Unlicensed driving and other related health risk behaviors: A study of Montana high school students

Purpose

Health risk behaviors tend to cluster in young people, not least among young drivers. Less is known about the health risk profile of young unlicensed drivers. This study investigates health risk behaviors among young unlicensed drivers compared to both their licensed and driving peers, and their non-driving peers.

Methods

High school students participating in the Youth Risk Behavior Surveillance System in Montana (US) and age-eligible to have a driver's license were studied (n = 5985), categorized according to their self-reported car driving and license practice (licensed driving, unlicensed driving, and non-driving). Ten health risk behaviors, of which four were related to car riding/driving, were considered. Multinomial logistic regression was used to compile sex-specific odds ratios (with 95% confidence intervals) of adopting those behaviors using licensed drivers as a reference and adjusting for age and race/ethnicity.

Results

Health risk behaviors tended to be more common among unlicensed drivers than other groups, although some behaviors were prevalent in all groups (i.e., alcohol use and lack of seat belt use). As a consequence, for both male and female students, there was a significant association between unlicensed driving and most health risk behaviors, except for being involved in a physical fight and riding with a drinking driver among female students.

Conclusions

Young unlicensed drivers are more likely than licensed drivers to adopt several health risk behaviors both in car driving/riding or otherwise, in particular alcohol use and cigarette smoking. This challenges any simplistic approach as unlicensed driving in youth is not an isolated act suggesting public health and traffic safety initiatives.     

Drug use among drivers who drank on alcohol outlets from Porto Alegre,Brazil

Background

Driving under the influence of multiple substances is a public health concern, but there is little epidemiological data about their combined use and putative impact on driving in low and middle-income countries where traffic crashes have been clustering in recent years. The aim of this study is to estimate the prevalence of alcohol and drug use – as well as their associated factors – among drivers in the context of alcohol outlets (AOs).

Methods

A probability three-stage sample survey was conducted in Porto Alegre, Brazil. Individuals who were leaving AO were screened, with the selection of 683 drivers who met the inclusion criteria. Drivers answered a structured interview, were breathalyzed, and had their saliva collected for drug screening. Prevalences were assessed using domain estimation and logistic regression models assessed covariates associated with substance use.

Findings

Benzodiazepines 3.9% (SE 2.13) and cocaine 3.8% (SE 1.3) were the most frequently detected drugs in saliva. Among drivers who were going to drive, 11% had at least one drug identified by the saliva drug screening, 0.4% two, and 0.1% three drugs in addition to alcohol. In multivariable analyses, having a blood alcohol concentration (BAC) > 0.06% was found to be associated with a 3.64 times (CI 95% 1.79–7.39) higher chance of drug detection, compared with interviewees with lower BACs.

Conclusions

To drive under the influence of multiple substances is likely to be found in this setting, highlighting an association between harmful patterns of consume of alcohol and the misuse of other substances.     

The acute effects of 3,4-methylenedioxymethamphetamine and methamphetamine on driving: A simulator study

Objectives

Illicit drugs such as MDMA and methamphetamine are commonly abused drugs that have also been observed to be prevalent in drivers injured in road accidents. Their exact effect on driving and driving behavior has yet to be thoroughly investigated.

Methods

Sixty-one abstinent recreational users of illicit drugs comprised the participant sample, with 33 females and 28 males, mean age 25.45 years. The three testing sessions involved oral consumption of 100 mg MDMA, 0.42 mg/kg methamphetamine, or a matching placebo. The drug administration was counter-balanced, double-blind, and medically supervised. At each session driving performance was assessed 3 h and 24 h post drug administration on a computerized driving simulator.

Results

At peak concentration overall impairment scores for driving (F_2,118 = 9.042, p < 0.001) and signaling (F_2,118 = 4.060, p = 0.020) were significantly different for the daytime simulations. Performance in the MDMA condition was worse than both the methamphetamine (p = 0.023) and placebo (p < 0.001) conditions and the methamphetamine condition was also observed to be worse in comparison to the placebo (p = 0.055). For signaling adherence, poorer signaling adherence occurred in both the methamphetamine (p = 0.006) and MDMA (p = 0.017) conditions in comparison to placebo in the daytime simulations.

