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

Adult-supervised practice in learner's permit phase has a significant but limited ability to improve safe driving skills

OBJECTIVES

Most U.S. states require adult-supervised practice for adolescent learner permit holders intending to obtain a driver's license before 18. However, the effectiveness of adult-supervised practice in imparting safe driving skills had been inconclusive prior to the recent development of consistent measures of adolescent learners' driving performance. We examined the relationship between the number of adult-supervised practice hours and driving performance and skill deficits for 441 learner permit holders ages 16 and 17 in Pennsylvania.

METHODS

Data came from a virtual driving assessment (VDA) deployed across Children's Hospital of Philadelphia's Primary Care Network and a self-reported survey at the time of the VDA. Based on a previous study, we defined two VDA Driving Classes that describe driving performance: Major Issues or Major Issues with Dangerous Behavior Class, and Minor Issues or No Issues Class. The response options for adult-supervised practice hours were presented to adolescents as categories (none, <15 h, 15-<65 h, 65 h, and >65 h). We grouped those with 65 h with those with >65 h given the low numbers of responses in these categories. The analysis used a Chi-square test and a binomial logit to investigate how adult-supervised practice hours correspond to adolescents' VDA Driving Classes.

RESULTS

Chi-square test showed weak associations between VDA Driving Classes and adult-supervised practice hours. The binomial logit found that adolescents who reported zero adult-supervised practice hours were more likely to be classified into the Major Issues or Major Issues with Dangerous Behavior Class than those who reported adult-supervised practice hours. For those who reported adult-supervised practice, the differences in VDA Driving Class were not statistically significant across the three practice categories (i.e., <15 h, 15-<65 h, and ≥ 65 h). The model found no significant associations between VDA Driving Class and whether adolescent learners reported practicing with a formal instructor.

CONCLUSIONS

Our findings suggest that under current adult-supervised practice routines, longer practice hours have limited associations with improvements in adolescents' VDA Driving Class. Some adolescents might not be ready to deal with the more dangerous settings the VDA presents even after completing the required hours of adult-supervised practice.

Factors Influencing Participation and Engagement in a Teen Safe Driving Intervention: A Qualitative Study

(1) Background: Few teen driving safety programs focus on increasing parental engagement with high-risk teen drivers, specifically those with a traffic violation. This study explored parents'/guardians' ('parents') experiences with a teen driving safety program, ProjectDRIVE, including facilitators and barriers to program engagement. (2) Methods: We conducted virtual, semi-structured interviews with parents who completed ProjectDRIVE, which included in-vehicle driving feedback technology and individualized virtual training with parents on effective parent-teen communication. (3) Results: Twenty interviews (with 17 females and three males) were transcribed verbatim and independently coded by three coders using systematic, open, and focused coding. Three major themes were identified: factors influencing a parent's initial decision to participate, factors influencing continued engagement, and perceived benefits of participation. The decision to participate was influenced by these subthemes: parental motivation to help their teen, perceived program usefulness, program endorsement, program incentives, parents' busy schedules, and lack of access to a car/internet. Subthemes impacting continued engagement included enhanced communication skills, teen willingness to engage, strong parental engagement, and teens' other priorities. Perceived benefits included greater self-efficacy in communication, improved communication patterns and frequency, and enhanced parent-teen relationships. (4) Conclusions: These findings may set the foundation for developing and implementing future court-ordered parent-based teen safe driving programs for teens with traffic citations.

Assessing the effectiveness of psychoeducational interventions on driving behavior: A systematic review and meta-analysis

This review aimed to quantitatively summarize the evidence concerning the effectiveness of psychoeducational interventions on driving behavior. A final pool of 138 studies, totaling approximately 97,000 participants, was included in the analyses and covered all types of driving behavior targeted by the interventions. Using a random effects model, significant results were found for almost all driving outcomes, both post-intervention and long-term. The strongest effect was for reducing distracted driving at post-intervention (d = 1.87 [1.12, 2.60], Z = 4.94, p < 0.001). The only non-significant effects were for reducing errors in the long term (d = 0.50 [-0.87, 1.86], Z = 0.71, p = 0.48) and driving under the influence at post-intervention (d = 0.35 [0.00, 0.71], Z = 1.96, p = 0.05). Concerning which type of intervention was more effective, feedback, training and motivational ones appear to work best. Educational interventions show only weak effects, while awareness interventions seem mostly ineffective. Overall, our results show that most interventions can reduce different types of driving behaviors, but there are specific aspects to be considered based on the targeted behavior.

Young drivers' early access to their own car and crash risk into early adulthood: Findings from the DRIVE study

INTRODUCTION

Car ownership at early licensure for young drivers has been identified as a crash risk factor, but for how long this risk persists is unknown. This study examined crash hazard rates between young drivers with their own vehicle and those who shared a family vehicle at early licensure over 13 years.

METHODS

The DRIVE study, a 2003/04 survey of 20,806 young novice drivers in New South Wales, Australia was used to link to police crash, hospital and death records up to 2016. The first police-reported crash and crash resulting in hospitalisation/death was modelled via flexible parametric survival analysis by type of vehicle access at baseline (own vs. shared family vehicle).

RESULTS

After adjusting for covariates, drivers with their own vehicle at early licensure had an almost 30 % increased hazard rate for any crash after one year (95 % CI:1.16-1.42) compared with those who only had access to a family car and this attenuated but remained significantly higher until year 7 (HR: 1.1, 95 % CI: >1.00-1.20). For crashes resulting in hospitalisation or death, an almost 15-times higher hazard (95 % CI: 1.40-158.17) was observed at the start of follow up, remaining 50 % to year 3 (95 % CI:1.01-2.18).

CONCLUSIONS

Parents and young drivers should be aware of the increased risks involved in car ownership at early licensure. Development of poorer driving habits has been associated with less parental monitoring at this time. Graduated Driving Licensing educators, researchers and stakeholders should seek to address this and to identify improved safety management options.

Real-world crash configurations and traffic violations among newly licensed young drivers with different route familiarity levels

OBJECTIVE

Young drivers aged 24 and below are at heightened risks of being influenced by their route familiarity levels. This study aims to compare prevalences of crash culpability, crash configurations and risky driver behaviors among newly licensed young drivers when they are driving on roads with different route familiarity levels.

