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Cell Phones and Young Drivers: A Systematic Review Regarding the Association Between Psychological Factors and Prevention a

Francesca Cazzulino , Rita V. Burke Upperman a

a b

a

a

, Valerie Muller , Helen Arbogast & Jeffrey S.

a b

Division of Pediatric Surgery , Children's Hospital Los Angeles , Los Angeles , California

b

Keck School of Medicine , University of Southern California , Los Angeles , California Accepted author version posted online: 29 Jul 2013.Published online: 27 Dec 2013.

Click for updates To cite this article: Francesca Cazzulino , Rita V. Burke , Valerie Muller , Helen Arbogast & Jeffrey S. Upperman (2014) Cell Phones and Young Drivers: A Systematic Review Regarding the Association Between Psychological Factors and Prevention, Traffic Injury Prevention, 15:3, 234-242, DOI: 10.1080/15389588.2013.822075 To link to this article: http://dx.doi.org/10.1080/15389588.2013.822075

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Traffic Injury Prevention (2014) 15, 234–242 C Taylor & Francis Group, LLC Copyright  ISSN: 1538-9588 print / 1538-957X online DOI: 10.1080/15389588.2013.822075

Cell Phones and Young Drivers: A Systematic Review Regarding the Association Between Psychological Factors and Prevention FRANCESCA CAZZULINO1, RITA V. BURKE1,2, VALERIE MULLER1, HELEN ARBOGAST1, and JEFFREY S. UPPERMAN1,2 1

Division of Pediatric Surgery, Children’s Hospital Los Angeles, Los Angeles, California Keck School of Medicine, University of Southern California, Los Angeles, California

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2

Received 21 November 2012, Accepted 1 July 2013

Objective: Cell phone use among young drivers has become increasingly common in recent years. Young people are the most likely to accept the use of new technology and least likely to understand the risks associated with cell phone use while driving (CPWD; defined here as talking on the phone only) and texting while driving (TextWD). Due to inexperience, young drivers are the most at risk when using cell phones while driving and therefore should be the target of the majority of prevention strategies. The intent of this review is to determine factors that influence young drivers to engage in CPWD and TextWD and suggest a basis for prevention campaigns and strategies that can effectively prevent current and future generations from using cell phones while driving. Methods: We conducted a search for original articles in PubMed, the Cochrane Library, and Web of Science. All abstracts were reviewed and for those that met the inclusion criteria, full articles were obtained and assessed. Results: Four hundred and twelve articles were identified in the search and, of those, 37 full-text articles were obtained. A total of 29 articles about the frequency of CPWD and the psychological effects influencing young driver’s tendency to engage in CPWD were included. There was a high frequency of both CPWD and TextWD despite a high perceived risk of both behaviors. This discrepancy was explained by a high perceived controllability, the effect of social norms, call importance, and lack of effective law enforcement. The intervention strategies reviewed were also found to be ineffective over the long term. Conclusions: The systematic review reveals that young drivers are an at-risk group for distracted driving. We propose preventative strategies based on identifying factors that influence drivers to engage in CPWD and TextWD as well as by reviewing strategies found in the reviewed articles. Further research is necessary to determine the effectiveness of these proposed strategies. Supplemental materials are available for this article. Go to the publisher’s online edition of Traffic Injury Prevention to view the supplemental file. Keywords: youth, teenager, distracted driving, cell phone, texting

Introduction In recent years, cellular phone use while driving has become commonplace for many drivers. Drivers may engage in talking on a cell phone while driving (referred to here as cell phone use while driving, CPWD) or texting while driving (TextWD) due to directions or car trouble, socializing, social pressure, boredom, or perceived productivity (Atchley et al. 2010). Given that the younger population has been shown to adopt new technology more readily than the older population (Lee 2007),

Address correspondence to Jeffrey S. Upperman, MD, Associate Professor of Surgery, Division of Pediatric Surgery, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4650 Sunset Boulevard, Mailstop #100, Los Angeles, CA 90027. E-mail: [email protected]

the focus should be aimed at curbing the cell phone use of teenage and young adult drivers. Motor vehicle crashes (MVCs) are the greatest public health concern for teenagers in the United States (McKay 2005). Though teen drivers account for only 6 percent of licensed drivers, they are involved in 14 percent of fatal crashes and 18 percent of all serious police-reported crashes (McKay 2005). This is mostly due to inexperience, which, when combined with distracted driving such as cell phone use, puts young drivers along with their passengers and other drivers on the road at increased risk of being involved in an MVC (Ginsburg et al. 2008). Inexperienced drivers need to focus their full attention on the road and cannot afford the distraction that cell phone use presents (Ginsburg et al. 2008). Learning the frequency at which they engage in CPWD and TextWD and the various social, psychological, and physical factors that influence that frequency are essential in determining potential intervention strategies.

