"It's okay because I'm just driving": an exploration of self-reported mobile phone use among Mexican drivers

Introduction

Technological advancements have the potential to enhance people's quality of life, but their misuse can have a detrimental impact on safety. A notable example is the escalating issue of distracted driving resulting from the use of mobile phones behind the wheel, leading to severe crashes and injuries. Despite these concerns, both drivers' usage patterns and their risk-related associations remain scarcely documented in Mexico. Therefore, this descriptive study aimed to examine the mobile phone usage of Mexican drivers, its relationships to risk awareness and near-miss/crash involvement, and the self-reported underlying reasons for this behavior.

Methods

This cross-sectional study utilized a sample of 1,353 licensed Mexican drivers who took part in a nationwide series of interviews regarding their onboard phone use settings.

Results

A significant percentage of drivers (96.8%) recognize using a mobile phone while driving as high-risk behavior. However, only 7.4% reported completely avoiding its use while driving, with 22.4% identified as high-frequency users. Frequency was also found positively associated with the self-reported rate of near-misses and crashes. Furthermore, qualitative data analysis highlights the emergence of a 'sense of urgency' to attend to phone-related tasks in response to daily demands and life dynamics, offering a potential explanation for this behavior.

Conclusion

The results of this study suggest common patterns of onboard mobile use among Mexican drivers concerning driving situations and associated risks. This underscores the need for increased efforts to discourage onboard phone use in the country.

Impact of mobile phone use on accidental falls risk in young adult pedestrians

Background

Mobile phone use is known to be a distraction to pedestrians, increasing their likelihood of crossing into oncoming traffic or colliding with other people. However, the effect of using a mobile phone to text while walking on gait stability and accidental falls in young adults remains inconclusive. This study uses a 70 cm low friction slip hazard and the threat of hazard to investigate the effects of texting while walking on gait stability, the ability to recover balance after a slip hazard and accidental falls.

Methods

Fifty healthy young adults performed six walking tasks, and one seated texting task in random order. The walks were conducted over a 10-m walkway. Four progressive hazard levels were used: 1) Seated; 2) Normal Walk (walking across the walkway with no threat of a slip); 3) Threat (walking with the threat of a slip); and 4) Slip (walking with an actual 70 cm slip hazard). The three walking conditions were repeated twice with and without the mobile phone texting dual-task. Gait kinematics and trunk posture were recorded using wearable sensors attached to the head, trunk, pelvis and feet. Study outcomes were analyzed using repeated measures analysis of variance with significance set to P≤.05.

Results

Mobile phone use significantly impaired postural balance recovery when slipping, as demonstrated by increased trunk sway. Mobile phone use negatively impacted gait stability as demonstrated by increased step time variability and decreased harmonic ratios. Increased hazard levels also led to reduced texting accuracy.

Conclusions

Using a mobile phone to text while walking may compete with locomotor tasks, threat assessment and postural balance control mechanisms, which leads to an increased risk of accidental falls in young adults. Pedestrians should therefore be discouraged through new educational and technology-based initiatives (for example a "texting lock" on detection of walking) from texting while walking on roadside footpaths and other environments where substantial hazards to safety exist.

Screen time and suicidal behaviors among U.S. children 9-11 years old: A prospective cohort study

Suicide is a leading cause of death among adolescents. Emerging literature has described relationships between excessive screen time and suicidal behaviors, though findings have been mixed. The objective of this study is to determine the prospective associations between screen time and suicidal behaviors two-years later in a national (U.S.) cohort of 9-11-year-old-children. We analyzed prospective cohort data from the Adolescent Brain Cognitive Development (ABCD) Study (N = 11,633). Logistic regression analyses were estimated to determine the associations between baseline self-reported screen time (exposure) and suicidal behaviors (outcome) based on the Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS-5) at two-year-follow-up. Participants reported an average of 4.0 h of total screen time per day at baseline. At two-year-follow-up, 1.38% of the sample reported at least one suicidal behavior. Each additional hour of total screen time was prospectively associated with 1.09 higher odds of suicidal behaviors at 2-year-follow-up (95% CI 1.03-1.14), after adjusting for covariates. For specific screen time modalities, each additional hour of texting (aOR 1.36, 95% CI 1.06-1.74), video chatting (aOR 1.30, 95% CI 1.03-1.65), watching videos (aOR 1.21, 95% CI 1.04-1.39), and playing video games (aOR 1.18, 95% CI 1.01-1.38) was associated with higher odds of subsequent suicidal behaviors. Higher screen time is associated with higher odds of reporting suicidal behaviors at two-year-follow-up. Future research should seek to identify how specific screen time experiences may influence suicidal behaviors.

Increasing Social Communication by Teaching Texting to Autistic Children

Objectives

In the present study, we increased the social communication of four autistic children by teaching texting conversation skills on smart phones.

Methods

A multiple baseline design across two dyads was used to assess the texting conversation intervention, with additional generalization probes taken across texting partners and FaceTime® sessions. One-month maintenance probes were also assessed.

Results

All four participants increased their conversational texting, and their conversation content was novel. Generalization across texting partners occurred, and skills were maintained. Appropriate verbal content spoken during FaceTime® probes was also observed.

Conclusions

Results are discussed in terms of the potential benefits of teaching autistic children social communication through text.

Determinants of preference for telehealth versus in-person treatment for substance use disorders: A discrete choice experiment

INTRODUCTION

Access to substance use disorder (SUD) treatment remains a significant issue in the United States. Telehealth has potential for increasing access to services; however, it is underutilized in SUD treatment compared to mental health treatment. This study uses a discrete choice experiment (DCE) to examine stated preferences for telehealth (videoconferencing, text-based + video, text only) versus in-person SUD treatment (community-based, in-home) and the attributes (location, cost, therapist choice, wait time, evidence-based practices) most important when choosing between modalities. Subgroup analyses are reported about preference differences based on type of substance and substance use severity.

METHODS

Four hundred participants completed a survey containing a DCE with eighteen choice sets, the alcohol use disorders inventory test, drug abuse screening test, and a brief demographic questionnaire. The study collected data between April 15, 2020, and April 22, 2020. Conditional logit regression provided a measure of strength for participant preferences for technology-assisted treatment compared to in-person care. The study provides willingness to pay estimates as a real-world measure for the importance of each attribute in participants' decision-making.

RESULTS

Telehealth options that include a video conference option were equally preferrable to in-person care modalities. Text-only treatment was significantly less preferable to all other modalities of care. The ability to choose one's own therapist was a significant driver of treatment preference beyond modality, while wait time did not appear significant in making decisions. Participants with the most severe substance use differed in that they were open to text-based care without video conferencing, did not express a preference for evidence-based care, and valued therapist choice significantly more than those with only moderate substance use.

CONCLUSIONS

Telehealth for SUD treatment is equally preferable to in-person care offered in the community or at home, signifying preference is not a barrier for utilization. Text-only modalities may be enhanced by offering videoconference options for most individuals. Individuals with the most severe substance use issues may be willing to engage in text-based support without synchronous meetings with a provider. This approach may offer a less intensive method to engage individuals in treatment who may not otherwise access services.

Communication technology practices used by midwives with pregnant women/people in Aotearoa New Zealand to ensure quality maternal and newborn care

INTRODUCTION

Communication technology such as texting is commonly used for sending appointment reminders and reinforcing health messages. Midwives have identified concerns with privacy of information or information taken out of context within an online format. How this technology is used to ensure quality maternal care within a continuity model of midwifery care is unknown.

AIM

To describe midwives' experiences of using communication technology with pregnant women/people in Aotearoa New Zealand.

METHODS

A mixed methods design was used to collect online survey data from Lead Maternity Carer midwives. Recruitment was through closed midwifery Facebook groups in Aotearoa New Zealand. Survey questions were informed by the Quality Maternal & Newborn Care framework & findings and an integrative literature review. Quantitative data was analysed using descriptive statistics, and qualitative comments analysed using thematic analysis.

