What are some ways that you can reduce driving risk when using the highway transportation system?

While GDL and minimum drinking age laws have led to reductions in risky driving and crashes, teen crash rates remain unacceptably high. Persistent concern about the issue is now stimulating a search to identify existing strategies that are not being exploited to their full potential. In addition, new technical interventions now offer the potential to protect novice drivers—and all drivers—in previously unimaginable ways.

The success of GDL has focused attention on the role that parents can and must play in the critical learning period for teen drivers. As Bruce Simons-Morton explained, parents influence teens’ actions during this period in a variety of ways, for good or ill; their intentions are good but the outcome is mixed. Parenting practices, parents’ knowledge, and the relationship between parents and their children all contribute to teenagers’ acquiring safe driving practices. Parents can play a critical role, but in many cases they don’t know what they should be doing to help their children drive safely—or how best to do it. Moreover, policy makers and others frequently do not take advantage of the opportunities they have to help parents become effective driving coaches and supervisors while their children are novice drivers.

Taking the parent-teen relationship first, Simons-Morton called attention to the familiar model of authoritative parenting that psychologists advocate, in which parents make and enforce rules but also are supportive, flexible, and responsive to their teens. If parents are involved in their children’s lives, monitor their children’s behavior, convey their expectations clearly, impose consequences, and maintain open communication and a sense of mutual trust, outcomes are likely to be better than if they do not.

However, even when these conditions are all in place, a variety of factors pushes both teens and parents to favor driving privileges. Parents as well as teens can be naïve about the actual risks of crashing. Parents may be satisfied with the teen’s mastery of the mechanical skills of managing the vehicle and fail to appreciate the importance of other safe driving skills, such as hazard detection, risk assessment, and anticipatory behaviors. Both parents and teens are subject to social pressures in favor of teen driving, and at the same time, parents may be eager to stop driving their teens around. Teens are generally eager to drive, and parents want to give them the gift of independence.

Simons-Morton summarized the more specific ways in which parents can influence teen driving and their potential effects on safety. Two things they can do have demonstrated safety benefits: delaying permission to test for a driving license and controlling access to the vehicles and driving circumstances (such as night driving and carrying passengers) for novice drivers. When it comes to drinking and driving, the role of parents is complex, and Simons-Morton noted that the example parents set may far outweigh other messages they attempt to send. Moreover, parents may believe they have explained what their children should do if they find themselves in a situation that involves drinking and driving, but teens report that they are not sure.

Finally, supervised practice driving, required in increasing numbers of state GDL programs, has significant potential, but it has not yet demonstrated safety effects (such as changes in crash or mortality rates) on its own in the United States, perhaps because parents have been offered little guidance on how to make use of this time. Another issue with supervised driving is that when parents are in the car, they tend to have the primary responsibility for safety and risk assessment, even if the teen is driving. They are scanning for hazards, coaching and guiding the teen, and may be making or influencing many of the decisions about acceptable conditions, avoiding dangerous intersections, and so forth. Thus, once the teen drives alone, the initial period of practice driving has not necessarily prepared him or her to anticipate hazards. There is a need to identify specific components of supervised driving, Simons-Morton explained, that can be tested experimentally and are associated with increased knowledge and behavioral improvements among youth. Developing driving proficiency requires experience, so the key is to allow learning drivers to gain that experience in circumstances that are relatively safe. Figure 4-1 compares crash rates for novice drivers who do and do not learn under supervised circumstances.

A program called Checkpoints, developed by researchers at the National Institute of Child Health and Human Development, provides a structure in which parents can work with their teens to reduce risk conditions during the first 12 months of driving. The program uses a combination of tools, including persuasive communications, such as videos and newsletters, written agreements between parents and their children, and limits on high-risk driving privileges. A controlled study, in which some families participated in the Checkpoints program and others received comparable driving safety materials but not all of the Checkpoints interventions, showed that Checkpoints families imposed and maintained significantly more restrictions on their teenagers’ driving. However, the study sample was not large enough to show ultimate effects on crash rates.

The Checkpoints program is based on the goals of changing both parents’ and teens’ perception of their risk, as well as their expectations regarding reasonable limitations—in order to decrease risky driving, traffic violations, and crashes. Although initial results for Checkpoints are positive, Simons-Morton noted, additional research on changes in novice driving performance over the first 18 months of driving, on the nature and effects of supervised driving, on other ways to deliver support and improve parental management, and on ways to incorporate findings about the process of learning to drive into driver education and testing and licensure programs would be of great benefit.

Richard Catalano provided an additional perspective on the role of family influences with a framework that is part of a larger social development approach to risk prevention. Key risk and protective factors that affect adolescent behavior may be evident long before youngsters reach the teen years, he explained, and targeted strategies can be used to improve outcomes for teens. Catalano described a study called Raising Healthy Children (RHC), in which five matched pairs of elementary schools were randomly assigned to receive either a prevention program based on the social development approach or a control condition.

