Identifying alcohol-related and built environment factors that can be modified to prevent pedestrian road traffic death

在美国，每年汽车造成大约6,000名行人死亡，另有70,000人受伤， 健康负担，特别是对于行人伤亡最常见的城市。超过35%的 被致命袭击的行人在死亡时受到酒精的影响。许多城市正在发展 促进夜生活区，突出提供酒精服务的场所，作为经济发展的一部分， 振兴城市空间的发展计划。通过聚集酒类销售点，这些城市举措还可以 将醉酒的行人聚集在醉酒或分心的司机附近。目前，研究和公共政策 专注于防止行人死亡的人未能考虑到行人走进的建筑环境， 他们离开卖酒的场所，尽管这些环境对行人造成伤害， 死亡人数此外，新出现的证据表明，无家可归的人特别容易受到行人的伤害。 受伤，他们构成了一个显着的百分比（~25%）的行人死亡，而在影响下， 酒精美国各地的城市都在制定计划，以防止所有行人死亡，但没有一个城市 计划甚至提到了行人饮酒的作用，或者有行动项目来解决这种可改变的风险 因子这项提案的主要目标是进行一项全国性的地理病例对照研究， 确定城市内可改变的零售、建筑、经济和社会环境风险因素， 特别是与酒精销售和消费有关的风险因素。案例地点将是城市街道段或 2017-2018年行人被致命袭击的十字路口和两个控制地点，街道段 或没有发生死亡事故的交叉路口，将与案件地点相匹配。醇的存在 零售场所（如酒吧、俱乐部、酒类商店）、夜生活区、为无家可归者提供的服务， 营地和非正式的避难场所（如桥梁和立交桥）将作为关键的独立 感兴趣的变量。我们假设，酒精涉及的行人死亡是一个独特的亚型， 行人死亡，并有不同的建筑环境风险因素的行人死亡，不 涉及酒精。病例和控制地点的社区、街道和交叉口级别特征将 通过地理信息系统分析和使用谷歌街景进行的邻里审计进行测量，我们的在线 计算机辅助邻里视觉评估系统（CANVAS）。作为其中的一部分 建议我们将扩大CANVAS的能力，通过以下方式进行全国范围的虚拟社区审计： 谷歌街景。我们还将测试附近是否有零售酒精店，夜生活区或服务， 无家可归者增加了行人死亡的风险，以及这种风险是否因建筑环境而加剧： 鼓励行人活动;将行人置于道路交通附近;或令行人或司机分心。 这个项目将是极具创新性的，因为它是第一个确定可改变的环境特征的国家研究项目。 将酒精作为减少城市内行人受伤风险的潜在解决方案。

Every year in the United States automobiles kill about 6,000 pedestrians and injure another 70,000, a significant health burden, especially for cities where pedestrian deaths and injuries are most common. Over 35% of all fatally struck pedestrians are under the influence of alcohol at the time they are killed. Many cities are developing and promoting nightlife districts, prominently featuring alcohol-serving establishments, as part of economic development plans to revitalize urban spaces. By clustering alcohol outlets, these urban initiatives may also cluster intoxicated pedestrians near intoxicated or distracted drivers. Currently, research and public policies focused on preventing pedestrian fatalities fail to account for the built environments pedestrians walk into when they leave alcohol-serving establishments, despite the risks these environments pose for pedestrian injuries and fatalities. In addition, emerging evidence suggests that homeless individuals are at particular risk for pedestrian injury, and they make up a significant percentage (~25%) of the pedestrians killed while under the influence of alcohol. Cities across the U.S. are developing plans to prevent all pedestrian fatalities, yet none of these city plans even mention the role of alcohol use by pedestrians or have action items to address this modifiable risk factor. The broad objective of this proposal is to conduct a nationwide geographic case-control study of pedestrian fatalities to identify modifiable retail, built, economic and social environment risk factors within cities, especially risk factors related to alcohol sales and consumption. Case locations will be urban street segments or intersections where pedestrians were fatally struck from 2017-2018 and two control locations, street segments or intersections where fatalities did not occur, will be matched to the case locations. The presence of alcohol retail establishments (e.g. bars, clubs, liquor stores), nightlife districts, services for the homeless and encampments and informal sheltering locations (e.g. bridges and overpasses) will serve as the key independent variables of interest. We hypothesize that alcohol-involved pedestrian fatalities are a distinct subtype of pedestrian fatality and have different built environment risk factor profiles from pedestrian fatalities that do not involve alcohol. Neighborhood-, street- and intersection-level features for case and control locations will be measured via GIS analyses and via neighborhood audits conducted using Google Street View and our online research tool, the Computer Assisted Neighborhood Visual Assessment System (CANVAS). As part of this proposal we will expand the capabilities of CANVAS for conducting nationwide virtual neighborhood audits via Google Street View. We will also test whether proximity to retail alcohol outlets, nightlife districts or services for the homeless increases risk for pedestrian fatality and whether this risk is heightened by built environments that: encourage pedestrian activity; place pedestrians near road traffic; or cause distractions to pedestrians or drivers. This project will be highly innovative as the first national study to identify modifiable environmental characteristics related to alcohol as potential solutions to reduce pedestrian injury risk within cities.