Drowsy and Distracted Drivers

Section V

Descriptions of Strategies

Objectives

The objectives for reducing crashes and crash-related injuries and deaths due to inattentive driving are to

• Make roadways safer for drowsy and distracted drivers,
• Provide safe stopping and resting areas,
• Increase driver awareness of the risks of drowsy and distracted driving and promote driver focus, and
• Target subpopulations at increased risk of drowsy or distracted driving crashes.

The first objective draws heavily from two earlier guides: Volume 6, addressing run-off-road collisions, and Volume 4, addressing head-on collisions. The second objective also targets the driving environment but from a different perspective—seeking to prevent distracted or drowsy driving in the first place. The third objective is directed at the general driving population, whereas the fourth targets subpopulations known to be at increased risk of involvement in distracted or drowsy driving crashes. These high-risk populations include young drivers (especially young males), drivers who work nighttimes or have irregular work schedules, commercial vehicle operators, persons with untreated sleep disorders, law enforcement officers, and young members of the military.

For each objective, two or more specific strategies are identified. The strategies are intended for implementation by state DOTs, highway safety offices, law enforcement agencies, motor vehicle departments, and others. Several of the strategies also require collaboration with and support from other public- and private-sector agencies and organizations. These collaborations are more fully explained in the individual strategy descriptions as well as in the descriptions of agencies and organizations currently implementing the strategy.

Exhibit V-1 summarizes the identified objectives and strategies.

Explanation of Strategy Types

The strategies in this guide were identified from a number of sources, including the literature, contacts with professionals in the field and with state and local agencies throughout the United States, and federal programs. Some of the strategies are widely used, while others are primarily an experimental idea of a single individual or agency. Some have been subjected to well-designed evaluations to prove their effectiveness. However, it was found that many strategies, including some that are widely used, have not been adequately evaluated.

The implication of the widely varying experience with these strategies, as well as of the range of knowledge about their effectiveness, is that the reader should be prepared to exercise caution in many cases before adopting a particular strategy for implementation. To help the reader, the strategies have been classified into three types, each identified by a letter:

• Proven (P)—Those strategies that have been used in one or more locations and for which properly designed evaluations have been conducted that show them to be effective. These strategies may be employed with a good degree of confidence, but any application can lead to results that vary significantly from those found in previous evaluations. The attributes of the strategies that are provided will help the user judge which strategy is the most appropriate for the particular situation.
• Tried (T)—Those strategies that have been implemented in a number of locations and that may even be accepted as standards or standard approaches, but for which there have not been found valid evaluations. These strategies—while in frequent, or even general, use—should be applied with caution, carefully considering the attributes cited in the guide, and relating them to the specific conditions for which they are being considered. Implementation can proceed with some degree of assurance that there is not likely to be a negative impact on safety and very likely to be a positive one. It is intended that as the experiences of implementation of these strategies continue under the AASHTO Strategic Highway Safety Plan initiative, appropriate evaluations will be conducted so that effectiveness information can be accumulated to provide better estimating power for the user and the strategy can be upgraded to a "proven" (P) one.
• Experimental (E)—Those strategies that have been suggested and that at least one agency has considered sufficiently promising to try on a small scale in at least one location. These strategies should be considered only after the others have proven not to be appropriate or feasible. Even where they are considered, their implementation should initially occur using a very controlled and limited pilot study that includes a properly designed evaluation component. Only after careful testing and evaluations show the strategy to be effective should broader implementation be considered. It is intended that as the experiences of such pilot tests are accumulated from various state and local agencies, the aggregate experience can be used to further detail the attributes of this type of strategy so that it can be upgraded to a "proven" (P) one.

Related Strategies for Creating a Truly Comprehensive Approach

The strategies listed above and described in detail below are those considered unique to this emphasis area. However, to create a truly comprehensive approach to the highway safety problems associated with this emphasis area, five types of related strategies should be included as candidates in any program planning process:

• Public Information and Education (PI&E) Programs—Many highway safety programs can be effectively enhanced with a properly designed PI&E campaign. The traditional emphasis with PI&E campaigns in highway safety is to reach an audience across an entire jurisdiction or a significant part of it. However, there may be a reason to focus a PI&E campaign on a location-specific problem. While this is a relatively untried approach, as compared with areawide campaigns, use of roadside signs and other experimental methods may be tried on a pilot basis. Within this guide, where the application of PI&E campaigns is deemed appropriate, it is usually in support of some other strategy. In such a case, the description for that strategy will suggest this possibility (see the attribute area for each strategy entitled "Associated Needs"). In some cases, specialized PI&E campaigns are deemed unique for the emphasis area and are detailed in the guide. In the future, additional guides may exclusively address the details regarding PI&E strategy design and implementation.
• Enforcement of Traffic Laws—Well-designed and -operated law enforcement programs can have a significant effect on highway safety. It is well established, for instance, that an effective way to reduce crashes (and their severity) is to have jurisdictionwide programs that enforce an effective law against driving under the influence (DUI) or driving without seat belts. When that law is vigorously enforced with well-trained officers, the frequency and severity of highway crashes can be significantly reduced. This should be an important element in any comprehensive highway safety program. Enforcement programs, by nature, are conducted at specific locations. The effect (e.g., lower speeds, greater use of seat belts, and reduced impaired driving) may occur at or near the specific location where the enforcement is applied. This effect can often be enhanced by coordinating the effort with an appropriate PI&E program. However, in many cases (e.g., speeding and seat belt usage), the impact is areawide or jurisdictionwide. The effect can be either positive (i.e., the desired reductions occur over a greater part of the system) or negative (i.e., the problem moves to another location as road users move to new routes where enforcement is not applied). Where it is not clear how the enforcement effort may impact behavior, or where an innovative and untried method could be used, a pilot program is recommended. Within this guide, where the application of enforcement programs is deemed appropriate, it is often in support of some other strategy. Many of those strategies may be targeted at either a whole system or a specific location. In such cases, the description for that strategy will suggest this possibility (see the attribute area for each strategy entitled "Associated Needs"). In some cases, where an enforcement program is deemed unique for the emphasis area, the strategy will be detailed. As additional guides are completed, they may detail the design and implementation of enforcement strategies.
• Strategies to Improve Emergency Medical and Trauma System Services—Locating and treating injured parties at highway crashes can significantly impact the level of severity and length of time during which an individual spends in treatment. This is especially true when it comes to timely and appropriate treatment of severely injured persons. Thus, a basic part of a highway safety infrastructure is a well-based and comprehensive emergency care program. While the types of strategies included here are often thought of as simply support services, they can be critical to the success of a comprehensive highway safety program. Therefore, an effort should be made to determine if there are improvements that can be made to this aspect of the system, especially for programs focused upon location-specific (e.g., corridors) or area-specific (e.g., rural areas) issues. Additional guides may detail the design and implementation of emergency medical system strategies.
• Strategies Directed at Improving the Safety Management System—The management of the highway safety system is foundational to success. There should be a sound organizational structure, as well as infrastructure of laws, policies, and so forth to monitor, control, direct, and administer a comprehensive approach to highway safety. A comprehensive program should not be limited to one jurisdiction, such as a state department of transportation (DOT). Local agencies often must deal with most of the road system and its related safety problems and are more familiar with their problems. Additional guides may detail the design and implementation of strategies for improving safety management systems.
• Strategies That Are Detailed in Other Emphasis Area Guides—Any program targeted at the safety problem covered in this emphasis area should be created having given due consideration to the inclusion of other applicable strategies covered in the following guides:
  
  • Volume 4: A Guide for Addressing Head-On Collisions (http://safety.transportation.org/guides.aspx?cid=25)
  • Volume 6: A Guide for Addressing Run-Off-Road Collisions (http://safety.transportation.org/guides.aspx?cid=27)
  • Volume 7: A Guide for Reducing Collisions on Horizontal Curves (http://safety.transportation.org/guides.aspx?cid=32)
  • Volume 13: A Guide for Reducing Collisions Involving Heavy Trucks (http://safety.transportation.org/guides.aspx?cid=34)

Objective 6.1 A—Make Roadways Safer for Drowsy or Distracted Drivers

Strategy 6.1 A1—Install Shoulder and/or Centerline Rumble Strips (P/T)

General Description

Rumble strips are raised or grooved patterns added to the paved surface of a roadway that produce both noise and vibration when a vehicle's tires travel across them. When placed along roadside shoulders, they alert drivers when they are about to run off the roadway, and when placed along centerlines, they alert drivers when they have inadvertently crossed into an opposing travel lane. Both placements have been described in earlier guides: shoulder rumble strips in the guide for addressing run-off-road collisions (Volume 6, http://safety.transportation.org/guides.aspx?cid=27), and centerline rumble strips in the guide for addressing head-on collisions (Volume 4, http://safety.transportation.org/guides.aspx?cid=25).

While not all roadway departure collisions are attributable to drowsy driving, research shows that a large percentage of them are. Morena (2003) distinguishes between run-off-road and a subset of drift-off-road collisions. Whereas run-off-road crashes can occur for many reasons (loss of control, swerving to avoid another vehicle or object, icy roadway conditions, etc.), drift-off-road crashes are solely attributed to drowsy or inattentive drivers. The Federal Highway Administration (FHWA) Rumble Strip website (http://safety.fhwa.dot.gov/roadway_dept/rumble/index.htm) estimates that 40–60 percent of single-vehicle crashes on rural freeways are actually drift-off-road crashes. In examining Michigan roadway data, Morena arrived at a much lower percentage of 16 percent, in part because nearly half (48 percent) of the run-off-road collisions in that state occurred on snowy or icy roadways and an additional 9 percent occurred on wet roadways (Morena, 2003).

