BackgroundMotorcycle crash victims form a high proportion of those killed or injured in road traffic crashes. Injuries to the head, following motorcycle crashes, are a common cause of severe morbidity and mortality. It seems intuitive that helmets should protect against head injuries but it has been argued that motorcycle helmet use decreases rider vision and increases neck injuries. This review will collate the current available evidence on helmets and their impact on mortality, and head, face and neck injuries following motorcycle crashes.ObjectivesTo assess the effects of wearing a motorcycle helmet in reducing mortality and head and neck injury following motorcycle crashes.Search strategyWe searched the Cochrane Injuries Group Specialised Register, Cochrane Central Register of Controlled Trials (The Cochrane Library issue 2, 2007), MEDLINE (up to April 2007), EMBASE (up to April week 16, 2007), CINAHL (January 1982 to February 2003), TRANSPORT (up to issue 12, 2006) (TRANSPORT combines the following databases: Transportation Research Information Services (TRIS) International Transport Research Documentation (ITRD) formerly International Road Research Documentation (IRRD), ATRI (Australian Transport Index) (1976 to Feb 2003), Science Citation Index were searched for relevant articles. Websites of traffic and road safety research bodies including government agencies were also searched. Reference lists from topic reviews, identified studies and bibliographies were examined for relevant articles.Selection criteriaWe considered studies that investigated a population of motorcycle riders who had crashed, examining helmet use as an intervention and with outcomes that included one or more of the following: death, head, neck or facial injury. We included any studies that compared an intervention and control group. Therefore the following study designs were included: randomised controlled trials, non-randomised controlled trials, cohort, case-control and cross-sectional studies. Ecological and case series studies were excluded.Data collection and analysisTwo authors independently screened reference lists for eligible articles. Two authors independently assessed articles for inclusion criteria. Data were abstracted by two independent authors using a standard abstraction form.Main resultsSixty-one observational studies were selected of varying quality. Despite methodological differences there was a remarkable consistency in results, particularly for death and head injury outcomes. Motorcycle helmets were found to reduce the risk of death and head injury in motorcyclists who crashed. From four higher quality studies helmets were estimated to reduce the risk of death by 42% (OR 0.58, 95% CI 0.50 to 0.68) and from six higher quality studies helmets were estimated to reduce the risk of head injury by 69% (OR 0.31, 95% CI 0.25 to 0.38). Insufficient evidence was found to estimate the effect of motorcycle helmets compared with no helmet on facial or neck injuries. However, studies of poorer quality suggest that helmets have no effect on the risk of neck injuries and are protective for facial injury. There was insufficient evidence to demonstrate whether differences in helmet type confer more or less advantage in injury reduction.Authors' conclusionsMotorcycle helmets reduce the risk of death and head injury in motorcycle riders who crash. Further well-conducted research is required to determine the effects of helmets and different helmet types on mortality, head, neck and facial injuries. However, the findings suggest that global efforts to reduce road traffic injuries may be facilitated by increasing helmet use by motorcyclists.

AIMSTo investigate the relationship between marijuana use prior to driving, habitual marijuana use and car crash injury.DESIGN AND SETTINGPopulation based case-control study in Auckland, New Zealand.PARTICIPANTSCase 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.MEASUREMENTSSelf 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.FINDINGSAcute 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).CONCLUSIONSThis 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.

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.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To quantify the effectiveness of pre‐ and post‐licence motorcycle rider training on the reduction of traffic crash involvement, injuries and deaths of motorcycle riders.

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.

OBJECTIVE:Previous studies have indicated that unlicensed drivers are more likely to engage in risky driving behaviors, and are more likely than licensed drivers to be at fault and more seriously injured when involved in a crash. However, the prevalence of unlicensed drivers in the general driving population has not been measured, and the risk of an unlicensed driver being involved in an injury crash has not been quantified. We examined the association between unlicensed driving and car crash injury using data from a population-based case control study.METHODS:The study population was the drivers of all cars on public roads in the Auckland region. Cases were 571 vehicles involved in a crash resulting in any occupant being hospitalised or killed, from the study base, during the recruitment period. Controls were 588 vehicles selected from the driving population using a random cluster sampling method. The drivers of all vehicles completed a structured interview covering multiple potentially crash-related factors.RESULTS:Driving unlicensed was reported by 12% of case and 1% of control drivers. Unlicensed drivers were at significantly higher risk of car crash injury than those holding a valid licence (odds ratio 11.1, 95% confidence interval 4.2 to 29.7) after adjustment for age and sex. After further adjustment for education level, ethnicity, driving exposure, time of day, sleepiness score, year of vehicle manufacture, passenger carriage, seatbelt use, blood alcohol concentration, and travelling speed at time of crash, the increased risk was still present but no longer significant (OR 3.9, 95% CI 0.7-22.4).CONCLUSIONS:Unlicensed drivers are a high risk group for car crash injury after taking other crash-related risk factors into account. Strategies to reduce unlicensed driving may therefore facilitate reductions in road crashes, although further work is needed in this area.

