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INTRODUCTION: Prior work has found incongruencies in injury information reported by crash and hospital records. However, no work has focused on child passengers. The objective of this study was to compare crash scene and hospital-reported injury information for crash-involved child passengers. This study also explored injury location and severity by child age and restraint type. METHODS: Utilizing linked New Jersey data from 2017 through 2019, the authors identified crash-involved child passengers <13 years old and their injuries in crash and hospital reports. Then, they characterized the congruency of injury frequency, severity, and location, as well as the frequency of injuries by child age and restraint type. Analyses were conducted from December 2023 through February 2024. RESULTS: Of 84,060 crash-involved child passengers, crash reports documented 7,858 (9%) children with at least "possible" injuries, while 2,577 (3%) had at least one injury in hospital events. Crash report and hospital data were incongruent for both body region of injury and injury severity. The proportion of children injured increased as children's ages increased and as restraint type progressed. CONCLUSIONS: Crash reports overestimated the number of injured child passengers and misrepresented injury severity and locations. Child restraint systems mitigated a child's injury risk. Importantly, injury information documented on crash reports currently informs the allocation of traffic safety resources. These results highlight the importance of improving these reports' accuracy and underscore calls to link administrative datasets for public health efforts.
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In 2021, there were 11.7 million licensed young drivers in the U.S. This is 1.5 million fewer young drivers compared to 2007. The phenomenon of delay in driving licensure among teens has notable implications for opportunities positioning them for life success when transitioning into emerging adulthood and in later life.
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Conducción de Automóvil , Concesión de Licencias , Humanos , Conducción de Automóvil/legislación & jurisprudencia , Adolescente , Concesión de Licencias/legislación & jurisprudencia , Estados Unidos , Bienestar Social , Adulto JovenRESUMEN
Alcohol-impaired driving is a formidable public health problem in the United States, claiming the lives of 37 individuals daily in alcohol-related crashes. Alcohol-impaired driving is affected by a multitude of interconnected factors, coupled with long delays between stakeholders' actions and their impacts, which not only complicate policy-making but also increase the likelihood of unintended consequences. We developed a system dynamics simulation model of drinking and driving behaviors among adolescents and young adults. This was achieved through group model building sessions with a team of multidisciplinary subject matter experts, and a focused literature review. The model was calibrated with data series from multiple sources and replicated the historical trends for male and female individuals aged 15 to 24 from 1982 to 2020. We simulated the model under different scenarios to examine the impact of a wide range of interventions on alcohol-related crash fatalities. We found that interventions vary in terms of their effectiveness in reducing alcohol-related crash fatalities. In addition, although some interventions reduce alcohol-related crash fatalities, some may increase the number of drinkers who drive after drinking. Based on insights from simulation experiments, we combined three interventions and found that the combined strategy may reduce alcohol-related crash fatalities significantly without increasing the number of alcohol-impaired drivers on US roads. Nevertheless, related fatalities plateau over time despite the combined interventions, underscoring the need for new interventions for a sustained decline in alcohol-related crash deaths beyond a few decades. Finally, through model calibration we estimated time delays between actions and their consequences in the system which provide insights for policymakers and activists when designing strategies to reduce alcohol-related crash fatalities.