In investigating the effectiveness of shoulder rumble strips in preventing only these drift-off-road collisions, Morena (2003) concluded that the rolled-in rumbles and the concrete intermittent rumbles reduced crash frequency by 20 percent, whereas the milled design reduced crash frequency by 39 percent. Earlier studies conducted in Pennsylvania and New York State had reported 60- to 65-percent reductions in drift-off-road crashes associated with use of the milled rumble strips (Hickey, 1997; Perrillo, 1998). Together, these studies confirm the effectiveness of milled rumble strips in alerting distracted or drowsy drivers traveling on Interstate and other multi-lane roadways in time to avoid a crash.

A variation on the typical installation of rumble strips is being practiced in Utah. Here, test sections of shoulder rumble strips are being painted with glass beads on the inside surface facing approaching traffic, making the edge of the road more visible to motorists at nighttime and under adverse weather conditions. The intent is to help drivers maintain alertness and avoid a run-off-road situation.

Today, most but not all states have adopted policies that require or encourage use of shoulder rumble strips on rural Interstates and Interstate-like roadways. In addition, rumble strips are increasingly being used on rural two-lane roadways. This is important, since analysis of 2000–2003 CDS crash data shows that three-fourths of drowsy driving crashes occur on two-lane roadways. In these situations, where wide paved shoulders are often lacking, states have been experimenting with "edgeline" and other modified shoulder rumble strips (see Strategy 6.1 A2). The modified rumble strips are narrower and retain a greater portion of the roadway shoulder for use by bicyclists.

Shoulder rumble strips are proven effective on freeways. Their incorporation on two-lane rural highways is relatively recent, and hence their effectiveness in the two-lane rural environment has yet to be proven. Two-lane highways have generally lower traffic volumes than freeways, but the quality of the roadside is generally not as good, and run-off-road crashes are the predominant type on such roads. As of the date of publication of this guide, there were a number of studies underway to measure the effectiveness of shoulder rumble strips in reducing run-off-road (and drowsy driving) crashes in the two-lane rural environment.

Another application of rumble strips is along the centerline of two-lane roads. As described in the guide for reducing head-on collisions (see Strategy 18.1 A1) and also in the guide for reducing collisions on horizontal curves (see Strategy 6.2 A5), centerline rumble strips vary in design, but generally straddle the centerline and extend 5 inches to 1.5 feet into the travel lane. Although they were designated as "tried but unproven" in the earlier guides, a recent study carried out by the Insurance Institute for Highway Safety showed that the centerline rumble strips decreased head-on and opposing-direction sideswipe crashes on rural two-lane roads by 21 percent and injury crashes by 25 percent (Persaud et al., 2003). The study compared crash rates on 210 miles of roadway in seven states (California, Colorado, Delaware, Maryland, Minnesota, Oklahoma, and Washington) where centerline rumble strips had been installed, with comparable untreated roadway sections.

Finally, some states are experimenting with the use of midlane rumble strips in locations where there is not adequate shoulder width to accommodate a shoulder rumble strip. The midlane rumble strips, which are placed in the center of the travel lane, alert drowsy or distracted drivers in the same way as shoulder or centerline rumble strips. However, there are a number of unresolved issues surrounding their use, including their effects on motorcyclists and whether they might themselves serve as a distraction to drivers. Midlane rumble strips are discussed in the run-off-road guide as an experimental strategy (see Strategy 6.1 A3).

As referenced above, the FHWA maintains a website providing information on a variety of issues surrounding shoulder and centerline rumble strips. The website contains the most recent FHWA Technical Advisory regarding roadway shoulder rumble strips and a link to a recent synthesis study summarizing the current state of the practice. Both documents provide guidance with respect to installing rumble strips. They also discuss the effects of rumble strips on other roadway users, especially bicyclists, and how to mitigate potential adverse effects. The FHWA website can be accessed at http://safety.fhwa.dot.gov/roadway_dept/rumble/index.htm. States are encouraged to refer to the website regularly for updated information about the use and effectiveness of rumble strip applications in keeping vehicles safe on the roadway.

For more detail on attributes, cost, effectiveness, and applications of rumble strips, the reader is encouraged to consult the accompanying Guide for Addressing Run-Off-Road Collisions (http://safety.transportation.org/guides.aspx?cid=27) and Guide for Addressing Head-On Collisions (http://safety.transportation.org/guides.aspx?cid=25).

Strategy 6.1 A2—Implement Other Roadway Improvements to Reduce the Likelihood and Severity of Run-Off-Road and/or Head-On Collisions (P/T)

General Description

Drowsy driving crashes typically involve a single vehicle traveling on a higher speed roadway departing the roadway or traveled way (NHTSA/NCSDR, 1998b). Thus, roadway improvements such as wider paved shoulders and median barriers that reduce the likelihood and severity of run-off-road and other lane departure collisions will also likely reduce many crashes resulting from drowsy driving.

Less is known about crashes due to driver distraction, in part because there is less available data for studying these crashes, but also because there are many different sources of driver distraction contributing to a wider variety of crash types. Overall, however, the data show that crashes involving distracted drivers are also more likely to involve a single vehicle departing the roadway or travel lane. Data from the 2000–2003 National Sampling System Crashworthiness Data System examined in Section III of this guide showed that while only 20 percent of drivers who were judged to be attentive at the time of their crash were involved in single-vehicle crashes, 32 percent of distracted drivers and 77 percent of sleepy or asleep drivers were in single-vehicle collisions.

Given these characteristics, a number of other strategies identified in the run-off-road and head-on guides may also be effective in reducing crashes and injuries due to drowsy and/or distracted driving. They include

• Applying shoulder treatments that keep vehicles from encroaching on the roadside, such as eliminating shoulder drop-offs and widening and paving shoulders (see Strategy 6.1 A8 in the guide for addressing run-off-road collisions);
• Providing enhanced pavement markings (see Strategy 6.1 A6 in the guide for addressing run-off-road collisions);
• Providing wider cross sections on two-lane roads (a relatively costly option) (see Strategy 18.1 A3 in the guide for addressing head-on collisions) and reallocating total two-lane roadway width to include a narrow "buffer median" (see Strategy 18.1 A5 in the guide for addressing head-on collisions) to reduce encroachments into opposing travel lanes.
• Providing enhanced shoulder or in-lane delineation and marking for sharp curves (see Strategy 6.1 A4 in the guide for addressing run-off-road collisions) and enhanced pavement markings at high-risk locations (see Strategy 6.1 A6 in the guide for addressing run-off-road collisions).
• Installing median barriers for narrow-width medians on multi-lane roads (see Strategy 18.1 B2 in the guide for addressing head-on collisions);
• Minimizing overturning in the event a vehicle does run off the road, including designing safer slopes and ditches (see Strategy 6.1 B1 in this guide) and removing or relocating objects in hazardous locations (see Strategy 6.1 B2 in this guide); and

• Reducing the severity of run-off-road crashes, including improved design of roadside hardware (see Strategy 6.1 C1 in this guide) and improved design and application of barrier and attenuation systems (see Strategy 6.1 C2 in this guide).

The effectiveness of these strategies have not been evaluated specifically with respect to drowsy and distracted driving crashes. However, all have been tried and either proven effective or shown promise in preventing lane departures or in lessening the severity of such departures. Since many distracted and drowsy driving crashes are known to involve lane departures, it is reasonable to assume that such countermeasures would also reduce these types of crashes. Note that many of these strategies are also referenced in the Guide for Reducing Collisions on Horizontal Curves (http://safety.transportation.org/guides.aspx?cid=32) and are similarly characterized by roadway departure collisions.

An example of a specific roadway treatment that may benefit both drowsy and distracted drivers is the "safety edge," designed to prevent crashes caused by unsafe pavement edge drop-offs. The safety edge is a paved fillet of 45º or less added to the pavement edge during new construction or resurfacing that provides a transition section and allows a departing vehicle to return safely to the roadway (see Exhibit V-2). FHWA is working with the Georgia DOT to demonstrate the treatment and to gain more experience in constructing the edge with various types of equipment and under various conditions (see http://safety.fhwa.dot.gov/media/pdf/safetyedge.pdf). Also, the AAA Foundation for Traffic Safety is sponsoring a study by the Center for Transportation Research and Education at Iowa State University and Midwest Research Institute examining the safety impacts of pavement edge drop-offs. A final report on the project is due in the summer of 2005. For information, contact Scott Osberg at sosberg@aaafoundation.org.

As another example, many states are replacing standard guardrails with median cable barriers, which are more forgiving upon impact. The Utah DOT is installing cable median barriers along divided highway corridors with high rates of head-on collisions, resulting in significant reductions in serious and fatal injuries (see Exhibit V-3).

For more detail on attributes, cost, effectiveness, and applications of these various roadway treatments, the reader is encouraged to consult the accompanying guide for addressing run-off-road collisions and guide for addressing head-on collisions.

Exhibit V-2

Roadway Safety Edge

Exhibit V-3

Utah's Cable Median Barrier

Strategy 6.1 A3—Implement Roadway Improvements to Reduce the Likelihood and Severity of Other Types of Distracted and Drowsy Driving Crashes (T/E)

General Description

The unsignalized intersection guide contains a number of strategies under the general objective of improving driver awareness of intersections as viewed from the intersection approach. One of the strategies is to "call attention to the intersection by installing [transverse] rumble strips on intersection approaches" (see Strategy 17.1 E6), and another is to "install flashing beacons at stop-controlled intersections" (see Strategy 17.1 E11). Both could help to alert drowsy or distracted drivers approaching an unanticipated intersection.

