Working to increase seatbelt usage among teenagers in rural settings: The Drive Alive Program (Under the direction of Dr. Monica Swahn) Background: Motor vehicle crashes are a leading cause of death in the United States. Teens are less likely to wear seatbelts than other age groups and more likely to be involved in a crash. The Drive Alive program was designed to improve seatbelt usage among teens. Purpose: This analysis aims to evaluate seatbelt use among teen drivers in a rural setting. Specifically, are there differences between males and females in terms of seatbelt use? Are drivers more likely to wear their seatbelts than passengers? Methods: Data was gathered from observational surveys (N= 3,743). Surveys were gathered by trained observers in South Georgia from 2010-2011. Records were analyzed in SPSS using three categories: occupant, sex, and belt use. The null hypotheses for this study are: 1) there is no significant difference between male and female drivers or passengers in seatbelt usage; and, 2) there is no significant difference between driver and passenger seatbelt usage. Results: Descriptive analyses were computed to determine average seatbelt use across all occupants. Chi Square for Independence tests were computed to determine differences between drivers and passengers and males and females. Females were significantly more likely than males to wear their seatbelt (Females, 70%; Males, 59%). There were no significant differences in seatbelt use for drivers and their passengers. Conclusions: Results for females being more likely to wear seatbelts is consistent with the literature. Future research might include comparison between schools with different versions of the program. Programs to increase seatbelt usage among teens should include parents, education, enforcement, teen-led activities, and partnership with educators and community organizations. Save the lives of young drivers by modeling seatbelt wearing, appropriately implementing comprehensive seatbelt use improvement programs, and enforcing the law. These simple measures will improve seatbelt use and reduce roadway fatalities.

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Young adults' risk-taking attitudes, risk perception, and knowledge of road laws and signs influence their driving behaviors. The adoption of risky driving behaviors increases young adults' risk of motor vehicle crashes. The purpose of this study was to increase the understanding of the factors that lead to increased risks of MVC-related mortality and morbidity for young adults in Belize, to provide support for the development of evidence-based programs, and, more importantly, to investigate the relationships involving young adults' risk-taking attitudes, risk perception, and knowledge of road laws and signs and their relation to driving behaviors. The Precaution Adoption Process Model provided the theoretical foundation for this study and was used as the framework to investigate the variables of interest. This study used a nonexperimental, cross-sectional research design to examine the relationships between the latent variables. A convenience sample of 532 students enrolled at the University of Belize participated in this study. Data were collected through the completion of the Driving Behavior Survey. Structural equation modeling was used to examine the strength and direction of relationships among these latent variables and provide a better understanding of the relationships among these latent variables. The study found that the majority of students were in the final stages of the Precaution Adoption Process Model and were exhibiting the safest behaviors. However, the risk-taking attitudes significantly contributed to the manifestation of risky driving behavior and to a lesser extent so did risk perception. The study's findings suggest that interventions should focus on lowering young adults' risk-taking attitudes and raising risk perception to reduce risky driving behaviors.

In the United States, motor vehicle crashes are one of the leading causes of unintentional injury death and disability for children ages 1'15 years. Despite local, state, and federal legislative and educational efforts, children continue to be restrained improperly and thus face harm. Identifying behaviors and barriers that place child occupants at risk is crucial for implementing focused, injury-prevention programs and policies. The purpose of this study was to evaluate the effectiveness of Connecticut's child passenger safety law that was strengthened in 2005. This study involved a multifactorial approach to predicting child seat use, guided by Roger's diffusion of innovations as the theoretical framework. The analysis determined if there was a difference in the prevalence of car seat use before as compared to after law implementation and identified variables that best predicted the use of car seats and premature transition to a seat belt. Using Connecticut's Crash Data Repository, a logistic regression analysis indicated that car seat use was 1.3 times more likely post law (OR 0.75; 95% CI: 0.65-0.86) and that in particular, children ages 4, 5, and 6 (combined) were most positively affected by the law (OR 0.67; 95% CI 0.54-0.82). Driver sex, crash time of day, child age, and child seating position were all determined to be significant predictors of whether or not a child was in a child safety seat. Additionally, these variables were also determined to be predictors of early transition to use of a lap/shoulder belt (versus child seat). The social change implication of this study is that identifying predictors of car seat use and early transition helps to formulate and implement injury prevention measures that could in turn help to decrease medical costs, save lives, and prevent injuries.

