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LETTER |
The author is with the Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; and the National Highway Traffic Safety Administration, Washington, DC.
Correspondence: Requests for reprints should be sent to Mary Pat McKay, MD, MPH, Brigham and Women’s Hospital, Neviell House, 75 Francis St, Boston, MA 02130 (e-mail: mpmckay{at}partners.org).
Recently, Leonard Evans unfavorably compared the United States with other developed countries with regard to effectiveness in reducing traffic injuries, and he proposed automatic monitoring devices such as red-light/speed cameras as the solution.1 However, the main problem is that the United States is behind other countries in addressing the 2 most basic causes of serious motor vehicle injury: drunk driving and failure to use safety belts.
In 2002, 32 605 (76.2%) of 42 815 US traffic fatalities occurred in cars, light trucks, or vans that contained safety belts.2 Of these fatalities, only 11 133 (34.1%) of the victims were properly restrained in a safety belt or child safety seat.3 Across all vehicles, safety belts prevent about 50% of serious or fatal injuries. In 2002, more than 10 000 people died in the United States because they failed to use an appropriate restraint in a motor vehicle.
In Australia, the United Kingdom, and Canada, where restraint legislation was enacted in the 1970s and 1980s, drivers’ use of safety belts is at or above 90%. As of June 2003, US drivers’ use of safety belts has risen to 79%.4 The single greatest difference in safety belt use campaigns is the lack of primary safety belt legislation in the United States. The initial US safety belt legislation was adopted as "secondary enforcement"—meaning a driver could not be stopped solely for failure to use a safety belt. As of August 2003, only 18 US states and the District of Columbia allowed for primary enforcement.5
Drunk driving is the second most common reason why people die on American roadways. In 2002, 15 019 fatalities (35.1%) occurred in a crash involving at least one driver with a blood alcohol concentration (BAC) of more than 0.08. Since 1998, the percent of fatal crashes involving a drunk driver has been increasing in the United States.6
There is good evidence that alcohol limits, automatic license revocation for drunk driving, zero alcohol tolerance for drivers under a minimum age, and sobriety checkpoints decrease rates of alcohol-related vehicular injuries and fatalities.7 In Australia, where such interventions have existed for years, 19% of drivers involved in fatal crashes in 1998 exceeded the BAC limit of 0.05.8 Although all 50 US states and the district of Columbia now legislate a specific BAC (0.08 or 0.10) as evidence of intoxication, only 15 have legislated zero tolerance for drivers under 21 and automatic license revocation and allow sobriety checkpoints.6
The United States is behind other developed countries in combating road traffic injuries. However, for optimal effectiveness, interventions with proven success in targeting the 2 greatest causes of US traffic fatalities—failure to use restraints and drunk driving—should be broadly implemented before automated technologies to curb traffic violations are widely employed.
References
1. Evans L. A new traffic safety vision for the United States. Am J Public Health. 2003;93:1384–1386.
2. Fatal Analysis Reporting System Web-Based Encyclopedia. Available at: http://www-fars.nhtsa.dot.gov. Queried using 2002; injury = fatal; vehicle NOT bus, large truck, motorcycle, moped, farm equipment. Accessed September 6, 2003.
3. Fatal Analysis Reporting System Web-Based Encyclopedia. Available at: http://www-fars.nhtsa.dot.gov. Queried using 2002; injury = fatal; vehicle NOT bus, large truck, motorcycle, moped, farm equipment; restraint = lap and shoulder or child safety seat, proper use. Accessed September 6, 2003.
4. Glassbrenner D. Safety belt and helmet use in 2003. Available at: http://www-nrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/Rpts/2003/SafetyBelt2003.pdf (PDF file). Accessed September 8, 2003.
5. Insurance Institute for Highway Safety. How state laws measure up. Available at: http://www.hwysafety.org. Accessed September 8, 2003.
6. Fatal Analysis Reporting System Web-Based Encyclopedia. Reports: Trends: Alcohol. Available at: http://www-fars.nhtsa.dot.gov. Accessed September 8, 2003.
7. Shults RA, Elder RW, Sleet DA, et al. Reviews of evidence regarding interventions to reduce alcohol-impaired driving [published correction appears in Am J Prev Med.2002;23:72]. Am J Prev Med. 2001;21(suppl 4):66–88.
8. Australian Transportation Safety Board. Monograph 5: Alcohol and road fatalities in Australia 1998. Available at: http://www.atsb.gov.au/road/pubs.cfm. Accessed September 8, 2003.
This article has been cited by other articles:
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  B. Pless Road traffic injury prevention BMJ, April 10, 2004; 328(7444): 846 - 846. [Full Text] [PDF]
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