A randomized trial of behavioral interventions yielding sustained reductions in distracted driving.

Distracted driving is responsible for nearly 1 million crashes each year in the United States alone, and a major source of driver distraction is handheld phone use. We conducted a randomized, controlled trial to compare the effectiveness of interventions designed to create sustained reductions in handheld use while driving (NCT04587609). Participants were 1,653 consenting Progressive® Snapshot® usage-based auto insurance customers ages 18 to 77 who averaged at least 2 min/h of handheld use while driving in the month prior to study invitation. They were randomly assigned to one of five arms for a 10-wk intervention period. Arm 1 (control) got education about the risks of handheld phone use, as did the other arms. Arm 2 got a free phone mount to facilitate hands-free use. Arm 3 got the mount plus a commitment exercise and tips for hands-free use. Arm 4 got the mount, commitment, and tips plus weekly goal gamification and social competition. Arm 5 was the same as Arm 4, plus offered behaviorally designed financial incentives. Postintervention, participants were monitored until the end of their insurance rating period, 25 to 65 d more. Outcome differences were measured using fractional logistic regression. Arm 4 participants, who received gamification and competition, reduced their handheld use by 20.5% relative to control (P < 0.001); Arm 5 participants, who additionally received financial incentives, reduced their use by 27.6% (P < 0.001). Both groups sustained these reductions through the end of their insurance rating period.

An event-based magnetoencephalography study of simulated driving: Establishing a novel paradigm to probe the dynamic interplay of executive and motor function.

Magnetoencephalography (MEG) is particularly well-suited to the study of human motor cortex oscillatory rhythms and motor control. However, the motor tasks studied to date are largely overly simplistic. This study describes a new approach: a novel event-based simulated drive made operational via MEG compatible driving simulator hardware, paired with differential beamformer methods to characterize the neural correlates of realistic, complex motor activity. We scanned 23 healthy individuals aged 16-23 years (mean age = 19.5, SD = 2.5; 18 males and 5 females, all right-handed) who completed a custom-built repeated trials driving scenario. MEG data were recorded with a 275-channel CTF, and a volumetric magnetic resonance imaging scan was used for MEG source localization. To validate this paradigm, we hypothesized that pedal-use would elicit expected modulation of primary motor responses beta-event-related desynchronization (B-ERD) and movement-related gamma synchrony (MRGS). To confirm the added utility of this paradigm, we hypothesized that the driving task could also probe frontal cognitive control responses (specifically, frontal midline theta [FMT]). Three of 23 participants were removed due to excess head motion (>1.5 cm/trial), confirming feasibility. Nonparametric group analysis revealed significant regions of pedal-use related B-ERD activity (at left precentral foot area, as well as bilateral superior parietal lobe: p < .01 corrected), MRGS (at medial precentral gyrus: p < .01 corrected), and FMT band activity sustained around planned braking (at bilateral superior frontal gyrus: p < .01 corrected). This paradigm overcomes the limits of previous efforts by allowing for characterization of the neural correlates of realistic, complex motor activity in terms of brain regions, frequency bands and their dynamic temporal interplay.

Novel use of a virtual driving assessment to classify driver skill at the time of licensure.

