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CORK Bibliography: Adolescents and Driving

53 citations. January 2004 to present

Prepared: December 2009

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 D; Langley J; Broughton J; Brookland R; Ameratunga S; McDowell A. New Zealand Drivers Study: A follow-up study of newly licensed drivers. Injury Prevention 15(4): e2, 2009. (76 refs.)

Background: Despite significant improvement since graduated licensing was introduced, traffic-related injury remains the leading cause of death and hospitalisation among young New Zealanders. Most research to date has used routinely collected crash data but has been limited in that these databases do not, and realistically cannot, include the level of detail required to ensure that learner driver policy and programmes are based on sound scientific evidence applicable to young drivers in the current New Zealand context. Objectives: To examine the driving-related experiences of newly licensed drivers to identify factors associated with increased or decreased risk of negative traffic outcomes. Design: Multistage prospective cohort study. Setting: New Zealand. Participants: Newly licensed drivers. Variables: Exposures: background demographic details, pre-licence driving, previous crashes, driving intentions, motivations for driving and licensing, sensation seeking, aggression, impulsivity, quality and quantity of driving experience, driving supervision, driving behaviour, alcohol and other drug use, compliance with New Zealand's graduated driver licensing scheme, driver training/education, cell phone use, and sleep. Outcomes: crash, conviction, infringements, risky driving. Data sources: Exposures: participants and their parents. Outcomes: participants and official records. Bias: On the basis of a pilot study, participation and attrition bias are likely to be minimal. A comparison of baseline data for those followed and those not followed will be undertaken. Information bias will be minimised by standardised questionnaires. Information on potential confounders is to be collected and controlled for in analyses. Study size: 5000 (including 1500 Maori). Statistical Methods: Survival analysis, logistic or Poisson regression, generalised estimating equations.

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.

Bingham CR; Shope JT; Parow JE; Raghunathan TE. Crash types: Markers of increased risk of alcohol involved crashes among teen drivers. Journal of Studies on Alcohol and Drugs 70(4): 528-535, 2009. (49 refs.)

Objective: Teens drink/drive less often than adults but are more likely to crash when they do drink/drive. This study identified alcohol-related crash types for which teen drivers were at greater risk compared with adults. Method: Michigan State Police crash records for drivers ages 16-19 (teens) and 45-65 years (adults) who experienced at least one crash from 1989 to 1996 were used to create alcohol crash types consisting of alcohol-related crashes that included specific combinations of other crash characteristics, such as drinking and driving at night (i.e., alcohol/nighttime). These data were combined with data from the 1990 and 1995 National Personal Travel Surveys and the 2001 National Household Travel Survey to estimate rates and rate ratios of alcohol-related crash types based on person-miles driven. Results: Teens were relatively less likely than adults to be involved in alcohol-related crashes but were significantly more likely to be in alcohol-related crashes that included other crash characteristics. Teen males' crash risk was highest when drinking and driving with a passenger, at night, at night with a passenger, and at night on the weekend, and casualties were more likely to result from alcohol-related nighttime crashes. All the highest risk alcohol-related crash types for teen female drinking drivers involved casualties and were most likely to include speeding, passenger presence, and nighttime driving. Conclusions: The frequency with which passengers, nighttime or weekend driving, and speeding occurred in the highest risk alcohol-related crash types for teens suggests that these characteristics should be targeted by policies, programs, and enforcement to reduce teen alcohol-related crash rates.

Bingham CR; Shope JT; Zakrajsek J; Raghunathan TE. Problem driving behavior and psychosocial maturation in young adulthood. Accident Analysis and Prevention 40(5): 1758-1764, 2008. (40 refs.)