Conclusions

The findings of this study have for the first time illustrated how both MDMA and methamphetamine effect driving performance, and provide support for legislation regarding testing for the presence of illicit drugs in impaired or injured drivers as deterrents for driving under the influence of illicit drugs.     

Young novice drivers and the risky behaviours of parents and friends during the Provisional (intermediate) licence phase: A brief report

Purpose

While there is research indicating that many factors influence the young novice driver's increased risk of road crash injury during the earliest stages of their independent driving, there is a need to further understand the relationship between the perceived risky driving behaviour of parents and friends and the risky behaviour of drivers with a Provisional (intermediate) licence.

Method

As part of a larger research project, 378 drivers aged 17–25 years (M = 18.22, SD = 1.59, 113 males) with a Provisional licence completed an online survey exploring the perceived riskiness of their parents’ and friends’ driving, and the extent to which they pattern (i.e. base) their driving behaviour on the driving of their parents and friends.

Results

Young drivers who reported patterning their driving on their friends, and who reported they perceived their friends to be risky drivers, reported more risky driving. The risky driving behaviour of young male drivers was associated with the perceived riskiness of their fathers’ driving, whilst for female drivers the perceived riskiness of their mothers’ driving approached significance.

Conclusions

The development and application of countermeasures targeting the risky behaviour of same-sex parents appears warranted by the robust research findings. In addition, countermeasures need to encourage young people in general to be non-risky drivers; targeting the negative influence of risky peer groups specifically. Social norms interventions may minimise the influence of potentially-overestimated riskiness.     

Reliability of simulator driving tool for evaluation of sleepiness,fatigue and driving performance

Study objective

To compare the impact of extended wakefulness (i.e., sleepiness) and prolonged driving (i.e., fatigue) at the wheel in simulated versus real-life driving conditions.

Design

Participants drove on an INRETS-MSIS SIM2 simulator in a research laboratory or an open French highway during 3 nocturnal driving sessions. A dose–response design of duration of nocturnal driving was used: a 2 h short driving session (3–5 AM), a 4 h intermediate driving session (1–5 AM) and an 8 h long driving session (9 PM–5 AM).

Participants

Two groups of healthy male drivers (20 for simulated driving and 14 drivers for real driving; mean age ± SD = 22.3 ± 1.6 years), free of sleep disorders.

Measurements

Number of inappropriate line crossings, self-rated fatigue and sleepiness were recorded in the last hour of driving sessions to control the effects of prior waking time and time of day.

Results

Compared to the daytime reference session, both simulated and real driving performance were affected by a short nocturnal driving session (P < .05 and P < .001, respectively). Extension of nocturnal driving duration affected simulated performance nonlinearly and more severely than that of real driving (P < .001).Compared to the daytime reference session, short nocturnal simulated and real driving sessions increased self-perceived fatigue and sleepiness. Real and simulated driving conditions had an identical impact on fatigue and sleepiness during extended periods of nocturnal driving.

Conclusions

In healthy subjects, the INRETS-MSIS SIM2 simulator appropriately measures driving impairment in terms of inappropriate line crossings related to extended wakefulness but has limitations to measure the impact of extended driving on drivers’ performance.     

