Driver's alcohol and passenger's death in motor vehicle crashes

OBJECTIVE: Previous studies on alcohol involvement associated with fatal injury in traffic crashes have focused on the drivers, but the passenger's view is not well known. This study (1) analyzes the relationship between passenger's death and alcohol inebriation of the driver and (2) estimates the role of alcohol as the cause of a crash by examining who was at fault, sober, or inebriated. METHOD: The study includes all motor vehicle passengers (n = 420) who died in crashes in Sweden 1993 through 1996 and were medicolegally autopsied. Autopsy reports from the Departments of Forensic Medicine, including toxicological analyses, and police reports were studied. Presence of alcohol among drivers was based on blood and breath tests. RESULTS: One-fifth of the fatally injured passengers and one-fifth of the tested drivers were under the influence of alcohol. The youngest drivers had the highest prevalence of drunken driving. Drivers at fault were alcohol positive in 21% of these crashes and drivers were not at fault in 2% of these crashes. In 53% of the crashes where both the passenger and driver were alcohol positive, the passenger had a lower alcohol concentration than the driver. Children (<16 years) comprised 15% of the killed passengers. Notably, the children were riding with a driver who was under influence of alcohol in 13% of these crashes. Alcohol involvement was not tested in half of the surviving drivers. CONCLUSIONS: The data show that 20% of both passengers and drivers were under the influence of alcohol. Increased testing of surviving drivers regarding alcohol and other drugs is recommended.     

Impact of primary safety belt laws on alcohol-related front-seat occupant fatalities: five case studies

OBJECTIVE: Impaired drivers and other high-risk road users are less likely to use their safety belts, thus increasing the risk of fatal injury in the event of a crash. Although safety belt laws have been shown to increase wearing rates for daytime non-crash-involved drivers and their front-seat passengers, little evidence is available on the effect these laws have on belt usage by crash-involved drinking drivers and their passengers. METHODS: This study evaluated the influence of primary safety belt law upgrades from secondary laws on front-seat occupants of passenger cars driven by drinking drivers in fatal crashes in five states: California, Illinois, Maryland, Michigan, and Washington. The outcome measures used to evaluate these law upgrades were (1) the change in safety belt usage rates of front-seat occupants in passenger cars driven by drinking drivers in fatal crashes and (2) the change in alcohol-related front-seat occupant fatalities in passenger cars driven by drinking drivers. RESULTS: Four of the five states demonstrated increases in safety belt use by front-seat occupants of passenger cars of drinking drivers in fatal crashes following the upgrade to primary safety belt laws. Three states (California, Michigan, and Washington) experienced significant reductions in the number of front-seat occupant fatalities in vehicles driven by drinking drivers. CONCLUSIONS: The adoption of primary law upgrades was associated with significant increases in safety belt use (four of five states) and significant reductions in fatalities among high-risk occupants (i.e., front-seat occupants involved in fatal crashes in vehicles driven by drinking drivers) in three of the five states studied.     

Factors related to seat belt use among fatally injured teenage drivers

PROBLEM: In the United States, teenage drivers have a higher crash risk and lower observed seat belt use than other age groups. METHOD: 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. Vehicle, driver, and crash factors potentially related to belt use were examined. State differences in belt use rates among fatally injured teenage drivers were related to states' observed belt use rates for all ages and other state-level variables. RESULTS: During 1995-2000, mean belt use was 36% among fatally injured teenage drivers and 23% among fatally injured teenage passengers. One of the strongest predictors of higher belt use for both drivers and passengers was whether the crash occurred in a state with a primary seat belt law. Belt use rates for 1995-2000 for fatally injured teenage drivers ranged from 20% or less in six states to more than 60% in two states. States with the highest use rates were those with strong primary belt use laws and those with high rates of observed belt use for all ages. 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. IMPACT ON TRAFFIC SAFETY: It is suggested that to increase teenage belt use, states should enact strong primary belt use laws and mount highly publicized efforts to enforce these laws. Graduated driver licensing systems should incorporate strong provisions that require seat belt use by teenage drivers and passengers.     

