Association between cellular-telephone calls and motor vehicle collisions

Association Between Mobile Telephone Interruptions and Medication Administration Errors in a Pediatric Intensive Care Unit

IMPORTANCE

Incoming text messages and calls on nurses' mobile telephones may interrupt medication administration, but whether such interruptions are associated with errors has not been established.

OBJECTIVE

To assess whether a temporal association exists between mobile telephone interruptions and subsequent errors by pediatric intensive care unit (PICU) nurses during medication administration.

DESIGN, SETTING, AND PARTICIPANTS

A retrospective cohort study was performed using telecommunications and electronic health record data from a PICU in a children's hospital. Data were collected from August 1, 2016, through September 30, 2017. Participants included 257 nurses and the 3308 patients to whom they administered medications.

EXPOSURES

Primary exposures were incoming telephone calls and text messages received on the institutional mobile telephone assigned to the nurse in the 10 minutes leading up to a medication administration attempt. Secondary exposures were the nurse's PICU experience, work shift (day vs night), nurse to patient ratio, and level of patient care required.

MAIN OUTCOMES AND MEASURES

Primary outcome, errors during medication administration, was a composite of reported medication administration errors and bar code medication administration error alerts generated when nurses attempted to give medications without active orders for the patient whose bar code they scanned.

RESULTS

Participants included 257 nurses, of whom 168 (65.4%) had 6 months or more of PICU experience; and 3308 patients, of whom 1839 (55.6%) were male, 1539 (46.5%) were white, and 2880 (87.1%) were non-Hispanic. The overall rate of errors during 238 540 medication administration attempts was 3.1% (95% CI, 3.0%-3.3%) when nurses were uninterrupted by incoming telephone calls and 3.7% (95% CI, 3.4%-4.0%) when they were interrupted by such calls. During day shift, the odds ratios (ORs) for error when interrupted by calls (compared with uninterrupted) were 1.02 (95% CI, 0.92-1.13; P = .73) among nurses with 6 months or more of PICU experience and 1.22 (95% CI, 1.00-1.47; P = .046) among nurses with less than 6 months of experience. During night shift, the ORs for error when interrupted by calls were 1.35 (95% CI, 1.16-1.57; P < .001) among nurses with 6 months or more of PICU experience and 1.53 (95% CI, 1.16-2.03; P = .003) among nurses with less than 6 months of experience. Nurses administering medications to 1 or more patients receiving mechanical ventilation and arterial catheterization while caring for at least 1 other patient had an increased risk of error (OR, 1.21; 95% CI, 1.03-1.42; P = .02). Incoming text messages were not associated with error (OR, 0.97; 95% CI, 0.92-1.02; P = .22).

CONCLUSIONS AND RELEVANCE

This study's findings suggest that incoming telephone call interruptions may be temporally associated with medication administration errors among PICU nurses. Risk of error varied by shift, experience, nurse to patient ratio, and level of patient care required.

Tracing the physiological response and behavioral performance of drivers at different levels of mental workload using driving simulators

INTRODUCTION

The use of mobile phones while driving is known to be a distraction factor and a cause of accidents. The way in which different kinds of conversations affect the behavioral performance of the driver as well as the persistence of the effects are not yet fully understood.

METHOD

In this study, in addition to comparing brain function and behavioral function in dual task conditions in three conversations types, the persistent effects of these types of conversations have also been traced.

RESULTS

The results show that the content of the mobile phone conversation while driving is the cause of the persistent changes in behavioral and brain functions. Increased time headway and lane departure was observed during and up to 5 min after the emotional conversation was finished. EEG bands also varied in different types of conversations. Cognitive conversations caused an increase in the activity of the alpha and beta bands while emotional conversations enhanced the rate of gamma and beta bands. A meaningful correlation was found between changes in the theta and alpha bands and changes in behavioral performance both during the dual task condition and after the conversation was finished, was also observed.

CONCLUSIONS

The content of the conversation is one of the most important factors that increase the risk of road accidents. This can also deteriorate the behavioral performance of the driver and can have persistent effects on behavioral performance and the brain. Practical applications: The findings of this study provide a basis to measure and tracing drivers' cognitive distractions induced by different levels of mental workload through physiological and behavioral performances.

As Violence Unfolds: A Space-Time Study of Situational Triggers of Violent Victimization among Urban Youth

OBJECTIVES

This study clarifies three important issues regarding situational or opportunity theories of victimization: 1) whether engaging in risk activities triggers violent assault during specific, often fleeting moments, 2) how environmental settings along individuals' daily paths affect their risk of violent assault, and 3) whether situational triggers have differential effects on violent assault during the day versus night.

METHODS

Using an innovative GIS-assisted interview technique, 298 young male violent assault victims in Philadelphia, PA described their activity paths over the course of the day of being assaulted. Case-crossover analyses compared each subject's exposure status at the time of assault with his own statuses earlier in the day (stratified by daytime and nighttime).

RESULTS

Being at an outdoor/public space, conducting unstructured activities, and absence of guardians increase the likelihood of violent victimization at a fine spatial-temporal scale at both daytime and nighttime. Yet, the presence of friends and environmental characteristics have differential effects on violent victimization at daytime versus nighttime. Moreover, individual risk activities appeared to exhibit better predictive performance than did environmental characteristics in our space-time situational analyses.

CONCLUSIONS

This study demonstrates the value of documenting how individuals navigate their daily activity space, and ultimately advances our understanding of youth violence from a real-time, real-life standpoint.

Distracted Driving and Risk of Crash or Near-Crash Involvement Among Older Drivers Using Naturalistic Driving Data With a Case-Crossover Study Design

BACKGROUND

The purpose of this study was to examine the association between secondary task involvement and risk of crash and near-crash involvement among older drivers using naturalistic driving data.

METHODS

Data from drivers aged ≥70 years in the Strategic Highway Research Program (SHRP2) Naturalistic Driving Study database was utilized. The personal vehicle of study participants was equipped with four video cameras enabling recording of the driver and the road environment. Secondary task involvement during a crash or near-crash event was compared to periods of noncrash involvement in a case-crossover study design. Conditional logistic regression was used to generate odds ratios (ORs) and 95% confidence intervals (CI).

RESULTS

Overall, engaging in any secondary task was not associated with crash (OR = 0.94, 95% CI 0.68-1.29) or near-crash (OR = 1.08, 95% CI 0.79-1.50) risk. The risk of a major crash event with cell phone use was 3.79 times higher than the risk with no cell phone use (95% CI 1.00-14.37). Other glances into the interior of the vehicle were associated with an increased risk of near-crash involvement (OR = 2.55, 95% CI 1.24-5.26). Other distractions external to the vehicle were associated with a decreased risk of crash involvement (OR = 0.53, 95% CI 0.30-0.94). Interacting with a passenger and talking/singing were not associated with crash or near-crash risk.

CONCLUSIONS

Older drivers should avoid any cell phone use and minimize nondriving-related eye glances towards the interior of the vehicle while driving. Certain types of events external to the vehicle are associated with a reduced crash risk among older drivers.

