History and current status of state graduated driver licensing (GDL) laws in the United States

Promoting transportation safety in adolescence: the drivingly randomized controlled trial

BACKGROUND

The impact of young drivers' motor vehicle crashes (MVC) is substantial, with young drivers constituting only 14% of the US population, but contributing to 30% of all fatal and nonfatal injuries due to MVCs and 35% ($25 billion) of the all medical and lost productivity costs. The current best-practice policy approach, Graduated Driver Licensing (GDL) programs, are effective primarily by delaying licensure and restricting crash opportunity. There is a critical need for interventions that target families to complement GDL. Consequently, we will determine if a comprehensive parent-teen intervention, the Drivingly Program, reduces teens' risk for a police-reported MVC in the first 12 months of licensure. Drivingly is based on strong preliminary data and targets multiple risk and protective factors by delivering intervention content to teens, and their parents, at the learner and early independent licensing phases.

METHODS

Eligible participants are aged 16-17.33 years of age, have a learner's permit in Pennsylvania, have practiced no more than 10 h, and have at least one parent/caregiver supervising. Participants are recruited from the general community and through the Children's Hospital of Philadelphia's Recruitment Enhancement Core. Teen-parent dyads are randomized 1:1 to Drivingly or usual practice control group. Drivingly participants receive access to an online curriculum which has 16 lessons for parents and 13 for teens and an online logbook; website usage is tracked. Parents receive two, brief, psychoeducational sessions with a trained health coach and teens receive an on-road driving intervention and feedback session after 4.5 months in the study and access to DriverZed, the AAA Foundation's online hazard training program. Teens complete surveys at baseline, 3 months post-baseline, at licensure, 3months post-licensure, 6 months post-licensure, and 12 months post-licensure. Parents complete surveys at baseline, 3 months post-baseline, and at teen licensure. The primary end-point is police-reported MVCs within the first 12 months of licensure; crash data are provided by the Pennsylvania Department of Transportation.

DISCUSSION

Most evaluations of teen driver safety programs have significant methodological limitations including lack of random assignment, insufficient statistical power, and reliance on self-reported MVCs instead of police reports. Results will identify pragmatic and sustainable solutions for MVC prevention in adolescence.

TRIAL REGISTRATION

ClinicalTrials.gov # NCT03639753.

Direct medical charges of all parties in teen-involved vehicle crashes by culpability

BACKGROUND

Motor vehicle crashes among teen drivers often involve passengers in the teen's vehicle and occupants of other vehicles, and the full cost burden for all individuals is largely unknown. This analysis estimated direct hospitalisation and emergency department charges for teen-involved crashes by teen culpability, comparing charges for the teen driver, passengers and occupants of other vehicles.

METHODS

Probabilistic linkage was performed to link the Iowa police crash reports with Iowa emergency department and Iowa hospital inpatient data. Teen drivers aged 14-17 involved in a crash from 2016 through 2020 were included. Teen culpability was determined through the crash report and examined by teen and crash characteristics. Direct medical charges were estimated from charges through linkage to the Iowa hospital inpatient and the Iowa emergency department databases.

RESULTS

Among the 28 062 teen drivers involved in vehicle crashes in Iowa between 2016 and 2020, 62.1% were culpable and 37.9% were not culpable. For all parties involved, the inpatient charges were $20.5 million in culpable crashes and $7.2 million in non-culpable crashes. The emergency department charges were $18.7 million in teen culpable crashes and $6.8 million in teen non-culpable crashes. Of the $20.5 million total inpatient charges in which a teen driver was culpable, charges of $9.5 million (46.3%) were for the injured teen driver and $11.0 million (53.7%) for other involved parties.

CONCLUSIONS

Culpable teen-involved crashes lead to higher proportions of injury and higher medical charges, with most of these charges covering other individuals in the crash.

Clinical-Pathological Study on Expressions β-APP, GFAP, NFL, Spectrin II, CD68 to Verify Diffuse Axonal Injury Diagnosis, Grade and Survival Interval

