Graduated driver licensing in Michigan: early impact on motor vehicle crashes among 16-year-old drivers.

CONTEXT: Graduated driver licensing (GDL) programs are being adopted in many states to address the high rate of motor vehicle fatalities among teens by requiring teenaged drivers to gain experience and maturity under conditions of relatively low crash risk before gaining full driving privileges. OBJECTIVE: To evaluate the early impact of Michigan's GDL program on traffic crashes among 16-year-old drivers. DESIGN, SETTING, AND SUBJECTS: Analysis of Michigan motor vehicle crash data from 1996 (before GDL program implementation) vs 1998 and 1999 (after GDL program implementation) for 16-year-olds, adjusting for trends among persons 25 years or older. INTERVENTION: Michigan's GDL program, instituted April 1, 1997, for teens younger than 18 years entering the driver license system, includes 3 licensure levels, each with driving restrictions and requirements to progress to the next level. Requirements include extended, supervised practice in the learning level, 2-phase driver education, and night driving restrictions in the intermediate level. MAIN OUTCOME MEASURES: Rates in 1996 vs 1998 and 1999 for all police-reported crashes; for fatal injury, nonfatal injury, and fatal/nonfatal injury combined crashes; for day, evening, and night crashes; for single-vehicle and multivehicle crashes; and for alcohol-related crashes. RESULTS: Overall, the rate of 16-year-old drivers (per 1000 population) involved in crashes declined from 154 in 1996 to 111 in 1999 (relative risk [RR], 0.72; 95% confidence interval [CI], 0.71-0.73). After adjusting for populationwide trends, the overall crash risk for 16-year-olds was significantly reduced in 1999 from 1996 by 25% (adjusted RR, 0.75; 95% CI, 0.74-0.77). There were also significant reductions for nonfatal injury and combined fatal and nonfatal crashes; for day, evening, and night crashes; and for single-vehicle and multivehicle crashes. Fatal crashes declined from 1996 to 1999, but not significantly (RR, 0.74; 95% CI, 0.49-1.14), and alcohol-related crashes continued at a low rate (RR, 1.01; 95% CI, 0.80-1.29). CONCLUSIONS: Analysis of the first 2 full calendar years following Michigan's GDL program implementation indicates substantial crash reductions among 16-year-olds. Future research is necessary to determine if these reductions are maintained and if other jurisdictions achieve similar results.

Adolescent antecedents of high-risk driving behavior into young adulthood: substance use and parental influences.

Driver history data, in combination with previously collected tenth-grade questionnaire data, for 4403 subjects were analyzed by Poisson regression models to identify the significant substance use and parental characteristics predicting subsequent high-risk driving of new drivers (starting at age 16) through age 23-24 years. Substance use (cigarettes, marijuana, and alcohol) reported at age 15 was shown to be an important predictor of subsequent excess risk of serious offenses and serious crashes for both men and women. In addition, negative parental influences (lenient attitudes toward young people's drinking; low monitoring, nurturance, family connectedness), were also demonstrated to increase the risk of serious offenses and serious crashes for both men and women.

Long-term follow-up of a high school alcohol misuse prevention program's effect on students' subsequent driving.

BACKGROUND: Alcohol-related injuries, particularly motor vehicle, are an important cause of adolescent mortality. School-based alcohol prevention programs have not been evaluated in terms of driving outcomes. This study examined the effects on subsequent driving of a high school-based alcohol prevention program. METHODS: The Alcohol Misuse Prevention Study included a randomized test of the effectiveness of an alcohol misuse prevention curriculum conducted among 4,635 10th-grade students. Students were assigned to intervention (n = 1,820) or control (n = 2,815) groups and were followed for an average of 7.6 years after licensure, which typically occurred during or shortly after 10th grade. Outcomes examined included alcohol-related and other serious offenses, and at-fault, single-vehicle, and alcohol-related crashes. RESULTS: Only serious offenses (which included alcohol-related) had a significant treatment effect (statistically marginal) after we adjusted for sex, age, race, alcohol use/misuse, family structure, presence of prelicense offenses, age of driver licensure, and parental attitudes toward teen drinking. The effect was found only during the first year of licensure (estimated adjusted relative risk = 0.80, confidence interval = 0.63-1.01). Two first-year serious offense interactions were found. The positive effect was strongest among the largest subgroup of students, those who were drinking less than one drink per week on average before the curriculum, compared with those who drank more than one drink per week (p = 0.009). The effect was also stronger for the small subgroup of students whose parents had not expressed disapproval of teens' drinking, compared with those whose parents had disapproved (p = 0.004). CONCLUSIONS: These findings suggest that a high school-based alcohol prevention program can positively affect subsequent driving, particularly that of students who do not use alcohol regularly. The results highlight the need to start prevention efforts early and extend them beyond the initial exposure to driving. Programs should incorporate the differing backgrounds of the students.

