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CORK Bibliography: Adolescents and Driving

53 citations. January 2003 to present

Prepared: January 2008

Adlaf EM; Mann RE; Paglia A. Drinking, cannabis use and driving among Ontario students. Canadian Medical Association Journal 168(5): 565-566, 2003. (168 refs.)

Little is known about the risk of injury among adolescents who drive after the use of alcohol or cannabis or ride in cars driven by drunk drivers. We examined data from self-administered interviews with 1846 students in grades 7 to 13 who participated in the 2001 Ontario Student Drug Use Survey about their experiences related to alcohol, cannabis and driving during the 12 months preceding the survey. In all, 31.9% of the students reported being a passenger in a car driven by a drunk driver; of the students in grades 10 to 13 who had a driver's licence, 15.1% reported driving within an hour after consuming 2 or more drinks, and 19.7% reported driving within an hour after using cannabis. Our study shows that a sizeable proportion of adolescents are exposed to alcohol- and drug-related driving risks.

Ahlin E; Rauch WJ; Zador PL. The risk of alcohol-related traffic events and recidivism among young offenders: A theoretical approach. Glasgow: ICADTS, 2004. (10 refs.)

This paper addresses theories to explain the risk of recidivism among young alcohol-related traffic offenders. Analysis is conducted using data from the State of Maryland to test two derivatives of deterrence theory: rational choice and reconceptualiization. There is no accompanying PowerPoint presentation.

Alcohol Epidemiologic Data System; Yi H-y; Williams GD; Dufour MC. Trends in Alcohol-Related Fatal Traffic Crashes, United States, 1977-2001. Surveillance Report No. 65. Bethesda MD: National Institute on Alcohol Abuse and Alcoholism, 2003. (28 refs.)

This is the 18th annual surveillance report from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) on trends in alcohol-related fatal traffic crashes. Data in this series of reports are compiled from sources provided by the National Highway Traffic Safety Administration (NHTSA), the Federal Highway Administration (FHA), and the U.S. Census Bureau. Beginning with this report, the 1990s population data used previously in the series were replaced with the reestimated intercensal population data that bridge the 1990 and 2000 censuses. This resulted in minor changes (mainly slight decreases) in the calculated population rates for the 1990s compared with prior reports (see below for details). Among the highlights of both changes in alcohol-related fatal traffic crashes between 2000 and 2001 and trends over the period from 1977 through 2001: (1) In 2001 the proportion of traffic crash fatalities that were alcohol-related was 30.5 percent, slightly lower than the 31.1 percent in 2000. (2) From 2000 to 2001 the number of alcohol-involved drivers in fatal traffic crashes decreased 1 percent for males and 2 percent for females. (3) From 2000 to 2001 alcohol-related traffic crash fatalities decreased 1 percent, while nonalcohol-related traffic crash fatalities increased 1 percent. (4) From 1977 to 2001 alcohol-related traffic crash fatalities per 100 million vehicle miles traveled, 100,000 population, 100,000 registered vehicles, and 100,000 licensed drivers decreased 61, 43, 53, and 47 percent, respectively. (5) The number of years of potential life lost (YPLL) attributable to alcohol-related traffic crashes declined 34 percent for both males and females during the study period. (6) From 1977 to 2001 the number of male drivers involved in alcohol-related fatal traffic crashes decreased 30 percent; for females the number increased 12 percent. (7) In 2001 the national BAC testing rate of drivers killed in traffic crashes was 73 percent, up from 55 percent in 1977. (8) In 2001 deaths (including driver, passenger, and pedestrian deaths) associated with young drinking drivers ages 16 to 24 increased 0.5 percent from 2000, and was half of the total in 1977.

Asbridge M; Poulin C; Donato A. Motor vehicle collision risk and driving under the influence of cannabis: Evidence from adolescents in Atlantic Canada. Accident Analysis and Prevention 37(6): 1025-1034, 2005. (89 refs.)

Objective: Employing a sample of 6087 senior students in Atlantic Canada, this paper examines the relationship between driving under the influence of cannabis (DUIC) and motor vehicle collision (MVC) risk. A series of models were analyzed adjusting for demographic characteristics, driver experience, and substance use. Methods: Participants were drawn from the 2002/2003 Student Drug Use Survey in the Atlantic Provinces, an anonymous cross-sectional survey of adolescent students in the Atlantic provinces of Canada. Logistic regression techniques were employed in the analysis of unadjusted and adjusted models. Results: Among senior students, the prevalence of DUIC in the past year was 15.1 % while the prevalence of MVCs was 8.1%. The predictors of DUIC were gender, driver experience, use of a fake ID, and driving under the influence of alcohol (DUIA). The predictors of MVC were gender, driver experience, DUIC, and DUIA. Conclusions: These findings extend our knowledge of DUIC as a socio-legal and public health issue with implications on road safety. Effort must be placed on educating new drivers about cannabis use in the context of driving.

Begg DJ; Langley JD; Stephenson S. Identifying factors that predict persistent driving after drinking, unsafe driving after drinking, and driving after using cannabis among young adults. Accident Analysis and Prevention 35(5): 669-675, 2003. (25 refs.)

The main aim of this study was to identify adolescent/young adulthood factors that predicted persistent driving after drinking, persistent unsafe driving after drinking, and persistent cannabis use and driving among young adults. It was a longitudinal study of a birth cohort (n=933, 474 males and 459 females) and was based on data collected at ages 15, 18, 21 and 26 years. At each of these ages members of the cohort attended the research unit for a personal interview by a trained interviewer, using a standardised questionnaire. For this study, the data for the outcome measures (persistent driving after drinking, persistent unsafe driving after drinking, and persistent driving after using cannabis) were obtained at ages 21 and 26 years. The main explanatory measures were collected at ages 15, 18, 21 years and included demographic factors (academic qualifications, employment, parenting); personality measures; mental health measures (substance use, cannabis dependence, alcohol dependence, depression); anti-social behaviour (juvenile arrest, aggressive behaviour, court convictions); early driving behaviour and experiences (car and motorcycle licences, traffic crashes). The analyses were conducted by gender. The results showed that females who persisted in driving after drinking (13%, n=61) were more likely than the others to have a motorcycle licence at 18. The males who persisted in driving after drinking (28%, n=135) were more likely than the other males to have some school academic qualifications and to be employed at age 26. Compared to the other males, those who persisted in unsafe driving after drinking (4%, n=17) were more likely to be aggressive at 18 and alcohol dependent at 21. Only six (1%) females persisted in unsafe driving after drinking so regression analyses were not conducted for this group. For persistent driving after using cannabis, the univariate analyses showed that females who persisted with this behaviour tended to have high substance use at 18, cannabis dependence at 21, police contact as a juvenile, and to be a parent at 21. For this group, because of the small numbers (3%, n=13) multivariate analyses were not appropriate. For the males who persisted in driving after using cannabis (14%, n=68) a wide range of variables were significant at the univariate stage. The multivariate analysis showed that the most important factors were dependence on cannabis at 21, at least one traffic conviction before 21, a non traffic conviction before 18, and low constraint at 18. Conclusion: These results show different characteristics were associated with persistence in each of these outcome behaviours. This indicates that different approaches would be required if intervention programmes were to be developed to target these behaviours.

Bina M; Graziano F; Bonino S. Risky driving and lifestyles in adolescence. Accident Analysis and Prevention 38(3): 472-481, 2006. (60 refs.)

Several studies have shown that risky driving is especially prevalent among young drivers and recent research has pointed out that driving in adolescence should be investigated in the more general context of adolescent development. The first aim of this contribution was to analyze involvement in risky driving in a normative sample of 645 Italian adolescents, boys and girls, aged 14-17, through a self-report questionnaire. A second aim was to evaluate the association between risky driving and lifestyle, defined as involvement in other health risk behaviors and leisure activities. The main results showed that many adolescents drove cars and motorcycles without the required driving license and the most frequent offences were speeding and failure to maintain a safe braking distance. Gender and age differences were also investigated. Results concerning the association between risky driving and lifestyle showed that risky driving was not an isolated behavior. Boys who displayed risky driving practices were more likely to adopt a lifestyle characterized by high involvement in antisocial behaviors, tobacco smoking, comfort eating and time spent in non-organized activities with friends. Girls involved in risky driving were more likely to be involved in other risk-taking behaviors, antisocial behaviors and drug use.

