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UW MEDICINE │ INJURY CONTROL
DISTRACTION & INJURY:HOLDING BACK THE TIDE
Beth Ebel, MD, MSc, MPHHarborview Injury Prevention & Research Center
University of Washington/Seattle Children’s Hospital
Nov 21, 2013
DISTRACTED DRIVING: A PUBLIC HEALTH PROBLEM
OUTLINE
1. Understanding distraction and injury risk
2. Distraction in Washington
3. Promising strategies for reducing distracted driving
– Individual– Enforcement– Legal framework
4. Distraction on the job
OUTLINE
1. Understanding distraction and injury risk
RISE IN DISTRACTION
• More mobile phones than people in the US (2011) .
• Up to 28% of vehicle crash risk attributable to distraction from cell phone use or text messaging.
RELATIVE RISK OF TEXTING & DRIVING
Series105
10152025
4 4
23.221.3
Relative Risk of Near Crash Event
blood alcohol .08Cell phoneText messagingblood alcohol 0.19
• Risk of distraction – Naturalistic study of
truckers– Cell phone use was
more common than texting, so greater overall risk.
– Relative crash risk highest for texting.
• Text messaging had the longest duration of eyes off road (VTTI)
CELL PHONE USE AT THE TIME OF THE LAST CRASH OR NEAR-CRASH, BY SEX AND AGE
Total 13%
NHTSA Traffic Safety Facts April 2012
8
NOT JUST KIDS…Study design:On-line convenience survey of 2,400 mothers with children under 2
Results:• 78% of moms talked on the
phone while driving with their kids
• 26% sent texts or checked email
• Nearly 10% of new moms reported they been in a crash while driving with their baby
American Baby magazine, June 2013
OUTLINE
1. Understanding distraction and injury risk
2. Distraction in Washington
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DISTRACTED DRIVING FATALITIES AND SERIOUS INJURIES IN WASH. 2009-2011
Total Distraction Related
Distraction as % of Total
Traffic Deaths
1,706 426 30.3%
Serious Injuries
7,249 867 12.0%
DISTRACTED DRIVING IN WASHINGTON
6 Washington counties
Drivers observed at controlled intersections
Observed electronic distraction (texting, talking, phone position)
13
• Observed 7930 drivers at 120 sites in 6 counties.
• At any given moment, nearly 1 in 10 were using cellular phone, either talking or texting (9.5%).
• At any given moment, 3.7% of drivers were texting
OBSERVATION RESULTS
14
Yakim
a
Wha
tcom
Spok
ane
Snoh
omish
Pierce King
0%2%4%6%8%
10%12%
3.60%
7.90%9.40% 9.40%
10.60%9.20%
Percentage of Distracted Drivers us-ing electronic devices for Six Counties
in WA (2013 UW Study)
Series1
Axis Title
Texting or visible ma-nipulation
of handheld device47%
Talking on cel-lular phone
(phone to ear) 38.1%
Talking on handheld phone (s-peaker)
4%
Talking hands-free (bluetooth, headset)
11%
Talking And Texting Among Drivers Using An Electronic Device
16
• Relative to males, female drivers more commonly engaged in electronic distraction (PR 1.23 (95% CI 1.01, 1.49))
• Females more likely to text while driving (PR 1.31, (95% CI 1.01, 1.69).
