The Art and Science of Behavior Change

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Text, Wednesdays with Woodward (registered trademark) A Webinar Series. The Art and Science of Behavior Change. Logos, The George Washington University Hospital, Travelers Institute, Travelers. N.S.C., National Safety Council, N.A.B.C., National Auto Body Council, Changing and Saving Lives Every Day. Joan Woodward appears in a picture-in-picture in the upper right corner. 

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Good afternoon, and thank you for joining us today. I'm Joan Woodward, and I'm honored to lead the Travelers Institute, the public policy and educational arm of Travelers. Today's program is part of our Wednesdays with Woodward series. We started this last year to explore issues impacting your personal and professional lives in these very uncertain times. 

We're pleased you're here today. And we hope you'll stay engaged with us. You can join our mailing list by emailing Institute@Travelers.com. Connect with me personally on LinkedIn or watch past replays of our webinars at TravelersInstitute.org. 

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LinkedIn name, Joan Kois Woodward. Hashtag, Wednesdays with Woodward 

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So before we get started, I'd like to share our disclaimer about today's program. 

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Text, About Travelers Institute (registered trademark) Webinars. Wednesdays with Woodward is an educational webinar series presented by the Travelers Institute, the Public policy division of Travelers. This program is offered for informational and educational purposes only. You should consult with your financial, legal, insurance or other advisors about any practices suggested by this program. Please note that this session is being recorded and may be used as Travelers deems appropriate. Next slide, Every Second Matters (registered trademark). Graphic of the Travelers umbrella logo inside a steering wheel with a short bar on top. 

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April is Distracted Driving Awareness Month. And it's an opportunity for us to refocus our efforts on auto safety. At the Travelers Institute, distracted driving has been one of our core educational initiatives over the past several years. 

We've hosted nearly 90 live events through our Every Second Matters campaign, elevating the conversation about why this matters. Unfortunately, attention to this issue is needed during the pandemic even more. Fewer Americans have been driving, but those who have been, have been taking more risks on the road and had much more fatal crashes in 2020. 

The National Safety Council reports that traffic fatalities in 2020 increased by 8% from 2019, even though miles driven were decreased substantially by 13%. This resulted in a 24% increase in the death rate. I hope that feels like a really shocking statistic to you, because it does to me. In fact, the highest percentage increase in the death rate in nearly 96 years in our country. 

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Text, Troubling Trends in Roadway Safety. Motor Vehicle Deaths in 2020 Estimated to be Highest in 13 Years, Despite Dramatic Drops in Miles Driven. A 24% spike in roadway death rates is highest in 96 years. Travelers risk index distracted driving. 24% of respondents said they think the roads are safer today than they were prior to the pandemic. Logos, National Safety Council, Travelers. 

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In addition to miles driven basis, the governor's Highway Safety Administration projects the 20% increase in the pedestrian fatality rate for the first half of 2020 compared to the first half of 2019. So despite this reality, new data released today shows that the Travelers Risk Index, many drivers assume roads are safer due to reduced travel. But there's a big disconnect here. 

So what does this mean for you? And what does this mean for your state? 

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Percent change in 2020 preliminary twelve month NSC estimates. US Deaths in 2020: 42,060. Percent change from 2019: + 8%. A color coded map of the US. Key at the bottom labeled Percent Change in Traffic Fatalities from 2019. Colors from negative 20 in dark blue to positive 36 in shades of orange and then brown. 

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The National Safety Council also reports these dramatic swings in fatalities on a state-by-state basis. If you live in one of these blue states on my chart, fatalities have declined. But if you're in a state that is shaded with a darker orange, fatalities have increased--and by a lot. And you can see there's a lot of orange on this chart. 

All of this to say, something needs to be done. And we're glad you're here to help us make that happen. There are a lot of issues at play, including speeding and driving under the influence. But today we're really going to focus on distraction, with specifically how we can get people to change that risky behavior they're engaged in. 

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Opening slide. 

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We're enormously grateful for our partners today and for helping us to present this program. 

A special thank you to the National Safety Council, the National Auto Body Council, and the George Washington University Hospital. I'm also thrilled to welcome our speakers. Terrific speakers today with us. They all bring views from the medical community and the public health communication community. And they're all dedicated to injury prevention. 

