License extensions for clean-record drivers: A 4-year follow-up

Over 4,000,000 of California's 17,000,000 licensed drivers used to come to the California Department of Motor Vehicles (DMV) annually to take written and vision tests in order to renew their driver licenses. In an effort to increase public convenience and reduce costs, extension of the license by mail was implemented for selected groups of drivers with clean records over the life of their previous licenses. Continued implementation of the program was subject to evaluation of its effect on traffic safety. Since clean-record drivers make up about 50% of the renewal population, this program made it possible for some 2,000,000 drivers annually to avoid coming to the DMV for license renewal. Two studies of program safety effects were conducted, one evaluating a 2-year extension (760,000 subjects), and the other a 4-year extension (407,000 subjects). Random assignment to a group offered extension by mail or to a control group undergoing standard renewal testing and procedures was followed by careful tracking of accident and conviction activity. During the 48-month period following mailing of renewal notices or extension offers, the extension group had a slightly higher accident rate than did the in-person renewal group — an increase of 1%, or 13 accidents for every 10,000 extension offers. Although this small increase in accident rate would translate into about 2,500 additional accident involvements per year if applied to the current volume of clean-record drivers eligible for extension, statistical tests of significance indicated that the increase could easily be due to sampling error (p>.10). A supplemental Bayesian analysis resulted in a .24 probability that there was no true increase. The administrative cost savings attributable to the extension program were conservatively estimated to be $3,000,000 per year.     

Accident rates of drivers with bioptic telescopic lenses

The major purpose of this study was to determine the accident rate of drivers with bioptic telescopic lenses (“bioptic drivers”) in California. The bioptic driver group consisted of 229 drivers, while a randomly selected comparison sample consisted of 21,064 drivers. The 2-year total and fatal/injury accident rates of the bioptic group were normalized to the age/sex distribution of the comparison sample. Normalized accident rates for bioptic drivers were significantly greater than the corresponding rates for comparison drivers. The study also included an analysis of the driving records of bioptic drivers prior and subsequent to acquisition of telescopic lenses and an analysis of total and fatal/injury accidents for bioptic and comparison drivers with valid licenses only. It was recommended that California continue to license bioptic drivers, but with greater use of license restrictions and more stringent post-licensing control.     

Specific and long-term effects of Nova Scotia's graduated licensing program

A graduated licensing (GL) program was introduced in Nova Scotia, Canada, in October 1994. Previous research has shown that it reduced collisions in the short term. The present study examined the relative contribution of each stage of the program (i.e., learner and intermediate levels) and the program's impact after beginning drivers graduated to full licensure. The research focused on teenage beginning drivers (age 16-17), but the effects on older beginners also was examined. Per-driver crash rates of two groups of novices selected from driver records in Nova Scotia were compared. One group (pre-GL) received their learner's permits during the 2 years before the program was implemented, and the second group (GL) received their learner's permits during the 2 years after implementation. The findings clearly establish that most of the collision reduction in Nova Scotia's program occurred during the first year of the program, particularly during the first 6 months when the majority of novices were driving under supervision. The collision rate for 16 to 17-year-old GL novices was 50% lower than the rate for pre-GL novices during the 6 months after they received their learner's permits, and about 10% lower during their first 2 years of licensure when unsupervised driving from midnight to 5 A.M. was prohibited. Much of this improvement for 16 to 17-year-olds occurred during restricted night hours. Collision rates also were lower during nonrestricted hours in the initial 6 months of licensure. The 3-month "time discount" for driver education provided no safety benefit, and GL novices with driver education had collision rates that were not lower than pre-GL novices. There was no long-term effect found for the program after 16 to 17-year-olds graduated to full licensure. For older beginning drivers, crash rates during the first year after obtaining a learner's permit showed a 31% reduction. This effect diminished rapidly. There was only a 2% reduction during the first year of licensure, and crash rates increased during the following 2 years. Overall the data indicate substantial benefits of graduated licensing for 16 to 17-year-old beginners, but no benefits beyond the learner stage for older beginners.     