METHODS

Based on the road traffic crash and violation data in Yunnan Province of China from January 2017 through December 2019, we classified drivers' different route familiarity levels by utilizing spatial distance away from residence-based method, including driving on high route familiarity (HRF) and low route familiarity (LRF) roads. Prevalence ratios were estimated using generalized estimating equation log-binomial regression models.

RESULTS

We identified 12016 newly licensed young drivers driving on HRF roads and 2189 drivers on LRF roads. Within 48 months of licensure, young drivers on LRF roads were more likely to be at fault for their motor vehicle crashes than those on HRF roads. Young drivers on LRF roads were more likely to be with failure to obey traffic control device, with failure to yield right of way, wrong way driving, backing unsafely and improper parking compared with those on HRF roads. Drivers on LRF roads were less likely to be inattentive and driving with unsafe speed and following too closely compared with those on HRF roads.

CONCLUSIONS

Several basic aspects of targeted countermeasures can be put forward. Visual impacts such as rectangular rapid-flashing beacon (RRFB) can be used in order to prevent wrong way driving on the tourist roadways. Arranging safety talks and programs in colleges and universities and technical interventions like Advanced Driver Assistance Systems (ADAS) can be used to reduce young drivers' driving distraction and overconfidence. It is recommended that the driving schools can use these research findings to include in licensure program to make young drivers more aware of the various factors that expose them to crash risks so that more defensive driving may be needed under different situations, and this can also help build the graduated driving licensure (GDL) programme in China.

ProjectDRIVE: study protocol for a randomized controlled trial to improve driving practices of high-risk teen drivers with a traffic violation

BACKGROUND

Teen drivers with a traffic violation are at increased risk for crashes and crash-related injuries; however, most parent-focused interventions target teen drivers with supervised learner's permits. Very few interventions are implemented at the probationary driver's license stage or target high-risk teen drivers, such as those with traffic violations. This paper describes the protocol of ProjectDRIVE, A Randomized Controlled Trial to Improve Driving Practices of High-Risk Teen Drivers with a Traffic Violation, which targets improving parent-teen communication about safe driving practices to reduce unsafe driving behaviors and traffic violation recidivism of teen drivers cited for traffic violation.

METHODS

Teen drivers (ages 16 or 17) cited for a moving violation and the parent/legal guardian most involved with the teen's driving are recruited from juvenile traffic courts following their required court hearing. After completing informed consent/assent, enrolled dyads are randomized into one of three groups using stratified block randomization: control, device feedback only, or device feedback plus parent communication training. Participating dyads are followed for 6 months with 3 months of active intervention. Using in-vehicle device and smartphone application technology, the study provides real-time and cumulative driving feedback to intervention teens and collects continually recorded, objectively measured driving outcome data throughout the teen's study participation. Primary outcomes include rates of risky driving events and unsafe driving behaviors per 1000 miles driven. Secondary outcomes include traffic violation recidivism up to 12 months following study completion and frequency and quality of parent-teen communication about safe driving practices.

DISCUSSION

Through partnership with the local juvenile traffic courts, this study integrates recruitment and randomization into existing court practices. Successfully completing this study will significantly impact juvenile traffic court's practices and policies by informing judges' decisions regarding the driving safety programs they refer to teens to prevent motor vehicle crashes and crash-related injuries and deaths. Trial registration The study was registered on ClinicalTrials.gov Registry (NCT04317664) on March 19, 2020, https://clinicaltrials.gov/study/NCT04317664 and updated on April 27, 2021. This protocol was developed per the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) Checklist.

Learning With a Supervisor Who has Traffic Offences and Young Driver Crashes: The DRIVE Study 13-Year Follow-Up

PURPOSE

Young learner drivers commonly must record substantial supervised practice driving before independent licensure. Supervisory driver requirements can be limited or highly regulated, yet research is lacking on the effectiveness of different approaches. The current objective was to explore whether young drivers who were mostly supervised by someone who they perceived had traffic offences versus no offences had different crash records over a period of 13 years postlicensing.

METHODS

DRIVE is an Australian prospective cohort study of more than 20,000 drivers who were aged 17-24 years and newly licensed during 2003-2004. They completed detailed baseline questionnaires, including whether the person they identified as supervising their learner driving the most had perceived traffic offences in the past 12 months. Responses were linked to their state crash, hospitalization, and death records to 2016. A parametric survival model was created to calculate hazard ratios of time to crash for those reporting that their supervisor had 0 versus 1 and 0 versus 2+ perceived offences, adjusting for the participants' prior crash history and other covariates.

RESULTS

After adjusting for covariates, 369 participants reporting supervisory drivers with 2+ perceived offences, compared to 15,451 participants reporting no such offences, had up to 1.67 (95% confidence interval 1.10-2.53 at 6 months) times the rate of any crash for the first 2.5 years and up to 2.01 (95% confidence interval 1.26-3.19 at 3.5 years) times the rate of crashes resulting in injury for 5.5 years.

DISCUSSION

Although overall supervision by a driver with two or more perceived offences was low, further attention is needed to ensure improved supervised driving experiences, with mentoring programs and professional instructor partnerships worthy of exploration.

Promoting transportation safety in adolescence: the drivingly randomized controlled trial

BACKGROUND

The impact of young drivers' motor vehicle crashes (MVC) is substantial, with young drivers constituting only 14% of the US population, but contributing to 30% of all fatal and nonfatal injuries due to MVCs and 35% ($25 billion) of the all medical and lost productivity costs. The current best-practice policy approach, Graduated Driver Licensing (GDL) programs, are effective primarily by delaying licensure and restricting crash opportunity. There is a critical need for interventions that target families to complement GDL. Consequently, we will determine if a comprehensive parent-teen intervention, the Drivingly Program, reduces teens' risk for a police-reported MVC in the first 12 months of licensure. Drivingly is based on strong preliminary data and targets multiple risk and protective factors by delivering intervention content to teens, and their parents, at the learner and early independent licensing phases.

METHODS

Eligible participants are aged 16-17.33 years of age, have a learner's permit in Pennsylvania, have practiced no more than 10 h, and have at least one parent/caregiver supervising. Participants are recruited from the general community and through the Children's Hospital of Philadelphia's Recruitment Enhancement Core. Teen-parent dyads are randomized 1:1 to Drivingly or usual practice control group. Drivingly participants receive access to an online curriculum which has 16 lessons for parents and 13 for teens and an online logbook; website usage is tracked. Parents receive two, brief, psychoeducational sessions with a trained health coach and teens receive an on-road driving intervention and feedback session after 4.5 months in the study and access to DriverZed, the AAA Foundation's online hazard training program. Teens complete surveys at baseline, 3 months post-baseline, at licensure, 3months post-licensure, 6 months post-licensure, and 12 months post-licensure. Parents complete surveys at baseline, 3 months post-baseline, and at teen licensure. The primary end-point is police-reported MVCs within the first 12 months of licensure; crash data are provided by the Pennsylvania Department of Transportation.

