A cohort study of 20,822 young drivers: the DRIVE study methods and population

Young drivers' early access to their own car and crash risk into early adulthood: Findings from the DRIVE study

INTRODUCTION

Car ownership at early licensure for young drivers has been identified as a crash risk factor, but for how long this risk persists is unknown. This study examined crash hazard rates between young drivers with their own vehicle and those who shared a family vehicle at early licensure over 13 years.

METHODS

The DRIVE study, a 2003/04 survey of 20,806 young novice drivers in New South Wales, Australia was used to link to police crash, hospital and death records up to 2016. The first police-reported crash and crash resulting in hospitalisation/death was modelled via flexible parametric survival analysis by type of vehicle access at baseline (own vs. shared family vehicle).

RESULTS

After adjusting for covariates, drivers with their own vehicle at early licensure had an almost 30 % increased hazard rate for any crash after one year (95 % CI:1.16-1.42) compared with those who only had access to a family car and this attenuated but remained significantly higher until year 7 (HR: 1.1, 95 % CI: >1.00-1.20). For crashes resulting in hospitalisation or death, an almost 15-times higher hazard (95 % CI: 1.40-158.17) was observed at the start of follow up, remaining 50 % to year 3 (95 % CI:1.01-2.18).

CONCLUSIONS

Parents and young drivers should be aware of the increased risks involved in car ownership at early licensure. Development of poorer driving habits has been associated with less parental monitoring at this time. Graduated Driving Licensing educators, researchers and stakeholders should seek to address this and to identify improved safety management options.

Learning With a Supervisor Who has Traffic Offences and Young Driver Crashes: The DRIVE Study 13-Year Follow-Up

PURPOSE

Young learner drivers commonly must record substantial supervised practice driving before independent licensure. Supervisory driver requirements can be limited or highly regulated, yet research is lacking on the effectiveness of different approaches. The current objective was to explore whether young drivers who were mostly supervised by someone who they perceived had traffic offences versus no offences had different crash records over a period of 13 years postlicensing.

METHODS

DRIVE is an Australian prospective cohort study of more than 20,000 drivers who were aged 17-24 years and newly licensed during 2003-2004. They completed detailed baseline questionnaires, including whether the person they identified as supervising their learner driving the most had perceived traffic offences in the past 12 months. Responses were linked to their state crash, hospitalization, and death records to 2016. A parametric survival model was created to calculate hazard ratios of time to crash for those reporting that their supervisor had 0 versus 1 and 0 versus 2+ perceived offences, adjusting for the participants' prior crash history and other covariates.

RESULTS

After adjusting for covariates, 369 participants reporting supervisory drivers with 2+ perceived offences, compared to 15,451 participants reporting no such offences, had up to 1.67 (95% confidence interval 1.10-2.53 at 6 months) times the rate of any crash for the first 2.5 years and up to 2.01 (95% confidence interval 1.26-3.19 at 3.5 years) times the rate of crashes resulting in injury for 5.5 years.

DISCUSSION

Although overall supervision by a driver with two or more perceived offences was low, further attention is needed to ensure improved supervised driving experiences, with mentoring programs and professional instructor partnerships worthy of exploration.

Self-harm in adolescence and risk of crash: a 13-year cohort study of novice drivers in New South Wales, Australia

INTRODUCTION

Self-harm and suicide are leading causes of morbidity and death for young people, worldwide. Previous research has identified self-harm is a risk factor for vehicle crashes, however, there is a lack of long-term crash data post licensing that investigates this relationship. We aimed to determine whether adolescent self-harm persists as crash risk factor in adulthood.

METHODS

We followed 20 806 newly licensed adolescent and young adult drivers in the DRIVE prospective cohort for 13 years to examine whether self-harm was a risk factor for vehicle crashes. The association between self-harm and crash was analysed using cumulative incidence curves investigating time to first crash and quantified using negative binominal regression models adjusted for driver demographics and conventional crash risk factors.

RESULTS

Adolescents who reported self-harm at baseline were at increased risk of crashes 13 years later than those reporting no self-harm (relative risk (RR) 1.29: 95% CI 1.14 to 1.47). This risk remained after controlling for driver experience, demographic characteristics and known risk factors for crashes, including alcohol use and risk taking behaviour (RR 1.23: 95% CI 1.08 to 1.39). Sensation seeking had an additive effect on the association between self-harm and single-vehicle crashes (relative excess risk due to interaction 0.87: 95% CI 0.07 to 1.67), but not for other types of crashes.

DISCUSSION

Our findings add to the growing body of evidence that self-harm during adolescence predicts a range of poorer health outcomes, including motor vehicle crash risks that warrant further investigation and consideration in road safety interventions. Complex interventions addressing self-harm in adolescence, as well as road safety and substance use, are critical for preventing health harming behaviours across the life course.

Acculturation and risk of traffic crashes in young Asian-born Australian drivers

The study examines changes over time in crash risk differences between young Australian drivers born in Asia and those born in Australia.Data from the 2003 baseline survey of the DRIVE cohort of 20 806 young drivers aged 17-24 years were linked to police, hospital and death data up until 2016. The association between country of birth and crash was investigated using flexible parametric survival models adjusted for confounders.Six months after baseline, the crash risk in Asian-born drivers was less than half that of their Australian-born counterparts (mean HR, MHR 0.41; 95% CI 0.29 to 0.57), only to increase steadily over time to resemble that of Australian-born drivers 13 years later (MHR 0.94; 95% CI 0.66 to 1.36).This is likely to be associated with acculturation and the adoption by young Asian-born Australian drivers of driving behaviour patterns akin to those born locally. This needs to be considered in future road safety campaigns.

