1. UW MEDICINE │ INJURY CONTROL DISTRACTION & INJURY: HOLDING BACK THE TIDE Beth Ebel, MD, MSc, MPH Harborview Injury Prevention & Research Center University of Washington/Seattle Children’s Hospital Nov 21, 2013

2. DISTRACTED DRIVING: A PUBLIC HEALTH PROBLEM

3. 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

4. OUTLINE 1.Understanding distraction and injury risk

5. 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.

6. RELATIVE RISK OF TEXTING & DRIVING 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)

7. 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 8 American Baby magazine, June 2013

9. Distracted driving video DISTRACTION IN ACTION 9

10. OUTLINE 1.Understanding distraction and injury risk 2.Distraction in Washington

11. DISTRACTED DRIVING FATALITIES AND SERIOUS INJURIES IN WASH. 2009-2011 11 TotalDistraction Related Distraction as % of Total Traffic Deaths1,70642630.3% Serious Injuries7,24986712.0%

12. 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 13

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15. 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 16

17. CITATIONS FOR CELL PHONE/TEXTING WHILE DRIVING, 6 LARGE WASHINGTON COUNTIES 17

18. Charge/Law Number201020112012201020112012 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) King787613383114654.998.407.04 King+Seattle(City Law)*838815100135545.329.478.32 Pierce2208355838293.685.896.24 Snohomish619112518954911.8523.8917.96 Spokane2558310127317.268.797.65 Whatcom873141711675.709.207.50 Yakima630129114323.587.318.03 CELL PHONE USE WHILE DRIVING 18

19. Charge/Law Number201020112012201020112012 TEXTING WHILE DRIVING Rate per 1,000 licensed drivers (46.61.668 / 46.61.668.1A / 46.61.668.1B / 11.84.460) King2655346040.170.330.37 King+Seattle (City Law)*2815796830.180.360.42 Pierce1663453750.280.570.61 Snohomish1332314020.250.440.76 Spokane1311011050.370.29 Whatcom2248520.140.310.33 Yakima2419350.140.110.20 TEXTING WHILE DRIVING 19

20. Charge/Law Number201020112012201020112012 INATTENTIVE DRIVING Rate per 1,000 licensed drivers King 101281086795636.426.825.87 King+Seattle (City Law)* 1048116111571.751.921.89 Pierce 1302562700.250.490.51 Snohomish 0000.00 Spokane 2542573041.661.671.95 Whatcom 3733943502.122.231.96 Yakima 1193312935116443.533.803.36 INATTENTIVE DRIVING 20

21. OUTLINE 1.Understanding distraction and injury risk 2.Distraction in Washington 3.Promising strategies for reducing distracted driving

22. 4 “E”s OF INJURY PREVENTION E ducation E nforcement Physical E nvironment Social E nvironment Changing Behaviors

23. 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 24 [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”

25. CLASSICAL CONDITIONING

26. 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? 27

28. E ducation E nforcement Physical E nvironment Social E nvironment 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 29

30. E ducation E nforcement Physical E nvironment Social E nvironment 4 “E’s” OF INJURY PREVENTION

31. Goal: Identify strategies for improving implementation and enforcement of distracted driving legislation IMPROVE ENFORCEMENT

32. Survey of WA law enforcement found significant variability in enforcement practices Significant variation in prosecution of distraction driving CELL PHONE DISTRACTION ENFORCEMENT

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34. Three focus groups held with law enforcement officers in King, Whatcom, and Spokane counties in 2013 OFFICER FOCUS GROUP STUDY

35. 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 36 “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

37. 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 patrols 4.Inform public that laws are enforced 5.Motorcycle enforcement HOW COULD ENFORCEMENT BE IMPROVED? 38

39. E ducation E nforcement Physical E nvironment Social E nvironment 4 “E’s” OF INJURY PREVENTION

40. TEXTING LEGISLATION 40 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. LawAtlas SM 20122001

41. 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

42. 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 2 nd offense 6.Decal to identify provisional license-holders, so laws pertaining to inexperienced drivers can be enforced HOW COULD THE LAW BE STRENGTHENED? 43

44. 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.Minn. Study 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 45

46. 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 47

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? 48

49. 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

50. UW MEDICINE │ INJURY CONTROL QUESTIONS?