Improved roadway delineation can also help drivers who are not fully alert respond to the demands of a changing roadway and traffic environment. Examples here include wider edge lines, raised pavement markings, and post-mounted delineators or chevrons. Strategies to improve roadway delineation have been described in several guides, including the unsignalized intersection guide noted above (Strategy 17.1 E1), the horizontal curve guide (Strategy 6.2 A2), and the run-off-road guide (Strategy 6.1 A6).

Interestingly, many of the roadway improvements identified in FHWA's Highway Design Handbook for Older Drivers and Pedestrians (Staplin et al., 2001; available at http://www.tfhrc.gov/humanfac/01103/coverfront.htm), intended to improve safety for older road users, should also benefit drowsy or distracted drivers. This is because roadway improvements designed to accommodate aging drivers' generally poorer vision, slower reaction times, poorer divided attention skills, and other functional declines will also accommodate drivers who may be similarly impaired due to drowsiness or lack of focus on the driving task. In other words, what is good for older drivers may benefit all drivers. Examples of the types of roadway treatments in the Highway Design Handbook that might also benefit drowsy or distracted drivers include advance stop signs; advance signing for lane closures; larger and more reflective signage; and improved delineation of curbs, medians, and obstacles. However, none of the recommended changes has been specifically evaluated with respect to reducing crashes due to distracted or drowsy driving.

Information on Agencies or Organizations Currently Implementing this Strategy

The Kansas Department of Transportation recently constructed the state's first high-speed rural roundabout at a site with a history of serious personal injury crashes. Although it is difficult to definitively link crashes at such locations to distracted and/or drowsy driving, driver inattention was believed to be a strong contributor to these crashes. See Appendix 3 for additional information on this experimental strategy.

Objective 6.1 B—Provide Safe Stopping and Resting Areas on Interstates

Strategy 6.1 B1—Improve Access to Safe Stopping and Resting Areas (T)

General Description

The importance of rest areas for reducing fatigue-related crashes for truck drivers was stressed in the guide for addressing crashes involving heavy trucks: Strategy 12.1 A1 describes the need to increase efficiency of use of existing parking spaces, and Strategy 12.1 A2 describes the need to create additional parking spaces for heavy trucks.

Rest areas are also important for safe motor vehicle operation. The California DOT website notes that "Rest areas provide opportunities for motorists to safely stop, stretch, take a nap, use the restroom, get water, check maps, place telephone calls, switch drivers, check vehicles and loads, and exercise pets. Rest areas reduce drowsy and distracted driving and provide a safe and convenient alternative to unsafe parking along the roadside" (Caltrans, 2004).

Studies have generally not revealed a shortage of rest area parking for non-commercial motor vehicle operators. However, some states continue to fall short in providing rest area facilities within the FHWA-recommended 50 miles or 1-hour driving time on major roadways. A 1989 NCHRP study estimated that while the average spacing between rest areas on Interstate highways nationwide was within this guideline, the average spacing within individual states ranged widely from 25 to 105 miles (King, 1989). States are encouraged to inventory their facilities with special attention to the needs of motorists and to explore options for expanding existing facilities or constructing new facilities where a need is indicated.

Constructing full-service rest areas is an expensive and time-consuming undertaking and is not in keeping with the focus of this guide on relatively inexpensive, short-term strategies for reducing distracted and drowsy driving crashes. In addition, such facilities are generally located on Interstate and other major roadways, whereas most crashes attributed to driver fatigue occur on two-lane rural roadways (NHTSA/NCSDR, 1998b).

To address the need for safe stopping and resting areas on these smaller roadways, it is recommended that states provide a continuum of options for safe stopping, ranging from smaller rest areas with most of the usual amenities to simple roadside parks with minimal or no amenities. Although some states already do this, the process may not be formalized, and there may not be any consistent signing and marking to announce these areas to motorists.

Appendix 4 provides information on Iowa's "roadside park" program, while Appendix 5 provides information on efforts in Texas to provide motorists expanded opportunities for safe stopping and resting. The latter has included innovative use of Federal Transportation Enhancement funds to both construct new facilities and renovate old facilities, all with the goal of making Texas roadways safer.

With regard to commercial motor vehicles, a 2002 FHWA report to Congress concluded that although overall truck and bus parking was adequate when both public and private facilities are considered, a shortage of total parking may exist in 12 states (FHWA, 2002). Parking supply generally exceeds demand at commercial truck stops, but the demand for truck parking spaces at public rest areas exceeds supply levels. As part of the study, individual state action plans were drafted to begin addressing these shortages. A combination of approaches was identified by the states, including expansion and improvement of existing public rest areas, expansion and improvement of commercial truck stops and travel plazas, formation of public-private partnerships, education of drivers about available spaces, provision of real-time information to drivers about space availability, and modification of parking enforcement rules (FHWA, 2002). States are encouraged to follow through with these recommendations as appropriate for their own situations.

Although there is no shortage of parking at commercial truck stops in most areas of the country, these stops are typically located off the Interstate and require a driver to exit the road to stop. A common complaint of truck drivers is the lack of real-time information on truck parking availability. It is believed that truck drivers would make better use of truck stop parking if they knew in advance whether spaces were available.

One of the recommendations of the FHWA study was that intelligent transportation systems be developed and deployed to provide commercial drivers with real-time information on the location and availability of parking spaces. Accordingly, the FMCSA Office of R&T is working with the Volpe National Transportation Systems Center to develop and pilot test "Smart Park" systems. A report describing this application and system requirements has been published (Smith et al., 2004), and a broad agency announcement soliciting proposals is imminent at this writing. Phase I of the initiative will include design and feasibility studies, followed by demonstrations and evaluation in Phase II. This program will involve a partnership of federal and state agencies, the truck stop industry, and the trucking industry. Appendix 6 provides the Volpe report, entitled Intelligent Transportation Systems and Truck Parking.

An additional strategy that can be implemented relatively quickly and at relatively low cost is to open weigh stations to parking by truck drivers. The majority of states now allow truck drivers to stop at weigh stations when not in use, and some states even provide added amenities such as restroom facilities and vending machines. See Appendix 7 for an example from the Kentucky Transportation Cabinet.

Information on Agencies or Organizations Currently Implementing this Strategy

The Minnesota DOT has developed an extensive program for rest area construction, maintenance, and operation that is in large part driven by the need to address the needs of drowsy drivers. The program was developed to ensure that resources expended on rest areas were achieving their primary function of meeting safety needs. The program includes public-private partnerships. See http://www.dot.state.mn.us/restareas.

The FMCSA Office of R&T has initiated an experimental "Smart Park" program to provide real-time truck stop parking availability information to commercial drivers. The FMCSA will be working with industry, state, and local jurisdictions to develop and pilot test this program. The FMCSA R&T point-of-contact for "Smart Park" is Quon Kwan, (202) 385-2389, quon.kwan@fmcsa.dot.gov.

In addition to its 40 full-service rest areas, Iowa has approximately 140 "roadside parks" that provide safe stopping and resting areas on less traveled roadways. The areas are locally sponsored and maintained, with the Iowa DOT issuing permits for their construction and providing appropriate signage (see Appendix 4).

The Texas DOT maintains approximately 750 "pullout" style rest areas, primarily on less traveled two-lane roadways, and has used transportation enhancement funds to expand and improve its full-service rest areas (see Appendix 5).

Kentucky has opened its truck weigh stations to truckers needing safe overnight parking spaces for sleeping (see Appendix 7).

In contrast to the practice in the United States of providing large-scale, full-service rest areas, Canada has long maintained a system of more frequent, smaller opportunities for stopping and resting, including simple pullout areas for both trucks and cars. (See http://transcanadahighway.com for a sample map of available facilities.)

Strategy 6.1 B2—Improve Rest Area Security and Services (T)

General Description

A significant challenge facing states is persuading motorists to stop at rest areas when they are feeling drowsy or when something is distracting them from the task of driving. Surveys have revealed that many motorists are reluctant to use rest areas because of concerns for personal safety (Fact Finders, Inc., 1994; Euritt et al., 1992; King, 1989). Two-thirds of the respondents to a survey of licensed drivers in New York State said that they would be very likely to stop at a rest area if they felt drowsy while driving; however, less than 30 percent said they would do so if driving alone at night, and for females, this percentage declined to just 17 percent (Fact Finders, Inc., 1994). Similar results were reported in an earlier study of motorists in Texas (Euritt et al., 1992).

To address problems of rest area security, the Rest Area Team for the New York State Task Force on Drowsy Driving recommended the following (New York State Task Force, 1994):

• Establishing state police substations or satellite offices at key rest area locations;
• Installing security lighting;
• Providing direct telephone access to the police;
• Investigating the feasibility of security cameras where appropriate;
• Employing uniformed DOT maintenance personnel at each rest area, with 24-hour staffing at selected rest areas; and
• Implementing design improvements, such as improved lighting and visibility from the roadway, to enhance rest area safety, security, and appearance.

