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In Bogotá, Colombia, motorcyclists represent a concern as the proportion of motorcycle users between 2013 and 2018 has increased from 18% to 35%. Despite available risk reduction strategies, the fatality rates are also growing, notably in young adults (15-29 years old). This study aims at identifying correct helmet use patterns and its relationship with official records of injuries and casualties in the city over time.Between 2015 and 2018, semiannual observational studies of motorcycle users in six randomly selected sites in Bogotá were conducted. Data was collected and analyzed on the number of occupants per vehicle (driver and passengers), gender, approximate age, type of helmet, and whether it was correctly used (strapped) or not. Bivariate and multivariate analyses were performed to identify the determinants of correct helmet use. Additionally, a spatial analysis was conducted to estimate the relationship between motorcycle's casualties and correct use of the helmet (full-face helmet use) prevalence.A total of 77,932 motorcycles were observed, showing a high prevalence of helmet use (99% for drivers and passengers), but only 88% use it correctly (89% drivers and 82% passengers). The presence of enforcement (camera or police personnel) increases the correct use of the helmet, especially in principal roads. Female, adults, and single riders are more likely to correctly wear the helmet. Finally, there is a relationship between the concentration of the fatalities and the incorrect helmet use in 80% of the observational sites.Incorrect helmet use has been found by the study to be related to higher mortality among motorcycle occupants in Bogotá. Our data shows that enforcement increases correct helmet use with the potential to reduce deaths among motorcycle occupants.

Background This is the first study to examine the costs of conducting a mobile phone survey (MPS) through interactive voice response (IVR) to collect information on risk factors for noncommunicable diseases (NCD) in three low- and middle-income countries (LMIC); Bangladesh, Colombia, and Uganda. Methods This is a micro-costing study conducted from the perspective of the payer/funder with a 1-year horizon. The study evaluates the fixed costs and variable costs of implementing one nationally representative MPS for NCD risk factors of the adult population. In this costing study, we estimated the sample size of calls required to achieve a population-representative survey and associated incentives. Cost inputs were obtained from direct economic costs incurred by a central study team, from country-specific collaborators, and from platform developers who participated in the deployment of these MPS during 2017. Costs were reported in US dollars (USD). A sensitivity analysis was conducted assessing different scenarios of pricing and incentive strategies. Also, costs were calculated for a survey deployed targeting only adults younger than 45 years. Results We estimated the fixed costs ranging between $47,000 USD and $74,000 USD. Variable costs were found to be between $32,000 USD and $129,000 USD per nationally representative survey. The main cost driver was the number of calls required to meet the sample size, and its variability largely depends on the extent of mobile phone coverage and access in the country. Therefore, a larger number of calls were estimated to survey specific harder-to-reach sub-populations. Conclusion Mobile phone surveys have the potential to be a relatively less expensive and timely method of collecting survey information than face-to-face surveys, allowing decision-makers to deploy survey-based monitoring or evaluation programs more frequently than it would be possible having only face-to-face contact. The main driver of variable costs is survey time, and most of the variability across countries is attributable to the sampling differences associated to reaching out to population subgroups with low mobile phone ownership or access.

Background Data collection on noncommunicable disease (NCD) behavioral risk factors has traditionally been carried out through face-to-face surveys. However, its high costs and logistical difficulties can lead to lack of timely statistics for planning, particularly in low and middle-income countries. Mobile phone surveys (MPS) have the potential to fill these gaps. Objective This study explores perceptions, feasibility and strategies to increase the acceptability and response rate of health surveys administered through MPS using interactive voice response in Colombia. Method A sequential multimodal exploratory design was used. We conducted key informant interviews (KII) with stakeholders from government and academia; focus group discussions (FGDs) and user-group tests (UGTs) with young adults and elderly people living in rural and urban settings (men and women). The KII and FGDs explored perceptions of using mobile phones for NCD surveys. In the UGTs, participants were administered an IVR survey, and they provided feedback on its usability and potential improvement. Results Between February and November 2017, we conducted 7 KII, 6 FGDs (n = 54) and 4 UGTs (n = 34). Most participants consider MPS is a novel way to explore risk factors in NCDs. They also recognize challenges for their implementation including security issues, technological literacy and telecommunications coverage, especially in rural areas. It was recommended to promote the survey using mass media before its deployment and stressing its objectives, responsible institution and data privacy safeguards. The preferences in the survey administration relate to factors such as skills in the use of mobile phones, age, availability of time and educational level. The participants recommend questionnaires shorter than 10 minutes. Conclusions The possibility of obtaining data through MPS at a population level represents an opportunity to improve the availability of risk-factor data. Steps towards increasing the acceptability and overcoming technological and methodological challenges need to be taken.