Changes in young adult offense and crash patterns over time.

A study of 13,809 young adult drivers in Michigan examined offenses and crashes ('incidents') for an average of 7 years after their original license date. During this period, 73% of subjects committed an offense that resulted in a conviction and 58% had a crash that was reported to the police. Forty-two percent had committed an offense classified as 'serious,' and 21% had an 'at-fault' crash. The odds of an offense being serious decreased approximately 8% per year of licensure, independent of gender or age at licensure. Similarly, the odds of a crash being at-fault decreased overall about 6% per year of licensure, but the decline was more than twice as fast for women as for men. Examining the empirical rates directly, it was found that the rate for minor offenses increased somewhat with time and then stabilized, while the rate for serious offenses declined. Also, offenses were less likely to be serious the later they occurred in the sequence of offenses for an individual. For crashes, the risk of having an at-fault crash declined more rapidly than the risk of a not-at-fault crash, although the rate of decrease began to equalize after approximately 5 years of licensure. The proportion of crashes that were at-fault did not decline over the sequence of crashes for an individual. Although crashes and offenses are positively correlated, they follow different trajectories over the early years of licensure.

Children dying in car trunks: how adequate are child death databases?

OBJECTIVE: To determine the frequency of and circumstances surrounding child deaths resulting from inadvertent entrapment in motor vehicle trunks in the US by querying child fatality review databases. METHOD: A telephone survey was conducted with the persons or offices identified as having primary responsibility for child fatality review programs in each state. The survey requested information on the number of child deaths resulting from trunk entrapments, the ages of the victims, the time period covered by the surveillance system, and variables concerning the circumstances surrounding each incident. RESULTS: All states reported that these deaths are exceedingly rare, with most reporting no such events in recent history. However, state databases could not be readily accessed to identify such deaths. There was enormous interstate variation in guidelines governing the population covered by the child fatality review process. The age range varied greatly from one jurisdiction to another, and often only children in the state's welfare system were included. Interstate differences in practices preclude meaningful compilation of data across jurisdictions. CONCLUSIONS: It was not possible to ascertain the incidence of inadvertent entrapment of children in vehicle trunks because there is no consistency in the available databases. A national database of child fatalities, based on standardized guidelines and definitions, is needed to identify causes and magnitude of specific child deaths, in order to design, implement, and evaluate interventions.

Crash characteristics and injuries of victims impaired by alcohol versus illicit drugs.

Alcohol has long been associated with injury, but the relationship between other drugs and injury is less clear. Blood samples from 894 patients presenting to two Emergency Departments for treatment of motor vehicle injury sustained in passenger cars, station wagons, vans and pickup trucks, were tested for alcohol and other drugs. Results were related to demographic characteristics, including prior history of alcohol and drug use; crash characteristics; and injury characteristics. Alcohol was associated with more severe crashes, but other drugs, in the absence of alcohol, were not. The crashes involving drugs but no alcohol were very similar to those involving neither alcohol nor drugs.

Alcohol abuse/dependence in motor vehicle crash victims presenting to the emergency department.

OBJECTIVE: 1) To determine the prevalence of current alcohol abuse/alcohol dependence (AA/AD) among the full injury range of ED motor vehicle crash (MVC) patients; and 2) compare AA/AD and non-AA/AD patient characteristics. METHODS: This was a prospective cohort study using a stratified random sample of MVC patients aged > or = 18 years presenting to a university hospital and university-affiliated community hospital ED from May 1, 1992, to August 30, 1994. A diagnosis of current AA/AD was based on the alcohol section of the Diagnostic Interview Survey (DIS). Other measurements included the presence of blood alcohol (BAC+), Injury Severity Score (ISS-85), occupant status (driver/passenger), age, gender, seat belt use, culpability for crash, and ED disposition (admitted vs released). A weighted prevalence was determined; subgroups were compared using t-tests, chi 2, 2-factor analysis, and logistic regression modeling; alpha = 0.05. RESULTS: 1,161 patients were studied. The weighted prevalence of current AA/AD was 22.5%; 53% of these patients were released from the ED. Almost 45% of the patients with current AA/AD were BAC-. When controlling for BAC and AA/AD, greater injury severity and culpability were associated with a BAC+, but not with current AA/AD. CONCLUSION: Almost 23% of ED MVC patients have current AA/AD; BAC testing does not accurately identify these patients. Intervention strategies must be directed to both admitted and released patients.

