Public health consequences of road traffic injuries – Estimation of seriously injured persons based on risk for permanent medical impairment

Despite the fact, that Sweden has one of the safest traffic environments in the world, a large number of people are still injured in road traffic accidents in Sweden. The core concept of the Vision Zero that was adopted by the Swedish parliament in 1997 is to decrease the number of deaths and serious injuries caused by traffic. The vision has been followed-up in terms of decreased mortality, but there was not a consensus on how the concept “seriously injured” should be measured at that time. The aim of this paper is to describe how to develop a measure to estimate the number of seriously injured people in Sweden. The results show that it is possible to estimate the health impact of road traffic accidents based on the definition of medical impairment. According to the results, 8389 people were seriously injured (permanently medical impaired more then 1%) in the road transport area in Sweden in 2013. If the number of people who had slipped or fallen down without any vehicle being involved is excluded, the number of seriously injured was around 4700. The result of the study has been included in the road safety goal for Sweden with the aim to have 25% less seriously injured people in 2020 than the average for the years 2006–2008. The results also showed that 91% of the seriously injured were transported by car, bike or by foot. The relatively high proportion of pedestrian fall accidents happening within the transport system irrespective of whether a vehicle was moving or not raises the question whether these types of accidents should be included in the reporting of formal road traffic accidents.     

Understanding cyclist identity and related interaction strategies. A novel approach to traffic research

It is an established fact that interaction of road users is crucial for road safety. However, the knowledge about what governs people’s behaviour in interaction with others and what these interactions mean is not well documented. The present study introduces a novel approach for traffic safety research and puts the cyclist identity at the centre of attention, in order to answer the questions how the heterogeneity of cyclists in terms of applied interaction strategies, opinions towards infrastructure and traffic safety can be explained. For this purpose, a qualitative study following the Grounded Theory methodology has been carried out. Fifteen in-depth-interviews with cyclists in Vienna were analysed in order to obtain data about these questions. As a result, we present a model sketch about constructing a cyclist identity, which serves as a framework that links different power relations in traffic, the switching perspectives of being a cyclist/car user and the changing conditions of cycling traffic policy through interaction strategies of self-portrayal, power demonstration and coping with fear. Finally, we argue that applying the often overlooked concept of ‘identity’ can bring new concepts into the debate on traffic safety for cyclists and support efficient traffic policy making.     

Cultural foundations of safety culture: A comparison of traffic safety culture in China,Japan and the United States

Understanding how to assess the influence of culture on traffic safety is important for improving traffic safety globally. Traffic safety culture is embedded in the larger context of country’s cultural norms and values, producing different safety outcomes even when other factors are similar. The current work examines how culture influences traffic safety outcomes in three of the largest automobile countries in the world, but which have very different cultural values and which also have very different traffic safety outcomes: China, Japan and the United States. China has an emerging driver population and cultural values that result in aberrant driving behaviors and “scrambling” to gain the right of way, producing a high number of crashes. Japan has an established driver culture, but an emphasis on reducing risk, which results in a lower rate of crashes. The United States, with the most established “car culture”, has an historical and cultural view of the car as a representation of freedom, leading to choices that result in higher crash rates than many countries around the world. The current work explores these cultural underpinnings for traffic safety culture in each country by establishing the historical basis for a traffic culture, examining road, vehicle engineering and legal standards, and reviewing available crash data and data on safety attitudes. These countries are compared across the different dimensions to establish unique cultural influences on traffic safety.     

Factors underlying bus-related crashes in Hanoi,Vietnam

Road traffic crashes accounted for almost 13% of the total mortality recorded at the public health facilities in Vietnam in 2010. This qualitative study investigated factors related to bus-related crashes in Hanoi, Vietnam using focus group discussions and in-depth interviews among 75 participants who are bus drivers, motorcycle users, bus passengers, bus company managers, traffic policemen and local authorities. The results suggested that bus drivers were not the sole contributor to road traffic crashes with other vehicles. The rapid population growth due to rural to urban migration and the poor transport system appeared to be important contributing factors. In addition, “village culture” was likely to influence both the traffic behaviors of road users and the practices of law enforcement officers. Moreover, drink-driving behaviors appeared to be an important contributor to bus-related crashes. Supervision and penalty policies of bus companies also appeared to influence the driving performance of bus drivers. For a long-term solution to reduce bus-related crashes, it is vital to improve the transport infrastructure and the state management capacity regarding road safety as well as to assist the positive transition of citizens migrating from rural areas to their new urban lifestyle.     

