Carrying passengers as a risk factor for crashes fatal to 16- and 17-year-old drivers

Effectiveness of a brief parent-directed teen driver safety intervention (Checkpoints) delivered by driver education instructors

BACKGROUND

The Checkpoints program (Checkpoints) uses a Parent-Teen Driving Agreement (PTDA) to help parents monitor teens' driving, and has shown efficacy in increasing parental restrictions on teens' driving and decreasing teens' risky driving. In previous trials, research staff administered Checkpoints. This study examined the effectiveness of Checkpoints when delivered by driver educators. It was hypothesized that Checkpoints would result in more PTDA use, greater PTDA limits on higher risk driving situations, and less high-risk driving.

METHODS

Eight trained driving instructors were randomly assigned to intervention or control groups in a group randomized trial. Instructors enrolled 148 parent-teen dyads (intervention = 99, control = 49); 35% of those eligible. Intervention parents joined teens for a 30-minute Checkpoints session during driver education. The session included a video, persuasive messages, discussion, and PTDA initiation. Teens completed four surveys: baseline, licensure, and 3- and 6-months post-licensure.

RESULTS

Intervention teens were more likely to report that they used a PTDA (OR= 15.92, p = .004) and had restrictions on driving with teen passengers (OR = 8.52, p = .009), on weekend nights (OR = 8.71, p = .021), on high-speed roads (OR = 3.56, p = .02), and in bad weather (b = .51, p = .05) during the first six months of licensure. There were no differences in offenses or crashes at six months, but intervention teens reported less high-risk driving (p = .04).

CONCLUSIONS

Although challenges remain to encourage greater parent participation, Checkpoints conducted by driver education instructors resulted in more use of PTDAs, greater restrictions on high-risk driving, and less high-risk driving. Including Checkpoints in driver education parent meetings/classes has potential to enhance teen driver safety.

Discriminant Profile of Young Adulthood Driving Behavior among Brazilian Drivers

The aim of this article was to describe the driving behavior profile of drivers aged 18 to 25 years old. Four hundred young adults were interviewed, 320 (80%) of them male and 80 (20%) female. Cluster analysis identified a group characterized by sensation-seeking behavior (Cluster 1), a group that did not show any risky driving behavior (Cluster 2), and a group engaged in transgressive behavior and driving under the influence of alcohol and/or drugs (Cluster 3). Discriminant analysis classified successfully and correctly 81.3% of the young adults into their original profiles. Function 1 distinguished cluster 1 from clusters 2 and 3, on the basis of the following factors: higher frequency of alcohol consumption, intrusive behavior, and motorcycle riding, as well as younger age, more aggressive behavior, and lower education level. Function 2 distinguished cluster 3 from cluster 1 and 2, especially as to higher amounts of alcohol consumption, higher frequency of marijuana use and delinquent behavior, larger number of traffic tickets and motor vehicle accidents, higher paternal education level, which were the variables with discriminant values above .20. Characteristics of vulnerability were identified, especially those related to alcohol consumption, drug use, and externalizing issues.

Sex Differences in Risk Taking Behavior among Dutch Cyclists

The majority of research examining sex differences in risk-taking behavior focuses on overt physical risk measures in which failed risk attempts may result in serious injury or death. The present research describes sex differences in patterns of risk taking in day-to-day behavior among Dutch cyclists. Through three observational studies we test sex differences in risk taking in situations of financial risk (fines for failing to use bike lights, Study 1), theft risk (bike locking behavior, Study 2) as well as physical risk (risky maneuvers, Study 3). Results corroborate previous findings by showing that across these domains men are more inclined to take risks than women. We discuss how these findings might be used in an applied context.

Teen driver risk in relation to age and number of passengers, United States, 2007-2010

OBJECTIVE

To provide updated estimates of the relationship between the number and ages of passengers present in a vehicle and the crash risk per mile driven of 16- and 17-year-old drivers.

METHODS

Data on crashes that occurred in years 2007-2010 and data on the number of miles driven in years 2008-2009 were examined. Rates of crash involvement and driver death per mile driven were estimated for 16- and 17-year-old drivers with no passengers; with 1, 2, and 3 or more passengers younger than age 21 (and no older passengers); and with at least 1 passenger aged 35 or older.

RESULTS

For 16- and 17-year-old drivers, having 1 passenger younger than age 21 (and no older passengers) was associated with 44 percent greater risk per mile driven of being killed in a crash, compared to having no passengers (relative risk [RR]: 1.44, 95% confidence interval [CI]: 1.01-2.04). Having 2 passengers younger than age 21 was associated with double the risk of being killed in a crash, compared to having no passengers (RR: 2.02, 95% CI: 1.36-2.99). Having 3 or more passengers younger than age 21 was associated with roughly quadruple the risk of being killed in a crash, compared to having no passengers (RR: 4.39, 95% CI: 1.45-13.31). The relative risk of being involved in any police-reported crash in the presence of young passengers followed a similar pattern; however, the differences in risks of being involved in any police-reported crash were smaller and were not statistically significant. Having at least 1 passenger aged 35 or older in the vehicle was associated with a 62 percent lower risk per mile driven of being killed in a crash (RR: 0.38, 95% CI: 0.24-0.60) and a 46 percent lower risk of being involved in any police-reported crash (RR: 0.54, 95% CI: 0.31-0.93) for 16- and 17-year-old drivers, compared to having no passengers.

CONCLUSIONS

These results show that although the overall number of teen driver fatalities has decreased substantially over the past several years, carrying young passengers is still a significant risk factor for young drivers. In contrast, carrying adult passengers is associated with significantly lower risk of crash involvement.

Harnessing the power of reputation: strengths and limits for promoting cooperative behaviors

Evolutionary approaches have done much to identify the pressures that select for cooperative sentiment. This helps us understand when and why cooperation will arise, and applied research shows how these pressures can be harnessed to promote various types of cooperation. In particular, recent evidence shows how opportunities to acquire a good reputation can promote cooperation in laboratory and applied settings. Cooperation can be promoted by tapping into forces like indirect reciprocity, costly signaling, and competitive altruism. When individuals help others, they receive reputational benefits (or avoid reputational costs), and this gives people an incentive to help. Such findings can be applied to promote many kinds of helping and cooperation, including charitable donations, tax compliance, sustainable and pro-environmental behaviors, risky heroism, and more. Despite the potential advantages of using reputation to promote positive behaviors, there are several risks and limits. Under some circumstances, opportunities for reputation will be ineffective or promote harmful behaviors. By better understanding the dynamics of reputation and the circumstances under which cooperation can evolve, we can better design social systems to increase the rate of cooperation and reduce conflict.

