National young-driver survey: teen perspective and experience with factors that affect driving safety

Attitudes toward driving after cannabis use: a systematic review

BACKGROUND

Driving after cannabis use (DACU) is associated with increased risk of motor vehicle collisions. As cannabis legalization expands, DACU is emerging as a major public safety concern. Attitudes have a significant impact on behavioural decision making. As such, understanding the degree to which people have favorable or unfavorable evaluations of DACU is an important first step for informing prevention efforts. This systematic review summarizes existing evidence on attitudes toward DACU, their association with actual or intended DACU, and changes in attitudes following legalization of recreational cannabis.

METHODS

Four electronic databases (MEDLINE, EMBASE, PsycINFO, and TRID) were searched for studies that reported attitudes or changes in attitudes toward DACU published between their inception dates and February 26 2024. A total of 1,099 records were retrieved. Studies were analyzed using an inductive thematic synthesis approach.

RESULTS

Seventy studies from seven countries originating predominantly from the United States and Canada met inclusion criteria. Thematic analysis identified six themes. (I) Attitudes toward the safety and acceptability of DACU are mixed; participants in 35 studies predominantly expressed negative attitudes toward DACU (e.g., DACU is dangerous, affects driving ability, and increases crash risk). However, 20 studies reported opposing views. (II) Attitudes toward DACU vary by age, sex/gender, and cannabis use frequency; youth, men, and frequent cannabis users tended to view DACU more favorably than older participants, women, and occasional or non-users. (III) Attitudes toward DACU are associated with past DACU and intention to DACU. (IV) DACU is viewed more favorably than driving after drinking alcohol. (V) The relationship between legal status of recreational cannabis and attitudes toward DACU is unclear. (VI) Perceived risk of apprehension for DACU is low to moderate.

CONCLUSIONS

This review found that perceptions of DACU are primarily negative but mixed. Findings suggest that attitudes toward DACU are important targets for interventions to reduce this behaviour.

An effective COVID-19 vaccine hesitancy intervention focused on the relative risks of vaccination and infection

We designed the Relative Risk Tool (RRT) to help people assess the relative risks associated with COVID-19 vaccination and infection. In May 2022 (N = 400) and November 2022 (N = 615), U.S. residents participated in a survey that included questions about the risks of vaccination and infection. In both cohorts, we found an association between relative risk perception and vaccine hesitancy. Participants in the May cohort were randomly assigned an intervention: to see information from the RRT or the Centers for Disease Control and Prevention (CDC). After the intervention, participants answered the same questions about risk perception and vaccination intent again. The RRT was more effective than the CDC at changing risk perception and increasing vaccination intent. In November, the survey structure was the same, but the RRT was the only intervention included, and we confirmed that the RRT was effective at changing opinions in this new sample. Importantly, the RRT provided accurate information about the risks of serious adverse outcomes to vaccination and still increased vaccination intent. Our work suggests that the RRT helps people assess relative risk, which can in turn help empower them to make informed decisions and ultimately reduce vaccine hesitancy.

Targeting young driver emotions can reduce their cellphone distractions

OBJECTIVE

This study sought to evaluate the relationship between young drivers' intention to engage in cellphone distractions while driving and their emotions towards the associated risks. First, we assessed whether the emotions of guilt, shame, and fear are associated with young drivers' intention to engage in cellphone distractions, through an extended Theory of Planned Behavior (TPB) model. Second, we evaluated whether road signs that may evoke these negative emotions reduce cellphone use intentions among young drivers.

METHODS

An online survey was conducted with young drivers (18 to 25 years old) from Ontario, Canada. 403 responses were collected, of which, 99 responses were used to evaluate the first objective and all 403 responses were used to evaluate the second objective.

RESULTS

Anticipating feelings of guilt, shame, and fear negatively predicted the intention to engage in cellphone distractions, above and beyond the standard TPB constructs (i.e., attitudes, subjective norms, and perceived behavioral control). When prompted with potentially emotion-evoking road signs (children crossing, my mom/dad works here), an increase in anticipated feelings of these emotions corresponded with lower intention to engage in cellphone distractions.

CONCLUSION

Countermeasures that target young driver emotions toward distracted driving risks may be effective in reducing their distraction engagement. Future studies in more controlled environments can investigate causal relationships between emotions and distracted driving among young drivers.

Study design to evaluate a web-intervention to prevent alcohol and cannabis-impaired driving and use among adolescents in driver education

BACKGROUND

Alcohol and cannabis are the most commonly used substances among adolescents in the U.S. The consequences related to using both substances together are significantly higher relative to use of either substance alone. Teens' propensity to engage in risky driving behaviors (e.g., speeding, rapid lane changes, and texting) and their relative inexperience with the timing and duration of cannabis' effects puts them at heightened risk for experiencing harms related to driving under the influence. Use of alcohol and cannabis peak at age 16, the legal age teens may apply for a provisional driver's license in some states. Targeting novice teen drivers prior to licensure is thus an ideal time for prevention efforts focused on reducing alcohol and/or cannabis initiation, use, and impaired driving.

METHODS

The current study proposes to evaluate the efficacy of webCHAT among 15.5 to 17-year-old adolescents (n = 150) recruited at driver education programs. WebCHAT is a single session online intervention that aims to prevent alcohol and cannabis use and risky driving behaviors. We will recruit adolescents enrolled in driver education programs, and stratify based on whether they used cannabis and/or alcohol in the past 3 months (60% screening negative and 40% screening positive). All participants will receive usual driver education and half will also receive webCHAT. We will test whether webCHAT in addition to usual driver education reduces alcohol and/or cannabis initiation or use and reduces risky driving attitudes and behaviors (intent to drive after drinking/using, riding as a passenger with someone who drank/used) compared to teens in usual driver education over a 6-month period. We will also explore whether variables such as beliefs and perceived norms serve as explanatory mechanisms for our outcomes.

DISCUSSION

The study has the potential to promote public welfare by decreasing adolescent initiation and use of cannabis and alcohol and reducing risky driving behaviors that can have substantial monetary, personal, and social costs. The study recruits adolescents who are at risk for substance use as well as those who are not and it is delivered remotely during a teachable moment when adolescents receive driver education. Trial registration This study was registered with ClinicalTrials.gov on July 13, 2021 (NCT04959461). https://clinicaltrials.gov/ct2/show/NCT04959461.

The Prevalence of Several Risky Driving Behaviors and Associated Crash Risk in Adolescent: A Population-Based Study of Tuscany Region

Objectives: To evaluate the prevalence of numerous risky driving behaviors (RDBs) and the associated risk of road traffic accidents (RTA) in a population-based sample of adolescent drivers (14–19 years) of Tuscany, Italy.

Methods: The frequency of participation -by age and sex- often RDBs were investigated: Multivariable analyses were performed to evaluate the association between RDBs and the risk of RTA and severe RTA.

Results: 2,737 adolescents were included in the study. Talking to passenger(s), listening to loud music, speeding, and texting showed the highest weekly participation rates. For all the considered RDBs, the frequency of participation significantly increased with age. Males reported a significantly higher participation in speeding, DUI of alcohol or drugs; while females reported listening to loud music and talking to passenger(s) more frequently. All the considered RDBs were significantly associated with the risk of RTA and severe RTA.

