SunSmart Accreditation and Use of a Professional Policy Drafting Service: Both Positively and Independently Associated with High Sun Protective Hat Scores Derived from Primary School Policies.

BACKGROUND: The head and neck are exposed to the highest solar ultraviolet radiation levels and experience a disproportionate skin cancer burden. Sun protective hats can provide an effective barrier. Since early life exposure contributes to skin cancer risk, the World Health Organisation recommends prevention programmes in schools. The New Zealand SunSmart Schools programme is one example. Two criteria concern wearing hat outdoors: students are required to wear a hat providing protection for the face, neck, and ears; if a suitable hat is not worn, students must play in shaded areas. OBJECTIVES: To investigate two internationally relevant interventions as plausible statistical predictors of hat policy strength: (1) skin cancer primary prevention programme membership, (2) use of a professional policy drafting service. METHODS: Of 1,242 (62%) eligible schools participating in a 2017 national survey, 1,137 reported a sun protection policy and 842 were available for categorising and allocating protective scores (0-3). RESULTS: In multinomial (polytomous) logistic regression models of cross-sectional association, adjusted for school characteristics, SunSmart accredited schools and those utilising a policy drafting service were independently significantly more likely than their counterparts to obtain the most protective compared to the least protective hat score (respectively, RRR 6.48: 95% CI 3.66, 11.47; 7.47: 3.67, and 15.20). For the dichotomous shade measure, similar associations were found using adjusted logistic regression (OR 3.28: 95% CI 2.11, 5.09; 2.70: 1.54, 4.74). CONCLUSIONS: Our findings provide support for two plausible interventions that could potentially be implemented beneficially in primary schools via established infrastructure in any jurisdiction, internationally.

Changes in awareness of cancer risk factors among adult New Zealanders (CAANZ): 2001 to 2015.

Behaviour change, specifically that which decreases cancer risk, is an essential element of cancer control. Little information is available about how awareness of risk factors may be changing over time. This study describes the awareness of cancer risk behaviours among adult New Zealanders in two cross-sectional studies conducted in 2001 and 2014/5.Telephone interviews were conducted in 2001 (n = 436) and 2014/5 (n = 1064). Participants were asked to recall things they can do to reduce their risk of cancer. They were then presented with a list of potential risk behaviours and asked if these could increase or decrease cancer risk.Most New Zealand adults could identify at least one action they could take to reduce their risk of cancer. However, when asked to provide specific examples, less than a third (in the 2014/5 sample) recalled key cancer risk reduction behaviours such as adequate sun protection, physical activity, healthy weight, limiting alcohol and a diet high in fruit. There had been some promising changes since the 2001 survey, however, with significant increases in awareness that adequate sun protection, avoiding sunbeds/solaria, healthy weight, limiting red meat and alcohol, and diets high in fruit and vegetables decrease the risk of developing cancer.

Sun protection practices in New Zealand secondary schools: a 2014 baseline study.

OBJECTIVE: Guided by the established primary school SunSmart programme, a survey of secondary schools' sun protection policies, planning, behavioural expectations, curriculum content and environment was undertaken in order to establish a baseline to inform advocacy and secondary level programme development. METHODS: All 448 principals of state or state integrated public secondary schools identified from the Ministry of Education database were mailed a hard copy questionnaire. School sun protection practices were assessed and a summative, non-weighted, 11-item Total Sun Protection Score (TSPS) was created. Associations between TSPS and socio-demographic factors, as well as school sun protection policy, were investigated using unadjusted and multiple linear regressions. RESULTS: Usable responses received from 211 of the 448 schools (47% participation) indicated reasonable representativeness of eligible schools, but under-representation of low socioeconomic decile institutions (p = 0.003) and those with the smallest roll size (p = 0.004). Only 50% of schools reported having a sun protection policy. The least attained TSPS components were outdoor event planning (17.1%), student breaks (16.6%), sun-protective clothing (8.5%) and shade provision (6.2%). The mean (SD) TSPS was 4.58 (2.06). In multivariable analysis, TSPS was statistically significantly positively associated with having a sun protection policy (p < 0.001) and the presence of primary level classes (p < 0.001) - the latter suggesting a possible influence of programme continuity, but negatively associated with integrated school status (p = 0.036). CONCLUSION: A standard SunSmart programme could be promoted to all schools, irrespective of socioeconomic decile, overall roll size, gender status or regional population density. Low attainment of some TSPS components indicates targeting priorities.

