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PUBH211 > Lecture 16: Unintentional Injury- Young Drivers > Flashcards

Lecture 16: Unintentional Injury- Young Drivers Flashcards

1
Q

how are road traffic injuries a global health problem?

A
  • annually 1.24 million deaths, - another 50 million injured
    (underestimated)
  • 90% of all road fatalities occur in lower/middle income countries
  • RTI is the leading cause of death in 15-29-year-olds
  • is predicted to be the 5th leading cause of death by 2030.
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2
Q

how are RTI important among different age groups?

A
  • in 5-14 year olds they tend to be pedestrians

in 15-29 year olds, they tend to be drivers

  • in 30-49 year olds, they tend to occur from occupational driving (i.e. exposure to driving is increased since its their job)
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3
Q

what is being done about this issue?

A

SDG #25 is to reduce global death from road traffic accidents by half

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4
Q

what is NZ doing about this issue?

A

Road to Zero strategy
- aim to have a 40% reduction in death and injury

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5
Q

what does this graph show?

A
  • a trend of deaths per 100,000 population (useful denominator but not the best since not everyone is exposed to the risk all the time)
  • there was a decrease until 2013, then it started increasing, then it flattened out a bit.
  • this trend was not found in countries we compare NZ to
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6
Q

what do these graphs show?

A
  • after changing the denominator to per 100,000 vehicles or per 100 million km travelled, which are more useful denominators, we still see the same upward trend
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7
Q

what are some things thought to have caused this upward shift?

A
  • a combination of more heavy vehicle traffic, more freight, aging vehicle fleets, higher open road speed limits with more people speeding
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8
Q

what is the rate of road injury deaths for both genders, males alone, females alone in 2017?

A

8.1 Deaths per 100,000

Males: 11.4/100,000

Females 5.0/100,000

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9
Q

what is the rate of road injuries for both genders, males alone, females alone in the 15-29 age group in 2017?

A

11.3/100,000

M: 16.7/100,000

F: 5.7/100,000

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10
Q

what is the rate of road injuries for both genders, males alone, females alone in the 20-24 age group in 2017?

A

1.4/100,000

M: 21/100,000

F: 7.8/100,000

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11
Q

what is the burden of road traffic injury?

A

Cost!

  • of acute event
  • subsequent disability
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12
Q

what does the social cost of a road crash or road crash injury include?

A
  • loss of life and life quality
  • loss of output due to temporary incapacitation
  • medical costs
  • legal costs
  • vehicle damage cost
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13
Q

what are the approximate costs per fatal crash, per reported serious crash and per reported minor injury crash?

A

per fatal crash: $4,537,300

per reported serious crash: $826,000

per reported minor injury crash: $85,000

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14
Q

what is the approx. cost of motor vehicle traffic crashes for 15-24 year olds?

A
  • $1.1B
  • which is 30% of the total costs of MVTC

(however, they don’t represent 30% of the population!!!)

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15
Q

what is the first step of the public health model and how does it apply to young driver crashes?

A

step 1: Defining and measuring the problem

  • there is a ‘U shape’ pattern in all data relating to MVTC’s.
  • There is a very high risk for young people, flattens during middle years, increases slightly again during older years.
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16
Q

what is the young driver problem like in New Zealand?

A

in NZ young people:

  • RTI is a leading cause of death
  • highest crash rate, all age groups
  • Maori twice the burden compared to non-Maori
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17
Q

what was the burden of MV crashes for young people in the 1980s?

A
  • more than 7000 people died on NZ roads in the 1980’s
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18
Q

what was the burden of MV crashes in 1986?

A
  • there were 767 deaths in NZ
  • 300 were 15-24 year olds (39% of crashes)
  • but 15-24 year olds only make up 18% of NZ’s population
  • so this is 47.9/100,000 population
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19
Q

how does NZ compare internationally of crash fatality rates per 100,000 population

A

Sweden - 18.3
UK - 17.7
Australia - 39.8
Canada - 33.8
NZ - 47.9
US - 35.0

NZ was the worst in the OECD out of 26 countries

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20
Q

what is the second step of the public health model and how does this apply to young driver crashes?

A

step 2: describe causes and consequences (risk factor identification)

  • needed to find risk factors for young driver crashes
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21
Q

Where can we look for evidence about causes for MVC?

A

routinely collected data

  • traffic crash reports, hospital admission data, ACC data
  • but these have limitations for assessing causality
  • epidemiological studies (e.g. case-control, cohort)
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22
Q

what is this?

