Teen Driving Safety – PediaCast 569

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  • Dr Holden Elkhammas and Dr Leah Middelberg visit the studio as we consider teen driving safety. Motor vehicle crashes are the leading cause of death for teenagers in the United States, but most of these deaths are preventable. We explore strategies for keeping young drivers safe on the road. We hope you can join us!

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[Dr Mike Patrick]
This episode of PediaCast is brought to you by Pediatric Emergency Medicine at Nationwide Children's Hospital. Hello everyone, and welcome once again to PediaCast. It is a pediatric podcast for moms and dads.

This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio. It's episode 569.

We're calling this one, Teen Driving Safety. I want to welcome all of you to the program. So, we have a really, really, really important topic for you today.

And that is because motor vehicle crashes are the leading cause of death for teenagers in the United States of America. And the overwhelming majority of these crashes are preventable. And there are proven strategies that can improve the safety of young drivers on the road.

So today we're going to take a deep dive into these strategies because they are something every parent of a teenager should know before they begin the process of learning to drive and receiving a driver's license. So, it's information that could literally save your teenager's life. So of course, listen to this, even if you don't have teenagers, so that you just have a better general understanding of teen driver safety.

But if you know someone who does have teenagers, you may just want to mention or send them a link to the podcast so they can take a listen, especially if maybe they have a younger teenager who is going to be driving in the next year or two. It's just good information to have on hand that can help make the road safer for everyone and in particular for teenage drivers. So, we're going to look into the statistics, of course, and the trends and the variables that are influencing the data and those trends related to teenage injuries and deaths associated with motor vehicle accidents.

So, this is one area where preventive medicine has really made a huge difference. So, as we have enacted seat belt laws and graduated driver's licensing programs and really just gotten the word out about teen driving safety, the numbers of teenage deaths associated with driving has really, really come down compared to just a decade ago. So, we've really made a lot of progress.

However, there's still way too many teen driving deaths. And so, there's definitely more work to do in terms of preventing more of these. And we'll talk about all of that today.

In our usual PediaCast fashion, we have a couple of terrific guests joining us in the studio. Dr. Holden Elkhammas is a second-year pediatric resident at Nationwide Children's and Dr. Leah Middelberg is a pediatric emergency medicine attending also at Nationwide Children's Hospital. Don't forget the information presented in every episode of our podcast is for general educational purposes only.

We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you are concerned about your child's health, be sure to call your health care provider. Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find at pediacast.org.

So, let's take a quick break. We'll get our experts settled into the studio, and then we will be back to talk about teen driving safety. It's coming up right after this.

[Dr Mike Patrick]
Dr. Holden Elkhammas is a second-year pediatric resident at Nationwide Children's Hospital, and Dr. Leah Middelberg is an emergency medicine physician at Nationwide Children's and an assistant professor of pediatrics at the Ohio State University College of Medicine. College of Medicine. Both have a passion for keeping kids and teenagers safe, which includes important safety tips for teenage drivers.

But before we get into that, let's offer a warm PediaCast welcome to our guests, Dr. Holden Elkhammas and Dr. Leah Middelberg. Thank you so much for stopping by today.

[Dr Holden Elkhammas]
Thank you so much for having us, Dr. Mike. It's a pleasure.

[Dr Leah Middelberg]
Hi, thanks for having us.

[Dr Mike Patrick]
Yeah, really, really great to have both of you here. Let's start with Dr. Elkhammas. How common are motor vehicle accidents, and in particular for teenagers?

[Dr Holden Elkhammas]
Yeah, it's actually a little bit more common than you would expect. It's actually one of the leading causes of deaths for teens who are aged like 13 to 19. If you want to get to some of the gritty details, it's like almost one teen dies every hour during the weekend, and even one teen dies every two hours during the week.

It's pretty interesting because you can tell that there's an increase of crashes in teens right after they get their licenses. It's almost like for the first couple of months, you can see that there is an increased risk, almost like three times as an increased risk for teenagers to die in a car crash after getting their license. It's just really due to this inability to perform and have that long-term kind of experience that adults have after many years of driving.

