Graduated Driver Licensing Night Driving Restrictions and Drivers Aged 16 or 17 Years Involved in Fatal Night Crashes - United States, 2009-2014.

Fatal crash risk is higher at night for all drivers, but especially for young, inexperienced drivers (1). To help address the increased crash risk for beginner teen drivers, 49 states and the District of Columbia include a night driving restriction (NDR) in their Graduated Driver Licensing (GDL) system. NDRs have been shown to reduce crashes among newly licensed teens, with higher reductions associated with NDRs starting at 10:00 p.m. or earlier (2-3). However, in 23 states and the District of Columbia, NDRs begin at 12:00 a.m. or later, times when most teen drivers subject to GDL are not driving. CDC analyzed 2009-2014 national and state-level data from the Fatality Analysis Reporting System (FARS) to determine the proportion of drivers aged 16 or 17 years involved in fatal crashes who crashed at night (9:00 p.m.-5:59 a.m.) and the proportion of these drivers who crashed before 12:00 a.m. Nationwide, among 6,104 drivers aged 16 or 17 years involved in fatal crashes during 2009-2014, 1,865 (31%) were involved in night crashes. Among drivers involved in night crashes, 1,054 (57%) crashed before 12:00 a.m. State-level analyses revealed an approximately twofold variation among states in both the proportions of drivers aged 16 or 17 years involved in fatal crashes that occurred at night and the proportions of night fatal crash involvements that occurred before 12:00 a.m. Because nearly all of the night driving trips taken by drivers aged 16 or 17 years end before 12:00 a.m., NDRs beginning at 12:00 a.m. or later provide minimal protection. States could consider updating their NDR coverage to include earlier nighttime hours. This descriptive report summarizes the characteristics of NDRs, estimates the extent to which drivers aged 16 or 17 years drive at night, and describes their involvement in fatal nighttime crashes during 2009-2014. The effects of NDRs on crashes were not evaluated because of the small state-level sample sizes during the 6-year study period.

The Predictive Influence of Youth Assets on Drinking and Driving Behaviors in Adolescence and Young Adulthood.

Drinking and driving among adolescents and young adults remains a significant public health burden. Etiological research is needed to inform the development and selection of preventive interventions that might reduce alcohol-involved crashes and their tragic consequences. Youth assets-that is, skills, competencies, relationships, and opportunities-can help youth overcome challenges, successfully transition into adulthood, and reduce problem behavior. We examined the predictive influence of individual, relationship, and community assets on drinking and driving (DD) and riding with a drinking driver (RDD). We assessed prospective relationships through analysis of data from the Youth Assets Study, a community-based longitudinal study of socio-demographically diverse youth. Results from calculation of marginal models using a Generalized Estimating Equation approach revealed that parent and peer relationship and school connectedness assets reduced the likelihood of both drinking and driving and riding with a drinking driver approximately 1 year later. The most important and consistent asset that influenced DD and RDD over time was parental monitoring, highlighting the role of parental influence extending beyond the immediate teen driving context into young adulthood. Parenting-focused interventions could influence factors that place youth at risk for injury from DD to RDD, complementing other evidence-based strategies such as school-based instructional programs and zero tolerance Blood Alcohol Concentration laws for young and inexperienced drivers.

Alcohol-Impaired Driving Among Adults - United States, 2012.

Alcohol-impaired driving crashes account for approximately one third of all crash fatalities in the United States. In 2013, 10,076 persons died in crashes in which at least one driver had a blood alcohol concentration (BAC) ≥0.08 grams per deciliter (g/dL), the legal limit for adult drivers in the United States. To estimate the prevalence, number of episodes, and annual rate of alcohol-impaired driving, CDC analyzed self-reported data from the 2012 Behavioral Risk Factor Surveillance System (BRFSS) survey. An estimated 4.2 million adults reported at least one alcohol-impaired driving episode in the preceding 30 days, resulting in an estimated 121 million episodes and a national rate of 505 episodes per 1,000 population annually. Alcohol-impaired driving rates varied by more than fourfold among states, and were highest in the Midwest U.S. Census region. Men accounted for 80% of episodes, with young men aged 21-34 years accounting for 32% of all episodes. Additionally, 85% of alcohol-impaired driving episodes were reported by persons who also reported binge drinking, and the 4% of the adult population who reported binge drinking at least four times per month accounted for 61% of all alcohol-impaired driving episodes. Effective strategies to reduce alcohol-impaired driving include publicized sobriety checkpoints, enforcement of 0.08 g/dL BAC laws, requiring alcohol ignition interlocks for everyone convicted of driving while intoxicated, and increasing alcohol taxes.

