Analysis of injury severity of drivers involved in single- and two-vehicle crashes on highways in Ontario

This study analyzes driver's injury severity in single- and two-vehicle crashes and compares the effects of explanatory variables among various types of crashes. The study identified factors affecting injury severity and their effects on severity levels using 5-year crash records for provincial highways in Ontario, Canada. Considering heteroscedasticity in the effects of explanatory variables on injury severity, the heteroscedastic ordered logit (HOL) models were developed for single- and two-vehicle crashes separately. The results of the models show that there exists heteroscedasticity for young drivers (≤30), safety equipment and ejection in the single-vehicle crash model, and female drivers, safety equipment and head-on collision in the two-vehicle crash models. The results also show that young car drivers have opposite effects between single-car and car–car crashes, and sideswipe crashes have opposite effects between car–car and truck–truck crashes. The study demonstrates that separate HOL models for single-vehicle and different types of two-vehicle crashes can identify differential effects of factors on driver's injury severity.     

Hierarchical Bayesian random intercept model-based cross-level interaction decomposition for truck driver injury severity investigations

Traffic crashes occurring on rural roadways induce more severe injuries and fatalities than those in urban areas, especially when there are trucks involved. Truck drivers are found to suffer higher potential of crash injuries compared with other occupational labors. Besides, unobserved heterogeneity in crash data analysis is a critical issue that needs to be carefully addressed. In this study, a hierarchical Bayesian random intercept model decomposing cross-level interaction effects as unobserved heterogeneity is developed to examine the posterior probabilities of truck driver injuries in rural truck-involved crashes. The interaction effects contributing to truck driver injury outcomes are investigated based on two-year rural truck-involved crashes in New Mexico from 2010 to 2011. The analysis results indicate that the cross-level interaction effects play an important role in predicting truck driver injury severities, and the proposed model produces comparable performance with the traditional random intercept model and the mixed logit model even after penalization by high model complexity. It is revealed that factors including road grade, number of vehicles involved in a crash, maximum vehicle damage in a crash, vehicle actions, driver age, seatbelt use, and driver under alcohol or drug influence, as well as a portion of their cross-level interaction effects with other variables are significantly associated with truck driver incapacitating injuries and fatalities. These findings are helpful to understand the respective or joint impacts of these attributes on truck driver injury patterns in rural truck-involved crashes.     

Impact of federal compliance reviews of trucking companies in reducing highway truck crashes

BACKGROUND: The compliance review (CR) is a federal program monitoring motor carrier safety performance and regulatory compliance. This study sought to assess the impact of CRs on reviewed trucking companies in reducing truck crashes. METHODS: Data was from the Motor Carrier Management Information System. Study subjects were trucking companies established during 1990-1995, had at least one truck, and remained active until April 2004. Truck crash data of these companies was examined from 1996 to 2003. The crash rates in 2003 and annual percentage changes in number of crashes were computed. Analyses were stratified by company size, organization, operation classification, and safety rating. RESULTS: Companies that received CRs had a higher crash rate than never-reviewed companies. Reviewed companies experienced a 39-15% reduction in number of crashes in the year the CR was performed. The reduction in crashes was observed in all reviewed companies regardless of company size, operation classification, type of organization, or safety rating. The reduction in crashes was sustained for at least 7 years after CRs. DISCUSSION: The study results were controlled for the year in which CRs were performed, crash trend, and CR selection bias. However, further studies, especially a randomized prospective longitudinal study, are needed to overcome the limitations that are associated with an observation study.     

The sleep of commercial vehicle drivers under the 2003 hours-of-service regulations

Previous research has found that commercial drivers get an average of 5.18 h of sleep per night. The revised hours-of-service (HOS) regulations (in the United States) are in place to provide drivers with more opportunities to get sleep. However, are drivers really getting more sleep under these new regulations? Also, is there a relationship between sleep quantity and involvement in critical incident (crashes, near-crashes, or crash-relevant conflicts)? Data from 73 truck drivers, collected during a naturalistic driving study after the implementation of the 2003 HOS regulations, were analyzed to determine overall sleep quantity (using actigraphy), along with sleep quantity prior to being involved in a critical incident. Sixty-two drivers had at least seven consecutive days (Monday through Sunday) of reliable actigraphy data; mean sleep quantity per 24-h period (midnight centered using the Cole-Kripke algorithm) for these drivers was 6.28 h (S.D.=1.42 h). Fifty-eight critical incidents were recorded in the 10th and 11th driving hours. Analysis results indicated that drivers received significantly less sleep in the period prior to a critical incident as compared to their mean overall sleep quantity. The results of this study indicate drivers may be getting more sleep under the revised 2003 HOS regulations as compared to the old regulations. In addition, significantly less sleep in the 24-h period prior to involvement in a critical incident suggests driver fatigue may have been a potential contributing factor in these critical incidents.     

