Older driver retraining: An updated systematic review of evidence of effectiveness

Problem and Objective

The number of older drivers who might benefit from driver retraining is growing. A previous review on the effectiveness of older driver retraining included intervention studies up to 2004. The objective was to perform an updated systematic review of the effectiveness of older driver retraining for improving driving-related skills and reducing crash rates.

Method

Articles published from 2004-2008 were grouped according to the intervention provided and outcome studied. Randomized clinical trials (RCTs) were appraised using the Physiotherapy Evidence Database (PEDro) Scale and scored for quality according to their internal validity. Each intervention's effectiveness was then rated and assigned a level of evidence by combining pre- and post- 2004 findings.

Results

Three RCTs and one matched-pairs cohort design met the inclusion criteria. There is strong evidence (Level 1a) that education combined with on-road training improves driving performance and moderate evidence (Level 1b) that it improves knowledge. There is moderate evidence (Level 1b) that physical retraining improves driving performance. There is moderate evidence (Level 1b) that an educational intervention curriculum alone is not effective in reducing crashes.

Summary

The updated evidence on the effectiveness of retraining aimed at older drivers is sufficiently encouraging to merit assertive health promotion actions regarding intervention and program planning.

Impact on Industry

These positive findings warrant a comprehensive plan that has both behavioral and monetary incentives encouraging older driver participation in programs aimed at driver safety.     

Parent involvement in novice teen driving: rationale, evidence of effects, and potential for enhancing graduated driver licensing effectiveness

Motor-vehicle crash rates are highly elevated immediately after licensure and then decline gradually over a period of years. Young age, risk taking, and inexperience contribute to the problem, but inexperience is particularly important early on. Driving is like other complex, skilled behaviors in which subtle improvements in perception and judgment develop gradually over a period of years. After all, safe driving is more a matter of attention and perception than physical management of the vehicle. Inexperience is particularly linked to driving performance and safety outcomes under certain driving conditions, with driving at night and with teen passengers as the most important cases. Surprisingly, driving outcomes do not appear to be affected by the pre-license training or supervised practice driving. Given the limits of training, safety effects can best be achieved by countermeasures that delay licensure or limit novice teen driving under high risk driving conditions while novices gain experience and develop safety competence. The two complementary approaches of Graduated Driver Licensing policies and parent management have been shown to provide safety effects by limiting the driving conditions of novice teenagers.     

When evidence is not enough: the challenge of implementing fall prevention strategies

Problem

As the evidence-based movement has advanced in public health, changes in public health practices have lagged far behind creating a science to service gap. For example, science has produced effective falls prevention interventions for older adults. It now is clearer WHAT needs to be done to reduce injury and death related to falls. However, issues have arisen regarding HOW to assure the full and effective uses of evidence-based programs in practice.

Summary

Lessons learned from the science and practice of implementation provide guidance for how to change practices by developing new competencies, how to change organizations to support evidence-based practices, and how to change public health systems to align system functions with desired practices. The combination of practice, organization, and system change likely will produce the public health benefits that are the promise of evidence-based falls prevention interventions.

Impact on public health

For the past several decades, the emphasis has been solely on evidence-based interventions. Public health will benefit from giving equal emphasis to evidence-based implementation.

Impact on Industry

We now have over two decades of research on the effectiveness of fall prevention interventions. The quality of this research is judged by a number of credible international organizations, including the Cochrane Collaboration (http://www.cochrane.org/), the American and British Geriatrics Societies, and the Campbell Collaboration (http://www.campbellcollaboration.org/). These international bodies were formed to ponder and answer questions related to the quality and relevance of research. These developments are a good first step. However, while knowing WHAT to do (an evidence-based intervention) is critical, we also need to know HOW to effectively implement the evidence. Implementation, organization change, and system change methods produce the conditions that allow and support the full and effective use of evidence-based interventions. It is time to focus on utilization of implementation knowledge in public health. Without this focus the vast amount on new evidence being generated on the prevention of falls and related injuries among older adults will have little impact on their health and safety.     

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.     

Ocean fertilization for geoengineering: A review of effectiveness,environmental impacts and emerging governance

Dangerous climate change is best avoided by drastically and rapidly reducing greenhouse gas emissions. Nevertheless, geoengineering options are receiving attention on the basis that additional approaches may also be necessary. Here we review the state of knowledge on large-scale ocean fertilization by adding iron or other nutrients, either from external sources or via enhanced ocean mixing. On the basis of small-scale field experiments carried out to date and associated modelling, the maximum benefits of ocean fertilization as a negative emissions technique are likely to be modest in relation to anthropogenic climate forcing. Furthermore, it would be extremely challenging to quantify with acceptable accuracy the carbon removed from circulation on a long term basis, and to adequately monitor unintended impacts over large space and time-scales. These and other technical issues are particularly problematic for the region with greatest theoretical potential for the application of ocean fertilization, the Southern Ocean. Arrangements for the international governance of further field-based research on ocean fertilization are currently being developed, primarily under the London Convention/London Protocol.     

