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Background: In Japan, older drivers have been encouraged to surrender their driving licenses for traffic safety, despite the potential adverse social and health outcomes of driving cessation. We reconsidered such policies and social pressure by comparing the risk of at-fault motor vehicle collisions (MVCs) across the age groups of drivers., Methods: Using the national data of police-reported MVCs that occurred between 2016 and 2020, we examined the number of at-fault MVCs per licensed driver (MVC rate) and the number of fatally and non-fatally injured persons per at-fault MVC by the sex and age groups of at-fault drivers., Results: The MVC rate of older drivers was higher than that of middle-aged drivers but lower than that of young drivers. The number of injured persons among the collided counterparts (collided car occupants, motorcyclists, bicyclists, and pedestrians) per MVC caused by older drivers was not greater than that by drivers in other age groups. In fatal MVCs caused by older drivers, drivers themselves or their passengers tend to be killed rather than their collided counterparts. Overall, the results were mostly consistent between male and female drivers., Conclusion: The risk of at-fault MVCs increased with the advancing age of drivers after middle age; however, this risk among older drivers did not exceed that among young drivers, without posing a high risk of injuries to their collided counterparts.

Background: Since 2011, commercial truck drivers have been required to take alcohol breath tests at the beginning and end of their working hours due to their employers' legal obligations. However, non-commercial truck drivers are not required to do so. We examined whether alcohol-related crashes had decreased after 2011 among commercial truck drivers., Methods: Using police data, we conducted a joinpoint regression analysis to examine the trend in the proportion of alcohol-related crashes from 1995 through 2020 caused by commercial truck drivers (who were subjected to alcohol breath testing) and non-commercial truck drivers (who were not subjected to testing). The annual percentage change in this trend was also estimated., Results: During the 26-year study period, truck drivers caused 1,846,321 at-fault crashes, and 0.4% of the crashes involved intoxicated driving. A significant decreasing trend in the proportion of alcohol-related crashes was identified among both commercial and non-commercial truck drivers in the 2000s, during which several legal amendments were made against drunk driving. The annual percentage change was -13.5% from 2001 to 2012 among commercial truck drivers, and -14.9% from 2001 to 2011 among non-commercial truck drivers. No decreasing trend was observed afterwards, despite the introduction of mandatory alcohol breath testing in 2011., Conclusion: The effect of mandatory alcohol breath testing on reducing alcohol-related crashes among commercial truck drivers was not evident.

Background: We examined whether the policy amendment from March 2017 for a cognitive screening test for older drivers at driver's license renewal was associated with the decreased risk of motor vehicle collisions for drivers and the increased risk of injuries for pedestrians and cyclists among older people., Methods: This was a controlled interrupted time-series study. We used police-reported data on the number of collisions as drivers and injuries as pedestrians and cyclists among people aged 70 years or older in Japan from July 2012 to December 2019. As the outcome measures, we used the ratio of the monthly number of collisions per population among drivers of three groups aged 75 years or older (75-79, 80-84, and ≥85 years), who were targeted or exposed by the policy, to that among drivers aged 70 to 74 years, who were unaffected or unexposed by the policy and would serve as controls. The ratio of pedestrian and cyclist injuries was also calculated, as previous studies have shown a concomitant increase in these injuries after the introduction of cognitive screening for driver's licenses., Results: During the study period, there were 602,885 collisions as drivers and 196,889 injuries as pedestrians and cyclists among people aged 70 years or older. After the policy amendment in March 2017, collisions decreased among male drivers, and injuries increased among some age subgroups in both sexes. Cumulative estimated changes in the numbers of collisions and injuries from March 2017 to December 2019 were -3670 (95% confidence interval: -5125, -2104) and 959 (95% confidence interval: 24, 1834), respectively., Conclusions: Following the policy amendment, there was a decrease in motor vehicle collisions as drivers and an increase in road injuries as pedestrians and cyclists among older people., (© 2023 The American Geriatrics Society.)

