Jeffrey C. Lunnen

Quantifying the underestimated burden of road traffic mortality in Mexico: a comparison of three approaches

Introduction: We present a novel multistep technique to estimate the actual burden of road traffic mortality in Mexico during the time period 1999 to 2009 by comparing 3 approaches for redistribution of nonspecific (“garbage”) International Classification of Diseases (ICD)-coded deaths. Methods: Road traffic (RT) mortality data were extracted using a secondary analysis of the Mexican mortality databases for the period 1999 to 2009. In an attempt to correct for underestimation due to inappropriately coded deaths, those deaths assigned to nonspecific codes were redistributed utilizing 3 different adjustment methods. A comparison of the 3 adjustment approaches (proportional, multiple imputation, and regression) is presented. A Poisson regression analysis was utilized to model mortality trends in the raw data and the 3 estimates. Results: After adjustments, the total number of RT deaths increased by 18 to 45 percent, showing significant underestimation when only the raw data are used. All 3 approaches showed statistically significantly higher RT mortality rates than the crude figures. The proportional approach resulted in the highest RT mortality rate estimate of 23 per 100,000 in 2009 and showed a statistically significant positive increase of 1.5 percent per year across the decade. The 60+ age group and pedestrians had the highest mortality rates of 40 and 10.3 per 100,000, respectively. Over the decade, there was an alarming 332 percent increase in the mortality rate for male motorcyclists. Conclusion: Though efforts to improve coding should continue to be implemented, we present an additional and often overlooked contribution to the underestimation of road traffic mortality: the ICD nonspecific codes. Improved estimates of road traffic mortality are important in Mexico for policy change and decision making, highlighting the importance of targeting road traffic deaths as a public health problem. The approach presented here may also be useful for estimating the burden of other deaths with similar coding problems.

Global childhood unintentional injury study: multisite surveillance data.

OBJECTIVES We aimed to analyze the epidemiology of childhood unintentional injuries presenting to hospitals in 5 select sites in low- and middle-income countries (LMICs) (Bangladesh, Colombia, Egypt, Malaysia, and Pakistan). METHODS We collected standardized data from children ages 0 to 12 years at participating emergency departments (EDs) in 2007. Statistical analyses were conducted to compare the characteristics of these injuries and to explore the determinants of injury outcomes. RESULTS Among 2686 injured children, falls (50.4%) and road traffic injuries (16.4%) were the most common, affecting boys more often (64.7%). Home injuries were more common among younger children (average 5.41 vs 7.06 years) and girls (38.2% vs 31.7%). Following an ED visit, 24% of injured children were admitted to the hospital, and 6 died. Injury outcomes were associated with risk factors, such as age and sex, to varying extents. CONCLUSIONS Standardized ED surveillance revealed unintentional injuries are a threat to child health. The majority of events took place inside the home, challenging traditional concepts of childrens safety and underscoring the need for intensified context-appropriate injury prevention.

Drinking and Driving in Vietnam: Public Knowledge, Attitudes, and Practices

Objective: Injuries are among the 10 leading causes of death for all ages in Vietnam, and road traffic fatalities account for approximately half of those deaths. Despite having what is considered to be one of the most stringent alcohol legislations in the region, alcohol involvement in road traffic crashes remains high. This study aims to illustrate the knowledge, attitudes, and practices around alcohol use and drinking and driving by age and sex in 3 provinces in Vietnam. Methods: This study was conducted between January and February 2011, surveying randomly selected road users over the age of 17 years at gas stations in 3 provinces: Ha Nam, Ninh Binh, and Bac Giang, Vietnam. Data were collected for one week at each gas station. A knowledge, attitudes, and practices (KAPs) survey was administered in 7 time blocks of 90 min throughout the day, from 07:30 am to 9:30 pm. Results: There were a total of 633 respondents almost evenly divided among the 3 provinces. Males accounted for 69.1 percent of respondents; the majority were 36 years of age or younger. Despite the belief that drinking and driving will increase the risk of a crash, a significant proportion of respondents (44.9%) reported drinking and driving; 56.7 percent admitted to drinking and driving within the last month. Drinking and driving was more common among males, with approximately 60.2 percent indicating a history of drinking and driving. This proportion was particularly high among males aged 17 to 26 (71.4%). It was found that preferred alternatives to drinking and driving when available were leaving with a nondrinker (42%), resting until “feeling conscious” (23%), and drinking less (20%). Conclusions: This study shows that, in general, alcohol use and drinking and driving remain a problem in Vietnam, a major concern given that the country is rapidly motorizing and likewise increasing the likelihood of road traffic crashes in the absence of effective interventions. To target drinking and driving in Vietnam we call for a multifaceted approach, including social marketing and public education campaigns, enhanced enforcement, and programs that either limit the number of drinks to drivers or young individuals or those that provide alternatives to drinking and driving.