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Accidentes de Tránsito , Consumo de Bebidas Alcohólicas , Conducción de Automóvil , Humanos , Adolescente , Estados Unidos/epidemiología , Masculino , Femenino , Adulto Joven , Accidentes de Tránsito/estadística & datos numéricos , Accidentes de Tránsito/prevención & control , Consumo de Bebidas Alcohólicas/epidemiología , Consumo de Bebidas Alcohólicas/psicología , Conducción de Automóvil/psicología , Conducción de Automóvil/estadística & datos numéricos , Conducir bajo la Influencia/estadística & datos numéricos , Conducir bajo la Influencia/prevención & control , Modelos TeóricosRESUMEN
PURPOSE: Driving after drinking is a preventable threat to public health. We examined the prospective association of adolescent-reported parental monitoring knowledge (PMK) with recurrent driving after drinking in emerging adulthood. METHODS: We analyzed six annual rounds (1-4, 6, 11) of the National Longitudinal Survey of Youth 1997 with a sample of 5,261 participants. PMK variables were created to recategorize parental monitoring measures by age of the youth. Recurrent driving after drinking was measured in 2002 and 2007 and dichotomized. Unadjusted and adjusted binary logistic regressions analyzed the association of PMK at ages 14, 15, 16, and 17 with recurrent drinking after driving in 2002 (ages 18-23) and 2007 (ages 22-28). Adjusted models included age, sex, race, household income, and education. RESULTS: Mother's PMK from ages 14 to 17 was inversely associated with recurrent driving after drinking in 2002 (adjusted odds ratios [AORs]: 0.89 [p = .003, age 14], 0.93 [marginal p = .062, age 15], 0.88 [p = .0003, age 16], 0.88 [p = .0003, age 17]). By 2007, the only significant association between mother's PMK and recurrent driving after drinking was for age 16 (AOR: 0.95, p = .017). For father's PMK, significant inverse associations were only found for ages 16 and 17 with 2002 recurrent driving after drinking (AORs: 0.93, p = .025 and .88, p = .0005) and age 15 (AOR: 0.95, p = .021) with 2007 recurrent driving after drinking. DISCUSSION: Adolescent perceived PMK appears to offer protection against recurrent driving after drinking in emerging adulthood. This protective effect appears to wane as youth reach their mid-twenties.
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Conducir bajo la Influencia , Humanos , Adolescente , Femenino , Masculino , Estudios Longitudinales , Adulto Joven , Conducir bajo la Influencia/prevención & control , Conducir bajo la Influencia/estadística & datos numéricos , Responsabilidad Parental/psicología , Adulto , Estudios Prospectivos , Conducción de Automóvil , Relaciones Padres-Hijo , Conducta del Adolescente/psicología , Consumo de Bebidas Alcohólicas , Consumo de Alcohol en Menores/prevención & control , Consumo de Alcohol en Menores/estadística & datos numéricosRESUMEN
OBJECTIVE: To explore shared and distinct parental influences on rural and suburban adolescents' riding with an impaired driver (RWI) and driving while impaired (DWI) behaviors during high school. METHODS: Participants in the NEXT Generation Health Study (NEXT) were classified into four RWI/DWI trajectory classes (i.e., Abstainer, Escalator, Decliner, Persister) which described patterns of RWI/DWI from high school to emerging adulthood. A follow-up, in-depth, qualitative interview was conducted with a purposeful selection of participants from each trajectory class between March and September 2020. Guided by Ecodevelopmental Theory, the interview included questions which explored parent-teen influences on driving and RWI/DWI. RESULTS: Imposition of a curfew was a shared parental influence in rural and suburban contexts. Unique to the rural context, parent modeling of RWI/DWI was described as normative and occurring since childhood. CONCLUSIONS: Prevention interventions targeting parent RWI/DWI may reduce their children's risk for RWI/DWI among rural adolescents.
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Conducción de Automóvil , Niño , Humanos , Adolescente , Adulto , Consumo de Bebidas Alcohólicas , Accidentes de Tránsito/prevención & control , Padres , Instituciones AcadémicasRESUMEN
OBJECTIVE: To explore decisions and perceptions of engaging in riding with a cannabis-impaired driver (RWI) during high school and young adulthood to build context around RWI-cannabis events. METHODS: Participants were sampled from the NEXT Generation Health Study (NEXT), a 7-year national cohort study of adolescent health behaviors. Four RWI and driving while impaired (DWI) trajectories classes (i.e., Abstainer, Escalator, Decliner, Persister) were previously derived.A theoretical model based on ecological systems theory guidedin-depth semi-structured interviews to includecomplex, social-developmental and environmental multi-level factors affectingpersonal experiences with RWI-cannabis during high school, after high school, and during young adulthood. Participants (n = 105) were purposively selected from each trajectory class for follow-up, in-depth, qualitative interviews. All interviews were conducted via Zoom between March and September 2020. RESULTS: Two unique themes emerged as facilitators of RWI-cannabis: "Driving Context" and "Trust in Driver". "Legal Concerns" and "Concerns with Safety Emerge with Age" were themes that described deterrents to RWI-cannabis. CONCLUSIONS: Current data suggest that youth RWI-cannabis occurs during daytime hours and while driving to everyday activities. Youth report legal concerns as a potential deterrent to RWI-cannabis in high school and concerns for safety emerge in young adulthood. The multifaceted nature of RWI-cannabis among young drivers identifies potential complexities for programming designed to reduce RWI/DWI-cannabis.
