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Introduction: A Critical Public Health Problem

In July 2003, Joshua Brown, a high school senior from Cartersville, Georgia, who had recently been accepted by the Berklee School of Music, was killed in a car crash. His death was tragic for his family, and it represents a tragic loss for the nation. Joshua was one of 3,657 young drivers who died in car crashes in the United States in 2003. When the additional deaths of teen passengers and pedestrians are included, motor vehicle crashes emerge as the leading cause of death for this age group in that year (accounting for 5,988 deaths among youth ages 16 to 20). These crashes were responsible for more adolescent deaths than the next four causes combined (National Center for Health Statistics, 2003).1

Young people in the United States are at greater risk of dying or being injured in an automobile than their peers around the world, in part because they are licensed to drive earlier and with less experience than youth in other countries (Insurance Institute for Highway Safety, 2006).2 If current

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The next four leading causes of death in 2003 for youth ages 16 to 20 were homicide (2,489), suicide (1,813), accidental poisoning (752), and malignant neoplasms (749) (National Center for Health Statistics, 2003).

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The risks of teen driving are nevertheless a serious concern in other countries, and a significant body of research from other countries exists. While there was not time to explore the contributions from this research at the workshop, interested readers are directed to a September 2006 report titled Young Drivers: The Road to Safety, prepared by the Transport Research Centre, a collaborative venture of the Organisation for Economic Co-operation and Development and the European Conference of Ministers of Transport.



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1 Introduction: A Critical Public Health Problem I n July 2003, Joshua Brown, a high school senior from Cartersville, Georgia, who had recently been accepted by the Berklee School of Music, was killed in a car crash. His death was tragic for his family, and it represents a tragic loss for the nation. Joshua was one of 3,657 young drivers who died in car crashes in the United States in 2003. When the additional deaths of teen passengers and pedestrians are included, motor vehicle crashes emerge as the leading cause of death for this age group in that year (accounting for 5,988 deaths among youth ages 16 to 20). These crashes were responsible for more adolescent deaths than the next four causes combined (National Center for Health Statistics, 2003).1 Young people in the United States are at greater risk of dying or being injured in an automobile than their peers around the world, in part because they are licensed to drive earlier and with less experience than youth in other countries (Insurance Institute for Highway Safety, 2006).2 If current 1The next four leading causes of death in 2003 for youth ages 16 to 20 were homicide (2,489), suicide (1,813), accidental poisoning (752), and malignant neoplasms (749) (Na- tional Center for Health Statistics, 2003). 2The risks of teen driving are nevertheless a serious concern in other countries, and a significant body of research from other countries exists. While there was not time to explore the contributions from this research at the workshop, interested readers are directed to a September 2006 report titled Young Drivers: The Road to Safety, prepared by the Transport Research Centre, a collaborative venture of the Organisation for Economic Co-operation and Development and the European Conference of Ministers of Transport. 1

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2 PREVENTING TEEN MOTOR CRASHES trends continue, a cumulative total of more than 100,000 adolescents and young adults (ages 16 to 24) who are alive today will die in car crashes in the next 10 years (Winston and Senserrick, 2006).3 Furthermore, nearly two of every three people killed in teen-driver crashes are people other than the teen driver (American Automobile Association, 2006). By any measure, then, automobile crashes are one of the most critical public health prob- lems in the United States. After Joshua’s death, his parents dedicated themselves to combating this problem, and they were by no means the first. States, counties, and school districts; the federal government; private organizations, such as the Insurance Institute for Highway Safety; advocacy groups, such as Mothers Against Drunk Driving; and others have addressed the problem in a variety of ways. Fatalities and injuries overall and for teenagers have been reduced substantially over the past 30 years as a result of changes in state laws, such as seat belt requirements and increases in the legal drinking age (National Highway Traffic Safety Administration, 2006a). Changes in licensure re- quirements, public information campaigns, and strategies for encouraging parent involvement in the training of new drivers are other valuable strate- gies that have been used to improve driving safety for teens. While the impact of these efforts is evident, novice drivers continue to have the high- est rates of crashes, injuries, and fatalities of any group; the sheer magni- tude of the injuries and fatalities that continue to result from teen crashes shows that current prevention efforts are inadequate. Knowledge about how and why teen motor vehicle crashes happen is the key to developing countermeasures to reduce their number—and a sig- nificant body of applicable knowledge, produced over several decades, ex- ists. However, few effective mechanisms are available for using that knowl- edge to directly influence teen behavior or to convert it into effective interventions. In addition, many of the efforts to reduce teen crashes that are in place are hampered by a lack of evidence as to which prevention strategies are most effective. Driving is a complex activity, mastery of which develops slowly over time, despite the fact that for most adults it seems largely automatic. It is a social activity as well as one that draws on a com- 3Estimate based on an analysis of 2003 data for adolescents and young adults (ages 16 to 24) from the Fatality Analysis Reporting System (FARS). Fatality information derived from FARS includes motor vehicle traffic crashes that result in the death of an occupant of a vehicle or a nonmotorist within 30 days of the crash.

