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PlasmaCar Pilot Project

July 2010

Authors & Acknowledgements

Authors:

Daphne Mayer, MPH, Research Associate, Research and Education Division, KFL&A Public Health Janine Monahan, MScN, RN, Manager, School Health Team, KFL&A Public Health

Contributors:

Lynn MacKinder, BNSc, RN, Public Health Nurse, School Health Team, KFL&A Public Health Kelly Johnson, BNSc, RN, Public Health Nurse, School Health Team, KFL&A Public Health

Acknowledgements:

We are sincerely grateful to Annette Simonian, Project Coordinator, Kingston Partners for a Safe Community for her help and support of this project.

Financial support from the Ontario Ministry of Transportation for the 2009 Road Safety Challenge is gratefully acknowledged.

For more information contact:

Daphne Mayer, Research Associate, Research and Education Division Kingston, Frontenac and Lennox & Addington Public Health

221 Portsmouth Ave, Kingston, ON K7M 1V5 Tel: (613) 549-1232, Ext 1125

Email: dmayer@kflapublichealth.ca

Recommended Citation:

Research and Education Division (RED) of Kingston, Lennox & Addington Public Health. PlasmaCar pilot project: final report. Kingston: Author; 2010 Jul.

Introduction

Kingston, Frontenac, Lennox & Addington (KFL&A) Public Health's Drive for Life (D4L) is an initiative focused on reducing alcohol-related injuries among high school students. The D4L program is an educational intervention for Grade 11 students. Teaching students about the physical and mental effects of consuming alcohol, and the consequences of alcohol use as it relates to drinking and driving are two program goals.

The D4L program was implemented as a KFL&A Public Health program in 1997, and the most recent evaluation of the program was completed in 2006. One of the program evaluation's recommendations was that KFL&A Public Health should consider partnering with other driving safety or injury prevention initiatives in order to maximize program reach(1). As a result, a partnership was formed between Kingston Partners for a Safe Community, Ontario Ministry of Transportation, and KFL&A Public Health for the pilot project discussed in this report. The 2006 D4L evaluation also recommended a review of program content related to specific behaviours, such as driving and drinking (1).

The PlasmaCar project was developed for the 2009 Ministry of Transportation Road Safety Challenge as part of a strategy to increase awareness about distracted and impaired driving in an interactive way. The PlasmaCar is a ride-on toy that is driven across the floor through the continuous side to side movement of the steering wheel. According to the toy's distributor (www.plasmacar.com), the PlasmaCar "harnesses the natural forces of inertia, centrifugal force, gravity and friction to drive on a smooth, flat surface". The activity designed around the PlasmaCar focused on driving safety as it relates to impaired and distracted driving. The PlasmaCar activity is meant to simulate driving while safely introducing a feeling of impairment (visual impairment goggles) or distraction (text messaging). If successful, the activity could be incorporated into D4L or other driving safety or injury prevention initiatives.

The PlasmaCar initiative meets Ontario's new Public Health Standards, by addressing On Road Safety and Alcohol use under the Injury Prevention and Substance Misuse requirements 2, 3, 4 and 5 (2).

Background

Injuries from motor vehicle collisions (MVCs) cost Ontarians over $1.1 billion in 1999 (3). Ontario's Ministry of Transportation has endorsed the national Road Safety Vision 2010 plan, which sets a target of a 30% reduction of road users killed or seriously injured, and a sub-target of a 40% decrease in road users fatally or seriously injured in alcohol related crashes (4).

Canadian youth have the highest rates of traffic deaths among drivers under 75 years of age (5). In 2006, Canadian youth, ages 15-24 years, accounted for 24.7% of all traffic related fatalities and 27.7% of traffic related serious injuries; furthermore, this group represents 23.3% and 25.3% of the drivers involved in traffic related fatalities and serious injuries, respectively (6). MVCs are the leading cause of hospital admissions and the second leading cause of emergency room visits for Ontario youth (7;8) Male drivers are three times more likely than female drivers to die a MVC (8) Conservative estimates indicate an overrepresentation of youth involved in alcohol-related crash fatalities. Youth between 15-24 year of age have the highest rates of weekly and of monthly heavy drinking among Canadian drinkers (5). Between 2001 and 2003, one third of drinking drivers in fatal crashers were between 16 and 24 years of age (9).