Driving offences and risk of subsequent crash in novice drivers: the DRIVE cohort study 12-year follow-up

Background

Penalties are a key component to improve road user safety, but previous studies suggested that they might not be successful in reducing crashing in offending drivers. However, these studies were not able to consider important crash risk factors in the analysis that might confound the results. Using data from a large prospective cohort study of young drivers in New South Wales, Australia, we explored if novice drivers with driving offences have a higher rates of car crash and if these differences are explained by established crash risk factors.

Methods

We used data from a 2003/2004 Australian survey of young drivers, linked to police reported offence and crash data, hospital data and deaths data up to 2016. We used Poisson regression models adjusted for confounders to estimate the association between driving offences during 2003–2006 with car crash during 2007–2016.

Results

The study cohort comprised 20 781 young drivers of whom 7860 drivers (37.8%) had at least one driving offence and 2487 (12.0%) were involved in at least one crash. After adjusting for confounders in the regression model, drivers with three or more driving offences had 2.25 (95% CI 1.98 to 2.57), 2.87 (95% CI 1.60 to 5.17) and 3.28 (95% CI 2.28 to 4.72) times higher rates of any crash, crashes that resulted in hospital admission or death and single vehicle crashes compared with drivers with no driving offences.

Conclusion

Measures that successfully mitigate the underlying risk factors for both, crashes and offences, have the potential to improve road safety.

Risky youth to risky adults: Sustained increased risk of crash in the DRIVE study 13 years on

The objective of this study was to investigate if drivers who exhibit risky driving behaviours during youth (aged 17-24 years) have an increased risk of car crash up to 13 years later. We used data from the DRIVE study, a 2003/04 survey of 20,806 young novice drivers in New South Wales, Australia. The data were linked with police crash, hospital and deaths data up to 2016. We analysed differences in crash associated with 13 items of risky driving behaviours using negative binominal regression models adjusted for driver demographics, driving exposure and known crash risk factors. The items were summarised in one index and grouped into quintiles for the analysis. After adjusting for confounding, drivers of the third (RR 1.16, 95% CI 1.05-1.30), fourth (RR1.22, 95% CI1.09-1.36) and fifth quintile (RR 1.36, 95% CI 1.21-1.53) had higher crash rates compared to the lowest risk-takers. Drivers with the highest scores on the risky driving measure had higher rates of crash related hospital admission or death (RR 1.92, 95% CI 1.13-3.27), crashes in wet conditions (RR 1.35,95% CI 1.05-1.73), crashes in darkness (RR 1.55, 95% CI 1.25-1.93) and head-on crashes (RR 2.14, 95% CI 1.07-4.28), compared with drivers with the lowest scores. Novice adolescent drivers who reported high levels of risky driving when they first obtained a driver licence remained at increased risk of crash well into adulthood. Measures that successfully reduce early risky driving, have the potential to substantially reduce road crashes and transport related injuries and deaths over the lifespan.

Are there sex differences in crash and crash-related injury between men and women? A 13-year cohort study of young drivers in Australia

BACKGROUND

Young men have long been known to be disproportionately impacted by road crash and crash-related injury compared to young women and older drivers. However, there is limited insight into how sex differences in crash and crash-related injury changes over time as men and women get older and gain more driving experience. To explore sex differences in crash and crash-related injury, we undertook a sex disaggregated analysis in a large longitudinal cohort of over 20,000 young drivers in New South Wales, Australia, for up to 13 years after they first attained their independent car driver licence.

METHODS

DRIVE Study survey data from 2003-04 were linked with police, hospital and deaths data up to 2016. Sex differences were analysed using cumulative incidence curves investigating time to first crash and in negative binominal regression models adjusted for driver demographics and crash risk factors.

RESULTS

After adjusting for demographics and driving exposure, compared with women, men had 1.25 (95% CI 1.18-1.33), 2.07 (1.75-2.45), 1.28 (95% CI 1.13-1.46), 1.32 (95% CI 1.17-1.50) and 1.59 (95% CI 1.43-1.78) times higher rates of any crash, single vehicle crash, crash on streets with a speed limit of 80 km/h or above, crash in wet conditions and crash in the dark, respectively. By contrast, men were less likely to be involved in crashes that resulted in hospitalisation compared to women 0.73 (95% CI 0.55-0.96).

CONCLUSIONS

Young men are at increased risk of crash, and this risk persists as they get older and gain more driving experience. Despite lower risk of crash, women are at higher risk of crash related injury requiring hospitalisation. These differences in men's and women's risk of crash and injury signal the need for better understanding of how sex and/or gender may contribute to risk of crash and injury across the life-course.

Association of Environmental Risk Factors and Personality Traits With Risky Driving Behaviors in a Sample of Young Adults From Saudi Arabia

Road traffic accidents represent a serious problem in the Kingdom of Saudi Arabia (KSA), with rates of such accidents far exceeding the rates in developed nations. Even so, there remains relatively little knowledge regarding the driving behaviors among Saudi Arabians. The current study sought to address this gap in the literature by examining the environmental and trait-based contributors to risky driving behaviors among male and female drivers in the KSA. To do so, a sample of college students from a large university in the KSA was analyzed. The results revealed that delinquent peers, low levels of self-control, and higher levels of driving anger were associated with involvement in risky driving behaviors for both male and female drivers. Understanding the interconnections among peers, self-control, anger, and risky driving behaviors may provide some insight into how to reduce risky driving behaviors. Focusing on ways to reduce exposure to risk factors for risky driving behaviors may be one strategy for reducing these types of driving behaviors.

Socioeconomic status during youth and risk of car crash during adulthood. Findings from the DRIVE cohort study

BACKGROUND

Young drivers of low socioeconomic status (SES) have a disproportionally high risk of crashing compared with their more affluent counterparts. Little is known if this risk persists into adulthood and if it differs between men and women.

METHODS

We used data from a 2003/2004 Australian survey of young drivers (n=20 806), which included measures of drivers' demographics and established crash risk factors. These data were linked to police-reported crash, hospital and death data up to 2016. We used negative binomial regression models to estimate the association between participants' SES, with car crash.

