The effects of graduated driver licensing on hospitalization rates and charges for 16-and 17-year-olds in North Carolina

OBJECTIVE: To mitigate the high risk of motor vehicle crashes for young beginning drivers, over 40 states and the District of Columbia have implemented graduated driver licensing (GDL) systems that gradually and systematically ease teen drivers into higher risk driving conditions. Evaluations of GDL programs using motor vehicle crash data have demonstrated marked declines in crashes. The objective of this study is to examine the association between the implementation of the North Carolina GDL program and the rate of hospitalization, as well as hospital charges, for 16-and 17-year-old drivers. METHODS: Data were obtained from the North Carolina Hospital Discharge Database for the 26 months before and 46 months after the December 1, 1997, implementation of the GDL program. ARIMA interrupted time series analyses were used to model monthly hospitalization rates, controlling for the hospitalization rates of 25-to 54-year-old drivers. ARIMA analyses were also used to determine whether changes occurred in monthly total hospital charges. RESULTS: Among the 568 16-year-old hospitalized drivers, GDL was associated with a 36.5% decline in the hospitalization rate per population and a 31.2% decline in the total monthly driver hospitalization charges. Although a 12% reduction in the rate of hospitalizations was observed among the 615 17-year-old drivers, the analysis lacked sufficient power to be statistically reliable. No consistent change was observed in the 16-year-old driver total monthly hospital charges. CONCLUSIONS: The North Carolina GDL program was associated with a marked decline in the rate of hospitalizations and hospital charges for 16-year-old drivers. Following the implementation of GDL, over $650,000 in hospital charges have been averted each year for 16-year-old drivers. Analyses suggest these reductions were primarily the result of reduced exposure rather than an improvement in teen driving.     

Graduated driver licensing: review of evaluation results since 2002

Unintentional injury from motor-vehicle crashes is the number one cause of death among teenagers in the United States. Increasingly, jurisdictions have adopted three-stage graduated driver licensing (GDL) systems for young novice drivers. Since a previous review of U.S. GDL evaluation results, many more U.S. states and Canadian provinces have implemented GDL and/or had enough time pass that additional evaluation results are now available. Twenty-one studies of GDL within 14 individual jurisdictions, and six studies of GDL in the U.S. nationwide, were collected, reviewed, and summarized. Positive results (usually crash reductions) of varying degrees were reported from nearly all the studies. Given differences in approaches, study goals, methods, and analyses, the results are surprisingly consistent. Overall, GDL programs have reduced the youngest drivers' crash risk by roughly 20 to 40%. Research on teen driving and comprehensive GDL enhancements could further reduce teen drivers' motor-vehicle crashes, injuries, and fatalities. IMPACT ON INDUSTRY: Policy-makers, as well as the motor vehicle, insurance, and other industries have been involved in teen driving safety and could enhance and coordinate their roles.     

The Iowa Graduated Driver Licensing program: effectiveness in reducing crashes of teenage drivers

PROBLEM: Graduated Driver Licensing (GDL) programs vary in the United States in terms of implementation and restrictions. The State of Iowa's GDL program is assessed for its effectiveness in reducing crashes among teenage drivers. METHOD: Time series analysis was used to evaluate police documented crashes involving 16-, 17-, and 18-year-old drivers over a 10 year period, with an intervention identified at the point of GDL implementation. RESULTS: After controlling for seasonal trends and auto-correlative effects, a significant reduction in the crash rate of and 16- and 17-year-old drivers was observed due to the GDL implementation. However, there were no significant reductions in crash rates for 18-year-old drivers. DISCUSSION: The analyses suggest that the Iowa GDL program is effective in reducing the crash rates of 16- and 17-year-old drivers but the effects do not sustain for 18-year-old drivers. IMPACT ON INDUSTRY: The results suggest that the program appears to be working, however further analysis is needed to determine what factors are preventing lasting effects for these teenage drivers.     