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Headshots of the three speakers, Dr. Susan Kartiko, Dr. Kit Delgado and Dr. Jay Winsten plus Joan Woodward and their titles. 

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First, we'll have Dr. Kit Delgado. He's an Assistant Professor of Emergency and Epidemiology at the University of Pennsylvania. He also serves as the Associate Director of Penn's Center for Health Incentives and Behavioral Economics, as well as the Director of the Behavioral Science and Analytics for Injury Reduction, or BeSafir Lab. 

Next, we'll have Dr. Jay Winsten. He's the Director of the Initiative on Media Strategies for Public Health within the TH Chan School of Public Health at Harvard University. And then joining us for a discussion later is Dr. Susan Kartiko. She's a trauma surgeon and Assistant Professor of Surgery at the George Washington University School of Medicine and Health Sciences. 

So with that, you can submit your questions to the program using the Q&A function at the bottom of your screen. And we're going to get kicked off right here with Dr. Kit Delgado. Kit, please take it away. 

Hi, and thanks for having me. So I'm an ER doctor, usually on nights and weekends, and do research during the day. And tell you about a patient I saw. The first patient off my shift, I walked into a room. There was a young guy, who looked like he was about 20, 21, completely confused, fiddling with his gown, trying to tie it on. And he tells me that he got in a car crash the night before. 

He was driving down the highway outside of our trauma center. He heard the ping go off on his phone. He reached down to pick it up, dropped the phone. Next thing you know, he hits the guardrail, spins around, and he's completely concussed. And I start talking to him. And he just told me, he's like, I know I shouldn't have done that. And it's emblematic of this behavior, the gap between knowing better and doing better. 

Nationally, we know that over 90% of American drivers know that distracted driving from cell phone use is risky and dangerous. Yet, as Joan highlighted in the data, and as we've seen in multiple national surveys, over 50% of American drivers admit to some form of cell phone distraction while driving. And I think this goes to, now, how do we change this behavior? And I study behavior change and trying to get people to reduce risky behaviors. And the classic behavior change models assume that if we educate people on the risks of a behavior, like the risks of doing drugs, the risks of unsafe sex, the risks of using your phone while driving, and showing all the gory images and things that can happen, that people take those risks in and change their behavior. 

But we know that, and we assume that, OK, you know people wear bike helmets and put on their seatbelts. But what we know from studying behavior is that people are actually predictably irrational and that we have constant flaws in our decision making that prevent us from doing the things that are in our best long-term interests. And that's really the field of behavioral economics where we can predict tendencies where people do not act in their best interests. 

So let's talk about two types of cell phone distractions. So the first type is--and two reasons why people use their phones. And we've studied this both in survey data and observed in some of our research. The first is, people using their phone like an extension of their car. So you need to figure out where you're going, you're not going to print out MapQuest directions like we used to, you're going to stream GPS. 

You want to listen to something else other than your local radio station, you're going to use Pandora or Spotify or streaming music. So people use the phone like it's an extension of the car. It makes driving a more enjoyable or user-friendly experience. And when we surveyed drivers about whether they're willing to give it up, they say no. They were not willing to give up that kind of phone use. 

The second type of phone use is the one that we sort of think about all the time, which is the impulsive type of phone use, where it's habitual, often subconscious, and involves responding to notifications, and things like that. Turns out, actually when we surveyed drivers, including teen drivers, about whether they're willing to give it up, over 95% are willing to give up texting, social media checking, and any kind of that kind of impulsive handheld use. 

So how do we get around to changing this behavior? So the first is acknowledging that when we come into a car, and with our phones, by default, the situation is risky, right? The phones are designed so that they draw attention, and that when their notification goes off, you draw attention to your phone. 

Also, there's no best way to put a phone into the car. By default, most people put it in a cup holder or that little space underneath the radio. And so when a notification goes off, if your phone is in the cup holder, by default, you're now going to take your eyes off the road. And that's the final common pathway between distraction and a crash. 

And then when that notification goes off, say it's your girlfriend, and your mind is now engaged in what's called "system one type thinking." It's the heuristic, split-second decision making, where you're making a quick calculation about what's the risk of me not responding to my girlfriend versus what's the risk of getting into a crash. I've recently driven 1,000 times and have not had any problems. I feel that I can manage this. And I'm overconfident in my ability. And I just look around, and everyone on the road is also using their phone. And so there's a social norm there. 

