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PubMed2005

Risky driving and lifestyles in adolescence.

Several studies have shown that risky driving is especially prevalent among young drivers and recent research has pointed out that driving in adolescence should be investigated in the more general context of adolescent development. The first aim of this contribution was to analyze involvement in risky driving in a normative sample of 645 Italian adolescents, boys and girls, aged 14-17, through a self-report questionnaire. A second aim was to evaluate the association between risky driving and lifestyle, defined as involvement in other health risk behaviors and leisure activities. The main results showed that many adolescents drove cars and motorcycles without the required driving license and the most frequent offences were speeding and failure to maintain a safe braking distance. Gender and age differences were also investigated. Results concerning the association between risky driving and lifestyle showed that risky driving was not an isolated behavior. Boys who displayed risky driving practices were more likely to adopt a lifestyle characterized by high involvement in antisocial behaviors, tobacco smoking, comfort eating and time spent in non-organized activities with friends. Girls involved in risky driving were more likely to be involved in other risk-taking behaviors, antisocial behaviors and drug use.

Adolescent↗
PubMed2004

Comparison of driving simulator performance and neuropsychological testing in narcolepsy.

Daytime sleepiness and cataplexy can increase automobile accident rates in narcolepsy. Several countries have produced guidelines for issuing a driving license. The aim of the study was to compare driving simulator performance and neuropsychological test results in narcolepsy in order to evaluate their predictive value regarding driving ability. Thirteen patients with narcolepsy (age: 41.5+/-12.9 years) and 10 healthy control patients (age: 55.1+/-7.8 years) were investigated. By computer-assisted neuropsychological testing, vigilance, alertness and divided attention were assessed. In a driving simulator patients and controls had to drive on a highway for 60 min (mean speed of 100 km/h). Different weather and daytime conditions and obstacles were presented. Epworth Sleepiness Scale-Scores were significantly raised (narcolepsy patients: 16.7+/-5.1, controls: 6.6+/-3.6, P < or = 0.001). The accident rate of the control patients increased (3.2+/-1.8 versus 1.3+/-1.5, P < or = 0.01). Significant differences in concentration lapses (e.g. tracking errors and deviation from speed limit) could not be revealed (9.8+/-3.5 versus 7.1+/-3.2, pns). Follow-up investigation in five patients after an optimising therapy could demonstrate the decrease in accidents due to concentration lapses (P < or = 0.05). Neuropsychological testing (expressed as percentage compared to a standardised control population) revealed deficits in alertness (32.3+/-28.6). Mean percentage scores of divided attention (56.9+/-25.4) and vigilance (58.7+/-26.8) were in a normal range. There was, however, a high inter-individual difference. There was no correlation between driving performance and neuropsychological test results or ESS Score. Neuropsychological test results did not significantly change in the follow-up. The difficulties encountered by the narcolepsy patient in remaining alert may account for sleep-related motor vehicle accidents. Driving simulator investigations are closely related to real traffic situations than isolated neuropsychological tests. At the present time the driving simulator seems to be a useful instrument judging driving ability especially in cases with ambiguous neuropsychological results.

Adult↗
PubMed2005

The prevalence of drinking and driving in the United States, 2001-2002: results from the national epidemiological survey on alcohol and related conditions.

Traffic deaths and injuries are among the most frequent causes of deaths and disability worldwide. In the United States, the National Highway Transportation Safety Administration (NHTSA) reported that approximately 40% of all traffic fatalities were alcohol-related. Yet, information about the prevalence of drinking and driving behaviors of the U.S. general population is lacking. The purpose of this study was to examine the magnitude of driver-based (i.e., driving while drinking and driving after having too much to drink) and passenger-based (i.e., riding with a drinking driver and riding as a passenger while drinking) drinking and driving behaviors confronting contemporary America. The past-year prevalence data were stratified by major sociodemographic characteristics to identify important determinants of drinking and driving behaviors for further research. Data were derived from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC, n=43,093). In 2001-2002 there were 23.4 million, or 11.3%, of American adults who reported engaging in at least one of the four driver- or passenger-based drinking and driving behaviors. The prevalences of passenger-based drinking and driving behaviors were generally greater than those of the driver-based measures. For all four drinking and driving behaviors, age was inversely associated with the risk and males were at greater risk with the associated male-to-female ratios of approximately 3.0. Our data also suggested that Native Americans, individuals who were widowed/separated/divorced or never married, and those with greater than a high school education were also at greater risks of all drinking and driving behaviors.