Enhancing the effectiveness of graduated driver licensing legislation

PROBLEM: Many states have enacted graduated driver licensing (GDL) systems in an effort to reduce the very high crash rates of young beginning drivers. This article addresses how to achieve the maximum benefit from GDL by ensuring compliance with protective restrictions. ENHANCING GDL THROUGH SYSTEM STRUCTURE: The major crash reductions due to GDL systems result from the protective restrictions during the initial two levels, which isolate novice drivers from the highest risk driving situations. Accordingly, GDL systems should include protective restrictions that adequately control the greatest dangers facing young drivers: multiple teen passengers and night driving before midnight. ENCOURAGING COMPLIANCE THROUGH SYSTEM STRUCTURE: Including protective restrictions that are supported by parents and teens will encourage compliance. Furthermore, linking a teen's advancement through GDL to demonstrated responsible driving will likely encourage compliance more than threatening punishment for violations. ENCOURAGING COMPLIANCE THROUGH ENFORCEMENT: Parents are in a prime position to enforce most GDL restrictions, but there is some evidence they do not enforce those restrictions that they consider too extreme. Little is currently known about the involvement of law enforcement in GDL systems, but there is potential for high visibility law enforcement activities to encourage compliance with restrictions. IMPACT ON RESEARCH, PRACTICE, AND POLICY: There is a need for better designed GDL systems in many states; more research is needed to examine compliance with restrictions and to evaluate enforcement efforts by parents and law enforcement.     

Michigan's graduated driver licensing program: evaluation of the first four years

INTRODUCTION: To evaluate the four-year outcome of Michigan's graduated driver licensing (GDL) program, motor-vehicle crash data for 16-year-old drivers in 1996 (pre-GDL), and 1998-2001 (post-GDL) were analyzed. METHOD: Relative risks and 95% confidence intervals for several crash types were computed, and pre-post-GDL population-based crash rates were compared. Reductions in crash risks among 16-year-olds previously found in 1998 and 1999 were generally maintained in 2000 and 2001. RESULTS: Reductions in crash risk among 16-year-olds from 1996 to 2001 were 29% for all, 44% for fatal, 38% each for nonfatal-injury and fatal-plus-nonfatal-injury, 32% for day, 31% for evening, 59% for night, 32% for single-vehicle, and 28% for multi-vehicle crashes. Even after adjusting for more general population-wide changes among drivers 25 years and older that might have contributed to changes in 16-year-old crash risk, reductions remained impressive (19% for all crashes in 2001). IMPACT ON INDUSTRY: As one approach to reducing teenage motor-vehicle morbidity and mortality, GDL remains promising.     

GDL then and now

The first comprehensive Graduated License (GDL) law was implemented in Florida in 1996. Now, most states have implemented one or more GDL provision including: extending the time for which a learners permit must be held prior to licensure; passenger restriction; and night driving restriction. Evidence to support each of these provisions existed prior to 1996 and has been largely confirmed with the evaluation of each new state to implement GDL. Nationally, fatal crash involvements of 16 year-old drivers have decreased 23% (1993-1995 vs. 2003-2005). Greater reductions have been seen for crash involvements at night and with passengers. The single most effective GDL provision appears to be the extension of the learners period when this extension has the effect of delaying the time at which unsupervised driving is permitted.     

Does the Maryland graduated driver licensing law affect both 16-year-old drivers and those who share the road with them?

PROBLEM: To assess effects of the 1999 Maryland graduated driver licensing (GDL) law on both 16-year-old drivers and other road users. METHOD: Calculation and comparison of crash involvement rates and non-fatal injury rates pre-GDL (1996-1998) and post-GDL (2001-2003) by type of road user, per population, and per licensed driver, with adjustment for trends among 30-59-year-old drivers. RESULTS: Post-GDL, prevalence of licensure decreased 24% among 16-year-olds, and rates of 16-year-old drivers involved in crashes significantly decreased per 16-year-old population (corrected rate ratio (RRc) 0.82; 95% CI (0.71, 0.96)). A significant decrease also was observed for non-fatal injuries per 16-year-old population among 16-year-old drivers involved in crashes (RRc 0.63; 95% CI (0.41, 0.98)). Similarly, decreases, albeit not statistically significant, were observed among their passengers and other vehicle occupants. Per 16-year-old licensed driver, a slight non-significant increase was observed in crash involvement rates; non-fatal injury rates per 16-year-old licensed driver suggest decreased risk (non-significant) among 16-year-old drivers, their passengers, and other vehicle occupants. SUMMARY: Maryland's GDL delayed licensure and reduced crashes and non-fatal injuries among 16-year-old drivers per population. Trends in injuries among other road users involved in crashes with 16-year-old drivers were suggestive of a benefit from GDL, although observed decreases were not significant. Per licensed driver, findings were not significant, but suggested little change in crash involvement and decreased non-fatal injuries. Because one-third fewer 16-year-olds were licensed post-GDL, these results may suggest a selection effect in licensure. IMPACT ON INDUSTRY: Because Maryland had nighttime restrictions for new drivers before 1999, this study suggests other components of GDL are beneficial for drivers and possibly for other road users. States with weak GDL laws should strongly consider revising them.     

