Identifying risky drivers with simulated driving

Objective: The present study aimed to examine whether high-risk drivers differ from low-risk drivers in driving behavior in a simulated environment.

Method: The 2 risk groups including 36 drivers (18 males and 18 females) performed driving tasks in a simulated environment. The simulated driving behaviors are compared between the 2 risk groups.

Results: The high-risk drivers drove much faster and exhibited larger offsets of the steering wheel than did the low-risk drivers in events without incidents. Additionally, the high-risk drivers used turn signals and horns less frequently than the low-risk drivers.

Conclusions: The present study revealed that the high-risk group differed from the low-risk group in driving behavior in a simulated environment. These results also suggest that simulated driving tasks might be useful tools for the evaluation of drivers’ potential risks.     

Transport company safety climate—The impact on truck driver behavior and crash involvement

Objective: The present study investigated the relationships between safety climate and driving behavior and crash involvement.

Methods: A total of 339 company-employed truck drivers completed a questionnaire that measured their perceptions of safety climate, crash record, speed choice, and aberrant driving behaviors (errors, lapses, and violations).

Results: Although there was no direct relationship between the drivers' perceptions of safety climate and crash involvement, safety climate was a significant predictor of engagement in risky driving behaviors, which were in turn predictive of crash involvement.

Conclusions: This research shows that safety climate may offer an important starting point for interventions aimed at reducing risky driving behavior and thus fewer vehicle collisions.     

“Are you still driving?” Metasynthesis of patient preferences for communication with health care providers

Aim: The aim of this study was to synthesize published qualitative studies to identify older adults' preferences for communication about driving with health care providers.

Background: Health care providers play a key role in addressing driving safety and driving retirement with older adults, but conversations about driving can be difficult. Guides exist for family members and providers, but to date less is known about the types of communication and messages older drivers want from their health care providers.

Design: A qualitative metasynthesis of studies published on or before October 10, 2014, in databases (PubMed, CINAHL, PsycINFO, and Web of Science) and grey literature was performed.

Review Methods: Twenty-two published studies representing 518 older adult drivers met the following inclusion criteria: the study (1) was about driving; (2) involved older drivers; (3) was qualitative (rather than quantitative or mixed methods); and (4) contained information on older drivers' perspectives about communication with health care providers.

Results: We identified 5 major themes regarding older adults' communication preferences: (1) driving discussions are emotionally charged; (2) context matters; (3) providers are trusted and viewed as authority figures; (4) communication should occur over a period of time rather than suddenly; and (5) older adults desire agency in the decision to stop driving.

Conclusion: Various stakeholders involved in older driver safety should consider older drivers' perspectives regarding discussions about driving. Health care providers can respect and empower older drivers—and support their family members—through tactful communication about driving safety and mobility transitions during the life course.     

State all-driver distracted driving laws and high school students' texting while driving behavior

Objective: Texting while driving is highly prevalent among adolescents and young adults in the United States. Texting while driving can significantly increase the risk of road crashes and is associated with other risky driving behaviors. Most states have enacted distracted driving laws to prohibit texting while driving. This study examines effects of different all-driver distracted driving laws on texting while driving among high school students.

Methods: High school student data were extracted from the 2013 National Youth Risk Behavior Survey. Distracted driving law information was collected from the National Conference of State Legislatures. The final sample included 6,168 high school students above the restricted driving age in their states and with access to a vehicle. Logistic regression was applied to estimate odds ratios of laws on texting while driving.

Results: All-driver text messaging bans with primary enforcement were associated with a significant reduction in odds of texting while driving among high school students (odds ratio = 0.703; 95% confidence interval, 0.513–0.964), whereas all-driver phone use bans with primary enforcement did not have a significant association with texting while driving (odds ratio = 0.846; 95% confidence interval, 0.501–1.429).

Conclusions: The findings indicate that all-driver distracted driving laws that specifically target texting while driving as opposed to all types of phone use are effective in reducing the behavior among high school students.     