How do passengers influence drivers' propensities for angry driving? Different effects of supervisors versus friends

A lot of researchers discussed the influence of passengers on drivers' behaviors without reaching a consistent conclusion. This study aimed to offer some new evidence concerning this issue. The study examined different effects of supervisors and friends as passengers on drivers' propensities for angry driving. In Study 1, drivers were asked to freely imagine a passenger either as their supervisor or friend. Results showed that compared with driving alone, drivers' propensities for angry driving increased when the passenger was a friend but decreased when the passenger was a supervisor. These findings were consistent with the generally accepted social norm. In Study 2, drivers read a description about either an aggressive supervisor or a cautious friend. Results showed that the effects of passengers on drivers' angry driving propensities were correspondingly reversed, indicating that a clearer behavior standard conveyed by a passenger had a stronger effect on drivers. Self-monitoring propensity showed a main effect on drivers' propensities for angry driving in a standard-free situation. And self-monitoring propensity moderated the effect of a passenger's role on angry driving propensities in a standard-set situation. Impression management processes were discussed with respect to these findings.

Peer passengers: how do they affect teen crashes?

PURPOSE

The specific mechanisms by which peer passengers increase teen drivers' crash risk are not completely understood. We aimed to provide insight on the two primary hypothesized mechanisms, distraction and promotion of risk-taking behavior, for male and female teen drivers and further for select driver-passenger gender combinations.

METHODS

From the National Motor Vehicle Crash Causation Survey (2005-2007), we analyzed a nationally representative sample of 677 drivers aged 16-18 years (weighted n = 277,484) involved in serious crashes, to compare the risk of specific distraction-related and risk-taking-related precrash factors (documented via on-scene crash investigation) for teens driving with peer passengers and teens driving alone.

RESULTS

Compared with males driving alone, those with peer passengers were more likely to perform an aggressive act (risk ratio, RR [95% confidence interval] = 2.36 [1.29-4.32]) and perform an illegal maneuver (RR = 5.88 [1.81-19.10]) just before crashing; risk taking increased regardless of passenger gender. Crash-involved males with passengers were also more likely to be distracted by an exterior factor (RR = 1.70 [1.15-2.51]). Conversely, females with passengers were more often engaged in at least one interior nondriving activity (other than conversing with passengers) (RR = 3.87 [1.36-11.06]), particularly when driving with opposite-gender passengers. Female drivers, both with and without passengers, rarely drove aggressively or performed an illegal maneuver before crashing.

CONCLUSIONS

Passengers may affect male teen driver crashes through both distraction and risk-promoting pathways, and female involvement primarily through internal distraction. Results of this and future studies investigating peer-driver interactions may guide development of passenger-related crash prevention efforts to complement already existing Graduated Driver Licensing passenger restrictions.

Factors associated with adolescents' propensity to drive with multiple passengers and to engage in risky driving behaviors

PURPOSE

Research shows that parenting factors and individual difference variables, such as sensation seeking (SS) and risk perceptions (RPs), are associated with increased motor vehicle crash risk for young drivers. The presence of peer passengers is also known to be associated with increased crash risk. However, as previous studies did not study these factors concurrently, less is known about the factors that are associated with driving with peer passengers and if peer passengers may mediate the effect of parenting and individual difference variables on adolescents' engagement in risky driving behavior.

METHODS

We examined predictors of driving with multiple passengers (DWMPs) and explored it as a potential mediator of pathways from three factors: (1) SS, (2) RPs, and (3) Parental monitoring and rule-setting to risky driving behaviors in a convenience sample of 198 adolescent drivers using a cross-sectional Web-based survey.

RESULTS

Findings indicate that both stronger RPs and perceiving parents as strong monitors and rule setters were associated with less engagement in risky driving, whereas greater SS was associated with more engagement in risky driving; RPs, monitoring, and SS were also significantly associated with DWMPs in these same directions. DWMPs partially mediated the effect of these risk factors on risky driving behavior.

CONCLUSIONS

Results inform theory and policy by examining factors associated with risk taking in the context of adolescent driving. Interventions can be developed to complement graduated driver licensing laws by targeting individual difference variables and decreasing opportunities for peer passenger carriage.

Developmental effects of decision-making on sensitivity to reward: an fMRI study

Studies comparing neural correlates of reward processing across development yield inconsistent findings. This challenges theories characterizing adolescents as globally hypo- or hypersensitive to rewards. Developmental differences in reward sensitivity may fluctuate based on reward magnitude, and on whether rewards require decision-making. We examined whether these factors modulate developmental differences in neural response during reward anticipation and/or receipt in 26 adolescents (14.05±2.37 yrs) and 26 adults (31.25±8.23 yrs). Brain activity was assessed with fMRI during reward anticipation, when subjects made responses with-vs.-without decision-making, to obtain large-vs.-small rewards, and during reward receipt. When reward-receipt required decision-making, neural activity did not differ by age. However, when reward receipt did not require decision-making, neural activity varied by development, reward magnitude, and stage of the reward task. During anticipation, adolescents, but not adults, exhibited greater activity in the insula, extending into putamen, and cingulate gyrus for large-vs.-small incentives. During feedback, adults, but not adolescents, exhibited greater activity in the precuneus for large-vs.-small incentives. These data indicate that age-related differences in reward sensitivity cannot be characterized by global hypo- or hyper-responsivity. Instead, neural responding in striatum, prefrontal cortex and precuneus is influenced by both situational demands and developmental factors. This suggests nuanced maturational effects in adolescent reward sensitivity.

High-risk driving behaviors among adolescent binge drinkers

BACKGROUND

Binge drinking is common among adolescents. Alcohol use, particularly binge drinking, has been associated with neurocognitive deficits and increased risk-taking behaviors, which may contribute to negative driving outcomes among adolescents even while sober.

OBJECTIVES

To examine potential differences in self-reported risky driving behaviors between adolescent binge drinkers and a matched sample of controls on measures of (1) compliance with graduated licensing laws, (2) high-risk driving behaviors, and (3) driving outcomes (i.e., crashes, traffic tickets).

METHODS

This study examined driving behaviors and outcomes in adolescent recent binge drinkers (n = 21) and demographically and driving history matched controls (n = 17) between the ages of 16-18 years.

RESULTS

Binge drinkers more frequently violated graduated licensing laws (e.g., driving late at night) and engaged in more "high-risk" driving behaviors, such as speeding and using a cell phone while driving. Binge drinkers had more traffic tickets, crashes, and "near crashes" than the control group. Speeding was the behavior most associated with crashes within the binge drinkers.

