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The effect on teen driving outcomes of the Checkpoints Program in a state-wide trial
Abstract
Crash rates among teenagers are highly elevated during the first months of licensure. Parent-imposed driving restrictions on initial driving privileges can reduce exposure to high-risk driving conditions, thus reducing crash risk while teens' driving proficiency develops. This report describes the effect of the Checkpoints Program on driving limits and outcomes. Connecticut teens who obtained a learners permit over a 9-month period were recruited, providing a final sample of 3743 who obtained driver licenses. Families were randomized to the intervention or comparison condition. Intervention families received by mail a series of persuasive communications related to high-risk teen driving and a parent-teen driving agreement, while comparison families received on the same schedule general information on driving and vehicle maintenance. Relative to the comparison group, teens and parents in the Checkpoints Program reported significantly greater limits on high-risk teen driving conditions at licensure, 3-, and 6-months post-licensure; and intervention teens reported significantly less risky driving at each reporting period. By the 12-month follow up teens in the intervention group were significantly less likely than those in the comparison group to have had a traffic violation. However, no treatment group effect was found for crashes. This is the first study to report significant effects on teen driving behavior and performance of education designed to increase parental-imposed teen driving limits.
... Young drivers have high crash rates relative to older drivers (1), particularly early in licensure (2), but there is substantial variability, with some young drivers experiencing very low risk and others very high risk (3)(4)(5)(6)(7)(8). The causes of young driver crashes are thought to include inexperience, young age, and risky driving (9). ...
... The Checkpoints Risky Driving Scale (C-RDS), employed in a number of studies (6,8,13,40,41), consists of 19 items that ask, "In the last 7 days, how often did you do each of the following (when you had the occasion to)?" Examples include driving 10 to 19 mph over the speed limit and going through an intersection when the light was red or just turning red. Response options ranged from never (1) to always (5). ...
... The measure of driving risk perceptions, used in previous studies on driving behavior (8,40), included 14 items that asked, "How much risk for crash or injury do you think newly licensed teens have if they drive unsupervised in the following situations?" Example situations included driving late at night, while not wearing a seat belt, in unfamiliar areas, with teenage passengers, under the influence of alcohol, and with passengers who had been drinking. ...
The objective of this study was to examine prospective associations of perceptions of driving risk and skill with teenage risky driving. The vehicles of 42 newly licensed teenage drivers were instrumented with a data acquisition system. Objective measures of risky driving [crash and near crash (CNC) and kinematic risky driving (KRD) rates] obtained from accelerometers were aggregated over three 6-month periods (T1, T2, and T3). The Checkpoints Self-Reported Risky Driving Scale (C-RDS) and perceptions of driving risk and driving skills were collected at corresponding 6-month intervals. The results indicated that CNC, KRD, and C-RDS were significantly correlated at T1 to T3. Perceptions of driving risk and skill were not signi cantly correlated with objective or self-reported measures of risky driving. No evidence was found that perceptions of risk or skill were prospectively associated with risky driving. It was concluded that perceptions of risk and driving skills may have limited utility as objectives of prevention efforts.
... Several studies have found that parental monitoring, with appropriate restrictions, influences driving safety. [17][18][19][20] In particular, a formal, written, driving-related, parent-teen agreement with clear parental expectations reduces risky driving among teens, 21,22 likely by reducing discordance between parent and teen interpretations of expectations and limits. 23 Monitoring is only one aspect of the protective influence of parental involvement. ...
... When parents imposed stricter rules regarding teen passengers and nighttime driving, teens reported safer driving behaviors 18 and fewer crashes. 65 Various parent-teen agreements have been used to codify restrictions, 22,66,67 to offer an understanding of both teen and parent responsibilities and expectations, and to create a framework whereby restrictions are reduced with increased experience. [21][22][23]68 Perhaps because of the clarity and structure they provide, parent-teen agreements have both short-term and sustained benefits. ...
... 65 Various parent-teen agreements have been used to codify restrictions, 22,66,67 to offer an understanding of both teen and parent responsibilities and expectations, and to create a framework whereby restrictions are reduced with increased experience. [21][22][23]68 Perhaps because of the clarity and structure they provide, parent-teen agreements have both short-term and sustained benefits. 21,65 Monitoring may facilitate effective targeted discussions or may be construed as controlling. ...
... Young drivers have high crash rates relative to older drivers (1), particularly early in licensure (2), but there is substantial variability, with some young drivers experiencing very low risk and others very high risk (3)(4)(5)(6)(7)(8). The causes of young driver crashes are thought to include inexperience, young age, and risky driving (9). ...
... The Checkpoints Risky Driving Scale (C-RDS), employed in a number of studies (6,8,13,40,41), consists of 19 items that ask, "In the last 7 days, how often did you do each of the following (when you had the occasion to)?" Examples include driving 10 to 19 mph over the speed limit and going through an intersection when the light was red or just turning red. Response options ranged from never (1) to always (5). ...
... The measure of driving risk perceptions, used in previous studies on driving behavior (8,40), included 14 items that asked, "How much risk for crash or injury do you think newly licensed teens have if they drive unsupervised in the following situations?" Example situations included driving late at night, while not wearing a seat belt, in unfamiliar areas, with teenage passengers, under the influence of alcohol, and with passengers who had been drinking. ...
Background/Purpose. Perceived risk is frequently cited as a predictor of teenage risky driving. Theoretically, people are less likely to engage in a behavior they perceive to involve potential harm, however the extent to which adolescents' perceptions of risk are associated with objective measures of risky driving has not been established. The purpose of this research is to evaluate the relationship between perceived risk and two self-reported and two objective measures of teenage risky driving.
Methods. Vehicles of 42 newly-licensed teenage drivers were instrumented with accelerometers, cameras, global positioning systems, allowing objective assessment of crashes/near crashes and elevated g-force events (kinematic risky driving). In addition, participants completed surveys three times over 18 months (T1 at 6 months, T2 at 12 months, and T3 at 18 months). These included two measures of risky driving (Checkpoints Risky Driving Scale (C-RDS) and Dula Aggressive Driving Scale (Dula) and one measure of perceived risk. Correlations between perceived risk, self-reported risky driving, and kinematic risky driving at each time point were calculated.
Results. Perceived risk was stable over time, with r>0.70 between T1, T2, and T3. Perceived risk at T1 was significantly correlated with the Dula at T1 (r=0.36), but not at T2 or T3 in either cross-sectional or prospective analyses. Perceived risk was not significantly associated with C-RDS at any time point, and correlated with kinematic risky driving only at T2 (r=0.35). Nor was it correlated with crash/near crash at any time point.
Conclusion: Perceived risk was not consistently associated with measures of risky driving.
... It is not possible to obtain a driver's license until one is 16 years old or older under Japanese law; therefore, these victims under 15 years old cannot be "driving themselves", meaning that parents or caregivers are mainly responsible for protecting infants and children. The improvement in Japan might be attributed to the widespread adoption of seat belts and appropriate child safety seats, the production of cars with improved safety standards, better constructed roads, and graduated driver licensing programs as reported in the U.S. [22,23]. ...
... It was reported that cardiopulmonary arrest (CPA) in pediatric patients may not be a result of hemorrhage shock but of a primary respiratory cause. Children are especially prone to CPA due to respiratory failure [23]. Simple airway maneuvers and intubations may prevent the development of hypoxic cardiac arrest. ...
The epidemiological and clinical characteristics, treatments, and outcomes of patients with traumatic out-of-hospital cardiac arrests (OHCAs) following traffic collisions have not been adequately investigated in Japan. We analyzed the All-Japan Utstein Registry data of 918 pediatric patients aged < 20 years with OHCAs following traffic collisions who were resuscitated by bystanders or emergency medical service personnel and were subsequently transported to hospitals between 2013 and 2019. Multiple logistic regression analysis was used to assess factors potentially associated with 1-month survival after OHCA. The 1-month survival rate was 3.3% (30/918), and the rate of neurologically favorable outcomes was 0.7% (60/918). The proportion of 1-month survival of all OHCAs after traffic collision origin did not significantly increase (from 1.9% (3/162) in 2013 to 4.5% (5/111) in 2019), and the adjusted odds ratio (OR) for a 1-year increment was 1.13 (95% confidence interval (CI) 0.93 to 1.37). In a multivariate analysis, ventricular fibrillation arrests and pulseless electrical activity (PEA) were significant predictors of 1-month outcome after OHCAs due to traffic collision. From a large OHCA registry in Japan, we demonstrated that 1-month survival after OHCAs due to traffic collision origin was approximately 3%, and some children even gained full recovery of neurological function.
... Adolescent drivers are at their highest risk for an MVC in their first year of licensure (Mayhew, Simpson, & Pak, 2003;McCartt, Shabanova, & Leaf, 2003;Williams & Tefft, 2014). Interventions that reduce adolescent crash risk during the first year of licensure have the potential to make significant inroads on reducing adolescent driver crashes (Simons-Morton, Hartos, Leaf & Preusser, 2006;. ...
... Most programs include three stages (learner, intermediate, and full privilege license; Governors Highway Safety Association, 2016). Interventions have also been developed that target parental roles, such as feedback and monitoring systems, parental contracts, and educational programs to increase diversity and quantity of supervised practice driving (Mirman et al., 2014;Simons-Morton, Hartos, Leaf, & Preusser, 2006;Zakrajsek et al., 2013). Skills-based interventions such as hazard anticipation training have also shown potential (Fisher et al., 2002). ...
Motor vehicle crashes are the leading cause of adolescent death. Inattention to the roadway contributes to crash risk and often results from distractions, such as cell phone calls, texting, and peer passengers. We report on the development of a web-based intervention based on the Theory of Planned Behavior that aims to reduce adolescent driver inattention (Let’s Choose Ourselves). In Phase I, we collected qualitative and quantitative data on adolescents’ attitudes, perceived behavioral control, and subjective norms about driver inattention through focus groups with newly licensed adolescent drivers. In Phase II, we developed the content in an e-learning delivery system, performed beta- and pilot testing, and made refinements. In Phase III, we conducted a randomized controlled trial to evaluate feasibility. The development of Let’s Choose Ourselves provides information for school nurses regarding intervention development strategies as well as promotion of safe adolescent driving by reducing driver inattention.
... Checkpoints Self-Reported Risky Driving Scale (C-RDS) was measured using 21 questions (Table 1) from the Checkpoints Self-Reported Risky Driving Scale (C-RDS) (Simons- Morton et al. 2006) to measure unsafe driving behavior (e.g., on how many days in the last 30 days have you "…exceeded the speed limit in residential or school zones?" "…purposely tailgated or followed another vehicle very closely?"). ...
... Secondary task engagement while driving (S-Task) was assessed on the basis of participants' responses to 9 questions (Table 1) (e.g., on how many days in the last 30 days had they "…received a call on your cell phone" or "…sent text messages" while driving?) (Simons-Morton et. al. 2006;Simons-Morton et. al. 2011). The internal consistency of the scale used to measure secondary task engagement while driving was good (Cronbach α = 0.87). We then dichotomized the scores of the 9 questions (1= at least 1 day vs 0 = none) and summed the 9 dichotomies, with possible scores ranging from 0 to 9. ...
Objective:
This research examined the extent to which teenagers who engaged in one form of risky driving also engaged in other forms and if 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, Checkpoints Risky Driving Scale (risky and unsafe driving), and secondary task engagement while driving.
