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

Series10

5

10

15

20

25

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

9

Distracted driving video

DISTRACTION IN ACTION

OUTLINE

1. Understanding distraction and injury risk

2. Distraction in Washington

11

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

Yaki

ma

Wha

tcom

Spok

ane

Snoh

omish

Pier

ceKin

g0%

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

18

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

19

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

24

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

29

• 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

lA

ug

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

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

Nu

mber

of

Case

Fil

ings

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

40

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

43

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

46

DISTRACTION ON THE JOB

47

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?