Traffic Medicine and Transportation Equity Research

Researchers at the Center for Injury Research and Prevention at Children’s Hospital of Philadelphia are collaborating with researchers from the Royal College of Physicians in Ireland, Brown University School of Public Health, the University of Pennsylvania, and other research organizations to conduct traffic medicine and transportation equity research.

Traffic medicine embraces all the disciplines, techniques, and methods developed to not only reduce injuries and deaths from motor vehicle crashes, but also to support safe mobility, including assessing fitness to drive as we age and providing alternative means of transportation when driving is not an option. The goal is to offer continued safe driving for those with relevant medical conditions whenever possible and to support the use of public transportation and ride sharing services like Uber and Lyft when it’s not.

Transportation equity research focuses on identifying and addressing barriers to reliable transportation for improving health outcomes and reducing health disparities, one of five non-medical priority areas for improving health as part of the Accountable Health Communities Initiative sponsored by Medicare and Medicaid. More than 3.6 million Americans miss or delay healthcare because of transportation barriers, and this lack of access to care can lead to serious short-term and long-term health issues.

Research Projects

Understanding Clinician Strategies for Discussing Driving Fitness with Patients: An Initiative to Improve Provider-Patient Discussions About Safe Driving

A team of researchers from the University of Pennsylvania and Children's Hospital of Philadelphia published results of a survey in Traffic Injury Prevention that aimed to understand neurosurgery and neurology providers’ knowledge and attitudes about fitness-to-drive assessments. Neurological impairments can adversely affect numerous skills important for safe driving, including attention, hand-eye coordination, processing speed, safety awareness, and judgment. Pennsylvania, where this survey was conducted, is one of six states that requires clinicians to notify the state department of transportation about patients with medical conditions that could impair their ability to safely drive.

The researchers found that only 20% of inpatient providers and 50% of outpatient providers usually or always discussed driving with patients, and only 54% reported ever having filed a report about a patient with PennDot. One-third, however, had referred a patient to a driver rehabilitation program within the last year. When asked what would help them improve their ability to assess fitness to drive, providers mentioned developing a handout about driver reporting guidelines in PA and surrounding states, information about local driver rehabilitation programs, and standardized driver screening tools. The research team plan to utilize this feedback to inform future quality improvement efforts.

Read a blog post about the research.

Authors: Arianna Unger, MPH; Flaura Winston, MD, PhD; Dominique G. Ruggieri, PhD; Joshua Remba, MSE

Funding: University of Pennsylvania Master of Public Health Program

Transportation Equity, Health and Aging: A Novel Approach to Healthy Longevity with Benefits Across the Life Span

There is a need for a balanced medical perspective when assessing fitness to drive, one that can appropriately weigh actual safety risks against the real health consequences of restricting mobility. A partnership between the fields of health care and transportation could facilitate this balance. More sophisticated, individualized approaches and modeling are becoming available and could allow for personalized prevention that optimize outcomes not only for older adults, but also across the life span. In a commentary for the National Academy of Medicine (NAM), researchers seek to promote a culture that ensures our future well-being by encouraging physicians to support safe transportation as a key determinant of health and social inclusion.

Read a blog post about the research.

Authors: Desmond O’Neill, MD; Elizabeth Walshe, PhD; Dan Romer, PhD; Nina R. Joyce, PhD; Andrew R. Zullo, PharmD, MPH; Jasjit S. Ahluwalia, MD; Melissa Pfeiffer, MPH; Allison E. Curry, PhD, MPH

Funding: Children’s Hospital of Philadelphia

Individual and Geographic Variation in Driver's Suspension: Evidence of Disparities by Race, Ethnicity, and Income

Using data from the New Jersey Safety and Health Outcomes (NJ-SHO) Data Warehouse 2004-2018, researchers from Brown University School of Public Health and CIRP compared characteristics of suspended drivers, their residential census tract, and access to public transportation and jobs, by reason for suspension (driving or non-driving-related). Their findings, published in the Journal of Transport & Health, show that the vast majority (91%) of license suspensions were for non-driving-related (NDR) events, with the most common reason for a suspension being failure to pay a fine.