This study examined the association between psychosocial maturation and problem driving behavior in young adulthood. Psychosocial maturation is the process of adopting adult roles, attitudes and behaviors and completing developmental tasks associated with becoming an adult. Past research has demonstrated that individuals' participation in health-risk behaviors decreases as psychosocial maturity increases. Not surprisingly, decreases in driving risk that occur over the first years of driving have often been assumed to result in large degree from general maturation; however, no research has tested this assumption. This study used data from a telephone survey of young adults to begin addressing this gap in the literature by testing three hypotheses: (1) indicators of higher psychosocial maturity are associated with lower problem driving behavior: (2) the association between the level of psychosocial maturity and problem driving behavior is cumulative: and, (3) these associations are moderated by sex. Problem driving behavior was evaluated by assessing three measures: high-risk driving, drink/driving, and drug/driving. Results: supported all three hypotheses. Participants with greater psychosocial maturity had lower levels of problem driving behavior than participants who were less psychosocially mature. Second, problem driving behavior was lower with higher psychosocial maturity. Third, these associations between psychosocial maturity and problem driving behavior were moderated by sex. The primary contributions of this study are: (I) initial evidence that psychosocial maturation may play a role in improvements in the safety of young drivers; and (2) the generation of questions and hypotheses that provide direction for future research on the role Of maturation in observed declines in risk among young drivers.

Calafat A; Adrover-Roig D; Blay N; Juan M; Bellis M; Hughes K et al. Which young people accept a lift from a drunk or drugged driver? Accident Analysis and Prevention 41(4): 703-709, 2009. (32 refs.)

Introduction: Riding with a drunk and/or a drugged driver (RDD) is a risk behaviour that has received very little attention in spite of its potential dangers. Young people involved in the recreational nightlife context are especially at risk. Method: 1363 regular users of recreational nightlife from nine European Countries (mean age: 21.75; 51.5% women) filled out a self-administered and anonymous questionnaire (in 2006). Results: 37.2% had practised RDD during the previous month. RDD is related to drunkenness and use of drugs, personality factors such as impulsivity, preferring to use a private car to get to nightlife venues, living in a southern European Country and being unemployed. No significant influence was found for age, gender, educational level or socioeconomic status. Discussion: It is important to raise awareness about the high prevalence of RDD. This lack of awareness can be related to its social acceptance among young people. The use of private cars for going to nightlife venues should be discouraged.

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

Chen CM; Yi H-Y; Williams GD; Faden VB. Trends in Underage Drinking in the United States, 1991-2007. Surveillance Report #86. Bethesda MD: National Institute on Alcohol Abuse and Alcoholism, 2009. (44 refs.)

This surveillance report, prepared by the Alcohol Epidemiologic Data System (AEDS), National Institute on Alcohol Abuse and Alcoholism (NIAAA), presents data on underage drinking for 1991- 2007 . This is the third of a series of reports to be published every two years on underage drinking and related attitudes and risk behaviors. Data is derived from three separate national surveys: the National Survey on Drug Use and Health (NSDUH), the Monitoring the Future (MTF) survey, and the Youth Risk Behavior Survey (YRBS). The following are highlights of trends from 1991 through 2007. Prevalence of use: The trends across all three survey data sources show an overall decline in the prevalence of alcohol consumption of "recent" (past 30 days) between 1991 and 2007. In 2007 28.2 percent of youth ages 12-20 reported drinking in the past month. Throughout the decade, rates of underage drinking remained highest among non-Hispanic whites, followed by Hispanics and non-Hispanic blacks. Rates were also higher among youth not enrolled in school. Drinking patterns: The median age of initiating alcohol use increased slightly from 13.65 years in 1991-1993 to 14.06 years in 2005-2007. In addition, there has been a gradual decline over the decade in the proportion of youth reporting initiating drinking at age 12 years or younger. Over the course of the decade, males have maintained higher average frequency, quantity, and volume of consumption in the past 30 days than females. In 2005-2007, those ages 12-20 reported drinking on a mean of 5.84 days in the past 30 days. They consumed an average of 4.79 drinks on the days that they did drank. One survey (NSDUH) indicates that rates of binge drinking have increased among 12- to 20-year-olds between 1993 and 2002, from 12.1 to 19.1 percent, but have leveled off in the recent 5 years. Alcohol-related attitudes include the following: There has been a gradual shift in youth attitudes towards underage drinking, with a decrease during the 1990s, particularly in the early 1990s, in the percentage of youth strongly disapproving of others regularly consuming alcohol or binge drinking, and in the percentage of those who consider regular or binge drinking a great risk (MTF). Recent data indicate these trends may be reversing. Alcohol-related risk behaviors: Between 1991 and 2007 trends from the YRBS show an overall decline in the prevalence of secondary school youth driving while under the influence of alcohol, however, the NSDUH data trends show an increase in prevalence between 1995 and 2002 . The difference is due to the large increase in rates among 18- to 20-year-olds-from 15.6 percent in 1995 to 22.2 percent in 2002-whereas rates among younger youth remained relatively stable. Data is presented in 14 tables and 34 figures.

