What moves truck drivers? A person-centered perspective on workplace physical activity promotion.

Objectives. In developing physical activity (PA) promotion measures in the workplace, individual needs of the target groups must be considered. For this reason, this study aimed to qualitatively identify the individual needs for an increase of PA in truck drivers, representing a neglected working group in terms of PA promotion. Methods. Semi-structured interviews were conducted (N = 19; mean age 50.5 years, SD 11.4 years; 10.5% female). The interview guide was based on the COM-B model to identify needs related to PA behavior in terms of capabilities, opportunities and motivation. The interviews were transcribed and coded by two independent investigators. Results. Altogether, the codes encompassed 395 statements, and the code system contained 14 codes. Three additional codes described further individual needs related to other health behaviors (nutrition, recreation) or external incentives for health interventions. Conclusion. The results reveal a variety of needs that are fundamental to the development of PA-promoting interventions for truck drivers. These needs appear to be closely linked, so a combination of capabilities, opportunities and/or motivation should be considered when developing holistic interventions. An example would be linking automatic motivation and psychological capabilities that encompass motivational techniques combined with information for psychoeducation of truck drivers.

The association of job fatigue with mental disorders among bus drivers.

OBJECTIVE: Mental disorders are a global problem with growing importance. However, the contribution of work factors to the development of mental disorders is inconclusive. This study aimed to assess the impact of fatigue and job stress on mental disorders in a prospective cohort of bus drivers. METHODS: The Taiwan Bus Driver Cohort Study (TBDCS) recruited 1652 bus drivers from a bus company in 2005. Participants self-completed a structured questionnaire in 2007, which included the Demand-Control-Support (DCS) model questions and the Swedish Occupational Fatigue Inventory-Chinese (SOFI-C). Psychiatric care visits and admissions were obtained from the National Health Insurance Research Dataset (NHIRD) from 2003 to 2016 for as a proxy for psychiatric diagnoses. Drivers with a history of psychiatric disorders before the questionnaire survey time were excluded (N=69). During the follow-up period, a new diagnosis with a psychiatric disorder was defined as an event. Cox proportional hazards model was used to estimate the hazard ratio (HR) for new one-set psychiatric disorders, adjusting for age, body mass index, marital status, education, alcohol consumption, smoking, exercise, bus driving experience, shift work, and chronic diseases. RESULTS: Among the 896 bus drivers retained for analysis, 85 were newly diagnosed with a psychiatric disorders. DCS score was not associated with the risk of developing a psychiatric disorders, but bus drivers with high SOFI-C scores (≥5) had an elevated risk for anxiety or mood disorders (HR 3.35, 95% confidence interval 1.23-9.09). CONCLUSIONS: Among bus drivers, occupational fatigue, as indicated by high a SOFI-C score, might result in an elevated risk of anxiety or mood disorders. Health service organizations should provide recommendations and guidance for drivers with high fatigue levels to avoid anxiety or mood disorders.

Driving performance and turning reaction time following hip arthroscopy for FAIS: does capsular repair matter?

PURPOSE: (1) To compare the pre- and postoperative driving performance in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS); (2) to examine the differences in driving performance between patients with versus without capsular repair. METHODS: Patients who underwent arthroscopic hip surgery for FAIS were included. Driving performance of participating patients was collected using a driving simulator preoperatively and at 2 weeks, 4-6 weeks and 8-12 weeks postoperatively. Data collected included demographics, surgery laterality, intraoperative procedures, left and right turn reaction time, total turn reaction time, gas off time (GOF), and break reaction time (BRT). Repeated measures analysis of variance (ANOVA) was used for statistical analysis. RESULTS: 21 subjects (9 males, 12 females) with a mean age of 30 ± 9 years were included and 57.1% of the subjects had right-sided surgery. There was no difference between the mean preoperative and the 2-week postoperative left (0.72 seconds and 0.75 seconds, respectively) right (0.77 seconds and 0.75 seconds, respectively), and total (0.74 seconds and 0.75 seconds, respectively) turn reaction times as well as GOF (0.62 seconds and 0.60 seconds, respectively) and BRT (0.92 seconds and 0.93 seconds, respectively), indicating that the patients' driving performance returned to the preoperative level as early as 2 weeks following hip arthroscopy for FAIS. There was no significant difference amongst any of the driving variables between patients who underwent capsular repair (50%) and those who did not. There was no significant difference amongst any of the driving variable s between patients who underwent left versus right hip arthroscopy. CONCLUSIONS: Patients' driving performance returns to the preoperative level as early as 2 weeks after hip arthroscopy for FAIS. Surgery laterality nor capsular repair make any significant difference in the time for driving abilities to return to baseline. The impact of intraoperative procedures performed, and the analgesic medications used postoperatively on the driving ability of patients undergoing hip arthroscopy warrants further investigation in larger patient populations.

