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

Teen drivers and the risk of injury to child passengers in motor vehicle crashes

OBJECTIVES

The first aim was to examine the relationship between driver's age (novice teens, older teens, and adults) and child passenger's restraint status, front row seating, and injury risk. The second aim was to explore whether there was an excess injury risk to child passengers in teen crashes compared to those in adult crashes by examining the contributing factors.

METHODS

A cross sectional study involving telephone interviews with insured drivers in a probability sample of 12 163 crashes involving 19 111 children was conducted. Sequential logistic regressions were employed.

RESULTS

Among child passengers aged 4-8, appropriate restraint was <1% for novice teens, 4.5% for older teens, and 23.6% for adults. Front row seating for children <13 years was more common in the novice teen group (26.8%) than in the other two groups. Compared with children riding with adults, those with both teen groups experienced excess injury risk. After adjusting for crash severity, there was a 43% reduction in the odds ratio (OR) for novice teens (OR 1.58, 95% confidence interval (CI) 1.14 to 2.19) and a 24% reduction for older teens (OR 2.15, 95% CI 1.42 to 3.26). After adjusting for vehicle type, child's restraint status and front row seating, there was a further 19% reduction in the OR for novice teens (OR 1.37, 95% CI 1.00 to 1.88) and a further 13% reduction for older teens (OR 1.74, 95% CI 1.14 to 2.66).

CONCLUSION

These findings suggest ways in which graduated driver licensing laws may be further enhanced to better protect child passengers from the excess injury risk associated with teen crashes.

Persistence of effects of the Checkpoints program on parental restrictions of teen driving privileges

OBJECTIVES

We describe intervention effects on parent limits on novice teenage driving.

METHODS

We recruited parents and their 16-year-old children (n = 469) with learner's permits and randomized them from August 2000 to March 2003. Intervention families received persuasive newsletters related to high-risk teenage driving and a parent-teenager driving agreement; comparison families received standard information on driver safety. We conducted interviews when the adolescents obtained a learner's permit, upon licensure, and at 3, 6, and 12 months postlicensure.

RESULTS

Intervention parents and teenagers reported stricter limits on teen driving compared with the comparison group at 12 months, with direct effects through 3 months and indirect effects through 12 months postlicensure.

CONCLUSIONS

A simple behavioral intervention was efficacious in increasing parental restriction of high-risk teen driving conditions among newly licensed drivers.

A survey of teenager unnatural deaths in northern Sweden 1981-2000

OBJECTIVE

To survey unnatural deaths among teenagers in northern Sweden and to suggest preventive measures.

SETTING

The four northernmost counties (908,000 inhabitants, 1991), forming 55% of the area of Sweden.

MATERIAL AND METHODS

All unnatural teenager deaths from 1981 through 2000 were identified in the databases of the Department of Forensic Medicine in Umea, National Board of Forensic Medicine. Police reports and autopsy findings were always studied, social and hospital records if present.

RESULTS

Three hundred and fifty-five deaths were found, of which 267 (75%) were males and 88 (25%) females. Ninety out of 327 (28%) tested positive for alcohol. Two hundred and forty-eight (70%) were unintentional and 102 (30%) were intentional deaths, and five (1%) were categorized as undetermined manner of death. Unintentional deaths decreased while the incidence of intentional deaths remained unaffected by time.

CONCLUSIONS

Injury-reducing measures have been effective concerning unintentional deaths and the fall in young licensed drivers due to the economical recess have probably also contributed to the decrease. However, there were no signs of decreasing numbers of suicides during the study period, which calls for resources to be allocated to suicide prevention.

Graduated driver licensing in Utah: Is it effective?

STUDY OBJECTIVE

We seek to examine the effectiveness of the graduated driver licensing system in Utah by determining whether crash rates of 16-year-old drivers decreased after graduated driver licensing implementation.

METHODS

We studied 16-year-old-driver crashes using statewide motor vehicle crash data probabilistically linked to emergency department (ED), hospital inpatient, and driver licensure data for 1996 to 2001. Outcomes examined included overall crash rates, nighttime crashes, crash severity indicators (eg, noninjury crash, injury crash, ED crash, inpatient crash, fatal crash), seat belt usage, licensure status, and citations. Rate ratios (RR), chi 2 tests, and interventional time series analyses were used to assess changes before and after graduated driver licensing implementation.

RESULTS

There were 27,304 16-year-old-driver crashes during the study period. The overall crash rate per 1,000 licensed 16-year-old drivers decreased by 5% (RR 0.95; 95% confidence interval [CI] 0.92 to 0.97), and a time-series analysis showed a reduction of 0.8 (SD 0.39) crashes per month per 1,000 licensed drivers after graduated driver licensing implementation (1996 to 1999 versus 1999 to 2001). The nighttime crash rate did not change (RR 0.91; 95% CI 0.78 to 1.04), and there was no association between crash severity and graduated driver licensing implementation ( P =.096). Reported seat belt usage increased by 6.3%, and few graduated driver licensing citations were issued by law enforcement.

CONCLUSION

The results suggest that graduated driver licensing may have contributed to a reduction in young driver crashes, but the effects were minimal compared with those shown in many other graduated driver licensing evaluations.

Student drivers: A study of fatal motor vehicle crashes involving 16-year-old drivers

STUDY OBJECTIVE

Motor vehicle crashes are the leading cause of death for US teenagers, accounting for 40% of fatalities. The purpose of this study was to compare novice (aged 16 years) and experienced (aged 25 to 49 years) drivers involved in fatal motor vehicle crashes with respect to crash characteristics and driver behaviors.

METHODS

This cross-sectional study of fatal motor vehicle crashes in Colorado used data from the Fatality Analysis Reporting System (1995 to 2001). Driver and crash variables were compared in the 2 age groups using separate logistic regression models, adjusted for sex, geographic locale, and year.