Accidents, Traffic↗
PubMed2005

Comparative sensitivity of a simulated driving task to self-report, physiological, and other performance measures during prolonged wakefulness.

OBJECTIVES: The objectives of this study were to compare (1) the sensitivity of simulated driving to self-report measures, nocturnal sleep latency tests (SLTs), and an auditory vigilance task and (2) urban and motorway driving. METHODS: Healthy males 18 to 35 years maintained wakefulness for one night and were tested at 2400, 0230, 0500 and 0730 h. In Study 1 (n=11), the SLTs were followed by auditory vigilance and simulated driving tasks; in Study 2 (n=18), the SLTs were preceded and followed by simulated driving on motorway and urban routes. RESULTS: In Study 1, speed variability, tracking variability, and driving off the road on the driving simulator had comparable sensitivity to d' on the auditory vigilance task. In Study 2, driving performance was consistently worse on the motorway route. CONCLUSION: The driving simulator was equally sensitive to another performance measure during prolonged wakefulness and impairments were greater with motorway driving.

Adolescent↗
PubMed2003

Risky, aggressive, or emotional driving: addressing the need for consistent communication in research.

PROBLEM: Researchers agree that a consistent definition for aggressive driving is lacking. Such definitional ambiguity in the literature impedes the accumulation of accurate and precise information, and prevents researchers from communicating clearly about findings and implications for future research directions. This dramatically slows progress in understanding the causes and maintenance factors of aggressive driving. SUMMARY: This article critiques prevailing definitions of driver aggression and generates a definition that, if used consistently, can improve the utility of future research. Pertinent driving behaviors have been variably labeled in the literature as risky, aggressive, or road rage. The authors suggest that the term "road rage" be eliminated from research because it has been used inconsistently and has little probability of being clarified and applied consistently. Instead, driving behaviors that endanger or have the potential to endanger others should be considered as lying on a behavioral spectrum of dangerous driving. Three dimensions of dangerous driving are delineated: (a). intentional acts of aggression toward others, (b). negative emotions experienced while driving, and (c). risk-taking. IMPACT ON INDUSTRY: The adoption of a standardized definition for aggressive driving should spark researchers to use more explicit operational definitions that are consistent with theoretical foundations. The use of consistent and unambiguous operational definitions will increase the precision of measurement in research and enhance authors' ability to communicate clearly about findings and conclusions. As this occurs over time, industry will reap benefits from more carefully conducted research. Such benefits may include the development of more valid and reliable means of selecting safe professional drivers, conducting accurate risk assessments, and creating preventative and remedial dangerous driving safety programs.

Accidents, Traffic↗
PubMed2006

The effects of the checkpoints program on parent-imposed driving limits and crash outcomes among Connecticut novice teen drivers at 6-months post-licensure.

INTRODUCTION: Because crash rates are highly elevated during the first months of licensure, it is advisable for parents to limit teen driving so that teens can gain independent driving experience under less dangerous driving conditions. This report describes the effect of the Checkpoints Program on parent limits on novice teen driving through six months post-licensure. METHODS: Nearly one-quarter of all Connecticut teens who obtained a learner's permit over a 9-month period were recruited, providing a final sample of 3,743 who obtained licenses within the next 16 months. Families were randomized to the intervention or comparison condition. Intervention families received by mail a series of persuasive communications related to high-risk teen driving and a parent-teen driving agreement, while on the same schedule comparison families received standard information on driver safety. RESULTS: Families who participated in the Checkpoints Program reported significantly greater limits on teen driving at licensure, 3-months, and 6-months post-licensure. However, there were no differences in reported risky driving behavior, violations, or crashes. CONCLUSION: This is the first statewide study testing the efficacy of the Checkpoints Program. The results indicate that it is possible to foster modest increases in parental restrictions on teen driving limits during the first six months of licensure using passive persuasive communications, but that the levels of restriction obtained were not sufficient to protect against violations and crashes.