An evaluation of Ontario's Group Education Session (GES) for license renewal of seniors aged 80 and above

IntroductionIn 1996, the Ministry of Transportation in Ontario (MTO) implemented the Group Education Session (GES), which is a mandatory license renewal program for drivers aged 80 and older. This study describes an evaluation of the GES to assess its impact on road safety in Ontario, as well as its effect on the safety of individual drivers who participated in the program.MethodsTime series analysis of senior driver records both before and after implementation of the GES, and logistic regression and survival analysis examining senior driver records prior to, and following, their participation in the GES.ResultsUsing time series analysis there is some evidence to suggest that the GES had a positive impact on road safety. According to the other analyses, participation in the GES is associated with a decrease in the odds of collisions and convictions, regardless of whether drivers pass their first attempt of the knowledge test or not. In addition, failing the first road test and/or having demerit points are strong indicators of future collision and conviction involvement.DiscussionResults from this evaluation suggest that the GES has had a protective effect on the safety of senior drivers.Practical ApplicationsThe findings and discussion will help MTO improve the GES program and provide insights to other jurisdictions that have, or are considering, introducing new senior driver programs.     

Evaluating 24/7 Sobriety Program participant reoffense risk

Objective: Our study investigated risk factors in survival among a subpopulation of drivers in North Dakota’s 24/7 Sobriety Program. Participants mandated for a second driving-under-the-influence of alcohol (DUI) arrest were studied for a three-year interval that commenced with the start date for a 360-day enrollment. Method: A Stratified Cox regression model was developed to compute the hazard ratios for survival. A subsequent DUI-related offense as event of interest. Relation to the explanatory variable array that could be construed from administrative records were investigated. Results: Older drivers were 6.31 times more likely to reoffend than the younger driver cohort of 18–35-years. The survival curve slope showed the fastest decline in the 361-day to 730-day interval. Neither gender nor residence region was a significant predictor in DUI reoffense over the three-year monitoring interval. Preliminary work suggests reoffense was more likely if an individual had program history prior to this court mandated 360-day term in the 24/7 Sobriety Program for a second DUI. The program experience finding was unexpected but could not be studied in greater detail due to data and resource limitations. Conclusions: Administrative records access created a novel opportunity to explore an evolving impaired driving prevention strategy that has shown early promise. Individual driver survival in and after the 24/7 Sobriety Program was studied for three-years. Findings show age, post-program time interval, and possibly program history as areas to explore to improve survival rates. Driver DUI offense were most common shortly after program completion. Although limited to a single state, findings increase knowledge for refining strategies designed to impact driver subpopulations at higher risk for reoffense.     

Effectiveness of mandatory license testing for older drivers in reducing crash risk among urban older Australian drivers

Most licensing jurisdictions in Australia maintain mandatory assessment programs targeting older drivers, whereby a driver reaching a specified age is required to prove his or her fitness to drive through medical assessment and/or on-road testing. Previous studies both in Australia and elsewhere have consistently failed to demonstrate that age-based mandatory assessment results in reduced crash involvement for older drivers. However studies that have based their results upon either per-population or per-driver crash rates fail to take into account possible differences in driving activity. Because some older people maintain their driving licenses but rarely if ever drive, the proportion of inactive license-holders might be higher in jurisdictions without mandatory assessment relative to jurisdictions with periodic license assessment, where inactive drivers may more readily either surrender or lose their licenses. The failure to control for possible differences in driving activity across jurisdictions may be disguising possible safety benefits associated with mandatory assessment. The current study compared the crash rates of drivers in Melbourne, Australia, where there is no mandatory assessment and Sydney, Australia, where there is regular mandatory assessment from 80 years of age onward. The crash rate comparisons were based on four exposure measures: per population, per licensed driver, per distance driven, and per time spent driving. Poisson regression analysis incorporating an offset to control for inter-jurisdictional road safety differences indicated that there was no difference in crash risk for older drivers based on population. However drivers aged 80 years and older in the Sydney region had statistically higher rates of casualty crash involvement than their Melbourne counterparts on a per license issued basis (RR: 1.15, 1.02-1.29, p=0.02) and time spent driving basis (RR: 1.19, 1.06-1.34, p=0.03). A similar trend was apparent based on distance travelled but was of borderline statistical significance (RR: 1.11, 0.99-1.25, p=0.07). Collectively, it can be inferred from these findings that mandatory license re-testing schemes of the type evaluated have no demonstrable road safety benefits overall. Further research to resolve this on-going policy debate is discussed and recommended.     

