Motor Vehicle Injuries
Publication Date: 12/07/2009
The Problem:
The leading cause of death for people age 34 and below in the United States is motor vehicle crashes. CDC: Motor Vehicle Safety Factsheet. Crashes occur due to impaired driving, inexperience, faulty vision and general recklessness. In congested areas, pedestrian safety is major public health concern. Approximately 700 children are killed each year by motor vehicles while walking. CDC: Reducing Childhood Pedestrian Injuries: Summary of a Multidisciplinary Conference.
The Law:
Traffic laws are designed to minimize motor vehicle crashes and to improve driver, passenger and pedestrian safety. Enforcing traffic laws can be difficult. Red light cameras take a picture of any car that fails to appropriately abide by a red light thereby endangering other drivers and pedestrians. The pictures are used to issue traffic citations, which often include sizable mandatory fines ($446 in Los Angeles: Photo Red Light Program). Twenty-four states and the District of Columbia have red light programs operating somewhere within their jurisdiction authorized either through state or local law. Governors’ Highway Association: Red Light Cameras. For an example of a state law authorizing the use of red light cameras, see RI Stat 42-28.9
The Evidence:
In a systematic review, Aeron-Thomas and Hess reviewed ten studies measuring the impact of red light cameras on motor vehicle crashes. Aeron-Thomas A, Hess, S. Red-Light Cameras for the Prevention of Road Traffic Crashes. The Cochrane Library. 2009, v.2. The reviewers found that the studies generally identified an association between the red light cameras and reductions in fatal crashes. However, weaker and often statistically insignificant relationships were observed between the cameras and overall crashes. On this basis, the reviewers concluded that there was sufficient evidence to establish the effectiveness of red light cameras as an intervention aimed at reducing fatal crashes, but that additional research is needed to validate the impact of these cameras on overall crashes and reckless driving generally.
The Bottom Line:
In the judgment of a Cochrane Collaborative expert panel, sufficient evidence exists to support red light cameras as an effective public health intervention to reduce motor vehicle crash fatalities, but there is insufficient evidence to validate the effectiveness of the cameras in reducing overall crashes.
Additional Information:
The Governors’ Highway Association provides online access to a table indicating in which states red light cameras are authorized or prohibited under state law.
Additional Resources: Governors’ Highway Association
Origin: PLoSMedicine, March 30, 2010
Additional URL(s):
PLoSMedicine Editorial
PLoSMedicine March 30, 2010
Publication Date: 12/07/2009
The Problem:
In the United States, motor vehicle–related accidents are the leading cause of death for all people under the age of 34. In 2000, motor vehicle crashes cost roughly $230 billion. CDC: Motor vehicle safety. The number of licensed drivers over the age of 65 has increased dramatically over the last decade. Drivers ages 80 and over have a higher rate of fatal crashes per miles driven than all other demographic groups except teenagers. The impact of aging on vision, cognitive functions, and other physical capacities has been identified as a contributing factor in motor vehicle crashes. CDC Website – Older Adult Drivers: Fact Sheet.
The Law:
State transportation and safety laws require different procedures and apply different standards in screening the vision of older drivers. For instance, to renew a license in California, an individual must have visual acuity of 20/40 with both eyes together and at least 20/40 in the stronger eye and 20/70 in the weaker eye, California Department of Motor Vehicles, CA Vehicle Code §12805; in Arizona, a minimum of 20/40 in one eye is required. Arizona Administrative Code: R17-4-502, R17-4-503. The age at which vision tests are required for renewal also varies (e.g., 40 years in Maryland (Maryland Transportation Code 16-115(h)) to 80 years in Virginia. Va. Code Ann. § 46.2-330 (C)). For another example of a state law requiring vision screening for individuals above a specified age, see FL Rev. State 322.18(5) (Florida).
The Evidence:
A Cochrane Collaboration Task Force attempted to conduct a systematic of studies assessing the impact of vision screenings for older drivers on motor vehicle crashes, but did not find any studies meeting its criteria. Subzwari S et al. Vision screening of older drivers for preventing road traffic injuries and fatalities. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.:CD006252. The task force accordingly concluded that there is insufficient evidence to determine whether vision screening programs for individuals above a specified age are effective in reducing crashes among older adults.
The Bottom Line:
In the judgment of a Cochrane Collaborative expert panel, laws requiring vision screening are a plausible means of reducing crashes involving older drivers, but there is insufficient evidence to rigorously assess their effectiveness at this time.
