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Inj Prev. 2006 June; 12(Suppl 1): i49–i55.
PMCID: PMC2563442

A conceptual framework for reducing risky teen driving behaviors among minority youth


Teenage drivers, especially males, have higher rates of motor vehicle crashes and engage in riskier driving behavior than adults. Motor vehicle deaths disproportionately impact youth from poor and minority communities and in many communities there are higher rates of risky behaviors among minority youth. In this paper, the authors review the data on teens, risky driving behaviors, and morbidity and mortality. They identify areas in which known disparities exist, and examine strategies for changing teen driving behavior, identifying what has worked for improving the use of seat belts and for reducing other risky behaviors. A multifaceted, multilevel model based on ecological theory is proposed for understanding how teens make choices about driving behaviors, and to understand the array of factors that can influence these choices. The model is used to create recommendations for comprehensive intervention strategies that can be used in minority communities to reduce disparities in risk behaviors, injury, disability, and death.

Keywords: disparities, ecological theory, minority communities, risky behaviors, teen driving

Despite the tremendous strides that have been attained in recent years towards improving overall health status through advances in behavioral and biomedical research, motor vehicle crashes continue to be the leading cause of death for young people 16–20 years of age.1 Even though the mortality rate among young drivers has been decreasing,2 young drivers aged 16–24 continue to be at higher risk of being in a motor vehicle crash and for fatal outcomes than middle aged drivers.3 According to the US Department of Transportation, 3620 drivers in this group died in car crashes in 2004, accounting for 14% of all the drivers involved in fatal crashes and 18% of all the drivers involved in police reported crashes. This figure is high no matter how it is calculated (per 100 000 000 vehicle miles traveled by teens; per 100 000 licensed teen drivers; or per 100 000 teens in the population).4 In addition, disparities in death, disability, and injury continue to exist for African American and Latino teens in comparison with white youth.5

The importance of safety belt use

The major reason teens are killed or seriously injured when involved in traffic crashes is a lack of safety belt use.6,7 The Fatality Analysis Reporting System (FARS)8 shows that more than two thirds of teen occupants killed in crashes were not wearing safety belts.9 According to the 2003 Motor Vehicle Occupant Safety Survey (MVOSS) sponsored by the National Highway Traffic Safety Administration (NHTSA), teen drivers are less likely to wear a safety belt “all the time” (79%) than older drivers (84%).10 Among teens, African Americans are more likely than non‐Latino whites to report not using a seat belt or to be injured or killed while not wearing a seatbelt.11,12,13

According to various NHTSA sponsored state and national safety belt surveys, young people 16–24 are observed wearing safety belts at rates 5–15% below rates for older people.14,15 Numerous surveys conducted in high school parking lots indicate typical teen belt use is about 50–60%, depending upon the state and the school,16 but that rates of seat belt use among teens vary dramatically based on age, gender, race, and urban/rural setting and region of the country. Teen seat belt use was found to be only 19% among male African Americans in Jackson, MS.17 These findings suggest that not only are interventions to increase seat belt use by young people greatly needed, but also that targeted messages among teens—based on age, gender, race, and urban/rural and regional differences—are also needed.

Understanding risky driving behavior

The driving behaviors of teens are influenced by many factors, including their personal levels of knowledge, awareness, skills, and experiences; characteristics of and conditions found in the motor vehicle; and the various conditions of the community in which the teen and his/her family live. Individual characteristics that have been found to be related to motor vehicle morbidity and mortality among teens include race, age, gender, cognition, driving experience, and level of acculturation.18 Other risk factors for motor vehicle crashes among youth include current biophysiological condition (for example, motor skills, sleep deprivation, and psychiatric/neurological status), mental status (for example, mood, thoughts, feelings),19,20,21,22,23 and behavioral dispositions (for example, risk taking, impulsivity) that the individual brings to the situation.24,25,26,27,28,29

Inexperience and immaturity both contribute to high crash rates involving teen drivers.30 Adolescent drivers tend to engage in numerous risky behaviors, including speeding, which has been found to significantly correlate with a greater risk for crashes.31 They are more likely to engage in other risk taking behaviors such as following too closely, unsafe accelerations, and rapid lane changes.32 According to 2004 NHTSA data, 17% of young drivers 16–20 years of age had a blood alcohol concentration at or above 0.08%, the level at which all states define drunk driving.33 Driving safety changes rapidly as novice drivers gain experience and skill.34 However, lack of driving skill may be less important than poor judgment,35 which develops more slowly than motor skills with extensive driving experience, and critical brain maturation.36

There is growing recognition that teens who engage in risk behaviors often participate in multiple types of risk behaviors, referred to as clustering or co‐occurrence of risky behaviour.35 Evidence suggests that adolescent risk behaviors share common underlying causes such as behavioral, biological, family, school, and neighborhood factors.36 In addition to monitoring adolescent participation in specific driving behaviors, it is important to focus on risk taking among teens and to monitor them for signs of any risky behaviors.

Behavioral choices are influenced not only by personal beliefs and histories, but also by family and peer expectations. Family expectations, parental conditions on driving by teens, and level of communication between parents and teen drivers may affect the risk taking behavior of teens. Similarly, peer expectations about driving safely, wearing seat belts, and risk taking also may influence the likelihood of teen drivers engaging in risky driving practices.39,40,41

Characteristics of the motor vehicle and conditions within the vehicle present another level of variables that need to be examined as potential risk/protective factors for teen motor vehicle crashes. Performance, size, age, value, and vehicle design, including safety characteristics, have been found to be closely related to teen driving behaviors and outcomes.42 Older model cars, because of their larger size, may increase risky driving behaviors by giving teen drivers a false sense of safety or because older models generally have less value and offer a sense of “less to lose”.