DISCUSSION

Most evaluations of teen driver safety programs have significant methodological limitations including lack of random assignment, insufficient statistical power, and reliance on self-reported MVCs instead of police reports. Results will identify pragmatic and sustainable solutions for MVC prevention in adolescence.

TRIAL REGISTRATION

ClinicalTrials.gov # NCT03639753.

Direct medical charges of all parties in teen-involved vehicle crashes by culpability

BACKGROUND

Motor vehicle crashes among teen drivers often involve passengers in the teen's vehicle and occupants of other vehicles, and the full cost burden for all individuals is largely unknown. This analysis estimated direct hospitalisation and emergency department charges for teen-involved crashes by teen culpability, comparing charges for the teen driver, passengers and occupants of other vehicles.

METHODS

Probabilistic linkage was performed to link the Iowa police crash reports with Iowa emergency department and Iowa hospital inpatient data. Teen drivers aged 14-17 involved in a crash from 2016 through 2020 were included. Teen culpability was determined through the crash report and examined by teen and crash characteristics. Direct medical charges were estimated from charges through linkage to the Iowa hospital inpatient and the Iowa emergency department databases.

RESULTS

Among the 28 062 teen drivers involved in vehicle crashes in Iowa between 2016 and 2020, 62.1% were culpable and 37.9% were not culpable. For all parties involved, the inpatient charges were $20.5 million in culpable crashes and $7.2 million in non-culpable crashes. The emergency department charges were $18.7 million in teen culpable crashes and $6.8 million in teen non-culpable crashes. Of the $20.5 million total inpatient charges in which a teen driver was culpable, charges of $9.5 million (46.3%) were for the injured teen driver and $11.0 million (53.7%) for other involved parties.

CONCLUSIONS

Culpable teen-involved crashes lead to higher proportions of injury and higher medical charges, with most of these charges covering other individuals in the crash.

Drowsy driving and teen motor vehicle crashes: Impact of changing school start times

INTRODUCTION

Motor vehicle crashes (MVC) are the second leading cause of death for adolescents in the United States, with drowsy driving a major contributing factor. Early school start times have been identified as a significant factor that reduces adolescent sleep duration, which in turn contributes to drowsy driving and MVC. This paper examined the longitudinal impact of delaying secondary school start times on self-reported student drowsy driving and teen MVC.

METHODS

Secondary school students (10th and 11th grade, 51.7% female, 67.8% White) in the United States completed annual surveys 1 year before and 2 years after implementation of later school start times (70-min delay, n range 1642-2452 per year), reporting frequency of drowsy driving (less than once/week vs. at least once/week). Teen (16-18 years) MVC data from the Colorado Department of Transportation for the 2 years before and 2 years after later start time implementation were compared for Arapahoe County (where start times changed) and neighboring Adams County and Douglas County (where start times did not change).

RESULTS

With later start times, there was a significant drop in the percent of students who reported frequent drowsy driving (pre-change: 32.6%, post-change: 21.9%, follow-up: 22.8%). Weekday teen MVC rates went down in Arapahoe County (p = .04) during the school year, while no change or increases in MVC rates were seen in neighboring counties.

CONCLUSIONS

Healthy school start times are important for adolescent health and safety, with study findings highlighting the downstream effects of increased sleep duration following a 70-min delay in secondary school start times on adolescent drowsy driving and teen MVC rates.

Sociodemographic characteristics of youth licensing at age 17 in the context of supervised driving in Denmark

INTRODUCTION

Allowing young drivers to gain experience while being supervised by an experienced driver is a widely used measure to try to reduce crash risk. On 1 January 2017, the Danish licensing system was updated to allow licensing at age 17 with post-license supervised driving until solo driving at age 18.

METHOD

Based on data from the Danish Driving License register and Statistics Denmark, including the entire population, the purpose of this study is to determine if sociodemographic characteristics and a history of violations and crash involvement among youth predict licensing at age 17. A second purpose is to estimate the time period from licensing until the driver turns 18 and to explore changes in license demand in the context of Denmark's updated licensing system.

RESULTS

An increasing proportion choose to license at the age of 17, but the proportion below 19 with a driver's license is unchanged. On average, the license is obtained 5.3 months before turning 18. Living in rural areas, with both parents, and in a family with several cars and higher income increases the likelihood of licensing at age 17. Young people with a history of involvement in non-traffic-related accidents or violations are more likely to license at age 17.

CONCLUSION

Lowering the license age to allow supervised driving increases early licensing. The average time period from licensing until the driver turns 18 is less than six months. Sociodemographic characteristics predict early licensing.

PRACTICAL IMPLICATIONS

Minimum requirements for the time period from licensing until the driver turns 18 are needed to support a safety benefit. Follow-up studies mapping supervised driving, crash involvement, and possible changes in crash risk associated with the change in the Danish licensing system are needed to specify the requirements.

Teen driver crashes potentially preventable by crash avoidance features and teen-driver-specific safety technologies

INTRODUCTION

Vehicle technologies have the potential to help address the disproportionate crash risk that teen drivers face. While crash avoidance features benefit the general population, several address crash scenarios for which teen drivers are particularly at risk, such as rear-end and lane-drift crashes. Other emerging technologies have been designed for teen drivers by addressing certain crash or injury risk factors associated with risky driving behavior, such as speeding or not wearing a seat belt.

METHODS

Using nationwide U.S. crash data from 2016 to 2019, this study examined the maximum potential safety benefits of three currently available crash avoidance features (front crash prevention, lane departure prevention, and blind spot monitoring) and three teen-driver-specific technologies (speeding prevention, extended seatbelt reminders and interlocks, and nighttime curfew violation alerts).

RESULTS

Teen-driver-specific features have the largest potential for reducing teen driver injuries and fatalities, followed by lane departure prevention, front crash prevention, and blind spot monitoring; however, altogether these technologies have the potential to prevent 78% of teen driver fatalities, 47% of injured teen drivers, and 41% of crashes involving teen drivers.

