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PubMed2000

On-road motor vehicle emissions and fuel consumption in urban driving conditions.

This paper reports on the analysis of on-road vehicle speed, emission, and fuel consumption data collected by four instrumented vehicles. Time-, distance-, and fuel-based average fuel consumption, as well as CO, HC, NOx, and soot emission factors, were derived. The influences of instantaneous vehicle speed on emissions and fuel consumption were studied. It was found that the fuel-based emission factors varied much less than the time- and distance-based emission factors as instantaneous speed changed. The trends are similar to the results obtained from laboratory tests. The low driving speed contributed to a significant portion of the total emissions over a trip. Furthermore, the on-road data were analyzed using the modal approach. The four standard driving modes are acceleration, cruising, deceleration, and idling. It was found that the transient driving modes (i.e., acceleration and deceleration) were more polluting than the steady-speed driving modes (i.e., cruising and idling) in terms of g/km and g/sec. These results indicated that the on-road emission measurement is feasible in deriving vehicle emissions and fuel consumption factors in urban driving conditions.

Automobile Driving↗
PubMed2005

Driving under the influence of drugs in Sweden with zero concentration limits in blood for controlled substances.

OBJECTIVE: This article describes the background and implementation in Sweden of zero-concentration limits for controlled drugs in the blood of drivers. Eliminating the need to prove that a person's ability to drive safely was impaired by drugs has greatly simplified the prosecution case, which now rests primarily on the forensic toxicology report. Driving under the influence of a prescription drug listed as a controlled substance is exempt from the zero-limit law provided the medication was being used in accordance with a physician's direction and the person was not considered unfit to drive. METHODS: The prevalence of driving under the influence of drugs (DUID) in Sweden was evaluated from police reports with the main focus on the toxicological findings. A large case series of DUID suspects was compared before and after introducing zero concentration limits in blood for controlled substances on July 1, 1999. The spectrum of drugs used by typical offenders and the concentrations of various licit and illicit substances in blood were evaluated and compared. RESULTS: Immediately after the zero-limit law came into force, the number of cases of DUID submitted by the police for toxicological analysis increased sharply and is currently ten-fold higher than before the new legislation. Statistics show that about 85% of all blood samples sent for toxicological analysis have one or more banned substances present. Amphetamine is by far the leading drug of abuse in Sweden and was identified in about 50-60% of all DUID suspects either alone or together with other controlled substances. The next most frequently encountered illicit drug was tetrahydrocannabinol (THC), with positive findings in about 20-25% of cases. Various prescription drugs, mainly sedative-hypnotics like diazepam and flunitrazepam, were also highly prevalent and these occurred mostly together with illicit substances. Opiates, such as 6-acetyl morphine and morphine, the metabolites of heroin, were high on the list of substances identified. Most DUID suspects in Sweden were men (85%) who were poly-drug users combining illicit substances, like amphetamine and/or cannabis, with a prescription medication such as various benzodiazepines. CONCLUSIONS: Sweden's zero-concentration limit has done nothing to reduce DUID or deter the typical offender because recidivism is high in this population of individuals (40-50%). Indeed, many traffic delinquents in Sweden are criminal elements in society with previous convictions for drunk and/or drugged driving as well as other offenses. The spectrum of drugs identified in blood samples from DUID suspects has not changed much since the zero-limit law was introduced.

Automobile Driving↗
PubMed2006

Cell phones and driving: review of research.