CONCLUSION

In this study, binge-drinking teens consistently engage in more dangerous driving behaviors and experience more frequent crashes and traffic tickets. They are also less compliant with preventative restrictions placed on youth while they are learning critical safe driving skills.

SCIENTIFIC SIGNIFICANCE

These findings highlight a need to examine the contribution of underlying traits (such as sensation seeking) and binge-related cognitive changes to these high-risk driving behaviors, which may assist researchers in establishing alternative prevention and policy efforts targeting this population.

Graduated driver licensing for reducing motor vehicle crashes among young drivers

BACKGROUND

Graduated driver licensing (GDL) has been proposed as a means of reducing crash rates among novice drivers by gradually introducing them to higher risk driving situations.

OBJECTIVES

To examine the effectiveness of GDL in reducing crash rates among young drivers.

SEARCH STRATEGY

Studies were identified through searching MEDLINE, EMBASE, CINAHL, Healthstar, Web of Science, NTIS Bibliographic Database, TRIS Online, SIGLE, the World Wide Web, conference proceedings, consultation with experts and reference lists in relevant published literature. The searches were conducted from the time of inception to May 2009, and the Cochrane Injuries Group conducted an updated search of the TRANSPORT database in September 2009.

SELECTION CRITERIA

Studies were included if: 1) they compared outcomes pre- and post-implementation of a GDL program within the same jurisdiction, 2) comparisons were made between jurisdictions with and without GDL, or 3) both. Studies had to report at least one objective, quantified outcome.

DATA COLLECTION AND ANALYSIS

Results were not pooled due to substantial heterogeneity. Percentage change was calculated for each year after the intervention, using one year prior to the intervention as baseline. Results were adjusted by internal controls. Analyses were stratified by denominators (population, licensed drivers). Results were calculated for the different crash types and presented for 16 year-olds alone as well as all teenage drivers.

MAIN RESULTS

We included 34 studies evaluating 21 GDL programs and 2 analyses of >40 US states. GDL programs were implemented in the US (n=16), Canada (n=3), New Zealand (n=1), and Australia (n=1) and varied in their restrictions during the intermediate stage. Based on the Insurance Institute for Highway Safety (IIHS) classification, eleven programs were good, four were fair, five were marginal, one was poor and two could not be assessed. Reductions in crash rates were seen in all jurisdictions and for all crash types. Among 16 year-old drivers, the median decrease in per population adjusted overall crash rates during the first year was 15.5% (range -27 to -8%, five studies). There was a decrease in per population adjusted injury crash rates (median -21%, range -46 to -2%, five studies). Results for all teenage drivers, rates per licensed driver, and rates adjusting for internal controls were generally reduced when comparing within jurisdictions.

AUTHORS' CONCLUSIONS

GDL is effective in reducing crash rates among young drivers, although the magnitude of the effect varies. The conclusions are supported by consistent findings, temporal relationship, and plausibility of the association. Stronger GDL programs (i.e. more restrictions or higher quality based on IIHS classification) appear to result in greater fatality reduction. Future studies should focus on which components and combination of components yield the greatest reductions.

An evaluation of graduated driver licensing effects on fatal crash involvements of young drivers in the United States

OBJECTIVE

Graduated driver licensing (GDL) systems are designed to reduce the high crash risk of young novice drivers. Almost all states in the United States have some form of a 3-phase GDL system with various restrictions in the intermediate phase. Studies of the effects of GDL in various states show significant reductions in fatal crash involvements of 16- and 17-year-old drivers; however, only a few national studies of GDL effects have been published. The objective of this national panel study was to evaluate the effect of GDL laws on the fatal crash involvements of novice drivers while controlling for possible confounding factors not accounted for in prior studies.

METHODS

The Fatality Analysis Reporting System (FARS) was used to examine 16- and 17-year-old driver involvement in fatal crashes (where GDL laws are applied) relative to 2 young driver age groups (19-20, 21-25) where GDL would not be expected to have an effect. Dates when various GDL laws were adopted in the states between 1990 and 2007 were coded from a variety of sources. Covariates in the longitudinal panel regression analyses conducted included 4 laws that could have an effect on 16- and 17-year-old drivers: primary enforcement seat belt laws, zero-tolerance (ZT) alcohol laws for drivers younger than age 21, lowering the blood alcohol concentration limit for driving to 0.08, and so-called use and lose laws where drivers aged 20 and younger lose their licenses for underage drinking violations.

RESULTS

The adoption of a GDL law of average strength was associated with a significant decrease in fatal crash involvements of 16- and 17-year-old drivers relative to fatal crash involvements of one of the 2 comparison groups. GDL laws rated as "good" showed stronger relationships to fatal crash reductions, and laws rated as "less than good" showed no reductions in crash involvements relative to the older driver comparison groups.

CONCLUSIONS

States that adopt a basic GDL law can expect a decrease of 8 to 14 percent in the proportion of 16- and 17-year-old drivers involved in fatal crashes (relative to 21- to 25-year-old drivers), depending upon their other existing laws that affect novice drivers, such as those used in these analyses. This finding is consistent with recent national studies that used different outcome measures and covariates. The results of this study provide additional support for states to adopt, maintain, and upgrade GDL systems to reduce youthful traffic crash fatalities.

A national evaluation of the nighttime and passenger restriction components of graduated driver licensing

INTRODUCTION

The high crash rate of youthful novice drivers has been recognized for half a century. Over the last decade, graduated driver licensing (GDL) systems, which extend the period of supervised driving and limit the novice's exposure to higher-risk conditions (such as nighttime driving), have effectively reduced crash involvements of novice drivers.

METHOD

This study used data from the Fatality Analysis Reporting System (FARS) and the implementation dates of GDL laws in a state-by-year panel study to evaluate the effectiveness of two key elements of GDL laws: nighttime restrictions and passenger limitations.

RESULTS

Nighttime restrictions were found to reduce 16- and 17-year-old driver involvements in nighttime fatal crashes by an estimated 10% and 16- and 17-year-old drinking drivers in nighttime fatal crashes by 13%. Passenger restrictions were found to reduce 16- and 17-year-old driver involvements in fatal crashes with teen passengers by an estimated 9%.

CONCLUSIONS

These results confirm the effectiveness of these provisions in GDL systems. Impact on Public Health. States without the nighttime or passenger restrictions in their GDL law should strongly consider adopting them.

