Young Drivers and Their Passengers: A Systematic Review of Epidemiological Studies on Crash Risk

Chinese adaptation of the reckless driving behaviour scale: Testing its psychometric properties and links with safe driving climate among family and peers

Purpose

The present study aimed to revise the Reckless Driving Behaviour Scale (RDBS) and examined its reliability and validity among young Chinese drivers.

Methods

The RDBS, the Safe Driving Climate among Friends Scale (SDCaF), the Family Climate for Road Safety Scale (FCRSS) and a social desirability scale were administrated to 560 young drivers. Exploratory factor analysis (EFA, n = 250) and confirmatory factor analysis (CFA, n = 250) were conducted to examine the factorial structure of the RDBS.

Results

The Chinese version of the RDBS has 18 items that are divided into 4 factors: distraction, substance use, extreme behaviour and positioning. Both the results of EFA and CFA confirmed its factorial structure. The reliability of the RDBS was acceptable and the concurrent validity of the scale was supported by its significant associations with the SDCaF and FCRSS factors. Finally, drivers who had violation involvement scored higher on all four factors than their peers who did not have violation involvement, providing evidence for its known-group validity.

Conclusion

The revised RDBS has similar structure with the original version and its reliability and validity were satisfactory. It is an effective tool to measure the reckless driving behaviour of young drivers in China and interventions that incorporated joint efforts of family and peers should be developed.

Distracted and Impaired Driving Among U.S. Adolescents, 2019, USA

Distracted driving, the act of focusing on something else while operating a vehicle, is a significant health problem among adolescents. Although some studies have reported on prevalence among adolescents in the United States, limited studies have examined differences by sexual identity status. The purpose of the present study was to examine past 30-day distracted driving by sexual identity status among a large, national sample of adolescents ages 14 to 18 years. A secondary analysis was conducted on the 2019 Youth Risk Behavioral Surveillance System (YRBSS) data, and associations between distracted driving and demographics (e.g., biological sex, age, race/ethnicity) were assessed with weighted logistic regression analyses. A total of 13,590 adolescents ages 14 to 18 years were part of the final analytic sample. Twenty-three percent of adolescents reported distracted driving in the past 30 days. Compared with heterosexual adolescents, gay/lesbian (14.3%), bisexual (18.1%), and questioning (12.9%) adolescents reported lower distracted driving in the past 30 days. Findings through a health equity approach may inform harm reduction efforts and behavioral interventions.

Looking out or Looking Away?-Exploring the Impact of Driving With a Passenger on Young Drivers' Eye Glance Behavior

OBJECTIVE

To explore how passenger presence and the degree of association between young driver and passenger influences young drivers' eye glance behavior when they are subjected to distraction.

BACKGROUND

Young drivers (18-20 years old) are at an elevated crash risk when subjected to distraction. They are likely to be distracted even further when they drive with passengers. However, the eye glance behavior of these drivers when driving with passengers has not been explored.

METHOD

Eye glance data of 34 young drivers between the ages of 18 and 20 years were collected. Participants drove with and without a passenger while subjected to three distracting tasks (visual-manual, cognitive, or visual-cognitive) and driving scenarios that required driver attention.

RESULTS

Visual-cognitive as well as visual-manual states of distraction result in higher mean and standard deviation of glance duration, along with higher number of glances away from road. Passenger presence is found to negatively influence young drivers' eye glance behavior. The degree of association between the young driver and the passenger may help reduce the deviation of eye glances towards the task-related objects.

CONCLUSION

In addition to distraction, passengers have a negative influence on the eye glance behavior of young drivers. However, a high degree of association between driver and passenger may mitigate the negative impact of distraction on the eye glance behavior of young drivers.

APPLICATION (NON-THEORETICAL WORKS)

This research may aid in the design of interventions that improve young drivers' eye glance behavior when they drive with their peers.

Prevention of "bygone futures" due to road traffic injuries in children

Road traffic injuries remain one of the common and leading causes of death among children and adolescents till the age of 19 years. Road safety is important for children since their physical activity, active travel, independence and development are largely affected by it. Solutions for road safety with benefits for people as well as an economy exist which should be implemented effectively and efficiently. These solutions which combine engineering, legislation and behavioural interventions should be implemented in an integrated Safe Systems Approach. The future of the children must be safeguarded from these injuries and every effort towards it being converted into "bygone figures" must be done diligently and honestly. The various risk factors and interventions possibly explained in this review article shall help in better understanding of the causes and possible guidelines at a policy level to prevent road traffic injuries in children.

Financial status and travel time to driving schools as barriers to obtaining a young driver license in a state with comprehensive young driver licensing policy

The highest lifetime risk for a motor vehicle crash is immediately after the point of licensure, with teen drivers most at risk. Comprehensive teen driver licensing policies that require completion of driver education and behind-the-wheel training along with Graduated Driver Licensing (GDL) are associated with lower young driver crash rates early in licensure. We hypothesize that lack of financial resources and travel time to driving schools reduce the likelihood for teens to complete driver training and gain a young driver's license before age 18. We utilize licensing data from the Ohio Bureau of Motor Vehicles on over 35,000 applicants between 15.5 and 25 years old collected between 2017 and 2019. This dataset of driving schools is maintained by the Ohio Department of Public Safety and is linked with Census tract-level socioeconomic data from the U.S. Census. Using logit models, we estimate the completion of driver training and license obtainment among young drivers in the Columbus, Ohio metro area. We find that young drivers in lower-income Census tracts have a lower likelihood to complete driver training and get licensed before age 18. As travel time to driving schools increases, teens in wealthier Census tracts are more likely to forgo driver training and licensure than teens in lower-income Census tracts. For jurisdictions aspiring to improve safe driving for young drivers, our findings help shape recommendations on policies to enhance access to driver training and licensure especially among teens living in lower-income Census tracts.

The relationship between aggressive driving and driver performance: A systematic review with meta-analysis

Traffic crashes remain a leading cause of accidental human death where aggressive driving is a significant contributing factor. To review the driver's performance presented in aggressive driving, this systematic review screens 2412 pieces of relevant literature, selects and synthesizes 31 reports with 34 primary studies that investigated the driver's control performance among the general driver population in four-wheeled passenger vehicles and published with full text in English. These 34 selected studies involved 1731 participants in total. By examining the selected 34 studies, the measures relating to vehicle speed (e.g., mean speed, n = 22), lateral control (e.g., lane deviation, n = 17) and driving errors (e.g., violation of traffic rules, n = 12) were reported most frequently with a significant difference observed between aggressive driving and driving in the control group. The result of the meta-analysis indicates that the aggressive driving behaviour would have 1) a significantly faster speed than the behaviour in the control group with an increase of 5.32 km/h (95% confidence interval, [3.27, 7.37] km/h) based on 8 studies with 639 participants in total; 2) 2.51 times more driving errors (95% confidence interval, [1.32, 3.71] times) than the behaviour in the control group, based on 5 studies with 136 participants in total. This finding can be used to support the identification and quantification of aggressive driving behaviour, which could form the basis of an in-vehicle aggressive driving monitoring system.

Peer pressure and risky driving: Development of a new scale

INTRODUCTION

Peer pressure is a main factor influencing risky driving behavior in young people. Most empirical studies have focused either on direct or indirect peer pressure, and comprehensive measures assessing both are currently lacking. The present study aimed at developing and validating a scale to examine the influence of different types of peer pressure on risky driving in young drivers: the Peer Pressure on Risky Driving Scale (PPRDS).

METHOD

Scale construction and assessment of its psychometric properties involved four phases: item development, assessment of content validity by expert reviewers, pre-testing of the scale and evaluation of psychometric properties of the final version in a sample of 773 young drivers aged 18-29.