Modeling of time-dependent safety performance using anonymized and aggregated smartphone-based dangerous driving event data

Safety performance functions (SPFs) are generally used to relate exposure to the expected number of crashes aggregated over a long time (e.g. a year) by holding all other risk factors constant, and to identify hotspots that have excessive crashes regardless of different time periods. However, it is highly likely that the relationships of exposure, risk factors and crash occurrence can vary across different times of day. This study aims to establish time-dependent SPFs for urban roads by using large-scale dangerous driving event data captured by smartphones in different times of day. Multivariate conditional autoregressive (MVCAR) models are developed to jointly account for spatial and temporal dependence of crash observations. Results of two-sample Kolmogorov-Smirnov tests affirm the heterogeneity of the safety effects of dangerous driving events in different time periods. Time-dependent hotspots are identified using potential for safety improvement (PSI) metric. The assumption here is that due to the change of traffic conditions and environment across different times of day, safety hotspots for different time periods should be different from each other. According to the results of Wilcoxon signed-rank tests, hotspots identified by times of day are found to be mostly different from each other. The findings of this study provide insights into temporal effects of risk factors and can support the development of time-dependent safety countermeasures. Besides, this study also shows the potential of leveraging anonymized and aggregated dangerous driving data to assess traffic safety issues.

Sleepiness and Driving: Benefits of Treatment

Drowsy driving is common and causes 21% of fatal crashes. Individuals at risk include young men, shift workers, older adults, and people with chronic short sleep duration, untreated obstructive sleep apnea (OSA), and narcolepsy. Untreated OSA is a particular concern in commercial drivers, who are at higher risk for the disorder. Treatment for sleep problems such as sleep extension for chronic short sleep, positive airway pressure (PAP) for OSA, pharmacologic treatments, and drowsy driving countermeasures may reduce the risk of crashes. Implementing screening measures to identify common sleep problems contributing to drowsy driving continues to be of high importance.

Incorporating behavioral variables into crash count prediction by severity: A multivariate multiple risk source approach

The frequency and severity of traffic crashes have commonly been used as indicators of crash risk on transport networks. Comprehensive modeling of crash risk should account for both frequency and injury severity-capturing both the extent and intensity of transport risk for designing effective safety improvement programs. Previous research has revealed that crashes are correlated across severity categories because of the combined influence of risk factors, observed or unobserved. Moreover, crashes are the outcomes of a multitude of factors related to roadway design, traffic operations, pavement conditions, driver behavior, human factors, and environmental characteristics, or in more general terms: factors reflect both engineering and non-engineering risk sources. Perhaps not surprisingly, engineering risk sources have dominated the list of variables in the mainstream modeling of crashes whereas non-engineering sources, in particular, behavioral factors, are crucially omitted. It is plausible to assume that crash contributing factors from the same risk source affect crashes in a similar manner, but their influences vary across different risk sources. Conventional crash frequency modeling hypothesizes that the total crash count at any roadway site is well-approximated by a single risk source to which several explanatory variables contribute collaboratively. The conventional formulation is not capable of accounting for variations between risk sources; therefore, is unable to discriminate distinct impacts between engineering variables and non-engineering variables. To address this shortcoming, this study contributes to the development of multivariate multiple risk source regression, a robust modeling technique to model crash frequency and severity simultaneously. The multivariate multiple risk source regression method applied in this study can effectively capture the correlation between severity levels of crash counts while identifyinging the varying effects of crash contributing factors originated from distinct sources. Using crashes on Wisconsin rural two-lane highways, two risk sources - engineering and behavioral - were employed to develop proposed models. The modeling results were compared with a single equation negative binomial (NB) model, and a univariate multiple risk source model. The results show that the multivariate multiple risk source model significantly outperforms the other models in terms of statistical fit across several measures. The study demonstrates a unique approach to explicitly incorporating behavioral factors into crash prediction models while taking crash severity into consideration. More importantly, the parameter estimates provide more insight into the distinct sources of crash risk, which can be used to further inform safety practitioners and guide roadway improvement programs.

The Association between Mobile Phone Use and Severe Traffic Injuries: A Case-Control Study from Saudi Arabia

Road traffic injury (RTI) is the third leading cause of death in Saudi Arabia. Using a mobile phone when driving is associated with distracted driving, which may result in RTIs. Because of limited empirical data, we investigated the association between mobile phone use and RTI in injured patients and community controls in Riyadh. Cases were patients admitted to King Abdulaziz Medical City (KAMC) between October 2016 and March 2018 due to RTIs. During admission, mobile phone use at the time of the accident was investigated. The controls were drivers observed at various locations citywide. A logistic regression model was constructed to estimate the association between mobile phone use while driving and sustaining RTIs. We included 318 cases and 1700 controls. For the cases, using a mobile phone was associated with higher severity and prevalence of disability. In addition, using a mobile phone while driving is associated with 44% higher odds of incurring a severe RTI (p = 0.04). Mobile phone use while driving is prevalent in Riyadh and pose a significant threat of disability. In addition, the low prevalence of seatbelt use is alarming and requires significant improvement. Prevention programs may use these findings to educate the public and policymakers and to advocate for increased visibility of enforcement to reduce RTIs and improve population health.

Effects of multitasking and intention-behaviour consistency when facing yellow traffic light uncertainty

We examined the effects of multitasking on resolving response bistability to yellow traffic lights, using the performance metrics of reaction time and stopping frequency. We also examined whether people's actual behaviours, measured by implicit foot pedal responses, differed from their intentions related to these factors, as measured by explicit verbal commands. In a dual-task paradigm, participants responded to random traffic light changes, presented over a static background photograph of an intersection, using either foot pedals or verbal commands, while simultaneously identifying spoken words as either "animals" or "artefacts" via button pressing. The dual-task condition was found to prolong reaction times relative to a single-task condition. In addition, verbal commands were faster than the foot pedal responses, and conservativeness was the same for both types of responses. A second experiment, which provided a more dynamic simulation of the first experiment, confirmed that conservativeness did not differ between verbal commands and foot pedal responses. We conclude that multitasking affects a person's ability to resolve response bistability to yellow traffic lights. If one considers that prolonged reaction times reduce the amount of distance available to safely stop at intersections, this study underscores how multitasking poses a considerable safety risk for drivers approaching a yellow traffic light.

Influence of sexual appeal in roadside advertising on drivers' attention and driving behavior

Sexual appeals are widely used in advertising to attract consumers’ attention. It has already been proved that they influence the addressee’s cognitive processing, which in turn raises the question if sexual appeals may pose a serious threat for road safety when used in roadside advertising. Three studies were designed to answer this question. Study I was a nationwide survey (N = 1095) which revealed that drivers subjectively perceive sexual contents in roadside advertising as distracting and dangerous. Study II was a modified version of the Attentional Network Test (N = 1063) which proved that in cognitive tasks reaction time increases in line with the sexual content of advertisements. Study III was a simulator study (N = 55) which confirmed that driving characteristics change when sexually-oriented advertisements are located along the road. These studies have led us to a conclusion that sexually appealing cues in roadside advertising may pose a threat for road safety.