Motor vehicle crash rates are highest immediately after licensure, and driver error is one of the leading causes. Yet, few studies have quantified driving skills at the time of licensure, making it difficult to identify at-risk drivers before independent driving. Using data from a virtual driving assessment implemented into the licensing workflow in Ohio, this study presents the first population-level study classifying degree of skill at the time of licensure and validating these against a measure of on-road performance: license exam outcomes. Principal component and cluster analysis of 33,249 virtual driving assessments identified 20 Skill Clusters that were then grouped into 4 major summary "Driving Classes"; i) No Issues (i.e. careful and skilled drivers); ii) Minor Issues (i.e. an average new driver with minor vehicle control skill deficits); iii) Major Issues (i.e. drivers with more control issues and who take more risks); and iv) Major Issues with Aggression (i.e. drivers with even more control issues and more reckless and risk-taking behavior). Category labels were determined based on patterns of VDA skill deficits alone (i.e. agnostic of the license examination outcome). These Skill Clusters and Driving Classes had different distributions by sex and age, reflecting age-related licensing policies (i.e. those under 18 and subject to GDL and driver education and training), and were differentially associated with subsequent performance on the on-road licensing examination (showing criterion validity). The No Issues and Minor Issues classes had lower than average odds of failing, and the other two more problematic Driving Classes had higher odds of failing. Thus, this study showed that license applicants can be classified based on their driving skills at the time of licensure. Future studies will validate these Skill Cluster classes in relation to their prediction of post-licensure crash outcomes.

Scaling and Disseminating Brief Bullying Prevention Programming: Strengths, Challenges, & Considerations.

Peer bullying occurs frequently among middle school youth, negatively impacting students and the broader school climate. However, during these years there is a gap in translating empirically supported prevention science into school-based practices. This paper describes how the evidence-based Free2B bullying prevention multi-media assembly was disseminated by a team of educators, researchers, and technologists to over 14,000 students in 40 middle schools across the state. This dissemination and scaling effort was conducted in partnership with the state's government officials and Office of Safe Schools in order to ensure that each school and district across the state had equal access in applying for the programming. Over half of participating students expressed concerns about school bullying, with 36% reporting victimization and 17% reporting perpetration of bullying in the past month. Significant improvements were found in problem-solving knowledge, confidence in being a positive bystander, and sympathy for peer victims. We discuss gender and community setting differences (urban, suburban, rural) in the findings, implications for dissemination and implementation science, and school psychologists' role in disseminating bullying prevention practices.

Safety at the edge: a safety framework to identify edge conditions in the future transportation system with highly automated vehicles.

Automated driving systems (ADS) have the potential for improving safety but also pose the risk of extending the transportation system beyond its edge conditions, beyond the operating conditions (operational design domain (ODD)) under which a given ADS or feature thereof is specifically designed to function. The ODD itself is a function of the known bounds and the unknown bounds of operation. The known bounds are those defined by vehicle designers; the unknown bounds arise based on a person operating the system outside the assumptions on which the vehicle was built. The process of identifying and mitigating risk of possible failures at the edge conditions is a cornerstone of systems safety engineering (SSE); however, SSE practitioners may not always account for the assumptions on which their risk mitigation resolutions are based. This is a particularly critical issue with the algorithms developed for highly automated vehicles (HAVs). The injury prevention community, engineers and designers must recognise that automation has introduced a fundamental shift in transportation safety and requires a new paradigm for transportation epidemiology and safety science that incorporates what edge conditions exist and how they may incite failure. Towards providing a foundational organising framework for the injury prevention community to engage with HAV development, we propose a blending of two classic safety models: the Swiss Cheese Model, which is focused on safety layers and redundancy, and the Haddon Matrix, which identifies actors and their responsibilities before, during and after an event.

Simulator Pre-Screening of Underprepared Drivers Prior to Licensing On-Road Examination: Clustering of Virtual Driving Test Time Series Data.