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Conducción de Automóvil , Cannabis , Adolescente , Humanos , Adulto Joven , Adulto , Estudios de Cohortes , Consumo de Bebidas Alcohólicas , Accidentes de Tránsito/prevención & controlRESUMEN
Importance: Alcohol use disorders have a high disease burden among US Latino groups. In this population, health disparities persist, and high-risk drinking has been increasing. Effective bilingual and culturally adapted brief interventions are needed to identify and reduce disease burden. Objective: To compare the effectiveness of an automated bilingual computerized alcohol screening and intervention (AB-CASI) digital health tool with standard care for the reduction of alcohol consumption among US adult Latino emergency department (ED) patients with unhealthy drinking. Design, Setting, and Participants: This bilingual unblinded parallel-group randomized clinical trial evaluated the effectiveness of AB-CASI vs standard care among 840 self-identified adult Latino ED patients with unhealthy drinking (representing the full spectrum of unhealthy drinking). The study was conducted from October 29, 2014, to May 1, 2020, at the ED of a large urban community tertiary care center in the northeastern US that was verified as a level II trauma center by the American College of Surgeons. Data were analyzed from May 14, 2020, to November 24, 2020. Intervention: Patients randomized to the intervention group received AB-CASI, which included alcohol screening and a structured interactive brief negotiated interview in their preferred language (English or Spanish) while in the ED. Patients randomized to the standard care group received standard emergency medical care, including an informational sheet with recommended primary care follow-up. Main Outcomes and Measures: The primary outcome was the self-reported number of binge drinking episodes within the last 28 days, assessed by the timeline followback method at 12 months after randomization. Results: Among 840 self-identified adult Latino ED patients (mean [SD] age, 36.2 [11.2] years; 433 [51.5%] male; and 697 [83.0%] of Puerto Rican descent), 418 were randomized to the AB-CASI group and 422 to the standard care group. A total of 443 patients (52.7%) chose Spanish as their preferred language at enrollment. At 12 months, the number of binge drinking episodes within the last 28 days was significantly lower in those receiving AB-CASI (3.2; 95% CI, 2.7-3.8) vs standard care (4.0; 95% CI, 3.4-4.7; relative difference [RD], 0.79; 95% CI, 0.64-0.99). Alcohol-related adverse health behaviors and consequences were similar between groups. The effect of AB-CASI was modified by age; at 12 months, the relative reduction in the number of binge drinking episodes within the last 28 days in the AB-CASI vs standard care group was 30% in participants older than 25 years (RD, 0.70; 95% CI, 0.54-0.89) compared with an increase of 40% in participants 25 years or younger (RD, 1.40; 95% CI, 0.85-2.31; P = .01 for interaction). Conclusions and Relevance: In this study, US adult Latino ED patients who received AB-CASI had a significant reduction in the number of binge drinking episodes within the last 28 days at 12 months after randomization. These findings suggest that AB-CASI is a viable brief intervention that overcomes known procedural barriers to ED screening, brief intervention, and referral to treatment and directly addresses alcohol-related health disparities. Trial Registration: ClinicalTrials.gov Identifier: NCT02247388.
