Kara E. MacLeod

Factors Associated with Hit-and-Run Pedestrian Fatalities and Driver Identification

As hit-and-run crashes account for a significant proportion of pedestrian fatalities, a better understanding of these crash types will assist efforts to reduce these fatalities. Of the more than 48,000 pedestrian deaths that were recorded in the United States between 1998 and 2007, 18.1% of them were caused by hit-and-run drivers. Using national data on single pedestrian-motor vehicle fatal crashes (1998-2007), logistic regression analyses were conducted to identify factors related to hit-and-run and to identify factors related to the identification of the hit-and-run driver. Results indicate an increased risk of hit-and-run in the early morning, poor light conditions, and on the weekend. There may also be an association between the type of victim and the likelihood of the driver leaving and being identified. Results also indicate that certain driver characteristics, behavior, and driving history are associated with hit-and-run. Alcohol use and invalid license were among the leading driver factor associated with an increased risk of hit-and-run. Prevention efforts that address such issues could substantially reduce pedestrian fatalities as a result of hit-and-run. However, more information about this driver population may be necessary.

Missed or Delayed Medical Care Appointments by Older Users of Nonemergency Medical Transportation

PURPOSE OF THE STUDY This study identified factors associated with canceling nonemergency medical transportation appointments among older adult Medicaid patients. DESIGN AND METHODS Data from 125,913 trips for 2,913 Delaware clients were examined. Mediation analyses, as well as, multivariate logistic regressions were conducted. RESULTS Over half of canceled trips were attributed to client reasons (e.g., no show, refusal). Client characteristics (e.g., race, sex, functional status) were associated with cancelations; however, these differed based on the cancelation reason. Regularly scheduled trips were less likely to be canceled. IMPLICATIONS The evolving American health care system may increase service availability. Additional policies can improve service accessibility and overcome utilization barriers.

Acceptance of drinking and driving and alcohol-involved driving crashes in California

BACKGROUND Alcohol-impaired driving accounts for substantial proportion of traffic-related fatalities in the U.S. Risk perceptions for drinking and driving have been associated with various measures of drinking and driving behavior. In an effort to understand how to intervene and to better understand how risk perceptions may be shaped, this study explored whether an objective environmental-level measure (proportion of alcohol-involved driving crashes in ones residential city) were related to individual-level perceptions and behavior. METHODS Using data from a 2012 cross-sectional roadside survey of 1147 weekend nighttime drivers in California, individual-level self-reported acceptance of drinking and driving and past-year drinking and driving were merged with traffic crash data using respondent ZIP codes. Population average logistic regression modeling was conducted for the odds of acceptance of drinking and driving and self-reported, past-year drinking and driving. RESULTS A non-linear relationship between city-level alcohol-involved traffic crashes and individual-level acceptance of drinking and driving was found. Acceptance of drinking and driving did not mediate the relationship between the proportion of alcohol-involved traffic crashes and self-reported drinking and driving behavior. However, it was directly related to behavior among those most likely to drink outside the home. DISCUSSION The present study surveys a particularly relevant population and is one of few drinking and driving studies to evaluate the relationship between an objective environmental-level crash risk measure and individual-level risk perceptions. In communities with both low and high proportions of alcohol-involved traffic crashes there was low acceptance of drinking and driving. This may mean that in communities with low proportions of crashes, citizens have less permissive norms around drinking and driving, whereas in communities with a high proportion of crashes, the incidence of these crashes may serve as an environmental cue which informs drinking and driving perceptions. Perceptual information on traffic safety can be used to identify places where people may be at greater risk for drinking and driving. Community-level traffic fatalities may be a salient cue for tailoring risk communication.

Non-Emergency Medical Transportation Needs of Middle-Aged and Older Adults: A Rural-Urban Comparison in Delaware, USA

Background: Older adults in rural areas have unique transportation barriers to accessing medical care, which include a lack of mass transit options and considerable distances to health-related services. This study contrasts non-emergency medical transportation (NEMT) service utilization patterns and associated costs for Medicaid middle-aged and older adults in rural versus urban areas. Methods: Data were analyzed from 39,194 NEMT users of LogistiCare-brokered services in Delaware residing in rural (68.3%) and urban (30.9%) areas. Multivariable logistic analyses compared trip characteristics by rurality designation. Results: Rural (37.2%) and urban (41.2%) participants used services more frequently for dialysis than for any other medical concern. Older age and personal accompaniment were more common and wheel chair use was less common for rural trips. The mean cost per trip was greater for rural users (difference of

Safe Routes to Play? Pedestrian and Bicyclist Crashes Near Parks in Los Angeles

2910 per trip), which was attributed to the greater distance per trip in rural areas. Conclusions: Among a sample who were eligible for subsidized NEMT and who utilized this service, rural trips tended to be longer and, therefore, higher in cost. Over 50% of trips were made for dialysis highlighting the need to address prevention and, potentially, health service improvements for rural dialysis patients.

