Graduated driver licensing (GDL) in the United States in 2016: A literature review and commentary

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.

Development of an algorithm for analysis of routes: Case studies using novice and older drivers

INTRODUCTION

This study addresses the lack of methods to quantify driver familiarity with roadways, which poses a higher risk of crashes.

METHOD

We present a new approach to assessing driving route diversity and familiarity using data from the DrivingApp, a smartphone-based research tool that collects trip-level information, including driving exposure and global positioning system (GPS) data, from young novice drivers (15-19 years old) to older drivers (67-78 years old). Using these data, we developed a GPS data-based algorithm to analyze the uniqueness of driving routes. The algorithm creates same route trip (SRT) arrays by comparing each trip of an identified user, employing statistically determined thresholds for GPS coordinate proximity and trip overlap. The optimal thresholds were established using a General Linear Model (GLM) to examine distance, and repeated observations. The Adjusted Breadth-First Search method is applied to the SRT arrays to prevent double counting or trip omission. The resulting list is classified as geographically distinct routes, or unique routes (URs).

RESULTS

Manual comparison of algorithm output with geographical maps yielded an overall precision of 0.93 and accuracy of 0.91. The algorithm produces two main outputs: a measure of driving diversity (number of URs) and a measure of route-based familiarity derived from the Rescorla-Wagner model. To evaluate the utility of these measures, a Gaussian mixture model clustering algorithm was used on the young novice driver dataset, revealing two distinct groups: the low-frequency driving group with lower route familiarity when having higher route diversity, whereas the high-frequency driving group with the opposite pattern. In the older driver group, there was a significant correlation found between the number of URs and Geriatric Depression Score, or walking gait speed.

PRACTICAL APPLICATIONS

These findings suggest that route diversity and familiarity could complement existing measures to understand driving safety and how driving behavior is related to physical and psychological outcomes.

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.

Driver's Licensure and Driving Outcomes Among Youths With Mood Disorders

Importance

Mood disorders are prevalent among adolescents and young adults, and their onset often coincides with driving eligibility. The understanding of how mood disorders are associated with youth driving outcomes is limited.

Objective

To examine the association between the presence of a mood disorder and rates of licensing, crashes, violations, and suspensions among adolescents and young adults.

Design, Setting, and Participants

This cohort study was conducted among New Jersey residents who were born 1987 to 2000, age eligible to acquire a driver's license from 2004 to 2017, and patients of the Children's Hospital of Philadelphia network within 2 years of licensure eligibility at age 17 years. The presence of a current (ie, ≤2 years of driving eligibility) mood disorder was identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Rates of licensure and driving outcomes among youths who were licensed were compared among 1879 youths with and 84 294 youths without a current mood disorder from 2004 to 2017. Data were analyzed from June 2022 to July 2023.

Main Outcomes and Measures

Acquisition of a driver's license and first involvement as a driver in a police-reported crash and rates of other adverse driving outcomes were assessed. Survival analysis was used to estimate adjusted hazard ratios (aHRs) for licensing and driving outcomes. Adjusted rate ratios (aRRs) were estimated for driving outcomes 12 and 48 months after licensure.

Results

Among 86 173 youths (median [IQR] age at the end of the study, 22.8 [19.7-26.5] years; 42 894 female [49.8%]), there were 1879 youths with and 84 294 youths without a mood disorder. A greater proportion of youths with mood disorders were female (1226 female [65.2%]) compared with those without mood disorders (41 668 female [49.4%]). At 48 months after licensure eligibility, 75.5% (95% CI, 73.3%-77.7%) and 83.8% (95% CI, 83.5%-84.1%) of youths with and without mood disorders, respectively, had acquired a license. Youths with mood disorders were 30% less likely to acquire a license than those without a mood disorder (aHR, 0.70 [95% CI, 0.66-0.74]). Licensed youths with mood disorders had higher overall crash rates than those without mood disorders over the first 48 months of driving (137.8 vs 104.8 crashes per 10 000 driver-months; aRR, 1.19 [95% CI, 1.08-1.31]); licensed youths with mood disorders also had higher rates of moving violations (aRR, 1.25 [95% CI, 1.13-1.38]) and license suspensions (aRR, 1.95 [95% CI, 1.53-2.49]).

Conclusions and Relevance

This study found that youths with mood disorders were less likely to be licensed and had higher rates of adverse driving outcomes than youths without mood disorders. These findings suggest that opportunities may exist to enhance driving mobility in this population and elucidate the mechanisms by which mood disorders are associated with crash risk.

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.

An exploratory study of parent acceptance of sanctions for driving offenses committed by their children

OBJECTIVE

Graduated driver licensing (GDL) systems are effective at reducing young driver crashes but rely on active parental involvement. However, some parents may accept sanctions (e.g., demerit points, monetary fines) for traffic offenses committed by their children, leading to experiences of punishment avoidance by young drivers. This aim of this exploratory study was to investigate several demographic and psychosocial influences that could possibly be associated with parent acceptance of sanctions.

METHOD

An online survey was completed by parents of young drivers (N = 149, M = 48.88 years, SD = 4.76 years; female = 86%) from 3 Australian states. The survey included measures of sociodemographic characteristics and driving history (e.g., crash involvement), socioeconomic status, parenting style, knowledge of their child's driving behavior, perceptions of their ability to manage their child's driving, attitudes toward GDL, and previous or potential acceptance of demerit points or payment of fines for road offenses committed by their child.

RESULTS

Twenty-nine percent of parents had accepted or would accept a sanction on behalf of their child. Number of children overall, number of children licensed, and household income were associated with parent acceptance of a sanction. Parenting style, attitude toward GDL restrictions, parent confidence in their knowledge of GDL restrictions and ability to manage their child's driving, and belief that their child would follow rules were not associated with (non)acceptance of a sanction.

CONCLUSIONS

These exploratory findings suggest that family size and income may be important influences on parent acceptance of sanctions on behalf of their offending children. The findings related to the psychosocial variables are discussed considering other research and the limitations of the study.

Driving Skills at Licensure and Time to First Crash

BACKGROUND AND OBJECTIVES

Young drivers are overrepresented in crashes, and newly licensed drivers are at high risk, particularly in the months immediately post-licensure. Using a virtual driving assessment (VDA) implemented in the licensing workflow in Ohio, this study examined how driving skills measured at the time of licensure contribute to crash risk post-licensure in newly licensed young drivers.

METHODS

This study examined 16 914 young drivers (<25 years of age) in Ohio who completed the VDA at the time of licensure and their subsequent police-reported crash records. By using the outcome of time to first crash, a Cox proportional hazard model was used to estimate the risk of a crash during the follow-up period as a function of VDA Driving Class (and Skill Cluster) membership.

RESULTS

The best performing No Issues Driving Class had a crash risk 10% lower than average (95% confidence interval [CI] 13% to 6%), whereas the Major Issues with Dangerous Behavior Class had a crash risk 11% higher than average (95% CI 1% to 22%). These results withstood adjusting for covariates (age, sex, and tract-level socioeconomic status indicators). At the same time, drivers licensed at age 18 had a crash risk 16% higher than average (95% CI 6% to 27%).

