The present section examines Phase 1, exploratory research in two groups at risk for drowsy driving, shiftworkers and young men. These groups were identified by the expert panel as likely groups to experience drowsy driving. Our hope in conducting detailed group interviews was to determine (1) the risk factors associated with drowsy driving, (2) the level of motivation for changing these factors, and (3) uncover potential avenues to intervene with these target groups to reduce the potential of fall-asleep crashes. We collected detailed information on the conditions that contribute to the increased risk of fall asleep crashes in the selected groups.
Although the expert panel identified both groups for being at increased risk for fall-asleep crashes, the reasons they are considered at risk differ in some key areas. For the most part, the moderator discussed the same topics with each group. However, separate discussion guides were developed to target these key areas of difference. The shift worker discussions focused more on the influence of the working environment on drowsy driving and the discussions with young men focused on long driving trips.
We conducted focus group interviews in Memphis, TN on September 8 and 9, 1997 and in San Diego, CA on September 15 and 16, 1997. The sites were selected according to the following criteria:
Two groups of high risk targets were interviewed based on the recommendations of the expert panel, (1) shift workers, and (2) young males. We conducted two groups on each night, one each of shift workers and young men, for a total of eight groups. Each group consisted of six to 10 participants, recruited by field houses at each site. Each participant was a licensed driver, although not licensed to drive commercial vehicles. Most important, each participant had a history of driving while drowsy as evidenced by responding "Yes" to at least two of the following statements:
A copy of the telephone screener appears in Appendix A.
A moderator's guide was prepared to focus the discussion on the topic areas to be covered. The guide included a warm up and introduction, a general discussion of drowsy driving, the factors that contribute to drowsy driving, and potential methods of educating the target group to change their behavior to reduce the risk of being in a fall-asleep crash. Each discussion group lasted approximately ninety to one-hundred twenty minutes. Topics discussed in the focus groups follow:
An outline of the discussion guide for each group appears in Appendix B (shift workers) and Appendix C (young males).
The reason most participants were at risk for fall-asleep accidents (and therefore selected to take part in the groups) was that they suffered from chronic sleep deprivation. The consensus of both target groups was that they do not get sufficient sleep. The most common response was that they could probably use an extra two hours of sleep per night beyond what they currently get. Many participants reported that they regularly get as little as three to four hours of sleep per night.
"I don't get as much sleep as I should, maybe four hours."
"I'm in bed at two, up at six, ready to go for the day."
"Working nights, I don't get enough sleep."
The lack of sleep by the participants is evident during the awake hours of their day. Their bodies are sending the message that they need more sleep.
"If I sit down, I'll fall asleep."
"I find myself dosing off at odd times."
However, they were quick to rationalize their lack of sleep.
"I can be alert on just a couple of hours of sleep."
"Four hours is sufficient."
"I don't require a lot of sleep."
"Eight hours are too much."
In order to compensate for this sleep loss, participants in both groups said they tried to sleep more on the weekend or their day off from work.
"I usually get three hours, and try to catch up on the weekend."
"I try to get some extra sleep on my days off."
In contrast to the general belief shared by most participants that they did not get sufficient sleep, a significant minority of the participants in both target groups said they suffer adverse effects if they sleep for too long.
"If I get more than four hours of sleep, I'm hyper."
"If you get too much sleep, it makes you feel drowsy."
"I don't function too well with too much sleep."
However, it was not clear whether these impressions were based upon the "over sleep" or "compensatory sleep" they get on days off and weekends or whether it was based on a regular schedule of seven hours of sleep per night.
The shift workers reported frequently getting poor quality sleep and mostly did not feel well rested. Some of this trouble is in establishing conditions that were conducive to getting quality sleep.
"Any distractions wake you up."
"When I wear a pager on-call, I don't get quality sleep. I worry about being called."
"My husband hits the snooze button on the alarm for an hour every morning."
