Traffic Inj Prev [JOURNAL]
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200 papers
Influence of child seat payload center of gravity on near-side impact performance.
Price CW, Brelin-Fornari J, Atkinson T
Traffic Inj Prev · 2026 Mar · PMID 41910473 · Publisher ↗
OBJECTIVE: Design features of automotive child restraint systems (CRS) can influence the performance of a child seat in a collision. Various features have been studied regarding side impact performance including the meth...
OBJECTIVE: Design features of automotive child restraint systems (CRS) can influence the performance of a child seat in a collision. Various features have been studied regarding side impact performance including the method of anchorage, the side geometry of the CRS, and the padding used for energy absorption. This study investigated the influence of the mass and position of combined CRS and ATD center of gravity (CG), referred to as the payload CG, with regard to the outboard lower anchor and initial contact point of a forward-facing (FF) CRS in near-side impact. METHODS: A consistent model of CRS was altered to relocate the CG by rigidly adding a constant mass at different locations on the CRS. Ten deceleration sled tests were conducted using a side impact seat assembly (SISA) attached to the sled at a 10-degree angle, adhering to FMVSS 213a procedures. Lower anchor attachments and top tether were used for all near-side impact tests, and 3-dimensional positions of the CRS CG, CRS initial contact point, and lower anchor were recorded before each test. Data was collected from an instrumented Q3s ATD, as well as video from multiple camera views. RESULTS: When the CRS weight was increased by 64.4% while keeping a similar CG location, head injury criterion (HIC15) increased by 10.8%. Additionally, for all tests, the most significant correlation found for the HIC was related to an impact axis that is formed between the outboard lower anchor on the seat and the initial contact point on the CRS on the xz-plane. As the payload (CRS and ATD) point mass moment of inertia about the impact axis changed due to the modified CRS, linear regression indicated the HIC15 changed by 37.7 for every 10% change in moment of inertia about the impact axis ( < 0.001). The change in HIC15 corresponded to the peak head y-acceleration, which is tangential to the axis. Other measured data such as chest deflection were investigated, but no other significant correlations were determined. CONCLUSIONS: The HIC had the strongest correlation to the payload mass moment of inertia about the axis formed between the initial contact point on the CRS and outboard lower anchor. Therefore, the most favorable geometry of a CRS for near-side impact would be to design and position the initial impact point close to the combined CRS and ATD CG. By reducing the axis of rotation or mass of the CRS, the payload would have a lower moment of inertia, and the risk of injury to the head could be reduced, all else equal.
Modeling a cognitive-behavioral pathway to drivers' behavioral intention in response to tunnel auditory warnings under acoustic fluctuations.
Huang Y, Wong YD, Song M … +2 more , Chen F, Pan X
Traffic Inj Prev · 2026 Mar · PMID 41881504 · Publisher ↗
OBJECTIVE: Tunnel roadside auditory warning systems are designed to deliver critical safety messages. In-cabin acoustic fluctuations, such as those caused by vehicle speed and window state, are considered important facto...
OBJECTIVE: Tunnel roadside auditory warning systems are designed to deliver critical safety messages. In-cabin acoustic fluctuations, such as those caused by vehicle speed and window state, are considered important factors that may impair perceptual and cognitive processing. This study examines how these acoustic variations influence drivers' detection, comprehension, and behavioral intention regarding auditory warnings. METHODS: The study recreated ten distinct in-cabin acoustic environments by combining five vehicle speeds (0, 20, 40, 60, and 80 km/h) with two window states (closed/open). Real-world tunnel auditory warning recordings under these conditions were integrated into an audio-visual experimental platform. Thirty-six licensed drivers participated in this controlled experiment, during which multiple cognitive processing indicators were collected: auditory perception reaction time, speech intelligibility, listening effort, semantic comprehension, heart rate variability, and behavioral intention. A two-stage analytical approach was implemented: generalized estimating equations (GEE) were first used to assess how speed and window state affected warning detection, followed by structural equation modeling (SEM) to evaluate the relationships among the cognitive processing indicators. RESULTS: Vehicle speed and window state significantly affected warning detection, with performance declining notably above 60 km/h, especially under open-window conditions. Both auditory perception reaction time and speech intelligibility were substantially impaired as speed increased. Listening effort rose with increased speech intelligibility, though this relationship demonstrated a non-linear pattern. Semantic comprehension was strongly predicted by speech intelligibility and showed significant variation across different levels of listening effort. Crucially, key information comprehension emerged as the strongest direct predictor of behavioral intention, while listening effort exhibited both direct and indirect effects on intention. The structural equation model confirmed these relationships, revealing significant mediation pathways through listening effort and comprehension in the connection between perceptual processing and behavioral outcomes. CONCLUSIONS: This study shows that drivers' responses to tunnel roadside auditory warnings cannot be explained by detectability alone. Post-detection cognitive factors, particularly speech intelligibility and key information comprehension, play a critical role in shaping drivers' behavioral intention following successful perception of the warning. The findings underscore the relevance of incorporating drivers' perceptual and cognitive responses when assessing roadside auditory warnings in complex tunnel environments.
Evaluating AR glasses for driving assistance: a comparative case study against an AR-HUD in simulated driving with navigation and infotainment conditions.
Hu L, Chen W, Luo J … +4 more , Wu L, Ma S, Li H, Yang Z
Traffic Inj Prev · 2026 Mar · PMID 41881498 · Publisher ↗
OBJECTIVE: The ongoing advancement of technology has established Augmented Reality (AR) as a significant component of in-vehicle assistance systems. AR glasses, an emerging form of AR device, can present information with...
