JOURNAL OF AMERICAN COLLEGE HEALTH, VOL. 56, NO.

College Students Use Cell Phones While Driving More Frequently Than Found in Government Study
Sheryl Cramer, MD, MPH; Joni Mayer, PhD; Sherry Ryan, PhD

Abstract. Objective: Cell phone use while driving is hazardous; it quadruples the risk of a collision and multiplies the risk of a fatality nine-fold. The National Highway Traffic Safety Administration estimates that 8% of young drivers and 5% of all drivers use cell phones while driving. Participants and Methods: The authors trained graduate student volunteers to observe the daytime cell phone use of 3,650 drivers leaving the student exits of college parking structures at a large university. Results: The student observers recorded a cell phone usage rate of 11.1%, which was significantly higher than that seen in the National Occupant Protection Use Survey (p < .00001). Female drivers were 1.51 times more likely to be using a cell phone while driving than were men (12.9% vs 8.6%, p < .001), and drivers with passengers were 0.15 times more likely to drive while telephoning than were solo drivers (1.8% vs 12.1%, p < .001). Conclusions: The authors offer suggestions for possible interventions to reduce this hazardous behavior. Keywords: cell phone, college health, driving, National Occupant Protection Use Survey

sing a cell phone while driving a vehicle quadruples the risk of a collision1 and increases the risk of a fatality occurring in an accident ninefold.2 In its 100-Car Naturalistic Driving Study, the US Department of Transportation National Highway Traffic Safety Administration found use of a wireless device while driving to be the single highest cause of driver inattention contributing to crashes, near crashes, and incidents.3 College students may be particularly vulnerable when using a cell phone while driving. Motor vehicle crashes are the leading cause of death and disability for young Americans, and drivers aged 16 to 19 years have a fatality rate 4 times that of drivers aged 25 to 69 years.4 Young
Drs Cramer and Mayer are with the Graduate School of Public Health, San Diego State University; Dr Ryan is with the School of Public Administration and Urban Studies, San Diego State University. Copyright 2007 Heldref Publications 181

drivers show marked reductions in dual-task processing5 and accuracy in visual search6 when talking on a cell phone while performing driving tasks in a simulator, reducing their reaction times to those of older drivers.7 Upon questioning 1,185 college students in a retrospective study, Seo and Torabi8 found that 64% had experienced an accident or near-accident, and, in 21% of these accidents or nearaccidents, at least 1 driver was using a cell phone. In 2000, the US Department of Transportation, in its National Occupant Protection Use Survey (NOPUS), first observed, quantified, and reported cell phone use while driving. At that time, young adult drivers used cell phones at approximately the same frequency as the general population of drivers (3.1% vs 3.2%).9 In the 2002 NOPUS, young drivers were using cell phones more often than the general population (5% vs 4%). This finding was repeated in the 2004 NOPUS (8% cell phone usage in drivers aged 16 to 24 years, vs 5% in older adults), which also revealed that the frequency of young drivers cell phone use was rising much faster than that of the general population.10 Our goal was to evaluate the prevalence of cell phone use by college student drivers. We directly observed the frequency of cell phone use of 3,650 drivers exiting the student parking structures of San Diego State University (SDSU). We hypothesized that the rates in this population would be higher than the rates for young people found in the 2004 NOPUS.10 We evaluated potential correlates of the behavior in an exploratory manner. METHODS Participants, Settings, and Procedures Nine-tenths of SDSUs 29,288 students commuted to the school, the majority by private vehicle. There are 6 permitonly parking structures with 14,000 parking spaces; half of the spaces are reserved for vehicles with faculty/staff permits. Three of the parking structures have separate parking levels for students and faculty/staff, with separate

