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PubMed2005

The relationship between performance on the standardised field sobriety tests, driving performance and the level of Delta9-tetrahydrocannabinol (THC) in blood.

The consumption of Delta9-tetrahydrocannabinol (THC) as cannabis has been shown to result in impaired and culpable driving. Testing drivers for the presence of THC in blood is problematic as THC and its metabolites may remain in the blood for several days following its consumption, even though the drug may no longer have an influence on driving performance. In the present study, the aim was to assess whether performance on the standardised field sobriety tests (SFSTs) provides a sensitive measure of impaired driving behaviour following the consumption of THC. In a repeated measures design, 40 participants consumed cigarettes that contained either 0% THC (placebo), 1.74% THC (low dose) or 2.93% THC (high dose). For each condition, after smoking a cigarette, participants performed the SFSTs on three occasions (5, 55 and 105 min after the smoking procedure had been completed) as well as a simulated driving test on two occasions (30 and 80 min after the smoking procedure had been completed). The results revealed that driving performance was not significantly impaired 30 min after the consumption of THC but was significantly impaired 80 min after the consumption of THC in both the low and high dose conditions. The percentage of participants whose driving performance was correctly classified as either impaired or not impaired based on the SFSTs ranged between 65.8 and 76.3%, across the two THC conditions. The results suggest that performance on the SFSTs provides a moderate predictor of driving impairment following the consumption of THC and as such, the SFSTs may provide an appropriate screening tool for authorities that wish to assess the driving capabilities of individuals suspected of being under the influence of a drug other than alcohol.

Adult↗
PubMedDate not supplied

Imposed versus involved: different strategies to effect driving cessation in cognitively impaired older adults.

In the lives of persons with cognitive impairments, a time comes when it is necessary to give up driving. This may be a particularly difficult issue for the driver, his or her family members, and their health care professionals. In this study, the phenomenon of unsafe driving by cognitively impaired older adults and the process of affecting driving cessation, was explored through guided interviews with 216 persons throughout the state of Florida. Participants included professionals working in the aging network, mobility counselors, safety officers, individuals with a mild degree of cognitive impairment and their family members. The strategies employed to influence or effect cessation could be categorized as those that involved the individual affected and those that were imposed on the individual. Conditions that appeared to influence whether driving cessation would occur were observed. There were distinct pros and cons to each strategy. In this article, specific information is provided to guide nurses working with cognitively impaired people who have become unsafe drivers. It is expected that driving cessation can be voluntarily effected in many cases but may have to be imposed in others. The skilled nurse will know when and which type of recommendation is appropriate.

Accidents, Traffic↗
PubMed2006

Endoscopy simulators: lessons from the aviation and automobile industries.

Individuals who are interested in using technology to promote education and quality assurance in endoscopy may turn to aviation and driver's test simulation for guidance. Of course the forces driving the innovation and the regulation governing these fields are entirely different from the ones faced in endoscopy. However, some of the general principles of how simulators can enhance training and how their strengths can be put to optimal use are quite pertinent to those individuals interested in the ongoing evolution of endoscopy simulation.

Automobile Driver Examination↗
PubMed2004

Evaluation of California's graduated driver licensing program.

PROBLEM: California's graduated driver licensing (GDL) program was implemented to reduce the high crash risk of teenage drivers. The program enhancements made in 1998 were evaluated in this study using methods that rule out the noticeable downward trend in California teen's fatal/injury crash rates as a possible explanation for any observed crash reductions that could otherwise be mistaken for program effects. METHOD: Monthly per capita fatal/injury crash rates for 15-to-17-year-olds and proportional representations of 16-17-year-olds' nighttime and passenger crashes were analyzed using intervention time series analysis. RESULTS: After removing trend, seasonality, and transition effects in the data, no overall reductions in fatal/injury crashes for 15-17-year-olds or 16-year-olds (separately) were found to be associated with the 1998 program enhancements, suggesting no overall exposure reduction effect of the longer instruction permit period nor increased competency associated with the higher number of required practice hours. However, the 12-month nighttime and 6-month passenger restrictions were found to be associated with annual savings of 55 and 816 fatal/injury crashes, respectively. DISCUSSION: Finding no overall impact of the 1998 GDL enhancements was not surprising given findings of an earlier survey suggesting that California teens and parents were largely already practicing program requirements prior to implementation and were not fully complying with the program requirements afterwards. Though the observed crash savings associated with the restrictions were of modest size, this is the first study to evidence a direct positive impact of the passenger restriction component of GDL programs. Larger reductions could be realized if the nighttime restriction started earlier and parents/law enforcement could be motivated to better enforce these restrictions. IMPACT ON INDUSTRY: The findings provide support for passenger and nighttime restriction components of GDL programs.

Accidents, Traffic↗
PubMed2006

Risky behavior of drivers of motorized two wheeled vehicles in India.