Is seat belt usage by front seat passengers related to seat belt usage by their drivers?

INTRODUCTION: Unrestrained drivers and passengers are involved in a significant amount of fatalities and injuries in motor-vehicle crashes in the United States. While the literature documents the effectiveness of seat belt usage in reducing crash outcomes, such as fatalities and the severity of injuries, there is a need to evaluate the impact of seat belt usage by drivers and passengers in their respective vehicles. These findings could help develop effective education and enforcement strategies to enhance occupant safety. METHOD: This paper summarizes a study comparing seat belt usage rates of drivers and passengers based on whether or not the driver uses a seat belt. Observational data from 50 sites in the state of Nevada over 3 years are used for analyses. The data are stratified based on the gender of the driver and passengers in the front seat of the vehicle and are based on area type (rural or urban). RESULTS: A comparison of the rates of seat belt usage across for the aggregated data and for various types of disaggregation and statistical analyses to compare the rates of seat belt use among passengers based on the use of seat belts by drivers confirms that when drivers use seat belts, their respective passengers are much more likely to use seat belts. Further, if drivers do not use seat belts, their passengers are not likely to use seat belts. This observation is comparable for male drivers and female drivers, and also for male passengers and female passengers. Further, there are no differences for combinations of the genders of the drivers and passenger (i.e., both male or female, or one male and one female). IMPACT ON INDUSTRY: These results suggest that education and enforcement strategies would benefit most by working toward increasing seat belt usage rates among drivers.     

Relationship between traffic fatalities and drunk driving in Japan

OBJECTIVE: The present study was performed to clarify the relation between alcohol use and traffic fatalities in accidents involving motor vehicles in Japan. METHODS: Data on traffic accidents were collected from Fukuoka Prefectural Police records of traffic accidents which occurred in that prefecture between 1987 and 1996. Multiple logistic regression models were used to assess the effect of alcohol use on the risk of traffic-accident death. RESULTS: The data showed that 58,421 male drivers were involved in traffic accidents during the 10-year study period, and that 271 of these were killed as a result of the accident. Alcohol use was significantly associated with speed, seat belt use, time, and road form. Among male motorcar drivers, the odds ratio of alcohol use before driving, after adjusting for age, calendar year, time, and road form, was 4.08 (95% confidence interval, 3.08-5.40), which means that about 75% of fatalities (attributable risk percent among exposed) might have been prevented if drivers had not drunk before driving. CONCLUSIONS: Alcohol use before driving resulted in a 4.08-fold increase in the risk of death in a traffic accident. It is suggested that alcohol use is considered an important risk factor for fatality in traffic accidents.     

杭州高速公路交通事故流行病学特点分析

目的:研究杭州高速公路交通事故的流行病学特点。方法:收集了2003—2006年杭州高速公路交通事故资料并对其进行流行病学分析。结果:①2003—2006年期间,发生交通事故8906起,涉及车辆12692辆,死亡115人,受伤1976人,造成直接经济损失1.15亿元;②交通事故以10月和1月发生最多,每周事故数呈逐渐上升趋势,9:00—11:00点和14:00—16:00点为事故的高发时段;③因驾驶员造成的交通事故超过事故总数的90%,主要原因为未保持安全的纵向距离和操作不当;车辆原因主要为爆胎和制动问题、天气及照明对事故有一定影响;④在高速公路交通事故中,乘客与驾驶员受到的危害程度相同。结论:研究高速公路交通事故的流行病学特点将有利于采取科学的措施减小高速公路交通事故给社会带来的危害。     

