A review of driving risks and impairments associated with attention-deficit/hyperactivity disorder and the effects of stimulant medication on driving performance

INTRODUCTION: Attention-Deficit/Hyperactivity Disorder (ADHD) may interfere with driving competence, predisposing those with the disorder to impaired driving performance and greater risk for adverse driving outcomes. Effective treatment may minimize the risk in those with ADHD. METHOD: We reviewed the scientific literature on driving risks and impairments associated with ADHD and the effects of stimulants on driving performance. Several lines of evidence were considered, including longitudinal studies and community-derived sample studies. The present review is based on a weekly review (by the first author) of all journals in the behavioral and social sciences indexed in the publication Current Contents spanning the past 15 years, as well as a search of the reference section of all studies found that pertained to driving risks associated with ADHD or to the treatment of ADHD as it relates to driving difficulties. RESULTS: The review of the scientific literature demonstrated well-documented driving risks and impairments associated with ADHD and the positive effects of stimulant medications on driving performance. CONCLUSIONS: Clinicians should educate patients/caregivers about the increased risk of adverse outcomes among untreated individuals with ADHD and the role of medication in potentially improving driving performance. IMPACT ON INDUSTRY: Owing to the significantly higher risk of adverse driving outcomes, the use of stimulant medications to treat people with ADHD who drive may reduce such safety risks.     

Gender differences of young drivers on injury severity outcome of highway crashes

ProblemGender differences of young drivers involved in crashes and the associated differences in risk factors have not been fully explored in the United States (U.S.). Accordingly, this study investigated the topic, where the odds ratios (ORs) were used to identify differences in crash involvements between male and female young drivers.MethodLogistic regression models for injury severity of young male drivers and young female drivers were developed. Different driver, environmental, vehicle, and road related factors that have affected young female drivers' and young male drivers' crash involvements were identified using the models.ResultsResults indicated that some variables are significantly related to female drivers' injury risk but not male drivers' injury risk and vice versa. Variables such as driving with valid licenses, driving on weekends, avoidance or slow maneuvers at time of crash, non-collision and overturn crashes, and collision with a pedestrian were significant variables in female driver injury severity model but not in young male driver severity model. Travel on graded roadways, concrete surfaces, and wet road surfaces, collision with another vehicle, and rear-end collisions were variables that were significant in male-driver severity model but not in female-driver severity model.SummaryFactors which increase young female drivers' injury severity and young male drivers' injury severity were identified. This study adds detailed information about gender differences and similarities in injury severity risk of young drivers.Practical applicationsIt is important to note that the findings of this study show that gender differences do exists among young drivers. This sends a message to the industry that the transportation professionals and researchers, who are developing countermeasures to increase the traffic safety, may need to pay attention to the differences. This might be particularly true when developing education materials for driver training for young/inexperienced drivers.     

The field performance of frontal air bags: a review of the literature

This article presents a broad review of the literature on frontal air bag field performance, starting with the initial government and industry projections of effectiveness and concluding with the most recent assessments of depowered systems. This review includes as many relevant metrics as practicable, interprets the findings, and provides references so the interested reader can further evaluate the limitations, confounders, and utility of each metric. The evaluations presented here range from the very specific (individual case studies) to the general (statistical analyses of large databases). The metrics used to evaluate air bag performance include fatality reduction or increase; serious, moderate, and minor injury reduction or increase; harm reduction or increase; and cost analyses, including insurance costs and the cost of life years saved for various air bag systems and design philosophies. The review begins with the benefits of air bags. Fatality and injury reductions attributable to the air bag are presented. Next, the negative consequences of air bag deployment are described. Injuries to adults and children and the current trends in air bag injury rates are discussed, as are the few documented instances of inadvertent deployments or non-deployment in severe crashes. In the third section, an attempt is made to quantify the influence of the many confounding factors that affect air bag performance. The negative and positive characteristics of air bags are then put into perspective within the context of societal costs and benefits. Finally, some special topics, including risk homeostasis and the performance of face bags, are discussed.     