Centers for Disease Control and Prevention; Eaton DK; Kann L; Kinchen S; Ross J; Hawkins J; Harris WA et al. Youth Risk Behavior Surveillance -- United Sates, 2005. MMWR. Morbidity and Mortality Weekly Report 55(No. SS-5): 1-108, 2006. (18 refs.)

Problem: Priority health-risk behaviors, which contribute to the leading causes of morbidity and mortality among youth and adults, often are established during childhood and adolescence, extend into adulthood, are interrelated, and are preventable. Reporting Period Covered: October 2004--January 2006. Description of the System: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-risk behaviors among youth and young adults, including behaviors that contribute to unintentional injuries and violence; tobacco use; alcohol and other drug use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infections; unhealthy dietary behaviors; and physical inactivity. In addition, the YRBSS monitors general health status and the prevalence of overweight and asthma. YRBSS includes a national school-based survey conducted by CDC and state and local school-based surveys conducted by state and local education and health agencies. This report summarizes results from the national survey, 40 state surveys, and 21 local surveys conducted among students in grades 9--12 during October 2004--January 2006. Results: In the United States, 71% of all deaths among persons aged 10--24 years result from four causes: motor-vehicle crashes, other unintentional injuries, homicide, and suicide. Results from the 2005 national Youth Risk Behavior Survey (YRBS) indicated that, during the 30 days preceding the survey, many high school students engaged in behaviors that increased their likelihood of death from these four causes: 9.9% had driven a car or other vehicle when they had been drinking alcohol; 18.5% had carried a weapon; 43.3% had drunk alcohol; and 20.2% had used marijuana. In addition, during the 12 months preceding the survey, 35.9% of high school students had been in a physical fight and 8.4% had attempted suicide. Substantial morbidity and social problems among youth also result from unintended pregnancies and STDs, including HIV infection. During 2005, a total of 46.8% of high school students had ever had sexual intercourse; 37.2% of sexually active high school students had not used a condom at last sexual intercourse; and 2.1% had ever injected an illegal drug. Among adults aged >25 years, 61% of all deaths result from two causes: cardiovascular disease and cancer. Results from the 2005 national YRBS indicated that risk behaviors associated with these two causes of death were initiated during adolescence. During 2005, a total of 23.0% of high school students had smoked cigarettes during the 30 days preceding the survey; 79.9% had not eaten >5 times/day of fruits and vegetables during the 7 days preceding the survey; 67.0% did not attend physical education classes daily; and 13.1% were overweight. Interpretation: Since 1991, the prevalence of many health-risk behaviors among high school students nationwide has decreased. However, many high school students continue to engage in behaviors that place them at risk for the leading causes of mortality and morbidity. The prevalence of many health-risk behaviors varies across cities and states.The data is summarized in 73 tables.

Public Domain

Donovan J. Gender differences in the psychosocial correlates and longitudinal predictors of drinking and driving in young adults. Glasgow: ICADTS, 2004. (6 refs.)

According to the most recent US national survey, from 2002, nearly 23 percent of young adults aged 18 to 25 reported that they had driven under the influence of alcohol, While more common among men than women, it is becoming more common among women. The study reported here endeavor to explore gender differences, and the relevant variables. The methodology is described, using a sample of licensed drivers from the State of Colorado; two follow-up surveys were conducted at year intervals. Analysis examined gender differences. Of note is that problem drinking is a stronger correlate and predictor of young women's drinking-driving than is the case for young men. There is an accompanying PowerPoint presentation with 27 slides.

Ehrlich PF; Brown JK; Drongowski R. Characterization of the drug-positive adolescent trauma population: Should we, do we, and does it make a difference if we test? Journal of Pediatric Surgery 41(5): 927-930, 2006. (26 refs.)

Purpose: Substance abuse (SA) is a significant cofactor for adolescent injury. Characterization of this population will help define a list of variables that are critical for designing interventions. The purpose of this study is to determine the frequency of SA testing and describe the injury characteristics of the adolescent trauma SA population. Methods: A urine drug screening (alcohol, cannabis, and opiates) protocol for all injured adolescents (14-17 years old) was used. Four years of data were analyzed. Three groups were defined: not tested (NT), negative (NEG), and positive (POS). Transfers from an outside hospital and those who received opiate pain medication before drug screening were excluded. A patient may have had more than one positive test. Tests were analyzed to compare sex, injury severity score (ISS), survival, mechanism, and length of stay (LOS). Results: Four hundred forty-three patients met the criteria (308 males and 135 females). Mean ISS was 13.5 +/- 0.5 SEM with a 2.9% mortality rate. One hundred ninety-three of 443 (44%) were screened (m = 120, f = 73) with 39% testing positive in each group. Twenty-nine percent of positive tests were opiates, 11.2% alcohol, and 20% cannabis. No sex differences for alcohol, cannabis, or opiate use were noted. There were no differences between the NT and the NEG/POS groups with respect to sex, LOS, or mechanism of injury. Fourteen-year olds were less likely to be drug screened. Mean ISS score was lower in the NT group (11.4 +/- 0.6 vs 15.7 +/- 1.0, P < .005). For the NEG and POS group analysis, a positive drug screen was not predicted by age, sex, ISS score, outcome, or LOS. Bicycle crashes were predictive of a positive drug screen (P < .005). Survival rates were not different between any of the groups. Conclusions: Forty percent of the patients screened positive, thus, supporting screening in adolescent trauma patients. Selective criteria based on injury characteristics are not justified.

Facy F; Rabaud M. Towards the prevention of alcohol abuse. Drugs: Education, Prevention and Policy 13(2): 139-149, 2006. (19 refs.)

Mortality resulting from alcohol abuse in young French people is too high in spite of prevention campaigns for road safety in particular. There are problems in identifying alcohol abuse in young people in preventive medicine or alcohol care services. This study was carried out in alcohol centres; data from patients under 25 are analysed and compared to a same-age group of young adults who are consulting in preventive medicine centres. In comparison with older people, these two groups of young adults presented similar characteristics, a lower educational grade, a precocity of psychotropic substance consumption, a preference for beers and spirits consumed episodically or during weekends, more frequent use of tobacco and cannabis, and, finally, greater frequency of drunkenness. The consequent risks of accidents are higher, on road use particularly. Therefore, early identification of alcohol abuse and training for professionals who work in socioeducational settings should be developed to improve the response to these new behaviours. The preventive medicine centres are appropriate for the detection of risk behaviours associated with alcohol or with polysubstance use. Local programs should be set up not only to delay the age of the first intake but to decrease the consumption peak.

Ferguson SA. Other high-risk factors for young drivers: How graduated licensing does, doesn't, or could address them. Journal of Safety Research 34(1): 71-77, 2003. (66 refs.)

Problem: Young drivers, particularly those who are newly licensed, have a very high crash risk. This paper examines the risk factors underlying their high crash rates and assesses the extent to which existing graduated licensing programs address these risks and whether improvements to these programs should be considered. Method: Review and synthesis of the literature. Results: The elevated risk among young drivers of being in an injury crash is the result of a number of factors found alone or in combination, such as risky driving, alcohol use, seat belt nonuse, driver distraction, fatigue, and vehicle choice. Nighttime and passenger restrictions, adopted widely in the United States, work by keeping drivers out of hazardous situations rather than by addressing risk factors directly. However, the risk factors remain in play in driving situations not specifically restricted by law. Although other graduated licensing components adopted around the world -- more stringent exit tests (i.e., you need to pass a test to move to the next stage), hazard perception tests, and restrictions on speed, vehicle power, and roadway access -- make sense based on the identified risk factors, they are not yet supported by research. Should research findings warrant it, consideration should be given to providing guidance to parents about how to keep their beginning drivers safe, including information on vehicle choice. Impact on research, practice, and policy: Researchers should continue to monitor and to evaluate innovative approaches to reduce the crash risk of young drivers. The effectiveness of new approaches should be established before adoption on a wider scale takes place.

Fergusson D; Swain-Campbell N; Horwood J. Risky driving behaviour in young people: Prevalence, personal characteristics and traffic accidents. Australian and New Zealand Journal of Public Health 27(3): 337-342, 2003. (33 refs.)

