Keeping Teenagers Safe while Driving – PediaCast 511
- Car crashes are the leading cause of death for teens who are 16 and older. Many of these deaths are preventable. We explore risk factors and share practical tips for keeping teenagers safe as they learn to drive. We hope you can join us!
- COVID-19 Vaccines for Kids
- Keeping Teenagers Safe while Driving
- Center for Injury Research and Policy at Nationwide Children’s Hospital
- Teens on the Road: How Technology, Policy and Parents Influence Driving Safety
Announcer 1: This is PediaCast.
Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.
Dr. Mike Patrick: Hello, everyone, and welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike coming to you from Nationwide Children's Hospital. We're in Columbus, Ohio.
It's Episode 511 for February 9th, 2022. We're calling this one "Keeping Teenagers Safe While Driving". I want to welcome all of you to the program.
We have an important topic for you today, especially if you have teenagers in the house. Of course, learning to drive is a rite of passage for teenagers. But it's also a high-risk time during the learning period and those first few years as an inexperienced driver.
In fact, car crashes are the leading cause of death for 16- and 19-year-olds in the United States. Plus a quarter of a million teenagers end up in US emergency departments every year due to injuries associated with driving. So there's definitely a need to make driving safer for teens. And it's doable once we know specific risk factors and then come up with effective ways to reduce those risks.
Fortunately, there is a team of investigators on the job keeping teenager driver safe, Dr. Matt Zhu and Dr. Ginger Yang, our principal investigators with the Center for Injury Prevention and Policy at Nationwide Children's Hospital. They're on a mission to lower injury and death rates among those teenage drivers. They will be here shortly to share what they're learning and to provide you with practical tips for parents and pediatricians, as we all work together to improve safety for new and inexperienced drivers.
Before we get to them, I have a message from the contact page I wanted to share with you. This comes from Gary in Utah. He says, "Hi, Dr. Mike, thank you for the great content over the years. I value the research and advice you provide. I have heard lots of mixed messages on COVID-19 vaccinations for young kids.
"I want to be as informed as possible when considering this for my children. What is your perspective and feedback? Thanks, Gary."
Well, that is a terrific question, Gary. I think whenever you get mixed messages about anything, it's always important to consider the source of each message, the evidence and experience relied upon to arrive at a particular conclusion or recommendation. Also important are the goals or motivation or agenda of that information source.
Now, fortunately for us, in the United States, we have an extremely trustworthy mechanism in place to look at data and provide recommendations with the goal of protecting those who live in our country. And that mechanism is overseen by the National Institutes of Health, the Food and Drug Administration and the Centers for Disease Control and Prevention.
Now, is it an absolutely perfect system? No, but it is as good and better than any other system in the world. And there are tons of checks and balances. There are public hearings. All of the data is available to sort through, but you do need insight into the context and significance of specific data.
If you're not expert in this area, it is really easy to misinterpret and then misrepresent numbers and the facts behind those numbers and then arrive at conclusion that are quite frankly faulty. So it's really important that you understand where that message is coming from and the expertise of those making that message.
There's also ongoing surveillance with our system after authorizations and recommendations are made in case of unexpected side effects or consequences or complications. And when significant things are found, they act. That's why recommendations change.
People say, "Oh, they were wrong. They didn't know what they're talking about." No, as more data becomes available, we're going to change recommendations based on the best information, on what we know.
And the reason is because at their core, these are good people who pride themselves on doing a fantastic job of keeping us all safe. That's what they do. And they're proud of their work and they're good at their work.
So when the NIH and the FDA and the CDC provide an authorization and recommendation, I trust it, for myself, my family, my children first, and then for the kids and families that I treat. And I do that in that order, because I would never get behind a recommendation that I would not follow myself.
Now, I can pretty much guarantee wherever you're getting mixed messages from, they do not have the same depth of experience, scrutiny and deliberation as those people taking pride in their role of protecting the American people, as individuals, as communities, and as a nation. They really do take that role seriously.
So when a recommendation comes out for kids six months to five years of age to get vaccinated against COVID, I would absolutely 100% do that for my kids. And I would 100% recommend it for children and families I treat. Because that recommendation, that message, will be coming from a system that I trust.
So I hope that helps, Gary. And of course, thanks for the question.
All right, let's move on to our usual reminders. Don't forget, you can find PediaCast wherever podcasts are found. We're in the Apple and Google podcast apps, iHeartRadio, Spotify, SoundCloud, Amazon Music, and most other podcast apps for iOS and Android.
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And if you have a comment for me or a question, much like Gary in Utah, it's really easy to get in touch. Just head over to pediacast.org and look for the Contact link and leave me a message.
Also, I want to remind you, the information presented in every episode of the podcasts is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your healthcare provider.
So let's take a quick break. We'll get Dr. Matt Zhu and Dr. Ginger Yang connected to the studio. And then we will be back to explore keeping teenagers safe while driving. It's coming up right after this.
Dr. Mike Patrick: Dr. Matt Zhu is a principal investigator with the Center for Injury Research and Policy at Nationwide Children's Hospital and a professor of Pediatrics and Epidemiology at the Ohio State University College of Medicine. Dr. Ginger Yang is also a principal investigator with the Center for Injury Research and Policy and a professor of Pediatrics at Ohio State.
One passion they share is keeping teenagers safe as they learn to drive entering the first few years of their driving career, which is a high-risk time for crashes, injury, and death. But before we talk about safe teenage driving, let's meet our guest Dr. Matt Zhu and Dr. Ginger Yang. Thank you both so much for being here today.
Dr. Matt Zhu: Glad to be here.
