National evaluation of the effect of graduated driver licensing laws on teenager fatality and injury crashes

Effectiveness of road safety interventions: An evidence and gap map

Background

Road Traffic injuries (RTI) are among the top ten leading causes of death in the world resulting in 1.35 million deaths every year, about 93% of which occur in low- and middle-income countries (LMICs). Despite several global resolutions to reduce traffic injuries, they have continued to grow in many countries. Many high-income countries have successfully reduced RTI by using a public health approach and implementing evidence-based interventions. As many LMICs develop their highway infrastructure, adopting a similar scientific approach towards road safety is crucial. The evidence also needs to be evaluated to assess external validity because measures that have worked in high-income countries may not translate equally well to other contexts. An evidence gap map for RTI is the first step towards understanding what evidence is available, from where, and the key gaps in knowledge.

Objectives

The objective of this evidence gap map (EGM) is to identify existing evidence from all effectiveness studies and systematic reviews related to road safety interventions. In addition, the EGM identifies gaps in evidence where new primary studies and systematic reviews could add value. This will help direct future research and discussions based on systematic evidence towards the approaches and interventions which are most effective in the road safety sector. This could enable the generation of evidence for informing policy at global, regional or national levels.

Search Methods

The EGM includes systematic reviews and impact evaluations assessing the effect of interventions for RTI reported in academic databases, organization websites, and grey literature sources. The studies were searched up to December 2019.

Selection Criteria

The interventions were divided into five broad categories: (a) human factors (e.g., enforcement or road user education), (b) road design, infrastructure and traffic control, (c) legal and institutional framework, (d) post-crash pre-hospital care, and (e) vehicle factors (except car design for occupant protection) and protective devices. Included studies reported two primary outcomes: fatal crashes and non-fatal injury crashes; and four intermediate outcomes: change in use of seat belts, change in use of helmets, change in speed, and change in alcohol/drug use. Studies were excluded if they did not report injury or fatality as one of the outcomes.

Data Collection and Analysis

The EGM is presented in the form of a matrix with two primary dimensions: interventions (rows) and outcomes (columns). Additional dimensions are country income groups, region, quality level for systematic reviews, type of study design used (e.g., case-control), type of road user studied (e.g., pedestrian, cyclists), age groups, and road type. The EGM is available online where the matrix of interventions and outcomes can be filtered by one or more dimensions. The webpage includes a bibliography of the selected studies and titles and abstracts available for preview. Quality appraisal for systematic reviews was conducted using a critical appraisal tool for systematic reviews, AMSTAR 2.

Main Results

The EGM identified 1859 studies of which 322 were systematic reviews, 7 were protocol studies and 1530 were impact evaluations. Some studies included more than one intervention, outcome, study method, or study region. The studies were distributed among intervention categories as: human factors (n = 771), road design, infrastructure and traffic control (n = 661), legal and institutional framework (n = 424), post-crash pre-hospital care (n = 118) and vehicle factors and protective devices (n = 111). Fatal crashes as outcomes were reported in 1414 records and non-fatal injury crashes in 1252 records. Among the four intermediate outcomes, speed was most commonly reported (n = 298) followed by alcohol (n = 206), use of seatbelts (n = 167), and use of helmets (n = 66). Ninety-six percent of the studies were reported from high-income countries (HIC), 4.5% from upper-middle-income countries, and only 1.4% from lower-middle and low-income countries. There were 25 systematic reviews of high quality, 4 of moderate quality, and 293 of low quality.

Authors' Conclusions

The EGM shows that the distribution of available road safety evidence is skewed across the world. A vast majority of the literature is from HICs. In contrast, only a small fraction of the literature reports on the many LMICs that are fast expanding their road infrastructure, experiencing rapid changes in traffic patterns, and witnessing growth in road injuries. This bias in literature explains why many interventions that are of high importance in the context of LMICs remain poorly studied. Besides, many interventions that have been tested only in HICs may not work equally effectively in LMICs. Another important finding was that a large majority of systematic reviews are of low quality. The scarcity of evidence on many important interventions and lack of good quality evidence-synthesis have significant implications for future road safety research and practice in LMICs. The EGM presented here will help identify priority areas for researchers, while directing practitioners and policy makers towards proven interventions.