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Alcoholismo , Consumo Excesivo de Bebidas Alcohólicas , Adulto , Femenino , Humanos , Masculino , Servicio de Urgencia en Hospital , Etanol , Hispánicos o Latinos , Persona de Mediana EdadRESUMEN
BACKGROUND: Although inequality in traumatic brain injury (TBI) by individual socioeconomic status (SES) exists, interventions to modify individual SES are difficult. However, as interventions for area-based SES can affect the individual SES, monitoring or public health intervention can be planned. We analyzed the effect of area-based SES on hospitalization for TBI and revealed yearly inequality trends to provide a basis for health intervention. METHODS: We included patients who were hospitalized due to intracranial injuries (ICIs) between 2008 and 2015 as a measure of severe TBI with data provided by the Korea National Hospital Discharge Survey. Area-based SES was synthesized using the 2010 census data. We assessed inequalities in ICI-related hospitalization rates using the relative index of inequality and the slope index of inequality for the periods 2008-2009, 2010-2011, 2012-2013, and 2014-2015. We analyzed the trends of these indices for the observation period by age and sex. RESULTS: The overall relative indices of inequality for each 2-year period were 1.82 (95% confidence interval, 1.5-2.3), 1.97 (1.6-2.5), 2.01 (1.6-2.5), and 2.01 (1.6-2.5), respectively. The overall slope indices of inequality in each period were 38.74 (23.5-54.0), 36.75 (21.7-51.8), 35.65 (20.7-50.6), and 43.11 (27.6-58.6), respectively. The relative indices of inequality showed a linear trend for men (P = 0.006), which was most evident in the ≥ 65-year age group. CONCLUSION: Inequality in hospitalization for ICIs by area-based SES tended to increase during the observation period. Practical preventive interventions and input in healthcare resources for populations with low area-based SES are likely needed.
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Disparidades en el Estado de Salud , Clase Social , Masculino , Humanos , Estudios Retrospectivos , Hospitalización , República de Corea/epidemiología , Factores SocioeconómicosRESUMEN
INTRODUCTION: The clinical model of screening, providing a brief psychosocial and/or pharmacological intervention, and directly referring patients to treatment (SBIRT) is a compelling model to address drug use among assault-injured individuals in the busy emergency department (ED) setting. Our objective in this study was to examine the current literature and determine ED-based strategies that have been reported that screen, directly refer to drug mis-use/addiction specialized treatment services, or initiate addiction treatment among individuals injured by non-partner assault in the United States. METHODS: We conducted a systematic review of ED-based studies using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol. OVID, MEDLINE, OVID Embase, OVID AMED, Web of Science-Core Collection, Cochrane CENTRAL, and CINAHL were systematically searched using keywords and Medical Subject Heading terms. Studies were excluded if they only involved intimate partner assault-injury, tobacco, or alcohol use. We categorized ED-based strategies as screening, direct referral, or treatment initiation. RESULTS: Of the 2,076 non-duplicated studies identified, we included 26 full-text articles in the final analysis. Fourteen studies were cross-sectional, 11 were cohort, and one was case-control in design. The most common drug use screening instrument used was the National Institute on Drug Abuse Quick Screen Question. Cannabis was the most common drug detected upon screening. CONCLUSION: Drug use, while highly prevalent, is a modifiable risk factor for non-partner assault-injury. The paucity of scientific studies is evidence for the need to intentionally address this area that remains a major challenge for the public's health. Future research is needed to evaluate ED-based interventions for drug use in this population.