OBJECTIVE: The ongoing advancement of technology has established Augmented Reality (AR) as a significant component of in-vehicle assistance systems. AR glasses, an emerging form of AR device, can present information within the driver's forward field of view. Consequently, there is a view that AR glasses are potential devices that can perform functions similar to those of Augmented Reality Head-Up Displays (AR-HUDs). However, systematic research has yet to verify the feasibility of AR glasses as a viable alternative in the automotive domain. Furthermore, as AR glasses can present both navigation and infotainment information, this research aims to conduct a case study to compare their effects on driving performance when displaying these distinct information types. METHODS: We utilized both a commercial AR glasses device and a real AR-HUD device. Thirty-eight participants were randomly assigned to one of the two AR device groups (AR glasses or AR-HUD) and completed simulated driving tasks under two information conditions (navigation and infotainment). Data on driving performance under both critical and non-critical scenarios, as well as subjective evaluations, were collected. RESULTS: Compared to the AR-HUD group, the AR glasses group exhibited lower speed variation during navigation tasks and reported lower disturbed-by-display scores. However, the AR glasses group demonstrated longer reaction time under the infotainment condition. CONCLUSIONS: The study shows the relative effectiveness of the specific AR glasses in automotive applications, but also reveals potential safety hazards. While this type of validation study applies to specific AR glasses devices, the findings still provide initial guidance for AR glasses in future in-vehicle assistance systems.
Crash safety improvements for females, injury risk differences between females and males, and rationale for prioritizing MAIS 4 + F prevention.
Viano DC
Traffic Inj Prev · 2026 Mar · PMID 41843417 · Publisher ↗
OBJECTIVE: There has been publicity about the 5th female THOR dummy and its need to improve safety for women. The publicity conveys the notion that not much progress has been made in female safety. This study reviews res...
OBJECTIVE: There has been publicity about the 5th female THOR dummy and its need to improve safety for women. The publicity conveys the notion that not much progress has been made in female safety. This study reviews research, epidemiology, and approaches used to improve female safety. METHOD: General Motors (GM) research on female safety using the 5th female Hybrid III in the 1980s-2000s is summarized. Epidemiologic studies are summarized on differences in risk between females and male conducted by GM, NHTSA, and others. The pitfalls of focusing on MAIS 2+ injury are evaluated, and the need for prevention of MAIS 4 + F is discussed. RESULTS: GM research improved female safety: (1) Testing showed the lightest weight occupant was more prone to submarining than heavier occupants. GM modified the 5th female Hybrid III adding a frangible abdomen that showed if the lap belt was on the abdomen with high enough loads to cause submarining injuries. The modified dummy was used during the phase-in of rear-seat lap-shoulder belts. (2) First generation driver airbags caused inflation induced deaths to OOP (out-of-position) female drivers. The 5th female Hybrid III was used to assess neck and chest injury risks with OOP (out-of-position) inflations and to prevent injuries by depowering and bag unfolding patterns. (3) There were concerns for OOP injuries to the fetus of pregnant drivers. GM led the effort to develop a fetal insert for the 5th female Hybrid III. Testing showed risks with 1st generation airbags were reduced by advanced airbags. (4) The 5th female Hybrid III was used during GM's development of head restraints to prevent whiplash in high retention seats, including the active head restraint (SAHR) introduced in 1996 Saab 9-3 and 9-5. Studies using FARS and the double pair comparison method showed the fatality risk for unbelted females was 28 ± 3% higher in 1975-1983 MY and 19.6 ± 2.6% higher in 1980-1984 MY vehicles than unbelted males of the same age. The risk difference steadily decreased to 0.5 ± 10.7% (not significant) with belt use in 2015-2020 MY vehicles. There is no gender difference in modern vehicles with advance belts and airbags. The 5th female Hybrid III research contributed to the decrease in female risks. The claim of 47% higher chest injury risks in females compared to males is inconsistent with the most reliable field data showing no significant difference in serious injuries between females and males in frontal crashes with airbag deployment. CONCLUSION: Progress in the protection of females was made in 1980s-2000s with special instrumentation in the 5th female Hybrid III. The testing and field data resulted in greater improvements in female safety than for males. Use of the 5th THOR with 150 channels of responses in NCAP and regulatory tests will not reduce fatalities or severe injuries. Further improvements in female safety require a focus on specific MAIS 4 + F injuries, where a few key responses and kinematics are studied in dummy testing.
80+ year old belted driver fatalities in 2017-2023 CISS.
Viano DC
Traffic Inj Prev · 2026 Mar · PMID 41843410 · Publisher ↗
OBJECTIVE: The aim of this study was to analyze fatal crashes investigated by NHTSA involving 80+ yo (year old) lap-shoulder belted drivers. The crash types, circumstances and injuries were evaluated. METHODS: NHTSA onli...