Changes in driving performance after first and second eye cataract surgery: A driving simulator study

Introduction: This study investigated the separate impact of first eye and second eye cataract surgery on driving performance, as measured on a driving simulator. Method: Forty-four older drivers with bilateral cataract aged 55+ years, awaiting first eye cataract surgery participated in a prospective cohort study. They completed a questionnaire, visual tests and a driving simulator assessment at three time points: before first eye, after first eye, and after second eye cataract surgery. Generalized Estimating Equation Poisson or linear regression models were undertaken to examine the change in four driving outcomes of interest after adjusting for cataract surgery and other potential confounders. Results: The rate of crashes/near crashes decreased significantly by 36% (incidence rate ratio (IRR) 0.64, 95% CI 0.47–0.88, p = 0.01) after first eye surgery and 47% (IRR 0.53, 95% CI 0.35–0.78, p < 0.001) after second eye surgery, compared to before first eye cataract surgery, after accounting for confounders. The rate of crashes/near crashes also decreased with better contrast sensitivity (IRR 0.69, 95% CI 0.48–0.90, p = 0.041). A separate model found that time spent speeding 10 kilometers per hour or more over the limit after second eye surgery was significantly less (0.14 min, p = 0.002), compared to before first eye surgery, after accounting for confounders. As contrast sensitivity improved, the duration of speeding also decreased significantly by 0.46 min (p = 0.038). There were no statistically significant changes in lane excursions or speed variation. Practical applications: The findings highlight the importance of timely first and second eye cataract surgery to ensure driver safety, especially as older drivers wait for second eye cataract surgery. It also provides further evidence that contrast sensitivity is probably a better predictor of driving ability in older drivers with cataract than visual acuity, the measure on which driver licensing requirements are currently based, and should also be used when assessing fitness to drive.     

Age-related differences in effects of non-driving related tasks on takeover performance in automated driving

Introduction: During SAE level 3 automated driving, the driver’s role changes from active driver to fallback-ready driver. Drowsiness is one of the factors that may degrade driver’s takeover performance. This study aimed to investigate effects of non-driving related tasks (NDRTs) to counter driver’s drowsiness with a Level 3 system activated and to improve successive takeover performance in a critical situation. A special focus was placed on age-related differences in the effects. Method: Participants of three age groups (younger, middle-aged, older) drove the Level 3 system implemented in a high-fidelity motion-based driving simulator for about 30 min under three experiment conditions: without NDRT, while watching a video clip, and while switching between watching a video clip and playing a game. The Karolinska Sleepiness Scale and eyeblink duration measured driver drowsiness. At the end of the drive, the drivers had to take over control of the vehicle and manually change the lane to avoid a collision. Reaction time and steering angle variability were measured to evaluate the two aspects of driving performance. Results: For younger drivers, both single and multiple NDRT engagements countered the development of driver drowsiness during automated driving, and their takeover performance was equivalent to or better than their performance without NDRT engagement. For older drivers, NDRT engagement did not affect the development of drowsiness but degraded takeover performance especially under the multiple NDRT engagement condition. The results for middle-aged drivers fell at an intermediate level between those for younger and older drivers. Practical Applications: The present findings do not support general recommendations of NDRT engagement to counter drowsiness during automated driving. This study is especially relevant to the automotive industry’s search for options that will ensure the safest interfaces between human drivers and automation systems.     