The risk and protective factors addressed in the RHC program are listed in Box 4-1. Such interventions as teacher and parent workshops, in-home services, and summer and after-school programs were offered to children as young as first grade to focus on such goals as developing social and other skills, addressing school and family management problems, and promoting prosocial behaviors. Brief family sessions were offered to families at critical transition points, including the transition from middle to high school, the transition out of high school, and the transition to driving.

Risk and Protective Factors. Risk Factors School

Based on the proposition that good parenting reduces poor driving, the sessions designed to improve driving safety had specific objectives. In the first session, parents and teens discuss trying new things in adolescence and examine their perspectives on risk-taking. In this discussion, parents and teens seek to understand the current driving laws and the risks of driving while young and inexperienced. In addition, teens practice skills for making healthy choices, focusing on motivations and consequences, while parents demonstrate the ability to coach their teen in using decision-making skills to reduce conflict and to establish effective communication. The session concludes with an exercise in which parents and teens strive to integrate this information and skills into guidelines and expectations for driving.

The second session had four goals:

1. parents display competence in using communication and anger management skills with their teen;

2. teens learn how to handle crashes, dead batteries, flat tires;

3. parents and teens implement a family driving contract; and

4. parents and teens apply a “guidelines, monitoring, and consequences” approach to driving-related difficulties and conflict (demonstrate knowledge and use of effective consequences, identify ideas for recognizing teens’ positive driving behavior).

Bearing in mind that the program was designed to address a broader range of risks than just those associated with driving, the program has demonstrated some promising results. For example, families receiving the intervention were four to six times more likely than the control families to report that they had established a driving contract. Teens in the families receiving the intervention also reported that they drove less frequently under the influence of alcohol or rode with peers who had been drinking.

While participants agreed that more study of effective means to harness the potential of parents and family dynamics in improving teens’ driving safety is needed, the potential benefits seemed clear.

Health care providers are not all doing their part to provide prevention messages to adolescents and their parents, according to specialist in adolescent and young adult medicine Lawrence D’Angelo. He indicated that this gap is notable, especially in light of evidence that this kind of counseling has had positive effects in other areas, such as reducing smoking. Driving safety is not a prominent topic during medical students’ training in pediatrics, he explained. Consequently, even experts in adolescent medicine (who receive specialized training and certification) report providing counseling about alcohol, drugs, and/or automobiles only 82.5 percent of the time during their annual examinations of adolescent patients. Specific threats to adolescent health, such as the risks of having passengers in the car and night driving, are mentioned far less frequently (12 and 7 percent, respectively). Indeed, D’Angelo pointed out, only 60 percent of adolescent specialists know whether the state has a GDL law, and the percentage was only slightly higher among those with adolescents in their own household (77 percent).

Another health care-based strategy that has not been well explored, participants pointed out, is that of pursuing individual characteristics that may increase driving risk. Attention deficit hyperactivity disorder, type 1 diabetes, and substance abuse are just a few of the factors that might put an individual teen at increased risk when driving. Teens with these problems are not routinely counseled about how their diagnoses may affect driving. Yet patients with other health risk factors, such as those for cardiovascular disease, are routinely identified and patients are counseled on ways to minimize negative outcomes.

Guidelines for health care providers, innovative ways of delivering counseling to youth and their families, and additional research that encompasses a broader health agenda for adolescents were all mentioned as viable ways to encourage providers to address teen driving risks. The role of public health agencies in addressing the risks of teen driving, as well as opportunities to promote responsible driving practices, were identified as particularly deserving further attention.

Without a doubt, intensified and improved efforts using existing strategies could yield further improvements in safety, but they offer only partial solutions to the fundamental problem—allowing young people to learn driving skills and gain experience behind the wheel without risking their lives. Many of the strategies already discussed address ways in which adults might either persuade or compel teens to behave differently or improve the training they receive or the quality of their practice time behind the wheel. Technology offers a very powerful companion strategy with significant potential to make driving safer not just for novices but for all drivers. Max Donath, Wade Allen, and John Lee described some of the technological innovations with particular promise.

Donath began by noting a few reasons why technology offers significant opportunities to reduce crash and fatality rates. Measures to increase seat belt use, for example, have had a significant impact on survival rates, but this improvement increased markedly as the policies shifted from voluntary interventions to mandatory requirements. When seat belts were first introduced in large numbers of cars in the 1960s, for example, they were used less than 25 percent of the time, and they were generally used by the lowest risk drivers. State laws requiring the use of seat belts helped to boost implementation rates, but large proportions of the driving population who were at higher risk of crash involvement did not tend to use the safety restraints until enforcement provisions were legally mandated. At present, teenage boys continue to be one of the groups least likely to wear seat belts (Transportation Research Board, 1989, 2003).

