Behind the Wheel: Unraveling the Impact of Experience Over Age Over the First 18 Months of Licensure.

OBJECTIVE: This study examined how driving attention develops with age and driving. METHODS: In this observational longitudinal study, 190 adolescents (53% female, 73% Black) were enrolled across four groups: 16- and 18-year olds with and without driving experience. They underwent driving simulation with eye-tracking technology seven times over 18 months. By using a combination of factorial and longitudinal designs, the study examined the individual and combined effects of age and driving experience on driving attention over time. RESULTS: Licensed participants had higher odds of glancing at safety-critical events initially (OR = 15.01, 95% CI: 1.36-165.53), but these odds decreased at higher driving speeds (b = -0.17, p<.01). Average glance length decreased over time (b = -0.26, p=.01), but less so in licensed participants (b=0.14, p=.01). Several visual behaviors were influenced by environmental and driving factors. CONCLUSIONS: Motor vehicle crashes (MVCs) are burdensome and costly to society. This study focused on the role of inattention in MVCs, particularly during the risky period of adolescence. Findings indicated that driving experience, as determined by licensure, had a considerable impact on visual behavior in both the short term (within two weeks of obtaining a license) and over the first 18 months of independent driving. Overall, these findings suggest that licensed adolescents are more likely to identify potential hazards on the road and navigate safely. To ensure effective guidance, pediatric psychologists and other professionals should consider the unique circumstances, needs, and concerns of individual patients.

COVID-19 effects on diet, sleep, and physical activity among mid- to late-adolescents residing in the deep south in the United States.

PURPOSE: This study investigated the differential impact of COVID-19 on United States (US) adolescents' physical health as a function of sociodemographic factors over 18 months. It was hypothesized that the impact of COVID-19 and its mitigation efforts on physical health factors would vary by sociodemographic factors. DESIGN AND METHODS: Data were drawn from a longitudinal study in which participants (ages 16 or 18) self-reported sleep, diet, and physical activity over 18months. Participants were enrolled between 2018 and 2022. Participants (n = 190, 73% Black/African American, 53% female) provided 1330 reports over 194 weeks (93 weeks before and 101 weeks after COVID-19 restrictions implementation). RESULTS: Physical health outcomes moderated by demographic factors were measured and assessed over 18 months. Multilevel models and general estimated equations estimated the impact of COVID-19 restrictions on participants' health outcomes. Sleep and physical activity worsened after COVID-19 regardless of moderating factors, but some specific outcomes varied across subgroups. CONCLUSIONS: This study diversifies the literature on the impact of COVID-19 and its mitigation measures on adolescents' social health. Further, it is based in the US's Deep South, largely populated by those identifying as Black/African American or of low socioeconomic status. Both subgroups are underrepresented in US-based health outcomes research. COVID-19 directly and indirectly impacted adolescents' physical health. PRACTICE IMPLICATIONS: Understanding if and how COVID-19 impacted adolescents' health will inform nursing practice to adapt to and overcome adverse sequelae to promote positive patient health outcomes.

Trajectories of self-regulatory driving practices: Role of learner phase practice.

INTRODUCTION: Previous research suggests that driving practice in diverse contexts may contribute to earlier licensure and improve driving skills among teen drivers. However, few studies have examined the role of practice diversity in driving outcomes post-licensure. Specifically, examining self-regulatory driving practices post-licensure may provide insight into the extent to which teens choose to avoid driving various environments. The current study examined the relationship between learner phase driving practice diversity and teen self-regulatory driving practices over the first six months of licensure. METHODS: Fifty-six newly licensed 16-year-olds reported pre-licensure practice diversity, driving exposure and, self-regulatory driving practices at three timepoints (within 2 weeks of licensure and at 3 and 6 months post-licensure). RESULTS: Multi-level models revealed self-regulatory driving practices significantly decreased over the first six months of independent driving. Practice in complex environments (e.g., on a commercial road, on a highway, etc.) was associated with fewer self-regulatory driving practices at baseline. Practice in simple environments (e.g., in a residential area, in a parking lot) was associated with more self-regulatory driving practices at baseline. Practice driving at night and in bad weather conditions predicted greater post-licensure self-regulation of driving in those specific environments. CONCLUSION: This study reinforces the importance of practice diversity for teens before independent driving, as early practice can have implications for self-regulatory driving practices immediately upon licensure. Future research examining this topic may inform parent-based interventions to maximize teen driver safety during the critical post-licensure period.