A very tight schedule and other obligations, particularly to family, drive the sleeping habits of shift workers. Intermittent sleep is one way to achieve a sufficient total amount of sleep time. Sleep is fit in around everything else.
"Sleep happens. You don't really schedule it."
"I sleep three to four times a day."
A similar tactic used frequently by the shift workers was napping throughout the day.
"I do cat naps. It seems to help."
"I'll take a quick nap, and then I'm ready for the rest of the day."
For some young mothers in the group, getting any additional sleep was seen as an unattainable goal and an unreasonable suggestion to improve their situation.
"Naps are a ridiculous concept. There is no time to take a nap when you have to work and have kids."
Young men were not as open to napping.
"Naps mess me up. If I take one, I can't sleep at night."
The conditions that participants agreed were most conducive for quality sleep were:
Sleep is clearly not a priority for these young men.
"It's not important at all, as long as I can function OK."
"It's real low on the scale of importance."
"If I can get just enough, I'll be OK."
"There's not enough time to do everything that you want to do."
School, work and social activities take far greater priority than getting any regular sleep. They are willing to sacrifice sleep so they do not miss anything that might be happening.
"It's like, 'I'm tired. So what? Let's hang out some more.'"
"If you're going to party, who needs rest?"
"You have to (sacrifice sleep) if you want to do something. I'll shave off sleep rather than work or fun."
"My friends have to do it for the money so they can go to school. Then they are out partying, staying up 'til three."
Young men report that they are out at night several times per week, doing mostly social things. For young men, work seemed to suffer from the combination of an active social schedule and the lack of sleep that results.
"If it's an average day at work, you might not make the effort to get full sleep."
"I like to be awake at school, at work I don't care."
However, later in the discussion, some respondents said that poor performance at work would compel them to get more sleep.
"If you are losing money in your employment situation or have poor performance at work."
"If you are not meeting your responsibilities."
Given these conflicting statements, it appears that these young men might not need to get more sleep in order to perform in a satisfactory manner on the job.
Several participants did voice a minority opinion that they needed sleep, although the reason given was their own emotional state.
"It's important to me. Otherwise, I'll mope around."
"If I want to be in a good mood, I need sleep."
In contrast to young men, many responsibilities related to work and family burden shift workers. Their schedules are very tight, with little room to do much else. Shift workers do not have time for social activities.
"Career goals are more important (than sleep)."
"There is nothing I can give up to get more sleep."
"I would give up work to get more sleep, but I can't do it. So there is nothing to give up."
"I give up a lot to make more money. I don't have much of an outside life. Sleep and social activities are sacrificed."
"I don't have a life either. I have kids and a job. I have to stay in touch with the kids."
Several shift workers in the groups reported working two jobs to support their family or go to school.
The attitude of shift workers toward sleep is that they don't have time to do it in their current situations.
"I resent the fact that I have to sleep."
"I'll sleep when I retire."
Despite the perception that there is no time to get sufficient sleep, there is some indication that time could be used more efficiently.
"Sometimes I push myself to stay awake to watch a movie."
In other cases, it is simply a desire to be awake and interact with the rest of the world in the daylight hours and they sacrifice sleep.
"I hate to waste the daylight. I stay up during the day and do things."
Work is the central factor in creating sleep deprivation for shift workers. Their schedule revolves around work, which is frequently taking place at a time when their family and friends are asleep. To interact with these people, shift workers have to sacrifice something, usually sleep. Even for the veteran shift workers, working the odd hours takes its toll.
"A rotating shift you just can't get used to."
"Your body doesn't understand why it is making it stay up at night."
"The 11-7 shift is very hard. I don't feel rested. You just can't get straight through rest."
Money is an important motivator. The higher wage paid to people willing to work the night shift is an incentive to deal with the problems associated with shift work. The extension of this problem is that people who work a second job or take overtime regularly become accustomed to the additional income and bring their lifestyle up to that income level. These workers then find it difficult to cut back, even if it means they are working an exhausting schedule.
