Motor-vehicle crashes are predictable and preventable, yet in the United States they are the second leading cause of death among adolescents and the fourth leading cause of nonfatal injury. In 2018, about 2,500 people aged 12–19 died in crashes — more than three quarters of them riding in passenger vehicles such as cars, pickups, vans and SUVs — and about 297,000 were injured. Those deaths and injuries cost about $12 billion in medical care and lost work.
Teenagers start with a handicap. Per mile driven, drivers aged 16–19 crash about four times as often as drivers aged 20 and older, largely through inexperience. Even at the same blood alcohol concentration, drivers aged 16–20 are much more likely to crash than older drivers, and phone distraction makes inexperience worse. Teens are also less likely to buckle up: in national roadside observations during 2016–2018, seat belt use was about 87% a year at ages 16–24, against 90% or more at 25 and older.
CDC's 2019 Youth Risk Behavior Survey (YRBS) measured four risky habits among U.S. high school students, and how they cluster.
The four behaviors, in the past 30 days
| Behavior | Students |
|---|---|
| Not always wearing a seat belt as a passenger | 43.1% of all students |
| Riding with a driver who had been drinking | 16.7% of all students |
| Driving after drinking alcohol | 5.4% of students who drove |
| Texting or e-mailing while driving | 39.0% of students who drove |
About 59.9% of students had driven in the past 30 days.
Who takes which risk
By age
The driving risks grow with age; the seat belt risk shrinks.
| Age | Drove after drinking | Texted while driving | Not always belted |
|---|---|---|---|
| 14 | 2.7% | 15.5% | 45.7% |
| 15 | 2.6% | 15.5% | 46.9% |
| 16 | 4.0% | 30.5% | 43.5% |
| 17 | 5.9% | 50.9% | 38.9% |
| 18 or older | 8.9% | 59.5% | 39.4% |
Riding with a drinking driver did not differ by age.
The authors note that teens take some driving risks less often with an adult in the car, as a learner's permit requires; as they begin to drive alone and gain experience, the risky habits can become more common. The fall in seat belt nonuse with age may mean that older teens, though more willing to take risks, still look after themselves.
By race and ethnicity
Every behavior differed, but not in one consistent direction:
| Black | Hispanic | White | |
|---|---|---|---|
| Not always belted | 61.7% | 48.2% | 36.6% |
| Rode with a drinking driver | 15.9% | 20.8% | 15.1% |
| Drove after drinking | 4.1% | 6.6% | — |
| Texted while driving | 29.5% | 35.2% | 43.9% |
Black students were more likely than Hispanic or white students not to always wear a seat belt, and Hispanic students more likely than white students. Hispanic students were more likely than Black or white students to ride with a drinking driver, and more likely than Black students to drive after drinking. White students were more likely than Black or Hispanic students to text while driving. Earlier research found that U.S.-born Hispanic youths were more likely to start drinking and driving than first-generation immigrant youths, even after adjusting for demographics.
By school grades
| Mostly C, D or F | Mostly A or B | |
|---|---|---|
| Not always belted | 57.0% | 38.8% |
| Rode with a drinking driver | 20.1% | 15.3% |
| Drove after drinking | 7.4% | 4.7% |
| Texted while driving | no difference |
Lower grades go with other health risks too. Whether an underlying readiness to take risks lowers grades, or risky behavior does, is unknown. Texting is the exception, perhaps because teens know it is unsafe but, in the moment, its perceived benefits outweigh the risk.
By sex and sexual identity
Few differences. Among drivers, boys were more likely than girls to drive after drinking (7.0% against 3.6%). Students not sure of their sexual identity were more likely than heterosexual students to ride with a drinking driver (21.9% against 15.7%); lesbian, gay and bisexual students (19.2%) did not differ from either.
One risk leads to another
After adjusting for age, sex, race and ethnicity, grades and sexual identity, a student who took any one of the risks was more likely to take each of the others. The ties to driving after drinking were the strongest.
How many times as likely a student was to take each risk, compared with students who did not take the risk in the left column:
| A student who… | Not always belted | Rode with a drinking driver | Drove after drinking | Texted while driving |
|---|---|---|---|---|
| did not always wear a seat belt | — | 1.80 | 2.73 | 1.29 |
| rode with a drinking driver | 1.42 | — | 9.87 | 1.50 |
| drove after drinking | 1.65 | 4.91 | — | 2.38 |
| texted while driving | 1.32 | 1.96 | 12.64* | — |
* Read with caution: the 95% confidence interval is wide. For the driving behaviors, the comparison group is students who drove but did not take that risk.
The risks compound: a teen who drives after drinking raises the chance of a crash, and one who also skips the seat belt raises the chance of being hurt or killed in it.
What helps
Tackle several risks at once. School and community programs built for other health behaviors can take on driving too. Programs that already involve families can add safe driving, since parents teach teens to drive, give them varied practice and set expectations — for example with a parent-teen driving agreement. Teens with supportive parents who monitor them were less likely to take several risks, from seat belt nonuse to phone use and drinking and driving. Counseling and social services for teens can add brief alcohol interventions, promising for those at high risk of drinking and driving.
Seat belt laws. Primary enforcement laws let police ticket an unbelted driver or passenger without any other violation. They raise belt use and have been shown to reduce fatal alcohol-related crashes among drivers aged 15–20.
Alcohol laws and checkpoints. In every state, drinking under 21 is illegal, and so is driving under 21 after drinking any alcohol (zero tolerance). Even so, about a fifth of drivers aged 16–20 killed in crashes in 2018 had a blood alcohol concentration of 0.08% or more. Minimum legal drinking age laws, zero tolerance laws and graduated driver licensing all help reduce drinking and driving among teens and should stay in force everywhere. Publicized sobriety checkpoints also work, including against crashes by underage drivers.
Texting. Campaigns, education and policy changes have had mixed results. Technology such as in-vehicle phone blocking may help, but its effectiveness and acceptability need study.
Who is at the wheel? Riding with a drinking driver is dangerous in itself, and teens exposed to it young are more likely to drink and drive themselves later. Knowing who those drivers are — parents, other relatives, friends — could help target interventions.
Because driving risks rise with age, the authors recommend keeping up proven prevention strategies for high school juniors and seniors in particular.
About the survey
The YRBS is a school-based, cross-sectional survey run every two years since 1991, drawing a nationally representative sample of public and private school students in grades 9–12 across the 50 states and the District of Columbia.
- Seat belt: any answer other than "always" counted as not always wearing one.
- Riding, drinking and texting: any occurrence in the past 30 days counted.
- Drivers: students who said they had not driven in the past 30 days were left out of the two driving questions. The survey does not ask directly whether students drive; "drivers" are those who did not choose "I did not drive" on either driving question.
- Students under 14 (87 of them) were left out of the analysis by age: too few, and too young to drive legally anywhere in the United States. Students of other or multiple races were too few for separate estimates but stayed in the sample.
Limits. The survey does not measure how much students drive or ride — trips, time or distance — so more exposure may mean more chances to take risks. It also does not ask who the drinking driver was.
Sources
Based on Yellman MA, Bryan L, Sauber-Schatz EK, Brener N, "Transportation Risk Behaviors Among High School Students — Youth Risk Behavior Survey, United States, 2019," MMWR Supplements volume 69, number 1, Centers for Disease Control and Prevention; a work of the United States government in the public domain. The report's discussion says Hispanic students drove after drinking more often than white students, but its results compare them only with Black students, so that comparison is not made here; its rounded "one of every five" for riding with a drinking driver is replaced by the measured 16.7%.
Licence: CC0 1.0 (public domain) · Adapted from www.cdc.gov
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