The on-road experiences and awareness of sleepiness in a sample of Australian highway drivers: A roadside driver sleepiness study

Objective: Driver sleepiness contributes substantially to road crash incidents. Simulator and on-road studies clearly reveal an impairing effect from sleepiness on driving ability. However, the degree to which drivers appreciate the dangerousness of driving while sleepy is somewhat unclear. This study sought to determine drivers' on-road experiences of sleepiness, their prior sleep habits, and personal awareness of the signs of sleepiness.

Methods: Participants were a random selection of 92 drivers traveling on a major highway in the state of Queensland, Australia, who were stopped by police as part of routine drink driving operations. Participants completed a brief questionnaire that included demographic information, sleepy driving experiences (signs of sleepiness and on-road experiences of sleepiness), and prior sleep habits. A modified version of the Karolinska Sleepiness Scale (KSS) was used to assess subjective sleepiness in the 15 min prior to being stopped by police.

Results: Participants' ratings of subjective sleepiness were quite low, with 90% reporting being alert to extremely alert on the KSS. Participants were reasonably aware of the signs of sleepiness, with many signs of sleepiness associated with on-road experiences of sleepiness. Additionally, the number of hours spent driving was positively correlated with the drivers' level of sleep debt.

Conclusions: The results suggest that participants had moderate experiences of driving while sleepy and many were aware of the signs of sleepiness. The relationship between driving long distances and increased sleep debt is a concern for road safety. Increased education regarding the dangers of sleepy driving seems warranted.     

Body Mass Index (BMI) as a first-line screening criterion for detection of excessive daytime sleepiness among professional drivers

OBJECTIVES: Obstructive sleep apnea (OSA) is the main predisposing factor of excessive daytime sleepiness (EDS), and, therefore, increases the risk of road crashes. However, it is difficult to rely on medical intake for OSA or fatigue since drivers' symptoms reports are not reliable. On the other hand, direct measurement of EDS among large numbers of drivers carries serious practical drawbacks. Obstructive sleep apnea, in turn, is strongly related to obesity, and elevated body mass index (BMI) is considered one of the major risk factors for OSA. Thus, it could be postulated that BMI may carry predictive value for EDS proneness. METHODS: The present study examined the interrelation between BMI, degree of OSA, as measured with Respiratory Distress Index (RDI), and the degree of EDS, as measured with the mean sleep onset latency in the Multiple Sleep Latency Test (MSLT) among obese (BMI = 32) professional drivers. The drivers went through polysomnography followed by the five sessions of MSLT in the next day. RESULTS: In accordance with prior studies, we have found strong correlation between BMI and the degree of OSA on the one hand, and between the degree of OSA and EDS on the other hand. OSA was detected among 77.7% of the drivers, 47.1% were sleepy, 19% had severe sleepiness [mean sleep latency [MSL < or = 5 min.], 28.1% had moderate sleepiness [MSL < or = 10 min.]. None of the drivers complained about any sleep problem, including snoring, and all reported that they do not experience excessive daytime sleepiness. Thus, there was no correlation between their subjective report and objective findings. CONCLUSIONS: Obese drivers with BMI above 32 are highly prone to be sleepy during the day. Their subjective reports of OSA or fatigue symptoms are not reliable. Therefore it is highly recommended to screen them easily by weight and height measure for further sleep study and decision about their driving abilities.     

Working conditions and sleepiness while driving among truck drivers

Objective: The objective of this study is to identify the role of working conditions as predictors of sleepiness while driving among truck drivers.

Methods: This was a cross-sectional study carried out among truck drivers who transported grains to Paranaguá Port, Paraná, Brazil. The truck drivers were interviewed and completed a self-administered questionnaire to collect data on sociodemographic and behavioral variables, working conditions, consumption of illicit psychoactive substances, and sleep patterns. Drivers were considered to be sleepy while driving if they reported a medium or high probability of napping while driving at night, during the daytime, or while stopped in traffic. The statistical analysis used logistic regression models progressively adjusted for age, behavioral variables, sleep duration, and other working conditions.

