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I drive a stick shift, I cycle to work about 3 days a week, including night time commuting. I also live in Boston so...Ma$$holes abound...

Some of the things I would posit...

-our roads suck, lines are hard to see and the lighting is terrible

- absent or awful sidewalks

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I used to bike down Mass Ave to Boston Medical Center when I was an intern 10 years ago, but I stopped because it was just too dangerous. Since then, urban roads in Boston (and many other cities) are much more bicycle and pedestrian friendly. I’ve seen many changes meant to enhance pedestrian visibility, like raised crosswalks and no parking near crosswalks so drivers can more easily see pedestrians. The decline in urban areas isn’t surprising, but the rise in suburban areas is a real head scratcher!

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Isn't it though, I bike Beacon to work and Comm Ave back home...Newton to Brookline...most days it is glorious

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Dec 23, 2023Liked by Chris Worsham

I think it's the large touch screens in cars but not because they are distracting (that would happen during the day as well) but because the brightness of the display narrows the pupils, ruining the driver's dark vision.

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Certainly possible. I don't know much about the safety regulations in place for this type of display. Mine dims and switches to dark mode, but the other day, I thought to myself "wow this is kind of bright" and realized it could have been much dimmer.

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Dec 24, 2023Liked by Chris Worsham

Yes, it would be interesting to know how dark/dimm mode on various car displays compare to the rear-lit instrument panel lighting and smaller mono color displays of old.

The nice thing is I think it would be pretty straightforward to test. Take some random participants, have them spend x minutes in a dark room, expose them to the display and then measure pupil contraction. This would be repeated for various displays and configurations and for each participant. Perhaps something like that has been done already and is buried in product testing data?

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Dec 23, 2023Liked by Chris Worsham

This is a rather strange "health" topic to explore!

The problem is a combination of multiple factors from PED"s not paying attention while they look at their cellphones, to wearing dark clothes at night and rivers not paying attention as they look at their cellphones or fiddle with their car displays while driving.

Then there is the problem that police enforcement of minor crimes such as cellphone use or not paying attention is negligible unless there is an accident.

Anyway, the solution soon be at hand. Once autonomous cars take over the roads, such problems mentioned above will disappear because drivers will not need to pay attention any longer. The car will do the driving and will have the sensors to avoid hitting PED's.

Then the PED's will only need to worry about criminals coming up on them when they aren't paying attention and robbing them or sucker punching them.

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Trauma is certainly a health topic! I agree that autonomous driving will likely help a lot, but as a relatively uninformed outside observer of automotive technology, it seems like avoiding pedestrians at night might be a more challenging task than avoiding collisions with other cars (but I could be wrong here).

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Fatalities are confounded by the quality of care in the vicinity of the pedestrian being struck. What can we learn by a diff-in-diffs analysis of fatalities -- places where emergency care is outstanding versus places where it is subpar (or non-existent), places where the quality of emergency has changed meaningfully over time? Do more people now live further away form outstanding emergency care (e.g., due to budget cutbacks in hospitals)? Same type of study could be undertaken relative to arrival of retail marijuana dispensing in some but not all parts of the country.

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I like this approach, since timeliness is certainly a core component of trauma care. Doing an analysis that takes advantage of natural variation in EMS response/distance to definitive hospital-based trauma care might shed light on just how much this could be contributing. Not sure how much access to trauma care might have been affected in the years since 2009 either. I worry that many of the fatal injuries are so severe that this may not be a major contributor. I really like the cannabis dispensary idea too--could use granular geographic data, expecting to see decreasing accidents the farther away you got from the dispensary.

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Dec 22, 2023Liked by Chris Worsham

Very interesting to me. I'm a Canadian that like most drives but also run and cycles. I'm more likely to run after dark than cycle. Even my motorcycle is parked before dark whenever just because it is clearly more dangerouse.

Canada is so similar to Amarica that it's hard to see why deaths would be very different in one or the other. We drive the same cars (often trucks) we have similar phone usage (people walking driving and cycling can't put them away) fashion isn't different (often dark colours). Lower drug use? Maybe but I know it's only getting worse here. Homeless people more at risk, accounts for the age group but our homeless problem is only getting worse too.

I have started dearing a flashing light vest thingy when I'm walking or running after dark. I'd advise it for everyone.

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Yeah I think a lot of the trends in the US are going to be similar enough to Canada as to not explain the difference. The absence of difference between Europe or Australia seems a lot easier to explain away than the difference with Canada. Very perplexing!

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Excellent points made regarding types of light the drivers eyes have to adjust to. Also the extreme brightness of oncoming headlights on certain vehicles. We can’t ignore the pedestrians who wear all dark clothing and who show little regard for safety rules while crossing the road. I live in an urban area of a city on the west coast of approximately 175,000. Constantly watching for pedestrians who are not following basic traffic laws in the area I live is common practice. I hope the studies being done on this will benefit the drivers, the pedestrians, the cyclists and all others who use our roadways 🙏

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Today's episode of The Daily offers many plausible reasons for this phenomenon.

https://www.nytimes.com/2024/01/04/podcasts/the-daily/pedestrian-deaths.html?showTranscript=1

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Dec 23, 2023Liked by Chris Worsham

Vehicles getting bigger before 2009? Yet, could we have passed a tipping point?