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Trastornos Relacionados con Sustancias , Consumo de Bebidas Alcohólicas , Servicio de Urgencia en Hospital , Humanos , Tamizaje Masivo/métodos , Derivación y Consulta , Trastornos Relacionados con Sustancias/epidemiología , Estados Unidos/epidemiologíaRESUMEN
In the United States, nearly 28 people die in alcohol-related motor vehicle crashes every day (1 fatality every 52 min). Over decades, states have enacted multiple laws to reduce such fatalities. From 1982 to 2019, the proportion of drivers in fatal crashes with a blood alcohol concentration (BAC) above 0.01 g/dl declined from 41% to 22%. States vary in terms of their success in reducing alcohol-related crash fatalities. The purpose of this study was to examine factors associated with changes in fatalities related to alcohol-impaired driving at the state level. We created a panel dataset of 50 states from 1985 to 2019 by merging different data sources and used fixed-effect linear regression models to analyze the data. Our two outcome variables were the ratio of drivers in fatal crashes with BAC ≥ 0.01 g/dl to those with BAC = 0.00, and the ratio of those with BAC ≥ 0.08 g/dl to those with BAC < 0.08 g/dl. Our independent variables included four laws (0.08 g/dl BAC per se law, administrative license revocation law, minimum legal drinking age law, and zero tolerance law), number of arrests due to impaired driving, alcohol consumption per capita, unemployment rate, and vehicle miles traveled. We found that the 0.08 g/dl per se law was significantly associated with lower alcohol-related crash fatalities while alcohol consumption per capita was significantly and positively associated with crash-related fatalities. Arrests due to driving under the influence (DUI) and crash fatalities were nonlinearly correlated. In addition, interaction of DUI arrests and two laws (0.08 g/dl BAC per se law, and zero tolerance) were significantly associated with lower crash-related fatalities. Our findings suggest that states which have more restrictive laws and enforce them are more likely to significantly reduce alcohol-related crash fatalities.
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Conducción de Automóvil , Conducir bajo la Influencia , Accidentes de Tránsito/prevención & control , Consumo de Bebidas Alcohólicas , Nivel de Alcohol en Sangre , Etanol , Humanos , Estados Unidos/epidemiologíaRESUMEN
Introduction: For young drivers, independent transportation has been noted to offer them opportunities that can be beneficial as they enter early adulthood. However, those that choose to engage in riding with an impaired driver (RWI) and drive while impaired (DWI) over time can face negative consequences reducing such opportunities. This study examined the prospective association of identified longitudinal trajectory classes among adolescents that RWI and DWI with their later health, education, and employment in emerging adulthood. Methods: We analyzed all seven annual assessments (Waves, W1-W7) of the NEXT Generation Health Study, a nationally representative longitudinal study starting with 10th grade (2009-2010 school year). Using all seven waves, trajectory classes were identified by latent class analysis with RWI (last 12 months) and DWI (last 30 days) dichotomized as ≥once = 1 vs. none = 0. Results: Four RWI trajectories and four DWI trajectories were identified: abstainer, escalator, decliner, and persister. For RWI and DWI trajectories respectively, 45.0% (N=647) and 76.2% (N=1,657) were abstainers, 15.6% (N=226) and 14.2% (N=337) were escalators, 25.0% (N=352) and 5.4% (N=99) were decliners, and 14.4% (N=197) and 3.8% (N=83) persisters. RWI trajectories were associated with W7 health status (χ2=13,20, p<.01) and education attainment (χ2=18.37, p<.01). Adolescent RWI abstainers reported better later health status than RWI escalators, decliners, and persisters; and decliners reported less favorable later education attainment than abstainers, escalators, and persisters. DWI trajectories showed no association with health status, education attainment, or employment. Conclusions: Our findings suggest the importance of later health outcomes of adolescent RWI. The mixed findings point to the need for more detailed understanding of contextual and time-dependent trajectory outcomes among adolescents engaging in RWI and DWI.
