Risks on the roads ================== * Ediriweera Desapriya * Ian Pike * Pamela Joshi In a recent article about global trends in injury,1 Sally Murray describes prevention efforts for traffic-related injuries, but 2 independent trends in the developed world may reverse some of the improvements that have already been made: the aging of the population and the increase in the use of sport utility vehicles (SUVs).2,3 Despite improvements to newer passenger vehicles to reduce the effect of collisions with larger vehicles, including SUVs, concern persists regarding the greater risk of injury to the drivers and occupants of passenger vehicles and to pedestrians during collisions between vehicles of differing size and mass4,5 (these factors being the chief determinants in severity of injuries). In the United States, 40% of new vehicles purchased are classified as light trucks or vans, many of which are SUVs. The preference for an SUV is shaped not only by individual choice but also by environmental influences, including economic and social factors.6 SUVs, some of which are marketed and purchased for their perceived safety image, are suggested to offer robust protection for child occupants. However, a recent study showed that despite greater vehicle weight, aggressive vehicle design and size of SUVs, the safety benefits for child occupants are similar to those offered by small vehicles.7 Given that motor vehicle crashes remain the leading cause of death and acquired disability in children,8 these data are troubling at best. SUVs also have the highest death rate for their own occupants of any broad class of vehicles, mainly because of high rollover rates. Traffic safety literature indicates that SUVs and trucks inflict substantial external safety costs when involved in a collision, causing damage to other vehicles, road infrastructure, roadside objects and vulnerable road users.3,6,7,9 In particular, the risk of injury is an important deterrent to walking and cycling. In the United Kingdom, cycling accounted for nearly 25% of all road traffic in 1951, but by 1994 this figure had fallen to just 1%.10 The number of miles walked also declined, on average, by 17% between 1975/76 and 1994.10 In a recent study that explored why children don't walk to school more often, 40% of parents reported traffic danger as one of several factors.11 If traffic danger continues to discourage people of all ages from walking and cycling, the disease burden related to inactivity will increase. ## REFERENCES 1. 1. Murray S. Global injury and violence. CMAJ 2006;174(5):620-1. [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNzQvNS82MjAiO3M6NDoiYXRvbSI7czoyNDoiL2NtYWovMTc0LzEyLzE3NDMuMS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 2. 2. Simms C, O'Neill D. Sports utility vehicles and older pedestrians: a damaging collision. Inj Prev 2006;12:6-7. [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6MTA6ImluanVyeXByZXYiO3M6NToicmVzaWQiO3M6NjoiMTIvMS82IjtzOjQ6ImF0b20iO3M6MjQ6Ii9jbWFqLzE3NC8xMi8xNzQzLjEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 3. 3. Desapriya EB, Chipman M, Joshi P, et al. The risk of injury and vehicle damage in vehicle mismatched crashes. Int J Inj Contr Saf Promot 2005;12:191-2. [CrossRef](http://www.cmaj.ca/lookup/external-ref?access_num=10.1080/1566097042000265782&link_type=DOI) [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=16335437&link_type=MED&atom=%2Fcmaj%2F174%2F12%2F1743.1.atom) 4. 4. *World report on road traffic injury prevention 2004*. Geneva: World Health Organization; 2004. 5. 5. Desapriya EB, Pike I, Kinney J. The risk of injury and vehicle damage severity in vehicle mismatched side impact crashes in British Columbia. Int Assoc Traffic Saf Sci Res 2005;29:60-6. 6. 6. Acierno S, Kaufman R, Rivara FP, et al. Vehicle mismatch: injury patterns and severity. Accid Anal Prev 2004;36:761-72. [CrossRef](http://www.cmaj.ca/lookup/external-ref?access_num=10.1016/j.aap.2003.07.001&link_type=DOI) [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=15203353&link_type=MED&atom=%2Fcmaj%2F174%2F12%2F1743.1.atom) [Web of Science](http://www.cmaj.ca/lookup/external-ref?access_num=000222426800007&link_type=ISI) 7. 7. Daly L, Kallan MJ, Arbogast B, et al. Risk of injury to child passengers in sport utility vehicles. Pediatrics 2006;117:9-14. [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MTA6InBlZGlhdHJpY3MiO3M6NToicmVzaWQiO3M6NzoiMTE3LzEvOSI7czo0OiJhdG9tIjtzOjI0OiIvY21hai8xNzQvMTIvMTc0My4xLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 8. 8. Soubhi H, Raina P, Kohen D. Neighborhood, family, and child predictors of childhood injury in Canada. Am J Health Behav 2004;28(5):397-409. [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=15482969&link_type=MED&atom=%2Fcmaj%2F174%2F12%2F1743.1.atom) [Web of Science](http://www.cmaj.ca/lookup/external-ref?access_num=000226554800002&link_type=ISI) 9. 9. Crandall JR, Bhalla KS, Madeley NJ. Designing road vehicles for pedestrian protection. BMJ 2002;324:1145-8. [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6MzoiYm1qIjtzOjU6InJlc2lkIjtzOjEzOiIzMjQvNzM0Ni8xMTQ1IjtzOjQ6ImF0b20iO3M6MjQ6Ii9jbWFqLzE3NC8xMi8xNzQzLjEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 10. 10. *Road transport and health*. London (UK): British Medical Association; 1997. 11. 11. Centers for Disease Control and Prevention. Barriers to children walking and biking to school —United States, 1999. *MMWR Morb Mortal Wkly* Rep 2002;51(32):701-4.