The effectiveness of alternative transportation programs in reducing impaired driving: A literature review and synthesis

Introduction: Studies have shown that approximately half of arrested intoxicated drivers had their last alcoholic drink at a licensed bar or restaurant. Current efforts to prevent intoxicated patrons from leaving licensed establishments and driving home have been only partially successful. Since a high proportion of drinkers drive to their drinking destination, promoting the use of alternative transportation (AT) – including safe ride shuttles, free or subsidized taxi and ridesharing services, voluntary or paid designated driver programs, and more accessible public transportation – is an important strategy for preventing impaired driving. The primary goal of this study was to review and synthesize the findings of research studies designed to test the effectiveness of AT programs in reducing alcohol-impaired driving. A secondary goal was to report if using AT has led to any unintended consequences, in particular greater alcohol consumption. Method: We identified relevant academic articles, new articles, government reports, and other documents (English only) through the University of Chicago library, Google Scholar, and Google Search. We also included published articles recommended by peers. Key search terms included: alternative transportation; safe rides; designated driver; alcohol-impaired driving; alcohol consumption, cost effectiveness; and reduce drunk driving. Initially, we identified 168 potentially relevant sources, of which only 57 were academic articles. After a thorough review, we narrowed down the number of relevant articles to 125 including some background articles and government reports. Results: Some AT programs produced reductions in one or more of the following outcomes: (1) impaired driving; (2) impaired driving crashes; (3) driving under the influence (DUI) arrests; and (4) traffic crashes in general, but others were not shown to be effective. A few programs resulted in greater self-reported alcohol use, but there were no significant findings indicating that drinking when using AT led to an increase in alcohol-related harms such as public intoxication, assaults, or other alcohol-related crime. Of the studies that conducted a cost-benefit analysis, most showed that AT programs yielded a positive benefit, but these studies did not include a sufficient number of variables to be considered true cost-benefit analyses. Conclusions: There is mixed evidence regarding the effectiveness of AT programs. Evaluations with more rigorous quasi-experimental and experimental designs are needed to identify which types of AT programs work best for different types of communities and target groups. Practical Applications: The literature review and synthesis revealed that the most successful AT programs typically have some of these attributes: (1) social acceptance; (2) high level of public awareness; (3) low cost; (4) year-round availability; (5) provide rides to and from drinking venues; (6) several sponsors that provide funding); (7) user convenience; and (8) perceived safety.     

Gender differences and demographic influences in perceived concern for driver safety and support for impaired driving countermeasures

IntroductionDriving safety, impaired driving, and legislation to address these concerns remain important issues. It is imperative countermeasures be targeted toward the most appropriate groups. This paper explores the potential relationship between gender and driving attitudes toward safety issues and impaired-driving countermeasures.MethodThe data are from the 2007 Impaired Driving Survey commissioned by Transport Canada and Mothers Against Drunk Driving (MADD) Canada. The survey is a, stratified by region, telephone survey of 1,514 Canadian drivers 18 years of age and older with a valid driver's license who had driven within the past 30 days.ResultsThe findings illustrate a consistent impact of gender on these issues. Other variables were also identified as relevant factors although less consistently. Current findings suggest that strategies for building support for interventions, or for changing risk perception/concern for risky driving behaviors should be tailored by gender to maximize the potential for behavior change.ImpactThis information may assist program and policy developers through the identification of more or less receptive target groups. Future research directions are also presented.     

Examining the asymptote in safety progress: a literature review

Many industries are confronted by plateauing safety performance as measured by the absence of negative events – particularly lower-consequence incidents or injuries. At the same time, these industries are sometimes surprised by large fatal accidents that seem to have no connection with their understanding of the risks they faced; or with how they were measuring safety. This article reviews the safety literature to examine how both these surprises and the asymptote are linked to the very structures and practices organizations have in place to manage safety. The article finds that safety practices associated with compliance, control and quantification could be partly responsible. These can create a sense of invulnerability through safety performance close to zero; organizational resources can get deflected into unproductive or counterproductive initiatives; obsolete practices for keeping human performance within a pre-specified bandwidth are sustained; and accountability relationships can encourage suppression of the ‘bad news’ necessary to learn and improve.     