A
  • traffic crash reports of all crashes reported to the police
  • shows that 35% of crashes are from a single vehicle, with young driver at fault
  • 41% are multi-vehicle, young driver primary responsibility
  • 4% multi-vehicle, some driver responsibility
  • 19% multi-vehicle, no young driver identified
  • 1% single vehicle, no young driver identified
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23
Q

what are the limitations with the traffic crash report?

A

there are limitations for assessing causality

  • subjective - emphasis is driver factors
  • biased underreporting (regional; crash type. but linkage reduces this)
  • descriptive only
  • no comparison group of non-crash drivers, cars and environments for “factors contributing”
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24
Q

what are 2 examples of NZ epidemiological studies of crash risk factors?

A

Case-control study
- Auckland Car Crash Study

Cohort Study
- New Zealand Drivers Study

25
Q

What are the most important risk factors of young driver crashes?

A
  • Age
  • Experience
  • Passengers
  • Time of day
  • Alcohol
26
Q

what does this graph say about age as a risk factor?

A

shows that regardless of experience, age is a risk factor for young people.

27
Q

what do these graphs show about experience as a risk factor?

A

shows that all young drivers are at higher crash risk because they lack the driving experience and judgement that only come with time and driving

  • as people get more experience, crash risk decreases for both genders
28
Q

what does this graph tell us about passengers as a risk factor for young driver crashes?

A

YD crash increases when carrying passengers compared to driving alone compared to older drivers

  • an exponential increase of risk per 10,000 trips as number of passengers increase.
29
Q

what does this graph tell us about passengers as a risk factor for crashes?

A

16-17 year olds crash risk per mile driven by age and number of passengers

  • we can see that having at least one passenger over 35 is protective
30
Q

what does this show about time of day as a risk factor in traffic crashes?

A

everyone has a higher crash risk during nighttime, especially young drivers

31
Q

what does this show about time of day as a risk factor for traffic crashes?

A

shows that for those aged up to 25 has a heightened risk between 9pm and 5am.

32
Q

how is alcohol as a risk factor for young driver crashes?

A

young drivers are over-represented in alcohol related crashes

  • young drivers have more fatal crashes at low blood-alcohol levels, compared to older drivers with similar BACs
33
Q

what are some other behaviours which increase crash risk?

A
  • drugs
  • speeding
  • thrill-seeking
  • close following/tailgating
  • dangerous overtaking
  • misjudge speed/gap distace
  • over-estimate own ability
34
Q

what is the third step of applying the public health model to young driver crashes?

A

step 3: intervention development and testing

  • the young driver problem is complex with multiple causes (as mentioned before)
  • we need interventions to try to address as many modifiable risk factors as possible at a population level
35
Q

what is one of the biggests interventions to address young driver MVTC risk?

A

Graduated Driver License System!

  • NZ is the first country to have this
  • is used as a model for other countries
36
Q

how is the GDL as an intervention:?

A

it is a response to higher risk for young drivers

  • alternative to raising the age (1987)
  • population-based approach which applies to all drivers

is a system for phasing in on-road drivng
- initial experience in low risk conditions, then more complex driving situations

37
Q

what were the 3 stages for the GDL?

A
  1. supervised learners stage, BAC <0.03mg%
  2. Intermediate stage with restrictions
    - passenger, night, BAC<0.03%
  3. Full privelege
38
Q

what is the fourth public health model step applied to young driver crashes?

A

step 4: programme implementation and evaluation

39
Q

what was the first evaluation of the effective of GDL to reduce injury burden?

A
  • they used hospital admissions data of motor vehicle traffic crash injury
  • predicted they could attribute approx 7% reduction of hospital visits due to car crashes
40
Q

what was the second evaluation of the impact of GDL restrictions?

A
  • linked police crash reports and national hospital and fatality date

compared with drivers licensed pre-GDL:

  • 34% fewer crashes at night
  • 27% fewer crashes with passengers
  • 28% fewer crashes involving alcohol

(they controlled for age, gender, linear trends)

41
Q

what came out of the driver licensing review 1995-1999?

A
  • applied to all novice drivers
  • learner licence for 6 months (no time discount)
  • restricted license 18-12 months with approved course (9-6 months if >25)
  • compulsory exit tests from restricted to full
  • L plates for learners
  • removed minimum age (20 years) for supervisor
  • automatic only license
  • penalty regime of demerits and fines
42
Q

what proposed changes were not introduced?

