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Purpose We examined the frequency of adolescents’ and their parents’ mobile phone use while driving (MPUWD) in the context of their peer and parent-child interlocutors (i.e., communication partners), considering individual differences in perceived risk and symptoms of technology addiction. Methods Ninety-four participants (47 parent-adolescent dyads) completed a survey battery measuring their symptoms of technology addiction, perceived risk of MPUWD, and MPUWD with family members and with their peers as assessed via the proportion of trips when drivers used a mobile phone to communicate. Results For both adolescents and their parents across both types of interlocutors (parent-child, peer), stronger risk perceptions were associated with less MPUWD, and stronger symptoms of technology addiction were associated with more MPUWD. A three-way interaction among technology addiction, interlocutor (parent-child, peer), and driver (parent, adolescent) was observed. For adolescents, the association between technology addiction and MPUWD was significantly stronger for MPUWD with their peers than it was for their MPUWD with their parents; this association was not observed for parents. Parents engaged in MPUWD with their children as frequently as adolescents engaged in MPUWD with their peers. Conclusions Symptoms of technology addiction play a stronger role for adolescents’ MPUWD with their peers than it does for adolescents’ MPUWD with their parents. These and other driver-by-interlocutor interactions should be considered in future research on distracted driving and in prevention efforts. [ABSTRACT FROM AUTHOR]

Objective. Inexperienced, less-skilled driving characterises many newly licensed drivers and contributes to high crash rates. A randomised trial of TeenDrivingPlan (TDP), a new learner driver phase internet-based intervention, demonstrated effectiveness in improving safety relevant, on-road driving behaviour, primarily through greater driving practice diversity. To inform future learner driver interventions, this analysis examined TDP use and its association with practice diversity. Design. Posthoc analysis of data from teen/parent dyads (n=107), enrolled early in learner phase and assigned to treatment arm in randomised trial. Methods. Inserted software beacons captured TDP use data. Electronic surveys completed by parents and teens assessed diversity of practice driving and TDP usability ratings at 24 weeks (end of study period). Results. Most families (84%) used TDP early in the learner period; however, the number of TDP sessions in the first week was three times higher among dyads who achieved greater practice diversity than those with less. By week five many families still engaged with TDP, but differences in TDP use could not be detected between families with high versus low practice diversity. Usability was not a major issue for this sample based on largely positive user ratings. Conclusions. An engaging internet-based intervention, such as TDP, can support families in achieving high practice diversity. Future learner driver interventions should provide important information early in the learner period when engagement is greatest, encourage continued learning as part of logging practice drives, and incorporate monitoring software for further personalisation to meet family needs [ABSTRACT FROM AUTHOR]