Personality subtypes of young drivers. Relationship to risk-taking preferences, accident involvement, and response to a traffic safety campaign

The present study aimed at identifying subtypes of young drivers (N=2524) and evaluate how these responded to a traffic safety campaign. On basis of a cluster analysis of personality measures, six subtypes of young drivers were identified. The subtypes were found to differ on self-reported risky driving behaviour, attitudes towards traffic safety, risk perception, estimation of own driving skills, and accident involvement. Two of the subtypes were identified as high-risk groups in traffic. The first high-risk group consisted of mostly men, characterised by low levels of altruism and anxiety, and high levels of sensation-seeking, irresponsibility, and driving related aggression. The second high-risk group reported high sensation seeking, aggression, anxiety, and driving anger. The subtypes were also found to differ on how they evaluated and responded to the traffic safety campaign. The results indicated that the campaign seemed to appeal most to the low-risk subtypes. Gender differences within each subtype were also found on the different traffic related measures, as well as on response to the campaign. It is concluded that young drivers should not be treated as a homogenous group pertaining to road safety. Practical suggestions on how to promote safe driving among these subtypes are also discussed.     

Can infrastructure improvements mitigate unsafe traffic safety culture: A driving simulator study exploring cross cultural differences

This paper presents the results of a cross-cultural study to investigate the influence of traffic safety culture and infrastructure improvements on driver behaviour. To achieve this, the driving style of UK drivers was compared with that of Nigerians with and without experience of driving in the UK. A driving simulator experiment compared the actual driving style of these three groups of drivers in different safety critical scenarios. The simulated road environment varied depending on how much infrastructure was provided (low or high infrastructure). In addition, the Driver Behaviour Questionnaire was used to collect self-reported data on violations, errors and lapses. It was hypothesised that Nigerian drivers with no experience of driving in a UK road system would report and engage in more unsafe driving behaviour compared to the other two groups, and that increasing infrastructure would have little positive benefit. Overall, the results supported these hypotheses, indicating that the behaviours of drivers are interpretable in relation to their traffic safety culture, compared to changes in their driving environment.     

Attitudes,risk perception and risk-taking behaviour among regular cyclists in Norway

The main aim of the study was to investigate whether attitudes toward traffic safety, risk perception, worry, risk tolerance, safety priority, and accident involvement are associated with cyclists’ risk-taking behaviour. Two types of cyclists’ risk-taking behaviour were studied: (1) ‘violation of traffic rules, and (2) ‘conflicts with other road users when cycling’. The study was based on a questionnaire survey carried out in 2017 among regular cyclists in Norway (n = 426). The results revealed that cyclists’ risk-taking behaviour was influenced by their attitudes, risk perception, and accident involvement. Pragmatic attitudes toward traffic rule violations and safety priority were found to be important predictors of the frequency of rule violations when cycling. Attitudes towards the enforcement of traffic rules for cyclists and dissatisfaction with the traffic rules for cyclists were found to be important predictors for the frequency of situations involving conflicts with other road users. Risk perception and accident involvement were found to be associated with conflicts with other road users, but not with rule violations when cycling. The findings show that risk perception and attitudes toward traffic safety are important for cyclists’ risk-taking behaviour in traffic. The road infrastructure and the traffic regulations are primarily planned for car drivers and pedestrians. If cyclists’ attitudes are to be changed, the cycling infrastructure and traffic rules for cyclists would need to be adjusted to cyclists as road users. When building new infrastructure and implementing new safety measures for cyclists, it is important to include attitude campaigns, as well as communications to the public about safety and the risks linked to cycling. Attitude campaigns could be used to strengthen the authorities’ communications that cyclists are prioritized as road users.     

