Do adolescent trajectories of riding with an impaired driver and driving impaired predict similar behaviors in early adulthood?

BACKGROUND: A recent study shows four trajectories of riding with an impaired driver (RWI) and driving while impaired (DWI) from adolescence to emerging adulthood. We examined prospective associations of adolescent RWI/DWI trajectory class with early adulthood RWI/DWI behavior. METHODS: Data were from the NEXT Generation Health Study (NEXT), a nationally representative longitudinal study (N = 2783) beginning with a 10th-grade cohort completing 7 annual assessment waves (W1-W7) between 2010 and 2016 and a later follow-up mixed methods study. Four RWI and DWI trajectories derived from a recently published latent class analysis study (RWI (last 12 months); DWI (last 30 days) dichotomized as ≥ once vs. none) were used: Abstainer, Escalator, Decliner, and Persister. In the follow-up examination, a purposive subsample (N = 105, 26.3 ± 0.5 y/o, Female 50.5%) of NEXT participants were selected by trajectory (31 Abstainers, 33 Escalators, 14 Decliners, and 27 Persisters) for in-depth interviews 4 years after NEXT. In interviews, self-reported RWI events (number of times) related to alcohol (Alc-RWI) or marijuana (MJ-RWI) use in the last 12 months, and DWI events (number of times) related to alcohol (Alc-DWI) & marijuana (MJ-DWI) use in January 2020 (pre-COVID pandemic) were collected using structured surveys. General linear models were used to examine associations of adolescents' RWI/DWI trajectories with early adulthood RWI/DWI behavior, controlling for sex, health status, education attainment, and work hours. RESULTS: The mean number (SD) of Alc-RWI and MJ-RWI events reported by Escalators (3.83(2.48), 2.43(2.77)) and Persisters (3.83(2.43), 3.57(2.54)) were higher (p≤0.05) than Abstainers (0.82(1.42), 0.77(2.04)) and Decliners (1.81 (2.69), 1.38 (2.04)). Similarly, Escalators (1.61 (2.28), 1.88(2.69)) and Persisters (1.96(2.08), 1.93(2.48)) reported more Alc-DWI and MJ-DWI events than Abstainers (0.18 (0.53), 0.42(1.38)) and Decliners (0.00 (0.00), 0.08(0.28)). Linear regression models indicated membership in Escalator and Persister classes compared to Abstainer class was associated (p≤0.01) with higher engagement in RWI/DWI in early adulthood. CONCLUSION: Adolescents with escalating and persistent high RWI/DWI may continue these health risking behaviors into their mid-twenties. Decliners during the transition maintained low RWI/DWI into their mid-twenties. Taken together, these findings suggest that earlier reduction may have long-term effects. Our findings can be used to inform the precision tailoring of prevention efforts aimed at effectively reducing alcohol/drug impairment crash injuries and related deaths among those in early adulthood.

Naturalistic assessment of the learner license period.

The purpose of this study was to describe the characteristics and progression of practice driving during the learner license period in a sample of teenagers. During the first and last 10h of practice driving, we examined (1) the amount, variety and complexity of conditions of practice; (2) the nature of parental instruction; and (3) errors that teens made while driving. Data were collected from 90 teens and 131 parents living in Virginia, USA, using in-vehicle cameras, audio recorders, GPS and trip recorders. Based on data collected from the instrumented vehicles, teens practiced for 46.6h on average, slightly higher than the GDL requirement for their jurisdiction, though half did not complete the required 45h of practice and only 17% completed the required 15h of night time driving. Exposure to diverse roadways increased over the practice driving period, which averaged 10.6 months. Most driving instruction occurred in reaction to specific driving situations, such as navigating and identifying hazards, and could be characterized as co-driving. Higher order instruction, which relates to the tactics or strategies for safe driving, was less frequent, but remained stable through the practice driving period. Instruction of all forms was more likely following an elevated gravitational force (g-force) event. Errors decreased over time, suggesting improvements in manual and judgment skills, but engagement in potentially distracting secondary tasks increased (when an adult was in the vehicle). A small percentage of trips occurred with no passenger in the front seat, and the g-force rate during these trips was almost 5 times higher than trips with an adult front-seat passenger. Taken collectively, these findings indicate (1) most teens got at least the required amount of supervised practice, but some did not; (2) instruction was mainly reactive and included some higher order instruction; (3) teens driving skills improved despite increased exposure to complex driving conditions, but secondary tasks also increased. Opportunities remained for improving the quality and variability in supervision and enhancing the development of skills during the lengthy period of practice.

Teen drivers' awareness of vehicle instrumentation in naturalistic research.

