5
Moving Forward

The workshop demonstrated that a wealth of information is available that can be used to save lives and reduce injuries from teen driving—from statistics that fill out the picture of how teenagers are harmed in crashes, to insights about how their physical, cognitive, and emotional development affects their behavior, to cutting-edge technology for making vehicles safer and improving training. As participants sifted through this material, two key points emerged. First, using this wealth of information to reduce the number of teens killed in crashes requires purposeful coordination among a variety of actors, and, second, several important questions still require research.

NEED FOR SYNTHESIS, COORDINATION, AND APPLICATION

Daniel Keating noted that each of the discussions, whether focused on aspects of adolescent development, the errors teen drivers make, or strategies for improving safety, referred frequently to omissions in skills and judgment. For him, the stark data showing the drop-off in crash rates after the first few months or few hundred miles on the road suggests the relevance of a growing body of knowledge from cognitive psychology on the development of expertise, which he emphasized is different from the simpler acquisition of skills or experience.

Keating offered a brief overview of the way expertise develops, noting that it takes considerable time in almost any context. True expertise entails



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5 Moving Forward T he workshop demonstrated that a wealth of information is avail- able that can be used to save lives and reduce injuries from teen driving—from statistics that fill out the picture of how teenagers are harmed in crashes, to insights about how their physical, cognitive, and emotional development affects their behavior, to cutting-edge technology for making vehicles safer and improving training. As participants sifted through this material, two key points emerged. First, using this wealth of information to reduce the number of teens killed in crashes requires pur- poseful coordination among a variety of actors, and, second, several impor- tant questions still require research. NEED FOR SYNTHESIS, COORDINATION, AND APPLICATION Daniel Keating noted that each of the discussions, whether focused on aspects of adolescent development, the errors teen drivers make, or strate- gies for improving safety, referred frequently to omissions in skills and judg- ment. For him, the stark data showing the drop-off in crash rates after the first few months or few hundred miles on the road suggests the relevance of a growing body of knowledge from cognitive psychology on the develop- ment of expertise, which he emphasized is different from the simpler acqui- sition of skills or experience. Keating offered a brief overview of the way expertise develops, noting that it takes considerable time in almost any context. True expertise entails 40

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41 MOVING FORWARD not only the development of particular sets of physical skills, but also the development of judgment about how and when to apply particular skills and knowledge. Essential to the process, again regardless of the context, is learning from errors. Errors made while learning to drive can be fatal, but Keating offered the example of the Ache people of eastern Paraguay, who have addressed the risks inherent in learning to hunt in a way strikingly similar to graduated driver licensing (GDL). In that tribe, at approximately age 13, youngsters begin to learn to hunt, but they are allowed to track only certain kinds of game. The process of learning encompasses several levels of increasing difficulty and risk, and it culminates in a status akin to full certi- fication as hunter. Keating observed that some studies indicate that it can take up to 10,000 hours of focused, goal-directed effort to develop real expertise in acquiring a complex, modern skill. He linked the processes that are neces- sary to develop expertise to the development of self-regulation in adoles- cents. Critical to the capacity to develop and successfully deploy the judg- ment and skills that come with growing expertise is the capacity to regulate one’s attention, emotions, and social behavior, which is still developing in teenagers. The relevance of each of these domains to driving is clear, but no purposeful strategy is available to address them in preparing young drivers. Moreover, Keating explained, it is the development of the prefrontal cortex in the brain during adolescence that regulates these capacities. During ado- lescence the prefrontal system emerges as the governor of other brain sys- tems. Neural pathways, partly dictated by experience, are established in the brain that will influence development and behavior—thus providing the basis for a lifetime of safe driving habits. In related work, some researchers have pointed out that adolescence is a period during which the basic neural pathways are established for accom- plishing complex tasks through the formation of representational, psycho- logical, and neural models that allow them to capture the “gist” of the task without requiring them to consciously decide each component of a com- plex endeavor each and every time. The frequent rehearsal of these tasks allows for greater speed in their execution and also allows the models to become embedded in the brain’s architecture and chemistry so that the execution of repetitive tasks (such as acceleration and braking) becomes automatic. It is during the formative period of the representational model and neural circuitry that prevention strategies, hazard assessment skills, and safe driving practices acquire special significance. The significance of these points for teen driving is twofold, Keating

