key: cord-0694128-gzi5gnuy
authors: Feiss, Robyn; Hautmann, Amanda; Asa, Nicole; Hamann, Cara; Peek-Asa, Corinne; Yang, Jingzhen
title: Balancing safety on the road with risk from COVID-19: A content analysis of policy adaptations by Divisions of Motor Vehicles
date: 2021-09-15
journal: Accid Anal Prev
DOI: 10.1016/j.aap.2021.106400
sha: 0e38d9a9d87a022de4914187cddcfa041d41719f
doc_id: 694128
cord_uid: gzi5gnuy

PURPOSE: The COVID-19 pandemic significantly altered people’s daily lives, including driving. However, how state Divisions of Motor Vehicles (DMV) adapted their operation policies in response to COVID-19 remains unknown. This study analyzed adaptations to the content of state DMV operation policies during the COVID-19 pandemic across 50 US states and assessed the relationships between these policy adoptions and their state-level COVID-19 restriction orders. METHODS: We merged data on policy adaptations due to COVID-19 obtained from DMV websites for all 50 states with data on state-level restrictions obtained from the National Academy for State Health Policy (NASHP). We created a codebook and analyzed the DMV policy adaptations in the following three areas: (1) road testing, (2) licensure extension and renewals, and (3) facility reopening. Two trained coders independently reviewed and coded the adaptations of policy content related to precaution to spread of COVID-19 and ease of obtaining licensure. We calculated summary scores for policy adaptations and ease of licensure and compared these scores across three categories of state-level COVID-19 restrictions using ANOVA. RESULTS: DMVs in all 50 states adapted their policies to slow the spread of COVID-19. The ease of licensure summary scores increased in some states but decreased in others. Extensions for licensure renewals was the most common change. Adoption of COVID-19 precautions during the road test was the most common road test adaptation, while road test waivers were the most controversial. Requiring appointments, social distancing, and/or face coverings/personal protective equipment [PPE] were common adaptations during facility reopening. However, variations in level of policy adaptations and ease of licensure were not associated with the state’s COVID-19 restrictions. CONCLUSIONS: Our findings provide insight into policy adaptations made by state DMVs to reduce the spread of COVID-19 and may inform future policy adaptations in DMVs and other government agencies during public health emergencies.

Novel coronavirus has resulted in vast disruptions to the daily lives of people of all ages in countries around the world (1) . To slow the spread of the COVID-19 infection, governments imposed "stay-at-home" and/or "social distancing" policies and restrictions and closed businesses and activity spaces (e.g., restaurants, schools, gymnasiums, etc.) (2, 3) . In the US, state governments took the lead in determining which strategies could keep their residents as safe as possible, with most enacting some type of mobility and social gathering restrictions (e.g., stay-at-home orders) (4) . Studies have demonstrated substantial effectiveness of state lockdown and social distancing mandates in limiting the spread of COVID-19 (5, 6) .

Recent preliminary analysis suggests that the COVID-19 pandemic significantly altered people's daily lives, including driving (7) . Road traffic volumes and mobility activities declined rapidly (8, 9) ; however, frequency of speeding and stunt driving increased, along with speedingrelated collisions (10) . With the implementation of public health countermeasures, state driver licensing agencies/Divisions of Motor Vehicles (DMV) modified their policies and procedures to balance safety from COVID-19 infection with continuing to provide licensing services to customers (7) . Some of these policy adaptations may have unintended road safety consequences.

For example, the state of Georgia issued licenses to nearly 20,000 teens without requiring road testing in order to address a backlog of thousands of road test requests put on hold due to COVID-19 (11) . While this amendment in licensing followed "social distancing" requirements and protected against virus exposure, public health experts are concerned about how this change could jeopardize road safety (12) , particularly for teen drivers who already have a high risk of crashing during the first months of unsupervised driving (13) (14) (15) .