Objectives: This research aimed to examine the prevalence of risky driving behaviour among young people, the characteristics of those who engage in risky driving behaviour, and the association between risky driving behaviours and accident risk. Methods: Data were gathered during the course of the Christchurch Health and Development Study. As part of this longitudinal study, data were gathered on self-reported risky driving behaviours (18-21 years), traffic accidents (18-21 years) and a variety of individual characteristics for 907 participants who reported having driven a motor vehicle. Results: More than 90% of drivers engaged in some form of risky driving behaviour. Those most likely to engage in frequent risky driving behaviours were: males (p<0.0001), who exhibited alcohol (p<0.0001) or cannabis abuse (p<0.001) in adolescence, who were involved in violent/property crime (p<0.01) and who affiliated with delinquent or substance-using peers (p<0.05). There was a strong (p<0.0001) association between the extent of risky driving behaviour and traffic accident risk. Conclusions: Risky driving behaviours are common among young people, particularly among young males prone to externalising behaviours (substance abuse, crime and affiliations with deviant peers). Risky driving is strongly linked to traffic accident risk. implications: There is a continued need to target risky driving behaviours among young people. Efforts to reduce risky driving should be targeted in particular at the high-risk group of young males prone to externalising behaviours. More generally, the results suggest the need for a multistrategy approach to the reduction of traffic accidents that focuses on the full spectrum of risky driving behaviours.

Fernandes R; Job S. Young driver characteristics in the prediction of drink-driving: Comparing drink-driving with a range of driving behaviours. Glasgow: ICADTS, 2004. (25 refs.)

Young drivers are over-represented in road crash statistics, in Australia and worldwide. In New South Wales, alcohol is estimated to contribute to 28% of fatal crashes. A number of factors are considered as influences: age, gender, sensation seeking, competitiveness, aggression, psychopath, authority defiance, time saving, an optimism bias, and other attitudes. Relevant driving behaviors are speeding, drink-driving, driving while fatigued, red light running, aggressive driving, competitive driving, not wearing seat melts, not using indicators, and tailgating. This study examines the behaviors, perceptions and risk-taking in relation to drink-driving; and examined the relationship of demographic, personality, and attitudinal factors. The results show that attitudes are an important predictor, but that the predictors vary for different types of risky behaviors. Drink-driving is predicted by sensation seeking, general optimism bias, attitude about crash avoidance (the belief that their driving skills can avoid being in a crash), and specific attitudes about drink-driving (that drinking driving is socially approved by friends). There is an accompanying PowerPoint presentation with 14 slides.

Griffin KW; Botvin GJ; Nichols TR. Long-term follow-up effects of a school-based drug abuse prevention program on adolescent risky driving. Prevention Science 5(3): 207-212, 2004. (18 refs.)

This study examined long-term follow-up data from a large-scale randomized trial to determine the extent to which participation in a school-based drug abuse prevention program during junior high school led to less risky driving among high school students. Self-report data collected from students in the 7th, 10th, and 12th grades were matched by name to students' department of motor vehicles (DMV) records at the end of high school. The DMV data included the total number of violations on students' driving records as well as the number of "points" that indicate the frequency and severity of the violations. A series of logistic regression analyses revealed that males were more likely to have violations and points on their driving records than females, and regular alcohol users were more likely to have violations and points than those who did not use alcohol regularly. Controlling for gender and alcohol use, students who received the drug prevention program during junior high school were less likely to have violations and points on their driving records relative to control group participants that did not receive the prevention program. Findings indicated that antidrinking attitudes mediated the effect of the intervention on driving violations, but not points. These results support the hypothesis that the behavioral effects of competence-enhancement prevention programs can extend to risk behaviors beyond the initial focus of intervention, such as risky driving.

Grube JW; Nygaard P. Alcohol policy and youth drinking: Overview of effective interventions for young people. IN: Stockwell T; Gruenewald PJ; Toumbourou JW; Loxley W, eds. Preventing Harmful Substance Use: The Evidence Base for Policy and Practice. New York: John Wiley & Sons, Ltd, 2005. pp. 113-127. (45 refs.)

Alcohol policy refers to (1) formal legal and regulatory mechanisms, rules, and procedures for reducing the consumption of alcohol or risky drinking behaviors; and (2) enforcement of these measures. Policy approaches to preventing and reducing drinking and drinking problems among youth have traditionally focused on limiting access to alcohol or on direct deterrence of young drinkers or those who supply alcohol to them. The aim of such policies is to increase the "full price" of alcohol to young people by increasing resources necessary for them to obtain it or the potential costs for possessing or consuming it. More recently, policies have begun to focus on harm reduction. Harm reduction policies attempt to prevent or reduce alcohol problems by targeting heavy drinking, drinking in risky situations, or by moderating the relationship between drinking and problem outcomes, without necessarily affecting overall consumption. Based on the available evidence, the most effective policies appear to be: (1) taxation or price increases; (2) increases in the minimum drinking age; (3) zero tolerance; and (4) graduated licensing. Random breath testing, sobriety check points, and dram shop liability appear promising for reducing drinking and drinking problems based on studies with the general population, although there is less evidence for their effectiveness specifically with young people. The evidence is growing for the effects of license restrictions (e.g., limiting outlet density or hours of sale). There is some support for responsible beverage service programs, particularly those that are mandated or motivated by reduction of liability. The evidence on advertising restrictions is conflicting. Evidence that designated driver and safe rides programs, warning labels, social host liability, and keg registration are effective strategies for preventing drinking or drinking problems among young people is lacking. Overall, there is insufficient research to evaluate the effects of many alcohol policies on alcohol consumption or problems among young people. Such research should be conducted to inform policy and evaluate policies as they are implemented. Finally, it is clear from the available research that policies cannot be effective unless accompanied by enforcement and by awareness on the part of the intended targets of the policy and enforcement efforts.

Gulliver P; Begg D. Influences during adolescence on perceptions and behaviour related to alcohol use and unsafe driving as young adults. Accident Analysis and Prevention 36(5): 773-781, 2004. (28 refs.)

Objective: To investigate whether aggression, parent and peer influences, and previous traffic-related experiences at ages 15 and 18 impacted on (a) differences between the perceived safe and estimated legal alcohol consumption limit, and (b) driving while impaired (DWI) behaviour at age 21. Method: The study population was a birth cohort involved in a longitudinal investigation of health and development. At the ages of 15 and 18, study members completed questionnaires assessing parent and peer attachment, experience travelling with an alcohol impaired adult or youth, aggression, and previous crash experience. At age 2 1, study members were questioned about how much alcohol they perceived they could drink and still drive safely, and whether they had driven after 'perhaps consuming too much alcohol'. For each participant their legal alcohol consumption limit was estimated using their height and weight. Path analysis was used to determine whether variables measured at ages 15 and 18 predicted differences between the perceived safe and estimated legal alcohol consumption limit and driving while impaired, both measured at age 21. Results: Insufficient females drove while impaired at age 2 1, who also had complete data on all other variables, to conduct path analysis for this outcome. For males, aggression at ages 15 and 18, travelling with an impaired youth at age 18, and previous crash experience at age 18 predicted DWI behaviour at age 21. Only aggression at age 15 predicted the difference between perceived safe and estimated legal alcohol consumption limit for the males. For females, aggression at ages 15 and 18, and travelling with an impaired adult at age 15 predicted the difference between perceived safe and estimated legal alcohol consumption limit. Conclusion: The results show that aggressive behaviours and adult and/or youth modelling of drink driving behaviours in mid- to late-adolescence are related to differences between perceived safe and estimated legal alcohol consumption limit for both genders and driving while impaired for males.

Haggerty KP; Fleming CB; Catalano RF; Harachi TW; Abbott RD. Raising healthy children: Examining the impact of promoting healthy driving behavior within a social development intervention. Prevention Science 7(3): 257-267, 2006. (59 refs.)

This study evaluated the impact of two targeted family sessions focused on driving issues delivered within the context of the Raising Healthy Children project. The Raising Healthy Children project began in the fall of 1993, drawing students in the 1st or 2nd grades from 10 schools. Schools were assigned to an intervention or control condition, and the school-wide, family- and student-focused preventive intervention to address developmentally salient risk and protective factors was delivered during elementary and middle school. The family driving sessions were administered to families in the intervention condition prior to and after teenagers received their driver's license. The first session consisted of a home visit with families designed to help parents and their children improve decision-making skills concerning driving and to develop clear standards and expectations regarding driving-related behavior. A second session, at the time of licensure, was designed to help parents and teens develop a written contract that stated family expectations, a plan for monitoring compliance with these expectations, and consequences for compliance or non-compliance. Consistent with the study's group-randomized design, intervention effects were assessed with multi-level logistic regression models in which students were grouped by their original school assignment. These models assessed specific effects of the driving sessions by adjusting for control variables measured when students were in 8th grade, prior to the driving sessions. Results indicated that students in the intervention group were more likely than students in the control group to report that they had a written driving contract (p = .003, OR = 4.98), and had participated in making the driving rules in the family (p = .025, OR = 1.70). Further, students in the intervention group reported significantly fewer risky behaviors including driving under the influence of alcohol (p = .021, OR = .45) and driving with someone who had been drinking (p = .038, OR = .56).

