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Alcoholic beverage choice, risk perception and self-reported drunk driving: effects of measurement on risk analysis.

AIMS: The present study examined effects of measurement on risk curve analysis in an application involving prediction of frequency and indicator measures of drunk driving with beverage-specific alcohol consumption and risk perception measures. DESIGN AND PARTICIPANTS: From a 1995 in-person survey of the US adult household population (response rate = 77%) the responses of 1260 adult drivers who reported any drinking in the prior year were selected for analysis. Regression and graphical techniques were used to investigate relationships between drinking pattern, beverage choice, perception of risks of drinking before driving, and frequency of drunk driving. MEASUREMENTS: Self-reported drunk driving (occurrence) was measured by a question assessing driving after drinking enough to be in trouble if stopped by the police within the prior 12 months; those affirming this (n = 191) were asked how many times they did so (frequency). Alcohol consumption was assessed by beverage and in combination. Risk perception was assessed as a factor score from three correlated measures. Demographic variables included age, ethnicity, education and income. FINDINGS: Controlling for demographics, heavy beer consumption (p < 0.01) more than heavy wine (NS) or liquor/spirits (p < 0.05) intake was strongly predictive of risk perception. A regression analysis showed a significant interaction between heavy beer consumption and perceived risk (p < 0.001) in predicting reported frequency of drunk driving, after controlling for heavy beer consumption (p < 0.05), total alcohol consumption and risk perception (both ps < 0.001). No interactions were important in equivalent models predicting dichotomous occurrence. Graphic analysis showed the shape of the risk curve is altered when frequency of drunk driving is taken into account rather than simple occurrence. CONCLUSIONS: Individuals' underestimation of beer's intoxicating effects, compared to other alcoholic beverage types, helps explain beer's over-representation in drinking driving violation reports. There is a need for creative public health campaigns designed to inform young men of beer's alcohol content and associated risks.

Adult↗

Driving cessation: what older former drivers tell us.

OBJECTIVES: To understand why older drivers living in a community setting stop driving. DESIGN: A cross-sectional study within a longitudinal cohort. SETTING: A geographically defined community in southern California. PARTICIPANTS: 1,950 respondents age 55 and older who reported ever being licensed drivers. MEASUREMENTS: A mailed survey instrument of self-reported driving habits linked to prior demographic, health, and medical information. RESULTS: Of the 1,950 eligible respondents, 141 had stopped driving within the previous 5 years. Among those who stopped, mean age was 85.5 years, 65.2% were female, and the majority reported they were in very good (43.4%) or good (34.0%) health. Nearly two-thirds reported driving less than 50 miles per week prior to stopping and 12.1% reported a motor vehicle crash during the previous 5 years. The most common reasons reported for stopping were medical (41.0%) and age-related (19.4%). In bivariate analyses, age and miles driven per week were each associated with cessation (P < or = .001). Medical conditions, crashes in the previous 5 years, and gender did not reach statistical significance at the P < or = .05 level. Logistic regression results found that the number of medical conditions was inversely associated with driving cessation. CONCLUSION: The relationship between medical conditions and driving is complex; while medical conditions were the most common reason given for driving cessation, those who stopped had fewer medical conditions than current drivers. This suggests that a broader measure of general health or functional ability may play a dominant role in decisions to stop driving.

Accidents, Traffic↗

Vision and driving self-restriction in older adults.

OBJECTIVES: To assess driving self-restriction (vision related and nonvision related) in relation to vision test performance of older adults. DESIGN: Cross-sectional study. SETTING: Population-based cohort of community-dwelling older adults. PARTICIPANTS: Six hundred twenty-nine current drivers aged 55 and older had driving behavior, health, and physical function assessed and vision function tested in 1993-95. MEASUREMENTS: Self-report of driving restriction as vision or non-vision related and performance on a comprehensive battery of vision tests (visual acuity; contrast sensitivity; effects of illumination level, contrast, and glare on acuity; visual fields with and without attentional load; color vision; temporal sensitivity; and the effect of dim light on walking ability). RESULTS: Demographic, health, and functional characteristics differed significantly between restrictors and nonrestrictors but not between vision- and nonvision-related restrictors. Controlling for potential confounding, only vision-related driving self-restriction was significantly associated with reduced performance on nonstandard measures of acuity. Poor depth perception was significantly associated with restriction for both vision- and nonvision-related reasons. Poor performance on attentional visual field tests, analyzed individually and in combination with standard field tests, was not associated with driving self-restriction. CONCLUSION: Older adults with early changes in spatial vision function and depth perception appear to recognize their limitations and restrict their driving even if they do not acknowledge the visual impairment as the cause for restriction. Poor visual attention, a risk factor for crashes, may not be recognized. Additional studies of driving self-restriction in relation to risk factors for crashes in older adults may help refine this strategy of reducing driving-related injury and death.