Developmental trajectories of driving attention in adolescents: Preliminary findings from REACT.

OBJECTIVE: To characterize the trajectory of driving attention as a function of age and driving experience. Hypotheses. The rate of change in driving attention will be greater for 16- compared to 18-year-olds and those acquiring driving experience (vs. non-drivers). Age and driving experience will interact, with the effect of driving experience being stronger among 16- compared to 18-year-olds. METHODS: In this longitudinal study, 190 adolescents were enrolled into 4 groups: (1) 16-year-olds and (2) 18-year-olds recruited within 2 weeks of obtaining a full driver's license; (3) 16-year-olds and (4) 18-year-olds with no driving experience (no permit/license, no intention to obtain either over study period). At seven time points over 18 months, participants drove in a high-fidelity driving simulator integrated with eye tracking. Participants completed three experimental drives with three safety critical events and varying cognitive load conditions. Driving attention was measured by vertical and horizontal eye movements, number of glances, and glance length. A multilevel model using SAS PROC MIXED (SAS 9.4) will estimate the baseline intercept and slope of driving attention over time, with baseline age, driving experience, and their interaction serving as predictors of intercept and slope. RESULTS: Preliminary analyses suggest driving attention changes over time as a function of age, driving experience, and across cognitive load conditions. CONCLUSIONS: Inattention is the primary contributor to motor vehicle crashes. It is critical to gain a clear understanding of how driving attention changes during adolescence, the riskiest developmental period for drivers. Results will reveal how driving impacts attention development through practice, providing a target for intervention.

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.

Gender moderates the relationship between media use and sleep quality.

With high screen time and poor sleep commonly reported in adolescents, it is important to more fully understand how screen time impacts sleep. Despite similar overall screen times, male and female media preferences and usages differ, making it critical to determine if different domains of screen time differentially affect sleep quality. The present study examined whether differing amounts and domains of screen-based media vary in impact on sleep quality of 16-year-old male and female adolescents over a 3-month period. A total of 98 adolescents (mean [SD] age 16.27 [0.29] years; 51% female) completed two online surveys spaced 3 months apart and comprised of well-validated self-reported measures of sleep quality, media usage, and depressive symptoms. The various domains of media were categorised into screen-based media with little-to-no peer-to-peer interaction involved (video-only) and screen-based media with interaction a predominant component to the usage (peer-to-peer interaction-involved). Self-reported sleep quality decreased across the 3-month study period. Gender moderated the effect of interactive screen time on sleep quality 3 months later, with interactive screen time associated with better sleep quality in males, but remaining poorer in females. Screen time competes with sleep time and may do so differentially depending on the media domain. Compared to females, interactive components of screen time may lessen worsening sleep quality over time in males. Understanding the relationships among screen time, its content, age, and gender may inform guidelines for educators, parents, and adolescents to help improve sleep quality of adolescents.

Adolescent driving behavior before and during restrictions related to COVID-19.

