Activities of the Bloomberg Philanthropies Global Road Safety Programme (formerly RS10) in Russia: promising results from a sub-national project
Ekaterina S. Slyunkina*a, Vladimir E. Kliavinb, Elena A. Gritsenkoc, Alexandr B. Petruhinc, Francesco Zambond, Huan Hea, Adnan A. Hydera
aJohns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USAbLipetsk State University of Technology, the Federal State Institution of Higher Professional Education, RussiacIvanovo State University of Technology, the Federal State Institution of Higher Professional Education, RussiadWorld Health Organization
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Injury
j our na l homepage: www.e lsev ie r.com/ loca te / in ju r y
E.S. Slyunkina et al. / Injury, Int. J. Care Injured 44 S5 (2013) S64–S69 S65
of RTIs in Russia was approximately US$26 billion.4 In 2011, RTIs
became the fourth cause of injury fatalities and accounted for
75% of all types of injuries and 60% of severe trauma cases.3,5 Road
traffic mortality rate in Russia peaked in the early 1990s (26.0 per
100,000 population) and, after an initial fall in 1997 (by 19.0 per
100,000 population), rose again by 23.9 per 100,000 populations
in 2004 and has been in decline since (19.6 per 100,000 population
in 2012). WHO estimates that majority of traffic fatalities in Russia
occur among car occupants (57%), followed by vulnerable road
users (42%).1 Speeding vehicles as reported cause one-third of car
crashes in Russia.3
The use of seatbelts has been shown to be an important means
of reducing the risk of death or serious injury in a road crash by
almost 50% for front seat occupants, and about 25% to 75% for
rear seat passengers.6-8 Child restraints, if correctly installed and
properly used, can reduce road traffic deaths by 70% in infants and
54-80% in small children.9 Developed countries have relatively
high seatbelt use rates: as high as 97% for front occupants and 92%
for rear seat occupants in Australia and 93% and 87% respectively
in Canada.1 Seatbelt wearing rates in low- and middle-income
countries (LMICs) are lower, as low at 0% and 1% in Cambodia
and Chad respectively.1 There are exceptions, such as Colombia,
which has reached 82%. Brazil, China and South Africa have
seatbelt wearing rates between 50% and 80%.1 Russia made
seatbelt-wearing compulsory in 1975 for drivers, front seat and
rear seat passengers, and in 2005 mandatory child restraints use
for children under 12 years of age was added to the Road Traffic
Rules provisions concerning child safety.10 WHO examined the
seatbelt rate (97% front seat occupants, 8% of rear seat passengers)
and ranked effectiveness of seatbelt law enforcement as 7 out of
10.1
The problem of excessive speed has long been recognized as a
major factor in road traffic crashes causation and is a major road
safety problem in all countries.1,11 The role of speed limits and
road crashes has also attracted considerable debate over the years
with a numbers of studies evaluating the effects of reduced speed
limits on crash involvement and injury rates.12,13 According to
the Organization for Economic Co-Operation and Development’s
International Transport Forum (OECD ITF) speed is a contributory
factor in 29% of road traffic deaths and speed limits are widely
flouted on Russian roads.1,9
The Bloomberg Philanthropies Global Road Safety Programme in
Russia
The overall goal of the Bloomberg Philanthropies Global
Road Safety Programme (formerly known as the Road Safety in
10 Countries Project, or RS10, and hereafter referred to as “the
Global Road Safety Programme”, or, “the programme”) in Russia
is defined as supporting the government in the implementation
of its national objectives and preventing deaths and serious
injury on the country’s roads.14 In 2012, Russia saw 27,991 road
deaths and 258,618 police-reported non-fatal road traffic injuries.
In Russia, seatbelts non-use and speeding are the two risk
factors being targeted by the program through legislation, police
enforcement and social-marketing campaigns. The program
is led in-country by the Department of Road Safety within the
Russian Ministry of Interior and jointly implemented by other
governmental departments at the national and regional level in
two interventions sites, Ivanovskaya and Lipetskaya Oblast. Criteria
for the selection of the sites included the road safety situation, the
population size, readiness to start large project and, political will
and support to road safety activities. A National Advisory Board
to the program was then established, and a joint work plan of
activities with inputs from international consortium partners, as
well as federal and regional partners was prepared and approved.