RESULTS

After adjusting for confounding, drivers of lowest SES had 1.30 (95% CI 1.20 to 1.42), 1.90 (95% CI 1.25 to 2.88), 3.09 (95% CI 2.41 to 3.95) and 2.28 (95% CI 1.85 to 2.82) times higher rate of crash, crash-related hospitalisation, crash in country areas and crash on streets with a speed limit of 80 km/hour or above compared with drivers of highest SES, respectively. For single-vehicle crashes, women in the lowest SES groups had 2.88 (95% CI 1.83 to 4.54) times higher rate of crash compared with those in the highest SES group, but no differences were observed for men from different SES groups.

CONCLUSION

Young drivers who lived in areas of low SES at the time of the survey had a sustained increased risk of crash over the following 13 years compared with drivers from the most affluent areas. Our findings suggest that in addition to traditional measures, road transport injury prevention needs to consider the wider social determinants of health.

Association between higher-order driving instruction and risky driving behaviours: Exploring the mediating effects of a self-regulated safety orientation

Adolescents' risky driving behaviours contribute to their over-representation in road trauma. Higher-order driving instruction is suggested to reduce such behaviours. To sustain positive behaviours in the long-term, self-determination theory identifies self-regulation as fundamental. The current research explored associations between higher-order driving instruction, risky driving behaviours, and a self-regulated safety orientation. Learner drivers (n = 544), aged 16-19 years, responded to a 91-item survey. Self-regulated safety orientation was found to fully mediate the relationship between higher-order driving instruction and inattentive risky driving behaviours, and between anticipatory higher-order driving instruction and intentional risky driving behaviours. A partial mediation was found between self-regulatory higher-order instruction and intentional risky driving behaviours. These results support that higher-order driving instruction, delivered to develop a self-regulated safety orientation, has potential to reduce young novice drivers' risky driving behaviours. Further research is recommended to triangulate these results through direct observation and longitudinal evaluation.

Neurodevelopmental Trajectories Related to Attention Problems Predict Driving-Related Risk Behaviors

Objective: Investigate neurodevelopmental trajectories related to attention/hyperactivity problems (AP) in a community sample of adolescents and whether these trajectories predict later-emerging health risk behaviors. Method: One hundred sixty-six participants underwent up to three magnetic resonance imaging (MRI) scans (n = 367) between 11 and 20 years of age. AP were measured during early adolescence using the Child Behaviour Checklist, and engagement in risk behaviors was measured during late adolescence using the "DRIVE" survey (i.e., driving risks) and items assessing alcohol-harms. Results: Greater AP scores during early adolescence were related to less reduction over time of left dorsal prefrontal, left ventrolateral prefrontal, and right orbitofrontal thickness. Less thinning of the orbitofrontal cortex was related to greater driving-related risk behaviors at late adolescence. Conclusion: Findings highlight altered neurodevelopmental trajectories in adolescents with AP. Furthermore, altered orbitofrontal development was related to later-emerging driving-related risk, and this neurobiological change mediated the association between attention problems and risk behaviors.

The UAE healthy future study: a pilot for a prospective cohort study of 20,000 United Arab Emirates nationals

Background

The United Arab Emirates (UAE) is faced with a rapidly increasing burden of non-communicable diseases including obesity, diabetes, and cardiovascular disease. The UAE Healthy Future study is a prospective cohort designed to identify associations between risk factors and these diseases amongst Emiratis. The study will enroll 20,000 UAE nationals aged ≥18 years. Environmental and genetic risk factors will be characterized and participants will be followed for future disease events. As this was the first time a prospective cohort study was being planned in the UAE, a pilot study was conducted in 2015 with the primary aim of establishing the feasibility of conducting the study. Other objectives were to evaluate the implementation of the main study protocols, and to build adequate capacity to conduct advanced clinical laboratory analyses.

Methods

Seven hundred sixty nine UAE nationals aged ≥18 years were invited to participate voluntarily in the pilot study. Participants signed an informed consent, completed a detailed questionnaire, provided random blood, urine, and mouthwash samples and were assessed for a series of clinical measures. All specimens were transported to the New York University Abu Dhabi laboratories where samples were processed and analyzed for routine chemistry and hematology. Plasma, serum, and a small whole blood sample for DNA extraction were aliquoted and stored at −80 °C for future analyses.

Results

Overall, 517 Emirati men and women agreed to participate (68% response rate). Of the total participants, 495 (95.0%), 430 (82.2%), and 492 (94.4%), completed the questionnaire, physical measurements, and provided biological samples, respectively.

Conclusions

The pilot study demonstrated the feasibility of recruitment and completion of the study protocols for the first large-scale cohort study designed to identify emerging risk factors for the major non-communicable diseases in the region.

Electronic supplementary material

The online version of this article (10.1186/s12889-017-5012-2) contains supplementary material, which is available to authorized users.

Road trauma among young Australians: Implementing policy to reduce road deaths and serious injury

OBJECTIVE

The objective of this study was to estimate the likely reduction in road trauma associated with the implementation of effective interventions to reduce road trauma among young Australians.

METHODS

A desktop evaluation was conducted to model the likely reduction in road trauma (deaths and serious injuries resulting in hospitalization) among young people aged 17-24 years residing in Queensland, New South Wales, and Victoria. Potential interventions were identified using a rapid literature review and assigned a score based on evidence of effectiveness and implementation feasibility with the 3 highest scoring interventions included in the modeling. Likely reduction in road trauma was estimated by applying the average risk reduction effect sizes for each intervention to baseline risk (passenger or driver death or serious injury per 100,000 population) of road trauma for young Australians. Point estimates were calculated for the potential number of deaths and serious injuries averted in each state and per 100,000 population, with a one-way sensitivity analysis conducted using uncertainty ranges identified.