Psychological Factors in Distracted Driving The purpose of this review is to examine the factors that influence young drivers to engage in and abstain from CPWD and TextWD. Such an examination may lead to identifying effective strategies to combat the increasing frequency of cell phone use among young drivers. We hypothesize that a high frequency cell phone use will be reported among young drivers primarily attributed to the belief that perilous results only occur for other drivers.

Methods

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Search Strategies A search of all original research studies was conducted using PubMed, the Cochrane Library, and Web of Science. The following keywords were entered into PubMed: distracted driving AND teenager (18 publications), distracted driving AND youth (one additional publication), cell phone AND driving AND teenager (78 additional publications), and texting AND driving AND teenager (2 additional publications; Figure A1, see online supplement). The same keywords were entered into the Cochrane Library and the Web of Science. Both the Web of Science and the Cochrane Library yielded no additional publications. The first screening took place on March 13, 2012. A second screening was performed on January 3, 2013, and a third on April 25, 2013, to further expand the included articles in the review. The following keywords were entered into Pubmed: distracted driving (73 publications) and cell phone AND driving (239 additional publications). The same keywords were entered into the Cochrane Library and the Web of Science. Both the Web of Science and the Cochrane Library yielded no additional publications. Abstracts were reviewed on 3 databases’ websites and those that met the selection criteria specified below were imported into Endnote, a bibliographic management software program (Oberhauser 2009). If the full abstract was unavailable, the full paper was obtained and reviewed for appropriateness. Once all papers were acquired, we proceeded with the review according to the PRISMA (Preferred Reporting Items for Systematic Reviews and MetaAnalyses) statement, which designates how to perform metaanalyses of randomized controlled trials (Moher et al. 2010).

235 Collection/Analysis A total of 29 articles met the selection criteria and were included in the review. Three major categories of research methods were identified from a complete review of the material. Data were independently collected from the studies based on relevance to the associated factors described in the review’s purpose. Measures for data analysis were quite diverse across the reviewed studies and therefore are individually included in the results with the data they represent. Given this diversity, data from the studies were compared qualitatively and extracted based on dominating themes throughout the collective data. The principal measures used were population percentage, r correlation and R2 variance. Risk of Bias in Individual Studies Assessment was performed on the risk of bias associated with the method of random sequence generation, blinding, and the completeness of outcome data. We rated the risk of bias as being low, high, or unclear for each study according to established criteria (Higgins and Green 2008).

Results Of the 29 articles included in this review, 6 themes emerged for CPWD and TextWD: frequency of cell phone use among young drivers, perceived risk, psychological influences, perceived versus actual control while engaging in CPWD, effect of intervention, and effect of law enforcement. Our findings are reported below. A summary of the details of the studies included is presented in Table 1. Risk of Bias in Individual Studies The eligible studies were assessed to have low risk of bias associated with selective reporting and completeness of outcome data. Risk of bias associated with random sequence generation, blinding of participants and personnel, and, to a lesser extent, blinding of outcome assessment, appear to be present in the current review (Figure 1).

Selection Criteria Titles and abstracts (n = 412) were screened to identify scientific papers reporting original research findings. Literature reviews were excluded as well as all articles not written in English. Inclusion criteria were as follows: original research papers regarding frequency of and factors influencing the choice to engage or abstain from cell phone use (both texting and talking) while driving by teenage drivers. Given the small number of studies examining only teenage drivers, the reviewed papers were expanded to include young adult drivers whose inexperience level is closer to that of teenage drivers than to adult drivers (Ginsburg et al. 2008; Wang et al. 2010). This expansion continued to present an insufficient number of studies and, therefore, studies that reported on all ages were included as a means of comparing young drivers’ use of CPWD and TextWD with older drivers (Figure A1).

Frequency of Cell Phone Use Among Young Drivers Of the 26 studies that reported on frequency of CPWD, 25 reported high frequencies of CPWD among their study participants. One of the studies reported that 86 percent of their participants occasionally spoke on the phone (Seo and Torabi 2004), and in another study, 100 percent of the subjects reported having spoken on the phone while driving at least at one point (Nelson et al. 2009). Another study reported that 79 percent of their teenage subjects had used their cell phone while driving, but only 12 percent reported CPWD often (O’Brien et al. 2010). Of the 6 studies that measured both the frequency of CPWD and TextWD, all reported a higher frequency of CPWD than TextWD. However, 4 of the these studies found still high frequencies of TextWD, with reported frequencies of 74, 72, 71, and 91 percent, respectively (Cook and Jones 2011;

236

United States United States

United States

United States United States United States

United States

New Zealand

United States United States United States France United States United States United States Australia United States