Results:
In adjusted auto-regression models the risk variables, demonstrated high levels of stability, with significant associations observed across the three waves. However, associations between variables were inconsistent. DWI at W2 was associated with risky and unsafe driving at W3 (β = 0.21, p < 0.01); 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). Overtime associations between DWI and secondary task engagement were not significant.
Conclusions:
Our findings provide modest evidence for the co-variability of risky driving, with prospective associations between the Risky Driving Scale and the other measures, and reciprocal associations between all three 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.
... Measures Primary study outcomes were: PTDA use and parent-imposed driving restrictions from licensure through Month6, and teen driving outcomes at Month6. All measures were used in previous Checkpoints studies [9] [12] [14]. PTDA use was measured with a single item asking, " Are you and your parent using a written parent-teen driving contract or agreement? ...
... Teen driving outcomes were measured only at Month6 using the Checkpoints Risky Driving Scale (C-RDS), a 19-item high-risk driving scale, self-reported offenses (number of times pulled over by law enforcement), and crashes (number of crashes). The C-RDS asked how many times in the past week teens engaged in each of 19 driving behaviors (e.g., sped in residential or school zone, drove 10e19 mph over speed limit, drove 20 or more mph over limit, drove too close behind another vehicle, drove through an intersection when light was yellow (and red), raced another vehicle, drove to show off, etc.) [12]. Elsewhere, the C-RDS has shown high consistency over time, correlations of r > .70 with another standard self-report measure, and r ¼ .45 with elevated g-force event rates, an objective measure of risky driving [15e17]. ...
Background/Purpose: The Checkpoints Program (Checkpoints) uses a Parent-Teen Driving Agreement (PTDA) to help parents monitor teen driving, and has shown efficacy in increasing parental restrictions on teens' driving, and decreasing teens' risky driving. Research staff administered Checkpoints in previous trials. This CDC-funded study examined the effectiveness of Checkpoints when delivered by driver educators. It was hypothesized that Checkpoints would result in more PTDA use, greater PTDA limits on higher risk driving situations, and less high-risk driving. Methods: Eight trained driving instructors were randomly assigned to intervention or control groups. Instructors enrolled 148 parent-teen dyads (intervention=99, control=49); 35% of those eligible. Intervention parents joined their teens for a 30-minute Checkpoints session during driver education class. The session included persuasive messages, discussion, and initiation of a PTDA. Teens completed four survey waves: baseline, licensure, and 3- and 6-months post-licensure. Results/Outcomes: Intervention teens were more likely to report that their parents used a PTDA (OR=15.92, p=.004) and restricted teens' driving with teen passengers (OR=8.52, p=.009), on weekend nights (OR=8.71, p=.021), on high-speed roads (OR=3.56, p=.02), and in bad weather (b=0.51, p=.05) during the first six months of licensure. There were no differences in offenses or crashes at six months, but intervention teens reported less high-risk driving (p=.04). Conclusions: While challenges remain to encourage greater parent participation, a Checkpoints program conducted by driver education instructors resulted in higher use of the PTDA, greater high-risk driving restrictions, and lower high-risk driving. Including Checkpoints in driver education parent meetings/classes has potential to enhance teen driver safety.
... NHTSA's national survey of parents found that awareness of the different GDL requirements, including the number of required hours of supervised driving, was low, averaging only 32%. 9 A potential strategy to improve this knowledge gap is mandating a parent class as a part of adolescent driver education. 10,11 Very few states require that parents participate in some type of formal educational class as a part of their teen's driver's education course; for instance, Massachusetts and Connecticut have a 2-hour mandatory parent class as a part of their driver education program. 12 However, several studies have shown a positive effect of voluntary parent driver education programs. ...
... 12 However, several studies have shown a positive effect of voluntary parent driver education programs. 10,11 A University of Michigan Transportation Research Institute randomized case-control study showed that newly licensed teens of a parent who participated in the Checkpoints parent education program were more likely to report using a parent-teen driver agreement and compliance with GDL restrictions, as well as less high-risk driving. They were not, however, able to demonstrate reduced crash rates among the intervention group teens during the 6 months after the program, although this may be related to having only 148 parent-teen dyads in the study. ...
... 8,23 However, there is very little research regarding when and how to communicate safe driving and limits. [24][25][26] The existing Checkpoints educational program, developed by Dr Bruce Simons-Morton and tested in several U.S. states, does address communication by encouraging establishment of a Parent-Teen Driving Agreement and explaining risks of teen driving and has been shown to reduce driving risk. 25 However, the Checkpoints Program focuses on the first year of a teen's unsupervised licensed driving. ...
... [24][25][26] The existing Checkpoints educational program, developed by Dr Bruce Simons-Morton and tested in several U.S. states, does address communication by encouraging establishment of a Parent-Teen Driving Agreement and explaining risks of teen driving and has been shown to reduce driving risk. 25 However, the Checkpoints Program focuses on the first year of a teen's unsupervised licensed driving. Our results support the need to intervene earlier because almost half (48.5%) of the pre-licensure teens in our study reported that they have driven unsupervised, either via school permits or illegally. ...
To examine pre-licensure agreement on driving expectations and predictors of teen driving expectations among parent-teen dyads.
Cross-sectional survey of 163 parent-teen dyads. Descriptive statistics, weighted Kappa coefficients, and linear regression were used to examine expectations about post-licensure teen driving.
Teens reported high pre-licensure unsupervised driving (N = 79, 48.5%) and regular access to a car (N = 130, 81.8%). Parents and teens had low agreement on teen driving expectations (eg, after dark, κw = 0.23). Each time teens currently drove to/from school, their expectation of driving in risky conditions post-licensure increased (β = 0.21, p = .02).
Pre-licensure improvement of parent-teen agreement on driving expectations are needed to have the greatest impact on preventing teens from driving in high risk conditions.
... "purposely tailgated or followed another vehicle very closely?"). 32 The internal consistency of the C-RDS was good (Cronbach a = 0.90). We then dichotomized responses on each of the 21 questions (1 = at least 1 day vs 0 = none) and summed the 21 dichotomies, with possible scores ranging from 0 to 21. ...
... We measured secondary task engagement while driving on the basis of participants' responses to 9 questions (e.g., on how many days in the last 30 days had they "received a call on your cell phone" or "sent text messages" while driving?). 15,32 The internal consistency of the scale used to measure secondary task engagement while driving was good (Cronbach a = 0.87). We then dichotomized the scores of the 9 questions (1 = at least 1 day vs 0 = none) and summed the 9 dichotomies, with possible scores ranging from 0 to 9. ...
Objectives:
We examined the prevalence of impaired driving among US high school students and associations with substance use and risky driving behavior.
Methods:
We assessed driving while alcohol or drug impaired (DWI) and riding with alcohol- or drug-impaired drivers (RWI) in a nationally representative sample of 11th-grade US high school students (n = 2431). We examined associations with drinking and binge drinking, illicit drug use, risky driving, and demographic factors using multivariate sequential logistic regression analysis.
Results:
Thirteen percent of 11th-grade students reported DWI at least 1 of the past 30 days, and 24% reported RWI at least once in the past year. Risky driving was positively associated with DWI (odds ratio [OR] = 1.25; P < .001) and RWI (OR = 1.09; P < .05), controlling for binge drinking (DWI: OR = 3.17; P < .01; RWI: OR = 6.12; P < .001) and illicit drug use (DWI: OR = 5.91; P < .001; RWI: OR = 2.29; P = .05). DWI was higher for adolescents who drove after midnight (OR = 15.7), drove while sleepy or drowsy (OR = 8.6), read text messages (OR = 11.8), sent text messages (OR = 5.0), and made cell phone calls (OR = 3.2) while driving.
Conclusions:
Our findings suggest the need for comprehensive approaches to the prevention of DWI, RWI, and other risky driving behavior.
... In recent years, the efficacy of publicized sobriety checkpoint programs has been drawn much attention to restrict risky driving maneuvers. Several studies confirmed the potential of parental supervision and guidance in curtailing violation risk as well as crash rates [102,103]. During supervised phases, parents can positively influence adolescents driving behavior by discussing the benefits of existing policies and sharing their early driving experiences. ...
In Louisiana, teenagers (aged 15 to 19 years) have been emphasized as a critical
driver population class because of their over-representation in fatal and injury crashes. The conventional parametric approaches rest on few predefined assumptions, which might not always be valid in a large complex multidimensional dataset. Also, individual attributes may be more speculative when combined with other factors. This research utilized five years (2014-2018) of Louisiana fatal and injury crash data to reveal the hidden crash patterns of at-fault teen drivers by employing joint correspondence analysis (JCA) and association rule mining (ARM). The unsupervised learning algorithms can explore meaningful associations among crash categories without restricting the nature of variables. The analyses discover intriguing associations to understand the potential causes and effects of crashes. For example, alcohol impairment results in fatal crashes with passengers, severe collisions occur to unrestrained drivers who have exceeded the posted speed limits at daytimes, and moderate injuries happen on urban two-lane highways involving drivers with acceptable blood alcohol concentration (BAC) levels. The findings also provide insights on driving behavior patterns associated with teen driver crashes, such as distracted driving in the morning hours, alcohol intoxication or using cellphone in light trucks, and so on. The knowledge can be included in driver education programs to mitigate risky driving maneuvers. Also, prioritizing crash attributes of key interconnections can help to develop practical safety countermeasures. Strategy that covers multiple interventions could be more effective in curtailing teenagers’
crash risk.
... When choosing to participate, parents receive educational materials such as a video, newsletter and a parent-teen driving agreement. Research indicates that the program encourages parents to set stricter limitations and there also appears to be a reduction in teen driving offences, but no differences in their subsequent crash rates (Simons-Morton, Hartos, Leaf, & Preusser, 2006). This program has also been delivered by driver educators, though this mode of delivery presents barriers to parental participation. ...
This study explored whether a third party policing approach is appropriate for increasing young driver compliance with graduated driver licensing restrictions. Focus groups (n = 3) and semi-structured interviews (n = 24) were conducted with young drivers from Brisbane, Queensland, Australia. Participants (n = 39 in total) were aged 17 to 19 years and held a Provisional 1 or 2 licence. Many young drivers appreciated the involvement of their parents in their novice driving period and reported that parents provided practical support and planning strategies. There is potential for the use of a third party policing intervention to improve compliance amongst young drivers.
... Answers were recoded as a 5-level categorical variable including no drinking, drinking but no binge drinking (males: 1 to 4; females: 1-3 drinks), binge (males: 5-9; females: 4-7 drinks), 2 times binge drinking (males: 10-14; females: 8-11 drinks), and 3 times binge drinking or more (males: 151; females: 121 drinks) in the past 12 months. 25 Self-Reported Checkpoints Risky Driving Scale (W4 to W7) Risky driving was measured by using 21 questions derived from the validated self-reported Checkpoints Risky Driving Scale (C-RDS) [26][27][28] to measure unsafe driving behavior (eg, on how many days in the last 30 days have you exceeded the speed limit in residential or school zones?). Internal consistency of the C-RDS was good (Cronbach a = 0.90). ...
