- okay let's start
Welcome to the ITS Friday Seminar and today we are going to introduce Professor Linda Hill.
She's from UCSD and she's a real MD
so [this] is probably the first time in this seminar where we have a medical doctor to give a talk.
She has a long list of accomplishments
and she's with the Department of Family Medicine and Public Health at UCSD
and she's the director of the UCSD SDSU, that's San Diego State in general preventive medicine
residency and senior staff position in San Diego family care. She's the director
of the UCSD training research education for driving safety and the Center for
Human and Urban Mobility and also directing AAA foundation for traffic safety long road
study at the San Diego site. Her primary safety work, it's really enhanced by the
collaborative effort with colleagues at UCSD
with expertise in robotics, computer science, neuroscience, and engineering.
I met Linda two years ago at the Irvine Symposium
and was fascinated by her work and thought we should invite her to come
here to give a talk and here she is. Welcome
- Thanks very much
When I was thinking about what to talk to you all about today, I'll tell you what I
didn't choose and then you can think about whether you want to hear about that.
So, at UCSD we are funded by AAA foundation for
traffic safety and we have the largest older driver cohort for collecting
prospective data on older drivers. We have their cars instrumented with a GPS
Accelerometer, we've now moved to a phone app to do that and we're
collecting five years of data on older drivers so that we can better understand
them. We also have a simulator lab and we've been doing work to try to
understand the distracted brain which we'll talk a little bit about because
I'm going to show you some of the work that we're doing
to try to influence distracted driving
So what I did decide to talk to you about was the work that we're doing, we’re Public
Health in the area of behavior change and the concept is that 95 percent of
crashes are due to human behaviors. Those behaviors are modifiable and don't
use the word accident anymore as you know because it kind of implies that
that wasn't a modifiable or predictable behavior that caused it and
injuries behave very much like others public health diseases
so we decided to approach them that way
and one of the things that we've done I think that's a little bit unusual with
our public health work is that we've partnered with law enforcement. This was not
something that I'd done as you kindly said in the introduction, I actually see
patients half time. I'm a preventive medicine of public health physician
in a nonprofit community health center. I spent my entire
career working with people who don't have insurance
and I'm also involved in migrant, asylum seeker, and displaced person health so
none of that had brought me in contact or personally in
contact with law enforcement so the concept of being able to use them for
Public Health was something that we came into about 15 years ago and the
way that we've been using them is so that law enforcement can be
our behavior change agents. I mean there's 40 million people in California, it's
very large, we're a really small group and it would be impossible for us to get
message of Public Health and Public Safety out in terms of driving safety so we
came up with this idea that we would harness what they call public
information officers the PIOs and it was California Highway Patrol who agreed to partner with us.
So, our model is that we think about what we want to impact, let's say distracted
driving and we'll do what you would do if you were writing a term paper, you’d look
at the scientific foundation of it, you’d do as much research as you could you’d
pick up some pilot studies and then base it on how promotion theories.
By the way if you have any questions just raise your hand
I can help answer them as we go ahead.
So, then we would design some kind of intervention that's usually in
the form of curriculum that I'm going to show you but not completely in the form of
intrusive curriculum and then start in to sort of a circle of quality improvement
trainer PIOs, get them to deliver it, evaluate it, and so on. So, CHP has
actually embraced this because they're generally not experts in curriculum,
they're not experts in you know psychology and behavior change, they're law
enforcement officers who go on to become public information officers, they were
very happy to have this partnership. As a result we've created six curriculum
better for the general public and I'm going to show you examples just so you
can see the kind of thing that we've done and then give you some very brief
examples of the kind of evaluation that we've done and I'll talk about that in a bit.
When we thought about what promotion
theory that we want to kind of model this driving behaviors on,
we were attracted to the Social Ecological Model and especially in the area of
let's say distracted driving. So, the Social Ecological Model says that if you're
trying to get somebody to change their behavior, often just talking to them about how
how that behavior affects them as an individual doesn't work.
I mean take smoking. You know, I spend a lot of time in the exam room in my
office, in my clinic trying to get people to quit smoke and sometimes they just say, well
for me the pleasure outweighs the risk, but when you start talking to people about
your modeling this behavior for your kids, you're providing second and third
hand smoke even, even if you don't smoke in front of them there is still third hand smoke,
you're also increasing the healthcare cost of your work so all of
this you're trying to say to people okay this is how it affects you as an
individual but there's also your personal, your work side and the community. I mean
one thing about smoking, it's one of these things where you know short-term
Pleasure, short-term addiction not that I know, I've actually never put a cigarette to my lips, but
the consequences are long-term
and so, this is very similar to what happens with our phones, a kind of addiction
that we have and you know it's an addiction because if one of you gets a
text well I'm talking even if I've managed to capture your interest, I know
you're going to look at it. It's completely capture us and all
those things and things are you know affecting our endorphin rush so on.
The first example of a behavior change that I'm going to show you is what we
call ‘Just Drive’ and this was our
curriculum for distracted driving. The curriculum goes through what some of the
reasons are that distracted driving is so dangerous. So I'll just give you some
examples. So it would say, when you're looking through your windshield your
eyes are unconsciously scanning the windshield in front of you
looking for things in the periphery, but when you're distracted, that actually
goes down by 50 percent and we know this because we've put eye trackers in cars and we’ve
put eye trackers in simulators. I just did that experiment this year.
