The role of cultural beliefs in contributing to risky road use behaviour in Pakistan

Background Pakistan has the highest population rate of road fatalities in South Asia (25.3 fatalities per 100,000 people: Global Status Report on Road Safety, WHO 2009). Along with road environment and vehicle factors, human factors make a substantial contribution to traffic safety in Pakistan. Beliefs about road crash causation and prevention have been demonstrated to contribute to risky road use behaviour and resistance to preventive measures in a handful of other developing countries, but has not been explored in Pakistan. In particular, fatalism (whether based on religion, other cultural beliefs or experience) has been highlighted as a barrier to achieving changes in attitudes and behaviour. Aims The research reported here aimed (i) to explore perceptions of road crash causation among policy makers, police officers, professional drivers and car drivers in Pakistan; (ii) to identify how cultural and religious beliefs influence road use behaviour in Pakistan; and (iii) to understand how fatalistic beliefs may work as obstacles to road safety interventions. Methods In-depth interviews were conducted by the primary author (mostly in Urdu) in Lahore, Rawalpindi and Islamabad with 12 professional drivers (taxi, bus and truck), 4 car drivers, 6 police officers, 4 policy makers and 2 religious orators. All but two were Muslim, two were female, and they were drawn from a wide range of ages (24 to 60) and educational backgrounds. The interviews were taped and transcribed, then translated into English and analysed for themes related to the aims. Results Fatalism emerged as a pervasive belief utilised to justify risky road use behaviour and to resist messages about preventive measures. There was a strong religious underpinning to the statement of fatalistic beliefs (this reflects popular conceptions of Islam rather than scholarly interpretations), but also an overlap with superstitious beliefs which have longer-standing roots in Pakistani culture. These beliefs were not limited to people of poor educational background or position. A particular issue which was explored in more detail was the way in which these beliefs and their interpretation within Pakistani society contributed to poor police reporting of crashes. Discussion and conclusions The pervasive nature of fatalistic beliefs in Pakistan affects road user behaviour by supporting continued risk taking behaviour on the road, and by interfering with public health messages about behaviours which would reduce the risk of traffic crashes. The widespread influence of these beliefs on the ways that people respond to traffic crashes and the death of family members contribute to low crash reporting rates and to a system which is difficult to change. The promotion of an evidence-based approach to road user behaviour is recommended, along with improved professional education for police and policy makers.

Bicycling injuries and perceived risk

Introduction Government promotion of active transport has renewed interest in cycling safety. Research has shown that bicyclists are up to 20 times more likely to be involved in serious injury crashes than drivers. On-road cycling injuries are under-reported in police data, and many non-serious injuries are not recorded in any official database. This study aims to explore the relationships between rider characteristics and environmental factors that influence per kilometre risk of bicycle-related crash and non-crash injuries. Method A survey of 2,532 Queensland adults who had ridden at least once in the past year was conducted from October 2009 to March 2010, with most responses received online (99.3%). Riders were asked where they rode (footpath, bike path, road etc.), average travel speed, purpose of riding, type of bike ridden, how far and how often they rode in. Measures of rider experience, skill, safety perceptions, safety behaviours, crash involvement and demographic characteristics were also collected. RESULTS Increasing exposure and having more expensive bicycles were shown to reduce the risk per km of crash and non-crash injury rates, and to reduce perceived risk. Never wearing bright coloured clothing related to increased crash risk, use of fluorescent and reflective clothing had no effect on crash risk. Riding in low-speed environments, never using a front light, and riding in low-speed environments were associated with reduced non-crash injury risk. Perceived risk was influenced by exposure, use of conspicuity aids and helmets, riding for utilitarian reasons, and group-riding behaviours. DISCUSSION Perceived risk does not appear to influence injury rates and injury rates do not appear to influence the perceived risk of cycling. Riders who perceive cycling to be risky tend not to be commuters, do not engage in group riding and always wear helmets. Not all measures of conspicuity were associated with risk, with rear lights found to have no relationship to injury. The risks of experiencing a crash or non-crash injury were similar, therefore injury prevention strategies should expand their scope to include other factors such as the importance of bicycle set-up.