Rates and predictors of teen driver crash culpability

BACKGROUND

Motor-vehicle crash risk is highest among teen drivers. Despite a wealth of research on the topic, there are still many contributors to these crashes that are not well understood. The current study sought to examine the contribution of graduated driver licensing (GDL) restrictions, sex, age, roadway circumstances, and citation history to teen drivers' crash culpability.

METHOD

Crash system data from the Iowa Department of Transportation were linked with traffic-related charges from the Iowa Court Information System. Crashes involving teens aged 14 to 17 years between 2016 and 2019 were analyzed (N = 19,847). Culpability was determined using the driver contributing circumstances from the crash report. Moving and non-moving traffic citations issued prior to the date of each crash were considered. A multivariable logistic regression model was constructed to examine predictors of crash culpability.

RESULTS

Teen drivers were determined to be culpable for more than two thirds of crashes (N = 13,604, 68.54%). Culpability was more prevalent among males, younger teens, in rural areas, in the presence of reported roadway contributing circumstances, during hours of restricted nighttime driving, and among teens with citation histories that included both moving and non-moving citations. Similarly, multivariable model results indicated that the likelihood of culpability was higher among males, in rural areas, and at each stage of GDL compared to teen drivers with unrestricted licenses. While drivers with a history of both moving and non-moving violations were more likely to be culpable, those with a history of only moving or only non-moving violations were less likely to be culpable compared to those with no violation history.

CONCLUSION

Sex, crash location, and GDL stage were associated with teen driver crash culpability. A singular prior moving or non-moving violation may play a protective role in teen crash culpability.

Financial status and travel time to driving schools as barriers to obtaining a young driver license in a state with comprehensive young driver licensing policy

The highest lifetime risk for a motor vehicle crash is immediately after the point of licensure, with teen drivers most at risk. Comprehensive teen driver licensing policies that require completion of driver education and behind-the-wheel training along with Graduated Driver Licensing (GDL) are associated with lower young driver crash rates early in licensure. We hypothesize that lack of financial resources and travel time to driving schools reduce the likelihood for teens to complete driver training and gain a young driver's license before age 18. We utilize licensing data from the Ohio Bureau of Motor Vehicles on over 35,000 applicants between 15.5 and 25 years old collected between 2017 and 2019. This dataset of driving schools is maintained by the Ohio Department of Public Safety and is linked with Census tract-level socioeconomic data from the U.S. Census. Using logit models, we estimate the completion of driver training and license obtainment among young drivers in the Columbus, Ohio metro area. We find that young drivers in lower-income Census tracts have a lower likelihood to complete driver training and get licensed before age 18. As travel time to driving schools increases, teens in wealthier Census tracts are more likely to forgo driver training and licensure than teens in lower-income Census tracts. For jurisdictions aspiring to improve safe driving for young drivers, our findings help shape recommendations on policies to enhance access to driver training and licensure especially among teens living in lower-income Census tracts.

Licensing Examination and Crash Outcomes Postlicensure in Young Drivers

IMPORTANCE

Despite US graduated driver licensing laws, young novice driver crash rates remain high. Study findings suggest comprehensive license policy that mandates driver education including behind-the-wheel (BTW) training may reduce crashes postlicensure. However, only 15 states mandate BTW training.

OBJECTIVE

To identify differences in licensing and crash outcomes for drivers younger than 18 years who are subject to comprehensive licensing requirements (graduated driver licensing, driver education, and BTW training) vs those aged 18 to 24 years who are exempt from these requirements.

DESIGN, SETTING, AND PARTICIPANTS

This prospective, population-based cohort study used Ohio licensing data to define a cohort of 2018 license applicants (age 16-24 years, n = 136 643) and tracked licensed driver (n = 129 897) crash outcomes up to 12 months postlicensure. The study was conducted from January 1, 2018, to December 31, 2019, and data analysis was performed from October 7, 2019, to February 11, 2022.

MAIN OUTCOMES AND MEASURES

Licensing examination performance and population-based, police-reported crash rates in the first 2 months and 12 months postlicensure across age groups, sex, and census tract-level sociodemographic variables were measured. Poisson regression models compared newly licensed driver crash rates, with reference to individuals licensed at 18 years, while controlling for census tract-level sociodemographic factors, time spent in the learner permit period, and licensing examination performance measures.