Another factor that motivates these workers to choose the night shift is that fewer people are working at that time, particularly managers and supervisors. The quiet work atmosphere is attractive.
"Nobody's looking over your shoulder."
"There are no politics at night."
Most of the shift workers reported that they try to sleep after they come home from work. This contrasts with how most people arrange their sleep and work schedule by sleeping just before leaving for work. The combination of being chronically sleep deprived and scheduling sleep immediately following work leaves them feeling exhausted and sleepy at the end of the work day.
"Driving to work is OK. Driving home is a problem."
"I fell asleep after working an evening shift waiting for a train."
Although many shift workers report that they are exhausted when they get home from work, most said they had difficulty going to sleep right away.
"I need a few hours when I get home to wind down."
"You're tired from work. Then you get home and you are wide awake."
"I get too wound up after work but I try to go to sleep."
Once they fall asleep, they report poor quality sleep. Frequent distractions such as the telephone, family, daylight, and the need to go places (such as the store, bank, etc.) while they are open, contribute to their insufficient sleep.
"Any distractions wake you up."
"I don't bother trying to go to sleep when the kids are around or awake. It's too distracting."
Shift workers reported that they were aware that drowsiness impaired their ability to drive and they tried to be more careful when they drove while sleepy. They regard drowsy driving as a big problem, for themselves and people who are in similar situations.
"I think it's a big problem."
"Odds are better (of involvement in a fall-asleep crash) than for someone working a normal shift."
"Commercial drivers have it the worst."
Driving home after work was a time that shift workers reported that they were most often exposed to drowsy driving and at risk for involvement in a fall-asleep crash. Most shared some war stories about not remembering how they got home or being on auto-pilot.
"The car knew the way home."
"I'm driving along and look back and say, how did I get here?"
The shift workers were genuinely frightened about the situations they put themselves in, yet they continued to place themselves in these risky situations.
"Those experiences scare you. They make you want to get off the road."
When considering those situations in retrospect, some tried to downplay the risk in their own mind or try not to think actively about the risky situations.
"I don't really think I'm that bad. I don't really think about it at the time."
Often the shift workers did not realize they were drowsy until they began to drive.
"I'm usually alert when I start driving . . . it's just after you get on the road."
Most participants felt that drowsy driving is a big problem, and some suggested that it was just as dangerous and alcohol-impaired driving. The shift workers believed that in comparison to drunk driving, more drowsy drivers were on the road, but a drunk driver has a greater risk of being involved in a crash. However, they did not view drowsy driving in the same negative light as drunk driving.
"People who drink and drive choose to do so. People who drive drowsy don't choose to be drowsy. Many times you don't know you are tired until you get behind the wheel."
Shift workers seem to understand the characteristics of fall asleep crashes (i.e., single car, run off the road, highway, no brake marks, very severe).
Young men have a different attitude toward driving while sleepy, compared to the shift workers. Awareness of the potential problems associated with drowsy driving may not be as real or salient to the young men.
"I think highway driving is the only time you need to be well rested."
"I wasn't very well rested, but I pulled through."
"People are aware of the problem, but they still tend to push themselves."
"I always nodded off coming home from my girlfriend's house at 10 p.m. I never thought anything of it."
The young men also rely heavily on their own ability to avoid crashes and put faith in their ability to stay awake and compete against their body's biological need for sleep.
"My brain won't let me sleep. I have to watch out for others"
"I feel mentally strong enough that I can decide when to pull off the road or that I'm able to wake myself up enough to drive."
"It doesn't apply to me. I think I can do something that somebody else can't. I know I'm wrong but it doesn't matter."
Young men understand the consequences of being in an automobile crash and even say they are willing to do things to avoid being in a crash, but they discount the possibility of it happening.
Often, they have already tempted fate and come out ahead. The benefits they derive from being out on the road when they are drowsy and from their perspective they clearly outweigh the small risk of being in an accident, although they do not appear to think about it directly in terms of weighing the benefits and costs of their actions.
