Source: Ekeh AP, Hamilton SB, D’Souza CD, et al. Long-term evaluation of a trauma center-based juvenile driving intervention program. J Trauma. 2011; 71: 223– 227; doi: 10.1097/TA.0b013e31821cc0fdResearchers from Wright State University in Ohio prospectively examined rates of recidivism among teen drivers convicted of moderate to severe traffic offenses, such as speeding, driving under the influence of alcohol, or being at fault in a crash. Two groups of teens convicted of a similar range of such offenses were compared. One group consisted of teens ordered to participate in a comprehensive prevention program called “Drive Alive” (DA), which was developed as an alternative to traditional sentencing for a traffic conviction. It involved 10 hours over 4 weeks, based in a Level I trauma center. Sessions included exposure to simulated trauma sessions, interactive forums with former trauma patients and their families, meetings with state troopers, and education on drugs and alcohol as well as on driving safety. The control group consisted of a random sample of teens who had committed similar offenses to those in the DA group and received standard sentencing. Rates of recidivism (defined as any traffic citation) in the two groups were compared at six-monthly intervals up to 60 months.Data on traffic offenses of 488 teens (346 male, mean age 17.4 years) who completed the DA program between May 2003 and October 2008 were compared to driving records of 458 “control” teens (326 male, mean age 16.4 years). Over the first six months following completion of DA or traditional sentencing, teens in the DA group had significantly lower recidivism compared to controls (26.4% vs 32.3%, P=.04). This effect was most pronounced for those teens aged 16 or younger (P=.006). After six months these differences diminished and became nonsignificant. Throughout the 60-month study period, rates of speeding citations were consistently higher in the DA group than in the controls, while citations for crashes were lower.The authors conclude that “booster” sessions of the DA program beyond six months may be needed to sustain the initial results of less recidivism in adolescents enrolled in the program.Dr Nelson has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.Motor vehicle crashes are the leading cause of death in teens and young adults.1 Young drivers convicted of traffic offenses are at elevated risk of repeat offenses and at-fault crashes,2 so efforts to reduce recidivism in these teens are well-justified. Unfortunately, educational efforts designed to foster safer driving among teens suffer from a paucity of research support;3 indeed, experts have decried the persistence of unjustified claims for the value of driver education.4 Therefore, the authors of the current study are to be commended for their rigor in evaluating the DA intervention by comparing actual driving records of the DA participants with those of relatively similar control subjects.The chief limitation of the study, which the authors recognize, is lack of randomization. While randomization in a judicial setting is probably logistically unfeasible, a key question left unanswered concerns what factors might have triggered judges’ decisions to send certain teens to the DA program. If these teens tended to have particular characteristics that distinguished them from other convicted teen drivers, the control group would be less comparable to the DA group, producing a potential to bias the findings in either direction. At the same time, the fact that the DA teens were a full year older than the controls might have produced some bias against the DA group, since older teens would likely have been driving more total miles than younger ones in the 60 subsequent months (and might have had greater access to vehicles).Ultimately, even though the DA program did achieve a reduction in recidivism over the initial six months, the authors’ suggestion that “continued education and possible booster interventions” might be necessary for sustaining the effect raises questions of cost and feasibility. A more justified, if humble, conclusion might be that, since such a well-conceived and delivered educational program produced only limited effects, and since teens’ attitudes and behaviors around driving are shaped by many social factors,5,6 we need to seek other methods of motivation. Some advocate a greater role for health care providers in individual education,7 but evidence supporting this approach is also scant. Greater peer or parent involvement might help. Still, we should note that the recent interventions credited with the greatest impact on teen driving outcomes, such as graduated driver licensing,8 have been legislative. Education in this area may work best when coupled with motivation in the form of stiff penalties for traffic convictions, and even stiffer ones for repeat offenses.
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