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Driving and Alzheimer's disease: the risk of crashes.

We designed this questionnaire-based study to determine the risk of auto crashes among Alzheimer's disease (AD) patients who continued to drive after the onset of AD, compared with normal age-matched control subjects and other drivers' statistical records. While ultimately all AD patients will become incapable of driving, it is not known whether, under current licensing regulations and self-imposed limitations, patients with AD present a definably increased risk of being involved in crashes, and if so, the relative magnitude of the risk and at what point in the course of the disease the risk may become significantly increased. We administered a brief questionnaire to the caregivers of 130 AD patients and to 112 age-matched, nondemented control subjects and their spouses. Annual rates of occurrence and severity of all crashes, and of crashes reported to the authorities, were determined from spousal or other caregiver responses. For all years of driving following the onset of dementia, AD patients had a mean of 0.091 reported crashes per year compared with matched controls, who had an average of 0.040 reported crashes per year in the same period of time. The average number of crashes per year changed with each year of driving following the onset of AD, with considerably lower reported crash rates during the initial years of dementia: in year 1, the crash rate was 0.068; in year 2, 0.097; in year 3, 0.093; in year 4, 0.159; in year 5 and beyond, 0.129.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Traffic↗

Localization of relevant consequences in anti-drinking and driving PSAs (public service announcements): a new approach to targeting underage college students?

Drinking and driving is prevalent among college students, particularly among underage college students. Although most of these students know that drunk driving is a potentially harmful behavior, many of them still make the decision to do so. The purpose of this study was to determine why underage students drink and drive and what consequences, if any, these students fear when they engage in this behavior. Focus groups and in-depth interviews were conducted, using the Health Belief Model as a guide for discussion topics. Participants revealed that PSAs focusing on relevant, localized consequences would have more meaning to underage college students than the more general campaigns that they reported seeing. In addition, they revealed that the consequence that they fear most is being charged with a DUI, yet current anti-drinking and driving PSAs never portray this as a possible negative consequence.

Adolescent↗

The effect of total hip replacement on driving reactions.

The driving reactions of 25 patients were assessed before and after operation for hip replacement. Driving reactions were tested by monitoring the delay and force of brake application after an emergency signal, using a simulated driving control system. Fifteen normal subjects were also tested. Statistical analysis demonstrated significant differences between patients with either left or right hip replacement and between pre- and postoperative testing. Most patients improved by the eighth week, but some had deteriorated and did not recover until re-tested eight months after operation. It is concluded that for most patients eight weeks' delay for return to driving is appropriate, but for a minority of patients with right hip replacement recovery of reaction speed requires longer rehabilitation.

Aged↗

Relation between glare and driving performance.

The present study investigated the effects of discomfort glare on driving behavior. Participants (old and young; U. S. and Europeans) were exposed to a simulated low-beam light source mounted on the hood of an instrumented vehicle. Participants drove at night in actual traffic along a track consisting of urban, rural, and highway stretches. The results show that the relatively low glare source caused a significant drop in detecting simulated pedestrians along the roadside and made participants drive significantly slower on dark and winding roads. Older participants showed the largest drop in pedestrian detection performance and reduced their driving speed the most. The results indicate that the deBoer rating scale, the most commonly used rating scale for discomfort glare, is practically useless as a predictor of driving performance. Furthermore, the maximum U. S. headlamp intensity (1,380 cd per headlamp) appears to be an acceptable upper limit.

Adolescent↗

Driver stress and performance on a driving simulator.

Effects of stress on driving performance can depend on the nature of driver's stress reactions and on the traffic environment. In an experimental study, we assessed multiple dimensions of vulnerability to driver stress by a questionnaire that was validated in previous field studies and related those dimensions to performance on a driving simulator. Results were broadly consistent with prediction. A dimension of habitual dislike of driving was associated with reduced control skills, greater caution, and disturbance of moods. A measure of aggressive driving predicted more frequent and more error-prone overtaking, which are effects attributed to the use of confrontive coping strategies in interaction with other vehicles. An alertness measure predicted speed of reaction to pedestrian hazards. This research has practical applications for system design, automated monitoring of driver performance, selection and assessment of drivers, and training.