RESULTS

Confirmatory factor analysis supported a three-factor structure that reflected the multifaceted definition of peer pressure on risky driving in the immediate driving context: risk-encouraging direct peer pressure; risk-discouraging direct peer pressure, and indirect pressure. The three factor scales showed good internal consistency and construct reliability, and correlated as expected with self-reported risky driving. Younger drivers (18-24) reported more direct and indirect peer pressure to engage in risky driving. Males indicated more direct peer pressure towards risky driving. Finally, interaction effects between age and sex were observed. Young male drivers reported the greatest direct peer pressure and adult female drivers the lowest direct peer pressure.

CONCLUSIONS

The 23-item PPRDS scale has good psychometric properties and provides a useful tool for assessing different forms of peer pressure on risky driving.

PRACTICAL APPLICATIONS

The PPRDS can be used for evaluating the impact of peer-based education and road safety programs. The scale also provides valuable information for the design of evidence-based intervention.

The prevalence and excess mortality risk of driving with children

INTRODUCTION

The presence of passengers can affect the driving behavior of motor-vehicle operators. Child passengers present unique motivations to drive more safely, as well as opportunities to distract drivers. Because motor-vehicle crashes are an important cause of premature childhood mortality, this study assesses whether adult drivers with child passengers are more or less likely to cause a fatal crash.

METHOD

Data include fatal crashes involving one or two vehicles from 2007 to 2017 in the U.S. Fatality Analysis Reporting System. We apply methods developed by Levitt and Porter (2001) and Dunn and Tefft (2020) -the LPDT approach- to estimate the risk that adult drivers (21 years or older) with at least one child passenger (15 year or younger) cause a fatal crash relative to adults without child passengers.

RESULTS

Childhood crash exposure when traveling with an adult driver is low: 0.78% of vehicle miles traveled by adults included a child passenger. Nevertheless, adult drivers with child passengers were significantly more likely to cause a fatal crash than adult drivers without child passengers. The estimated risk of causing a single-vehicle crash was 6.2 times higher among the full sample of adults, 7.2 times higher among female drivers, and 5.0 times higher among drivers 25-44 years old.

CONCLUSIONS

Despite their relatively low crash exposure, child passengers are associated with much greater risk of causing a fatal crash.

PRACTICAL APPLICATIONS

This study not only informs about the need to develop interventions to remind parents and adult drivers of the risks associated with driving children, but also reminds researchers about the enormous potential of the LPDT approach when applied to traffic safety issues.

Insights for speed management among Iranian drivers: a social marketing formative research study

BACKGROUND

Road traffic crashes are among the leading causes of death and disability in the world, particularly in low and middle-income countries. This study aimed at to conduct a social marketing formative research to inform the development of a campaign to manage driving speed on the intercity roads of Iran.

METHODS

To carry out the social marketing formative research, a qualitative and quantitative study were conducted. Also, a literature review of the speed management strategies was carried out and an analysis of traffic accident data and speeding violations was performed in selected provinces during 2019 and 2020.

RESULTS

Based on the findings of the qualitative study, perceived sense of lack of speed control, poor monitoring system, and law enforcement are the main reasons drivers exceed the speed limit. They mostly suggest using punitive levers and more stringent law enforcement practices for speed management. Literature reviews also confirm that to successfully develop an effective speed management plan a set of measures should be implemented together, including road safety engineering, raising awareness, social marketing strategies, and finally strict law enforcement. The overriding findings of the formative research revealed that to persuade Iranian drivers to respect the speed limit, the messages of the campaign should focus on strict law enforcement in the selected corridors.

CONCLUSIONS

In the minds of the Iranian audience, strict law enforcement is of paramount importance for a speed management strategy to work; hence it should be taken into consideration when tailoring the campaign messages. From the findings of the present study, it can be concluded that to manage speed on intercity routes in Iran, a social marketing campaign is needed to encourage compliance with speed limits.

The Prevalence of Several Risky Driving Behaviors and Associated Crash Risk in Adolescent: A Population-Based Study of Tuscany Region

Objectives: To evaluate the prevalence of numerous risky driving behaviors (RDBs) and the associated risk of road traffic accidents (RTA) in a population-based sample of adolescent drivers (14–19 years) of Tuscany, Italy.

Methods: The frequency of participation -by age and sex- often RDBs were investigated: Multivariable analyses were performed to evaluate the association between RDBs and the risk of RTA and severe RTA.

Results: 2,737 adolescents were included in the study. Talking to passenger(s), listening to loud music, speeding, and texting showed the highest weekly participation rates. For all the considered RDBs, the frequency of participation significantly increased with age. Males reported a significantly higher participation in speeding, DUI of alcohol or drugs; while females reported listening to loud music and talking to passenger(s) more frequently. All the considered RDBs were significantly associated with the risk of RTA and severe RTA.

Conclusion: The prevalence of RDBs and the associated risk of RTA largely varied in adolescents. Findings provide evidence for tailoring prevention interventions and suggest the need to include common- but traditionally overlooked- RDBs in road safety campaigns.

Passenger Presence and the Relative Risk of Teen Driver Death

PURPOSE

This study examines the relative risk of death among crash-involved teenage drivers in relation to the number and ages of passengers present.

METHODS

We performed cross-sectional analysis of police-reported crashes in the United States in years 2016-2019 to estimate rate ratios for death among drivers aged 16-17 years by passenger composition (no passengers, one teen, ≥two teens, teens and adults aged 20-34 years, adults aged 20-34 years only, ≥one adult aged 35-64 years). Models were adjusted for confounding and effect modification related to driver, crash, and environmental factors.

RESULTS

Crash-involved teen drivers carrying ≥2 teen passengers were twice as likely to die as teens driving alone. The driver was seven times as likely to die when carrying a mix of teen and young adult passengers compared with teens driving alone. Teen drivers' risk of death was lowest in the presence of an adult passenger aged 35-64 years. Carrying one teen passenger presents greater risk of death than driving alone for male teen drivers but not for females.

DISCUSSION

When teen drivers crash, they are more likely to die if they are carrying teen and/or young adult passengers than if they are driving alone or with a mature adult. The results support the current graduated licensing policies restricting young novice drivers from carrying teenage passengers. Results also help to clarify why previous studies have found that young passengers are associated with increased risk of fatal crashes, but not nonfatal crashes: it appears that passengers may have an effect on crash severity.

Taking Care of Friends: The Implementation Evaluation of a Peer-Focused School Program Using First Aid to Reduce Adolescent Risk-Taking and Injury

Injury is a leading cause of adolescent deaths, with risk-taking associated with a sizeable proportion of injuries and many of those risks undertaken in the presence of peers or with peers’ knowledge. Novel ways to promote safety are required and using the peer-relationship may be an important mechanism for prevention. This study reports on the implementation evaluation of the Skills for Preventing Injury in Youth (SPIY) program. SPIY is a high-school program designed to reduce injury by encouraging peers to look out for one another and prevent risk-taking, complemented by developing peer helping and first aid skills as well as school connectedness. 152 students and 12 teachers who delivered SPIY participated in separate 30 min focus groups and reported on students’ understanding of peer protective behaviour and the program implementation (adherence, dose, quality of program delivery, and participant responsiveness). Students reported on many approaches to protecting friends and both students and teachers reported they found the program interesting, interactive, and able to be delivered. Peer protection messages were relevant and acceptable to teachers and students in a risk-taking harm reduction program to reduce adolescent injury.

Oral Health Implications of Risky Behaviors in Adolescence

Adolescence is a time for new discoveries, which may lead teens to engage in impulsive behaviors. Although social media and the Internet have brought great benefits to the world, they can also have a negative influence on adolescents, facilitating their engagement in risky behaviors. Positive parenting and healthy friendships in adolescence have a protective effect against sensation-seeking behaviors. Dental practitioners also have a significant role in steering young patients toward healthy behaviors. They play an essential role in the early recognition, initiation of appropriate interventions, and referrals for treatment of youth at risk.

Identifying modifiable factors related to novice adolescent driver fault in motor vehicle collisions

OBJECTIVE

Novice adolescent drivers have a higher propensity to engage in risky driving and are at higher odds of being involved in collisions. Graduated driver licensing programs have been instituted to help novice drivers gain experience while avoiding higher risk driving circumstances. This study examines modifiable risk factors contributing to novice adolescent driver fault in collisions.

