Assessing the American public's preferences for reforms to teen driving licensure systems: a discrete choice experiment.

OBJECTIVES: To analyse factors influencing the American public's preferences for changes to teenage driver licensing requirements. METHODS: We employed a discrete choice experiment (DCE) with 808 participants from National Opinion Research Center's AmeriSpeak panel to assess preferences for two existing elements (on-road testing and intermediate licensure period) and a new feature (driver monitoring with telematics during the intermediate licensure period) of licensing system. Multinomial and mixed logit models were used to estimate preference weights, marginal rates of substitution and the relative importance of each attribute. RESULTS: Among 730 respondents who completed all DCE choice tasks, we found robust support for changes to teenage driver licensing requirements, with preferences varying by individual characteristics. Respondents expressed a high baseline support for changes to teen driving licensure policies. They favoured testing, prioritising easy tests and opposed prolonged driver monitoring and extended intermediate licensure periods. Baseline preference weights exhibited substantial heterogeneity, emphasising the diversity of public preferences. The marginal rates of substitution revealed a preference for extended driver monitoring over an extended intermediate licensure period. An easy test was valued at 2.85 times more than a hard one. The most influential attributes were the length of intermediate licence period and testing requirements, with the former twice as important. CONCLUSIONS: Our study found robust support for reforms to teenage driver licensing requirements, favouring easier on-road driving tests over an extended period of intermediate licensure and driver monitoring. Public preferences for licensing systems need to be balanced with the broader policy objectives including optimising mobility and maximising safety.

Public support for logbooks during the supervised practice driving phase of graduated driver licensing: a national survey of teens and parents in the USA.

BACKGROUND: Verification of the completion of supervised practice driving hours for teenagers is challenging. Electronic logbooks could provide an objective alternative to paper logbooks. Factors influencing the adoption of electronic logbooks are poorly understood. We conducted a survey of a nationally representative sample of teenagers and parents in the USA to address these gaps in understanding. METHODS: The survey was fielded to teenagers who were currently learning to drive or had a full driver's licence, and parents of teenager with a learner's permit or a driver's licence. We measured (1) support for supervised practice driving requirements and logbook requirements, (2) preferences between paper and electronic logbooks and (3) features that would make an electronic logbook useful. RESULTS: Most parents and teenagers supported both supervised practice driving and logbook requirements. The overwhelming majority of teenagers and parents preferred an electronic logbook over paper. Electronic logbooks that provide (1) summary information about completed drives, (2) parent certification of drives and (3) automatic trip detection were features that were rated most useful by respondents. DISCUSSION: This is the first study to measure teen and parent support for the logbook format to track supervised practice driving. Public support for electronic logbooks is high, suggesting that policy makers could consider adding an electronic logbook requirement to graduated driver licensing systems to objectively measure completed practice driving hours. Driver educators could also promote the use electronic logbooks to track practice and calibrate behind-the-wheel lessons to the amount of practice driving that has been completed.

The Future of Road Safety: Challenges and Opportunities.

Policy Points Traditional approaches to addressing motor vehicle crashes are yielding diminishing returns. A comprehensive strategy known as the Safe Systems approach shows promise in both advancing safety and equity and reducing motor vehicle crashes. In addition, a range of emerging technologies, enabled by artificial intelligence, such as automated vehicles, impairment detection and telematics hold promise to advance road safety. Ultimately, the transportation system will need to evolve to provide the safe, efficient, and equitable movement of people and goods without reliance on private vehicle ownership, towards encouraging walking, bicycling and the use of public transportation.

Safety Concerns in Mobility-Assistive Products for Older Adults: Content Analysis of Online Reviews.

