Challenging Dogma - Spring 2011

Sunday, May 8, 2011

R U Driving to School 2day? : Teenagers, Cell Phones and the Flawed Approach to Distracted Driving

Think about the day you passed your driver’s test. Or when you drove out of your parents’ driveway for the first time without a licensed driver (i.e. your parent) in the passenger seat. Or the time you said to your friend, “I’ll pick you up for the movie,” and you didn’t need to coordinate with your mom first. If the intense feeling of liberation and freedom in these moments feels far away for us as graduate students, now think about your response when you see a text message flash on your cell phone screen, or what you do when you hear your phone ring. This potent combination of newfound freedom and the sometimes Pavlovian response our cell phones create is the growing public health problem of distracted driving.

Because we cannot expect ourselves to fully recapture the teenage mindset, it is no wonder that public health professionals are pursuing a misguided approach when it comes to addressing the issue of texting behind the wheel. But we can and we should use social science and behavior change theory to look critically at current strategies to reduce distracted driving, such as the Department of Transportation’s effort, D! (1). Targeted at parents, educators and teens, D! launched in 2009. Involving Secretary of Transportation Ray LaHood, President Obama and a range of corporate and non-profit partners, D! is the most visible distracted driving public health intervention to date.

Distraction Behind the Wheel

Over the past ten years, cell phones have become an indispensable part of modern life. For teenagers seeking independence from their parents, a cell phone represents the ability to make and receive unscreened phone calls and texting is quickly becoming many teens’ main means of communication with their peers. According to the Pew Internet and American Life Project, 75% of American teenagers between the ages of 12 and 17 own a cell phone, and of those teens, 66% use their phones for texting (2). Among teenagers ages 16-17, 52% of those who own cell phones say they have talked on the phone while driving and 48% of teens ages 12-17 say they have been in the car when the driver was texting (2). Pew’s research found that older teens are most likely to own cell phones (2), a population that corresponds to the age of new drivers.

In 2009, the National Highway Traffic Safety Administration recorded that 20 percent of injury crashes and 16 percent of all traffic fatalities were connected to distracted driving (3). NHTSA also found that the largest group of distracted drivers were in the under-20 age group (3) and that drivers who use cell phones while driving are four times more likely to get into crashes that are serious enough to injure themselves (3). Numerous studies have shown that performing a dual task, such as talking on the phone or texting, while driving significantly increases the risk of a crash (4). Texting in particular causes drivers to take their eyes off the road for four times as long as other common dual tasks like for example, changing the radio station (4).

Distraction at the wheel is not a new phenomenon, but the use of cell phones, especially among younger, more inexperienced drivers, has prompted a wave of new legislation at the state level to regulate the use of hand-held devices while operating a vehicle. Currently, 31 states ban text messaging while driving, and twelve of those laws were passed in 2010 alone (5). However, only eight states ban the use of hand-held devices completely for all drivers (5). Other states have passed legislation restricting texting and talking for younger drivers but do not regulate more experienced/older drivers.

The Flawed Approach of D!

From the dramatic black and orange color scheme to phrases like “deadly epidemic” and “serious, life-threatening practice,” D! has chosen to strongly embrace a negative, threat-based approach to the issue of distracted driving. The website casts teenagers as “offenders” and positions parents and teachers as “educators” who are the only ones capable of stopping bad behavior. In a quotation from an April 2011 press release, Secretary Ray LaHood even seems to blame teenage drivers outright; “Distracted driving has become a deadly epidemic on America’s roads, and teens are especially vulnerable because of their inexperience behind the wheel and, often, peer pressure,”…“Behind the statistics are real families who have been devastated by these tragedies.” (6) Although Sec. LaHood likely did not mean to structure his campaign around blaming teenagers for perpetuating “these tragedies,” he has unfortunately positioned teenagers as the villains. Promising to “not rest until we stop it,” (6) the Department of Transportation has set the stage for a failed intervention based on this negative tone, an inappropriate application of the Health Belief Model, and the failure to recognize the Theory of Optimistic Bias and Psychological Reactance Theory.

A Misapplication of the Health Belief Model

As one of the core behavior change models in public health, the Health Belief Model (HBM) is an individual-level model that proposes that individuals make health choices based on the rational weighing of benefits and consequences, such as perceived severity and susceptibility (7). The HBM is classified as a rational belief model, and “it assumes that human behavior is determined by an objective, logical, thorough process.”(8) Many health education campaigns are based on the HBM, and while it can be effective in certain contexts, distracted driving is not one of them. The central tenet of the HBM is the behavior is rational, accurately assessed by the individual, and upon that assessment, negative behavior will be changed through intention (7).