Gender differences in children's pedestrian behaviors: Developmental effects

IntroductionAll child pedestrians are vulnerable to road traffic injuries, but there is evidence that boys may be at greater risk than girls, at least among some age groups.MethodTo create effective intervention programs, research on how boys and girls of particular ages behave as pedestrians, and whether there are gender differences that increase risk for particular genders at particular ages, is needed. In this study, 255 boys and 235 girls in grade 1 through 6 from two primary schools in Nantong city, China, were unobtrusively videotaped when walking to school in the morning. Videotapes were reviewed and coded for seven pedestrian safety behaviors, including activities related to crossing streets (walking instead of running/hopping, observing traffic, using the crosswalk instead of walking outside the crosswalk, and keeping close to an accompanying adult) and those related to walking alongside busy streets (walking instead of running/hopping on the sidewalk, not playing on the sidewalk, walking alone instead of walking side-by-side with a partner).ResultsResults revealed that as a whole, boys played on the sidewalk more often than girls (p < 0.01) and crossed with an accompanying adult more than girls (p < 0.05), while girls walked side-by-side with partners more often than boys (p < 0.05). With a few exceptions, boys and girls in the younger grades (1–2) as well as those in the older grades (5–6) behaved fairly similarly as pedestrians, but boys and girls in the middle grades (3–4) presented with several significant gender-based differences. In the middle grades, boys watched traffic more than girls while crossing (p < 0.01); ran, hopped and played on the sidewalk more often than girls (p < 0.05); and walked side-by-side less often with partners than girls (p < 0.05). We also detected different gender-based trends in the development of pedestrian skills. With increasing age, girls performed more safely in pedestrian tasks, but boys did not show a similar developmental trend.ConclusionsWe conclude that boys and girls exhibit different characteristics in their pedestrian behaviors and discuss implications for prevention.     

First year as a licensed car driver: Gender differences in crash experience

Objective: To explore the crash experience and crash consequences of newly licensed male and female drivers aged 18–29 years.Methodology: A national register-based population cohort of persons born between 1970 and 1972 was followed for the period 1988–2000 on the basis of crash data in Swedish police records. The analyses focused on two crash categories regardless of consequences: single car (SC) and car-to-motor vehicle (CMV).Results: Crash incidence for men was nearly double that of women in all age groups in both crash categories. Age had a protective effect for both sexes, especially for SC crashes. Males, but not females, showed a lag in time from driving license issue date to first crash for SC crashes, which increased with age of obtaining a license. Men’s crash fatality rate was five times higher than that of women for SC crashes (32.2 and 6.1 per 1000, respectively), but the rate was comparable for CMV crashes (16.1 and 15.7, respectively). The crash morbidity rate was 25–30% higher for male drivers in both crash categories.Conclusions: Both young age and male sex emerge as important determinants of crash risk and crash consequences among young Swedish drivers.     

Gender differences in the perception of organizational influence tactics

A short incident describing a political influence attempt was given to 152 management level and professional employees. Subjects were then asked to complete short attitude scales pertaining to the characteristics of the actor and the incident. The experimental factorial design included three factors (1) sex of subject, (2) sex of influencing party, (3) sex of target of influence. The results suggest that males are more tolerant of political behavior than women. Subjects view political manipulators of their own sex more favorably than manipulators of the opposite sex. Subjects of both sexes are more tolerant of political behavior when the victim of the behavior is a member of the opposite sex rather than of their own sex. The results may suggest a growing inclination on the part of both genders to identify with members of their own sex as a meaningful coalition and react to organizational events in view of the implications to members of their own gender. Possible implications for research and intervention are suggested.     