Background: Modal shifts in transport may reduce overall road injuries. Cyclist junior high school students are at a high risk of road injuries while commuting in Japan, and injuries among junior high school students could be reduced if the cyclists switch to other transport modes., Methods: We estimated the change in the incidence of road deaths and serious injuries while commuting in months with heavy snowfall, when cyclists are likely to switch to other transport modes. Using police data on the monthly number of road injuries while commuting among junior high school students in Japan between 2004 and 2013 and corresponding population statistics and snowfall data, we calculated the monthly injury rate (number of deaths and serious injuries divided by population) at the prefecture level. We conducted Poisson regression analysis to estimate the change in the rate in months with a snowfall of ≥100 cm, compared to months without snowfall., Results: A total of 3,164 deaths and serious injuries occurred during 2004 to 2013. The injury rate among cyclists was almost zero in months with a snowfall of ≥100 cm. That among cyclists and pedestrians in these months was reduced by 68% (95% confidence interval, 43-82%)., Conclusion: In months with heavy snowfall, road injuries while commuting were reduced due to the near-elimination of cycling injuries among junior high school students in Japan. Switching from cycling to other transport modes would reduce overall road injuries among this population, and inducing modal shifts can be an important tool for road safety.

Background: In 1948, Japan started a short-term publicity and enforcement campaign for traffic safety nationwide, and since 1952, the campaign has been conducted twice a year for 10 days. We aimed to quantify the short-term effect of the spring sessions of the campaign, which were conducted in different months in different years, on road fatalities in Japan using data from 1949 to 2019., Methods: We obtained national police data on the monthly number of road deaths and conducted a time series regression analysis with three steps: smoothing the long-term patterns with the natural cubic spline function, calculating the ratio of the monthly number of deaths to the corresponding smoothed value, and regressing the ratio on the number of months from January 1949 and the binary variable for the conduct of spring sessions. We repeated the analysis for four subperiods (1949-1964, 1965-1989, 1990-2004 and 2005-2019)., Results: During the study period, there were 632577 road deaths. Our analysis revealed that the spring sessions changed the number of deaths per day by -2.5% (95% CI -4.1% to -0.9%) in the months when they were conducted. In the four subperiods, the estimated changes were -4.5% (95% CI -8.9% to -0.1%), -2.6% (95% CI -5.0% to -0.1%), -0.1% (95% CI -2.9 to 2.7) and -3.5% (95% CI -7.9 to 0.9)., Conclusions: Road fatalities were reduced in the months when the spring sessions of the campaign were conducted, but the reduction was modest. The effect might have been somewhat larger until 1964, when Japan was a middle-income country., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To evaluate the effect of adding a cognitive test to a license renewal procedure for drivers aged 75 years or older in reducing their motor vehicle collisions (MVCs). The test has been obligatory since June 2009., Methods: Using monthly police-reported national data on MVCs from January 2005 through December 2016, we calculated the rates of MVCs per licensed driver-year by sex and age group (70-74, 75-79, 80-84 and 85 years or older) for each month together with the ratios of MVC rates of drivers in the three oldest age groups (which are subject to the test) to those of the 70-74 years group (not subject to the test) to control for extraneous factors affecting MVCs over the study period. Then, we conducted an interrupted time-series analysis by regressing the rate ratio stratified by sex and age group on the number of months from January 2005, June 2009 (when the cognitive test was introduced to a license renewal procedure) and June 2012 (when all drivers subject to the test have taken it at least once)., Results: The rates showed a longitudinal decrease in male and female drivers over the study period without any apparent effects of the introduction of the cognitive test while no significant decrease was observed in the rate ratios after the introduction of the cognitive test., Conclusions: There were no clear safety benefits of the cognitive test for drivers aged 75 years or older to reduce their MVCs., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: To deal with the increasing number of motor vehicle collisions (MVCs) among older drivers, a cognitive test has been introduced to a license renewal procedure for drivers aged ≥75 years since June 2009. This might have prompted the reduction or cessation of driving by older drivers. We therefore examined whether older drivers' chance of experiencing MVCs as unprotected road users has increased after the test was introduced., Methods: Using police-reported national data on MVCs from January 2005 through December 2016, we calculated the monthly injury rates (including deaths, severe injuries, and minor injuries) among unprotected road users (bicyclists and pedestrians) by sex and age group (70-74, 75-79, 80-84, and ≥85 years). The ratios of the injury rates of unprotected road users in the three oldest age groups (who were subjected to the test) to those aged 70-74 years (not subjected to the test) were also calculated. Then, we conducted an interrupted time-series analysis based on the injury rate ratios to control for extraneous factors affecting MVCs over the study period., Results: There was a significant increase in traffic injuries of unprotected road users at the time the test was introduced among females aged 75-84 years, and at a later time among males aged ≥80 years and females aged ≥85 years., Conclusion: Licensing policies for older drivers should be rigorously evaluated, taking into account the safety of older unprotected road users, and should be balanced against it., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objectives. To quantify the impact of the "Zone 30" policy introduced in September 2011 on the incidence of cyclist and pedestrian injuries in Japan. Methods. This was an interrupted time-series study. We used the data of cyclist and pedestrian injuries recorded by the Japanese police between 2005 and 2016. We evaluated the monthly number of deaths and serious injuries per person-time on narrow roads (width < 5.5 m, subjected to the policy) compared with that on wide roads (≥ 5.5 m) to control for secular trends. We regressed the injury rate ratio on 2 predictors: the numbers of months after January 2005 and after September 2011. Using the regression results, we estimated the number of deaths and serious injuries prevented. Results. There were 266 939 deaths and serious injuries. By 2016, the cumulative changes in the rate ratio spanned from -0.26 to -0.046, depending on sex and age, and an estimated number of 1704 (95% confidence interval = 1293, 2198) injuries were prevented. Conclusions. The policy had a large preventive impact on cyclist and pedestrian deaths and serious injuries at the national level.