We had some funding from the ITS that was given to us to study that we just finished in September,
looking at what happens to eyes in a simulator during distraction. It completely narrows
the focus either to the phone or straight ahead at all the stuff that's happening
when the periphery gets missed. The other thing we show people is you can't really
multitask. So here's your brain. You have to imagine somebody got the IRB to do
this experiment about somebody lying in an MRI with a simulator over them and a
steering wheel and some cell phone in their ear. When they
started talking on the phone the language part of the brain lit up and the
visual spatial part lost a third of its function so we're trying to get
- You don't want to put people through what I've put people through. It's not worth
it. I tell my story and I want them to look at me and be able to say I do not
want to do what he did. I don't want to cause the pain that he's
caused. I was 19 years old on my way to work. I made a choice to text and drive. I
think back now and I mean what was I thinking. It is clearly dangerous, clearly obvious,
and it makes no sense to me that I could think like that and you know now I have
to live every day in regret because I thought I could do it.
I hate myself everyday for it. I was less then five minutes away from work. Could
whatever I was texting have waited five minutes? Yeah absolutely.
So we don't want to spend our entire 45 minutes that we have with our audience
scaring them because we don't think that works, but we also want to show that
being either a victim or a perpetrator is not a very good place to be and so we
also show it from the victim’s point of view. We've also tried in our talks
to interject humor and you may be a
little doubtful about this, but the PIOs that we employ to give our talks,
they have been very good at telling stories about the stupid things
that people do when they're distracted driving. What we hope is that people
then go home at night and talk to their families and they talk to their employees. One
of the ways that we've been able to get to the public, the distracted public is
by going through employers and saying if you let us have your employers for an
hour, at the end of that hour we hope they'll be more informed about distracted
driving, you'll have less liability
and by the way we'll work with you also to make sure that your policies are
the way that they should be. We've done a number of surveys asking people about
distracted driving. One of the things people say is well, if my boss calls
I have to answer the call. So we went to the
bosses and said you want to have that, you don't want your employees to think
that they have to pick up the phone. So here's an example of what I just spoke about
- A day in the life, this is what I
talk about with you guys, what I've seen out there on the highway.
Southbound 15, South Amer Mesa I looked to my right there's a young 19 year old
kid in his white Honda Civic. I followed him for three miles until we get to
Miramar Way. We get to Miramar way. He looks left. We make eye contact and we
have what I like to call a true ejection. All right it looks like this - and he chucks his phone.
What did he forget? He forget to turn it off yes, but what else? He forgot that his back window is down.
So as he ejects his cell phone from his hand I watch it come out of his hand
hit his rear seat come out his left rear window
over the right side of my patrol car, his cellphone slides across five lanes of
the 15 right and then Mr. Big Rig finishes it off. Right, a little cell
phone fatality out there. I took my little yellow blanket and I covered up
the cell phone right. - So then he goes out to say, "So what kind of ticket did I give him?"
and somebody in the audience says "littering" and he says "you guys are really harsh, that ticket's $1000.
I gave him a $150 ticket." So that's
just some snippets from what we do on distracted driving and I know this
groups gonna say, "well how do you know you’ve changed behavior?" So that's very difficult to
measure. We're funded by a California Office of Traffic Safety to do this
Public Safety work. California Office of Traffic Safety, it's in a research
institution. They're like, go out and fix distracted driving. Go out and change the
public's behaviors. So, we've had to build our evaluation into pre and post testing and then
I'll show you one thing that we were able to do, but it has limitations. When
the PIOs go out and they're not the people who work for me going out to do
this. I have even less control over how to get back that evaluation and
certainly nobody signs up. We don't have a way of tracking people. I mean ideally
we'd administer into the intervention of the control group but that's not how
OTS rolls. OTS is like just go fix it. We don't want you testing some kind of
intervention that you've done. So, it has been somewhat frustrating to rely on pre
and post-testing and when you ask somebody who just saw this "how motivated
are you to change your behavior?" Yeah I mean I'm glad to
see you know 89 percent of people said yes, but I'd be kind of shocked if
at the end of post-testing they didn't. So we did get
some rather reassuring participant comments that I'm just showing you some
snippets that people were happy with the intervention. One thing that was very
reassuring to us is we asked our volunteers who are willing to give us
their emails and then we suddenly we put them in a lottery for an iPad and
Then, we have a way on survey monkey where we can not break their
confidentiality in terms of the answers to the question but their names can
still be put into a lottery to be able to get prizes, and for those of you who
are trying to collect data from people it's a much cheaper way than paying
people ten or twenty dollars per person to do this and it seems to be very
well received, just an FYI. I was happy to see
that people three months later said I do less of these things. So less hands-on and hands-free.
By the way before we leave this Topic, hands-held and hands-free are just
as dangerous one to the other. If you're thinking that you're safer going home from
this talk and you're not riding your bike and you're on Bluetooth, you're not
safer. You're much safer than you are if you are texting obviously. If your eyes
are off the road, you're very unsafe but you're not better off than you would
be holding it your ear.