Dementia and driving: an attempt at consensus.

The number of older drivers in Sweden will be rapidly increasing during the next decades. A possible relationship exists between the increased relative crash risk of older drivers and the prevalence of age-related diseases such as dementia. However, a clear-cut policy for evaluating driving competence in demented persons is still lacking. In recognition of this fact, the Swedish National Road Administration invited a group of researchers to formulate a consensus on the issue of driving and dementia. This consensus document is aimed at providing primary care physicians with practical advice concerning the assessment of cognitive status in relation to driving. Suggestions are based on a review of existing research and discuss the use of general and driving-specific sources of information available to the physician. Consensus was reached on the statement that a diagnosis of moderate to severe dementia precludes driving and that certain individuals with mild dementia should be considered for a specialized assessment of their driving competence.

Alcohol-related predictors of adolescent driving: gender differences in crashes and offenses.

Demographic and alcohol-related data collected from eight-grade students (age 13 years) were used in logistic regression to predict subsequent first-year driving crashes and offenses (age 17 years). For young men's crashes and offenses, good-fitting models used living situation (both parents or not), parents' attitude about teen drinking (negative or neutral), and the interaction term. Young men who lived with both parents and reported negative parental attitudes regarding teen drinking were less likely to have crashes and offenses. For young women's crashes, a good-fitting model included friends' involvement with alcohol. Young women who reported that their friends were not involved with alcohol were least likely to have crashes. No model predicting young women's offenses emerged.

Factors in adolescent drinking/driving: binge drinking, cigarette smoking, and gender.

During three consecutive years, 3,137 high school seniors from three graduating classes in one Michigan county were surveyed. The primarily White sample reported their use of alcohol and cigarettes, driving experience, and drinking/driving experience. Survey data were linked with state driver history records. Fully one-third of the high school seniors reported driving after drinking in the past six months. To identify factors associated with self-reported drinking/driving, correlation and regression analyses were conducted. Frequent binge drinking and riding with a drinking driver were consistent factors in driving after drinking frequency. Being male, smoking cigarettes, having frequent use of a motor vehicle, having a driving offense on record, and number of years licensed were important correlates, varying by year of graduation. Comprehensive interventions to moderate drinking, smoking, and driving after drinking are needed.

Crashes and violations among drivers with Alzheimer disease.

BACKGROUND: Several small studies have found a high automobile crash rate for drivers with Alzheimer disease (AD) compared with unaffected elderly drivers, prompting the suggestion that the diagnosis of AD mandate cessation of driving. OBJECTIVES: To compare automobile crash and violation rates of a large number of patients with AD with appropriately matched elderly subjects. To determine if neuropsychological test scores predict these adverse driving events. To determine if intervention by physicians or family members influences driving cessation. DESIGN: Review of crashes and violations from 1986 to 1993 in police-filed Michigan State driving records of 143 licensed patients with AD and 715 licensed comparison subjects matched 5 to 1 in age (+/- 6 years), sex, and county of residence. We correlated crashes and violations with neuropsychological test scores. A questionnaire-based inquiry on the influence of physician, family, and state interventions on driving cessation was administered. RESULTS: The crash and violation rates of patients with AD were not significantly different from those of comparison subjects. However, patients with AD probably drove fewer kilometers than did comparison subjects. Neuropsychological test scores did not predict future crashes or violations. CONCLUSIONS: This study, the largest to our knowledge involving state driving records of patients with AD, does not confirm the previously reported excessive crash rate among drivers with AD relative to an appropriate comparison population. Reduced driving exposure of patients with AD probably kept their crash adverse equal to that of comparison subjects. Intervention by physicians and family members was major factor in reducing driving exposure. These findings affirm that the mere diagnosis of AD does not justify license revocation.

Women, alcohol, and driving.

Alcohol-related crashes and fatalities have shown a dramatic decrease over the last decade. While males continue to account for most alcohol-related crashes, females are an increasing proportion of alcohol-involved drivers in both fatal and nonfatal crashes. Although most research has not addressed the possibility of gender differences in the effects of alcohol on driving performance, available evidence suggests that such differences may exist. Alcohol appears to have greater effects on females in terms of biomedical damage and impaired performance, although these effects have not been systematically investigated in relation to driving. Effective prevention programs for women require more focused research to understand gender-related factors in the effects of alcohol on driving.

Some biases in the alcohol investigative process in traffic fatalities.

