Risk factors affecting Driving Behaviour during Adolescence

1. Risk factors affecting Driving Behaviour during Adolescence John Brennan, Director Child & Adolescent Mental Health Service Sydney Children’s Hospital Associate Professor (UNSW Conjoint)

2. Driving Performance & Traffic Accidents (Barkley et al, 2004) • Human factors are considered to be the most common cause of automobile accidents • Driving is a complex multidimensional behaviour that can be conceptualised on three hierarchical levels of competency • Strategic • Tactical • Operational Deficits in lower levels especially at the operational, can have a profound effect on higher levels of competency.

3. Operational Competency • Comprises elementary mental functions • Attention and concentration • Reaction time • Visual scanning • Spatial perception and orientation • Visual motor integration • Speed of cognitive processing • Motor co-ordination

4. Driving Performance & Traffic Accidents • Inattention and distraction from within the vehicle (eg mobile phone, playing with radio/CD iPod, talking to other passengers) is among the most common contributors to traffic accidents.

5. TACTICAL COMPETENCY • Skills and decision making to deal with different driving conditions Eg - dense traffic - rain - intersections - traffic lights - changing speed limits - passing other vehicles - country roads - rough roads - navigating unfamiliar areas

6. STRATEGIC COMPETENCY • Decisions about whether to drive and when eg - weather conditions - time of day and impact of fatigue - time needed to complete journey - route to take - rest stops - vehicle safety (ie. roadworthy)

7. Association of driving with the 3 hierarchical levels of competency — operational, tactical, and strategic.Russell A. Barkley , Daniel CoxJournal of Safety Research 38 (2007) 113–128

8. PATTERNS OF RISK FOR ADOLESCENT DRIVERS • In assessing risk age matters • 16-19yrs when grouped lose important information about age as a risk factor • Similar issues when considering older drivers 65+, 75+, 85+ • Distance travelled allows comparison of crash risk relative to exposure • License data – per person rates • Population data – overall risk for age group (slides refer to US date aggregated across 50 states)

9. TEENAGE DRIVERS RISK FACTORS (AF WILLIAMS (2003) • Teenage driving risks can be considered under 3 headings. • (a) Situations where risk is elevated for all drivers • (b) Situations where risk is elevated for teenage drivers relative to older drivers • (c) situations where risk is unique to teenagers

10. Teenage drivers: patterns of riskAllan F. Williams*Journal of Safety Research 34 (2003) 5– 15 • The following slides-indicate that younger and older drivers have the highest rates • Younger > older crash rates • Males > females • Women > males, per mile driven • Fatal crash rates per distance travelled 16yr olds greatest • Older drivers greater fatality rate/mile – as they are more fragile Note: mileage based rates exaggerates risks for younger and older drivers. They are driving shorter distances on more congested roads/younger drivers more night time exposure.

11. Teenage drivers: patterns of riskAllan F. Williams*Journal of Safety Research 34 (2003) 5– 15

12. Teenage drivers: patterns of riskAllan F. Williams*Journal of Safety Research 34 (2003) 5– 15

13. Teenage drivers: patterns of riskAllan F. Williams*Journal of Safety Research 34 (2003) 5– 15Crashes / licence holder • Youngest 16-19 (greatest for all crashes, greatest for fatal crashes) • Young males slightly greater crash rate Per capita rates - youngest least likely to have a licence so 16yr olds lowest/capita - fatal crashes/16yr olds, and 20-24yr have highest per capita

14. Teenage drivers: patterns of riskAllan F. Williams*Journal of Safety Research 34 (2003) 5– 15

15. Teenage drivers: patterns of riskAllan F. Williams*Journal of Safety Research 34 (2003) 5– 15

16. Teenage drivers: patterns of riskAllan F. Williams*Journal of Safety Research 34 (2003) 5– 15

17. Times of highest risk Learner period – low risk as parents are supervising Permit period – Nova Scotia data; Clear increased risk immediately following Licensing Night time driving risk – greatest risk especially in younger drivers. Night time greater risk for fatal crashes (drivers 20-24 even greater relative increase than in daytime Alcohol plays a greater role in older adolescents and young adults. Time of day – fatal crashes two peaks; before and after school day for 16/17yr old drivers. Per trip students are 44 times more likely to be killed in a vehicle with a teen driver than whilst riding a school bus.

