Teen Driving & Alcohol

Introduction

The automobile has profoundly impacted our country; it has affected where we live, where we work, and how we spend our free time. Outside of a few major metropolitan areas, driving is the fastest and easiest way to get around town. Young teens are often reliant on parents and carpools in order to attend school, to participate in after-school activities, and to visit friends. Thus, across the United States, teens anxiously await the day they can obtain their drivers' licenses and drive on their own. Many parents are also excited for their teen children to drive, relieving parents of their extensive chauffeuring responsibilities. Having a driver's license gives a teen mobility and freedom.

However, teen driving also brings with it a great deal of responsibility and risk. Motor vehicle crashes are the leading cause of death among young people 15-24 years of age. Alcohol is implicated in a majority of these deaths. This resource is designed to initiate discussion between you and your teen. Teen Driving & Alcohol will help you understand why teens are at high risk for motor vehicle collisions and learn what has been done to reduce this risk — helping you, as parents and adult influencers, talk with your teen about how to be a safe passenger and a safe driver.

The Facts

A) What are the statistics — do teens really have more car accidents than older drivers?

Yes — teens have the highest rate of motor vehicle accidents of any age group. Motor vehicle collisions are the leading cause of death among teens; collisions are responsible for 40% of all deaths among young people, or over 5,000 deaths per year⁽¹⁾. Two-thirds of teen passenger deaths occur when another teen is driving. Per mile driven, teen motor vehicle crash rates are calculated to be three to ten times higher than adult crash rates⁽²⁾. Furthermore, in analyses conducted by the National Highway Traffic Safety Administration, injuries related to motor vehicle accidents represent 4.5% of all emergency department visits and these visits are most common among teens and young adults 15-24 years of age⁽³⁾.

Two-thirds of teen passenger deaths occur when another teen is driving.

B) Why do teens have such high rates of motor vehicle accidents?

There are many reasons why teens are thought to be at increased risk for accidents while driving. By far the most alarming reason for teens to be involved in motor vehicle collisions is driving after drinking alcohol. Despite wfforts to prevent underage drinking, alcohol use is still quite common among teens.

In a national survey, one in four high school students reported binge drinking in the past 30 days, with binge drinking defined as having five or more drinks at one sitting⁽⁴⁾.

Alcohol consumption by minors, even in small quantities, leads to impaired coordination, slowing of reflexes, and impaired judgment. These effects can be deadly when an intoxicated teen is behind the wheel of a car.

Alcohol use is responsible for significant mortality among youth. Alcohol is implicated in a majority of teen driving fatalities. 25% of drivers ages 15-20 who died in motor vehicle crashes had been drinking alcohol⁽⁶⁾. Furthermore, marijuana and other drugs, either alone or in combination with alcohol, can also contribute to motor vehicle accidents and fatalities.

C) Most teens know drinking and driving is dangerous and illegal, so why do they do it?

Reasons for driving after drinking alcohol vary for different teens. Many teens have a sense of invulnerability — they feel that nothing bad will ever happen to them. Even though they may know that drinking and driving is dangerous, they think that they will be safe. In addition, many adolescents are prone to testing limits and taking risks. Thus, knowing that drinking and driving is illegal may not be a deterrent. Other teens may agree to put themselves in dangerous situations, such as driving after drinking alcohol, due to peer pressure and a desire to be accepted. Still others may be forced to accept a ride from a friend who has been drinking because they do not know of an alternative way to get home after a party.

25% of drivers ages 15-20 who died in motor vehicle crashes

D) Are there reasons other than driving after drinking that make teens more likely to be involved in car accidents?

While impaired driving is one key reason for teens to be involved in motor vehicle collisions, other factors include: Inexperience, Distracted Driving and Immaturity.

Inexperience: Research demonstrates that the newest, youngest drivers have the highest rates of both motor vehicle accidents and motor vehicle-related fatalities⁽⁷⁾. Lack of driving experience is a risk for getting into an accident. Inexperienced drivers are thought to be particularly at risk for accidents in situations that require more skill, such as driving at night or driving in rain or snow. Inexperienced drivers may be less able to anticipate changes in traffic patterns or to navigate congested or tricky intersections.