Results: In total, 670 male drivers, with a mean age of 41.9 (±11.1) years, were enrolled. The prevalence of sleepiness while driving was 31.5%. After model adjustments, the following working conditions were associated with sleepiness while driving: Distance from the last shipment of more than 1,000?km (odds ratio [OR]?=?1.54; 95% confidence interval [CI], 1.07–2.23) and a formal labor contract with a productivity-based salary (OR = 2.65; 95% CI, 1.86–3.78). Consumption of illicit psychoactive substances (OR = 1.99; 95% CI, 1.14–3.47) was also associated with sleepiness while driving.

Conclusions: Distance traveled and a formal labor contract with productivity-based earnings were the working conditions associated with sleepiness while driving, regardless of other working or behavioral characteristics, age, consumption of illicit psychoactive substances, and sleep duration.     

Deriving heart rate variability indices from cardiac monitoring—An indicator of driver sleepiness

Objective: Driver fatigue is considered to be a major contributor to road traffic crashes. Cardiac monitoring and heart rate variability (HRV) analysis is a candidate method for early and accurate detection of driver sleepiness. This study has 2 objectives: to evaluate the (1) suitability of different preprocessing strategies for detecting and removing outlier heartbeats and spectral transformation of HRV signals and their impact of driver sleepiness assessment and (2) relation between common HRV indices and subjective sleepiness reported by a large number of drivers in real driving situations, for the first time.

Methods: The study analyzed >3,500 5-min driving epochs from 76 drivers on a public motorway in Sweden. The electrocardiograph (ECG) data were recorded in 3 studies designed to evaluate the physiological differences between awake and sleepy drivers. The drivers reported their perceived level of sleepiness according to the Karolinska Sleepiness Scale (KSS) every 5?min. Two standard methods were used for identifying outlier heartbeats: (1) percentage change (PC), where outliers were defined as interbeat intervals deviating >30% from the mean of the four previous intervals and (2) standard deviation (SD), where outliers were defined as interbeat interval deviating >4 SD from the mean interval duration in the current epoch. Three standard methods were used for spectral transformation, which is needed for deriving HRV indices in the frequency domain: (1) Fourier transform; (2) autoregressive model; and (3) Lomb-Scargle periodogram. Different preprocessing strategies were compared regarding their impact on derivation of common HRV indices and their relation to KSS data distribution, using box plots and statistical tests such as analysis of variance (ANOVA) and Student’s t test.

Results: The ability of HRV indices to discriminate between alert and sleepy drivers does not differ significantly depending on which outlier detection and spectral transformation methods are used. As expected, with increasing sleepiness, the heart rate decreased, whereas heart rate variability overall increased. Furthermore, HRV parameters representing the parasympathetic branch of the autonomous nervous system increased. An unexpected finding was that parameters representing the sympathetic branch of the autonomous nervous system also increased with increasing KSS level. We hypothesize that this increment was due to stress induced by trying to avoid an incident, because the drivers were in real driving situations.

Conclusions: The association of HRV indices to KSS did not depend on the preprocessing strategy. No preprocessing method showed superiority for HRV association to driver sleepiness. This was also true for combinations of methods for frequency domain HRV indices. The results prove clear relationships between HRV indices and perceived sleepiness. Thus, HRV analysis shows promise for driver sleepiness detection.     

Crash risk perception of sleepy driving and its comparisons with drink driving and speeding: Which behavior is perceived as the riskiest?

Objective: Driver sleepiness is a major crash risk factor but may be underrecognized as a risky driving behavior. Sleepy driving is usually rated as less of a road safety issue than more well-known risky driving behaviors, such as drink driving and speeding. The objective of this study was to compare perception of crash risk of sleepy driving, drink driving, and speeding.

Methods: Three hundred Australian drivers completed a questionnaire that assessed crash risk perceptions for sleepy driving, drink driving, and speeding. Additionally, the participants' perceptions of crash risk were assessed for 5 different contextual scenarios that included different levels of sleepiness (low, high), driving duration (short, long), and time of day/circadian influences (afternoon, nighttime) of driving.

Results: The analysis confirmed that sleepy driving was considered a risky driving behavior but not as risky as high levels of speeding (P < .05). Yet, the risk of crashing at 4 a.m. was considered as equally risky as low levels of speeding (10 km over the limit). The comparisons of the contextual scenarios revealed driving scenarios that would arguably be perceived as quite risky because time of day/circadian influences were not reported as high risk.