FINDINGS

104 midwives responded to the online survey. Phone calls, texting and emails were commonly used by midwives to reinforce health messages and decision making. Communication technology supported, and enhanced relationships midwives develop with their pregnant clients. Texting enhanced documentation of care and enabled midwives to work efficiently. Midwives, however identified concerns when managing expectations around urgent and non-urgent communication.

DISCUSSION

Midwives are bound by regulations to ensure they provide safe care to pregnant women/people. Negotiating and understanding expectations around use of communication technology is vitally important to ensure that communications and connections are undertaken in a safe manner.

Does texting while walking affect spatiotemporal gait parameters in healthy adults, older people, and persons with motor or cognitive disorders? A systematic review and meta-analysis

BACKGROUND

Smartphone use during postural-locomotor tasks is an everyday activity for individuals of all ages in diverse environmental situations and with various health conditions. Nevertheless, the use of smartphones during walking is responsible for many accidents.

RESEARCH QUESTION

This systematic review and meta-analysis examined spatiotemporal gait parameters during the dual-task situation "texting + gait" versus isolated gait task (single task) in adult persons (>18 years).

METHODS

Electronic database searches were performed in PubMed, Embase, CINHAL, and LISSA. Two examiners assessed the eligibility and quality of appraisal with the Downs and Black checklist. The standardized mean difference (SMD) with 95 % confidence intervals was calculated to compare single- and dual-task situations. The pooled estimates of the overall effect were computed using a random or fixed effects method, and forest plots were generated.

RESULTS AND SIGNIFICANCE

A total of 25 studies were included. All studies included healthy adults, with four studies including older persons and three including people with pathological conditions. The walking task was with (N = 4) and without (N = 21) obstacles and in laboratory (N = 21) or ecological conditions (N = 7). The quality scores were 6-8/16 for eight studies, 9-12/16 for seven studies, and more than 12/16 for three studies. During the "texting + gait" tasks, the meta-analysis highlighted a significant impairment of gait speed, step and stride length, cadence, and double and single support (p < 0.05). The spatiotemporal parameters of gait were systematically altered during the texting task regardless of the population and test conditions. However, the quality of the studies is moderate, and few studies have been conducted for people with motor deficiencies. The impact of texting on walking should be better considered to develop prevention actions.

Voice messaging while driving: Effects on driving performance and attention

The aim of this study was to analyze the performance and attentional effects of sending voice messages while driving as compared to calling and texting. To this end, participants were asked to drive a given path while they either receive a phone call, send voice messages, or send text messages on a given cell phone, as well as a control condition. Driving performance, eye tracking, and subjective measures were collected. The results showed that voice messaging, while not as detrimental to driving performance as texting, does lead to similar levels of visual and cognitive distraction as texting and is generally more distracting than calling. Drivers also seem to be unaware of the dangers of voice messaging while driving. This research provides the basis for improved guidelines and legislation and more targeted awareness campaigns that emphasize the dangers of voice messaging while driving on a level with other banned practices.

The Self-perception of Text message Dependence Scale (STDS): A Brazilian-Portuguese validation and expansion of its psychometric properties

Text messaging is the primary form of technology-mediated interpersonal contact and the most carried out activity on cell phones. Despite its advantages, text messaging is not exempt from risks. The present paper aimed to validate and expand the psychometric properties of the Self-perception of Text-message Dependency Scale (STDS) in a Brazilian sample of adult internet users. In this cross-sectional study, we recruited a convenience sample of Brazilian internet users aged 18 and over. A total of 1,642 (M age = 38.6, SD = 13.5; 73% female) participants completed the STDS, the Mobile Phone Problem Usage Scale-27 (MPPUS), and the Problematic Internet Use Questionnaire - Short form - 9 questionnaires (PIUQ-SF-9). Multigroup confirmatory factor analysis showed measurement invariance for gender and age. Internal consistency was high when accessed by both McDonalds' Omega and Cronbach's alpha. Network Analysis provided insights into the core symptoms of problematic text messaging. Convergent validity of the STDS was demonstrated by the subscale's correlation with MPPUS and PIUQ-SF-9. Due to its expanded psychometric properties and brevity, the STDS can be used in more comprehensive investigations about other excessive technology-related behaviors, such as problematic smartphone and internet use, allowing a better understanding of the mechanisms involved in problematic technology use.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-02957-8.

Nudge me: tailoring text messages for prescription adherence through N-of-1 interviews

Almost 50% of patients with cardiovascular diseases face challenges in taking medications and increased morbidity and mortality. Text messaging may impact medication refill behavior and can be delivered at scale to patients by texting mobile phones. To obtain feedback from persons with chronic conditions on the design of interactive text messages and determine language of message for making messages that can motivate patients to refill medications on time. We purposively sampled 35 English and Spanish speaking patients with at least one chronic condition from three large healthcare delivery systems to participate in N-of-1 video-based synchronous interviews. Research assistants shared ideas for theory-informed text messages with content intended to persuade patients to refill their medication. We transcribed recorded interviews and conducted a content analysis to identify strategies to employ generating a dynamic interactive text message library intended to increase medication refill. Those interviewed were of diverse age and race/ethnicity and typical of persons with multiple chronic conditions. Several participants emphasized that personally tailored and positively framed messages would be more persuasive than generic and/or negative messages. Some patients appreciated humor and messages that could evoke a sense of social support from their providers and rejected the use of emojis. Messages to remind patients to refill medications may facilitate improvements in adherence, which in turn can improve chronic care. Designing messages that are persuasive and can prompt action is feasible and should be considered given the ease with which such messages can be delivered automatically at scale.

Semi-literate Texting (SLT): Survey based text message dataset from digitally semi-literate users in India

The dataset explicates text messages and associated metadata from digitally semi-literate mobile phone users in India. A survey among urban and rural representatives conducted between July 2020 and November 2020 is the origin for this dataset. The data has been collected through face to face interviews and online surveys across urban and rural geographies in India, largely from western region of Maharashtra. A total of 382 respondents, accumulating 3368 messages has been composed (approximately 90% through face to face surveys and 10% from online mode). To the best of our knowledge there is no factual text message data from digitally semi-literate users being available till date. This dataset can be used for bridging the digital divide in human computer interaction using machine learning, data mining, behavioural analysis as well as in other fields.

Introduction to the Special Edition on Social Media

This special issue of the Journal for Technology in Behavioral Science includes articles focused on some of the diverse uses and issues related to social media use by the public, clients and patients, and health care professionals. Social media broadly includes many forms of electronic communications other than Facebook and Twitter, is continuously evolving, and for many a frequent form of communicating with others. Potential benefits and risks of using social media are identified with no clear consensus on many of the issues it presents.

Posting Alcohol-Related Content and Texting Under the Influence Among Hispanic College Students

Social media use and texting among college students often coincide with drinking. The present study investigated the associations between monthly alcohol use, social media habits, sharing alcohol references, and drunk texting among Hispanic college students. Participants (n = 620, 71.6% female; Mage = 21.07 years, SD = 3.60) completed an online survey containing: demographics, drug use frequency, Sharing of Alcohol-Related Content on Social Media Sites Scale (SARC), Texting Under the Influence Scale, Strategic Self Presentation Scale, Bergen Social Media Addiction Scale, and iPhone Screen Time. Bivariate correlations assessed relationships between all variables. Six logistic regressions assessed subscales of the SARC, and a linear regression assessed the Texting Under the Influence Scale. Almost 15% of participants met criteria for social media addiction, almost 40% reported ever sharing alcohol posts, and approximately 20% reported drunk texting at least once per month. Participants with iPhones averaged 16.84 weekly hours on social media (based on "screen time"). Frequently posting references of drinking alone was associated with more time on social media, higher social media addiction, and greater public sharing of alcohol content. Conversely, posting references of drinking at social gatherings was associated with privately sharing alcohol references and increased social media addiction. Drunk texting was related to increased age, greater Instagram use, decreased Facebook use, and privately sharing alcohol posts. Findings suggest patterns of drinking and sharing alcohol-related content to inform health promotion efforts, especially while many during COVID-19 are heightening use of alcohol and social media.

