ORIGINAL ARTICLE
Trends in Alabama teen driving death and injury Kathy Monroe, MD, Elizabeth Irons, MD, Marie Crew, RNC-NIC, Jesse Norris, Michele Nichols, MD, and William D. King, RPh MPH, DrPH, Birmingham, Alabama
Motor vehicle crashes (MVCs) are a leading cause of morbidity and mortality in teens. Alabama has been in the Top 5 states for MVC fatality rate among teens in the United States for several years. Twelve years of teen MVC deaths and injuries were evaluated. Our hypothesis is that the teen driving motor vehicleYrelated deaths and injuries have decreased related to legislative and community awareness activities. METHODS: A retrospective analysis of Alabama teen MVC deaths and injury for the years 2000 to 2011 was conducted. MVC data were obtained from a Fatality Analysis Reporting System data set managed by the Center for Advanced Public Safety at the University of Alabama. A Lowess regressionYscattergram analysis was used to identify period specific changes in deaths and injury over time. Statistical analysis was conducted using True Epistat 5.0 software. When the Lowess regression was applied, there was an obvious change in the trend line in 2007. To test that observation, we then compared medians in the pre-2007 and post-2007 periods, which validated our observation. Moreover, it provided a near-even number of observations for comparison. The Spearman rank correlation was used to test for correlation of deaths and injury over time. The Mann-Whitney U-test was used to evaluate median differences in deaths and injury comparing pre-2007 and post-2007 data. RESULTS: Alabama teen MVC deaths and injury demonstrated a significant negative correlation over the 12-year period (Rs for deaths and injury, j0.87 [ p G 0.001] and j0.92 [ p G 0.001], respectively). Lowess regression identified a notable decline in deaths and injury after the year 2006. Median deaths and injury for the pre-2007 period were significantly higher than the post-2007 period, (U = 35.0, p = 0.003). CONCLUSION: Alabama teen driver deaths and injury have decreased during the 12-year study period, most notably after 2006. Factors that may have contributed to this trend may include stricter laws for teen drivers (enacted in 2002 and updated in 2010), less teen driving because of a nationwide economic downturn, delayed licensing in teens, steady improvements in overall seat belt use, and heightened public awareness of risky behaviors in teen driving. (J Trauma Acute Care Surg. 2014;77: S51YS54. Copyright * 2014 by Lippincott Williams & Wilkins) LEVEL OF EVIDENCE: Epidemiologic study, level V. KEY WORDS: Teen driving; motor vehicle crash; graduated drivers license. BACKGROUND:
M
otor vehicle crashes (MVCs) remain the Number 1 cause of deaths for teens. The risk of MVCs is higher among 16-year-olds to 19-year-olds than among any other age group.1 For every 100,000 teen drivers, Alabama had 31.2 fatalities based on data collected from a 5-year period (2006Y2010).2 According to the Alabama Department of Public Health, alcohol consumption, lack of seat belt use, and distractions are three of the primary contributing factors to teen driving deaths.3 In addition, reckless driving and/or speeding contribute to teen driving deaths in our state.3 Alabama ranks fourth in the United States in teen driving deaths.2 Teen drivers include approximately 6.7% of licensed drivers in Alabama yet accounted for 12.2% of crashes and 8.7% of fatal crashes.4 Both legislation and community awareness Submitted: December 21, 2013, Revised: June 1, 2014, Accepted: June 4, 2014. From the Pediatric Emergency Medicine (K.M., M.N., W.D.K.), and SafeKids of Alabama (M.C.), Southeast Child Safety Institute (W.D.K.), Children’s of Alabama (E.I.), University of Alabama Hospital Systems, Birmingham; and Center for Advanced Public Safety (J.N.), The University of Alabama, Tuscaloosa, Alabama. Results from this article were presented in part at the Southern Society for Pediatric Research, February 2012, in New Orleans, and at the 18th annual conference of the Injury Free Coalition for Kids, November 8Y10, 2013, in Fort Lauderdale, Florida. Address for reprints: Kathy Monroe, MD, University of Alabama Hospital Systems, Children’s of Alabama Pediatric Emergency Medicine, 1600 7th Ave, South Suite 110 CPP Birmingham, AL 35233; email: [email protected]. DOI: 10.1097/TA.0000000000000399
campaigns have been used in an attempt to decrease the teen driving deaths.