As the pandemic surge plateaus in some areas, attention has shifted to the lifting of shutdown orders and reopening businesses (16) . However, reopening before vaccinations are widely available poses risks. DMVs, which oversee driver and motor vehicle licensing and registration, are facing challenges in mitigating these risks while reopening and providing services to the public. Various state agencies developed and implemented policies and plans designed to resume operations as safely as practicable (17, 18) . However, limited data are available on what changes DMVs made in their operation procedures to weigh the benefits of social distancing policies against road safety risks (19) .

The purpose of this study was to analyze adaptations to the content of state DMV operation policies during the COVID-19 pandemic across 50 US states and assess the relationships between these policy adoptions and their state-level COVID-19 restriction orders.

Specifically, we examined the policy adaptations regarding COVID-19 safety and ease of obtaining licensure in the following three content areas: (1) road testing, (2) licensure extension and renewals, and (3) facility reopening.

We searched DMV websites for all 50 states, excluding the District of Columbia and US territories, for data related to adaptations made in response to the COVID-19 pandemic. This search encompassed all pages and tabs of the website between August 10, 2020 and September 18, 2020, including news/press releases linked to the website. We conducted an additional search on December 1, 2020 to extract data from the National Academy for State Health Policy's (NASHP) (20) chart about state restriction orders (e.g., Stay-At-Home) made between June 1, 2020 and June 30, 2020 in response to COVID-19. These dates were selected to allow an approximately one-month lag for the influence of state restriction orders on the DMV policies.

This study was determined to be non-human research and was waived from approval by the Institutional Review Board at Nationwide Children's Hospital.

We merged data on DMVs' policy adaptations due to COVID-19 with data on state-level restriction orders in response to COVID-19 to create a static record of state DMV licensing policy adaptations and state-level restrictions. We then reviewed the static records for each state independently to extract data on adaptations and restriction orders due to COVID-19 made by each state, based on a recent COVID-19 related content analysis (21) . Following the initial data extraction, the authors met to discuss and determine the major content areas. Three areas of policy adaptations were chosen for the content analysis: (1) road testing, (2) licensure extension and renewals, and (3) facility reopening.

Two coders independently analyzed the adaptations of policy content relevant to the three areas for each state to identify themes. Disagreements on themes were resolved via discussion between all authors. We repeated this process until the final themes were identified for each content area. We identified a total of 14 themes: five themes for road testing, four for licensure extension/renewals, and five for facility reopening.

Two coders independently reviewed the state-level restrictions due to COVID-19 and assigned each state into one of three mutually exclusive restriction categories ( Table 1 ). The three categories were 1) Stay-at-home order: states had a stay-at-home order in place as of June 1, 2020; 2) Increased restrictions: states did not have a stay-at-home order in place as of June 1, 2020, but increased restrictions (i.e., closed business, paused/froze reopening plans, reversed to a previous reopening phase) during this time, and 3) No restrictions/eased restrictions: states never enacted a stay-at-home order or states eased some or all of their restrictions during this time. 

The authors developed a codebook using existing methodologies for policy content analysis (22) and assigned a numerical value to each theme identified. Teen driving safety experts outside the research team reviewed the initial codebook and provided recommendations that were used to finalize the codebook ( Table 2 ). The numerical values were determined based on the precautions mentioned to prevent the spread of COVID-19, with a score of "1" for states adapting a specific precaution policy, "-1" for states not adapting a specific precaution policy, and "0" for states not mentioning a specific precaution policy. For example, a state that waived road tests received a score of "1", a state that stated they were not waiving the road test received a score of "-1", and a state that did not mention whether they were waiving the road test received a score of "0". Furthermore, to address potential unintended consequences on road safety from these adaptations, we determined the influence of each of the 14 themes on ease of licensure. We coded a score of "1" for a theme that increased the ease of licensure, "-1" for a theme that decreased the ease of licensure, or "0" for a theme that had no influence. For example, road test waivers, online knowledge test, extension length made it easier to obtain licensure and each received score of 1 ( Table 2) . 3 1 Yes A health screening (e.g., temperature check, questionnaire, etc.) was required for customers to enter the facility. Each theme was also coded for its implication of ease (or difficulty) in obtaining licensure. 1 The theme was scored as "1" for increasing the ease of obtaining licensure; 2 The theme was scored as "-1" for decreasing the ease of obtaining licensure; 3 The theme was scored as "0" for having no influence on the ease of obtaining licensure.

