Adolescent Cellphone Use While Driving: An Overview of the Literature and Promising Future Directions for Prevention

Feedback and Financial Incentives for Reducing Cell Phone Use While Driving: A Randomized Clinical Trial

Importance

Handheld phone use while driving is a major factor in vehicle crashes. Scalable interventions are needed to encourage drivers not to use their phones.

Objective

To test whether interventions involving social comparison feedback and/or financial incentives can reduce drivers' handheld phone use.

Design, Setting, and Participants

In a randomized clinical trial, interventions were administered nationwide in the US via a mobile application in the context of a usage-based insurance program (Snapshot Mobile application). Customers were eligible to be invited to participate in the study if enrolled in the usage-based insurance program for 30 to 70 days. The study was conducted from May 13 to June 30, 2019. Analysis was completed December 22, 2023.

Interventions

Participants were randomly assigned to 1 of 6 trial arms for a 7-week intervention period: (1) control; (2) feedback, with weekly push notification about their handheld phone use compared with that of similar others; (3) standard incentive, with a maximum $50 award at the end of the intervention based on how their handheld phone use compared with similar others; (4) standard incentive plus feedback, combining interventions of arms 2 and 3; (5) reframed incentive plus feedback, with a maximum $7.15 award each week, framed as participant's to lose; and (6) doubled reframed incentive plus feedback, a maximum $14.29 weekly loss-framed award.

Main Outcome and Measure

Proportion of drive time engaged in handheld phone use in seconds per hour (s/h) of driving. Analyses were conducted with the intention-to-treat approach.

Results

Of 17 663 customers invited by email to participate, 2109 opted in and were randomized. A total of 2020 drivers finished the intervention period (68.0% female; median age, 30 [IQR, 25-39] years). Median baseline handheld phone use was 216 (IQR, 72-480) s/h. Relative to control, feedback and standard incentive participants did not reduce their handheld phone use. Standard incentive plus feedback participants reduced their use by -38 (95% CI, -69 to -8) s/h (P = .045); reframed incentive plus feedback participants reduced their use by -56 (95% CI, -87 to -26) s/h (P < .001); and doubled reframed incentive plus feedback participants reduced their use by -42 s/h (95% CI, -72 to -13 s/h; P = .007). The 5 active treatment arms did not differ significantly from each other.

Conclusions and Relevance

In this randomized clinical trial, providing social comparison feedback plus incentives reduced handheld phone use while individuals were driving.

Trial Registration

ClinicalTrials.gov Identifier: NCT03833219.

Is Nomophobia Problematic or Functional? A Perspective from Bifactor Structure

With the extensive use of mobile phones globally, some people engage in excessive or problematic phone use behaviors. However, little is known regarding the latent structure of problematic mobile phone use. The current study employed the Chinese versions of the Nomophobia Questionnaire, Mobile Phone Addiction Tendency Scale, and Depression-Anxiety-Stress Scale-21 to explore the latent psychological structure of problematic mobile phone use and nomophobia and their associations with mental health symptoms. Results showed that a bifactor latent model best fit nomophobia, which contained a general factor and four unique factors involving the fear of being unable to access information, losing convenience, losing contact, and losing one's Internet connection. Results also showed significant correlations among latent factors of nomophobia, problematic mobile phone use, and mental health symptoms. Through these findings, we can conclude that two problematic mobile phone use behaviors share a common factor concerning excessive use, and nomophobia has independent unique factors concerning usable function. This study clarifies the structure of problematic mobile phone use, and it implies that we can distinguish problematic mobile phone use from functional use; further investigation of problematic mobile phone use is warranted.

Normative influences on young drivers' illegal smartphone use: Applying an extended Theory of Normative Social Behaviour

In the 12 months to November 2021, 19 % of the people killed on Australian roads were aged between 17 and 25 years, despite this age group making up just 12 % of the driving population. A substantial number of these crashes resulted from smartphone use. It is widely accepted that norms influence young drivers' smartphone use; however, there is a dearth of research investigating how different norms interact to influence this behaviour. The current survey study (N = 137) applied an extended Theory of Normative Social Behaviour (TNSB) to investigate illegal smartphone use among young drivers. The original TNSB model proposes that injunctive norm (i.e., perceived societal approval), outcome expectancies, and group identity each moderate the relationship between descriptive norm and behavioural intention. The current study added subjective norm (i.e., perceived approval from important others) to the model. Moderation analyses found that only subjective norm moderated the relationship between descriptive norm and behavioural intention, whereas subjective norm, injunctive norm, and outcome expectancies each partially mediated this relationship. These findings provided partial support for the TNSB. They highlighted the influence of a range of norms on young drivers' smartphone use (i.e., descriptive norm, subjective norm, and injunctive norm) and, in particular, the influence of subjective norm in this context. It also highlights the importance of investigating how norms interact with each other to influence the relationship between descriptive norm and behavioural intention. In accordance with these findings, future public education messages should challenge normative influences, and subjective norm in particular, on young drivers' smartphone use.

Effectiveness of a Text Message Intervention to Reduce Texting While Driving Among Targeted Young Adults: A Randomized Controlled Trial

PURPOSE

This randomized clinical trial tested the efficacy of a 6-week text message program to reduce texting while driving (TWD) for young adults.