It appears that D! applies elements of the HBM primarily to a parental audience, instead of to teens. This in and of itself is a curious choice. D! focuses on educating parents about the risks of distracted driving and it does provide more than adequate support for its claims. A positive feature of this intervention is that the site has become an information clearinghouse for statistics and news about distracted driving. However, the information is designed to drive up parents’ feelings about the severity of the consequences and susceptibility of their teenagers. An educational brochure includes such steps as “Educate yourself” surrounded by tragic stories of teenagers who died in distracted driving related crashes (9). For these parents, the HBM approach might in fact increase their feelings about the severity of the issue, but D! does not reach beyond parents to a teen audience. This is a misapplication of the model; a model that has additional flaws when it comes to this public health problem.

Research supports the idea that a logical, rational approach is not the best fit for the issue of texting and driving. A study conducted in England showed that 100 percent of study participants rated their driving performance as worse when sending a message, and 90 percent rated their driving performance as worse when retrieving a message (10). According to the principles of the HBM, and by extension D!, these study participants (who are aware of their affected performance) should cease texting and driving. This study, as well as others, shows that applying the HBM to texting and driving is flawed, as people who practice distracted driving are aware of their distraction and yet are still doing the behavior. Furthermore, a 2010 survey of teenagers in states with texting and driving bans revealed that 60 percent of teens surveyed still text and drive regardless of a ban (11). If the HBM held true, these teenagers should be weighing the risks and benefits of breaking the law and driving while compromising their performance. However, their behavior does not reflect a rational weighing of the risks and benefits, rather it indicates that other impulses are at work.

Bad Things Happen to Other People

Teenagers are a population that is particular susceptible to what one might call “magical thinking” about risks to their lives and health. Speaking generally, teenagers tend to engage in risk-taking behavior to push boundaries of their own independence, test the limits of their perceived invincibility and differentiate themselves from authority figures. And even when engaging in risky behavior, such as texting and driving, the teenage brain can rationalize away uncomfortable feelings, often through behavior that is still risky but viewed by teens as “not as bad”. Numerous studies have cited behavior that teens use to modify their texting, such as only using one hand, only texting when the car is stopped, and reading text messages but not responding (4). But the risk from performing a dual task while driving stays relatively the same regardless of the teens perception of modification (4). Social sciences theory supports many of these beliefs about teenagers and their behavior. Unfortunately, D! does not adequately account for many of these theories, and one in particular, the Theory of Optimistic Bias, is a critical omission.

The Theory of Optimistic Bias holds that a person’s own perception of risk is skewed by a bias toward optimistic outcomes, or that bad things might happen to other people but not to them (12). Research has shown that optimistic bias is especially high in adolescents, just like our target population of teenage drivers (13). One study in particular looked at college students and their attitudes about the likelihood of positive and negative future life events (12). The study showed that participants are prone to believing that they are much more likely to experience positive events and less likely to be affected by negative events in comparison to their peers (12).

With texting and driving teenagers often underestimate the level of distraction that answering or sending a text message produces, even though the University of Utah found that using a cell phone while driving delays reactions as much as having a blood alcohol level of .08 percent (3). Because of their developmental period, teenagers have higher levels of optimistic bias and studies show that this can lead to increased crash risk, with or without the added risk of texting while driving (13). D! does not address the Theory of Optimistic Bias or the skewed perception of risk and leans into parent-child power dynamics instead of acknowledging the developmental differences of their target population.

Another way that D! escalates the tone of the intervention as well as ignoring the Theory of Optimistic Bias is through the use of video stories called “Faces of Distracted Driving” (14). These stories are heartbreaking incidents of injury and death as a result of distracted driving. Many of them are straight to camera appeals by the parents of the dead teen. While it is possible to praise D! for their use of real stories to illuminate the problem of distracted driving, these stories are not used strategically to combat the problem of optimistic bias.