RESULTS

Of 136 643 novice drivers, 69 488 (50.9%) were male and 67 152 (49.1%) were female. Mean (SD) age at enrollment (age at first on-road examination) was 17.7 (2.1) years. License applicants aged 16 and 17 years performed best on license examinations (15 466 [21.6%] and 5112 [30.9%] failing vs 7981 [37.5%] of applicants aged 18 years). Drivers licensed at 18 years had the highest crash rates of all those younger than 25 years. Compared with drivers licensed at 18 years, crash rates were 27% lower in individuals aged 16 years and 14% lower in those aged 17 years during the first 2 months postlicensure when controlling for socioeconomic status, time spent in learner permit status, and license examination performance measures (adjusted relative risk [aRR] at age 16 years: 0.73; 95% CI, 0.67-0.80; age 17 years: aRR, 0.86; 95% CI, 0.77-0.96). At 12 months postlicensure, crash rates were 19% lower for individuals licensed at age 16 years (aRR, 0.81; 95%, CI, 0.77-0.85) and 6% lower at age 17 years (aRR, 0.94; 95% CI, 0.89-0.99) compared with individuals aged 18 years.

CONCLUSIONS AND RELEVANCE

In Ohio, drivers younger than 18 years who are subject to graduated driver licensing and driver education, including BTW training requirements, had lower crash rates in the first year postlicensure compared with those aged 18 years, with controls applied. These findings suggest that it may be fruitful for future work to reconsider the value of mandated driver license policies, including BTW training, and to examine reasons for delayed licensure and barriers to accessing training.

Alcohol- and speeding-related fatal crashes among novice drivers age 18-20 not fully licensed at the time of the crash

INTRODUCTION

Some teens may intentionally delay their driving licensure until age 18 or later, thereby skipping the learning and driver safety benefits provided by graduated driver licensing (GDL) programs. Delaying driving initiation could elevate teen crash risk once they begin driving. This study compares the prevalence of alcohol use and speeding among individuals aged 18-20 y/o who were not fully licensed drivers (NFLD) at the time of the fatal crash with that of their fully licensed counterparts (FLD).

MATERIALS AND METHODS

Data came from the 2010-2017 Fatality Analysis Reporting System (FARS). Census data were added to measure mean household income at drivers' zip code. Bivariate (chi-square) and logistic regressions were used to assess the likelihood young drivers were alcohol-positive and/or speeding at the time of the crash as a function of drivers' license status, demographic, socioeconomic, and the strength of GDL programs in the state.

RESULTS

Compared with females and White drivers age 18-20 y/o, males, Latino, and Black drivers were more likely to be NFLD at the time of the fatal crash (p < .0001). Living in zip codes with low median household income (p < .001) and the strength of GDL restrictions (p < .0001) were associated with individuals being NFLD at the time of the fatal crash. Alcohol-related fatal crashes were more prevalent among NFLD than FLD (p < .02).

CONCLUSIONS

The study provides indirect evidence suggesting that alcohol use may be more detrimental for NFLD than for FLD.

Impact of helmet laws on motorcycle crash mortality rates

BACKGROUND

Helmets are effective in reducing traumatic brain injury. However, population effects of helmet laws have not been well described. This study assesses the impact of helmet laws on the motorcycle (MC) fatality rate in the United States from 1999 to 2015.

METHODS

Fatality Analysis Reporting System MC fatalities (aged ≥16 years), crash characteristics, and MC-related laws were collected by year for all 50 states from 1999 to 2015 to create a pooled time series. Generalized linear autoregressive modeling was applied to assess the relative contribution of helmet laws to the MC fatality rate while controlling for other major driver laws and crash characteristics.

RESULTS

Universal helmet laws were associated with a 36% to 45% decline in the motorcycle crash mortality rate during the study period across all age cohorts (unstandardized regression coefficients are reported): 16 to 20 years, B = -0.45 (p < 0.05); 21 to 55 years, B = -0.42 (p < 0.001); 56 to 65 years, B = -0.38 (p < 0.04); and older than 65 years, B = -0.36 (p < 0.02). Partial helmet laws were associated with a 1% to 81% increase in the fatality rate compared with states with no helmet laws and a 22% to 45% increase compared with universal laws. Helmet usage did not attenuate the countervailing effect of weaker partial laws for 16 to 20 years (B = 0.01 [p < 0.001]). Other laws associated with a declining motorcycle crash mortality rate included the following: social host/overservice laws, 21 to 55 years (B = -0.38 [p < 0.001]); 56 to 65 years (B = -0.16 [p < 0.002]), and older than 65 years (B = -0.12 [p < 0.003]); laws reducing allowable blood alcohol content, 21 to 55 years (B = -4.9 [p < 0.02]); and laws limiting passengers for new drivers 16 to 20 years (B = -0.06 [p < 0.01]).