BACKGROUND: Older adults who have difficulty moving around are commonly advised to adopt mobility-assistive devices to prevent injuries. However, limited evidence exists on the safety of these devices. Existing data sources such as the National Electronic Injury Surveillance System tend to focus on injury description rather than the underlying context, thus providing little to no actionable information regarding the safety of these devices. Although online reviews are often used by consumers to assess the safety of products, prior studies have not explored consumer-reported injuries and safety concerns within online reviews of mobility-assistive devices. OBJECTIVE: This study aimed to investigate injury types and contexts stemming from the use of mobility-assistive devices, as reported by older adults or their caregivers in online reviews. It not only identified injury severities and mobility-assistive device failure pathways but also shed light on the development of safety information and protocols for these products. METHODS: Reviews concerning assistive devices were extracted from the "assistive aid" categories, which are typically intended for older adult use, on Amazon's US website. The extracted reviews were filtered so that only those pertaining to mobility-assistive devices (canes, gait or transfer belts, ramps, walkers or rollators, and wheelchairs or transport chairs) were retained. We conducted large-scale content analysis of these 48,886 retained reviews by coding them according to injury type (no injury, potential future injury, minor injury, and major injury) and injury pathway (device critical component breakage or decoupling; unintended movement; instability; poor, uneven surface handling; and trip hazards). Coding efforts were carried out across 2 separate phases in which the team manually verified all instances coded as minor injury, major injury, or potential future injury and established interrater reliability to validate coding efforts. RESULTS: The content analysis provided a better understanding of the contexts and conditions leading to user injury, as well as the severity of injuries associated with these mobility-assistive devices. Injury pathways-device critical component failures; unintended device movement; poor, uneven surface handling; instability; and trip hazards-were identified for 5 product types (canes, gait and transfer belts, ramps, walkers and rollators, and wheelchairs and transport chairs). Outcomes were normalized per 10,000 posting counts (online reviews) mentioning minor injury, major injury, or potential future injury by product category. Overall, per 10,000 reviews, 240 (2.4%) described mobility-assistive equipment-related user injuries, whereas 2318 (23.18%) revealed potential future injuries. CONCLUSIONS: This study highlights mobility-assistive device injury contexts and severities, suggesting that consumers who posted online reviews attribute most serious injuries to a defective item, rather than user misuse. It implies that many mobility-assistive device injuries may be preventable through patient and caregiver education on how to evaluate new and existing equipment for risk of potential future injury.

Acquisition, mobility and food insecurity: integrated food systems opportunities across urbanicity levels highlighted by COVID-19.

OBJECTIVE: To investigate acquisition and mobility experiences of food-insecure individuals across urbanicity levels (i.e., urban, suburban, rural) in the early months of the COVID-19 pandemic. DESIGN: Cross-sectional study using a nationally representative online panel to measure where food-insecure individuals acquired food, food acquisition barriers and mobility to food sources, which were evaluated across urbanicity levels using chi-squared tests and 95 % CI. SETTING: USA. PARTICIPANTS: 2011 adults (18 years or older). RESULTS: Food insecurity impacted 62·3 % of adults in urban areas, 40·5 % in rural areas and 36·7 % in suburban areas (P < 0·001). Food acquisition barriers that were significantly more prevalent among food-insecure adults in urban areas were a change in employment status (34·2 %; 95 % CI 27·2 %, 41·1 %; P < 0·0001) and limited availability of food in retailers (38·8 %; 95 % CI 31·7 %, 45·9 %; P < 0·001). In rural areas, food-insecure adults primarily acquired food for the household from supercentres (61·5 %; 95 % CI 50·4 %, 72·5 %; P < 0·05), while locally sourced foods were less common among food-insecure adults in rural areas (6·9 %; 95 % CI 0·01 %, 13·0 %) compared to urban areas (19·8 %; 95 % CI 14·3 %, 25·4 %; P < 0·01). Transportation as a barrier did not vary significantly by urbanicity, but food-insecure adults across urbanicity levels reported utilising a range of transportation modes to acquire food. CONCLUSIONS: A planning approach that links urban and rural areas could address food insecurity by enhancing the integration of food production, transportation and food distribution, building towards a more resilient and equitable food system for all Americans.

State and city laws governing the use of child restraint systems in rideshare vehicles and taxicabs: requirements and responsibility.