Objectives: To investigate the extent and patterns of regional disparities of road traffic injury rates involving elementary and junior high school children while commuting among Japan's 47 prefectures., Methods: We conducted a cross-sectional ecological study using the national police data for 2004-2013 on the number of children who were killed or seriously injured (KSI) in traffic collisions stratified by prefecture, grade, mode of transport, and purpose of trip (commuting or non-commuting). We calculated stratified KSI rates by dividing the number of KSI cases by the corresponding number of children and presented these rates for the 47 prefectures. Also, for pedestrian elementary school children and cyclist junior high school children, we regressed the KSI rates while commuting by prefecture on the non-commuting KSI rates and the proportion of people who live in the urban, densely inhabited districts., Results: There were 6463 KSI cases while commuting. The ratios of the highest KSI rate to the lowest KSI rate among prefectures were 12, 30, and 58 for pedestrian elementary school children and pedestrian and cyclist junior high school children, respectively. The non-commuting KSI rates and the proportion of those living in densely inhabited districts were positively and inversely associated with the commuting KSI rates, respectively. The analysis of the residuals of the regression models did not identify prefectures with significantly higher or lower KSI rates while commuting than others., Conclusions: There were large inter-prefecture disparities in the KSI rates while commuting, and the disparity was especially large among cyclist junior high school children., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objectives: To quantitatively describe the recent longitudinal trend in road injuries involving school children while commuting to and from school in Japan and to identify groups or situations with particularly large or small decreasing trends., Methods: Data on the number of children aged 6-15 years who sustained road injuries while commuting were obtained, stratified by year, demographic characteristics, mode of transport and other variables. The rates of killed or seriously injured (KSI) children were calculated from the number of KSI cases (the numerator) and the product of population and the proportion of each mode of transport estimated using the Person Trip Survey data (the denominator). We conducted descriptive analyses of the longitudinal trend in KSI rates stratified by the variables, and Poisson regression analyses were employed to quantify the annualised changes in the rates., Results: During the study period, 166 children were killed and 8484 children were seriously injured; the KSI rate decreased approximately 30%. The KSI rate was almost 10 times higher among cyclists than pedestrians. In cyclists, the decrease in the KSI rate among children aged 12-15 years was smaller in boys than in girls (estimated change -14% vs -30%). The KSI rate of male pedestrians aged 6-7 years was larger than female and older pedestrians, with a large decrease of 48%., Conclusions: Although the overall rate of road injuries among children while commuting was decreasing, cyclists were at a much greater risk than pedestrians, and the improvements for cyclists occurred at a slower pace., Competing Interests: Competing interests: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