Background Despite demonstrating basic vehicle operations skills sufficient to pass a state licensing test, novice teen drivers demonstrate several deficits in tactical driving skills during the first several months of independent driving. Improving our knowledge of the types of errors made by teen permit holders early in the learning process would assist in the development of novel approaches to driver training and resources for parent supervision. Methods The purpose of the current analysis was to describe driving performance errors made by teens during the permit period, and to determine if there were differences in the frequency and type of errors made by teens: (1) in comparison to licensed, safe, and experienced adult drivers; (2) by teen and parent-supervisor characteristics; and (3) by teen-reported quantity of practice driving. Data for this analysis were combined from two studies: (1) the control group of teens in a randomized clinical trial evaluating an intervention to improve parent-supervised practice driving ( n = 89 parent-teen dyads) and (2) a sample of 37 adult drivers (mean age 44.2 years), recruited and screened as an experienced and competent reference standard in a validation study of an on-road driving assessment for teens (tODA). Three measures of performance: drive termination (i.e., the assessment was discontinued for safety reasons), safety-relevant critical errors, and vehicle operation errors were evaluated at the approximate mid-point (12 weeks) and end (24 weeks) of the learner phase. Differences in driver performance were compared using the Wilcoxon rank sum test for continuous variables and Pearson's Chi-square test for categorical variables. Results 10.4% of teens had their early assessment terminated for safety reasons and 15.4% had their late assessment terminated, compared to no adults. These teens reported substantially fewer behind the wheel practice hours compared with teens that did not have their assessments terminated: tODA early (9.0 vs. 20.0, p < 0.001) and tODA late (19.0 vs. 58.3, p < 0.001). With respect to critical driving errors, 55% of teens committed a total of 85 critical errors (range of 1–5 errors per driver) on the early tODA; by comparison, only one adult committed a critical error ( p < 0.001). On the late tODA, 54% of teens committed 67 critical errors (range of 1–8 errors per driver) compared with only one adult ( p < 0.001). No differences in teen or parent gender, parent/teen relationship type or parent prior experience teaching a teen to drive were observed between teens who committed a critical error on either route and teens that committed no critical errors. A borderline association between median teen-reported practice quantity and critical error commission was observed for the late tODA. The overall median proportion of vehicle operation errors for teens was higher than that of adults on both assessments, though median error proportions were less than 10% for both teens and adults. Conclusion In comparison to a group of experienced adult drivers, a substantially higher proportion of learner teens committed safety-relevant critical driving errors at both time points of assessment. These findings, as well as the associations between practice quantity and the driving performance outcomes studied suggest that further research is needed to better understand how teens might effectively learn skills necessary for safe independent driving while they are still under supervised conditions. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The goal was to explore the association between parenting style and driving behaviors. METHODS: The 2006 National Young Driver Survey gathered data on driving safety behaviors from a nationally representative sample of 5665 ninth-, 10th-, and 11th-graders. A parenting style variable was based on adolescent reports and separated parents into 4 groups, (1) authoritative (high support and high rules/monitoring), (2) authoritarian (low support and high rules/monitoring), (3) permissive (high support and low rules/monitoring), and (4) uninvolved (low support and low rules/monitoring). Associations between parenting style and driving behaviors and attitudes were assessed. RESULTS: One half of parents were described as authoritative, 23% as permissive, 8% as authoritarian, and 19% as uninvolved. Compared with teens with uninvolved parents, those with authoritative parents reported one half the crash risk in the past year (odds ratio [OR]: 0.47 [95% confidence interval [Cl]: 0.26-0.87]), were 71% less likely to drive when intoxicated (OR: 0.29 [95% CI: 0.19-0.44]), and were less likely to use a cellular telephone while driving (OR: 0.71 [95% CI: 0.50-0.99]). Teens with authoritative or authoritarian parents reported using seat belts nearly twice as often (authoritative: OR: 1.94 [95% Cl: 1.49-2.54]; authoritarian: OR: 1.85 [95% Cl: 1.08-3.181) and speeding one half as often (authoritative: OR: 0.47 [95% Cl: 0.36-0.611; authoritarian: OR: 0.63 [95% Cl: 0.40-0.99]) as teens with uninvolved parents. No significant differences in crash risk or seat belt use were found between permissive and uninvolved parents. CONCLUSIONS: Clinicians should encourage parents to set rules and to monitor teens' driving behaviors, in a supportive context. [ABSTRACT FROM AUTHOR]

New Jersey (NJ) implemented the first-in-the-US Graduated Driver Licensing (GDL) decal provision in May 2010 for young drivers with learner's permits or intermediate licenses. Previous analyses found an association between the provision and crash reduction among intermediate drivers. The aim of this study is to examine the association between NJ's provision and GDL citation and crash rates among drivers aged <21 years with learner's permits. We estimated monthly per-driver rates from January 2006 through June 2012. Negative binomial modeling compared pre and post decal crash rates adjusted for gender, age, calendar month, and gas price. The monthly GDL citation rate was two per 10 000 drivers in the predecal and postdecal periods. Crashes were rare and rates declined similarly pre and post decal (adjusted rate ratio of postdecal vs predecal slope: 1.04 (0.97 to 1.12)). NJ's GDL decal provision was not associated with a change in citation or crash rates among young NJ drivers with learner's permits. [ABSTRACT FROM AUTHOR]