IMPACT ON INDUSTRY

The results of this study indicate that nighttime restrictions and passenger limitations are very important components of any GDL law.

Risky and aggressive driving in young adults: Personality matters

Young, novice drivers constitute a disproportionate percentage of fatalities and injuries in road traffic accidents around the world. This study, attempts to identify motivational factors behind risky driving behavior, and examines the role of personality, especially sensation seeking, impulsivity and sensitivity to punishment/reward in predicting negative driving outcomes (accident involvement and traffic offences) among young drivers. Gender and driver's age are additional factors examined in relation to driving outcomes and personality. Adopting the contextual mediated model of traffic accident involvement (Sümer, 2003), the study is based on the theory that personality, age and gender represent distal factors that predict accident involvement indirectly through their relationship with stable tendencies towards aberrant driving behavior. Results from correlations and Structural Equation Modeling using AMOS 6 indicated that direct personality effects on driving outcomes were few, whereas personality had significant correlations with aberrant driving behavior, showing that personality is a distal but important predictor of negative driving outcomes. These high risk traits appear to be at a peak among young male drivers. Thus, personality is important in understanding aggressive and risky driving by young adults and needs to be taken into consideration in designing targeted accident prevention policies.

Naturalistic assessment of novice teenage crash experience

BACKGROUND

Crash risk is highest during the first months after licensure. Current knowledge about teenagers' driving exposure and the factors increasing their crash risk is based on self-reported data and crash database analyses. While these research tools are useful, new developments in naturalistic technologies have allowed researchers to examine newly-licensed teenagers' exposure and crash risk factors in greater detail. The Naturalistic Teenage Driving Study (NTDS) described in this paper is the first study to follow a group of newly-licensed teenagers continuously for 18 months after licensure. The goals of this paper are to compare the crash and near-crash experience of drivers in the NTDS to national trends, to describe the methods and lessons learned in the NTDS, and to provide initial data on driving exposure for these drivers.

METHODS

A data acquisition system was installed in the vehicles of 42 newly-licensed teenage drivers 16 years of age during their first 18 months of independent driving. It consisted of cameras, sensors (accelerometers, GPS, yaw, front radar, lane position, and various sensors obtained via the vehicle network), and a computer with removable hard drive. Data on the driving of participating parents was also collected when they drove the instrumented vehicle.

FINDINGS

The primary findings after 18 months included the following: (1) crash and near-crash rates among teenage participants were significantly higher during the first six months of the study than the final 12 months, mirroring the national trends; (2) crash and near-crash rates were significantly higher for teenage than adult (parent) participants, also reflecting national trends; (3) teenaged driving exposure averaged between 507 and 710km (315-441miles) per month over the study period, but varied substantially between participants with standard errors representing 8-14 percent of the mean; and (4) crash and near-crash types were very similar for male and female teenage drivers.

DISCUSSION

The findings are the first comparing crash and near-crash rates among novice teenage drivers with those of adults using the same vehicle over the same period of time. The finding of highly elevated crash rates of novice teenagers during the first six months of licensure are consistent with and confirm the archival crash data showing high crash risk for novice teenagers. The NTDS convenience sample of teenage drivers was similar to the US teenage driver population in terms of exposure and crash experience. The dataset is expected be a valuable resource for future in-depth analyses of crash risk, exposure to risky driving conditions, and comparisons of teenage and adult driving performance in various driving situations.

Prevalence of teen driver errors leading to serious motor vehicle crashes

OBJECTIVES

Motor vehicle crashes are the leading cause of adolescent deaths. Programs and policies should target the most common and modifiable reasons for crashes. We estimated the frequency of critical reasons for crashes involving teen drivers, and examined in more depth specific teen driver errors.

METHODS

The National Highway Traffic Safety Administration's (NHTSA) National Motor Vehicle Crash Causation Survey collected data at the scene of a nationally representative sample of 5470 serious crashes between 7/05 and 12/07. NHTSA researchers assigned a single driver, vehicle, or environmental factor as the critical reason for the event immediately leading to each crash. We analyzed crashes involving 15-18 year old drivers.

RESULTS

822 teen drivers were involved in 795 serious crashes, representing 335,667 teens in 325,291 crashes. Driver error was by far the most common reason for crashes (95.6%), as opposed to vehicle or environmental factors. Among crashes with a driver error, a teen made the error 79.3% of the time (75.8% of all teen-involved crashes). Recognition errors (e.g., inadequate surveillance, distraction) accounted for 46.3% of all teen errors, followed by decision errors (e.g., following too closely, too fast for conditions) (40.1%) and performance errors (e.g., loss of control) (8.0%). Inadequate surveillance, driving too fast for conditions, and distracted driving together accounted for almost half of all crashes. Aggressive driving behavior, drowsy driving, and physical impairments were less commonly cited as critical reasons. Males and females had similar proportions of broadly classified errors, although females were specifically more likely to make inadequate surveillance errors.

CONCLUSIONS

Our findings support prioritization of interventions targeting driver distraction and surveillance and hazard awareness training.

Factors affecting hospital charges and length of stay from teenage motor vehicle crash-related hospitalizations among United States teenagers, 2002-2007

Motor vehicle crashes are the leading cause of death for all teenagers, and each year a far greater number of teens are hospitalized with non-fatal injuries. This retrospective cohort study used the National Inpatient Sample data to examine hospitalizations from the years 2002 to 2007 for 15-18-year-old teenagers who had been admitted due to a motor vehicle crash. More than 23,000 teens were hospitalized for motor vehicle-related crash injuries each year, for a total of 139,880 over the 6-year period. Total hospital charges exceeded $1 billion almost every year, with a median hospital charge of more than $25,000. Older teens, boys, those with fractures, internal injuries or intracranial injuries, and Medicaid/Medicare as a payer were associated with higher hospital charges and longer lengths of stay. These high charges and hospitalization periods pose a significant burden on teens, their families, and the health care system.

Sexual differentiation of the human brain: relation to gender identity, sexual orientation and neuropsychiatric disorders

During the intrauterine period a testosterone surge masculinizes the fetal brain, whereas the absence of such a surge results in a feminine brain. As sexual differentiation of the brain takes place at a much later stage in development than sexual differentiation of the genitals, these two processes can be influenced independently of each other. Sex differences in cognition, gender identity (an individual's perception of their own sexual identity), sexual orientation (heterosexuality, homosexuality or bisexuality), and the risks of developing neuropsychiatric disorders are programmed into our brain during early development. There is no evidence that one's postnatal social environment plays a crucial role in gender identity or sexual orientation. We discuss the relationships between structural and functional sex differences of various brain areas and the way they change along with any changes in the supply of sex hormones on the one hand and sex differences in behavior in health and disease on the other.