Prevalence of medical factors related to aging among older car drivers: a multicenter, cross-sectional, descriptive study.

AIM: An increasing number of older adults in Japan are at an increased risk of road traffic crashes. This study aimed to investigate the prevalence of potential underlying medical factors that increase the risk of road traffic crashes among older people. METHODS: This cross-sectional observational study was conducted in 11 medical institutions in Japan using self-administered questionnaires and physical examination from January to May 2021. The background and social data, data on the use of nursing care insurance, and clinical data suggestive of polypharmacy, sarcopenia, cognitive impairment, and frailty/oral frailty were obtained. The prevalence of these factors was compared between everyday and occasional drivers. RESULTS: Data of 127 patients were collected; their median (interquartile range) age was 73 (70-78) years. Of the total participants, 82 were men (64.6%) and 45 were women (35.4%). There were 77 everyday drivers and 50 occasional drivers. Of these, 121 (95.3%) had not applied for nursing care insurance, but the numbers of those who required help 1 and 2 were 1 (0.8%) and 3 (2.4%), respectively. Prevalence of medical factors was as follows: polypharmacy, 27.6%; sarcopenia, 8.7%; dementia, 16.4%; frailty, 15.0%; and oral frailty, 54.3%; it was not significantly different between every day and occasional drivers. Intention to return the car license was significantly higher among the occasional drivers (2.6% vs. 14.0%; odds ratio: 6.7, 95% confidence interval: 1.2-70.6, p = 0.024). CONCLUSION: We uncovered the prevalence of medical factors that can be associated with road traffic crashes among Japanese older people aged ≥ 65 years in our community.

Associação entre horas de trabalho e de descanso e o uso de substâncias psicoativas entre motoristas profissionais de caminhão / Association between hours of work and rest and the use of psychoactive substances among professional truck drivers

OBJETIVO: Investigar a associação de horas diárias de trabalho e de descanso com o uso de substâncias psicoativas entre motoristas profissionais de caminhão. MÉTODOS: Estudo transversal conduzido em 2016 com 354 motoristas profissionais de caminhão que aguardavam a inspeção da mercadoria transportada em um Posto de Controle Fiscal localizado na cidade de Itatiaia, RJ, Brasil. A associação entre horas diárias de trabalho (exposição), horas diárias de descanso (exposição) e uso de substâncias psicoativas (desfecho) foi investigada por meio de modelos de regressão linear que estimaram coeficientes de regressão (ß) e respectivos erros-padrão, considerando p < 0,05. RESULTADOS: Mostraram-se positivas as associações entre horas diárias de trabalho e uso de anfetamina (ß = 0,91; erro-padrão = 0,19; p < 0,01) e de cocaína/crack (ß = 1,32; erro-padrão = 0,35; p < 0,01) e negativa a associação entre horas diárias de descanso e uso de anfetamina (ß = -0,43; erro-padrão = 0,09; p < 0,01). CONCLUSÃO: Horas diárias de trabalho e de descanso parecem ser determinantes do uso de anfetamina e de cocaína/ crack entre motoristas profissionais de caminhão.

