Public Health Model to Promote Safe Elderly Driving

描述（由申请人提供）：老年驾驶员安全是一个复杂的现象，它超越了个人层面，延伸到多个系统（例如，监管、政策制定、社会和医疗保健）。尽管在现有文献中已经确定了无数的安全驾驶预测因素，但它们并没有整合到一个有意义的因果模型中。除非我们采用一种以统一的公共卫生模式为基础的综合方法，否则我们将无法采取适当的步骤来了解行为、生态、健康教育、行政、政策和监管战略如何促进老年人安全驾驶。对这些需求的持续忽视，再加上“美国的老龄化”，可能会使死于车祸的老年人数量急剧增加，并使更多的人受伤和致残。我提出的工作将为老年人安全驾驶制定一个统一的公共卫生模型。健康促进的先行-进行模型将提供理论框架：1)应用Cochrane协作描述方法系统地回顾当前文献；2)利用流行病学方法和结构方程模型（SEM）检验现有基于人群的定量数据的拟合性，以及b)利用内容分析的定性数据；3)对模型进行细化，制定老年人安全驾驶干预方案。这一职业发展计划对提高我对促进老年人安全驾驶的认识至关重要，包括：1)在系统审查、数据库分析（SEM）、模型改进和应用方面的监督培训；(2)研究项目：对老年驾驶员相关文献进行叙事综合和meta分析，验证老年驾驶员健康促进的先行-进行模型，制定老年安全驾驶试点方案；3)正式的教学课程，最终满足本提案的要求。这段时间的监督研究和培训，在公共卫生与卫生专业学院、医学院流行病学和卫生政策研究系、生物统计学的指导下，结合本计划提出的具体监督研究，将使我获得新的数据，用于申请NIH R-03奖。这一步将有助于我过渡到一个独立的联邦资助的调查员，并直接关系到我的长期目标，测试一个公共卫生模型，以指导评估，预测和促进老年人安全驾驶的计划。

DESCRIPTION (provided by applicant): Older driver safety is a complex phenomenon that extends beyond the person level to multiple systems (e.g., regulatory, policy-making, societal and health care). Although a myriad of predictors for safe driving have been identified in the existing literature, they are not integrated into a meaningful causative model. Unless we use an integrated approach, grounded in a unifying public health model, we will not have taken the adequate steps to understand how behavioral, ecological, health education, administrative, policy and regulatory strategies may promote safe elderly driving. Continued neglect of these needs, accompanied with the "graying of America", could sharply increase the number of older people killed in crashes, and leave many more injured and disabled. The work I propose will develop a unifying public health model for safe elder driving. The Precede-Proceed Model of Health Promotion will provide the theoretical framework to: 1) review the current literature systematically by applying the Cochrane Collaborative Descriptive Methodology; 2) test the fit of existing population-based a) quantitative data, using epidemiological methods and structural equation modeling (SEM), and b) qualitative data using content analysis; and 3) refine the model to develop an intervention plan for safe elderly driving. This career development plan, vital to enhance my understanding of promoting safe elderly driving, includes: 1) supervised training in systematic reviews, data base analyses (SEM), model refinement and application; 2) research projects producing a narrative synthesis and meta-analysis of the older driver literature, (dis)confirmation of the Precede-Proceed model of health promotion for the older driver, and developing a pilot plan for safe elderly driving; and 3) formal didactic coursework to culminate fulfilling the requirements of this proposal. This period of supervised research and training, with the guidance from the College of Public Health and Health Professions and the College of Medicine's Departments of Epidemiology and Health Policy Research, and Biostatistics, combined with the specific supervised research proposed in this plan, will allow me to obtain novel data for application of a NIH R-03 award. This step will facilitate my transition to an independent federally funded investigator, and is directly related to my long-term goal of testing a public health model to guide a plan of assessment, prediction and promotion of safe elderly driving.