YOUNG DRIVERS: THE PROBLEM OF SLEEP

YOUNG DRIVERS: THE PROBLEM OF SLEEP ALAN R WOODSIDE and IMELDA C WILSON Transport and Road Assessment Centre, School of the Built Environment, Room 5D...
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YOUNG DRIVERS: THE PROBLEM OF SLEEP ALAN R WOODSIDE and IMELDA C WILSON Transport and Road Assessment Centre, School of the Built Environment, Room 5D12 University of Ulster, Newtownabbey, County Antrim, BT37 OQB Northern Ireland, UK Telephone: +44 2890 368706, Fax: +44 2890368707 Email: [email protected] SUMMARY Virtually, almost all studies that have analyzed data or conducted surveys measuring sleepiness, by gender and age group found that young drivers, especially males, were most likely to be involved in a sleep-related road traffic accident. An interview survey of 522 young drivers (17-24 year old) was undertaken. It was designed to investigate the relationship between young drivers in Northern Ireland’s communities and daytime sleepiness (measured using the Epworth Sleepiness Scale) and other relevant physical characteristics such as average nightly sleep and aspects of social and work life. The drivers were randomly selected to participate in this study. This research is beneficial as it proves that there is a definite link between drowsiness and driver performance and will therefore enables measures to be designed to eradicate the risk of road traffic accidents occurring as a result of drowsiness. Keywords:

Accidents; driver performance; sleep deprivation; young drivers

INTRODUCTION Road traffic injury accidents are a daily occurrence and are responsible for a vast number of deaths and serious injury in each society. The Global Burden of Disease study estimated traffic injury to be the ninth leading cause of death and disability in the world in 1990, and it projected that it would be the third leading cause by 2020 (Murray, 1997). Many causes and contributing factors of road traffic injury accidents have been identified, such as drink, drugs, use of mobile phones and speed. However, major reviews and in depth research have suggested that fatigue or sleepiness in drivers of cars or other road vehicles dramatically increases accident risk. As research has proved fatigue related crashes have many of the characteristics of drink related accidents e.g. inability to brake or swerve until it is too late. Despite their similarities, fatigue has not been considered with equal concern. It must be said however, that fatigue is considerably more difficult to identify or measure; there is no device available to police officers that detects fatigue of a driver. Driver fatigue has particularly injurious consequences because of its ability to impair drivers from making critical,

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sound, spilt-second and in many cases life-saving decisions, such as swerving or braking. Evidently there is a problem relating poor sleep habits to below average driver performance. The fact remains that NI is a relatively small area of 5,500 square miles (about the size of Yorkshire) with approximately 1,688,600 inhabitants, of which on average 150 people each year are killed as a result of a road traffic accident. Fatigue is an up and coming problem as NI moves ever closer to becoming a 24-hour society. Sleep for many is becoming less of a priority and hectic work schedules and over active social lives are taking over. Not only is individual health deteriorating but for the population who drive this is becoming a death weapon on our roads. Road Safety is stressed constantly and at the highest level, fatigue is a new phenomenon and is one that is not going away as it grows steadily affecting everyone. What Is Already Known On This Topic? • Statistics show that NI has not escaped without the ill effect of sleep related accidents, over a five -year period (1997-2001) NI has fallen victim to a total of 135 accidents occurred where the principal factor was driver fatigue. Of these 135 accidents, 12 were fatal, 58 serious injuries and 112 slight injuries. (PSNI, 2001) • Driving while sleep deprived is clearly a risk factor to the majority of the populace particularly those who take the risk to driving whilst feeling sleepy / fatigued. • Studies have indicated that it is as potentially dangerous as drink driving as the same inability to react until it is too late is a common denominator. • There are an estimated high proportion of car crashes that are attributable to the driver and that a high percentage if these accidents involve single vehicles (hitting a tree, drifting lanes or plunging off the road). • Persons whom are prone to sleep-related accidents are shift workers and people who work long hours or people with a sleep disorder. • RAC motoring foundation released findings from a poll which showed ‘more than 60% of drivers questioned said they had driven while sleepy. Of these 8%, said they had nodded off momentarily at the wheel’. • The UK is vast becoming a 24 by 7 society with huge emphasis and pressures put on professional/managerial workers. • Young people are over represented in Road Traffic Injury accidents HISTORY OF SLEEP-RELATED ACCIDENTS IN NORTHERN IRELAND Sleep deprivation is a major contributing factor to many road traffic accidents in NI. During the period 1999/00 fatigue related incidents accounted for 34 accidents of which the primary factor primarily attributed to the driver was sleep deprivation. Of these 34 accidents resulted in 3 fatalities, 17 seriously injured, 34 slightly injured and a total of 54 casualties. These figures were an improvement on the same period for the previous year. 1998/99 experienced a total of 40 accidents, resulting in 5 deaths, 17 seriously injured, 47 slightly injured totaling 69 casualties. In Northern Ireland over a five-year period (1997-2001) a total of 135 accidents occurred where the principal factor was