Conclusion: The prevalence of RDBs and the associated risk of RTA largely varied in adolescents. Findings provide evidence for tailoring prevention interventions and suggest the need to include common- but traditionally overlooked- RDBs in road safety campaigns.

Driving after marijuana use among U.S. adolescents: Prevalence profiles and related behaviors

OBJECTIVES

The interplay between marijuana legislation, perceptions of risks associated with marijuana use, and marijuana-related risk behaviors is an ever changing and complex issue. Marijuana impaired driving is of concern as legalization continues to expand in the United States. While driving after using marijuana has been shown to be prevalent among adults, little research has examined the behavior in adolescents. The aim of the present study was to examine the prevalence of driving after using marijuana among U.S. adolescents, with an examination of the relationship to age of marijuana initiation and marijuana usage patterns.

METHODS

We analyzed data from the 2017 Youth Risk Behavior Survey, a nationally representative sample of high schools students in the U.S. The sample was current marijuana users, defined as past 30 day use. Driving after using marijuana was the main outcome variable, with analyses examining the association between the outcome and age of initiation and patterns of use. Prevalence ratios were obtained by modeling Poisson regression to examine factors associated with driving under the influence of marijuana.

RESULTS

Nearly half of all marijuana users reported driving after use during the past 30 days, and did not differ between males and females. Prevalence of driving after using marijuana was significantly higher among heavy users (PR = 2.8; 95% CI 2.1-3.6). A higher prevalence of driving after drinking alcohol (PR = 1.7; 95% CI 1.5-1.9) was also found among those who had driven after using marijuana.

CONCLUSIONS

Among adolescent marijuana users, the prevalence of driving after using marijuana was high. Enhanced surveillance, prevention, and control measures are necessary to mitigate the negative impacts of marijuana consumption and related behaviors.

Understanding crash potential associated with teen driving: Survey analysis using multivariate graphical method

INTRODUCTION

Teen crash involvement is usually higher than other age groups, and they are typically overrepresented in car crashes. To infer teen drivers' understanding of crash potentials (factors that are associated with crash occurrence), two sources of data are generally used: retrospective data and prospective data. Retrospective data sources contain historical crash data, which have limitations in determining teen drivers' knowledge of crash potentials. Prospective data sources, like surveys, have more potential to minimize the research gap. Prior studies have shown that teen drivers are more likely to be involved in crashes during their early driving years. Thus, there is a benefit in examining how teen drivers' understanding of crash potentials change during their transition through licensing stages (i.e., no licensure to unrestricted licensure).

METHOD

This study used a large set of teen driver survey data (a dataset from approximately 88,000 respondents) of Texas teens to answer the research question. Researchers provided rankings of the crash potentials by gender and licensure stages using a multivariate graphical method named taxicab correspondence analysis (TCA).

RESULTS

The findings show that driving behavior and understanding of crash potentials differ among teens based upon various licensing stages. Practical applications: Findings from this study can help government authorities to refine policies of teen driver licensing and implement potential countermeasures for safety improvement.

Decision Tree Ensemble Method for Analyzing Traffic Accidents of Novice Drivers in Urban Areas

Presently, there is a critical need to analyze traffic accidents in order to mitigate their terrible economic and human impact. Most accidents occur in urban areas. Furthermore, driving experience has an important effect on accident analysis, since inexperienced drivers are more likely to suffer fatal injuries. This work studies the injury severity produced by accidents that involve inexperienced drivers in urban areas. The analysis was based on data provided by the Spanish General Traffic Directorate. The information root node variation (IRNV) method (based on decision trees) was used to get a rule set that provides useful information about the most probable causes of fatalities in accidents involving inexperienced drivers in urban areas. This may prove useful knowledge in preventing this kind of accidents and/or mitigating their consequences.

Personality Traits and Beliefs About Peers' On-Road Behaviors as Predictors of Adolescents' Moped-Riding Profiles

Several efforts aimed at discriminating between different degrees of on-road risky attitudes have been devoted to the identification of personality profiles among young drivers. However, the results are often inconsistent because of the limits of self-report measures. To overcome these limits, we tried to identify different profiles based on our study participants’ driving performances in a virtual environment and to look for psychological predictors of inclusion in one of three profiles. One-hundred and fourteen inexperienced adolescents were involved in this study, which included two experimental sessions. During the first, before riding along five virtual courses on a moped simulator, participants’ sensation seeking, locus of control, aggressiveness and beliefs about their peers’ on-road behaviors were measured by means of self-report tools. During the second session, the participants drove the simulator along six courses that were different from those faced in the first session. A cluster analysis was run on a wide number of indexes extracted from the participants’ performances to detect different riding profiles. Three profiles emerged (Imprudent, Prudent and Insecure), with specific riding patterns. The profiles also differed in terms of riding safety, assessed by means of the scores automatically given by the simulator to the participants’ performances. Reporting an external locus of control, underestimating peers’ on-road risky behaviors and showing less concern for fate among the possible causes of crashes are predictors that increase the risk of being included in the Imprudent profile. Low levels of dangerous thrill seeking predict inclusion in the Prudent profile, whereas high rates of self-reported anger play a role in discriminating the Insecure riders from the other profiles. The study indicates that it is possible to identify riding profiles with different degrees of on-road safety among inexperienced adolescents by means of simulated road environments. Moreover, inclusion in these profiles is predicted by different patterns of personality variables and beliefs. Further research is needed to verify the validity of these conclusions in real road conditions.

School safe driving climate: Theoretical and practical considerations for promoting teen driver safety in school settings

OBJECTIVE

The aims of this study were to extend the current literature on school climate that is focused on understanding how teacher, administrator, and student perceptions about driving-focused aspects of the social, educational, and institutional climate of schools can affect students' achievement, behavior, and adjustment toward the development of the concept of a school safe driving climate (SSDC) and initiate the development of tools and processes for assessing SSDC.

METHODS

A mixed methods approach was used to develop an initial version of a survey-based measure of SSDC that involved self-report surveys (students) and in-depth interviews (teachers). Exploratory factor analytic procedures identified SSDC constructs and a regression framework was used to examine associations among SSDC constructs and self-reported driving behaviors. Qualitative data were subjected to inductive analysis, with a goal of elucidating teachers' perspectives on SSDC and an SSDC intervention.

RESULTS

The study sample consisted of 947 adolescents (48% male) from one large high school and 44 teacher advisors. Participants were recruited from a school participating in a state-wide effort to promote transportation safety through peer-led programming. Two SSDC factors were identified-Administrative contributions to school safety and value of school safety-that were associated with adolescents' perceptions of their driving behaviors. Adolescents perceived that the intervention affected administrative safety. Teacher interviews contextualized these results and provided guidance on program revisions.

CONCLUSIONS

Safe driving climate may be an important, modifiable, and measurable aspect of school climate. Additional research is needed to refine the assessment tool and to use it in longitudinal and experimental studies.

