American Journal of Preventive Medicine
Overview and introductionTeen Driving: Motor-Vehicle Crashes and Factors That Contribute
Introduction
The safety of teen drivers has too often been neglected in books and publications on adolescent health, even though motor-vehicle crashes are the greatest single public health threat to teens in many countries, including the U.S. According to the Web-based Injury Statistics Query and Reporting System,1 in 2004 crashes accounted for 41% of all deaths among teens aged 13–19 years in the U.S. In contrast, other unintentional injuries accounted for 15%, homicide accounted for 15%, and suicide for 14% of all teen deaths. Awareness of the health threat posed by crashes needs to be raised among public health practitioners working with teenagers so that new interventions can be developed and existing programs can be enhanced to reduce teens' involvement in motor-vehicle crashes. This article summarizes data on the motor-vehicle risk of teen drivers, historical trends in teen driver crashes, the effect of policies on teen driver crashes, characteristics of teen driver crashes, and combinations of crash characteristics. Finally, this article addresses multiple factors that contribute to teen driving behavior in a conceptual framework, and offers implications for the prevention of teen driver crashes.
Excess crash risk is a major contributor to teen mortality and morbidity.2, 3 In spite of the success of graduated driver licensing (GDL)4 and other programs, the rates of traffic crashes, injuries, and fatalities2 and the economic cost of crashes involving teen drivers5, 6 are unacceptably high. Teen drivers have the highest crash rate per mile driven of any age group.7 Male teens have an especially high rate of fatal crashes and an even higher rate of nonfatal injury crashes.7 Crash rates are highest among the youngest drivers,7 declining with each year of increasing age but not reaching the lowest levels until after age 30.
Among teen drivers in 2000, those aged 16 years had the highest crash involvement rate—35 crashes per million miles traveled—followed by those aged 17, 18, and 19, at 20, 14, and 13 crashes per million miles traveled, respectively.3 Thus, per mile traveled, drivers aged 16 years had nearly three times as many crashes as did those at 19. In comparison, drivers aged 45–54 had four crashes per million miles traveled. Fatal crashes followed a similar pattern, with drivers aged 16 having 13 fatal crashes per million miles traveled and those aged 17, 18, and 19 having eight, six, and six fatal crashes per million miles, respectively.3 Thus, per mile traveled, drivers aged 16 had more than twice as many fatal crashes as did those at 19. In comparison, drivers aged 45–54 years had one to two fatal crashes per million miles traveled. Fatalities are not the only lasting outcome of teen crashes. Although youth are more resilient than adults, especially the elderly, teens who survive injuries received in crashes often experience significant deficits in quality of life, and these deficits occupy a larger portion of their lives than do injuries to older individuals.8
Section snippets
Historical Trends in Teen Driver Crashes
Historical trends of crash rates among teens and among adult drivers provide perspective on the current situation. Trends in crash rates are presented by combining data from the Fatality Analysis Reporting System (FARS, www-nrd.nhtsa.dot.gov/departments/nrd-01/summaries/FARS_98.html); the U.S. census; the National Household Travel Survey (NHTS; www.bts.gov/programs/national_household_travel_survey/); and the National Personal Travel Survey (NPTS) conducted by the U.S. Department of
Motor-Vehicle Policies and Their Effect on Teen Drivers
The data on crash rates presented above suggest that, although efforts to curb crashes may have had limited success in reducing crash rates, such efforts may have prevented the rates from increasing at a greater pace. In fact, they may be responsible for teens showing no increase in crashes since 1994, when crash rates are measured in person-miles driven (Figure 2). Some efforts that have been made in the U.S. include traffic safety campaigns and changes in motor-vehicle safety design, roadway
Passengers
Teen drivers often have passengers, because cars are an important mode for socializing. Because of the social function of motor vehicles in teens' lives, teens often travel in motor vehicles with other teens, either as the driver or the passenger of a teen driver. Given that teens often drive with passengers and drive less safely than adults, it is not surprising that the number of crashes that claim the lives of children begins to climb sharply at age 13 and peaks at age 17–18.3 Not only are
Combinations of Crash Risk Factors
Driving entails a complex set of skills and behaviors and often may be executed in the presence of more than one risk factor. These data indicate that, whether a teen or adult is driving, when risk factors co-occur crash risk increases. The authors have examined the effect of combinations of crash characteristics on risk ratios comparing crash rates of drivers aged 16–19 years with those of drivers aged 45–65 years.43 The data for this study are from Michigan State Police crash records for
Conceptual Approach to Understanding Teen Driving
The population crash data presented above highlight a serious public health problem yet portray only part of the teen driving picture. An understanding is needed of why teen crash risk is higher and why some teens are more likely to crash than others. Teen driving overall and the factors that contribute to an individual teen's driving must be understood in order to develop and implement public health approaches, strategies, and policies that will ultimately reduce teen motor-vehicle crashes and
Discussion and Conclusion
Teen drivers in the U.S. are at considerable excess risk of motor-vehicle crashes compared with adult drivers. This excess risk has existed for many years, despite some success in traffic safety efforts. Potential interventions to prevent the risky teen driving behavior that can lead to crashes should be based on research. Crash statistics highlight certain conditions, such as nighttime and passenger presence, that increase crash risk for teen drivers. These factors lend themselves to
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