The NHTSA & NCSDR Program to Combat Drowsy Driving
Report to the House and Senate Appropriations Committees
Describing Collaboration Between
National Highway Traffic Safety Administration
and
National Center on Sleep Disorders Research
National Heart, Lung and Blood Institute
National Institutes of Health

Table Of Contents

Legislative History

FY 1996 Report Language
FY 1997 Report Language

Program Overview
Detailed Project Descriptions

Analyze Role of Fatigue, Sleep Disorders, & Inattention (FSDI) in Highway Crashes

Biology of Human Sleep and Sleepiness
Characteristics of Drowsy-Driving Crashes
Risk Factors for Drowsy-Driving Crashes
Population Groups at Highest Risk
Countermeasures
Panel Recommendations for an Educational Campaign

Investigate Instances of Fatigue-related Events in Motor-vehicle Operation
Develop and Test Educational Countermeasures for Fatigue-related Highway Crashes
Develop Strategy and Lay Foundation for Education and Information Campaign
Promulgate the Educational Program to Implementation Sites
Evaluate Information and Education Campaign
Conduct Supplementary Implementation Activities for Youth Audiences

Develop and Distribute Educational Materials Specifically for Young Audiences
Conduct a Strategy Development Workshop

Conclusions

Tables

Table 1: Project Objectives and Statistics

Attachments

Attachment 1

NCSDR/NHTSA Expert Panel on Driver Fatigue and Sleepiness: Membership Roster

Attachment 2

NCSDR/Scholastic Magazine Educational Materials for Youth Audiences: Insert from Choices, Health Choices, and Teacher's Guide, May, 1998

Attachment 3

NCSDR/Scholastic Magazine Educational Materials for Youth Audiences: Insert from Scope, May 11, 1998

Attachment 4

NCSDR/Scholastic Magazine Educational Materials for Youth Audiences: Insert from Coach and Athletic Director, May/June, 1998

Attachment 5

NCSDR Strategy Development Workshop on Educating Youth About Sleep and Drowsy Driving: Agenda & List of Participants, June 5, 1998


NHTSA & NCSDR Program to Combat Drowsy Driving
Report to the House and Senate Appropriations Committees
Describing Collaboration Between
National Highway Traffic Safety Administration
and
National Center on Sleep Disorders Research
National Heart, Lung and Blood Institute
National Institutes of Health

In 1996, the National Highway Traffic Safety Administration (NHTSA) embarked on a congressionally mandated effort to develop educational countermeasures to the effects of fatigue, sleep disorders, and inattention on highway safety. In collaboration with National Center on Sleep Disorders Research (NCSDR), the program established three main components: a workplace education program for shift workers to reduce the incidence of drowsy driving, a school-based program for high-schools to increase students' awareness of the dangers of drowsy driving, and an in-vehicle data-collection effort to obtain driver and vehicle performance measures of real-life inattention events.

The Committee on Appropriations of the U.S. Senate, in Senate Report 104-325 on the Department of Transportation and Related Agencies Appropriations Bill, 1997, directed NHTSA to report to the House and Senate Appropriations Committees describing the collaborative efforts and funding activities between NHTSA and the NCSDR. In addition to providing the requested information, this report provides an overview of and status report on the agencies' development, implementation, and evaluation activities.


Legislative History

The following paragraphs provide the text of the Appropriations Committee Conference Reports from fiscal years 1996 and 1997, which guided the development of NHTSA's fatigue education program.