Objective:
To study the longitudinal associations of 12th-grade binge drinking with driving while impaired (DWI), riding with an impaired driver (RWI), blackouts, extreme binge drinking, and risky driving (self-reported Checkpoints Risky Driving Scale) among emerging adults up to 4 years after leaving high school.
Methods:
The data were all 7 waves (W 1 to W 7 of the NEXT Generation Health Study; a US nationally representative study (N = 2785) with a probability cohort of 10th-graders (mean age = 16.2 years; SE = 0.03) starting in the 2009-2010 year. Binary and ordinal logistic regressions were used for the analysis.
Results:
Binge drinking prevalence in W1 to W3 was 27.2%, 23.8%, and 26.8%, respectively. Twelfth-grade binge drinking was associated with a higher likelihood of DWI, RWI, blackouts, and risky driving in W4 to W7 and extreme binge drinking in W7. Adolescents who binged ≥3 times in high school were more likely to DWI, RWI, blackout (W4 to W7), be involved in extreme binge drinking (W7), and report riskier driving several years after high school. In some waves, parental practices appeared to have enduring effects in protecting against DWI, RWI, and blackouts.
Conclusions:
Twelfth-grade binge drinking is a robust predictor of early adulthood DWI, RWI, blackout, extreme binge drinking, and risky driving. Our study suggests that ongoing parental practices could be protective against DWI, RWI, and blackouts once adolescents transition from high school into early adulthood. Prevention programs that incorporate binge drinking-focused screening and bolster parental practices may reduce the likelihood of later major alcohol-related health-risk behaviors and consequences in emerging adults.
... Estos resultados pueden explicarse, en parte, por lo que se ha reportado sobre la contribución de las creencias normativas, 34 definidas como la percepción del comportamiento de amigos o aceptación de un comportamiento por parte de un amigo, a un mayor riesgo de conducción bajo los efectos de la marihuana o ser un pasajero con alguien que conduce bajo los efectos de esta sustancia. 35 La evidencia también ha demostrado que los jóvenes perciben la conducción bajo los efectos de la marihuana como aceptable entre sus compañeros y consideran que las consecuencias negativas son menores que las asociadas a la conducción bajo los efectos del alcohol. 28 ...
Objective: analyze the relationship between the perception of risk and the behavior of driving under the influence of alcohol or marijuana or getting into a vehicle driven by someone under the effects of these substances in order to identify risk factors and protective factors. Method: multicenter study cross sectional survey with students from a University in Colombia (n = 493) completed a survey prepared during the International Program of Training in Research for Health Professionals and Related Areas to Study the Drug Phenomenon in Latin America and the Caribbean. Results: an inverse relationship was observed between each of the three levels of risk perception: detection (p<.001), punishment (p<.05) and harm (p<.001), and driving behaviors with alcohol. This same type of relationship is observed with marijuana in terms of perceived risk of being involved in an accident (p<.05). However, regarding to marijuana, there is not enough evidence of an association with the perceived risk of being arrested or punished. The results show that there is an inverse relationship between what the students' relatives and friends think and do and the perception of risk of being arrested (p<.001), punished (p<.001) or of being involved in an accident (p<.001) for driving under the influence of alcohol and marijuana at the same time. Conclusion: the results suggest that there are risk factors and protective factors that can be intervened to prevent injuries or fatal events associated with driving under the influence of alcohol or marijuana.
... For example, the Checkpoints program, which uses a parent-teen driving agreement used to assist parents in monitoring teen driving, has been used to bolster parental restrictions on teen driving behavior and reduced risky driving. 87 Similarly, a randomized trial of the Teen Driving Plan, which was used to address the quality and variety of parent-supervised teen driving, suggested that the program improved the supervised practice and the driving performance of prelicensed teen drivers. 96 The Centers for Disease Control and Prevention maintains a useful Web page for parents of teen drivers that includes a sample parent-teen driving agreement (see Resources). ...
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 rate of deaths from motor vehicle crashes among children and adolescents showed the most notable change over time (Fig. 1), with a relative decrease of 38% between 2007 and 2016. This has been attributed to the widespread adoption of seat belts and appropriate child safety seats, the production of cars with improved safety standards, better constructed roads, graduated driver-licensing programs, 8,9 and a focus on reducing teen drinking and driving. Such reductions in mortality occurred despite increases in the overall number of U.S. vehicles and annual vehiclemiles traveled. ...
This report details the 10 leading causes for the 20,360 deaths of children and adolescents in the United States in 2016. The analysis also includes trends over time and comparisons among countries.
... For example, Wagenaar and Toomey (2002) found that increasing the minimum legal drinking age to 21 reduced traffic crashes, alcohol use, and injury among 18-to 21-year-olds. Universal prevention programs using sobriety checkpoints (Shults et al., 2001) and universal and selective parent education and involvement strategies (Haggerty et al., 2006;Simons-Morton et al., 2006) have also been effective in reducing drunk driving and auto accidents involving adolescents. In addition to preventing substance use, the school-based LST program has been shown to reduce risky driving (Griffin et al., 2004). ...
... For example, Wagenaar and Toomey (2002) found that increasing the minimum legal drinking age to 21 reduced traffic crashes, alcohol use, and injury among 18-to 21-year-olds. Universal prevention programs using sobriety checkpoints (Shults et al., 2001) and universal and selective parent education and involvement strategies (Haggerty et al., 2006;Simons-Morton et al., 2006) have also been effective in reducing drunk driving and auto accidents involving adolescents. In addition to preventing substance use, the school-based LST program has been shown to reduce risky driving (Griffin et al., 2004). ...
... Several facets of the parent-adolescent relationship and communication quality have been shown to be related to adolescents' safe driving (Taubman-Ben-Ari, 2010). For example, the quality of communication and social support between parents and adolescents has been shown to be a key factor associated with increased parental engagement during the supervised learner period (Jacobsohn, García-España, Durbin, Interventions designed to improve parent-teen communication and related behaviors (e.g., solicitation, monitoring, disclosure, parent engagement) can reduce a variety of risk behaviors in adolescence, including risky driving (Carney, Mcgehee, Lee, Reyes, & Raby, 2010;Mirman, Curry, Elliot, Long, & Pfeiffer, 2018;Simons-Morton, Hartos, Leaf, & Preusser, 2006;Taubman-Ben-Ari & Lotan, 2011). Parentdirected interventions that are theory-based, inclusive of the parentadolescent dyad, and interactive (as opposed to passive dissemination of unengaging materials) have the greatest potential for success (Curry, Peek-Asa, Hamann, & Mirman, 2015). ...
Introduction:
The aims of the current pilot study were to evaluate the feasibility, acceptability, and preliminary efficacy of the Talking with Teens about Traffic Safety Program. The program consists of a clinic-based health coaching session with parents of adolescents at their annual well-child visit to promote parent-teen communication about teen driver safety including: a Parent Handbook that is designed to serve as a primer on teen driver safety and facilitate parent-teen communication on a variety of teen driver topics; an interactive practice driving toolset; and an endorsement of the materials by the primary care provider.
Method:
Fifty-four parent-teen dyads (n = 108 total) were recruited from a primary care practice. Dyads were randomized (1:1) into a treatment group or a usual care group. Implementation fidelity was assessed using checklists completed by health coaches and parent interviews. After 6 months, parents reported how often they talked with their teen about 12 safe driving topics (e.g., state graduated driver licensing laws).
Results:
Parents in the treatment group reported more frequent discussions than parents in the control group on 7 out of the 12 topics. Fidelity data indicate that 100% of sessions were implemented as designed and were acceptable to parents.
Conclusions:
The program was feasible to administer and there was evidence for preliminary efficacy. Generally, effects were larger for more infrequently discussed topics, which is to be expected due to the potential for ceiling effects on more commonly discussed topics (e.g., distracted driving). A larger multi-site study is warranted.
Practical applications:
The results from this pilot study provide support for implementation fidelity and establish a proof-of-concept for the Talking with Teens about Traffic Safety Program. The results provide guidance for developing partnerships with pediatricians and parents to develop parent-teen communication interventions on injury prevention topics.
... 37 Exclusion criteria were previous history of gastric surgery, gastric stump cancer, locally advanced gastric cancer, as well as metastatic disease, severe comorbidities (score ≥ 4) according to American Society of Anesthesiologists, 38 proven mental illness, and absence of informed consent. Preoperative diagnosis, evaluation of tumor characteristics, and staging were carried out by means of preoperative esophagogastroduodenoscopy, endoscopic ultrasonography, 39 and total body contrastenhanced computed tomography. Biopsies were performed only when clinically indicated, in order to avoid complications. ...
Background:
Laparoscopic surgery for gastric tumor is considered a demanding procedure because of lymph node dissection and reconstruction. Billroth-I (B-I) reconstruction after laparoscopic distal gastrectomy is commonly performed extracorporeally because of the complexity of an intracorporeal procedure. Robotic surgery overcomes some limitations of laparoscopy, allowing to reproduce the basic maneuvers of open surgery. We describe a new technique to perform robotic B-I anastomosis.
Methods:
Between January 2012 and February 2015, 5 patients underwent distal gastrectomy with intracorporeal B-I-stapled anastomosis. Patient demographics, tumor characteristics, histopathologic features, and perioperative data were analyzed.
Results:
Median operative time was 170 minutes (145 to 180 min). There were no conversions. Contrast swallow was routinely performed on the third postoperative day. Median postoperative hospitalization was 7 days (range: 6 to 8). No major complications or mortality were observed.
Conclusions:
Robotic distal gastrectomy with intracorporeal B-I anastomosis is a safe and promising technique in selected cases of gastric tumors.
... Developed by National Institutes of Health researchers, Checkpoints™ complements Graduated Driver Licensing (GDL), encourages parental monitoring of teens' independent driving, and has demonstrated success in different delivery modes evaluated in several controlled trials. [4][5][6][7][8][9] Statistically significant positive effects were found in greater PTDA adoption, stricter limits on high-risk driving conditions (night, passengers, high-speed roads, bad weather), less risky driving, and fewer traffic offenses. ...
Addressing teen driver crashes, this study adapted an effective CheckpointsTM program for parents of teen drivers for dissemination by primary care practitioners (PCPs) and the web; distributed the PCP/web program through pediatric practices; and examined dissemination to/implementation by parents. The website, youngDRIVERparenting.org, and brief intervention protocol were developed. PCPs delivered interventions and materials to parents, referred them to the website, and completed follow-up surveys. Google Analytics assessed parents’ website use. Most PCPs reported delivering interventions with fidelity, and thought the program important and feasible. Brief interventions/website referrals, averaging 4.4 minutes, were delivered to 3465 (87%) of 3990 eligible parents by 133 PCPs over an 18-week average. Website visits (1453) were made by 42% of parents, who spent on average 3:53 minutes viewing 4.2 topics. This program costs little (its website, training and promotional materials are available) and could be one component of a comprehensive approach to reducing teen driver crashes.
... Such interventions also complement evidence-based strategies that reduce RDD (e.g., school-based instructional programs; Elder et al., 2005), and alcohol-related motor vehicle crashes among teens (e.g., minimum legal drinking age of 21; ''zero tolerance'' BAC laws for young and inexperienced drivers; Shults et al., 2001). Interventions that support parental involvement more generally in their teen's lives complement effective policies that directly enhance parental supervision in the proximal driving context, such as graduated driver licensing systems (McCartt, Teoh, Fields, Braitman, & Hellinga, 2010) and programs that incorporate Parent-Teen Driving Agreements (Simons-Morton, Hartos, Leaf, & Preusser, 2006). ...