To assess the effect of a permanent gun-carrying restriction on gun-related mortality in Colombia between 2008 and 2014, and determine differences in the effect of the restriction by place of death and sex.In 2012, Bogotá and Medellín introduced a permanent gun-carrying restriction. We compared gun-related mortality rates in these cities (intervention cities) with the rates in all other Colombian cities with more than 500 000 inhabitants (control cities). We used data from the Colombian National Department of Statistics to calculate monthly gun-related mortality rates between 2008 and 2014 for intervention and control cities. We used a differences-in-differences method with fixed effects to assess differences in gun-related mortality in intervention and control cities before and after the introduction of the gun-carrying restriction. We stratified effects by place of death (public area or residence) and sex. We made robustness checks to test the assumptions of the models.Gun-related deaths in the control and intervention cities decreased between 2008 and 2014; however, the decrease was greater in the intervention cities (from 20.29 to 14.93 per 100 000 population; 26.4%) than in the control cities (from 37.88 to 34.56 per 100 000 population; 8.8%). The restriction led to a 22.3% reduction in the monthly gun-related mortality rate in Bogotá and Medellín. The reduction was greater in public areas and for males. Robustness checks supported the assumptions of the models.The permanent restriction on carrying guns reduced gun-related deaths. This policy could be used to reduce gun-related injuries in urban centres of other countries with large numbers of gun-related deaths.Évaluer l'impact d'une restriction permanente du port d'armes sur le taux de mortalité lié aux armes à feu en Colombie entre 2008 et 2014, et déterminer les différences d'impact de cette restriction en fonction du lieu du décès et du sexe.En 2012, Bogotá et Medellín ont instauré une restriction permanente du port d'armes. Nous avons comparé les taux de mortalité liés aux armes à feu dans ces villes (villes d'intervention) avec les taux observés dans l'ensemble des autres villes colombiennes de plus de 500 000 habitants (villes de contrôle). Les données fournies par le Département administratif national de la statistique en Colombie nous ont permis de calculer les taux de mortalité liés aux armes à feu entre 2008 et 2014 dans les villes d'intervention et de contrôle. Nous avons utilisé la méthode des doubles différences à effets fixes pour mesurer les disparités entre la mortalité liée aux armes à feu dans les villes d'intervention et de contrôle, avant et après l'instauration de la restriction du port d'armes. Nous avons ensuite segmenté les résultats en fonction du lieu du décès (espace public ou domicile) et du sexe. Nous avons également procédé à des tests de robustesse pour évaluer les hypothèses des modèles.Les décès causés par des armes à feu dans les villes de contrôle et d'intervention ont diminué entre 2008 et 2014. Cependant, la diminution était plus importante dans les villes d'intervention (de 20,29 à 14,93 par 100 000 habitants ; 26,4 %) que dans les villes de contrôle (de 37,88 à 34,56 par 100 000 habitants ; 8,8 %). La restriction a entraîné une baisse de 22,3 % de la mortalité mensuelle liée aux armes à feu, tant à Bogotá qu'à Medellín. Cette baisse s'est avérée plus importante dans les espaces publics et pour les individus de sexe masculin. Les tests de robustesse ont confirmé les hypothèses des modèles.La restriction permanente du port d'armes a un impact positif sur la mortalité liée aux armes à feu. Cette politique pourrait être employée par d'autres pays où le nombre de décès attribuables aux armes à feu est élevé, afin de réduire le nombre de blessures par balles dans les centres urbains.Evaluar el efecto de una restricción permanente al porte de armas en la mortalidad relacionada con las armas en Colombia entre 2008 y 2014, y determinar las diferencias en el efecto de la restricción por lugar de muerte y sexo.En 2012, Bogotá y Medellín establecieron una restricción permanente al porte de armas. Se compararon las tasas de mortalidad por arma de