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

Individual and social-environmental factors among young drivers informing decisions to ride with an impaired driver and drive impaired: A sequential mixed methods assessment

OBJECTIVE

To contextually examine facilitators of young driver decisions to ride with an impaired driver (RWI) or drive while impaired (DWI).

METHODS

Data were from the NIH's NEXT Generation Health Study (NEXT), a 7-year longitudinal nationally representative study with a U.S. probability cohort of 10th graders starting in 2009-2010. Using a multistage sequential explanatory mixed methods approach, we conducted latent class analysis (n = 2,783) to identify RWI/DWI trajectories from adolescence to young adulthood (Stage-1). We then conducted in-depth qualitative interviews with purposively sampled young adults (N = 105, 26.30 ± 0.43 y/o) from four identified RWI/DWI trajectory classes (Stage-2): 31 Abstainers (consistently low probability), 33 Escalators (low-to-high probability), 14 Decliners (high-to-low probability), and 27 Persisters (consistently high probability). In Stage-2, the qualitative interview guide was informed by Stage-1 findings and Ecodevelopmental Theory. Using directed content analysis, we applied inductive and deductive theory-grounded codes to interview transcripts. With data immersion, reflexivity, and team dialogue, we derived themes from the code, "Facilitators of RWI and/or DWI". Demographics and validated measures of resiliency, health-related quality of life, Timeline Follow Back for alcohol and marijuana, and recent engagement in RWI/DWI were collected during the interviews.

RESULTS

Based on the interview transcripts, five themes emerged around RWI/DWI facilitators during and after high school: (1) beliefs about alcohol/drug effects; (2) trust of others; (3) trust of self; (4) parental disapproval; and (5) transportation factors. Participants who RWI confidently placed their trust in their assessment of the driver's impairment and their own in the context of close relationships. Those who DWI described desire to maintain simple/easy vehicle access while avoiding tickets/towing. The joint display of the quantitative and qualitative data is presented.

CONCLUSIONS

Notable misperceptions exist about how alcohol/drugs impact driving in the RWI/DWI context, particularly regarding the subtle signs of impairment. Youth commonly relied on their own assessment of impairment before driving themselves or riding with a potentially impaired driver, sometimes to avoid parental disapproval. Some engage in RWI/DWI to avoid discord with parents. DWI may relate to needing easy/immediate vehicle access. Pragmatic remedy considerations could include educating youth and young drivers about impairment, enhancing safe public transportation, and expanding ride-share programing.

Alcohol outlet density and adolescent drinking behaviors in Thailand, 2007-2017: A spatiotemporal mixed model analysis

This study aimed to explore the relationship between alcohol outlet density and the proportion of alcohol consumption among Thai adolescents. We utilized the alcohol consumption data from the 2007, 2011, and 2017 Tobacco and Alcohol Consumption Survey in Thailand. We analyzed the relationships between alcohol sales license figures and consumption behavior using a spatiotemporal mixed model. Our data had two levels. The upper (provincial) level featured alcohol sales license density (spatial effect), the years of survey (temporal effect), and the social deprivation index. The lower (individual) level included the demographic data of the adolescents. A total of 9,566 Thai adolescents participated in this study, based on surveys conducted in 2007 (n = 4,731), 2011 (n = 3,466), and 2017 (n = 1,369). The density of alcohol sales licenses increased the odds for the one-year current drinker category (odds ratio [OR] = 1.08, 95% confidence interval [CI], 1.04-1.45), especially in male adolescents (OR = 1.09, 95% CI, 1.04-1.14). Furthermore, it increased the odds for the heavy episodic drinker category for female adolescents (OR = 1.23, 95% CI, 1.05-1.44). Increased alcohol sales licenses are associated with higher alcohol consumption among Thai adolescents. This highlights the need for government organizations to develop and apply strategies to reduce the number of licenses for the sale of alcohol.

Modeling of drinking and driving behaviors among adolescents and young adults in the United States: Complexities and Intervention outcomes

Alcohol-impaired driving is a formidable public health problem in the United States, claiming the lives of 37 individuals daily in alcohol-related crashes. Alcohol-impaired driving is affected by a multitude of interconnected factors, coupled with long delays between stakeholders' actions and their impacts, which not only complicate policy-making but also increase the likelihood of unintended consequences. We developed a system dynamics simulation model of drinking and driving behaviors among adolescents and young adults. This was achieved through group model building sessions with a team of multidisciplinary subject matter experts, and a focused literature review. The model was calibrated with data series from multiple sources and replicated the historical trends for male and female individuals aged 15 to 24 from 1982 to 2020. We simulated the model under different scenarios to examine the impact of a wide range of interventions on alcohol-related crash fatalities. We found that interventions vary in terms of their effectiveness in reducing alcohol-related crash fatalities. In addition, although some interventions reduce alcohol-related crash fatalities, some may increase the number of drinkers who drive after drinking. Based on insights from simulation experiments, we combined three interventions and found that the combined strategy may reduce alcohol-related crash fatalities significantly without increasing the number of alcohol-impaired drivers on US roads. Nevertheless, related fatalities plateau over time despite the combined interventions, underscoring the need for new interventions for a sustained decline in alcohol-related crash deaths beyond a few decades. Finally, through model calibration we estimated time delays between actions and their consequences in the system which provide insights for policymakers and activists when designing strategies to reduce alcohol-related crash fatalities.

Evaluation of Adolescents' Awareness of Seat Belt Use and the Relationship with Risky Behaviors

The one of the leading causes of adolescent morbidity and mortality worldwide is motor vehicle accidents (MVA). The use of seat belts significantly lowers MVA fatalities and injuries. The aim of this study is to investigate adolescent seat belt usage patterns and relation with risky behaviors. The study conducted at two medical institutions with non-immigrant and literate adolescents aged 12-18. Demographics, seat belt use, and risk-taking behavior were collected through questionnaires. 726 teenagers (422 girls and 304 boys) with an average age of 176.7 ± 23.37 months participated in the study. Parents' educational levels and front-seat belt use have been found to be correlated. Comparatively to non-users, seat belt users demonstrated lower risk scores (total, traffic, substance, and social). The use of seat belts was significantly predicted by traffic risk, according to logistic regression. The frequency of seatbelt use was higher among participants from cities with higher socioeconomic status. As a result, it was found that adolescents who exhibited more risky behaviors had a lower frequency of seat belt use and seat belt use was associated with socioeconomic level and parental education level. It is thought that population-based studies to be conducted on this subject are important.

The association between single and dual use of cannabis and alcohol and driving under the influence and riding with an impaired driver in a large sample of Canadian adolescents

OBJECTIVE

Dual use of cannabis and alcohol has increased in adolescents, but limited research has examined how it relates to impaired driving or riding with an impaired driver (IDR) compared to single substance use. This study aimed to examine the odds of alcohol- and/or cannabis-IDR among adolescents based on their use of alcohol and/or cannabis, and whether associations differed by gender and age.

METHODS

Cross-sectional survey data were used from a sample of 69,621 students attending 182 Canadian secondary schools in the 2021/22 school year. Multilevel logistic regression estimated the odds of exclusive alcohol-IDR, exclusive cannabis-IDR, and both alcohol and cannabis IDR (alcohol-cannabis-IDR). Substance use interactions with gender and age were tested.

RESULTS

Overall, 14.7% of participants reported IDR; 7.5% reported exclusive alcohol-IDR, 3.2% reported exclusive cannabis-IDR, 4.0% reported alcohol-cannabis-IDR, and 7.4% were unsure if they had experienced IDR. The prevalence of IDR varied across substance use groups, 8.0% among nonuse, 21.9% among alcohol-only use, 35.9% among cannabis-only use, and 49.6% among dual use groups. Gender diverse, older, and students with lower socioeconomic status exhibited a higher likelihood of reporting alcohol-cannabis-IDR. Dual use was significantly associated with 9.5 times higher odds of alcohol-cannabis-IDR compared to alcohol-only use, and 3.0 times higher odds compared to cannabis-only use. Dual use was also associated with an increased likelihood of either alcohol- or cannabis-IDR.