Multiple processing limitations underlie multitasking costs

Human multitasking is typically defined as the practice of performing more than one task at the same time (dual task) or rapidly alternating between multiple tasks (task switching). The majority of research in multitasking has been focusing on individual paradigms, with surprisingly little effort in understanding their relationships. We adopted an individual-difference approach to reveal the limitations underlying multitasking costs measured in different paradigms. Exploratory factor analyses revealed not a general multitasking factor but instead three different processing limitations associated with response selection, retrieval and maintenance of task information, and task-set reconfiguration. The three factors were only weakly correlated with and thus not reducible to common measures of processing speed, working memory capacity and fluid intelligence. Males and females excelled in different aspects of multitasking, demonstrating the benefit of using a multifaceted view of multitasking competency in group comparison. Findings of the current study help resolve conflicting results between studies using different paradigms, and form the basis of more comprehensive measurement tools and training protocols covering different aspects of multitasking limitations. The study will also help future integration of multitasking abilities into the theoretical framework of executive function.

Effect of Using Mobile Phones on Driver's Control Behavior Based on Naturalistic Driving Data

Distracted driving behaviors are closely related to crash risk, with the use of mobile phones during driving being one of the leading causes of accidents. This paper attempts to investigate the impact of cell phone use while driving on drivers' control behaviors. Given the limitation of driving simulators in an unnatural setting, a sample of 134 cases related to cell phone use during driving were extracted from Shanghai naturalistic driving study data, which provided massive unobtrusive data to observe actual driving process. The process of using mobile phones was categorized into five operations, including dialing, answering, talking and listening, hanging up, and viewing information. Based on the concept of moving time window, the variation of the intensity of control activity, the sensitivity of control operation, and the stability of control state in each operation were analyzed. The empirical results show strong correlation between distracted operations and driving control behavior. The findings contribute to a better understanding of drivers' natural behavior changes with using mobiles, and can provide useful information for transport safety management.

The effects of auditory satellite navigation instructions and visual blur on road hazard perception

The distracting effects of mobile telephone use while driving are well known, however the effects of other sources of distraction, such as auditory navigation devices, are less well understood. Whether the effects of auditory distraction might interact with other sensory impairments, such as vision impairment, is of interest given that visual impairment is relatively common within the population, particularly as a result of uncorrected refractive error. In this experiment, 20 current drivers (mean age of 29.4 ± 3.2 years), binocularly viewed video recordings of traffic scenes presented as part of the Hazard Perception Test and responded to potential hazards within the traffic scenes. Half of the presented scenes included auditory navigation instructions as an auditory distractor. Additionally, some of the scenes were viewed through optical lenses to induce different levels of refractive blur (+0.50 DS, +1.00 DS and +2.00 DS). Hazard perception response times increased significantly (p < 0.05) with increasing blur. Participants were significantly slower in reacting to hazards for the +1.00 DS and +2.00 DS blur conditions compared to the control condition (with no blur). There was also a significant increase in response times to hazards in the presence of the auditory navigation instructions. The combined effect of blur and auditory instructions was additive, with the worst performance being in the presence of both blur and auditory instructions. These results suggest that the delivery of auditory navigation guidance for those with visual impairments, such as blur, which are relatively common in the population, should be further investigated.

Crash causes, countermeasures, and safety policy implications

There are interrelationships between crash causes, countermeasures, and policy implications, but they are not necessarily direct and obvious. Part of the problem is the definition of a cause. The seminal 1979 Indiana University "Study of Accident Causes" has cemented some false assumptions that must be overcome to yield an effective crash countermeasures policy. The taxonomy of crash causes and the prevalence of different causes are determined by the investigators, who are biased in different ways. The prevalent notion that approximately 90 percent of the crashes are due to human errors or failures is due to a threshold bias, and the implied notion that 90 percent of the countermeasures should be directed at changing these behaviors is based on an erroneous assumption that the cure must be directly linked to the stated cause. A more balanced approach to the definition of a cause and to the search for crash countermeasures is needed, and the safe system approach appears to be a most promising one.

Analysis of Observational Self-matched Data to Examine Acute Triggers of Outcome Events with Abrupt Onset

Several self-matched approaches have been proposed, including case-crossover, case-time control, fixed-effects case-time control, and self-controlled case series. Rather than comparing treatment effects between different individuals, studies use these approaches to evaluate the acute effects of transient exposures, often called “triggers,” by comparing outcome risk among the same individual at different times. This eliminates confounding by between-person characteristics that remain stable over time, allowing for valid analyses even in situations where information on some health behaviors is not available, such as long-term smoking history. However, to attain valid results, differences in the probability of exposure and outcome that change over time must be addressed in the design and analysis of the study. In this article, we describe the setting, assumptions and analytic options for conducting studies using self-matched data. Approaches that involve matching or a group of noncases to address time-varying confounding may have less statistical flexibility but they are powerful tools that overcome the need to assume a particular form of any time trends in potential confounders. If data are available for all of the person–time under study, there is a gain in statistical efficiency and the ability to address time-varying confounding using flexible regression models, under the strong assumption of no mis-specification of the model.

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.

Assessing the impacts of enriched information on crash prediction performance

While high road safety performing countries base their effective strategies on reliable data, in developing countries the unavailability of essential information makes this task challenging. As a result, this drawback has led researchers and planners to face dilemmas of "doing nothing" or "doing ill", therefore restricting models to data availability, often limited to socio-economic and demographic variables. Taking this into account, this study aims to demonstrate the potential improvements in spatial crash prediction model performance by enhancing the explanatory variables and modelling casualties as a function of a more comprehensive dataset, especially with an appropriate exposure variable. This includes experimental work, where models based on available information from São Paulo, Brazil, and Flanders, the Dutch speaking area of Belgium, are developed and compared with each other. Prediction models are developed within the framework of Geographically Weighted Regression with the Poisson distribution of errors. Moreover, casualties and fatalities as the response variables in the models developed for Flanders and São Paulo, respectively, are divided into two sets based on the transport mode, called active (i.e., pedestrians and cyclists) and motorized transport (i.e., motorized vehicle occupants). In order to assess the impacts of the enriched information on model performance, casualties are firstly associated with all available variables for São Paulo and the corresponding ones for Flanders. In the next step, prediction models are developed only for Flanders considering all the available information in the Flemish dataset. Findings showed that by adding the supplementary data, reductions of 20% and 25% for motorized transport, and 25% and 35% for active transport resulted in AICc and MSPE, respectively. Considering the practical aspects, results could help identify hotspots and relate most influential factors, suggesting sites and data, which should be prioritized in future local investigations. Besides minimizing costs with data collection, it could help policy makers to identify, implement and enforce appropriate countermeasures.