Australia United States Finland

Finland

Kuwait

United States

United States China

United States

UK

United States

United States

2010 2012

2010

2011 2006 2009

2012

2010

2011 2008 2003 2007 2003 2004 2010 2006 2010

2010 2010 2005

2005

2010

2009

2004 2010

2012

2004

2005

2012

20–69

17–55

12–93

17–28

18–23 18–24

17–22

18–35

15–65+

17–24 16–17 18–76

18–24 18–34 55–82 25–36 55–65 14–19 18–65+ 18–65+ 18–65+ 18–65 18–37

16–80

16–17

17–29 Not provided 16–17

18–65+

18–30 13–24

Age group (years)

n = 108

n = 330

n = 1320

n = 1006

n = 1291 n = 30

n = 69

survey: n = 1500 observation: n = 9041 n = 217

n = 133 n = 537 n = 834

n = 103 n = 40 n = 36 n = 1129 n = 37,462 n = 50,033 n = 70,057 n = 1347 n = 327

n = 274 n = approx. 7150a Prelaw: n = 6164 postlaw: n = 6401 observation: n = 5546 survey: n = 536 n = 1057

n = 401 Study 1: n = 160 Study 2: n = 200 n = 1219

Sample size

R2 variance, P value significance r and ß correlation and P value significance Population percentage Mann-Whitney U test and Wilcoxon signed rank test r Correlation and P value significance Mean scale values; analysis of variance Mean scale values; analysis of variance Population percentage; chi-square analysis

r Correlation and P value significance Likert scale Analysis of variance Mean scale values Population percentage Population percentage Population percentage Population percentage Population percentages r Correlation and P value significance Population percentage Population percentage Driver skill index; population percentages; mean scores Population percentages

Population percentage

Population percentage; chi-square analysis Population percentage Population percentage Population percentage

Likert scale Likert Scale

Summary measures

Survey/simulator

Survey

Survey

Survey

Survey Simulator

Survey/simulator

Survey

Survey/observation

Survey Survey Survey

Survey Survey/simulator Survey/simulator Survey Observation Observation Observation Survey Survey

Survey

Observation/survey

Survey Observation Observation

Survey

Survey Survey

Research category

CPWD

CPWD

CPWD

CPWD/TextWD

CPWD CPWD

CPWD

CPWD/TextWD

CPWD

TextWD CPWD/TextWD CPWD

TextWD CPWD CPWD CPWD CPWD CPWD CPWD CPWD CPWD/TextWD

CPWD

CPWD/TextWD

CPWD/TextWD CPWD CPWD

CPWD/TextWD

Text WD CPWD TextWD

CPWD/TextWD

Zhao et al.

Wogalter and Mayhorn

White et al.

Weller et al.

Seo et al. Wang et al.

Schlehofer et al.

Riquelme et al.

Rajalin et al.

Nemme and White O’Brien et al. ¨ Poysti et al.

Harrison Horrey et al. Lesch et al. Martha and Griffet McCartt et al. McCartt and Geary McCartt et al. McEvoy et al. Nelson et al.

Hallet et al.

Goodwin et al.

Cook and Jones Clayton et al. Foss et al.

Braitman and McCartt

Atchley et al. Atchley et al.

Author

number of participants not given in original article; approximation determined given frequency of observations and given approximation of participants observed per hour (110 observations/hour).

aSpecific

Country

Year

Table 1. Characteristics of studies included in review

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Psychological Factors in Distracted Driving Low

237 Perceived Risk Associated With CPWD and TextWD

High

Random sequence generation

Blinding of participants and personnel

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Blinding of outcome assessment

Incomplete outcome data

Selective reporting

0

20

40

60

80

100

%

Fig. 1. Risk of bias assessment in individual studies.

Harrison 2011; Nelson et al. 2009; O’Brien et al. 2010). Two of the studies differentiated between initiating text messaging, replying to a text message, and reading but not replying to a text messaging and found differences in the frequency for each behavior (Atchley et al. 2010; Nelson et al. 2009). One of those studies found that 70 percent initiated text messaging while driving, 81 percent replied to texts while driving, and 92 percent read received messages but did not respond (Atchley et al. 2010). Another study found a similar relationship between reading and sending texts while driving, demonstrating that 65 percent of participants read a text in the past week while driving, whereas only 47 percent had sent one (Nemme and White 2010). One study found that 22 percent of their participants texted at least several times a day, compared to a few times per week or month or seldom engaging in TextWD (Cook and Jones 2011). The same study also reported that 83 percent of participants seldom or never accessed the web while driving (Cook and Jones 2011). Braitman and McCartt (2010) found that only 13 percent of total participants engaged in TextWD; however, of those 13 percent, 43 percent were between the ages of 18 and 24 years old. In summary, the 10 studies discussed here found high frequencies for both CPWD and TextWD; however, in the studies where the 2 frequencies were compared, drivers had a greater tendency to engage in CPWD than TextWD. Furthermore, within the TextWD category, reading texts was more common than sending them. TextWD was also found to be more common among younger than older drivers.

