On May 14, 2013 the National Transportation Safety Board (NTSB) in the United States released a report titled, “Reaching Zero: Actions to Eliminate Alcohol-Impaired Driving.” 

http://www.ntsb.gov/doclib/reports/2013/SR1301.pdf

 The National Transportation Safety Board is a legislatively mandated independent federal agency that is charged with, among other things, making recommendations related to transportation safety.  The NTSB report is substantial and it notes that alcohol-impaired driving remains a major safety issue in the United States with close to one-third of all highway fatalities associated with alcohol.  The report makes a number of recommendations to U.S. states that include the following taken directly from the report.

• Reduce the per se blood alcohol concentration (BAC) limit for all drivers,
• Conduct high-visibility enforcement of impaired driving laws and incorporating passive alcohol sensing technology into enforcement efforts,
• Expand the use of in-vehicle devices to prevent operation by an impaired driver,
• Use driving while intoxicated (DWI) courts and other programs to reduce recidivism by repeat DWI offenders, and
• Establish measurable goals for reducing impaired driving and tracking progress toward those goals.

The recommendation that seems to have already garnered the most attention is the recommendation to lower state blood alcohol concentration limits to 0.05g/dl.

http://well.blogs.nytimes.com/2013/05/14/cracking-down-on-drinking-and-driving/?src=xps

The current standard that exists in all U.S. states is 0.08g/dl while most developed countries have a 0.05g/dl standard.  Not surprisingly, there appears to be strong resistance to the 0.05g/dl BAC recommendation from the beverage industry.  A representative from the American Beverage Institute was quoted in the following article as saying, “Moving from 0.08 to 0.05 would criminalize perfectly responsible behavior” and “further restriction of moderate consumption of alcohol by responsible adults prior to driving does nothing to stop hard-core drunk drivers from getting behind the wheel.”

http://www.nytimes.com/2013/05/15/us/legal-limit-drunken-driving-safety-board.html?hp

And a representative from the Beer Institute was quoted as saying, “…we strongly encourage policymakers to direct their efforts where we know we can get results: by focusing on repeat offenders and increasing penalties on those with BAC of (0.15) or more.”

http://www.cnn.com/2013/05/14/us/ntsb-blood-alcohol/index.html?c=homepage-t

Scientific research on the topic summarized in the NTSB report however, clearly supports the assertion that moving to a 0.05g/dl BAC standard would save additional lives.

It will be interesting to see how responsive the states are to the NTSB’s recommendations.  In an effort to help motivate the states, the NTSB also recommends that some type of incentive grants be offered to states if they adopt the best practice recommendations including the 0.05 g/dl BAC standard.

Efforts to advance gun control legislation in the United States are stalling. Even in the state of Connecticut, where the Newtown shootings took place, legislative efforts to address gun related violence haven’t gone anywhere.

http://www.nytimes.com/2013/03/25/nyregion/connecticut-still-working-on-gun-law-frustrating-some.html?src=xps

It is amazing to see how the political will to address the issue of gun violence has lost energy so quickly despite the national outrage at recent mass shootings and numerous polls showing that Americans support a range of gun-control measures.

Michael Bloomberg, the mayor of New York City, appears to be concerned as well. He is putting forward $12 million of his own money to fund advertising campaigns targeting legislators in swing states to try and get them to support federal legislation on universal background checks.

http://www.nytimes.com/2013/03/24/nyregion/bloombergs-tv-blitz-on-guns-puts-swing-state-senators-on-the-spot.html?src=xps

Notably, an assault weapons ban no longer appears to be part of Bloomberg’s policy ask. In the month following the Newtown shooting, the public support and political will for an assault weapons ban of some type was high but 2 to 3 months appears to have changed at least the political will part. The NRA is predictably on top of it and is pledging to fight tooth and nail against even universal background checks.

http://thecaucus.blogs.nytimes.com/2013/03/24/n-r-a-chief-says-he-will-counter-gun-control-campaign-by-bloomberg/?src=xps

The policy landscape surrounding gun control measures has shifted significantly over the past couple of months (or was it just my imagination). Despite some policy successes, including New York and Colorado, gun control proposals are loosing steam and it is frightening to think what an additional month or two might bring.

