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E D U C AT I N G

YO U T H A B O U T

S L E E P A N D

D R O W S Y D R I V I N G

S T R AT E G Y

D E V E L O P M E N T

W O R K S H O P R E P O R T

N A T I O N A L I N S T I T U T E S O F H E A L T H

N A T I O N A L H E A R T , L U N G , A N D B L O O D I N S T I T U T E

N a t i o n a l C e n t e r o n S l e e p D i s o r d e r s R e s e a r c h a n d O f f i c e o f P r e v e n t i o n , E d u c a t i o n , a n d C o n t r o l

E D U C AT I N G

YO U T H A B O U T

S L E E P A N D

D R O W S Y D R I V I N G

S T R AT E G Y

D E V E L O P M E N T

W O R K S H O P R E P O R T

NATIONAL CENTER ON

SLEEP DISORDERSRESEARCH

NATIONAL HEART, LUNG,

AND BLOOD I NSTITUTE

NATIONAL I NSTITUTES

OF HEALTH

FOR ADMINISTRATIVE USE ONLY

SEPTEMBER 1998

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Workshop Participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

Overview of the Problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10

Sleep and Youth: The State of the Science . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10

Sleep in Adolescence [Dr. Mary Carskadon] . . . . . . . . . . . . . . . . . . . . . . .10

Drowsy Driving and Teens [Dr. Allan Pack] . . . . . . . . . . . . . . . . . . . . . . . .12

Drowsy Driving Reports [Dr. Kingman Strohl] . . . . . . . . . . . . . . . . . . . . . .14

NCSDR and NHTSA Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Top Ideas and Recommendations From the Small-Group Discussions . . . . . . . . . .15

Group 1: Driver Education (private and public sector) . . . . . . . . . . . . . . .15

Group 2: High School . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15

Group 3: Middle School . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

Group 4: Community-Based Programs . . . . . . . . . . . . . . . . . . . . . . . . . .16

Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

Appendix A: The Workshop Vision and Objectives . . . . . . . . . . . . . . . . . . . . . . . .18

Appendix B: Questions for Small Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

Appendix C: Workshop Agenda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20

CONTENTS

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Anne T. McCartt, Ph.D. (Co-chair)Deputy DirectorInstitute for Traffic Safety Management

and ResearchAlbany, NY

Richard P. Millman, M.D. (Co-chair)Director, Sleep Disorders CenterRhode Island HospitalProvidence, RI

Jesse Blatt, Ph.D.Special AssistantNational Highway Traffic Safety

AdministrationWashington, DC

Mary Carskadon, Ph.D.Professor of Psychiatry and Human

BehaviorBrown UniversityEast Providence, RI

Peggy Connolly, Ed.D.Mentorship CoordinatorIllinois Mathematics and ScienceAcademy

Aurora, IL

Peter W. CookDirector of Professional ServicesNew England League of Middle SchoolsTopsfield, MA

Gary A. Decker, M.P.A.Public Information and EducationCoordinator

DMV Safety GroupAlbany, NY

Rick DelanoDirector, Youth Development ProgramsScholastic, Inc.New York, NY

Darrel DrobnichDirector, Government and TransportationAffairs

National Sleep FoundationWashington, DC

Bruce Fuchs, Ph.D.DirectorOffice of Science EducationNational Institutes of HealthRockville, MD

John Hampu, M.Ed.Director, Federal Programs andCommunity ServicesAlliance City School DistrictAlliance, OH

Susan HardmanDirector, Bureau of Injury PreventionNYS Department of HealthAlbany, NY

John Harvey, M.S.Regional Traffic SafetyEducation Coordinator

Education Service District 101Spokane, WA

Sarah James, M.S.Clinical Applications SpecialistRespironicsPittsburgh, PA

WORKSHOP PARTICIPANTS

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Murray L. Katcher, M.D., Ph.D.Chairperson, Committee on Injury andPoison Prevention

American Academy of PediatricsMadison, WI

Paula KunDirector of Public RelationsNational Association for Sport and PhysicalEducation

Reston, VA

Allan I. Pack, M.B., Ch.B., Ph.D.Professor of Medicine and PsychiatryHospital of the University of PennsylvaniaPhiladelphia, PA