Adolescent↗
PubMed2004

Correlation between driving errors and vigilance level: influence of the driver's age.

During long and monotonous driving at night, most drivers progressively show signs of visual fatigue and loss of vigilance. Their capacity to maintain adequate driving performance usually is affected and varies with the age of the driver. The main question is to know, on one hand, if occurrence of fatigue and drowsiness is accompanied by a modification in the driving performance of the driver and, on the other hand, if this relationship partially depends on the driver's age. Forty-six male drivers, divided into three age categories: 20-30, 40-50, and 60-70 years, performed a 350-km motorway driving session at night on a driving simulator. Driving errors were measured in terms of number of running-off-the-road incidents (RORI) and large speed deviations. The evolution of physiological vigilance level was evaluated using electroencephalography (EEG) recording. In older drivers, in comparison with young and middle-aged drivers, the degradation of driving performance was correlated to the evolution of lower frequency waking EEG (i.e., theta). Contrary to young and middle-aged drivers, the deterioration of the vigilance level attested by EEG correlated with the increase in gravity of all studied driving errors in older drivers. Thus, depending on the age category considered, only part of the driving errors would constitute a relevant indication as for the occurrence of a state of low arousal.

Accidents, Traffic↗
PubMed1998

Why do older drivers give up driving?

All Finnish license holders aged 70 years (from the cohort born in 1922) who did not renew their driver license, and a corresponding comparison group among those who did renew their license, were contacted by a mail survey. They were asked about their reasons to continue or to stop driving, about their current living conditions and health status, and about some aspects of their driving behavior. The reasons to stop or to continue driving were different for men and women. Male drivers considered more frequently than female drivers the use of private car a necessity. Male respondents who did not renew their license (ex-drivers) were less healthy than those who did renew their license (drivers). The most frequently indicated reason to stop driving among men was deteriorated health. However, only 6.9% of the ex-drivers had received professional advice to stop driving. For most of these cases, this advice had been given by the physician responsible for the treatment of their main illness. The change in health condition was related to a shift in driving activity: those still driving were in best health, followed by those ex-drivers who stopped driving at the age of 70 years, while those who had stopped driving at an earlier age had the highest number of illnesses and had most frequently experienced a deterioration of their health status during the last year. Both male and female ex-drivers reported more feelings of stress in traffic and more frequent avoidance of certain traffic situations than drivers. Women reported more frequently traffic-related stress and avoidance than men as both drivers and ex-drivers.

Aged↗
PubMed2006

Simulated driving and brain imaging: combining behavior, brain activity, and virtual reality.

INTRODUCTION: Virtual reality in the form of simulated driving is a useful tool for studying the brain. Various clinical questions can be addressed, including both the role of alcohol as a modulator of brain function and regional brain activation related to elements of driving. OBJECTIVE: We reviewed a study of the neural correlates of alcohol intoxication through the use of a simulated-driving paradigm and wished to demonstrate the utility of recording continuous-driving behavior through a new study using a programmable driving simulator developed at our center. METHODS: Functional magnetic resonance imaging data was collected from subjects while operating a driving simulator. Independent component analysis (ICA) was used to analyze the data. Specific brain regions modulated by alcohol, and relationships between behavior, brain function, and alcohol blood levels were examined with aggregate behavioral measures. Fifteen driving epochs taken from two subjects while also recording continuously recorded driving variables were analyzed with ICA. RESULTS: Preliminary findings reveal that four independent components correlate with various aspects of behavior. An increase in braking while driving was found to increase activation in motor areas, while cerebellar areas showed signal increases during steering maintenance, yet signal decreases during steering changes. Additional components and significant findings are further outlined. CONCLUSION: In summary, continuous behavioral variables conjoined with ICA may offer new insight into the neural correlates of complex human behavior.