Assessing fitness to drive—A validation study on patients with mild cognitive impairment

Objectives: There is no consensus yet on how to determine which patients with cognitive impairment are able to drive a car safely and which are not. Recently, a strategy was composed for the assessment of fitness to drive, consisting of clinical interviews, a neuropsychological assessment, and driving simulator rides, which was compared with the outcome of an expert evaluation of an on-road driving assessment. A selection of tests and parameters of the new approach revealed a predictive accuracy of 97.4% for the prediction of practical fitness to drive on an initial sample of patients with Alzheimer's dementia. The aim of the present study was to explore whether the selected variables would be equally predictive (i.e., valid) for a closely related group of patients; that is, patients with mild cognitive impairment (MCI).

Methods: Eighteen patients with mild cognitive impairment completed the proposed approach to the measurement of fitness to drive, including clinical interviews, a neuropsychological assessment, and driving simulator rides. The criterion fitness to drive was again assessed by means of an on-road driving evaluation. The predictive validity of the fitness to drive assessment strategy was evaluated by receiver operating characteristic (ROC) analyses.

Results: Twelve patients with MCI (66.7%) passed and 6 patients (33.3%) failed the on-road driving assessment. The previously proposed approach to the measurement of fitness to drive achieved an overall predictive accuracy of 94.4% in these patients. The application of an optimal cutoff resulted in a diagnostic accuracy of 100% sensitivity toward unfit to drive and 83.3% specificity toward fit to drive. Further analyses revealed that the neuropsychological assessment and the driving simulator rides produced rather stable prediction rates, whereas clinical interviews were not significantly predictive for practical fitness to drive in the MCI patient sample.

Conclusions: The selected measures of the previously proposed approach revealed adequate accuracy in identifying fitness to drive in patients with MCI. Furthermore, a combination of neuropsychological test performance and simulated driving behavior proved to be the most valid predictor of practical fitness to drive.     

Evaluating the Brazilian zero tolerance drinking and driving law: Time series analyses of traffic-related mortality in three major cities

Objective: A zero tolerance alcohol restriction law was adopted in Brazil in 2008. In order to assess the effectiveness of this intervention, the present study compares specific mortality in 2 time series: 1980–2007 and 2008–2013.

Methods: Data on mortality and population were gathered from official Brazilian Ministry of Health information systems. Segmented regression analyses were carried out separately for 3 major Brazilian capitals: Belo Horizonte, Rio de Janeiro, and São Paulo.

Results: In 2 cities (Belo Horizonte and Rio de Janeiro) there were no significant changes in mortality rate trends in 2 periods, 1980 to 2007 and 2008 to 2013, where the observed rates did not differ significantly from predicted rates. In São Paulo, a decreasing trend until 2007 unexpectedly assumed higher levels after implementation of the law.

Conclusion: There is no evidence of reduced traffic-related mortality in the 3 major Brazilian capitals 5.5 years after the zero tolerance drinking and driving law was adopted.     

Risk factors for the severity of injury incurred in crashes involving on-duty police cars

Objective: This article explores the risk factors associated with police cars on routine patrol and/or on an emergency run and their effects on the severity of injuries in crashes.

Methods: The binary probit model is used to examine the effects of important factors on the risk of injuries sustained in crashes involving on-duty police cars.

Results: Several factors significantly increase the probability of crashes that cause severe injuries. Among those causes are police officers who drive at excessive speeds, traffic violations during emergency responses or pursuits, and driving during the evening (6 to 12 p.m.) or in rainy weather. Findings also indicate some potential issues associated with an increase in the probability of crashes that cause injuries. Younger police drivers were found to be more likely to be involved in crashes causing injuries than middle-aged drivers were. Distracted driving by on-duty police officers as well as civilian drivers who did not pull over to let a police car pass in emergency situations also caused serious crashes.

Conclusions: Police cars are exempted from certain traffic laws under emergency circumstances. However, to reduce the probability of being involved in a crash resulting in severe injuries, officers are still obligated to drive safely and follow safety procedures when responding to emergencies or pursuing a car. Enhancement of training techniques for emergency situations or driving in pursuit of an offender and following the safety procedures are essential for safety in driving during an emergency run by police.     