Dr. Ginger Yang: Thank you, Mike, for inviting us.
Dr. Mike Patrick: Absolutely. It is a pleasure to chat with both of you. And before we jump in to safe driving for teenagers, I had mentioned that both of you are principal investigators with the Center for Injury Research and Policy. What exactly is that, Matt? What is the Center for Injury Research and Policy at Nationwide Children's?
Dr. Matt Zhu: Our center was founded by Dr. Gary Smith and our mission is to reduce injury related to pediatric death and disability. We are one of the first 12 Centers of Emphasis within our Research Institute at Nationwide Children's Hospital. And our center is one of the only nine injury control research centers currently funded by the CDC.
Dr. Mike Patrick: So you really are looking at keeping kids safe and doing whatever research is necessary to make that happen with lots of funding at the federal level. And you've been doing it for a really long time. You've mentioned Dr. Gary Smith kind of started the center way back when.
And I've known Gary for a long time. He was in pediatric emergency medicine before he started that center. And so we go way back. So anyway, you have to tell Gary that I said hi next time that you see him.
Let's go ahead and jump into teenage driving. So Matt, what impact do motor vehicle crashes have on teenagers in the United States. Why should we care about this problem?
Dr. Matt Zhu: Vehicle crashes are the leading cause of death for kids aged 16 to 19 in the United States, about seven teenagers die from motor vehicle crashes every day in the United States. Daily, 700 teenagers are treated in emergency departments for motor vehicle crashes every day in the United States.
Dr. Mike Patrick: So 7 teenagers die and almost 700 are injured every day in the US. That's a lot of kids impacted by car crashes.
And there's also societal costs for distractive driving related crashes. I've seen just here in Ohio, $1.2 billion every year, which is over $2,000 a minute that it really costs society because of distracted drivers and motor vehicle crashes that happens as a result of that.
Ginger, what risk factors are associated with teenage motor vehicle accidents? What are the four main categories that we have to think about?
Dr. Ginger Yang: I think there are many risk factors that elevate the crash risks among teens. First, teenagers, their lack of driving experience. When they are inexperienced, they encounter some situations they don't know how to handle.
Second, probably is they're often exhibiting risk factors. The second is their willingness to take a risk, because they don't recognize that it's a risk. So for example, they are speeding, they follow too close to another car. Or they're drinking after they are driving.
They can also be facing many distractions, for example, cellphone while they're driving. Sometimes, they also have a teen driver passengers in their car and that creates the distraction. And the night time driving also is another issue because when the light situation, they cannot see well, that can affect their decision-making.
So I would just say, experience definitely play a significant role. And another is their willingness to take a risk because they don't know that could be a risk.
Dr. Mike Patrick: So they're inexperienced. They're risk takers in general with all sorts of things in their life. And of course, with cellphones today and smart phones, I mean there's just so much distraction opportunity available inside the car. And then you mentioned, after drinking, after drugs of any kind, really just any substance use and then driving the car can really be an issue. So definitely, lots of ways in which it's risky for teenagers when they get behind the wheel.
Now, in terms of the experience part of it, it seems like things are a little better than when I learned to drive. So when I learned to drive, you took drivers ed. You took a test with an instructor in the car. You took a written test and then you're just given an unrestricted license.
But there's really more of a step-up process these days, right? Tell us about that.
Dr. Ginger Yang: So right now, there is one thing called graduated licensure process. So the teen, as you said in the past, they just take the test and get the driver license.
Now, basically, the first step, they will give them learner permit. So that requires an adult or their parents sitting in the car help them learning to drive. And after that stage, they will go to next stage called the intermediate driver licensure phase or probation period.
So during that phase, the teen can drive without being supervised by adult but they're also in the limited condition to driving, particularly limited to those high-risk conditions. For example, certain times, they cannot drive during the night. They're limited to only one passenger in the car. And they definitely cannot use the cellphone while they are driving.
They also have the age like how old can you start the second phase. And also, how long you need in the first phase before you progress to the second phase. They're driving in this limited phase, of course, when they're 18, they can be at the full licensure. But we also sometimes have years that they are in the second before they go to the next phase, depending on each state. Each state is different.
Dr. Mike Patrick: That's one of the comments I was going to make. It's different from state to state and what you're describing is how it is here in Ohio. And many other states have similar systems.
But as I'm thinking about this, really, we have to let parents play a really big role in this. Because if we're going to say that there are these conditions that you can drive in, your parent doesn't have to be in the car, but you have to maintain these criteria and conditions. There's got to be some trust between the kid and the parent that this is really going to happen. You really are not going to use your smart phone. You really are not going to be driving at night.
And so, how can a parent ensure that those conditions are going to be kept by their teenager?
Dr. Ginger Yang: Parents definitely play the key role in helping their teens become safe driver. And there is evidence showing what the parents what can do. There are several programs showing. The first is they can discuss with the teens, set the contract, what we call the contract. So parents communicate their expectations, when you need to be home. And so they create that contract that both parents and the teen agreed. So the teen follow this contract to practice safe driving behavior. So that have shown effectiveness, it improves safe driving because they communicate with their teenagers.
And the other approach is parents to talk to their teen, communicate with their teen about driving safety. And that needs to start with teaching them about driving, sit in the car when they teach them and talk about the driving safety.
Also, practice with them while they are driving. So practice with them. Tell them this is something you need to watch and how you do. So that way, to help teens become safe drivers.
And our program here at Nationwide, we're actually doing that. We engage parents, training them about utilizing the motivational interview skill to discuss with our teen about driving safety. So in that way, parents discuss with non-judgmental and also motivate their teen's own motivation to want to be driving safe. Instead of, "I do this, because I wanted the key," and so, when they do not have that restriction, they were not driving safely.
