NewPublicHealth Q&A: Kathleen Hoke, Network for Public Health Law

Apr 23, 2014, 1:48 PM


Earlier this month U.S. Department of Transportation Secretary Anthony Foxx kicked off April’s National Distracted Driving Awareness Month by announcing the department’s first-ever national advertising campaign and law enforcement crackdown in states with distracted driving bans. That effort ended last week, but through individual interactions with drivers by law enforcement and through ads on television, radio and online, the effort raised attention to the dangers—and penalties—of distracted driving, according to the National Highway Traffic Safety Administration (NHTSA.) According to NHTSA 3,328 people were killed and an estimated 421,000 were injured in distraction-related crashes in 2012, the latest year for which data is available.

"This campaign puts distracted driving on par with our efforts to fight drunk driving or to encourage seatbelt use," said Foxx.

According to NHTSA, the national campaign built upon the success of federally funded distracted driving state demonstration programs in California and Delaware, “Phone in One Hand, Ticket in the Other.” Over three enforcement waves, California police issued more than 10,700 tickets for violations involving drivers talking or texting on cell phones, and Delaware police issued more than 6,200 tickets. Observed hand-held cell phone use dropped by approximately a third at each program site, from 4.1 percent to 2.7 percent in California, and from 4.5 percent to 3.0 percent in Delaware.

Currently 43 states, the District of Columbia, Puerto Rico, Guam and the U.S. Virgin Islands ban text messaging for drivers of all ages; 12 states, Washington, D.C., Puerto Rico, Guam and the U.S. Virgin Islands prohibit drivers of all ages from using hand-held cell phones while driving; and 37 states and D.C. ban cell phone use by new drivers.

More state campaigns are expected to be launched, according to NHTSA. To find out more about the ability of public health laws such as laws aimed at reducing distracted driving to improve health and save lives, NewPublicHealth recently spoke with Kathleen Hoke, director of the Network for Public Health Law, Eastern Region. The Network is a program of the Robert Wood Johnson Foundation.

NewPublicHealth: In his announcement of the campaign, Secretary Foxx said that the national distracted driving reduction efforts show how public health laws can be transformative. What public health does this build on? Could this have been done if there hadn’t been a history of using laws to help improve the public’s health?

Kathleen Hoke: I think there is kind of a cycle that we see in public health using law to effectuate improvements in public health, particularly injury prevention. I know we can’t think today that there was a time that children weren’t in car seats, but there was. And what happened was there was an education campaign much like the Department of Transportation’s current campaign that was all about encouraging folks to put their children in safety seats. The law took it to a certain level, so we went from roughly 20 percent of people putting their kids in car seats to maybe 60 percent of people putting their kids in car seats.

But that’s as far as the public education campaign was getting things. Then the law stepped in and legislators around the country started passing laws to mandate that folks put their kids in safety seats. And you saw a skyrocketing of the number to nearly 100 percent of children being properly secured in their car seats. And we have continuing public education campaigns reminding folks to put their kids in car seats and then taking it to the next level—making sure that they’re properly installing car seats. Then really taking it to the next level with the law again by mandating that car manufacturers have the anchors for car seats available in all car models from a certain year forward. So public education campaigns coupled with law can together push things to that next level, that higher level.

NPH: In his announcement of the campaign, the Secretary said “this is an instance where law can help save lives.” How important is it to this and other public health laws that leaders such as the Secretary connect the dots between law and improving public health?

Hoke: It is certainly helpful to those who are advocating using law for improvements in public health, which is a huge effort of the Robert Wood Johnson Foundation, among others using laws to improve public health.

There are some really great local, state and federal legislators and policy makers who get it, who understand whether and how law can be used in certain situations to improve public health. And there are also cautionary principles to say sometimes law isn’t the right place to start—you know, sometimes we need to start somewhere else and not with law, and maybe get to the law when we better understand what the problem we’re dealing with is. We need research and we need public education before we can figure out how the law should respond to things.

NPH: When it comes to the recent texting and driving campaign, is one limitation the need to get drivers to stop even when, like now, the national campaign has ended for the time being?

Hoke: The law can only do so much. Once it became a law, there are folks who will immediately stop doing it. You take that segment of the population and say “OK, great, the law adherence folks are not texting and driving.” Then you have another group who’s probably going to reduce their texting and driving to situations when they think it’s “safer” as a result of this campaign. And some folks, now if they see a police officer they’re going to put down their phone or be mindful of that, just like that are with speeding. But I think that over the course of time continuing with the campaign at the state and federal levels, where law enforcement officers are actually trying to find people who are texting and driving and issuing those citations, will have a chilling effect on that behavior and we would hope that it would result in culture change and custom change.

I hope we’ll see technology changes such as parental controls in the vehicle so that your child could always be able to call 911 from their phone or maybe even always be able to call a safe number such as your own phone number from the phone, but could do nothing else while they were driving.

One of the best examples, I think, in public health comes from smoking. So, in the ‘80s we had kind of modest provisions prohibiting people from smoking in public places. Most schools were smoke free and some public places were smoke free, and then we started to see a proliferation of clean indoor air laws applying in workplaces and public places. At the same time, while the law did not—and does not even to this day—restrict smoking in people’s homes, the trickledown effect of clean indoor air laws becoming so prolific and so comprehensive was that folks stopped smoking in their own homes. So the kind of communication about the dangers of secondhand smoke and it being important enough for the law to regulate it, caught people’s attention and got people who were not compelled to do so to stop smoking in their own homes.

That’s an important example of law helping to create a social norm change.

This commentary originally appeared on the RWJF New Public Health blog.