Road safety knowledge exchange and capacity building between China and Australia

Road traffic injuries are one of the major public health burdens worldwide. The United Nations Decade of Action for Road Safety (2011-2020) implores all nations to work to reduce this burden. This decade represents a unique and historic period of time in the field of road safety. Information exchange and co-operation between nations is an important step in achieving the goal. The burden of road crashes, fatalities and injuries is not equally distributed. We know that low and middle-income countries experience the majority of the road trauma burden. Therefore it is imperative that these countries learn from the successes of others that have developed and implemented road safety laws, public education campaigns and countermeasures over many years and have achieved significant road trauma reductions as a result. China is one of the countries experiencing a large road trauma burden. Vulnerable road users such as pedestrians and cyclists make up a large proportion of fatalities and injuries in China. Speeding, impaired/drug driving, distracted driving, vehicle overloading, inadequate road infrastructure, limited use of safety restraints and helmets, and limited road safety training have all been identified as contributing to the problem. Some important steps have been taken to strengthen China’s approach, including increased penalties for drunk driving in May 2011 and increased attention to school bus safety in 2011/12. However, there is still a large amount of work needed to improve the current road safety position in China. This paper provides details of a program to assist with road safety knowledge exchange between China and Australia that was funded by the Australian Government which was undertaken in the latter part of 2012. The four month program provided the opportunity for the first author to work closely with key agencies in Australia that are responsible for policy development and implementation of a broad range of road safety initiatives. In doing so, an in-depth understanding was gained about key road safety strategies in Australia and processes for developing and implementing them. Insights were also gained into the mechanisms used for road safety policy development, implementation and evaluation in several Australian jurisdictions. Road traffic law and enforcement issues were explored with the relevant jurisdictional transport and police agencies to provide a greater understanding of how Chinese laws and practices could be enhanced. Working with agencies responsible for public education and awareness campaigns about road safety in Australia also provided relevant information about how to promote road safety at the broader community level in China. Finally, the program provided opportunities to work closely with several world-renowned Australian research centres and key expert researchers to enhance opportunities for ongoing road safety research in China. The overall program provided the opportunity for the first author to develop knowledge in key areas of road safety strategy development, implementation and management which are directly relevant to the current situation in China. This paper describes some main observations and findings from participation in the program.

Consumer perceptions of medication warnings about driving : a comparison of French and Australian labels

OBJECTIVE Little research has examined user perceptions of medication warnings about driving. Consumer perceptions of the Australian national approach to medication warnings about driving are examined. The Australian approach to warning presentation is compared with an alternative approach used in France. Visual characteristics of the warnings and overall warning readability are investigated. Risk perceptions and behavioral intentions associated with the warnings are also examined. METHOD Surveys were conducted with 358 public hospital outpatients in Queensland, Australia. Extending this investigation is a supplementary comparison study of French hospital outpatients (n = 75). RESULTS The results suggest that the Australian warning approach of using a combination of visual characteristics is important for consumers but that the use of a pictogram could enhance effects. Significantly higher levels of risk perception were found among the sample for the French highest severity label compared to the analogous mandatory Australian warning, with a similar trend evident in the French study results. The results also indicated that the French label was associated with more cautious behavioral intentions. CONCLUSION The results are potentially important for the Australian approach to medication warnings about driving impairment. The research contributes practical findings that can be used to enhance the effectiveness of warnings and develop countermeasures in this area. Hospital pharmacy patients should include persons with the highest level of likelihood of knowledge and awareness of medication warning labeling. Even in this context it appears that a review of the Australian warning system would be useful particularly in the context of increasing evidence relating to associated driving risks. Reviewing text size and readability of messages including the addition of pictograms, as well as clarifying the importance of potential risk in a general community context, is recommended for consideration and further research.

