Jessica H. Mirman

From Passengers to Drivers Parent Perceptions About How Adolescents Learn to Drive

Motor vehicle crashes are the leading cause of death for adolescents in most developed countries. In some countries including the United States, parents play a critical role in teaching adolescents to drive; however, little is known about what parents believe to be necessary in developing safe, skilled drivers, including the kind of instruction and experiences needed. The aim of this study was to address this gap in the research by describing what parents know and believe about the learning-to-drive process using semistructured interviews and surveys. U.S. parents were asked to identify and describe important skills and concepts, learning methodologies, common problems, and evaluation metrics for novice drivers. An emic account of the learning-to-drive period was generated to inform future interventions to support families and to generate hypotheses for future research.

Development of Web-Based Parent Support Program to Improve Quantity, Quality, and Diversity of Teens’ Home-Based Practice Driving

The purpose of this paper is to describe the development of a web-based program, the teen driving plan (TDP), for the parents of teen drivers and the results of a process evaluation to determine whether this intervention can be used as intended for the target population. The TDP is designed to promote parents’ facilitation of their teens’ home-based practice driving to increase the quantity, quality, and diversity of teens’ practice. The core functionality of the program centers on encouraging parents to plan and log practice drives. Use of these online tools encourages parents to watch short video tutorials that provide guidance on how to structure practice drives. Results of the mixed-methods process evaluation (n = 16 families) suggest that the TDP was viewed favorably by families and can be used by parents of learner teen drivers to plan and log practice drives. Families were followed over a 6-week period, and data were collected on the TDP use, participants’ practice driving, participants’ reactions to using the program, and their suggestions for improving the TDP. Multiple research methods were used, including user-tracking software, online surveys, focus groups and interviews, and a technical assistance log. Participants provided helpful feedback about website design and functionality. Overall, the results indicate that the TDP is a promising new intervention worthy of further development and research.

Child coping and parent coping assistance during the peritrauma period in injured children.

Pediatric physical injury is a very common, potentially traumatic medical event that many families face each year. The role that child or parent coping behavior plays in emotional recovery from injury is not well understood. This study described coping used by children and coping assistance implemented by parents in the early aftermath of a childs injury. Ten child-parent dyads participated in individual semistructured interviews that were audiorecorded, transcribed, and coded using hierarchical coding schemes. Study findings highlight reliance on a broad range of coping strategies. Although children and parents report some similarities in their perceptions of child coping, parents do not recognize all the coping strategies that children report. This suggests potential for improvement in parent-child communication concerning coping techniques. Parents report a limited number of coping assistance strategies, indicating a niche for preventive programs. Further research should examine coping during the peritrauma period as it relates to physical and emotional outcomes to inform secondary prevention programs.

Driving errors of learner teens: Frequency, nature and their association with practice

BACKGROUND Despite demonstrating basic vehicle operations skills sufficient to pass a state licensing test, novice teen drivers demonstrate several deficits in tactical driving skills during the first several months of independent driving. Improving our knowledge of the types of errors made by teen permit holders early in the learning process would assist in the development of novel approaches to driver training and resources for parent supervision. METHODS The purpose of the current analysis was to describe driving performance errors made by teens during the permit period, and to determine if there were differences in the frequency and type of errors made by teens: (1) in comparison to licensed, safe, and experienced adult drivers; (2) by teen and parent-supervisor characteristics; and (3) by teen-reported quantity of practice driving. Data for this analysis were combined from two studies: (1) the control group of teens in a randomized clinical trial evaluating an intervention to improve parent-supervised practice driving (n=89 parent-teen dyads) and (2) a sample of 37 adult drivers (mean age 44.2 years), recruited and screened as an experienced and competent reference standard in a validation study of an on-road driving assessment for teens (tODA). Three measures of performance: drive termination (i.e., the assessment was discontinued for safety reasons), safety-relevant critical errors, and vehicle operation errors were evaluated at the approximate mid-point (12 weeks) and end (24 weeks) of the learner phase. Differences in driver performance were compared using the Wilcoxon rank sum test for continuous variables and Pearsons Chi-square test for categorical variables. RESULTS 10.4% of teens had their early assessment terminated for safety reasons and 15.4% had their late assessment terminated, compared to no adults. These teens reported substantially fewer behind the wheel practice hours compared with teens that did not have their assessments terminated: tODAearly (9.0 vs. 20.0, p<0.001) and tODAlate (19.0 vs. 58.3, p<0.001). With respect to critical driving errors, 55% of teens committed a total of 85 critical errors (range of 1-5 errors per driver) on the early tODA; by comparison, only one adult committed a critical error (p<0.001). On the late tODA, 54% of teens committed 67 critical errors (range of 1-8 errors per driver) compared with only one adult (p<0.001). No differences in teen or parent gender, parent/teen relationship type or parent prior experience teaching a teen to drive were observed between teens who committed a critical error on either route and teens that committed no critical errors. A borderline association between median teen-reported practice quantity and critical error commission was observed for the late tODA. The overall median proportion of vehicle operation errors for teens was higher than that of adults on both assessments, though median error proportions were less than 10% for both teens and adults. CONCLUSION In comparison to a group of experienced adult drivers, a substantially higher proportion of learner teens committed safety-relevant critical driving errors at both time points of assessment. These findings, as well as the associations between practice quantity and the driving performance outcomes studied suggest that further research is needed to better understand how teens might effectively learn skills necessary for safe independent driving while they are still under supervised conditions.