INTRODUCTION: Understanding who heeds the driving-related COVID-19 restrictions is critical for assisting public health professionals improve response to this and future pandemic events. The purpose of the current study was to characterize driving behavior changes among adolescents as a function of COVID-19 restrictions. It was hypothesized that adolescent driving would be reduced by COVID-19 restrictions, especially for younger teens, non-minorities, females, non-working teens, and those with higher prosocial tendencies. METHODS: Participants were licensed drivers in "REACT," a longitudinal study of adolescent driving attention. Upon enrollment in REACT, drivers were required to be age 16 or 18, have been issued a driver's license within the last two weeks, and be fluent in written/spoken English. The current observational cohort study was of drivers reporting driving exposure between February 8 and April 22, 2020. Linear mixed-effects models estimated differences in driving changes between COVID-19 periods. RESULTS: Results indicated a decrease across pre-COVID-19 period (February 8 - March 13, 2020) in days driven per week and vehicle miles driven (VMD) was explained by the change of slope post-COVID-19 restrictions (March 14 - April 22, 2020). Post-COVID-19, driving days per week decreased by 37 % and VMD decreased by 35 %. This decrease was lower in ethnic minorities, older adolescents, and employed adolescents. Those with greater dire prosocial tendencies showed greater post-COVID-19 driving decline. DISCUSSION: Findings provide early evidence of COVID-19 restriction-related adolescent driving changes suggesting older, employed, minority teens and teens with lower prosocial tendencies are less likely to reduce driving behavior. These observations provide a foundation for more extensive studies of adolescent drivers during various driving and contact restrictions and inform future public health campaigns for social distancing.

Impact of adolescent media multitasking on cognition and driving safety.

Adolescence is a critical period in brain development particularly in regions related to attention and executive function (EF). As the use of electronics and media in daily activities increases, one essential question is how adolescent attention development and related executive and speed processes are impacted by media multitasking (MM), or the simultaneous use of media (e.g., text messaging while watching television). This review examines current literature concerning (a) the prevalence of MM during adolescence; (b) relations between MM and adolescent cognitive development, specifically attention, speed of processing, and EF; and (c) real-world implications of MM including adolescents and driver distraction. Finally, future challenges and opportunities in MM research are explored with special attention given to overcoming the limitations of current research in this area and the critical need to advance our understanding of the impact of MM on adolescent driver safety.

Does participation mediate the prospective relationships of impairment, injury severity, and pain to quality of life following burn injury?

We examined the prospective impact of injury severity, functional impairment, and pain on participation in the community and subsequently on life satisfaction and self-rated health of 260 burn survivors 5 years post-discharge. Predictor variables include injury severity and total body surface area burned (assessed during acute care), functional independence (assessed at 12 months post-discharge), pain (assessed at the 24th month), and participation (assessed at the 48th month). Participation predicted life satisfaction and self-rated health. Functional independence and injury severity had significant indirect influences on adjustment via their influence on participation. Pain predicted both outcome variables. Clinical and research implications are discussed.

Distracted Driving in Teens With and Without Attention-Deficit/Hyperactivity Disorder.

OBJECTIVE: This study is among the first to examine the effect of talking on a cell phone or text messaging while driving in teens with and without attention deficit/hyperactivity disorder (ADHD). METHOD: Teens (average age 17years) with a diagnosis of ADHD (N=16) were matched with typically developing controls (N=18). All participants operated a driving simulator while (1) conversing on a cell phone, (2) text messaging, and (3) with no distraction during a baseline condition. Six indicators of driving performance were recorded: (a) time to complete the drive; (b) lane deviations; (c) variability in lane position (i.e., root mean square [RMS]); (d) reaction time; (e) motor vehicle collisions; and, (f) speed fluctuation. RESULTS: Significantly greater variation in lane position occurred in the texting task compared to no task and the cell phone task. While texting, in particular, teens with ADHD took significantly less time to complete the scenario. No significant main effects of group were found. CONCLUSIONS: Generally, those with ADHD did not differ in regard to driving performance, when compared to controls, with the exception of one outcome: time to complete scenario. These findings suggest that distracted driving impairs driving performance of teen drivers, regardless of ADHD status. Texting while driving had the greatest negative impact on driving performance, particularly with regard to variability in lane position (i.e., RMS). This study sheds light on key issues regarding injury prevention, with the intent of providing pediatric care providers with the knowledge to inform teen drivers of risks associated with distracted driving which will ultimately result in reduced rates of motor vehicle crashes and concomitant injuries.