CONCLUSIONS

This study highlights that all students, regardless of substance use, are at risk of IDR, but students engaged in dual use of alcohol and cannabis face an elevated risk compared to both peers who do not use substances and those who use only a single substance. These findings emphasize the importance of targeted interventions that address the risks associated with IDR.

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.

Associations between muscle-building exercise and alcohol use behaviors among adolescent boys: Results from the 2019 Youth Risk Behavior Survey

BACKGROUND AND OBJECTIVES

To explore the association between muscle-building exercise (MBE) and alcohol use behaviors among adolescent boys.

METHODS

Data from the 2019 Youth Risk Behavior Survey (N = 4120) were analyzed using multiple logistic regressions.

RESULTS

A greater number of days of MBE in the past week was associated with higher odds of four alcohol use behaviors, including recent alcohol use and binge drinking.

DISCUSSION AND CONCLUSIONS

Findings extend prior research showing relationships between team sports participation and alcohol use behaviors.

SCIENTIFIC SIGNIFICANCE

This study is the first to examine associations between MBE and alcohol use behaviors among adolescent boys.

Trajectories and Outcomes of Adolescents that Ride With an Impaired Driver/Drive While Impaired

Introduction

For young drivers, independent transportation has been noted to offer them opportunities that can be beneficial as they enter early adulthood. However, those that choose to engage in riding with an impaired driver (RWI) and drive while impaired (DWI) over time can face negative consequences reducing such opportunities. This study examined the prospective association of identified longitudinal trajectory classes among adolescents that RWI and DWI with their later health, education, and employment in emerging adulthood.

Methods

We analyzed all seven annual assessments (Waves, W1-W7) of the NEXT Generation Health Study, a nationally representative longitudinal study starting with 10th grade (2009-2010 school year). Using all seven waves, trajectory classes were identified by latent class analysis with RWI (last 12 months) and DWI (last 30 days) dichotomized as ≥once = 1 vs. none = 0.

Results

Four RWI trajectories and four DWI trajectories were identified: abstainer, escalator, decliner, and persister. For RWI and DWI trajectories respectively, 45.0% (N=647) and 76.2% (N=1,657) were abstainers, 15.6% (N=226) and 14.2% (N=337) were escalators, 25.0% (N=352) and 5.4% (N=99) were decliners, and 14.4% (N=197) and 3.8% (N=83) persisters. RWI trajectories were associated with W7 health status (χ2=13,20, p<.01) and education attainment (χ2=18.37, p<.01). Adolescent RWI abstainers reported better later health status than RWI escalators, decliners, and persisters; and decliners reported less favorable later education attainment than abstainers, escalators, and persisters. DWI trajectories showed no association with health status, education attainment, or employment.

Conclusions

Our findings suggest the importance of later health outcomes of adolescent RWI. The mixed findings point to the need for more detailed understanding of contextual and time-dependent trajectory outcomes among adolescents engaging in RWI and DWI.

Mapping the complex causal mechanisms of drinking and driving behaviors among adolescents and young adults

BACKGROUND

The proportion of motor vehicle crash fatalities involving alcohol-impaired drivers declined substantially between 1982 and 1997, but progress stopped after 1997. The systemic complexity of alcohol-impaired driving contributes to the persistence of this problem. This study aims to identify and map key feedback mechanisms that affect alcohol-impaired driving among adolescents and young adults in the U.S.

METHODS

We apply the system dynamics approach to the problem of alcohol-impaired driving and bring a feedback perspective for understanding drivers and inhibitors of the problem. The causal loop diagram (i.e., map of dynamic hypotheses about the structure of the system producing observed behaviors over time) developed in this study is based on the output of two group model building sessions conducted with multidisciplinary subject-matter experts bolstered with extensive literature review.

RESULTS

The causal loop diagram depicts diverse influences on youth impaired driving including parents, peers, policies, law enforcement, and the alcohol industry. Embedded in these feedback loops are the physical flow of youth between the categories of abstainers, drinkers who do not drive after drinking, and drinkers who drive after drinking. We identify key inertial factors, discuss how delay and feedback processes affect observed behaviors over time, and suggest strategies to reduce youth impaired driving.

CONCLUSION

This review presents the first causal loop diagram of alcohol-impaired driving among adolescents and it is a vital first step toward quantitative simulation modeling of the problem. Through continued research, this model could provide a powerful tool for understanding the systemic complexity of impaired driving among adolescents, and identifying effective prevention practices and policies to reduce youth impaired driving.

Prediction of Seat Belt Use Behavior among Adolescents Based on the Theory of Planned Behavior

BACKGROUND

Road Traffic Injuries (RTIs) are the important causes of unintentional injuries and deaths. In this respect, seat belt wearing is an influential factor in reducing the mortality and severity of road traffic injuries. The rate of seat belt use among is lower adolescents, compared to adults. The present study aimed to investigate the influential factors on seat belt-weraing behavior among adolescent students as car occupants based on the Theory of Planned Behavior (TPB).

STUDY DESIGN

  A cross-sectional design.

METHODS

This study was conducted among 952 adolescent students studying in grades 7, 8, and 9 in the schools of Tabriz, Iran, in the 2019-20 academic year. A researcher-made questionnaire was designed based on TPB for data collection, the validity and reliability of which have been confirmed.

RESULTS

The results indicated that the rate of seat belt use in the front seat inside the city was lower than that outside the city. Regarding TPB constructs, perceived behavioral control (β=0.137; 95% CI: 0.006-0.013; P<0.001), subjective norm (β=0.313; 95% CI: 0.021-0.032; P<0.001), and attitude (β=0.322; 95% CI: 0.034-0.053; P<0.001) had a significant and positive relationship with the intention of seat belt-wearing behavior. Moreover, the behavioral intention (β=0.571; 95% CI: 0.62-0.64; P<0.001) had a significantly positive relationship with seat belt-wearing behavior.

CONCLUSION

The Theory of Planned Behavior is appropriate to determine predictor factors of seat belt-weraing behavior among adolescent students as car occupants. In addition, the results of the present study may provide a theoretical basis for policy-making to improve adolescent students' seat belt use.

Alcohol, marijuana, and nicotine use as predictors of impaired driving and riding with an impaired driver among college students who engage in polysubstance use

OBJECTIVE

While alcohol, marijuana, and nicotine are the most commonly used substances, there is limited research on the between- and within-person associations of their use and driving under the influence (DUI) and riding with an impaired driver (RWID). The current study utilized a burst design to assess how use and co-use of these substances is associated with DUI and RWID.

METHODS

College student drinkers with past-year marijuana and/or nicotine use (N = 367) were assessed on two consecutive weekends for three semesters. Logistic regression compared students who only reported drinking to student drinkers who used marijuana, nicotine, or all three substances on likelihood to DUI and RWID. Multilevel logistic models assessed the associations of varied combinations of substances with the daily likelihood of DUI and RWID.

RESULTS

Compared to students who only used alcohol, students who also reported marijuana use were more likely to DUI (OR = 5.44), and students who reported use of alcohol, nicotine and marijuana more likely to DUI (OR = 10.33) and RWID (OR = 10.22). Compared to occasions when only alcohol was used, DUI was more likely on marijuana only occasions (OR = 9.08), and RWID was more likely on alcohol and marijuana occasions (OR = 3.86). However, confidence intervals were wide for effects.

DISCUSSION

Students reporting use of all 3 substances had higher overall risk of DUI and RWID indicating prevention efforts for DUI and RWID should include all substances. Implications for prevention and intervention strategies at the individual and environmental level are discussed.