OBJECTIVE This study evaluated 12 years of teen MVC-related deaths and injuries to discern if changes in trend occurred after legislative and educational interventions. Our hypothesis is that the teen driving motor vehicleYrelated deaths and injuries have decreased related to legislative and community awareness activities.
PATIENTS AND METHODS A retrospective analysis of Alabama teen MVC deaths and injury for the years 2000 to 2011 was conducted after institutional review board approval (institutional review board protocol number X130320003). Data on mortality were obtained from the Fatality Analysis Reporting System data set, and data on teen driving injuries were obtained from the Center for Advanced Public Safety (CAPS) at the University of Alabama. The University of Alabama CAPS maintains an electronic crash reporting and transmission procedure developed by CAPS working under the direction and close collaboration of the Alabama Department of Public Safety. This project is sponsored by the Alabama Department of Economic and Community Affairs and directed by
J Trauma Acute Care Surg Volume 77, Number 3, Supplement 1
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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J Trauma Acute Care Surg Volume 77, Number 3, Supplement 1
Monroe et al.
the Alabama Department of Public Safety. This Critical Analysis Reporting Environment (CARE) system has been upgraded several times and is now on Version 10. CARE has been implemented as a component of the enterprise traffic safety data system in 12 different states. CARE uses a number of different methodologies to provide descriptive statistics, information mining, geographic information system support, and roadway safety engineering support. The database was queried for any crash in the state of Alabama involving a driver between the ages of 16 years and 19 years. MVC death and injury data were analyzed over time. A Lowess regressionYscattergram analysis was used to identify period specific changes in deaths and injury over time. When the Lowess regression was applied, there was an obvious change in the trend line in 2007. To test that observation, we then compared medians in the pre-2007 and post-2007 periods, which validated our observation. Moreover, it provided a neareven number of observations for comparison. The Spearman rank correlation was used to test for correlation of deaths and injury over time. The Mann-Whitney U-test was used to evaluate median differences in deaths and injury comparing pre-2007 and post-2007 data. All statistical analysis was conducted using True Epistat 5.0 software
RESULTS Alabama teen MVC deaths demonstrated a significant negative correlation over the years from 2000 to 2011, with fatalities decreasing from 76 in the year 2000 to 50 in the year 2011 (Rs = j0.87, p G 0.001). Similarly Alabama teen MVC injury rates decreased from a high of 4,451 in the year 2000 to 3,012 in the year 2011 (Rs = j0.92, p G 0.001). Deaths decreased from 76 to 50 per year, while injuries seen in the medical system declined from 4,451 to 3,012 per year during the entire study period (Table 1). Lowess regression showed a notable decline in deaths and injury after the year 2006 (Figs. 1 and 2). Sex distribution for pre-2007 (68% males) was similar to post-2007 (63% male) for fatalities. When evaluating injury data, sex distribution was also similar for pre-2007 (46% males) to post-2007 (45% males). Median death numbers in the pre-2007 period were significantly higher than in the post-2007 period (U = 35.0, p = 0.003). Median injury numbers were also significantly higher in the pre-2007 period compared with the post-2007 period.
Figure 1. Trends in teen driver injuries in state from 2000 to 2011.