Evaluation of the skills for preventing injury in youth program : impact on health risk behaviors, injury and school connectedness

Injury is the leading cause of death among young people, and involvement in health risk behaviors, such as alcohol use and transport-related risks, is related to increased risk for injury. Effective health promotion programs for adolescents focus on multiple levels, including relationships with peers and parents, student knowledge, behavior and attitudes, and school-level factors such as school connectedness. This study describes the pilot evaluation of a comprehensive, multi-level injury prevention program for 13-14 year old adolescents, targeting change in injury associated with transport and alcohol risks. The program, called Skills for Preventing Injury in Youth (SPIY), incorporates two primary elements: an 8-week, teacher delivered attitude and behavior change curriculum with peer protection and first aid messages; and professional development for program teachers focusing on strategies to increase students’ connectedness to school. Five Australian high schools were recruited for the pilot evaluation research, with three being assigned to receive intervention components and two assigned as curriculum-as-usual controls. In the intervention schools, 118 Year 8 students participated in surveys at baseline, with 105 completing surveys at follow up, six months following the intervention. In the control schools, 196 Year 8 students completed surveys at baseline and 207 at follow up. Survey measures included self-reported injury, risk taking behavior and school connectedness. Results showed that students in the control schools were significantly more likely to report riding bikes without helmets, riding with dangerous drivers, having driven cars on the road, and using alcohol six months after the program, while the intervention group showed no such increase in these behaviors. Additionally, students in the control schools were significantly more likely to report having had pedestrian-related injuries at follow up than they were at the baseline measurement, while intervention school students showed no change. There was also a trend observed in terms of a decrease in bicycle related injuries among intervention school students, compared with a slight increasing trend in bicycle injuries among control students. Overall, scores on the school connectedness scale decreased significantly from baseline to follow up for both intervention and control students, however measurement limitations may have impacted on results relating to students’ connectedness. Overall, the SPIY program has shown promising results in regards to prevention of students’ health risk behavior and injuries. Evidence suggests that the curriculum component was important; however there was limited evidence to suggest that teacher training in school connectedness strategies contributed to these promising results. While school connectedness may be an important factor to target in risk and injury prevention programs, programs may need to incorporate whole-of-school strategies or target a broader range of teachers than were selected for the current research.

Factors influencing speeding in school zones : the role of mindfulness

Background Excessive speed contributes to the incidence and severity of road crashes. The Theory of Planned Behaviour (TPB) has successfully explained variance in speeding intentions and behaviour. However, studies have shown that more than 40% of the variance in outcome measures of speeding remains unexplained, thus, suggesting additional constructs may help to enhance the TPB’s predictive power. Therefore, this study examined mindfulness; a promising construct which has not yet been tested as an additional TPB predictor. Aims The aims of this study were to explore drivers’ beliefs about speeding in school zones using the extended TPB as a framework and to examine the effect that mindfulness had on driver speeding behaviour in school zones. Methods Australian drivers (N = 17) participated in one of four focus group discussions. The overall sample was comprised of five males and twelve females who were aged between 17 to56 years. All participants were recruited via purposive sampling among 1st year psychology students at a large South East Queensland University. The group discussions took approximately one hour and were guided by a structured interview schedule which sought to elicit drivers’ beliefs, thoughts and opinions on speeding in school zones and the factors which motivate such behaviour. Results Overall, thematic analysis revealed some similar issues emerged across the groups. . In particular and perhaps somewhat unsurprisingly, given public concerns regarding the want to ensure the safety of school children, there was much agreement that speeding in school zones was dangerous and unacceptable. Somewhat paradoxically however, some participants also agreed that they had unintentionally or mindlessly sped in school zones. There were several factors that drivers believed influenced their speeding in school zones including their current mood (e.g., if in a bad mood, anxious, or excited they may be more likely to drive without awareness of, and being attentive to, their driving environment) and the extent to which they were familiar with the environment (i.e., more familiar contexts, more likely to drive mindlessly). Thus, although drivers expressed a belief that speeding in school zones was dangerous and acceptable, the extent to which a driver is mindful does influence whether or not a driver may actually engage in speeding in this context. Discussion and conclusions This study highlights the potential role of mindfulness in helping to explain speeding behaviour in school zones. Mindless drivers may speed unintentionally and while unintentional still be endangering the safety and lives of school children. The findings of this research suggest that unintentional speeding, especially in school zones, may be reduced by countermeasures which heighten the extent to which drivers are mindful of approaching and/or driving through a school zone, such as street markings and engineering measures (e.g.,flashing lights and speed bumps).