Evaluating the impact of passengers on the safety of older drivers

PROBLEM: This study involved a quasi-induced exposure analysis of 4 years of crashes involving older drivers in the state of Kentucky. METHOD: Single- and multivehicle crashes were disaggregated according to the number of passengers: (a) no passenger, (b) one passenger, and (c) two or more passengers. RESULTS: Overall, the presence of two or more passengers was found to negatively impact the probability that drivers 75 years of age or older were at fault in crashes. Several potential factors were studied for interactive effects with passengers: vehicle occupant gender mix, time of the day, road curvature, grade, and number of lanes. The negative impact of passengers increased for some geometric road conditions. However, older drivers were found to be safer at night when carrying two or more passengers. The presence or absence of passengers was not found to affect the 65- to 74-year-old driver group. Groups of male vehicle occupants with a 75+ male driver were found to have high single-vehicle crash rates. IMPACT: These results are among the first to directly consider the effect of passengers on the crash-causing propensity of older drivers and the findings suggest more work is warranted to consider causes for the crash rate differences.     

Investigating traffic fatality trends and restraint use among rear-seat passengers in the United States, 2000–2016

Introduction: Motor-vehicle crash is one of the leading causes of unintentional injury death in the United States. Previous studies focused on fatalities among drivers and front-seat passengers, with a limited number of studies examining rear-seat passenger fatalities. The objectives of this study were to assess trends in rear-seat passenger motor-vehicle fatalities in the United States from 2000 to 2016 and to identify demographic factors associated with being unrestrained among fatally injured rear-seat passengers. Methods: Rear-seat passenger fatality data were obtained from the Fatality Analysis Reporting System (FARS) database. The fatality rate ratios for overall rear-seat passengers and for different age and sex groups were determined by comparing fatality rates in 2000 and 2016 using random effects models. Risk ratios of being unrestrained for age and sex groups were obtained using general estimating equations. Results: Compared to 2000, the overall rear-seat passenger fatality rate in 2016 decreased by 44% (95% confidence interval [CI]: 39–49%). In particular, the fatality rate among rear-seat passengers decreased more in males than females, and passengers aged 14–19 years experienced a larger decline than all other age groups. Fatally injured male rear-seat passengers had a higher risk of being unrestrained (adjusted risk ratio: 1.06, 95% CI: 1.04–1.07) than their female counterparts, and both youngest (≤13 years) and oldest (65–85 years) passengers were less likely to be unrestrained than those aged 20–64 years. Conclusions: Overall, fatality rates among rear-seat passengers have declined, with differential degrees of improvement by age and sex. Practical Applications: Continued restraint use enforcement campaigns targeted at teenagers and males would further preserve them from fatal injuries and improve traffic safety for the overall population.     

The effect of extending graduated driver licensing to older novice drivers in Indiana

Introduction: Graduated driver licensing (GDL) systems have been shown to reduce rates of crashes, injuries, and deaths of young novice drivers. However, approximately one in three new drivers in the United States obtain their first driver’s license at age 18 or older, and thus are exempt from most or all provisions of GDL in most states. Method: In July 2015, the state of Indiana updated its GDL program, extending its restrictions on driving at night and on carrying passengers during the first 6 months of independent driving, previously only applicable to new drivers younger than 18, to all newly-licensed drivers younger than 21 years of age. The current study examined monthly rates of crashes per licensed driver under the affected conditions (driving at night and driving with passengers) among Indiana drivers first licensed at ages 18, 19, and 20 under the updated GDL system compared with drivers licensed at the same ages under the previous GDL system. We used Poisson regression to estimate the association between the GDL system and crash rates, while attempting to control for other factors that might have also influenced crash rates. We used linear regression to estimate the association between the GDL system and the proportion of all crashes that occurred under conditions restricted by the GDL program. Results: Results showed, contrary to expectations, that rates of crashes during restricted nighttime hours and with passengers were higher among drivers licensed under the updated GDL system. This mirrored a statewide increase in crash rates among drivers of all ages over the study period and likely reflected increased overall driving exposure. The proportions of all crashes that were at night or with passengers did not change. Practical Applications: More research is needed to understand how older novice drivers respond when GDL systems originally designed for younger novice drivers are applied to them.     