Conclusions: The results suggest a lack of awareness or appreciation of circadian rhythm functioning, particularly the descending phase of circadian rhythm that promotes increased sleepiness in the afternoon and during the early hours of the morning. Yet, the results suggested an appreciation of the danger associated with long-distance driving and driver sleepiness. Further efforts are required to improve the community's awareness of the impairing effects from sleepiness and, in particular, knowledge regarding the human circadian rhythm and the increased sleep propensity during the circadian nadir.     

Sleepy driving and risk of obstructive sleep apnea among truck drivers in Saudi Arabia

Objective: Truck drivers represent a group at a particularly higher risk of motor vehicle accidents (MVAs). Sleepy driving and obstructive sleep apnea (OSA) among truck drivers are major risk factors for MVAs. No study has assessed the prevalence of sleepy driving and risk of OSA among truck drivers in Saudi Arabia. Therefore, this study aimed to assess sleepy driving and risk of OSA among these truck drivers.

Methods: This study included 338 male truck drivers working in Saudi Arabia. A validated questionnaire regarding sleepy driving and OSA was used. The questionnaire included sociodemographic assessment, the Epworth Sleepiness Scale (ESS), the Berlin Questionnaire (BQ), and driving-related items.

Results: The drivers had a mean age of 42.9?±?9.7 years. The majority (94.7%) drove more than 5?h a day. A history of MVAs during the last 6 months was reported by 6.5%. Approximately 95% of the participants reported that they had accidentally fallen asleep at least once while driving over the past 6 months, and 49.7% stated that this had happened more than 5 times during the last 6 months. Based on the BQ score, a high risk of OSA was detected in 29% of the drivers. “Not getting good-quality sleep” (odds ratio [OR]?=?2.89; 95% confidence interval [CI], 1.08–7.75; P = .014) and driving experience from 6 to 10 years (OR = 3.37; 95% CI, 1.28–8.91; P = .034) were the only independent predictors of MVAs in the past 6 months.

Conclusions: Sleepy driving and a high risk of OSA was prevalent among the study population of male truck drivers in Saudi Arabia. Not getting good-quality sleep and driving experience from 6 to 10 years contributes to the accident risk among these truck drivers.     

Motivational factors underlying the intention to drink and drive in young male drivers

Problem: Anyone drinking and driving has a high risk of being involved in an accident. Young male drivers, however, run the highest risk at the same levels of blood alcohol as other candidates, as they have more accidents than any other group. A better understanding of their motivations toward drinking and driving is needed to help create effective prevention. Method: In the present study, 115 male drivers aged 18–24 completed a questionnaire—based on Ajzen's theory of planned behavior—designed to study the motivational factors leading to drinking and driving. Results: Young males' intention to drink and drive is predicted by their attitudes, their perceived behavioral control (PBC), and, to a lesser degree, subjective norms. Impact on Industry: The results showing slightly positive PBC over driving after drinking suggest that work aimed at reducing this perception to a more realistic level is a potential prevention avenue.     

Relationship between THC concentration in blood and impairment in apprehended drivers

OBJECTIVE: The most important psychoactive ingredient in cannabis, Delta (9)-tetrahydrocannabinol (THC) is one of the most frequently detected substances in blood samples from suspected impaired drivers in Norway. There is growing concern over possible links between the use of cannabis and increased risk of motor-vehicle crashes. Experimental studies have provided useful information on the role of THC and dose-effect relations with respect to psychomotor performance. The main purpose of the present study was to investigate whether a physician's judgment on impairment in a real-life setting among suspected drugged drivers, was related to blood THC concentration. METHODS: In Norway a police physician performs a clinical test for impairment (CTI) shortly after apprehension. The Norwegian Institute of Public Health analyze blood samples from all drivers suspected of driving under the influence of non-alcoholic drugs. In the present study 589 samples from approximately 30,000 cases of suspected drug impaired driving from the period 1997-99, contained THC as the only drug. In 456 of these cases a conclusion of the CTI was available. RESULTS: 230 (54%) drivers were considered not impaired and 226 (46%) impaired. Impaired drivers had higher blood THC concentration than the drivers who were judged as not impaired (median; 2.5 ng/mL (range; 0.3-45.3 ng/mL) vs 1.9 ng/mL (range; 0.32-24.8 ng/mL), (p < 0.05). Furthermore, drivers with blood THC concentrations above 3 ng/mL had an increased risk for being judged impaired compared to drivers with lower concentration ranges. CONCLUSION: The relationship between the concentration of THC in blood and risk of being assessed impaired found in this cross-sectional study of suspected drugged drivers, supports findings from previous experimental studies of concentration related effects of THC on psychomotor performance and driving skills.     

