Translational Research in Child and Adolescent Transportation Safety

Steering Teens Safe: translation to a workplace wellness program in the USA

Parent-based teen driving interventions have been shown to increase safe teen driving but few have been translated beyond the research setting. As employers focus more on total worker health, the workplace offers a unique opportunity to implement a safe teen driving program into a workplace wellness program. The aim of this study was to adapt the evidence-based, parent-focused teen safe driving program Steering Teens Safe (STS) into workplace wellness programs, and to evaluate the implementation process and effect on parent-teen communication. The Replicating Effective Programs framework was used to modify STS to fit the workplace setting. The implementation process of the STS workplace wellness program was measured using direct observation and recordings of parent communication trainings while the effectiveness was measured by parent questionnaires. Forty-five parent employees across three businesses participated in the study. STS trainers were skilled in training parents in effective communication, including using open-ended questions and reflections. Parents reported increased success in conversations with their teens regarding safe driving through increased affection, receptivity, trust and equality in conversations. Workplaces may play a key role in assisting parents with teaching their children about safe driving.

The impact of the 2007 graduated driver licensing law in Massachusetts on the rate of citations and licensing in teenage drivers

OBJECTIVE

We recently demonstrated that the 2007 Massachusetts Graduated Driving Licensing (GDL) law decreased the rate of motor vehicle crashes in teenage drivers. To better understand this decrease, we sought to examine the law's impact on the issuance of driving licenses and traffic citations to teenage drivers.

METHODS

Citation and license data were obtained from the Massachusetts Department of Transportation. Census data were obtained from the Census Data Center. Two study periods were defined: pre-GDL (2002-2006) and post-GDL (2007-2012). Two populations were defined: the study population (aged 16-17) and the control population (aged 25-29). The rates of licenses per population were compared pre- vs. post-GDL for the study group. The numbers of total, state, and local citations per population were compared pre- vs. post-GDL for both populations. A sensitivity analysis was performed for the rates of citations using licenses issued as a denominator.

RESULTS

While licenses per population obtained by the study group decreased over the entire period, there was no change in the rate of decrease per year pre- vs. post-GDL (2.0% vs. 1.4%; p=0.6392). In the study population, total, state, and local citations decreased post-GDL (17.8% vs. 8.1%, p<0.0001; 3.7% vs. 2.2%, p<0.0001; 14.1% vs. 5.8%, p<0.0001, respectively). In the control group, total and state citations did not change (26.7% vs. 23.9%, p=0.3606; 9.2% vs. 10.2%, p=0.3404, respectively), and local citations decreased (17.5% vs. 13.7%, p=0.0389). The rates of decrease per year for total, state, and local citations were significantly greater in the study population compared with control (p<0.0001, p=0.0002, p<0.0001, respectively).

CONCLUSIONS

The 2007 GDL law in Massachusetts was associated with fewer traffic citations without a change in the rate of licenses issued to teenagers. These findings suggest that 2007 GDL may be improving driving habits as opposed to motivating teenagers to delay the issuing of licenses.

Interventions to Prevent Unintentional Injuries Among Adolescents: A Systematic Review and Meta-Analysis

Globally, every day, ∼2,300 children and adolescents succumb to unintentional injuries sustained from motor vehicle collisions, drowning, poisoning, falls, burns, and violence. The rate of deaths due to motor vehicle injuries in adolescents is 10.2 per 100,000 adolescents. We systematically reviewed published evidence to identify interventions to prevent unintentional injuries among adolescents aged 11-19 years. We defined unintentional injuries as a subset of injuries for which there was no evidence of predetermined intent, and the definition included motor vehicle injuries, suffocation, drowning, poisoning, burns, falls, and sports and recreation. Thirty-five studies met study eligibility criteria. The included studies focused on interventions to prevent motor vehicle injuries and sports-related injuries. Results suggest that possession of a graduated driver license (GDL) significantly reduced road accidents by 19% (relative risk [RR]: .81; 95% confidence interval [CI]: .75-.88; n = 5). There was no impact of GDL programs on incidence of injuries (RR: .78; 95% CI: .57-1.06; n = 2), helmet use (RR: 1.0; 95% CI: .98-1.02; n = 3), and seat belt use (RR: .99; 95% CI: .97-1.0; n = 3). Sports-related injury prevention interventions led to reductions in the incidence of injuries (RR: .66; 95% CI: .53-.82; n = 15), incidence of injury per hour of exposure (RR: .63; 95% CI: .47-.86; n = 5), and injuries per number of exposures (RR: .79; 95% CI: .70-.88; n = 4). Subgroup analysis according to the type of interventions suggests that training ± education and the use of safety equipment had significant impacts on reducing the incidence of injuries. We did not find any study focusing on interventions to prevent suffocation, drowning, poisoning, burns, and falls in the adolescent age group. The existing evidence is mostly from high-income countries, limiting the generalizability of these findings for low- and middle-income countries. Studies evaluating these interventions need to be replicated in a low- and middle-income country-context to evaluate effectiveness with standardized outcome measures.