Likewise, conditions within the vehicle also have been found to affect teen driving behavior and outcomes. The presence and number of passengers in the car, passenger ages, passenger behaviors, and distractions—including alcohol, music, and cell phones—are associated with risky driving behaviors and adverse outcomes.7,43,44 See also papers by Williams and Shope in this supplement.45,46

The physical environment outside the car, including street conditions such as presence of street lights, signage, speed bumps, passing lanes, as well as weather and time of day, also play a role in teen driving behavior and crash risk. Differences in rural and urban settings create different kinds of risks for young drivers.47 The social, political, and economic environments found at the community level also have been found to shape the development of a teen's frame of reference about driving behaviors, including knowledge, attitudes, awareness, and expectations, which in turn influence how the teen will respond when presented with the choice between risky and safe behaviors.48 The social environment includes many factors, including urban crowding, exposure to media, community norms about wearing seat belts, cultural standards regarding drinking while driving, presence of law enforcement, and police ticketing practices. All of these social contextual conditions have been found to be associated with teen driving behaviour.49,50,51,52,53

The political and policy environments of state and/or local governments also are closely related and can play an important role in influencing teen driving. The level of support for public policies such as primary and secondary seat belt laws, drinking while driving, having auto insurance, allocation of resources to enforce laws, and the activity of interest groups who support or oppose certain laws have been found to affect teen seat belt use.54,55,56 At the community level, economic factors are associated with teen motor vehicle driving.57,58 Whether and when teens have access to a car and the purpose for driving (school, work, recreation) often depend on a family's financial circumstances. Family finances may be affected by macro economic cycles, region, ethnicity, and geography.

Risky driving behavior among minority teens

Other than for seat belt use, the evidence is unclear about differences in risk taking behaviors among African American and Latino teens in contrast to other racial/ethnic groups. There is growing evidence of a relationship between early onset of drinking and involvement in motor vehicle crashes among individuals aged 18 and older.59 Adults who started drinking by age 14 were three times more likely to report driving after drinking than those who began drinking after age 21. Crashes were four times more likely for those who began drinking at age 14 when compared to those who began drinking after age 21.59 Results from a study using data from the 1997 Youth Risk Behavior Survey (YRBS) found that black youth were less likely to drink than whites, Latinos (males) equally likely, while Latinas (females) and males of “other” racial backgrounds were more likely to be current drinkers. Both blacks and Latinos, however, reported higher rates of drinking related risky behavior (including driving after drinking) than did whites. The higher rates of driving after drinking might be because blacks and Latinos tend to be concentrated in areas associated with community risk factors for drinking (for example, poverty, billboard advertising, greater number of off‐premise sales establishments).60

Other research suggests that Latinos, especially newly arrived immigrants, may be more likely than the general population to drink and drive as they may be unaware of US traffic laws.61 A recent survey found that Latino males have the highest rate of ever having been arrested for driving under the influence of alcohol. Study results indicate that Latinos believed the number of drinks needed to affect driving was generally higher than the number perceived by whites and blacks. One fifth of Latino males who drove a car during the 12 months before the survey reported being drunk enough to be in trouble if stopped by police.61,62 However, it is unclear whether differences found among Latinos are the same for teens as adults, for Latinos with different immigration status, and of different national origins (Mexican, Puerto Rican, Cuban, Central American).

Reducing adverse outcomes of motor vehicle crashes among minority teens

Minority teen injury, disability, and death resulting from motor vehicle crashes can be reduced through three categories of interventions: (1) those targeting the general population; (2) those focusing on teens in general; and (3) interventions that specifically target minority youth. To date, most interventions have relied on strategies that fall into the first two categories, while few have specifically targeted minority youth. Efforts that target the general population of drivers have focused primarily on changing driving behaviors through education, public policy, modifying the motor vehicle, and/or altering the environment.

Strategies that target the general population

Interventions that have been identified as having the greatest potential for increasing teen safety belt use include: changes in public policy, such as primary and secondary enforcement laws; high visibility enforcement, Click it or ticket mobilizations; and increased sanctions for safety belt violations, including increased fines and points on the driver's license.63

Teen seat belt use has been found to be higher in states with primary safety belt laws.64 McCartt and Shabanova20 reviewed nationwide crash data and found that teens aged 16–19 used safety belts to a higher degree in states with primary belt laws. The highly publicized Click it or ticket enforcement efforts have demonstrated that safety belt use will increase even in secondary enforcement states if frequent, consistent, and sustained Click it or ticket enforcement is tailored to young drivers (for example, near high schools, colleges, recreational facilities) by publicizing it on youth oriented radio stations and television channels, etc.65 Focus groups we have conducted with African American youth as well as policy makers, however, have raised a strong level of concern that strong enforcement efforts of primary safety belt laws will lead to increased racial profiling of minority drivers. Even though enhanced, highly visible enforcement and media publicity have been shown to be highly effective, there are significant personnel and financial resource limitations to those approaches.