INTRODUCTION: Naturalistic driving methods require the installation of instruments and cameras in vehicles to record driving behavior. A critical, yet unexamined issue in naturalistic driving research is the extent to which the vehicle instruments and cameras used for naturalistic methods change human behavior. We sought to describe the degree to which teenage participants' self-reported awareness of vehicle instrumentation changes over time, and whether that awareness was associated with driving behaviors. METHOD: Forty-two newly-licensed teenage drivers participated in an 18-month naturalistic driving study. Data on driving behaviors including crash/near-crashes and elevated gravitational force (g-force) events rates were collected over the study period. At the end of the study, participants were asked to rate the extent to which they were aware of instruments in the vehicle at four time points. They were also asked to describe their own and their passengers' perceptions of the instrumentation in the vehicle during an in-depth interview. The number of critical event button presses was used as a secondary measure of camera awareness. The association between self-reported awareness of the instrumentation and objectively measured driving behaviors was tested using correlations and linear mixed models. RESULTS: Most participants' reported that their awareness of vehicle instrumentation declined across the duration of the 18-month study. Their awareness increased in response to their passengers' concerns about the cameras or if they were involved in a crash. The number of the critical event button presses was initially high and declined rapidly. There was no correlation between driver's awareness of instrumentation and their crash and near-crash rate or elevated g-force events rate. CONCLUSION: Awareness was not associated with crash and near-crash rates or elevated g-force event rates, consistent with having no effect on this measure of driving performance. PRACTICAL APPLICATIONS: Naturalistic driving studies are likely to yield valid measurements of driving behavior.

Acceptability of the Checkpoints Parent-Teen Driving Agreement: pilot test.

BACKGROUND: Parent-teen driving agreements are potentially important tools to facilitate parental management of teen driving and reduce adolescent driving risk. The Checkpoints Parent-Teen Driving Agreement (Checkpoints P-TDA) was designed so that parents could initially impose strict limitations on teen driving in high-risk driving conditions (e.g., at night and with teen passengers) and gradually increase driving privileges over time as teens demonstrate responsible driving behavior. METHODS: To assess the acceptability of the format and content of the Checkpoints P-TDA, it was pilot tested with a convenience sample of 47 families recruited as their teens tested for a driver's license at five private driving schools in Connecticut. Family members were interviewed at the driving schools about potential limits on teen driving, asked to use the driving agreement, and re-interviewed within 3 months about acceptability of the driving agreement and initial driving limits placed on teens. RESULTS: Most families (38 of 47) used and liked the agreement. In addition, most parents placed the recommended strict initial limits on teen driving related to driving unsupervised at night, with teen passengers, and on high-speed roads. Moreover, parents reported placing more strict limits on their teens' driving than they originally intended. CONCLUSIONS: The results showed promise for the acceptability of the Checkpoints P-TDA, which will be tested statewide.

Children's frequency of consumption of foods high in fat and sodium.

We administered a food frequency instrument to third-fifth grade students (n = 943) in four Texas schools. Comparison of foods reported on the food frequency questionnaire and on 24-hour dietary recalls (n = 7) produced a percent agreement of 83.3. The most frequent 25 foods accounted for 64.0% of food choices across all meals, 93.5% of breakfast choices, 76.4% of lunch choices, 70.5% of supper choices, and 76.0% of snack choices. Breads, milk, hamburger or steak, soda pop, tomato sauce or tomatoes, and cheese were the most frequently consumed foods. Fruits and juices accounted for 6.1% of total selections for boys and 6.6% for girls, while vegetables accounted for 15.7% of total selections for boys and 16.2% for girls. Fruit was more likely to be consumed for snacks than for meals, and vegetables were consumed in about the same frequency at lunch and supper and for snacks. We analyzed the total fat, saturated fat, and sodium content of the most frequently consumed foods. Seventeen of the top 25 foods for the total day and 13-16 for each meal or snack exceeded by at least 50% the recommended levels for fat, saturated fat, or sodium. The pattern of consumption was one of frequent consumption of a relatively small number of foods, many of which are high in fat or sodium.

Health communication in the prevention of alcohol, tobacco, and drug use.

Research on substance abuse prevention programs indicates that effectiveness is greater when multiple intervention approaches that address the specific vocabulary, perceptions, and values of the target population are employed. The field of health communication provides unique perspectives on media that can be applied to increase the salience and effectiveness of substance abuse prevention programs. Well-designed and well-delivered health communications have the capacity for reaching remote audiences, changing health attitudes and behavior, shaping social norms, changing the way health issues are portrayed by the popular media, and influencing decisions about legislation and policies. Health communication approaches are generally employed within the broad context of health promotion programs, along with education, community development, empowerment, and social change approaches. This article describes the role of health communication in substance abuse prevention, reviews major conceptualizations of health communication, and introduces the unique features of the four articles included in this special section of Health Education & Behavior.

Strategies to improve patient compliance with antihypertensive therapy.

Compliance is a critical issue in the treatment of hypertension. Strategies designed for individual patients, based on an analysis of their specific personality characteristics, are probably the most productive. At present, however, necessary educational diagnoses cannot easily be made. Therefore, more general strategies involving simplification of the treatment regimen, stimuli to appropriate behavior, positive reinforcement, increased attention by providers, and open communications should be employed. These are of particular value for patients with inadequately controlled blood pressure who admit to noncompliance.

Great Sensations: a program to encourage heart healthy snacking by high school students.