In addition to being safe and secure, rest areas should be appealing to motorists, i.e., they should be clean, attractive, and provide basic amenities. To reduce drowsy driving crashes, rest areas should ideally provide an opportunity for motorists to get a hot cup of coffee, but for rest areas located along Interstates, only vending machines are typically available since federal law prohibits commercial operations on Interstate right-of-ways. One option is to allow private non-profit groups to dispense coffee, if not on a regular basis then during holidays or other peak travel periods. This is an approach that has been followed in California for a number of years (see http://www.dot.ca.gov/hq/LandArch/rest-areas.htm). Another option again involves joining with the private sector to construct and/or operate rest area facilities off of the Interstate right-of-way. The popularity of travel plazas along many toll roads and other private roadways attests to the importance of amenities for encouraging motorists to stop and take a break from driving. The Minnesota DOT has formed partnerships with a number of non-profit organizations to develop rest areas. The DOT is also seeking to change state legislation to enable and encourage private organizations to partner with the DOT in construction and operation of rest areas. See http://www.dot.state.mn.us/restareas and click on "Partnerships."

A growing number of states are moving beyond providing basic amenities to creating rest areas where motorists will want to stop and spend time. As part of its "Road Connect" program, Texas is in the process of equipping all of its rest areas and travel information centers with free wireless Internet service, along with pay-telephone-like kiosks for travelers without computers. The kiosks will enable motorists to access information on nearby sites, find accommodations, check weather conditions, etc. In addition, since 1999 TxDOT has used federal enhancement funding to update the state's rest areas and make them more attractive to motorists by designing facilities that incorporate regional history and culture and that blend in with the natural landscape (see Appendix 8).

Similar activities are underway in Iowa. Here, old and outdated rest area facilities are being replaced by new, theme-based buildings designed by a team of landscape architects and artists. The themes are selected to reveal something about the history and significance of the area and help promote interest in local tourism. Since the program was begun in 1997, 10 of the state's 40 rest areas have been updated. More recently, the state has also moved to equip its rest areas with wireless Internet services that provide visitors with access to electronic monitors and maps with a wide range of options to assist them in their travels (see Appendix 9).

While these efforts in Texas and Iowa must be considered experimental with respect to reducing crashes due to drowsy and distracted driving, they clearly are designed to encourage motorists to stop and take a break from driving. Early evidence suggests that they are quite successful in this regard, with wireless Internet access appealing especially to young males, a high-risk group for drowsy driving crashes.

Information on Agencies or Organizations Currently Implementing this Strategy

The North Carolina DOT Division of Motor Vehicle Enforcement Section conducts Operation Rest Assured, a statewide rest area safety and surveillance patrol program. For more information, call the DMV Enforcement Section at (919) 861-3185 or check the website at http://www.doh.dot.state.nc.us/operations/dp_chief_eng/roadside/rest/download/RestAreaFlyer.pdf.

The Illinois DOT is installing security cameras and call boxes in all of its 53 Interstate rest areas. Video images from the cameras will be available to the Illinois DOT, the Illinois State Police, and other law enforcement agencies so that they can monitor the rest areas on a routine basis or go to a specific camera when a call box is activated to help determine the problem (see http://transportation.org/aashto/success.nsf/allpages/33-ILCameras).

Further information on efforts in Texas to improve services at its rest areas is contained in Appendix 8, while information on Iowa's activities is contained in Appendix 9.

Objective 6.1 C—Increase Driver Awareness of the Risks of Drowsy and Distracted Driving and Promote Driver Focus

Strategy 6.1 C1—Conduct Education and Awareness Campaigns Targeting the General Driving Public (T)

General Description

Education by itself will not immediately effect change in population behavior. This is especially true if the educational intervention is an isolated event (e.g., a single TV public service announcement or a pamphlet in the mail) rather than a multi-faceted and sustained intervention over time. The latter can succeed in changing behavior if it alters the public mindset about what is acceptable and unacceptable behavior and creates new societal norms—in this case about driving while drowsy and driving while choosing to engage in other potentially distracting activities, such as talking on a cell phone. In this sense, education is a necessary, but by no means sufficient, condition for reducing crashes resulting from driver inattention. Many legislative countermeasures require an educational component, but even roadway and environmental countermeasures such as rest areas and rumble strips are most effective if they also incorporate an educational component, e.g., to inform motorists of their purpose and persuade them to heed their warnings.

The goals of a comprehensive educational campaign directed at reducing drowsy and/or distracted driving should be to increase public awareness of the problem, motivate a response (i.e., a change in behavior), and provide information on effective responses. As an example, the National Sleep Foundation (NSF) annually releases results of its Sleep in America poll to the media highlighting the prevalence of sleepiness among U.S. adults and the consequences of falling asleep while driving. Its website and related materials also outline the warning signs for drowsy driving and let drivers know exactly what does and does not work to counteract drowsiness behind the wheel (see www.drowsydriving.org). Working with NHTSA, the AAA Foundation for Traffic Safety, and others, NSF conducts an ongoing national public awareness campaign to reduce drowsy driving.

In the case of distracted driving, public education campaigns and materials have sometimes focused on the broad problem of driver inattention and have sometimes more narrowly focused on specific causes of driver inattention, such as cell phones. Examples of the former include the Network of Employers for Traffic Safety's (NETS's) "Who's Driving" campaign and the AAA Foundation for Traffic Safety's "Pay Attention" brochure. Examples of the latter include efforts by the California Highway Patrol to educate drivers in that state about the dangers of cell phone use while driving, as well as PI&E efforts by individual insurance and cell phone companies.

Many of these materials are available to states to adopt and use in their own PI&E campaigns. In particular, states are encouraged to regularly check NHTSA, NSF, AAA Foundation for Traffic Safety, and NETS websites for updated information on programs and materials for reducing drowsy and distracted driving.

One very important message to convey with respect to drowsy driving is the synergistic effects of sleep loss and alcohol. Most people are unaware that even modest sleep loss, when accompanied by alcohol, can result in significant decreases in performance and alertness (Lumley et al., 1987; Dement and Vaughan, 1999). This is important, given that alcohol is a factor in 15-20 percent of sleep crashes identified on police crash files (Pack et al., 1995; Wang et al., 1996). Other important messages to convey are the effects of medications and drugs on alertness and the dangers associated with undiagnosed sleep disorders, such as sleep apnea.

With respect to distracted driving, it is important to emphasize that any activity that draws a driver's attention from the primary task of driving can increase the risk of crashing. Cell phones are often singled out as a source of distraction, but as the data presented in Section III of this report clearly show, many activities distract drivers and lead to crashes— manipulating the radio or CD player, reaching for objects inside the vehicle, eating and drinking, and tending to young children are all important sources of distraction. And even if drivers have their "hands on the wheel and eyes on the road," they can still be at risk of crashing if they are not cognitively focused on the task of driving.

In addition to print materials, public service announcements, billboards, and other typical mediums for a public information and awareness campaign, states should incorporate information on drowsy and distracted driving in their driver license manuals and on their driver license tests. A June 2003 review of state driver license manuals by the AAA Foundation for Traffic Safety revealed that only six (Arkansas, Michigan, Minnesota, New Jersey, Virginia, and Wisconsin) contained sections on distracted driving. And while 20 states did note potential dangers of cell phone use while driving, less than half this number discussed other potential distractions such as eating and drinking, reading, radio controls, and distractions from children and other passengers (AAA Foundation for Traffic Safety, 2003). By incorporating information on drowsy and distracted driving into state driver license manuals and tests and making materials available at licensing offices, state departments of motor vehicles (DMVs) can help raise public awareness of these important safety issues.

Information on Agencies or Organizations Currently Implementing this Strategy

NETS, a public-private partnership dedicated to improving traffic safety in the workplace, has developed "Who's Driving?" a workplace program that specifically addresses distracted driving, and "Asleep at the Wheel," a program addressing drowsy driving. Information on both programs can be obtained from the NETS website at http://www.trafficsafety.org/.

The Utah DOT and Utah Highway Patrol have teamed with Med One Medical to conduct a broad-based campaign to educate the public about the dangers of drowsy driving. Information on their "Sleep Smart Drive Smart" campaign is available at http://www.sleepsmartdrivesmart.com/. Also, see Appendix 10 on partnering with other agencies and organizations to increase public awareness.

AAA California and the AAA Foundation for Traffic Safety have teamed to develop two radio and one television public service announcements (PSAs). During October–December, 2003, the radio PSAs were distributed to 750 radio stations, were broadcast an estimated 22,000 times, and reached a total estimated audience of over 79 million persons. For information about these materials, contact Fairly Washington, Communications Director, at (202) 638-5944. The AAA Foundation has also produced a number of brochures and other materials on distracted and drowsy driving that can be ordered from their website (http://www.aaafoundation.org/products/index.cfm).

AAA South developed the "Stay Focused: Keep Your Mind on the Road" campaign to educate motorists about common distractions and their effects on driving, along with tips for better managing these distractions. See http://www.aaasouth.com/acs_news/focus.asp.

In response to high crash rates along sections of Route 18 and Route 22 in northwest Oregon, ODOT created an innovative public-private partnership to conduct a three-pronged campaign of education, engineering, and enforcement. Since many of the crashes occurring were cross-over crashes, the educational campaign used billboards, tabletop "tent" ads, bumper stickers, and movie screen advertising to focus attention on the hazards of drowsy driving in the corridor. For more information on the campaign, see http://www.tfhrc.gov/pubrds/02mar/03.htm.

The American Medical Association has adopted a broad policy defining sleepiness behind the wheel as a major public health issue and encouraging a national public education campaign by appropriate federal agencies and relevant advocacy groups. See the full policy statement on the website at http://www.ama-assn.org/apps/pf_new/pf_online?f_n=browse&doc=policyfiles/HnE/H-15.958.HTM.