The effects of a new traffic safety law in the Republic of Serbia on driving under the influence of alcohol

The aim of the study presented here has been to see what the effects of the new traffic safety law are, 2 years into its initial implementation, on driving under the influence of alcohol. Until the end of 2009, the legal limit for blood concentration for drivers in Serbia was 0.5 g/l; however, the new traffic safety law stipulates the new limit to be 0.3 g/l. A retrospective autopsy study was performed over a 6-year period (from 2006 to 2011) whose sample covered cases of fatally injured drivers who had died at the scene of the incident, before being admitted to hospital. A total of 161 fatally injured drivers were examined for their blood alcohol concentration. The average age for these drivers was 40.2 ± 15.4 years, with a significant male predominance of 152 men to 9 women (χ² = 152.000, p < 0.001). This study has shown no decrease in the ratio of drivers under the influence of alcohol vs. all drivers (Pearson χ² = 4.415, df = 5, p = 0.491), nor in the number of drivers under the influence of alcohol (Pearson χ² = 6.629, df = 5, p = 0.250), nor a decrease in the mean blood alcohol concentration in drivers (1.72 ± 0.87 vs. 1.68 ± 0.95 g/l, t = 0.177, df = 80, p = 0.860). The conclusion of this study is that the new law has had a limited effect on driving under the influence of alcohol, which still remains one of the major human factors, responsible for road-traffic crashes in Serbia.     

Confirmatory factor analysis of the Behaviour of Young Novice Drivers Scale (BYNDS)

Purpose

The greatly increased risk of being killed or injured in a car crash for the young novice driver has been recognised in the road safety and injury prevention literature for decades. Risky driving behaviour has consistently been found to contribute to traffic crashes. Researchers have devised a number of instruments to measure this risky driving behaviour. One tool developed specifically to measure the risky behaviour of young novice drivers is the Behaviour of Young Novice Drivers Scale (BYNDS) (Scott-Parker et al., 2010). The BYNDS consists of 44 items comprising five subscales for transient violations, fixed violations, misjudgement, risky driving exposure, and driving in response to their mood. The factor structure of the BYNDS has not been examined since its development in a matched sample of 476 novice drivers aged 17–25 years.

Method

The current research attempted to refine the BYNDS and explore its relationship with the self-reported crash and offence involvement and driving intentions of 390 drivers aged 17–25 years (M = 18.23, SD = 1.58) in Queensland, Australia, during their first 6 months of independent driving with a Provisional (intermediate) driver's licence. A confirmatory factor analysis was undertaken examining the fit of the originally proposed BYNDS measurement model.

Results

The model was not a good fit to the data. A number of iterations removed items with low factor loadings, resulting in a 36-item revised BYNDS which was a good fit to the data. The revised BYNDS was highly internally consistent. Crashes were associated with fixed violations, risky driving exposure, and misjudgement; offences were moderately associated with risky driving exposure and transient violations; and road-rule compliance intentions were highly associated with transient violations.

Conclusions

Applications of the BYNDS in other young novice driver populations will further explore the factor structure of both the original and revised BYNDS. The relationships between BYNDS subscales and self-reported risky behaviour and attitudes can also inform countermeasure development, such as targeting young novice driver non-compliance through enforcement and education initiatives.     

Which visual measures affect change in driving difficulty after first eye cataract surgery?

Objective

To investigate self-reported driving difficulty before and after first eye cataract surgery and determine which visual measures are associated with changes in self-reported driving difficulty after surgery.

Methods

A cohort of 99 older drivers with bilateral cataract were assessed the week before and 12 weeks after first eye cataract surgery. Visual measures including visual acuity, contrast sensitivity, stereopsis and useful field of view were assessed. Self-reported driving difficulty was measured via the Driving Habits Questionnaire. Cognitive status was assessed using the Mini Mental State Examination. Regression analysis was undertaken to determine the association between changes in visual measures and self-reported driving difficulty after first eye cataract surgery.

Results

Overall, self-reported driving difficulty improved after first eye cataract surgery. However, 16% of participants did not improve and driving difficulty worsened in 11% following surgery. Improvement in driving difficulty score after first eye cataract surgery was associated with improved contrast sensitivity in the operated eye (p < 0.001), new glasses after surgery (p < 0.001), and fewer chronic health conditions (p = 0.016).

Conclusion

Contrast sensitivity rather than visual acuity was a significant factor affecting change in self-reported driving difficulty after first eye cataract surgery for bilateral patients. This has implications for driver licensing authorities worldwide that rely heavily on visual acuity as a measure of visual fitness to drive.     