Trajectories of risky driving among emerging adults with their mental and psychosomatic health predictors in the 12th grade

OBJECTIVE

To identify trajectory classes of risky driving among emerging adults and examine predictive associations of depressive and psychosomatic symptoms in the 12th grade with the identified trajectory classes.

METHODS

Data were from the last year in high school (12th-Grade - Wave 3 [W3]) and years 1-4 after high school (Waves 4-7 [W4-7]) of the NEXT Generation Health Study, a nationally representative study starting with 10th grade (2009-2010). We measured risky driving with the 21-item Checkpoints Self-Reported Risky Driving Scale (C-RDS). Using C-RDS data from W3-7, the latent class growth modeling (LCGM) was used to identify risky driving trajectory classes. Independent variables were W3 depressive symptoms and W3 psychosomatic symptoms. Covariates included family affluence and urbanicity. The LCGM was conducted with SAS PROC Traj. The multinomial logistic regressions were used to examine the associations between the trajectory classes and independent variables, taking complex survey sampling features into account.

RESULTS

Three risky driving trajectories were identified: low (N = 583, 21.43%, weighted and hereafter), medium (N = 1423, 59.22%), and high (N = 389, 19.35%) risky driving classes. Compared to the low risky driving class, one unit increase in W3 depressive symptoms was significantly associated with a higher likelihood of belonging to the medium (adjusted odds ratio [AOR] = 1.04, 95% CI 1.01, 1.07) and the high (AOR = 1.05, 95% CI 1.02, 1.08) risky driving classes, respectfully, when controlling for the covariates. Likewise, compared to the low risky driving class, one unit increase in W3 psychosomatic symptoms was significantly associated with a higher likelihood of belonging to the medium (AOR = 1.06, 95% CI 1.00, 1.13) and the high (AOR = 1.10, 95% CI 1.04, 1.16) risky driving classes, respectively, when controlling for the covariates.

CONCLUSIONS

High school students with depressive and psychosomatic symptoms were at higher risk of engaging in risky driving in the immediate years after leaving high school. These findings suggest that prevention programs that incorporate screening, referral to treatment, and treatment of mental and psychosomatic symptoms in high school may be important opportunities to reduce risky driving among youth as they transition from adolescence to emerging adulthood.

Cannabis use prior to legalisation among alcohol consumers in the Canadian Yukon and Northwest territories

Although rates of substance use are higher in the Canadian territories than the provinces, there is little research on cannabis use. This exploratory study describes cannabis use and related risk behaviours among alcohol consumers in Whitehorse (Yukon) and Yellowknife (Northwest Territories), with comparisons to data from the provinces. Prior to non-medical cannabis legalisation, respondents (n = 387) aged ≥19 were recruited from a study on alcohol labelling to complete an online cannabis survey. Logistic regression was used to compare territorial and provincial data, and correlates of cannabis use in the territories. Forty-seven percent of respondents were past 12-month cannabis consumers, and 15.5% were daily/almost daily consumers, significantly higher than in the provinces (p < 0.001 for both). Dried herb (85.7%) and edibles (58.2%) were most commonly used among consumers. Use of dried herb, edibles, solid concentrates and tinctures was significantly higher than in the provinces (all p ≤ 0.01). Twenty-four percent of respondents had ridden with a driver who had used cannabis, while 31.9% of cannabis consumers had driven within 2h of cannabis use, significantly higher than the provinces (both p < 0.001). Further research should examine the impact of legalisation on cannabis use in the territories, including rural communities.

Time to licensure for driving among U.S. teens: Survival analysis of interval-censored survey data

OBJECTIVE

Novice drivers who delay in driving licensure may miss safety benefits of Graduate Driver Licensing (GDL) programs, potentially putting themselves at higher crash-risk. Time to licensure relates their access to independent transportation to potential future economic- and educational-related opportunities. The objective of this study was to explore time to licensure associations with teens' race/ethnicity and GDL restrictions.

METHODS

Secondary analysis using all seven annual assessments of the NEXT Generation Health Study, a nationally representative longitudinal study starting with 10th grade (N = 2785; 2009-2010 school year). Data were collected in U.S. public/private schools, colleges, workplaces, and other settings. The outcome variable was interval-censored time to licensure (event = obtained driving licensure). Independent variables included race/ethnicity and state-specific GDL restrictions. Covariates included family affluence, parent education, nativity, sex, and urbanicity. Proportional hazards (PH) models were conducted for interval-censored survival analysis based on stepwise backward elimination for fitting multivariate models with consideration of complex survey features. In the PH models, a hazard ratio (HR) estimates a greater (>1) or lesser (<1) likelihood of licensure at all timepoints.

RESULTS

Median time to licensure after reaching legal driving age for Latinos, African Americans, and Non-Latino Whites was 3.47, 2.90, and 0.41 years, respectively. Multivariate PH models showed that Latinos were 46% less likely (HR = 0.54, 95%CI: 0.35-0.72) and African Americans were 56% less likely (HR = 0.44, 95%CI: 0.32-0.56) to have obtained licensure at any time compared to Non-Latino Whites. Only learner minimum age GDL restriction was associated with time to licensure. Living in a state with a required learner driving minimum age of ≥16 years (HR = 0.57, 95%CI: 0.16-0.98) also corresponded with 43% lower likelihood of licensure at legal eligibility compared to living in other states with a required learner driving minimum age of <16 years.

CONCLUSION

Latinos and African American teens obtained their license approximately three years after eligibility on average, and much later than Non-Latino Whites. Time to licensure likelihood was associated with race/ethnicity and required minimum age of learner permit, indicating important implications for teens of different racial/ethnic groups in relation to licensure, access to independent transportation, and exposure to GDL programs.

Associations Between Graduated Driver Licensing Restrictions and Delay in Driving Licensure Among U.S. High School Students

INTRODUCTION

Some of the most vulnerable groups of teens choose to delay driving licensure (DDL). We assessed longitudinal associations between state-level Graduated Driver Licensing (GDL) restrictions and DDL among U.S. high school students.

METHODS

Data from seven waves of the NEXT Generation Health Study (starting 10th-grade (2009-2010)), were analyzed in 2020 using Poisson regression. The outcome was DDL (delay vs. no-delay). Independent variables were driving restrictions (at learner and intermediate phases of licensure), sex, race/ethnicity, family affluence, parent education, family structure, and urbanicity.

RESULTS

Of 2525 eligible for licensure, 887 (38.9%), 1078 (30.4%), 560 (30.7%) reported DDL 1-2 years, >2 years, no DDL, respectively. Interactions between GDL restrictions during the learner permit period and covariates were found. In states requiring ≥30 hours of supervised practice driving, Latinos (Adjusted relative risk ratio [aRRR]=1.55, p<.001) and Blacks (aRRR=1.38, p<.01) were more likely to DDL than Whites. In states where permit holding periods were <6 months, participants with low (aRRR=1.61, p<.001) and moderate (aRRR=1.45, p<.001) vs. high affluence were more likely to DDL. Participants in single-parent households vs. both-biological parent households were also more likely to DDL (aRRR=1.37, p<.05). In states where permit holding periods were ≥6 months, participants with low (aRRR=1.33, p<.05) vs. high affluence were more likely to DDL. In states that allowed ≥3 passengers or no passenger restriction, participants living in non-urban vs. urban (aRRR=1.52, p<.05) areas were more likely to DDL, and in states that allowed only 1 or no passenger, participants living in non-urban vs. urban areas (aRRR=0.67, p<.001) were less likely to DDL.

CONCLUSIONS

Our findings heighten concerns about increased crash risk among older teens who age out of state GDL policies thereby circumventing driver safety related restrictions. Significant disparities in DDL exist among more vulnerable teens in states with stricter GDL driving restrictions.