Cell phones and driving: review of research

OBJECTIVE: The research literature on drivers' use of cell phones was reviewed to identify trends in drivers' phone use and to determine the state of knowledge about the safety consequences of such use. METHODS: Approximately 125 studies were reviewed with regard to the research questions, type and rigor of the methods, and findings. Reviewed studies included surveys of drivers, experiments, naturalistic studies (continuous recording of everyday driving by drivers in instrumented vehicles), studies of crash risk, and evaluations of laws limiting drivers' phone use. RESULTS: Observational surveys indicate drivers commonly use cell phones and that such use is increasing. Drivers report they usually use hand-held phones. Experimental studies have found that simulated or instrumented driving tasks, or driving while being observed, are compromised by tasks intended to replicate phone conversations, whether using hand-held or hands-free phones, and may be further compromised by the physical distraction of handling phones. Effects of phone use on driving performance when drivers are in their own vehicles are unknown. With representative samples of adequate size, naturalistic studies in the future may provide the means to document the patterns and circumstances of drivers' phone use and their effects on real-world driving. Currently, the best studies of crash risk used cell phone company billing records to verify phone use by crash-involved drivers. Two such studies found a fourfold increase in the risk of a property-damage-only crash and the risk of an injury crash associated with phone use; increased risk was similar for males and females, younger and older drivers, and hands-free and hand-held phones. A number of jurisdictions in the United States and around the world have made it illegal for drivers to use hand-held phones. Studies of these laws show only limited compliance and unclear effects on safety.CONCLUSIONS: Even if total compliance with bans on drivers' hand-held cell phone use can be achieved, crash risk will remain to the extent that drivers continue to use or switch to hands-free phones. Although the enactment of laws limiting drivers' use of all phones is consistent with research findings, it is unclear how such laws could be enforced. At least in the short term, it appears that drivers' phone use will continue to increase, despite the growing evidence of the risk it creates. More effective countermeasures are needed but are not known at this time.     

Influence of task demands on occupational stress: Gender differences

IntroductionOccupational stress is a common phenomenon in our society, and generates problems for both workers' health and the functioning of organizations. Over past decades numerous studies have examined occupational stress from the perspective of gender, offering somewhat contradictory results. Some of them found no differences and others indicated that either men or women suffer from greater amounts of occupational stress.MethodThe purpose of this study was to analyze gender differences in stress in situations that involve certain occupational demands. The data used were taken from a random sample population of 11,054 (5,917 men and 5,137 women) from the VI National Survey on Working Conditions (NSWC) which was conducted in Spain in 2007. To carry out this study, a probabilistic model was constructed using Bayesian networks, with the following variables related to task demands: working with tight deadlines, quick work, intellectually demanding work, complicated tasks, repetitive tasks, excessive work, and work demanding high attention levels.ResultsThe results of this study reveal that: the indicators studied significantly increased stress levels; women initially had higher stress levels than men; and when exposed to determined task demands, stress differences between genders tended to increase.Impact on IndustryCompanies need to consider the gender of their workers when assigning tasks in high demand/stress jobs.     

Determinants of safety outcomes and performance: A systematic literature review of research in four high-risk industries

IntroductionIn spite of increasing governmental and organizational efforts, organizations still struggle to improve the safety of their employees as evidenced by the yearly 2.3 million work-related deaths worldwide. Occupational safety research is scattered and inaccessible, especially for practitioners. Through systematically reviewing the safety literature, this study aims to provide a comprehensive overview of behavioral and circumstantial factors that endanger or support employee safety.MethodA broad search on occupational safety literature using four online bibliographical databases yielded 27.527 articles. Through a systematic reviewing process 176 online articles were identified that met the inclusion criteria (e.g., original peer-reviewed research; conducted in selected high-risk industries; published between 1980-2016). Variables and the nature of their interrelationships (i.e., positive, negative, or nonsignificant) were extracted, and then grouped and classified through a process of bottom-up coding.ResultsThe results indicate that safety outcomes and performance prevail as dependent research areas, dependent on variables related to management & colleagues, work(place) characteristics & circumstances, employee demographics, climate & culture, and external factors. Consensus was found for five variables related to safety outcomes and seven variables related to performance, while there is debate about 31 other relationships. Last, 21 variables related to safety outcomes and performance appear understudied.ConclusionsThe majority of safety research has focused on addressing negative safety outcomes and performance through variables related to others within the organization, the work(place) itself, employee demographics, and—to a lesser extent—climate & culture and external factors.Practical applicationsThis systematic literature review provides both scientists and safety practitioners an overview of the (under)studied behavioral and circumstantial factors related to occupational safety behavior. Scientists could use this overview to study gaps, and validate or falsify relationships. Safety practitioners could use the insights to evaluate organizational safety policies, and to further development of safety interventions.     