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entrances and exits. An informal pilot study performed by one of the authors in November 2004 showed that in these 3 structures, students almost exclusively used the student exit ramps, with few or no faculty or staff members driving out through these exits. The SDSU Institutional Review Board approved a protocol to observe cell phone use while driving at these exits, with exemption from the requirement for informed consent. We trained 6 graduate student volunteers in the use of an observation data-collection sheet and in safety techniques. Each of these observers performed their first 50 observations in partnership with another observer, allowing estimation of inter-rater reliability. They made observations in 2 three-hour daylight sessions on 2 sequential days in the third week of spring semester, 2005. Of the 3,650 vehicles observed exiting the 3 parking structures via the student exits, 2 of the volunteers simultaneously observed 200, and a single volunteer observed 3,450. Instrument All observers used a checklist observation sheet. Categorical variables included cell phone use, gender, vehicle type, vehicle color, and number of people present in the vehicle. Each observer recorded time of day and any instances of use of a hand-held device in spaces provided on the sheet. Data Analysis We entered the data using SPSS, Windows version 11.5 (SPSS Inc, Cary, NC), which generated frequency distributions for each variable. We used the kappa statistic to estimate inter-rater agreement between observers. We used the binomial procedure to compare the observed cell phone usage rate with the national rate reported for the 2004 NOPUS.11 We performed univariate analyses between the primary variable (use/ nonuse of a cell phone while driving) and each of the other variables using chi-square tests. We transferred the data to Stata 9 (StataCorp, College Station, TX) for binomial logistic regression analysis assessing the relationship between each potential predictor variable and cell phone use, while controlling for each of the other variables. RESULTS Observations and Reliability Data The student volunteers observed 3,650 vehicles. Agreement between observers was excellent (see Table 1). Demographic Characteristics Female drivers predominated (59.3%), passenger cars were more frequent than trucks or SUVs/vans (73.7%, 11.6%, and 14.7% respectively), and solo drivers outnumbered drivers with 1 or more passengers (89.7% vs 10.3%). The 5 vehicle color categories contained almost equal numbers of vehicles. Observers recorded the time of each observation to the nearest minute. These times were grouped into quarters
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TABLE 1. Agreement Between Observers of Vehicles Exiting Campus Parking Structures Variable Cell phone use Gender Passengers present Vehicle type Vehicle color n 198 199 196 185 154 Agreement (%) 98.9 95.9 99.0 86.5 81.8 0.949 0.913 0.928 0.722 0.764 p < .001 < .001 < .001 < .001 < .001

after the hour. Within each hour, more vehicles exited the structures during the first and last quarters of the hour (27.7% and 26.4%) than during the second or third quarters (25.7% and 19.2%). This was consistent with SDSUs class schedule, in which classes typically end either on the hour or at 40 minutes past the hour. Observed Cell Phone Use Compared With National Rate Of the 3,650 observed drivers, 403 (11%) used a cell phone at the time they exited an SDSU parking structure. We performed a binomial procedure to compare this percentage with the 8% of young drivers (aged 16 to 25 years) reported in the 2004 NOPUS.10 The difference was highly significant, with p < .00001.11 Correlates of Use of a Cell Phone While Driving As seen in Tables 2 and 3, three of the variables we examined reached statistical significance: gender of the driver, presence/absence of passengers, and time within the hour. Female drivers were 1.51 times more likely to use a cell phone while driving than were male drivers; drivers with passengers were 0.15 times more likely to use a cell phone than was an unaccompanied driver; and drivers in the first and fourth quarters of the hour (presumed to be leaving the school immediately after their classes let out) were slightly more likely to use a cell phone than were other drivers. Choice of parking structure and type and color of vehicle showed no significant association with the frequency of cell phone use while driving. COMMENT Cell phone use while driving has increased among all Americans over the past 5 years.10 The rate of use has increased fastest among young drivers, with 8% of drivers aged 1625 years using a cell phone in the 2004 NOPUS.10 Our results showed that usage rates are even higher among drivers exiting the student-permit levels of a large urban universitys parking structures, averaging 11.1%. This difference was statistically significant (p < .00001), suggesting that college students use cell phones while driving more often than do other young drivers. In this study, women drivers used cell phones more often than did men (12.9% vs 8.6%), mirroring the 2004 NOPUS general adult population findings of 6% usage by female drivers and 4% usage by male drivers. Compared with the
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Student Cell Phone Use TABLE 2. Rates of Cell Phone Use, by Potential Correlates, With Results of Univariate Tests Total Variable Gender Male Female Passengers present Yes No Time within the hour First quarter-hour Second quarter-hour Third quarter-hour Fourth quarter-hour Vehicle type Car Truck SUV/van Vehicle color Light Metallic Colorful Bright Dark n % Used cell phone n % 2 15.96 33.01 9.934 df 1 1 3 p < .001 < .001 .024