18. Teenage drivers: patterns of riskAllan F. Williams*Journal of Safety Research 34 (2003) 5– 15

19. Teenage drivers: patterns of riskAllan F. Williams*Journal of Safety Research 34 (2003) 5– 15

20. Teenage drivers: patterns of riskAllan F. Williams*Journal of Safety Research 34 (2003) 5– 15

21. Teenage drivers: patterns of riskAllan F. Williams*Journal of Safety Research 34 (2003) 5– 15

22. Teenage drivers: patterns of riskAllan F. Williams*Journal of Safety Research 34 (2003) 5– 15

23. Teenage Drivers • Alcohol Low in teenage drivers compared to older drivers When young drivers do drink however, their relative increase in risk is greater than older drivers Alcohol related fatalities have fallen substantially due to changes in law.

24. Socio-cultural risk Factors • Driving is a rite of passage and a developmental milestone for most adolescents • Driving can be crucial for many young persons employment and education • Driving contributes to normal social development, self confidence and esteem with peers • Adolescents value driving as an opportunity for getting together with other adolescents without being supervised and scrutinized by adults • Music, distracting talk, joking around together, are considered to be important pleasurable aspects of teenage driving experience but can encourage risk taking

25. Crash Risks Unique to Adolescence • Having passengers in the vehicle - creates a social situation affecting driving behaviour - associated with increased risk It is a very high-risk situation for teenage drivers to have multiple passengers when they are also teenagers. More than 50% of all deaths in crashes of 16-17 year old drivers occur when passengers younger than 20 years old are present and there is not adult in the vehicle.

26. Teenage Passenger Crash Rates: Many teens die as passengers in motor vehicles. - 40% of deaths in 16-19 yr olds travelling in passenger vehicles were passengers. - for 16yr olds it is 50% of fatalities - often travelling with teenage drivers

27. Teenage drivers: patterns of riskAllan F. Williams*Journal of Safety Research 34 (2003) 5– 15

28. Teenage drivers: patterns of riskAllan F. Williams*Journal of Safety Research 34 (2003) 5– 15

29. Crash Risks Unique to Adolescence • Crash rates by driver age and number of passenger present per 10,000 trips. • With increasing numbers of passengers the risk for older driver falls • For teenagers the rate increases exponentially with 1-3 plus passengers • The risk increases for male and female drivers with night time rates being higher • The highest risk for male and female teenager drivers is with male passengers • The risk for teenage males falls with female passengers. • The presence of one male passenger doubles the fatality rate; the presence of two male passengers doubles the fatality rate again ( for male and female teenage drivers) • Driving behaviour is affected, increased speed, increased risks • But when carrying female passengers teenagers drive more safely

30. Factors related to seat belt use among fatally injured teenage drivers Anne T. McCartt , and Veronika Shabanova Northrup • Seat belt use was examined for teenage (16–19 years) drivers who were fatally injured in traffic crashes occurring in the United States during the years 1995–2000. • Results:During 1995–2000, mean belt use was 36% among fatally injured teenage drivers • and 23% among fatally injured teenage passengers. • Lower belt use among fatally injured teenage drivers was associated with • increasing age; • Male drivers; • Drivers of SUVs, vans, or pickup trucks rather than cars; older vehicles; • crashes occurring late at night; • crashes occurring on rural roadways; single vehicle crashes; • and drivers with BACs of 0.10 or higher. • Teenage driver belt use declined as the number of teenage passengers increased, • but increased in the presence of at least one passenger 30 years or older.