Riding with an impaired driver and driving while impaired among adolescents: Longitudinal trajectories and their characteristics

PURPOSE

The purpose of this study was to identify and characterize trajectory classes of adolescents who ride with an impaired driver (RWI) and drive while impaired (DWI).

METHODS

We analyzed all 7 annual assessments (Waves W1-W7) of the NEXT Generation Health Study, a nationally representative longitudinal study starting with 10th grade (2009-2010 school year). Using all 7 waves, latent class analysis was used to identify trajectory classes with dichotomized RWI (last 12 months) and DWI (last 30 days; once or more = 1 vs. none = 0). Covariates were race/ethnicity, sex, parent education, urbanicity, and family affluence.

RESULTS

Four RWI trajectories and 4 DWI trajectories were identified: abstainer, escalator, decliner, and persister. For RWI and DWI trajectories respectively, 45.0% (n = 647) and 76.2% (n = 1,657) were abstainers, 15.6% (n = 226) and 14.2% (n = 337) were escalators, 25.0% (n = 352) and 5.4% (n = 99) were decliners, and 14.4% (n = 197) and 3.8% (n = 83) persisters. Race/ethnicity (χ2 = 23.93, P = .004) was significantly associated with the RWI trajectory classes. Race/ethnicity (χ2 = 20.55, P = .02), sex (χ2 = 13.89, P = .003), parent highest education (χ2 = 12.49, P = .05), urbanicity (χ2 = 9.66, P = .02), and family affluence (χ2 = 12.88, P = .05) were significantly associated with DWI trajectory classes.

CONCLUSIONS

Among adolescents transitioning into emerging adulthood, race/ethnicity is a common factor associated with RWI and DWI longitudinal trajectories. Our results suggest that adolescent RWI and DWI are complex behaviors warranting further detailed investigation of the respective trajectory classes. Our study findings can inform the tailoring of prevention and intervention efforts aimed at preventing illness/injury and preserving future opportunities for adolescents to thrive in emerging adulthood.

Association between a delay in driving licensure and driving while impaired and riding with an impaired driver among emerging adults

BACKGROUND

Teens who delay driving licensure may not be subject to graduated driver licensing restrictions that are known to reduce crash risk. We explored the association of delay in licensure with driving while impaired (DWI) and riding with an impaired driver (RWI) among emerging adults.

METHODS

Data from the NEXT Generation Health Study, starting with 10th grade (2009-2010), were analyzed. The outcome variables were Wave 7 (W7) self-reported DWI and RWI as dichotomous variables. The independent variable was delay in licensure. Covariates included sex, urbanicity, race/ethnicity, family structure, parent education, family affluence, teen's highest education, minimum legal drinking age laws, and onset age of alcohol use. Descriptive analysis and logistic regressions were conducted.

RESULTS

Of 2525 participants eligible for licensure, 887 reported a delay in licensure by 1-2 years (38.9%, weighted) and 1078 by > 2 years (30.3% weighted) across 7 waves. In W7, 23.5% (weighted and hereafter, 5.6% once, 17.8% ≥twice) of participants reported DWI and 32.42% (5.6% once, 25.4% ≥twice) reported RWI. Logistic regressions showed no overall significant association of delay in licensure with either W7 RWI or W7 DWI. However, in stratified analyses, among African American youth, delay in licensure was positively associated with DWI (OR = 2.41, p = 0.03) and RWI (OR = 2.72, p = 0.05). Among those with ≤ high school or lower education by W7, delayed licensure was positively associated with RWI (OR = 2.51, p < 0.01).

CONCLUSIONS

While in the overall sample, delayed licensure did not appear to be associated with DWI or RWI, our findings suggest that delayed licensure may be of concern to teen risk of DWI and RWI among African Americans and among those with lower educational attainment. Furthermore, as two-thirds of youth delayed licensure, more research is needed to determine whether this is more of a positive (i.e., protective) factor by reducing their exposure to crash risk or a negative (i.e., risk) factor due to their missing important driver safety stages of graduated driver licensing.

Psychoactive Substance Use and Its Associated Factors among Truck Drivers in Ethiopia

Background

Road traffic accidents (RTAs) remain an important public health issue worldwide. Psychoactive substance use is one of the main contributors to the occurrence of traffic accidents, and its use by truck drivers is a global problem. Also, psychoactive substance use is a commonly observed behavior among truck drivers. To the best of our knowledge, no evidence shows the prevalence and factors associated with psychoactive substance use among truck drivers in Ethiopia. Therefore, this study was aimed at assessing the prevalence and factors associated with psychoactive substance use among truck drivers in Ethiopia.

Methods

A cross-sectional study was conducted among 400 systematically selected truck drivers at Modjo dry port in Ethiopia, from February 1 to March 1, 2018. The data were collected through face-to-face individual interviews using a structured questionnaire. The collected data were entered into EpiData version 4.2.0.0 and analyzed using SPSS version 20. Binary logistic regression analysis was computed to determine the association using crude and adjusted odds ratios at 95% confidence intervals. The level of significance was declared at p value < 0.05 in the multivariable binary logistic regression analysis.

Results

Of the 400 truck drivers interviewed, the overall one-month self-reported prevalence of psychoactive substance use was 70% (n = 280). In the multivariable binary logistic regression analysis, aged 38 years and above (AOR = 0.40, 95% CI [0.23-0.69]), Christianity religion (AOR = 0.52, 95% CI [0.28-0.97]), college and university education (AOR = 3.47, 95% CI [1.27-9.47]), having a family size of 3 or more (AOR = 0.34, 95% CI [0.20-0.60]), having 6 or more hours spent sleeping at night (AOR = 0.46, 95% CI [0.28-0.75]), and rest breaks between driving (AOR = 2.13, 95% CI [1.14-3.97]) were significantly associated with psychoactive substance use.

Conclusion

The one-month prevalence of psychoactive substance use among truck drivers was remarkably high. We can conclude that psychoactive substance use is a public health problem among truck drivers, which is a major threat to themselves and others on the road. The sociodemographic and occupational factors are the factors associated with drivers' psychoactive substance use. Therefore, devising health education and counseling program for drivers to tackle the problem plays paramount importance.

Associations of mental health with driving while impaired and risky driving in emerging adults

OBJECTIVE

Examined cross-sectional associations of driving while impaired (DWI) and risky driving with mental and psychosomatic health among U.S. emerging adults.

METHODS

Data were from years 1-4 after high school (waves 4-7) of the NEXT Generation Health Study, a nationally representative study starting with 10th grade (2009-2010). Outcome variables were DWI (dichotomous variable: ≥ 1 day vs. 0 days in the last 30 days) and risky driving Checkpoints Self-Reported Risky Driving Scale (C-RDS). Independent variables included depressive symptoms and psychosomatic symptoms. Multivariate logistic and linear regressions were conducted with complex survey features considered.

RESULTS

Higher depressive and psychosomatic symptoms were associated with modestly higher likelihood of DWI (Adjusted odds ratio [AOR] ranged from 1.02 to 1.03 and from 1.04 to 1.05, respectively) and higher C-RDS scores (b ranged from 0.06 to 0.12 and from 0.08 to 0.23, respectively) in years 1-4 after high school.

CONCLUSIONS

Depressive and psychosomatic symptoms were associated with greater DWI and risky driving in all 4 years after high school. Negative mental and psychosomatic health should be targeted components of DWI and risky driving prevention to lower fatal motor vehicle crashes among emerging adults.