While telling stories is a great way to create impact, many of these videos present extreme situations that might feel foreign to the target audience of D! For example, the educational brochure (9) for parents highlights a story of a girl who unfortunately died after becoming distracted at the wheel and crossing into the other lane of traffic into the wheels of a loaded logging truck. Even though the crucial element of the story (the distracted driving) could apply to many teens, the visual of the logging truck could place it out of reach for many teenagers, especially those who live in urban areas. The logging truck seems like an unlucky twist of fate for one teenager, not an everyday occurrence in the lives of the target audience. Other similarly intense stories have the potential to make the issue feel more foreign to teens rather than related to a behavior that many of them do frequently in their lives. Since heightened optimistic bias is already skewing teens’ perception of risk, these (in their minds) more farfetched stories do not succeed in puncturing their optimism about what could happen to them and in fact reinforces the idea that bad things happen to other people.

The Ultimate Power Struggle

Parents and teenagers alike dread the power struggles of adolescence. Whether it’s a request to participate in family dinner, a tussle over household chores, or a too short skirt, the teenage years are often characterized by frequent eruptions of anger, defiance and intense negotiation. Like clothing and mealtime, the car can become a battlefield. Teenagers are eager to spread their wings and experience the independence that driving brings. Parents are anxious about the lack of control and the possibility of injury or other consequences. Both sides are experiencing heightened emotions.

Unfortunately, D! neglects to recognize many of these dynamics as well as the social science theory that underpins many actions of teenagers in response to their parents: Psychological Reactance Theory. Psychological Reactance Theory posits that when one’s freedom is threatened, a likely response is immediately acting to restore that freedom (15). Psychological Reactance Theory is best understood as the common sense idea of being told one thing only to want to do the opposite in response (16). Furthermore, a study showed that when parents over-restrict their child’s access to social media (computer, phone, texting), psychological reactance occurs (17). The boomerang effect of psychological reactance has been well documented in the literature, but primarily for other public health programs such as anti-smoking and anti-drug campaigns. Studies in among college smokers have demonstrated high reactance to being told not to smoke, to the point where the negative effect from reactance has far outweighed the educational goals or supposed benefit of the campaign (18).

Under the principles of Psychological Reactance Theory, D! is poised to induce extreme reactance among the target audience. D! has taken authority figures and put them in charge of the problem as it instructs parents to “Talk to Your Teen” and download educational materials that tell parents how to broach the subject of distracted driving. Another way that D! might cause reactance is its portrayal of teenagers as the bad actors. In fact on the site’s Frequently Asked Questions, it includes the question, “Who are the offenders?” with the response that everyone is guilty but that youngest Americans are most at-risk (19). This type of characterization only reinforces the way teenagers feel at home with their parents, that they are the bad guys and that the only result of their actions is punishment. This negative portrayal of teenagers has the potential to heighten reactance.

Using Different Strategies

Given the body of social science and behavior change research that exists to draw upon, D! needs to pursue different strategies to accomplish its goals of reducing distracted driving. The needs and wants of a teenage audience (independence and control) might seem harder to relate to or understand than those of their parents (safety) but it is possible.

Moving Beyond the Health Belief Model

The teenage years are marked by rites of passage, many of which are directly related to giving teenagers more control of their own lives. These rites, including but not limited to: getting a driver’s license, a longer curfew, a cell phone, a bigger allowance, or applying to college, are treasured events by many teenagers. Knowing this, wouldn’t it more effective to structure a distracted driving intervention that made feel teens in control, rather than lectured at by their parents?

To modify D!’s approach, it is important to move beyond the HBM and the idea that texting and driving is a behavior that can be changed by asking teenagers to rationally weigh the risks and benefits of their actions. In the case of texting and driving, one way to accomplish this would be to use strategies that replace the rational thought process with something that focuses on giving control back to teens. As Ellen Langer of Yale University demonstrated in her study, “The Illusion of Control,” competition and choice can lead to increased feelings of confidence and control of the outcome (20). Therefore, what if the federal government’s public health intervention for distracted driving focused on giving control back through a campaign that used competition? Teens could challenge their friends to go a certain number of days without texting, and there could be rewards for the longest number of days. The campaign would leverage the power of teenage social networks and combine that with a rewards system that was shareable across social network platforms such as Facebook, Twitter, MySpace and Tumblr. Instead of being asked by Secretary Ray LaHood to stop texting and driving, your best friend would challenge you through a social media tool and your Facebook friends would be able to keep track of the number of consecutive days you went without texting and driving. You could also challenge your friends and monitor the progress of your friends through social media.

