Association between cellular-telephone calls and motor vehicle collisions

Demographic characteristics and trends of cell phone use while driving citations in selected states in the United States, 2010-2020

OBJECTIVE

Distracted driving is a leading cause of motor vehicle crashes, and cell phone use is a major source of in-vehicle distraction. Many states in the United States have enacted cell phone use laws to regulate drivers' cell phone use behavior to enhance traffic safety. Numerous studies have examined the effects of such laws on drivers' cell phone use behavior based on self-reported and roadside observational data. However, little was known about who actually violated the laws at the enforcement level. This study sought to uncover the demographic characteristics of drivers cited for cell phone use while driving and whether these characteristics changed over time since the enactment of cell phone laws.

METHODS

We acquired useable traffic citation data for 7 states in the United States from 2010 to 2020 and performed descriptive and regression analyses.

RESULTS

Male drivers were cited more for cell phone use while driving. Handheld and texting bans were associated with a greater proportion of cited drivers aged 40 and above, compared to texting-only bans. Trends in the citations issued based on drivers' age group following the enactment of different cell phone laws were also uncovered. The proportion of citations issued to drivers aged 60 and above increased over time but the temporal trend remained insignificant when population effect was considered.

CONCLUSIONS

This study examined the demographic characteristics of drivers cited for cell phone use while driving in selected states with texting-only bans or handheld and texting bans. The results reveal policy-based differences in trends in the proportion of citations issued to drivers in different age groups.

Syncope and Traffic Crash: A Population-Based Case-Crossover Analysis

BACKGROUND

Among individuals with recent syncope, recurrence of syncope while driving might incapacitate a driver and cause a motor vehicle crash. Current driving restrictions assume that some forms of syncope transiently increase crash risk. We evaluated whether syncope is associated with a transient increase in crash risk.

METHODS

We performed a case-crossover analysis of linked administrative health and driving data from British Columbia, Canada (2010 to 2015). We included licensed drivers who visited an emergency department with "syncope and collapse" and who were involved as a driver in an eligible motor vehicle crash, both within the study interval. Using conditional logistic regression, we compared the rate of emergency visits for syncope in the 28 days before crash (the "pre-crash interval") with the rate of emergency visits for syncope in 3 self-matched 28-day control intervals (ending 6, 12, and 18 months before the crash).

RESULTS

Among eligible crash-involved drivers, 47 of 3026 pre-crash intervals and 112 of 9078 control intervals had emergency visits for syncope, indicating syncope was not significantly associated with subsequent crash (1.6% vs 1.2%; adjusted odds ratio [OR], 1.27; 95% confidence interval [CI], 0.90-1.79; P = 0.18). There was no significant association between syncope and crash in subgroups at higher risk for adverse outcomes after syncope (eg, age > 65 years, cardiovascular disease, cardiac syncope).

CONCLUSIONS

In the context of prevailing modifications of driving behaviour after syncope, an emergency department visit for syncope did not transiently increase the risk of subsequent traffic collision. Overall crash risks after syncope appear to be adequately addressed by current driving restrictions.

Personality, perceptions and behavior: A study of speeding amongst drivers in Victoria, Australia

INTRODUCTION

Road crashes present a serious public health issue. Many people are seriously or fatally injured every year in avoidable crashes. While these crashes can have multiple contributing factors, including road design and condition, vehicle design and condition, the environment and human error, the performance of illegal driving behavior, including speeding, may also play a role. The current study aimed to examine the mediating influence that four potential deterrents (perceptions towards enforcement, crash risk, social norms and disapproval, and negative personal/emotional affect) have between the Big Five personality traits (conscientiousness; extraversion; agreeableness; neuroticism; openness) and expectations to speed.

METHODS

A total of 5,108 drivers in Victoria, Australia completed an online survey in 2019. A mediated regression analysis was used to examine pathways in a conceptual model developed for the study.

RESULTS

The results showed that perceptions towards the four potential deterrents examined did mediate the relationship (either completely or partially) between personality and expectations to speed.

CONCLUSIONS

The results of this study suggest that if interventions to deter illegal driving behavior are to be successful, one factor that could be taken into account is the personality traits of drivers who may be at greatest risk of the performance of illegal driving behaviors.

Occupational hand trauma - Mechanism of injury and transient risk factors in Jerusalem

INTRODUCTION

Although prevalent, and variable geographically, there is little information on the incidence and risk factors for occupation hand trauma in our health care system. This pilot study was designed to determine the optimal data collection methods for transient risk factors locally METHODS: All adult patients with occupational hand trauma treated at an emergency department (ED) during a three-month period were interviewed, either in person or by phone, using a case crossover designed questionnaire, regarding occupation and exposure to potential transient risk factor.

RESULTS

Of 206 patients treated with occupational trauma during the study period, 94 had trauma distal to the elbow (46%). Patient compliance was high - 89% of the patients consented to phone interviews and 83% completed in-person ED interviews. In the 75 patients which participated in the study, several risk factors were found to be significant, including machine maintenance and being distracted, including by a cellular phone. We found lack of job experience, limited training on the job site and reports of previous injuries in these workplaces to be prevelent.

DISCUSSION

The risk factors implicated in this study are similar to those reported in previous studies at other locations and are modifiable although this is the first report linking cellular phone use and occupation trauma. This finding should be further examined in a larger group and according to occupational categories. Compliance with the study was high, in person or with phone interviews, making these options viable for further studies. Several minor changes to the questionnaire were suggested although it did conform with the case-crossover study design. According to this study, standard preventive measures may be lacking in Jerusalem and should be implemented more uniformly, including specific workplace safety plans and education and taking into consideration the risk factors documented here.

Optimization method to reduce the risky driving behaviors of ride-hailing drivers

INTRODUCTION

To promote the safety level of ride-hailing services, this study develops the Targeted and Differentiated Optimization Method of Risky Driving Behavior Education and Training (TDOM-RDBET) founded on driver type classification of high-risk drivers.

METHOD

Based on value and goal orientations, 689 drivers were classified into four driver types and were assigned to three groups, including an experimental group, a blank control group, and a general control group. This research preliminarily analyzes the effectiveness of the TDOM-RDBET to reduce mobile phone use while driving by assessing the main effects of the group and test session on the risk value ranking of mobile phone use while driving (AR), the frequency per 100 km of mobile phone use while driving (AF), and the frequency per 100 km of risky driving behaviors (AFR), as well as the interactive effects of the two factors on AR, AF, and AFR, based on a two-way analysis of variance (two-way ANOVA).

RESULTS

The results demonstrate an overall significant reduction in AR (F = 8.653, p = 0.003), AF (F = 11.027, p = 0.001), and AFR (F = 8.072, p = 0.005) for the experimental group after training. Moreover, significant interactive effects of the driver group × test session on AR (F = 7.481, p = 0.001) and AF (F = 15.217, p < 0.001) were found. AR was significantly lower for the experimental group than for the blank control group (p < 0.05) in the post-training condition. Moreover, AF was also significantly lower for the experimental group than for the blank control group (p < 0.05) and general control group (p < 0.05) in the post-training condition.

PRACTICAL APPLICATIONS

On the whole, it was preliminarily verified that the TDOM-RDBET is more effective than the general training method at modifying the risky driving behavior.

Investigating the role of beliefs in influencing the hand-held and hands-free mobile phone use among pedestrians in India

Mobile phone distraction is a significant contributor to pedestrian injuries. However, mobile phone engagement among pedestrians has been scarcely explored in a developing country like India. The present study utilized the beliefs-based theory of planned behaviour to examine the association between pedestrian beliefs towards distracted walking (behavioural, normative, and control) and their mobile phone use frequencies. Based on a survey of 560 pedestrians (64.6% males), it was found that the major use of mobile phones was for listening to music (30.7%), followed by receiving a call (25%), making a call (18.9%), texting (9.8%), navigation (8.5%) and internet browsing (7.1%). A series of multivariate ANOVAs and logistic regression models were developed to investigate the relationships between the beliefs and frequencies of mobile phone use in hands-free and hand-held conditions. Significant multivariate differences were found for behavioural and normative beliefs in hands-free conditions and all three types of beliefs in hand-held conditions. The frequency of mobile phone use was significantly predicted by normative beliefs (p < 0.001) in the hands-free condition, and by behavioural (p = 0.041) and normative beliefs (p = 0.004) in the hand-held condition. The findings may assist the road safety countermeasures in addressing the issue of pedestrian distraction.