So how do we design around these realities? So I think the first thing we need to focus on instead telling people what not to do, we have to make it easier to do the right thing and use more harm reduction type thinking and build less risky phone habits behind the wheel. So I'm going to give you four strategies to do this. 

So Susan mentioned the first one, which is we should be activating Do Not Disturb While Driving to come on automatically. That will make it by default a less risky situation in the phone. You set it once, and then your one and done. And then you have an auto reply so that if your girlfriend texts you, you automatically reply so she's not feeling like she's dissed. And if it's urgent for whatever reason, they can still text "urgent" and get through. 

I've always argued that this should be the out-of-the-box factory setting for cell phones. We've done some surveys, and it turns out that the vast majority of people would not be offended if that was the out-of-the-box factory setting. And we know from the science that would greatly increase uptake. 

The second is we need to add phone mounts in the car set at eye level. If you're going to have a phone in the car, the chances are you're going to use it. Might as well put it at a level that is going to reduce the amount of time you take your eyes off the road, particularly if you're using GPS and music and things like that. We have some early research suggesting that this really does reduce, in a sustainable way, the amount of time people will use their phone. 

The next thing is given that people are using GPS and music, and it's one of the most common ways that people use their phone while driving, is to program that ahead of time so that it's set, and you can forget it. And then lastly, we need to make it more instantly rewarding to stay off the phone. I think this is where there's a lot of future promise. Most of the large auto insurers right now are offering insurance options in which you're priced on your actual driving behavior as opposed to your average demographics. 

And phone use is actually being incorporated into those driving metrics so you can get a discount for having reduced phone use. And we're doing some studies right now to figure out the best ways to provide feedback in and framing those discounts to get people to reduce their phone so that they can save money on auto insurance. And it's more instantly rewarding. That's it, thanks. 

OK, thanks so much, Kit. Dr. Winsten, would you take it away from Harvard and give us your thoughts on behavioral change? 

Yes, thank you so much. You know, I'd start by suggesting we all have to acknowledge that nothing has worked at a global level in changing behavior around distracted driving for the last 15 years. And there are a number of reasons for that. And the other two speakers have gone over some of that. I tend to think, and I agree with Susan on this, that changing social norms is going to be crucial. 

I'll go to a cocktail party, and someone will ask, what are you--at least before COVID--what are you working on? And I'd say, distracted driving. And more likely than not, they'll look up at the ceiling, and roll their eyes, and say, yeah, I'm probably one of the worst offenders. I guess I'm going to have to change my behavior. You wouldn't do that around drunk driving. Nobody is amused in talking about their drunk driving, because the norm has changed and there's a stigma associated with drunk driving. Not so about distracted driving. 

And the norm is to drive while distracted. And there's very, very little social penalty connected to it. And until we change the social norms, I'm not sure people are going to take the action of silencing their phones when they get into the cars, et cetera. So norms change is key. 

So we've been looking at other aspects of this and other ways into the problem of looking for fresh messages on the communication side. And we looked at all the survey research conducted, including by major insurance companies, the Travelers Risk Index, for example, 71% of people interviewed state that they are scared to death of the other drivers on the road. They don't think they're going to cause the crash, but they are really worried about everybody else who's out there, that they're going to injure them or they're going to kill them. 

And this is a consistent finding across each and every one of the surveys. So we asked ourselves, is there a positive way to take advantage, in a sense, of this pre-existing fear and kind of flip it around. Instead of saying to people, don't drive distracted. Flip it to, be an attentive driver in order to protect yourself from the other drivers on the road. And so it's all about situational awareness and maintaining situational awareness. And then how do we get that down to--people don't want to hear complicated terms like situational awareness. So we worked hard to frame what that message should be. 

And can I have the first slide, because I'm going to show you a couple of examples. 

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A photo of four dancers as they walk on a crosswalk, all dressed in black. The third one is up in the air with one leg straight out and the other bent under her. Traffic is stopped in the background. Text, Courtesy of Tourism Ireland. Expect the Unexpected. It happens fast: some jerk runs a red light; a distracted driver loses control; Irish dancers cross Abbey Road without looking. Keep your guard up and your phone down. Logos, Project Look Out, Harvard T.H. Chan School of Public Health. Copyright 2021, President and Fellows of Harvard College 

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Here we go. Expect the unexpected. It happens fast. Some jerk runs a red light. A distracted driver loses control. Irish dancers across Abbey Road without looking. Keep your guard up and your phone down. That will be the consistent message throughout. And it will go a little bit further. Keep your guard up and your phone down, and scan the road for surprises. 

