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PubMed2004

Aggressive driving: an observational study of driver, vehicle, and situational variables.

Over 2000 aggressive driving behaviors were observed over a total of 72 h at six different sites. The behaviors selected for observation were those that are commonly included in "aggressive driving" lists, and they consisted of honking, cutting across one or more lanes in front of other vehicles, and passing on the shoulders. In addition, an exposure sample of 7200 drivers were also observed at the same times and places. Relative risks (RRs) and odds ratios (ODs) were calculated to show the relative likelihood that different drivers under different conditions will commit aggressive behaviors. The rate of aggressive actions observed in this study decreased from the most frequent behavior of cutting across a single lane, through honking, and to the least frequent behaviors of cutting across multiple lanes and passing on the shoulders. Relative to their proportion in the driving population, men were more likely than women to commit aggressive actions, and the differences increased as the severity of the action increased. Drivers who were 45 years old or older were less likely to drive aggressively than younger ones. The presence of passengers was associated with a slight but consistent reduction in aggressive driving of all types; especially honking at other drivers. There was a strong linear association between congestion and the frequency of aggressive behaviors, but it was due to the number of drivers on the road. However, when the value of time was high (as in rush hours), the likelihood of aggressive driving--after adjusting for the number of drivers on the road--was higher than when the value of time was low (during the non-rush weekday or weekend hours). The results have implications for driver behavior modifications and for environmental design.

Adult↗
PubMed1997

Sensation seeking and risky driving: a review and synthesis of the literature.

The relationship between sensation seeking and risky behaviour has been observed since the 1970s. During the late 1980s and early 1990s, road safety researchers have examined the relationship between sensation seeking and risky driving (e.g. driving while impaired, speeding, following too closely), as well as its consequences (e.g. collisions, violations). There is also growing evidence that sensation seeking may also moderate the manner in which drivers respond to other factors such as alcohol impairment and perceived risk. This paper reviews and synthesizes the literature on sensation seeking as a direct influencer of risky driving and its consequences and as a moderator of the influence of other factors. The vast majority of the 40 studies reviewed showed positive relationships between sensation seeking (SS) and risky driving, with correlations in the 0.30-0.40 range, depending on gender and the measure of risky driving and SS employed. Of those studies that have looked at the subscales of Zuckerman's Sensation Seeking Scale, Thrill and Adventure Seeking appears to have the strongest relationship to risky driving. The biological bases of SS is discussed as are the implications for collision prevention measures.

Accidents, Traffic↗
PubMed2000

Performance of persons with juvenile-onset amputation in driving motor vehicles.

OBJECTIVE: To study the driving of motor vehicles by persons with juvenile-onset amputation and to compare the percentage of drivers among them with that found in the general population. DESIGN: A follow-up study of subjects who were younger than 18 years of age at amputation and who underwent one-sided amputation, covering the period 1976 to 1996. SETTING: The Prosthesis Service of the Asturias Central Hospital, Spain. SUBJECTS: A total of 236 juvenile amputee patients. RESULTS: The percentage of women with amputations who drive is lower than that of their male counterparts (p<.05). The percentage of drivers with upper limb amputations is greater than that of drivers with amputation of the lower limb (p<.05). Motor vehicle adaptations were used more frequently by people with upper limb amputations (p<.05). The ability to drive was not affected by the etiology or the side of amputation, or by the use of a prosthesis. The level of amputation affected driving ability in cases of amputation of the lower limb, but not in those of amputation of the upper limb. CONCLUSION: The percentage of persons with juvenile-onset amputation who drive (47.4%) is similar to that found in the general population (40.8%), and the use of a prosthesis does not have any influence on the capacity to drive a car--89.2% of drivers and 93.5% of nondrivers used a prosthesis.

Adult↗
PubMed2000

Driving skills in elderly persons with stroke: comparison of two new assessment options.

OBJECTIVE: To compare the effectiveness of two methods of assessing off-road driving skills that claim to predict on-road driving fitness of persons with stroke. METHOD: Fifty-six persons with stroke (age 44 to 82 yrs; mean, 60.2 yrs) completed the 2 off-road driving assessments along with standard clinical and on-road driving tests. MAIN OUTCOME MEASURES: Linear stepwise regression on 4 variables of the Dynavision Performance Assessment Battery (DPAB), the Cognitive Behavioral Driver's Inventory (CBDI) variable (composite score), and the variables of age, gender, and lesion side. RESULTS: A 4-minute endurance subtest from the DPAB was superior to the CBDI in predicting success/failure in the on-road driving test (75%). However, success on both the 4-minute endurance subtest from the DPAB and the CBDI tests significantly improved the prediction of on-road success. If participants passed the CBDI and the endurance test from the DPAB, they also passed the on-road assessment. CONCLUSION: Driving fitness of elderly persons with stroke can be assessed with reasonable accuracy using off-road tests, minimizing the expense and risk associated with on-road assessments in this population.