Abstract: Context: The American Academy of Pediatrics and the National Highway Traffic Safety Administration currently recommend that, unless they are under 57in. in height, 8–12-year-old children use seat belts and all should ride in the rear seats of vehicles. These recommendations assume that the vehicle seat belt should provide adequate protection for these older children in the event of a crash. Objectives: To describe characteristics of older children in the rear seat using seat belts in crashes, to estimate their risk and body region distribution of injury, and to identify risk factors for injury. Methods: A representative sample of 6680 seat belt-restrained occupants, 8–12 years of age, seated in the rear seat during crashes involving insured vehicles in 16 US states between December 1998 and December 2007. A telephone interview was conducted with the driver of each vehicle. The main outcome was the parent-reported injury defined as Abbreviated Injury Scale (AIS) 2 or greater injuries. Results: The risk of injury for belted 8–12 year olds in the rear seat was 1.3%. Head injury was the most common injury (60%), followed by injuries to the face (9%), upper extremity (9%) and abdomen (9%). One out of five (21%) 8–12 year olds either did not use the shoulder portion of the vehicle seat belt or placed it incorrectly behind their back or under their arm. Bivariate analyses indicated a higher risk of injury for these children (1.8%) as compared to children using both the lap and shoulder portions of the seat belt (1.1%). However, this difference was not statistically significant when other risk factors such as crash severity and characteristics of the driver were considered. Conclusions: Injuries to the head, face, abdomen and upper extremity are the most common injuries to target for improved protection among 8–12 year olds in seat belts. Driver and crash characteristics are important risk factors for injury. A recent federal motor vehicle safety standard requiring lap and shoulder belts in all rear seat positions has the potential to further decrease the risk of injury to older children using seat belts. [Copyright &y& Elsevier]

Abstract: This study describes frequency of injury and short-term physical limitation among child occupants ≤15 years in motor vehicle crashes and examines the association between age, restraint use, seating position, and type of crash on the presence of physical limitations. Conducted from 1/1/2005–11/30/2007, as part of a child-specific crash surveillance system in 15 U.S. states; data were collected using claims records and parent/driver telephone surveys. Respondents were asked whether children sustained physical limitations from the crash and the duration limitations persisted. Overall, 3.3% had ≥1 physical limitations. Limitations increased with age, from 0.7% for children ≤3 years to 7.6% for adolescents 13–15 years (p <0.001). Among children with AIS ≥2 injuries, the proportion with physical limitations ranged from 58% to 91% depending on injury diagnosis. Among children with whiplash, 47% resulted in physical limitations. Suboptimally restrained children were nearly twice as likely to have a limitation compared to optimally restrained children. After adjusting for driver characteristics and vehicle type, child''s age, restraint use, and type of initial impact were independently associated with the presence of physical limitations. Our results show the importance of assessing children for physical limitations following motor vehicle crashes. We also observed that children with whiplash were at risk for physical limitations. [Copyright &y& Elsevier]

The objective of this study was to determine the effectiveness of forward facing child restraint systems (FFCRS) in preventing serious injury and hospitalization to children 12–47 months of age as compared with similar age children in seat belts. Data were obtained from a cross-sectional study of children aged 12–47 months in crashes of insured vehicles in 15 states, with data collected via insurance claims records and a telephone survey. Effectiveness estimates were limited to those children between 12 and 47 months of age seated in the back row(s) of vehicles, restrained in FFCRS, regardless of misuse, or seat belts of all types and usage. Completed survey information was obtained on 1207 children, representing 12,632 children in 11,619 crashes between 1 December 1998 and 31 May 2002.Serious injuries occurred to 0.47% of all 12–47-month olds studied, including 1.72% of those in seat belts and 0.39% of those in child restraint systems. The risk of serious injury was 78% lower for children in FFCRS than in seat belts (odds ratio (OR)=0.22, 95% confidence interval (CI)=0.11–0.45, P<0.001). The risk of hospitalization was 79% lower for children in FFCRS than in seat belts (OR=0.21, 95% CI=0.09–0.50, P=0.001). There was no difference between the restraint types in preventing minor injuries.As compared with seat belts, CRS are very highly effective in preventing serious injuries and hospitalization, respectively. This effectiveness estimate is substantially higher than older estimates, demonstrating the benefits of current CRS designs. These results provide those educating parents and caregivers population-based data on the importance of child restraint use. [Copyright &y& Elsevier]