And it's just kind of like that complex task of multitasking and everything that you can see that we kind of develop over our skill sets. And, you know, while there is this kind of scary statistic, unfortunately, a lot of teens die in car crashes. There are really some effective ways that we can do to kind of prevent these collisions and to prevent teen death.

[Dr Mike Patrick]
Yeah. I just want to let the one number that you mentioned sink in. So, one teenager dies every hour during the weekends, and one teenager dies every two hours during the week in motor vehicle accidents, making it really the number one cause of death in teenagers.

So, this is a really important topic because, of course, we want to save lives. And I would imagine that the vast majority of motor vehicle accidents in the teenage years are preventable. I mean, you know, sometimes you can't prevent if, you know, someone else crosses a line and runs into you.

You can be the best defensive driver in the world, and it still can happen. But there are many, many cases where these are preventable. And then has this been increasing or decreasing in recent years?

[Dr Holden Elkhammas]
You know, it's actually really fortunate we have seen a decline in car crashes, especially in teens that are fatal. You know, that can be attributed to a lot of things, anything from technology to a lot of other things I will actually talk about later in this podcast. But it's interesting when we talk about the percentage, it's about like a 38% decrease that we have seen in the past kind of few decades here.

Interesting enough, we've seen like a little minor increase from 8% of those who are like 21% and older. But when we're seeing kind of like an overall death rate, I think we had about a 45% decrease of overall deaths when kids are actually getting in a car crash. So, it's interesting because we're seeing these trends for kids are actually not driving as early as they used to.

I think people may be in like the 80s and 90s when I was around people a lot more excited to get out of the house and go driving. But I think we're seeing a lot more kids kind of delaying about getting their driver's license. And we're also seeing for like the fatal car crashes for about like 10,000 licensed drivers, that this 34% has decreased for drivers under 21, which is actually a really good trend.

So again, we're just seeing like a lot of this is coming to the safety programs that we're putting across the United States that I know like Dr. Middelberg will talk about a little later as well.

[Dr Mike Patrick]
Yeah. Yeah. So really a combination of things, but I guess that's great news, but still one teenager every hour on the weekends is still way too many.

And I can't even imagine when it was even nearly twice that. So definitely making a difference in terms of teenagers waiting a little while, maybe we have to rethink the 15 to 16 for your initial driver's permit. And then the safety programs, which again, we'll talk about here more in a few minutes, but that can really make a big difference as you kind of step-up responsibility and, and, you know, give kids a little bit of a longer leash stepwise instead of just like, Hey, here's your license.

Here's a car, go at it. Probably not the best way to do it. Are there any other trends that we are seeing in teen vehicle crashes?

[Dr Holden Elkhammas]
Yeah, of course. Like these are trends. So, there are more correlations.

So really hard to, for us as physicians to define causation for them, but some trends that we have also seen that almost half of these like motor vehicle crash deaths are occurring, we can like 9pm and 6am. So not really between like normal driving hours, especially for kids who are learning to drive. We're also seeing that kind of an increase in these crashes for speeding or those were distracted driving, such as with like your cell phones.

In 2020, we found that there was an increased crash death rate for male drivers who are aged 16 to 19, which unfortunately was three times higher than females. So, it could be like we have seen some statistics that this could be more participants participation of male teams in like speed racing that we have seen. And again, when we're talking about the distracted driving, we're always telling everybody to put their cell phones down.

I know there's an increase in states that are making it illegal to have your cell phone like anywhere near your hand when you're driving. But we can definitely say that unfortunately, we're talking about how complex driving is being a driver. If that one little text message or sending a tweet or making a Tik-Tok in your car is probably not the best for a new driver.

But we can definitely tell there's about a 23% increase in crashes when teens are texting.

[Dr Mike Patrick]
Yeah, I mean, that's almost like alcohol, you know, in terms of, you know, you being disabled in terms of being able to drive responsibly and make good decisions and have good reactions to things to what you're seeing, you know, and stopping the car in time or, you know, making an evasive maneuver. You're not going to be able to do that when you're influenced by alcohol, but you're also not going to be able to do that when you are texting. And so, you probably have need to get the message out there that being on your phone while you're driving is dangerous, just like drinking and driving is.

