Effect of Primary Care Parent-Targeted Interventions on Parent-Adolescent Communication About Sexual Behavior and Alcohol Use: A Randomized Clinical Trial.

Importance: Adolescent well care visits provide opportunities for clinicians to facilitate parent-adolescent communication (PAC) to reduce pregnancy, sexually transmitted infections, and alcohol-related harm among adolescents. Objective: To test the effect of brief parent-targeted interventions delivered in primary care settings on PAC about sexual and alcohol use behaviors. Design, Setting, and Participants: Randomized clinical trial conducted at a primary care pediatric practice from January 4, 2016, to April 10, 2017. Adolescents who were scheduled for a well care visit were recruited, along with their parent or guardian. Data analyses continued through April 30, 2018. Interventions: During well care visits, parents in sexual health intervention and alcohol prevention intervention groups received coaching to discuss written intervention materials encouraging PAC about sex or alcohol, respectively, with their adolescent within 2 weeks, followed by a brief clinician endorsement. After 2 weeks, parents received a follow-up telephone call. Control group parents received usual care. Main Outcomes and Measures: Participants were surveyed 4 months after the well care visit. Parent-reported and adolescent-reported quality of PAC was measured using the 20-item Parent-Adolescent Communication Scale, in which a higher score indicates better PAC; and frequency of PAC about sex or alcohol was measured using a 4-point Likert-type scale with 1 indicating not at all or never, and 4 indicating a lot or often. Results: Of 196 parent-adolescent dyads assessed for eligibility, 118 (60.2%) were eligible to participate. These 118 dyads were randomized to 1 of 3 groups: (1) sexual health intervention (n = 38 [32.2%]); (2) alcohol prevention intervention (n = 40 [33.9%]); and control (n = 40 [33.9%]); 104 parents (88.1%) and 99 adolescents (83.9%) completed the study. Parents included 112 women (94.9%) and had a mean (SD) age of 45.8 (6.9) years. Adolescents included 60 girls (50.9%); 67 adolescents (56.8%) were aged 14 years, and 51 adolescents (43.2%) were aged 15 years. Participant race/ethnicity reflected that of the practice (63 black adolescents [53.4%]; 46 white adolescents [38.9%]; 111 non-Hispanic adolescents [94.1%]). At baseline, 15 adolescents (12.7%) reported a history of sexual behavior and 16 adolescents (13.6%) reported a history of alcohol use. Intention-to-treat analyses found that 4 months after the intervention, adolescents in the sexual health intervention group reported a higher mean frequency score for PAC about sex compared with those in the control group (2.32 [95% CI, 1.97-2.66] vs 1.79 [95% CI, 1.50-2.08]; P = .02); adolescents in the alcohol prevention intervention group reported a higher mean frequency score for PAC about alcohol compared with those in the control group (2.93 [95% CI, 2.60-3.25] vs 2.40 [95% CI, 2.08-2.72]; P = .03). Parent-reported frequency scores for PAC about sex or alcohol did not differ by group. Conclusions and Relevance: Brief parent-targeted interventions in primary care settings increased adolescent-reported frequency of PAC about sexual health and alcohol use and may be an important strategy for parents to influence adolescent behaviors and health outcomes. Trial Registration: ClinicalTrials.gov identifier: NCT02554682.

Advanced driver assistance systems for teen drivers: A national survey of teen and parent perceptions.