Hedlund J; Shults RA; Compton R. Graduated driver licensing and teenage driver research in 2006. (review). Journal of Safety Research 37(2): 107-121, 2006. (106 refs.)

This is the third update of research on graduated driver licensing (GDL) and related teenage driver issues. It briefly summarizes research published since or not included in the 2005 update (Hedlund, J., & Compton, R. (2005). Graduated driver licensing research in 2004 and 2005. Journal of Safety Research, 36(2), 109-119.), describes research in progress of which the authors are aware, and announces plans for a symposium on teenage driving and GDL to be held in February 2007.

Hingson R; Heeren T; Winter M; Wechsler H. Magnitude of alcohol-related mortality and morbidity among US college students ages 18-24: Changes from 1998 to 2001. (review). Annual Review of Public Health 26: 259-279, 2005. (83 refs.)

Integrating data from the National Highway Traffic Safety Administration, the Centers for Disease Control and Prevention, national coroner studies, census and college enrollment data for 18-24-year-olds, the National Household Survey on Drug Abuse, and the Harvard College Alcohol Survey, we calculated the alcohol-related unintentional injury deaths and other health problems among college students ages 18-24 in 1998 and 2001. Among college students ages 18-24 from 1998 to 2001, alcohol-related unintentional injury deaths increased from nearly 1600 to more than 1700, an increase of 6% per college population. The proportion of 18-24-year-old college students who reported driving under the influence of alcohol increased from 26.5% to 31.4%, an increase from 2.3 million students to 2.8 million. During both years more than 500,000 students were unintentionally injured because of drinking and more than 600,000 were hit/assaulted by another drinking student. Greater enforcement of the legal drinking age of 21 and zero tolerance laws, increases in alcohol taxes, and wider implementation of screening and counseling programs and comprehensive community interventions can reduce college drinking and associated harm to students and others.

Hingson R; Kenkel D. Social, health, and economic consequences of underage drinking. IN: Committee on Developing a Strategy to Reduce and Prevent Underage Drinking; Bonnie RJ; O'Connell ME, eds. Reducing Underage Drinking: A Collective Responsibility. Washington DC: National Academies Press, 2004. pp. 351-382. (74 refs.)

Since 1988, it has been illegal for someone under the age of 21 to drink alcohol in all 50 states. This was a reversal of an earlier policy trend: In the wake of the 1972 constitutional amendment that extended the right to vote to 18-year-olds, 29 states had also lowered their legal drinking ages. Higher traffic fatalities and other problems experienced in those states were part of the impetus for the national drinking age of 21. This national drinking age has been a clear policy success. However, many underage youth continue to consume alcohol and to experience alcohol related problems. This chapter reviews evidence on the health and social consequences of underage drinking. Research from different perspectives --i n terms of disciplines, data, and methods-helps to document these consequences. Areas addressed include: deaths related to drinking and driving; unintentional injury; intentional injury deaths (alcohol being involved in 47% of homicides and 29% of suicides. Heavy drinking is also related to other health risks, which incur econmic costs; it is estimated that $7.3 billion is spent annually for treatment of alcohol abuse by underage drinkers. Drinking is estimated to be associated with 1.5 fewer years of education, and high school graduation rate 4.3% below peers. Drinking among underage youth is also associated with an increased rate of sexually transmitted disease, an increasing rate of alcohol problems in adulthood,

Huckle T; Pledger M; Casswell S. Trends in alcohol-related harms and offences in a liberalized alcohol environment. Addiction 101(2): 232-240, 2006. (25 refs.)

Aim: To assess alcohol-related harms and offences in New Zealand from 1990 to 2003, a period of alcohol policy liberalization, that included the lowering of the purchase age from 20 to 18 years in 1999. Design, setting and participants: Time trend analyses were carried out on routinely collected data for prosecutions for driving with excess alcohol; alcohol-involved vehicle crashes (all and fatal) and prosecutions for disorder offences. These were carried out separately for those aged 14-15, 16-17, 18-19, 20-24 and 25 years and over. Measurements: Rates of prosecutions for driving with excess alcohol (1990-2003); rates of alcohol-involved vehicle crashes (all and fatal) (1990 2003); and rates of prosecutions for disorder offences (1994-2003). Findings: Effects of alcohol policy liberalization -- positive trends were found in the rates of prosecutions for disorder in the 16-17, 18-19, 20-24 and 25+ age groups; with 18-19-year-olds and 16-17-year-olds having the largest rates and largest positive trend in rates. For 16-17-year-olds, there was a positive trend in the rates of prosecutions for excess breath alcohol. Negative trends in rates were found for alcohol-related crashes (all and fatal) among all age groups. Negative trends for those over 16-17 years were found for prosecutions for driving with excess breath alcohol (this was prior to the lowering of the purchase age). Effects of lowering the minimum purchase age: the lowering of minimum purchase age coincided with an increase in the trend of alcohol-related crashes for 18-19-year-olds; the next largest increase was among the 20-24-year-olds (all other age groups also increased but at a much lower rate). A similar result was found for driving with excess alcohol for those aged 18-19 (and those aged 20-24 years). An increase in the rates of prosecutions for disorder offences occurred for the 14-15-year-old group following the lowering of the purchase age. Conclusion: The liberalization of alcohol throughout the 1990s may have influenced younger people more, as reflected in increases in their disorder offences and drink driving. The lowering of the minimum purchase age may have led to an increase in drink-driving among the 18-19-year-olds (those directly affected by the change in purchase age).

Ivers RQ; Blows SJ; Stevenson MR; Norton RN; Williamson A; Eisenbruch M et al. A cohort study of 20,822 young drivers: The DRIVE study methods and population. Injury Prevention 12(6): 385-389, 2006. (30 refs.)

Background and objective: Research on young drivers directly linking risk factors to serious injury and death outcomes is required. The DRIVE Study was established to facilitate this aim. This paper outlines the study methods and describes the population that has been recruited, in order to demonstrate that the necessary heterogeneity in risk factors has been attained. Design, setting and participants: Drivers aged 17-24 years holding their first-stage provisional driver's licence from New South Wales, Australia, were recruited into a prospective cohort study. The participants were contacted by mail and asked to complete the study questionnaire at an online site or via a mailed questionnaire. Baseline data collection involved a questionnaire with questions to drivers about their training, risk perception, driver behavior, sensation-seeking behavior and mental health. Participants gave consent for prospective data linkage to their data on licensing, crashes and injuries, held in routinely collected databases. Results: 20 822 drivers completed the baseline questionnaire, of whom 45.4% were men, 74.3% resided in capital cities and 25.7% in regional or remote areas. The recruited study population showed a wide variation in the risk factors under examination. For example, almost 40% of drivers reported drinking alcohol at hazardous levels and about 32% of participants seemed to be at a high or very high risk of psychological distress. Participants reported a mean of 67.3 h (median 60 h) of supervised driver training while holding their learner's permit. Conclusions: The DRIVE Study has a robust study design aimed at minimizing bias in the collection of outcome data. Analyses of baseline data showed substantial heterogeneity of risk factors in the study population. Subsequent prospective linkages comparing relative differences in exposures at baseline with the outcomes of interest have the potential to provide important new information needed to develop targeted interventions aimed at young drivers.

Kalafatelis E; McMillen P; Palmer S. Youth and Alcohol: 2003 ALAC Youth Drinking Monitor. Wellington New Zealand: Alcohol Advisory Council, 2003

This survey is the sixth in a series begun in 1997, designed to evaluate and provide direction to the Advisory Council of New Zealand. The report is focused upon youth age 12-17 years. (The legal drinking age was lowered to age 18 in December 1999.) Among the major findings are that a high proportion of 14-17 year olds drink regularly, although less than in the prior year, but there is evidence that the age at which drinking begins is trending downward. Since 2001, proportions of heavier drinkers and lighter drinkers has decreased significantly, and the proportion of non-drinkers has increased. Nonetheless risky, or "binge" drinkiing remains prevalent -- 48% of theose 14-17 reported drinking five or more drinks in the preceding two weeks. This is most common among Maori and Pacific youth. While the proportion of "heavier" drinkers is smaller, there is evidence of increased levels of high risk drinking. Almost half of those who do report drinking, report drinking more than in the prior years. Among the concerns most frequently reported were drunk driving, violence/aggressive situations and the behavior effects associated with drinking. The major source of alcohol is parents and friends, especially those 18 and older. A significant proportion of young people described speaking openly and candidly with parents about alcohol use. Among youth, the perceived benefits (easier to speak with people, enjoyment of buzz, improved mood) attributed to drinking appear to be balanced by a reasonable awareness of the negative consequences (efforts to moderate amount consumed to avoid behavior that they will regret, restriction of amount to avoid passing out or throwing up, or effecting mental performance.) Among the underage drinkers who purchase alcohol (13%) few report being asked for proof of age.