John W. Palmer, Ph.D.Director, Minnesota Highway Safety CenterSt. Cloud State UniversitySt. Cloud, MN

Jude Pelchat, Ph.D.Senior AssociateAnnenberg Institute for School ReformProvidence, RI

Marcia Rubin, Ph.D., M.P.H.Director of Research and SponsoredPrograms

American School Health AssociationKent, OH

Michael SmithResearch PsychologistNational Highway Traffic SafetyAdministration

Washington, DC

Kingman P. Strohl, M.D.Professor of MedicineCase Western Reserve UniversityCleveland, OH

Michelle TreistmanAssistant Editor, Special PublicationsNational Science Teachers AssociationArlington, VA

Kyla L. Wahlstrom, Ph.D.Associate Director, Center for AppliedResearch and Educational Improvement

University of MinnesotaMinneapolis, MN

Deitra Wengert, Ph.D.Board MemberAmerican Association for HealthEducation

Towson, MD

David P. White, M.D.Director, Sleep Disorders ProgramBrigham and Women’s HospitalBoston, MA

David WillisPresidentAAA Foundation for Traffic SafetyWashington, DC

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NATIONAL HEART, LUNG, AND BLOODINSTITUTE STAFF

James P. Kiley, Ph.D.Director, National Center on Sleep

Disorders ResearchNational Heart, Lung, and Blood InstituteNational Institutes of HealthBethesda, MD

Susan D. Rogus, R.N., M.S.Coordinator, Sleep Education ActivitiesNational Heart, Lung, and Blood InstituteNational Institutes of HealthBethesda, MD

Ellen Sommer, M.B.A.Public Affairs SpecialistNational Heart, Lung, and Blood InstituteNational Institutes of HealthBethesda, MD

SUPPORT STAFF

Pamela A. Christian, R.N., M.P.A.R.O.W. Sciences, Inc.Rockville, MD

Susan T. Shero, R.N., M.S.R.O.W. Sciences, Inc.Rockville, MD

INTRODUCTION

The Strategy Development Workshop on EducatingYouth About Sleep and Drowsy Driving wasconvened by the National Heart, Lung, and BloodInstitute’s National Center on Sleep DisordersResearch (NCSDR) as part of a collaborativeeffort with the National Highway Traffic SafetyAdministration (NHTSA) to develop information ondrowsy driving and promote educational activities.The purpose of this workshop was to identify priorities,methods, and messages for educating youths aboutdrowsy driving. The workshop was chaired by Dr.Richard Millman, Professor of Medicine at BrownUniversity School of Medicine, Providence, RhodeIsland, and Dr. Anne McCartt, Deputy Director ofthe Institute for Traffic Safety Management andResearch in Albany, New York.

The objectives of the workshop were (1) to identifystrategies and recommend priorities for educatingyouths about the importance of sleep and the dangersof drowsy driving, and (2) to identify opportunities forpartnering among organizations interested in educatingyouths about sleep and sleep deprivation. The work-shop’s intended outcomes were to increase awarenessthat: youths and those around them should becomemore knowledgeable about the importance of adequatesleep to good health and the consequences of sleepdeprivation; youths should obtain adequate sleep;drowsy driving needs to decrease among youths;

and youths’ support systems must be well informedabout the sleep needs of youths and the consequencesof sleep deprivation, especially the dangers of drowsydriving (see appendix A).

Recognizing that drowsy driving is a crosscuttingissue involving the disciplines of highway safety,public health, and education, the organizers of theworkshop invited individuals who represent manydisciplines and areas of interest.

The workshop began with presentations by expertsin sleep medicine on the state of the science in thearea of sleep and youth. This provided the partici-pants a common understanding of the issues uponwhich to launch their discussions. Following thepresentations, the workshop participants divided intofour small groups to focus on the following environ-ments: driver education programs,high schoolcurricula and programs, middle school curricula andprograms, and community-based programs. Each ofthe small groups considered specific questions for theirenvironment (see appendix B). The small groups thengenerated ideas for integrating sleep education mes-sages into their particular environment andconsidered which organizations might be needed toimplement the ideas. Each small group presented its“top ideas” to the full group for further discussion andrefinement of the priority activities (see appendix C).