Drinking and driving among adolescents and young adults remains a significant public health burden. Etiological research is needed to inform the development and selection of preventive interventions that might reduce alcohol-involved crashes and their tragic consequences. Youth assets—that is, skills, competencies, relationships, and opportunities—can help youth overcome challenges, successfully transition into adulthood, and reduce problem behavior. We examined the predictive influence of individual, relationship, and community assets on drinking and driving (DD) and riding with a drinking driver (RDD). We assessed prospective relationships through analysis of data from the Youth Assets Study, a community-based longitudinal study of socio-demographically diverse youth. Results from calculation of marginal models using a Generalized Estimating Equation approach revealed that parent and peer relationship and school connectedness assets reduced the likelihood of both drinking and driving and riding with a drinking driver approximately 1 year later. The most important and consistent asset that influenced DD and RDD over time was parental monitoring, highlighting the role of parental influence extending beyond the immediate teen driving context into young adulthood. Parenting-focused interventions could influence factors that place youth at risk for injury from DD to RDD, complementing other evidence-based strategies such as school-based instructional programs and zero tolerance Blood Alcohol Concentration laws for young and inexperienced drivers.
... Parents should therefore be encouraged to fulfill their obligation to guide, set rules, and monitor their teens' early driving by modeling safe driving and positive attitudes. Indeed, it has been found for example in the United States, that relative to a comparison group, parents and teens involved in the Checkpoints Program reported significantly greater limits on high-risk teen driving conditions, and teen reported significantly less risky driving and traffic violations (Simons-Morton, Hartos, Leaf, & Preusser, 2006). In Israel, a study evaluating Green Light for Life, a novel program targeting both young drivers and their parents in an effort to ensure the effectiveness of the accompanied driving phase, indicated that program participants showed more positive views regarding the accompanied driving phase and were less involved in car crashes than nonparticipants (Taubman -Ben-Ari & Lotan, submitted for publication). ...
In Israel, a new driver must be accompanied by an experienced driver for the first 3 months after licensure. In the case of teens, the accompanying driver is usually one of the parents. However, no previous study set to examine the relationship between parents’ and offsprings’ attitudes toward accompanied driving (ATAD), and the associations between the way parents habitually drive and their offsprings’ ATAD. The current study examined the associations between young drivers’ ATAD on the one hand, and parents’ ATADs, driving styles, and driving history, on the other. One hundred and twenty-nine young drivers completed a questionnaire assessing their ATAD, and their principal accompanying driver completed the same ATAD scale along with the Multi-dimensional Driving Style Inventory. The findings indicate a correspondence between parents’ and children’s ATAD scores, as well as significant associations between teens’ ATADs and their parents’ driving styles and involvement in car crashes. Specifically, higher Tension, Relatedness, Avoidance, Disapproval, and Anxiety reported by the young driver were positively correlated with higher reports on the same attitudes by parents. In addition, parents’ maladaptive driving styles were positively associated with their offspring’s Tension, Avoidance, Disapproval and Anxiety ATADs, whereas parents’ careful driving style was related to offspring’s higher relatedness and lower negative ATADs. Higher involvement of parents in car crashes contributed significantly to teens’ higher Tension, Disapproval, and Anxiety, and lower relatedness. The results are discussed in respect to the relationship between the parental model and the young driver’s attitude toward accompanied driving, pointing to the importance of parents’ role in promoting young drivers’ safety attitudes and behaviors.
... Again, results are promising and show a positive impact on traffic violations although not on driving accidents. 187 Conclusion A wide variety of universal and targeted approaches are available at both primary and secondary level to prevent the occurrence of abuse and neglect. Universal approaches include possible legislative changes and media campaigns, as well as specific programmes that can be introduced on a population basis. ...
Safeguarding Children Across Services is an Overview of the key messages from fifteen studies in a research programme jointly funded by the Department for Education and the Department of Health, the purpose of which is to strengthen the evidence base for the development of policies and practice to improve the protection of children in England. The studies aim to identify how children might be better safeguarded in three key areas: identification and initial response to abuse and neglect; effective interventions after abuse or its likelihood have been identified; and effective inter-agency and inter-disciplinary working. In each of these areas the research encompasses a specific focus on neglect and emotional abuse.
... Developed by National Institutes of Health researchers, Checkpoints™ complements Graduated Driver Licensing (GDL), encourages parental monitoring of teens' independent driving, and has demonstrated success in different delivery modes evaluated in several controlled trials. [4][5][6][7][8][9] Statistically significant positive effects were found in greater PTDA adoption, stricter limits on high-risk driving conditions (night, passengers, high-speed roads, bad weather), less risky driving, and fewer traffic offenses. ...
Purpose: This study evaluates the translation of CheckpointsTM, an evidence-based parent-directed intervention that encourages parents to set limits on and monitor their novice teen’s driving, for delivery via brief intervention by pediatric practitioners (PEDs) caring for teens. The brief intervention refers parents to the website “youngdriverparenting.org” and encourages them to register and use the interactive CheckpointsTM agreement and other materials.
Methods: In collaboration with Pediatric Research in Office Settings (PROS), the American Academy of Pediatrics practice-based research network, and its practitioners, study methods included developing: 1) PED intervention protocol (scripted) and materials (e.g, keychains); 2) PED recruiting plan and materials; 3) CheckpointsTM website with state-specific teen driver information; and 4) PED training plan and promotional materials. The website’s fidelity to CheckpointsTM was verified, and pilot-testing the PED intervention was completed. Recruitment resulted in 228 participating PEDs from 16 targeted states, with each PED completing IRB requirements and implementation training. Each PED delivers the two-minute intervention and distributes keychains (imprinted with youngdriverparenting.org) and other materials to 35 families who meet eligibility criteria (parents of teens ages 14-17), and completes a post-study survey. Evaluation of the translation effort involves assessing distribution and fidelity from PEDs, and dissemination (reach, exposure, exploration, and access) and implementation (initiation, adoption, and maintenance) from parents. Google Analytics software collects website traffic information.
Results: To date, 119 PEDs have completed training and are delivering interventions (41 have finished) to the required 35 families, with remaining PEDs soon to complete training and deliver interventions. A total of 2,803 parents have been reached by PEDs to date. Of 1,140 website visits, visitor engagement averaged 4.5 pages and 4.2 minutes, with a 44.6% bounce rate, results better than on comparable websites. Content/pages viewed most were teen driving risks, account registration, and state-specific teen driving laws. Twelve percent of visitors (127) registered; 119 agreements were created; and the printable agreement was accessed 266 times. Final, complete study data will be reported.
Conclusions: PEDs are willing and able to deliver a brief intervention regarding teen driving safety to parents, and encourage them to use the CheckpointsTM website. The short message from a credible professional resource gets parents to the website, where they use proven-effective resources more than they might otherwise.
Significance & Contribution: With motor vehicle crashes the leading cause of death among teens, effective prevention above and beyond graduated driver licensing is needed. Teen drivers who have parents actively engaged in monitoring their driving, are less risky drivers. Having PEDs deliver a brief intervention that guides parents to an evidence-based intervention on a website has the potential to reach many families and greatly enhance teen driver safety.
* Funded by CDC’s National Center for Injury Prevention and Control
... Parents also have the opportunity to communicate expectations that teenagers exercise safe driving judgment and establish parental management of independent driving. Teenagers of parents who set limits on their novice teenage driver report less risky driving [12]. ...
... The agreement is designed to help parents set up driving limits for their teenagers in order to safely guide them through their first months of licensure. A study by Simons-Morton et al. (2006) evaluated this program by surveying two groups of parent-teen dyads. One group was enrolled in the Checkpoints program while the other was not. ...
... For example, weakness in attentional capabilities such as in ADHD is detrimental to driving safety. Parents may be essential to monitor their adolescent drivers during the training period [122,123]. One approach to enabling parents to extend their supervisory role is the use of in-vehicle video surveillance systems that can provide parents and teen drivers with feedback about their hazardous driving practices [124,125]. ...
Motor vehicle crashes are the leading source of morbidity and mortality in adolescents in the United States and the developed world. Inadequate allocation of attention to the driving task and to driving hazards are important sources of adolescent crashes. We review major explanations for these attention failures with particular focus on the roles that brain immaturity and lack of driving experience play in causing attention problems. The review suggests that the potential for overcoming inexperience and immaturity with training to improve attention to both the driving task and hazards is substantial. Nevertheless, there are large individual differences in both attentional abilities and risky driving tendencies that pose challenges to novice driver policies. Research that can provide evidence-based direction for such policies is urgently needed.
... Figure 2 demonstrated that the overall young driver system has not been fully elucidated when examining the causes of young driver crashes. Next, a review of the literature on young driver crash countermeasures was used to populate an AcciMap (see the Provisional licence period (e.g., Scott-Parker et al., 2012a), and interrelationships such as the positive road safety outcomes associated with parent support programs such as Checkpoints (e.g., Simons-Morton et al., 2006) which can augment driver training (e.g., Stanley and Mueller, 2010) and licensing programs (Williams, 2007) suggests that a multitude of interrelationships are important in overall young driver road safety. ...
The persistent overrepresentation of young drivers in road crashes is universally recognised. A multitude of factors influencing their behaviour and safety have been identified through methods including crash analyses, simulated and naturalistic driving studies, and self-report measures. Across the globe numerous, diverse, countermeasures have been implemented; the design of the vast majority of these has been informed by a driver-centric approach. An alternative approach gaining popularity in transport safety is the systems approach which considers not only the characteristics of the individual, but also the decisions and actions of other actors within the road transport system, along with the interactions amongst them. This paper argues that for substantial improvements to be made in young driver road safety, what has been learnt from driver-centric research needs to be integrated into a systems approach, thus providing a holistic appraisal of the young driver road safety problem. Only then will more effective opportunities and avenues for intervention be realised.
... A series of studies has focused on the Checkpoints program, which uses a parent-teenager driving agreement to encourage parents to stay involved throughout the licensing process and to limit their teenagers' driving under high-risk situations. Well-controlled studies reported that Checkpoints increased parents' limit-setting and reduced teenagers' reported risky driving and traffic citations [19,20]. Zakrajsek et al. [12] report that when driver education instructors presented Checkpoints to parent-teenager dyads, teenagers reported more often using a parent-teenager driving agreement, more parent driving restrictions, and less high-risk driving during the first 6 months of licensure than control group teenagers. ...
In the United States, motor vehicle crashes are a leading cause of injury and death in adolescents. Driving is a complex task that requires integrating several cognitive processes. However, the prefrontal cortex, which is the brain area responsible for these higher-level functions, is not fully developed in adolescents. Slow development of the prefrontal cortex further contributes to teens’ impulsivity and risk-taking behavior. This chapter presents research on the risky behaviors undertaken by teen drivers, including cell phone use, peer passengers, speeding, inconsistent seat belt use, alcohol/substance use, and sleep deprivation. The chapter then outlines existing intervention efforts to reduce car crash injury and death among teens, such as graduated driver's licensing laws and regulations regarding distracted and impaired driving. Finally, the authors provide recommendations for parents and health care providers to address teen driving safety.
