Adult Drivers Research Articles

The effects of cognitive training on driving performance.

Driving is a complex task necessitating an intricate interplay of sensory, motor, and cognitive abilities. Extensive research has underscored the role of neurocognitive functions, including attention, memory, executive functions, and visuospatial skills, in driving safety and performance. Despite evidence suggesting cognitive training's potential in enhancing driving abilities, comprehensive cognitive training's impact on driving performance in young adult drivers remains unexplored. Our study aimed to fill this gap by implementing an intensive, 8-week, multidomain computerized cognitive training program and assessing its transfer effects on the driving performance of young adult drivers, using a high-fidelity simulator. The study employed a randomized controlled trial design, with passive control group. The mixed-design analysis of variance (ANOVA) revealed a notable interaction between the time of testing and the respective participant groups concerning driving performance. Post hoc analyses showed that, compared to the control group, participants undergoing cognitive training demonstrated significantly fewer traffic infractions in the post-training evaluation. These findings suggest that cognitive training could be a useful tool for enhancing driving safety and performance in young adult drivers. Further research should aim to address the limitations posed by the absence of an active control group.

Dietary supplement use is common in older adult drivers: an analysis from the AAA LongROAD study

BackgroundDietary supplement (DS) use is common and increasing among older adults, though much data available on use frequencies are from surveys and performed cross-sectionally. This paper sought to assess the frequency and pattern of dietary supplement use among older adults over time.MethodsA secondary analysis of data from the AAA LongROAD study, a longitudinal prospective cohort study of older adult drivers, using data from baseline and the first two years of follow up included a total of 2990 drivers aged 65–79 years recruited at five study sites across the US from July 2015 to March 2017. Participants underwent baseline and annual evaluations, which included a “brown bag” medication review. DS were identified and categorized according to type and key components. Prevalence and pattern of DS use over time and relationship to demographics were measured with frequency and Chi squared analyses.Results84% of participants took at least one dietary supplement during the 2-year study period, and 55% of participants continually reported use. DS accounted for approximately 30% of the total pharmacologic-pill burden in all years. Participants who were White non-Hispanic, female, 75–79 years of age at baseline, and on more non-supplement medications took significantly more dietary supplements (P < 0.05). Vitamin D, multivitamins, calcium, and omega-3 formulations were the most common supplements, with stable use over time. Use of individual herbal supplements and cannabis products was uncommon (< 1% participants per year).ConclusionsDS use among older adults is common and relatively stable over time and contributes to polypharmacy. In clinical settings, providers should consider the influence of DS formulations on polypharmacy, and the associated cost, risk of medication interactions, and effect on medication compliance.

Age-related driver injury occurrence from crashes at curve–grade combined segments

Objectives Due to their relatively complex roadway characteristics, horizontal and vertical curve segments are associated with decreased visibility and a higher risk of rollovers. Multiple studies have identified the associated risk of young and older drivers separately in such complicated driving environments. This study investigated the relationship between driver age and injury occurrence from crashes occurring along curve–grade combined segments. Methods Crash data recorded in Ohio State between 2012 and 2017 were used in this study. Driver age was categorized into 3 groups: teen (age <20 years), adult (age 20–64), and older adult (age >64). Descriptive statistics were summarized using random forest, gradient boosting, and extreme gradient boosting (XGBoost) to estimate the probability of a driver incurring an injury in case of a crash at curve–grade combined segments. The area under the receiver operating characteristics curve (AUROC) was used to select the best performing model. Partial dependence plots (PDPs) were used to interpret the model results. Results The probability of injury occurrence is different for older drivers compared to teen and adult drivers. Although teen and adult drivers showed a higher probability of sustaining injuries in crashes with an increase in the degree of curvature, older drivers were more likely to sustain injuries in roadways with higher annual average daily traffic (AADT), steeper grades, and more occupants in the vehicle. Older drivers were observed to have a higher probability of sustaining injuries during peak hours and when unrestrained compared to teen and adult drivers. Conclusions The results emphasize the significance of tailored education and outreach countermeasures, particularly for teen and older drivers, aimed at decreasing the likelihood of injuries in such driving environments. This research adds to the expanding body of knowledge concerning the age-related occurrence of driver injuries resulting from crashes at curve–grade combined segments. The study findings provide insights into the potential over- or underrepresentation of certain age groups in analyzing crash injury occurrence. The insights gained from the machine learning analysis could also assist policymakers, transportation agencies, and traffic safety experts in developing targeted strategies to enhance road safety and protect vulnerable age groups.