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PURPOSE: Driving licensure remains a major developmental milestone for adolescents as they become more independent to access important health, education, and employment opportunities. Today, more teens are delaying driving licensure than before. We investigated associations of delayed licensure with health, education, and employment 4 years after high school. METHODS: We analyzed data from all seven annual assessments (W1-W7) of the NEXT Generation Health Study, a nationally representative cohort survey starting at 10th grade (W1, 2009-2010). The independent variable was delaying driving licensure (DDL [delaying ≥1 year] vs. No-DDL), defined as participants receiving driver licensure ≥1 year after the initial legal eligibility time until W7. Outcome variables were self-reported health, education, and employment at W7. Covariates included sex, race/ethnicity, family affluence, parental education, and urbanicity. Multinomial logistic regressions were conducted considering complex survey features. RESULTS: No-DDL versus DDL was associated with a higher likelihood of (1) excellent (adjusted odds ratio [AOR] = 2.06, p < .001), good (AOR = 1.74, p < .001), and fair (AOR = 1.34, p = .008) health compared with poor health; (2) completing a 4-year college or graduate school [AOR = 2.71, p < .001] and tech/community college [AOR = 1.92, p = .004] compared with high school or less; and (3) working ≥30 hours/week (AOR = 7.63, p = .011) and working <30 hours/week (AOR = 1.54, p = .016) compared with not working. DISCUSSION: Among emerging adults, no delay in driving licensure was associated with better self-reported health, higher education, and more working hours four years after leaving high school. Although earlier driving licensure increases driving exposure and risk, avoiding DDL appears to provide advantages for health, education, and employment during early adulthood.
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Conducción de Automóvil , Adolescente , Adulto , Escolaridad , Empleo , Humanos , Concesión de Licencias , Instituciones AcadémicasRESUMEN
BACKGROUND: The proportion of motor vehicle crash fatalities involving alcohol-impaired drivers declined substantially between 1982 and 1997, but progress stopped after 1997. The systemic complexity of alcohol-impaired driving contributes to the persistence of this problem. This study aims to identify and map key feedback mechanisms that affect alcohol-impaired driving among adolescents and young adults in the U.S. METHODS: We apply the system dynamics approach to the problem of alcohol-impaired driving and bring a feedback perspective for understanding drivers and inhibitors of the problem. The causal loop diagram (i.e., map of dynamic hypotheses about the structure of the system producing observed behaviors over time) developed in this study is based on the output of two group model building sessions conducted with multidisciplinary subject-matter experts bolstered with extensive literature review. RESULTS: The causal loop diagram depicts diverse influences on youth impaired driving including parents, peers, policies, law enforcement, and the alcohol industry. Embedded in these feedback loops are the physical flow of youth between the categories of abstainers, drinkers who do not drive after drinking, and drinkers who drive after drinking. We identify key inertial factors, discuss how delay and feedback processes affect observed behaviors over time, and suggest strategies to reduce youth impaired driving. CONCLUSION: This review presents the first causal loop diagram of alcohol-impaired driving among adolescents and it is a vital first step toward quantitative simulation modeling of the problem. Through continued research, this model could provide a powerful tool for understanding the systemic complexity of impaired driving among adolescents, and identifying effective prevention practices and policies to reduce youth impaired driving.
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Conducción de Automóvil , Conducir bajo la Influencia , Accidentes de Tránsito , Adolescente , Consumo de Bebidas Alcohólicas/efectos adversos , Consumo de Bebidas Alcohólicas/epidemiología , Conducir bajo la Influencia/prevención & control , Humanos , Adulto JovenRESUMEN
INTRODUCTION: There is consensus that riding with an impaired driver (RWI) constitutes a major threat to public health. The aim of this study was to characterize the factors contributing to the motor-vehicle deaths of 15-20â¯year-old (y/o) passengers that RWI with a peer. METHOD: Secondary analyses of the 2010-2018 Fatality Analysis Reporting System. 5,673 passengers aged 15-20â¯y/o killed while riding in passenger cars with a driver aged 21 or older, 3,542 of these drivers also aged 15-20â¯y/o. Analyses were conducted between October 2019 and December 2020. RESULTS: Sixty-three percent of the young passengers were killed while riding with a driver 15-20â¯y/o. Of these drivers, 26.8% had a blood alcohol concentration (BAC) >0.00â¯g/dL and 77.1% had a BAC ≥0.08â¯g/dL. Compared with those occurring during the day on weekdays, fatalities of young passengers who RWI with a peer driver with a BACâ¯≥â¯0.08â¯g/dL often occurred on weekend nights (ORâ¯=â¯8.2) and weekday nights (ORâ¯=â¯5.2), and when the passenger and driver were both male (ORâ¯=â¯1.8). Race/ethnicity was not a significant contributor to RWI fatalities. CONCLUSIONS: Most 15-20â¯y/o RWI fatalities occurred on weekends, at night, when the driver was a young peer with a high BAC, and the passenger and driver were male. The high prevalence of fatalities in these high-risk situations suggests that young driver-passenger dynamics may contribute to alcohol-related fatalities. Practical Applications: To curb RWI fatalities among underage passengers, countermeasures should focus not only on underage drinking drivers and riders, but also on drinking drivers of all ages. Prevention should increase focus on situations in which both the young passenger and young driver are males.