Traumatic brain injury (TBI) is one of the leading causes of death worldwide, particularly in young people. Diffuse axonal injuries (DAI) are the result of strong rotational and translational forces on the brain parenchyma, leading to cerebral oedema and neuronal death. DAI is typically characterized by coma without focal lesions at presentation and is defined by localized axonal damage in multiple regions of the brain parenchyma, often causing impairment of cognitive and neuro-vegetative function. Following TBI, axonal degeneration has been identified as a progressive process that begins with the disruption of axonal transport, leading subsequently to axonal swelling, axonal ballooning, axonal retraction bulges, secondary disconnection and Wallerian degeneration. The objective of this paper is to report on a series of patients who have suffered fatal traumatic brain injury, in order to verify neurological outcomes in dynamics, relative to the time of injury, using antibodies for neurofilament (NFL), spectrin II, beta-amyloid (β-APP), glial fibrillary acidic protein (GFAP) and cluster of differentiation 68 (CD68). From the studied cases, a total of 50 cases were chosen, which formed two study groups. The first study group comprises 30 cases divided according to survival interval. The control group comprises 20 cases with no history of traumatic brain injury. Cardiovascular disease and history of stroke, cases suffering from loss of vital functions, a post-traumatic survival time of less than 15 min, autolysis and putrefaction were established as criteria for exclusion. Based on their expression, we tested for diagnosis and degree of DAI as a strong predictor of mortality. Immunoreactivity was significantly increased in the DAI group compared to the control group. The earliest changes were recorded for GFAP and CD68 immunolabeling, followed by β-APP, spectrin II and NFM. The most intense changes in immunostaining were recorded for spectrin II. Comparative analysis of brain apoptosis, reactive astrocytosis and inflammatory reaction using specific immunohistochemical markers can provide important information on diagnosis of DAI and prognosis, and may elucidate the timing of the traumatic event in traumatic brain injury.

Learning to drive: Parental attitudes toward introducing teen drivers to advanced driver assistance systems

OBJECTIVE

Advanced driver assistance systems (ADAS) have the potential to help mitigate the crash risk faced by new teen drivers. There has been little research on how these drivers use ADAS, as most only have access to these systems in their parents' vehicles when learning to drive because teens tend to drive older, less expensive vehicles when driving independently. This study examined how parental attitudes toward ADAS influence how and when parents introduce their teens to these systems when teaching them to drive.

METHODS

Three web-based focus groups were conducted with parents who owned ADAS-equipped vehicles and who either had a teen with either a learner permit or a teen who recently began driving independently. The moderator-led discussion examined participant attitudes about teen driving risk, the perceived benefits or risks associated with teen use of ADAS, and parents' teaching strategies for ADAS. Researchers generated a list of likely themes from a review of existing literature and then coded participant responses according to those themes.

RESULTS

Parents who chose to introduce ADAS to their new teen drivers did so while also reporting conflicting opinions about the reliability of vehicle technologies and the impact of such systems on driving safety and skill acquisition. Many parents reported some distrust of ADAS and concerns that some features could hinder the development of good driving habits, although most participants stated that ADAS have had a positive impact on their teen drivers' safety. Opinions were split about the best point at which to introduce ADAS to teens, with half preferring introduction at the outset and half preferring to wait until the teen had mastered basic driving skills. Attitudes varied according to individual vehicle systems, with a preference for blind spot monitoring and a general dislike of lane-keeping assistance.

CONCLUSIONS

Specific concerns about the potential impact of ADAS on teen driving safety and skill acquisition do not prevent parents from using such systems, although the teaching strategies parents use vary according to their preferences for individual systems.

The effects of graduated driver licensing on teenage body weight

The graduated driver licensing (GDL) program requires teenage drivers to pass through an intermediate stage, which contains specific driving restrictions such as a night curfew or a limit on the number of teen passengers to be carried, before earning full driving privileges. Using individual data from the 1999 to 2017 biennial Youth Risk Behavior Surveillance System (YRBS) combined with state-level GDL policy variations, we estimate the effects of GDL on teenage body weight in the United States. We find that the presence of GDL raises adolescents' body mass index Z-score and their likelihood of being overweight or obese. Among the restrictions imposed, a night curfew implemented together with a passenger restriction makes the most significant impact. These estimated effects are concentrated among states with more restrictive GDL policies. We also find that the presence of GDL reduces adolescent physical activity and heavy smoking, while increasing their time spent watching TV and milk intake, perhaps contributing to youth weight gain. An event study analysis reveals that the effects of GDL on adolescent weight increase may be transitory.

Time to licensure for driving among U.S. teens: Survival analysis of interval-censored survey data

OBJECTIVE

Novice drivers who delay in driving licensure may miss safety benefits of Graduate Driver Licensing (GDL) programs, potentially putting themselves at higher crash-risk. Time to licensure relates their access to independent transportation to potential future economic- and educational-related opportunities. The objective of this study was to explore time to licensure associations with teens' race/ethnicity and GDL restrictions.

