates of injuries were examined by age group, gender, primary body part injured, diagnosis, and hospital admission status. RESULTS: During 2001–2010, an estimated 361 161 ATV riders aged ≤15 years were treated in EDs for ATV-related injuries. The injury rate peaked at 67 per 100 000 children in 2004 and then declined to 42 per 100 000 children by 2010. The annualized injury rate for boys was double that of girls (73 vs 37 per 100 000). Children aged 11 to 15 years accounted for two-thirds of all ED visits and hospitalizations. Fractures accounted for 28% of ED visits and 45% of hospitalizations. CONCLUSIONS: The reasons for the decline in ATV-related injuries among young riders are not well understood but might be related to the economic recession of the mid-2000s and decreased sales of new ATVs. Although many states have regulations governing children’s use of ATVs, their effectiveness in reducing injuries is unclear. Broader use of known effective safety measures, including prohibiting children aged ≤15 years from riding adult-sized ATVs, always wearing a helmet while riding, not riding on paved roads, and not riding as or carrying a passenger could additionally reduce ATV-related injuries among children. Last, more research to better understand ATV crash dynamics might lead to safer designs for ATVs.

Fatal Crashes of 16- to 17-Year-Old Drivers Involving Alcohol, Nighttime Driving, and Passengers

Objective: The objective of this study was to provide a contemporary analysis of the alcohol-impaired driving problem among 16- to 17-year-olds and to consider the potential role of night and passenger restrictions in dealing with the alcohol problem by determining how many of the alcohol-related crashes take place at night or with passengers. Methods: The data were derived from the Fatality Analysis Reporting System for 16- to 17-year-old passenger vehicle drivers in fatal crashes during 2005–2009. Results: During the 5-year period, 15 percent of the 8664 16- to 17-year-old drivers in fatal crashes had positive blood alcohol concentrations, most of which were 0.08 percent or greater. Drivers in alcohol-related crashes were more likely than those in non-alcohol-related crashes to be male, unbelted, in single vehicles, and speeding, and their crashes were more likely to occur on Saturday or Sunday, at night, and when passengers were present. Of the alcohol-related crashes, 88 percent took place at night or with passengers present or both, as did 67 percent of the non-alcohol-related crashes. Conclusions: Stronger night and passenger restrictions with increased compliance and greater application of alcohol-specific policies would likely be effective in reducing the alcohol-related and non-alcohol-related crashes of 16- to 17-year-olds. Increasing the licensing age beyond age 16 would supplement the effectiveness of these actions.

ATV riding and helmet use among youth aged 12-17 years, USA, 2011: results from the YouthStyles survey

Background National estimates of all-terrain vehicle (ATV) riding patterns among youth in the USA are lacking. Methods We analysed the 2011 YouthStyles survey to estimate the proportion of 12–17 year olds in the USA who had ridden an ATV at least once during the past 12 months and summarise their patterns of helmet use. Results Of the 831 youth respondents, an estimated 25% reported riding an ATV at least once during the past year. The proportion of youth living outside of a Metropolitan Statistical Area who reported riding an ATV was twice that of those living inside of a Metropolitan Statistical Area. Males and females reported similar proportions of riding at least once during the past year, but among riders, the proportion of males who rode ≥6 times was triple that of females. Only 45% of riders reported always wearing a helmet, and 25% reported never wearing a helmet. The most frequent riders had the lowest consistent helmet use, with 8 of 10 youth who rode ≥6 times during the past year not always wearing a helmet. Conclusions ATV riding appears to remain popular among youth in the USA, particularly in rural areas, and consistent helmet use while riding is low. A more thorough understanding of gender differences in ATV riding patterns among youth and perceived risks and benefits of both safe and unsafe riding practices might help inform future ATV injury prevention efforts.

Adult opinions about the age at which children can be left home alone, bathe alone, or bike alone: Second Injury Control and Risk Survey (ICARIS-2)

PROBLEM This study describes adult opinions about child supervision during various activities. METHODS Data come from a survey of U.S. adults. Respondents were asked the minimum age a child could safely: stay home alone; bathe alone; or ride a bike alone. Respondents with children were asked if their child had ever been allowed to: play outside alone; play in a room at home for more than 10 minutes alone; bathe with another child; or bathe alone. RESULTS The mean age that adults believed a child could be home alone was 13.0 years (95% CI=12.9-13.1), bathe alone was 7.5 years (95% CI=7.4-7.6), or bike alone was 10.1 years (95% CI=10.0-10.3). There were significant differences by income, education, and race. DISCUSSION Assessing adults understanding of the appropriate age for independent action helps set a context for providing guidance on parental supervision. Guidelines for parents should acknowledge social norms and child development stages. IMPACT ON INDUSTRY Knowledge of social norms can help guide injury prevention messages for parents.

