The San Joaquin valley project is a collaborative effort between the Central Valley health Policy Institute, California State University and six county health department directors and/or their designees to include Fresno, Kern, Kings, Madera, Merced, and Tulare counties. Other external support from institutions, such as the California Highway Patrol and Emergency Medical Services, has also been particularly valuable for the achievement of the project goals.

Problem Statement-
Motor vehicle crashes (MVCs) continue to be the leading cause of death in the United States for individuals between the ages of 4 and 34 years, and the second most frequent cause of death for toddlers.1 Injuries from MVCs are also expensive, resulting in an estimated 3.2% of all U.S. medical expenditures, as well as more than 14% of all medical costs for persons aged 15 to 24 years.2 Death rates for MVCs have decreased significantly over the past three decades, although recent data suggest that no such decrease has occurred in rural America.3 In fact, while residents of rural areas made up just 21% of the U.S. population in 2004, 58% of all traffic fatalities were the result of accidents in rural areas.4 In addition, racial and ethnic minorities are disproportionately killed in motor vehicle accidents, compared with non-Hispanic whites. This seems especially true for Hispanics, for whom MVCs are the fifth leading cause of death for all age groups.1 In one studied region, Hispanics accounted for 45% of all MVCs, whereas they comprised only 30% of the area's population.

Three of the six counties participating in the San Joaquin Valley project are within the top ten California counties for which motor vehicle fatalities are most frequent. Kern County ranks sixth in the state; Fresno County is ranked seventh. 6 Although there is a shortage of conclusive data demonstrating that San Joaquin Valley MVCs occur at a higher rate in rural areas or to ethnic minorities to date, this is likely to be the case given the national statistics mentioned above, the ethnic diversity of the region (39.8% Hispanic), and the rural/agricultural characteristics of the valley.

Acquiring data on MVCs in the San Joaquin Valley is paramount to addressing the social conditions that lead to motor vehicle injuries and fatalities in the region and to the social disparities that likely exist. The purpose of our study is to identify and develop a regional database for the San Joaquin Valley to assess the social determinants of MVCs for minority populations in rural areas throughout the project’s six counties and to use this data to inform program, practice, and policy development.    

Targeted Actions-
The team continues to identify and engage stakeholders, hold regular meetings to develop and finalize plans, create a network for regular communication with potential leaders in the region, and to stay in touch with Place Matters staff and organizers for support and clarification. Potential sources of data are being identified and reviewed and a comprehensive literature review is being conducted to inform research activities. In addition, our research analyst is registered to receive training in GIS mapping and community analysis. The skills obtained in creating thematic maps of data and displaying spatial trends in information will be highly valuable to the achievement of project goals.

At this stage in the project, plans for the allocation of resources to address health disparities are tentative, as the determinants of motor vehicle accidents disparity in the region are still unknown. Regardless of what determinants are found, however, the dissemination of information to relevant stakeholders and to the community as a whole will be a major focus of efforts to influence change. In fact, it is our goal to disseminate findings beyond the local level and to inform the state and the nation as a whole about the determinants of health disparities found in our research by submitting our reports for publications in refereed journals and presenting at national, state and local conferences. Collaboration with relevant community agencies to disseminate and utilize the findings in programs, practices, and/or policies that will reduce health disparities will depend largely on the type of determinants found in data analysis to be influential. If, for example, it is discovered that a major cause of regional motor vehicle accidents is a lack of law enforcement in rural areas, collaborations with local law enforcement agencies will be formed so that relevant and effective changes can be implemented.


Anticipated results and outcomes-

In the long-term, it is anticipated that motor vehicle related mortality and morbidity rates will decrease in the San Joaquin Valley and that there will be a reduction in social disparities related to motor vehicle injuries and fatalities. The identification of the determinants that drive motor vehicle crashes, injuries, and fatalities in the region will be invaluable in determining the best ways to invest time, money, and effort into interventions that have a real and lasting impact. The collaboration among the participating counties will increase the likelihood that information is disseminated and that a greater number of areas are affected by findings and related interventions. Further, collaborations with community agencies, based on findings on significant determinants, will ensure that efforts to reduce disparities in motor vehicle morbidity and mortality in the region will be effective and relevant.


REFERENCES

1. National Highway Traffic Safety Administration, Race and Ethnicity in Fatal Motor Vehicle Traffic Crashes 1999-2004. DOT 809 956. Washington, DC: NHTSA, 2006.
   
2. Miller TR, Lestina DC, Spicer RS. Highway crash costs in the United States by driver age, blood alcohol, victim age, and restraint use. Accid Anal Prev. 1998; 30:137–150.
3. Brown LH, Khanna A, Hunt RC. Rural vs. urban motor vehicle crash death rates: 20 years of FARS data. Prehosp Emerg Care. 2000: 4:7–13.
4. National Highway Traffic Safety Administration, Traffic Safety Facts 2004 Data: Rural/Urban Comparison. DOT 809 938. Washington, DC: NHTSA, 2006.
   
5. California Highway Patrol. Annual report of Fatal and Injury Motor Vehicle Traffic Collisions. Statewide Integrated Traffic Records System, 1995.
6. National Highway Traffic Safety Administration, Toll of Motor Vehicle Crashes, California, 2005.
7. Lopez, Alejandra. Latino Communities of the Central Valley: Population, Families, and Households. Center for Comparative Studies in Race and Ethnicity, 2001.