Long-Term Effects of a Multi-Component Community-Level Intervention to Reduce Single Vehicle Nighttime Crashes: Follow up Findings from a 24-Community Randomized Trial.

This follow up study examines whether a multi-component, high-visibility alcohol enforcement intervention implemented in 12 California cities had long-term effects on alcohol-related motor vehicle crashes beyond the time period of the original study. Previous results indicated a significant reduction in single vehicle nighttime (SVN) crashes among 15 to 30-year-olds in intervention cities relative to controls (Saltz et al., 2021). A randomized trial was conducted with 24 randomly chosen California cities from 2012 to 2017 to evaluate a multi-component intervention to reduce excessive drinking and driving while impaired among adolescents and young adults. Twelve of the cities were randomly assigned to the intervention condition and implemented high-visibility alcohol enforcement operations and other components from April 2013 to March 2016. Multi-level negative binomial regression analyses were conducted with motor vehicle crash data from 2010 to 2021 to examine whether single vehicle nighttime (SVN) crashes among 15 to 30-year-olds decreased in intervention cities relative to controls after the multi-component intervention was implemented. Analyses controlled for community sociodemographic characteristics, the overall time trend, the COVID pandemic, and pre-intervention levels of SVN crashes and adjusted for correlation of repeated observations within cities over time. Regression analyses indicated a significantly lower level of monthly SVN crashes among 15-to-30-year-olds in intervention cities during post-intervention months through 2021 relative to control cities [Event Rate Ratio (95%CI) = 0.88 (0.79, 0.98), p<.05] when controlling for community sociodemographic characteristics, the overall time trend, COVID, and pre-intervention levels of SVN crashes. Study findings suggest that a multi-component, high-visibility alcohol enforcement intervention can have long-term effects on alcohol-related motor vehicle crashes and related injuries and fatalities among adolescent and young adult drivers.

Transferability of Effective Consultation Skills for Decision-Making Support in the Voluntary Surrender of Older Adult Drivers' Licences in Super-Aged Japan.

Previously, we identified eight effective consultation skills to support decision-making in the voluntary surrender of older adult drivers' licences in super-aged Japan. This study aimed to clarify the transferability of these skills. We collected text data by interviewing 11 safe-driving counsellors (four police officers, four clerical staff and three nurses) in the License Division of the National Police Agency from February to March 2022. Interviews were semi-structured and conducted by telephone or email. During the interview, participants were asked to recall their experiences as counsellors providing decision-making support to older drivers and to compare their experiences with the eight consultation skills. We analysed the content of the responses by quantitative text analysis with KH Coder 3 software. As a characteristic of the words and phrases used by counsellors in their narratives about consultation skills, the most frequently extracted words from among 3147 words were think, parties and family, and promote had the highest mediation centrality. The eight subgraphs were 'Respecting the will of relevant parties from their standpoint is natural', 'Listening attentively and empathetically to relevant parties is effective', 'Presenting objective data to guide decisions is successful', 'Showing cognitive functioning test results is often effective', 'Counselors with medical expertise can elicit positive counseling outcomes', 'Intervention by medical or police counselors facilitates the decision to surrender voluntarily', 'Counseling skills need to be improved' and 'A diagram of the 8 skills is helpful for inexperienced counselors'. The results suggest that the eight consultation skills have similarities and are transferable. This transferability might contribute to practical application or cohort follow-up study research. These skills can be incorporated into counsellor training, and counsellors can be expected to use these skills in the future. Regardless of the safe-driving counsellor's years of experience, the skills can help them provide uniform and accurate support in decision-making regarding the voluntary surrender of older adult drivers' licences. These skills are a promising approach to help older adults lead safe and secure lives as they age.

