José Ignacio Nazif-Muñoz

Did Chile’s traffic law reform push police enforcement? Understanding Chile’s traffic fatalities and injuries reduction

Background The objective of the current study is to determine to what extent the reduction of Chile’s traffic fatalities and injuries during 2000–2012 was related to the police traffic enforcement increment registered after the introduction of its 2005 traffic law reform. Methods A unique dataset with assembled information from public institutions and analyses based on ordinary least square and robust random effects models was carried out. Dependent variables were traffic fatality and severe injury rates per population and vehicle fleet. Independent variables were: (1) presence of new national traffic law; (2) police officers per population; (3) number of traffic tickets per police officer; and (4) interaction effect of number of traffic tickets per police officer with traffic law reform. Oil prices, alcohol consumption, proportion of male population 15–24 years old, unemployment, road infrastructure investment, years’ effects and regions’ effects represented control variables. Results Empirical estimates from instrumental variables suggest that the enactment of the traffic law reform in interaction with number of traffic tickets per police officer is significantly associated with a decrease of 8% in traffic fatalities and 7% in severe injuries. Piecewise regression model results for the 2007–2012 period suggest that police traffic enforcement reduced traffic fatalities by 59% and severe injuries by 37%. Conclusions Findings suggest that traffic law reforms in order to have an effect on both traffic fatality and injury rates reduction require changes in police enforcement practices. Last, this case also illustrates how the diffusion of successful road safety practices globally promoted by WHO and World Bank can be an important influence for enhancing national road safety practices.

Did Child Restraint Laws Globally Converge? Examining 40 Years of Policy Diffusion.

Objective: The objective of the current study is to determine what factors have been associated with the global adoption of mandatory child restraint laws (ChRLs) since 1975. Methods: In order to determine what factors explained the global adoption of mandatory ChRLs, Weibull models were analyzed. To carry out this analysis, 170 countries were considered and the time risk corresponded to 5,146 observations for the period 1957–2013. The dependent variable was first time to adopt a ChRL. Independent variables representing global factors were the World Health Organization (WHO) and World Banks (WB) road safety global campaign; the Geneva Convention on Road Traffic; and the United Nations (UN) 1958 Vehicle Agreement. Independent variables representing regional factors were the creation of the European Transport Safety Council and being a Commonwealth country. Independent variables representing national factors were population; gross domestic product (GDP) per capita; political violence; existence of road safety nongovernmental organizations (NGOs); and existence of road safety agencies. Urbanization served as a control variable. To examine regional dynamics, Weibull models for Africa, Asia, Europe, North America, Latin America, the Caribbean, and the Commonwealth were also carried out. Results: Empirical estimates from full Weibull models suggest that 2 global factors and 2 national factors are significantly associated with the adoption of this measure. The global factors explaining adoption are the WHO and WBs road safety global campaign implemented after 2004 (P <.01), and the UNs 1958 Vehicle Agreement (P <.001). National factors were GDP (P <.01) and existence of road safety agencies (P <.05). The time parameter ρ for the full Weibull model was 1.425 (P <.001), suggesting that the likelihood of ChRL adoption increased over the observed period of time, confirming that the diffusion of this policy was global. Regional analysis showed that the UNs Convention on Road Traffic was significant in Asia, the creation of the European Transport Safety Council was significant in Europe and North America, and the global campaign was in Africa. In Commonwealth and European and North American countries, the existence of road safety agencies was also positively associated with ChRL adoption. Conclusions: Results of the world models suggest that the WHO and WBs global road safety campaign was effective in disseminating ChRLs after 2004. Furthermore, regions such as Asia and Europe and North America were early adopters since specific regional and national characteristics anticipated the introduction of this policy before 2004. In this particular case, the creation of the European Transport Safety Council was fundamental in promoting ChRLs. Thus, in order to introduce conditions to more rapidly diffuse road safety measures across lagging regions, the maintenance of global efforts and the creation of road safety regional organizations should be encouraged. Lastly, the case of ChRL convergence illustrates how mechanisms of global and regional diffusion need to be analytically differentiated in order better to assess the process of policy diffusion.