In multiple situational light settings, visual observation for skin colour assessment is comparable with colorimeter measurement.

BACKGROUND: Finding inexpensive and reliable techniques for assessing skin colour is important, given that it is related to several adverse human health outcomes. Visual observation is considered a subjective approach assessment and, even when made by trained assessor, concern has been raised about the need for controlled lighting in the study venue. The aim of this study is to determine whether visual skin colour assessments correlate with objective skin colour measurements in study venues with different lighting types and configurations. METHODS: Two trained investigators, with confirmed visual acuity, visually classified the inner, upper arm skin colour of 556 adults using Munsell(®) colour classifications converted to Individual Typology Angle (°ITA) values based on published data. Skin colour at the same anatomic site was also measured using a colorimeter. Each participant was assessed in one of 10 different buildings, each with a different study day. Munsell(®) -derived °ITA values were compared to colorimeter °ITA values for the full sample and by building/day. RESULTS: We found a strong positive, monotonic correlation between Munsell(®) derived °ITA values and colorimeter °ITA values for all participants (Spearman ρ = 0.8585, P < 0.001). Similar relationships were found when Munsell(®) and colorimeter °ITA values were compared for participants assessed in the same building for all 10 buildings (Spearman ρ values ranged from 0.797 to 0.934, all correlations were statistically significant at P < 0.001). CONCLUSION: It is possible to visually assess individual skin colour in multiple situational lighting settings and retrieve results that are comparable with objective measurements of skin colour. This was true for individuals of varying population groups and skin pigmentation.

Food for thought: edible gardens in New Zealand primary and secondary schools.

ISSUE ADDRESSED: School gardens are a potentially important health promotion tool, allowing the growth and consumption of fruit and vegetables to be embedded within the students' educational experience. This study aimed to investigate the implementation of edible gardens in New Zealand (NZ) primary and secondary schools. METHODS: A questionnaire mailed to principals from a randomly selected sample of 764 NZ schools included questions on whether or not the school had a garden and, if so, what produce was grown; how long the garden had been in place; how harvested crops were distributed; and curriculum integration. RESULTS: Among 491 responding schools (64.3% response rate), 52.9% currently had an edible garden - with most gardens started in the previous two years. Vegetables, herbs and tree fruit were commonly grown. Gardens were integrated into curriculum subjects, cooking lessons, recipes and messages promoting increased fruit and vegetable consumption. CONCLUSIONS: Edible gardens were common within NZ schools, though often relatively new, and were used for teaching in a variety of curriculum areas. SO WHAT?: Given the current popularity of school gardens, there are opportunities to deliver health promotion messages regarding consumption of fruit and vegetables, and for these to be reinforced by real life experience growing and preparing healthy food.

Comparison of Munsell(®) color chart assessments with primary schoolchildren's self-reported skin color.

BACKGROUND: Skin color is related to human health outcomes, including the risks of skin cancer and vitamin D insufficiency. Self-perceptions of skin color may influence health behaviours, including the adoption of practices protective against harmful solar ultraviolet radiation levels. Misperception of personal risk may have negative health implications. The aim of this study is to determine whether Munsell(®) color chart assessments align with child self-reported skin color. METHODS: Two-trained investigators, with assessed color acuity, visually classified student inner upper arm constitutive skin color. The Munsell(®) classifications obtained were converted to Individual Typology Angle (ITA) values and respective Del Bino skin color categories after spectrocolorimeter measurements based on published values/data. As part of a written questionnaire on sun protection knowledge, attitudes, and behaviours, self-completed in class time, students classified their end of winter skin color. Student self-reports were compared with the ITA-based Del Bino classifications. A total of 477 New Zealand primary students attending 27 randomly selected schools from five geographic regions. The main measures were self-reported skin color and visually observed skin color. RESULTS: A monotonic association was observed between the distribution of spectrophotometer ITA scores obtained for Munsell(®) tiles and child self-reports of skin color, providing some evidence for the validity of self-report among New Zealand primary school children, although the lighter colored ITA defined groups were most numerous in this study sample. Statistically significant differences in ITA scores were found by ethnicity, self-reported skin color, and geographic residence (P < 0.001). Certain Munsell(®) color tiles were frequently selected as providing a best match to skin color. CONCLUSION: Assessment using Munsell(®) color charts was simple, inexpensive, and practical for field use and acceptable to children. The results suggest that this method may prove useful for making comparisons with other studies using visual tools to assess skin color. Alignment between the ITA distribution derived from the Munsell(®) assessment and child skin color self-reports could probably be improved, particularly with the addition of another 'light'/'white' color category in the self-report instrument.