Driving among high school students - United States, 2013.

During 2004-2013, the number of passenger vehicle drivers aged 16-19 years involved in fatal crashes in the United States declined by 55% from 5,724 to 2,568.* In addition to graduated driver licensing (GDL) programs and safer vehicles,† other possible contributors to the decline include adolescents waiting longer to get their driver licenses and driving less. The crash risk for drivers of any age is highest during the first months of independent driving, and this risk is highest for the youngest teenage drivers. To estimate the percentage of high school students aged ≥16 years who have driven during the past 30 days, by age, race/ethnicity, and location, CDC analyzed 2013 data from the national Youth Risk Behavior Survey (YRBS) and YRBS data collected by 42 states and 21 large urban school districts. Nationwide, 76.3% of high school students aged ≥16 years reported having driven during the 30 days before the survey; 83.2% of white students had driven compared with <70% of black and Hispanic students. Across 42 states, the percentage of students who drove ranged from 53.8% to 90.2%. Driving prevalence was higher in the midwestern and mountain states. Across the 21 large urban school districts, the percentage of drivers varied more than twofold from 30.2% to 76.0%. This report provides the most detailed evidence to date that the percentage of students who drive varies substantially depending on where they live. Such information will be vital as states and communities consider potential ways to improve safety for older teenage novice drivers and plan for safe, affordable transportation options for those who do not drive.

ATV riding and helmet use among youth aged 12-17†years, USA, 2011: results from the YouthStyles survey.

BACKGROUND: National estimates of all-terrain vehicle (ATV) riding patterns among youth in the USA are lacking. METHODS: We analysed the 2011 YouthStyles survey to estimate the proportion of 12-17 year olds in the USA who had ridden an ATV at least once during the past 12 months and summarise their patterns of helmet use. RESULTS: Of the 831 youth respondents, an estimated 25% reported riding an ATV at least once during the past year. The proportion of youth living outside of a Metropolitan Statistical Area who reported riding an ATV was twice that of those living inside of a Metropolitan Statistical Area. Males and females reported similar proportions of riding at least once during the past year, but among riders, the proportion of males who rode ≥6 times was triple that of females. Only 45% of riders reported always wearing a helmet, and 25% reported never wearing a helmet. The most frequent riders had the lowest consistent helmet use, with 8 of 10 youth who rode ≥6 times during the past year not always wearing a helmet. CONCLUSIONS: ATV riding appears to remain popular among youth in the USA, particularly in rural areas, and consistent helmet use while riding is low. A more thorough understanding of gender differences in ATV riding patterns among youth and perceived risks and benefits of both safe and unsafe riding practices might help inform future ATV injury prevention efforts.

Drowsy driving and risk behaviors - 10 States and Puerto Rico, 2011-2012.

