Adolescent Drivers: Fine-Tuning Our Understanding

The role of inexperience in motorcycle crashes among novice and returning motorcycle riders

OBJECTIVES

To examine the crash trends of younger novice and older novice/returning motorcycle riders.

METHODS

We used a linked database of North Carolina crash and licensing data from 1991 through 2018 that included 103,142 younger novice and 98,540 older novice/returning motorcycle riders. We examined the percent of riders who crashed each month after obtaining a motorcycle license.

RESULTS

Crash rates peak for both younger novice and older novice/returning motorcycle riders immediately after licensure. Crash rates decline rapidly, and the rate of decrease resembles a power function. The improvement rate (IR) for younger novice riders is 0.42; that is, the crash rate for younger novices declines by approximately 42% as experience doubles.

CONCLUSION

The crash curve for novice motorcyclists is similar to that of novice car drivers and is consistent with a learning process.

PRACTICAL APPLICATIONS

The crash trends of novice motorcycle riders indicate that current training, licensing, and educational efforts are not adequately preparing new riders. Additional efforts to develop more effective training, and research to inform a well-calibrated graduated licensing process for new riders are needed.

Does geographic location matter for transportation risk behaviors among U.S. public high school students?

Introduction

Teen motor vehicle crash fatality rates differ by geographic location. Studies assessing teen transportation risk behaviors by location are inconclusive. Therefore, we explored the role of census region and metropolitan status for driving prevalence and four transportation risk behaviors among U.S. public high school students.

Methods

Data from 2015 and 2017 national Youth Risk Behavior Surveys were combined and analyzed. Multivariable models controlled for sex, age, race/ethnicity, grades in school, and school socioeconomic status.

Results

Overall, 41% of students did not always wear a seat belt. Students attending schools in the Northeast were 40% more likely than those in the Midwest to not always wear a seat belt. Among the 75% of students aged ≥16 years who had driven during the past 30 days, 47% texted/e-mailed while driving. Students in the Northeast were 20% less likely than those in the Midwest to text/e-mail while driving, and students attending suburban or town schools were more likely to text/e-mail while driving (20% and 30%, respectively) than students attending urban schools. Nineteen percent of students rode with a driver who had been drinking alcohol, and 7% of drivers aged ≥16 years drove when they had been drinking alcohol, with no significant differences by location for either alcohol-related behavior.

Conclusions

We found few differences in teen transportation risk behaviors by census region or metropolitan status. Age at licensure, time since licensure, driving experience, and the policy and physical driving environment might contribute more to variation in teen fatal crashes by location than differences in transportation risk behaviors. Regardless of location, teen transportation risk behaviors remain high. Future research could address developing effective strategies to reduce teen cell phone use while driving and enhancing community implementation of existing, effective strategies to improve seat belt use and reduce alcohol consumption and driving after drinking alcohol.

An Integrative Review of Return to Driving After Concussion in Adolescents

Concussion is a common injury among adolescents. It is unknown how a concussion affects driving behavior and performance in adolescents. Although there are guidelines for return to learn, exercise, and sports that school nurses can help support in school, little is known about return to driving after concussion. The goal of this integrative review was to summarize the current literature on return to driving after concussion in adolescents. Six articles published between 2016 and 2020 were included in the review. Physicians and nurse practitioners find providing driving recommendations to adolescents to be appropriate; however, they are unclear what metrics to use to determine whether a patient is fit to drive. Future studies should explore clinical predictors of readiness to return to driving in adolescents. School nurses have an opportunity to support adolescents in their resumption of typical activities after concussion including school, sports, and, as more evidence becomes available, driving.

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.

Pilot Efficacy of a DriveFocus™ Intervention on the Driving Performance of Young Drivers

Road traffic injuries are the leading cause of death for youth between the ages of 15 and 29 around the world. A need remains for evidence-based interventions that can improve the underlying skills of young drivers, including hazard perception and anticipation. This pilot study investigated the preliminary impact of a six session DriveFocus™ intervention on the ability of young novice drivers (mean age = 18.6, SD = 2.12) to detect (visual scanning), and respond (adjustment to stimuli) to critical roadway information. Using a CDS-200 DriveSafety™ simulator, drives were recorded and sent to a blinded evaluator (occupational therapist), who scored the recorded drives for number and type (visual scanning and adjustment to stimuli) of errors. We observed a statistically significant decline in the number of visual scanning [t(34) = 2.853, p = 0.007], adjustment to stimuli [t(34) = 3.481, p = 0.001], and total driving errors [t(34) = 3.481, p = 0.002], among baseline and post-test 2.

Driving After Adolescent Concussion: Advice From Nurse Practitioners in the Absence of Standardized Recommendations

INTRODUCTION

Nurse practitioners (NPs) are authorized to manage concussion recovery. Common adolescent activities, like driving, are omitted from guidelines. We investigated NP driving guidance and its clinical basis for restriction or limitation following adolescent concussion.

METHOD

NPs completed a web-based questionnaire after viewing a scripted video scenario of an adolescent describing symptoms of concussion occurring 72 hours prior. Driving recommendations were collected using an open-ended query, then coded and categorized by type, characteristic, and basis.

RESULTS

1,051 (20%) responded to the question of interest. The majority (93.8%) provided driving recommendations: 32.6% based on time, 49.8% based on symptoms, and 28.5% based on health care utilization. 5.3% mentioned fatigue and sleep symptoms. 1% advised use of a standardized assessment tool.

DISCUSSION

Symptomatology, examination, and time were key factors in clinical decision-making for post-concussion driving, rather than use of standardized tools. Persistent symptoms that can impact driving, such as sleep and visual disturbances, may warrant consideration.