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A reflection of a freight truck in a side view mirror. Text is read. Logos same as previous. 

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Likewise, danger comes quickly. A distracted driver swerves into your lane. Traffic suddenly halts. Behind the wheel, keep your guard up and your phone down. And we'll get to the scanning for surprises in a later series of ads. And in the last one, again, it happens fast. A distracted driver loses control. Traffic suddenly halts. Keep your guard up and your phone down. 

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Blurred images of cars as they drive on a curved highway. Text, On the Road Again! Rest of text read. 

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So we'll see how all that goes. We've packaged this into an initiative that we call Project Lookout. It's a social media campaign, initially. And our messages will go live. We're launching the campaign this coming month during Distracted Driving Awareness Month. I think I'll stop there. And let's move on to questions. 

First to you, Susan. And then, do you, Kit, I mentioned those jaw-dropping statistics about roadway safety during this pandemic. And the National Safety Council is talking about injuries. Nearly 5 million people were injured on top of all the fatalities that we saw. And since COVID, Susan, what are you seeing in your trauma center? Are you seeing a corresponding change in injuries coming in? 

Yes, I do. So during the pandemic, we have a decrease in trauma activation. And trauma activation means that they are quite ill, enough that they call a trauma surgeon from the get go. However, we saw a decrease throughout, in terms of the number. But the ones that we got in, especially for the MVC or the motor vehicle crashes, they are very injurious. So they are injured more. So I would really believe that fatality increases, because they are higher injury severity for the patients that I see. 

OK, and Dr. Delgado, what about your ER? What are you seeing? You said you do the weekend, right, most weekends? 

Yeah, yeah we still see a lot of motor vehicle crashes. I would say the kind of interesting and unfortunate thing about the pandemic is that, particularly in March and April, where they were stay at home orders, the streets were much more open. And we had numerous cases in the Philadelphia area where not only there was the routine, like what I would call routine crashes, but we had several documented episodes of people having drag races in the streets because there is no traffic, which led to some very severe crashes. 

So I think--and I saw a question in the Q&A--there are people adjusting to the fact that there's less drivers. And I have seen some data suggesting that the average speed of travel is increased with less traffic. And I think that also probably increases maybe less driving exposure, but higher risk driving with there being less traffic to impede travel 

OK, thank you both for that. I want to get into the psychology of why people engage in risky behavior. So obviously, we're talking about distracted driving. But Susan, to you and some of your research, so smoking, drinking, driving fast, driving distracted, there's the why in this and the psychology around it. Can you spend a minute and talk to us about that? 

Well, the psychology behind--they are related. So people who drive distracted are more likely to drive drunk, as well, or hitch a ride with someone who's drunk. And the risky behavior relates to each other. I don't know if it's the feeling of oh, I'm doing something wrong and it's exciting. I'm not sure about that. I don't really quite have the psychology behind it. I do know that they are related to each other. And so the awareness of it, it kind of hits the same population. And these are the--I guess, the younger population, the younger adult, and also the high school students. 

OK, all right. So Dr. Winsten, we're going to go to you now. You were famous in the early period and helped bring this campaign to life around a designated driver, right, in the 1970s, '80s, '90s, the designated driver and changing the social norm. Let's talk about public health communication 101. What are the dos and don'ts when you're trying to get people to make these healthier choices for themselves? 

It's tough. It's hard. And as Kit was indicating, these things take many, many years, and as Susan was as well. Part of why designated driver succeeded is we went to the Hollywood community. It was the first large-scale effort to mobilize Hollywood around the pro-social cause. And we asked the TV writers to depict the use of designated drivers, to model the behavior right in the storyline itself. And 160 primetime TV episodes did so for us. 

And it was estimated that it was worth about $100 million per year in donated television airtime, which is the level that you need to be at--and this is the challenge that we have today. $100 million is what you need for a major new product introduction in the US. And that's what we were seeking to do, to package and to market a new product to the American public, the designated driver, and then motivate them to take it off the shelf and consistently use that product. 