The program interventions on seat belt were first designed and
carried out in Lipetskaya Oblast, where the seat belt campaign was
formally launched in November 2010, and in Ivanovskaya Oblast
in May 2011. A new social marketing with the motto “Do not
disconnect the line of life”.15 A social marketing speed campaign
similar to that on seat belt was officially launched in August 2011
in Lipetskaya Oblast and in April 2012 in Ivanovskaya Oblast. The
motto of the speed campaign was, “Life is more important than
speed”.2,5
The overall goal of this paper is to provide an interim
assessment of the current situation in both interventions
sites, and to suggest, on the basis of these preliminary results,
recommendations for future road safety initiatives. This paper
will add to what is known about seatbelt use and speeding
in Russia by examining a number of road behaviors and
establishing a benchmark of safety in two Russian region by
providing a: a) seat belt wearing rates for all seat positions
and b) percentage of speeding vehicles by speed limit and road
types. This study was undertaken by a research team at the Johns
Hopkins Internationally Injury Research Unit (JH-IIRU) at the
Johns Hopkins Bloomberg School of Public Health (JHSPH) in
partnership with the Lipetsk and Ivanovo State Universities of
Technology. Previous literature has demonstrated the advantage
of observational studies on seatbelt use to establish a benchmark
of safety on the roads, but very little data was collected on
seatbelt use and speeding in Russian regions. To our knowledge,
this is among the first such attempt in Russia to provide such
information. This study hopes to guide the effective enforcement
of existing policies surrounding these two risk factors, or develop
more targeted social marketing and public education campaigns
in the country.
Methods
Lipetskaya Oblast, is part of the Central Federal district and
located approximately 500 km southeast of Moscow.16 The
population of Lipetskaya Oblast is 1,165,800 of which 67% live in
urban areas and 33% live in rural areas.17 In Lipetskaya Oblast, the
rate of RTIs is slighter higher than in the Russian Federation, at
23.1 per 100,000 population and 249.1 per 100,000 population
representing 271 deaths and 2,927 non-fatal road traffic injuries
in 2012.2 The second Intervention site is also part of the Central
Federal district with the capital Ivanovo city. The population
of Ivanovskaya Oblast is 1,053,800 of which 19% live in rural
areas and 81% live in urban areas.18 In Ivanovskaya Oblast, the
rate of road traffic fatalities is slighter lower than in the Russian
Federation, at 17.6 per 100,000 population, representing 187
deaths in 2012. Similarly, the non-fatal road traffic injuries
were approximately 15 times as many deaths, 2,760 (190.1 per
100,000).2
The study was held in six provinces in Lipetskaya Oblast:
Lipetsk, Yelets, Gryazi, Dankov, Usman and Chaplygin; and
seven provinces in Ivanovskaya Oblast: Rodnikovsky, Teikovsky,
Vichugsky, Ivanovsky, Furmanovsky, Privolzhsky, and Shuisky.
The observations were carried out in three sites in each province,
for a total of 18 sites in Lipetskaya Oblast and 21 sites in
Ivanovskaya Oblast. For each of the provinces in both Oblasts,
the following site selection process was used: Site 1, paved city
road (urban|60 km/h); Site 2, main highway (90 km/h); and
Site 3, village road (rural|60 km/h). The observation sites were
selected to ensure diversity of traffic and roads. Preferences were
given to sites with higher traffic volumes in order to maximize
the amount of data that could be collected over short period of
time. Both the Institutional Review Board (IRB) at JHSPH, USA
and Department of Public Health of Lipetskaya and Ivanovskaya
Oblast approved the observational study surveys.
S66 E.S. Slyunkina et al. / Injury, Int. J. Care Injured 44 S5 (2013) S64–S69
For seatbelt and child restraint use, the following behavioral
safety indicators (explanatory variables) were measured in
each round: seatbelt use by drivers and passengers; passenger’s
seating position in the car; child restraint usage and vehicle
occupancy rate. The observational locations comprised
intersections which allowed clear visibility for observers to view
vehicle occupant(s), and excluded any sites that might risk the
safety of observers. Observation periods were limited to daylight
hours, but in order to represent each site at different times of the
day, observational studies took place in 90-minute blocks. Time
periods were randomly distributed across observational locations
and selected to capture a representative sample of traffic flow
across the working day and weekend days. Observations were
carried out for seven days simultaneously by 48 observers in in
Lipetskaya Oblast and by 62 observers in Ivanovskaya Oblast. Ten
rounds of observation studies on selected roads of Lipetskaya
Oblast were carried out between October 2010 and March 2013.
In Ivanovskaya Oblast, eight rounds of data collection were
conducted between April 2011 and March 2013.