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.

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.

Galanter M, ed. Recent Developments in Alcoholism, Volume 17. Alcohol Problems in Adolescents and Young Adults: Epidemiology, Neurobiology, Prevention, Treatment. New York: Kluwer Academic/Plenum Press, 2005. (Chapter refs.)

The edited volume in the series "Recent Developments in Alcoholism" addresses teen drinking -- epidemiology, neurobiology, behavioral phenomena, diagnostic and assessment issues, prevention and treatment data -- in a developmental context. It is organized into four sections and includes 17 chapters and 50 contributors. In the first section on epidemiology, chapters deal with the initiation and course of alcohol use, those at risk for alcohol problems, as well as both acute and long-term problems. Section II on neurobiology considers the age-related effects, as well effects on memory, and phenomenon related to the fact that the adolescent brain is not fully matured. Section III on prevention contains chapters dealing with programs for specific populations, such as college students, and high risk groups, as well as an examination of policies to reduce underage drinking. In respect to treatment, attention is directed to co-occurring alcohol, drug and psychiatric disorders, cognitive-behavioral treatments, family therapy, and elements involved in assessment.

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.

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).

Hall W. The adverse health effects of cannabis use: What are they, and what are their implications for policy? (review). International Journal of Drug Policy 20(6, Special Issue): 458-466, 2009. (165 refs.)

Background: The adverse health effects of cannabis are a source of contention in debates about policies towards the drug. Methods: This paper provides a review of epidemiological evidence on the major adverse health effects of cannabis use and considers its implications for policy. Results: The evidence strongly suggests that cannabis can adversely affect some users, especially adolescents who initiate use early and young adults who become regular users. These adverse effects probably include increased risks of: motor vehicle crashes, the development of cannabis dependence, impaired respiratory function, cardiovascular disease, psychotic symptoms, and adverse outcomes of adolescent development, namely, poorer educational outcomes and an increased likelihood of using other illicit drugs. Conclusions: Politically, evidence of adverse health effects favours the status quo in developed countries like Australia where cannabis policy has been framed by the media as a choice between two views: (1) either cannabis use is largely harmless to most users and so we should legalize, or at the very least decriminalize its use; or (2) it harms some of its users so we should continue to prohibit its use.

Hall W; Degenhardt L. Adverse health effects of non-medical cannabis use. (review). Lancet 374(9698): 1383-1391, 2009. (97 refs.)

For over two decades, cannabis, commonly known as marijuana, has been the most widely used illicit drug by young people in high-income countries, and has recently become popular on a global scale. Epidemiological research during the past 10 years suggests that regular use of cannabis during adolescence and into adulthood can have adverse effects. Epidemiological, clinical, and laboratory studies have established an association between cannabis use and adverse outcomes. We focus on adverse health effects of greatest potential public health interest --that is, those that are most likely to occur and to affect a large number of cannabis users. The most probable adverse effects include a dependence syndrome, increased risk of motor vehicle crashes, impaired respiratory function, cardiovascular disease, and adverse effects of regular use on adolescent psychosocial development and mental health.

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 -- 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).

Hutchens L; Senserrick TM; Jamieson PE; Romer D; Winston FK. Teen driver crash risk and associations with smoking and drowsy driving. Accident Analysis and Prevention 40(3): 869-876, 2008. (48 refs.)