Adult↗
PubMed1998

Predicting ability to drive after stroke.

OBJECTIVE: To determine the ability of perceptual testing to predict on-road driving outcome in subjects with stroke. STUDY DESIGN: Historical cohort study of 84 individuals with stroke who completed both the perceptual testing and the on-road driving evaluation conducted in a driving evaluation service. MEASURES: Perceptual tests, such as the Motor Free Visual Perception Test (MVPT) and Trail Making B test, and an on-road driving evaluation. Based on driving behaviors, a pass or fail outcome was determined by the examiners. RESULTS: Subjects who passed the on-road evaluation had better average scores on the majority of perceptual tests compared with those who failed. The MVPT was the most predictive of on-road performance (positive predictive value=86.1%; negative predictive value=58.3%). The combination of tests resulting in the most predictive and parsimonious model was the MVPT plus Trail Making B, such that those who scored poorly on both were 22 times more likely to fail the on-road evaluation. CONCLUSION: A screening process is useful in identifying persons who are not ready to undergo an on-road driving evaluation.

Adult↗
PubMed2000

Vision standards for driving in Canada and the United States. A review for the Canadian Ophthalmological Society.

We review the vision requirements for driving with the goal of revising current Canadian Ophthalmological Society (COS) recommendations for vision standards for driving. The report comprises two sections. In the first section we report the results of a survey of transportation authorities in Canada and the United States conducted on behalf of the COS to determine the current standards and medical review procedures. The results suggest that although the standards in Canada are more consistent than those in the United States, few of the standards in either country are evidence-based. In the second section we review the recent literature on visual function and driving. We conclude from this review that adequate contrast sensitivity is as important as, if not more important than, good visual acuity for driving and that there is little evidence to support a monocular standard for acuity, contrast sensitivity or visual field. Although there is evidence that the extent of a visual field defect is related to the ability to perform driving tasks, there is little evidence to suggest a relation between the location of the visual field defect and fitness to drive.

Automobile Driving↗
PubMed2002

Doctor, can I drive with this plaster? An evidence based response.

The purpose of this study is to assess the effect of the commonly used below elbow plaster casts on driving ability. The position of the Driver and Vehicle Licensing Agency and five motor insurance companies is established. The study aims to help doctors decide whether or not a patient is fit to drive with a plaster cast. Three types of cast were tested using one driver. A score was given for several driving abilities. The right Colles cast was found to have no effect on ability to drive. Scaphoid and Bennett's casts were found to have significant affects on driving ability. The DVLA has no specific guidelines regarding driving with a plaster cast and the position of insurance companies is variable, but will usually depend upon medical advice.

Automobile Driving↗
PubMed2003

A neglected risky behavior among children and adolescents: underage driving and injury in New South Wales, Australia.

PROBLEM: Among different causes of injury, roads and traffic-related incidents contributed most to all child deaths. The majority of childhood and adolescent traffic-related deaths are young people killed as pedestrians or bicyclists. Underage driving is a particular risky behavior much neglected. This study aimed to describe some characteristics related to motor-vehicle crashes and crash-related injury in which the vehicle was driven by a young person who was under the legal age of obtaining a learner license in New South Wales, Australia. METHODS: Data used in this study were made available from the Roads and Traffic Authority of NSW for the period between 1996 and 2000. Crash information was collected and reported by NSW police at the scene of these motor-vehicle crash incidents. RESULTS: There were 526 crashes involving an underage driver recorded within the study period. The majority (79.5%) of these underage drivers were males with slightly more than half (58.0%) aged 15 years, and nearly 30% aged 14 years. Among these, 83.6% involved the driver of the vehicle being killed or injured. Among the injured or killed passengers, 128 (73.6%) were nonadult passengers under the age of 18 years. Seventy of these crashes occurred while the car was in pursuit by police. The adjusted relative risk of injury to at least one occupant in the vehicle should a crash occur for female underage drivers was two times (OR=2.01, 95% CI=1.27-3.20) as compared to male underage drivers. DISCUSSION: Underage driving poses a serious problem in terms of crash outcomes. Experimental driving and late-night outings for adolescents should be discouraged. Well-designed studies are required to further investigate the relationship between underage driving and on road risk-taking behavior among licensed adolescents. IMPACT ON INDUSTRY: Data obtained from this study indicate that adults, particularly parents, should discourage underage adolescents from experimenting driving and should actively cultivate a positive attitude toward driving.