The influence of daily sleep patterns of commercial truck drivers on driving performance

Fatigued and drowsy driving has been found to be a major cause of truck crashes. Lack of sleep is the number one cause of fatigue and drowsiness. However, there are limited data on the sleep patterns (sleep duration, sleep percentage in the duration of non-work period, and the time when sleep occurred) of truck drivers in non-work periods and the impact on driving performance. This paper examined sleep patterns of 96 commercial truck drivers during non-work periods and evaluated the influence these sleep patterns had on truck driving performance. Data were from the Naturalistic Truck Driving Study. Each driver participated in the study for approximately four weeks. A shift was defined as a non-work period followed by a work period. A total of 1397 shifts were identified. Four distinct sleep patterns were identified based on sleep duration, sleep start/end point in a non-work period, and the percentage of sleep with reference to the duration of non-work period. Driving performance was measured by safety-critical events, which included crashes, near-crashes, crash-relevant conflicts, and unintentional lane deviations. Negative binomial regression was used to evaluate the association between the sleep patterns and driving performance, adjusted for driver demographic information. The results showed that the sleep pattern with the highest safety-critical event rate was associated with shorter sleep, sleep in the early stage of a non-work period, and less sleep between 1 a.m. and 5 a.m. This study also found that male drivers, with fewer years of commercial vehicle driving experience and higher body mass index, were associated with deteriorated driving performance and increased driving risk. The results of this study could inform hours-of-service policy-making and benefit safety management in the trucking industry.     

Declines in fatal crashes of older drivers: changes in crash risk and survivability

Objectives

Previous research has found that older driver fatal crash involvement rates per licensed driver declined substantially in the United States during 1997–2006 and declined much faster than the rate for middle-age drivers. The current study examined whether the larger-than-expected decline for older drivers extended to nonfatal crashes and whether the decline in fatal crash risk reflects lower likelihood of crashing or an improvement in survivability of the crashes that occur.

Methods

Trends in the rates of passenger vehicle crash involvements per 100,000 licensed drivers for drivers 70 and older (older drivers) were compared with trends for drivers ages 35–54 (middle-age drivers). Fatal crash information was obtained from the Fatality Analysis Reporting System for years 1997–2008, and nonfatal crash information was obtained from 13 states with good reporting information for years 1997–2005. Analysis of covariance models compared trends in annual crash rates for older drivers relative to rates for middle-age drivers. Differences in crash survivability were measured in terms of the odds of fatality given a crash each year, and the historical trends for older versus middle-age drivers were compared.

Results

Fatal crash involvement rates declined for older and middle-age drivers during 1997–2008 (1997–2005 for the 13 state subsample), but the decline for drivers 70 and older far exceeded the decline for drivers ages 35–54 (37 versus 23 percent, nationally; 22 versus 1 percent, 13 states). Nonfatal injury crash involvement rates showed similarly larger-than-expected declines for older drivers in the 13 state subsample, but the differences were smaller and not statistically significant (27 percent reduction for older drivers versus 16 percent for middle-age drivers). Property-damage-only crash involvement rates declined for older drivers (10 percent) but increased for middle-age drivers (1 percent). In 1997, older drivers were 3.5 times more likely than middle-age drivers to die in police-reported crashes (6.2 versus 1.8 deaths per 1000 crashes), but this difference was reduced during the 9-year study period to 2.9 times, as the rate of older drivers dying in a crash declined (5.5 deaths per 1000 crashes in 2005) and the death risk remained relatively stable for middle-age drivers.

Conclusions

Contrary to expectations based on increased licensure and travel by older drivers, their fatal crash risk has declined during the past decade and has declined at a faster rate than for middle-age drivers. The decreased risk for older drivers appears to extend not only to nonfatal injury crashes but also to property-damage-only crashes, at least as reported to police in the 13 states included in the nonfatal injury analysis. Although insurance collision data suggest that overall crash risk of older drivers may not be changing relative to middle-age drivers, the current analysis indicates that the reduced fatality risk of older drivers reflects both less likelihood of being involved in a police-reported crash and greater likelihood that they will survive when they do crash.     