Head lights. E-code headlight lens have a sharp focus cut off which puts low beam light on the road instead of into trees and oncoming driver eyes. Europe has had those. Were illegal in USA. Current LED USA headlights are white and blindingly bright, mounted at eye level of approaching sedans and small cars. Yellow eye glasses necessary on oncoming drivers to help preserve as much night vision as possible. Such lenses also enhance detail vision lost in bright white light. Yes, I wear them.

Large pickups and SUVs directly injure the torso of adults, shifting previous impact area from legs and pelvis upward to vital organs.

The Magenta Effect. When human pilot or driver is lulled into believing that technology is a safe bubble, relinquishing attention and agency to the tech. So called because of magenta color of cockpit instrument lighting.

The "bubble" is given more credence than it has capability. Can be as simple as believing that four wheel drive also means better four wheel stop.

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I hadn't considered the idea that even if car technology hadn't changed that much, that our perception of increased safety may have. Fascinating!

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Dec 23, 2023·edited Dec 23, 2023Liked by Chris Worsham

You want another strange issue to explore? I was curious about this but discovered after some web searches that there is no definitive answer as to if people who drive convertible cars experience more skin cancers than others. Go for it.

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I bet they do! But they're also probably people who spend more time in the sun when they're not in their car, so hard to know how much of the effect is the convertible specifically. There's some data suggesting a slight increase in skin cancer on the left compared to the right side of the boy in the U.S. which might be due to sun exposure while driving.

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"I bet they do! But they're also probably people who spend more time in the sun when they're not in their car, so hard to know how much of the effect is the convertible specifically."

That is why scientific studies are needed that compensate for such variables.

I recall reading a story about how people who drive a lot had higher incidences of skin cancer on their left arms, EVEN THROUGH THEIR CAR WINDOWS, which indicates that car windows don't offer as much sun protection as some might assume.

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I'm a Canadian who lives in Vancouver and in Southern California during the winter months. I offer a couple of observations based on my experience. When shopping we primarily cycle and rarely drive in either location. We live in downtown Vancouver, so we also walk and use transit a lot. Anecdotal observations but here's what we experience: a lack of sidewalks where we live in SoCal but HUGE amounts of parking so that few stores are accessible even if you did want to walk. There is a Whole Foods within walking distance from us in SoCal with a sidewalk for only a short distance and we'd need to negotiate a monster parking lot to get to the store entry, similar to any grocery store we frequent in SoCal. The vast majority of stores in SoCal are located in malls - it's next to impossible to get to them any other way but in a car. Subsequently, we cycle to shops but once we get there, there are no bike racks so one of has to stay with the bikes. Here in Vancouver, we walk to stores where the entry is from the sidewalk. We cycle to Costco where there are multiple bike racks. In SoCal, the traffic speeds are much faster, the roads are very wide (6 lanes is not uncommon), cars routinely run red lights and rarely come to a full stop before turning right. In our SoCal neighbourhood, there are almost no sidewalks which means drivers aren't expecting pedestrians. We also notice a lot more mobile phone usage by drivers in SoCal, and not hands free, instead they hold their phone up to their mouth to talk into the microphone and so many drivers are consuming a Starbucks or eating a meal while they are driving so I think there is more distracted driving in the US. Because we live in a very urban setting in Canada I can only comment on that experience, but it seems to me that people we know in the US drive a lot more, spending enormous amounts of time in their cars, so aren't primed to think about the existence of pedestrians. Roads are for cars and that view is reinforced by the lack of sidewalks in most of the areas where they drive. In the larger cities we frequent in SoCal (LA and San Diego) the distances are too great for people to walk and again, parking lots are everywhere reinforcing the notion that public space like roads is for cars, not pedestrians and transit is seen as only for 'poor people'. Pedestrians are an anomaly and the built environment supports that. In my experience, pedestrians are not an aberration where I live in Canada and walking is encouraged. Pedestrian demand buttons are common at intersections and advanced pedestrian lights are becoming common allowing pedestrians to enter into the intersection ahead of drivers so they are seen. If only we could outlaw right turns on red!