Hospital outpatients' responses to taking medications with driving warnings

OBJECTIVE The study investigates the knowledge, intentions, and driving behavior of persons prescribed medications that display a warning about driving. It also examines their confidence that they can self-assess possible impairment, as is required by the Australian labeling system. METHOD We surveyed 358 outpatients in an Australian public hospital pharmacy, representing a well-advised group taking a range of medications including those displaying a warning label about driving. A brief telephone follow-up survey was conducted with a subgroup of the participants. RESULTS The sample had a median age of 53.2 years and was 53 percent male. Nearly three quarters (73.2%) had taken a potentially impairing class of medication and more than half (56.1%) had taken more than one such medication in the past 12 months. Knowledge of the potentially impairing effects of medication was relatively high for most items; however, participants underestimated the possibility of increased impairment from exceeding the prescribed dose and at commencing treatment. Participants' responses to the safety implications of taking drugs with the highest level of warning varied. Around two thirds (62.8%) indicated that they would consult a health practitioner for advice and around half would modify their driving in some way. However, one fifth (20.9%) would drive when the traffic was thought to be less heavy and over a third (37.7%) would modify their medication regime so that they could drive. The findings from the follow-up survey of a subsample taking target drugs at the time of the first interview were also of concern. Only just over half (51%) recalled seeing the warning label on their medications and, of this group, three quarters (78%) reported following the warning label advice. These findings indicated that there remains a large proportion of people who either did not notice or did not consider the warning when deciding whether to drive. There was a very high level of confidence in this group that they could determine whether they were personally affected by the medication, which may be a problem from a safety perspective. CONCLUSION This study involved persons who should have had a very high level of knowledge and awareness of medication warning labeling. Even in this group there was a lack of informed response to potential impairment. A review of the Australian warning system and wider dissemination of information on medication treatment effects would be useful. Clarifying the importance of potential risk in the general community context is recommended for consideration and further research.

Parental perceptions of the learner driver log book system in two Australian states

Objective While many jurisdictions internationally now require learner drivers to complete a specified number of hours of supervised driving practice before being able to drive unaccompanied, very few require learner drivers to complete a log book to record this practice and then present it to the licensing authority. Learner drivers in most Australian jurisdictions must complete a log book that records their practice thereby confirming to the licensing authority that they have met the mandated hours of practice requirement. These log books facilitate the management and enforcement of minimum supervised hours of driving requirements. Method Parents of learner drivers in two Australian states, Queensland and New South Wales, completed an online survey assessing a range of factors, including their perceptions of the accuracy of their child’s learner log book and the effectiveness of the log book system. Results The study indicates that the large majority of parents believe that their child’s learner log book is accurate. However, they generally report that the log book system is only moderately effective as a system to measure the number of hours of supervised practice a learner driver has completed. Conclusions The results of this study suggest the presence of a paradox with many parents possibly believing that others are not as diligent in the use of log books as they are or that the system is too open to misuse. Given that many parents report that their child’s log book is accurate, this study has important implications for the development and ongoing monitoring of hours of practice requirements in graduated driver licensing systems.

Enabling safe autonomous driving in real-world city traffic using multiple criteria decision making

This paper addresses the topic of real-time decision making for autonomous city vehicles, i.e., the autonomous vehicles' ability to make appropriate driving decisions in city road traffic situations. The paper explains the overall controls system architecture, the decision making task decomposition, and focuses on how Multiple Criteria Decision Making (MCDM) is used in the process of selecting the most appropriate driving maneuver from the set of feasible ones. Experimental tests show that MCDM is suitable for this new application area.

Beyond the barriers : road construction safety issues from the office and the roadside

Conceptually, the management of safety at roadworks can be seen in a three level framework. At the regulatory level, roadworks operate at the interface between the work environment, governed by workplace health and safety regulations, and the road environment, which is subject to road traffic regulations and practices. At the organizational level, national, state and local governments plan and purchase road construction and maintenance which are then delivered in-house or tendered out to large construction companies who often subcontract multiple smaller companies to supply services and labor. At the operational level, roadworks are difficult to isolate from the general public, hindering effective occupational health and safety controls. This study, from the State of Queensland, Australia, examines how well this tripartite framework functions. It includes reviews of organizational policy and procedures documents; interviews with 24 subject matter experts from various road construction and maintenance organizations, and on-site interviews with 66 road construction personnel. The study identified several factors influencing the translation of safety policies into practice including the cost of safety measures in the context of competitive tendering, lack of firm evidence of the effectiveness of safety measures, and pressures to minimize disruption to the travelling public.