METHODS

Eligible individuals recruited from four emergency departments from December 2019 to June 2021 were aged 18-25 years who reported TWD in the past 2 weeks. Participants were randomly assigned 1:1 to intervention:assessment control. The intervention arm (n = 57) received an automated interactive text message program, including weekly queries about TWD for 6 weeks with feedback and goal support to promote cessation of TWD. The assessment control arm (n = 55) received identical weekly TWD queries but no additional feedback. Outcomes were collected via web-based self-assessments at 6- and 12 weeks and analyzed under intent-to-treat models, presented as adjusted odds ratios (ORs) with 95% confidence intervals (CIs).

RESULTS

The mean (SD) age was 21.7 (2.1) years, 73 (65%) were female, and 40 (36%) were White. The 6-week follow-up rate was 77.7% (n = 87) and 12-week follow-up rate was 64.3% (n = 72). At 6 weeks, 52.6% (95% CI, 39.0%-66.0%) of intervention participants reported TWD versus 63.6% (95% CI, 49.6%-76.2%) of control participants (adjusted OR, 0.71; 95% CI, 0.32-1.59). At 12 weeks, 38.2% (95% CI, 22.8%-53.5%) of intervention participants reported TWD versus 69.3% (95% CI, 53.8%-84.7%) of control participants (adjusted OR, 0.29; 95% CI, 0.11-0.80).

DISCUSSION

An interactive text message intervention was more effective at reducing self-reported TWD among young adults than assessment control at 12 weeks.

Improving Our Understanding of Driving Changes in Preclinical and Early Symptomatic Alzheimer’s Disease: The Role of Naturalistic Driving Studies

Research on how preclinical and early symptomatic Alzheimer’s disease (AD) impacts driving behavior is in its infancy, with several important research areas yet to be explored. This paper identifies research gaps and suggests priorities for driving studies over the next few years among those at the earliest stages of AD. These priorities include how individual differences in demographic and biomarker measures of AD pathology, as well as differences in the in-vehicle and external driving environment, affect driving behavior. Understanding these differences is important to developing future interventions to increase driving safety among those at the earliest stages of AD.

An analysis of the novice motorcyclist crashes in Taiwan

OBJECTIVE

Motorcycles comprised over 60% of motor vehicles in Taiwan. There were still many motorcycle crashes in Taiwan, especially among young riders. This study investigated the characteristics of novice motorcyclist crashes in Taiwan over the period January 2011 to December 2016. Various risk factors affecting the severity of novice motorcyclist crashes, such as the rider characteristics, licensing conditions, and the environment, were examined.

METHODS

To model the count data with multiple crash severities, several regression models were considered. The multinomial logit (MNL) model, ordered logit (OL) model, and partial proportional odds (PPO) model were chosen and investigated for the relationships between the severity of novice motorcyclist crashes and potential risk factors.

RESULTS

The results showed that the novice rider who was underage or unlicensed had a higher probability of a fatal crash. Male sex, helmet use, drinking, college student, frontal impact, urban or dry road, and daytime all played significant roles in novice motorcyclist crashes.

CONCLUSIONS

Taiwan traffic safety needs further policy adjustments and public education toward novice motorcycle crashes. Adequate driving training and providing a user-friendly environment for novice riders could help. Taiwan should consider graduated driver licensing systems for skill-building and riding supervision for new motorcyclists.

Smartphone use among young drivers: Applying an extended Theory of Planned Behaviour to predict young drivers' intention and engagement in concealed responding

Young drivers, aged 17-25 years, are more likely than other age groups to access social interactive technologies (e.g., Snapchat, Facebook) on their smartphones while driving. Many of these young drivers do so in a concealed manner, thereby diverting their eyes from the road for extended periods and increasing their crash risk. In accordance with previous research, an extended Theory of Planned Behaviour (TPB) was applied in this survey study to investigate psychosocial predictors of young drivers' intention, and behaviour, of responding to social interactive technology on a smartphone in a concealed manner. Participants (N = 154) resided in Australia, were aged 17-25 years, owned a provisional or an open licence, and owned a smartphone. Participants completed two online surveys administered 1-week apart. The first survey measured intention and assessed the TPB standard constructs of attitude, subjective norm, and perceived behavioural control, as well as the additional constructs of anticipated action regret, anticipated inaction regret, and problematic mobile phone usage. The first survey also assessed whether there were any differences in the salient beliefs (elicited in a previous study) about smartphone use between high and low intenders to engage in this behaviour. The second survey measured engagement in the behaviour of responding in a concealed manner in the previous week. Hierarchical multiple regression analyses showed the standard TPB accounted for 69% of variance in intention, and a further 4% was accounted for by the extended constructs. In the final model, all variables, except anticipated inaction regret, were significant predictors of intention. Intention was the only significant predictor of behaviour. A series of MANOVAs found significant differences in the salient belief items between high and low intenders (e.g., high intenders were more likely to believe that friends/peers and other drivers would approve of them engaging in this behaviour). These key findings can be used as focal points for public education messages to persuade young drivers to reduce the frequency of their smartphone use, which is vital to improve road safety for all users.

Adolescent Riding Behavior During the COVID-19 Pandemic in Urban Area, Indonesia: A Cross-sectional Study

BACKGROUND

According to police reported crash, in 2020 there have been 510 road traffic accidents among adolescents aged 16-25 years. The problem is that although restrictions on social activities have been implemented, 9.80% of accidents have caused deaths in Semarang City. There were many factors that influence the occurrence of road traffic accidents; one of those is the poor knowledge about safe riding behavior. The aim of this study is to determine the factors that contribute to the occurrence of road traffic accidents in adolescents during the pandemic.