This study investigated the distribution of motorcyclists, including drivers and passengers, who were involved in road traffic crashes and admitted to hospital in Vientiane Capital, Laos. The focus was on child motorcycle drivers and passengers under 15 years. A hospital-based injury surveillance database in Vientiane Capital was used. The surveillance was performed in two hospitals. From 1 September to 31 December 2009, 3968 patients were admitted to the participating hospitals with road traffic injuries. Patients under 15 years accounted for 10.8% (427/3968). The majority of patients under 15 years were motorcycle drivers or passengers (71.7%, 306/427). Child motorcyclists including drivers and passengers were less likely to wear a helmet than adults (adjusted odds ratio [OR], 0.3, 95% confidence interval [CI], 0.2-0.5, for children 10-14 years; adjusted OR: 0.1, 95% CI, 0.05-0.4, for children under 10 years). It is suggested that stricter regulation enforcement for child motorcycle drivers and passengers may be needed. In addition, barriers against wearing helmets for motorcycle drivers and passengers in Laos should also be examined in further studies.

Objectives: Road traffic injuries, particularly pedestrian injuries, are a major health issue among children worldwide. The present study quantitatively analyzed the time trends of child pedestrian injuries in Japan from 1975 to 2013 by age., Study Design: Time trend analysis of nationally aggregated data., Methods: We analyzed police data on pedestrian injuries requiring medical treatment among children aged 0-15 years occurring between 1975 and 2013. To quantify the time trends of pedestrian injury morbidity rates and to identify change-points in the trends, joinpoint regression analysis was applied by age group. Children were categorized into the age groups of 0-3, 4-6, 7-9, 10-12, and 13-15 years old., Results: Preschool children aged 0-6 years old showed continuous declining trends throughout the study period; these declining trends accelerated in the 2000s. School-age children aged 7-15 years old showed minimal changes from the early 1970s to the 1990s; of this age group, children aged 7-12 years old showed slight but significant declining trends in the first half and increasing trends in the latter half of this period. Children aged 7-15 years old showed declining trends in the 2000s. Despite the consistent declining trends among all age groups in the 2000s, the younger age groups showed steeper declines during this period., Conclusions: The declining trends in all age groups in the 2000s may reflect the improved traffic environments in Japan although the environmental approaches are not yet sufficiently adopted yielding modest effects. The continuing contrast between preschool and school-age children may reflect different behaviour changes by age such as more restricted outdoor activities among young children., (Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

In aging societies, increasing numbers of older drivers are involved in motor vehicle collisions (MVCs), and preserving their safety is a growing concern. In this study, we focused on whether older drivers were more likely to cause MVCs and injuries than drivers in other age groups. To do so we compared at-fault MVC incidence and resulting injury risks by drivers' ages, using data from Japan, a country with a rapidly aging population. The at-fault MVC incidence was calculated based on distance traveled made for non-commercial purposes, and the injury risks posed to at-fault drivers and other road users per at-fault MVCs. We used MVC data for 2010 from the National Police Agency of Japan and driving exposure data from the Nationwide Person Trip Survey conducted by a Japanese governmental ministry in 2010. The at-fault MVC incidence showed a U-shaped curve across the drivers' ages, where teenage and the oldest drivers appeared to be the highest risk groups in terms of causing MVCs, and the incidence was higher for female drivers after age 25. The injury risk older drivers posed to other vehicle occupants because of their at-fault MVCs was lower than for drivers in other age groups, while their own injury risk appeared much higher. As the number of older drivers is increasing, efforts to reduce their at-fault MVCs appear justified., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