An anti-drowsy driving campaign message used in Utah and some other states makes use of pillows, laid out on the ground as coffins, to symbolize the number of people killed in traffic crashes due to drowsy driving. See Appendix 11 for photos of Utah's "36 Pillow" media event.

Strategy 6.1 C2—Visibly Enforce Existing Statutes to Deter Distracted and Drowsy Driving (E)

General Description

Enactment of legislation prohibiting or restricting drivers from using cell phones or engaging in other potentially distracting activities while driving is a controversial topic. The National Conference of State Legislatures reports that since 1999 every state has considered legislation related to the use of wireless phones (Sundeen, 2003). However, no state currently bans talking on all types of cell phones while driving, and only two states (New York and New Jersey) plus the District of Columbia prohibit use of hand-held phones. As of August 2004, 17 states have enacted legislation placing some level of restriction on cell phone use, most often by school bus drivers and sometimes by novice drivers (Sundeen, 2003; GHSA, 2004). In addition, 10 states considered legislation in 2003 directed at driving distractions beyond cell phone use (Sundeen, 2003).

To date, there is little evidence that such legislation changes driver behavior with regard to cell phone use. An evaluation of the long-term effects of the New York State law, which went into effect November 2001, showed that following an initial decline (from 2.3 percent to 1.1 percent) in the percentage of drivers observed using hand-held cell phones, use rates climbed back to 2.1 percent 16 months post-law (McCartt and Geary, 2004). The authors concluded that, as with other traffic safety laws, enforcement and publicity of enforcement are critical to compliance. Even though enforcement of the New York ban on hand-held phone use had been fairly consistent, averaging 7,800 citations per month during the previous year, media attention had declined and there was no ongoing, coordinated enforcement and publicity campaign to reinforce compliance with the law.

Although laws prohibiting use of hand-held cell phones while driving have not been proven effective in terms of reduced cell phone use and crashes, the media attention surrounding passage of a law (and subsequent enforcement) can have the positive effect of raising public awareness of the importance of maintaining focus while driving. At the same time, such laws might also have a negative effect if they send a message that use of hands-free cell phones is "safe," leading to more frequent and/or longer conversations. A study published in the New England Journal of Medicine showed no safety benefits from the use of hands-free versus hand-held cell phones (Redelmeier and Tibshirani, 1997), a finding that has been confirmed in laboratory and simulator studies (Strayer et al., 2002). In general, the cognitive distraction of cell phone conversations is what is most critical to motoring safety.

Rather than trying to legislate driver behavior directly, an alternative approach to discouraging distracted and drowsy driving is to send a clear message to the driving public that those who choose to engage in potentially distracting activities while driving, or who choose to drive when drowsy or fatigued, will be held accountable for their decision should a crash occur. New Jersey recently enacted "Maggie's Law," which allows criminal prosecution of fatigued drivers who cause injury to someone in a crash. The law defines fatigue as being without sleep for a period of 24 hours or more and allows prosecution under the state's existing vehicular homicide statute pertaining to reckless driving. Although problems remain in crafting laws that are neither too broad nor too narrow, and that can be enforced by the judicial system, there appears to be strong public support for laws that can be effectively applied to prosecute the most serious instances of abuse.

Even without such legislation, however, law enforcement officials can send a powerful educational message to the public if they actively enforce statutes already in place to sanction serious instances of distracted or drowsy driving. As a starting point, drivers who cause crashes due to their willful engagement in distracting activities, or due to driving while drowsy, should be cited and prosecuted. In response to a recent survey by the NSF, 48 states indicated that they could prosecute such cases under their state's existing statutes. However, states need to evaluate their situation more closely to determine the extent to which drivers actually are being cited and prosecuted, and to identify barriers to successful prosecution. If the evidence suggests that cases of inattentive driving are not being taken seriously either by law enforcement officials or the judiciary, then steps should be taken to educate and inform these key parties. If cases are being prosecuted, either in criminal or civil courts, then word needs to get out to the public that this is being done.

By bringing the issue of distracted and drowsy driving before the public and fostering public debate on the legal responsibilities of drivers and the role of law enforcement and the courts in upholding these responsibilities, states will be educating the public about the risks of distracted and drowsy driving. The long-term goal of such efforts is to effect a change in public attitudes and behaviors so that people are less likely to choose to engage in potentially distracting activities while driving or to drive impaired from inadequate sleep.

Information on Agencies or Organizations Currently Implementing this Strategy

The Governor's Highway Safety Association maintains a website that tracks state and local legislation with regard to cell phone use while driving. The website is http://ghsa.org/html/stateinfo/laws/cellphone_laws.html

Information on the New Jersey legislation addressing drowsy driving ("Maggie's Law") is available on the NSF website at http://www.sleepfoundation.org/hottopics/index.php?secid=10&id=247. The text of the law is also available at http://www.njleg.state.nj.us/2002/Bills/A1500/1347_R2.HTM. Pending evaluation of the effects of the law, it is considered an experimental strategy.

Objective 6.1 D—Implement Programs That Target Populations at Increased Risk of Drowsy or Distracted Driving Crashes

Strategy 6.1 D1—Strengthen Graduated Driver Licensing Requirements for Young Novice Drivers (P/T)

General Description

In recent years all but a few U.S. states have adopted some form of graduated driver licensing (GDL) for young beginning drivers. Central to the GDL concept is a probationary license period between learner and full licensure stages, typically lasting 6–12 months. During this period, additional restrictions are placed on the teen's driving privilege. Most often these involve restrictions on unsupervised driving at nighttime and with other passengers in the vehicle. In addition, many states now require a certain number of hours of supervised driving prior to full licensure.

The rationale behind GDL is that learning to drive is a high-risk venture, and teens need to be able to gain driving experience in as low-risk an environment as possible. Nighttime driving and driving with teen passengers both significantly increase a novice driver's likelihood of crashing. Nationally, 41 percent of teenage motor vehicle deaths in 2002 occurred between 9 p.m. and 6 a.m. (IIHS, 2003). In addition, having two or more passengers in the car under the age of 21 has been shown to more than double a beginning driver's risk of crashing (Chen et al., 2000; McKnight and Peck, 2002; Foss and Goodwin, 2003; see Exhibit V-8). Both situations reflect an added layer of complexity and distraction to the driving task. Despite this evidence, only six states have nighttime driving restrictions starting before 11 p.m., and only about half limit the number of teen passengers to two or fewer (IIHS, 2004).

Exhibit V-8

Death Rate of 16- and 17-Year-Old Drivers with and without Passengers

Source: Chen et al., 2000

Sleep experts point to another potential benefit of restricted nighttime driving for teens—namely, if teens are not allowed to drive at night, they are more likely to be at home, and perhaps also more likely to go to bed earlier and get more sleep (Drobnich and Murray, in press). This, in turn, could lead to less daytime drowsiness and a reduced risk of a sleep-related crash.

The National Transportation Safety Board recently recommended an additional restriction on novice drivers: it recommended that drivers with learners or provisional licenses be prohibited from using cell phones or other wireless communication devices while driving (NTSB, 2003). The rationale was the same as for other restrictions on a novice driver's license—learning to drive is a challenging undertaking and needs to occur in as low-risk an environment as possible. Beginning drivers need to be able to direct their full attention to the task of driving and not be distracted by trying to operate a cell phone and carry on a conversation. To date, Maine, New Jersey, and the District of Columbia have enacted such legislation.

In 2002, 5,178 teens died in motor vehicle crashes as either drivers or passengers of motor vehicles (IIHS, 2003). The extent to which fatigue or inattention contributed to these crashes is not known; nevertheless, license restrictions that discourage nighttime driving and that reduce the likelihood of distractions by limiting the number of passengers in vehicles and prohibiting use of cell phones should help lower this number.

While it is recognized that implementing or amending legislation can be a lengthy process, states that are reviewing their GDL requirements or considering enacting GDL legislation should consider the rationale behind passenger restrictions and earlier nighttime driving restrictions. Both have proven effective in reducing traffic fatalities among novice drivers. In addition, states should consider the as yet unevaluated (and thus categorized in this report as "tried") restriction on cell phone use by novice drivers.

For more detailed information on specific strategy attributes with respect to strengthening GDL requirements to reduce young driver crashes, the reader is encouraged to refer to the guide for reducing collisions involving young drivers.

Information on Agencies or Organizations Currently Implementing this Strategy

As noted above, Maine, New Jersey, and the District of Columbia have all placed restrictions on cell phone use by novice drivers. The Governors Highway Safety Association website maintains information on cell phone restrictions placed on novice drivers. See http://www.ghsa.org/html/stateinfo/laws/cellphone_laws.html.

According to information maintained by the Insurance Institute for Highway Safety, Delaware, Idaho, Mississippi, New York, North Carolina, and South Dakota all have restrictions in place that prohibit unsupervised driving after 10 p.m. by drivers holding provisional licenses. Twenty-five states have some restrictions in place regarding the number of passengers that can be carried, although the number of passengers allowed and the timeframe for the restriction varies greatly. See "Licensing Systems for Young Drivers" at http://www.iihs.org/laws/state_laws/grad_license.html.