Activities while driving, such as conversing with passengers, eating, smoking, manipulating controls, reaching inside the vehicle, and cell phone use, are potentially distracting tasks that drivers engage in for approximately 30 percent of the time that their motor vehicles are in motion (10). Text messaging, a common communication medium for youth, is a driving distraction that can impact driving safety. It is suggested that interactive information delivery systems, such as cell phones, are more distracting than the more traditional sources of driver distraction because the interaction with these devices is for longer periods of time and requires more cognitive engagement (11). Currently there is limited research on the impact of text messaging on driving safety. Furthermore, there are no Canadian data that can clearly identify vehicle crash fatalities or injuries related to text messaging. A small British study revealed that the simulated driving performance of 17-25 year olds while text messaging was significantly impaired because of a combination of impairment of concentration, impairment of the physical act of driving while holding the device, and the shifting of visual orientation between the device and the road (12).

Although the study was small, the results highlight the need to recognize that text messaging is a driving distraction, and is a potential youth driving behaviour.

In response to concerns about distracted driving, the Ontario Government amended the Highway Traffic Act (Bill 118) in April 2009, prohibiting driving while holding or using a hand-held wireless communication device or electronic entertainment device (13). The Ontario Government started enforcing the Bill in October 2009 via issued warnings, and the implementation of fines began in February 2010. This behavioural countermeasure is one component of a multi-pronged approach to changing behaviours. Youth driving behaviours, such as driving while impaired or driving while distracted, are influenced by many factors including driving ability, biopsychosocial development, personality characteristics, demographic factors, the perceived environment, and the driving environment. Some of these factors are more amenable to change than others (14).

Evaluation Objectives

The aim of this process evaluation was to obtain student feedback about the appropriateness of the PlasmaCar activity as a teaching aid for this high school population, and thereby determine the activity's potential fit with the D4L program or other driving safety or injury prevention programs.

Initially, the evaluation was designed to determine if the use of vision impaired goggles or text messaging while driving the PlasmaCar resulted in a decline in performance. Additionally, the evaluation aimed to determine if, after driving while wearing vision impaired goggles or while text messaging, students reassessed their ability to drive the PlasmaCar while impaired or distracted (Appendix A). A pre-test of the design revealed that the evaluation objective was not appropriate, because, for some students, their performance actually improved from baseline to intervention. It was concluded that the wrong message was being conveyed, and as such the activity and the evaluation was redesigned.

A research associate (DM) in KFL&A Public Health's Research and Education Division conducted the evaluation.

Method

EVALUATION DESIGN

A post-test evaluation design was used, where participating students were surveyed upon completion of the PlasmaCar activity for their feedback about the activity.

PILOT STUDY POPULATION

Students were drawn from secondary schools in the Limestone District School Board and the Algonquin and Lakeshore Catholic District School Board. The D4L program is targeted specifically to Grade 11 students; however the piloting of the PlasmaCar activity was open to all student grades. The activity was run over the lunch break of participating schools between May 7, 2009 and May

26, 2009.

DESCRIPTION OF THE ACTIVITY

The purpose of the activity was to give students a sense of how their driving performance can be affected by simulated visual impairment or by distraction. Members of the KFL&A Public Health's School Health Team designed a pylon course through which participants navigated a PlasmaCar. The students negotiated the course either wearing goggles that simulated visual impairment due to alcohol consumption (DWEyes goggles) or while text messaging on a cell phone. The participants then repeated the course without the impairment or distraction. Each time the student drove through the pylon course, they were timed and the number of pylons hit and the number of times they went off-course were recorded. Data collected on course time, number of pylons hit, and number of times participants went off course were not recorded for analysis purposes rather the data were used to provide performance feedback to each participant during the activity.

DATA COLLECTION AND ANALYSIS

Students' PlasmaCar course time, the number of pylons hit, and the number of times they went off course were recorded (Appendix B). Student responses to the following feedback questions were recorded verbatim on the feedback form (Appendix B).

"Now that you've tried the course without any distraction, how do you think < the goggles or text messaging> impacted your ability to drive the PlasmaCar course?"
"While driving the PlasmaCar is not the same as driving a real car, do you think this type of activity demonstrates the impact of <impaired driving or distracted driving> on driving safety? Why or why not?"

Data were entered into SPSS and Microsoft Excel spreadsheets for analysis. Participant characteristics were analyzed quantitatively. Responses to feedback questions were analyzed qualitatively. All responses were read through and themes were identified. The comments were read over multiple times and, if necessary, one or more themes were identified for each comment.

Ethical Considerations

The pilot project evaluation underwent scientific review in accordance with the policies and procedures at KFL&A Public Health. The project also received approval from the Limestone District School Board and the Algonquin and Lakeshore Catholic District School Board. All data were treated as confidential and no identifying information was collected from the participating students. Feedback forms were stored in KFL&A Public Health's Research and Education Program area. In compliance with KFL&A Public Health's record retention guidelines, feedback forms will be destroyed 5 years after completion of the final report and the data set will be deleted after 7 years.