- "Linda people have very short memories
So, after they go through this they may be impressed and then they will change for awhile, but then
they get uninvested again. So have you thought about having people repeatedly doing
this training maybe for two years and seeing how that will work?"
- So, we did build in a kind of sustainability component in that we train PIOs every year and
the CHP has been an incredible partner. So in both North and
South part of California, we hold Workshops, the PIOs come. So we're
continually finding, you know as the PIOs turnover, we're able to train them.
They're able to go out back out to their communities as many times as an employer
would want them to go. For some of these, and I'll get back to that, we have a
little bit more of a captive audience and we're able to do some maintenance.
So that's a really good Segway. We are trying to change distracted driving in
commercial drivers. So it's one thing to have a 3,000 pound
weapon and you're driving blind because you're looking down at your phone and
it's another to have a 12,000 pound weapon going down the road and the
driver is distracted. The way that we've been able to reach out to
commercial drivers is through more of their regulatory agencies who have given
us access to the commercial drivers. In that case, and we just got funded to
do this nationally, in that case we're definitely building it maintenance.
We're going out we're doing kind of the initial this is why we care and then
going back to them with reminders, little video clips, emails that we hope they're
not looking at while they're driving, and so on. This is just again to give you some
examples of the goals of what we want the commercial drivers to know about and
talking to them about the increase in fatalities amongst commercial drivers.
Then we try to include in all of our talk some kind of interaction with
the audience. You know true and false and
you know, what do you think the answer is to this, why do you think people are
behaving that way. We also try to incorporate a lot of videos.
- The California Highway Patrol has commercial enforcement units on the road looking
out for distracted commercial drivers. Often when we make commercial vehicle
stops for people that are distracted using their cell phones, talking or
texting they give excuses that "Hey my boss just called," "I'm trying to find out
where I'm going," and the bottom line is the call can wait. They can wait till
they get where they're going or exit the freeway to a safe location. I think one of
the most difficult things is when we go to vehicle collisions involving commercial
motor vehicles, a lot of times they're preventable. People a lot of times
are distracted. They're not paying attention. If they had just been watching the
road the whole thing could have been avoided.
- So again I’ve got a number of curriculum to get through so
I'm just giving you some of the snippets that sort of give you the idea. Each of
our audiences is slightly different. The commercial drivers obviously have a very
different focus you know. They are wanting to you know... they drive for
living, they have different regulations, and so on.
Speaking of audiences, we also do pedestrian safety workshop. Now as you
may know the pedestrian fatalities are concentrated
in the youngest and the oldest populations in the United States. The youngsters
are often covered by their schools. There's quite a bit of programs across
the country. We have pedestrian safety for the youngsters. So we focus on the older adults and
use the same model. So, training PIOs to go into senior centers, community
centers, talking to older adults about what they can do to keep themselves from
being a victim of a crash. Talking to them about how pedestrian fatalities are
increasing. Now I've shown this to you in order. You know high amounts of
distracted driving increase in pedestrian fatalities, I
think there's relationship.
- "We do it all the time - cross the street. Usually without being hit by a car,
but pedestrian vehicle collisions are an increasing problem. Especially for older
adults. Nearly always leading to serious injury- even death. Fortunately, many of
these injuries and fatalities are preventable by simply following basic
traffic laws." - So, you get the idea. We talk to people about,
sorry about the crash. We talk to people about what they can do. I mean there are really
specific things that people can do that will reduce it. Something like 60-70 percent
of pedestrian fatalities are people who aren't crossing at the light, when the lights
green, and when there's enough time to cross.
- "We did a data collection last
year for new pedestrian signal and some of the signs we found allowed the pedestrians to walk
when they are not supposed to."
- Yeah I did some pro bono work the city of New York
only because I really like theater and I'll go to New York, any excuse to go to theater.
So, I've been working with them for about six years and the jaywalking in
New York is just completely out of control and their senior population is
also highly over-represented as the pedestrian fatalities.
So we also have a program for older adults
on safe driving. Again the PIOs go out and track
wherever older adults, older drivers are hanging out, finding them,
advertising, getting people to come to the seminars. So, we created the
curriculum for them, talking about these topics. One of the topics that you haven't seen before
is kind of self-assessment. So it's estimated that if we live long enough, your average
woman will outlive their driving by ten years of the average man by six years.
Just because men have a shorter life expectancy. So, at some point
we hope older adults will have the opportunity to experience driving
retirement. So one of the things that we want to give the message is like how do
you self-regulate and what are the things that you're going to look for, that your
driving is deteriorating. We just did a study in the simulator
showing that how reflexes decrease with age and also how being able to
identify objects in the periphery especially during distraction
deteriorate with age, not that anybody does it well. One of the things that we
suggest to the older adults, just again I'm just giving you snippets of the
curriculum, is that they make more right turns then left turns. So interestingly in
our AAA study of the three thousand older drivers
across the country that we recorded to our AAA study, we looked at which
medications were associated with these driving behaviors. What we found in
CNS drugs that cause, so your CNS drugs are like your pain killers including
opiates. Those were associated with speeding. Antihistamines
were associated with people making more right turns then left turns. The ratio
changed. So, we're thinking, well maybe people are
feeling a little dizzy from their antihistamine. They're a little insecure so
they're gonna make arrangements more often.