After you?! – Use of external human-machine interfaces in road bottleneck scenarios

In the near future, automated vehicles (AVs) will enter the urban transport system. This fact will lead to mixed traffic consisting of AVs, human car drivers and vulnerable road users. Since the AV’s passenger no longer has to monitor the driving scene, conventional communication does not exist anymore, which is essential for traffic efficiency and safety. In research, there are plenty of studies focusing on how AVs could communicate with pedestrians. One approach is to use external human-machine interfaces (eHMIs) on the AV’s surface. In contrast to the studies dealing with AV-pedestrian communication, this paper focuses on communication strategies of AVs with drivers of regular vehicles in different road bottleneck scenarios. The eHMI development and design is building on previously defined requirements and on fundamentals of human visual perception. After designing several eHMI drafts, we conducted a user survey with 29 participants resulting in the final eHMI concept. The evaluation of the evolved eHMI was conducted in a driving simulator experiment with 43 participants investigating the AV-human driver interaction at road bottlenecks. The participants were assigned either to the experimental group being faced with the eHMI or to the baseline group without explicit communication. The results show significantly shorter passing times and fewer crashes among the human drivers in the group with the eHMI. Additionally, the paper researches the aftereffects of an automation failure, where the AV first yields the right of way and then changes its strategy and insisted on priority. Experiencing the automation failure is reflected in increased passing times, reduced acceptance ratings and a lower perceived usefulness. In conclusion, especially in unregulated bottleneck scenarios flawless communication via eHMIs increases traffic efficiency and safety.     

A systematic review of definitions of motor vehicle headways in driver behaviour and performance studies

Headway is a safety measure commonly used to investigate driving behaviour and driver performance. Its purpose is to reflect the following distance or time between a leading and following vehicle in traffic. It is therefore associated with drivers’ response time, such as in braking or swerving, during safety critical events. In the literature, distance and time headway are defined in different ways, despite standard definitions in the traffic engineering literature, which prompted this systematic review of headway definitions across a range of study designs, in order to recommend approaches to improve the accuracy and reproducibility of headway definitions used in road safety contexts. PRISMA guidelines were followed to search four databases (EMBASE, COMPENDEX, SCOPUS and MEDLINE) for studies that reported on headways or discussed methodological approaches. The search and filtering of abstracts identified 110 articles for a qualitative synthesis. Four broad approaches to measuring headways were detected: studies using simulation, roadside external features, on-road features, and on-vehicle features. Studies were coded as to whether they included written explanation, mathematical statements, or pictorial depictions of headway. Only 49.6% of studies contextualised headway sufficiently for reproducibility. Reproducibility is crucial for accurate interpretation of research findings and comparisons across studies. It is recommended that headway definitions should a) exclude vehicle or parts of vehicle lengths, b) include reference points (e.g., bumper/axle/rear), c) have a consistent terminology, and d) include the accuracy of headway measuring devices to report the precision of a study’s findings.     

Seizing Control: Estimating Multiple Decision Processes and the Investigation of Self-Control

There is a widespread consensus regarding the importance of self-control for various personal and social issues. However, the concept itself remains elusive, with numerous definitions and operational measurements competing. This article proposes a widely applicable statistical framework. Most theories propose that multiple, usually two, latent processes affect self-control. Mixture models can estimate to what extent hypothesized processes explain choice data. They also allow measuring how various dispositional and situational variables affect the relative contribution of each process considered. The approach promises to help seizing the concept of self-control, testing competing theories, and clarifying the effect of various variables.     

阻塞性睡眠呼吸暂停低通气综合征是引发道路交通事故的重要原因

为了分析我国道路交通事故是否与阻塞性睡眠呼吸暂停相关,以道路交通事故为主题查阅1993年~2012年万方数据库,并辅以手检同期《中华创伤杂志》和《中华流行病学杂志》,重点查阅全国性及地区性道路交通事故原因的论著,看其是否涉及阻塞性睡眠呼吸暂停问题。结果显示这期间共发表了相关论著43篇,全部论文在分析道路交通事故时均未提及阻塞性睡眠呼吸暂停这一重要原因,提示国内道路交通安全研究中忽略了一个与之关系密切的阻塞性睡眠呼吸暂停问题,建议今后将这个问题引入到道路交通安全管理项目中。     