Road safety and distraction, results from a responsibility case-control study among a sample of road users interviewed at the emergency room

Despite the complexities of the driving task, more and more drivers engage in non-driving secondary tasks that take their hands (manual distraction), their eyes (visual distraction) and/or their mind (cognitive distraction) away from their primary task. Inattention arising from external distractions has received much less consideration beyond the impact of mobile phone use. We aimed to investigate the association between distraction behind the wheel and risk of being responsible for a road traffic crash in a responsibility case-control study. The study population included 1912 drivers injured in a road traffic crash recruited in two rounds of recruitment (from April 2010 to August 2011 and from March 2013 to January 2015) in the adult emergency department of Bordeaux University Hospital (France). Responsibility levels were estimated using a standardized method. Self-reported activities among a pre-established list of potential distractions were combined into four external distraction variables: visual distraction, manual distraction, auditory distraction, and verbal interaction. A significantly increased risk of being responsible for a road traffic crash was associated with the exposure to activities that take drivers' eyes off the road (adjusted odds ratio 2.99, 95% confidence interval 1.42-6.28) and activities that take drivers' hands off the wheel (adjusted odds ratio 2.12, 95% confidence interval 1.20-3.75). No significant associations were found for verbal interaction and listening to the radio and/or singing. This study suggests that beyond the use of mobile phone, particular attention must be paid to activities that involve visual and/or manual distraction.

The role of working memory for syntactic formulation in language production

Four picture-description experiments investigated if syntactic formulation in language production can proceed with only minimal working memory involvement. Experiments 1-3 compared the initiation latencies, utterance durations, and errors for syntactically simpler picture descriptions (adjective-noun phrases, e.g., the red book) to those of more complex descriptions (relative clauses, e.g., the book that is red). In Experiment 4, the syntactically more complex descriptions were also lexically more complex (e.g., the book and the car vs. the book). Simpler and more complex descriptions were produced under verbal memory load consisting of 2 or 4 unrelated nouns, or under no load. Across experiments, load actually made production more efficient (as manifested in shorter latencies, shorter durations or both), and sped up the durations of relative clauses more than those of adjective-noun phrases. The only evidence for disproportional disruption of more complex descriptions by load was a greater increase of production errors for these descriptions than for simpler descriptions under load in Experiments 2 and 4. We thus conclude that syntactic formulation in production (for certain constructions or in certain situations) can proceed with minimal working memory involvement. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Texting/Emailing While Driving Among High School Students in 35 States, United States, 2015

PURPOSE

Determine the prevalence and explore individual- and state-level factors associated with texting/emailing while driving (TWD) among adolescent drivers in the United States.

METHODS

Data from 35 states that administered the 2015 state Youth Risk Behavior Survey were analyzed. We used Poisson regression models with robust error variance to estimate prevalence ratios (PRs) for TWD.

RESULTS

Among the 101,397 high school students aged ≥ 14 years who had driven a vehicle during the past 30 days, 38% reported TWD at least once. TWD prevalence ranged from 26% in Maryland to 64% in South Dakota. TWD prevalence was higher in states with a lower minimum learner's permit age and in states where a larger percentage of students drove. Multivariable analyses revealed that the likelihood of TWD increased substantially with age, and white students were more likely to engage in TWD than students of all other races/ethnicities. Infrequent seatbelt users were 21% more likely to engage in TWD compared with frequent seatbelt users (adjusted PR = 1.21, 95% confidence interval: 1.16-1.26), and students who reported drinking and driving were almost twice as likely to TWD as compared to students who did not (adjusted PR = 1.91, 95% confidence interval: 1.79-2.04).

CONCLUSIONS

Prevalence of TWD among US high school students varied by more than two-fold across states. TWD prevalence was higher in states with lower minimum learner's permit ages and in states where a larger percentage of students drove. Older age, white race/ethnicity, and other risky driving behaviors were associated with TWD.

The driver-level crash risk associated with daily cellphone use and cellphone use while driving

This study examined the overall prevalence of cellphone use, including the rates of calls and texts both per day and hourly while driving, and assessed whether or not individual crash risk was correlated with cellphone use. The study used data from the Second Strategic Highway Research Program Naturalistic Driving Study (SHRP 2 NDS), which had more than 3500 participants who provided up to three years of driving data. Of these participants, 620 provided cellphone records, 564 of which included both call and text records. The prevalence of cellphone calls and texts per day was calculated. By overlaying the cellphone records with the SHRP 2 NDS data, we also evaluated the rates of calls and texts while driving by driver demographics. Crashes for these cellphone-using participants were also identified from the SHRP 2 NDS data. Negative binomial regression models were used to determine whether the crash rate was associated with cellphone use. Participants made an average of 27.1 texts and 7.3 calls per day. They averaged 1.6 texts and 1.2 calls per hour of driving. Cellphone use varied significantly by age, especially for texting. The texting rate for drivers aged 16-19 was 59.4 per day and 2.9 per hour of driving, four times higher than the 14.3 per day and 1.0 per hour for drivers 30-64 years old. The texting rate for drivers 20-29 years old was also high at 42.4 per day and 2.6 per hour of driving. Participants experienced 243 crashes in 216,231 h of driving. It was found that those who texted more often per day or per hour of driving had higher crash rates after adjusting for age and gender effects. The severe crash rate increases 0.58% for every additional text per day and all 8.3% for every text per hour of driving; overall crash rate increases 0.41% for every additional text per day and 6.46% for every text per hour of driving. The results show that cellphone texting and calling are quite common while driving. The texting rate for young drivers is substantially higher than for middle-aged and senior drivers. This study confirmed that those who text at a higher rate are associated with a higher crash risk.

Systematic review of observational studies on secondary task engagement while driving

The last decade has seen a worldwide exponential increase in the use of mobile information systems, especially smartphones. This trend covers all areas of life, and also seems to include phone use while driving. In order to assess the scope of secondary task occupation, especially smartphone use while driving, observation studies from outside the car have been established as an efficient and valid method. A review of international studies using traffic observation was done finding 51 publications with a total of 117 observation studies with more than 1,800,000 single observations at more than 17,500 sites from nine different countries. The review describes the relevant aspects of the observation methods and gives an overview about the trends found in the data. As the methods differ widely over the years as well as between the countries and studies, an integration of the results is not possible. However, from all studies it is very clear that smartphone use has increased including not only phoning while driving but also, more important to traffic safety, using apps and texting on the smartphone. Additional observable secondary tasks were only rarely examined. Thus, further research using observational studies is strongly recommended. Suggestions are given with regard to the methodology which can contribute to get comparable and valid results across countries and studies.

Patient Safety: Driving After Foot and Ankle Surgery

This article provides a review of the existing literature regarding driving limitations following lower extremity orthopedic surgery. Medicolegal requirements and insurance recommendations are often vague and subject to interpretation. Several studies have examined the impact of surgery and immobilization on brake reaction time. This study summarizes the findings of these studies. Additionally, the authors consider the impact of lower extremity amputations and peripheral vascular disease on driving. Literature regarding opioid use, obesity, sleep apnea, increasing age, and distraction is also reviewed. An improved understanding of these topics will enhance the orthopedic surgeon's ability to counsel patients and optimize their safety.

Prevalence of risky driving behaviours on popular television series

Summary

Motor vehicle crashes are a leading cause of death among young adults. Social media and television have been shown to affect the likelihood that young adults will engage in risk-taking behaviour. We watched 216 episodes of five popular television series on Netflix and identified 333 separate driving scenes, of which 271 (81.4%) portrayed at least one risky driving behaviour. Unsafe driving (not wearing a seat belt) was the most common risky driving behaviour noted, occurring in 245 (73.6%) of driving scenes. Distracted driving (36 [18.8%]) and driving while using a cellphone (28 [8.4%]) were also noted. Popular television series model unsafe driving behaviours. Seat belts are infrequently used. As well, drivers are often distracted, looking away from the road to talk or talking on their cellphones. Television producers should be sensitive to modelling unsafe driving behaviours, particularly if the audience consists largely of young people.