- "Timing is everything and when you're on the Highway, every second counts.
- Professor Linda Hill "We did not make this video."
- We usually think of stopping in terms of space
but what really matters is time. It takes about one and a half seconds to notice a
potential risk in front of you and another one and a half seconds to
react, hit the brakes, and slow it down. So you want to give
yourself at least three seconds between the car in front of you and your vehicle.
To measure, wait for the car ahead of you to pass a set objective tree road sign
light pole - any clear marker will do. Effort passes start counting - one
thousand one, one thousand two, one thousand three."
- You get the idea.
Sometimes we find really good videos that somebody else has made and if we don't find them
we make our own. I would say we make our own about four-fifths.
- "I'm curious how your participants, especially in amounts of aid,
respond to the notion of losing independence. I've this issue with my own family and it's like
No, how am I going to be able to get anywhere if I can't drive myself?
How do conversations go?"
- So, I've never given a
talk on older driver safety without somebody raising their hand and saying
that they're facing this. It's so common and it's very difficult for people to not drive in this country.
Before the talk we were having lunch and just talking above the problems of inadequate
public transportation in this country and really that gets to the heart of it in
terms of what do people do when they are giving up driving.
So, what we do is we talk to them about
what are the disadvantages to driving. So, you have your issues around
liabilities. Do you know, have you guys seen the study, how much does AAA
estimate that it costs to operate a car every year.
- The statistics I saw it is on
cars like five to six thousand dollars. - So AAA says nine thousand, you
know maybe how much they're including like you know you, in addition to
the car, the depreciation, the car, the gas, the parking and the
concerns about liability. So, we've been trying to put a positive spin on it. Definitely, it’s a very emotional
issue. It was so emotional that you knocked your water over.
(laughter) -audience member who dropped water- "I mean I couldn't handle it." (laughter)
- *Professor Linda Hill* I really feel for you.
- "Hey, I have a follow up question. Have you talked at all with
some of your older participants or people that you're speaking with
about these vehicles with semi-autonomous capabilities, like
adaptive cruise control, lane correction, and stuff like that.
Do you know if that makes them a more qualified driver then they would be on their
own. We're collecting all that data in our AAA
study and we have all the data on what equipment this group of
3000 older adults has and what they are using.
There's an umbrella insurance watchdog, not a watchdog,
that does research on this kind of thing and I often sit on a panel with them and
they have been collecting this very carefully and have been showing that
those have reduced crashes. That those kinds of things, the lane warnings,
all the bells and whistles that are at front stop, have been very
helpful. So as people's cars turn over and they require these things, that is useful.
You’ve still got the problem with the older driver that you've got a decrease
in vision where over the age of eighty, 25 percent of people have
severe vision impairment that can't be corrected.
You have cognitive decline with 30 to 50 percent of the people over the
age of 85 having significant cognitive decline and then you
general frailty medications and other conformities. That's just the
reality, it's not ageism, it's just the reality of what we're dealing with. So
I'll show you very quickly what we're doing with teens. We have also been
partnering with a local police in going out to schools and Boys and Girls Clubs and
other places where teens hang out and talking to them about alcohol and
underage drinking and driving. So we've
incorporated kind of this as well, but most of the focus is on alcohol.
- "Blood alcohol Content (BAC) is the amount of alcohol in your system.
If you are over 21, 0.08 percent BAC is illegal. Under 21
0.01 percent is illegal. Here's the thing, one drink, just one
drink could get you to that point. California has a zero-tolerance law. If
you are stopped and tested at 0.01 percent, it can lead to a citation
and additional consequences including having your license suspended.
You see, we hopefully change the content of our videos to sort of match our audience.
We also paired the work that we're doing with teen alcohol, with having law enforcement has
a program that'll take teens out to see DUI check spots. For those who can't go
out and see them, we created a video. So what happens at a checkpoint? It all
depends on what officers see, smell, and hear. First, they ask a couple of
questions, check out how your breath smells, and take a look at your eyes
using a test called the horizontal gaze nystagmus test.
- "All right, watch my finger with your eyes only,
keep your head still, don't move your head please. Thank you."
Even if you think you're cool under pressure or that breath mints will
mask the smell of a beer, you can't control what happens to your eyes when
you are impaired.
So, we talk to them about cannabis as well and how, you know, with the
legalization of cannabis, that there has been an uptake.
Actually, the fastest group, but not the group with the most users is the
baby boomers who were smoking when they were young and then now that it's legal are smoking again.
All of these, I'm just giving you snippets, all of our curriculum lasts about 45-50 minutes
with room for questions and then we end with this one.
*new video begins*
*video ends*
We didn't write that one, but we really like it.
So, with the legalization of cannabis we thought we'd better go out and talk to the adults
about cannabis and driving. So, this is our most recent curriculum. We just
finished it and did our pilot studies in the fall and now this is rolling out. Now
we're training our PIOs. So, included in this is the increase in THC concentration
just from 2001, just a massive increase. Also, we talk a lot about the effects of
cannabis and how long it lasts apropos to driving.