Fatigue and crashes: The case of freight transport in Colombia

Truck drivers have been involved in a significant number of road fatalities in Colombia. To identify variables that could be associated with crashes in which truck drivers are involved, a logistic regression model was constructed. The model had as the response variable a dichotomous variable that included the presence or absence of a crash during a specific trip. As independent variables the model included information regarding a driver's work shift, with variables that could be associated with driver's fatigue. The model also included potential confounders related with road conditions. With the model, it was possible to determine the odds ratio of a crash in relation to several variables, adjusting for confounding. To collect the information about the trips included in the model, a survey among truck drivers was conducted. The results suggest strong associations between crashes (i.e., some of them statistically significant) with the number of stops made during the trip, and the average time of each stop. Survey analysis allowed us to identify the practices that contribute to generating fatigue and unhealthy conditions on the road among professional drivers. A review of national regulations confirmed the lack of legislation on this topic.     

Prevalence and factors associated with road traffic crash among taxi drivers in Hanoi,Vietnam

Injury due to road traffic crash is a major cause of ill health and premature deaths in developing countries. Taxis provide a main mode of public transport in Vietnam but there has been little research on the risk of crash for taxi drivers. This retrospective study collected information on taxi crashes for the period 2006–2009 by interviewing drivers from five taxi companies in Hanoi, Vietnam, using a structured questionnaire. Of the total 1214 participants recruited, 276 drivers reported at least one crash, giving an overall crash prevalence of 22.7%. Among the crashed group, 50 drivers (18.1%) were involved in two to four crashes. Logistic regression analysis further identified age of driver, type of driving licence, employment status, perceived sufficiency of income, seat-belt usage, and traffic infringement history to be significantly associated with the crash risk. Further prospective and qualitative studies are recommended to provide detailed crash characteristics as well as behaviour and perception of taxi drivers, so that an effective intervention can be developed to improve road safety and to prevent injury of these commercial drivers.     

Determining the effective location of a portable changeable message sign on reducing the risk of truck-related crashes in work zones

Truck-related crashes contribute to a significant percentage of vehicle crashes in the United States, which often result in injuries and fatalities. The amount of truck miles traveled has increased dramatically with the growing rate of freight movement. Regarding truck crashes in the highway work zones, many studies indicated that there was a significant increase in crash severity when a truck crash occurred in work zones. To mitigate the risk of truck crashes in work zones, a portable changeable message sign (PCMS) was frequently utilized in addition to standard temporary traffic control signs and devices required by the Manual on Uniform Traffic Control Devices. To justify the use of a PCMS in work zones, there is a need to study the effective location of a PCMS deployed in a work zone by measuring the changes of truck and passenger car speed profiles. The difference of speed changes between trucks and passenger cars was considered as one of the major reasons which caused truck-related crashes in work zones. Therefore, reducing the difference of speed changes between trucks and passenger cars could potentially improve safety in work zones. The outcomes of this study will provide required knowledge for traffic engineers to effectively utilize the PCMS in work zones with the purpose of reducing truck-related crashes. In addition, the success of this study will provide a roadmap to investigate the effective deployment of other temporary traffic control devices on mitigating the risk of truck-related crashes in work zones.     

A comprehensive analysis of factors influencing the injury severity of large-truck crashes

Given the importance of trucking to the economic well being of a country and the safety concerns posed by the trucks, a study of large-truck crashes is critical. This paper contributes by undertaking an extensive analysis of the empirical factors affecting injury severity of large-truck crashes. Data from a recent, nationally representative sample of large-truck crashes are examined to determine the factors affecting the overall injury severity of these crashes. The explanatory factors include the characteristics of the crash, vehicle(s), and the driver(s). The injury severity was modeled using two measures. Several similarities and some differences were observed across the two models which underscore the need for improved accuracy in the assessment of injury severity of crashes. The estimated models capture the marginal effects of a variety of explanatory factors simultaneously. In particular, the models indicate the impacts of several driver behavior variables on the severity of the crashes, after controlling for a variety of other factors. For example, driver distraction (truck drivers), alcohol use (car drivers), and emotional factors (car drivers) are found to be associated with higher severity crashes. A further interesting finding is the strong statistical significance of several dummy variables that indicate missing data – these reflect how the nature of the crash itself could affect the completeness of the data. Future efforts should seek to collect such data more comprehensively so that the true effects of these aspects on the crash severity can be determined.     

