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

在美国，每年约有6000名行人被汽车撞死，7万人受伤，这是一个巨大的数字 健康负担，特别是对于行人伤亡最常见的城市。超过35%的人 被撞致死的行人在被撞死时是在酒精的影响下。许多城市都在发展中 推广夜生活区，突出地以酒类服务机构为特色，作为经济活动的一部分 发展计划，以振兴城市空间。通过聚集酒类销售点，这些城市倡议也可能 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，而没有考虑到行人进入的建筑环境 他们离开了提供酒精服务的场所，尽管这些环境对行人和 死亡事故。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，他们占行人在受影响时死亡的很大比例(~25%) 酒精。美国各地的城市都在制定防止所有行人死亡的计划，但这些城市中没有一个 计划甚至提到了行人饮酒的作用，或者制定了应对这一可改变风险的行动项目 因素。这项建议的总体目标是进行一项全国性的地理病例对照研究 行人死亡，以确定城市内可更改的零售、建筑、经济和社会环境风险因素， 尤其是与酒类销售和消费相关的风险因素。案件地点将在城市路段或 2017-2018年行人被撞致死的十字路口和两个控制点，路段 或未发生死亡的十字路口，将与病例位置匹配。酒精的存在 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以及 营地和非正式避难所(如桥梁和立交桥)将作为主要的独立住房 感兴趣的变量。我们假设与酒精有关的行人死亡是一种独特的亚型 行人死亡，并具有与非行人死亡不同的建筑环境风险因素概况 牵涉到酒精。案件和控制地点的邻里、街道和十字路口级别的要素将是 通过地理信息系统分析和使用谷歌街景和我们的在线社区进行的社区审计进行测量 研究工具，计算机辅助邻里视觉评估系统(CARAVS)。作为这项工作的一部分 建议我们将扩展Canvas的能力，通过以下方式在全国范围内进行虚拟社区审计 谷歌街景。我们还将测试是否靠近酒类零售店、夜生活区或服务 无家可归者会增加行人死亡的风险，以及满足以下条件的建筑环境是否会增加这种风险： 鼓励行人活动；将行人放置在道路交通附近；或分散行人或司机的注意力。 该项目将是第一个确定可改变的环境特征的全国性研究，具有很高的创新性 作为减少城市内行人受伤风险的潜在解决方案，与酒精有关。

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.