31. Passenger effects on teenage driving and opportunities for reducing the risks of such travelllan F. Williamsa, , , Susan A. Fergusonb and Anne T. McCarttcbFerguson International LLC, 1328 Lancia Drive, McLean, VA 22102, USA 2007 • Despite passenger restrictions in the majority of states, • 42% of 16- and 17-year-old drivers in fatal crashes in 2005 were transporting teenagers with no adults in the vehicle; • 61% of teenage passenger deaths (1,222 in 2005) occurred in vehicles driven by other teenagers. • Wider application of passenger restrictions is indicated. • Ways to make passenger restrictions more effective are needed, and other techniques for reducing this major problem need development and testing.

32. Teenage drivers with ADHD A review of driving risks and impairments associated withADHDRussell A. Barkley , Daniel CoxJournal of Safety Research 38 (2007) 113–128 • Inattention/distractibility key factors increasing risk • Young drivers with ADHD-- key findings • 2-4 times more risk of traffic accidents • 3 times more risk of injuries • 4 times more risk of being at fault • 6-8 times more risk of license suspension • Comorbid factors which add to risk • Increased aggression • Poor emotional regulation, anger • Increased risk taking / limited insight • If Conduct Disorder is also diagnosed even greater risk • Should we mandate that they take medication when driving?

33. Association of driving with the 3 hierarchical levels of competency — operational, tactical, and strategic.Russell A. Barkley , Daniel CoxJournal of Safety Research 38 (2007) 113–128

34. The effect of teenage passengers on the fatal crash risk of teenage driversPreusser, DF | Ferguson, SA | Williams, AFAccident Analysis & Prevention [Accid. Anal. Prev.]. Vol. 30, no. 2, pp. 217-222. Mar 1998. • Fatal crash-involved drivers of passenger vehicles were identified in the Fatality Analysis Reporting System for the period 1990 through 1995. Each driver was categorized as being alone in the vehicle at the time of the crash or with one or more passengers. Drivers at fault or responsible for crash occurrence were defined as all drivers involved in a single-vehicle crash, or drivers in multiple-vehicle crashes who were coded in the Fatality Analysis Reporting System as committing one or more driver errors. The results indicated that passenger presence was associated with proportionately more at-fault fatal crashes for drivers aged 24 and younger, were a neutral factor for drivers aged 25-29, and were associated with fewer at-fault involvements for drivers aged 30 and older. Relative risk of fatal crash involvement was particularly high for teenage drivers traveling, day or night, with two or more teenage passengers. • Additional research is needed to determine how the added risk associated with teenage passengers riding with teenage drivers can be reduced or eliminated.

35. Passenger effects on teenage driving and opportunities for reducing the risks of such travelllan F. Williamsa, , , Susan A. Fergusonb and Anne T. McCarttcbFerguson International LLC, 1328 Lancia Drive, McLean, VA 22102, USA 2007 • Passenger presence increases crash risk for teenage drivers, especially when the passengers are other teenagers and especially when they are male. • Teenagers are more susceptible to peer influences than adults. • The combination of passenger-induced distraction and driving inexperience can disrupt driving behavior, • teenage driver risk taking increases in vehicles with multiple teenagers. • Possible ways to reduce the resulting crash problem include altering the in-vehicle behavior of teenagers or influencing their selection of travel partners. • Legal restrictions on passengers with teenage drivers have been found effective in reducing the crash problem. Parental monitoring of teenage driving behavior, • programs aimed at teenagers themselves, could be other options • but their efficacy is unproven. • It currently is unknown why female passengers have a different effect than males or if that might offer clues about future interventions. • Conclusions • Despite passenger restrictions in the majority of states, • 42% of 16- and 17-year-old drivers in fatal crashes in 2005 were transporting teenagers with no adults in the vehicle; • 61% of teenage passenger deaths (1,222 in 2005) occurred in vehicles driven by other teenagers. • Wider application of passenger restrictions is indicated. • Ways to make passenger restrictions more effective are needed, and other techniques for reducing this major problem need development and testing.