CONCLUSION

During the period of the study, universal helmet laws were associated with a declining mortality rate, while partial helmet laws were associated with an increasing mortality rate. Other state driver laws were also associated with a declining rate. In addition to universal helmet laws, advocating for strict alcohol control legislation and reevaluation of licenses in older riders could also result in significant reduction in MC-related mortality.

LEVEL OF EVIDENCE

Prognostic and epidemiological, level III.

The impact of state laws on motor vehicle fatality rates, 1999-2015

BACKGROUND

Motor vehicle crash (MVC) fatalities have been declining while states passed various legislation targeting driver behaviors. This study assesses the impact of state laws on MVC fatality rates to determine which laws were effective.

METHODS

Publically available data were collected on driver-related motor vehicle laws, law strengths, enactment years, and numbers of verified-trauma centers. Prospective data on crash characteristics and MVC fatalities 16 years or older from Fatality Analysis Reporting System 1999 to 2015 (n = 850) were obtained. Generalize Linear Autoregressive Modeling was used to assess the relative contribution of state laws to the crude MVC fatality rate while controlling for other factors.

RESULTS

Lowering the minimum blood alcohol content (BAC) was associated with largest declines for all ages, especially the older cohorts: 16 years to 20 years (B = 0.23; p < 0.001), 21 years to 55 years (B = 1.7; p < 0.001); 56 years to 65 years (B = 3.2; p < 0.001); older than 65 years (B = 4.1; p < 0.001). Other driving under the influence laws were also significant. Per se BAC laws accompanying a reduced BAC further contributed to declines in crude fatality rates: 21 years to 55 years (B = -0.13; p < 0.001); older than 65 years (B = -0.17; p < 0.05). Driving under the influence laws enhancing the penalties, making revocation automatic, or targeting social hosts had mixed effects by age. Increased enforcement, mandatory education, vehicle impoundment, interlock devices, and underage alcohol laws showed no association with declining mortality rates. Red light camera and seatbelt laws were associated with declines in mortality rates for all ages except for older than 65 years cohort, but speed camera laws had no effect. Graduated Driver License laws were associated with declines for 16 years to 21 years (B = -0.06; p < 0.001) only. Laws targeting specific risks (elderly, motorcycles, marijuana) showed no effect on declining MVC mortality rates during the study period.

CONCLUSION

States have passed a wide variety of laws with varying effectiveness. A few key laws, specifically laws lowering allowable BAC, implementing red light cameras, and mandating seatbelt use significantly reduced MVC mortality rates from 1999 to 2015. Simply adding more laws/penalties may not equate directly to lives saved. Continued research on state laws will better inform policy makers to meet evolving public health needs in the management of MVC fatalities.

LEVEL OF EVIDENCE

Epidemiological, Level III.

Associations between graduated driver licensing and road trauma reductions in a later licensing age jurisdiction: Queensland, Australia

