Thanks to a significant amount of research and promotion, the AAOS has increased Americans' awareness that distracted driving is causing crashes, injuries, and even deaths. It's an important public safety issue that the AAOS has championed for more than 5 years. In 2015, the Academy expanded its injury prevention efforts to include distracted walking—pedestrians focused on their cell phones, bopping to the music in their ear buds, or otherwise not paying attention to their surroundings. As a result, they may fall down stairs, trip over curbs or other streetscapes, and, in some instances, step into traffic—sustaining cuts, bruises, sprains, and fractures.

The Academy's "Digital Deadwalkers" public service announcement (PSA) campaign includes television and radio advertisements that humorously but effectively highlight what can happen when people talk, text, listen to music, or focus on anything or anyone other than getting where they need to go. Introduced in 2015, the campaign will air through the end of this year. To date, the PSAs have reached more than 723 million viewers and listeners.

Although the PSAs are raising awareness of the distracted walking issue, the AAOS Communications Cabinet thought that a lack of information and understanding about American perceptions and behaviors related to distracted walking were potentially limiting their impact.

We know that emergency department visits for pedestrian injuries involving a cell phone more than doubled between 2004 and 2010, according to a study appearing in the journal Accident Analysis & Prevention. We also know that distracted pedestrians may have been a contributing factor in the 4,200 pedestrian deaths and 70,000 injuries in traffic crashes in 2010, according to the National Highway Transportation Safety Administration.

But who is walking distracted? What do Americans think about distracted walking? Is it a serious issue? And if so, why are pedestrians not more focused on their surroundings and the task of safely getting to where they need to go?

Research: The first step
To learn more, the Academy commissioned a study involving 2,000 respondents nationally, and another 500 in each of the following cities: New York, Los Angeles, Chicago, Philadelphia, Houston, Phoenix, Atlanta, and Seattle. The study was conducted by Ipsos Public Affairs during October 2015. The research revealed some surprising results (Fig. 1).

Although 78 percent of U.S. adults believe that distracted walking is a "serious" issue, three-quarters of them say it is "other people" who walk distracted. Only 29 percent of respondents admitted that they personally are distracted walkers. And the sense of "it's not me, it's you" cuts across a range of distracted walking behaviors, as the following statistics show:

• 90 percent of respondents say they see walkers talking on the phone (37 percent admit doing so themselves)
• 88 percent say others are engaging in conversation (75 percent say they do so as well)
• 88 percent say others are listening to music (but only 34 percent do it themselves).
• 85 percent say distracted walkers are using a smartphone (yet just 28 percent admit doing so themselves)
• 64 percent say others are generally "zoning out" (38 percent say they also do so)

Despite the obvious risks associated with distracted walking, as many believe it is embarrassing as admit it is dangerous (46 percent). Furthermore, 31 percent of respondents say distracted walking is "something I'm likely to do" and 22 percent think distracted walking is "funny," according to the study.

Nearly 4 out of 10 Americans say they have personally witnessed a distracted walking incident, and just over a quarter (26 percent) say they have been in an incident themselves. Research revealed the following:

• Of those injured, women age 55 and older are most likely to sustain serious injuries, while Millennials, ages 18 to 34, are least likely to be injured in a distracted walking incident, according to the survey, despite the higher rates of distracted walking incidents among them.
• The perceptions of distracted walking also differ by generation, with 70 percent of Millennials and 81 percent of those aged 35 years and older believing that distracted walking is a serious issue.
• Millennials are more likely to engage in common distracted walking behaviors—texting, listening to music, or talking on the phone—than older people.
• Half of Millennials think distracted walking is embarrassing in a funny way.

Are we overly confident in our ability to multitask?
One of the challenges in combatting distracted walking may be that many Americans, myself included, are overly confident in their ability to multitask.

When asked why they walk distracted, 48 percent of respondents say "they just don't think about it," 28 percent feel "they can walk and do other things," and 22 percent use my personal favorite excuse, suggesting that they "are busy and want to use their time productively."

Among distracted walking behaviors, 75 percent of respondents say they personally "usually/always" or "sometimes" have "active conversations" with another person they are walking with, making this the most common distracted walking behavior people admit to doing themselves.

Perceptions vary by city, region
An individual's perception of the issue may slightly depend on where he or she lives. For example:

• Among the eight markets, New York City residents are most likely to view distracted walking as a serious issue (86 percent), and Seattle residents were least likely to view the issue as serious (77 percent).
• New Yorkers are more likely to say they personally walk distracted (39 percent) than walkers living in the other cities.
• Residents of Chicago and Philadelphia are most likely to see distracted walking as "dangerous" (49 percent), while those in Houston were the least likely to think it's dangerous (40 percent).

The Academy announced the survey results on Dec. 1, 2015, resulting in media interviews across the country and a renewed focus on the distracted walking issue during the busy holiday season. Readers, listeners and viewers were directed to OrthoInfo.org/DistractedPedestrians

Going forward, all of us—including myself—need to put down the phone, turn off the music, and focus on getting where we need to go—whether we're racing to catch a plane or train or simply walking through the hospital—to avoid injuring ourselves and others.

As our PSA urges viewers and listeners, "Engage!"

Alan S. Hilibrand, MD, chairs the AAOS Communications Cabinet.

Deliver the message
Take advantage of online resources to help deliver the message about distracted walking. Download the infographic shown on page 50, direct patients to the video on YouTube, share the survey results with your local media, or draft a "letter to the editor" or "op-ed" piece for your local paper. Materials are available online at http://newsroom.aaos.org/PSA or www.orthoinfo.org/distractedpedestrians

References:

1. Nasar JL, Troyer D: Pedestrian injuries due to mobile phone use in public places. Accid Anal Prev 2013 Aug;57:91–95. Doi: 10.1016/j.aap.2013.03.021. Epub 2013 Apr 3. Available at http://www.sciencedirect.com/science/article/pii/S000145751300119X. Accessed on December 7, 2015.
2. AAOS: Distracted Walking: A Serious Issue for You, Not Me. Available at http://newsroom.aaos.org/media-resources/news/distracted-walking-a-serious-issue-for-you-not-me.htm. Accessed on December 7, 2015.
3. Distracted Walking Survey Results: Available at http://www.anationinmotion.org/wp-content/uploads/2015/12/AAOS-Distracted-Walking-Topline-11-30-15.pdf. Accessed on December 7, 2015.
4. Patient information: Available at http://www.orthoinfo.org/topic.cfm?topic=A00748. Accessed on December 7, 2015.
5. Public Service Announcements: http://newsroom.aaos.org/PSA/orthopaedic-surgeons-address-the-risks-of-distracted-walking-in-2015-public-service-announcement.htm. Accessed on December 7, 2015.
6. View the PSA "Digital Deadwalkers": http://newsroom.aaos.org/video_display.cfm?video_id=6813. Accessed on December 7, 2015.