consistently been ranked among the highest for teen fatalities related to MVCs. Efforts have included the enactment of legislation, strengthening of legislation, community awareness projects, public service announcements, and multiple Web sites for parents and teens. This study examined the trend of both teen driving fatalities and injuries, and our data indicate that Alabama has seen a decline in teen driving fatalities and injuries during the period between 2000 and 2011. Graduated driver licensing (GDL) is a method of gradually introducing driving privileges to beginning teen drivers to allow them to gain driving experience while keeping them out of various unsupervised, high-risk driving situations. The goal of GDL is to phase youth into full driving privileges over time.5,6 Alabama has consistently been on the list of the states with the highest teen drivingYrelated deaths.2 In an attempt to lower these rates, our state enacted a Graduated Drivers’ License Law, Act No. 2002-408, which went into effect as of October 1, 2002.7 The initial law required 30 hours of supervised driving or proof of a driver’s education class before getting a temporary
DISCUSSION Multiple efforts have been initiated to counteract the high rates of teen driving crashes in Alabama. The state has TABLE 1. Number of Fatalities and Injuries for 2000 Through 2011 Year
2000
2001
2002
2003
2004
2005
Fatalities Injuries Year Fatalities Injuries
76 4,451 2006 71 4,079
71 4,396 2007 65 3,547
72 4,482 2008 61 3,200
72 4,403 2009 51 3,005
77 4,397 2010 48 3,155
69 4,236 2011 50 3,012
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Figure 2. Trends of teen driver deaths in state from 2000 to 2011. * 2014 Lippincott Williams & Wilkins
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
J Trauma Acute Care Surg Volume 77, Number 3, Supplement 1
license. The GDL limits driving times to 6:00 AM to midnight (no driving between midnight and 6:00 AM) unless there is an adult in the car or the teen driving is on the way to or from school, work, church or was driving because of an emergency. Finally, the 2002 GDL also limited the number of passengers in the car to no more than four excluding a parent or legal guardian. In July 2010, ACT #2010-735 strengthened Alabama legislation by limiting the number of passengers to one nonadult passenger and added a ban on nonessential handheld communication devices.8 An addition to the law was made to the curfew exceptions to include driving to and from hunting or fishing activities. These laws still lag behind American Academy of Pediatrics’ recommendations in that Alabama GDL curfew and passenger limits do not extend to age 18 years; the curfew is midnight instead of 11:00 PM, and the number of supervised driving hours required to obtain a licensure hours is 30 instead of the recommended 50 hours and offers a number of exclusions to the nighttime driving rules.5 However, studies have shown that the presence of any GDL legislation is associated with a lower burden of motor vehicleYrelated injury.9 Despite having a GDL since 2002 and a change to the legislation in 2010, studies in our state reveal that details of the GDL are not widely known. In 2011, many teens surveyed did not know that there was a law and very few knew the details.10 A teen driving coalition was created in our state and included partners such as the state Academy of Pediatrics, Children’s of Alabama Hospital, University of South Alabama pediatric training program, VOICES for Alabama Children, SafeKids of Alabama, AAA, Children’s First, Think First, Jefferson State Community College/Greater Birmingham Highway Safety Office, Alabama Department of Public Health, Alabama Child Death Review Team, the Alabama Department of Transportation, and others. As part of community awareness, each of these coalition members promoted a series of media events and television advertisements to increase public awareness. During the course of 12 years, Alabama has seen a steady decline in the number of teen drivingYrelated deaths. Alabama has had primary seat belt legislation since 1999, and in August 2012, House Bill 2 banned texting behind the wheel for all ages.11,12 In addition, the legislations in 2002 (first GDL law) and 2010 (change in GDL) have had a positive impact on teen driving deaths in our state. A variety of community outreach efforts have been ongoing in the state, with a particular push in the years 2007 to 2008 to increase awareness of safe teen driving and the graduated drivers’ license laws Nationally, there was a similar downward trend in teen drivingYrelated deaths. Multiple factors have been postulated as having resulted in this trend including more public awareness, less teen driving because of economic downturn, and delayed licensure for teens.
LIMITATIONS Our state has seen a downward trend during the course of the past 12 years. Limitations of this study include uncertainty regarding which factors impacted this trend and if the trend will persist.
Monroe et al.
CONCLUSION A significant downward trend in teen driving fatalities was achieved between 2000 and 2011. Key legislation and educational efforts occurred during this time frame. The longterm impact remains a question. Further research should focus on continued trends in teen driver fatalities and injuries. Ongoing support of media campaigns to increase awareness and legislation to strengthen teen driving laws are also necessary. We are encouraged by the downward trend and will continue to push for further legislation and public awareness.
AUTHORSHIP K.M. was involved in the literature search, study design, data analysis, data interpretation, manuscript writing, and critical revisions. E.I. was involved in the study design, data interpretation, manuscript writing, and critical revisions. M.C. was involved in the literature search, data interpretation, and critical revisions. J.N. was involved in the data collection and critical revisions. M.N. was involved in the study design, data interpretation, and critical revisions. W.D.K. was involved in the study design, data analysis, data interpretation, and critical revisions.
DISCLOSURE The authors declare no conflicts of interest.