Strategy 6.1 D2—Incorporate Information on Distracted/Fatigued Driving into Education Programs and Materials for Young Drivers (T)

General Description

Young drivers, ages 16–24, are a high-risk group for both distracted and drowsy driving crashes. When learning to drive, even small distractions such as tuning the radio or talking to a passenger can pose problems for teens. This is one reason why passenger restrictions for new drivers have been shown to have such a dramatic effect on crash involvement. An analysis of 1995–1999 national crash data showed the highest percentage of distracted driving crashes for drivers under the age of 20. Leading the list of distractions were radios and cassette tape or CD players, outside-the-vehicle distractions, and other occupants inside the vehicle (Stutts et al., 2001). Young adults are also more likely to own and use cell phones and other wireless technologies, such as voice mail and instant messaging, while driving (Royal, 2003; Stutts et al., 2002).

In addition, young drivers are a high-risk group for drowsy driving crashes. An analysis of national crash data revealed that nearly two-thirds of drivers in drowsy driving crashes were under the age of 30 (Knipling and Wang, 1995), and in an analysis of North Carolina crash data, age 20 was the peak age for drivers involved in a sleep-related crash (Pack et al., 1995). An expert panel convened by NHTSA and the NCSDR recommended that educational efforts to reduce drowsy driving crashes be directed at young males ages 16–24 and shift workers (NHTSA/NCSDR, 1998b). Subsequently, NCSDR hosted a workshop to develop strategies for best educating youth about sleep and drowsy driving (NCSDR, 1998), and the NSF prepared a report summarizing sleep-related issues affecting adolescents (NSF, 2000).

A starting point for educating youth about the dangers of both drowsy and distracted driving is to incorporate pertinent information into driver education and training programs. It has been estimated that half of all novice drivers participate in a formal driver education program (NCSDR, 1998). The new model driver education curriculum developed jointly by NHTSA and the American Driver and Traffic Safety Education Association (ADTSEA) addresses both areas, although not in great detail. States that provide for driver education for young novice drivers can require or encourage incorporation of appropriate material in all approved driver education programs and can reinforce the message by including relevant questions on their driver license test.

Educational materials should also be made available through other venues such as websites, school health and safety classes, college orientations, and military training programs. In addition, efforts should be directed toward parents, teachers, law enforcement, and others who have opportunities to influence young people's high-risk driving behavior.

Information on programs and materials that have shown promise in educating teens and young adults about the dangers of drowsy and distracted driving are identified below under "Information on Agencies or Organizations Currently Implementing this Strategy." Of particular note is a Texas-based program for college students that was developed in response to the death of a Texas A&M student who fell asleep at the wheel (see http://studentorgs.utexas.edu/sa/resources/spotlights/fall00/drowsy/medina.html ); and materials directed at high school age drivers developed by NHTSA in collaboration with Scholastic magazine (see http://www.nhlbi.nih.gov/health/public/sleep/aaw/awake.htm).

Information on Agencies or Organizations Currently Implementing this Strategy

Student government officials at both Texas A&M and Baylor universities have implemented a program to educate students about the dangers of driving while drowsy and provide an option for students who are too sleepy to continue driving. The program, which has not been formally evaluated, includes discounts at cooperating Hotel 8 and Hampton Inn hotels throughout the state. See http://studentorgs.utexas.edu/sa/resources/spotlights/fall00/drowsy/medina.html for further information.

The Utah DOT partnered with Med One Medical, the Department of Public Safety, and the Highway Patrol to develop a campaign for high school students to raise awareness of drowsy driving. The campaign involved a contest to create a 25-second television commercial about the dangers of drowsy driving, with the winning commercial to be aired on a local television station (see Appendix 10).

In Pennsylvania, Highway Patrol and other law enforcement officers visit area middle and high schools to present a 1-hour program called "Survival 101." The multi-media program includes information on factors contributing to teen crashes, including driver distraction and fatigue (see Appendix 12).

Cingular Wireless has developed a program to educate novice drivers about the importance of managing distractions while driving, including cell phone use. The program includes a video, detailed teacher's guide, poster, and classroom activities. See http://www.be-sensible.com/.

The USAA Educational Foundation has developed the Driver Safety Awareness Program (DSAP), which includes a module on distracted and drowsy driving. See http://www.usaaedfoundation.org/auto/index.asp.

Materials addressing drowsy driving developed by NHTSA in cooperation with Scholastic Magazine and the National Heart, Lung and Blood Institute (NHLBI) are available on the NHLBI website at http://www.nhlbi.nih.gov/health/public/sleep/aaw/awake.htm.

The National Institutes of Health has also developed a science-based sleep curriculum for high school age students that includes information on the risks of drowsy driving. See http://science.education.nih.gov/supplements/nih3/sleep/default.htm.

Although not directly focused on educating young persons about the risks of drowsy driving, efforts underway in communities nationwide to delay school start times, especially for high schools, can promote increased sleep by teens and decrease the likelihood of drowsy driving. Preliminary evidence also suggests that they may decrease teen crash involvement (either because teens are less drowsy or because they are in school later in the day). See http://www.sleepfoundation.org/hottopics/index.php?secid=18&id=206 (or go to www.sleepfoundation.org and click on "Teens and Sleep").

Strategy 6.1 D3—Encourage Employers to Offer Fatigue Management Programs to Employees Working Nighttime or Rotating Shifts (P)

General Description

In 1996 Congress directed NHTSA to collaborate with the NCSDR to develop an educational program to reduce fatigue-related crashes. As part of its work, NHTSA convened an expert panel to review relevant literature, identify risk factors, identify population groups at highest risk, and recommend countermeasures for lowering their risk (NHTSA/NCSDR, 1998b). Identified high-risk populations included people ages 16–29, especially young males; shift workers whose sleep is disrupted by working at night or working long or irregular hours; and people with untreated sleep disorders. Subsequent focus groups with shift workers and their supervisors provided input to the development of a comprehensive workplace education program that includes a video, posters, brochures for workers and their families, tip cards, six brief PowerPoint training sessions, and a program administrator's guide. (See Exhibit V-10. Information and materials available on the NHTSA website at .)

Exhibit V-10

NHTSA Drowsy Driving Safety Materials

An estimated 21 million workers, or 20 percent of the workforce, engage in some form of shift work (NHTSA/NCSDR, 1998a). Included are truck drivers, police officers, taxi drivers, transit operators, and others for whom driving is a part of their job. Many more shift workers are employed in industries, hospitals, and in service professions. For those working nighttime shifts, the trip home in the morning can be especially dangerous. An examination of the time of day distribution of drowsy driving crashes not involving alcohol shows a sharp increase in such crashes between 4 a.m. and 8 a.m. (Pack et al., 1995).

Shift workers average only about 5 hours of sleep a night, or about 1.5 hours less than non-shift workers. Also, the sleep they do get is often fragmented and less restorative (Kessler, 1992; NHTSA/NCSDR, 1998a). Persons with nighttime jobs are working against their natural biological clocks that cause them to be sleepiest in the middle of their work period and most alert just when they get home and need to sleep. For those working rotating shifts, there may be little opportunity for their bodies to adjust to the changing wake/sleep schedules. A study involving telephone interviews with drivers involved in recent crashes showed that 18 percent of those in sleep-related crashes worked night shifts, compared to just 4 percent of drivers in non-sleep-related crashes (Stutts et al., 2003).

The workplace program developed by NHTSA and the NCSDR provides shift workers and their employers information on warning signs for dangerous drowsy driving, how to safely manage the commute home, tips for better sleep, and guidance for dealing with family members and friends. For employers, it provides detailed information on planning and implementing a workplace program. In its evaluation, NHTSA found workers to be highly receptive to the program's messages.

Other agencies and organizations have also developed programs and materials that target shift workers. For example, the Transit Cooperative Research Program sponsored the development of a "Toolbox for Transit Operator Fatigue" designed specifically for that high-risk population (Gertler et al., 2002). Finally, a wide range of resources exist in the private sector to assist employees in creating safer working environments for employees working irregular or long hours. A number of these resources are identified below (see Information on Agencies and Organizations Currently Implementing this Strategy).

Information on Agencies or Organizations Currently Implementing this Strategy

NHTSA's Wake Up and Get Some Sleep Program is described at http://www.nhtsa.dot.gov/people/injury/drowsy_driving1/human/drows_driving/.

The NSF has produced "Sleep Strategies for Shiftworkers" and other related materials, which are available at http://www.sleepfoundation.org/.

The National Institute for Occupational Safety and Health (NIOSH) has produced "Plain Language about Shiftwork" (Publication No. 97-145), available at no charge by calling 1-800-35-NIOSH. The publication can also be downloaded from the NIOSH website at http://www.cdc.gov/niosh/pdfs/97-145.pdf.

"Toolbox for Transit Operator Fatigue" was developed as a Transit Cooperative Research Program project specifically to address fatigue driving issues affecting transit operators. A copy of the final report is available at http://trb.org/news/blurb_detail.asp?id=2531.

Appendix 13 (http://www.circadian.com/publications/training.pdf) describes the benefits to employers of offering lifestyle training to employees engaged in shiftwork, while Appendix 14 (http://www.circadian.com/publications/apnea.pdf) describes a program to screen employees for obstructive sleep apnea.

Strategy 6.1 D4—Enhance Enforcement of Commercial Motor Vehicle Hours of Service Regulations (P)

General Description

As debate continues over what changes will be incorporated into revised federal hours of service (HOS) regulations for Interstate motor carriers, there is a general consensus in the industry, at least, that the revised regulations have had a positive overall impact on safety (Woodruff, 2005). At the same time, there is also evidence that HOS regulations are commonly violated (Braver et al., 1992; McCartt et al., 1997). Nearly half of the truckers surveyed at truck stops and inspection stations in New York State reported that they sometimes, often, or always drove more than the 10 hours permitted by the rules, that they took off less time than the required 8 hours, or that they drove longer than recorded in their logbooks (McCartt et al., 1997). Another recent survey revealed that 25 percent of commercial vehicle operators reported working 75 or more hours in the preceding 7 days, and 10 percent reported working more than 90 hours (Freund, 1999).