CONCLUSIONS

This population-level study reveals that driving skills measured at the time of licensure are a predictor of crashes early in licensure, paving the way for better prediction models and targeted, personalized interventions. The authors of future studies should explore time- and exposure-varying risks.

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.

The prototype willingness model: An application to adolescent driver speeding

INTRODUCTION

Many young drivers are involved in crashes due to speeding. Some studies have used the Prototype Willingness Model (PWM) to explain the risky driving behavior of young people. However, many have measured PWM constructs in a manner inconsistent with its formulation. The PWM asserts that the social reaction pathway is underpinned by a heuristic comparison of oneself with a cognitive prototype of someone who engages in a risky behavior. This proposition has not been comprehensively examined and few PWM studies specifically examine social comparison. The current study investigates intentions, expectations, and willingness to speed by teen drivers using operationalizations of PWM constructs more aligned with their original conceptualizations. Additionally, the influence of dispositional social comparison tendency on the social reaction pathway is examined to further test the original propositions underpinning the PWM.

METHOD

Two hundred and eleven independently driving adolescents completed an online survey including items measuring PWM constructs and social comparison tendency. Hierarchical multiple regression was used to investigate the influence of perceived vulnerability, descriptive and injunctive norms, and prototypes on speeding intentions, expectations, and willingness. A moderation analysis examined the effect of social comparison tendency on the association between prototype perceptions and willingness.

RESULTS

The regression models explained substantial amounts of variance in intentions (39%), expectations (49%), and willingness (30%) to speed. There was no evidence that social comparison tendency influences the relationship between prototypes and willingness.

CONCLUSIONS

The PWM is useful for predicting teenage risky driving. More studies should confirm that social comparison tendency does not moderate the social reaction pathway. However, there may be need for further theoretical development of the PWM.

PRACTICAL APPLICATIONS

The study suggests that it may be possible to develop interventions to reduce adolescent driver speeding based on manipulation of PWM constructs such as speeding driver prototypes.

Identifying community-level disparities in access to driver education and training: Toward a definition of driver training deserts

OBJECTIVE

Obtaining a license may be challenging for teens due to access to driving instruction; in some states, behind-the-wheel (BTW) instruction is required to secure a license before age 18. We investigate spatial accessibility to BTW centers, and how this geographic distribution intersects with metrics of social disparity at the metropolitan level, toward identifying Driver Training Deserts (DTDs): geographic areas of disconnection to driver training.

METHODS

For the Columbus OH region, we collect socioeconomic variables at the Census tract unit of analysis and geocoded locations of public and private BTW training centers and estimate travel time to the nearest BTW training center. We define travel time as either the mean or the maximum travel time to BTW centers across all 1 km × 1 km grid cells within a Census tract. We employ spatial statistical approaches, including homogeneous/inhomogeneous K functions, to determine whether BTW training centers are clustered. Next, we define DTDs as Census tracts with a poverty rate and travel time to BTW centers larger than the 75th percentile values across the region.

RESULTS

BTW training centers are spatially clustered across the region; the magnitude of this clustering is so great that BTW centers exhibit statistically significant patterns of clustering, even when considering the underlying spatial distribution of socio-economic characteristics. We find that 11-27 Census tracts are identified as DTDs depending on the definition of travel time. DTDs contain a disproportionate percent of the high poverty population (8.7-23.5%) and, depending on the definition of travel time, a disproportionately large African American population.

CONCLUSIONS

Methodologically, defining DTDs necessitates a fine-grained spatial approach as suburban and rural Census tracts tend to be large and thus can be poorly represented by travel times averaged over the Census tract. Defining DTDs as a measure of individual-specific variables - income and impedance - allows DTDs to be addressed with policy interventions. The findings motivate future research correlating DTDs with licensure rates, enrollment in driver training, and safe driving outcomes to understand if DTDs can help explain health equity outcomes related to young driver safety.

The role of inexperience in motorcycle crashes among novice and returning motorcycle riders

OBJECTIVES

To examine the crash trends of younger novice and older novice/returning motorcycle riders.

METHODS

We used a linked database of North Carolina crash and licensing data from 1991 through 2018 that included 103,142 younger novice and 98,540 older novice/returning motorcycle riders. We examined the percent of riders who crashed each month after obtaining a motorcycle license.

RESULTS

Crash rates peak for both younger novice and older novice/returning motorcycle riders immediately after licensure. Crash rates decline rapidly, and the rate of decrease resembles a power function. The improvement rate (IR) for younger novice riders is 0.42; that is, the crash rate for younger novices declines by approximately 42% as experience doubles.

CONCLUSION

The crash curve for novice motorcyclists is similar to that of novice car drivers and is consistent with a learning process.

PRACTICAL APPLICATIONS

The crash trends of novice motorcycle riders indicate that current training, licensing, and educational efforts are not adequately preparing new riders. Additional efforts to develop more effective training, and research to inform a well-calibrated graduated licensing process for new riders are needed.

Unlicensed driving among young drivers in North Carolina: a quasi-induced exposure analysis

BACKGROUND

Little is known about the prevalence of driving among teenagers who have not yet obtained a license. The primary objective of the present study was to estimate the prevalence of unlicensed driving among young drivers using the quasi-induced exposure (QIE) approach and to determine whether unlicensed driving was more common among minority and lower-income teenagers. Additionally, we examined whether unlicensed driving among adolescents increased following the implementation of a graduated driver licensing (GDL) system and whether GDL differentially affected minority and low-income adolescents.

METHODS

Using North Carolina crash and driver license data, we identified 90,267 two-vehicle crashes from 1991 through 2016 where only one driver was considered contributory and the non-contributory driver was a White or Black 16 or 17 years old. In the QIE approach, these non-contributory young drivers are assumed to be representative of all adolescents driving in the state during this time period. The prevalence of unlicensed driving among adolescents by age and year was estimated by identifying the proportion of non-contributory drivers who had never been licensed by the time of their involvement in these two-vehicle crashes. We further conducted logistic regression analyses to examine the likelihood of a non-contributory young driver being unlicensed as a function of race, neighborhood income level, and licensing era (prior to or after GDL was implemented).

RESULTS

During the 26 years for which data were available, the mean annual prevalence of unlicensed driving was 1.2% for 16-year-olds and 1.7% among 17-year-olds. Young Black drivers and individuals living in lower-income neighborhoods were somewhat more likely to drive before obtaining a license, but the rates of unlicensed driving among these groups were also quite low. Unlicensed driving increased slightly for 17-year-olds following the implementation of GDL, but returned to previous levels after a few years.

CONCLUSION

Unlicensed driving among adolescents in North Carolina is substantially less common than suggested by previous self-report studies and analyses of fatal crash data.

