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This study aims to provide a better understanding of Native American women veterans’ experiences with Veteran Administration and Indian Health Services. Eighteen interviews were conducted with special attention to the quality and quantity of health and mental health care services veterans accessed, the barriers and local contextual factors in accessing and utilizing services, and potential solutions to service gaps for women veterans from two Montana reservations, the Northern Cheyenne Reservation and the Confederated Salish and Kootenai Tribes of the Flathead Reservation.

We examine the barriers and needs of Native American veterans in both reservations using qualitative methods. The research analyzed 18 interviews with women veterans from the Northern Cheyenne and Flathead reservations.

Native American women veterans identified a number of barriers to accessing care, some of which include lack of information regarding eligibility and the types of services available. Women often found the application process to be confusing and difficult. Other barriers included distance, cost of travel, and conflicts with their work schedule.

This exploratory case study served to clarify the challenges and obstacles Native American women veterans experience with accessing health and mental health services. This research revealed several patterns and themes in the experience of Native American women veterans in both reservation communities when attempting to access and seek care at Veterans Administration (VA) facilities and Indian Health Services (IHS). This research calls for policy changes and research to clarify how resources can be more efficiently and effectively distributed to rural veterans.

Little research has addressed the needs of Native American veterans. American Indians and Alaska Natives serve at a higher rate in the U.S. military than any other population. This research provides important information about Native American veterans who are often underrepresented in survey research, yet a rapidly growing segment of the United States military and veteran population.

Purpose – The purpose of this chapter is to review the methodological and empirical underpinnings of transport network screening, or management, as it relates to improving road safety. As jurisdictions around the world are charged with transport network management in order to reduce externalities associated with road crashes, identifying potential blackspots or hotspots is an important if not critical function and responsibility of transport agencies.

Methodology – Key references from within the literature are summarised and discussed, along with a discussion of the evolution of thinking around hotspot identification and management. The theoretical developments that correspond with the evolution in thinking are provided, sprinkled with examples along the way.

Findings – Hotspot identification methodologies have evolved considerably over the past 30 or so years, correcting for methodological deficiencies along the way. Despite vast and significant advancements, identifying hotspots remains a reactive approach to managing road safety – relying on crashes to accrue in order to mitigate their occurrence. The most fruitful directions for future research will be in the establishment of reliable relationships between surrogate measures of road safety – such as ‘near misses’ – and actual crashes – so that safety can be proactively managed without the need for crashes to accrue.

Research implications – Research in hotspot identification will continue; however, it is likely to shift over time to both closer to ‘real-time’ crash risk detection and considering safety improvements using surrogate measures of road safety – described in Chapter 17.

Practical implications – There are two types of errors made in hotspot detection – identifying a ‘risky’ site as ‘safe’ and identifying a ‘safe’ site as ‘risky’. In the former case no investments will be made to improve safety, while in the latter case ineffective or inefficient safety improvements could be made. To minimise these errors, transport network safety managers should be applying the current state of the practice methods for hotspot detection. Moreover, transport network safety managers should be eager to transition to proactive methods of network safety management to avoid the need for crashes to occur. While in its infancy, the use of surrogate measures of safety holds significant promise for the future.

Purpose – Intersections are hazardous locations and to improve their safety we need to understand the factors contributing to crashes at these locations and provide evidence-based recommendations to reduce them. This chapter provides a summary of the findings on infrastructure-related factors contributing to crashes at urban and rural intersections and some discussions on the implications and potential countermeasures.

Approach – A review of the literature on intersection crashes was performed to identify the infrastructure-related crash-contributing factors. Some discussions on the implications and potential countermeasures are then provided.

Findings – The factors contributing to road crashes are diverse and complex. While the safety effects of a few factors (e.g., exposure and speed) are relatively consistent, many factors have different impacts on crash frequency and severity (e.g., types of intersection) and different impacts on urban and rural intersections (e.g., bus stops).

