The road most travelled: the geographic distribution of road traffic injuries in England.

BACKGROUND: Both road safety campaigns and epidemiological research into social differences in road traffic injury risk often assume that road traffic injuries occur close to home. While previous work has examined distance from home to site of collision for child pedestrians in local areas, less is known about the geographic distribution of road traffic injuries from other modes. This study explores the distribution of the distance between home residence and collision site (crash distance) by mode of transport, geographic area, and social characteristics in England. METHODS: Using 10 years of road casualty data collected by the police, we examined the distribution of crash distance by age, sex, injury severity, area deprivation, urban/rural status, year, day of week, and, in London only, ethnic group. RESULTS: 54% of pedestrians, 39% of cyclists, 17% of powered two-wheeler riders and 16% of car occupants were injured within 1 km of home. 82% of pedestrians, 83% of cyclists, 54% of powered two-wheeler and 53% of car occupants were injured within 5 km of home. We found some social and geographic differences in crash distance: for all transport modes injuries tended to occur closer to home in more deprived or urban areas; younger and older pedestrians and cyclists were also injured closer to home. Crash distance appears to have increased over time for pedestrian, cyclist and car occupant injuries, but has decreased over time for powered two-wheeler injuries. CONCLUSIONS: Injuries from all travel modes tend to occur quite close to home, supporting assumptions made in epidemiological and road safety education literature. However, the trend for increasing crash distance and the social differences identified may have methodological implications for future epidemiological studies on social differences in injury risk

Controlling for exposure changes the relationship between ethnicity, deprivation and injury: an observational study of child pedestrian injury rates in London.

BACKGROUND: Research has suggested that inequalities in risk exposure may help explain identified ethnic inequalities in child pedestrian injury risk. However, addressing risk exposure in epidemiological research presents theoretical and methodological challenges. This article conceptualises the risk of child pedestrian injury as related to both exposure levels (the quantity of time children spend as pedestrians) and the probability of a hazard where that exposure takes place (the quality of the road environment). OBJECTIVE: To investigate the sensitivity of results on ethnic inequalities in child pedestrian injury risk in London to control for exposure and hazard levels. METHODS: Using police records of injury 2000-2009, we modelled the relationship between ethnicity, deprivation and child pedestrian injury rates in London using characteristics of the road environment to control for hazard levels and restricting the analysis to the time of the weekday morning commute (7.00-9.00 am), when most children must make a journey to school, to control for exposure levels. RESULTS: Controlling for risk exposure in this way fundamentally changed the nature of the relationship between ethnicity, deprivation and child pedestrian injury. During the time of the morning commute to school, 'Black' children were found to have higher pedestrian injury rates in the least-deprived areas. CONCLUSIONS: To inform effective strategies for reducing injury inequality, it is vital that exposure to risk is both acknowledged and considered

Reduced street lighting at night and health: A rapid appraisal of public views in England and Wales.

Financial and carbon reduction incentives have prompted many local authorities to reduce street lighting at night. Debate on the public health implications has centred on road accidents, fear of crime and putative health gains from reduced exposure to artificial light. However, little is known about public views of the relationship between reduced street lighting and health. We undertook a rapid appraisal in eight areas of England and Wales using ethnographic data, a household survey and documentary sources. Public concern focused on road safety, fear of crime, mobility and seeing the night sky but, for the majority in areas with interventions, reductions went unnoticed. However, more private concerns tapped into deep-seated anxieties about darkness, modernity 'going backwards', and local governance. Pathways linking lighting reductions and health are mediated by place, expectations of how localities should be lit, and trust in local authorities to act in the best interests of local communities

Age, disability and everyday mobility in London: An analysis of the correlates of ‘non-travel’ in travel diary data