A summary score for COVID-19 policy adaptations was calculated for each state by summing the scores from each theme, ranging from -14 to 14, with a higher summary score indicating more policy adaptations or increased COVID-19 safety. Direct quotes pertaining to the themes were also extracted (Table 3) . Additionally, a summary score for the influence of policy adaptations on ease of licensure was calculated for each state, ranging from -10 to 10, with a higher summary score indicating greater ease of licensure or increased potential risk of unintended consequences for road safety. Lastly, differences in mean policy adaptation and ease of licensure summary scores were compared across three categories of state-level COVID-19 restrictions using ANOVA. The analysis was conducted in SAS in February 2021. Statistical significance was set to p < 0.05 for all analyses.

DMVs in 31 states adapted their road test policies in response to COVID-19. Five reoccurring themes emerged: (1) road test waivers, (2) online knowledge testing, (3) third party testing, (4) COVID-19 precautions, and (5) road test modifications (Table 3a) .

Six states (12.8%), Alabama, Georgia, Mississippi, North Carolina, North Dakota, and Wisconsin, implemented a waiver for road testing during the COVID-19 pandemic. Alabama was the first state to implement a waiver, starting on March 24, 2020, although it is not stated whether waivers were in response to the COVID-19 pandemic. Georgia issued a road test waiver via executive order on April 23, 2020, but quickly issued a second executive order on May 12, 2020 stating that those who were issued licenses via the waiver would have to take a road test by September 30, 2020 to keep their license, due to growing concerns about the impacts of the waivers on road safety (16) . Additionally, Arkansas, Iowa, and Nebraska prior to the outbreak only required road tests under limited circumstances, for example if the individual has not completed an approved driver education/driver safety course. Therefore, these states did not need a road test waiver; however, Iowa and Arkansas both stated that road tests would continue to be offered in-person by appointment only for individuals who were required to complete the road test. Requirements for waivers generally included holding a learner's permit for 6 months to 1

year, completing a specified number of supervised behind-the-wheel training hours, and not having any violations. However, the majority of states (n=27, 57.4%) specified that road tests would not be waived due to COVID-19.

Two states (4.0%), Iowa and Massachusetts, implemented online knowledge tests in response to COVID-19. Most states (n=44, 88.0%) did not specifically mention how the knowledge tests had to be administered (i.e., online vs. in-person). For example, Iowa stated that "teens getting their driver's instruction permit now have the option to take the web-knowledge test that is required to obtain the permit at home." In contrast, Minnesota stated that the knowledge test was offered in-person only.

Of the 44 states that did not waive the road test, 9 (20.5%) allowed individuals to complete their road test via third-party authorized vendors. For example, Pennsylvania stated "Authorized Third Party Testers are also available for non-commercial testing." Florida allowed both the knowledge and road test to be administered by a third party while Washington only allowed the knowledge test to be administered by a third party and the remaining 7 states only allowed a third party to be utilized for the road test. The remaining 35 states (79.5%) did not mention anything regarding utilizing a third-party vendor for knowledge or road testing. In some cases, the use of third-party vendors allowed for the continuation of testing while DMVs were closed. Furthermore, this policy can spread out the number of people wanting to complete testing across more facilities, reducing the load on the DMVs after reopening.

Nearly half of states (n=22, 47.8%) had additional COVID-19 precautions for individuals taking a road test, such as requiring them to disinfect their car before testing, open the windows for increased ventilation, and/or have plastic covers on the seat. This included Georgia, which used contactless road tests after their road test waiver was reversed, and North Dakota, which required a health screening, face coverings/PPE, and the car to be cleaned for those who did not use a road test waiver. The remaining 24 states (52.2%) did not mention any specific instructions for individuals taking the road test.