The contribution of fatal crashes involving teens transporting teens

OBJECTIVE

We determined the proportion of all fatal crashes of 16- and 17-year-old drivers that involved the presence of teenage passengers from 2004 to 2008.

METHODS

Data on fatal crashes of 16- and 17-year-old drivers were derived from the Fatality Analysis Reporting System for the years 2004-2008.

RESULTS

For both 16- and 17-year-old drivers, in each of the 5 years examined, at least 39 percent of all their fatal crash events involved the presence of 13- to 19-year-old passengers and no one younger or older. For 16- to 17-year-olds combined, the proportion of crashes involving drivers with teen passengers changed little from 2004 (43%) to 2008 (41%), despite the growth in the number of states with passenger restrictions from 23 to 37 during this period.

CONCLUSION

A high proportion of teen crashes involve the presence of other teens as passengers at the time of the crash. There is a need to find effective ways to reduce these crashes.

The blind date: the effects of change blindness, passenger conversation and gender on looked-but-failed-to-see (LBFTS) errors

This study examined situations where drivers looked-but-failed-to-see (LBFTS) hazards, and whether passenger conversation and gender affected hazard detection rates. To reliably produce LBFTS errors, 40 young drivers (M=20.3) encountered motorcycles and pedestrians while making left turns in the University of Calgary Driving Simulator (UCDS). Prior to turn initiation the UCDS screens flickered using an extension of change blindness methods. In addition, drivers either drove alone or conversed with an attractive confederate passenger. Measures of LBFTS errors, hazard detection and social factors were analyzed. Higher rates of LBFTS errors and hazard detection occurred while conversing than while driving alone. A discriminant function analysis (DFA) using conversation and gender as predictors accurately classified LBFTS errors. Higher passenger attraction and higher extroversion were related to critical events being missed. The basis of LBFTS errors in divided and selective attention and classification implications are discussed.

Examining the influence of aggressive driving behavior on driver injury severity in traffic crashes

In this paper, we capture the moderating effect of aggressive driving behavior while assessing the influence of a comprehensive set of variables on injury severity. In doing so, we are able to account for the indirect effects of variables on injury severity through their influence on aggressive driving behavior, as well as the direct effect of variables on injury severity. The methodology used in the paper to accommodate the moderating effect of aggressive driving behavior takes the form of two models--one for aggressive driving and another for injury severity. These are appropriately linked to obtain the indirect and direct effects of variables. The data for estimation is obtained from the National Motor Vehicle Crash Causation Study (NMVCCS). From an empirical standpoint, we consider a fine age categorization until 20 years of age when examining age effects on aggressive driving behavior and injury severity. There are several important results from the empirical analysis undertaken in the current paper based on post-crash data collection on aggressive behavior participation just prior to the crash and injury severity sustained in a crash. Young drivers (especially novice drivers between 16 and 17 years of age), drivers who are not wearing seat belt, under the influence of alcohol, not having a valid license, and driving a pick-up are found to be most likely to behave aggressively. Situational, vehicle, and roadway factors such as young drivers traveling with young passengers, young drivers driving an SUV or a pick-up truck, driving during the morning rush hour, and driving on roads with high speed limits are also found to trigger aggressive driving behavior. In terms of vehicle occupants, the safest situation from a driver injury standpoint is when there are two or more passengers in the vehicle, at least one of whom is above the age of 20 years. These and many other results are discussed, along with implications of the result for graduated driving licensing (GDL) programs.

A practical approach for applying best practices in behavioural interventions to injury prevention

Behavioural science when combined with engineering, epidemiology and other disciplines creates a full picture of the often fragmented injury puzzle and informs comprehensive solutions. To assist efforts to include behavioural science in injury prevention strategies, this paper presents a methodological tutorial that aims to introduce best practices in behavioural intervention development and testing to injury professionals new to behavioural science. This tutorial attempts to bridge research to practice through the presentation of a practical, systematic, six-step approach that borrows from established frameworks in health promotion and disease prevention. Central to the approach is the creation of a programme theory that links a theoretically grounded, empirically tested behaviour change model to intervention components and their evaluation. Serving as a compass, a programme theory allows for systematic focusing of resources on the likely most potent behavioural intervention components and directs evaluation of intervention impact and implementation. For illustration, the six-step approach is applied to the creation of a new peer-to-peer campaign, Ride Like a Friend/Drive Like You Care, to promote safe teen driver and passenger behaviours.

Adolescent development and risk of injury: using developmental science to improve interventions

In adolescence, there is a complex interaction among physical, cognitive, and psychosocial developmental processes, culminating in greater risk-taking and novelty-seeking. Concurrently, adolescents face an increasingly demanding environment, which results in heightened vulnerability to injury. In this paper, we provide an overview of developmental considerations for adolescent injury interventions based on developmental science, including findings from behavioural neuroscience and psychology. We examine the role that typical developmental processes play in the way adolescents perceive and respond to risk and how this integrated body of developmental research adds to our understanding of how to do injury prevention with adolescents. We then highlight strategies to improve the translation of developmental research into adolescent injury prevention practice, calling on examples of existing interventions including graduated driver licensing.

Trends in fatalities from distracted driving in the United States, 1999 to 2008

OBJECTIVES

We examined trends in distracted driving fatalities and their relation to cell phone use and texting volume.

METHODS

The Fatality Analysis Reporting System (FARS) records data on all road fatalities that occurred on public roads in the United States from 1999 to 2008. We studied trends in distracted driving fatalities, driver and crash characteristics, and trends in cell phone use and texting volume. We used multivariate regression analysis to estimate the relation between state-level distracted driving fatalities and texting volumes.

RESULTS

After declining from 1999 to 2005, fatalities from distracted driving increased 28% after 2005, rising from 4572 fatalities to 5870 in 2008. Crashes increasingly involved male drivers driving alone in collisions with roadside obstructions in urban areas. By use of multivariate analyses, we predicted that increasing texting volumes resulted in more than 16,000 additional road fatalities from 2001 to 2007.

CONCLUSIONS

Distracted driving is a growing public safety hazard. Specifically, the dramatic rise in texting volume since 2005 appeared to be contributing to an alarming rise in distracted driving fatalities. Legislation enacting texting bans should be paired with effective enforcement to deter drivers from using cell phones while driving.