Accidents, Traffic↗
PubMed2002

Stability and skill in driving.

Two experiments addressed the relation between postural stability, perceptual sensitivity, and stability of driving performance. A vehicle was fitted with differential GPS for measuring position and speed, position sensors for measuring brake and accelerator depression, force transducers for measuring door, console and footrest bracing forces, and an accelerometer for measuring the 3D accelerations of the vehicle. In Experiment 1, we investigated whether the initiation of deceleration and the control of braking might be due to sensitivity to the perceptual variable tau, which specifies time-to-contact (TTC), and in particular, whether its first derivative, tau-dot, is used to maintain a constant deceleration profile. Using both untrained experienced drivers (EDs) and trained driving instructors from the Holden Performance Driving Centre (HPDC), results confirmed that, regardless of skill level, tau-dot was maintained at a value close to 0.5 and, as predicted by Lee [Perception 5 (1976) 437], braking was initiated when TTC approximately 5 s. In Experiment 2, we wished to quantify the purported differences in driving behaviour between EDs and HPDC instructors during a variety of everyday manoeuvres. Results indicated that instructors utilised a different cornering trajectory, a different emergency braking strategy, and were able to perform a high-speed swerve and recovery task more effectively than the EDs. In general, the instructors applied greater bracing forces using the door and console compared with EDs. The instructors also applied greater footrest forces during emergency braking than did the EDs. The greater use of bracing by instructor drivers to resist g-forces represents a strategy of active stabilisation that enhances both postural stability, as well as overall stability and consistency of driving performance. Results are discussed with regard to the dynamics of perceptual-motor coordination, and how increased stability might improve sensitivity to relevant perceptual information. We conclude that driver-training programmes that focus on increasing driver stability (as a pre-requisite for increased control) show great promise as a means to improving one's attention during driving, and hence have the potential to dramatically improve road safety in general.

Adult↗
PubMed2000

The long-term effects of rally driving on spinal pathology.

OBJECTIVES: To investigate the consequences of rally driving on lumbar degenerative changes. BACKGROUND: Vehicular driving is suspected to accelerate disc degeneration through whole-body vibration, leading to back problems. However, in an earlier well-controlled study of lumbar MRI findings in monozygotic twins, significant effects of lifetime driving on disc degeneration were not demonstrated. Another study of machine operators found only long-term exposure to vibration on unsprung seats led to a reduction in disc height. DESIGN: Case-control study comparing rally drivers with population sample. METHODS: Eighteen top rally drivers and co-drivers, mean age 43 yrs (SD, 10), volunteered for the study. The subjects were interviewed and imaged with a MR scanning and lumbar images were analyzed for degenerative findings using a standard scoring protocol previously published. The reference group was composed of 14 men, mean age 55 yrs (SD, 10), selected from a population sample. RESULTS: Overall results showed no significant differences in lumbar degenerative findings as assessed from MR images between the rally drivers and the reference group; age-adjusted differences were not statistically significant for disc heights, bulges, herniations, end-plate irregularities, or osteophytes. CONCLUSION: Even extreme vehicular vibration as experienced in rally driving does not appear to have significant effects on disc generation. RELEVANCE: The study results do not support driving, and its associated whole body vibration, as a significant cause of disc degeneration and question the theory that the higher incidence of back pain among drivers is due to accelerated disc degeneration. Other driving-related factors, such as postural stress, may deserve more attention.

Adult↗
PubMedDate not supplied

Drinking location and risk of alcohol-impaired driving among high school seniors.

This study investigated environmental predictors of teenagers' alcohol-impaired driving, such as drinking location and alcohol source. Data for this study were part of the 15 Communities Mobilizing for Change on Alcohol Project. Relationships between drinking-driver status, alcohol source, drinking location, alcohol consumption, and individual demographics were determined for the full sample as well as for males and females separately, using mixed-model, logistic regression. Analyses were restricted to high school seniors who were drivers and who consumed alcohol within the last 30 days (N = 1,914). For males and females, the risk of alcohol-impaired driving rose significantly with increases in both the number of binge-drinking events and estimates of the number of drinks required to impair their driving. Drinking location was important in that students who drank outdoors or in a moving car or truck were at significant risk for drinking-driving. Drinking-driving risks specific to females were number of drinking occasions and drinking at someone else's house. Strategies to prevent drinking-driving among teenagers need to consider drinking patterns as well as drinking locations for both males and females.