Today, there is special challenge--when we did designated driver, there were only three television networks. That's all there was. And there was no internet to speak of. And there was no cable except for reruns of the broadcast network shows. And so if you had three friends, one at each network, you could hope to reach 75% of the American public on any given evening. And we had three friends. So we were in business. 

But today, with the fragmentation of the media marketplace, and beyond that, the extremely short attention span of the public, even if you come up with a breakthrough creative idea, like an ice bucket challenge which generates over a billion dollars worth of TV exposure in five weeks around the world and raises a lot of money for an important cause, but that's only five weeks. And if you want to change behavior and norms, you're talking about years. 

And so after that five weeks, what do you do the rest of the year, and what do you do the year after that? They tried to come back to the ice bucket challenge the following summer, but its moment had passed. And it just didn't work. So it's the sustainability of the message. And unless you have a very large budget to buy that exposure, you need to be very creative and come up with a series of peaks of synchronicity, of attention brought to the problem. 

You can't maintain that high level of exposure for very long, because the public will move on to the next thing. But you want to repeatedly come back to it in a fresh way. And that's the big challenge. And the truth be told, no one has really figured out the solution. That's part of why we're launching Project Lookout. We want to use that as an experimental lab to see what it's going to take in this media environment to change norms and to change behavior. 

Thank you, Dr. Winsten. Kit Delgado, let's go back to you. And I know you've done some research around carrots and sticks. So what do we know about using incentives to change behavior around distracted driving? 

Yeah, we've done some research with regards to just phone distraction as measured by the apps for usage-based auto insurance. I think, with distraction as well as other types of health behaviors, when we're trying to incentivize behavior change, we know that providing rewards--well, just backtrack a little bit. So we know that one pathway and the reason why some people do things even though they know they're not good for them is because that thing that they want to do is instantly more rewarding in the short-term, even though, in the long-term, it may not be good for them. 

So for example, using drugs, responding immediately or checking social media notification that comes through, even though those things might be worse for you in the long-term that's called present bias. We tend to favor immediate rewards or respond to immediate costs rather than bigger ones in the future. And so basically, what's been shown across all kinds of health behaviors and in some of our recent work with getting people to not use their phone, is that if instead of providing a discount way off in the future, at the end of a six-month policy term, if you're able to take that same amount of funds and give people more instant rewards, so saying, here we're going to give you your discount up front. And we're going to give it to you on a weekly basis, just chopped up. That increases the behavioral effect. 

I think the other thing, too, is that people--and this was a Nobel Prize in economics--people, all things being equal, framing things as something that you're taking away as opposed to giving something, it almost doubles the effect of that thing. So giving someone $10 feels like $10. Taking away $10 from someone, feels like you're taking away $20. And so if you can say, OK, hey, we have this pot of funds for your discount, you're going to get it. But every time you use your phone, we're going to dock from that say $100 or whatever, and make you aware of that so that it's salient, people respond to that. 

Great. Thank you. Thank you for that. So Jay, I want to go back to you. And then, I'm going to bring you in, Susan, on this question. At Harvard, I know that you and your colleagues are involved in a major campaign trying to persuade Americans to get vaccinated, right, with the COVID vaccine. What lessons on behavioral change could be applied to the pandemic, if you will, in terms of--vis-a-vis distracted driving on behavioral change? 

The most important lesson is to listen to people. Don't tell them what the research says. Explain it. And if people have concerns, you have to find out by talking to them what those concerns are. And you have to take those concerns seriously. And you need to treat people with respect. 

Only then do you have the possibility of their being open to changing their minds and to listen to you. And when I say you, that "you" has to be an individual, either prominent or not, who they trust, who they relate to--a local minister, their own physician, et cetera, not a national celebrity, but a local celebrity, someone who they follow and they respect and who they care about, and who they trust cares about them. And that's the most important. 

And that research takes time. I know the federal government is pursuing that research for their upcoming campaign. And likewise, the Advertising Council and the COVID Collaborative together are doing the same with a tremendous emphasis on formative research focus groups and the like to get a sense, in a segmented way, as to where people are coming from. But it's all about listening. And it's about respect. 