Distracted Driving: Distracted driving is often cited as a cause for motor vehicle accidents among teens. Reasons for teens to be distracted while driving include listening to loud music, adjusting radio or CD settings, driving with multiple passengers, and/or using cell phones while driving. The use of cell phones while driving has recently been a focus of much interest and debate. One recent study found that young drivers participating in a simulated driving exercise were twice as likely to miss traffic signals when talking on a cell phone. Furthermore, this research found that both hand-held and hands-free cell phones were distracting to drivers⁽⁸⁾. Another recent study found cell phone conversations to be more distracting to drivers than conversations with passengers⁽⁹⁾. When young, distracted drivers drink alcohol, the risk of motor vehicle collision increases substantially⁽¹⁰⁾.

Immaturity: Immaturity is another important reason why young drivers are at increased risk for accidents. The period when many teens begin driving on their own is often characterized by separation from parents, allying with peers, and engaging in many risky behaviors. With respect to driving, this immature developmental stage can be quite dangerous, leading to overconfidence in driving skills and speeding or racing with friends. When alcohol use is combined with immaturity, this leads to poor decision-making and raises the risk of being in an accident.

E) What has been done to make driving safer for teens?

States and municipalities have adopted a variety of measures to prevent teen motor vehicle accidents and their associated morbidity and mortality. Federal, state, and local programs to promote safer cars, seat belt usage, non-distracted drivers, and reduced access to alcohol have all been shown to be effective in reducing motor vehicle accidents for drivers of all ages⁽¹¹⁾. Two programs targeted at preventing motor vehicle accidents among our youngest drivers are graduated driver's license programs and Zero Tolerance laws.

F) What are graduated driver's license programs?

Graduated driver's license programs are a diverse group of programs implemented by states to allow teens to gain important driving experience before being given unrestricted driving privileges. These programs were designed specifically to address some of the reasons why teens are at increased risk for accidents: inexperience, immaturity and distracted driving. While programs vary by state, most graduated driver's license programs consist of three stages:

Researchers have found that graduated driver's license programs that include a three month or longer waiting period before obtaining an intermediate license, nighttime driving restriction, and either passenger restrictions or requirements of greater than 30 hours of supervised driving, are associated with reduced teen driving fatalities⁽¹²⁾. Other recent studies have also demonstrated that comprehensive graduated driver's license programs can reduce teen motor vehicle accidents and teen motor vehicle fatalities^(13,14).

...graduated driver's license programs can reduce teen motor vehicle accidents...

Along with the graduated driver's license programs, states have tried other ways to keep teens safe behind the wheel. Many states have enacted restrictions on cell phone use while driving. Some states even have unique programs that allow parents to delay or suspend teen licensure. You can find out more about the driving laws for your state from the Insurance Institute for Highway Safety Web site: www.iihs.org.

Zero Tolerance laws specify that for drivers under 21, it is illegal to drive with any alcohol in the blood.

G) What are Zero Tolerance laws?

Zero Tolerance laws are another step that states have taken to send a clear message about underage drinking and reduce teen driving accidents and fatalities. As discussed above, impaired driving increases the risk of motor vehicle accidents. Zero Tolerance laws specify that for drivers under 21, it is illegal to drive with any alcohol in the blood. These laws were developed as a result of research demonstrating that even low levels of intoxication were associated with impaired driving in minors. In 1995, Congress passed a law recommending that all states pass a Zero Tolerance law for underage drivers. By 1998, all states had enacted such laws. Multiple studies have demonstrated Zero Tolerance laws to be effective in reducing teen motor vehicle crashes and fatalities^(15,16).

Conversations

It is important to start conversations early and to repeat topics over time. While your teen may appear to not be listening, he or she is almost always interested in what you have to say. Your teen will not only listen to what you say but he/she will learn from your actions. Research has shown that teen driving behaviors are closely related to how their parents drive⁽¹⁷⁾. So, it is important to model safe driving behaviors, such as limiting distractions and not driving after drinking alcohol. How to discuss safe driving with your child will vary based on your child's age or developmental maturity.

A) How do the stages of adolescent development influence how you talk to your teen?

Developing one's own moral code and establishing an identity separate from parents is a major task of adolescence. Early adolescence (ages 11-14) is the first stage of this separation from parents. This period is marked by wanting to look and act like one's friends and having difficulty with impulse control. Middle adolescence (ages 15-17), the period where many teens begin driving on their own, is characterized by further distancing from parents and trying to gain acceptance by peers. During middle adolescence, teens often display feelings of omnipotence and immortality. Testing limits and taking risks are normal behaviors during this stage of development. With respect to driving, this immature developmental stage can be quite dangerous, leading to overconfidence in driving skills and speeding or racing with friends. By late adolescence (ages 18-21) most young adults have established their own identity and their own moral code. These young adults are more confident and better able to delay gratification; these traits can lead to safer driving practices.