OBJECTIVE: The aim of this study was to analyze fatal crashes investigated by NHTSA involving 80+ yo (year old) lap-shoulder belted drivers. The crash types, circumstances and injuries were evaluated. METHODS: NHTSA online database of 2017-2023 CISS (Crash Investigation Sampling System) crashes was searched for 80+ yo driver fatalities. Each case was downloaded. Only investigator confirmed belted drivers were summarized for driving maneuvers, crash types, impact severities, older driver demographics, and injury sources. Photographs were reviewed for vehicle deformation and intrusion. RESULTS: Thirty-one (31) cases met the selection criteria of an 80+ yo belted driver fatality. The drivers were 84.5 ± 4.4 years old, 92.3% were White, 54.8% were male and 10.0% used alcohol/drugs. The crashes occurred primarily in the morning or afternoon. The vehicles were 9.9 ± 6.6 years old. In 71% of the cases, the 80+ yo driver caused the crash by: 1) crossing or turning in front of another vehicle at an intersection causing a side impact (23%), 2) driving into another vehicle at an intersection causing a frontal impact (13%), 3) drifting out of lane into an oncoming vehicle or off road causing a frontal impact (29%) or 4) speeding, losing control and rolling over (6%). The last cluster was: 5) another driver causing the crash (29%). The intersection crashes had 39.0 ± 10.1 km/h delta V. The drift out of lane crashes had 53.4 ± 21.2 km/h delta V. The extent of vehicle damage was severe (51.6%), moderate (35.5%) or minor (12.9%). The injury severity (MAIS) was 3.7 ± 1.4. The chest (80.8%) was frequently injured with multiple rib fractures followed by the head (30.8%) and spine (26.9%). Most (66.7%) of the 80+ yo deaths occurred within a day, 33.3% within an hour and 11.1% died immediately. The median time to death was 2.65 hr. The seatbelt (59.3%) and steering system (33.3%) were the most common injury sources followed by the driver door, A- pillar and B-pillar (22.2%) and far-side interior (18.5%) in 29 of the known cases. CONCLUSIONS: The 80+ yo drivers caused most (71%) of the fatal crashes at intersections (36%), by drifting out of lane (29%) and by speeding (6%). Most fatal crashes seemed to involve errors in perception, vision, and judgment where sensory and cognitive functions failed to recognize the presence and speed of a crossing or oncoming vehicle. The crashes mainly involved partial overlap frontal or side impacts causing chest injuries with the majority dying within a day. Older drivers should stay vigilant, maintain lane control, and heed the advice to "look left, right and left" at intersections.
Toward the application of Wrong Way Driving countermeasures in European countries: Identification of the effectiveness and potential benefits of new technologies using a systematic review.
Guadagno M, Lucci C, Savino G
Traffic Inj Prev · 2026 Mar · PMID 41837803 · Publisher ↗
OBJECTIVE: Wrong Way Driving (WWD) is a very dangerous phenomenon for all road users. Although it occurs less frequently than other types of road collisions, every year in Europe results in crashes with severe consequenc...
OBJECTIVE: Wrong Way Driving (WWD) is a very dangerous phenomenon for all road users. Although it occurs less frequently than other types of road collisions, every year in Europe results in crashes with severe consequences in terms of injuries and fatalities. Through a systematic review of the literature, this study aimed to identify the most effective countermeasures to avoid or mitigate injuries caused by WWD to foster their introduction in European countries. METHODS: The study used the methodology of Systematic Review of the international scientific literature. Initially, the scientific literature was analyzed to investigate the research topic in-depth and identify the keywords to be used for retrieving all relevant studies. The systematic search was then performed on the most relevant digital databases, identifying 505 documents, which were reduced to 328 after removing duplicates. These were screened and analyzed in three stages: title, abstract, and full text. The final set of documents were thoroughly examined and sorted according to the following criteria: solution category, type of study, and countermeasure analyzed. In addition, a comparison of the effectiveness of promising solutions was carried out. RESULTS: Seventeen papers were ultimately included and categorized into three types of countermeasures: Simple Signals, Intelligent Technological Solutions (ITS), and Road Design. Simple Signals can help reduce wrong-way driving events but are not always sufficient to prevent them. Practical solutions exist for different situations, yet wrong-way driving maneuvers may still occur despite their implementation. Considering ITS, Rectangular Rapid Flashing Beacons (RRFBs) are the most effective solution, followed by Light Emitting Diode (LED) systems. These solutions, combined with conventional signs, can reduce wrong-way driving events and collisions up to 60-85% with expected benefit-cost ratios up to 23. Regarding Road Design, improved layouts at intersections and entrances/exits of high-traffic roads, along with the use of barriers and appropriate devices, can help reduce WWD events. CONCLUSIONS: Intelligent Technological Solutions, particularly RRFBs, have been extensively and successfully tested on United States roads, with proven positive effects for crash reduction. Given their relative ease of implementation, such solutions are the most promising for addressing and mitigating the phenomenon of wrong-way driving in the European road context. Based on the findings of this study, a proposal for a tailored countermeasure suitable for implementation within the European countries was proposed.
A pilot study on the cognitive and driving performance of high-contact sports athletes in a conditionally automated vehicle.
Islam F, O'Neill J, Turner I … +7 more , Hunter S, Kammerman B, Dulas M, Komor T, Lugade V, Howell D, Shi C
Traffic Inj Prev · 2026 Mar · PMID 41817670 · Publisher ↗
OBJECTIVES: Conditionally automated vehicles (CAVs) can perform most dynamic driving tasks but still require human drivers to resume control when automation reaches its limits. Successful takeovers depend on drivers' cog...
OBJECTIVES: Conditionally automated vehicles (CAVs) can perform most dynamic driving tasks but still require human drivers to resume control when automation reaches its limits. Successful takeovers depend on drivers' cognitive resources-especially mental workload (MWL) management and situational awareness (SA)-which can be affected by sport-related concussion (SRC) and repeated head impacts. Guided by our proposed conceptual framework linking SRC-associated neurocognitive inefficiencies to MWL, SA, and CAV driving performance, this pilot study examined whether participation in high-contact sports is associated with CAV-relevant cognitive and behavioral differences. METHODS: Seventeen professional ice hockey players and seventeen control participants with no history of contact sports completed a simulated CAV driving task involving multiple takeover events. Eye-tracking was used to index MWL- and SA-related oculomotor activity, and driving performance was assessed using takeover success rate and manual driving duration. Generalized linear mixed models, including binary logistic models, were employed to examine the effects of group ((high-contact sports athletes vs. controls) on cognitive and driving performances. RESULTS: The findings showed that contact sports athletes exhibited higher MWL-related eye-tracking indicators, lower takeover success rates, and shorter mean manual driving duration than the control group. CONCLUSION: These preliminary findings support the proposed framework and suggest that prior exposure to high-contact sports-where SRCs are common and often underreported-may make takeover episodes more cognitively demanding, underscoring the need for future CAV safety research to account for drivers' neurocognitive readiness.