The success of driver graduated licensing systems (GLS) is demonstrated primarily in jurisdictions that licence at young ages with requirements expiring at age 18. In Australia, GLS requirements typically apply for all applicants aged under 25. In 2007, the Queensland licensing system was strengthened, extending the learner and introducing a 100-hour supervised driving requirement, introducing restrictions on passenger carriage at night and high-powered vehicles for provisional drivers, and on phone use for all novice drivers (learner and provisional). The objective of the current research was to evaluate whether these changes were associated with reductions in crashes (all) and killed-and-serious-injury (KSI) crashes involving novice drivers, and respective casualties. Government licensing and police crash records were linked and interrupted time series analysis was used to examine potential shifts in crash trends by rates of licensed drivers per month. Substantial declines were found in novice driver crashes (13.1% per year; 95%CI -0.0130, -0.0096), crash casualties (13.9% per year; 95%CI -0.0137, -0.0101), KSI crashes (5.4% per year; 95%CI -0.0080, -0.0046) and associated casualties (5.2% per year; 95%CI -0.0075, -0.0039). Compared to the total licensed driver population, declines in crashes (3.0% per year; 95%CI -0.0027, -0.0007) and crash casualties (2.9% per year; 95%CI -0.0029, -0.0006) but not KSI outcomes were observed. More narrowly, declines were found for provisional-licensed driver crashes (9.3% per year; 95%CI -0.0096, -0.0063) and KSI crashes (3.6% per year; 95%CI -0.0004, -0.0128) that were approximately 2.6% and 1.2% greater than respective declines for 25-29-year-old open-licensed drivers. Substantial declines also were observed in novice driver single-vehicle, night, passenger and alcohol crashes. Overall, these results demonstrate that GLS can be effective in a later age licensing jurisdiction. However, KSI outcomes were limited. Modelling research is recommended on ways to further strengthen Queensland’s GLS to achieve greater trauma reductions.

Brief Report: The Association of Graduated Driver Licensing with Nondriver Transport-related Injuries Among Adolescents

BACKGROUND

As a phased approach to initiating driving, graduated driver licensing restricts driving by young drivers with the aim of reducing crashes. It might increase riding with parents or on buses, which might be safer, or walking or biking, which might be more dangerous. We examined whether it increases nondriver injuries, and whether it reduces total injuries combining drivers and nondrivers.

METHODS

We conducted longitudinal analyses of 1995-2012 traffic injuries from 43 states. Using Poisson mixed regression, we estimated adjusted rate ratios for visible, incapacitating, and fatal injury.

RESULTS

Among 16 year olds, graduated driver licensing was associated with reduced passenger injuries (adjusted rate ratio 0.93, 95% confidence interval: 0.89, 0.97). It was not associated with increased injuries as bus riders, pedestrians, or bicyclists among 16- or 17-year olds. It was associated with a 10% reduction in total injuries among 16-year olds, but not 17-year olds.

CONCLUSION

Graduated driver licensing was associated with reduced passenger injuries and total injuries.

The impact of the 2007 graduated driver licensing law in Massachusetts on the rate of citations and licensing in teenage drivers

OBJECTIVE

We recently demonstrated that the 2007 Massachusetts Graduated Driving Licensing (GDL) law decreased the rate of motor vehicle crashes in teenage drivers. To better understand this decrease, we sought to examine the law's impact on the issuance of driving licenses and traffic citations to teenage drivers.

METHODS

Citation and license data were obtained from the Massachusetts Department of Transportation. Census data were obtained from the Census Data Center. Two study periods were defined: pre-GDL (2002-2006) and post-GDL (2007-2012). Two populations were defined: the study population (aged 16-17) and the control population (aged 25-29). The rates of licenses per population were compared pre- vs. post-GDL for the study group. The numbers of total, state, and local citations per population were compared pre- vs. post-GDL for both populations. A sensitivity analysis was performed for the rates of citations using licenses issued as a denominator.

RESULTS

While licenses per population obtained by the study group decreased over the entire period, there was no change in the rate of decrease per year pre- vs. post-GDL (2.0% vs. 1.4%; p=0.6392). In the study population, total, state, and local citations decreased post-GDL (17.8% vs. 8.1%, p<0.0001; 3.7% vs. 2.2%, p<0.0001; 14.1% vs. 5.8%, p<0.0001, respectively). In the control group, total and state citations did not change (26.7% vs. 23.9%, p=0.3606; 9.2% vs. 10.2%, p=0.3404, respectively), and local citations decreased (17.5% vs. 13.7%, p=0.0389). The rates of decrease per year for total, state, and local citations were significantly greater in the study population compared with control (p<0.0001, p=0.0002, p<0.0001, respectively).

CONCLUSIONS

The 2007 GDL law in Massachusetts was associated with fewer traffic citations without a change in the rate of licenses issued to teenagers. These findings suggest that 2007 GDL may be improving driving habits as opposed to motivating teenagers to delay the issuing of licenses.