OBJECTIVE: The research literature on drivers' use of cell phones was reviewed to identify trends in drivers' phone use and to determine the state of knowledge about the safety consequences of such use. METHODS: Approximately 125 studies were reviewed with regard to the research questions, type and rigor of the methods, and findings. Reviewed studies included surveys of drivers, experiments, naturalistic studies (continuous recording of everyday driving by drivers in instrumented vehicles), studies of crash risk, and evaluations of laws limiting drivers' phone use. RESULTS: Observational surveys indicate drivers commonly use cell phones and that such use is increasing. Drivers report they usually use hand-held phones. Experimental studies have found that simulated or instrumented driving tasks, or driving while being observed, are compromised by tasks intended to replicate phone conversations, whether using hand-held or hands-free phones, and may be further compromised by the physical distraction of handling phones. Effects of phone use on driving performance when drivers are in their own vehicles are unknown. With representative samples of adequate size, naturalistic studies in the future may provide the means to document the patterns and circumstances of drivers' phone use and their effects on real-world driving. Currently, the best studies of crash risk used cell phone company billing records to verify phone use by crash-involved drivers. Two such studies found a fourfold increase in the risk of a property-damage-only crash and the risk of an injury crash associated with phone use; increased risk was similar for males and females, younger and older drivers, and hands-free and hand-held phones. A number of jurisdictions in the United States and around the world have made it illegal for drivers to use hand-held phones. Studies of these laws show only limited compliance and unclear effects on safety. CONCLUSIONS: Even if total compliance with bans on drivers' hand-held cell phone use can be achieved, crash risk will remain to the extent that drivers continue to use or switch to hands-free phones. Although the enactment of laws limiting drivers' use of all phones is consistent with research findings, it is unclear how such laws could be enforced. At least in the short term, it appears that drivers' phone use will continue to increase, despite the growing evidence of the risk it creates. More effective countermeasures are needed but are not known at this time.

Accidents, Traffic↗
PubMedDate not supplied

Urban-rural comparisons of drink-driving behaviour among late teens: a preliminary investigation.

A preliminary study was conducted to examine the nature and extent of urban-rural differences in self-reported drinking and driving among youths in Western Australia. A total of 102 youths aged 17, 18 and 19 years were surveyed via a random street sampling technique about their alcohol consumption and drink-driving behaviour. Analyses indicated that urban youths had a significantly higher level of self-reported drink-driving behaviour than their rural counterparts. Males indicated a higher level of self-reported drink-driving behaviour than females. This article also provides a review and summary of youth drink-driving literature with special focus on urban-rural comparisons.

Adolescent↗
PubMed2002

Assessment of driving with the global positioning system and video technology in young, middle-aged, and older drivers.

BACKGROUND: Driving is a complex task that is difficult to fully characterize objectively or in a blinded fashion. The main objective of this study was to determine the usefulness of the global positioning system (GPS) and video technology for examining age-related differences in driving. In this study, GPS was used to determine the position, velocity, and acceleration of a vehicle, driven by subjects of different ages, while video footage was used to provide a detailed context of the drive. METHODS: Twenty-four subjects who were young (20 to 29; n = 6), middle-aged (30 to 64; n = 8), and older (65 years of age and older; n = 10) drove their own vehicles on a 30-km route of various types of roads, with a GPS receiver and video camera recording. RESULTS: The combination of GPS and video data allowed for the determination of many age-related driving differences. The young subjects drove faster, had a shorter deceleration distance and time, as well as a shorter acceleration time. Young subjects also had a substantially higher number of infraction demerit points primarily due to speeding, not stopping fully at stop signs, and following too closely. Although the older subjects had a smaller number of demerit points assessed, they tended to make different types of errors than the young subjects, including not stopping at all at a stop sign and turning errors. CONCLUSIONS: GPS and video technology offer new opportunities for the assessment of age-related driving performance.

Adult↗
PubMed2005

Driving cessation and increased depressive symptoms.

BACKGROUND: To understand the consequences of driving cessation in older adults, the authors evaluated depression in former drivers compared with active drivers. METHODS: Depression (as assessed using the Center for Epidemiological Studies Depression Scale), driving status, sociodemographic factors, health status, and cognitive function were evaluated for a cohort of 1953 residents of Sonoma County, California, aged 55 years and older, as part of a community-based study of aging and physical performance. The authors re-interviewed 1772 participants who were active drivers at baseline 3 years later. RESULTS: At baseline, former drivers reported higher levels of depression than did active drivers even after the authors controlled for age, sex, education, health, and marital status. In a longitudinal analysis, drivers who stopped driving during the 3-year interval (i.e., former drivers) reported higher levels of depressive symptoms than did those who remained active drivers, after the authors controlled for changes in health status and cognitive function. Increased depression for former drivers was substantially higher in men than in women. CONCLUSIONS: With increasing age, many older adults reduce and then stop driving. Increased depression may be among the consequences associated with driving reduction or cessation.