OBSERVATION RESULTS
17
CITATIONS FOR CELL PHONE/TEXTING WHILE DRIVING, 6 LARGE WASHINGTON COUNTIES
2010 2011 20120
5000
10000
15000
20000
25000
30000
35000
40000
20848
36985
32262
757 1323 1652
Phone Use while DrivingTexting while Driving
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Charge/Law Number 2010 2011 2012 2010 2011 2012
CELL PHONE USE WHILE DRIVING Rate per 1,000 licensed drivers
(46.61.667 / 46.61.667.1A / 46.61.667.1B/ 11.84.480) King 7876 13383 11465 4.99 8.40 7.04
King+Seattle(City Law)* 8388 15100 13554 5.32 9.47 8.32 Pierce 2208 3558 3829 3.68 5.89 6.24 Snohomish 6191 12518 9549 11.85 23.89 17.96 Spokane 2558 3101 2731 7.26 8.79 7.65 Whatcom 873 1417 1167 5.70 9.20 7.50 Yakima 630 1291 1432 3.58 7.31 8.03
CELL PHONE USE WHILE DRIVING
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Charge/Law Number 2010 2011 2012 2010 2011 2012
TEXTING WHILE DRIVING Rate per 1,000 licensed drivers
(46.61.668 / 46.61.668.1A / 46.61.668.1B / 11.84.460) King 265 534 604 0.17 0.33 0.37
King+Seattle (City Law)* 281 579 683 0.18 0.36 0.42 Pierce 166 345 375 0.28 0.57 0.61 Snohomish 133 231 402 0.25 0.44 0.76 Spokane 131 101 105 0.37 0.29 0.29 Whatcom 22 48 52 0.14 0.31 0.33 Yakima 24 19 35 0.14 0.11 0.20
TEXTING WHILE DRIVING
20
Charge/Law Number 2010 2011 2012 2010 2011 2012
INATTENTIVE DRIVING Rate per 1,000 licensed drivers
King 10128 10867 9563 6.42 6.82 5.87
King+Seattle (City Law)* 1048 1161 1157 1.75 1.92 1.89 Pierce 130 256 270 0.25 0.49 0.51 Snohomish 0 0 0 0.00 0.00 0.00 Spokane 254 257 304 1.66 1.67 1.95 Whatcom 373 394 350 2.12 2.23 1.96 Yakima 11933 12935 11644 3.53 3.80 3.36
INATTENTIVE DRIVING
OUTLINE
1. Understanding distraction and injury risk
2. Distraction in Washington
3. Promising strategies for reducing distracted driving
4 “E”s OF INJURY PREVENTION
• Education
• Enforcement
• Physical Environment
• Social Environment
Changing Behaviors
HARD TO CHANGE THIS RISKY BEHAVIOR
• Drivers know texting and talking on a cell phone is dangerous
• Drivers know texting and talking on a handheld phone is illegal
• Drivers are irritated at the distracted driving around them
Yet….• They continue to talk and text
while driving
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1. “Habit” of picking up the device to answer is hard to suppress
2. Holding phone is physical (eyes off the road, hand off the wheel) and cognitive distraction
CELL PHONE/TEXTING CAN BE COMPULSIVE
[After pulling over a driver, he waved to let me know]….”I know you’re back there, but I’ve got to finish this phone conversation”.“When is it a big enough deal to realize that we need to draw a line in the sand? We can either stop [texting/talking] in the hopes that we’ll have fewer crashes, or we just have to agree that we all might lose some family members because it’s so important that we text.”
“You’ve just got to answer that phone, you’ve got to get that next call. It’s the same like you’ve got to get the next hit of heroin”
CLASSICAL CONDITIONING
26
DEVELOPING MARKETING STRATEGIES FOR REDUCING DISTRACTED DRIVING
Big Fat Tobacco Wants to Control You
27
• Learn from what has worked• Drunk driving• Seat belt use
• Barriers• I’m a better/safer driver than others• My calls are “important”• Compulsive habit
WHAT WORKS TO CURB DISTRACTED DRIVING?
Education
Enforcement
Physical Environment
Social Environment
4 “E’s” OF INJURY PREVENTION
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• General education on why reducing distraction is an important public health problem
• Opportunities for parent role-model; review family commitment to distraction-free driving
• There’s an app for that: technological solutions
• Education on risk of citation (not crash)
• Traffic court for distraction?
EDUCATING INDIVIDUALS
Education
Enforcement
Physical Environment
Social Environment
4 “E’s” OF INJURY PREVENTION
Goal: Identify strategies for improving implementation and enforcement of distracted driving legislation
IMPROVE ENFORCEMENT
• Survey of WA law enforcement found significant variability in enforcement practices
• Significant variation in prosecution of distraction driving
CELL PHONE DISTRACTION ENFORCEMENT
33
CELL PHONE DISTRACTION ENFORCEMENTJu
lAu
gSe
pO
ctN
ovD
ec Jan
Feb
Mar Apr
May Jun Jul
Aug
Sep
Oct
Nov
Dec Jan
Feb
Mar Apr
May Jun Jul
Aug
Sep
Oct
Nov
Dec Jan
Feb
Mar Apr
May Jun Jul
Aug
Sep
Oct
Nov
Dec Jan
Feb
Mar Apr
May Jun Jul
2008 2009 2010 2011 2012
0
1,000
2,000
3,000
4,000
5,000
642
4,182
2,561
4,980
2,817
3,728
Washington Case Filings for 'Hand Held Cell Phone Use' Violation
Num
ber
of C
ase
Fili
ngs
Primary law effective June 10, 2010
Data source: Adminstrative Offices of the Courts (AOC). Number of cases filed under RCW 46.61.667 (using wireless telecommunications device while driving) for violations identified by WSP and local law enforcement. Does not include cases filed in Seattle Municpal Court (SMC).