Investigations on road noise level spatial variability within a specially designed acoustic balcony

An investigation into the spatial distribution of road traffic noise levels on a balcony is conducted. A balcony constructed to a special acoustic design due to its elevation above an 8 lane motorway is selected for detailed measurements. The as-constructed balcony design includes solid parapets, side walls, ceiling shields and highly absorptive material placed on the ceiling. Road traffic noise measurements are conducted spatially using a five channel acoustic analyzer, where four microphones are located at various positions within the balcony space and one microphone placed outside the parapet at a reference position. Spatial distributions in both vertical and horizontal planes are measured. A theoretical model and prediction configuration is presented that assesses the acoustic performance of the balcony under existing traffic flow conditions. The prediction model implements a combined direct path, specular reflection path and diffuse reflection path utilizing image source and radiosity techniques. Results obtained from the prediction model are presented and compared to the measurement results. The predictions are found to correlate well with measurements with some minor differences that are explained. It is determined that the prediction methodology is acceptable to assess a wider range of street and balcony configuration scenarios.

Piecing the puzzle together : enhancing the quality of road trauma surveillance through linkage of police and health data

This program of research linked police and health data collections to investigate the potential benefits for road safety in terms of enhancing the quality of data. This research has important implications for road safety because, although police collected data has historically underpinned efforts in the area, it is known that many road crashes are not reported to police and that these data lack specific injury severity information. This research shows that data linkage provides a more accurate quantification of the severity and prevalence of road crash injuries which is essential for: prioritising funding; targeting interventions; and estimating the burden and cost of road trauma.

Initial burden of disease estimates for South Africa, 2000

BACKGROUND This paper describes the first national burden of disease study for South Africa. The main focus is the burden due to premature mortality, i.e. years of life lost (YLLs). In addition, estimates of the burden contributed by morbidity, i.e. the years lived with disability (YLDs), are obtained to calculate disability-adjusted life years (DALYs); and the impact of AIDS on premature mortality in the year 2010 is assessed. METHOD Owing to the rapid mortality transition and the lack of timely data, a modelling approach has been adopted. The total mortality for the year 2000 is estimated using a demographic and AIDS model. The non-AIDS cause-of-death profile is estimated using three sources of data: Statistics South Africa, the National Department of Home Affairs, and the National Injury Mortality Surveillance System. A ratio method is used to estimate the YLDs from the YLL estimates. RESULTS The top single cause of mortality burden was HIV/AIDS followed by homicide, tuberculosis, road traffic accidents and diarrhoea. HIV/AIDS accounted for 38% of total YLLs, which is proportionately higher for females (47%) than for males (33%). Pre-transitional diseases, usually associated with poverty and underdevelopment, accounted for 25%, non-communicable diseases 21% and injuries 16% of YLLs. The DALY estimates highlight the fact that mortality alone underestimates the burden of disease, especially with regard to unintentional injuries, respiratory disease, and nervous system, mental and sense organ disorders. The impact of HIV/AIDS is expected to more than double the burden of premature mortality by the year 2010. CONCLUSION This study has drawn together data from a range of sources to develop coherent estimates of premature mortality by cause. South Africa is experiencing a quadruple burden of disease comprising the pre-transitional diseases, the emerging chronic diseases, injuries, and HIV/AIDS. Unless interventions that reduce morbidity and delay morbidity become widely available, the burden due to HIV/AIDS can be expected to grow very rapidly in the next few years. An improved base of information is needed to assess the morbidity impact more accurately.

The high burden of injuries in South Africa

Objective To estimate the magnitude and characteristics of the injury burden in South Africa within a global context. Methods The Actuarial Society of South Africa demographic and AIDS model (ASSA 2002) – calibrated to survey, census and adjusted vital registration data – was used to calculate the total number of deaths in 2000. Causes of death were determined from the National Injury Mortality Surveillance System profile. Injury death rates and years of life lost (YLL) were estimated using the Global Burden of Disease methodology. National years lived with disability (YLDs) were calculated by applying a ratio between YLLs and YLDs found in a local injury data source, the Cape Metropole Study. Mortality and disability-adjusted life years’ (DALYs) rates were compared with African and global estimates. Findings Interpersonal violence dominated the South African injury profile with age-standardized mortality rates at seven times the global rate. Injuries were the second-leading cause of loss of healthy life, accounting for 14.3% of all DALYs in South Africa in 2000. Road traffic injuries (RTIs) are the leading cause of injury in most regions of the world but South Africa has exceedingly high numbers – double the global rate. Conclusion Injuries are an important public health issue in South Africa. Social and economic determinants of violence, many a legacy of apartheid policies, must be addressed to reduce inequalities in society and build community cohesion. Multisectoral interventions to reduce traffic injuries are also needed. We highlight this heavy burden to stress the need for effective prevention programmes.