Research Implications – More studies are needed on developing a stronger theoretical or conceptual foundation on the effects of roadway designs and traffic controls on different dimensions of safety (e.g., exposure, frequency, severity, etc.), types of crashes (e.g., head-on, rear-end, etc.) or road users involved (e.g., drivers, pedestrians, cyclists, etc.).

Practical Implications – Transport engineers need to be aware that some treatments may have different effects on different crash types and road users involved. Even though the overall safety may be improved by the treatments designed, they need to consider and mitigate any unintended consequences to satisfy the Pareto improvement principle and the social equity criterion.

Purpose – Driver education and licensing are two mechanisms used to reduce crash rates. The purpose of this chapter is to provide an overview of these countermeasures and consider how simulators can be used to augment more traditional approaches.

Approach – A literature review was undertaken evaluating key concepts in driver licensing including graduated driver licensing (GDL), the role of parents in licensing, compliance and enforcement, driver testing and how the driver licensing system impacts on levels of unlicensed driving. Literature regarding driver education for individuals who have and not yet obtained a licence was also reviewed.

Findings – GDL is a successful countermeasure for reducing the crash rates of young novice drivers as it limits their exposure to higher risk situations. The support for driver education initiatives is mixed. As there are big differences between education programs, there is a need to consider each program on its own merits. Driving simulators provide a safe environment for novices to gain experience. In particular, they may be bifacial for development of hazard perception and visual scanning skills.

Practical Implications – GDL systems should be introduced where appropriate. Existing systems should be strengthened where possible by including additional, best-practice and restrictions. When considering driver education as a countermeasure, the type of program is very important. Education programs that have been shown to increase crashes should not be introduced. Further research and development are necessary to ensure that driver education and licensing adequately equip novice drivers with the skills necessary to drive in the 21st century.

Purpose – Driver distraction and other forms of driver inattention remain significant road safety problems. The purpose of this chapter is to explore recent developments in theoretical and empirical research on driver distraction and inattention and provide the reader with a sense for, and understanding of, the key issues.

Methodology – Key references from the literature are reviewed and discussed.

Findings – First, we discuss one way of conceptualising the distinction between driver distraction and other forms of inattention, as well as the mechanisms which may underlie these forms of inattention. Second, we underscores how driver distraction may derive from a plethora of sources, and how the potential for performance degradation deriving from driver interaction with these sources may be moderated by a range of factors. Third, we review recent literature on the types of impairments in driving performance and safety associated with driver distraction. Fourth, we outline recent literature on driver distraction and inattention in the realm of highly automated vehicles that will drive the transport future. Finally, we discuss some promising strategies aimed at preventing and mitigating the impact of driver distraction.

Research implications – There are many gaps in the driver distraction literature that need to be addressed. In addition, further research needs to be undertaken to examine the role of driver distraction in the realm of highly automated vehicles.

Practical implications – The findings point towards of a range of injury prevention countermeasures that have potential to prevent and mitigate driver distraction.

Purpose: This chapter synthesises a variety of findings on the topic of aggressive driving and delivers a suite of strategies for moderating such behaviours. Examples and formal definitions of aggressive driving acts are given, along with specific techniques for reducing excessive speed and other aggressive behaviours.

Methodology: Key references from the literature are summarised and discussed, and two examples detailing how multi-parameter distributions and models compare with the negative binomial distribution and model are presented.

Findings: Speeding is the most common type of aggressive driving, and speeding-related crashes represent a high share of traffic deaths. Speeding relates to many factors, including public attitudes, personal behaviours, vehicle performance capabilities, roadway design attributes, laws and policies. Anonymity, while encased in a vehicle, and driver frustration, due to roadway congestion or other issues, contribute to aggressive driving.

Research implications: More observational data are needed to quantify the effects of the contributing factors on aggressive driving.