Recent surveys have provided insight on the primary reasons why US teens delay licensure but are limited in their ability to estimate licensing rates and trends. State administrative licensing data are the ideal source to provide this information but have not yet been analyzed for this purpose. Our objective was to analyze New Jersey’s (NJ) licensing database to: (1) describe population-based rates of licensure among 17- to 20-year-olds, overall and by gender and zip code level indicators of household income, population density, and race/ethnicity; and (2) examine recent trends in licensure. We obtained records on all licensed NJ drivers through June 2012 from the NJ Motor Vehicle Commission’s licensing database and determined each young driver’s age at the time of intermediate and full licensure. Data from the US Census and American Community Survey were used to estimate a fixed cohort of NJ residents who turned 17 years old in 2006–2007 ( n = 255,833). Licensing data were used to estimate the number of these drivers who obtained an intermediate license by each month of age (numerators) and, among those who obtained an intermediate license, time to graduation to full licensure. Overall, 40% of NJ residents—and half of those who ultimately obtained a license by age 21—were licensed within a month of NJ’s minimum licensing age of 17, 64% by their 18th birthday, and 81% by their 21st birthday. Starkly different patterns of licensure were observed by socioeconomic indicators; for example, 65% of 17-year-olds residing in the highest-income zip codes were licensed in the first month of eligibility compared with 13% of residents living in the lowest-income zip codes. The younger an individual obtained their intermediate license, the earlier they graduated to a full license. Finally, the rate and timing of licensure in NJ has been relatively stable from 2006 to 2012, with at most a 1–3% point decline in rates. These findings support the growing body of literature suggesting that teens delay licensure primarily for economic reasons and that a substantial proportion of potentially high-risk teens may be obtaining licenses outside the auspices of a graduated driver licensing system. Finally, our finding of a relatively stable trend in licensure in recent years is in contrast to national-level reports of a substantial decline in licensure rates. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To assess the incidence of breathing difficulty and tinnitus in children involved in motor vehicle crashes with and without passenger airbag (PAB) deployment, and its relationship to seating position and to whether the airbag deployed was first versus second-generation. Methods: We studied motor vehicle crashes with child passengers, over a 3-year period, in three large regions of the United States, by means of telephone interviews with the driver/parent. The crashes were classified into those with and without a PAB deployment. Complete data were collected on 7383 children in 4817 crashes, who, because of the sample design of the study, represent an estimated 120,987 children in 83,267 crashes. Results: Among children involved in crashes with PAB deployment, 6.6% complained of breathing difficulty versus 1.4% without airbag deployment (OR 5.2, 95% CI 3.3–8.2). The corresponding figures for tinnitus were 5.0% versus 0.7% (OR 7.4, 95% CI 4.0–13.7). Analysis of data for children exposed to PABs indicated that 14.1% of children in the front seat versus 1.1% in the rear complained of tinnitus (OR 14.4, 95% CI 5.9–34.7). Seating row did not significantly affect the incidence of breathing difficulty. The type of airbag deployed did not significantly affect the incidence of breathing difficulty or of tinnitus. Conclusion: Breathing difficulty and tinnitus were much more common among children in crashes with PAB deployment as against those without PAB deployment. Among children in crashes with PAB deployment, tinnitus was about 14 times more likely for those sitting in the front versus rear seat. The incidence of breathing difficulty was not affected significantly by seating row. Introduction of second-generation airbags has not affected the incidence of breathing difficulty or of tinnitus. [Copyright &y& Elsevier]