METHODS

Secondary analysis using all seven annual assessments of the NEXT Generation Health Study, a nationally representative longitudinal study starting with 10th grade (N = 2785; 2009-2010 school year). Data were collected in U.S. public/private schools, colleges, workplaces, and other settings. The outcome variable was interval-censored time to licensure (event = obtained driving licensure). Independent variables included race/ethnicity and state-specific GDL restrictions. Covariates included family affluence, parent education, nativity, sex, and urbanicity. Proportional hazards (PH) models were conducted for interval-censored survival analysis based on stepwise backward elimination for fitting multivariate models with consideration of complex survey features. In the PH models, a hazard ratio (HR) estimates a greater (>1) or lesser (<1) likelihood of licensure at all timepoints.

RESULTS

Median time to licensure after reaching legal driving age for Latinos, African Americans, and Non-Latino Whites was 3.47, 2.90, and 0.41 years, respectively. Multivariate PH models showed that Latinos were 46% less likely (HR = 0.54, 95%CI: 0.35-0.72) and African Americans were 56% less likely (HR = 0.44, 95%CI: 0.32-0.56) to have obtained licensure at any time compared to Non-Latino Whites. Only learner minimum age GDL restriction was associated with time to licensure. Living in a state with a required learner driving minimum age of ≥16 years (HR = 0.57, 95%CI: 0.16-0.98) also corresponded with 43% lower likelihood of licensure at legal eligibility compared to living in other states with a required learner driving minimum age of <16 years.

CONCLUSION

Latinos and African American teens obtained their license approximately three years after eligibility on average, and much later than Non-Latino Whites. Time to licensure likelihood was associated with race/ethnicity and required minimum age of learner permit, indicating important implications for teens of different racial/ethnic groups in relation to licensure, access to independent transportation, and exposure to GDL programs.

Support for distracted driving laws: An analysis of adolescent drivers from the Traffic Safety Culture Index from 2011 to 2017

INTRODUCTION

Adolescent drivers are often the focus of traffic safety legislation as they are at increased risk for crash-related injury and death. However, the degree to which adolescents support distracted driving laws and factors contributing to their support are relatively unknown. Using a large, nationally weighted sample of adolescent drivers in the United States, we assessed if perceived threat from other road users' engagement in distracted driving, personal engagement in distracted driving behaviors, and the presence of state distracted driving laws was associated with support for distracted driving laws.

METHODS

The sample included 3565 adolescents (aged 16-18) who participated in the Traffic Safety Culture Index survey from 2011 to 2017. A modified Poisson regression model with robust errors was fit to the weighted data to examine support for distracted driving laws. Models included age, gender, year, state distracted driving laws, personal engagement in distracted driving behavior, and perceived threat from other road users' engaging in distracted driving.

RESULTS

Approximately 87% of adolescents supported a law against texting and emailing compared to 66% who supported a universal handheld cellphone law. Support for distracted driving legislation was associated with greater perceived threat of other road users engaging in distracted driving while accounting for personal engagement in distracted driving, state distracted driving laws, and developmental covariates.

DISCUSSION

Greater understanding of the factors behind legislative support is needed. Public health interventions focused on effectively translating the risks of cellphone use while driving and effective policy will further improve the traffic safety culture.

Do Brief Alcohol Interventions Reduce Driving After Drinking Among College Students? A Two-step Meta-analysis of Individual Participant Data

Aims

College students who drink are at an increased risk of driving after drinking and alcohol-involved traffic accidents and deaths. Furthermore, the persistence of driving after drinking over time underscores a need for effective interventions to prevent future drunk driving in adulthood. The present study examined whether brief alcohol interventions (BAIs) for college students reduce driving after drinking.

Methods

A two-step meta-analysis of individual participant data (IPD) was conducted using a combined sample of 6801 college students from 15 randomized controlled trials (38% male, 72% White and 58% first-year students). BAIs included individually delivered Motivational Interviewing with Personalized Feedback (MI + PF), Group Motivational Interviewing (GMI), and stand-alone Personalized Feedback (PF) interventions. Two outcome variables, driving after two+/three+ drinks and driving after four+/five+ drinks, were checked, harmonized and analyzed separately for each study and then combined for meta-analysis and meta-regression analysis.

Results

BAIs lowered the risk of driving after four+/five+ drinks (19% difference in the odds of driving after drinking favoring BAIs vs. control), but not the risk of driving after two+/three+ drinks (9% difference). Subsequent subgroup analysis indicated that the MI + PF intervention was comparatively better than PF or GMI.

