Driver education: Enhancing knowledge of sleep, fatigue and risky behaviour to improve decision making in young drivers☆
Introduction
In 2010, the global road fatality toll reached approximately 1.24 million, the injury toll reached 30–50 million, and the estimated total cost of fatal and serious injury was US$1855 billion (World Health Organisation, 2013). In Australia, the estimated cost of road trauma is in excess of AU$27 billion and the fatality toll reached 1205 in 2015 (Bureau of Infrastructure, Transport and Regional Economics (BITRE), 2016). Approximately 20%–30% of motor vehicle accidents (MVAs) are caused by sleepiness related fatigue as a result of inadequate sleep, extended duration of wakefulness, driving during circadian nadir and/or sleep disorders (Clarke et al., 2010, Horne and Reyner, 1995; Connor et al., 2002; Martiniuk et al., 2013; Pizza et al., 2010). The sleepiness impairs alertness, concentration and reaction time, and increases the risk of microsleeps. Sleepiness related MVAs are also more likely to result in death or severe injuries (Boyle et al., 2008; Bunn et al., 2005).
Young people (25 years≤) are at particularly high risk for MVAs, including sleepiness related crashes (Pack et al., 1995). Lack of experience and risk taking behaviours such as recklessness, speeding, and drug and alcohol use contribute to MVA risk in this population (Clarke et al., 2010; Hung and Winston, 2011). In addition, increased social pressures, academic and work demands, and maturational changes experienced during adolescence and early adulthood can lead to sleep deprivation, and in turn, increase the risk of sleepiness-related MVAs (Millman, 2005; Carskadon and Acebo, 2002). Indeed, drivers aged 18–24 are 5–10 times more likely to be involved in a MVA at night (Akestedt and Kecklund, 2001), and male drivers aged 25 or younger are three times more likely to die from a MVA (BITRE, 2012; Toroyan & Peden, 2007) than female drivers. Furthermore, 31% of all young driver fatalities in Australia occur between midnight and 6 a.m. (BITRE, 2009).
While subjective sleepiness is correlated with objective sleepiness (Horne, & Baulk, 2004; Connor et al., 2002), individuals often fail to accurately predict, identify or act on sleepiness while driving (Kaplan et al., 2007). Educating individuals about more specific signs and risk factors for drowsiness and fatigue may help improve driver recognition of sleepiness and decision making (Howard et al., 2014). Education in conjunction with modifying attitudes has been shown to modify speeding behaviour and hazard perception (Fisher et al., 2006; Parker et al., 1996).
This study assessed the impact of an intensive education program on knowledge of sleep and sleepiness in relation to driving in young adults, along with whether the program altered their driving performance and decisions to continue driving while impacted by sleepiness, following a period of extended wakefulness.
Section snippets
Participants
Thirty-four young adults (18–26) were recruited from Victoria University, Australia. Young drivers were selected because research shows that this group is the most traffic accident prone group due to sleepiness (Pack et al., 1995). Exclusion criteria included; epilepsy, insulin dependent diabetes, chronic psychiatric illness, visual impairment not corrected by wearing eye-glasses, inability to read or write English, five or more caffeinated drinks per day, ten or more cigarettes per day, and
Results
Thirty-four young adults (age M = 20.66 ± SD = 1.76) who averaged 26.77 months of probationary driving were recruited and completed the project (Table 1). There were no significant differences in baseline demographics, driving characteristics or sleepiness between the intervention and control groups (Table 1).
Post-hoc tests conducted at the. 05 level showed that pre- intervention, the control group reported significantly higher sleep behaviour knowledge than the intervention group (p < .05).
Discussion
An intensive education program addressing sleep and driving improved circadian rhythm knowledge in young drivers, but did not alter attitude to risk taking or other sleep related knowledge. There was a trend towards participants in the control group choosing to stop driving due to severe sleepiness more than the intervention group during a simulated night drive, even though the intervention group self-reported a higher level of sleepiness after the drive. However, there was also a trend towards
Acknowledgement
We gratefully acknowledge the assistance of Dr Philip Swann in the design of the study.
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This work was performed at the Institute for Breathing & Sleep, Department of Respiratory & Sleep Medicine, Austin Health, Australia.