Aged↗

Learner drivers with spina bifida and hydrocephalus: the relationship between perceptual-cognitive deficit and driving performance.

This study investigated the relationship between perceptual-cognitive skills and driving performance in a group of eleven learner drivers disabled by spina bifida and hydrocephalus. Perceptual-cognitive skills assessed include figure-ground discrimination, visual scanning/tracking, spatial orientation, language, reasoning and memory ability. Following ten hours driving tuition in suitably adapted cars, driving performance in off-road manoeuvres and in-traffic situations was measured. Results showed that the perceptual-cognitive skills of this group were in the low average or below average range compared to a non-handicapped population. Spearman Rank Order Correlations between clinical tests and driving performance indicated that although certain tests correlated with off-road manoeuvres, no perceptual measures were reliable indicators of in-traffic driving. There were indications that practical measures of spatial orientation and reasoning ability may be more relevant to some aspects of driving than tested perceptual skills. Memory for road signs, landmarks and routes was also investigated. Accurate retention seemed more dependent on general reasoning ability than tested aspects of memory functioning. It is suggested that as clinically tested perceptual skills do not seem to be reliable indicators of driving performance, an individual's test results should not be used to deter him from learning to drive.

Adolescent↗

The interactionist nature of drinking and driving: a structural model.

A structural model is described that examines the contributions of personal and situational determinants (interactionist theory) for the elicitation of previous self-reported drink-driving offending. Responses of 1011 UK driver's licence holders to 57 questions concerning demographics, driving experience/exposure, deterrence issues, attitudinal factors and situation specific drink-driving behaviour were subjected to a series of multiple regression analyses. Seven variables (five personal and two situational) accounting for 46% of the sample variance were shown to be significantly predictive of undetected offending behaviour. Of these age and safe driving consumption estimates were found to be best described in terms of their direct effects on offending behaviour. The relationships between general alcohol consumption and exposure to secondary level enforcement (breath test) with drink-driving behaviour have both direct and indirect effects. Two attitudinal factors referring to a belief of deterrence if random breath testing were introduced into the UK, and arranging alternative transport on a drinking occasion, as well as exposure to a drink-driving charge, show approximately proportional direct and spurious links with offending. Findings are discussed i n terms of the utility of an interactionist approach for the study of drink-driving behaviour, previous attempts at modelling drink-driving behaviour, and the implications that such results have for counter-measure development.

Adolescent↗

Evaluation of the driving ability in disabled persons: a practitioners' view.

PURPOSE AND METHODS: The purpose of this paper is to present, on the basis of four genuine cases from the Rehabilitation Research Unit of Oulu University, the theoretical frame in which evaluations of driving ability of disabled persons can be made. RESULTS: First, it is not the operations with the control devices but the correct mental actions which the driver carries out with the help of the control devices which are crucial for safe driving. Second, driving ability is only partly a biomedical object of research and one ought to avoid an excessive medicalisation of an evaluation of driving ability. Third, the driver meets traffic situations not by his or her separate biological or psychological functions, such as vision, attention, memory, thinking, motives, but as an integrated whole, as a personality. CONCLUSIONS: By its complexity an evaluation of driving ability can be compared to an evaluation of working capacity where often a multidisciplinary team is needed. When evaluating driving ability we have to take a step from low-level motor operations towards high-level mental actions, from the measurement of acuity of eyesight towards the testing of the flexibility of perception, from the diagnosis-based evaluation to the patient-based evaluation, from using the common pencil-paper tests towards the traffic-related task-specific tests and from the testing of separate single general non-driving-related factors towards an evaluation of the theoretically based driving performance as whole.