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42 PREVENTING TEEN MOTOR CRASHES explained. First, they demonstrate the importance of what he called evi- dence-based advocacy. While policy makers may not need to delve into the intricacies of brain development in adolescence, it is important that advo- cates recognize and use the full range of knowledge that supports the push for a strategy such as GDL. No one at the workshop dissented from the view, mentioned numerous times, that there is no good reason to license young people to drive at age 16. But gaining support for further restraints or delays on what is commonly accepted as a natural rite of passage for adolescence would require a crisp summary of the implications of the de- velopmental status of youngsters at this stage for driving and an evidence base that could demonstrate the costs and benefits associated with different ages of licensure. Even with 18-year-olds, the crash rates in the first few months following licensure are very high. The work of pulling together this kind of knowledge from the behavioral and social sciences and considering its practical application to driver education and other tools is only just beginning. James Hedlund amplified this point when he described an ideal com- prehensive approach to safe teen driving. Such a system would include: • driver education that uses computer technology and is integrated with a strict GDL program; • departments of motor vehicles that implement and enforce com- prehensive GDL programs and modern methods of testing for licensure that address the range of skills that teens need to develop; • supports for parents that guide them in managing their teens’ driv- ing and supervising their practice driving hours; • law enforcement that makes sure teens recognize that laws and re- strictions will be enforced; and • a comprehensive community health program for driving safety that links health care practitioners, public health messages, and data collection strategies. This list illustrates a point that was made repeatedly: not only must a wide range of knowledge be incorporated into thinking about ways to keep teens safe when they drive, but also new opportunities are needed for a range of individuals and groups to collaborate to apply this complex set of knowledge in consistent, effective ways. Possibilities include: in-depth re- views of the research literature, such as those conducted in the course of ad hoc consensus studies by the National Academies or occasional workshops,

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43 MOVING FORWARD roundtables, or forums on topics of common interest. The critical need is for researchers, policy makers, advocates, and stakeholders to have sustained opportunities for dialogue and the critical examination of emerging re- search and strategies to apply this knowledge both to public policy and to the development of new prevention programs. Such gatherings could also stimulate the development of new public- and private-sector partnerships that would build on and strengthen existing prevention efforts, fostering consensus about innovative strategies. Although the success of GDL and other measures demonstrates the possibilities for further reducing crash rates, the synthesis and collaboration that are needed to move forward will not happen automatically. SPECIFIC RESEARCH NEEDS Despite the significant research findings and promising strategies that were highlighted at the workshop, participants identified a number of gaps in the existing research base. Members of the workshop committee drew on the full discussion to generate a list of key questions to guide future efforts. What happens during the first few months of driving? What, exactly, changes and how does this change occur in different age groups? Both further insight into crashes that involve newly licensed drivers and identifi- cation of the essential skills that driver education should instill in novice drivers are needed. How can minor driving mishaps or near misses be used as teachable moments? What can be learned from naturalistic studies of teen driving behavior? What are the characteristics of adolescents who drive safely from the start? What cognitive, sensory, or behavioral factors might influence the formation of safety driving practices and stimulate the devel- opment of expertise in this realm? What are the benefits and possible risks of new technologies? Can tech- nology be used in more individualized ways, for example to track driver progress over time and to provide feedback that strengthens error correc- tion and hazard detection? Can technologies such as global positioning systems provide more insight into the environmental conditions and set- tings that foster risky behaviors or encourage safer driving practices? Could some technologies have unforeseen negative consequences, such as pre- venting learning drivers from developing certain skills by superseding their judgment? What are the best ways to influence parents’ behavior? What can be done

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44 PREVENTING TEEN MOTOR CRASHES to support parents and other adults in guiding and supervising their teens and also to increase parents’ motivation to monitor and restrict their teens? How might adolescents’ health care providers be coached to increase their counselling on driving safety and the effectiveness of their efforts? What are the best ways to influence teens’ behavior? What can be done to foster and reward safe driving as normative behavior for teens? Which ado- lescent characteristics can work as protective factors, and how might they best be harnessed? What is known about teens’ own attitudes regarding driving safety and potential solutions? What role do the media play now— how might the influence of the media and commercial vendors (such as the automotive and communications industries) be harnessed to foster respon- sible driving practices? What is known about the effectiveness of current media campaigns? How might law enforcement and the insurance industry play bigger, more proactive roles in improving safety? What are the best ways to influence policy makers and the public? To the extent that the research community can reach consensus on the need for further changes in laws and public policies, as well as attitudes and expecta- tions among parents and the public, what social marketing and other strat- egies have demonstrated effectiveness for this purpose in other contexts? How are new and existing programs performing? Evaluations that en- compass new findings about teenagers and driver behavior are needed to improve the quality of existing driver education programs, including ad- vanced skills training, as well as other approaches that draw on new research on adolescent development, behavior, and decision-making processes. What are the costs and benefits of different types of interventions? Linking specific interventions or strategies to selected costs and benefits is a daunt- ing challenge. Large study samples are required to examine the effects of certain approaches with selected cohorts of teen populations, taking into account significant individual and demographic variables. Interventions that entail costs that accrue to individuals (such as the fees associated with driver education or the installation of new technology in automobiles) may offer major benefits to society through the reduction of injury and im- provement of safety. These relationships deserve further consideration in the design of incentives and regulatory frameworks. What policies might best address the problem of sleep deprivation? The cycles associated with teen sleep patterns are well known, but this research has not been applied in any consistent manner to the design of licensure standards, driver education programs, or public health messages for teens

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45 MOVING FORWARD and their parents. Health care providers and educators are important but undeveloped assets who are in a position to guide teens and parents about the importance of adequate sleep in preventing risky and dangerous behaviors. NEXT STEPS This set of questions could serve as the starting point for further explo- ration of these complex issues. Many participants expressed the hope that additional opportunities will emerge—through new public and private part- nerships—for interdisciplinary collaboration in the development of pre- vention strategies for teen drivers. The workshop clearly demonstrated that a wealth of information is available that has not been brought to bear on a public health issue of immense proportions.