RESULTS

Peer passenger and night driving restrictions as well as improved vehicle safety measures had the greatest potential to reduce road trauma. Peer passenger restrictions could avert 14 (range: 5-24) and 24 (range: 8-41) hospitalizations per year in Queensland and New South Wales, respectively, and night driving restrictions could avert 17 (range: 7-26), 28 (range: 12-45), and 13 (range: 6-21) hospitalizations annually in Queensland, New South Wales, and Victoria. These interventions reduced fatalities by less than 1 death annually in each state. Improved vehicle safety measures could avert 0-3, 0-4, and 0-3 deaths and 3-91, 4-156, and 2-75 hospitalizations in Queensland, New South Wales, and Victoria.

CONCLUSIONS

Key elements of graduated licensing (peer passenger and night driving restrictions) along with vehicle safety interventions offer modest but practically significant reductions in road trauma for young Australians. State governments need to revise current legislation to ensure that these reductions in road trauma can be realized.

The Australian Longitudinal Study on Women's Health: Using Focus Groups to Inform Recruitment

Background

Recruitment and retention of participants to large-scale, longitudinal studies can be a challenge, particularly when trying to target young women. Qualitative inquiries with members of the target population can prove valuable in assisting with the development of effective recruiting techniques. Researchers in the current study made use of focus group methodology to identify how to encourage young women aged 18-23 to participate in a national cohort online survey.

Objective

Our objectives were to gain insight into how to encourage young women to participate in a large-scale, longitudinal health survey, as well as to evaluate the survey instrument and mode of administration.

Methods

The Australian Longitudinal Study on Women’s Health used focus group methodology to learn how to encourage young women to participate in a large-scale, longitudinal Web-based health survey and to evaluate the survey instrument and mode of administration. Nineteen groups, involving 75 women aged 18-23 years, were held in remote, regional, and urban areas of New South Wales and Queensland.

Results

Focus groups were held in 2 stages, with discussions lasting from 19 minutes to over 1 hour. The focus groups allowed concord to be reached regarding survey promotion using social media, why personal information was needed, strategies to ensure confidentiality, how best to ask sensitive questions, and survey design for ease of completion. Recruitment into the focus groups proved difficult: the groups varied in size between 1 and 8 participants, with the majority conducted with 2 participants.

Conclusions

Intense recruitment efforts and variation in final focus group numbers highlights the “hard to reach” character of young women. However, the benefits of conducting focus group discussions as a preparatory stage to the recruitment of a large cohort for a longitudinal Web-based health survey were upheld.

Thrill and adventure seeking as a modifier of the relationship of perceived risk with risky driving among young drivers

Risky driving contributes to road trauma, a leading cause of mortality among young people. Health-relevant behaviour models suggest a negative relationship between risky driving and perceived risk of its outcomes. However, high sensation seekers may value the "thrill" of the risk, and positive associations between sensation seeking and risky driving have been observed. This is the first study to examine whether aspects of sensation seeking modify the relationship between perceived risk and risky driving. Young drivers in metropolitan Sydney and rural New South Wales [NSW] (n=797) completed a survey relating to one of the four risky driving behaviours (speeding, drink-driving, driving while fatigued, and failing to wear a seatbelt). Results suggest that the Thrill and Adventure Seeking subscale of Zuckerman's (1994) Sensation Seeking Scale moderate the relationship of perceived risk with risky driving - indicating a negative relationship for low-scores, but not high-scorers, on the TAS subscale. Thus, road safety campaigns that emphasize the riskiness of a particular behaviour may be of limited benefit to thrill and adventure seekers.

The NASOROSSO (Rednose) project: an Italian study on alcohol consumption in recreational places

The Nasorosso project of the Italian Youth Department and the National Institute of Health, aimed to raise awareness about drinking and driving under the influence of alcohol among club goers with a series of initiatives. Within the framework of the project, blood alcohol concentration (BAC) was measured on 106,406 individuals before and after clubbing in 66 different recreational sites from 11 Italian provinces, over 16 months. Participating individuals were interviewed regarding sociodemographic and environmental characteristics and alcohol intoxicated people were offered to be taken home. The BAC median at the club entry was 0.26 g/L with 65.3% subjects showing a BAC value under the driving legal limit of 0.5g/L. At the exit from clubs, BAC median value rose to 0.44 g/L and subjects with BAC value under the legal limit decreased to 54.9%. Being male, aged between 18 and 34 years with a diploma, being a drinker and entering the disco with a BAC already beyond the legal limit predicted a BAC value beyond 0.5 g/L at exit from the recreational place. Conversely, being a driver, being a student and exiting from the disco before 4 a.m. reduced the probability of having a BAC higher than 0.5 g/L at the end of the night. Health policies to prevent harmful use of alcohol in young people should continue to offer targeted information/ prevention; in order to steadily increase the awareness of the dangers and the damages of excessive use of alcohol.

The relationship between alcohol consumption and fatal motor vehicle injury: high risk at low alcohol levels

BACKGROUND

Alcohol consumption causes motor vehicle accident (MVA) injury in a dose-response fashion. However, the relationship between how this risk is different with respect to fatal and nonfatal outcomes is not clear. A meta-analysis has already been completed for alcohol consumption and nonfatal MVA injury, but none exists for fatal injury. Thus, an analysis of the acute dose-response relationship between alcohol and motor vehicle injury death is warranted to generate single occasion- and dose-specific relative risks for the first time.

METHODS

A systematic literature review and inverse-variance weighted, random effects meta-analysis were conducted to fill this gap. Fractional polynomial regression was used to model the dose-response relationship. Usual tests of heterogeneity and publication bias were run.

RESULTS

Five studies meeting the inclusion criteria of this analysis were selected. At all levels of blood alcohol concentration (BAC), the odds ratio (OR) of fatal motor vehicle injury was significant. Overall, the 5 combined studies yielded an OR of fatal injury of 1.74 (95% CI: 1.43-2.14) for every 0.02% increase in BAC. At 0.08, the legal limit in most countries, the OR was 13.0 (95% CI: 11.1-15.2).

