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Background: Adolescents (10-19 years old) comprise a fifth of the Indian population (253.2 million), yet there is very little published information about the burden of disease and injury for this age group. This paper aims to provide a contemporary picture of the leading causes of death and disability for Indian adolescent girls and boys for 2013, and changes in deaths and disability between 1990 and 2013., Methods: Data from the Global Burden of Disease (GBD) study for India, for the years 1990 and 2013, were accessed. Data were categorized into two age groups: 10 to 14 years (younger adolescents) and 15 to 19 years (older adolescents) and analysed separately for girls and boys., Results: The study shows that for both younger and older adolescent boys and for older adolescent girls, non-communicable diseases (NCDs) and injuries are responsible for a greater number of deaths and disability-adjusted life-years (DALYs) than communicable diseases. Communicable diseases are still important causes of death and disability for young adolescents. Among older adolescents there is an increasing burden of death and disability due to self-harm, road traffic injuries, fire- and heat-related injuries and mental disorders such as depressive disorders., Conclusions: Although strategies to reduce the burden of communicable diseases among adolescents must continue to be an important focus, innovative, evidence-based strategies aimed at reducing the growing burden of NCDs and injuries must be elevated as a priority., (© The Author 2017; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association)

Road traffic crashes have been an increasing threat to the wellbeing of road users worldwide; an unacceptably high number of people die or become disabled from them. While high-income countries have successfully implemented effective interventions to help reduce the burden of road traffic injuries (RTIs) in their countries, low- and middle-income countries (LMICs) have not yet achieved similar results. Both scientific research and capacity development have proven to be useful for preventing RTIs in high-income countries. In 1999, a group of leading researchers from different countries decided to join efforts to help promote research on RTIs and develop the capacity of professionals from LMICs. This translated into the creation of the Road Traffic Injuries Research Network (RTIRN) - a partnership of over 1,100 road safety professionals from 114 countries collaborating to facilitate reductions in the burden of RTIs in LMICs by identifying and promoting effective, evidenced-based interventions and supporting research capacity building in road safety research in LMICs. This article presents the work that RTIRN has done over more than a decade, including production of a dozen scientific papers, support of nearly 100 researchers, training of nearly 1,000 people and 35 scholarships granted to researchers from LMICs to attend world conferences, as well as lessons learnt and future challenges to maximize its work.

Injury and violence rank among the leading causes of death worldwide, with more than 5 million deaths annually, representing a significant portion of the global burden of disease. This article examines how injury and violence relate to global health using recent global burden of disease data and selected key studies and databases, and further explores risk factors and intervention initiatives that address unintentional and intentional injuries. The article serves as a call to action to enhance understanding of the growing burden of injury and violence, especially in low-income and middle-income countries, where more than 90% of injuries occur., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Study Objective: Evidence about the burden of disability after motor vehicle crashes has relied primarily on trauma center-based studies. We examine the impact of serious crashes on the longer-term health of car drivers, independent of natural variation, in a population-based study in Auckland, New Zealand., Methods: The study population comprised 218 car drivers surviving nonfatal crashes in Auckland, in which at least 1 occupant in the vehicle was admitted to a hospital, and a representative sample of 254 car drivers in the region, recruited from roadside surveys. All participants were interviewed at recruitment (subjects reported their precrash health) and 5 and 18 months later. The drivers' changes in health were obtained with a global health transition indicator and the Short Form-36, with analyses adjusting for potential confounders., Results: Compared with 7% of drivers in the comparison group, 43% of crash drivers admitted to the hospital (adjusted odds ratio 10.4; 95% confidence interval 5.5 to 19.6) and 20% of those not admitted (odds ratio 3.3; 95% confidence interval 1.4 to 8.3) reported that their overall health at 18-month follow-up was worse than at baseline (precrash). Among the drivers reporting worsened health, prospectively ascertained Short Form-36 scores revealed greater reductions in physical health in those admitted after the crash, but these scores improved from 5 to 18 months. In contrast, mental and general health scores worsened from 5 to 18 months in admitted and nonadmitted crash drivers., Conclusion: A substantial proportion of drivers surviving serious crashes experience reductions in longer-term health, a burden likely to be underappreciated among those not admitted to a hospital. Emergency departments could serve as useful settings in which to develop and validate clinical decision rules that can help target services for crash survivors at increased risk of adverse outcomes.

Risky driving is an important cause of motor vehicle injury, but there is a lack of good epidemiological data in this field, particularly data comparing risky driving in younger drivers to those of other age groups. We examined the relationship between risky driving habits, prior traffic convictions and motor vehicle injury using cross-sectional data amongst 21,893 individuals in New Zealand, including 8029 who were aged 16-24 years. Those who reported frequently racing a motor vehicle for excitement or driving at 20 km/h or more over the speed limit, and those who had received traffic convictions over the past 12 months, were between two and four times more likely to have been injured while driving over the same time period. Driving unlicensed was a risk factor for older but not younger drivers, and driving at 20 km/h or more above the speed limits was a stronger risk factor for younger (<25 years) than older drivers. These results confirm the need for interventions targeting risky driving and suggest that different strategies may be required for different high-risk groups.