METHODS

This was a cross-sectional study, collected data using an online questionnaire distributed to adolescents aged 15-20 years in Semarang City, Indonesia. It was distributed during February-April 2021. The data included participant's demographic information, riding behavior, and knowledge about safe riding. We analyzed using chi-square and logistic regression to determine the most influential factors.

RESULTS

The sample included 725 participants with a mean age of 17.4 years (SD=0.97); 260 (35.9%) males. We have found that gender was associated with the incidence of road traffic accidents (AOR=1.455, 95% CI [1.048-2.020], P=0.025) after adjusting for experience road safety education, vehicle type, and knowledge of safe riding.

CONCLUSION

It is necessary to carry out Road Safety Education efforts to male students during the pandemic to reduce the incidence of traffic accidents.

Rethinking Cell Phone Use While Driving: Isolated Risk Behavior or a Pattern of Risk-Taking Associated with Impulsivity in Young Drivers?

This study examines whether cell phone use stands apart from a general pattern of risky driving practices associated with crashes and impulsivity-related personality traits in young drivers. A retrospective online survey study recruited 384 young drivers from across the United States using Amazon’s Mechanical Turk to complete a survey measuring risky driving practices (including cell phone use), history of crashes, and impulsivity-related personality traits. Almost half (44.5%) of the drivers reported being involved in at least one crash, and the majority engaged in cell phone use while driving (up to 73%). Factor analysis and structural equation modeling found that cell phone use loaded highly on a latent factor with other risky driving practices that were associated with prior crashes (b = 0.15, [95% CI: 0.01, 0.29]). There was also an indirect relationship between one form of impulsivity and crashes through risky driving (b = 0.127, [95% CI: 0.01, 0.30]). Additional analyses did not find an independent contribution to crashes for frequent cell phone use. These results suggest a pattern of risky driving practices associated with impulsivity in young drivers, indicating the benefit of exploring a more comprehensive safe driving strategy that includes the avoidance of cell phone use as well as other risky practices, particularly for young drivers with greater impulsive tendencies.

Blueprint for a Simulation Framework to Increase Driver Training Safety in North America: Case Study

Despite numerous recent advances in the classroom and in-vehicle driver training and education over the last quarter-century, traffic accidents remain a leading cause of mortality for young adults—particularly, those between the ages of 16 and 19. Obviously, despite recent advances in conventional driver training (e.g., classroom, in-vehicle, Graduated Driver Licensing programs), this remains a critical public safety and public health concern. As advanced vehicle technologies continue to evolve, so too does the unintended potential for mechanical, visual, and/or cognitive driver distraction and adverse safety events on national highways. For these reasons, a physics-based modeling and high-fidelity simulation have great potential to serve as a critical supplementary component of a near-future teen-driver training framework. Here, a case study is presented that examines the specification, development, and deployment of a “blueprint” for a simulation framework intended to increase driver training safety in North America. A multi-measure assessment of simulated driver performance was developed and instituted, including quantitative (e.g., simulator-measured), qualitative (e.g., evaluator-observed), and self-report metrics. Preliminary findings are presented, along with a summary of novel contributions through the deployment of the training framework, as well as planned improvements and suggestions for future directions.

Evaluation of a population health strategy to reduce distracted driving: Examining all "Es" of injury prevention

BACKGROUND

Cell phone use while driving (CPWD) increases the risk of crashing and is a major contributor to injuries and deaths. The objective of this study was to describe the evaluation of a multifaceted, evidence-based population health strategy for the reduction of distracted driving.

METHODS

A multipronged campaign was undertaken from 2014 to 2016 for 16- to 44-year-olds, based on epidemiology, focused on personal stories and consequences, using the "Es" of injury prevention (epidemiology, education, environment, enforcement, and evaluation). Education consisted of distracted driving videos, informational cards, a social media AdTube campaign, and a movie theater trailer, which were evaluated with a questionnaire regarding CPWD attitudes, opinions, and behaviors. Spatial analysis of data within a geographic information system was used to target advertisements. A random sample telephone survey evaluated public awareness of the campaign. Increased CPWD enforcement was undertaken by police services and evaluated by ARIMA time series modeling.

RESULTS

The AdTube campaign had a view rate of >10% (41,101 views), slightly higher for females. The top performing age group was 18- to 24-year-olds (49%). Our survey found 61% of respondents used handheld CPWD (14% all of the time) with 80% reporting our movie trailer made them think twice about future CPWD. A stakeholder survey and spatial analysis targeted our advertisements in areas of close proximity to high schools, universities, near intersections with previous motor vehicle collisions, high traffic volumes, and population density. A telephone survey revealed that 41% of the respondents were aware of our campaign, 17% from our print and movie theater ads and 3% from social media. Police enforcement campaign blitzes resulted in 160 tickets for CPWD. Following campaign implementation, there was a statistically significant mean decrease of 462 distracted driving citations annually (p = 0.001).

CONCLUSION

A multifaceted, evidence-based population health strategy using the Es of injury prevention with interdisciplinary collaboration is a comprehensive method to be used for the reduction of distracted driving.

LEVEL OF EVIDENCE

Therapeutic, level IV.