Eleven of the reviewed studies measured participants’ perceived risk of engaging in any type of cell phone use while driving; of these, 7 studies measured the perceived risk associated only with CPWD. Three of the CPWD studies reported that a majority (69, 74, and 70%, respectively) of their participants believed that CPWD is associated with high risk, increased likelihood of MVCs, or being moderately unsafe (Hallett et al. 2010; Martha and Griffet 2007; Seo and Torabi 2004). One of these studies found a significant positive correlation between amount of time spent engaging in CPWD and how safe participants felt while engaging in the activity (Hallett et al. 2010). The authors of this study also determined that as age increased, so did risk perception associated with CPWD (Hallett et al. 2010). This claim was supported by the findings of O’Brien et al. (2010), who reported that only 16 percent of their teenage subjects believed that talking on a phone while driving was dangerous. Three studies examined risk perception as it differs between drivers who claim to engage in CPWD and those who do not. For the 2 studies that measured engagement in CPWD as it pertains to risk perception, both found that participants who engaged in CPWD demonstrated lower risk perception than those who did not engage in CPWD (White et al. 2004; Wogalter and Mayhorn 2005). Additionally, both studies found differences in risk perception associated with CPWD for self compared to other drivers. Wogalter and Mayhorn (2005) found that the attitude of drivers who engaged in CPWD was more positive than those drivers who did not engage in CPWD regarding (a) whether one can use a cell phone while driving safely (P < .001) and (b) whether people in general can use a cell phone while driving safely (P < .01). Additionally, those who engaged in CPWD believed that other drivers were more dangerous than they were while engaging in CPWD (Wogalter and Mayhorn 2005). It was also found that those who did not engage in CPWD preferred that others did not use cell phones while driving (Wogalter and Mayhorn 2005). However, White et al. (2004) found that for all drivers, irrespective of whether they engaged in CPWD, the perceived probability of being involved in an accident was ¨ lower than that for others (White et al. 2004). Poysti et al. (2005) found compounding results regarding perceived risk, safety, and how age can be taken into account. They found that the more competent drivers think they were, the more likely they are to engage in CPWD. Furthermore, they found that the more safety-oriented drivers were, the less likely they were to engage in CPWD. Nearly half (44%) of their study participants who engaged in CPWD reported having experienced a hazardous situation while engaging in CPWD in the past 6 months, and the younger drivers (18–24 years) reported experiencing a hazardous situation nearly 8 times more than older drivers (64 years and older). Nelson et al. (2009) evaluated the relationships between perceived risk, frequency of CPWD, and relative emotionality or importance of a call as predictors of answering or initiating a call while driving. They found that perceived risk was negatively correlated with both answering a phone call while driving (r = −0.219, P < .001) and initiating a phone call

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238 while driving (r = −0.195, P < .001). Yet, there was a positive correlation between perceived importance of a call and both frequency of CPWD (r = 0.665, P < .0001) and likelihood of initiating a call (r = 0.463, P < .0001). By examining the strength of the various beta weights of the contribution of perceived risk and perceived importance on the likelihood of initiating a phone call while driving, they concluded that positive beta weights of importance on initiating a phone call (β = 0.507) significantly outweighed the negative beta weights of perceived risk on initiating a phone call (β = −0.164); therefore, though young drivers may be aware of the risks of engaging in CPWD, they will waive that acknowledgement if they believe that the call is important (Nelson et al. 2009). McEvoy et al. (2006) found that those who engaged in CPWD and TextWD also engaged in other risky driving behaviors such as speeding and driving with a blood alcohol concentration of 0.05 g/dL. This finding was confirmed by the results of Zhao et al. (2012), who found that drivers who reported a greater frequency of CPWD also engaged in speeding and changing lanes frequently. Two of the reviewed studies addressed the perceived risk associated solely with TextWD and 3 measured perceived risks of both TextWD and CPWD. All 5 studies revealed that young drivers view TextWD as a greater risk than CPWD. In the same study that found that only 16 percent of participants associated some perceived risk with CPWD, 40 percent reported a high risk associated with reading a text while driving, and 62 percent reported a high risk associated with sending a text while driving (O’Brien et al. 2010). Atchley et al. (2010) found that on a Likert scale of 1 (not dangerous) to 7 (extremely dangerous), the mean score for replying to text messages while driving was 4.63 and for initiating texts while driving it was 5.28. Regardless of these results, the 2 studies that compared high perceived risk with intention to stop engaging in CPWD found little to no intention to stop engaging in TextWD (Atchley et al. 2010; Harrison 2011). Harrison (2011) found that though participants disagreed (mean score = 1.9, 1 = disagree strongly, 5 = agree strongly) with the statement that TextWD is not distracting, when asked whether they would continue to text while driving, the mean response was neutral (mean score = 2.9). Additionally, the majority of participants claimed to never have experienced any dangerous detriment to their driving while texting, such as injuring themselves, someone else, or their vehicle (Harrison 2011). However, 55 percent of participants admitted to drifting into another lane while texting and 39 percent reported to have known that by engaging in TextWD they were driving recklessly (Harrison 2011). Thus, there is compounding evidence that adult and, to a lesser extent, young drivers attribute a high risk to CPWD and TextWD. In summary, despite acknowledging a high risk associated with CPWD and TextWD, young drivers continued to engage in this behavior. Drivers were more likely to trust themselves while engaging in CPWD than other drivers, and younger drivers also expressed a lower perceived risk than older drivers. Additionally, importance of the phone call was found to outweigh the high perceived risk of answering the call. Though drivers were aware that TextWD is more dangerous than CPWD, many claimed to have never experienced any danger due to engaging in TextWD.