Factors affecting conviction rates of intoxicated driver patients in two large trauma centers

Objective: Outcomes from previous studies report the driving under the influence (DUI) conviction rates for trauma patients in several cities within Canada and the United States over the last 2 decades. This study reports charge, conviction, and prosecution rates for trauma patients at 2 level I trauma centers servicing a large metropolitan city.

Methods: A retrospective review of the trauma databases was completed to identify patients meeting inclusion criteria. Four hundred sixty patients were identified and their records were compared with the district attorney's records for DUI charges and convictions.

Results: The conviction rate for this study was 8.7%, demonstrating continued low rates of conviction despite growing interest and public awareness of drinking and driving.

Conclusions: We discuss legal considerations that providers should consider when treating patients who have been drinking and driving.     

The use of navigation systems in naturalistic driving

Objective: In this study, we assessed the use of portable navigation systems in everyday driving by applying in-vehicle naturalistic driving.

Method: Experienced users of navigation systems, 7 females and 14 males, were provided with a specially equipped vehicle for approximately 1 month. Their trips were recorded using 4 cameras, Global Positioning System (GPS) data, and other sensor data. The drivers’ navigation system use data were coded from the video recordings, which showed how often and for how long the system was activated and how often and for how long a driver operated the system.

Results: The system was activated for 23% of trips, predominantly on longer and unique trips. Analyses of the percentage of time for which the speed limit was exceeded showed no evidence of differences between trips for which the navigation system was used or not used. On trips for which the navigation system was activated, participants spent about 5% of trip time interacting with the device. About 40% of interacting behavior took place in the first 10% of the trip time, and about 35% took place while the car was standing still or moving at a very low speed; that is, 0–10 km/h.

Conclusion: These results shed light on how and when drivers use navigation systems. They suggest that although drivers regulate their use of such systems to some extent, they often perform risky tasks while driving.     

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.     

Predictors of health care provider anticipatory guidance provision for older drivers

Objective: The objective of this study was to determine the frequency of health care provider (HCP) driving safety/cessation-related anticipatory guidance provision and predictors of driving safety-related anticipatory guidance provision by HCPs.

Methods: HCPs in several central/upper Midwest states were surveyed about frequency of anticipatory guidance provision (n = 265).

Results: More than half of HCPs stated that they frequently or always provide driving safety/cessation-related anticipatory guidance to patients aged 85 or older, 38.7% provided this guidance to patients aged 75 to 84, and 13.7% to patients aged 65 to 74. Predictors of driving safety/cessation-related anticipatory guidance provision differed by patient age. For patients aged 65–74, HCP personal experience with a motor vehicle crash (either the HCP themselves or a friend/family member) was significant in predicting anticipatory guidance provision. However, for patients aged 75 and older, significant predictors included HCP rural practice, HCP age, and percentage of HCP patients who were older adults.

Conclusion: HCP counseling provision related to driving issues differs by patient age and several HCP characteristics, including HCP rurality, age, and personal experience with motor vehicle crashes. Because aging results in physical and mental changes that affect driving and can be identified by HCPs, HCPs are in a position to counsel patients on the potential impacts of aging on the act of driving. Future research should examine the reasons for the differences in anticipatory guidance provision found in this study.     

Drinking and driving and perceptions of arrest risk among California drivers: Relationships with DUI arrests in their city of residence

Objective: Addressing drinking and driving remains a challenge in the United States. The present study aims to provide feedback on driving under the influence (DUI) in California by assessing whether drinking and driving behavior is associated with the DUI arrest rates in the city in which the driver lives; whether this is due to perceptions that one can get arrested for this behavior; and whether this differed by those drivers who would be most affected by deterrence efforts (those most likely to drink outside the home).

Methods: This study consisted of a 2012 roadside survey of 1,147 weekend nighttime drivers in California. City DUI arrest rates for 2009–2011 were used as an indicator of local enforcement efforts. Population average logistic modeling was conducted modeling the odds of perceived high arrest likelihood for DUI and drinking and driving behavior within the past year.