fuego en estas ciudades (ciudades de intervención) con las tasas en todas las demás ciudades colombianas con más de 500.000 habitantes (ciudades de control). Se utilizaron los datos del Departamento Nacional de Estadística de Colombia para calcular las tasas mensuales de mortalidad por armas de fuego entre 2008 y 2014 para las ciudades de intervención y control. Se utilizó un método de diferencia en diferencias con efectos fijos para evaluar las diferencias en la mortalidad relacionada con armas de fuego en las ciudades de intervención y control antes y después del establecimiento de la restricción al porte de armas. Se estratificaron los efectos por lugar de muerte (área pública o residencia) y sexo. Se realizaron controles de solidez para probar los supuestos de los modelos.Las muertes relacionadas con armas de fuego en las ciudades de control e intervención disminuyeron entre 2008 y 2014; sin embargo, la disminución fue mayor en las ciudades de intervención (de 20, 29 a 14,93 por cada 100.000 habitantes; 26,4 %) que en las ciudades de control (de 37,88 a 34,56 por cada 100.000 habitantes; 8,8 %). La restricción condujo a una reducción del 22,3 % en la tasa mensual de mortalidad relacionada con armas de fuego en Bogotá y Medellín. La reducción fue mayor en las áreas públicas y en los hombres. Los controles de solidez apoyaron los supuestos de los modelos.La restricción permanente al porte de armas redujo las muertes relacionadas con las armas. Esta política podría ser utilizada para reducir las lesiones relacionadas con armas de fuego en los centros urbanos de otros países con un gran número de muertes relacionadas con este tipo de armas.تقييم تأثير التقييد الدائم لحمل السلاح على الوفيات المرتبطة بالأسلحة في كولومبيا بين عامي 2008 و2014، وتحديد الاختلافات في تأثير التقييد حسب مكان الوفاة والجنس.قامت كل من بوجوتا وميديلين في عام 2012، بفرض تقييد دائم على حمل السلاح. وقمنا بمقارنة معدلات الوفيات المرتبطة بالأسلحة في هاتين المدينتين (مدن التدخل)، بالمعدلات المقابلة لها في جميع المدن الكولومبية الأخرى التي يزيد عدد سكانها عن 500000 نسمة (مدن السيطرة). وقمنا بالاستعانة بالبيانات من إدارة الإحصاءات الوطنية الكولومبية لحساب معدلات الوفيات الشهرية المرتبطة بالسلاح بين عامي 2008 و2014 في مدن التدخل والسيطرة. كما استخدمنا طريقة الاختلافات في الفارق ذات التأثيرات الثابتة، لتقييم الاختلافات في الوفيات المرتبطة بالأسلحة النارية في مدن التدخل والسيطرة قبل وبعد فرض قيود حمل السلاح. وقمنا بتصنيف التأثيرات حسب مكان الوفاة (المنطقة العامة أو مقر الإقامة) والجنس. كما أجرينا فحوصات فعالية لاختبار افتراضات النماذج.انخفض معدل الوفيات المرتبطة بالأسلحة في مدن السيطرة والتدخل بين عامي 2008 و2014؛ إلا أن الانخفاض كان أكبر في مدن التدخل (من 20.29 إلى 14.93 لكل 100000 نسمة؛ 26.4%)، منه في مدن السيطرة (من 37.88 إلى 34.56 لكل 100000 نسمة؛ 8.8%). أدى التقييد إلى انخفاض بنسبة 22.3% في معدل الوفيات الشهرية المرتبطة بالسلاح في بوجوتا وميديلين. كان الانخفاض أكبر في المناطق العامة، وبالنسبة للذكور. كما أيدت فحوصات الفعالية افتراضات النماذج.أدى التقييد الدائم على حمل السلاح إلى خفض الوفيات المرتبطة بالأسلحة. يمكن استخدام هذه السياسة للحد من الإصابات المرتبطة بالأسلحة في المراكز الحضرية في البلدان الأخرى ذات الأعداد الكبيرة من الوفيات المرتبطة بالأسلحة.旨在评估 2008 年至 2014 年哥伦比亚实施的永久性持枪限制对涉枪死亡率的影响，并根据死亡地点和性别确定限制效果的差异。.2012 年，波哥大和梅德林实施了永久性持枪限制。我们比较了这两座城市（干预城市）与居住人口超过 500 000 的所有其他哥伦比亚城市（控制城市）的涉枪死亡率。我们使用哥伦比亚国家统计局的数据，计算 2008 年至 2014 年干预城市和控制城市每月涉枪事件的死亡率。我们采用具有固定效应的倍差法来评估实施持枪限制前后干预城市和控制城市涉枪死亡率的差异。我们根据死亡地点（公共区域或居民区）和性别对影响进行分层。我们开展了稳健性检验来验证模型的假设。.2008 年至 2014 年间，控制城市和干预城市中涉枪事件的死亡人数有所下降；但干预城市的下降幅度（从每 100 000 人口 20.29 下降至 14.93；26.4%）大于控制城市（从每 100 000 人口 37.88 下降至 34.56；8.8%）。这一限制导致波哥大和梅德林每月涉枪死亡率下降 22.3%。这一数字在公共区域和男性中的减少幅度更大。稳健性检验支持模型的假设。.对携带枪支的永久性限制减少了涉枪死亡率。对于涉枪死亡人数较多的其他国家而言，这项政策可以用来减少其城市中心地区涉枪事件带来的损伤。.Оценить влияние постоянного ограничения на ношение оружия на уровень смертности от огнестрельных ранений в Колумбии в период с 2008 по 2014 годы и определить различия в эффективности ограничения в зависимости от места гибели и пола жертвы.