Background
Successful public health policies and injury prevention efforts have reduced pediatric automobile fatalities across the United States. In 2019, firearm injuries exceeded motor vehicle crashes (MVC) as the leading cause of childhood death in Colorado. We sought to determine if similar trends exist nationally and if state gun laws impact firearm injury fatality rates.
Methods
Annual pediatric (≤19 years-old) fatality rates for firearm injuries and MVCs were obtained from the CDC WONDER database (1999-2020). State gun law scores were based on the 2014-2020 Gifford's Annual Gun Law Scorecard and strength was categorized by letter grades A-F. Poisson generalized linear mixed models were used to model fatality rates. Rates were estimated for multiple timepoints and compared between grade levels.
Results
In 1999, the national pediatric fatality rate for MVCs was 248% higher than firearm injuries (Incidence Rate Ratio (IRR) 95% Confidence Interval (CI): 2.25-2.73, p<0.0001). By 2020, the fatality rate for MVCs was 16% lower than that of firearm injuries (IRR 95% CI: 0.75- 0.93, p=0.0014). For each increase in letter grade for gun law strength there was an 18% reduction in the firearm fatality rate (IRR 95%CI: 0.78-0.86, p<0.0001). States with the strongest gun laws (A) had a 55% lower firearm fatality rate compared to those with the weakest laws (F).
Conclusion
Firearm injuries are the leading cause of death in pediatric patients across the United States. State gun law strength has a significant impact on pediatric firearm injury fatality rates. New public health policies, political action, media attention and safer guns are urgently needed to curb this national crisis.
Level of Evidence/Study Type
Level III, Retrospective
In 2017, the Division of Intramural Population Health Research (DIPHR), within the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), reached a significant milestone: 50 years in existence. DIPHR celebrated this anniversary with a scientific program that reviewed past accomplishments and reflected on future directions in support of promoting the health of populations across the life course. Extending from the scientific program, the impetus of this article is to contribute to archiving and consolidating the legacy of intramural population health research at NICHD over the past 50 years. We present a brief history of the origin and evolution of intramural population health research at NICHD. Next, we conduct an empirical assessment of the scientific impact and evolving scope of this research over the past five decades and present specific key discoveries emerging from topics spanning the life course: (1) reproductive health, (2) the health of pregnant women and fetuses, (3) the health of children, and (4) associated methodologies. We also explore the Division's service to the profession in the form of mentorship of the next generation of scientists in population health research. Finally, we conclude with thoughts about future directions of population health research and reaffirm the DIPHR's commitment to promoting the health and well-being of the many populations we serve, both locally and globally.
Junge Erwachsene im Strassenverkehr sind das Thema des Vorliegenden bfu-Sicherheitsdossiers. Neben dem Unfallgeschehen der 18 bis 24-Jährigen wird auf die spezifischen Risikofaktoren sowie Präventionsmassnahmen zur Erhöhung der Sicherheit dieser Altersgruppe im Strassenverkehr eingegangen.
The important influence of the environmental context on health and health behavior—which includes place, settings, and the multiple environments within place and settings—has directed health promotion planners from a focus solely on changing individuals, toward a focus on harnessing and changing context for individual and community health promotion. Health promotion planning frameworks such as Intervention Mapping provide helpful guidance in addressing various facets of the environmental context in health intervention design, including the environmental factors that influence a given health condition or behavior, environmental agents that can influence a population’s health, and environmental change methods. In further exploring how to harness the environmental context for health promotion, we examine in this paper the concept of interweaving of health promotion into context, defined as weaving or blending together health promotion strategies, practices, programs, and policies to fit within, complement, and build from existing settings and environments. Health promotion interweaving stems from current perspectives in health intervention planning, improvement science and complex systems thinking by guiding practitioners from a conceptualization of context as a backdrop to intervention, to one that recognizes context as integral to the intervention design and to the potential to directly influence health outcomes. In exploring the general approach of health promotion interweaving, we examine selected theoretical and practice-based interweaving concepts in relation to four key environments (the policy environment, the information environment, the social/cultural/organizational environment, and the physical environment), followed by evidence-based and practice-based examples of health promotion interweaving from the literature. Interweaving of health promotion into context is a common practice for health planners in designing health promotion interventions, yet one which merits further intentionality as a specific health promotion planning design approach.
Sadly, motor vehicle crashes (MVCs) take the lives of all too many children and adolescents. The crash described above is illustrative: a teenage driver with multiple teenage passengers not wearing safety belts driving a not very safe vehicle at night. Rollover crashes tend to result in serious injuries and modern passenger vehicles are built to prevent rolling over, but the higher center of gravity of many sport utility vehicles makes them susceptible to rolling in certain types of crashes. Of course, being thrown from a vehicle is the most dangerous result of a crash, and safety belts are effective at keeping passengers in the vehicle and free from contact with cabin objects only when they are worn. Many fatalities such as these could be prevented through the combination of improved technology, strict policies, enhanced enforcement, and effective education.
The United States has a long and romantic history with vehicles and roads (Vanderbilt 2009), despite their ongoing and substantial contribution to national injury and death tolls. Because the country is geographically large and relatively wealthy, the United States has developed a greater reliance on motor vehicle transportation than any other nation, with only Australia and Canada similarly dependent on motor vehicles. Consequently, the United States leads the world in annual miles driven per driver and has one of the highest rates of injury and death due to MVCs, with more than 33,000 fatalities in 2009 (National Highway Traffic Safety Administration [NHTSA] 2010), approximately 35% of deaths for all causes.
Although much of the knowledge in transportation psychology has been gained by means of self-report measures, there is still a dispute regarding the usefulness and validity of such instruments. This series of two studies employed multivariate statistical models to examine associations between self-report and objective measures in two samples of young drivers. Study 1 (n = 151) compared scores on the Multidimensional Driving Style Inventory (MDSI), a self-report questionnaire tapping four broad driving styles, with the naturalistic driving recorded by an in-vehicle data recorder (IVDR). Study 2 (n = 80) compared responses to the Reckless Driving Habits Scale, assessing the frequency with which drivers commit a set of risky behaviors, with driving measures collected by a simulator. This study also examined the personality trait of sensation seeking, as well as gender and driving experience. In Study 1, the analysis revealed positive associations between high scores on the risky and hostile driving styles measured by the MDSI and risky behaviors measured by the IVDR, as well as inverse correlations between the latter and high MDSI scores on the anxious and careful driving styles. Similarly, in Study 2 associations were found between the self-reported frequency of reckless driving habits and several risky behaviors measured by the driving simulator. In addition, risky behaviors correlated with the sociodemographic variables and sensation seeking. The two studies therefore show that self-report measures are reliable tools for assessing driving behaviors for purposes of research, evaluation, and intervention.
Prior research suggests that greater parental involvement in the safety and learning of their young novice driver can have a positive impact on their child's safety. Safer driving agreements, which typically involve a formal statement of driving conditions and restrictions ratified by a driver and another party, most often parents, are an increasingly common initiative to enhance young novice driver safety. However, there are few formal evaluations of such initiatives and the limited available research suggests only modest differences in traffic violations, and minimal impacts on crash involvement. The current paper reports on an assessment of the potential efficacy of safer driving agreements in the Australian context, via a literature review and extensive stakeholder and community consultations. Specifically, discussions were conducted with an expert panel of United States researchers and program developers; a survey was completed with Australian police, transport and motoring stakeholders; and focus groups and surveys were completed with young drivers and parents. Overall, results suggested mixed understanding of, and support for, safer driving agreements in Australia, with issues relating to voluntary participation and accurate monitoring of behaviour cited as major barriers. Indeed, the potential effectiveness of the initiative was largely perceived as being limited to those young drivers who are already safety conscious, and as being dependent on existing strong relationships with parents (e.g., trust, honesty and respect). Implications of the study and recommendations for future research are discussed.
The overall aim of this study is to contribute to a better understanding of the importance of parents in young moped riders’ behaviour in traffic. The study consists of three parts; a literature review, a survey and an interview study. In the survey, 440 parents of teenagers (who had passed their test for mopeds) participated. In the interview study, 10 of the parents who took part in the survey were interviewed. The results from the literature review show that parents play an important role in young people’s perceptions, attitudes, norms, and behaviours associated with moped driving. Parents can also get involved in different ways to help in improving their teenagers’ knowledge and behaviour in traffic. In general, the review show that parents need support in order to be able to take control, and they also need support from other parents. The main results of the survey show that parents have great faith in the teenager when it comes to their knowledge and behaviour in traffic. In general, the results show that moped driving is not a topic being discussed very much. Some parents have implemented restrictions and the most common ones are related to alcohol and the usage of a helmet. In this study, less than ten percent wanted some form of support from others. Those who need help do not to the same extent as the others, believe that their teenager behave properly in traffic and they also believe that they are more influenced by social media. The study also found that the perception of boys and girls differ. Girls are considered to be safer on the roads but despite this, they have more restrictions placed on them than boys. Even if women value the teen’s knowledge and behaviour in traffic higher than men, they also have imposed more restrictions. In the family, women are talking more about risks in traffic than men are. The results from the interview study show that very few parents are in need of support when it comes to their children’s moped use. More detailed analyses of the interviews, however, reveals that parents would appreciate various forms of assistance, such as written information, training and/or information sessions as well as Internet-based parental forums. Implications of the current finding for the development of methods to increase parental commitment and engagement are presented.
Introduction
Driver distraction is an important contributor to crash risk. Teenage driver distraction can be influenced by the attitudes and behaviors of parents. This study examined teens' and their parents' engagement in distracting behavior while driving.
Method
Survey data were collected from a national sample of 403 parent-teen dyads using random-digit dialing telephone interviews.
Results
Results demonstrated few parent or teen sex differences in distracting behavior engagement while driving, or in their perceptions of each others' behavior. Parents and teens' frequencies of distracting behavior engagement were positively correlated. Parents' and teens' perceptions of each others' distracting behavior engagement while driving exceeded their own selfreports. Finally, the likelihood that teens reported engaging in distracting behavior while driving was more strongly associated with their perceptions of their parents' distracting behavior than by parents' self reports of their own behavior.
Conclusions
These results suggest that parents' examples of driving behavior are an important influence on teen driving behavior, but potentially more important are teens' perceptions of their parents' behaviors.
We critically reviewed recent parent-directed teen driving interventions to summarize their success in meeting stated goals; identify promising intervention components and knowledge gaps; aid in the selection, adaptation, and dissemination of effective interventions; and guide future research efforts.
We focused on interventions that included a direct parent component, explicitly stated outcomes related to the teen and/or their parents, were evaluated for parent or teen outcomes, targeted drivers younger than the age of 21 years, and had at least one evaluation study published since 1990 and in English. We conducted a comprehensive systematic search of 26 online databases between November 2013 and January 2014 and identified 34 articles representing 18 interventions.
Several interventions-in particular, those that had an active engagement component, incorporated an in-vehicle data recorder system, and had a strong conceptual approach-show promise in improving parental supervisory behaviors during the learner and early independent phases, increasing teen driver skill acquisition, and reducing teens' risky driving behaviors.
We identify essential characteristics of effective parent-involved teen driving interventions and their evaluation studies, propose a comprehensive and multitiered approach to intervention, and discuss several research areas and overarching issues for consideration.
Copyright © 2015 Society for Adolescent Health and Medicine. All rights reserved.