OBJECTIVES: To identify, describe and critique state and local policies related to child passenger safety in for-hire motor vehicles including ridesharing and taxis. METHODS: We used standard legal research methods to collect policies governing the use of child restraint systems (CRS) in rideshare and taxi vehicles for all 50 states and the 50 largest cities in the USA. We abstracted the collected policies to determine whether the policy applies to specific vehicles, requires specific safety restraints in those vehicles, lists specific requirements for use of those safety restraints, seeks to enhance compliance and punishes noncompliance. RESULTS: All 50 states have policies that require the use of CRS for children under a certain age, weight or height. Seven states exempt rideshare vehicles and 28 states exempt taxis from their CRS requirements. Twelve cities have relevant policies with eight requiring CRS in rideshare vehicles, but not taxis, and two cities requiring CRS use in both rideshare vehicles and taxis. CONCLUSION: Most states require CRS use in rideshare vehicles, but not as many require CRS use in taxis. Though states describe penalties for drivers who fail to comply with CRS requirements, these penalties do not actually facilitate the use of CRS in rideshare or taxis. Furthermore, there is ambiguity in the laws about who is responsible for the provision and installation of the restraints. To prevent serious or fatal injuries in children, policy-makers should adopt policies that require, incentivise and facilitate the use of CRS in rideshare vehicles and taxis.

Evaluating a smartphone application to increase the quantity and improve the quality of supervised practice driving.

BACKGROUND: The learner stage of graduated driver licensing (GDL), when teenagers are supervised by an adult driver, represents an opportunity to develop skills that could confer a safety benefit during their years of independent driving. This paper describes the design of a teenage driving study, which aims to evaluate the impact of a smartphone application, the 'DrivingApp,' to increase the quantity and improve the quality of supervised practice driving. METHODS: This longitudinal intervention study of teenage drivers and a parent/guardian spans the final 6 months of the learner licence and the first year of independent driving. Participants will be assigned to experimental or control groups using block allocation. Parent-teenage dyads assigned to the intervention arm will receive information about their practice driving via a smartphone application, including miles driven and total drive time. Baseline and monthly surveys will be administered to both experimental and control participants to measure the outcome measures during the learner stage: (1) practice driving amount, (2) consistency and (3) variety. Outcomes during independent driving are (1) self-reported number of attempts at the driving test and (2) number of crashes during the first year of independent driving. DISCUSSION: Improving the quality of teenagers' supervised practice driving is an unmet research need. This study will contribute to the evidence about what can be done during the learner period of GDL to maximise teenage drivers' safety during the first years of independent driving, when crash risk is highest.

Public health principles to inform testing and build trust in automated vehicles.

Highly publicised crashes involving self-driving or autonomous vehicles (AVs) have raised questions about safety and eroded public trust in the technology. In this State of the Art Review, we draw on previous successes in injury prevention and public health to focus attention on three strategies to reduce risk and build public confidence as AVs are being tested on public roads. Data pooling, a graduated approach to risk exposure, and harm reduction principles each offer practical lessons for AV testing. The review points out how the eventual deployment of AV technology could have a substantial impact on public health. In this regard, inclusive testing, public education and smart policy could extend the social value of AVs by improving access to mobility and by directing deployments towards scenarios with the greatest population health impact. The application of these strategies does not imply slowing down progress; rather, their implementation could accelerate adoption and result in realising the benefits of AVs more quickly and comprehensively while minimising risks.

Teen Drivers' Perceptions of Their Peer Passengers: Qualitative Study.