Encouraging compliance with graduated driver licensing restrictions

PROBLEM: Although graduated driver licensing (GDL) programs have reduced the high crash rates for 16-and 17-year-old drivers, research suggests that some teenagers fail to comply with restrictions on nighttime driving and carrying passengers. METHOD: A program to encourage compliance with GDL restrictions and seat belt requirements was implemented in Guilford County, North Carolina. The program combined increased enforcement with a multi-faceted publicity campaign drawing attention to the enforcement activity. A comparison community was studied to assess whether changes over time could be reasonably attributed to the program. RESULTS: Several measures indicate that greater enforcement did occur in the intervention community and that teenagers perceived the increase. However, self-reported data and direct observations of young drivers in the intervention and comparison communities showed the program resulted in only modest changes in compliance with GDL restrictions. DISCUSSION: The program put in place the mechanisms known to produce changes in driver behavior, but these may have been insufficient to alter the behavior of the minority of teenagers (and parents) who were not already complying with restrictions. However, the modest changes in young driver behavior plus the clear changes in both actual and perceived enforcement suggest that high visibility enforcement programs merit further use and evaluation in other communities, particularly those where compliance with GDL provisions is lower than in Guilford County.     

Graduated driver licensing (GDL) in the United States in 2016: A literature review and commentary

This is the sixth in a series of reviews of research on graduated driver licensing (GDL) published in the Journal of Safety Research, the present review covering the period mid-2012 through 2016. In the two decades since GDL programs began to be introduced on a widespread basis in the United States, a vast amount of research has been published. The current review discusses recent research and the present state of knowledge on the following topics: characteristics of the novice driver population; effects of GDL on crashes for ages 16–19; the learner and intermediate periods; night and passenger restrictions; cellphone laws; GDL for older novices; enforcement of GDL rules; and programs attempting to influence GDL compliance and safe driving practices in general. GDL stands out as a successful policy for reducing teen driver crashes and is worth building on to extend its benefits. Strengthening existing GDL programs has the most potential for producing further crash reductions.     

History and current status of state graduated driver licensing (GDL) laws in the United States

Introduction: The objective of this study is to describe changes in teenage driver licensing policies in the United States during the past two decades with the introduction of graduated driver licensing (GDL) programs, assess GDL laws currently in place, and discuss the possibilities and likely consequences of further changes.Methods: The history of laws introducing and amending GDL programs was tracked, based on records maintained by the Insurance Institute for Highway Safety (IIHS). Counts of states included the District of Columbia.Results: A few states had elements of GDL prior to the mid-1990s, and between 1996 and 2006 all other states adopted a learner period of 2 months or more, a minimum supervised practice hours requirement for the learner period, or a night or passenger restriction once initially licensed. All but seven states have upgraded their original laws one or more times. Very few states weakened their laws, usually in minor ways. In 158 instances, minimum learner periods, minimum practice hour requirements, or night or passenger restrictions were added or strengthened. Fifteen states raised the minimum age for a license allowing any unsupervised driving.Conclusion: GDL policies have reduced teenage driver crashes. Most states now have at least minimum requirements for basic GDL features, although there is substantial opportunity for strengthening existing policies. Additional upgrades would result in further crash reductions, but very few have been made in recent years.Practical applications: Guidelines for maximizing the crash reduction potential of GDL programs are available, based on the experience of U.S. states, other countries with GDL programs, and the evaluation literature in regard to GDL components.     

A national evaluation of the nighttime and passenger restriction components of graduated driver licensing

Introduction

The high crash rate of youthful novice drivers has been recognized for half a century. Over the last decade, graduated driver licensing (GDL) systems, which extend the period of supervised driving and limit the novice's exposure to higher-risk conditions (such as nighttime driving), have effectively reduced crash involvements of novice drivers.

Method

This study used data from the Fatality Analysis Reporting System (FARS) and the implementation dates of GDL laws in a state-by-year panel study to evaluate the effectiveness of two key elements of GDL laws: nighttime restrictions and passenger limitations.

Results

Nighttime restrictions were found to reduce 16- and 17-year-old driver involvements in nighttime fatal crashes by an estimated 10% and 16- and 17-year-old drinking drivers in nighttime fatal crashes by 13%. Passenger restrictions were found to reduce 16- and 17-year-old driver involvements in fatal crashes with teen passengers by an estimated 9%.

Conclusions

These results confirm the effectiveness of these provisions in GDL systems. Impact on Public Health. States without the nighttime or passenger restrictions in their GDL law should strongly consider adopting them.

Impact on Industry

The results of this study indicate that nighttime restrictions and passenger limitations are very important components of any GDL law.     

