A model for preventing serious traffic injury in teens: or "keep those teenagers out of our ICU!"

Simulated Driving Performance, Self-Reported Driving Behaviors, and Mental Health Symptoms in Adolescent Novice Drivers

BACKGROUND

Risky driving behaviors contribute to adolescent injury, disability, and death, yet little is known about how mental health factors are associated with adolescent driving behaviors.

OBJECTIVES

The purpose of the research was to determine the association of risky driving behaviors and mental health symptoms in novice adolescent drivers.

METHODS

We recruited a convenience sample (n = 60) of adolescents to complete an assessment of driving performance errors in a high-fidelity simulator (Simulated Driving Assessment [SDA] Error Score) and a self-report measure of risky driving (Behavior of Young Novice Drivers Survey [BYNDS]). Participants also completed a mental health assessment of self-reported symptoms of depression (Center for Epidemiologic Studies-Depression Scale) and attention-deficit/hyperactivity disorder (ADHD; inattention and hyperactivity-impulsivity), conduct disorder, and oppositional defiant disorder (Conners-3 self-report and parent report). We evaluated the cross-sectional relationships between SDA Error Score, BYNDS, and mental health survey data with descriptive statistics, bivariate correlations, and linear regression.

RESULTS

In linear regression models, higher self-reported inattentive ADHD T-scores were associated with higher SDA Error Score (model adjusted R = .20). Higher self-reported T-scores of hyperactive-impulsive ADHD and conduct disorder were associated with higher BYNDS total scores (model adjusted R = .32). Parent report measures were not associated with adolescent BYNDS total score or SDA Error Score.

DISCUSSION

These data highlight the association of risky driving with adolescent symptoms of inattention, hyperactivity, and conduct disorder. The early stage of independent driving is an important time for addressing the relationship between driving performance and mental health conditions.

Teen Drivers' Perceptions of Inattention and Cell Phone Use While Driving

OBJECTIVE

Inattention to the roadway, including cell phone use while driving (cell phone calls, sending and reading texts, mobile app use, and Internet use), is a critical problem for teen drivers and increases risk for crashes. Effective behavioral interventions for teens are needed in order to decrease teen driver inattention related to cell phone use while driving. However, teens' perceptions of mobile device use while driving is a necessary component for theoretically driven behavior change interventions. The purpose of this study was to describe teen drivers' perceptions of cell phone use while driving in order to inform future interventions to reduce risky driving.

METHODS

We conducted 7 focus groups with a total of 30 teen drivers, ages 16-18, licensed for ≤ 1 year in Pennsylvania. The focus group interview guide and analysis were based on the Theory of Planned Behavior, identifying the attitudes, perceived behavioral control, and norms about inattention to the roadway. Directed descriptive content analysis was used to analyze the focus group interviews. All focus groups were coded by 2 research team members and discrepancies were reconciled. Themes were developed based on the data.

RESULTS

Teens had a mean age of 17.39 (SD = 0.52), mean length of licensure of 173.7 days (SD = 109.2; range 4-364), were 50% male and predominately white (90%) and non-Hispanic (97%). From the focus group data, 3 major themes emerged: (1) Recognizing the danger but still engaging; (2) Considering context; and (3) Formulating safer behaviors that might reduce risk. Despite recognizing that handheld cell phone use, texting, and social media app use are dangerous and distracting while driving, teens and their peers often engaged in these behaviors. Teens described how the context of the situation contributed to whether a teen would place or answer a call, write or respond to a text, or use a social media app. Teens identified ways in which they controlled their behaviors, although some still drew attention away from the roadway.

CONCLUSIONS

Cell phone use while driving is a contributor to motor vehicle crashes in teens, and effective interventions to decrease risks are needed. Teens viewed some types of cell phone use as unsafe and describe methods in which they control their behaviors. However, some of their methods still take attention off the primary task of driving. Teens could benefit from behavior change interventions that propose strategies to promote focused attention on the roadway at all times during the driving trip.

Risky driving, mental health, and health-compromising behaviours: risk clustering in late adolescents and adults

BACKGROUND

Health-compromising behaviours in adolescents and adults co-occur. Because motor vehicle crashes are the leading cause of death and disability for these age groups, understanding the association between risky driving and other health-compromising behaviours is critical.

METHODS

We performed a secondary analysis of data from a randomised controlled trial of an intervention for participants who screened positive for risky driving and problem drinking. Using baseline data, we examined relationships among conduct behaviour problems before and after age 15 years, depressive symptoms, sleep, problem drinking, and risky driving (hostile, reckless and drinking and driving) in late adolescents ages 18-24 (n=110) years, and adults ages 25-44 (n=202) years. We developed a measurement model for the entire sample using confirmatory factor analysis, which was then specified as a multigroup structural equation model.

RESULTS

Late adolescents and adults had some similar associations for pathways through problem drinking to drinking and driving; depression to reckless driving; and conduct behaviour problems after 15 years of age to hostile driving. Late adolescents, however, had more complex relationships: depressive symptoms and conduct behaviour problems before 15 years of age were associated with more risky driving behaviours through multiple pathways, and males reported more risky driving.

CONCLUSIONS

Risky driving is associated with other health-compromising behaviours and mental health factors. It is a multidimensional phenomenon more pronounced in late adolescence than adulthood. In order to promote safe driving, the findings support the need to consider behaviours that are a health threat in the late adolescent population during driving training and licensure.

TRIAL REGISTRATION NUMBER

NCT00164294.

Emergency Department-Based Brief Intervention to Reduce Risky Driving: A Life Course Perspective

Screening, Brief Intervention, and Referral to Treatment (SBIRT) has promise as a clinical intervention for health-compromising behaviors. We used a randomized controlled design in an Emergency Department (ED) setting to determine the efficacy of a nurse-delivered SBIRT to address risky driving in people 18 to 44 years of age. Risky drivers (n = 476) were randomized to brief intervention (BIG), contact-control (CCG), or no-contact-control (NCG) groups and were followed at 3, 6, 9, and 12 months. Outcomes included safety belt use, speeding, and driving through traffic lights. Safety belt use, times speeding between 10 and 19 mph over speed limit, and times driving through a yellow light declined significantly in the BIG as compared with the CCG at 3, 6, and 9 months. SBIRT reduced risky driving in our sample, but its effects did not persist after 9 months. We suggest that SBIRT has the potential to reduce vehicular-related injury in the 9 months after a brief intervention.

Thinkfirst for teens: finding an injury-prevention approach for teenagers

Teenagers are a vulnerable population for devastating injuries. The ThinkFirst for Teens injury-prevention program, which includes scientific information and real-life stories, was presented to high school freshman students and Web-based preprogram and postprogram surveys were used to evaluate injury knowledge and safety behaviors and influences. No statistically significant difference was found in the students' answers on the preprogram and postprogram surveys. After the program, student-reported seat belt and bicycle helmet compliance had improved from that reported in the preprogram survey. Other safety behaviors that did not improve remained better than the national trends reported in the 2009 Youth Risk Behavior Surveillance data. The study supports the literature reporting that parents influence their teenagers' safety behaviors.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Graduated driver licensing research, 2007-present: a review and commentary

The evolution of graduated licensing systems in the past 25 years has resulted in dramatic growth in research on this topic. The most recent summary reports have covered the period up to 2007. In the present article more recent and ongoing research is categorized, summarized, and discussed.