RESULTS

Two thousand four hundred twenty fatal motor vehicle crashes were included; 158 fatalities (6.5%) were novice drivers. Novice drivers were more likely to have been speeding (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.34 to 3.08); driving recklessly (OR 4.78, 95% CI 3.31 to 6.92); charged with a traffic violation (OR 3.08, 95% CI 2.20 to 4.31); in a single-vehicle (OR 1.84, 95% CI 1.32 to 2.57), rollover (OR 1.36, 95% CI 0.97 to 1.91) or run-off-the-road (OR 1.54, 95% CI 1.03 to 2.30) crash; and carrying 2 (OR 4.52, 95% CI 2.75 to 7.41) or more (OR 4.07, 95% CI 2.49 to 6.55) passengers. Safety belt nonuse was high for novice (48%) and experienced (42%) drivers (OR 1.19, 95% CI 0.86 to 1.67). Novice drivers had older cars (mean difference 1.5 years, 95% CI 0.37 to 2.57 years). Novice drivers were less likely to be involved in crashes caused by alcohol (OR 0.24, 95% CI 0.14 to 0.41) or adverse weather (OR 0.37, 95% CI 0.19 to 0.75) and to be driving a sport utility vehicle (OR 0.62, 95% CI 0.39 to 0.97).

CONCLUSION

Fatal motor vehicle crashes involving novice drivers are characterized by speeding, recklessness, single-vehicle and rollover crashes, and traffic law violations, suggesting that novice drivers bear considerable responsibility for their fatal crashes. Moreover, almost half of 16-year-old drivers involved in fatal motor vehicle crashes were not wearing their safety belts. These data may prove useful in strengthening graduated licensing laws and in improving drivers' education courses and public safety campaigns.

High school off-campus lunch policies and adolescent motor vehicle crash risks

PURPOSE

To examine differences in motor vehicle crash involvement for teenagers in communities with and without school policies enabling teens to drive off campus during lunchtime.

METHODS

Comparison of lunchtime motor vehicle crashes involving teen drivers in two North Carolina counties having open-lunch policies with a third county without an open-lunch policy. We also compare crash rates during the before-school period and at all times of the day in the three counties. Data were analyzed by computing rate ratios of teens' involvement in a crash during the three time periods and comparing them among the three counties.

RESULTS

Crash rates over the lunch hours were significantly higher for teenagers in the counties with open-lunch policies, despite these counties having no elevated crash risk during other time periods. This resulted in a relative risk of lunchtime crash involvement of 3.10 and 2.98 (95% CI 1.97-4.89 and 1.87-4.74, respectively) compared with the county without an open-lunch policy. Number of vehicle occupants also increased during the lunch hours in the counties with open-lunch policies.

CONCLUSIONS

Open-lunch policies contribute to motor vehicle crashes in teenagers and encourage a situation where there are multiple occupants per vehicle, a known risk factor for teenage motor vehicle crashes.

Increased parent limits on teen driving: positive effects from a brief intervention administered at the Motor Vehicle Administration

The purpose of this study was to determine whether exposure to a brief intervention administered at the Motor Vehicle Administration (MVA) increases parental limits on teen driving. A total of 658 parents and their 16-year-old adolescents were recruited from a local MVA site as adolescents successfully tested for provisional licenses. At the MVA, participating parents completed written surveys about expected teen driving during the 1st month of provisional licensure. One month later, 579 parent-teen dyads completed follow-up telephone interviews about teen driving within the past month. On weeks assigned as intervention, parents were exposed to a video and given the video and a driving agreement to take home. In multivariate linear regression analyses, the results indicated that when controlling for selected demographic and baseline psychosocial variables, intervention parents reported more driving rules, restricted driving, limits for high-speed roads, weekend night restrictions, and overall driving limits than did parents in the control group. When compared to control teens, intervention teens reported more limits on passengers, high-speed roads, and night driving, and on overall driving limits, but there were no differences for overall driving or driving under high-risk conditions. In addition, intervention parents were about 3 times, and intervention teens were about 5 times, more likely than controls to report using a parent-teen driving agreement. These results indicate that brief exposure to intervention at an MVA office may help increase parental limits on teen driving.

The influence of passengers on the risk of the driver causing a car collision in Spain. Analysis of collisions from 1990 to 1999

OBJECTIVE

To determine how the number of passengers, their age and their sex influence the risk of different types of Spanish drivers causing a collision between two or more cars.

METHODS

We selected, from the Spanish database of traffic crashes resulting in personal injuries or death, those collisions between two or more cars that occurred between 1990 and 1999 in which only one of the involved drivers committed a driving infraction. These drivers were considered the cases; non-infractor drivers were considered their matched controls. We collected information on the number, age and sex of the passengers in each vehicle, along with some potential confounding variables of the drivers and the vehicles involved. Crude and adjusted odds ratios were calculated for the main categories of driver and passenger.

RESULTS

A protective effect for the presence of passengers was detected (adjusted odds ratio: 0.69; 95% CI: 0.67-0.70). The protective effect was higher for drivers aged more than 45 years and lower for the youngest drivers (<24 years old). The strongest association was observed for female passengers who accompanied male drivers. The protective effect was lower for passengers older than 64 years.

CONCLUSIONS

Our results suggest that drivers are less likely to cause a car collision between two or more cars that results in personal injuries or death when they are accompanied by passengers, regardless of driver or passenger characteristics.

Michigan's graduated driver licensing program: evaluation of the first four years

INTRODUCTION

To evaluate the four-year outcome of Michigan's graduated driver licensing (GDL) program, motor-vehicle crash data for 16-year-old drivers in 1996 (pre-GDL), and 1998-2001 (post-GDL) were analyzed.