Accidents, Traffic↗
PubMed1998

Attention and driving performance in Alzheimer's disease.

The present study examined the relationship between visual attention measures and driving performance in healthy older adults and individuals with very mild and mild dementia of the Alzheimer type (DAT). Subjects were administered an on-road driving assessment and three visual attention tasks (visual search, visual monitoring, and useful field of view). The results indicated that error rate and reaction time during visual search were the best predictors of driving performance. Furthermore, visual search performance was predictive of driving performance above and beyond simple dementia severity and several traditional psychometric tests. The results suggest that general cognitive status may be useful for identifying individuals "at risk" for unsafe driving. However, measures of selective attention may serve to better differentiate safe versus unsafe drivers, especially in the DAT population.

Aged↗
PubMed2003

Audit in occupational medicine: an audit of fitness to drive among voluntary drivers in an NHS trust.

BACKGROUND: A health surveillance programme, to assess fitness to drive, was initiated for voluntary drivers in an NHS Trust because of reports of increasing frailty and slow reactions among some drivers. After discussion between the occupational health department, voluntary services manager and personnel department it was considered appropriate to apply Driver and Vehicle Licensing Authority (DVLA) Group 2 fitness to drive standards to those voluntary drivers who drove the Trusts minibuses. RESULTS: An audit of the initial health surveillance of 47 drivers is presented. The mean age of the voluntary drivers was 66.4 years. A large number of medical problems with the potential to affect driving were discovered (average of 1.9 medical problems per driver). The outcome was that five voluntary drivers were found unfit to drive the hospital minibus and one voluntary driver was found unfit for car driving. CONCLUSIONS: A fitness assessment form for drivers is presented. This form is primarily for the use of occupational health nurses, to help them to decide when referral to an occupational health physician is indicated.

Aged↗
PubMed2006

Effects of driving on low back pain.

BACKGROUND: Many previous studies have demonstrated that driving a car is a risk factor for low back pain (LBP). We have frequent contact with medical representatives who often drive cars for business, and have noticed that many of them suffer from LBP. AIMS: To investigate how driving affected the occurrence of LBP in medical representatives. METHODS: Questionnaire survey of all medical representatives working in Mie Prefecture (Japan). RESULTS: A total of 551 medical representatives replied (92%). We divided the subjects into Group A (with LBP) and Group B (without LBP). There was no significant difference in mean age, height, weight or duration of continuous employment between the two groups. Mean total mileage was 342 539 km in Group A and 251 945 km in Group B (P < 0.05). There was no significant difference in estimated daily mileage or estimated daily driving time between the two groups. As for backrest inclination, most of the respondents in Group A chose 105 degrees and the majority in Group B chose 120 degrees (P < 0.001). CONCLUSION: The total mileage was significantly higher in Group A than in Group B. We considered that the risk for LBP increased as the lumbar spine load accumulated day by day while driving a car almost every day without a holiday.

Adult↗
PubMed1996

Effect of sleep deprivation on driving safety in housestaff.