Distraction "Hangover": Characterization of the Delayed Return to Baseline Driving Risk After Distracting Behaviors

OBJECTIVE

We measured how long distraction by a smartphone affects simulated driving behaviors after the tasks are completed (i.e., the distraction hangover).

BACKGROUND

Most drivers know that smartphones distract. Trying to limit distraction, drivers can use hands-free devices, where they only briefly glance at the smartphone. However, the cognitive cost of switching tasks from driving to communicating and back to driving adds an underappreciated, potentially long period to the total distraction time.

METHOD

Ninety-seven 21- to 78-year-old individuals who self-identified as active drivers and smartphone users engaged in a simulated driving scenario that included smartphone distractions. Peripheral-cue and car-following tasks were used to assess driving behavior, along with synchronized eye tracking.

RESULTS

The participants' lateral speed was larger than baseline for 15 s after the end of a voice distraction and for up to 25 s after a text distraction. Correct identification of peripheral cues dropped about 5% per decade of age, and participants from the 71+ age group missed seeing about 50% of peripheral cues within 4 s of the distraction. During distraction, coherence with the lead car in a following task dropped from 0.54 to 0.045, and seven participants rear-ended the lead car. Breadth of scanning contracted by 50% after distraction.

CONCLUSION

Simulated driving performance drops dramatically after smartphone distraction for all ages and for both voice and texting.

APPLICATION

Public education should include the dangers of any smartphone use during driving, including hands-free.

Labeling Out-of-View Objects in Immersive Analytics to Support Situated Visual Searching

Augmented Reality (AR) embeds digital information into objects of the physical world. Data can be shown in-situ, thereby enabling real-time visual comparisons and object search in real-life user tasks, such as comparing products and looking up scores in a sports game. While there have been studies on designing AR interfaces for situated information retrieval, there has only been limited research on AR object labeling for visual search tasks in the spatial environment. In this article, we identify and categorize different design aspects in AR label design and report on a formal user study on labels for out-of-view objects to support visual search tasks in AR. We design three visualization techniques for out-of-view object labeling in AR, which respectively encode the relative physical position (height-encoded), the rotational direction (angle-encoded), and the label values (value-encoded) of the objects. We further implement two traditional in-view object labeling techniques, where labels are placed either next to the respective objects (situated) or at the edge of the AR FoV (boundary). We evaluate these five different label conditions in three visual search tasks for static objects. Our study shows that out-of-view object labels are beneficial when searching for objects outside the FoV, spatial orientation, and when comparing multiple spatially sparse objects. Angle-encoded labels with directional cues of the surrounding objects have the overall best performance with the highest user satisfaction. We discuss the implications of our findings for future immersive AR interface design.

Mobile phone penalties and road crashes: Are changes in sanctions effective?

INTRODUCTION

Road crashes are a major, preventable cause of death and serious injury. Being distracted by a mobile phone while driving can increase the risk of a crash by three to four times and increase crash severity. To reduce distracted driving, on 1 March 2017 the penalty for using a hand-held mobile phone while driving in Britain doubled to ₤200 and six penalty points.

METHOD

We examine the effects of this increased penalty on numbers of serious or fatal crashes over 6 weeks either side of the intervention using Regression Discontinuity in Time.

RESULTS

We find no effect of the intervention, suggesting the increased penalty is not effective in reducing the more serious road crashes.

CONCLUSIONS

We rule out an information problem and an enforcement effect, concluding the increase in fines was insufficient to change behaviour. With very low detection rates of mobile phone use, our result could occur if the perceived certainty of punishment remained very low after the intervention.

PRACTICAL APPLICATION

Future technology will increase the ability to detect mobile phone usage, and there may be fewer road crashes if the solution is to raise awareness of such technology and publicise numbers of offenders caught. Alternatively, a mobile phone blocking application could avert the problem.

How do the type and duration of distraction affect speed selection and crash risk? An evaluation using naturalistic driving data

Distracted driving is among the leading causes of roadway crashes worldwide. However, due to limitations of police-reported crash data, it is often challenging to understand the nature and magnitude of this problem. Distraction has also been shown to affect driver speed selection, which is important as both mean speed and speed variance have substantive impacts on crash risk. This study utilizes naturalistic driving data to investigate the relationship between the engagement in various secondary (non-driving) tasks and driver speed selection under different driving contexts. Separate analyses were conducted for low-speed and high-speed driving environments. Two-way random effects linear regression models were estimated for both speed regimes, while controlling for driver, roadway, and traffic characteristics. The differences were assessed based upon ten types of secondary tasks. In general, engagement in all tasks was found to decrease speeds in high-speed environments while the effects were mixed in low-speed settings. The changes in speeds were much pronounced for secondary tasks that include a combination of visual, manual, and cognitive distractions, such as cell phone use. Among all secondary tasks, an average episode of a driver talking on a handheld cellphone was associated with a 6-mph speed reduction in high-speed environments, but a 3.5-mph increase in low-speed settings. In addition to examining impacts on speed selection, the risk of involvement in crash and near-crash events was also evaluated in consideration of the type and duration of distraction. Interestingly, distractions tended to show similar relationships, in both direction and magnitude, with the risk of involvement in both crash and near-crash events. From a policy standpoint, this study provides further motivation for legislation and other programs aimed at curbing distracted driving.

Do Cellphone Bans Save Lives? Evidence From Handheld Laws on Traffic Fatalities

Distracted driving is one of the leading causes of fatal motor vehicle accidents in the United States. Policymakers in several states have responded to this phenomenon by implementing laws that restrict the use of handheld devices while operating a vehicle. In this paper, we utilize various quasi-experimental designs to estimate the impact of state-level handheld mandates on traffic fatalities. We find robust evidence that restricting the use of handheld devices while driving reduces daily traffic fatalities by 0.63 individuals in the short term. The results further indicate that while the magnitude of the impact is smaller in the long term, this policy is still effective at curbing traffic fatalities, saving more than 69 lives per state each year.

Control Yourself: Broad Implications of Narrowed Attention

Attention represents a key element of self-control, and multiple theoretical accounts have highlighted the role played by abundant attentional capacity in effecting successful self-regulation. What, then, are the consequences of living in today's world, in which attention can become so easily divided by a multitude of stimuli? In this article, we consider the implications of divided attention for self-control and show that although the end result is typically disinhibited behavior, under specified conditions, attentional limitation, or what we term attentional myopia, can be associated with enhanced restraint.

Factors Influencing Pedestrian Smartphone Use and Effect of Combined Visual and Auditory Intervention on “Smombies”: A Chinese Observational Study

Objective: This was a large-scale multicenter study with two objectives. One was to study the factors influencing pedestrian smartphone use while crossing roads, and the other was to study the effect of combined visual and auditory intervention on smartphone zombies (smombies) at crossroads.

Methods: This study was conducted in four different Chinese cities. By observing pedestrians crossing intersections, the weather, time, and characteristics of the pedestrians were recorded by four researchers. Then, its influencing factors and the effects of the intervention were studied in two consecutive periods.

Results: A total of 25,860 pedestrians (13,086 without intervention and 12,774 with visual and auditory intervention) were observed in this study. Logistic regressions showed that gender, age of the pedestrians, weather, and time were the factors influencing smombies crossing roads. The number of smartphone users decreased from 4,289 to 3,579 (28.1%) (χ² = 69.120, p < 0.001) when the intervention was conducted.

Conclusion: Based on large-sample, multicenter research, this study revealed the factors influencing pedestrian smartphone use while crossing roads, contributing to our understanding of the current situation of smombies in China. Furthermore, the effect of visual and auditory intervention was demonstrated, providing a new paradigm for global prevention of smombie behavior.