Teenage drivers: patterns of risk

PROBLEM: To determine patterns of risk among teenage drivers. METHOD: Review and synthesis of the literature. RESULTS: On most measures, crash rates during the teenage years are higher than at any other age, for both males and females. Risk among teenagers varies greatly by driving situation; it is particularly low in some situations (e.g., the learner period) and particularly high in others (e.g., right after licensure, late at night, with passengers present). In some of these high-risk driving situations, risk is elevated for drivers of all ages (e.g., late night driving), in others risk is elevated more for teens than adults (e.g., driving after consuming alcohol), and in others the risk is unique to teen drivers (e.g., having passengers). IMPACT ON RESEARCH, PRACTICE, AND POLICY: These varying patterns of risk form the basis for graduated licensing systems, which are designed to promote low-risk and discourage high-risk driving.     

The effectiveness of reducing illegal blood alcohol concentration (BAC) limits for driving: evidence for lowering the limit to .05 BAC

PURPOSE: This scientific review provides a summary of the evidence regarding the benefits of reducing the illegal blood alcohol concentration (BAC) limit for driving and providing a case for enacting a .05 BAC limit. RESULTS: Fourteen independent studies in the United States indicate that lowering the illegal BAC limit from .10 to .08 has resulted in 5-16% reductions in alcohol-related crashes, fatalities, or injuries. However, the illegal limit is .05 BAC in numerous countries around the world. Several studies indicate that lowering the illegal per se limit from .08 to .05 BAC also reduces alcohol-related fatalities. Laboratory studies indicate that impairment in critical driving functions begins at low BACs and that most subjects are significantly impaired at .05 BAC. The relative risk of being involved in a fatal crash as a driver is 4 to 10 times greater for drivers with BACs between .05 and .07 compared to drivers with .00 BACs. SUMMARY: There is strong evidence in the literature that lowering the BAC limit from .10 to .08 is effective, that lowering the BAC limit from .08 to .05 is effective, and that lowering the BAC limit for youth to .02 or lower is effective. These law changes serve as a general deterrent to drinking and driving and ultimately save lives. IMPACT ON INDUSTRY: This critical review supports the adoption of lower illegal BAC limits for driving.     

Graduated driver licensing: the New Zealand experience

In New Zealand, on 1 August 1987, a three-stage graduated driver licensing (GDL) system that applied to all new drivers aged 15-24 years was introduced. The essential elements of GDL were a 6-month learner license (supervised driving) and an 18-month restricted license stage (with restrictions on night driving and carrying passengers). A blood alcohol limit of 0.03 mg% applied at both stages. EVALUATION STUDIES: Early studies indicated that young people were reasonably accepting of the restrictions, with the passenger restriction being the least acceptable. Problems of compliance with the restricted license driving restrictions were reported. Evaluations of the impact of the graduated driver licensing (GDL) on serious traffic-related injury showed that up until 1991-1992, an 8% reduction could be attributed to GDL. At this time, it was considered that reduced exposure was the main reason for this reduction. However, the number of fatalities and hospital admissions among young people continued to decline, as did the population rate and the rate per number of licensed drivers among the young driver age group. A further evaluation study showed that drivers with a restricted license had a smaller proportion of crashes at night, and with passengers, compared with drivers licensed before GDL. IMPACT OF GDL: These results suggested that GDL restrictions had contributed to the reduction in crashes among young people and that it was not simply a case of reduced exposure to risk. An update of the most recent crash statistics indicated that, compared with older age groups, the fatal and serious injury crash rate among young people has remained substantially below the pre-GDL level. This suggests that the impact of GDL has not diminished over time.     