The Influence of Passengers on Older Drivers Involved in Fatal Crashes

The authors examined if the presence of passengers affects the risk of making unsafe actions among older drivers, and determined what specific types of unsafe actions may be affected (positively or adversely) by the presence of passengers. They used 1975 to 1998 data from the U.S. Fatality Analysis Reporting System (FARS); unsafe actions were based on driver-related factors. The authors calculated the odds ratio (OR) of making unsafe driving actions in the presence of passengers compared to situations where drivers were alone. In general, the presence of passengers was beneficial to older drivers (e.g., for drivers aged 65 to 79 with four or more passengers, OR = 0.73 [99% Confidence interval[CI] = 0.61, 0.86. For drivers aged 65 to 79, the presence of passengers was associated with a reduced risk of some unsafe actions (e.g., driving the wrong way, OR = 0.37 [95% CI = 0.30, 0.46]) but a higher risk of other actions (e.g., ignoring signs/warnings/right of way, OR = 1.18 [95% CI = 1.15, 1.22]). These findings are discussed in the context of strategies to maximize safe driving in older adults.

D'Angelo LJ, Halpern-Felsher BL, Abraham A. Adolescents and driving: a position paper of the Society for Adolescent Health and Medicine

Motor vehicle crashes continue to be the leading cause of mortality and severe morbidity among adolescents and young adults. All states have changed their drivers' licensure laws to make the process of obtaining a license more protracted and focused on the development of safe driving skills. Health care providers who counsel children and adolescents should actively address safe driving with them, and also involve their parents in this discussion. Additionally, they should also advocate for strict and uniform graduated licensure laws.

Crash involvement during the different phases of the New Zealand Graduated Driver Licensing System (GDLS)

INTRODUCTION

The New Zealand Graduated Driver Licensing System (GDLS) is designed to allow novice drivers to gain driving experience under conditions of reduced risk.

METHOD

To examine the effectiveness of the GDLS, an analysis of how the crash involvement of novice drivers changes as drivers move through the GDLS was undertaken. Crash profiles were created by data matching the New Zealand license and crash databases, covering a time period from 1999-2006.

RESULTS

The crash profiles show that the initial learner period of the GDLS is relatively safe and the time at which novice drivers have the highest rate of crash involvement is during the first few months of solo driving. Analysis using logistic regression also showed an effect of age and gender, with higher crash involvement associated with younger drivers and males. In addition, individuals who gained a full license within 12-18 months of holding a restricted license, due to completion of a time-discount associated educational program, had a higher level of involvement in crashes than individuals who gained a full license after 18 months.

CONCLUSIONS

The crash profiles provide an insight into the crash risk associated with different phases of the New Zealand GDLS.

IMPACT ON INDUSTRY

Increasing the age at which drivers first begin to solo drive and the removal of the time-discount associated with completion of an educational program should be considered.

Teen driving exposure in Michigan: demographic and behavioral characteristics

Motor vehicle crashes are the leading cause of death and a leading cause of non-fatal injury for teenagers in the United States. Understanding teen crashes requires a good measure of crash risk. The measure of exposure that is used in the calculation of risk estimates determines what information the resulting rates and rate ratios provide and the conclusions that can be drawn about teen driver crash risk. The purpose of this study is to provide an initial description of three measures of individual-level exposure to driving for 16-17-year-olds in the state of Michigan, using data from the state-wide Michigan Travel Counts survey conducted in 2004 and 2005. The total miles, minutes, and trips driven within the 48-h survey period were calculated for each respondent using self-reported measures and geo-spatial mapping. Young drivers who worked and those with greater access to a vehicle drove significantly more than their peers who did not work and those who had less access to a vehicle. Those from urban residences spent more time driving than those from rural residences. All 16-17-year-olds drove substantially more during the day than at night, and on their own than with passengers. There was little difference in overall driving exposure and driving behavior between young men and young women. This study provides an initial description of driving exposure and behavior for a population for which there is very little specific information about amounts and patterns of individual driving exposure. The relationship between individual driving exposure and risk of motor vehicle crash, injury or fatality requires further investigation.

Graduated licensing laws and fatal crashes of teenage drivers: a national study

OBJECTIVES

The objective of the current study was to quantify the effects of the strength of US state graduated driver licensing laws and specific licensing components on the rate of teenage driver fatal crash involvements per 100,000 teenagers during 1996-2007. The strengths of state laws were rated good, fair, marginal, or poor based on a system developed previously by the Insurance Institute for Highway Safety.

METHODS

Analysis was based on quarterly counts of drivers involved in fatal crashes. Associations of overall ratings and individual licensing components with teenage crash rates were evaluated using Poisson regression, with the corresponding fatal crash rate for drivers ages 30-59 controlling for state- or time-dependent influences on crash rates unrelated to graduated licensing laws.

RESULTS

Compared with licensing laws rated poor, laws rated good were associated with 30 percent lower fatal crash rates among 15- to 17-year-olds. Laws rated fair yielded fatal crash rates 11 percent lower. The longer the permit age was delayed, or the longer the licensing age was delayed, the lower the estimated fatal crash rates among 15- to 17-year-olds. Stronger nighttime restrictions were associated with larger reductions, and reductions were larger for laws limiting teenage passengers to zero or one than laws allowing two or more teenage passengers or laws without passenger restrictions. After the effects of any related delay in licensure were accounted for, an increase in the minimum learner's permit holding period showed no association with fatal crash rates. An increase in required practice driving hours did not appear to have an independent association with fatal crash rates.

CONCLUSIONS

Graduated licensing laws that include strong nighttime and passenger restrictions and laws that delay the learner's permit age and licensing age are associated with lower teenage fatal crash rates. States that adopt such laws can expect to achieve substantial reductions in crash deaths.

