Texting while driving is illegal in 35 states and the District of Columbia.
Courtesy of iStockphoto\Thinkstock


Published 2/1/2012
Neil M. Issar, BSc, William T. Obremskey, MD, MPH, A. Alex Jahangir, MD; Manish K. Sethi, MD

Distracted Driving: The Emerging Policy on Cell Phone Use

Lessons learned from drinking and driving are being applied

In response to a series of fatal accidents in which driver distraction was determined to be a cause, the National Transportation Safety Board (NTSB) recently recommended a nationwide ban on the use of portable electronic devices while driving. The unanimous recommendation is much stricter than any current state law and would apply to all cell phones, including hands-free devices.

The NTSB cited a University of Utah study in claiming that the use of a cell phone, whether handheld or hands-free, impairs a driver’s reactions as much as having a blood alcohol content (BAC) of .08, the national standard for driving under the influence. In its national campaign, the NTSB repeatedly draws parallels between using a cell phone and driving under the influence of alcohol.

Current policy
At present, nine states and Washington, D.C., prohibit drivers from using handheld cell phones while driving; 30 states and Washington, D.C., have outlawed cell phone use by novice drivers (usually defined as people 18 and younger). The nation’s capital and 35 states also have bans on texting while driving, with 12 of the bans being enacted in 2010 alone, but no state imposes an outright ban on hands-free devices for drivers. (For a state-by-state breakdown of laws governing cell phone use while driving, see the online version of this article, available at www.aaosnow.org)

In the past 10 years, the NTSB has increasingly sought to limit the use of portable electronic devices, recommending bans for novice drivers, school bus drivers, and commercial truckers. The federal government recently banned interstate truck and bus drivers from using cell phones while driving, but the NTSB’s most recent recommendation, if adopted by states, would be the strictest and most comprehensive prohibition.

Some critics have argued that a sweeping ban on cell phone use while driving is too severe and that current measures to counteract driver distraction are sufficient. For example, in 2011 the National Highway Traffic Safety Administration (NHTSA) reported on successful pilot projects in Syracuse, N.Y., and Hartford, Conn.Combining increased ticketing of drivers with a high-profile public education campaigns produced significant reductions in distracted driving—as much as 33 percent in Syracuse and 57 percent (handheld phone usage) in Hartford.

Despite the increased use of cell phones while driving—and an increase in the number of national vehicle miles traveled, U.S. Department of Transportation data for 2010 show that total traffic fatalities and traffic fatalities per 100 million vehicle miles of travel fell to the lowest levels on record. Alcohol-related fatalities also dropped to approximately 10,000, a 4.9 percent decrease from 2009.

Thus, disagreement persists regarding both the contribution of cell phone use to motor vehicle accidents and the appropriate measures needed to reduce distracted driving. Is cell phone use any more distracting or reaction-impairing than eating while driving, changing radio stations, listening to an audio book, or having a conversation? If further studies can conclusively show that driving while inebriated and driving while using a cell phone or being distracted in other ways result in similar levels of impairment, future legislation regulating activity while driving may parallel the evolution of drinking and driving laws.

Drinking and driving laws
In 1910, New York became the first state to adopt laws regarding driving under the influence (DUI). Early DUI laws simply stated that a driver could not operate a motor vehicle while intoxicated; however, intoxication was not clearly defined and the severity of enforcement at the time is unclear. Not until the National Safety Council developed tests that could be used to determine intoxication and found that a driver with a BAC of 0.15 or higher should be deemed inebriated were these limits set.

In the 1980s, lobbying by Mothers Against Drunk Driving (MADD), formed by a woman whose 13-year-old daughter was killed by a drunk driver with three previous DUI convictions, and Students Against Drunk Driving (SADD) resulted in more severe DUI laws and penalties. In 1984, Congress passed the National Minimum Drinking Age Act, which required states to raise the age for purchase and public possession of alcohol to 21 years by October 1986 or lose 10 percent of their federal highway funds. Some states initially refused to comply, but by 1988, every state had raised the drinking age to 21.

The impact of the legislation was seen almost immediately, with the National Safety Council citing a 13 percent decrease in alcohol-related traffic fatalities among 18- to 20-year-olds within a month of enforcing the new drinking age. Similar federal pressure on states reduced the legal BAC limit from 0.15 to 0.10, and then to the present-day limit of 0.08.

The parallel to cell phone use
The push for stricter regulation regarding motorists’ use of cell phones and other electronic devices, however, has not been as clear cut as that for drinking and driving. Several groups, such as FocusDriven and the American Automobile Association’s Foundation for Traffic Safety, advocate the elimination of cell phone use while driving as part of their mandate. The AAOS and the Orthopaedic Trauma Association (OTA) are currently highlighting the dangers of texting while driving via the Decide to Drive national public service campaign.

On the other hand, both the Seward Square Group, a Washington lobbying firm, and the Consumer Electronics Association, a major trade group, are trying to reframe the debate over the dangers of distracted driving. The two groups argue that prohibiting the broad use of certain devices might hinder innovation or the adoption of technologies with the potential to improve safety, such as voice-activated phones. They believe that comparisons to DUI laws are detrimental, and that current state-specific and state-regulated bans on texting while driving, no-phone use for young drivers, and hands-free legislation are adequate.

Because the NTSB can only make recommendations, lobbying Congress to apply federal pressure on state governments could be the only option for groups that support restrictions on cell phone use while driving. However, Congress may be reluctant to apply such pressure and force a ban on all cell phone use by motorists.

Current legislation, which allows the use of hands-free technology, has helped spur sales of equipment for hands-free calling. Such devices generated approximately $230 million in sales for the technology industry in the first 11 months of 2011. For wireless retailers, sales of hands-free equipment and headsets accounted for 1.5 percent of all hardware revenues. Hence, federal consideration of profit may counter any efforts to impose a widespread ban on motorists` use of cell phones.

Cell phone use by motorists occurs far more frequently than drinking while driving, but the impairment caused by the former activity is less well known than the impairment caused by the latter. Thus, if lobbying Congress to apply federal pressure on states is unsuccessful, advocacy groups must attempt to influence public opinion on the effect of cell phone use while driving. Proponents and critics of a widespread ban on cell phone use must also determine if such a ban would even be enforceable.

Further studies are also needed to conclusively prove that the NTSB’s comparison of cell phone use and inebriated driving is valid. Regardless of the future of legislation regarding cell phone use while driving, few can argue the soundness of efforts to inform motorists of the dangers associated with distracted driving for any reason.

Neil M. Issar, BSc; William T. Obremskey, MD, MPH; A. Alex Jahangir, MD; and Manish K. Sethi, MD, are all associated with the Vanderbilt Orthopaedic Institute Center for Health Policy.

Editor’s Note: Ending the practice of distracted driving has been a hallmark of the AAOS public service campaign for the past 2 years. (See cover story, “Academy rolls out new public service messages.”) Although drivers may be distracted in many ways, cell phone use while driving has come under increased scrutiny, as this “Orthopaedic Policy Perspective” column shows.

Did you know…

  • More than 3,000 roadway fatalities in 2011 involved distracted drivers.
  • At any given daylight moment, 13.5 million drivers are using hand-held phones.
  • Drivers who use cell phones are four times as likely to get into crashes serious enough to injure themselves.
  • Driving while using a cell phone reduces the amount of brain activity associated with driving by 37 percent.