METHOD

Relative risks and 95% confidence intervals for several crash types were computed, and pre-post-GDL population-based crash rates were compared. Reductions in crash risks among 16-year-olds previously found in 1998 and 1999 were generally maintained in 2000 and 2001.

RESULTS

Reductions in crash risk among 16-year-olds from 1996 to 2001 were 29% for all, 44% for fatal, 38% each for nonfatal-injury and fatal-plus-nonfatal-injury, 32% for day, 31% for evening, 59% for night, 32% for single-vehicle, and 28% for multi-vehicle crashes. Even after adjusting for more general population-wide changes among drivers 25 years and older that might have contributed to changes in 16-year-old crash risk, reductions remained impressive (19% for all crashes in 2001).

IMPACT ON INDUSTRY

As one approach to reducing teenage motor-vehicle morbidity and mortality, GDL remains promising.

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 systems in reducing crash rates of young drivers.

SEARCH STRATEGY

Studies were identified through searches of MEDLINE, EMBASE, CINAHL, Healthstar, Web of Science, NTIS Bibliographic Database, TRIS Online, SIGLE, the World Wide Web, relevant conference proceedings, consultation with experts and authors, and reference lists. The search was not restricted by language or publication status.

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. Two reviewers independently screened searches and assessed the full text of potentially relevant studies for inclusion using a standard form.

DATA COLLECTION AND ANALYSIS

Data were extracted by one reviewer and checked by a second. Additional data were requested from authors. Results were not pooled due to substantial heterogeneity between studies. Percentage change was calculated for each year after the intervention, using one year prior to the intervention as the baseline rate. Results were adjusted by internal controls. Analyses were stratified by different denominators (population, licensed drivers). Results were calculated for the different crash types (overall, injury, fatal, night-time, alcohol, and those resulting in hospitalization). Results were presented for 16 year-olds alone and all teenage drivers combined.

MAIN RESULTS

We included 13 studies evaluating 12 GDL programs that were implemented between 1979 and 1998 in the US (n=7), Canada (3), New Zealand (1), and Australia (1). Programs varied in their restrictions during the intermediate stage: e.g. night curfews (8); limitations of extra passengers (2); roadway restrictions (1). Based on the Insurance Institute for Highway Safety classification scheme, no programs were good, six were acceptable, five were marginal, and one was poor. 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 overall crash rates during the first year was 31% (range 26-41%). Per population injury crash rates were similar (median 28%, range 4-43%). Results for all teenage drivers, rates per licensed driver, and rates adjusting for internal controls were generally reduced when comparing within jurisdictions.

REVIEWERS' CONCLUSIONS

The existing evidence shows that GDL is effective in reducing the crash rates of young drivers, although the magnitude of the effect is unclear. The conclusions are supported by consistent direction of the findings, and the temporal relationship and plausibility of the association. The reviewers have made recommendations for primary research on GDL (e.g. study methods, standardized reporting of outcomes and results, long-term follow-up). The project has also shown what is needed to carry out systematic reviews of observational studies (e.g. quality assessment instruments).

An in-depth look at parent-imposed driving rules: their strengths and weaknesses

INTRODUCTION

With a growing interest in increasing parental involvement in teen driving, it is important to find out what parents are already doing.

METHOD

This study assessed the content, delivery, rigidity, and consequences of 143 driving rules reported by 24 parent-teen dyads.

RESULTS

Strengths included that driving rules covered the full range of concerns, especially night driving limits and passenger limits, and most parents and teens reported that violations would be followed by consequences, especially talk/warn or no driving. Weaknesses included that many rules were not very strict and only half showed parent-teen agreement on content.

CONCLUSIONS

These findings suggest that teen driving rules are not clearly defined.

The influence of alcohol, age and number of passengers on the night-time risk of driver fatal injury in New Zealand

Breath alcohol measurements and other data collected at randomly selected roadside sites were combined with data on fatally injured drivers in crashes occurring on the same weekdays and times (Friday and Saturday nights) at locations matched by the size of the nearest town. A logistic model was fitted to these data for the years 1995-2000 to estimate the effects of alcohol, driver's age and the influence of passengers carried on the risk of driver fatal injury in New Zealand. The estimated risks increased steeply with increasing blood alcohol concentration (BAC), closely following an exponential curve at levels below about 200mg/dl (i.e. 0.2%) and increasing less than exponentially thereon. The model fitted to data for drivers under 200mg/dl showed that risks at all BAC levels were statistically significantly higher for drivers aged under 20 (over five times) and for drivers aged 20-29 (three times) than for drivers aged 30 and over. Further, controlling for age and BAC level, driving with a single passenger was associated with approximately half the night-time risk of driver fatal injury relative to driving either solo or with two or more passengers. According to a recent travel survey, the types of passengers carried at the times of night and days of week studied appear to differ significantly from the types of passengers carried generally, which may lead to different passenger effects on driver behaviour. The high relative risk of teenage drivers means that they reach high risk levels commonly regarded as unacceptable in the field of road safety even at their current legal limit of 30mg/dl, particularly when more than one passenger is carried in the car.

Passenger carriage and car crash injury: a comparison between younger and older drivers

This study was conducted to investigate the effects of passenger carriage, including the number of passengers and the ages of passengers, on the risk of car crash injury. The study utilised data obtained from a case-control study conducted in the Auckland region of New Zealand between 1998 and 1999. Cases were car drivers who involved in crashes in which at least one occupant was hospitalised or killed. Controls were selected from a cluster random sample of car drivers on the roads in the same region. Self-report information on the numbers of passengers carried and their ages at the time of crash or at the time of the roadside survey, as well as potential confounding factors, was obtained from the drivers, or a proxy, using an interviewer-administered questionnaire. A total of 571 cases (93% response rate), including 195 younger drivers (aged <25 years), and 588 controls (79% response rate), including 94 younger drivers participated in the study. After adjusting for other risk factors, the odds of car crash injury among younger drivers was 15.55 times (95% CI 5.76-42.02) for those who carried two or more same age passengers, and 10.19 times (95% CI 2.84-36.65) for those who carried two or more other age passengers, compared with unaccompanied drivers. In comparison, no increase in risk was observed for older drivers who carried two or more passengers regardless of age. The carriage of two or more passengers, irrespective of the ages of passengers, significantly increases the risk of car crash injury among younger drivers. Passenger restriction as part of the graduate licensing system was discussed in the light of these results.