CONCLUSIONS

Crash avoidance features and teen-driver-specific vehicle technologies appear to address different risk factors and crash scenarios, which emphasizes the importance of utilizing both types of safety features to reduce the crash risk of teen drivers.

PRACTICAL APPLICATIONS

Wider acceptance, accessibility, and use of these technologies are needed for their safety potential to be realized. More manufacturers should offer and advertise teen-driver-specific technology suites that integrate crash avoidance systems and safety features that address risky driving behavior. While this study shows the maximum potential safety benefits of these technologies, further research is needed to understand the behavioral implications as teens learn to drive with these features.

Effects of interventions for preventing road traffic crashes: an overview of systematic reviews

BACKGROUND

Road traffic crashes (RTCs) are among the eight-leading causes of death globally. Strategies and policies have been put in place by many countries to reduce RTCs and to prevent RTCs and related injuries/deaths.

METHODS

In this review, we searched the following databases Ovid Medline, Embase, Cochrane Database of Systematic Reviews, Epistemonikos, Web of Science, and LILACS for reviews matching our inclusion criteria between periods January 1950 and March 2020. We did not apply language or publication restrictions in the searches. We, however, excluded reviews that focused primarily on injury prevention and reviews that looked at crashes not involving a motor vehicle.

RESULTS

We identified 35 systematic reviews matching our inclusion criteria and most of the reviews (33/35) included studies strictly from high-income countries. Most reviews were published before 2015, with only 5 published between 2015 and 2020. Methodological quality varied between reviews. Most reviews focused on enforcement intervention. There was strong evidence that random breath testing, selective breath testing, and sobriety checkpoints were effective in reducing alcohol-related crashes and associated fatal and nonfatal injuries. Other reviews found that sobriety checkpoints reduced the number of crashes by 17% [CI: (- 20, - 14)]. Road safety campaigns were found to reduce the numbers of RTCs by 9% [CI: (- 11, - 8%)]. Mass media campaigns indicated some median decrease in crashes across all studies and all levels of crash severity was 10% (IQR: 6 to 14%). Converting intersections to roundabouts was associated with a reduction of 30 to 50% in the number of RTCs resulting in injury and property damage. Electronic stability control measure was found to reduce single-vehicle crashes by - 49% [95% CI: (- 55, - 42%)]. No evidence was found to indicate that post-license driver education is effective in preventing road traffic injuries or crashes.

CONCLUSION

There were many systematic reviews of varying quality available which included studies that were conducted in high-income settings. The overview has found that behavioural based interventions are very effective in reducing RTCs.

Trajectories of self-regulatory driving practices: Role of learner phase practice

INTRODUCTION

Previous research suggests that driving practice in diverse contexts may contribute to earlier licensure and improve driving skills among teen drivers. However, few studies have examined the role of practice diversity in driving outcomes post-licensure. Specifically, examining self-regulatory driving practices post-licensure may provide insight into the extent to which teens choose to avoid driving various environments. The current study examined the relationship between learner phase driving practice diversity and teen self-regulatory driving practices over the first six months of licensure.

METHODS

Fifty-six newly licensed 16-year-olds reported pre-licensure practice diversity, driving exposure and, self-regulatory driving practices at three timepoints (within 2 weeks of licensure and at 3 and 6 months post-licensure).

RESULTS

Multi-level models revealed self-regulatory driving practices significantly decreased over the first six months of independent driving. Practice in complex environments (e.g., on a commercial road, on a highway, etc.) was associated with fewer self-regulatory driving practices at baseline. Practice in simple environments (e.g., in a residential area, in a parking lot) was associated with more self-regulatory driving practices at baseline. Practice driving at night and in bad weather conditions predicted greater post-licensure self-regulation of driving in those specific environments.

CONCLUSION

This study reinforces the importance of practice diversity for teens before independent driving, as early practice can have implications for self-regulatory driving practices immediately upon licensure. Future research examining this topic may inform parent-based interventions to maximize teen driver safety during the critical post-licensure period.

Does geographic location matter for transportation risk behaviors among U.S. public high school students?

Introduction

Teen motor vehicle crash fatality rates differ by geographic location. Studies assessing teen transportation risk behaviors by location are inconclusive. Therefore, we explored the role of census region and metropolitan status for driving prevalence and four transportation risk behaviors among U.S. public high school students.

Methods

Data from 2015 and 2017 national Youth Risk Behavior Surveys were combined and analyzed. Multivariable models controlled for sex, age, race/ethnicity, grades in school, and school socioeconomic status.

Results

Overall, 41% of students did not always wear a seat belt. Students attending schools in the Northeast were 40% more likely than those in the Midwest to not always wear a seat belt. Among the 75% of students aged ≥16 years who had driven during the past 30 days, 47% texted/e-mailed while driving. Students in the Northeast were 20% less likely than those in the Midwest to text/e-mail while driving, and students attending suburban or town schools were more likely to text/e-mail while driving (20% and 30%, respectively) than students attending urban schools. Nineteen percent of students rode with a driver who had been drinking alcohol, and 7% of drivers aged ≥16 years drove when they had been drinking alcohol, with no significant differences by location for either alcohol-related behavior.

Conclusions

We found few differences in teen transportation risk behaviors by census region or metropolitan status. Age at licensure, time since licensure, driving experience, and the policy and physical driving environment might contribute more to variation in teen fatal crashes by location than differences in transportation risk behaviors. Regardless of location, teen transportation risk behaviors remain high. Future research could address developing effective strategies to reduce teen cell phone use while driving and enhancing community implementation of existing, effective strategies to improve seat belt use and reduce alcohol consumption and driving after drinking alcohol.

Support for legislative, technological, and organizational strategies to reduce cellphone use while driving: Psychological predictors and influences of language

OBJECTIVE

A large body of research has established that cellphone use while driving (CUWD) is common and dangerous. However, little research has been conducted about how people react psychologically to various distraction-reduction strategies and, ultimately, support or do not support them. Understanding support for reduction is important for predicting use of technological solutions and compliance with laws and for improving communication and education about the risks of CUWD.

METHODS

We measured support for a variety of legislative, technological, and organizational strategies to reduce CUWD in an online sample of American drivers (N = 648). We also developed evidence-based communication techniques, describing strategies in terms of benefits vs. costs or using freedom-invoking vs. freedom-reducing language to assess what would influence support.

