Challenging Dogma

Monday, May 7, 2012

Where u at? Teenagers, Texting and the Road: A Critique of the Public Health Response to Distracted Driving – Shannon McAuliffe

I have so many things to do today! I need to go pick up my clothes from the cleaner, I have to get a birthday card for my sister, I have to drop off…oh wait, is that my phone ringing? It must be in my purse somewhere...
We all know how easy it is to become distracted while driving. Our mind shuffles through all the things we need to get accomplished in the next couple of hours while we struggle to find our ringing phone at the bottom of a bag without missing the green light. It is estimated that distracted driving played a role in 1,090,748 motor vehicle crashes in 2009 in the USA; 385,910 of these accidents were estimated to involve teenagers (1). Distracted driving can occur in three forms: visual, manual and cognitive (1). Visual distraction involves taking one’s eyes off the road, manual distraction involves taking one’s hands off the wheel and cognitive distraction involves taking one’s mind off the task of driving (1). While distracted drivers are 23 times more likely to get in to a car accident that those who are focused on driving, teen drivers are already 4 times more likely to get in to an accident than more experienced drivers (2). A study done at the University of Utah found that using a cell phone while driving, regardless of whether it is hands-held or hands-free, has the same effect on a driver’s reaction time as a blood alcohol concentration of .08%, the legal limit (3). By combining the inexperience of young drivers with the distractions provided by a cellular phone, tragedy can ensue.
Text messaging has become the primary means of communication for young adults, as a recent study of 13-19 year olds found that over 78% reported using their phone more for texting than for placing calls (4). In fact, during the month of June 2011, more than 196 billion text messages were sent or received in the United States; this was up nearly 50% from June 2009 (5). Sending or receiving a text message strengthens a teen’s social network, assuring them that they are still connected to their peers even if they may not be in the same place at the same time. Parents can also feel comforted by the fact that their child is only a phone call away if they run into any problems, on the road or elsewhere. However, with the presence of a cell phone in the car, it can be difficult for a teen to ignore an incoming call or text, regardless of whether they are stopped at a red light or cruising down the highway. Texting while driving combines all three types of distraction described previously (1).  Not only is the driver manually distracted when they take their hand off the wheel to pick up their phone, they are also cognitively distracted when they think about what the incoming call or text could say and visually distracted when they look at the screen instead of the road. When sending or receiving a text and traveling at 55 miles per hour, the driver’s eyes are pulled from the road for an average of 4.6 seconds; the distance traveled at this speed in this amount of time equals the length of a football field (5). Essentially, that driver is careening down the road, blinded to what lies before, behind or to the side of them, for almost 5 seconds.
Currently, the use of all cell phone functions by new drivers is restricted in 31 states and the District of Columbia while text messaging is banned for all drivers in 37 states and the District of Columbia (6). The U.S. Department of Transportation has also joined the fight to eliminate distracted driving. Led by Secretary of Transportation Ray LaHood, a website has been created to address the frightening facts about distracted driving and what can be done to prevent its dangers. provides the explicit statistics about the dangers of cell phone use while driving, as well as tools for employers, educators and parents to use to talk to the teens in their care about the hazards of driving while distracted. struggles to create an effective public health campaign addressing the dangers of texting while driving for a number of reasons. While motor vehicle crashes are the leading cause of death for teenagers in the US (7), strongly implies that teens are the primary perpetrators of distracted driving. In a message written by Senator LaHood in a recent brochure, he states that “…teens are especially vulnerable because of their inexperience behind the wheel and, often, peer pressure,” (7). While this may be accurate, is this the most appropriate way to begin a discussion with teens about the dangers of driving while distracted? By instructing parents and educators to talk to their kids about the dangers of texting or calling while driving, this campaign paints teens as the only guilty party who must be instructed by their elders in order to understand the complexities of such an issue. Teens may feel targeted, treated as the only suspects with the rest of their communities labeled as the potential victims. Through its lack of appreciation for the Theory of Psychological Reactance and the Theory of Optimistic Bias, as well as its misuse of the Theory of Planned Behavior, cannot serve as a source respected by teenagers and parents alike in the fight against distracted driving.

Criticism 1: “I’ll do what I want to do!”