Lastly, a few states (n=11, 24.4%) mentioned a modification to the road test due to COVID-19, including Georgia which stated that "…The parent/responsible adult will remain in the vehicle to ride with the driver" regarding required road tests following their temporary waiver. The remaining states (n=34, 75.6%) did not mention a modification for the road test.

Examples of modifications included a closed course-based test, such as Maryland, or having a GPS-camera system installed in the car for DMV staff to remotely observe the driving, used by Alaska.

The DMVs in all 50 states adapted licensure renewal policies in response to COVID-19.

Four reoccurring themes based on policy adaptations were identified: (1) extension length, (2) online/mail renewal, (3) fee waivers, and (4) senior citizen precautions (Table 3b ).

All states (n=49, 98.0%), except Utah, mentioned an extension length for driver's licenses expiring during the COVID-19 period. The licensure extension varied by state in terms of extension length, beginning date, and end date. For example, while Kansas extended the deadline to renew a driver's license or identification card by 10 months, Rhode Island's extension was only 90 days. Some states specified licensure renewal dates in reference to the time frame of COVID-19 state orders, such as Nebraska, which stated that licenses that "expire on or after March 1, 2020 have been extended until 30 days after the emergency order is lifted.

There is no date set for when this order may be lifted."

The majority of states (n=43, 86.0%) allowed license renewals online or by mail, while Arizona, Arkansas, and Connecticut stated that they did not process online requests. Some states required the license holder to meet qualifications for online renewal; the most common qualification included being a citizen of the state and the US. Utah's policy stated that "for those who qualify to do so, renewing a license online is both effective and supports the current directive."

A few states (n=6, 12.0%) waived fees associated with licensure expiration, including fees for expired credentials, general late fees, and administrative fees. Only one state (2.0%), Wisconsin, stated that the renewal fee would not change. North Carolina's policy stated that "any fines and fees related to expired credentials are being temporarily waived." "All behind-the-wheel drive test applicants will be required to wear a face covering and answer screening questions. . . Temperature checks will be added to protocols. . . DMV examiners will wear protective equipment … and place plastic covers on the test vehicle's passenger seat and floorboard... two windows need to be lowered during the test…Examiners will conduct more of the test outside of the vehicle. . .The DMV is also … shortening the testing route in many locations. . ." (CA)

"All applicants to wear face coverings; all applicants to abide by social distancing requirements; applicants appearing for skills testing to arrive with a sanitized vehicle and face covering (mask)" (MO) ". . .DMV has adopted a new procedure for road skills testing that ensures new drivers demonstrate safe driving skills and allows for social distancing for everyone's health and well-being. . ." (VA) "All Class D road test applicants will be tested using cameras that are placed in the vehicle by DMV staff that will be recording your drive on a pre-determined route with the help of a satellite navigation system (GPS)." (AK) Figure 1A shows the distribution of the of COVID-19 policy adaptation scores by state.

The vast majority of states (98%) had scores greater than zero, though Arizona had a score of zero, due to a net of zero adaptations (e.g., adapted one policy and did not adapt a different policy). Thirteen states (26%) had very high scores (7 to 9), 12 states (24%) had high scores (5 or 6), 14 states (28%) had moderate scores (3 or 4) and 10 states (20%) had low scores (1 to 2).

The ease of licensure summary scores ranged from -3 to 4 (Mean = 0.74, SD = 1.44). Twelve states (24%) had scores of zero, indicating no adaptations were made that influenced ease of licensure or the adaptations had a net score of no influence (e.g., one adaptation that increased ease and one that decreased ease). There were also 10 states (20%) whose policy adaptations decreased ease of licensure (score of -3 to -1).

