A population-based study of crashes involving 16- and 17-year-old drivers: the potential benefit of graduated driver licensing restrictions

Effect of Age on the Patterns of Traumatic Femoral Fractures: Seven Years of Experience at a Regional Tertiary Hospital

Objective

Femoral fractures are a common cause of mortality and functional loss, mainly among older people, and there are few studies about the age in relation to traumatic femoral fractures. The aim of this study was to investigate the effect of age on the patterns of traumatic femoral fractures in patients presenting to our regional tertiary hospital.

Methods

The records of 2020 patients who presented with traumatic femoral fractures between 2013 and 2019 were retrospectively reviewed. The patients' clinical and radiographic records were reviewed. Univariate and multivariable logistic regression were used to identify independent risk factors for associated injuries and complications.

Results

The patients were divided into a child group (CH group, n = 342) aged under 18 years, a young adult group (YA group, n = 484) aged 18–60 years, and an older people group (OP group, n = 1194) aged 60 years and over. There were significant differences among the three groups in several indexes, such as sex ratio (χ² = 301.699, p < 0.001), osteoporosis (χ² = 375.463, p < 0.001), injury time of day (χ² = 114.913, p < 0.001), injury cause (χ² = 748.187, p < 0.001), injury location (χ² = 490.153, p < 0.001), fracture side (χ² = 57.000, p < 0.001), fracture site (χ² = 806.650, p < 0.001), associated injuries (χ² = 322.921, p < 0.001), coma after injury (χ² = 147.814, p < 0.001), non‐surgery‐related complications (χ² = 7.895, p = 0.019), and surgery‐related complications (χ² = 82.186, p < 0.001). The YA group had a significantly higher percentage of patients with surgery‐related complications than the OP group. The OP group had a higher frequency of non‐surgery‐related complications than the YA group and CH group. The most common non‐surgery‐related complications were pneumonia (7.1%) in the OP group and deep venous thrombosis (6.4%) in the YA group. Multivariable logistic regression showed that young adults, high‐energy injury, outdoors, coma after injury, and fracture sites except for the proximal region were independent risk factors for associated injuries. Older age, male, and fracture site except for the proximal region were independent risk factors for complications.

Conclusions

Traumatic femoral fractures are mostly the result of low‐energy trauma and predominantly affect the proximal site of the femur among older people. A higher rate of shaft fractures, fractures occurring outdoors, and associated injuries were observed among young adults and children than among older people.

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

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

Young Drivers and Their Passengers: A Systematic Review of Epidemiological Studies on Crash Risk

PURPOSE

A systematic review of the literature was conducted to appraise the evidence from epidemiological studies of crash risk in young drivers accompanied by passengers, compared with solo driving.

METHODS

Databases searched were the Cochrane Library, Embase, Scopus, Transportation Research Information Services, and Web of Science for studies published between January 1, 1989 and August 1, 2013. Epidemiological studies were selected for review if they focused on crashes of young drivers (≤24 years old) and included both a no-passenger comparison group and some measure of exposure to enable calculation of estimates.

RESULTS

Fifteen articles (17 studies) were selected; seven studies reported on fatal crashes and 10 on nonfatal or combined fatal/nonfatal crashes. Studies on fatal crashes showed increased risk, compared with solo driving, for young drivers with at least one passenger (significant estimates ranging from 1.24 to 1.89) and two or more passengers versus solo driving (1.70-2.92). Increased risk was also found for fatal crashes and for combined or nonfatal crashes with male versus female passengers (1.53-2.66) and for younger versus older drivers (1.42-3.14).

CONCLUSIONS

Results more clearly indicated an increased risk for passenger presence in fatal crashes than that in nonfatal or combined fatal/nonfatal crashes. Findings of this review, based on correlational studies, support licensing policies that limit the presence and number of young passengers for young drivers.

Graduated driver licensing for new drivers: effects of three states' policies on crash rates among teenagers

BACKGROUND

Evidence is mixed on the effects of graduated driver licensing (GDL) on motor vehicle crashes involving drivers aged 18 years.