How the cognitive load of simulated driving affects the brain dynamics underlying auditory attention

Objective Distracted driving is a primary contributor to for motor vehicle crashes, the leading cause for injuries and fatalities for youth. Although attention and working memory clearly underlie driving abilities, few studies explore these functions on the brain-level under the cognitive load of driving. To understand the load driving has on auditory attention processing, we examined the differences in dynamic brain response to auditory stimuli during LOAD (while driving in a high-fidelity driving simulator) and No-LOAD conditions (seated in simulator, parked on the side of the road). Methods Twenty-seven young adult drivers (18–27 y/o; 15 = women) completed a Selective Auditory Attention Task during both a LOAD (driving) and No-LOAD condition in a ½ cab miniSim® high-fidelity driving simulator. During the task, participants responded by pressing the volume control button on the steering wheel when a target tone was presented to a target ear. Electroencephalography-recorded event-related brain responses to the target tones were evaluated through alpha and theta oscillations for two response windows (early: 150–330ms; late: 350–540ms). Results During an early time window, we observed a significant interaction between attended/unattended and LOAD/No-LOAD theta power in the right frontal cortical region (F(1, 24)= 5.4, p=.03, partial η 2=.18). During the later window, we observed a significant interaction between attended/unattended and LOAD/No-LOAD alpha response in the posterior cortical region (F(1, 24)=11.81, p=.002, partial η 2=.15) and in the right temporal cortical region during the window (F(1, 24)=4.3, p=.05, partial η 2=.33). Conclusions Our data provide insight into the demand that driving has on cognitive faculties and how dual task engagement may draw resources away from driving. We suggest future research directly incorporate vehicle control abilities into study design to understand how brain-based measures relate to driving behaviors.

Metacognitive Awareness of Older Adult Drivers with Mild Cognitive Impairment: Relationships with Demographics, Subjective Evaluation of Cognition, and Driving Self-Efficacy.

(1) Self-regulation of driving is a means of maintaining one's driving identity. The purpose of this study was to investigate the extent to which older drivers with Mild Cognitive Impairment (MCI) are metacognitively aware of the requirements of specific demanding driving conditions and whether this awareness is linked to subjective assessments of cognition. (2) One hundred seventeen (117) older MCI drivers participated in a telephone survey in which they reported their metacognitive experiences in nine driving conditions, listed as an aim of self-regulation. The analyses included the participants' subjective cognitive assessments, both in terms of their cognitive state and their perceived driving self-efficacy. (3) The analyses pointed out a direct and negative effect of age on the formation of the metacognitive feeling of certainty. Furthermore, an indirect effect of sex through driving self-efficacy was established. This effect was negative in the case of the metacognitive feeling of difficulty and the estimation of effort and positive in the case of the metacognitive feeling of certainty. (4) This position points out the need to establish appropriate levels of the perceived self-efficacy of older drivers with MCI, and it raises issues when it moves to fictitious levels.

Diabetes mellitus and hard braking events in older adult drivers

BackgroundDiabetes mellitus (DM) can impair driving safety due to hypoglycemia, hyperglycemia, diabetic peripheral neuropathy, and diabetic eye diseases. However, few studies have examined the association between DM and driving safety in older adults based on naturalistic driving data.MethodsData for this study came from a multisite naturalistic driving study of drivers aged 65–79 years at baseline. Driving data for the study participants were recorded by in-vehicle recording devices for up to 44 months. We used multivariable negative binomial modeling to estimate adjusted incidence rate ratios (aIRRs) and 95% confidence intervals (CIs) of hard braking events (HBEs, defined as maneuvers with deceleration rates ≥ 0.4 g) associated with DM.ResultsOf the 2856 study participants eligible for this analysis, 482 (16.9%) reported having DM at baseline, including 354 (12.4%) insulin non-users and 128 (4.5%) insulin users. The incidence rates of HBEs per 1000 miles were 1.13 for drivers without DM, 1.15 for drivers with DM not using insulin, and 1.77 for drivers with DM using insulin. Compared to drivers without DM, the risk of HBEs was 48% higher for drivers with DM using insulin (aIRR 1.48; 95% CI: 1.43, 1.53).ConclusionOlder adult drivers with DM using insulin appear to be at increased proneness to vehicular crashes. Driving safety should be taken into consideration in DM care and management.