BACKGROUND: A large Midwestern state commissioned a virtual driving test (VDT) to assess driving skills preparedness before the on-road examination (ORE). Since July 2017, a pilot deployment of the VDT in state licensing centers (VDT pilot) has collected both VDT and ORE data from new license applicants with the aim of creating a scoring algorithm that could predict those who were underprepared. OBJECTIVE: Leveraging data collected from the VDT pilot, this study aimed to develop and conduct an initial evaluation of a novel machine learning (ML)-based classifier using limited domain knowledge and minimal feature engineering to reliably predict applicant pass/fail on the ORE. Such methods, if proven useful, could be applicable to the classification of other time series data collected within medical and other settings. METHODS: We analyzed an initial dataset that comprised 4308 drivers who completed both the VDT and the ORE, in which 1096 (25.4%) drivers went on to fail the ORE. We studied 2 different approaches to constructing feature sets to use as input to ML algorithms: the standard method of reducing the time series data to a set of manually defined variables that summarize driving behavior and a novel approach using time series clustering. We then fed these representations into different ML algorithms to compare their ability to predict a driver's ORE outcome (pass/fail). RESULTS: The new method using time series clustering performed similarly compared with the standard method in terms of overall accuracy for predicting pass or fail outcome (76.1% vs 76.2%) and area under the curve (0.656 vs 0.682). However, the time series clustering slightly outperformed the standard method in differentially predicting failure on the ORE. The novel clustering method yielded a risk ratio for failure of 3.07 (95% CI 2.75-3.43), whereas the standard variables method yielded a risk ratio for failure of 2.68 (95% CI 2.41-2.99). In addition, the time series clustering method with logistic regression produced the lowest ratio of false alarms (those who were predicted to fail but went on to pass the ORE; 27.2%). CONCLUSIONS: Our results provide initial evidence that the clustering method is useful for feature construction in classification tasks involving time series data when resources are limited to create multiple, domain-relevant variables.

Usability, Acceptability, and Impact of a Pediatric Teledermatology Mobile Health Application.

OBJECTIVE: Pediatric dermatology appointment wait times often exceed several months. We evaluated the usability, acceptability, and clinical impact of a store-and-forward teledermatology mobile application (app) linking families with pediatric dermatologists. METHODS: Parents of children age 6 weeks to 17 years or individuals 18-21 years old were invited (by e-mail or referral) to participate in this single group, prospective study. Within the app, users photographed the skin condition, answered questions, and submitted their case for review. One pediatric dermatologist viewed cases, diagnosed conditions, and provided instructions and prescriptions. User surveys immediately following app use and 1 week later, supplemented by electronic logs, assessed usability, acceptability, and impact. RESULTS: One hundred ninety-seven parents and one adolescent submitted cases within 39 days of invitation. App users were more likely to be white than those in the population invited (67% vs. 34%, p < 0.001) and their children were slightly younger (mean 7.3 vs. 9.0 years, p < 0.001). A majority, 83% found the app easy to use, 97% felt that submitting a case took "the right amount of time," 87% were satisfied, and 93% would use the app again. Prescription receipt was associated with increased app satisfaction (p = 0.008). The median user received a response in 2.8 h (interquartile range 1.1-6.4). Had the app been unavailable, 44% reported that they would have waited for primary care, 32% for a dermatology appointment, and 7% would have gone to an urgent care clinic. CONCLUSIONS: A mobile health app allowing families to directly consult a pediatric dermatologist was usable, acceptable, and expedited care.

The latent structure of Acute Stress Disorder symptoms in trauma-exposed children and adolescents.

BACKGROUND: The revision of Acute Stress Disorder (ASD) in the DSM-5 (DSM-5, 2013) proposes a cluster-free model of ASD symptoms in both adults and youth. Published evaluations of competing models of ASD clustering in youth have rarely been examined. METHODS: We used Confirmatory Factor Analysis (combined with multigroup invariance tests) to explore the latent structure of ASD symptoms in a trauma-exposed sample of children and young people (N = 594). The DSM-5 structure was compared with the previous DSM-IV conceptualization (4-factor), and two alternative models proposed in the literature (3-factor; 5-factor). Model fit was examined using goodness-of-fit indices. We also established DSM-5 ASD prevalence rates relative to DSM-IV ASD, and the ability of these models to classify children impaired by their symptoms. RESULTS: Based on both the Bayesian Information Criterion, the interfactor correlations and invariance testing, the 3-factor model best accounted for the profile of ASD symptoms. DSM-5 ASD led to slightly higher prevalence rates than DSM-IV ASD and performed similarly to DSM-IV with respect to categorising children impaired by their symptoms. Modifying the DSM-5 ASD algorithm to a 3+ or 4+ symptom requirement was the strongest predictor of impairment. CONCLUSIONS: These findings suggest that a uni-factorial general-distress model is not the optimal model of capturing the latent structure of ASD symptom profiles in youth and that modifying the current DSM-5 9+ symptom algorithm could potentially lead to a more developmentally sensitive conceptualization.