Can't text, I'm driving - Factors influencing intentions to text while driving in the UK

There is clear research evidence that using a mobile phone while driving is dangerous. However, although drivers generally know this is a risky behaviour, many continue to use a handheld mobile phone while driving. The present research used the Theory of Planned Behaviour (TPB) to explore the psychological reasons underpinning intentions to use a mobile phone while driving in general, as well as to send and read text messages while driving across four different scenarios. Convenience sampling was used to obtain data from 314 participants who held a valid licence to drive in the UK, had driven at least once in the last six months and owned a mobile phone. General intentions to use a mobile phone while driving were predicted by positive Attitudes towards the behaviour and higher Perceived Behavioural Control. Moreover, when predicting intentions to send and read text messages, it was positive Attitudes that was the most consistent and significant predictor. Surprisingly, neither Perceived Behavioural Control nor Subjective Norms were significant predictors of intentions to send or read text messages. Furthermore, perceptions of risk (crashing and being apprehended by the police) were significant predictors of intentions to send and read texts over and above that provided by the TPB variables. The present research highlights the need for interventions to target attitudinal change and to increase risk perceptions in order to reduce the prevalence of these risky behaviours.

Performance of ground-level signal detection when using a phone while walking

Ground-level traffic lights or safety signs have been introduced recently as a prevention measure for smartphone-related pedestrian accidents. However, quantitative evaluation of smartphone users' detection performance during distracted walking has been scarce. A laboratory experiment was conducted to evaluate the performance of detecting ground-level visual cues during the concurrent use of a smartphone while walking. Thirty-eight young smartphone users performed ground-level visual cue detection trials, 1) while walking upright on a treadmill without using a smartphone; 2) when conducting one-handed browsing while walking; and, 3) when conducting two-handed texting while walking. Visual cues were presented on the ground at 24 locations by a ceiling-mounted projector, and participants were asked to respond verbally when they perceived the appearance of each cue. Study results show that the concurrent use of a smartphone decreased the detection rate significantly (p < 0.05) from 93.5 % to 76.3∼74.1 %, and increased the reaction time from 0.90 s to 1.04∼1.15 s. Among the 24 cue locations, cues that were presented closer to participants were detected significantly (p < 0.05) more often and faster than cues that were shown at further locations. The results of this laboratory-based study imply that the ground-level signals might not be detected well by smartphone users, specifically when they were conducting more demanding tasks such as texting while walking. However, the laboratory conditions were confined to a specific usage environment; therefore, future research should be focused on the situation awareness of smartphone users under various usage scenarios and more realistic environments.

Prevalence and trends of distracted driving in Canada

INTRODUCTION

This study evaluates prevalence and trends in distracted driving in Canada based on multiple indicators collected from the Road Safety Monitor (RSM) and Canada's National Fatality Database maintained by the Traffic Injury Research Foundation (TIRF).

METHOD

Data from the RSM on self-reported distracted driving behaviors were analyzed using multivariate techniques including logistic regression analysis in various years spanning from 2004 to 2019. Data from TIRF's National Fatality Database from 2000 to 2016 were also analyzed using piecewise regression analysis to evaluate trends and prevalence of driver distraction.

RESULTS

Significantly more Canadians reported talking on their phone hands-free or handheld phone while driving in 2019 compared to 2010. There was a 102% increase in the percentage that reported texting while driving in 2019 (9.7%) compared to 2010 (4.8%). For every 10-year increase in age, drivers were 44% less likely to text, 38% less likely to use a handheld phone, and 28% less likely to use a hands-free phone. Males were 62% more likely to use a handheld phone and 50% more likely to use a hands-free phone than females. Findings related to drivers' perceived danger of distracted driving and attitudes are also presented. Although the number of distraction-related fatalities has not increased substantially from 2000 to 2016, the percentage of all fatalities where distraction was a contributing factor has increased. Unlike drinking drivers, distracted drivers more often kill other road users in crashes than kill themselves.

CONCLUSIONS

In conclusion, while most Canadians appear to understand that one of the high-risk forms of distracted driving (i.e., texting while driving) is indeed dangerous, there is a minority who are unaware of, or resistant to, this fact. Practical Applications: Enforcement activities and education initiatives to combat distracted driving ought to be tailored to the target audience based on the patterns uncovered.

Does texting interrupt imitation learning in 19-month-old infants?

Observed disruptions to parent-child interactions during parental media use, such as texting, have been termed technoference. For example, when a language learning interaction was disrupted by a phone call, toddlers were less likely to acquire the word. Other studies demonstrated that parents often exhibit a still face while silently reading information on their cell phones. In the present study, the effect of a text interruption on infant imitation learning was examined. Parents demonstrated three target actions to their infants and then infants were given the opportunity to repeat those interactions. The actions were demonstrated four times. Text interruptions occurred before or between demonstrations. Performance of these groups was compared to a baseline control group where the infant did not see a demonstration of the target actions and a no-interruption group where the parents demonstrated the target actions four times without interruption. Parents were randomly assigned to three conditions, interruption-first condition, one-interruption condition, or three-interruptions condition. Infant behavior was measured during the interruptions. Across text interruption groups parents exhibited high levels of still face during the interruptions (77 %). However, infants in all 3 interruption groups performed significantly above the baseline control indicating learning despite the interruptions. Higher reported maternal reliance on the smartphone was related to poorer imitation performance overall. In contrast, when parents reported that they found it easier to multi-task infant imitation rates were higher. These findings indicate that infants can learn under conditions of brief technoference and that individual differences in family media ecology are associated with learning.

Efficacy of text messaging apprentices to reinforce ergonomics and safety voice training

INTRODUCTION

Injuries and work-related musculoskeletal disorders (MSDs) are common among masons. SAfety Voice for Ergonomics (SAVE) integrates training in ergonomic and safety problem-solving skills into masonry apprenticeship training. The purpose of this study was to assess the efficacy of text messaging to reinforce SAVE program content.

METHOD

SAVE effectiveness was evaluated at masonry apprenticeship training centers across the United States by comparing three experimental groups: (1) Ergonomics training, (2) Ergonomics and Safety Voice training, and a (3) Control. Apprentices received SAVE training with their standard instruction. To reinforce classroom training, refresher training was implemented by sending weekly text messages for six months. Half of the text messages required a response, which tested knowledge or assessed behavior, while the remaining reiterated knowledge. Apprentices (n = 119) received SAVE text messages. Response rates and percentage of correct responses were compared with chi-square tests and independent group t-tests. Multivariable logistic regression analysis predicted apprentice response with selected demographic and work experience variables. Finally, feedback on of the use of text messaging was obtained.

RESULT

Of 119 participants, 61% (n = 72) responded to at least one text message. Logistic regression revealed that being a high school graduate and a brick and block mason significantly affected the odds of responding. Sixty-nine percent of apprentices agreed that text messages reinforced SAVE content.

CONCLUSION

Even though there was no training center requirement to respond, the high response rate suggests that text messaging can effectively be used to reinforce ergonomics and safety voice training for both knowledge and behavior. Practical Application: The prevalent use of text messaging creates opportunities to reinforce health and safety training and engage workers, especially for populations that may be at various locations over time such as construction sites. Instructors and practitioners should consider the utility of text messaging for supporting their training and safety programs.

A novel digital health intervention to improve patient engagement to stimulants in adult ADHD in the primary care setting: Preliminary findings from an open label study

AIMS

We piloted the effectiveness and acceptability of a novel text messaging-based (SMS) digital health intervention aimed at addressing the previously documented poor rate of patient engagement in stimulant treatment in the primary care setting.