STRATEGY DEVELOPMENT WORKSHOP ON EDUCATING

YOUTH ABOUT SLEEP AND DROWSY DRIVING

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OVERVIEW OF THE PROBLEM

Over the past two decades, the field of highwaysafety has evolved into the current model in whichStates and localities, in partnership with NHTSA,other Federal agencies, and the private sector, take acomprehensive approach that encompasses education,enforcement, legislation, and engineering improve-ments to vehicles and roadways. Drowsy drivingdiffers in some respects from other highway safetyissues. For example, given the low level of publicawareness of drowsy driving and the problems inherentin identifying the role of drowsiness in a crash, thereare difficulties in developing and applying legalsanctions against drowsy driving. There is a generalrecognition among the highway safety communitythat educational initiatives are a primary mechanismfor reducing drowsy driving. Furthermore, althoughdrowsy driving is a highway safety issue, it is importantalso to recognize that it is a public health issue. Thus,education about the effects of sleepiness on drivingperformance may be most effective when coupledwith more general education about the health andperformance benefits of good sleep hygiene.

SLEEP AND YOUTH:THE STATE OF THE SCIENCE

Sleep in Adolescence [Dr. Mary Carskadon]

It is now recognized that sleep is obligatory andgetting optimal sleep enhances performance, cogni-tion, and mood. Major developmental trends occurduring adolescence, including (1) a decrease in theamount of sleep obtained, (2) a delay in the timingof sleep (going to bed later), and (3) an increase inthe school night/weekend night discrepancy in thesleep schedule. Numerous psychosocial and biolog-ical factors influence the sleep patterns of adolescents,including parents, peers, jobs, and school:

• Parents’ role changes during their child’steen years. Parents of preadolescents usually setbedtimes. By the time their children are of highschool age, parents retreat from setting bedtimesand instead focus on waking them in the morning.

Parents may think that older children need lesssleep than they did previously, when in fact theyneed at least as much or more sleep.

• Peers may influence the amount of sleepobtained relative to social activities, televisionviewing, and the Internet. This area needs furtherexploration.

• Careful sociological studies indicate thatmost teens work to buy personal consumables(such as clothing) and to pay for entertainment,rather than to contribute to family income. Mostare employed in entry-level positions or in jobsrequiring unskilled labor. Many teens work on theweekends and on weeknights after school. Thosewho work 20 or more hours per week tend to havea later bedtime, shorter sleep period, more fallingasleep in class, and more oversleeping.

• For most teens, the school start time means anonnegotiable wake-up time. Most adolescentswould sleep significantly longer if they could.Preliminary data indicate a trend over the past 25years toward earlier school start times, with highschools starting earlier than middle and elementaryschools.

New studies show that the well-known adolescentsleep patterns of going to bed later and rising latermay have a biological as well as a psychosocial basis.A study with sixth graders showed a preference forphase delay that is related to puberty. Recent dataindicate that the circadian clock in adolescence is“ticking” somewhat slower than that in adults,thereby accounting for the phase-delay preference.

One field study showed that many 10th gradersattending school at 7:20 a.m. were sleepy, and somehad sleep abnormalities similar to those seen innarcolepsy. Another recent study evaluated theamount that teens slept during the school week.The average amount of sleep was about 61/2hours,with the longest sleeper getting less than 8 hours.There was some increase in weekend sleep, but notenough to compensate fully.

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Bibliography

Carskadon MA. Sleep disturbances. In: FriedmanSB, Fisher M, Schonberg SK, Alderman EM, eds.Comprehensive Adolescent Health Care. SecondEdition. St. Louis: Mosby, 1997;805-814.

Carskadon MA. Patterns of sleep and sleepiness inadolescents. Pediatrician1990;17:5-12.

Carskadon MA. Factors influencing sleep patternsof adolescents. In: Carskadon MA, ed. AdolescentSleep Patterns: Biological, Social, andPsychological Influences. New York: CambridgeUniversity Press, 1998 (in press).

