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Distracted Driving and Implications for Injury Prevention in Adults

Hoff, Jane MSN, CNM, RN; Grell, Jennifer BSN, RN; Lohrman, Nicole MSN, RN, CCRN; Stehly, Christy BS; Stoltzfus, Jill PhD; Wainwright, Gail MSN, RN; Hoff, William S. MD, FACS

Author Information
doi: 10.1097/JTN.0b013e318286616c


Distracted driving, a significant public safety issue, is typically categorized as cell phone use and texting. However, with the availability of such mobile technology as global positioning systems and vehicle entertainment systems, additional sources of distraction have become increasingly available to drivers.1 The increase in distracted driving behaviors (DDBs) has been identified 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 distraction occurred from 1999 to 2008.2

Self-reported perceptions of drivers with regard to DDB may offer some interesting insight into the planning and design of trauma prevention and outreach efforts specific to this significant and correctable problem. The purpose of this study was to identify the frequency and perception of DDBs in adults.


This study was a collaborative effort between the Take a STANDD© Organization, a community outreach and awareness group and a university-affiliated level I trauma center. The study received an exempt status from the St. Luke's institutional review board. A survey was sent electronically to employees of a single health care network. 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 fields.

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 degree). Four questions specific to DDB constituted the primary outcome data for the study (Table 1). Distracted driving behaviors were compared between the various demographic groups.

Questions Specific to Distracted Driving Behavior

Statistical analysis utilized the chi-square test of general association for categorical variables and the Kruskal-Wallis analysis of variance for ordinal variables. For all analyses, statistical significance was defined as P ≤ .05, with no adjustment for the multiple comparisons.


There were 1857 respondents to the survey over a 1-month period. Demographic characteristics of the respondents are reported in Table 2. Of note, 93% of respondents 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.

Respondent Demographic Summary

Complete data (ie, all survey questions answered) on DDB were available for 1838 respondents. One thousand eighteen respondents (72%) reported finding themselves distracted while driving always, frequently, or sometimes; 28% were rarely or never distracted while driving (Table 3). Distraction was significantly 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).

Overall Reported Distracted Driving

Specific 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 doctoral 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 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 respondents (P = .03).

Figure 1
Figure 1:
Distracted driving behaviors.

Text messaging was reported by 29%, with respondents in the youngest age categories (18–22 and 23–34 years old) reported sending or receiving texts significantly more often (P < .001). Texting was also significantly associated 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 significant gender differences in any specific 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 significant difference in these responses based on age, gender, or level of education. One hundred sixty-eight respondents (9%) reported being involved in a motor vehicle collision related to distracted driving, but there were no statistical associations related to age, gender, or education level.


There are many studies regarding cell phone use, texting, 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 influence of alcohol.3 Studies have documented that conversing on a cell phone detracts considerably 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 “inattention blindness,” processing up to 50% less environmental information that is vital to safe motor vehicle operation.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 inattention 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 using 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 subjects 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 Carlos8 demonstrated that distractions secondary to peer passengers 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 restricted 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 dangers 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 performed collaboratively with a comprehensive education program sponsored by Take a STANDD to specifically examine perceptions of DDB in teenaged drivers. In addition, analysis of DDB of noncustodial transporters of children (eg, school bus drivers) is also planned.

Distracted driving is a serious problem in adult drivers. Three-quarters of adult drivers report experiencing distraction while driving. However, the majority believe that they can safely operate a motor vehicle while distracted. Distracted driving is not restricted to cell phone use and texting; many other activities must be considered when discussing DDB. Specific age groups and education levels should be targeted when designing prevention programs.


1. Drews F, Yazdani H, Godfrey C, et al. Text messaging during simulated driving. Hum Factors. 2009;51:762–770.
2. Wilson F, Stimpson J. Trends in fatalities from distracted driving in the United States, 1999 to 2008. Am J Pub Health. 2010;100:2213–2219.
3. Ship A. The most primary of care—talking about driving and distraction. N Engl J Med. 2010;362:2145–2147.
4. Strayer DL, Johnson WA. Driven to distraction: dual-task studies of simulated driving and conversing on a cellular phone. Psychol Sci. 2001;12:462–466.
5. Strayer DL, Drews FA, Johnson WA. Cell phone induced failures of visual attention during simulated driving. J Exp PsycholAppl. 2003;9:23–52.
6. Strayer DL, Drews FA. Cell-phone induced inattention blindness. Curr Dir Psych Sci. 2001;16:128–131.
7. Stutts J, Feaganes J, Rodgman E, et al. Distractions in everyday driving. Report Prepared for AAA Foundation for Traffic Safety, Washington, DC. 2003:1–105.
8. Heck K, Carlos R. Passenger distractions among adolescent drivers. J Safety Res. 2008;39:437–443.

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