The teenage years are already known to create tension between adolescents and their parents. As teenagers learn to develop their own opinions and understand what they like and do not like, they strive to assert their independence and be in control of their own lives. Teens want to stay out later at night, go to parties where adults will not be present and wear the latest questionable fashions, regardless of what their parents say or feel. With a brand-new license in hand and many roads to explore, discussions between parents and their new drivers may become even more combative. A parent is concerned about the safety of their child and wants to make sure that they will take all of the right precautions when they are on the road by themselves for the first time, whereas their teen just cannot wait to get in to the driver’s seat. When parents tell their son or daughter to keep the phone out of their hands while driving, it can be the last thing a young driver remembers when they get behind the wheel. plays a similar role in the life of a teen driver as do the teen’s own parents. By using slogans such as “Stop Texts, Stop Wrecks” and “No one is jk or LOL now,” the intervention functions by telling teens what they should not do and by playing a patronizing role (2). Telling teens that if they stop texting car accidents will not occur can be seen as an omnipresent superior telling the young driver what to do. When the intervention uses the slang terms “jk” and “LOL,” it can be seen as an adult speaking down to an adolescent by mimicking social jargon.  Both of these examples can serve to incite psychological reactance in teen viewers. The theory of psychological reactance is based on the concept that when someone is told what to do and they find their freedom restricted, they will respond negatively and do whatever they can to reestablish their control (8). Described as the “boomerang effect,” when a freedom is limited, people can respond by choosing to exercise that freedom (9).
As teenagers are known to do whatever their parents tell them not to do, campaigns that incite similar reactions in young drivers may not be successful as they infringe upon the apparent freedom of teens. When the messenger is the government, moreover, the message may not be well perceived by teenagers; they would be more likely to respond to a source that they felt they could relate to, such as one of their peers (10).
Criticism 2: “But it would never happen to ME…”
Teenagers can be bombarded daily with warnings about what dangers await them around every corner. If you use a tanning bed, you have an increased risk of getting melanoma. If you drink and drive, you can kill yourself and others.  If you smoke, you can develop lung cancer or emphysema. Even though they know the statistics and facts, how many teens take these precautions to heart? While they may understand the risks associated with getting in a car with a driver who has been drinking or not practicing abstinence or using birth control, adolescents tend to believe they are invincible and that only good things will happen to them.
The Theory of Optimistic Bias explains the idea that we tend to underestimate the chance that bad things are going to happen to us personally while overestimating the chance that good things will happen to us (11). This is not only true regarding teenagers; adults can also be unrealistically optimistic about the future while overlooking the possibility that a negative event will affect them.
The current government intervention shared through provides statistics about the dangers of texting while driving. The site recommends that parents and educators talk with the teens in their care about these alarming statistics, insinuating that the problem lies in adolescents not understand the dangers of using a cell phone while driving. However, teenagers know how dangerous texting while driving can be; in a recent study, 84% of teen drivers said they were aware that distracted driving could increase their risk of being involved in a car accident (2). Through the optimistic bias, they understand the risk of their actions but do not think it will apply to them. One study showed that 4 in 5 young drivers admit they have texted while driving (2), while other studies reveal that up to 91.2% of college drivers admitted to texting while driving (12). It is evident that frightening facts and statistics about the perils of distracted driving have done little to curb such behaviors in young drivers who believe that they have their whole lives ahead of them.
Criticism 3: The Theory of Planned Behavior…Gone Wrong
A number of the suggestions posited by revolve around the Theory of Planned Behavior, which focuses on the rational decision-making processes involved in human risk assessment (13). This theory explains how, as rational human beings, we think about our actions before we perform them, though we may not always act based on our personal attitudes (13). The intention to act is determined by a number of factors, such as the person’s perceived behavioral control (whether they believe they will be able to perform that action), perceived power (the amount of power that the person believes they have over performing that action), as well as subjective norms (what the person thinks their peers and social groups will think of the action) (13).
As described previously, the behavior of texting while driving in the teen population is not reflective of their lack of knowledge regarding this behavior’s dangers. Adolescents understand that texting while driving is not a safe activity to engage in, although this knowledge does not prevent them from performing that behavior. With the Theory of Planned Behavior, it is believed that teens will make the rational decision not to text while driving simply because they understand its hazards and because they have the ability and power not to text while driving. This is clearly an incorrect assumption that can have deadly consequences. In fact, it has been shown that past behaviors are one of the strongest predictors of the future intention and behavior of a person (14); this implies that over 90% of teens will text while driving in the future (12). strongly emphasizes that the power to stop texting and calling while driving is available to all of us. Any teen can make the decision that they will not use a cell phone while behind the wheel; the website even provides a pledge teenagers can sign, guaranteeing that they will “Protect lives by never texting or talking on the phone while driving; Be a good passenger and speak out if the driver in my car is distracted; Encourage my friends and family to drive phone-free,” (15). However, it is clear that having this power and knowing the statistics does not ensure that a teen will not pick up the phone while they are driving.