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driver fatigue. Of these 135 accidents, 12 were fatal, 58 serious injuries and 112 slight injuries and it must be added all were unnecessary. Consideration must also be given to the fact that due to the inability to accurately measure fatigue or lack of sleep that many sleep-related incidents go unrecorded. It has been clearly stated throughout this investigation that driving while deprived of much needed sleep can significantly distort driving ability. This deterioration of driver performance has lead to many accidents and will continue to be a nuisance for road safety. According to leading medical practitioners and researchers the average human being requires at least eight hours sleep to provide for sixteen hours of sustained wakefulness. Many projects have found that if people are deprived of much needed sleep at night they will become sleepy throughout the day and are more likely to fall asleep at inappropriate times. This has major implications for most of the population who drive and other road users. In NI whilst a low percentage of young people actually drive, their involvement in road traffic accidents and in particular, sleep-related accidents is substantial. Research conducted by Carskadon (1990), concluded that those young people with part time jobs have been affected in terms of quality and quantity of sleep. It shows that a part time job has significant impact on sleep patterns and those who work more than 20 hours a week are sleeping significantly less, go to bed later, are more sleepy throughout the day and drink more caffeine and alcohol. Carskadon’s primary conclusion was that many young people are not getting enough sleep. She says, that the consequences of the chronic pattern of insufficient sleep are daytime sleepiness, vulnerability to catastrophic accidents, mood and behaviour problems, and increased vulnerability to drugs and alcohol. Disruptions to sleep are sourced from many differing aspects of life, for a young person, e.g. 1. Ever-changing academic demands (transition from school to university or work) 2. Expanding / extensive social opportunities and commitments – sometimes as a result of 1 3. Parent-child relationships (no longer told what time to go to bed – self-motivation and responsible) 4. Part-time job (not as much spare time – working more hours) 5. Increased access (as a result of more money) to alcohol and drugs, which can induce drowsiness. This paper investigates the tendency of young drivers to fall asleep at the wheel and the many reasons causing their lack of sleep. Young people by their very nature (youth) should be fit, healthy and able to cope with life, but nowadays with emphasis put on socializing, fast/convenience food and the increasing car culture, many are overweight and spend less time sleeping adequately.

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One of the most interesting but dangerous effects of sleeplessness is increased risk taking, research conducted by Loughborough University and Sleep Expert Professor Jim Horne. This research noted that as individuals become progressively more sleep-deprived the greater the risk taken. Young drivers are generally categorized as risk takers, reflected in the road traffic accident statistics for NI, young drivers are not only involved but are responsible for many of the ‘risk-taking’ type accidents, such as, speed. Even the most resilient person who believes they are a safe obedient driver will be guilty of risk taking as sleepiness is induced due to lack of sleep. This study highlights the possibility of deteriorated driving performance as a result of lack of sleep. Driver fatigue may be a contributing factor to one in five road traffic accidents and this is a potentially dangerous problem for road safety. Driving standards for most age ranges whilst lacking much needed sleep deteriorated notably. This project found, however, that the effect of driving with age group 17-24 years old and indeed 25-34 years old deteriorated more significantly than any other age range. This age group (17-24) was therefore highlighted as a high-risk group. Surveys from the 17-24 year old age group showed that more males than females tended to be drowsy at inappropriate times. Sleep deprivation has the potential to affect all drivers, as not obtaining adequate sleep can be done without intent. For example, someone in a stressful high-powered job, who also has a family to care for, can be at risk of obtaining less sleep as a result of more demands. However, for the majority of the young driving population, this is not the case. The top priorities encountered by young people include, university, job (semi-skilled or lower), socialising and/or a part-time job. Lack of sleep is derived as a result of an over zealous social life (which is considered to be part of university life) running late with an assignment or working a weekend job. METHOD Subjects 522 drivers between the age of 17 and 24 were questioned. These drivers were identified from groups, which they featured, i.e. sex bands (figure 1), occupation (figure 2), and driving experience (figure 3).