Use of theory to guide development and application of sensor technologies in Nursing

Sensor technologies for health care, research, and consumers have expanded and evolved rapidly. Many technologies developed in commercial or engineering spaces, lack theoretical grounding and scientific evidence to support their need, safety, and efficacy. Theory is a mechanism for synthesizing and guiding knowledge generation for the discipline of nursing, including the design, implementation, and evaluation of sensors and related technologies such as artificial intelligence and machine learning. In this paper, three nurse scientists summarize their presentations at the Council for the Advancement of Nursing Science 2019 Advanced Methods Conference on Expanding Science of Sensor Technology in Research discussing the theoretical underpinnings of sensor technologies development and use in nursing research and practice. Multiple theories with diverse epistemological roots guide decision-making about whether or not to apply sensors to a given use; development of, components of, and mechanisms by which sensor technologies are expected to work; and possible outcomes.

Social distance and texting while driving: A behavioral economic analysis of social discounting

Objective: Texting while driving is a dangerous behavior. Drivers continue to engage in the behavior despite knowing its risks, and the factors responsible for the decision to text while driving are poorly understood. This study examined how the relationship of the sender to the driver, in addition to the delay to the destination, may affect the decision to text while driving with the use of a social- and delay-discounting paradigm. Methods: Ninety-four (N = 94) undergraduate students completed a hypothetical social- and delay-discounting task in which they rated their likelihood of replying to a text message immediately versus waiting to reply until arriving at a destination. The social distance of the sender and the delay to the destination were varied across trials. Results: For both social and delay discounting, the likelihood of replying and waiting, respectively, decreased as a function of social distance and delay to the destination. Participants were more likely to text while driving as the social distance of the sender decreased and the delay to the destination increased. Social discounting varied inversely as a function of delay to the destination: The shorter the delay to the destination, the greater the social discounting. Conclusion: The findings indicate that social distance of the sender is an important factor involved in the decision to text while driving. Participants were more likely to reply to a text while driving if the sender was less socially distant. When they were closer to their destination, they were less likely to reply to socially distant people than those closer to them. The roles that social consequences play in drivers' decision making to text while driving are discussed.

An Integrative Review on Teen Distracted Driving for Model Program Development

Distracted driving, especially driver inattention, is associated with high levels of crash-related fatalities and injury. Teen novice drivers are one of the groups most likely to drive distracted and to suffer its consequences. Teens have a higher risk of engaging in texting or secondary tasks, e.g., eating while driving. Distracted driving interventions to date aim to improve teen and societal safety, but few have achieved effectiveness. A need exists for effective evidence-based distracted driving interventions. We used an integrative review to identify rigorous evidence, and inform the development of a teen distracted driving educational intervention. This five-step review included: identifying the research problem; collecting literature; evaluating literature; synthesizing data; and presenting results. We searched 6 databases, identifying 185 articles. Following three rounds of inclusion screening (title, abstract, and full-text), captured according to a PRISMA flow chart, 17 studies met inclusion. We categorized these studies, conducted in the U.S., as five intervention types that used approaches including presentations, videos or instructional programs, education or training programs, driving simulator training, in-vehicle monitoring or feedback, and integrated programs. Study designs included randomized controlled trials pre-post, quasi-experimental, and experimental designs with prospective longitudinal cohorts. The studies were heterogeneous in design, intervention and outcome. However, three core themes emerged across studies: i.e., hazard awareness, hazard mitigation and attention maintenance are primary critically necessary skills to prevent distracted driving; engaging a parent or adult as a partner in the intervention process from classroom to car contributed to the effectiveness of the intervention; and leveraging technology in training enhanced the effectiveness of the intervention. Study limitations pertained to a focus on short-term effects; sampling distributions that did not account for gender, age, race, and/or ethnicity; types of interventions; and bias. The limitations affect the generalizability of included study findings and, potentially, the review findings, as they may not apply to populations or contexts outside those synopsized. Strengths included our team's expertise in conducting evidence-based reviews, support of a health science librarian, and use of international review guidelines. As an outcome, we are applying findings of the integrated review to develop a computer-based training addressing teen distracted driving.

A Behavioral Economic Analysis of Demand for Texting while Driving

The overarching goal of the present study was to determine whether a behavioral economic framework of demand analysis is applicable to texting while driving. To this end, we developed a novel hypothetical task designed to quantify the intensity and elasticity of the demand for social interaction from texting while driving. This task involved a scenario in which participants receive a text message while driving, and they rated the likelihood of replying to a text message immediately versus waiting to reply until arriving at a destination when the amounts of a fine for texting while driving ranged from $1 to $300. To assess the construct validity of the task, the scenario presented two delays to a destination (15 min and 60 min). The demand for social interaction from texting was more intense (greater at the lowest amount of the fine) and less elastic (less sensitive to the increase in the amounts of the fine) for drivers who self-reported a higher frequency of texting while driving than for those who self-reported a lower frequency of texting while driving. Demand was also more intense and less elastic under the 60-min delay condition than under the 15-min condition. The results of this proof-of-concept study suggest that behavioral economic demand analyses are potentially useful for understanding and predicting texting while driving.