Mining key factors of traffic accident risk at tunnel exits.
Jiao F, Shi Z, Tang X … +3 more , Xu W, Guo H, Liu Y
Traffic Inj Prev · 2026 Mar · PMID 41811364 · Publisher ↗
OBJECTIVE: With the continuous improvement of transportation infrastructure, tunnels, as an important type of road connecting key traffic nodes, have become increasingly prominent in the transportation system, and traffi...
OBJECTIVE: With the continuous improvement of transportation infrastructure, tunnels, as an important type of road connecting key traffic nodes, have become increasingly prominent in the transportation system, and traffic accidents are frequent with serious consequences. Therefore, this study explores the key causal factors of tunnel exit safety traffic accident risk from multiple dimensions, including human factors, traffic conditions, environmental factors, road characteristics, and safety facilities, in order to prevent traffic injuries. METHODS: Based on the analysis of 851 academic literature research since 2000, an improved Apriori algorithm combining subjective and objective methods was used to calculate support, confidence, and lift to mine frequent itemsets and strong association rules. By using the distance function method to fuze and modify the subjective and objective weights, an indicator system consisting of 5 primary indicators and 14 secondary indicators was constructed. A judgment matrix was constructed using expert questionnaires and AHP data to achieve accurate identification and importance ranking of various causal factors of traffic accident risk. RESULTS: In the current field of tunnel traffic accidents and safety research, human factors account for 28.24% of the total, becoming the primary focus of attention; traffic safety facilities and road factors follow closely behind with a proportion of 20.21% and 19.47%, respectively, with a total proportion of over 65%, highlighting their core position in tunnel safety research. It is worth noting that 52.94% of scholars focus their research on traffic safety facilities when exploring strategies to improve tunnel traffic safety. The correlation between the color, location, and frequency of traffic safety facilities shows a high degree of causality, with a confidence interval of 0.5526 ∼ 1 and a maximum lift reaching 5.2308. By improving the Apriori algorithm, the key influencing factors for tunnel exit safety are more accurately identified as the location, frequency, and vehicle speed of traffic safety facilities, with weights of 0.2607, 0.2241, and 0.1840, respectively. CONCLUSIONS: Research findings on key influencing factors of tunnel traffic safety revealed that driver-related factors dominated accident causation, followed by traffic facilities and road factors. Statistical analysis demonstrated significant associations among traffic facility parameters (position, frequency, and color). The improved algorithm quantitatively identified facility position, arrangement frequency, and facility color as critical factors influencing tunnel exit safety. These results provided scientifically validated identification of key determinants, establishing an evidence base for tunnel traffic injury prevention and safety enhancement measures.
Characteristics associated with alcohol and cannabis-related impaired risky driving and riding behaviors among adolescents.
Tran S, Nameth K, Rodriguez A … +3 more , D'Amico EJ, Hummer JF, Osilla KC
Traffic Inj Prev · 2026 Mar · PMID 41811351 · Full text
OBJECTIVE: Adolescents who are learning to drive are in a pivotal developmental period during which the risk of engaging in substance use, driving under the influence (DUI), and riding with an impaired driver (RWID) are...
OBJECTIVE: Adolescents who are learning to drive are in a pivotal developmental period during which the risk of engaging in substance use, driving under the influence (DUI), and riding with an impaired driver (RWID) are amplified. We examined the extent to which alcohol and/or cannabis use, peer and parent influences, resistance self-efficacy, and individual perceived driving risks were associated with RWID and future willingness to DUI/RWID among adolescents enrolled in a Colorado driver education program. METHODS: The current study was part of a larger randomized controlled trial, webCHAT, designed to prevent risky driving behaviors among novice drivers aged 15.5-17 years. The included sample ( = 196) was 57% female, 75% White, and averaged 15.7 ( = 0.35) years of age. We used logistic regression models to investigate the association between behavioral/attitudinal risk factors and self-reported risky driving behaviors. RESULTS: One-quarter of participants reported consuming alcohol (25.5%), 5.6% cannabis, and 3.1% alcohol and cannabis simultaneously in the past three months, with 22.0% reporting RWID with alcohol and/or cannabis and 3.6% endorsing DUI in their lifetime. Adolescents who perceived driving under the influence of cannabis (DUIC) or alcohol (DUIA) as less risky were significantly more likely to endorse RWID. CONCLUSIONS: The study reveals that individual perceived attitudes are associated with risky driving among young people learning to drive and highlights ideas for early prevention during this developmental milestone. Driver education programs provide an existing platform which can address both risk perceptions of impaired driving behaviors and cannabis-related permissive attitudes.
Observational study of adherence to effective helmet use among parents and students who are dropped by two-wheeler to school.
Shukla S, Sharma N, Shukla D
Traffic Inj Prev · 2026 Mar · PMID 41811303 · Publisher ↗
OBJECTIVES: Road traffic injuries (RTIs) are a major cause of morbidity and mortality among children and adolescents in India. Despite legislative mandates requiring helmet use for all motorized two-wheeler riders aged 4...