Cazzulino et al. Psychological Influences on CPWD and TextWD Four of the reviewed studies attempted to determine how social norms and psychological models and predictors could be used to assess drivers’ intentions to engage in CPWD and TextWD. One study looked at the theory of planned behavior, which proposes that an individual’s behavior is dictated by his or her intention to perform that behavior and that intention is determined by attitude, subjective norm, and perceived behavioral control (Nemme and White 2010). The study measured these variables as they relate to frequency of TextWD and intention to TextWD. They found that attitude was the only significant predictor of intention to engage in TextWD, whereas perceived control and subjective norm were found to be the only significant predictors of sending texts while driving. Riquelme et al. (2010) looked specifically at 4 social norms that they had previously hypothesized to have an effect on intention to engage in CPWD: injunctive and subjective norms, which are associated with peer and society’s response to CPWD, and verbal and explicit behavioral norms, which regard the effect of law enforcement in engaging in CPWD. They determined that the belief that law enforcement does not caution or fine drivers for CPWD was the most significant factor in predicting intentions to engage in CPWD. These variables accounted for a measurable amount of variability in intention to abstain from CPWD, with an R2 value of 0.28 (Riquelme et al. 2010). They also found that the perception that it is considered antisocial to abstain from CPWD had the strongest effect on intention to engage in CPWD and the interaction between perceiving that behavior as antisocial yet as a productive use of time to have an even stronger effect (P = .08). Weller et al. (2012) investigated the association between possession attachment and risk perception as a means of predicting the tendency of younger drivers to engage in CPWD. Using an online survey, they measured respondents’ personal attachment to their cell phones. They found that 62 percent of participants would feel uncomfortable if they did not have their phone with them for a long period of time and that 56 percent reported experiencing momentary distress upon discovering that they had left their phone at home. Given this, they also found a negative association (r = −0.17, P < 001) between perceived risk and perceived attachment to one’s cell phone. They also determined that lower risk perception toward CPWD and greater perceived attachment were associated with both CPWD (r = −0.4, P < .0001 and r = 0.19, P < .001, respectively) and TextWD (r = −.039 and r = 0.26, P < .001, respectively). The researchers found that older drivers (23–28 years old) were less likely to send or receive texts while driving; however, the exception was for those older drivers who also reported a strong attachment to their phone. Atchley et al. (2012) conducted a survey of university students to determine the role of social norms in distracted driving. Specifically, they compared participants’ views on both drunk driving and distracted driving as the antecedent to a hypothetical crash, measuring driver responsibility and appropriate legal punishment. It was found that participants believed that those texting before the crash were found to be more responsible (mean responsibility 6.2) for the crash than those talking on a phone or those drunk driving (mean

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Psychological Factors in Distracted Driving responsibility 5.9 and 5.9, respectively). However, participants were less willing to assign punishment to those engaging in TextWD or CPWD than to drunk drivers. Drunk drivers were assigned longer jail times regardless of crash severity than drivers engaging in CPWD and TextWD. Therefore, the belief that distracted drivers are more responsible for a hypothetical crash had no effect on the punishment that these drivers should receive. In summary, multiple psychological factors have been found to influence both young and older drivers to engage in CPWD and TextWD. Social acceptance and time productivity are notable influences as well as a positive attitude toward CPWD and TextWD and possession attachment, which have both been demonstrated to decrease the perceived risk that drivers associate with CPWD and TextWD. Using the theory of planned behavior, the above results regarding attitude and social acceptance as influential factors toward the tendency to engage in TextWD were confirmed in addition to finding that perceived control also influences a driver to send a text while driving. Finally, the passage of time has been proposed as a factor that might have a positive influence on young drivers’ intentions to engage in CPWD for future generations. Perceived Versus Actual Control While Engaging in CPWD Five of the reviewed studies measured their participants’ perceived ability while engaging in CPWD, a factor that has been proposed to potentially determine both young and older drivers’ intentions and history of using cell phones while driving. White et al. (2004) found that for study participants who both do and do not engage in CPWD, when perceived controllability over the effects of distraction of CPWD was low, their preference to legally restrict CPWD was high regardless of the severity of the actual impact associated with CPWD. However, when the participants viewed controllability to be high, the decision to legally ban cell phone use was dependent on whether the negative impact of CPWD was viewed as high or low. Therefore, when the participants believed that a driver had high control over his or her driving while engaging in CPWD, they were less inclined to support cell phone–banning legislation regardless of the actual impact that CPWD might have on driving. However, when participants believed that a driver had low control while engaging in CPWD, the impact of CPWD on driving ability did in fact determine whether or not the participants supported a legal cell phone ban. Three of the reviewed studies used surveys and simulated driving to determine the difference between drivers’ perceived ability to control for the effects of distracted driving and their actual ability to control for those effects. Though driving simulators cannot fully replicate reality, they have been found to function effectively as a research tool. Among studies assessing the validity of STISIM Drive simulators (Systems Technology Inc., Hawthorne, CA), a particular model of driving simulator, as a research tool, one study found no significant effect on driving error between the subjects using the simulator and subjects driving an actual car in a real-world road experience (Shechtman et al. 2009). Schlehofer et al. (2009) used a STISIM Drive simulator, and the results of their initial questionnaire revealed that the frequency of CPWD was pos-

