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Teen drivers: A public health threat?

What parent hasn't felt at least a little dread at the thought of handing over the car keys to their son or daughter? Teen driving is a real public health issue.

Our experience
Just last year in our emergency department alone, we saw 21 motor vehicle accident victims aged 16-18 whose injuries were serious enough that they had to be admitted to the hospital. Of these, 13 were drivers and 8 were passengers in cars driven by teens. Head and chest or abdominal trauma, fractures and spinal cord injuries were common, with 10 patients having injury to more than one organ system.

States are increasingly taking notice and have toughened up the driver licensing process with new "graduated driver's licensing" programs in at least 30 states. In 1979, Maryland was one of the first states to enact such regulations, which have decreased by 10 percent the number of daytime violations and convictions among teen drivers. California followed closely behind in 1983 with its own legislation.

What are driving restricted programs?
The goal of these programs is to give teens more driving experience before they are allowed an unrestricted license. Though programs vary, most programs have three stages:

• a learner's stage for driving while supervised;
• an intermediate stage, where driving alone may be restricted;
• an unrestricted stage, which can be as early as age 16 or as late as 18.

Do they work?
The adoption of strict regulations in Ontario in 1994 has resulted in a 27 percent decrease in motor vehicle crashes caused by teens. The fatality rate for 16-year-old drivers there used to be three times the rate of adults. It's now even. So the data is telling us what we might have instinctively believed—limiting teen driving is a smart move.

Looking at the Utah study
The Utah study was actually done from data that is relatively old (1992 - 1996). It supports other studies, such as one published in the March 2000 issue of JAMA (Journal of the American Medical Association) that showed teens were more likely to engage in risky behavior when they had passengers in the car.

By looking at only hospital inpatient charges, the Utah study figure of $11 million underestimated the true costs of these car accidents. The researchers did not break out the types of injuries—whether these were simple fractures or extensive brain injuries that could have long-lasting consequences. The $11 million does not take into account the cost of rehabilitation, loss of function or, most importantly, the real impact on the lives of these young people and their families.

Alcohol and drugs
The study also didn't discuss the role of alcohol and/or drugs and motor vehicle accidents. Because it has an effect on a patient's medical care, we routinely screen teenagers for drugs and alcohol when they come to the emergency department for injuries due to motor vehicle accidents. Of course, this information is held in strict confidence.

The study also didn't discuss the role of alcohol and/or drugs. In our experience, drugs and alcohol are frequently involved, and their effects often have an impact on the length of time it takes to evaluate a patient for injuries. For example, a patient who is drunk cannot reliably tell you if his or her neck hurts, and frequently we leave them in cervical collars, even though their radiologic studies look normal, until he or she can tell us that they can move the neck without pain.

Call for change
In the Utah study, there were also 158 fatalities. Nationally, motor vehicle crashes are the leading cause of death among teenagers in our country, causing 36 percent of all deaths of 15- to 19-year-olds. Teens make up only 7 percent of the population, but cause 14 percent of all fatalities according to the National Highway Traffic Safety Administration (NHTSA). In fact, the NHTSA and the American Academy of Pediatrics have recommended legislation for graduated driver licensing programs.

Opponents say that teens need to drive to get to jobs or events. But in most programs, the restrictions focus mainly on late-night driving or limiting the number of passengers, so most jobs would not be affected.

It's important to realize these restrictions are only for a limited time. Trading off some inconveniences for fewer accidents, injuries and deaths is probably something most people can live with easily.

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Dr. Bechtel is an attending physician in the emergency department of Yale-New Haven Children's Hospital, trauma coordinator for the pediatric emergency department and assistant professor of pediatrics at Yale University School of Medicine.