TEEN DRIVING:WHAT WORKS….WHAT DOESN’T

Injury Free Coalition for Kids/SECSI

Alabama has a GDL law

1 2 3

33% 33%33%1. Yes2. No3. Don’t know

Alabama’s GDL law addresses which of the following:1. Number of

passengers2. Time of driving3. Both4. neither

1 2 3 4

25% 25%25%25%

I discuss safe driving with my teen patients…..1. Always2. sometimes3. never4. I don’t see teens

in my practice

1 2 3 4

25% 25%25%25%

Teen driving: (1/3rd)

34% are passenger

Why are teens at risk Novice, night, passenger

Brain centers “under construction”(areas of impulse control, prioritization, and strategy

The number of teens who died in 2007 could fill up 10 sophomore homeroom classes, ranking Alabama as one of the deadliest states nationwide for young drivers. – Anniston Star

The 10 deadliest hotspots among the nation's 50 largest metro areas: Tampa-St. Petersburg-Clearwater, FL

Orlando-Kissimmee, FLJacksonville, FLNashville-Davidson--Murfreesboro, TN******Birmingham-Hoover, AL*****Phoenix-Mesa-Scottsdale, AZKansas City, MO-KSAtlanta-Sandy Springs-Marietta, GACharlotte-Gastonia-Concord, NC-SC

AllState Foundation Teen Driving “Hotspots

Alabama Teen (16-19 year old) MVC crashes

From 2000-2011 there were 783 deaths 46413 reported injuries

Alabama Teens: risky business?

When asked about driving behaviors in the past 30 days: 41% report texting 11% report drinking after drivingWhen asked about passenger situations: 67% reported being passenger when driver

texting 27% reported being passenger when driver

drinking

Overall 58% reported no seatbelt13% have driven after drug use60% routinely drive over the speed limit

Specific Data 80% had discussed safe driving with a

parent

25% had signed a driver contract

63% had taken a driver education class

16% with a physician

So… how can we help? Driver’s education

Parents

GDL laws

Pediatricians

Drivers education in Alabama: current state Convenience sample study: 2011

PED and Adolescent Health Center

17 questions re: knowledge of Alabama graduated driver’s license laws

83 Surveys with overall score of 27%

Results: There was no statistical correlation to

show that attending driver’s education improved your knowledge of the states new GDL law

(t=-.43 p=0.67).

mean score of 26% vs 28% on the evaluation

Parents: 93% of parents feel they can teach their

children to drive

60% or less are aware of current GDL law in their state

>50% of parents talked on cell phone, >33% read texts and 20% sent text while driving

Parent effect: Review of literature is clear:

risky driving, traffic violations and crashes are lower among teens whose parents apply restrictions

Parents intend to impose substantial limits on trip conditions but not on risk conditions

Large number of rules, with talking or warning as the primary consequence

Four new and interesting studies:

Karaca-Mandic P, Ridgeway G. Behavioral impact of graduated driver licensing on teenage driving risk and exposure. J Hlth Econ. 2010; 29: 48-61.

Maston SV, Foss RD, Marshall SW. Graduated driver licensing and fatal crashes involving 16- to 19-year-old drivers. JAMA 2011; 306 (10):1098-1103.

Rogers SC, Bentley GC, Campbell B. et al. Impact of Connecticut’s gdl system on teenage mvc rates. J Trauma 2011 Nov;71(5 Suppl 2): S527-30.

Jacobsohn L, Garcia-Espana JF, Durbin DR, Erkoboni D, Winston F. Adult-supervised practice driving for adolescent learners: The current state and directions for interventions. J Safety Res 2012 Feb; 43(1):21-8.

Karaca-Mandic P, Ridgeway G. Behavioral impact of graduated driver licensing on teenage driving risk and exposure. J Hlth Econ. 2010; 29: 48-61.

Do GDL laws improve driving behavior or simply reduce teen drivers on the roads? Do GDL laws result in better teen drivers later in life? Comment: The article has an excellent literature review for studies evaluating GDL and crash outcomes (pgs 49-50). This study has a very complex

methodology and statistical analysis, it takes time for a thorough review and understanding.

Results:J Hlth Econ. 2010; 29: 48-61.

GDL policies have reduced the number of 15-17 yo crashes by limiting the amount of teen driving (not improving teen driver behavior).

GDL reduces relative teen driving prevalence by 5% in day and 15% in night.

Stricter policies have been more effective (night time and passenger restrictions).

GDL policies do not make teens better drivers in later years.