Motor vehicle crashes are the leading cause of death for young people in the United States. The goal of this study was to identify risk factor profiles of teen and young adult drivers involved in crashes. General demographic and behavioral as well as driving-related factors were considered. Analysis of a nationally representative telephone survey of U.S. young drivers ages 14 to 22 (N=900) conducted in 2005 was restricted to 506 licensed drivers (learners excluded). Statistically significant univariate associations between factors of interest and the primary outcome, crash involvement (ever) as a driver, were identified and included within a multivariate logistic regression model, controlling for potential demographic confounders. Aside from length of licensure, only driving alone while drowsy and being a current smoker were associated with having been in a crash. Gaining a better understanding of these behaviors could enhance the development of more customized interventions for new drivers.

Impinen A; Rahkonen O; Karjalainen K; Lintonen T; Lillsunde P; Ostamo A. Substance use as a predictor of driving under the influence (DUI) rearrests. A 15-year retrospective study. Traffic Injury Prevention 10(3): 220-226, 2009. (37 refs.)

Background: Recidivism is a major problem in the prevention of DUI offenses. It is suggested that impairing substances used by drivers may relate to a higher risk of recidivism. This study aims to determine rearrest rates in different groups of arrested drivers focusing on different substances found in the blood. Material and Methods: The data utilized were obtained from the register of suspected DUI offenders maintained by the Finnish National Institute for Health and Welfare (THL). Data were available for the 15-year period between 1993 and 2007. The number of rearrests was traced from the individuals' ID codes. The mean blood alcohol concentration (BAC) of the DUI offenders was studied as well as their age at the time of the first arrest. Rearrest rates according to alcohol and drug findings were estimated using survival analysis methods. Results: At the time of the first arrest, the drivers with a single DUI arrest were older and had a lower BAC than those who had a later arrest. The proportion of female drivers decreased as the number of rearrests increased. Drivers with drugs only or a combination of drugs and alcohol had a significantly higher rearrest rate than drivers with alcohol alone. Drivers with amphetamines only had the highest rearrest rates. Findings of benzodiazepine and opioids alone did not increase the risk of rearrest in the long run. Young age, male sex, high blood alcohol level, and arrest during the nighttime and during weekdays constituted a higher risk for rearrest. Conclusions: A third of those suspected of driving under the influence of alcohol and/or drugs are rearrested within 15 years. Drugs, especially amphetamines, are a risk factor for faster rearrest. These results show that the groups at risk of recidivism can be pinpointed. Interventions to prevent recidivism should be developed particularly for drugged drivers. Substance abuse beginning in adolescence seems to be a greater risk.

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.

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; Olds RS; Thombs DL; Ding KL. Driving privileges facilitate impaired driving in those youths who use alcohol or marijuana. Journal of Child & Adolescent Substance Abuse 18(1): 106-116, 2009. (20 refs.)

The aim of this study was to determine whether possession of a driver's license increases the risk of impaired driving among adolescents who use alcohol or marijuana. An anonymous questionnaire was administered to secondary school students in northeast Ohio across multiple school districts. Logistic regression analyses revealed that after accounting for socio-demographic variables, legal driving privileges were independent risk factors for both alcohol- and marijuana-impaired driving, and more robust than substance use in distinguishing between impaired and non-impaired drivers. Prevention strategies must address conventional licensing policies in addition to social and contextual factors leading to adolescent alcohol and marijuana use and associated risks.

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.

Lynskey MT; Bucholz KK; Madden PAE; Heath AC. Early-onset alcohol-use behaviors and subsequent alcohol related driving risks in young women: A twin study. Journal of Studies on Alcohol and Drugs 68(6): 798-804, 2007. (43 refs.)