CONCLUSIONS

This study is able to definitively show and quantify, for the first time, the significantly increased OR for fatal motor vehicle injury. This analysis showed some evidence of both study heterogeneity and publication bias, likely due to the increased variation we could expect from a small study number. The alcohol-caused fatal motor vehicle injury literature is sparse with respect to dose-response information. More studies investigating this relationship and other injury types are recommended in this area to be able to calculate stable estimates of risk overall and by injury type specifically.

Global burden of injuries attributable to alcohol consumption in 2004: a novel way of calculating the burden of injuries attributable to alcohol consumption

Background

Alcohol consumption is a major risk factor for injuries; however, international data on this burden are limited. This article presents new methods to quantify the burden of injuries attributable to alcohol consumption and quantifies the number of deaths, potential years of life lost (PYLL), and disability-adjusted life years (DALYs) lost from injuries attributable to alcohol consumption for 2004.

Methods

Data on drinking indicators were obtained from the Comparative Risk Assessment study. Data on mortality, PYLL, and DALYs for injuries were obtained from the World Health Organization. Alcohol-attributable fractions were calculated based on a new risk modeling methodology, which accounts for average and heavy drinking occasions. 95% confidence intervals (CIs) were calculated using a Monte Carlo simulation method.

Results

In 2004, 851,900 (95% CI: 419,400 to 1,282,500) deaths, 19,051,000 (95% CI: 9,767,000 to 28,243,000) PYLL, and 21,688,000 (95% CI: 11,097,000 to 32,385,000) DALYs for people 15 years and older were due to injuries attributable to alcohol consumption. With respect to the total number of deaths, harms to others were responsible for 15.1% of alcohol-attributable injury deaths, 14.5% of alcohol-attributable injury PYLL, and 11.35% of alcohol-attributable injury DALYs. The overall burden of injuries attributable to alcohol consumption corresponds to 17.3% of all injury deaths, 16.7% of all PYLL, and 13.6% of all DALYs caused by injuries, or 1.4% of all deaths, 2.0% of all PYLL, and 1.4% of all DALYs in 2004.

Conclusions

The novel methodology described in this article to calculate the burden of injuries attributable to alcohol consumption improves on previous methodology by more accurately calculating the burden of injuries attributable to one’s own drinking, and for the first time, calculates the burden of injuries attributable to the alcohol consumption of others. The burden of injuries attributable to alcohol consumption is large and is entirely avoidable, and policies and strategies to reduce it are recommended.

Attempts at the practical on-road driving test and the hazard perception test and the risk of traffic crashes in young drivers

OBJECTIVE

This study separately examined the impact of the outcomes of a practical on-road driving test and a hazard perception test on the likelihood of traffic crashes among a cohort of newly licensed young drivers in New South Wales (NSW), Australia.

METHODS

The DRIVE study is a prospective cohort study of drivers aged 17 to 24 years holding their first-year provisional driver license in NSW. Information obtained from 20,822 participants in a detailed baseline questionnaire was linked to information on the number of attempts at a mandatory practical on-road driving test and hazard perception test as well as police-reported traffic crashes.

RESULTS

After controlling for a number of sociodemographic and behavioral factors as well as factors related to driver learning experiences, multivariate analysis showed that those who failed the practical on-road test at least 4 times had an increased risk of involvement in a traffic crash compared to those who passed the test at first attempt (relative risk [RR]: 1.79, 95% confidence interval [CI]: 1.20-2.65). The crash risk among those who failed the practical on-road test at least 4 times was particularly high in females (RR: 2.10, 95% CI: 1.20-3.68). Similarly, those who failed the hazard perception test at least twice had an increased risk of involvement in a traffic crash (RR: 1.83, 95% CI: 1.27-2.63) compared to those who passed the test on the first attempt. The crash risk of those who failed the hazard perception test at least twice was particularly high in males (RR: 2.5, 95% CI: 1.5-4.1) and among those from rural and remote areas (RR: 5.53, 95% CI: 1.63-18.71).

CONCLUSIONS

The findings have implications on licensing practices and suggest the need for adequate strategies to assist young drivers with multiple failures in the driving and hazard perception tests.

Prevalence of teen driver errors leading to serious motor vehicle crashes

OBJECTIVES

Motor vehicle crashes are the leading cause of adolescent deaths. Programs and policies should target the most common and modifiable reasons for crashes. We estimated the frequency of critical reasons for crashes involving teen drivers, and examined in more depth specific teen driver errors.

METHODS

The National Highway Traffic Safety Administration's (NHTSA) National Motor Vehicle Crash Causation Survey collected data at the scene of a nationally representative sample of 5470 serious crashes between 7/05 and 12/07. NHTSA researchers assigned a single driver, vehicle, or environmental factor as the critical reason for the event immediately leading to each crash. We analyzed crashes involving 15-18 year old drivers.

RESULTS

822 teen drivers were involved in 795 serious crashes, representing 335,667 teens in 325,291 crashes. Driver error was by far the most common reason for crashes (95.6%), as opposed to vehicle or environmental factors. Among crashes with a driver error, a teen made the error 79.3% of the time (75.8% of all teen-involved crashes). Recognition errors (e.g., inadequate surveillance, distraction) accounted for 46.3% of all teen errors, followed by decision errors (e.g., following too closely, too fast for conditions) (40.1%) and performance errors (e.g., loss of control) (8.0%). Inadequate surveillance, driving too fast for conditions, and distracted driving together accounted for almost half of all crashes. Aggressive driving behavior, drowsy driving, and physical impairments were less commonly cited as critical reasons. Males and females had similar proportions of broadly classified errors, although females were specifically more likely to make inadequate surveillance errors.