RESULTS

Support for CUWD reduction was generally high. It was predicted by driver characteristics and beliefs. For example, drivers who supported reducing CUWD more also had lower CUWD reactance, greater anti-CUWD beliefs, higher personal risk perceptions of CUWD, and greater self-reported distracted driving. Age and perceived ability to drive distracted did not predict overall support. However, two strategies that allow for handsfree phone use were supported more by people who engaged in more CUWD, perceived they had greater ability to CUWD, perceived more benefits to CUWD, had more positive affect to cellphones, and were younger. Communication techniques also influenced support. Specifically, the same strategy was supported more when described using benefits and permissive language instead of costs and restrictive language.

CONCLUSIONS

Most respondents supported strategies to reduce CUWD, and beliefs about risks and benefits predicted this snupport. Reactance to CUWD messaging emerged as a key predictor of lower support (and of greater self-reported distracted driving), indicating that it could be an important variable to consider when designing strategies to reduce CUWD. When targeting people resistant to quitting CUWD entirely, communicators could recommend a switch to handsfree use. Communicators who emphasize benefits and use permissive language also may increase support for CUWD reduction.

Characteristics of vehicles driven by teens and adults killed in crashes, 2013-2017

INTRODUCTION

Teen drivers experience higher crash risk than their experienced adult counterparts. Legislative and community outreach methods have attempted to reduce this risk; results have been mixed. The increasing presence of vehicle safety features across the fleet has driven fatality numbers down in the past decades, but the disparity between young drivers and others remains.

METHOD

We merged Fatality Analysis Reporting System (FARS) data on fatal crashes with vehicle characteristic data from the Highway Loss Data Institute (HLDI). The analysis compared the vehicle type, size, age, and the presence of select safety features in vehicles driven by teens (ages 15-17 years) and adult drivers (ages 35-50 years) who were killed in crashes from 2013 to 2017. Results were compared with a similar analysis conducted on data from 2007 to 2012.

RESULTS

Teen drivers were more likely than their adult counterparts to be killed while driving older, smaller vehicles that were less likely to have the option to be equipped with side airbags.

DISCUSSION

Teenage drivers remain more likely to be killed while driving older, smaller vehicles than adult drivers. Parents and guardians are mainly responsible for teen vehicle choice, and should keep vehicle size, weight, and safety features in mind when placing their teen in a vehicle. Practical Application: These findings can help guide safer vehicle choice for new teen drivers.

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

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

Vehicle safety characteristics in vulnerable driver populations

OBJECTIVE

National data suggest drivers who are younger, older, and have lower socioeconomic status (SES) have heightened crash-related injury rates. Ensuring vulnerable drivers are in the safest vehicles they can afford is a promising approach to reducing crash injuries in these groups. However, we do not know the extent to which these drivers are disproportionately driving less safe vehicles. Our objective was to obtain population-based estimates of the prevalence of important vehicle safety criteria among a statewide population of drivers.

METHODS

We analyzed data from the NJ Safety and Health Outcomes warehouse, which includes all licensing and crash data from 2010-2017. We borrowed the quasi-induced exposure method's fundamental assumption-that non-responsible drivers in clean (i.e., only one responsible driver) multi-vehicle crashes are reasonably representative of drivers on the road-to estimate statewide prevalence of drivers' vehicle characteristics across four driver age groups (17-20; 21-24; 25-64, and ≥65) and quintiles of census tract median household income (n = 983,372). We used NHTSA's Product Information Catalog and Vehicle Listing platform (vPIC) to decode the VIN of each crash-involved vehicle to obtain model year, presence of electronic stability control (ESC), vehicle type, engine horsepower, and presence of front, side, and curtain air bags.

RESULTS

The youngest and oldest drivers were more likely than middle-aged drivers to drive vehicles that were older, did not have ESC, and were not equipped with side airbags. Additionally, across all age groups drivers of higher SES were in newer and safer vehicles compared with those of lower SES. For example, young drivers living in lowest-income census tracts drove vehicles that were on average almost twice as old as young drivers living in highest-income tracts (median [IQR]: 11 years [6-14] vs. 6 years [3-11]).

CONCLUSIONS

Vehicle safety is an important component of seminal road safety philosophies that aim to reduce crash fatalities. However, driver groups that are overrepresented in fatal crashes-young drivers, older drivers, and those of lower SES-are also driving the less safe vehicles. Ensuring drivers are in the safest car they can afford should be further explored as an approach to reduce crash-related injuries among vulnerable populations.

More aware, more protected: a cross-sectional study on road safety skills predicting the use of passive safety elements among Spanish teenagers

OBJECTIVE

This study had two objectives: first, to test the effects of sociodemographic variables, and the effects of three key road safety skills (knowledge-risk perception-attitudes) on the use of passive safety elements (PSEs) among teenagers; and second, to assess the differential impact of the study variables on PSEs use from a gender-based perspective.

SETTING AND PARTICIPANTS

This cross-sectional study was framed in the paradigm of primary care, and it involved students from several educational centres in Spain. A sample of 827 Spanish teenagers (52.4% females and 47.6% males) with a mean age of M=14.41-7 (12-19) years was used.

RESULTS

Through SEM modelling, we found that the use of PSEs is largely explained by psychosocial variables through the mediation of three road safety skills: risk perception (β=0.103^***), rule knowledge (β=0.095^*) and attitudes towards road safety (β=0.186^***). Furthermore, multigroup analyses showed that, although most variables explain the use of PSEs among teenagers in a similar way, key gender-based differences exist in this regard.

CONCLUSIONS

Road safety skills have a significant effect on the use of PSEs among Spanish teenagers, and gender explains some differences in the mechanisms which predict them. Also, in the study we discuss the need for strengthening school-based interventions aimed at helping this vulnerable group of road users acquire and develop positive behavioural competences.

A randomized trial to test the impact of parent communication on improving in-vehicle feedback systems

This randomized controlled trial evaluated the impact of integrating Steering Teens Safe, a parent communication intervention, with feedback from an in-vehicle video recording system. In-vehicle video systems that trigger a recording when the vehicle exceeds a g-force threshold have been used to provide feedback to young drivers. Few of these programs have involved parental engagement. Parent-teen dyads were randomized to three groups and 150 dyads completed the study. All groups received an in-vehicle video system that recorded driving events. The control group received no feedback or intervention. In the first intervention group, teens received real-time feedback, and parent-teen dyads received summary feedback, based on information recorded by the in-vehicle system. The second intervention group received the same feedback, plus parents were taught strategies to improve communication with their teen about safe driving. The primary outcome variable was unsafe driving event rates per 1000 miles driven and the primary independent variable was group assignment. Generalized linear models were used to calculate effect estimates. Compared with the control group, the Event Recorder Feedback group had a rate ratio of 0.35 (95% CI = 0.24 - 0.50) and the combined intervention group (Event Recorder Feedback and parent communication) had a rate ratio of 0.21 (95% CI = 0.15 - 0.30). Furthermore, the combined intervention group had a significantly lower event rate than the Event Recorder Feedback only group (rate ratio = 0.60, 95% CI = 0.41 - 0.87). While in-vehicle feedback systems can help reduce unsafe driving events in early independent driving, teaching parents strategies for effective communication with their young driver may further improve impact.