In Japan, a driving lesson consisting of a lecture, a driver aptitude test, on-road driving assessment and a discussion session was added to the driving license renewal procedure for drivers aged 75 years or older in 1998 and for drivers aged 70 years or older in 2002. We investigated whether these additions contributed to a reduction in at-fault motor vehicle collisions (MVCs) by examining the trend of the at-fault MVC rates per licensed driver and the rate ratios of the older drivers relative to those aged 65-69 years for the years 1986-2011. All data were derived from nationwide traffic statistics. If the introduction of the lesson was effective in reducing at-fault MVCs of older drivers, the rate ratio should have declined, given that the lesson targeted only the older drivers. We found this was not the case, i.e., there was no declining trend in the at-fault MVC rate ratios of both drivers aged 75 years or older and drivers aged 70 years or older, relative to drivers aged 65-69 years, after the driving lesson at license renewal became mandatory for these older drivers. Therefore, the mandatory lesson for the older drivers at license renewal needs to be reconsidered., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objectives: In Japan, child restraint use among preschool children started to increase before compulsory child restraint use for children aged 0-5 years was introduced by legislation in April 2000. This study determined the effects of increased child restraint use in reducing motor vehicle occupant injuries among children aged 0-5 years., Methods: We obtained monthly police data of child vehicle occupant injuries from 1990 to 2009. We calculated monthly ratios of morbidity rates per population of children aged 0-5 years to those of children aged 6-9 years. Time trends of the morbidity rate ratios were analyzed using a joinpoint regression model to determine whether there were trend changes in child occupant injuries and when they occurred if there were trend changes., Results: The morbidity rate ratios showed a slightly increasing trend of 0.03% per month (95% confidence interval [CI], -0.02% to 0.09%) until the change-point in December 1997 (95% CI, July 1996 to January 1999), which then changed to a decreasing trend of -0.14% per month (95% CI, -0.16 to -0.11), with an overall trend change of -0.17% (95% CI, -0.23 to -0.11). No change-point was identified in or around April 2000 when compulsory restraint use was introduced., Conclusions: The present study used comparative indicators relative to age groups that were not covered by the legislation and showed that a decreasing trend of occupant morbidity among children aged 0-5 years started before the introduction of compulsory restraint use. This change probably reflects the prelegislative voluntary increase in child restraint use.

Background: In Japan, introduction of severe drunk-driving penalties and a lower blood alcohol concentration (BAC) limit in June 2002 was followed by a substantial reduction in fatal alcohol-related crashes. However, previous research suggests that this reduction started before the legal amendments. The causes of the decrease have not been studied in detail., Methods: Monthly police data on fatal road traffic crashes from January 1995 to August 2006 were analyzed using a joinpoint regression model to identify change-points in the trends of the proportion of drunk-driving among drivers primarily responsible for fatal crashes. We analyzed the data by BAC level (≥0.5 or <0.5 mg/ml), then conducted analyses stratified by vehicle type (car or motorcycle) and age group (<45 or ≥45 years) only for the proportion of those with a BAC of 0.5 mg/ml or higher., Results: Among all drivers, the proportion of those with a BAC of 0.5 mg/ml or higher and those with a BAC greater than 0 but less than 0.5 mg/ml showed a change-point from increase to decrease in February 2000 and in May 2002, respectively. The proportion of those with a BAC of 0.5 mg/ml or higher showed a change-point from increase to decrease in October 1999 among car drivers and in April 2000 among drivers younger than 45 years. There was no change-point among motorcyclists. A change-point from no trend to a decrease in January 2002 was observed among those 45 years or older., Conclusions: The change-point identified around the end of 1999 to the start of 2000 suggests that a high-profile fatal crash in November 1999, which drew media attention and provoked public debate, triggered subsequent changes in drunk-driving behavior.