PURPOSE

This study examined the effects of GDL on crashes involving drivers aged 18 years in three states: Maryland, where GDL applies to novice drivers of all ages, and Florida and Michigan, where GDL applies only to new drivers aged <18 years. In addition, this study sought to confirm positive effects of GDL among drivers aged 16 and 17 years.

METHODS

Monthly rates for three levels of crash severity (fatal/disabling injury, nondisabling injury, and possible injury/property damage only [PDO]) for drivers aged 16, 17, and 18 years were calculated using crash records and census data. Data for Maryland spanned 1998 to 2009, for Florida 1990 to 2009, and Michigan 1992 to 2009. GDL's effects on teen driver crashes by age were estimated using time-series analyses, conducted in 2012.

RESULTS

Crash rates for drivers aged 16 and 17 years declined in all three states following implementation or revision of GDL. For drivers aged 18 years, revision of an existing GDL law in Maryland was followed by a 6.9% decrease in possible-injury/PDO crashes; in Michigan, GDL implementation was followed by a 3.6% increase in possible-injury/PDO crashes; and in Florida, GDL had no effect.

CONCLUSIONS

GDL led to expected declines in crash rates for drivers aged 16 and 17 years. However, the findings suggest that when GDL applies only to novice drivers aged <18 years, rather than to all novice drivers, crash rates among drivers aged 18 years may increase. In order to potentially extend the safety benefits of GDL, the age at which GDL for new drivers should be applied requires further attention.

Discriminant Profile of Young Adulthood Driving Behavior among Brazilian Drivers

The aim of this article was to describe the driving behavior profile of drivers aged 18 to 25 years old. Four hundred young adults were interviewed, 320 (80%) of them male and 80 (20%) female. Cluster analysis identified a group characterized by sensation-seeking behavior (Cluster 1), a group that did not show any risky driving behavior (Cluster 2), and a group engaged in transgressive behavior and driving under the influence of alcohol and/or drugs (Cluster 3). Discriminant analysis classified successfully and correctly 81.3% of the young adults into their original profiles. Function 1 distinguished cluster 1 from clusters 2 and 3, on the basis of the following factors: higher frequency of alcohol consumption, intrusive behavior, and motorcycle riding, as well as younger age, more aggressive behavior, and lower education level. Function 2 distinguished cluster 3 from cluster 1 and 2, especially as to higher amounts of alcohol consumption, higher frequency of marijuana use and delinquent behavior, larger number of traffic tickets and motor vehicle accidents, higher paternal education level, which were the variables with discriminant values above .20. Characteristics of vulnerability were identified, especially those related to alcohol consumption, drug use, and externalizing issues.

Developmental effects of decision-making on sensitivity to reward: an fMRI study

Studies comparing neural correlates of reward processing across development yield inconsistent findings. This challenges theories characterizing adolescents as globally hypo- or hypersensitive to rewards. Developmental differences in reward sensitivity may fluctuate based on reward magnitude, and on whether rewards require decision-making. We examined whether these factors modulate developmental differences in neural response during reward anticipation and/or receipt in 26 adolescents (14.05±2.37 yrs) and 26 adults (31.25±8.23 yrs). Brain activity was assessed with fMRI during reward anticipation, when subjects made responses with-vs.-without decision-making, to obtain large-vs.-small rewards, and during reward receipt. When reward-receipt required decision-making, neural activity did not differ by age. However, when reward receipt did not require decision-making, neural activity varied by development, reward magnitude, and stage of the reward task. During anticipation, adolescents, but not adults, exhibited greater activity in the insula, extending into putamen, and cingulate gyrus for large-vs.-small incentives. During feedback, adults, but not adolescents, exhibited greater activity in the precuneus for large-vs.-small incentives. These data indicate that age-related differences in reward sensitivity cannot be characterized by global hypo- or hyper-responsivity. Instead, neural responding in striatum, prefrontal cortex and precuneus is influenced by both situational demands and developmental factors. This suggests nuanced maturational effects in adolescent reward sensitivity.