Sleep deprivation is known to affect driving safety. Housestaff (HS) are routinely sleep-deprived when on call. We hypothesized that this would affect their driving. We therefore administered questionnaires regarding driving to 70 pediatric HS, who were on call every fourth night, and to 85 faculty members (FAC), who were rarely disturbed at night. HS were questioned about events during their residency, and FAC were questioned about events during the preceding three years. There was an 87% response rate for each group. HS slept 2.7 +/- 0.9 (SD) hours when on call vs 7.2 +/- 0.8 hours when not on call (p < 0.001). 44% of HS had fallen asleep when stopped at a light, vs 12.5% FAC (p < 0.001). 23% of HS had fallen asleep while driving vs. 8% FAC (ns). A total of 49% of HS had fallen asleep at the wheel; 90% of these events occurred post-call. In contrast, only 13% of FAC had fallen asleep at the wheel (p < 0.001). HS had received a total of 25 traffic citations for moving violations vs. 15 for FAC and were involved in 20 motor vehicle accidents vs. 11 for FAC. One traffic citation clearly resulted from HS falling asleep at the wheel vs. none for FAC. We conclude that HS frequently fall asleep when driving post-call. We speculate that current HS work schedules may place some HS at risk for injury to themselves and others. Further study, using prospectively objective measures is indicated.

Accidents, Traffic↗
PubMed2000

Evaluating fitness to drive after cerebral injury: basic issues and recommendations for medical and legal communities.

Specialists in rehabilitation are typically called upon to evaluate and render an opinion about whether or not a person can be entrusted to resume driving. And, because driving is an individual privilege to be balanced against the public's right to safety and protection from the dangers of a driver whose residual deficits may impede ability to drive safely, these specialists have developed a number of methods to assess fitness to drive. Unfortunately, many evaluators remain unfamiliar with research used as basis for evaluations or lack understanding of the strengths and weaknesses of tests in use. Therefore, there may be unquestioning trust in tests and methods that leads to errors of significant consequence in decisions about fitness to drive as well as unawareness of expanding risks of litigation that can emanate from inappropriate recommendations. This article intends to draw attention to issues, considerations, and problems underlying the conduct of driver evaluations, including focus on ways in which the legal and medical communities approach question of fitness, legal and medical definitions and terminology, responsibility for assessment as well as tests and methods used in evaluations. Conclusions are drawn from discussion of these matters and recommendations are outlined for addressing identified problems at the interface between medical and legal communities.

Automobile Driving↗
PubMed1997

Inattentive and hyperactive behaviors and driving offenses in adolescence.

OBJECTIVE: The associations between symptoms of attention-deficit hyperactivity disorder (ADHD), conduct disorder, anxiety, or depression and no disorder in relation to driving offenses were examined in 916 adolescents. METHOD: Self-report and parent report were used to assess a birth cohort of New Zealand adolescents' mental health status at age 15 years. Adolescents who scored 1.5 SD above the mean on the DSM-III total ADHD symptom scale were identified as reporting significant ADHD symptomatology. Self-report data and official traffic conviction records were used to identify adolescents who had committed driving offenses between ages 15 and 18 years. RESULTS: ADHD symptomatology and conduct disorder were strongly associated with driving offenses. ADHD symptomatology in females was significantly associated with driving offenses and more traffic crashes compared with other disorder or no disorder. CONCLUSIONS: Adolescents with a history of ADHD and conduct problems are significantly more likely than their peers to commit traffic offenses. Research in ADHD and risky driving should include female adolescents, as those with attentional difficulties are at a high risk for being involved in traffic crashes than females who do not experience attentional difficulties.

Adolescent↗
PubMed1998

Venlafaxine's effects on healthy volunteers' driving, psychomotor, and vigilance performance during 15-day fixed and incremental dosing regimens.