METHODS

Police traffic collision report data from municipalities in Alberta for the years 2010-2016, inclusive, were used. Fault in collision was assigned using an automated and previously validated tool for assigning culpability. Factors contributing to novice adolescent (16-19 years of age) fault in collision were examined using multivariable logistic regression.

RESULTS

Novice adolescent drivers had higher adjusted odds ratios (aOR) of being at-fault in collision when driving from 01:00-05:00 (aOR = 1.38; 95% Confidence Interval [CI]: 1.26-1.50). Novice adolescent drivers had lower odds of fault when driving with an adult (aOR= 0.62; 95% CI: 0.57-0.68) or a single peer (aOR= 0.87; 95% CI: 0.80-0.94), but higher odds of causing a severe collision with a single peer present (aOR= 2.23; 95% CI: 1.21-4.11). Impairment of the teen driver was reported in 25% of all fatal collisions, and 40% of late-night fatal collisions.

CONCLUSIONS

The findings support policies that allow driving with a single adult or peer passenger during daytime hours. Driving during late-night hours should be restricted for novice adolescent drivers.

Driving contradictions: behaviors and attitudes regarding handheld and hands-free cellphone use while driving among young drivers

Background

Cellphone use while driving (CUWD) is a frequent source of distraction for young drivers. These distractions commonly lead to motor vehicle crashes and, in some cases, death. Crash risk differs depending on if the driver is engaging in handheld or hands-free CUWD. This pilot study sought to investigate the differences between handheld versus hands-free CUWD behaviors in younger drivers and the attitudes and social norms that inform them.

Methods

Young drivers (mean age: 19.6 years, standard deviation: 0.8 years) were recruited from a large Midwestern city in the United States as part of a pilot study. The 62 enrolled drivers (51 females, 43 non-Hispanic white) completed an online survey measuring behavioral frequencies, attitudes, and social norms regarding talking on the phone, sending messages, and reading messages. These cross-sectional data were then categorized and used for a descriptive analysis.

Results

The majority of young drivers reported participating in some form of handheld CUWD, with reading messages being the most popular (95%). Only 43% of participants used hands-free technology for sending messages and 30% for reading messages, while half reported not using the technology at all. Whereas handheld messaging behaviors were viewed negatively by the participants, they were unsure of the impact on their driving ability and the legality surrounding hands-free messaging behaviors.

Conclusions

Handheld CUWD behaviors were more popular among young drivers compared to hands-free CUWD. Further, even though young drivers understood handheld cellphone use while driving is unsafe, they engaged in it anyway. The findings of this pilot study highlight the importance of better educational initiatives and optimizing hands-free interventions for young driver use cases.

Associations Between Graduated Driver Licensing Restrictions and Delay in Driving Licensure Among U.S. High School Students

INTRODUCTION

Some of the most vulnerable groups of teens choose to delay driving licensure (DDL). We assessed longitudinal associations between state-level Graduated Driver Licensing (GDL) restrictions and DDL among U.S. high school students.

METHODS

Data from seven waves of the NEXT Generation Health Study (starting 10th-grade (2009-2010)), were analyzed in 2020 using Poisson regression. The outcome was DDL (delay vs. no-delay). Independent variables were driving restrictions (at learner and intermediate phases of licensure), sex, race/ethnicity, family affluence, parent education, family structure, and urbanicity.

RESULTS

Of 2525 eligible for licensure, 887 (38.9%), 1078 (30.4%), 560 (30.7%) reported DDL 1-2 years, >2 years, no DDL, respectively. Interactions between GDL restrictions during the learner permit period and covariates were found. In states requiring ≥30 hours of supervised practice driving, Latinos (Adjusted relative risk ratio [aRRR]=1.55, p<.001) and Blacks (aRRR=1.38, p<.01) were more likely to DDL than Whites. In states where permit holding periods were <6 months, participants with low (aRRR=1.61, p<.001) and moderate (aRRR=1.45, p<.001) vs. high affluence were more likely to DDL. Participants in single-parent households vs. both-biological parent households were also more likely to DDL (aRRR=1.37, p<.05). In states where permit holding periods were ≥6 months, participants with low (aRRR=1.33, p<.05) vs. high affluence were more likely to DDL. In states that allowed ≥3 passengers or no passenger restriction, participants living in non-urban vs. urban (aRRR=1.52, p<.05) areas were more likely to DDL, and in states that allowed only 1 or no passenger, participants living in non-urban vs. urban areas (aRRR=0.67, p<.001) were less likely to DDL.

CONCLUSIONS

Our findings heighten concerns about increased crash risk among older teens who age out of state GDL policies thereby circumventing driver safety related restrictions. Significant disparities in DDL exist among more vulnerable teens in states with stricter GDL driving restrictions.

Self-regulation differences across learner and probationary drivers: The impact on risky driving behaviours

Risky driving behaviours are a known contributor to young drivers' overrepresentation in road trauma, with self-regulation suggested as an important associated construct, but yet to be extensively explored. The aims of this study were to examine the utility of self-determination theory in explaining risky driving behaviours and to explore differences between young Learner and Provisional (P1)- licensed drivers in regard to their self-regulated safety orientation and engagement in risky driving behaviours. Learners (n = 1038) and P1(n = 589) drivers, aged 16-19 years, responded to a 91-item online survey, including self-regulated safety orientation items adapted from self-determination theory and inattentive and intentional risky driving behaviour items. Results showed that self-determination theory had good predictive power for the two types of risky driving behaviours for both licence groups. Learner and P1 drivers' engagement in risky behaviours was similar, however, the relative importance of self-regulated safety orientation elements to reduced engagement in these behaviours differed. Learners' engagement in intentional risky behaviours reflected greater perceived effort/importance and pressure/tension compared to P1 drivers. Greater effort/importance is an overarching indicator of internalised regulation concerning safe driving behaviours, which might be primed when first exposed to driving. However, greater perceived pressure/tension suggests that internalisation of self-regulatory processes is being suppressed during the Learner phase. This might stem from the required presence of driver trainers and supervisory drivers, as well as interactions with other road users. Whilst only tentative explanations in this first exploration, the findings suggest there is potential for greater efforts in Learner driver training and supervision to encompass the types of skills and learning that encourage the development of self-regulation to reduce risky driving behaviours during both the Learner and P1 stage. These findings contribute to the limited research regarding self-regulation by young novice drivers and informs a better understanding of the psychological influences of engagement in risky driving behaviours, including the first such examination among early independent licensed drivers.

Autopsy findings in drivers and passengers from fatal motor vehicle collisions: limited differences in injury patterns and toxicological test results

We performed a retrospective study of the injuries and characteristics of occupant fatalities in motor vehicle collisions in southeast Norway. The goal was to provide updated knowledge of injuries sustained in modern vehicles and detect possible differences in injury pattern between drivers and passengers. Forensic autopsy reports, police, and collision investigation reports from 2000 to 2014 were studied, data extracted and analyzed.

A total of 284 drivers, 80 front-seat passengers, and 37 rear-seat passengers were included, of which 67.3% died in front collisions, 13.7% in near-side impacts, 13.5% in rollovers and 5.5% in other/combined collisions. Overall, 80.5% died within one hour after the crash. The presence of fatal injuries to the head, neck, thorax and abdomen were observed in 63.6%, 10.7%, 61.6% and 27.4% respectively. All occupants with severe injuries to the head or neck had signs of direct impact with contact point injuries to the skin or skull. Injuries to the heart and spleen were less common in front-seat passengers compared to drivers. Seat belt abrasions were more common and lower extremity fractures less common in both front-seat and rear-seat passengers compared to drivers. Blood alcohol and/or drug concentrations suggestive of impairment were present in 30% of all occupants, with alcohol more often detected among front-seat passengers compared to drivers.

Few driver-specific and passenger-specific patterns of injury could be identified. When attempting to assess an occupant’s seating position within a vehicle, autopsy findings should be interpreted with caution and only in conjunction with documentation from the crash scene.