Karlsson G; Halldin J; Leifman A; Bergman H; Romelsjo A. Hospitalization and mortality succeeding drunk driving and risky driving. Alcohol and Alcoholism 38(3): 281-286, 2003. (27 refs.)

Aims: The association between drunk driving (DD) and/or risky driving (RD) offences and subsequent hospitalization and mortality was studied during a 25-year period. Methods: Information about drinking habits and psychosocial factors for the 8122 conscripts from Stockholm County in 1969-1970 was linked to register data on hospitalization, mortality, DD and RD. Results: Analyses comparing background characteristics of DD and RD groups showed that the prevalence of problem behaviour and drug use was highest in the RD group. The relative risk (RR) for hospitalization after DD and/or RD was significantly elevated in multivariate logistic regression analysis for all the studied diagnostic categories (alcohol diagnoses, narcotic diagnoses, suicide attempts, psychoses, E-codes, all diagnoses), and was especially high for alcohol (RR = 7.2) and diagnosis of drug misuse (RR = 9.2). The RR of all hospitalization was 1.5 for the DD group, 1.8 for the RD group, and 1.9 for those who had been sentenced both for drunk driving and risky driving (DRD), all of which were significantly increased. The RR of death was significantly elevated in all three groups. Conclusions: The results show a significantly increased risk of hospitalization and mortality both in the DD and the RD group. From a public health and traffic safety perspective, this implies a need for developing and implementing better prevention strategies.

Kerr J; Elwell J. A drunk driving prevention program for your students. (editorial). American Biology Teacher 65(3): 199-205, 2003. (15 refs.)

Leung S; Starmer G. Gap acceptance and risk-taking by young and mature drivers, both sober and alcohol-intoxicated, in a simulated driving task. Accident Analysis and Prevention 37(6): 1056-1065, 2005. (52 refs.)

A single-blind randomized study was conducted on young (18-21 years, n = 16) and mature (25-35 years, n = 16) drivers to assess how age, combined with a modest dose of alcohol (0.7 g/kg for males and 0.6 g/kg for females), influenced performance on a driving simulator. The driving tasks included detecting the presence of a vehicle on the horizon as quickly as possible, estimating the point on the road that an approaching vehicle would have passed by the participants' vehicle (time-to-collision) and overtaking another vehicle against a steady stream of oncoming traffic. The results of the vehicle detection task showed that detection times were significantly slower with maturity, alcohol consumption and lower approaching vehicle speeds (50 kph), particularly on curved sections of road. Approaching vehicle speed was also found to significantly influence time-to-collision (TTC) judgments, such that faster approach speeds led to less underestimated (and therefore riskier) judgments of TTC than slower speeds. In the overtaking task, mature participants demonstrated impaired discrimination skills with varying approaching vehicle speeds, while young participants recorded significantly slower speeds while overtaking a vehicle, thus increasing the time that they spent in the opposing lane. In conclusion, young and mature drivers demonstrated pivotal differences in behavior in this study. Young drivers showed a greater tendency to engage in risky driving, while experienced drivers appeared to be more susceptible to perceptual influences. Overall, alcohol consumption impaired a driver's ability to divide attention, but had little effect on decision-making processes.

Lewis TF; Thombs DL; Olds RS. Profiles of alcohol- and marijuana-impaired adolescent drivers. Addiction Research & Theory 13(2): 145-154, 2005. (39 refs.)

The aim of the study was to identify risk factors that distinguish alcohol-impaired and marijuana-impaired drivers from non-impaired drivers, among adolescents with a history of using these substances. An anonymous questionnaire was administered to 6594 seventh- to twelfth-grade students in nine Ohio public school districts. Data analyses were conducted on the 11th to 12th grade sub-sample that had prior experience of alcohol (n = 1378) and/or marijuana use (n = 678). Logistic regression analyses confirmed that the involvements in alcohol-impaired and marijuana-impaired driving were both associated with higher levels of use of these two drugs. However, the profiles of these two risk behaviors were relatively distinct. Boyfriend/girlfriend alcohol use, hours spent at a job, race, family structure, and academic performance also had significant, independent relationships with the two driving practices. To effectively deter impaired driving among adolescents, prevention efforts must address the social context of adolescent alcohol and marijuana use.

Linkenbach JW; Perkins HW. Misperceptions of peer alcohol norms in a statewide survey of young adults. IN: Perkins HW, ed. Social Norms Approach to Preventing School and College Age Substance Abuse: A Handbook for Educators, Counselors, and Clinicians. San Francisco: Jossey-Bass, 2003. pp. 173-181. (9 refs.)

This chapter describes misperceptions of peer alcohol norms in a 1998 statewide survey of young adults in Montana. The purpose was to reduce the incidence of impaired driving among Montana's young adults by using environmental prevention approaches from a social norms framework. One of the main difficulties encountered in this statewide approach was the gathering of accurate data, not only from the college student population, but also from those 18-24 year-olds not in college. An independent research group identified a diverse group of 497 young people who participated in a telephone survey concerning personal drinking habits. Moderation in drinking or abstinence was clearly the predominant reported behavior for personal drinking patterns in this sample. A large majority (81%) reported typically consuming four or fewer drinks when they drank or not drinking at all. About two-thirds of the males (66%) and three-quarters of the females (76%) typically consumed three or fewer drinks or reported not drinking at all. Forty-five percent of the men and 51% of the women were abstainers, with 59% of young adults under 21 abstaining and 40% of those 21 and older abstaining. Comparing the actual patterns of personal use with these young adult Montanans believed to be the practice among their peers, however, revealed a highly distorted perception of common drinking behavior. The pattern of misperceptions in college populations was virtually the same as in their non-college peers. Young people tended to exaggerate the amount of alcohol-related risk-taking.

McCarthy DM; Brown SA. Changes in alcohol involvement, cognitions and drinking and driving behavior for youth after they obtain a driver's license. Journal of Studies on Alcohol 65(3): 289-296, 2004. (25 refs.)

Objective: This study tested whether obtaining a driver's license was associated with increases in alcohol and other drug involvement and changes in alcohol-related cognitions for youth, and whether drinking and driving behavior increased with driving experience. Method: Confidential, anonymous surveys were conducted at two time points (fall. spring) with students at four high schools in San Diego county (N = 2 865. 51% female). Data were collected on alcohol, cigarette and marijuana use. license status, alcohol use by peers, attitudes towards drinking, and driving, and drinking and driving behaviors. Results: Nondrivers (60%). new drivers (obtained a license between Time I and Time 2) and experienced drivers (26%) were compared on study variables at both time points and over time. Initially obtaining a driver's license was associated with increased frequency of substance use. Results were not significant for quantity of alcohol use, frequency of heavy drinking or perceived alcohol use norms. Attitudes towards drinking and driving reflected an increase in the perceived dangerousness of this behavior for new drivers. Drinking and driving behavior during the last 30 days increased with increased driving experience. Conclusions: The results indicate a number of changes in substance involvement after obtaining a driver's license. However, initially this transition may also indicate a period of protection against drinking and driving. These results may have implications for the target and content of drinking and driving interventions.

McCarthy DM; Pedersen SL; Thompsen DM; Leuty ME. Development of a measure of drinking and driving expectancies for youth. Psychological Assessment 18(2): 155-164, 2006. (46 refs.)

The present study constructs and provides initial validation for a measure of positive expectancies for drinking and driving for use with adolescents and young adults (PEDD-Y). In Study 1, items were generated through open-ended responses from high school- and college-age youth. Data collected from a 2nd sample of college students (n = 404) identified a 29 item, 4 factor questionnaire. Two of the PEDD-Y factors (Convenience, Avoiding Consequences) explained additional variance in drinking and driving behavior above and beyond other cognitions about drinking and driving. Study 2 extended these results to a high school sample (n = 185). Study 3 demonstrated test-retest reliability of the PEDD-Y in college-age youth (n = 165). These results provide initial evidence for the utility of the PEDD-Y in assessing drinking and driving risk in adolescents and college students.