So, with inhaling, because of the rapid intake through the lungs,
it gets in faster, it gets out faster, but with the edibles being a problem and as
you probably heard one of the things about edibles is that because people
don't feel high fast enough, sometimes they eat too much and then they have a
delayed effect. So that can really affect. I mean eight to ten hours is a long time
to not be driving after cannabis use. So we have a lot of discussions about that
in the curriculum that we have. One of the researchers that I work with
at UCSD, Tom Arcot, has a grant from California Highway Patrol in their
Cannabis Research Center at UCSD where they were given IRB permission to bring
people who already used cannabis into their lab, roll them a joint and then
start collecting breath, saliva, blood, and urine from them every 30 to 60 minutes
and putting them in a simulator. One of the things that he's found is that
there was a delay in when people realized that they were no longer, I'm not
saying this properly. So, every hour they would ask people "do you think you're
ready to drive?" What they found
is that the impairment went on for four hours but after three hours the subjects
thought "I'm ready to drive," but yet they could still demonstrate impairment in
the simulator.
- "Wouldn't that just be based on a person's tolerance to the drug. Like some
people could be consuming cannabis every day and it wouldn't do anything to them but
then someone that consumes it once a week could be impacted more and might have
to wait longer like that. "
- In this case they were showing that people were still impaired till four
hours but the same people were saying I'm ready to drive at three hours but
they showed they weren't ready to drive until four hours. It's
true that you have a situation where some people are using
cannabis out there, you know using it in a way that there's some situation but in
this particular example, these were people who were still demonstrating
impairment in the simulator.
- "Feeling okay to drive is
like the most subjective thing."
-For sure, but people make those decisions all the time. You
go to a bar or in my case you go to a dinner party and somebody serves you
know wine and then you're saying "I'm okay to drive." You're always making that
decision so the question is how accurate is that decision.
- "Well, that’s what drugs do. They make you feel like you could do something
when you probably shouldn't. "
- Right so our message to people is, we have lots of options now,
well actually I think I'm jumping ahead.
- "You can smoke and drink a little and you'll be fine to drive."
"No you can't. "
"I actually drive better when I'm high."
"No."
" The police can't tell that I'm driving high."
"Yeah we can."
- So we made that as a PSA, but we also have a longer version
that we show in the video and then we talk to people about what their options
are. We tell people make your transportation plans before you leave,
whether it's alcohol or cannabis. Why not plan ahead? One thing about a
designated driver is sometimes when people have been asked in the group
who's the designated driver and what makes them the designated driver, the
answer sometimes is that's the person who's have the least to drink where as
your designated driver should be someone that has had nothing to drink.
Let me just stop there, that's actually much higher than that. So when
you say "how many people have we've been able to reach with our interventions?"
With distracted driving alone,
we had control of it before we even gave it to the PIOs.
We were over 10,000 people that we've been able to reach and now the PIOs are
going across California with the curriculum, but we know that it's a
really labor-intensive way of reaching people and it's not the best way to
reach 40 million people. We've also used social marketing which draws on, you
Know, advertising other kinds of marketing. Social media is one aspect of
social marketing, but like that particular clip that I just showed you,
can turn into a PSA that could be a stand alone and we've done that with a little bit of additional stuff.
- "Weed, pot, kush, dank, no matter
what you call, it's illegal to drive high. Driving high is a DUI.
Brought to you by the Trans Higher Education Project at UC San Diego"
- "If you do, don't.
It's illegal to drive high. Driving high is a DUI.
Brought to you by the Trans Higher Education Project at UC San Diego.
We also made cannabis fact cards. We encouraged our law enforcement partners
that one of the things that they could do besides giving citations or arresting
people is educate people on the street. So we created like fact cards for them to
try to tell people how long people may be impaired. We also
do work with physicians and I'm going to talk to you
about that, I still have some time and I wanted to talk to you about
our professional training as well. Physicians are a really difficult route
to get to do things because, well you know I've been doing patient care for a
long time, you're just under a lot of pressure to keep going. We've got about
15 minutes to get all of our messages across and take care of people's
concerns and order lab and prescribe drugs. It's just a very hectic
environment. So when I try to get physicians to actually do what I want
them to do which is to be behavior change agents in the area of injury
prevention, it takes a lot of convincing. You have to make things
very simple for them so we created pocket guides where you can just say to
People, “look if you're going to smoke cannabis these are the things you should worry about, if
you're gonna drink, don’t drive” and try and make their
points for them very easy. As you can imagine with social marketing, this again
outdated, it's been very easy to reach people on Facebook, on YouTube. CHP has
posted our videos on their website. That has been like a way of reaching people
but we don't have any way of knowing really how well we're doing at changing
behavior. These (the videos on the CHP website) are very short little snippets some of them and it's been
difficult. So as I said, we also do professional education because we view
this as a way of also changing behavior. So, first I'm going to tell you about what
we developed for older drivers. Why do you need to train law enforcement
on older drivers? Well we did focus groups with law enforcement and it turns out
that law enforcement said to us "we really hate the older driver stuff.
