Introduction

Violence has occurred within society since the start of civilization. The concept of vehicular violence is not commonly associated, nor recognized, within society as compared to other acts of violence, e.g., homicide, suicide and rape, in addition to organized acts of violence such as gang shootings and terrorist attacks. The use of a weapon to facilitate an act of violence is commonly associated with a knife, blunt instrument (e.g. baseball bat) or a gun, but we fail to recognize that a vehicle, whether be a passenger car, motorcycle, or truck, can be used as a weapon as well.

This blog will attempt to bring to light the public health burden of vehicular violence by understanding the "zones of relevance" (Schutz, 1970; Rothe, 2008), identifying risk factors for vehicular violence and addressing the magnitude of the issue with respect to individual acts of violence.

The following sections are adapted and expanded upon from Peter Rothe's book Driven To Kill: Vehicles as Weapons. Dr. Rothe is an associate professor in the Centre for Health Promotion Studies, School of Public Health, University of Alberta. He is also a senior associate of the Alberta Centre for Injury Control & Research.

Social Culture

Social culture involves what is generally accepted within society, which includes our behaviors, relationships (intimate or professional), social acceptance, authoritative figures and politics. Part of the social culture spawned during the vehicle revolution, more notably known as the vehicle culture. Vehicles are found everywhere in society and are used for a variety of activities. A vehicle is a symbol of modern times; it is an instrument of success, personal image, power, freedom and comfort in addition to providing instant transportation (Rothe, 2008). People of society even go as far as to name their personal vehicle (I named my car B.B., short for Betsy Beth). We as a society interact with vehicles on a daily basis: travel to and from work, pick up children from school and extracurricular activities and go grocery shopping among other things. Vehicles can become and often are an extension of who we are or who we want to be.

Some would say that one of the greatest technological advancements of human life in the U.S. was the development of the interstate highway system. As a result, we depend on vehicles to take us places, often over some distance, which does not encourage the use of other modes of transportation, such as walking or biking. As roadways and streets become congested with vehicles, we get a sense of invasion. The personal space that we draw around ourselves is extended to the perimeter of our vehicle (Rothe, 2008). As an example, when riding along in slow moving traffic, if another car jumps in front of us, we can become aggravated, may verbalize obscenities either internally or externally, or take more aggressive tactics and try to jump in front of the car that invaded our space.

An Example of a Risk Factor within Social Culture
Aggression on the roadway can lead to the phenomenon known as road rage, which is an act of vehicular violence. Road rage is defined as "an incident in which an angry or impatient motorist or passenger intentionally injures or kills another motorist, passenger, or pedestrian, or attempts or threatens to injure or kill another motorist, passenger or pedestrian" (Rathbone & Huckabee, 1999). Road rage violence affects the public health in three general ways: direct physical harm between road rage motorist and others, indirect mental endangerment, and accidental harm due to innocent motorist being involved in a collision with other than the road raged motorist (Ayar, 2006). This type of vehicular violence is of public health concern because the prevalence within the population is high and can cause adverse effects to the general population - anybody on the road is susceptible to road rage or becoming a victim of road rage.

A survey of risk factors for road rage indicated that it is most like to occur Friday afternoon, during peak hours of travel and in fair weather conditions. Road rage incidents occur more often during the summer months and do not appear to be related to holiday stress. Incidents encountered under conditions of moderate vehicle congestion on the road ways, while the use of alcohol or drugs may be a contributing factor (Sharkin, 2004).

The Person

People that make up society are variable in nature, meaning that each and every one of us has different personalities, interests, opinions, beliefs (e.g. political or religious) etc (all risk factors for a perpetrator). We are all of different age, race, ethnicity, shape and size. We are all at different mental states while driving and individual attributes of impulsivity, mood, frustration and propensity to take risk are risk factors as well for vehicular violence (Rothe, 2008). There are many mental states and characteristics to examine for an individual to understand the risk factors for vehicular violence.

Examples of Risk Factors within 'The Person'
Social stress (also referred to as "emotional stress") results in the overloading of stress that one is able to handle or control. Social stress risk factors include unemployment, financial worries, divorce and other situations, which can cause increases in adverse health and mental well-being. This can lead to an increase risk in engaging in an act of vehicular violence. It is known that degradation in driving performance occurs under emotional influences such as anger and stress (Kass, Cole, & Legan, 2008; Selzer, Rogers, & Kern, 1968). Under such mental pressure, the risk of road rage or aggressive forms of driving is increased.