Risky and aggressive driving in young adults: Personality matters

Young, novice drivers constitute a disproportionate percentage of fatalities and injuries in road traffic accidents around the world. This study, attempts to identify motivational factors behind risky driving behavior, and examines the role of personality, especially sensation seeking, impulsivity and sensitivity to punishment/reward in predicting negative driving outcomes (accident involvement and traffic offences) among young drivers. Gender and driver's age are additional factors examined in relation to driving outcomes and personality. Adopting the contextual mediated model of traffic accident involvement (Sümer, 2003), the study is based on the theory that personality, age and gender represent distal factors that predict accident involvement indirectly through their relationship with stable tendencies towards aberrant driving behavior. Results from correlations and Structural Equation Modeling using AMOS 6 indicated that direct personality effects on driving outcomes were few, whereas personality had significant correlations with aberrant driving behavior, showing that personality is a distal but important predictor of negative driving outcomes. These high risk traits appear to be at a peak among young male drivers. Thus, personality is important in understanding aggressive and risky driving by young adults and needs to be taken into consideration in designing targeted accident prevention policies.

Driver and passenger seatbelt use among U.S. high school students

BACKGROUND

In 2005, 40% of motor-vehicle occupant deaths in the group aged 16-19 years involved passengers. Although seatbelts can reduce crash mortality by 50% or more, little is known about the differences in driver-versus-passenger seatbelt use among teens.

METHODS

In 2007, data from the 2001 and 2003 Youth Risk Behavior Surveys were analyzed for 12,731 black, white, and Hispanic high school students aged >or=16 years reporting seatbelt use as both drivers and passengers. Seatbelt use was compared for driver- and passenger-seat positions, and stratified by age, gender, race/ethnicity, school grades, and histories of either drinking and driving or riding with a drinking driver.

RESULTS

Overall, 59% of students always used seatbelts when driving, but only 42% always buckled up as passengers. Across all covariate strata, passenger seatbelt use was significantly less prevalent than driver seatbelt use (p<0.001). A concordance analysis showed that only 38% of students always wore seatbelts both when driving and while riding as a passenger. Multivariate analyses indicated that, regardless of seat position, seatbelt use was lower for young men, blacks, students with poor grades, and students who reported either drinking and driving or riding with a drinking driver.

CONCLUSIONS

U.S. high school students aged >or=16 years are significantly less likely to wear seatbelts as passengers than as drivers. Interventions designed to promote seatbelt use among teens need to address this disparity.

Does the Maryland graduated driver licensing law affect both 16-year-old drivers and those who share the road with them?

PROBLEM

To assess effects of the 1999 Maryland graduated driver licensing (GDL) law on both 16-year-old drivers and other road users.

METHOD

Calculation and comparison of crash involvement rates and non-fatal injury rates pre-GDL (1996-1998) and post-GDL (2001-2003) by type of road user, per population, and per licensed driver, with adjustment for trends among 30-59-year-old drivers.

RESULTS

Post-GDL, prevalence of licensure decreased 24% among 16-year-olds, and rates of 16-year-old drivers involved in crashes significantly decreased per 16-year-old population (corrected rate ratio (RRc) 0.82; 95% CI (0.71, 0.96)). A significant decrease also was observed for non-fatal injuries per 16-year-old population among 16-year-old drivers involved in crashes (RRc 0.63; 95% CI (0.41, 0.98)). Similarly, decreases, albeit not statistically significant, were observed among their passengers and other vehicle occupants. Per 16-year-old licensed driver, a slight non-significant increase was observed in crash involvement rates; non-fatal injury rates per 16-year-old licensed driver suggest decreased risk (non-significant) among 16-year-old drivers, their passengers, and other vehicle occupants.

SUMMARY

Maryland's GDL delayed licensure and reduced crashes and non-fatal injuries among 16-year-old drivers per population. Trends in injuries among other road users involved in crashes with 16-year-old drivers were suggestive of a benefit from GDL, although observed decreases were not significant. Per licensed driver, findings were not significant, but suggested little change in crash involvement and decreased non-fatal injuries. Because one-third fewer 16-year-olds were licensed post-GDL, these results may suggest a selection effect in licensure.

IMPACT ON INDUSTRY

Because Maryland had nighttime restrictions for new drivers before 1999, this study suggests other components of GDL are beneficial for drivers and possibly for other road users. States with weak GDL laws should strongly consider revising them.