Conclusions

BAIs provide a harm reduction approach to college drinking. Hence, it is encouraging that BAIs reduce the risk of driving after heavy drinking among college students. However, there may be opportunities to enhance the intervention content and timing to be more relevant for driving after drinking and improve the outcome assessment and reporting to demonstrate its effect.

Factors Contributing to Delay in Driving Licensure Among U.S. High School Students and Young Adults

PURPOSE

More teens delay in driving licensure (DDL). It is conceivable they miss Graduated Driver Licensing (GDL) safety benefits. We assessed prevalence, disparities, and factors associated with DDL among emerging adults.

METHODS

Data used were from all seven waves (W1-7) of the NEXT Generation Health Study (W1 in 10th grade [2009-2010]). The outcome variable was DDL (long-DDL [delayed >2 years], intermediate-DDL [delayed 1-2 years] versus no-DDL), defined as participants receiving driver licensure ≥1 year after initial eligibility. Independent variables included sex, urbanicity, race/ethnicity, family structure, parental education, family affluence, parental monitoring knowledge, parent perceived importance of alcohol nonuse, and social media use. Logistic regressions were conducted.

RESULTS

Of 2,525 participants eligible for licensure, 887 (38.9%) reported intermediate-DDL and 1,078 (30.1%) long-DDL. Latinos (adjusted odds ratio [AOR] = 2.5 vs. whites) and those with lower affluence (AOR = 2.5 vs. high) had higher odds of intermediate-DDL. Latinos (AOR = 4.5 vs. whites), blacks (AOR = 2.3 vs. whites), those with single parent (AOR = 1.7 vs. both biological parents), whose parents' education was high school or less (AOR = 3.7 vs. bachelor+) and some college (AOR = 2.0 vs. bachelor+) levels, and those with lower affluence (AOR = 4.4 vs. high) had higher odds of long-DDL. Higher mother's monitoring knowledge (AOR = .6) was associated with lower odds of long-DDL, but not intermediate-DDL.

CONCLUSIONS

Some teens that DDL "age out" of protections afforded to them by GDL driver restrictions. Minority race/ethnicity, socioeconomic status, urbanicity, and parenting factors contribute to DDL. Further study of these factors and their individual/collective contributions to DDL is needed to understand potential unintended consequences of GDL, particularly in more vulnerable youth.

Coupling neuroscience and driving simulation: A systematic review of studies on crash-risk behaviors in young drivers

OBJECTIVE

Motor vehicle crashes are a leading cause of death for adolescents and young adults. The aim of this study is to examine and discuss the state-of-the-art literature which uses neuroscience methods in the context of driving simulation to study adolescent and young adult drivers.

METHODS

We conducted a systematic English-language literature search of Ovid MEDLINE (1946-2020), PsycINFO (1967-2020), PubMed, Web of Science, SCOPUS, and CINAHL using keywords and MeSH terms. Studies were excluded if participants were not within the ages of 15-25, if the driving simulator did not include a visual monitor/computer monitor/projection screen and steering wheel and foot pedals, or brain data (specifically EEG [electroencephalogram], fNIRS [functional near-infrared spectroscopy], or fMRI [functional magnetic resonance imaging]) was not collected at the same time as driving simulation data.

RESULTS

Seventy-six full text articles of the 736 studies that met inclusion criteria were included in the final review. The 76 articles used one of the following neuroscience methods: electrophysiology, functional near-infrared spectroscopy, or functional magnetic resonance imaging. In the identified studies, there were primarily two areas of investigation pursued; driving impairment and distraction in driving. Impairment studies primarily explored the areas of drowsy/fatigued driving or alcohol-impaired driving. Studies of distracted driving primarily focused on cognitive load and auditory and visual distractors.

CONCLUSIONS

Our state of the science systematic review highlights the feasibility for coupling neuroscience with driving simulation to study the neurocorrelates of driving behaviors in the context of young drivers and neuromaturation. Findings show that, to date, most research has focused on examining brain correlates and driving behaviors related to contributing factors for fatal motor vehicle crashes. However, there remains a considerable paucity of research designed to understand underlying brain mechanisms that might otherwise facilitate greater understanding of individual variability of normative and risky driving behavior within the young driving population.