Leah, what are the best practices then for using seatbelts while driving or being a teenage passenger? And I do want to point out here really quick that we did an episode, I think it was earlier this year actually, on child passenger safety, where we were really talking about car seats and booster seats. And that was, by the way, episode 560.

So, if you're interested in listening to that one, I'll put a link in the show notes over at PediaCast.org so you can find it really easily. So, think of that as sort of a part one on child passenger safety. But as we think about teenagers and seatbelts, what are the rules there?

[Dr Leah Middelberg]
Yeah, you're exactly right. Child passenger safety and car seats and booster seats, I think a lot of families understand the importance of those items and know the significant improvement in safety that those provide a family. But I think we kind of drop the ball and start getting a little lax when kids start getting a little bit older and not maybe emphasizing seatbelts as much.

But seatbelts should be worn by every passenger, front seat, back seat, every time they're in a car. Studies have shown that teens and young adults wear their seatbelts less consistently than older adults. But not only is buckling up the law, it's also one of the easiest and most effective ways to reduce the chances of death and injury in a crash.

You know, seatbelts can prevent a passenger from being thrown from the car, which is a really catastrophic way that people can suffer injuries in a collision. And it's also important to help our teens understand this, understand why these seatbelts are essential. You know, there's a lot of really great ways as parents that we can get this message across.

I just think this doesn't have to start when your teen is getting ready to drive, right? As soon as your forward-facing in those car seats, they are taking in driving behaviors and they're really watching. That's intimidating.

That sounds intimidating. But it's a great opportunity from when the time our children are even young to start impressing upon them the importance of things like seatbelts. So being a good role model as a parent, as adults in the car, always making sure that you're wearing your seatbelt, talking about the importance of putting on our seatbelt as we're doing it, and, you know, trying not to be distracted like Holden was just talking about in the car, you keeping your cell phone away, all good modeling behaviors so we can start setting that example really young.

You know, in the car with my kiddos, we do a seatbelt check roll call where, you know, we kind of yell out someone's name, and once they have their seatbelt on, they have to yell check. But it just kind of reinforces to the whole car that seatbelts are an expectation for everybody. And then when your teen's getting ready to drive, these conversations continue.

[Dr Mike Patrick]
Yeah, and that is such a fun way to do that. You know, call out their name and then check, you know, kind of like they're astronauts or, you know, getting ready to pilot an airplane.

[Dr Leah Middelberg]
Or getting ready to launch, exactly.

[Dr Mike Patrick]
That's so much fun. And again, that's something that once you set that habit at a young age, then it just becomes natural to put your seatbelt on as soon as you get in a car, you know, as you get older. And I would imagine that that also kind of comes into play with this big reduction that we've seen in recent years in teenage deaths.

Because I remember when I was a teenager, you really did just hop in the car. And you know, maybe sometimes it depended on who was driving, whether you wore your seatbelt or not, which is not a good way to do it. But I'm just saying back in the day before there were seatbelt laws, before we recognized just how important seatbelts are at preventing deaths and injuries in car accidents.

[Dr Leah Middelberg]
Yeah, absolutely.

[Dr Mike Patrick]
And I would imagine that we have seen that in the numbers too, right?

[Dr Leah Middelberg]
Yeah. You know, we know that seatbelts are effective at preventing serious injury and death. You know, they can decrease a chance of being in a, having a significant injury or fatality when you're in a crash by almost 50%.

You know, severe injury by 50% and death by 40%. So, something that takes just seconds for you guys to do, for your team to be able to do, increases your risk of surviving by half. I mean, you can't, that's a pretty good risk-benefit relationship there.

[Dr Mike Patrick]
Yeah. Yeah, absolutely. And then Holden, we did mention alcohol briefly in saying that texting while driving is also dangerous, but alcohol really does impair drivers.

And especially when you're thinking about a student driver or, you know, an early driver, how does alcohol impact teenage driving?

[Dr Holden Elkhammas]
Yeah. I know, I feel like it's going to be a centralized theme throughout this whole podcast of like how complex driving really can be. And, you know, it's very nerve-wracking.