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60

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%

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0 Male

Female

Figure 1 Sex of Driver

Referring to figure 1 above, it can be noted that 54% of the survey population were male. 50

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%

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0 d ye plo em Un

ing ork ew im ll t Fu

Job PT

n tio ca du ee im ll t Fu

& Ed FT

Figure 2 Occupation of Driver

The occupation category was set as the variable factor and as a result of this, each of the four groups were targeted differently. Being based in a university campus, it was straightforward to recruit two of the four categories (full time education and full time education with part-time job). Full time workers section was 80% completed in a call centre and the remaining 20% was accomplished through friends and family who correspond with the appropriate category. Unemployed participants were more difficult to obtain. Unemployed young people in NI account for approximately 1.3% of the total workforce

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(economically active). During March 2003 there were more males unemployed than females by 50%. However of those who are unemployed a small minority actually drive. This is a result of many reasons, such as; one factor of being unemployed is that one does not have the money to spend on motoring costs. At this young age most people are only learning to drive and again this costs money. The cheapest driving lesson in the province would cost on average £15 and the tests (theory and practical), insurance and other expenses to complete the test are expensive. These costs are almost impossible to sustain without a regular income from a job. The Labour Force Survey estimate of the number economically inactive in Northern Ireland at March - May 2003 was 505,000; which is a decrease of 18,000 over the year. There were 781,000 economically active people in Northern Ireland in the period March - May 2003, an increase of 28,000 from the previous year. In the period March - May 2003 the unemployment rate1 in Northern Ireland was 5.2%, a decrease of 0.2 percentage points on the rate of 5.4% one year earlier. The unemployment rate for young people aged 18-24 is 9.8%, which is 4.6 percentage points higher than the rate for all ages (5.2%). (Department of Enterprise, Trade and Investment Northern Ireland Labour Force Statistics).

30

%

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0 1

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Figure 3 Driving Experience (Years)

Just over 50% of drivers questioned record up to 3 years driving experience. A little over one tenth of drivers are still restricted or have just completed their one years’ restricted driving. Only a very small quantity of drivers (~12%) had been driving for six years or more, therefore driving from the youngest possible legal age – 17.

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Questionnaire Design The questionnaire used consisted of 2 main parts. Each part could be analysed independently and then cross-tabulated with each other. Section one simply asked about sex, occupation, average nightly sleep, driving experience etc. It aimed to gain an illustration of each driver’s personality, daily routine and driving history. Section one was essential to depict individual habits and induced fatigue and for these to be grouped. Section two, consisted of the Epworth Sleepiness Scale (John, 1995), which gives a simple measure of excessive daytime sleepiness. It is brief, user friendly and simply asks the interviewee to rate their chances (on a scale 0-3) of dozing or falling asleep in eight different situations. EPWORTH SLEEPINESS SCALE In contrast to feeling tired, how likely are you to doze off or fall asleep – even for a spilt second, in the following situations? (Even if you have not done some of these things recently, try to work out how they would have affected you). Use the following scale to choose the most appropriate number for each situation. 0 = Would never doze 1 = Slight chance of dozing 2 = Moderate chance of dozing 3 = High chance of dozing Situation Sitting & Reading Watching TV Sitting inactive in a public area (i.e. theatre) As a passenger for an hour without a break Lying down to rest in the afternoon Sitting and talking to someone Sitting quietly after lunch without alcohol In a car, while stopping for a few minutes of traffic

Chance of Dozing _______ _______ _______ _______ _______ _______ _______ _______

Each participant can have a total score between 0 and 24; depending on how likely they would be to doze under the above circumstances. A score of 10 or greater is said to be a cause for concern as it indicates significant daytime sleepiness. A score below 10 is not a concern for daytime sleepiness. PROCESS Design The desired target group was redefined to obtain a practical group to be surveyed. It was impossible to move forward with a target group of ‘drivers’ the vast amount of them even in Northern Ireland was excessive. Therefore the following definition was formed for the targeted population: 1) All drivers who were aged between 17 and 24 years old, © Association for European Transport 2003