A Systematic Review of Effective Interventions and Strategies to Support the Transition of Older Adults From Driving to Driving Retirement/Cessation.

In most western countries, older adults depend on private cars for transportation and do not proactively plan for driving cessation. The objective of this review was to examine current research studies outlining effective interventions and strategies to assist older adults during their transition from driver to driving retirement or cessation. A search was completed across 9 databases using key words and MeSH terms for drivers, cessation of driving, and older adult drivers. Eligibility screening of 9,807 titles and abstracts, followed by a detailed screening of 206 papers, was completed using the Covidence platform. Twelve papers were selected for full-text screen and data extraction, comprising 3 papers with evidence-based intervention programs and 9 papers with evidence-informed strategies. Three papers met the research criteria of a controlled study for programs that support and facilitate driving cessation for older adults. Nine additional studies were exploratory or descriptive, which outlined strategies that could support older drivers, their families, and/or healthcare professionals during this transition. Driving retirement programs/toolkits are also presented. The driver retirement programs had promising results, but there were methodological weaknesses within the studies. Strategies extracted contributed to 6 themes: Reluctance and avoidance of the topic, multiple stakeholder involvement is important, taking proactive approach is critical, refocus the process away from assessment to proactive planning, collaborative approach to enable "ownership" of the decision is needed, and engage in planning alternative transportation should be the end result. Meeting the transportation needs of older adults will be essential to support aging in place, out-of-home mobility, and participation, particularly in developed countries where there is such a high dependency on private motor vehicles.

Demographic and injury trends for car crash casualties hospitalized in Level I Trauma centers over two decades: data from the National Trauma Registry

BackgroundDuring the past two decades, there have been many changes in automotive and medical technologies, road infrastructure, trauma systems, and demographic changes which may have influenced injury outcomes. The aim of this study was to examine injury trends among traffic casualties, specifically private car occupants, hospitalized in Level I Trauma Centers (TC).MethodsA retrospective cohort study was performed based on data from the Israel National Trauma Registry. The data included occupants of private cars hospitalized in all six Level I TC due to a traffic collision related injury between January 1, 1998 and December 31, 2019. Demographic, injury and hospitalization characteristics and in-hospital mortality were analyzed. Chi-squared (X2) test, multivariable logistic regression models and Spearman’s rank correlation were used to analyze injury data and trends.ResultsDuring the study period, 21,173 private car occupants (14,078 drivers, 4,527 front passengers, and 2,568 rear passengers) were hospitalized due to a traffic crash. The percentage of females hospitalized due to a car crash increased from 37.7% in 1998 to 53.7% in 2019. Over a twofold increase in hospitalizations among older adult drivers (ages 65+) was observed, from 6.5% in 1998 to 15.7% in 2018 and 12.6% in 2019. While no increase was observed for severe traumatic brain injury, a statistically significant increase in severe abdominal and thoracic injuries was observed among the non-Jewish population along with a constant decrease in in-hospital mortality.ConclusionsThis study provides interesting findings regarding injury and demographic trends among car occupants during the past two decades. Mortality among private car occupant casualties decreased during the study period, however an increase in serious abdominal and thoracic injuries was identified. The results should be used to design and implement policies and interventions for reducing injury and disability among car occupants.

Relationship between Driving Ability and Physical Fitness Factors in Older Adults: A Multiple Linear Regression Analysis.

The number of older drivers is increasing with the aging population; this has led to concerns about traffic accidents involving older drivers. For older adults, the automobile is not just a means of transportation, but a life necessity that promotes social activities and maintains and improves health-related quality of life. In this study, we aimed to clarify the relationship between driving ability and physical fitness factors among 70 older adult drivers using a single regression analysis and multiple regression models adjusted for age, sex, and other factors. Driving ability was evaluated by driving an actual car on an ordinary road without a simulator. The single regression analysis revealed no relationship between driving ability and any physical fitness factor. In the multiple regression model analysis, only grip strength was an important explanatory factor; however, the driving ability scores decreased as grip strength scores increased. By clarifying the physical fitness factors that influence the maintenance and improvement of driving ability, it is possible to propose more efficient intervention programs to maintain and improve driving ability. We could not identify the relevant physical fitness factors in this study; therefore, further research is required to improve safe driving among older adults.