METHODS

117 adults ages 18-55 from primary care and psychiatric practices who were prescribed a stimulant medication for ADHD treatment received the SMS intervention. Comparators were age-, race-, and sex-matched patients from the same health care organization's electronic medical record who had been prescribed stimulant medications over a similar time period. Using documented prescription records, we determined whether patients had timely prescription refills.

RESULTS

Ninety-six percent (N = 112) of participants completed our a priori metric of patient engagement consisting of 37 days of the SMS program. Eighty-one percent of participants refilled their index prescriptions in a timely manner compared to only 36% of patients receiving treatment as usual (OR=7.54, 95% CI: 4.46, 12.77; p<0.001). We found no significant interaction between prescribing source (non-psychiatry vs. psychiatry) and intervention group (SMS vs. treatment as usual).

CONCLUSIONS

These data suggest that an ADHD-centric, digital health intervention using text messaging significantly improves patient engagement in stimulant treatment in adults with ADHD.

Insecure attachment and addiction: Testing the mediating role of emotion dysregulation in four potentially addictive behaviors

Insecure attachment has been associated with an array of addictive behaviors. However, the mechanism by which insecure attachment leads to addictive behaviors remains largely unknown. In the present research we tested whether emotion dysregulation mediated the relationship between insecure attachment (anxious, avoidant) in substance use (alcohol, marijuana) and DSM-5 (Internet gaming) and non-DSM-5 (texting) behavioral dependencies. A sample (N = 712) of participants recruited from a university in the United States completed an online battery of instruments, assessing adult attachment style, emotion dysregulation, and self-reported DSM-5 symptoms adapted from substance use disorder criteria. In separate mediation analyses, anxious attachment was associated with self-reported DSM-5 symptoms for alcohol, marijuana, texting, but not Internet gaming; whereas emotion dysregulation was associated with self-reported DSM-5 symptoms of all four potentially addictive behaviors. Avoidant attachment was not associated with self-reported DSM-5 symptoms for any of the addictive behaviors. Emotion dysregulation mediated the relationship between both anxious and avoidant attachment and self-reported DSM-5 symptoms for alcohol, marijuana, and texting. In contrast, emotion dysregulation mediated the relationship between anxious but not avoidant attachment and Internet gaming. Insecure attachment, specifically anxious attachment and emotion dysregulation may be important psychological characteristics that increase the risk for alcohol, marijuana and texting, while Internet gaming corresponds with unique characteristics. Whereas attachment styles may be resistant to change, emotion dysregulation has been found to be modifiable and may provide a potential target in the treatment of substance use disorders and some behavioral dependencies for those who manifest attachment insecurities.

Using European naturalistic driving data to assess secondary task engagement when stopped at a red light

PROBLEM

Some evidence exists that drivers choose to engage in secondary tasks when the driving demand is low (e.g., when the car is stopped). While such a behavior might generally be considered as rather safe, it could be argued that the associated diversion of attention away from the road still leads to a reduction of situational awareness, which might increase collision risk once the car regains motion. This is especially relevant for texting, which is associated with considerable eyes-off-the-road-time. Nonetheless, it seems that previous research has barely addressed the actual engagement in secondary tasks while waiting at a red light (as compared to just addressing the tasks' mere prevalence).

OBJECTIVE

The present study investigated secondary task engagement while stopped at a red light using European naturalistic driving data collected through the UDRIVE project. Attention was given to the whole engagement process, including simple prevalence and the tasks' relation (in terms of start/end) to the red light period. Moreover, given that texting is one of the most problematic forms of distraction, it was characterized in more detail regarding glance behavior.

METHOD

Videos of 804 red light episodes from 159 drivers were annotated. Glance behavior was also coded for a sub-set of 75 texting events and their matched baselines. Results, conclusions and practical applications: Drivers engaged in at least one secondary task across almost half of the annotated red light episodes. Drivers who texted while stopped spent most of the time looking at their cell phone. Consequently, drivers might not have been prepared for potentially unexpected events once the light turned green. Further, drivers concluded texting a considerable number of times well after the red light period, which has potential implications for traffic safety.

Engagement With Crisis Text Line Among Subgroups of Users Who Reported Suicidality

OBJECTIVE

Despite the interest in technology-enhanced preventive interventions for suicidality, there is minimal peer-reviewed research on conversations of text message hotlines. In this large-scale study, the authors explored distinct classes of users of the Crisis Text Line who reported suicidality. Classes were based on texters' presenting psychosocial issues and were explored across frequency of hotline use and conversation number.

METHODS

Data included 153,514 conversations from 122,909 individuals collected by the Crisis Text Line (2013-2017). Analyses were restricted to conversations from users who mentioned current or previous suicidality and excluded texters who discussed a third party. The authors used latent class analysis to identify distinct classes of texters on the basis of crisis counselor-assigned issue tags and across subgroups reflecting whether the conversation was the first or last contact with the hotline and frequency of use (one-time, two-time, or ≥3-time texters).

RESULTS

Three classes emerged in all subsamples. The largest class, "lower distress," had the lowest prevalence of all issues. The second largest class, "anxious distress," had the highest prevalence of anxiety or stress and elevated depression. The smallest class, "relational distress," had the highest prevalence of depression and self-harm and higher probability of endorsing relational indicators.

CONCLUSIONS

Psychological and relational issues mostly distinguished the three classes. Despite differing frequency of hotline usage, most texters who reported suicidal ideation and behaviors endorsed similar issues, and these issues did not seem to vary across conversations. Yet there appeared to be distinct subgroups of texters with different presenting issues, which may inform how crisis counselors tailor strategies for both low- and high-volume texters.

A text message delivered smoking cessation intervention: Design and rationale of the Text My Quit Study

INTRODUCTION

Smoking cessation interventions delivered through mobile technologies offer promise as an effective intervention tool. However, most existing programs have not been empirically tested, were not developed with end-user participation, and/or do not address evidence-based cognitive and behavioral variables shown to enhance smoking cessation in clinical trials. In addition, many programs tested in research trials have required users to access the internet and/or a smartphone app to access all program features, limiting the potential reach of those programs.

METHODS/DESIGN

This study is a randomized controlled trial testing the efficacy of the TMQ intervention for smoking cessation. All participants are randomly assigned to receive 12 weeks of either; (1) a tailored smoking-cessation intervention delivered 100% through text messaging (TMQ), or (2) non-smoking-related text messages serving as a control for contact and subject burden (Mojo). Assessments are conducted at baseline, 3- and 6-month follow-up. The primary outcome is prolonged abstinence using an intent-to-treat approach. To understand why TMQ may be more effective than Mojo, we will test several posited mechanisms of action (i.e., mediators) that may underlie intervention efficacy and will examine use of the TMQ integrated social support (ISS) network. At the end of treatment, semi-structured interviews will be conducted with TMQ participants.

CONCLUSIONS

This study will provide a rigorous test of an innovative smoking cessation program delivered 100% through text messages. Use of mixed methodologies will provide the opportunity to enhance our understanding of the user's experience with TMQ and identify areas for future enhancement and/or expansion.

Poison control centers and alternative forms of communicating with the public: what's all the chatter about?

Context: Short messaging service (SMS or text messaging) allows for the exchange of electronic text messages. Online chatting refers to Internet-based transmission of messages for real-time conversation. Poison Control Centers (PCCs) in the United States communicate with the public primarily via telephone. However, people increasingly prefer the convenience of SMS and chatting. Our objective is to describe the use of SMS and chatting by PCCs in the United States. Methods: An electronic survey questionnaire was distributed to all 55 US poison control center members of the American Association of Poison Control Centers. The survey assessed protocols for SMS and chatting, inquiry volume, and staff satisfaction. Centers reporting use of SMS or chatting services were administered follow-up questions, which further documented SMS and chatting interfaces and startup and maintenance costs. Descriptive statistics were used to describe the data. No statistical analysis was performed. Results: Of the 55 PCCs, 51 (93%) responded to the survey, 6 (12%) of which currently use or formerly used SMS and/or chatting. Inquiry volume ranged from 0 to 1 per day for SMS and 0 to 20 per day for chats. Startup costs ranged from $0 to $25,000. The most beneficial aspect, reported by 4 of the 6 PCCs (66.6%), was providing an alternative contact for inquiries. Most SMS and chatting interactions were completed within 10 and 30 min, respectively. All six centers completed telephone interactions within 10 min. The most disadvantageous aspects, reported by 2 of the 6 PCCs (33.3%), were staff apprehension and interaction length. Technology, such as syncing with existing call queuing software and databases, presented the greatest barrier to implementation. Conclusions: A minority of PCCs in the United States use SMS and chatting. Further research may investigate the economic feasibility of these systems, if SMS and chatting effectively expands public access, and patient comfort in contacting PCCs.