Binge Drinking and Drunk Driving Among Current Drinkers in Thailand: Analysis of Cigarette Smoking and Alcohol Drinking Behavior Surveys From 2007 to 2017

This study aimed to evaluate the association between binge drinking and drunk driving among the Thai population. Data in 2007, 2011, and 2017 of the Thai National surveys on Tobacco and Alcohol Consumption were analyzed. The household surveys collected information from the population, aged >15 years, using a face-to-face interview. There were 89 002 current drinkers from the 3 waves of surveys. About 40% reported drunk driving in the past 12 months. Binge drinking accounted for 17.3%, 17.8%, and 42.8% of the current drinkers in 2007, 2011, and 2017, respectively. The prevalence of drunk driving also increased from 36.6% to 57.7% over the 10-year period. Both occasional binge drinkers and regular binge drinkers showed about twice the risk of drunk driving (range of odds ratios [ORs] from 1.81; 95% confidence interval [95% CI] = 1.71-1.92 to OR 2.96; 95% CI = 2.64-3.31), compared with non-binge drinkers, and these OR increased by drinking frequency.

Prevalence and Predictors of Driving after Prescription Opioid Use in an Adult ED Sample

Introduction

Prescription opioid use and driving is a public health concern given the risks associated with drugged driving, but the issue remains under-studied. We examined the prevalence and correlates of driving after taking prescription opioids (DAPO) among adults seeking emergency department (ED) treatment.

Methods

Participants (aged 25–60) seeking ED care at a Level I trauma center completed a computerized survey. Validated instruments measured prescription opioid use, driving behaviors, and risky driving. Patients who reported past three-month prescription opioid use and drove at least twice weekly were administered an extended study survey measuring DAPO, depression, pain, and substance use.

Results

Among participants completing the screening survey (n = 756; mean age = 42.8 [standard deviation {SD} =10.4]), 37.8% reported past three-month prescription opioid use (30.8% of whom used daily), and 14.7% reported past three-month DAPO. Of screened participants, 22.5% (n = 170) were eligible for the extended study survey. Unadjusted analyses demonstrated that participants reporting DAPO were more likely to use opioids daily (51.1% vs 15.9%) and had higher rates of opioid misuse (mean Current Opioid Misuse Measure score 3.4 [SD = 3.8] vs 1.1 [SD = 2.1]) chronic pain (80.7% vs 42.7%), and driving after marijuana or alcohol use (mean intoxicated driving score 2.1 [SD = 1.3] vs 0.3 [SD = 0.8]) compared to patients not reporting DAPO (all p<0.001). Adjusting for age, gender, employment, and insurance in a logistic regression model, participants reporting DAPO were more likely to report a chronic pain diagnosis (odds ratio [OR] = 3.77, 95% confidence interval [CI], 1.55–9.17), daily opioid use (OR = 3.81, 95% CI, 1.64–8.85), and higher levels of intoxicated driving (OR = 1.62, 95% CI, 1.07–2.45). Alcohol and marijuana use, depression, and opioid misuse were not associated with DAPO in adjusted analyses.

Conclusion

Nearly one in six adult patients seeking ED care reported DAPO. The ED may be an important site for interventions addressing opioid-related drugged driving.

Trajectories of Driving after Drinking among Marijuana-Using Youth in the Emergency Department: Substance Use, Mental Health, and Peer and Parental Influences

Background: The psychosocial correlates and longitudinal trajectories of driving after drinking (DAD) among youth remain understudied in at-risk populations. Objectives: We investigated the relationships of DAD trajectories and negative peer and parental influences, substance use, and mental health among predominantly marijuana-using youth seeking emergency department (ED) treatment. Methods: Data were from a 2-year prospective cohort study of drug-using patients (97.4% used marijuana) ages 14-24 seeking ED care for assault injury, or as part of a non-assaulted comparison group. Validated surveys measured DAD behaviors and correlates at baseline, 6, 12, 18, and 24 months. Latent class growth analysis identified characteristic DAD trajectory groups; baseline predictors were analyzed descriptively and using multinomial logistic regression. Results: Three DAD trajectory groups were identified among driving-age youth (n = 580): no DAD (NDAD; 55.2%), low-steady (LDAD; 29.0%), and high-declining (HDAD; 15.9%). In unadjusted analyses, HDAD youth were older, but otherwise similar to other groups demographically. Compared to NDAD, LDAD and HDAD group members had higher rates of drug and alcohol use disorders (p < .001). Further, HDAD group members had higher rates of anxiety symptoms and were more likely to be diagnosed with PTSD or depression than NDAD or LDAD youth (p < .05). Negative peer and parent influences were significantly higher in progressively more severe trajectory groups (p < .01). Adjusted effects from the multinomial model were analogous for peer and parental influences and substance use disorders, but not mental health. Conclusion: DAD is strongly associated with negative social influences and substance use disorders among marijuana-using youth, reinforcing their importance when developing interventions.

Associations between driving under the influence or riding with an impaired driver and future substance use among adolescents

Objective: Risky driving behaviors among adolescents, such as riding with a drinking or impaired driver (RWID) or driving while under the influence (DUI) of alcohol or drugs, are significant public health concerns. Few studies have examined associations of RWID and DUI with future substance use and problems after controlling for baseline substance use. Given that the DUI/RWDD event may be a teachable moment to prevent future consequences (e.g., when injured or arrested), it is important to understand how this risk behavior relates to subsequent use and problems. This study therefore examined characteristics of adolescents who reported DUI and RWID and assessed their risk of future alcohol and marijuana use and consequences 6 months later. Methods: Participants were 668 adolescents aged 12 to 18 (inclusive) recruited at 1 of 4 primary care clinics in Pittsburgh and Los Angeles as part of a larger randomized controlled trial. They completed surveys about their health behaviors at baseline and 6 months after baseline. We examined baseline characteristics of adolescents who reported DUI and RWID and then assessed whether past-year DUI and RWID at baseline were associated with alcohol and marijuana use and consequences 6 months after baseline. Results: Fifty-eight percent of participants were female, 56% were Hispanic, 23% were Black, 14% were White, 7% were multiethnic or other, and the average age was 16 years (SD = 1.9). At baseline, participants who reported RWID or DUI were more likely to be older, report past-year use of alcohol and marijuana, and more likely to have an alcohol use disorder or cannabis use disorder versus those who did not report RWID or DUI, respectively. At 6-month follow-up and after controlling for baseline demographics and baseline alcohol use, RWID was associated with more frequent drinking episodes in the past 3 months and greater number of drinks in the past month when they drank heavily. DUI at baseline was associated with more frequent heavy drinking episodes and alcohol and marijuana consequences 6 months later. Conclusions: RWID and DUI are significantly associated with greater alcohol and marijuana use over time. This study highlights that teens may be at higher risk for problem substance use in the future even if they ride with someone who is impaired. Prevention and intervention efforts for adolescents need to address both driving under the influence and riding with an impaired driver to prevent downstream consequences.

Patterns of Self-Reported Driving While Intoxicated Among Older Adults

Objective: This study examines the prevalence of self-reported driving while intoxicated (DWI) among drivers aged 65 and older. Method: This cross-sectional study was based on baseline data from the AAA Longitudinal Research on Aging Drivers (LongROAD) study, a multisite prospective cohort study of 2,990 older adult drivers. Alcohol-related variables from the baseline questionnaire were examined in relation to demographics, health status, and driving behaviors. A logistic regression model assessed variables associated with DWI. Results: Of the 2,990 participants, 72.7% reported consuming alcohol, 15.0% reported high-risk drinking, and 3.3% reported DWI. High-risk drinking (OR = 12.01) and risky driving behaviors (OR = 13.34) were significantly associated with at least occasional DWI. Avoidance of hazardous driving conditions (OR = 0.71) and higher level of comfort during challenging driving scenarios (OR = 0.65) were less likely to be associated with DWI. Conclusion: A large number of older adults engage in high-risk drinking and DWI. Public health education and DWI-related interventions should include older adults.

Effectiveness of a collaborative, student-run campaign to increase safety belt use among adolescents

Background

MVCs are the leading cause of death among adolescents. Seat belts have been shown to decrease MVC-related death. The purpose of this retrospective cohort study was to evaluate the effectiveness of a community-supported, student-run campaign to increase safety belt use among adolescents in Southwest Florida.