Objectives: To examine the relationship between seatbelt non-use at the time of a crash, habitual non-use of seatbelts, and car crash injury; and to calculate the population attributable risk for car crash injury due to seatbelt non-use., Methods: A population-based case control, interview study in Auckland, New Zealand, with 571 injured or killed drivers as cases and 588 population-based controls randomly selected from the driving population., Results: Unbelted drivers had 10 times the risk of involvement in an injury crash compared to belted drivers after adjustment for multiple confounders. Habitual non-users were likely to be unbelted when involved in a crash. The population attributable risk for seatbelt non-use was 13%., Conclusions: Non-use of seatbelts is very strongly associated with increased injury crash involvement. Even where seatbelt use rates are higher than 90%, there remains a small group of habitual non-users who are at high risk; these drivers may benefit from targeted interventions.

Aims: To investigate the relationship between marijuana use prior to driving, habitual marijuana use and car crash injury., Design and Setting: Population based case-control study in Auckland, New Zealand., Participants: Case vehicles were all cars involved in crashes in which at least one occupant was hospitalized or killed anywhere in the Auckland region, and control vehicles were a random sample of cars driving on Auckland roads. The drivers of 571 case and 588 control vehicles completed a structured interview., Measurements: Self reported marijuana use in the 3 hours prior to the crash/survey and habitual marijuana use over the previous 12 months were recorded, along with a range of other variables potentially related to crash risk. The main outcome measure was hospitalization or death of a vehicle occupant due to car crash injury., Findings: Acute marijuana use was significantly associated with car crash injury, after controlling for the confounders age, gender, ethnicity, education level, passenger carriage, driving exposure and time of day (OR 3.9, 95% CI 1.2-12.9). However, after adjustment for these confounders plus other risky driving at the time of the crash (blood alcohol concentration, seat-belt use, travelling speed and sleepiness score), the effect of acute marijuana intake was no longer significant (OR 0.8, 95% CI 0.2-3.3). There was a strong significant association between habitual use and car crash injury after adjustment for all the above confounders plus acute use prior to driving (OR 9.5, 95% CI 2.8-32.3)., Conclusions: This population-based case-control study indicates that habitual use of marijuana is strongly associated with car crash injury. The nature of the relationship between marijuana use and risk-taking is unclear and needs further research. The prevalence of marijuana use in this driving population was low, and acute use was associated with habitual marijuana use, suggesting that intervention strategies may be more effective if they are targeted towards high use groups.

With improving rates of survival following road traffic injuries in many countries, healthy years of life lost due to crashes increasingly reflect the prevalence of disabling sequelae. This review examines the epidemiological evidence regarding the risk of disability due to car crashes, published between 1980 and 2002. Studies of sequelae limited to specific domains (e.g. head injury, whiplash, psychiatric morbidity) were excluded. Of the 19 studies meeting the criteria for review, most focused on the prevalence of disability following crashes but not the association between them. Prevalence estimates of post-crash disability varied from 2 to 87%. The potential sources of heterogeneity included differences in study settings and period, duration of follow-up, and definitions of exposure and outcome. Methodological problems that compounded the difficulties in interpretation and generalisability of study findings included selection biases and use of non-representative samples, idiosyncratic outcome measures, inadequate adjustment for confounding, and the prevailing medico-legal or compensation context. The findings highlight the need for well-designed population-based epidemiological studies using validated outcome measures and appropriate comparison groups to determine the independent risk of disability due to car crashes. The review also revealed a critical need for data from low- and middle-income countries, the setting for over 90% of the estimated global burden of road traffic injury.

Background: China has made tremendous progress in its economic development in the past two decades. Accompanying this economic development has been an evident shift in the modes of transport, from walking and cycling to the use of motorcycles and, increasingly, four-wheel vehicles. Such changes are likely to have also produced changes in the patterns and numbers of road traffic injuries, including increases in motorcycle injuries. However, such changes have not been well documented. The work described in this paper sought, therefore, to document the changes in motorcycle ownership, motorcyclist mortality and injury rates in China since 1987., Methods: National traffic ownership and injury data from 1987 to 2001 were obtained from the National Bureau for Traffic Administration. Additionally, traffic ownership and injury records from 1997 to 2001 were collected from local police offices from 20 counties in Guangxi Region. Population data were obtained from the national and county statistics bureaus. Motorcycle ownership, fatality and injury trends over time were calculated., Results: Nationally, motorcycles accounted for 23.4% of all registered motor vehicles in 1987, increasing to 63.2% in 2001. Motorcyclist fatalities and injuries increased 5.5-fold and 9.3-fold, respectively, between 1987 and 2001. In 1987, 7.5% of all traffic fatalities and 8.8% of all traffic injuries were sustained by motorcyclists, with the corresponding proportions increasing to 18.9% and 22.8%, respectively, in 2001. The changing proportions of both traffic fatalities and injuries sustained by motorcyclists were positively correlated with the change in the proportion of motorcycles among all motor vehicles. In the 20 counties in Guangxi, motorcyclist fatality and injury rates also increased between 1997 and 2001. Moreover, these rates were considerably higher than the national rates., Conclusions: Motorcyclist injury in China is a serious public health problem. Motorcyclist fatalities and injuries are likely to continue to increase unless appropriate intervention programmes are implemented.