REFERENCES 1. Center for Disease Control and Prevention Teen Driving Fact Sheet. Available at: www.cdc.gov/motorvehiclesafety/teen-drivers/teendriverse-factsheet.html. Accessed October 12, 2013. 2. Teen driving: a state-by-state look at death rates of teen passengers and drivers. Available at: http://www.eriesense.com/teen-driving-deaths/. Accessed October 15, 2013. 3. Alabama Department of Public Health Teen Driving Facts. Available at: http:// www.adph.org/teendriving/index.asp?ID=4439. Accessed September 10, 2013. 4. Alabama Traffic Safety Center: novice driver training course. Available at: http://legacy.montevallo.edu/atsc/tdc/NDTC/stats.shtm. Accessed October 30, 2013. 5. The teen driver. Available at: http://pediatrics.aappublications.org/content/ 118/6/2570.full. Accessed October 21, 2013. 6. Rouse HL, Aitken ME, Lein SD, Leath KJ, Halverson P, Thompson JW. Statewide policies for safer teen driving: an evaluation of the impact of graduated driver licensing in Arkansas. J Trauma Acute Care Surg. 2013; 75(4 Suppl 3):S281YS284. 7. Alabama Department of Education: ALSDE Driver Education Facts. Available at: http://www.alsde.edu/home/Sections/SectionFAQs.aspx?SectionID=92. Accessed October 21, 2013. 8. 2010 Synopsis of Graduated Driver License Act #2010-745. Available at: http://dps.alabama.gov/Documents/Documents/DriverLicenseGraduatedDLProgram.pdf. Accessed October 15, 2013. 9. Pressley JC, Benedicto CB, Trieu L, Kendig T, Barlow B. Motor vehicle injury, mortality, and hospital charges by strength of graduated driver licensing laws in 36 states. J Trauma. 2009;67(Suppl 1):S43YS53. 10. Scott A, Monroe K, Gibbs T, Nichols M, King W. Southern Regional Meeting AbstractsV‘‘Abstract 369. Teenage Driving Safety and Awareness of Graduated Drivers’ License Programs: What You Don’t Know Can’t Deter You.’’ J Investig Med. 2011;59(2):475. 11. ADPH: Alabama Department of Public Health: Injury Prevention. Available at: http://www.adph.org/injuryprevention/index.asp?id=1033. Accessed June 12, 2013. 12. Distractions.gov: get the facts. Available at: http://www.distraction.gov/ content/get-the-facts/state-laws.html. Accessed October 19, 2013.
* 2014 Lippincott Williams & Wilkins
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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Monroe et al.
EDITORIAL CRITIQUE The overriding theme of most of the articles presented at the annual meeting of the Injury Free Coalition for Kids relates to what works in injury prevention and what does not. Most of the reports define innovations that are associated with a change in injury incidence or pattern. Occasionally, some describe good ideas that simply did not work. Monroe et al. provide a very relevant overview of the real message in injury prevention. Their documentation of a progressively decreasing incidence of a very common killer of adolescents in a state where the problem was a major threat to teenaged drivers illustrates that change can occur. The decreasing trend across time shows no dramatic inflection related to any one act either by the legislature or by the health care community. Rather, it shows that real change results from a constant combination of every available tool to improve education, enhance public awareness, and initiate active and passive processes designed to make driving safer. The second sentence of this paragraph uses the word associated rather than cause and effect. This report and most of those that have preceded it in this and previous issues define a change for the better that is the product of multiple efforts in many sectors. Essentially, that is the overarching
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message of injury control. No one thing is guaranteed to work. Rather, a commitment by concerned leaders to educate the population about risks and to lead processes of innovation that make the environment safer are the drivers of gradual culture change that will make the world a safer place for our children. Monroe et al. were almost certainly looking for a sentinel event that really changed the problem of teenaged driving fatalities for the better. Instead, they found that multiple initiatives from various sectors gradually improved the teenaged driving culture in their state. There were lots of people doing many things, illustrating, once again, that injury prevention is everyone’s responsibility. *The author declares no conflict of interest.