Background: Decal laws have been implemented internationally to facilitate police enforcement of graduated driver licensing (GDL) restrictions (e.g., passenger limit, nighttime curfew) but have not been evaluated. New Jersey implemented the first decal law in the U.S. on May 1, 2010. Purpose: The aim of this study was to evaluate the effect of New Jersey''s law on the rate of citations issued for violation of GDL restrictions and police-reported crashes among probationary drivers aged <21 years and to estimate the number of probationary drivers whose crashes were prevented by the law. Methods: New Jersey''s licensing and crash databases were linked from January 1, 2008 to May 31, 2011, and each driver''s license status, age, and outcome status were ascertained for each month. Monthly rates were calculated as the proportion of probationary drivers who experienced the outcome in that month. The pre-law period was defined as January 2008–January 2010 and the post-law period as May 2010–May 2011. Negative binomial regression models with robust SEs were used to determine the law''s effect on crash and citation rates (adjusted for gender, seasonal trends, and overall trends) and estimate prevented crashes. Analyses were conducted in 2012. Results: In the first year post-law, there was a 14% increase in the GDL citation rate (adjusted rate ratio 1.14 [95% CI=1.05, 1.24]); a 9% reduction in the police-reported crash rate (adjusted rate ratio 0.91 [95% CI=0.86, 0.97]), and an estimated 1624 young probationary drivers for whom a crash was prevented. Conclusions: Findings suggest that the law is positively affecting probationary drivers'' safety. Results contribute to building the evidence base for the effectiveness of decal laws and provide valuable information to U.S. and international policymakers who are considering adding decal laws to enhance existing GDL laws. [Copyright &y& Elsevier]

OBJECTIVE. The popularity of sport utility vehicles (SUVs) is growing, and they are increasingly being used as family vehicles. Because of the large size of SUVs, relative to passenger cars, parents may perceive that they are safer family vehicles. However, little is known about the safety of children in SUVs, compared with passenger cars. The objective of this study was to determine the relative risk of injury to children involved in crashes in SUVs, compared with those in passenger cars. DESIGN. From an on-going motor vehicle crash surveillance system, a probability sample of 3922 child occupants 0 to 15 years of age, representing 72 396 children in crashes of either SUVs or passenger cars (model year 1998 or newer), from 3 large US regions, was identified between March 1, 2000, and December 31, 2003. Injuries were defined as concussions and other brain injuries, spinal cord injuries, facial fractures and lacerations, internal organ injuries, extremity fractures, and scalp lacerations. Logistic regression modeling was used to compute the odds ratio (OR) of injury for children in SUVs versus passenger cars, both unadjusted and adjusted for several potential confounders, including differences in child seating position, restraint use, vehicle weight, exposure of the child to a passenger airbag, and whether the vehicle rolled over. RESULTS. A total of 38.2% of children were in SUVs and 61.8% were in passenger cars. The average weight of SUVs was 1317 lb greater than the average weight of passenger cars. Among all children in the study, those restrained appropriately were less likely to be injured (OR: 0.25; 95% confidence interval [CI]: 0.15-0.45) and those in the front seat were more likely to be injured (OR: 2.06; 95% CI: 1.33-3.21). In both vehicle types, children exposed to a passenger airbag were more likely to be injured than were those who were not (OR: 4.70; 95% CI: 2.36-9.37). Rollover crashes increased the risk of injury in both vehicle types (OR: 3.29; 95% CI: 1.88-5.76) and occurred more than twice as frequently with SUVs (2.9%, compared with 1.2% with passenger cars). There was a trend for increasing vehicle weight being a protective factor with both vehicle types (OR: 0.86; 95% CI: 0.73-1.01). After adjustment for all of the aforementioned factors, the risk of injury was not significantly different for children in SUVs versus passenger cars (adjusted OR: 1.50; 95% CI: 0.88-2.57). Especially detrimental for children in SUVs was being unrestrained versus restrained in a rollover crash (OR: 24.99; 95% CI: 6.68-93.53). CONCLUSIONS. Despite the greater vehicle weight of SUVs, the risk of injury for children in SUVs is similar to that for children in passenger cars. The potential advantage offered by heavier SUVs seems to be offset by other factors, including an increased tendency to roll over. Age-appropriate child restraint and rear seat positioning are important, particularly for children in SUVs, given the very high risk of injury for children restrained inappropriately in rollover crashes. [ABSTRACT FROM AUTHOR]