Adolescent↗
PubMed1998

Confidentiality and the management of patients with epilepsy who fail to comply with doctor's advice not to drive: a survey of medical/legal opinions in Australia.

This study sought the opinions of a select group of professionals, trained in medicine and law concerning: professional privilege; management of patients who posed risks to society; and the legal charge to impose upon a patient with uncontrolled epilepsy who caused a fatality by driving contrary to medical advice. The second Academic Seminar of the Australian College of Legal Medicine was surveyed to define demographics and opinions. Of 23 respondents, 14 were trained in law and medicine, of whom eight had post graduate medical qualifications and seven had more than basic legal training; 20/23 supported professional privilege in medicine but 18/23 denied its absoluteness; 22/23 felt the doctor had a right to divulge information in the public interest. Only 14/23 (although still a majority opinion) felt this right was a duty and 6/23 refuted the same. When concerned regarding compliance not to drive, 7/23 would discuss it with family/friends in contravention of patient consent, 12/23 would report to the driving authorities where concern became fact, 13/23 would advise the patient that a report would be sent, 4/23 would report without the patient's knowledge and four would threaten but not send the report. In the case of a fatality consequent to non-compliance, 10/23 considered murder and 22/23 considered manslaughter charges to be appropriate. The majority supported professional privilege in the doctor/patient relationship but also supported the right or even a duty to report risks to society. Where a concern arose that a patient with epilepsy may drive contrary to advice, one-third of doctors would discuss with family/friends, without consent, one-half would report the patient to the driving authorities, while almost three-quarters would report the patient if concern was realised. Murder and manslaughter, serious charges, were deemed appropriate for patients who caused death by driving against medical advice.

Australia↗
PubMed2005

Neuropsychological deficits associated with driving performance in Parkinson's and Alzheimer's disease.

Neuropsychological and motor deficits in Parkinson's disease that may contribute to driving impairment were examined in a cohort study comparing patients with Parkinson's disease (PD) to patients with Alzheimer's disease (AD) and to healthy elderly controls. Nondemented individuals with Parkinson's disease [Hoehn & Yahr (H&Y) stage I-III], patients with Alzheimer's disease [Clinical Demetia Rating scale (CDR) range 0-1], and elderly controls, who were actively driving, completed a neuropsychological battery and a standardized road test administered by a professional driving instructor. On-road driving ability was rated on number of driving errors and a global rating of safe, marginal, or unsafe. Overall, Alzheimer's patients were more impaired drivers than Parkinson's patients. Parkinson's patients distinguished themselves from other drivers by a head-turning deficiency. Drivers with neuropsychological impairment were more likely to be unsafe drivers in both disease groups compared to controls. Compared to controls, unsafe drivers with Alzheimer's disease were impaired across all neuropsychological measures except finger tapping. Driving performance in Parkinson's patients was related to disease severity (H&Y), neuropsychological measures [Rey Osterreith Complex Figure (ROCF), Trails B, Hopkins Verbal List Learning Test (HVLT)-delay], and specific motor symptoms (axial rigidity, postural instability), but not to the Unified Parkinson Disease Rating Scale (UPDRS) motor score. Multifactorial measures (ROCF, Trails B) were useful in distinguishing safe from unsafe drivers in both patient groups.

Accidents, Traffic↗
PubMed1999

The impact of HIV-related neuropsychological dysfunction on driving behavior. The HNRC Group.

HIV infection often results in neuropsychological (NP) impairment. In order to assess the impact that HIV-related NP deficits may have on automobile driving, we evaluated 68 HIV-seropositive drivers using an NP battery and two PC-based driving simulations. Thirty-two participants were classified as NP impaired; most (72%) evidenced only mild impairment, and none met criteria for HIV-associated dementia. After controlling for degree of immunosuppression and disease stage, NP-impaired participants failed a previously validated driving simulation at a much higher rate than cognitively intact participants [OR = 5.3, 95% CI (1.7, 17.0), p = .006]. Similarly, on a simulation of city driving, NP impaired participants were more likely to fail based upon the number of accidents [OR = 6.1, 95% CI (1.5, 24.6), p = .01]. Simulator performance was predicted by functioning in a number of NP domains, with NP tests accounting for 13-30% of the variance on the simulations. Although it would be premature to extrapolate these findings to impairment in on-the-road driving, they do argue for greater attention to the impact that even mild HIV-related NP deficits may have on driving skills.

AIDS Dementia Complex↗
PubMed2004

Long-term follow-up effects of a school-based drug abuse prevention program on adolescent risky driving.