ConclusionJ Hlth Econ. 2010; 29: 48-61

The Public Health Perspective

More restrictive GDL policies for 15-17 year old drivers reduce teen crashes and fatalities.

Stronger GDL policies defer unrestricted driving thus reducing teens’ exposure to high risk driving situations.

GDL policies could emphasize stronger measures to improve teen driving skill. (increase the supervised driving period or as a personal note – integrate skill based checklists in the mentored driving period).

Maston SV, Foss RD, Marshall SW. Graduated driver licensing and fatal crashes involving 10- to 19-year-old drivers. JAMA 2011; 306 (10):1098-1103.

Objective: To estimate the association of GDL programs with involvement in fatal crashes among 16- to 19-year-old drivers.

Outcomes: Fatal crash rates for each age group - 16, 17, 18, 19 year old drivers.

Compared strong restriction states/quarters (night driving restriction (before 1 am and 1 passenger) to weaker restriction states/quarters.

Results: JAMA 2011; 306 (10):1098-1103.

Fatal crash incidence among teen drivers increased with

age. (note: un-adjusted for vmt, vmt adjusted rates for 16 and 17 yrs are 150% and 90% higher than 18 and 19 yrs).

After adjustment for confounders: stronger GDL programs were associated with lower incidence of fatal crashes in 16 year old drivers. (RR=0.74, 95%CI (0.65, 0.84)).

RR’s for 17 and 19 year olds and combined ages 16-19, were not statistically different from the null.

Stronger GDL programs were associated with higher fatal crash incidence for 18 year old drivers (RR=1.12, 95%CI (1.01, 1.23)).

Authors Comments and Conclusions GDL programs are designed to improve learning

among novice drivers and to protect them from their inexperience. (Not a program to control excessive behaviors involved in fatal crashes).

GDL programs in the U.S. were associated with substantial reductions in fatal crashes of drivers to whom the protective elements most apply – 16 year olds.

GDL programs are associated with somewhat higher fatal crash incidence among 18 year old drivers, who are not directly subject to GDL restrictions.

Questions: 1. Should GDL age restrictions be increased to 18 year old drivers? 2. What factors account for the increase among 18 year old drivers?

Rogers SC, Bentley GC, Campbell B. et al. Impact of Connecticut’s GDL system on teenage mvc rates. J Trauma 2011 Nov;71(5 Suppl 2): S527-30.

Description – a ten year look at age stratified mvc rates pre and post GDL intervention.

GDL included restrictions on age, passengers, late night driving (11p thru 5a).

MVC rate decreased 40% for 16 yo’s and 30% for 17 yo’s. MVC rates decreased 16% for 18 yo’s and 7% for 19 yo’s.

During late night driving restriction period , MVC rates decreased 54% in 16 yo’s and 49% for 17 yo’s.

MVC rate with passengers decreased by 65% in 16yo’s and 53% for 17yo’s.

Jacobsohn L, Garcia-Espana JF, Durbin DR, Erkoboni D, Winston F. Adult-supervised practice driving for adolescent learners. J Safety Res 2012 Feb; 43(1):21-8.

Description – a national survey of 945 parents

Purpose – to determine correlates to the amount of parent supervised practice hours of novice teen drivers.

Results: 61% parents reported practicing 50 or more hours. Correlates to 50+hrs : 2 parent involvement ; state

law mandate of 50 or more hours. Use of a professional driving instructor was not a

correlate to parent teen practice hours .

RISK TO TEEN DRIVERS: INEXPERIENCE

Novice driver crash risk

Months Miles

Note: 1st 6 months or 1000 miles of driving

Source: Mayhew, 2002; McCartt et al, 2001

WHAT CAN PARENTS DO?SET LIMITS

to reduce the risk of afatal crash

for drivers 16-19 years of age.For at least 6 months or

1,000 milesof driving time

to reduce crash risk.

Use skill based training plans

+

HELP SET THE RULES• Always wear seatbelts ! Put away cell phone !