The prevalence and correlates of texting while driving among a population-based sample of Ontario students

OBJECTIVE

Texting while driving (TWD) has a deleterious impact on driving performance and may pose a significant challenge to traffic safety. This challenge may be particularly relevant for young and inexperienced drivers. This study examined the prevalence and risk factors of writing text messages or emails while driving during the past 12 months.

METHOD

This study analyzed a subpopulation of 1,133 licensed students 16 years of age or older from the 2013 Ontario Student Drug Use Survey (OSDUHS), a population-based survey of students in Ontario, Canada.

RESULTS

Our results indicate that 36% of licensed drivers reported writing a text message while driving during the past 12 months; of those who did, 56% reported doing so 4 or more times. Graduated licensing was the strongest factor predicting TWD. Compared to students with the more restrictive G1 license, students with a G2 or full license were 9.4 times more likely to report TWD after controlling for the effect of all other factors. Older students, white students, and students attending school in urban centers were more likely to report TWD, and the amount of time spent on social media sites, being a passenger with a driver using substances, and past-year collisions were also significantly associated with TWD. Gender differences and participation in driver education training were not associated with TWD.

CONCLUSIONS

This research demonstrates that TWD is an extremely common behavior among licensed student drivers in Ontario, particularly among those who have passed the first stage of graduated licensing. TWD is associated with other risky driving behaviors and outcomes, and the findings from this study underscore the need to better understand the harms associated with this behavior.

The prevalence of seatbelt and mobile phone use among drivers in Riyadh, Saudi Arabia: An observational study

INTRODUCTION

Road traffic injuries (RTIs) are the third leading cause of death in Saudi Arabia. Numerous factors may increase the likelihood of RTIs. The prevalence of risk factors associated with RTIs may vary due to several reasons. Because little is known about these risk factors locally, we examined the prevalence of mobile phone and seatbelt use and their association with spatial locations.

METHODS

This is an observational study conducted at major highways and inner intersections throughout Riyadh, the country's capital. Two observers captured seatbelt and mobile phone use among drivers. Logistic regression models were constructed to examine the association between real estate prices and mobile phone or seatbelt use. Observations were categorized as taken place in an affluent neighborhood if the average price per square meter was above 2500 Saudi Riyal.

RESULTS

A total of 1700 drivers were observed in 13 sites citywide. 13.8% of drivers were seen using mobile while driving and only a third of drivers (34%) were wearing seatbelts. Being at an affluent neighborhood was associated with close to three times higher odds of wearing seatbelts (OR = 2.7, 95% CI = 1.9-3.7) and also associated with 42% lower odds of mobile phone use among drivers (OR = 0.58, 95% CI = 0.36-0.92).

DISCUSSION

This study found a high prevalence of traffic violations among drivers in Riyadh. Based on our estimate, 660,000 drivers are roaming the street during daytime while using their phones and they are less likely to wear seatbelts. Unfortunately, this estimate might contribute to increasing RTIs. Despite existing regulations, seatbelt use among drivers is significantly lower than in developed countries (i.e. USA 94%).

CONCLUSION

Our study found a high prevalence of traffic violations represented by lack of compliance with seatbelt and mobile phone use laws. These findings provide a basis for their underlying prevalence in SA. Practical applications: Public health prevention programs may use these findings to facilitate support to increasing investment in awareness campaigns and further enforcement by the traffic police to reduce RITs and improve population health.

Driving habits – A Canadian study

Introduction

Motor vehicle accidents are a significant cause of morbidity and mortality. Safe driving behavior constitutes proper use of seat belts as a driver and as a passenger. The correct use of seat belts has been shown to reduce death and injury following motor vehicle accidents by more than 50%. This study aims at investigating seat belt use and driving habits among Canadians.

Method

A population-based database from the Canadian Community Health Survey was analyzed.

Result

About 12% reported that they use seat belts most of the times, rarely or never and 27% of respondents were using cellphone while driving often or sometimes; 8% of respondents admitted to driving after 2 or more alcoholic drinks. Seat belt use in taxi passengers is much lower than in own cars, with 40% not using a seatbelt all of the time when in a taxi.

Discussion and conclusions

The major risk factors for not wearing seat belt as a passenger include age, education, ethnicity and income.

Association between mobile phone traffic volume and road crash fatalities: A population-based case-crossover study

Use of mobile phones while driving is known to cause crashes with possible fatalities. Different habits of mobile phone use might be distracting forces and display differential impacts on accident risk; the assessment of the relative importance is relevant to implement prevention, mitigation, and control measures. This study aimed to assess the relationship between the use of mobile phones at population level and road crash fatalities in large urban areas. Data on road crashes with fatalities were collected from seven Italian metropolitan areas and matched in time and space with high resolution mobile phone traffic volume data about calls, texts, Internet connections and upload/download data. A case-crossover study design was applied to estimate the relative risks of road accident for increases in each type of mobile phone traffic volumes in underlying population present in the small areas where accidents occurred. Effect modification was evaluated by weekday/weekend, hour of the day, meteorological conditions, and street densities. Positive associations between road crashes rates and the number of calls, texts, and Internet connections were found, with incremental risks of 17.2% (95% Confidence Interval [CI] 7.7, 27.6), 8.4% (CI 0.7, 16.8), and 54.6% (CI 34.0, 78.5) per increases (at 15 min intervals) of 5 calls/100 people, 3 text/100 people, and 40 connections/100 people, respectively. Small differences across cities were detected. Working days, nighttime and morning hours were associated with greater phone use and more road accidents. The relationship between mobile phone use and road fatalities at population level is strong. Strict controls on cellular phone in the vehicle may results in a large health benefit.

Risk Perceptions of Cellphone Use While Driving: Results from a Delphi Survey

Cellphone use while driving has been recognized as a growing and important public health issue by the World Health Organization and U.S. Center for Disease Control and Prevention. Surveys typically collect data on overall texting while driving, but do not differentiate between various forms of cellphone use. This study sought to improve the survey indicators when monitoring cellphone use among young drivers. Experts and young drivers were recruited to propose behavioral indicators (cellphone use while driving behaviors) and consequential indicators (safety consequences of cellphone use while driving) in 2016. Subsequently, experts and young drivers selected the top indicators using the Delphi survey method. We enrolled 22 experts with published articles on cellphone use while driving nationally, and seven young drivers who were freshmen at a state university. Sending a text or e-mail on a handheld phone was picked as the top behavioral indicator by both groups. However, young drivers chose playing music on a handheld phone as the second most important behavioral indicator, which was overlooked by experts. Injury/death and collision were the top two consequential indicators. Experts and young drivers identified the important survey indicators to monitor cellphone use while driving.

The effects of age on crash risk associated with driver distraction

Background

Driver distraction is a major contributing factor to crashes, which are the leading cause of death for the US population under 35 years of age. The prevalence of secondary-task engagement and its impacts on distraction and crashes may vary substantially by driver age.

