[PDF] - from rigorous science from rigorous science to impactful practice PDF Document

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September 17, 2009 September 17, 2009

from rigorous science … from rigorous science … … to impactful practice … to impactful practice

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Toward elimination of healthcare associated infections (Oct 15)

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Public health impact of tobacco product and advertising regulation in the United States (Nov 22)



Polio vaccine effectiveness in India – implications for polio eradication (Dec 17)

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Food safety (January 21)

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Toward elimination of healthcare associated infections (Oct 15)

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Public health impact of tobacco product and advertising regulation in the United States (Nov 22)

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Polio vaccine effectiveness in India – implications for polio eradication (Dec 17)

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Food safety (January 21)

Stay Tuned Stay Tuned Getting to Zero Traffic-Related Deaths Getting to Zero Traffic-Related Deaths

National Center for Injury Prevention and Control National Center for Injury Prevention and Control

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Outline Outline

 Presentation: Grant Baldwin, PhD, MPH and Ann Dellinger, PhD: Applying What Works: Promoting Evidence-based Motor Vehicle Interventions  Focused discussion: David Sleet, PhD: Global Road Traffic Safety: The United States in Context  Partner perspective: Justin McNaull, Director, State Relations, AAA: The Roles and Experiences of Stakeholders in Influencing Motor Vehicle Policies  Focused discussion: Barron H. Lerner, MD, PhD: Historical Barriers to Traffic Safety  Presentation: Grant Baldwin, PhD, MPH and Ann Dellinger, PhD: Applying What Works: Promoting Evidence-based Motor Vehicle Interventions  Focused discussion: David Sleet, PhD: Global Road Traffic Safety: The United States in Context  Partner perspective: Justin McNaull, Director, State Relations, AAA: The Roles and Experiences of Stakeholders in Influencing Motor Vehicle Policies  Focused discussion: Barron H. Lerner, MD, PhD: Historical Barriers to Traffic Safety

10 Leading Causes of Death by Age Group, United States, 2006 10 Leading Causes of Death by Age Group, United States, 2006

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Years of Potential Life Lost before Age 65:

Top 10 Causes of Death and Motor Vehicle Deaths, United States, 2006 Years of Potential Life Lost before Age 65: Top 10 Causes of Death and Motor Vehicle Deaths, United States, 2006

Source: CDC, NCIPC, Office of Statistics and Programming, WISQARS. Data Source: CDC, NCHS, National Vital Statistics System.

1,000,000 2,000,000 3,000,000

All Injury (excluding Motor Vehicle) Malignant Neoplasms Heart Disease Motor Vehicle Perinatal Period Congenital Anomalies Cerebrovascular Liver Disease HIV Diabetes Mellitus Chronic Lower Respiratory Disease Years Potential Life Lost

Economic Costs of Motor Vehicle Death Economic Costs of Motor Vehicle Death and Injuries and Injuries

Deaths Percentage

f Deaths

Injuries Percentage

f Injuries

Costs (in millions) Percentage

f Costs

ROAD USER TYPE MV Occupant 33,230 73.8% 2,790,567 75.8% 70,083 70.6% Motorcyclist 4,550 10.1% 237,689 6.5% 11,945 12.0% Pedalcyclist 1,006 2.2% 474,355 12.9% 5,488 5.5% Pedestrian 6,056 13.4% 167,029 4.5% 10,310 10.4% MV Unspecified 187 0.4% 13,104 0.4% 1,493 1.5% Total 45,029 3,682,744 99,318 AGE Kids (0-14) 2,147 4.8% 512,975 13.9% 7,352 7.4% Teens (15-19) 4,904 10.9% 530,008 14.4% 13,628 13.7% Adults (20-64) 30,670 68.1% 2,441,527 66.3% 75,087 75.6% Older Adults (65+) 7,308 16.2% 198,234 5.4% 3,251 3.3% Total 45,029 3,682,744 99,318