• Three focus groups held with law enforcement officers in King, Whatcom, and Spokane counties in 2013
OFFICER FOCUS GROUP STUDY
THEME: DRIVERS KNOW LAWS BUT CONTINUE THEIR DISTRACTING PRACTICES
“If you don’t know that there’s a cell phone law in this state you shouldn’t be driving. Because it’s out there... They know it’s a big deal. So give them a ticket.” – WA Officer
“Short of calling 911, there is no excuse. [for using a cell phone while driving]. If you need to be on the phone all day, get a blue tooth.” – WA Officer
36
THEME : ENFORCEMENT CHANGES DRIVER BEHAVIOR
• Behavior change happens when law enforcement and public education go hand in hand.
• Ex: stigma of DUI• Ex: seat belt enforcement
• Most effective enforcement is writing a ticket.
• Traffic school viewed as positive learning experience
“If you give somebody a warning, it’s not going to change their behavior. They’re driving away with an “I got away with it” kind of attitude. - WA officer
“We need to change the way the public sees the importance of traffic enforcement as a whole. Criminals drive cars; normal people drive cars. It is easier to give a criminal a ticket, than a normal person. But normal people kill people because they’re distracted.” - WA officer
• Various levels of enforcement within & between agencies
• “To ear” language in state law
• Proof of texting (drivers “throw” the phone)
• Citation outcomes
• Lack of extra patrol funds
• Law enforcement ‘users’ of in-vehicle technology
ENFORCEMENT CHALLENGES
38
1. Each law enforcement office adopt policy on distracted driving
2. Track citations and convictions locally
3. Emphasis patrols4. Inform public that laws
are enforced5. Motorcycle
enforcement
HOW COULD ENFORCEMENT BE IMPROVED?
Education
Enforcement
Physical Environment
Social Environment
4 “E’s” OF INJURY PREVENTION
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TEXTING LEGISLATION
By 2012, forty-five states had a law that bans texting for any group of drivers defined by age or driving experience, up from zero in 2001. LawAtlasSM
20122001
Cell use: A person operating a moving motor vehicle while holding a wireless communications device to his or her ear is guilty of a traffic infraction. (exempts hands-free) (RCW 46.61.667)
Texting: A person operating a moving motor vehicle who, by means of an electronic wireless communications device, sends, reads or writes a text message, is guilty of a traffic infraction. (RCW 46.61.668)
Holders of Instruction Permit or Intermediate License: Cannot use any wireless communication device (regardless if hand-held or hands-free) while driving unless in an emergency situation. (RCW 46.20.055; RCW 46.20.075)
WASHINGTON DISTRACTION LAW
• Local ordinances address ‘inattention’
• Fines vary between $25-$1000 (many limit fine to >$250)
• Fines levied under local ordinances ‘stay local’
• Primary enforcement
LOCAL ORDINANCES – 2 COUNTIES, 44 CITIES
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1. Drop “phone to ear”; include any talking on handheld device
2. Change “texting” to “manipulating handheld device”
3. Drop “stop sign/signal” exemption
4. Escalating fine ($124 -> $250)5. Consider points on license for
2nd offense6. Decal to identify provisional
license-holders, so laws pertaining to inexperienced drivers can be enforced
HOW COULD THE LAW BE STRENGTHENED?
OUTLINE
1. Understanding distraction and injury risk
2. Distraction in Washington
3. Strategies for reducing distracted driving
4. Distraction at work
45
OFFICER DISTRACTED DRIVING• Minn. Study found distracted
driving contributed to 14% of all claims; 17% of all costs.
• One half of all crashes that involved distraction from technology involved the use of Mobile Data Terminals (MDT’s).
• MDT claims were most expensive, averaging about $10,000 per claim.
Distracted Driving: Law Enforcement’s Achilles’ Heel
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DISTRACTION ON THE JOB
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1. Distracted Driving is Impaired Driving• Make distracted driving a priority area
for law enforcement • There are no “safe” distracted drivers• Current law, while not perfect, is
enforceable and prosecutable
2. Adopt distraction policy for officers• Officer as role model• Liability• Loss of vehicle time• Loss of life
3. Review MDT policies• Is there a voice-control option?
ACTION STEPS FOR LEADERSHIP
48
1. Adopt mobile device law similar to Oregon (does not require “phone to ear”; device button-pushing of any sort not allowed)
2. Adopt “Inattentive driving” citation when distracted behavior but source not ascertainable
3. Strengthen laws (points, on the record)
HOW COULD LEGISLATION BE STRENGTHENED?
CONCLUSIONS
1. Distraction is a growing hazard
2. Strengthening enforcement of distracted driving laws is most effective strategy
3. Distraction risky for the public and for law enforcement
UW MEDICINE │ INJURY CONTROL
QUESTIONS?