Sun-tanning perceptions of a new zealand urban population (1994-2005/6).

Background. Sun-tanning perceptions are monitored to identify changes and help refine targeting of skin cancer prevention messages. Aim. To investigate associations between perceptions of sun-tanning and demographic factors among a New Zealand urban population, 1994-2006. Methods. A telephone survey series was conducted during summer in 1994, 1997, 1999/2000, 2002/2003, and 2005/2006. Demographic and personal information (sex, age group, skin sun-sensitivity, and self-defined ethnicity) obtained from 6,195 respondents, 50.2% female, 15-69 years, was investigated in relation to six sun-tanning related statements. A total "positive perceptions of tanning" (ProTan) score was also calculated. Regression analyses modelled each component and the ProTan score against survey year and respondent characteristics. Results. Statistically significantly higher ProTan scores were found for age group (strong reverse dose-response effect), male sex, residence (highest in Auckland), ethnicity (highest among Europeans), and sun sensitivity (an n-shaped association). There was no statistically significant change in total ProTan scores from baseline. Conclusions. The development, pretesting, and evaluation of messages for those groups most likely to endorse ProTan statements should be considered for the New Zealand skin cancer prevention program. To achieve and embed significant change, mass media campaigns may require greater intensity and reinforcement with sustained contextual support for settings-based behavioural change.

Edible gardens in early childhood education settings in Aotearoa, New Zealand.

ISSUE ADDRESSED: This paper aims to explore the presence and role of edible gardens in Aotearoa/New Zealand Early Childhood Education Services (ECES). METHODS: Participant ECES providers were identified from the Ministry of Education database of Early Childhood Education Services (March 2009). These include Education and Care and Casual Education and Care, Kindergarten, Home-based Education and Care services, Playcentres, Te Kohanga Reo. A structured, self-administered questionnaire was sent to the Principal or Head Teacher of the service. RESULTS: Of the 211 ECES that responded (55% response rate), 71% had edible gardens, incorporating vegetables, berry fruit, tree fruit, edible flowers and nut trees. Garden activities were linked with teaching across all strands of the New Zealand early childhood curriculum. In addition, 34% provided guidance on using garden produce and 30% linked the garden with messages on fruit and vegetable consumption. Most gardens were established recently (past 2 years) and relied on financial and non-financial support from parents, teachers and community organisations. Barriers included a lack of funding, space, time and staff support. CONCLUSIONS/IMPLICATIONS: Study findings suggest that gardens are already being used as a versatile teaching tool in many ECES settings. Most gardens are new, with a need to support the sustainability and workforce development among teachers and parents in order to be able to maintain these resources for future generations. SO WHAT?: Given the inherent links between gardening and healthy food and exercise, there seem to be extensive opportunities for health promotion aligned with the edible garden movement.

Baseline survey of sun protection policies and practices in primary school settings in New Zealand.

The SunSmart Schools Accreditation Programme (SSAP) was launched as a national programme in October 2005 to help reduce the risk of excessive child exposure to ultraviolet radiation. As part of the need for evaluation, this paper reports the findings of a national survey of a randomly selected sample of approximately 12% of New Zealand primary schools prior to the national launch of the SSAP. Principals at 242 schools completed a mail survey (81% response rate) relating to school sun protection policies, practices, curriculum and environment. Survey responses were evaluated according to the 12 criteria of the SSAP, with schools assigned a score from 0 to 12. No school fully met all 12 accreditation criteria, although 2% of schools attained 11 criteria and another 2% attained 10. Nine per cent of schools attained three or fewer criteria. Overall, 7 was the most common score, achieved by 23%. School socio-economic decile rating and roll size were positively associated with higher scores (both P < 0.02). Continued support and resources are needed to encourage schools to address sun protection across the spectrum of curriculum, practices and environment and through commitment to written policy.

Patterns of real-time occupational ultraviolet radiation exposure among a sample of outdoor workers in New Zealand.