OK, thank you for that. And thank you for your work in that area. I'm going to go back to Susan for a moment here. When behavioral change doesn't work and a collision occurs, what other measures give people the best odds of staying out of your trauma center. So is it reduced speeds, is it buckling up, is it automatic emergency braking? What's most likely to save your life or prevent a serious injury? 

Buckle up. Buckle up is the most life-saving, I think. And then all the other ones are actually quite important as well. We're talking so far about us as being the distracted driver and us getting into the accident. A lot of the injuries that are sustained from a motor vehicle crash from distracted driving is actually on the bystander. 

So as a bystander, like Jay said, just be aware of your surroundings. We see a lot of people who are also using their cell phone and walking across on the street. Don't do that. And be aware of all these cars and motorcycles and bikes around you. As a motor vehicle driver or a passenger, wearing your seatbelt has saved multiple lives. You may still get injured, but I can tell you that the fatality rate has decreased very, very high. 

The other thing is, if you're a motorcycle rider, then wear your helmet. Helmet is very important. Also bikers wear helmets. A lot of injuries that I have seen in my trauma bay with a serious brain injury, that has been averted because they've been wearing helmets. 

OK, thank you for that. So our Every Second Matters campaign, which we have, advocates for proactive passengers, so that passenger, to take away the phone from the driver or offer to dial or text for them. According to our risk index, fewer than half of our respondents, 48%, said they speak up when a driver is distracted. 

So how do we make those interventions by a passenger or maybe a child in the back seat--children and high school kids are hearing a lot about distracted driving, and we want the parents to model that behavior. So how do we make those interventions more comfortable for people, more socially accepted? So I don't know, Kit, you want to take that. 

Yeah, no, I'm really glad you mentioned that. We've been focusing just in general on cell phone distraction. But passengers can be a distraction, particularly in teen drivers. But we actually know that they can also reduce the risk of phone use and in distraction by handing off the phone to them and programming directions, and music, and things like that. So I think this goes to I think where we should be shifting our public education. 

I think we've maxed out scaring everyone about the statistics. I think we need to make it easy to do the right thing ok. And if you look at the behavioral insights team, which has done all kinds of work on how to change behavior in the public, they have a mnemonic. And I'll put it in the chat. It's called EAST--make things easy, attractive, social, and timely. 

And so basically, I would, in addition to getting increased use of do not disturb while driving, increased use of phone mounts for harm reduction, I would increase the social norms about handing your phone off to a passenger for programming GPS and music while you're in the middle of driving, responding to notifications, and things like that. So I think that is a promising approach, similar to the approaches to have a designated driver for reducing alcohol-impaired crashes. 

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I think another way to help it become more comfortable is--and we're going to be, is show your favorite characters from your TV shows avoiding distracted driving or, if they're a passenger, speaking up if their driver becomes distracted, to make it normative, and to model the behavior in the same way we did about designated drivers. So we are going to be reaching out as part of Project Lookout to the Hollywood creative community to engage with them, again, around the modeling of behavior towards promoting attentive driving through the power of storytelling. 

That's terrific. OK, audience questions now. We're going to take a bunch. I'm going to do some rapid fire. So this is about talking on the phone to a person on the phone versus a person in the car. So if you just talk and listen, and you don't look at the phone, and do nothing more than have a conversation, how is this different than having a conversation with someone who's sitting in the car? So is a phone conversation more distracting than a live person? 

I can answer that. So it's a great question. It kind of goes to the question are some types of distraction more distracting and riskier than other types. So the evidence that we have comes from two types of settings. One is in driving simulators, so simulating all these different types of distractions and seeing what happens in a driving simulator scenario. The other body of evidence comes from actually installing cameras in people's cars and doing very detailed epidemiologic research. 

So we know that, basically, compared to doing just driving, all of these different things, whether it's turning on the radio, talking to a passenger, talking to someone on the phone, you have an incrementally increased risk. But what we do know is that, by far, the most risky thing is picking up handheld engagement with the phone--typing, swiping--and that increases the risk of a crash by eightfold. That's because your eyes are on the phone, and you're cognitively thinking about it and not thinking about driving. 

With regards to talking on the phone, simulator studies did show an increase in risk, but once you actually typed on the phone and were holding it and just talking to someone and driving, they found that just in that scenario, it's not as risky as we once thought. It's not that much more risky than talking to a passenger. They say that talking to a passenger is less risky because the passenger is a second set of eyes on the road. 