B) Discussions with your early teen — ages 11-14

It is never too early to talk to your child about motor vehicle safety. Even young children need to know to use a seat belt and to not get into a car with a teen or adult who has been drinking. Over 20% of motor vehicle fatalities among children 11-14 years of age are alcohol related⁽¹⁸⁾. This is especially important to think about if your child spends time with brothers and sisters, cousins, or older friends. It may be helpful to role-play with your child about how to ask for help or how to find an alternative ride home if they are in a situation where the driver has been drinking.

C) Discussions with your middle teen — ages 15-17

As your child approaches middle adolescence, it is important to start talking about driving and its risks and associated responsibilities. Parents can set clear expectations regarding driving privileges. Remind children that for those under 21, there is Zero Tolerance for driving after drinking any alcohol. At this stage of development, children will be quick to point out if you are driving after drinking. Be a role model — kids are perceptive and will quickly notice if you say one thing yet do another. Therefore, teens may be more likely to follow a Zero Tolerance policy if they see their parents also refusing to drive after drinking.

Be a role model — kids are perceptive and will quickly notice if you say one thing yet do another.

D) Talking to your teen once they have an intermediate driver's license

It is important to know the laws in your state regarding teen driving privileges with each stage of obtaining a driver's license. At a minimum, teens must comply with state laws. If you live in a state with few restrictions on young drivers, you might consider adopting household rules to allow young drivers to be gradually introduced to more challenging driving scenarios. Research has demonstrated that such household rules do reduce teen motor vehicle accidents⁽¹⁹⁾.

Furthermore, teens should be reminded not to use cell phones while driving and to limit other potential driving distractions. Parents may choose to restrict access to driving if a teen is not able to follow the household rules. Some possible household rules to gradually introduce driving privileges for a teen with a Learner's Permit could be to have them complete at least 30 hours of supervised driving. For teens at the intermediate stage, you may choose to allow one teen passenger at a time and restrict nighttime driving. Enforce these rules until your teen turns seventeen and is responsible enough to completely handle the freedom of an unrestricted driver's license.

E) Talking to your teen once they have an unrestricted driver's license

Once a teen has obtained full legal driving privileges or an unrestricted license, parents can still remain involved to help ensure that their child stays safe. You can continue to talk to your child about motor vehicle safety — use of seat belts, restricting cell phone use, following speed limits, and Zero Tolerance for driving after drinking any amount of alcohol. You may choose to contract with your child about safe driving habits. In some states, parents can have their child's driver's license suspended if the child is not following these rules. During this stage it is still important for you, as a parent, to set a positive example by limiting distractions while driving, following seat belt and speed limit regulations, and not driving when impaired.

F) Responding to a news article regarding teens arrested, injured or killed in an accident or collision

Should the news report on a teen being injured or killed in a motor vehicle accident, it is sometimes helpful to discuss the issue with your teenager. During middle adolescence, teens often feel invincible — "it can't happen to me". As a parent, you can remind your teen that anything can happen and that driving safely and responsibly is the best way to prevent a motor vehicle accident.

G) Preparing for an evening out — having a safe ride home

It is important to talk with your child before they leave the house, whether they are going to a big party or hanging out with a few friends. You can ask where they will be, who else will be there, and how they will get to and from the event. Teens are less likely to get into trouble when they know that their parents expect that they will not drink alcohol or use drugs⁽²⁰⁾. It is also important to have a back-up safety plan — if your child or their planned ride home has been drinking, your child may need a safe way to get home. Depending on your location, this may involve giving cab fare or agreeing to pick up your child, with no questions asked that evening. Remember, there is time to talk the next day, after you have all gotten some sleep. Stress that safety comes first.

...even with older teens, it is still important to talk about safe driving, not drinking and driving, and limiting distractions while driving.

H) Talking with your driving teen ? ages 18-21

At this stage, most teens are more mature and able to understand the risks and consequences of their actions. Also, many late adolescents are living outside of the house and so it is more difficult to monitor their driving safety. However, even with older teens, it is still important to talk about safe driving, not drinking and driving, and limiting distractions while driving. Late adolescents are still subject to Zero Tolerance laws, thus driving after drinking any amount of alcohol is illegal.