Maintaining everyday mobility is important for health at older age. This paper explores one indicator of lack of mobility: not leaving the home on a particular day, which we term ‘non-travel’. We used travel diary data from London residents between 2005 and 2015 to identify the correlates of non-travel for adults. Rates of non-travel were associated with: female gender, unemployment, lack of access to a car, lack of travel concessions, increasing age, disability and being retired. In a logistic regression analysis, older age was independently associated with non-travel, with those aged 60–69, 70–79 and over 80 more likely than working age adults (odds ratios 1.76; 2.18; 3.88 respectively) to report non-travel than working age adults. London faces similar problems to other global cities, with an increasing older population, and policy obligations to shift further from private car based transport to public and active modes. This study has demonstrated that declining levels of mobility at older age in London are not due solely to leaving the labour market or to disability, and that the availability of transport helps reduce, but does not entirely mitigate, the barriers of older age and impairment. To ensure that cities are as health-promoting as possible, more attention is needed to guarantee transport systems foster mobility at older age

Evaluation of Graduated Driving Licence in the UK - Baseline Qualitative Study

Graduated Driver Licensing (GDL) schemes aim to reduce crash rates among young drivers by helping them to gradually build experience within a supportive environment. The introduction of a proposed GDL scheme in one country of the UK (Northern Ireland) provides an opportunity to determine the impact that these schemes have upon wellbeing outcomes by comparing crash rates and other outcomes before and after the intervention in the exposed population (Northern Ireland) and non-exposed population (other countries of the UK). This collection contains baseline qualitative data captured prior to the introduction of the proposed GDL scheme in Northern Ireland. It contains transcripts of 21 focus (natural) group interviews conducted with young adults aged 16-22 or their parents from Northern Ireland, England and Wales. Topics covered include the role of driving, giving and taking lifts, the local transport system and alternatives to driving

Pathways linking car transport for young adults and the public health in Northern Ireland: a qualitative study to inform the evaluation of graduated driver licensing.

BACKGROUND: Novice drivers are at relatively high risk of road traffic injury. There is good evidence that Graduated Driving Licensing (GDL) schemes reduce collisions rates, by reducing exposure to risk and by extending learning periods. Legislation for a proposed scheme in Northern Ireland was passed in 2016, providing an opportunity for future evaluation of the full public health impacts of a scheme in a European context within a natural experiment. This qualitative study was designed to inform the logic model for such an evaluation, and provide baseline qualitative data on the role of private cars in health and wellbeing. METHODS: Nine group interviews with young people aged 16-23 (N = 43) and two group interviews with parents of young people (N = 8) were conducted in a range of settings in Northern Ireland in 2015. Data were analysed using thematic content analysis. RESULTS: Informal car-pooling within and beyond households led to routine expectations of lift provision and uptake. Experiences of risky driving situations were widespread. In rural areas, extensive use of farm vehicles for transport needs meant many learner drivers had both early driving experience and expectations that legislation may have to be locally adapted to meet social needs. Cars were used as a site for socialising, as well as essential means of transport. Alternative modes (public transport, walking and cycling) were held in low esteem, even where available. Recall of other transport-related public health messages and parents' existing use of GDL-type restrictions suggested GDL schemes were acceptable in principle. There was growing awareness and use of in-car technologies (telematics) used by insurance companies to reward good driving. CONCLUSIONS: Key issues to consider in evaluating the broader public health impact of GDL will include: changes in injury rates for licensed car occupants and other populations and modes; changes in exposure to risk in the licensed and general population; and impact on transport exclusion. We suggest an important pathway will be change in social norms around offering and accepting lifts and to risk-taking. The growing adoption of in-car telematics will have implications for future GDL programmes and for evaluation

Effect of 20 mph traffic speed zones on road injuries in London, 1986-2006: controlled interrupted time series analysis

Objective To quantify the effect of the introduction of 20 mph (32 km an hour) traffic speed zones on road collisions, injuries, and fatalities in London

Integrating quasi-experimental and inductive designs in evaluation: a case study of the impact of free bus travel on public health