BACKGROUND: The presence of peer passengers increases teenage drivers' fatal crash risk. Distraction and social influence are the two main factors that have been associated with increased risk. Teen drivers' perceptions of their peer passengers on these factors could inform our understanding of the conditions under which peer passengers increase crash risk or promote safer driving. The purpose of this study was to examine teen drivers' perceptions of their peer passengers on distraction and social influence. METHOD: A convenience sample of male and female drivers participated in a semi-structured interview that included questions on their perceptions of the effects of peer passengers on driving on distraction and social influence. The analysis of the interviews was guided by a grounded theory approach. FINDINGS: Teenage drivers were aware of the risk that peer passengers posed. Some described having passengers in the vehicle as distracting, and recognized that the level of distraction increased with the number of passengers in the vehicle. Drivers that felt responsible for the safety of their peer passengers described strategies they used to control the in-vehicle environment. Drivers described driving with passengers as a performance, and articulated direct and indirect sources of pressure, gender norms, and unspoken expectations of their passengers as influencing their driving behavior. CONCLUSIONS: The influence of passengers is situation specific and dependent on whom the passenger(s) may be. Passenger influence may be either protective or harmful, depending on the circumstances. Some passengers exert direct influence, but often their influence appears more indirect and subtle.

Prevalence and Use of Driver Monitoring Systems: A National Survey in the United States.

The purpose of this study was to measure the prevalence of use of driver monitoring systems among U.S. adults, and factors influencing their adoption. One in five U.S. adults has used driver monitoring, primarily to obtain a discount on insurance. Safety benefits and financial incentives are likely to influence adoption.

Work-related crashes in rideshare drivers in the United States.

INTRODUCTION: Motor vehicle crashes (MVCs) are the leading cause of work-related deaths in the United States. The increasing popularity of the competitive rideshare market and the lack of oversight over workforce health and safety limits understanding of the current occupational hazards and associated risk factors faced by this precarious workforce. The objective of this analysis was to determine what the personal, social and occupational risk factors for work-related crashes in rideshare drivers are in the United States and suggest further research required to understand occupational health risks and opportunities for interventions. MATERIAL AND METHODS: We conducted a survey of a convenience sample of rideshare and taxi drivers using an online questionnaire. Rideshare respondents (n = 277) were recruited through an email that was distributed to people who subscribe to TheRideshareGuy.com. We examined the general characteristics of rideshare drivers by history of work-related MVCs and logistic regression models were used to determine major predictors of MVCs. RESULTS: Of 276 rideshare drivers that reported their crash history, one-third (n = 91, 33%) reported being involved in a work-related crash. Results from a multivariable logistic regression model showed rideshare MVCs were more likely in older drivers (aOR for 10 year increases in age, 1.55, p = 0.001), if drivers undertook 10 or more rideshare trips per day (aOR 1.84, p = 0.041), frequently or very frequently were driving on unfamiliar roads (aOR 1.72, p = 0.048) and driving whilst tired (aOR 3.03, p = 0.003). CONCLUSION: Precarious workers and health and safety is emerging as a major area of research focus. There is a unique opportunity to explore the occupational health risks in rideshare drivers to provide interventions that encourage growth of a healthy and fit rideshare workforce and promote work practices and future regulations aimed at improving safe work practices. PRACTICAL APPLICATIONS: This analysis paints a complex picture of personal and occupational factors that are associated with MVCs in rideshare drivers suggesting that additional policy development related to occupational health and safety of rideshare drivers could be constructive.

Speeding behavior among teenage drivers during the learner and early independent driving stage: A case study approach.

INTRODUCTION: Speed is a primary contributing factor in teenage driver crashes. Yet, there are significant methodological challenges in measuring real-world speeding behavior. METHOD: This case study approach analyzed naturalistic driving data for six teenage drivers in a longitudinal study that spanned the learner and early independent driving stages of licensure in Maryland, United States. Trip duration, travel speed and length were recorded using global position system (GPS) data. These were merged with maps of the Maryland road system, which included posted speed limit (PSL) to determine speeding events in each recorded trip. Speeding was defined as driving at the speed of 10 mph higher than the posted speed limit and lasting longer than 6 s. Using these data, two different speeding measures were developed: (1) Trips with Speeding Episodes, and (2) Verified Speeding Time. Conclusions & Practical Applications: Across both measures, speeding behavior during independent licensure was greater than during the learner period. These measures improved on previous methodologies by using PSL information and eliminating the need for mapping software. This approach can be scaled for use in larger samples and has the potential to advance understanding about the trajectory of speeding behaviors among novice teenage drivers.