Objective: The purpose of this study was to estimate associations between early-onset alcohol use/intoxication and subsequent risks of alcohol-related driving risks in young women after control for familial liability for these behaviors. Method: Self-reported data on alcohol use and associated risks were collected from a representative sample of 3,786 Missouri-born adolescent female twins. Results: After statistical control for familial liability to alcohol-related driving risks, alcohol dependence, and length of exposure to risk (i.e., time between the earlier of age at onset of drinking or age 16 [the minimum legal driving age in Missouri]), young women who reported early-onset alcohol use/intoxication had odds of alcohol-related driving risks that were from 1.6 to 2.2 times higher than those with a later onset of alcohol use or intoxication. Conclusions: Young women who commence drinking at an early age are at heightened risks for subsequent alcohol-related driving risks, and these associations cannot be explained entirely by familial liability for these behaviors.

Maxwell JC; Freeman J; Davey J. Too young to drink but old enough to drive under the influence: A study of underage offenders as seen in substance abuse treatment in Texas. Drug and Alcohol Dependence 104(1-2): 107-112, 2009. (32 refs.)

Driving under the influence (DUI) is a major road safety problem. Historically, alcohol has been assumed to play a larger role in crashes and DUI education programs have reflected this assumption, although recent evidence suggests that younger drivers are becoming more likely to drive drugged than to drive drunk. This is a study of 7096 Texas clients under age 21 who were admitted to state-funded treatment programs between 1997 and 2007 with a past-year DUI arrest, DUI probation, or DUI referral. Data were obtained from the State's administrative dataset. Multivariate logistic regressions models were used to understand the differences between those minors entering treatment as a DUI as compared to a non-DUI as well as the risks for completing treatment and for being abstinent in the month prior to follow-up. A major finding was that over time, the primary problem for underage DUI drivers changed from alcohol to marijuana. Being abstinent in the month prior to discharge, having a primary problem with alcohol rather than another drug, and having more family involved were the strongest predictors of treatment completion. Living in a household where the client was exposed to alcohol abuse or drug use, having been in residential treatment, and having more drug and alcohol and family problems were the strongest predictors of not being abstinent at follow-up. As a result, there is a need to direct more attention towards meeting the needs of the young DUI population through programs that address drug as well as alcohol consumption problems.

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. Reciprocal associations between drinking-and-driving behavior and cognitions in adolescents. Journal of Studies on Alcohol and Drugs 70(4): 536-542, 2009. (41 refs.)

Objective: The present study tested reciprocal associations between drinking-and-driving behavior and cognitions as youths transition to driving independently. We hypothesized that experience with driving and experience with drinking and driving would effect changes in cognitions about drinking and driving over time. We also tested cognitions as predictors of later drinking-and-driving behavior. Method: Two hundred and two high school youths completed mailed questionnaire measures at two time points, approximately 8 months apart. Questionnaire measures assessed youths' drinking-and-driving behavior, riding with a drinking driver, drinking-and-driving attitudes, normative beliefs, and perceived negative consequences at both time points. Results: Consistent with hypotheses, prior drinking-and-driving experience influenced changes in drinking-and-driving cognitions. Youths with drinking-and-driving experience at Time 1 saw drinking and driving as more dangerous over time; however, they perceived their peers as more accepting of this behavior. Time 1 attitudes predicted increased drinking-and-driving frequency at Time 2, and normative beliefs predicted increased frequency of riding with a drinking driver. Conclusions: These results support reciprocal associations between drinking-and-driving cognitions and behavior. Results of this study may have implications for the timing and content of drinking-and-driving interventions to reduce drinking and driving as well as riding with a drinking driver.

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.

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. Drugs and driving by America high school seniors, 2001-2006. Journal of Studies on Alcohol and Drugs 68(6): 834-842, 2007. (22 refs.)