2) Who hold a full current UK drivers licence, 3) In Northern Ireland, and 4) During February to April 2003 Selection Bias This survey was designed to target drivers but only those aged between 17 and 24 years old (young drivers). Due to non-responses the actual survey population may differ slightly from the desired target population this was unavoidable. Information Bias In reviewing all literature on the issue of fatigue, it is important to remember that not all variables can be controlled or examined in a single study. Every study regardless of topic area will have its weak points and no single study can offer the ultimate, final answer or sets of answers. What are important are the conclusions drawn and recommendations made for the particular study and its circumstances. The overall picture that emerges must be credited in its own right for the work completed. RESULTS

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0 less than 30 minutes

1 hour - 2 hours

30 minutes - 1 hour

more than 2 hours

Figure 4 Travel to & from Work / University

Almost 70% of drivers questioned travel up to one hour to and from their place of work or university. However small, 8% of drivers are faced with 2 hours or more of travelling each day.

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Accidents 80

%

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0 No accidents

2 accidents 1 accident

4 accidents 3 accidents

5 accidents

Figure 5 Accident History (5 years)

Analysis of the 5-year accident history shows that an impressive three quarters of drivers have not been involved in any road traffic accidents. However, approximately one in five drivers have been involved in at least one accident in their driving experience. A further 6% of drivers have recorded involvement in 2 or more accidents, with no more than involvement in 5 accidents. Accidents in relation to sex and driving experience 100 90 80 70

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Figure 6 Accident History & Driving Experience

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The only group of drivers who reported no accident involvement were those who were in their eighth year of driving. All other groups recorded involvement in at least one accident. Those with 2, 3, 4 and 5 years experience expressed accident involvement in up to three and four accidents. 100 5 90

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%

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No accidents Male

Female

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Figure 7 Accident History & Sex of Driver

Males reported more involvement in road traffic accidents than females. There were 31% of males reporting some extent of accident involvement compared to 17% of females.

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No accidents ce an ch gh Hi ce an ch te era od M

ze do

e nc ha tc gh Sli

r ve ne ld ou W

Chances of Dozing Figure 8 Accident History & Chances of Dozing

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The above graph (figure 8) speaks volumes when correlating an accident history with a driver’s chances of dozing whilst stopped in a few minutes of traffic. Most noticeable is those drivers who claim to have a high chance of dozing whilst in traffic, also are those who have been involved in more road traffic accidents. These are the only group to record up to and including involvement in 5 accidents. Only 50% of this group reported no accident involvement, in the past 5 years. 16 14 12

%

10 8 6 4 2 0 Speed

Alcohol

Fatigue

Other

Principal factor in accident

Figure 9 Principal Factors in Accident

Those drivers who had been involved in accidents were asked what was the principal factor in the accident. The above depicts the answers from a choice of four factors. ‘Other’ and ‘Speed’ were reported as the top two factors, contributing to 14% and 7% respectively. ‘Fatigue’ and ‘Alcohol’ were two other principal factors noted, contributing to 3% and 2% respectively.

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100 90

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d ye plo em Un ing ork ew im ll t Fu n tio ca du ee im ll t Fu

& Ed FT

Occuaption of Driver Figure 10 Accident History & Occupation

The main factor highlighted in the figure 10 above shows the unemployed to be involved in fewer accidents than any other occupation. Only 12% of the unemployed questioned had accident involvement and this was in no more than one accident. Daytime sleepiness 14 12 10

%

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Epworth Sleepiness Scale

Figure 11 Epworth Sleepiness Scale

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16 15

19 17

Any driver participating in the Epworth Sleepiness Scale study has the potential to score between 0 and 24. Again a score of 10 or more depicts concern for daytime sleepiness as shown below. The range for this group was a little as zero to a high of 19.

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Daytime sleepiness

Epworth Scale

Figure 12 Epworth Scale - Yes or No

The Epworth Sleepiness Scale concluded that nearly half (41%) of all drivers interviewed had concern for excessive daytime sleepiness. This equates to major concern when these drivers take to the roads.