Factors associated with young drivers' car crash injury: comparisons among learner, provisional, and full licensees

This exploratory study aimed to investigate factors associated with car crash injury among young drivers aged <25 years with different license status. Of special interest were the differences in risk patterns among different license holders of different age groups. Data utilised in this study were obtained from the New South Wales (NSW) police. The results indicated that female young drivers were more at risk of being killed or injured in a crash than males. Some risk factors, in particular environment-related factors, were identified as license-status-and-age specific. On the contrary, disregarding their driving experiences and ages, young drivers were more influenced by their own behaviours and driving conditions. Young drivers of 16-17 years with learner and provisional licenses tended to have increased risk of crash injury due to special road features. Night-time driving seemed to be a problem for older and more experienced drivers only. Fully licensed drivers of 18-19 and 20-24 years were more susceptible to the influence of alcohol. Risk-taking, speeding, fatigue, and carrying many passengers increased the risk of crash injury to car occupants for nearly all young drivers disregarding their ages and driving experiences. The results obtained provided indicative information on areas where the graduated licensing systems in NSW might be effective, and on other areas that might be lacking. A population-based case-control study was proposed to overcome the limitations of this study.

Nighttime driving, passenger transport, and injury crash rates of young drivers

OBJECTIVE

This study examines the association of nighttime driving and the carrying of passengers with the rate of motor vehicle crashes that resulted in severe or fatal injury to young drivers in California before the implementation of a graduated licensing system.

METHOD

Passenger vehicle drivers aged 16 or 17 involved in injury crashes in California from 1 January 1993 to 30 June 1998 were identified through a police crash database. An induced exposure method was used to estimate driving exposure. Odds ratios for driver injury crashes were estimated with logistic regression.

RESULTS

Driving at night, driving without adult supervision, driving with passengers, using alcohol, being 16, and being male were associated with high rates of driver injury crash.

CONCLUSIONS

The injury crash rate for drivers aged 16 or 17 increases during nighttime hours and in the absence of adult supervision, with or without other passengers. Driving between 10 pm and midnight is particularly dangerous for young drivers. Nighttime driving restrictions that begin at 10 pm or earlier and restrictions on carrying passengers at any hour may increase the effectiveness of graduated licensing systems.

Persistence of effects of a brief intervention on parental restrictions of teen driving privileges

OBJECTIVE

The purpose of this study was to determine the extent to which effects of exposure to a brief intervention designed to increase parental restrictions on teen driving privileges persisted over time.

DESIGN

A total of 658 parents and their 16 year old adolescents were recruited from a local motor vehicle administration (MVA) site as adolescents successfully tested for provisional licenses. At the MVA, parents completed written surveys about expected teen driving during the first month of provisional licensure. Afterwards, on weeks assigned as intervention, parents watched a video and were given the video and a driving agreement to take home. Both parents and teens completed follow up telephone interviews about communication, amounts, and limits on teen driving at one month (579 dyads), four months (529 dyads), and nine months (528 dyads).

RESULTS

The results indicated that both intervention parents and teens were much more likely to report using a driving agreement at each follow up during the nine month period. Significant treatment group differences persisted for communication about driving, but effects related to limits on teen driving that were evident at one month declined over time. Reports for passenger, road, and overall limits remained significant at four months; fewer were present at nine months. There were no differences in amounts of teen driving at four or nine months.

CONCLUSIONS

It is possible to reach parents through brief interventions at the MVA and successfully promote increases in initial parental restrictions on teen driving with modest persistence for at least four months.

Driving experience, crashes and traffic citations of teenage beginning drivers

Teenagers were surveyed by telephone every 6 months from their freshman to senior high school years (N=911). Self-reported crash involvements and citations were examined for each teenager's first year of licensure and first 3500 miles driven. Based on survival analysis, the risk of a first crash during the first month of licensure (0.053) was substantially higher than during any of the next 11 months (mean risk per month: 0.025). The likelihood of a first citation during the first month of licensure (0.023) also was higher than during any of the subsequent 11 months (mean risk per month: 0.012). Similarly, when viewed as a function of cumulative miles driven, the risk of a first crash or citation was highest during the first 500 miles driven after licensure. Fewer parental restrictions (e.g. no nighttime curfew) and a lower grade point average (GPA) were associated with a higher crash risk. Male gender, a lower GPA and living in a rural area were associated with a higher citation rate.

Factors associated with fatal and injurious car crash among learner drivers in New South Wales, Australia

This exploratory study investigated factors associated with car crash injury among learner drivers across difference ages by using data routinely collected by the NSW police. The results obtained indicated that some factors are commonly associated with car crash injury across nearly all ages. On the other hand, some others are more age specific. On the whole, female learner drivers were more at risk of being killed or injured as compared to males. The drivers of 16 years old had an increased risk of crash injury due to environmental factors, such as special road feature, and distraction outside the vehicle. The increased risk of crash injury for older drivers (> or =25 years) was associated with distractions from both inside and outside vehicle. Night time driving posed a special risk to learner drivers aged 20-24 years old, but not other age groups. Speeding was a common factor for the increased risk of crash injury across all age groups. The implication of the results and limitations of the study were discussed.

Teenage driver safety: should graduated drivers licensing be universal?