A
  • raise the minimum licensing age from 15 to 16
  • reduce blood and breath alcohol limits to zero
  • discontinue time discount in the restricted licence phase
43
Q

what questions need to be asked to consider the effectiveness of GDLS in NZ?

A
  1. has the crash rate for young drivers decreased?
  2. are young drivers still over-represented?

(goes back to step 1 of PH- defining and measuring problem)

44
Q

how did Begg and Stephenson 2003 measure the effectiveness of GDLs?

A

measured if the crash rate for young drivers have decreased:

  • per head of population
  • per number of licensed drivers
  • compared with other age groups
45
Q

what does this tell us about GDLs?

A

since GDLs were implemented, we can see fata; and serious injury rates remained below pre-GDL rates

46
Q

what does this tell us about the effectiveness of GDLs?

A

average risk for a young driver being hospitalised for driver injuries have gone done. but are still over-represented

47
Q

what is the young driver situation for 15-24-year-olds in early 2000’s?

A
  • 23.4/100,000 population (2004, compared with 47.9 in 1985) almost halved!
  • MVC is the leading cause of death (1/3 of all deaths transport related)
  • is a leading cause of morbidity and lifelong disability
  • males twice crash risk to females
  • social cost is high, $1.1B; 30% of costs of MVTC annually
48
Q

what does this show us about the risks in each phase of the GDL?

A

Learner license had a very low crash risk
- likely due to inadequate quality and quantity of driving experience

Restricted license shows highest crash risk
- could be due to low compliance with conditions

  • full after 12 and 18 months had higher risk than learners, but lower than restricted
49
Q

what did the New Zealand Drivers Study do to help the young driver problem with complex multiple causes?

A
  • a prospective cohort study of newly licensed drivers (3992 newly licensed drivers and 1200 parents)
50
Q

what was the goal of the NZDS?

A

to provide an evidence base to inform policy and programmes aimed at reducing traffic-related injury in NZ, and especially among the high-risk adolescent/young adult population

51
Q

what are the key agency relationships of the NZDS knowledge translation and implementation?

A
  • ministry of transport
  • nz police
  • nz transport agency
52
Q

what are the national policy/programmes for the NZDS knowledge translation and implementatoin?

A
  • ‘safer journeys’ NZ 2020 road safety strategy
  • minimum driver license age increase (2011)
  • ‘safe teen driver’; ‘parent of teen drivers’ programme (2012+)
  • ‘safe vehicle choice for teens’ guide (2012)
  • license pooling legislation (2014)
  • ‘DRIVE’ nationwide young driver programme (2016)
53
Q

what are international policies/programmes for NZDS?

A
  • Australia - Victoria and ACT GDLs reform
  • UK - proposal to introduce GDLs in UK
  • EU - inform driver training and licensing
54
Q

what were the interventions that came from the ‘safer journeys’ strategy 2010-2020?

A
  • legal BAC limit for under 20 year olds (ZERO!)
  • age of learning licensing moved up to 16 years
  • safe teen driver, parent programme, safe vahicles
  • 5 year time limits on GDL licences
  • ‘DRIVE’ online/app

in 2019- evaluation of NZ GDLS; 2 year amnesty to license expiry

in 2020 - review of GDLS - including time limits, barriers to progression

55
Q

which recommended changes were not implementeds?

A

extended learner license from 6 months to 12 months

  • allow 120 hours to be achievable
  • not a lot of evidence showing what driving hours is useful

remove restricted license time discount for completing courses

  • NZ Crash and licensure data shows that those who took the courses had 3x higher crash risk on full license
  • NZDS found that the main reason for doing the course was for time discount. drivers had an increased likelihood of having an offence on full licence
56
Q

what has the progress of MV death for 15-24 year olds in NZ been like from 1985 to 2019?

A

1985 - 47.9/100,000 population
2004 - 23.4/100,000 population
2012 - 9.4/100,000 population
2019 - 12.3/100,000 population (15-19yr)
2019: 14.6/100,000 population (20-24yr)

work is still required!

57
Q

who else in the world has taken up GDLs?

A

NZ, USA, Canada, Australia, Israel

  • GDL in northern ireland coming soon
  • GDL in UK has a potential rollout
58
Q

what has the Cochrane review (2011) found about the effectiveness of GDLs?

A
  • there are 21 different GDL programmes in US, Canada, NZ
  • there is variability in quality/strength of the programmes
  • stronger GDL programmes = greater fatality reductions
  • they found reductions in crash rates in ALL jurisdiction, for ALL crash types

PUBH211 (31 decks)

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