Other public health interventions to increase motor vehicle safety that benefit teens include strategies that have targeted vehicular changes, such as safety belt use monitoring devices, ignition interlock devices, and improvements in comfort and convenience.66 Manufacturers encounter resistance to some of these strategies (for example, interlock devices) due to adverse public opinion and are consequently resistant to large scale investment in them. Changing roadway design also has been used to influence driving behaviors. Features like left turns across busy lanes, unprotected turn signals, poorly timed traffic signals, and multilane roads have been demonstrated to increase crash risk.67,68,69 Alterations to the physical environment have included changes to the transportation infrastructure through roadway design, roadway hazards, and safety features. They include adopting features like four‐way stops, speed bumps, islands, and roundabouts to slow traffic.70,71,72 Efforts to address low lighting conditions and wet or icy roads also have been undertaken to reduce the risk of motor vehicle crashes.73,74

Strategies that target teen drivers

There has been increasing recognition, however, that strategies that target the general population do not necessarily have the same effect on all segments of the population. Increasingly, interventions have been implemented that target improved safety and reduced crash risk specifically among teens.

A majority of states has now adopted graduated driver licensing (GDL) laws. Some of the GDL laws either include safety belt use as a provision or provide for sanctions if a safety belt violation occurs. Safety belt provisions are not always incorporated into GDL laws, however. Even where they exist, some teens and their parents are not aware of seat belt requirements of GDL. GDL laws could be used to provide cause for stopping young drivers and ascertaining compliance with safety belt laws. However, not everyone agrees with adding safety belt provisions to GDL. Focus groups that were conducted with African American youth and black mayors have voiced concern that this provision might lead to racial profiling.75

The most common prevention strategy to change teen seat belt use behavior has been education, especially school based interventions.76,77,78 Schools are the primary social institutions that provide access to youth under the age of 20 and therefore are an ideal setting for health and safety interventions. An educational approach typically focuses on changing knowledge and beliefs, modifying attitudes (for example, increase self‐esteem or personal commitment), and teaching new skills. Content areas that have been identified as necessary for an effective prevention curriculum include: normative education, social skills, social influences, perceived harm, protective factors, and refusal skills. These strategies also include broad based approaches such as driver's education courses and school based and/or public health education campaigns.35,79

Incentive programs which reward teens for buckling up, such as high school reward programs and insurance incentives, have also been identified as potentially effective. Other promising strategies include parental management to monitor teens more closely and establish restrictions on teen driving, and school and employer policies that mandate seat belt use by students and employees. Most interventions that have been proposed or implemented which use education and persuasion approaches have relied on universal approaches that target individual level characteristics for change, usually knowledge, attitudes, and behaviors. These interventions are often associated with adolescent developmental theory and target inexperience, immaturity, a sense of immortality, emotionality, sensation seeking, risk taking, peer influence, influence of parents, and distractions.14,28,80,81,82,83,84 Universal messages such as these tend to target “typical” teens with a “general” message. The extent to which a teen identifies with both the way the message is presented as well as with the messenger may affect its impact on behavioral change.

Fell et al described various community approaches that have been successfully implemented to increase safety belt use among young people.85 They include strategies that target not only teens, but also their families, school, neighborhood, and surrounding community. These approaches often incorporate both risk and protective factors. He found that the most successful motor vehicle crash injury prevention programs targeting teens tend to use a variety of strategies that are aimed not just at the teen, but at the environmental context as well.85 Specifically, Fell reported that effective prevention education programs typically include some combination of knowledge content, social norming, personal commitment, and resistance skills strategies.85 These programs have demonstrated up to a 71% increase in seat belt use based on observations.85

Media campaigns that target teens have been offered as a way to affect teen driving behavior. Much of our knowledge about effective strategies for altering risk taking behaviors using mass media is derived from research that has been undertaken in the areas of smoking and substance abuse prevention and control.86,87,88,89,90 Campaigns which have been part of more comprehensive programs, specifically high intensity media campaigns combined with school education programs and/or other community level interventions, have been found to be the most successful. This suggests that there are synergies from multiple interventions that simultaneously address different levels such as individual, school, neighborhood, or public policy.91

Strategies that target minority youth

To influence social norms and behaviors in minority communities, strategies will be needed that incorporate different levels of interventions such as health education, public media campaigns,92,93 community messaging, and traffic law enforcement.92,94 Community based strategies that engage the target population in prevention efforts are likely to be the most effective. For instance, focus groups can be conducted with the target population (for example, African American teens) to help in the development and/or adaptation of developmentally, culturally, linguistically, and environmentally appropriate messages. The most successful media campaigns employ a social marketing approach in which multiple themes are directed at specific demographic groups (for example, Latinos, African Americans, etc), followed by consumer testing and feedback, and then message adjustment based on the feedback.95,96 See also the paper by Smith, this supplement.97

Other community messaging strategies could include engaging families, schools, the faith community and other local institutions, organizations, and businesses to reinforce a “buckle up” message that is likely to be more effective than a general teen communication campaign.

A peer‐to‐peer (service learning) approach has been found to be an effective alternative to traditional public health education campaigns. Service learning overcomes some of the barriers associated with an inappropriate message and/or messenger found in traditional health education campaigns.98,99,100 It is rooted in experiential learning theory and involves methods under which students learn and develop through active participation in thoughtfully organized service that: (1) is conducted in and meets the needs of a community; (2) is usually coordinated with a secondary school or institution of higher education; (3) helps foster civic responsibility; (4) is integrated into and enhances the (core) academic curriculum of the students in which the participants are enrolled; and (5) provides structured time for the students or participants to reflect on the service experience.98

Using the service learning model to increase seat belt use among minority teens is a promising new approach being studied by the Meharry‐State Farm Alliance, National Center for Optimal Health at Meharry Medical College. A total of six high school service learning programs in Columbus, Ohio; Detroit, Michigan; and Jacksonville, Florida are presently participating in a study to assess their impact on teen seat belt usage. Preliminary results suggest that students respond well to other students who structure health promotion messages and strategies. The peer‐to‐peer model used in service learning is consistent with research that has found teens to be heavily influenced by their peers and helps to ensure that the messengers and messages are culturally appropriate.