The prevalence of mobile phone use among motorcyclists in three Mexican cities

Objective: To quantify the prevalence of mobile phone use among motorcyclists in 3 Mexican cities and to identify associated factors. Methods: Two rounds of roadside observations were conducted in Guadalajara-Zapopan, León, and Cuernavaca from December 2011 to May 2012. Observation sites were selected randomly and all motorcyclists circulating at those sites were recorded. Motorcyclists observed talking into a phone (either handheld or hands-free) or texting were recorded as using a mobile phone while driving. Results: A total of 4244 motorcyclists were observed. The overall prevalence of mobile phone use was 0.64 percent (95% confidence interval [CI]: 0.42–0.92); it was highest in Guadalajara-Zapopan (1.03%; 95% CI: 0.61–1.63) and among motorcyclists not using a helmet (1.45% versus 0.4%; P = .000) and those riding on 1-lane roads (1.6% versus 0.8% on 2-lane roads and 0.5% in 3- to 5-lane roads; P = .046). Conclusions: To our knowledge this is the first study that reports the prevalence of mobile phone use while driving among motorcyclists. The observed prevalence is higher than the prevalence stated in a previous report from China on electric bicycle riders. This risk factor should be monitored in the future given the growing popularity of motorcycles and the availability of mobile devices. Current legislation should be enforced to avoid potential injuries and deaths attributable to this risk factor.

Distracted driving: mobile phone use while driving in three Mexican cities.

Mexico has a significant road traffic injury and mortality burden, and several states/municipalities have begun passing legislation restricting mobile phone use while driving (MPUWD). Little information is available about the prevalence of MPUWD in Mexico. This study measures the prevalence of mobile phone talking and texting among drivers in three cities, and identifies associated demographic and environmental factors. Two rounds of roadside observations from a group of randomly selected automobile drivers were conducted during 2011–2012 in Guadalajara-Zapopan, León and Cuernavaca. The overall prevalence of MPUWD was 10.78%; it was highest in Guadalajara-Zapopan (13.93%, 95% CI 12.87 to 15.05), lowest in Cuernavaca (7.42%, 95% CI 6.29 to 8.67), and remained stable over two rounds of observations, except for León, where the prevalence increased from 5.27% to 10.37% (p=0.000). Driving alone on major roads in non-taxi cars during the weekdays was associated with MPUWD. Results highlight the importance of studying the risk of mobile phone use, and designing and evaluating specific preventive interventions to address this problem in Mexico.

Traumatismos causados por el tránsito en países en desarrollo: agenda de investigación y de acción

Road traffic injury (RTI) is the leading cause of death in persons aged 10-24 worldwide and accounts for about 15% of all male deaths. The burden of RTI is unevenly distributed amongst countries with over eighty-fold differences between the highest and lowest death rates. Thus the unequal risk of RTI occurring in the developing world, due to many reasons, including but not limited to rapid motorization and poor infrastructure, is a major global challenge. This editorial highlights a number of key issues that must inform programs designed to prevent RTI in the developing world, where the epidemic is all the more insidious. firstly, road safety is a development issue; secondly, road traffic injury is a major health issue; thirdly, road traffic injuries can be prevented by the implementation of scientific measures; fourthly, pre-hospital and hospital emergency care is needed; and fifthly, research on RTI is neglected in low-income and middle-income countries. The repercussion of such progress to Peru is also discussed.