Results: As the DUI arrest rates for the city in which the driver lives increased, perceived high risk of DUI arrest increased. There was no significant relationship between either city DUI arrest rates or perceived high risk of DUI arrest with self-reported drinking and driving behavior in the full sample. Among a much smaller sample of those most likely to drink outside the home, self-reported drinking and driving behavior was negatively associated with DUI arrests rates in their city of residence but this was not mediated by perceptions.

Conclusion: The results of the present study suggest that perceptions are correlated with one aspect of DUI efforts in one's community. Those who were more likely to drink outside the home could be behaviorally influenced by these efforts.     

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.     

Driving restrictions post-stroke: Physicians' compliance with regulations

Objective: Suffering a stroke might lead to permanent cognitive and/or physical impairment. It has been shown that these impairments could have an impact on an individual's fitness to drive. In Sweden, as in many other countries, there are regulations on driving cessation post-stroke. Information on driving cessation should be given to all patients and noted in the journal. The present study sought to determine physician's compliance to driving regulations post-stroke as well as follow-up and gender aspects.

Method: A retrospective study of medical records on stroke patients was carried out. The study covered all of the medical records on stroke incidents (n = 342) during a year at a typical medium to large-sized hospital in Sweden.

Results: A journal entry on driving cessation post-stroke was missing in 81% of the medical records. Only 2% of the patients were scheduled for a follow-up meeting specifically concerning fitness to drive. Significantly more men than women had an entry on driving in the journal.

Conclusions: We conclude that the Swedish regulations on driving cessation post-stroke were not followed at the participating hospital. It is crucial that all stroke patients receive information on driving cessation because their condition might affect fitness to drive. Analysis of follow-up records showed that there was no consistent method for assessment of a patient's fitness to drive. There was also a gender difference in the material, which warrants further investigation.     

Delays in DUI blood testing: Impact on cannabis DUI assessments

Objective: This study examined the time from law enforcement dispatch to the first blood draw in cases of driving under the influence (DUI) vehicular homicide and a subset of DUI vehicular assault cases in Colorado in 2012. Laboratory toxicology results were also examined to understand the implications of delays in blood draws in cases of driving while under the influence of marijuana's delta-9-tetrahydrocannabinol (THC).

Methods: Colorado court records were reviewed and information regarding charges, presence of alcohol and/or drugs, time of law enforcement contact and blood draw, crash location, and other contextual factors were identified. The distributions of first blood draw times were studied by charge and by responding law enforcement agency. Toxicology data from a different cohort of DUI traffic arrests in Colorado and Washington were examined to determine the proportion of blood tests for THC that were above specified legal limits in those states.

Results: The average time from law enforcement dispatch to blood draw in cases of vehicular homicide and vehicular assault was 2.32 h (SD ± 1.31 h), with a range of 0.83 to 8.0 h and a median of 2.0 h. Data from DUI traffic arrests found that between 42 and 70% of all cannabinoid-positive traffic arrests tested below 5 ng/ml THC in blood, which is the legal limit in Colorado and Washington.

Conclusion: Given the current delays to blood testing in cases of arrests for vehicular homicide and vehicular assault in Colorado, many blood tests are unlikely to confirm that drivers who are impaired from smoking marijuana have THC levels above established legal limits.     

The combined effects of on-road and simulator training with feedback on older drivers' on-road performance: Evidence from a randomized controlled trial

Objective: A number of training programs that seek to improve driving performance among older drivers are available accompanied by a growing interest in their effectiveness. The purpose of the present investigation was to examine the combined effect of (1) basic in-class training (BT); (2) on-road training with individualized feedback (OR); and (3) training on a driving simulator (S).

Methods: Using a randomized controlled trial study design, 78 older drivers were randomly assigned to one of 3 groups (BT, BT + OR, or BT + OR + S). All participants completed a pre- and postintervention on-road driving evaluation on a standardized route. The driving evaluations were recorded using video and Global Positioning System (GPS) equipment and were scored by a blind assessor.