"People don't think of it like that. At the time, it's just I want to go home and go to bed. You don't think about accidents."
Even when the young men experienced negative outcomes from driving while drowsy, such as involvement in a crash or a "near-miss," it did not motivate them to change. The participants openly said that these experiences were not enough to cause them to change. The benefits or the potential to lose something they believe they have (i.e., a warm bed, or social contacts 50 miles away) keep them driving even when they know they are at risk for a crash.
"You don't change. You just keep pushing. I can go fifty more miles, or one hundred more miles."
"I know how scary being drowsy is, but at the same time, I'm going to push myself so I can get home and see my family as soon as I can."
Peer pressure may also play a significant role in pushing the young men to stay awake when their body tells them to go to sleep.
"My friends are like, 'I can party all night. I can stay out all night. I guess you can't hang.'"
"If others are doing it, I try to push myself."
"It affects my decision of when I go to sleep."
"You don't want to fall asleep, 'cause your friends will mess with you. You have to defend yourself."
Young men report that they are frequently driving at night. The reasons they are out at night are social or for work. The reduced traffic and the perception of being less exposed to potential police apprehension due to the darkness encourage the young men to take more chances when driving at night.
"It's easier to drive fast at night."
These risk taking behaviors may be further complicated because of impaired judgement that results from drowsiness.
For others, nighttime is a more difficult time to drive, although those participants who expressed this feeling were more likely to be driving to or from work, compared with a social event.
"Night is a hard time (to drive)."
The most common reason shift workers were driving at night was due to their work schedule, either driving to, or returning from work.
"When I get off at eight (p.m.) it is a safe time. The later is gets, the more weird it gets."
The darkness was another complicating factor that makes the shift workers more sleepy driving home from work.
The young men take frequent "road trips" looking for exciting things to do in other locals. Another common reason for taking some long trips was driving back and forth to school. The young men like to drive, especially on long trips. They are proud of their ability to drive and like the freedom the ability to drive allows them.
On these trips the young men like to drive in long time blocks. A frequent comment about their long trips was . . .
"I drove the whole way."
"I did the whole thing without stopping, except to get gas."
Despite the apparent lack of planning for long trips, the young men report that they do tend to plan for long driving trips and drive more cautiously, compared with shorter trips around town.
"I get some coffee and bring someone else along."
"I try to sleep beforehand."
"I try to do it during the day, or in the morning."
"I tell the passengers that they can't fall asleep. They have to keep me awake."
Others said they usually do not change their habits or make special plans when they know they will be driving a long distance. Mostly they did not give much though about what they were doing.
"For some reason we started to go at midnight. After a while you start to see things."
"I push through because I usually wait until the last minute."
Overall, the young men did not really seem to really know what planning meant or understand the question. When asked what they did to plan for a long trip, most of the responses were related to what they do after they have already become drowsy, not what they do to prevent becoming drowsy.
The excitement and anticipation at the beginning of the trip reportedly keep them awake and alert while driving. Little was mentioned about planning for the return trip.
Some long trips are spontaneous and the nature of that quick decision seems to add to the fun of the trip.
"Some friends and I decided at 11 o'clock at night to drive to Vegas (from San Diego). We drove there, gambled all night, and came home at 7 a.m."
Shift workers also report taking long trips, usually on vacations with family. On these trips they are inclined to drive at night to avoid the traffic and maximize their vacation time.
The shift workers reported being more responsible and aware of the potential problems encountered on long driving trips, compared with young men, and took action to prevent those problems.
"I'm always the awake passenger. I feel it's my responsibility."
The shift workers also reported more planning before leaving on long trips, compared with the young men.
"If I'm going on a trip, I try not to work the night shift so I can get a good night rest."
"I try to rest up and get prepared."
For some, especially the single mothers, trip planning itself was exhausting.