This study compares data regarding alcohol involvement from police records and from chemical analyses of body fluids taken prior to or after death of 121 traffic fatalities in Washtenaw County, Michigan. Differences regarding the choice of who will or will not be screened for alcohol were found. The police and emergency room personnel were more likely to focus on males and drivers, while medical examiners were less biased. The police documented whether or not drinking took place in only 36% of the cases and suspected drinking in only half of these cases. Males and at-fault drivers were most likely to be investigated. Blood alcohol level was measured before death in 11 of 29 emergency room treated victims, with 10 (91%) positive samples. All but two of those tested before death were drivers, and all but one were males. After death, blood alcohol was measured in 47% of the 121 cases, with a higher proportion of males and motor-vehicle occupants tested, compared to females and pedestrians. Alcohol was detected in 63% of the samples. A lower mean blood alcohol concentration was found in victims who received intravenous treatment, and a higher proportion of positive samples was found in victims who died immediately in the crash. Thus, the frequency of alcohol-related traffic fatalities varied between the different data sources. The police records revealed 51%, the emergency records 91%, and the medical examiner records 63% with alcohol involvement. This wide discrepancy has the potential of leading to erroneous results here and possibly in studies done elsewhere.(ABSTRACT TRUNCATED AT 250 WORDS)

The older driver.

Older drivers constitute the most rapidly growing segment of the driving population in number of drivers licensed, miles driven, and proportion of the driving population. Yet the highway transportation system has not been designed for these drivers. This lack of fit is reflected in the accelerating rate of crashes per mile driven experienced by older drivers beginning around age 55. Furthermore, older persons are more vulnerable to injury once a crash occurs and as a group experience a higher fatality rate. The increasing proportion of our population consisting of older persons, in conjunction with a relative decrease in the young adult population, underscores the need for research to develop a greater understanding of the needs and capabilities of this age group and to develop system improvements that will enable as many older persons as possible to continue to meet their own transportation needs safely.

Epilepsy and driving in North Carolina: an exploratory study.

Epileptic drivers offer a risk to the general driving population, both because of affected brain function and because of possible effects of medication. A 1982 pilot study examined the driving records of 112 persons using North Carolina Division of Health Services clinics for the treatment of epilepsy who also held a North Carolina driver's license. Of those undergoing treatment in the clinics, 26% were known by the Division of Motor Vehicles (DMV) to be epileptics. This group had a reported crash rate 1.4 times that of the general driving population, whereas the rate for epileptics not known to the DMV was 1.1 times the general rate. Epileptics with grand mal and temporal or psychomotor seizures accounted for all recorded crashes. Implications for highway safety administrators and for future research are discussed.

Female drinking and driving: recent trends in North Carolina.

Data on driver licensing, DWI arrests, crashes, and fatalities in the State of North Carolina from the mid-70s to the mid-80s are analyzed to examine trends in drinking and driving by women. Findings presented are based on rates per licensed driver. Results suggest that more women are driving and are experiencing greater exposure to the hazards of drinking and driving. DWI arrest rates for women increased by 43% while rates for men decreased by 9%. Likewise, the proportion of legally intoxicated drivers among women is increasing. Women account for a growing proportion of alcohol-related (A/R) crashes and their involvement in single vehicle nighttime crashes is increasing. A dramatic decrease was observed in A/R fatalities in the male licensed driving population. This decrease was not paralleled by women. Authors conclude women will make up an increasing proportion of those arrested and convicted for DWI and will have more A/R crashes. Findings have implications for the design and implementation of education, deterrence, enforcement, and rehabilitation programs.

The highway transportation system as a commons: implications for risk policy.

The highway transportation system may be viewed as a commons, that is, property that is owned by everyone and open to use by everyone. However, a commons has certain characteristics that lead to its exploitation or even demise. The motor carrier industry is used to illustrate the dilemma posed by the commons and how existing systems of deterrents and incentives fail to promote safety. Recommendations are made for modifications in motor carrier safety regulations to take into account the commons characteristics of the highway transportation system.

The potentiating effects of alcohol on driver injury.

It is well established that alcohol (ethanol) is associated with increased probability of traumatic injury. This relationship has been attributed to alcohol's impairment of judgment and psychomotor performance, leading to increased probability of an injury-producing mishap. Once an accident occurs, it is widely believed that alcohol may protect against injury. However, controlled laboratory studies using animal models indicate that alcohol exacerbates the injurious effects of trauma. In this study, detailed analysis of data from more than 1 million drivers involved in motor vehicle crashes indicates that when the effects of injury-related variables such as safety belt use, vehicle deformation, vehicle speed, driver age, and vehicle weight are taken into account, the drinking driver is more likely to suffer serious injury or death compared with the nondrinking driver. These findings do not support the widespread belief that alcohol is protective against injury, but rather indicate that alcohol increases vulnerability to injury in any given crash.