Teen Crashes Declined After Massachusetts Raised Penalties For Graduated Licensing Law Restricting Night Driving

In 2007, as part of the Massachusetts graduated driver-licensing program designed to allow junior operators (ages 16½-17 years) to gain experience before receiving full licensure, stringent penalties were introduced for violating a law prohibiting unsupervised driving at night; driver education, including drowsy driving education, became mandatory; and other new restrictions and penalties began. We evaluated the impact of these changes on police-reported vehicle crash records for one year before and five years after the law's implementation in drivers ages 16-17, inclusive, and two comparison groups. We found that crash rates for the youngest drivers fell 18.6 percent, from 16.24 to 13.22 per 100 licensed drivers. For drivers ages 18-19 the rates fell by 6.7 percent (from 9.59 to 8.95 per 100 drivers), and for those ages 20 and older, the rate remained relatively constant. The incidence rate ratio for drivers ages 16-17 relative to those ages 20 and older decreased 19.1 percent for all crashes, 39.8 percent for crashes causing a fatal or incapacitating injury, and 28.8 percent for night crashes. Other states should consider implementing strict penalties for violating graduated driver-licensing laws, including restrictions on unsupervised night driving, to reduce the risk of sleep-related crashes in young people.

Association of Graduated Driver Licensing With Driver, Non-Driver, and Total Fatalities Among Adolescents

INTRODUCTION

Graduated driver licensing systems typically require an extended learner permit phase, and create night-time driving or passenger restrictions for adolescent drivers. Restricted driving might increase the use of alternative transportation to replace driving and consequently increase crashes and injuries for passengers, bus riders, pedestrians, and bicyclists. This study examined whether graduated driver licensing increases non-driver fatalities among adolescents, and whether it reduces total traffic fatalities combining drivers and non-drivers.

METHODS

Longitudinal analyses were conducted using data from the 1995-2012 U.S. Fatality Analysis Reporting System. Adjusted rate ratios were estimated for being fatally injured in a crash according to: (1) presence/absence of a graduated driver licensing system; and (2) four levels of graduated driver licensing systems (absent, weak, medium, strong). Analyses were conducted in 2015.

RESULTS

Among adolescents aged 16 years, graduated driver licensing was not associated with increased passenger fatalities (adjusted rate ratio, 0.96; 95% CI=0.90, 1.03) or pedestrian and bicyclist fatalities (adjusted rate ratio, 1.09; 95% CI=0.85, 1.39), but was associated with an 11% reduction in total traffic fatalities. Among those aged 17 years, graduated driver licensing was not associated with increased fatalities as passengers, pedestrians, or bicyclists, and was not associated with reduced total traffic fatalities.

CONCLUSIONS

In general, graduated driver licensing systems were not associated with increased fatalities as passengers, pedestrians, bicyclists, and bus riders. Graduated driver licensing systems were associated with reduced total fatalities of adolescents aged 16 years.

Evaluating adverse rural crash outcomes using the NHTSA State Data System

INTRODUCTION

The population-based rate of motor vehicle crash mortality is consistently higher in rural locations, but it is unclear how much of this disparity might be due to geographic barriers or deficiencies in emergency medical services (EMS). We sought to analyze separately factors associated with the occurrence of a severe injury and those associated with death after injury had occurred.

METHODS

Data from all police-reported crashes in 11 states from 2005-2007 were obtained through the National Highway Traffic Safety Administration (NHTSA) State Data System (SDS). Logistic regression was used to estimate factors associated with (1) death; (2) severe (incapacitating or fatal) injury; and (3) death given severe injury. Models included covariates related to the person, vehicle, and event; county location was specified using Rural-Urban Continuum Codes (RUCC).

RESULTS

Older age, not wearing a belt, ejection, alcohol involvement, high speed, and early morning times were associated with increased risk of both severe injury and death. Controlling for these factors, and restricting analysis to persons who had suffered a severe injury, the adjusted odds ratio (aOR) associated with death was higher for counties classified rural (RUCC 6-7, aOR 1.23, 95% CI 1.16-1.31) or very rural (RUCC 8-9, aOR 1.31, 95% CI 1.18-1.46).

CONCLUSIONS

Persons severely injured in crashes are more likely to die if they are in rural locations, possibly due to EMS constraints. As NHTSA-SDS data become more available and more uniform, they may be useful to explore specific factors contributing to this increased risk.

Prevention of taxi accidents in Xi'an, China: what matters most?