OBJECTIVE: To investigate the association of hours of work and rest with use of psychoactive substances among professional truck drivers. METHODS: Cross-sectional study conducted in 2016 with 354 professional truck drivers waiting for the inspection of the goods transported at a Fiscal Control Post located in the city of Itatiaia, RJ, Brazil. The association between daily working hours (exposure), daily rest hours (exposure) and use of psychoactive substances (outcome) was investigated using linear regression models that estimated regression coefficients (ß) and respective standard error, considering p < 0.05. RESULTS: They were positive the associations between daily working hours and use of amphetamine (ß = 0.91; standard error = 0.19; p < 0.01) and cocaine/crack (ß = 1.32; standard error = 0.35; p < 0.01) and the association between daily rest hours and use of amphetamine (ß = - 0.43; standard error = 0.09; p < 0.01) was negative. CONCLUSION: Daily hours of work and rest seem to be determinants of the use of amphetamine and cocaine/crack among professional truck drivers.

Bilateral cataract surgery improves neurologic brake reaction time and stopping distance in elderly drivers.

AIMS: To determine brake reaction times before and after bilateral cataract surgery in elderly drivers. METHODS: Sixty-four patients were evaluated on the day of and 4 weeks after bilateral cataract surgery. Forty-three healthy individuals with a valid driving licence served as the control group. A driving simulator was used to determine brake reaction times after receiving a visual stimulus. Total brake reaction time (BRT) as well as neurologic reaction time (NRT), foot transfer time (FTT) and brake pedal travel time (BPTT) were measured, and the measurements obtained before and after cataract surgery were compared. The correlations between NRT, best-corrected visual acuity (BCVA) and contrast sensitivity (CS) were assessed. RESULTS: Out of the 64 patients with bilateral cataract, 53 were assessed for postsurgical measurements. All time measures improved significantly after cataract surgery (BRT, 815.7(224) versus 647.9(148) ms; NRT, 364.7(91) versus 283.5(44) ms; FTT, 290.8(62) versus 248.6(58) ms; and BPTT, 160.6(96) versus 116.6(72) ms, p < 0.001). The calculated stopping distance improved significantly after surgery (22.3(6) versus 19.9(4) m at 50 km/h). Best-corrected visual acuity (BCVA) and contrast sensitivity (CS) improved significantly after surgery (0.25(0.2) versus 0.05(0.05), n = 53, p < 0.001; 1.4(0.2) versus 1.6(0.1), p < 0.001, respectively). There was a significant negative correlation between CS and NRT before surgery (r = -0.253, n = 64, p = 0.04, Pearson's correlation). CONCLUSION: Our findings show a significant effect of CS on neurological BRTs and the corresponding stopping distances. This highlights the importance of presurgical CS evaluation as a critical factor in cataract surgery decisions in elderly drivers.

Driving after marijuana use among U.S. adolescents: Prevalence profiles and related behaviors.

OBJECTIVES: The interplay between marijuana legislation, perceptions of risks associated with marijuana use, and marijuana-related risk behaviors is an ever changing and complex issue. Marijuana impaired driving is of concern as legalization continues to expand in the United States. While driving after using marijuana has been shown to be prevalent among adults, little research has examined the behavior in adolescents. The aim of the present study was to examine the prevalence of driving after using marijuana among U.S. adolescents, with an examination of the relationship to age of marijuana initiation and marijuana usage patterns. METHODS: We analyzed data from the 2017 Youth Risk Behavior Survey, a nationally representative sample of high schools students in the U.S. The sample was current marijuana users, defined as past 30 day use. Driving after using marijuana was the main outcome variable, with analyses examining the association between the outcome and age of initiation and patterns of use. Prevalence ratios were obtained by modeling Poisson regression to examine factors associated with driving under the influence of marijuana. RESULTS: Nearly half of all marijuana users reported driving after use during the past 30 days, and did not differ between males and females. Prevalence of driving after using marijuana was significantly higher among heavy users (PR = 2.8; 95% CI 2.1-3.6). A higher prevalence of driving after drinking alcohol (PR = 1.7; 95% CI 1.5-1.9) was also found among those who had driven after using marijuana. CONCLUSIONS: Among adolescent marijuana users, the prevalence of driving after using marijuana was high. Enhanced surveillance, prevention, and control measures are necessary to mitigate the negative impacts of marijuana consumption and related behaviors.

Effects of surgery for obstructive sleep apnea on cognitive function and driving performance.