Adolescent↗

Drinking and driving behaviors of 16 to 19 year-olds.

A total of 192 high-school-age drivers (67 girls) were interviewed with respect to their drinking and driving behavior and academic performance. Although traffic violations and citations were correlated with increases in risky driving behavior and alcohol and drug use, much dangerous driving and social drinking went without consequence. It is suggested that the young male driver is at significantly greater risk for involvement in dangerous driving and drinking. Contributing developmental, situational and personality factors are discussed.

Achievement↗

Identifying impaired drivers among the general driving population.

The primary purpose of this study was to identify predictors of impaired driving among a random sample of Canadian drivers who consume beverage alcohol. A second purpose was to determine if impaired drivers in the general population have characteristics similar to those reported among convicted and accident-involved impaired drivers. Amount of alcohol consumed over the past seven days was found to be the single most powerful predictor of both frequency of drinking-driving and of impaired driving. Impaired drivers differed from moderate-drinking drivers on a number of measures and were characterized by more irresponsible attitudes and higher risk behavior, consistent with findings of other impaired-driver subgroups. It is concluded that impaired driving may be just one behavior which is part of a deviant behavioral syndrome typified by high-risk behaviors.

Accidents, Traffic↗

Legislated policies and recidivism for driving under the influence of liquor in Massachusetts.

Legislation on driving under the influence of liquor was changed significantly in Massachusetts on 1 December 1975; it permitted courts to continue cases without a finding if defendants were place probation and assigned to driver alcohol education. The effect of the revisions on the incidence of rearrest was assessed. The 3-yr arrest records of 522 individuals arrested for drunken driving 2 yr before the changes (1973) were compared with 716 and 690 offenders arrested 1 (1976) and 2 (1977) yr post-law modification. Sample participants were selected randomly. The legislation strongly affected court dispositions. Over 70% of the 1976-1977 cases were continued without findings and more offenders were sanctioned. The proportion found not guilty dropped from 1973 to 1976-1977. Absolute rearrest rates were similar for each cohort. Probability of arrest, however, rose substantially between 1973 and 1980. Relative to the increased arrest rate, there was a significant decline in rearrests 2 and 3 yr after a drunken driving arrest during the post-law period. The legislation apparently contributed to an amelioration of the drunken driving problem by encouraging judicial reforms and educational interventions.

Accidents, Traffic↗

Estimating social-psychological effects in decisions to drink and drive: a factorial survey approach.

Although there has been considerable research on both habitual drinking drivers and aggregate-level trends in automobile fatalities as a result of legal countermeasures to deter drinking drivers, little is known about the occasional driver who drinks away from home. The present study uses a factorial survey design to gather individual-level data to examine situational dimensions that influence 95 college students' responses to opportunities to drink and drive. Implications from the study are that the level of alcohol impairment, distance to be driven, weather conditions, time of day and existence of driving alternatives have significant effects on students' intentions to drink and drive. Other significant variables include the number of police roadblocks, familiarity with roads, the way in which incidents of drunken driving are reported in the community and the number of passengers depending on the driver for transportation.

Accidents, Traffic↗

Gender roles and female drinking-driving.

Using roadside survey data on 2044 drivers in a southern metropolitan community, the potential of gender roles for explaining the role behavior of female drinking drivers was examined. Although female drinking drivers are like female nondrinking drivers in previous driving and drinking-driving experiences, overall they are more like male drinking drivers. Both female and male drinking drivers tend to drive in similar places and to be on the roads at similar times and days. They also carry similar numbers and types of passengers. The greater similarity of female drinking drivers to male drinking drivers than to nondrinking female drivers suggests caution in leaning too heavily on gender roles as explanations of female drinking-driving behavior.

Accidents, Traffic↗

Macroeconomic conditions and alcohol-impaired driving.