Adverse Events Associated With Coprescription of Phosphodiesterase Type 5 Inhibitors and Oral Organic Nitrates in Male Patients With Ischemic Heart Disease : A Case-Crossover Study

BACKGROUND

Concomitant use of oral organic nitrates (nitrates) and phosphodiesterase type 5 (PDE5) inhibitors is contraindicated.

OBJECTIVE

To measure temporal trends in the coprescription of nitrates and PDE5 inhibitors and to measure the association between cardiovascular outcomes and the coprescription of nitrates with PDE5 inhibitors.

DESIGN

Case-crossover design.

SETTING

Nationwide study of Danish patients from 2000 to 2018.

PATIENTS

Male patients with International Classification of Diseases, 10th Revision (ICD-10) codes for ischemic heart disease (IHD), including those who had a continuing prescription for nitrates and a new, filled prescription for PDE5 inhibitors.

MEASUREMENTS

Two composite outcomes were measured: 1) cardiac arrest, shock, myocardial infarction, ischemic stroke, or acute coronary arteriography and 2) syncope, angina pectoris, or drug-related adverse event.

RESULTS

From 2000 to 2018, 249 541 male patients with IHD were identified. Of these, 42 073 patients had continuing prescriptions for nitrates. During this period, the prescription rate for PDE5 inhibitors in patients with IHD who were taking nitrates increased from an average of 0.9 prescriptions (95% CI, 0.5 to 1.2 prescriptions) per 100 persons per year in 2000 to 19.5 prescriptions (CI, 18.0 to 21.1 prescriptions) in 2018. No statistically significant association was found between the coprescription of nitrates with PDE5 inhibitors and the risk for either composite outcome (odds ratio [OR], 0.58 [CI, 0.28 to 1.13] for the first outcome and OR, 0.73 [CI, 0.40 to 1.32] for the second outcome).

LIMITATION

An assumption was made that concurrently filled prescriptions for nitrates and PDE5 inhibitors equaled concomitant use.

CONCLUSION

From 2000 to 2018, the use of PDE5 inhibitors increased 20-fold among Danish patients with IHD who were taking nitrates. A statistically significant association between concomitant use of these medications and cardiovascular adverse events could not be identified.

PRIMARY FUNDING SOURCE

Ib Mogens Kristiansens Almene Fond and Helsefonden.

Clinical Decision Support Stewardship: Best Practices and Techniques to Monitor and Improve Interruptive Alerts

Interruptive clinical decision support systems, both within and outside of electronic health records, are a resource that should be used sparingly and monitored closely. Excessive use of interruptive alerting can quickly lead to alert fatigue and decreased effectiveness and ignoring of alerts. In this review, we discuss the evidence for effective alert stewardship as well as practices and methods we have found useful to assess interruptive alert burden, reduce excessive firings, optimize alert effectiveness, and establish quality governance at our institutions. We also discuss the importance of a holistic view of the alerting ecosystem beyond the electronic health record.

EXPRESS: Are there Associations between Daily Multitasking Experience and Multitasking Performance?

Research showed mixed findings regarding the relationships between daily multitasking experience and laboratory multitasking performance. One measurement issue was the low reliability and validity of using a single measurement for daily multitasking experience. Another measurement issue was the popular use of simple laboratory paradigms that may or may not capture well cognitive processes underlying real-life multitasking. The current study revisited the relationship between daily multitasking experience and multitasking performance with a better design. Multiple measurements were used to ensure good reliability and validity. This included a mobile phone task switching measurement - an arguably better proxy for daily multitasking experience and three realistic multitasking paradigms that mimic real life multitasking situations. The results showed that (1) phone switching was not significantly associated with the media multitasking index, suggesting that they were measuring different aspects of multitasking experience; (2) indicators of the multitasking performance were moderately correlated among themselves, suggesting that different realistic multitasking paradigms were measuring overlapping multitasking abilities; and, intriguingly, (3) no significant association between multitasking experience and performance indicators was found. One possibility is that people can only benefit from daily multitasking practice when they engaged in daily multitasking activities with an intention to improve the performance. Other possibilities and implications were also discussed.

Vision, Driving Exposure, and Collisions in Bioptic Drivers

SIGNIFICANCE

Lack of knowledge regarding the mileage driven by drivers with low vision who use bioptic telescopes could obscure the relationship between vision and road safety. This study provides data suggesting that worse vision is correlated with less mileage driven but more collisions per mile in bioptic drivers.

PURPOSE

The purpose of this study was to determine whether vision or demographic factors predict mileage driven in bioptic drivers and per-mile motor vehicle collision rate and also to compare the collision rate of bioptic drivers with previous estimates for the general population.

METHODS

Driver data were collected retrospectively from clinic records. Collision data were collected from the Ohio Bureau of Motor Vehicles database. Subjects were also asked to estimate their yearly mileage. Regression models were used to investigate relationships between vision and collision rates.

RESULTS

Seventy-three licensed Ohio bioptic drivers (36 male) were included. Mean ± standard deviation age was 51 ± 16 years. Mean logMAR visual acuity was 0.67 (approximately 20/100). Mean log contrast sensitivity was 1.57. Mean reported annual mileage was 9746. Age, sex, and previous (nonbioptic) driving experience were not associated with mileage. LogMAR visual acuity was inversely related to mileage (P = .02), and contrast sensitivity (P = .01) and horizontal visual field (P = .02) were directly associated with mileage. Visual acuity (P = .02) and visual field (P = .005), but not contrast sensitivity (P = .19), were associated with number of collisions.

CONCLUSIONS

Visual acuity, visual field, and contrast sensitivity were associated with driving exposure in bioptic drivers (with drivers with poorer vision reporting lower annual mileage), and poorer visual acuity and visual field were associated with more collisions. The per-mile collision rate for bioptic drivers was within the range of that previously reported for fully sighted drivers, although higher than would be expected for fully sighted drivers of similar age distribution.

Risk of Accidents or Chronic Disorders From Improper Use of Mobile Phones: A Systematic Review and Meta-analysis

Background

Mobile phone use has brought convenience, but the long or improper use of mobile phones can cause harm to the human body.

Objective

We aimed to assess the impact of improper mobile phone use on the risks of accidents and chronic disorders.

Methods

We systematically searched in PubMed, EMBASE, Cochrane, and Web of Science databases for studies published prior to April 5, 2019; relevant reviews were also searched to identify additional studies. A random-effects model was used to calculate the overall pooled estimates.

Results

Mobile phone users had a higher risk of accidents (relative risk [RR] 1.37, 95% CI 1.22 to 1.55). Long-term use of mobile phones increased accident risk relative to nonuse or short-term use (RR 2.10, 95% CI 1.63 to 2.70). Compared with nonuse, mobile phone use resulted in a higher risk for neoplasms (RR 1.07, 95% CI 1.01 to 1.14), eye diseases (RR 2.03, 95% CI 1.27 to 3.23), mental health disorders (RR 1.16, 95% CI 1.02 to 1.32), and headaches (RR 1.25, 95% CI 1.18 to 1.32); the pooled risk of other chronic disorders was 1.20 (95% CI 0.90 to 1.59). Subgroup analyses also confirmed the increased risk of accidents and chronic disorders.

Conclusions

Improper use of mobile phones can harm the human body. While enjoying the convenience brought by mobile phones, people have to use mobile phones properly and reasonably.

Structural anatomy and temporal trends of road accident research: Full-scope analyses of the field

INTRODUCTION

Scholarly research on road accidents over the past 50 years has generated substantial literature. We propose a robust search strategy to retrieve and analyze this literature.

METHOD

Analyses was focused on estimating the size of this literature and examining its intellectual anatomy and temporal trends using bibliometric indicators of its articles.

RESULTS

The size of the literature is estimated to have exceeded N = 25,000 items as of 2020. At the highest level of aggregation, patterns of term co-occurrence in road accident articles point to the presence of six major divisions: (i) law, legislation & road trauma statistics; (ii) vehicular safety technology; (iii) statistical modelling; (iv) driving simulator experiments of driving behavior; (v) driver style and personality (social psychology); and (vi) vehicle crashworthiness and occupant protection division. Analyses identify the emergence of various research clusters and their progress over time along with their respective influential entities. For example, driver injury severity " and crash frequency show distinct characteristics of trending topics, with research activities in those areas notably intensified since 2015 Also, two developing clusters labelled autonomous vehicle and automated vehicle show distinct signs of becoming emerging streams of road accident literature.

