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JOURNAL OF TRAUMA NURSING WWW.JOURNALOFTRAUMANURSING.COM 31
RESEARCH
Copyright © 2013 Society of Trauma Nurses. Unauthorized reproduction of this article is prohibited.
Distracted Driving and Implications for Injury
Prevention in Adults
Jane Hoff , MSN, CNM, RN ■ Jennifer Grell , BSN, RN ■ Nicole Lohrman , MSN, RN, CCRN ■
Christy Stehly , BS ■ Jill Stoltzfus , PhD ■ Gail Wainwright , MSN, RN ■ William S. Hoff , MD, FACS
ABSTRACT
Distracted driving, a signifi cant public safety issue, is
typically categorized as cell phone use and texting. The
increase of distracted driving behavior (DDB) has resulted
in an increase in injury and death. The purpose of this
study was to identify the frequency and perception of DDB
in adults. A 7-question SurveyMonkey questionnaire was
distributed to a convenience sample of adults. Standard
demographics included age, gender, and highest levels
of education. Primary outcome questions were related
to frequency of DDB, and overall perceptions specifi c to
distracted driving. Results were compared on the basis
of demographics. Chi-square testing and the Kruskal-
Wallis analysis of variance were applied, with statistical
signifi cance defi ned as P .05. There were 1857
respondents to the survey: 1721 were aged 23-64 years
(93%); 1511 were women (81%); 1461 had high school
education or greater (79%). A total of 168 respondents
(9%) reported being involved in a car accident while
distracted. The highest reported frequency of DDB
included cell phone use (69%), eating/drinking (67%),
and reaching for an object in the care (49%). Younger age
(18-34 years) and higher level of education (bachelor’s
degree or greater) were statistically associated with these
DDB; gender demonstrated no statistical signifi cance. Text
messaging was reported by 538 respondents (29%), with
a statistically signifi cant association with age (18-34 years),
higher education (bachelor’s degree or greater), and gender
(males). A total of 1143 respondents (63%) believed
that they could drive safely while distracted. This study
demonstrates that DDB in adults is not restricted to reading
and sending text messages. Moreover, these results
indicated that people fail to perceive the dangers inherent
in distracted driving. Prevention and outreach education
should not be limited to texting and cell phone use but
should target all forms of DDB. The age group 18-34 years
should be the primary target in the adult population.
Key Words
Distracted driving , Injury prevention , Take a STANDD
D istracted driving, a signifi cant public safety issue, is
typically categorized as cell phone use and texting.
However, with the availability of such mobile tech-
nology as global positioning systems and vehicle
entertainment systems, additional sources of distrac-
tion have become increasingly available to drivers.
1
The
increase in distracted driving behaviors (DDBs) has been
identifi ed as an important etiology of accidental injury
and death. According to the Fatality Analysis Reporting
System, a total of 51,857 fatalities caused by driver distrac-
tion occurred from 1999 to 2008.
2
Self-reported perceptions of drivers with regard to
DDB may offer some interesting insight into the plan-
ning and design of trauma prevention and outreach ef-
forts specifi c to this signifi cant and correctable problem.
The purpose of this study was to identify the frequency
and perception of DDBs in adults.
MATERIALS AND METHODS
This study was a collaborative effort between the Take
a STANDD© Organization, a community outreach and
awareness group and a university-affi liated level I trau-
ma center. The study received an exempt status from the
St. Luke’s institutional review board. A survey was sent
Author Affi liations: Take a STANDD© Organization, Bethlehem, Penn-
sylvania (Ms Hoff); and St. Luke’s University Hospital, Division of Trauma,
Bethlehem, Pennsylvania (Mss Grell, Lohrman, Stehly, and Wainwright,
Drs Stoltzfus and Hoff) .
The authors declare no confl icts of interest.
Presentations: Poster Presentation, Eastern Association for the Surgery of
Trauma Meeting, Orlando, Florida, January 2012.
Author Contributions: Literature search : J. Hoff, Grell, Lohrman, Simons,
Stehly, Wainwright, W. Hoff; Study design : J. Hoff, Grell, Lohrman,
Simons, Stehly, Wainwright, W. Hoff, J. Stoltzfus; Data collection : J. Hoff,
Grell, Lohrman, Simons, Stehly, Wainwright, W. Hoff; Data analysis : J.
Hoff, J. Stoltzfus, W. Hoff; Data interpretation : J. Hoff, J. Stoltzfus, W.
Hoff; Writing : J. Hoff, J. Stoltzfus, W. Hoff; Critical review : J. Hoff, Grell,
Lohrman, Simons, Stehly, Wainwright, W. Hoff, Stoltzfus; and Figures: J.
Hoff, Stehly, W. Hoff.