When a person does not get enough sleep, even onone night, a “sleep debt” begins to build andincreases until enough sleep is obtained. Problemsleepiness occurs as the debt accumulates. If toomuch sleep has been lost, sleeping in on the weekendmay not completely reverse the effects of not gettingenough sleep during the week. In general, preado-lescents may be getting sufficient sleep, particularlyif parents help “protect” sleep times. Older adoles-cents, however, are staying up later, rising earlier,and incurring sleep debts. As a result, teachers endup with sleepy students, and teens live under a“dark cloud of insufficient sleep” that may includemicrosleeps, attention lapses, decreased reaction times,impaired divergent thinking skills, impaired mentalfunctioning, low mood, and a higher rate of accidentsand injuries (see chart).

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Carskadon MA, Acebo C, Richardson GS, Tate BA,Seifer R. An approach to studying circadianrhythms of adolescent humans. Journal ofBiological Rhythms1997;12(3):278-289.

Carskadon MA, Dement WC. Daytime sleepiness:quantification of behavioral state. Neuroscience andBiobehavioral Reviews1987;11:307-317.

Carskadon MA, Manusco J, Rosekind MR. Impactof part-time employment on adolescent sleeppatterns. Sleep Research1989;18:114.

Carskadon MA, Wolfson AR, Acebo C, TzischinskyO, Seifer R. Adolescent sleep patterns, circadiantiming, and sleepiness at a transition to early schooldays. Sleep1998 (in press).

Dahl R, Carskadon MA. Sleep and its disorders inadolescence. In: Ferber R, Kryger M, eds.Principles and Practice of Sleep Medicine in theChild. Philadelphia: W.B. Saunders, 1995;19-27.

Wolfson AR, Carskadon MA. Early school starttimes affect sleep and daytime functioning inadolescents. Sleep Research1996;25:117.

Wolfson AR, Carskadon MA. Sleep schedules anddaytime functioning in adolescents. ChildDevelopment(in press).

Drowsy Driving and Teens [Dr. Allan Pack]

There is a discrepancy between police-reportedcrash data and self-reported data. Police-reporteddata show that drowsy driving-related crashescomprise 1 percent of all crashes and 4 percent ofcrashes in which a fatality occurs. The number ofself-reported drowsy driving-related crashes is muchhigher. Some of the factors that likely contribute tothis discrepancy include:

• Not all sleep-related crashes are reportedto the police, since many are drive-off-the-roadcrashes.

• Police may not recognize the crash asdrowsy-driving related.

• Police may be reluctant to code a crash asthe “fall-asleep” sort without physical evidenceto support it in court.

• Standardized reporting for drowsy drivingdoes not exist.

Data from a 1995 study conducted in NorthCarolina showed the following characteristics ofcrashes that police attributed to the driver fallingasleep:

• Crashes were predominantly drive-off-the-road types.

• Crashes were often serious because nocorrective action was taken.

• The times of occurrence were late atnight and midafternoon (siesta time).

The data from this study further showed that mostof the crashes were predominantly among youngpeople. Fifty-five percent of all crashes occurredamong those under age 26. There was a differencein the time of occurrence of these crashes amongdrivers of different ages (see table on page 13).

A major risk group that was identified comprisesyoung males driving alone at night. A question thatneeds to be addressed is: Why are young malesdriving alone at night? Questions concerning socialfactors, lifestyles, and employment practices—and

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whether these crashes are more common in sleep-deprived youth—need to be examined.

A recent study showed that self-reported tirednesswhile driving at night correlated with slowed reactiontimes. With the addition of alcohol, the reactiontimes in all drivers decreased significantly. Evensmall amounts of alcohol when combined with sleepdeprivation had major detrimental effects on reactiontimes and driving performance. Based on studiesthat used a driving simulator, even moderateamounts of alcohol combined with sleep deprivationhave a major deleterious effect on driving performance.

Another issue that needs to be addressed is whetherthe effects of alcohol should be incorporated intodrowsy-driving messages, since there clearly is aninteraction between alcohol and sleepiness.Previous focus group studies showed that drivers didnot want the messages combined. The focus groupparticipants offered two observations: some of thepublic have been saturated with drunk-driving mes-sages, and the drowsy-driving message may be lostif combined with messages about alcohol.