Travel distance to prenatal care and high blood pressure during pregnancy

BACKGROUND Areas near parks may present active travelers with higher risks than in other areas due to the confluence of more pedestrians and bicyclists, younger travelers, and the potential for increased traffic volumes. These risks may be amplified in low-income and minority neighborhoods due to generally higher rates of active travel or lack of safety infrastructure. This paper examines active travel crashes near parks and builds on existing research around disparities in park access and extends research from the Safe Routes to School and Safe Routes to Transit movements to parks. METHODS We utilized the Green Visions Parks coverage, encompassing Los Angeles County and several other cities in the LA Metropolitan area. We used negative bionomial regression modeling techniques and ten years of geolocated pedestrian and bicyclist crash data to assess the number of active travel injuries within a quarter mile (~400m) buffer around parks. We controlled for differential exposures to active travel using travel survey data and Bayesian smoothing models. RESULTS Of 1,311,736 parties involved in 608,530 crashes, there were 896,359 injuries and 7317 fatalities. The number of active travel crash injuries is higher within a quarter-mile of a park, with a ratio of 1.52 per 100,000 residents, compared to areas outside that buffer. This higher rate near parks is amplified in neighborhoods with high proportions of minority and low-income residents. Higher traffic levels are highly predictive of active travel crash injuries. CONCLUSIONS Planners should consider the higher risks of active travel near parks and the socioeconomic modification of these risks. Additional traffic calming and safety infrastructure may be needed to provide safe routes to parks.

Influence of school environments on childhood obesity in California

ABSTRACT Objective: To assess whether poor geographic accessibility to prenatal care, as indicated by long distance trips to prenatal care, produced high blood pressure (HPB) during pregnancy. Methods: Using the 2007 Los Angeles Mommy and Baby Study for women without hypertension prior to pregnancy (n = 3405), we compared self-reported HBP by travel distance to prenatal care controlling for age, race/ethnicity, marital status, education, household income, weight status, and physical activity. Results: Results of the multilevel logistic regression shows traveling more than 50 mi to prenatal care is associated with an increased odds for having HPB during pregnancy (odds ratio [OR] = 2.867, 95% confidence interval [CI] = 1.079,7.613), as compared with a travel distance shorter than 5 mi. Traveling 5–14 mi (OR = 0.917, 95% CI = 0.715–1.176), 15–29 mi (OR = 0.955, 95% CI = 0.634–1.438), or 30–50 mi (OR = 1.101, 95% CI = 0.485–2.499) were not significantly associated with more risk of HBP during pregnancy. Conclusion: To our knowledge, no previous studies have examined the association between poor geographic accessibility to care and the possible harms of travel burdens for pregnant women. Future research that replicates these findings can assist in developing recommendations for pregnant women and health-care accessibility.

Drinking and driving and perceptions of arrest risk among California drivers: Relationships with DUI arrests in their city of residence

Objective: To conduct a state‐wide examination of public schools and the school neighborhood as potential targets for environmental public health tracking to address childhood obesity. Methods: We examined the relationship of social and physical environmental attributes of the school environment (within school and neighborhood) and childhood obesity in California with machine learning (Random Forest) and multilevel methods. We used data compiled from the California Department of Education, the U.S. Geological Survey, ESRIs Business Analyst, the U.S. Census, and other public sources for ecologic level variables for various years and assessed their relative importance to obesity as determined from the statewide Physical Fitness Test 2003 through 2007 for grades 5, 7, and 9 (n = 5,265,265). Results: In addition to individual‐level race and gender, the following within and school neighborhood variables ranked as the most important model contributors based on the Random Forest analysis and were included in multilevel regressions clustered on the county. Violent crime, English learners, socioeconomic disadvantage, fewer physical education (PE) and fully credentialed teachers, and diversity index were positively associated with obesity while academic performance index, PE participation, mean educational attainment and per capita income were negatively associated with obesity. The most highly ranked built or physical environment variables were distance to the nearest highway and greenness, which were 10th and 11th most important, respectively. Conclusions: Many states in the U.S. do not have school‐based surveillance programs that collect body mass index data. System‐level determinants of obesity can be important for tracking and intervention. The results of these analyses suggest that the school social environment factors may be especially important. Disadvantaged and low academic performing schools have a higher risk for obesity. Supporting such schools in a targeted way may be an efficient way to intervene and could impact both health and academic outcomes. Some of the more important variables, such as having credentialed teachers and participating in PE, are modifiable risk factors. HighlightsOf the school environment variables, social more than built factors influenced obesity.Violent crime, language, socioeconomic disadvantage were among the leading social factors.Distance to the nearest highway and greenness were among the leading built factors.Having credentialed teachers and participating in PE are modifiable risk factors.School social environment can be important for public health tracking of childhood obesity.

Driving Cessation and Increased Depressive Symptoms

ABSTRACT Objective: Addressing drinking and driving remains a challenge in the United States. The present study aims to provide feedback on driving under the influence (DUI) in California by assessing whether drinking and driving behavior is associated with the DUI arrest rates in the city in which the driver lives; whether this is due to perceptions that one can get arrested for this behavior; and whether this differed by those drivers who would be most affected by deterrence efforts (those most likely to drink outside the home). Methods: This study consisted of a 2012 roadside survey of 1,147 weekend nighttime drivers in California. City DUI arrest rates for 2009–2011 were used as an indicator of local enforcement efforts. Population average logistic modeling was conducted modeling the odds of perceived high arrest likelihood for DUI and drinking and driving behavior within the past year. Results: As the DUI arrest rates for the city in which the driver lives increased, perceived high risk of DUI arrest increased. There was no significant relationship between either city DUI arrest rates or perceived high risk of DUI arrest with self-reported drinking and driving behavior in the full sample. Among a much smaller sample of those most likely to drink outside the home, self-reported drinking and driving behavior was negatively associated with DUI arrests rates in their city of residence but this was not mediated by perceptions. Conclusion: The results of the present study suggest that perceptions are correlated with one aspect of DUI efforts in ones community. Those who were more likely to drink outside the home could be behaviorally influenced by these efforts.