Threat appeals reduce impulsive decision making associated with texting while driving: A behavioral economic approach

The primary purpose of the present study was to examine the effectiveness of threat appeals in influencing impulsive decision making associated with texting while driving. The participants in the treatment group were exposed to a threatening message about the danger of texting while driving, whereas those in the control group were exposed to a non-threatening message. Following the exposure to either message, the participants completed a delay-discounting task that assessed the degree of impulsive decision making in a hypothetical texting-while-driving scenario. A comparison between the groups revealed that the threat appeals reduced the degree of impulsive decision making associated with texting while driving. In addition, the threat appeals led to greater anticipated regret from texting while driving, less favorable attitudes toward texting while driving, and decreased intentions to text while driving in the future in the treatment group. These results suggest that video-based threat appeals are promising intervention strategies for the public health challenge of texting while driving. Implications from the behavioral economic perspective are discussed.

Novel Smartphone-Based Measures of Cell Phone Use While Driving in a Sample of Newly Licensed Adolescent Drivers

BACKGROUND

Motor vehicle crashes are the leading cause of adolescent death. Cell phone use while driving is a contributor to adolescent motor vehicle crash risk. Objective and directly observable measures of cell phone use while driving are needed to implement interventions aimed at reducing cell phone-related crash risk.

AIMS

To describe novel smartphone-based measures of cell phone use while driving in a sample of newly licensed male and female adolescent drivers.

METHODS

Newly licensed adolescents in Pennsylvania installed a windshield-mounted device that pairs with a smartphone application to collect data on cell phone use while driving over 2 weeks during June 2016-October 2016. Descriptive statistics, independent t tests, and Wilcoxin Mann-Whitney U test were used to characterize handheld cell phone use ("unlock") and call time while accounting for driving exposure.

RESULTS

Data from 16 adolescents (50% male) resulted in 5,624 miles in 705 trips, 964 cell phone unlocks, and 146.22 minutes of call time. Participants had a mean of 23.96 unlocks/100 miles ( SD = 22.97), 1.23 unlocks/trip ( SD = 0.96), and 4.87 unlocks/hour driven ( SD = 3.93). Males had significantly more unlocks/100 miles, unlocks at speed >25 mph/100 miles, unlocks/hour driven, and unlocks at speed > 25 mph/hour driven ( p < .05).

CONCLUSIONS

Smartphone-based applications are an innovative means by which to collect continuous data on cell phone use while driving that can be used to better understand and intervene on this frequent behavior in newly licensed adolescent drivers.

Texting/Emailing While Driving Among High School Students in 35 States, United States, 2015

PURPOSE

Determine the prevalence and explore individual- and state-level factors associated with texting/emailing while driving (TWD) among adolescent drivers in the United States.

METHODS

Data from 35 states that administered the 2015 state Youth Risk Behavior Survey were analyzed. We used Poisson regression models with robust error variance to estimate prevalence ratios (PRs) for TWD.

RESULTS

Among the 101,397 high school students aged ≥ 14 years who had driven a vehicle during the past 30 days, 38% reported TWD at least once. TWD prevalence ranged from 26% in Maryland to 64% in South Dakota. TWD prevalence was higher in states with a lower minimum learner's permit age and in states where a larger percentage of students drove. Multivariable analyses revealed that the likelihood of TWD increased substantially with age, and white students were more likely to engage in TWD than students of all other races/ethnicities. Infrequent seatbelt users were 21% more likely to engage in TWD compared with frequent seatbelt users (adjusted PR = 1.21, 95% confidence interval: 1.16-1.26), and students who reported drinking and driving were almost twice as likely to TWD as compared to students who did not (adjusted PR = 1.91, 95% confidence interval: 1.79-2.04).

CONCLUSIONS

Prevalence of TWD among US high school students varied by more than two-fold across states. TWD prevalence was higher in states with lower minimum learner's permit ages and in states where a larger percentage of students drove. Older age, white race/ethnicity, and other risky driving behaviors were associated with TWD.

The Teen Driver

For many teenagers, obtaining a driver's license is a rite of passage, conferring the ability to independently travel to school, work, or social events. However, immaturity, inexperience, and risky behavior put newly licensed teen drivers at risk. Motor vehicle crashes are the most common cause of mortality and injury for adolescents and young adults in developed countries. Teen drivers (15-19 years of age) have the highest rate of motor vehicle crashes among all age groups in the United States and contribute disproportionately to traffic fatalities. In addition to the deaths of teen drivers, more than half of 8- to 17-year-old children who die in car crashes are killed as passengers of drivers younger than 20 years of age. This policy statement, in which we update the previous 2006 iteration of this policy statement, is used to reflect new research on the risks faced by teen drivers and offer advice for pediatricians counseling teen drivers and their families.

The prevalence and correlates of texting while driving among a population-based sample of Ontario students

OBJECTIVE

Texting while driving (TWD) has a deleterious impact on driving performance and may pose a significant challenge to traffic safety. This challenge may be particularly relevant for young and inexperienced drivers. This study examined the prevalence and risk factors of writing text messages or emails while driving during the past 12 months.

METHOD

This study analyzed a subpopulation of 1,133 licensed students 16 years of age or older from the 2013 Ontario Student Drug Use Survey (OSDUHS), a population-based survey of students in Ontario, Canada.

RESULTS

Our results indicate that 36% of licensed drivers reported writing a text message while driving during the past 12 months; of those who did, 56% reported doing so 4 or more times. Graduated licensing was the strongest factor predicting TWD. Compared to students with the more restrictive G1 license, students with a G2 or full license were 9.4 times more likely to report TWD after controlling for the effect of all other factors. Older students, white students, and students attending school in urban centers were more likely to report TWD, and the amount of time spent on social media sites, being a passenger with a driver using substances, and past-year collisions were also significantly associated with TWD. Gender differences and participation in driver education training were not associated with TWD.