Explaining Chile's traffic fatality and injury reduction for 2000-2012

Objectives: The objective of the current study is to determine the contribution of Chiles 2005 traffic law reform, police enforcement, and road investment infrastructure to the reduction of traffic fatalities and severe injuries from 2000 to 2012. Methods: Analyses based on structural equation models were carried out using a unique database merging aggregate administrative data from several Chilean public institutions. The sample was balanced (13 regions, over 13 years; N = 169). Dependent variables were rates of traffic fatality (total, drivers, passengers, and pedestrians), severe injuries, and total number of crashes per vehicle fleet. Independent variables were (1) traffic law reform, (2) police enforcement, and (3) road infrastructure investment. Oil prices, alcohol consumption, proportion of male population 15–24 years old, unemployment, years’ effects and regions’ effects, and lagged dependent variables were entered as control variables. Results: Empirical estimates from the structural equation models suggest that the enactment of the traffic law reform is significantly associated with a 7% reduction of pedestrian fatalities. This association is entirely mediated by the positive association the law had with increasing police enforcement and reducing alcohol consumption. In turn, police enforcement is significantly associated with a direct decrease in total fatalities, driver fatalities, passenger fatalities, and pedestrian fatalities by 17%, 18%, 8%, and 60%, respectively. Finally, road infrastructure investment is significantly associated with a direct reduction of 11% in pedestrian fatalities, and the number of total crashes significantly mediates the effect of road infrastructure investment on the reduction of severe injuries. Tests of sensitivity indicate these effects and their statistical significance did not vary substantively with alternative model specifications. Conclusions: Results suggest that traffic law reform, police enforcement, and road infrastructure investment have complex interwoven effects that can reduce both traffic fatalities and severe injuries. Though traffic reforms are ultimately designed to change road user behaviors at large, it is also important to acknowledge that legislative changes may require institutional changes—that is, intensification of police enforcement—and be supported by road infrastructure investment, in order to effectively decrease traffic fatalities and injuries. Furthermore, depending on how road safety measures are designed, coordinated, and implemented, their effects on different types of road users vary. The case of Chile illustrates how the diffusion of road safety practices globally promoted by the World Health Organization and World Bank, particularly in 2004, can be an important influence to enhance national road safety practices.

Protecting only white children: the impact of child restraint legislation in Brazil

Background In 2010, Brazil introduced child restraint legislation (CRL). We assessed the effectiveness of CRL in reducing child (aged 0-8 years) injuries and fatalities by race. We performed an evaluation study with an interrupted time-series design. Methods We measured the effect of CRL on two outcomes-number of child deaths and number of child injured in traffic collisions per child population, stratified by race, from 2008 to 2014. We controlled for time, unemployment rate and oil consumption (barrels/day in thousands). Results The CRL was associated with a 3% reduction in the rate of child injuries among whites (incidence rate ratio (IRR): 0.97; 95% CI: 0.96-0.99), but no reduction in child injuries among non-whites (IRR: 0.99; 95% CI: 0.99-1.00). In the first month after the implementation of Brazils CRL we observed a 39% reduction in all child fatalities (IRR: 0.61; 95% CI: 0.44-0.84), including a 52% reduction among whites (IRR: 0.48; 95% CI: 0.33-0.68), but no reduction in non-white fatalities (IRR: 0.87; 95% CI: 0.55-1.37). Conclusions Our results support the hypothesis that socially advantaged populations were more likely to consistently adopt and employ restraint devices following the reform. Countries should also consider complementary policies that facilitate an equitable distribution of safety devices that reach vulnerable populations.

Child labour and health: a systematic review

ObjectivesThis study aimed to synthesise the available knowledge, identify unexplored areas and discuss general limits of the published evidence. We focused on outcomes commonly hypothesised to be affected by child labour: nutritional status, harmful exposures and injuries.MethodsFour electronic databases (EMBASE, MEDLINE, Scopus, ISI Web of Science) were searched in November 2017. All articles published since 1996, without restrictions on language, were considered for inclusion.ResultsOut of the 1090 abstracts initially identified by the search, 78 articles were selected for inclusion and reviewed. Most of the studies were conducted in Asia and South America, and only a third of them compared working children to a control group of non-working children. Child labour appears to be associated with poor nutritional status, diseases due to harmful exposures, and a higher prevalence of injuries.ConclusionsDespite evidence for a negative relation between child work and health, the cross-sectional design of most studies limits the causal interpretation of existing findings. More rigorous observational studies are needed to confirm and better quantify these associations.