You've got you know an 85 year old driving the wrong way on a residential
street and that stop is going to take hours and meanwhile there's
you know there are these young people who are speeding or they're
driving impaired and we'd rather be dealing with them. So what they were
telling us is that they were being very lenient with the older drivers and they
were not reporting them to the DMV. So the mechanism for law enforcement to
help the older drivers, first of all if they're impaired right now, if I have
somebody in front of me who doesn't know who they are, where they are, or what
time it is, that somebody is who shouldn't be driving right now. So that person
should be off the road now. The question about how long they should be off the
road isn't my decision as a mandated reporter and it's not law enforcement’s
Decisions, that's DMV. But DMV doesn't know there's a problem unless you tell
them. After having focus groups with law enforcement and figuring out you
know how much more problem do we have we created a curriculum for law
enforcement to show them that this is a problem and this is what you should do.
So one of the things that we did to try to help the officers is we created a
tool for them to keep in their ticket book and the tool was this
concept of orientation to person, place, and time. We've been using this and notice
it a lot. So, the term disoriented is not the same as dementia.
Dementia is a diagnosis, it’s a you know a progressive neurological
disease that causes cognitive impairment. Disorientation means right now I
am so confused I don't know where I am or who I am or whatever. Often people who
are disoriented also have dementia, but we created a tool for officers. They're
not trying to diagnose, they just need to know is somebody confused right now. So
we created a tool for them that we call the DOSCI and we also developed it for
their cell phones so that they could just download this for free. We made this
available as freeware and any officer across the country can download this.
In fact, COBEX made this into law.
I met them at a conference, they heard about this
and they have incorporated the DOSCI into law.
So that you know, as I said, it asks about you know who you are, where
you are, and what state you're in. You might ask the question, "well what if you're
drunk? Are you gonna be disoriented when you're drunk?"
So the way they tested that is the way law enforcement trains officers to do
roadside tests is they get a bunch of volunteers to come to the Doubletree
hotel or wherever and they systematically get them intoxicated and
then the officers get a chance to test people and they keep doing breath tests.
“Okay here's a bunch of people who had a 0.08 and here's a bunch of people
who are 0.16, see if you can tell the difference and so on.” So we're
like "hey could we come in and administer the DOSCI to people as they're getting
intoxicated?" It turns out you can be really drunk and you still know your
name, your date of birth, and where you live. So, we were quite sure that the officers were not going to confuse
disorientation and intoxication. Then, just to be sure that we had this right
we went to our Alzheimer's Center where they have a lot of
older volunteer controls and we were able to show that on average, people who
are disoriented, who have dementia, missed
two-and-a-half of our questions. So then we train officers on who should be
reported to the DMV. Again, as a physician, as an officer, we don't take away
licenses. We only let the DMV know to evaluate further.
-"But that's all part of growing old
but what does that have to do with my driving anyway?
Based on my observations of your driving, you pulled out in front of another car, you're
swerving all over your lane, and I just think that it's in the safest interest of
everybody else and yourself that you don't continue to drive today okay? Is
there anybody that you know that we could call and maybe come pick you up. No, I'm
perfectly fine. I've been driving longer than you've
been alive. Sir I understand."
- "I understand doctors are very reluctant due to the patient client relationship
to report their client."
- That's a wonderful Segway to my last curriculum
that I'm going to show you thank you. That was a snip from a 9 minute video
that we created that's like the ideal traffic stop. [It] shows the officer, who's a
real officer, using the DOSCI with an actor and then you know taking him off
the road. So, funny story I'm in New York as I said to do pro bono work and NYPD asked
me to come present the you know older driver traffic stopped at NYPD.
I'm like okay and they take me out to their training center and I'm at the
podium and 200 armed men in blue show up in the audience and I'm like *Professor Hill performs hyperventilating motion*
So I go through my talk and I show this video and they're
doubled over laughing and I'm like okay why?
They're like "California Highway patrol - they're not that polite." (laughter)
So we have trained every single California Highway Patrol officer in the state on older driver safety.
I lied. I actually have two more things to show you. *laughter*
So, we also ask them - how about if we help officers not get distracted. We think it's a problem
for officers too and they said yes. We told them that when their PIOs are
going out and talking to the public, often somebody in the audience will
raise their hand and say, "hey I see officers on their phone." So they were like
- "Yeah we want your help." So, we created a Just Drive like curriculum but
targeting officers to try to improve their safety and we talk to them
about similar things, but all the pictures are police cars and you know we
have testimony from officers
- "I'm going over an overpass and a buddy of mine sent me a text on where to meet for
lunch so I have the phone in my right hand and I'm looking down at my phone
and as soon as I look up, I'm doing about 35 miles per hour and I see the traffic has
stopped ahead of me. What was funny is I looked in the sideview mirror of the car
that I was approaching and I could see the lady gripping her steering wheel
like bracing for the impact because she saw the patrol car coming at her you
know pretty fast. So I hit the brakes and was just able to stop about a foot off
of her bumper. As I stopped, I looked at her. She looked at me. We both took a deep breath.
Waved and that was it. So I was this close because I was looking at my cell phone,
from hitting that car."
So, you get the idea. Better that the testimony came from another officer.