CONCLUSIONS

This research demonstrates that TWD is an extremely common behavior among licensed student drivers in Ontario, particularly among those who have passed the first stage of graduated licensing. TWD is associated with other risky driving behaviors and outcomes, and the findings from this study underscore the need to better understand the harms associated with this behavior.

Examination of associations between risky driving behaviors and hazardous drinking among a sample of college students

OBJECTIVE

Hazardous drinking is associated with other risky behaviors and negative health-related outcomes. This study examined covariation between hazardous drinking scores and the following risky driving behaviors: Falling asleep while driving, texting (receiving and sending) while driving, and driving after consuming alcohol.

METHODS

The participants in this study were a sample of undergraduate students (N = 1,298) who were enrolled in an introductory health course at a large Southeastern university in spring 2016 and completed an online health survey that assessed hazardous drinking, falling asleep while driving, texting while driving, and driving after consuming alcohol. We conducted a series of 2-step regression analyses to examine covariation between hazardous drinking scores (using the Alcohol Use Disorders Identification Test-Consumption [AUDIT-C]) and the risky driving behaviors of interest.

RESULTS

We found that the majority of participants did not drink and drive (91.8%), nor did they fall asleep while driving (80.4%); however, the majority did read a text while driving (81.7%) and sent a text while driving (75.3%). In the full multivariable model, hazardous drinking score was positively associated with drinking and driving (step 2 odds ratio [OR] = 1.28, 95% confidence interval [CI], 1.18, 1.38) and sending a text message while driving (step 2 b = 0.19, P = .01). Hazardous drinking score was also positively associated with reading a text while driving (step 1 b = 0.14, P < .001) and falling asleep while driving (step 1 b = 0.02, P = .02) in the model only controlling for demographic characteristics. The analyses also indicated covariability between the following risky driving behaviors: (1) drinking and driving/reading a text message while driving, (2) drinking and driving/falling asleep and driving, (3) reading a text while driving/sending a text while driving, and (4) sending a text while driving/sleeping and driving.

CONCLUSION

The findings of this study indicate a need for interventions discouraging both hazardous drinking and risky driving behaviors in college student populations; recommendations to reduce risky driving and hazardous drinking are discussed.

The roles of delay and probability discounting in texting while driving: Toward the development of a translational scientific program

A sample of 109 college students completed a survey to assess how frequently they send or read text messages while driving. In a novel discounting task with a hypothetical scenario in which participants receive a text message while driving, they rated the likelihood of replying to a text message immediately versus waiting to reply until arriving at a destination. The scenario presented several delays to a destination and probabilities of a motor vehicle crash. The likelihood of waiting to reply decreased as a function of both the delay until the destination and the probability of a motor vehicle crash. Self-reported higher frequencies of texting while driving were associated with greater rates of both delay and probability discounting. The degree of delay discounting was altered as a function of the probability of a motor vehicle crash and vice versa. These results suggest that both delay and probability discounting are important underlying mechanisms of drivers' decision to text while driving.

Measurement Invariance of the Short Version of the Problematic Mobile Phone Use Questionnaire (PMPUQ-SV) across Eight Languages

The prevalence of mobile phone use across the world has increased greatly over the past two decades. Problematic Mobile Phone Use (PMPU) has been studied in relation to public health and comprises various behaviours, including dangerous, prohibited, and dependent use. These types of problematic mobile phone behaviours are typically assessed with the short version of the Problematic Mobile Phone Use Questionnaire (PMPUQ⁻SV). However, to date, no study has ever examined the degree to which the PMPU scale assesses the same construct across different languages. The aims of the present study were to (i) determine an optimal factor structure for the PMPUQ⁻SV among university populations using eight versions of the scale (i.e., French, German, Hungarian, English, Finnish, Italian, Polish, and Spanish); and (ii) simultaneously examine the measurement invariance (MI) of the PMPUQ⁻SV across all languages. The whole study sample comprised 3038 participants. Descriptive statistics, correlations, and Cronbach's alpha coefficients were extracted from the demographic and PMPUQ-SV items. Individual and multigroup confirmatory factor analyses alongside MI analyses were conducted. Results showed a similar pattern of PMPU across the translated scales. A three-factor model of the PMPUQ-SV fitted the data well and presented with good psychometric properties. Six languages were validated independently, and five were compared via measurement invariance for future cross-cultural comparisons. The present paper contributes to the assessment of problematic mobile phone use because it is the first study to provide a cross-cultural psychometric analysis of the PMPUQ-SV.

Attitudes on technological, social, and behavioral economic strategies to reduce cellphone use among teens while driving

OBJECTIVE

The majority of U.S. teens admit to handheld cellphone use while driving, an increasingly common cause of crashes. Attitudes toward novel cellphone applications and settings that block use while driving are poorly understood, potentially limiting uptake. We examined teens' willingness to reduce cellphone use while driving and perceptions of potential strategies to limit this behavior.

METHODS

Teen drivers (n = 153) aged 16-17 who owned smartphones and admitted to texting while driving completed an online survey. Survey instruments measured willingness to give up cellphone use and perceptions of technological and behavioral economic strategies to reduce cellphone use while driving. We used chi-square tests to test the hypothesis that willingness to give up certain types of cellphone use while driving and the perceptions of strategies to reduce cellphone use while driving would differ by self-reported frequency of texting while driving in the past 30 days (low [1-5 days] vs. high [6 or more days]).