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Nightly Sleep 50

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Average Nightly Sleep

Figure 13 Average Nightly Sleep

As stated previously, 8 hours is the recommended amount of sleep. As much as half (50%) of the survey population are not receiving their sufficient nightly sleep. Reassuringly 40% are gaining the eight hours recommended, with a fortunate 10% acquiring 9 and 10 hours rest. 100 90 80 70

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%

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& part-time job 10 0

Full time education urs ho 10 rs ou 9h rs ou 8h rs ou 7h rs ou 6h rs ou 5h rs ou s 4 h r les o rs ou 3h

Average nightly sleep

Figure 14 Average Nightly Sleep & Occupation

It is surprising how the different occupations express totally diverse sleeping patterns. The recommended is 8 hours each night; all but 1% of the unemployed are gaining their adequate sleep. This is not true for the other occupations. The other occupations are sporadically spread across the bands. However it is only those in full time employment that sleep 4 hours or

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less. Those in full time education and with a part time job tend to get at least five hours sleep but up to 10 hours sleep. Week Nights Socialising 40 37

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1 night

2 nights

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Week Nights Socialising

Figure 15 Week Nights Socialising

Only 5% of 17-24 year olds do not socialise during the working week (Monday-Friday). The same amount (5%) are socialising every night of the working week. Over half (58%) of these drivers socialise at least once or twice each week. Furthermore, 1/3 go out 3 and 4 nights from Monday to Friday. 100 90

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Week Nights Socialising

Figure 16 Week Nights Socialising & Accident History

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Unfortunately a link has been noticed between socialising and accident history (figure 16). Only those who reported socialising five nights during the working week are those who also reported involvement in five road traffic accidents. The drivers who did not go out during the week recorded more ‘no accidents’. 100 90 80 70

%

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Principal factor 40 Other 30 Fatigue

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Alcohol

10 0

Speed Male

Female

Sex of Driver

Figure 17 Sex of Driver & Principal Factor

The “little boy racer” title cannot be used accordingly to this graph one third of both male and female who were involved in an accident reported the principal factor as speed. Fatigue was more of an issue for females.

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Work Through the Night 40

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Sometimes

Rarely

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Work Through Night

Figure 18 Work Through Night

Only one in three drivers noted that they ‘Never’ worked through the next night to finish a piece of work or prepare for the next day. 70% of drivers stated that they ‘Always’, ‘Sometimes’ or ‘Rarely’ (meaning they had done before and would do it again) worked through the night – depriving themselves of much needed sleep – to complete work demands. 100 90 80 70

%

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Drowsy when driving

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Always d ye plo em Un ing ork ew im ll t Fu n tio ca du ee im ll t Fu n tio ca du ee im ll t Fu

Occuaption of Driver

Figure 19 Occupation & Drowsy when driving

Again the only occupation that did not record ‘Always’ being drowsy whilst driving was the unemployed. As many as 41% of the unemployed stated ‘Never’ being drowsy whilst driving. The next to this was 15% representing the full time employed.

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Opinions 60

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0 Definitely

Maybe

Not really

No

Major factor in NI RTA

Figure 20 Is Sleep a Major Factor in NI's RTA?

This question caused drivers to pause and think about road traffic accidents in NI. 40% of respondents claimed that fatigue was ‘Definitely’ a major factor in road traffic accidents in NI and over half replied ‘Maybe’. A small minority were not convinced that fatigue has such an impact on accidents, 7% answered ‘Not really’ and 3% replied with adamant ‘No’. 60

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Disagree

Don't know

As Serious as Drink Driving

Figure 21 Is Sleep as serious as Drink-Driving?

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Another question that inflicted thought on the participants was the seriousness of fatigue compared to that of drink-driving, as it has been compared on many occasions. It was reassuring to know that over half (56%) agree that driving whilst much deprived of sleep is as serious as driving whilst under the influence of alcohol. However almost one third of drivers disagreed Discussion: In Northern Ireland people under the age of 25 comprise 37% of the country’s overall population. Of this 37% approximately one quarter of them are of legal driving age (17 ages +). According to Police Service of NI and Department of Environment data, young car drivers (17-25) form a lesser percentage of NI car drivers, however they are attributable for a sizeable amount of fatal and serious road traffic injury accidents. Young male car drivers total 6.9% of all NI car drivers, but are attributable for 27.4% of all fatal and serious injury accidents. Young female car drivers form 5.5% of all NI car drivers and account for 6.7% of injurious accidents. It is clear that of all age groups of drivers, it is the young drivers that are contributing to more road traffic accidents that any other age group. It is clear from the above data that young drivers are over-represented in road traffic accidents. Just recently in NI another campaign was launched which concentrated on speeding and in particular identified young males (On local roads 8 out of 10 speed-related fatal crashes are caused by male drivers aged 17 to 24 – so speed is the biggest single cause of road deaths and young males are the biggest single killers). Cumulative effects of induced tiredness could occur with a combination of elements happening to an individual at any one time. Examples include: - Disruption sleep, (waking during the night) - Lack of sleep, (not receiving adequate – 8 hours nightly sleep) - Driving at peak ‘fatiguing’ times (midnight-6am and mid afternoon) - Driving after lunch (mid afternoon – especially older drivers) - Whilst using sedating medicines (even OTC cough mixtures) - Untreated or unrecognized sleep disorders - After consuming even a low dose of alcohol. The investigation also noted that people, who tend to be ‘dozy’ per se, were at more risk of being involved in a sleep-related accident that those who were of an ‘alert’ behaviour normally. It emphasises the risk of young drivers, particularly young male drivers and the danger to themselves and other as a result of lack of sleep. Concluding Remarks: Young people in society are the future, they need to learn from example but also to set example to the next generation of drivers. It is unfortunate that this study highlighted the problems that young drivers are causing for road safety. As adults they need to be made more aware and accept full responsibility for their actions. But as they make up the smallest age group of drivers but the largest in terms of accidents; their responsibility must be questioned.