Identifying best practices in a process evaluation of a novice driver education program

Best practice for learning to drive programs should be evidence-based and incorporate the range of lower and higher-order skills outlined in the internationally recognized Goals for Driver Education (GDE) matrix. A set of practices derived from the matrix, together with pertinent adult learning approaches and driving instruction research formed the basis of an evaluation checklist developed to review the Keys2drive program (a national single-session interactive education program for learner drivers in Australia). The checklist criteria consisted of 18 practices, including: having a sound theoretical base; reflecting various GDE components; facilitating parental involvement; provision of feedback; building resilience; use of coaching approaches; commentary driving; self-assessment; understanding of risk factors; and supporting safe vehicle choices and graduated licensing schemes. The program review sought to determine the extent to which Keys2drive is aligned with best practice according to the checklist criteria. Evaluations of driver education programs should recognize that novice drivers, in discussions with their instructors/supervisors, may have differing interpretations and values concerning various GDE goals, such as their awareness of critical risk factors. As a best practice, instructors should be prepared to ask the novice 'How?' and 'Why?' questions relevant to their GDE goal interpretations and values.

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.

Novel use of a virtual driving assessment to classify driver skill at the time of licensure

Motor vehicle crash rates are highest immediately after licensure, and driver error is one of the leading causes. Yet, few studies have quantified driving skills at the time of licensure, making it difficult to identify at-risk drivers before independent driving. Using data from a virtual driving assessment implemented into the licensing workflow in Ohio, this study presents the first population-level study classifying degree of skill at the time of licensure and validating these against a measure of on-road performance: license exam outcomes. Principal component and cluster analysis of 33,249 virtual driving assessments identified 20 Skill Clusters that were then grouped into 4 major summary "Driving Classes"; i) No Issues (i.e. careful and skilled drivers); ii) Minor Issues (i.e. an average new driver with minor vehicle control skill deficits); iii) Major Issues (i.e. drivers with more control issues and who take more risks); and iv) Major Issues with Aggression (i.e. drivers with even more control issues and more reckless and risk-taking behavior). Category labels were determined based on patterns of VDA skill deficits alone (i.e. agnostic of the license examination outcome). These Skill Clusters and Driving Classes had different distributions by sex and age, reflecting age-related licensing policies (i.e. those under 18 and subject to GDL and driver education and training), and were differentially associated with subsequent performance on the on-road licensing examination (showing criterion validity). The No Issues and Minor Issues classes had lower than average odds of failing, and the other two more problematic Driving Classes had higher odds of failing. Thus, this study showed that license applicants can be classified based on their driving skills at the time of licensure. Future studies will validate these Skill Cluster classes in relation to their prediction of post-licensure crash outcomes.

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.

The Static and Dynamic Analyses of Drivers’ Gaze Movement Using VR Driving Simulator

Drivers collect information of road and traffic conditions through a visual search while driving to avoid any potential hazards they perceive. Novice drivers with lack of driving experience may be involved in a car accident as they misjudge the information obtained by insufficient visual search with a narrower field of vision than experienced drivers do. In this regard, the current study compared and identified the gap between novice and experienced drivers in regard to the information they obtained in a visual search of gaze movement and visual attention. A combination of a static analysis, based on the dwell time, fixation duration, the number of fixations and stationary gaze entropy in visual search, and a dynamic analysis using gaze transition entropy was applied. The static analysis on gaze indicated that the group of novice drivers showed a longer dwell time on the traffic lights, pedestrians, and passing vehicles, and a longer fixation duration on the navigation system and the dashboard than the experienced ones. Also, the novice had their eyes fixed on the area of interests straight ahead more frequently while driving at an intersection. In addition, the novice group demonstrated less information at 2.60 bits out of the maximum stationary gaze entropy of 3.32 bits that a driver can exhibit, which indicated that their gaze fixations were concentrated. Meanwhile, the experienced group displayed approx. 3.09 bits, showing that their gaze was not narrowed on a certain area of interests, but was relatively evenly distributed. The dynamic analysis results showed that the novice group conducted the most gaze transitions between traffic lights, pedestrians and passing vehicles, whereas experienced drivers displayed the most transitions between the right- and left-side mirrors, passing vehicles, pedestrians, and traffic lights to find more out about the surrounding traffic conditions. In addition, the experienced group (3.04 bits) showed a higher gaze transition entropy than the novice group (2.21 bits). This indicated that a larger entropy was required to understand the visual search data because visual search strategies changed depending on the situations.

Salesperson knowledge of teen-specific vehicle safety features

OBJECTIVE

Teen drivers experience elevated crash risk compared with experienced adult drivers. Active parental oversight can improve teen driving safety, and several manufacturers have released teen-focused safety features over the past decade. Still, parents don't always use these systems and often don't even know their vehicle is equipped. A recent survey found that parents who do know about such systems on their vehicle first learned of them from a salesperson at a dealership. The current study examined how salespeople discuss and sell teen-specific safety systems on vehicles to parents shopping for a new teen driver.

METHODS

The study focused on four vehicle brands. Two researchers posed as the parents of a new teen driver who were shopping for a vehicle for their teen. They entered dealerships and conducted semistructured interviews with the salesperson that approached them, using prompts of increasing specificity about their teen driver and their interest in safety, and tracking at what point each salesperson mentioned their brand's teen-specific systems, what features they mentioned, and how accurate those mentions were.

RESULTS

Thirty of the 40 participating salespeople were able to mention their brand's teen-specific system at some point during the procedure. Hyundai salespeople most consistently brought up their brand's teen features, and Chevy salespeople mentioned the most features while Ford salespeople mentioned the fewest. Salespeople often mentioned speed-related features, although the most commonly mentioned features varied by brand. No participating salespeople reported receiving training specifically about their brand's teen features.

DISCUSSION

Most salespeople approached did mention their brand's teen-focused safety systems, but did not usually do so until they had received more targeted prompts. Information these salespeople did share was often vague and general. Salespeople are a key source of information about a vehicle's specific and relevant safety features, and parents without at least some vague preexisting knowledge about the systems or features that could be available on a vehicle of interest are not likely to leave a dealership with a clear idea of all available features that could aid their efforts to keep their teen drivers safe.

Learning to drive: Parental attitudes toward introducing teen drivers to advanced driver assistance systems

OBJECTIVE

Advanced driver assistance systems (ADAS) have the potential to help mitigate the crash risk faced by new teen drivers. There has been little research on how these drivers use ADAS, as most only have access to these systems in their parents' vehicles when learning to drive because teens tend to drive older, less expensive vehicles when driving independently. This study examined how parental attitudes toward ADAS influence how and when parents introduce their teens to these systems when teaching them to drive.

METHODS

Three web-based focus groups were conducted with parents who owned ADAS-equipped vehicles and who either had a teen with either a learner permit or a teen who recently began driving independently. The moderator-led discussion examined participant attitudes about teen driving risk, the perceived benefits or risks associated with teen use of ADAS, and parents' teaching strategies for ADAS. Researchers generated a list of likely themes from a review of existing literature and then coded participant responses according to those themes.

RESULTS

Parents who chose to introduce ADAS to their new teen drivers did so while also reporting conflicting opinions about the reliability of vehicle technologies and the impact of such systems on driving safety and skill acquisition. Many parents reported some distrust of ADAS and concerns that some features could hinder the development of good driving habits, although most participants stated that ADAS have had a positive impact on their teen drivers' safety. Opinions were split about the best point at which to introduce ADAS to teens, with half preferring introduction at the outset and half preferring to wait until the teen had mastered basic driving skills. Attitudes varied according to individual vehicle systems, with a preference for blind spot monitoring and a general dislike of lane-keeping assistance.