Estimating link-dependent origin-destination matrices from sample trajectories and traffic counts

In transport networks, Origin-Destination matrices (ODM) are classically estimated from road traffic counts whereas recent technologies grant also access to sample car trajectories. One example is the deployment in cities of Bluetooth scanners that measure the trajectories of Bluetooth equipped cars. Exploiting such sample trajectory information, the classical ODM estimation problem is here extended into a link-dependent ODM (LODM) one. This much larger size estimation problem is formulated here in a variational form as an inverse problem. We develop a convex optimization resolution algorithm that incorporates network constraints. We study the result of the proposed algorithm on simulated network traffic.

Key beliefs influencing young drivers' engagement with social interactive technology on their Smartphones: A qualitative study

Objective The main aim of this study was to identify young drivers' underlying beliefs (i.e., behavioral, normative, and control) regarding initiating, monitoring/reading, and responding to social interactive technology (i.e., functions on a Smartphone that allow the user to communicate with other people). Method This qualitative study was a beliefs elicitation study in accordance with the Theory of Planned Behavior and sought to elicit young drivers' behavioral (i.e., advantages, disadvantages), normative (i.e., who approves, who disapproves), and control beliefs (i.e., barriers, facilitators) which underpin social interactive technology use while driving. Young drivers (N = 26) aged 17 to 25 years took part in an interview or focus group discussion. Results While differences emerged between the three behaviors of initiating, monitoring/reading, and responding for each of the behavioral, normative, and control belief categories, the strongest distinction was within the behavioral beliefs category (e.g., communicating with the person that they were on the way to meet was an advantage of initiating; being able to determine whether to respond was an advantage of monitoring/reading; and communicating with important people was an advantage of responding). Normative beliefs were similar for initiating and responding behaviors (e.g., friends and peers more likely to approve than other groups) and differences emerged for monitoring/reading (e.g., parents were more likely to approve of this behavior than initiating and responding). For control beliefs, there were differences between the beliefs regarding facilitators of these behaviors (e.g., familiar roads and conditions facilitated initiating; having audible notifications of an incoming communication facilitated monitoring/reading; and receiving a communication of immediate importance facilitated responding); however, the control beliefs that presented barriers were consistent across the three behaviors (e.g., difficult traffic/road conditions). Conclusion The current study provides an important addition to the extant literature and supports emerging research which suggests initiating, monitoring/reading, and responding may indeed be distinct behaviors with different underlying motivations.

Designing and evaluating a persuasive child restraint television commercial

Objective Relatively high rates of child restraint inappropriate use, misuse and faults in the installation of restraints have suggested a crucial need for public education messages to raise parental awareness of the need to use restraints correctly. This project involved the devising and pilot testing of message concepts, filming of a television advertisement (the TVC), and the evaluation of the TVC. This paper focuses specifically upon the evaluation of the TVC. The development and evaluation of the TVC were guided by an extended Theory of Planned Behaviour which comprised the standard constructs of attitude, subjective norm, and perceived behavioural control as well as the additional constructs of group norm and descriptive norm. The study also explored the extent to which parents with low and high intentions to self-check restraint/s differed on salient beliefs regarding the behaviour. Methods An online survey of parents (N = 384) was conducted where parents were randomly assigned to either an Intervention group (n = 161), and therefore viewed the advertisement within the survey, or the Control group (n = 223) and therefore did not view the advertisement. Results Following a one-off exposure to the TVC, the results indicated that, although not a significant difference, parents in the Intervention group reported stronger intentions (M = 4.43, SD = .74) to self-check restraints than parents in the Control group (M = 4.18, SD = .86). Also, parents in the Intervention group (M = 4.59, SD = .47) reported significantly higher levels of perceived behavioural control than parents in the Control group (M = 4.40, SD = .73). The regression results revealed that, for parents in the Intervention group, attitude and group norm were significant predictors of parental intentions to self-check their child restraint. Finally, the exploratory analyses of parental beliefs suggested that those parents with low intentions to self-check child restraints were significantly more likely than high intenders to agree that they did not have enough time to check restraints or that having a child in a restraint is more important than checking the installation of the restraint. Conclusion Overall, the findings provide some support for the persuasiveness of the child restraint TVC and provide insight into the factors influencing reported parental intentions as well as salient beliefs underpinning self-checking of restraints. Interventions that attempt to increase parental perceptions of the importance of self-checking restraints regularly and brevity of the time involved in doing so may be effective.