Preventing highway crashes by raising the legal minimum age for drinking: An empirical confirmation

In recent years there has been increased interest in reducing the massive social costs due to alcohol-related motor vehicle crashes. Raising the legal minimum age for purchase and consumption of alcohol beverages has been proposed as one way to reduce alcohol-related crashes among young drivers. Currently, many states are raising the legal age, in contrast to the trend towards lower legal drinking ages in the early 1970s. Recent studies of the effects of raising the drinking age are reviewed, and results from a controlled multiple time-series evaluation of the experience in Michigan are presented. Significant 11 to 28% reductions in alcohol-related crash involvements are shown to be attributable to the raised drinking age in Michigan. Suggestions for further research and discussion of policy implications are included.     

Improving graduated driver licensing systems: a conceptual approach and its implications

Graduated driver licensing (GDL) is a concept for how to transform non-drivers into reasonably safe drivers while minimizing the risks as they learn. Several state GDL programs can be improved by moving their structures closer to an adequate implementation of that concept. The learner stage of a GDL system needs to be long enough for beginners to obtain a thorough introduction to the vagaries of driving. The second or intermediate stage needs to effectively limit exposure to known high risk conditions as novices adapt to being fully in charge of the vehicle. The benefits of GDL to date are due almost entirely to the risk-reducing conditions it implements. To improve the functioning of GDL will probably require a better understanding of teen driving than we presently have. The likelihood of further gains will be enhanced by efforts to learn more about the actual causes of teen crashes, the nature and type of teen driver exposures, and what parents do with their teens during the supervised driving stage of GDL. Without a better understanding of these, and other, phenomena it will be difficult to further reduce crashes among young beginning drivers, whether through GDL enhancements or with other approaches.     

Understanding adolescent development: implications for driving safety

PROBLEM: The implementation of Graduated Driver Licensing (GDL) programs has significantly improved the crash and fatality rates of novice teen drivers, but these rates remain unacceptably high. METHOD: A review of adolescent development research was undertaken to identify potential areas of improvement. RESULTS: Research support for GDL was found to be strong, particularly regarding early acquisition of expertise in driving safety (beyond driving skill), and to limitations that reduce opportunities for distraction. GDL regimes are highly variable, and no US jurisdictions have implemented optimal regimes. SUMMARY: Expanding and improving GDL to enhance acquisition of expertise and self-regulation are indicated for implementation and for applied research. Driver training that effectively incorporates safety goals along with driving skill is another target. IMPACT ON INDUSTRY: The insurance industry will benefit from further GDL enhancements. Benefits may accrue to improved driver training, improved simulation devices during training, and automated safety feedback instrumentation.     

Teenage driver crash incidence and factors influencing crash injury by rurality

BackgroundPrevious research has identified teenage drivers as having an increased risk for motor-vehicle crash injury compared with older drivers, and rural roads as having increased crash severity compared with urban roads. Few studies have examined incidence and characteristics of teen driver-involved crashes on rural and urban roads.MethodsAll crashes involving a driver aged 10 through 18 were identified from the Iowa Department of Transportation crash data from 2002 through 2008. Rates of overall crashes and fatal or severe injury crashes were calculated for urban, suburban, rural, and remote rural areas. The distribution of driver and crash characteristics were compared between rural and urban crashes. Logistic regression was used to identify driver and crash characteristics associated with increased odds of fatal or severe injury among urban and rural crashes.ResultsFor younger teen drivers (age 10 through 15), overall crash rates were higher for more rural areas, although for older teen drivers (age 16 through 18) the overall crash rates were lower for rural areas. Rural teen crashes were nearly five times more likely to lead to a fatal or severe injury crash than urban teen crashes. Rural crashes were more likely to involve single vehicles, be late at night, involve a failure to yield the right-of-way and crossing the center divider.ConclusionsIntervention programs to increase safe teen driving in rural areas need to address specific risk factors associated with rural roadways.Impact on IndustryTeen crashes cause lost work time for teen workers as well as their parents. Industries such as safety, health care, and insurance have a vested interest in enhanced vehicle safety, and these efforts should address risks and injury differentials in urban and rural roadways.     

Passenger effects on teenage driving and opportunities for reducing the risks of such travel

OBJECTIVES: To review the research evidence concerning the effects of passengers on teenage driving and crash involvement, and to explore ways to reduce negative effects. METHODS: Review of the international literature on these topics. RESULTS: Passenger presence increases crash risk for teenage drivers, especially when the passengers are other teenagers and especially when they are male. Female passengers do not have the same effects. Teenagers are more susceptible to peer influences than adults. The combination of passenger-induced distraction and driving inexperience can disrupt driving behavior, and there is evidence that 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, and 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. IMPACT ON INDUSTRY: Ways to make passenger restrictions more effective are needed, and other techniques for reducing this major problem need development and testing.     