Overall, there were no strong regional patterns in either the COVID-19 policy adaptation or ease of licensure scores. Additionally, the score patterns by state for COVID-19 policy adaptations did not follow the same pattern as ease of licensure-i.e., one did not predict the other. 

A few limitations of this study should be noted. First, information regarding the date(s) on which these state policy adaptations were enacted was not always available. Therefore, it is possible that some policies, such as road test waivers and online knowledge testing, were in place prior to the COVID-19 pandemic or reversed at the time of our search. Secondly, the unprecedented nature of the COVID-19 pandemic requires frequent changes in policies to respond to COVID-19. Therefore, DMV policies and state-level restrictions may have changed frequently throughout the pandemic. We used a static record (i.e., download of webpage) to extract data from; thus, the data we extracted and reported here may not be consistent with current DMV policies nor reflect state-level restrictions before June 1, 2020 or after June 30, 2020. Finally, the meaning of lack of information varies by context, making the interpretation challenging. For example, lack of information about road testing changes or fee waivers likely means that these policies are not in place, while a lack of information on disinfecting policies may not indicate a lack of disinfecting practices, as disinfecting procedures have become commonplace in nearly all places of business during the COVID-19 pandemic (32, 33).

Many of these COVID-19 related policy adaptations impact the ability of DMVs to serve customers more safely and efficiently during the pandemic, and it is unclear if they will retain any of these changes for the long term. For example, continuing to allow online or mail-in renewals may increase the number of customers that can be served over the same period of time, making it advantageous to retain. This adaptation may also remove barriers for individuals who are unable to make appointments due to work, child caring responsibilities, or lack of transportation. Potentially improved efficiency and convenience needs to be carefully weighed against any influence on road safety, as these changes reduce opportunities to screen for risky drivers. At the policy level, such adaptations provide examples of approaches and considerations that can help DMV agencies adapt in the event of a public health emergency, particularly one that requires limited person-to-person contact. It is possible that many of these policy changes will continue beyond the COVID-19 pandemic or provide the groundwork for future policy changes both in the DMVs and other government facilities.

All 50 states adapted their DMV policies in some capacity in response to the COVID-19

pandemic. Surprisingly, these adaptations were not related to the state-level of COVID-19

restrictions. The overarching goal of these policy adaptations was to balance the health of DMV customers and employees with maintaining practices that increase road safety. Some policy adaptations, such as road test waivers, seemed to favor health over road safety, while others, such as requiring appointments to visit the DMV facility, were more balanced. Future research, particularly longitudinal studies, are necessary to understand how these policies changed throughout the pandemic and the long-term impact of these policy adaptations on road safety.

Robyn Feiss: Conceptualization; Data curation; Formal analysis; Investigation; Methodology

Project administration; Validation; Visualization; Writing -original draft; Writing -review & editing. Amanda Hautmann: Conceptualization; Data curation; Investigation; Methodology

Nicole Asa: Conceptualization; Data curation; Investigation; Methodology; Writing -original draft; Writing -review & editing. Cara Hamann: Conceptualization; Methodology; Visualization; Writing -review & editing. Corinne Peek-Asa: Conceptualization; Methodology; Writing -review & editing. Jingzhen Yang: Conceptualization; Methodology; Project administration; Supervision; Validation; Writingoriginal draft

Funding: Research reported in this publication was partially supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health (R01HD098176 and R01HD100420) and Centers for Disease Control and Prevention (R49CE003074). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or Centers for

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Robyn Feiss: Conceptualization; Data curation; Formal analysis; Investigation; Methodology

Project administration; Validation; Visualization; Writing -original draft; Writing -review & editing. Amanda Hautmann: Conceptualization; Data curation; Investigation; Methodology

Nicole Asa: Conceptualization; Data curation; Investigation; Methodology; Writing -original draft; Writing -review & editing. Cara Hamann: Conceptualization; Methodology; Visualization; Writing -review & editing. Corinne Peek-Asa: Conceptualization; Methodology; Writing -review & editing. Jingzhen Yang: Conceptualization; Methodology