Development of a nuanced approach to aggressive driving: An investigation into the self-regulatory and attitudinal profiles of aggressive drivers and their contextual role in negative road interactions

This study aimed to provide a novel perspective on aggressive driving behaviour (ADB) by developing a self-report measure of aggressive driving styles (the Aggressive Driving Styles Questionnaire; ADSQ) and comparing how different types of drivers (according to their attitudes and self-regulatory functioning) might differentially engage in such driving styles. An online survey was completed by a sample of Australian adult drivers (N = 527), who reported engaging in an ADB in the past month. An initial confirmatory factor analysis indicated that the proposed factor structure of instrumental, reactive, proactive and interpersonal driver aggression, was a good fit for the data, and reliability tests suggested that the ADSQ had good internal consistency (α = 0.73 - 0.91). Next, correlational analysis showed that the ADSQ had positive associations with (a) driver anger and rumination; (b) problematic attitudes towards instrumental and hostile aggressive driving; and (c) various domains (i.e., cognitive, attentional, emotional) of self-regulatory dysfunctioning. K-means cluster analysis was then used on the variables to determine potential profiles of ‘self-regulated’ drivers among the participants. The results suggested that three driver types significantly differed according to their attitudes and level of self-regulatory dysfunction: self-regulated drivers (high functioning; low attitudes), antisocial drivers (medium functioning; high attitudes), and dysregulated drivers (low functioning, high attitudes). These cluster groups were shown to significantly differ in their tendency to engage in aggressive driving styles and what behaviours they perceived as most triggering when driving on the road. The ADSQ and associated findings of this study provide a nuanced perspective on how ADBs can be approached, observed, and operationalised.

Reducing crash risk for young drivers: Protocol for a pragmatic randomised controlled trial to improve young driver sleep

BackgroundRoad trauma is a leading cause of death and disability for young Australians (15–24 years). Young adults are overrepresented in crashes due to sleepiness, with two-thirds of their fatal crashes attributed to sleepy driving. This trial aims to examine the effectiveness of a sleep extension and education program for improved road safety in young adults. MethodsYoung adults aged 18–24 years (n = 210) will be recruited for a pragmatic randomised controlled trial employing a placebo-controlled, parallel-groups design. The intervention group will undergo sleep extension and receive education on sleep, whereas the placebo control group will be provided with information about diet and nutrition. The primary outcomes of habitual sleep and on-road driving performance will be assessed via actigraphy and in-vehicle accelerometery. A range of secondary outcomes including driving behaviours (driving simulator), sleep (diaries and questionnaire) and socio-emotional measures will be assessed. DiscussionSleep is a modifiable factor that may reduce the risk of sleepiness-related crashes. Modifying sleep behaviour could potentially help to reduce the risk of young driver sleepiness-related crashes. This randomised control trial will objectively assess the efficacy of implementing sleep behaviour manipulation and education on reducing crash risk in young adult drivers.

Cannabis legalization and driving under the influence of cannabis and driving under the influence of alcohol among adult and adolescent drivers in Ontario, Canada (2001–2019)

BackgroundThe impacts of cannabis legalization on driving under the influence of cannabis and driving under the influence of alcohol among adults and adolescents were examined in Ontario, Canada. MethodsData were sourced from adult (N=38,479) and adolescent (N=23,216) populations-based surveys (2001–2019). The associations between cannabis legalization and driving within an hour of using cannabis and driving within an hour of drinking two or more drinks of alcohol were quantified using logistic regression, with testing of multiplicative interactions between cannabis legalization and age and sex. All analyses were conducted separately for adults and adolescents and restricted to participants with a valid driver’s license. ResultsCannabis legalization was not associated with driving within an hour of using cannabis among adults (OR, 95% CI: 1.21, 0.69–2.11). However, a multiplicative interaction indicated that there was an increased likelihood of driving within an hour of using cannabis among adults ≥55 years of age (4.23, 1.85–9.71) pre-post cannabis legalization. Cannabis legalization was not associated with driving within an hour of using cannabis among adolescents (0.92, 0.72–1.16), or with driving within an hour of consuming two or more drinks of alcohol among adults (0.78, 0.51–1.20) or adolescents (0.87, 0.42–1.82). ConclusionsAn increased likelihood of driving under the influence of cannabis among adults ≥55 years of age was detected in the year following cannabis legalization, suggesting the need for greater public awareness and education and police monitoring and enforcement concerning driving under the influence of cannabis, particularly among older adults.

