VII. FOCUSING AN EDUCATIONAL CAMPAIGN: PANEL RECOMMENDATIONS To assist the NCSDR/NHTSA in developing its educational initiatives, the panel recommended three priorities for the campaign Educate young males (ages 16 to 24) about drowsy driving and how to reduce lifestyle-related risks. Promote shoulder rumble strips as an effective countermeasure for drowsy driving; in this context, raise public awareness about drowsy-driving risks and how to reduce them. Educate shift workers about the risks of drowsy-driving and how to reduce them. EDUCATE YOUNG MALES ABOUT DROWSY DRIVING AND HOW TO REDUCE LIFESTYLE-RELATED RISKS Young males, ages 16 to 24, received highest priority because of their clear over-representation in crash statistics and because many of their lifestyle risks are amenable to change. Although males up to age 45 have increased crash risks, the panel targeted only the younger group to enable specific tailoring of educational messages to this population's needs and preferences. In fact, campaign designers may want to segment further, creating different messages for the 16-to-18 and 19-to-24 age groups. The younger group is high school age and more likely to live at home with parents; members of the older group are more likely to be working or in college, living on their own and less subject to parental authority. The panel also believes it may be worthwhile to educate preteen boys, their parents, and their schools to influence attitudes before problems begin. The messages might be the following: sleepiness is not inevitable for teens, and it is not okay to drive when you are sleepy. The panel recognized that the risk-taking behaviors of younger men will be a challenge in developing successful educational approaches. Focus group research is needed to develop a better understanding of young men's perceptions of fall-asleep crash risk and the kinds of interventions that would be effective with this group. Based on the literature, however, the panel suggests that campaign designers consider the following message points, many of which are appropriate for all public audiences: Sleepiness is a serious risk for young male drivers. Although little is known about the knowledge and attitudes of this group regarding sleepiness and driving risk, surveys of the general population suggest that knowledge of the risk is likely to be low and awareness will need to be raised. It also will be important for messages to affect attitudes, so that young men and their parents believe the risk is serious and young men are vulnerable. Misconceptions that sleepiness is inevitable at this age and that chronic sleepiness is a safe lifestyle choice need to be overcome. Under- standing the concept of sleep debt could be useful, as could recognizing the uncontrollable nature of falling asleep at high levels of drowsiness. Driving between midnight and 6 a.m. is a high-risk situation. Scheduling a trip at another time is a simple way to reduce risk, especially if the drive is long. An active lifestyle that restricts sleep is a special risk. Many young men will recognize themselves in the picture of a chronically sleepy student who also works part-time, participates in extracurricular activities, and has an active social life. The "all nighter" represents an acute risk because extreme tiredness follows one sleepless night. The recommended action is not to start a long drive after one or more sleepless nights (e.g., do not drive home from college the day your exams are over; get a good night's sleep first). Drinking alcohol increases sleepiness, and the combination of alcohol and sleepiness decreases performance and increases risk, even at low levels of alcohol use. A message that would convince young men not to drink when they are already sleepy could be useful. However, focus groups of youth in New York State revealed that drowsy-driving messages could be lost or ignored if paired with "don't drink and drive" messages, which some believe are already overemphasized (New York GTSC Sleep Task Force, 1994). You can take effective steps if you become sleepy while driving. These steps include stopping driving altogether, if possible; consuming the caffeine equivalent of two cups of coffee; taking a 20-minute nap, and after the nap, driving to the closest safe resting spot, such as a motel, friend's house, or home; and sleeping. Successful strategies from drinking and driving campaigns might also be adapted to drowsy driving if focus groups confirm their appeal. For example, an educational campaign could suggest that teens call a friend or a parent for a ride or let a friend drive home instead of driving while sleepy. Complementary educational messages to parents might suggest that they tell teenagers to call for a ride at any hour without recriminations if they feel too sleepy to drive. In another alcohol strategy variation, parents might allow sleepy friends of teens to sleep over rather than drive home. The campaign also could counter common misconceptions of useful "stay awake" behaviors, such as exercising, turning on the radio, or opening the windows, which have not been shown to prevent sleep attacks. Messages to policymakers could promote the value of graduated driver licensing that does not permit younger drivers to drive during late night hours (e.g., after midnight). These leaders may need information on the drowsy-driving problem and the special risks of