A multilevel approach to preventing death among minority teens from motor vehicle crashes

Understanding how minority youth make decisions regarding driving and risk taking behaviors and the variables that influence those decisions requires articulation of a dynamic, theoretical framework. The factors that influence the driving behaviors of minority teens, the likelihood that they will engage in risk taking or health promoting behaviors and activities, and how characteristics of both the motor vehicle and the environment affect them, and subsequent outcomes must be incorporated into the framework.101,102

In figure 11,, we present a multifaceted, multilevel model that is based on ecological theory103,104,105,106 for understanding minority youth driving behavior and its consequences. This model views teen behavior as dynamically interacting with and responsive to a series of expanding spheres of environmental influence.107,108 This multilevel approach is useful because it allows for the consideration and integration of current and historical, social, cultural, economic, and political conditions as potential sources of influence on individual behavior.109

figure ip12872.f1
Figure 1 A multilevel, multisystems model of driving behaviour.

According to this model, the same complex systems that create the context for behaviors also mediate and moderate the consequences of these behaviors. Some consequences are immediate, while others are intermediate or long term. Adverse outcomes of driving behaviors are typically described in terms of personal injury, disability, and death. Yet, outcomes of behavioral choices also have a detrimental effect on others, including family members, peers, neighbors and the community. Some choices have long term personal, physical, emotional, and financial consequences (for example, serious injury, drunk driving conviction, increases in insurance rates)110 while others may have incremental effects on social, political, environmental, and economic systems (the activism of Mothers Against Drunk Driving is an example).

While this model of teen driving behavior is presented as moving through time from left to right, in reality it is an iterative process in which new events continually combine with antecedents to influence the choices of the individual in the present. Choices made in the present affect subsequent behavioral decisions, creating new situations that influence and constrain future choices. It is in the present, however, that an individual has an opportunity to make choices about driving behaviors that increase or decrease the risk of a crash.

The proposed model is offered as a guide for considering the range and combination of strategies that might be adapted within a community to change the driving behaviors of minority youth. The model asserts that multifaceted and multilevel interventions hold the greatest promise for reducing risky minority teen driving behaviors and their adverse outcomes rather than interventions that target only one level of risk factor. Interventions that engage communities in their development and implementation are likely to be more effective than solutions imposed by experts or government agencies. While participatory approaches are important in all communities and with all teens, engaging the community is critically important for minority teen populations. Messages must be presented in an age appropriate and linguistically appropriate manner and in a time and place where the message will be heard. The messenger must be someone with whom minority teens can readily identify, and the message must address the unique social realities they experience, and be presented through a medium to which the target group is receptive.

Safe driving campaigns should consider using a range of engaging delivery media such as foreign language radio stations and other non‐traditional media outlets to reach the widest audience. For urban African American youth, this may mean using hip‐hop music, advertising, youth websites, and text messaging as potential media for getting the message out. In rural areas, by contrast, strategies might include use of billboards, flyers, and talk radio. In a rural area, influential figures for teens may be more likely to be the faith community, community leaders, and authority figures, whereas in an urban environment, the most effective messengers may be entertainers, sports figures, or celebrities.

Inner city and rural communities of high poverty where minority teens are most likely to live often lack social and economic resources that provide teens with opportunities for healthy growth and development. Interventions that target behavioral change among minority youth must be responsive to their unique physical, social, political, and economic environments. In low income communities of color, strategies that coordinate with and/or are integrated into other public health interventions need to take advantage of existing social capital. Many community organizations already work with minority teens on issues such as HIV/AIDS prevention, substance abuse prevention, violence prevention, conflict resolution, and sexuality education. Where effective programs exist, advocates should partner with these organizations to add information about seat belt use and other risk factors for motor vehicle crashes.


Despite a continuing decline in the adverse effects of motor vehicle crashes in the general population of the US, and in teens, disparities in death, disability, and injury continue to exist for African American and Latino teens in comparison with white youth. We suggest that while it is important to continue efforts to affect changes in behaviors through health education, media, and changes at the community level, disparities in outcomes continue to exist. We present a model of teen driving behavior based on ecological theory that offers a more comprehensive and dynamic approach for reaching minority teens. For effective strategies to increase teen seat belt use, however, they also must address the ways in which the physical, social, political, and economic environment of a community shape individual behaviors. We propose that efforts which employ multiple levels of prevention strategies, culturally and linguistically appropriate messaging, and engage the target population in the development and implementation of targeted strategies will be more effective. These multilevel, multifaceted interventions hold great promise not only for reducing motor vehicle injury, disability, and death among minority teens, but also for reducing disparities in these outcomes.

