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Falls in older adults are associated with increased motor vehicle crash risk, possibly mediated by driving behavior. We examined the relationship of falls and fear of falling (FOF) with subsequent objectively measured driving habits.This multi-site, prospective cohort study enrolled 2990 active drivers aged 65-79 (53% female). At enrollment, we assessed falls in the past year and FOF (Short Falls Efficacy Scale-International). Driving outcomes included exposure, avoidance of difficult conditions, and unsafe driving during one-year follow-up, using in-vehicle Global Positioning System devices.Past-year falls were associated with more hard braking events (HBE). High FOF was associated with driving fewer days, miles, and trips, driving nearer home and more HBE. Differences were attenuated and not significant after accounting for health, function, medications and sociodemographics.Differences in objectively measured driving habits according to past-year fall history and FOF were largely accounted for by differences in health and medications. Rather than directly affecting driving, falls and FOF may serve as markers for crash risk and reduced community mobility due to age-related changes and poor health.

Introduction Although the number of alcohol-impaired driving (AID) fatalities has declined over the past several years, AID continues to be a serious public health problem. The purpose of this effort was to gain a better understanding of the U.S. driving population's perceptions and thoughts about the impacts of lowering the blood alcohol concentration (BAC) driving standard below.08% on AID, health, and other outcomes. Methods A questionnaire was administered to a nationally representative sample of licensed drivers in the U.S. (n = 1011) who were of age 21 or older on driving habits, alcohol consumption habits, drinking and driving habits, attitudes about drinking and driving, experiences with and opinions of drinking and driving laws, opinions about strategies to reduce drinking and driving, general concerns about traffic safety issues, and demographics. Results One-third of participants supported lowering the legal BAC standard, and participants rated a BAC standard of .05% to be moderately acceptable on average. 63.9% indicated that lowering 30 the BAC to .05% would have no effect on their decisions to drink and drive. Nearly 60% of respondents lacked accurate knowledge of their state's BAC standard. Conclusions Public support for lowering the BAC standard was moderate and was partially tied to beliefs about the impacts of a change in the BAC standard. The results suggest that an opportunity for better educating the driving population about existing AID policy and the implications for lowering the BAC level on traffic injury prevention. Practical applications The study results are useful for state traffic safety professionals and policy makers to have a better understanding of the public's perceptions of and thoughts about BAC standards. There is a clear need for more research into the effects of lowering the BAC standard on crashes, arrests, AID behavior, and alcohol-related behaviors.

Introduction Potential health and cost impacts of lowering the BAC limit for U.S. drivers below .08% were explored through analyses of reductions in crash incidence, injury severity, and costs based on five scenarios with varying assumptions about how the change to a .05% BAC limit might affect alcohol-impaired driving. Methods Distribution of crashes by injury level and highest driver or non-occupant BAC levels for 2010, together with unit crash costs provided a base for comparison. Scenario 1 assumed all alcohol-impaired driving ceased; scenario 2 assumed all drivers obeyed the law, and scenario 3 assumed decreases in driver BAC levels would be limited to those who had been driving near the legal limit before the change. Scenario 4 was based on changes in driver BAC levels associated with a 08% to .05% BAC limit change in Australia, and scenario 5 was based on changes in alcohol-related crashes associated with the change to the .08% BAC limit in the United States. The number of casualties prevented in each scenario was estimated using relative risks of crash involvement, and changes in societal costs were estimated using the unit costs. Results Reductions ranging from 71% to 99% in fatalities, injuries, and costs related to alcohol-impaired driving were estimated in scenarios 1 and 2. Scenarios 3–5 produced smaller reductions ranging from 4% to 16% for alcohol-impaired fatalities, injuries, and costs. Conclusion The wide difference between the outcomes of the two sets of scenarios reflects the sensitivity of BAC policy benefits to driver compliance behavior. Practical application The quantification of the reduction in the number and costs of traffic crash casualties in the set of behavioral scenarios explored in this research can inform policymakers about the extent and limits of benefits achievable by lowering the BAC limits as they consider strategies to reduce alcohol-impaired driving.