BACKGROUND: Obstructive sleep apnea (OSA) is associated with a significantly increased risk of motor vehicle accidents in addition to such cognitive impairments as attention and memory deficits. The aim of the study was to examine the effect of upper airway surgery for OSA on driving and cognitive function. METHODS: Adult patients who underwent surgery for OSA at a tertiary medical center in 2016-2019 were prospectively recruited. Patients were assessed before and 3-6 months after surgery with a self-report and neurocognitive battery and a driving simulation platform. RESULTS: The cohort included 32 patients of average age 46.9 ± 11.6 years. During the 3 years before treatment, 9 patients had been involved in road accidents and 18 were detained by police for traffic violations. After surgery, there was a significant decrease in the Epworth Sleepiness Scale (13.7 vs. 8.1, p 0.043) and a significant reduction in time to completion of the Color Trail Test (part 1: 21.4 vs 18.7 s, p = 0.049; part 2: 46.8 vs 40.5 s, p = 0.038). Improvements in divided attention and selective attention response times were noted on the advanced stages of the Useful Field of Vision Scale (p = 0.013, p = 0.054). Before surgery, patients showed a high tendency to drive over the speed limit and to cross the dividing line to the opposite lane on the simulation test. Nevertheless, all considered themselves good drivers. These tendencies decreased after treatment. CONCLUSIONS: Surgery for OSA can significantly improve driving performance and cognitive function.

The Impact of HIV-Associated Neurocognitive Impairment on Driving Performance in Commercial Truck Drivers.

Driving ability can be diminished amongst people with HIV with associated neurocognitive impairment (NCI). We explore the relationship between HIV status, NCI and driving ability in professional truck drivers. Forty male professional drivers (20 HIV-positive; mean age = 39.20 ± 7.05) completed a neuropsychological test battery, two driving simulator tasks that assessed driving ability, and a driving history and habits questionnaire. A higher proportion of HIV-positive drivers exhibited impaired overall cognitive performance (p ≤ 0.001). Overall, drivers with NCI (defined as z ≤ 1.00) were more likely than those without NCI to crash (p = 0.002). There were no significant between-group (HIV-positive versus HIV-negative) differences with regard to self-reported on-road driving events. Professional drivers with NCI, as measured on a driving simulator, are at increased risk of making driving errors under high-risk conditions compared to their neurocognitively normal counterparts. These data should inform driver health management with regard to annual medical screening and surveillance.

RESUMEN: La capacidad de conducción puede verse disminuida entre las personas con VIH con deterioro neurocognitivo asociado (neurocognitive impairment, NCI). Exploramos la relación entre la situación frente al VIH, el NCI y la capacidad de conducción en conductores profesionales de camiones. Cuarenta conductores profesionales masculinos (20 seropositivos, edad media = 39.20 ± 7.05) completaron una batería de pruebas neuropsicológicas, dos tareas de simulador de conducción que evaluaron la capacidad de conducción y un cuestionario de hábitos y antecedentes de conducción. Una mayor proporción de conductores VIH positivos exhibió un desempeño cognitivo general deficiente (p ≤ 0.001). En general, los conductores con NCI (definido como z ≤ 1.00) tenían más probabilidades de chocar que aquellos sin NCI (p = 0.002). No hubo diferencias significativas entre los grupos (VIH positivo frente a VIH negativo) con respecto a los eventos autoinformados de conducción en carretera. Los conductores profesionales con NCI, según lo medido en un simulador de conducción, tienen un mayor riesgo de cometer errores de conducción en condiciones de alto riesgo en comparación con sus homólogos neurocognitivamente normales. Estos datos deberían informar a la gestión de la salud del conductor en lo que respecta a la vigilancia y los exámenes médicos anuales.

Return to Driving After Foot and Ankle Surgery: A Novel Survey to Predict Passing Brake Reaction Time.