Adult↗

Drink-driving and perceptions of legally permissible alcohol use.

OBJECTIVE: The leading cause of death for young people in developed countries is road traffic crashes, a large proportion of which are attributable to drink-driving. The aims of the study were to estimate the prevalence of drink-driving and drink-riding in a sample of New Zealand university students, and to identify potential risk factors, in particular, students' perceptions of legally permissible consumption before driving. METHODS: Participants were 1,564 survey respondents (82% response, mean age = 20.5 years) who were asked to indicate whether they had driven after having "perhaps too much to drink to be able to drive safely," if they had been a passenger in a vehicle "where the driver had perhaps too much to drink to be able to drive safely," and how many standard drinks they could consume in one hour and legally drive a car. An estimated blood alcohol concentration was computed and compared with legal limits. RESULTS: Drink-driving (past four weeks) was reported by 3.4% of women and 8.4% of men. Drink-riding (past four weeks) was reported by 7.0% of women and 11.5% of men. Estimated blood alcohol concentrations from students' reports of how much they could drink in one hour and be below the legal limit of 0.08 g/ml, showed that most respondents dramatically underestimated permissible consumption; only 5.8% overestimated it. CONCLUSIONS: This may be a case where misperception of a public health message serves the public good. Further reductions in drink-driving/riding will require attention to transport needs, more visible enforcement of existing legislation, and modification of youth drinking behavior.

Accidents, Traffic↗

The impact of chronic pain patients' psychotropic drug knowledge and warning labels on the decision whether to drive a car or not.

OBJECTIVE: The attitudes of patients towards driving a car while taking medication with psychotropic side effects is unclear. A growing number of patients use these psychotropic medicines on a daily basis, and this may interfere with their ability to drive a car. METHODS: By means of a survey, we examined attitudes towards driving while using psychotropic medicinal drugs and the effect of warning labels on the decision whether to drive a car or not in patients with chronic pain. RESULTS: Fifty-eight of 100 patients possessing a driver's license used psychotropic medication. Despite warning labels affixed on the packages that these drugs might impair driving ability, the majority (71%) of these patients continued driving a car. A point of concern is that 40% of these patients reported not to be more cautious in traffic after taking psychotropic drugs. CONCLUSION: The results of this survey indicate that drug warning labels applied by Dutch pharmacies do not significantly change attitudes towards driving a car in patients taking medicinal drugs with psychotropic side effects. Future road-safety campaigns should pay more attention to the impairing effects of psychotropic drugs on driving.

Accidents, Traffic↗

Alcohol-related problems and fitness to drive.

This paper analyses the alcohol consumption patterns in Spanish drivers, the incidence of alcohol-related problems and attempts to ascertain whether, in the end, drivers with alcohol-related problems are considered fit or unfit to drive. In accordance with Spanish and European Union legislation, driving licences cannot be issued or renewed to people suffering from alcohol-related problems. A medical, psychological and eyesight evaluation was performed to test the driving fitness of 8043 drivers attending 25 Medical Driving Test Centres on a national scale. Among other things, information was collected on the patterns of alcohol consumption, the AUDIT and CAGE tests, the incidence of alcohol-related problems (DSM-IV criteria for abuse, dependence and alcohol-induced disorder), as well as an evaluation of their fitness to drive. In all, 60.3% of drivers drink alcohol on a regular basis; 7.3% of drivers scored > or = 8 points in the AUDIT test, and 2% met criteria for DSM-IV alcohol abuse, dependence or induced disorder. Drivers with alcohol-related problems have been involved in traffic accidents (23.2%) and have infringed driving regulations (18.7%) more frequently (P < 0.0001) than those without alcohol-related problems. Of those with alcohol-related problems, 72.2% were considered fit to drive. The study reveals that alcohol consumption is common among drivers, that a significant number of drivers have alcohol-related problems, and that three in four of the latter were considered fit to drive.