Findings in published reports have suggested that drowsy driving is a factor each year in as many as 7,500 fatal motor vehicle crashes (approximately 25%) in the United States. CDC previously reported that, in 2009-2010, 4.2% of adult respondents in 19 states and the District of Columbia reported having fallen asleep while driving at least once during the previous 30 days. Adults who reported usually sleeping ≤6 hours per day, snoring, or unintentionally falling asleep during the day were more likely to report falling asleep while driving compared with adults who did not report these sleep patterns. However, limited information has been published on the association between drowsy driving and other risk behaviors that might contribute to crash injuries or fatalities. Therefore, CDC analyzed responses to survey questions regarding drowsy driving among 92,102 respondents in 10 states and Puerto Rico to the 2011-2012 Behavioral Risk Factor Surveillance System (BRFSS) surveys. The results showed that 4.0% reported falling asleep while driving during the previous 30 days. In addition to known risk factors, drowsy driving was more prevalent among binge drinkers than non-binge drinkers or abstainers and also more prevalent among drivers who sometimes, seldom, or never wear seatbelts while driving or riding in a car, compared with those who always or almost always wear seatbelts. Drowsy driving did not vary significantly by self-reported smoking status. Interventions designed to reduce binge drinking and alcohol-impaired driving, to increase enforcement of seatbelt use, and to encourage adequate sleep and seeking treatment for sleep disorders might contribute to reductions in drowsy driving crashes and related injuries.

Attitudes towards requiring ignition interlocks for all driving while intoxicated offenders: findings from the 2010 HealthStyles Survey.

Ignition interlocks are effective in reducing recidivism among driving while intoxicated (DWI) offenders while installed on their vehicles. However, the devices are not widely used in the USA. This survey gauged public support for requiring ignition interlocks for all convicted DWI offenders including first-time offenders. 69% of respondents supported such a policy. Support was lowest (38%) among persons who reported drinking and driving in the past 30 days. Multivariate regression analysis indicated that support varied little by region, community size or most measured individual characteristics. Persons who did not drink and drive were 80% more likely to support the requirement than those who drink and drive. These findings suggest that laws requiring ignition interlocks for all convicted DWI offenders may face the most opposition in communities with high levels of drinking and driving.

Comparison of 2008 national and state-level self-reported and observed seatbelt use estimates.

The objective of the study was to compare national and state-level estimates of self-reported and observed seatbelt use for 2008. Self-reported seatbelt use from the 2008 Behavioral Risk Factor Surveillance System was compared with 2008 observed seatbelt use published by the National Highway Traffic Safety Administration. The ratio of self-reported belt use to observed use was calculated for each state, and the correlation between the two seatbelt measures was examined using the Pearson correlation coefficient. The median state ratio of self-reported to observed belt use was 0.97. Self-reported use was lower than observed use in 38 states. A moderate association was revealed between the self-reported and observed use (r=0.71, p<0.01). The findings suggest that, as seatbelt use has increased over time, measures of self-reported and observed use have converged, and any upward bias in self-reported use due to social desirability has substantially declined.

Does geographic location matter for transportation risk behaviors among U.S. public high school students?

Introduction: Teen motor vehicle crash fatality rates differ by geographic location. Studies assessing teen transportation risk behaviors by location are inconclusive. Therefore, we explored the role of census region and metropolitan status for driving prevalence and four transportation risk behaviors among U.S. public high school students. Methods: Data from 2015 and 2017 national Youth Risk Behavior Surveys were combined and analyzed. Multivariable models controlled for sex, age, race/ethnicity, grades in school, and school socioeconomic status. Results: Overall, 41% of students did not always wear a seat belt. Students attending schools in the Northeast were 40% more likely than those in the Midwest to not always wear a seat belt. Among the 75% of students aged ≥16 years who had driven during the past 30 days, 47% texted/e-mailed while driving. Students in the Northeast were 20% less likely than those in the Midwest to text/e-mail while driving, and students attending suburban or town schools were more likely to text/e-mail while driving (20% and 30%, respectively) than students attending urban schools. Nineteen percent of students rode with a driver who had been drinking alcohol, and 7% of drivers aged ≥16 years drove when they had been drinking alcohol, with no significant differences by location for either alcohol-related behavior. Conclusions: We found few differences in teen transportation risk behaviors by census region or metropolitan status. Age at licensure, time since licensure, driving experience, and the policy and physical driving environment might contribute more to variation in teen fatal crashes by location than differences in transportation risk behaviors. Regardless of location, teen transportation risk behaviors remain high. Future research could address developing effective strategies to reduce teen cell phone use while driving and enhancing community implementation of existing, effective strategies to improve seat belt use and reduce alcohol consumption and driving after drinking alcohol.