Trajectories of life satisfaction five years after medical discharge for traumatically acquired disability.

OBJECTIVES: We studied the predictive impact of family satisfaction, marital status, and functional impairment on the trajectories of life satisfaction over the first 5 years following medical treatment for traumatic spinal cord injury, burns, or interarticular fractures (total N = 662). It was anticipated that fewer functional impairments, being married, and greater family satisfaction would predict higher life satisfaction trajectories. METHOD: The Functional Independence Measure, the Family Satisfaction Scale, and the Life Satisfaction Index were administered 12, 24, 48, and 60 months postdischarge. RESULTS: Trajectory modeling revealed that greater functional impairment significantly predicted lower life satisfaction, regardless of injury type. However, this association diminished when marital status and family satisfaction were entered into the models. Greater family satisfaction and being married predicted greater life satisfaction across time. Moreover, there was no evidence for increases in life satisfaction trajectories over time: Trajectories were stable across time for all injury groups. CONCLUSIONS: Results suggest that being married and greater family satisfaction promote life satisfaction among those who traumatically acquire disability, and these beneficial effects may be more salient than the degree of functional impairment imposed by the condition.

Predicting quality of life 5 years after medical discharge for traumatic spinal cord injury.

OBJECTIVES: This study tested an a priori contextual model of the mediating effects of participation on the predictive relationships of functional impairment, family satisfaction, and pain to quality of life (QoL) following traumatic spinal cord injury (SCI). DESIGN: A longitudinal design was used to study 144 persons following discharge for traumatic SCI. Predictor variables included functional impairment and family satisfaction (at 12 months post-discharge) and the presence of pain (at 24 months), and mediating variables were two indicators of participation (assessed 48 months post-discharge). Life satisfaction and self-rated health status at 60 months post-discharge were the outcome variables. METHODS: A path model tested hypothesized prospective effects of functional impairment, family satisfaction and pain on participation and the subsequent effects of participation on the QoL variables. RESULTS: Greater functional impairment and pain were predictive of less participation, and participation significantly predicted both indicators of QoL. The two participation variables mediated the relationship of functional impairment and pain to life satisfaction over time. Family satisfaction had an indirect effect on QoL through its association with social integration. CONCLUSIONS: Participation appears to mediate the prospective influence of functional impairment, family satisfaction, and pain on QoL in the years following SCI. These findings provide insight into factors that can predict QoL post-SCI and support the use of contextual models to understand the temporal influence of disability and psychological variables on participation and subsequent QoL. STATEMENT OF CONTRIBUTION: What is already known on this subject? Life satisfaction and self-rated health status are important aspects of quality of life following traumatic spinal cord injury. Functional impairment has been inconsistently predictive of these variables over time. Prospective research to date has not examined the mediating effects of participation in predicting quality of life. What does this study add? The results indicate that greater functional impairment and pain are prospectively predictive of lower participation. Greater participation, in turn, is prospectively predictive of greater quality of life. Participation appears to mediate the prospective influence of functional impairment, family satisfaction, and pain to quality of life.

Modeling the prospective relationships of impairment, injury severity, and participation to quality of life following traumatic brain injury.

Identifying reliable predictors of positive adjustment following traumatic brain injury (TBI) remains an important area of inquiry. Unfortunately, much of available research examines direct relationships between predictor variables and outcomes without attending to the contextual relationships that can exist between predictor variables. Relying on theoretical models of well-being, we examined a theoretical model of adjustment in which the capacity to engage in intentional activities would be prospectively associated with greater participation, which in turn would predict subsequent life satisfaction and perceived health assessed at a later time. Structural equation modeling of data collected from 312 individuals (226 men, 86 women) with TBI revealed that two elements of participation--mobility and occupational activities--mediated the prospective influence of functional independence and injury severity to optimal adjustment 60 months following medical discharge for TBI. The model accounted for 21% of the variance in life satisfaction and 23% of the variance in self-rated health. Results indicate that the effects of functional independence and injury severity to optimal adjustment over time may be best understood in the context of participation in meaningful, productive activities. Implications for theoretical models of well-being and for clinical interventions that promote adjustment after TBI are discussed.

