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Objectives: In conditional automation for automated vehicles (AVs), drivers are tasked with remaining vigilant and ready to assume control should the system encounter a malfunction. However, little to no information is provided to the driver either about the AV's intended maneuvers or the AV's awareness of potential threats in the surrounding environment. To address this research gap, the present study proposes 2 human-machine interaction (HMI) concepts: Firstly, the shared intended pathway (SIP), which presents a forecast of the AV's intended maneuvers and, secondly, object recognition bounding boxes (ORBBs), which place transparent blue squares around other road users likely to contribute to a crash., Methods: An online experiment with both within- and between-group factors tested 2 HMI designs: One with both SIP and ORBB and one with SIP only. Six videos were presented sequentially, each depicting 10 to 15 s of automated driving, to 394 participants ( M age  = 28.24 years, 64% male) in Australia. Participants monitored the AV in each of the videos, which were presented in 1 of 3 randomized conditions: no HMI display, SIP only, or SIP + ORBB. Questions after each video measured trust, situational awareness, stress, and user acceptance, as measured by the technology acceptance model (TAM) about user acceptance., Results: Results suggest that SIP is beneficial in conditional automation monitoring, in terms of reduced stress, increased perceived usefulness, and future intentions to use AVs. Further, ORBB presence increased participant ratings of perceived usefulness and intentions to use AVs compared to no ORBB. The findings also provided support for the TAM, because perceived ease of use and perceived usefulness were found to be significant positive predictors of future intentions to use AVs., Conclusions: The current study provides some evidence to suggest that SIP may be beneficial in automated driving. However, further on-road testing of HMI displays for AVs that include SIP and ORBBs are needed to enhance the user experience and acceptability of AVs and to provide more ecological validity.

Distracted driving is a traffic safety issue worldwide. While the development of comprehensive information and road rules about distracted driving by governments is essential to address the issue, there is evidence showing that existing road rules and information may not always deter drivers from engaging in distractions while driving. Therefore, this study explored drivers' views on government information and road rules concerning distracted driving, aiming to understand how these rules and information have shaped drivers' perceptions and behaviour towards distractions. Interviews (n = 35) were conducted with Queensland drivers aged between 21 and 70 years and a thematic analysis was used to explore the data. Based on the findings, government information on distracted driving was believed by participants to be incomprehensive, not effectively communicated, and focused on mobile phone use. Road rules and enforcement measures often prioritise mobile phone use and contain grey areas that may confuse drivers about legal and illegal distractions. The results showed that the perceived risk of distractions varies among drivers, with some distractions not being considered as risky as other behaviours (e.g., using a smartwatch). Findings showed that government practices are believed to influence drivers' perceptions and behaviour about distracted driving, encouraging an inaccurate perception about driver safety and with the potential to prompt drivers to engage with distracting behaviours without knowledge nor consideration of the risks. The results of this study offer important insights for policymakers in developing and disseminating comprehensive information and road rules for distracted driving., 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 © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The shared responsibility between conditional AVs drivers demands shared understanding. Thus, a shared intended pathway (SIP)-a graphical display of the AV's planned manoeuvres in a head-up display to help drivers anticipate silent failures is proposed. An online, randomised photo experiment was conducted with 394 drivers in Australia. The photos presented traffic scenarios where the SIP forecast either safe or unsafe manoeuvres (silent failures). Participants were required to respond by selecting whether driver intervention was necessary or not. Additionally, the effects of presented object recognition bounding boxes which indicated whether a road user was recognised or not were also tested in the experiment. The SIP led to correct intervention choices 87% of the time, and to calibrating self-reported trust, perceived ease of use and usefulness. The bounding boxes found no significant effects. Results suggest SIPs can assist in monitoring conditional automation. Future research in simulator studies is recommended. Practitioner summary: Conditional AV drivers are expected to take-over control during failures. However, drivers are not informed about the AV's planned manoeuvres. A visual display that presents the shared intended pathway is proposed to help drivers mitigate silent failures. This online photo experiment found the display helped anticipate failures with 87% accuracy.

Participatory data stewardship (PDS) empowers individuals to shape and govern their data via responsible collection and use. As artificial intelligence (AI) requires massive amounts of data, research must assess what factors predict consumers' willingness to provide their data to AI. This mixed-methods study applied the extended Technology Acceptance Model (TAM) with additional predictors of trust and subjective norms. Participants' data donation profile was also measured to assess the influence of individuals' social duty, understanding of the purpose and guilt. Participants ( N  = 322) completed an experimental survey. Individuals were willing to provide data to AI via PDS when they believed it was their social duty, understood the purpose and trusted AI. However, the TAM may not be a complete model for assessing user willingness. This study establishes that individuals value the importance of trusting and comprehending the broader societal impact of AI when providing their data to AI. Practitioner summary: To build responsible and representative AI, individuals are needed to participate in data stewardship. The factors driving willingness to participate in such methods were studied via an online survey. Trust, social duty and understanding the purpose significantly predicted willingness to provide data to AI via participatory data stewardship.