This study, describing the overall patterns of acute healthcare resource utilization by child crash victims (age 15 years and younger), was conducted between 28 July 1999 and 30 November 2000 as part of an on-going large-scale, child-specific crash surveillance system, Partners for Child Passenger Safety: insurance claims from 15 states and the District of Columbia function as the source of subjects, with telephone survey and on-site crash investigations serving as the primary sources of data. A probability sample of 4862 eligible crashes with 7368 child occupants formed the study sample. Our results suggest that for every 1000 children involved in crashes, 3 are hospitalized; 108 are treated and released from an emergency department (ED); 48 are evaluated in a physician’s office, urgent care center, or other facility; and 841 receive no care at all. Comprehensive surveillance systems for motor vehicle crashes must capture children treated in physicians’ offices, emergency departments, and other healthcare facilities in order to provide accurate estimates of the impact on the health care system related to motor vehicle trauma. [Copyright &y& Elsevier]

Objective. To assess the success of re-cent outreach activities to promote appropriate child re-straint in motor vehicles by examining trends in restraint types used by children under age 9 in 3 large regions of the United States. Methods. Cross-sectional study was conducted of children who were under age 9 and in crashes of insured vehicles in 15 states, with data collected via insurance claims records and a telephone survey. A probability sample of 8730 crashes involving 10 195 children, repre-senting 128 291 crashes involving 149 820 children, was collected between December 1, 1998, and November 30, 2002. Parent report was used to determine restraint type used in the crash. Logistic regression models were used to analyze the secular trend of restraint type use. Results. Overall, for children under age 9, seat belt use decreased significantly from 49% to 36% between 1998 and 2002; for 7- and 8-year-olds, from 97% to 92%; and for 3- to 6-year-olds, from 63% to 34%. Concurrently, gains were achieved in overall child restraint use from 49% to 63%, for 7- and 8-year-olds, from 2% to 5%; and for 3- to 6-year-olds, from 35% to 65%. Child restraint use remains stable for children from birth to 2 years of age (from 97% in 1998 to 98% in 2002). Both the use of child safety seat and belt positioning booster seat increased significantly, whereas shield booster seat use decreased significantly. Conclusion. Although considerable achievements have been realized over a short period of time, substan-tial inappropriate restraint still remains: 62% of children aged 4 to 8 remain inappropriately restrained in adult seat belts. Parents hear safety messages when they are relevant to their children. As a result, sustained efforts about appropriate restraint must continue to maintain and improve the gains achieved in appropriate child restraint use. The additional benefits realized by recent changes in child restraint laws remain to be evaluated... [ABSTRACT FROM AUTHOR]

Estimated traveling speed and speed limit have typically been used in population-based surveillance data to estimate crash severity. The accuracy of these measures in predicting crash severity is unknown. The Partners for Child Passenger Safety (PCPS) surveillance system offers a unique opportunity to compare these measures, as well as a novel measure of crash severity, “self-report” delta-V, to the accepted measure of delta-V estimated during detailed crash-investigations in 118 crashes. This “self-report” delta-V was computed from the estimated traveling speeds and direction of impact obtained from telephone interviews with drivers. These “self-reported” delta-V estimates are modestly associated with crash-investigation delta-V estimates, with the degree of association a function of the direction of impact: when the respondent was struck from the rear, the degree of association is strong; frontal, side, and single-vehicle crashes yield weaker associations. This “self-reported” delta-V measure, however, is a substantial improvement over use of estimated traveling speed or speed limit only. [Copyright &y& Elsevier]