Transcript teen driving: what works….what doesn`t

TEEN DRIVING:
WHAT WORKS….WHAT
DOESN’T
Injury Free Coalition for Kids/SECSI
Alabama has a GDL law
1.
2.
3.
Yes
No
Don’t know
33%
1
33%
2
33%
3
Alabama’s GDL law addresses which
of the following:
1.
2.
3.
4.
Number of
passengers
Time of driving
Both
neither
25%
1
25%
25%
2
3
25%
4
I discuss safe driving with my teen
patients…..
1.
2.
3.
4.
Always
sometimes
never
I don’t see teens in
my practice
25%
1
25%
25%
2
3
25%
4
Teen driving:
rd
(1/3 )
Novice drivers
Per mile driven:
4 times the risk
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, FL
Jacksonville, FL
Nashville-Davidson--Murfreesboro, TN
******Birmingham-Hoover, AL*****
Phoenix-Mesa-Scottsdale, AZ
Kansas City, MO-KS
Atlanta-Sandy Springs-Marietta, GA
Charlotte-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 driving
When asked about passenger situations:

67% reported being passenger when driver texting

27% reported being passenger when driver drinking
Overall 58% reported no seatbelt
13% have driven after drug use
60% 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: 4861.
Maston SV, Foss RD, Marshall SW. Graduated driver licensing and fatal
crashes involving 16- to 19-year-old drivers. JAMA 2011; 306 (10):10981103.
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. Adultsupervised 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.
Conclusion
J 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
Note: 1st 6 months or 1000 miles of driving
Months
Miles
Source: Mayhew, 2002; McCartt et al, 2001
WHAT CAN PARENTS DO?
SET LIMITS
to reduce the risk of a
fatal crash
for drivers 16-19 years of age.
For at least 6 months or
1,000 miles
of 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)
Value
OverSpeedLimit
OverCorrecting/OverSteering
DistractedbyUseofOtherElectronicDevice
NegotiatingaCurve
AggressiveOperation
DistractedbyUseofElectronicCommunDevice
RanOffRoadRight
FailedtoYieldRight‐of‐WayfromStopSign
DistractedbyPassenger
Fatigued/Asleep
VehicleLeftinRoad
SingleVehicleCrash(alltypes)
AvoidObjectinRoad
RanOffRoadLeft
DrivingtooFastforConditions
FailedtoYieldRight‐of‐WayfromTrafficSignal
FailedtoYieldRight‐of‐WayMakingLeftorU‐Turn
Significant
TRUE
TRUE
TRUE
TRUE
TRUE
TRUE
TRUE
TRUE
TRUE
TRUE
TRUE
TRUE
TRUE
TRUE
TRUE
TRUE
TRUE
Odds
Ratio
4.91
3.00
2.95
2.70
1.98
1.89
1.87
1.87
1.86
1.85
1.80
1.71
1.66
1.61
1.61
1.53
1.48
adapted from: http://www.safehomealabama.gov/InfoTraining/YoungDriverIssues.aspx
authors: J Norris and D Brown
Injury
MaxGain
1205
171
49
516
72
55
224
295
48
102
81
1236
67
86
299
64
134
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 (0.380.78), 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.
2.
3.
4.
Often
Rarely
Never
Was not familiar
with driving contracts
til today
25%
1
25%
25%
2
3
25%
4
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 lecture
1.
2.
Yes
No
50%
1
50%
2
Alabama’s GDL limits the number of
passengers a teen can transport
1.
2.
3.
Yes
No
Don’t Know
33%
1
33%
2
33%
3
Alabama GDL sets a curfew for teen
drivers with a restricted license
1.
2.
3.
Yes
No
Don’t Know
33%
1
33%
2
33%
3
How many Adolescents do you see in
your practice in a year?
1.
2.
3.
4.
5.
<10
10-30
30-50
50-70
>70
20%
1
20%
20%
2
3
20%
4
20%
5
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)