OBJECTIVES

Since the city of Xi'an has been extremely concerned with the serious problem of taxi involved crashes, injuries and fatalities, the primary purpose of this study is to identify the risk factors associated with the magnitude and nature of the problem and provide possible measures for enhancing the overall safety performance of taxi industry.

METHODS

Using 726 crash samples from the original of 7,183 observations in Xi'an over the period from 2006 to 2012, comparative statistics and systematic analysis were employed to describe the distribution of taxi crashes by driver characteristics, roadway contributors and environmental factors and then determine the significant factors contributing to crash injuries and fatalities.

RESULTS

The trend and pattern of taxi involved crashes vary significantly. Middle aged (77.27%) male (91.60%) drivers with limited education (68.59%) and less driving (31.27%) and job (82.50%) experience were much more likely to be involved in such a crash. Additionally, it is found that a large majority of taxi crashes occurred with the most frequent type of rear end collisions (30.72%), on six-lane segments without median (16.94%) or four legged intersections (15.29%), under adverse weather conditions (31.82%), at weekends (34.99%), and during winter days (34.72%), but fatal and serious crashes were more likely to happen at night (30.72%) or under wet road surface conditions (16.94%), due to driver's overspeeding, unbelted, disregarding signs or signals, or other types of risk driving behaviour.

CONCLUSIONS

The risk of taxi related crashes varies by drivers, roadways and environment. To reduce the risk of potential crashes for taxi drivers, we recommend the targeted legislation and enforcement, stronger night and trip restrictions, awareness of risk behaviour, and periodical training requirement. Such proposals and measures are expected to help mitigate taxi crashes and promote road safety in China.

The association of graduated driver licensing with miles driven and fatal crash rates per miles driven among adolescents

BACKGROUND

Graduated driver licensing (GDL) laws are associated with reduced crash rates per person-year among adolescents. It is unknown whether adolescents crash less per miles driven or drive less under GDL policies.

METHODS

We used data from the US National Household Travel Survey and Fatality Analysis Reporting System for 1995-1996, 2001-2002 and 2008-2009. We compared adolescents subject to GDL laws with those not by estimating adjusted IRRs for being a driver in a crash with a death per person-year (aIRRpy) and per miles driven (aIRRm), and adjusted miles driven ratios (aMR) controlling for changes in rates over time.

RESULTS

Comparing persons subject to GDL policies with those not, 16 year olds had fewer fatal crashes per person-year (aIRRpy 0.63, 95% CI 0.47 to 0.91), drove fewer miles (aMR 0.79, 95% CI 0.63 to 0.98) and had lower crash rates per miles driven (aIRRm 0.83, 95% CI 0.65 to 1.06). For age 17, the aIRRpy was 0.83 (95% CI 0.60 to 1.17), the aMR 0.80 (95% CI 0.63 to 1.03) and the aIRRm 1.03 (95% CI 0.80 to 1.35). For age 18, the aIRRpy was 0.93 (95% CI 0.72 to 1.19), the aMR 0.92 (95% CI 0.77 to 1.09) and the aIRRm 1.01 (95% CI 0.84 to 1.23).

CONCLUSIONS

If these associations are causal, GDL laws reduced crashes per person-year by about one-third among 16 year olds; half the reduction was due to fewer crashes per miles driven and half to less driving. For ages 17 and 18, there was no evidence of reduced crash rates per miles driven.

Graduated Driver Licensing: An international review

Graduated driver licensing (GDL) aims to gradually increase the exposure of new drivers to more complex driving situations and typically consists of learner, provisional and open licence phases. The first phase, the learner licence, is designed to allow novice drivers to obtain practical driving experience in lower risk situations. The learner licence can delay licensure, encourage novice drivers to learn under supervision, mandate the number of hours of practice required to progress to the next phase and encourage parental involvement. The second phase, the provisional licence, establishes various driving restrictions and thereby reduces exposure to situations of higher risk, such as driving at night, with passengers or after drinking alcohol. Parental involvement with a GDL system appears essential in helping novices obtain sufficient practice and in enforcing compliance with restrictions once the new driver obtains a provisional licence. Given the significant number of young drivers involved in crashes within Oman, GDL is one countermeasure that may be beneficial in reducing crash risk and involvement for this group.