Results

The PlasmaCar activity was piloted in three Kingston secondary schools - Kingston Collegiate and Vocational Institute (KCVI), LaSalle Secondary School, and Holy Cross Catholic Secondary School. A total of 118 students participated in the evaluation. Sixteen KCVI students were involved in the pre-testing of the activity. Their participation helped in the refinement of the activity design and the evaluation instrument. After these modifications, the activity was then pilot tested at LaSalle Secondary School and Holy Cross Catholic Secondary School. One hundred and two students from LaSalle Secondary School and Holy Cross Catholic Secondary School participated in the evaluation.

CHARACTERISTICS OF PARTICIPANTS

Overall, the majority of participants were male (n=60, 59.4%). The average age of participants was

15.9 years (range 14 - 19 years). (Table 1)

Approximately 50% of participating students were assigned to drive the PlasmaCar course wearing the visual impairment goggles (n=53, 52%). The remaining students (n=49, 48%) drove the course while text messaging.

Table 1: Student characteristics
School	# of student participants	Male (n)	Male %	Female (n)	Female %
LaSalle Secondary School	29	21	72.4%	8	27.6%
Holy Cross Catholic Secondary*	73	39	54.2%	33	45.8%

*missing gender data for one student

STUDENT FEEDBACK QUESTION

1.THE IMPACT OF TEXT MESSAGING OR VISUAL IMPAIRMENT GOGGLES ON DRIVING THE PLASMACAR

Students participating in the PlasmaCar activity were asked ".....how do you think the <goggles OR text messaging> impacted your ability to drive the PlasmaCar course?" Student comments revealed that both text messaging and the visual impairment goggles impacted students' ability to drive the PlasmaCar course. Only one student who wore the visual impairment goggles felt the activity did not impact the ability to drive. A few students commented that while the activity "did not make me feel drunk" (visual impairment goggles) or was "not realistic" (text messaging), they acknowledged that the goggles or text messaging did impact their ability to safely drive the PlasmaCar through the course.

Themes identified from the student responses were grouped into three broad categories about the impact on driving ability.

Impact on driving ability: concentration and perception

First, students identified whether the text messaging or the visual impairment goggles affected their levels of concentration and perception. This theme was identified by both students who text messaged and those who wore the visual impairment goggles. Specifically, text messaging while driving the PlasmaCar did not allow them to "really pay attention", and when they were not text messaging they were less distracted and hit fewer pylons. Students who wore the visual impairment goggles noted that their overall perception of the course and their depth perception impacted their ability to safely navigate the course.

"It made it seem like things were there when they were not there. It was kind [of] like an illusion or distortion which occurs when you are drinking. " (Male, 15, visual impairment goggles).

"Things looked like it (sic) was moving; couldn't see straight; couldn't judge distance." (Female, no age provided, visual impairment goggles)

"The goggles changed my depth perception which made it harder to drive the course." (Male, 17, visual impairment goggles.)

Participants who text messaged discussed concentration, focus and distraction as major themes.

"I couldn't go anywhere. I was very distracted; hitting a lot of stuff." (Male, 19, text messaging).

"Yes, concentrating on texting - didn't see road signs." (Female, 15, text messaging)

Impact on driving ability: the physical act of driving

Students identified that the physical act of driving was impacted by the visual impairment goggles or by text messaging. Sub-themes common to both groups were driving speed, the mechanics of driving, and the difficulty of the activity. As a consequence, particular aspects of driving the PlasmaCar, such as steering and avoiding obstacles and the overall control of the PlasmaCar, were more difficult to achieve.

"I couldn't.....get up any speed. I drove a lot faster without the cell." (Male, 14, text messaging).

"It was harder. Couldn't hold steering wheel and text at the same time." (Female, no age provided, text messaging).

"....harder to turn, so it was more difficult to drive the course without hitting anything." (Male, 16, visual impairment goggles).

Impact on driving ability: physical or emotional reaction

Finally, students discussed physical or emotional reactions related to their ability to drive the PlasmaCar. This theme was observed only among participants who wore the visual impairment goggles. Physical reactions included dizziness, problems with balance, blurred vision and headaches. Emotional reactions included feeling scared and self conscious.