INTRODUCTION: Appropriate self-regulation of driving - that is, adjusting one's driving patterns by driving less or avoiding specific situations considered challenging - shows promise as a strategy for extending safe driving. However, results on the extent of self-regulatory practices among older drivers vary considerably across studies. METHOD: The purpose of this study was to develop and test a questionnaire to measure self-regulation at multiple levels of driver performance and decision making, using a sample of older drivers comprised of individuals with clinically-determined functional impairments, as well as older adults recruited from the general population. RESULTS: Results suggest that the questionnaire is a user-friendly instrument for gathering information from older adults about their self-regulatory practices which has good construct validity. Feedback on the questionnaire was positive. Construct validity of the questionnaire was assessed by comparing the recruitment populations along various dimensions on which they might be expected to differ (e.g., self-rated health and functioning, abilities for safe driving, and feelings of driving comfort/safety) and looking for correlations between variables that one would reasonably expect to be correlated. CONCLUSIONS: Overall, participants rated their general health and functioning, and abilities for safe driving quite highly. However, participants from the clinic population rated themselves lower than participants from the general population on several abilities including seeing clearly during the day and night, remembering things, and processing information. While participants reported high levels of driving comfort and safety for most driving situations, the clinic population reported lower levels of comfort and safety for every driving circumstance except driving alone. High correlations were found between comfort and safety and the absolute mean scores were nearly identical for each driving circumstance. Finally, the clinic population was more likely to report trying to avoid driving at night, in unfamiliar areas, and on the expressway, as well as chatting with passengers. IMPACT ON THE INDUSTRY: Results of this pilot work provide insights into the self-regulatory driving process that could eventually inform efforts to extend safe mobility among older adults. Language: en

Introduction Nearly all direct observation studies of safety belt use are conducted exclusively during daylight hours. Recent work has suggested that safety belt use at night may differ from daytime belt use. Methods An observational study of nighttime safety belt use, utilizing specialized night vision equipment, was conducted in Indiana surrounding the Click It or Ticket 2006 safety belt mobilization activities. A pre- and a post-mobilization statewide direct observation survey was conducted at night coinciding with daytime safety belt use data collection conducted by the state of Indiana. Daytime and nighttime belt use rates were compared. Results The comparisons across the mobilization period revealed a significant increase during the day, but a significant decrease at night. Comparisons between daytime and nighttime belt use revealed no overall difference during the pre wave, but a significant difference during the post wave. Finally, many common daytime trends in belt use were also found at night, with the exception of the typical age and seating position effects. Discussion The mobilization activities had a positive effect on daytime belt use, but no effect on nighttime belt use, likely resulting in the differences between daytime and nighttime belt use observed during the post wave. Impact on Industry The findings of this study suggest that safety belt mobilizations implemented only during the day do not influence nighttime safety belt use. Changes to how these programs are implemented or additional programs specifically targeting belt use at night should be considered, along with continued monitoring of nighttime belt use.

PURPOSE: This study aims to assess whether the Driving Decisions Workbook, a self-assessment instrument for older drivers, increased self-awareness and general knowledge. This study also assessed perceptions regarding its usefulness, particularly as a tool for facilitating discussions within families of older drivers. A secondary purpose of the study was to determine if problems identified by drivers in the workbook related to problems they had with actual driving. DESIGN AND METHODS: The Driving Decisions Workbook was administered along with a questionnaire and a road test. A convenience sample of 99 licensed drivers aged 65 and above was used. RESULTS: After completing the workbook, about three fourths of the participants reported being more aware of changes that could affect driving. Fourteen percent reported that they had discovered a change in themselves of which they had not been previously aware. All respondents found the workbook to be at least a little useful and thought the workbook could help facilitate family discussions. Workbook responses were positively correlated with overall road test scores. Significant correlations were also noted between the road test and a majority of workbook subsection responses. IMPLICATIONS: This study indicates that the workbook may be a useful first-tier assessment instrument and educational tool for the older driver. It may encourage an older driver to drive more safely and/or to seek clinical assessment, and help in facilitating discussions about driving within their families.