Exposure-based assessment of the effectiveness of Michigan’s graduated driver licensing nighttime driving restriction

The objective of the study is to assess the effectiveness of Michigan’s graduated driver licensing (GDL) program in terms of nighttime driving restriction. The research uses the quasi-induced exposure technique to capture and represent the exposure and accident risk change of the impacted driver groups due to the implementation of the GDL program. Six years of Michigan accident data were used, including three years before the GDL implementation and three years after. The effectiveness of Michigan’s GDL program in terms of nighttime driving is reflected in several dimensions: for the impacted drivers (16- and 17-year-olds), there is a significant reduction of exposure compared to the reference group and a decrease in the relative accident involvement ratio (thus a reduced accident risk); and examination of time of day distributions of impacted teenage drivers shows that there is a conspicuous percentage drop of impacted teenage drivers at the point where the nighttime curfew starts. With the implementation of the GDL program, the affected group tends to drive increasingly more in the several hours prior to the restricted time period to avoid violating the curfew law. As opposed to the traditional exposure measurements such as population or licensed drivers, quasi-induced exposure technique has the capability of depicting the accident propensity and quantifying exposure change from different age groups.     

Fatal crash trends for Australian young drivers 1997-2007: Geographic and socioeconomic differentials

Background

Little has been published on changes in young driver fatality rates over time. This paper examines differences in Australian young driver fatality rates over the last decade, examining important risk factors including place of residence and socioeconomic status (SES).

Methods

Young driver (17-25 years) police-recorded passenger vehicle crashes were extracted from New South Wales State records from 1997-2007. Rurality of residence and SES were classified into three levels based on drivers’ residential postcode: urban, regional, or rural; and high, moderate, or low SES areas. Geographic and SES disparities in trends of fatality rates were examined by the generalized linear model. Chi-square trend test was used to examine the distributions of posted speed limits, drinking driving, fatigue, seatbelt use, vehicle age, night-time driving, and the time from crash to death across rurality and socioeconomic status.

Results

Young driver fatality rate significantly decreased 5% per year (p < 0.05); however, stratified analyses (by rurality and by SES) showed that only the reduction among urban drivers was significant (average 5% decrease per year, p < 0.01). The higher relative risk of fatality for rural versus urban drivers, and for drivers of low versus high SES remained unchanged over the last decade. High posted speed limits, fatigue, drink driving and seatbelt non-use were significantly associated with rural fatalities, whereas high posted speed limit, fatigue, and driving an older vehicle were significantly related to low SES fatality.

Conclusion

The constant geographic and SES disparities in young driver fatality rates highlight safety inequities for those living in rural areas and those of low SES. Better targeted interventions are needed, including attention to behavioral risk factors and vehicle age.     

Risk factors associated with truck-involved fatal crash severity: Analyzing their impact for different groups of truck drivers

Introduction: Fatal crashes that include at least one fatality of an occupant within 30 days of the crash cause large numbers of injured persons and property losses, especially when a truck is involved. Method: To better understand the underlying effects of truck-driver-related characteristics in fatal crashes, a five-year (from 2012 to 2016) dataset from the Fatality Analysis Reporting System (FARS) was used for analysis. Based on demographic attributes, driving violation behavior, crash histories, and conviction records of truck drivers, a latent class clustering analysis was applied to classify truck drivers into three groups, namely, ‘‘middle-aged and elderly drivers with low risk of driving violations and high historical crash records,” ‘‘drivers with high risk of driving violations and high historical crash records,” and ‘‘middle-aged drivers with no driving violations and conviction records.” Next, equivalent fatalities were used to scale fatal crash severities into three levels. Subsequently, a partial proportional odds (PPO) model for each driver group was developed to identify the risk factors associated with the crash severity. Results' Conclusions: The model estimation results showed that the risk factors, as well as their impacts on different driver groups, were different. Adverse weather conditions, rural areas, curved alignments, tractor-trailer units, heavier weights and various collision manners were significantly associated with the crash severities in all driver groups, whereas driving violation behaviors such as driving under the influence of alcohol or drugs, fatigue, or carelessness were significantly associated with the high-risk group only, and fewer risk factors and minor marginal effects were identified for the low-risk groups. Practical Applications: Corresponding countermeasures for specific truck driver groups are proposed. And drivers with high risk of driving violations and high historical crash records should be more concerned.     