Another issue to consider is whether efforts shouldfocus on prevention or on coping strategies.Preventive strategies seek to decrease the incidenceof drowsy driving among youth. Examples ofpreventive strategies might include employinggraduated licensing as a mechanism to decreasenighttime driving among youth, or educating youth

about good sleep hygiene. On the other hand,copingstrategies encompass measures that can beemployed if a driver becomes drowsy while driving.Examples of effective coping strategies are pullingoff the road to take a short nap or drinking acaffeinated beverage. Education about effectivecoping mechanisms is needed because manyineffective strategies, such as opening a window orturning up the volume on the radio, are currentlyreported as being used by drivers.

Bibliography

Knipling RR, Wang J-S. Crashes and fatalitiesrelated to driver drowsiness/fatigue. Research Note.NHTSA, U.S. Department of Transportation, 1994.

Pack AI, Pack AM, Rodgman E, Cucchiara A,Dinges DF, Schwab CW. Characteristics of crashesattributed to the driver having fallen asleep. AccidAnal Prev1995;27(6):769-775.

Roehrs T, Beare D, Zorick F, Roth T. Sleepinessand ethanol effects on simulated driving. AlcoholClin Exp Res1994;18(1):154-158.

Years of Age Time of Occurrence

16-25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .most crashes at night

25-45 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .crashes less frequent; still mostly at night

45-65 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .not as many crashes at night; peak time 7:00 a.m.

>65 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .few crashes at night; mid-afternoon peak

D R I V E R A G E / T I M E O F C R A S H O C C U R R E N C E

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Drowsy Driving Reports [Dr. Kingman Strohl]

The American Medical Association’s (AMA)Council on Scientific Affairs recently released areport that will help focus attention on drowsydriving relative to policy and medical issues. Thereport, “Sleepiness, Driving, and Motor VehicleCrashes,” was published in the June 17, 1998, issueof the Journal of the American Medical Association.This report provides a good review of the literatureand discusses key drowsy driving-related recom-mendations passed by the AMA House of Delegatesin 1996.

The NCSDR and NHTSA have also recentlyfinalized a major report on drowsy driving. Anexpert panel (chaired by Dr. Strohl) was convened toreview the literature and describe the key issuesinvolved in the problem of driver fatigue andsleepiness. The panel’s report is designed toprovide direction to an NCSDR/NHTSA education-al campaign to combat drowsy driving. A copy ofthe report, “Drowsy Driving and AutomobileCrashes,” is available on both agencies’ Web sites atwww.nhtsa.dot.gov and www.nhlbi.nih.gov.

The expert panel identified three broad populationgroups to be at the highest risk for drowsy driving:

• Younger people (ages 16 to 29), especiallymales;

• Shift workers whose sleep is disrupted bynight work or long or irregular work hours; and

• People with untreated sleep apneasyndrome and narcolepsy.

The report recommends that the two Federalagencies focus their efforts on three priority areas:

• Educating young males about drowsy driving and how to reduce their lifestyle risks;

• Promoting shoulder rumble strips as aneffective countermeasure for drowsy driving and;

• Educating shift workers about the risks ofdrowsy driving and how to reduce them.

NCSDR AND NHTSA A CTIVITIES

Dr. James Kiley, director of the National Center onSleep Disorders Research (NCSDR), and Dr. JesseBlatt of the National Highway Traffic SafetyAdministration (NHTSA) commented that, inresponse to the expert panel’s recommendations, bothagencies are launching educational activities aimedat combating drowsy driving. The NCSDR is focus-ing its efforts on young people, and NHTSA’s focusis on shift workers, including young males. Thisworkshop is an initial activity of the NCSDR toidentify priorities in educating youths. Anotheractivity completed by the NCSDR in the spring of1998 was the development and distribution of aneducational insert in several Scholastic, Inc.magazines targeted to high school students. Majormessages included the need for adequate sleep,teens’ need for more sleep as compared withyounger children and most adults, and the dangers ofinadequate sleep, especially the danger of drowsydriving. Future educational efforts by the NCSDRwill continue to focus on school-age youths withmessages about the relationship between sleep andhealth and performance, and the consequences ofsleep deprivation. Specific future educationalactivities remain to be determined. NHTSA’sefforts include the award of approximately 15 pilotgrants to address the issue of drowsy driving amongshift workers. The grants will be available to a widevariety of organizations, from private businesses tocommunity-based traffic safety programs.

