Impact of psychoactive substances and attention-related impairments on driving performance: Sex differences and road crash involvement

IF 1.7 4区医学 Q3 MEDICINE, LEGAL

Journal of forensic and legal medicine Pub Date : 2026-01-01 Epub Date: 2025-12-12 DOI:10.1016/j.jflm.2025.103050

Claudio Terranova , Clara Cestonaro , Stefano Palumbi , Laura Marino , Alessandro Gentili , Francesco Pozzebon , Rocco Miazzi , Anna Aprile

{"title":"Impact of psychoactive substances and attention-related impairments on driving performance: Sex differences and road crash involvement","authors":"Claudio Terranova , Clara Cestonaro , Stefano Palumbi , Laura Marino , Alessandro Gentili , Francesco Pozzebon , Rocco Miazzi , Anna Aprile","doi":"10.1016/j.jflm.2025.103050","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>Crashes are a global public health concern, with psychoactive substance use and attention impairments potentially increasing risk and affecting male and female drivers differently. This study aims to identify factors related to psychoactive substance use and attention impairments that predict road crash involvement by sex, offering insights for targeted prevention effort.</div></div><div><h3>Methods</h3><div>This observational study examined individuals assessed for driving license reissuance after driving under the influence of alcohol and/or drugs. Data collected included personal and sociodemographic details, results from a Continuous performance test (CPT-3) (a neuropsychological test assessing inattentiveness, impulsivity, sustained attention, and vigilance), and toxicological analyses of biological samples. Statistical analyses (chi-square, logistic regression, and ROC curve) aimed at identifing sex-specific predictors of road crash involvement.</div></div><div><h3>Results</h3><div>The study included 169 participants (82.8 % males, 17.2 % females). Initial univariate analyses indicated sex differences that were not confirmed after Bonferroni correction for multiple comparisons. Logistic regression found blood alcohol concentration predictive of crashes in males (p = 0.005, OR = 2.52), while inattentiveness was a major factor for females (p = 0.045, OR = 12.0). In the combined model, sex itself was not an independent predictor after adjusting for these factors. The model showed moderate accuracy for males (ROC-AUC = 0.695) and higher accuracy for females (ROC-AUC = 0.816), suggesting that inattentiveness may play a particularly important role in predicting crashes in the female subgroup.</div></div><div><h3>Conclusions</h3><div>Inattentiveness and alcohol use emerged as key predictors of crash involvement, with inattentiveness showing particular relevance in the female subgroup. Prevention should focus on modifiable risk factors rather than sex. The model's higher accuracy in females suggests attentional measures may help identify at-risk drivers, though the small female sample limits generalizability.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"117 ","pages":"Article 103050"},"PeriodicalIF":1.7000,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of forensic and legal medicine","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1752928X25002513","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/12/12 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"MEDICINE, LEGAL","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

Crashes are a global public health concern, with psychoactive substance use and attention impairments potentially increasing risk and affecting male and female drivers differently. This study aims to identify factors related to psychoactive substance use and attention impairments that predict road crash involvement by sex, offering insights for targeted prevention effort.

Methods

This observational study examined individuals assessed for driving license reissuance after driving under the influence of alcohol and/or drugs. Data collected included personal and sociodemographic details, results from a Continuous performance test (CPT-3) (a neuropsychological test assessing inattentiveness, impulsivity, sustained attention, and vigilance), and toxicological analyses of biological samples. Statistical analyses (chi-square, logistic regression, and ROC curve) aimed at identifing sex-specific predictors of road crash involvement.

Results

The study included 169 participants (82.8 % males, 17.2 % females). Initial univariate analyses indicated sex differences that were not confirmed after Bonferroni correction for multiple comparisons. Logistic regression found blood alcohol concentration predictive of crashes in males (p = 0.005, OR = 2.52), while inattentiveness was a major factor for females (p = 0.045, OR = 12.0). In the combined model, sex itself was not an independent predictor after adjusting for these factors. The model showed moderate accuracy for males (ROC-AUC = 0.695) and higher accuracy for females (ROC-AUC = 0.816), suggesting that inattentiveness may play a particularly important role in predicting crashes in the female subgroup.

Conclusions

Inattentiveness and alcohol use emerged as key predictors of crash involvement, with inattentiveness showing particular relevance in the female subgroup. Prevention should focus on modifiable risk factors rather than sex. The model's higher accuracy in females suggests attentional measures may help identify at-risk drivers, though the small female sample limits generalizability.

查看原文本刊更多论文

精神活性物质和注意力相关障碍对驾驶表现的影响：性别差异和道路交通事故参与。

导言：车祸是一个全球性的公共卫生问题，精神活性物质的使用和注意力障碍可能增加风险，对男性和女性司机的影响不同。本研究旨在确定与精神活性物质使用和注意力障碍相关的因素，这些因素可以预测性别道路交通事故的发生，为有针对性的预防工作提供见解。方法：本观察性研究调查了在酒精和/或药物影响下驾驶后被评估补发驾照的个体。收集的数据包括个人和社会人口学细节，持续表现测试（CPT-3）（一种评估注意力不集中、冲动、持续注意力和警惕性的神经心理学测试）的结果，以及生物样本的毒理学分析。统计分析（卡方、逻辑回归和ROC曲线）旨在确定道路交通事故涉及的性别特异性预测因子。结果：研究纳入169名参与者（男性82.8%，女性17.2%）。最初的单变量分析表明，在Bonferroni校正多重比较后，性别差异未得到证实。Logistic回归发现血液酒精浓度可预测男性的撞车（p = 0.005, OR = 2.52），而注意力不集中是女性的主要因素（p = 0.045, OR = 12.0）。在综合模型中，在调整了这些因素后，性别本身并不是一个独立的预测因子。该模型显示，男性的准确度中等（ROC-AUC = 0.695），女性的准确度较高（ROC-AUC = 0.816），这表明注意力不集中可能在预测女性亚组的撞车事故中起着特别重要的作用。结论：注意力不集中和饮酒是导致车祸的关键因素，其中注意力不集中在女性亚组中表现出特别的相关性。预防应侧重于可改变的危险因素，而不是性别。该模型在女性中的较高准确性表明，注意力测量可能有助于识别有风险的驱动因素，尽管女性样本较少限制了普遍性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of forensic and legal medicine MEDICINE, LEGAL-

CiteScore

2.70

自引率

6.70%

发文量

106

审稿时长

57 days

期刊介绍： The Journal of Forensic and Legal Medicine publishes topical articles on aspects of forensic and legal medicine. Specifically the Journal supports research that explores the medical principles of care and forensic assessment of individuals, whether adult or child, in contact with the judicial system. It is a fully peer-review hybrid journal with a broad international perspective. The Journal accepts submissions of original research, review articles, and pertinent case studies, editorials, and commentaries in relevant areas of Forensic and Legal Medicine, Context of Practice, and Education and Training. The Journal adheres to strict publication ethical guidelines, and actively supports a culture of inclusive and representative publication.