Patricia F. Waller

THE OLDER DRIVER

Older drivers constitute the most rapidly growing segment of the driving population in number of drivers licensed, miles driven, and proportion of the driving population. Yet the highway transportation system has not been designed for these drivers. This lack of fit is reflected in the accelerating rate of crashes per mile driven experienced by older drivers beginning around age 55. Furthermore, older persons are more vulnerable to injury once a crash occurs and as a group experience a higher fatality rate. The increasing proportion of our population consisting of older persons, in conjunction with a relative decrease in the young adult population, underscores the need for research to develop a greater understanding of the needs and capabilities of this age group and to develop system improvements that will enable as many older persons as possible to continue to meet their own transportation needs safely.

Adolescent antecedents of high-risk driving behavior into young adulthood: substance use and parental influences

Driver history data, in combination with previously collected tenth-grade questionnaire data, for 4403 subjects were analyzed by Poisson regression models to identify the significant substance use and parental characteristics predicting subsequent high-risk driving of new drivers (starting at age 16) through age 23-24 years. Substance use (cigarettes, marijuana, and alcohol) reported at age 15 was shown to be an important predictor of subsequent excess risk of serious offenses and serious crashes for both men and women. In addition, negative parental influences (lenient attitudes toward young peoples drinking; low monitoring, nurturance, family connectedness), were also demonstrated to increase the risk of serious offenses and serious crashes for both men and women.

DEMENTIA AND DRIVING: AN ATTEMPT AT CONSENSUS

Summary:The number of older drivers in Sweden will be rapidly increasing during the next decades. A possible relationship exists between the increased relative crash risk of older drivers and the prevalence of age-related diseases such as dementia. However, a clear-cut policy for evaluating driving competence in demented persons is still lacking. In recognition of this fact, the Swedish National Road Administration invited a group of researchers to formulate a consensus on the issue of driving and dementia. This consensus document is aimed at providing primary care physicians with practical advice concerning the assessment of cognitive status in relation to driving. Suggestions are based on a review of existing research and discuss the use of general and driving-specific sources of information available to the physician. Consensus was reached on the statement that a diagnosis of moderate to severe dementia precludes driving and that certain individuals with mild dementia should be considered for a specialized assessment of their driving competence.

Crash characteristics and injuries of victims impaired by alcohol versus illicit drugs

Alcohol has long been associated with injury, but the relationship between other drugs and injury is less clear. Blood samples from 894 patients presenting to two Emergency Departments for treatment of motor vehicle injury sustained in passenger cars, station wagons, vans and pickup trucks, were tested for alcohol and other drugs. Results were related to demographic characteristics, including prior history of alcohol and drug use; crash characteristics; and injury characteristics. Alcohol was associated with more severe crashes, but other drugs, in the absence of alcohol, were not. The crashes involving drugs but no alcohol were very similar to those involving neither alcohol nor drugs.

Alcohol effects on motor vehicle crash injury.

CONTEXT Although alcohol is frequently present in injured patients, whether it exacerbates injury and whether tolerance to alcohol changes such a relationship is less clear. Most clinical studies do not consider other important predictors of injury, making interpretation of their findings problematic. OBJECTIVE To examine alcohols role in injuries, taking into account other important factors, and to examine the effect of tolerance, if any. DESIGN Prospective cohort study. SETTING University hospital and community hospital emergency departments and morgue. PATIENTS 1362 Motor Vehicle Crash patients age >/=18, treated and released, admitted, and deceased. MAIN OUTCOME MEASURES Excess injury measured by Injury Severity Scale (ISS) 90, Weighted Revised Trauma Score (WRTS), and G-Score. RESULTS Using regression analysis, the best predictors of injury severity were vehicle crush (TAD), safety belt use, and their interaction, and age. Alcohol use further predicted injury. Using the final regression model, the effect of alcohol was to increase ISS90, on average, by about 30% (from a predicted ISS90 of 5.1 to 6.8, all else being equal). The adjusted odds ratio for serious injury (ISS90>15), was 1.59 for a patient with a positive blood alcohol concentration (alc+) compared to a alc- patient. This potentiating effect is seen even for patients with low levels of alcohol (<22 mmol/liter; <0.100 BAC) but is not linear with increasing alcohol level. Tolerance to alcohol did not affect the potentiation of injury by alcohol. CONCLUSION When other relevant variables are considered, alcohol increases injury, but the effects of alcohol level and alcohol tolerance are less clear. These findings have important implications for injury prevention, treatment, and research.