The association of self-regulation, habit, and mindfulness with texting while driving

The saturation of mobile phones throughout Australia has led to some individuals being unable to regulate their use within situations that are inappropriate or risky. One of the most prevalent risky mobile phone use behaviours is texting while driving. Attempts to explain texting while driving suggest cognitive variables and personality characteristics are key factors. This study explored relationships between trait self-regulation, habitual text messaging, trait mindfulness, and texting while driving. One hundred and seventy participants comprising Australian undergraduate psychology students and members of the public completed an online survey measuring trait self-regulation, habitual text messaging behaviour, trait mindfulness, and frequency of texting while driving. It was found that habitual texting behaviour mediated the relationship between trait self-regulation and frequency of texting while driving. Additionally, trait mindfulness moderated the relationship between habit and texting while driving, such that habitual texting was significantly, positively related to texting while driving, but only for individuals with low to moderate trait mindfulness. These results suggest personality constructs related to attention, awareness, and control of behaviour play a significant role in counteracting the association that habitual texting behaviour has with the frequency of texting while driving. As these traits are considered malleable, this association may be applicable in future development of intervention programs aimed at increasing control over mobile phone use and reducing the frequency with which people text while driving.

Changes in the sources of distracted driving among Northern Virginia drivers in 2014 and 2018: A comparison of results from two roadside observation surveys

INTRODUCTION

An increase in distracted driving has been suggested as a factor contributing to the 15% increase in fatal crashes from 2014 to 2016, but objective information about the prevalence of distracted driving in recent years is incomplete or lacking. The current study replicated a 2014 observation study conducted in Northern Virginia to examine whether the prevalence of distracted driving overall and of individual secondary behaviors has changed.

METHOD

Drivers of moving or stopped vehicles were observed at 12 locations across 4 Northern Virginia communities during the daytime. The presence of 12 different secondary behaviors was recorded.

RESULTS

In 2018, about 23% of drivers were engaged in at least one secondary behavior, which was not significantly different from 2014. Overall phone use was not significantly different between 2014 and 2018. However, the likelihood of holding a cellphone significantly decreased while the likelihood of manipulating a cellphone significantly increased in 2018 relative to 2014. About 14% of drivers were engaged in noncellphone secondary behaviors in 2014 and 2018, which exceeded the proportion using phones in both years.

CONCLUSIONS

There was no evidence that distracted driving has become more common in recent years, but the prevalence of some secondary behaviors has changed. Most concerning was the 57% increase in the likelihood of cellphone manipulation in 2018 relative to 2014, a behavior that has been consistently linked to increased crash risk; however, because the behavior is uncommon overall, the increased prevalence would be expected to only slightly increase crash rates. Practical applications: Although cellphone use was frequently observed in 2014 and 2018, collectively, other noncellphone secondary behaviors were more prevalent. Practitioners and policymakers should continue targeting cellphone use, but also must target other common secondary behaviors to fully address distracted driving.

Distracted Pedestrian Behavior on two Urban College Campuses

Pedestrian injuries injure about 180,000 individuals and kill 6000 each year in the United States, and pedestrian injury rates have increased each of the last several years. Distracted pedestrian behavior may play a role in the trend of increasing risk for pedestrian injury. Using in vivo behavioral coding over the course of  two weeks on two urban college campuses, this study aimed to (1) understand the type and rate of distractions engaged in by pedestrians on urban college campuses, and (2) investigate the impact of distraction on street-crossing safety and behavior. A total of 10,543 pedestrians were observed, 90% of them young adults. Over one-third of those pedestrians were distracted while actively crossing roadways. Headphones were the most common distraction (19% of all pedestrians), followed by text-messaging (8%) and talking on the phone (5%). Women were more likely to text and talk on the phone than men, and men were more likely to be wearing headphones. Distracted pedestrians were somewhat less likely to look for traffic when they entered roadways. As handheld device usage continues to increase, behavioral interventions should be developed and implemented. Changes to policy concerning distracted pedestrian behavior, including improvement of the built environment to reduce pedestrian risk, should be considered in busy pedestrian areas like urban college campuses.

Visual scanning behavior during distracted walking in healthy young adults

BACKGROUND

An epidemic of pedestrian accidents when walking while texting suggests that people are less aware of their surroundings during distracted walking, and highlights the importance of visual scanning for pedestrian safety. Quantitative examination of visual scanning during distracted walking is still lacking.

RESEARCH QUESTION

Is visual scanning behavior altered by distracted walking in healthy young adults?

METHODS

We compared visual scanning behavior in 20 young adults during usual (single-task) walking, walking while performing a letter-fluency task, and walking while texting. Visual scanning behavior was measured by fixation count and dwell time percentage in specific areas of interest. Dual-task effects on gait speed, letter fluency, texting speed and accuracy, and situational awareness were also examined.

RESULT

Visual scanning behavior differed between the three walking conditions. During dual-task letter fluency, participants had significantly more non-walking path fixations than either of the other two conditions (i.e., more frequent, broader visual scanning). Conversely, during dual-task texting, gaze was focused predominantly on the phone, with little visual scanning of the walking path and surrounding environment. When walking without texting or talking, gaze was directed equally to far walking path and surrounding environment.

SIGNIFICANCE

Texting while walking is associated with a considerable reduction in overt visual attention to the walking path and surrounding areas. Whether this translates to reduced conscious awareness of environmental stimuli remains unclear. Performing a verbal task while walking was associated with more frequent, wider visual scanning behavior, which may be specific to the nature of the verbal task in this study.

Effects of texting on accident risk during a sudden hazardous event: Analysis of predetection and postdetection phases

OBJECTIVE

The present study aims to quantify the effects of texting and driver behavior on the accident risk associated with a sudden event. Further, the study attempts to compare the effects of driving behavior of inexperienced young and professional drivers on risk during predetection and postdetection phases of the event.

METHODS

Forty-nine drivers from 2 categories-inexperienced young drivers and experienced professional drivers-took part in simulated experiments. The participants drove in a free-flow road environment under 3 driving conditions: no distraction (baseline) and writing short and long texts while driving. The participants were exposed to a sudden hazardous event during each drive. Accident probability during the sudden event was modeled with a generalized linear mixed model (with a logit link function).

RESULTS

As expected, both texting tasks increased accident risk, and the risk was much higher for inexperienced young drivers than for professional drivers. Time lapsed in reducing speed increased the odds for accident risk significantly. A comparative analysis of the driver categories showed that impairment in driving behavior due to the texting tasks was similar for both groups during the predetection phase. However, the risk associated with the texting tasks was higher for young drivers during the postdetection phase. A possible reason could be that young drivers had 65% and 75% higher approach speeds (than the professional drivers) during the short and long text tasks, respectively.

CONCLUSIONS

The results provide statistical evidence that increased speed is expressed as increased risk-taking behavior among young drivers, which subsequently is the main reason for their higher accident risk during texting tasks. Moreover, the results confirm that professional drivers are not able to mitigate the increased accident risk associated with texting tasks due to late detection of the event during the tasks.