The use of seatbelts and child restraints in three Mexican cities

Seatbelts and child restraints can reduce deaths resulting from road traffic crashes, and are one of the risk factors being targeted by the Road Safety in 10 Countries project in Mexico. This study quantifies the prevalence of restraint use in two of the intervention sites (Guadalajara-Zapopan and León) and one comparison site (Cuernavaca). Three rounds of roadside observations were conducted between November 2010 and January 2012. The overall prevalence of seatbelt use was 45.0% (95% CI = 44.3–45.7) amongst all occupants ≥10 years of age in the three cities. Child restraint use in children <5 years of age ranged from 7.9 to 17.4%. Two rounds of surveys were administered to all road traffic injury (RTI) victims presenting at a tertiary hospital in each city; RTI victims had lower seatbelt use than the general population (31% vs 42%, p = 0.037). This study demonstrates the need for further targeted intervention to increase use of these highly efficacious safety devices in Mexico.

Reduction of childhood mortality through millennium development goal 4.

Will not be maximised unless injury prevention is integrated into the overall plan

Alcohol Consumption Among Drivers in Curitiba, Brazil

Introduction: The combination of drinking and driving is globally understood as a risk factor for road traffic crashes and disastrous outcomes such as injury and disability or death. However, the magnitude of the problem may not always be known in many countries, particularly where there are legislative loopholes. In Brazil, until December 2012, verification by breathalyzer of drinking and driving was dependent on drivers’ acceptance of the tests after being stopped by the police. Objective: To describe the epidemiological profile of drinking and driving behaviors of a sample of drivers from Curitiba, Brazil, and explore the sociodemographic characteristics of those interviewed at police sobriety checkpoints. Methods: Drivers were selected and interviewed at police checkpoints on public roads in Curitiba. The local police, after informed consent, applied breathalyzer tests to check the drivers’ blood alcohol content and the results were compared with data previously collected through interviews containing self-reports of drinking and driving. Data were collected between March and November 2012. Results: Of the 511 drivers asked to participate in the study, 398 (77.9%) agreed to give a roadside interview. Most respondents were single men between the ages of 18 and 29 years, with 8.3% of interviewed drivers self-reporting alcohol consumption in the last 6 h before driving. On the other hand, only 46.2% of the whole sample accepted the breathalyzer testing. Among those breathalyzed by the police, 2.7% tested positive for alcohol. Discussion: This study, conducted on public roads in Curitiba, shows a noticeable proportion of drivers voluntarily self-reporting drinking and driving. However, a smaller percentage was confirmed to have positive blood alcohol content, likely due to the high breathalyzer refusal rate.

The prevalence of motorcycle helmet use from serial observations in three Mexican cities

Motorcycle use as a functional and recreational means of transportation is increasing in Mexico; the associated mortality rate has also increased. Appropriate helmet use can reduce a motorcyclists risk of death or serious injury. This study quantified the prevalence of motorcycle helmet use in three Mexican cities (Cuernavaca, Guadalajara-Zapopan, and León) within the context of several ongoing road safety initiatives. Four rounds of roadside observations were conducted between November 2010 and April 2012. The overall prevalence of helmet use was 73.8% among all users; helmet use was much lower among females (55.3%). Drivers tended to use helmets more frequently than passengers (76.3% vs. 51.6%). The prevalence was higher in León (85.9%, 95% CI = 84.8–87.0) than Cuernavaca (71.5%, 95% CI = 69.3–73.6) and Guadalajara-Zapopan (62.7%, 95% CI = 61.1–64.2). Helmet use decreased in León (p = 0.003) but increased in Guadalajara-Zapopan (p = 0.000) during this period. Motorcycle helmet use could be improved in all three cities. Since motorcycle use is increasing, interventions targeting motorcycle users and greater enforcement of helmet use are necessary to reduce crashes and non-fatal and fatal injuries.