The use of alcohol to suppress stress leads to another danger, drinking and driving. It is well understood the inability to perform a driving task safely while impaired, but the prevalence is still high on the roads. Fatalities on the roadway have been shockingly steady for the last 3 decades hovering around 40,000 (NHTSA, 2010) with alcohol being involved in 30-34% of the crashes for the last 15 years. A risk factor that is currently being argued is the availability or access to alcohol. This factor increases the use, and thereby increases the chances of violence, either traffic-related of not. Government statutes and policies such as the deregulation of liquor sales in some places may be a "contributing factor to people taking less social responsibility for their behavior" (Rothe, 2008).

The Situation

The situation a driver is in can play a role in causing a perpetrator to commit an act of vehicular violence. The situation can include scenarios of the roadway, such as traffic congestion and volume, in addition to personal situations such as work stress and family strains (Rothe, 2008). These factors are in essence risk factors for aggression on the roadway, which we know can lead to road rage, along with other acts of violence.

The Vehicle

Vehicle factors include the way a vehicle is portrayed or used in an act of violence. Cars can be used as physical weapons of destruction, such as battering rams or as car bombs. Vehicle factors include use within all "zones of relevance": the mediate, intermediate and immediate zones (Rothe, 2008; Schutz, 1970). The mediate zone is the farthest one would consider the vehicle to be involved in an act of violence. For simplicity, the vehicle is not directly used as the weapon to commit the act, but is used for convenience to transport to and from the location where the violent act is committed. In the intermediate zone, the vehicle is integral to committing the act of violence; however, similarly to the mediate zone, the vehicle is still not used as the physical instrument to commit the violence. In the immediate zone, the perpetrator uses the vehicle directly to commit the criminal act of violence (e.g. homicide, suicide). Without the vehicle, the act would not be committed unless alternative methods or modes are used.

Strategies for Prevention and Control

Prevention and control of vehicular violence is not as "simple" as compared to gun laws and control. If firearms are an issue, federal, state or local legislation can be written and signed into law to prevent the selling, owning, carrying or distribution of firearms. To prevent and control vehicular violence, it goes beyond legislation. It would be ridiculous for a law to be written that bans the use of a vehicle. The prevention and control of specific acts of vehicular violence can be addressed, or attempted to, at different levels of government.

In order to prevent and control vehicular violence, we must know what are the factors that are involved in the act. To do this, one can use a publich health approach to assess the factors. Haddon's Matrix 's involves the typical epidemiological triangle of host, agent and environment with pre and post levels of intervention. The following section contains a sample Haddon's Matrix identifying factors for homicide/suicide during pre, during and post event.

Example Haddon Matrix

Vehicular Violence (Homicide/Suicide)

 

Factors

Host

Agent/Vehicle

Physical Environment

Social Environment

Pre-Event

·     Driver experience

·     Alcohol/drug impairment

·     Mental State

·     Pre-convictions

·     Fatigue

·     Speed

·     In vehicle safety devices

·     Ease of control

·     Obstructed view

 

·     Weather conditions

·     Roadway markers

·     Inadequate barriers

·     No vehicle zones

·     Obstructed view

·     Convictions less severe

·      Public tolerance of mental instability

·     Law not prohibiting at risk individuals to obtain access to vehicle

Event

·     Failure in wearing safety belt

·     Age

·     Sex

·     Bone density

·     Safety systems failed to engage

·     Vehicle size

·     Air bags deployment

·     Poor design in safety barriers

·     Police identification of intentionality

Post-Event

·     Preexisting condition

·     Social environment and situation

·     Poor design crush zone or other parts of vehicle

·     Emergency readiness to location

·     Judicial sentencing

 

Outcomes of Selected Acts

Identifying statistics on the health outcome, cost and YPLL for vehicular violence is difficult to come by. In 1997, injuries (most of which are motor vehicle related) accounted for 20% more YPLL than cancer did (1,990 per 100,000 compared to 1,500 per 100,000, respectively) (USDHHS, 2010). Financial burdens for injuries related to motor vehicle violence can be determined, but has many limitations. For example, a zero tolerance for alcohol for drivers under the age of 21 yields a total benefit to society of $850 for a cost of $34 per driver (Child Safety Network, 2005). Mothers Against Drunk Driving estimated that alcohol-related crashes cost approximately $45 billion a year. In addition to the cost associated with the crash, survivors of alcohol-related crashes suffer an additional loss of $40.5 billion a year in quality of life (Newhouse, 1999). Other acts of vehicular violence (e.g. sexual assaults) are difficult to determine or extrapolate too.

Magnitude of the Problem

The magnitude of vehicular violence is not a clear-cut picture as there are uncertainties between unintentional and intentional acts. For example, if a driver drove off a road and crashed into a tree and died upon impact, was this an intentional act of suicide or did the driver just loose control. Because of problems such as the one just described, the data that is obtained and disseminated to the public is certainly underreported and potentially misclassified.