About the senior author

Nathan Stinson Jr is the former Deputy Assistant Secretary for Health and the Director of the US Office of Minority Health and Assistant Surgeon General (1999–2004). In that capacity he served as the principal advisor to the Secretary of Health and Human Services on minority health. He has served as Director of the Center for Optimal Health at Meharry Medical College since January 2005. Dr Stinson received an MA from the University of California and a PhD from the University of Colorado, both in environmental biology. He earned an MD degree from the University of Colorado Health Sciences Center in 1981 and an MPH in Health Care Administration from the Uniformed Services University of the Health Sciences in 1990. The Center for Optimal Health (COH) is designed to maximize the health, healthcare delivery systems, and community health programs of racial and ethnic minority populations through public policy, research, and health education intervention. Primary areas of focus are unintentional injury prevention, cardiovascular disease, diabetes, obesity, cancer, and HIV/AIDS.


This paper was first presented as part of the first Expert Panel meeting of the Youthful Driver Research Initiative, a collaborative research program between the Center for Injury Research and Prevention ( at the Children's Hospital of Philadelphia (CHOP) ( and State Farm Insurance Companies® (State Farm) ( The views presented in this paper are those of the author(s) and are not necessarily the views of CHOP or State Farm.


FARS - Fatality Analysis Reporting System

MVOSS - Motor Vehicle Occupant Safety Survey

NHTSA - National Highway Traffic Safety Administration

YRBS - Youth Risk Behavior Survey


1. Subramanian R. Motor vehicle traffic crashes as a leading cause of death in the United States, 2000. Traffic Safety Facts Research Note (DOT HS 809 661) 2003
2. Evans C A, Jr, Fielding J E, Brownson RC et a l. Motor‐vehicle occupant injury: strategies for increasing use of child safety seats, increasing use of safety belts, and reducing alcohol‐impaired driving. MMWR Recomm Rep 2001. 50(RR‐7)1–14.14 [PubMed]
3. Insurance Institute for Highway Safety Fatality facts 2004: children. Available at (accessed April 2006)
4. National Highway Traffic Safety Administration Traffic safety facts 2001: young drivers. Available at http://www‐‐30/NCSA/TSF2001/2001youngdr.pdf (accessed April 2006)
5. Baker S P, O'Neill B, Ginsburg M J. et alThe injury fact book. 2nd ed. New York: Oxford University Press, 1992
6. Schlundt D G, Warren R, Miller S. Reducing unintentional injuries on the nation's highways: a literature review. J Health Care Poor Underserved 2004. 1577–99.99 [PubMed]
7. McCartt A T, Northrup V S. Factors related to seat belt use among fatally injured teenage drivers.J Safety Res 2004. 3529–38.38 [PubMed]
8. National Highway Traffic Safety Administration Fatality Analysis Reporting System (FARS). Washington, DC: US Department of Transportation, Available at http://www‐ (accessed April 2006)
9. Chen L H, Baker S P, Braver E R. et al Carrying passengers as a risk factor for crashes fatal to 16‐ and 17‐year‐old drivers. JAMA 2000. 2831578–1582.1582 [PubMed]
10. Boyle J, Vanderwolf P. 2003 Motor vehicle occupant safety survey. Volume 2, Safety Belt Report. Washington, DC: National Highway Traffic Safety Administration, 2003
11. Vivoda J M, Eby D W, Kostyniuk L P. Differences in safety belt use by race. Accid Anal Prev 2004. 361105–1109.1109 [PubMed]
12. Wells J K, Williams A F, Farmer C M. Seat belt use among African Americans, Hispanics, and Whites.Accid Anal Prev 2002. 34523–529.529 [PubMed]
13. Briggs N C, Levine R S, Haliburton W P. et al The Fatality Analysis Reporting System as a tool for investigating racial and ethnic determinants of motor vehicle crash fatalities. Accid Anal Prev 2005. 37641–649.649 [PubMed]
14. Williams A F, McCartt A T, Geary L. Seatbelt use by high school students. Inj Prev 2003. 925–28.28 [PMC free article] [PubMed]
15. Glassbrenner D. Safety Belt Use in 2003 [cited 2004 Feb 5, 2004]; DOT HS 809 646. Washington, DC: National Highway Traffic Safety Administration, US Department of Transportation 2003, Available at http://www‐‐30/NCSA/Rpts/2003/809646.pdf (accessed April 2006)
16. McCartt A T, Shabanova V I. Teenage Seat Belt Use: White Paper. 2002. Available at (accessed April 2006)
17. Schlundt D G, Easley S, Goldzweig I. et alRacial disparities in seat belt use: an observational study in 4 American cities. A paper presented at the 2005 American Public Health Association Conference, Philadelphia, PA, December 2005
18. Braver E R. Race, Hispanic origin, and socioeconomic status in relation to motor vehicle occupant death rates and risk factors among adults. Accid Anal Prev 2003. 35295–309.309 [PubMed]
19. O'Malley P M, Johnston L D. Unsafe driving by high school seniors: national trends from 1976 to 2001 in tickets and accidents after use of alcohol, marijuana and other illegal drugs.J Stud Alcohol 2003. 64305–312.312 [PubMed]