Automobile Driving↗
PubMed1998

Can I drive after those drops, doctor?

PURPOSE: To document the experience of patients driving after drops to dilate the pupils. There are no documented guidelines on driving after pupillary dilatation. This is a study of patients who drove a car after attending the eye casualty for an ocular examination during which their pupils were dilated. METHODS: Thirty patients were identified who felt confident to drive after their pupils were dilated. Distant visual acuities, colour vision and confrontation visual fields were assessed before and after pupillary dilatation with 2.5% phenylephrine and 1% tropicamide. These patients met the legal requirements for driving after pupillary dilatation. The patients completed a questionnaire that recorded their subjective experiences of driving while their pupils were dilated. RESULTS: The mean age of the patients was 51.9 +/- 19.7 years (range 20-73 years). Twenty-seven of the 30 patients undertook the journey on familiar roads, and 14 of 30 wore spectacles. The mean spherical equivalent was +2.00 dioptre sphere for distance and a mean additional spherical equivalent of 1.75 dioptre sphere for near. Twenty patients experienced glare, which was severe enough to cause difficulty driving in three cases. Two of these patients drove in sunny weather conditions and one in light (not sunny) weather. Six patients had difficulty with road signs, two had difficulty judging distances and one reported difficulty with traffic lights. CONCLUSIONS: Dilating the pupils did not reduce distance visual acuity. However, it would seem appropriate to warn patients of the problems associated with glare and, if driving is their only option for transport home, recommend that they allow sufficient time to adapt to a dilated pupillary state, drive only on familiar roads and avoid driving in sunny weather.

Adult↗
PubMed2005

Role of premorbid factors in predicting safe return to driving after severe TBI.

PRIMARY OBJECTIVE: The present study explored the possibility of predicting post-injury fitness to safe driving in patients with severe traumatic brain injury (TBI) (n = 66). METHODS AND PROCEDURE: Sixteen different measures, derived from four domains (demo/biographic, medico-functional, neuropsychological, and psychosocial) were used as predictor variables, whereas driving outcomes were assessed in terms of driving status (post-TBI drivers versus non-drivers) and driving safety (number of post-TBI car accidents and violations). MAIN OUTCOMES AND RESULTS: About 50% of the patients resumed driving after TBI. Compared to post-TBI non-drivers, post-injury drivers had shorter coma duration. With regard to driving safety, the final multiple regression model combined four predictors (years post-injury, accidents and violations before TBI, pre-TBI-risky-personality-index, and pre-TBI-risky-driving-style-index) and explained 72.5% of variance in the outcome measure. CONCLUSIONS: Since the best three predictors of post-injury driving safety addressed patients' premorbid factors, the results suggest that in order to evaluate the actual possibility of safe driving after TBI, it would be advisable to consider carefully patients' pre-TBI histories.

Accidents, Traffic↗
PubMed2004

The effects of cognitive abilities on driving in people with Parkinson's disease.

OBJECTIVE: The aim was to develop a cognitive screening procedure, which could be used to identify cognitive problems in patients with Parkinson's disease, which might affect their safety to drive. DESIGN: Two group comparison of those found safe to drive and those found unsafe. SETTING: People living in the community who were attending an outpatient Movement Disorders clinic or who had been referred to a Regional Mobility Centre. PARTICIPANTS: Fifty-one people with Parkinson's disease who were driving or who wished to resume driving. The 41 men and 10 women were aged 44 - 85 years (mean 64.4 SD 9.1). MAIN MEASURES: Webster's Rating Scale, Unified Parkinson's Disease Rating Scale motor examination, Stroke Drivers Screening Assessment, Adult Memory and Information Processing Battery, Stroop, Paced Auditory Serial Addition Task and a Tapping task. RESULTS: The unsafe drivers were significantly more disabled, as assessed on Webster's Scale, than those who were found safe to drive. There were no significant differences in the cognitive abilities of safe and unsafe drivers. The most common faults, which caused drivers to be judged unsafe, were lack of observations to the side at junctions, poor positioning on the road and poor driving on roundabouts. There were significant correlations (p < 0.05) between driving ability and performance on the SDSA Dot Cancellation task and the AMIPB Story Recall and Information Processing A. CONCLUSIONS: Cognitive abilities were not found to be associated with fitness to drive in people with Parkinson's disease. Webster's Rating Scale differentiated between safe and unsafe drivers. This could be used to determine who to refer to a mobility centre for advice on fitness to drive.