Despite the promised benefits, the introduction of Automated Vehicles (AVs) on roads will be confronted by many challenges, including public readiness to use those vehicles and share the roads with them. The risk profile of road users is a key determinant of their safety on roads. However, the relation of such risk profiles to road users' perception of AVs is less known. This study aims to address the above research gap by conducting a cross-sectional survey to investigate the acceptance of Fully Automated Vehicles (FAVs) among different non-AV-user groups (i.e., pedestrians, cyclists, and conventional vehicle drivers). A total of 1205 road users in Queensland (Australia) took part in the study, comprising 456 pedestrians, 339 cyclists, and 410 drivers. The Theory of Planned Behaviour (TPB) is used as the theoretical model to examine road users' intention towards sharing roads with FAVs. The risk profile of the participants derives from established behavioural scales and individual characteristics are also included in the acceptance model. The study results show that pedestrians reported lowest intention in terms of sharing roads with FAVs among the three groups. Drivers and cyclists in a lower risk profile group were more likely to report higher intention to share roads with FAVs than those in a higher risk profile group. As age increased, pedestrians were less likely to accept sharing roads with FAVs. Drivers who had more exposure time on roads were more likely to accept sharing roads with FAVs. Male drivers reported higher intention towards sharing roads than female drivers. Overall, the study provides new insights into public perceptions of FAVs, specifically from the non-AV-user perspective. It sheds light on the obstacles that future AVs may encounter and the types of road users that AV manufacturers and policymakers should consider closely. Specifically, groups such as older pedestrians and road users who engage in more risky behaviours might resist or delay the integration of AVs., 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 © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Injury severity studies typically rely on police-reported crash data to examine risk factors associated with traffic injuries. The police crash database includes essential information on roadways, crashes and driver-vehicle characteristics but may not contain accurate and sufficient information on traffic injuries. Despite sizable efforts on injury severity modelling, very few studies have employed hospital records to classify injury severities accurately. As such, the inferences drawn from the police-recorded injury severity classifications may be questionable. This study investigates factors affecting road traffic injuries of motor vehicle crashes in two approaches (1) police-reported injury severity data and (2) a data fusion approach linking police and hospital records. Data from 2015 to 2019 were collected from the Abu Dhabi Traffic Police Department and linked with hospital records by the Department of Health, Abu Dhabi. A total of 6,333 casualty crashes were categorised into non-severe, severe, and fatal crashes following police-reported data and non-hospitalised, hospitalised and fatal crashes based on the police-hospital linked data. The state-of-the-art random thresholds random parameters hierarchical ordered Probit models were then employed to examine the differences in factors affecting crash-injury severities between police-reported and police-hospital linked data. While there are similarities between these two approaches, there are numerous notable differences in injury severity factors. For instance, head-on collisions are associated with high crash-injury severities in the model with police-hospital linked data, but they tend to show low injury severities in the model with police-reported data. In addition, the police-reported approach identifies that crashes occurred in remote areas and angle collisions are associated with low injury severities, which is not intuitive. These findings highlight that modelling the misclassified injury severity in police crash data may lead to wrong estimations and misleading inferences. Instead, the data fusion approach of police-hospital linked data provides critical and accurate insights into road traffic injuries and is a valuable approach for understanding traffic injuries., 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 © 2022 Elsevier Ltd. All rights reserved.)

Introduction: Engagement in prosocial and altruistic on-road behaviors is a new area of research with potential safety benefits for road users. This paper systematically reviewed studies on road users' engagement in prosocial and altruistic behaviors to provide guidance regarding the next steps in this area of research, particularly to inform targeted interventions. The objective was to identify the types of on-road prosocial and altruistic behaviors that have been studied, and the factors associated with these behaviors. Road users were defined as drivers, passengers, or vulnerable road users (e.g., pedestrian, motorcyclists, and bicyclists)., Method: The database search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRIMSA) guidelines and was conducted in June 2021. A total of 23,090 articles were identified in four databases including APA PsycINFO, Embase, Web of Science, and the Transportation Research Information Database. Eleven articles (13 studies) published between 2004 and 2021 met the inclusion criteria and were included in the review., Results: Six studies focused on intervening behaviors, specifically relating to passengers' willingness or intentions to speak up to a driver engaging in unsafe driving behaviors, four studies focused on drivers' yielding behaviors at crosswalks, and one study each focused on altruistic driving behaviors, prosocial driving behavior at long-wait stops, and prosocial behavior towards cyclists. Studies typically examined characteristics of the prosocial road user, including self-esteem, efficacy, and subjective norms, as well as contextual factors, such as other road users' behaviors and on-road messaging., Conclusions: This review highlights specific factors that may predict road users' engagement in prosocial and altruistic on-road behaviors., Practical Applications: The outcomes from this review may be used to guide the development of future road safety public education messages designed to encourage greater participation in prosocial and altruistic on-road behaviors that act to benefit all road users., (Published by Elsevier Ltd.)

Introduction: This research systematically reviewed relevant studies on users' acceptance of conditional (Level 3) to full (Level 5) automated vehicles when such vehicles are to be used privately (herein referred to as 'private automated vehicles or private AVs)., Method: The search followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, and was undertaken in three databases: APA PsycINFO, Transport Research International Documentation, and Web of Science. Articles were required to focus on individuals' acceptance of private SAE Level 3-5 AVs. Acceptance was defined as individuals' attitudes towards or intentions and/or willingness to use AVs in the future. A total of 2,354 articles were identified in the database search. Thirty-five articles were included in the review, six of which included multiple studies and/or comparison groups., Results: Most studies (n = 31) applied self-reported measures to assess user acceptance together with a range of psychosocial factors predicting such acceptance. The meta-analytic correlations revealed that perceived behavioral control, perceived benefits/usefulness, perceived ease of use, and subjective/social norms had significant positive pooled relationships with attitudes and intentions. Trust and sensation seeking also had significant positive pooled correlations with intentions, while knowledge of AVs had a significant and negative pooled correlation with intentions. Age did not show any significant pooled relationship with attitudes, intentions, or willingness., Conclusions: The findings obtained from the systematic review and meta-analysis provide support for psychosocial models to aid understanding of users' acceptance of private AVs. Practical applications: Examining acceptance of AVs after participants have experienced these vehicles on closed tracks or open roads would advance contemporary knowledge of users' intentions to use these vehicles in the future. Further, experiencing these vehicles firsthand may also help with addressing any perceived barriers reducing acceptance of future use of private AVs., (Copyright © 2021.)

Young driver speeding behaviour remains a large contributor to road trauma worldwide. In order to provide a more-in depth understanding of how to deter young drivers from this behaviour, this study developed and tested a model of the legal and non-legal factors that influence young driver's intentional speeding behaviour (exceeding the speed limit by more than 10 km/hr). A prospective survey design was conducted to measure the impact of perceptions of legal factors (including classical deterrence and reconceptualised deterrence variables) and non-legal factors (including the variables of fear of physical loss, material loss and perceived social sanctions, as well as the perception that it is safe to engage in the behaviour without being involved in a crash) at time 1, on engagement in speeding behaviour at time 2, which occurred 3 months later. A total of 200 participants aged 17-25 years completed both surveys (Mean age = 20.44 years). Using structural equation modelling, a unique model combining classical and extended deterrence theory, as well as prominent non-legal factors was created, and the variables were able to explain 41% of the variance in speeding behaviour. A high perceived severity of the punishment, experiencing direct punishment avoidance and perceiving that it is safe to speed were significant direct predictors. Meanwhile, there were also numerous significant partially mediated relationships found for both legal and non-legal variables. These findings provide important implications for both the application of deterrence-based theories in road safety and for improving countermeasures to deter young drivers more effectively from engagement in speeding., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

This study addressed the causal ordering problem in deterrence research by examining the perceptual stability of deterrence variables over time and comparing the results via cross-sectional and longitudinal surveys. This research extends upon scant previous research by including three key classical deterrence variables (i.e., the perceived certainty of apprehension and the perceived severity and swiftness of punishment), as well as Homel's (1988) extra-legal deterrence-related variables of the fear of physical loss, material loss and social sanctions. A longitudinal survey design was utilised over a three month-time period (N = 200, Mage = 20.38 years, 71 males) that examined the stability of the deterrence-related variables for three road rule violations, consisting of 1) exceeding the speed limit by more than 10 km/hr, 2) reading a message on a phone while driving and 3) using the social media platform of Snapchat while driving. Overall, fluctuations were found in all the deterrence-related variables (both legal and extra-legal sanctions), with the largest difference being for the perceptions of the certainty of apprehension. Consequently, it can be suggested that: (a) longitudinal surveys are more reliable when measuring the impact of deterrence perceptions on engagement in offending behaviour and (b) the problem of causal ordering regarding utilising cross-sectional surveys is further illuminated. The results suggest that deterrence is a dynamic process, constantly changing based upon individual experiences, which reinforces the need for continued enforcement efforts (both legal and non-legal), within the road safety arena to maximise rule compliance., (Crown Copyright © 2020. Published by Elsevier Ltd. All rights reserved.)