Background: Japanese road traffic law was amended in 2002 and 2007 to increase the penalties for drink-driving in response to media coverage, publicity campaigns, and debates following high-profile alcohol-related motor-vehicle crashes in 1999 and 2006., Objective: To test the hypothesis that the proportion of crashes involving drink-driving started to decline before the law amendments, because of changes in social norms and driver behaviour after the high-profile crashes., Methods: In order to assess the impact of the cases in 1999 and 2006, time-series analyses were used to examine the trends in the proportion of crashes involving drink-driving, and whether there were abrupt changes in the level or slope at the expected time points, using monthly police data for the period between January 1995 and December 2008., Results: In 1999, the proportion of alcohol-related fatal crashes in which the driver had a blood alcohol concentration (BAC) ≥0.5 mg/ml started to decline with a slope change of -0.09 percentage points per month (95% CI -0.15 to -0.03) but no level change, whereas there were no changes for drivers with a BAC <0.5. In 2006, the trends for drivers with a BAC ≥0.5 or <0.5 showed significant level declines of -3.1 (-5.0 to -1.2) and -1.7 (-2.5 to -0.9) percentage points, respectively, but no slope changes., Conclusions: Media coverage of high-profile crashes, and subsequent publicity campaigns and debates might have altered social norms and driver behaviour, reducing the proportion of alcohol-related crashes before the introduction of more severe penalties for drink-driving.

Objectives: We examined road safety policies and trends in road traffic injuries (RTIs) in Japan between 1970 and 2008 from the viewpoints of population and high-risk-individual approaches to see what lessons can be learned from the example of a country that experienced a decline in RTIs following comprehensive road safety policies., Methods: We reviewed research papers and policy documents, obtained from relevant ministries, decade by decade. We obtained data on RTIs from police and from vital statistics., Results: Japan started the Fundamental Traffic Safety Program to combat the increase in RTIs, and succeeded in reducing both RTI mortality and morbidity rates in the 1970s by implementing vast road safety improvements, using population approaches with a particular focus on protecting the most vulnerable population groups at that time. However, RTIs increased again in the 1980s because of increasing traffic volume. In the 1990s and 2000s, safety policies targeted at high-risk driving behaviors succeeded in reducing RTI mortality rates but failed to change morbidity rates., Conclusions: To achieve a safer road environment, more emphasis is required on population approaches that reduce risk among the whole population, with a balance between population and high-risk-individual approaches., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Objective: To investigate the perception and actual use of mobile phones among Japanese high school students while riding their bicycles, and their experience of bicycle crash/near-crash., Methods: A questionnaire survey was carried out at high schools that were, at the time of the survey, commissioned by the National Agency for the Advancement of Sports and Health to conduct school safety research., Results: In the survey, we found that mobile phone use while riding a bicycle was quite common among the students during their commute, but those who have a higher perception of danger in this practice, and those who perceived that this practice is prohibited, were less likely to engage in this practice. Male students and students commuting to school by bicycle only were more likely to have used phones while riding. There was a significant relationship between phone usage while riding a bicycle and the experience of bicycle crash/near-crash, although its causality was not established. Bicycle crash/near-crash experienced while using a phone was less prevalent among the students who had a higher perception of danger in phone usage while riding, students who perceived that this practice is prohibited, and students with a shorter travel time by bicycle during the commute., Conclusions: Since mobile phone use while riding a bicycle potentially increases crash risk among cyclists, student bicycle commuters should be made aware of this risk. Moreover, they should be informed that cyclists' phone usage while riding is prohibited according to the road traffic law.