Methods

Driving performance and behaviour data were collected continuously using multiple cameras and sensors in situ for 3542 participant drivers recruited for up to 3 years for the Second Strategic Highway Research Program Naturalistic Driving Study. Secondary-task engagement at the onset of crashes and during normal driving segments was identified from videos. A case-cohort approach was used to estimate the crash odds ratios associated with, and the prevalence of, secondary tasks for four age groups: 16-20, 21-29, 30-64 and 65-98 years of age. Only severe crashes (property damage and higher severity) were included in the analysis.

Results

Secondary-task-induced distraction posed a consistently higher threat for drivers younger than 30 and above 65 when compared with middle-aged drivers, although senior drivers engaged in secondary tasks much less frequently than their younger counterparts. Secondary tasks with high visual-manual demand (e.g. visual-manual tasks performed on cell phones) affected drivers of all ages. Certain secondary tasks, such as operation of in-vehicle devices and talking/singing, increased the risk for only certain age groups.

Conclusions

Teenaged, young adult drivers and senior drivers are more adversely impacted by secondary-task engagement than middle-aged drivers. Visual-manual distractions impact drivers of all ages, whereas cognitive distraction may have a larger impact on young drivers.

Falling asleep at the wheel and distracted driving. The High-Risk Professional Drivers study

Background:

Sleepiness at the wheel and driving while engaged in other activities are well known risk factors for traffic accidents. This article estimates the prevalence of these factors among Italian Professional Drivers (PDs) and their impact on reported driving mistakes.

Methods:

A cross-sectional study was conducted using anonymous questionnaires. PDs (n=497) were divided into two groups: high-risk PDs (HiRis_PDs) (those who self-reported more than one incident during the last 3 years and/or more than one mistake during the past year) and non-HiRis_PDs (subjects who did not meet the above-mentioned inclusion criteria). Logistic regression analyses were performed to assess the association of self-reported sleepiness and/or risky driving behaviour with the condition of being a high-risk driver.

Results:

161 (32.4%) subjects were defined as HiRis_PDs. Forty-one percent of the interviewees experienced at least one episode per month of sudden-onset sleep at the wheel. Twenty-eight point two percent reported a regular use of a hand-held cell phone. Predictive factors for being HiRis_PDs were: at least one self-reported episode per month of falling asleep at the wheel [odds ratio (OR) 5, 95% confidence interval (CI) 3.21-7.80, P<0.001], driving while regularly engaged in other activities (mainly hand-held cell phone use) (OR 6.11, 95% CI 2.90-12.84, P<0.001), and young age (OR 0.96, OR 1 year of age increase, 95% CI 0.94-0.98, P=0.001).

Conclusions:

Focusing prevention efforts on recognizing sleepiness at the wheel and on avoiding other distracting activities while driving can reduce the possibility of driving errors on the road by about 5-6 times.

Mind Your Step: the Effects of Mobile Phone Use on Gaze Behavior in Stair Climbing

Stair walking is a hazardous activity and a common cause of fatal and non-fatal falls. Previous studies have assessed the role of eye movements in stair walking by asking people to repeatedly go up and down stairs in quiet and controlled conditions, while the role of peripheral vision was examined by giving participants specific fixation instructions or working memory tasks. We here extend this research to stair walking in a natural environment with other people present on the stairs and a now common secondary task: using one’s mobile phone. Results show that using the mobile phone strongly draws one’s attention away from the stairs, but that the distribution of gaze locations away from the phone is little influenced by using one’s phone. Phone use also increased the time needed to walk the stairs, but handrail use remained low. These results indicate that limited foveal vision suffices for adequate stair walking in normal environments, but that mobile phone use has a strong influence on attention, which may pose problems when unexpected obstacles are encountered.

Ridesharing and Motor Vehicle Crashes in 4 US Cities: An Interrupted Time-Series Analysis

Uber, the world's largest ridesharing company, has reportedly provided over 2 billion journeys globally since operations began in 2010; however, the impact on motor vehicle crashes is unclear. Theoretically, ridesharing could reduce alcohol-involved crashes in locations where other modes of transportation are less attractive than driving one's own vehicle while under the influence of alcohol. We conducted interrupted time-series analyses using weekly counts of injury crashes and the proportion that were alcohol-involved in 4 US cities (Las Vegas, Nevada; Reno, Nevada; Portland, Oregon; and San Antonio, Texas). We considered that a resumption of Uber operations after a temporary break would produce a more substantial change in ridership than an initial launch, so we selected cities where Uber launched, ceased, and then resumed operations (2013-2016). We hypothesized that Uber's resumption would be associated with fewer alcohol-involved crashes. Results partially supported this hypothesis. For example, in Portland, Uber's resumption was associated with a 61.8% reduction (95% confidence interval: 38.7, 86.4) in the alcohol-involved crash rate (an absolute decrease of 3.1 (95% confidence interval: 1.7, 4.4) alcohol-involved crashes per week); however, there was no concomitant change in all injury crashes. Relationships between ridesharing and motor vehicle crashes differ between cities over time and may depend on specific local characteristics.

Does Talking on a Cell Phone, With a Passenger, or Dialing Affect Driving Performance? An Updated Systematic Review and Meta-Analysis of Experimental Studies

Objective An up-to-date meta-analysis of experimental research on talking and driving is needed to provide a comprehensive, empirical, and credible basis for policy, legislation, countermeasures, and future research. Background The effects of cell, mobile, and smart phone use on driving safety continues to be a contentious societal issue. Method All available studies that measured the effects of cell phone use on driving were identified through a variety of search methods and databases. A total of 93 studies containing 106 experiments met the inclusion criteria. Coded independent variables included conversation target (handheld, hands-free, and passenger), setting (laboratory, simulation, or on road), and conversation type (natural, cognitive task, and dialing). Coded dependent variables included reaction time, stimulus detection, lane positioning, speed, headway, eye movements, and collisions. Results The overall sample had 4,382 participants, with driver ages ranging from 14 to 84 years ( M = 25.5, SD = 5.2). Conversation on a handheld or hands-free phone resulted in performance costs when compared with baseline driving for reaction time, stimulus detection, and collisions. Passenger conversation had a similar pattern of effect sizes. Dialing while driving had large performance costs for many variables. Conclusion This meta-analysis found that cell phone and passenger conversation produced moderate performance costs. Drivers minimally compensated while conversing on a cell phone by increasing headway or reducing speed. A number of additional meta-analytic questions are discussed. Application The results can be used to guide legislation, policy, countermeasures, and future research.

Mobile phone use while driving and the risk of collision: A study among preparatory year students at King Saud University, Riyadh, Saudi Arabia

OBJECTIVES:

The objectives of this study were to determine the rate of mobile phones use while driving by the students of King Saud University, Riyadh, Saudi Arabia, their perception of the risks, and contribution to collisions.

MATERIALS AND METHODS:

A cross-sectional study was conducted in May 2014 targeting 986 male students of King Saud University, Riyadh, Saudi Arabia. A questionnaire was used to obtain data on possessing a driving license, years of driving experience, driving hours, and collision or near misses in the 6 months preceding the study. Eight statements were used to assess the behavior and perceptions related to the use of mobile phones while driving. Data were analyzed using the Chi-square statistic, odds ratio, and the 95% confidence interval.