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Accidentes de Tránsito , Conducción de Automóvil , Accidentes de Tránsito/prevención & control , Adolescente , Adulto , Nivel de Alcohol en Sangre , Etanol , Humanos , Masculino , Vehículos a Motor , Grupo Paritario , Adulto JovenRESUMEN
Objective: This exploratory study aimed to examine associations between executive function and simulated and self-reported driving behavior among young adults with and without a history of prenatal cocaine exposure (PCE).Methods: Young adult drivers with PCE (n = 38) and with no drug exposure (NDE; n = 25) were recruited from an ongoing longitudinal birth cohort study assessing effects of PCE on development (Mean age = 23.7; 60.3% male; 61.9% with a valid U.S. driver's license, 38.1% report independent driving without a license). Participants completed executive function tasks (i.e., the Stop Signal Task and Groton Maze Learning Task) and self-reported driving measures (i.e., Checkpoints Risky Driving Scale (C-RDS)) outside the cab. Average stop signal reaction time(s) measured inhibitory control, number of exploratory errors measured visuo-spatial working memory, and the total C-RDS score measured self-reported risky driving. Participants completed a high-fidelity driving simulation scenario in a miniSim™ ½ cab National Advanced Driving Simulator (NADS) that yielded indicators of driving performance shown in previous research to correlate with inhibitory control (e.g., average speed, standard deviation lane position (SDLP)) and working memory (minimum headway time, lane departures). Multivariate linear regression models tested whether PCE status, licensure status and executive function measures were associated with simulated driving measures or C-RDS, controlling for sex.Results: Multivariate regression models demonstrated inhibitory control, working memory and PCE group status was not significantly associated with driving outcomes. Licensure was significantly associated with total lane departures (ß = -0.66, SE = 0.19; p < 0.01) and C-RDS (ß = 5.86, SE = 1.4; p ≤ 0.001).Conclusions: This exploratory study suggests that young adults with PCE have similar neurocognitive performance and driving behaviors as their non-drug exposed (NDE) peers. These findings add to the growing literature demonstrating that the effect of PCE on cognitive functions in childhood may not persist to young adulthood. Further research with similar groups of young drivers in a naturalistic driving context (i.e., instrumented vehicles) is needed to more definitively translate and confirm our findings.