FY 1996 Report Language

"Driver fatigue and inattention. -- NHTSA data indicate that in recent years there have been about 56,000 crashes annually in which driver drowsiness/fatigue was cited by police. An annual average of roughly 40,000 nonfatal injuries and 1,550 fatalities result from these crashes. It is widely recognized that these statistics under report the extent of these types of crashes. These statistics also do not deal with crashes caused by driver inattention, which is believed to be a larger problem. The Committee maintains that NHTSA has not devoted sufficient resources to understanding and dealing with the role of driver fatigue, sleep disorders, and inattention in highway safety. Consequently, the Committee's allowance includes $1,000,000 to analyze the role of these problem areas in highway crashes; to develop and test appropriate educational countermeasures; and to develop a strategy and lay the foundation for a public information campaign using a variety of media and approaches. These activities will be conducted in close cooperation with the National Center on Sleep Disorders Research. In planning this initiative, NHTSA should include an assessment of public knowledge and behavior before and after the implementation of the public information campaign. The Committee intends to recommend additional funds for completion of the campaign and its evaluation in the future. The funds recommended above are in addition to any support for studies conducted under the ITS program."


FY 1997 Report Language

"Driver fatigue. -- The conference agreement includes $1,000,000 to analyze the role of driver fatigue, sleep disorders, and inattention. NHTSA should collaborate directly with the National Center on Sleep Disorders Research to conduct and assess public information activities in these three areas and submit a report to the House and Senate Appropriations Committees by May 1, 1997 that describes these collaborative efforts."


Program Overview

In order to comply with the mandates issued in the FY 1996 and FY 1997 appropriations bills, NHTSA established a coordinated program of research and development comprising the seven component projects listed in Table 1. Although the appropriations language did not specify a schedule, staff endeavored to speed the development process so that it would produce actual program materials within two years. To accelerate the initiation of actual program development work, NHTSA established all projects through cooperative agreements, interagency agreements, and task orders under existing indefinite-quantity contracts.


Table 1.
Project Objectives and Statistics

Project Objectives Amount

Start Date

Duration

Participants
Analyze role of fatigue, sleep disorders, & inattention (FSDI) in highway crashes Describe characteristics of FSDI crashes

Identify subgroups most at risk

$130,000

8/14/96

30 mo

National Center on Sleep Disorders Research
Investigate instances of fatigue-related events in motor-vehicle operation Observe drivers during fatigue-related inattention incidents

Establish characteristics of inattention

$100,000

9/23/96

24 mo

NHTSA Vehicle Research and Test Center
Develop and test educational countermeasures for fatigue-related highway crashes

Specify target populations

Determine message themes (content)

Establish motiva-tional approaches

Establish dissemi-nation strategies

$175,000

6/26/96

30 mo

Harvard Univ. School of Public Health
Develop strategy and lay foundation for education and information campaign

Determine campaign objectives & target audience

Determine content, strategy, & media mix

Prepare and test draft materials

Refine materials

$325,000

9/20/96

30 mo

Global Exchange, Inc.
Promulgate the educational program to implementation sites Identify communities, organizations and associations that serve appropriate target group constituencies

Create interest in program implementation

Award competitive grants to support implementation activities

Provide program materials to implementors

$271,000

9/26/97

24 mo

Global Exchange

(materials production & program administration)

$200,000

fall 98

6-12 mo

To be Arranged

(grants to implementors)

Evaluate information and education campaign to combat fatigue-related highway crashes

Determine appropriate outcome measures & evaluation design

Choose evaluation sites

Collect pre- & post-campaign data

Evaluate campaign

Recommend revisions

$516,000

9/1/97

30 mo

Systems Assessment and Research, Inc.
Conduct supplementary implementation activities for youth audiences Adapt campaign themes for use in ongoing educational programs for target audiences

Produce and disseminate supplementary materials through appropriate channels to reach target audience

$234,000

(9/15/97)

12 mo

National Center on Sleep Disorders Research



NHTSA established several principles to guide the design of the program:

These guidelines provided the structure for a program-development process that focused resources on issues that had the support of the extended sleep-research community, concerned a significant and identifiable population, and would be amenable to educational countermeasures.