20. Dula C S, Geller E S. Risky, aggressive, or emotional driving: addressing the need for consistent communication in research. J Safety Res 2003. 34559–566.566 [PubMed]
21. Galovski T E, Blanchard E B, Malta L S. et al The psychophysiology of aggressive drivers: comparison to non‐aggressive drivers and pre‐ to post‐treatment change following a cognitive‐behavioural treatment. Behav Res Ther 2003. 411055–1067.1067 [PubMed]
22. Deery H A, Fildes B N. Young novice driver subtypes: relationship to high‐risk behavior, traffic accident record, and simulator driving performance. Hum Factors 1999. 41628–643.643 [PubMed]
23. Cummings P, Koepsell T D, Moffat J M. et al Drowsiness, counter‐measures to drowsiness, and the risk of a motor vehicle crash. Inj Prev 2001. 7194–199.199 [PMC free article] [PubMed]
24. Zuckerman M, Kuhlman D M. Personality and risk‐taking: common biosocial factors. J Pers 2000. 68999–1029.1029 [PubMed]
25. Hoyle R H. Personality processes and problem behavior. J Pers 2000. 68953–966.966 [PubMed]
26. Turner C, McClure R. Age and gender differences in risk‐taking behaviour as an explanation for high incidence of motor vehicle crashes as a driver in young males. Inj Control Saf Promot 2003. 10123–130.130 [PubMed]
27. Woodward L J, Fergusson D M, Horwood L J. Driving outcomes of young people with attentional difficulties in adolescence. J Am Acad Child Adolesc Psychiatry 2000. 39627–634.634 [PubMed]
28. Bingham C R, Shope J T. Adolescent developmental antecedents of risky driving among young adults. J Stud Alcohol 2004. 6584–94.94 [PubMed]
29. Anstey K J, Wood J, Lord S. et al Cognitive, sensory and physical factors enabling driving safety in older adults. Clin Psychol Rev 2005. 2545–65.65 [PubMed]
30. McKnight A J, McKnight A S. The behavioral contributors to highway crashes of youthful drivers. Annu Proc Assoc Adv Automot Med 2000. 44321–333.333 [PubMed]
31. Elander J, West R, French D. Behavioral correlates of individual differences in road‐traffic crash risk: an examination method and findings. Psychol Bull 1993. 113279–294.294 [PubMed]
32. Preusser D F, Ferguson S A, Williams A F. The effect of teenage passengers on the fatal crash risk of teenage drivers. Accid Anal Prev 1998. 30217–222.222 [PubMed]
33. National Highway Traffic Safety Administration Traffic Safety Facts 2004 data. Washington, DC: US Department of Transportation 2005, Available at http://www‐‐30/NCSA/TSF2004/809911.pdf (accessed April 2006)
34. Mayhew D R, Simpson H M, Pak A. Changes in collision rates among novice drivers during the first months of driving.Accid Anal Prev 2003. 35683–691.691 [PubMed]
35. Vernick J S, Li G, Ogaitis S. et al Effects of high school driver education on motor vehicle crashes, violations, and licensure. Am J Prev Med 1999. 16(Suppl 1)40–46.46 [PubMed]
36. Giedd J N, Blumenthal J, Jeffries N O. et al Brain development during childhood and adolescence: a longitudinal MRI study. Nat Neurosci 1999. 2861–863.863 [PubMed]
37. Mathews J, Zollinger T, Przybylski M. et al The association between risk‐taking behavior and the use of safety devices in adolescents. Annu Proc Assoc Adv Automot Med 2001. 4523–36.36 [PubMed]
38. Payton J W, Wardlaw D M, Graczyk P A. et al Social and emotional learning: a framework for promoting mental health and reducing risk behavior in children and youth. J Sch Health 2000. 70179–185.185 [PubMed]
39. Braithwaite R L, Lythcott N. Community empowerment as a strategy for health promotion for black and other minority populations. JAMA 1989. 26282–283.283 [PubMed]
40. Chinman M, Hannah G, Wandersman A. et al Developing a community science research agenda for building community capacity for effective preventive interventions. Am J Community Psychol 2005. 35143–157.157 [PubMed]
41. Williams D R, Jackson P B. Social sources of racial disparities in health. Health Aff (Millwood) 2005. 24325–334.334 [PubMed]
42. Wood D P. Safety and the car size effect: a fundamental explanation. Accid Anal Prev 1997. 29139–151.151 [PubMed]
43. Simons‐Morton B, Lerner N, Singer J. The observed effects of teenage passengers on the risky driving behavior of teenage drivers. Accid Anal Prev 2005. 37973–982.982 [PubMed]
44. Doherty S T, Andrey J C, MacGregor C. The situational risks of young drivers: the influence of passengers, time of day and day of week on accident rates. Accid Anal Prev 1998. 3045–52.52 [PubMed]
45. Williams A. Young driver risk factors: successful and unsuccessful approaches for dealing with them and an agenda for the future. Inj Prev 2006. 12(Suppl 1)i4–i8.i8 [PMC free article] [PubMed]
46. Shope J T. Influences on youthful driving behavior and their potential for guiding interventions to reduce crashes. Inj Prev 2006. 12(Suppl 1)i9–i14.i14 [PMC free article] [PubMed]
47. Ossenbruggen P J, Pendharkar J, Ivan J. Roadway safety in rural and small urbanized areas. Accid Anal Prev 2001. 33485–498.498 [PubMed]
48. Cooper C R, Denner J. Theories linking culture and psychology: universal and community‐specific processes. Annu Rev Psychol 1998. 49559–584.584 [PubMed]
49. Vlahov D, Galea S. Urbanization, urbanicity, and health. J Urban Health 2002. 791S–12.12 [PMC free article] [PubMed]