Source: Naumann et al., 2009 Unpublished

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– –

N

S

e a t B e l t A l c

h
l

S p e e d i n g A l l T h r e e

Percent of Population Percent of Fatalities Percent of Licensed Drivers Percent of Fatalities Percent of Registered Drivers Percent of Fatalities

Percentage of Motor Vehicle Fatalities Percentage of Motor Vehicle Fatalities Involving Key Risk Fact Involving Key Risk Factors, 2007

rs, 2007

54 32 31 7 10 20 30 40 50 60

Percent

Source: NHTSA Traffic Safety Facts - 2007

Percenta Percentage of Popul ge of Population/Licensed Drivers/ ation/Licensed Drivers/ Registered Vehicles vs. P Registered Vehicles vs. Pe ercentage of rcentage of Motor Vehicle Fatalities by Risk Factor, 2007 Motor Vehicle Fatalities by Risk Factor, 2007

13 23 6.4 3 13 57 10 20 30 40 50 60

Percent Rural Teenagers Motorcyclists

Source: NHTSA Traffic Safety Facts - 2007

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 7 fold variation in rates  States with lowest rates tend to have stronger laws, but the relationship is not that simple

55 mph Limit Seat Belt Laws MV Safe Act BAC Law 0.10 to 0.08

Motor Vehicle Death Rates by State, 2006 Motor Vehicle Death Rates by State, 2006

5 10 15 20 25 30 35 M S W Y M T A L A R N M S C S D L A W V T N K Y O K A Z I D N C G A F L M O N D N V K S T X D E I N N E I A M N V T U T W I O R A K M D P A V A C O C A H I O H M N M I W A I L C T N H N J N Y R I M A D . C .

Age-adjusted Rate per 100,000

Source: CDC, NCIPC, Office of Statistics and Programming, WISQARS. Data Source: CDC, NCHS, National Vital Statistics System.

 7 fold variation in rates  States with lowest rates tend to have stronger laws, but the relationship is not that simple

State State

Fatalities and Fatality Rates per 100 Million Vehicle Miles Traveled from 1961-2008 Fatalities and Fatality Rates per 100 Million Vehicle Miles Traveled from 1961-2008

Speed 55 mph Speed Limit Seat Belt Laws ty MV Safety Act BAC Law 0.10 to 0.08

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Domains Important for Motor Vehicle Safety Domains Important for Motor Vehicle Safety

People People Roads Infrastructure Roads Infrastructure Vehicles Vehicles

Focus on People Focus on People

 High risk groups  Safety device use  Risk factors  Policy  High risk groups  Safety device use  Risk factors  Policy

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In the first 6 months, newly licensed drivers are 8 times more likely to be involved in fatal crashes than more experienced drivers.

Teenage Drivers: Risk Factors Teenage Drivers: Risk Factors

 Inexperience  Immaturity  Teenage passengers  Inexperience  Immaturity  Teenage passengers

Months of Licensure Months of Licensure Crashes per 10,000 Novice Drivers Crashes per 10,000 Novice Drivers Crash Rates by Months of Licensure Crash Rates by Months of Licensure

Source: Mayhew, 2003

Benefits of Driving Experience Benefits of Driving Experience

In the first 6 months, newly licensed drivers are 8 times more likely to be involved in fatal crashes than more experienced drivers.

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Male Driver Crash Rates per Licensed Driver During

1 - 4 Years of Licensure by Driver Age, Ontario Male Driver Crash Rates per Licensed Driver During 1 - 4 Years of Licensure by Driver Age, Ontario

Source: Mayhew and Simpson, unpublished

Crash Rates by Driver Age and Passenger Presence - per 10,000 Trips Crash Rates by Driver Age and Passenger Presence - per 10,000 Trips

1 2 3 4 5 6 1 2 3+ 1 2 3+ 1 2 3+ Ages 18-19 Ages 30 59 Ages 16-17 Number of Passengers

Source: Insurance Institute for Highway Safety

Rate

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Risks for Everyone, but Greater for Teens

Risks for Everyone, but Greater for Teens

 Non-use safety belts  Speed  Night-time driving  Distraction  Alcohol  Fatigue  Non-use safety belts  Speed  Night-time driving  Distraction  Alcohol  Fatigue