Advancing our understanding of cognitive development and motor vehicle crash risk: A multiverse representation analysis

Neurobiological and cognitive maturational models are the dominant theoretical account of adolescents' risk-taking behavior. Both the protracted development of working memory (WM) through adolescence, as well as individual differences in WM capacity have been theorized to be related to risk-taking behavior, including reckless driving. In a cohort study of 84 adolescent drivers Walshe et al. (2019) found adolescents who crashed had an attenuated trajectory of WM growth compared to adolescent drivers who never reported being in a crash, but observed no difference in WM capacity at baseline. The objectives of this report were to attempt to replicate these associations and to evaluate their robustness using a hybrid multiverse - specification curve analysis approach, henceforth called multiverse representation analysis (MRA). The authors of the original report provided their data: 84 adolescent drivers with annual evaluations of WM and other risk factors from 2005 to 2013, and of driving experiences in 2015. The original analysis was implemented as described in the original report. An MRA approach was used to evaluate the robustness of the association between developmental trajectories of WM and adolescents' risk-taking (indexed by motor vehicle crash involvement) to different reasonable methodological choices. We enumerated 6 reasonable choice points in data processing-analysis configurations: (1) model type: latent growth or multi-level regression, (2) treatment of WM data; (3) which waves are included; (4) covariate treatment; (5) how time is coded; and (6) link function/estimation method: weighted least squares means and variance estimation (WLSMV) with a linear link versus logistic regression with maximum likelihood estimation. This multiverse consists of 96 latent growth models and 18 multi-level regression models.

Initial Testing of a Web-Based Intervention to Reduce Adolescent Driver Inattention: A Randomized Controlled Trial

INTRODUCTION

Motor vehicle crashes are the leading cause of adolescent death. Inattention to the roadway contributes to crash risk. The objective of this study was to deploy an initial study of a web-based intervention (Let's Choose Ourselves) designed to improve adolescent driver attention to the roadway.

METHODS

We used a randomized controlled trial design in a sample of adolescent drivers to test if a web-based intervention decreased cell phone engagement in driving simulation at 3 months as compared with controls. As secondary hypotheses, we tested if the intervention increased the use of peer passengers to manage distractions and decreased eyes off the forward roadway in driving simulation and decreased self-reported risky driving behaviors. Adolescents, aged 16-17 years, licensed for ≤90 days were randomized to Let's Choose Ourselves with distractions in the simulator protocol at baseline, Let's Choose Ourselves with no distractions, an attention control intervention on healthy eating with distractions, or attention control with no distractions. We used Poisson regression modeling to test the primary and secondary hypotheses.

RESULTS

The trial included 60 adolescents (66.7% female, 78.3% non-Hispanic white subjects, mean age 16.8 years, licensed 50.8 days). In Poisson regression, controlling for sex, we found no significant effects of Let's Choose Ourselves on primary or secondary outcomes. However, there was a significant effect of visit on self-report outcomes, with self-reported distracted driving behaviors increasing over time.

DISCUSSION

Although there were no significant effects of Let's Choose Ourselves, self-reported risky driving behaviors increased over time. Further investigation of the relationship between driving experience and increasing inattention to the road in adolescents is warranted.

The effect of extending graduated driver licensing to older novice drivers in Indiana

INTRODUCTION

Graduated driver licensing (GDL) systems have been shown to reduce rates of crashes, injuries, and deaths of young novice drivers. However, approximately one in three new drivers in the United States obtain their first driver's license at age 18 or older, and thus are exempt from most or all provisions of GDL in most states.

METHOD

In July 2015, the state of Indiana updated its GDL program, extending its restrictions on driving at night and on carrying passengers during the first 6 months of independent driving, previously only applicable to new drivers younger than 18, to all newly-licensed drivers younger than 21 years of age. The current study examined monthly rates of crashes per licensed driver under the affected conditions (driving at night and driving with passengers) among Indiana drivers first licensed at ages 18, 19, and 20 under the updated GDL system compared with drivers licensed at the same ages under the previous GDL system. We used Poisson regression to estimate the association between the GDL system and crash rates, while attempting to control for other factors that might have also influenced crash rates. We used linear regression to estimate the association between the GDL system and the proportion of all crashes that occurred under conditions restricted by the GDL program.

RESULTS

Results showed, contrary to expectations, that rates of crashes during restricted nighttime hours and with passengers were higher among drivers licensed under the updated GDL system. This mirrored a statewide increase in crash rates among drivers of all ages over the study period and likely reflected increased overall driving exposure. The proportions of all crashes that were at night or with passengers did not change. Practical Applications: More research is needed to understand how older novice drivers respond when GDL systems originally designed for younger novice drivers are applied to them.

Mobility management to prevent, reduce, or delay driving a car in teenagers

BACKGROUND

Rates of injury and death caused by car crashes with teenage drivers remain high in most high-income countries. In addition to injury and death, car use includes other non-traffic risks; these may be health-related, such as physical inactivity or respiratory disease caused by air pollution, or have global significance, such as the environmental impact of car use. Research demonstrates that reducing the amount of time driving reduces the risk of injury, and it is expected that it would also reduce other risks that are unrelated to traffic. Mobility management interventions aim to increase mobility awareness and encourage a shift from private car use to active (walking, cycling, skateboarding), and public (bus, tram, train), transportation. 'Soft' mobility management interventions include the application of strategies and policies to reduce travel demand and may be instigated locally or more widely, to target a specific or a non-specific population group; 'hard' mobility management interventions include changes to the built environment or transport infrastructure and are not the focus of this review. Between the ages of 15 to 19 years, young people enter a development stage known as the 'transition teens' in which they are likely to make long-lasting lifestyle changes. It is possible that using this specific time point to introduce mobility management interventions may influence a person's long-term mobility behaviour.

OBJECTIVES

To assess whether 'soft' mobility management interventions prevent, reduce, or delay car driving in teenagers aged 15 to 19 years, and to assess whether these mobility management interventions also reduce crashes caused by teenage drivers.

SEARCH METHODS

We searched the Cochrane Injuries Group Specialised Register, CENTRAL, MEDLINE, Embase, Web of Science, and Social Policy and Practice on 16 August 2019. We searched clinical trials registers, relevant conference proceedings, and online media sources of transport organisations, and conducted backward- and forward-citation searching of relevant articles.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) or controlled before-after studies (CBAs) evaluating mobility management interventions in teenagers aged 15 to 19 years. We included informational, educational, or behavioural interventions that aimed to prevent, reduce, or delay car driving in this age group, and we compared these interventions with no intervention or with standard practice. We excluded studies that evaluated graduated drivers licensing (GDL) programmes, separate components of GDL, or interventions that act in conjunction with, or as an extension of, GDL. Such programmes aim to increase driving experience and skills through stages of supervised and unsupervised exposure, but assume that all participants will drive; they do not attempt to encourage people to drive less in the long term or promote alternatives to driving. We also excluded studies which evaluated school-based safe-driving initiatives.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed studies for inclusion, extracted data, and assessed risks of bias. We assessed the certainty of evidence with GRADE.

MAIN RESULTS

We included one RCT with 178 participants and one CBA with 860 participants. The RCT allocated university students, with a mean age of 18 years, who had not yet acquired a driving licence, to one of four interventions that provided educational information about negative aspects of car use, or to a fifth group in which no information was given. Types of educational information about car use related to cost, risk, or stress, or all three types of educational information combined. In the CBA, 860 school students, aged 17 to 18 years taking a driving theory course, had an additional interactive lesson about active transport (walking or cycling), and some were invited to join a relevant Facebook group with posts targeting awareness and habit. We did not conduct meta-analyses because we had insufficient studies. We could not be certain whether educational interventions versus no information affected people's decision to obtain a driving licence 18 months after receiving the intervention (risk ratio 0.62, 95% confidence interval 0.45 to 0.85; very low-certainty evidence). We noted that fewer participants who were given information obtained a driving licence (42.6%) compared to those who did not receive information (69%), but we had very little confidence in the effect estimate; the study had high or unclear risks of bias and the evidence was from one small study and was therefore imprecise. We could not be certain whether interventions about active transport, given during a driving theory course, could influence behavioural predictors of car use. Study authors noted: - an increased intention to use active transport after obtaining a driving licence between postintervention and an eight-week follow-up in students who were given an active transport lesson and a Facebook invitation compared to those given only the active transport lesson; and - a decrease in intention between pre- and postintervention in those given an active transport lesson and Facebook invitation compared to those given the active transport lesson only. There were high risks of bias in this CBA study design, a large amount of missing data (very few participants accepted the Facebook invitation), and data came from a single study only, so we judged the evidence to be of very low certainty. These studies did not measure our primary outcome (driving frequency), or other secondary outcomes (driving distance, driving hours, use of alternative modes of transport, or car crashes).