McKinnon SA; O'Rourke KM; Thompson SE; Berumen JH. Alcohol use and abuse by adolescents: The impact of living in a border community. Journal of Adolescent Health 34(1): 88-93, 2004. (25 refs.)

Purpose: To determine the rates of alcohol consumption and alcohol-related risk behaviors among a sample of high school students living on the U.S.-Mexico border, as well as to investigate factors associated with alcohol use among this population. Methods: A self-administered anonymous questionnaire was administered to students in grades 9-12 during Fall and Spring semesters of 2001 (n = 1366; 639 males and 722 females) in 16 high schools in a community along the U.S.-Mexico border. The questionnaire addressed demographic factors, alcohol consumption, and alcohol-related behaviors. Surveys were completed by Chi-square tests for homogeneity of the odds ratio and logistic regression models were used to identify factors significantly associated with the outcome variables. Results: Rates of binge drinking (45%), drinking and driving (19%), and riding with a driver who had been drinking (46%) were higher for our study population when compared with state and national rates. Students who consumed alcohol were more likely to report alcohol-related problems and lower academic grades. Drinking while in Mexico was significantly associated with binge drinking (OR = 6.44), drinking and driving (OR = 5.39), and riding with a driver who has been drinking (OR = 3.12).Conclusions: The high rates of alcohol risk behaviors among students living on the U.S.-Mexico border underscore the need to develop and implement culturally appropriate prevention programs that address alcohol consumption in Mexico, particularly in terms of students driving back home.

Miauton L; Narring F; Michaud PA. Chronic illness, life style and emotional health in adolescence: Results of a cross-sectional survey on the health of 15-20-year-olds in Switzerland. European Journal of Pediatrics 162(10): 682-689, 2003. (45 refs.)

The objective was to evaluate the prevalence of chronic conditions (CC) in adolescents in Switzerland; to describe their behaviour (leisure, sexuality, risk taking behaviour) and to compare them to those in adolescents who do not have CC in order to evaluate the impact of those conditions on their well-being. The data were obtained from the Swiss Multicentre Adolescent Survey on Health, targeting a sample of 9268 in-school adolescents aged 15 to 20 years, who answered a self-administered questionnaire. Some 11.4% of girls and 9.6% of boys declared themselves carriers of a CC. Of girls suffering from a CC, 25% (versus 13% of non carriers; P=0.007) and 38% of boys (versus 25%; P=0.002) proclaimed not to wear a seatbelt whilst driving. Of CC girls, 6.3% (versus 2.7%; P=0.000) reported within the last 12 months to have driven whilst drunk. Of the girls, 43% (versus 36%; P=0.004) and 47% (versus 39%; P=0.001) were cigarette smokers. Over 32% of boys (versus 27%; P=0.02) reported having ever used cannabis and 17% of girls (versus 13%; P=0.013) and 43% of boys (versus 36%; P=0.002) admitted drinking alcohol. The burden of their illness had important psychological consequences: 7.7% of girls (versus 3.4%; P=0.000) and 4.9% of boys (versus 2.0%; P=0.000) had attempted suicide during the previous 12 months. Conclusion: experimental behaviours are not rarer in adolescents with a chronic condition and might be explained by a need to test their limits both in terms of consumption and behaviour. Prevention and specific attention from the health caring team is necessary.

Miller T; Snowden C; Birckmayer J; Hendrie D. Retail alcohol monopolies, underage drinking, and youth impaired driving deaths. Accident Analysis and Prevention 38(6): 1162-1167, 2006. (20 refs.)

Objective: To explore associations of state retail alcohol monopolies with underage drinking and alcohol-impaired driving deaths. Data: Surveys on youth who drank alcohol and binge-drank recently and their beverage choices; census of motor vehicle fatalities by driver blood alcohol level. Methods: Regressions estimated associations of monopolies with under-21 drinking, binge drinking, alcohol-impaired driving deaths, and odds a driver under 21 who died was alcohol-positive. Results: About 93.8% of those ages 12-20 who consumed alcohol in the past month drank some wine or spirits. In states with a retail monopoly over spirits or wine and spirits, an average of 14.5% fewer high school students reported drinking alcohol in the past 30 days and 16.7% fewer reported binge drinking in the past 30 days than high school students in non-monopoly states. Monopolies over both wine and spirits were associated with larger consumption reductions than monopolies over spirits only. Lower consumption rates in monopoly states, in turn, were associated with a 9.3% lower alcohol-impaired driving death rate under age 21 in monopoly states versus non-monopoly states. Alcohol monopolies may prevent 45 impaired driving deaths annually. Conclusions: Continuing existing retail alcohol monopolies should help control underage drinking and associated harms.

Nygaard P; Grube JW. Mixed messages: Contributions to adolescent drinking and driving. Addiction Research & Theory 13(5): 411-426, 2005. (11 refs.)

This qualitative study focused on the discrepancies in messages concerning alcohol use presented by adults to young people. The purpose was to investigate how these discrepancies might impact adolescents drinking, and drinking and driving behavior. The data consisted of semi-structured interviews with 44 adolescents who in a previous survey had admitted having been involved in drinking and driving, riding with a drunk driver, or both. The analysis of the interviews focused on the discrepancies between messages presented by adult authorities and the respondents experience of actual behavior from these authorities. The findings indicate that there are serious problems in the communication between adult authorities and adolescents. Parents, schools, and police are not consistent and persistent in their communication with adolescents concerning alcohol and drinking and driving. This inconsistency seems to prevent teenagers from understanding the extent of the problem of drinking and driving. Implications for research and prevention are discussed.

O'Malley PM; Johnston LD. Unsafe driving by high school senior's: National trends from 1976 to 2001 in tickets and accidents after use of alcohol, marijuana and other illegal drugs. Journal of Studies on Alcohol 64(3): 305-312, 2003. (20 refs.)

Objective: This study reports trends from 1976 to 2001 in the number of tickets or warnings that high school seniors receive, the number of vehicle accidents in which they are drivers and the number of these events that occur after use of alcohol, marijuana or other illegal drugs. Method: The data come from the Monitoring the Future study, in which nationally representative samples of high school seniors have been surveyed annually since 1976. Results: Results demonstrate that the problem of unsafe or inappropriate driving among American youth is of considerable magnitude, although there has been a downward trend when adjusted for number of miles driven. The frequency of tickets received and vehicle accidents that occurred after use of alcohol has diminished markedly compared to the incidence of tickets and accidents after use of marijuana over the interval from 1976 to 2001. Conclusions: Despite the decline in the number of vehicle accidents occurring and tickets received after drinking or using illicit drugs, aggressive policies are still needed to deter youths from engaging in such risky behaviors.

Poulin C; Boudreau B; Asbridge M. Adolescent passengers of drunk drivers: A multi-level exploration into the inequities of risk and safety. Addiction 102(1): 51-61, 2007. (43 refs.)

This study determined the individual-, neighbourhood- and provincial-level effects of rural residence, socio-economic status (SES), substance use and driving behaviours on adolescents' riding with a drunk driver (RDD). Multi-level study based on cross-sectional self-reported anonymous data from the Student Drug Use Survey in the Atlantic Provinces (SDUSAP) and Census Canada data, merged on the postal code of participating schools. The sample design of the SDUSAP was a single-stage cluster sample of randomly selected classes stratified by grade and region. The Atlantic provinces of Canada. A total of 12 990 students in junior and senior high schools, with an average age of 15 years, participated in the 2002 SDUSAP. The outcome variable was past-year RDD. The main individual-level independent variables were SES, rural residence, substance use and driving behaviours. The school-neighbourhood independent variables were the prevalence of heavy episodic drinking, driving under the influence of alcohol, driver's licence, highest level of educational attainment and low income. The prevalence of RDD was 23.3% in 2002. Among students in grades 9-12, lower family SES, rural residence, substance use and driving under the influence were found to be independent individual-level risk factors for RDD; having a driver's licence was found to be protective. At the provincial and school-neighbourhood levels, a high prevalence of driving under the influence of alcohol and low educational attainment were found to be independent risk factors for RDD after taking into account individual characteristics. This study provides evidence that inequities exist in the options for adolescents to be ensured of passenger safety, and that interventions aimed at decreasing the extent to which adolescents engage in riding with a drunk driver should be based on conceptual approaches that recognize ecological factors as well as individual-level susceptibility.