Speeding behaviour has been shown to account for a large number of deaths and serious injuries on Australian roads. Vehicle impoundment is one countermeasure which has been implemented to discourage drivers from engaging in high-range speeding. Despite this countermeasure being used as a sanction in all Australian jurisdictions to combat high-range speeding offences, limited research has examined the effectiveness of vehicle impoundments in Australia. The purpose of this research was to examine the effectiveness of vehicle impoundment for high-range speeding offences on subsequent offence and crash rates. Data were collected from drivers with an eligible excessive speeding offence in Victoria, Australia between 1 July 2006 and 31 December 2014. During this time, there were 17,440 impoundment eligible offences, 6,883 (41.8 %) of which resulted in vehicle impoundment. The analysis revealed that drivers who had a vehicle impounded were more likely to be male, younger, hold a probationary licence, and to have a court offence. In terms of the effectiveness of vehicle impoundment, among high-range offenders, re-offence rates for those who had their vehicle impounded were statistically significantly lower for all licence periods compared with offenders who did not have their vehicle impounded. There was evidence of an effect of impoundment on reducing speeding re-offence rates during the impoundment period as well as some evidence that the impact of licence suspension was greater for those who experienced impoundment. Given that vehicle impoundment is a sanction which aims to discourage and/or incapacitate drivers from engaging in on-road risk taking behaviour, in this case high-range speeding behaviour, the longer-term positive effects of this sanction may assist with the on-going effort to reduce on-road risk taking behaviours., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: To evaluate the evidence for psychological treatments for persistent postconcussion symptoms following mild traumatic brain injury. There is scant evidence from limited clinical trials to direct the psychological management of persistent symptoms. Method: Databases were searched for studies that: (1) included adults (≥ aged 16 years) following injury (from any cause); (2) tested interventions for postconcussion symptoms after the acute injury period (e.g., after hospital discharge), but prior to established chronicity (e.g., not more than 12 months post-injury), and; (3) applied one of five broadly-defined psychological interventions (cognitive behavioural therapy, counselling, psychoeducation, education/reassurance, or mindfulness). All controlled trials were eligible for inclusion. Results: Of the 20,945 articles identified, 10 underwent risk-of-bias analysis by two independent reviewers. Nine were retained for data extraction. They used: cognitive behaviour therapy ( n  = 2), counselling ( n  = 2), psychoeducation ( n  = 2), education/reassurance ( n  = 2), or compared cognitive behaviour therapy to counselling ( n  = 1). Conclusion: Counselling or cognitive behaviour therapy have the most support but the evidence remains limited. We encourage further randomized controlled trials of early interventions in samples at risk for persistent symptoms, including closer study of psychological risk-factors and the 'active' ingredient. To advance the field, future trials must include additional methodological controls and improved reporting.Implications for rehabilitationPersistent symptoms following mild traumatic brain injury can be disabling and psychological management for rehabilitation may be proposed.However, Controlled trials show that while some psychological approaches hold promise for this purpose, there are significant gaps in the underpinning evidence.The best results are seen when postconcussion programs use counselling or cognitive behaviour therapy and are targetted for people with an increased risk of persistent symptoms.

To assess and explain finely drivers' a priori acceptance of highly automated cars, this study used the Theory of Planned Behaviour (TPB) and the Unified Theory of Acceptance and Use of Technology (UTAUT). Further, the current study sought to extend upon previous research to assess if intentions to use highly automated cars in the future differed according to country (i.e., Australia, France, & Sweden). These three countries were selected to enable comparisons of a priori acceptance between countries of differing levels of exposure to highly automated cars. Participants (N = 1563; 62.1 % male) were recruited in Australia (n = 558), France (n = 625), and Sweden (n = 380) to complete a 20 min online questionnaire. The findings differed according to country of residence. Individuals residing in France reported significantly greater intentions to use highly automated cars when they become publicly available compared to individuals residing in Australia and in Sweden. Of the TPB constructs entered at step 1 in the hierarchical regression, attitudes, subjective norms, and perceived behavioural control (capability and controllability) were significant predictors of intentions to use highly automated cars for participants residing in Australia and France. For participants residing in Sweden, only attitudes and PBC-capability were significant predictors of intentions. Of the UTAUT constructs entered at step 2, performance expectancy and effort expectancy were significant predictors of intentions for participants residing in France and only performance expectancy a significant predictor of intentions for participants residing in both Australia and Sweden. Age and gender did not add to the prediction of intentions when entered at step 3. However, pre-existing knowledge was a significant negative predictor of intentions when entered at step 3 for participants residing in Australia. Overall, the findings found some support for applying the TPB and UTAUT to assess intentions to use highly automated cars in different countries. The findings also highlight differences in a priori acceptance across countries and the factors which predict such acceptance., 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.)