A mixed methods examination of adolescents' reasons for pretending to text

INTRODUCTION

The purpose of this study was to examine reasons adolescents give for pretending to text in various social situations. Pretending to text was conceptualized as when a person uses a cellphone to make it look like they are texting, but they are not actually sending messages. Little research is available from the adolescent perspective regarding self-presentation and avoidance when using digital devices in social contexts.

METHODS

A convergent mixed methods approach was used to understand the experience of high school sophomores, juniors, and seniors (n = 216) in the United States. Chi-square analyses and t-tests were used to examine differences between those who pretended to text and those who did not. Qualitative data were analyzed using van Manen's line-by-line approach.

RESULTS & CONCLUSIONS

Participants indicated they pretended to text for reasons of avoidance, to maintain a positive appearance, and sometimes to provide a sense of security if they felt unsafe in a situation. This study uses self-presentation to further understand adolescent perceptions of pretending to text.

Texting Brief Podcasts to Deliver Faculty Development to Community-Based Preceptors in Longitudinal Integrated Clerkships

INTRODUCTION

Longitudinal integrated clerkships (LICs) are an increasingly popular clerkship model that relies heavily on community-based preceptors. The availability of an engaged and prepared community-based faculty is crucial to the success of these programs. Teachers in these programs are often geographically separate from medical school campuses, are engaged in busy practices, and have limited time to devote to faculty development activities.

METHODS

We created a series of five brief faculty development podcasts directed towards community-based teachers in LICs from three US medical schools. Topics included encouraging continuity, bedside teaching, encouraging student ownership of patients, communicating and managing patient results between clinic days, and choosing the right patients for continuity. The podcasts were sent via a grouped text message just prior to preceptors' morning commute time. Pre- and postsurveys assessed the acceptability and effectiveness of the podcasts.

RESULTS

Among the 33 postintervention survey responders, 27 (81.8%) listened to at least three podcasts, 21 (63.6%) found them moderately or very helpful, 23 (69.7%) perceived that the podcasts altered their teaching style, 23 (69.7%) would likely or highly likely listen to further podcasts, and 18 (54.5%) would likely or highly likely recommend the podcasts to colleagues.

DISCUSSION

In a cohort of multispecialty faculty teaching in LICs, educational podcasts were well received and perceived by preceptors to impact their teaching style. Texting these podcasts to other community-based preceptors may offer an effective strategy for providing faculty development to busy clinicians.

Driving behaviour while self-regulating mobile phone interactions: A human-machine system approach

Mobile phone distracted driving is a recurrent issue in road safety worldwide. Recent research on driving behaviour of distracted drivers suggests that in certain circumstances drivers seem to assume safer behaviours while using a mobile phone. Despite a high volume of research on this topic, self-regulation by mobile phone distracted drivers is not well understood as many driving simulator experiments are designed to impose an equal level of distraction to participants being tested for their driving performance. The aim of this research was to investigate the relationship between self-regulatory secondary task performance and driving. By a driving simulator experiment in which participants were allowed to perform their secondary tasks whenever they feel appropriate, the driving performance of 35 drivers aged 18-29 years was observed under three phone conditions including non-distraction (no phone use), hands-free interactions and visual-manual interactions in the CARRS-Q advanced driving simulator. Drivers' longitudinal and lateral vehicle control observed across various road traffic conditions were then modelled by Generalized Estimation Equations (GEE) with exchangeable correlation structure accounting for heterogeneity resulting from multiple observations from the same driver. Results show that the extent of engagement in the secondary task influence both longitudinal and lateral control of vehicles. Drivers who engaged in a large number of hands-free interactions are found to select lower driving speed. In contrast, longer visual-manual interactions are found to result in higher driving speed among drivers self-regulating their secondary task. Among the road traffic conditions, drivers distracted by their self-regulated secondary tasks are found to select lower speeds along the s-curve compared to straight and motorway segments. In summary, the applied human-machine system approach suggests that road traffic demands play a vital role in both secondary task management and driving performance.

Understanding the psychological precursors of young drivers' willingness to speed and text while driving

This study applied the Prototype Willingness Model (PWM) to investigate the factors that may predict young drivers' (non-intentional) willingness to text while driving, text while stopped, and engage in high and low levels of speeding. In addition, the study sought to assess whether general optimism bias would predict young drivers' willingness to text and speed over and above the PWM. Licenced drivers (N = 183) aged 17-25 years (M = 19.84, SD = 2.30) in Queensland, Australia completed an online survey. Hierarchical multiple regressions revealed that the PWM was effective in explaining the variance in willingness to perform all four illegal driving behaviours. Particularly, young drivers who possessed favourable attitudes and a positive prototype perception towards these behaviours were more willing to engage in texting and speeding. In contrast to the study's predictions, optimistically biased beliefs decreased young drivers' willingness to text while stopped and engage in high and low levels of speeding. The findings of the study may help inform policy and educational campaigns to better target risky driving behaviours by considering the influence of attitudes, prototypes and the non-intentional pathway that may lead to engagement in texting while driving and stopped and engagement in high and low levels of speeding.

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.

Concurrent phone texting alters crossing behavior and induces gait imbalance during obstacle crossing

Texting during walking has become a very common daily activity and could alter gait performance, especially during locomotion when additional visual attention is demanded, such as obstacle crossing. The purpose of this study was to examine biomechanical changes in obstructed gait characteristics while engaging in a phone texting activity. Gait analyses were performed on ten young healthy adults under the following two tasks: 1) walking and crossing an obstacle set at a 10% of the subject's height and 2) walking and crossing an obstacle while responding to a text message. Whole body motion data were collected with a 10-camera motion capture system. Our data demonstrated that a conservative gait pattern was adopted while performing texting when approaching and crossing over the obstacle, which was indicated by slower walking speeds and greater toe-obstacle clearances. This gait pattern was, however, accompanied by a greater body sway in the frontal plane during crossing, which could be an indication of perturbed gait balance control. Increased visual-attentional demand from a concurrent phone texting could negatively impact young pedestrians' safety during obstacle crossing.

Examining teen driver crashes and the prevalence of distraction: Recent trends, 2007-2015

INTRODUCTION

Teen drivers crash at a much higher rate than adult drivers, with distractions found as a factor in nearly 6 out of 10 moderate-to-severe teen crashes. As the driving environment continues to rapidly evolve, it is important to examine the effect these changes may be having on our youngest and most vulnerable drivers.

METHOD

The purpose of this study was to identify types of vehicle crashes teens are most frequently involved in, as well as the distracting activities being engaged in leading up to these crashes, with a focus on identifying changes or trends over time. We examined 2,229 naturalistic driving videos involving drivers ages 16-19. These videos captured crashes occurring between 2007 and 2015. The data of interest for this study included crash type, behaviors drivers engaged in leading up to the collision, total duration of time the driver's eyes were off the forward roadway, and duration of the longest glance away from forward.

RESULTS

Rear-end crashes increased significantly (annual % change=3.23 [2.40-4.05]), corresponding with national data trends. Among cell phone related crashes, a significant shift occurred, from talking/listening to operating/looking (annual % change=4.22 [1.15-7.29]). Among rear-end crashes, there was an increase in the time drivers' eyes were off the road (β=0.1527, P=0.0004) and durations of longest glances away (β=0.1020, P=0.0014).

CONCLUSIONS

Findings suggest that shifts in the way cell phones are being used, from talking/listening to operating/looking, may be a cause of the increasing number of rear-end crashes for teen drivers.

PRACTICAL APPLICATIONS

Understanding the role that cell phone use plays in teen driver crashes is extremely important. Knowing how and when teens are engaging in this behavior is the only way effective technologies can be developed for mitigating these crashes.

"To sleep, perchance to tweet": in-bed electronic social media use and its associations with insomnia, daytime sleepiness, mood, and sleep duration in adults

OBJECTIVES

The use of mobile device-based electronic social media (ESM) in bed is rapidly becoming commonplace, with potentially adverse impacts on sleep and daytime functioning. The purpose of this study was to determine the extent to which in-bed ESM use is associated with insomnia, daytime sleepiness, mood, and sleep duration in adults.