Joseph J. Tepas III, MD Division of Pediatric Surgery Department of Surgery University of Florida Health Science Center Jacksonville, Florida
* 2014 Lippincott Williams & Wilkins
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Trends in Alabama teen driving death and injury Kathy Monroe, MD, Elizabeth Irons, MD, Marie Crew, RNC-NIC, Jesse Norris, Michele Nichols, MD, and William D. King, RPh MPH, DrPH, Birmingham, Alabama
Motor vehicle crashes (MVCs) are a leading cause of morbidity and mortality in teens. Alabama has been in the Top 5 states for MVC fatality rate among teens in the United States for several years. Twelve years of teen MVC deaths and injuries were evaluated. Our hypothesis is that the teen driving motor vehicleYrelated deaths and injuries have decreased related to legislative and community awareness activities. METHODS: A retrospective analysis of Alabama teen MVC deaths and injury for the years 2000 to 2011 was conducted. MVC data were obtained from a Fatality Analysis Reporting System data set managed by the Center for Advanced Public Safety at the University of Alabama. A Lowess regressionYscattergram analysis was used to identify period specific changes in deaths and injury over time. Statistical analysis was conducted using True Epistat 5.0 software. When the Lowess regression was applied, there was an obvious change in the trend line in 2007. To test that observation, we then compared medians in the pre-2007 and post-2007 periods, which validated our observation. Moreover, it provided a near-even number of observations for comparison. The Spearman rank correlation was used to test for correlation of deaths and injury over time. The Mann-Whitney U-test was used to evaluate median differences in deaths and injury comparing pre-2007 and post-2007 data. RESULTS: Alabama teen MVC deaths and injury demonstrated a significant negative correlation over the 12-year period (Rs for deaths and injury, j0.87 [ p G 0.001] and j0.92 [ p G 0.001], respectively). Lowess regression identified a notable decline in deaths and injury after the year 2006. Median deaths and injury for the pre-2007 period were significantly higher than the post-2007 period, (U = 35.0, p = 0.003). CONCLUSION: Alabama teen driver deaths and injury have decreased during the 12-year study period, most notably after 2006. Factors that may have contributed to this trend may include stricter laws for teen drivers (enacted in 2002 and updated in 2010), less teen driving because of a nationwide economic downturn, delayed licensing in teens, steady improvements in overall seat belt use, and heightened public awareness of risky behaviors in teen driving. (J Trauma Acute Care Surg. 2014;77: S51YS54. Copyright * 2014 by Lippincott Williams & Wilkins) LEVEL OF EVIDENCE: Epidemiologic study, level V. KEY WORDS: Teen driving; motor vehicle crash; graduated drivers license. BACKGROUND:
M
otor vehicle crashes (MVCs) remain the Number 1 cause of deaths for teens. The risk of MVCs is higher among 16-year-olds to 19-year-olds than among any other age group.1 For every 100,000 teen drivers, Alabama had 31.2 fatalities based on data collected from a 5-year period (2006Y2010).2 According to the Alabama Department of Public Health, alcohol consumption, lack of seat belt use, and distractions are three of the primary contributing factors to teen driving deaths.3 In addition, reckless driving and/or speeding contribute to teen driving deaths in our state.3 Alabama ranks fourth in the United States in teen driving deaths.2 Teen drivers include approximately 6.7% of licensed drivers in Alabama yet accounted for 12.2% of crashes and 8.7% of fatal crashes.4 Both legislation and community awareness Submitted: December 21, 2013, Revised: June 1, 2014, Accepted: June 4, 2014. From the Pediatric Emergency Medicine (K.M., M.N., W.D.K.), and SafeKids of Alabama (M.C.), Southeast Child Safety Institute (W.D.K.), Children’s of Alabama (E.I.), University of Alabama Hospital Systems, Birmingham; and Center for Advanced Public Safety (J.N.), The University of Alabama, Tuscaloosa, Alabama. Results from this article were presented in part at the Southern Society for Pediatric Research, February 2012, in New Orleans, and at the 18th annual conference of the Injury Free Coalition for Kids, November 8Y10, 2013, in Fort Lauderdale, Florida. Address for reprints: Kathy Monroe, MD, University of Alabama Hospital Systems, Children’s of Alabama Pediatric Emergency Medicine, 1600 7th Ave, South Suite 110 CPP Birmingham, AL 35233; email: [email protected]. DOI: 10.1097/TA.0000000000000399
campaigns have been used in an attempt to decrease the teen driving deaths.