Land-traffic crash leading to passenger vehicle submersion,drowning and other fatal injuries: A 44-year study based on records from the Finnish Crash Data Institute

Background: Land motor traffic crash (LMTC) -related drownings are an overlooked and preventable cause of injury death. The aim of this study was to analyze the profile of water-related LMTCs involving passenger cars and leading to drowning and fatal injuries in Finland, 1972 through 2015. Materials and methods: The database of the Finnish Crash Data Institute (FCDI) that gathers detailed information on fatal traffic accidents provided records on all LMTCs leading to drowning during the study period and, from 2002 to 2015, on all water-related LMTCs, regardless of the cause of death. For each crash, we considered variables on circumstances, vehicle, and fatality profiles. Results: During the study period, the FCDI investigated 225 water-related LMTCs resulting in 285 fatalities. The majority of crashes involved passenger cars (124), and the cause of death was mostly drowning (167). Only 61 (36.5%) fatalities suffered some–generally mild–injuries. The crashes frequently occurred during fall or summer (63.7%), in a river or ditch (60.5%), and resulted in complete vehicle’s submersion (53.7 %). Half of the crashes occurred in adverse weather conditions and in over 40% of the cases, the driver had exceeded the speed limit. Among drivers, 77 (68.8%) tested positive for alcohol (mean BAC 1.8%). Conclusion: Multidisciplinary investigations of LMTCs have a much higher potential than do exclusive police and medico-legal investigations. The risk factors of water-related LMTCs are similar to those of other traffic crashes. However, generally the fatal event in water-related LMTC is not the crash itself, but drowning. The paucity of severe physical injuries suggests that victims’ functional capacity is usually preserved during vehicle submersion. Practical Applications: In water-related LMTCs, expansion of safety measures is warranted from general traffic-injury prevention to prevention of drowning, including development of safety features for submerged vehicles and simple self-rescue protocols to escape from a sinking vehicle.     

Predominance of alcohol and illicit drugs among traffic accidents fatalities in an urban area of Brazil

Objective: The objective of this study was to determine the prevalence of alcohol and illicit drug use among victims of fatal traffic accidents in the Metropolitan Region of Vitória, Brazil, during the period 2011–2012.

Methods: Blood samples were collected and analyzed for the presence of drugs from 391 deceased victims of traffic crashes that occurred in the Metropolitan Region of Vitória, Brazil. The victims included drivers, passengers, and pedestrians. Sociodemographic variables such as age, gender, day of the week, and period of the year in which the accidents occurred were recorded. The analyses were performed by a gas chromatography–flame ionization method for alcohol and by a gas chromatography–mass spectrometry for amphetamines, cocaine, and cannabis.

Results: The results showed that 44.8% (n = 175) of all cases were positive for alcohol and/or illicit drugs. The detection of alcohol and/or drugs was more frequent in young males, aged 17 to 34, whose samples were positive in 46.8% of cases. Small differences among drivers, passengers, and pedestrians were observed (drivers = 45.9%, passengers = 46.4%, and pedestrians = 45.6%). In general, the most prevalent drug was alcohol, with 141 positive cases (36.1%), followed by cocaine, with 47 positive cases (12%). Amphetamines and cannabis had positivity rates of 4.1 and 4.3%, with 16 and 17 positive cases, respectively. The combined use of alcohol and other drugs was found in 36 cases (9.2%). Crack cocaine use was observed in 27.7% of the positive cases for cocaine.

Conclusions: For the effective reduction of traffic accidents related to driving under influence of drugs (DUID), we suggest the intensification of enforcement actions against the use of alcohol by drivers, the definition of which illicit drugs should be surveyed, as well the cutoff values, the promotion of changing legislation to oblige drivers to provide samples for toxicological testing, and the establishment of public information programs and specific actions aimed at young drivers to promote behavioral changes.     