Driving self-regulation and ride service utilization in a multicommunity, multistate sample of U.S. older adults

ABSTRACT Objectives: This study examined a multicommunity alternative transportation program available 24 hours a day, 7 days a week, for any purpose, offering door-through-door service in private automobiles to members who either do not drive or are transitioning away from driving. Specific aims were to describe the characteristics of members by driving status and ride service usage of these members. Methods: Data came from administrative records maintained by a nonprofit ride service program and include 2,661 individuals aged 65+ residing in 14 states who joined the program between April 1, 2010, and November 8, 2013. Latent class analysis was used to group current drivers into 3 classes of driving status of low, medium, and high self-regulation, based on their self-reported avoidance of certain driving situations and weekly driving frequency. Demographics and ride service use rate for rides taken through March 31, 2014, by type of ride (e.g., medical, social, etc.) were calculated for nondrivers and drivers in each driving status class. Results: The majority of ride service users were female (77%) and aged 65–74 years (82%). The primary method of getting around when enrolling for the transportation service was by riding with a friend or family member (60%). Among the 67,883 rides given, nondrivers took the majority (69%) of rides. Medical rides were the most common, accounting for 40% of all rides. Conclusions: Reported ride usage suggests that older adults are willing to use such ride services for a variety of trips when these services are not limited to specific types (e.g., medical). Further research can help tailor strategies to encourage both nondrivers and drivers to make better use of alternative transportation that meets the special needs of older people.

Disparities in Motor Vehicle–Related Deaths Among Females—United States, 2005–2009

BACKGROUND In 2010, almost 11,000 females were killed in motor vehicle crashes, and racial/ethnic minorities were affected disproportionally. METHODS To assess disparities in motor vehicle-related death rates by race/ethnicity among females in the United States, the Centers for Disease Control and Prevention analyzed 2005-2009 data from the National Vital Statistics System. Death rates and corresponding 95% confidence intervals were calculated, and differences between 2005 and 2009 death rates were examined. RESULTS The motor vehicle-related death rate for females was 6.8 deaths per 100,000 population in 2009. American Indian/Alaska Native females had the highest motor vehicle-related death rates, followed by whites, blacks, Hispanics, and Asian/Pacific Islanders. The greatest decrease in death rates between 2005 and 2009 occurred among whites from a rate of 9.4 per 100,000 population (95% CI: 9.2-9.6) to 7.1 per 100,000 population (95% CI: 6.9-7.2; absolute rate change: -2.3; p<0.001). CONCLUSION Despite the recent declines in motor vehicle-related death rates noted in this article, the need remains for increased use of evidence-based strategies to reduce the burden of motor vehicle-related deaths among females overall and especially among American Indian/Alaska Natives.

How do older adult drivers self-regulate? Characteristics of self-regulation classes defined by latent class analysis ☆

PROBLEM Motor-vehicle crashes were the second leading cause of injury death for adults aged 65-84years in 2014. Some older drivers choose to self-regulate their driving to maintain mobility while reducing driving risk, yet the process remains poorly understood. METHODS Data from 729 older adults (aged ≥60years) who joined an older adult ride service program between April 1, 2010 and November 8, 2013 were analyzed to define and describe classes of driving self-regulation. Latent class analysis was employed to characterize older adult driving self-regulation classes using driving frequency and avoidance of seven driving situations. Logistic regression was used to explore associations between characteristics affecting mobility and self-regulation class. RESULTS Three classes were identified (low, medium, and high self-regulation). High self-regulating participants reported the highest proportion of always avoiding seven risky driving situations and the lowest driving frequency followed by medium and low self-regulators. Those who were female, aged 80years or older, visually impaired, assistive device users, and those with special health needs were more likely to be high self-regulating compared with low self-regulating. CONCLUSIONS AND PRACTICAL APPLICATIONS Avoidance of certain driving situations and weekly driving frequency are valid indicators for describing driving self-regulation classes in older adults. Understanding the unique characteristics and mobility limitations of each class can guide optimal transportation strategies for older adults.