Advancing Transportation Equity and Safety Through Autonomous Vehicles.

Motor vehicle crashes are a leading cause of death in the United States, and disproportionately impact communities of color. Replacing human control with automated vehicles (AVs) holds the potential to reduce crashes and save lives. The benefits of AVs, including automated shuttles, buses, or cars could extend beyond safety to include improvements in congestion, reductions in emissions, and increased access to mobility, particularly for vulnerable populations. However, AVs have not attained the level of public trust that has been expected, given their potential to save lives and increase access to mobility. Public opinion surveys have highlighted safety and security concerns as reasons for this lack of confidence. In this study, we present the findings of an experiment we conducted to actively shift mindsets on AVs toward advancing health equity. We demonstrate through a nationally representative sample of 2265 U.S. adults that the public support for AVs can be improved by expanding their scope of application to include advancing social benefit. The survey began with questions on respondent's support for AVs based on a priori knowledge and beliefs. Consistent with prior surveys, baseline support (strong support and some degree of support) was low at 26.4% (95% confidence interval 24.0-29.0). After introducing information about how AVs could be used to provide mobility for older adults, those with limited income, or the vision-impaired, respondents were asked to reassess their support for AVs. Support significantly increased to include the majority of respondents. By prioritizing the deployment of AVs to serve individuals and communities in greatest need of mobility, AVs would not only demonstrate compelling social value by reducing disparities but would also gain widespread public support among the U.S. public.

Development of an algorithm for analysis of routes: Case studies using novice and older drivers.

INTRODUCTION: This study addresses the lack of methods to quantify driver familiarity with roadways, which poses a higher risk of crashes. METHOD: We present a new approach to assessing driving route diversity and familiarity using data from the DrivingApp, a smartphone-based research tool that collects trip-level information, including driving exposure and global positioning system (GPS) data, from young novice drivers (15-19 years old) to older drivers (67-78 years old). Using these data, we developed a GPS data-based algorithm to analyze the uniqueness of driving routes. The algorithm creates same route trip (SRT) arrays by comparing each trip of an identified user, employing statistically determined thresholds for GPS coordinate proximity and trip overlap. The optimal thresholds were established using a General Linear Model (GLM) to examine distance, and repeated observations. The Adjusted Breadth-First Search method is applied to the SRT arrays to prevent double counting or trip omission. The resulting list is classified as geographically distinct routes, or unique routes (URs). RESULTS: Manual comparison of algorithm output with geographical maps yielded an overall precision of 0.93 and accuracy of 0.91. The algorithm produces two main outputs: a measure of driving diversity (number of URs) and a measure of route-based familiarity derived from the Rescorla-Wagner model. To evaluate the utility of these measures, a Gaussian mixture model clustering algorithm was used on the young novice driver dataset, revealing two distinct groups: the low-frequency driving group with lower route familiarity when having higher route diversity, whereas the high-frequency driving group with the opposite pattern. In the older driver group, there was a significant correlation found between the number of URs and Geriatric Depression Score, or walking gait speed. PRACTICAL APPLICATIONS: These findings suggest that route diversity and familiarity could complement existing measures to understand driving safety and how driving behavior is related to physical and psychological outcomes.

Defective Assistive Device Involvement in Older Adult Emergency Department Visits.