The number of motor vehicle deaths has decreased significantly in the last quarter century. However, there remain a disproportionate number of automobile crashes involving teenage drivers. Studies have shown these accidents are related to several, possibly behavioral, factors, including driver error, speeding, and increasing numbers of passengers. The injuries and fatalities also involve a disproportionate number of teenage passengers. A three-stage Graduated Drivers Licensure process has been adopted by 34 states to try to address this potentially preventable problem. The Graduated Drivers Licensure involves a very well-supervised permit period, a lengthened provisional period that includes advanced drivers' education and supervised practice, and finally a full license. Studies from Maryland, California, Oregon, Florida, Michigan, North Carolina, and Kentucky have shown significant decreases in the crash rates among teenage drivers. The Graduated Drivers Licensure, if adopted as a national standard, may be effective in decreasing the toll of teenage driving accidents.

Seatbelt use by high school students

OBJECTIVE

To determine seatbelt use of teenage drivers arriving at high schools in the morning and at evening football games compared with belt use of adults driving teenage passengers to these events, and teenage passenger belt use depending on whether they were being driven by another teenager or an adult.

METHODS

Unobtrusive observations of belt use were made at 12 high schools in Connecticut and Massachusetts.

RESULTS

Among males, teenage drivers had lower belt use than adults; differences between female teenage and female adult drivers were slight. Teenage passengers had lower belt use in vehicles driven by other teenagers than in cars driven by adults, but more than 40% of teenage passengers in vehicles driven by adults, presumed in most cases to be the teenager's parent, were not belted. Teenage passenger belt use was lower than teenage driver use regardless of gender. These differences were found both at morning arrivals and at football games, but teenage belt use was not much different in these two settings. Teenage passengers were belted more often if drivers were belted, whether the driver was another teenager or an adult, but a third of male passengers and 25%-30% of female passengers were unbelted even when drivers were belted.

CONCLUSION

Teenagers have high crash risk but low belt use, which adds to their injury problem. Avenues to address this include strong belt use laws and their enforcement, building belt use requirements into graduated licensing systems, keeping young beginners out of high risk driving situations, and finding ways to influence parents and other adults to ensure that their teenage passengers use seatbelts.

Enhancing the effectiveness of graduated driver licensing legislation

PROBLEM

Many states have enacted graduated driver licensing (GDL) systems in an effort to reduce the very high crash rates of young beginning drivers. This article addresses how to achieve the maximum benefit from GDL by ensuring compliance with protective restrictions.

ENHANCING GDL THROUGH SYSTEM STRUCTURE

The major crash reductions due to GDL systems result from the protective restrictions during the initial two levels, which isolate novice drivers from the highest risk driving situations. Accordingly, GDL systems should include protective restrictions that adequately control the greatest dangers facing young drivers: multiple teen passengers and night driving before midnight.

ENCOURAGING COMPLIANCE THROUGH SYSTEM STRUCTURE

Including protective restrictions that are supported by parents and teens will encourage compliance. Furthermore, linking a teen's advancement through GDL to demonstrated responsible driving will likely encourage compliance more than threatening punishment for violations.

ENCOURAGING COMPLIANCE THROUGH ENFORCEMENT

Parents are in a prime position to enforce most GDL restrictions, but there is some evidence they do not enforce those restrictions that they consider too extreme. Little is currently known about the involvement of law enforcement in GDL systems, but there is potential for high visibility law enforcement activities to encourage compliance with restrictions.

IMPACT ON RESEARCH, PRACTICE, AND POLICY

There is a need for better designed GDL systems in many states; more research is needed to examine compliance with restrictions and to evaluate enforcement efforts by parents and law enforcement.

How well do parents manage young driver crash risks?

Motor vehicle crashes are extremely high among young drivers during at least the first year of licensure. Crash risks decline with increased experience, but the more newly licensed teenagers drive, the greater their risk exposure. Hence, the dilemma facing policy makers and parents is how to provide young drivers with driving experience without unduly increasing their crash risk. Graduated driver licensing policies serve to delay licensure and then limit exposure to the highest risk conditions after licensure, allowing young drivers to gain experience only under less risky driving conditions. A similar strategy is needed to guide parents. Parents do not appear to appreciate just how risky driving is for novice drivers and tend to exert less control over their teenage children's driving than might be expected. Recent research has demonstrated that simple motivational strategies can persuade parents to adopt driving agreements and impose greater restrictions on early teen driving.

Teenage drivers: patterns of risk

PROBLEM

To determine patterns of risk among teenage drivers.

METHOD

Review and synthesis of the literature.

RESULTS

On most measures, crash rates during the teenage years are higher than at any other age, for both males and females. Risk among teenagers varies greatly by driving situation; it is particularly low in some situations (e.g., the learner period) and particularly high in others (e.g., right after licensure, late at night, with passengers present). In some of these high-risk driving situations, risk is elevated for drivers of all ages (e.g., late night driving), in others risk is elevated more for teens than adults (e.g., driving after consuming alcohol), and in others the risk is unique to teen drivers (e.g., having passengers).

IMPACT ON RESEARCH, PRACTICE, AND POLICY

These varying patterns of risk form the basis for graduated licensing systems, which are designed to promote low-risk and discourage high-risk driving.

The provisional license: nighttime and passenger restrictions--a literature review

PROBLEM

Due to inexperience and inadequate driving skills, the road is a very risky place for young and beginning drivers, yet such experience and skills can only be built by increased driving and exposure to risks on the road. Graduated driver licensing (GDL) allows beginning drivers to get their initial driving experience under less risky conditions and gradually eases them into more complex driving situations. This paper reviews the literature exploring two key features of the intermediate licensing phase of GDL, nighttime driving restrictions and passenger restrictions.

METHOD

Literature review.