Freight transport and non-driving work duties as predictors of falling asleep at the wheel in urban areas of Crete

BACKGROUND: This study investigated the impact of subjective reports of drowsy driving and non-driving duties on the falling asleep responses and road crash involvement of professional drivers in Crete. An attempt was also made to elucidate other driving parameters, such as freight transportation, which could be potential predictors of risky driving, after controlling for lifestyle patterns. METHOD: A sample of 317 professional drivers was studied through personal interviews. The interview questionnaire included items about sleep and fatigue as contributing factors to falling asleep probability and crash risk. In addition, the drivers reported the type of freight they carried in their last trip, as well as practices such as smoking and alcohol consumption. RESULTS: The first logistic regression analysis showed that the most significant predictors of falling asleep at the wheel were transportation of fruits/vegetables and livestock, non-driving hours of work, insufficient hours of sleep, and smoking. The second logistic regression analysis revealed all the previous items as powerful factors of crash probability, including the transportation of express freight and freezer. IMPACT: The findings of the current study are discussed as they pertain to directions for future studies and for the development of fatigue countermeasures.     

Can variations in visual behavior measures be good predictors of driver sleepiness? A real driving test study

Objective: The primary purpose of this study was to examine the association between variations in visual behavior measures and subjective sleepiness levels across age groups over time to determine a quantitative method of measuring drivers' sleepiness levels.

Method: A total of 128 volunteer drivers in 4 age groups were asked to finish 2-, 3-, and 4-h continuous driving tasks on expressways, during which the driver's fixation, saccade, and blink measures were recorded by an eye-tracking system and the subjective sleepiness level was measured through the Stanford Sleepiness Scale. Two-way repeated measures analysis of variance was then used to examine the change in visual behavior measures across age groups over time and compare the interactive effects of these 2 factors on the dependent visual measures.

Results: Drivers' visual behavior measures and subjective sleepiness levels vary significantly over time but not across age groups. A statistically significant interaction between age group and driving duration was found in drivers' pupil diameter, deviation of search angle, saccade amplitude, blink frequency, blink duration, and closure duration. Additionally, change in a driver's subjective sleepiness level is positively or negatively associated with variation in visual behavior measures, and such relationships can be expressed in regression models for different period of driving duration.

Conclusions: Driving duration affects drivers' sleepiness significantly, so the amount of continuous driving time should be strictly controlled. Moreover, driving sleepiness can be quantified through the change rate of drivers' visual behavior measures to alert drivers of sleepiness risk and to encourage rest periods. These results provide insight into potential strategies for reducing and preventing traffic accidents and injuries.     

Alcohol problems among Swedish drunk drivers: differences related to mode of detection and geographical region

OBJECTIVE: To investigate the prevalence of alcohol problems in a representative sample of Swedish drivers suspected of drunk driving in comparison with control drivers and the general Swedish population in relation to mode and time of detection. Is the time of day or night or the detection mode important for the prevalence of alcohol problems and which are the best predictors for identifying alcohol problems among DUI offenders? METHODS: Two thousand and one hundred drivers (169 females) suspected of DUI offence during 1997-2001 who agreed to respond to the AUDIT questionnaire (Alcohol Use Disorders Identification Test) and 785 control drivers (266 females) not suspected of DUI recruited at general traffic controls were investigated. RESULTS: Both mode and time of detection were found to be important. The greatest impact on the prevalence of alcohol problems emanated from the predictors in the following order: high BAC; unlicensed driving; detection hours between 12.00 and 18.00, and age under 26 years. Age over 55 years and detection in general traffic controls were the two strongest factors negatively correlated to alcohol problems prevalence. The differences between regions with regard to alcohol problems incidence could only partly be explained by police routines and resources. CONCLUSIONS: Mode and time of detection affect the prevalence of DUI offenders with alcohol problems, and to a lesser degree also BAC level. Both the detection mode and the time of detection are significant for the proportion of identified DUIs with alcohol problems. Because the majority of committed DUI offenses are never identified, it is important to optimize the detection strategies of the police with the purpose of minimizing public damage and expenses.     