Vehicle safety characteristics in vulnerable driver populations

OBJECTIVE

National data suggest drivers who are younger, older, and have lower socioeconomic status (SES) have heightened crash-related injury rates. Ensuring vulnerable drivers are in the safest vehicles they can afford is a promising approach to reducing crash injuries in these groups. However, we do not know the extent to which these drivers are disproportionately driving less safe vehicles. Our objective was to obtain population-based estimates of the prevalence of important vehicle safety criteria among a statewide population of drivers.

METHODS

We analyzed data from the NJ Safety and Health Outcomes warehouse, which includes all licensing and crash data from 2010-2017. We borrowed the quasi-induced exposure method's fundamental assumption-that non-responsible drivers in clean (i.e., only one responsible driver) multi-vehicle crashes are reasonably representative of drivers on the road-to estimate statewide prevalence of drivers' vehicle characteristics across four driver age groups (17-20; 21-24; 25-64, and ≥65) and quintiles of census tract median household income (n = 983,372). We used NHTSA's Product Information Catalog and Vehicle Listing platform (vPIC) to decode the VIN of each crash-involved vehicle to obtain model year, presence of electronic stability control (ESC), vehicle type, engine horsepower, and presence of front, side, and curtain air bags.

RESULTS

The youngest and oldest drivers were more likely than middle-aged drivers to drive vehicles that were older, did not have ESC, and were not equipped with side airbags. Additionally, across all age groups drivers of higher SES were in newer and safer vehicles compared with those of lower SES. For example, young drivers living in lowest-income census tracts drove vehicles that were on average almost twice as old as young drivers living in highest-income tracts (median [IQR]: 11 years [6-14] vs. 6 years [3-11]).

CONCLUSIONS

Vehicle safety is an important component of seminal road safety philosophies that aim to reduce crash fatalities. However, driver groups that are overrepresented in fatal crashes-young drivers, older drivers, and those of lower SES-are also driving the less safe vehicles. Ensuring drivers are in the safest car they can afford should be further explored as an approach to reduce crash-related injuries among vulnerable populations.

Investigating traffic fatality trends and restraint use among rear-seat passengers in the United States, 2000-2016

INTRODUCTION

Motor-vehicle crash is one of the leading causes of unintentional injury death in the United States. Previous studies focused on fatalities among drivers and front-seat passengers, with a limited number of studies examining rear-seat passenger fatalities. The objectives of this study were to assess trends in rear-seat passenger motor-vehicle fatalities in the United States from 2000 to 2016 and to identify demographic factors associated with being unrestrained among fatally injured rear-seat passengers.

METHODS

Rear-seat passenger fatality data were obtained from the Fatality Analysis Reporting System (FARS) database. The fatality rate ratios for overall rear-seat passengers and for different age and sex groups were determined by comparing fatality rates in 2000 and 2016 using random effects models. Risk ratios of being unrestrained for age and sex groups were obtained using general estimating equations.

RESULTS

Compared to 2000, the overall rear-seat passenger fatality rate in 2016 decreased by 44% (95% confidence interval [CI]: 39-49%). In particular, the fatality rate among rear-seat passengers decreased more in males than females, and passengers aged 14-19 years experienced a larger decline than all other age groups. Fatally injured male rear-seat passengers had a higher risk of being unrestrained (adjusted risk ratio: 1.06, 95% CI: 1.04-1.07) than their female counterparts, and both youngest (≤13 years) and oldest (65-85 years) passengers were less likely to be unrestrained than those aged 20-64 years.

CONCLUSIONS

Overall, fatality rates among rear-seat passengers have declined, with differential degrees of improvement by age and sex. Practical Applications: Continued restraint use enforcement campaigns targeted at teenagers and males would further preserve them from fatal injuries and improve traffic safety for the overall population.

Impacts of graduated driver licensing regulations

We evaluate the impact of the Graduated Driver Licensing (GDL) system introduced in Victoria, Australia as they influence both injury and fatality rates. Since 1990, the Victorian GDL scheme has undergone several modifications including the introduction of new requirements and the stricter enforcement of existing regulations. Our evaluation of the GDL is based on monthly mortality and morbidity data for drivers 18-25 for the period January 2000 to June 2017. We estimate the immediate and long-term impacts of each policy change to the GDL system. Our results indicate that several initiatives in the GDL system have had impacts on both fatalities and injuries requiring hospitalisation when differentiated by gender. In a number of cases we observe that reactions to these measures are common to both genders. These include: the signalling of the proposed GDL changes in the media, the introduction of an extra probationary year for those under 21, the total alcohol ban for the entire probationary period, and limits on peer passengers for the first year. Stricter mobile phone restrictions appear to have had no impact on injuries for either males or females although they were associated with lower fatality rates for both. In addition, we found an indication that in the period prior to the introduction of the mandatory requirement of 120 h supervised driving, there was a rise in male driver injuries possibly caused by a rush of more inexperienced learners to obtain their probationary licence.