Sensitivity to reward and risky driving,risky decision making,and risky health behaviour: A literature review

Young driver road safety has persisted as a global problem for decades, despite copious and diverse intervention. Recently the influence in reward sensitivity, which refers to the individual’s personal sensitivity to rewards, has received attention in health-related research, including more generally through decision making in risky circumstances, and in risky driving behaviour specifically. As such, a literature review and synthesis of the literature regarding reward sensitivity in relation to risky driving, risky decision making, and risky health behaviour, with a focus on literature in which adolescents and young adults feature, is timely. Thirty-one papers were identified, and the literature revealed that young drivers with greater reward sensitivity engage in more risky driving behaviours including speeding, crashes and traffic violations; and that individuals with greater reward sensitivity engage in more risky decision making and other risky health-related behaviours (such as drinking and drug use). Adolescents and young adults exhibit heightened sensitivity to rewards in the presence of peers, which has considerable implications for young driver road safety as research consistently demonstrates that carrying peer passengers places all vehicle occupants at greater risk of being involved in a road crash. Consideration of the influence of reward sensitivity in young driver road safety, and other adolescent/young adult health-related safety, appears to be a promising avenue of intervention, with gain-framed messages more likely to be accepted by young drivers with greater reward sensitivity. Future research in jurisdictions other than Australia and Europe will increase our understanding of the influence of reward sensitivity, and exploration of the differential impacts of reward-responsiveness and fun-seeking specifically are warranted.     

How can we improve safety culture in transport organizations? A review of interventions,effects and influencing factors

The main objectives of the present study are to (a) map interventions that can be used to develop good safety culture in transport companies within road, sea, air and rail transport, (b) assess expected effects of interventions on safety culture and safety outcomes and (c) identify factors influencing safety culture change. By systematically reviewing the scientific literature, we identify 20 studies that describe and evaluate interventions to improve safety culture in road, rail, sea and air transport organizations. The review is reported according to PRISMA guidelines. The interventions studied vary widely in their comprehensiveness, but a lack of both standardized outcome measures and controlled evaluations means that it is difficult to compare different interventions, either within or across sectors. Most studies, however, report improvements in safety culture where this is measured. We find that attempts to understand the mechanisms of cultural change leading to behavioural change and improved safety performance are lacking. Although safety culture is an organizational measure, we only found one peer-reviewed study of an attempt to improve safety culture in a single air transport organization and no studies of this in the maritime sector. We conclude that on the whole the reviewed safety culture interventions seem to be effective, but comprehensive and resource demanding. We suggest that future research should develop simpler interventions by focusing on the basic requirements of safety culture change. We contribute to this by identifying four key activities (content) which seem to be common in all the reviewed interventions, and eight key factors (process) influencing the success of efforts to influence safety culture. The basic requirements of safety culture change seem to be to institutionalize joint discussions of work place hazards facilitated by manager commitment and employee involvement.     

The role of values in road safety culture: Examining the valuation of freedom to take risk,risk taking and accident involvement in three countries

National focus on individual freedom versus paternalistic values is a fundamental theme, which defines the status of traffic safety in different countries. The present study examines the role of such values in road safety culture based on survey data from car and bus drivers from three countries with distinctly different road safety records: Norway (N = 596), Israel (N = 129) and Greece (N = 386). While Norway has the highest road safety level in Europe, and Israel also performs better than the EU average, the road safety level in Greece was far below the EU average. As these positions reflect differences in policies and national regulations in drivers’ freedom to take risk, we hypothesize a higher focus on individual freedom to take risk and lower focus on paternalism among the Greek drivers. Results indicate, in accordance with our hypothesis, that the Greek drivers value freedom to take risk in traffic higher than drivers from Norway and Israel. Greek drivers also expect higher levels of risk taking from other drivers in their country, they report higher levels of risky driving themselves, and are more often involved in accidents. Thus, it seems that values have an important role in Road Safety Culture (RSC), legitimizing and motivating risky driving, which are related to accidents. We found, however, contrary to our hypotheses, that the Greek drivers also had the most paternalistic attitudes among the drivers in the three countries. In the present paper, we try to solve this Greek paradox.     