METHODS

This was a cross-sectional observational study conducted among 855 hospital employees and university students (mean age, 43.6years; 85% female) via an online questionnaire.

RESULTS

Nearly 70% of participants indulged in in-bed ESM use, with nearly 15% spending an hour or more a night doing so. The degree of in-bed ESM use did not vary by gender, but higher levels of in-bed ESM use were seen in younger and middle-aged than elderly participants. Compared with participants with no in-bed ESM use and controlling for age, gender, and ethnicity, participants with high in-bed ESM use were more likely to have insomnia, anxiety, and short sleep duration on weeknights, but not depression or daytime sleepiness; low in-bed ESM use only increased the likelihood of short sleep duration on weeknights. In-bed ESM use by a bed partner did not have an adverse association with sleep or mood.

CONCLUSIONS

In-bed ESM use is associated with sleep and mood dysfunction in adults. These findings are of relevance to clinicians, therapists, and the public at large, as they suggest that limitation of in-bed ESM use is a potential interventional strategy in the overall management of sleep hygiene and mental health.

Everyday multitasking habits: University students seamlessly text and walk on a split-belt treadmill

With increasing numbers of adults owning a cell phone, walking while texting has become common in daily life. Previous research has shown that walking is not entirely automated and when challenged with a secondary task, normal walking patterns are disrupted. This study investigated the effects of texting on the walking patterns of healthy young adults while walking on a split-belt treadmill. Following full adaptation to the split-belt treadmill, thirteen healthy adults (23±3years) walked on a tied-belt and split-belt treadmill, both with and without a simultaneous texting task. Inertial-based movement monitors recorded spatiotemporal components of gait and stability. Measures of spatial and temporal gait symmetry were calculated to compare gait patterns between treadmill (tied-belt and split-belt) and between texting (absent or present) conditions. Typing speed and accuracy were recorded to monitor texting performance. Similar to previous research, the split-belt treadmill caused an alteration to both spatial and temporal aspects of gait, but not to time spent in dual support or stability. However, all participants successfully maintained balance while walking and were able to perform the texting task with no significant change to accuracy or speed on either treadmill. From this paradigm it is evident that when university students are challenged to text while walking on either a tied-belt or split-belt treadmill, without any other distraction, their gait is minimally affected and they are able to maintain texting performance.

EndCancer: development and pilot testing of multimedia recruitment for a text message campaign to increase cancer screening

BACKGROUND

Colorectal cancer (CRC) is the second leading cause of cancer mortality in the US but is preventable with timely colonoscopy screening. Although CRC incidence and mortality have been decreasing and screening rates increasing, southeastern Coloradans in particular remain in great need of CRC screening. Media outreach campaigns have previously proven successful in this region, and local clinical partners expressed interest in text messaging and social media community outreach.

METHODS

The Colorado Cancer Screening Program partnered with the Colorado Cancer Coalition and two community health centers to develop theory-based text messages to encourage cancer screening behavior. Participants were recruited into this text message program through 4 weeks of radio advertisements, locally-posted flyers, and 12 weeks of social media messaging asking community members to text a key word or enter their phone number online to receive additional information about cancer screening.

RESULTS

Facebook advertisement proved to be the most successful in engaging community members in the outreach campaign with over 22,600 exposed to ads. Radio and print advertisements were less successful than previous campaigns suggested. Theory-based text messages were effective in maintaining interest in the topic of cancer screening. Ninety-six percent of text message participants remained enrolled through receipt of all CRC messages.

CONCLUSIONS

The EndCancer campaign provides evidence of strategies that can be used to reach hard-to-reach and hard-to-screen populations in need of CRC screening. Engagement was high with Facebook ads, and those who viewed ads clicked through to the sign-up page, an indication of intent to enroll. Given the promising results of engagement with Facebook ads among the target demographic, social media marketing may prove a successful avenue to enroll hard-to-reach populations into cancer screening educational initiatives.

Texting while walking differently alters gait patterns in people with multiple sclerosis and healthy individuals

BACKGROUND

In recent times, increasing safety concerns have been associated with the use of mobile phones by pedestrians. In particular, texting has been shown to significantly alter gait patterns. However, no specific investigations have been performed on people with Multiple Sclerosis (pwMS), who are already characterized by gait dysfunctions caused by the disease.

OBJECTIVE

To assess the existence of possible alterations in spatio-temporal parameters of gait in pwMS when simultaneously texting on a smartphone and walking.

METHODS

Fifty-four pwMS (mean age 40.5 ± 10.5) and 40 age-matched unaffected individuals were tested in two conditions: walking, and walking while texting on a smartphone. Spatio-temporal parameters of gait were assessed using a wearable accelerometer located on the lower back.

RESULTS

Texting induces reduction of gait speed, stride length and cadence in both groups, but such changes were smaller in magnitude in pwMS. An increase of stance and double support and reduction of swing phase were observed in pwMS only.

CONCLUSIONS

Texting alters gait patterns of pwMS differently from unaffected individuals, probably due to a different prioritization of the task, which appears to take into account the motor and sensory impairments associated with the disease by favoring the motor task.

Mobile phone use during driving: Effects on speed and effectiveness of driver compensatory behaviour

This study analysed and modelled the effects of conversation and texting (each with two difficulty levels) on driving performance of Indian drivers in terms of their mean speed and accident avoiding abilities; and further explored the relationship between speed reduction strategy of the drivers and their corresponding accident frequency. 100 drivers of three different age groups (young, mid-age and old-age) participated in the simulator study. Two sudden events of Indian context: unexpected crossing of pedestrians and joining of parked vehicles from road side, were simulated for estimating the accident probabilities. Generalized linear mixed models approach was used for developing linear regression models for mean speed and binary logistic regression models for accident probability. The results of the models showed that the drivers significantly compensated the increased workload by reducing their mean speed by 2.62m/s and 5.29m/s in the presence of conversation and texting tasks respectively. The logistic models for accident probabilities showed that the accident probabilities increased by 3 and 4 times respectively when the drivers were conversing or texting on a phone during driving. Further, the relationship between the speed reduction patterns and their corresponding accident frequencies showed that all the drivers compensated differently; but, among all the drivers, only few drivers, who compensated by reducing the speed by 30% or more, were able to fully offset the increased accident risk associated with the phone use.

Experiential exposure to texting and walking in virtual reality: A randomized trial to reduce distracted pedestrian behavior

BACKGROUND

Distracted pedestrian behavior is a significant public health concern, as research suggests distracted pedestrians have significantly higher risk of injury compared to fully attentive pedestrians. Despite this, efforts to reduce distracted pedestrian behavior are scant.

OBJECTIVE

Using a repeated measures experimental research design, we implemented a behavioral intervention to reduce distracted pedestrian behavior in the high-risk environment of an urban college campus and simultaneously monitored behavior on a control urban college campus not exposed to the intervention. We had two primary aims: reduce perceived vulnerability to injury among individual pedestrians and reduce distracted pedestrian behavior in the environment through a change in community-based norms.

METHODS

The hallmark of the behavioral intervention was a week-long opportunity for community members to experience personally the risks of distracted pedestrian behavior by attempting to cross a virtual pedestrian environment street while text-messaging. This was supplemented by traditional and social marketing and publicity through various campus partners. A sample of 219 individuals completed self-report surveys about perceived vulnerability to distracted pedestrian injury before experiencing the distracted virtual street-crossing and again after 2 weeks and 5 months. Observational assessment of distracted pedestrian behavior was conducted at a busy intersection on the campus as well as at a control campus not exposed to the intervention at baseline, post-intervention, 10 weeks, and 6 months.

RESULTS

The intervention achieved mixed results. Individuals exposed to texting within a simulated pedestrian environment reported changes in their intentions to cross streets while distracted and in perceived vulnerability to risk while crossing streets, but we did not witness evidence of changed community norms based on observed rates of distracted pedestrian behavior before and after the intervention compared to a control campus not exposed to the intervention.