Risky driving behavior among university students and staff in the Sultanate of Oman

Background

There is a well developed literature on research investigating the relationship between various driving behaviors and road crash involvement. However, this research has predominantly been conducted in developed economies dominated by western types of cultural environments. To date no research has been published that has empirically investigated this relationship within the context of the emerging economies such as Oman.

Objective

The present study aims to investigate driving behavior as indexed in the driving behavior questionnaire (DBQ) among a group of Omani university students and staff.

Methods

A convenience non-probability self-selection sampling approach was utilized with Omani university students and staff.

Results

A total of 1003 Omani students (n = 632) and staff (n = 371) participated in the survey. Factor analysis of the BDQ revealed four main factors that were errors, speeding violation, lapses and aggressive violation. In the multivariate logistic backward regression analysis, the following factors were identified as significant predictors of being involved in causing at least one crash: driving experience, history of offenses and two DBQ components, i.e., errors and aggressive violation.

Conclusion

This study indicates that errors and aggressive violation of the traffic regulations as well as history of having traffic offenses are major risk factors for road traffic crashes among the sample. While previous international research has demonstrated that speeding is a primary cause of crashing, in the current context, the results indicate that an array of factors is associated with crashes. Further research using more rigorous methodology is warranted to inform the development of road safety countermeasures in Oman that improves overall Traffic Safety Culture.     

Pre-licensed driving experience and car crash involvement during the learner and restricted,licence stages of graduated driver licensing: Findings from the New Zealand Drivers Study

Objective

The aim of this study was to determine whether pre-licence driving experiences, that is driving before beginning the licensing process, increased or decreased crash risk as a car driver, during the learner or the restricted licence stages of the graduated driver licensing system (GDLS).

Method

Study participants were 15–24 year old members of the New Zealand Drivers Study (NZDS) – a prospective cohort study of newly licensed car drivers. The interview stages of the NZDS are linked to, the three licensing stages of the GDLS: learner, restricted and full. Baseline demographic (age, ethnicity, residential location, deprivation), personality (impulsivity, sensation seeking, aggression) and, behavioural data, (including pre-licensed driving behaviour), were obtained at the learner licence interview. Data on distance driven and crashes that occurred at the learner licence and restricted licence stages, were reported at the restricted and full licence interviews, respectively. Crash data were also obtained from police traffic crash report files and this was combined with the self-reported crash data. The analysis of the learner licence stage crashes, when only supervised driving is allowed, was based on the participants who had passed the restricted licence test and undertaken the NZDS, restricted licence interview (n = 2358). The analysis of the restricted licence stage crashes, when unsupervised driving is first allowed, was based on those who had passed the full licence test and completed the full licence interview (n = 1428).

Results

After controlling for a range of demographic, personality, behavioural variables and distance driven, Poisson regression showed that the only pre-licence driving behaviour that showed a consistent relationship with subsequent crashes was on-road car driving which was associated with an increased risk of being the driver in a car crash during the learner licence period.

Conclusion

This research showed that pre-licensed driving did not reduce crash risk among learner or restricted licensed drivers, and in some cases (such as on-road car driving) may have increased risk. Young people should be discouraged from the illegal behaviour of driving a car on-road before licensing.     

Alcohol and drugs in fatally and non-fatally injured motor vehicle drivers in northern Sweden

Alcohol and drugs are important risk factors for traffic injuries, a major health problem worldwide. This prospective study investigated the epidemiology and the presence of alcohol and drugs in fatally and hospitalized non-fatally injured drivers of motor vehicles in northern Sweden. During a 2-year study period, blood from fatally and hospitalized non-fatally injured drivers was tested for alcohol and drugs. The study subjects were recruited from well-defined geographical areas with known demographics. Autopsy reports, medical journals, police reports, and toxicological analyses were evaluated. Of the fatally injured, 38% tested positive for alcohol and of the non-fatally 21% tested positive; 7% and 13%, respectively, tested positive for pharmaceuticals with a warning for impaired driving; 9% and 4%, respectively, tested positive for illicit drugs. The most frequently detected pharmaceuticals were benzodiazepines, opiates, and antidepressants. Tetrahydrocannabiol was the most frequently detected illicit substance. No fatally injured women had illegal blood alcohol concentration. The relative proportion of positively tested drivers has increased and was higher than in a similar study 14 years earlier. This finding indicates that alcohol and drugs merit more attention in future traffic safety work.     