OBJECTIVES: Exposure to solar ultraviolet radiation (UVR) is an occupational health and safety issue for outdoor workers since excessive exposure is associated with negative health outcomes, including eye conditions and skin cancers. The objective of this research was to describe the pattern of UVR exposure experienced by outdoor workers from selected occupations in New Zealand in order to identify the impact of behaviour and work conditions on exposure. STUDY DESIGN: This paper reports on the occupational UVR exposure arm of a dual arm cross-sectional study that also examined workers' sun protection practices. METHODS: For five consecutive working days in January-March 2007, electronic dosimeters were used to record the time-stamped UVR exposure of a sample of 77 outdoor workers from three occupations (building, horticulture and roading) in Central Otago, New Zealand. RESULTS: The geometric mean total daily UVR exposure (between 1100 and 1600 h) was 5.32 standard erythemal doses (SED; 95% reference range 0.28-19.97 SED). The geometric mean total daily UVR exposure as a percentage of the total daily ambient UVR was 20.5% (95% confidence interval 1.4-83.0%). Personal UVR exposure dipped between 1200 h and 1300 h--the same time that ambient UVR peaked--indicating the effect of shade seeking over the lunch period. Personal UVR exposure peaked between 1400 h and 1500 h, alongside decreasing ambient UVR levels, suggesting the influence of behavioural rather than climatic factors. The difference in workers' exposure between 1200 h and 1300 h, and 1400 h and 1500 h was statistically significant for both measured personal exposure (P < 0.005) and exposure calculated as a percentage of concurrent available ambient UVR (P < 0.005). CONCLUSIONS: All the workers in this study recorded mean daily UVR exposure in excess of the current recommended occupational exposure limits. Only a minority of workers sought shade during their lunch break; most remained in highly exposed conditions. There is no evidence that work tasks which involve substantial sun exposure are being scheduled outside the high UVR period.

Youth solar ultraviolet radiation exposure, concurrent activities and sun-protective practices: a review.

To assist standardization of procedures, facilitate comparisons, and help guide research efforts to optimally inform development of appropriately targeted interventions, there is a need to review methods used to quantify child and adolescent solar ultraviolet radiation (UV) exposure, related outdoor activities and sun-protective practices. This holistic approach is essential for comprehensive research that will provide all-inclusive, informative and meaningful messages for preventive measures of harmful UV exposure. Two databases were searched and 29 studies were retrieved, and these studies report measurement or assessment techniques documenting UV exposure patterns and related outdoor activities. Polysulfone film badges were the main measurement instrument used in 10 studies, with questionnaire, survey data, observation, a model, electronic dosimeters, biological dosimeters, colorimeter and UV colouring labels used in the remaining studies. Methods used to record activities included self-report, parental report, a logbook and observation. Measurement duration and unit of UV exposure varied in most studies, but a method common to 15 studies was measured UV exposure as a percentage of ambient UV. The studies reviewed do not provide sufficient information for the development and evaluation of targeted youth sun protection programs. Studies are required which document precise UV exposure, concurrent activities and sun protection usage for children and adolescents.

Sponsorship and fund-raising in New Zealand schools: implications for health.

OBJECTIVE: To examine school participation in sponsorship, incentive and fundraising initiatives and to describe feedback about potential health implications and possible solutions from key stakeholders in the health and education sectors. METHODS: All secondary/area schools and 15% of primary/intermediate schools were randomly selected from six geographical regions of New Zealand. School principals completed a self-report questionnaire. Survey findings were summarised in a discussion document and forwarded to 53 key stakeholders for comment. RESULTS: Most schools reported participation in sponsorship, incentive and fundraising initiatives (83% of primary/intermediate and 85% of secondary/area schools). Some partnerships delivered positive health messages to students, but others were linked with products or activities potentially deleterious to health. Examples of the latter included provision of foods high in fat and sugar to students and funding from organisations whose profits were generated from gambling and alcohol sales. Key stakeholder concerns included the undermining of classroom health education and perceptions that schools were endorsing product consumption. Suggestions to address these concerns included increasing co-ordination and awareness, alternative sources of funding, and policy guidelines or legislation. CONCLUSIONS: Most schools were involved in some sort of sponsorship, incentive and fundraising initiatives, some of which had the potential to have a negative impact on the health of students. IMPLICATIONS: There is an urgent need for co-operation between the health and education sectors to ensure that these funding partnerships do not compromise student health.

Fine forecasts: encouraging the media to include ultraviolet radiation information in summertime weather forecasts.