Seat Belt Use by Age Seat Belt Use by Age

Source: NHTSA (2009)

Age Group

82% 83% 83% 80% 84% 88% 77% 84%

50% 60% 70% 80% 90% 100%

8 15 16 24 25-69 70+

2007 2008

Seat Belt Use

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1 6 1 7 1 8 1 9 2

2

5

3
3

5

4
4

5

5
5

5

6
6

5

7

+

Speeding Drivers in Fatal Crashes Speeding Drivers in Fatal Crashes

5 10 15 20 25 30 35 40 45

15-20 21-24 25-34 35 44 45-54 55 64 65-74 75+ Males Females

Percent

Source: NHTSA (2008)

Age Group

Fatal Crashes per 100 Million Miles Fatal Crashes per 100 Million Miles

Da Day y v vs

s. Night, by

. Night, by Driver Age Driver Age

5 10 15 20 25 30 day night Fatal Crashes per 100 M Miles

Age Group

Source: Insurance Institute for Highway Safety

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Crash Risk by Age and Blood Alcohol Concentration (BAC) Crash Risk by Age and Blood Alcohol Concentration (BAC)

5 10 15 20 25 30 . . 1 . 2

.

3 . 4

.

5 . 6

.

7 . 8

.

9 . 1

.

1 4 . 1 5

.

1 9 . 2 + 16-20 35-49

Source: Preusser, 2002

BAC

Crash Risk

 Seat Belts: raise seat belt use to 100% (1,325 lives saved

a year)

 State-based Graduated Drivers Licensing Policy: all

states strong GDL (175 16-year old drivers saved a year)

 Alcohol policies: no alcohol-impaired driving by drivers

under 21 (984 lives saved a year)

Challenge: compliance with existing policy
Challenge: state by state progress
Challenge: difficult to enforce

 Seat Belts: raise seat belt use to 100% (1,325 lives saved

a year)

 State-based Graduated Drivers Licensing Policy: all

states strong GDL (175 16-year old drivers saved a year)

 Alcohol policies: no alcohol-impaired driving by drivers

under 21 (984 lives saved a year)

Challenge: compliance with existing policy
Challenge: state by state progress
Challenge: difficult to enforce

Teen Driving: Effective Interventions, Potential Impact & Challenges Teen Driving: Effective Interventions, Potential Impact & Challenges

Source: Baker et al., 2007

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yxwvutsrponmlkjihgfedcbaVUTSRPONMLKIHGEDCBA 5,100 deaths  288,000 ED-treated nonfatal injuries

Motorcyclist Fatal and Nonfatal Injury Rates, 2001-2007 Motorcyclist Fatal and Nonfatal Injury Rates, 2001-2007

Source: FARS, NHTSA, 2009 & WISQARS, CDC, 2009 0.0 0.4 0.8 1.2 1.6 2.0 2001 2002 2003 2004 2005 2006 2007

Year

Death Rates

20 40 60 80 100 120 Nonfatal Injury Rates

Deaths Injuries

 5,100 deaths  288,000 ED-treated nonfatal injuries

Motorcyclists: Risk Factors Motorcyclists: Risk Factors

 No helmet use: 42% of riders  Speeding: 36% of motorcyclist

deaths

 Invalid license: 26% of

motorcyclist deaths

 Alcohol: 28% of motorcyclist

deaths BAC >.08

 No helmet use: 42% of riders  Speeding: 36% of motorcyclist

deaths

 Invalid license: 26% of

motorcyclist deaths

 Alcohol: 28% of motorcyclist

deaths BAC >.08

Source: NHTSA (2008)

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yxwvutsrponmlkjihgfedcbaVUTSRPONMLKIHGEDCBA Helmets - 37% effective in preventing death  Universal helmet laws lead to 100% use  Partial helmet laws lead to 50% use

Motorcycles: Effective Interventions Motorcycles: Effective Interventions

Source: Insurance Institute for Highway Safety (2009)