Correspondence: Jane Hoff, MSN, CNM, RN, Take a STANDD© Organiza-
tion, 1966 Sunderland Dr, Bethlehem, PA 18015 ( jgehoff@verizon.net ).
DOI: 10.1097/JTN.0b013e318286616c
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32 WWW.JOURNALOFTRAUMANURSING.COM Volume 20 | Number 1 | January–March 2013
Copyright © 2013 Society of Trauma Nurses. Unauthorized reproduction of this article is prohibited.
RESULTS
There were 1857 respondents to the survey over a
1-month period. Demographic characteristics of the re-
spondents are reported in Table 2 . Of note, 93% of re-
spondents were between 23 and 64 years of age. The vast
majority (81%) were women, and 79% were educated at
an associate degree-level or greater.
Complete data (ie, all survey questions answered) on
DDB were available for 1838 respondents. One thousand
eighteen respondents (72%) reported fi nding themselves
distracted while driving always, frequently, or sometimes;
28% were rarely or never distracted while driving ( Table 3 ).
Distraction was signifi cantly more likely to be reported in
older age categories ( P .0001), less likely in women ( P
.01), and less likely in more highly educated respondents
( P .005).
Specifi c distractive behaviors are presented in Figure 1 .
The highest reported DDB was cell phone use (either
hands free or hand-held) in 79% of respondents, eating
and drinking (67%) and reaching for an object outside of
the driver’s compartment (50%). More respondents in the
23- to 44-year age category ( P .0001) and with a doc-
toral degree ( P .0001) reported talking hands free on
a cell phone. A statistically higher percentage of younger
respondents aged 18 to 44 years ( P .0001) and more
respondents with bachelor’s degrees ( P .02) reported
talking on a non–hands-free cell phone while driving.
Eating and drinking were reported more frequently in
23- to 44-year-olds ( P .0001) and in respondents with
electronically to employees of a single health care net-
work. Surveys were subsequently forwarded by initial
recipients using various social networks and computer
Web sites. The survey was limited to adults with driver’s
licenses. Data were collected and preliminarily analyzed
using a SurveyMonkey tool, which was developed by
content experts from multiple fi elds.
Standard demographics included respondent age by
category (18-22; 23-34; 35-44; 45-54; 55-64; 65 years),
gender, and level of education (high school; associate’s
degree; bachelor’s degree; master’s degree; doctoral de-
gree). Four questions specifi c to DDB constituted the pri-
mary outcome data for the study ( Table 1 ). Distracted
driving behaviors were compared between the various
demographic groups.
Statistical analysis utilized the chi-square test of gen-
eral association for categorical variables and the Kruskal-
Wallis analysis of variance for ordinal variables. For all
analyses, statistical signifi cance was defi ned as P .05,
with no adjustment for the multiple comparisons.
TABLE 1 Questions Specifi c to Distracted
Driving Behavior
1. How often do you fi nd yourself distracted while driving?
Always
Frequently
Sometimes
Rarely
Never
2. Which of the following activities have you done in the past
week while operating a moving vehicle?
Read or sent text message
Talked on cell phone (not hands free)
Talked on cell phone (hands free)
Applied make up
Ate and/or drank
Waved to pedestrians
Reached for something in passenger or back seat
Other
3. Do you believe you are able to drive safely while performing
these activities?
Yes
No
4. Have you ever been involved in a car accident that in-
volved distracted driving?
Yes
No
TABLE 2 Respondent Demographic Summary
Demographic Number %
Age, y
18-22 72 4
23-34 392 21
35-44 384 21
45-54 527 29
55-64 404 22
65 60 3
Gender
Male 353 19
Female 1504 81
Education
High school 382 21
Associate’s degree 473 26
Bachelor’s degree 561 31
Master’s degree 330 18
PhD 86 4
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JOURNAL OF TRAUMA NURSING WWW.JOURNALOFTRAUMANURSING.COM 33
Copyright © 2013 Society of Trauma Nurses. Unauthorized reproduction of this article is prohibited.
DISCUSSION
There are many studies regarding cell phone use, tex-
ting, and other vehicular technologies that may produce
a distraction while driving. It has been stated that driving
while distracted is approximately equivalent to driving
while under the infl uence of alcohol.
3
Studies have docu-
mented that conversing on a cell phone detracts consider-
ably from driving performance whether in the hand-held
or hands-free mode.
1
,
4
Strayer and colleagues revealed
that drivers conversing on cell phones demonstrate “inat-
tention blindness,” processing up to 50% less environ-
mental information that is vital to safe motor vehicle op-
eration.
5
,
6
However, certain behaviors are noted to be less
of an impediment to driving safely. Studies suggest that
neural pathways may be diverted differently in the case of
conversation with a passenger, with less incidence of inat-
tention blindness than during a cell phone conversation.