I don't know if you remember your first time driving, but trying to like, make sure to check your mirrors every like five seconds, as well as like being mindful of everybody else that we have long known in medicine that alcohol really impairs our reaction time, as well as how we like process information. And while alcohol is of course illegal for anybody to consume under 21, there's unfortunately access issues that we can see, especially in the pediatric population. There's sometimes alcohol accessible in caregivers' houses or somehow they get it through friends or acquaintances.

We actually see around like 22% of drivers from 15 to 18-year-old who get in fatal car crashes have been drinking. It's like really important for conversations, especially like Dr. Middelberg is saying like having these conversations early would be a really good thing to have is like, while this happens, like if you happen to have a beverage, maybe you should try to like call another friend to drive you or call your parents or just don't drive at all, which would probably be the best thing. But I think it's also important to like, while being proactive for your children to also tell your kids the consequences of what happens.

If you are fortunate to survive a car crash while you were drinking, and you're under 21, there actually can be a lot of consequences, especially because you're breaking the law. So, you could possibly go to jail, you can lose your license, you know, you can cost a lot of money with all the attorney fees are going through the court costs and other fines, their caregiver or parents’ insurances rates will go up. And there's a possibility if like you're a budding athlete or an academic and you're wanting to go to a great college that could really scar your record for your life.

[Dr Mike Patrick]
Yeah, yeah, absolutely. I also think that there is a role for parents here in terms of just being realistic about what teens do. And so, you know, I'm sure there's parents out there who are like, my kid does not drink.

And then they get the call that they were involved in an accident. And they were, you know, the 22% of accidents that involve alcohol. They're one of those statistics now.

And that's just a terrible thing. But if you have those conversations early, and you say, look, I'd prefer that you not drink. But you know, these are the facts.

And if you find yourself needing a ride home, call me, please. And you know, we'll talk about it later. But I'd rather have that conversation the next day or whatever.

But just to sort of give kids the freedom to be able to say, hey, I messed up or hey, I need help without feeling like the world's going to crash in on them, which is actually what's going to happen if they get in the car, possibly. So, I think just having these conversations early is going to be an important thing. We've talked trends.

Are we seeing any trends as we think about injuries and deaths associated with drinking and driving in teenagers?

[Dr Holden Elkhammas]
Yeah, of course. I don't know how much of a history buff you are with laws of the United States. But we can definitely know that in the 1960s and 1970s, when we actually like reduced in the United States, the minimum alcohol drinking age, there's actually a huge increase of deaths of individuals under 21 related to alcohol.

And so now that it's now illegal to have any consumption of beverages under 21, we've actually seen about like, between 2013 and 2017, about like every state in the US has stayed around like 2000, almost 3000 lives, which is pretty awesome. We still have kind of that increased risk because we're still growing in our mind development, our bodies getting bigger, the blood alcohol content that is like maybe different, you know, than me, I'm a large six foot three, 250-pound person can be a little different than a person who is say, no five foot four and like 100, 120 pounds. So that difference in blood alcohol concentration is definitely going to be a little different between two people, especially when it comes to driving.

So, I think that's really important to know. But also, what's really interesting that it's like not really related to alcohol, but we are seeing probably some more trends of marijuana use and marijuana use, especially with people driving as well. So, it's going to be really interesting for us as pediatricians and those taking care of kids with driving to see if there's any correlations with driving under the influence, especially when it comes to weed as becomes more prevalent and accessible.

[Dr Mike Patrick]
Yeah, yeah, really, really good point. I want to go outside of the car now. There are other things to consider, including pedestrians and cyclists, because motor vehicles can certainly impact those folks, because oftentimes you're sharing roadways.

Leah, what are some ways in which we can be safer as we are sharing the road with pedestrians and cyclists, both from the teenage driver point of view, but then also the pedestrians and the cyclists, what can they do to remain safe?

[Dr Leah Middelberg]
It is important to remember that unfortunately, pedestrians, cyclists, scooter riders, they're always going to be at an inherent disadvantage when it comes to these traffic crashes. When there's a much larger, faster moving vehicle involved, the vehicle is always going to win. So as pedestrians and bicycle riders, we really have to be aware of our surroundings.

But, you know, to bring it back to our young teen drivers, they may not have the experience or the reaction time to be able to avoid these pedestrians and cyclists. So, all the more reason to really encourage both training and restrictions on our young drivers but following appropriate precautions for our young pedestrians and cyclists as well.