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4. Develop an electronically based curriculumpackage and supplements for novice drivers,instructors, and parents.

5. Create a Web-based resource directory forpractitioners, students/novice drivers, parents,teachers, vendors of curricula, safety/trafficorganizations, and sleep communities.

6. Develop a driver’s manual and knowledge examfor novice drivers.

Group 2: High SchoolFacilitator: Dr. Jude Pelchat

Education in the high school environment needsto be addressed at three levels:

• Curriculum and supplemental materials—fundamental ideas about sleep deprivation needto be worked into curricula or supplementalmaterials.

• Special programs—activities and informationfrom special initiatives such as National SleepAwareness Week and the High School 2000 TaskForce should be incorporated into high schooleducational efforts.

• High-risk circumstances—high-risk times forstudents, such as exam week, prom season, andspring break, should be addressed.

Recommendations:

1. Offer sessions at the annual meetings of relevanteducation organizations, such as the NationalScience Teachers Association and the NationalAssociation of Secondary School Principals.

2. Develop and publish sleep-related articles inpopular teen magazines, such as SeventeenandNintendo Power.

3. Sponsor essay/poster contests on sleep to raiseawareness. The Sleep Research Society alreadydoes this—other organizations could do some-thing similar.

TOP IDEAS AND RECOMMENDATIONSFROM THE SMALL -GROUP DISCUSSIONS

In developing their ideas and recommendations, thesmall groups considered the current focus on sleepeducation in each environment, as well as targetaudiences, primary messages, and factors that mighthelp or hinder incorporating sleep education into theenvironment (see appendix B). In most cases, nowidespread sleep-related programs or curriculacould be identified. However, there are somelimited-scope programs in place around the UnitedStates that could possibly serve as models for largerscale, national initiatives.

Group 1: Driver Education(private and public sector) Facilitator: Dr. John Palmer

It is estimated that approximately 50 percentof novice drivers go through a formal drivereducation program. Educational efforts willneed to address the fact that driver trainingcurrently is taking place in a multitude ofenvironments.

Recommendations:

1. Develop a national model curriculumpackage for students/novice drivers, parents, andteachers. Curriculum vendors, the traffic safetycommunity, the sleep community, and schooladministrators would be involved in contributingto the content or disseminating the product. Aprimary message is that sleep is not a wasteof time.

2. Hold symposia on sleep deprivation for thedriver education community. Traffic safety andsleep experts should develop the content for thesymposia.

3. Develop self-assessment tools for novicedrivers. A consortium of driver education, trafficsafety, and sleep organizations should implementthis idea.

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5. Develop a federally funded national publicrelations campaign focused on youth and sleep.The campaign could include mass media such asradio, television (MTV), print, and Scholastic,Inc., materials.

Group 4: Community-Based ProgramsFacilitator: Ms. Susan Hardman

Educational messages should be packaged in a waythat promotes something new, something interesting,and something people want to read or learn about.Community-based programs should include the lawenforcement sector, other government sectors, theeducation community, community and advocacygroups, health professionals, and the private sector.Ideally, educational materials should be culturallysensitive and multilingual.

Recommendations:

1. Support police training to recognize andproperly report drowsy-driving crashes. Stateand local police, the criminal justice system, policebenevolent societies, and highway authorities needto be involved to foster further police training.

2. Support public policy initiatives such asrumble strips, delayed school start times, and saferest areas. Organizations needed include legislators,school boards, law enforcement agencies, divisionsof motor vehicles, parent-teacher associations, andcommunity groups.

3. Develop a public education and informationcampaign targeted to parents, children, profes-sionals, and others about sleep and drowsydriving. This initiative needs to be supported byFederal, State, and local governments; the trafficsafety community; the public health community;the medical community; the media; the privatesector; and service organizations.

4. Develop interactive curricular materials forteachers and students, including a sleep bibliography.

5. Develop partnerships and distribution channelsthat provide support to professional organizations.

Group 3: Middle SchoolFacilitator: Mr. Gary Decker

Teaching students about sleep and sleep deprivation inmiddle school can set the stage for further learningduring the high school years. It may also be easier toget sleep-related materials into the middle schoolcurricula. During the middle school years, animportant part of students’development is learning tomake choices. Making choices about sleep allowsteens to have some control over their schedules.