Pilot Randomized Controlled Trial of a Novel Web-Based Intervention to Prevent Posttraumatic Stress in Children Following Medical Events.

OBJECTIVE: To assess feasibility and estimate effect size of a self-directed online intervention designed to prevent persistent posttraumatic stress after acute trauma. METHODS: Children aged 8-12 years with a recent acute medical event were randomized to the intervention (N = 36) or a 12-week wait list (N = 36). Posttraumatic stress, health-related quality of life, appraisals, and coping were assessed at baseline, 6, 12, and 18 weeks. RESULTS: Most children used the intervention; half completed it. Medium between-group effect sizes were observed for change in posttraumatic stress severity from baseline to 6 weeks (d = -.68) or 12 weeks (d = -.55). Exploratory analyses suggest greatest impact for at-risk children, and a small effect for intervention initiated after 12 weeks. Analysis of covariance did not indicate statistically significant group differences in 12-week outcomes. CONCLUSIONS: This pilot randomized controlled trial provides preliminary evidence that a self-directed online preventive intervention is feasible to deliver, and could have an effect in preventing persistent posttraumatic stress.

Engagement with the TeenDrivingPlan and diversity of teens' supervised practice driving: lessons for internet-based learner driver interventions.

OBJECTIVE: Inexperienced, less-skilled driving characterises many newly licensed drivers and contributes to high crash rates. A randomised trial of TeenDrivingPlan (TDP), a new learner driver phase internet-based intervention, demonstrated effectiveness in improving safety relevant, on-road driving behaviour, primarily through greater driving practice diversity. To inform future learner driver interventions, this analysis examined TDP use and its association with practice diversity. DESIGN: Posthoc analysis of data from teen/parent dyads (n=107), enrolled early in learner phase and assigned to treatment arm in randomised trial. METHODS: Inserted software beacons captured TDP use data. Electronic surveys completed by parents and teens assessed diversity of practice driving and TDP usability ratings at 24 weeks (end of study period). RESULTS: Most families (84%) used TDP early in the learner period; however, the number of TDP sessions in the first week was three times higher among dyads who achieved greater practice diversity than those with less. By week five many families still engaged with TDP, but differences in TDP use could not be detected between families with high versus low practice diversity. Usability was not a major issue for this sample based on largely positive user ratings. CONCLUSIONS: An engaging internet-based intervention, such as TDP, can support families in achieving high practice diversity. Future learner driver interventions should provide important information early in the learner period when engagement is greatest, encourage continued learning as part of logging practice drives, and incorporate monitoring software for further personalisation to meet family needs. TRIAL REGISTRATION: NCT01498575.

Simulated Driving Assessment (SDA) for teen drivers: results from a validation study.

BACKGROUND: Driver error and inadequate skill are common critical reasons for novice teen driver crashes, yet few validated, standardised assessments of teen driving skills exist. The purpose of this study is to evaluate the construct and criterion validity of a newly developed Simulated Driving Assessment (SDA) for novice teen drivers. METHODS: The SDA's 35 min simulated drive incorporates 22 variations of the most common teen driver crash configurations. Driving performance was compared for 21 inexperienced teens (age 16-17 years, provisional license ≤90 days) and 17 experienced adults (age 25-50 years, license ≥5 years, drove ≥100 miles per week, no collisions or moving violations ≤3 years). SDA driving performance (Error Score) was based on driving safety measures derived from simulator and eye-tracking data. Negative driving outcomes included simulated collisions or run-off-the-road incidents. A professional driving evaluator/instructor (DEI Score) reviewed videos of SDA performance. RESULTS: The SDA demonstrated construct validity: (1) teens had a higher Error Score than adults (30 vs. 13, p=0.02); (2) For each additional error committed, the RR of a participant's propensity for a simulated negative driving outcome increased by 8% (95% CI 1.05 to 1.10, p<0.01). The SDA-demonstrated criterion validity: Error Score was correlated with DEI Score (r=-0.66, p<0.001). CONCLUSIONS: This study supports the concept of validated simulated driving tests like the SDA to assess novice driver skill in complex and hazardous driving scenarios. The SDA, as a standard protocol to evaluate teen driver performance, has the potential to facilitate screening and assessment of teen driving readiness and could be used to guide targeted skill training.

