Stop Death on California's Rural Roads
By Marlene Bengiamin, Ph.D., John Capitman, Ph.D., Heather Berg, MA
California State University-Fresno, Central Valley Health Policy Institute

Motor vehicle accidents (MVAs) remain a leading cause of injury and death in Central California’s San Joaquin Valley, especially for minority, low-income citizens of rural communities. Living in a rural location may contribute to one’s risk of being in an MVA. According to the NCSA (2005), rural accidents account for 58% of motor vehicle fatalities, although only 21% of Americans live in rural areas; and rural accidents tend to be more severe, disabling 14% more vehicles in fatal collisions than in urban areas (81% to 67%). In addition, victims of rural crashes are also twice as likely to die when compared to urban crashes (Chen, et al., 1995); a study by Muelleman & Mueller (1996) found that fatality rates in MVAs are inversely proportional to population densities. Residents of rural communities are likely to be at the greatest risk for dying in MVAs, as they are presumably most likely to travel on rural roads.

The relationship between driver behaviors such as seat-belt use, speeding, and driving while intoxicated (DWI) and higher MVA rates have been well documented (Harper, et al., 2000; NCSA, 2006a; Romano, et al., 2005). The role of driver characteristics such as socio-economic status, race/ethnicity, and rural residence has also been studied, both individually and in terms of their interaction with behaviors (Braver, 2003; Campos-Outcalt, et al., 2003). While driver related factors have been the focus of most analyses, environmental factors such as road condition remain largely unexplored. It is possible that such factors explain a substantial share of the differences between rural and urban MVAs, as well as higher fatality rates for specific populations. Further, as far as we can tell, prior research has not addressed the issue of motor vehicle accidents from a multivariate perspective. Such research would adjust for a wider range of contributing factors and give a clearer understanding of where intervention efforts should be focused.

Public health experts from six counties collaborated to identify the underlying social and environmental determinants behind the disparities in rural/urban MVAs.  This collaboration was part of the Place Matters national demonstration program, a national initiative of the Joint Center for Political and Economic Studies, Health Policy Institute to reduce/eliminate health disparities by targeting upstream causes associated with social determinants of health.  

We used discriminate analysis to determine which indicators differentiate between rural and urban MVAs using Fatality Analysis Reporting System (FARS) data from 2001 to 2005 for six SJV counties. Demographic, behavioral, and environmental variables were investigated.
A strong majority (65%) of fatal accidents in the six counties from 2001 to 2005 occurred on rural roads; Those involved in fatal accidents in the Valley (including drivers, passengers, and non-motorists) from 2001 to 2005 were most frequently local residents (88% of all individuals in the database). Hispanics accounted for almost half of all fatalities. Rural MVAs were found to differ from urban for demographic, behavioral, and environmental variables. Significant variables associated with rural accidents included two-way roads without dividers, fewer than three travel lanes, unlit roads, non-junctions, higher speed limits, absence of traffic control devices, absence of functional air bags, weekend driving, invalid license status, non-use of safety restraints, and violations for driving mistakes (such as improper passing).

Because population criteria is given more weight in funding calculations than is number of road miles, those counties with the greatest amount of rural roads and highest MVA mortality rates receive smaller amounts of funding for creating safe traffic environments (http://www.cacrash.org/index.html; California Department of Transportation, 2006). For example, the formula used to distribute funding to counties from California’s SB 1266 in 2006 based 75% of the funding allocation on the number of vehicles registered in each county relative to those registered in all counties in the state and 25% on the number of county road miles. Because the number of registered vehicles in a county is directly related to its population, rural counties with fewer registered vehicles (and therefore lower populations and more miles of rural roads) receive a smaller share of the funding than more heavily populated counties with fewer miles of rural roads and lower fatality rates.

It is estimated that MVAs cost California over $20 billion in the year 2000 (NCSA, 2006b); MVA costs are high for individual counties, as well. Accidents on Fresno County roads in 2003, for example, were estimated to cost the county $326 million (Fresno County Department of Public Works & Planning, 2004). This amount represents an equivalent of 21% of Fresno County’s 2007-2008 fiscal budget (Fresno County Auditor-Controller/Treasurer-Tax Collector’s Office, 2007). In the long-term, it would cost Fresno County five times less to provide adequate maintenance now, than it would to re-construct a badly damaged road in the future (Fresno County Department of Public Works & Planning, 2004).