[Dr Mike Patrick]
Yeah, that's going to be really important. If you are a pedestrian, the rules, just to remind folks, you want to walk against traffic. Is that right?

If you're walking and if you're a cyclist, you want to go with traffic.

[Dr Leah Middelberg]
Yes. Yeah. You know, if you're walking against traffic, you can see everything that's coming at you, right?

You really want to try to walk on sidewalks whenever they're available. You want to follow the rules of the road, just like the traffic. So, you want to stop at stop signs, stop at stoplights, and really providing yourself an opportunity to surveil your surroundings using crosswalks and intersections and looking for cars kind of both ways.

Avoiding drug and alcohol when you're out walking, especially if you're going to be walking at times of decreased visibility. So, whether that's early morning or late at night, that's just going to, like Holden was just talking about, really impair your ability to make good decisions and be aware of what's going on around you. Whereas when you're a bicyclist, same thing goes for impaired riding.

But if you're going with traffic, say that sidewalk ends, it's a little bit more seamless for you to go ahead and just stay as close to the side of the road and kind of continue to go forward, continue to follow all the traffic laws, just as if you were a pedestrian or you were in a vehicle. Unfortunately, we've seen a big increase in pedestrian deaths and some bicycle deaths as well. And so really an area to look at.

[Dr Mike Patrick]
Yeah, yeah. And helmets, I think it's a good opportunity to talk about wearing helmets when you're on any non-motorized or motorized vehicle that doesn't have a frame around you. So, whether you're on a motorcycle, a bicycle, a scooter, you're rollerblading, skateboarding, any of those things around, well, not even just around motor vehicles, just in general, because you can certainly fall off of those and hit your head and head injuries can be very difficult to recover from.

[Dr Leah Middelberg]
Seatbelts and bicycle helmets are among the top of my easy but effective ways to keep our children safe.

[Dr Mike Patrick]
Yeah, yeah, absolutely. Why do you think that we are seeing an increase in pedestrian deaths around cars?

[Dr Leah Middelberg]
Yeah, you know, we have seen an increase really in the last couple years. I think a lot of injury patterns have changed after COVID, right? As all of our behaviors were changing in a lot of ways, a lot of big ways.

But we're seeing more pedestrians dying from being struck by a vehicle here in the last several years than we were seeing even before COVID with a peak in 2022. And so, there's, you know, almost 7,500 people, pedestrians dying every year, and a portion of those are children. Same with bicyclists.

You know, we're seeing some slow, steady declines from like the 70s and late, you know, late 2000s or late 1990s and early 2000s. And unfortunately, we've seen a steady uptick here in the last decade or so. And we have continued to see some of those improvements around young people, around children, but we've had, we have seen an increase really in some older bicyclists being struck.

And so, I think reinforcing, again, talking about good modeling behavior is important for everyone.

[Dr Mike Patrick]
And from a community standpoint, having dedicated spaces for walking and for cycling, so you're really separating motor vehicles from walkers and bikers can be really helpful. So that's something that has to happen at the community level in terms of, you know, maybe with new construction, there has to be sidewalks in those areas. I know in our community, that's the way it is, is they're building new homes, but also apartment complexes that are like on what you would think of as more of a rural road, those also now have to have walking paths in front of them.

Of course, until you get continuity, you know, you may have a path in front of one big building, and then there's a field with nothing, and then another building with a path, but that's just the way it is where I live right now. Having dedicated spaces, I think, would, you know, make things safer too. Holden, how do states compare with each other?

Because a lot of these, a lot of these laws are either local or state laws, which then gives us differences from one state to another. How do states compare with one another in terms of teenage deaths in car accidents?

[Dr Holden Elkhammas]
Yeah. And if you're okay, I just wanted to add one thing with Dr. Middelberg, because I think it'd be really important for us to also note is like there's an increased usage of like scooters. I don't know if you've seen all those scooters around town, but sometimes there can be a lot of confusion of people, one, using those in the streets, using them on the sidewalks, which direction use, and obviously a lot of those are getting used late at nights and obviously without helmets.