State-level seat belt use in the United States, 2011-2016: Comparison of self-reported with observed use and use by fatally injured occupants.

INTRODUCTION: Despite 49 states and the District of Columbia having seat belt laws that permit either primary or secondary enforcement, nearly half of persons who die in passenger vehicle crashes in the United States are unbelted. Monitoring seat belt use is important for measuring the effectiveness of strategies to increase belt use. OBJECTIVE: Document self-reported seat belt use by state seat belt enforcement type and compare 2016 self-reported belt use with observed use and use among passenger vehicle occupant (PVO) fatalities. METHODS: We analyzed the Behavioral Risk Factor Surveillance System (BRFSS) self-reported seat belt use data during 2011-2016. The Pearson correlation coefficient (r) was used to compare the 2016 BRFSS state estimates with observed seat belt use from state-based surveys and with unrestrained PVO fatalities from the Fatality Analysis Reporting System. RESULTS: During 2011-2016, national self-reported seat belt use ranged from 86-88%. In 2016, national self-reported use (87%) lagged observed use (90%) by 3 percentage points. By state, the 2016 self-reported use ranged from 64% in South Dakota to 93% in California, Hawaii, and Oregon. Seat belt use averaged 7 percentage points higher in primary enforcement states (89%) than in secondary states (82%). Self-reported state estimates were strongly positively correlated with state observational estimates (r = 0.80) and strongly negatively correlated with the proportion of unrestrained PVO fatalities (r = -0.77). CONCLUSION: National self-reported seat belt use remained essentially stable during 2011-2016 at around 87%, but large variations existed across states. Practical Applications: If seat belt use in secondary enforcement states matched use in primary enforcement states for 2016, an additional 3.98 million adults would have been belted. Renewed attention to increasing seat belt use will be needed to reduce motor-vehicle fatalities. Self-reported and observational seat belt data complement one another and can aid in designing targeted and multifaceted interventions.

Nighttime seat belt use among front seat passengers: Does the driver's belt use matter?

INTRODUCTION AND METHOD: We explored the relationship between nighttime seat belt use of right-front passengers and their drivers using observational data from 33,310 vehicles in east Tennessee during March 2015 - May 2017. RESULTS: Overall, nighttime passenger seat belt use varied by 50 percentage points from 92% when drivers were belted to 42% when drivers were not belted, suggesting that part-time seat belt users can be heavily influenced by the seat belt status of their traveling companions. When stratified by vehicle type and sex, passenger seat belt use by driver seat belt status varied as much as 74 percentage points from 96% to 22%. Passenger seat belt use was typically lower when riding with unbelted same-sex drivers than when riding with unbelted drivers of the opposite sex. Conclusions and Practical Applications: This finding suggests that the role of peer influence in decision-making about seat belt use may differ depending on the sex of a vehicle driver and his or her passengers. Further research is warranted to explore this finding as well as other social and cultural influences that have not been fully examined in seat belt research.

Alcohol and marijuana use among young injured drivers in Arizona, 2008-2014.