A new method for assessing content validity in model-based creation and iteration of eHealth interventions.

BACKGROUND: The advent of eHealth interventions to address psychological concerns and health behaviors has created new opportunities, including the ability to optimize the effectiveness of intervention activities and then deliver these activities consistently to a large number of individuals in need. Given that eHealth interventions grounded in a well-delineated theoretical model for change are more likely to be effective and that eHealth interventions can be costly to develop, assuring the match of final intervention content and activities to the underlying model is a key step. We propose to apply the concept of "content validity" as a crucial checkpoint to evaluate the extent to which proposed intervention activities in an eHealth intervention program are valid (eg, relevant and likely to be effective) for the specific mechanism of change that each is intended to target and the intended target population for the intervention. OBJECTIVE: The aims of this paper are to define content validity as it applies to model-based eHealth intervention development, to present a feasible method for assessing content validity in this context, and to describe the implementation of this new method during the development of a Web-based intervention for children. METHODS: We designed a practical 5-step method for assessing content validity in eHealth interventions that includes defining key intervention targets, delineating intervention activity-target pairings, identifying experts and using a survey tool to gather expert ratings of the relevance of each activity to its intended target, its likely effectiveness in achieving the intended target, and its appropriateness with a specific intended audience, and then using quantitative and qualitative results to identify intervention activities that may need modification. We applied this method during our development of the Coping Coach Web-based intervention for school-age children. RESULTS: In the evaluation of Coping Coach content validity, 15 experts from five countries rated each of 15 intervention activity-target pairings. Based on quantitative indices, content validity was excellent for relevance and good for likely effectiveness and age-appropriateness. Two intervention activities had item-level indicators that suggested the need for further review and potential revision by the development team. CONCLUSIONS: This project demonstrated that assessment of content validity can be straightforward and feasible to implement and that results of this assessment provide useful information for ongoing development and iterations of new eHealth interventions, complementing other sources of information (eg, user feedback, effectiveness evaluations). This approach can be utilized at one or more points during the development process to guide ongoing optimization of eHealth interventions.

Traumatic Stress, Depression, and Recovery: Child and Parent Responses After Emergency Medical Care for Unintentional Injury.

OBJECTIVE: To assess psychological symptoms in injured children (aged 8-17 years) and their parents after emergency department (ED) care to examine the relationship between posttraumatic stress and depression symptoms, co-occurrence of symptoms within families, and the relationship of these symptoms to parent-reported overall recovery. METHODS: Children and parents (n = 263 child-parent dyads) were enrolled during ED treatment for unintentional injury. Approximately 5 months later, children and parents (n = 178 dyads) completed standardized measures of posttraumatic stress and depression symptoms and parents reported on child overall recovery. RESULTS: Follow-up assessments found significant posttraumatic stress symptoms in 15% of children and 5% of parents, significant depression symptoms in 13% of children and 16% of parents, and problematic overall recovery in 17% of children. For both children and parents, posttraumatic stress and depression symptom severity were strongly associated. Child and parent symptoms were only modestly associated with each other, and there were few families in which both child and parent had significant posttraumatic stress or depression. Parent symptoms, but not child symptoms, were inversely associated with children's overall recovery. CONCLUSIONS: For about 1 in 6 children and parents, unintentional injury treated in the ED can be associated with negative psychological sequelae and suboptimal recovery. Within families, child and parent responses may differ; their relative association with overall recovery deserves additional research. To promote emotional recovery, ED clinicians should be aware of the potential psychological impact of unintentional injury, provide timely evidence-based anticipatory guidance, and communicate these concerns to primary care clinicians.