Introduction. Brake reaction time (BRT) is an accepted method for establishing recommendations for safe return to driving by the National Highway Traffic Safety Administration. Other than performing a BRT test in clinic, there is no established clinical tool to help physicians differentiate safe from unsafe drivers once patients reach general recovery milestones. The purpose is to present individual recommendations to the patient through a novel, validated survey evaluating safe return to driving after orthopaedic surgery of the right foot and ankle. Methods. A total of 171 patients undergoing 1 of 3 specific foot and ankle procedures were prospectively enrolled. A 4-question survey and BRT were completed 6 weeks postoperatively. The following questions were asked: (1) "I think my brake reaction time is slower than most drivers my age," (2) "I think my brake reaction time is faster than most drivers my age," (3) "I think my brake reaction time is about the same as most drivers my age," (4) "Based on what I think my brake reaction time is, I think I am ready to drive." Internal consistency was determined with Cronbach's α and item total correlation. External validity was determined by Spearman's correlation coefficient. A BRT less than 0.850 s was considered as a pass. Results. Of 171 patients, 162 (95%) with ages ranging from 21 to 83 years achieved a passing BRT by 7.6 weeks. After removing 1 question because of internal inconsistency, the optimal threshold for predicting passing BRT was 10/15 points or higher, which had 99% probability of success that a patient would pass the BRT (95% CI = 96%, 100%). Conclusion. This novel, 3-question driving readiness survey can accurately predict a passing BRT Achilles rupture repair, total ankle arthroplasty, and hallux valgus correction performed in the right foot and ankle as early as 6 weeks postoperatively.Level of Evidence: Level II: Comparative study.

Roadway features associated with elderly drivers in motor vehicle crashes.

BACKGROUND: As the number of older US drivers has increased over the past decades, so has the number of injuries, hospitalizations, and deaths from motor vehicle crashes (MVCs) involving elderly drivers. We seek to identify personal, environmental, and roadway features associated with increased crashes involving elderly drivers. We hypothesize that elderly drivers are more likely to be involved in MVCs at intersections with more complex signage and traffic flow. METHODS: This is a retrospective observational study using 2015 to 2019 police traffic crash reports and a Department of Public Health database of built-environment variables from a single urban center. Demographics and environmental/road features were compared for vehicle-only MVCs involving elderly (≥65 years) and younger drivers. χ2 and nonparametric tests were used to analyze 36,168 drivers involved in MVCs. RESULTS: There were 2,575 (7.1%) elderly drivers involved in MVCs during the study period. Left turns and all-way stop signs were associated with increased crash risk among elderly drivers compared with younger drivers. Elderly-involved MVCs were less likely to occur at intersections with left-turn restrictions, traffic lights, only one-way streets, and bike lanes compared with MVCs with younger drivers. Elderly drivers were more likely to be involved in MVCs on weekdays, less often intoxicated at the time of the crash, and less frequently involved in fatal MVCs compared with younger drivers. However, elderly drivers were more frequently the at-fault party, especially after the age of 75 years. CONCLUSION: Updates to roadway features have potential to decrease injury and death from MVCs involving elderly adults. Left turn restrictions or other innovative safety treatments at all-way stops or where left turns are permitted may mitigate road crashes involving older adults. Education may increase awareness of higher-risk driving tasks such as turning left, and driving alternatives including public transportation/paratransit may offer alternate means to maintain activities of daily living. LEVEL OF EVIDENCE: Prognostic/Epidemiological, level IV.

Coupling neuroscience and driving simulation: A systematic review of studies on crash-risk behaviors in young drivers.

OBJECTIVE: Motor vehicle crashes are a leading cause of death for adolescents and young adults. The aim of this study is to examine and discuss the state-of-the-art literature which uses neuroscience methods in the context of driving simulation to study adolescent and young adult drivers. METHODS: We conducted a systematic English-language literature search of Ovid MEDLINE (1946-2020), PsycINFO (1967-2020), PubMed, Web of Science, SCOPUS, and CINAHL using keywords and MeSH terms. Studies were excluded if participants were not within the ages of 15-25, if the driving simulator did not include a visual monitor/computer monitor/projection screen and steering wheel and foot pedals, or brain data (specifically EEG [electroencephalogram], fNIRS [functional near-infrared spectroscopy], or fMRI [functional magnetic resonance imaging]) was not collected at the same time as driving simulation data. RESULTS: Seventy-six full text articles of the 736 studies that met inclusion criteria were included in the final review. The 76 articles used one of the following neuroscience methods: electrophysiology, functional near-infrared spectroscopy, or functional magnetic resonance imaging. In the identified studies, there were primarily two areas of investigation pursued; driving impairment and distraction in driving. Impairment studies primarily explored the areas of drowsy/fatigued driving or alcohol-impaired driving. Studies of distracted driving primarily focused on cognitive load and auditory and visual distractors. CONCLUSIONS: Our state of the science systematic review highlights the feasibility for coupling neuroscience with driving simulation to study the neurocorrelates of driving behaviors in the context of young drivers and neuromaturation. Findings show that, to date, most research has focused on examining brain correlates and driving behaviors related to contributing factors for fatal motor vehicle crashes. However, there remains a considerable paucity of research designed to understand underlying brain mechanisms that might otherwise facilitate greater understanding of individual variability of normative and risky driving behavior within the young driving population.