RESULTS

Most teens were willing or somewhat willing to give up reading texts (90%), sending texts (95%), and social media (99%) while driving. However, they were not willing to give up navigation (59%) and music applications (43%). Those who engaged in high-frequency texting while driving were more likely to say that they were not willing to give up navigation applications (73 vs. 44%, P <.001), music applications (54 vs. 32%, P <.001), and reading texts (15 vs. 4%, P =.029). Overall, the following strategies where rated as likely to be very effective for reducing texting while driving: gain-framed financial incentives (75%), loss-framed financial incentives (63%), group-based financial incentives (58%), insurance discounts (53%), automatic phone locking while driving (54%), e-mail notifications to parents (47%), automated responses to incoming texts (42%), peer concern (18%), and parental concern (15%). Those who engaged in high-frequency texting while driving were less likely to say that following strategies would be very effective: automated responses to incoming texts (33 vs. 53%, P =.016), peer concern (9 vs. 29%, P =.002), and parental concern (9 vs. 22%, P =.025). The strongest perceived benefit of cellphone blocking apps was decreasing distraction (86%). The predominant reason for not wanting to use this technology was not wanting parents to monitor their behavior (60%).

CONCLUSIONS

Promising strategies for increasing acceptance of cellphone blocking technology among teen drivers include automated screen locking and permitting hands-free navigation and music combined with behavioral economic incentives to sustain engagement.

The Self-perception of Text-message Dependency Scale (STDS): Psychometric update based on a United States sample

BACKGROUND

Some have suggested that text messaging is an addictive behavior. However, this characterization is uncertain, partly due to lack of well-validated measures of text messaging attitudes and behaviors. One standard instrument for measuring text messaging attitudes and behaviors is the Self-perception of Text-message Dependency Scale (STDS), though the psychometric properties of this scale have only been examined with a sample of Japanese youth.

OBJECTIVES

The primary objective of this study was to evaluate the STDS in the United States to determine its utility as a measure of text messaging dependence. We were interested in examining the factor structure and determining the extent to which this scale would correlate with two important outcome measures: motor vehicle accidents (MVAs) and moving violations.

METHODS

We analyzed data from 468 adults (age 18-74; 274 women) recruited via Amazon's Mechanical Turk (mTurk) service. Participants completed the STDS and provided information about their driving-related incidents in the past year.

RESULTS

First we performed a confirmatory factor analysis, which supported the instrument's original factor structure. Then we tested the relationship between scores on the STDS and two important variables, MVAs and moving violations. We found that the STDS significantly correlated with both MVAs and moving violations.

CONCLUSION

The present study confirms that the STDS is a potentially useful instrument for studying texting dependence in the United States and with adults of all ages. The instrument may be particularly useful in predicting motor vehicle outcomes.

Executive function and dangerous driving behaviors in young drivers

The purpose of the present study was to investigate the behavioral and cognitive processes underlying dangerous driving behaviors. We used a survey to assess levels of executive function in college students. The sample consisted of 59 males and 77 females and their age ranged from 18 to 24. We stratified the students into two groups based on executive function scores and compared the extent to which each group engaged in four dangerous driving behaviors (texting while driving, driving without a seat belt, driving while intoxicated, and speeding) as well as how often they experienced three negative driving outcomes (crashes, pulled over, and ticketed). We also investigated how these driving behaviors and outcomes are correlated with subcategories of executive function. The results show that students with a low level of executive function were more likely to engage in dangerous driving behaviors and more likely to experience negative driving outcomes. The results also show that texting while driving, driving while intoxicated, and speeding were most strongly correlated with the executive function subcategory of Impulse Control, whereas driving without a seat belt was most strongly correlated with the executive function subcategory of Strategic Planning. These results suggest that different behavioral or cognitive processes are involved in different dangerous driving behaviors and different interventions may be needed to target each underlying process.

A multiyear assessment of a hospital-school program to promote teen motor vehicle safety

BACKGROUND

Motor vehicle crashes are the leading cause of death among teen drivers. The main goal of this program was to reduce texting while driving among high school teens through a unique peer-generated anti-texting campaign.

METHODS

The program consisted of two phases. In phase 1, student leaders participated in a half-day, hospital-based experiential program that emphasized safe teen driving. In phase 2, these students conceptualized and implemented an anti-texting while driving campaign during the school year. The program enrolled 32 schools with 137 student participants in phase 1. This study uses a prospective quasi-experimental pre-post design. A presurvey and a follow-up online survey were used. Response rate was 81%. In phase 2, two rounds of observations of drivers were made near the participating schools at the beginning and end of the phase 2 campaign. The results were analyzed using proportion tests.

RESULTS

There was a strong belief (6.49 on a seven-point scale) that texting while driving could result in a crash. About 58% had texted while driving in the previous 7 days in the pre-survey. This proportion decreased significantly to 44% in the follow-up (p < 0.05). Knowledge of Tennessee Graduated Driver Licensing laws and feeling of empowerment to take action with a teen driver who was texting improved significantly (p < 0.05). In phase 2, 12,309 drivers (adults and teens) were observed in the first round, and 13,153 were observed in the second round of observations. Significant reduction in the proportion of drivers texting while driving (from 13% to 9%; p < 0.0001) was observed.