CONCLUSIONS

By objectively documenting temporal patterns in the development of the field, these analyses could offer new levels of insight into the intellectual composition of this field, its future directions, and knowledge gaps. Practical Applications: The proposed search strategy can be modified to generate specific subsets of this literature and assist future conventional reviews. The findings of temporal analyses could also be instrumental in informing and enriching literature review sections of original research articles. Analyses of authorships can facilitate collaborations, particularly across various divisions of accident research field.

Smartphone-Related Accidents in Children and Adolescents: A Novel Mechanism of Injury

OBJECTIVES

Smartphones have become an integral part of daily life, often grabbing full attention of its user. We hypothesized that smartphone-associated trauma in children and adolescents has increased in the last decade. The objective of this study was to analyze smartphone-related injuries in children at two German centers for pediatric emergency care.

METHODS

Smartphone-related injuries were recorded between January 2008 and March 2018 at two centers of pediatric surgery in Germany. Data were assessed for patient demography, cause of accident, type of injury, treatment, and outcome.

RESULTS

Ten children (8 girls, 2 boys; mean ± SD age, 10.6 ± 6.0 years; range, 10 weeks to 17 years) were included. Two patients were injured in 2008 to 2015, eight in 2016 to 2018, of which three required hospital admissions. Six accidents happened in public spaces, and four within domestic environments. Eight children (mean ± SD age, 13.3 ± 2.4 years; 7 girls) were injured while using their smartphone, therefore being distracted. Two children (mean ± SD age, 6.5 ± 6.4 months) were involuntarily hurt by the smartphone of their caregivers. The causes of accident and related injuries were highly variable and ranged from minor trauma (mild head injury [n = 3], abrasions [n = 2], bruises of fingers [n = 2]/hand [n = 1]/ankle [n = 2]) to major injuries requiring intensive care treatment (pelvic [n = 1] or vertebral body fractures [n = 1]).

CONCLUSIONS

Smartphone-associated injuries mainly caused by distraction gain increasing importance in pediatric traumatology. The frequency is higher in females compared with their male counterparts. The prevention of these accidents should become part of educational programs for children and adolescents.

The mere presence of a mobile phone: Does it influence driving performance?

The ubiquity of mobile phones has led to a rapid increase in its presence and use in vehicles, especially among young adults (up to 25 years), who are generally the least experienced group of drivers. The potential for phones to draw attention away from the main driving task has significant consequences for road safety. Previous studies have found that the mere presence of a mobile phone can be distracting by impairing attention in experimental non-driving contexts. However, the effect of phone presence, independent to usage, has not yet been examined in the context of driving. As such, the present study examined whether the mere presence of a mobile phone, its proximity to the driver, and power status (on/off) influenced the driving performance of young drivers. Additionally, this study assessed whether the effects of phone presence and proximity were moderated by an individual's level of dependence on, or emotional attachment to, their phone. A sample of 127 undergraduate psychology students (M = 19.76, SD = 1.63) were randomly assigned to one of four conditions: (1) phone absent (control), (2) phone on, in holder, (3) phone off, in holder, and (4) phone on, in pocket. They all completed the same simulated drive, and were measured for degree of phone dependence and phone emotional attachment. Overall, drivers in all the phone present conditions made significantly more driving errors (speeding and collision) compared to those in the phone absent (control) condition, irrespective of proximity to the phone and whether it was on or off. Phone dependence, but not phone emotional attachment, moderated the effect of phone presence on speeding behaviour. These findings suggest that the mere presence of a phone is distracting for drivers, especially so for those who are highly dependent on their phone, which may place them at a greater risk of a distraction induced crash.

Bans on Cellphone Use While Driving and Traffic Fatalities in the United States

BACKGROUND

As of January 2020, 18 of 50 US states comprehensively banned almost all handheld cellphone use while driving, 3 states and the District of Columbia banned calling and texting, 27 states banned texting on a handheld cellphone, and 2 states had no general cellphone ban for all drivers. However, it remains unknown whether these bans were associated with fewer traffic deaths and whether comprehensive handheld bans are more effective than isolated calling or texting bans. We evaluated whether cellphone bans were associated with fewer driver, non-driver, and total fatalities nationally.

METHODS

We conducted a longitudinal panel analysis of traffic fatality rates by state, year, and quarter. Population-based rate ratios and 95% CIs were estimated comparing state-quarters with and without cellphone bans.

RESULTS

From 1999 through 2016, 616,289 persons including 344,003 drivers died in passenger vehicle crashes in the United States. Relative to no ban, comprehensive handheld bans were associated with lower driver fatality rates (adjusted rate ratio aRR = 0.93, 95% CI = 0.90, 0.97) but not for non-driver fatalities (aRR = 1.01, 95% CI = 0.95, 1.07) or total fatalities (aRR = 0.98, 95% CI = 0.94, 1.01). We found no differences in driver fatalities for calling-only bans (aRR = 1.00, 95% CI = 0.97, 1.03), texting-only bans (aRR = 1.02, 95% CI = 0.99, 1.05), texting plus phone-manipulating bans (aRR = 0.99, 95% CI = 0.93, 1.04), or calling and texting bans (aRR = 0.98, 95% CI = 0.88, 1.09).

CONCLUSIONS

Comprehensive handheld bans were associated with fewer driver fatalities.

A survey of distracted driving and electronic device use among app-based and taxi drivers

OBJECTIVES

The purpose of this study was to identify, characterize and compare attitudes, beliefs, behaviors and other factors related to electronic device (ED) use and distracted driving (DD) among taxi and app-based drivers.

METHODS

A survey among drivers in San Diego and across the United States was used to collect self-reported attitudes and behaviors among taxi and app-based passenger-carrying drivers from October 1, 2016 to January 31, 2017. Chi-square or Fisher's exact test was used to assess the difference between sociodemographics, ED use, ED use attitudes, and citation and crash history by driver type. Prevalence ratios were assessed for differences in ED use and ED use attitudes by driver type using Poisson regression models with robust error variance and a log link function. The final models adjusted for age, sex, level of experience, education and English fluency. All analyses were performed using SAS version 9.4.

RESULTS

Of the 175 drivers that met eligibility criteria, 131 reported driving for app-based services and 44 identified as taxi drivers. Compared to taxi drivers, app-based drivers were more likely to be female, native English speaking, and have fewer than 3 years of experience in the transportation business. All drivers reported at least one type of DD while the car was in motion. App-based drivers were significantly more likely to use a smartphone while driving (adjusted prevalence ratio (APR): 1.42), report that while driving it is safe or very safe to accept a call (APR: 1.73), receive/respond to a passenger request (APR: 3.40), or process a payment (APR: 5.39). Taxi drivers were more likely to either receive a citation for ED use (31.8% v 7.6%, p < 0.001) or be in a collision while using ED (29.6% v 4.6%, p < 0.001). Almost all drivers who received a citation or who were involved in a crash reported becoming somewhat or significantly more cautious about using ED while driving.

CONCLUSIONS

Drivers in the small passenger-carrying transportation industry engage in DD frequently due to occupational demands. Given the known increased crash risk with DD, effective policies and interventions for app-based and taxi drivers are needed.

The effect of cellphone position on driving and gaze behaviour

Legislation frequently restricts the use of cellphones while driving. Despite this, many people continue to interact with cellphones covertly while driving, typically by concealing their device in their lap. This strategy leads to frequent diversion of the drivers' gaze from the road ahead, potentially reducing their driving performance. To evaluate the influence of cellphone use on driving, 30 participants took part in three randomly ordered 7-min virtual reality driving simulations. In each condition, drivers were presented with either (a) no cellphone, (b) a cellphone fixed to the windscreen, or (c) a cellphone positioned at lap level. Their task was to maintain road position and observe speed limits while answering maths problems (delivered intermittently via 'text message') and searching for external target objects. Outcome measures included speed, lane position standard deviation (LPSD), and fixation behaviour, which were compared between trials. In trials where a cellphone was present, participants shifted fixation more frequently, drove approximately 6 km/h faster, exhibited a lower LPSD and spent more time in the correct lane on the road (compared to the no-cellphone condition; all p < 0.001). Cellphone position influenced eye gaze behaviour, with drivers looking at the cellphone less frequently, and the speedometer more frequently. when the cellphone was in their lap compared to when the cellphone was positioned on the windscreen. Our results are consistent with participants driving more cautiously-checking speed and lane position more frequently-when they have a cellphone in the lap. Real-world driving data would be useful to determine whether this change in driving behaviour we observed is sufficient to offset the increased risk introduced by spending less time looking at the road ahead.