Is the perceived neighborhood built environment associated with domain-specific physical activity in Latin American adults? An eight-country observational study.

BACKGROUND: Characteristics of the neighborhood built environment are associated with physical activity (PA). However, few studies with representative samples have examined environmental correlates of domain-specific PA in Latin America. We examined the associations of the perceived neighborhood built environment with domain-specific PA in a large sample of adults from eight Latin American countries. METHODS: This study examined data from 8185 adults (aged 18-65 years) from eight Latin American countries. The Neighbourhood Environment Walkability Survey - Abbreviated (NEWS-A) scale was used to assess perceptions of land use mix-diversity, land use mix-access, street connectivity, walking/cycling facilities, aesthetics, safety from traffic, and safety from crime. Perceived proximity from home to public open spaces (metropolitan parks, playgrounds, public squares) and to shopping centers was also measured. Transport-related and leisure-time PA were assessed using the long form of the International Physical Activity Questionnaire. Both logistic and linear regression models were estimated on pooled data. RESULTS: Perceptions of higher land use mix-access (OR: 1.40; 95% CI: 1.22,1.61), the existence of many alternative routes in the neighbourhood (1.12; 1.04,1.20), slow speed of traffic (1.19; 1.03,1.35) and few drivers exceeding the speed limits (1.09; 1.03,1.15) were associated with greater odds of reporting at least 10 min/week of transport-related PA. Perceptions of higher levels of land use mix-diversity, better aesthetics and greater safety from crime, the presence of crosswalks and pedestrian signals, and greater proximity of shopping centers were associated with more min/week of transport-related PA. Perceptions of higher land use mix-diversity (1.12; 1.05,1.20), higher land use mix-access (1.27; 1.13,1.43), more walking/cycling facilities (1.18; 1.09,1.28), and better aesthetics (1.10; 1.02,1.18) were associated with greater odds of engaging in at least 10 min/week of leisure-time PA versus none. Perceptions of higher land use mix-diversity were associated with more min/week of leisure PA. CONCLUSIONS: Different perceived neighborhood built environment characteristics were associated with domain-specific PA among adults from Latin America countries. Interventions designed to modify perceptions of the neighbourhood built environment might influence initiation or maintenance of domain-specific PA. TRIAL REGISTRATION: ClinicalTrials. Gov NCT02226627 . Retrospectively registered on August 27, 2014.

Enhancing the Clinical Utility of DriveSafe DriveAware for People with Huntington's Disease.

DriveSafe DriveAware (DSDA) is a cognitive screening tool assessing driving safety. Previously, we found DSDA categorised some HD participants as 'likely to pass' on-road assessments, despite displaying cognitive impairments in domains known to impact driving. As processing speed is affected early in HD, we examined whether DSDA completion time could provide supplementary cognitive information to support clinical decision-making. The HD group completed subtests significantly slower than controls, and completion times correlated with cognitive functions essential for driving. Considering DSDA completion time may tailor the assessment for people with HD so that it is more reflective of HD-related cognitive functioning.

Psychological Constructs Related to Seat Belt Use: A Nationally Representative Survey Study.