The nature of the road environment requires drivers to be vigilant and attentive. Distracted driving is a primary concern, as it threatens the safety of road users. However very little research has been conducted into interventions to combat such an issue. Existing interventions such as police enforcement and legislation appear to have limited effect. The use of mobile phone applications to assist in limiting driver distraction is an alternative intervention that is currently gaining traction. With a great array of potential benefits, such as reducing road toll, these applications can be readily available to all road users. Despite the positive implications, it is vital that drivers accept the use of such a technology for the intervention to be effective. Therefore, understanding driver acceptance is an important step in implanting such applications. To assess this, the present study examines the utility of two versions of the Technology Acceptance Model (TAM), the Theory of Planned Behaviour (TPB) and the Unified Theory of Acceptance and Use of Technology (UTAUT) for understanding the acceptance of technology designed to reduce distraction. Participants were presented with two different applications and responded to questions that indicated their attitudes towards the factors included in the TAM, TPB and UTAUT, alongside their intent to use the technology. A total of 731 participants responded to the survey, and their responses analysed. The results indicated that overall, Davis' (1985) TAM was slightly better in explaining behavioural intent for both Mobile Phone Application (MPA) 1 and MPA 2, explaining 66.1% and 68.7% of the variance, respectively. Davis' (1989) TAM and the TPB were close behind, while the UTAUT explained the least variance in behavioural intent of all the models. Overall, the findings of this study provide support for using psychological theories to assess the acceptance of mobile phone applications., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

This study applied the revised-Reinforcement Sensitivity Theory (r-RST) to assess the influence of individual differences in young male and female drivers' risk perceptions and intentions to exceed the posted speed limit in a 60 km/hr zone. Relevant to the current study was the Behavioural Activation System (BAS; sensitive to reward), with a specific focus on the BAS processes: Reward Interest, Goal-Drive Persistence, Reward Reactivity and Impulsivity, and the Fight-Flight-Freeze System (FFFS; sensitive to punishment). It was hypothesised that young male and female drivers with stronger BAS traits would report lower risk perceptions towards speeding behaviour than those with weaker BAS traits and this risk perception would predict greater intentions to exceed the posted speed limit in 60 km/hr zones. It was further hypothesised that young male and female drivers with stronger FFFS traits would report higher risk perceptions towards speeding behaviour than those with weaker FFFS traits and this risk perception would predict lower intentions to exceed the posted speed limit in 60 km/h zones. Participants were 367 young licensed Australian drivers aged between 17 and 25 years. The results of a mediation analyses showed that females with stronger Impulsivity had low perceptions of risk and higher intentions to speed than participants with weaker Impulsivity. Further, males with stronger Goal-Drive Persistence and reported higher perceptions of risk and lower intentions to speed than participants with weaker Goal-Drive Persistence. Contrary to expectations, the BAS processes of Reward Interest and Reward Reactivity, and the FFFS were not significant. The findings contribute to the theoretical understanding of how the r-RST traits, specifically Goal-Drive Persistence and Impulsivity may influence speeding behaviour as well as the understanding of the unique influence of the four underlying BAS processes., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

This study applied the Prototype Willingness Model (PWM) to investigate the factors that may predict young drivers' (non-intentional) willingness to text while driving, text while stopped, and engage in high and low levels of speeding. In addition, the study sought to assess whether general optimism bias would predict young drivers' willingness to text and speed over and above the PWM. Licenced drivers (N = 183) aged 17-25 years (M = 19.84, SD = 2.30) in Queensland, Australia completed an online survey. Hierarchical multiple regressions revealed that the PWM was effective in explaining the variance in willingness to perform all four illegal driving behaviours. Particularly, young drivers who possessed favourable attitudes and a positive prototype perception towards these behaviours were more willing to engage in texting and speeding. In contrast to the study's predictions, optimistically biased beliefs decreased young drivers' willingness to text while stopped and engage in high and low levels of speeding. The findings of the study may help inform policy and educational campaigns to better target risky driving behaviours by considering the influence of attitudes, prototypes and the non-intentional pathway that may lead to engagement in texting while driving and stopped and engagement in high and low levels of speeding., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Introduction: This research systematically reviewed the existing literature in regards to studies which have used both self-report and objective measures of driving behavior. The objective of the current review was to evaluate disparities or similarities between self-report and objective measures of driving behavior., Methods: Searches were undertaken in the following electronic databases, PsycINFO, PubMed, and Scopus, for peer-reviewed full-text articles that (1) focused on road safety, and (2) compared both subjective and objective measures of driving performance or driver safety. A total of 22,728 articles were identified, with 19 articles, comprising 20 studies, included as part of the review., Results: The research reported herein suggested that for some behaviors (e.g., driving in stressful situations) there were similarities between self-report and objective measures while for other behaviors (e.g., sleepiness and vigilance states) there were differences between these measurement techniques. In addition, findings from some studies suggested that in-vehicle devices may be a valid measurement tool to assess driving exposure in older drivers., Conclusions: Further research is needed to examine the correspondence between self-report and objective measures of driving behavior. In particular, there is a need to increase the number of studies which compare "like with like" as it is difficult to draw comparisons when there are variations in measurement tools used., Practical Applications: Incorporating a range of objective and self-report measurements tools in research would help to ensure that the methods used offer the most reliable measures of assessing on-road behaviors., (Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.)

This study applied the Theory of Planned Behavior (TPB) and the Technology Acceptance Model (TAM) to assess drivers' intended use of automated vehicles (AVs) after undertaking a simulated driving task. In addition, this study explored the potential for trust to account for additional variance to the psychosocial factors in TPB and TAM. Seventy-four participants (51% female) aged between 25 and 64 years (M = 42.8, SD = 12.9) undertook a 20 min simulated experimental drive in which participants experienced periods of automated driving and manual control. A survey task followed. A hierarchical regression analysis revealed that TPB constructs; attitude toward the behavior, subjective norms, and perceived behavioral control, were significant predictors of intentions to use AV. In addition, there was partial support for the test of TAM, with ease of use (but not usefulness) predicting intended use of AV (SAE Level 3). Trust contributed variance to both models beyond TPB or TAM constructs. The findings provide an important insight into factors that might reflect intended use of vehicles that are primarily automated (longitudinal, lateral, and manoeuvre controls) but require and allow drivers to have periods of manual control., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objective: This study examined whether reward and punishment sensitivities, as conceptualized by Gray and McNaughton's revised reinforcement sensitivity theory (RST), influenced young female drivers' attention toward a series of positive and negative antispeeding advertisement images. Young females' increasing crash risk is associated with their engagement in risky behaviors, which, in turn, has been associated with a stronger behavioral approach system (BAS; sensitive to rewards). It was predicted that individuals with a stronger BAS would elicit larger N100 and N200 mean amplitudes (reflecting greater attention) toward the positive images. Similar associations were predicted in relation to the fight-flight-freeze system (FFFS; sensitive to punishments) for negative images., Method: Twenty-four female drivers (17-25 years; final N = 16) completed Corr-Cooper's RST-Personality Questionnaire, prior to undergoing an event-related potential computerized visual task (i.e., oddball paradigm) that included positive, negative, and neutral images as targets against checkerboard image distractors., Results: Contrary to expectations, individuals with a stronger BAS (Reward Reactivity and Impulsivity) demonstrated significantly larger N200 mean amplitudes at the Cz electrode site on presentation of the negative images than those with a weaker BAS. No other significant RST effects were found., Conclusions: These findings provide some preliminary objective support for the use of negative emotion-based road safety advertisements for young females. Further, this study provides support for using psychophysiological measures to enhance understanding of traffic injury persuasion.