Lesley Day sent me this report of an opinion piece written by Rod McClure, director of the Monash Injury Research Institute and printed in The Sidney Morning Herald,one of the leading newspapers in Australia. It notes that the four top-ranked conditions that killed Australians in 2010 were heart disease, cancer, lung disease and injuries but not all attract the same attention. It goes on to make a point many of us believe to lie at the heart of the failure of public health to address injuries as they deserve to be addressed. “(It is) because the community fragments the public health problem of injury into small separate categories – falls, skateboard accidents, snake bites, etc, – in contrast to the way we clump cancers, heart and lung disease into single-issue conditions”.  In contrast, McClure  also calls attention to data in the Lancet’s Global Burden of Disease that show that the incidence of many injury problems has increased over the last 20 years such that they are now leading many of the more ‘popular’ causes of death. Yet, as is true for most countries, the Australian government continues to focus on other health problems, not injuries.

McClure concludes with a frequently heard message: “What is urgently needed is a national commitment to addressing the problem of all-cause injury – for those 9,000 Australians each year who do not need to die, and many times more who do not need to live the rest of their life with disability.” This is an eloquent piece that deserves to be read in its entirety and not just by Australians. I fully agree that national commitments are lacking everywhere.

France has achieved remarkable road safety results in the last decade. It almost halved its road fatalities from 2002 to 2005, and the decreasing trend has continued. Most of these reductions are attributed to rigorous speed control, particularly by automated cameras and the issuance of speed tickets. Drunk driving, however, remains a major problem as it is a contributory factor in one third of road fatalities in France, a proportion that has remained unchanged in the last decade. Recently, the French Government introduced a law that made it mandatory for every car to be equipped with one single-use breath alcohol test. The government is hoping that by using this test the French drivers will understand their impairment levels after drinking events and consequently avoid drunk driving. The law was introduced on July 1, 2012 with first sanctions intended to start by Nov 1, 2012. Due to an inadequate supply of the breath alcohol tests, the date of sanctioning has been postponed until March 1, 2013. Though it is too early to tell what the real impact of this measure is, this intervention is already appealing to road safety advocacy groups outside France.

 Introduction of French law:

http://www.lefigaro.fr/actualite-france/2012/03/02/01016-20120302ARTFIG00538-ethylotest-obligatoire-le-mode-d-emploi.php

 Postponement of sanctioning date:

http://news.autoplus.fr/news/1459830/Alcotest-Ethylotest-Infraction-Mars-2013-Amende

 Opinion of Quebec road safety advocates:

http://fr.canoe.ca/infos/quebeccanada/archives/2012/12/20121229-224613.html

Earlier this week I commented on the insight into research deficits which can be highlighted in reviews of the extant literature. In particular, I commented on the need for consistent and complete data collection which is suitable for a variety of research purposes and which ultimately can inform the development and refinement of policy and practice.

Relevant to this issue is the choice of an indicator of intervention success. The injury prevention literature abounds with a variety of key improvement indicators, and there are considerable implications for the indicator of choice. Is the merit, and therefore success, of interventions such as graduated driver licensing (GDL) best measured by a reduction in fatal crashes? Injury crashes? What about offences? Such diverse indicators were also pointed out in a recent Injury Prevention paper by Zhu, Cummings, Chu, Coben, and Li in which the crash-reductions associated with GDL were examined separately for 16 -, 17-, and 18- year old drivers (see link below).

Moreover, we are interested in injury prevention, therefore a reliance upon the use of fatalities as an indicator, rather than injuries (which can incorporate fatal injuries), merits reconsideration. Again that may require Researcher advocacy within a political climate which is preoccupied with fatalities, but which is at great risk of misunderstanding the bigger picture.

http://injuryprevention.bmj.com/content/early/2012/12/03/injuryprev-2012-040474.short?g=w_injuryprevention_ahead_tab

Reviews such as the “Graduated Driver Licensing Research Review, 2010 – Present” released in November by the AAA Foundation of Traffic Safety (see link below) provide an excellent summary of recent research for researchers, practitioners, and policy-makers alike. Williams, Tefft and Grabowski succinctly summarise a multitude of research projects. Perhaps most importantly, however, is their identification of gaps in the extant literature. For example, we are yet to fully understand the mechanisms of learning to become a safe independent driver, and to identify the optimal graduated driver licensing (GDL) program structure.