Predictors of health-related quality-of-life following traumatic brain injury.

PRIMARY OBJECTIVE: To examine the predictive associations of family satisfaction, functional impairment, pain, and depression on health-related quality-of-life (HRQoL) among persons with traumatic brain injury (TBI) through structural equation modelling (SEM). RESEARCH DESIGN: Participants were part of a larger longitudinal study of adjustment following TBI. Direct and indirect effects of predictor variables on HRQoL were analyzed through SEM. METHODS AND PROCEDURES: The sample included 131 participants with TBI (89 men, 42 women) who had been discharged from an acute care hospital. The Sickness Impact Profile was administered to measure HRQoL at or beyond 24 months post-discharge. Predictor variable measures included the Functional Independence Measure, Family Satisfaction Scale and single items assessing the presence of pain and depression. MAIN OUTCOMES AND RESULTS: SEM revealed direct effects of functional impairment (p < 0.001), family satisfaction (p < 0.01), depression (p < 0.05) and pain (p < 0.01) on HRQoL. Indirect effects from functional impairment (p < 0.05) and pain (p < 0.05) to HRQoL through depression were also present. CONCLUSIONS: The presence of pain and depression, greater functional impairment and lower family satisfaction were predictively associated with lower HRQoL. Depression further mediated the effects of pain and functional impairment on HRQoL. The present study advances understanding of the ways in which pain, depression and functional impairment predict HRQoL.

Family satisfaction predicts life satisfaction trajectories over the first 5 years after traumatic brain injury.

OBJECTIVES: Examined the influence of functional impairment, stable marital status, and family satisfaction on life satisfaction trajectories for 609 individuals (435 men, 174 women) over the first 5 years after traumatic brain injury (TBI). MEASURES: Participants completed the Family Satisfaction Scale (FSS), Functional Independence Measure (FIM), and the Life Satisfaction Index (LSI) at years 1, 2, 4, and 5 after sustaining a TBI. RESULTS: Trajectory modeling revealed that higher family satisfaction was associated with increases in life satisfaction for individuals with less functional impairment. Stable marital status was not significantly associated with life satisfaction trajectories. IMPLICATIONS: Family satisfaction appears to have pronounced beneficial effects on life satisfaction for persons with less functional impairment after TBI regardless of marital status. In contrast, a stable marriage appears to have no apparent benefits to self-reported life satisfaction over the first 5 years post-TBI. Theoretical and clinical implications of these results are discussed.

Trajectories of life satisfaction in the first 5 years following traumatic brain injury.

OBJECTIVES: The trajectories of life satisfaction for 609 individuals who sustained a traumatic brain injury (TBI) were studied. Hierarchical linear modeling analysis examined individual level growth trends over the first 5 years following TBI using gender, functional independence, age, and time to estimate life satisfaction trajectories. MEASURES: Participants completed the Functional Independence Measure and the Life Satisfaction Inventory at years 1, 2, 4, and 5 after sustaining TBI. RESULTS: Participants who reported higher functional independence at year 1 also had higher life satisfaction at year 1. Participants with lower functional independence across the 5-year period had life satisfaction trajectories that decreased at significantly greater rates than the individuals with more functional independence. The life satisfaction trajectory declined for the sample, but participants reporting lower cognitive and motor functional independence had significantly greater declines in life satisfaction trajectories. Age and gender were not significant factors in predicting life satisfaction trajectories following TBI. IMPLICATIONS: Individuals with greater cognitive and motor impairments following TBI are likely to experience significant declines in life satisfaction within 5 years of living with TBI.