50. Pickett S T A, Cadenasso M L, Grove J M. et al Urban ecological systems: linking terrestrial ecological, physical, and socioeconomic components of metropolitan areas. Annu Rev Ecol Syst 2001. 32127–157.157
51. Schulz A, Northridge M E. Social determinants of health: implications for environmental health promotion. Health Educ Behav 2004. 31455–471.471 [PubMed]
52. Vlahov D, Gibble E, Freudenberg N. et al Cities and health: history, approaches, and key questions. Acad Med 2004. 791133–1138.1138 [PubMed]
53. Auchincloss A H, Hadden W. The health effects of rural‐urban residence and concentrated poverty. J Rural Health 2002. 18319–336.336 [PubMed]
54. Boden L I. Policy evaluation: better living through research. Am J Ind Med 1996. 29346–352.352 [PubMed]
55. Sherraden M S, Slosar B, Sherraden M. Innovation in social policy: collaborative policy advocacy. Soc Work 2002. 47209–221.221 [PubMed]
56. Grabowski D C, Morrisey M A, The effect of state regulations on motor vehicle fatalities for younger and older drivers: a review and analysis Milbank Q. 2001;79: 517–45, iii–iv, [PubMed]
57. Fiscella K, Williams D R. Health disparities based on socioeconomic inequities: implications for urban health care. Acad Med 2004. 791139–1147.1147 [PubMed]
58. Mechanic D. Disadvantage, inequality, and social policy. Health Aff (Millwood) 2002. 2148–59.59 [PubMed]
59. Hingson R, Heeren T, Levenson S. et alAge of drinking onset, driving after drinking, and involvement in alcohol‐related motor vehicle crashes. DOT HS 809. Springfield, VA: National Technical Information Service, 2001 [PubMed]
60. Hanna E, Hsiao‐ye Y, DuFour M. et alRisky behavior by sex and race among currently drinking ninth graders in the United States: results from the 1997 Youth Risk Behavior Survey (YRBS). Poster presented at the 23rd Annual Scientific Meeting of the Research Society on Alcoholism, June 24–29, 2000, Denver, Co. Available at‐kids‐alcohol_2.pdf (accessed April 2006)
61. Stiles M C, Grieshop J I. Impacts of culture on driver knowledge and safety device usage among Hispanic farm workers. Accid Anal Prev 1999. 31235–241.241 [PubMed]
62. National Highway Traffic Safety Administration Highway safety needs of U.S. Hispanic communities: issues and strategies. Washington, DC: US Department of Transportation; September 1995, DOT HS 808 373. Available at (accessed April 2006)
63. Maupin J E, Jr, Schlundt D, Warren R. et al Reducing unintentional injuries on the nation's highways: research and program policy to increase seat belt use. J Health Care Poor Underserved 2004. 154–17.17 [PubMed]
64. Cvijanovich N Z, Cook L J, Mann L C. et al A population‐based study of crashes involving 16‐ and 17‐year‐old drivers: the potential benefit of graduated driver licensing restrictions. Pediatrics 2001. 107632–637.637 [PubMed]
65. Solomon M G, Ulmer R G, Preusser D F. Evaluation of Click It or Ticket model programs. Washington, DC: National Highway Traffic Safety Administration, US Department of Transportation 2002, Available at (accessed April 2006)
66. MacKenzie E J. Epidemiology of injuries: current trends and future challenges. Epidemiol Rev 2000. 22112–119.119 [PubMed]
67. Abdel‐Aty M, Keller J. Exploring the overall and specific crash severity levels at signalized intersections.Accid Anal Prev 2005. 37417–425.425 [PubMed]
68. Newton C, Mussa R N, Sadalla E K. et al Evaluation of an alternative traffic light change anticipation system. Accid Anal Prev 1997. 29201–209.209 [PubMed]
69. Retting R A, Weinstein H B, Williams A F. et al A simple method for identifying and correcting crash problems on urban arterial streets. Accid Anal Prev 2001. 33723–734.734 [PubMed]
70. Bunn F, Collier T, Frost C. et al Area‐wide traffic calming for preventing traffic related injuries. Cochrane Database Syst Rev 2003. CD003110 [PubMed]
71. Elvik R. Area‐wide urban traffic calming schemes: a meta‐analysis of safety effects. Accid Anal Prev 2001. 33327–336.336 [PubMed]
72. Morrison D S, Petticrew M, Thomson H. What are the most effective ways of improving population health through transport interventions? Evidence from systematic reviews. J Epidemiol Community Health 2003. 57327–333.333 [PMC free article] [PubMed]
73. Keall M D, Frith W J, Patterson T L. The contribution of alcohol to night time crash risk and other risks of night driving. Accid Anal Prev 2005. 37816–824.824 [PubMed]
74. Eisenberg D. The mixed effects of precipitation on traffic crashes. Accid Anal Prev 2004. 36637–647.647 [PubMed]
75. Goldzweig I. Cultural challenge: reaching diverse populations to decrease preventable death & injury on the highways. Charlotte, NC: Presented at the National Lifesavers Conference, 2005
76. Bosworth K. Assessment of drug abuse prevention curricula developed at the local level. J Drug Educ 1998. 28307–325.325 [PubMed]
77. Bosworth K, Earthman E. From theory to practice: school leaders' perspectives on resiliency.J Clin Psychol 2002. 58299–306.306 [PubMed]
78. Dryfoos J G. School‐ and community‐based pregnancy prevention programs. Adolesc Med 1992. 3241–256.256 [PubMed]