Belief-bias and labor unions: The effect of strong attitudes on reasoning

This study compared three types of reasoning bias associated with strong belief: Judgement of plausibility, contrast effects, and social attribution. Respectively, these relate to bias in the perceived validity and extremity of statements and bias in causal interpretations of actions. Technical college students (N = 153) in two highly unionized communities completed one scale for each form of bias and a section of the IRC Union Attitude Scale which measured their attitude toward unions. Belief–bias was indicated across all three measures although there were differences in their salience. Social attribution was the strongest type of bias manifested (r = 0.58, p ? 0.001) and contrast effects (r = 0.33, p ? 0.001) were a second and third. The implications of these results are explored and future research directions in this new line of study are suggested.     

Work values in East and West Germany: different weights,but identical structures

On the basis of representative data collected in 1991 as part of the German General Social Survey (ALLBUS) Baseline Study in East and West Germany an answer is sought to the question whether East Germans differ from West Germans with respect to work values. Work values are classified into existence, growth and relatedness (ERG) categories and, at the same time, into performance-dependent and performance-independent ones. As from previous studies it is known that East Germans put more emphasis on existence and on relatedness values than West Germans, while growth values are weighted identically in both parts of Germany, the present paper concentrates on the structural aspect. Employing multidimensional scaling (MDS) it can be demonstrated that the structures of work values are highly similar in East and West Germany: both samples verify the ERG- and the performance-dependency facet in the same way, i.e. by exhibiting radex patterns. Moreover, the item correlations are all positive in both samples, as predicted by a new theory of directed behavior. Finally, after subtracting the value scores of each individual from the individual's mean score, the item correlations in both East and West Germany are largely compatible with predictions derived from Alderfer's theory of motivation. Thus, widespread assumptions about fundamental differences in the work values of East and West Germans prove false in many ways.     

Rollover injury: effects of near- and far-seating position, belt use, and number of quarter rolls

PURPOSE: Vehicle and occupant responses in rollovers are complex since many factors influence both. This study analyzes the following factors: 1) belt use, 2) seated position with respect to the lead side in the rollover, 3) another front occupant in the crash, and 4) number of quarter rolls. The aim was to improve our understanding of rollover injury mechanisms. METHOD: Rollover accidents were analyzed using 1992-2004 NASS-CDS data. The sample included adult drivers and right-front passengers. All occupants were evaluated and then a subset of non-ejected occupants was analyzed. Using roll direction and seating position, the sample was divided into near- and far-seated occupants. Injury and fatality risks were determined by seatbelt use, occupancy, rollover direction, and number of quarter rolls. Risk was defined as the number of injured (e.g., MAIS 3+) divided by the number of exposed occupants (MAIS 0-6). Significance in differences was determined. A matched-pair analysis was used to determine the risk of serious injury for near- and far-seated occupants who were either belted or unbelted in the same crash. RESULTS: For all occupants, serious injury risks were highest for far-seated, unbelted occupants at 18.1% +/- 4.8%, followed by near-seated unbelted occupants at 12.0% +/- 3.5%. However, the difference was not statistically significant. Belted near- and far-seated occupants had a similar injury risk of 4.3% +/- 1.2% and 4.0% +/- 1.2%, respectively. For non-ejected occupants, serious injury risk was 9.5% +/- 3.2% for far-seated unbelted occupants and 4.9% +/- 2.1% for near-seated unbelted occupants, not a statistically significant difference. Serious injury risk was similar for belted near- and far-seated non-ejected occupants, at 3.6% +/- 1.1%. Seatbelts were 64.2%-77.9% effective in preventing serious injury for all occupants and 62.1%-26.5% for far- and near-seated, non-ejected occupants, respectively. Based on the matched pairs, seatbelts were less effective for near-seated (5.0%) compared to far-seated (2.8%) occupant MAIS 3+F risks. This was similar for non-ejected occupants. An unbelted near-seated occupant increased the risk for a belted far-seated occupant by 2.2 times, whereas an unbelted far-seated occupant increased the risk for a belted near-seated occupant by 10.2 times. For all occupants, the risk of serious injury increased with the number of quarter rolls, irrespective of seated position. For near-seated occupants, seatbelt effectiveness was higher in < or =1 roll than 1+ roll, at 72.3% compared to 28.3%. For far-seated occupants, seatbelt effectiveness was similar in < or =1 and 1+ roll samples at 78.3% and 76.8%, respectively. Near-seated occupants had the lowest serious injury risk when they were the sole occupant in the vehicle. This was also true for non-ejected occupants. However, far-seated occupants had a lower injury risk when another occupant was involved in the crash. CONCLUSIONS: The effect of carrying another occupant appears to reduce the risk of serious injury to far-seated occupants. However, near-seated occupants are better off being the sole occupant in the vehicle. Seatbelt effectiveness was lowest at 28.3% for non-ejected, near-seated occupants in 1+ rolls. This finding deserves further evaluation in an effort to improve seatbelt effectiveness in rollovers. For belted drivers alone in a rollover, fatality risks are 2.24 times higher for the far- versus near-seated position. Analysis of rollovers by quarter turns indicates that occupants are both far-side and near-side in rollovers. The extent to which this confounds the relationship between roll direction, seating position, and injury risk is unknown.     