Melanoma and skin cancer are largely attributable to over-exposure to solar ultraviolet radiation (UVR). Reports of UVR levels within media weather forecasts appear to be well received by the public and have good potential to communicate the need for appropriate sun protection to a broad audience. This study describes provision of UVR messages by New Zealand newspapers, radio and TV stations over a 4-year period, and examines the impact of an intervention which aimed to address media concerns about the financial costs of accessing UVR information for broadcast. Newspaper and radio presentation of UVR information increased immediately after these costs were removed; however, among radio stations it dropped in subsequent years. Among those media that were presenting UVR, this information was broadcast throughout the summer period and repeated throughout the day. Furthermore, most reports included concomitant, behavioral sun protection messages. At the final assessment (summer 2001/02), 66% of radio stations, both TV channels and 48% of newspapers reported UVR information in summertime weather reports. Efforts to further increase UVR presentation will need to address media concerns about time constraints on weather forecasts and media perceptions of poor audience demand or understanding of some UVR messages.

Nicotine dependence and attempts to quit or cut down among young adult smokers.

AIMS: To describe tobacco smoking behaviours, attempts to cut down or quit, and estimate the prevalence of DSM-IV nicotine dependence among young adult smokers. To relate these findings to population demand for national Quitline services. METHODS: Confidential interviews were conducted during the assessment of the Dunedin Multidisciplinary Health and Development Study birth cohort at age 26 years. Current smokers who had smoked daily for at least one month during the twelve months before interview were asked questions to identify nicotine dependence, based on DSM-IV criteria. RESULTS: Overall, 40% (n = 386) of the cohort followed up were current smokers who met the twelve month daily smoking criterion, one third of whom fulfilled DSM-IV criteria for nicotine dependence. The mean number of attempts to quit or cut down in the past year was 1.2. Assuming that each attempt represents a potential call to the Quitline, more than 5500 calls per month might be anticipated from the 25-29 year age group and in excess of 40 000 from the total New Zealand population, eighteen years and older. CONCLUSIONS: Results indicate that many young adult smokers are potential users of smoking cessation services and many are nicotine dependent. In order to satisfy this reservoir of need and reduce the population burden of ill-health and premature death due to tobacco smoking, resources should continue to be provided to support and enhance tobacco control programmes with proven effectiveness in helping smokers to quit.

Tobacco smoking among fourth form school students in Wellington, New Zealand, 1991-97.

OBJECTIVE: To investigate trends in smoking and associated demographic factors among fourth form (14-15 years) school students. METHOD: In 1991, all 35 secondary schools in Wellington, New Zealand, were invited to participate; 15 took part. Smoking behaviours were assessed biennially by self-report. Trends were examined among 5,834 students, using multilevel regression. RESULTS: When adjusted for sex, ethnicity and their interaction, the baseline (1991) prevalence of smoking within the past month was 18% (95% CI 10-29) rising to 28% (95% CI 15-46) in 1997. The comparable baseline prevalence of daily smoking was 8% (95% CI 3-21) rising to 15% (95% CI 4-40) in 1997. Smoking was more common among girls than boys and most common among Maori girls, for whom the adjusted odds of current and daily smoking were, respectively, 3.40 times (95% CI 2.56-4.52) and 5.00 times (95% CI 3.64-6.87) those of Europeans. School socio-economic status and sex composition added to the explanatory power of the model for daily smoking, but had negligible effect on the odds ratios for sex and ethnic group. CONCLUSIONS AND IMPLICATIONS: The suggested rise in the prevalence of smoking has implications for future adult smoking rates and health costs. Under-representation of socio-economically disadvantaged schools may have produced conservative estimates. The increased odds of smoking among girls and Maori confirm the need to develop interventions appropriate for these groups.

An evaluation of the general effect of the New Zealand graduated driver licensing system on motorcycle traffic crash hospitalisations.

In 1987, New Zealand introduced a comprehensive Graduated Driver Licensing System (GDLS) which was designed to allow new drivers to gain driving experience while being excluded from high risk situations. This study sought to evaluate the impact of the GDLS on motorcycle traffic crashes that resulted in serious injury. Injury crash data were obtained from the New Zealand Health Information Services national public hospital inpatient data files for the years 1978-1994, inclusive. Cases were disaggregated into three age groups, 15-19 years, 20-24 years, and 25 years or older, for which injury trends were obtained. In order to determine whether trends in motorcycle traffic crashes simply followed national trends in other injury events, two non-traffic comparison groups for the main target group (15-19 years) were included. Using time series analyses, the introduction of the GDLS was found to be closely followed by a significant reduction (22%) in motorcycle traffic crash hospitalizations for the 15-19 year age group. An examination of vehicle registration and driver licensure data suggests that the reduction in injury crashes may, largely, be attributable to an overall reduction in exposure to motorcycle riding.