CONCLUSIONS

Specific concerns about the potential impact of ADAS on teen driving safety and skill acquisition do not prevent parents from using such systems, although the teaching strategies parents use vary according to their preferences for individual systems.

Risky youth to risky adults: Sustained increased risk of crash in the DRIVE study 13 years on

The objective of this study was to investigate if drivers who exhibit risky driving behaviours during youth (aged 17-24 years) have an increased risk of car crash up to 13 years later. We used data from the DRIVE study, a 2003/04 survey of 20,806 young novice drivers in New South Wales, Australia. The data were linked with police crash, hospital and deaths data up to 2016. We analysed differences in crash associated with 13 items of risky driving behaviours using negative binominal regression models adjusted for driver demographics, driving exposure and known crash risk factors. The items were summarised in one index and grouped into quintiles for the analysis. After adjusting for confounding, drivers of the third (RR 1.16, 95% CI 1.05-1.30), fourth (RR1.22, 95% CI1.09-1.36) and fifth quintile (RR 1.36, 95% CI 1.21-1.53) had higher crash rates compared to the lowest risk-takers. Drivers with the highest scores on the risky driving measure had higher rates of crash related hospital admission or death (RR 1.92, 95% CI 1.13-3.27), crashes in wet conditions (RR 1.35,95% CI 1.05-1.73), crashes in darkness (RR 1.55, 95% CI 1.25-1.93) and head-on crashes (RR 2.14, 95% CI 1.07-4.28), compared with drivers with the lowest scores. Novice adolescent drivers who reported high levels of risky driving when they first obtained a driver licence remained at increased risk of crash well into adulthood. Measures that successfully reduce early risky driving, have the potential to substantially reduce road crashes and transport related injuries and deaths over the lifespan.

The effects of road safety education on the occurrence of motorcycle violations and accidents for novice riders: An analysis of population-based data

The prevalence of motorcycle riding among novice riders in most Southeast Asia countries presents an alarming rate of traffic violations and fatal accidents. Since 2013, Taiwan's government has gradually required a road safety class (RSC) for the rider's licensing process. The RSC consisted of watching videotapes of motorcycle-involved crashes followed by lectures on safety measures. Our study tried to see whether a compulsory RSC could lower the likelihood and frequency of road accidents and traffic violations among novice riders. To avoid self-selection bias, we selected 480,114 novice riders aged 18-20 years, licensed one year before starting the trial period and one year after full implementation of RSC. Using the 2012-2018 data from the Taiwan Ministry of Transportation and Communication (MOTC), we applied the logistic model to evaluate RSC effects on the risk of violations and accidents. Then, we used the negative binomial regression to model their frequency in response to RSC exposure. Following the novice drivers 1-3 years after licensing, our results showed that the RSC has a short-term effect in lowering their traffic violations' likelihood by 12%∼17% and their frequency by 11%; however, the RSC effects only last two years in reducing the counts of motorcycle-involved offenses and accidents. The RSC reduction effect was lower for the tendency of accidents than the violations, probably because committing traffic violations was self-determined; in contrast, the collision occurrence was more or less related to the riders' own or other road users' carelessness. The RSC could be more effective if a certification test for road safety education were required or if a penalty is imposed on distracted learners during the training.

Introducing accompanied driving in Denmark. Safety-related differences between youth licensing with immediate or delayed access to solo driving

In Denmark, the legal license age was lowered from 18 to 17, to allow practice with an experienced driver before solo driving from age 18. The change gives the candidate driver a choice between: a) licensing at age 17 followed by a phase of accompanied driving until solo driving at age 18 (L17), and b) licensing at age 18 (or older) giving immediate access to solo driving (L18). The purpose of this study is: First, to explore safety-related differences between youth choosing the L17 or the L18 option, with a particular focus on safety attitude and self-assessed driving skills. Second, to map patterns in the use of accompanied driving and its predictors as well as the interaction between the L17 driver and the accompanying person (ACP). A sample of 632 drivers (53% male) between 17 and 19 years of age completed a survey. Among the participants 61% licensed through L17 and 39% through L18. Our results identify different risk profiles between L17 and L18. A higher score on perceptual-motor skills, lower score on safety skills and lower support to speed limits predicted L17. Female L17 were more safety-oriented compared to male L17. L17 who had experienced a supportive atmosphere and engagement in complex traffic situations during the drive were more likely to indicate that accompanied driving had improved their driving skills. However, results also indicate that the amount of experience obtained by L17 may be insufficient to obtain a safety benefit. Measures to address speeding and other risk-taking behaviours among male candidate drivers are needed to ensure a safety benefit of the Danish accompanied driving scheme. In addition, requirements may be needed to increase the amount of accompanied driving. Finally, parent guidelines could support the creation of a positive atmosphere during the drive.

Changes in Driving Behaviors After Concussion in Adolescents

PURPOSE

Although return to learn, exercise, and sports have evidence-based guidelines, there is limited research investigating return to driving after concussion. The purpose was to characterize and compare adolescent driving behaviors after concussion.

METHODS

Using the Minds Matter Concussion Registry, we queried data of adolescents, aged 16-19 years, diagnosed with a concussion ≤28 days of injury and seen between January 31, 2017 and August 31, 2018 at the specialty care concussion program. Outcomes included patient report of: changes postinjury driving behaviors; Post-Concussion Symptom Inventory; return to school, and exercise and sports. Provider recommendations for return to school after initial clinical assessment were also examined. Descriptive statistics, analysis of covariance, and chi-square tests were performed.

RESULTS

Of the 332 drivers (46.1% female; mean age 17.5 years, 95% confidence interval [CI], 17.4-17.6), 46.9% had returned to driving since injury. Of those who returned to driving, 58.9% reported "Driving with No Changes." The Post-Concussion Symptom Inventory score was higher among "Driving with Changes" (48.7, 95% CI: 42.2-55.2) than "Driving with No Changes" (27.4, 95% CI: 22.3-32.5, p < .01) and "Has Not Driven Since Injury" (42.3, 95% CI: 38.4-46.3, p < .01). Among the 332 drivers, few had returned to exercise (15.4%) or organized sports (6.0%). Of those in school (n = 291), only 8.9% were provider recommended to return to full school days after clinical assessment.

CONCLUSION

Many adolescents continued to drive after concussion, despite not yet having returned to exercise or sport. Nine of 10 were advised to return to school with accommodations to begin a gradual increase in cognitive activity, suggesting a gradual increase in driving may be justified.

Comparison of Motor Vehicle Crashes, Traffic Violations, and License Suspensions Between Autistic and Non-Autistic Adolescent and Young Adult Drivers

OBJECTIVE

One-third of autistic individuals obtain a driver's license by age 21 years; however, prior studies suggest they may be at heightened risk for motor vehicle crashes. We compared objective rates of crashes, traffic violations, and license suspensions for newly licensed autistic and non-autistic adolescents.

METHOD

This retrospective cohort study included New Jersey residents born from 1987 through 2000 who were patients of the Children's Hospital of Philadelphia health care network. Electronic health records were linked with statewide driver licensing and crash databases. Autism status was classified via International Classification of Diseases (ICD) diagnostic codes; individuals with intellectual disability were excluded. We compared rates among 486 autistic and 70,990 non-autistic licensed drivers over their first 48 months of driving. Furthermore, we examined the proportion of crashes attributed to specific driver actions and crash types.