Gender differences in trajectories of alcohol use from ages 13 to 33 across Latina/o ethnic groups

BACKGROUND

Research examining alcohol use trajectories among Latina/os is scarce. Further, prior findings on alcohol use by ethnic group and gender is mixed. The purpose of this study was twofold: (a.) to examine developmental trajectories for two types of alcohol (drunkenness and heavy drinking) use across four Latina/o ethnic groups (Cubans, Puerto Ricans, Central/South American, and Mexican Americans) and, (b.) to examine the role of gender and ethnicity in developmental trajectories of drunkenness and heavy drinking among Latina/os.

METHODS

Data were drawn from Waves I-IV of the National Longitudinal Study of Adolescent to Adult Health. The sample consisted of 1670 Latina/os that were followed from adolescence into adulthood. Multi-level logistic regression models were used to estimate drunkenness and heavy drinking trajectories and trajectories by gender.

RESULTS

indicate that, for all four ethnic groups examined, the probability of drunkenness and heavy drinking gradually increased in adolescence, peaked in "emerging adulthood", and decreased as they transitioned into adulthood. Findings also show divergent age trajectories by gender, but patterns varied across ethnicity and alcohol use outcome.

CONCLUSIONS

Key findings from this study demonstrate that among Latina/os, there are critical developmental periods for reported drunkenness and heavy drinking in the last 12 months, and that ethnicity and gender play substantial roles in the development of hazardous alcohol use over the life course.

Prevalence of texting while driving and other risky driving behaviors among young people in Ontario, Canada: Evidence from 2012 and 2014

This paper reports on the prevalence of texting while driving and other risky driving behaviors by age and gender in two large samples of youth aged 16-19 years in Ontario, Canada. In Study 1 (N=6133), we found that males reported more frequent texting while driving and speeding than females and, in terms of age, sixteen year olds reported frequent texting while driving than older participants. In Study 2 (N=4450), which was conducted two years later, males again reported more frequent texting while driving, however there was no difference in the rate of talking on the phone while driving among males and females. Participants also reported on experiences that led to a significant reduction in their texting while driving. The most common reasons were the perceived danger of texting while driving, laws and fines against texting while driving, and observing close-calls and accidents experienced by other people. The results of both studies suggest that driving-related risk-taking behaviors co-occur and that young passengers in vehicles, including 14 and 15 year olds, are bystanders to texting while driving. Finally, there was a substantial decline in the prevalence of texting while driving across the studies. In Study 1, 27% of participants reported "sometimes" to "almost always" texting while driving compared to 6% of participants in Study 2. Limitations and implications for public campaigns targeted youth distracted driving are discussed.

Texting while driving as impulsive choice: A behavioral economic analysis

The goal of the present study was to examine the utility of a behavioral economic analysis to investigate the role of delay discounting in texting while driving. A sample of 147 college students completed a survey to assess how frequently they send and read text messages while driving. Based on this information, students were assigned to one of two groups: 19 students who frequently text while driving and 19 matched-control students who infrequently text while driving but were similar in gender, age, years of education, and years driving. The groups were compared on the extent to which they discounted, or devalued, delayed hypothetical monetary rewards using a delay-discounting task. In this task, students made repeated choices between $1000 available after a delay (ranging from 1 week to 10 years) and an equal or lesser amount of money available immediately. The results show that the students who frequently text while driving discounted delayed rewards at a greater rate than the matched control students. The study supports the conclusions that texting while driving is fundamentally an impulsive choice made by drivers, and that a behavioral economic approach may be a useful research tool for investigating the decision-making processes underlying risky behaviors.

Effectiveness of Parent-Focused Interventions to Increase Teen Driver Safety: A Critical Review

PURPOSE

We critically reviewed recent parent-directed teen driving interventions to summarize their success in meeting stated goals; identify promising intervention components and knowledge gaps; aid in the selection, adaptation, and dissemination of effective interventions; and guide future research efforts.

METHODS

We focused on interventions that included a direct parent component, explicitly stated outcomes related to the teen and/or their parents, were evaluated for parent or teen outcomes, targeted drivers younger than the age of 21 years, and had at least one evaluation study published since 1990 and in English. We conducted a comprehensive systematic search of 26 online databases between November 2013 and January 2014 and identified 34 articles representing 18 interventions.

RESULTS

Several interventions-in particular, those that had an active engagement component, incorporated an in-vehicle data recorder system, and had a strong conceptual approach-show promise in improving parental supervisory behaviors during the learner and early independent phases, increasing teen driver skill acquisition, and reducing teens' risky driving behaviors.

CONCLUSIONS

We identify essential characteristics of effective parent-involved teen driving interventions and their evaluation studies, propose a comprehensive and multitiered approach to intervention, and discuss several research areas and overarching issues for consideration.

A qualitative study of college students' perceptions of risky driving and social influences

OBJECTIVES

Young adults and teens are documented as the riskiest drivers on the road, and newer issues such as texting and driving are a growing concern. This study sought to determine the risk perceptions of young adults regarding various driving behaviors, their past experiences, how their social circles are structured, and how this might affect their driving.

METHODS

This study conducted qualitative research with 25 college undergraduate students to determine their peer and social influences regarding distracted driving. Data were analyzed and related to the health belief model and past research on social influence.

RESULTS

Though most participants felt that their behaviors were set after learning to drive, they were, in fact, quite susceptible to the influence of those in their social circles (e.g., fear of judgment and accountability) and, more broadly, to social norms. Texting and driving was the largest and most topical distracted driving issue and was also identified as very difficult to stop due to perceived barriers and the idea that intervening is rude. Participants identified low perceived susceptibility and severity (perceived threat) for a number of risky driving behaviors, including texting and driving.

CONCLUSIONS

Training is needed to encourage people to intervene and speak up regarding behaviors other than drinking and driving, and cues to action and campaigns should target intervention to increase self-efficacy, as well as norms, susceptibility, and common rationalizations for risky behavior.

Teen Drivers' Perceptions of Their Peer Passengers: Qualitative Study

BACKGROUND

The presence of peer passengers increases teenage drivers' fatal crash risk. Distraction and social influence are the two main factors that have been associated with increased risk. Teen drivers' perceptions of their peer passengers on these factors could inform our understanding of the conditions under which peer passengers increase crash risk or promote safer driving. The purpose of this study was to examine teen drivers' perceptions of their peer passengers on distraction and social influence.

METHOD

A convenience sample of male and female drivers participated in a semi-structured interview that included questions on their perceptions of the effects of peer passengers on driving on distraction and social influence. The analysis of the interviews was guided by a grounded theory approach.

FINDINGS

Teenage drivers were aware of the risk that peer passengers posed. Some described having passengers in the vehicle as distracting, and recognized that the level of distraction increased with the number of passengers in the vehicle. Drivers that felt responsible for the safety of their peer passengers described strategies they used to control the in-vehicle environment. Drivers described driving with passengers as a performance, and articulated direct and indirect sources of pressure, gender norms, and unspoken expectations of their passengers as influencing their driving behavior.