Objective: To examine the relationship between the perceived safety of specified road behaviors, self-described road behaviors, and pedestrian injury among adolescent students in Kathmandu, Nepal., Methods: A cross-sectional study was conducted among 1557 adolescents in grades 6-8 across 14 schools in Kathmandu using a self-administered questionnaire in 2003. A multiple logistic regression analysis was used to analyze the data., Results: Adolescents were more likely to suffer from pedestrian injury when they did not always "wait for green signals to cross the road". There were no significant associations between road behaviors such as "looking both ways along the road before crossing" or "playing in the road or sidewalks" and pedestrian injury. Adolescents who "perceived it safe to cross the road from any point" or "did not perceive it to be safer to cross the road at a zebra crossing" were less likely to "look both ways" or "wait for green signals" before crossing the road. Adolescents who "perceived it to be safe to play in the road" were more likely to play in the road or sidewalk. Similarly, this study showed a positive association between road safety education and adolescents' road crossing behaviors., Conclusion: Adolescents' road behaviors, except for compliance with green signals, were not significantly associated with pedestrian injury. This suggests that a behavioral approach without modification of the traffic environment (such as provision of crossing signals) might not effectively prevent the occurrence of pedestrian injury in developing countries with poor traffic conditions.

This study assessed the relationship between pedestrian activity at the time of injury, the type of vehicle involved and resulting activity limitation among school adolescents in the Kathmandu and Lalitpur districts of Nepal. A cross-sectional study of 1557 students in grades 6-8 across 14 schools was conducted using a self-administered questionnaire from August to September 2003. Twenty-three percent of adolescents reported pedestrian injuries, 38% were from urban and 21% from semi-urban areas. Adolescents were commonly injured by motorcycles and motor vehicles while crossing the road; however, while walking and playing, they were commonly injured by bicycles and motorcycles. Bicycles and motor vehicles were less likely to be involved in injury while crossing the roads and playing, respectively (p < 0.001). Activity was more likely to be limited for a longer period of time (> 7 days) with injuries endured while crossing the road (p < 0.001). In urban areas, boys and girls were more likely to be injured while crossing the road and walking, respectively (p < 0.05), and both were commonly injured by motorcycles. In semi-urban areas, boys and girls were commonly injured while walking and were more likely to be injured by motorcycles and bicycles, respectively (p < 0.05). In both areas, more boys than girls were injured while playing. These findings have important implications for pedestrian safety interventions in poor countries.

Previous research has indicated that unbelted drivers are at higher risk of involvement in fatal crashes than belted drivers, suggesting selective recruitment that high-risk drivers are unlikely to become belt users. However, how the risk of involvement in fatal crashes among unbelted drivers varies according to the level of seat belt use among general drivers has yet to be clearly quantified. We, therefore, developed mathematical models describing the risk of fatal crashes in relation to seat belt use among the general public, and explored how these models fitted to changes in driver mortality and changes in observed seat belt use using Japanese data. Mortality data between 1979 and 1994 were obtained from vital statistics, and mortality data in the daytime and nighttime between 1980 and 2001 and belt use data between 1979 and 2001 were obtained from the National Police Agency. Regardless of the data set analyzed, exponential models, assuming that high-risk drivers would gradually become belt users in order of increasing risk as seat belt use among general motorists reached high levels, showed the best fit. Our models provide an insight into behavioral changes among high-risk drivers and support the selective recruitment hypothesis.

This study investigated the temporal distribution of risky behaviors among injured motorcyclists, that is, riding unhelmeted or while intoxicated, and showed how they are associated with risk of fatal injuries. Data of motorcyclists injured in Khon Kaen municipality in northeastern Thailand and transferred to Khon Kaen Regional Hospital were obtained from the trauma registry system of the hospital. Case fatalities were compared by time of day, age group, helmet use, and alcohol intoxication. Unhelmeted riding peaked late in the evening and riding while intoxicated peaked around midnight. Both were associated with increased fatality risk after stratification by time of day; the odds ratios were 3.49 (95% confidence interval (CI) = 1.48-9.36) and 3.01 (CI = 1.71-5.19), respectively. Nighttime injuries were not significantly associated with increased fatality risk after stratification by helmet use or alcohol intoxication. Unhelmeted driving was prevalent and associated with higher fatality risk among younger drivers, whereas intoxicated driving was less prevalent among teens but associated with increased risk among those aged 20-39 years. This study shows that riding unhelmeted or while intoxicated can explain the increased fatality risk at night, suggesting that safety education or enforcements should be targeted at specific age groups and appropriate times.