So throughout this I haven't bombarded you with a lot of evaluation. Again every
time we do this we do pre and post testing. We're trying to build in, especially in
higher education, the same kind of concept. Give us your email. We'll send you
an email. Your answers will be anonymous. We'll roll you in a lottery.
We're trying to do that as much as Possible.
Certainly, officers were harder to convince that they were not safe driving
while they're using cell phones. I mean still disappointingly low results,
but they did say that their awareness and they intended to change some of
their cell phone behavior went up and you know a lot of nice comments. So the
last thing I'm going to show you is what we try to do to get to the answer to
your question is "how do we talk to doctors." So we created a curriculum for
doctors talking about... by the way I think it’s kind of interesting. This is what the world looks like for someone with macular degeneration.
The middle part of their vision goes away and eventually it's just
completely gone. You can see how driving with macular degeneration would
be a problem. This is cataracts that are untreated.
Leading cause of blindness in the world, but you know completely reversible and
glaucoma. Glaucoma you can see causes peripheral vision
problems but the central vision spared. So, we remind doctors of that and
then again, I'm just giving you the snippets. The American Medical
Association, the National Highway Traffic Safety Administration, the American Geriatric
Society all got together and said "what are the tests that we can do for older
adults that best predict who should be driving." We talk to them about what
medications are bad. I mean doctors are prescribing the medicine, they should
know what the effects of those medications are on driving.
One way to get to physicians is to talk to them about risk management and
their liability. So, I point out which many people, many physicians don't know
is that dementia is a reportable disease. All lapses of consciousness are
reportable disease. So as a physician in California of course I have
to report TB, corona virus, measles you know of course I have to report all
those things. What those doctors don't realize is lapses of consciousness is on
that list and if you don't report, then you're liable. So, what's
happened in California on a number of occasions is the physician has not
reported. Their patient has gotten in a crash and then the victim's family or
the victim that survives sues the physician. So I get physicians attention
that way you know. It's one way of approaching it. Across the United
States, there's a huge variety of ways of reporting. So California is a mandated
reporting state but only six other states are. The other states are
either permissive or there's no mechanism for reporting. There's no way
that I as physician could tell the DMV that I had a patient with a brain tumor
who was you know losing consciousness. The other way that we've been able to
reach docs is through the medical court. So this is who licenses physicians,
physician assistants, and podiatrist. So every quarter we get this in the mail
and the first thing doctors do is they open it up and they look to see who got
reprimanded because it's got a list of all the doctors who were reprimanded. So this news letter
really gets people's attention. So, what we've done is we've convinced them that if
we'll write three 400-word essays on the physicians role in driving safety and we
know it reaches a 160,000 practitioners in the
state. So really cool way of reaching people.
- "Older adults and their families depend on us to identify risk factors - inaudible- and assist
with the transition into driving retirement."
So again, trying to make it easy for the doctors. All they have to do is
go to our website and the training that I provide in
Person, they can get online. We created, again just like with the cops who tried
to model the ideal office visit telling the patient that in this case this
patient was just diagnosed with dementia and talking to them about what
language they can use so that their patients aren't worried, feel supported, know
the reasons that you're reporting them. That has been a really awesome way of
reaching physicians between the newsletters and we've had, you know, some
good results with physicians saying that they often don't know about this reporting
and then we did the same three-month thing and this
is just one example, my counseling has gone up.
So that's the end of my talk
Open to questions.
So speaking about the distracted driving - so using cell phone,
either hands free or hand-held cell phone-
is significantly affecting their driving practice, but potentially car manufacturers are
trying to get those drivers more distracted with speaker display or
Bluetooth, hands free connection. How do you think about that. Well, what you can do for
cutting off manufactures or aviation systems No it's completely
Ridiculous and there's something about talking to
somebody else. If you have the person sitting next to you, it seems that
that's a kind of shared experience. You both see what's going on. The
person's merging, the person stops talking, or in my husband's case- he's a much
better driver when I'm telling him what do. Slow down, watch out.
When you're talking on the phone, there's no shared experience and the person who's
driving is like the whole to the person on the other end of the phone.
And you guys all know this, I mean you know
you're in a restaurant and you're talking to the person you're with
and then person at the next table gets on the phone and they're like so
clued out. They don't know how loud they're talking. They're saying things like... Are
you kidding you're saying that out loud, next to me.
So I think I think it's a really
bad idea. Anytime the driver takes their eyes off the road
they're driving blind. I mean it's crazy.
For a while I
would see a truck driver holding something and talking on it and I would call
the truck company and report it and then somebody said 'oh it's a radio.'
It's not a cell phone, it's a radio."
That they're holding to their ear?
Ya.
Ok.
So it seems that generally music is not a problem.
It's the interaction that's the problem.
I do know truck drivers can engage with like rest stops and stuff like that.
So they definitely have the radios. I think that’s the main idea.
Its not like music or any of that.
So it's more of a CD?
You talk to other truckers.
Yeah you know anytime it's interactive it's going to be a problem.
I think they're pre-installed in the trucks and everything ."
No, its uh, what can I tell you.
Is there anything that people have done to change the
design of phones so that they can't be used?
So certainly. Definitely the phone companies could take care of this tomorrow.
They can just say if the pumps going more than 10 miles an hour that that phone will be disabled.