Given the reality of widespread violations, states are encouraged to undertake more systematic and focused enforcement activities in support of their motor carrier safety regulations, including driver licensing, vehicle maintenance, and HOS (Patten, 2001b). Identifying and targeting high-risk drivers, high-risk companies, and high-risk roadways contribute to more efficient use of the limited resources available for enforcement activities.

Improved enforcement, carried out as part of FMCSA-mandated Compliance Reviews and Roadside Inspection programs, can help to increase operator and carrier compliance with HOS regulations. The emphasis of this strategy is on systematic, well-publicized, and focused enforcement efforts. Such focused enforcement efforts can be used to identify companies at increased risk for violation of HOS regulations, and thus increase efficiency of other ongoing enforcement activities.

Of course, HOS enforcement is not conducted independently but rather as a part of an overall commercial vehicle safety inspection program that includes both driver and vehicle inspection. Many of the critical elements of a comprehensive enforcement program are not specific to HOS enforcement but rather relate to enforcement of all regulations. Patten (2001a and 2001b; see Appendices 17 and 18) conducted a survey of best enforcement practices and developed a report describing a "toolbox" of practices to enhance the effectiveness of motor carrier safety enforcement, including HOS. The "toolbox" included the following practices:

• Use of mobile safety inspection teams to supplement fixed sites.
• Use of ASPEN software (developed by and available from the FMCSA) to collect and access inspection data. This permits access to the following subsystems:
  
  • Commercial Driver License Information System (CDLIS) for driver license status.
  • Past Inspection Query (PIQ) for recent inspection reports, including driver HOS checks.
  • Inspection Selection System (ISS) to screen motor carrier vehicles and identify priority (high-risk) carriers for inspection.
• Exchange of data via the Safety and Fitness Electronic Records (SAFER) mailbox (a data exchange system developed by the FMCSA).
• Use of the FMCSA Safety Status Measurement System (SafeStat) to identify high-risk carriers for on-site compliance reviews.
• Use of the Performance and Registration Information Systems Management (PRISM) to link the commercial vehicle registration process to motor carrier safety.
• Use of electronic clearance equipment at inspection stations to rapidly screen vehicles and select high-risk carriers for inspection.
• Regular on-site motor carrier safety compliance reviews and/or audits (conducted in coordination with the FMCSA).
• Use of state commercial vehicle crash investigation teams for selected crashes.
• Regular provision of safety performance information (e.g., out-of-service rates) to carriers to encourage safety improvements.
• Development and use of a state-maintained Internet site with motor carrier safety information (e.g., federal and state HOS regulations and fatigue education materials).

Commercial drivers know the locations of fixed inspection sites and may avoid them if they are driving in violation of the HOS rules or have other likely out-of-service violations. The use of mobile inspection units is an important intervention to catch these violators. In Connecticut, a wireless data access system was developed to equip mobile inspection vehicles with data access and exchange capabilities (involving systems like the ISS and PIQ) for improved HOS and other enforcement. Connecticut equipped 68 mobile units, a significant complement to the state's five fixed sites. Appendix 15 describes the Connecticut initiative and system.

Current systems for prioritizing vehicles and drivers for inspection are based upon the motor carrier's safety record, not on the safety records of individual drivers. Research has shown, however, that commercial drivers within fleets may vary widely in their violation histories and other safety measures (Knipling et al., 2004). Efforts are underway to develop metrics, systems, and protocols for making inspection selection more specific to individual drivers (Lantz et al., 2004). This is an expected enhancement to be made to existing systems in the coming years.

States can expand their support of HOS regulations in other important ways as well. Many provide safety information, education, and consultation to the motor carrier industry, including instruction on HOS and other compliance. Patten (2001a) surveyed state motor carrier safety agencies in 1999 concerning their enforcement and educational activities and the perceived effectiveness of these activities. Potential educational activities include distribution of safety-related publications (brochures, manuals, bulletins, etc.), seminars and workshops for fleet safety managers, "circuit rider" visits to motor carriers to provide free or low-cost safety consultation, volunteer mentoring for new or problem carriers by established safe carriers, non-punitive compliance reviews, and advisory warning letters sent to problem carriers before any punitive actions are taken. Thirty-three responding states (79 percent of the sample) regularly conducted state-sponsored education activities for motor carriers, and 97 percent of responding officials from these states rated the programs as effective or very effective. Strategy 12.1 G1 of the guide for reducing collisions involving heavy trucks describes various state motor carrier safety educational and consultative activities in more detail.

States can also promote use of new technologies such as electronic on-board recorders (EOBRs) for improved compliance with HOS regulations and newer technologies that assist truck drivers in monitoring their own levels of alertness. Information can be made available to trucking companies about available new technologies for monitoring and helping to maintain driver alertness. The effectiveness of in-vehicle technologies for reducing heavy-truck crashes was addressed in Strategy 12.1 G2 of the heavy-truck guide.

Information on Agencies or Organizations Currently Implementing this Strategy

Appendix 15 provides a state agency profile of an initiative by the Connecticut Department of Motor Vehicles to increase the speed and efficiency of roadside inspections, and support more mobile inspections, through wireless data access at the roadside. This program deployed the safety information exchange components of the Intelligent Transportation Systems (ITS) Commercial Vehicle Information Systems and Networks (CVISN) technology program.

Strategy 6.1 D5—Encourage Trucking Companies and Other Fleet Operators to Implement Fatigue Management Programs (T)

General Description

In 2003 large trucks were involved in 457,000 crashes, resulting in nearly 5,000 deaths and an estimated additional 122,000 injuries (NHTSA, 2004). An estimated 1 percent of all large-truck crashes, 3-6 percent of fatal heavy-truck crashes, and 15–33 percent of crashes fatal to the truck occupant only can be attributed primarily to driver fatigue. Fatigue also plays a large (but not yet quantified) contributing role in crashes (Knipling and Shelton, 1999). As emphasized previously, driver vigilance is essential for safe driving, and a major effect of fatigue—even low-to-moderate levels—is reduced vigilance. For commercial drivers, fatigue and alertness are ever-present concerns. A combination of long hours on the road, nighttime driving, and irregular work and sleep schedules combine to make fatigue an especially challenging problem.

Instrumented vehicle studies involving volunteer commercial drivers and in-cab video recording have demonstrated the role that drowsiness plays in increasing the risk of driver errors and resulting crashes. An instrumented vehicle study by Hanowski et al. (2000) found that the average truck driver drowsiness level (as measured by degree of eyelid "droop") for truck-driver-at-fault traffic incidents was more than 10 times greater than the average drowsiness level for normal, non-incident driving periods. This further demonstrates that drowsiness is manifested not only in asleep-at-the-wheel, run-off-road crashes, but also in driver errors associated with a variety of crash types and scenarios.

Since the early 1990s, commercial vehicle operator fatigue has been a top safety priority for government researchers and regulators, as well as for the trucking industry. In 1990 the National Transportation Safety Board released the results of its study of fatal-to-the-driver, large-truck crashes, reporting that fatigue was the probable cause in 31 percent of the investigated crashes (NTSB, 1990). The Congressionally mandated Driver Fatigue and Alertness Study, completed by FHWA in 1996, provided first-time knowledge of drivers' alertness and performance levels and the factors that influence them (Wylie et al., 1996). Participants at the 1995 National Truck and Bus Safety Summit identified driver fatigue as the highest priority safety issue facing the industry. Commercial driver fatigue and related issues such as HOS rules and driver distraction continue to be primary concerns among industry observers and safety stakeholders (FMCSA, 2003).

Created in 1999, the FMCSA has continued FHWA's initiatives in carrying out a wide range of driver alertness and fatigue-related research and technology projects (see www.fmcsa.dot.gov/facts-research/research-technology/topics/fatigue.htm for a summary). Many of these fatigue-related research projects have been directed toward supporting improved HOS rules for commercial drivers. Others have looked at the potential for fleet fatigue management practices going beyond compliance with HOS rules to address driver fatigue more proactively and comprehensively. Currently, the FMCSA is collaborating with Transport Canada to develop and promote a model North American Fatigue Management Program for motor carriers. The joint U.S.-Canadian effort builds on program design and development work performed earlier in the Canadian provinces of Alberta and Quebec. Working with industry and government, researchers identified fatigue management requirements; developed a training program for drivers, dispatchers, and carrier safety managers; and evaluated the program in six fleets. The next phase of the collaborative program will develop more formalized fatigue management protocols and operationally test the effectiveness of comprehensive fatigue management programs (FMPs) on a larger scale in both the United States and Canada.

In the meantime, trucking companies and other fleet operators should be encouraged to develop and implement FMPs on their own. A recent synthesis entitled Effective Commercial Truck and Bus Safety Management Techniques (Knipling et al., 2003), sponsored by the FMCSA and based on the North American FMP model and other carrier fatigue management approaches, identified the following components of an effective FMP:

• "Alertness-friendly" scheduling that take sleep needs and circadian rhythms into consideration during dispatching and empowers drivers to adjust schedules, without recrimination, when needs dictate;
• Medical screening, counseling, and treatment for sleep disorders, in particular sleep apnea; and
• Fatigue education, for both drivers and carrier managers, emphasizing the importance of driver alertness, the nature of sleep, the effects of sleep deprivation, and "sleep hygiene" practices for improved driver sleep and alertness.