Society's aggression level as a predictor of traffic fatality rate

This research investigated the relationship of violence/aggression and other societal variables to traffic accidents. In the first of two studies, multiple regression was applied to 1977 data from each of the 50 states and the District of Columbia. Traffic fatalities per registered vehicle was the dependent variable. The independent variables were homicide rate, suicide rate, fatality rate from other causes, unemployment rate, personal income, density of physicians, alcohol consumption, motor vehicles per capita, road mileage per vehicle, sex and age distribution of drivers, and attained education. The main finding was that the homicide rate (but not the suicide rate) predicted the traffic fatality rate; additional significant predictors were the proportion of young drivers and the fatality rate from non-motor-vehicle accidents. The two primary predictors (homicides and young drivers) accounted for 64 % of the variance of traffic fatalities. In the second study, validation was performed by using the 1977 regression coefficients to estimate 1978 traffic fatalities. The results indicate that when the 1977 regression coefficients were applied to the 1978 values for homicides and young drivers, they accounted for 49 % of the variance of the 1978 traffic fatalities. The findings are discussed in terms of how society's violence/aggression may contribute to traffic accidents.     

Characteristics of teens-with-teens fatal crashes in the United States, 2005–2010

BackgroundMore than 40% of fatal crashes of 16- and 17-year-old drivers occur when transporting teenagers. Characteristics of this predominant crash type and prevention possibilities are described, based on data from fatal crashes in the United States during 2005–2010.ResultsFifty-seven percent of 16- and 17-year old drivers in fatal crashes had at least one passenger. Most commonly, all passengers were ages 13–19 (42% of all drivers and 73% of those with passengers). Of fatal crashinvolved drivers with teenage passengers and no passengers of other ages, 56% had one passenger, 24% had two, and 20% had three or more. Most frequently, passengers were the same sex and within one year of the driver. Risk factors involving speeding, alcohol use, late-night driving, lack of a valid license, seat belt non-use, and crash responsibility were more prevalent with teenage passengers than when driving alone, and the prevalence of these factors increased with the number of teenage passengers. Many risk factors were most prevalent with passengers ages 20–29, although few crashes had this occupant configuration. Risk factors were least prevalent with a passenger 30 or older.DiscussionFatal crashes of 16- and 17-year-old drivers with teen passengers are a common crash scenario, despite passenger restrictions in 42 states and the District of Columbia during some or all of the study period. The proportion of these fatal crashes decreased slightly from 46% in 1995 (pre-GDL) to 43% in 2010 and showed no signs of decreasing during the six-year study period (range 41% to 43%).Practical applicationsExisting passenger restrictions are relatively weak and could be strengthened. Fatal crashes involving teen passengers, especially multiple passengers, are more likely to involve alcohol, late-night driving, driver error, and invalid licensure, so stepped-up enforcement of existing laws involving these behaviors might reduce the prevalence of such crashes.     

Characteristics of crashes and injuries among 14 and 15 year old drivers,by rurality

Purpose: Motor-vehicle crashes continue to be the leading cause of death for teenagers in the United States. The United States has some of the youngest legal driving ages worldwide. The objective of this study was to determine rates and factors associated with injury crashes among 14- and 15-year-old drivers and how these varied by rurality. Methods: Data for this cross-sectional study of 14- and 15-year-old drivers were obtained from the Iowa Department of Transportation from 2001 to 2013. Crash and injury crash rates were calculated by rurality. The relationship between crash and driver factors and injury was assessed using logistic regression. Findings: Teen drivers, aged 14 and 15 years, had a statewide crash rate of 8 per 1,000 drivers from 2001 to 2013. The majority of crashes occurred in urban areas (51%), followed by in town (29%), remote rural areas (13%), and suburban areas (7%). Crash and injury crash rates increased as level of rurality increased. The odds of an injury crash increased more than 10-fold with the presence of multiple other teens as passengers, compared to no passengers (OR = 10.7, 95% CI: 7.1–16.2). Conclusions: Although 14- and 15-year-old drivers in Iowa have either limited unsupervised (school permits) or supervised only driving restrictions, they are overrepresented in terms of crashes and injury crashes. Rural roads and multiple teen passengers are particularly problematic in terms of injury outcomes. Practical applications: Results from this study support passenger restrictions and teen driving interventions designed with a rural focus.     