CONCLUSIONS

The influence of passengers is situation specific and dependent on whom the passenger(s) may be. Passenger influence may be either protective or harmful, depending on the circumstances. Some passengers exert direct influence, but often their influence appears more indirect and subtle.

Alcohol and marijuana use patterns associated with unsafe driving among U.S. high school seniors: high use frequency, concurrent use, and simultaneous use

OBJECTIVE

This article examines noncausal associations between high school seniors' alcohol and marijuana use status and rates of self-reported unsafe driving in the past 12 months.

METHOD

Analyses used data from 72,053 students collected through annual surveys of nationally representative cross-sectional samples of U.S. 12th-grade students from 1976 to 2011. Two aspects of past-12-month alcohol and marijuana use were examined: (a) use frequency and (b) status as a nonuser, single substance user, concurrent user, or simultaneous user. Measures of past-12-month unsafe driving included any tickets/warnings or accidents, as well as tickets/warnings or accidents following alcohol or marijuana use. Analyses explored whether an individual's substance use frequency and simultaneous use status had differential associations with their rate of unsafe driving.

RESULTS

Higher substance use frequency (primarily alcohol use frequency) was significantly and positively associated with unsafe driving. The rate of engaging in any unsafe driving was also significantly and positively associated with simultaneous use status, with the highest rate associated with simultaneous use, followed by concurrent use, followed by use of alcohol alone. Individuals who reported simultaneous use most or every time they used marijuana had the highest likelihood of reporting unsafe driving following either alcohol or marijuana use.

CONCLUSIONS

This article expands the knowledge on individual risk factors associated with unsafe driving among teens. Efforts to educate U.S. high school students (especially substance users), parents, and individuals involved in prevention programming and driver's education about the increased risks associated with various forms of drug use status may be useful.

Distracted driver behaviors and distracting conditions among adolescent drivers: findings from a naturalistic driving study

PURPOSE

The proliferation of new communication technologies and capabilities has prompted concern about driving safety. This concern is particularly acute for inexperienced adolescent drivers. In addition to being early adopters of technology, many adolescents have not achieved the degree of automaticity in driving that characterizes experienced adults. Consequently, distractions may be more problematic in this group. Yet little is known about the nature or prevalence of distracted driving behaviors or distracting conditions among adolescent drivers.

METHOD

Vehicles of 52 high-school age drivers (N=38 beginners and N=14 more experienced) were equipped for 6 months with unobtrusive event-triggered data recorders that obtain 20-second clips of video, audio, and vehicle kinematic information when triggered. A low recording trigger threshold was set to obtain a sample of essentially random driving segments along with those indicating rough driving behaviors.

RESULTS

Electronic device use (6.7%) was the most common single type of distracted behavior, followed by adjusting vehicle controls (6.2%) and grooming (3.8%). Most distracted driver behaviors were less frequent when passengers were present. However, loud conversation and horseplay were quite common in the presence of multiple peer passengers. These conditions were associated with looking away from the road, the occurrence of serious events, and, to a lesser extent, rough driving (high g-force events).

CONCLUSIONS

Common assumptions about adolescent driver distraction are only partially borne out by in-vehicle measurement. The association of passengers with distraction appears more complex than previously realized. The relationship between distractions and serious events differed from the association with rough driving.

Evaluating a novice driver and pre-driver road safety intervention

Intervention or evaluation studies represent a small proportion of traffic psychology research. The current study evaluated the effectiveness of a road safety intervention by measuring attitudes toward unsafe driving behaviors and risk perception. A sample of high school students (n=133) participated in a road safety intervention program focusing on attitudes and risk perceptions of young people as novice drivers, pre-drivers, and passengers. This sample was compared with a matched sample of students who did not take the program (n=172) on their attitudes and perceived risk toward unsafe driving, both prior to the program (T1), immediately after the program (T2), and at 6-week follow-up (T3). While no changes in attitudes toward unsafe driving were found for the control group, the intervention group reported riskier attitudes toward unsafe driving behaviors from T1 to T2 and T3. No differences were found from T1 to T3 in perceived risk toward unsafe driving for either the intervention or control groups. Implications of the study include encouraging a higher rate of road safety program evaluations, leading to better understanding of the effectiveness of road safety intervention programs and how they may be designed and delivered to ensure lower engagement in unsafe driving behaviors by young drivers.

Cell phones and young drivers: a systematic review regarding the association between psychological factors and prevention

OBJECTIVE

Cell phone use among young drivers has become increasingly common in recent years. Young people are the most likely to accept the use of new technology and least likely to understand the risks associated with cell phone use while driving (CPWD; defined here as talking on the phone only) and texting while driving (TextWD). Due to inexperience, young drivers are the most at risk when using cell phones while driving and therefore should be the target of the majority of prevention strategies. The intent of this review is to determine factors that influence young drivers to engage in CPWD and TextWD and suggest a basis for prevention campaigns and strategies that can effectively prevent current and future generations from using cell phones while driving.

METHODS

We conducted a search for original articles in PubMed, the Cochrane Library, and Web of Science. All abstracts were reviewed and for those that met the inclusion criteria, full articles were obtained and assessed.

RESULTS

Four hundred and twelve articles were identified in the search and, of those, 37 full-text articles were obtained. A total of 29 articles about the frequency of CPWD and the psychological effects influencing young driver's tendency to engage in CPWD were included. There was a high frequency of both CPWD and TextWD despite a high perceived risk of both behaviors. This discrepancy was explained by a high perceived controllability, the effect of social norms, call importance, and lack of effective law enforcement. The intervention strategies reviewed were also found to be ineffective over the long term.

CONCLUSIONS

The systematic review reveals that young drivers are an at-risk group for distracted driving. We propose preventative strategies based on identifying factors that influence drivers to engage in CPWD and TextWD as well as by reviewing strategies found in the reviewed articles. Further research is necessary to determine the effectiveness of these proposed strategies.

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.

Impaired-driving prevalence among US high school students: associations with substance use and risky driving behaviors

OBJECTIVES

We examined the prevalence of impaired driving among US high school students and associations with substance use and risky driving behavior.

METHODS

We assessed driving while alcohol or drug impaired (DWI) and riding with alcohol- or drug-impaired drivers (RWI) in a nationally representative sample of 11th-grade US high school students (n = 2431). We examined associations with drinking and binge drinking, illicit drug use, risky driving, and demographic factors using multivariate sequential logistic regression analysis.

RESULTS

Thirteen percent of 11th-grade students reported DWI at least 1 of the past 30 days, and 24% reported RWI at least once in the past year. Risky driving was positively associated with DWI (odds ratio [OR] = 1.25; P < .001) and RWI (OR = 1.09; P < .05), controlling for binge drinking (DWI: OR = 3.17; P < .01; RWI: OR = 6.12; P < .001) and illicit drug use (DWI: OR = 5.91; P < .001; RWI: OR = 2.29; P = .05). DWI was higher for adolescents who drove after midnight (OR = 15.7), drove while sleepy or drowsy (OR = 8.6), read text messages (OR = 11.8), sent text messages (OR = 5.0), and made cell phone calls (OR = 3.2) while driving.