Background and Objectives: Many older adults adopt equipment to address physical limitations and reduce dependence on others to complete basic activities of daily living. Although a few prior studies have considered injuries associated with assistive devices for older adults, those studies focused on older adults' health and functional risks for injury. There is limited analysis of older adult injuries involving defective or malfunctioning assistive devices. Research Design and Methods: Data from this study are from the National Electronic Surveillance System All Injury Program which collected data on consumer product-related injuries from a probability sample of 66 hospital Emergency Departments across the United States. Data from 30 776 older adult Emergency Department (ED) injury narratives from 2016 to 2020 were coded according to the assistive device involved and whether malfunctioning led to the injury. The study team manually examined all narratives in which the assistive device was coded to have malfunctioned. Results: A total of 10 974 older adult ED cases were treated for 12 488 injuries involving a defective device. Injuries included 4 212 head and neck injuries (eg, concussion), 4 317 trunk injuries (eg, hip fractures), and 3 959 arm or leg injuries (eg, leg fracture). Of these patients, 4 586 were admitted to a hospital ward for further evaluation and treatment. Seventy percent of these patients were injured while using a walker; in contrast, wheelchairs were implicated in only 4% of the above cases. Design flaws were identified in 8 158 cases and part breakage/decoupling incidents in 2 816 cases. Discussion and Implications: Our findings provide evidence that assistive devices are actively involved in older adult injuries. Further research is needed to reduce injuries associated with assistive devices by educating patients and their careproviders about device use and assembly and developing effective methods for informing manufacturers about malfunctioning devices.

Individual and environmental bicycling determinants during a pandemic.

Introduction: Research has identified many factors associated with bicycling, but little is known on their relative influence for an individual's decision to bicycle or what led to the surge in bicycling during the COVID-19 pandemic in the U.S. Methods: Our research leverages a sample of 6735 U.S. adults to identify key predictors and their relative influence on both increased bicycling during the pandemic and on whether an individual commutes by bicycle. LASSO regression models identified a reduced set of predictors for the outcomes of interest from 55 determinants included in the modeling. Results: We find individual and environmental factors have a role in explaining the shift towards bicycling-with key differences in predictors for increased overall cycling during the pandemic compared to bicycle commuting. Conclusions: Our findings add to the evidence base that policies can impact bicycling behavior. Specifically, increasing e-bike accessibility and limiting residential streets to local traffic are two policies that show promise for encouraging bicycling.

Can a Smartphone Application Be Used to Measure Practice Driving Behavior During the Learner Permit Period? A Step Toward Performance-Based Licensing.

Introduction: Supervised practice during the learner stage of graduated driver licensing is required in all U.S. states and some international jurisdictions. Several U.S. states require driving hours to be recorded in a paper logbook, making it susceptible to errors or falsification. A smartphone app that operates as an electronic logbook could serve as an alternative. The purpose of this study was to measure the impact of the logbook format (i.e., paper versus electronic) on self-reported driving behavior. Design: Parent‒teen dyads were enrolled and assigned to electronic (n=147) and paper (n=131) logbook groups using a block design. Setting/Participants: This study was conducted in Maryland. Data were collected for 6 continuous months while teenagers held a learner permit between January 2020 and December 2021. Intervention: Electronic logbook to measure practice driving. Outcome measure: Self-reported driving between the electronic and paper logbook groups. For those using electronic logbooks, an agreement between self-reported trips and electronic logbook trips and perceptions of using an electronic logbook to measure driving. Results: There were no statistically significant differences in any measures of self-reported practice driving by logbook type (electronic versus paper). Agreement between self-reported and electronic logbook‒recorded trips ranged between 68.6% and 79.0% (allowing a difference of 2 trips per week). User satisfaction with the electronic logbook was high, with 93.0% of teenagers and 91.9% of parents stating that they would recommend the app to a friend. Conclusions: An electronic logbook is a viable approach to measuring practice driving. Eventually, it could become part of a system where practice requirements are verified, allowing states to move toward performance-based graduated driver licensing.

Association between perceived risk of COVID-19 and support for transportation policies.

The association between perceived risk of COVID-19 at the individual level and support for transportation policies designed to mitigate coronavirus transmission has received little attention. We surveyed a nationally representative sample of U.S. adults (N = 2,011) in June 2020 to examine how support for public policy varied according to perceived risk. We used logistic regression models to control for demographic factors and identify the effect of perceived risk, defined as a combination of self-reported perceptions of personal risk of acquiring the disease and the severity of the illness if infected, on support for a range of policies related to transportation. We found that perceived risk did not vary significantly by sex, race, urbanicity, income, or age. Support for policies aimed at mitigating COVID-19 transmission was consistently higher among those with higher perceived risk of the disease.