OBJECTIVES: Road traffic injuries (RTIs) are a major cause of morbidity and mortality among children and adolescents in India. Despite legislative mandates requiring helmet use for all motorized two-wheeler riders aged 4 years and older, adherence remains poor, particularly among children. This study aimed to assess the prevalence and patterns of helmet use among parents and children commuting to school on motorized two-wheelers through direct observation. METHODS: A cross-sectional observational study was conducted in October 2024 at 4 schools located on roads of differing traffic densities in southern Bangalore. Observations were made during morning drop-off hours recording helmet use among parents and their accompanying children using an online tally counter. Helmet use was categorized as proper helmet, cap helmet, or no helmet. Statistical analysis included chi-square tests for differences between parents and children and across schools, with odds ratios and 95% confidence intervals (CIs) calculated. RESULTS: A total of 785 parent riders and 966 child pillion riders were observed. Proper helmet use was recorded in 42.0% of parents and only 4.5% of children, while 33.3% of parents and 92.7% of children did not wear any helmet. No child was observed wearing a helmet when their parent did not. Children were 25.3 times less likely to wear a helmet than their parents (95% CI: 19.05-33.6). Significant inter-school variation was observed ( < 0.001), but differences were primarily in the distribution of proper versus cap helmets rather than overall helmet use. CONCLUSIONS: Helmet use among child pillion riders in Bangalore remains alarmingly low despite legal requirements. The study highlights a large gap between parent and child compliance, reflecting poor awareness, lack of enforcement, and limited availability of child-sized helmets. Strengthening enforcement, improving access to child helmets, and implementing school-based education and parent awareness programs are essential to enhance compliance and reduce preventable head injuries among children in India.
Potentially driver-impairing health conditions and typical fatal crash circumstances among older drivers. Epidemiological national register-based study in Sweden.
Laflamme L, Skyving M, Schwab C … +1 more , Möller J
Traffic Inj Prev · 2026 Mar · PMID 41811302 · Publisher ↗
OBJECTIVES: The circumstances of fatal crashes among older drivers have been attributed to a few typical triggers, most commonly erroneous maneuver and acute disease. Whether these triggers are one-off events or can be l...
OBJECTIVES: The circumstances of fatal crashes among older drivers have been attributed to a few typical triggers, most commonly erroneous maneuver and acute disease. Whether these triggers are one-off events or can be linked to existing potentially driver-impairing (PDI) conditions and medications remains to be determined. This study investigates this question more closely. METHOD: Drivers aged 50 and older who died on the road between 2010 and 2019 as a result of an erroneous maneuver or an acute disease were identified in the Swedish In-Depth Registry of Road Fatalities ( = 332 and = 193, respectively). Their history of PDI conditions and medications prior to the fatal crash was then traced in the National Patient Register (hospitalization and specialized outpatient care in the past 12 months) and the National Prescribed Drug Register (past three months). RESULTS: For both triggers, more than half of the drivers had no documented PDI condition in the past 12 months (51.3% and 55.7%, respectively) and when they did, cardiovascular condition was by far the most common one (20.2% and 32.6%), significantly more prevalent than at population level in both instances. By contrast, over 75% were on PDI medication in the past three months, with cardiovascular ones being the most prevalent (53.6% and 68.9%), followed by three groups acting on either blood and blood-forming organs (20.2% and 29.0%), the nervous system (31.0% and 21.2%), and the alimentary tract and metabolism (21.4% and 22.3%). CONCLUSION: An underlying driver-impairing condition can be detected in remarkably many instances of fatal crashes typical for older drivers; those triggered by either an erroneous maneuver or an acute disease. The latter is more readily discernible in the medications they are prescribed than in their relatively recent hospital care history. In both scenarios, a current cardiovascular condition features prominently, either as a past-year treated condition or an ongoing targeted pharmaceutical treatment. A few additional ones are also detectable which prevalence and rank are trigger specific. These findings underscore the importance of individualized medication reviews and, where appropriate, deprescribing, alongside the responsibilities of both drivers and health care providers.
Cognitive activation and emotional regulation effects of olfactory intervention in the context of advanced driver assistance systems.
Peng S, Li R, Xiang ZR … +4 more , Ding TC, Li L, Qiu LW, Wang DP
Traffic Inj Prev · 2026 Mar · PMID 41811267 · Publisher ↗
OBJECTIVE: Olfactory stimulation is an emerging sensory activation approach that can effectively mitigate passive distraction in advanced driver assistance systems (ADAS). Therefore, it is necessary to further determine...
OBJECTIVE: Olfactory stimulation is an emerging sensory activation approach that can effectively mitigate passive distraction in advanced driver assistance systems (ADAS). Therefore, it is necessary to further determine its efficacy and to elucidate its differential effects within urban and highway driving environments. METHODS: A simulated vehicle cabin odor mixture served as the control baseline. Peppermint and bergamot were selected as intervention odors after screening. Thirty-four licensed drivers completed simulated driving under urban or highway conditions across three odor conditions, with physiological measures (EEG, EDA), task performance (RT, RTSD, accuracy), and subjective assessments (NASA-TLX, POMS Vigor and Confusion, SMS) recorded to systematically investigate the modulatory effects of olfactory interventions within ADAS. Parametric analyses were used when assumptions were met and aligned rank transform analyses were applied otherwise. RESULTS: Relative to the simulated cabin baseline, olfactory stimulation improved driving attention performance and driver state. Peppermint produced the largest reduction in reaction time and increased beta-related alertness, with higher sympathetic activation. Bergamot yielded smaller speed gains but stronger stabilization of response rhythms and lower perceived workload with reduced confusion. Moreover, olfactory interventions exhibit significant context dependence across driving settings. In urban driving, characterized by high information density, bergamot more effectively suppressed low frequency electroencephalography indices and reduced variability, whereas peppermint sometimes increased variability. In highway driving, which is monotony prone, peppermint sustained vigilance and reduced attentional drift. CONCLUSIONS: Olfactory benefits are context dependent and follow the Yerkes-Dodson law. Scenario matched deployment is recommended: peppermint for vigilance support in monotonous highway driving and bergamot for stabilization and stress relief in complex urban traffic. These findings provide novel insights into the development of context-adaptive olfactory systems for intelligent vehicle-cabin, facilitating safer human-machine co-driving environments.