CONCLUSIONS

Our findings suggest the need for comprehensive approaches to the prevention of DWI, RWI, and other risky driving behavior.

Impact of distraction on the driving performance of adolescents with and without attention-deficit/hyperactivity disorder

IMPORTANCE

This study extends the literature regarding attention-deficit/hyperactivity disorder (ADHD)-related driving impairments to a newly licensed, adolescent population.

OBJECTIVE

To investigate the combined risks of adolescence, ADHD, and distracted driving (cell phone conversation and text messaging) on driving performance.

DESIGN, SETTING, AND PARTICIPANTS

Adolescents aged 16 to 17 years with (n = 28) and without (n = 33) ADHD engaged in a simulated drive under 3 conditions (no distraction, cell phone conversation, and texting). During each condition, one unexpected event (eg, another car suddenly merging into driver's lane) was introduced.

INTERVENTIONS

Cell phone conversation, texting, and no distraction while driving.

MAIN OUTCOMES AND MEASURES

Self-report of driving history, average speed, standard deviation of speed, standard deviation of lateral position, and braking reaction time during driving simulation.

RESULTS

Adolescents with ADHD reported fewer months of driving experience and a higher proportion of driving violations than control subjects. After controlling for months of driving history, adolescents with ADHD demonstrated more variability in speed and lane position than control subjects. There were no group differences for braking reaction time. Furthermore, texting negatively impacted the driving performance of all participants as evidenced by increased variability in speed and lane position.

CONCLUSIONS

To our knowledge, this study is one of the first to investigate distracted driving in adolescents with ADHD and adds to a growing body of literature documenting that individuals with ADHD are at increased risk for negative driving outcomes. Furthermore, texting significantly impairs the driving performance of all adolescents and increases existing driving-related impairment in adolescents with ADHD, highlighting the need for education and enforcement of regulations against texting for this age group.

Compulsive cell phone use and history of motor vehicle crash

PURPOSE

Few studies have examined the psychological factors underlying the association between cell phone use and motor vehicle crash. We sought to examine the factor structure and convergent validity of a measure of problematic cell phone use, and to explore whether compulsive cell phone use is associated with a history of motor vehicle crash.

METHODS

We recruited a sample of 383 undergraduate college students to complete an online assessment that included cell phone use and driving history. We explored the dimensionality of the Cell Phone Overuse Scale (CPOS) using factor analytic methods. Ordinary least-squares regression models were used to examine associations between identified subscales and measures of impulsivity, alcohol use, and anxious relationship style, to establish convergent validity. We used negative binomial regression models to investigate associations between the CPOS and motor vehicle crash incidence.

RESULTS

We found the CPOS to be composed of four subscales: anticipation, activity interfering, emotional reaction, and problem recognition. Each displayed significant associations with aspects of impulsivity, problematic alcohol use, and anxious relationship style characteristics. Only the anticipation subscale demonstrated statistically significant associations with reported motor vehicle crash incidence, controlling for clinical and demographic characteristics (relative ratio, 1.13; confidence interval, 1.01-1.26). For each 1-point increase on the 6-point anticipation subscale, risk for previous motor vehicle crash increased by 13%.

CONCLUSIONS

Crash risk is strongly associated with heightened anticipation about incoming phone calls or messages. The mean score on the CPOS is associated with increased risk of motor vehicle crash but does not reach statistical significance.

Texting while driving and other risky motor vehicle behaviors among US high school students

OBJECTIVE

To assess the prevalence of texting/e-mailing while driving (TWD) and association of TWD with other risky motor vehicle (MV) behaviors among US high school students.

METHODS

Data were used from the Centers for Disease Control and Prevention's 2011 national Youth Risk Behavior Survey, which assessed TWD during the 30 days before the survey among 8505 students aged ≥16 years from a nationally representative sample of US high school students. TWD frequency was coded into dichotomous and polychotomous variables. Logistic regression assessed the relationship between TWD and other risky driving behaviors, controlling for age, race/ethnicity, and sex.

RESULTS

The prevalence of TWD on ≥1 days during the 30 days before the survey was 44.5% (95% confidence interval: 40.8%-48.2%). Students who engaged in TWD were more likely than their non-TWD counterparts to not always wear their seatbelt (prevalence ratio; 95% confidence interval: 1.16; 1.07-1.26), ride with a driver who had been drinking alcohol (1.74; 1.57-1.93), and drink alcohol and drive (5.33; 4.32-6.59). These other risky MV behaviors were most likely to occur among students who frequently engaged in TWD.

CONCLUSIONS

Nearly half of US high school students aged ≥16 years report TWD during the past 30 days; these students are more likely to engage in additional risky MV behaviors. This suggests there is a subgroup of students who may place themselves, their passengers, and others on the road at elevated risk for a crash-related injury or fatality by engaging in multiple risky MV behaviors.

Stereotype threat and hazard perception among provisional license drivers

Stereotype threat refers to the negative impact a stereotype about one's group can have on one's performance in domains relevant to the stereotype. In the current paper, we explore whether the negative stereotype of provisional license drivers (PLDs) might produce stereotype threat in a driving-related hazard perception task. We manipulate threat by asking participants to self-identify as PLDs in a categorization condition, or by reminding PLD participants explicitly of the stereotype of PLDs in an explicit stereotype condition. Results reveal increments in hazard perception in the categorization condition, and decrements in hazard perception in the explicit stereotype condition. Mediation analysis reveals that hazard perception performance is fully mediated by increased effort in the categorization condition and by decreased effort in the explicit stereotype condition. We discuss these findings in terms of their implications for stereotype threat and its mediators, and for public policy that explicitly discriminates between PLDs and other driver groups.

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.

Safety belt laws and disparities in safety belt use among US high-school drivers

OBJECTIVES

We compared reported safety belt use, for both drivers and passengers, among teenagers with learner's permits, provisional licenses, and unrestricted licenses in states with primary or secondary enforcement of safety belt laws.

METHODS

Our data source was the 2006 National Young Driver Survey, which included a national representative sample of 3126 high-school drivers. We used multivariate, log-linear regression analyses to assess associations between safety belt laws and belt use.

RESULTS

Teenaged drivers were 12% less likely to wear a safety belt as drivers and 15% less likely to wear one as passengers in states with a secondary safety belt law than in states with a primary law. The apparent reduction in belt use among teenagers as they progressed from learner to unrestricted license holder occurred in only secondary enforcement states. Groups reporting particularly low use included African American drivers, rural residents, academically challenged students, and those driving pickup trucks.

CONCLUSIONS

The results provided further evidence for enactment of primary enforcement provisions in safety belt laws because primary laws are associated with higher safety belt use rates and lower crash-related injuries and mortality.