Seat belt use can significantly reduce fatalities in motor vehicle crashes (Kahane, 2000). Nevertheless, the current U.S. seat belt use rate of 89.6% (Enriquez & Pickrell, 2019) indicates that a relatively small but pervasive portion of the population does not wear seat belts on a full-time basis. Whereas much is known about the demographic predictors of seat belt use, far less is understood about psychological factors that predict individual proclivities toward using or not using a seat belt. In this study, we examined some of these potential psychological predictors. A probability-based web survey was conducted with 6,038 U.S. residents aged 16 or older who reported having driven or ridden in a car in the past year. We measured self-reported seat belt use and 18 psychological constructs and found that delay of gratification, life satisfaction, risk aversion, risk perception, and resistance to peer influence were positively associated with belt use. Impulsivity and social resistance orientation were negatively associated with belt use. Prior research has shown that psychological factors like delay of gratification, risk aversion/perception, and impulsivity predict other health behaviors (e.g., cigarette smoking, sunscreen use); our results extend this literature to seat belts and can aid the development of traffic safety programs targeted at non-users who-due to such factors-may be resistant to more traditional countermeasures such as legislation and enforcement.

Applying a social-ecological lens to opinions about HIV self-testing among Kenyan truckers who declined to test: a qualitative study.

HIV prevalence among truckers in Africa is high and testing rates suboptimal. With numerous African countries having approved HIV self-testing kits, more information on how to design acceptable and accessible self-testing programs for high-risk populations is necessary. We explored views about self-testing via in-depth interviews with 24 truckers participating in a randomised controlled trial who refused HIV testing. A social-ecological lens was used to guide data analysis and frame study findings. While most participants said that they would use an HIV self-test, perceived barriers and facilitators were identified at multiple levels. Many participants noted lack of time to test or obtain a self-test kit as a major barrier (intrapersonal) and varied in their views about self-testing with a partner (interpersonal). Participants offered programmatic/policy recommendations, suggesting that they preferred accessing self-test kits in settings where training could be provided. Participants believed they should be able to pick up multiple test kits at the same time and that the test kits should be free or low cost. These study findings will help guide the design of self-testing programs for truckers and other mobile populations.

Recreational cannabis use impairs driving performance in the absence of acute intoxication.

BACKGROUND: Across the nation, growing numbers of individuals are exploring the use of cannabis for medical or recreational purposes, and the proportion of cannabis-positive drivers involved in fatal crashes increased from 8 percent in 2013 to 17 percent in 2014, raising concerns about the impact of cannabis use on driving. Previous studies have demonstrated that cannabis use is associated with impaired driving performance, but thus far, research has primarily focused on the effects of acute intoxication. METHODS: The current study assessed the potential impact of cannabis use on driving performance using a customized driving simulator in non-intoxicated, heavy, recreational cannabis users and healthy controls (HCs) without a history of cannabis use. RESULTS: Overall, cannabis users demonstrated impaired driving relative to HC participants with increased accidents, speed, and lateral movement, and reduced rule-following. Interestingly, however, when cannabis users were divided into groups based on age of onset of regular cannabis use, significant driving impairment was detected and completely localized to those with early onset (onset before age 16) relative to the late onset group (onset ≥16 years old). Further, covariate analyses suggest that impulsivity had a significant impact on performance differences. CONCLUSIONS: Chronic, heavy, recreational cannabis use was associated with worse driving performance in non-intoxicated drivers, and earlier onset of use was associated with greater impairment. These results may be related to other factors associated with early exposure such as increased impulsivity.

The need for speed: observational study of physician driving behaviors.

OBJECTIVE: To determine whether fast driving, luxury car ownership, and leniency by police officers differ across medical specialties. DESIGN: Observational study. SETTING: Florida, USA. PARTICIPANTS: 5372 physicians and a sample of 19 639 non-physicians issued a ticket for speeding during 2004-17. MAIN OUTCOME MEASURES: Observed rates of extreme speeding (defined as driving >20 mph above the speed limit), luxury car ownership, and leniency of the speeding ticket by police officers, by physician specialty, after adjustment for age and sex. RESULTS: The sample included 5372 physicians who received 14 560 speeding tickets. The proportion of drivers who were reported driving at speeds greater than 20 mph was similar between physicians and a sample of 19 639 non-physicians who received a ticket for speeding (26.4% v 26.8% of tickets, respectively). Among physicians who received a ticket, psychiatrists were most likely to be fined for extreme speeding (adjusted odds ratio of psychiatry compared with baseline specialty of anesthesia 1.51, 95% confidence interval 1.07 to 2.14). Among drivers who received a ticket, luxury car ownership was most common among cardiologists (adjusted proportion of ticketed cardiologists who owned a luxury car 40.9%, 95% confidence interval 35.9% to 45.9%) and least common among physicians in emergency medicine, family practice, pediatrics, general surgery, and psychiatry (eg, adjusted proportion of luxury car ownership among family practice physicians 20.6%, 95% confidence interval 18.2% to 23.0%). Speed discounting, a marker of leniency by police officers in which ticketed speed is recorded at just below the threshold at which a larger fine would otherwise be imposed, was common, but rates did not differ by specialty and did not differ between physicians and a sample of non-physicians. CONCLUSIONS: Rates of extreme speeding were highest among psychiatrists who received a ticket, whereas cardiologists were the most likely to be driving a luxury car when ticketed. Leniency by police officers was similar across specialties and between physicians and non-physicians.