Linking built environments and pre-crash pedestrian behaviors: A Safe Systems approach to crash severity.
Park S, Akar G
Traffic Inj Prev · 2026 Mar · PMID 41805636 · Publisher ↗
OBJECTIVE: Pedestrians are the most vulnerable road users, and the number of crashes has increased in the past decade. Within the Safe Systems framework that recently gained attention, crashes result from the interaction...
OBJECTIVE: Pedestrians are the most vulnerable road users, and the number of crashes has increased in the past decade. Within the Safe Systems framework that recently gained attention, crashes result from the interaction between environmental factors and the parties involved, and pedestrian safety can be improved by creating more supportive environments. Previous studies have examined the influence of built environment and other risk factors on crash severity, yet little is known about how their protective effects differ across pre-crash pedestrian behaviors. METHODS: Using pedestrian-vehicle crashes in Georgia from 2013-2022 ( = 17,233), our analysis contributes to this literature by discerning the role of built environment across different situational contexts, categorized by three pedestrian behaviors at the time of crash: crossing at crosswalk, crossing not at crosswalk, and walking along traffic. Multinomial logit models are separately estimated for each case. RESULTS: Across all crashes, those involving pedestrians aged over 65 years, large vehicles, unlit road conditions, and high speed limits are more likely to result in severe pedestrian injuries. Behavior-specific models show that even when pedestrians are crossing mid-block, higher pedestrian-oriented network density mitigates injury severity. Additionally, crashes are more likely to be severe in areas with dense auto-oriented links, particularly when pedestrians are walking along the traffic, often due to lack of supportive infrastructures. Lastly, where pedestrians are at crosswalks, drivers aged 20-24 years are associated with a higher likelihood of serious pedestrian injuries. CONCLUSIONS: These findings highlight the heterogeneous role of built environments in shaping crash outcomes depending on contexts. The patterns align with the Safe Systems framework such that insufficient built environments elevate injury severity, while pedestrian-oriented infrastructures can mitigate harm even when behaviors are less predictable. Thus, infrastructure improvements should be recognized as behavioral interventions and injury prevention strategies that absorb human errors, not simply as street environment upgrades.
Florida golf cart crashes (2011-2021): a statewide analysis of crash patterns and predictors.
Moore MW, Gorucu S, Bliznyuk NA
Traffic Inj Prev · 2026 Mar · PMID 41805591 · Publisher ↗
OBJECTIVE: Golf carts are increasingly sharing public roads with other vehicles, creating new safety challenges due to their design limitations and gaps in regulation. This study aimed to establish a clear, statewide pic...
OBJECTIVE: Golf carts are increasingly sharing public roads with other vehicles, creating new safety challenges due to their design limitations and gaps in regulation. This study aimed to establish a clear, statewide picture of golf cart crashes in Florida (2011-2021), describing who is affected, when and where the crashes concentrate, and to identify the circumstances most consistently linked to injury. Ultimately, this study provides a clear, evidence-based baseline for understanding the risks associated with golf cart use. METHODS: A methodology was developed to identify golf cart crashes from the Florida Department of Highway Safety and Motor Vehicles (FLHSMV) database (2011-2021), as golf carts are not categorized as a specific vehicle type within the FLHSMV data. Using spatial, temporal, and person-level analysis, we examined crash patterns and characteristics. Logistic regression and machine learning models helped identify key predictors of injury and high-risk groups. RESULTS: A total of 4,105 golf cart crashes were identified, involving 2,718 injuries and 72 fatalities. Crash frequency increased significantly after 2016 and displayed clear seasonal patterns peaking in March. Seniors and children were disproportionately represented among those injured, with ejection from the vehicle increasing the likelihood of injury nearly 17-fold. Logistic regression identified occupant ejection, driver age, non-collision events, and rural/urban context as significant predictors of increased injury risk. Machine learning models confirmed these results, with logistic regression yielding the highest classification accuracy. CONCLUSIONS: Results indicated that golf cart occupants, particularly children and older adults, experienced substantially elevated injury risk compared to occupants of other vehicles. These findings highlight the need for improved safety practices.
Thermal imaging for the detection of driver impairment: evidence from a high-fidelity driving simulator study.
Göbel JP, Mertens JC, Riener A
Traffic Inj Prev · 2026 Mar · PMID 41805549 · Publisher ↗
OBJECTIVES: Driving under the influence of alcohol (DUI) remains a major contributor to fatal traffic crashes worldwide. With increasing regulatory pressure, such as requirements by Euro NCAP for in-vehicle impairment de...