Epidemiology and mechanisms of femur fractures in children

The most common pediatric orthopaedic injury requiring hospitalization is a femur fracture. This study aimed to identify the epidemiology and mechanisms of injury so that these injuries might be reduced through specifically targeted safety measures. Data for this study were culled from the 2000 Kids' Inpatient Database representing over 2.5 million pediatric hospital discharges. Of the nearly 10,000 femur fractures, 1076 (11%) occurred in children younger than 2 years; 2119 (21%) in children aged 2 to 5 years; 3237 (33%) in children aged 6 to 12 years; and 3528 (35%) in adolescents aged 13 to 18 years. The most (71%) occurred in male patients. Falls and motor vehicle collisions accounted for two thirds of those injuries, with the incidence of falls greater in the younger children and motor vehicle collisions more prevalent in older children. Fifteen percent of femoral fractures in children younger than 2 years were because of child abuse. Length of hospital stay, number of diagnoses and procedures, and hospital charges were greatest in the adolescent age group, likely because of high-energy trauma with resultant polytrauma. Hospital charges were more than 222 million dollars with the average charge over 2.5 times that in adolescents compared with infants/toddlers. Pediatric orthopaedists must continue to press for increased safety for our children, particularly adolescent motor vehicle safety. Abuse should be considered when a child younger than 2 years presents with a femoral fracture.

A conceptual framework for reducing risky teen driving behaviors among minority youth

Teenage drivers, especially males, have higher rates of motor vehicle crashes and engage in riskier driving behavior than adults. Motor vehicle deaths disproportionately impact youth from poor and minority communities and in many communities there are higher rates of risky behaviors among minority youth. In this paper, the authors review the data on teens, risky driving behaviors, and morbidity and mortality. They identify areas in which known disparities exist, and examine strategies for changing teen driving behavior, identifying what has worked for improving the use of seat belts and for reducing other risky behaviors. A multifaceted, multilevel model based on ecological theory is proposed for understanding how teens make choices about driving behaviors, and to understand the array of factors that can influence these choices. The model is used to create recommendations for comprehensive intervention strategies that can be used in minority communities to reduce disparities in risk behaviors, injury, disability, and death.

Underage driving as an indicator of risky behavior in children and adolescents

Driving among children and adolescents below the legal driving age in Texas was examined. There were 4170 accidents between 1995 and 2000 (66.5% involved injury/fatality). Drivers were more often male, and underage driving was greatest during the late afternoon/early evening. Risk of severe injury or death was inversely related to speed and nighttime driving, and was greater in rural areas, in accidents involving passengers and among black children and youth compared with white.

Motor vehicle collision risk and driving under the influence of cannabis: evidence from adolescents in Atlantic Canada

OBJECTIVE

Employing a sample of 6087 senior students in Atlantic Canada, this paper examines the relationship between driving under the influence of cannabis (DUIC) and motor vehicle collision (MVC) risk. A series of models were analyzed adjusting for demographic characteristics, driver experience, and substance use.

METHODS

Participants were drawn from the 2002/2003 Student Drug Use Survey in the Atlantic Provinces, an anonymous cross-sectional survey of adolescent students in the Atlantic provinces of Canada. Logistic regression techniques were employed in the analysis of unadjusted and adjusted models.

RESULTS

Among senior students, the prevalence of DUIC in the past year was 15.1% while the prevalence of MVCs was 8.1%. The predictors of DUIC were gender, driver experience, use of a fake ID, and driving under the influence of alcohol (DUIA). The predictors of MVC were gender, driver experience, DUIC, and DUIA.

CONCLUSIONS

These findings extend our knowledge of DUIC as a socio-legal and public health issue with implications on road safety. Effort must be placed on educating new drivers about cannabis use in the context of driving.

A survey of teenager unnatural deaths in northern Sweden 1981-2000

OBJECTIVE

To survey unnatural deaths among teenagers in northern Sweden and to suggest preventive measures.

SETTING

The four northernmost counties (908,000 inhabitants, 1991), forming 55% of the area of Sweden.

MATERIAL AND METHODS

All unnatural teenager deaths from 1981 through 2000 were identified in the databases of the Department of Forensic Medicine in Umea, National Board of Forensic Medicine. Police reports and autopsy findings were always studied, social and hospital records if present.