В 2012 году в городах Богота и Медельин были введены постоянные ограничения на ношение оружия. Авторы сравнили уровень смертности от огнестрельного оружия в этих городах (города проведения вмешательства) с показателями в других колумбийских городах с населением более 500 000 жителей (контрольные города). Для расчета показателей смертности от огнестрельных ранений в городах проведения вмешательства и контрольных городах использовались данные Национального административного департамента статистики Колумбии за период с 2008 по 2014 годы. Авторы применили метод «разность разностей» с фиксированными эффектами для оценки разницы в показателях смертности от огнестрельных ранений в городах проведения вмешательства и контрольных городах до и после вступления в силу ограничений на ношение оружия. Эффекты были стратифицированы по месту гибели (в общественном месте или дома) и полу жертв. Для проверки модельных предположений авторы провели проверку надежности результатов.Уровень смертности от огнестрельных ранений в период с 2008 по 2014 годы снизилась как в городах проведения вмешательства, так и в контрольных городах; однако в городах проведения вмешательства снижение было значительнее (с 20,29 до 14,93 человека на 100 000 населения; 26,4%), чем в контрольных городах (с 37,88 до 34,56 человека на 100 000 населения; 8,8%). Ежемесячный показатель смертности от огнестрельных ранений в городах Богота и Медельин вследствие введенного ограничения снизился на 22,3%. Снижение было значительнее выражено для общественных мест и для мужчин. Проверка надежности результатов подтвердила основные предположения модели.Постоянное ограничение на ношение оружия уменьшило количество погибших от огнестрельных ранений. Этот подход может использоваться для уменьшения травматизма от огнестрельных ранений в городских центрах других стран с высокими показателями смертности от огнестрельных ранений.

BackgroundIn Colombia, smoking is the second leading modifiable risk factor for premature mortality. In December 2016, Colombia passed a major tax increase on tobacco products in an effort to decrease smoking and improve population health. While tobacco taxes are known to be highly effective in reducing the prevalence of smoking, they are often criticised as being regressive in consumption. This analysis attempts to assess the distributional impact (across socioeconomic groups) of the new tax on selected health and financial outcomes.MethodsThis study builds on extended cost-effectiveness analysis methods to study the new tobacco tax in Colombia, and estimates, over a time period of 20 years and across income quintiles of the current urban population (80% of the country population), the years of life gained with smoking cessation and the increased tax revenues, all associated with a 70% relative price increase of the pack of cigarettes. Where possible, we use parameters that vary by income quintile, including price elasticity of demand for cigarettes (average of −0.44 estimated from household survey data).FindingsOver 20 years, the tax increase would lead to an estimated 191 000 years of life gained among Colombia’s current urban population, with the largest gains among the bottom two income quintiles. The additional annual tax revenues raised would amount to about 2%–4% of Colombia’s annual government health expenditure, with the poorest quintiles bearing the smallest tax burden increase.ConclusionsThe tobacco tax increase passed by Colombia has substantial implications for the country’s population health and financial well-being, with large benefits likely to accrue to the two poorest quintiles of the population.

Road injuries are an important cause of global mortality especially in low- and middle-income countries. While these countries undergo major urban transformations, an integral part of their development has often been the implementation of mass transportation systems, including Bus Rapid Transit (BRT) systems. However, the net effect of BRT systems on road safety is still unclear, and while there is reason to believe that BRT systems improve safety, very few available empirical studies have tested this hypothesis using observational data. Furthermore, the existing evidence is mixed and sparse. This paper reviews the available literature on the links of BRT systems and road safety and calls for more research to strengthen the body of evidence on the effect of BRT systems on road safety in the future.