Methods

We reviewed results of campaigns at 14 high schools from 2012 to 2018. The primary outcome was change in rates of student-driver seat belt use over the course of each campaign. Secondary outcomes included trends in seat belt use and MVC-related fatalities over the study period. Wilcoxon signed-rank test was used to compare rates of seat belt use before and after each intervention and over the course of the study period. Multivariate logistic regression was used to estimate the independent effects of demographic covariates on outcomes.

Results

Altogether, 85 campaigns were reviewed. A total of 8500 preintervention and 8500 postintervention observations of student seat belt use were assessed. The median rate of seat belt use increased from 82% prior to the intervention to 87% following the intervention (p<0.001). We did not detect a sustained trend in seat belt use or MVC-related fatalities over the study period. On multivariate analysis, schools with a higher proportion of minority students were less likely to experience a substantial increase in seat belt use following the intervention (OR=0.17, 95% CI 0.03 to 0.84, p=0.030).

Conclusion

This collaborative campaign resulted in a modest, short-term increase in seat belt use among high school students. Future studies should evaluate which interventions are most effective and how short-term increases in seat belt use can be sustained.

Emerging Adults Riding With Marijuana-, Alcohol-, or Illicit Drug-Impaired Peer and Older Drivers

OBJECTIVE

The purpose of this study was to examine the prevalence and covariates among emerging adults of riding with an impaired peer or older adult driver (RWI) because of marijuana (MJ), alcohol (ALC), or illicit drugs (ID).

METHOD

Data were from Waves 4 (W4, N = 2,085) and 5 (W5, N = 2,116) of the NEXT Generation Health Study, collected in 2013-2014, 1 and 2 years after high school. W5 RWI was specified for substance-specific impaired peer and older adult (peer/older adult) drivers. Multinomial logistic regressions estimated W5 association of substance-specific RWI with W4 RWI, and W5 heavy episodic drinking, MJ use, and school/residence/work status.

RESULTS

At W5, 33% of the participants reported RWI in the past year, including riding with ALC- (21%), MJ- (17%), and ID- (5%) impaired peer drivers and ALC- (2%), MJ- (4%), and ID- (0.7%) impaired older adult drivers. W4 RWI was associated with W5 RWI with impaired peer/older adult drivers for ALC- (adjusted odds ratio [AOR] = 4.28, 2.69) and MJ-RWI (AOR = 2.34, 3.56). W5 heavy episodic drinking was positively associated with W5 peer ALC-related RWI (AOR = 2.16) and peer/older adult MJ-related RWI (AOR = 2.38, 5.45). W5 MJ use was positively associated with W5 peer ALC-related RWI (AOR = 2.23), peer/older adult MJ-related (AOR = 10.89, 2.98), and peer/older adult ID-related (AOR = 9.34, 4.26) RWI. ID-related RWI was higher among those not attending 4-year college (AOR = 3.38), attending technology school (AOR = 16.23), living on their own (AOR = 6.85), or living on campus (AOR = 11.50).

CONCLUSIONS

The high prevalence of RWI among emerging adults occurred mostly with ALC- or MJ-impaired peer drivers. The findings support the need for precisely tailored programs to prevent impaired driving according to substance use and age.

Under the influence: examination of prevalence and correlates of alcohol and marijuana consumption in relation to youth driving and passenger behaviours in Canada. A cross-sectional study

BACKGROUND

Consequences of alcohol- and drug-impaired driving affect youth disproportionately. We describe individual- and area-level characteristics associated with risky driving and passenger behaviours among grade 9-12 students in Canada.

METHODS

The 2014-2015 Canadian Student Tobacco, Alcohol and Drug Survey was administered to 24 650 students in provincially generalizable samples. Dichotomous outcomes included ever and last-30-day driving after drinking alcohol, ever and last-30-day driving after using marijuana, and ever and last-30-day reporting of being a passenger with a driver who had been drinking or using marijuana.

RESULTS

A total of 9.1% (99% confidence interval 7.9-10.3) of grade 11-12 students reported ever driving after drinking, and 9.4% (99% confidence interval 8.3-10.4) reported ever driving after using marijuana. Almost half (48%) of grade 11-12 students reported ever participating in any risky driving or passenger behaviour. Over one-third (35%) of grade 9-12 students reported ever riding with a driver who had been drinking, and 20% reported ever riding with a driver who had been using marijuana. Logistic regression models showed that boys had higher odds of risky driving behaviours relative to girls, whereas girls had higher odds of risky passenger behaviours relative to boys. Students from rural schools had higher odds of drinking and driving and of riding with a driver who had drunk relative to students from urban schools. There were significant differences in risky driving and passenger behaviours by province.

INTERPRETATION

A substantial number of Canadian youth reported risky driving and passenger behaviours, which varied by individual and area-level characteristics. Federal marijuana policy should aim to reduce the prevalence of drug-impaired driving. Additional provincial policies to prevent impaired driving are needed.

Psychopathology and personality traits associated with driving while intoxicated in Beijing, China: Implications for interventions

BACKGROUND AND OBJECTIVES

Driving while intoxicated (DWI) represents an area of grave concern in China, yet little research has focused on it or on the personality traits and psychiatric disorders among these drivers.

METHODS

We enrolled 325 of 382 residents charged with DWI in a compulsory detention center in Beijing, China. And 351 male drivers who had never had any alcohol arrests as control participants. All were screened for Axis I disorders using the Chinese version of the Structured Clinical Interview for the Diagnostic Statistical Manual of Mental Disorders IV-TR (SCID), the Minnesota Multiphasic Personality Inventory (MMPI-2), and the Sixteen Personality Factor Questionnaire (16PF).

RESULTS

The subjects were all males with a mean (±SD) age of 34.41 ± 8.48 years, and almost 30% met DSM-IV criteria for alcohol abuse or dependence (n = 92). Compared to normal controls they showed greater Social Boldness, Abstractedness, Apprehension, Liveliness and Tension, and poorer Reasoning, Vigilance, Openness to Change, and Self-reliance. On the MMPI-2, DWI subjects showed greater Hypochondriasis, Psychopathic Deviate, Paranoia, Psychasthenia, Schizophrenia and Hypomania; and lower Social introversion.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

Severe alcohol problems are more common in Beijing's drunk drivers than in the Chinese general population. These DWI drivers also have a broad variety of traits that increase their tendency to be venturesome and socially bold while enjoying excitement and risk-taking. (Am J Addict 2017;26:374-378).

Associations Between Adolescents' Perceptions of Alcohol Norms and Alcohol Behaviors: Incorporating Within-School Variability

Background

Social norm interventions have been implemented in schools to address concerns of alcohol use among high school students; however, research in this area has not incorporated measures of variability that may better reflect the complexity of social influences.

Purpose

To examine the association between perceived alcohol norms, the student and school-level variability of those norms, and alcohol use behaviors among high school students.

Methods

A sample of 25,824 students from 58 high schools completed an online self-report survey. Hierarchical linear regression models were fit to examine the relationships between student- and school-level alcohol norm predictors, within school variability, and current alcohol use and binge drinking.

Results

Individual- and school-level norms were predictive of both current alcohol use and binge drinking. Whereas measures of norm diversity at the school-level were not predictive of alcohol use behaviors, individual norm proximity was predictive of both current alcohol use and binge drinking.

Discussion

The study findings were both consistent with prior research and support assertions that variability measures should be incorporated into social norms research approaches.

Translation to Health Education Practice

The findings support the incorporation of student-level variability measures, which could assist in identifying students who are susceptible to peer influence.

Risky driving and sexual behaviors as developmental outcomes of co-occurring substance use and antisocial behavior

PURPOSE

To examine the associations between substance use and antisocial behavior trajectories and seven risky behaviors over time.

METHOD

Data were collected from a high-risk sample of adolescents followed into young adulthood. Five trajectory classes, identified based on dual development of substance use and antisocial behavior symptoms, were used to predict three risky driving and four risky sexual behaviors.