AUTHORS' CONCLUSIONS

We found only two small studies, and could not determine whether mobility management interventions were effective to prevent, reduce, or delay car driving in teenagers. The lack of evidence in this review raises two points. First, more foundational research is needed to discover how and why young people make decisions surrounding their personal transport, in order to find out what might encourage them to delay licensing and driving. Second, we need longitudinal studies with a robust study design - such as RCTs - and with large sample sizes that incorporate different socioeconomic groups in order to evaluate the feasibility and effectiveness of relevant interventions. Ideally, evaluations will include an assessment of how attitudes and beliefs evolve in teenagers during these transition years, and the potential effect of these on the design of a mobility management intervention for this age group.

Socio-Demographic Determinants of Road Traffic Fatalities in Women of Reproductive Age in the Republic of Georgia: Evidence from the National Reproductive Age Mortality Study (2014)

Purpose

Globally and in the European region, the road traffic injuries (RTI) have emerged as a major public health and development problem, killing the most productive adult members of a population, including women. This study aimed to identify the key socio-demographic determinants of premature and avoidable RTI mortality in reproductive-aged women (15–49 years) in Georgia.

Materials and Methods

The study employed verbal autopsy data from the second national reproductive age mortality survey (RAMOS 2014). Univariate and multivariate logistic regression models were fitted using the Firth method to assess the crude and adjusted effects of each individual level socio-demographic factor on the odds of RTI-attributed death, with corresponding 95% confidence intervals (COR and AOR, 95% CI).

Results

Of 843 women aged 15–49 years, 78 (9.3%) were the victims of fatal traffic crashes. After multivariate adjustment, the odds of dying from RTI were significantly higher in women aged 15–29 years (AOR=7.73, 95% CI= 4.20 to 14.20), those being employed (AOR=2.11, 95% CI= 1.22 to 3.64) and the wealthiest (AOR=2.88, 95% CI= 1.44 to 5.77) compared, respectively, to their oldest (40–49 years), unemployed and poorest counterparts. Conversely, there were no statistically significant ethnic, marital, rural/urban, and educational disparities in women’s RTI fatalities. Overall, motorized four-wheeler occupants (78.2%), particularly passengers (71.8%), appeared to be the most common victims of fatal road injuries than pedestrians (20.5%). Alarmingly, the vast majority (85.9%) of any type of road users died instantly at the scene of collision, as compared to deaths en route to hospital (1.3%) or in hospital (11.5%).

Conclusion

Age, employment, and wealth status appeared to be the strong independent predictors of young women’s RTI mortality in Georgia. Future comprehensive research would be advantageous for further deciphering the differential impact of social determinants on traffic-induced fatalities, as a vital platform for evidence-based remedial actions on this predictable and preventable safety hazard.

Use of theory to guide development and application of sensor technologies in Nursing

Sensor technologies for health care, research, and consumers have expanded and evolved rapidly. Many technologies developed in commercial or engineering spaces, lack theoretical grounding and scientific evidence to support their need, safety, and efficacy. Theory is a mechanism for synthesizing and guiding knowledge generation for the discipline of nursing, including the design, implementation, and evaluation of sensors and related technologies such as artificial intelligence and machine learning. In this paper, three nurse scientists summarize their presentations at the Council for the Advancement of Nursing Science 2019 Advanced Methods Conference on Expanding Science of Sensor Technology in Research discussing the theoretical underpinnings of sensor technologies development and use in nursing research and practice. Multiple theories with diverse epistemological roots guide decision-making about whether or not to apply sensors to a given use; development of, components of, and mechanisms by which sensor technologies are expected to work; and possible outcomes.

Crash rates over time among younger and older drivers in the SHRP 2 naturalistic driving study

OBJECTIVE

To examine crash rates over time among 16-17-year-old drivers compared to older drivers.

METHODS

Data were from a random sample of 854 of the 3,500 study participants in SHRP 2, a U.S. national, naturalistic driving (instrumented vehicle) study. Crashes/10,000 miles by driver age group, 3-month period, and sex were examined within generalized linear mixed models.

RESULTS

Analyses of individual differences between age cohorts indicated higher incidence rates in the 16-17-year old cohort relative to older age groups each of the first four quarters (except the first quarter compared to 18-20 year old drivers) with incident rate ratios (IRR) ranging from 1.98 to 18.90, and for the full study period compared with drivers 18-20 (IRR = 1.69, CI = 1.00, 2.86), 21 to 25 (IRR = 2.27, CI = 1.31, 3.91), and 35 to 55 (IRR = 4.00, CI = 2.28, 7.03). Within the 16-17-year old cohort no differences were found in rates among males and females and the decline in rates over the 24-month study period was not significant.

CONCLUSIONS

The prolonged period of elevated crash rates suggests the need to enhance novice young driver prevention approaches such as Graduated Driver's Licensing limits, parent restrictions, and post-licensure supervision and monitoring. Practical Applications: Increases are needed in Graduated Driver's Licensing limits, parent restrictions, and postlicensure supervision and monitoring.

Driving distracted with friends: Effect of passengers and driver distraction on young drivers' behavior

Both passengers and driver distraction can have negative effects on young driver behavior. However, it is not known how these two concepts interact to influence driver behavior. The objective of this study was to examine the effect of passenger presence and driver distraction on young drivers' behavior. Forty-eight participants aged 18-20 participated in a driving simulator study. Participants completed three distracting tasks (visual, cognitive, or combined) while navigating a highway scenario. Results indicated that passenger presence interacted with driver distraction to have an effect on elevated g-force events in curves. Separately, distraction affected driving performance differently according to whether the task was visual, cognitive or combined. Having a close friendship resulted in less speeding and male drivers tended to maintain a better lane position compared to females. The results have implications for licensing laws as well as intervention programs aimed at improving young driver behavior.

Drivers with child passengers: distracted but cautious?

OBJECTIVE

A remarkable portion of children's traffic-related deaths occurred when travelling in as passengers in vehicles, but so far, few studies have focused on crash characteristics and crash risks of drivers with child passengers. It has been assumed that drivers with child passengers drive responsibly, but on the contrary, children in vehicles can distract drivers, increasing crash risks. In this study, we examined fatal crash characteristics and fatal crash risks of drivers with child passengers.

METHODS

Fatal crash data from the U.S. Fatality Analysis Reporting System (FARS) for 1996-2015 were used. Only passenger-vehicle drivers aged 23-46 years old were included in the analysis because they represent the typical age of drivers with 0-9-year-old child passengers in the database. Prevalence of crash characteristics and the odds of being at fault were examined for drivers with only child passengers and compared to drivers with only adult passengers, with no passengers and with both adult and child passengers. Analyses were done separately for intersection crashes and non-junction crashes.

RESULTS

Female drivers were involved in twice as many fatal crashes alone with child passengers compared to male drivers. Drivers with only child passengers were more often reported as being inattentive, but for them, risk-taking behaviours were less typical than for drivers without child passengers. Our results showed that these differences were more evident in non-junction crashes than in intersection crashes. When risk-taking behaviours were controlled, both male and female drivers with only child passengers had higher odds of being at fault than drivers with adult passengers (with or without children) in non-junction crashes, but these differences were not significant in intersection crashes.