Speed measurement was measured for passenger saloon
cars or derivatives (4-door cars, taxis), light trucks such as
pickup trucks and double-cabin trucks, large trucks (lorries
and tankers), small passenger vans (minibuses) and regular
buses, and SUVs (all 4-wheel drive vehicles). Only those vehicles
demonstrating free speeds, that are a minimum of four-second
clear headway18 (i.e. speed is not limited by other vehicles), were
included in the road-speed sample. If more than one vehicle
simultaneously passed by, the vehicle closest to the curb of
roadside was observed. Identified observational locations were
flat, straight or curved section of road with an adequate safe site
distance, located in the distance from traffic-enforcement camera
or other type of police enforcement and suitable for the use of
speed gun (Figure 1). Vehicle speeds in km/h for all free speeding
vehicles were recorded continuously over the four study days in all
provinces at each site for 1.5 hour each round. Figure 1 showed the
observation scheme. The time of day allocation was identical to
that of the seatbelt observation studies. Behavioral data on speed
was collected through seven rounds of observation studies on
selected roads of Lipetskaya Oblast between July 2011 and March
2013. In Ivanovskaya Oblast, five rounds of data collection on
speeding were conducted between March 2012 and March 2013.
All observational data were obtained in Microsoft Excel®
sheets, and for data analysis, both Microsoft Excel® and Stata 11®
were utilized. We reported the seatbelt use rate and used z-tests
to test for differences in frequencies. The missing rate for seatbelt
use and child constraints use are both less than 0.5%, the missing
rate for the explanatory variables are less than 1.5%. Therefore
no data imputation needed to be done. Bivariate tabulation was
done to describe the distribution of vehicle and demographic
characteristics, with of 2 significance test. Proportion estimations
by seat position are done for each round and region with 95%
confidence interval.
Results
In total 30 rounds of observational studies was conducted
with an overall sample size of 909,120 between October 2010 and
March 2013.
Figure 2 demonstrates the preliminary findings of the ten
rounds of obse rvational studies for seatbelt use and child seat
use in Lipetskaya Oblast. It can be seen that seatbelt use has
continuously increased among both drivers and passengers
over this time period. For drivers, seatbelt use increased from
55.7% (N=26,897 in October 2010) to 74.8% (N=22,163 in March,
2013), a statistically significant (P<0.05) 19% increase. Among
passengers, the increase is even more significant: from 46.3%
(N=15,024) to 70.5% (N=9,578), a 24% increase. The proportion of
passengers wearing their seat belts was low for the rear seating
position at 34.9% (N=1,770) in March 2013; this is in contrast to
the proportion of front seat passengers wearing seatbelts at 78.6%
(N=7,784), almost 4% higher compare to the seatbelt prevalence in
drivers. Child restraints use for children 0-13 years has remained
at a low level (40.6%, N=276), even though there is a 20% increase,
over time.
Figure 3 demonstrates the observed seatbelt use over 8
rounds of data collection in Ivanovskaya Oblast. At baseline, 9,127
vehicles were observed, among which 52.0% (N=9,127) drivers
and 39.4% (N=5,020) of all passengers were wearing seatbelts.
The proportion of front seat passengers wearing their seatbelt
was 50.0% (N=3,265), and similar to Lipetskaya Oblast, rear seat
passengers had a much lower seatbelt use rate of 20.0% (N=1,604).
Seatbelt use has continuously increased among both drivers and
passengers over this time period: the seatbelt use rate among
drivers in March 2013 significantly increased to 91.6% (N=20,951)
and among passengers, seatbelt usage increased to 83.8%
(N=11,476). Front seat passengers had a significant 42% increase
Figure 1. Observational Studies Speeding: Observation Scheme. Source: Lipetsk State University of Technology (2011).
E.S. Slyunkina et al. / Injury, Int. J. Care Injured 44 S5 (2013) S64–S69 S67
while rear seat passengers had a 22% increase. The use of child
car seat increased from 20.4% to 68.9% (N=428). Although overall,
real seat passengers and children still have a low rate of seatbelt
or seat use.
Table 1 demonstrates the differences in observed speeding
patterns on the roads of Lipetskaya Oblast. Preliminary free speed
measurements in Round 1 (July 2011) revealed that 47.0% of vehicles
were above the speed limit, among which 9% were speeding over
30% above the speed limit. In March 2013 (Round 7), 32,521 vehicles
were observed, among which 26.1% of all vehicles were above the
speed limit, 21% statistically lower than that observed in July 2011.
When comparing the patterns of speeding, we notice that the large
samples of speed data indicate a consistent pattern of reductions in
all six sites and on all types of roads.