 Helmets - 37% effective in preventing death  Universal helmet laws lead to 100% use  Partial helmet laws lead to 50% use

Motorcycles: Potential Impact & Challenges Motorcycles: Potential Impact & Challenges

 Excess deaths: 100% helmet use would save

800 lives a year

Challenge: state by state policy
Challenge: strong opposition
Challenge: personal freedom argument

against, not lack of science

Challenge: multi-causal nature of crashes for

calculating lives saved

 100% helmet use would save $250 million a year  Excess deaths: 100% helmet use would save

800 lives a year

Challenge: state by state policy
Challenge: strong opposition
Challenge: personal freedom argument

against, not lack of science

Challenge: multi-causal nature of crashes for

calculating lives saved

 100% helmet use would save $250 million a year

Source: NHTSA (2008)

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Alcohol-Impaired Driving: Burden Alcohol-Impaired Driving: Burden

  Ever Every y da day y 36 people die and 700 36 people die and 700 more are injured in crashes that more are injured in crashes that involve an alcohol-impaired involve an alcohol-impaired driver driver   One arrest for ever One arrest for every y 88 episodes 88 episodes

f drink
f drinki

ing and driv ng and driving ing   Societal cost is $1.00 per drink Societal cost is $1.00 per drink consumed consumed   160 million annual s 160 million annual se elf-reported lf-reported episodes episodes

Alcohol-Impaired Driving: Alcohol-Impaired Driving: Who is Most at Risk? Who is Most at Risk?

  Risk of i

Risk of im mpaired driver death paired driver death

Males: 81%

Males: 81% of impaired

f impaired driver deaths, M/F RR=1.9

driver deaths, M/F RR=1.9

Young adults: 64

Young adults: 64% % i im mpaired driver deaths are paired driver deaths are aged aged 21-34 year 21-34 years s

Nighttime drivers: vs.

Nighttime drivers: vs. 6 am - 6 am - 9 9:00 pm, RR= 4 :00 pm, RR= 4

Seat belt non-users: 74

Seat belt non-users: 74% % impaired driver deaths impaired driver deaths are unbelted, PR = 1.7 are unbelted, PR = 1.7

  Risk of self-reported impaired driving episode

Risk of self-reported impaired driving episode

Person

Persons who binge drin s who binge drink at least monthly: k at least monthly: RR=13.6 RR=13.6 15

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 .05 BAC (blood alcohol concentration): + 500

lives saved a year

Challenge: lack of political will and strong

industry opposition

Challenge: measurement of BAC is inconsistent

across states, imputation for between 16% - 87%

 Ignition Interlocks: Reduce DUI recidivism by

64%

Challenge: logistics of widespread use not

determined

 .05 BAC (blood alcohol concentration): + 500

lives saved a year

Challenge: lack of political will and strong

industry opposition

Challenge: measurement of BAC is inconsistent

across states, imputation for between 16% - 87%

 Ignition Interlocks: Reduce DUI recidivism by

64%

Challenge: logistics of widespread use not

determined

Alcohol-Impaired Driving: Potential Impact

f Two Interventions & Challenges

Alcohol-Impaired Driving: Potential Impact

f Two Interventions & Challenges

 Seat Belts: +50% effective

preventing death

 2008 use 83% in US

State use differs, 64%-98%

 Seat Belts: +50% effective

preventing death

 2008 use 83% in US

State use differs, 64%-98%

Seat Belts: Epidemiology Seat Belts: Epidemiology

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 100% use saves 4,000-5,000 a year 

90% use saves $5 billion a year

Challenge: 19 states have only secondary

enforcement laws

Challenge: enforcement at night is more

difficult, but belt use is lower at night

 100% use saves 4,000-5,000 a year 

90% use saves $5 billion a year

Challenge: 19 states have only secondary

enforcement laws

Challenge: enforcement at night is more

difficult, but belt use is lower at night

Seat Belts: Potential Impact & Challenges Seat Belts: Potential Impact & Challenges

 Strengthening effective policy  Strengthening effective policy

What Should CDC Be Doing? What Should CDC Be Doing?