Persistence of Violation and Crash Behavior Over Time

This analysis examines the ability of previous offenses to predict future high-risk offenses, and similarly, the ability of crashes to predict future high-risk crashes, using the complete driver history data (up to 9 years) for a set of young Michigan subjects. As expected, those with previous ticketed offenses or reported crashes are at greater risk for future offenses or crashes; with a previous-year serious offense doubling the odds of serious offenses during the subsequent year, and a previous-year at-fault crash increasing the odds of subsequent-year at-fault crashes by nearly 50%. There is modest evidence that serious offenses and at-fault crashes may better predict subsequent behavior in females and in more experienced drivers. This latter finding is also evidenced by the fact that records of these young drivers are less predictive of subsequent driving history than is true for records of all drivers in general found in other studies. This suggests that, in the early stages of driving, offenses and crashes are, at least in part, attributable to inexperience, and hence, characteristic of all beginning drivers.

Some biases in the alcohol investigative process in traffic fatalities

This study compares data regarding alcohol involvement from police records and from chemical analyses of body fluids taken prior to or after death of 121 traffic fatalities in Washtenaw County, Michigan. Differences regarding the choice of who will or will not be screened for alcohol were found. The police and emergency room personnel were more likely to focus on males and drivers, while medical examiners were less biased. The police documented whether or not drinking took place in only 36% of the cases and suspected drinking in only half of these cases. Males and at-fault drivers were most likely to be investigated. Blood alcohol level was measured before death in 11 of 29 emergency room treated victims, with 10 (91%) positive samples. All but two of those tested before death were drivers, and all but one were males. After death, blood alcohol was measured in 47% of the 121 cases, with a higher proportion of males and motor-vehicle occupants tested, compared to females and pedestrians. Alcohol was detected in 63% of the samples. A lower mean blood alcohol concentration was found in victims who received intravenous treatment, and a higher proportion of positive samples was found in victims who died immediately in the crash. Thus, the frequency of alcohol-related traffic fatalities varied between the different data sources. The police records revealed 51%, the emergency records 91%, and the medical examiner records 63% with alcohol involvement. This wide discrepancy has the potential of leading to erroneous results here and possibly in studies done elsewhere.(ABSTRACT TRUNCATED AT 250 WORDS)

WOMEN, ALCOHOL, AND DRIVING

Alcohol-related crashes and fatalities have shown a dramatic decrease over the last decade. While males continue to account for most alcohol-related crashes, females are an increasing proportion of alcohol-involved drivers in both fatal and nonfatal crashes. Although most research has not addressed the possibility of gender differences in the effects of alcohol on driving performance, available evidence suggests that such differences may exist. Alcohol appears to have greater effects on females in terms of biomedical damage and impaired performance, although these effects have not been systematically investigated in relation to driving. Effective prevention programs for women require more focused research to understand gender-related factors in the effects of alcohol on driving.

Predicting Offenses and Crashes from Young Drivers' Offense and Crash Histories

Previous research has indicated that offenses are better predictors of subsequent crashes than crashes themselves. We examined this hypothesis for 13,800 young beginning drivers in Michigan for up to nine years during the initial years of driving. Our analyses indicated that previous-year offenses are better predictors of both subsequent-year offenses and crashes than either previous-year crashes or at-fault crashes. This finding also held for the apparently higher-risk subset of subsequent-year serious offenses and at-fault crashes. Although there were no gender differences in the predictive power of crashes, it was found that the predictive power of previous offenses to subsequent serious offenses was significantly stronger for women than for men. The predictive power of incidents appeared to increase somewhat with increasing driving experience, suggesting that early incidents may be more attributable to inexperience, a characteristic of all beginning drivers, while later incidents may be more attributable to individual differences.

Children dying in car trunks: how adequate are child death databases?

Objective—To determine the frequency of and circumstances surrounding child deaths resulting from inadvertent entrapment in motor vehicle trunks in the US by querying child fatality review databases. Method—A telephone survey was conducted with the persons or offices identified as having primary responsibility for child fatality review programs in each state. The survey requested information on the number of child deaths resulting from trunk entrapments, the ages of the victims, the time period covered by the surveillance system, and variables concerning the circumstances surrounding each incident. Results—All states reported that these deaths are exceedingly rare, with most reporting no such events in recent history. However, state databases could not be readily accessed to identify such deaths. There was enormous interstate variation in guidelines governing the population covered by the child fatality review process. The age range varied greatly from one jurisdiction to another, and often only children in the states welfare system were included. Interstate differences in practices preclude meaningful compilation of data across jurisdictions. Conclusions—It was not possible to ascertain the incidence of inadvertent entrapment of children in vehicle trunks because there is no consistency in the available databases. A national database of child fatalities, based on standardized guidelines and definitions, is needed to identify causes and magnitude of specific child deaths, in order to design, implement, and evaluate interventions.