Family Communication Patterns and Teen Driving Intervention Effectiveness

Objectives: Teen drivers are at increased crash risk, largely due to lack of experience. Parents play a key role in influencing teen behaviors and attitudes around driving safety. Parent-involved interventions may improve teen driving safety but tend to be resource intensive and have limited scalability. In this study, we examined how family communication patterns (FCPs) impact teen risky driving and the effectiveness of a parent-focused teen driving intervention. Methods: Our data came from a large randomized controlled teen driving intervention trial. We randomized parent-teen dyads into one of 3 groups: parent communication intervention plus in-vehicle event recorder feedback; in-vehicle event recorder feedback only ; or control. The primary outcome variable was teen risky driving (self-reports and triggered events); the primary exposure variables were FCPs and intervention group. We used generalized linear models to calculate effect estimates. Results: Teens' baseline risky driving did not vary by family communication pattern. The impact of the parent-focused intervention was stronger in families with a laissez-faire FCP. The laissez-faire FCP focuses little on child conformity and downplays communication. Conclusions: These results provide a framework for targeting high-resource teen driving interventions (event recorder feedback and parent-communication training) to families with laissez-faire communication patterns to attain the greatest risk reductions.

Learning to drive: A reconceptualization

Drivers' population-level crash rates incrementally decrease following licensure, which has led to the implicit assumption that an individual driver's crash risk also decreases incrementally after licensure as they accrue experience. However, in the aggregate data an incremental decrease in crash rate can reflect both incremental reductions in crash risk within individuals and an incremental increase in the proportion of drivers who have experienced an abrupt decrease in crash risk. Therefore, while it is true to say that the population of drivers' crash risk reduces in the months following licensure, it is not necessarily true to say that a driver's crash risk reduces in the months following licensure; that is, it cannot be assumed that individual-level changes in crash risk mirror the population-level changes in crash rates. In statistics, this is known as an ecological fallacy and in formal logic it is known as the fallacy of division, a type of category error. Using computational cognitive modeling methods we demonstrate that aggregating individual-level abrupt decreases in crash risk (i.e., non-incremental change trajectories) accurately fits population-level crash rate data from over 1 million adolescents and uniquely accounts for effects of two interventions found to reduce police-reported MVCs. Thus, we demonstrate that (1) a power-law artifact is readily observable in newly licensed drivers' aggregate crash data, which is not necessarily indicative of individual-level change processes, (2) interventions can alter crash risk trajectories by inducing immediate phase changes in crash risk into a lower risk stratum, or increasing the probability of such a change, (3) a phase transition model provides a stronger and more parsimonious account of the existing data than an incremental-accrual model.

Simulated Driving Performance, Self-Reported Driving Behaviors, and Mental Health Symptoms in Adolescent Novice Drivers

BACKGROUND

Risky driving behaviors contribute to adolescent injury, disability, and death, yet little is known about how mental health factors are associated with adolescent driving behaviors.

OBJECTIVES

The purpose of the research was to determine the association of risky driving behaviors and mental health symptoms in novice adolescent drivers.

METHODS

We recruited a convenience sample (n = 60) of adolescents to complete an assessment of driving performance errors in a high-fidelity simulator (Simulated Driving Assessment [SDA] Error Score) and a self-report measure of risky driving (Behavior of Young Novice Drivers Survey [BYNDS]). Participants also completed a mental health assessment of self-reported symptoms of depression (Center for Epidemiologic Studies-Depression Scale) and attention-deficit/hyperactivity disorder (ADHD; inattention and hyperactivity-impulsivity), conduct disorder, and oppositional defiant disorder (Conners-3 self-report and parent report). We evaluated the cross-sectional relationships between SDA Error Score, BYNDS, and mental health survey data with descriptive statistics, bivariate correlations, and linear regression.

RESULTS

In linear regression models, higher self-reported inattentive ADHD T-scores were associated with higher SDA Error Score (model adjusted R = .20). Higher self-reported T-scores of hyperactive-impulsive ADHD and conduct disorder were associated with higher BYNDS total scores (model adjusted R = .32). Parent report measures were not associated with adolescent BYNDS total score or SDA Error Score.

DISCUSSION

These data highlight the association of risky driving with adolescent symptoms of inattention, hyperactivity, and conduct disorder. The early stage of independent driving is an important time for addressing the relationship between driving performance and mental health conditions.

Behavior Change for Youth Drivers: Design and Development of a Smartphone-Based App (BackPocketDriver)

Background

The over-representation of youth in road crash injury and fatality rates is a major public health issue globally. In New Zealand, youth drivers are most vulnerable in the restricted license period when they can drive without the requirement for supervision by an experienced adult. Behavioral change interventions delivered using mobile phone technology to young drivers could serve as a useful mechanism to develop safe driving skills, but this potential remains to be fully explored.

Objective

This study aimed to apply behavioral change principles to design and develop a smartphone-based intervention with the aim of helping youth drivers to develop and hone safe driving skills.

Methods

An iterative process was used to support development of the smartphone intervention. We reviewed behavioral change literature, identifying fundamental principles and exploring use of behavior change techniques (BCTs) in other areas of public health. We engaged with key stakeholders, including young drivers, government agencies, and relevant organizations. We also took into account technology adoption considerations when designing the app.

Results

We developed BackPocketDriver (BPD), an Android smartphone app that uses in-built sensors to monitor and infer driver behavior. The app implements features that were identified during the design process and are traceable to BCTs and theory. A key feature is messaging, which is used to instruct, motivate, educate, and relay feedback to participants. In addition, messaging addresses attitudes and beliefs. Other features include journey feedback summaries, goal setting, achievements, and leaderboards.