1,470 2,139 338 3,273 1,010 942 703 967 2,625 412 525 573 683 503 369 596

40.7 59.3 10.3 89.7 27.7 25.7 19.2 26.4 73.7 11.6 14.7 21.0 25.1 18.4 13.6 21.9

127 276 6 396 94 126 70 112 295 45 56 70 70 56 54 83

8.6 12.9 1.8 12.1 9.3 13.4 10.0 11.6 11.2 10.9 10.7 12.2 10.2 11.1 14.6 13.9

0.163

.922

6.65

.156

national study, SDSU drivers with passengers were even less likely to use cell phones than were solo drivers (1.8% vs 12.1%); in the 2004 NOPUS, the corresponding national rates were 2% vs 6%.10 Further research is needed to confirm that college students are a particularly high-risk group for using cell phones while driving. Replication of this study with confirmation of the student status of the observed drivers is necessary. In addition, more research is needed to describe the timing of cell phone calls within the temporal span of a journey and whether the call was initiated or received by the driver. In this study, our volunteers observed drivers as they exited a parking structure, and therefore they were at the beginning of a journey. Because of the poor signalreception characteristics of the SDSU parking structures, it is almost certain that the drivers were the initiators of their calls. In contrast, the NOPUS observations were made at stop signs, so it is likely that the observed drivers were in mid-journey. To our knowledge, in the NOPUS, there was no way to differentiate driver-initiated calls from calls received by the driver. A separate issue is that of the use of hands-free devices. Researchers in the 20009 and 200210 NOPUS surveys did not record the frequency of use of these devices; investigators in the 2004 NOPUS10 recorded the number of drivers wearing headsets but did not attempt to determine whether the drivers were actually engaged in a cell phone conversation. In this study, the observers made a notation on the observation sheet when they saw a driver talking while wearing a headset or an earpiece. Only 4 such drivVOL 56, SEPTEMBER/OCTOBER 2007

TABLE 3. Logistic Regression Analysis Comparing Groups on the Probability of Using a Cellular Phone While Driving Adjusted for Selected Characteristics Variable Gender Malea Female Passengers present Noa Yes Time within the hour 2nd quarter-houra 1st quarter-hour 3rd quarter-hour 4th quarter-hour Vehicle type Cara Truck SUV/van Parking structure (PS) PS 1a PS 4 PS 5 OR 95% CI p

1.0 1.51 1.0 0.15 1.0 0.66 0.70 0.87 1.0 1.11 0.96 1.0 0.94 1.13

1.201.90 0.0660.34 0.490.88 0.510.97 0.661.15 0.791.18 0.711.56 0.741.18 0.831.54

< .001 < .001 .004 .029 .332 .82 .56 .59 .45

Note. OR = odds ratio; CI = confidence interval. a Reference category.

