Characteristics of teens-with-teens fatal crashes in the United States, 2005-2010

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.

Passenger Presence and the Relative Risk of Teen Driver Death

PURPOSE

This study examines the relative risk of death among crash-involved teenage drivers in relation to the number and ages of passengers present.

METHODS

We performed cross-sectional analysis of police-reported crashes in the United States in years 2016-2019 to estimate rate ratios for death among drivers aged 16-17 years by passenger composition (no passengers, one teen, ≥two teens, teens and adults aged 20-34 years, adults aged 20-34 years only, ≥one adult aged 35-64 years). Models were adjusted for confounding and effect modification related to driver, crash, and environmental factors.

RESULTS

Crash-involved teen drivers carrying ≥2 teen passengers were twice as likely to die as teens driving alone. The driver was seven times as likely to die when carrying a mix of teen and young adult passengers compared with teens driving alone. Teen drivers' risk of death was lowest in the presence of an adult passenger aged 35-64 years. Carrying one teen passenger presents greater risk of death than driving alone for male teen drivers but not for females.

DISCUSSION

When teen drivers crash, they are more likely to die if they are carrying teen and/or young adult passengers than if they are driving alone or with a mature adult. The results support the current graduated licensing policies restricting young novice drivers from carrying teenage passengers. Results also help to clarify why previous studies have found that young passengers are associated with increased risk of fatal crashes, but not nonfatal crashes: it appears that passengers may have an effect on crash severity.

Incorporating accident liability into crash risk analysis: A multidimensional risk source approach

In the field of traffic safety, the occurrence of accidents remains a cause of concern for road regulators as well as users. Exploring risk factors inducing the accidents and quantifying the accident risk will not only benefit the prevention and control of traffic accidents but also assist in developing effective risk propagation model for road accidents. This study uses detailed accident record data to mine the risk factors affecting the occurrence of accidents, and quantify the accident risk under the combination of risk factors. First, by reviewing relevant literature and analyzing historical accident, we construct a multi-dimension characterization framework of risk factors with bi-level structure. The Human Factors Analysis and Classification System (HFACS) is applied to supplement and improve the framework. Next, under this framework, we identify the risk factors in traffic accident record, and analyze the statistical characteristics from the level of risk sources and risk characteristics. Then, the concept of accident liability weight is proposed to measure the impact of risk factors on accident occurrence. Through the liability affirmation of risk factors, the accident probability are updated. Last, we establish an accident risk quantify model (ARQM) based on the mean mutual information to compare the likelihood of accidents in different scenarios. In addition, we compare the accident probability and risk under equivalent liability and liability affirmation, as well as give some fundamental ideas regarding how to effectively prevent accidents.

Initial Testing of a Web-Based Intervention to Reduce Adolescent Driver Inattention: A Randomized Controlled Trial

INTRODUCTION

Motor vehicle crashes are the leading cause of adolescent death. Inattention to the roadway contributes to crash risk. The objective of this study was to deploy an initial study of a web-based intervention (Let's Choose Ourselves) designed to improve adolescent driver attention to the roadway.

METHODS

We used a randomized controlled trial design in a sample of adolescent drivers to test if a web-based intervention decreased cell phone engagement in driving simulation at 3 months as compared with controls. As secondary hypotheses, we tested if the intervention increased the use of peer passengers to manage distractions and decreased eyes off the forward roadway in driving simulation and decreased self-reported risky driving behaviors. Adolescents, aged 16-17 years, licensed for ≤90 days were randomized to Let's Choose Ourselves with distractions in the simulator protocol at baseline, Let's Choose Ourselves with no distractions, an attention control intervention on healthy eating with distractions, or attention control with no distractions. We used Poisson regression modeling to test the primary and secondary hypotheses.

RESULTS

The trial included 60 adolescents (66.7% female, 78.3% non-Hispanic white subjects, mean age 16.8 years, licensed 50.8 days). In Poisson regression, controlling for sex, we found no significant effects of Let's Choose Ourselves on primary or secondary outcomes. However, there was a significant effect of visit on self-report outcomes, with self-reported distracted driving behaviors increasing over time.