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INTRODUCTION : Les jeunes de moins de 25 ans constituent le groupe de conducteurs le plus impliqué dans les collisions routières (CR). L’objectif de cette étude est de déterminer l’importance de certains facteurs humains et de l’environnement routier dans les collisions les nuits de la fin de semaine chez les jeunes conducteurs. Les hypothèses postulent des chances plus élevées de CR les nuits de la fin de semaine, comparativement aux CR survenant à d’autres moments de la semaine, en présence d’un seul facteur de risque et de deux facteurs de risque. MÉTHODE : Cette étude transversale porte sur les CR ayant causé des blessures légères, graves ou mortelles au Québec chez les conducteurs âgés de 16 à 24 ans. Les informations sur les 58 478 CR survenus de 2007 à 2011 et les facteurs associés à ces CR proviennent de la banque de données de la Société de l’assurance automobile du Québec. Les CR les nuits de la fin de semaine (vendredi à samedi et samedi à dimanche de 20 h 00 à 04 h 59) sont comparées aux CR survenues aux autres moments de la semaine. L’importance des facteurs humains (p. ex., conduite avec capacités affaiblies) et de l’environnement routier (p. ex., courbes) dans ces CR est évaluée à l’aide d’analyses de régression logistique binaire et multinomiale. RÉSULTATS : Plusieurs facteurs sont liés à une augmentation des chances de CR les nuits de la fin de semaine, comparativement aux autres moments de la semaine. Ces facteurs incluent, par ordre d’importance décroissant : la conduite avec les capacités affaiblies (rapport des cotes ajusté [RCA] = 5,05 et intervalles de confiance à 99 % [IC 99 %] = 4,53‒5,64), la fatigue et le sommeil (RCA = 2,40 ; IC 99 % = 2,12‒2,73), la présence de passagers (RCA = 1,81 ; IC 99 % = 1,69‒1,94), le genre masculin (RCA = 1,36 ; IC 99 % = 1,27‒1,46), les courbes (RCA = 1,21 ; IC 99 % = 1,11‒1,32) et la vitesse (RCA = 1,18 ; IC 99 % = 1,09‒1,28). Les résultats sur la présence de deux de ces facteurs suggèrent l’importance des capacités affaiblies. Les chances de CR sont particulièrement importantes lorsque la présence de capacités affaiblies et d’un autre facteur est comparée à l’absence de ces deux facteurs. Dans ces cas, les chances de CR s’étalent de 5,33 (IC 99 % = 4,40‒6,45) pour la combinaison avec les courbes à 7,68 (IC 99 % = 6,52‒9,05) pour la combinaison avec la présence de passagers. CONCLUSION : Cette étude a permis de déterminer l’importance de plusieurs facteurs de risque, notamment la conduite avec capacités affaiblies, dans l’implication des jeunes conducteurs dans les CR les nuits de la fin de semaine. Les résultats suggèrent diverses stratégies afin de mieux cibler la conduite avec capacités affaiblies, incluant l’accès graduel à la conduite avec de jeunes passagers la nuit après l’obtention du permis de conduire. / Abstract : INTRODUCTION: Young people under 25 represent the group of drivers most involved in motor vehicle crashes (MVC). The aim of this study is to determine the significance of certain human and road environment factors in weekend night crashes involving young drivers. The hypotheses postulate higher odds of crash occurrence on weekend nights, as compared to crashes at other times during the week, when there is the presence of a single risk factor and two risk factors. METHOD: This cross-sectional study examines MVC causing minor, severe or fatal injuries in Quebec drivers aged 16 to 24. The information pertaining to the 58 478 MVC that occurred from 2007 to 2011 and the factors associated with these MVC comes from the databank of the Société de l’assurance automobile du Québec. Weekend night MVC (Friday to Saturday and Saturday to Sunday from 8:00 p.m. to 4:59 a.m.) are compared to MVC occurring at other times of the week. The significance of human factors (e.g., driving under the influence) and road environment factors (e.g., curves) in these crashes is assessed using binary and multinomial logistic regression analyses. FINDINGS: Several factors are associated with the increased odds of an MVC occurring on weekend nights, as compared to other times of the week. These factors include, by order of decreasing significance: driving under the influence (adjusted odds ratio [AOR] = 5.05 and 99% confidence interval [99% CI] = 4.53‒5.64), fatigue and sleep (AOR = 2.40; 99% CI = 2.12‒2.73), presence of passengers (AOR = 1.81; 99% CI = 1.69‒1.94), male gender (AOR = 1.36; 99% CI = 1.27‒1.46), curves (AOR = 1.21; 99% CI = 1.11‒1.32), and speed (AOR = 1.18; 99% CI = 1.09‒1.28). The findings on the presence of two of these factors suggest the significance of driving under the influence. The odds of MVC occurrence are particularly high when the presence of driving under the influence and another factor is compared against the absence of these two factors. In such instances, the odds of MVC occurrence range from 5.33 (99% CI = 4.40‒6.45) when curves are also involved to 7.68 (99% CI = 6.52‒9.05) when passengers are also present. CONCLUSION: This study determined the significance of several risk factors, particularly driving under the influence, in young drivers’ involvement in MVC on weekend nights. The findings suggest various strategies to better target driving under the influence, including gradual access to driving with young passengers at night after obtaining a driver’s licence.