Detailed Project Descriptions

The following sections describe in greater detail each of the component projects listed in Table 1. While NHTSA staff determined the general approach and the nature of each project, the ultimate shape of the program became the product of a development team comprising key personnel from each individual project and staff from NHTSA and NCSDR. As in all complex program development efforts, various components of this program overlap in both time and content. For example, the development of the program evaluation must necessarily coincide with the development of the program objectives and materials. By working collaboratively and collegially, the development team has seamlessly integrated the development of each program component at each stage of development.


Analyze Role of Fatigue, Sleep Disorders, & Inattention (FSDI) in Highway Crashes

NHTSA established an interagency agreement with the NCSDR, an agency of the NIH that is organizationally located within the National Heart, Lung, and Blood Institute (NHLBI), using FY 1996 funds to convene a panel of experts to guide the development of the educational program. A roster of the panel members is provided as Attachment 1.

The panel of experts reviewed the literature on fatigue-related crashes and produced a 36-page report covering the biology of human sleep and sleepiness, characteristics of drowsy-driving crashes, risk factors for drowsy-driving crashes, population groups at highest risk, countermeasures, and recommendations for an educational campaign.

In addition to the guidance provided by the panel's report, the NCSDR selected a steering committee from among the members of the panel to provide oversight of the program development effort and to participate with the development team in making critical decisions affecting program direction.

The expert panel report was published as a joint DOT/NIH report (DOT HS 808 707) in April, 1998 and distributed by both NHTSA and the NCSDR. The report is also available electronically on each agency's web site. The copy at www.nhtsa.dot.gov/people/perform/human/Drowsy.html can be read directly from the browser. The copy at www.nhlbi.nih.gov /nhlbi/sleep/prof drsy_drv.htm preserves the appearance of the original and must be downloaded and viewed using the Adobe Acrobat Reader.

The subsequent paragraphs are extracted from the executive summary of the panel's report .

Biology of Human Sleep and Sleepiness

Sleep is a neurobiologic need with predictable patterns of sleepiness and wakefulness. Sleepiness results from the sleep component of the circadian cycle of sleep and wakefulness, restriction of sleep, and/or interruption or fragmentation of sleep. The loss of one night's sleep can lead to extreme short-term sleepiness, while habitually restricting sleep by 1 or 2 hours a night can lead to chronic sleepiness. Sleeping is the only way to reduce sleepiness. Sleepiness causes auto crashes because it impairs performance and can ultimately lead to the inability to resist falling asleep at the wheel. Critical aspects of driving impairment associated with sleepiness are reaction time, vigilance, attention, and information processing.

Characteristics of Drowsy-Driving Crashes

Subjective and objective tools are available to approximate or detect sleepiness. However, unlike the situation with alcohol-related crashes, no blood, breath, or other measurable test is currently available to quantify levels of sleepiness at the crash site. Although current understanding largely comes from inferential evidence, a typical crash related to sleepiness has the following characteristics:

Risk Factors for Drowsy-Driving Crashes

Although evidence is limited or inferential, chronic predisposing factors and acute situational factors recognized as increasing the risk of drowsy driving and related crashes include:

These factors have cumulative effects; a combination of them substantially increases crash risk.

Population Groups at Highest Risk

Although no driver is immune, three broad population groups are at highest risk, based on evidence from crash reports and on self-reports of sleep behavior and driving performance. These groups are:

Countermeasures

To prevent drowsy driving and its consequences, Americans need information on approaches that may reduce their risks.

Panel Recommendations for an Educational Campaign

To assist the educational campaign in developing its educational initiatives, the panel recommended the following three priority areas:

1. Educate young males (ages 16 to 24) about drowsy driving and how to reduce lifestyle-related risks.

2. Promote shoulder rumble strips as an effective countermeasure for drowsy driving; in this context, raise public and policymaker awareness about drowsy-driving risks and how to reduce them.

3. Educate shift workers about the risks of drowsy driving and how to reduce such risks.

The panel also identified complementary messages for educational campaigns and called for the active involvement of other organizations to promote sufficient sleep--as a public health benefit as well as a means to reduce the risk of fall-asleep crashes.