79. Ian R, Irene K. School based driver education for the prevention of traffic crashes. Cochrane Database Syst Rev 2001. CD003201 [PubMed]
80. Fergusson D, Swain‐Campbell N, Horwood J. Risky driving behaviour in young people: prevalence, personal characteristics and traffic accidents. Aust N Z J Public Health 2003. 27337–342.342 [PubMed]
81. Begg D J, Langley J D. Identifying predictors of persistent non‐alcohol or drug‐related risky driving behaviours among a cohort of young adults. Accid Anal Prev 2004. 361067–1071.1071 [PubMed]
82. Arnett J J. Developmental sources of crash risk in young drivers. Inj Prev. 2002;8: ii17–21; discussion ii21–3, (Suppl 2) [PMC free article] [PubMed]
83. Williams A F, Ferguson S A. Rationale for graduated licensing and the risks it should address. Inj Prev 2002. 8(Suppl 2)ii9–14 discussion ii146.14 discussion ii146 [PMC free article] [PubMed]
84. Williams A F. Risky driving behavior among adolescents. In: Jessor R (ed). New perspectives on adolescent risk behavior. New York, NY: Cambridge University Press, 1988. 221–237.237
85. Fell J C, Baker T K, McKnight A S. et alIncreasing teen safety belt use: a program and literature review. Washington, DC: National Highway Traffic Safety Administration, US Department of Transportation, Available at (accessed May 2006)
86. Lantz P M. Smoking on the rise among young adults: implications for research and policy.Tob Control 2003. 12(Suppl 1)i60–i70.i70 [PMC free article] [PubMed]
87. Wakefield M, Chaloupka F. Effectiveness of comprehensive tobacco control programmes in reducing teenage smoking in the USA. Tob Control 2000. 9177–186.186 [PMC free article] [PubMed]
88. Botvin G J, Kantor L W. Preventing alcohol and tobacco use through life skills training.Alcohol Res Health 2000. 24250–257.257 [PubMed]
89. Byrne A M, Dickson L, Derevensky J L. et al The application of youth substance use media campaigns to problem gambling: a critical evaluation. J Health Commun 2005. 10681–700.700 [PubMed]
90. Farrelly M C, Niederdeppe J, Yarsevich J. Youth tobacco prevention mass media campaigns: past, present, and future directions. Tob Control 2003. 12(Suppl 1)i35–i47.i47 [PMC free article] [PubMed]
91. Aggleton P. Behavior change communication strategies. AIDS Educ Prev 1997. 9111–123.123 [PubMed]
92. Salzberg P M, Moffat J M. Ninety five percent: an evaluation of law, policy, and programs to promote seat belt use in Washington state. J Safety Res 2004. 35215–222.222 [PubMed]
93. Elder R W, Shults R A, Sleet D A. et al Effectiveness of mass media campaigns for reducing drinking and driving and alcohol‐involved crashes: a systematic review. Am J Prev Med 2004. 2757–65.65 [PubMed]
94. Geary L L, Ledingham K A, Maloney S C. Connecticut statewide sTEP wave evaluation. J Safety Res 2005. 36333–340.340 [PubMed]
95. Lefebvre R C, Flora J A. Social marketing and public health intervention. Health Educ Q 1988. 15299–315.315 [PubMed]
96. Maibach E, Holtgrave D R. Advances in public health communication. Annu Rev Public Health 1995. 16219–238.238 [PubMed]
97. Smith W. Social marketing: an overview of approach and effects. Inj Prev 2006. 12(Suppl 1)i38–i43.i43 [PMC free article] [PubMed]
98. In: Billig S W, Waterman A.(eds) Studying service‐learning: innovations in education research methodology. Mahwah, NJ: Lawrence Erlbaum Associates Inc, 2003
99. Fiske E B. Learning in deed. the power of service‐learning for American schools. Battle Creek, MI: WK Kellogg Foundation, 2001
100. Eyler J G, Giles D E., Jr Where's the learning in service‐learning?. San Francisco: Jossey‐Bass, 1999
101. Joffe H. Risk: from perception to social representation. Br J Soc Psychol 2003. 4255–73.73 [PubMed]
102. Neumark‐Sztainer D. The social environments of adolescents: associations between socioenvironmental factors and health behaviors during adolescence. Adolesc Med 1999. 1041–55.55 [PubMed]
103. Earls F, Carlson M. The social ecology of child health and well‐being. Annu Rev Public Health 2001. 22143–166.166 [PubMed]
104. Grzywacz J G, Fuqua J. The social ecology of health: leverage points and linkages. Behav Med 2000. 26101–115.115 [PubMed]
105. Green L W, Richard L, Potvin L. Ecological foundations of health promotion. Am J Health Promot 1996. 10270–281.281 [PubMed]
106. Kothari A R, Birch S. Multilevel health promotion research: conceptual and analytical considerations. Can J Nurs Res 2004. 3656–75.75 [PubMed]
107. Yen I H, Syme S L. The social environment and health: a discussion of the epidemiologic literature. Annu Rev Public Health 1999. 20287–308.308 [PubMed]
108. McLeroy K R, Bibeau D, Steckler A. et al An ecological perspective on health promotion programs. Health Educ Q 1988. 15351–377.377 [PubMed]
109. Fisher E B, Walker E A, Bostrom A. et al Behavioral science research in the prevention of diabetes: status and opportunities. Diabetes Care 2002. 25599–606.606 [PubMed]
110. Cydulka R K, Harmody M R, Barnoski A. et al Injured intoxicated drivers: citation, conviction, referral, and recidivism rates. Ann Emerg Med 1998. 32349–352.352 [PubMed]

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