CONCLUSIONS

Our findings support prioritization of interventions targeting driver distraction and surveillance and hazard awareness training.

Novice riders and the predictors of riding without motorcycle protective clothing

BACKGROUND

While helmet usage is often mandated, few motorcycle and scooter riders make full use of protection for the rest of the body. Little is known about the factors associated with riders' usage or non-usage of protective clothing.

METHODS

Novice riders were surveyed prior to their provisional licence test in NSW, Australia. Questions related to usage and beliefs about protective clothing, riding experience and exposure, risk taking and demographic details. Multivariable Poisson regression models were used to identify factors associated with two measures of usage, comparing those who sometimes vs rarely/never rode unprotected and who usually wore non-motorcycle pants vs motorcycle pants.

RESULTS

Ninety-four percent of eligible riders participated and usable data was obtained from 66% (n=776). Factors significantly associated with riding unprotected were: youth (17-25 years) (RR = 2.00, 95% CI: 1.50-2.65), not seeking protective clothing information (RR = 1.29, 95% CI = 1.07-1.56), non-usage in hot weather (RR = 3.01, 95% CI: 2.38-3.82), awareness of social pressure to wear more protection (RR = 1.48, 95% CI: 1.12-1.95), scepticism about protective benefits (RR = 2.00, 95% CI: 1.22-3.28) and riding a scooter vs any type of motorcycle. A similar cluster of factors including youth (RR = 1.17, 95% CI: 1.04-1.32), social pressure (RR = 1.32, 95% CI: 1.16-1.50), hot weather (RR = 1.30, 95% CI: 1.19-1.41) and scooter vs motorcycles were also associated with wearing non-motorcycle pants. There was no evidence of an association between use of protective clothing and other indicators of risk taking behaviour.

CONCLUSIONS

Factors strongly associated with non-use of protective clothing include not having sought information about protective clothing and not believing in its injury reduction value. Interventions to increase use may therefore need to focus on development of credible information sources about crash risk and the benefits of protective clothing. Further work is required to develop motorcycle protective clothing suitable for hot climates.

Does psychological distress increase the risk for motor vehicle crashes in young people? findings from the DRIVE study

PURPOSE

Earlier research demonstrates increased and decreased risk of crash related to psychological distress; however, previous literature has almost entirely used retrospective study designs and has not been able to adequately control for important confounders such as exposure to driving, alcohol and drug use, or having had a previous crash. This study aimed to assess the relationship between psychological distress and risk of motor vehicle crashes.

METHODS

The DRIVE study is a prospective cohort study of 20,822 novice drivers aged 17-24 years in Australia. Information on risk factors for motor vehicle crash was collected through online questionnaire and subsequently linked to police-reported crashes. Poisson regression was used to analyze risk of various crash types by low, moderate, high, and very high levels of psychological distress, taking into account other known risk factors for crash.

RESULTS

Compared to the referent group with low or no distress, a protective effect against crash was observed for young people who reported a moderate amount of psychological distress in unadjusted (RR = .87; 95% CI = .76-1.00) and multivariable analyses (RR = .85; 95% CI = .74-.97). Severe psychological distress was not significantly associated with an increase or decrease in the risk of crash. Psychological distress was not significantly associated with an increased risk of single vehicle crash.

CONCLUSION

Earlier studies may have overestimated risk for motor vehicle crashes associated with psychological distress. This study found little convincing evidence to support a strong risk relationship for higher levels of distress and indeed found a modest protective association for low levels of distress.

Short sleep duration in prevalent and persistent psychological distress in young adults: the DRIVE study

OBJECTIVES

Young people are sleeping less. Short sleep duration has a range of negative consequences including a hypothesized link with psychological distress, which has yet to be studied

DESIGN

Prospective cohort study

SETTING

Community-based sample from Australia

PARTICIPANTS

Twenty thousand (20,822) young adults (aged 17-24) identified through the state vehicle licensing authority. A random sample (n = 5000) was approached for follow-up 12-18 months later, with 2837 providing full data.

MAIN OUTCOME MEASURE

Psychological distress, determined by a Kessler 10 score > 21, at baseline; and as both onset and persistence of distress at follow-up.

RESULTS

Shorter sleep duration was linearly associated with prevalent psychological distress: relative risk (RR) 1.14 (95% CI 1.12 to 1.15). Only the very short (< 5 h) sleepers among those not distressed at baseline had an increased risk for onset of psychological distress (RR 3.25 [95% CI 1.84, 5.75]). Of 945 cohort participants reporting psychological distress at baseline, 419 (44%) were distressed at follow-up. Each hour less of sleep increased the risk of psychological distress persisting after adjustment for potential confounding variables: RR 1.05 (95% CI 1.01 to 1.10). Long sleep duration showed no association with distress at any time point.

CONCLUSIONS

Self-reported shorter sleep duration is linearly associated with prevalent and persistent psychological distress in young adults. In contrast, only the very short sleepers had a raised risk of new onset of distress. Different approaches to sleep duration measurement yield different results and should guide any interventions to improve subjective sleep duration in young adults.

The more you drink, the harder you fall: a systematic review and meta-analysis of how acute alcohol consumption and injury or collision risk increase together

Alcohol consumption causes injury in a dose-response manner. The most common mode of sustaining an alcohol-attributable injury is from a single occasion of acute alcohol consumption, but much of the injury literature employs usual consumption habits to assess risk instead. An analysis of the acute dose-response relationship between alcohol and injury is warranted to generate single occasion- and dose-specific relative risks. A systematic literature review and meta-analysis was conducted to fill this gap. Linear and best-fit first-order model were used to model the data. Usual tests of heterogeneity and publication bias were run. Separate meta-analyses were run for motor vehicle and non-motor vehicle injuries, as well as case-control and case-crossover studies. The risk of injury increases non-linearly with increasing alcohol consumption. For motor vehicle accidents, the odds ratio increases by 1.24 (95% CI: 1.18-1.31) per 10-g in pure alcohol increase to 52.0 (95% CI: 34.50-78.28) at 120 g. For non-motor vehicle injury, the OR increases by 1.30 (95% CI: 1.26-1.34) to an OR of 24.2 at 140 g (95% CI: 16.2-36.2). Case-crossover studies of non-MVA injury result in overall higher risks than case-control studies and the per-drink increase in odds of injury was highest for intentional injury, at 1.38 (95% CI: 1.22-1.55). Efforts to reduce drinking both on an individual level and a population level are important. No level of consumption is safe when driving and less than 2 drinks per occasion should be encouraged to reduce the risk of injury.