Background Cost–benefit analysis is a useful tool for priority setting in road safety. The value of statistical life (VOSL) is a metric used to estimate the benefits of road interventions in cost–benefit analyses. The International Road Assessment Program (iRAP), for example, created a rule-of-thumb to calculate VOSL benefits of road infrastructure when performing cost–benefit assessments in countries where data on VOSL are sparse. Aim To evaluate the rapid assessment metric developed by iRAP and provide suggestions for improvement in these methods. Methods We replicated iRAP calculations in order to make a critical assessment of the sources, results and conclusions. Conclusions We found the iRAP metric a good example for highlighting some relevant aspects that should be considered in any VOSL estimation in order to enhance its use as a guiding principle for assessing road interventions. Specifically, we recommend the explicit disclosure of the assumptions, the use of sensitivity analysis and the avoidance of omitted variables bias.

In settings with low seatbelt use prevalence, self-reported seatbelt use estimates often lack validity, and routine observational studies are scarce. In this paper, we aim to describe the prevalence of seatbelt use and associated factors in drivers and front-seat passengers across eight sites in four countries (Egypt, Mexico, Russia, Turkey) using observational studies as well as to produce estimates of country-level and site-level variance. As part of the Bloomberg Philanthropies Global Road Safety Program, data on driver and passenger seatbelt use across four middle-income countries was collected between October 2010 and May 2011 (n=122,931 vehicles). Logistic regression and Intraclass Correlation Coefficient analyses for sites- and country-level clustering were performed. We found high variability of seatbelt wearing rates ranging from 4 to 72% in drivers and 3-50% in front-seat passengers. Overall, average seatbelt wearing rates were low (under 60% in most sites). At the individual level, older and female drivers were more likely to wear seatbelts, as well as drivers of vehicles transiting at times of increased vehicle flow. We also found that 26-32% and 37-41% of the variance in seatbelt use among drivers and front-seat passengers respectively was explained by differences across sites and countries. Our results demonstrate that there is room for improvement on seatbelt use in middle-income countries and that standardized cross-country studies on road safety risk factors are feasible, providing valuable information for prevention and monitoring activities. Language: en

Background Body Mass Index (BMI) and waist circumference (WC) are anthropometric indicators strongly associated with diabetes, cardiovascular disease, cancer and mortality. Focusing on secular changes in the mean values of BMI and WC can mask differences at the lower- and upper-tails of the distribution. Our network of health examination survey researchers from the Americas and the UK quantified secular changes in the BMI and WC distributions in England, Scotland, and the United States (US). Methods Nationally-representative surveys of adults aged 25–64 y from similar time periods: Health Survey for England (1999–2012; n = 75,813); Scottish Health Survey (1998–2011; n = 33,010) and US National Health and Nutrition Examination Survey (1999–2012; n = 22,340). Comparisons across time for mean values of measured height, weight, BMI, and WC and prevalence of obesity (BMI ≥ 30 kg/m2) and abdominal obesity (WC ≥ 88 cm) were performed by age-standardising descriptive estimates by the direct-method to the 2000 US population. Quantile regression was used to evaluate whether BMI and WC values increased across survey years at pre-specified centiles of the distribution (5th, 50th, 95th). Models were adjusted for age, age-squared and survey year. Results Mean BMI values for men (women) at baseline were 27.1 kg/m2 (26.6 kg/m2) in England; 27.1 kg/m2 (26.8 kg/m2) in Scotland; and 27.8 kg/m2 (28.6 kg/m2) in the US. Obesity and abdominal obesity increased for both sexes in England and in Scotland. In the US, obesity increased only for men; abdominal obesity increased only for women. Mean BMI increased by 0.4 kg/m2 (0.7 kg/m2) for men (women) in England; 0.8 kg/m2 for both sexes in Scotland; and 1.0 kg/m2 for men in the US. BMI at the 5th centile was unchanged in England, but increased in Scotland and the US. Increases at the median and upper-tail occurred in each country: the increase at the 95th BMI percentile was 2.1 kg/m2 (1.3 kg/m2) for men (women) in England; 1.9 kg/m2 for both sexes in Scotland; and 2.0 kg/m2 (1.9 kg/m2) in the US (each P Mean WC increased by 2.1 cm (4.7 cm) for men (women) in England; 3.4 cm (6.5 cm) in Scotland; and 2.4 cm (3.8 cm) in the US. The increase at the 95th WC percentile was 6.3 cm (5.4 cm) for men (women) in England; 3.6 cm (8.4 cm) in Scotland; and 4.5 cm (18.3 cm) in the US (each P Ongoing analyses will incorporate data from Chile, Colombia, Mexico, and Brazil. Conclusion Secular increases in BMI and WC were fairly consistent by country for both sexes, with clear evidence of increases across the whole distribution in Scotland and the US.