The Transdisciplinary-Translation Revolution

A transdisciplinary-translation matrix is posited as a new direction reflected by the work presented in this and the two previous special issues. In fact, the demands inherent in this matrix suggest that a revolution in health research is in the works. Potential barriers and future directions of the matrix are suggested.

Parental influence on adolescent compliance with graduated driver licensing conditions and crashes as a restricted licensed driver: New Zealand drivers study

AIM

To examine the influence of parental knowledge of, and support for graduated driver licensing (GDL) conditions, parental management of adolescent driving and parental driving behaviour on adolescent compliance with GDL conditions and crashes as a restricted licence driver.

METHOD

This research was part of the New Zealand Drivers Study (NZDS), a prospective cohort study of 3992 newly licensed car drivers. NZDS participants were recruited at the learner licence stage, with follow-up aligned with the GDL stages. At the restricted licence stage 1200 parents of NZDS adolescents, aged 15-17 years at learner licensure, were recruited and completed interviews. 895 of these adolescents progressed to their full licence and completed the full licence interview. These 895 parent-adolescent pairs were the study population in this research. Topics examined included parental knowledge of, and support for GDL conditions, management of adolescent driving (driving rules, adolescent vehicle ownership, delaying licensure), and their own driving behaviours. Outcomes examined were adolescent compliance with GDL restricted licence conditions (night-time and passenger), and crashes as a driver during the restricted licence stage.

RESULTS

After controlling for other variables, factors independently associated with adolescent low compliance with GDL conditions were: low parental knowledge of conditions, parents' implementing few driving rules, adolescent vehicle ownership, and parent crash involvement. Factors independently associated with adolescents being a crash involved driver were: parents' actively delaying licensure, adolescent vehicle ownership, and parent crash involvement.

CONCLUSION

There is increasing recognition of the importance of parental involvement in adolescent driving. The results show that parents are influential in determining adolescent compliance with GDL and risk of crash. Parents can have considerable positive influence on their adolescent's driving through ensuring compliance with the components of GDL, limiting vehicle ownership and by modelling safe driving behaviours.

Keep your eyes on the road: young driver crash risk increases according to duration of distraction

PURPOSE

Secondary task engagement that distracts the driver is a contributing factor to motor vehicle crashes among adults. However, the association between eye glance duration and crash risk with novice teenage drivers has not been determined.

METHODS

Vehicles of 42 newly licensed teenage drivers were instrumented with cameras, accelerometers, Global Positioning System(s) (GPS), and other devices. Data were collected continuously for 18 months. Crashes and near crashes (CNCs) were identified by examining highly elevated gravitational force events. Video footage of the 6 seconds prior to each CNC and randomly sampled non-CNC road segments were coded for the duration of eye glances off the forward roadway and the presence of secondary task engagement. The likelihood (odds ratios) of CNC due to eye glance behavior was calculated by comparing the prevalence of secondary task engagement and duration of eyes off road prior to CNC with the prevalence and duration of eyes off road during non-CNC road segments.

RESULTS

Crash risk increased with the duration of single longest glance during all secondary tasks (OR=3.8 for >2 s) and wireless secondary task engagement (OR=5.5 for >2 s). Single longest glance provided a more consistent estimate of crash risk than total time eyes off the forward roadway.

CONCLUSIONS

Those eye glances away from the forward roadway involving secondary tasks increased the likelihood of CNC. The longer the duration of eye glance away from the road the greater the risk, regardless of type of secondary task. Education and policy discouraging secondary task engagement, particularly for prolonged periods, is warranted.