Objective: To investigate whether the risk of motorcycle crash related injuries is associated with the conspicuity of the driver or vehicle., Design: Population based case-control study., Setting: Auckland region of New Zealand from February 1993 to February 1996., Participants: 463 motorcycle drivers (cases) involved in crashes leading to hospital treatment or death; 1233 motorcycle drivers (controls) recruited from randomly selected roadside survey sites., Main Outcome Measures: Estimates of relative risk of motorcycle crash related injury and population attributable risk associated with conspicuity measures, including the use of reflective or fluorescent clothing, headlight operation, and colour of helmet, clothing, and motorcycle., Results: Crash related injuries occurred mainly in urban zones with 50 km/h speed limit (66%), during the day (63%), and in fine weather (72%). After adjustment for potential confounders, drivers wearing any reflective or fluorescent clothing had a 37% lower risk (multivariate odds ratio 0.63, 95% confidence interval 0.42 to 0.94) than other drivers. Compared with wearing a black helmet, use of a white helmet was associated with a 24% lower risk (multivariate odds ratio 0.76, 0.57 to 0.99). Self reported light coloured helmet versus dark coloured helmet was associated with a 19% lower risk. Three quarters of motorcycle riders had their headlight turned on during the day, and this was associated with a 27% lower risk (multivariate odds ratio 0.73, 0.53 to 1.00). No association occurred between risk and the frontal colour of drivers' clothing or motorcycle. If these odds ratios are unconfounded, the population attributable risks are 33% for wearing no reflective or fluorescent clothing, 18% for a non-white helmet, 11% for a dark coloured helmet, and 7% for no daytime headlight operation., Conclusions: Low conspicuity may increase the risk of motorcycle crash related injury. Increasing the use of reflective or fluorescent clothing, white or light coloured helmets, and daytime headlights are simple, cheap interventions that could considerably reduce motorcycle crash related injury and death.

Objectives: This paper examines the association between periodic motor vehicle inspection and frequent tire pressure checks, and the risk of car crash injury., Methods: Data were analysed from the Auckland Car Crash Injury Study, a population-based case-control study in Auckland, NZ, where vehicles are required to undergo six-monthly safety inspections. Cases were all cars involved in crashes in which at least one occupant was hospitalised or killed, which represented 571 drivers. Controls were randomly selected cars on Auckland roads (588 drivers). Participants completed a structured interview., Results: Vehicles that did not have a current certificate of inspection had significantly greater odds of being involved in a crash where someone was injured or killed compared with cars that had a current certificate, after adjustment for age, sex, marijuana use, ethnicity and licence type (OR 3.08, 95% CI 1.87-5.05). Vehicles that had not had their tire pressure checked within the past three months also had significantly greater odds of being involved in a crash compared with those that had a tire pressure check, after adjustment for age, sex, ethnicity, seatbelt use, licence type, self-reported speed and hours per week of driving exposure (OR 1.89, 95% CI 1.16-3.08)., Conclusions: This study provides new evidence, using rigorous epidemiological methods and controlling for multiple confounding variables, of an association between periodic vehicle inspections and three-monthly tire pressure checks and reduced risk of car crash injury., Discussion: This research suggests that vehicle inspection programs should be continued where they already exist and contributes evidence in support of introducing such programs to other areas.

Objectives: To estimate the contribution of driver sleepiness to the causes of car crash injuries., Design: Population based case control study., Setting: Auckland region of New Zealand, April 1998 to July 1999., Participants: 571 car drivers involved in crashes where at least one occupant was admitted to hospital or killed ("injury crash"); 588 car drivers recruited while driving on public roads (controls), representative of all time spent driving in the study region during the study period., Main Outcome Measures: Relative risk for injury crash associated with driver characteristics related to sleep, and the population attributable risk for driver sleepiness., Results: There was a strong association between measures of acute sleepiness and the risk of an injury crash. After adjustment for major confounders significantly increased risk was associated with drivers who identified themselves as sleepy (Stanford sleepiness score 4-7 v 1-3; odds ratio 8.2, 95% confidence interval 3.4 to 19.7); with drivers who reported five hours or less of sleep in the previous 24 hours compared with more than five hours (2.7, 1.4 to 5.4); and with driving between 2 am and 5 am compared with other times of day (5.6, 1.4 to 22.7). No increase in risk was associated with measures of chronic sleepiness. The population attributable risk for driving with one or more of the acute sleepiness risk factors was 19% (15% to 25%)., Conclusions: Acute sleepiness in car drivers significantly increases the risk of a crash in which a car occupant is injured or killed. Reductions in road traffic injuries may be achieved if fewer people drive when they are sleepy or have been deprived of sleep or drive between 2 am and 5 am.