Recommendations:

1. Raise awareness about sleep and sleep-related issuesamong the pertinent national organizations, such asthe National Middle School Association, NationalScience Teachers Association, and the NewEngland League of Middle Schools. The NationalInstitutes of Health (NIH) and NHTSA should sup-port this effort by establishing a science base foreducational messages.

2. Develop classroom materials for teachers andstudents. Involvement of various professionalsources will be needed to implement this idea,including teachers’ organizations (both general andspecialty), national and State education depart-ments, principals’ associations, National Parent-Teacher Association, NIH, sleep organizations, andcurriculum coordinators.

3. Begin sleep education in elementary school toprovide a platform on which to build in later years.

4. Expand the current knowledge base by increasingresearch on sleep and sleep deprivation using longi-tudinal, descriptive, cross-sectional, and interven-tional studies. Sleep-related organizations,research organizations, and foundations will beneeded to implement this idea.

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In the course of its deliberations, the group identifiedthe following as issues to be addressed in all theenvironments considered:

• While a great deal is known about sleep and sleepdeprivation and the effects of sleepiness ondriving performance, and there is an appropriatebasis for action, more research is also needed.Educational messages must be credible and basedon science in order to be effective and persuasive.

• Infrastructures for the dissemination of informationexist in many environments for youth, includingschools; local, State, and national governmentagencies; business and industry; and professional,educational, highway safety, and public healthassociations.

• The focus of sleep education differs from that ofdisease-based entities—it may require a differentapproach and strategy than are traditionally usedfor educating about disease-based topics.

• Developing partnerships among key nationalorganizations will be necessary to ensure thesuccessful implementation of these ideas. Inparticular, it is important that NHTSA and theNCSDR continue to expand their collaborativeefforts.

Discussion

Strategies were discussed for implementing thesmall groups’ recommendations for educating youthabout sleep and drowsy driving. The followingthree possible goals were discussed:

• Continue and build on specific programsand initiatives already under way.

• Bring efforts to the State level, using pioneerStates such as New York and Washington asmodels.

• Develop a national strategy in which a Federalagency or agencies or other national organizationswould lead, coordinate, and oversee efforts todevelop and implement educational initiatives foryoung people.

There was a general consensus that youthful drowsydriving is an important issue. There was also agree-ment that much more needs to be done to providesufficient education on sleep and drowsy driving toyoung people and their support systems, includingeducators and parents. It was also acknowledged,however, that there is no mechanism for providingthe necessary leadership and coordination to expandcurrent efforts and to develop and implement newinitiatives. The interested organizations need amechanism for communicating what they are doing;establishing joint priorities; sharing information,programs, materials, and other resources; developingcollaborative efforts; and identifying funding.

Participants suggested a number of possible methodsfor increasing communication among organizations.It was also pointed out that while State and localgovernments are the primary mechanism for deliveringprograms in highway safety, the Federal governmentplays a critical role in establishing national priorities,providing technical assistance, conducting and spon-soring research, and providing funding. At present, nosingle government agency has primary responsibilityfor conducting research and developing programs ondrowsy driving. The important roles of nonprofitorganizations and foundations in advancing this issuewere also stressed.

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APPENDIX A: THE WORKSHOP VISION AND OBJECTIVES

OBJECTIVES

1) To identify strategies and recommend prioritiesfor educating youth regarding the importance ofsleep and the danger of drowsy driving for theNCSDR and other organizations to consider.

2) To identify opportunities for partnering andcoordination among organizations having aninterest in the education of youth about sleepand sleep deprivation.

VISION

1) That youth and those around them become more knowledgeable about the importance of adequatesleep to good health, and the consequences ofsleep deprivation;

2) That youth obtain adequate sleep;

3) That drowsy driving decreases among youth,including that

a) They avoid getting into a drowsy drivingsituation, and that

b) They know what to do if faced with adrowsy driving situation;

4) That youths’ support systems (including parents,teachers, coaches, employers, school health per-sonnel and others) are well informed about sleepneeds and the consequences of sleep deprivation,especially the danger of drowsy driving.

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Part 1:

The small groups will consider the followingquestions for their particular program area (i.e., driv-er education, high school curricula/programs, mid-dle school curricula/programs, or community-basedprograms).