Priorities for developing and evaluating data quality characteristics of road crash data in Australia

The National Road Safety Strategy 2011-2020 outlines plans to reduce the burden of road trauma via improvements and interventions relating to safe roads, safe speeds, safe vehicles, and safe people. It also highlights that a key aspect in achieving these goals is the availability of comprehensive data on the issue. The use of data is essential so that more in-depth epidemiologic studies of risk can be conducted as well as to allow effective evaluation of road safety interventions and programs. Before utilising data to evaluate the efficacy of prevention programs it is important for a systematic evaluation of the quality of underlying data sources to be undertaken to ensure any trends which are identified reflect true estimates rather than spurious data effects. However, there has been little scientific work specifically focused on establishing core data quality characteristics pertinent to the road safety field and limited work undertaken to develop methods for evaluating data sources according to these core characteristics. There are a variety of data sources in which traffic-related incidents and resulting injuries are recorded, which are collected for a variety of defined purposes. These include police reports, transport safety databases, emergency department data, hospital morbidity data and mortality data to name a few. However, as these data are collected for specific purposes, each of these data sources suffers from some limitations when seeking to gain a complete picture of the problem. Limitations of current data sources include: delays in data being available, lack of accurate and/or specific location information, and an underreporting of crashes involving particular road user groups such as cyclists. This paper proposes core data quality characteristics that could be used to systematically assess road crash data sources to provide a standardised approach for evaluating data quality in the road safety field. The potential for data linkage to qualitatively and quantitatively improve the quality and comprehensiveness of road crash data is also discussed.

A further exploration of sensation seeking propensity, reward sensitivity, depression, anxiety, and the risky behaviour of young novice drivers in a structural equation model

Young novice drivers constitute a major public health concern due to the number of crashes in which they are involved, and the resultant injuries and fatalities. Previous research suggests psychological traits (reward sensitivity, sensation seeking propensity), and psychological states (anxiety, depression) influence their risky behaviour. The relationships between gender, anxiety, depression, reward sensitivity, sensation seeking propensity and risky driving are explored. Participants (390 intermediate drivers, 17-25 years) completed two online surveys at a six month interval. Surveys comprised sociodemographics, Brief Sensation Seeking Scale, Kessler’s Psychological Distress Scale, an abridged Sensitivity to Reward Questionnaire, and risky driving behaviour was measured by the Behaviour of Young Novice Drivers Scale. Structural equation modelling revealed anxiety, reward sensitivity and sensation seeking propensity predicted risky driving. Gender was a moderator, with only reward sensitivity predicting risky driving for males. Future interventions which consider the role of rewards, sensation seeking, and mental health may contribute to improved road safety for younger and older road users alike.

On the significance of omitted variables in intersection crash modeling

Advances in safety research—trying to improve the collective understanding of motor vehicle crash causes and contributing factors—rest upon the pursuit of numerous lines of research inquiry. The research community has focused considerable attention on analytical methods development (negative binomial models, simultaneous equations, etc.), on better experimental designs (before-after studies, comparison sites, etc.), on improving exposure measures, and on model specification improvements (additive terms, non-linear relations, etc.). One might logically seek to know which lines of inquiry might provide the most significant improvements in understanding crash causation and/or prediction. It is the contention of this paper that the exclusion of important variables (causal or surrogate measures of causal variables) cause omitted variable bias in model estimation and is an important and neglected line of inquiry in safety research. In particular, spatially related variables are often difficult to collect and omitted from crash models—but offer significant opportunities to better understand contributing factors and/or causes of crashes. This study examines the role of important variables (other than Average Annual Daily Traffic (AADT)) that are generally omitted from intersection crash prediction models. In addition to the geometric and traffic regulatory information of intersection, the proposed model includes many spatial factors such as local influences of weather, sun glare, proximity to drinking establishments, and proximity to schools—representing a mix of potential environmental and human factors that are theoretically important, but rarely used. Results suggest that these variables in addition to AADT have significant explanatory power, and their exclusion leads to omitted variable bias. Provided is evidence that variable exclusion overstates the effect of minor road AADT by as much as 40% and major road AADT by 14%.

Adolescent involvement in anti-social and delinquent behaviours : predicting future injury risk

The purpose of this study was to challenge the broadly based focus of injury prevention strategies towards concern with the needs of young adolescents who engage in multiple anti-social and delinquent behaviours. Five hundred and forty 13-14 year olds reported on injuries and truancy, violence, illegal road behaviours, drug, and alcohol use. Engagement in these behaviours was found to contribute to the likelihood of an injury. Those engaging in the most anti-social and delinquent behaviours were around five times more likely to report medically-treated injuries in the past three months. Their likelihood of future injury was 1.8 times more likely when they were followed up three months later. The engagement in multiple delinquent and illegal behaviours thus significantly increased the likelihood of injury and identifies a particularly vulnerable group. The findings also suggest that reaching these young people represents a key target for change strategies in injury prevention programs.