Objective: To catalogue arguments that can be anticipated in public debate when passenger and night driving restrictions are being advocated. Design and setting: Frame analysis of all relevant coverage of these topics in Australian print media during the three month period between June and September 2004 when intensive debate on the topic occurred. Main outcome measures: Debating frames used in reports and commentary on passenger and night driving restrictions. Results: There were 52 relevant articles published containing seven distinct frames supporting the restrictions and six opposing them. Overall, more instances of frames supporting the restrictions were published; these mostly focused on the potential for saving lives. Opposition to the restrictions focused largely on their inappropriateness as a road safety measure as well as on the importance of young people’s autonomy and freedom. Conclusions: Advocates of passenger and night driving restrictions have a number of arguments available to advance their case; however, it is important to anticipate and address possible counter arguments. Future research should address the saliency of different arguments to the public and key decision makers in government.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: Primary objective: To examine the effect of motorcycle helmet legislation on death and injury rates in motorcyclists. Secondary objective: To examine effect of motorcycle helmet legislation on helmet wearing rates

The DRIVE study is a prospective cohort study which aims to examine and identify risk factors for motor vehicle injury in young drivers. The investigators chose to use an online questionnaire where study participants could enter their data directly into a secure database. In this paper the authors describe the pilot study. (non- author abstract)

Despite speculation about the role of vehicle insurance in road traffic accidents, there is little research estimating the direction or extent of the risk relationship. Data from the Auckland Car Crash Injury Study (1998-1999) were used to examine the association between driving an uninsured motor vehicle and car crash injury. Cases were all cars involved in crashes in which at least one occupant was hospitalized or killed anywhere in the Auckland region. Controls were 588 drivers of randomly selected cars on Auckland roads. Participants completed a structured interview. Uninsured drivers had significantly greater odds of car crash injury compared to insured drivers after adjustment for age, sex, level of education, and driving exposure (odds ratio 4.77, 95% confidence interval 2.94-7.75). The causal mechanism for insurance and car crash injury is not easily determined. Although we examined the effects of multiple potential confounders in our analysis including socioeconomic status and risk-taking behaviours, both of which have been previously observed to be associated with both insurance status and car crash injury, residual confounding may partly explain this association. The estimated proportion of drivers who are uninsured is between 5 and 15% in developed countries, representing a significant public health problem worthy of further investigation.

Objective: To quantify the association between vehicle age and risk of car crash injury. Design and setting: Data from a population based case-control study conducted in the Auckland region in 1998/99 was used to examine the adjusted risk of car crash injury or death due to vehicle age, after controlling for a range of known confounders. Cases were all cars involved in crashes in which at least one occupant was hospitalized or killed anywhere in the Auckland region, and controls were randomly selected cars on Auckland roads. The drivers of the 571 case vehicles and 588 control vehicles completed a structured interview. Main outcome measure: Hospitalisation or death of a vehicle occupant due to car crash injury. Results: Vehicles constructed before 1984 had significantly greater chance of being involved in an injury crash than those constructed after 1994 (odds ratio 2.88, 95% confidence interval (CI) 1.20 to 6.91), after adjustment for potential confounders. There was also a trend for increasing crash risk with each one year increase in vehicle age after adjustment for potential confounders (odds ratio 1.05, 95% CI 0.99 to 1.11; p = 0.09). Conclusion: This study quantifies the increased risk of car crash injury associated with older vehicle year and confirms this as an important public health issue.

Reliable evidence about the causes of young driver injuries is required if the substantial burden imposed by such injuries on young people in Australia and internationally is to be reduced. The specific risk factors to be examined in this study include pre-licence road and driving exposure/experience; type, quality and quantity of driver training; and road risk perceptions and engagement in sensation seeking behaviours. The study will provide reliable evidence on risk factors for motor vehicle crash injury among young drivers. Such information should be of value to driver training and road safety professionals, in the design of practical road safety strategies aimed at reducing the burden of young driver injuries. (a) For the covering entry of this conference, please see ITRD abstract no. E208180.