OBJECTIVE This study evaluated 12 years of teen MVC-related deaths and injuries to discern if changes in trend occurred after legislative and educational interventions. Our hypothesis is that the teen driving motor vehicleYrelated deaths and injuries have decreased related to legislative and community awareness activities.
PATIENTS AND METHODS A retrospective analysis of Alabama teen MVC deaths and injury for the years 2000 to 2011 was conducted after institutional review board approval (institutional review board protocol number X130320003). Data on mortality were obtained from the Fatality Analysis Reporting System data set, and data on teen driving injuries were obtained from the Center for Advanced Public Safety (CAPS) at the University of Alabama. The University of Alabama CAPS maintains an electronic crash reporting and transmission procedure developed by CAPS working under the direction and close collaboration of the Alabama Department of Public Safety. This project is sponsored by the Alabama Department of Economic and Community Affairs and directed by
J Trauma Acute Care Surg Volume 77, Number 3, Supplement 1
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
S51
J Trauma Acute Care Surg Volume 77, Number 3, Supplement 1
Monroe et al.
the Alabama Department of Public Safety. This Critical Analysis Reporting Environment (CARE) system has been upgraded several times and is now on Version 10. CARE has been implemented as a component of the enterprise traffic safety data system in 12 different states. CARE uses a number of different methodologies to provide descriptive statistics, information mining, geographic information system support, and roadway safety engineering support. The database was queried for any crash in the state of Alabama involving a driver between the ages of 16 years and 19 years. MVC death and injury data were analyzed over time. A Lowess regressionYscattergram analysis was used to identify period specific changes in deaths and injury over time. When the Lowess regression was applied, there was an obvious change in the trend line in 2007. To test that observation, we then compared medians in the pre-2007 and post-2007 periods, which validated our observation. Moreover, it provided a neareven number of observations for comparison. The Spearman rank correlation was used to test for correlation of deaths and injury over time. The Mann-Whitney U-test was used to evaluate median differences in deaths and injury comparing pre-2007 and post-2007 data. All statistical analysis was conducted using True Epistat 5.0 software
RESULTS Alabama teen MVC deaths demonstrated a significant negative correlation over the years from 2000 to 2011, with fatalities decreasing from 76 in the year 2000 to 50 in the year 2011 (Rs = j0.87, p G 0.001). Similarly Alabama teen MVC injury rates decreased from a high of 4,451 in the year 2000 to 3,012 in the year 2011 (Rs = j0.92, p G 0.001). Deaths decreased from 76 to 50 per year, while injuries seen in the medical system declined from 4,451 to 3,012 per year during the entire study period (Table 1). Lowess regression showed a notable decline in deaths and injury after the year 2006 (Figs. 1 and 2). Sex distribution for pre-2007 (68% males) was similar to post-2007 (63% male) for fatalities. When evaluating injury data, sex distribution was also similar for pre-2007 (46% males) to post-2007 (45% males). Median death numbers in the pre-2007 period were significantly higher than in the post-2007 period (U = 35.0, p = 0.003). Median injury numbers were also significantly higher in the pre-2007 period compared with the post-2007 period.
Figure 1. Trends in teen driver injuries in state from 2000 to 2011.