Preventing texting while driving: a statement of the American College of Preventive Medicine

The American College of Preventive Medicine (ACPM) is providing a set of recommendations designed to reduce the morbidity and mortality associated with distractions due to texting while driving. According to the National Highway Traffic Safety Administration, 12% of all fatal crashes involving at least one distracted driver are estimated to be related to cell phone use while driving. Given the combination of visual, manual, and cognitive distractions posed by texting, this is an issue of major public health concern for communities. Therefore, the ACPM feels it is timely to discuss this issue and provide the following recommendations: 1. Encourage state legislatures to develop and pass legislation banning texting while driving, while simultaneously implementing comprehensive and dedicated law enforcement strategies including penalties for these violations. Legislatures should establish a public awareness campaign regarding the dangers of texting while driving as an integral part of this legislation. 2. Promote further research into the design and evaluation of educational tools regarding texting while driving that can be incorporated into the issuance of driver’s licenses. 3. Provide primary care providers with the appropriate tools to educate patients of all ages. 4. Conduct additional studies investigating the risks associated with cell phone usage while driving, particularly texting, with motor vehicle crashes.

The role of parents and non-parents in the supervision of learner drivers in Australia

The purpose of this study was to contrast the role of parental and non-parental (sibling, other family and non-family) supervisors in the supervision of learner drivers in graduated driver licensing systems. The sample consisted of 522 supervisors from the Australian states of Queensland (n=204, 39%) and New South Wales (n=318, 61%). The learner licence requirements in these two states are similar, although learners in Queensland are required to accrue 100h of supervision in a log book while those in New South Wales are required to accrue 120h. Approximately 50 per cent of the sample (n=255) were parents of the learner driver while the remainder of the sample were either siblings (n=72, 13.8%), other family members (n=153, 29.3%) or non-family (n=114, 21.8%). Parents were more likely than siblings, other family or non-family members to be the primary supervisor of the learner driver. Siblings provided fewer hours of practice when compared with other supervisor types while the median and mode suggest that parents provided the most hours of practice to learner drivers. This study demonstrates that non-parental supervisors, such as siblings, other family members and non-family, at least in jurisdictions that require 100 or 120h of practice, are important in facilitating learner drivers to accumulate sufficient supervised driving practice.

Child injury control: trends, themes, and controversies

Injury is a major cause of morbidity and mortality among US children, and an important driver of health status globally. Despite its enormous burden, injury is preventable. Over the last 10 years, significant progress has been made in the reduction of unintentional injury among US children. However, aggregate trends mask important disparities by age group, region, and injury mechanism. Basic and translation research is needed to develop and test prevention strategies to address these new or recalcitrant problems. Motor vehicle occupant injury has fallen to historic lows, but challenges remain in protecting novice drivers and managing the distraction of new technologies. Injury to pedestrians has also declined, but likely as a result of decreased exposure as fewer children walk. This calls for a broader public health perspective to promote activity while enhancing safety. Deaths due to drowning are common and illustrate the difficulty in measuring and promoting appropriate supervision. Environmental modification and use of protective products may be a more appropriate response. Concussion in sport is another challenging issue: public health laws promote identification and appropriate management of concussed athletes, but less progress has been made on primary prevention of these injuries. Unintentional poisoning is on the rise, attributable to misuse of, and overdose with, prescription opioids. Injury deaths to infants are also increasing. This trend is driven in part by better death investigation that classifies more sleep-related deaths as suffocation events. Finally, we examine a sample of cross-cutting themes and controversies in injury control that might be amenable to empiric evaluation.

Adolescence extended: implications of new brain research on medicine and policy

Last December, the Excellence in Paediatrics conference presented a panel discussion of how new biologic findings from brain imaging cast new light on adolescent development. This study will review this presentation, focusing on the interplay between adolescent development and new brain research findings.

CONCLUSION

Paediatricians can consider these new insights in both interacting individually with patients and advocating for policies within their communities.

Graduated driver licensing research, 2010-present

This is the latest in a series of reviews of research on graduated driver licensing (GDL) published in the Journal of Safety Research, covering the period January 1, 2010-June 1, 2012 and works in progress. The intent is to keep researchers and policy makers current regarding the existing state of knowledge about GDL, and to identify information gaps and areas where clarification of research findings are needed. The recent research indicates that we continue to learn about ways to extend GDL benefits, but there remain important questions in need of further inquiry. In terms of impact on industry, the review provides guidance for the future GDL research agenda.