Dr. Mike Patrick: Really good points. I want to circle back around to the contract. Do you recommend that you write that out? Like these are the things, and then you sign it and your kid signs it. So when you say that that's a useful thing that has been shown to improve safety, it's actually a written contract, correct?
Dr. Ginger Yang: Yes, that is correct. Basically, that is what a parent need to discuss but to also write down both agree. Because when you write down instead of you talk, everyone remember. And the parents can also utilize to say, "Okay, if you do not do this, you will have a consequence." It is not what they need to do, but what are the consequences associated with it if they did not follow what they had agreed.
So the basic approach is use both. Have the contract, but also motivate teen to drive safely because they want it to be, not because "I want to do this for my parents." They want to do them for themselves so that behavior stay with them even when they become adults.
Dr. Mike Patrick: Yeah, that's great. And we need to model the behaviors that we're asking of our teenagers too, right? So when even before, you may be listening to this and you have a kid that's 13. Now is a good time to make sure that you're following all the safe driving rules yourself, so that you're coming from a place where you're not looking hypocritical or asking your kids to do something that you're not doing yourself. So make sure that you understand the safe rules and follow them.
Matt, what are some of the risk-taking behaviors that are associated with teenagers and motor vehicle crashes? What are the things that parents should especially be watching out for and talking to their kids to make sure that they're not taking those risks?
Dr. Matt Zhu: Yeah, I mentioned two risk factors, one is distracted driving. The other is driving under the influence of alcohol or drugs. Distracted driving is highly linked with cellphone usage. Cellphone related distracted driving include call and texting, looking at apps and various other use.
We analyzed 2019 National Youth Risk Behavior Survey and found that two out of five high school student drivers texted while driving. So basically, it's a high percentage. Studies have shown that cellphone use increases the crash risk by four times.
Another risk factor is driving under the influence of alcohol or drugs. Drinking any amount of alcohol increases the crash risk. Given the same amount alcohol content, teens are more likely to crash than older drivers.
As we all know that marijuana use becomes more accepted due to legalization. As the access to marijuana increases, we see an increased number of teen drivers under the influence of marijuana.
Our recent study found out 13% of high school senior drivers reported driving after marijuana use relative to 5% for driving after alcohol use.
Dr. Mike Patrick: So definitely no smart phones, no cellphones should be used while you're driving. So no texting. And really, it's better not even have phone calls, right? Especially for those really early drivers. And then substance use, definitely a no-no.
Some other risk-taking behaviors that even as adults, as experienced drivers, there's still some risk-taking things that we do that are sort of soft, like speeding, for example. So an adult that's keeping with traffic on the interstate and you're going 5 miles an hour over is different than a teenager who has not had that same experience.
When you think about reaction times, you really want to keep those speeds lower for those earlier drivers. So that's definitely a risk-taking move. And then some kids just want to put to the pedal to the metal and go as fast as they can. And certainly, that's going to be risky.
Paying attention to stop lights, not speeding through the yellow lights but yellow means start slowing down now, not speeding and try to make it to the intersection. So we don't want to run those orange lights, right? The one that are halfway between yellow and red. So that's going to be an important thing to not do.
And then, too many passengers in the car. Not wearing seatbelts, maybe trying your luck on a country road with your lights out just for the thrill of it. These are things that's okay to talk to your kids about, right? You're not going to put those ideas in their head to go out and take those risks by telling them about them, right?
Dr. Matt Zhu: I agree totally with you, Mike. You talked about passengers. Studies have found that passengers are associated with teenage crashes. Carrying one passenger increases the crash risk by 40%. Carrying two passengers increases crash risk by 90%. Carrying three-plus passenger triples the crash risk.
And there's another risk driving factor. It's called night driving. Per mile driven, the fatal crash rate for night driving is four times that for daytime driving. So all these factors, like passenger distraction, night driving factor, they are regulated by graduated driver licensing law because we know they are the known risk factors for teen drivers.
Dr. Mike Patrick: So nighttime driving and the more passengers you have in the car, the more dangerous it is. And then, that's something else to talk to your kids about. They're not only going to be driving. There's going to be instances where they're the passenger and they ought to know that you're going to be safer in that car if you're not distracting the driver while they're trying to drive.
So have the conversations, before you get in the car, maybe just listen to some music. It's a little awkward, you got everybody in the car and no one's saying anything. So I don't know, maybe music would be better. But conversations, you really have to, in engaging, use a part of your brain that is going to be taken away from paying attention to the road. And so, just to keep that in mind.
Are particular ways that we can help lower those risk factors other than just talking about them?
Dr. Matt Zhu: Well, we all know injury prevention framework, it crosses three E's. The first E is education. Today, we are doing PediaCast. This is one from education as you can infer about communicating safe driving among teens.
The second E is engineering to design out hazards. This include technological solutions. And I can discuss this later, we'll have specific risk factors such as cellphone use, text while driving.
So thirdly is enforcement, passing and then enforcing drive safety laws. All these help lower these risk-taking behaviors.
So probably, I can give you one example about engineering. Engineering about the reckless driving technological solutions. For example, we know that a driving mode in a cellphone blocking app, they can block cellphone use when the app or the built-in mode detects the phone is traveling, the owner is driving. It will silence the notifications for calls and text and block your access to the app.
Dr. Ginger Yang: So I want to add is another technological solution we're currently implementing in our study is to provide direct feedback to the teen drivers when they are driving, some reminds them. For example, the technology called in-vehicle device that a lot of insurance company utilize that to check the mileage driven and save the gas.