ers were seen, out of the 403 drivers noted to be using a cell phone. If this study is repeated, researchers should
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provide a separate column for the presence of hands-free cell phone usage on the observation sheet. The major strength of this study was the reliability of the data, as evidenced by the high kappa values and rates of inter-observer agreement. The large size of the sample (N = 3,650) allowed comparison with student body demographics to ensure that the volunteers observed students rather than faculty or staff members; 59.3% of the observed drivers were women, compared with 59.2% of the students enrolled at SDSU. A possible weakness of the study was that we collected no unique identifiers, so we could not confirm the student status of the drivers. Another possible weakness was the limitation of the study to a single college campus; we suggest repetition of the study at other universities. In conclusion, our results suggest that college students are a high-risk, high-prevalence group for this hazardous behavior. An intervention targeted specifically at college students might include an informational component, laying out the hazards of talking on a cell phone while driving in materials included in the parking permit application. An attitudinal component might include speakers describing accidents caused by inattention and a social attitude campaign aimed at making talking while driving socially unacceptable. Behavioral components could include a fine-enforced ban on cell phone use in the college parking structures, along with the provision of safe, comfortable and private places to make cell phone calls prior to entering ones vehicle. With the unprecedented high rate of cell-phone usage that we found, such an intervention is clearly warranted.
NOTE

REFERENCES 1. Redelmeier DA, Tibshirani RJ. Association between cellular-telephone calls and motor vehicle collisions. N Engl J Med. 1997;336:453458. 2. Violanti JM. Cellular phones and fatal traffic collisions. Accid Anal Prev. 1998;30:519524 3. Neale VL, Dingus TA, Klauer SG, Sudweeks J, Goodman M. An Overview of the 100-Car Naturalistic Study and Findings. Washington, DC: National Highway Traffic Safety Administration. Paper Number 05-0400.2005. Available at: http://www.nrd.nhtsa.dot.gov/pdf/nrd12/100Car_ESV05summary.pdf. Accessed November 6, 2005. 4. Advocates for Highway and Auto Safety. Graduated Driver Licensing. Washington, DC: Advocates for Highway and Auto Safety; 2004. Available at http://www.saferoads.org/issues/ fs-GDL.htm. Accessed April 18, 2005. 5. Mourant RR, Tsai FJ, Al-Shihabi T, Jaeger BK. Divided Attention Ability of Young and Older Drivers. Virtual Environments Laboratory, Northeastern University. Boston, MA. 2000. Available at: http://www-nrd.nhtsa.dot.gov/departments/nrd-13/ driver-distraction/PDF/9.PDF. Accessed November 11, 2005. 6. McPhee LC, Scialfa CT, Dennis W, Ho G, Caird,JK. Age differences in visual search for traffic signs during a simulated conversation. Hum Factors. 2004;46:674685 7. Strayer DL, Drews FA. Profiles in driver distraction: effects of cell phone conversations on younger and older drivers Hum Factors. 2004;46:640649. 8. Seo D, Torabi MR. The impact of in-vehicle cell-phone use on accidents or near-accidents among college students. J Am Coll Health. 2004;53:101108. 9. Utter D. Research Note: Passenger Vehicle Driver Cell Phone Use Results From the Fall 2000 National Occupant Protection Use Survey. Washington, DC: US Dept of Transportation, National Highway Traffic Safety Administration, National Center for Statistics and Analysis; 2001. DOT HS 809 293. Available at: http://www.nhtsa.dot.gov /people/ncsa/ResearchNotes/809-293.pdf. Accessed April 10, 2004. 10. Glassbrenner D. Traffic Safety Facts Research Note: Driver Cell Phone Use in 2004Overall Results. Washington, CD: US Dept of Transportation, National Highway Traffic Safety Administration, National Center for Statistics and Analysis; 2005. DOT HS 809 847. Available at: http://www-nrd.nhtsa.dot.gov/pdf/nrd-30/ NCSA/RNotes/2005/809847.pdf. Accessed March 14, 2005. 11. SISA. Simple Interactive Statistical Analysis. Available at: http://home.clara.net/sisa/binohlp.htm. Accessed March 17, 2005.

For comments and further information, address correspondence to Dr Sheryl Cramer, 3570 First Ave, #9, San Diego, CA 92103 (e-mail: drscramer@cox.net).

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