INTRODUCTION: Motorized two-wheeled vehicles (MTV) account for a large proportion of road traffic in India and the riders of these vehicles have a high risk of road traffic injuries. We report on the availability of drivers licenses, use of a helmet, driver behavior, and condition of vehicles for MTV drivers in Hyderabad, a city in India METHODS: Drivers of a MTV aged >16 years were interviewed at petrol filling stations RESULTS: There were 4,183 MTV drivers who participated in the study. Four hundred sixty one (11%; 95% CI 9.7-12.3%) drivers had not obtained a drivers license and 798 (21.4%) had obtained a license without taking the mandatory driving test. Two thousand nine hundred twenty (69.8%; 95% CI 67.9-71.7%) drivers reported no/very occasional use of a helmet, the significant predictors of which included that those driving borrowed a MTV (odds ratio 7.90; 95% CI 3.40-18.40) or driving moped/scooterette/scooter as compared with motorcycle (3.32; 2.76-3.98), lower education (3.10; 2.66-3.61), age >45 years (2.41; 1.63-3.57), and males (1.57; 1.16-2.13). Two thousand five hundred and eight (59.9%) drivers reported committing a traffic law violation at least once within the last 3 months. Overall, 1,222 (29.2%) drivers reported ever being caught by traffic police for a traffic law violation with data on violations available for 1,205 of these drivers, of whom 680 (56.4%) paid a fine, 310 (25.7%) paid by bribe, and 215 (17.8%) made no payment. The proportion of those who did not make payment for committed violation was significantly higher among females (46.8%) than males (16.3%). Two thousand fifty two (49%) of all MTVs had no rearview mirror CONCLUSIONS: These data suggest the need to enact and enforce policy interventions for improving the drivers license system, mandatory use of a helmet, effective traffic law enforcement, and ensuring good vehicle condition to reduce the risk factors that potentially contribute to mortality and morbidity in road traffic crashes in MTV drivers in Indian cities.

Accidents, Traffic↗
PubMed2006

Graduated driver licensing and teenage driver research in 2006.

This is the third update of research on graduated driver licensing (GDL) and related teenage driver issues. It briefly summarizes research published since or not included in the 2005 update (Hedlund, J., & Compton, R. (2005). Graduated driver licensing research in 2004 and 2005. Journal of Safety Research, 36(2), 109-119.), describes research in progress of which the authors are aware, and announces plans for a symposium on teenage driving and GDL to be held in February 2007.

Accidents, Traffic↗
PubMed2002

Responses of teenagers and their parents to California's graduated licensing system.

In 1998, California adopted a strong graduated licensing system that lengthened the learner's permit stage from 1 month to a mandatory 6 months and introduced passenger and nighttime restrictions for initial license holders. The passenger restriction (no passengers younger than 20 for the first 6 months) is stronger than such restrictions in any other state; the nighttime ban is relatively weak, not beginning until midnight. Surveys were undertaken to learn what teenagers and their parents thought about the new requirements and how they responded to them. Two groups of beginning California license holders were surveyed three times during the first year of licensure; their parents were interviewed twice. One group (n = 543) was subject to the graduated licensing requirements, the other (n = 814) was not. Parents strongly endorsed the new system. The vast majority approved of the new permit requirements and the nighttime and passenger restrictions. Among parents whose children were subject to the new requirements, 79% were strongly in favor of the new system and only 4% were neutral or opposed. Teenagers were less favorable toward the new requirements. Most approved of the new learner's permit rules, and the majority of teenagers favored the night restriction, but only about one-third endorsed the passenger restriction. Compliance with the new rules was not close to universal, but the new licensing system resulted in young people holding their learner's permits longer, accumulating more practice driving prior to licensure and decreased the amount of reported driving after midnight and transportation of teenagers when initially licensed. Most teenagers subject to the new rules said they were able to do the activities they wanted despite the changes; almost three-quarters said they were not affected much by either the nighttime or passenger restriction. Overall the results indicate that the new licensing system is accepted favorably by teenagers and their parents and has substantially increased the types of behaviors that collectively should lead to crash and injury reductions.

Accidents, Traffic↗
PubMed2003

Accident involvement among learner drivers--an analysis of the consequences of supervised practice.

It is a well-known fact that experience is important for safe driving. Previously, this presented a problem since experience was mostly gained during the most dangerous period of driving-the first years with a licence. In many countries, this "experience paradox" has been addressed by providing increased opportunities to gain experience through supervised practice. One question, however, which still needs to be answered is what has been lost and what has been gained through supervised practice. Does this method lead to fewer accidents after licensing and/or has the number of accidents in driving practice increased? There were three aims in the study. The first was to calculate the size of the accident problem in terms of the number of accidents, health risk and accident risk during practising. The second aim was to evaluate the solution of the "experience paradox" that supervised practice suggests by calculating the costs in terms of accidents during driving practice and the benefits in terms of reduced accident involvement after obtaining a licence. The third aim was to analyse conflict types that occur during driving practice. National register data on licence holders and police-reported injury accidents and self-reported exposure were used. The results show that during the period 1994-2000, 444 driving practice injury accidents were registered, compared to 13657 accidents during the first 2 years with a licence. The health risk during the period after licensing was 33 times higher and the accident risk 10 times higher than the corresponding risk during practice. The cost-benefit analysis showed that the benefits in terms of accident reduction after licensing were 30 times higher than the costs in terms of driving practice accidents. It is recommended that measures to reduce such accidents should focus on better education of the lay instructor, but not on introducing measures to reduce the amount of lay-instructed practice.

