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and enforce than those of alcohol.80 What might expanded legalization of marijuana and increased opioid abuse mean for impaired driving in the years ahead and for appropriate safety responses? How do other legal and illegal drugs affect driving performance and which drugs should drivers be tested for following incidents and crashes? 29. Despite long-term trends in reduced death and injury rates in highway transportation due to improved vehicles and infrastructure, the United States is experiencing rapid growth in pedestrian and cyclist deaths (a 46% increase in pedestrian deaths since 2009)81 and is falling behind the safety level being achieved in other industrialized democracies. Which strategies would be most effective in reducing the growing number of pedestrian and cyclist deaths and injuries? Equity The United States is a prosperous nation, but its benefits are not equally shared. More than 40 million citizens live below the poverty line, 23 million of whom are working-age adults.82 An estimated 9% of households lack an automobile,83 and this percentage grows to 21% in households earning below $25,000.84 Being employed without an automobile is manageable in some central cities with good public transportation and taxi and ride-sharing services, but can be a genuine hardship in places where access to jobs requires a personal vehicle.85 Transportation equity has many dimensions, including affordable access to transportation for workers to reach job sites and for the aged and disabled to reach health care facilities, family members, and services. Yet, a different equity dimension exists with regard to the disproportionate impact that transportation operations and emissions have on low-income and minority neighborhoods (also discussed in the previous section). Nearly 17.5 million workers live in households that lack cars or have more workers in the household than vehicles.86 Nearly 40 million Americans have some form of disability, almost 16 million of whom are age 35 to 64.87 All of these equity issues are compounded in suburban areas with limited public transportation and rural areas that lack public transportation entirely. Moreover, the population is aging: the 49 million citizens currently over age 65 (15% of the population) will increase to 73 million (21% of the population) by 2030.88 These problems are not new, but they are particularly hard to solve and evolving technology and services may create new barriers to the disabled and economically disadvantaged. Access to employment, health care, and services can be expanded through transportation policies and programs, but strategies need to be affordable and effective, which are significant challenges in sparsely populated areas. Ensuring that the negative consequences of expanding transportation networks and operations do not fall disproportionately on low-income and minority neighborhoods is an ongoing challenge that is rarely fully met. trb | transportation research board16