They could completely solve this problem. You know people will say well I'm a
passenger and they're just gonna press the I'm not driving. You know that
exists too. If my husband's driving and and I try to make a call or
a call is coming in, my phone will block it unless I tell it I'm not driving.
I mean people will get around it, but they could drastically reduce the amount of
distracted driving if they wanted, the technology's there. They've just chosen
not to and in fact AT&T has done a massive
campaign "It can wait" and it's only focused on texting. They've made
the decision that they're not going to address cell phone use just texting.
*Audience member* "So then there are a lot people who put their cellphones as a navigation device and put
on the dashboard. Would that have some effects on distraction?"
If you take your eyes off the road, you're going to take your eyes off the road.
So, if you're having to look away a lot to look at that
navigation device, that's a problem. The navigation device is talking to you.
That's fine and it's not like a cellphone. Again, if you're not having to
respond, your brain doesn't like incorporate the language part of your
brain like that. So I think especially the ones that talk, that's fine. What you
know what we say is you know plan your route ahead of time and look at your GPS
ahead of time and then put it there and try to get it to talk to you.
*Audience member* "I'm curious about the use of law enforcement.
You mentioned at the beginning of your talk
that you usually work with communities that are impacted. It’s mainly by law
enforcement in the areas of migrant communities and undocumented folks. From my experience
in studying vision zero and people's resistance to that extra enforcement piece because of
the negative effects it has on more vulnerable communities and the amount of
trust that we can have with law enforcement, I'm thinking a lot about
like how effective is using CHP PIOs and do you have plans to use other folks?"
We do and we do use other folks. We invite anybody to come to our
trainings. So, the problem has been who's got the time and who’s paid to do it.
So, we're not paid to do it. We're only paid to develop curriculum, but
other groups do come out to our trainings and do go out into the
community. I think when law enforcement is acting in an educational role, maybe
they're better received. I think CHP is better received than local law enforcement. I totally know what you're saying.
It's the other reason that we use social marketing. It's so that we have alternatives in terms of reaching.
Sorry and your question?
*Audience member* "So I feel like there's a greater divide between like talk the talk and walk the walk.
So even after this seminar, we know that being distracted or using your phone in the car is really bad.
But once we get out of this room and start driving *inaudible*
So is there another mechanism to reduce the gap between 'talk the talk’ and ‘walk the walk'?"
*Professor Hill* Yeah that's it right?
It's the total challenge in public health is that you know how do
you go from knowledge to behavior change. That is the whole thing that we
you know try to work on. Knowing that, you know,
starting out with knowledge change is part of it,
but trying to move people into motivation, that's the big thing that you have to do.
and so thinking about how you can get your message across that's as motivating as possible.
*Audience member* "I mean so far the motivation is all low cost.
Whether it's a fine, loss of life, or you know.
Is there a mechanism besides the cost that can motivate people like help people understand?
Or like reduce the gap between 'talk the talk’ and ‘walk the walk'."
*Professor Hill* Did you have an answer?
*A different audience member* Well I was just gonna say. I feel like it's kind of tough because what I think works the best
would be like when people feel shamed to do something. I feel like that's a really
good deterrent from getting them to do that, but as like a public health
professional you shouldn't really be shaming people because you also want to
be an outlet for them to speak with and communicate with about these things that
they have going on. But I mean that's what I kind of struggle when I
think about this, is I feel like shame is a really good way to deter people but
it's also not appropriate to shame people.
*Another audience member* "There's a behavioral economic study that there's a
case with kindergartens parents who are always late and initially they fine
them like five dollars and ten dollars and the parents just give the money, but then
later on they shame the people who are late and don't need to pay the money and
actually that reduce significant amount of the late students.
So that's a case for your shame example."
*Profesor Hill* Yeah I mean I think we have to look at the lessons that we have done where we've had
public health successes. So, you know smoking has been a public health success
and again, as I said at the beginning, part of the way that we got people to
change their behavior was by having them look at how it affected the people in
their lives. I didn't have time to go into all of the manipulation that we do
during our talks, but one thing we ask people to do is to do a pledge card and
to write down one thing, who are they doing it for and one
thing they can do to reduce their distracted driving. Again, trying to play
on who are your connections,
who would care. It's just like people are using kids to get to their parent
smokers and that kind of family they had. I will say that I'm all about education and I'm all
about the individual changing their behavior. I think there is a role
for enforcement. I think if you were to stop Highway Patrol from
stopping any speeders on highway 80, that people would be driving faster. I mean it's really sad
right. It seems to be that enforcement has a role in public health
and again, look at what happened with smoking. I did a
sabbatical in England where smoking was still allowed in the hospitals
and you're talking to the surgeons and they're saying
"You expect me to get through a surgery and I haven't had a cigarette all day, like really?"
And then, you know then they finally came in and they said "there's not going
to be any smoking in public places. The cops aren't smoking." You can talk until you're
blue in the face and then sometimes legislation comes in and they change
your behavior and look at California. Less than 10 percent. UCSD, probably UC
Davis - completely smoke free campus. You know, imagine that!
*Audience member* "Now all of the cigarettes are on the street.
*Professor Hill* It’s got to be a deterrent.
I think what we'll stop here.