I. Background and Overview of the Project

Driver fatigue, inattention, and sleepiness have recently become the focus of research efforts aimed at preventing motor vehicle fatalities. Data that describe the extent of fall-asleep motor vehicle crashes are difficult to obtain due to the absence of objective criteria (e.g., blood test) and the inability to debrief victims of fatal fall-asleep crashes. However, anecdotal reports suggest that these types of crashes and "near-miss" crashes warrant attention. The purpose of the present exploratory research is to better understand the nature of drowsy, fatigued or sleepy driving that may lead to fall-asleep automobile crashes. For the purposes of this report, we examine the one antecedent to these types of crashes, drowsy driving.

The primary objectives of this project were to (1) describe the antecedents to drowsy driving, (2) profile groups of people that may be at elevated risk for involvement in a fall-asleep motor vehicle crash and (3) develop informational campaigns that would be appealing and educational to these groups. Describing the extent of the problem was not an objective for this project.

At the outset of this work, the National Highway Traffic Safety Administration, in conjunction with the National Center for Sleep Disorders Research and the National Heart, Lung, and Blood Institute, convened a panel of experts to examine the problem of drowsy driving. The panel identified young men and shift workers as two groups that are likely to be at increased risk for fall-asleep automobile crashes, based upon the available evidence. The present report focuses on the problem of drowsy driving in these two high risk groups.

The purpose of the project is to (1) better understand the nature of drowsy, fatigued or sleepy driving that may lead to fall-asleep automobile crashes, (2) identify opportunities to intervene to decrease the risk of drowsy driving, and (3) identify barriers to implementation of potentially successful interventions.

This research was completed by the Harvard School of Public Health under a cooperative agreement with the National Highway Traffic Safety Administration and in collaboration with Global Exchange, Inc. of Bethesda, MD.

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The findings presented in this report are based on focus group interviews, a qualitative research technique. Focus groups are useful tools for providing insight into the experiences, behavior, attitudes, and perceptions of a specific audience. The people selected to participate in focus groups are chosen according to common characteristics related to the topic of the group.

Focus groups provide information that would be difficult to obtain using other research methodologies. Focus group discussions allow for group interaction and provide insight into why a specific audience holds certain opinions beyond that which we can achieve through other quantitative research techniques. However, several limitations of qualitative research must be considered when reviewing the findings of this research. The samples for qualitative research are generally small and neither represent nor can be generalized to a larger group of the population. The primary goal of qualitative research is to obtain in-depth information. In order to maximize the information obtained and to ensure that the moderator can tailor the questioning to each group's and each respondent's needs and abilities, the questioning, techniques, and wording can vary from group to group or from respondent to respondent. The responses received are dependent upon the context of the discussion and participants may influence each other.

Focus groups cannot replace more traditional survey methods in which results can be statistically analyzed, compared with normative groups, and extrapolated to represent entire populations. The findings presented in this report should be viewed with caution and should be used as a starting point for additional thinking on the issue.

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