This review evaluated the evidence for psychological interventions to improve sleep and reduce fatigue after mild traumatic brain injury (mTBI). Eight electronic databases were searched up until August 2016 for studies that: 1) included adults; 2) tested intervention effectiveness on sleep quality and fatigue post-acutely; and 3) applied a broadly-defined psychological intervention (e.g., cognitive behavioral therapy [CBT], counseling, or education). Only randomized controlled trials were eligible for inclusion. Of the 698 studies identified, four met the eligibility criteria and underwent data extraction. These studies were assessed for risk of bias by two independent reviewers using the Scottish Intercollegiate Guidelines Network Methodology Checklist 2 for randomized controlled trials. One study applied CBT and three studies used enhanced education to improve outcomes. Limited evidence and methodological bias prevents strong conclusions about the effectiveness of psychological interventions for sleep and fatigue after mTBI. All but one study targeted general post-concussion symptoms rather than sleep or fatigue specifically. This runs the risk that the potential benefits of a targeted approach are underestimated in this literature, and future sleep- and fatigue-focused interventions are recommended. It is tentatively concluded that compared with standard care or the provision of generic advice, small improvements in sleep and fatigue are observed through psychological intervention post-mTBI.

Fixed and mobile speed cameras are an important element of enforcement initiatives designed to create a strong deterrent effect and improve road safety. Despite the widespread use of the technology and the need to create a strong deterrent effect, research has yet to determine if there is a relationship between levels of exposure to the devices and subsequent self-reported deterrent effects. As a result, licensed motorists (N=536; 51% female) in Queensland (Australia) were recruited to complete a questionnaire that measured exposure to speed cameras and associated offending behaviours. Data were analyzed utilising descriptive, bivariate and multivariate statistics. The key findings that emerged were: the sample reported a higher level of exposure to fixed cameras (even though there are more operational mobile cameras), younger males were most likely to speed and be observant of speed cameras and that perceived certainty of apprehension was the largest reported deterrent force. However, a positive (rather than negative) relationship was found between perceived camera exposure levels and speeding behaviours, which indicates a range of additional factors (both legal and non-legal factors as well as driving exposure levels) influence speed limit non-compliance. Furthermore, multivariate analysis revealed that higher levels of perceptual certainty were associated with general speed compliance and perceptions of the severity and swiftness of sanctions, rather than levels of self-reported camera exposure. This paper is the first to reveal that while motorists prone to speed may be more cognisant of speed camera operations, this in itself does not ensure appropriate behaviour modification., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

We review 20 studies that examined persuasive processing and outcomes of health messages using neurocognitive measures. The results suggest that cognitive processes and neural activity in regions thought to reflect self-related processing may be more prominent in the persuasive process of self-relevant messages. Furthermore, activity in the medial prefrontal cortex, the superior temporal gyrus and the middle frontal gyrus were identified as predictors of message effectiveness, with the medial prefrontal cortex accounting for additional variance in behaviour change beyond that accounted for by self-report measures. Incorporating neurocognitive measures may provide a more comprehensive understanding of the processing and outcomes of health messages.

Utilizing the Classical Deterrence theory and Stafford and Warr's (1993) reconceptualized model of deterrence, the current study examined whether age, gender, and discounting the future tendencies influence perceptions of being apprehended for speeding offences. Licensed motorists (N=700; 57% female) in Queensland (Australia) were recruited to complete a self-report questionnaire that measured perceptual deterrence, speeding related behaviors and discounting the future tendencies. Data were analyzed utilizing descriptive, bivariate and multivariate regressions. Significant (albeit weak) positive correlations were found between age and perceptions of apprehension certainty. Males were significantly more likely to report higher incidences of speeding (including while avoiding detection) compared to females. In contrast, females were more likely to perceive high levels of apprehension certainty and consider impending penalties to be more severe. At a multivariate level, discounting the future tendencies (in addition to being male, reporting lower levels of perceptual severity and swiftness, and more instances of punishment avoidance) were predictive of lower perceptual certainty levels. This study is one of the first to reveal that being male and having a tendency to discount the consequences of the future may directly influence drivers' perceptual deterrence levels., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objective: Self-report measures are typically used to assess the effectiveness of road safety advertisements. However, psychophysiological measures of persuasive processing (i.e., skin conductance response [SCR]) and objective driving measures of persuasive outcomes (i.e., in-vehicle Global Positioning System [GPS] devices) may provide further insights into the effectiveness of these advertisements. This study aimed to explore the persuasive processing and outcomes of 2 anti-speeding advertisements by incorporating both self-report and objective measures of speeding behavior. In addition, this study aimed to compare the findings derived from these different measurement approaches., Methods: Young drivers (N = 20, M age = 21.01 years) viewed either a positive or negative emotion-based anti-speeding television advertisement. While viewing the advertisement, SCR activity was measured to assess ad-evoked arousal responses. The RoadScout GPS device was then installed in participants' vehicles for 1 week to measure on-road speed-related driving behavior. Self-report measures assessed persuasive processing (emotional and arousal responses) and actual driving behavior., Results: There was general correspondence between the self-report measures of arousal and the SCR and between the self-report measure of actual driving behavior and the objective driving data (as assessed via the GPS devices)., Conclusions: This study provides insights into how psychophysiological and GPS devices could be used as objective measures in conjunction with self-report measures to further understand the persuasive processes and outcomes of emotion-based anti-speeding advertisements.