Accidents, Traffic↗
PubMed2000

Effect of Florida's graduated licensing program on the crash rate of teenage drivers.

On 1 July 1996, Florida instituted a graduated licensing program for drivers younger than age 18. For the first 3 months, holders of learner's licenses are not allowed to drive at all between 19:00 and 06:00 h; thereafter, they may drive until 22:00 h. Learner's licenses must be held for 6 months prior to eligibility for the intermediate license. Sixteen-year-old intermediate license holders are not permitted to drive unsupervised from 23:00 to 06:00 h, 17 year-olds from 01:00 to 06:00 h. All drivers younger than 18 have strict limits on the number of traffic violations they can accumulate and, effective 1 January 1997, all drivers younger than 21 are subject to a zero tolerance law for drinking and driving. Florida crash data for 1995-1997 were obtained and compared with similar data from Alabama, a state that borders Florida but does not have graduated licensing. For 15, 16, and 17 year-olds combined, there was a 9% reduction in the fatal and injury crash involvement rate in Florida during 1997, the first full year of graduated licensing, compared with 1995. On a percentage basis, crashes declined most among 15 year-olds, followed by 16 year-olds and then 17 year-olds. Reductions were not seen among Alabama teenagers nor among 18 year-olds in Florida.

Accidents, Traffic↗
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↗
PubMed2004

Concurrent validity of the stroke drivers screening assessment.

OBJECTIVE: To determine the concurrent validity of the Stroke Drivers Screening Assessment (SDSA). DESIGN: Comparison of the SDSA with criterion standards. SETTING: Subjects' homes in the community in the United Kingdom. PARTICIPANTS: Ninety-three stroke patients (age range, 22-83y) who were referred for assessment of fitness to drive or who had been driving before their stroke. Participants were assessed a median of 5 months post stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Patients were assessed on the SDSA and tests of visuospatial ability (Visual Object and Space Perception [VOSP] Battery), executive abilities (Stroop Neuropsychological Screening Test, Trail-Making Test [TMT], Cognitive Estimates Test [CET]), and visual memory (Recognition Memory Tests [RMT], Verbal Descriptions of Road Signs [VDRS]). RESULTS: The SDSA subtests all correlated significantly with the Stroop test (P<.001) and TMT (P<.001), which suggests that they measure executive abilities and attention. The SDSA Dot Cancellation (DC) also correlated significantly with the VDRS (P<.01). The SDSA Square Matrices (SM) test correlated significantly with the VOSP cube analysis (P< or =.01) and the RMT faces subtest (P<.001), which suggests that the SM test also measures visuospatial abilities and visual memory. The SDSA Road Sign Recognition (RSR) test also correlated significantly with the VOSP cube analysis (P<.05), which suggests that the RSR test also measures visuospatial abilities. Factor analysis produced a 2-factor solution with DC time, SM compass, and RSR all loading on factor 1, together with the Stroop and TMT. This factor was interpreted as "executive abilities and attention." The RMT faces subtest and CET loaded onto a second factor. CONCLUSIONS: The SDSA seems to measure predominantly attention and executive abilities, which have previously been shown to be important determinants of safety to drive. This may account for the high predictive validity of the SDSA.

Adult↗
PubMed2003

Reliability of a road test after stroke.

OBJECTIVE: To determine the reliability of the road test performed by stroke patients. DESIGN: Prospective study of a 6-month predriving evaluation. SETTING: Driving safety center in Belgium. PARTICIPANTS: Thirty patients with sequelae of stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Results of driving performance as judged by 2 assessors from the Center for Determination of Fitness to Drive and Car Adaptations (CARA), in a car fitted with a video camera. A third assessor also evaluated all the video recordings. Interrater reliability was evaluated by comparing results from real-life performance and video recording, as judged by the CARA assessors and video judgments between CARA assessors and the third assessor. RESULTS: Most subitems of the road test showed more than 80% scoring agreement between the various evaluations. Intraclass correlation coefficients (ICCs) of the items varied from -.08 to 1.0. The ICC of the overall performance was.62 when real-life scores were compared with video evaluations and.80 in video versus video comparison. CONCLUSION: The reliability of assessing overall performance of stroke patients in the road test is moderately high and better when assessed using the same evidence. Yet, the reliability of some items needs further attention.

Automobile Driver Examination↗