Preliminary free speed measurements in Round 1 (March 2012)
in Ivanovskaya Oblast revealed that across the surveyed sites in
60 km/h and 90 km/h speed zones, 54.7% of vehicles were above
the speed limit, almost 9% were speeding over 30% of the speed
limit (Table 2). In March 2013 (Round 5) speeding observations in
were recorded for 33,146 vehicles and 40.1% were above the speed
limit (15 % statistically lower than that in March 2012), among
which 1.4% were speeding over 30%. About 32.8% of vehicles were
exceeding the 60 km/h speed limit in March 2013 (compared to
61.1% in Round 1), 28% statistically lower. About 45.8% of vehicles
were exceeding the 90 km/h speed limit (49.8% in Round 1), 4%
statistically lower. Examining those vehicles exceeding the speed
limit by vehicle type showed that a greater proportion of SUV
vehicles and cars, compared to light and large trucks were observed
Figure 2. Observed seatbelt wearing rates in Lipetskaya Oblast, 10 rounds, October 2010 – March 2013. Child Restraint Use for child <13 as a passenger Included in front,
center and rear seat passengers.
Fig ure 3. Observed seatbelt wearing rates in Ivanovskaya Oblast, 8 rounds, October 2010 – March 2013. Child Restraint Use for child <13 as a passenger Included in front,
center and rear seat passengers.
S68 E.S. Slyunkina et al. / Injury, Int. J. Care Injured 44 S5 (2013) S64–S69
exceeding the speed limit. Vehicles on highways, and both city and
local rural roads showed a reduction in speeding patterns.
Discussion
There is a very little current research underway in country to
identify and explain the role of vehicle speed in road behavior and
traffic crashes; our study is among the first to assess and describe
the changes in the regional risk factor prevalence over time that
measured in the sequential roadside observations. As in high-
income countries, adoption of proven road safety legislation and
strategies supported by the targeted social marketing campaigns
could contribute to reducing the Russian road toll. Further
monitoring and investigation of reason for non-compliance with
speeding and wearing seatbelts is required to guide future speed
compliance and seatbelt-wearing campaigns, including attitudinal
studies of drivers and passengers. Speeding and seatbelt wearing
rates should continue to be monitored and multiple data points
obtained.
Observational studies demonstrate an increase in seatbelt
wearing rates from the first survey held in October 2010 in
Lipetskaya Oblast and April 2011 in Ivanovskaya Oblast, prior
to the start of the Global Road Safety Programme. The overall
prevalence of seatbelt use increased from 52.4% to 73.5%
amongst all occupants in Lipetskaya Oblast and from 47.5% to
88.8% in Ivanovskaya Oblast. While seatbelt use has continued
to increase among both drivers and passengers, child car seat
use remains at a low level in both intervention regions. The data
also demonstrates the need for continuous targeted intervention
to increase seatbelt use, especially the use of child restraints
and seatbelt use among rear seat passengers, and to decrease
speeding. It should be noted there was a higher rate of national
seatbelt usage reported by the Russian government to WHO1
than is shown in the regional data.
Observational studies on speeding also show signs that
drivers are speeding less from the first survey held in July 2011 in
Lipetskaya Oblast and March 2012 in Ivanovksya Oblast. During
the time the Global Road Safety Programme interventions were
being implemented the data was shown to have consistent
reductions in vehicle speeds of 6.8 km/h in Ivanovskaya Oblast
and 3.5 km/h in Lipetskaya Oblast, and a significant reduction
in the p roportion of vehicles exceeding the speed limit: from
54.7% to 40.1% in Ivanovskaya Oblast and from 47.0% to 26.1% in
Lipetskaya Oblast.
The Police data in Lipetskaya Oblast shows a decrease of 16
fatalities in comparison to the same period of 2011 that correlate
with the programmes interventions that started early in
Lipetskaya Oblast.2 We should note the absence of a comparison
Oblast and or the liability to distinguish between the results of a
concurrent federally funded road safety program and the Global
Road Safety Programme. This calls for caution in attributing
trends to the programmes interventions alone since it is too early
to draw any definite conclusions.
This paper has several strengths, including the use of multiple
data collection methods and various sources, multiple time
points with regular rounds of data collection, large sample size,
carefully designed representation of the region, detailed records
of all seat positions and speed observed across different roads
among various vehicles. However, it is too early to document
the impact on road traffic outcomes specific to risk factors (i.e.
crashes/injuries/deaths due to speeding), and some disaggregated
data is not available (i.e. by road user category, by demographics,
etc.). Secondly, we were only able to observe speed and seatbelt
use during specific times of the day and in limited number of
provinces in both Oblast. Though these data do provide variable
information about the issues and risks for drivers and vehicle
occupants, they are not nationally representative. Lastly, the
absence of a comparison region calls for caution in attributing
trends to interventions alone.
Our preliminary results of observational studies show some
promising signs that speeding and seatbelt use are moving in
the right direction in both Oblasts subsequent to the various
programme countermeasures being implemented. However, it is
too early to draw any definite conclusions. If behavioral changes
Table 1Speed observations in Lipetskaya Oblast, seven rounds, July 2011 – March 2013
Average 0-10% 10-20% 20-30% >=30%
Total speed Range Over the over the over the over the over the