Traffic climate and driver behaviors: The moderating role of driving skills in Turkey and China

Introduction: While road traffic accidents and fatalities are a worldwide problem, the rates of road traffic accidents and fatalities show differences among countries. Similarly, driver behaviors, traffic climate, and their relationships also show differences among countries. The aim of the current study is to investigate the moderating effect of driving skills on the relationship between traffic climate and driver behaviors by country. (Turkey and China). Method: There were 294 Turkish drivers and 292 Chinese drivers, and they completed the Traffic Climate Scale, the Driving Skills Inventory, and the Driver Behavior Questionnaire. The moderated moderation analyses were conducted with Hayes PROCESS tool on SPSS. Results: The results showed that safety skills moderated the relationship between internal requirements and violations both in Turkey and China. Safety skills also moderated the relationship between internal requirements and errors only in China and the relationship between functionality and violations in Turkey. Perceptual-motor skills moderated the relationships between external affective demands and errors, and also the relationship between internal requirements and positive driver behaviors in Turkey. It can be inferred that driving skills has different influences on traffic climate-driver behaviors relationship in different cultures and there might be cultural differences in the evaluation of drivers’ own driving skills. Practical Applications: Among driving skills, safety skills have a more critical role to increase road safety by decreasing number of violations. Interventions to increase safety skills of drivers might be promising for road safety.     

Road traffic crashes among farm vehicle drivers in southern China: A cross-sectional survey

Objective: The objective of this study was to identify the prevalence and potential risk factors of farm vehicle–related road traffic crashes among farm vehicle drivers in southern China.

Methods: A cross-sectional study was used to interview 1,422 farm vehicle drivers in southern China. Farm vehicle–related road traffic crashes that occurred from December 2013 to November 2014 were investigated. Data on farm vehicle–related road traffic crashes and related factors were collected by face-to-face interviews.

Results: The prevalence of farm vehicle–related road traffic crashes among the investigated drivers was 7.2%. Farm vehicle–related road traffic crashes were significantly associated with self-reported vision problem (adjusted odds ratio [AOR] = 6.48, 95% confidence interval [CI], 3.86–10.87), self-reported sleep disorders (AOR = 10.03, 95% CI, 6.28–15.99), self-reported stress (AOR = 20.47, 95% CI, 9.96–42.08), reported history of crashes (AOR = 5.40, 95% CI, 3.47–8.42), reported history of drunk driving (AOR = 5.07, 95% CI, 2.97–8.65), and reported history of fatigued driving (AOR = 5.72, 95% CI, 3.73–8.78). The number of road traffic crashes was highest in the daytime and during harvest season. In over 96% of farm vehicle–related road traffic crashes, drivers were believed to be responsible for the crash. Major crash-causing factors included improper driving, careless driving, violating of traffic signals or signs, and being in the wrong lane.

Conclusion: Findings of this study suggest that farm vehicle–related road traffic crashes have become a burgeoning public health problem in China. Programs need to be developed to prevent farm vehicle–related road traffic crashes in this emerging country.     