Teen driver licensure provisions, licensing, and vehicular fatalities

Between 1996 and 2015, vehicular fatalities per capita involving 16- to 17-year-old drivers declined by 68.7%. During this same period, states enacted teen driver licensure provisions in an á la carte fashion, now collectively referred to as graduated driver licensing (GDL) programs, that restricted teen driving. While the literature demonstrates that 'good' GDL programs reduce vehicular fatalities, how these reductions occur remains open. In this study, separate GDL provisions and no pass, no drive laws are studied to understand reduction mechanisms. The evaluation is based on a state-by-year panel and uses difference-in-difference and triple-difference specifications to identify causal impacts on rates of licensing, vehicular fatalities, and fatalities per licensee. The empirical results find that the minimum intermediate licensing age of 16.5 or older provision reduces licensing of 16- to 17-year-old teens by 20.1%, and no other licensure provision consistently impacts licensing. In addition, vehicular fatalities decrease from the minimum intermediate licensing age of 16.5 or older provision by 22.7%, the driver's education reduces supervised hours provision by 5.9%, and no pass, no drive laws by 7.3%, while vehicular fatalities increase from the supervised driving hours required provision by 6.3%. Furthermore, only teen driver cellphone or texting bans have impacts on vehicular fatalities per 16- to 17-year-old licensed female and few long-term impacts are identified on those ages 18-20 who 'graduated' from licensing programs. This research suggests that GDL programs affect vehicular fatalities mostly through incapacitation, rather than programmatically.

Spatial variation in teens' crash rate reduction following the implementation of a graduated driver licensing program in Michigan

Motor vehicle crashes are a leading cause of injury, and teen drivers contribute disproportionately to that burden. Graduated Driver Licensing (GDL) programs are effective at reducing teen crash risk, but teen crash rates remain high. Between-state variation in the teen crash rate reduction following GDL implementation has been documented, but this is the first study to examine small-area variation in such a reduction. Fusing together crash data from the Michigan State Police, census data, and organizational data (alcohol outlet, movie theatre, and school locations), we analyzed spatial correlates of teen injury crash, and place-based features that modified the injury crash rate difference following GDL implementation. Specifically, using census-based units, we estimated changes in injury crash rates among teens using negative binomial regression controlling for spatial autocorrelation, and tested whether any measured spatial characteristics modified the crash rate change in the pre versus post GDL periods. There was a substantial reduction in teen crashes after GDL implementation (RR = 0.66, 95%CI: [0.65, 0.67]), and this effect was robust across gender and time-of-day (light/dark). We found evidence that this reduction varied across space; areas with more alcohol outlets corresponded to a larger daytime crash rate reduction post-GDL, while areas near schools corresponded to a smaller daytime crash rate reduction. Concentrations of movie theatres corresponded to larger post-GDL crash rate reductions after dark. Maximizing the substantial successes of GDL programs requires understanding why crash rate reductions were larger in some areas following GDL implementation, and harnessing that understanding to improve its effectiveness across a state, focusing on identifying priorities for improving driver training (e.g., by parents and driver educators), law enforcement, and future policy changes to current GDL laws.

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.

Associations between graduated driver licensing and road trauma reductions in a later licensing age jurisdiction: Queensland, Australia

The success of driver graduated licensing systems (GLS) is demonstrated primarily in jurisdictions that licence at young ages with requirements expiring at age 18. In Australia, GLS requirements typically apply for all applicants aged under 25. In 2007, the Queensland licensing system was strengthened, extending the learner and introducing a 100-hour supervised driving requirement, introducing restrictions on passenger carriage at night and high-powered vehicles for provisional drivers, and on phone use for all novice drivers (learner and provisional). The objective of the current research was to evaluate whether these changes were associated with reductions in crashes (all) and killed-and-serious-injury (KSI) crashes involving novice drivers, and respective casualties. Government licensing and police crash records were linked and interrupted time series analysis was used to examine potential shifts in crash trends by rates of licensed drivers per month. Substantial declines were found in novice driver crashes (13.1% per year; 95%CI -0.0130, -0.0096), crash casualties (13.9% per year; 95%CI -0.0137, -0.0101), KSI crashes (5.4% per year; 95%CI -0.0080, -0.0046) and associated casualties (5.2% per year; 95%CI -0.0075, -0.0039). Compared to the total licensed driver population, declines in crashes (3.0% per year; 95%CI -0.0027, -0.0007) and crash casualties (2.9% per year; 95%CI -0.0029, -0.0006) but not KSI outcomes were observed. More narrowly, declines were found for provisional-licensed driver crashes (9.3% per year; 95%CI -0.0096, -0.0063) and KSI crashes (3.6% per year; 95%CI -0.0004, -0.0128) that were approximately 2.6% and 1.2% greater than respective declines for 25-29-year-old open-licensed drivers. Substantial declines also were observed in novice driver single-vehicle, night, passenger and alcohol crashes. Overall, these results demonstrate that GLS can be effective in a later age licensing jurisdiction. However, KSI outcomes were limited. Modelling research is recommended on ways to further strengthen Queensland’s GLS to achieve greater trauma reductions.