2. THE PLASMACAR - AN APPROPRIATE TOOL?

To understand the appropriateness of the activity in the delivery of messages about driving safety as it relates to impaired and distracted driving, students were asked "...do you think this type of activity demonstrates the impact of <impaired driving or distracted driving> on driving safety?

Why or why not?"

Most students found that the PlasmaCar activity demonstrated the impact of impaired or distracted driving on driving safety. The activity was found to be "realistic", or at least to be similar enough to driving a car that the intended message was recognized. Realism subthemes were oriented around the environment (i.e. the PlasmaCar course), the physical act of driving, and the demands on attention while participating in the activity.

"Yes, because it's similar and the pylons are similar to what you have on the road and if you can't pay attention here, how could you when you're really driving." (Female, 16, text messaging).

Yes. Because you still have one less hand on the wheel and you are looking at the phone too. (Female, 16, text messaging).

Yes, shows how hard it is to drive if you had kid or cell phone; you are more distracted. (Male, 15, visual impairment goggles).

Some students felt that the activity effectively demonstrated the impact of impairment or distraction on driving safety because they were required to use their judgment to complete the activity. Furthermore, students identified that the activity was appropriate because it was interactive in nature and thereby elevated their level of enjoyment.

"...it's a fun way to experience impaired vision with driving and I think kids learn better when they are having fun. I wish there were more fun things in school." (Male, 16, visual impairment goggles).

Discussion

The piloting of the PlasmaCar activity in three secondary schools was successful. It was received well by the secondary school audience, and was deemed by students as an appropriate mode for the delivery of messages about impaired and distracted driving. Although the activity was not similar

to driving a real automobile, students identified links between their actions while driving the PlasmaCar, impaired or distracted, to potential outcomes in real driving situations. This observation is consistent with other examinations of youth perceptions about the impact of substance use and distractions on driving safety. Ginsberg and colleagues found that students ranked impaired driving, followed by text-messaging, racing and road rage, as having the most impact on driving safety (15).

Youth driving behaviours are influenced by a multitude of factors and, consequently, interventions must be comprehensive for this population. The D4L program and the PlasmaCar activity focus on many of the factors impacting youth driving behaviours. Furthermore, it is recommended that a creative approach to programming is required due to the complex nature of driving behavior (14). The strengths of the PlasmaCar activity design include aspects of realism, interactiveness, and fun.

Conclusion

As a result of the positive feedback about the PlasmaCar activity, it was recommended that the PlasmaCar activity designed by the School Health Team at KFL&A Public Health be used to update D4L program content, or be incorporated in other driving safety or injury prevention programming. This pilot evaluation was designed to provide useful preliminary information about the activity. Future evaluation must consider this activity within the context of the specific program it will support.

In October 2009, the PlasmaCar event was promoted at the Truth Uncensored leadership, skill building, and youth engagement workshop for KFL&A secondary school students. The event was then offered in the 2009-2010 academic year to all KFL&A area secondary schools as a peer led initiative. Leadership students were asked to host the event, in partnership with their KFL&A public health nurse, for their student population. Schools were encouraged to link this event with other school related injury prevention activities.

References

Research and Education Program (REP) of Kingston Lennox & Addington Public Health. Evaluation of KFL&A Public Health's "Drive for Life" program. Kingston: Author; 2006 Nov.
Ministry of Health and Long-term Care. Ontario Public Health Standards 2008. Toronto: Author; 2008.
SMARTRISK. The economic burden of injury in Ontario. Toronto: Author; 2006.
Ministry of Transportation. Ontario road safety annual report 2005. Toronto: Author; 2005.
Solomon R, Chamberlain E. Youth and impaired driving in Canada: opportunities for progress. Oakville: Mothers Against Drunk Drivers; 2006.
Transport Canada. Canadian motor vehicle traffice collision statistics 2006. Ottawa: Author; 2007. Report No.: TP 3322.
SMARTRISK. The Ontario injury compass: injuries among youth. Toronto: Author; 2008.
Emery P, Mayhew D, Simpson H. Youth and road crashes: magnitude, characteristics and trends. Ottawa: Traffic Injury Research Foundation; 2008.
Transport Canada. A quick look at alcohol-related crashes in Canada. Fact sheet RS-2008- 09 [Internet]. 2009 [cited 2010 Apr 14]. Available from: http://www.tc.gc.ca/eng/roadsafety/tp-tp2436-rs200809-menu-397.htm
Ranney TA. Driver distraction: a review of the current state-of-knowledge [Internet]. Washington: National Highway Traffic Safety Administration; 2008 [cited 2010 Apr 14]. Report No.: DOT HS 810 787. Available from: http://www.nhtsa.gov/DOT/NHTSA/NRD/Multimedia/PDFs/Crash%20Avoidance/2008/810787.pdf
Strayer DL, Drews FA, Crouch DJ. A comparison of the cell phone driver and the drunk driver. Hum Factors 2006; 48(2):381-91.
Reeds N, Robbins R. The effect of text messaging on driver behaviour: a simulator study. Crowthorne: Transport Research Laboratory; 2009 [cited 2010 Feb 25]. Report No.: PPR
367. Available from: http://www.trl.co.uk/
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Shope JT. Influence on youthful driving behaviour and their potential for guiding interventions to reduce crashes. Inj Prev. 2006;12(Suppl 1):i9-i14. doi:10.1136/ip.2006.011874.
Ginsburg KR, Winston FK, Senserrick TM, Garcia-Espana F, Kinsman SK, Quistberg DA, Ross GR, Elliott MR. National young-driver survey: teen perspective and experience with factors that affect driving safety. Pediatrics 2008;121(5):1391-403. doi:10.1542/peds.2007-2595