The study also found that these NDR suspensions disproportionately affect people living in low-income neighborhoods and in neighborhoods with a high proportion of Black and Hispanic residents. Almost half (45%) of these NDR suspensions occurred in 2018. Future research will explore how these NDR suspensions may negatively affect health and economic well-being, particularly among individuals and communities already facing other barriers to employment and healthcare.

Read a blog post about the research.

Principal Investigators: Nina R. Joyce, PhD; Allison E. Curry, PhD, MPH

Funding: Agency for Healthcare Research and Quality; Department of Veterans Affairs Office of Academic Affiliations in Health Services Research and Development; Eunice Kennedy Shriver National Institute of Child Health and Human Development; Centers of Biomedical Research Excellence

Vehicle Safety Characteristics in Vulnerable Driver Populations

This study, published in Traffic Injury Prevention, highlights important disparities in vehicle safety features among drivers by age and income. The researchers analyzed data from the NJ Safety and Health Outcomes Data Warehouse, which includes all crash and licensing data for the state of NJ from 2010-17 and used NHTSA’s Product Information Catalog and Vehicle Listing platform to decode the VIN of each crash-involved vehicle to obtain model year, presence of electronic stability control (ESC), vehicle type, engine horsepower, and presence of front, side, and curtain airbags. They found that teens, older adults (age 65+), and those from low-income neighborhoods are more likely to be driving vehicles that are less safe, putting them at greater risk of injury and death in the event of a crash.

Read a blog post about the research.

Principal Investigators: Kristi Busico Metzger, PhD, MPH; Allison E. Curry, PhD, MPH

Funding: Eunice Kennedy Shriver National Institute of Child Health and Human Development

Driver’s License Suspension Policies as a Barrier to Health Care

CIRP researchers are partnering with researchers from Brown University School of Public Health to address barriers to reliable transportation for improving health outcomes and reducing health disparities. In 43 states courts can suspend a driver’s license for non-driving-related (NDR) events, such as failure to pay a fine or appear in court. Evidence suggests that NDR suspensions are disproportionately imposed on low-income and racial and ethnic minority drivers who are already more likely to face other barriers to care. In an editorial published in the American Journal of Public Health, researchers explain the impact of a suspended license on access to health care and what must be addressed to improve transportation equity in this area.

Read a blog post about the editorial.

Authors: Nina R. Joyce, PhD; Andrew R. Zullo, PharmD, MPH; Jasjit S. Ahluwalia, MD; Melissa Pfeiffer, MPH; Allison E. Curry, PhD, MPH

Funding: Agency for Healthcare Research and Quality; Department of Veterans Affairs Office of Academic Affiliations in Health Services Research and Development; National Institute on Aging; Eunice Kennedy Shriver National Institute for Child Health and Development; Centers of Biomedical Research Excellence

Facilitating Research On Racial and Ethnic Disparities and Inequities in Transportation: Application and Evaluation of the Bayesian Improved Surname Geocoding (BISG) Algorithm

CIRP researchers recently explored the accuracy of an algorithm to estimate race and ethnicity in transportation research datasets. Their findings, published in Traffic Injury Prevention, suggest that the Bayesian Improved Surname Geocoding (BISG) Geocoding algorithm is a promising method to incorporate race and ethnicity for the four largest racial/ethnic groups in population-level crash, licensing, and other transportation databases via use of collected name and address data, regardless of whether these data are linked to external sources with known race and ethnicity information.  

Taken with previous studies, their findings suggest that applying BISG to traffic safety analyses may also reduce potential biases commonly found in data collection and analysis, ultimately promoting more effective traffic safety interventions and equitable policies.

Read a blog post about the research.

Authors: Emma Sartin, PhD, MPHKristi Busico Metzger, PhD, MPH; Melissa Pfeiffer, MPH; Rachel K. Myers, PhD, MS; Allison E. Curry, PhD, MPH

Funding: Eunice Kennedy Shriver National Institute for Child Health and Development