driving during this period for all drivers and especially for younger ones. PROMOTE SHOULDER RUMBLE STRIPS AS AN EFFECTIVE COUNTERMEASURE FOR DROWSY DRIVING; IN THIS CONTEXT, RAISE PUBLIC AWARENESS ABOUT DROWSY-DRIVING RISKS AND HOW TO REDUCE THEM The panel believes that focusing a campaign on shoulder rumble strips offers multiple educational opportunities to convey key drowsy-driving messages. Messages to the general public can explain the following: What rumble strips are and why they are increasingly being used. A message that rumble strips are designed to arouse sleepy drivers before they drive off the road could be an attention-getting way to highlight the prevalence of chronic sleepiness and point out the risks and possible consequences of drowsy driving. People who have driven over a rumble strip in the past could personalize the risk, and even seeing the strips on the highway in the future could repeatedly remind people of the message. What to do when awakened by driving over a rumble strip. Rumble strips act as an alarm clock, alerting drivers to the fact that they are too impaired to drive safely. The key to safety is what the driver does after hearing the alarm. In the short term, risk-reducing actions include stopping immediately if possible (e.g., a more alert driver can take over); consuming the caffeine equivalent of two cups of coffee; and taking a 20-minute nap. Then the driver should get off the road (e.g., at a motel or rest stop) as soon as possible and sleep. In the longer term, planning ahead can help people avoid driving while drowsy. Key steps include planning sleep and naps before long trips, scheduling trips to avoid midnight through 6 a.m. driving, and avoiding alcohol and sedating medicines while sleepy or sleep deprived. The limitations of rumble strips. Rumble strips should not give drivers a false sense of security about driving while sleepy. The strips are useful as alerting devices, but they will not protect drivers who continue to drive while drowsy. Being awakened by driving over a rumble strip is a warning to change sleep and driving behaviors for safety. The strips are not a technological quick fix for sleepy drivers. Messages to policymakers, especially from States in which rumble strips are not currently used, can emphasize what rumble strips are, their relative cost-effectiveness, and why they are a valuable addition to highways in rural areas. Policymakers also may need information on the risks of drowsy driving and crashes to put the need for rumble strips in perspective. EDUCATE SHIFT WORKERS ABOUT THE RISKS OF DROWSY DRIVING AND HOW TO REDUCE THEM Employers, unions, and shift workers are potential target audiences for education on shift work and drowsy driving issues. The panel believes that an initial focus on employees would complement and reinforce other drowsy-driving messages directed to the public. Although many shift workers are not in a position to change or affect their fundamental work situation, they and their families may benefit from information on their risks for drowsy driving and effective countermeasures. Key message points include the following: Shift work may increase the risk of drowsy-driving crashes. Night-, early morning-, and rotating-shift workers are often sleepy because their work times are inconsistent with the natural sleep-wake cycle. Workers on these shifts routinely get less sleep and lower quality sleep than do day workers. Driving while sleepy is a risky behavior that leads to many serious crashes each year. Driving between midnight and 6 a.m. and driving home immediately after an extended or night shift are special risks for a drowsy-driving crash. Driving during late night/early morning hours increases risk for all drivers because those hours are a natural period of sleepiness. Many drowsy-driving crashes occur at this time. Driving while acutely tired, such as after a night shift, also increases the risk of crashing. Shift workers, many of whom are already chronically sleep deprived, are at extra risk. You can take effective steps to reduce your risks. First, it is important to give regular priority to getting good sleep by creating a quiet, cool, dark environment, allowing sufficient time for sleep, and trying to sleep during the same hours each day. Another strategy is to avoid driving home from work while sleepy (e.g., getting a ride from a family member, taking a cab, napping before heading home). Consuming caffeine equivalent to two cups of coffee may help improve alertness for a short period. OTHER ORGANIZATIONS CAN PROVIDE DROWSY DRIVING EDUCATION The panel recognizes that limitations in resources will not allow NCSDR/NHTSA to conduct all needed educational interventions. However, other sponsors can make an important contribution by disseminating messages to high-risk audiences, intermediaries, and gatekeepers, such as industries where shift work is prevalent. Potential sponsors may include consumer, voluntary, health care professional, and industry groups and other government agencies. The panel encourages such groups to use this report and resulting campaign materials to inform and assist their own audience-specific efforts. NCSDR/NHTSA efforts to educate the public, especially youth, about the importance of sleep and sleep hygiene should complement other initiatives and, in combination, reinforce messages on the prevention of fall-asleep crashes.