Several distinct bodies of literature indicate that economic factors influence alcohol consumption and driving behavior, including: econometric studies of effects of income and price on drinking, studies of booming and depressed communities, studies of the effects of recession on mental health and studies of the effects of the business cycle on driving patterns. The core research questions of this study were: (1) Does the state of the economy affect the rate of fatal motor vehicle crashes involving drinking drivers? and (2) Is the relationship between the state of the economy and motor vehicle fatalities mediated by effects of economic conditions on amount of alcohol consumed and amount of driving? Data were collected on multiple indicators of economic conditions, alcohol consumption, vehicle miles traveled and rates per population of fatal crashes in the United States on a monthly basis from 1976 through 1985. Nonlinear time-series modeling methods were used to estimate both direct and indirect effects and both coincident and lagged relationships. Results showed that economic conditions significantly influence fatal crash rates both directly and via changes in aggregate amount of alcohol consumed and aggregate amount of driving. However, these interrelationships at multiple lags are complex and not yet fully understood.

Accidents, Traffic↗

Gender differences in the control of alcohol-impaired driving in California.

OBJECTIVE: An examination of gender differences in alcohol-impaired driving. METHOD: Attitudes, perceptions and behaviors concerning drinking and driving were compared for male and female California drivers in three random-digit-dialing telephone survey interviews from 1983, 1986 and 1994 (survey response rates of 58%, 52% and 49%, respectively). A moral reasoning framework was applied to account for observed gender differences. RESULTS: Gender differences were examined within aggregate data from the 1983 and 1986 surveys (n = 291), and within the 1994 survey data (n = 608). Self-reported drinking-driving violations showed a substantial decline for both men and women across the survey periods (although violations remained much higher for men), paralleling the well-documented drop in alcohol-related traffic crashes during this time span. Men and women responded equally to the threat of punishment from the legal system (threat of arrest, jail, loss of license, fine, increased insurance), but women were much more responsive to social and internal controls (perceived disapproval from friends, feelings of guilt, violation of a moral standard). CONCLUSIONS: These gender differences suggest that women may play an important role in strengthening broad social and moral constraints regarding alcohol-impaired driving. Implications of these findings to deterrence, the effects of sanctions, and social change are discussed.

Alcohol Drinking↗

Parent-based intervention strategies to reduce adolescent alcohol-impaired driving.

OBJECTIVE: To review selected issues to consider when designing parent-based interventions for reducing alcohol-impaired driving in adolescent populations and to present a theoretical framework for analyzing such behavior. METHOD: The existing literature on alcohol-impaired driving and parent influences is considered based on a literature review of contemporary social science journals. Data also are presented from a survey of junior and senior high school students in the Capitol District of New York. CONCLUSIONS: Parent-based approaches are promising and represent an additional tool in the armament of strategies to reduce alcohol-impaired driving. Programs should focus on variables that are amenable to change (cognitions and attitudes), conduct preliminary studies to isolate relevant attitudes and cognitions for the target population of interest, formulate strategies that recognize the numerous demands in a parent's life and take into account existing theoretical frameworks on alcohol-impaired driving in adolescents.

Adolescent↗

Effects of Maine's 1981 and Massachusetts' 1982 driving-under-the-influence legislation.

In 1981, Maine passed a drunk driving law with mandatory penalties and a new civil charge to increase the conviction rate. One year later, Massachusetts increased drunk driving penalties, particularly for repeat offenders and intoxicated drivers involved in fatal crashes. In Maine, single-vehicle nighttime fatal crashes declined 22 per cent the year before passage of the law, and 33 per cent the year after. Maine's rates returned to pre-law levels by the third post-law year. Prior to Massachusetts' new law, single-vehicle nighttime and overall fatal crashes there also declined 20% and 22%, whereas after this law fatal crash rates did not decline further compared with the pre-law year or other New England states. Pre- and post-law surveys indicate that both laws were followed by some increases in public perceptions that drunk drivers stopped by police would be arrested, convicted, and receive automatic penalties. But, few believed it was very likely that drunk drivers would be stopped. For only two of three years studied after Maine's law did more people there report decisions not to drive because they had drunk too much. In Massachusetts, reported driving after heavy drinking declined as much the year before as the three years after its law.