3
The present study provides unique information regarding
the perceptions of adult drivers with regard to distracted
driving.
The American Automobile Association performed a
blind analysis of the typical distractions experienced by
adults while driving and the percentage of time spent
distracted.
7
The behavior of 71 drivers was observed us-
ing video camera and a coder; the drivers had no input
regarding their perception of distractions. During 3 hours
of coded driving time, almost all of the volunteer sub-
jects were observed manipulating vehicle controls and
reaching for objects inside their moving vehicle. Nearly as
many were observed manipulating audio controls or had
their attention drawn to something outside the vehicle.
Three-fourths ate or drank while driving or conversed
with a passenger. Reading/writing and grooming were
also common activities. Nearly one-third of the subjects
used a cellular telephone while driving or were distracted
by passengers in their vehicles.
A study of adolescent drivers by Heck and Carlos
8
dem-
onstrated that distractions secondary to peer passengers
bachelor’s degrees ( P .0001). A higher frequency of
reaching behavior was reported in the 18- to 34-year age
categories ( P .0001) and in more highly educated re-
spondents ( P .03).
Text messaging was reported by 29%, with respon-
dents in the youngest age categories (18-22 and 23-34
years old) reported sending or receiving texts signifi cantly
more often ( P .001). Texting was also signifi cantly as-
sociated with education level; the highest frequency of
texting behavior was reported in respondents with both
bachelor’s and doctoral degrees ( P .001). There were
no statistically signifi cant gender differences in any spe-
cifi c DDB.
Sixty-three respondents (63%) believed that they could
drive safely while engaging in DDB, while 37% believed
that DDBs were an impediment to safe driving. There
was a signifi cant difference in these responses based on
age, gender, or level of education. One hundred sixty-
eight respondents (9%) reported being involved in a mo-
tor vehicle collision related to distracted driving, but there
were no statistical associations related to age, gender, or
education level.
TABLE 3 Overall Reported Distracted
Driving
Demographic
Distracted
Driving Reported
a
No Distracted
Driving Reported
b
Age, y
18-22 52 (72%) 20 (28%)
23-34 322 (82%) 70 (18%)
35-44 309 (80%) 75 (20%)
45-54 375 (71%) 152 (29%)
55-64 234 (58%) 170 (12%)
65 27 (77%) 33 (13%)
Gender
Male 221 (65%) 120 (35%)
Female 1097 (73%) 399 (17%)
Education
High school 247 (65%) 135 (35%)
Associates 340 (72%) 133 (18%)
Degree 423 (75%) 138 (25%)
Bachelor’s
degree
244 (74%) 86 (26%)
Master’s
degree
59 (69%) 27 (31%)
PhD
a Distracted driving reported as always, frequently or sometimes.
b Distracted driving reported as rarely or never.
Figure 1. Distracted driving behaviors.
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34 WWW.JOURNALOFTRAUMANURSING.COM Volume 20 | Number 1 | January–March 2013
Copyright © 2013 Society of Trauma Nurses. Unauthorized reproduction of this article is prohibited.
may be equivalent to those experienced by adults using
cell phones while driving. This study did not examine
other distracted behaviors such as eating or drinking,
grooming, or reaching for things in the back seat. The
mere presence of passengers in the vehicle was suggested
as an important form of distraction for teenaged drivers.
This study demonstrates that DDB in adults is not re-
stricted to cellular phone technology such as talking on
the phone, reading, or sending text messages. Moreover,
these results indicate that people fail to perceive the dan-
gers inherent in distracted driving. The subgroup of adults
with the highest DDBs were 18 to 34 years old.
Awareness programs concerning distracted driving are
slowly being developed across the United States. The
programs are not keeping up with the morbidity and
mortality rates involving individuals in all age groups.
Active education of adults may be a key element in injury
prevention and outreach activities.
Studies similar to this one are currently being per-
formed collaboratively with a comprehensive education
program sponsored by Take a STANDD to specifi cally
examine perceptions of DDB in teenaged drivers. In ad-
dition, analysis of DDB of noncustodial transporters of
children (eg, school bus drivers) is also planned.
Distracted driving is a serious problem in adult driv-
ers. Three-quarters of adult drivers report experiencing
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distraction while driving. However, the majority believe
that they can safely operate a motor vehicle while dis-
tracted. Distracted driving is not restricted to cell phone
use and texting; many other activities must be consid-
ered when discussing DDB. Specifi c age groups and
education levels should be targeted when designing
prevention programs.
For more than 56 additional continuing education articles related to
emergency care and 20 additional continuing education articles
related to safety, go to NursingCenter.com\CE.
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