Conclusions

BPD’s design rests on a sound foundation of theory and evidence. With explicit links between theory and features, the app aims to be an effective intervention to change and improve youth driver behavior. The next phase of this study is to run a small pilot study to assess BPD’s effectiveness.

The Teen Driver

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

Design and implementation of a parent guide for coaching teen drivers

INTRODUCTION

Teens beginning to drive independently are at significant increased risk of motor-vehicle crashes relative to their other life stages. There is, however, little guidance for parents as to how best to supervise learning to drive.

METHOD

This study sought to undertake an informed approach to development and implementation of a Parent Guide. We included a multi-stage development process, using theory, findings from a Delphi-study of young driver traffic-safety experts, and parent focus groups. This process informed the development of a Guide that was then evaluated for feasibility and acceptability, comparing a group that received the Guide with a control group of parent and teen dyads. Both members of the dyads were surveyed at baseline, again at the approximate time teens would be licensed to drive independently (post-test), and again three months later.

RESULTS

We found no difference in the proportion of teens who became licensed between those given the new Guide and control teens (who received the state-developed booklet); that is the Guide did not appear to promote or delay licensure. Teens in the Guide group reported that their parents were more likely to use the provided resource compared with control teens. Responses indicated that the Parent Guide was favorably viewed, that it was easy to use, and that the logging of hours was a useful inclusion. Parents noted that the Guide helped them manage their stress, provided strategies to keep calm, and helped with planning practice. In contrast, control parents noted that their booklet helped explain rules. Among licensed teens there was no significant difference in self-reported risky driving at the three-month follow-up. We discuss the challenges in providing motivation for parents to move beyond a set number of practice hours to provide diversity of driving practice.

Talking with teens about traffic safety: Initial feasibility, acceptability, and efficacy of a parent-targeted intervention for primary care settings

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.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Can Adolescent Drivers' Motor Vehicle Crash Risk Be Reduced by Pre-Licensure Intervention?

PURPOSE

Although motor vehicle crashes are the leading cause of death for adolescents, there is a scarcity of research addressing adolescents' lack of pre-licensure practical driving experience, which is theorized to increase their post-licensure crash risk.

METHODS

Utilizing police-reported crashes and survey data from a randomized and quasi-randomized trial (n = 458 adolescents, 16 or 17 years of age at enrollment), the impact of a parent-directed supervised practice driving intervention and a comprehensive on-road driving assessment (ODA) with feedback was evaluated on adolescent drivers' motor vehicle crashes involvement.

RESULTS

Compared with the control condition, a nonsignificant 20% relative reduction in risk was observed for the parent-directed intervention: adjusted hazard ratio  = .80 (95% confidence interval [CI] .44, 1.43); the unadjusted absolute risk reduction was 1.1% (95% CI -4.4, 7.1). Exposure to the ODA resulted in an 53% relative reduction of risk: adjusted hazard ratio  = .47 (95% CI .24, .91); the unadjusted absolute risk reduction was 5.4% (95% CI -.3, 10.7).

CONCLUSIONS

Comprehensive ODA might be protective for adolescents; however, additional research is needed.

Partnering with parents to advance child health research

Although patient engagement in research is widely touted as an important foundation for improving the relevance and sustainability of research findings, there is little consensus on how to do it in practice. This article describes our research team's experiences working with and engaging parents throughout the entire research process to reach full partnership in the identification, management, and dissemination of research. Our report of these experiences includes lessons learned along the way regarding how healthcare and research organizations can better support researchers and patients to achieve successful partnerships.

Longitudinal study of driver licensing rates among adolescents and young adults with autism spectrum disorder

Driving may increase mobility and independence for adolescents with autism without intellectual disability (autism spectrum disorder); however, little is known about rates of licensure. To compare the proportion of adolescents with and without autism spectrum disorder who acquire a learner's permit and driver's license, as well as the rate at which they progress through the licensing system, we conducted a retrospective cohort study of 52,172 New Jersey residents born in the years 1987-1995 who were patients of the Children's Hospital of Philadelphia healthcare network ⩾12 years of age; 609 (1.2%) had an autism spectrum disorder diagnosis. Electronic health records were linked to New Jersey's driver licensing database (2004-2012). Kaplan-Meier curves and log-binomial regression models were used to determine the age at and rate of licensure, and estimate adjusted risk ratios. One in three adolescents with autism spectrum disorder acquired a driver's license versus 83.5% for other adolescents and at a median of 9.2 months later. The vast majority (89.7%) of those with autism spectrum disorder who acquired a permit and were fully eligible to get licensed acquired a license within 2 years. Results indicated that a substantial proportion of adolescents with autism spectrum disorder do get licensed and that license-related decisions are primarily made prior to acquisition of a permit instead of during the learning-to-drive process.

Compliance With and Enforcement of Graduated Driver Licensing Restrictions

INTRODUCTION

Graduated Driver Licensing (GDL) is the most effective strategy to reduce the burden of young driver crashes, but the extent to which young intermediate (newly licensed) drivers comply with, and police enforce, important GDL passenger and night-time restrictions is largely unknown. Population-level rates of intermediate drivers' compliance were estimated as well as police enforcement among crash-involved drivers who were noncompliant.

METHODS

New Jersey's statewide driver licensing and crash databases were individually linked. The quasi-induced exposure method's fundamental assumption-that nonresponsible young intermediate drivers in clean (i.e., only one responsible driver) multivehicle crashes are reasonably representative of young intermediate drivers on the road-was borrowed. Incidence was then estimated among the 9,250 nonresponsible intermediate drivers who were involved in clean multivehicle crashes from July 2010 through June 2012. The proportion of crash-involved noncompliant intermediate drivers who were issued a GDL citation, by crash responsibility, was calculated. Data were collected in 2013 and analyzed in 2015.

RESULTS

Overall, 8.3% (95% CI=7.8%, 8.9%) of intermediate drivers' trips were noncompliant with New Jersey's passenger restriction and 3.1% (95% CI=2.8%, 3.5%) with its night-time restriction; compliance was significantly lower among those residing in low-income and urban areas, among male drivers, on weekends, and in summer months. The proportion of crash-involved noncompliant intermediate drivers who were issued a GDL citation was low (nonresponsible drivers, 10.3%; responsible drivers, 19.0%).

CONCLUSIONS

The vast majority of intermediate driver trips are in compliance with GDL restrictions. Outreach activities should consider focusing on higher-risk situations and groups with higher noncompliance rates.