I think that's really important, especially for our pedestrians and cyclists and car drivers and scooters to be a little safe when they are using all those devices. But as far as how states are comparing to other with car accidents, I think it's a really interesting, there's a lot of data on this one, and I will happily give you a few states that we're seeing a lot of increase and decreases with, but it can really vary by barrier, just like has everything in the US. While we are all under the same constitution, we all have different laws depending on the state.

So, when we see the three largest states that we've seen an increase with is the kind of Mississippi, Montana, and North Dakota. I think what we see the biggest one is District of Columbia with 181% increase. But it's really important for us to note like the differences in population of these states, which can like see like the biggest increases in a percentage-wise over the past 20 years.

But where we've seen kind of the largest decrease in like deaths per state is kind of Minnesota, like 71%. West Virginia, same with 71%. And then South Dakota, 62%.

And Wyoming, 61. So kind of like all kind of scattered around the US, the differences in deaths with car accidents.

[Dr Mike Patrick]
Yeah. And without dropping into those states, it's hard to say why that's the case. I mean, it may be a combination of things.

So was Montana, that was one of the ones at the top? At the bottom.

[Dr Holden Elkhammas]
We saw Montana have like a 14% increase of young driver crash fatalities.

[Dr Mike Patrick]
Oh, okay. Yeah. Yeah.

That's interesting. And because that's not a very populous state, you do wonder then what are the laws? What is drinking and driving like in that state?

So, there's lots of variability there. In general, what can states do to make teenage drivers safer?

[Dr Holden Elkhammas]
Yeah. There's actually, fortunately, a lot of things, a lot of research, a lot of money, a lot of really passionate people have been working on this to help decrease these deaths per state. I know Dr. Middelberg is going to talk about something with the graduated driver licensing laws. That's really important and has proven to be very effective. But we've also been talking about how important parental and caregiver involvement is, especially at an earlier age. We can be talking about when they're getting closer to having the driver's permits of really working on like, hey, let's review, talk through what I've been doing in driving, so then you can be more familiar about it when you're behind the wheel.

The driver education and training, I know that's something that can be very variable from state to state, depending on how many hours people have to use and complete prior to driving. There's a lot of peer-to-peer safety programs. Sometimes you can get checked out with us lecturing to them all the time.

Having some similar friends who are going through the same thing to advocate for each other to be safe is really important. Also, the biggest thing that we've been seeing is the vehicle safety technology. Driving is very difficult, especially when you're tired and you're new at it.

When you're having all these new alarm systems to see someone in your blind spots or cars that automatically stop for you, we're definitely seeing a lot of increased safety, especially with new drivers when that technology is increasing. But I think the biggest thing too is that distractibility. Our youth are very social lights, and so they love to chat with their friends.

I think we see an increase of crashes when they are having friends in the car. I think it's pretty important for at least the first six months to really limit the amount of people who are in the car to those who are kind of mentoring them driving. It's not having a lot of people who are under the age of 20 of them distracting them from driving.

I think that'll be really important things for them all to focus on. I know it's a lot, but really all-important stuff.

[Dr Mike Patrick]
If those things start with legislation and laws, then those laws can get communicated with kids that are learning to drive through driver's ed programs, but it has to start somewhere with communities. The legislature can enact laws that help kids think about what it is that makes kids safe in the car, and then make those things required through the law. Then hopefully that gets disseminated through driver's ed and through parents.

[Dr Holden Elkhammas]
It's interesting, too, because you can think of the differences of growing up and driving in California versus here in Ohio. California, you probably don't have snowstorms or anything you have to worry about, where you probably have a lot of different conditions of weather that you have to get used to when you're younger. It could be safer to drive in California where it's nice and sunny all the time and not really varied weather conditions.

It's really important as someone's learning to drive, especially in a varied weather state, that they're practicing on different roads. In the city versus roads that are really not well marked, as well as getting experience in both sun, rain, shine, snow, whatever, maybe, just so they can be safer when you're not around.

[Dr Mike Patrick]
Yeah. Wildfire smoke. That's the California equivalent of our snow.

[Dr Holden Elkhammas]
Hurricane in Florida.

[Dr Mike Patrick]
Yes, yes. That's exactly right. We have been hinting that later in the program, we're going to talk about teenage driver safety programs.