Objective: The aim of this study was to report trends from 2001 to 2006 in the percentage of all high school seniors who drive after using marijuana, other illicit drugs, or alcohol or who are exposed as passengers to such behaviors. A second objective is to examine demographic and psychosocial correlates of these behaviors. Method: The data were obtained from the Monitoring the Future study, in which nationally representative samples of high school seniors have been surveyed annually since 1975. Results: In 2006, 30% of high school seniors reported exposure to a drugged or drinking driver in the past 2 weeks, down from 35% in 2001. Exposure was demonstrated to be widespread as defined by demographic characteristics (population density, region of the country, socioeconomic status, race/ethnicity, and family structure). Individual lifestyle factors (religiosity, grade point average, truancy, frequency of evenings out for fun, and hours of work) showed considerable association with the outcome behaviors. Conclusions: Impaired driving by youth remains a problem needing serious attention despite some progress in recent years.

Pedersen SL; McCarthy DM. Person-environment transactions in youth drinking and driving. Psychology of Addictive Behaviors 22(3): 340-348, 2008. (67 refs.)

Drinking and driving is a significant health risk behavior for adolescents. This study tested mechanisms by which disinhibited personality traits (impulsivity and sensation seeking) and aspects of the adolescent home/social environment (parental monitoring and alcohol accessibility) can influence changes in drinking and driving behavior over time. Two hundred two high school age youths were assessed at 2 time points, approximately 8 months apart. Zero-inflated Poisson regression analyses were used to test (a) an additive model, where personality and environmental variables uniquely predict drinking and driving engagement and frequency: (b) a mediation model, where Time 2 en viron mental variables mediate the influence of disinhibited personality: and (c) an interaction model, where environmental factors either facilitate or constrain the influence of disinhibited personality on drinking and driving. Results supported both the additive and interaction model but not the mediation model. Differences emerged between results for personal drinking and driving and riding with a drinking driver. Improving our understanding of how malleable environmental variables can affect the influence of disinhibited personality traits on drinking and driving behaviors call help target and improve prevention/intervention efforts.

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.

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.

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.

Sise CB; Sack DI; Sise MJ; Riccoboni ST; Osler TM; Swanson SM et al. Alcohol and high-risk behavior among young first-time offenders. Journal of Trauma, Injury, Infection and Critical Care 67(3): 498-502, 2009. (27 refs.)

Background: Underage drinking carries a high risk of injury. An important approach for reducing underage drinking is limiting youth access to alcohol. Underage drinkers obtain alcohol from multiple sources and patterns of access may vary by region. We examined patterns of access to alcohol and alcohol use among youth in a local court-ordered diversion program for first-time adolescent alcohol offenders as a basis for designing and evaluating community prevention efforts. Methods: Youth in the program completed a survey of demographic data, type of offense, source, setting, and quantity of alcohol consumed at time of offense, and 1-year alcohol-related high-risk behaviors. Significance was attributed to p <= 0.05. Results: Completed surveys were obtained from 1,158 (84.8%) of 1,366 eligible participants during the 23-month study period. There were 71% males and 29% females with a mean age of 17.2 years (range, 12-24 years). Respondents were Caucasian (64.5%), Hispanic/Latino (19.9%), Asian (3.5%), African American (2.5%), and others (9.6%). Offenses included minor in possession (55.8%), driving under the influence (21.2%), and drunk in public (20.4%). Consumption at time of offense was one or less drinks in 36.3%, two to five drinks in 31.7%, and 32.0% reported six or more drinks. Social sources of alcohol (got it from someone else) were reported by 72.9% and commercial sources (bought it or took it from a store) were reported in 11.9%. The two most common places of consumption were someone else's home (30.7%) and the beach (14.6%). Multiple 1-year high-risk behaviors were reported and 41.0% drove after drinking or rode with someone else who had been drinking. Binge drinking (5 or more drinks for males; 4 or more drinks for females) was reported by 43.1% of males and 36.7% of females. All high-risk behaviors were more common in binge drinkers (p < 0.001). Drinking and driving or riding with a drinking driver was reported in 54.2% of those who binged. Females who hinged reported a higher rate than males in 8 of 10 high-risk behaviors. Conclusions: This study revealed the predominance of social sources of alcohol among young first-time alcohol offenders. Drinking and driving or riding with a drinking driver was reported at an alarmingly high rate. Other alcohol-related high-risk behaviors were also common. Efforts to prevent alcohol-related trauma should target social access to alcohol, the resulting high-risk behaviors, and include a special focus on young females.