Encouraging the use of social media sites such as Facebook and Twitter to spread the word to friends about the risks of using a cell phone while driving serves to address the social norms component of the Theory of Planned Behavior. By designing competitions such as the Distracted Driving Design Challenge, which asks high school students to design an icon representing distracted driving that can be shared on social media sites, addresses the importance of social networking and how critical it is to the life of a teen (16). In a “Toolkit” segment of the website, teens can even print up posters that say “iSmash my car because iUsed my phone while driving” or “iCrash because iCalled my boyfriend while driving”, playing off the visible marketing of Apple products that so many teens own and use on a daily basis (17).
The website also provides startling statistics about the prevalence of texting while driving in the teen community. While this may seem like an excellent way to get adolescents to understand the gravity of the issue, by illustrating the ubiquitous nature of the problem, texting while driving is seen as the social norm and, therefore, can actually encourage more teens to text while driving. As discussed in a study out of Australia, public health interventions should “…[minimize] the perceived texting frequency of other young people, [endeavoring] to portray texting while driving as a [behavior] which few young adults engage in or approve of,” (14).
Overall, creates a truly well-planned campaign based off of the Theory of Planned Behavior by addressing each of its essential components and providing plenty of documentation to support the development of healthy behavioral intentions. Although the intervention may be well-designed, it is still not effective. In fact, a recent study found that the Theory of Planned Behavior only accounted for a small percentage (11-14%) of the variance in people’s intention to text while driving (14). There must be other factors that are influencing to teens to engage in such risky behaviors that cannot be explained by this theory or quelled by the intervention designed by
So Where Do We Go From Here? Employing New Strategies
            How do we design a public health campaign that adequately addresses the concerns of parents and lawmakers while appealing to the adolescent population? Designing a campaign for teenagers is not like designing a campaign that is meant to target adults. As previously discussed, adolescents are extremely social yet fragile human beings who react differently to public health tactics than their parents and older role models. By using the previous criticisms to mold an intervention that minimizes psychological reactance and combats the optimistic bias, it is feasible to create a campaign that truly challenges the social norm and incites change in the teenage population.
             To avoid the psychological reactance that is so present in current public health campaigns, an intervention must strive for explicitness and reason while avoiding dominance and putting the control back in the hands of the audience (10).  While is certainly explicit in its presentation of the issue, there is a high level of dominance that can overtake the meaning behind the message. A website created by a government entity is hardly a source that a teen would pay attention to when there are so many other sites they would rather be visiting. It would be more effective to use a source that is similar to the target audience and in a forum that the target audience would commonly visit.
Optimistic bias is a difficult obstacle to overcome in the carrying out of public health campaigns. Regardless of the very real and frightening reports of motor vehicle crashes caused by distracted driving, any driver can believe that such a terrible event would never happen to them or anyone they cared about.
The law of small numbers further complicates this dynamic: statistics are not easily accessible to the general population (10). While we may hear that 1 in 6 fatal car accidents in 2008 were the result of distracted driving (18), if we do not have a face to put with that one fatality, we can lose site of the life lost. As teens certainly know many of their peers who have texted while driving and not gotten in to an accident, their perception is severely altered in terms of the actual risks associated with such a behavior (10). They know that they have texted behind the wheel before and nothing has happened, so why would that ever change in the future? If adolescents were able to hear true stories of other teens who had died behind the wheel while reading or sending a text message, even if they did not personally know these young men and women, they could begin to see the consequences of a seemingly innocent action.
Further, using the Theory of Planned Behavior to build a campaign designed for teenagers is irresponsible. As a theory based on the rationality of the human decision-making process, it does not address the fact that teenagers often act irrationally, speaking and acting before they think. As described in numerous studies, adolescents are experiencing a number of significant hormonal, physical and emotional changes during this time in their life (19). It would be difficult to expect them to rationally consider each thought before they acted on it when so much of their lives is out of their control. Rather than focusing on the significance of perceived behavioral control that a human being is assumed to have, a strong intervention would tackle the most important element of a teen’s life: the social network.
A novel intervention that employed the strengths of current campaigns while focusing on appealing to the teenage audience could successfully catch the ears and eyes of our youngest drivers. A video campaign that shared the individual story of a family affected by their teen texting while driving could help all young men and women grasp the severity of taking such actions. This is not just an ad providing a statistic; this is an ad introducing you to a real family who lost a beloved child. To make this campaign even more powerful, each state in the country could have a specific ad that told the tale of a teenager from their state. If a Massachusetts teen were to see the face of one of their peers that perished in a car accident in a town nearby, it would be difficult for them to ignore such a story. This could be you. This could be your best friend. This could be your cousin. By personalizing this issue, teens can no longer believe that accidents caused by distracted driving are isolated events that occur outside of their worlds. These advertisements could air on television channels frequented by teenagers, such as MTV and E!