Costs of large truck-involved crashes in the United States

This study provides the estimates of the costs of highway crashes involving large trucks by type of truck involved. These costs represent the present value of all costs over the victims' expected life span that result from a crash. They include medically related costs, emergency services costs, property damage costs, lost productivity, and the monetized value of the pain, suffering, and lost quality of life that a family experiences because of death or injury. Based on the latest data available, the estimated cost of police-reported crashes involving trucks with a gross weight rating of more than 10,000 pounds averaged US$ 59,153 (in 2000 dollars). Multiple combination trucks had the highest cost per crash (US$ 88,483). The crash costs per 1000 truck miles however, were US$ 157 for single unit trucks, US$ 131 for single combination trucks, and US$ 63 for multiple combinations.     

Statistical implications of using moving violations to determine crash responsibility in young driver crashes

Traditional methods for determining crash responsibility – most commonly moving violation citations – may not accurately characterize at-fault status among crash-involved drivers given that: (1) issuance may vary by factors that are independent of fault (e.g., driver age, gender), and (2) these methods do not capture driver behaviors that are not illegal but still indicative of fault. We examined the statistical implications of using moving violations to determine crash responsibility in young driver crashes by comparing it with a method based on crash-contributing driver actions. We selected all drivers in police-reported passenger-vehicle crashes (2010–2011) that involved a New Jersey driver <21 years old (79,485 drivers < age 21, 61,355 drivers ≥ age 21). For each driver, crash responsibility was determined from the crash report using two alternative methods: (1) issuance of a moving violation citation; and (2) presence of a driver action (e.g., failure to yield, inattention). Overall, 18% of crash-involved drivers were issued a moving violation while 50% had a driver action. Only 32.2% of drivers with a driver action were cited for a moving violation. Further, the likelihood of being cited given the presence of a driver action was higher among certain driver subgroups—younger drivers, male drivers, and drivers in single-vehicle and more severe crashes. Specifically among young drivers, those driving at night, carrying peer passengers, and having a suspended or no license were more often cited. Conversely, fatally-injured drivers were almost never cited. We also demonstrated that using citation data may lead to statistical bias in the characterization of at-fault drivers and of quasi-induced exposure measures. Studies seeking to accurately determine crash responsibility should thoughtfully consider the potential sources of bias that may result from using legal culpability methods. For many studies, determining driver responsibility via the identification of driver actions may yield more accurate characterizations of at-fault drivers.     

Suicidal ideation, antidepressive medication and car crash injury

OBJECTIVE: This study aimed to investigate the association between suicidal ideation, antidepressive medication and the risk of a car crash resulting in serious injury. DESIGN: This was a population-based case-control study. Cases were car drivers who were involved in crashes in which at least one occupant of their car was hospitalised or killed. Controls were selected using a cluster random sample of car drivers on the roads in the same region. Self-reported information on suicidal ideation in the 12 months prior to the crash or roadside survey, current usage of antidepressive medication as well as other crash-related risk factors was obtained from the drivers, or by proxy, using an interviewer-administered questionnaire. SETTING: The study was conducted in the Auckland region of New Zealand in 1998 and 1999. RESULTS: There was a significant association between drivers who had suicidal ideation but without current antidepressive medication and the risk of an injury crash (OR=4.16, 95% CI=2.14-8.10), when compared to drivers without any suicidal ideation. CONCLUSION: The risk of an injury crash was significantly increased for those drivers who reported to have previous or current suicidal ideation but without current antidepressant medication.     

Prevalence of teen driver errors leading to serious motor vehicle crashes

Objectives

Motor vehicle crashes are the leading cause of adolescent deaths. Programs and policies should target the most common and modifiable reasons for crashes. We estimated the frequency of critical reasons for crashes involving teen drivers, and examined in more depth specific teen driver errors.

Methods

The National Highway Traffic Safety Administration's (NHTSA) National Motor Vehicle Crash Causation Survey collected data at the scene of a nationally representative sample of 5470 serious crashes between 7/05 and 12/07. NHTSA researchers assigned a single driver, vehicle, or environmental factor as the critical reason for the event immediately leading to each crash. We analyzed crashes involving 15–18 year old drivers.