Efforts across the nation to lower the incidence of MVA injuries and fatalities have traditionally focused on enforcement and education. Current models of intervention generally seek to enforce traffic safety laws and educate individuals on restraint system use and DWI (Braver, 2003; Dinh-Zarr et al., 2001; Elder et al., 2004; Elder et al., 2005; Harper, et al., 2000; Romano, et al., 2005; Shults et al., 2001). The results of this study, however, indicate that environmental characteristics such as lighting and physical barriers play a major role in rural MVAs. While driver education and enforcement of laws covering behaviors such as seat-belt use are undoubtedly important to the reduction of rural MVAs, interventions and preventative measures must address the environmental conditions associated with rural MVAs.

References
National Center for Statistics and Analysis. (2005). Traffic safety facts: 2004 data, rural/urban comparison. Washington, DC: National Highway Traffic Safety Administration. Retrieved on March 6, 2008, from http://www-nrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/TSF2004/809938.pdf

Chen, B., Maio, R.F., Green, P.E., & Burney, R.E. (1995). Geographic variation in preventable deaths from motor vehicle crashes. The Journal of Trauma, 38(2), 228-232.

Muelleman, R.L. & Mueller, K. (1996). Fatal motor vehicle crashes: Variations of crash characteristics within rural regions of different population densities. The Journal of Trauma, 41(2), 315-320.

Harper, J. S., Marine, W.M., Garrett, C.J., Lezotte, D., & Lowenstein, S. R. (2000). Motor vehicle crash fatalities: A comparison of Latino and non-Latino motorists in Colorado. Annals of Emergency Medicine 36(6), 589-596.

National Center for Statistics and Analysis. (2006a). Race and ethnicity in fatal motor vehicle traffic crashes 1999-2004. Washington, DC: National Highway Traffic Safety Administration. Retrieved on March 6, 2008, from http://www-nrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/Rpts/2006/809956/809956.htm

Romano, E., Tippetts, S., Voas, R. (2005). Fatal red light crashes: The role of race and ethnicity. Accident Analysis and Prevention, 37, 453-460.

Braver, E. R. (2003). Race, Latino origin, and socioeconomic status in relation to motor vehicle occupant death rates and risk factors among adults. Accident Analysis and Prevention, 35, 295-309.

Campos-Outcalt, D., Bay, C., Dellapena, A., & Cota, M. K. (2003). Motor vehicle crash fatalities by race/ethnicity in Arizona, 1990-96. Injury Prevention, 9, 251-256.

California Department of Transportation (2006). SB 1266 Formula Distribution by County. Retrieved July 30, 2008 from http://www.dot.ca.gov/docs/sb1266/SB1266FormulaDistributionbyCounty.pdf

National Center for Statistics and Analysis. (2006b). Toll of motor vehicle crashes, 2005. Retrieved on January 21, 2007, from http://www-nrd.nhtsa.dot.gov/departments/nrd-30/ncsa/STSI/6_CA/2005/6_CA_2005.HTM

Fresno County Auditor-Controller/Treasurer-Tax Collector’s Office (2007). 2007-08 Budget. Retrieved January 30, 2008 from http://www.co.fresno.ca.us/0410/BudgetBook/BudgBook07-08.pdf

Dinh-Zarr, T., Sleet, D., Shults, R., Zaza, S., Elder, R., Nichols, J., et al.(2001). Reviews of evidence regarding interventions to increase the use of safety belts. American Journal of Preventive Medicine, 21(4S), 48-65.

Elder, R., Nichols, J., Shults, R., Sleet, D., Barrios, L., Compton, R. (2005). Effectiveness of school-based programs for reducing drinking and drinking and riding with drinking drivers A systematic review. American Journal of Preventive Medicine, 28(5S), 288-304.

Elder, R., Shults, R., Sleet, D., Nichols, R., Thompson, R., Rajab, W. (2004). Effectiveness of mass media campaigns for reducing drinking and driving and alcohol-involved crashes: a systematic review. American Journal of Preventive Medicine, 27(1), 57-65.

Shults, R., Elder, R., Sleet, D., Nichols, J., Alao, M., Carande-Kulis, V., et al. (2001). Reviews of evidence regarding interventions to reduce alcohol-impaired driving. American  Journal of  Preventive Medicine, 21(4S), 66-88.

Marlene Bengiamin can be reached at marleneb@csufresno.edu

Article posted on 1/6/08