Adult↗
PubMed2006

Neuropsychological function and driving ability in people with Parkinson's disease.

In this study the association between cognitive symptoms of PD and driving performance was investigated by examining the correlation between neuropsychological test performance and driving simulator behavior. Eighteen participants with PD and 18 healthy participants in a matched comparison group completed a range of neuropsychological measures. These data were correlated with driving simulator performance results from an earlier study. Significant correlations were found between several measures of neuropsychological test performance and driving behavior in participants with PD. In contrast, few significant correlations were obtained in the comparison group. Results suggest that executive difficulties in people with PD such as working memory, planning and set shifting are associated with reduced tactical level driving performance such as speed adaptation and complex curve navigation. Impaired information processing, visual attention and visual perception in people with PD appears associated with reduced operational level driving performance, such as reacting to road obstacles and maintaining constant lane position. Few correlations were found between measures of physical mobility and psychomotor speed with driving measures. Overall, this study highlights the important role of cognitive function in driving performance within the PD population. Comprehensive assessment of cognitive function should be included when assessing driving competency in people with PD.

Aged↗
PubMed1999

A survey of attitudes and knowledge of geriatricians to driving in elderly patients.

OBJECTIVE: To assess the attitudes of consultant members of the British Geriatrics Society to elderly patients driving motor vehicles. DESIGN: An anonymous postal survey assessing knowledge and attitudes to driving in elderly people. A standardized questionnaire was used and five case histories were offered for interpretation. SETTING: The study was co-ordinated from a teaching hospital. SUBJECTS: The 709 consultant members of the British Geriatrics Society. Four hundred and eighteen responses were obtained, which represents a 59% response rate. RESULTS: 275 Respondents (68%) correctly realised that a person aged 70 had a duty to inform the Driving and Vehicle Licensing Authority (DVLA) about their eligibility to drive. The remainder did not. Most (315; 75%) believed that the overall responsibility for informing the DVLA was with the patient. If a patient was incapable of understanding advice on driving because of advanced dementia, 346 (83%) would breach patient confidentiality and inform the authority directly. Where a patient was fully capable of understanding medical advice but ignored it, 72% of geriatricians would have legitimately breached patient confidentiality and informed the DVLA. Most geriatricians (88%) saw their main role as one of providing advice on driving to patients and their families. Enforcing DVLA regulations was not seen as an appropriate function, unless the patient was a danger to themselves or other drivers. CONCLUSIONS: There is a wide variation in knowledge of driving regulations and attitudes to driving in elderly patients. Better education of geriatricians should improve awareness of when elderly drivers can safely continue to drive.

Aged↗
PubMed1993

Medical conditions associated with driving cessation in community-dwelling, ambulatory elders.

The decision to stop driving leads to severe contraction of independence, and most localities do not curtail driving privileges in impaired elders. In a population of community-based, ambulatory individuals 70-96 years old, annual medical screening showed that 276 of 1,656 (16.7 +/- 1.8%) who reported driving regularly in the past do not currently drive. The cessation of driving behavior was examined in terms of specific medical conditions occurring within the past 5 years. Retired drivers were disproportionately female, and driving cessation risk rose with age. Age-sex-adjusted logistic regression found that six conditions explained about 50 percent of the decisions to stop driving: macular degeneration; retinal hemorrhage; any deficit in Activities of Daily Living; Parkinson's disease; stroke-related residual paralysis or weakness; and syncope. Strikingly, only 1.8 percent of those who stopped driving had ever had a license revoked; 58.7 percent reported voluntarily stopping; 31.9 percent gave health or medical reasons. Clearly, the decision to cede driving privileges is complex and not dependent solely on medical problems.