Adult↗

Visual attention and driving behaviors among community-living older persons.

BACKGROUND: Older drivers have higher rates of crashes per mile driven compared with most other drivers, and these crashes result in greater morbidity and mortality. Various aspects of cognition, particularly visual attention, have been linked with crash risk among older individuals. The current study was designed to specify those cognitive variables associated with specific on-road driving behaviors in a sample of older, nonclinic-referred individuals. METHODS: 35 community-residing active drivers aged 72 years and older (M = 80) underwent a standardized, on-road driving evaluation involving parking lot maneuvers, and urban, suburban, and highway driving. They were also administered tests of visual attention, executive function, visuospatial cognition, and memory. RESULTS: Driving score was significantly correlated with visual attention, visual memory, and executive function. Visual attention was associated with 25 of 36 driving behaviors, including those involving scanning the environment, interaction with traffic or pedestrians, and distance judgments. Executive function and visual memory were associated with fewer maneuvers, most of which were a subset of maneuvers that correlated with visual attention. CONCLUSIONS: Visual attention, a cognitive function involving search, selection, and switching, plays an important role in driving risk among older drivers. In the current study, key driving maneuvers involving interaction with other vehicles/pedestrians, such as yielding right of way and negotiating safe turns or merges, have the greatest association with visual attention. Specification of both the cognitive risk factors and their impact on problematic driving maneuvers may provide guidelines for developing targeted interventions to reduce risk among older adults.

Accidents, Traffic↗

Consequences of driving cessation: decreased out-of-home activity levels.

OBJECTIVES: Increasing age, socioeconomic factors, and declining function and health have been linked to driving cessation, but little is known about the consequences of stopping driving. This study was designed to test the hypothesis that driving cessation leads to a decline in out-of-home activity levels. METHODS: In 1989 a survey of driving practices was administered to surviving noninstitutionalized members of the New Haven Established Populations for Epidemiologic Studies of the Elderly (EPESE) cohort. Of 1,316 respondents, 502 were active drivers as of 1988, 92 had stopped driving between 1982 and 1987, and 722 never drove or stopped before 1982. Information on sociodemographic and health-related variables came from in-home EPESE interviews in 1982, 1985, and 1988, and from yearly phone interviews. Activity was measured at all three in-home interviews, and an activity measure was created based on self-reported participation in nine out-of-home activities. A repeated measures random-effects model was used to test the effect of driving cessation on activity while controlling for potential confounders. RESULTS: Driving cessation was strongly associated with decreased out-of-home activity levels (coefficient-1.081, standard error 0.264, p < .001) after adjustment for sociodemographic and health-related factors. DISCUSSION: The potential consequences of driving limitations or cessation should be taken into account when advising older drivers and developing alternative transportation strategies to help maintain their mobility.

Activities of Daily Living↗

What is the driving performance of ambulatory surgical patients after general anesthesia?

BACKGROUND: Ambulatory surgical patients are advised to refrain from driving for 24 h postoperatively. However, currently there is no strong evidence to show that driving skills and alertness have resumed in patients by 24 h after general anesthesia. The purpose of this study was to determine whether impaired driver alertness had been restored to normal by 2 and 24 h after general anesthesia in patients who underwent ambulatory surgery. METHODS: Twenty patients who underwent left knee arthroscopic surgery were studied. Their driving simulation performance, electroencephalographically verified parameters of sleepiness, subjective assessment of sleepiness, fatigue, alertness, and pain were measured preoperatively and 2 and 24 h postoperatively. The same measurements were performed in a matched control group of 20 healthy individuals. RESULTS: Preoperatively, patients had significantly higher attention lapses and lower alertness levels versus normal controls. Significantly impaired driving skills and alertness, including longer reaction time, higher occurrence of attention lapses, and microsleep intrusions, were found 2 h postoperatively versus preoperatively. No significantly differences were found in any driving performance parameters or electroencephalographically verified parameters 24 h postoperatively versus preoperatively. CONCLUSIONS: Patients showed lower alertness levels and impaired driving skills preoperatively and 2 h postoperatively. Based on driving simulation performance and subjective assessments, patients are safe to drive 24 h after general anesthesia.