Other, more complex technologies can influence other driving behaviors, Donath noted, in one of three ways.

The first is forcing behavior, which involves using technology to make it impossible to operate the vehicle in certain circumstances. For example, a seat belt interlock can prevent the car from starting unless all occupants have engaged their seat belts. An alcohol ignition interlock feature requires the driver to puff into a tube connected to a BAC sensor, which engages the interlock if a preset BAC threshold is breached. Intelligent speed adaptation (ISA), in which a system using a global positioning system (GPS) and a digital road map can prevent a driver from exceeding the posted speed limit, is another example of forcing behavior. ISA may also use the second of the three approaches, driver feedback, by signaling to the driver the need to reduce speed. Some versions of ISA are even designed to adapt warnings to such factors as road and weather conditions, traffic congestion, and time of day. Interlock systems can be installed when cars are manufactured, so new vehicles might come with “smart” keys that identify drivers, for example, with the possibility of programming different restrictions for different members of a family.

Driver feedback is a system for providing real-time warnings of poor driving, hazardous conditions, or other potential risks. For example, this technology might recognize curves in the road or departure from a lane and alert the driver to make corrections to speed and steering. This type of technology could also be used to control misuse of entertainment systems, which can be very distracting for teen (and other) drivers.

Reporting behavior is a system for collecting data about driver performance that can either be saved for later review by parents or other driving supervisors or transmitted in real time so that parents have the option to intervene. The driving “report card” might include data on speed, acceleration, braking, throttle use, and time and location of the trip, which can allow parents to supervise their teen’s driving even when they are not physically present. Such programs may be initiated through novel features, such as cell phones or web sites that use GPS to report phone or vehicle location, speed and direction of travel, and time of day on a routine basis.3

John Lee described other kinds of driver supports that can enhance safety, some of which are already available and some of which will be soon. Forward collision warnings, road departure warnings, and steering assist devices are among the adaptive technologies that can either warn the driver of a potential risk or actually intervene to minimize or prevent it. He predicted that the market for such devices could reach $10 to $100 billion by 2010.

While many technical innovations offer promising approaches to prevention, several participants observed that new interventions and technology need to be carefully evaluated before they are widely adopted. Eagerness to reduce teen driver crashes can too easily encourage the adoption of new devices based on a perception of potential benefits rather than a rigorous assessment of their actual effects and risks. Although some technical innovations may offer superior ways to teach driving skills and prevent some impaired drivers from operating their vehicles, the overall effects of technology on changing attitudes among the youth population about risk and responsible driving may be very small. Drivers may also adapt to new technologies in unexpected ways, taking other risks that lessen the intended value of the new devices. In addition, public resistance to forced behaviors or technical overrides should not be underestimated.

As discussed above, traditional driver education has focused on teaching skills, driving practices, and the rules of the road. Computer-based instruction makes it possible for the objectives of driver education to include not only a more complex conception of driving skills—encompass-ing perceptual, psychomotor, and cognitive skills—but also attitudes about driving and risk-taking and a wider range of knowledge about the challenges of driving. As Wade Allen, who provided an overview of the potential of this technology, explained, computer-based instruction also offers practical advantages as well—it can be administered on the web, for example, and can be provided consistently and easily by school districts and driver education schools.

The primary advantage of computer-based instruction is that it can use scoring to motivate and encourage students and to focus attention on the criteria for successful completion of the course. As it does in other contexts, computer-based instruction allows novice drivers to practice handling hazardous situations without risking their lives. Students can experience roadway and traffic hazards, even crashes, in real time and practice situational awareness (awareness of the surrounding situation and potential risks) and decision making under stress. Scoring for practice sessions can instantly indicate the consequences of driver decisions. Computer adaptive technology could allow the program to focus on a student’s weaknesses, allowing follow-up practice to reinforce learning from mistakes.

Computer-based instruction can be delivered on a desktop computer (the least expensive model), in a console simulator or a more complex display system, or by means of a portable computer installed in a vehicle that is equipped with a virtual reality headset (the car’s wheels are placed on turntables so the learner can operate the steering wheel). Although the costs increase significantly with the complexity of the hardware, the face validity—that is, the extent to which the simulated experience resembles a real-life experience—is likely to correspond to the sophistication of the hardware as well.

As Allen explained, the benefits of computer-based instruction are many and the obstacles to widespread adoption are not technological but economic and social. This point hearkens back to earlier discussion of strategies that are underused, as well as to a broader point that emerged throughout the workshop sessions: a broad, multifaceted approach offers the greatest potential to bring about meaningful improvements in driving safety for teens.