RESULTS

Compared with non-autistic drivers, autistic drivers were estimated to have lower average monthly rates of crash involvement (adjusted rate ratio (adjRR) = 0.89, 95% CI = 0.75-1.05), moving violations (adjRR = 0.56, 95% CI = 0.48-0.67), and suspensions (adjRR = 0.32, 95% CI = 0.18-0.58). Among drivers involved in a crash, autistic drivers were half as likely to crash because of unsafe speed, but substantially more likely to crash because of their failure to yield to a vehicle/pedestrian and while making left-turns or U-turns.

CONCLUSION

Newly licensed autistic adolescent drivers have similar to lower estimated rates of adverse driving outcomes; the extent to which these can be attributed to different driving patterns is a critical point for future investigation. There were several notable differences in the characteristics of these crashes, which directly inform interventions to improve driving safety of autistic adolescent drivers.

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.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Behind the Wheel: Specialized Driving Instructors' Experiences and Strategies for Teaching Autistic Adolescents to Drive

IMPORTANCE

In the transition to adulthood, driving supports independence. For autistic adolescents, training provided by specialized driving instructors, including occupational therapists, may establish fitness to drive and continued independence.

OBJECTIVE

To examine specialized driving instructors' experiences providing behind-the-wheel instruction to autistic adolescents.

DESIGN

We recruited participants through purposive and snowball sampling of members of ADED, the Association for Driver Rehabilitation Specialists. Interviews investigated experiences providing instruction, autistic students' strengths and challenges, strategies used, and recommendations to improve the learning-to-drive process. We coded transcripts using a directed content analysis approach.

SETTING

Telephone interviews.

PARTICIPANTS

Specialized driving instructors (N = 17) trained as occupational therapists, driver rehabilitation specialists, or licensed driving instructors with recent experience providing behind-the-wheel training for autistic adolescents participated.

RESULTS

Behind-the-wheel challenges included mental inflexibility, distractibility, and difficulties with social cues and motor coordination. Instructors acknowledged students' strengths, including adherence to rules of the road, limited risk taking, and careful observations. Instructors scaffolded learning to help students develop skills. Although licensure and driving outcomes were sometimes unknown to instructors, students who became licensed frequently drove with supervision or restrictions.

CONCLUSIONS AND RELEVANCE

Licensure is possible for autistic adolescents, although developing fitness to drive requires individualization and rigorous specialized instruction, which may culminate in delayed or restricted driving. What This Article Adds: This article highlights challenges and strengths encountered by specialized driving instructors teaching autistic adolescents. Despite requiring prolonged training, autistic adolescents can achieve licensure when supported by specialized instruction that is individualized to their needs and strengths.

Self-regulation differences across learner and probationary drivers: The impact on risky driving behaviours

Risky driving behaviours are a known contributor to young drivers' overrepresentation in road trauma, with self-regulation suggested as an important associated construct, but yet to be extensively explored. The aims of this study were to examine the utility of self-determination theory in explaining risky driving behaviours and to explore differences between young Learner and Provisional (P1)- licensed drivers in regard to their self-regulated safety orientation and engagement in risky driving behaviours. Learners (n = 1038) and P1(n = 589) drivers, aged 16-19 years, responded to a 91-item online survey, including self-regulated safety orientation items adapted from self-determination theory and inattentive and intentional risky driving behaviour items. Results showed that self-determination theory had good predictive power for the two types of risky driving behaviours for both licence groups. Learner and P1 drivers' engagement in risky behaviours was similar, however, the relative importance of self-regulated safety orientation elements to reduced engagement in these behaviours differed. Learners' engagement in intentional risky behaviours reflected greater perceived effort/importance and pressure/tension compared to P1 drivers. Greater effort/importance is an overarching indicator of internalised regulation concerning safe driving behaviours, which might be primed when first exposed to driving. However, greater perceived pressure/tension suggests that internalisation of self-regulatory processes is being suppressed during the Learner phase. This might stem from the required presence of driver trainers and supervisory drivers, as well as interactions with other road users. Whilst only tentative explanations in this first exploration, the findings suggest there is potential for greater efforts in Learner driver training and supervision to encompass the types of skills and learning that encourage the development of self-regulation to reduce risky driving behaviours during both the Learner and P1 stage. These findings contribute to the limited research regarding self-regulation by young novice drivers and informs a better understanding of the psychological influences of engagement in risky driving behaviours, including the first such examination among early independent licensed drivers.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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.

At what stages of licensing do graduated driver licensing systems reduce crashes? Example from Queensland, Australia

Evaluations of new graduated licensing systems (GLS) commonly examine pre-post young driver crash rates relative to another driver group. This comparison approach is important to account for other influences on crashes over time, but has limited ability to determine which GLS components are most effective and at what stage during the licensing process. We previously identified declines in young driver crashes in Queensland, Australia, following introduction of a new GLS in 2007. The objective of the current research was to conduct complementary modelling to identify at what points through the licensing process had particular GLS policies contributed to reductions. Crash trends were explored for learner and provisional drivers under the new GLS versus previous system for three time periods relative to the month of acquiring a provisional licence: the preceding learner period, the first month of provisional licensure (when crashes typically peak), and the overall provisional period. Interrupted time series analyses were conducted for the log ratio of crashes per 10,000 licensed (learner and provisional) drivers with the total number of licensed drivers as an offset. The greatest declines were found in the first month of licensure, with indications that a longer learner period, higher supervised driving hours, and a new provisional night-passenger restriction were key contributors to provisional crash reductions. There was also some indication that a restriction on all phone use reduced crashes during the learner period. We conclude that time series analysis focusing on licensing stage, rather than calendar time only, offers a complementary approach to analysing GLS effectiveness by better identifying where and how changes impact crashes.

Advancing our understanding of cognitive development and motor vehicle crash risk: A multiverse representation analysis

Neurobiological and cognitive maturational models are the dominant theoretical account of adolescents' risk-taking behavior. Both the protracted development of working memory (WM) through adolescence, as well as individual differences in WM capacity have been theorized to be related to risk-taking behavior, including reckless driving. In a cohort study of 84 adolescent drivers Walshe et al. (2019) found adolescents who crashed had an attenuated trajectory of WM growth compared to adolescent drivers who never reported being in a crash, but observed no difference in WM capacity at baseline. The objectives of this report were to attempt to replicate these associations and to evaluate their robustness using a hybrid multiverse - specification curve analysis approach, henceforth called multiverse representation analysis (MRA). The authors of the original report provided their data: 84 adolescent drivers with annual evaluations of WM and other risk factors from 2005 to 2013, and of driving experiences in 2015. The original analysis was implemented as described in the original report. An MRA approach was used to evaluate the robustness of the association between developmental trajectories of WM and adolescents' risk-taking (indexed by motor vehicle crash involvement) to different reasonable methodological choices. We enumerated 6 reasonable choice points in data processing-analysis configurations: (1) model type: latent growth or multi-level regression, (2) treatment of WM data; (3) which waves are included; (4) covariate treatment; (5) how time is coded; and (6) link function/estimation method: weighted least squares means and variance estimation (WLSMV) with a linear link versus logistic regression with maximum likelihood estimation. This multiverse consists of 96 latent growth models and 18 multi-level regression models.