Risky driving behavior and road traffic crashes among young Asian Australian drivers: findings from the DRIVE study

OBJECTIVE

To examine differences in risky driving behavior and likelihood of traffic crash according to the country of birth of recently licensed young drivers. The groups examined include those born in Australia, those born in Asia, and those born in other countries.

DESIGN AND SETTING

The DRIVE study is a prospective cohort study of drivers aged 17-24 years holding their first-year provisional driver license in New South Wales, Australia. Information obtained from 20,822 participants who completed a baseline questionnaire was linked to police-reported traffic crashes.

MAIN OUTCOME MEASURES

Self-reported risky driving behaviors and police-reported traffic crashes in young drivers.

RESULTS

Young drivers who were born in Asian countries were less likely to report engaging in risky driving behaviors than their Australian-born counterparts. The proportion of participants reporting a high level of risky driving was 31.5 percent (95% confidence intervale [CI], 30.8-32.1) among Australian-born drivers compared to 25.6 percent (95% CI, 23.1-28.2) among Asian-born drivers and 30.4 percent (95% CI, 28.4-32.5) among those born in other regions. Asian-born participants had half the risk of a crash as a driver than their Australian-born counterparts (relative risk [RR] 0.55; 95% CI, 0.41-0.75) after adjusting for a number of demographic factors and driving and risk-taking behaviors. The comparative risk was even lower among those aged 17 years (RR 0.29; 95% CI, 0.29-0.75). Risk estimates for people born in other regions did not differ to those for Australian-born respondents.

CONCLUSIONS

The study highlights the lower level of risky driving and significantly reduced crash risk for Australian drivers born in Asian countries relative to those born locally. Further research is needed to examine factors underlying this reduced risk and the impact of the length of residence in the host country.

A European study on alcohol and drug use among young drivers: the TEND by Night study design and methodology

Background

Young individuals are the age group with the highest risk of car accidents. One of main explanations relies on the use of psychoactive substances (alcohol, illegal and medicinal drugs), which are known to be major risk factors of road accidents, and whose consumption is almost universally more common among younger drivers. Although the correlation between psychoactive substances use and decrease in driving performance has been established in controlled experimental or laboratory settings, few studies were conducted in naturalistic circumstances. The TEND by Night project has been designed to evaluate the relationship between driving performance and psychoactive substances assumption in young drivers enrolled at typical places of consumption.

Methods/Design

The TEND by Night project, endorsed by the European Commission, is a multidisciplinary, multi-centric, cross-sectional study conducted in six European countries (Italy, Belgium/Netherlands, Bulgaria, Spain, Poland and Latvia). The study population consists of 5000 young drivers aged 16-34 years, attending recreational sites during weekend nights. The intervention is based on the portal survey technique and includes several steps at the entrance and exit of selected sites, including the administration of semi-structured questionnaires, breath alcohol test, several drug assumption test, and measurement of the reaction time using a driving simulator. The main outcome is the difference in reaction time between the entrance and exit of the recreation site, and its correlation with psychoactive substances use. As a secondary outcome it will be explored the relationship between reaction time difference and the amount of consumption of each substance. All analyses will be multivariate.

Discussion

The project methodology should provide some relevant advantages over traditional survey systems. The main strengths of the study include the large and multicentric sample, the objective measurement of substance assumption (which is typically self-reported), the application of a portal survey technique and the simultaneous evaluation of several psychoactive substances.

Association between Supervisory Driver Offences and Novice Driver Crashes Post-Licensure

This research explore associations between driving offences of learner supervisory drivers and subsequent crashes as novice independent drivers in a prospective cohort of 20,822 drivers aged 17-24 in New South Wales, Australia, on their first independent driver licence. Information on demographics, primary supervisory drivers, and various risk factors was collected via an online questionnaire and subsequently linked to police-reported crashes two years later. Poisson regression determined that the unadjusted relative risk of crash was 1.35 (CI 1.14-1.60) for novices whose supervisors had offences, with this association remaining when adjusting for supervisor age, gender and relationship to the novice (RR=1.37, CI 1.16-1.63), but not when additionally controlling for novice driver demographics and characteristics (RR=1.50, CI 0.83-2.70). These findings suggest newly-licensed drivers previously supervised by drivers with recent traffic offences have a one-third higher risk of crashing. This risk is independent of the supervisor demographics, but mitigated by the young drivers' personal characteristics. Careful consideration should be given to policy developments regarding supervised driving requirements that rely heavily on parents to adopt this role.

Self-harm and risk of motor vehicle crashes among young drivers: findings from the DRIVE Study

BACKGROUND

Some motor vehicle crashes, particularly single-vehicle crashes, may result from intentional self-harm. We conducted a prospective cohort study to assess the risk that intentional self-harm poses for motor vehicle crashes among young drivers.

METHODS

We prospectively linked survey data from newly licensed drivers aged 17-24 years to data on licensing attempts and police-reported motor vehicle crashes during the follow-up period. We investigated the role of recent engagement in self-harm on the risk of a crash. We took into account potential confounders, including number of hours of driving per week, psychological symptoms and substance abuse.