Using Gray and McNaughton's (2000) revised reinforcement sensitivity theory (r-RST), we examined the influence of personality on processing of words presented in gain-framed and loss-framed anti-speeding messages and how the processing biases associated with personality influenced message acceptance. The r-RST predicts that the nervous system regulates personality and that behaviour is dependent upon the activation of the behavioural activation system (BAS), activated by reward cues and the fight-flight-freeze system (FFFS), activated by punishment cues. According to r-RST, individuals differ in the sensitivities of their BAS and FFFS (i.e., weak to strong), which in turn leads to stable patterns of behaviour in the presence of rewards and punishments, respectively. It was hypothesised that individual differences in personality (i.e., strength of the BAS and the FFFS) would influence the degree of both message processing (as measured by reaction time to previously viewed message words) and message acceptance (measured three ways by perceived message effectiveness, behavioural intentions, and attitudes). Specifically, it was anticipated that, individuals with a stronger BAS would process the words presented in the gain-frame messages faster than those with a weaker BAS and individuals with a stronger FFFS would process the words presented in the loss-frame messages faster than those with a weaker FFFS. Further, it was expected that greater processing (faster reaction times) would be associated with greater acceptance for that message. Driver licence holding students (N=108) were recruited to view one of four anti-speeding messages (i.e., social gain-frame, social loss-frame, physical gain-frame, and physical loss-frame). A computerised lexical decision task assessed participants' subsequent reaction times to message words, as an indicator of the extent of processing of the previously viewed message. Self-report measures assessed personality and the three message acceptance measures. As predicted, the degree of initial processing of the content of the social gain-framed message mediated the relationship between the reward sensitive trait and message effectiveness. Initial processing of the physical loss-framed message partially mediated the relationship between the punishment sensitive trait and both message effectiveness and behavioural intention ratings. These results show that reward sensitivity and punishment sensitivity traits influence cognitive processing of gain-framed and loss-framed message content, respectively, and subsequently, message effectiveness and behavioural intention ratings. Specifically, a range of road safety messages (i.e., gain-frame and loss-frame messages) could be designed which align with the processing biases associated with personality and which would target those individuals who are sensitive to rewards and those who are sensitive to punishments., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Short-term studies with fenofibrate, an established treatment for hyperlipidaemia, have shown that its unique side effect of urate lowering is mediated through enhanced renal urate clearance. The long-term effects of fenofibrate on hyperuricaemia and gout have not previously been reported. We report two patients with hyperlipidaemia in association with hyperuricaemia in whom long-term fenofibrate therapy was associated with a sustained reduction in serum urate and lipid levels, together with remission from recurrent attacks of acute gout. The mechanisms involved in these effects and the potential role for fenofibrate in the management of gout are discussed.

Objective: To assess the short-term urate-lowering effect of fenofibrate in men on long-term allopurinol therapy for hyperuricaemia and gout., Methods: Ten male patients (38-74 yr) with a history of chronic tophaceous or recurrent acute gout with hyperuricaemia and on established allopurinol at 300-900 mg/day for > or =3 months were studied in an open-crossover study of fenofibrate therapy. Allopurinol at the established dose was continued throughout the study. Clinical and biochemical assessments (serum urate and creatinine, 24-h urinary excretion of urate and creatinine, liver function tests, creatine kinase and fasting serum lipids) were undertaken at: (i) baseline, (ii) after 3 weeks of once-daily therapy with micronized fenofibrate (Lipantil Micro) at 200 mg and (iii) 3 weeks after fenofibrate was withdrawn., Results: Fenofibrate was associated with a 19% reduction in serum urate after 3 weeks of treatment (mean+/-S.E. 0.37+/-0.04 vs 0.30+/-0.02 mM/l; P=0.004). The effect was reversed after a 3-week fenofibrate withdrawal period (0.30+/-0.02 vs 0.38+/-0.03 mM/l). There was a rise in uric acid clearance with fenofibrate treatment of 36% (7.2+/-0.9 vs 11.4+/-1.6 ml/min, normal range 6-11; P=0.006) without a significant change in creatinine clearance. Both total cholesterol and serum triglycerides were also reduced. No patient developed acute gout whilst taking fenofibrate., Conclusions: Fenofibrate has a rapid and reversible urate-lowering effect in patients with hyperuricaemia and gout on established allopurinol prophylaxis. Fenofibrate may be a potential new treatment for hyperuricaemia and the prevention of gout, particularly in patients with coexisting hyperlipidaemia or those resistant to conventional therapy for hyperuricaemia.

The clinical variables affecting DFT for ICD systems are not completely determined, especially with regard to biphasic shocking devices. To distinguish which factors correlate with DFT, we examined data from patients who were enrolled in the Ventak P2/Endotak protocol. A total of 284 patients were enrolled in the study. Two patients had a DFT > 25 J and did not receive the device; 154 did not undergo stepdown to failure DFT testing. The remaining 128 patients had formal DFT testing and were suitable for analysis. Variables available for analysis included age, body surface area (BSA), LVEF, gender, lead configuration, primary arrhythmia, primary cardiac disease, and use of cardioactive medication. Data were evaluated using regression analysis, fitting DFT (range, 1-25 J, mean 11 +/- 5 J) as a function of each variable. As a univariate predictor. BSA was found to be significant in predicting DFT, but accounted for only 9% of the total variation on the DFT (P < 0.01, r = 0.3). This study suggests that DFT using a biphasic shocking waveform is modestly in fluenced by the BSA of the patient. Other specific factors, including LVEF, do not predict DFT.

Objective: To screen patients with systemic sclerosis (SSc) for esophageal disease and to demonstrate a new system of grading dysmotility; to determine the relationship between the symptom of dysphagia and the degree of hypomotility shown by scintigraphy., Methods: 301 patients with SSc were studied by esophageal scintigraphy using a semisolid orally ingested bolus to detect esophageal dysfunction and gastroesophageal reflux. A new system of grading was used to quantitate the degree of dysfunction, ranging from grade 0 (normal) to grade 4 (severe abnormality)., Results: 246 (82%) patients in the study population had evidence of esophageal hypomotility. Gastroesophageal reflux was noted in 83 (28%) patient. The largest number of patients (33%) were found to have grade 2 abnormalities. The number of patients with reflux decreased with increasing severity of grade, from grade 2 to grade 4 (35 to 13%). A retrospective study of the symptoms of 50 of the total study population showed that increasing severity of grade correlated with increasing mean duration of SSc. There was no significant relationship between disease subset and the presence or severity of esophageal hypomotility. 60% of patients in grades 1 and 2 (i.e. with observed dysmotility shown on scintigraphy) had no symptoms of dysphagia. In the more severe grades (scan grades 3 and 4), symptoms of dysphagia correlated with increase in grade., Conclusion: Symptoms may be unreliable in judging the presence of extent of esophageal disease in SSc. Esophageal scintigraphy is a useful noninvasive screening test for the detection of asymptomatic disease. The new grading system provides information that rapidly identifies the stage of esophageal disease and gives comparative data for followup and interventional studies.

Escherichia coli O157:H7-related vascular damage such as hemolytic uremic syndrome is believed to require the Shiga-like toxins. This study demonstrated that sodium butyrate sensitized human umbilical vein endothelial cells to Shiga toxin and increased the expression of Shiga toxin receptor, globotriaosylceramide (Gb3), on human umbilical vein endothelial cells.

