Epidemiology of road accidents involving young adults: alcohol, drugs and other factors.

This paper reviews the magnitude and characteristics of the problem of road accidents involving young adults. The magnitude of the problem is considered from the perspective of the contribution of road accidents to mortality and morbidity among young people, relative to other causes. The over-representation of young adults in road accidents is examined to determine the extent to which it occurs as a result of their involvement as drivers, passengers, or as pedestrians. To determine the characteristics of collisions involving young adults, the potential contributory role of alcohol, drugs, and other factors in their collisions is evaluated on the basis of current epidemiological evidence, drawn particularly from studies conducted in Canada. The review examines factors that are related not only to the frequency of collision involvement, but also to the severity of the collision. Although the principal intention of the review is to identify what is known about factors that appear to contribute to accidents involving young adults, an additional purpose is to identify what is not known, and in this context, to suggest, given current methodological and practical limitations, what is capable of being determined in the near term.

Effectiveness and role of driver education and training in a graduated licensing system.

Formal driver education/training programs exist in almost all jurisdictions around the world. They are generally accepted as an efficient and effective means for learning to drive, and, more importantly, for learning to drive safely, although empirical evidence for safety benefits is lacking. Recently, there has been a heightened interest in driver education/training, largely as a result of the adoption of graduated licensing in a few jurisdictions in North America and elsewhere. These jurisdictions have effectively elevated the status of driver education/training by integrating it into the licensing system. Implicitly, this suggests that driver education provides safety benefits. This article provides a contemporary review of the value of driver education/training, particularly in relation to new licensing systems such as graduated ones. The article examines the safety benefits of driver education/training and considers the merits of integrating driver education/training programs with new approaches to the licensing of young drivers.

Youth, alcohol and relative risk of crash involvement.

Deaths and injuries due to road-crash involvement are a major health and safety problem, especially among youth. Numerous factors can account for the overrepresentation of young drivers in road crashes and one of these--alcohol--has received renewed attention. This paper examines evidence pertaining to drinking and driving among youth to determine the extent to which alcohol has special significance for crashes involving young drivers. Three sets of studies are reviewed: those providing data on the extent of drinking and drinking-driving among youth, those that examine alcohol use among youth involved in road crashes and those that estimate the relative risk of a road crash for young drinking drivers. Findings show that frequent and heavy alcohol consumption among teenagers and young adults is not unusual, although they are less likely than older age groups to drive after drinking. Nonetheless, those young people who drive after drinking have a greater risk of crash involvement than older drinking drivers at all blood alcohol concentrations. One explanation of this finding assumes that young people are "inexperienced" with drinking and with driving. Limited behavioural research done to date supports some but not all assumptions implicit in this reasoning. There is also evidence in favour of an alternative hypothesis, namely, that the comparatively higher crash-risk among young drinking drivers is attributable to a subset of this group, those that engage in risky driving behaviour and who also happen to use alcohol. Further investigation into the personal and social characteristics of young people who drive after drinking would provide a sounder empirical basis for policies and programmes to reduce crash involvement among youth.

Trends in drinking driver fatalities in Canada.

Public and political concern and action focussed on the problem of drinking and driving during the 1980s was unprecedented. This paper examines the impact of these collective efforts by analyzing trends in the magnitude of the alcohol crash problem in Canada as reflected by drinking driver fatalities. After many years of little or no change in the magnitude of the drinking-driving problem, beginning in the early 1980s, both the number and percent of drinking driver fatalities began to decline. This trend continued over the entire decade. Despite these gains, a significant problem remains, in particular drivers with very high blood alcohol concentrations who appear to be relatively unaffected by countermeasures based on traditional measures such as deterrence and persuasion. New, innovative programs will be necessary to deal effectively with this "hard core" heavy drinking group.

Hard core drinking drivers.

The term "hard core" has been used extensively over the past 15 years to identify persons who drink and drive regularly, typically at high blood alcohol levels. This article discusses how the term arose and clarifies what it means, both as a concept and in practice. It describes the characteristics of hard core drinking drivers and estimates their contribution to drinking driver trips, arrests, and crashes. It summarizes current knowledge and recommendations on the most effective means to affect their behavior and reduce their drinking and driving.

Youth and traffic accidents.

THIS PAPER ADDRESSES THE PROBLEM OF TRAFFIC ACCIDENTS INVOLVING YOUNG ADULTS: specifically, what is known about the causes of their accidents, and what preventive action seems warranted. In this context, we consider what role the family physician might play in dealing with this major public health problem.

The safety value of driver education and training.

BACKGROUND: New drivers, especially young ones, have extremely high crash rates. Formal instruction, which includes in-class education and in-vehicle training, has been used as a means to address this problem. OBJECTIVES: To summarize the evidence on the safety value of such programs and suggest improvements in program delivery and content that may produce safety benefits. METHODS: The empirical evidence was reviewed and summarized to determine if formal instruction has been shown to produce reductions in collisions, and to identify ways it might achieve this objective. RESULTS: The international literature provides little support for the hypothesis that formal driver instruction is an effective safety measure. It is argued that such an outcome is not entirely unexpected given that traditional programs fail to address adequately the age and experience related factors that render young drivers at increased risk of collision. CONCLUSIONS: Education/training programs might prove to be effective in reducing collisions if they are more empirically based, addressing critical age and experience related factors. At the same time, more research into the behaviors and crash experiences of novice drivers is needed to refine our understanding of the problem.