Interaction between pedestrians and automated vehicles: Exploring a motion-based approach for virtual reality experiments

External human machine interfaces (eHMI) might contribute to an enhanced traffic flow and road safety by providing relevant information to surrounding road users. To quantify the effect of eHMI on traffic flow, the majority of studies required participants to indicate their crossing decision in an explicit manner, such as pressing a button. While this approach proved to be efficient, the transfer to real-world behavior is unclear. Here, we propose a more realistic, motion-based approach allowing pedestrians to actually cross the road in front of a vehicle in a virtual reality environment. Participants (N = 51) encountered simulated automated vehicles (AVs) in two scenarios. We investigated the effect of different eHMIs on traffic flow and road safety. Pedestrians’́ body movements were obtained using a motion capturing system with six sensors. Our approach was validated using a two-step procedure. First, we assessed crossing behavior and subjective safety feeling while approaching AVs with and without eHMI. Second, we tested to which extent objective crossing behavior matched self-reported safety feeling. For this purpose, we evaluated if subjective safety feeling can be reliably predicted from actual crossing behavior using a functional data analysis. The proposed motion-based approach proved a valid investigation method for eHMI designs. The results indicated that eHMIs have a beneficial effect on traffic flow and road safety. Regarding traffic flow, participants crossed the road earlier and felt significantly safer when encountering an AV with an eHMI compared to no eHMI. In addition, in situations in which only some of the AVs were equipped with an eHMI, participants’ crossing behavior and safety feeling became more conservative for encounters without eHMI, indicating higher road safety. Further, subjective safety feeling was significantly predicted from actual crossing behavior. These findings highlight that eHMIs are beneficial for pedestrians’ crossing decision, both from an objective and subjective perspective.     

Traffic safety climate attitudes of road users in Germany

This paper validates traffic safety climate attitudes based on a representative sample of road users of all travel modes. We use the German version of the Traffic Climate Scale (TCS) which was applied in a large-scale road safety survey in 2010. A total of 1680 people were surveyed. The sample is representative for socio-demographic characteristics and travel mode choice in Germany. Factor analysis reveals a three-factor structure of traffic safety climate with the factor ‘External affective demands’ describing emotional engagement in traffic, the factor ‘Internal requirements’ representing individual skills and abilities to successfully participate in traffic, and the factor ‘Functionality’ describing requirements for a functional traffic system. The less emotionally demanding and the more functional traffic is perceived to be, the safer people feel in traffic. External affective demands are consistently related to the perception of others’ driving/riding style but not to one’s own, whereas internal requirements are consistently related to one’s own driving/riding style but not to the perception of others. There is no relation between traffic safety climate and accidents or near accidents. Contrary to our expectations, a positive traffic safety climate is associated with more secondary tasks while driving and traffic violations. Behavioural control beliefs may mediate the traffic climate–traffic behaviour relationship. The results are discussed with reference to attitude research and the theory of planned behaviour in particular.     

What Does It Mean to Be Relational? A Framework for Assessment and Practice

The authors begin with a question regarding how to better draw upon relational thinking in making case assessments and treatment plans. They first address issues regarding the cultural construction of self and relationships, integrating women's psychology, family systems, and collectivist culture literatures within a discussion of power. Then they present a heuristic framework for how individuals orient themselves within relationships that includes two dimensions--focus and power--and evolves out of the social context. From these two dimensions, a typology of four basic relational orientations is presented: position directed, rule directed, independence directed, and relationship directed. Case examples from couple's therapy and suggestions for practice are provided.     

Stressbew?ltigung

Training for coping with stress as the core instrument of prevention of stress-related disorders at the individual level is characterized within the framework of prominent theoretical concepts of stress and derived from these. Response-focused, situation-focused and relational definitions of stress as well as the main results of stress research are described. The cognitive-transactional stress theory and the concept of coping are then outlined in their main features and control of stressor exposition, problem-focused coping, cognitive reappraisal, emotion-focused coping and mobilization of social support are characterized as main targets and modes of intervention in coping skills group programs. General aspects of such programs, selected findings on effectiveness and methodological considerations regarding the evaluation are then depicted. It is concluded that training of individual coping skills should be supplemented by preventive intervention at the institutional or organizational level.