consistently been ranked among the highest for teen fatalities related to MVCs. Efforts have included the enactment of legislation, strengthening of legislation, community awareness projects, public service announcements, and multiple Web sites for parents and teens. This study examined the trend of both teen driving fatalities and injuries, and our data indicate that Alabama has seen a decline in teen driving fatalities and injuries during the period between 2000 and 2011. Graduated driver licensing (GDL) is a method of gradually introducing driving privileges to beginning teen drivers to allow them to gain driving experience while keeping them out of various unsupervised, high-risk driving situations. The goal of GDL is to phase youth into full driving privileges over time.5,6 Alabama has consistently been on the list of the states with the highest teen drivingYrelated deaths.2 In an attempt to lower these rates, our state enacted a Graduated Drivers’ License Law, Act No. 2002-408, which went into effect as of October 1, 2002.7 The initial law required 30 hours of supervised driving or proof of a driver’s education class before getting a temporary
DISCUSSION Multiple efforts have been initiated to counteract the high rates of teen driving crashes in Alabama. The state has TABLE 1. Number of Fatalities and Injuries for 2000 Through 2011 Year
2000
2001
2002
2003
2004
2005
Fatalities Injuries Year Fatalities Injuries
76 4,451 2006 71 4,079
71 4,396 2007 65 3,547
72 4,482 2008 61 3,200
72 4,403 2009 51 3,005
77 4,397 2010 48 3,155
69 4,236 2011 50 3,012
S52
Figure 2. Trends of teen driver deaths in state from 2000 to 2011. * 2014 Lippincott Williams & Wilkins
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
J Trauma Acute Care Surg Volume 77, Number 3, Supplement 1
license. The GDL limits driving times to 6:00 AM to midnight (no driving between midnight and 6:00 AM) unless there is an adult in the car or the teen driving is on the way to or from school, work, church or was driving because of an emergency. Finally, the 2002 GDL also limited the number of passengers in the car to no more than four excluding a parent or legal guardian. In July 2010, ACT #2010-735 strengthened Alabama legislation by limiting the number of passengers to one nonadult passenger and added a ban on nonessential handheld communication devices.8 An addition to the law was made to the curfew exceptions to include driving to and from hunting or fishing activities. These laws still lag behind American Academy of Pediatrics’ recommendations in that Alabama GDL curfew and passenger limits do not extend to age 18 years; the curfew is midnight instead of 11:00 PM, and the number of supervised driving hours required to obtain a licensure hours is 30 instead of the recommended 50 hours and offers a number of exclusions to the nighttime driving rules.5 However, studies have shown that the presence of any GDL legislation is associated with a lower burden of motor vehicleYrelated injury.9 Despite having a GDL since 2002 and a change to the legislation in 2010, studies in our state reveal that details of the GDL are not widely known. In 2011, many teens surveyed did not know that there was a law and very few knew the details.10 A teen driving coalition was created in our state and included partners such as the state Academy of Pediatrics, Children’s of Alabama Hospital, University of South Alabama pediatric training program, VOICES for Alabama Children, SafeKids of Alabama, AAA, Children’s First, Think First, Jefferson State Community College/Greater Birmingham Highway Safety Office, Alabama Department of Public Health, Alabama Child Death Review Team, the Alabama Department of Transportation, and others. As part of community awareness, each of these coalition members promoted a series of media events and television advertisements to increase public awareness. During the course of 12 years, Alabama has seen a steady decline in the number of teen drivingYrelated deaths. Alabama has had primary seat belt legislation since 1999, and in August 2012, House Bill 2 banned texting behind the wheel for all ages.11,12 In addition, the legislations in 2002 (first GDL law) and 2010 (change in GDL) have had a positive impact on teen driving deaths in our state. A variety of community outreach efforts have been ongoing in the state, with a particular push in the years 2007 to 2008 to increase awareness of safe teen driving and the graduated drivers’ license laws Nationally, there was a similar downward trend in teen drivingYrelated deaths. Multiple factors have been postulated as having resulted in this trend including more public awareness, less teen driving because of economic downturn, and delayed licensure for teens.
LIMITATIONS Our state has seen a downward trend during the course of the past 12 years. Limitations of this study include uncertainty regarding which factors impacted this trend and if the trend will persist.
Monroe et al.
CONCLUSION A significant downward trend in teen driving fatalities was achieved between 2000 and 2011. Key legislation and educational efforts occurred during this time frame. The longterm impact remains a question. Further research should focus on continued trends in teen driver fatalities and injuries. Ongoing support of media campaigns to increase awareness and legislation to strengthen teen driving laws are also necessary. We are encouraged by the downward trend and will continue to push for further legislation and public awareness.
AUTHORSHIP K.M. was involved in the literature search, study design, data analysis, data interpretation, manuscript writing, and critical revisions. E.I. was involved in the study design, data interpretation, manuscript writing, and critical revisions. M.C. was involved in the literature search, data interpretation, and critical revisions. J.N. was involved in the data collection and critical revisions. M.N. was involved in the study design, data interpretation, and critical revisions. W.D.K. was involved in the study design, data analysis, data interpretation, and critical revisions.
DISCLOSURE The authors declare no conflicts of interest.