Characteristics and risks of drivers with low annual distance driven

OBJECTIVES: It has been noted by several authors that risk (defined only in terms of total expected numbers of crash involvements per total distance driven) paints a misleading picture of crash liability, particularly for the young and the old, as their high risk is associated with risky driving patterns typical of people who drive low annual kms. This article sets out to analyze these driving patterns of low-km drivers and to evaluate the risk of these patterns. As licensing programs tend to focus on young and old drivers, who tend to drive lower annual distances, income and employment data are also analyzed for low-km drivers. This is to provide a better picture for policy makers of the sort of people and the sorts of transportation requirements that their policies may affect. METHODS: Crash data and travel data were disaggregated by driver characteristics and by driving conditions (road type, day and night, weekend and weekday) and combined to form estimates of risk for typical driving patterns of driver groups. Characteristics of driving patterns and of the drivers themselves were derived for groups defined by age and by the amount of annual driving undertaken. RESULTS: Older drivers who drive less tend to have higher risk per km mainly due to their predominantly urban trips. Nevertheless, because older drivers on average manage to reduce their risk per distance driven by choosing driving patterns that are safer than the driving patterns of other age groups, the risk of older drivers as a group is not overestimated. CONCLUSION: Despite being quite different from one another, the low- and high-km driving patterns of younger drivers were found to impose identical risks.     

Survival risk factors for fatal injured car and motorcycle drivers in single alcohol-related and alcohol-unrelated vehicle crashes

Introduction

A high percentage of drivers who die as a result of a single vehicle crash are under the influence of alcohol. We aimed to better understand the prevalence of these fatalities and the ratio of death to injuries based on various risk factors. We focused on alcohol-related and -unrelated single-vehicle crashes to investigate the influence of such risk factors on the time until death for car and motorcycle drivers.

Methods

We combined data from national police reports and a vital registration database in Taiwan. Survival analysis using Cox regression models was used to identify the risk factors of time until death.

Results

Overall, nearly 60% of car driver fatalities and 40% of motorcycle driver fatalities involved the consumption of alcohol. Survival analysis of single-vehicle crashes suggested that the traffic island separation between a car moving at a higher speed and motorcycle traffic resulted in a higher risk of death over time for motorcycle drivers who consumed alcohol. The factors attributed to a higher risk of death over time for motorcycle drivers were older age, crashing into trees, night-time driving, driving on curved roads, and driving on local roads. Driving without restraints and driving on roads with higher speed limits attributed to a higher risk of death over time for car drivers.

Conclusions

The factors that influence the risk of death over time in a motor-vehicle accident involving alcohol depended on different elements, which should each be considered when attempting to reduce this risk.

Impact on Industry

More efforts should be made to investigate the various risk factors in areas with large motorcycle populations.     

Marijuana use and driving in Washington State: Risk perceptions and behaviors before and after implementation of retail sales

Objective: Washington is among the first states to legalize recreational use of marijuana. This study examined marijuana use and risk perceptions before and after retail sales of recreational marijuana began in July 2014, the relationship between risk perceptions and marijuana use, and the relationship between self-reported marijuana use and drug test results.

Methods: Roadside surveys were conducted in 3 waves: June 2014, the month before retail sales of marijuana began; 5–6 months later (November–December 2014); and 1 year later (June 2015). A total of 2,355 drivers completed a marijuana questionnaire about their past and current marijuana use and perceived risks associated with driving after using marijuana. Data collection also included biological specimens (oral fluid and/or blood for marijuana testing and breath for alcohol testing). Drivers who tested positive for delta-9-tetrahydrocannabinol or 11-hydroxy-delta-9-tetrahydrocannabinol in oral fluid or blood were defined as THC-positive.

Results: The proportion of drivers who reported recent marijuana use was similar across the 3 surveys. However, the proportion of THC-positive daytime drivers increased from 8% before retail sales to 23% 6 months after retail sales; this proportion did not change among nighttime drivers (19 and 20%). Drivers’ perceived risk of impairment by marijuana and perceived risk of being arrested for marijuana-impaired driving were similar before and after retail sales. The odds of being THC-positive were 40% lower among drivers who perceived that marijuana was very likely to impair driving, compared to other drivers. Drivers’ perceived risk of being arrested for marijuana-impaired driving was not predictive of THC-positive driving.

Conclusions: The prevalence of daytime THC-positive drivers increased substantially a few months after retail sales of marijuana were legal. Daytime and nighttime prevalence of THC-positive drivers was similar after retail sales. This pattern differs from that typically found for alcohol use, which is consistently higher among drivers at nighttime, compared to daytime. Reports of marijuana use were not always consistent with drug test results, which suggests that comparisons of self-reported marijuana use before and after legalization could be biased. This study examined marijuana use and risk perceptions over the course of 1 year. However, law changes may influence cultural norms gradually over a longer period of time. Future studies should continue to monitor marijuana use over time, as well as identify ways to determine whether drivers are impaired by marijuana.     