RESULTS

Nighttime driving restrictions have been shown to effectively reduce the number and rate of crash involvements on the part of teenage drivers. Data suggest that having passengers in the car increases the likelihood of a fatal injury in young drivers and that this risk increases with the number of passengers. Young drivers were more likely to cause a crash when accompanied by their peers.

DISCUSSION

Nighttime driving and passenger restrictions are effective in decreasing injuries among teenage drivers and their passengers, especially in the context of a full GDL system. Several research questions remain to be answered in order to fully refine and optimize the impact of these provisional measures.

Evaluating the impact of passengers on the safety of older drivers

PROBLEM

This study involved a quasi-induced exposure analysis of 4 years of crashes involving older drivers in the state of Kentucky.

METHOD

Single- and multivehicle crashes were disaggregated according to the number of passengers: (a) no passenger, (b) one passenger, and (c) two or more passengers.

RESULTS

Overall, the presence of two or more passengers was found to negatively impact the probability that drivers 75 years of age or older were at fault in crashes. Several potential factors were studied for interactive effects with passengers: vehicle occupant gender mix, time of the day, road curvature, grade, and number of lanes. The negative impact of passengers increased for some geometric road conditions. However, older drivers were found to be safer at night when carrying two or more passengers. The presence or absence of passengers was not found to affect the 65- to 74-year-old driver group. Groups of male vehicle occupants with a 75+ male driver were found to have high single-vehicle crash rates.

IMPACT

These results are among the first to directly consider the effect of passengers on the crash-causing propensity of older drivers and the findings suggest more work is warranted to consider causes for the crash rate differences.

Views of US drivers about driving safety

PROBLEM

To assess how drivers view dangers on the highway, what motivates them to drive safely, how they say they reduce their crash and injury risk, and how they rate their own driving skills.

RESULTS

Most drivers rated their skills as better than average. The biggest motivating factor for safe driving was concern for safety of others in their vehicle, followed by negative outcomes such as being in a crash, increased insurance costs, and fines. The greatest threats to their safety were thought to be other drivers' actions that increase crash risk such as alcohol impairment or running red lights. In terms of reducing crashes and injuries, drivers tended to focus on actions they could take such as driving defensively or using seat belts. There was less recognition of the role of vehicles and vehicle features in crash or injury prevention.

IMPACT ON RESEARCH, PRACTICE, AND POLICY

Knowing how drivers view themselves and others, their concerns, and their motivations and techniques for staying out of trouble on the roads provides insight into the difficulty of changing driving practices.

Responsibility of drivers, by age and gender, for motor-vehicle crash deaths

PROBLEM

Motor-vehicle crash rate comparisons by age and gender usually are based on the extent to which drivers in a particular age/gender category are themselves injured or involved in crashes (e.g., the number of 20-year-old females in crashes). Basing comparisons instead on the extent to which drivers in various age/gender groups are responsible for deaths (including themselves) in their crashes is more revealing of their overall contribution to the problem.

METHODS

Data from the Fatality Analysis Reporting System (FARS, 1996-2000) were used in the analysis, which was based on crashes that involved one or two vehicles only. Drivers in fatal single-vehicle crashes were assumed to have responsibility for the crash. In fatal two-vehicle crashes, driver operator errors reported by police were used to assign crash responsibility.

RESULTS

When all crashes were considered, both the youngest and oldest drivers were most likely to be responsible for deaths in their crashes. In two-vehicle crashes, the oldest drivers were more likely than young drivers to be responsible. Young males were more likely than young females to be responsible for crash deaths, whereas females in their 50s and older were more likely than same-age males to be responsible. In terms of responsibility for deaths per licensed driver, young drivers, especially males, had the highest rates because of their high involvement rates and high responsibility rates. The majority of deaths for which young drivers were responsible occurred to people other than themselves, especially passengers in their vehicles, whereas the bulk of the deaths for which older drivers were responsible were their own.

DISCUSSION

The results highlight the contribution of young drivers to the motor-vehicle crash problem, the need for measures such as passenger restrictions in graduated licensing systems, and the need for vehicle modifications to better protect older occupants.

Rationale for graduated licensing and the risks it should address

The increased crash risk of young, beginning drivers has long been cause for concern. Graduated licensing systems, which seek to phase in driving experience gradually over time, have recently been adopted by many states in an effort to reduce these risks. In an attempt to define the basic rationale for graduated licensing, relevant research evidence that describes the conditions under which risk is known to be increased for young drivers was reviewed. Potential changes in licensing laws that best address these known risk factors are described. It was found that certain situations contribute to even greater crash risk, most notably nighttime driving and driving with passengers in the peer group. The underlying premise for graduated licensing is that while crash risk of young drivers is heightened under all situations, some situations are more or less risky than others. If experience can be gained initially under lower risk conditions, both in the learning stage and when first licensed, crash risk will be reduced.

Promoting parental management of teen driving

OBJECTIVE

Parenting may be an important protective factor against teen driving risk; however, parents do not limit teen driving as much as might be expected. The Checkpoint Program was designed to promote parental management of teen driving through the use of staged persuasive communications.

METHODS

Parent-teen dyads (n = 452) were recruited when teens received learner's permits and interviewed over the telephone at baseline, licensure, and three months post-licensure. After baseline, families were randomized to either the intervention group that received persuasive communications or to the comparison group that received general information about driving safety.

RESULTS

Both parents and teens in the intervention group reported significantly greater limits on teen driving at licensure and three months post-licensure. In multivariate analyses, intervention and baseline driving expectations had significant effects on driving limits at licensure. Intervention and driving limits established at licensure were associated with three month driving limits.

CONCLUSION

The findings indicate that exposure to the Checkpoints Program increased parental limits on teen driving.