Gender differences in driver's license theory test scores in the Netherlands

INTRODUCTION: Gender differences were investigated in a sample of persons (N=34,755) who completed the driver's license theory test in the Netherlands. RESULTS: Contrary to recent findings from Sweden, no gender differences were found. IMPACT OF INDUSTRY: The present study signifies the importance of standardization in driver testing.     

Epidemiology of occupational acute traumatic hand injuries: a literature review

The purpose of this review was to summarize the literature on occupational, acute, traumatic hand injury and suggest directions for future research. In 1996, the leading occupational injury treated in United States' hospital emergency departments was an acute hand injury (e.g. laceration, crush or fracture). These injuries affected 30% of an estimated 3.3 million injured workers (990,000). Cuts and lacerations of the fingers ranked third after back and leg strains in the number of lost workday cases in the USA in 1994. The incidence rate of hand injuries studied in seven manufacturing environments around the world ranged from 4 to 11 per 100 workers per year. Workers aged 24 years or less had the highest risk of hand injury. Men had higher rates of severe hand injury than women.Despite the high frequency and significant amount of lost work time associated with these injuries, they are poorly understood from an etiological perspective. There is only one case-control study of occupational hand injury in the literature. That study suggested an important role for both fixed (age) and transient risk factors (doing an unusual task) at the time of the injury. More analytic epidemiological research is needed to identify potentially modifiable risk or protective factors (e.g. glove use) for acute hand injuries. In this regard, the case-crossover design, a relatively new epidemiological approach using cases as their own controls, could prove an efficient method for determining transient, modifiable risk factors for acute, occupational hand injury.     

基于速度特征指标的高速公路线形一致性综合评价

为量化评价已建和拟建高速公路交通安全性,以实测运行车速数据和事故率数据为基础,根据公路空间属性的变化,采用不定长法进行路段划分。考虑不同路段车速协调性和连续性的需求,引入客货差极差比、车速降低系数、路段车速离散度等车速特征指标。通过对运行车速特征指标与事故率的相关性分析,采用多元回归的方法建立了高速公路线形设计一致性综合评价模型,同时结合事故多发点改善效果的显著性,确定我国高速公路安全性服务水平,在此基础上提出线形设计一致性评价标准和评价方法。太旧高速公路的实例应用结果表明,该方法可准确有效地评价线形设计一致性。     

Effects of mobile phone use on driving performance in a multiresource workload scenario

Objective: This study explores the influence of mobile phone secondary tasks on driving from the perspective of visual, auditory, cognitive, and psychomotor (VACP) multiple resource theory, and it is anticipated to benefit the human-centered design of mobile phone use while driving.

Methods: The present study investigated 6 typical phone use scenarios while driving and analyzed the effects of phone use distractions on driving performance. Thirty-six participants were recruited to participate in this experiment. We abandoned traditional secondary tasks such as conversations or dialing, in which cognitive resources can become interference. Instead, we adopted an arrow secondary task and an n-back delayed digit recall task.

Results: The results show that all mobile phone use scenarios have a significant influence on driving performance, especially on lateral vehicle control. The visual plus psychomotor resource occupation scenario demonstrated the greatest deterioration of driving performance, and there was a significant deterioration of driving speed and steering wheel angle once the psychomotor resource was occupied.

Conclusions: Phone use distraction leads to visual, cognitive, and/or motor resource functional limitations and thus causes lane violations and traffic accidents.