Traffic crashes are the leading cause of death among teens. Health care providers have an opportunity to address what works to keep teens safe on the road during the patient visit. An online survey was conducted of 1088 health care providers who saw patients at or near driving age. The survey assessed which road safety topics were discussed and which types of educational products were used most often. Family and general practice physicians represented 44.3% of the sample, followed by pediatricians (22.5%), nurse practitioners (17.6%), and internists (15.5%). Nearly all respondents (92.9%) reported addressing one or more driving safety factors (seat belt use, nighttime driving, fatigue, teen passengers, alcohol/drug use, speeding/reckless driving, and cell phone use/texting) with adolescent patients and/or their parents. Seat belt use was reported more often (83.7%) than other topics. The use of parent–teen driving agreements, a known effective intervention, was reported by less than 10% of respondents. Since health care providers expressed interest in receiving written resource materials, distribution of parent–teen driving agreements to health care providers might encourage greater uptake and use of this effective intervention.
Road traffic crashes, among the top 10 leading causes of death worldwide, are increasingly recognized as a public health priority.¹ Regardless of a country’s licensing policies, novice drivers are at increased risk for crashes.²- 4 In the United States, which allows driving at a relatively young age (14-16 years), motor vehicle crashes are the leading cause of death for teenagers. With increasing awareness of the high motor vehicle crash rates among newly licensed teenaged drivers have come interventions to prevent crashes and reduce their health burden.
Abstract— Motor vehicle accidents are the leading cause of death during adolescence, but developmentalists rarely study teen driving behavior. This article argues that developmentalists can help reduce motor vehicle accidents and deaths and that studies focusing on teen driving behavior can inform developmental theory. It reviews current research and potential contributions from developmentalists with expertise in parenting and peer relationships; identifies potential contributions from developmentalists with expertise in cognitive, affective, and psychomotor development; and discusses similarities and differences between driving behavior and other behaviors that developmentalists more commonly study.
Introduction
Les décès et blessés lors d’accidents de la route constituent un problème de santé publique dans le monde entier, en conséquence il existe un intérêt et un investissement considérables à développer des interventions pour changer le comportement des usagers de la route. En parallèle, il y a une prise de conscience croissante de la nécessité d’évaluer les interventions et d’identifier les mécanismes les plus efficaces par lesquels le comportement peut être changé. Des progrès ont été entravés par le manque de taxonomie commune avec laquelle on peut définir des techniques spécifiques utilisées pour changer le comportement.
Objectif
Les techniques de changement du comportement (TCC) ont été déployées avec succès pour modifier toute une gamme de comportements de santé différents. Cet article définit une série de TCC qui peut être appliquée dans le domaine de la sécurité routière et interroge lesquelles trouver parmi les interventions à utiliser en sécurité routière pour les jeunes usagers de la route ?
Méthode
Abraham et Michie (2008) ont identifié 26 techniques utilisées dans les interventions de changement du comportement. Ces TCC, plus une autre adaptée de la psychologie médico-légale, sont classées en neuf groupes. Six interventions éducatives de sécurité routière couramment utilisées au Royaume-Uni pour les élèves conducteurs et les jeunes conducteurs novices sont caractérisées selon les TCC employées.
Résultats
Seule une petite partie des TCC est employée dans la plupart des interventions. Elles se concentrent principalement sur l’augmentation de la prise de conscience des risques associés à un comportement particulier et de la gravité des conséquences négatives potentielles.
Conclusion
Des recommandations sont données pour améliorer l’efficience des interventions de sécurité routière pour les jeunes, y compris les jeunes conducteurs novices, par l’augmentation de l’étendue des TCC déployées.
Motor vehicle crashes, the leading cause of teen deaths in the United States, pose a major public health threat for teen drivers, their passengers, and others on the road.1 Yet only one implemented intervention has proven effective in reducing fatal teen crashes—3-stage graduated driver licensing (GDL) systems.2 Recognizing that the first 6 months of solo driving pose the highest crash risk, GDL restricts new drivers to lower risk driving situations, progressively allowing increased exposure to higher risk situations with experience. Substantial and sustained reductions in teen deaths have been realized by the states that have instituted GDL, but GDL alone is not sufficient to address the epidemic of teen crashes. Some teen drivers possess characteristics (eg, attention-deficit/hyperactivity disorder [ADHD]) and/or perform risky driving behaviors (eg, texting while driving) that could put them at heightened risk for the perfect storm, a serious crash. There is an urgent health need to build on the foundation of GDL with additional effective interventions to reduce teen driver crashes.
This study examines the effectiveness of Iowa's Driver Improvement Program (DIP) by gender and age, measured as the reduction in the number of driver convictions and crashes subsequent to the DIP. The analysis involved a random sample of 9,055 drivers who had been directed to attend DIP and corresponding data on driver convictions, crashes, and driver education training history that were provided by the Iowa Motor Vehicle Division. The sample was divided into two groups based on gender (female and male), and three groups based on age (30 years old or younger, 31 to 40 years old, and older than 40 years old). In each specific group, the sample was then divided into two groups based on the DIP outcome, satisfactory or unsatisfactory completion. The evaluation period considered was one year after the DIP date (probation period) for each driver in the random sample.
The evaluation of Iowa's DIP showed that there is evidence of effectiveness in terms of reducing driver convictions subsequent to attending the DIP. Among the 6,790 (75%) drivers who completed the course satisfactorily, 73% of drivers had no actions and 93% were not involved in a crash during the probation period. Turning to the differences by age and gender, male drivers and young drivers (30 years old or younger) incurred more convictions, while older drivers (40 years old or older) had fewer crashes in both the satisfactory and unsatisfactory groups. Drivers in the satisfactory groups had lower conviction rates but more crashes than those in the unsatisfactory group. Econometric modeling estimation results showed that, regardless of the DIP outcome, the likelihood of a conviction and frequency of subsequent convictions depends on other factors such as age, driver history, and DIP location, and interaction effects among these factors. The association rules show that DIP is not associated with a reduction in the likelihood of the occurrence of one crash after DIP. This is consistent with previous studies in which the effectiveness of DIP in reducing subsequent crashes could not be established.
Low-cost, early intervention measures are suggested to enhance the effectiveness of Iowa's DIP. These measures include advisory and warning letters (customized based on the driver's age) sent within the first year after the DIP date and soon after the end of the probation period, as well as a closer examination of DIP instruction across the 17 community colleges that host the program. Given the large number of suspended drivers who continued to drive, consideration should also be given to measures to reduce driving while suspended offenses. Other states also can benefit from this study and results.
Most unintentional deaths among 16-17 year olds are due to motor vehicle crashes; crash rates for teens are highest for novice teen drivers during the first six months and 1,000 miles after licensure. To date, no on-road research efforts have documented the initial deficits in driving skills for novice teen drivers and improvements with experience. In addition, few efforts have investigated the effects of in-vehicle tasks on driving performance for teens. To address this shortcoming, the performance of novice teen (licensed <1 month) and experienced adult drivers was investigated on a test track. Results for intersection tasks revealed that adults were more likely to stop for an amber light activated at various distances. When performing a cellular phone task while approaching an intersection, adults were more likely to notice and stop for the red light, and teens who did notice the red light were indecisive about how to respond.
The goal of this study was to examine relations among problem-driving practices and parenting practices. Three hundred adolescents licensed 2 years or less were interviewed about driving behaviors, parenting practices, and orientations toward deviance. Factors significantly related to risky driving behaviors, traffic violations, and motor vehicle crashes included lower levels of parental monitoring and control, and lenient parental restrictions on driving (i.e., friends as passengers and driving curfews). Parental monitoring was among the subset of variables most useful in predicting risky driving behaviors. Violations were 4 times more likely with lenient restrictions related to frequency of friends as passengers and 2 times more likely with low parental control. Crashes were 7 times more likely with lenient restrictions related to frequency of friends as passengers. Overall, the findings suggest that adolescent problem driving is related to parenting practices.
Eyeglance behavior and scanning patterns may be learned as a driver gains experience and lead to greater situation awareness on the part of the driver. This may help to explain differences observed in the safety records of novice teen and experienced adult drivers. For example, new drivers may focus almost exclusively on the road ahead and spend little time scanning the vehicle's mirrors. However, a novice driver performing a secondary task may spend more time with his or her eyes on the task than on the road, because of unfamiliarity with the vehicle or inexperience with consequences of long glances away from the forward view. For this study, 18 novice teen (under 17.5 years old and within 4 weeks of licensure) and 18 experienced adult drivers performed a set of in-vehicle tasks on a test track. A baseline driving segment was also included. Measures consisted of percentage of eyes-off-road (EOR) time, number of glances, and mean single-glance time. Results showed that teens glanced at the rearview mirror significantly fewer times than did adults, both during baseline driving and while performing invehicle tasks. Teens also had a significantly higher percentage of EOR time than adults had while performing a challenging reading task. The novice teen drivers spent more of their overall EOR time looking at the task display (e.g., cell phone), whereas adults used some EOR time to check mirrors or windows. Overall findings indicate that novice teens may lack the situation awareness of experienced adults.
Injuries from motor vehicle crashes are the leading cause of death among teenagers. Carrying passengers has been identified as a possible risk factor for these crashes.
To determine whether the presence of passengers is associated with an increased risk of crashes fatal to 16- and 17-year-old drivers and whether the risk varies by time of day and age and sex of drivers and passengers. DESIGN AND SETTING INCIDENCE: study of data from the Fatality Analysis Reporting System and General Estimates System (1992-1997), as well as the Nationwide Personal Transportation Survey (1995).
Drivers aged 16 and 17 years who drove passenger cars, vans, or pickup trucks.
Driver deaths per 10 million trips by number of passengers, driver age and sex, and time of day; and driver deaths per 1000 crashes by passenger age and sex.
Compared with drivers of the same age without passengers, the relative risk of death per 10 million trips was 1.39 (95% confidence interval [CI], 1.24-1.55) for 16-year-old drivers with 1 passenger, 1.86 (95% CI, 1.56-2.20) for those with 2 passengers, and 2.82 (95% CI, 2.27-3.50) for those with 3 or more passengers. The relative risk of death was 1.48 (95% CI, 1.35-1.62) for 17-year-old drivers with 1 passenger, 2.58 (95% CI, 2.24-2.95) for those with 2 passengers, and 3.07 (95% CI, 2.50-3.77) for those with 3 or more passengers. The risk of death increased significantly for drivers transporting passengers irrespective of the time of day or sex of the driver, although male drivers were at greater risk. Driver deaths per 1000 crashes increased for 16- and 17-year-olds transporting male passengers or passengers younger than 30 years.
Our data indicate that the risk of fatal injury for a 16- or 17-year-old driver increases with the number of passengers. This result supports inclusion of restrictions on carrying passengers in graduated licensing systems for young drivers.
The increased crash risk of young, beginning drivers has long been cause for concern. Graduated licensing systems, which seek to phase in driving experience gradually over time, have recently been adopted by many states in an effort to reduce these risks. In an attempt to define the basic rationale for graduated licensing, relevant research evidence that describes the conditions under which risk is known to be increased for young drivers was reviewed. Potential changes in licensing laws that best address these known risk factors are described. It was found that certain situations contribute to even greater crash risk, most notably nighttime driving and driving with passengers in the peer group. The underlying premise for graduated licensing is that while crash risk of young drivers is heightened under all situations, some situations are more or less risky than others. If experience can be gained initially under lower risk conditions, both in the learning stage and when first licensed, crash risk will be reduced.