Teens also like to feel control in their relationships, especially with parents and significant others. So instead of using commands, such as D!’s “Put it down” directive, it might be better to construct a campaign around the idea that by not texting, the teen is in control. For example, a teenager might be driving in the car with her cell phone in the cup holder. The phone flashes, it’s the boy she thinks is cute. But instead of picking the phone up, the ad appeals to the idea that by not responding, she stays in control. A message such as “You can make him wait,” or “Answer him when you want to,” could resonate with teens as they to look to take control of their decisions and lives in even in simple forms like a text message. All of these proposed changes to the intervention are designed to shift from a more static, rationally based model like the HBM to dynamic strategies that might be more appropriate for the target audience of teenagers.

Combating Optimistic Bias

Contending with optimistic bias in teenagers is a common problem for public health practitioners who are designing interventions for teens. In part, this is why the omission by D! is so glaring. Optimistic bias is tricky to reduce and many interventions take the route chosen by D!, they choose to ratchet up the threat level and use of fear appeals to scare people into behavior change. From antidrug to anti-drinking and driving campaigns, fear and death have been the natural choices. This makes sense when you think about the people designing the campaigns as many of them could be parents and to parents, losing your child is the worst thing imaginable. And it’s not that teenagers aren’t empathetic or affected by tragedy, it’s just not always the best way to reach them.

However, D! could be modified to more effectively puncture optimistic bias while still educating teenagers about the tragic side of drinking driving. But instead of ten stories of teens dying, some of the videos would be replaced with stories about the more mundane and much less dramatic consequences of texting and driving. Whether it’s a video story of a teenager adding up all the money she owes for getting tickets for texting or the story of a boy missing prom because he texted while driving his little brother to school, the stories would bring down the fear factor and perhaps feel more relatable to the lives of teenagers. D! could increase its effectiveness by reducing the intensity of some of the video stories and adding situations that feel more relevant to more teenagers.

Minimizing Psychological Reactance

Texting and driving is understandably a scary behavior for parents and in many states, it is against the law. These are just some of the reasons why it is not surprising that D! chose a negative, punishing tone for its intervention. Defaulting to the authoritative parent-child relationship is natural, but unfortunately deeply flawed when it comes to minimizing psychological reactance. Instead of adopting an accusatory tone focused on deadly epidemics and offenders, D! would more be successful if it took steps to minimize reactance rather than increasing it.

Teenagers are, for the most part, extremely social creatures. They are often trying on identities for size, and both experimenting with taking stands on issues that matter to them and also looking for the direction of the crowd. To minimize reactance, studies show that increasing similarity and familiarity (16) of those who deliver the messages has an impact. For teens, this could mean using spokespeople who are their age, instead of, with all due respect, a gray-haired Secretary LaHood. By leaning into familiarity and staying away from authority figures, teens might be less likely to experience reactance and continue texting as a way to restore their freedom. D! should not make teenagers into the offenders, instead it should look for ways to include teenagers in their decision to stop texting and driving. Movement interventions, such as, a youth-led effort to stop teen smoking in Massachusetts, have proven very effective with teenagers (21). doesn’t accuse teenagers of trying a cigarette, or smoking, or having friends who smoke, rather it focuses on the positive decision of choosing not to smoke and how that makes teenagers part of something larger than themselves (21).

Minimizing psychological reactance in teenagers is not the impossible task that some might claim it is. Teenagers are too often seen as purely oppositional, defiant and as risk-takers, where they can also be bright, curious, energetic and capable of creative solutions. D! should take steps to modify its tone and create spokespeople who are more accessible and relatable for teens, steps that would go a long way to reducing psychological reactance.


As of October 2010, the average American teenager sends approximately 3,339 text messages a month, or more than six per waking hour (22). And many of these texts probably occur behind the wheel of a car, whether it’s at a stoplight, making a left turn, or while driving down the highway. This is a public health problem that deserves interventions that work and take into account the needs and wants of teenagers as well as what will keep them safe. In addition to developing better interventions, states also need to take steps to change their driver education programming requirements to include education about distracted driving. Currently, only 18 states and D.C. require distracted driving education in their driver education curricula (23). Making distracted driving a great part of driver education is a necessary step toward raising the education level of new drivers about the dangers of texting and driving.

The public health community should take a multi-facted approach to texting and driving interventions that takes into account social science and behavior change theories that are appropriate for a teenage audience. Whether it’s creating a social media competition around the number of days a teen goes without texting or targeting messages that make teens feel that they are in control of their decision or part of a movement, public health practitioners will need a diversity of interventions to tackle this problem.


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