Characteristics of traffic crashes in Maryland (1996-1998): differences among the youngest drivers

Motor vehicle crashes (MVCs) are the leading cause of death among teenagers in the US. The present study examines how crash rates and crash characteristics differed among drivers aged 16-21 in the state of Maryland from 1996 to 1998. The results show that, based on police reports. the youngest drivers have the highest rate of MVCs per licensed driver and per annual miles driven. Furthermore, crash characteristics suggest that inexperience rather than risky driving may account for the differing rates. Drivers closer to the age of 16 had their crashes under the safest conditions: during the day in clear weather while drinking less.

Teen driving risk: the promise of parental influence and public policy

An analysis is presented of adolescent driving risk, the advantages of graduated licensing programs, and the potential for parent-based programs to moderate teen driving risks. Risk factors associated with youthful driving illustrate the potential importance and benefits of limiting the amount and conditions under which teens can drive. State policies, such as graduated driver licensing systems that formalize restrictions on youthful driving. have been shown to be effective. However, teen driving risks remain elevated. Parents are in a prime position to extend the benefits of state restrictions by developing and implementing their own tailored family policies on adolescent driving. Unfortunately, parents of adolescent drivers are often under-aware of the need to do so and fail to impose effective driving restrictions. An ongoing parent-based intervention to increase parental restriction on teen driving is described, and issues involved in implementing and evaluating family-centered approaches to reduce teen driving risk are raised.

Distractions and the risk of car crash injury: the effect of drivers' age

PROBLEM

Motor-vehicle accidents are one of the major causes of injury in most motorized countries. Driver distractions have been suggested as a contributor to traffic accidents. Moreover, age of the driver seems to have a role in the relationship between distractions and car crashes. But very few studies have investigated the effect of driver's age on this relationship. This exploratory study investigated the association between distractions, both inside and outside the vehicle, and the increased risk of car crash injury among drivers across different ages.

METHOD

This study used a case series design to analyze data routinely collected by the NSW police in Australia. A special focus of this study was on how drivers' age affects the risk of car crash injury, which was determined by using a well-documented risk estimation methodology.

RESULTS

The results obtained indicated that drivers of all ages, on the whole, are more susceptible to distractions inside the vehicle than distractions coming from outside. Age was shown to affect the relationship between in-vehicle distraction and the risk of car crash injury. A separate analysis was also conducted on hand-held phone usage while driving with results supplementing previous findings reported in the literature.

IMPACT TO INDUSTRY

Safety strategies to countermeasure in-vehicle distractions have been suggested and discussed.

Rates of pediatric and adolescent injuries by year of age

OBJECTIVE

The purpose of this study was to analyze causes of injury hospitalization/death by individual year of age and by specific causes of injury and to examine how well aggregate age groups represented individual year-of-age rates.

METHODS

Hospital discharge data and death certificate data for California residents age 0 to 19 years with a principal external cause of injury code (E-code) of E800 to E869, E880 to E929, or E950 to E999, calendar year 1997, were analyzed. Annual rates of injury hospitalization/death by year of age were calculated using combined hospital discharges and deaths as the numerator for major causes and important subcategories. For comparison, rates of injury hospitalization/death were calculated for conventional vital statistics age groups: <1 year, 1 to 4 years; 5 to 9 years, 10 to 14 years, and 15 to 19 years.

RESULTS

In 1997 in California, 35 277 children and adolescents 0 to 19 years were hospitalized and 1934 died as a result of injury, a ratio of 17 hospitalizations to 1 death. The distribution was bimodal with rates highest among 18-year-olds (732/100 000) and 1-year-olds (495/100 000). Except for children who were 5 to 9 years of age, the group rates for all injuries were not reflective of the individual year-of-age rates. In specific categories of injuries, variation in rates by year of age were masked by age group rates for unintentional poisoning among 1- to 4-year-olds, self-inflicted poisoning for 10- to 19-year-olds, falls from playground equipment among 5- to 9-year-olds, falls from furniture among 1- to 4-year-olds, and motor vehicle occupant injury rates among 10- to 19-year-olds. The peak rate of falls from playground equipment among 6-year-olds (34/100 000) was more than twice the rate for 9-year-olds (15/1000,000). Motor vehicle occupant injury rates doubled between 10 and 14 years of age and quadrupled between 14 and 18 years of age.

CONCLUSIONS

Analyses using conventional age groups did not identify the age of highest risk for many causes of childhood injury. Changes in the rates often transected the traditional age groups and were not apparent with conventional age group analysis. These data can inform on the age at which to begin a specific injury intervention and on how to allocate resources. These data allow pediatricians and other health professionals to be anticipatory in providing injury prevention counseling. The greatest impact can be achieved by making the counseling topic most age appropriate in anticipation of the high-risk period.

Acceptability of the Checkpoints Parent-Teen Driving Agreement: pilot test

BACKGROUND

Parent-teen driving agreements are potentially important tools to facilitate parental management of teen driving and reduce adolescent driving risk. The Checkpoints Parent-Teen Driving Agreement (Checkpoints P-TDA) was designed so that parents could initially impose strict limitations on teen driving in high-risk driving conditions (e.g., at night and with teen passengers) and gradually increase driving privileges over time as teens demonstrate responsible driving behavior.

METHODS

To assess the acceptability of the format and content of the Checkpoints P-TDA, it was pilot tested with a convenience sample of 47 families recruited as their teens tested for a driver's license at five private driving schools in Connecticut. Family members were interviewed at the driving schools about potential limits on teen driving, asked to use the driving agreement, and re-interviewed within 3 months about acceptability of the driving agreement and initial driving limits placed on teens.

RESULTS

Most families (38 of 47) used and liked the agreement. In addition, most parents placed the recommended strict initial limits on teen driving related to driving unsupervised at night, with teen passengers, and on high-speed roads. Moreover, parents reported placing more strict limits on their teens' driving than they originally intended.

CONCLUSIONS

The results showed promise for the acceptability of the Checkpoints P-TDA, which will be tested statewide.