Practice-based research networks, part I: clinical laboratories to generate and translate research findings into effective patient care

CONTEXT

To improve patient care, athletic training clinicians and researchers should work together to translate research findings into clinical practice. Problems with patient care observed in clinical practice should be translated into research frameworks, where they can be studied. Practice-based research networks (PBRNs) provide a compelling model for linking clinicians and researchers so they can conduct translational research to improve patient care.

OBJECTIVE

To describe (1) the translational research model, (2) practice-based research as a mechanism for translating research findings into clinical practice, (3) the PBRN model and infrastructure, (4) the research potential using the PBRN model, and (5) protection of human participants in PBRN research.

DESCRIPTION

Translational research is the process of transforming research findings into health behavior that ultimately serves the public and attempts to bridge the gap between research and clinical practice. Practice-based research represents the final step in the translational research continuum and describes research conducted by providers in clinical practices. The PBRNs are characterized by an organizational framework that transcends a single site or study and serves as the clinical research "laboratory" for conducting comparative-effectiveness studies using patient-oriented measures. The PBRN approach to research has many benefits, including enhanced generalizability of results, pooling of resources, rapid patient recruitment, and collaborative opportunities. However, multisite research also brings challenges related to the protection of human participants and institutional review board oversight. CLINICAL AND RESEARCH ADVANTAGES: Athletic training studies frequently include relatively few participants and, consequently, are able to detect only large effects. The incidence of injury at a single site is sufficiently low that gathering enough data to adequately power a treatment study may take many years. Collaborative efforts across diverse clinical practice environments can yield larger patient samples to overcome the limitations inherent in single-site research efforts.

Using an event-triggered video intervention system to expand the supervised learning of newly licensed adolescent drivers

OBJECTIVES

We examined whether feedback from an event-triggered video intervention system reduced the number of safety-relevant driving errors made by newly licensed adolescents.

METHODS

We used a 1-group pretest-posttest quasi-experimental design to compare the rate of coachable error events per 1000 miles for 18 drivers who were aged 16 years. The intervention consisted of immediate visual feedback provided to the drivers and weekly event reports and videos provided to the drivers and their parents.

RESULTS

The number of coachable events was reduced by 61% overall during the intervention (chi(2) = 11.42; P = .001) and did not significantly increase during the second baseline, which was assessed after the intervention ended (chi(2) = 1.49; P = .223). The greatest reduction was seen in the category of improper turns or curves and for drivers identified at the first baseline as "high-event" drivers.

CONCLUSIONS

Our results show that immediate visual feedback for adolescents and cumulative video feedback for parents and adolescents during the early period of independent driving can have a dramatic influence on the rate of safety-relevant driving events. To the extent that such events are a proxy for crash risk, we suggest that feedback can enhance adolescent driving safety.

Injury patterns among obese children involved in motor vehicle collisions

PURPOSE

The purpose of this study was to compare injury patterns among obese children to their nonobese counterparts involved in motor vehicle collisions.

METHODS

A nationwide data collection program containing occupant, collision, and injury details from police-reported tow-away crashes between 1997 and 2006 were used. Risk ratios (RRs) and associated 95% confidence intervals (CIs) were adjusted for age, sex, restraint, seat track position, vehicle curb weight, and total velocity change.

RESULTS

An estimated 9 million children aged 2 to 17 years (20.2% obese) were involved in motor vehicle collisions during the study period. Among 2-to-5-year-olds, obesity increased the risk of severe head (RR, 3.67; 95% CI, 1.03-13.08) and thoracic (2.27; 1.01-5.08) injuries. Among 6-to-9-year-olds, obesity increased risk of thoracic (2.31; 1.08-4.95) and lower extremity (LE) injuries (1.89; 1.03-3.47). Among 10-to-13-year-olds, obesity increased the risk of severe thoracic (1.98; 1.08-3.65) and LE (6.06; 2.23-16.44) injuries. Among 14-to-17-year-olds, obesity increased risk of severe LE injuries (1.44; 1.04-2.00) but decreased risk of abdominal (0.20; 0.07-0.60) and head (0.33; 0.18-0.60) injuries, very similar to the pattern reported in obese adults.

CONCLUSION

The pattern of obesity-associated injuries changes from a higher risk of head and thoracic injuries among young children to a pattern in late teenagers that is similar to obese adults.