Early driving experience and influence on risk perception in young rural people

Young people, particularly males and those from a rural area, are over represented in road crashes; this occurs in vehicle dependent countries around the world, including Australia. The attitudes, experiences and behaviours of young drivers are some of the key factors which affect their potential to have an early on road driving experience that is crash free. This paper considers the views of young people, some of whom were brought up on rural properties, and had significant, responsible roles in agricultural work, including task related driving from a very early age. This early responsibility and associated awareness of risk of injury in farm related tasks can affect risk perception and impact on later risk taking behaviours. Ten focus groups were conducted with young people attending schools in four towns in rural New South Wales, Australia. These were recorded and analysed using qualitative methodology. The results indicate that risk factors in driving, on and off road, are clearly identified and understood; the majority of young people in rural areas are not "high" risk takers or sensation seekers. They also indicate that, in rural NSW, early vehicle handling, before the age for obtaining a license for driving on roads, is customary practice within the community. Attitudes towards speeding, however, reflect that it is tolerable behaviour, and almost inevitable, and often not considered to be risky. Drink driving is considered more risky, and less acceptable, at both the personal and community levels. Future intervention strategies to reduce crash rates in young rural drivers should aim to address the attitudes and actions associated with speeding on rural roads.

Variation in teen driver education by state requirements and sociodemographics

OBJECTIVES

There is renewed attention on national standardization of formal driver education (DE) instruction and momentum toward realigning DE with its original goal of producing safer teen drivers. However, teen DE participation rates and how they differ among sociodemographic groups and in states with and without DE requirements remain largely unknown. Thus, our objective was to estimate national teen participation rates in formal classroom and behind-the-wheel DE instruction in relevant demographic subgroups and also estimate subgroup-specific participation rates by presence of a state DE requirement.

METHODS

Data were collected via the National Young Driver Survey, administered to a nationally representative sample of 5665 public school 9th- through 11th-graders in Spring 2006. Analyses were restricted to 1770 students with driver licenses. Survey data were weighted to reflect national prevalence estimates.

RESULTS

Overall, 78.8% of students reported participating in formal DE. However, in states without DE requirements, more than 1 in 3 students had no formal DE before licensure, and more than half had no behind-the-wheel training. Hispanics, blacks, males, and students with lower academic achievement participated in DE at markedly lower levels than counterparts in states with requirements. Notably, 71% of Hispanic students in states with no requirement received a license without receiving formal DE.

CONCLUSIONS

Considerable racial/ethnic, socioeconomic, and gender disparities in DE participation may exist in states with no DE requirements. State DE requirements may be an effective strategy to reduce these disparities.

“My Son Is Reliable”

The high crash rates among teenage drivers are of great concern across nations. Parents’ involvement is known to help increase their young drivers’ driving safety. In particular, parents can place restrictions on their son’s/daughter’s driving (e.g., restrict night time driving), which can enable the young driver to gain driving experience in safer conditions. Yet little is known about what do parents think about parental responsibility regarding young drivers’ driving. This study aimed to address this question. It draws on both quantitative and qualitative data obtained through a phone survey of 906 Israeli parents of young drivers that included both open- and closed-ended items and 20 semistructured interviews with parents. The main findings were that parents tended to be optimistic about their own child’s driving compared with other young drivers and were relatively unconcerned about speeding. Whereas most parents thought restrictions regarding driving at night or talking on the phone should be placed on young drivers, most believed many parents do not enforce them. Most also believed many parents feel they are unable to influence young drivers’ driving. The exception, however, was they believed most parents restrict young drivers driving when they are tired. Two contrasting conceptions of parental responsibility were identified and presented as a model. Potential implications for road safety campaigns from a social norms perspective are discussed.

Factors associated with driving in teens with autism spectrum disorders

OBJECTIVE

To compare the characteristics of driving and nondriving teens and explore the driving outcomes for teens with higher functioning autism spectrum disorders.

METHODS

Parents of teens aged 15 to 18 years with a parent-reported diagnosis of an autism spectrum disorder enrolled in Interactive Autism Network, an online research registry, were eligible for this cross-sectional study. An online survey was used for data collection.

RESULTS

A total of 297 parents completed the survey. Sixty-three percent of teens currently drive or plan to drive. Twenty-nine percent of the teens who are age-eligible to drive currently drive. Compared with age-eligible but nondriving teens, a greater proportion of driving teens were in full-time regular education (p < .005), planned to attend college (p < .001), and held a paid job (p = .008). A greater proportion of parents of driving teens had taught ≥1 teen to drive previously (p < .001). There were no differences in gender, autism subtype, attention deficit/hyperactivity disorder diagnosis, parental age or education, or access to public transportation. Driving predictors included individualized education plans with driving goals, indicators of functional status (classroom placement, college aspiration, and job experience), and parent experience with teaching teens to drive. Twelve percent of teens received driving citations, and 12% of teens had been involved in a motor vehicle crash.

CONCLUSIONS

Although a significant proportion of teens with higher functioning autism spectrum disorders were driving or learning to drive, the fact that most driving teens' individualized education plans did not include driving goals suggests an area of opportunity for improvement in transition planning. Driving teens were more frequently in regular education settings with college aspirations, which could help schools identify potential drivers.

Determining subgroups of teens for targeted driving injury prevention strategies: a latent class analysis approach

OBJECTIVE

To utilize teen traffic safety belief profiles to improve targeting of resources and messages to young novice drivers.

METHODS

The National Young Driver Survey is a nationally representative sample 5665 of 9th to 11th graders in the United States. Using latent class analysis, we grouped beliefs about 25 safety-relevant behaviors into a summary set of belief profiles and related these profiles to demographics and driver/passenger experience.

RESULTS

We determined 5 safety belief profiles of teens: "everything" (rated most of the 25 behaviors as important to safety); "drivers/personal responsibility" (rated driver-related behaviors but few others as important); "driver drinking" (rated only driver alcohol use as always important); "distractions/external forces" (rated predominantly passenger rather than driver issues as important); and "nothing" (rated no issues as important). Three key groups emerged who were more likely than their counterparts to belong to the distractions/external forces than the everything class and for whom targeted messaging might be effective: males, non-white adolescents, and teens who had experienced an injury crash as a driver.

CONCLUSIONS

The classes appear to organize around the locus of control (LOC) social learning framework, with some teens perceiving crashes resulting primarily from their own behavior and others believing that forces in their environment determine the events that result in a crash. Designing interventions that help young drivers understand their role in crashes may help improve the safety behavior of young drivers. In particular, for those involved in crashes, interventions designed to help them understand that the crash was a result of their actions, rather than a random or externally driven event, may influence them to take control with safety-oriented behaviors.

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.

Drinking and driving among immigrant and US-born Hispanic young adults: results from a longitudinal and nationally representative study

OBJECTIVE

To evaluate the risk factors associated with the initiation of driving under the influence (DUI) among Hispanics in a longitudinal and nationally-representative sample of adolescents and young adults. Specifically, this study tests the effect of demographic variables, individual-level risk factors, and eco-processes (e.g., peer drug use, parental involvement) during adolescence on DUI among Hispanic young adults.

METHODS

Data were derived from 1734 Hispanic adolescents surveyed for the National Longitudinal Study of Adolescent Health (Add Health). Survey logistic regression procedures were used to examine the effects of nativity status on DUI initiation, to evaluate the independent effect of each risk factor (demographic, individual-level, and eco-processes), and to identify whether and to what extent these factors are associated with the initiation of DUI.