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This paper concludes that young drivers are a danger to the society in which they live as a result of their daily behaviour and lifestyle. Young males are in general ‘high risk’ in NI, this is somewhat confirmed in relation to total number of accidents that they cause or contribute to. One well-known principal causation being speed, but with an increasing number of incidents attributable to driver fatigue, it is stressing that lack of sleep is a major contentious issue for the new century as we constantly push forward to a 24 by 7 hour society. Recommendations: Awareness is a very successful key in the aim to reduce these types of accidents. Detection is very difficult for police officers as there are no mechanisms available to them for identifying sleep deprivation / drowsiness. Educating drivers through a range of mediums would be more beneficial than many in-car technology systems (as these often detect sleepiness when it is too late and the driver does not need to be asleep to be involved in a sleeprelated accident). Fatigue is most frightening as no diver is exempt from the feeling of tiredness and anyone can have a disruptive night’s sleep for many reasons. It is therefore, for these reasons that fatigue-related accidents will continue to dominate road traffic injuries and deaths on our roads. Education, Engineering, and Enforcement are heavily used in NI’s society to combat accident issues such as speed and drink driving. Tackling young drivers is a separate issue and one that needs a lot of preparation and time. Encouragement could be seen as the way forward coupled with education (awareness). Encouragement could be seen as a tool to not putting young drivers down and alienating them as amateurs, as they resent this approach by authorities and elders, making them feel responsible and in control of their speed (to reduce it) may have a better impact on road safety than telling them and imposing on them more rules and regulations. References: Carskadon, Mary. 1990. “Patterns of sleep and sleepiness in adolescents.” Pediatrician. Carskadon, MA, Harvey, K., Duke, P., Anders, TF, Litt, IF, Dement, WC. 1980. “Pubertal Changes in Daytime Sleepiness,” Sleep 2: 453-460. Coyne, P., (1994) Roadcraft: The Police Driver’s Handbook The Police Foundation, HMSO Hartley, L., (1995) Fatigue and Driving: Driver impairment, driver fatigue and driving simulation Taylor and Francis Horne, J., Reyner, L., (1995) Sleep Related Vehicle Accidents British Medical Journal 310 (6979) pp 565-567

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John, M.W., (1995) A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale Sleep 14, pp 540-545 Lenne, M.G., Triggs, T.J., Redman, J.R., (1997) Time of Day variations in driving performance Accident Analysis and Prevention, Vol 29, No.4, pp 431 – 437 Maycock, G., (1997) Sleepiness and Driving: The Experience of U.K. Car Drivers Accident Analysis and Prevention, Vol 29, No. 4, pp 453 – 462 Murray, C., Lopez, A., (1997) Alternative projections of mortality and disability by cause 1990-2020; Global Burden of Disease Study, Lancet 349, 14981504 Police Service of Northern Ireland, (2001) Road Traffic Accident Statistics Annual Report, www.psni.police.uk Tassi, P., Muzet, A. 'Sleep Inertia'. Sleep Medicine Reviews, Vol.4, No. 4, 341-353. August, 2000 Wolfson, AR, Carskadon, M.A., “Sleep Schedules and Daytime Functioning in Adolescents. Child Development 1998 (69): 875-887

1

The number of working age in employment as a percentage of the total population of working age.

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