Analyzing Longitudinal Data with Multilevel Models: An Example with Individuals Living with Lower Extremity Intra-articular Fractures.

The use and quality of longitudinal research designs has increased over the past two decades, and new approaches for analyzing longitudinal data, including multi-level modeling (MLM) and latent growth modeling (LGM), have been developed. The purpose of this paper is to demonstrate the use of MLM and its advantages in analyzing longitudinal data. Data from a sample of individuals with intra-articular fractures of the lower extremity from the University of Alabama at Birmingham's Injury Control Research Center is analyzed using both SAS PROC MIXED and SPSS MIXED. We start our presentation with a discussion of data preparation for MLM analyses. We then provide example analyses of different growth models, including a simple linear growth model and a model with a time-invariant covariate, with interpretation for all the parameters in the models. More complicated growth models with different between- and within-individual covariance structures and nonlinear models are discussed. Finally, information related to MLM analysis such as online resources is provided at the end of the paper.

Does Wechsler Intelligence Scale administration and scoring proficiency improve during assessment training?

Studies have found that Wechsler scale administration and scoring proficiency is not easily attained during graduate training. These findings may be related to methodological issues. Using a single-group repeated measures design, this study documents statistically significant, though modest, error reduction on the WAIS-III and WISC-III during a graduate course in assessment. The study design does not permit the isolation of training factors related to error reduction, or assessment of whether error reduction is a function of mere practice. However, the results do indicate that previous study findings of no or inconsistent improvement in scoring proficiency may have been the result of methodological factors. Implications for teaching individual intelligence testing and further research are discussed.

Decreasing scoring errors on Wechsler Scale Vocabulary, Comprehension, and Similarities subtests: a preliminary study.

Studies of graduate students learning to administer the Wechsler scales have generally shown that training is not associated with the development of scoring proficiency. Many studies report on the reduction of aggregated administration and scoring errors, a strategy that does not highlight the reduction of errors on subtests identified as most prone to error. This study evaluated the development of scoring proficiency specifically on the Wechsler (WISC-IV and WAIS-III) Vocabulary, Comprehension, and Similarities subtests during training by comparing a set of 'early test administrations' to 'later test administrations.' Twelve graduate students enrolled in an intelligence-testing course participated in the study. Scoring errors (e.g., incorrect point assignment) were evaluated on the students' actual practice administration test protocols. Errors on all three subtests declined significantly when scoring errors on 'early' sets of Wechsler scales were compared to those made on 'later' sets. However, correcting these subtest scoring errors did not cause significant changes in subtest scaled scores. Implications for clinical instruction and future research are discussed.

The reliability and validity of the Life Satisfaction Index-A with survivors of traumatic brain injury.

PRIMARY OBJECTIVE: To investigate the internal consistency, long-term stability and validity of the Life Satisfaction Index-A (LSI-A) in a sample of survivors of traumatic brain injury (TBI). RESEARCH DESIGN: Cohort study. METHODS AND PROCEDURES: LSI-A was administered to survivors of TBI at 12, 24, 48 and 60 months post-injury during telephone interviews. Participants rated their quality of life, independence and participation in activities as well as health status at 24 months. Internal consistency was evaluated with Coefficient alpha. Pearson's r was used to investigate score stability. Test validity was explored with Pearson's r and Analysis of Covariance with age and sex as covariates. EXPERIMENTAL INTERVENTIONS: None. MAIN OUTCOMES AND RESULTS: Coefficient alphas ranged from 0.85-0.92. Test-re-test coefficients ranged from 0.42-0.77. The LSI-A was positively correlated with self-reported quality of life, independence, activity level and health status. CONCLUSIONS: The LSI-A is a reliable and valid measure of the construct of life satisfaction among survivors of TBI.