Enhancing Deterrence for Child Motorbike Riders in Indonesia: A Legal Sanctions Model

Objective: The main objective of this research is to formulate a concept for recommendations for changes in the regulation of criminal sanctions and the concept of compensation responsibility, which can provide a deterrent effect against violations by child motorbike drivers. Method: This research was conducted using a normative legal research method with a statutory approach. Results: This research found disharmony in the concept of children, and there is no regulation of criminal sanctions and responsibility for compensation for parents or families. Child motorbike driver violations provide more significant benefits and profits to parents or families. The contribution of this research can provoke legislators to encourage the participation of parents or families to help prevent child motorbike drivers by regulating the imposition of criminal sanctions and responsibility for compensation, and can immediately harmonize the concept of children in statutory regulations. Conclusions: Criminal sanctions for child motorbike drivers are similar to those for adult drivers. Violations for child and adult motorbike drivers use different criminal justice systems. The difference in the concept of children between Law Number 22 of 2009 regarding Road Traffic and Transportation (RTT) and Law Number 11 of 2012 concerning the Juvenile Criminal Justice System (JCJS), results in ambiguity in law enforcement for child motorbike driver violation.

Return to driving post upper or lower extremity orthopaedic surgical procedures: a scoping review of current published literature.

Patients undergoing planned or unplanned orthopaedic procedures involving their upper or lower extremity can prevent them from safe and timely return to driving, where they commonly ask, 'Doctor, when can I drive?' Driving recommendations after such procedures are varied. The current evidence available is based on a heterogenous data set with varying degrees of sample size and markedly differing study designs. This instructional review article provides a scoping overview of studies looking at return to driving after upper or lower extremity surgery in both trauma and elective settings and, where possible, to provide clinical recommendations for return to driving. Medline, EMBASE, SCOPUS, and Web of Science databases were searched according to a defined search protocol to elicit eligible studies. Articles were included if they reviewed adult drivers who underwent upper or lower extremity orthopaedic procedures, were written in English, and offered recommendations about driving. A total of 68 articles were included in the analysis, with 36 assessing the lower extremity and 37 reviewing the upper extremity. The evidence available from the studies reviewed was of poor methodological quality. There was a lack of adequately powered, high quality, randomised controlled trials (RCTs) with large sample sizes to assess safe return to driving for differing subset of injuries. Many articles provide generic guidelines on return to driving when patients feel safe to perform an emergency stop procedure with adequate steering wheel control. In future, RCTs should be performed to develop definitive return to driving protocols in patients undergoing upper and lower extremity procedures.

Responsible Driving In The Age Of Smartphones: Applied Research For Improving Road Safety In The Motor City

Smartphones have become ubiquitous commodities in our contemporary lives and essential to our daily experiences. With limited public transportation in the United States and dependence on cars, the combination of smartphones and driving raises important questions of safety. We discuss our collaboration with Chevrolet-GM in Detroit in product development and user experience research, namely beta-testing a mobile phone app that was developed by Chevrolet to eliminate texting while driving, thereby improving car and road safety. We illustrate that the heightened awareness of distracted driving to self and others created spaces for young adult drivers to demonstrate their moral personhood through the care of and for others in their individual use of the app and in their promotion of its use to family members and friends. The practical applications of this finding resulted in a successful app product and its launch campaign, which incorporated the emerging insights from this study.