Investigate Instances of Fatigue-related Events in Motor-vehicle Operation

This project was designed to fill two needs: to obtain graphic representations of drowsy drivers in real-world situations and to document instances of driver inattention separate from drowsiness. To these ends, NHTSA's Vehicle Research and Test Center (VRTC) has conducted a program of research that involved installation of an unobtrusive, portable data acquisition system called Micro-DAS into the private vehicles of 10 paid volunteer test participants. The test participants spanned a range of college students, shift workers, and military personnel on leave, i.e., populations thought to be at high risk for drowsy driving. In addition to using their privately owned vehicles, the test participants were observed while making trips of their own choosing rather than routes provided by the researchers. The data collection periods varied from 2 weeks for a shift worker to a long weekend for a military person on a long-distance trip while on weekend leave. Micro-DAS instrumentation included video of the road scene, video of the driver's face to capture eye glance and eye closure data, as well as numerous engineering measures such as steering wheel inputs, travel speeds, braking events, and lane position.

The study produced over 100 hours of real-time driver and vehicle data. Because all data was digitally recorded, targeted events can be identified and analyzed using automated procedures.

Analysis of this data is currently being completed by VRTC. Periods of drowsy driving are being identified by means of a NHTSA-sponsored drowsy driver detection system algorithm and verified by observed eye closure data. The algorithm uses engineering measures of steering inputs and lane-keeping to predict drowsy driving periods. These are then verified by measures of eye closure during those same periods. Since visual inattention can give rise to similar disruptions in steering behavior and lane-keeping, driver eyes-off-road glances will be analyzed to determine the extent to which the algorithm might be able to detect distracted or inattentive driving, apart from drowsy driving periods. This work will contribute valuable real-world data to an assessment of drowsy driving and inattentive driving.

Preliminary analyses have identified several dramatic examples of both sleepiness-related and non-sleepiness-related inattention. A full report of this study is expected in early 1999. Videos from this study will be incorporated into the educational program to provide dramatic illustration of events related to drowsy driving and inattention. These videos and associated vehicle data will also be made available to investigators who wish to establish similarities among and differences between events resulting in driver inattention.


Develop and Test Educational Countermeasures for Fatigue-related Highway Crashes

NHTSA established a cooperative agreement with the Harvard School of Public Health to create the research foundation for the public education program. Accordingly, Harvard's project staff attended the meetings of the NCSDR expert panel and used the recommendations of the panel to plan and execute a series of focus groups to explore the educational needs and motivational approaches of the two potential target populations recommended by the expert panel: young males and shift workers.

Project staff conducted a total of eight focus group discussions in two cities (San Diego, CA, and Memphis, TN) with members of two potential target groups (young males and shift workers).

Based on the apparent intractability of the young male group and the high level of interest in change shown by the shift workers, the development team recommended to the steering committee that the program should target shift workers. Some members of the steering committee, acknowledging the difficulty of achieving results with young males, nevertheless expressed concern that young males constituted the bulk of the problem and were given highest priority by the expert panel. The steering committee and the development team agreed to defer target group selection until more information could be obtained regarding program implementation in the work place and acceptance by shift work employees and supervisors.

Accordingly, a second round of focus groups, conducted in Framingham, MA, and Atlanta, GA, gathered information from shift workers and shift-work supervisors. The participants in these groups confirmed the findings of the earlier groups and revealed a number of areas in which shift workers feel "forgotten" by management:

Discussions with shift-work supervisors indicated that supervisors have the same concerns as the staff they supervise. Many supervisors make ad-hoc adjustments to company policy to accommodate the needs of their staff, but all agreed that changing official policies would be difficult, if not impossible.