This study examined long-term follow-up data from a large-scale randomized trial to determine the extent to which participation in a school-based drug abuse prevention program during junior high school led to less risky driving among high school students. Self-report data collected from students in the 7th, 10th, and 12th grades were matched by name to students' department of motor vehicles (DMV) records at the end of high school. The DMV data included the total number of violations on students' driving records as well as the number of "points" that indicate the frequency and severity of the violations. A series of logistic regression analyses revealed that males were more likely to have violations and points on their driving records than females, and regular alcohol users were more likely to have violations and points than those who did not use alcohol regularly. Controlling for gender and alcohol use, students who received the drug prevention program during junior high school were less likely to have violations and points on their driving records relative to control group participants that did not receive the prevention program. Findings indicated that antidrinking attitudes mediated the effect of the intervention on driving violations, but not points. These results support the hypothesis that the behavioral effects of competence-enhancement prevention programs can extend to risk behaviors beyond the initial focus of intervention, such as risky driving.

Adolescent↗
PubMed2000

The effect of pupil dilation with tropicamide on vision and driving simulator performance.

PURPOSE: To assess the effect of pupil dilation on vision and driving ability. METHODS: A series of tests on various parameters of visual function and driving simulator performance were performed on 12 healthy drivers, before and after pupil dilation using guttae tropicamide 1%. A driving simulator (Transport Research Laboratory) was used to measure reaction time (RT), speed maintenance and steering accuracy. Tests of basic visual function included high- and low-contrast visual acuity (HCVA and LCVA), Pelli-Robson contrast threshold (CT) and Goldmann perimetry (FIELDS). Useful Field of View (UFOV--a test of visual attention) was also undertaken. The mean differences in the pre- and post-dilatation measurements were tested for statistical significance at the 95% level using one-tail paired t-tests. RESULTS: Pupillary dilation resulted in a statistically significant deterioration in CT and HCVA only. Five of 12 drivers also exhibited deterioration in LCVA, CT and RT. Little evidence emerged for deterioration in FIELDS and UFOV. Also, 7 of 12 drivers appeared to adjust their driving behaviour by reducing their speed on the driving simulator, leading to improved steering accuracy. CONCLUSIONS: Pupillary dilation may lead to a decrease in vision and daylight driving performance in young people. A larger study, including a broader spectrum of subjects, is warranted before guidelines can be recommended.

Adult↗
PubMed2003

Driving ability after pupillary dilatation.

BACKGROUND: The Royal College of Ophthalmologists' guidelines and Driver and Vehicle Licensing Agency (DVLA) recommend that a patient should not drive with dilated pupils based on the rationale that vision may be compromised in acuity and ability to tolerate glare. Arguments exist against these recommendations suggesting that pupillary dilatation does not have any real bearings on driving ability. Aim To determine the effects of pupillary dilatation on the ability to drive. METHODS: The study was randomised and prospective. A total of 28 patients had their visual parameters (distance vision, near vision, licence plate reading at 20 m or shorter, and glare) measured and analysed pre- and post-tropicamide 1% dilatation. Paired two-tailed Student's t-test and chi(2)-test were used in the analysis. RESULTS: At 20 min, following instillation of one drop of tropicamide 1% there is a significant reduction in visual acuity (VA), for distance Snellen and near. There is a significant reduction in the number of people who could read the licence plate at 20 m. Subjective glare assessment changed from 'none' (average score) in the undilated state to 'mild' in the dilated states. The overall patient feedback indicated that a significant 14% believed they would find it difficult to drive postdilatation. CONCLUSION: This study demonstrates the rationale behind disallowing driving following pupillary dilatation. The risks to safe driving are proved significant as a result of significant reduction in visual quality and quantity after dilatation.

Adult↗
PubMed1996

The geography of availability and driving after drinking.

This paper reports on an analysis of geographically based data from four communities conducted to evaluate relationships between measures of the physical availability of alcohol and rates of driving after drinking. From a review of the literature, it was expected that rates of driving after drinking would be directly related to the availability of alcohol at on-premise establishments. Based on theoretical arguments regarding the life activities which underlie drinking and driving it was expected that the effects of availability upon these outcomes would extend significantly beyond the local areas of outlets. Taking into account the geographic variations in environmental characteristics (road network density, traffic flow, population density), and socioeconomic (age, gender, race, marital status, income, employment) and drinking characteristics (rates of abstention, frequency and quantity of use) of resident populations, a spatial analysis of drinking driving and alcohol-related crashes was conducted. The results of the analysis showed that physical availability was unrelated to self-reports of driving after drinking and driving while intoxicated and significantly related to rates of single vehicle night-time crashes. In the latter case, physical availability affected both local and adjacent area rates of crashing.

Accidents, Traffic↗