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Yeah I agree that U.S. car culture certainly sets us up for differences with other countries--I think many of the factors you describe here explain the baseline differences between the U.S. and other countries that goes way back. The challenge here is that it’s not like there was a sudden change in 2009 when it comes to Americans’ relationship with their cars. To the extent infrastructure has been changing, urban areas have become more pedestrian friendly, but I don’t think suburban or rural areas have been becoming more hostile to pedestrians. That being said, a lack of good pedestrian infrastructure might amplify problems brought on by something else that changed around 2009

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I wonder about the trip modal share of car vs. pedestrian in different countries. Are more trips by car in the US or more miles driven in the US? Thinking about 2009 as the point at which the differences emerge implicates cell phone usage/ubiquity leading to distracted driving in my mind. When considering the time of day of the accidents, is the increase in sleep deprivation and the fact that more accidents occur late in the day when the impact of sleep deprivation on cognition is greatest a factor? Is sleep deprivation greater in the US than the other countries - it seems like people in the US work longer hours and start earlier in the day. Most car vs pedestrian accidents occur at intersections. After the recession of 2008/2009 were more people walking for economic reasons, putting more people at risk in an environment with more cars driven by distracted drivers? When did the trend towards bigger vehicles start and are there differences in the size of cars in the US vs the other countries. Maybe it's not a single factor but several overlaid on the US car culture that is driving the difference? Determining the causes could have enormous public benefit - let's hope it attracts the attention it deserves.

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I agree, certainly seems plausible that economic making people work more jobs/later hours, they're traveling by foot after hours when they otherwise wouldn't have, etc. could certainly put pedestrians on streets that they otherwise wouldn't have been on. Combine that with the other factors (such as this disproportionately affecting suburban/rural areas) and it seems plausible that it could explain these findings.

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I live in Chilliwack and wonder if the truck culture plays into it. Pretty hard to see someone over a hood the size of a semi. Shocked the hasting street jaywalking doesn't push up the Canada numbers as well although the same crew shamble randomly across busy streets in the wack too.

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Dec 22, 2023Liked by Chris Worsham

I am wondering if there is granular enough data on the types of cars involved. Some car manufacturers, Subarus until recently for example, have used more knob controls versus screens. Would looking at that help get at the lights or the audio/climate control issue?

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I like this idea! On the one hand, you do have some issues because people who drive Subarus (or any other make) are different drivers than those who drive other makes of cars. But on the other hand, if you were to look only at brand loyalists who always buy a certain make of car, you could look for changes in rates of accidents, pedestrian strikes, etc after they got rid of buttons/knobs, and compare them to people who were loyal to other brands that didn’t make the switch

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Dec 23, 2023Liked by Chris Worsham

If you end up looking into this, Mazda having knob controls for Apple CarPlay was a deciding factor in me buying one 😉 Not having to take my eyes off the road is a huge part of why I bought one!

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Anything that takes your eyes off the road is dangerous. And that includes not only the car displays but also those drivers who insist on turning their heads to the right to look at passengers when they talk to them!

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Dec 22, 2023Liked by Chris Worsham

I think it’s partly a growing sense of entitlement. Comments on local Facebook groups (British Columbia) often express frustration with pedestrians’ rights - eg. “If they don’t want to be hit, they should just get out of the way!” - seems to coincide with anti-vaccine sentiment also. There’s a lot of “you can’t make me” around these days.

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Interesting. I would hope that this attitude doesn’t translate into true recklessness behind the wheel! But it also seems like there wouldn’t be many differences between the U.S. and Canada here, and yet we see it in the data. 🤔

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There have been some news stories where kiddies think it is fun to search out bike riders and PED's and sideswipe them or even hit them as they film the event. It's been on the news lately.

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But you have Trump! We’re not quite there yet.

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close Little PP gonna win by default like we are apt to do in canada. We vote out leaders, don't vote in...

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Fascinating and sad. One possibility missing is that, seemingly paradoxically, more street lighting leads to more accidents. The increase in use of LEDs and brighter lighting gives harsher shadows making it harder to see someone in the shadows (this is why you should not go for the brightest security lighting). Also, at places like intersections with crosswalks where there are lots of lights it makes seeing lights (including traffic lights) more difficult. I recall once near a brightly lit intersection the police were doing random breath tests and standing in the middle of the road waving a torch around. I was pulled over for a test (negative!) and immediately said to the police officer that they could not be seen properly on the road. He laughed - within 10 seconds a car went into a four wheel slide trying to avoid the officer on the road. All because there were too many lights.

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"The increasing popularity of brighter LED bulbs might impact the vision of drivers traveling the opposite direction, especially if the light beam is not aimed correctly (such as when installing an after-market bulb)"

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I don't think that modern lights have "adjustments" any longer. I know my car doesn't and it is far from new. And I have changed the bulbs multiple times.

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I don't know why I have to keep signing on Substack. Is this something to do with Nazi's?

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deletedDec 23, 2023Liked by Chris Worsham
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These are some great points. Re #1, there is some discussion in the original article about economic forces possibly placing more workers on the streets as pedestrians, which seems plausible though I imagine it's very difficult to take measurements of actual pedestrians. I also like the idea of thinking of this in a per-mile-driven effect; those same economic forces in certain areas could be putting more drivers on the road as well. And the difference in incentives--it's on the manufacturers to focus on safety within the car, government's responsibility to engineer pedestrian safety--is also a fascinating consideration. If we're looking at a future of autopilots, it certainly seems like protecting people in cars would be easier than protecting pedestrians, who are unpredictable and harder to spot.

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