CONCLUSIONS

Drivers with child passengers represent a specific driver population. They have a higher tendency to engage in distractions while driving, but they have fewer risk-taking behaviour-related fatal crashes compared to drivers with no child passengers. Our results indicate that the effects of child-passenger-related distractions on fatal crash risks are more relevant outside intersections, presumably because drivers may try to self-regulate their interactions with child passengers and focus on driving in more demanding traffic situations.

Efficacy of intervention at traffic schools reducing impulsive action, and association with candidate gene variants

OBJECTIVE

Road traffic injuries are the leading cause of death among young people. Recognition of the contribution of impulsive behaviour may help novice drivers to behave more safely. Previously a brief intervention focusing on impulsive traffic behaviour conducted by psychologists in driving schools had been effective. The aim of this study was an independent re-evaluation of the effect of the intervention, as conducted by driving school teachers, and assessment of the potential associations with candidate genotypes.

METHODS

Driving school students (mean age 22.5, SD=7.9) were divided into intervention (n=704) and control (n=737) groups. Driving school teachers were trained to administer the intervention which consisted of a lecture and group work (1.5 h in total) on impulsivity. Traffic offences and crashes were monitored during 3 years, using police and traffic insurance fund databases. Functional polymorphisms of the dopamine transporter (DAT) and serotonin transporter genes (DAT1 VNTR and 5-HTTLPR) were assessed.

RESULTS

The intervention significantly lowered general traffic risk and prevalence of traffic accidents. DAT1 VNTR 9R carriers, particularly males, had higher general traffic risk in the whole sample. Female 5-HTTLPR s' allele carriers of the intervention group had the lowest general traffic risk. Intervention was most effective in female DAT1 VNTR 10R/10R homozygotes.

CONCLUSIONS

Brief impulsivity-centred intervention appears as a promising strategy for preventing risk-taking behaviour in novice drivers and can be fully integrated to driving school curriculum.

The Effect of Teenage Passengers on Simulated Risky Driving Among Teenagers: A Randomized Trial

Teenage passengers might influence risky driving, particularly in certain mental states. Notably, social exclusion could increase social conformity. Two studies examined simulated intersection management among young drivers after a social exclusion activity (Cyberball). In Study 1 [112 males (mean = 17.3 years)], risky driving was significantly greater among excluded males driving with a risk-accepting vs. passive passenger; no effect of social exclusion. In Study 2 [115 females (mean = 17.1 years)], risky driving was significantly greater among excluded females driving with a risk-accepting vs. a passive passenger, and greater among those included (fair play) vs. excluded when driving with a risk-accepting passenger. Risky driving behavior among male and female teenagers may be influenced uniquely by passenger norms and social exclusion.

Factors Associated With Unrestrained Young Passengers in Motor Vehicle Crashes

: media-1vid110.1542/5984244682001PEDS-VA_2018-2507Video Abstract BACKGROUND AND OBJECTIVE: Unrestrained child passengers are at significant risk of crash-related injury. Previous researchers using nationally representative crash data from 1992 to 1993 found an association between driver and passenger safety-belt use. Our objective in this study is to investigate factors associated with young, unrestrained passengers in fatal and nonfatal motor vehicle crashes using updated national crash data.

METHODS

We analyzed 2011-2015 Fatality Analysis Reporting System and National Automotive Sampling System data and included vehicles with a young passenger (≤19 years old) in a crash. Driver and passenger characteristics were compared by using bivariate analyses separately for fatal and nonfatal crashes. Logistic regression analyses were performed on a combined data set to predict passenger restraint use.

RESULTS

In unadjusted bivariate models, unrestrained drivers had a higher probability of having an unrestrained passenger across all passenger age groups for both fatal and nonfatal crashes. In multivariate logistic regression models that included both fatal and nonfatal crashes and were adjusted for several driver and passenger characteristics, unrestrained drivers had a higher risk of having an unrestrained young passenger across all age groups.

CONCLUSIONS

In both fatal and nonfatal crashes, a driver being unrestrained is a strong predictor of the child passenger also being unrestrained. Policy and regulation to better ensure that drivers are properly restrained (eg, expanding primary seat-belt laws to all states) may serve as effective means for increasing rates of proper child-occupant-restraint use.

Technology-Based Interventions, Assessments, and Solutions for Safe Driving Training for Adolescents: Rapid Review

BACKGROUND

Safe driving training for adolescents aims to prevent injury and promote their well-being. In that regard, information and communication technologies have been used to understand adolescent driving behavior and develop interventions.

OBJECTIVE

The purpose of this review is to explore and discuss existing approaches to technology-based driving interventions, driving assessments, and solutions in the literature.

METHODS

We searched the Web of Science and PubMed databases following a review protocol to collect relevant peer-reviewed journal articles. Inclusion criteria were (1) being published in the English language, (2) being published in a peer-reviewed journal, (3) testing the driving behavior of teens with technology-based intervention methods, and (4) being published between January 2000 and March 2018. We appraised the articles by reading their abstracts to select studies matching the inclusion criteria and reading the full text of articles for final refinement.

RESULTS

Initial keyword searches on technology-based solutions resulted in 828 publications that we refined further by title screening (n=131) and abstract evaluation against inclusion criteria (n=29). Finally, we selected 16 articles that met the inclusion criteria and examined them regarding the use of technology-based interventions, assessments, and solutions. Use of built-in tracking devices and installation of black box devices were widely used methods for capturing driving events. Smartphones were increasingly adapted for data collection, and use of gamification for intervention design was an emerging concept. Visual and audio feedback also were used for intervention.

CONCLUSIONS

Our findings suggest that social influence is effective in technology-based interventions; parental involvement for promoting safe driving behavior is highly effective. However, the use of smartphones and gamification needs more study regarding their implementation and sustainability. Further developments in technology for predicting teen behavior and programs for behavioral change are needed.

Characteristics of Single Vehicle Crashes with a Teen Driver in South Carolina, 2005-2008

OBJECTIVE

Teens' crash risk is highest in the first years of independent driving. Circumstances surrounding fatal crashes have been widely documented, but less is known about factors related to nonfatal teen driver crashes. This study describes single vehicle nonfatal crashes involving the youngest teen drivers (15-17 years), compares these crashes to single vehicle nonfatal crashes among adult drivers (35-44 years) and examines factors related to nonfatal injury producing crashes for teen drivers.

METHODS

Police crash data linked to hospital inpatient and emergency department data for 2005-2008 from the South Carolina Crash Outcomes Data Evaluation System (CODES) were analyzed. Nonfatal, single vehicle crashes involving passenger vehicles occurring on public roadways for teen (15-17 years) drivers were compared with those for adult (35-44 years) drivers on temporal patterns and crash risk factors per licensed driver and per vehicle miles traveled. Vehicle miles traveled by age group was estimated using data from the 2009 National Household Travel Survey. Multivariable log-linear regression analysis was conducted for teen driver crashes to determine which characteristics were related to crashes resulting in a minor/moderate injury or serious injury to at least one vehicle occupant.

RESULTS

Compared with adult drivers, teen drivers in South Carolina had 2.5 times the single vehicle nonfatal crash rate per licensed driver and 11 times the rate per vehicle mile traveled. Teen drivers were nearly twice as likely to be speeding at the time of the crash compared with adult drivers. Teen driver crashes per licensed driver were highest during the afternoon hours of 3:00-5:59 pm and crashes per mile driven were highest during the nighttime hours of 9:00-11:59 pm. In 66% of the teen driver crashes, the driver was the only occupant. Crashes were twice as likely to result in serious injury when teen passengers were present than when the teen driver was alone. When teen drivers crashed while transporting teen passengers, the passengers were >5 times more likely to all be restrained if the teen driver was restrained. Crashes in which the teen driver was unrestrained were 80% more likely to result in minor/moderate injury and 6 times more likely to result in serious injury compared with crashes in which the teen driver was restrained.