Union elections at the local level: the role effectiveness of committee persons

Survey data were collected before and after a local union governance election in which half of the committeeperson incumbents lost. Examination of committeeperson role effectiveness shows that those who lost were rated significantly lower before the election compared to those who were retained. Newcomers who replaced incumbents were rated higher than those they replaced. © 1998 John Wiley & Sons, Ltd.     

The effect of workers' visibility on effectiveness of intervention programs: supervisory-based safety interventions

INTRODUCTION: This paper discusses an organizational change intervention program targeting safety behaviors and addresses important considerations concerning the planning of organizational change. Using layout of the plant as a proxy for ease of daily leader-member interaction, the effect of workers' visibility on the effectiveness of supervisory-based safety (SBS) interventions is examined. Through a reinforcement-learning framework, it is suggested that visibility can affect supervisors' incentive to interact with subordinates regarding safety-related issues. METHOD: Data were collected during SBS intervention studies in five manufacturing companies. RESULTS: Results suggest a reinforcement cycle model whereby increased visibility generates more frequent exchanges between supervisors and employees, resulting in improved safety behavior among employees. In turn, employees' safer behavior reinforces continued supervisory safety-related interaction. CONCLUSION AND IMPACT ON INDUSTRY: Visibility is an important moderator in supervisory based safety interventions, and can serve to increase workplace safety. Implications of these findings for safety are discussed.     

Smoking,belt use,and road accidents of youth in Kuwait

Youth, worldwide, are involved in a disproportionate number of road accidents, in general, and fatal accidents, in particular. Kuwait is no exception to this trend. The objectives of this funded research were to identify the trends in belt use, smoking in motion, and road accidents of young drivers in Kuwait. Findings of a person-interview questionnaire survey of 1467 randomly selected young drivers in Kuwait are presented. The socio-economic, driving experience, belt use, smoking behaviour, and road accident involvements of the sample young drivers are given. The interrelationships between the socio-economic, belt use, smoking behaviour, and road traffic accidents are also examined. Degrees of association between these variables are determined, and the extent of potential contribution of smoking-in-motion to causes of road accidents is also determined. Young female drivers were found to be generally safer drivers than their young male counterparts; those who smoked while driving used seat belt less, and had a higher involvement rate in road traffic accidents. A number of recommended measures for the improvement of road safety in Kuwait end the paper.     

The effectiveness of electronic stability control in reducing real-world crashes: a literature review

OBJECTIVE: Electronic stability control (ESC) is designed to help drivers maintain heading control of their vehicles in high-speed or sudden maneuvers and on slippery roads. The wider proliferation of ESC across the vehicle fleet has allowed evaluation of its effects in real-world crashes in many countries, including Japan, Germany, Sweden, France, Great Britain, and the United States. This article provides a summary of the findings. METHODS: Studies that examined the real-world effectiveness of ESC were reviewed. Crash effects have been examined for different roadways, using differing analytic methods, different crash severities, and different make/model vehicles including both cars and SUVs. The review discusses the methodological differences and examines the findings according to vehicle type, crash type and severity, and road conditions. RESULTS: The overwhelming majority of studies find that ESC is highly effective in reducing single-vehicle crashes in cars and SUVs. Fatal single-vehicle crashes involving cars are reduced by about 30-50% and SUVs by 50-70%. Fatal rollover crashes are estimated to be about 70-90% lower with ESC regardless of vehicle type. A number of studies find improved effectiveness in reducing crashes when road conditions are slippery. There is little or no effect of ESC in all multi-vehicle crashes; however, there is a 17-38% reduction in more serious, fatal multi-vehicle crashes. CONCLUSIONS: Given the extraordinary benefits of ESC in preventing crashes, especially those with more serious outcomes, the implementation of ESC should be accelerated to cover the full range of passenger vehicles in both developed and developing markets.     

Age and work outcomes: The moderating effects of self-efficacy and tool design effectiveness

This field study addressed the relationship between age and work outcomes by investigating the effects of two potential moderators of age–work outcome relations: self-efficacy and perceptions of tool design effectiveness, while controlling for job tenure, job demands, and gender. Findings revealed that job-focused self-efficacy beliefs moderated the relationship between age and absenteeism, while tool design moderated the relationship between age and performance. Self-efficacy and tool design both had direct positive main effects on job satisfaction. Implications for research on age and constructive work force management are discussed.