Factors affecting behavior of mobile phone use while driving and effect of mobile phone use on driving performance

This study analyzed factors affecting behavior of mobile phone use while driving and its effects on driving performance, in terms of speed, lateral position, steer deviation, steer speed, following distance, perception-reaction time, and occurrence of a near miss situation. To investigate the factors affecting behavior of mobile phone use while driving, 1106 respondents from four different regions in Thailand participated in the questionnaire survey study. Theory of Planned Behavior (TPB) was used to explain these factors including two additional extended factors which are risk perception and law enforcement knowledge. The outcome of this part shows that attitude, norm, and law enforcement knowledge significantly affect the intention and behavior of the drivers. Even though approximately 90 percent of drivers realized that using a mobile phone while driving was dangerous and against the law, they have reported that they still use mobile phone while driving. To determine the effect of mobile phone use on driving performance, a 2-lane, straight rural highway, with a leading vehicle and an unexpected "STOP" sign, were simulated in order to examine the driving performance of drivers "without a phone", "talking on a phone call", and "texting a message" conditions. The results found that using mobile phone while driving can reduce speed and following distance, but increase lateral deviation, steer deviation, steer speed, perception-reaction time, and number of near misses leading to higher risks for road crashes.

Characterizing phone usage while driving: Safety impact from road and operational perspectives using factor analysis

Phone use while driving (PUWD) is one of the most crucial factors of distraction related traffic crashes. This study utilized an unsupervised learning method, known as factor analysis, on a unique distracted driving dataset to understand PUWD behavior from the roadway geometry and operational perspectives. The results indicate that the presence of a shoulder, median, and access control on the relatively higher functional class roadways could encourage more PUWD events. The roadways with relatively lower speed limits could have high PUWD event occurrences if the variation in operating speed is high. The results also confirm the correlations between the frequency of PUWD events and the frequency of distracted crashes. This relationship is strong on urban roadways. For rural roadways, this correlation is only strong on the roadways with a large amount of PUWD events. The findings could help transportation agencies to identify suitable countermeasures in reducing distraction related crashes. Moreover, this study provides researchers a new perspective to study PUWD behavior rather than only focus on drivers' personalities.

Road Injuries Associated With Cellular Phone Use While Walking or Riding a Bicycle or an Electric Bicycle: A Case-Crossover Study

Vulnerable road users (pedestrians, bicyclists, and motorcyclists) account for an increasing proportion of traffic injuries. We used a case-crossover study design to examine the association between cell-phone usage and traffic injuries among pedestrians, bicyclists, and electric bicycle riders during the course of their travel. We studied 643 pedestrians, bike riders, and electric bike riders aged 10-35 years who were involved in a road injury, visited the emergency department in one of the 3 hospitals in Shanghai, China, in 2019, and owned a cell phone. Half of the participants (n = 323; 50.2%) had used a cell phone within 1 minute before the injury happened. A pedestrian's or rider's use of a mobile phone up to 1 minute before a road injury was associated with a 3-fold increase in the likelihood of injury (odds ratio = 3.00, 95% confidence interval: 2.04, 4.42; P < 0.001). The finding was consistent across subgroups by sex, occupation, reason for travel, mode of transportation, and location of injury. Use of a cell phone when walking or riding was associated with an increased risk of road injury. Measures should be taken to make people aware of this detrimental impact on the risk of road injury.

Driving safety assessment for ride-hailing drivers

Ride-hailing services, which have become increasingly prevalent in the last decade, provide an efficient travel mode by matching drivers and travelers via smartphone apps. Ride-hailing services enable millions of non-traditional taxi drivers to provide travel services, but may also raise safety concerns due to heterogeneity in the driver population. This study evaluated crash risk factors for ride-hailing drivers, including driving history and ride-hailing operational characteristics, using a sample of 189,815 drivers. We utilized the Poisson generalized additive model to accommodate for the potential nonlinear relationship between crash rate and risk factors. Results showed that crash history, the percentage of long-shift bookings, driving distance, operations during peak hours, years of being a ride-hailing driver, and passenger rating were significantly associated with crash risk. Several factors showed nonlinear relationships with crash risk. We adopted the SHapley Additive exPlanation (SHAP) method to assess and visualize the impact of each risk factor. The results indicated that passenger average rating, total driving distance, and crash history were the leading contributing factors. The findings of this study provide critical information for the development of safety countermeasures, driver education programs, as well as safety regulations for the ride-hailing industry.

Effects of a dual task and different levels of divided attention on motor-related cortical potential

[Purpose] The aim of this study was to investigate the effect of divided attention on motor-related cortical potential (MRCP) during dual task performance while the difficulty of the secondary task was altered. [Participants and Methods] Twenty-two right-handed healthy volunteers participated in the study. MRCPs were recorded during two tasks, a single task (ST) and a simple (S-DT) or complex dual task (C-DT). The ST involved a self-paced tapping task in which the participants extended their right index finger. In the dual task, the participants performed the ST and a visual number counting task simultaneously. [Results] The amplitude and integral value of MRCP from electroencephalography electrode C3 was significantly higher in the S-DT than in the ST, whereas they were similar between the C-DT and the ST. Medium-load divided attention (i.e., S-DT) led to significantly more changes in the MRCP magnitude than did low-load divided attention (i.e., ST). However, the MRCP of high-load divided attention (i.e., C-DT) was similar to that of low-load divided attention. [Conclusion] These results suggest that MRCP reflects the function of or network between the supplementary motor area and the dorsolateral prefrontal cortex, and may serve as a marker for screening the capacity of individuals to perform dual tasks.

Cellphone laws and teens' calling while driving: analysis of repeated cross-sectional surveys in 2013, 2015, 2017, and 2019

Background

Distracted driving among teens is a public health and safety concern. Most states in the U.S. have sought to restrict cellphone use while driving by enacting laws. This study examines the difference in prevalence of self-reported calling while driving (CWD) between states with different cellphone bans.

Methods

Demographics and CWD data were extracted from state Youth Risk Behavior Surveys (YRBS) from 14 states in 2013, 2015, 2017, and 2019. The state YRBS is conducted every 2 years with a representative sample of 9th through 12th grade students attending public school. States were grouped by type of cellphone law(s): no ban (the absence of both handheld calling ban and young driver ban), young driver ban (a ban on all forms of cellphone use while driving, for young drivers only), or concurrent ban (a young driver ban plus a ban on handheld calling for all drivers irrespective of age). Poisson regression models with robust variance were used to estimate prevalence ratios comparing CWD prevalence across ban types.

Results

In total, 157,423 high school students participated in the surveys, and 65,044 (45%) participants reached the minimum age to obtain an intermediate license and drove during the 30 days prior the survey. Approximately 53% of participants reported CWD at least once during the previous 30 days, and the percentages varied widely by states (range: 51–55%). Compared to students from states with no ban, those from states with concurrent bans were 19%(95% CI: 14–24%) less likely to engage in CWD. Students in states with concurrent bans were 23% less likely to engage in CWD compared to students in states with young driver bans (95% CI:17–27%).

Conclusions

Engaging in CWD is common among teen drivers. The concurrent implementation of a handheld calling ban and a young driver ban was associated with a lower prevalence of CWD.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40621-020-00290-x.