OBJECTIVE: We examined alcohol and marijuana use among injured drivers aged 16-20 years evaluated at Arizona level 1 trauma centers during 2008-2014. METHODS: Using data from the Arizona State Trauma Registry, we conducted a descriptive analysis of blood alcohol concentration (BAC) and qualitative test results (positive or negative) for delta-9-tetrahydrocannabinol (THC) by year of age, sex, race, ethnicity, injury severity, seat belt use, motorcycle helmet use, and type of vehicle driven. To explore compliance with Arizona's motorcycle helmet law requiring helmet use for riders <18 years old, we examined helmet use by age. RESULTS: Data on 5,069 injured young drivers were analyzed; the annual number of injured drivers declined by 41% during the 7-year study period. Among the 76% (n = 3,849) of drivers with BAC results, 19% tested positive, indicating that at least 15% of all drivers had positive BACs. Eighty-two percent of the BAC-positive drivers had BACs ≥0.08 g/dL, the illegal threshold for drivers aged ≥21 years. Among the 49% (n = 2,476) of drivers with THC results, 30% tested positive, indicating that at least 14% of all drivers were THC-positive. American Indians and blacks had the highest proportion of THC-tested drivers with positive THC results (38%). In addition, 28% of tested American Indians had positive results for both substances, more than twice the proportion seen in all other race or ethnic groups. Crude prevalence ratios suggested that drivers who tested positive for alcohol or THC were less likely than those who tested negative to wear a helmet or seat belt, further increasing their injury risk. Helmet use among motorcyclists was lower among 16- and 17-year-old riders compared to 18- to 20-year-olds, despite Arizona's motorcycle helmet law requiring riders aged <18 years to wear a helmet. CONCLUSIONS: About 1 in 4 injured drivers aged 16-20 years tested positive for alcohol, THC, or both substances. Most drivers with positive BACs were legally intoxicated (BAC ≥0.08 g/dL). All substance-using young drivers in this study were candidates for substance abuse screening and possible referral to treatment. Broader enforcement of existing laws targeting underage access to alcohol and alcohol-impaired driving could further reduce injuries among young Arizona drivers. To further reduce crash-related injuries and fatalities among all road users, the state could consider implementing a primary enforcement seat belt law and a universal motorcycle helmet law.

Characteristics of Single Vehicle Crashes with a Teen Driver in South Carolina, 2005-2008.

OBJECTIVE: Teens' crash risk is highest in the first years of independent driving. Circumstances surrounding fatal crashes have been widely documented, but less is known about factors related to nonfatal teen driver crashes. This study describes single vehicle nonfatal crashes involving the youngest teen drivers (15-17 years), compares these crashes to single vehicle nonfatal crashes among adult drivers (35-44 years) and examines factors related to nonfatal injury producing crashes for teen drivers. METHODS: Police crash data linked to hospital inpatient and emergency department data for 2005-2008 from the South Carolina Crash Outcomes Data Evaluation System (CODES) were analyzed. Nonfatal, single vehicle crashes involving passenger vehicles occurring on public roadways for teen (15-17 years) drivers were compared with those for adult (35-44 years) drivers on temporal patterns and crash risk factors per licensed driver and per vehicle miles traveled. Vehicle miles traveled by age group was estimated using data from the 2009 National Household Travel Survey. Multivariable log-linear regression analysis was conducted for teen driver crashes to determine which characteristics were related to crashes resulting in a minor/moderate injury or serious injury to at least one vehicle occupant. RESULTS: Compared with adult drivers, teen drivers in South Carolina had 2.5 times the single vehicle nonfatal crash rate per licensed driver and 11 times the rate per vehicle mile traveled. Teen drivers were nearly twice as likely to be speeding at the time of the crash compared with adult drivers. Teen driver crashes per licensed driver were highest during the afternoon hours of 3:00-5:59 pm and crashes per mile driven were highest during the nighttime hours of 9:00-11:59 pm. In 66% of the teen driver crashes, the driver was the only occupant. Crashes were twice as likely to result in serious injury when teen passengers were present than when the teen driver was alone. When teen drivers crashed while transporting teen passengers, the passengers were >5 times more likely to all be restrained if the teen driver was restrained. Crashes in which the teen driver was unrestrained were 80% more likely to result in minor/moderate injury and 6 times more likely to result in serious injury compared with crashes in which the teen driver was restrained. CONCLUSIONS: Despite the reductions in teen driver crashes associated with Graduated Driver Licensing (GDL), South Carolina's teen driver crash rates remain substantially higher than those for adult drivers. Established risk factors for fatal teen driver crashes, including restraint nonuse, transporting teen passengers, and speeding also increase the risk of nonfatal injury in single vehicle crashes. As South Carolina examines strategies to further reduce teen driver crashes and associated injuries, the state could consider updating its GDL passenger restriction to either none or one passenger <21years and dropping the passenger restriction exemption for trips to and from school. Surveillance systems such as CODES that link crash data with health outcome data provide needed information to more fully understand the circumstances and consequences of teen driver nonfatal crashes and evaluate the effectiveness of strategies to improve teen driver safety.