REFERENCES 1. Center for Disease Control and Prevention Teen Driving Fact Sheet. Available at: www.cdc.gov/motorvehiclesafety/teen-drivers/teendriverse-factsheet.html. Accessed October 12, 2013. 2. Teen driving: a state-by-state look at death rates of teen passengers and drivers. Available at: http://www.eriesense.com/teen-driving-deaths/. Accessed October 15, 2013. 3. Alabama Department of Public Health Teen Driving Facts. Available at: http:// www.adph.org/teendriving/index.asp?ID=4439. Accessed September 10, 2013. 4. Alabama Traffic Safety Center: novice driver training course. Available at: http://legacy.montevallo.edu/atsc/tdc/NDTC/stats.shtm. Accessed October 30, 2013. 5. The teen driver. Available at: http://pediatrics.aappublications.org/content/ 118/6/2570.full. Accessed October 21, 2013. 6. Rouse HL, Aitken ME, Lein SD, Leath KJ, Halverson P, Thompson JW. Statewide policies for safer teen driving: an evaluation of the impact of graduated driver licensing in Arkansas. J Trauma Acute Care Surg. 2013; 75(4 Suppl 3):S281YS284. 7. Alabama Department of Education: ALSDE Driver Education Facts. Available at: http://www.alsde.edu/home/Sections/SectionFAQs.aspx?SectionID=92. Accessed October 21, 2013. 8. 2010 Synopsis of Graduated Driver License Act #2010-745. Available at: http://dps.alabama.gov/Documents/Documents/DriverLicenseGraduatedDLProgram.pdf. Accessed October 15, 2013. 9. Pressley JC, Benedicto CB, Trieu L, Kendig T, Barlow B. Motor vehicle injury, mortality, and hospital charges by strength of graduated driver licensing laws in 36 states. J Trauma. 2009;67(Suppl 1):S43YS53. 10. Scott A, Monroe K, Gibbs T, Nichols M, King W. Southern Regional Meeting AbstractsV‘‘Abstract 369. Teenage Driving Safety and Awareness of Graduated Drivers’ License Programs: What You Don’t Know Can’t Deter You.’’ J Investig Med. 2011;59(2):475. 11. ADPH: Alabama Department of Public Health: Injury Prevention. Available at: http://www.adph.org/injuryprevention/index.asp?id=1033. Accessed June 12, 2013. 12. Distractions.gov: get the facts. Available at: http://www.distraction.gov/ content/get-the-facts/state-laws.html. Accessed October 19, 2013.
* 2014 Lippincott Williams & Wilkins
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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J Trauma Acute Care Surg Volume 77, Number 3, Supplement 1
Monroe et al.
EDITORIAL CRITIQUE The overriding theme of most of the articles presented at the annual meeting of the Injury Free Coalition for Kids relates to what works in injury prevention and what does not. Most of the reports define innovations that are associated with a change in injury incidence or pattern. Occasionally, some describe good ideas that simply did not work. Monroe et al. provide a very relevant overview of the real message in injury prevention. Their documentation of a progressively decreasing incidence of a very common killer of adolescents in a state where the problem was a major threat to teenaged drivers illustrates that change can occur. The decreasing trend across time shows no dramatic inflection related to any one act either by the legislature or by the health care community. Rather, it shows that real change results from a constant combination of every available tool to improve education, enhance public awareness, and initiate active and passive processes designed to make driving safer. The second sentence of this paragraph uses the word associated rather than cause and effect. This report and most of those that have preceded it in this and previous issues define a change for the better that is the product of multiple efforts in many sectors. Essentially, that is the overarching
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message of injury control. No one thing is guaranteed to work. Rather, a commitment by concerned leaders to educate the population about risks and to lead processes of innovation that make the environment safer are the drivers of gradual culture change that will make the world a safer place for our children. Monroe et al. were almost certainly looking for a sentinel event that really changed the problem of teenaged driving fatalities for the better. Instead, they found that multiple initiatives from various sectors gradually improved the teenaged driving culture in their state. There were lots of people doing many things, illustrating, once again, that injury prevention is everyone’s responsibility. *The author declares no conflict of interest.
Joseph J. Tepas III, MD Division of Pediatric Surgery Department of Surgery University of Florida Health Science Center Jacksonville, Florida
* 2014 Lippincott Williams & Wilkins
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