Improving seat belt use among teen drivers: Findings from a service-learning approach

Background

Low seat belt use and higher crash rates contribute to persistence of motor vehicle crashes as the leading cause of teenage death. Service-learning has been identified as an important component of public health interventions to improve health behavior.

Methodology

A service-learning intervention was conducted in eleven selected high schools across the United States in the 2011–2012 school year. Direct morning and afternoon observations of seat belt use were used to obtain baseline observations during the fall semester and post-intervention observations in the spring. The Mann–Whitney U test for 2 independent samples was used to evaluate if the intervention was associated with a statistically significant change in seat belt use. We identified factors associated with seat belt use post-intervention using multivariable logistic regression.

Results

Overall seat belt use rate increased by 12.8%, from 70.4% at baseline to 83.2% post-intervention (p < 0.0001). A statistically significant increase in seat belt use was noted among white, black, and Hispanic teen drivers. However, black and Hispanic drivers were still less likely to use seat belts while driving compared to white drivers. Female drivers and drivers who had passengers in their vehicle had increased odds of seat belt use.

Conclusion

A high school service-learning intervention was associated with improved seat belt use regardless of race, ethnicity, or gender, but did not eliminate disparities adversely affecting minority youth. Continuous incorporation of service-learning in high school curricula could benefit quality improvement evaluations aimed at disparities elimination and might improve the safety behavior of emerging youth cohorts.     

The influence of anger,impulsivity, sensation seeking and driver attitudes on risky driving behaviour among post-graduate university students in Durban,South Africa

Introduction

Road traffic accidents (RTAs) constitute a serious global health risk, and evidence suggests that young drivers are significantly overrepresented among those injured or killed in RTAs. This study explores the role of anger, impulsivity, sensation seeking and driver attitudes as correlates for risky driving practices among drivers, drawing comparisons between age and gender.

Method

The study used a cross-sectional survey design, with a sample of 306 post-graduate university students from two universities in Durban, South Africa, who completed the self-administered questionnaire.

Results

The results indicate that drivers with higher driver anger, sensation seeking, urgency, and with a lack of premeditation and perseverance in daily activities were statistically more likely to report riskier driving acts. Males reported significantly more acts of risky driving behaviour (RDB) than females. Driver attitudes significantly predicted self-reported acts of RDB on most indicators. Older drivers (25 years and older) had safer driver attitudes and a lower sense of sensation seeking and urgency in life.

Conclusion

Interventions targeting young drivers, which focus on impeding the manifestation of anger, impulsivity and sensation seeking are recommended. Also, the empirical support for the attitude–behaviour hypothesis evidenced in this study vindicates the development or continuation of interventions that focus on this dynamic.     

Graduated driver license nighttime compliance in U.S. teen drivers involved in fatal motor vehicle crashes

Background

Examination of teen driver compliance with graduated driver licensing (GDL) laws could be instrumental in identifying factors associated with persistently high motor vehicle mortality rates.

Methods

Fatality analysis reporting system (FARS) data from the years 2006 to 2009 were used in this nation-wide cross-sectional study of drivers covered by a state nighttime GDL law (n = 3492). A new definition of weekend, based on the school night in relation to the teenage social landscape, redefined Friday night as a weekend night and Sunday night as a weekday/school night and compared it to previous weekend definitions. Multiple logistic regression was used to examine independent effects of demographic, behavioral, environmental, contextual, and other factors on compliance with nighttime GDL laws. All analyses were performed in Stata version 11.