• Six months or 1,000 miles Passenger Rule

• No nighttime driving (until stage 4 training)

• Safe driving behaviors: no alcohol, cell phone, or speeding

• Complete skills based training plans

Practice Skills

Stage 1: Beginner (low speed, low traffic) basics, turning, braking, accelerating Stage 2: Intermediate (low speed, low

traffic) scanning for hazards, passing, maintaining speeds, following distances, 4 way stops, light change pause Stage 3: Advanced ( speed and traffic) merging, passing, changing lanes, emergency lane Stage 4: Advanced (challenging

conditions) night time, weather, passengers

Table 1. Most Critical Teen Driver Caused Crash Factors (2008-2011)

Odds Injury Value Significant Ratio MaxGain OverSpeedLimit TRUE 4.91 1205

OverCorrecting/OverSteering TRUE 3.00 171 DistractedbyUseofOtherElectronicDevice TRUE 2.95 49 NegotiatingaCurve TRUE 2.70 516 AggressiveOperation TRUE 1.98 72 DistractedbyUseofElectronicCommunDevice TRUE 1.89 55 RanOffRoadRight TRUE 1.87 224 FailedtoYieldRight of WayfromStopSign ‐ ‐ TRUE 1.87 295 DistractedbyPassenger TRUE 1.86 48 Fatigued/Asleep TRUE 1.85 102 VehicleLeftinRoad TRUE 1.80 81 SingleVehicleCrash(alltypes) TRUE 1.71 1236 AvoidObjectinRoad TRUE 1.66 67 RanOffRoadLeft TRUE 1.61 86 DrivingtooFastforConditions TRUE 1.61 299 FailedtoYieldRight of WayfromTrafficSignal ‐ ‐ TRUE 1.53 64 FailedtoYieldRight of WayMakingLeftorU Turn ‐ ‐ ‐ TRUE 1.48 134

adapted from: http://www.safehomealabama.gov/InfoTraining/YoungDriverIssues.aspxauthors: J Norris and D Brown

Alabama Teen Driver Deaths(Years 2000 - 2011)

(r sub s = -0.87, p<0.001)

Data Needs Seat belt use among Alabama teen drivers. Prevalence of cell phone and hand held device

use among Alabama teen drivers. Prevalence of risk behaviors among Alabama

teen drivers. Prevalence of night and day driving (teen driver

VMT). Parents’ knowledge of the Alabama GDL. Crash scenarios over-represented among

Alabama teen drivers (fatal versus nonfatal events).

Enforcement levels of current Alabama GDL law.

Pediatricians- How are we doing?

150/1301 (11.5%) of participants had spoken to their pediatrician about driving.

Within that group that had spoken to their pediatrician they were less likely to text while driving (OR 0.55, 95% CI (0.38-0.78), p<0.01), less likely to be a passenger in a car with someone who had been drinking alcohol (OR 0.68, 95% CI (0.47-0.99), p <0.03).

AAP Guidelines (cont’d) Encourage parents to restrict driving

Spend time in car with teen Written contract

Remind teens and parents of state laws

In the past I’ve recommended driving contracts to my families ….1. Often2. Rarely3. Never4. Was not familiar

with driving contracts til today

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25% 25%25%25%

Implications for Pediatricians:Anticipatory Guidance Start discussing safe passenger behavior

by age 11 years Help parents set limits Start discussing driving rules by age 13

Alabama GDL (Cliff notes) 15 year olds get “temporary” – have to

be accompanied by adult 16 yo can get restrictive :

Passengers Cell phones curfew

Two take home messages:

Our states’ teens are at exceptionally high risk for death or injury when driving or as passengers

Parents are the key influence on teens and we can help parents set rules, teach skills and keep our teens safe

I knew the components of the GDL law BEFORE today’s lecture1. Yes2. No

1 2

50%50%

Alabama’s GDL limits the number of passengers a teen can transport

1 2 3

33% 33%33%1. Yes2. No3. Don’t Know

Alabama GDL sets a curfew for teen drivers with a restricted license

1 2 3

33% 33%33%1. Yes2. No3. Don’t Know

How many Adolescents do you see in your practice in a year?1. <102. 10-303. 30-504. 50-705. >70

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20% 20% 20%20%20%

Alabama GDL Stage 1 learners permit

15 or older Written exam and accompanied by

guardian or licensed driver over 21 Minimum 30 hrs supervised driving or

complete drivers ed Must have 6 month holding period for this

stage

Restricted license Stage 2

16 or over and guardians permission Road skills exam No more than one passenger in vehicle other

than parents, or drivers over 21 No handheld communications devices No driving between midnight and 6 am

unless….. With adult Going to work, school or religious event Medical, fire, legal emergency Hunting/fishing activities

Unrestricted license Must be 17 or older (must have had a stage 2 license for at

least 6 months if 17 yo)

New texting bill

Bans driving while manually using a cellphone or other wireless device to communicate by text message or email

Does not apply to calls for emergency services If parked on side of road GPS systems

Fine: $25 first office, $50 for second and $75 third

Each conviction carries 2 points on driving record (suspended license for 12 pt in 2 yrs)