Results

822 teen drivers were involved in 795 serious crashes, representing 335,667 teens in 325,291 crashes. Driver error was by far the most common reason for crashes (95.6%), as opposed to vehicle or environmental factors. Among crashes with a driver error, a teen made the error 79.3% of the time (75.8% of all teen-involved crashes). Recognition errors (e.g., inadequate surveillance, distraction) accounted for 46.3% of all teen errors, followed by decision errors (e.g., following too closely, too fast for conditions) (40.1%) and performance errors (e.g., loss of control) (8.0%). Inadequate surveillance, driving too fast for conditions, and distracted driving together accounted for almost half of all crashes. Aggressive driving behavior, drowsy driving, and physical impairments were less commonly cited as critical reasons. Males and females had similar proportions of broadly classified errors, although females were specifically more likely to make inadequate surveillance errors.

Conclusions

Our findings support prioritization of interventions targeting driver distraction and surveillance and hazard awareness training.     

Risk and type of crash among young drivers by rurality of residence: Findings from the DRIVE Study

Background

Most previous literature on urban/rural differences in road crashes has a primary focus on severe injuries or deaths, which may be largely explained by variations of medical resources. Little has been reported on police-reported crashes by geographical location, or crash type and severity, especially among young drivers.

Methods

DRIVE is a prospective cohort study of 20,822 drivers aged 17-24 in NSW, Australia. Information on risk factors was collected via online questionnaire and subsequently linked to police-reported crashes. Poisson regression was used to analyse risk of various crash types by three levels of rurality of residence: urban, regional (country towns and surrounds) and rural.

Results

Compared to urban drivers, risk of crash decreased with increasing rurality (regional adjusted RR: 0.7, 95% CI 0.6-0.9; rural adjusted RR: 0.5, 95% CI 0.3-0.7). Among those who crashed, risk of injurious crash did not differ by geographic location; however, regional and rural drivers had significantly higher risk of a single versus multiple vehicle crash (regional adjusted RR 1.8, 95% CI 1.3-2.5; rural adjusted RR: 2.0, 95% CI 1.1-3.6), which was explained by speeding involvement and road alignment at the time or site of crash.

Conclusions

Although young urban drivers have a higher crash risk overall, rural and regional residents have increased risk of a single vehicle crash. Interventions to reduce single vehicle crashes should aim to address key issues affecting such crashes, including speeding and specific aspects of road geometry.     

Defective equipment and tractor-trailer crash involvement

The role of defective equipment in large truck crashes on interstate highways in Washington State was investigated using a case-control study design. For each large truck involved in a crash, three trucks were randomly selected from the traffic stream at the same time and place as the crash, but one week later both crash and comparison trucks were inspected by Commercial Vehicle Enforcement officers of the Washington State Patrol. The effects of truck equipment condition, truck operating characteristics (carrier type, carrier operation, and truck load), and driver characteristics (driver age, hours of driving) on crash involvement were analyzed by comparing their relative frequency among crash-involved and comparison sample tractor-trailers. A logistic regression model was used to estimate the adjusted odds ratio for each factor. Overall, 77% of tractor-trailers in crashes and 66% of those not involved in crashes had defective equipment warranting a citation. Forty-one percent in crashes had defective equipment warranting taking the truck out of service, and 31% not in crashes had these defects. Brake defects were the most common type and were found in 56% of tractor-trailers in crashes; steering equipment defects were found in 21%. The relative risk of crash involvement for trucks with brake defects was about one and one-half times that for trucks without brake defects. For trucks with steering defects, the relative risk of crash involvement was at least twice that for trucks with steering defects, the relative risk of crash involvement was at least twice that for trucks without defects, and the risk increased substantially for trucks with out-of-service steering defects.     

Factors associated with civilian drivers involved in crashes with emergency vehicles

Motor vehicle crashes involving civilian and emergency vehicles (EVs) have been a known problem that contributes to fatal and nonfatal injuries; however, characteristics associated with civilian drivers have not been examined adequately. This study used data from The National Highway Traffic Safety Administration's Fatality Analysis Reporting System and the National Automotive Sampling System General Estimates System to identify driver, roadway, environmental, and crash factors, and consequences for civilian drivers involved in fatal and nonfatal crashes with in-use and in-transport EVs. In general, drivers involved in emergency–civilian crashes (ECCs) were more often driving: straight through intersections (vs. same direction) of four-points or more (vs. not at intersection); where traffic signals were present (vs. no traffic control device); and at night (vs. midday). For nonfatal ECCs, drivers were more often driving: distracted (vs. not distracted); with vision obstructed by external objects (vs. no obstruction); on dark but lighted roads (vs. daylight); and in opposite directions (vs. same directions) of the EVs. Consequences included increased risk of injury (vs. no injury) and receiving traffic violations (vs. no violation). Fatal ECCs were associated with driving on urban roads (vs. rural), although these types of crashes were less likely to occur on dark roads (vs. daylight). The findings of this study suggest drivers may have difficulties in visually detecting EVs in different environments.     