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Die Überlebenswahrscheinlichkeit der Unfallopfer nach Straßenverkehrsunfällen hängt von der Zeitspanne vom Unfall bis zur ersten suffizienten Hilfeleistung (therapiefreies Intervall) sowie von der Qualität der Erstversorgung ab. Das therapiefreie Intervall kann durch automatische Notrufsysteme (ACN) und suffiziente Laienhilfe verkürzt werden. In dieser Dissertation werden (1) Modelle zur Prognose der Verletzungsschwere von Fahrzeuginsassen für den Einsatz in erweiterten automatischen Notrufsystemen (AACN) entwickelt und (2) Anforderungen an Telemedizinsysteme zur Unterstützung von Laien bei der Durchführung von Erste-Hilfe-Maßnahmen untersucht. (1) Die Prognose der Verletzungsschwere ist für eine optimale Disposition der Rettungsmittel erforderlich. Auf der Basis der amerikanischen Unfalldatenbank NASS/ CDS und der deutschen Unfalldatenbank GIDAS werden Prognosemodelle mit multivariaten inferenzstatistischen Verfahren (decision tree, logistic regression) entwickelt, die Bedeutung einzelner Eingangsgrößen untersucht und die Leistungsfähigkeit der Modelle überprüft. Die Leistungsfähigkeit beider statistischen Verfahren stellt sich in ROC-Analysen als vergleichbar heraus. Mit den Prognosemodellen kann eine Dispositionsempfehlung erstellt werden, die heutigen Dispositionsentscheidungen auf der Grundlage eines Telefongesprächs mit dem Unfallmelder qualitativ entspricht. (2) Zur Entwicklung eines Telemedizinsystems für die Laienunterstützung wird untersucht, ob die telemedizinische Anleitung von Laien bei der Durchführung von Erste-Hilfe-Maßnahmen zu einer Erhöhung der Hilfsbereitschaft führt und welche Anforderungen ein Telemedizinsystem erfüllen muss. Dazu werden die am häufigsten indizierten Erste-Hilfe-Maßnahmen nach Verkehrsunfällen durch Auswertung der GIDAS-Datenbank identifiziert, der Stand der heutigen Laienhilfe analysiert, die erforderlichen Funktionen eines Telemedizinsystems abgeleitet und der Einfluss einer verbesserten Laienhilfe auf die Überlebenswahrscheinlichkeit bestimmt. / The probability of survival of motor vehicle accident victims depends on two factors: the time interval between the accident and the initial provision of appropriate first-aid (therapy-free interval), and the quality of the first-aid treatment. The therapy-free interval can be shortened significantly by automatic crash notification systems (ACN) and by adequate bystander first aid. In this thesis, (1) models are developed for predicting the severity of injury of vehicle occupants for use in advanced automatic crash notification systems (AACN) and (2) requirements of telemedical bystander support systems are examined. (1) The prediction of the severity of injury is needed for optimal disposition of rescue services. Therefore, prediction models are developed on the basis of the American accident database NASS/ CDS and its German counterpart, GIDAS, using multivariate inference statistical procedures (decision tree, logistic regression). In addition, the importance of individual parameters and the efficiency of these models are investigated. The performance of the two statistical procedures proves to be equal by using the ROC analyses. The prediction models allow for recommendations of rescue services that correspond in quality to contemporary dispatching decisions for rescue services on the basis of a telephone call between the individual reporting the accident and a dispatcher. (2) Concerning the development of a telemedical bystander support system, the paper examines whether the availability of telemedical guidance leads to an increase in bystander willingness to provide first aid. In order to evaluate the requirements of a telemedical system, the most frequently indicated first-aid measures after traffic accidents are identified by evaluating the GIDAS database. Furthermore, the status of assistance currently offered by bystanders is analyzed, the necessary functions of a telemedical system are scrutinized, and the influence of improved bystander assistance on the probability of accident victims’ survival is determined.