The purpose of this study was to determine the extent to which effects of exposure to a brief intervention designed to increase parental restrictions on teen driving privileges persisted over time.
A total of 658 parents and their 16 year old adolescents were recruited from a local motor vehicle administration (MVA) site as adolescents successfully tested for provisional licenses. At the MVA, parents completed written surveys about expected teen driving during the first month of provisional licensure. Afterwards, on weeks assigned as intervention, parents watched a video and were given the video and a driving agreement to take home. Both parents and teens completed follow up telephone interviews about communication, amounts, and limits on teen driving at one month (579 dyads), four months (529 dyads), and nine months (528 dyads).
The results indicated that both intervention parents and teens were much more likely to report using a driving agreement at each follow up during the nine month period. Significant treatment group differences persisted for communication about driving, but effects related to limits on teen driving that were evident at one month declined over time. Reports for passenger, road, and overall limits remained significant at four months; fewer were present at nine months. There were no differences in amounts of teen driving at four or nine months.
It is possible to reach parents through brief interventions at the MVA and successfully promote increases in initial parental restrictions on teen driving with modest persistence for at least four months.
We describe intervention effects on parent limits on novice teenage driving.
We recruited parents and their 16-year-old children (n = 469) with learner's permits and randomized them from August 2000 to March 2003. Intervention families received persuasive newsletters related to high-risk teenage driving and a parent-teenager driving agreement; comparison families received standard information on driver safety. We conducted interviews when the adolescents obtained a learner's permit, upon licensure, and at 3, 6, and 12 months postlicensure.
Intervention parents and teenagers reported stricter limits on teen driving compared with the comparison group at 12 months, with direct effects through 3 months and indirect effects through 12 months postlicensure.
A simple behavioral intervention was efficacious in increasing parental restriction of high-risk teen driving conditions among newly licensed drivers.
Volume 2 discusses the relationship between patient and caregiver in terms of structural and interactional determinants. The impact of provider characteristics on "compliance" and "adherence" is given especially noteworthy treatment. Each volume features extensive supplementary and integrative material prepared by the editor, the detailed index to the entire four-volume set, and a glossary of health behavior terminology.
Students in 75 high schools in seven states participated in a questionnaire survey. The results showed that high school students want to become licensed as soon as possible and that parents are important in teaching them to drive. Once licensed, the majority of students have their own cars, though they do not typically pay the majority of the costs. Seventy-one percent of licensed students who do not have their own cars reported that they can usually or always use a family car. Most students, particularly younger ones and females, reported that their parents expect them to conform to certain rules or restrictions when driving and when riding as passengers. The most common restrictions were that their parents asked them not to drive after drinking, to tell parents where they were going and with whom, and to be home at a certain time. Students were far less likely to report that their parents required that they wear seat belts.
This report describes intervention effects on parent-imposed driving limits on novice young drivers at licensure. Parent-adolescent dyads (4,344) completed baseline surveys at permit and were randomly assigned to intervention or comparison groups. Intervention families received persuasive communications related to protection motivation theory variables including threat appraisal regarding high-risk adolescent driving and coping appraisal regarding restrictions on high-risk driving conditions during the early months of adolescent licensure. Comparison families received standard information on driving, vehicles, and road safety. Among the 4,344 families, 3,786 adolescents obtained licenses, and 3,398 parent-adolescent dyads completed surveys at licensure. Significant treatment group differences favoring the Checkpoints Program were found at licensure for driving limits, perceived risk, expected limits, and outcome expectations. Perceived risk and outcome expectations partially mediated and expected limits fully mediated treatment effects. The results provide evidence that persuasive materials can alter threat and coping appraisal and expectations, thereby increasing parent-imposed driving limits at licensure.
As drivers become more experienced many changes have been observed in their patterns of visual search. Differences between novice and experienced drivers are particularly marked in demanding or hazardous road situations and this has led researchers to speculate that limitations in search patterns may explain some of the accidents where newly qualified drivers are involved. This paper reports a training intervention that informs novice drivers about their typical patterns of visual search and stresses the need for scanning multiple locations in the visual scene for sources of potential danger. Two groups of drivers were evaluated on three occasions over the course of their first year after gaining a full driving licence. The evaluations involved recording drivers' eye movements while driving a route on real roads in traffic, and while watching videos of hazardous situations. One of the groups received the training intervention before the second occasion of testing. The intervention produced notable changes in the drivers' search patterns in both situations though not all changes were still detectable at a final phase of testing three to six months after the intervention had been delivered.
Context Injuries from motor vehicle crashes are the leading cause of death among
teenagers. Carrying passengers has been identified as a possible risk factor
for these crashes.Objective To determine whether the presence of passengers is associated with an
increased risk of crashes fatal to 16- and 17-year-old drivers and whether
the risk varies by time of day and age and sex of drivers and passengers.Design and Setting Incidence study of data from the Fatality Analysis Reporting System
and General Estimates System (1992-1997), as well as the Nationwide Personal
Transportation Survey (1995).Subjects Drivers aged 16 and 17 years who drove passenger cars, vans, or pickup
trucks.Main Outcome Measure Driver deaths per 10 million trips by number of passengers, driver age
and sex, and time of day; and driver deaths per 1000 crashes by passenger
age and sex.Results Compared with drivers of the same age without passengers, the relative
risk of death per 10 million trips was 1.39 (95% confidence interval [CI],
1.24-1.55) for 16-year-old drivers with 1 passenger, 1.86 (95% CI, 1.56-2.20)
for those with 2 passengers, and 2.82 (95% CI, 2.27-3.50) for those with 3
or more passengers. The relative risk of death was 1.48 (95% CI, 1.35-1.62)
for 17-year-old drivers with 1 passenger, 2.58 (95% CI, 2.24-2.95) for those
with 2 passengers, and 3.07 (95% CI, 2.50-3.77) for those with 3 or more passengers.
The risk of death increased significantly for drivers transporting passengers
irrespective of the time of day or sex of the driver, although male drivers
were at greater risk. Driver deaths per 1000 crashes increased for 16- and
17-year-olds transporting male passengers or passengers younger than 30 years.Conclusion Our data indicate that the risk of fatal injury for a 16- or 17-year-old
driver increases with the number of passengers. This result supports inclusion
of restrictions on carrying passengers in graduated licensing systems for
young drivers.
Motor vehicle crashes (MVCs) are the leading cause of injury and death among adolescents 16 to 19 years of age. Three areas of countermeasures for decreasing young driver risk are driver education, licensing policies, and parental management. Driver education is an essential part of teaching adolescents the rules of the road and operating a vehicle; however, it has not proven to prevent MVCs among young drivers. Graduated Driver Licensing (GDL) is a policy innovation accepted widely in the U. S. that delays licensure and restricts driving among novices under the most dangerous conditions. GDL programs have effectively reduced motor vehicle crashes where adopted; however, adoption and effectiveness of these policies vary. Parental management of teen driving has not been systematically studied until recently and may be an important part of reducing teen driving risk. Research indicates that parents place modest restrictions on their teens' driving and that restrictions are related to fewer risky driving behaviors, tickets, and MVCs. The Checkpoints Program aims to increase parental management of teen driving and has been shown to do so in short-term follow-ups in several randomized trials. Each countermeasure is important to teen safety and may need improvements; however, the greatest protection against MVCs among young drivers would be to provide better integration among, and wider implementation of, countermeasures. (Contains 2 tables.)
Parents of 15 year-olds in Florida and Connecticut were first interviewed in 1996 about their views concerning new licensing requirements in their states. Connecticut had introduced a 6-month learner's permit requirement, effectively increasing the licensing age from 16 years to 16 years, 6 months (16 years, 4 months with driver education). Florida enacted a 6-month learner's permit period plus a night driving restriction for 16 and 17 year-olds. In 1996, parents were very supportive of the new requirements, particularly the minimum permit period and nighttime restrictions, even though they recognized they would be inconvenienced to some extent. The same parents were interviewed again in 1999, after most of their teenagers had obtained driver's licenses, and were even more supportive than before of the additional restrictions. Few parents reported that the laws inconvenienced them, and less than 20 percent said the laws had made it harder for their teenagers to get jobs. Furthermore, many were in favor of additional requirements, such as teenage passenger restrictions, not currently part of their states” laws. These findings should encourage other states to proceed with graduated licensing systems or to augment systems already in place.
Protection motivation theory is one formulation of the effects of threatening health information on attitude and behavior change. This chapter provides an updated description of protection motivation theory, reviews the research of the past 15 yrs, and poses questions for future research. This description represents a revision of protection motivation theory by examining one theory of how health threat information can persuade people to adopt a health communicator's recommendations. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Motor vehicle crashes are the leading cause of death and injury to teenagers. Crash risks result from their age, inexperience, and risky driving. The purpose of this study was to determine whether parent-imposed delayed licensure and restricted driving are related to fewer teenage risky driving behaviors. At baseline, 275 teenagers with a learner's permit and one of their parents were interviewed about driving attitudes and teenage behaviors. One year later, 161 of the teenagers had since obtained a provisional license and were reinterviewed about time of licensure, parental restrictions on driving, and driving attitudes and behaviors. The results indicated that parents delayed licensure until teens were ready, and limited their driving in terms of trip and risk conditions. Higher levels of risky driving behaviors were predicted by younger ages at licensure and fewer limits on driving in the first month, in addition to male gender, higher conflict over driving, lower perceptions of dangers related to driving, more problem behaviors at baseline, and more high-risk driving (e.g., at night, teenage passengers). Overall, the results indicate that a combination of being older at licensure and restricting driving under high-risk conditions at licensure may be an effective way to curb teens' risky driving behaviors.
This paper provides new insight into the situational risks of young drivers, especially in terms of the passenger effect. Two 1988 data bases from the Ontario Ministry of Transportation were used to estimate accident involvement rates by number of passengers, time of day and day of the week--first individually and then for all two-way combinations with the passenger variable. Accident data were derived from police reports for all accidents involving a fatality, personal injury or property damage exceeding $700. Estimates of exposure were based on the most up-to-date provincial travel survey available at the time of the study. Results indicate that the accident involvement rates of 16-19 year old drivers are higher than those of 20-24 and 25-59 year olds in all situations that were examined, but that they were disproportionately high on weekends, at nighttime and with passengers. The results of the passenger variable are particularly interesting because, unlike weekends and nighttime, the negative effect of passengers on overall accident rates was evident only for 16-19 year old drivers. This effect was quite pronounced for both sexes, with accident involvement rates being approximately twice as high with passengers as without. For 16-19 year olds, accident rates were also significantly higher for two or more passengers versus one passenger. The highest rates for this age group occurred with passengers at nighttime. Possible explanations for these patterns and policy implications are discussed.