AT&T has headlined an advertising campaign entitled “It Can Wait,” giving the individual stories of real teenagers and the last texts they sent before they were killed in motor vehicle accidents (20). The families of these teens detail their last moments alive, bravely demonstrating the pain that is left behind after a loved one has passed away. The idea behind this intervention is simple: look back at the last text message you sent or received and read it out loud. Is this message worth getting in an accident over? (20)
This type of ad campaign lowers reactance and optimistic bias because the source of the message is someone that the target audience of teenagers can relate to. An adult is not just listing all the sobering statistics associated with driving while texting. A teen viewer can relate to the source and understand that such a tragedy could happen to them or one of their friends if they continue to drive while distracted. By giving the exact words of the text the driver was sending or reading when they crashed, the campaign is being as explicit as possible; “is this text worth losing your life over?” One of the examples given depicts a beautiful teenage girl who was driving to meet a boy the day before her high school graduation. The last text she received read “where u at?” (20). Such an insignificant message would hopefully cause teenagers to pause and consider their own decisions when they are reaching to answer their cell phone during their next drive.
Such a concept gives control back to the teens in the target audience. This use of the Illusion of Control understands that when people make their own choices, there is an illusion that they control their own fate (10). It becomes their choice whether it is necessary to read that incoming message immediately or whether it can wait until the car is in park. As so much in the lives of teenagers is out of their control, this can be used as an opportunity to have some say in what happens to them. They can make the decision that the incoming text message is not as important as getting to their destination safely. Through AT&T’s campaign, a teenager can begin to see and grasp the realities of distracted driving in a way that straight facts do not provide while allowing them to take responsibility for their own decisions.
Finally, if the Theory of Planned Behavior cannot be successfully used to develop this campaign, another social and behavioral science principle can be utilized to intervene at the most vulnerable level. A teen is nothing without their social network, or so they may believe. How can we effectively target the power of the teen social network without losing sight of the final goal to erase texting while driving?
The idea behind the Social Networking Theory is that people and events are interdependent and it is immensely arduous to change the behavior of one individual when the rest of their environment does not change (21). Whether a study looks at cell phone use in a group of teenage peers or obesity in the Framingham Heart Study (21), it is obvious that an individual is influenced by the family and friends that surround them. By intervening at a group level, the focus is on social norms rather than individual actions (10). It is more feasible to change the behaviors of a teenager if their peers are also being challenged to think about the hazards of their actions. understands the importance of social media in the lives of adolescents by encouraging them to reach out to their peers and tell them about the dangers of distracted driving. However, the website still relies on the Theory of Planned Behavior, believing that if a teen driver knows the facts, they will make the correct decision to not text while driving. The Social Networking Theory is a much better fit for such a targeted intervention, where the entire adolescent population is the desired audience.
While engaging the principles used in the most recent campaign by AT&T, a successful intervention should go one step further, taking advantage of the Facebook, Twitter and Tumblr scene. An intervention could partner with Facebook or Twitter, sponsoring ads that plaster the sides of the website that teenagers visit every day; in fact, the Kaiser Family Foundation Report on Media Use recently found that 53% of 15–18 year olds use a social networking website daily (22). This would ensure that over 50% of the target audience could be exposed to the message at least once every 24 hours.
Furthermore, this campaign would elicit help from celebrities who are widely recognized by the teen demographic. Placing these well-know public figures in the print ads would catch the eye of the teen viewer, hopefully encouraging them to pause and read the words that the celebrity is supporting.
            In an era when the average teen is sending 3,417 texts per month (23), it is obvious that we are not going to change adolescent reliance on text messaging. As an activity that has become so strongly engrained in our culture, we must find ways of ensuring that teens are texting in the right place and at the right time. This intervention would combat the main criticisms found with the campaign. It would decrease psychological reactance by emphasizing the power teens have in making such important behavioral decisions. It would limit the optimistic bias, as the individual stories of actual teens killed in accidents related to texting while driving provide faces to go along with the powerful statistics and facts. By developing an intervention derived from the power of Social Networking Theory, we can reach teenagers in a way that is less offensive and overpowering than the methods currently in place. A campaign portraying real teenagers and their deaths behind the wheel can remind our young drivers that life is fleeting. Forget the statistics and facts; this can happen to you. Getting respected celebrities on board can help prove to these young men and women that distracted driving is a real concern that everyone needs to be aware of. While this intervention would not necessarily reach all the adolescents who currently text and drive, it could begin to open the eyes of our vulnerable young driver population.  We are not alone in this goal; as we strive to create more effective public health campaigns, wireless communication companies are designing devices that can disable drivers’ cell phones when they are in moving vehicles (24). In the future, we may have such technology that completely We are not going to change the dependence on cell phones and text messaging but we can hope to change the culture that goes along with it.


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