Changes in driving behavior and cognitive performance with different breath alcohol concentration levels

OBJECTIVE: This study examines the changes in driving behavior and cognitive performance of drivers with different breath alcohol concentration (BrAC) levels. METHODS: Eight licensed drivers, aged between 20 and 30 years, with BrAC levels of 0.00, 0.25, 0.4 and 0.5 mg/l performed simulated driving tests under high- and low-load conditions. Subjects were asked to assess their subjective psychological load at specified intervals and perform various tasks. The outcome was measured in terms of reaction times for task completion, accuracy rates, and driver's driving behavior. RESULTS: The effects of BrAC vary depending on the task. Performance of tasks involving attention shift, information processing, and short-term memory showed significant deterioration with increasing BrAC, while dangerous external vehicle driving behavior occurred only when the BrAC reached 0.4 mg/l and the deterioration was marked. CONCLUSION: We can conclude that the cognitive faculty is the first to be impaired by drinking resulting in deteriorated performance in tasks related to divided attention, short-term memory, logical reasoning, followed by visual perception. On the other hand, increasing alcohol dose may not pose an immediate impact on the external vehicle driving behavior but may negatively affect the driver's motor behavior even at low BrAC levels. Experience and will power could compensate for the negative influence of alcohol enabling the drivers to remain in full steering control. This lag between alcohol consumption and impaired driving performance may mislead the drivers in thinking that they are still capable of safe steering and cause them to ignore the potential dangers of drunk driving.     

Driver's alcohol and passenger's death in motor vehicle crashes

OBJECTIVE: Previous studies on alcohol involvement associated with fatal injury in traffic crashes have focused on the drivers, but the passenger's view is not well known. This study (1) analyzes the relationship between passenger's death and alcohol inebriation of the driver and (2) estimates the role of alcohol as the cause of a crash by examining who was at fault, sober, or inebriated. METHOD: The study includes all motor vehicle passengers (n = 420) who died in crashes in Sweden 1993 through 1996 and were medicolegally autopsied. Autopsy reports from the Departments of Forensic Medicine, including toxicological analyses, and police reports were studied. Presence of alcohol among drivers was based on blood and breath tests. RESULTS: One-fifth of the fatally injured passengers and one-fifth of the tested drivers were under the influence of alcohol. The youngest drivers had the highest prevalence of drunken driving. Drivers at fault were alcohol positive in 21% of these crashes and drivers were not at fault in 2% of these crashes. In 53% of the crashes where both the passenger and driver were alcohol positive, the passenger had a lower alcohol concentration than the driver. Children (<16 years) comprised 15% of the killed passengers. Notably, the children were riding with a driver who was under influence of alcohol in 13% of these crashes. Alcohol involvement was not tested in half of the surviving drivers. CONCLUSIONS: The data show that 20% of both passengers and drivers were under the influence of alcohol. Increased testing of surviving drivers regarding alcohol and other drugs is recommended.     

A Random,Roadside Breathalyzer Survey of Alcohol Impaired Driving in Ghana

To ascertain the prevalence and pattern of alcohol impaired driving in an African nation, we conducted a random, roadside, breathalyzer survey of drivers in Ghana. A total of 149 (21%) of 722 drivers tested had a detectable blood alcohol concentration (BAC). In addition, 7.3% of drivers had a BAC ≥ 80 mg/dl. The prevalence of impaired driving (BAC ≥ 80) was higher among private drivers (9.8%) than commercial drivers (6.4%). However, due to a higher volume, the majority (64%) of impaired drivers were commercial drivers. Alcohol use was higher among uneducated (11%) compared to educated drivers (5.4%) and was higher among middle aged drivers (30 - 49 years, 9.1% impaired) compared with younger (< 30 years; 5.0%) or older drivers (≥ 50 years; 0%). Alcohol impaired driving is a significant problem in this African nation. Anti-drunk driving measures should be an important component of road safety efforts. Such measures may need to be different than industrialized nations and will need to target less educated drivers, middle aged drivers, and commercial drivers.