RESULTS

Three hundred and fifty-five deaths were found, of which 267 (75%) were males and 88 (25%) females. Ninety out of 327 (28%) tested positive for alcohol. Two hundred and forty-eight (70%) were unintentional and 102 (30%) were intentional deaths, and five (1%) were categorized as undetermined manner of death. Unintentional deaths decreased while the incidence of intentional deaths remained unaffected by time.

CONCLUSIONS

Injury-reducing measures have been effective concerning unintentional deaths and the fall in young licensed drivers due to the economical recess have probably also contributed to the decrease. However, there were no signs of decreasing numbers of suicides during the study period, which calls for resources to be allocated to suicide prevention.

Graduated driver licensing in Utah: Is it effective?

STUDY OBJECTIVE

We seek to examine the effectiveness of the graduated driver licensing system in Utah by determining whether crash rates of 16-year-old drivers decreased after graduated driver licensing implementation.

METHODS

We studied 16-year-old-driver crashes using statewide motor vehicle crash data probabilistically linked to emergency department (ED), hospital inpatient, and driver licensure data for 1996 to 2001. Outcomes examined included overall crash rates, nighttime crashes, crash severity indicators (eg, noninjury crash, injury crash, ED crash, inpatient crash, fatal crash), seat belt usage, licensure status, and citations. Rate ratios (RR), chi 2 tests, and interventional time series analyses were used to assess changes before and after graduated driver licensing implementation.

RESULTS

There were 27,304 16-year-old-driver crashes during the study period. The overall crash rate per 1,000 licensed 16-year-old drivers decreased by 5% (RR 0.95; 95% confidence interval [CI] 0.92 to 0.97), and a time-series analysis showed a reduction of 0.8 (SD 0.39) crashes per month per 1,000 licensed drivers after graduated driver licensing implementation (1996 to 1999 versus 1999 to 2001). The nighttime crash rate did not change (RR 0.91; 95% CI 0.78 to 1.04), and there was no association between crash severity and graduated driver licensing implementation ( P =.096). Reported seat belt usage increased by 6.3%, and few graduated driver licensing citations were issued by law enforcement.

CONCLUSION

The results suggest that graduated driver licensing may have contributed to a reduction in young driver crashes, but the effects were minimal compared with those shown in many other graduated driver licensing evaluations.

Identifying best practices states in motorcycle rider education and licensing

PROBLEM

After decreasing to a historic low in 1997, motorcycle crash-related fatalities are increasing. Although causes remain unclear, motorcycle rider education and licensing play key roles in reducing motorcycle crashes and injuries. Yet, little is known about what constitutes effective rider training and licensing. This study develops a model of best practices in motorcycle rider education and licensing and combines primary and secondary data to identify states that most closely adhere to this model. Evidence on the validity of the model is also examined.

METHOD

States were rated along three areas of best practices: (a) program administration; (b) rider education; and (c) licensing based on 2001 data collected for a National Highway Traffic Safety Administration (NHTSA)-sponsored study.

RESULTS

Results indicate wide variation in states' adherence to best practices; several states meet most, others very few. When the areas of best practices are considered separately, a state tends to behave similarly on all three. Initial evidence supports the validity of the model, with high best practices states having the lowest rates of motorcycle fatalities.

IMPACT ON TRAFFIC SAFETY

As motorcycle-related crashes increase and state and federal support for rider education programs diminishes, it is critical that states identify deficiencies in their program and learn from successful states about efficient, cost-effective strategies for increasing best practices in motorcycle rider education and licensing.

Safety halls--an evaluation

PROBLEM

In most countries, drivers licensing systems usually include teaching some aspects of using safety equipment (e.g., airbags and seat belts). However, there is now evidence worldwide that such education is inadequate, as indicated by, for example, the overrepresentation of young drivers who do not use seat belts.

METHOD

A randomized controlled study was conducted in Sweden to evaluate the effects of visiting a facility known as a "safety hall" in combination with the mandatory skid training. The results were assessed to determine the effects of the knowledge and attitudes of learner drivers in the following subjects: airbags, securing loads, seat belts, sitting posture, speed, and tires. An experimental group and a control group comprising 658 and 668 learners, respectively, answered identical questionnaires on three different occasions (pretest, posttest 1, and posttest 2).