Effects of venlafaxine, an antidepressant acting by selective serotonin and norepinephrine reuptake inhibition with a potency ratio of 5:1, were assessed in a standardized, actual driving test, a battery of psychomotor tests (Critical Flicker/Fusion Frequency, Critical Tracking, Divided Attention), and a 45-minute vigilance test (Mackworth Clock). Thirty-seven healthy volunteers, 22 of whom completed the study, received venlafaxine in fixed (37.5 mg twice a day) and incremental (37.5-75 mg twice a day) doses as well as mianserin (10-20 mg three times a day) and placebo according to a 4-period (15 days each), double-blind, crossover design. Testing occurred on days 1 and 7 and after dose increments, on days 8 and 15. Plasma concentrations of venlafaxine and its active metabolite were measured on test days for confirming compliance. Venlafaxine had no significant effect on the primary driving parameter (standard deviation of lateral position) and failed to impair psychomotor performance. Mianserin profoundly and consistently impaired driving and psychomotor performance. However, both drugs significantly impaired vigilance performance. Maximal effects occurred on day 1 with mianserin and similarly on day 7 with venlafaxine in both series. The increment in venlafaxine's dose on day 8 did not increase this effect. The drug's selectively impairing effect on vigilance is shared by other "serotonergic" anxiolytics and antidepressants, suggesting that interference with 5-HT transmission reduces arousal in particularly monotonous tasks or environments. This study concludes that venlafaxine does not generally affect driving ability and should be safe for use by patients who drive.

Adult↗
PubMed2001

The road to danger: the comparative risks of driving while sleepy.

OBJECTIVES/HYPOTHESIS: A large sector of the population of the United States has sleep deprivation directly leading to excessive daytime sleepiness. The prevalence of excessive daytime sleepiness in this population ranges from 0.3% to 13.3%. The consequences of even 1 to 2 hours of sleep loss nightly may result in decrements in daytime functions resulting in human error, accidents, and catastrophic events. The magnitude of risks in the workplace or on the highways resulting from sleepiness is not fully understood or appreciated by the general population. Hence, to more clearly emphasize the magnitude of these risks, we question whether mild sleep deprivation may have the same effect as alcohol on reaction times and driving performance. STUDY DESIGN: Nonrandomized prospective cohort investigation. METHODS: Sixteen healthy matched adult subjects (50% women) were stratified into two groups, sleep deprived and alcohol challenged. The sleep-deprived group was further subdivided into acute (one night without sleep) and chronic (2 h less sleep nightly for 7 d) sleep deprivation. Each group underwent baseline reaction time testing and then drove on a closed course set up to test performance. Seven days later, the group repeated this sequence after either sleep deprivation or alcohol intake. RESULTS: There were no significant between-group differences (sleep deprivation or alcohol challenged) in the changes before and after intervention for all 11 reaction time test metrics. Moreover, with few exceptions, the magnitude of change was nearly identical in the two groups, despite a mean blood alcohol concentration of 0.089 g/dL in the alcohol-challenged group. On-track driving performances were similar (P =.724) when change scores (hits and errors) between groups were compared (baseline minus final driving trial). CONCLUSION: This comparative model suggests that the potential risks of driving while sleepy are at least as dangerous as the risks of driving illegally under the influence of alcohol.

Adult↗
PubMed2002

Sleep disordered breathing and driving risk.

Obstructive sleep apnea syndrome leads to an increased risk of motor vehicle accidents through multiple pathways. Sleep apnea and motor vehicle crashes are common, and motor vehicle collisions are the leading causes of death amongst accidents. Therefore, the clinician charged with the care of apneic patients must address the issue of safe driving. Some recent evidence reveals that driving simulator technology may discriminate apneic drivers from control drivers as well as those apneics at a lesser risk for automobile crashes. This same tool demonstrates an improvement in driving capabilities to baseline when patients with sleep apnea are treated with nasal continuous positive airway pressure and that this improvement may occur rapidly. The prevention of driving accidents in patients with sleep apnea appears cost effective. Educating the patient with sleep apnea about sleepy driving and objective documentation of treatment efficacy are important in reducing the likelihood of accidents.

Accidents, Traffic↗
PubMedDate not supplied

The effect of opioids on driving and psychomotor performance in patients with chronic pain.