It has been shown to compensate for if someone comes out in front of you, they'll say, hey, stop. So talking hand-held on the phone is riskier than talking to a passenger, but not as risky as typing on the phone. And then hands-free use, once talking, is worse than just driving, but it's not quite as risky. So at the very far end--handheld phone use, typing, and swiping is bad, then hand-held call use, and then least risky is hands-free talking. 

OK, thank you. So should we all have a conversation with our family members and say, I'm going to be an activist passenger in the car. I'm not going to be a nagger, in the backseat driver, but I am going to ask to take your phone. I'm going to help you watch the road and scan the road. I mean, is this something we should all just do with our families on a regular basis and say, look, I'm not going to be the mother nagging you to slow down or do this, but I am going to be an active participant in our car. Is that fair? 

Absolutely, I think education from home or within your own small circle, it brings more volume than listening this campaign on a billboard or something like that. If your family member actively tells you, you know what, let me hold your cell phone while you drive, and I'll take care of it, and I'll give it back to you, I think that will be much better education for everybody involved. And the children, the small children there is in the backseat, they learn that behavior, too, when they're smaller, when they're younger. And then they realize this. And when they're older, they will make better decision and better choices just because it's modeled by their parents, their older brother, older sister, whoever they may be. 

If you have an Uber driver--a lot of people are hesitant, when an Uber driver is distracted, to say something. Because number one, you're going to get a lousy rating from that driver and you care about that, because all the other drivers will see that over time. They may not want to pick you up. 

But there's just as social awkwardness about speaking up, even though you're paying this driver and it's your life at stake. And you don't know them, and you don't have an ongoing relationship, but it's still very difficult. It's awkward. People have a lot of trouble speaking up and intervening. And that, I think Hollywood can help us with as well in terms of modeling behavior. 

Great. OK, another question coming in from Jennifer Hologounis. What are your thoughts on the fast-moving legalization of recreational marijuana in certain states and the impact it will have on our roads? Are you concerned about that? Kit, let's start with you. 

Yeah, I mean, certainly the use of any substance can increase the risk. As far as what we've--at least the research that I'm aware of, maybe this has changed. But I think there is a big fear there would be a massive increase in crashes with increasing legalization of marijuana. And at least the early data, there may be some suggestion of that. But I don't think it was quite at the magnitude that was feared with regards to legalization. 

I think, from a public policy perspective and in terms of where there's still major opportunities with regards to laws and reducing motor vehicle crashes, with distracted driving, I think there's something like 17 states in which texting is banned, but not handheld use. And so texting while driving is, like, so seven years ago. You get pulled over in one of those states, and you can say, oh, I was just checking Instagram. And that would still be legal. 

And so some of the recent research has shown that states that implemented full hand-held bans have actually reduced crashes. With alcohol-impaired driving, crashes, there's still 10,000 plus fatal crashes per year. There's still a lot of opportunity there. And we have the highest legal driving limit of any modern country. And there's pretty ample evidence if we reduce the legal driving limit to 0.5%, that would make a marked reduction in crashes. 

Using ignition interlocks for people who have had convictions would also markedly reduce crashes. So I think there's a lot out there that can be done. I'm not sure about that the marijuana legislation is at the top of the list of opportunities. 

All right, another question coming in from my friend Steve Pierson in San Francisco there. Some vehicles have retina reading cameras to gauge the driver's attention. So a lot of the autonomous vehicles now has a retina reader to see where your eyes are. Is this a cost effective tool? Is this a good idea? Should we have the government mandate this retina reading for all car manufacturers? 

Yeah, I mean, I think it kind of goes along with the push for more "automazation" in driving in autonomous vehicles. Certainly one thing that's going to make a difference is the rear crash avoidance and I think that is [AUDIO OUT] to make an impact. Some cars that do scan and see if your eyes are on the road and sort of nudge you to keep your eyes on the road, I think that has a potential. So any of these engineering things that help design for human error and account for human error, I mean, that's how we've made major gains in safety is designing around human error. So I welcome all these things in terms of reducing the risk of a crash. 