RESULTS

In this high-risk sample (n=530), participants reported notably high overall rates of reckless driving (55.5%) and unprotected sex under the influence (44.8%) in the past year. Risky behaviors that are typically of low base rates in population-based studies were also elevated, with 8.8% reporting past-year driving under the influence (DUI) charge, 17.6% reporting lifetime sexually transmitted infection (STI), and 10.4% reporting lifetime injection drug use. The Dual Chronic class had the highest levels of all seven risky behaviors, and were 3-4 times more likely to report risky driving, lifetime STI, and injection drug use than the Relatively Resolved class. Rates of past-year reckless driving and DUI were elevated among classes with persistent antisocial behavior, whereas rates of DUI, DUI charge, and unprotected sex under the influence were elevated among classes with persistent substance use.

CONCLUSIONS

Young adults with persistent co-occurring substance use and antisocial behavior engage in multiple very costly risky behaviors. Differential associations between risky behaviors and trajectory classes highlight the need for targeted interventions.

Riding with Impaired Drivers Among Recent Latino Immigrants in Southern Florida

In a previous effort we showed that compared with immigrants who are permanent residents, undocumented immigrants are more likely to binge drink, but less likely to drink while impaired (DWI) partly due to their limited amount of driving. This report examines a related risk: riding with an impaired driver (RWI). Data came from an ongoing longitudinal sample of Latino immigrants to Miami-Dade County, FL. Descriptive analyses and regression techniques were applied. While DWI rates among Latino immigrants is heavily limited by their access to a car, RWI rates were not restricted by driving limitations, nor related to participants' legal immigration status (LIS). RWI rates were linked only to heavy drinking. Because it is not affected by driving limitations, RWI for these Latino immigrants is perhaps a more immediate risk than DWI. Addressing RWI among Latino immigrants should be a priority for traffic safety to Miami/Dade country.

Marijuana-, alcohol-, and drug-impaired driving among emerging adults: Changes from high school to one-year post-high school

INTRODUCTION

Driving while impaired (DWI) increases the risk of a motor vehicle crash by impairing performance. Few studies have examined the prevalence and predictors of marijuana, alcohol, and drug-specific DWI among emerging adults.

METHODS

The data from wave 3 (W3, high school seniors, 2012, N=2407) and wave 4 (W4, one year after high school, N=2178) of the NEXT Generation Health Study with a nationally representative cohort. W4 DWI (≥1day of past 30days) was specified for alcohol-specific, marijuana-specific, alcohol/marijuana-combined, illicit drug-related DWI. Multinomial logistic regression models estimated the association of W4 DWI with W3 covariates (perceived peer/parent influence, drinking/binge drinking, marijuana/illicit drug use), and W4 environmental status variables (work/school/residence) adjusting for W3 overall DWI, demographic, and complex survey variables.

RESULTS

Overall DWI prevalence from W3 to W4 changed slightly (14% to 15%). W4 DWI consisted of 4.34% drinking-specific, 5.02% marijuana-specific, 2.41% drinking/marijuana combined, and 3.37% illicit drug-related DWI. W3 DWI was significantly associated with W4 alcohol-related and alcohol/marijuana-combined DWI, but not other DWI. W3 marijuana use, binge drinking, and illicit drug use were positively associated with W4 marijuana-specific, alcohol/marijuana-combined, and illicit drug-related DWI, respectively. W3 friend drunkenness and marijuana use were positively associated with W4 alcohol-specific and marijuana-related DWI, respectively. W3 peer marijuana use was negatively associated with W4 alcohol-specific DWI.

CONCLUSIONS

Driving under the influence of alcohol, marijuana, and illicit drugs is a persistent, threatening public health concern among emerging U.S. adults. High school seniors' binge drinking as well as regular alcohol drinking and marijuana/illicit drug use were independently associated with respective DWI one year after high school. Peer drunkenness and marijuana use in high school may be related to subsequent DWI of emerging adults.

PRACTICAL APPLICATIONS

The results support the use of injunctive peer norms about getting drunk and smoking marijuana in guiding the development of prevention programs to reduce youth DWI.

Transitions in Riding With an Alcohol/Drug-Impaired Driver From Adolescence to Emerging Adulthood in the United States

OBJECTIVE

The purpose of this study was to examine changes and predictors of changes in riding with an alcohol/drug-impaired driver (RWI) from 10th grade through the first post-high school year.

METHOD

Transition models were used to estimate the association of four waves (W1-W4) of RWI with W4 environmental-status variables and time-varying covariates in the NEXT Generation Health Study, a nationally representative cohort of U.S. 10th graders (N = 2,785).

RESULTS

Overall, 33% (weighted) of adolescents reported RWI in the past 12 months in W1, and slightly declined in W2 (24%), W3 (27%), and W4 (26%). Across time, transition models with generalized estimating equations showed that RWI was more likely among those who previously reported RWI (ORs from 3.62 to 3.66, p < .001), substance use (ORs from 1.81 to 1.82, p < .001), and heavy episodic drinking (ORs from 1.85 to 1.86, p < .001). Those living on college campuses were somewhat more likely to engage in RWI (OR = 1.38, .05 < p <.10) than those living at home. The effects of parental monitoring knowledge and peer alcohol/substance use on RWI were suppressed when individual substance use and heavy episodic drinking were taken into consideration.

CONCLUSIONS

Substance use and heavy episodic drinking in previous waves and the history of RWI were persistent factors of RWI in a dynamic pattern. The setting in which emerging adults live during their first post-high school year could affect their engagement in RWI. The findings suggest that harm-reduction strategies should focus on the identification of early RWI coupled with reduction of substance use and heavy episodic drinking.

Covariability in three dimensions of teenage driving risk behavior: impaired driving, risky and unsafe driving behavior, and secondary task engagement

OBJECTIVE

This research examined the extent to which teenagers who engaged in one form of risky driving also engaged in other forms and whether risky driving measures were reciprocally associated over time.

METHODS

The data were from waves 1, 2, and 3 (W1, W2, and W3) of the NEXT Generation study, with longitudinal assessment of a nationally representative sample starting with 10th graders starting in 2009-2010. Three measures of risky driving were assessed in autoregressive and cross-lagged analyses: driving while alcohol/drug impaired (DWI), Checkpoints Risky Driving Scale (risky and unsafe driving), and secondary task engagement while driving.

RESULTS

In adjusted autoregression models, the risk variables demonstrated high levels of stability, with significant associations observed across the 3 waves. However, associations between variables were inconsistent. DWI at W2 was associated with risky and unsafe driving at W3 (β = 0.21, P < .01); risky and unsafe driving at W1 was associated with DWI at W2 (β = 0.20, P < .01); and risky and unsafe driving at W2 is associated with secondary task engagement at W3 (β = 0.19, P < .01). Over time, associations between DWI and secondary task engagement were not significant.

CONCLUSIONS

Our findings provide modest evidence for the covariability of risky driving, with prospective associations between the Risky Driving Scale and the other measures and reciprocal associations between all 3 variables at some time points. Secondary task engagement, however, appears largely to be an independent measure of risky driving. The findings suggest the importance of implementing interventions that addresses each of these driving risks.

Teens and seat belt use: What makes them click?

PROBLEM

Motor vehicle crashes kill more adolescents in the United States than any other cause, and often the teen is not wearing a seat belt.

METHODS

Using data from the 2011 Youth Risk Behavior Surveys from 38 states, we examined teens' self-reported seat belt use while riding as a passenger and identified individual characteristics and environmental factors associated with always wearing a seat belt.