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 Strengthening effective policy  Strengthening effective policy

What Should CDC Be Doing? What Should CDC Be Doing?

 Assess effectiveness of interventions

 Community Guide systematic reviews

Ignition interlock programs
Multi-component programs with community

mobilization

 Assess effectiveness of interventions

 Community Guide systematic reviews

Ignition interlock programs
Multi-component programs with community

mobilization

What Should CDC Be Doing? What Should CDC Be Doing?

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Cost: $518 Billion year

3,000 deaths each day Outline Outline

 Presentation: Grant Baldwin, PhD, MPH and Ann Dellinger, PhD: Applying What Works: Promoting Evidence-based Motor Vehicle Interventions  Focused discussion: David Sleet, PhD: Global Road Traffic Safety: The United States in Context  Partner perspective: Justin McNaull, Director, State Relations, AAA: The Roles and Experiences of Stakeholders in Influencing Motor Vehicle Policies  Focused discussion: Barron H. Lerner, MD, PhD: Historical Barriers to Traffic Safety  Presentation: Grant Baldwin, PhD, MPH and Ann Dellinger, PhD: Applying What Works: Promoting Evidence-based Motor Vehicle Interventions  Focused discussion: David Sleet, PhD: Global Road Traffic Safety: The United States in Context  Partner perspective: Justin McNaull, Director, State Relations, AAA: The Roles and Experiences of Stakeholders in Influencing Motor Vehicle Policies  Focused discussion: Barron H. Lerner, MD, PhD: Historical Barriers to Traffic Safety

20-50 million injuries annually 3,000 deaths each day 20-50 million injuries annually Global Burden of Road Traffic Injuries Global Burden of Road Traffic Injuries $518 billion dollars annually

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Low/Middle Income High Income

Leading Causes of Death 2004 and 2030 Compared Leading Causes of Death 2004 and 2030 Compared

2.0 HIV/AIDS 10 2.0 Prematurity & low birth weight 10 2.2 Stomach cancer 9 2.2 Road traffic injuries Road traffic injuries 9 2.3 Hypertensive heart disease 8 2.3 Trachea, bronchus, lung cancers 8 2.5 Diabetes mellitus 7 2.5 Tuberculosis 7 3.5 Trachea, bronchus, lung cancers 6 3.5 HIV/AIDS 6 3.6 Road traffic injuries Road traffic injuries 5 3.6 Diarrhoeal diseases 5 5.1 Lower resp. infectious 4 5.1 Chronic obstr. pulmonary disease 4 7.0 Chronic obstr. pulmonary disease 3 7.0 Lower resp. infectious 3 9.7 Cerebrovascular disease 2 9.7 Cerebrovascular disease 2 12.2 Ischaemic heart disease 1 12.2 Ischaemic heart disease 1 % LEADING CAUSE % LEADING CAUSE

TOTAL 2030 TOTAL 2004

Source: WHO, 2009

International Comparison: MV Deaths per 100,000 Population, 2007 International Comparison: MV Deaths per 100,000 Population, 2007

5 10 15 20 25 30 35

Deaths per 100,000 pop.

N e t h e r l a n d s N

r

w a y S w e d e n U K F r a n c e A u s t r a l i a I r e l a n d C a n a d a S p a i n U S A P

l

a n d V i e t n a m I n d i a T h a i l a n d M e x i c

P

a k i s t a n S . A f r i c a K e n y a E g y p t Low/Middle Income High Income

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Do nothing Decade of Action

1. Political Commitment
2. Global Action Plan ($300 million)
3. 10% Road Building Funds on Safety

Contributing Factors Global Status Report – 2009 Contributing Factors Global Status Report – 2009



Less than half of countries have a BAC law at 0.05 g/dL or below



60% of countries lack a universal motorcycle helmet law



43% lack primary seat belt laws that cover the driver and all passengers



29% have urban speed limits below 30 mph



Less than half of countries have a BAC law at 0.05 g/dL or below



60% of countries lack a universal motorcycle helmet law



43% lack primary seat belt laws that cover the driver and all passengers



29% have urban speed limits below 30 mph

Do nothing Decade of Action

A Decade of Action… Saving 5 Million Lives A Decade of Action… Saving 5 Million Lives