Results: The results indicated a significant reduction of approximately 30% in overall number of driving errors/omissions among participants in the BT + OR and the BT + OR + S groups in comparison to participants in the BT group.

Conclusions: This study adds to the mounting evidence demonstrating the effectiveness of individualized driver training in improving safe driving among older adults.     

Representativity and univocity of traffic signs and their effect on trajectory movement in a driving simulation task: Warning signs

Objective: The effect of traffic signs on the behavior of drivers is not completely understood. Knowing about how humans process the meaning of signs (not just by learning but instinctively) will improve reaction time and decision making when traveling. The economic, social, and psychological consequences of car accidents are well known.

Methods: This study sounds out which traffic signs are more ergonomic for participants, from a cognitive point of view, and determines, at the same time, their effect in participants' movement trajectories in a driving simulation task.

Results: Results point out that the signs least representative of their meaning produce a greater deviation from the center of the road than the most representative ones.

Conclusions: This study encourages both an in-depth analysis of the effect on movement of roadside signs and the study of how this effect can be modified by the context in which these signs are presented (with the aim to move the research closer to and analyze the data in real contexts). The goal is to achieve clarity of meaning and lack of counterproductive effects on the trajectory of representative signs (those that provoke fewer mistakes in the decision task).     

Exploring the association between working memory and driving performance in Parkinson's disease

Objective: The aim of this study was to explore whether varying levels of operational and tactical driving task demand differentially affect drivers with Parkinson's disease (PD) and control drivers in their sign recall.

Methods: Study participants aged between 50 and 70 years included a group of drivers with PD (n = 10) and a group of age- and sex-matched control drivers (n = 10). Their performance in a sign recall task was measured using a driving simulator.

Results: Drivers in the control group performed better than drivers with PD in a sign recall task, but this trend was not statistically significant (P =.43). In addition, regardless of group membership, subjects' performance differed according to varying levels of task demand. Performance in the sign recall task was more likely to drop with increasing task demand (P =.03). This difference was significant when the variation in task demand was associated with a cognitive task; that is, when drivers were required to apply the instructions from working memory.

Conclusions: Although the conclusions drawn from this study are tentative, the evidence presented here is encouraging with regard to the use of a driving simulator to examine isolated cognitive functions underlying driving performance in PD. With an understanding of its limitations, such driving simulation in combination with functional assessment batteries measuring physical, visual, and cognitive abilities could comprise one component of a multitiered system to evaluate medical fitness to drive.     

Difficulties in emotion regulation and risky driving among Lithuanian drivers

Background: Risky driving is a common cause of traffic accidents and injuries. However, there is no clear evidence of how difficulties in emotion regulation contribute to risky driving behavior, particularly in small post-Soviet countries. The present study aimed to investigate the relationship between difficulties in emotion regulation and self-reported risky driving behavior in a sample of Lithuanian drivers.

Methods: A total of 246 nonprofessional Lithuanian drivers participated in a cross-sectional survey. Difficulties in emotion regulation were assessed using the Difficulties in Emotion Regulation Scale (DERS; Gratz and Roemer 2004), and risky driving behavior was assessed using the Manchester Driver Behaviour Questionnaire (DBQ; Lajunen et al. 2004).

Results: Males scored higher than females in aggressive violations and ordinary violations. Females scored higher for the nonacceptance of emotional responses, whereas males had more difficulties with emotional awareness than females. More difficulties in emotion regulation were positively correlated with driving errors, lapses, aggressive violations, and ordinary violations for both males and females. Structural equation modeling showed that difficulties in emotion regulation explained aggressive and ordinary violations more clearly than lapses and errors. When controlling for interactions among the distinct regulation difficulties, difficulties with impulse control and difficulties engaging in goal-directed behavior predicted risky driving. Furthermore, nonacceptance of emotional responses and limited access to emotion regulation strategies were related to less violations and more driving errors.

Conclusion: Emotion regulation difficulties were associated with the self-reported risky driving behaviors of Lithuanian drivers. This provides useful hints for improving driver training programs in order to prevent traffic injuries.