The Great Sensations program consisted of three interrelated educational strategies--classroom instruction, parent outreach, and media campaign. These strategies were designed to teach inner-city high school students about salt and high blood pressure, and to encourage them to eat more low-salt snacks and fewer high-salt snacks. Eight classes at the experimental school were randomly assigned to class instruction or parent outreach in a factoral design. All students in the experimental school were exposed to the media campaign. Students at a nearby high school served as the comparison group. All but a few of the 490 students at the two schools were black. Students who received the classroom instruction reported lower Salty Snack selection and higher Target Snack selection at posttest and eight-week follow-up. Students receiving media only reported lower Salty Snack selection at posttest but this condition returned to baseline by eight weeks. The control group reported little change in snack selection at posttest and eight weeks. After six months, program effects were no longer evident for either experimental group.

Physical education and its role in school health promotion.

In this article, the authors promote the concept of health-oriented physical education, discuss professional standards, examine the current status of physical education programs, and discuss trends affecting physical education. Recommendations to make physical education more effective are provided.

School promotion of healthful diet and exercise behavior: an integration of organizational change and social learning theory interventions.

In the Go For Health project, interventions based on organizational change and social learning theory facilitate changes in diet and exercise behavior by elementary school children. Baseline data documented the need for behavior change. Based on chemical analyses, average per meal amounts of total fat and sodium were higher than national recommendations: total fat was 29.3% higher than U.S. Dietary Goals; sodium was 107.4% greater than recommended levels. Observations of students in physical education class revealed children moved through space 50.1% of the time and moved continuously an average of 2.2 minutes per class period. These findings suggest the need for policy and practice changes in the school environment to enable children to engage in more healthful diet and exercise behavior.

Health promotion and disease prevention. Roles for the primary care physician.

The practice of health promotion and disease prevention (HPDP), an increasingly important approach to healthcare, includes influencing health behaviors of the population at risk for disease as well as environmental conditions that affect health. The major role of the clinician in HPDP is at the individual level: screening for risk factors and disease and providing early treatment, advice, counseling, and referral. Primary care physicians can broaden their impact by assuming roles at organizational, community, and government levels (eg, as an active member of an organization or a consultant to an outside organization, a community leader or an agent of change, an influential constituent or a lobbyist). These roles enable primary care physicians to have an impact both on individuals and on environments to reduce disease risk factors.

Prescribing physical activity to prevent disease.

Despite an increase in the public's awareness of the ample health benefits of physical activity, less than 20% of US adults regularly participate in moderate to vigorous physical activity. For most adults, increasing physical activity even moderately is likely to benefit health. Physicians can prescribe physical activity and incorporate an emphasis on physical activity into clinical practice.

Driving miles estimates by teen drivers: how accurate are they?

The objective of this study was to determine how accurately teens can report miles driven. Participants were 118 drivers in Connecticut (average age 17(1/2) years; average time licensed 11 months). Half had their own vehicle; half shared family vehicles. Teens completed a telephone survey about their preceding week's driving, then completed a daily trip log for the next week and a second survey about the details of the logged week's trips and miles. Teens with their own vehicle provided odometer readings. Summing the miles for every trip was generally consistent with estimates from odometer readings. Overall mileage estimates were 20-30% lower than those from trip-by-trip listings, except for very low estimates for the first week by teens who shared vehicles. The results indicate that single overall estimates frequently understate total miles driven, but that prompted reviews of each trip can provide valid and detailed information.

Adolescent drinking and driving: etiology and interpretation.

In the adolescent population, drinking and driving is an important cause of injury, disability and premature death. A literature review of the demographics and etiology of drinking and drinking/driving reveals: 1) which subgroups of the adolescent population are more likely to drink and drink/drive; 2) where and why adolescents drink and drink/drive; 3) peer and family issues associated with adolescent drinking and drinking/driving; and 4) adolescent expectancies and perceived efficacies associated with drinking and drinking/driving. A discussion of the role of theory and the use of etiologic data in intervention research precedes an overview of several types of school-based alcohol-prevention programs and recommendations for more theory based interventions.

Evaluation of a local designated driver and responsible server program to prevent drinking and driving.

Point of purchase interventions by beverage alcohol servers provide one promising approach to preventing drinking and driving and many communities now support such programs. To evaluate the impact of a designated driver and responsible server program in Houston, we assessed server training courses, observed and interviewed servers and patrons at five establishments participating in the program, and reviewed the distribution of vouchers awarded for a safe ride home by taxi. The training course for alcoholic beverage servers produced significant improvements in the participants' perceptions about their role in preventing drunk driving. In five participating establishments 15.6 percent of servers wore buttons announcing the establishment's participation in the program; immediately after retraining 26.6 percent wore the buttons. Of the eligible patrons in these establishments 6.6 percent actually participated in the designated driver program. The program provided an average of 0.7 safe ride home vouchers per establishment per month. In one additional establishment an experiment was conducted in which servers always announced the designated driver program to patrons, but no increase in the prevalence of designated drivers occurred.