Characteristics of driver cell phone use and their influence on driving performance: A naturalistic driving study

Cell phone use while driving is becoming a key problem in traffic safety as it causes visual-manual distraction and has been linked to increases in crash rates. The use of hand-held phones has been banned in several countries, yet research comparing the safety of hands-free phone use with hand-held has produced inconsistent results. Analysis of specific phone use characteristics could help move this traffic safety problem toward a solution, but few studies have considered the influence on driving performance of specific sets of phone use characteristics in combination with other factors such as driving context and driver demographic characteristics. The main objective of this paper is therefore to identify and analyze these factors to determine their effects on driving performance indicators such as speed changes. To this end, 1244 phone events were collected from 52 drivers from the Shanghai Naturalistic Driving Study (SH-NDS), the first naturalistic driving data in China. Because subtasks within a phone event may cause different visual-manual distractions, a hierarchical coding structure for phone events was built. A total of 5662 eyes-off-road (EOR) cases and 4237 subtasks were extracted. The results showed that on average, the participating drivers used the phone for 6.08 % of their driving time; for 17 % of phone use time, drivers used both hands to manipulate the phone; and their average EOR time was 3.16 s, which is equivalent to driving blindly for 22.82 m at an average speed of 7.22 m/s, or 26 km/hr. The effect of phone use on driving performance, including speed, headway, and lane offset, was analyzed with ANOVA. Results showed that standard deviations (SD) of all three parameters were significantly lower during phone periods than during baseline periods. The speed SD during phone use was 0.95 lower than baseline, the headway SD was 2.48 lower, and the absolute lane offset SD was 685.72 lower than baseline. These lower SDs indicate that drivers operated their vehicles with less fluctuation during phone use. While we were unable to find similar differences in mean speed and mean headway, mean lane offset was also significantly lower with phone use than without. A decision tree was developed to identify the factors influencing driver speed change. Results showed that drivers increased, decreased, or maintained speed depending on the type and duration of phone tasks, the duration of the trip, and the type of roadway. Greater understanding of the specific aspects of phone use and their influences on driver distraction and performance will permit the development of more effective countermeasures, including legislation, enforcement, blocking technologies, social norms education, and sending Do Not Disturb messages to callers, all of which will be required to mitigate continued deaths and injuries from phone use while driving.

Do beliefs differ between frequent and infrequent hand-held and hands-free phone users while driving? A Polish study

Aim

Although it is currently legal in Poland to use a hands-free mobile phone while driving, research suggests that it is not significantly safer than using a hand-held mobile phone. The present study used the theory of planned behaviour (TPB) to examine the relationships that three types of beliefs (behavioural, normative and control beliefs) have with the frequency of drivers’ hands-free and hand-held mobile phone use.

Subjects and methods

The sample comprised 298 Polish drivers (35% females) aged between 18 and 40 years old (mean age: 21.05 years, standard deviation = 2.38).

Results

Two multivariate analyses of variance (MANOVAs) were conducted to investigate the differences between the two groups (hand-held and hands-free) of frequent and infrequent mobile phone users, with regard to their behavioural, normative and control beliefs. Significant differences were found in all of the control beliefs for both hand-held and hands-free mobile phone users. Similar normative differences were identified for both hands-free and hand-held mobile phone use, but while three behavioural beliefs differed significantly for hands-free use, no behavioural beliefs were significant for hand-held mobile phone use. Finally, composite measures of the behavioural and control beliefs were predictive of being a frequent hand-held mobile phone user, but none of the three beliefs were predictive of being a frequent hands-free user.

Conclusions

These results demonstrate potential directions for behavioural change aimed at reducing or preventing the use of mobile phones while driving.

Methodological considerations in MVC epidemiological research

Background

The global burden of MVC injuries and deaths among vulnerable road users, has led to the implementation of prevention programmes and policies at the local and national level. MVC epidemiological research is key to quantifying MVC burden, identifying risk factors and evaluating interventions. There are, however, several methodological considerations in MVC epidemiological research.

Methods

This manuscript collates and describes methodological considerations in MVC epidemiological research, using examples drawn from published studies, with a focus on the vulnerable road user population of children and adolescents.

Results

Methodological considerations in MVC epidemiological research include the availability and quality of data to measure counts and calculate event rates and challenges in evaluation related to study design, measurement and statistical analysis. Recommendations include innovative data collection (eg, naturalistic design, stepped-wedge clinical trials), combining data sources for a more comprehensive representation of collision events, and the use of machine learning/artificial intelligence for large data sets.

Conclusions

MVC epidemiological research can be challenging at all levels: data capture and quality, study design, measurement and analysis. Addressing these challenges using innovative data collection and analysis methods is required.

Therapeutic Strategies for Mitigating Driving Risk in Patients with Narcolepsy

Narcolepsy is a central nervous system hypersomnia disorder characterized by uncontrollable episodes of daytime sleep, sleep state instability, and cataplexy (sudden loss of muscle tone precipitated by emotion). Individuals with narcolepsy report more frequent sleep-related crashes, near crashes, and drowsy driving than drivers with other sleep disorders. As such, evaluating risk of sleep-related crashes is of great importance for this patient population. There are no established guidelines for ensuring driving safety in patients with narcolepsy; however, many providers currently use a combination of subjective report, report of prior crashes or near-misses, report of previously falling asleep while driving, sleepiness screening tools, and maintenance of wakefulness testing (MWT) to determine risk. Driving simulator tests, though often unavailable to the clinician, provide data to support the use of MWT for evaluation of alertness in drivers with narcolepsy. Treatments such as modafinil may improve driving performance; however, the impact of other treatments such as stimulants and sodium oxybate on driving has not been extensively studied. Behavioral and lifestyle modifications may also reduce risk, including scheduled naps, driving only short distances, and avoiding driving after meals, sedating medications, and alcohol intake. Even with effective treatment, alertness in patients with narcolepsy may never reach that of normal drivers; however, studies have suggested that narcolepsy patients may be able to drive safely with appropriate limitations.

Hold the Phone! Cell Phone-Related Injuries in Children, Teens, and Young Adults Are On the Rise

We describe trends in cell phone-related injuries in patients 21 years of age and under presenting to United States Emergency Departments. We calculated age-adjusted rates of cell phone-related injury per 100 000 individuals using data from the National Electronic Injury Surveillance System (NEISS) database and United States Census Bureau. From 2002 to 2015, an estimated 38 063 patients 21 years old and younger sustained a cell phone-related injury. The overall rate of injuries for all ages increased from 17.1 injuries per 100 000 in 2002 to 138 injuries per 100 000 in 2015, an increase of over 700%. The incidence of cell phone-related injuries increased across all age groups, with children 2 years of age and under experiencing the highest single incidence rate of 159 injuries per 100 000 in 2014. These findings highlight an important and relatively under-reported pediatric safety issue. Anticipatory guidance and injury prevention plans should be updated accordingly.

Mobile phones and "inattention" injuries: the risk is real

OBJECTIVE

Mobile phones though indispensable have a flip side, in that they adversely affecting our ergonomics and mobility. They share an etiologic burden on the changed profile of inattention injuries and now have proven to be a necessary evil in the changing lifestyles. We aim to evaluate the role of mobile phones as a causative factor in these head and neck injuries.

METHODOLOGY

We evaluated various injury statistics published throughout the world that attributed the concurrence of neurological injuries to portable handheld communication devices. We evaluated the dangers posed by simultaneous engagement on phone and mobility and examined the impact on walking and field of view. We have also reviewed the current management strategies to combat this new mode of injury. The recent sensation Pokemon Go has been discussed as a case study of a spike in the incidence of injuries due to mobile phone use.

RESULTS

Age>35 yrs is a risk factor for mobile phone use and injuries as they have a higher chance of being distracted (81%) when compared to millennials (70% distracted). The highest incidence was that of head injuries being 33.1% of the estimated total followed by face, including eyelid, eye area, and nose (32.7%); and neck (12.5%). The most common injury diagnoses included laceration (26.3% of estimated total), contusion/abrasion (24.5%), and internal organ injury (18.4%). A heightened sense of self-protection and a multitasking attitude remains at the core of the trouble despite having knowledge of the required behavior.

