2.1 Communications and Outreach on Drowsy Driving
Overall Effectiveness Concerns: This countermeasure has not been systematically examined. There are insufficient evaluation data available to conclude that the countermeasure is effective.
Drowsy driving typically occurs because drivers don’t get enough sleep (Royal, 2003), although certain medical conditions and medications can also cause drowsiness while driving (Colvin & Collop, 2016; Watson et al., 2015). In a NHTSA telephone survey, 66% of the drivers who reported they had nodded off while driving had 6 or fewer hours of sleep the previous night (Royal, 2003). The AAA Foundation conducted a survey in 2015 and found that almost one third of respondents (31.5%) reported driving when they were so tired that they had a hard time keeping their eyes open in the past 30 days (AAAFTS, 2016). Stutts, Wilkins, and Vaughn (1999) interviewed 467 crash-involved drowsy drivers (reported as “fatigued” or “asleep” by the investigating officer) and 529 other crash-involved drivers who were not drowsy. Half of the drowsy drivers had 6 or fewer hours of sleep the previous night compared to fewer than 10% of the other drivers. Similarly, about 40% of 2,613 respondents reported sleeping 6 hours or fewer hours daily in a 2017 survey (AAAFTS, 2018); drivers who sleep fewer than 7 hours are estimated to be at elevated levels of crash risk compared to sleeping at least 7 hours (Tefft, 2016).
States and national organizations such as the National Sleep Foundation have conducted drowsy driving communications and outreach campaigns directed to the general public (Stutts et al., 2005, Strategy C1; NSF, 2004; NSF, n.d.; GHSA, 2016). Campaign goals usually include:
- raising awareness of the dangers of drowsy driving;
- motivating drivers to take action to reduce drowsy driving; and
- providing information on what drivers can do, either before they start out on a trip or if they become drowsy while driving.
The GHSA summarizes public awareness efforts by NHTSA, the AAA Foundation for Traffic Safety, and the American Academy of Sleep Medicine (AASM) in its 2016 report to States (GHSA, 2016). The focus is on the development of evidence-based messages on the risk of driver drowsiness, implementation or enhancement of employer-provided policies and education, and the development of web-accessible awareness material for the general population. Examples include the NSC’s Defensive Driving Course (www.nsc.org/safety-training/defensive-driving), the North American Fatigue Management Program’s free training program for commercial driver and employers (www.nafmp.com/index.php?lang=en), and the AASM online guide for children and young adults on the benefits of good sleep habits (https://aasm.org/). The report also notes the potential for SHSOs to partner with community or victim advocates and organizations (e.g., SADD) to develop and publicize information targeted at young or novice drivers and parents (GHSA, 2016).
GHSA’s Wake Up Call! identifies three groups that are over-involved in drowsy driving crashes: drivers in their teens and 20s; shift and night workers (police and emergency medical services, health care workers, commercial motor vehicle operators); and people suffering from sleep apnea or narcolepsy (GHSA, 2016). The joint NHTSA-NCSDR Report to Congress on drowsy driving recommended that communications and outreach on drowsy driving be directed to shift workers, people with sleep disorders, and especially to young drivers (NHTSA, 1999). This information can be delivered in several ways. The new model curriculum developed by NHTSA and the American Driver and Traffic Safety Education Association includes information on drowsy driving that can be used in driver education programs (www.adtsea.org/ADTSEA%20Curriculum%20Free%20Download.html). NHTSA’s 2015 Drowsy Driver Symposium identified a short-term goal of improving messaging and developing new material (especially for high-risk groups) that covers aspects of drowsy driving, including: intensity and risk, prevention measures, danger signs, and responses to danger signs (www.nhtsa.gov/nhtsa/symposiums/november2015/index.html). See the Drowsy Driving chapter and Appendix 10, Sections 3.1 and 3.2, for additional discussion of shift workers and medical conditions, respectively.
The ultimate goal of drowsy driving communications and outreach is to change driver behavior; however, there are substantial obstacles. As discussed in other chapters, communications and outreach by themselves rarely change driving behavior (the Alcohol- and Drug-Impaired Driving chapter, Section 5.2; the Seat Belts and Child Restraints chapter, Sections 3.1 and 3.2; the Speeding and Speed Management chapter, Section 4.1; see also Stutts et al., 2005, Strategy C1). To have any chance of success, stand-alone campaigns must be carefully pre-tested, communicate health information not previously known, be long-term, and have substantial funding (Williams, 2007).
An additional barrier is that, for many drivers, drowsy driving is a byproduct of busy lifestyles that do not include enough sleep. The only truly effective method to prevent drowsy driving crashes in these cases is to get enough sleep (Nguen et al., 1998; NHTSA, 2001). Traffic safety messages urging enough sleep may be overwhelmed by the other demands on a driver’s time that are responsible for insufficient sleep. Focus group discussions with young men and shift workers, two groups at high risk of drowsy driving, supported this conclusion (Nelson et al., 2001). Most shift workers and many young men understood well the risks caused by lack of sleep. Many had crashed or almost crashed after falling asleep at the wheel or had friends who had crashed. But neither their knowledge nor their crash experience changed their sleep habits. They sacrificed sleep for the demands of their work, families, and social lives. Campaigns directed to young drivers also must overcome the higher risk-taking behavior and overall immaturity of young drivers, as discussed in the Young Drivers chapter. The Governors Highway Safety Association’s report on drowsy driving for States identifies online resources developed by organizations such as AAA, National Sleep Foundation, and the American Academy of Sleep Medicine for providing information and training on drowsy driving (GHSA, 2016).
In Greece a national communication campaign was implemented in 2008 and 2009 to curb drowsy driving. Entitled “Sleep, but not at the wheel,” the campaign was designed to raise awareness of the risks of driving while tired, and to increase knowledge of effective countermeasures to reduce fatigue (e.g., taking short breaks while driving). The campaign included thousands of TV and radio messages, as well as posters and leaflets distributed across the country (Adamos et al., 2013).
Use: States including Iowa, Texas, New York, and Utah have conducted drowsy driving campaigns for the general public (GHSA, 2016). In addition, Alabama, California, Florida, and Texas have instituted a drowsy driving awareness day/week (NCSL, 2018).
Effectiveness: The Greek communication campaign increased awareness for the causes and effects of fatigue on drivers, and there was a small self-reported increase in the percentage of drivers who reported stopping and resting when they got tired (Adamos et al., 2013). The effect of the program on drowsy driver crashes is unknown. Beyond this, there are no other studies of any campaign’s effects on driver knowledge, attitudes, or behavior.
Costs: A high-quality campaign will be expensive to develop, test, and implement.
Time to implement: A high-quality campaign will require at least 6 months to plan, produce, and distribute.