239 itively correlated with illusion of control (r = 0.29, P < .05), perceived ability to compensate while engaging in CPWD (r = 0.47, P < .001), and cognitive controlling style (r = 0.3, P < .05). Using multiple regression analyses, they determined that these psychological variables can account for 43 percent of the variance found in frequency of CPWD (ß = 0.27, P < .05). Perceived ability to compensate for distractions (β = 0.48, P < .05) independently contributed to the prediction of frequency of cell phone use and was also significantly correlated with overestimation of ability on the simulator. Horrey et al. (2008) used an initial questionnaire where the participants were asked to compare themselves to the average U.S. driver to determine their perceived control of the car while engaging in CPWD. This survey was followed by a simulated driving experience in a 2002 Ford Windstar minivan that was outfitted with sensors and computers to record the driver’s ability to achieve the task while engaging in CPWD. The researchers found that drivers who had estimated the smallest detriment to their driving due to CPWD in fact exhibited the largest detriments in their actual performance. Furthermore, younger men were found to have the most confidence in their ability to compensate for the effects of CPWD; however, they performed the worst when engaging in CPWD. Lesch and Hancock (2004) confirmed these results in their study, which also involved a presurvey followed by driving in a simulator. Lesch and Hancock (2004) determined that younger drivers expressed greater confidence than older drivers in their ability to deal with distractions associated with CPWD (on a scale of 1 = very uncomfortable to 4 = very comfortable; 3.1 versus 2.5, respectively). However, Lesch and Hancock (2004) found a difference in gender when determining the correlation between confidence and actual driving performance. Among participants who felt confident in their driving abilities while engaging in CPWD, females performed more poorly than males while engaging in CPWD. Given the findings, Lesch and Hancock (2004) asserted that drivers are generally unaware of the actual performance detriment that CPWD has on their driving. The results from these 3 studies demonstrated that drivers have higher perceived control over the effects of distraction due to CPWD and TextWD than their actual demonstrated driving performance. Additionally, younger drivers were found to be more confident of their driving ability while engaging in CPWD, whereas in fact they performed the worst of all of the age groups. This discrepancy between perceived ability and performance has been proposed to potentially explain why drivers, especially younger drivers, often engage in CPWD and TextWD regardless of the understood risks. Effect of Intervention on CPWD Two studies used 2 different intervention techniques to determine the effect they had on the frequency of CPWD. The first study used a driving simulator and compared 30 novice drivers to 30 older drivers to determine the effect of feedback intervention on driving performance with and without use of a cell phone (Wang et al. 2010). The drivers were asked to perform 5 different driving scenarios based on real-life occurrences and for each scenario. They completed it once with

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240 the use of a cell phone and once without. Half of each group, novice and experienced, were provided with a 20- to 30-minute feedback session that included video recordings of their driving performance extracted from the simulator. Directly after the intervention, both experienced (older) and inexperienced drivers exhibited a decrease in perceived ability to drive while engaging in cell phone use; however, in a one-month follow-up, there was no significant difference found between the intervention novice drivers and the nonintervention novice drivers in their perceived ability to engage in CPWD. These findings indicate that feedback intervention has a short-term effect on perceived control over CPWD; however, that effect diminishes over time. The second study utilized a different intervention technique that examined the effect of displaying signs reading “Please Hang Up—I Care” on one side and “Thank You” on the reverse (Clayton et al. 2006). For those drivers observed to be engaging in CPWD by an initial set of researchers, a second set of researchers displayed the intervention sign and recorded the effect on the drivers current CPWD. In the second year of observations, a third set of researchers observed from around the corner to determine whether the intervention effect continued after the sign was no longer visible. The percentage of drivers engaging in CPWD was 6 percent and the compliance rate at which those drivers hung up their phone upon visualization of the sign was 28 percent in the first year of observations and 33 percent in the second year. The percentage of drivers reengaging their cell phone use around the corner from the sign prompting them to refrain from CPWD use after initially hanging up was 36 percent. Both intervention techniques reported in the review appeared to have had little effect in deterring drivers from engaging in CPWD. Though both reported a short-term effect, the long-term effect was negligible. Effect of Law Enforcement on CPWD Eight of the reviewed articles conducted observations to determine the effect that law enforcement and recent cell phone–restricting legislation has had on drivers engaging in CPWD; only one of these studies measured both CPWD and TextWD. Seven of those studies found little to no difference in the frequency of CPWD among drivers of all ages for both the short term and long term (Braitman and McCartt 2010; Foss et al. 2009; Goodwin et al. 2012; McCartt et al. 2003; McCartt and Geary 2004; McEvoy et al. 2006; Rajalin et al. 2005). Goodwin et al. (2012) observed a long-term decrease; however, it was only by 1 percent (from 11 to 10%). Rajanlin et al. (2005) found that for drivers who regularly engaged in CPWD while driving, the passage of a cell phone restriction law had little effect on their continued CPWD; however, for those who only occasionally engaged in CPWD, their use dropped immediately after the law was implemented, from 37 to 20 percent. This drop in frequency increased significantly to 25 percent a year following passage of the law. Only one study investigated the effect of legislation on TextWD and found that there was no difference in texting frequency between drivers in states with texting bans and those without (Braitman and McCartt 2010).