But we can use that to put in the car that has OBD function that can detect the car moving. So when the teen driver's speeding exceeded the speed limit, the beeper will start. So that in real time, they are reminded "You are speeding," although the parent is not sitting in the car. This serves as a virtual parent to help remind them, "You are speeding," or "You turned too fast here." So the technology can serve that function as well.
Dr. Mike Patrick: And that can be in the form of devices inside the car and also apps on smartphones. And Matt had mentioned, those apps can even detect, "Hey, you're moving in a car now." It's going to block access to texting and phone calls and other apps. And so that can be safe.
And then, those kind of technologies can then send some of that data to the parents, right? And then that will help to inform conversations that you can have with your kids in terms of driving and how they can improve with the safety.
Dr. Ginger Yang: You're correct. Because what we're doing in the study right now is actually utilize that feedback provided to parents. The real-time feedbacks to kids, we also give them summary reporting every other week showing how they did compared to their peers.
So then, we are training parents to use that objective information instead of their own judgement to discuss about their teen driving behavior. So we also instruct parents not only just to focus on negative side, should also praise if they did a good job.
So we find that, actually, the parents like it because they can use this as a teachable moment to teach their teens about their driving safety. And the teenagers also feel, "I have a proof. Maybe I stopped too fast, too sudden, or break too hard. It's because I'm doing the right thing. Some car in front of me, they did wrong. But I did not. So I avoided hitting them."
So indicate also they did a good job. Indicate the proof they did a good job. So I think both sides can help with the technology where it helps with the driving safety.
Dr. Mike Patrick: Yeah, and I love the positive reinforcement. It's easy for us to focus on the negative. So it's always good to give them a pat on the back when they're doing a good job. And then like you mentioned, there may be a reason that you broke too… I mean, if I hadn't done that, I would have crashed the car.
And so the nuances of that doesn't come out unless you're actively having conversations with each other. So really good points.
So the 2019 National Youth Risk Behavior Survey showed that 39% of high school drivers said that they texted and/or emailed at least once while they were driving in the previous month. So I mean that's approaching close to half of teenage drivers. So we definitely have work to do in terms of raising awareness and talking about this because it only takes one text message to result in a tragedy.
So it's really, really important stuff here. And the distraction is not just with texting or email, right? Especially early drivers, even phone calls can be distracting, right?
Dr. Ginger Yang: Yeah, the passenger can be also distracting, especially teenagers in the car. So that is why when they are driving, during the probation period, they're limited to number of passenger in the car, as Matt just mentioned. As you have additional passenger in the car, especially teenagers, that increases the risk.
Now, other distraction can be they are eating food. All this can be also distractive.
Dr. Mike Patrick: Yeah, absolutely. As we think about smartphone use and distraction, the distraction is actually on many levels, right? I mean, in order to manipulate the device, you have to take a hand off of the steering wheel. So you're not at that 10 and 2 position anymore. So that is a distraction.
But also your eyes come off of the road, so we have a visual distraction. And then also, as you're thinking about what you're going to text back, your mind is off of driving. So now you have a cognitive distraction. So it's not just a simple distraction. I mean, it's like on three different levels. And I'm sure that those add up to a huge amount of distraction for teenage drivers.
All right, Matt, let's talk a little bit more about drinking alcohol and drugs and the effect that that has on motor vehicle crashes. There was a 2020 study in JAMA Network Open that showed that nearly 50% of teens reported marijuana use. And many of them reported that they did drive under the influence of marijuana.
Dr. Matt Zhu: Yes, this is our recently published article. As we know, in Columbus, Ohio, medical marijuana has been legalized. And there are efforts to legalize recreational marijuana in Ohio. And nationally, marijuana use becomes more established to both legalization for medical and recreational use.
We definitely see an increase in number of teen drivers under the influence of marijuana. Marijuana substance impairs driving ability critically, vehicle lateral control and then reaction time. Several meta-analysis reported that marijuana increase the crash rate. And the estimate crash risk are varied from 26% to 156%.
Dr. Mike Patrick: And that's mostly through slower reaction times?
Dr. Matt Zhu: Slower reaction time and also vehicle lateral control. This means weaving the lane. It's not maintained within the lane.
Dr. Mike Patrick: So the effects of marijuana sort of making you feel good and having joy do not translate well to controlling the motor vehicle.
Dr. Matt Zhu: That's correct.
Dr. Mike Patrick: And so that's something a lot of parents don't even know that their kids are using marijuana. So if 50% of teenagers report that they have used it recently, there's an opener conversation right now to talk to your kids about are they using marijuana or not?
And we have to be careful how we have those conversations, right, Ginger? You have mentioned in a non-judgmental way. What is your suggestion for kind of strengthening that parent-teen relationship and talking about things that are difficult like marijuana use.
Dr. Ginger Yang: So good point, the difficult conversation do need to occur. So what we say, the parent's non-judgmental, probably use more open-ended question approach instead of "So, let's discuss this issue." And in our program design, we do give a parent's conversation starter.
So they have to discuss because these are the issues that can impact their driving. So that is something parents can discuss with the teen.
Also, even if they're not using, that topic need to be discussed. If they find that they are using that, it even need to be discussed more.
Dr. Mike Patrick: Absolutely. This is something I think, especially if there are folks who are listening, who have young kids, it's really important to start at an early age having open lines of communication without judgement. Because if there's judgement there, kids are not just going talk about it, right?
And so if we really want to help our kids make good decisions, we have to have those hard conversations in a non-judgmental way. But even early on, this starts way before they're 16. So that then when you get to the marijuana discussion, it's not as unexpected because we talked about everything anyway.