The lived experience of post-traumatic stress disorder as described by motor vehicle accident victims in Jordan

Aim: To explore the lived experience of post-traumatic stress disorder (PTSD) as described by individuals who have been involved in a motor vehicle accident (MVA) in Jordan. Background: Motor vehicle accident (MVA) survivors who develop post-traumatic stress disorder (PTSD) have become an important health issue. The World Health Organisation (WHO) states that trauma resulting from MVAs is a phenomenon of increasing concern, with death from injuries projected to rise from 5.1 million in 1990 to 8.4 million in 2020 particularly in developing countries such as Jordan (WHO, 2002). The impact of trauma from MVAs inevitably compromises the victim’s quality of life (WHO, 2002; Blanchard & Hickling, 2007) resulting in psychological and emotional distress, occupational disability, family disintegration, and socio-economic difficulty (Jordan Ministry of Health, 2005). The development of PTSD as a result of an MVA is not limited to the individual, but also extends to the family, friends, and the health care team involved in the person's care and rehabilitation. Design: A descriptive phenomenological approach was used for this study. Method: This study was conducted in an orthopaedic unit in Amera Basma Hospital in Irbid Jordan. Fifteen (15) participants were voluntary recruited through the process of purposeful sampling. Data was collected by face-to-face in depth-interviews. Interviews were digitally recorded and transcribed verbatim. The process of analysis was undertaken using Colaizzi’s (1978) eight step approach with the addition of two extra steps. Findings: The process of analysis identified seven themes explicated from the participants’ transcripts of interview. The seven themes were: 1. Feeling frustrated at a diminishing health status 2. Struggling to maintain a sense of independence 3. Harbouring feelings of not being able to recover 4. Feeling discriminated against and marginalised by society 5. Feeling ignored and neglected by health care professionals 6. Feeling abandoned by family, and 7. Moving toward acceptance through having faith in Allah. Conclusion: The findings of this study have the potential to make a significant contribution to extant knowledge on the topic which can inform future nursing practice, education, policy development, and research initiatives in Jordan and internationally.

Mother-child communication about sexual abuse prevention

Two hundred and twelve Australian mothers completed an online survey examining features of mother-child communication about child sexual abuse prevention. Two-thirds (67.5%) of respondents had discussed child sexual abuse prevention with their children. Proportions of mothers talking with their children about child sexual abuse prevention varied according to age range (highest for mothers with children aged 5-12 years) and only child status (lowest for mothers of only children). The number of topics discussed with their children differed according to child gender (greater number of topics discussed by mothers with both girls and boys) and age range (greater number of topics discussed by mothers with children aged 5-12 years). These findings provide new insights into mother-child communication about child sexual abuse prevention.

Theoretical perspectives on motorcycle training: reducing risk taking

Little past empirical support has been found for the efficacy of motorcycle rider training as a road safety countermeasure. However, it has been argued that rider training should focus more particularly on the psychosocial factors that influence risk taking behaviour in addition to the traditional practice of developing vehicle-handling skills. This paper examines how rider training to reduce risk taking could be guided by appropriate theories. Two fundamental perspectives are examined: firstly training can be considered in terms of behaviour change, and secondly in terms of adult learning. Whilst behaviour change theories assume some pre-existing level of dysfunctional behaviour, an adult learning perspective does not necessarily carry this assumption. This distinction in perspectives conceptually aligns with the notions of intervention and prevention (respectively), with possible implications for specific target groups for pre-licence and post-licence training. The application of the Theory of Reasoned Action (Ajzen & Fishbein, 1975, 1980) and Transformative Learning Theory (Mezirow, 1997) to a pre-licence rider training program in Queensland, Australia is discussed.

Relationships between maternal feeding and child weight in younger Australian children – Findings from the NOURISH obesity prevention trial

Studies show that in 3-11 year-olds, parental feeding style is directly associated with child weight [1] and also moderates the association between feeding practices and weight [2]. This cross-sectional study aimed to examine these relationships in younger children. Data from 331 of 698 first-time mothers of healthy term children (151 boys, mean age 24±1 months) enrolled in the NOURISH RCT included (a) measured child weight, (b) self-reported feeding styles and controlling feeding practices, and (c) maternal and child covariates. ANCOVA compared mean child weight-for-age z-score (cWAZ) across 4 feeding styles. Regression examined the associations between cWAZ and 5 controlling feeding practices. Moderated multiple regression analysis was planned to examine effects of feeding style on relationships between feeding practices and cWAZ. Feeding style (indulgent = 38.6%, authoritarian = 35.8%, authoritative = 13.1%, uninvolved = 12.5%) was not independently associated with cWAZ. However, ’pressure to eat’ was negatively associated with cWAZ (�=-0.131, p<0.05) higher pressure associated with lower cWAZ. Given feeding style was not associated with cWAZ, moderation analysis was not performed. Contrary to findings in older children, cWAZ in 2-year-olds was not associated with maternal feeding style. However, the negative association between child weight and pressure feeding found in 6-11year-olds [2] appears to hold in toddlers. Educating mothers about potentially detrimental long-term effects of pressure feeding in early childhood, may be more practical and effective in promoting healthy weight than targeting the less concrete concept of feeding styles. References: [1] Hughes, Appetite, 2005;44:83-92. [2] Hennessy, Appetite, 2010;54:369-377.