OBJECTIVES: Driving under the influence of alcohol (DUI) remains a major contributor to fatal traffic crashes worldwide. With increasing regulatory pressure, such as requirements by Euro NCAP for in-vehicle impairment detection, there is a growing need for reliable, real-time monitoring solutions. While traditional DUI detection approaches focus on driving behavior or eye movement analysis, this study explores the potential of thermal imaging as a noninvasive alternative for detecting alcohol impairment. METHODS: We conducted a large-scale experimental study with 120 participants in a high-fidelity driving simulator, capturing thermal facial data under both non-impaired and alcohol-impaired conditions. A novel temperature extraction method was developed based on facial landmarks, incorporating multiple frames to reduce noise and improve temporal stability. Ambient cabin temperature was also recorded to normalize facial temperature readings and control for environmental influences. Several machine learning classifiers, including Logistic Regression, Random Forest, Support Vector Machine (SVM), and Gradient-Boosting Models, were trained using five facial temperature features (cheek, temple, ear, forehead, and nasal tip) and evaluated five-fold subject-wise cross-validation. RESULTS: Significant temperature changes were observed in specific facial regions (particularly the cheek, ear, temple, and nasal tip) under alcohol influence. Among the evaluated models, Logistic Regression achieved the highest average classification accuracy (62%), while SVM demonstrated the most stable performance across folds. The model showed a slight conservative bias toward predicting the baseline (non-impaired) class, thereby reducing the risk of false positive classifications. Environmental conditions, including cabin temperature, were verified to be stable across both driving sessions, ensuring the validity of the physiological measurements. CONCLUSIONS: This study demonstrates the feasibility of using thermal imaging for in-vehicle DUI detection under realistic conditions. Our contributions include the development of a robust facial temperature processing pipeline, the creation of a unique dataset collected under ecologically valid conditions, and a comprehensive comparison of seven state-of-the-art classification models. Thermal imaging represents a promising complementary modality for future driver monitoring systems focused on safety and impairment detection.
Sex differences in cannabis- and alcohol-related motor vehicle collisions in three U.S. states with legalized cannabis: A multicenter observational study.
Wongtanasarasin W, Nishijima DK, Trent SA … +3 more , Ye Y, Cherpitel CJ, Choo EK
Traffic Inj Prev · 2026 Mar · PMID 41805464 · Publisher ↗
OBJECTIVES: As recreational cannabis legalization expands in the United States, concerns about cannabis-impaired driving and traffic injury risk have increased. Although cannabis impairs driving performance, less is know...
OBJECTIVES: As recreational cannabis legalization expands in the United States, concerns about cannabis-impaired driving and traffic injury risk have increased. Although cannabis impairs driving performance, less is known about how sex-specific behavioral and psychosocial contexts shape pathways to motor vehicle collisions (MVCs), particularly in legalized settings. We examined sex differences in cannabis and alcohol use, driving behaviors, mental health context, and crash-related outcomes among injured drivers. METHODS: We conducted a secondary analysis of a multicenter cross-sectional study of 813 adults presenting to emergency departments in Denver, Portland, and Sacramento within 8 h of an MVC. Recent cannabis and alcohol use were identified using self-report and biological testing. Sex-specific differences in substance use, driving behaviors, mental health indicators, and clinical outcomes were evaluated using descriptive statistics. RESULTS: Recent cannabis use did not differ significantly between males and females (9% vs. 6%, = 0.21), whereas alcohol use was higher among males (17% vs. 9%, = 0.005). Male drivers more frequently engaged in high-risk driving behaviors, including higher reported speeds, use of open vehicles, and vehicle rollovers, and were more often admitted to the hospital (58% vs. 43%). Female drivers more commonly reported cannabis use for anxiety and a higher burden of posttraumatic stress symptoms (24% vs. 17%). Injury severity scores were similar between sexes. CONCLUSIONS: Similar prevalence of cannabis use among injured drivers concealed distinct sex-specific pathways to MVC risk. Among men, alcohol co-use and high-risk driving behaviors represented established mechanisms of crash severity and health-care utilization. Among women, cannabis use more often occurred within a mental health context, suggesting different pathways linking substance use to traffic injury risk. Traffic injury prevention strategies in legalized cannabis environments should incorporate sex- and gender-responsive approaches, including targeted interventions addressing polysubstance use and hazardous driving behaviors, and integration of mental health considerations into impaired-driving prevention.
Prevalence of cannabis use among trauma patients presenting to the emergency department: A systematic review and meta-analysis.
Wongtanasarasin W, Oon-Arom A, Sairai R … +1 more , Nishijima DK
Traffic Inj Prev · 2026 Mar · PMID 41805442 · Publisher ↗
OBJECTIVES: Cannabis use is a potentially important exposure among trauma patients presenting to emergency departments (EDs), yet reported prevalence varies widely across regions and study designs. We aimed to estimate t...
OBJECTIVES: Cannabis use is a potentially important exposure among trauma patients presenting to emergency departments (EDs), yet reported prevalence varies widely across regions and study designs. We aimed to estimate the pooled prevalence of cannabis use among trauma patients presenting to the ED and to examine variation by geographic region and cannabis detection method. METHODS: We searched PubMed, Embase, Web of Science, and the Cochrane Library from inception to June 30, 2025. Observational studies reporting the prevalence of cannabis use among ED trauma patients were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Joanna Briggs Institute checklist for prevalence studies. Pooled prevalence estimates were calculated using a random-effects model, with prespecified subgroup analyses by geographic region, overall risk of bias, and cannabis detection method. RESULTS: Thirty studies published between 2000 and 2025, comprising >6 million ED encounters, were included. The pooled prevalence of cannabis use among trauma patients presenting to the ED was 4.2% (95% CI 4.0%-4.4%), with substantial heterogeneity ( > 95%). Studies using biological toxicology testing reported higher prevalence estimates than studies relying on administrative diagnostic coding. Prevalence varied by region, with higher pooled estimates observed in South America and lower estimates in Asia and North America. CONCLUSION: Cannabis use is present in a measurable proportion of ED trauma patients, but prevalence estimates vary widely, largely reflecting differences in detection methods and case definitions. Standardized, biologically based screening approaches are needed to improve comparability and interpretation in acute trauma care.
Ta-SLOA: Taylor snow leopard optimization with XCovNet-based object classification using vehicle image.