EMERGENCY BRAKING IN ADULTS VERSUS NOVICE TEEN DRIVERS: RESPONSE TO SIMULATED SUDDEN DRIVING EVENTS.

Motor vehicle crashes remain the leading cause of death in teens in the United States. Newly licensed drivers are the group most at risk for crashes. Their driving skills are very new, still very often untested, so that their ability to properly react in an emergency situation remains a research question. Since it is impossible to expose human subjects to critical life threatening driving scenarios, researchers have been increasingly using driving simulators to assess driving skills. This paper summarizes the results of a driving scenario in a study comparing the driving performance of novice teen drivers (n=21) 16-17 year olds with 90 days of provisional licensure with that of experienced adult drivers (n=17) 25-50 year olds with at least 5 years of PA licensure, at least 100 miles driven per week and no self-reported collisions in the previous 3 years. As part of a 30 to 35 simulated drive that encompassed the most common scenarios that result in serious crashes, participants were exposed to a sudden car event. As the participant drove on a suburban road, a car surged from a driveway hidden by a fence on the right side of the road. To avoid the crash, participants must hard brake, exhibiting dynamic control over both attentional and motor resources. The results showed strong differences between the experienced adult and novice teen drivers in the brake pressure applied. When placed in the same situation, the novice teens decelerated on average 50% less than the experienced adults (p<0.01).

Evaluation of a Risk Awareness Perception Training Program on Novice Teen Driver Behavior at Left-Turn Intersections.

Collisions at left turn intersections are among the most prevalent types of teen driver serious crashes, with inadequate surveillance as a key factor. Risk awareness perception training (RAPT) has shown effectiveness in improving hazard anticipation for latent hazards. The goal of this study was to determine if RAPT version 3 (RAPT-3) improved intersection turning behaviors among novice teen drivers when the hazards were not latent and frequent glancing to multiple locations at the intersection was needed. Teens aged 16-18 with ≤180 days of licensure were randomly assigned to: 1) an intervention group (n=18) that received RAPT-3 (Trained); or 2) a control group (n=19) that received no training (Untrained). Both groups completed RAPT-3 Baseline Assessment and the Trained group completed RAPT-3 Training and RAPT-3 Post Assessment. Training effects were evaluated on a driving simulator. Simulator (gap selection errors and collisions) and eye tracker (traffic check errors) metrics from six left-turn stop sign controlled intersections in the Simulated Driving Assessment (SDA) were analyzed. The Trained group scored significantly higher in RAPT-3 Post Assessment than RAPT-3 Baseline Assessment (p< 0.0001). There were no significant differences in either traffic check and gap selection errors or collisions among Trained and Untrained teens in the SDA. Though Trained teens learned about hazard anticipation related to latent hazards, learning did not translate to performance differences in left-turn stop sign controlled intersections where the hazards were not latent. Our findings point to further research to better understand the challenges teens have with left turn intersections.

Residual cognitive disability after completion of inpatient rehabilitation among injured children.