Additional Information:
The Physician’s Guide to Assessing and Counseling Older Drivers, created by the American Medical Association (AMA) with support from the National Highway Traffic Safety Administration (NHTSA), is available online and provides substantial information about state policies regarding vision screening.
The International Council of Ophthalmology provides online access to a table of vision requirements for the fifty US states.
Additional Resources: Physician’s Guide to Assessing and Counseling Older Drivers, AMA, NHTSA, International Council of Ophthalmology
Publication Date: 12/07/2009
The Problem:
In 2008, 968 children under the age of 15 died from injuries suffered during motor vehicle crashes and approximately 168,000 other children were injured. CDC: Child Passenger Safety Factsheet. The use of child safety seats has been found to substantially reduce the risk of mortality to infants in motor-vehicle accidents (70 percent) and in children ages 1 to 4 years (47 precent to 54 percent). Yet, each year children are injured and killed due to the nonuse or improper use of child safety seats. Zaza S, et al. Recommendations to reduce injuries to motor vehicle occupants increasing child safety seat use, increasing safety belt use, and reducing alcohol-impaired driving. Am J Prev Med. 2001;21(4S):16–22. It is estimated that universal proper child safety seat use could save roughly 160 lives and prevent 20,000 injuries each year. Zaza S, et al. Reviews of evidence regarding interventions to increase use of child safety seats. Am J Prev Med. 2001;21(4S):31-47
The Law:
Today, every state has a law requiring children to be restrained in federally-approved child safety seats while riding in motor-vehicles. These laws differ from state to state based on number of factors (e.g., age, height and weight of the children requiring safety seats). All current child safety seat laws allow for primary enforcement, meaning a police officer can stop a driver solely for a violation of such laws. Child restraint/belt use laws: The Insurance Institute for Highway Safety, Highway Loss Data Institute. For examples of child safety seat laws, see La. R.S. 32:295 (Louisiana), Tenn. Code Ann. § 55-9-602 (Tennessee), Ala. Code § 32-5-222 (Alabama) and N.J.S. 39:3-76.2a (New Jersey).
The Evidence:
In a systematic review, Zaza et al. reviewed nine studies that evaluated the effectiveness of child safety seat laws in reducing rates of childhood motor-vehicle injuries. Zaza S, et al. Reviews of evidence regarding interventions to increase use of child safety seats. Am J Prev Med. 2001;21(4S):31-47. The underlying studies focused on laws that were passed in every state in the United States between the years 1978 and 1986. The reviewers found a 35 percent median reduction in fatal childhood injuries and 17.3 percent reduction in overall motor-vehicle child injuries following the introduction and enforcement of child safety seat laws. The effects of additional requirements in particular states (for example, requiring a particular seating position or providing for harsher penalties) could not be determined from the available studies. The reviewers also identified a 13 percent increase in the use of child safety seat use subsequent to the adoption of child safety seat laws.
The Bottom Line:
There is strong evidence to support the effectiveness of child safety seat laws in substantially reducing injuries to children during motor vehicle crashes, according to a Community Guide expert panel.
Additional Resources: Insurance Institute for Highway Safety
Publication Date: 12/07/2009
The Problem:
Safety belts saved approximately 164,753 lives between 1975 and 2002 according to the National Highway Traffic Safety Administration (NHTSA). However, despite rising rates of safety belt use in the United States over the past 20 years, many American still do not consistently wear safety belts. David J. Houston and Lilliard E. Richardson, Jr., “Getting Americans to buckle up: The efficacy of state seat belt laws,” Accident Analysis and Prevention, 37 (2005) 1114–1120, at 1114
The Law:
Primary enforcement seatbelt laws authorize police officers to stop drivers solely because individuals in a vehicle are not complying with safety belt laws. Secondary enforcement, in contrast, only authorizes enforcement of safety belt laws in conjunction with another offense (i.e., drivers cannot be stopped if the only offense is not wearing a belt). For example of primary enforcement safety belt laws, see GA Code Ann § 40-8-6 (Georgia) and Fla Stat § 316.614 (Florida).
The Evidence:
In a systematic review, Dinh-Zarr et al. reviewed 13 studies that examined the effectiveness of primary enforcement safety belt laws as a means of reducing injuries related to motor vehicle crashes. Dinh-Zarr TB, et al. Reviews of evidence regarding interventions to increase the use of safety belts. Am J Prev Med. 2001;21(4S): 48-65. Nine of the reviewed studies compared the effectiveness of primary enforcement laws to that of secondary enforcement laws in the US; the other four measured the impact of changing from a secondary enforcement law to a primary enforcement law. Three studies focused their assessment on the impact of enacting primary enforcement legislation on specific populations (drunk drivers, African-American and Hispanics). The review found that primary enforcement laws are more effective in reducing fatal injuries and in increasing the frequency of safety belt use than secondary enforcement laws. Primary laws were found to reduce fatal injuries by a median 8 percent and to increase observed safety belt use a median 14 percent. Two studies found that primary enforcement laws increased safety-belt use by African-Americans and Hispanics compared to whites. There was no evidence in these studies that the difference was based on differential enforcement.