Homicide and Suicide
Data taken from the Center for Disease Control and Prevention's (CDC) Web-based Injury Statistics Query and Reporting System (WISQARS)


  • Between 1999-2006, there were 3,459 transportation-related homicides

  • Transportation-related homicides is ranked 11th of the top 20 leading causes of violence-related injury deaths.

  • 15% of identifiable deaths coded as ICD-10 Y03: Assault (homicide) by crashing of motor vehicle

  • Between 1999-2006, there were 855 transporation-related suicides (0.3% of all suicides)

  • All suicide deaths were coded as ICD-10 X82: Intentional self-harm (suicide) by crashing of motor vehicle

Vehicle Theft
Data taken from the National Highway Traffic Safety Administration


  • Available data shows vehicle theft based on model year has increased from 2004 (1.83) to 2006 (2.08 per 1,000 vehicles) but the overall trend since 1993 has been going down.

Road Rage
Data taken from AAA


  • Road rage incidents are more prevalent during rush hour times: 6-8am (10.5%), 2-4pm(15.8%), 4-6pm(25%)

  • 68% of observed incidents occurred during fair weather conditions

  • 37.8% occurred in the summer months

Sexual Assaults
Data taken from Rothe (2008) (Canada) and Saltzman et al. (2007) (United States)
Results from Canada


  • 25% within a vehicle

  • 24% in the victims home

  • 21% in public places

  • 20% in the perpetrator's home

  • 10%in someone else's home


Results from the United States


  • 4.2% (143,647) of assaults that were seen in emergency departments between 2001-2002 were sexual assaults.

  • Locale was not determined

References used within the paper

Ayar, A. (2006). Road Rage: recognizing a psychological disorder. The Journal of Psychiatry & Law, 34(Summer).

 

Bandura, A. (1973). Aggression: A social learning analysis. Oxford, England: Prentice-Hall.

 

CDC (2010). Injury Prevention & Control: Data & Statistics (WISQARS).

 

Child Safety Network (2005). Injury prevention is a good investment, 2010, from http://www.sophe.org/ui/injury.shtml

 

Clearly, J., & Cox, J. (2006). Minnesota Felony Driving While Impaired.

 

Jamieson, L. (2009). Sport and Violence: A Critical Examination of Sport.

 

Kass, S. J., Cole, K., & Legan, S. (2008). The Role of Situation Awareness in Accident Prevention. In A. De Smet (Ed.), Transportation Accident Analysis and Prevention (pp. 107-122): Nova Science Publishers.

 

Mizell, L. Aggressive Driving. AAA Foundation for Traffic Safety.

 

Newhouse, E. (1999). Society shoulders cost of mopping up alcohol messes. Great Falls Tribune, from http://www.gannett.com/go/difference/greatfalls/pages/part11/mess.html

 

NHTSA (1999). National Aggressive Driving Action Guide Recommendations for the Six Areas, 2010, from http://www.nhtsa.gov/people/injury/enforce/dot%20aggress%20action/guide.htm

 

NHTSA (2008). Final Theft Data; Motor Vehicle Theft Prevention Standard.

 

NHTSA (2010). Fatality Analysis Reporting System. from National Highway Traffic Safety Administration:

 

Rathbone, D. B., & Huckabee, J. C. (1999). Controlling Road Rage: A literature Review and Pilot Study. The AAA Foundation for Traffic Safety.

 

Rothe, J. P. (2008). Driven To Kill: Vehicles as Weapons: The University of Alberta Press.

 

Sacerdote, B., & Glaeser, E. (2003). Vengeance, Deterrence, and Incapacitation. The Journal of Legal Studies, 32(2).

 

Saltzman, L., Basile, K., Mahendra, M., Steenkamp, M., Ingram, E., & Ikeda, R. (2007). National Estimates of Sexual Violence Treated in Emergency Departments. Annals of Emergency Medicine, 49(2), 210-217.

 

Schutz, A. (1970). On phenomenology and social relations. Chicago: University of Chicago Press.

 

Selzer, M. L., Rogers, J. E., & Kern, S. (1968). Fatal accidents: The role of psychopathology, social stress, and acute disturbance. American Journal of Psychiatry, 124, 1028-1036.

 

Sharkin, B. S. (2004). Road rage: risk factors, assessment, and intervention strategies. Journal of Counseling and Development.

 

USDHHS (2010). Healthy People 2010: Chapter 15 Injury and Violence Prevention, 2010, from http://www.healthypeople.gov/document.html/volume2/15injury.htm

 

Zalaquett, C. P., Thornton, H., & Thornton, D. Aggressive Driving & Road Rage, 2010, from http://www.coedu.usf.edu/zalaquett/roadrage/roadrage.html

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