Perceived Effectiveness of Anti-Marijuana Messages in Adult Users and Nonusers: An Examination of Responses to Messages About Marijuana's Effects on Cognitive Performance, Driving, and Health.

OBJECTIVE: Marijuana use is associated with negative cognitive and health outcomes and risky driving. Given the rapidly changing policies regarding legal recreational and medicinal marijuana use, it is important to examine what types of marijuana prevention messages may be effective in minimizing such outcomes. This study examined cognitive and affective responses to anti-marijuana public health messages in a sample of adult marijuana users and nonusers to determine the correlates of perceived message effectiveness. METHOD: Participants (N = 203; mean age = 37.7 years) were adult marijuana users and nonusers recruited via Amazon Mechanical Turk (August 2017). After completing self-report measures of marijuana use, they viewed six anti-marijuana messages presented in a random order, addressing marijuana's effects in each of three topic areas: cognitive performance, driving, and adverse health outcomes (e.g., two messages per topic). Participants completed assessments of cognitive and affective perceptions after viewing each message. For each message topic, a linear regression model was used to determine which cognitive and affective perceptions were most predictive of perceived message effectiveness. RESULTS: For all message topics, nonusers perceived the messages as more effective than did users (p < .001). In the majority of analyses, greater message effectiveness was associated with increased perceived harm of marijuana and increased liking of the message. For driving and health messages, greater message effectiveness was also significantly correlated with lower pleasant affect. CONCLUSIONS: The findings suggest that audience perceptions may be uniquely predictive of message effectiveness, depending on the topic.

Cannabidiol (CBD) content in vaporized cannabis does not prevent tetrahydrocannabinol (THC)-induced impairment of driving and cognition.

BACKGROUND: The main psychoactive component of cannabis, delta-9-tetrahydrocannabinol (THC), can impair driving performance. Cannabidiol (CBD), a non-intoxicating cannabis component, is thought to mitigate certain adverse effects of THC. It is possible then that cannabis containing equivalent CBD and THC will differentially affect driving and cognition relative to THC-dominant cannabis. AIMS: The present study investigated and compared the effects of THC-dominant and THC/CBD equivalent cannabis on simulated driving and cognitive performance. METHODS: In a randomized, double-blind, within-subjects crossover design, healthy volunteers (n = 14) with a history of light cannabis use attended three outpatient experimental test sessions in which simulated driving and cognitive performance were assessed at two timepoints (20-60 min and 200-240 min) following vaporization of 125 mg THC-dominant (11% THC; < 1% CBD), THC/CBD equivalent (11% THC, 11% CBD), or placebo (< 1% THC/CBD) cannabis. RESULTS/OUTCOMES: Both active cannabis types increased lane weaving during a car-following task but had little effect on other driving performance measures. Active cannabis types impaired performance on the Digit Symbol Substitution Task (DSST), Divided Attention Task (DAT) and Paced Auditory Serial Addition Task (PASAT) with impairment on the latter two tasks worse with THC/CBD equivalent cannabis. Subjective drug effects (e.g., "stoned") and confidence in driving ability did not vary with CBD content. Peak plasma THC concentrations were higher following THC/CBD equivalent cannabis relative to THC-dominant cannabis, suggesting a possible pharmacokinetic interaction. CONCLUSIONS/INTERPRETATION: Cannabis containing equivalent concentrations of CBD and THC appears no less impairing than THC-dominant cannabis, and in some circumstances, CBD may actually exacerbate THC-induced impairment.