Cazzulino et al. Two of the studies conducted telephone surveys in conjunction with their observations and found that 59 percent of the teens had knowledge of the new law before its enactment and that percentage increased, yet not significantly, after the law was enacted (Foss et al. 2009). Seventy-four percent of parents strongly approved of the law pre-implementation and 82 percent approved after that law was implemented, whereas only 27 percent of the teenagers strongly approved of the law after its enactment and 47 percent somewhat approved (Foss et al. 2009). The majority of both parents and teenagers preenactment (50 and 58%, respectively) and post-enactment (61 and 71%, respectively) believed that the restriction would be rarely or not at all enforced by authorities (Foss et al. 2009). The awareness of the new cell phone restriction law did significantly increase over the 2 years from 59 to 75 percent (Goodwin et al. 2012). Given these results, the researchers concluded that awareness of cell phone restrictions is not sufficient to affect the frequency of CPWD, and this may be due to a perceived lack of enforcement (Goodwin et al. 2012). The researchers determined that on average, 68 citations were issued annually from 2007 to 2010 (Goodwin et al. 2012). McEvoy et al. (2006) also found that 69 percent of their participants believed that it is unlikely that they would be caught by law enforcement while engaging in CPWD. Given these compounding results, Rajalin et al. (2005), Goodwin et al. (2012), and McEvoy et al. (2006) all advocated for stricter and more visible law enforcement if cell phone restrictions are implemented. One study did find significant long-term decreases in observed CPWD after the passage of cell phone–banning legislation. Using data from relative rates of CPWD of both control and intervention states in the months prior to the legislation’s enactment and a Poisson regression model that assumes exponential growth with no cell phone restriction, the researchers determined the expected rate of CPWD in the absence of any cell phone–banning legislation (McCartt et al. 2010). They compared these hypothetical rates to their observed rates in 3 different states with CPWD legislation after 5–8 years and found that there was a significant decrease in observed rates of CPWD as compared to the hypothetical rates; however, the extent of that decrease varied. In Washington, D.C., which enacted cell phone–banning legislation in 2004, there was found to be a 41 percent decrease in CPWD (from 6 to 3.5%) immediately after the law’s passage and a 43 percent decrease (to 4% in 2009) over the next 5 years. The researchers suggested that rigorous law enforcement may have aided to this significant decrease given that 8 percent of all moving violations in D.C. were cell phone citations. In summary, the majority of the studies measuring the observed effect of law enforcement found that there was no significant decrease in frequency of CPWD and TextWD. Though there was knowledge of new cell phone restrictions in the states studied, many of those who knew about the restrictions did not believe that they would actually be enforced. Effective law enforcement was found to produce a significant reduction in CPWD for one of the reviewed studies, and the researchers found citation evidence confirming that effective law enforcement was a probable cause (McCartt et al. 2010). Though legislation often deters citizens from engaging in illegal behavior, enforcement of such legislation is crucial to its success and

Psychological Factors in Distracted Driving therefore has been proposed as a contributing factor in the realization of effective CPWD and TextWD legislation.