1) What is the current focus on sleep/sleepdeprivation in this environment?

2) Where would sleep education naturally fit intothis environment?

3) What audiences need to be reached in thisenvironment?

4) What messages are needed?

5) What factors* exist that would help toincorporate sleep education (or to achieveadequate sleep) in this environment?

6) What factors* exist that would hinder sleepeducation (or the attainment of adequate sleep)?

7) Which organizations could be involved inimplementing sleep education in this environment?

*Some factors to consider:

a) Knowledge and attitudes (of students,teachers, parents, others)

b) School schedulesc) Athleticsd) Employmente) Driver licensing/curfews/regulationsf) Others (specify)

Part 2:

The small groups will brainstorm about ideas forintegrating sleep education messages into theirprogram area, as well as possible organizations toimplement activities. They then will score and rankthe ideas according to: a) the idea’s likelihood ofsuccess (1-10 points where 1= not very likely tosucceed and 10= very likely to succeed); and b) itsease of implementation (1-10 points where 1= not atall easy to implement and 10= very easy to implement).

The four small groups will present their “top” ideas,and possible organizations to implement them, tothe full group in the afternoon for general discussionand further refinement.

APPENDIX B: QUESTIONS FOR SMALL GROUPS

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APPENDIX C: WORKSHOP AGENDA

8:00 - 8:20 Welcome and Introductions . . . . . . . . . . . . . . . . . . . . . . . . .Dr. Millman/Dr. McCartt

Purpose of Workshop . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Ms. Rogus

8:20 - 8:50 Sleep in Adolescence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Dr. Carskadon

8:50 - 9:30 Drowsy Driving and Teens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Dr. Pack/Dr. Strohl

9:30 - 9:45 BREAK

NOTE: Participants will be assigned to four small groups for the remainder of the

morning to focus on the following specific program areas:

• Driver Education Programs

• High School Curricula/Programs

• Middle School Curricula/Programs

• Community-Based Programs

9:45 - 10:45 Part 1: Current Opportunities for/Obstacles to

Incorporating Sleep Education Into Program Area . . . . . . . . . . . . . . . .Small Groups

10:45 - 11:45 Part 2: What Can Be Done to Integrate Sleep

Education Into Program Area? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Small Groups

11:45 - 1:00 LUNCH

1:00 - 4:15 Top Ideas for Successful Integration of

Sleep Education Into: . . . . . . . . . . . . . . . . . . . . . . . . . .Small Group Presentations/

Large Group Discussion

1:00 - 1:45 . . . . . . . . . . . . . . . . . . . . . . . . . . . .Driver Education Programs

1:45 - 2:30 . . . . . . . . . . . . . . . . . . . . . . . .High School Curricula/Programs

2:30 - 2:45 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .BREAK

2:45 - 3:30 . . . . . . . . . . . . . . . . . . . . . .Middle School Curricula/Programs

3:30 - 4:15 . . . . . . . . . . . . . . . . . . . . . . . . . .Community-Based Programs

4:15 - 4:30 Summary

4:30 Adjournment

NATIONAL CENTER ON SLEEP DISORDERS RESEARCHSTRATEGY DEVELOPMENT WORKSHOP ON EDUCATING YOUTHABOUT SLEEP AND DROWSY DRIVING

Omni Shoreham HotelWashington, DCJune 5, 1998

Discrimination Prohibited: Under provisions ofapplicable public laws enacted by Congress since1964, no person in the United States shall, onthe grounds of race, color, national origin, handicap, or age, be excluded from participationin, be denied the benefits of, or be subjected todiscrimination under any program or activity (or, on the basis of sex, with respect to any education program or activity) receiving Federalfinancial assistance. In addition, Executive Order11141 prohibits discrimination on the basis ofage by contractors and subcontractors in the performance of Federal contracts, and ExecutiveOrder 11246 states that no federally funded contractor may discriminate against any employ-ee or applicant for employment because of race,color, religion, sex, or national origin. Therefore,the National Heart, Lung, and Blood Institutemust be operated in compliance with these lawsand Executive Orders.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health ServiceNational Institutes of HealthNational Heart, Lung, and Blood Institute

September 1998