CONCLUSIONS

The health hazard of mobile phone use driving or walking needs to be highlighted with special emphasis on public education, law adherence, and technological solutions to mitigate the risk. The onus lies on the public as any technological advance would only work on the multitasking strategy and the price would be paid by the vulnerable road users.

Fifty Years of Accident Analysis & Prevention: A Bibliometric and Scientometric Overview

Accident Analysis & Prevention (AA&P) is a leading academic journal established in 1969 that serves as an important scientific communication platform for road safety studies. To celebrate its 50^th anniversary of publishing outstanding and insightful studies, a multi-dimensional statistical and visualized analysis of the AA&P publications between 1969 and 2018 was performed using the Web of Science (WoS) Core Collection database, bibliometrics and mapping-knowledge-domain (MKD) analytical methods, and scientometric tools. It was shown that the annual number of AA&P's publications has grown exponentially and that over the course of its development, AA&P has been a leader in the field of road safety, both in terms of innovation and dissemination. By determining its key source countries and organizations, core authors, highly co-cited published documents, and high burst-strength publications, we showed that AA&P's areas of focus include the "effects of hazard and risk perception on driving behavior", "crash frequency modeling analysis", "intentional driving violations and aberrant driving behavior", "epidemiology, assessment and prevention of road traffic injuries", and "crash-injury severity modeling analysis". Furthermore, the key burst papers that have played an important role in advancing research and guiding AA&P in new directions - particularly those in the fields of crash frequency and crash-injury severity modeling analyses were identified. Finally, a modified Haddon matrix in the era of intelligent, connected and autonomous transportation systems is proposed to provide new insights into the emerging generation of road safety studies.

Do statutory holidays impact the number of opioid-related hospitalizations among Canadian adults? Findings from a national case-crossover study

OBJECTIVE

In Canada, emergency department visits, hospitalizations, and deaths due to opioid use have risen substantially in recent years. While these events have exhibited seasonal and day of week patterns, there have been no attempts to investigate the extent to which statutory holidays influence these patterns, particularly opioid-related hospitalizations.

METHODS

We applied a time-stratified case-crossover study design to investigate whether statutory holidays were predictive of opioid-related hospitalizations using the Canadian Discharge Abstract Database (excluding Quebec) for fiscal years 2011/2012 to 2016/2017. This design controls for day of week effects. We restricted analyses to opioid hospitalizations (ICD-10 codes: F11.x, T40.0-T40.4, and T40.6) among individuals 15 years and older. Conditional logistic regression models were fit to estimate the odds of opioid-related hospitalization on holidays relative to non-holidays. We examined these patterns across different holiday types, namely social gathering holidays (e.g., Canada Day) and family holidays (e.g., Christmas). Stratified analyses were done to identify whether these associations varied by age group and sex.

RESULTS

We identified a total of 59,965 opioid-related hospitalizations. Overall, we found a 12% reduced odds in opioid hospitalizations on holidays (odds ratio [OR] = 0.88, 95% CI 0.83, 0.93) relative to non-holidays. Similar reductions were observed for both family (OR = 0.86, 95% CI 0.79, 0.93) and social gathering holidays (OR = 0.90, 95% CI 0.84, 0.96). No substantive differences were noted by age group or sex.

CONCLUSIONS

Our findings support the hypothesis that opioid-related hospitalizations occur less frequently on statutory holidays. This knowledge may help inform healthcare resources and health promotion activities to reduce the impacts of opioid use.

Evaluating the causal effects of cellphone distraction on crash risk using propensity score methods

INTRODUCTION/OBJECTIVE

This paper evaluates the causal effects of cellphone distraction on traffic crashes using propensity score weighting approaches and naturalistic driving study (NDS) data.

METHODS

We adopt three propensity score weighting approaches to estimate the causal odds ratio (OR) of cellphone use on three different event-populations, including average treatment effect (ATE) on the whole population, average treatment effect on the treated population (ATT), and average treatment effect on the overlapping population (ATO). Three types of cellphone distractions are evaluated: overall cellphone use, talking, and visual-manual tasks. The propensity scores are estimated based on driver, roadway, and environmental characteristics. The Second Strategic Highway Research Program NDS data used in this study include 3400 participant drivers with 1047 severe crashes and 19,798 random case-cohort control driving segments.

RESULTS

The study reveals several highly imbalanced potential confounding factors among cellphone use groups, e.g., income, age, and time of day, which could lead to biased risk estimation. All three propensity score approaches improve the balance of the baseline characteristics. The propensity score adjusted ORs differ from unweighted ORs substantially, ranging from -44.25% to 54.88%. Specifically, the adjusted ORs for young drivers are higher than unweighted ORs and these for middle-age drivers are lower. Among different cellphone related distractions, the ORs associated with visual-manual tasks (OR range: 3.47-6.63) are uniformly higher than overall cellphone distraction and cellphone talking (OR range: 0.63-4.15). Cellphone talking increases the risk for young drivers but has no significant impact on middle-age drivers.

CONCLUSION

Propensity score approaches effectively mitigate potential confounding effect caused by imbalanced driver environmental characteristics in the observational NDS data. The ATT and ATO estimands are recommended for NDS case-cohort studies. ATT reflects the effect among exposed events, i.e. crashes or controls with cellphone exposure and ATO reflects the effect among events with similar characteristics. The study confirms the significant causal effect of overall cellphone distraction on crash risk and the heterogeneity in safety impact by age group.

Approximate Bayesian inference for case-crossover models

A case-crossover analysis is used as a simple but powerful tool for estimating the effect of short-term environmental factors such as extreme temperatures or poor air quality on mortality. The environment on the day of each death is compared to the one or more "control days" in previous weeks, and higher levels of exposure on death days than control days provide evidence of an effect. Current state-of-the-art methodology and software (integrated nested Laplace approximation [INLA]) cannot be used to fit the most flexible case-crossover models to large datasets, because the likelihood for case-crossover models cannot be expressed in a manner compatible with this methodology. In this paper, we develop a flexible and scalable modeling framework for case-crossover models with linear and semiparametric effects which retains the flexibility and computational advantages of INLA. We apply our method to quantify nonlinear associations between mortality and extreme temperatures in India. An R package implementing our methods is publicly available.

The Association between High-risk Behavior and Central Nervous System Injuries: Analysis of Traffic-related Fatalities in a Large Coroner's Series

High-risk behaviors leading to traffic fatalities are often a result of severe traumatic brain and spine injuries. The objective of the study was to analyze patterns of behavior in drivers and motorcyclists that are associated with central nervous system (CNS)-related prehospital deaths that may serve as a basis for future prevention initiatives. Our study group comprised 514 fatalities with severe CNS injuries documented at autopsy. The majority (n = 491) was the result of motor vehicle collisions (MVCs). In this group, male drivers predominated and the majority, 80 per cent, wore seatbelts. Toxicology analysis revealed 53 per cent of drivers with a mean concentration of ethanol above the legal limit. Texting while driving comprised 45 per cent of the study group. Less than 5 per cent of the fatalities were the result of road or weather conditions. In the motorcycle group (n = 23), 100 per cent of the victims were unhelmeted. We report a large autopsy series of CNS-related deaths with analysis of behavioral factors associated with the fatalities. Substance abuse and distracted driving are dominant patterns of high-risk behavior in MVCs and not wearing a motorcycle helmet is deadly for victims of motorcycle crashes.

Who uses a mobile phone while driving for food delivery? The role of personality, risk perception, and driving self-efficacy

INTRODUCTION

The existing literature on mobile phone use while driving (MPUWD) mainly targets the participants from general population and the young adults, however, few studies pay attention to this form of distracted driving with samples in professional contexts. The present study aims to bridge the gap by identifying the extent of and the motives behind making use of mobile phones while driving for food dispatch among deliveryman.

METHOD

The snowball sampling was used to collect the data (N = 317) through a self-reported questionnaire, including demographics, personality traits, risk perception, driving self-efficacy, and mobile phone use while driving.