The effect of training on question formulation among public health practitioners: results from a randomized controlled trial

OBJECTIVE

To improve understanding of the information-seeking behaviors of public health professionals, the authors conducted this randomized controlled trial involving sixty participants to determine whether library and informatics training, with an emphasis on PubMed searching skills, increased the frequency and sophistication of participants' practice-related questions.

METHODS

The intervention group (n = 34) received evidence-based public health library and informatics training first, whereas the control group (n = 26) received identical training two weeks later. The frequency and sophistication of the questions generated by both intervention and control groups during the interim two-week period served as the basis for comparison.

RESULTS

The intervention group reported an average of almost 1.8 times more questions than those reported by the control group (1.24 vs. 0.69 questions per participant); however, this difference did not reach statistical significance. The intervention group overall produced more sophisticated (foreground) questions than the control group (18 vs. 9); however, this difference also did not reach statistical significance.

CONCLUSION

The training provided in the current study seemed to prompt public health practitioners to identify and articulate questions more often. Training appears to create the necessary precondition for increased information-seeking behavior among public health professionals.

Need and possibilities for seat belt use promotion in Bashkortostan, Russia

Bashkortostan is a republic in the Russian Federation with a population of 4.1 million. As with other health behaviors, the prevalence of seat belt use is low, which may account in part for the very high rate of motor-vehicle-related mortality in this republic. The authors discuss the need and potential for translating seat belt promotion programming from other Russian regions and other countries to Bashkortostan. The authors conclude that current policies developed in other countries could work well in the republic, if they are enforced. Meanwhile, initiatives such as the Sakhalin Road Safety Partnership offer great potential for translation in Bashkortostan as well as in other regions with similarly low seat belt use prevalence.

Parent involvement in novice teen driving: rationale, evidence of effects, and potential for enhancing graduated driver licensing effectiveness

Motor-vehicle crash rates are highly elevated immediately after licensure and then decline gradually over a period of years. Young age, risk taking, and inexperience contribute to the problem, but inexperience is particularly important early on. Driving is like other complex, skilled behaviors in which subtle improvements in perception and judgment develop gradually over a period of years. After all, safe driving is more a matter of attention and perception than physical management of the vehicle. Inexperience is particularly linked to driving performance and safety outcomes under certain driving conditions, with driving at night and with teen passengers as the most important cases. Surprisingly, driving outcomes do not appear to be affected by the pre-license training or supervised practice driving. Given the limits of training, safety effects can best be achieved by countermeasures that delay licensure or limit novice teen driving under high risk driving conditions while novices gain experience and develop safety competence. The two complementary approaches of Graduated Driver Licensing policies and parent management have been shown to provide safety effects by limiting the driving conditions of novice teenagers.

Do recommended driving limits affect teen-reported traffic violations and crashes during the first 12 months of independent driving?

OBJECTIVES

Motor vehicle crashes are highly elevated among newly licensed teenage drivers. Limits on high-risk driving conditions by driver licensing policies and parents can protect novice teens from negative driving outcomes, while they experience and driving proficiency. The purpose of this research was to evaluate the effects of strict parent-imposed driving limits on driving outcomes during the first year of licensure.

METHODS

A sample of 3,743 Connecticut teens was recruited and randomized to the Checkpoints Program or comparison condition. Assessments conducted at baseline, licensure, 3-, 6-, and 12-months postlicensure included parent-imposed driving limits, traffic violations, and crashes. Bivariate and multivariate analyses were conducted to assess the effects of strict parent limits on traffic violations and crashes during the first year of licensure.

RESULTS

Thirty percent of teens reported at least one traffic violation and 40% reported at least one crash. More strict parent-imposed limits at licensure, 3-, 6-, and 12-months postlicensure, were associated with fewer violations and crashes in multivariate analyses. Notably, adherence to recommended night curfew was consistently associated with fewer violations and crashes.

CONCLUSIONS

The findings indicate that strict parent-imposed limits may protect novice teen drivers from negative driving outcomes.

Graduated driver licensing and teenage driver research in 2006

This is the third update of research on graduated driver licensing (GDL) and related teenage driver issues. It briefly summarizes research published since or not included in the 2005 update (Hedlund, J., & Compton, R. (2005). Graduated driver licensing research in 2004 and 2005. Journal of Safety Research, 36(2), 109-119.), describes research in progress of which the authors are aware, and announces plans for a symposium on teenage driving and GDL to be held in February 2007.