DISCUSSION

Although there were no significant effects of Let's Choose Ourselves, self-reported risky driving behaviors increased over time. Further investigation of the relationship between driving experience and increasing inattention to the road in adolescents is warranted.

High School Student Driving Perceptions Following Participation in a Distracted Driving Curriculum

Objectives. Distracted driving is a major public health issue in the United States. In response to requests from high school students participating in a university-based initiative, the authors describe the collaborative development and implementation of a curriculum designed to address distracted driving behaviors among students in four high-needs school districts in the northeastern United States. Method. The curriculum integrates current statistics on distracted and drowsy driving and three interactive learning stations: driving while distracted, walking while distracted, and driving while drowsy. Pre- and postsurveys were conducted to collect student driving data, assess student satisfaction with the program, and assess their likelihood of speaking up as a passenger in a high-risk situation. Results. The majority of students reported that they learned new information and would recommend the program to others. A Wilcoxon signed-rank test showed that students were more likely to speak up as a passenger with a distracted or drowsy driver (p < .001) after the program. Conclusion. This experience demonstrates a voluntary, multidisciplinary, university-based collaboration in the development of a novel public health education initiative. Based on the success of this phase, school districts elected to participate in Train the Trainer sessions to continue the program within their local high-needs school district.

A comparison of hazard perception and hazard prediction tests across China, Spain and the UK

Hazard perception (HP) is the ability to spot on-road hazards in time to avoid a collision. This skill is traditionally measured by recording response times to hazards in video clips of driving, with safer, experienced drivers often out-performing inexperienced drivers. This study assessed whether HP test performance is culturally specific by comparing Chinese, Spanish and UK drivers who watched clips filmed in all three countries. Two test-variants were created: a traditional HP test (requiring timed hazard responses), and a hazard prediction test, where the film is occluded at hazard-onset and participants predict what happens next. More than 300 participants, across the 3 countries, were divided into experienced and inexperienced-driver groups. The traditional HP test did not discriminate between experienced and inexperienced drivers, though participant nationality influenced the results with UK drivers reporting more hazards than Chinese drivers. The hazard prediction test, however, found experienced drivers to out-perform inexperienced drivers. No differences were found for nationality, with all nationalities being equally skilled at predicting hazards. The results suggest that drivers' criterion level for responding to hazards is culturally sensitive, though their ability to predict hazards is not. We argue that the more robust, culturally-agnostic, hazard prediction test appears better suited for global export.

Unwarranted clinical variation in the care of children and young people hospitalised for injury: a population-based cohort study

INTRODUCTION

Injury is a leading cause of death and disability among children and young people. Recovery may be negatively affected by unwarranted clinical variation such as representation to an emergency department (ED), readmission to a hospital, and mortality. The aim of this study was to examine unwarranted clinical variation across providers of care of children and young people who were hospitalised for injury in New South Wales (NSW).

MATERIALS AND METHODS

Retrospective population-based cohort study using linked ED, hospital, and mortality data of all children and young people aged ≤25 years who were injured and hospitalised during 1 January 2010-30 June 2014 in NSW. Unwarranted clinical variation across providers was examined using three indicators. That is, for each hospital that treated ≥100 cases per year, risk standardised ratios were calculated with 95% and 99.8% confidence limits using the number of observed and expected events of (1) representations to ED within 72 h, (2) unplanned readmissions to hospital within 28 days, and (3) all-cause mortality within 30 days.

RESULTS

There were 189,990 injury-related hospitalisations of children and young people. Of these, 4.4% represented to an ED, 8.7% were readmitted to hospital, and 0.2% died. Of the 45 public hospitals that treated ≥100 cases per year, higher than expected rates of ED representations, hospital readmissions, and mortality were observed in eleven, six, and two hospitals, respectively.

CONCLUSION

The rates of ED representations, hospital readmissions, and mortality among children and young people hospitalised for injury in NSW were similar to the rates reported in other countries. However, unwarranted clinical variation across public hospitals was observed for all three indicators. These findings suggest that by improving routine follow-up support services post-discharge for children and young people and their families, it may be possible to reduce unwarranted clinical variation and improve health outcomes.