RESULTS

Descriptive analysis for the assessed MPUWD behaviors showed that 96.3% (N = 315) of food deliveryman undertook the MPUWD behaviors, though disproportionate distribution among these behaviors existed. Structural equation modeling analysis displayed that psychoticism and driving self-efficacy directly predicted the MPUWD behaviors. The mediating role of driving self-efficacy was verified with the findings that driving self-efficacy completely mediated the relationships that between risk perception and MPUWD behaviors and that between extraversion and MPUWD behaviors, as well as partially mediated the correlation between psychoticism and MPUWD behaviors.

CONCLUSIONS

The present study confirms the prevalence of MPUWD behaviors among food deliveryman. The SEM estimates and bootstrap estimates suggest that personality traits and perceived risk perception per se display limited predicting utility to MPUWD behaviors among food deliveryman, whereas driving self-efficacy and the proposed predictors together well illustrate the assessed MPUWD behaviors among food deliveryman. Practical Applications: These findings imply that developing and implementing intervention efforts in a concerted way would curb these behaviors effectively.

Measuring multimorbidity series-an overlooked complexity comparison of self-report vs. administrative data in community-living adults: paper 2. Prevalence estimates depend on the data source

OBJECTIVE

The objective of the study was to compare multimorbidity prevalence using self-reported and administrative data and identify factors associated with agreement between data sources.

STUDY DESIGN AND SETTING

Self-reported cross-sectional data from four Canadian Community Health Survey waves were linked to administrative data in Ontario, Canada. Multimorbidity prevalence was examined using two definitions, 2+ and 3+ chronic conditions (CCs). Agreement between data sources was assessed using Kappa and Phi statistics. Logistic regression was used to estimate associations between agreement and sociodemographic, health behavior, and health status variables for each multimorbidity definition.

RESULTS

Regardless of multimorbidity definition, prevalence was higher using administrative data (2+ CCs: 55.5% vs. 47.1%; 3+ CCs: 30.0% vs. 24.2%). Agreement between data sources was moderate (2+ CCs K = 0.482; 3+ CCs K = 0.442), and while associated with sociodemographic, health behavior, and health status factors, the magnitude and sometimes direction of association differed by multimorbidity definition.

CONCLUSION

A better understanding is needed of what factors influence individuals' reporting of CCs and how they align with what is in administrative data as policy makers need a solid evidence base on which to make decisions for health planning. Our results suggest that data sources may need to be triangulated to provide accurate estimates of multimorbidity for health services planning and policy.

Ridesharing and motor vehicle crashes: a spatial ecological case-crossover study of trip-level data

BACKGROUND

Ridesharing services (eg, Uber, Lyft) have facilitated over 11 billion trips worldwide since operations began in 2010, but the impacts of ridesharing on motor vehicle injury crashes are largely unknown.

- METHODS

This spatial ecological case-cross over used highly spatially and temporally resolved trip-level rideshare data and incident-level injury crash data for New York City (NYC) for 2017 and 2018. The space-time units of analysis were NYC taxi zone polygons partitioned into hours. For each taxi zone-hour we calculated counts of rideshare trip origins and rideshare trip destinations. Case units were taxi zone-hours in which any motor vehicle injury crash occurred, and matched control units were the same taxi zone from 1 week before (-168 hours) and 1 week after (+168 hours) the case unit. Conditional logistic regression models estimated the odds of observing a crash (separated into all injury crashes, motorist injury crashes, pedestrian injury crashes, cyclist injury crashes) relative to rideshare trip counts. Models controlled for taxi trips and other theoretically relevant covariates (eg, precipitation, holidays).

RESULTS

Each additional 100 rideshare trips originating within a taxi zone-hour was associated with 4.6% increased odds of observing any injury crash compared with the control taxi zone-hours (OR=1.046; 95% CI 1.032 to 1.060). Associations were detected for motorist injury and pedestrian injury crashes, but not cyclist injury crashes. Findings were substantively similar for analyses conducted using trip destinations as the exposure of interest.

CONCLUSIONS

Ridesharing contributes to increased injury burden due to motor vehicle crashes, particularly for motorist and pedestrian injury crashes at trip nodes.

Assessing the impact of the 2015 introduction of increased penalties and enhanced public awareness and enforcement activities on texting while driving among adults in Ontario, Canada

Objective: Texting while driving (TWD) is considered a particularly hazardous form of distracted driving. It is highly prevalent among young drivers, but fewer studies of TWD among adult drivers exist and these prevalence rates may approach those of younger drivers. The effectiveness of measures to prevent distracted driving, and TWD specifically, is unclear. On September 1, 2015, Ontario introduced increased penalties for distracted driving accompanied by public education programs to increase public awareness of the new regulations. Provincial police also introduced enhanced enforcement efforts. The current study examined self-reported TWD in a representative sample of Ontario adults before and after introduction of the new legislation and the enhanced public education and enforcement efforts.Methods: Data were based on telephone interviews with 1,846 respondents who reported having driven in the past year. Data were derived from the 2015-2016 cycles of the Centre for Addiction and Mental Health (CAMH) Monitor, an ongoing cross-sectional telephone survey of adults aged 18+ years in Ontario, Canada. A binary logistic regression analysis of TWD in the previous 30 days was conducted, adjusting for demographic characteristics (sex, age), driving exposure, and introduction of the legislation (before versus after).Results: The proportion of the sample reporting TWD declined significantly from 37.6% before the law was introduced to 24.2% after the law was introduced. The impact appeared to be most pronounced among drivers who reported TWD more frequently. Adjusted odds of TWD declined 42% following introduction of the legislation and associated enhanced public education and enforcement.Conclusions: These results identify a decrease in TWD following the introduction of enhanced penalties with corresponding public education and enforcement efforts, adding to the existing evaluative evidence base to inform transportation safety policy. These results also support the need to examine TWD and its determinants among all age groups.

The effects of cognitive distraction on behavioural, oculomotor and electrophysiological metrics during a driving hazard perception task

Previous research has demonstrated that the distraction caused by holding a mobile telephone conversation is not limited to the period of the actual conversation (Haigney, 1995; Redelmeier & Tibshirani, 1997; Savage et al., 2013). In a prior study we identified potential eye movement and EEG markers of cognitive distraction during driving hazard perception. However the extent to which these markers are affected by the demands of the hazard perception task are unclear. Therefore in the current study we assessed the effects of secondary cognitive task demand on eye movement and EEG metrics separately for periods prior to, during and after the hazard was visible. We found that when no hazard was present (prior and post hazard windows), distraction resulted in changes to various elements of saccadic eye movements. However, when the target was present, distraction did not affect eye movements. We have previously found evidence that distraction resulted in an overall decrease in theta band output at occipital sites of the brain. This was interpreted as evidence that distraction results in a reduction in visual processing. The current study confirmed this by examining the effects of distraction on the lambda response component of subjects eye fixation related potentials (EFRPs). Furthermore, we demonstrated that although detections of hazards were not affected by distraction, both eye movement and EEG metrics prior to the onset of the hazard were sensitive to changes in cognitive workload. This suggests that changes to specific aspects of the saccadic eye movement system could act as unobtrusive markers of distraction even prior to a breakdown in driving performance.

Hazard Warning Systems to Improve Young Distracted Drivers’ Hazard Perception Skills

Texting while driving has been shown to impair driving performance with the greatest probability of leading to an accident. This is a great concern with young and inexperienced drivers, who are reported to be the most prolific users of texting while driving and are disproportionately involved in car crashes as compared to their experienced and older counterparts. Hazard Warning Systems (HWSs) have been researched to reduce distracted driving and improve driving performance. The first purpose of this study is to showcase a game-based, multi-player, online simulated training (GMOST) application with an integrated HWS. The second is to examine whether such an HWS integrated into the GMOST improves young and inexperienced drivers’ hazard perception skills, as measured by hazard reaction time (HRT) and horizontal road scanning (HS). A total of 22 high school students from a private school participated in this study. To determine the effects of HWS, a 2 × 2 ANOVA and a 2 × 2 MANOVA were run. The results of this study suggest that the GMOST with integrated HWS leads to earlier detection and reaction to hazards as well as wider HS by novice drivers. Therefore, this study reports that HWSs improve novice distracted drivers’ hazard perception skills. Accordingly, a wide-spread use of the GMOST-like training applications by novice drivers would be a proactive approach to lower accident rates caused by texting while driving.