Tracking traffic citations through court adjudications to posting to public driver records

Research has shown that one of the best predictors of a driver's future crash risk is the number of prior moving traffic violations (e.g., speeding). Public driver records are used by government and nongovernment users to assess drivers' future crash risks. However, the adequacy of such records may be compromised by deficient recordkeeping systems and by court-based diversion programs (e.g., probation before judgment, traffic school election) that allow drivers presumed guilty to avoid convictions in court and posting of the violations to their driver records. Using a case study approach in four jurisdictions in three states, citations issued for traffic violations were tracked through court adjudication to placement on driver records. Individual court case records and driver history records were reviewed. The percentages of citations issued that appeared on driver records were 58-87% for moving violations, 30-94% for driving while impaired (DWI), and 67-95% for occupant restraint violations. Diversion programs were a significant factor in two states, where 21% and 35% of moving violation citations resulted in diversions. Almost all court convictions in each jurisdiction were recorded on driver records, but few citations resulting in diversions were recorded. Thus, diversion programs in some jurisdictions substantially reduce the utility of public driver records as reliable indicators of prior traffic violations and future crash risks. Recordkeeping inefficiencies and errors were less important factors in this study.     

Impact of the Graduated Driver Licensing Program in Nova Scotia

A comprehensive evaluation of the Nova Scotia graduated licensing program was conducted. This program was implemented on October 1, 1994 and applies to all novice drivers, regardless of age. It spans 2 1/2 years in two stages: a 6-month learner phase, followed by a 24-month newly licensed driver phase. During both phases several driving restrictions apply, most notably a requirement for adult supervision at all times in the learner phase and a night driving restriction from midnight to 5 a.m. in the newly licensed driver phase. The evaluation of this program used a series of increasingly refined analyses that controlled for the influence of other explanatory variables. All the analyses showed that the graduated licensing program in Nova Scotia was associated with a significant reduction in crashes. For drivers age 16, there was a 24 percent decrease in total crashes during the first full year of the program and a 37 percent reduction during the first 3 years of the program. Comparable decreases occurred in injury crashes. Improvements also were observed for all novice drivers, not just those who are young - there was a 19 percent decrease in the crash rate for all novice drivers. Comparisons with results from other graduated licensing programs indicate the Nova Scotia program has been more effective than others in reducing crashes.     

Breath alcohol ignition interlock devices: controlling the recidivist

This study compares the recidivism rates of two groups of Illinois drivers who had their driver's licenses revoked for alcohol-impaired driving and who received restricted driving permits. Drivers in both groups had more than two driving under the influence (DUI) actions against their record within 5 years or were classed as level III alcohol dependents. Drivers in one group were required to install breath alcohol ignition interlock devices in their vehicles and drivers in the other group were not. The research found that drivers with the interlock were one-fifth as likely to be arrested for DUI during the 1 year the device was installed as the comparison group, which did not have the device. However, once the ignition interlock was removed, drivers in this group rapidly returned to DUI arrest rates similar to those in the comparison group. These findings echo previous literature. Additionally, the study showed that this voluntary program in Illinois reached only 16% of the drivers who met the requirements for installing the interlock device. Finally, this study found that individuals who were removed from the interlock program and returned to revoked status continued to drive. Within 3 years, approximately 50% of this latter group were involved in a crash or were arrested for DUI or with an invalid driver's license. Conclusions drawn from the study suggest that the breath alcohol ignition interlock device is effective in preventing continued driving while impaired. However, the large-scale effectiveness of the device is limited since most of the drivers eligible for the device do not have it installed. To have a significant impact, the interlock device must represent a better alternative to drivers whose licenses were suspended or revoked because of alcohol arrests compared to remaining on revoked status without having the device installed. Finally the research suggests that, given the rapid return to predevice recidivism, the devices should remain installed until drivers can demonstrate an extended period of being alcohol free.     