DISCUSSION

The intervention created some change in self-reported intentions and thoughts but did not create significant behavior change on the campus exposed to it. Further efforts to develop interventions that will yield a reduction in distracted pedestrian behavior are needed.

Effects of smartphone texting on the visual perception and dynamic walking stability

Mobile phone use while walking can cause dual-task interference and increases safety risks by increasing attentional and cognitive demands. While the interference effect on cognitive function has been examined extensively, how perception of the environment and walking dynamics are affected by mobile phone use while walking is not well understood. The amount of visual information loss and its consequent impact on dynamic walking stability was examined in this study. Young adults (mean, 20.3 years) volunteered and walked on a treadmill while texting and attending to visual tasks simultaneously. Performance of visual task, field of regard loss, and margin of stability under dual-task conditions were compared with those of single-task conditions (i.e., visual task only). The results revealed that the size of visual field and visual acuity demand were varied across the visual task conditions. Approximately half of the visual cues provided during texting while walking were not perceived as compared to the visual task only condition. The field of regard loss also increased with increased dual-task cost of mobile phone use. Dynamic walking stability, however, showed no significant differences between the conditions. Taken together, the results demonstrate that the loss of situational awareness is unavoidable and occurs simultaneously with decrements in concurrent task performance. The study indicates the importance of considering the nature of attentional resources for the studies in dual-task paradigm and may provide practical information to improve the safe use of mobile phones while walking.

Do the Elderly Get the Message? A Comparative Study of Stories Produced Verbally and as a Text Message

When young adults re-tell a story, they naturally produce more concise but sufficiently informative narratives. The repeated narratives of elderly adults, on the other hand, tend towards prolixity. In the present study, participants were explicitly instructed to re-tell a story in a more succinct (but informative format) to investigate whether they were able to produce informative narratives in a compressed format. 30 younger adults ([Formula: see text]) and 30 older adults ([Formula: see text]) constructed a verbal narrative from a series of cartoon frames depicting a story about a cowboy and his horse. Participants then re-told this narrative as a text message. The second narrative produced by the older adult sample did on average contain fewer words, but at the expense of informative content and discourse cohesion. The tendency of older adults to produce longer narratives with re-telling is not merely reflective of a strategic choice but rather reflects a genuine macrolinguistic deficit.

Social Media: Challenges and Concerns for Families

This article explores the impact of social media on child development and family health. Why do we allow our children to use social media sites before their privacy policies allow? Why do we let them lie about their ages to use these sites? What is it about technology that lets us bend these rules in a way we would never do in the unplugged world? Gaining insight into the answers to these questions and what is positive and negative about social media and the digital world allows us to talk to families about this world, allay their concerns, and keep children of all age safe when using social media.

Differential impact of personality traits on distracted driving behaviors in teens and older adults

OBJECTIVE

To determine the impact of personality on distracted driving behaviors.

METHOD

Participants included 120 drivers (48 teens, 72 older adults) who completed the 45-item Big Five Personality questionnaire assessing self-reported personality factors and the Questionnaire Assessing Distracted Driving (QUADD) assessing the frequency of distracted driving behaviors. Associations for all five personality traits with each outcome (e.g., number of times texting on the phone, talking on the phone, and interacting with the phone while driving) were analyzed separately for teens and older adults using negative binomial or Poisson regressions that controlled for age, gender and education.

RESULTS

In teens, higher levels of openness and conscientiousness were predictive of greater reported texting frequency and interacting with a phone while driving, while lower levels of agreeableness was predictive of fewer reported instances of texting and interacting with a phone while driving. In older adults, greater extraversion was predictive of greater reported talking on and interacting with a phone while driving. Other personality factors were not significantly associated with distracted driving behaviors.

CONCLUSIONS

Personality traits may be important predictors of distracted driving behaviors, though specific traits associated with distracted driving may vary across age groups. The relationship between personality and distracted driving behaviors provides a unique opportunity to target drivers who are more likely to engage in distracted driving behavior, thereby increasing the effectiveness of educational campaigns and improving driving safety.

Safety-critical event risk associated with cell phone tasks as measured in naturalistic driving studies: A systematic review and meta-analysis

A systematic review and meta-analysis of naturalistic driving studies involving estimates of safety-critical event risk associated with handheld device use while driving is described. Fifty-seven studies identified from targeted databases, journals and websites were reviewed in depth, and six were ultimately included. These six studies, published between 2006 and 2014, encompass seven sets of naturalistic driver data and describe original research that utilized naturalistic methods to assess the effects of distracting behaviors. Four studies involved non-commercial drivers of light vehicles and two studies involved commercial drivers of trucks and buses. Odds ratios quantifying safety-critical event (SCE) risk associated with talking, dialing, locating or answering, and texting or browsing were extracted. Stratified meta-analysis of pooled odds ratios was used to estimate SCE risk by distraction type; meta-regression was used to test for sources of heterogeneity. The results indicate that tasks that require drivers to take their eyes off the road, such as dialing, locating a phone and texting, increase SCE risk to a greater extent than tasks that do not require eyes off the road such as talking. Although talking on a handheld device did not increase SCE risk, further research is required to determine whether it indirectly influences SCE risk (e.g., by encouraging other cell phone activities). In addition, a number of study biases and quality issues of naturalistic driving studies are discussed.

Do we really need to use our smartphones while driving?

Smartphone usage while driving, a prominent type of driver distraction, has become a major concern in the area of road safety. Answers to an internet survey by 757 Israeli drivers who own smartphones were analyzed with focus on two main purposes: (1) to gain insights regarding patterns of smartphone usage while driving and its motivation, (2) to probe drivers' views on the perceived risk and the need to use smartphones while driving, as well as their willingness to use blocking apps that limit such usages. Phone calls and texting were found to be the most common usages while driving, hence, both were chosen to be further analyzed. 73% (N=551) of the respondents make phone calls while driving and almost half of them may be considered frequent callers as they admit to do it intensively while driving. As for texting, 35% of the respondents (N=256) text while driving and a quarter of them do so frequently. While phone calls were perceived to compromise safety by 34% of the users, texting was perceived to compromise safety by 84% of the users. However, we found that drivers place limitations on themselves as more than 70% avoid texting when they think they need to devote attention to driving. A logistic regression model indicates that perceived need and perceived safety are significant factors associated with being a frequent smartphone phone calls user, but only perceived need significantly predicts being a frequent texting user. Approximately half of all the respondents are willing to try an app which blocks smartphone usage while driving. The willingness to use such technology was found to be related primarily to perceived need. Less significant factors are work-related usage and perceived safety. Frequency of usage was not found to affect this willingness, indicating that it should not be a factor in designing and implementing interventions to limit smartphone usage while driving.

Dual task interference during walking: The effects of texting on situational awareness and gait stability

Dual-task interference caused by mobile phone use while walking increases safety risks by increasing attentional and cognitive demands. Situational awareness, important for control of walking and safety, has been examined previously but measured only by the awareness of visually noteworthy objects in the environment or the number of times the person looked up from the phone. This study systematically investigated the effects of texting on situational awareness to different environments and its consequent impact on gait kinematics. Twenty healthy volunteers walked on a treadmill while texting and attending to visual tasks simultaneously. Gait parameters and situational awareness examined under dual-task conditions (walk and text or walk, text, and visual task) were compared with those of single-task conditions (text, walk or visual task only). The size of the visual field, display duration of the visual cue, and visual acuity demand were varied across the visual task conditions. About half of the visual cues provided during walking and texting were not perceived (48.3%) as compared to the visual task only condition. The magnitude of this loss of situational awareness was dependent upon the nature of visual information provided. While gait parameters were not different among visual task conditions, greater total medial-lateral excursion of the pelvis was observed in the walk and text condition compared to the walk only condition, showing the dual-task effects of texting on gait kinematics. The study provides further evidence of dual-task effects of texting on situational awareness as well as gait kinematics.