CONCLUSIONS

Despite the reductions in teen driver crashes associated with Graduated Driver Licensing (GDL), South Carolina's teen driver crash rates remain substantially higher than those for adult drivers. Established risk factors for fatal teen driver crashes, including restraint nonuse, transporting teen passengers, and speeding also increase the risk of nonfatal injury in single vehicle crashes. As South Carolina examines strategies to further reduce teen driver crashes and associated injuries, the state could consider updating its GDL passenger restriction to either none or one passenger <21years and dropping the passenger restriction exemption for trips to and from school. Surveillance systems such as CODES that link crash data with health outcome data provide needed information to more fully understand the circumstances and consequences of teen driver nonfatal crashes and evaluate the effectiveness of strategies to improve teen driver safety.

Situational influences on response time and maneuver choice: Development of time-critical scenarios

Findings concerning drivers' response times to sudden events vary considerably across studies due to different experimental setups and situational characteristics, such as expectancy of an event and urgency to react. While response times are widely reported in the literature, understanding of drivers' choice of maneuvers in time-critical situations is limited. Standardized test scenarios could enhance the comparability of studies and help in attaining a better understanding of driver behavior in these situations. In an effort to achieve these improvements, three driving simulator studies (N = 131) were conducted to investigate drivers' response time and maneuver choice under a range of situational conditions. Each study took place in a specific environmental setting (urban, rural, and highway) and incorporated one unexpected and 12 subsequent events (increased expectancy). Four different time-critical scenarios were used to evoke different driver responses. In three scenarios, obstacles suddenly entered the roadway (braking, steering, or both possible). A fourth scenario comprised the sudden braking of a leading vehicle (only braking possible). Half of the drivers performed a cognitive secondary task. To validate the findings, results from an additional field test (N = 14) were compared to the results from the simulated urban environment. As expected, response choice was influenced by scenario characteristics (available braking distance and room for evasive maneuvers). Braking maneuvers were more frequent in settings with lower speed limits (urban) while steering maneuvers were found at higher speed limits (highway). Responses to suddenly appearing obstacles were fastest in the urban setting at 540-680 ms; these responses were 200-300 ms slower in the rural and highway settings. Response times increased by 100-200 ms when drivers responded to braking leading vehicles rather than obstacles. Braking responses were 200-350 ms slower and steering responses were 90-200 ms slower when drivers responded to an unexpected event rather than subsequent events. The cognitive secondary task had no significant effect. The simulated environment and the field test produced comparable response behavior. The current study provides reference numbers that help to establish a set of standardized test scenarios for future studies. On basis of this study, nine scenarios are recommended for the context of time-critical crash avoidance maneuvers. Such standardized test scenarios could improve the comparability of future studies on response time and maneuver choice.

The Teen Driver

For many teenagers, obtaining a driver's license is a rite of passage, conferring the ability to independently travel to school, work, or social events. However, immaturity, inexperience, and risky behavior put newly licensed teen drivers at risk. Motor vehicle crashes are the most common cause of mortality and injury for adolescents and young adults in developed countries. Teen drivers (15-19 years of age) have the highest rate of motor vehicle crashes among all age groups in the United States and contribute disproportionately to traffic fatalities. In addition to the deaths of teen drivers, more than half of 8- to 17-year-old children who die in car crashes are killed as passengers of drivers younger than 20 years of age. This policy statement, in which we update the previous 2006 iteration of this policy statement, is used to reflect new research on the risks faced by teen drivers and offer advice for pediatricians counseling teen drivers and their families.

Vehicle ownership and other predictors of teenagers risky driving behavior: Evidence from a naturalistic driving study

OBJECTIVE

Risky driving behavior may contribute to the high crash risk among teenage drivers. The current naturalistic driving study assessed predictors for teenagers' kinematic risky driving (KRD) behavior and the interdependencies between them.

METHOD

The private vehicles of 81 novice teenage drivers were equipped with data acquisition system that recorded driving kinematics, miles driven, and video recordings of the driver, passengers and the driving environment. Psychosocial measures were collected using questionnaires administered at licensure. Poisson regression analyses and model selection were used to assess factors associated with teens' risky driving behavior and the interactions between them.

RESULTS

Driving own vs shared vehicle, driving during the day vs at night, and driving alone vs with passengers were significantly associated with higher KRD rates (Incidence rate ratios (IRRs) of 1.60, 1.41, and 1.28, respectively). Teenagers reporting higher vs lower levels of parental trust had significantly lower KRD rates (IRR = 0.58). KRD rates were 88% higher among teenagers driving with a passenger in their own vehicle compared to teenagers driving with a passenger in a shared vehicle. Similarly, KRD rates during the day were 74% higher among teenagers driving their own vehicle compared to those driving a shared vehicle.

CONCLUSIONS

Novice teenagers' risky driving behavior varied according to driver attributes and contextual aspects of the driving environment. As such, examining teenagers' risky driving behavior should take into account multiple contributing factors and their interactions. The variability in risky driving according to the driving context can inform the development of targeted interventions to reduce the crash risk of novice teenage drivers.

Why do drivers become safer over the first three months of driving? A longitudinal qualitative study

Drivers are at high crash risk when they begin independent driving, with liability decreasing steeply over the first three months. Their behavioural development, and other changes underlying improved safety are not well understood. We adopted an innovative longitudinal qualitative design, with thirteen newly qualified drivers completing a total of 36 semi-structured interviews, one, two and three months after acquiring a full UK driving license. The interviews probed high-risk factors for new drivers, as well as allowing space for generating novel road safety issues. Analysis adopted a dual deductive and inductive interpretative thematic approach, identifying three super-ordinate themes: (1) Improvements in car control skills and situation awareness; (2) A reduction in the thrill of taking risks when driving against a background of generally increasing driving speed; (3) Early concerns about their social status in the eyes of other road users during the early stages of driving, which may put pressure on them to drive faster than they felt comfortable with. The study provides important new leads towards understanding how novice driving becomes safer over the first few months of driving, including how well-studied concepts of driving skill and style may change during development of independent driving, and bringing the less rigorously studied concept of social status into focus.

Risky driving and the persistent effect of a randomized intervention focusing on impulsivity: The role of the serotonin transporter promoter polymorphism

Road traffic accidents are a serious public health issue, and real-life traffic offences are an excellent indicator of the behavioural tendencies of impulsivity and risk-taking. We have previously reported on short-term efficacy of a brief intervention in driving schools to reduce traffic risks (Paaver et al., Accid. Anal. Prev., 2013; 50, 430-437), and have now addressed the question of whether does the impact of the intervention last for a few years, and whether traffic behaviour and the intervention effect are associated with the serotonin transporter polymorphism (5-HTTLPR) genotype as the central serotonin system is strongly associated with impulse control. Participants of the study were 1866 novice car-drivers (mean age 23.0, SD = 7.2 years). Data on traffic violations were obtained four years after intervention from the police database and on traffic collisions from the national traffic insurance database. DNA samples were available for 767 participants and 5-HTTLPR genotypes were classified using the triallelic model. For the observation period after the intervention, speeding, drunk driving and involvement in traffic accidents were significantly lower in the intervention group. 5-HTTLPR genotype was associated with traffic behaviour: The S'-allele carriers had significantly lower odds for speeding offences and traffic accidents. The lower prevalence of S'-allele carriers among those who had committed speeding offences was statistically significant in females, while the lower prevalence of having been involved in a traffic accident was rather observed in males. Statistically significant intervention effects were observed only in the L'/L' homozygotes who had higher prevalence of traffic incidents. Conclusively, the brief intervention in traffic schools had a significant impact on traffic safety within subsequent four years, and traffic behaviour was associated with the serotonin transporter genotype. These findings suggest that subjects who are less likely to self-regulate their driving habits while gaining experience would benefit from training of impulsivity recognition.