I) Once your child has turned 21

Upon turning 21, young adults may start drinking more because they are now able to purchase alcohol legally. However, driving after drinking is always dangerous, even when you are of legal age. Parents should continue to discuss with their young adult the need to not drive when drinking, and plan for a safe ride home when they do drink.

Final Thoughts

In conclusion, driving is an important milestone in a teenager's life. Driving alone allows a teen freedom to plan and attend activities or to hold a part-time job. However, teen driving also comes with responsibility and risks.

Parents can play an important role in teaching their children to drive safely, to avoid driving after drinking, and to limit distractions. By beginning the conversations early, clearly and regularly communicating expectations, and knowing the facts, you can help your children to become responsible, safe, and mature drivers.

About

Health Alliance on Alcohol

A national education initiative on underage consumption of alcohol through parent/child communications.

New York-Presbyterian Healthcare System

The New York-Presbyterian Healthcare System, the largest secular not-for-profit non-governmental health care system in the U.S., is committed to providing high-quality, cost-effective and accessible care to communities throughout the greater New York Metropolitan region. The System, made up of 38 acute care hospitals, 100 ambulatory sites, 16 residential health care facilities, three specialty institutions, and more than 15,000 affiliated physicians, serves one in four patients in the Greater New York Metropolitan Area. The System is also the largest not-for-profit employer in New York City.

System members are affiliates of the Joan and Sanford I. Weill Medical College of Cornell University or Columbia University College of Physicians and Surgeons. During 2006, System institutions discharged more than 540,000 inpatient cases and saw more than 5,700,000 cases on an outpatient basis. For additional information, visit www.nyp.org.

White Plains Hospital Center

White Plains Hospital Center (WPHC) is a 292-bed voluntary, not-for-profit health care organization with the primary mission of offering high quality, acute health care and preventive medical care to all people who live in, work in, or visit Westchester County and its surrounding areas. Centers of Excellence include the Dickstein Cancer Treatment Center, The William & Sylvia Silberstein Neonatal & Maternity Center, The Ruth and Jerome A. Siegel Stroke Center, and The Westchester Orthopaedic Institute. The Hospital has the busiest Emergency Department in Westchester County, treating more than 45,000 patients a year. White Plains Hospital Center is a five-time winner of the Consumer Choice Award, an honor given to the nation's top hospitals by the National Research Corporation. WPHC is a member of the NewYork-Presbyterian Healthcare System and the Stellaris Health Network, Inc. For additional information, visit www.wphospital.org.

Morgan Stanley Children’s Hospital of NewYork-Presbyterian

Ranked by U.S. News & World Report as one of the top six children's hospitals in the country, Morgan Stanley Children's Hospital of NewYork-Presbyterian offers the best available care in every area of pediatrics — including the most complex neonatal and critical care and all areas of pediatric subspecialties — in a family-friendly and technologically advanced setting. Building a reputation for more than a century as one of the nation's premier children's hospitals, Morgan Stanley Children's Hospital of New York-Presbyterian is affiliated with Columbia University College of Physicians and Surgeons, and is New York City's only hospital dedicated solely to the care of children and the largest provider of children's health services in the tristate area with a long-standing commitment to its community. Morgan Stanley Children's Hospital of New York-Presbyterian is also a major international referral center, meeting the special needs of children from infancy through adolescence worldwide. For more information, visit www.nyp.org.

Heineken USA

Heineken USA is the nation's premier importer and a subsidiary of Heineken International (Netherlands), the world's most international brewer. The company and its affiliates are firmly committed to promoting responsible consumption of alcoholic beverages. Among other distinctions, Heineken was the first brewer in the world to place a responsible consumption message on all of its bottles and cans. Heineken USA was also the first alcohol company to place a responsibility message on all of its television, radio, and print advertising. Please visit www.EnjoyHeinekenResponsibly.com.

Authors

Elyse Olshen Kharbanda, MD, MPH
Assistant Clinical Professor of Pediatrics and Public Health
Departments of Pediatrics and Population and Family Health,
Columbia University,
Morgan Stanley Children's Hospital New York

Joli Yuknek, MD
Director, Pediatric Hospitalist Program
and Pediatric Emergency Medicine,
White Plains Hospital Center

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