Longitudinal associations between internalizing symptoms and driving avoidance in newly licensed adolescents

BACKGROUND

Extensive literature assesses risky adolescent driving, but nothing examines what makes teens avoid driving. Many assume teenagers are eager to drive, but evidence suggests internalizing symptoms lead some to avoid driving.

AIMS

This study tested whether depressive and anxious symptomology predicted longitudinal driving avoidance in novice teen drivers.

MATERIALS AND METHODS

N = 56 16-year-olds (52% female; 48% Black/African American) completed three observations over 6 months. At Time 1, participants reported depressive (Center for Epidemiological Studies Depression 10-item Scale) and anxious (Generalized Anxiety Disorder 7-item Scale) symptomologies, and driving avoidance (Driving Habits Questionnaire [DHQ]), repeating DHQ at Times 2 and 3. Multiple linear regression tested whether symptomologies predicted avoidance at licensure. Linear mixed models tested associations between symptomologies and avoidance over time.

RESULTS

High anxiety predicted greater avoidance at baseline and over 6 months. Depressive symptoms did not predict avoidance.

DISCUSSION

Findings warrant an assessment of anxious adolescents' barriers to driving and avoidance impacts on crash risk.

Factors Contributing to Delay in Driving Licensure Among U.S. High School Students and Young Adults

PURPOSE

More teens delay in driving licensure (DDL). It is conceivable they miss Graduated Driver Licensing (GDL) safety benefits. We assessed prevalence, disparities, and factors associated with DDL among emerging adults.

METHODS

Data used were from all seven waves (W1-7) of the NEXT Generation Health Study (W1 in 10th grade [2009-2010]). The outcome variable was DDL (long-DDL [delayed >2 years], intermediate-DDL [delayed 1-2 years] versus no-DDL), defined as participants receiving driver licensure ≥1 year after initial eligibility. Independent variables included sex, urbanicity, race/ethnicity, family structure, parental education, family affluence, parental monitoring knowledge, parent perceived importance of alcohol nonuse, and social media use. Logistic regressions were conducted.

RESULTS

Of 2,525 participants eligible for licensure, 887 (38.9%) reported intermediate-DDL and 1,078 (30.1%) long-DDL. Latinos (adjusted odds ratio [AOR] = 2.5 vs. whites) and those with lower affluence (AOR = 2.5 vs. high) had higher odds of intermediate-DDL. Latinos (AOR = 4.5 vs. whites), blacks (AOR = 2.3 vs. whites), those with single parent (AOR = 1.7 vs. both biological parents), whose parents' education was high school or less (AOR = 3.7 vs. bachelor+) and some college (AOR = 2.0 vs. bachelor+) levels, and those with lower affluence (AOR = 4.4 vs. high) had higher odds of long-DDL. Higher mother's monitoring knowledge (AOR = .6) was associated with lower odds of long-DDL, but not intermediate-DDL.

CONCLUSIONS

Some teens that DDL "age out" of protections afforded to them by GDL driver restrictions. Minority race/ethnicity, socioeconomic status, urbanicity, and parenting factors contribute to DDL. Further study of these factors and their individual/collective contributions to DDL is needed to understand potential unintended consequences of GDL, particularly in more vulnerable youth.

Exploratory analysis of young adults' trajectories through the UK driving license acquisition process

OBJECTIVE

The UK is one of many high-income countries to experience a decline in driving license acquisition among young adults in the 2000s. This paper draws on newly available nationally representative microdata that captures the progress of individual drivers through the UK driving license acquisition process, to establish socio-demographic correlates.

METHODS

Using the 2016 and 2017 editions of England's National Travel Survey data, a series of binary logit models were employed to identify factors associated with progression through the various phases of the UK's driving license acquisition process. Factors that are associated with (1) the frequency of taking the driving license tests, (2) the number of times having failed the theory and driving tests are then identified.

RESULTS

The socio-demographic explanators considered were each found to be associated with driving license holding in intuitive ways that are consistent with prior literature. However, relatively few factors are significantly associated with progress through the steps of the license acquisition process, and the goodness-of-fit for progress through these intermediate phases are generally lower (indicating that other unobservable idiosyncratic personal or contextual characteristics are dominant in these processes). A consistent theme is the strong relationship with labor market participation. Links between income and the intermediate phases, however, were generally weaker. Age is negatively associated with progress through the early phases when respondents are applying for provisional license and taking theory test, but this relationship turns positive in later stages of the acquisition process.

CONCLUSION

To the authors' knowledge, this study is the first opportunity to evaluate this novel data resource covering the UK's driving license acquisition process. This is an important research direction to help policymakers understand young adults' delay in acquiring licenses, particularly the extent to which there may be structural inequalities. The main finding is that socio-demographic factors appear to be relatively poor predictors, with employment status the strongest single correlate of the variables that were tested. This paper is concluded with suggestions for designers of household travel surveys in regions where youth license-acquisition is of increasing focus, as well as a brief discussion of future research needs.

Higher-order driving instruction and opportunities for improvement: Exploring differences across learner driver experience

INTRODUCTION

Few studies have investigated what guidance occurs during the Learner phase of driving, particularly during formal lessons. The objective of this research was threefold: (a) investigate functional and higher-order driving instruction (HO-DI) in formal Learner lessons, (b) explore teaching approaches within the context of a theoretical framework, and (c) investigate variation in these three elements of instruction as a function of Learner driving experience. The theoretical framework developed to guide this research integrated the constructivist Goals for Driver Education and self-determination theory.

METHOD

Professional instruction was explored through naturalistic observation; 15 instructors provided GoPro recordings of 110 driving lessons with Learners aged 16-19 years (n = 96) at varying levels of experience: Early (<20 logbook hours), Mid (21-70 h), and Late (71->100 h).

RESULTS

Employing a previously-developed coding taxonomy, instructor guidance opportunities were identified as 15% HO-DI, 73% functional instruction, and 12% untaken or missed HO-DI. Functional instruction peaked in the Mid Phase, while HO-DI was prominent in the Early phase suggesting missed opportunities in the later phases when use of silence peaked. Some elements of self-determination theory's needs-supportive model were readily identified in teaching approaches, such as feedback.

CONCLUSIONS

An understanding of functional and HO-DI, including teaching strategies, was established within the context of an integrated theoretical framework, with different trajectories across Learner experience identified. Teaching strategies reflected constructivism and self-determination theory providing theoretical support for these frameworks to be applied in future driver training studies. Continued research efforts are needed to understand how best to balance functional and HO-DI to maximize young novice drivers' learning prior to independent driving, particularly during the late Learner period. Practical Applications: Naturalistic observation of current HO-DI and teaching approaches supports the feasibility of integrating recommended improvements arising from the theoretical framework within current practice, with practical implications for improvements to industry training.