Objectives: To examine vehicle related mortality trends of children in Japan; and to investigate how environmental modifications such as the installation of public parks and pavements are associated with these trends., Design: Poisson regression was used for trend analysis, and multiple regression modelling was used to investigate the associations between trends in environmental modifications and trends in motor vehicle related child mortality rates., Setting: Mortality data of Japan from 1970 to 1994, defined as E-code 810-23 from 1970 to 1978 and E810-25 from 1979 to 1994, were obtained from vital statistics. Multiple regression modelling was confined to the 1970-1985 data. Data concerning public parks and other facilities were obtained from the Ministry of Land, Infrastructure, and Transport., Subjects: Children aged 0-14 years old were examined in this study and divided into two groups: 0-4 and 5-14 years., Main Results: An increased number of public parks was associated with decreased vehicle related mortality rates among children aged 0-4 years, but not among children aged 5-14. In contrast, there was no association between trends in pavements and mortality rates., Conclusions: An increased number of public parks might reduce vehicle related preschooler deaths, in particular those involving pedestrians. Safe play areas in residential areas might reduce the risk of vehicle related child death by lessening the journey both to and from such areas as well as reducing the number of children playing on the street. However, such measures might not be effective in reducing the vehicle related mortalities of school age children who have an expanded range of activities and walk longer distances.

Objectives: This study investigated the effect of the helmet act for motorcyclists on increasing helmet use and reducing motorcycle-related deaths and severe injuries in Thailand., Methods: Data were derived from a trauma registry at the Khon Kaen Regional Hospital in the northeast Thailand. Helmet use and outcome in motorcycle crashes were compared 2 years before (1994-1995) and after (1996-1997) enforcement of the helmet act. During the study period, there were 12002 injured motorcyclists including 129 death cases in the municipality of Khon Kaen Province who were brought to the regional hospital., Results: After enforcement of the helmet act, helmet-wearers increased five-fold while head injuries decreased by 41.4% and deaths by 20.8%. Those who had head or neck injuries or died were less likely wearing a helmet. Compliance of helmet use was lower at night. Fatality of injured motorcyclists did not significantly decrease in the post-act period and among helmet-wearers., Conclusion: Enforcement of the helmet act increased helmet-wearers among motorcyclists but helmet use did not significantly reduce deaths among injured motorcyclists. Motorcyclists should be instructed to properly and consistently wear a helmet for their safety.

Objectives: To clarify why seatbelt legislation did not achieve the expected reduction in mortality in Japan. LOCATION AND BACKGROUND: Seatbelt legislation was enacted in Japan in September 1985 and penalties were introduced in November 1986., Methods: The driver deaths per vehicle km traveled (D/VKT) were calculated to adjust for changes in traffic volume. Decreases in D/VKT were compared with the reduction expected after legislation. The association between percentage changes of driver D/VKT, seatbelt use rate, and seatbelt non-use rate were explored. Deaths of passengers, pedestrians, and cyclists were also examined. Mortality data were obtained from vital statistics, traffic volume figures from the Ministry of Land, Infrastructure, and Transport, and seatbelt use rates from the National Police Agency., Results: Although the decrease in D/VKT after the law was enforced was larger than the absolute number of deaths, it was far less than predicted. The percentage decrease in seatbelt non-use rate showed the strongest correlation with the percentage decrease in driver mortality. Mortality did not increase among other road users after the law was enacted., Conclusion: Accurate evaluation of the effect of seatbelt legislation must take into account changes in traffic volume. The selective recruitment hypothesis-that high risk drivers were less responsive to seatbelt legislation-fits well with the findings. There was no conclusive evidence supporting risk compensation-that is, an increase in injuries among other road users.