Graduated driver licensing: the New Zealand experience

In New Zealand, on 1 August 1987, a three-stage graduated driver licensing (GDL) system that applied to all new drivers aged 15-24 years was introduced. The essential elements of GDL were a 6-month learner license (supervised driving) and an 18-month restricted license stage (with restrictions on night driving and carrying passengers). A blood alcohol limit of 0.03 mg% applied at both stages. EVALUATION STUDIES: Early studies indicated that young people were reasonably accepting of the restrictions, with the passenger restriction being the least acceptable. Problems of compliance with the restricted license driving restrictions were reported. Evaluations of the impact of the graduated driver licensing (GDL) on serious traffic-related injury showed that up until 1991-1992, an 8% reduction could be attributed to GDL. At this time, it was considered that reduced exposure was the main reason for this reduction. However, the number of fatalities and hospital admissions among young people continued to decline, as did the population rate and the rate per number of licensed drivers among the young driver age group. A further evaluation study showed that drivers with a restricted license had a smaller proportion of crashes at night, and with passengers, compared with drivers licensed before GDL. IMPACT OF GDL: These results suggested that GDL restrictions had contributed to the reduction in crashes among young people and that it was not simply a case of reduced exposure to risk. An update of the most recent crash statistics indicated that, compared with older age groups, the fatal and serious injury crash rate among young people has remained substantially below the pre-GDL level. This suggests that the impact of GDL has not diminished over time.     

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.     

Child passengers and driver culpability in fatal crashes by driver gender

Objective: Studies based on accident statistics generally suggest that the presence of a passenger reduces adult drivers' accident risk. However, passengers have been reported to be a source of distraction in a remarkable portion of distraction-related crashes. Although the effect of passengers on driving performance has been studied extensively, few studies have focused on how a child passenger affects the driver.

?A child in a car is a potential distractor for parents, especially for mothers of small children, who often suffer from sleep deficit. The aim of this study was to examine how the presence of child passengers of different ages is associated with a higher driver culpability, which was expected due to child-related distraction and fatigue.

Methods: The analysis was based on the comprehensive data of fatal crashes studied in-depth by multidisciplinary road accident investigation teams in Finland during 1988–2012. Teams determine the primary party who had the most crucial effect on the origin of the event. We define the primary party as culpable and the others involved as nonculpable drivers. The culpability rate was defined as the percentage of culpable drivers and rates were compared for drivers with a child/teen passenger aged 0–17 years (N = 348), with an adult passenger without children (N = 324), and when driving alone (N = 579), grouped by child age and driver gender.

?Drivers with specific risk-related behavior (substantial speeding, driving when intoxicated, unbelted, or without a license) were excluded from the analyses, in order to make the drivers with and without children comparable. Only drivers 26–47 years old were included, representing parents with children 0–9 years of age.

Results: Male drivers were less often culpable with 0- to 17-year-old passengers in the car than alone or with adults. This was not the case with female drivers. The gender difference in culpability was most marked with small children age 0–4 years. Female drivers' culpability rate with a 0- to 4-year-old child passenger was higher and male drivers' culpability rate was lower compared to drivers without passengers or with only adult passengers.

Conclusion: The results indicate that female drivers are at higher risk of crashes than male drivers when driving with small children. Further research is needed to replicate this finding and to determine causal mechanisms.     

Passenger distractions among adolescent drivers

PROBLEM: Adolescents who drive with peers are known to have a higher risk of crashes. While passengers may distract drivers, little is known about the circumstances of these distractions among teen drivers. METHOD: This study used survey data on driving among 2,144 California high school seniors to examine distractions caused by passengers. RESULTS: Overall, 38.4% of youths who drove reported having been distracted by a passenger. Distractions were more commonly reported among girls and students attending moderate- to high-income schools. Talking or yelling was the most commonly reported type of distraction. About 7.5% of distractions reported were deliberate, such as hitting or tickling the driver or attempting to use the vehicle's controls. Driving after alcohol use and having had a crash as a driver were both significant predictors of reporting passenger-related distraction. CONCLUSION: Adolescents often experience distractions related to passengers, and in some cases these distractions are intentional. IMPACT ON INDUSTRY: These results provide information about teenage drivers who are distracted by passenger behaviors. In some cases, passengers attempted to use vehicle controls; however, it seems unlikely that this behavior is common enough to warrant redesign of controls to make them less accessible to passengers.