RESULTS

The overall prevalence of DUI initiation was 18.3%. Differences were observed in the rates of DUI initiation by nativity status: first-generation immigrants reported the lowest rates of DUI initiation (15.4%) when compared with second-generation US-born Hispanic youth (17.4%) and third-generation and beyond US-born Hispanic youth (21.5%). US-born Hispanic youth were also more likely to report higher frequency of alcohol use (t=3.46, p=0.001) and marijuana use (t=2.34, p=0.021) compared to immigrant adolescents. After adjusting for a number of risk factors, men (OR=2.86), marijuana users (OR=1.98), and those who reported feeling safe in their neighborhoods (OR=2.02) were at an increased risk DUI initiation.

CONCLUSIONS

Findings provide support for the "immigrant paradox": immigrant youth reported lower rates of DUI initiation and other high-risk behaviors when compared with US-born Hispanic youth.

"The little squealer" or "the virtual guardian angel"? Young drivers' and their parents' perspective on using a driver monitoring technology and its implications for parent-young driver communication

INTRODUCTION

In-vehicle driving monitoring technologies have the potential to enable young drivers to learn from self-assessment. However, their use is largely dependent on parental involvement.

METHOD

A total of 79 interviews were conducted with young drivers and parents regarding this technology and its use. Most had the experience of having an in-vehicle data recorder installed in the vehicle driven by the young drivers. Parents and the young drivers expressed both appreciation as well as reservations about its potential as a means to enhance the driving safety of young drivers.

RESULTS

A surprising finding was that some parents did not check the feedback and said they relied on the young driver to do so. Main concerns related to privacy, parent-young driver relationship, self-esteem and confidence, constructive use of the feedback data, and the limitations of the documentation that can be done by the technology.

CONCLUSIONS

Providing parents and young drivers with a support system and tools to discuss and utilize the feedback are underscored. Challenges include addressing the invasion of young drivers' privacy and gender differences, and using the monitoring-capacity of the technology to enhance safe driving practices. Implications for programs to enhance communication and a dialogical approach between parents and young drivers are discussed.

Adolescent drivers' perceptions of the advantages and disadvantages of abstention from in-vehicle cell phone use

Driver in-vehicle cell phone use presents a dangerous distraction for adolescent drivers for whom motor vehicle crashes represents the leading cause of death. We used the National Young Driver Survey (NYDS), a nationally representative (N=5665) cross-sectional study of adolescent driving behavior, to examine potential psychosocial correlates of cell phone use while driving (CPWD). Results indicated that stronger beliefs about the advantages of abstention from CPWD were associated with less frequent CPWD, adjusted OR: 0.46 95% [CI: 0.40-0.53]), while stronger beliefs about the disadvantages of abstention were associated with more frequent CPWD, adjusted OR: 1.41 95% CI: [1.21-1.64]. In the absence of strong advantage beliefs, disadvantage beliefs did not have a meaningful association with less frequent CPWD. Almost 30% of adolescents held weaker advantage beliefs coupled with stronger disadvantage beliefs, placing them most at risk. These findings offer guidance for a wide range of intervention and health promotion efforts.

Do perceptions of effective distractive driving public service announcements differ between adults and teens?

BACKGROUND

Motor vehicle crashes remain the leading cause of death and disability in teenagers. Graduated licensing laws, enforcement of a legal drinking age of 21 years, zero tolerance, and mandatory restraints have been successful in reducing crashes and fatalities. Media safety campaigns have been less successful. This study was designed to analyze whether perceived effectiveness of public service announcements (PSAs) differed between teens and adults. We hypothesized that adult-derived intent differs from teen perception.

METHODS

High-school students attending an annual municipal student safety exposition were asked to rank order six PSAs that were previously judged by an almost all adult committee. Additionally, students were asked to rate the PSAs on an agreement Likert scale assessing interest, understandability, and believability and to indicate potential effect on driving behavior. Students further graded their agreement with 10 top-published driving distracters and were asked to list additional perceived driving distracters.

RESULTS

Of the 330 surveys collected, 201 students aged 14 years to 19 years selected at least one choice and 181 ranked-ordered >1 PSA. The PSA #3 selected by the original adult judges was ranked second (33%) by teens with PSA #1 in first place (34%). PSA 1 was not considered as effective by the adult judges. Student age, race, grade, or gender did not produce statistically significant differences. A cohort of 186 teens responded to nationally noted driving distracters with >86% in agreement. Eating and applying cosmetics were additional distracters noted by students completing the survey.

CONCLUSION

Preventative media messages should include teen stakeholder review. The components of effective adolescent safety messages continue to require further study.

A practical approach for applying best practices in behavioural interventions to injury prevention

Behavioural science when combined with engineering, epidemiology and other disciplines creates a full picture of the often fragmented injury puzzle and informs comprehensive solutions. To assist efforts to include behavioural science in injury prevention strategies, this paper presents a methodological tutorial that aims to introduce best practices in behavioural intervention development and testing to injury professionals new to behavioural science. This tutorial attempts to bridge research to practice through the presentation of a practical, systematic, six-step approach that borrows from established frameworks in health promotion and disease prevention. Central to the approach is the creation of a programme theory that links a theoretically grounded, empirically tested behaviour change model to intervention components and their evaluation. Serving as a compass, a programme theory allows for systematic focusing of resources on the likely most potent behavioural intervention components and directs evaluation of intervention impact and implementation. For illustration, the six-step approach is applied to the creation of a new peer-to-peer campaign, Ride Like a Friend/Drive Like You Care, to promote safe teen driver and passenger behaviours.

Knowledge and early adoption of the HPV vaccine among girls and young women: results of a national survey

PURPOSE

In 2006, universal human papillomavirus (HPV) vaccination of females ages 9 to 26 years became a formal recommendation, yet little is known about knowledge and adoption of this vaccine.

METHODS

A cross-sectional survey of females aged 13 to 26 years was drawn from a nationally representative panel, and developed and maintained by Knowledge Networks, Inc. (Menlo Park, CA). Outcome measures included: (a) knowledge about HPV and the HPV vaccine, (b) barriers to vaccine adoption, and (c) prevalence and correlates of early vaccine receipt.

RESULTS

Overall, 1,011 of 2,143 subjects (47%) completed the survey. Thirty percent of 13- to 17-year-olds and 9% of 18- to 26-year-olds reported receipt of at least one HPV injection. Knowledge about HPV varied; however, 5% or fewer subjects believed that the HPV vaccine precluded the need for regular cervical cancer screening or safe-sex practices. Adjusting for healthcare utilization and sources of information, vaccine receipt was more likely among 13- to 17-year-olds who reported a recent healthcare visit (adjusted odds ratio [AOR] 7.31, confidence interval [CI] 2.00-26.8) and reported discussing the HPV vaccine (AOR 4.50, CI 1.02-19.90) with a healthcare provider; and more likely among 18- to 26-year-olds who reported discussing the HPV vaccine (AOR 3.08, CI 1.21-7.80) with family or a healthcare provider (AOR 11.92, CI 2.62-54.27).