Accidents, Traffic↗

Sociodemographic and health factors in driving patterns after 50 years of age.

Data from the 1990 Panel Study of Income Dynamics were used to predict, by means of logistic regression, the likelihood that people who had previously driven would continue to drive and to drive after dark after 50 years of age. The results support the conclusion that driving patterns appear to be explained partly by a combination of sociodemographic factors and health status. Furthermore, it is shown that those reported to drive for nondrivers appear to be the same individuals known to provide most informal support for functionally impaired elderly people.

Age Factors↗

Patterns of alcohol use and the risk of drinking and driving among US high school students.

Approximately one third of deaths among persons aged 15 to 24 years are the result of motor vehicle-related crashes. Data from a national sample of US high school students were used to assess patterns of alcohol use among adolescents in relation to the risk of drinking and driving. Prevalence and odds ratios were calculated for drinking and driving associated with patterns of alcohol use. Drinking and driving increased with increasing frequency of alcohol use and binge drinking and when alcohol was used in addition to other drugs. Efforts to reduce drinking and driving among adolescents should address underage drinking that is frequent or heavy.

Adolescent↗

Drinking and driving among US high school seniors, 1984-1997.

OBJECTIVES: This article reports the prevalence of, and trends in, driving after drinking and riding in a car with a driver who has been drinking among American high school seniors, based on data from more than a decade (1984-1997) of annual national surveys. METHODS: Logistic regressions were used to assess the effects of demographic factors (gender, region of country, population density, parental education, and race/ethnicity) and selected "lifestyle" factors (religious commitment, high school grades, truancy, illicit drug use, evenings out per week, and miles driven per week). RESULTS: Rates of adolescent driving after drinking and riding with a driver who had been drinking declined significantly from the mid-1980s to the early or mid-1990s, but the declines have not continued in recent years. Rates of driving or riding after drinking were higher among high school seniors who are male. White, living in the western and northeastern regions of the United States, and living in rural areas. Truancy, number of evenings out, and illicit drug use all related significantly positively with the dependent variables, whereas grade point average and religious commitment had a negative relationship. Miles driven per week related positively to driving after drinking.

Adolescent↗

Lower-extremity function for driving an automobile after operative treatment of ankle fracture.

BACKGROUND: The purpose of this study was to determine when patients recover the ability to safely operate the brakes of an automobile following operative repair of an ankle fracture. METHODS: A computerized driving simulator was developed and tested. Eleven healthy volunteers were tested once to establish normal mean values (Group I), and a group of thirty-one volunteers with a fracture of the right ankle were tested at six, nine, and twelve weeks following operative repair (Group II). The subjects were tested with a series of driving scenarios (city, suburban, and highway). Scores on the Short Form Musculoskeletal Assessment were recorded at six, nine, and twelve weeks and were compared with the results of the driving test. We investigated the effect of the time of the visit and of the testing condition on the braking times. RESULTS: The total braking time was 1079 msec for Group I and 1330, 1172, and 1160 msec for Group II at six, nine, and twelve weeks, respectively, postoperatively (p = 0.0094). The total braking time consistently improved for each of the driving scenarios at each successive data point (p = 0.05). The increase in the total braking time at six weeks meant an increase in the distance traveled by the automobile before braking of 22 ft (6.7 m) at 60 mph (96.6 km/hr), and the increase at nine weeks meant an increase of 8 ft (2.4 m) at 60 mph. The functional outcome improved at each successive visit, although no significant association was found between the functional scores and normalization of total braking time. CONCLUSION: By nine weeks, the total braking time of patients who have undergone fixation of a displaced right ankle fracture returns to the normal, baseline value.

Activities of Daily Living↗