Tracking progress in teenage driver crash risk in the United States since the advent of graduated driver licensing programs

IntroductionThis study examined U.S. teenagers' crash rates since 1996, when the first graduated driver licensing (GDL) program in the United State was implemented.MethodsPassenger vehicle driver crash involvement rates for 16–19 and 30–59 (middle-aged) year-olds were examined, using data from the Fatality Analysis Reporting System, National Automotive Sampling System General Estimates System, Census Bureau, and National Household Travel Surveys.ResultsPer capita fatal and police-reported crash rates in 2012 were lower for 16 year-olds than for middle-aged drivers but older teenagers' rates were higher. Mileage-based fatal and police-reported crash rates in 2008 were higher for teenagers than for middle-aged drivers and higher for 16–17 year-olds than for older teenagers. In 1996–2012, teenagers' per capita fatal and police-reported crash rates declined sharply, especially for 16–17 year-olds, and more so than for middle-aged drivers. Substantial declines also occurred in teenagers' mileage-based fatal and police-reported crash rates from 1995–96 to 2008, generally more so than for middle-aged drivers. Regarding factors in fatal crashes in 1996 and 2012, proportions of young teenagers' crashes occurring at night and with multiple teenage passengers declined, more so than among older teenagers and middle-aged drivers. The proportion of fatally injured drivers who had been drinking declined for teenagers but changed little for middle-aged drivers. Improvements were not apparent in rates of driver errors or speeding among teenage drivers in fatal crashes.ConclusionsTeenage drivers' crash risk dropped during the period of implementation of GDL laws, especially fatal crash types targeted by GDL. However, teenagers' crash risk remains high, and important crash factors remain unaddressed by GDL.Practical applicationsAlthough this study was not designed to examine the role of GDL, the results are consistent with the increased presence of such laws. More gains are achievable if states strengthen their laws.     

Evaluation of California's graduated driver licensing program

Problem: California's graduated driver licensing (GDL) program was implemented to reduce the high crash risk of teenage drivers. The program enhancements made in 1998 were evaluated in this study using methods that rule out the noticeable downward trend in California teen's fatal/injury crash rates as a possible explanation for any observed crash reductions that could otherwise be mistaken for program effects. Method: Monthly per capita fatal/injury crash rates for 15-to-17-year-olds and proportional representations of 16–17-year-olds' nighttime and passenger crashes were analyzed using intervention time series analysis. Results: After removing trend, seasonality, and transition effects in the data, no overall reductions in fatal/injury crashes for 15–17-year-olds or 16-year-olds (separately) were found to be associated with the 1998 program enhancements, suggesting no overall exposure reduction effect of the longer instruction permit period nor increased competency associated with the higher number of required practice hours. However, the 12-month nighttime and 6-month passenger restrictions were found to be associated with annual savings of 55 and 816 fatal/injury crashes, respectively. Discussion: Finding no overall impact of the 1998 GDL enhancements was not surprising given findings of an earlier survey suggesting that California teens and parents were largely already practicing program requirements prior to implementation and were not fully complying with the program requirements afterwards. Though the observed crash savings associated with the restrictions were of modest size, this is the first study to evidence a direct positive impact of the passenger restriction component of GDL programs. Larger reductions could be realized if the nighttime restriction started earlier and parents/law enforcement could be motivated to better enforce these restrictions. Impact on Industry: The findings provide support for passenger and nighttime restriction components of GDL programs.     

California's graduated driver license law: Effect on teenage drivers' deaths through 2005

PROBLEM: While many researchers believe Graduated Driver Licensing (GDL) laws save lives by imposing restrictions and delayed licensure on drivers under age 18, longer term effects on older teenagers have not been studied. METHOD: The effects of California's strict GDL law on deaths of drivers ages 16-19 were analyzed for 1995-2005 using Incidence Rate Ratios (IRR) and Auto-Regressive Integrated Moving Average (ARIMA) time series analysis of Fatality Analysis Reporting System mortality data. RESULTS: The two methods yielded similar results. IRR analysis found California 16-year-old drivers subject to the GDL experienced a 15% fatality decline (95% CI, 0.70-0.99), while 18 year-old drivers experienced a 15% increase (95% CI, 1.02-1.27). ARIMA analysis found 16 year-old drivers experienced a near-significant 20% fatality decline (p=0.07), while 18 year-olds experienced a 24% increase (p=0.01). Unlicensed teenage drivers and older teen drivers driving alone and transporting teenage passengers suffered significant fatality increases. SUMMARY AND DISCUSSION: California's GDL may negatively affect older teenagers and other driver subpopulations and merits reevaluation.