The Bottom Line:
Safety belt laws work, but there is strong evidence to support that primary enforcement safety belt laws are more effective than secondary enforcement laws in increasing seat belt use and reducing crash injuries.
Publication Date: 12/07/2009
The Problem:
According to the Centers for Disease Control and Prevention, inexperienced drivers are a significant public health problem. Motor vehicle accidents is the leading cause of death of young adults between age 15 and 20. CDC. Teen Drivers: Fact Sheet.
The Law:
Graduated driver licensing (GDL) laws require inexperienced drivers to satisfy one or more requirements before being granted full privileges to operate a motor vehicle without supervision. For example, a common feature of these programs is the issuance of a provisional license authorizing an inexperienced driver to operate a vehicle exclusively under the supervision of a fully licensed adult. In many instances, inexperienced drivers must also adhere for a period of time to other restrictions such as not driving at night or with more than one passenger. If an inexperienced driver satisfies the requirements of the provisional period, a fully unrestricted license may be issued. For examples of graduated license laws, see Fla. Stat. § 322.16 (Florida), MCLS § 257.310(e)( Michigan), and ORC Ann. 4507.05(Ohio).
The Evidence:
Harling et al. systematically reviewed fifteen studies measuring the impact of graduated driver licensing programs on one or more of the following: overall crashes, crashes with an injury, hospitalization, fatal crashes, crashes at night, alcohol-related crashes, injured teen passengers, convictions and license suspensions, and property damage. Hartling L et al. Graduated driver licensing for reducing motor vehicle crashes among young drivers. Cochrane Database Syst Rev. 2004;(2):CD003300. The review found a median reduction of 31 percent in crash rates among 16 year-old drivers following the adoption of GDL laws. These findings indicate that GDL programs are effective reducing crashes among novice drivers.
The Bottom Line:
In the judgment of a Cochrane Collaboration expert panel, the current evidence suggest that graduated driver licensing programs are effective public health interventions aimed at significantly reducing the incidence of motor vehicle morbidity and mortality attributable to inexperienced drivers.
Publication Date: 12/07/2009
The Problem:
Safety belts saved approximately 164,753 lives between 1975 and 2002 according to the National Highway Traffic Safety Administration (NHTSA). However, despite rising rates of safety belt use in the United States over the past 20 years, many Americans still do not consistently wear safety belts. David J. Houston and Lilliard E. Richardson, Jr. Getting Americans to buckle up: The efficacy of state seat belt laws. Accident Analysis and Prevention, 37 (2005) 1114–1120, at 1114.
The Law:
Enhanced enforcement of safety belt laws may include increased numbers of officers on patrol, increased numbers of tickets issued for safety belt violations during normal patrols, and setting up safety belt checkpoints. Dinh-Zarr TB, et al. Reviews of evidence regarding interventions to increase the use of safety belts. Am J Prev Med. 2001;21(4S): 48-65. These programs are usually publicized through media campaigns. Enhanced enforcement programs usually take the form of short, intense efforts (called waves or blitzes) lasting for days or weeks.
The Evidence:
The Community Guide reviewed 15 studies that measuring the effectiveness of enhanced enforcement programs, focusing on programs that targeted safety belt use and excluding studies of programs that simultaneously targeted other driving practices. Dinh-Zarr TB, et al. Reviews of evidence regarding interventions to increase the use of safety belts. Am J Prev Med. 2001;21(4S): 48-65. The reviewed studies analyzed a variety of city, county, state, provincial and national programs in the United States and Canada. Enhanced enforcement programs were found to be effective in reducing both fatal and nonfatal injuries as well as in increasing the frequency of safety belt use. The two studies measuring the effects of enhanced enforcement programs on injury rates found a reduction of 7 percent and 15 percent. Across the studies, the median increase in safety belt use was 16 percent.
The Bottom Line:
Seat belt laws work, and there is strong evidence that enhanced seat belt enforcement interventions can substantially increase seat belt use and its associated benefits.
Additional Information:
The Community Guide provides an online table listing the enhanced enforcement programs underlying the reviewed studies.
Additional Resources: The Community Guide
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