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Conducción de Automóvil , Cocaína , Accidentes de Tránsito , Adulto , Cocaína/efectos adversos , Estudios de Cohortes , Femenino , Humanos , Masculino , Embarazo , Tiempo de Reacción , Autoinforme , Adulto JovenRESUMEN
OBJECTIVE: Transporting severely injured pediatric patients to a trauma center has been shown to decrease mortality. A decision support tool to assist emergency medical services (EMS) providers with trauma triage would be both as parsimonious as possible and highly accurate. The objective of this study was to determine the minimum set of predictors required to accurately predict severe injury in pediatric patients. METHODS: Crash data and patient injuries were obtained from the NASS and CISS databases. A baseline multivariable logistic model was developed to predict severe injury in pediatric patients using the following predictors: age, sex, seat row, restraint use, ejection, entrapment, posted speed limit, any airbag deployment, principal direction of force (PDOF), change in velocity (delta-V), single vs. multiple collisions, and non-rollover vs. rollover. The outcomes of interest were injury severity score (ISS) ≥16 and the Target Injury List (TIL). Accuracy was measured by the cross-validation mean of the receiver operator curve (ROC) area under the curve (AUC). We used Bayesian Model Averaging (BMA) based on all subsets regression to determine the importance of each variable separately for each outcome. The AUC of the highest performing model for each number of variables was compared to the baseline model to assess for a statistically significant difference (p < 0.05). A reduced variable set model was derived using this information. RESULTS: The baseline models performed well (ISS ≥ 16: AUC 0.91 [95% CI: 0.86-0.95], TIL: AUC 0.90 [95% CI: 0.86-0.94]). Using BMA, the rank of the importance of the predictors was identical for both ISS ≥ 16 and TIL. There was no statistically significant decrease in accuracy until the models were reduced to fewer than five and six variables for predicting ISS ≥ 16 and TIL, respectively. A reduced variable set model developed using the top five variables (delta-V, entrapment, ejection, restraint use, and near-side collision) to predict ISS ≥ 16 had an AUC 0.90 [95% CI: 0.84-0.96]. Among the models that did not include delta-V, the highest AUC was 0.82 [95% CI: 0.77-0.87]. CONCLUSIONS: A succinct logistic regression model can accurately predict severely injured pediatric patients, which could be used for prehospital trauma triage. However, there remains a critical need to obtain delta-V in real-time.
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Accidentes de Tránsito , Heridas y Lesiones , Teorema de Bayes , Niño , Humanos , Puntaje de Gravedad del Traumatismo , Vehículos a Motor , Centros TraumatológicosRESUMEN
OBJECTIVE: To identify trajectory classes of risky driving among emerging adults and examine predictive associations of depressive and psychosomatic symptoms in the 12th grade with the identified trajectory classes. METHODS: Data were from the last year in high school (12th-Grade - Wave 3 [W3]) and years 1-4 after high school (Waves 4-7 [W4-7]) of the NEXT Generation Health Study, a nationally representative study starting with 10th grade (2009-2010). We measured risky driving with the 21-item Checkpoints Self-Reported Risky Driving Scale (C-RDS). Using C-RDS data from W3-7, the latent class growth modeling (LCGM) was used to identify risky driving trajectory classes. Independent variables were W3 depressive symptoms and W3 psychosomatic symptoms. Covariates included family affluence and urbanicity. The LCGM was conducted with SAS PROC Traj. The multinomial logistic regressions were used to examine the associations between the trajectory classes and independent variables, taking complex survey sampling features into account. RESULTS: Three risky driving trajectories were identified: low (N = 583, 21.43%, weighted and hereafter), medium (N = 1423, 59.22%), and high (N = 389, 19.35%) risky driving classes. Compared to the low risky driving class, one unit increase in W3 depressive symptoms was significantly associated with a higher likelihood of belonging to the medium (adjusted odds ratio [AOR] = 1.04, 95% CI 1.01, 1.07) and the high (AOR = 1.05, 95% CI 1.02, 1.08) risky driving classes, respectfully, when controlling for the covariates. Likewise, compared to the low risky driving class, one unit increase in W3 psychosomatic symptoms was significantly associated with a higher likelihood of belonging to the medium (AOR = 1.06, 95% CI 1.00, 1.13) and the high (AOR = 1.10, 95% CI 1.04, 1.16) risky driving classes, respectively, when controlling for the covariates. CONCLUSIONS: High school students with depressive and psychosomatic symptoms were at higher risk of engaging in risky driving in the immediate years after leaving high school. These findings suggest that prevention programs that incorporate screening, referral to treatment, and treatment of mental and psychosomatic symptoms in high school may be important opportunities to reduce risky driving among youth as they transition from adolescence to emerging adulthood.