Persuasion and licensure: a randomized controlled intervention trial to increase licensure rates among Maryland motorcycle owners

OBJECTIVE: This study aimed to determine whether a persuasive educational intervention could increase licensure among motorcycle owners. Unlicensed motorcycle operators appear to be disproportionately involved in police-reported motorcycle crashes in Maryland, accounting for about 27% of motorcycle operators in police-reported crashes, although unlicensed owners comprise 17% of primary motorcycle owners. METHODS: A randomized controlled trial was conducted among unlicensed owners. Linking Maryland records of registered motorcycles with license files, 8,499 unlicensed owners who had no licensed co-owners were identified. Half were randomized to receive a persuasive educational mailing in early June 2005 from Maryland Motor Vehicle Administration (MVA). Motorcycle licenses can be attained by passing an accredited motorcycle training class or passing knowledge and skills tests administered by the state driver licensing agency. Licensure rates and motorcycle class enrollment were followed for 6 months post-intervention. RESULTS: As of December 16, 2005, 280 intervention group owners had obtained Class M motorcycle licenses and 158 had obtained Class R motorcycle learner's permits. The comparison group obtained 209 M licenses and 122 R permits. The overall success rate in the intervention group, defined as obtaining Class M or R, was 10.4% compared with 7.9% in the comparison group (licensure ratio (LR) = 1.33; 95% confidence interval (CI) = 1.16-1.52). The intervention was most successful among men, whose LR for obtaining M licenses was 1.45 (95% CI = 1.21-1.75). LRs were higher among owners ages 40-48 and 49+ receiving the intervention compared with younger groups. Motorcycle training class enrollment rates were higher in the intervention group, particularly among those taking a course for riders with intermediate skills (enrollment ratio = 2.24; 95% CI = 1.41-3.55). CONCLUSION: The intervention appeared to increase licensure, yet the licensure rate remained low among the intervention group. Potential risks and benefits of increasing the percentage of motorcyclists who are licensed need to be studied.     

Breath alcohol ignition interlock devices: controlling the recidivist

This study compares the recidivism rates of two groups of Illinois drivers who had their driver's licenses revoked for alcohol-impaired driving and who received restricted driving permits. Drivers in both groups had more than two driving under the influence (DUI) actions against their record within 5 years or were classed as level III alcohol dependents. Drivers in one group were required to install breath alcohol ignition interlock devices in their vehicles and drivers in the other group were not. The research found that drivers with the interlock were one-fifth as likely to be arrested for DUI during the 1 year the device was installed as the comparison group, which did not have the device. However, once the ignition interlock was removed, drivers in this group rapidly returned to DUI arrest rates similar to those in the comparison group. These findings echo previous literature. Additionally, the study showed that this voluntary program in Illinois reached only 16% of the drivers who met the requirements for installing the interlock device. Finally, this study found that individuals who were removed from the interlock program and returned to revoked status continued to drive. Within 3 years, approximately 50% of this latter group were involved in a crash or were arrested for DUI or with an invalid driver's license. Conclusions drawn from the study suggest that the breath alcohol ignition interlock device is effective in preventing continued driving while impaired. However, the large-scale effectiveness of the device is limited since most of the drivers eligible for the device do not have it installed. To have a significant impact, the interlock device must represent a better alternative to drivers whose licenses were suspended or revoked because of alcohol arrests compared to remaining on revoked status without having the device installed. Finally the research suggests that, given the rapid return to predevice recidivism, the devices should remain installed until drivers can demonstrate an extended period of being alcohol free.     