So I'll get off my soap box. Generally, as a pediatrician, we definitely want to encourage parents and their kids to have those open conversations because they really are so important.
So how can parents strengthen the parent-teen driver relationship? How can we make that stronger, Ginger?
Dr. Ginger Yang: In addition to the effective communication as we said, the discussion of these parents also can provide more positive supervised driving experience. So parents need to engage when they are learning, provide supervised driving experience including teaching them about different road type. So kind of hand-holding as they go in.
Also, parents themselves need to have good driving behavior for the teen to model. We find our study, we teach parents about safe driving discussion with their teens. Actually, they said, "Okay, I better do it myself, not using the cellphone while I'm driving. I'm also not speeding." Because sometimes, the parents also rush and are speeding.
So parents, to be a good role to their teen. And the most important when it comes to the driving, as we said, non-judgmental, also be supportive to their teens when they are learning to drive.
Understand that yes, everyone make a mistake, but to make sure next time, you don't make a mistake when you're driving.
Dr. Mike Patrick: Yeah, absolutely. Matt, so we've talked about some of the technologies that parents can tap into to help their kids drive more safely, the trackers that are in the car and the smartphone apps.
I understand that you did a research study on the effectiveness of the smartphone apps. Can you tell us a little bit about that?
Dr. Matt Zhu: This is an active study. We will recruit about 1,200 young drivers around Columbus, Ohio. And this is a randomized controlled trial. And this is a five-year project and we will start in March this year.
So basically, we have two active interventions. One is built-in cellphone driving mode. This can be Apple's Do Not Disturb While Driving or Google's Do Not Disturb While Driving, or Verizon's driving mode in Messages+ app.
And then, we also have a commercial cellphone blocking app. So they will be compared to see either the cellphone blocking app or the built-in drive mode. Are they effective? Do they have the same effectiveness or one is better?
We hypothesize both the built-in drive mode and the commercial cellphone blocking app have similar effectiveness. And the built-in mode are free and they have the systems upgrade from the phone operating system. So we are just starting this project. It's a five-year project.
Dr. Mike Patrick: Got you. So the application that's just a part of the phone, is there something within the settings that you activate those kind of modes?
Dr. Matt Zhu: So basically, for example, for built-in driving mode with iPhone, there's an option you can set for a Do Not Disturb Option. You can choose based on the phone GPS or when there's Bluetooth connection with the vehicle, then the mode will be activated. And it is tasked to block calls, text, every use.
And there's also be a visual message to show you that you will not receive notification while you're driving. And also, you have the option to automatically reply that you are driving. You will now reply to read the calls and texts later after you stopped driving.
Dr. Mike Patrick: And so, your study is looking at those systems that are just built in to the phone to detect that you're driving and to sort of cut off communications at that point versus commercial apps that you install. And so, you're thinking that there probably going to be equally effective but you're trying to show that with your data, correct?
Dr. Matt Zhu: That's somehow correct. And so, basically, I didn't mention, we have a like a three arms. In randomized controlled type, we have to have a control arm. For this control arm, we have an active cellphone blocking app. So that can block any calls, text. Just run it in the background, detect all these calls and texts.
And then, two intervention arms, one is the built-in drive mode. The other is the cellphone blocking app. So we're going to compare with the control arm. And also will compare these two.
While we hypothesize that these two intervention arms, the built-in drive mode and the cellphone block app as effective, why do we have the cellphone blocking app? One reason is that need to detect all the calls and texts. If we just have the driving mode, they are purely by Apple. They don't provide the ability to detect any calls and text. With the commercial app, we can set it active or inactive. So we can detect all these calls and texts.
Dr. Mike Patrick: Got you. So the control arm just has an app so that you can keep track of when people are driving and whether calls or texts are happening or not. And then, the built-in app, that's one arm. And then the app with the app in it is the other one.
Dr. Matt Zhu: That's correct. So I also want to talk about some technology solution we are working to improve general teen driving. We are finishing a driving app called Behind the Wheel. This app is in coordination with our Research Information Solutions and Innovations, RISI.
We developed this app to quantify driving behaviors and promote safe driving behaviors among teen drivers. So basically, this cellphone app tracks driving behaviors such as speeding, hard-braking. It will provide individualized feedback on driving errors, driving safety score, and driving badges for teens.
It also has a teen-supervised driving activities for parents to practice with teen drivers. And these activities include parking, curb driving, in the rain, and so forth.
So basically, we do have a pilot project with CDC. This is a feasibility trial. And then we plan to enroll 90 teens to pilot test this app and determine the preliminary efficacy of this app.
Dr. Mike Patrick: Yeah, so this is an app that really does the in-vehicle tracking stuff would do, right?
Dr. Matt Zhu: Yeah.
Dr. Mike Patrick: So it's going to show you, it's kind of like a black box, like an airplane black box, right? To let you know, are you braking hard? Are you accelerating too quickly? Are you speeding? And then reports that information back to the parent again to inform conversations. And then your research is to look, does this increase safety, right?
Dr. Matt Zhu: Yes. And so, this app is different from Dr. Ginger Yang's project. This is more toward like the teens. So the app is sorts of the teen's form and the feedback is provided directly to the teens. It's for general all the teen drivers.
And I think for that of Ginger Yang's study, it's focused on teens with traffic citations. So this is more towards the teen driver side.
Dr. Ginger Yang: Yeah, that is correct. We use the technology. Our study is focused on high-risk teen drivers, those drivers who are 16 and 17 years old. They're starting independent driving first time, so they can drive without adults sitting next to them. But these teen drivers also received traffic citations.