One currently available fatigue management training program is Understanding Fatigue and Alert Driving, which was developed by the American Transportation Research Institute (ATRI, formerly the American Trucking Associations Foundation) in partnership with the FMCSA. This is primarily a "train-the-trainer" program designed for carrier safety managers, who in turn would use program materials to educate their drivers. The program package includes an instructor guide, student materials, a film, and slides. ATRI periodically presents the "train-the-trainer" fatigue instruction and a similar driver health and wellness program at various locations across the country. ATRI contact information is provided below.

Studies have also looked at fleet management practices and compared these with driver fatigue outcomes. An FMCSA-sponsored research study involving a random sample of drivers from both trucking and motor coach companies showed that trucking company practices mitigating driver fatigue included carrier assistance with loading and unloading, carrier efforts to minimize nighttime driving, and driver voluntary attendance at corporate safety and training meetings. Motor coach company practices most likely to mitigate operator fatigue included attempts to minimize nighttime driving and drivers' perceptions of the company's safe driving culture and policies (Crum et al., 2002)

Companies should also consider incorporating available new technologies into their FMPs. Examples of technologies that have been tested in NHTSA and the FMCSA research programs include the actigraph (a "sleep watch" that estimates sleep based on body motion and predicts likely alertness level), in-vehicle alertness monitoring and warning systems (based on eyelid closure or other measures of alertness), and EOBRs for tracking on-duty status. Lane departure warning systems are also seeing increased use within the trucking industry and are generally well accepted by drivers (Brewster et al., 2005; Malloy, 2005). These systems typically consist of forward-looking video cameras that use image processing to detect unplanned lane departures (i.e., lane departures not accompanied by turn signal use). They provide a warning, such as a simulated rumble strip sound, when the vehicle crosses the lane line. They are also capable of providing a general assessment of the quality of driving performance based on the degree of lateral movement within the lane lines. Deterioration of lane tracking is one of the most reliable signs of incipient driver drowsiness and eventually leads to lane departures if drivers do not stop for rest.

Information on Agencies or Organizations Currently Implementing this Strategy

As noted, the FMCSA and Transport Canada are collaborating on a program to develop FMP protocols and to empirically demonstrate the value of FMPs. Information on this program is available from the FMCSA Program Manager for FMPs, Mr. Robert Carroll, 202-385-2388, Robert.carroll@fmcsa.dot.gov.

The FMCSA and the NSF are teaming to develop a sleep apnea education and outreach program targeting truck drivers, motor carriers, and other related stakeholders. A toolkit of materials for the "Get on the Road to Better Health" campaign will be available on the FMCSA and NSF websites. See Appendix 16 for more information on this program.

Summaries of FMCSA and NHTSA research studies carried out to evaluate the effectiveness of various technologies to increase driver alertness are available on the following websites: http://www.fmcsa.dot.gov/safetyprogs/saftresearch.htm, http://www-nrd.nhtsa.dot.gov/vrtc/ca/its.htm#completed, and http://www.fmcsa.dot.gov/safetyprogs/fatigue/fatigue.htm.

ATRI is an independent research and development organization affiliated with the American Trucking Associations (ATA). ATRI is conducting research on commercial driver HOS, fatigue management, fatigue-related technologies, and driver medical conditions relevant to alertness and driving performance. More information is available at http://www.atri-online.org.

Strategy 6.1 D6—Implement Targeted Interventions for Other High-Risk Populations (T/E)

General Description

There are a number of other populations at increased risk for involvement in inattention or fatigue-related crashes. While some of these populations also fall into the category of shift workers, they each have unique characteristics that set them aside and that provide an opportunity for targeted intervention. This strategy addresses three especially high-risk populations: (1) persons with untreated sleep disorders, (2) law enforcement officers, and (3) young military personnel.

Along with young people and shift workers, persons with untreated sleep disorders were a third high-risk group identified by the joint NCSDR/NHTSA Expert Panel on Driver Fatigue and Sleepiness (NCSDR, 1998). Specifically, the panel was concerned about the documented high crash risks associated with sleep apnea and narcolepsy. Sleep apnea is a condition in which a person's airway collapses during sleep, causing temporary blockage of air into the lungs, which then triggers an awakening response. The pattern can be repeated throughout the night, usually without the individual being aware of the awakenings. However, the resulting fragmented sleep can lead to extreme daytime sleepiness and a two- to seven-fold increase in the risk of motor vehicle crash involvement. An estimated 4–5 percent of men and 2 percent of women have undiagnosed sleep apnea (see NCSDR, 1998; also see the NSF website).

Narcolepsy is a much less common, but potentially more serious condition in that a person with narcolepsy can fall asleep with little or no warning, sometimes "napping" for as long as 10–20 minutes. Although some states have adopted regulations and guidelines for drivers with narcolepsy as well as sleep apnea, a major drawback continues to be that the vast majority of these cases are not diagnosed.

Three strategies that states can adopt to address the needs of this population are (1) incorporate information on sleep disorders and their potential impact on driving safety in driver licensing handbooks, (2) work with the driver licensing medical advisory board to help educate physicians in recognizing and diagnosing suspected sleep disorders, and (3) partner with the medical community to provide free sleep screenings and education during Sleep Awareness Week and/or at other times (see Appendix 16 for description of a successful program statewide in Michigan).

A number of factors contribute to fatigue among law enforcement officers. These include irregular work hours, night work, overtime duties, "moonlighting," and the high stress that comes with the job. Although data on police involvement in fatigue-related crashes remains mostly anecdotal, a recent study raises some alarming concerns (Vila, 2000). As part of the study, the author collected detailed information on officers' work hours and related accident and on-the-job injury data, as well as objective and perceived measures of sleepiness. The resulting book, Tired Cops: The Prevalence and Potential Consequences of Police Fatigue (Vila, 2000), documents study findings and provides guidance for developing fatigue and alertness policies and programs for law enforcement agencies. Many of the recommendations parallel those described in the earlier strategy on FMPs for commercial vehicle operators.

State DOT and law enforcement agencies can help address this problem by reviewing law enforcement in-service training and education programs to ensure that they adequately address key sleep topics (e.g., the importance of good sleep habits, the hazards of shift work, and mechanisms for coping) and providing resources where needed. States can also encourage law enforcement agencies to review their policies and procedures for establishing work schedules.

Training law enforcement officers to better recognize and manage fatigue in their own lives may have the added benefit of encouraging them to (1) be more conscientious in identifying and reporting fatigue-related motor vehicle crashes and (2) include fatigue and the risks of drowsy and inattentive driving when speaking to driver education classes and other audiences.

The third high-risk population identified in this strategy is military personnel. While injury rates among military personnel have declined since the early 1980s, unintentional injury remains the most significant health problem for all three branches of the military services, and motor vehicle injuries are the largest single cause of death (Jones et al., 2000; Powell et al., 2000). Increases in seat belt use and decreases in alcohol use have contributed to the decline in motor-vehicle-related deaths, but there is room for improvement. Defense Secretary Donald Rumsfeld challenged all branches of the military to cut the rate of preventable accidents and fatalities by at least 50 percent by 2005 (see http://detnews.com/2004/autosinsider/0406/08/c03-176756.htm).

Drowsiness is a frequent component of many military crashes, often the result of young soldiers driving for too long and without enough rest when returning to their base after a 3-day pass. Although state DOTs and other agencies have little direct influence over policies and programs in place on military bases, information and materials could be made available to, and partnerships formed with, private civilian organizations to help promote safety. In addition, law enforcement in military communities can exert a greater presence at times when soldiers are leaving and, most importantly, returning to their bases. If done with the knowledge and consent of base officials and publicized ahead of time to the soldiers, such targeted enforcement can serve as a valuable tool for reinforcing messages about the importance of maintaining alertness when behind the wheel.

Information on Agencies or Organizations Currently Implementing this Strategy

The NSF maintains a state-by-state listing of Community Sleep Awareness Partners on its website at . These are healthcare providers who have "committed to promoting public understanding of sleep and sleep disorders and supporting sleep-related education, research and advocacy to improve public health and safety in their communities."

The Ingham Center for Sleep & Alertness at the Ingham Regional Medical Center in Lansing, Michigan, an NSF Community Partner, provides a good example of how the medical and highway safety and law enforcement communities can support one another's efforts to address the problem of drowsy driving. In addition to making presentations at annual highway safety conferences and to a variety of state and local agencies, the Center for Sleep & Alertness worked with the Michigan State Police Motor Carrier Division to provide one-on-one education and sleep disorder screening to commercial vehicle operators in violation of HOS regulations. The center has also led "train the trainer" sessions for law enforcement officers, providing basic training on impairment from sleep deprivation and its role in accident investigation. For more information about these activities, contact Pamela Minkley with the Ingham Center for Sleep & Alertness (517-377-8520) or Dan Vartanian, NETS Coordinator with the Office of Highway Safety Planning (517-333-5322).

Although distracted and fatigued driving are recognized as significant personal motor vehicle risk factors in all branches of the military, no specific programs were identified addressing these factors. A Defense Safety Oversight Council (DSOC) Private Motor Vehicle Task Force is currently investigating these issues. Developing permanent partnerships (e.g., partnering with local law enforcement at Department of Defense installations) is one of the task force's identified approaches for achieving behavior change.