Marijuana and alcohol use among injured drivers evaluated at level I trauma centers in Arizona, 2008-2014.

BACKGROUND: We examined marijuana and alcohol use trends among drivers aged ≥16 years evaluated at Level I trauma centers before and after Arizona legalized medical marijuana in April 2011. METHODS: We conducted interrupted time series (ITS) analysis of urine drug screens for marijuana metabolites and blood alcohol concentration (BAC) data from the 2008-2014 Arizona State Trauma Registry. RESULTS: Among 30,083 injured drivers, 14,710 had marijuana test results, and 2590 were positive for marijuana; of these, 1087 (42%) also tested positive for alcohol. Among 23,186 drivers with BAC results, 5266 exceeded the legal limit for their age. Compared with prelaw trends (models if law had not been enacted), postlaw models showed small but significant annual increases in the proportions of drivers testing positive for either substance. By the end of 2014, the proportion of drivers testing positive for marijuana was 9.6% versus a projected 5.6% if the law had not been enacted, and the proportion of drivers with illegal BACs was 15.7% versus a projected 8.2%. When ITS was restricted to only substance-tested drivers, no significant differences were detected. CONCLUSIONS: Despite the small annual postlaw increases in the proportion of marijuana-positive drivers compared with the prelaw trend, alcohol-impaired driving remains a more prevalent threat to road safety in Arizona.

Patterns of alcohol consumption and alcohol-impaired driving in the United States.

BACKGROUND: Alcohol-related motor vehicle crashes kill approximately 17,000 Americans annually and were associated with more than $51 billion in total costs in 2000. Relatively little is known about the drinking patterns of alcohol-impaired (AI) drivers in the United States. METHODS: 2006 Behavioral Risk Factor Surveillance System (BRFSS) was analyzed for alcohol consumption and self-reported AI driving among U.S. adults aged > or =18 years for all states. Alcohol consumption was divided into 4 categories: binge/heavy, binge/nonheavy, nonbinge/heavy, and nonbinge/nonheavy. Binge drinking was defined as > or =5 drinks for men or > or =4 drinks for women on one or more occasions in the past month, and heavy drinking was defined as average daily consumption of >2 drinks/day (men) or >1 drink/day (women). The prevalence of AI driving was examined by drinking pattern and by demographic characteristics. Logistic regression analysis was used to assess the association between drinking patterns and AI driving. RESULTS: Five percent of drinkers were engaged in AI driving during the past 30 days. Overall, 84% of AI drivers were binge drinkers and 88% of AI driving episodes involved binge drinkers. By drinking category, binge/nonheavy drinkers accounted for the largest percentage of AI drivers (49.4%), while binge/heavy drinkers accounted for the most episodes of AI driving (51.3%). The adjusted odds of AI driving were 20.1 (95% CI: 16.7, 24.3) for binge/heavy, 8.2 (6.9, 9.7) for binge/nonheavy, and 3.9 (2.4, 6.3) for nonbinge/heavy drinkers, respectively. CONCLUSIONS: There is a strong association between binge drinking and AI driving. Most AI drivers and almost half of all AI driving episodes involve persons who are not heavy drinkers (based on average daily consumption). Implementing effective interventions to prevent binge drinking could substantially reduce AI driving.

Child passenger restraint use and emergency department--reported injuries: a special study using the National Electronic Injury Surveillance System-All Injury Program, 2004.

INTRODUCTION: In 2004, more than 180,000 child passengers aged

Opioid Prescribing in the United States.

Evidence-based information for nurses on the risks and benefits of prescription opioids.

Texting/Emailing While Driving Among High School Students in 35 States, United States, 2015.

