1. Sydney, AUSTRALIA | Beijing, CHINA | Hyderabad, INDIA | London, UK Affiliated with the University of Sydney

2. 2 Socio-economic status and crash risk in young drivers A/Professor Rebecca Ivers

4. Over-representation of youth in road trauma  #1 cause of death & acquired disability of adolescents & young adults  NSW novice drivers (<26 years of age)  15% licensed driver population  36% road fatalities  NSW 17 year-old drivers in first stage of licensing  4x more likely to be involved in fatal crash than driver 26+

5. Inexperience primary contributing factor Figure 1. Casualty crashes in Victoria by years licensed, 2000-2006 (VicRoads, 2008)

6. Novice drivers in the UK 6 Lynam et al, 2006

7. The social gradient of injury  The social class gradient in injury is well documented, especially for children ( Towner and Dowswell, 2001)  Drowning  Choking  House fires (15 times increased risk)  Road injury (5 times increased risk)  Risk of injury increases with deprivation ( Laflamme and Diderichsen, 2000)  Gap in deprivation is increasing in the UK  Increased risk reflects differential exposure of children to various hazards (rather than differences in behaviour) 7

8. Life expectancy and income level 8 Marmot Review

9. Crash rates in Australia by social status  Crash rates decreasing by ~5% per year for novice drivers over past 10 years  Due to combination of graduated licensing, enforcement and general improvements in road safety  But NOT decreasing for drivers who live in rural areas, or those of low SES – no significant change (Chen HY et al, Journal of Safety Research, 2010) 9

10. Trends in fatality rate for young drivers in NSW by SES, 1997-2007 10

11. WHY? Individual level factors  Increased driving exposure  Risk behaviours, including substance abuse  Poor parental behaviours  Older, less safe cars  Fatigue  Mental health?  Experience Area level factors  Low SES associated with regional or rural areas  Less or different enforcement?  Poor road conditions and road related infrastructure  Higher posted speed limits 11

12. Factors associated with increased risk  The factors that contributed significantly to increased risk were:  For rural fatalities: High posted speed limits, drink driving and not wearing a seatbelt  For low SES fatalities: High posted speed limits, fatigue and driving an older vehicle 12

13. Factors inter-related  Many factors that increase risk in low SES areas also influence risk in rural areas  E.g. rural and low SES drivers may share the same risky behaviours, such as high alcohol consumption and failure to wear seatbelts while driving  E.g. drivers of low SES may drive longer distances or use less safe cars, which is also likely to be true for rural residents 13

14. DRIVE Study  Data from 20,000 novice drivers in NSW  Participants completed survey and consented to linkage to police reported crash reports, and road related hospitalisations  Opportunity to disentangle area level factors (age, gender, risk behaviours, driving experience and exposure) from area level effects (place of residence, socioeconomic status) 14

15. Findings  People from low SES areas had ~double risk of crash related hospitalisation (ie serious injury)  Analysis took into account where they lived (urban vs rural) as well as individual level factors  Results means that there are some factors related to social status that increase the risk of crash after we take into account where they live, how far they drive, risk behaviours 15

16. Implications  Need to better understand the factors that relate to social status  Area level factors eg infrastructure  Community behaviour?  Cars?  Need for investment in prevention in low SES areas Speed management Road infrastructure Community policing Education? Access to safe and convenient public transport 16

17. A Safe Systems approach  Safe roads and places  Safe people  Safe vehicles 17

18. Safe roads (and places)  Road design to minimise speed (chicanes, speed humps)  Prevent crashes/minimise impact of crashes  Intersection design  Right hand turn lanes  Shoulders and curved sections  Design for vulnerable road users eg pedestrians and cyclists  Appropriate urban planning  Reduce exposure to driving  Good public transport systems 18

19. Safe people  Graduated licensing for novice drivers  Appropriate enforcement (including speed detection devices  Education and social marketing  Targeted initiatives for high risk populations  Eg parent-teen contracts, involvement of schools and communities, parental support, building resilience (eg Griffin, 2004)  Lessons can be learned from child injury research:  Minimize exposure  Community partnerships (involve families and communities)  Less focus on individual behaviours and more on structural issues  19

20. Safe vehicles  Fleet safety  Novice drivers in second hand car market  Need to have good fleet safety overall  Other ways to increase safety of novice driver cars? 20

21. Summary  Increasing understanding of the social gradient in novice driver injury  But little research specifically aimed at developing or evaluating programs  Significant opportunities to close the gap 21

22. Acknowledgements Funding  National Health and Medical Research Council  In-kind support from RTA  NRMA Motoring and Services  NRMA-ACT Road Safety Trust  NSW Health  Motor Accidents Authority of NSW Advisory Committee Participants 22