Fatal crash-involved drivers of passenger vehicles were identified in the Fatality Analysis Reporting System for the period 1990 through 1995. Each driver was categorized as being alone in the vehicle at the time of the crash or with one or more passengers. Drivers at fault or responsible for crash occurrence were defined as all drivers involved in a single-vehicle crash, or drivers in multiple-vehicle crashes who were coded in the Fatality Analysis Reporting System as committing one or more driver errors. The results indicated that passenger presence was associated with proportionately more at-fault fatal crashes for drivers aged 24 and younger, were a neutral factor for drivers aged 25-29, and were associated with fewer at-fault involvements for drivers aged 30 and older. Relative risk of fatal crash involvement was particularly high for teenage drivers traveling, day or night, with two or more teenage passengers. Additional research is needed to determine how the added risk associated with teenage passengers riding with teenage drivers can be reduced or eliminated.
To re-examine and refine estimates for alcohol-related relative risk of driver involvement in fatal crashes by age and gender as a function of blood alcohol concentration (BAC) using recent data.
Logistic regression was used to estimate age/gender specific relative risk of fatal crash involvement as a function of the BAC for drivers involved in a fatal crash and for drivers fatally injured in a crash, by combining crash data from the Fatality Analysis Reporting System with exposure data from the 1996 National Roadside Survey of Drivers.
In general, the relative risk of involvement in a fatal vehicle crash increased steadily with increasing driver BAC in every age/gender group among both fatally injured and surviving drivers. Among 16-20 year old male drivers, a BAC increase of 0.02% was estimated to more than double the relative risk of fatal single-vehicle crash injury. At the midpoint of the 0.08% - 0.10% BAC range, the relative risk of a fatal single-vehicle crash injury varied between 11.4 (drivers 35 and older) and 51.9 (male drivers, 16-20). With only very few exceptions, older drivers had lower risk of being fatally injured in a single-vehicle crash than younger drivers, as did women compared with men in the same age range. When comparable, results largely confirmed existing prior estimates.
This is the first study that systematically estimated relative risk for drink-drivers with BACs between 0.08% and 0.10% (these relative risk estimates apply to BAC range midpoints at 0.09%.) The results clearly show that drivers with a BAC under 0.10% pose highly elevated risk both to themselves and to other road users. 2000)
Parent-teen driving agreements are potentially important tools to facilitate parental management of teen driving and reduce adolescent driving risk. The Checkpoints Parent-Teen Driving Agreement (Checkpoints P-TDA) was designed so that parents could initially impose strict limitations on teen driving in high-risk driving conditions (e.g., at night and with teen passengers) and gradually increase driving privileges over time as teens demonstrate responsible driving behavior.
To assess the acceptability of the format and content of the Checkpoints P-TDA, it was pilot tested with a convenience sample of 47 families recruited as their teens tested for a driver's license at five private driving schools in Connecticut. Family members were interviewed at the driving schools about potential limits on teen driving, asked to use the driving agreement, and re-interviewed within 3 months about acceptability of the driving agreement and initial driving limits placed on teens.
Most families (38 of 47) used and liked the agreement. In addition, most parents placed the recommended strict initial limits on teen driving related to driving unsupervised at night, with teen passengers, and on high-speed roads. Moreover, parents reported placing more strict limits on their teens' driving than they originally intended.
The results showed promise for the acceptability of the Checkpoints P-TDA, which will be tested statewide.
This study examined relations between risky driving, parenting, and deviance, and the stability of risky driving over time. Two hundred and sixty-one licensed adolescents completed telephone interviews about risky driving, parenting practices, and orientations toward deviance at baseline and about risky driving at follow-up 3 months later. The results indicated that risky driving at follow-up was predicted by risky driving at baseline, parental restrictions on driving, and sensation seeking. In addition, risky driving was stable within 80% of teens. When compared with adolescents with low risky driving over time (n = 129), adolescents with high risky driving over time (n = 79) were 3 times more likely to report low parental monitoring, 2 times more likely to report low parental restrictions, and almost 5 times more likely to report high deviance acceptance. The results suggest that high levels of risky driving are related to parenting.
Seventeen states enacted graduated driver licensing (GDL) programs that were implemented from 1996 through 1999 and for which evaluations are of interest.
We received evaluation results reported for six states for which data were available. Summarizing results is difficult in other than the most global terms because of differences in pre-GDL programs, differences in GDL programs, and differences in evaluation methodology.
All states identified some crash reduction among teen drivers following GDL implementation. This positive effect was observed across different geographic regions, and with different GDL programs. Simple counts are down-fewer teens are experiencing crashes and becoming injured. After calculating crash rates to adjust for changes over time in populations or licensed drivers, reductions generally were still found. Population-adjusted risks of injury/fatal crash involvement of 16-year-old drivers in Florida and Michigan were reduced by 11% and 24%, respectively. Population-adjusted risks of any crash involvement of 16-year-old drivers in Michigan and North Carolina were reduced by 25% and 27%, respectively. Reductions in night (restricted hours) crash risk were impressive in Florida, Michigan, and North Carolina. A comparison state design was only possible in the Florida evaluation, and results showed greater crash reductions under GDL. Change-point analyses of Michigan's crash data trends over time provided additional support of GDL's effectiveness in reducing crashes.
Taken as a whole, and including the preliminary findings from California, Ohio, and Pennsylvania, these reports demonstrate the early effectiveness of GDL in reducing the crash risk of teen drivers. The impact of these studies and others to come will guide future research, practice, and policy.
To determine patterns of risk among teenage drivers.
Review and synthesis of the literature.
On most measures, crash rates during the teenage years are higher than at any other age, for both males and females. Risk among teenagers varies greatly by driving situation; it is particularly low in some situations (e.g., the learner period) and particularly high in others (e.g., right after licensure, late at night, with passengers present). In some of these high-risk driving situations, risk is elevated for drivers of all ages (e.g., late night driving), in others risk is elevated more for teens than adults (e.g., driving after consuming alcohol), and in others the risk is unique to teen drivers (e.g., having passengers).
These varying patterns of risk form the basis for graduated licensing systems, which are designed to promote low-risk and discourage high-risk driving.
Teenagers were surveyed by telephone every 6 months from their freshman to senior high school years (N=911). Self-reported crash involvements and citations were examined for each teenager's first year of licensure and first 3500 miles driven. Based on survival analysis, the risk of a first crash during the first month of licensure (0.053) was substantially higher than during any of the next 11 months (mean risk per month: 0.025). The likelihood of a first citation during the first month of licensure (0.023) also was higher than during any of the subsequent 11 months (mean risk per month: 0.012). Similarly, when viewed as a function of cumulative miles driven, the risk of a first crash or citation was highest during the first 500 miles driven after licensure. Fewer parental restrictions (e.g. no nighttime curfew) and a lower grade point average (GPA) were associated with a higher crash risk. Male gender, a lower GPA and living in a rural area were associated with a higher citation rate.
As a group, young drivers have crash rates that far exceed those of older, experienced drivers. But even among teenagers there are age-related differences; crash rates decline consistently and dramatically with each yearly increase in age. A more precise understanding of how crash rates decline within the teenage group might provide insights into when experience is most influential. To address this issue, this study examines month-to-month changes in collisions among new drivers. It was found that crash rates drop most dramatically during the first 6 months of driving. Involvement in certain types of crashes-e.g. run-off-the-road, single-vehicle, night, weekend-declines more rapidly. The findings suggest that novices improve their driving in a relatively short period of time. A graduated driver licensing system is identified as an effective method for ensuring that this development takes place in a more forgiving environment.
This report presents injury mortality data for 2001 using the external cause of injury mortality matrix for the International Classification of Diseases, Tenth Revision (ICD-10), a detailed and comprehensive framework for tabulating and presenting injury deaths by mechanism and intent of death. Data are presented by age, sex, race, Hispanic origin, and State. This report also presents data on injury deaths classified according to the nature of the injury sustained. Deaths resulting from the terrorist attacks on September 11, 2001, are presented and the impact of these deaths on the trends in injury mortality is discussed. This report supplements the annual report of final mortality statistics.
Data in this report are based on information from all death certificates filed in the 50 States and the District of Columbia in 2001. Causes of death and nature of injury are processed and coded in accordance with the ICD-10.
In 2001, 157,078 resident deaths occurred as the result of injuries. Of these injury deaths, 64.6 percent were classified as unintentional, 19.5 percent were suicides, 12.9 percent were homicides, 2.7 percent were of undetermined intent, and 0.3 percent involved legal intervention or operations of war. The five leading mechanisms of injury death were motor vehicle traffic, firearm, poisoning, falls, and suffocation, accounting for 78 percent of all injury deaths. A head injury was mentioned in 32 percent of injury deaths and was the most commonly mentioned injury condition resulting in death. Poisoning and toxic effects were the second most common, mentioned in 16 percent of injury deaths and were the underlying cause of 14 percent of injury deaths. In 2001, 36,753 deaths (1.6 percent of deaths) had a natural underlying cause of death but included one or more mentions of an external cause on the death certificate.
Injury mortality data presented in this report using the external cause of injury mortality matrix for ICD-10 provide detail on the mechanism of death needed for research and other activities related to injury prevention. This report also highlights the importance of multiple causes of death when analyzing injury mortality data. The Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS) is involved in several ongoing projects related to the study of injury and injury mortality.
With a growing interest in increasing parental involvement in teen driving, it is important to find out what parents are already doing.
This study assessed the content, delivery, rigidity, and consequences of 143 driving rules reported by 24 parent-teen dyads.
Strengths included that driving rules covered the full range of concerns, especially night driving limits and passenger limits, and most parents and teens reported that violations would be followed by consequences, especially talk/warn or no driving. Weaknesses included that many rules were not very strict and only half showed parent-teen agreement on content.
These findings suggest that teen driving rules are not clearly defined.
Cognitive mediation of treatment group effects on teen driving limits at licensure
- B G Simons-Morton
- J L Hartos
- W A Leaf
- D Preusser
Simons-Morton, B.G., Hartos, J.L., Leaf, W.A., Preusser, D., 2006. Cognitive
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Deaths: injuries, 2001. Center for disease control and prevention
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Recommendations for an ideal graduated licensing law. Status Rep Fatality Reduction by Safety Belts for Front-Seat Occu-pants of Cars and Light Trucks. National Highway Traffic Safety Admin-istration Changes in collision rates among novice drivers during the first months of driving
- Kahane
Insurance Institute for Highway Safety (IIHS), 1999. Recommendations for an ideal graduated licensing law. Status Rep. 34, 6. Kahane, C.J., 2000. Fatality Reduction by Safety Belts for Front-Seat Occu-pants of Cars and Light Trucks. National Highway Traffic Safety Admin-istration, Washington, DC. Mayhew, D.R., Simpson, H.M., Pak, A., 2003. Changes in collision rates among novice drivers during the first months of driving. Accid. Anal. Prev. 35 (5), 683–691.
Center for disease control and prevention
- R N Anderson
- A M Miniño
- L A Fingerhut
- M Warner
- M A Heinen
Anderson, R.N., Miniño, A.M., Fingerhut, L.A., Warner, M., Heinen, M.A.,
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Natl. Vital Stat. Rep. 52 (21), 1-87.
Fatality Reduction by Safety Belts for Front-Seat Occupants of Cars and Light Trucks
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Kahane, C.J., 2000. Fatality Reduction by Safety Belts for Front-Seat Occupants of Cars and Light Trucks. National Highway Traffic Safety Administration, Washington, DC.
Deaths: injuries, 2001. Center for disease control and prevention
- Anderson
Cognitive mediation of treatment group effects on teen driving limits at licensure
- Simons-Morton