How similar are two-unit bicycle and motorcycle crashes?

This paper explores the similarities and differences between bicycle and motorcycle crashes with other motor vehicles. If similar treatments can be effective for both bicycle and motorcycle crashes, then greater benefits in terms of crash costs saved may be possible for the same investment in treatments. To reduce the biases associated with under-reporting of these crashes to police, property damage and minor injury crashes were excluded. The most common crash type for both bicycles (31.1%) and motorcycles (24.5%) was intersection from adjacent approaches. Drivers of other vehicles were coded most at fault in the majority of two-unit bicycle (57.0%) and motorcycle crashes (62.7%). The crash types, patterns of fault and factors affecting fault were generally similar for bicycle and motorcycle crashes. This confirms the need to combat the factors contributing to failure of other drivers to yield right of way to two-wheelers, and suggest that some of these actions should prove beneficial to the safety of both motorized and non-motorized two-wheelers. In contrast, child bicyclists were more often at fault, particularly in crashes involving a vehicle leaving the driveway or footpath. The greater reporting of violations by riders and drivers in motorcycle crashes also deserves further investigation.     

Crash risk factors related to individuals sustaining and drivers following traumatic brain injuries

Objective

Some crashes result in drivers experiencing (or sustaining) a traumatic brain injury (TBI) while other crashes involve drivers that have already experienced a TBI. The objective of this study is to examine the factors that influence these two TBI crash groups.

Methods

Data from the Iowa Department of Public Health's Brain Injury Registry and Department of Transportation's crash records were linked together and used in logistic regression models to predict the likelihood of a driver sustaining a TBI in a crash and those who drive after a TBI.

Results

Between 2001 and 2006, there were 2382 crashes in which an individual sustained a TBI. As expected, a higher likelihood of sustaining a TBI was observed for motorcycle drivers who did not wear a helmet and in crashes that resulted in total or disabling vehicle damage. Focusing specifically on the post-TBI drivers (and not occupants), 1583 were involved in crashes. These post-TBI drivers were less likely to wear seatbelts or have passengers in the vehicle at the time of the crash, and were more likely to crash at night. Post-TBI drivers were also involved in significantly more multiple crashes (about 14%) when compared to drivers who have not experienced a TBI (about 10%) during the study period. When controlling for gender, date of injury, and severity of TBI (using Glasgow Coma Scale), individuals that sustained a TBI when they were younger were more likely to be involved in multiple crashes.

Conclusions

Different factors influence the crash likelihood for those that sustain a TBI in a crash and those that crash following a TBI. In general, post-TBI drivers have a higher occurrence of multiple crashes and this should be further explored to guide driver rehabilitation, evaluation, and training.     

The prevalence of, and factors associated with, serious crashes involving a distracting activity

The study's objectives were to determine the prevalence and types of distracting activities involved in serious crashes, and to explore the factors associated with such crashes. We interviewed 1367 drivers who attended hospital in Perth, Western Australia between April 2002 and July 2004 following a crash. A structured questionnaire was administered to each driver and supplementary data were collected from ambulance and medical records. Over 30% of drivers (433, 31.7%) cited at least one distracting activity at the time of crashing and driver distraction was reported to have contributed to 13.6% of all crashes. The major distracting activities were conversing with passengers (155, 11.3%), lack of concentration (148, 10.8%) and outside factors (121, 8.9%). Using logistic regression, a distracting activity at the time of a crash was significantly more likely among drivers with shorter driving experience (0-9 years, 38.3% versus >or=30 years, 21.0%, p<0.001). Distracting activities at the time of serious crashes are common and can cause crashes, and the types of activities reported are varied. Increased driver awareness of the adverse consequences of distracted driving with a focus on novice drivers, enforcement of existing laws (e.g. those requiring a driver to maintain proper control of a vehicle), and progress on engineering initiatives (such as collision warning systems) are needed to reduce injury.