Nonadult Supervision of Children in Low- and Middle-Income Countries: Results from 61 National Population-Based Surveys

Despite scarce empirical research in most countries, evidence has shown that young children are unsupervised or under the supervision of another young child while their adult caregivers attend work or engage in other activities outside the home. Lack of quality supervision has been linked to unintentional childhood injuries and other negative outcomes. Nationally representative, population-based data from rounds four and five of the Multiple Indicator Cluster Surveys (MICS) and four to eight of the Demographic and Health Surveys (DHS) from 61 low- and middle-income countries were used to estimate prevalence and socio-economic factors associated with leaving children under five years old home alone or under the care of another child younger than 10 years of age. Socio-economic factors included age and sex of the child, rurality, wealth, maternal education, and household composition. Large variations in the prevalence rates (0.1–35.3% for children home alone and 0.2–50.6% for children supervised by another child) and associated factors have been recorded within and across regions and countries. Understanding why and under what conditions children are home alone or under the supervision of another child is crucial to the development of suitable policies and interventions to protect young children, promote healthy growth, and support caregivers.

Impact of child restraint policies on child occupant fatalities and injuries in Chile and its regions: An interrupted time-series study

OBJECTIVES We assessed the effectiveness of the child restraint legislation (CRL) introduced in Chile in December 2005 and the National Decree enacted in February 2007, which regulated the technical characteristics of child restraint devices with the goal of reducing child occupant fatalities and severe injuries nationally and within Chiles regions. METHODS An interrupted time-series design was used to measure the effect of CRL and the National Decree on two dependent variables-number of child occupant deaths in traffic collisions and number of child occupants severely injured in traffic collisions per vehicle fleet from 2002 to 2014 (police data). Our analyses compared the incidence of these outcomes in the post-intervention period (2006 to 2014) with the period prior to these interventions (2002-2005) nationally and by region, controlling for several confounders. RESULTS Nationally, the child restraint policies were associated with a 39.3% (95% CI: 4.7; 73.9) reduction in child occupant fatalities, but no significant decrease was observed in child severe injuries. These interventions were associated with a 75.3% (95% CI: 15.6; 135.1) reduction in the rate of child occupant fatalities in the southern regions, and a 32.9% (95% CI: 1.1; 67.0) reduction in the rate of children severely injured in the northern regions. CONCLUSION In the short term, the CRL and the National Decree were associated with fewer child occupant fatalities, at the national level and in the southern regions, and severely injured child occupants in traffic collisions in Chiles northern regions. These results demonstrate a limited temporal and territorial impact. This suggests that to effectively protect vulnerable populations across all territories, efforts should be expanded more consistently and sustained over time.

Effectiveness of child restraints and booster legislation in Israel

Introduction 96 countries in the world have enacted child restraints and booster legislation (CRBL). Yet, findings regarding the effectiveness of CRBLs are mixed. The current study is the first to examine the association between Israel’s CRBL, implemented in November 2004, and the traffic injury and fatality rates among children aged 0–9 years. We extend on previous studies by accounting for risk exposure and by comparing populations of children affected by the legislation to those who were not. Methods We used an interrupted time series design of kilometre driven-based traffic injury rates for children aged 0–4 years and children aged 5–9 years using childred aged 10–14 years as a comparison group. We estimated the effects of Israel’s CRBL using monthly injury and fatality count data from the Israeli Central Bureau of Statistics. The sample includes all child vehicle occupants injured and killed in crashes in Israel between January 2003 and December 2011. Results Children aged 0–4 years experienced a 5.17% yearly reduction in traffic injury rate (incidence rate ratio (IRR): 0.94(95% CI 0.92 to 0.96); p=0.000), and the injury rate for children aged 5–9 years was associated with a 4.10% yearly reduction (IRR: 0.95(95% CI 0.93 to 0.98); p=0.001). The comprehensive CRBL implemented in Israel was associated with a 6.3% (95% CI −7.2% to5.5%; p=0.001) reduction in traffic injuries and fatalities for children aged 0–9 years. Conclusion This is the first study comparing traffic injury rates per kilometre driven for motor vehicle-occupant children before and after the implementation of the CRBL in Israel.