Preusser DF; Leaf WA. Provisional license. Journal of Safety Research 34(1): 45-49, 2003. (18 refs.)

The Provisional or Intermediate license is the central phase in a comprehensive Graduated Licensing System. Young drivers qualify for a Provisional license by completing their Learners phase, reaching a specified age, and passing a road test. Provisional license holders are allowed to drive unsupervised subject to various restrictions. Typical restrictions include prohibitions against night driving, passengers and alcohol. The goal is to limit teen exposure to risky driving situations during their first few months of licensure, a time when their crash rates are extremely high. States with such restrictions have been shown to have lower teen crash rates than states without. Parents indicate strong support both for Graduated Licensing Systems and for the specific restrictions.

Rauch W; Zador P; Ahlin E. Risk of recidivating among young alcohol-related traffic offenders by administrative and/or criminal sanctions imposed. Glasgow: ICADTS, 2004. (6 refs.)

The study found that having even one alcohol-related event is a strong risk factor of subsequent alcohol-related events among 18-25 year old Maryland drivers, with the odds rations for year two recidivism among drivers with a prior compared to those with no prior was 4:6 for non-African American males and 11:2 for all females. Regardless of disposition, drivers with a prior alcohol related event had substantially higher odds for a subsequent event. While females and African Americans with no prior event had lover recidivism than white males, once they one prior, drivers in both groups had a higher ratio than white males with no prior. There is an accompanying PowerPoint presentation with 22 slides.

Shope J; Bingham R; Raghunathan T; Zakrajsek JS; Tang X. Patterns of infractions among young novice drivers by sex and high school substance use. Glasgow: ICADTS, 2004. (6 refs.)

It is recognized that novice drinkers have more driving infractions. This study examined, separately for men and women young novice drinkers, infractions during their first 12 years of driving licensure. The relationship between substance use (alcohol, cigarettes, and marijuana during high school, selected risk factors and driving infractions was examined. The relationship of prior substance use with driving over time was of particular interest. The methodology and data analysis are described. There is an accompanying PowerPoint presentation with 23 slides.

Shope JT. Influences on youthful driving behavior and their potential for guiding interventions to reduce crashes. Injury Prevention 12(Supplement 1): 9-14, 2006. (48 refs.)

This paper presents an organized, comprehensive view of the factors known to influence young drivers' behavior and how those factors might inform interventions to reduce crashes. This effort was done from the perspective of a public health professional, with a background in health behavior and health education, interested in preventing injury and death among young people from motor vehicle crashes. The author's own studies, selected relevant literature, observation, and experience were considered and organized. A framework of six categories of influences on youthful driving behavior was developed, including the following elements: driving ability, developmental factors, personality factors, demographics, the perceived environment, and the driving environment. It is apparent that a complex set of many different factors influences young drivers' behavior. To reduce crashes, comprehensive, multilevel interventions are needed that target those factors in the framework that are amenable to change.

Shope JT; Raghunathan TE; Patil SM. Examining trajectories of adolescent risk factors as predictors of subsequent high-risk driving behavior. Journal of Adolescent Health 32(3): 214-224, 2003. (38 refs.)

Purpose: To examine the effects on early high-risk driving behavior of changes over time (trajectories) in adolescent alcohol use, friends' support for drinking, susceptibility to peer pressure, and tolerance of deviance. Methods: Statewide driving data were obtained for 4813 subjects who had completed at least two previous school-based questionnaires. The self-administered questionnaire data provided predictor measures from 5th through 10th grades. Trajectory information on predictor measures was summarized using each measure's slope over time and level at the 10th grade data collection (last value). Regression models used serious offenses, alcohol- related offenses, serious crashes, and alcohol-related crashes as outcomes, trajectory measures as predictors, and produced parameter estimates adjusted for demographic measures. Probabilities of having a serious offense or serious crash for five sample trajectories on each measure were obtained from the estimated regression models. Results: All four predictor measures were important, particularly in predicting serious offenses, alcohol-related offenses, and alcohol-related crashes. The highest probabilities for young adult high-risk driving were found among those with consistently high or increasingly high trajectories of friends' support for drinking, susceptibility to peer pressure, and tolerance of deviance. Conclusions: Programs to prevent adolescent risk behavior should take into account environmental and personality influences. Prevention efforts need to emphasize preserving low levels, preventing increases, and promoting decreases over time of adolescent risk factors for unhealthy behaviors, such as high-risk driving.

Simons-Morton B; Lerner N; Singer J. The observed effects of teenage passengers on the risky driving behavior of teenage drivers. Accident Analysis and Prevention 37(6): 973-982, 2005. (12 refs.)

The association between teenage passengers and crash risks among young drivers may be due to risky driving behavior. We investigated the effect on two measures of risky driving in the presence of young male and female passengers. Vehicles exiting from parking lots at 10 high schools were observed and the occupants were identified by gender and age (teen or adult). At a nearby site, the speed and headway of passing traffic were recorded using video and LIDAR technology. Teenage drivers drove faster than the general traffic and allowed shorter headways, particularly in the presence of a male teenage passenger. Both male and female teenage drivers allowed shorter headways (relative to no passenger or a female passenger) in the presence of a male teenage passenger, while the presence of a female teenage passenger resulted in longer headways for male teenage drivers. Overall, the observed rate of high risk driving (defined as speed �15 mph or more above the posted speed limit and/or headway of �1.0 s) for the teen male driver/male passenger condition was about double that of general traffic. In conclusion, the presence of male teenage passengers was associated with risky driving behavior among teenage drivers.

Stein LAR; Colby SM; Barnett NP; Monti PM; Golembeske C; Lebeau-Craven R. Effects of motivational interviewing for incarcerated adolescents on driving under the influence after release. American Journal on Addictions 15(Supplement 1): 50-57, 2006. (42 refs.)

Motivational Interviewing (MI) to reduce alcohol and marijuana-related driving events among incarcerated adolescents was evaluated. Adolescents were randomly assigned to receive MI or Relaxation Training. Follow-up assessment showed that, as compared to RT, adolescents who received MI had lower rates of drinking and driving, and being a passenger in a car with someone who had been drinking. Effects were moderated by levels of depression. At low levels of depression, MI evidenced lower rates of these behaviors; at high levels of depression, effects for MI and RT were equivalent. Similar patterns were found for marijuana-related risky driving, but effects were nonsignificant.

Suris JC; Nebot M; Parera N. Behaviour evaluation for risk-taking adolescents (BERTA): an easy to use and assess instrument to detect adolescent risky behaviours in a clinical setting. European Journal of Pediatrics 164(6): 371-376, 2005. (40 refs.)

To create an instrument to be used in an outpatient clinic to detect adolescents prone to risk-taking behaviours. Based on previous research, five identified variables (relationship with parents and teachers, liking going to school, average grades, and level of religiosity) were used to create a screening tool to detect at least one of ten risky behaviours (tobacco, alcohol, cannabis and other illegal drugs use; sexual intercourse and sexual risky behaviour; driving while intoxicated, riding with an intoxicated driver, not always using a seat belt, and not always using a helmet). The instrument was tested using the Barcelona Adolescent Health Survey 1993. A Receiver Operating Characteristics curve was used to find the best cut-off point between high and low risk score. Odds ratios and 95% confidence intervals were calculated to detect at least one risky behaviour and for each individual behaviour. In order to assess its predictive value, the analysis was repeated using the Barcelona Adolescent Health Survey 1999. In both cases, analyses were conducted for the whole sample and for younger and older adolescents. Adolescents with a high-risk score were more likely to take at least one risky behaviour both when the whole sample was analysed and by age groups. With very few exceptions, the Behaviour Evaluation for Risk-Taking Adolescents showed significant odds ratios for each individual variable. Conclusion: The Behaviour Evaluation for Risk-Taking Adolescents has shown its potential as an easy to use instrument to screen for risk-taking behaviours. Future research must aim towards assessing this instrument's predictive value in the clinical setting and it's application to other populations.

Treno AJ; Grube JW; Martin SE. Alcohol availability as a predictor of youth drinking and driving: A hierarchical analysis of survey and archival data. Alcoholism: Clinical and Experimental Research 27(5): 835-840, 2003. (23 refs.)