Adjuvants, Anesthesia↗

The neural correlates of driving.

We studied 12 healthy subjects with fMRI while they performed a driving simulation task. In the active condition they steered the car themselves (driving), in the passive condition a person from outside the scanner was steering the car (passive driving). Common activations in both conditions were found in occipital and parietal regions bilaterally. Activity specifically associated with driving was found only in the sensorimotor cortex and the cerebellum. Compared to passive driving, activity during driving was reduced in numerous brain regions including MT/MST. It is concluded that simulated driving requires mainly perceptual-motor integration and that the limited cognitive capacity model of driving has to be revised.

Adult↗

Driving evaluation after traumatic brain injury.

Traumatic closed head injury results in a variety of cognitive and behavioral deficits that may be difficult to assess fully. Adequately evaluating driving safety is a common and important problem for health care professionals. The purpose of this study was to examine the relationship between standardized measures of cognitive function and measures of driving performance in patients with closed head injuries and in their age-matched relative or friend cohorts. Thirteen patients were evaluated. They had each sustained a closed head injury (followed by more than 1 h of coma) 3 to 6 months before testing. Their scores were analyzed along with those of seven cohorts. Assessments of cognitive function and behind-the-wheel driving performance were conducted by examiners blinded to subjects' group membership and medical condition. There was a significant relationship (r = 0.44) between the sum of rated scores of the Tactual Performance Test and Trail Making Test and the global pass/fail ratings of the behind-the-wheel driving test, but it was not related to the driving performance score. The difference between the verbal and performance IQs, and the difference between the block design and other performance tests of the Wechsler Adult Intelligence Scale-Revised were also not significantly related to driving performance. These results suggest that tests of cognitive function alone are not adequate to predict driving performance, and should be used along with standardized driving performance evaluations before recommendations are made.

Adolescent↗

Driving performance of glaucoma patients correlates with peripheral visual field loss.

PURPOSE: To identify clinical vision measures that are associated with the driving performance of glaucoma patients who have visual field loss and visual acuity better than 20/100 and to compare the driving performance of glaucoma patients with the driving performance of a group of age- and sex-equivalent individuals without eye disease. PATIENTS: Forty patients with glaucoma and 17 normally sighted control subjects participated in this study. METHODS: Clinical vision data, consisting of visual acuity, letter contrast sensitivity, and visual fields, were collected. Driving performance was assessed by (1) an interactive driving simulator that measured 7 indices of performance (including number of accidents) and (2) the self-reported accident involvement for the past 5 years. MAIN OUTCOME MEASURES: Driving simulator performance and real-world, self-reported accident involvement. RESULTS: The number of accidents as measured on the driving simulator in the glaucoma group was significantly correlated with three Goldmann visual field measures: combined horizontal extent (rho = -0.47, P = 0.01), total horizontal extent (rho = -0.49, P = 0.007), and total peripheral extent (rho = -0.55, P = 0.002). There were no statistically significant correlations between the driving performance of the glaucoma group and the visual acuity or contrast sensitivity measures. When compared with the control group, a significantly greater proportion of the glaucoma group reported having at least one real-world accident within the past 5 years (Fisher exact test, P = 0.005). CONCLUSIONS: Visual field reduced to less than 100 degrees of horizontal extent may place patients with peripheral field loss at greater accident risk. A higher incidence of real-world and simulator accidents was found for the group with glaucoma.

Adult↗

Predicting components of closed road driving performance from vision tests.