Continuity and change in sporting and leisure time physical activities during adolescence.

OBJECTIVES: To map the pattern of involvement in physical activities by adolescents at ages 15 and 18 years. METHODS: Data from a longitudinal cohort study were used. Participants in the Dunedin Multidisciplinary Health and Development Study provided information about their sporting and similar physical activities during the 12 months before study assessments at ages 15 and 18 years. RESULTS: Total participation time at age 18 was 63% of that reported at age 15. Mean participation time for girls decreased from 7.5 hours a week to 4.3 hours a week (p<0.001) whereas for boys it decreased from 11.7 hours a week to 7.8 hours a week (p<0.001). At both ages, boys spent significantly more time in physical activity than girls. More time in physical activity at age 18 was reported by participants who judged their fitness higher than their peers (odds ratio (OR) 1.7: 1.2, 2.5), those who played sport for their school (OR 1.8: 1.3, 2.4), and those reporting very good self assessed health (OR 1.4: 1.0, 1.8) at age 15. The overall median number of activities decreased from seven at age 15 to three at 18. Boys were involved in more activities at age 15 but there was no sex difference at age 18 in the number of different activities reported. CONCLUSION: Although involvement in school sporting activities and high levels of fitness in mid-adolescence may protect against marked reductions in physical activity in late adolescence, social and organisational factors are also likely to be important. There is a need for innovative approaches to health promotion which will encourage adolescents to maintain higher levels of physical activity after they leave school.

Psychological and social predictors of motorcycle use by young adult males in New Zealand.

Motorcycle riding is a significant cause of serious injuries to young males. Little is known about the psychological and social characteristics of these riders, despite such knowledge being potentially important for the targeting of appropriate injury prevention interventions. Using problem-behaviour theory to broadly guide and structure the research, the present study focused on identifying predictors of motorcycle riding. Previous research investigating differences between riders and non-riders has tended to be inconclusive, methodologically limited, and lacking in explicit theoretical foundations. The present research was based on the birth cohort enrolled in the Dunedin Multidisciplinary Health and Development Study (DMHDS), a comprehensive New Zealand longitudinal study of health, development, attitudes, and behaviours. Logistic regression models were built using prior measures of health risk behaviour, other psychological and social factors, and motorcycle riding history as potential predictors of any motorcycle use at the age of 18 years. The strongest predictors were early motorcycle riding, including illegal on-road driving at age 13 (OR 4.0; 95% CI 1.7, 9.1), below average reading skills (OR 2.4; 95% CI 1.3, 4.6) and fighting in a public place at age 15 (OR 2.9; 95% CI 1.2, 6.9). It was of particular interest that this profile tended to fit less well those subgroups of riders with greatest exposure to on-road motorcycle driving. Although based on small numbers, this finding was consistent with earlier cross-sectional research that linked casual and unlicensed driving with less protective motorcycling opinions and behaviours. Some implications for injury prevention and public policies regarding motorcycling are discussed. In particular, stricter enforcement of present licensing regulations and stronger penalties for their violation could help to reduce the number of less responsible riders.

Inattentive and hyperactive behaviors and driving offenses in adolescence.

OBJECTIVE: The associations between symptoms of attention-deficit hyperactivity disorder (ADHD), conduct disorder, anxiety, or depression and no disorder in relation to driving offenses were examined in 916 adolescents. METHOD: Self-report and parent report were used to assess a birth cohort of New Zealand adolescents' mental health status at age 15 years. Adolescents who scored 1.5 SD above the mean on the DSM-III total ADHD symptom scale were identified as reporting significant ADHD symptomatology. Self-report data and official traffic conviction records were used to identify adolescents who had committed driving offenses between ages 15 and 18 years. RESULTS: ADHD symptomatology and conduct disorder were strongly associated with driving offenses. ADHD symptomatology in females was significantly associated with driving offenses and more traffic crashes compared with other disorder or no disorder. CONCLUSIONS: Adolescents with a history of ADHD and conduct problems are significantly more likely than their peers to commit traffic offenses. Research in ADHD and risky driving should include female adolescents, as those with attentional difficulties are at a high risk for being involved in traffic crashes than females who do not experience attentional difficulties.