Twenty-four patients with proven systemic sclerosis and with symptoms suggestive of malabsorption (i.e. chronic diarrhoea and weight loss) were investigated for small bowel bacterial overgrowth. Of the patients selected, six were suffering from the diffuse form of the disease. Jejunal aspiration was performed in all patients, and in nine normal volunteers. A specially designed double-lumen sterile catheter was used for this purpose and was introduced via a gastroscope. Twenty of these patients underwent a glucose hydrogen breath test. Eight patients (33%) had significant bacterial counts: > 10(5) colony forming units per ml (cfu/ml) of jejunal fluid. Less than 10(2) cfu/ml were found in the jejunal fluid from the nine control subjects. Glucose hydrogen breath testing was positive in seven patients, all of whom had significant jejunal bacterial growth. Diarrhoea rather than weight loss was shown to be the symptom which correlated best with the presence of bacterial overgrowth. Ciprofloxacin was used in six patients whose diarrhoeal symptoms ceased dramatically within 48 h of commencing the antibiotic. Trimethoprim produced a partial response despite bacterial sensitivity. A disadvantage of the hydrogen breath test is that subsequent antibacterial therapy cannot be specific, as bacterial species, antibiotic sensitivity and resistance are unknown. Systemic sclerosis involving the small intestine in the past has been said to more prevalent in patients with diffuse disease, whereas this study showed a preponderance of patients with long-standing limited cutaneous systemic sclerosis and small bowel involvement.

Polymyositis and dermatomyositis are serious inflammatory muscle disorders which may present life-threatening complications. It is important to recognise and treat the condition in the early stages of the disease. Corticosteroids remain the mainstay of treatment, and their resistance and other forms of immunotherapy are discussed.

We investigated duodenal and gastric mucosal blood flow by endoscopic laser Doppler flowmetry (LDF) in ten patients with systemic sclerosis (SSc) and in ten healthy volunteers. In addition, we tested for the presence of small bowel bacterial overgrowth by jejunal aspiration. Jejunal aspiration and LDF were done consecutively, via a gastroscope, using a flexible catheter and laser Doppler probe. Following these procedures, two duodenal biopsies were obtained for light and electron microscopy. Mean duodenal and gastric blood flow were significantly lower in patients with SSc than in normal subjects (516 flux units vs. 240, 521 vs. 202, both p < 0.001). There was no correlation between age and blood flow in patients or volunteers. Four of the ten patients had evidence of significant bacterial overgrowth on jejunal aspiration (> 10(5) colony-forming units/ml). These findings support the hypothesis that within the small intestine of patients with SSc, factors independent of bacterial overgrowth may be responsible for malabsorption. The observed reduction in small-intestine mucosal blood flow may play an important contributory role. Further studies are required to determine whether this represents reversible or chronic progressive ischaemia, and its effect on nutrient absorption.

In Pseudomonas aeruginosa, production of exotoxin A, an ADP-ribosyltransferase, is a complex and highly regulated process. Two positively acting regulatory genes, regA and regB, have been cloned and characterized. To identify additional exotoxin A regulatory genes, we have characterized four N-methyl-N'-nitro-N-nitrosoguanidine-generated mutants of P. aeruginosa PA103 which are deficient in exotoxin A production. These mutants (PA103-8, PA103-15, PA103-16, and PA103-19) do not accumulate intracellular exotoxin A and are not complemented by the cloned toxA or regAB genes. This observation indicates that the lesion(s) in the mutants is probably in an exotoxin A regulatory gene(s) and is not in the genes for secretion of exotoxin A or in the toxA or regAB genes. To assess the effect of the putative regulatory mutations on the toxA and regAB genes, we compared the activity of the toxA and regAB promoters in the mutant and parental strains using plasmids containing the genes for beta-galactosidase or chloramphenicol acetyltransferase under the control of either the toxA or the regAB promoter. The toxA promoter-beta-galactosidase fusion plasmid could not be maintained in PA103-8. beta-Galactosidase expression driven by the toxA promoter was absent in the mutant PA103-19 and occurred at a low level, which was not repressed by iron in mutants PA103-15 and PA103-16. The regAB genes are temporally controlled by two promoters, P1 and P2. In all four mutants, regAB P1 promoter activity was reduced; however, expression under the control of the regAB P2 promoter was normal. These observations suggest the existence of one or more regulatory genes which directly affect expression of both the toxA and the regAB P1 promoters.

Development of hemolytic uremic syndrome (HUS) after infection by Shigella dysenteriae 1 or enterohemorrhagic Escherichia coli has been associated with the production of Shiga toxins (verotoxins). The putative target of Shiga toxins in HUS is the renal microvascular endothelium. This report shows that preincubation of human umbilical vein endothelial cells (HUVEC) with interleukin-1 beta (IL-1 beta) enhances the cytotoxic potency of Shiga toxin toward HUVEC. A preincubation of HUVEC with IL-1 beta is required for sensitization of HUVEC to Shiga toxin. Sensitization of HUVEC to Shiga toxin is IL-1 beta dose dependent. Development of the IL-1 beta response is time dependent, beginning within 2 h of IL-1 beta preincubation and increasing over the next 24 h. That these responses were due to IL-1 beta was demonstrated by heat inactivation of IL-1 beta, by neutralization of IL-1 beta by specific antibody, and by the ability of an IL-1 beta receptor antagonist to inhibit the effect of IL-1 beta. Shiga toxin-related inhibition of HUVEC protein synthesis preceded loss of cell viability. IL-1 beta incubation with HUVEC induced the receptor for Shiga toxin, globotriaosylceramide. Lipopolysaccharide included during IL-1 beta preincubation with HUVEC increased sensitivity to Shiga toxin in an additive manner. We conclude that IL-1 beta may induce Shiga toxin sensitivity in endothelial cells and contribute to the development of HUS.

We examined the association of fat distribution with a number of personality attributes and behaviours in a sample of 5115 young blacks and whites. Body fat distribution, measured by the ratio of waist-to-hip circumferences (WHR), was significantly and positively associated with cigarette smoking and negatively associated with education in all of the race and sex groups. WHR was positively associated with alcohol consumption in men and black women and with marijuana use in women. A number of psychosocial factors assessing personality attributes and behaviours were also examined, including the Cook-Medley hostility score, type A/B behaviour pattern, life events, social support, financial situation, and diagnosis of a nervous, emotional or mental disorder. In age- and BMI-adjusted analyses, only the Cook-Medley hostility score and a financial situation score were significantly and positively associated with WHR in all race and sex groups. In multivariate linear regression, these psychosocial factors were associated with WHR in some of the race and sex groups, accounting for less than 1% of the variation in WHR in any one group. These results suggest that fat distribution is weakly associated with these personality attributes and behaviours.