To get some idea of how upper management would respond to suggestions for changing the work environment and company policies to accommodate the needs of shift workers, project staff conducted one-on-one telephone interviews with over a dozen executives. Most executives represented companies or organizations that had expressed interest in traffic safety in general and drowsy driving of shift workers in particular. They had numerous suggestions for ways in which employers could be involved in providing some assistance to shift workers.

Based on these studies, project staff recommended to the steering committee that the educational program should specifically target shift workers, recognizing that some portion of the shift-work population would be young males.

The program should provide information on how shift workers could improve both the amount and the quality of their sleep, including recommendations for changing sleep schedules, use of sleep aids such as room-darkening shades or white-noise machines, exercise and nutrition programs, and changes to the work environment. The program should appeal to the shift worker's natural desire to feel more rested. Information should be provided through a variety of media and channels, including safety training sessions, posters in the workplace, flyers and brochures (perhaps included with pay stubs), and a short video for employees to take home to watch with their families. Employers should be encouraged to participate by providing information regarding the general effects of drowsiness on productivity and more specifically, the lost productivity resulting from injuries caused by traffic crashes.

The steering committee approved the focus on shift workers.


Develop Strategy and Lay Foundation for Education and Information Campaign

NHTSA issued a task order to Global Exchange, Inc., to cover the development and production of camera-ready materials for all program elements, including educational materials and administrative and implementation guidelines.

The focus of this project is to develop materials for both shift workers and their employers. Materials will contain information on methods to improve the quality of sleep the shift worker currently gets, thereby lowering the probability of the worker being involved in a crash due to sleepiness. These materials will also provide information on how to change work and home environments, as well as life-style choices, to improve the quality of sleep.

Materials will include brochures, posters, paycheck stuffers, an educational video, and scripts for safety meetings. Specific messages may cover issues such as quality of life, productivity, consequences of drowsy driving, and general sleep education. Since the major communications channel with shift workers is anticipated to be through employers, the program will not develop materials for mass media distribution, such as radio or TV public service announcements.

The materials will be subjected to focus-group testing and revision prior to duplication and distribution.


Promulgate the Educational Program to Implementation Sites

NHTSA issued a second task order to Global Exchange, Inc., to conduct the implementation phase of the program. This task order set aside $200,000 for awarding mini-grants to employers or community agencies to implement the drowsy-driver educational program for shift workers. The grants will range in magnitude from $5,000 to $15,000, depending on the extent to which the applicants intend to adopt the recommended program elements and the degree to which they participate in collecting evaluation data. The number of grants awarded will depend on the amounts awarded.

Global Exchange staff, in conjunction with program evaluation staff from Systems Assessment and Research, Inc. (see next section), have developed guidelines for applicants and prepared a simplified application form. Project staff will publicize the availability of these grants and the application procedures using mailings and published notices:

Applications will be reviewed by the members of the development team and the steering committee according to the criteria specified in the application notices. The current schedule anticipates that awards will be determined by December, 1998, for program implementation to begin in February, 1999.

NHTSA Administrator Dr. Ric Martinez will announce the awards early in 1999, in a joint press conference with Dr. Claude Lenfant, director of the NCSDR's parent organization, the National Heart, Lung, and Blood Institute. This press event will also highlight the collaborative activities of the two agencies as well as other NHTSA and DOT efforts to combat fatigue and inattention in highway crashes.

Project staff will duplicate and distribute program materials to awardees, monitor program implementation, and provide technical assistance as needed.

Evaluate Information and Education Campaign

NHTSA obtained the services of Systems Analysis and Research, Inc. (SAR) through an interagency agreement with the General Services Administration Federal Systems Integration and Management Center. This agreement covers evaluation design; pretesting of instruments; collecting process, pre- and post-program data; and preparing an evaluation report including recommendations for revisions of the program materials and procedures.

Evaluation project staff are active members of the development team, ensuring that the program objectives are realistic and can be evaluated. During the course of the early development process, SAR staff have established realistic objectives that can be evaluated and developed a number of candidate measures for capturing appropriate data to assess program functions and effects. Evaluation staff have recruited a number of organizations employing shift workers to serve as test sites for pilot testing the evaluation instruments and procedures.