So the research is showing, first, the teen driver already have three or four times risk compared to 20 years older. And if they received the citation, those make even higher risk about the crash. Because they tend to those certain behavior patterns associated with the risk.
So our study basically used when they received citation, parents care about their teen drivers. So we use this as a teachable moment, because they receive the citation, now parents are talking, "Okay, my insurance increased because you are on my insurance," right?
And then, parents also care about because if they make one mistake, they can make another citation or that mistake can cause their life. So we use that as a teachable moment. We put that in-vehicle device in the teen driver's car.
This is also a randomized trial with one group as a control. Now, one group, just feedback from technology only. Then, another group, we have a feedback.
Plus, parent training, we're training parents, utilize motivational interview technique to discuss with their teen about driving safety use. Use the feedback from the device and also report from device, as I just mentioned. So in that way, take that teachable moment to help teen improve their driving safety.
Dr. Mike Patrick: Thank you for that clarification. So Ginger, your research is really focused on those high-risk drivers and then parents using the information from the tracker to inform conversation. And Matt, your current research is really more an app on the teenager's phone that's going to give feedback to the teenager on a regular basis, on how they're driving and then to see if that kind of technology helps to improve safety and decrease crashes and injuries and deaths, right?
Dr. Matt Zhu: That's correct.
Dr. Ginger Yang: Yeah, you are correct. And I think, also, Matt's study population is early when they just start learning to drive. So at this time, first time learning. But my study population is those teenagers already passing that supervised period. So they become most high risk so they can drive unsupervised for the first time.
But the approach, overall, we use a different approach. Both Matt's study and our study is with the goal to help these teenagers to be safe drivers.
Dr. Mike Patrick: What kind of timeline is your… So I think, Matt, did you say it's a five-year project? So when are we looking to having results?
Dr. Matt Zhu: So I have like two projects. Basically, now with teen drivers, for this project, it will start February of this year. And this is a two-year-and-a-half project. So it will end July of 2024.
And another project is really about cellphone use while driving, the technological intervention, that's a five-year project. For that project, it will end in 2026.
Dr. Mike Patrick: So you guys have all kinds of stuff going on. And we're going to have more answers and be able to improve safety based on your research in the coming years for sure.
So Matt, there is a driving simulation lab at Ohio State. What exactly is that?
Dr. Matt Zhu: This driving simulation lab offers a state-of-the-art facility to measure driving behaviors. They have three separate simulator systems: a fully-instrumented sedan cab, a drive-on setup, and also a desktop simulator.
Actually, Dr. Ginger Yang uses the driver simulation lab and she can add more details.
Dr. Ginger Yang: Thank you, Matt. We can tell you a little bit about using the driving simulator with our current study. It actually is also funded by NIH. So that is called using the most sophisticated, it is high-fidelity driving simulator. So that driving simulator have a full cab. Just the person driving just sitting in the real car that is a Honda Accord. That is actually provided by Honda because OSU have a collaboration with them.
Then, the person is driving in the car. The car is not moving but the screen is a full cab. The screen is actually moving so you feel like you are driving in the real world.
So our study is actually utilized to study about the teen drivers when they have a TBI, how that TBI affect their driving, and when they can be ready to return to driving. So the study is focused on teen drivers when they're injured, they had a TBI. This age group is 16 to 20 because we know that teens also have high risk of crash and also have high risk of TBI. So the group is high risk for both issues.
So when the kids suffer TBI, the teen driver had the TBI, that affect their decision-making and also affect their reaction time because of the brain injury. And driving is such that you need to make a decision with a different situation in such a short time.
So we actually have a teenager who had a TBI driving on the driving simulator. And then, we also have a match to control who doesn't have a TBI also driving at driving simulator. So we can compare if they have any deficit after their TBI.
In addition to that, because they are in the driving simulator, so we actually add and increase the cognitive load when they are driving. So we provide the distraction to the driver when they are driving in the driving simulator without actually risking them.
So the question we want to answer first is whether the TBI affect their driving. So we compare them with their uninjured control.
Second is maybe they can drive but not in the distractive situation with high cognitive load. So maybe if not too many traffic, they can drive. But if the traffic situation, they should avoid. So we have that additional to see the cognitive load to help them.
So based on the result, the physician maybe make decision or recommendations and say, "Okay, first you should not be driving. Second, you probably can only drive under certain condition, not of the other," to address that research question.
Then, we follow them from their injury. We have them driving every week until their symptom resolution. Then we have them driving another try. So in that way, we can see their driving performance. So we can say, "Maybe you don't go back first week. Maybe you can go back the second week."
So far, this is collaboration with University of Alabama. So both sides will do the same protocol. So far we had enrolled two cases. Both cases cannot finish the simulator, the first, within 96 hours. That indicates maybe it is not safe. But we don't know, we just have two cases enrolled.
Dr. Mike Patrick: So this is really early on in the research. I just want to point out for folks, TBI is traumatic brain injury. So we're talking about kids with concussion.
And just as there are recommendations for returning to school after concussion and there are recommendations for returning to sports and physical activities, and slow return, and physician supervised return after concussion, what we're saying is that most likely, there needs to be a slow return to driving as well.
But we want numbers to prove this. And is it safe after one week? Is it safe after two weeks? Do you really have to wait for the symptoms and how long do you have to wait for the symptoms to be gone? We want to answer all those questions, but we don't want to do it by putting kids at risk on the road. So we moved them into the driving simulator to drive at various points after their concussion, to see what point it's safe or not safe.