Potential benefits of restrictions on the transport of teenage passengers by 16 and 17 year old drivers

OBJECTIVES

The presence of passengers is associated with fatal motor vehicle crashes of teenage drivers. A restriction against newly licensed teenage drivers carrying passengers has been included in some, but not all, graduated licensing systems. The purpose of this study was to predict the net effects on all types of road users, including vehicle occupants and non-occupants, of possible prohibitions against 16-17 year old drivers carrying passengers.

METHODS

Two national datasets, a census of fatal crashes and a sample of trips in the United States, were used to compute 1995 road user death rates. Potential effects of restrictions on drivers ages 16-17 carrying passengers younger than 20 were estimated, based on road user death rates and potential choices made by passengers who would have traveled with 16-17 year old drivers if there were no restrictions.

RESULTS

There were 1,181 road user deaths in 1995 involving drivers ages 16-17 whose passengers were all younger than age 20. The predicted number of lives in the United States that would be saved annually ranges from 83 to 493 (corresponding to reductions of 7-42% in road user deaths) for drivers ages 16 and 17 combined. Similar percentages of reductions (8-44%) were predicted solely for 16 year old drivers. Assuming passenger restrictions would apply to all 16 year old drivers and at least one third of 17 year old drivers, an estimated 60-344 fewer deaths per year may occur if restrictions are mandated.

CONCLUSIONS

Restrictions on carrying passengers younger than 20 should be considered for inclusion in graduated licensing systems. Even if fewer than half the drivers obey the restrictions, a substantial reduction in road user deaths would be expected. Further evaluation based on real world experience is needed to confirm their efficacy.

Do parent-imposed delayed licensure and restricted driving reduce risky driving behaviors among newly licensed teens?

Motor vehicle crashes are the leading cause of death and injury to teenagers. Crash risks result from their age, inexperience, and risky driving. The purpose of this study was to determine whether parent-imposed delayed licensure and restricted driving are related to fewer teenage risky driving behaviors. At baseline, 275 teenagers with a learner's permit and one of their parents were interviewed about driving attitudes and teenage behaviors. One year later, 161 of the teenagers had since obtained a provisional license and were reinterviewed about time of licensure, parental restrictions on driving, and driving attitudes and behaviors. The results indicated that parents delayed licensure until teens were "ready," and limited their driving in terms of trip and risk conditions. Higher levels of risky driving behaviors were predicted by younger ages at licensure and fewer limits on driving in the first month, in addition to male gender, higher conflict over driving, lower perceptions of dangers related to driving, more problem behaviors at baseline, and more high-risk driving (e.g., at night, teenage passengers). Overall, the results indicate that a combination of being older at licensure and restricting driving under high-risk conditions at licensure may be an effective way to curb teens' risky driving behaviors.

A population-based study of crashes involving 16- and 17-year-old drivers: the potential benefit of graduated driver licensing restrictions

OBJECTIVE

To evaluate the potential effectiveness of graduated driver licensing programs using population-based linked data for motor vehicle crashes (MVCs) that involved teenaged drivers (TDs).

METHODS

Utah crash, inpatient hospital discharge, and emergency department databases were analyzed and probabilistically linked. We computed hospital charges and compared violations, contributing factors, seatbelt use, and passengers for TDs (16-17 years old) relative to adult drivers (18-59 years old).

RESULTS

TDs comprised 5.8% of the study population, but were involved in 19.0% of MVCs. TD crashes resulted in $11 million in inpatient hospital charges and 158 fatalities. TD crashes were 1.70 times (95% confidence interval [CI]: 1.34, 2.04) less likely to result in fatal injury to drivers than were crashes that involved adult drivers, but TDs were 2.20 times (95% CI: 1.96, 2.47) more likely to receive citations. The following were findings of the study: 1) 11% of all TD crashes but 19% of fatal TD crashes occurred between 2200 and 0600 hours; 2) TDs used seatbelts less often than did adult drivers (79.1% vs 84.4%) and less often with passengers present (81.9% vs 75.0%; 3) TDs were 1.72 times (95% CI: 1.38, 2.14) more likely to be involved in crashes that resulted in seriously or fatally injured occupants when driving with passengers than when driving alone.

CONCLUSIONS

TDs are overrepresented in MVCs. TD crashes have a higher fatality rate at night, and TDs wear seatbelts less often than do adult drivers. Passengers affect TD crash characteristics. Graduated driver licensing programs that target state-specific characteristics of TDs may decrease morbidity and mortality.

Trends and subgroup differences in transportation-related injury risk and safety behaviors among high school students, 1991-1997

PURPOSE

To examine national trends in transportation-related injury risk and safety behaviors among U.S. high school students.

METHODS

To examine secular trends in riding with a driver who had been drinking, driving after drinking, and using seat belts, bicycle helmets, and motorcycle helmets, we used logistic regression to analyze data from national Youth Risk Behavior Surveys (YRBS) conducted in 1991, 1993, 1995, and 1997. The YRBS is a self-administered, anonymous survey that uses a national probability sample of U.S. students in public and private schools from grades 9-12 (N = 55,734 for all years combined).

RESULTS

The percentages of students who rode with a driver who had been drinking (36.6% in 1997), drove after drinking alcohol (16.9% in 1997), always wore seat belts (33.2% in 1997), and always wore a motorcycle helmet when riding a motorcycle (45.0% in 1997) remained stable between 1991 and 1997. From 1991 to 1997, the percentage of bicycle riders who always wore a helmet when bicycling showed a small but statistically significant increase (1.1% in 1991 to 3.8% in 1997), but helmet use remained low.

CONCLUSION

Many young people place themselves at unnecessary risk for motor vehicle- and bicycle-related crash injuries and fatalities. Improved motor vehicle- and bicycle-related injury prevention strategies are needed that specifically target adolescents.