Using the U.S. National Household Travel Survey to estimate the impact of passenger characteristics on young drivers' relative risk of fatal crash involvement

Motor vehicle crashes are the main cause of morbidity and mortality in teenagers and young adults in the United States. Driving exposure and passenger presence, which can both vary by driver and passenger characteristics, are known to influence crash risk. Some studies have accounted for driving exposure in calculating young driver fatal crash risk in the presence of passengers, but none have estimated crash risk by driver sex and passenger age and sex. One possible reason for this gap is that data collection on driving exposure often precludes appropriate analyses. The purpose of this study was to examine, per 10 million vehicle trips (VT) and vehicle-miles traveled (VMT), the relative risk of fatal crash involvement in 15-20-year-old male and female drivers as a function of their passenger's age and sex, using solo driving as the referent. The Fatality Analysis Reporting System provided fatal motor vehicle crash data from 1999 to 2003 and the 2001 National Household Travel Survey (NHTS) provided VT and VMT. The NHTS collects driving exposure for both household and non-household members (e.g., friends, colleagues), but demographic characteristics only on household members. Missing age and sex of non-household passengers were imputed with hot deck using information from household passengers' trips with non-household drivers, thereby enabling the calculation of crash rate and relative risk estimates based upon driver and passenger characteristics. Using this approach, the highest risk was found for young male drivers with 16-20-year-old passengers (relative risk [RR] per 10 million VT=7.99; 95% confidence interval [CI], 7.34-8.69; RR per 10 million VMT=9.94; 95% CI, 9.13-10.81). Relative risk was also high for 21-34-year-old passengers, again particularly when both drivers and passengers were male. These effects warrant further investigation and underscore the importance of considering driving exposure by passenger characteristics in understanding crash risk. Additionally, as all imputation techniques are imperfect, a more accurate estimation of U.S. fatal crash risk per distance driven would require national surveys to collect data on non-household passenger characteristics.

Behavioral impact of graduated driver licensing on teenage driving risk and exposure

Graduated driver licensing (GDL) is a critical policy tool for potentially improving teenage driving while reducing teen accident exposure. While previous studies demonstrated that GDL reduces teenage involvement in fatal crashes, much remains unanswered. We explore the mechanisms through which GDL influences accident rates as well as its long term effectiveness on teen driving. In particular, we investigate: (1) whether GDL policies improve teenage driving behavior, or simply reduce teenage prevalence on the roads; (2) whether GDL exposed teens become better drivers in later years. We employ a unique data source, the State Data System, which contains all police reported accidents (fatal and non-fatal) during 1990-2005 for 12 states. We estimate a structural model that separately identifies GDL's effect on relative teenage prevalence and relative teenage riskiness. Identification of the model is driven by the relative numbers of crashes between two teenagers, two adults, or a teenager and an adult. We find that the GDL policies reduce the number of 15-17-year-old accidents by limiting the amount of teenage driving rather than by improving teenage driving. This prevalence reduction primarily occurs at night and stricter GDL policies, especially those with night-time driving restrictions, are the most effective. Finally, we find that teen driving quality does not improve ex post GDL exposure.

Who is that masked person: the use of face masks on Mexico City public transportation during the Influenza A (H1N1) outbreak

This article examines three issues: (1) the use, over time, of facemasks in a public setting to prevent the spread of a respiratory disease for which the mortality rate is unknown; (2) the difference between the responses of male and female subjects in a public setting to unknown risks; and (3) the effectiveness of mandatory and voluntary public health measures in a public health emergency. The use of facemasks to prevent the spread of respiratory diseases in a public setting is controversial. At the height of the influenza epidemic in Mexico City in the spring of 2009, the federal government of Mexico recommended that passengers on public transport use facemasks to prevent contagion. The Mexico City government made the use of facemasks mandatory for bus and taxi drivers, but enforcement procedures differed for these two categories. Using an evidence-based approach, we collected data on the use of facemasks over a 2-week period. In the specific context of the Mexico City influenza outbreak, these data showed mask usage rates mimicked the course of the epidemic and gender difference in compliance rates among metro passengers. Moreover, there was not a significant difference in compliance with mandatory and voluntary public health measures where the effect of the mandatory measures was diminished by insufficiently severe penalties, the lack of market forces to create compliance incentives and sufficient political influence to diminish enforcement. Voluntary compliance was diminished by lack of trust in the government.

Poverty as a determinant of young drivers' fatal crash risks

PROBLEM

U.S. teenaged and young-adult drivers' elevated rates of fatal traffic crash involvement typically are attributed to biological and developmental risk-taking associated with young age. However, young drivers differ from older ones along several sociodemographic dimensions, including higher poverty rates and greater concentration in poorer areas, which may contribute to their risks.

METHOD

Using Fatality Analysis Reporting System, Census, and Federal Highway Administration data for 1994-2007, bivariate and multivariate regression analyses were conducted of fatal motor-vehicle crash involvements per 100 million miles driven by driver age (16 through 74) and state along with 14 driver-, vehicle-, and state-level variables.

RESULTS

Driver age was not a significant predictor of fatal crash risk once several factors associated with high poverty status (more occupants per vehicle, smaller vehicle size, older vehicle age, lower state per-capita income, lower state population density, more motor-vehicle driving, and lower education levels) were controlled. These risk factors were significantly associated with each other and with higher crash involvement among adult drivers as well.

SUMMARY AND DISCUSSION

The strong association between fatal crash risk and environments of poverty as operationalized by substandard vehicle and driving conditions suggests a major overlooked traffic safety factor particularly affecting young drivers.

Associations between parenting styles and teen driving, safety-related behaviors and attitudes

OBJECTIVE

The goal was to explore the association between parenting style and driving behaviors.

METHODS

The 2006 National Young Driver Survey gathered data on driving safety behaviors from a nationally representative sample of 5665 ninth-, 10th-, and 11th-graders. A parenting style variable was based on adolescent reports and separated parents into 4 groups, (1) authoritative (high support and high rules/monitoring), (2) authoritarian (low support and high rules/monitoring), (3) permissive (high support and low rules/monitoring), and (4) uninvolved (low support and low rules/monitoring). Associations between parenting style and driving behaviors and attitudes were assessed.

RESULTS

One half of parents were described as authoritative, 23% as permissive, 8% as authoritarian, and 19% as uninvolved. Compared with teens with uninvolved parents, those with authoritative parents reported one half the crash risk in the past year (odds ratio [OR]: 0.47 [95% confidence interval [CI]: 0.26-0.87]), were 71% less likely to drive when intoxicated (OR: 0.29 [95% CI: 0.19-0.44]), and were less likely to use a cellular telephone while driving (OR: 0.71 [95% CI: 0.50-0.99]). Teens with authoritative or authoritarian parents reported using seat belts nearly twice as often (authoritative: OR: 1.94 [95% CI: 1.49 -2.54]; authoritarian: OR: 1.85 [95% CI: 1.08 -3.18]) and speeding one half as often (authoritative: OR: 0.47 [95% CI: 0.36-0.61]; authoritarian: OR: 0.63 [95% CI: 0.40-0.99]) as teens with uninvolved parents. No significant differences in crash risk or seat belt use were found between permissive and uninvolved parents.

CONCLUSIONS

Clinicians should encourage parents to set rules and to monitor teens' driving behaviors, in a supportive context.