OBJECTIVE: Recently developed advanced driver assistance systems (ADAS) have the potential to compensate for teen driving errors and reduce overall crash risk. To date, very limited research has been conducted on the suitability of ADAS for teen drivers-the population most likely to benefit from such systems. The opportunity for ADAS to reduce the frequency and severity of crashes involving teen drivers is hindered when there is a lack of trust, acceptance, and use of those technologies. Therefore, there is a need to study teen and parent perceptions of ADAS to help identify and overcome any potential barriers to ADAS use. METHODS: A U.S. national survey was developed based on themes from previously conducted teen and parent ADAS focus groups. Survey topics included trust in ADAS, effect of ADAS on teen driver safety and driving behavior, effect of ADAS on skill development, data privacy, and cybersecurity. Responses included 5-point Likert scales and open-ended questions. The survey was managed through an online respondent panel by ResearchNow. Eligibility criteria included licensed teens (16-19 years) and parents of licensed teens. Teen and parent responses were compared using chi-square statistics in SAS 9.4. RESULTS: Two thousand and three (teens = 1,000; parents = 1,003) respondents qualified for and completed the survey between September 1 and September 20, 2017. Overall, teens (72%) and parents (61%) felt that ADAS would have a positive impact on transportation. However, teens were more likely to exhibit a positive outlook on ADAS, whereas parents were more likely to have a negative outlook (P < .01). Teens felt that ADAS would be useful during bad weather or drowsy driving but were less concerned than parents about ADAS intervention during their own risky driving (P < .01). The majority of teens (65%) and parents (71%) agreed that teens should learn to drive on vehicles without ADAS, with parents being more likely to agree than teens (P < .01). Parents (55%) were more likely than teens (47%) to be concerned about insurance companies keeping track of teen driving data (P < .01). Most respondents exhibited some concern of ADAS being susceptible to hacking (57%). CONCLUSIONS: This study represents the first effort to quantify ADAS perceptions among teen drivers and their parents at the U.S. national level. These data highlight potential barriers to ADAS use among teen drivers, including a relative disinterest among teens for ADAS intervention during risky driving as well as concerns among both teens and parents that ADAS will inhibit skill development. These survey findings will help inform educational programs to accelerate fleet turnover and provide the foundation for ADAS optimization and evaluation studies among sociodemographic groups.

Parental influence on driver licensure in adolescence: A randomized controlled trial.

OBJECTIVE: Newly licensed adolescent drivers have skill deficits that increase risk for motor vehicle crashes. Development of programs targeted to prelicensed adolescents has been hindered by concerns about encouraging overconfidence and early licensure. The study had 2 primary objectives: (a) determine whether an Internet-based intervention designed to improve parent-supervised practice (TeenDrivingPlan [TDP]) influenced adolescents' time to licensure and parents' perceptions of adolescents' driving skill, expertise, and safety and (b) evaluate the association of these perceptions and practice diversity (number of different environments where practiced occurred) with time to licensure. METHOD: A randomized controlled trial was used to compare TDP with a control condition. Participants (N = 295 parent-adolescent dyads) completed periodic surveys over 24 weeks and were subsequently followed for up to a year to determine adolescents' licensure status. RESULTS: TDP did not influence time to licensure and did not affect parents' perceptions of skill, expertise, and safety. Practice diversity was associated with faster licensure. A more favorable perception of adolescents' skill in comparison to peers was associated with faster licensure. CONCLUSIONS: Targeting parents' beliefs about adolescents' safety in relation to other road users may not be conducive to altering licensing trajectories, whereas sensitizing parents to their adolescents' emerging skills might be more effective in promoting safe entry into licensure. (PsycINFO Database Record

It takes two: a brief report examining mutual support between parents and teens learning to drive.

Parental supervision of teen drivers has been identified as a way to mitigate teen crash risk. However, we know little about what motivates parents to be engaged supervisors throughout all phases of the learning-to-drive process. As a result, we are just beginning to understand what factors might motivate parents to actively supervise pre-license practice. In the current study, we examine how the provision of social support between parent and teen dyads might relate to parents' intention to remain engaged supervisors for the entire learner phase. Participants were a national sample of 309 teens with learner permits (age range 15-17 years, M (SD) 16.1 (0.8)) and a parent practice supervisor in the United States. Results indicated that parents in mutually supportive dyads reported stronger intentions to be engaged in their teens' practice driving over the course of the permit phase as compared to dyads where both members reported receiving low support: (adjusted odds ratio (aOR) [95% confidence interval (CI)]: 2.02 [1.04, 3.94]; p=0.038). No benefit was observed for only having one member of the dyad provide support, irrespective of it being the parent or the teen. Future research on this topic should consider reciprocal parent-teen interactions as potential determinates of parent driving supervision behaviors.