Small K. Interventions to prevent adolescent motor vehicle crashes a literature review. Orthopaedic Nursing 27(5): 283-290, 2008. (36 refs.)

Adolescent injury and death from motor vehicle crashes continues to be a pressing public health concern. The adolescent age group present a unique challenge in terms of prevention because of their age and thought processes. Over the years, many intervention strategies have emerged to target prevention of motor vehicle crashes in this age group. Some have been more successful than others. When implementing intervention programs for their own communities, nurses must be aware of information regarding adolescent injury prevention in the literature. Reality-based prevention programs appear to be a promising intervention strategy to target motor vehicle crash prevention in adolescents.

Stafstrom M; Ostergren PO. A community-based intervention to reduce alcohol-related accidents and violence in 9th grade students in southern Sweden: The example of the Trelleborg Project. Accident Analysis and Prevention 40(3): 920-925, 2008. (26 refs.)

The purpose of the present study was to analyse if a community-based intervention has led to a decrease in alcohol-related accidents and violence, and whether this was mediated by a reduction in excessive drinking and frequency of distilled spirits consumption. We applied logistic regression analyses on cross-sectional, non-repeated data, which was collected from a questionnaire distributed in classrooms to all 9th graders from 1999 to 2001, and in 2003 (n = 1376, 724 boys and 652 girls; response rate = 92.3%). All alcohol abstainers (n = 330) were excluded from the analyses, making the sample 1046 individuals. The odds ratio for alcohol-related accidents was significantly lower, comparing the baseline year (1999) with 2003 (OR 0.5, 95% CI 0.27-0.76). There was also an indication that self-reported alcohol-related violence had decreased between 1999 and 2003 (OR 0.7, 95% CI 0.43-1.01). When controlling these estimates for excessive drinking and frequency of distilled spirits consumption, the differences between survey years were substantially reduced or even deleted. In conclusion, the decrease in alcohol-related accidents and violence among 15-16-year-olds in Trelleborg, between 1999 and 2002, is likely to be attributed to the identified reduction in excessive drinking and frequency of distilled spirits consumption.

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.

Stewart TC; Polgar D; Girotti MJ; Vingilis E; Caro D; Corbett BA et al. Evaluation of an adolescent hospital-based injury prevention program. Journal of Trauma, Injury, Infection and Critical Care 66(5): 1451-1459, 2009.

Background: IMPACT (Impaired Minds Produce Actions Causing Trauma) is an adolescent, hospital-based program aimed to prevent injuries and their consequences caused by alcohol or drug impairment and other high-risk behaviors. The overall objective of this evaluation was to determine the effect of the program on students' knowledge and behavior regarding drinking and driving, over time. Methods: A randomized control trial between students randomly selected to attend IMPACT and those not selected served as a control group. Students completed a questionnaire before the program and at three posttime periods (1 week, 1 month, and 6 months). Panel data models were used to analyze the effects of the experiment on students' knowledge of alcohol and crash issues and negative driving behaviors (no seat belt, driving while using a cell phone, involved in conversation, eating, annoyed with other drivers, and drowsy). Descriptive statistics and logistic regression models were used to analyze the effect of IMPACT on students' influence on friends and family about road safety. Results: This study consisted of 269 students (129 IMPACT; 140 control) with an overall response rate of 84% (range, 99% presurvey to 71% at 6 months). The IMPACT group had a 57%, 38%, and 43% increase in the number of correct answers on alcohol and crash issues during the three time periods, respectively (p < 0.05). Students in the IMPACT group would try to influence friends and family to improve their road safety twice as often as 1-week postprogram (odds ratio 1.94, confidence interval 1.07, 3.53). The models did not suggest that the program had an effect on negative driving behaviors. Men and students who drove more frequently had worse driving behavior. Conclusions: Our evaluation demonstrates that the IMPACT program had a statistically significant, positive effect on students' knowledge of alcohol and crash issues that was sustained over time. IMPACT had an initial effect on students' behaviors in terms of peer influence toward improving road safety (i.e., buckling up, not drinking, and driving) 1 week after the program, but this effect diminished after I month. Other negative driving behaviors had low prevalence at baseline and were not further influenced by the program.