A Novel Health-Transportation Partnership Paves The Road For Young Driver Safety Through Virtual Assessment

Motor vehicle crashes remain the leading cause of adolescent mortality and injury in the United States. For young drivers, crash risk peaks immediately after licensure and declines during the next two years, making the point of licensure an important safety intervention opportunity. Legislation in Ohio established a unique health-transportation partnership among the State of Ohio, Children's Hospital of Philadelphia, and Diagnostic Driving, Inc., to identify underprepared driver license applicants through a virtual driving assessment system. The system, a computer-based virtual driving test, exposes drivers to common serious crash scenarios to identify critical skill deficits and is delivered in testing centers immediately before the on-road examination. A pilot study of license applicants who completed it showed that the virtual driving assessment system accurately predicted which drivers would fail the on-road examination and provided automated feedback that informed drivers on their skill deficits. At this time, the partnership's work is informing policy changes around integrating the virtual driving assessment system into licensing and driver training with the aim of reducing crashes in the first months of independent driving. The system can be developed to identify deficits in safety-critical skills that lead to crashes in new drivers and to address challenges that the coronavirus disease 2019 pandemic has introduced to driver testing and training.

The effect of extending graduated driver licensing to older novice drivers in Indiana

INTRODUCTION

Graduated driver licensing (GDL) systems have been shown to reduce rates of crashes, injuries, and deaths of young novice drivers. However, approximately one in three new drivers in the United States obtain their first driver's license at age 18 or older, and thus are exempt from most or all provisions of GDL in most states.

METHOD

In July 2015, the state of Indiana updated its GDL program, extending its restrictions on driving at night and on carrying passengers during the first 6 months of independent driving, previously only applicable to new drivers younger than 18, to all newly-licensed drivers younger than 21 years of age. The current study examined monthly rates of crashes per licensed driver under the affected conditions (driving at night and driving with passengers) among Indiana drivers first licensed at ages 18, 19, and 20 under the updated GDL system compared with drivers licensed at the same ages under the previous GDL system. We used Poisson regression to estimate the association between the GDL system and crash rates, while attempting to control for other factors that might have also influenced crash rates. We used linear regression to estimate the association between the GDL system and the proportion of all crashes that occurred under conditions restricted by the GDL program.

RESULTS

Results showed, contrary to expectations, that rates of crashes during restricted nighttime hours and with passengers were higher among drivers licensed under the updated GDL system. This mirrored a statewide increase in crash rates among drivers of all ages over the study period and likely reflected increased overall driving exposure. The proportions of all crashes that were at night or with passengers did not change. Practical Applications: More research is needed to understand how older novice drivers respond when GDL systems originally designed for younger novice drivers are applied to them.

A new version of the Behaviour of Young Novice Drivers Scale (BYNDS). Insights from a randomised sample of 700 German young novice drivers

In Germany, every year 66,000 road crashes lead to death or injury of young novice drivers. This makes them twice as likely to be involved in, or cause, vehicle crashes compared to their older and more experienced counterparts. This study aims to address this societal issue by developing a better understanding of the German young driver problem. For this purpose, we created an updated, 55-item strong version of the Behaviour of Young Novice Drivers Scale (BYNDS), originally developed by Scott-Parker et al. in 2010. To make the new version of the BYNDS understandable for German young novice drivers, this research used a new method of translation in combination with extensive pre-testing. As a result, we identified possible threats for response errors such as retrospective formulated questions or double negations. Due the adjustment of the possible sources of error the presented version of the BYNDS is semantically and conceptually different from the original. However, due to the application of the updated version of the BYNDS in a robust sample of 700 participants, this paper presents the first reliable and validated tool to measure novices risky driving behaviour in Germany. Moreover, it offers an updated and extended version of the BYNDS that allows practitioners but also researchers to broaden their understanding of young driver risk.

Risky driving behaviour in Abu Dhabi, United Arab Emirates: a cross-sectional, survey-based study

Background

Traffic collision fatality rates per mile travelled have declined in Abu Dhabi similar to many developed countries. Nevertheless, the rate is still significantly higher than the average of countries with similar GDP and socio-demographic indicators. The literature on the subject in the UAE is limited especially in the area of studying drivers behaviour. This study aims to find determinants of risky driving behaviours that precipitate having a road traffic collision (RTC) in the United Arab Emirates (UAE).

Methods

A cross-sectional, survey-based study was employed. Participants were 327 active drivers who were attending Abu Dhabi Ambulatory Health Care Services clinics. They were provided with a questionnaire consisting of demography, lifestyle history, medical history, driving history, and an RTC history. They were also given a driving behaviour questionnaire, a distracted driving survey, depression screening and anxiety screening.

Results

Novice drivers (less than 25 years old) were 42% of the sample and 79% were less than 35 years. Those who reported a history of an RTC constituted 39.8% of the sample; nearly half (47.1%) did not wear a seatbelt during the collision. High scores in the driving behaviour questionnaire and high distraction scores were evident in the sample. Most distraction-prone individuals were young (90.5% were less than 36 years old). High scores in the driving behaviour questionnaire were also associated with high distraction scores (p < 0.001). Respondents with high depression risk were more likely to be involved in the RTC. With each one-point increase in the driver’s distraction score, the likelihood of a car crash being reported increased by 4.9%.

Conclusion

Drivers in the UAE engage in risky behaviours and they are highly distracted. Some behaviours that contribute to severe and even fatal injuries in RTCs include failing to wear a seatbelt and being distracted. Younger people were more likely distracted, while older drivers were more likely to have higher depression scores. Depression is suggested as a determinant factor in risky driving. These findings are informative to other countries of similar socioeconomic status to the UAE and to researchers in this field in general.

Characteristics of crashes and injuries among 14 and 15 year old drivers, by rurality

PURPOSE

Motor-vehicle crashes continue to be the leading cause of death for teenagers in the United States. The United States has some of the youngest legal driving ages worldwide. The objective of this study was to determine rates and factors associated with injury crashes among 14- and 15-year-old drivers and how these varied by rurality.

METHODS

Data for this cross-sectional study of 14- and 15-year-old drivers were obtained from the Iowa Department of Transportation from 2001 to 2013. Crash and injury crash rates were calculated by rurality. The relationship between crash and driver factors and injury was assessed using logistic regression.

FINDINGS

Teen drivers, aged 14 and 15 years, had a statewide crash rate of 8 per 1,000 drivers from 2001 to 2013. The majority of crashes occurred in urban areas (51%), followed by in town (29%), remote rural areas (13%), and suburban areas (7%). Crash and injury crash rates increased as level of rurality increased. The odds of an injury crash increased more than 10-fold with the presence of multiple other teens as passengers, compared to no passengers (OR = 10.7, 95% CI: 7.1-16.2).

CONCLUSIONS

Although 14- and 15-year-old drivers in Iowa have either limited unsupervised (school permits) or supervised only driving restrictions, they are overrepresented in terms of crashes and injury crashes. Rural roads and multiple teen passengers are particularly problematic in terms of injury outcomes. Practical applications: Results from this study support passenger restrictions and teen driving interventions designed with a rural focus.