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Discussion The prevalence of CPWD and TextWD is high among young drivers. Additionally, both younger and older drivers perceive CPWD and TextWD to have a high associated risk. When a behavior is recognized as dangerous, future engagement in that activity is typically minimized. However, this was not the reported case with CPWD and TextWD and warrants further investigation into factors that may influence young and older drivers to continue to knowingly put themselves in danger by engaging in CPWD and TextWD. This review identified multiple factors that have been found to influence both young and older drivers to engage in CPWD and TextWD. The importance of an incoming or outgoing call, social acceptance, possession attachment, and a positive attitude toward CPWD and TextWD were all found to be contributing factors to drivers’ engagement in CPWD and TextWD. The importance of answering or making the call while driving was found to have greater weight than the perceived risk associated with CPWD; however, none of the other factors were assessed for this relative weight comparison. Additionally, drivers who engaged in CPWD and TextWD tended to have a lower perceived risk than drivers who did not, which may explain why drivers continued to engage in CPWD and TextWD. The lower perceived risk for drivers engaging in CPWD and TextWD was associated with greater perceived control over their driving abilities while engaging in CPWD and TextWD. This greater perceived controllability or illusion of control appeared to be influential for drivers tending to continue to knowingly engage in dangerous activities. However, people who did not engage in CPWD or own a cell phone would prefer that others did not use a cell phone while driving (Wogalter and Mayhorn 2005). Therefore, it may be true that if people who engaged in CPWD were willing to ignore the associated risks because of their own perceived prowess, then perhaps making them aware of others who did not support their view and had chosen to abstain may affect their judgment in the choice to engage in CPWD. However, there is no evidence reported in this review that supports this hypothesis and no research has been found to have investigated it. From the evidence found in this review, it appears that perceived prowess along with other social factors that outweigh the risk of engaging in CPWD and TextWD are far more influential in determining whether or not a driver will engage in CPWD or TextWD than the associated perceived risk. Significant work remains to prevent continued high frequency of CPWD and TextWD among young drivers. Although young drivers are aware of the risks, they must recognize the severity of those risks and that the risks apply to them. It was found in this review that younger drivers tended to associate a lower risk with CPWD than older drivers and tended to engage in TextWD more than older drivers. However, there appears to be a lack of research in this area, which may be important in determining effective prevention strategies for these younger at-risk drivers. Incorporating several practices, including illusion of control and perceived ability to

241 compensate for distractions, use of simulators, and feedback in driving courses, allows new drivers to understand the low level of competence that they have with CPWD. However, it is evident from the results presented that this knowledge has not been effective long term in preventing future CPWD. This ineffectiveness is partially explained by the fact that social norms, perceived prowess, and phone call importance play significant roles in young drivers’ intentions to engage in CPWD. Therefore, prevention strategies must be aimed at addressing these influences and perhaps determining a means for overcoming them if there is any hope to decrease the frequency of CPWD and TextWD. The effect of law enforcement also played a role in determining a young driver’s frequency of CPWD. With insufficient enforcement of cell phone–banning legislation, it appears that drivers are inclined to continue to engage in CPWD and that the enactment of such legislation has had little to no effect. However, it has been found that there was a lack of belief that such legislation would be enforced. Explicit verbal and behavioral norms associated with law enforcement had one of the strongest effects on intention to abstain from CPWD for young drivers (Riquelme et al. 2010).Therefore, it appears that if cell phone restriction laws were enforced more regularly and strictly, then the frequency of cell phone use among younger drivers may decrease. There was found to be a decrease in the rate of CPWD when the legislation was rigorously enforced, indicating that increased visible law enforcement can deter drivers from engaging in CPWD (McCartt et al. 2010). However given that these results were only found in one of the 8 studies aimed at determining the effect of legislation on CPWD, continued enforcement and research regarding its effect on CPWD is needed. Finally, the findings of Atchley et al. (2012) comparing young drivers’ perceptions of drunk driving and CPWD/ TextWD suggest that with the passage of time and continued educational and legislative efforts, distracted driving will be viewed as dangerous and unacceptable, as drunk driving is now widely considered. Though high risk perception, observed detriment to driving performance, and current law enforcement were reported to have achieved little in preventing the prevalence of CPWD and TextWD, perhaps with time and continued efforts, social norms will change. This may lead to future generations that view CPWD and TextWD as dangerous as drunk driving. Given the diversity of our studies’ data summary measures, our inability to conduct a risk of bias across studies may have limited the conclusions made in this review. This limitation was compounded by the risk of bias due to lack of random sequence generation and blinding of participants found within the individual studies. An additional limitation of this review was the lack of comprehensive research on this topic. Though extending our reviewed articles to include drivers of all ages increased the breadth of data presented in this review, our conclusions cannot be viewed as entirely representative given the compounding lack of data and significant findings. Furthermore, some of our conclusions were based on the lack of positive findings. For these reasons, we advocate for further research to be done that corroborates our conclusions as well as validates other findings presented in this review.

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Future Directions Future prevention strategies can avoid focusing on the risk associated with CPWD and TextWD, given that many drivers acknowledge the inherent risk and continue to engage in this behavior. Future prevention strategies can attempt to counter the other factors that influence drivers to use a cell phone while driving, such as social norms. Given the findings regarding social norms and CPWD and TextWD, it might be of interest to evaluate strategies that counter the perceived antisocial behavior by accepting abstaining from CPWD and TextWD as the social norm. Additionally, given the high rate of fear of law enforcement and perception that little enforcement exists, stricter cell phone restrictions should be implemented and enforced. CPWD and TextWD are relatively recent risks to safe driving; therefore, we hope that repeated education may be eventually effective with the passage of time as social norms and legislation change. Distracted driving will continue to have a high prevalence among young drivers unless efforts are continued to research new and effective strategies to prevent future injuries and death.

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