Stimson GV; Grant M; Choquet M; Garrison P, eds. Drinking in Context: Patterns, Interventions, and Partnerships. London: Routledge, 2006. 250 pages.

Three premises underpin this book. One, the patterns of drinking are the best way to understand alcohol's place in society; two, targeted interventions are the most sensitive to cultural differences; and three, partnerships offer the best opportunity to develop policies that reflect the values of society as a whole. The book is directed to policy-makers, public health and social policy specialists, health advocates, scientists and scholars, beverage alcohol industry members, educators and prevention personnel. The book was promoted and sponsored by the International Center for Alcohol Policies, a group supported by the alcohol beverage industry. The book is organized into three major sections. Following an introductory chapter that argues for a fresh approach to alcohol policy, the book discusses how drinking patterns can provide a more nuanced way of describing drinking behavior than is the case when the emphasis is mainly on levels of consumption (Chapter 2). Chapter 3 demonstrates how relatively simple assessment procedures can yield insights and provide the basis for targeted interventions, which are seen as having the greatest utility. Chapter 4 provides an overview of targeted interventions, with the next three chapters addressing each in detail alcohol-impaired driving, public disorder, and drinking among young people. The next chapter (Chapter 8) drawing upon these examples, presents an approach to assessment and policy development. The concluding chapter turns to the importance of building strategic partnerships, while exploring potential conflicts of interest.

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.

Tin ST; Ameratunga S; Robinson E; Crengle S; Schaaf D; Watson P. Drink driving and the patterns and context of drinking among New Zealand adolescents. Acta Paediatrica 97(10): 1433-1437, 2008. (30 refs.)

Aim: To examine the association between drink driving and the patterns and locations of usual drinking among New Zealand adolescents. Methods: This is a secondary analysis of data from a nationally representative youth health survey, the sampling frame for which was all New Zealand secondary schools with more than 50 students enrolled in years 9 to 13 (ages 12 to 18 years) in 2001. The analysis was restricted to the 3408 survey respondents aged 15 years or older who were current drinkers and drivers. Results: In total, 17.3% of participants reported drink driving in the previous month. Drink driving was significantly associated with frequent (at least weekly) alcohol use, binge drinking and usually drinking away from home, that is in cars, outdoors, at bars or nightclubs, at parties, at school and at work. Students' perception that parents and schools care about them, parental monitoring, and high academic achievement was associated with a reduced risk of drink driving while having friends who drink alcohol increased this risk. These associations were similar among boys and girls. Conclusion: The findings support calls to address how and where young people drink, and indicate the potential gains to be made with family- and school-based interventions.

Vassallo S; Smart D; Sanson A; Cockfield S; Harris A; McIntyre A et al. Risky driving among young Australian drivers. II: Co-occurrence with other problem behaviours. Accident Analysis and Prevention 40(1): 376-386, 2008. (40 refs.)

This study examined the co-occurrence of risky driving with a range of externalising and internalising problems among 1055 young Australian drivers participating in an ongoing, 23-year longitudinal study. This issue was examined by: (1) investigating the co-occurrence of risky driving and other problem outcomes at 19-20 years; (2) exploring the rate of single and multiple problems among high, moderate and low young risky drivers and (3) investigating connections between risky driving in early adulthood and adolescent problem behaviours. Concurrent and longitudinal associations between risky driving and both substance use (alcohol, cigarette and marijuana use, binge drinking) and antisocial behaviour were found. However, risky driving generally appeared unrelated to internalising problems (depression, anxiety) and early sexual activity. Overall, young risky drivers varied considerably in the number and types of problem behaviours exhibited, although the great majority (70%) had displayed at least one other type of problem behaviour.

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.

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.

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.