Graduated driver licensing (GDL) in the United States in 2016: A literature review and commentary

This is the sixth in a series of reviews of research on graduated driver licensing (GDL) published in the Journal of Safety Research, the present review covering the period mid-2012 through 2016. In the two decades since GDL programs began to be introduced on a widespread basis in the United States, a vast amount of research has been published. The current review discusses recent research and the present state of knowledge on the following topics: characteristics of the novice driver population; effects of GDL on crashes for ages 16-19; the learner and intermediate periods; night and passenger restrictions; cellphone laws; GDL for older novices; enforcement of GDL rules; and programs attempting to influence GDL compliance and safe driving practices in general. GDL stands out as a successful policy for reducing teen driver crashes and is worth building on to extend its benefits. Strengthening existing GDL programs has the most potential for producing further crash reductions.

Provisional drivers' perceptions of the impact of displaying P plates

OBJECTIVE

P plates (or decals) identify a driver's license status to other road users. They are a compulsory part of the graduated driver licensing system in Queensland, Australia, for drivers on a P1 (provisional 1) or P2 (provisional 2) license. This study explored the perceptions of young drivers regarding the display of P plates (decals) in Queensland, Australia.

METHODS

In this study, 226 young drivers with a provisional (intermediate/restricted) license completed a 30-min online survey between October 2013 and June 2014. t Tests were used to compare the opinions of people who displayed their plates nearly always with those who displayed them less frequently.

RESULTS

Participants approved of the requirement to display P plates with 69% of those on a P1 license and 79% on a P2 license supporting the condition to display P1 (red) plates. Participants on a P1 license (62%) and a P2 license (68%) also approved the requirement to display P2 (green) plates. However, young drivers also perceived that the display of P plates (measured from 1 = never to 5 = nearly all the time) enabled newly licensed drivers to be targeted by police and other drivers (those who do not always display P plates: M = 3.72, SD = 0.94; those who nearly always display P plates: M = 3.43, SD = 1.09).

CONCLUSIONS

The study findings suggest that participants who nearly always display their P plates are more likely to report that having to display their plates resulted in them driving more carefully.

School transportation mode, by distance between home and school, United States, ConsumerStyles 2012

INTRODUCTION

Motor-vehicle crashes are a leading cause of death among children in the United States, and almost one-fourth of all trips by school-aged children are trips to and from school. This study sought to determine how children (5-18years) travel to and from school and, among those living ≤1mile of school, to explore the role of school bus service eligibility on school travel mode.

METHODS

We used national 2012 survey data to determine prevalence of usual school travel mode, stratified by distance from school. For those living ≤1mile of school, multivariable regression was conducted to assess the association between bus service eligibility and walking or bicycling.

RESULTS

Almost half (46.6%) of all children rode in passenger vehicles (PV) to school and 41.8% did so for the trip home. Results were similar among those living ≤1mile (48.1%, PV to school; 41.3%, PV to home). Among those living ≤1mile, 21.9% and 28.4% of children walked or bicycled to and from school, respectively. Ineligibility for school bus service was strongly associated with walking or bicycling to school [adjusted prevalence ratio (aPR: 5.36; p<0.001)] and from school (aPR: 5.36; p<0.001).

CONCLUSIONS

Regardless of distance from school, passenger vehicles were a common mode of travel. For children who live close to school, the role that school bus service eligibility plays in walking or bicycling deserves further consideration.

PRACTICAL APPLICATIONS

Given the large proportion of children who use passenger vehicles for school travel, effective interventions can be adopted to increase proper child restraint and seat belt use and reduce crash risks among teen drivers. Better understanding of conditions under which bus service is offered to children who live close to school could inform efforts to improve pedestrian and bicyclist safety for school travel.