Introduction Self-screening by older drivers has shown considerable promise for increasing self-awareness about functional abilities associated with safe driving. The purpose of this study was to improve upon existing self-screening instruments by focusing entirely on “health concerns” that affect driving – that is, the symptoms that people experience due to medical conditions and the medications used to treat them – rather than the medical conditions or medications themselves. Method A computer-based, easy-to-use self-screening instrument for older drivers was developed to provide individualized feedback intended to increase self-awareness about declines in driving-related abilities, as well as suggestions for behavioral changes or safety tips to maintain safe driving, further evaluation from a physician/health professional, and vehicle modifications to help compensate for driving-related declines. Results This paper describes the development of the self-screening instrument and summarizes findings relative to increasing self-awareness among older drivers. This research represents an important first step in improving self-awareness among older drivers through self-screening.

Introduction The purpose of the study reported here was to develop and pilot test a comprehensive battery of assessment instruments for older drivers that would be inexpensive and easy to administer so that it could be used in longitudinal studies. Method The resulting battery was developed by selecting a set of validated assessment instruments and combining them into a package, with a total acquisition cost of less than $900. As part of this battery, three questionnaires were developed utilizing items from established questionnaires with minor modifications. The battery was pilot tested with a convenience sample of 38 drivers aged 65 years or older. Results Results showed that the entire battery required less than one hour to complete. Data from the assessment outcomes fell within normative ranges. Feedback from subjects indicated that the battery was acceptable, free of problems, presented tasks in a good order, and was not too long. Conclusions Based on study findings, the assessment battery appeared to be low-cost, transportable, easy to administer, easy for subjects to complete, provides a comprehensive assessment of a person's physical health, mental health, and driving behaviors, and would serve as a valuable data collection tool for a longitudinal study of older drivers. Such a longitudinal study is needed in order to answer some of the most important questions about older driver safety and mobility.

IntroductionThis article examines five major road-safety risk factors: exceeding posted speed limits, not using safety belts, driving while intoxicated, nighttime driving, and young drivers.MethodThe importance of each of these factors is documented, known effective countermeasures (both policy and technology based) are discussed, and impediments to the implementation of these countermeasures in the United States are examined.ResultsBased on current understanding of the five major risk factors, and of the available countermeasures, there appear to be a variety of opportunities to make substantial gains in road safety using existing knowledge. The limited implementation of a variety of known countermeasures therefore appears to be inconsistent with high-level, strategic goals to improve road safety. Consequently, a recommendation is made to comprehensively re-examine the balance between the countermeasures discussed in this article and economic, mobility, and privacy concerns.Impact on Public SafetySuch a re-examination is likely to result in broad support for these countermeasures, with a consequent major improvement in road safety.

Introduction The use of hand-held cellular (mobile) phones while driving has stirred more debate, passion, and research than perhaps any other traffic safety issue in the past several years. There is ample research showing that the use of either hand-held or hands-free cellular phones can lead to unsafe driving patterns. Whether or not these performance deficits increase the risk of crash is difficult to establish, but recent studies are beginning to suggest that cellular phone use elevates crash risk. Methods The purpose of this study was to assess changes in the rate of hand-held cellular phone use by motor-vehicle drivers on a statewide level in Michigan. This study presents the results of 13 statewide surveys of cellular phone use over a 4-year period. Hand-held cellular phone use data were collected through direct observation while vehicles were stopped at intersections and freeway exit ramps. Data were weighted to be representative of all drivers traveling during daylight hours in Michigan. Results The study found that driver hand-held cellular phone use has more than doubled between 2001 and 2005, from 2.7% to 5.8%. This change represents an average increase of 0.78 percentage points per year. The 5.8% use rate observed in 2005 means that at any given daylight hour, around 36,550 drivers were conversing on cellular phones while driving on Michigan roadways. The trend line fitted to these data predicts that by the year 2010, driver hand-held cellular phone use will be around 8.6%, or 55,000 drivers at any given daylight hour. Conclusions These results make it clear that cellular phone use while driving will continue to be an important traffic safety issue, and highlight the importance of continued attempts to generate new ways of alleviating this potential hazard.