OK, next question. Susan, why don't you take this one? My question to the panel--this is from David Valentine. My question to the panel is, do you think individuals' behavior for distracted driving can be changed if their everyday behavior outside of the car remains the same when interacting with their phones all the time? So in terms of, can you separate out how you interact with your phone while you're driving versus constantly being on it during the day. And it's completely acceptable in everyone's job to be looking at your phone throughout the whole day. 

Yeah, so I think that goes hand in hand. And I think this is where employee-based incentive and penalty when you're found on your phone all the time, I think there has to be a little bit of separation between you as yourself and your phone. I know that there is a lot of pressure of continually have to be technologically engaged. And if someone sends me email at 9:00 PM from work, by god, I'm going to reply to it at 9:05. 

And there has to be a change of culture where it is normal or it should be normalized that we don't reply right then and there all the time. I think it is possible just being in the car, even if you are engaged on your phone all the time, that when you're in the car, then you can make it into a sacred place. And it's actually, probably good for decreasing stress going home. 

For example, like driving home from the office and using that time as a downtime. And it's perfect, just do not disturb while driving. And pay attention when you're driving home, and be not engaged so much in work. It's probably a healthier lifestyle, as well, not to be connected to your phone all the time. 

OK, another question coming in. I might comment on this one. Are auto insurance companies required to educate their customers and provide awareness to drivers on changing behavior, distracted driving, and road rage. So we are not required, but we are very, very dedicated to educating consumers, customers, even our non-customers. 

We view it as our responsibility as a leader in the insurance industry to have a huge public campaign and spend lots of money trying to talk about the dangers here. And because we see claim data coming in, as Kit mentioned, during the pandemic, it was very shocking to us and very sad to see the fatalities coming through our claim data and the injuries. And we know those can be prevented. This is preventable. And so we are just happy and excited to continue this campaign. 

Jay, there was a question coming in from another lady. She's asking you, have you gone to the CEOs of Amazon and Apple, and all these Google, and all these companies--Netflix, and have you tried to encourage them to have some sort of a campaign around this as well? 

We've approached the--and we're talking with the auto industry. We have an initial grant from General Motors. And we're hoping that the industry as a whole will get behind this effort. We're also hoping that insurance companies will step forward. It's a tough climate to get people to do things where there's a preoccupation, for good reasons right now, on both COVID-19 and on Black Lives Matter. And a lot of corporate attention has shifted in that direction. 

But it's going to be very important to reach out. Apple has spent money on national advertising to encourage people to activate the Do Not Disturb While Driving function that's already on their smartphone. They didn't have much success. And it's only about 5% to 10% of drivers who have an Apple phone are actually using that technology. And that's why we have to change the social norms. Until we do that, nothing else is going to change. 

Well, we're at the top of the hour, and I could go on. We have a lot of other questions. But I really, really appreciate the three of you joining us today for this discussion. It's critically important. Dr. Delgado put in the chat feature how to turn on your Do Not Disturb on your iPhone. So please, everyone on the call today, don't be one of the 5% of us who have it on. 

And let's try to get that number up. Talk to your customers, talk to your clients, talk to your family about this important issue. And we just really appreciate being able to bring this to you today. So thank you again, all three of you wonderful doctors. Would love to have you back on soon to hopefully get some updates. 

And now I just want to, again, talk about our Wednesday webinar sessions. And I'll give you a sneak peek into what's coming up. On April 14, we have Dr. Ashish Jha from Brown University talking about the vaccine successes, the variants, and what's the outlook for herd immunity, getting back to normal in our lives. So join us then. 

And then, April 28, we have Future Ready, Trends in Personal Insurance Distribution, with Loree Toedman and Jay Gauthier. Then we have, on May 5, a very special event, Behind the Scenes at the Travelers Championship. This is our big golf event in Connecticut with the tournament director, Nathan Grube and Andy Bessette. And then on May 12, we have a focus on small businesses and getting your small businesses back to work, employment issues, liability issues, on May 12. 

So again, thank you to the three doctors on our call today. We're incredibly grateful for your public service and all you've done around this topic. And please do follow us on the TravelersInstitute.org to register for these programs. Stay safe, my friends. Get your vaccine. Wear your mask. And we'll see you on next Wednesday. Thank you. Thank you all. 

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Text for May 12 webinar, Small Business -- Big Opportunity, Travelers' Eric Nordquist & The U.S. Chamber of Commerce's Tom Sullivan. Register: travelers institute dot org