Background: Much attention has recently been directed toward developing preventive interventions to reduce drinking and driving through efforts to limit the numbers and locations of alcohol outlets at the community level. Although evaluations of these efforts have suggested linkages between alcohol outlets and problem outcomes, they have not addressed the linkage between outlets and drinking and driving among youth. The analysis reported here investigates the relationship between alcohol outlet densities and underage drinking and driving as self-reported on two telephone surveys conducted in California. Methods: These analyses were based on data obtained from two telephone surveys conducted by the Prevention Research Center and archival data collected by the California Department of Alcoholic Beverage Control and the US Census Bureau. The sample for the first survey consisted of 15- to 20-year-old adolescents and young adults contacted by telephone, using a random digit dialing of exchanges in the greater San Francisco Bay Area. A second set of survey data was similarly collected by a random sample of households throughout California, and the Bay Area subset was also used for this analysis. Results: At the individual level, older respondents were more likely to report drinking and driving and riding with drinking drivers, whereas females and Asians were less so. At the aggregate or city-level, alcohol outlet density, as measured by the number of on- and off-premises establishments licensed to sell alcohol, was associated with both drinking and driving and riding with drinking drivers. These effects were moderated by a number of individual level effects, with younger respondents and females more likely to be affected by outlet densities. Conclusions: The findings here provide support for the implementation of policies targeting alcohol outlet density reductions. Areas with large numbers of such outlets provide ample opportunities to youth for alcohol purchases.

Voas R. Rating government safety programs: Problems and opportunities for safety advocates. Glasgow: ICADTS, 2004. (8 refs.)

Oft times highway safety is given low priority by governments facing apparently more severe problems such as the economy, security, and health issues. To promote safety legislation requires expending substantial efforts by proponents. Efforts are further complicated by failure to fully enforce legislation. Citizen advocate groups need to track legislation, law enforcement, and safety programs. Mothers Against Drunk Driving (MADD) recognizing the challenges faced by local groups has untaken efforts to provide education as well as allow comparisons across states. One such effort is "Rating the States," implemented every 3 years to determine the status of safety legislation, drinking-and-driving enforcement, and alcohol-related crashes in each of the 50 states., Letter grades from "A" to "F" are assigned for 8 topical areas. These include executive leadership, BAC testing, law enforcement, administrative and criminal sanctions, underage drinking and drinking and driving, victims issues, alcohol safety laws, and fatality trends. There is an accompanying PowerPoint presentation with 23 slides.

Waiters ED; Grube JW; Keefe D. Why do they do it? A qualitative study of adolescent drinking and driving. Substance Use & Misuse 38(7): 835-863, 2003. (21 refs.)

Despite a decline in the prevalence of fatal traffic crashes involving adolescent drinking drivers in recent years, underage drinking and driving (DD) and riding with drinking drivers (RWDD) remain serious problems. This article reports the findings of a qualitative study investigating the influence of beliefs and expectancies on adolescents' decisions to participate in DD or RWDD. Forty-four adolescents, who in a previous survey admitted to having been involved in either DD or RWDD, were interviewed in 2000 about their experiences concerning either driving after drinking or getting into a car with a driver who had been drinking. Findings indicate that adolescent DD and RWDD are complex behaviors. Expectancies and control beliefs do not seem to influence the decision, whereas normative beliefs to some extent do. However, findings also indicate that increased enforcement of the laws may be helpful in preventing young people from getting involved in drinking and driving.

Walker S; Treno AJ; Grube JW; Light AM. Ethnic differences in driving after drinking and riding with drinking drivers among adolescents. Alcoholism: Clinical and Experimental Research 27(8): 1299-1304, 2003. (18 refs.)

Background: This study examined the relationship between ethnicity and driving after drinking (DD) and riding with drinking drivers (RWDD) while controlling for drinking patterns, driving practices, and background demographic characteristics including age and gender. Methods: Using random-digit dialing procedures, 1534 young adults ranging from 15- to 20-years of age(mean = 17.6) living in California were recruited to participate in a telephone survey. Latinos, African, Americans, and Asian Americans were oversampled to allow cross-group comparisons. Results: Rates of DD were lower for females than for males and were also lower for African Americans and Asian Americans than for whites. However, after we controlled for drinking patterns and driving practices, the results showed Latinos at greater risk for DD than white adolescents. Compared with whites and males, Asian American and female adolescents were less likely to report RWDD. When drinking patterns and driving practices were taken into account, Latino adolescents were nearly twice as more likely to ride with drinking drivers than whites. Conclusions: These findings indicate a greater need for directing prevention efforts to target Latino youth and youth at risk. Moreover, research aimed at elucidating the social and environmental factors involved in the low prevalence rates of DD and RWDD among Asian American youth may indicate possible protective factors to DD and RWDD operating within the Asian American community.

Williams AF. Teenage drivers: Patterns of risk. Journal of Safety Research 34(1): 5-15, 2003. (29 refs.)

Problem: To determine patterns of risk among teenage drivers. Method: Review and synthesis of the literature. Results: On most measures, crash rates during the teenage years are higher than at any other age, for both males and females. Risk among teenagers varies greatly by driving situation; it is particularly low in some situations (e.g., the learner period) and particularly high in others (e.g., right after licensure, late at night, with passengers present). In some of these high- risk driving situations, risk is elevated for drivers of all ages (e.g., late night driving), in others risk is elevated more for teens than adults (e.g., driving after consuming alcohol), and in others the risk is unique to teen drivers (e.g., having passengers). Impact on Research, Practice, and Policy: These varying patterns of risk form the basis for graduated licensing systems, which are designed to promote low- risk and discourage high-risk driving.

Williams AF. Young driver risk factors: Successful and unsuccessful approaches for dealing with them and an agenda for the future. Injury Prevention 12(Supplement 1): 4-8, 2006. (62 refs.)

The extent to which various interventions to deal with the young driver crash problem have worked are discussed, and promising interventions that should be tried are identified. Traditional forms of driver licensing and driver education have not worked. Graduated licensing reduces the problem and existing laws need to be strengthened. Programs involving parents and police have shown some potential to increase compliance with graduated licensing restrictions. Insurer discount programs also have potential. In other public health areas, comprehensive programs have worked better than those based on single components. There are continuing efforts to develop new driver education and training programs and methods of delivery that can combine with graduated licensing and contribute to reductions in the young driver problem. The most promising intervention strategy is likely to be a coordinated community based program in states with strong graduated licensing laws as a foundation, involving modern education and training techniques, insurance discount programs, and well publicized enforcement and education programs featuring parents and police in combination, with as much input and participation as possible from the target group of young drivers.

Yacoubian GS. Correlates of ecstasy use among high school seniors surveyed through Monitoring the Future. Drugs: Education, Prevention and Policy 10(1): 65-72, 2003. (24 refs.)

The authors estimate the prevalence of the use of 3,4-methylenedioxymethamphetamine (MDMA or 'ecstasy') among 1,679 high school seniors with data collected in 1999 through the Monitoring the Future study. Prevalence estimates of ecstasy use were generated, and associations between ecstasy use, demographic characteristics, alcohol and other drug use, and other behaviors/perceptions were explored. Eight percent of the sample reported lifetime ecstasy use, 6% reported use within the past 12 months, and 3% reported use within the past 30 days. Compared to non-users, 12-month ecstasy users were significantly more likely to be White and to have used all other drugs of abuse during the 12 months preceding the interview. While there were no significant differences between users and non-users with respect to levels of parental education, non-ecstasy users were significantly more likely than past-year ecstasy users to believe that religion was a very important part of their life. Compared to non-ecstasy users, 12-month users were significantly more likely to have received a traffic violation during the 12 months before the interview, and to approve of the regular use of most illegal drugs, including marijuana and cocaine.

Zakrajsek JS; Shope JT. Longitudinal examination of underage drinking and subsequent drinking and risky driving. Journal of Safety Research 37(5): 443-451, 2006. (35 refs.)

Introduction: Alcohol use, alcohol misuse, and risky driving from adolescence into young adulthood were compared by drinking onset age. Methods: Surveys were administered in Grades 5/6, 6/7, 7/8, 10, 12, and at approximately age 23. Participants were placed into Drinking Onset groups based on self-reported alcohol use frequency on the adolescent surveys. Driving records were examined in three age periods: under 21, 21-25, and 26+. Results: The earliest drinking initiators reported higher alcohol use and misuse on each survey, and were more likely to have risky driving offenses before age 21 and to have alcohol driving offenses in all three age periods. Discussion: The earliest drinking initiators engaged in risky drinking behavior and risky driving behavior that was consistently higher than those with later drinking initiation, beginning in adolescence and persisting well into young adulthood.