Results

Given coverage under nighttime GDL laws, drivers aged 15–17 years were non-compliant in 14.9% of the fatal MVCs in which they were involved, and nearly one-fifth (18.8%) of all fatalities aged 15–17 years were associated with non-compliance. Mortality risk was 10% higher using a revised social (school night) versus traditional (Sat–Sun) weekend definitions. In multivariable analysis, drivers non-compliant with nighttime GDL laws were more likely to be drinking (OR = 4.97, 3.85–6.40), unbelted (OR = 1.58, 1.25–1.99), driving on the weekend (OR = 1.82, 1.47–2.24), and killed (OR = 1.31, 1.04–1.65).

Conclusion

GDL non-compliance contributes to teen motor vehicle mortality. Legislative and enforcement efforts targeting non-school night driving, seatbelt nonuse and alcohol have potential to further reduce teen driving mortality.     

Short-term outcomes of a motivation-enhancing approach to DUI intervention

Objective

We compared a group-delivered, theory-based, motivation-enhancing program (PRIME For Life^® – PFL, n = 450) to an intervention as usual (IAU, n = 72).

Method

Individuals convicted of a substance related offense in North Carolina, typically first offense alcohol and drug-impaired driving, participated in a PFL or IAU group. We compare the interventions on program satisfaction and changes made from preintervention to postintervention, and examined the moderating effects of demographics and alcohol dependence level.

Results

When significant, findings varied in magnitude from small to medium effects. Participants in both interventions showed intentions to use statistically significantly less alcohol and drugs in the future compared to their previous use, and differences between the groups were not statistically significant. Otherwise, findings favored PFL. PFL exhibited greater benefit than IAU on understanding tolerance, perceived risk for addiction, problem recognition, and program satisfaction. Additionally, IAU perceived less risk for negative consequences postintervention than they had at preintervention. Moderation analyses showed that the between-condition findings occurred regardless of gender, age, education, and number of alcohol dependence indicators. Additionally, younger people and those with more dependence indicators – groups of particular concern – showed the greatest change.

Conclusions

Findings suggest that a motivation-enhancing approach can be effective in producing short-term change in factors that can help facilitate and sustain behavioral change. This is consistent with previous research on the use of motivational approaches, and extends such findings to suggest promise in group-based settings and with people across demographic categories and dependence levels. Future research should focus on larger studies looking at long-term behavioral change, including recidivism.     

The rate ratio of injury and aggressive incident for alcohol alone,cocaine alone and simultaneous use before the event: A case–crossover study

Objectives

(i) To estimate the rate ratio (RR) of use of alcohol alone, cocaine alone, and both substances simultaneously on acute injury or an aggressive incident, (ii) to compare the RRs for simultaneous use within 3 or 6 h of the event; and (iii) to compare the RRs of two measures of exposure, “hours of feeling effects” vs estimates based on self-reported quantity and frequency of use.

Methods

The study employed a case–crossover design with the frequency approach. Clients (N = 616) in substance abuse treatment for alcohol or cocaine issues from 2009 to 2012 completed a self-administered questionnaire on their substance use within 3 and 6 h before a recent injury or physically aggressive incident. Clients also reported detailed quantity and frequency information in relation to their typical substance use, as well as information on “feeling effects”. The RR of acute harms due to substance use was estimated using the Mantel–Haenszel estimator.

Results

In the 6-h window before the event, use of cocaine alone, alcohol alone and simultaneous alcohol and cocaine use were each significantly (P < 0.05) related to a recent injury and aggressive incident. Simultaneous use was not significantly greater than use of either drug alone. Estimates of RR based on simultaneous use for a 3-h window before the event were consistently larger than those based on a 6-h window, and comparisons were significant (P < 0.05) for an aggressive incident but not an injury. With reference to the two measures of exposure, three of eight comparisons of RRs were significantly larger for feeling the effects of the substance in comparison to quantity and frequency of substance use.