OBJECTIVES: This study compared the psychomotor performance and driving ability of patients with chronic pain managed with stable regimens of opioid analgesics with that of normal healthy volunteers. The hypothesis was that patients with chronic pain on stable opioid analgesic regimens operate their automobiles safely with proficiency equal to normal volunteer controls. METHODS: Patients were evaluated for errors while driving their own automobile through a predetermined route in the community, including variable residential and highway conditions, and for speed and accuracy on repeated trials through a 5-station obstacle course that evaluated forward and reverse driving, turning, and parallel parking. Patients also completed the Test of Variables of Attention and the Digit Symbol Substitution Test. RESULTS: No significant differences were observed among groups in driving performance in the community and on the obstacle course or on the Test of Variables of Attention. Results on dependent measures within the opioid group generally were not correlated with morphine equivalent daily opioid doses, which averaged 118 mg (median 40 mg). CONCLUSIONS: Many patients with chronic pain, even if treated with potent analgesics such as morphine and hydromorphone, show comparable driving ability as normals.

Accidents, Traffic↗
PubMed2003

Alcohol availability as a predictor of youth drinking and driving: a hierarchical analysis of survey and archival data.

BACKGROUND: Much attention has recently been directed toward developing preventive interventions to reduce drinking and driving through efforts to limit the numbers and locations of alcohol outlets at the community level. Although evaluations of these efforts have suggested linkages between alcohol outlets and problem outcomes, they have not addressed the linkage between outlets and drinking and driving among youth. The analysis reported here investigates the relationship between alcohol outlet densities and underage drinking and driving as self-reported on two telephone surveys conducted in California. METHODS: These analyses were based on data obtained from two telephone surveys conducted by the Prevention Research Center and archival data collected by the California Department of Alcoholic Beverage Control and the US Census Bureau. The sample for the first survey consisted of 15- to 20-year-old adolescents and young adults contacted by telephone, using a random digit dialing of exchanges in the greater San Francisco Bay Area. A second set of survey data was similarly collected by a random sample of households throughout California, and the Bay Area subset was also used for this analysis. RESULTS: At the individual level, older respondents were more likely to report drinking and driving and riding with drinking drivers, whereas females and Asians were less so. At the aggregate or city-level, alcohol outlet density, as measured by the number of on- and off-premises establishments licensed to sell alcohol, was associated with both drinking and driving and riding with drinking drivers. These effects were moderated by a number of individual level effects, with younger respondents and females more likely to be affected by outlet densities. CONCLUSIONS: The findings here provide support for the implementation of policies targeting alcohol outlet density reductions. Areas with large numbers of such outlets provide ample opportunities to youth for alcohol purchases.

Adolescent↗
PubMed1976

Residual effects and skills related to driving after a single oral administration of diazepam, medazepam or lorazepam.

Psychomotor skills and visual functions related to driving were measured double-blind cross-over in ten healthy volunteers before, and 1,3,5 and 7 h after a single oral administration of diazepam (10mg), medazepam (15 mg) or lorazepam (2.5 mg). The late effects of lorazepam were tested in seven other subjects 12 and 24 h after the administration. Lorazepam impaired almost all the measured skills more (P less than 0.05 to 0.001) than diazepam, medizepam or the placebo. The lorazepam impairment of reactive skills and flicker fusion discrimination remained statistically significant (P less than 0.05) for as long as 12 h. Medazepam impaired only reactive skills and flicker fusion, the latter remaining impaired (P less than 0.05) for as long a 5 h after the administration. The magnitude and duration of the effects of diazepam were intermediate between those of lorazepam and medazepam. Diazepam impaired perceptual speed and reactive and co-ordinative skills as well as flicker fusion discrimination and visual parameters related to driving. Slight impairments in performance were measurable for up to 5 h after administration but at 7 h the results resembled those measured after the placebo. The lack of alterations in adaptation to darkness, sensitivity to brightness or visual discrimination ability in bright counterlight at a time when flicker fusion discrimination was severely depressed suggests that an impaired ability to discriminate flickering light is of no or little clinical significance to driving ability. It is concluded that patients receiving a 2.5 mg dose of lorazepam should not drive or operate machinery for 24 h after the administration. After diazepam (10 mg) or medazepam (15 mg) patients should refrain from driving or participating inskilled performances for only 5 to 7 hours.

Adult↗