Leah, let's start with the American Academy of Pediatrics, since they're very involved in child and teenage safety. What recommendations does the American Academy of Pediatrics have for driver training and licensing?

[Dr Leah Middelberg]
Like Holden alluded to, every state may have different laws around young drivers, and some may reflect more minimal restrictions, and some may be a little bit more maximal. But we know that parents don't want the minimum when it comes to their kids, right? That they want the best.

So, this means that, yes, you have to follow the laws in your state, but you don't have to stop there. Parents can have additional restrictions that might be best for their child and their family. If they feel like their child needs a longer period of practicing before they're ready for that final license, that's up to parents, right?

And so, the AEP recommendations really play in with letting families know what is the evidence-based components that we know can help new drivers. And so, a lot of it starts at the beginning with just how old learners are when they can get their permit. AEP does recommend learners be 16 when they start doing that learner's permit, having a learning period that lasts no fewer than six months, having a good number, you know, 50 hours of supervised driving behind the wheel with least 10 hours being at night.

Holden alluded earlier, but those nighttime hours we know have an increased risk for our young teen drivers. And so, getting them the opportunity to practice that in a supervised setting is so important. But then after they get their license, limiting that nighttime driving, you know, potentially it's curfew hours, midnight to 5 a.m. or 9 p.m., whatever, you know, feels, one, best for your state, because there are restrictions that are existing for some states, but also what you feel is best for your young driver. And no passengers, like Holden just talked about, those other passengers can be really distracting. I actually remember being a young 16-year-old driver driving teammates in the backseat, and that is distracting, right? And so really limiting those other teen passengers for the first six months after driving and really even continuing that a little bit longer after that first six months and just allowing minimum number of passengers until about 18.

And then trying to decrease that distraction level. So, you know, trying to say, no cell phone use when you're driving, making sure that it's kind of put away somewhere where it's not going to be a tempting factor, no alcohol or drug use, wearing seatbelts always, and ways to kind of enforce all this really good educational and training experiences for them. I think the emphasis on the fact that we've seen really great improvements in both collisions and fatalities when it comes to teen driving because of injury prevention efforts, this is like one area where it's really exciting and encouraging to say, hey, we can look at the data and identify those places that can best help our teens and we can enact some programs to reflect that.

And we actually see the needle moving because of those programs, I think is really exciting. But there's always room to improve more, right? Any death in a teen is unacceptable.

And so, we want to continue to really put out a lot of great evidence and a lot of great data about how we can keep our kids even safer.

[Dr Mike Patrick]
Yeah, all really important things. There's also something called a graduated driver licensing system. What exactly is that?

[Dr Leah Middelberg]
The graduated driving license or GDL has been a huge advance in teen driving safety over the last 25 years. And now some component of the GDL is present in almost all 50 states. And really the goal is to introduce driving in a manner of increased risk and responsibility.

So, we recognize that driving is a skill that benefits from prolonged supervised practice, but gradually increasing those dangerous elements like higher speeds or driving at night, just so we're not throwing everything at a new young driver at once, right? So, they really can kind of slowly ramp up to kind of a real-world driving scenario. So, the National Highway Traffic Safety Administration recommends a staged process, so kind of a learner stage and an intermediate or basically like a provisional license stage, and then finally transitioning to that full licensure.

And that learning stage does a lot of the good things that the AAP recommended as well, having minimum ages, minimum time of practicing or duration of that training period, those supervised hours and restricting those dangerous time zones of, you know, the decreased visibility. And then that intermediate or provisional license, again, would have a minimum age with some nighttime driving restrictions and then those passenger restrictions that we talked about as well. And then kind of slowly ramping up to that full licensure.

The goal is really not that whole process happening in six months, but really over a couple years.

[Dr Mike Patrick]
Yeah. And are states adopting this system? And for the states that are, is that making a difference?

[Dr Leah Middelberg]
Yes, yes. Florida was the first state in the U.S. to actually adopt a graduated driving license back in 1996. So, and it's kind of slowly, parts of it have slowly been adopted across the U.S. where it's in every 50 states at this point. And we are seeing big reduces in those novice driver crashes. And so, our data is ranging from like 20 to 40%. But, you know, in 2022, teenage crash deaths declined by 50% from where they were just 25 years prior.