RESULTS:

Almost half of the participants (45.3%) had driving experience of 4–6 years and 18.3% of them did not possess a driving license. Collision in the preceding 6 months was reported by 44.6% of participants, and 37.9% of them attributed these collisions to mobile phones. Variable proportions reported that they always texted (53.3%) or talked on a handheld (66.2%) or hands-free (26.1%) phones while driving. A higher proportion conceded that there were hazards in texting (77.0%) and speaking on handheld mobile phones (83.9%) rather than hands-free (35.9%) while driving. The risk increased significantly from 2.052 among participants who reported that they drove daily for 1–2 h to 3.165 of those who reported that they drove for more than 6 h. No significant risk was observed in relation to participants' perceptions, age, driving experience, and possession of a driving license.

CONCLUSIONS:

There was a risk of collision with the use of handheld and hands-free mobile phones. As hands-free mobile phones are no safer, national legislation should consider restricting their use by drivers and implementing legislations to reinforce safety on the roads. An objective assessment of the contribution of mobile phones to road traffic injuries is recommended.

Accident risk associated with smartphone addiction: A study on university students in Korea

Background and aims The smartphone is one of the most popular devices, with the average smartphone usage at 162 min/day and the average length of phone usage at 15.79 hr/week. Although significant concerns have been made about the health effects of smartphone addiction, the relationship between smartphone addiction and accidents has rarely been studied. We examined the association between smartphone addiction and accidents among South Korean university students. Methods A total of 608 college students completed an online survey that included their experience of accidents (total number; traffic accidents; falls/slips; bumps/collisions; being trapped in the subway, impalement, cuts, and exit wounds; and burns or electric shocks), their use of smartphone, the type of smartphone content they most frequently used, and other variables of interests. Smartphone addiction was estimated using Smartphone Addiction Proneness Scale, a standardized measure developed by the National Institution in Korea. Results Compared with normal users, participants who were addicted to smartphones were more likely to have experienced any accidents (OR = 1.90, 95% CI: 1.26-2.86), falling from height/slipping (OR = 2.08, 95% CI: 1.10-3.91), and bumps/collisions (OR = 1.83, 95% CI: 1.16-2.87). The proportion of participants who used their smartphones mainly for entertainment was significantly high in both the accident (38.76%) and smartphone addiction (36.40%) groups. Discussion and conclusions We suggest that smartphone addiction was significantly associated with total accident, falling/slipping, and bumps/collisions. This finding highlighted the need for increased awareness of the risk of accidents with smartphone addiction.

The Belief and Attitude of the Drivers Toward the Usage of Cellphone while Driving; A Population-Based Survey

Objective

To presents a survey investigating differences between drivers' beliefs regarding utilizing cellphone when driving.

Methods

In this population-based survey, the participants who were studied in the North of Iran, Gorgan, were categorized as main urban and rural areas. A sample of 400 drivers, 92 women and 308 men, filled out the four sections questionnaire which was based on the Theory of Planned Behavior (TPB) used for measuring the differences between the drivers' opinions (attitudinal beliefs, normative beliefs, and perceived control behavioral beliefs) about utilizing a cell phone when driving along with their age and driving purpose. Data were collected by distributing the 68- query questionnaire between the drivers.

Results

The MANOVA analysis showed that important discrepancies were found between the normative, control and behavioral beliefs of cellular phone users while driving. As expected, frequent business and younger users with sturdy intention expressed more benefits of further concentration on family members and fewer obstacles that would prevent them from utilizing cellphone when driving than older and frequently personal users.

Conclusion

These results indicated that the benefits of utilizing cellphone while driving are greater than its dangers. To reduce cellphone utilization when driving and increase road safety, more effort is required to lower the perceived advantages of the behavior and to outstand the risks of this hazardous driving act.

Functional connectivity analysis of distracted drivers based on the wavelet phase coherence of functional near-infrared spectroscopy signals

The present study aimed to evaluate the functional connectivity (FC) in relevant cortex areas during simulated driving with distraction based on functional near-infrared spectroscopy (fNIRS) method. Twelve subjects were recruited to perform three types of driving tasks, namely, straight driving, straight driving with secondary auditory task, and straight driving with secondary visual vigilance task, on a driving simulator. The wavelet amplitude (WA) and wavelet phase coherence (WPCO) of the fNIRS signals were calculated in six frequency intervals: I, 0.6-2 Hz; II, 0.145-0.6 Hz; III, 0.052-0.145 Hz; IV, 0.021-0.052 Hz; and V, 0.0095-0.021 Hz, VI, 0.005-0.0095Hz. Results showed that secondary tasks during driving led to worse driving performance, brain activity changes, and dynamic configuration of the connectivity. The significantly lower WA value in the right motor cortex in interval IV, and higher WPCO values in intervals II, V, and VI were found with additional auditory task. Significant standard deviation of speed and lower WA values in the left prefrontal cortex and right prefrontal cortex in interval VI, and lower WPCO values in intervals I, IV, V, and VI were found under the additional visual vigilance task. The results suggest that the changed FC levels in intervals IV, V, and VI were more likely to reflect the driver's distraction condition. The present study provides new insights into the relationship between distracted driving behavior and brain activity. The method may be used for the evaluation of drivers' attention level.

Effect of Cellular Mobile Phone Use and Cetrizine on Hand-Eye Coordination and Visual Acuity

INTRODUCTION

Cellular mobile phones are a major cause of distraction especially while driving. The aggressive and inappropriate use of cellular mobile phones has increased the risk of accidents. Similar alerts are available in literature for certain substances and drugs (e.g. second generation anti H1 drug -Cetirizine) which also derange psychomotor performance and parameters of alertness.

AIM

This study measured variations in hand-eye coordination and visual acuity due to use of cellular mobile phone in comparison to that of commonly used antihistaminic drug viz., single dose Cetirizine 10 mg.

MATERIALS AND METHODS

It was a single blind, single dose, interventional study, 100 healthy human volunteers divided into two groups. Baseline readings of all volunteers were noted. Group-I (n=50) was Cetirizine group (10mg orally stat), Group -II (n=50) Cellular mobile phone user group. Alertness was tested on hand- steadiness tester (Reaction Time Index = RTI) and on Flicker-fusion apparatus (visual acuity - Critical Flicker Fusion Frequency per second= CFFF/sec). Baseline readings of all volunteers were noted before intervention. Baseline was compared with readings at three hour post-intervention and was analysed by paired t-test. Inter-group comparison of parameters was also done and was analysed by unpaired t-test.

RESULTS

The baseline RTI (95.46±41.74, 85.11±39.05) and CFF low and high (40.07±9.970, 40.76±9.309 and 40.42±9.035, 40.48±9.863) respectively, in Cetirizine group and Mobile user group were comparable. The RTI increased significantly (116.4±51.46, 102.8±49.26) in both the groups after intervention. However, there is no significant change in CFF intensity from baseline in either group post-intervention.