Child safety and booster seat use in five tribal communities, 2010-2014

PROBLEM Motor-vehicle crashes are a leading cause of death for American Indian/Alaska Natives (AI/AN) including AI/AN children. Child safety seats prevent injury and death among children in a motor-vehicle crash, yet use is low among AI/AN children. METHODS To increase the use of child safety seats (CSS; car seats and booster seats), five tribal communities implemented evidence-based strategies from the Guide to Community Preventive Services during 2010-2014. Increased CSS use was evaluated through direct observational surveys and CSS event data. CSS events are used to check the installation, use, and safety of CSS and new CSS can be provided. RESULTS CSS use increased in all five programs (ranging from 6% to 40%). Four out of five programs exceeded their goals for increased use. Among the five communities, a total of 91 CSS events occurred resulting in 1417 CSS checked or provided. CONCLUSIONS AND PRACTICAL APPLICATIONS Evidence-based child passenger safety interventions are both feasible in and transferable to tribal communities.

300 Unlocking keys to effecive ignitiion interlock programs to reduce alcohol impaired driving

Background Ignition interlocks, when installed on vehicles of drivers convicted of alcohol-impaired driving (AID), reduce repeat arrest by 67%. However post-interlock removal, recidivism (AID re-arrest) among previous interlock users equals that of AID-convicted drivers who never used interlocks. Also, the low numbers of offenders installing interlocks limits the impact. Study objectives include determining interlock program characteristics associated with increased interlock use and evaluating including alcohol treatment in the program to reduce post-interlock recidivism. Methods To determine effective program characteristics, eight interlock program keys (e.g. requirement to instal interlocks) were identified and each rated on 1–5 scale for 28 U.S. state interlock programs. Correlation analysis between rate of interlocks in use/10,000 population, and program key rating was conducted. To evaluate treatment in the one state with a treatment program, survival analysis using Cox regression proportional hazards model was performed with post-interlock recidivism as the terminal event. The treatment group (n = 640) were offenders with three or more violations (two alcohol-positive start attempts within four hours) who completed alcohol treatment. A comparison group (n = 806) of those with one or two violations who did not attend alcohol treatment was created by matching to the treatment group on demographic and risk factors. Results The program keys most correlated with higher interlock rates were having a requirement to instal interlocks (r = 0.63), and monitoring to ensure interlocks are installed and used (r = 0.56). Incorporating alcohol treatment into an interlock program was effective with the treatment group experiencing 32% lower recidivism following interlock removal compared with the non-treatment group. Conclusions Strengthening program keys and incorporating treatment into interlock programs increases use of interlocks and reduces AID re-arrest.

957 The mobility planning tool: helping older adults prepare for changes in mobility

Background As we age our transportation options may become more limited due to mobility changes. These mobility changes may include declining driving abilities, or factors related to ageing and health. The objective of this study was to develop and evaluate a mobility assessment tool for older adults that would help them consider their mobility options as they age. Methods A four-page Mobility Assessment Tool was developed that was designed to identify current and future mobility needs and challenges. An evaluation questionnaire that measured mobiltiy-related attitudes, beliefs and opinions was administered by phone to 1000 respondents age 60–74 years, who reported good or very good mobility Respondents were asked initial questions, given the tool for review, and then asked follow-up questions. Also, respondents had the opportunity to comment on the usefulness of the tool as they consider alternative mobility options. Results Mobility-related attitudes increased after reviewing the tool. On a scale of 1–5 (where 1 equals “not at all” and 5 equals “very much”), the average scores increased for thinking about mobility from 2.4 to 3.4 (p < 0.0001), for thinking about protecting mobility from 2.5 to 3.8 (p < 0.0001), and for feeling confident about knowing how to protect mobility from 3.5 to 4.2 (p < 0.0001). The most frequently reported challenges to mobility were driving and other transportation barriers (48%) and physical mobility (18%). Most respondents found the tool understandable (97%) and easy to complete (94%) with two-thirds finding the tool relevant. Reasons given for not liking the tool included that it wasn’t applicable to their situation, or gave no new information. Conclusions Administering the Mobility Assessment Tool with older adults resulted in increased awareness of the mobility challenges they could face, and helped them be more confident of being able to protect and preserve mobility options as they age.