And so, you know, the GDL, the adoption of GDL has been a huge component of that. You know, the biggest impact that we've seen in our data from components of the GDL tend to be that restricting nighttime driving, other teen passengers, and then the delayed licensure age. And so having a lot of practice time, having practice time at high-risk times of that nighttime driving and limiting other distractions like other teens, as that graduated driving license has been shown to really be driving some of these good reductions in motor crashes that we've seen.

[Dr Mike Patrick]
Yeah. Yeah. So really important.

And I think that, so kudos to Florida for being the first back in 1996. But as you said, all states now do have some sort of graduated licensing system in place, but some may be a little stronger than others. And the more that they incorporate those recommendations from the American Academy of Pediatrics, probably the better.

And we are going to have in the show notes, a link to the AAP policy statement on teen drivers, and then a summary of the recommendations that they have. So, if you are a state lawmaker, you may want to check out those recommendations and to see how well your state's graduated driver's licensing system matches up with what the American Academy of Pediatrics recommends. And those recommendations are based on data and research to show what actually does help make drivers safer when they're first learning how to drive.

Speaking of the links in the show notes, we're also going to have, again, I had mentioned the previous PediaCast we did, 560 on child passenger safety. That's going to be there. There's actually a large collection of articles on teen driving safety from the American Academy of Pediatrics.

And we're going to put a link to that has all of those articles listed on it. And there's also a parent teen driving agreement that the AAP has. That's something that you can print out and talk about all the rules of the road and what your expectations are as a parent.

And then that's a great place where, as Leah had mentioned, parents can make their own rules for their teenage drivers that maybe goes above and beyond their states, especially if you live in a state that has some weaker requirements. So that's an opportunity and a talking point that parents and their teenagers can talk through together. Here in Ohio, the Ohio American Academy of Pediatrics has a teen safe driving initiative.

And I'll put a link to that in the show notes. Even if you live in a different state, you may find that to be helpful as well. And then, of course, we'll put links to emergency medicine at Nationwide Children's Hospital and the pediatric residency program also at Nationwide Children's.

So once again, Dr. Holden Elkhammas, Pediatric Resident at Nationwide Children's and Dr. Leah Middelberg, Pediatric Emergency Medicine Physician at our hospital. Thank you both so much for stopping by today.

[Dr Holden Elkhammas]
Thank you so much for having us.

[Dr Leah Middelberg]
Thank you for having us to talk about this important topic.

[Dr Mike Patrick]
We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that. Also, thanks again to our guests this week, Dr. Holden L. Elkhammas, Pediatric Resident at Nationwide Children's and Dr. Leah Middelberg, Pediatric Emergency Medicine attending, also at Nationwide Children's Hospital. Don't forget, you can find our podcast wherever podcasts are found. We're in the Apple and Google podcast apps, iHeartRadio, Spotify, SoundCloud, Amazon Music, YouTube, and most other podcast apps for iOS and Android.

Our landing site is PediaCast.org. You'll find our entire archive of past programs there, along with show notes for each of the episodes, our terms of use agreement, and the handy contact page if you have a future topic that you would like us to discuss on the program. Reviews are helpful wherever you get your podcasts.

We always appreciate when you share your thoughts about the show, and we love connecting with you on social media. You'll find us on Facebook, Instagram, Threads, LinkedIn, and Twitter. Simply search for PediaCast. We also have another podcast called PediaCast CME. CME stands for Continuing Medical Education. It's similar to this program. We do turn the science up a couple notches and offer free, again, continuing medical education credit for those who listen.

We do have joint accreditation, so that means that we have the credit that folks need in individual state licensing arenas for not only physicians, but also nurse practitioners, physician assistants, nurses, pharmacists, psychologists, social workers, and dentists. And again, since we do have joint accreditation for all of those professional organizations, it's likely that we offer the exact credits you need to fulfill your state's continuing medical education requirements, if you are any of the professionals that I mentioned. Shows and details are available at the landing site for that program, PediaCastcme.org.

You can also listen wherever podcasts are found. Simply search for PediaCast CME. Thanks again for stopping by, and until next time, this is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids. So long, everybody.
 

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