Development of a Theoretically Grounded, Web-Based Intervention to Reduce Adolescent Driver Inattention

Motor vehicle crashes are the leading cause of adolescent death. Inattention to the roadway contributes to crash risk and often results from distractions, such as cell phone calls, texting, and peer passengers. We report on the development of a web-based intervention based on the Theory of Planned Behavior that aims to reduce adolescent driver inattention ( Let's Choose Ourselves). In Phase I, we collected qualitative and quantitative data on adolescents' attitudes, perceived behavioral control, and subjective norms about driver inattention through focus groups with newly licensed adolescent drivers. In Phase II, we developed the content in an e-learning delivery system, performed beta- and pilot testing, and made refinements. In Phase III, we conducted a randomized controlled trial to evaluate feasibility. The development of Let's Choose Ourselves provides information for school nurses regarding intervention development strategies as well as promotion of safe adolescent driving by reducing driver inattention.

Peer Passenger Norms and Pressure: Experimental Effects on Simulated Driving Among Teenage Males

OBJECTIVE

Serious crashes are more likely when teenage drivers have teenage passengers. One likely source of this increased risk is social influences on driving performance. This driving simulator study experimentally tested the effects of peer influence (i.e., risk-accepting compared to risk-averse peer norms reinforced by pressure) on the driving risk behavior (i.e., risky driving behavior and inattention to hazards) of male teenagers. It was hypothesized that peer presence would result in greater driving risk behavior (i.e., increased driving risk and reduced latent hazard anticipation), and that the effect would be greater when the peer was risk-accepting.

METHODS

Fifty-three 16- and 17-year-old male participants holding a provisional U.S., State of Michigan driver license were randomized to either a risk-accepting or risk-averse condition. Each participant operated a driving simulator while alone and separately with a confederate peer passenger. The simulator world included scenarios designed to elicit variation in driving risk behavior with a teen passenger present in the vehicle.

RESULTS

Significant interactions of passenger presence (passenger present vs. alone) by risk condition (risk-accepting vs. risk-averse) were observed for variables measuring: failure to stop at yellow light intersections (Incident Rate Ratio (IRR)=2.16; 95% Confidence Interval [95CI]=1.06, 4.43); higher probability of overtaking (IRR=10.17; 95CI=1.43, 73.35); shorter left turn latency (IRR=0.43; 95CI=0.31,0.60); and, failure to stop at an intersection with an occluded stop sign (IRR=7.90; 95CI=2.06,30.35). In all cases, greater risky driving by participants was more likely with a risk-accepting passenger versus a risk-averse passenger present and a risk-accepting passenger present versus driving alone.

CONCLUSIONS

Exposure of male teenagers to a risk-accepting confederate peer passenger who applied peer influence increased simulated risky driving behavior compared with exposure to a risk-averse confederate peer passenger or driving alone. These results are consistent with the contention that variability in teenage risky driving is in part explained by social influences.

Neural responses to exclusion predict susceptibility to social influence

PURPOSE

Social influence is prominent across the lifespan, but sensitivity to influence is especially high during adolescence and is often associated with increased risk taking. Such risk taking can have dire consequences. For example, in American adolescents, traffic-related crashes are leading causes of nonfatal injury and death. Neural measures may be especially useful in understanding the basic mechanisms of adolescents' vulnerability to peer influence.

METHODS

We examined neural responses to social exclusion as potential predictors of risk taking in the presence of peers in recently licensed adolescent drivers. Risk taking was assessed in a driving simulator session occurring approximately 1 week after the neuroimaging session.

RESULTS

Increased activity in neural systems associated with the distress of social exclusion and mentalizing during an exclusion episode predicted increased risk taking in the presence of a peer (controlling for solo risk behavior) during a driving simulator session outside the neuroimaging laboratory 1 week later. These neural measures predicted risky driving behavior above and beyond self-reports of susceptibility to peer pressure and distress during exclusion.

CONCLUSIONS

These results address the neural bases of social influence and risk taking; contribute to our understanding of social and emotional function in the adolescent brain; and link neural activity in specific, hypothesized, regions to risk-relevant outcomes beyond the neuroimaging laboratory. Results of this investigation are discussed in terms of the mechanisms underlying risk taking in adolescents and the public health implications for adolescent driving.