Evaluation project staff have also worked closely with the team responsible for awarding and overseeing the implementation grants, to ensure that the grant announcement includes the appropriate information regarding the implementors' involvement in the evaluation process and that the application process properly indicates the level of participation of the grantees in the collection of data in support of the program evaluation.

Evaluation staff will monitor the implementation process and collect data from workers both before and after program implementation. Staff will also provide technical assistance to employers that wish to collect additional data related to program functioning.

After analyzing the data, evaluation staff will make recommendations to the materials development contractor to improve the effectiveness of the educational and administrative materials.

Conduct Supplementary Implementation Activities for Youth Audiences

While the main thrust of NHTSA's drowsy driving program is for shift workers (many of whom are young males), the project development team also sought ways to influence a more general audience of young drivers. Using FY 1997 appropriations, NHTSA executed an interagency agreement with the NCSDR to conduct two activities directed towards this end.

Develop and Distribute Educational Materials Specifically for Young Audiences

To reach young drivers, NCSDR called on an existing partnership with Scholastic Magazine, Inc., an information source that reaches students in virtually all high schools in the United States. Under the direction of the NCSDR, NHTSA, and the steering committee, Scholastic Magazine developed a series of educational materials for distribution to high school audiences (both students and teachers) through its existing channels.

Conduct a Strategy Development Workshop

A second activity under the interagency agreement was a strategy development workshop that was held on June 5, 1998 on educating youth about the importance of sleep and the dangers of sleep deprivation, especially drowsy driving. The workshop brought together experts from the areas of adolescent sleep, driver education, high-school education, middle-school education, and curriculum development. NCSDR published the workshop proceedings, "Educating Youth about Sleep and Drowsy Driving," which will also be available on their web site. Ideas generated at the workshop will be used in planning future education activities directed toward youth. Attachment 5 provides the workshop agenda and list of participants.


Conclusions

Despite extensive analytical efforts, determining the extent to which fatigue is involved in traffic crashes has remained elusive. The techniques currently used can only reveal crashes in which the drivers appear to have actually fallen asleep. At best, this approach can provide only a "bare minimum" number of fatigue-related crashes. Until a driver's level of fatigue can be determined by a reliable physical measurement, analogous to using blood alcohol concentration to determine alcohol impairment, establishing accurate estimates of fatigue involvement in crashes is virtually impossible.

Even so, some population groups are at much greater risk for drowsy-driving crashes than others. As reported by the NCSDR expert panel, young males (especially those who drive on long trips involving late-night hours) and shift workers are especially vulnerable among non-commercial drivers. The programs described in this report show how NHTSA and the NCSDR have focused educational efforts on shift workers and youthful drivers.

Fatigue is becoming an issue of growing importance as our society evolves into one that offers an increasing number of services on a 24-hours, 7 day/week basis. Currently 15 million people are working non-daytime shifts. While factory workers still constitute the largest number of shift workers (over 4 million), the largest percentage gains have been in service occupations and technical services, such as 24 hour catalog ordering and computer support. Other social forces, such as welfare-to-work programs, may also swell the number of shift workers.

The materials for providing education to shift workers are nearing completion and will be ready for distribution in February, 1999. Grants for implementation and evaluation of the programs are expected to be awarded by late fall, permitting programs to begin by March, 1999. The evaluation report and recommendations for program revisions are expected by then end of December, 1999.

In addition to the programs described in this report, NHTSA has plans to initiate a program to address long-distance driving by young males in FY 2000. Also in FY 2000, NHTSA will undertake a program, in coordination with FHWA, to educate the public regarding the function of rumble strips and proper responses to their warnings. Meanwhile, NHTSA continues its work to develop in-car devices to detect drowsy or inattentive driving and systems to provide warnings to drivers to take appropriate actions.