Caregivers' confidence in performing child safety seat installations: what matters most?

Background Although effective when used correctly, child restraint systems (CRS) are commonly misused. Caregivers must make accurate judgements about the quality of their CRS installations, but there is little research on the psychological, technological, or contextual factors that might influence these judgements. Methods Seventy-five caregivers were observed installing a CRS into a vehicle and completed self-report surveys measuring risk appraisals, previous utilisation of CRS resources, task difficulty, and confidence that the CRS was installed correctly. Results Approximately 30% of caregivers installed the CRS inaccurately and insecurely, but reported that it was correctly installed. Predictors of confidence were ease of use (β=0.47) and exposure to CRS resources (β=−0.34). Installation errors and CRS security were unrelated to caregivers’ confidence. Conclusions An interdisciplinary approach is needed to understand factors influencing caregivers’ judgements about their installations, optimise channels to connect caregivers to CRS resources, and to design safety technologies in light of these findings.

Development of On-Road Driving Assessment for Learner Teen Drivers

Teen drivers complete the learner permit period with difficulty in executing a variety of driving behaviors. The ability to identify these skill deficits during the learner permit phase would significantly advance teen driver research. The objective of this study was to develop a safe, develop-mentally appropriate, and challenging assessment of teen drivers during the learner permit phase that can assess a wide range of specific driving tasks and identify safety-relevant errors (classified as critical errors). The On-Road Driving Assessment for Learner Teen Drivers (tODA) was developed and tested for feasibility of administration by professional driving evaluators. Two assessment routes were developed and administered to 28 teen permit holders at approximately 12 and 24 weeks into their permit holding period. Forty licensed adult drivers drove the routes to begin to establish a criterion standard for route Performance; adult participants were required to meet safety and Performance standards to be included in the analyses. Three teen participants (10.7%) had the early tODA terminated for safety concerns; one of these participants (3.5%) also had the late tODA terminated for safety concerns. In addition, two teen participants (7.1%) did not complete the highway module of the late tODA secondary to teen or parental request. No adults were terminated, and none skipped the highway module. Preliminary data suggest that the tODA expands the repertoire of driving assessments by providing a means to safely and systematically assess drivers with varying levels of expertise in the context of practical evaluations of driver Performance as well as for research purposes.

Evaluating the effect of a mechanical adjunct to improve the installation of child restraint systems to vehicles

Objectives: We explored if an alternative CRS design that utilized a mechanical adjunct to amplify the force applied to the adult seat belt (intervention CRS) results in more accurate and secure attachment between the CRS and the vehicle compared to similar CRS models that use LATCH or the existing adult seat belt. We conducted three separate studies to address this question and additionally explored: (1) the contribution of prior CRS installation experience (Study 1), (2) the value-added of CRS labeling (Study 2), and (3) paper-based vs. video instructions (Study 3). Methods: In Studies 1 and 2 we assessed a forward facing combination CRS design (intervention CRS) compared to a commercially available LATCH equipped model (control CRS) and in Study 3 we conducted a similar study using a convertible model of both the intervention and control CRS. Participants installed both CRS in a contemporary minivan and could choose which type of attachment to use for the control CRS (LATCH or seat belt); order of installation was counter-balanced. Evaluators systematically examined installations for accuracy and security. Results: Study 1: A greater proportion of participants in both the experienced and inexperienced groups was able to securely install the intervention CRS compared to the control CRS: (45% vs. 16%, p =.0001 for experienced) and (37% vs. 6%, p =.003 for inexperienced). No differences between the CRS were observed for accuracy of installation in either user group. Study 2: A greater proportion of participants were able to securely install the enhanced intervention CRS compared to the control CRS: (62% vs. 9%, p =.001). The intervention CRS demonstrated reduced installation accuracy: (30% vs. 61%, p =.001). Study 3: A greater proportion of participants was able to securely install the intervention CRS compared to the control CRS: 79% vs. 66% p =.03, but this effect was smaller than in the previous studies. Participants were less likely to achieve an accurate installation with the intervention CRS compared to the control CRS: 54% vs. 79%, p =.004. Common accuracy errors in each study included twisting or misrouting the seatbelt when installing the intervention CRS. Conclusions: Our results suggest that novel CRS designs that utilize mechanical advantage to facilitate attachment of the CRS to the vehicle result in a tighter installation compared to LATCH equipped models, but an increase in accuracy errors occurred.