Aged↗
PubMed2005

The Maintenance of Wakefulness Test and driving simulator performance.

STUDY OBJECTIVES: It has been suggested that the Maintenance of Wakefulness Test (MWT) may be clinically useful to assess fitness to drive, yet little is known about the actual relationship between sleep latency and driving performance. This study examined the ability of 2 MWT trials to predict driving-simulator performance in healthy individuals. DESIGN: Experimental. SETTING: NA. PATIENTS OR PARTICIPANTS: Twenty healthy volunteers (mean age 22.8 years; 9 men). INTERVENTIONS: NA. MEASUREMENTS AND RESULTS: The MWT and driving-simulator performance were examined under 2 conditions-partial sleep deprivation and a combination of partial sleep deprivation and alcohol consumption. Each subject was studied a week apart, with the order randomly assigned. Subjects completed a nighttime 70-minute AusEd driving simulation task and two 40-minute MWT trials, 1 before (MWT1) and 1 after (MWT2) the driving task. In the sleep-deprived condition, the MWT1 sleep latency was inversely correlated with braking reaction time. During the partial sleep deprivation and alcohol condition, the number of microsleeps during the driving task, steering deviation, braking reaction time, and crashes all negatively correlated with the MWT1 sleep latency. Additionally, construction of a receiver-operator characteristic curve revealed that MWT1 sleep latency in the partial sleep deprivation plus alcohol condition significantly discriminated subjects who had a crash from those who did not. CONCLUSIONS: These results indicate that sleep latency on the MWT is a reasonable predictor of driving simulator performance in sleepy, alcohol-impaired, normal subjects. Further research is needed to examine the relationship between daytime MWT results and driving simulator performance in sleepy patients (eg, those with obstructive sleep apnea) and in experimentally sleep-deprived normal subjects.

Adolescent↗
PubMed1997

Evaluating the driving competence of dementia patients.

The driving behaviors of dementia patients have received little in the way of empirical scrutiny except through retrospective reports of crash rates. Understanding the driving errors of dementia patients and how they differ from those of normal older and younger drivers is important. This knowledge is basic to the development of road tests and scoring procedures to evaluate the driving competence of older, experienced drivers, especially those whose fitness to drive may have been compromised by a medical illness that alters their mental abilities. We have drive tested over 100 currently driving elderly patients with clinically significant cognitive decline (mostly diagnosed as the early stages of Alzheimer disease) and compared their performance with that of normal drivers. The study identified the types of driving errors that distinguish and differentiate the cognitively impaired group as well as a set of driving errors typical of both cognitively impaired and normal experienced drivers but differing in the number and severity of errors. A set of errors was also identified that did not differentiate the groups and should not be used in evaluating a person's competence to drive.

Adult↗
PubMed2003

Driving habits and health-related quality of life in patients with age-related maculopathy.

PURPOSE: To characterize the driving habits of persons with age-related maculopathy who present to a low-vision rehabilitation clinic and to examine how driving status relates to vision-specific health-related quality of life. METHODS: The Driving Habits Questionnaire, the National Eye Institute Vision Function Questionnaire-25, and the Life Space Questionnaire were administered via telephone interview to 126 patients with age-related maculopathy who presented to a low-vision clinic during the previous year and were either past or current drivers. RESULTS: Twenty-four percent of the sample reported being a current driver. Compared with those who stopped driving, current drivers were more likely to be male, younger, have better visual acuity and higher National Eye Institute Vision Function Questionnaire-25 scores. Drivers reported driving an average of 4 days and 10 miles per week. Over 50% of drivers reported that because of their vision, they had difficulty with or did not drive at all in rain, at night, on freeways or interstate highways, in heavy traffic areas, or during rush hour. Drivers and nondrivers did not differ in their life space, the spatial extent of their excursions into their environment. CONCLUSION: Some individuals who present to a low-vision clinic with age-related maculopathy do drive, although their driving exposure is low and they report avoiding challenging on-road situations. Driving status in age-related maculopathy appears to be related to better eye visual acuity and vision-specific health-related quality of life.

Activities of Daily Living↗