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3 INTRODUCTION plex array of physical and cognitive abilities that are still developing in teenagers. Moreover, driving is a skill that adolescents need to learn—the aim of public health efforts is not to prevent the activity altogether (as it is with many other public health initiatives) but to help teens do it more responsibly. Consequently, an understanding of teenage driving would be enhanced by a systematic review of contributions from the behavioral, cognitive, so- cial, health, and biological sciences. These disciplines have shed light on distinctive aspects of teenagers: their approach to risk assessment, learning processes, skill development, brain functioning, reward incentives, and in- teractions with peers and adults. Applying this understanding to the devel- opment of prevention strategies holds significant promise for improving safety. While many fields of research have already produced studies that are relevant to this topic, this body of knowledge has not been synthesized in ways that allow key findings to be applied effectively in policy and practice. Furthermore, opportunities for collaboration among researchers from di- verse fields to address questions about teenage driving are rare. Research studies are often published in specialized journals that are not widely read by others working in different disciplines or diverse professional environ- ments, and current citation indexing systems make it difficult to integrate research from fields as diverse as public health, traffic safety, adolescent development, and social psychology. To address this void, the Board on Children, Youth, and Families, un- der the auspices of the National Research Council and the Institute of Medi- cine, and in collaboration with the Transportation Research Board, formed the Committee on Contributions from the Behavioral and Social Sciences in Reducing and Preventing Teen Motor Crashes to plan a workshop at which experts from the relevant fields could share information and con- sider ways to put their combined expertise to work. The committee met in person and collaborated extensively by phone and electronic mail to review the kinds of evidence that are available and identify objectives for the work- shop as well as the experts who could best help meet them. The committee was not charged with developing specific recommendations regarding ways to reduce teen motor crashes, but rather with exploring three questions: 1. How do theories and evidence from the behavioral, cognitive, so- cial, health, and biological sciences inform understanding of both the risk

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4 PREVENTING TEEN MOTOR CRASHES factors that increase teen motor vehicle crashes and the protective factors that reduce such crashes? 2. How can theories and evidence from the behavioral, cognitive, so- cial, health, and biological sciences inform improved prevention, program, and policy interventions to reduce risky teen motor vehicle driving behav- iors, as well as promote responsible teen driving? 3. What research and interventions are most likely to advance teen motor vehicle safety over the short and the long term? The workshop planned to address these questions, held May 15 and 16, 2006, assembled a multidisciplinary group who shared information and insights on topics ranging from adolescent development to emerging technology for studying, monitoring, and controlling driving behavior. The workshop program was structured to bring together researchers who had not addressed studies of teen driving, but who might have unique insights in the field of adolescent development and other areas of social and behav- ioral research, with experts who have deep experience in the field of high- way safety. Presenters laid out aspects of the problem and addressed some of the challenges that face policy makers, and participants engaged in ex- tensive discussion of the implications of the data presented and possible ways forward. A workshop agenda and a complete list of participants ap- pear in the appendix to this report. This report documents the information presented at the workshop and the discussions that took place. Its purpose is to lay out the key ideas that emerged from the workshop, both for researchers interested in interdisci- plinary work in this area and for those who are involved in developing prevention strategies. The report should be viewed as only a first step in exploring opportunities to develop a synthesis of diverse research and ap- plying this knowledge to the problem of preventing teen crashes, and it is confined to the material presented by the workshop speakers. Neither the workshop nor this report is intended as a comprehensive review of what is known about teen driving. Many important topics—such as the potential of insurance incentives or law enforcement practices to strengthen preven- tion strategies—were not addressed in the limited time available for the workshop. A more comprehensive review and synthesis of relevant research knowledge, including lessons learned from the experiences of other coun- tries, will have to wait for further development. The report is organized to provide both an overview of the factual information that was presented as well as insights that emerged about the

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5 INTRODUCTION role that researchers can play in reducing and preventing teen motor ve- hicle crashes. Chapter 2 provides an exploration of teen crashes, how they happen, and the risk factors that contribute to them. Chapter 3 addresses specific features of adolescence that may play a role in the way teenagers drive and their high crash risk. Chapter 4 explores the strategies already being used to improve teenagers’ safety on the road, as well as promising strategies not yet being fully implemented. The report closes with a discus- sion of future directions—Chapter 5 addresses both the need for ongoing research to address pressing questions that have not yet been resolved or have emerged from technological developments, as well as the vital impor- tance of coordinating and capitalizing on an already impressive body of knowledge about teen driving.