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

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

Effect of the teen driving plan on the driving performance of teenagers before licensure: a randomized clinical trial.

IMPORTANCE: Many studies have failed to show an effect of parent-supervised practice driving on the driving performance of teenagers; nevertheless, most Graduated Driver Licensing programs have provisions that require supervised practice. OBJECTIVE: To determine whether a web-based intervention, the Teen Driving Plan (TDP), can improve the driving performance of teenagers before licensure as measured by the Teen On-road Driving Assessment (tODA). DESIGN, SETTING, AND PARTICIPANTS: Randomized, single-blind, clinical trial among 217 dyads (1 parent: 1 teenaged learner's-permit holder) to test TDP effectiveness on increasing the quantity and diversity of supervised practice and improving the teenagers' prelicensed driving performance. The study was conducted from December 2011 through January 2013 in Southeastern Pennsylvania. INTERVENTIONS: Dyads were randomized (3:2) to receive the TDP or the Pennsylvania driver's manual (control group). The TDP is a psychoeducational intervention designed to increase the quantity and diversity of parent-supervised practice. Materials are grouped by the following driving environments: empty parking lots, suburban residential streets, intermediate (1- or 2-lane) roads, highways, rural roads with curves and elevation changes, and commercial districts. MAIN OUTCOMES AND MEASURES: The main outcomes were self-reported practice driving across 6 environments and 2 conditions and driving performance as measured by the teenagers' completion of the standardized and validated tODA 24 weeks after enrollment. Certified professional driving evaluators blinded to randomization status terminated the tODA if they determined that the teenager could not safely complete it. We examined mean differences in the quantity of supervised practice, differences in the overall proportion of teenagers in each group that had assessments terminated for unsafe driving, and the point of termination during the assessment. RESULTS: The TDP dyads reported more practice in 5 of the 6 environments and at night and in bad weather compared with the control dyads. Overall, 5 of 86 TDP teenagers (6%) had the tODA terminated compared with 10 of 65 control teenagers (15%) (risk difference [TDP - control], -9% [95% CI, -21% to 2%]; P = .06). The hazard ratio for exposure to TDP was 0.35 (95% CI, 0.12-1.03; P = .05, log-rank test). CONCLUSIONS AND RELEVANCE: Preliminary evidence suggests that the TDP improves supervised practice and the driving performance of prelicensed teenaged drivers. Future studies can explore how to revise the TDP to enhance the treatment effect and how best to disseminate the TDP without compromising implementation fidelity. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01498575.

TeenDrivingPlan effectiveness: the effect of quantity and diversity of supervised practice on teens' driving performance.

PURPOSE: The large contribution of inexperience to the high crash rate of newly licensed teens suggests that they enter licensure with insufficient skills. In a prior analysis, we found moderate support for a direct effect of a web-based intervention, the TeenDrivingPlan (TDP), on teens' driving performance. The purpose of the present study was to identify the mechanisms by which TDP may be effective and to extend our understanding of how teens learn to drive. METHODS: A randomized controlled trial conducted with teen permit holders and parent supervisors (N = 151 dyads) was used to determine if the effect of TDP on driver performance operated through five hypothesized mediators: (1) parent-perceived social support; (2) teen-perceived social support; (3) parent engagement; (4) practice quantity; and (5) practice diversity. Certified driving evaluators, blinded to teens' treatment allocation, assessed teens' driving performance 24 weeks after enrollment. Mediator variables were assessed on self-report surveys administered periodically over the study period. RESULTS: Exposure to TDP increased teen-perceived social support, parent engagement, and practice diversity. Both greater practice quantity and diversity were associated with better driving performance, but only practice diversity mediated the relationship between TDP and driver performance. CONCLUSIONS: Practice diversity is feasible to change and increases teens' likelihood of completing a rigorous on-road driving assessment just before licensure. Future research should continue to identify mechanisms that diversify practice driving, explore complementary ways to help families optimize the time they spend on practice driving, and evaluate the long-term effectiveness of TDP.