Practical implications: Driver frustration, intoxication and stress can lead to serious crashes and other traffic problems. They can be addressed, to some extent, through practical enforcement, design decisions and education campaigns.

Purpose – This chapter provides an overview of issues related to analysing crash data characterised by excess zero responses and/or long tails and how to overcome these problems. Factors affecting excess zeros and/or long tails are discussed, as well as how they can bias the results when traditional distributions or models are used. Recently introduced multi-parameter distributions and models developed specifically for such datasets are described. The chapter is intended to guide readers on how to properly analyse crash datasets with excess zeros and long or heavy tails.

Methodology – Key references from the literature are summarised and discussed, and two examples detailing how multi-parameter distributions and models compare with the negative binomial distribution and model are presented.

Findings – In the event that the characteristics of the crash dataset cannot be changed or modified, recently introduced multi-parameter distributions and models can be used efficiently to analyse datasets characterised by excess zero responses and/or long tails. They offer a simpler way to interpret the relationship between crashes and explanatory variables, while providing better statistical performance in terms of goodness-of-fit and predictive capabilities.

Research implications – Multi-parameter models are expected to become the next series of traditional distributions and models. The research on these models is still ongoing.

Practical implications – With the advancement of computing power and Bayesian simulation methods, multi-parameter models can now be easily coded and applied to analyse crash datasets characterised by excess zero responses and/or long tails.

Purpose – This chapter first provides the motivation for writing this book. It then describes the challenges involved with assessing societal safety through the analysis of transport system crashes. It concludes with a summary of the contents of the remainder of the book, identifying how various dimensions of the transport system challenges are addressed.

Methodology/Approach – This chapter discusses important real-world and methodological challenges that practitioners, academics and researchers face in making a more sustainable highway system through a reduction in the number and severity of transport network crashes resulting in fatalities, injuries and property damage.

Findings – The chapter first describes important challenges, such as complexity of the driving task, the challenges of engineering transport systems for humans, unanticipated effects that arise from differences between driver safety and security, the co-mingling of mobility modes of travel, and challenges in evaluating road safety. The chapters are separated into five general themes: driver behaviour, the transportation network, vulnerable road users, methods for understanding and predicting safety performance, and methods for evaluating safety impacts of countermeasures.

Practical Implications – Comprehending the challenges associated with road crashes is a first step in making the roadway system more sustainable. This book provides a broad and understandable description of these challenges and how they can be overcome by academics and practitioners working in transport network safety management.

Originality – This book presents a clear understanding and offers insights about the challenges and potential solutions that can be brought to bear to make a more sustainable and safe transport system, whether it is located in an urban or rural area, and for a wide variety of functional classifications and designs. The topics covered in this book are intended to be useful and applied to tackle transport system management anywhere in the world.

Purpose – Bicycle riding provides a sustainable and affordable solution to many of the significant problems associated with motorised transport and physical inactivity. The provision of infrastructure plays an important role in encouraging people to begin and subsequently continue to ride bicycles and to do so safely.

Methodology – This chapter describes different types of on- and off-road infrastructure and reviews studies of their effects on rider numbers and safety. In addition, it looks at the roles that end-of-trip facilities and bikeshare programs can play in contributing to bicycle use and general transport sustainability.

Findings – Infrastructure characteristics can influence both perceived and objective levels of safety. It is important to identify and avoid treatments that increase perceived safety but are actually less safe. The type of infrastructure needed or desired differs between current and potential riders and according to trip purpose. Well-designed marked bicycle lanes on roads can reduce crash rates. Safety at intersections can be improved by: advanced green lights for cyclists, short cuts for right-hand turns, brightly coloured bicycle paths and advanced waiting positions for cyclists. Off-road facilities are generally safer, but intersections with roads must be carefully treated. Shared paths and footpaths are risky for older pedestrians (and older cyclists).

Implications – In many countries the provision of more infrastructure that increases the perceived safety of riding is needed to encourage cycling, particularly transport cycling and cycling by women.