PURPOSE: Determine the prevalence and explore individual- and state-level factors associated with texting/emailing while driving (TWD) among adolescent drivers in the United States. METHODS: Data from 35 states that administered the 2015 state Youth Risk Behavior Survey were analyzed. We used Poisson regression models with robust error variance to estimate prevalence ratios (PRs) for TWD. RESULTS: Among the 101,397 high school students aged ≥ 14 years who had driven a vehicle during the past 30 days, 38% reported TWD at least once. TWD prevalence ranged from 26% in Maryland to 64% in South Dakota. TWD prevalence was higher in states with a lower minimum learner's permit age and in states where a larger percentage of students drove. Multivariable analyses revealed that the likelihood of TWD increased substantially with age, and white students were more likely to engage in TWD than students of all other races/ethnicities. Infrequent seatbelt users were 21% more likely to engage in TWD compared with frequent seatbelt users (adjusted PR = 1.21, 95% confidence interval: 1.16-1.26), and students who reported drinking and driving were almost twice as likely to TWD as compared to students who did not (adjusted PR = 1.91, 95% confidence interval: 1.79-2.04). CONCLUSIONS: Prevalence of TWD among US high school students varied by more than two-fold across states. TWD prevalence was higher in states with lower minimum learner's permit ages and in states where a larger percentage of students drove. Older age, white race/ethnicity, and other risky driving behaviors were associated with TWD.

Associations between sociodemographics and safety belt use in states with and without primary enforcement laws.

OBJECTIVES: secondary enforcement laws (police may issue a safety belt citation only if the vehicle has been stopped for another reason). METHODS: We analyzed 2002 Behavioral Risk Factor Surveillance System data from 50 states and the District of Columbia. We performed multivariable, log-linear regression analyses to assess the effect of sociodemographic characteristics and safety belt laws on safety belt use. Analyses were stratified by the type of enforcement permitted by state laws. RESULTS: Reported safety belt use was higher in states that had primary versus secondary enforcement laws, both overall and for each sociodemographic characteristic examined. Safety belt use was 85% in states that had primary enforcement laws and 74% in states that had secondary enforcement laws. Cross-sectional data suggested that primary enforcement laws may have the greatest effect on sociodemographic groups that reported lower levels of safety belt use. CONCLUSIONS: Primary enforcement laws are an effective population-based strategy for reducing disparities in safety belt use and may, therefore, reduce disparities in crash-related injuries and fatalities.

Trends in teen driver licensure, driving patterns and crash involvement in the United States, 2006-2015.

INTRODUCTION: The Monitoring the Future (MTF) survey provides nationally-representative annual estimates of licensure and driving patterns among U.S. teens. A previous study using MTF data reported substantial declines in the proportion of high school seniors that were licensed to drive and increases in the proportion of nondrivers following the recent U.S. economic recession. METHOD: To explore whether licensure and driving patterns among U.S. high school seniors have rebounded in the post-recession years, we analyzed MTF licensure and driving data for the decade of 2006-2015. We also examined trends in teen driver involvement in fatal and nonfatal injury crashes for that decade using data from the Fatality Analysis Reporting System and National Automotive Sampling System General Estimates System, respectively. RESULTS: During 2006-2015, the proportion of high school seniors that reported having a driver's license declined by 9 percentage points (11%) from 81% to 72% and the proportion that did not drive during an average week increased by 8 percentage points (44%) from 18% to 26%. The annual proportion of black seniors that did not drive was consistently greater than twice the proportion of nondriving white seniors. Overall during the decade, 17- and 18-year-old drivers experienced large declines in fatal and nonfatal injury crashes, although crashes increased in both 2014 and 2015. CONCLUSIONS: The MTF data indicate that licensure and driving patterns among U.S. high school seniors have not rebounded since the economic recession. The recession had marked negative effects on teen employment opportunities, which likely influenced teen driving patterns. Possible explanations for the apparent discrepancies between the MTF data and the 2014 and 2015 increases in crashes are explored. PRACTICAL APPLICATIONS: MTF will continue to be an important resource for clarifying teen driving trends in relation to crash trends and informing strategies to improve teen driver safety.