Description of Various Factors Contributing to Traffic Accidents in Youth and Measures Proposed to Alleviate Recurrence

Traffic accidents are the leading cause of hospitalization in adolescence, with the 18-24-year-old age group accounting for 23% of deaths by traffic accidents. Recurrence rate is also high. One in four teenagers will have a relapse within the year following the first accident. Cognitive impairments known in adolescence could cause risky behaviors, defined as repetitive engagement in dangerous situations such as road accidents. Two categories of factors seem to be associated with traffic accidents: (1) factors specific to the traffic environment and (2) "human" factors, which seem to be the most influential. Moreover, the establishment of a stronger relation to high speed driving increases traffic accident risks and can also be intensified by sensation seeking. Other factors such as substance use (alcohol, drugs, and "binge drinking") are also identified as risk factors. Furthermore, cell phone use while driving and attention deficit disorder with or without hyperactivity also seem to be important risk factors for car accidents. The family environment strongly influences a young person's driving behavior. Some interventional driving strategies and preventive measures have reduced the risk of traffic accidents among young people, such as the graduated driver licensing program and advertising campaigns. So far, few therapeutic approaches have been implemented. Reason why, we decided to set up an innovative strategy consisting of a therapeutic postaccident group intervention, entitled the ECARR2 protocol, to prevent recurrence among adolescents and young adults identified at risk, taking into account the multiple risk factors.

Parental influence on driver licensure in adolescence: A randomized controlled trial

OBJECTIVE

Newly licensed adolescent drivers have skill deficits that increase risk for motor vehicle crashes. Development of programs targeted to prelicensed adolescents has been hindered by concerns about encouraging overconfidence and early licensure. The study had 2 primary objectives: (a) determine whether an Internet-based intervention designed to improve parent-supervised practice (TeenDrivingPlan [TDP]) influenced adolescents' time to licensure and parents' perceptions of adolescents' driving skill, expertise, and safety and (b) evaluate the association of these perceptions and practice diversity (number of different environments where practiced occurred) with time to licensure.

METHOD

A randomized controlled trial was used to compare TDP with a control condition. Participants (N = 295 parent-adolescent dyads) completed periodic surveys over 24 weeks and were subsequently followed for up to a year to determine adolescents' licensure status.

RESULTS

TDP did not influence time to licensure and did not affect parents' perceptions of skill, expertise, and safety. Practice diversity was associated with faster licensure. A more favorable perception of adolescents' skill in comparison to peers was associated with faster licensure.

CONCLUSIONS

Targeting parents' beliefs about adolescents' safety in relation to other road users may not be conducive to altering licensing trajectories, whereas sensitizing parents to their adolescents' emerging skills might be more effective in promoting safe entry into licensure. (PsycINFO Database Record

Parental perceptions of teen driving: Restrictions, worry and influence

INTRODUCTION

Parents play a critical role in preventing crashes among teens. Research of parental perceptions and concerns regarding teen driving safety is limited. We examined results from the 2013 Summer ConsumerStyles survey that queried parents about restrictions placed on their teen drivers, their perceived level of "worry" about their teen driver's safety, and influence of parental restrictions regarding their teen's driving.

METHODS

We produced frequency distributions for the number of restrictions imposed, parental "worry," and influence of rules regarding their teen's driving, reported by teen's driving license status (learning to drive or obtained a driver's license). Response categories were dichotomized because of small cell sizes, and we ran separate log-linear regression models to explore whether imposing all four restrictions on teen drivers was associated with either worry intensity ("a lot" versus "somewhat, not very much or not at all") or perceived influence of parental rules ("a lot" versus "somewhat, not very much or not at all").

RESULTS

Among the 456 parent respondents, 80% reported having restrictions for their teen driver regarding use of safety belts, drinking and driving, cell phones, and text messaging while driving. However, among the 188 parents of licensed teens, only 9% reported having a written parent-teen driving agreement, either currently or in the past. Worrying "a lot" was reported less frequently by parents of newly licensed teens (36%) compared with parents of learning teens (61%).

CONCLUSIONS AND PRACTICAL APPLICATIONS

Parents report having rules and restrictions for their teen drivers, but only a small percentage formalize the rules and restrictions in a written parent-teen driving agreement. Parents worry less about their teen driver's safety during the newly licensed phase, when crash risk is high as compared to the learning phase. Further research is needed into how to effectively support parents in supervising and monitoring their teen driver.

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

Motor vehicle crashes are the leading cause of death in adolescents, and drivers aged 16-19 are the most likely to die in distracted driving crashes. This paper provides an overview of the literature on adolescent cellphone use while driving, focusing on the crash risk, incidence, risk factors for engagement, and the effectiveness of current mitigation strategies. We conclude by discussing promising future approaches to prevent crashes related to cellphone use in adolescents. Handheld manipulation of the phone while driving has been shown to have a 3 to 4-fold increased risk of a near crash or crash, and eye glance duration greater than 2 seconds increases crash risk exponentially. Nearly half of U.S. high school students admit to texting while driving in the last month, but the frequency of use according to vehicle speed and high-risk situations remains unknown. Several risk factors are associated with cell phone use while driving including: parental cellphone use while driving, social norms for quick responses to text messages, and higher levels of temporal discounting. Given the limited effectiveness of current mitigation strategies such as educational campaigns and legal bans, a multi-pronged behavioral and technological approach addressing the above risk factors will be necessary to reduce this dangerous behavior in adolescents.

Identifying beliefs underlying pre-drivers' intentions to take risks: An application of the Theory of Planned Behaviour

Novice motorists are at high crash risk during the first few months of driving. Risky behaviours such as speeding and driving while distracted are well-documented contributors to crash risk during this period. To reduce this public health burden, effective road safety interventions need to target the pre-driving period. We use the Theory of Planned Behaviour (TPB) to identify the pre-driver beliefs underlying intentions to drive over the speed limit (N=77), and while over the legal alcohol limit (N=72), talking on a hand-held mobile phone (N=77) and feeling very tired (N=68). The TPB explained between 41% and 69% of the variance in intentions to perform these behaviours. Attitudes were strong predictors of intentions for all behaviours. Subjective norms and perceived behavioural control were significant, though weaker, independent predictors of speeding and mobile phone use. Behavioural beliefs underlying these attitudes could be separated into those reflecting perceived disadvantages (e.g., speeding increases my risk of crash) and advantages (e.g., speeding gives me a thrill). Interventions that can make these beliefs safer in pre-drivers may reduce crash risk once independent driving has begun.