6 Back-To-Drive Project. Assessment of Fitness-To-Drive in Older and Cognitively Impaired Adult Drivers: Adaptation of the on-Road Driving Observation Schedule to Simulation-Based Environments

Objective:Cognitive, motor and sensory deficits associated with aging, and with some neurological conditions such as acquired brain injury, may lead to severe driving performance impairment. While rehabilitation and driver assistance technologies may improve driving performance, the assessment of the actual fitness-to-drive of these people is challenging. Office-based neuropsychological/physical tests are considered insufficient to understand one’s ability to drive. The gold standard is the on-road assessment with dual control cars, superior in ecological validity, but expensive, stressful, and potentially unsafe. Valid, more cost-effective solutions for a safer, more accurate, standardized assessment of fitness-to-drive are currently needed. Modern and sensorized driving simulators offer key advantages, such as the possibility of exposing drivers to several relevant driving scenarios, including hazard situations, and of assessing their driving performance without being physically at risk. However, the extraction and direct interpretation of existing simulator-produced data may require specialized data processing skills or simulation expertise. To overcome this, we have developed an easy-to-use, pencil-and-paper observational instrument. The Sim-DOS is an adaptation of the widely used instrument to assess “natural driving”, the Driving Observation Schedule (DOS; Vlahodimitrakou et al., 2013).Participants and Methods:Via expert consensus, DOS targeted behaviors were adapted to a simulated-based environment (signaling, observation of environment, speed regulation, slow or unsafe reaction, distance interpretation, vehicle/lane positioning), and the Sim-DOS scores calculation (based on errors while doing such behaviors) was adapted from DOS to include hazard situations (HS, 0-100) and free driving (FD, 0-°°) scores. The instrument was then piloted with a sample of 35 older adults, along with the collection of simulator-produced data on number of harsh events and driving speed. Participants drove two consecutive 20-minutes long scenarios, with low and high traffic density (LTD, HTD). In each scenario, there were periods with and without potentially hazard situations.Results:Assessments were performed by two independent trained observers, producing substantial inter-rater reliability (intra-class correlation coefficients above 0.94). Participants (70.7±4.1 years old, 60% male, 46.1±6.7 years of driving experience) were mostly regular drivers (74%). However, psychomotor skills of the majority were compromised, with only one participant being above the 80th percentile in the reaction times test of the national mandatory driving assessment. When exposed to hazard situations, most of the participants (94.1%) did not perform well, independently of traffic density, with average Sim-DOS-HS scores of 87.1±9.7 (out of 100, t-values&gt;7.3, p-values&lt;.05).Compared to LTD scenarios, in HTD scenarios participants drove less smoothly (HTD:0.97±1.24 vs. LTD:0.33±0.58 of harsh events, Z=3.1, p&lt;.05). However, they also drove slower (HTD:82.41±27.43 vs. LTD:103.55±14.61 km/h, t=5.2, p&lt;.05), improving their ability to manage hazard situations, and therefore producing higher than expected Sim-DOS scores (HTD:87.05±10.28). During free driving, participants performed worse under LTD conditions (Sim-DOS-FD scores: HTD:11.68±6.20 vs. LTD:14.40±9.58, t=2.15, p&lt;.05) as they drove at higher speed (HTD:85.01±24.28 vs. LTD:104.70±11.94 km/h, t=5.8, p&lt;.05), although they did it more smoothly (HTD:1.94±3.74 vs. LTD:0.45±0.74 harsh events, Z=2.65, p&lt;.05).Conclusions:Our study provides a validated driving assessment tool for use in driving simulators that will allow a safer, more ecologic, holistic and informative evaluation of the fitness-to-drive of older adults and neurological patients.