Appendix A: Pretest Evaluation Plan

Project Activity objective:

To give students a sense of how their driving performance can be impaired through alcohol (simulated by DWEyes goggles) or text messaging.

Evaluation purposes

To determine if the use of DWEyes or text messaging while driving the PlasmaCar results in a decline in performance, as measured by increased time to complete the course and/or an increase in the number of pylons hit, and, if so,

o To determine if the experience of DWEyes or text messaging while driving the PlasmaCar causes students to re-assess their ability to more closely resemble actual performance, as measured by estimated time to complete the course and/or estimated number of pylons hit.

Evaluation Questions

Will student performance decline (i) while wearing the DWEyes goggles or (ii) while text messaging?
Will students perceive that their driving performance declines as a result of (i) wearing the DWEyes goggles or(ii) text messaging?

Evaluation Design

The evaluation will use a one group pre-test post test design. Each student acts as their own control.

Table: Pre-Intervention
Pre-Intervention
Performance while not Impaired or Distracted	Self-perception of Performance while Impaired or Distracted	Intervention: Simulation of Impaired or Distracted Performance
O₁ Amount of time taken to navigate pylon course Number of pylons hit	O₂ Perceived ability to navigate the course while impaired or distracted	X DWEyes Goggles or Text messaging

Table: Post-Intevention
Post-Intervention
Actual Performance while Impaired or Distracted	Self-perception of Performance while Impaired or Distracted
O₃ Amount of time taken to navigate pylon course Number of pylons hit	O₄ Re-assessment of perceived ability to navigate the course while impaired or distracted

Evaluation Method

Each participating student will drive the PlasmaCar through the pylon course. Baseline course time and number of pylons that were hit will be recorded. The student will be told how long the course took him/her, and how many pylons were hit.
The student will be assigned to drive the course again either (i) wearing the DWEyes goggles or (ii) while text messaging.
Before re-attempting the pylon course, the student's response to the following questions will be recorded:
1. 1. Do you think you will be able to drive through the pylons without hitting any while wearing the DWEyes goggles? If no, how many do you think you will hit? How long do you think it will take you to drive the course? OR
  2. Do you think you will be able to drive through the pylons without hitting any while text messaging? If no, how many do you think you will hit? How long do you think it will take you to drive the course?
The student will drive the course either wearing DWEyes Googles or text messaging. The course time and number of pylons that were hit will be recorded.
Upon completion of the pylon course, the student's response to the following questions will be recorded:
1. 1. If you were to do this activity again, do you think you will be able to drive through the pylons without hitting any while wearing the DWEyes goggles? If no, how many do you think you will hit? How long do you think it will take to drive the course? OR
  2. If you were to do this activity again, do you think you will be able to drive through the pylons without hitting any while text messaging? If no, how many do you think you will hit? How long do you think it will take to drive the course?

Measurement of Outcome

The main outcome of interest will be the difference between O₄ and O₂ . However, a difference can be expected only if a difference in actual performance is observed, that is, a difference between O₃ and O₁.

Data Collection Tools

To be developed by the School Health program staff with assistance from Daphne Mayer, Research Officer.

Data analysis

All data will be entered into SPSS Version 15 for Windows. Descriptive and non-parametric statistics will be used to compare pre-intervention and post-intervention actual performance, and pre-intervention and post-intervention perceived ability.

Pilot

The PlasmaCar initiative will be piloted in one physical education class, approximately 30 students. The frequency distribution of course time and number of hits will be used to determine the number of students needed in the two subsequent sessions.