PURPOSE: Mild cataracts can interfere with visually dependent everyday activities, although they only minimally affect static visual acuity. This study compared the effects of simulated cataracts with that of optical blur on driving performance and determined the extent to which acuity could account for variations in driving performance either alone or in combination with supplementary vision tests. METHODS: Closed road driving performance was measured in 24 young, normally sighted subjects under five binocular acuity levels, four produced by different levels of optical blur (6/4.5, 6/12, 6/30, 6/60) and one by frosted lenses simulating mild cataracts (6/12c). Driving measures included gap perception, total driving time, sign recognition, road hazard avoidance, maneuvering time, and errors. Subjects were also tested with the Pelli-Robson chart, SKILL card, and Berkeley Glare Test under comparable acuity levels. RESULTS: Total driving time, sign recognition, and hazard avoidance were linearly related to the acuity degradation produced by blur; performance in the 6/12c condition was similar to that in the 6/60 blur condition. Static acuity predicted 30% to 60% of the variance in these driving measures when the 6/12c condition was excluded from analysis; this proportion was reduced by a factor of two to three when the 6/12c condition was included. However, using any one of the three supplementary tests with visual acuity in a multiple regression analysis recaptured much of the lost variance. CONCLUSIONS: Static acuity can only predict variations in closed road driving performance measured under degraded conditions that include simulated mild cataracts when it is combined with supplementary vision tests.

Adult↗

On-road driving with moderate visual field loss.

PURPOSE: We examined the relationship between visual field extent and driving performance in an open, on-road environment using a detailed scoring method that assessed the quality of specific skills for a range of maneuvers. The purpose was to determine which maneuvers and skills should be included in future, larger scale investigations of the effect of peripheral field loss on driving performance. METHODS: Twenty-eight current drivers (67 +/- 14 years) with restricted peripheral visual fields participated. Binocular visual field extent was quantified using Goldmann perimetry (V4e target). The useful field of view (UFOV) and Pelli-Robson letter contrast sensitivity tests were administered. Driving performance was assessed along a 14-mile route on roads in the city of Birmingham, Alabama. The course included a representative variety of general driving maneuvers, as well as maneuvers expected to be difficult for people with restricted fields. RESULTS: Drivers with more restricted horizontal and vertical binocular field extents showed significantly (p < or = 0.05) poorer skills in speed matching when changing lanes, in maintaining lane position and keeping to the path of the curve when driving around curves, and received significantly (p < or = 0.05) poorer ratings for anticipatory skills. Deficits in UFOV performance and poorer contrast sensitivity scores were significantly (p < or = 0.05) correlated with overall driving performance as well as specific maneuver/skill combinations. CONCLUSIONS: In a small sample of drivers, mild to moderate peripheral visual field restrictions were adversely associated with specific driving skills involved in maneuvers for which a wide field of vision is likely to be important (however most were regarded as safe drivers). Further studies using similar assessment methods with drivers with more restricted fields are necessary to determine the minimum field extent for safe driving.

Aged↗

Stimulant effects of 3,4-methylenedioxymethamphetamine (MDMA) 75 mg and methylphenidate 20 mg on actual driving during intoxication and withdrawal.

BACKGROUND: 3,4-methylenedioxymethamphetamine (MDMA) is currently one of the most popular drugs of abuse in Europe. Its increasing use over the last decade has led to concern regarding possible adverse effects on driving. The aims of the present study were to investigate the acute effects of MDMA on actual driving performance during the intoxication and withdrawal phase. METHODS: Eighteen recreational MDMA-users (nine males, nine females) aged 21-39 years participated in a double-blind, placebo-controlled, three-way cross-over study. MDMA 75 mg, methylphenidate 20 mg and placebo were administered on day 1 of treatment (intoxication phase). Driving tests were conducted between 3 and 5 hours post-drug. Subjects returned the following day for a repetition of the driving tests between 27 and 29 hours post-drug (withdrawal phase). On-the-road driving tests consisted of a road-tracking test and a car-following test. Its main parameters were standard deviation of lateral position (SDLP), time to speed adaptation (TSA), brake reaction time (BRT) and gain. FINDINGS: MDMA and methylphenidate significantly decreased SDLP in the road-tracking tests by about 2 cm relative to placebo on day 1 (intoxication phase). In addition, MDMA intoxication decreased performance in the car-following test as indicated by a significant rise in the 'overshoot' of the subjects' response to speed decelerations of the leading vehicle. Driving performance was not affected by treatments during withdrawal on day 2. CONCLUSION: Collectively, these data indicate that MDMA is a stimulant drug that may improve certain aspects of the driving task, such as road-tracking performance, but may reduce performance in other aspects of the driving task, such as accuracy of speed adaptation during car-following performance.

Adult↗