Crash types: markers of increased risk of alcohol-involved crashes among teen drivers

OBJECTIVE

Teens drink/drive less often than adults but are more likely to crash when they do drink/drive. This study identified alcohol-related crash types for which teen drivers were at greater risk compared with adults.

METHOD

Michigan State Police crash records for drivers ages 16-19 (teens) and 45-65 years (adults) who experienced at least one crash from 1989 to 1996 were used to create alcohol crash types consisting of alcohol-related crashes that included specific combinations of other crash characteristics, such as drinking and driving at night (i.e., alcohol/nighttime). These data were combined with data from the 1990 and 1995 National Personal Travel Surveys and the 2001 National Household Travel Survey to estimate rates and rate ratios of alcohol-related crash types based on person-miles driven.

RESULTS

Teens were relatively less likely than adults to be involved in alcohol-related crashes but were significantly more likely to be in alcohol-related crashes that included other crash characteristics. Teen males' crash risk was highest when drinking and driving with a passenger, at night, at night with a passenger, and at night on the weekend, and casualties were more likely to result from alcohol-related nighttime crashes. All the highest risk alcohol-related crash types for teen female drinking drivers involved casualties and were most likely to include speeding, passenger presence, and nighttime driving.

CONCLUSIONS

The frequency with which passengers, nighttime or weekend driving, and speeding occurred in the highest risk alcohol-related crash types for teens suggests that these characteristics should be targeted by policies, programs, and enforcement to reduce teen alcohol-related crash rates.

Novice drivers' risky driving behavior, risk perception, and crash risk: findings from the DRIVE study

OBJECTIVES

We explored the risky driving behaviors and risk perceptions of a cohort of young novice drivers and sought to determine their associations with crash risk.

METHODS

Provisional drivers aged 17 to 24 (n = 20 822) completed a detailed questionnaire that included measures of risk perception and behaviors; 2 years following recruitment, survey data were linked to licensing and police-reported crash data. Poisson regression models that adjusted for multiple confounders were created to explore crash risk.

RESULTS

High scores on questionnaire items for risky driving were associated with a 50% increased crash risk (adjusted relative risk = 1.51; 95% confidence interval = 1.25, 1.81). High scores for risk perception (poorer perceptions of safety) were also associated with increased crash risk in univariate and multivariate models; however, significance was not sustained after adjustment for risky driving.

CONCLUSIONS

The overrepresentation of youths in crashes involving casualties is a significant public health issue. Risky driving behavior is strongly linked to crash risk among young drivers and overrides the importance of risk perceptions. Systemwide intervention, including licensing reform, is warranted.

Effect of a Graduated Licensing System on Motor Vehicle Crashes andAssociated Injuries Involving Drivers Less Than 18 Years-of-Age

OBJECTIVES

The rate of motor vehicle crashes in the United States is higher among adolescent drivers than among any other age group. This study was conducted to determine whether implementation of a graduated driver's licensing program is associated with a reduced the rate of motor vehicle crashes and injuries involving adolescent driver.

METHODS

Time periods before and after establishment of Delaware's GDL program were compared. The one year "before" period spanned January 1, 1998, through December 31, 1998, and the 3-year "after" period spanned January 1, 2000, to December 31, 2002. Following enactment of the GDL program on July 1, 1999, we delayed data collection during the "after" period for 6 months to allow for full implementation of the program. Information was obtained for all Delaware registered drivers between ages 16 and 17 years were involved in motor vehicle crashes involving property damage or injury from 1998 to 2002. The rate of crashes involving property damage, EMS transport, injury, hospitalization, and death were determined pre- and post-GDL,. Length of hospitalization and hospital charges were compared, and the presence and age of passengers, along with time of day were determined.

RESULTS

The total number of licensed 16- and 17-year-old drivers in Delaware was 14,320 during 1998 (the before period), 16,849 for 2000, 14,098 for 2001, and 14,276 for 2002, for a total of 45,223 licensed drivers studied during the after period. The proportion of hospitalizations, injuries, crashes involving property damage and total number of crashes involving registered 16- and 17-year-old drivers after GDL each decreased by at least 30%. In addition, this GDL program was associated with a reduction in nighttime crashes and in crashes involving cars with multiple passengers in comparison with the time period before GDL.

CONCLUSIONS

Two years after implementation, the hospitalization rate, injury rate, and crash rate decreased significantly with enactment of the GDL program in the State of Delaware. The Delaware's GDL program appears successful in decreasing motor vehicle crashes and resultant injuries in adolescent drivers.

Hard Braking Events Among Novice Teenage Drivers By Passenger Characteristics

In a naturalistic study of teenage drivers (N = 42) hard braking events of ≤-0.45 g were assessed over the first 6 months of licensure. A total of 1,721 hard braking events were recorded. The video footage of a sample (816) of these events was examined to evaluate validity and reasons for hard braking. Of these, 788 (96.6%) were estimated valid, of which 79.1% were due to driver misjudgment, 10.8% to risky driving behavior, 5.3% to legitimate evasive maneuvers, and 4.8% to distraction. Hard braking events per 10 trips and per 100 miles were compared across passenger characteristics. Hard braking rates per 10 trips among newly licensed teenagers during the first 6 months of licensure were significantly higher when driving with teen passengers and lower with adult passengers than driving alone; rates per 100 miles were lower with adult passengers than with no passengers. Further examination of the results indicates that rates of hard braking with teenage passengers were significantly higher compared with no passengers: 1) for male drivers; 2) during the first month of licensure. The data suggest that that novice teenage driving performance may not be as good or safe when driving alone or with teenage passengers than with adult passengers and provide support for the hypothesis that teenage passengers increase driving risks, particularly during the first month of licensure.

Efficacy of a brief group parent-teen intervention in driver education to reduce teenage driver injury risk: a pilot study

The purpose of this study was to test the efficacy of an adapted Checkpoints Program designed to increase parental limits on novice teen independent driving under high-risk conditions. Twenty-seven class sessions with a minimum of 5 dyads each were delivered in driver education to 231 parent-teen dyads. Entire driving school classes were randomized to Checkpoints Program or comparison group sessions, both led by a trained health educator. At licensure, compared with parents in the comparison group, treatment parents had increased awareness of teen driving risk and were more likely to have completed a parent-teen driving agreement and met Checkpoints recommendations for restrictions on teen driving in inclement weather and road types. They were also marginally more likely to have met Checkpoints restrictions on driving with teen passengers. This study indicates that it is feasible to implement the Checkpoints Program in driver education with positive effects on parent management practices.