Objective: To test the hypothesis that both body mass index (expressed as the ratio of weight in kilograms per height in meters squared) and the ratio of waist circumference to hip circumference are positively associated with mortality risk in older women., Design: Prospective cohort study with a 5-year follow-up period., Setting: General community., Participants: Random sample of 41,837 Iowa women aged 55 to 69 years., Main Outcome Measure: Total mortality (1504 deaths)., Main Results: Body mass index, an index of relative weight, was associated with mortality in a J-shaped fashion: rates were elevated in the leanest as well as in the most obese women. In contrast, waist/hip circumference ratio was strongly and positively associated with mortality in a dose-response manner. Adjusted for age, body mass index, smoking, education level, marital status, estrogen use, and alcohol use, a 0.15-unit increase in waist/hip circumference ratio (eg, a 15-cm [6-in] increase in waist measurement in a woman with 100-cm [40-in] hips) was associated with a 60% greater relative risk of death. The observed associations were not explained to any great degree by bias from weight loss prior to baseline or higher early deaths among lean participants., Conclusions: Waist/hip circumference ratio is a better marker than body mass index of risk of death in older women. Waist/hip circumference ratio should be measured as part of routine surveillance and risk monitoring in medical practice.

The relation between central adiposity, measured by the waist/hip circumference ratio (WHR), and 4-year risk of fatal coronary artery disease was examined in a large cohort (n = 32,898) of women aged 55 to 69 years. The age-adjusted relative risk of death from coronary artery disease (115 deaths) was 3.3 for women in the highest tertile of WHR compared to the lowest tertile (95% confidence interval: 2.0, 5.6). After adjustment for age, body mass, smoking, physical activity, estrogen use, marital status, and alcohol intake, the relative risk of coronary death for women in the middle and highest tertiles versus those in the lowest tertile of WHR were 1.3 and 2.8, respectively (P for linear trend < 0.001). Further adjustment for hypertension and diabetes mellitus reduced the estimates slightly to 1.2 and 2.0, but the trend in relative risk remained statistically significant (P = 0.03). In contrast, body mass index showed no independent association with coronary death. Hypertension, diabetes mellitus, cigarette smoking, estrogen nonuse, and being unmarried were significant predictors of greater risk of coronary death in the multivariate model. These results indicate that central adiposity, reflected by an increased WHR, is an important risk factor for death from coronary artery disease in women, most of whom were postmenopausal. The association of central adiposity with risk of coronary death is independent, for the most part, of its association with hypertension and diabetes.

Pregnancy is thought to be a major contributor to the excess prevalence of obesity in women compared to men. Pregnancy-related increases in weight are purported to increase the risk that women will develop chronic diseases associated with high body weight. The assertion that pregnancy is associated with permanent weight gain and overweight was examined among 41184 post-menopausal women participating in a population-based study. Women reported lifetime parity, weight at ages 18, 30, 40 and 50 years, and current height. Body weight and body mass index (BMI) increased with age. On average, women gained 11.05 kg, or 0.35 kg per year between the ages of 18 and 50 years. Parity was associated with an increase in body weight from age 18 to 50 years of 0.55 kg per live birth, or 0.09 kg per live birth per year. At each age, women with lifetime parity of one or two live births had lower mean body weight and BMI, and a lower proportion overweight (BMI greater than 27 kg/m2), than either nulliparous women or those with three or more lifetime births. These results indicate a strong association between ageing and weight gain and a weak association between parity and both weight gain and overweight in women.

The authors report the results of a dietary survey of 38,121 Iowa women, 55-69 years of age in 1986, based on a semiquantitative food frequency questionnaire previously tested among Boston-area women aged 34-59 years. The Iowa women, compared with the younger Boston-area women, consumed a similar amount of calories (1,767 vs. 1,844 kcal) and a similar amount of total calories from fat (35 vs. 37%) but had markedly greater intake of the following micronutrients after including supplement use: iron (+18%), calcium (+33%), vitamin A (+43%), riboflavin (+46%), thiamine (+50%), and pyridoxine (+122%). The reproducibility of the questionnaire was examined in two more administrations to 44 of the Iowa women in January and June of 1988. Reproducibility was highest for alcohol (Pearson's r = 0.99), caffeine (r = 0.95), and vitamin E (r = 0.90) and lowest for sucrose (r = 0.53), polyunsaturated fat (r = 0.56), and iron (r = 0.59). Micronutrient intakes were generally more reproducible than macronutrient intakes. The agreement between the June 1988 questionnaire and the average of five 24-hour dietary recalls was also assessed in the 44 subjects. The median correlations of energy-adjusted intake were as follows: for macronutrients, r = 0.45; for micronutrients without supplements, r = 0.33; and for micronutrients with supplements, r = 0.64. This food frequency questionnaire appears to be reasonably reproducible and accurate, so that its use may be extended to epidemiologic studies of older women with a broad range of socioeconomic backgrounds.

Background: Although the results of animal studies and cross-cultural comparisons generally support a role for dietary fat in the etiology of breast cancer, results of analytic epidemiology studies are equivocal., Purpose: The association between dietary fat and subsequent breast cancer was examined in a cohort of 34,388 postmenopausal women from Iowa., Methods: Dietary habits were assessed by a food-frequency questionnaire mailed in January 1986. Through December 31, 1989, 459 incident cases of breast cancer occurred in this cohort. Proportional hazards regression was used to examine the dietary fat-breast cancer association while adjusting for potential confounders. The effects on this association of four analytic approaches to adjustment for energy intake were also considered., Results: After adjustment for known determinants of breast cancer, a modest positive association of total fat intake with risk of breast cancer was seen. Polyunsaturated fat intake was also positively associated with breast cancer (relative risk from lowest to highest intake, 1.0, 1.25, 1.31, and 1.49; P for trend = .052). Different approaches to adjustment for energy intake, however, provided different impressions of the dietary fat-breast cancer association. One method, involving categorization of crude fat intake and inclusion of total energy intake in regression analysis, gave relative risk estimates from low to high fat intake of 1.0, 1.17, 1.25, and 1.38 (P for trend = .18). Another method, based on categorization of fat intake residuals in which the variation in fat due to total energy intake was removed, gave corresponding estimates of 1.0, 1.24, 1.30, and 1.16 (P for trend = .29). The former suggests increasing breast cancer risk with increasing fat intake; the latter suggests no association., Conclusions: These results are consistent with other cohort studies that have shown a weak association or no association between dietary fat and breast cancer. They are also consistent with studies suggesting that fat intake is a determinant of breast cancer, particularly after accounting for inaccuracies in dietary assessment. The effects of different energy-adjustment methods may account in part for the varying interpretations of four previous cohort studies of dietary fat and breast cancer., Implications: Further work is needed to clarify not only the nature of the dietary fat-breast cancer association, but also the impact of different analytic methods used in the investigation of diet-disease associations.