Prevalence of alcohol-impaired driving and riding in northern Ghana

Objective The objective of this study was to determine the roadside prevalence of alcohol-impaired driving among drivers and riders in northern Ghana. The study also verifies motorists’ perception on their own alcohol use and knowledge of legal Blood Alcohol Concentration (BAC) limit of Ghana. Method With the assistance of police, the systematic random sampling was used to collect data at roadblocks using a cross-sectional study design. Breathalyzers were used to screen whether motorists had detectable alcohol in their breath and a follow-up breath tests conducted to measure the actual breath alcohol levels among positive participants. Results In all, 9.7% of the 789 participants had detectable alcohol among whom 6% exceeded the legal (BAC) limit of 0.08%. The prevalence of alcohol-impaired driving/riding was highest among cyclists (10% of all cyclists breath tested) followed by truck drivers 9% and motorcyclists (7% of all motorcyclists breath tested). The occurrence of a positive BAC among cyclists was about 8 times higher, (OR=7.73; p<0.001) and 2 times higher, among motorcyclists (OR=2.30; p=0.039) compared with private car drivers. The likelihood for detecting a positive BAC among male motorists/riders was higher than females (OR=1.67; p=0.354). The odds for detecting a positive BAC among weekend motorists/riders was significantly higher than weekdays (OR=2.62; p=0.001). Conclusion Alcohol-impaired driving/riding in Ghana is high by international standards. In order to attenuate the harmful effects of alcohol misuse such as alcohol-impaired driving/riding, there is the need to educate road users about how much alcohol they can consume and stay below the legal limit. The police should also initiate random breath testing to instil the deterrence of detection, certainty of apprehension and punishment, and severity and celerity of punishment among drink-driving motorists and riders.

General motor vehicle drivers' knowledge and practices regarding drink driving in Yinchuan and Guangzhou, China

Objective: Drink driving contributes to significant levels of injury and economic loss in China but is not well researched. This study examined knowledge, drink-driving practices, and alcohol misuse problems among general drivers in Yinchuan. The objectives were to gain a better understanding of drink driving in Yinchuan, identify areas that need to be addressed, and compare the results with a similar study in Guangzhou. Methods: This was a cross-sectional study with a survey designed to collect information on participants’ demographic characteristics and their knowledge and practices in relation to drinking and driving. The survey was composed of questions on knowledge and practices in relation to drink driving and was administered to a convenience sample of 406 drivers. Alcohol misuse problems were assessed by using the Alcohol Use Disorders Identification Test (AUDIT). Results: Males accounted for the main proportion of drivers sampled from the general population (“general drivers”). A majority of general drivers in both cities knew that drunk driving had become a criminal offense in 2011; however, knowledge of 2 legal blood alcohol concentration (BAC) limits was quite low. Fewer drivers in Yinchuan (22.6%) than in Guangzhou (27.9) reported having been stopped by police conducting breath alcohol testing at least once in the last 12 months. The mean AUDIT score in Yinchuan (M = 8.2) was higher than that in Guangzhou (M = 7.4), and the proportion of Yinchuan drivers with medium or higher alcohol misuse problems (31.2%) was correspondingly higher than in Guangzhou (23.1%). In Yinchuan, males had a significantly higher AUDIT score than females (t = 3.454, P < .001), similar to Guangzhou. Multiple regression analyses were conducted on potential predictors of the AUDIT score (age, gender, monthly income, education level, years licensed, and age started drinking). There were significant individual contributions of gender (beta = 0.173, P = .09) and age at which drinking started (beta = 0.141, P = .033), but the overall model for Yinchuan was not significant, unlike Guangzhou. Conclusions: The results show that there are shortfalls in knowledge of the legislation and how to comply with it and deficiencies in police enforcement. In addition, there was evidence of drink driving and drink riding at high levels in both cities. Recommendations are made to address these issues.