Thirumavalavan S, Kaliyaperumal V, Ramaiyan A … +1 more , Pattusamy D
Traffic Inj Prev · 2026 Mar · PMID 41790519 · Publisher ↗
OBJECTIVE: Detecting objects is a core challenge in computer vision and plays a vital role in applications like self-driving cars, traffic surveillance, and smart transportation networks. Accurate vehicle object detectio...
OBJECTIVE: Detecting objects is a core challenge in computer vision and plays a vital role in applications like self-driving cars, traffic surveillance, and smart transportation networks. Accurate vehicle object detection is essential for various applications such as autonomous driving, traffic surveillance, and intelligent transportation systems. METHOD: This research proposes an optimization-based deep learning (DL) model for object classification from vehicle images. Initially, the input image is denoised by employing the adaptive weighted median filter (AWMF). Next, the contrast limited adaptive histogram equalization (CLAHE) is used for enhancing the image, which improves its quality. Thereafter, the fast fuzzy c-means (FFCM) clustering model is used for segmentation of objects and then augmentation of images is done. The segmented image is then subjected to object detection using You Only Look Once v9 Squeeze M-SegNet (YOLO v9-S Net), which is obtained by combining Squeeze M-SegNet (SM-SegNet) with YOLO v9 models. Finally, object classification is effectuated by Xception Convolutional Neural Network (XCovNet), and the Taylor snow leopard optimization algorithm (Ta-SLOA) is employed for training the XCovNet model. Ta-SLOA is a novel algorithmic technique devised by merging Taylor series and snow leopard optimization algorithm (SLOA). RESULTS: The Ta-SLOA_XCovNet outperforms traditional techniques, achieving impressive precision, F1-score, and recall values of 93.181%, 93.724%, and 92.970%. CONCLUSION: Experimental results demonstrate that the proposed Ta-SLOA-optimized XCovNet framework significantly improves vehicle object detection accuracy and efficiency, thereby offering a robust solution for real-time applications in autonomous driving and intelligent transportation systems.
The interactive effects of NDRT cognitive complexity and traffic density on takeover performance in level 3 automated driving: a multimodal EEG and behavioral study.
Guo Q, Tang M, Yang Y
Traffic Inj Prev · 2026 Feb · PMID 41747278 · Publisher ↗
OBJECTIVE: In Level 3 automated driving, driver takeover performance is influenced by cognitive state and external traffic conditions. This study investigates the interactive effects of Non-Driving Related Task (NDRT) co...
OBJECTIVE: In Level 3 automated driving, driver takeover performance is influenced by cognitive state and external traffic conditions. This study investigates the interactive effects of Non-Driving Related Task (NDRT) cognitive complexity and traffic density on takeover performance. METHODS: A 2 (NDRT type: low-complexity perception task vs. high-complexity decision task) × 2 (traffic density: low 10 veh/km vs. high 30 veh/km) within-subjects design was employed, with electroencephalography (EEG) and behavioral metrics analyzed. RESULTS: (1) NDRT cognitive complexity significantly influenced EEG spectral power, with the decision task leading to lower theta and alpha power, suggesting a higher cognitive load; (2) While neither factor alone had a significant main effect on takeover performance, their interaction had a significant impact on takeover reaction time (TORT). The shortest TORT was observed under the perception task with high traffic density. (3) Increased cognitive load during decision tasks prolonged the time taken to regain control (TORT) and reduced safety (measured by time to collision in minutes, TTCmin), but it improved stability (measured by mechanical response acceleration, MRA). This combination ultimately enhanced the Takeover Performance Index (TOPI). (4) Takeover performance metrics were closely interrelated. TORT effectively predicted TTCmin (R = 0.841), and TORT, MRA, and TTCmin collectively predicted TOPI (R = 0.899). CONCLUSIONS: The interaction between NDRT cognitive complexity and traffic density is a critical factor influencing driver takeover performance in Level 3 automated driving. The findings provide theoretical support and a modeling basis for the design of cognitive state-aware intelligent takeover systems.
The impact of guide sign informational density on driver cognitive load: An integrated simulator and real-world driving study.
Meng Y, Li J, Shen J … +5 more , Li B, Liu Z, Qing G, Chen F, Hu H
Traffic Inj Prev · 2026 Feb · PMID 41747273 · Publisher ↗
OBJECTIVE: In road sign design, inappropriate layout can easily lead to excessive cognitive load on drivers. This hinders their ability to effectively allocate attention, resulting in missed critical road information and...
OBJECTIVE: In road sign design, inappropriate layout can easily lead to excessive cognitive load on drivers. This hinders their ability to effectively allocate attention, resulting in missed critical road information and increased accident risks. Through empirical studies on drivers' visual recognition characteristics and cognitive load, this study investigates the rationality of information volume settings in urban road guide signs. METHODS: It employed a combination of simulation experiments and real vehicle tests. An information volume calculation model for guide signs was established. The visual recognition simulation experiment was designed to collect data. Real vehicle experiment was conducted to dynamically record drivers' physiological indicators. A cognitive load assessment model was developed to explore the reasonable range of information density for sequentially signs. RESULTS: From the perspective of ensuring reasonable visual recognition accuracy, the information volume of a single guide sign should be less than 90 bit on arterial roads and below 95 bit on secondary distributor roads. Real vehicle test results indicate that when the information density is below 9.1 bit/s, drivers experience relatively low cognitive load. When the information density exceeds 10.7 bit/s, cognitive load increases significantly. To ensure driving comfort and safety, the information density of signs should not exceed 12.0 bit/s. CONCLUSION: The information volume on guide sign should be maintained within a reasonable range. The information density of successive signs significantly influences drivers' cognitive load levels. These findings provide theoretical guidance and practical recommendations for optimizing the information design of urban guide signs and enhancing traffic safety.
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