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.

Traumatic Brain Injury-Related Emergency Department Visits, Hospitalizations, and Deaths - United States, 2007 and 2013

PROBLEM/CONDITION

Traumatic brain injury (TBI) has short- and long-term adverse clinical outcomes, including death and disability. TBI can be caused by a number of principal mechanisms, including motor-vehicle crashes, falls, and assaults. This report describes the estimated incidence of TBI-related emergency department (ED) visits, hospitalizations, and deaths during 2013 and makes comparisons to similar estimates from 2007.

REPORTING PERIOD

2007 and 2013.

DESCRIPTION OF SYSTEM

State-based administrative health care data were used to calculate estimates of TBI-related ED visits and hospitalizations by principal mechanism of injury, age group, sex, and injury intent. Categories of injury intent included unintentional (motor-vehicle crashes, falls, being struck by or against an object, mechanism unspecified), intentional (self-harm and assault/homicide), and undetermined intent. These health records come from the Healthcare Cost and Utilization Project's National Emergency Department Sample and National Inpatient Sample. TBI-related death analyses used CDC multiple-cause-of-death public-use data files, which contain death certificate data from all 50 states and the District of Columbia.

RESULTS

In 2013, a total of approximately 2.8 million TBI-related ED visits, hospitalizations, and deaths (TBI-EDHDs) occurred in the United States. This consisted of approximately 2.5 million TBI-related ED visits, approximately 282,000 TBI-related hospitalizations, and approximately 56,000 TBI-related deaths. TBIs were diagnosed in nearly 2.8 million (1.9%) of the approximately 149 million total injury- and noninjury-related EDHDs that occurred in the United States during 2013. Rates of TBI-EDHDs varied by age, with the highest rates observed among persons aged ≥75 years (2,232.2 per 100,000 population), 0-4 years (1,591.5), and 15-24 years (1,080.7). Overall, males had higher age-adjusted rates of TBI-EDHDs (959.0) compared with females (810.8) and the most common principal mechanisms of injury for all age groups included falls (413.2, age-adjusted), being struck by or against an object (142.1, age-adjusted), and motor-vehicle crashes (121.7, age-adjusted). The age-adjusted rate of ED visits was higher in 2013 (787.1) versus 2007 (534.4), with fall-related TBIs among persons aged ≥75 years accounting for 17.9% of the increase in the number of TBI-related ED visits. The number and rate of TBI-related hospitalizations also increased among persons aged ≥75 years (from 356.9 in 2007 to 454.4 in 2013), primarily because of falls. Whereas motor-vehicle crashes were the leading cause of TBI-related deaths in 2007 in both number and rate, in 2013, intentional self-harm was the leading cause in number and rate. The overall age-adjusted rate of TBI-related deaths for all ages decreased from 17.9 in 2007 to 17.0 in 2013; however, age-adjusted TBI-related death rates attributable to falls increased from 3.8 in 2007 to 4.5 in 2013, primarily among older adults. Although the age-adjusted rate of TBI-related deaths attributable to motor-vehicle crashes decreased from 5.0 in 2007 to 3.4 in 2013, the age-adjusted rate of TBI-related ED visits attributable to motor-vehicle crashes increased from 83.8 in 2007 to 99.5 in 2013. The age-adjusted rate of TBI-related hospitalizations attributable to motor-vehicle crashes decreased from 23.5 in 2007 to 18.8 in 2013.

INTERPRETATION

Progress has been made to prevent motor-vehicle crashes, resulting in a decrease in the number of TBI-related hospitalizations and deaths from 2007 to 2013. However, during the same time, the number and rate of older adult fall-related TBIs have increased substantially. Although considerable public interest has focused on sports-related concussion in youth, the findings in this report suggest that TBIs attributable to older adult falls, many of which result in hospitalization and death, should receive public health attention.

PUBLIC HEALTH ACTIONS

The increase in the number of fall-related TBIs in older adults suggests an urgent need to enhance fall-prevention efforts in that population. Multiple effective interventions have been identified, and CDC has developed the STEADI initiative (Stopping Elderly Accidents Deaths and Injuries) as a comprehensive strategy that incorporates empirically supported clinical guidelines and scientifically tested interventions to help primary care providers address their patients' fall risk through the identification of modifiable risk factors and implementation of effective interventions (e.g., exercise, medication management, and Vitamin D supplementation).