RESULTS

We included 18 871 drivers who participated in the DRIVE Study for whom data on self-harm and motor vehicle crashes were available. The mean follow-up was 2 years. Overall, 1495 drivers had 1 or more crashes during the follow-up period. A total of 871 drivers (4.6%) reported that they had engaged in self-harm in the year before the survey. These drivers were at significantly increased risk of a motor vehicle crash compared with drivers who reported no self-harm (relative risk [RR] 1.42, 95% confidence interval [CI] 1.15-1.76). The risk remained significant, even after adjustment for age, sex, average hours of driving per week, previous crash, psychological distress, duration of sleep, risky driving behaviour, substance use, remoteness of residence and socio-economic status (RR 1.37, 95% CI 1.09-1.72). Most of the drivers who reported self-harm and had a subsequent crash were involved in a multiple-vehicle crash (84.1% [74/88]).

INTERPRETATION

Engagement in self-harm behaviour was an independent risk factor for subsequent motor vehicle crash among young drivers, with most crashes involving multiple vehicles.

Young driver education programs that build resilience have potential to reduce road crashes

OBJECTIVE

The research aimed to explore associations between participation in 2 education programs for school-based learner drivers and subsequent road traffic offenses and crashes among a large cohort of newly licensed drivers.

METHODS

DRIVE is a prospective cohort study of 20822 first-year drivers aged 17 to 24 in New South Wales (NSW), Australia. Participants completed a detailed questionnaire and consented to data linkage in 2003-2004. Questionnaire items included year of participation in 2 specific education programs: a 1-day workshop-only program focusing on driving risks ("driver-focused") and a whole-of-community program also including a 1-day workshop but also longer term follow-up activities and a broader focus on reducing risk-taking and building resilience ("resilience-focused"). Survey data were subsequently linked to police-reported crash and offense data for 1996-2005. Poisson regression models that adjusted for multiple confounders were created to explore offenses and crashes as a driver (dichotomized as 0 vs >or=1) after program participation.

RESULTS

Offenses did not differ between groups; however, whereas the driver-focused program was not associated with reduced crash risk, the resilience-focused program was associated with a 44% reduced relative risk for crash (0.56 [95% confidence interval: 0.34-0.93]).

CONCLUSIONS

The large effect size observed and complementary findings from a comparable randomized, controlled trial in the United States suggest programs that focus more generally on reducing risks and building resilience have the potential to reduce crashes. A large, representative, randomized, controlled trial is urgently needed to confirm road safety benefits and ensure evidence-based spending and practitioner recommendations in this field.

Novice drivers' risky driving behavior, risk perception, and crash risk: findings from the DRIVE study

OBJECTIVES

We explored the risky driving behaviors and risk perceptions of a cohort of young novice drivers and sought to determine their associations with crash risk.

METHODS

Provisional drivers aged 17 to 24 (n = 20 822) completed a detailed questionnaire that included measures of risk perception and behaviors; 2 years following recruitment, survey data were linked to licensing and police-reported crash data. Poisson regression models that adjusted for multiple confounders were created to explore crash risk.

RESULTS

High scores on questionnaire items for risky driving were associated with a 50% increased crash risk (adjusted relative risk = 1.51; 95% confidence interval = 1.25, 1.81). High scores for risk perception (poorer perceptions of safety) were also associated with increased crash risk in univariate and multivariate models; however, significance was not sustained after adjustment for risky driving.

CONCLUSIONS

The overrepresentation of youths in crashes involving casualties is a significant public health issue. Risky driving behavior is strongly linked to crash risk among young drivers and overrides the importance of risk perceptions. Systemwide intervention, including licensing reform, is warranted.

Risk and type of crash among young drivers by rurality of residence: findings from the DRIVE Study

BACKGROUND

Most previous literature on urban/rural differences in road crashes has a primary focus on severe injuries or deaths, which may be largely explained by variations of medical resources. Little has been reported on police-reported crashes by geographical location, or crash type and severity, especially among young drivers.

METHODS

DRIVE is a prospective cohort study of 20,822 drivers aged 17-24 in NSW, Australia. Information on risk factors was collected via online questionnaire and subsequently linked to police-reported crashes. Poisson regression was used to analyse risk of various crash types by three levels of rurality of residence: urban, regional (country towns and surrounds) and rural.

RESULTS

Compared to urban drivers, risk of crash decreased with increasing rurality (regional adjusted RR: 0.7, 95% CI 0.6-0.9; rural adjusted RR: 0.5, 95% CI 0.3-0.7). Among those who crashed, risk of injurious crash did not differ by geographic location; however, regional and rural drivers had significantly higher risk of a single versus multiple vehicle crash (regional adjusted RR 1.8, 95% CI 1.3-2.5; rural adjusted RR: 2.0, 95% CI 1.1-3.6), which was explained by speeding involvement and road alignment at the time or site of crash.

CONCLUSIONS

Although young urban drivers have a higher crash risk overall, rural and regional residents have increased risk of a single vehicle crash. Interventions to reduce single vehicle crashes should aim to address key issues affecting such crashes, including speeding and specific aspects of road geometry.

Recent developments in young driver education, training and licensing in Australia

Australian young driver education and training approaches have differed from the mandatory school-based programs found internationally; generally comprising voluntary programs conducted outside of licensing. This paper reports on recent developments pertaining to the pre-learner, learner, and provisional license stages. Given its important context, state-based graduated driver licensing systems are also reviewed. There has been a shift toward starting driver education younger (pre-learner), greater involvement of parents, and more school-based programs; many now conducted by licensing authorities. The majority of initiatives are yet to be evaluated, particularly relative to crash outcomes; however, some studies suggest other positive outcomes, including increased supervised practice and delayed licensure. Furthermore, the federal government is proceeding with plans for a national license-based program. Several jurisdictions have also announced the introduction of passenger and nighttime restrictions on provisional licenses. Together these initiatives offer promise of reductions in young driver-related fatalities and injuries in the very near future.