And then, so you've only enrolled two people. And I suspect there's going to be more. I'm sure the pandemic has not helped with that. So I think there are as many kids getting concussions during the pandemic. But once school sports is back completely normal, unfortunately, we'll see more concussions.
Can folks get in touch with you to see about enrolling if their child has a concussion in their driving age?
Dr. Ginger Yang: Yes, of course. And we just started the second year. As you said, the pandemic could have affected it. But we also need them to be in the study within 96 hours of injury. So we actually are going to the schools to tell them about the study so we want them to be in our study. And that we are not taking those individuals who are in the learner phase. We are taking those individuals who either have probation driving license or the full license.
But I really appreciate you made the point about return to play and the return to school. So right now, there is no guideline about when the teens can return to drive. In Canada and Australia, they have recommendation, no driving within 24 hours but in United States, no such recommendation. The most study conducted to return to driving is among those who have severe TBI.
So they have the period of not driving, then they return to driving. But there is no study looking at teen drivers who's still learning to drive. Their driving skills has not fully developed. When they have concussion, also type of a mild TBI, that really impacted them, their judgment could put them, not only themselves, but also other drivers.
Thinking about the football player driving himself to the football games, sustained the concussion. Then so what, is he driving back himself or need someone actually driving him back?
So those issues, we hope our data can provide evidence for clinician make the recommendation.
Dr. Mike Patrick: Yeah, I definitely think that will be helpful. And just as an aside, a little shop talk here. You may want to tap into the emergency department in terms of recruiting folks to enroll in your study. Because we see a lot of kids with concussion. And we, of course, have research assistants and I'm sure that there could a collaboration with getting more kids enrolled that would meet your criteria. But we can talk about that after the podcast itself.
Dr. Ginger Yang: Yeah.
Dr. Mike Patrick: So what is up next then? You guys have a lot of projects ongoing. What other questions do you have? What other research do you see in the future related to safe driving?
Dr. Matt Zhu: So Mike, I want to add something. Maybe this is related to driving simulation research or the max safe driving research. We are planning a project to work with Maria Tiberi Foundation Simulator Lab. The driver simulation lab is not at Ohio State. It's at the Tolles Career and Technical Center in Plain City. And it features 25 desktop built-in simulators.
They have 16 different lesson plans. And this lesson takes about six hours to complete. So we are discussing this project with Maria Tiberi Foundation. They plan to enroll about 140 teen drivers a year to evaluate the effectiveness of this driving stimulator lesson.
For folks who are not familiar with Maria Tiberi Foundation, this foundation was established by Dom Tiberi. Dom is the weekday sports anchor of 10TV News in Columbus, Ohio. And this foundation was established to honor his daughter, Maria. And their efforts are devoted to better driver training and distraction-free driving in Ohio.
So this is the project we are trying to do. In this project, we will evaluate the effectiveness of driving education. I think the effectiveness of driver education classes in terms of improving driver safety, this is still unknown in the academic field. Also, Maria Tiberi Foundation has these driver stimulation lessons. And with our randomized controlled trial, we can evaluate the effectiveness of these driver stimulations for teen drivers, for the new drivers.
Dr. Mike Patrick: So as new teaching techniques and ways to impart information comes about, we can test that safely in a driving lab, rather than seeing how many accidents actually happen and then finding out what kind of instruction that they had. So it's just a safer way to figure out best practices for driver education.
Dr. Ginger Yang: I would say, probably, it's just an additional in the innovative way to deliver the educational stuff that you just mentioned. So instead of you just go to the website for the lesson or give you the printed material, this have you hands-on. Actually, you practice the driving skills in the simulation, the environment. So you actually encounter the high-risk situation, instead of you just reading it. You actually experience it.
So in that way, when you're actually driving in the car, you already experience certain events and then knows how to deal with it.
Dr. Mike Patrick: Kind of like flight simulator for airline pilots.
Dr. Ginger Yang: Yes.
Dr. Mike Patrick: And you start throwing emergencies at them and see how they handle it, the same kind of thing. I bet the teenagers really love it. It's kind of a fun thing, right?
Dr. Matt Zhu: Yeah, this is really fun. And they have some high school student to kick it and they love it. The funny thing is I was there to test these simulation lessons with five of my team members. And all my team members enjoyed it very much.
I think someone passed the test with maybe 100% score. But another team member failed the test and were put in jail because of something. I've forgotten, maybe he intended to or something what's it like to be put in jail. And then, they have like all these legal procedure.
Yeah, it's really great, a driver simulator and you have a steering wheel. You have the break. And it feels real.
Dr. Mike Patrick: That is fantastic. And that's at Tolles Technical School in Plain City, you said.
Dr. Matt Zhu: Yes.
Dr. Mike Patrick: Yeah, great. So Ginger, we haven't talked about policy at all yet. There are a lot of states have cellphone laws that are present. How effective are those at keeping all of us, not just teenagers safe.
Dr. Ginger Yang: So you made very good point because researchers show that when the top down, that is a policy always important because that could help the behavior change or outcome. So having a policy itself may not be sufficient. So having it on the book is not sufficient. We need to bring it to street. So how to enforce it, that is very important. I know that here, the enforcement may not be much, even having a policy if you're not going to enforce, it's not going to make the impact.
I know Dr. Zhu have done some research with cellphone laws. Those, maybe he can tell you more. But I think it is very important to have the policy, to improve the outcome. Dr. Zhu?
Dr. Matt Zhu: Yeah, like Ginger mentioned, there are two aspects of policy intervention. One is having the law on the book. The other is to have the actual enforcement. I would say both are effective. The graduated licensing law is just a law on the book. The problem is to enforce the law. Actually, they have no active police enforcement. The graduated licensing law have been shown to be very effective.