RESULTS

Only 51% of high school students living in 38 states reported always wearing a seat belt when riding as a passenger; prevalence varied from 32% in South Dakota to 65% in Delaware. Seat belt use was 11 percentage points lower in states with secondary enforcement seat belt laws compared to states with primary enforcement laws. Racial/ethnic minorities, teens living in states with secondary enforcement seat belt laws, and those engaged in substance use were least likely to always wear their seat belts. The likelihood of always being belted declined steadily as the number of substance use behaviors increased.

DISCUSSION

Seat belt use among teens in the United States remains unacceptably low. Results suggest that environmental influences can compound individual risk factors, contributing to even lower seat belt use among some subgroups.

PRACTICAL APPLICATIONS

This study provides the most comprehensive state-level estimates to date of seat belt use among U.S. teens. This information can be useful when considering policy options to increase seat belt use and for targeting injury prevention interventions to high-risk teens. States can best increase teen seat belt use by making evidence-informed decisions about state policy options and prevention strategies.

Effects of Brief Alcohol Interventions on Drinking and Driving among Youth: A Systematic Review and Meta-analysis

OBJECTIVE

Alcohol-impaired driving persists as a major cause of traffic fatalities and injuries among young drivers. This meta-analysis examined whether brief alcohol interventions were effective in reducing driving after drinking among adolescents and young adults.

METHOD

Our systematic search identified 12 experimental/quasi-experimental evaluations (16 intervention groups) that measured driving while intoxicated and related consequences and provided data for effect size calculation (N = 5,664; M age =17 years; 57% male). The studies were published between 1991 and 2011. Three-level random-effects meta-analyses using a structural equation modeling approach were used to summarize the effects of the interventions.

RESULTS

Compared with controls, participants in brief alcohol interventions reported reduced drinking and driving and related consequences (ḡ = 0.15, 95% CI [0.08, 0.21]). Supplemental analyses indicated that reductions in driving while intoxicated were positively associated with the reduced post-intervention heavy use of alcohol. These findings were not attenuated by study design or implementation factors.

CONCLUSIONS

Brief alcohol interventions under 5 hours of contact may constitute a promising preventive approach targeting drinking and driving among adolescents and young adults. Reducing heavy episodic alcohol consumption appeared to be a major factor in reducing drunk-driving instances. Interpretation of the findings must be made with caution, however, given the possibility of publication bias and the small observed effect size. Future research should focus on the exact mechanisms of behavior change leading to beneficial outcomes of brief alcohol interventions and the potential effectiveness of combined brief interventions and other preventive approaches.

Statewide Administration of the CRAFFT Screening Tool: Highlighting the Spectrum of Substance Use

BACKGROUND

Adolescent alcohol and drug use in the United States are associated with negative consequences spanning multiple domains. Much of the public health surveillance of these behaviors relies on self-report survey data. These data frequently takes the form of frequency or prevalence data for specific substances, which may not provide a complete picture of use.

OBJECTIVES

This study analyzes a state-level survey that includes the CRAFFT screening tool. The study's goal is to elucidate the spectrum of substance use severity across a large segment of substance-using adolescents attending schools in the state of Indiana and to assess the contribution of a variety of predictor variables to the variance between users falling into each category of use severity.

METHODS

Data were collected in 2011 from 168,801 adolescents, of whom 25,204 met the inclusion criteria for this study. The authors utilize multinomial logit analyses to highlight variables, including sociodemographic data, poly-drug use, and risk/protective behavior scales, associated with each category of use.

RESULTS

Seriousness of use is not uniform across substance-using adolescents; 49% were categorized as nonproblem users, 33% as problem users, and 18% as dependent users. Risk and protective factors predict adolescents' severity of substance use, but do not do so uniformly. Poly-drug use is a significant predictor of problem use and dependent use as well.

CONCLUSIONS

The CRAFFT may provide a more nuanced perspective of adolescent substance use than frequency/prevalence data alone; the authors describe the implications derived from these data and analyses to the adolescent prevention and treatment systems.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

TRIAL REGISTRATION NUMBER

NCT00164294.

Frequent nonprescription stimulant use and risky behaviors in college students: the role of effortful control

OBJECTIVE

The goal of this study was to (a) investigate the association between nonprescription stimulant use (NPSU) and risky behaviors, including risky sex, driving, financial behaviors, and drug use and (b) collect preliminary evidence on mechanisms that may link NPSU to risky behaviors.

PARTICIPANTS

A sample of 555 college students was collected between August 2010 and February 2012.

METHODS

Students completed several self-report measures assessing their drug use history, attention-deficit and hyperactivity symptoms, temperament, and risky behaviors beyond drug use.

RESULTS

Those who reported more frequent NPSU were more likely to engage in high-risk behavior across all 4 domains studied. Further, effortful control abilities partially mediated the link between NPSU and risky behaviors.

CONCLUSIONS

These results highlight the associated risks of frequent NPSU for college students as well as provide future directions for examining effortful control as a potentially important mechanism linking NPSU to other risky behaviors.

Association between riding with an impaired driver and driving while impaired

OBJECTIVE

To examine the association between driving while alcohol/drug impaired (DWI) and the timing and amount of exposure to others' alcohol/drug-impaired driving (riding while impaired [RWI]) and driving licensure timing among teenage drivers.

METHODS

The data were from waves 1, 2, and 3 (W1, W2, and W3, respectively) of the NEXT Generation Study, with longitudinal assessment of a nationally representative sample of 10th graders starting in 2009-2010. Multivariate logistic regression was used for the analyses.

RESULTS

Teenagers exposed to RWI at W1 (adjusted odds ratio [AOR] = 21.12, P < .001), W2 (AOR = 19.97, P < .001), and W3 (AOR = 30.52, P < .001) were substantially more likely to DWI compared with those reporting never RWI. Those who reported RWI at 1 wave (AOR = 10.89, P < .001), 2 waves (AOR = 34.34, P < .001), and all 3 waves (AOR = 127.43, P < .001) were more likely to DWI compared with those who never RWI. Teenagers who reported driving licensure at W1 were more likely to DWI compared with those who were licensed at W3 (AOR = 1.83, P < .05).

CONCLUSIONS

The experience of riding in a vehicle with an impaired driver increased the likelihood of future DWI among teenagers after licensure. There was a strong, positive dose-response association between RWI and DWI. Early licensure was an independent risk factor for DWI. The findings suggest that RWI and early licensure could be important prevention targets.

Drinking and parenting practices as predictors of impaired driving behaviors among U.S. adolescents

OBJECTIVE

The purpose of this study was to identify the extent to which 10th-grade substance use and parenting practices predicted 11th-grade teenage driving while alcohol-/other drug-impaired (DWI) and riding with alcohol-/other drug-impaired drivers (RWI).

METHOD

The data were from Waves 1 and 2 of the NEXT Generation study, with longitudinal assessment of a nationally representative sample of 10th graders starting in 2009-2010. Multivariate logistic regression analysis was used to examine the prospective associations between proposed predictors (heavy episodic drinking, illicit drug use, parental monitoring knowledge and control) in Wave 1 and DWI/RWI.

RESULTS

Heavy episodic drinking at Wave 1 predicted Wave 2 DWI (odds ratio [OR] = 3.73, p < .001) and RWI (OR = 3.92, p < .001) after controlling for parenting practices and selected covariates. Father's monitoring knowledge predicted lower DWI prevalence at Wave 2 when controlling for covariates and teenage substance use (OR = 0.66, p < .001). In contrast, mother's monitoring knowledge predicted lower RWI prevalence at Wave 2 when controlling for covariates only (OR = 0.67, p < .05), but the effect was reduced to nonsignificance when controlling for teen substance use.

CONCLUSIONS

Heavy episodic drinking predicted DWI and RWI. In addition, parental monitoring knowledge, particularly by fathers, was protective against DWI, independent of the effect of substance use. This suggests that the enhancement of parenting practices could potentially discourage adolescent DWI. The findings suggest that the parenting practices of fathers and mothers may have differential effects on adolescent impaired-driving behaviors.