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.     

Crash rates over time among younger and older drivers in the SHRP 2 naturalistic driving study

Objective: To examine crash rates over time among 16–17-year-old drivers compared to older drivers. Methods: Data were from a random sample of 854 of the 3,500 study participants in SHRP 2, a U.S. national, naturalistic driving (instrumented vehicle) study. Crashes/10,000 miles by driver age group, 3-month period, and sex were examined within generalized linear mixed models. Results: Analyses of individual differences between age cohorts indicated higher incidence rates in the 16–17-year old cohort relative to older age groups each of the first four quarters (except the first quarter compared to 18–20 year old drivers) with incident rate ratios (IRR) ranging from 1.98 to 18.90, and for the full study period compared with drivers 18–20 (IRR = 1.69, CI = 1.00, 2.86), 21 to 25 (IRR = 2.27, CI = 1.31, 3.91), and 35 to 55 (IRR = 4.00, CI = 2.28, 7.03). Within the 16–17-year old cohort no differences were found in rates among males and females and the decline in rates over the 24-month study period was not significant. Conclusions: The prolonged period of elevated crash rates suggests the need to enhance novice young driver prevention approaches such as Graduated Driver’s Licensing limits, parent restrictions, and post-licensure supervision and monitoring. Practical Applications: Increases are needed in Graduated Driver’s Licensing limits, parent restrictions, and postlicensure supervision and monitoring.     

Using naturalistic driving data to examine drivers' seatbelt use behavior: Comparison between teens and adults

ProblemTeens and young drivers are often reported as one driver group that has significantly lower seatbelt use rates than other age groups.ObjectiveThis study was designed to address the questions of whether and how seatbelt-use behavior of novice teen drivers is different from young adult drivers and other adult drivers when driving on real roads.MethodDriving data from 148 drivers who participated in two previous naturalistic driving studies were further analyzed. The combined dataset represents 313,500 miles, 37,695 valid trips, and about 9500 h of driving. Drivers did not wear their seatbelts at all during 1284 trips. Two dependent variables were calculated, whether and when drivers used seatbelts during a trip, and analyzed using logistic regression models.ResultsResults of this study found significant differences in the likelihood of seatbelt use between novice teen drivers and each of the three adult groups. Novice teen drivers who recently received their driver's licenses were the most likely to use a seatbelt, followed by older drivers, middle-aged drivers, and young drivers. Young drivers were the least likely to use a seatbelt. Older drivers were also more likely to use seatbelts than the other two adult groups. The results also showed that novice teen drivers were more likely to fasten their seatbelts at the beginning of a trip when compared to the other three adult groups.SummaryNovice teen drivers who were still in the first year after obtaining their driver's license were the most conservative seatbelt users, when compared to adult drivers.Practical applicationFindings from this study have practical application insights in both developing training programs for novice teen drivers and designing seatbelt reminder and interlock systems to promote seatbelt use in certain driver groups.     

Characteristics of speeders

OBJECTIVE: To determine the characteristics of speeders, defined as drivers of vehicles traveling at least 15 mph above the posted speed limit and relatively faster than surrounding vehicles. METHODS: Vehicle speeds were recorded on 13 roads in Virginia with speed limits ranging from 40 to 55 mph. Speeders were compared with slower drivers, defined as drivers of adjacent vehicles traveling no more than 5 mph above the speed limit. License plates were used to identify vehicle owners; owners were inferred to have been driving if observed gender and estimated age matched those of the registered owner. For these drivers, information on exact driver age and gender, vehicle make and model, and driving record was obtained from the Virginia Department of Motor Vehicles. RESULTS: Five percent of the vehicles observed were traveling at least 15 mph above the limit, and 3% qualified as speeders, as defined in this study. Speeders were younger than drivers in the comparison group, drove newer vehicles, and had more speeding violations and other moving violations on their records. They also had 60% more crashes. DISCUSSION: Speeders are a high-risk group. Their speeding behavior is not likely to be controlled without vigorous, consistent enforcement, including the use of automated technology.     

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.