Evaluations of ‘natural experiments’ in public policy are typically considered ‘weak’ evidence. Challenges include: making credible claims for causal inference (internal validity); generalising beyond the case (external validity); and providing useful evidence for decision makers. In public health, where experimental evidence is encouraged by funders and enjoys a degree of rhetorical favour, in theory if not practice, current guidance for evaluating natural experiments focuses largely on methods for strengthening internal validity. Using a case study of the evaluation of free bus travel for young people in London, UK, we demonstrate a pragmatic approach to strengthening both internal and external validity in evaluations through integrating the logic of quasi-experimental methods with inductive qualitative analysis. Combining theoretical and inductive analysis in this way to address questions of policy interest through evaluations of natural experiments may be fruitful, and have methodological advantages over randomised designs

Pedestrian injuries in collisions with pedal cycles in the context of increased active travel: Trends in England, 2005-2015.

Introduction: Increasing levels of active travel in the population brings many public health benefits, but may also change the risks of road injury for different road users. We examined changes in rates of pedestrian injuries resulting from collisions with pedal cycles and motor vehicles in England during 2005-2015, a period of increased cycling activity, and described the gender, age distribution and locations of pedestrians injured in collisions with pedal cycles and motor vehicles. Methods: Collisions data were obtained from police STATS19 datasets. We used two measures of cycle/motor vehicle use; miles per annum, and estimated average travel time, and assessed evidence for trends towards increase over time using Poisson regression analysis. Results: There were 3414 pedestrians injured in collisions with one or more pedal cycles in England during 2005-2015, 763 of whom were killed or seriously injured (KSI). This accounted for 1.3% of the total pedestrians KSI from all vehicles. Of those KSI in collisions with cycles, 62% were female; 42% over the age of 60; 26% were on the footway or verge and 24% were on a pedestrian crossing. There was a 6% (IRR 1.056; 95% CI 1.032-1.080, p < 0.001) annual increase in the pedestrian KSI rate per billion vehicle miles cycled in England over the time span. This increase was disproportionate to the increase in cycle use measured by vehicle miles or time spent cycling. Conclusions: Increases in cycling were associated with disproportionate increases in pedestrian injuries in collisions with pedal cycles in England, although these collisions remain a very small proportion of all road injury. Increased active travel is essential for meeting a range of public health goals, but needs to be planned for with consideration for potential impact on pedestrians, particularly older citizens

The effect of reduced street lighting on road casualties and crime in England and Wales: controlled interrupted time series analysis.

BACKGROUND: Many local authorities in England and Wales have reduced street lighting at night to save money and reduce carbon emissions. There is no evidence to date on whether these reductions impact on public health. We quantified the effect of 4 street lighting adaptation strategies (switch off, part-night lighting, dimming and white light) on casualties and crime in England and Wales. METHODS: Observational study based on analysis of geographically coded police data on road traffic collisions and crime in 62 local authorities. Conditional Poisson models were used to analyse longitudinal changes in the counts of night-time collisions occurring on affected roads during 2000-2013, and crime within census Middle Super Output Areas during 2010-2013. Effect estimates were adjusted for regional temporal trends in casualties and crime. RESULTS: There was no evidence that any street lighting adaptation strategy was associated with a change in collisions at night. There was significant statistical heterogeneity in the effects on crime estimated at police force level. Overall, there was no evidence for an association between the aggregate count of crime and switch off (RR 0.11; 95% CI 0.01 to 2.75) or part-night lighting (RR 0.96; 95% CI 0.86 to 1.06). There was weak evidence for a reduction in the aggregate count of crime and dimming (RR 0.84; 95% CI 0.70 to 1.02) and white light (RR 0.89; 95% CI 0.77 to 1.03). CONCLUSIONS: This study found little evidence of harmful effects of switch off, part-night lighting, dimming, or changes to white light/LEDs on road collisions or crime in England and Wales