Does Talking on a Cell Phone, With a Passenger, or Dialing Affect Driving Performance? An Updated Systematic Review and Meta-Analysis of Experimental Studies

Objective An up-to-date meta-analysis of experimental research on talking and driving is needed to provide a comprehensive, empirical, and credible basis for policy, legislation, countermeasures, and future research. Background The effects of cell, mobile, and smart phone use on driving safety continues to be a contentious societal issue. Method All available studies that measured the effects of cell phone use on driving were identified through a variety of search methods and databases. A total of 93 studies containing 106 experiments met the inclusion criteria. Coded independent variables included conversation target (handheld, hands-free, and passenger), setting (laboratory, simulation, or on road), and conversation type (natural, cognitive task, and dialing). Coded dependent variables included reaction time, stimulus detection, lane positioning, speed, headway, eye movements, and collisions. Results The overall sample had 4,382 participants, with driver ages ranging from 14 to 84 years ( M = 25.5, SD = 5.2). Conversation on a handheld or hands-free phone resulted in performance costs when compared with baseline driving for reaction time, stimulus detection, and collisions. Passenger conversation had a similar pattern of effect sizes. Dialing while driving had large performance costs for many variables. Conclusion This meta-analysis found that cell phone and passenger conversation produced moderate performance costs. Drivers minimally compensated while conversing on a cell phone by increasing headway or reducing speed. A number of additional meta-analytic questions are discussed. Application The results can be used to guide legislation, policy, countermeasures, and future research.

Teens' distracted driving behavior: Prevalence and predictors

INTRODUCTION

Teen drivers' over-involvement in crashes has been attributed to a variety of factors, including distracted driving. With the rapid development of in-vehicle systems and portable electronic devices, the burden associated with distracted driving is expected to increase. The current study identifies predictors of secondary task engagement among teenage drivers and provides basis for interventions to reduce distracted driving behavior. We described the prevalence of secondary tasks by type and driving conditions and evaluated the associations between the prevalence of secondary task engagement, driving conditions, and selected psychosocial factors.

METHODS

The private vehicles of 83 newly-licensed teenage drivers were equipped with Data Acquisition Systems (DAS), which documented driving performance measures, including secondary task engagement and driving environment characteristics. Surveys administered at licensure provided psychosocial measures.

RESULTS

Overall, teens engaged in a potentially distracting secondary task in 58% of sampled road clips. The most prevalent types of secondary tasks were interaction with a passenger, talking/singing (no passenger), external distraction, and texting/dialing the cell phone. Secondary task engagement was more prevalent among those with primary vehicle access and when driving alone. Social norms, friends' risky driving behaviors, and parental limitations were significantly associated with secondary task prevalence. In contrast, environmental attributes, including lighting and road surface conditions, were not associated with teens' engagement in secondary tasks.

CONCLUSIONS

Our findings indicated that teens engaged in secondary tasks frequently and poorly regulate their driving behavior relative to environmental conditions. Practical applications: Peer and parent influences on secondary task engagement provide valuable objectives for countermeasures to reduce distracted driving among teenage drivers.

Pathways linking car transport for young adults and the public health in Northern Ireland: a qualitative study to inform the evaluation of graduated driver licensing

Background

Novice drivers are at relatively high risk of road traffic injury. There is good evidence that Graduated Driving Licensing (GDL) schemes reduce collisions rates, by reducing exposure to risk and by extending learning periods. Legislation for a proposed scheme in Northern Ireland was passed in 2016, providing an opportunity for future evaluation of the full public health impacts of a scheme in a European context within a natural experiment. This qualitative study was designed to inform the logic model for such an evaluation, and provide baseline qualitative data on the role of private cars in health and wellbeing.

Methods

Nine group interviews with young people aged 16–23 (N = 43) and two group interviews with parents of young people (N = 8) were conducted in a range of settings in Northern Ireland in 2015. Data were analysed using thematic content analysis.

Results

Informal car-pooling within and beyond households led to routine expectations of lift provision and uptake. Experiences of risky driving situations were widespread. In rural areas, extensive use of farm vehicles for transport needs meant many learner drivers had both early driving experience and expectations that legislation may have to be locally adapted to meet social needs. Cars were used as a site for socialising, as well as essential means of transport. Alternative modes (public transport, walking and cycling) were held in low esteem, even where available. Recall of other transport-related public health messages and parents’ existing use of GDL-type restrictions suggested GDL schemes were acceptable in principle. There was growing awareness and use of in-car technologies (telematics) used by insurance companies to reward good driving.

Conclusions

Key issues to consider in evaluating the broader public health impact of GDL will include: changes in injury rates for licensed car occupants and other populations and modes; changes in exposure to risk in the licensed and general population; and impact on transport exclusion. We suggest an important pathway will be change in social norms around offering and accepting lifts and to risk-taking. The growing adoption of in-car telematics will have implications for future GDL programmes and for evaluation.

Development of a Theoretically Grounded, Web-Based Intervention to Reduce Adolescent Driver Inattention

Motor vehicle crashes are the leading cause of adolescent death. Inattention to the roadway contributes to crash risk and often results from distractions, such as cell phone calls, texting, and peer passengers. We report on the development of a web-based intervention based on the Theory of Planned Behavior that aims to reduce adolescent driver inattention ( Let's Choose Ourselves). In Phase I, we collected qualitative and quantitative data on adolescents' attitudes, perceived behavioral control, and subjective norms about driver inattention through focus groups with newly licensed adolescent drivers. In Phase II, we developed the content in an e-learning delivery system, performed beta- and pilot testing, and made refinements. In Phase III, we conducted a randomized controlled trial to evaluate feasibility. The development of Let's Choose Ourselves provides information for school nurses regarding intervention development strategies as well as promotion of safe adolescent driving by reducing driver inattention.

"Good Passengers and Not Good Passengers:" Adolescent Drivers' Perceptions About Inattention and Peer Passengers

PURPOSE

The purpose of this qualitative focus group elicitation research study was to explore teen driver perceptions of peer passengers and driver inattention.

DESIGN & METHODS

We utilized focus groups for data collection and content analysis to analyze the data, both of which were guided by the theory of planned behavior. We conducted 7 focus groups with 30 teens, ages 16-18, licensed for ≤1year to examine attitudes, perceived behavioral control, and norms related to driving inattention and peer passengers.

RESULTS

The sample was 50% male, mean age 17.39 (SD 0.52) with mean length of licensure 173.7days (SD 109.2). Three themes emerged: 1) "Good and not good" passengers; 2) Passengers and technology as harmful and helpful; and 3) The driver is in charge.

CONCLUSIONS

While passengers can be a source of distraction, our participants also identified passenger behaviors that reduced risk, such as assistance with technology and guidance for directions.

PRACTICAL IMPLICATIONS

An understanding of teens' perceptions of peer passengers can contribute to the development of effective interventions targeting teen driver inattention. Nurses are well-positioned to contribute to these teen crash prevention efforts.

Learning to Drive Safely: Reasonable Expectations and Future Directions for the Learner Period

The young driver problem is typified by high crash rates early in licensure that decline with experience, but are higher initially and decline more slowly for the youngest novices. Despite considerable effort, only Graduated Driver Licensing System (GDLS) policies have been shown to improve novice young driver safety outcomes. Unfortunately, GDLS policies are mostly limited to countries with a relatively young licensure age. Meanwhile, it is not entirely clear how GDLS and other young driver transportation safety efforts, including driver training and testing, supervised practice and parental management of young drivers, can best be configured. Notably, professional training can foster improvements in vehicle management skills that are necessary, but do not assure safe driving behavior. Substantial recent research has focused on training methods to improve driving skills, but the safety benefits of driver training have not been established. While prolonged practice driving increases experience and provides supervisors with opportunities to prepare novices for independent driving, the transition to independent driving challenges novices to employ, on their own, poorly-mastered skills under unfamiliar and complex driving conditions. Licensing policies and parental management practices can limit the complexity of driving conditions while novices gain needed driving experience. Nevertheless, an emerging body of literature suggests that future advances in training and supervision of novice teenage drivers might best focus on the translation of learning to independent driving by fostering safe driving attitudes and norms, judgment, dedicated attention to driving tasks and self-control at the wheel.