Conclusion

These findings are consistent with increased likelihood of harms related to the acute effects of alcohol alone, cocaine alone or simultaneous use. The results are suggestive that the acute effects of these drugs may be better measured within a 3-h time window than a 6-h window. Finally, we found that “hours of feeling effects” yielded higher estimates of RR than the quantity–frequency approach; however both measures support the overall findings.     

Dominant role of drivers’ attitude in prevention of road traffic crashes: A study on knowledge,attitude, and practice of drivers in Iran

Objective

Evaluating the relation between Iranian drivers’ knowledge, attitude, and practice (KAP) regarding traffic regulations, and their deterministic effect on road traffic crashes (RTCs).

Setting

Two cities of Tehran and Zahedan, Iran.

Methods

A cross-sectional study was designed. Using a simplified cluster sampling design, 2200 motor vehicle drivers including 1200 in Tehran and 1000 in Zahedan were selected. Sixty locations in Tehran and 50 in Zahedan were chosen. In each pre-identified location, 20 adult drivers were approached consecutively. A questionnaire developed by researchers was filled by each participant. The questionnaire had four sections including items assessing the demographics, knowledge, attitude and practice of drivers toward traffic regulations. Logistic regression analysis was used to evaluate the relationship between the RTCs and KAP variables.

Results

The study sample consisted of 619 (28.1%) occupational and 1580 (71.8%) private drivers. Among them, 86.4% were male. The median age was 33.6 ± 10.83. Drivers in Tehran and Zahedan had no significant differences between their mean scores of KAP items of the questionnaire. Higher knowledge, safer attitude, and safer practice were associated with a decreased number of RTC. After adjusting for possible confounders, increase of one standard deviation in attitude and practice scores (but not knowledge) resulted in 26.4% and 18.5% decrease in RTC, respectively. Finally, considering knowledge, attitude and practice of drivers in one model to assess their mutual effect, it was shown that only attitude is significantly associated with a decrease of RTC (OR = 0.76, P = 0.007).

Conclusion

Increase in attitude and practice accompanied with decreased number of RTCs in Iranian drivers. Specifically, drivers’ attitude had the crucial effect. It is not knowledge and standard traffic education; rather it is how such education is registered as an attitude that translates what is being learned into actions. Without safer attitude, even safer self-reported practice will not result in lower RTCs.     

Fitness-to-drive after mild traumatic brain injury: Mapping the time trajectory of recovery in the acute stages post injury

Introduction

Little is known about the trajectory of recovery in fitness-to-drive after mild traumatic brain injury (mTBI). This means that health-care professionals have limited evidence on which to base recommendations to this cohort about driving.

Objective

To determine fitness-to-drive status of patients with a mTBI at 24 h and two weeks post injury, and to summarise issues reported by this cohort about return to driving.

Method

Quasi-experimental case-control design. Two groups of participants were recruited: patients with a mTBI (n = 60) and a control group with orthopaedic injuries (n = 60). Both groups were assessed at 24 h post injury on assessments of fitness-to-drive. Follow-up occurred at two weeks post injury to establish driver status.

Main Measures

Mini mental state examination, occupational therapy-drive home maze test (OT–DHMT), Road Law Road Craft Test, University of Queensland-Hazard Perception Test, and demographic/interview form collected at 24 h and at two weeks.

Results

At the 24 h assessment, only the OT–DHMT showed a difference in scores between the two groups, with mTBI participants being significantly slower to complete the test (p = 0.01). At the two week follow-up, only 26 of the 60 mTBI participants had returned to driving. Injury severity combined with scores from the 24 h assessment predicted 31% of the variance in time taken to return to driving. Delayed return to driving was reported due to: “not feeling 100% right” (n = 14, 23%), headaches and pain (n = 12, 20%), and dizziness (n = 5, 8%).

Conclusion

This research supports existing guidelines which suggest that patients with a mTBI should not to drive for 24 h; however, further research is required to map factors which facilitate timely return to driving.