Mapping global evidence on strategies and interventions in neurotrauma and road traffic collisions prevention: a scoping review

BACKGROUND

Neurotrauma is an important global health problem. The largest cause of neurotrauma worldwide is road traffic collisions (RTCs), particularly in low- and middle-income countries (LMICs). Neurotrauma and RTCs are preventable, and many preventative interventions have been implemented over the last decades, especially in high-income countries (HICs). However, it is uncertain if these strategies are applicable globally due to variations in environment, resources, population, culture and infrastructure. Given this issue, this scoping review aims to identify, quantify and describe the evidence on approaches in neurotrauma and RTCs prevention, and ascertain contextual factors that influence their implementation in LMICs and HICs.

METHODS

A systematic search was conducted using five electronic databases (MEDLINE, EMBASE, CINAHL, Global Health on EBSCO host, Cochrane Database of Systematic Reviews), grey literature databases, government and non-government websites, as well as bibliographic and citation searching of selected articles. The extracted data were presented using figures, tables, and accompanying narrative summaries. The results of this review were reported using the PRISMA Extension for Scoping Reviews (PRISMA-ScR).

RESULTS

A total of 411 publications met the inclusion criteria, including 349 primary studies and 62 reviews. More than 80% of the primary studies were from HICs and described all levels of neurotrauma prevention. Only 65 papers came from LMICs, which mostly described primary prevention, focussing on road safety. For the reviews, 41 papers (66.1%) reviewed primary, 18 tertiary (29.1%), and three secondary preventative approaches. Most of the primary papers in the reviews came from HICs (67.7%) with 5 reviews on only LMIC papers. Fifteen reviews (24.1%) included papers from both HICs and LMICs. Intervention settings ranged from nationwide to community-based but were not reported in 44 papers (10.8%), most of which were reviews. Contextual factors were described in 62 papers and varied depending on the interventions.

CONCLUSIONS

There is a large quantity of global evidence on strategies and interventions for neurotrauma and RTCs prevention. However, fewer papers were from LMICs, especially on secondary and tertiary prevention. More primary research needs to be done in these countries to determine what strategies and interventions exist and the applicability of HIC interventions in LMICs.

Impacts of graduated driver licensing regulations

We evaluate the impact of the Graduated Driver Licensing (GDL) system introduced in Victoria, Australia as they influence both injury and fatality rates. Since 1990, the Victorian GDL scheme has undergone several modifications including the introduction of new requirements and the stricter enforcement of existing regulations. Our evaluation of the GDL is based on monthly mortality and morbidity data for drivers 18-25 for the period January 2000 to June 2017. We estimate the immediate and long-term impacts of each policy change to the GDL system. Our results indicate that several initiatives in the GDL system have had impacts on both fatalities and injuries requiring hospitalisation when differentiated by gender. In a number of cases we observe that reactions to these measures are common to both genders. These include: the signalling of the proposed GDL changes in the media, the introduction of an extra probationary year for those under 21, the total alcohol ban for the entire probationary period, and limits on peer passengers for the first year. Stricter mobile phone restrictions appear to have had no impact on injuries for either males or females although they were associated with lower fatality rates for both. In addition, we found an indication that in the period prior to the introduction of the mandatory requirement of 120 h supervised driving, there was a rise in male driver injuries possibly caused by a rush of more inexperienced learners to obtain their probationary licence.

Understanding the impact of road design characteristic on teen driver's fatality

Objective: There is little research simultaneously examining both teen drivers' characteristics and the driving environment. This study aimed to investigate how traffic engineering factors (road designs, traffic operations, and surface conditions) contribute to risks of teen driver's fatality. Understanding the role of traffic engineering factors can further improve efforts to reduce teen diving-related fatal crashes.Methods: This study used the Fatality Analysis Reporting System and General Estimate System for years 2014 to 2015. We explored numerous engineering variables: horizontal/vertical alignment, intersections types, interchange areas, traffic ways types, posted speed limit, work zone areas, types of traffic control devices and road surface conditions. Traditional variables considered in this study included sex, age, presence of passengers in relation to age group, time of day, lighting condition, season, vehicle model year, vehicle type, seatbelt use, crash type and movement prior to a crash. We ran cross-tabulations and unadjusted analyses to report unadjusted odds ratios of teen driver's fatality. A multiple logistic regression model was used to identify which variables related to road design and traffic operations remained significant after being adjusted by other variables.Results: For traditional factors, results corroborated prior findings. All the engineering factors, except work zone area, were significant in the unadjusted analyses; four variables - horizontal alignments, posted speed limit, traffic control device type, and traffic way type - remained statistically significant in the final model. The adjusted odds ratio (AOR) of curved high-speed segment was nearly seven times (6.94; 95% CI = 3.58, 13.46) that of a straight segment with a low posted speed limit (reference group). The AOR of no traffic control was four times (4.17; 95% CI = 2.95, 5.88) that of roads with traffic controls. The AOR of a two-way undivided road was almost three times (2.75, 95% CI = 1.43, 5.29) that of a two-way median barrier road (reference group).Conclusions: This study suggests teen driver education programs consider addressing road design characteristics. For example, incorporating focused lessons on traffic signs and traffic control types may better prepare young people for their driving experiences. Additionally, more supervised driving time is needed on various road types, especially those that present greater risks (e.g., roads with grades/curves, intersections with no traffic signal, undivided roads, and unpaved roads).

The public health implications of telematic technologies: An exploratory qualitative study in the UK

INTRODUCTION

Reducing motorised transport is crucial for achieving public health goals, but cars will continue to be essential for many in the medium term. The role of emerging technologies in mitigating the public health disadvantages of this private car use has been under-examined to date. Telematics are increasingly used by novice drivers in the UK to reduce insurance premiums. An exploratory study of novice drivers' experiences of telematics identified implications for public health that warrant urgent further research.

METHODS

An exploratory qualitative study, using semi-structured interviews with 12 drivers aged 17-25 in three regions of the UK (Aberdeenshire, Hertfordshire and London).

RESULTS

Telematics were acceptable to young drivers, and reported to mitigate some negative health consequences of driving (injury risks, over-reliance on car transport), without reducing access to determinants of health such as employment or social life. However, there were suggestions that those at higher risk were less likely to adopt telematics.

CONCLUSION

Market-based mechanisms such as telematics are potential alternatives to well-evaluated policy interventions such as Graduated Driver Licensing for reducing road injury risks for novice drivers, with a different mix of risks and benefits. However, claims to date from insurance companies about the contribution of telematics to public health outcomes should be evaluated carefully to account for biases in uptake.

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.

Public health principles to inform testing and build trust in automated vehicles

Highly publicised crashes involving self-driving or autonomous vehicles (AVs) have raised questions about safety and eroded public trust in the technology. In this State of the Art Review, we draw on previous successes in injury prevention and public health to focus attention on three strategies to reduce risk and build public confidence as AVs are being tested on public roads. Data pooling, a graduated approach to risk exposure, and harm reduction principles each offer practical lessons for AV testing. The review points out how the eventual deployment of AV technology could have a substantial impact on public health. In this regard, inclusive testing, public education and smart policy could extend the social value of AVs by improving access to mobility and by directing deployments towards scenarios with the greatest population health impact. The application of these strategies does not imply slowing down progress; rather, their implementation could accelerate adoption and result in realising the benefits of AVs more quickly and comprehensively while minimising risks.