One of the obstacles to understanding and thereby maximising the benefits of interventions such as GDL – and this is not specific to GDL by any means – is the quality and quantity of data collected by the various regulatory authorities. Researchers strive to rigorously interpret this data and to present as complete a picture as possible; however these efforts can be hindered by incomplete, limited, or simply a lack of pertinent data.

Perhaps one of our tasks as Researchers is to advocate for the collection and provision of quality data – that is, data that meets our research needs, and fundamentally that means data that can inform the development and refinement of injury prevention policy, practice, and future research endeavours.

https://www.aaafoundation.org/graduated-driver-licensing-research-review-2010-present

Over the years, the Global Burden of Disease Study (GBDS) has provided an excellent resource to support advocacy for injury prevention research. The Lancet has recently published (Dec 14, 2012) findings from the latest GBDS funded by the Bill and Melinda Gates Foundation. The GBDS 2010 focused on comparing estimated mortality and morbidity trends between 1990 and 2010. The strengths of GBDS 2010 include increased number of diseases and risk factors studied as well as computing 95% uncertainty levels (the authors’ preferred name for 95% confidence intervals) of the estimated frequencies of diseases and injuries in 1990 and 2010.

In terms of major causes of injury deaths, the recent report’s findings paralleled previous ones; road traffic injuries (RTIs) accounted for 28%, self-harm 17%, falls 11%, and interpersonal violence 9% of all injury deaths estimated at 5.07 million in 2010 (95% uncertainty interval=4.55-5.54). Injury death counts increased by one-quarter though some injury causes increased disproportionately. RTIs, for instance, increased by almost one half from 1990 to 2010. RTIs are now ranked as No. 8 for global mortality causes. Similarly, suicides have increased by a third and are ranked as the 13^th mortality cause globally. Injury deaths due to falls have increased by more than half and have jumped from 30^th mortality cause in 1990 to 22^nd in 2010. Exposure to forces of nature seems to be the “unfortunate” winner here, increasing by almost 535% from 1990 to 2010.

I think that a detailed review of GBDS 2010 findings for setting the next injury prevention research agenda is a must. Age, sex and geographic region-wise distributions readily provide foundation for targeting injury prevention research in vulnerable populations. I encourage you to take account of GBD 2010 injury statistics in your upcoming grants, manuscripts, and research advocacy activities.

Of interest, several related podcasts of panel discussions on these findings moderated by Drs. Christopher L. Murray and Richard Horton are available on the Lancet website. [http://www.thelancet.com/lancet-audio-2012/]

The Newtown gun violence tragedy has influenced opinions inside and outside United States (US). Los Angeles (LA) County, which has an annual buyback plan to exchange grocery cards for US$100 to US$200 for guns in May each year, decided to hold this event again on December 27, 2012. According to officials, the program duration had to be extended as the numbers of vehicles lining up for returning guns were greater than in May 2012. Over 2 000 guns were exchanged for grocery cards this time around compared with approximately 1 700 in May 2012. Editor: While this event brings a good public image to LA County, I think that it is somewhat reactive in nature without much though going into it. Obviously this program does not fully address gun violence, which is a large and complex problem. One question that I am forced to ask myself is why people buy the guns in the first place? Is it for their safety, leisure, thrill or something else? For me, the groceries-for-guns program needs to be refined using innovative social marketing approaches should authorities want it to become one of the “meaningful actions” to control gun violence in the US. A clear understanding of local population perceptions played an important role in marketing contraceptive use in many difficult low-income unwilling settings. The buy-back approach is a good start but it needs to be more universal and more deeply entrenched. I think that in-depth reflections on how to integrate a social marketing approach within the gun buyback program would make it a significant contributor to control gun violence.

Like all of you, my heart is saddened by Friday’s gun violence at Newton, Connecticut, United States (US). As a parent of two (one of school age), thoughts about the loss that parents of deceased children in the Sandy Hook Elementary now face made me feel helpless. Nevertheless, listening to President Obama’s speech on Saturday and observing that the media has begun to respond to his call for “Meaningful Action” I see a flickering light at the end of this long dark tunnel. I think that the burning question that my colleagues in the US shall face tomorrow is where to start “meaningfully”? All comments and ideas are welcomed…