87 Virtual Driving Relates to Real-World Risky Driving

Objective:Driving is a cognitively demanding activity commonly affected by brain injury and illness. Accurate driving assessment is essential for reducing risk, optimizing independence, and informing driving-related interventions. Virtual reality driving simulation (VRDS) enables safe, sensitive, objective, and standardized measurement of driving abilities. VRDS has been validated in relation to self-reports and driver records. However, self-reports are subjective, and driver records include only major events (collisions, violations). Video telematics platforms can measure naturalistic driving in a more objective and sensitive manner. The present study used video telematics to examine relationships between VRDS performance and directly observed naturalistic driving.Participants and Methods:20 healthy adult drivers (ages 23-61, mean age=36; 75% women) completed a VRDS assessment that included 1) driving on a straight road, 2) following a truck on a highway, and 3) reacting to a child running into a street to retrieve a ball. Primary VRDS measures were 1) speed and lane management on the straight road; 2) speed and following distance management in the truck-following task; and 3) reaction time, stopping, and distance from the child in the child-ball task. Participants also completed 28 days of naturalistic driving with a video telematics platform in their vehicle. Driving events were detected automatically using accelerometer, GPS, and video data, and driving behaviors were coded by driving risk analysts. The primary naturalistic measure was the number of unsafe driving behaviors per hour driven; specific driving behaviors served as exploratory variables. We examined correlations between VRDS and naturalistic driving variables. Given limited statistical power, we reported correlations that were small-to-medium or greater (r&gt;.2) in primary analyses and medium-to-large or greater (r&gt;.4) in exploratory analyses.Results:On average, drivers exhibited approximately one unsafe driving behavior per hour (M=0.9, SD=0.9, range=0.1-2.7). Common behaviors were failing to stop, unsafe following distance, speeding, and cell phone use. No collisions occurred. Average lane position in VRDS (specifically, leftward deviation from the center of the lane) was correlated with more real-world unsafe driving behaviors per hour (r=.35, p=.13), as were higher average straight road speed (r=.26, p=.27), greater straight road speed variability (r=.28, p=.24), and failing to stop for the child in the child-ball task (r=.22, p=.36). In exploratory analyses, failing to stop for the child was associated with real-world distracted driving (r=.45, p=.047), greater lane position variability in VRDS was associated with real-world unsafe following distance (r=.57, p=.009), and greater speed variability in VRDS was associated with real-world seat belt non-use/misuse (r=.49, p=.03).Conclusions:The present findings provide preliminary evidence that VRDS variables are related to directly observed naturalistic driving, supporting the potential utility of VRDS as a sensitive, ecologically valid driving evaluation tool. As the present study used a small sample of healthy drivers, further research will explore this topic in larger samples and in clinical populations, such as acquired brain injury. Future work will also investigate whether incorporating VRDS with conventional driving evaluation tools (e.g., neuropsychological tests, behind-the-wheel assessments) can enhance the ability of clinical driving evaluations to predict real-world risky driving.

Willingness of Voluntary Counseling and Testing Among Long Distance Truck Drivers: A Window of Opportunity in Control of Retroviral Disease

Objective: To evaluate the factors influencing the practice of voluntary counselling and testing among long-distance truck drivers as it affects the spread of retroviral disease.&#x0D; Design: This was a quantitative cross-sectional study conducted in the major bus terminals in Enugu State, Nigeria. A questionnaire-based tool was used to collect data from a population of adult bus drivers.&#x0D; Setting: It was conducted at the 3 main motor parks in Enugu metropolis from January 2019 – March 2020. &#x0D; Participants: 500 long-distance truck drivers aged 19-65 years.&#x0D; Intervention: The knowledge and practices of the participants were assessed using a semi-structured interview guide. They were interviewed on various aspects of HIV/AIDS.&#x0D; Main Outcome Measures: Knowledge and practices. On Knowledge and practice performance scale rating; &lt; 50% is poor, 50 -75% is fair, and &gt; 75% is good.&#x0D; Results: Among the five hundred (500) long-distance truck drivers (LDTD) studied 68.0% showed a fair knowledge of HIV/AIDS. The prevalent high-risk behaviour was multiple sexual partners (73.2%). The practice of voluntary counselling and testing was poor, as (17.0%) had practised it; however, their risk perception was high at (76.0%). Fortunately, there was also a high willingness to screen 302 (60.4%) which was significantly higher in those with a tertiary level of education (100%) and the married participants (75.8 %) (χ2=174.4, p &lt; 0.01).&#x0D; Conclusion: There was a high-risk perception in this study population with a high willingness to be tested. We hereby recommend regular screening service at the motor packs of truck drivers in Enugu State.