Our research have shown that graduated licensing law have been reduced traffic crashes by teenagers for 20%. This is just a law on the book.
Another, when we talk about the cellphone laws. We recently just analyzed US fatal crashes from 1999 to 2016. And we found that comprehensive handheld ban was associated with lower driver fatality rate. Basically, the comprehensive handheld ban bans almost all handheld cellphone use, including calling, texting and app use.
We also found that calling-only ban, texting-only ban, and calling-and-text ban don't have the same life-saving benefits as the comprehensive handheld bans. Currently, about 20 city states have comprehensive handheld bans and we strongly encourage the remaining states to pass comprehensive handheld bans. And it all finally has got a lot of media attention and it has been reported by over 240 TV stations, including CBS, NBC and ABC.
So definitely, I would say it's important to have the laws in books and then you put there active enforcement, if that's possible. You may have more effect, in terms of cellphone laws here.
Dr. Mike Patrick: So the graduated programs with supervision and gradual increasing of independence of the teenage driver is really the way to go, especially when parent take an active role and making sure that all the safety guidelines are followed and having those conversations with their kids.
I'm going to wrap things up with the top six pieces of advice that pediatricians can give to support safe teen drivers. We do have a lot of pediatric providers who listen to this podcast. And so, these are things that you can talk about with your families but then these are also things that are going to be important for parents to talk with the kids about.
So I'm just going to run through this really quick. And it really goes again down to those four big risk factors that we have talked about: inexperience, risk-taking behaviors, substance use, and distractions.
And those six big pieces of advice would be, of course, don't drive at all after drinking alcohol, using marijuana or other drugs. So there's the conversation about kids using them to begin with, but the important thing here is do not drive after you use them.
And then, put those phones down. Use hands-free options if it's an absolute must. So you know that Bluetooth connectivity and you push the button on this steering wheel to make the phone call. So it's hands free, so both hands are still on the wheel. But the best thing is don't use your cellphone at all, unless it's an emergency and you really do need to contact someone.
And then, number three is to keep a safety-first mindset that driving is a privilege and that it should be taken seriously. And again, by having the contract with these things written down kind of reinforces that it is a real serious thing. And the fact that we're going to talk about it and kind of monitor your driving and those kind of things.
And then, I love number four, and that's to communicate what the teen driver is doing well, in addition to what areas need improvement. So that positive reinforcement, partly, have good conversations in addition to the difficult conversations.
And then, number five is to set expectations for safe driving and enforced those expectations with consequences. And so, what those consequences are is going to really be depended upon your family and what motivates your child to not want those consequences to occur.
It may be you can't drive for a week. Or it might be you can't watch TV for a week. Or you can't hang out with your friends for a week or whatever. Whatever is going to motivate your kids to take this seriously, to not only have those consequences in place but be ready to follow through with whatever these consequences are.
And then, finally, number six is that parents should always be a role model for safe driving. So no driving after substance use. Avoid distractions yourself. Avoid risky behaviors.
And you should really be doing that as soon as your kids are able to watch you drive, which is really during the young child years. So if they grow up with the role model of safe driving. The hope is that they'll more likely to become safe drivers themselves.
So those are the six big ones, right? Did I miss anything there?
Dr. Ginger Yang: No, you said it very well and these six are very good advice to parents.
Dr. Mike Patrick: So everybody pause and rewind couple of minutes and just listen to those again. And that will also help you write those contacts for your teenage drivers.
Dr. Matt Zhu: So…
Dr. Mike Patrick: All right… Yes, please.
Dr. Matt Zhu: Mike, I just want to add, we talked about teachable moments, right? When an injured teen visit an emergency department, at that moment, he or she is more open to receiving some communication counseling about changing their behaviors. These are the teachable moment when they are injured.
This can also happen if you are in the regular pediatric visit. When they are injured, they might be more open to receiving messages about changing their behavior.
Dr. Mike Patrick: That would be an interesting Helping Hand with these six things on it that could be handed out in the emergency department, when kids do come in from car accidents, to help facilitate those teachable moments. See, more shop talk here as we're trying to figure out how to collaborate in the emergency department.
All right, we are going to put a couple of links in the show notes for you over at pediacast.org. We'll have a link to the Center for Injury Research and Policy at Nationwide Children's Hospital if you'd like to learn more about their work.
And then, there was a really great article in Pediatrics Nationwide which is a publication of Nationwide Children's called Teens on the Road: How Technology, Policy and Parents Influence Driving Safety. Really well-done article and I'll put a link to that in the show notes as well, so folks can find it very easily.
So we really thank both of you for your time today. And hopefully, we can make the roads safer for all of us, and especially for teenagers drivers by following all the things that we talked about today. So Dr. Matt Zhu and Dr. Ginger Yang, both with the Center for Injury Research and Policy at Nationwide Children's Hospital. Thank you both so much for being here.
Dr. Ginger Yang: Thank you.
Dr. Matt Zhu: Thank you, Mike, so much. We really appreciate the opportunity to discuss safe teenage driving here.
Dr. Mike Patrick: We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that.
Also, thanks to Dr. Matt Zhu and Dr. Ginger Yang, both with the Center for Injury Research and Policy at Nationwide Children's Hospital.
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Thanks again for stopping by. And until next time, this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids. So, long, everybody.
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This was one of the best pediacast I have every heard, it hits close to home as I have a 15yr old. I would like to share these statistics with my daughter’s school. Is there an educational points document you have developed that will allow me to educate students and parents?
There is a link to one in the show notes!