"Single parents do all the preparing."
Others suggested that the anticipation of the trip make it difficult for them to be rested.
"It's hard 'cause you're getting hyped up."
The cause of drowsy driving for each of these high risk groups is chronic sleep deprivation. The primary difference between the young men and the shift workers was their attitude toward changing their habits to get more sleep. Young men were resistant to suggestions that they would change their behavior to get more sleep. Young men did not seem to recognize the relationship between the behavior and their increased risk for involvement in a drowsy driving crash, or at least are not willing to change their behavior if they did recognize the risk.
On the other hand, shift workers recognized the need for good sleep hygiene but felt helpless to control their environments to improve their sleep.
Many young men felt that given the current situations in their lives, little could be done to motivate them to get more sleep.
"Right now, I'm a student and that's the way it is."
Shift workers also felt that they could do little to change their sleep habits.
"We got bills. You do what you gotta do."
Most of the participants said they thought about the consequences of a crash to their family, themselves, and others on the road.
"Being in a crash, losing your job, tearing up your car."
"Yeah, I think about it."
"If I was in a crash, my life would be over. I'd be devastated."
However, most do not view these consequences as very likely to happen to them.
"It has to happen to me individually for me to do something."
This response contradicts what they mentioned previously about the effect of being in a crash or being in a "near miss." Beyond making them "think" about it, the crash did little to effect or change their behavior.
Preventing situations where these high risk groups are driving while drowsy appear to have the most promise for reducing exposure to fall-asleep crashes. However, drowsy driving for both target groups was clearly a problem dealt with on a regular basis.
The respondents said that they employed a variety of tactics to avoid nodding off while driving. These tactics did not seem to differ between the young men and shift worker groups. The tactics that participants described as effective were:
A variety of other tactics were considered less effective were:
The participants acknowledge that these tricks can work only to a point, and beyond a certain point nothing is going to help.
"Nothing helps when you are that tired."
"The longer I drive, the worse it gets."
Occasionally, a participant even reported engaging in some behaviors that place them at even greater risk for a fall-asleep crash.
"I put my sunglasses on so I could close my eyes a bit."
Nearly every participant reported having experienced continuous shoulder rumble strips (CSRS) while driving. Everyone also seemed to agree that CSRS were quite effective in alerting the driver when he or she was drifting off the road. Similarly, the raised lane dividers (lane dots) provide feedback to drivers when their cars drift out of a lane.
"They seem to work very well. They wake you up quick."
"The best thing in the world are those (lane dots). They're lifesavers."
"I've hit those bumps lots and lots of times."
"It's like braille driving over those line dots."
"I can't tell you how many times I've been woken up by those. That's a godsend to me."
One caution about CSRS is evident from the groups. Most respondents reported that once they experienced driving over CSRS, the shock caused by doing so made them alert enough to continue driving. The empirical evidence on this point (i.e., whether the vibrations caused by CSRS significantly arouse a drowsy driver) is lacking, as is the time duration of any possible effects it may have. If the message from CSRS is to get off the road, the respondents we interviewed did not receive it.
Alerting devices that send a signal when the driver shows signs of drowsiness (such as loud noises when the head dips or eyes droop) were discussed. Shift workers were quite interested in these devices and most said they would purchase such a device if it were available as an option on new cars.
"If it worked, I'd love it."
"That's what I need."
"Having the thing on my ear would keep me awake."
The young men were less inclined to be interested in an alerting device. Some were interested in learning more about it. Others were concerned that they may use the device to push themselves and take greater risks since the device would be there to back them up.
"I'd want to drive at night to test out my new device. It would make me want to drive."
Some participants held a cynical attitude about the effectiveness of such a device. Many were concerned that the device would make the noise at other times when they did not need it. Others said the expense would not make it worth buying.
"I had one. It never worked."
"If they didn't work (the noise) would just be annoying."
Others said it would not work because they would simply become accustomed to the noise and they would fall asleep anyway.