CONCLUSIONS

Few girls and young women believe that the HPV vaccine is protective beyond the true impact of the vaccine. Despite moderate uptake, many females at risk of acquiring HPV have not yet received the vaccine. These findings suggest the important role of both healthcare providers and parents in HPV vaccine adoption.

Primary access to vehicles increases risky teen driving behaviors and crashes: national perspective

OBJECTIVE

The goal was to explore teen driver vehicle access and its association with risky driving behaviors and crashes.

METHODS

A nationally representative, school-based survey of 2167 ninth-, 10th-, and 11th-graders examined patterns of vehicle access (primary access [ie, the teen is the main driver of the vehicle] versus shared access) and associated driving exposure, risky driving behaviors, and sociodemographic factors.

RESULTS

Seventy percent of drivers reported having primary access to vehicles. They were more likely to be white, to be in 11th grade, to attend schools with higher socioeconomic levels, to have mostly A/B grades, to have a job, to drive a pickup truck, and to drive more hours per week but were not more or less likely to consume alcohol or to wear seat belts while driving. Compared with drivers with shared access, drivers with primary access reported more than twice the crash risk (risk ratio [RR]: 2.05 [95% confidence interval [CI]: 1.41-2.99]) and higher likelihoods of using cellular telephones while driving (RR: 1.23 [95% CI: 1.12-1.35]) and speeding> or =10 mph above the posted limit (RR: 1.24 [95% CI: 1.11-1.40]).

CONCLUSIONS

Primary access of novice teen drivers to vehicles is highly prevalent in the United States. This practice is a dangerous norm, because primary access is associated with risky driving behaviors. Healthcare providers and schools should consider counseling parents to discourage giving novice teen drivers primary access to vehicles. In communities where teens require primary access (eg, due to limited public transportation options), greater efforts should be made to promote safe behaviors.

Associations between parenting styles and teen driving, safety-related behaviors and attitudes

OBJECTIVE

The goal was to explore the association between parenting style and driving behaviors.

METHODS

The 2006 National Young Driver Survey gathered data on driving safety behaviors from a nationally representative sample of 5665 ninth-, 10th-, and 11th-graders. A parenting style variable was based on adolescent reports and separated parents into 4 groups, (1) authoritative (high support and high rules/monitoring), (2) authoritarian (low support and high rules/monitoring), (3) permissive (high support and low rules/monitoring), and (4) uninvolved (low support and low rules/monitoring). Associations between parenting style and driving behaviors and attitudes were assessed.

RESULTS

One half of parents were described as authoritative, 23% as permissive, 8% as authoritarian, and 19% as uninvolved. Compared with teens with uninvolved parents, those with authoritative parents reported one half the crash risk in the past year (odds ratio [OR]: 0.47 [95% confidence interval [CI]: 0.26-0.87]), were 71% less likely to drive when intoxicated (OR: 0.29 [95% CI: 0.19-0.44]), and were less likely to use a cellular telephone while driving (OR: 0.71 [95% CI: 0.50-0.99]). Teens with authoritative or authoritarian parents reported using seat belts nearly twice as often (authoritative: OR: 1.94 [95% CI: 1.49 -2.54]; authoritarian: OR: 1.85 [95% CI: 1.08 -3.18]) and speeding one half as often (authoritative: OR: 0.47 [95% CI: 0.36-0.61]; authoritarian: OR: 0.63 [95% CI: 0.40-0.99]) as teens with uninvolved parents. No significant differences in crash risk or seat belt use were found between permissive and uninvolved parents.

CONCLUSIONS

Clinicians should encourage parents to set rules and to monitor teens' driving behaviors, in a supportive context.

Teenagers--we thought we knew--we didn't--lessons learned

BACKGROUND

Motor vehicle crashes are the leading cause of death and disability to teenagers in the United States. The development of resources to assist physicians and high school teachers in anticipatory guidance of adolescent drivers and their parents provides a way to disseminate important information. As adults with years of experience working with teens in a variety of settings, we hypothesized we would have similar responses to a standardized message as teenagers themselves.

METHODS

Convenience-based focus groups of teens and adults evaluated the resource materials and their responses were collected. The adult group was made up of trauma, injury prevention and school staff, the teen group was made of students in random familiar settings (school programs, sports events, and mall). Each group was asked to evaluate three posters and select the one most likely to attract the attention of a teen and be most effective at supporting positive driving behavior. Seat belt usage was the primary message of all three posters.

RESULTS

Teens and adults have dramatically different responses to the posters. The primary choice of the adults was never selected by the teens and the primary choice of the adolescents was never the choice of the adults. Interestingly, both groups agreed that one of the posters was ineffective.

CONCLUSION

Experience with adolescents does not necessarily result in successful prediction of teen choices. The focus group experience gives the teen a voice in the process and ensures the message being sent is the one being received. Involving teens in development of educational materials targeted at this population is critical for successful implementation.

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.

Costs, mortality likelihood and outcomes of hospitalized US children with traumatic brain injuries

PRIMARY OBJECTIVE

To examine the hospitalization costs and discharge outcomes of US children with TBI and to evaluate a severity measure, the predictive mortality likelihood level.

RESEARCH DESIGN

Data from the 2006 Healthcare Cost and Utilization Project Kids' Inpatient Database (KID) were used to report the national estimates and characteristics of TBI-associated hospitalizations among US children < or =20 years of age. The percentage of children with TBI caused by motor vehicle crashes (MVC) and falls was calculated according to the predictive mortality likelihood levels (PMLL), death in hospital and discharge into long-term rehabilitation facilities. Associations with the PMLL, discharge outcomes and average hospital charges were examined.

RESULTS

In 2006, there were an estimated 58 900 TBI-associated hospitalizations among US children, accounting for $2.56 billion in hospital charges. MVCs caused 38.9% and falls caused 21.2% of TBI hospitalizations. The PMLL was strongly associated with TBI type, length of hospital stay, hospital charges and discharge disposition. About 4% of children with fall or MVC related TBIs died in hospital and 9% were discharged into long-term facilities.

CONCLUSION

The PMLL may provide a useful tool to assess characteristics and treatment outcomes of hospitalized TBI children, but more research is still needed.

Views of Connecticut parents of teens and other adults about graduated licensing upgrades

OBJECTIVES

Many states, including Connecticut, have strengthened their licensing laws in response to continuing teen deaths. At the time of the survey, Connecticut was considering further changes and it is likely that other states will be doing the same. The objective was to determine parental views about enhancements to the learner stage and to existing night and passenger restrictions.

METHODS

Parents of teens and a sample of other adults were interviewed by telephone.

RESULTS

Connecticut parents were well aware of the provisions of the current law. The majority of parents of teens and a majority of "other adults" supported a requirement for increased driving supervision, a longer permit period, a longer-term passenger restriction, and a night restriction starting earlier than midnight. About half favored a higher minimum permit age. Support was highest among "other adults" and among females in both groups.

CONCLUSIONS

Survey results such as these can provide guidance to states wishing to reduce the young driver problem through changes in licensing laws. Connecticut in fact enacted new legislation effective August 1, 2008, strengthening requirements in ways supported by parents and other adults. Survey results were available to legislators during their deliberations and may have played a role.