Assessing driver-passenger interactions in a simulated driving environment: a pilot study with teen drivers

The combination of teen drivers and peer passengers presents a unique challenge to roadway safety. Teen drivers, being inexperienced, have not mastered essential driving skills and may not know how to safely manage their passengers. Peer passengers may not know how to help the driver and, as a result, become a source of distraction and a risk-promoting factor. We examined the effect of working relationships (i.e. cooperative, individualistic, and competitive) on driver-passenger social interactions in a driving simulator using observational and self-report methods by experimentally inducing the type of working relationship via a pre-drive social interaction task. The preliminary results indicated that dyads assigned to the cooperation condition produced more ‘helpful’ comments compared to dyads in the competition condition. Initial findings suggest that this type of experimental manipulation may be useful for examining driver-passenger interactions among teens, and those interactions between driver-passenger dyads prior to carry-over into in-vehicle social dynamics. More research is needed to further examine driver-passenger interactions and how differences in these interactions may be associated with safety outcomes.

Enhancing Our Understanding of Teen-Driver Crashes

Whileprogresshasbeenmade in reducing thenumberof teens killedinmotorvehiclecrashes,crashescontinuetobetheleading causeofdeathfor teens intheUnitedStates.1Thehighcrashrate for teens isowing in largepart to theirlackofdrivingexperience.2,3 Continued identificationof specific characteristicsof teens that leadtoelevatedcrashriskcan informinterventions forhigh-risk subgroups.Thismonth’sissueofJAMAPediatrics includesastudy byOuimetetal4 thatexaminedtheassociationbetweencortisol reactivity and subsequent occurrence of crash and near-crash (CNC) events among newly licensed teens. As part of theNaturalisticTeenDrivingStudy,salivarycortisolreactivity inresponse toa stress-inducing taskwasassessedatbaseline ina sampleof 42 healthy, typically developing 16-year-old participants, after which they drove instrumented vehicles for 18months. Ouimetetal4 foundthat teenswith lowercortisol reactivity in response to the stressorhadhigherCNC ratesduring the first 18monthsof licensure. Inaddition, thosewith lowercortisol reactivityhadaslowerdecreaseinCNCratesovertime.Theauthors positedthattheassociationsobservedintheirstudycouldbeowingtoindividualdifferencesinoptimalphysiologicalarousaland/ or tothemannerbywhichteensprocessemotional information. The extent to which the authors believe these are competing, complementary,or interactiveprocesses remainsunclear.Most compelling,andsupportedbyotherliterature, istheideaofanormativeemotional learningpathway,whereby individualdifferences in hypothalamic-pituitary-adrenal (HPA) axis reactivity affect thesensitivityofdrivers to stimuli in thedrivingenvironment,whichsubsequentlyaffectslearning.5Forexample,asteens gain independent driving experience, they are exposed to a varietyofemotionallyevocativestimuli—suchasnearmisseswith unexpected hazards—which enables them to better anticipate, avoid, and react more effectively in the future. In this hypothesizedpathway, theemotional response (as indicatedbygreater cortisol reactivity) to stressorsandchallengesexperiencedduring the learning-to-driveprocesspromoteseffective learningof necessaryskills.ThefindingsbyOuimetetal4wouldsuggestthat, althoughall teensgainexperienceover timeandthisexperience is associatedwithdecreasingCNCs, individual variation in cortisol reactivity—specificallyaweakeremotional reactivity in responsetohazards—mightattenuate theassociationbetweenexperienceandlowercrashrisk.Furthersupport for theemotional learninghypothesis among teendrivers isprovidedbyprior experimental research. In a small convenience sample of experienced and novice drivers, Kinnear et al6 found that themagnitude of skin conductance response, a physiologicalmeasure of autonomic arousal, to simulateddrivinghazards increased as a function of real-world driving experience. Implications for Researchers Themost immediate implicationof the findingsof theOuimet et al4 study is for continued research tobetter characterize the relationship between cortisol reactivity in response to stressors and crash risk in the general population of healthy teens and among those teenswhomight be at higher crash risk owing to preexisting conditions or history of risky behaviors. For example, variation in function of the HPA axis has been implicated in clinical samples of youthas apotential factor in the development of antisocial disorders, aswell as a variety of internalizing and externalizing disorders.7-9 Although thecurrent studybenefited fromstrongdata collection methods, generalizations are difficult to make owing to the small and likely nonrepresentative sample of healthy, typically developing teens; very few actual crash events; and limited characterization of the near crashes. It remains unclear what proportion of novice teen-driver crashesmight be explained by individual differences in HPA regulation. Previous research has suggested that most crashes involving teen drivers aredue to inexperienceandnotovert risk takingon the part of teens,2,3 lending additional support to an emotional learning pathway. Further research is needed to explicate the mechanisms by which individual differences in the HPA systemcovarybydevelopmental factors, driving experience, and other individual difference variables (eg, attention-deficit/ hyperactivity disorder and conduct disorder) to affect driving behaviors and outcomes.