RESULTS

The results show that, for most of the topics considered, knowledge and attitudes in both groups were better at posttest 2 than at the pretest, and in general, the best knowledge and attitudes were found in the experimental group. The combined safety/skid training seems to have had the greatest effect on seat belts and loads. The findings also indicate that the safety halls can be further improved to achieve an even better effect.

IMPACT ON TRAFFIC SAFETY

The use of safety halls has improved the knowledge and attitudes of learner drivers concerning several important areas related to traffic safety. Since knowledge and attitudes are important predictors of behavior, implementing safety halls can be expected to lead to improvements, especially regarding the use of safety belts and securing loads.

Demographics of traumatic amputations in children. Implications for prevention strategies

BACKGROUND

The demographics of traumatic amputations in children are not well known. The purpose of this review was to identify those demographics for use as a possible guide for prevention strategies.

METHODS

The study was a retrospective review of the data on children with traumatic amputation who had received care at one center in the upper midwestern United States from 1980 to 2000. The child's gender and age at the time of the amputation, the date and etiology of the amputation, and the amputation level were tabulated. Statistical analyses of seasonal variations were performed.

RESULTS

There were 256 amputations in 235 children. The mean age (and standard deviation) at the time of the amputation was 7.9 +/- 5.0 years. The amputation involved one extremity in 217 children, two extremities in sixteen, and three and four extremities in one child each. Of the 256 amputations, 165 involved the lower extremity. The traumatic amputation was caused by a lawnmower in sixty-nine children, farm machinery in fifty-seven, a motor-vehicle accident in thirty-eight, a train in twenty, and miscellaneous mechanisms in fifty-one. The mean age at the time of the injury varied according to the mechanism of injury and ranged from 1.9 years for burns to 11.5 years for boating injuries. Fifty-four (78%) of the sixty-nine children with a lawnmower amputation were five years of age or less. There were significant seasonal variations: the mean date of the lawnmower injuries was June 10, the mean date of the farming injuries was September 2, and the mean date of the motor-vehicle-related injuries was July 16.

CONCLUSIONS

There are common patterns of traumatic amputations in children based on the mechanism of injury, the season, and the age of the child. The ideal time for an educational campaign for the prevention of lawnmower injuries appears to be March and April and should be directed toward parents. The best times for such a campaign for the prevention of farming-related accidents appear to be both the spring and the early fall, and the campaign should be directed toward both parents and older children.

How well do parents manage young driver crash risks?

Motor vehicle crashes are extremely high among young drivers during at least the first year of licensure. Crash risks decline with increased experience, but the more newly licensed teenagers drive, the greater their risk exposure. Hence, the dilemma facing policy makers and parents is how to provide young drivers with driving experience without unduly increasing their crash risk. Graduated driver licensing policies serve to delay licensure and then limit exposure to the highest risk conditions after licensure, allowing young drivers to gain experience only under less risky driving conditions. A similar strategy is needed to guide parents. Parents do not appear to appreciate just how risky driving is for novice drivers and tend to exert less control over their teenage children's driving than might be expected. Recent research has demonstrated that simple motivational strategies can persuade parents to adopt driving agreements and impose greater restrictions on early teen driving.

Promoting parental management of teen driving

OBJECTIVE

Parenting may be an important protective factor against teen driving risk; however, parents do not limit teen driving as much as might be expected. The Checkpoint Program was designed to promote parental management of teen driving through the use of staged persuasive communications.

METHODS

Parent-teen dyads (n = 452) were recruited when teens received learner's permits and interviewed over the telephone at baseline, licensure, and three months post-licensure. After baseline, families were randomized to either the intervention group that received persuasive communications or to the comparison group that received general information about driving safety.

RESULTS

Both parents and teens in the intervention group reported significantly greater limits on teen driving at licensure and three months post-licensure. In multivariate analyses, intervention and baseline driving expectations had significant effects on driving limits at licensure. Intervention and driving limits established at licensure were associated with three month driving limits.

CONCLUSION

The findings indicate that exposure to the Checkpoints Program increased parental limits on teen driving.