CONCLUSION

Concurrent use of mobile phone while performing tasks, showed significant impairment of hand-steadiness which was comparable to that produced by single dose Cetirizine 10 mg and this may be one of the factors contributing to their close association with road traffic accidents.

Determinants of injuries and Road Traffic Accidents amongst service personnel in a large Defence station

BACKGROUND

Injuries are assuming epidemic proportions globally; and in India. Also, previous decade witnessed carnage on Indian roads, with nearly 12 lakh people killed and 55 lakhs disabled in road crashes. The trend in Armed Forces is reflective of the aforesaid patterns. Behaviour and socio-demographic background of the victims are significant determinants of injuries and road accidents. Community-based epidemiological information on these aspects is envisaged to contribute in their preventive strategy. Towards this direction, the present study was conducted with aim to generate socio-behavioural profile of injuries and Road Traffic Accidents (RTAs) amongst service personnel in a large defence station; and to evaluate their determinants.

METHODS

A cross sectional descriptive study was carried out among 796 Naval personnel onboard warships in large Naval station. Data on socio-behavioural aspects and determinants of injuries and road accidents was collected using a pre-validated questionnaire; and by scrutiny of relevant records. Data was analysed using MSExcel, Epi-info and SPSS 17.

RESULTS

Young and middle-aged persons were predominantly involved in injuries and road accidents. Two-wheeler users sustained maximum road accidents. Human factor was a significant determinant in RTAs and injuries. A majority of victims admitted that human factors were the predominant cause of road accidents; and opined that the events were preventable.

CONCLUSIONS

Age-specific Behavioural Change Communication strategies aimed at refining user outlook are imperative; tailored to sociodemographic milieu of user/victim. Incorporation of a dynamic feedback/reporting mechanism, creation of 'armed forces-specific road safety and injury prevention policy' and safety audits on injuries and road crashes are measures in this direction.

Adolescent and adult drivers' mobile phone use while driving with different interlocutors

PURPOSE

We examined the frequency of adolescents' and their parents' mobile phone use while driving (MPUWD) in the context of their peer and parent-child interlocutors (i.e., communication partners), considering individual differences in perceived risk and symptoms of technology addiction.

METHODS

Ninety-four participants (47 parent-adolescent dyads) completed a survey battery measuring their symptoms of technology addiction, perceived risk of MPUWD, and MPUWD with family members and with their peers as assessed via the proportion of trips when drivers used a mobile phone to communicate.

RESULTS

For both adolescents and their parents across both types of interlocutors (parent-child, peer), stronger risk perceptions were associated with less MPUWD, and stronger symptoms of technology addiction were associated with more MPUWD. A three-way interaction among technology addiction, interlocutor (parent-child, peer), and driver (parent, adolescent) was observed. For adolescents, the association between technology addiction and MPUWD was significantly stronger for MPUWD with their peers than it was for their MPUWD with their parents; this association was not observed for parents. Parents engaged in MPUWD with their children as frequently as adolescents engaged in MPUWD with their peers.

CONCLUSIONS

Symptoms of technology addiction play a stronger role for adolescents' MPUWD with their peers than it does for adolescents' MPUWD with their parents. These and other driver-by-interlocutor interactions should be considered in future research on distracted driving and in prevention efforts.

Injury prevention programs against distracted driving among students

BACKGROUND

Motor vehicle crashes are the leading cause of death and nonfatal injury among young adults. The aims of this study were to assess the magnitude of distracted driving (DD) among students and to examine the effectiveness of awareness campaign against DD. We hypothesized that DD is prevalent among students and educational efforts such as DD awareness campaign can effectively reduce it.

METHODS

This study was conducted within the University of Arizona that has a student enrollment of 42,000 students. We conducted our prospective interventional study in four phases at the university campus. Phase 1 involved 1-week preintervention observation, Phase 2 involved 1-week intervention, Phase 3 involved 1-week postintervention observation, and Phase 4 involved 1-week 6-month postintervention observation. We used a combination of e-mails, pamphlets, interactive sessions, and banners as intervention tools in student union. Our primary outcome was the prevalence of DD before, after, and 6 months after intervention.

RESULTS

A total of 47,764 observations (before, 14,844; after, 17,939; 6 months after, 14,981) were performed. During the study period, overall rate of DD rate among the students was 8.8 (5.4) per 100 drivers (texting, 4.8 [3.7] per 100 drivers; talking, 3.9 [2.0] per 100 drivers).The baseline rate of DD among students during the phase one was 9.0 (1.2) per 100 drivers (texting, 4.8 [1.7] per 100 drivers; talking, 4.1 [1.1] per 100 drivers). Following intervention, there was a 32% significant reduction in overall DD (9.0 [1.2] vs. 6.1 [1.7], p < 0.001) in the immediate postintervention phase; however, the rate of DD returned to baseline at 6 months after intervention and trended toward increase (9.0 [1.2] vs. 11.1 [8.4], p = 0.34).

CONCLUSION

DD is prevalent among university students. Following a comprehensive preventive campaign against DD, there was a 32% reduction in the rate of DD in the immediate postintervention period. However, a single episode of intervention did not have a sustainable preventive effect on the DD, and the rate increased to the baseline at 6-month follow-up. Targeting DD with a successful injury prevention campaign with repeated boosters may decrease its prevalence among the students.

Transient effects of transfusion and feeding advances (volumetric and caloric) on necrotizing enterocolitis development: A case-crossover study

Objective

To evaluate the short-term effects of feed fortification, feed volume increase, and PRBC transfusion on the odds of developing NEC.

Study design

Case-crossover study of neonatal intensive care infants born at ≤ 32 weeks’ gestation who were admitted to 5 central Ohio intensive care units from January 2012-July 2016 and developed NEC Bell Stage ≥2. Each patient served as their own control, with exposure during the 48-hour period just prior to NEC onset (hazard period) being compared to a preceding 48-hour control period, thus eliminating confounding by patient factors fixed between both intervals. NEC onset was determined by chart review as the earliest occurrence of one of the following within 24 hours of confirmatory x-ray: (1) antibiotic initiation, (2) enteral feeding cessation, (3) physician first notified of abdominal concerns, or (4) abdominal x-ray ordered. Conditional logistic regression compared exposures to feed volume increase, fortification, and PRBC transfusion during the 48-hour period prior to NEC onset to those during a preceding 48-hour control period. Analyses were stratified by gestational age and anemia (defined: hemoglobin ≤ 9.3 g/dL within 7 days of NEC onset).

Results

We included 63 infants with confirmed NEC. Acute exposure to fortification (odds ratio [OR]: 1.67, 95% confidence interval [CI]: 0.61, 4.59), feed volume increase (OR: 0.63, 95% CI: 0.28, 1.38), and PRBC transfusion (OR: 1.80, 95% CI: 0.60, 5.37) was not associated with the onset of NEC. Gestational age and anemia did not significantly modify the associations. Sensitivity testing substituting 24- and 72-hour hazard and control periods produced similar results.

Conclusion

Using a case-crossover design, we did not detect an association between NEC development and feed fortification, feed volume increase, or PRBC transfusion within 48-hours prior to NEC-onset. Replication in a larger set of cases is needed.