CONCLUSION

Results of driver observations support the effectiveness of this program in meeting the key objective of reducing texting while driving. The program also influenced teenagers' willingness to take positive steps when faced with a driver who was texting. Future efforts should aim to influence social and peer norms.

LEVEL OF EVIDENCE

Therapeutic study, level IV.

Executive Function Capacities, Negative Driving Behavior and Crashes in Young Drivers

Motor vehicle crashes remain a leading cause of injury and death in adolescents, with teen drivers three times more likely to be in a fatal crash when compared to adults. One potential contributing risk factor is the ongoing development of executive functioning with maturation of the frontal lobe through adolescence and into early adulthood. Atypical development resulting in poor or impaired executive functioning (as in Attention-Deficit/Hyperactivity Disorder) has been associated with risky driving and crash outcomes. However, executive function broadly encompasses a number of capacities and domains (e.g., working memory, inhibition, set-shifting). In this review, we examine the role of various executive function sub-processes in adolescent driver behavior and crash rates. We summarize the state of methods for measuring executive control and driving outcomes and highlight the great heterogeneity in tools with seemingly contradictory findings. Lastly, we offer some suggestions for improved methods and practical ways to compensate for the effects of poor executive function (such as in-vehicle assisted driving devices). Given the key role that executive function plays in safe driving, this review points to an urgent need for systematic research to inform development of more effective training and interventions for safe driving among adolescents.

Adolescent Health Crisis: What Sleep-Related Factors Contribute to a Decline in Mental Health and Safety?

Sleep loss can disrupt neuron growth in the brain during adolescence, a critical period for cognitive development. Only 7.6% of teens get the recommended 9-10 hours of sleep. This study evaluates the relationship between sleep and adolescent mental health, which impacts physical health, safety and performance. The rise by 200% of disability and death rates during adolescence may be related to mental health. 160 people participated: 62 males and 98 females ranging in age from 14-17. Participants completed a 3-part assessment: a questionnaire assessing their sleep habits, an anxiety scale (AFARS), and a depression scale (CDS-DC). Multiple regression analyses were used to determine the extent to which sleep-related factors predict depression and anxiety. The overall depression and anxiety models were significant. School start time was a significant predictor of depression, and often being tired at school predicted anxiety. School start time predicted depression; however, it was not a significant predictor of anxiety. While an early school start time has been found to have many significant negative outcomes, the average high school starts at 7:30. The findings of this study imply that the benefit of offering a later school start outweigh potential inconveniences.

The Eastern Association for the Surgery of Trauma's Injury Control and Violence Prevention Committee's annual distracted driving outreach event: Evaluating attitude and behavior change in high school students

BACKGROUND

The National Center for Statistics and Analysis reports at least eight deaths and 1,160 daily injuries due to distracted driving (DD) in the United States. Drivers younger than 20 years are most likely to incur a distraction-related fatal crash. We aimed to determine short- and long-term impact of a multimodal educational program including student-developed interventions, simulated driving experiences, and presentations by law enforcement and medical personnel.

METHODS

A single-day program aimed at teen DD prevention was conducted at a high school targeting students aged 15 years to 19 years old. Students were surveyed before, after, and at 6 weeks. We surveyed age, gender, knowledge, and experience regarding DD. Summary statistics were obtained at each survey time point. Bivariate and multivariable analysis were conducted to assess whether change in responses varied over time points. Multivariable models were adjusted for sex and urban and rural driving.

RESULTS

Preintervention, postintervention, and 6-week follow-up surveys were completed by 359, 272 (76%), and 331 (92%) students, respectively. At baseline and 6-week follow-up, the most frequent passenger-reported DD behaviors were cell phone (63% [63% at follow-up) and radio use (61% [63%]). Similarly, the most frequent driver-reported DD behaviors were cell phone (68% [72%]) and radio use (79% [80%]). When students were asked, "How likely are you to use your cell phone while driving?" they answered "never" 35%, 70%, and 46% on the preintervention, postintervention, and 6-week surveys. They were less likely to report consequences to be worse or change in attitude to a great extent at 6 weeks (p < 0.01). Gender and urban or rural driving were not significantly associated with responses.

CONCLUSIONS

While DD education may facilitate short-term knowledge and attitude changes, there appears to be no lasting effect. Research should be focused toward strategies for longer-term impact.

LEVEL OF EVIDENCE

Therapeutic study, level II.

Texting while driving, executive function, and impulsivity in college students

The purpose of the present study was to investigate the cognitive processes underlying texting while driving. A sample of 120 college students completed a survey to assess how frequently they send and read a text message while driving. Based on this information, students were assigned to one of two groups: 20 students who frequently text while driving and 20 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 differed in self-reported measures of executive function and impulsivity. The groups were also compared on a behavioral measure of impulsivity: the extent to which they discounted hypothetical monetary rewards as a function of the delay. For this measure, the students made repeated choices between smaller monetary rewards available immediately and larger rewards available after delays ranging from 1 week to 6 months. The results show that the group of students who frequently text while driving showed (a) significantly lower levels of executive function and (b) higher levels of self-reported impulsivity, although the groups did not differ significantly on the behavioral measure of impulsivity. These results support a general conclusion that drivers with lower levels of executive function and higher levels of impulsivity are more likely to text while driving.