Severity of driver injury and vehicle damage in traffic crashes at intersections: A Bayesian hierarchical analysis

Most crash severity studies ignored severity correlations between driver-vehicle units involved in the same crashes. Models without accounting for these within-crash correlations will result in biased estimates in the factor effects. This study developed a Bayesian hierarchical binomial logistic model to identify the significant factors affecting the severity level of driver injury and vehicle damage in traffic crashes at signalized intersections. Crash data in Singapore were employed to calibrate the model. Model fitness assessment and comparison using Intra-class Correlation Coefficient (ICC) and Deviance Information Criterion (DIC) ensured the suitability of introducing the crash-level random effects. Crashes occurring in peak time, in good street lighting condition, involving pedestrian injuries are associated with a lower severity, while those in night time, at T/Y type intersections, on right-most lane, and installed with red light camera have larger odds of being severe. Moreover, heavy vehicles have a better resistance on severe crash, while crashes involving two-wheel vehicles, young or aged drivers, and the involvement of offending party are more likely to result in severe injuries.

Modeling fault among motorcyclists involved in crashes

Singapore crash statistics from 2001 to 2006 show that the motorcyclist fatality and injury rates per registered vehicle are higher than those of other motor vehicles by 13 and 7 times respectively. The crash involvement rate of motorcyclists as victims of other road users is also about 43%. The objective of this study is to identify the factors that contribute to the fault of motorcyclists involved in crashes. This is done by using the binary logit model to differentiate between at-fault and not-at-fault cases and the analysis is further categorized by the location of the crashes, i.e., at intersections, on expressways and at non-intersections. A number of explanatory variables representing roadway characteristics, environmental factors, motorcycle descriptions, and rider demographics have been evaluated. Time trend effect shows that not-at-fault crash involvement of motorcyclists has increased with time. The likelihood of night time crashes has also increased for not-at-fault crashes at intersections and expressways. The presence of surveillance cameras is effective in reducing not-at-fault crashes at intersections. Wet road surfaces increase at-fault crash involvement at non-intersections. At intersections, not-at-fault crash involvement is more likely on single lane roads or on median lane of multi-lane roads, while on expressways at-fault crash involvement is more likely on the median lane. Roads with higher speed limit have higher at-fault crash involvement and this is also true on expressways. Motorcycles with pillion passengers or with higher engine capacity have higher likelihood of being at-fault in crashes on expressways. Motorcyclists are more likely to be at-fault in collisions involving pedestrians and this effect is higher at night. In multi-vehicle crashes, motorcyclists are more likely to be victims than at fault. Young and older riders are more likely to be at-fault in crashes than middle-aged group of riders. The findings of this study will help to develop more targeted countermeasures to improve motorcycle safety and more cost-effective safety awareness program in motorcyclist training.

Applying Bayesian hierarchical models to examine motorcycle crashes at signalized intersections

Motorcycles are overrepresented in road traffic crashes and particularly vulnerable at signalized intersections. The objective of this study is to identify causal factors affecting the motorcycle crashes at both four-legged and T signalized intersections. Treating the data in time-series cross-section panels, this study explores different Hierarchical Poisson models and found that the model allowing autoregressive lag 1 dependent specification in the error term is the most suitable. Results show that the number of lanes at the four-legged signalized intersections significantly increases motorcycle crashes largely because of the higher exposure resulting from higher motorcycle accumulation at the stop line. Furthermore, the presence of a wide median and an uncontrolled left-turn lane at major roadways of four-legged intersections exacerbate this potential hazard. For T signalized intersections, the presence of exclusive right-turn lane at both major and minor roadways and an uncontrolled left-turn lane at major roadways of T intersections increases motorcycle crashes. Motorcycle crashes increase on high-speed roadways because they are more vulnerable and less likely to react in time during conflicts. The presence of red light cameras reduces motorcycle crashes significantly for both four-legged and T intersections. With the red-light camera, motorcycles are less exposed to conflicts because it is observed that they are more disciplined in queuing at the stop line and less likely to jump start at the start of green.