500000 1000000 1500000 2000000 2500000

2000 2005 2010 2015 2020 Global RTI Deaths

1900000 900000 5 Million Fatalities 50 Million Serious Injuries

50% Fatality Reduction Target

1. Political Commitment
2. Global Action Plan ($300 million)
3. 10% Road Building Funds on Safety

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Success Story - Vietnam Success Story - Vietnam

Before After

 3% helmet use prior to the law  99% use after law (2007)  Saved 1,000 lives to date,

injuries down 25%

 Child helmet coverage began in

2009

 3% helmet use prior to the law  99% use after law (2007)  Saved 1,000 lives to date,

injuries down 25%

 Child helmet coverage began in

2009

What Should CDC Be Doing Globally? What Should CDC Be Doing Globally?

 Create public-private

partnerships

 Improve and expand global

surveillance

 Translate the most effective

interventions and policies

 Provide technical assistance

& training

 Integrate road safety into

CDC’s other global public health activities

 Create public-private

partnerships

 Improve and expand global

surveillance

 Translate the most effective

interventions and policies

 Provide technical assistance

& training

 Integrate road safety into

CDC’s other global public health activities 22

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yxvutsrponmlkjihgfedcbaWVUTSRPNMIHGECBA

Outline Outline

 Presentation: Grant Baldwin, PhD, MPH and Ann Dellinger, PhD: Applying What Works: Promoting Evidence-based Motor Vehicle Interventions  Focused discussion: David Sleet, PhD: Global Road Traffic Safety: The United States in Context  Partner perspective: Justin McNaull, Director, State Relations, AAA: The Roles and Experiences of Stakeholders in Influencing Motor Vehicle Policies  Focused discussion: Barron H. Lerner, MD, PhD: Historical Barriers to Traffic Safety  Presentation: Grant Baldwin, PhD, MPH and Ann Dellinger, PhD: Applying What Works: Promoting Evidence-based Motor Vehicle Interventions  Focused discussion: David Sleet, PhD: Global Road Traffic Safety: The United States in Context  Partner perspective: Justin McNaull, Director, State Relations, AAA: The Roles and Experiences of Stakeholders in Influencing Motor Vehicle Policies  Focused discussion: Barron H. Lerner, MD, PhD: Historical Barriers to Traffic Safety

Traffic Safety Efforts in the U.S. Traffic Safety Efforts in the U.S.

 Federal  State  Local  Non-government  Federal  State  Local  Non-government

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Legisla Legislat tive Climate for CDC Pri ive Climate for CDC Prio

rities

rities

  Teen Driver Safety

Teen Driver Safety

  Seat Belts and

Seat Belts and Occupant Protection Occupant Protection

  Alcohol Impaired

Alcohol Impaired Driving Driving

  Motorc

Motorcycle Helmet ycle Helmet Laws Laws

Outline Outline

  Presen Presenta tation tion: Gr : Grant Bald ant Baldw wi in n, , PhD, M PhD, MP PH H and and Ann Ann Dellinger, PhD: Dellinger, PhD: Appl Applying Wha ying What t Work Works: s: Promoting Evidence-based Motor Vehicle Interventions  Focused discussion: David Sleet, PhD: Global Road Traffic Safety: The United States in Context  Partner perspective: Justin McNaull, Director, State Relations, AAA: The Roles and Experiences of Stakeholders in Influencing Motor Vehicle Policies  Focused discussion: Barron H. Lerner, MD, PhD: Historical Barriers to Traffic Safety Promoting Evidence-based Motor Vehicle Interventions  Focused discussion: David Sleet, PhD: Global Road Traffic Safety: The United States in Context  Partner perspective: Justin McNaull, Director, State Relations, AAA: The Roles and Experiences of Stakeholders in Influencing Motor Vehicle Policies  Focused discussion: Barron H. Lerner, MD, PhD: Historical Barriers to Traffic Safety

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