OBJECTIVE: To determine the prevalence and nature of residual cognitive disability after inpatient rehabilitation for children aged 7-18 years with traumatic injuries. STUDY DESIGN: This retrospective cohort study included children aged 7-18 years in the Uniform Data System for Medical Rehabilitation who underwent inpatient rehabilitation for traumatic injuries in 523 facilities from 2002-2011. Traumatic injuries were identified by standardized Medicare Inpatient Rehabilitation Facility-Patient Assessment Instrument codes. Cognitive outcomes were measured by the Functional Independence Measure instrument. A validated, categorical staging system derived from responses to the items in the cognitive domain of the functional independence measure was used and consisted of clinically relevant levels of cognitive achievement from stage 1 (total cognitive disability) to stage 7 (completely independent cognitive function). RESULTS: There were 13,798 injured children who completed inpatient rehabilitation during the 10-year period. On admission to inpatient rehabilitation, patients with traumatic brain injury (TBI) had more cognitive disability (median stage 2) than those with spinal cord injury or other injuries (median stage 5). Cognitive functioning improved for all patients, but children with TBI still tended to have significant residual cognitive disability (median stage on discharge, 4). CONCLUSIONS: Injured children gained cognitive functionality throughout inpatient rehabilitation. Those with TBI had more severe cognitive disability on admission and more residual disability on discharge. This is important not only for patient and family expectation setting but also for resource and service planning, as discharge from inpatient rehabilitation is a critical milestone for reintegration into society for children with serious injury.

Child passenger safety practices and injury risk in crashes with father versus mother drivers.

In order to test stereotypes that mothers are more safety conscious than fathers, this study aimed to explore differences in restraint patterns, front-row seating and injury for children in crashes when driven by fathers versus mothers, both when driving alone and with other adults. From 15 January 2003 to 30 November 2007, data were collected via insurance claims records and telephone surveys on a weighted sample of 10,715 child passengers in crashes. When riding with children and no other adults, father drivers in crashes were more likely than mother drivers to transport children <9 years old unrestrained or suboptimally restrained (35.0% vs 26.1%, p=0.001) and to seat children <13 years old in the front row (23.7% vs 14.3%, p<0.001). For children <16 years, no statistically significant difference in injury risk was noted for father versus mother drivers, regardless of adult passenger presence. Further improvements in child passenger safety might be gained with campaigns directed at both fathers and mothers.

Adult-supervised practice in learner's permit phase has a significant but limited ability to improve safe driving skills.

OBJECTIVES: Most U.S. states require adult-supervised practice for adolescent learner permit holders intending to obtain a driver's license before 18. However, the effectiveness of adult-supervised practice in imparting safe driving skills had been inconclusive prior to the recent development of consistent measures of adolescent learners' driving performance. We examined the relationship between the number of adult-supervised practice hours and driving performance and skill deficits for 441 learner permit holders ages 16 and 17 in Pennsylvania. METHODS: Data came from a virtual driving assessment (VDA) deployed across Children's Hospital of Philadelphia's Primary Care Network and a self-reported survey at the time of the VDA. Based on a previous study, we defined two VDA Driving Classes that describe driving performance: Major Issues or Major Issues with Dangerous Behavior Class, and Minor Issues or No Issues Class. The response options for adult-supervised practice hours were presented to adolescents as categories (none, <15 h, 15-<65 h, 65 h, and >65 h). We grouped those with 65 h with those with >65 h given the low numbers of responses in these categories. The analysis used a Chi-square test and a binomial logit to investigate how adult-supervised practice hours correspond to adolescents' VDA Driving Classes. RESULTS: Chi-square test showed weak associations between VDA Driving Classes and adult-supervised practice hours. The binomial logit found that adolescents who reported zero adult-supervised practice hours were more likely to be classified into the Major Issues or Major Issues with Dangerous Behavior Class than those who reported adult-supervised practice hours. For those who reported adult-supervised practice, the differences in VDA Driving Class were not statistically significant across the three practice categories (i.e., <15 h, 15-<65 h, and ≥65 h). The model found no significant associations between VDA Driving Class and whether adolescent learners reported practicing with a formal instructor. CONCLUSIONS: Our findings suggest that under current adult-supervised practice routines, longer practice hours have limited associations with improvements in adolescents' VDA Driving Class. Some adolescents might not be ready to deal with the more dangerous settings the VDA presents even after completing the required hours of adult-supervised practice.