"It'd be like an alarm clock. You just turn it off."
Very little seemed able to influence the participants to stop driving and get the necessary rest when they began to feel drowsy. The young men were unwilling to get off the road because they felt able to reach their destination.
"I don't want to pull over because I'm almost there."
The shift workers reported being more willing to pull over and get some rest, although the main concern was the danger to their personal safety at rest stops or by the roadside.
"I'll pull over. I'm not going to risk it."
"I don't feel safe enough to pull over."
Concerns about money from both groups prevented them from getting a hotel room so they could get some sleep.
In other focus group and survey research on traffic safety issues, we have found that certain other people could probably influence the behavior of at risk individuals. The current research suggests that a variety of other individuals may have some influence over both high risk groups. The most frequently mentioned individuals that would have an impact on behavior were:
"My girlfriend asks, but I tell her I'm OK."
"If I'm tired or cranky, my husband tells me to go to bed. He picks up the slack."
"My family motivates me."
"I work with power tools. I can't afford to be drowsy. I don't want to lose any fingers."
"I need to sleep. (Being drowsy) is dangerous on the job."
"Employers don't like people being overtired or sleepy."
Many young men felt that others could not influence them and only they could control their own behavior.
Most of the young men did not seem aware of the risks of drowsiness, or at least did not see that it applied directly to their own situation. Most participants seemed to accept that people do it, while others had a certain admiration for people who could function with little sleep.
"They think it's crazy."
"They wish they could do it."
"It's self-inflicted. It's stupid."
"They are admired. They are able to work more."
"If they can do that, I think it's pretty cool."
"Seems like the norm. Everyone's doing it."
The shift workers saw sleep deprivation more as an inevitable part of their life and something that others could not and would not understand.
"My friends don't get it."
"They say, 'How can you do it?' They don't understand."
"It's just something that you have to do. Sometimes I get pity. Most people just don't understand."
For the shift workers, a certain level of understanding exists between their co-workers and they help each other to overcome or combat drowsiness.
"My co-workers understand. Sometimes people have a bad night and others pick up the slack."
"In the airline industry everybody seems to understand."
A common experience of insufficient sleep seems to build that sense of comradery on the job.
Another benefit of working in a close work situation is that they can exert some social control over their coworkers and encourage them to take care of themselves so they can perform on the job.
"I resent people (I work with) who are not taking care of themselves."
On the other hand, shift workers did not have many positive feelings for their employers and did not feel they cared or were interested in their problems.
"Employers don't get it. They've never done it."
"Some supervisors or foremen do it too. They think if they can do it, you can too."
The shift workers wanted their employers to take an active role and demonstrate some concern about the working conditions and the problems associated with shift work.
Both target groups were somewhat skeptical about whether their employers would be willing to take any action to improve work conditions or help them to get more or better quality sleep. Most felt cynical about whether their employer cared very much about them and instead felt they were just being used to make a profit.
The participants were very well informed about some steps employers had taken to reduce employee fatigue and drowsiness. Some suggestions for employers to improve the work environment of the shift workers were the following:
Others felt that the extra money offered to work the night shift is to compensate people for working at that hour. They felt that people who choose to work the night shift should be responsible enough to be well rested and the employer should not have any responsibility.
"It's your responsibility to be rested when you work that shift."
Most of the shift workers were very interested and open to employers providing material on sleep hygiene and said they would use the information if they provided it.
Both groups could not recall any particular educational message or public awareness campaign related to drowsy driving.
"There's not much out there on drowsy driving."
"Maybe something in the newspaper about it."
"I saw a news report about tired truckers."
The participants did not see public service announcements as an effective method of delivering messages related to drowsy driving.
"On the news it has more impact. People start ignoring PSAs after a while."
Most of the public awareness on this issue appears to come from the news media. To date, there appears to have been little direct targeting of either group to reduce drowsy driving on a broad scale..