Over the past few decades, multipronged efforts have made substantial strides in reducing adolescent morbidity and mortality related to motor vehicle crashes (MVCs). However, MVCs remain the leading cause of adolescent death, fatalities that are largely preventable.1 Although several factors contribute to adolescent MVCs, an increase in cell phone use while driving has been posited as a factor in the unexpected increase in adolescent MVC rates from 2013 to 2016.2 Previous studies have demonstrated an association between laws banning texting while driving and lower rates of fatal crashes3 and more recently nonfatal injury crashes in the overall population.4 However, as new state laws have been introduced, the relative effectiveness of different levels of implementation for adolescent drivers are not well characterized, including primary enforcement (ie, a police officer can stop the vehicle and cite the driver for texting while driving), secondary enforcement (ie, the driver can only be cited for texting while driving if another primary violation is observed), banning texting for all drivers, banning all handheld cell phone use for all drivers, and banning all novice driver cellphone use (both handheld and hands-free use).
In their article “Distracted Driving Laws and Motor Vehicle Crash Fatalities,” Flaherty et al5 address this knowledge gap through an analysis of 2007–2017 data from the US Fatality Analysis Reporting System. They found that states with primarily enforced texting bans had fewer fatal MVCs involving 16- to 19-year-old drivers. In addition, all-driver handheld device use bans were also associated with reduced fatal MVCs involving 16- to 19-year-old drivers. Their findings indicate that reducing adolescent MVC fatalities is not just about targeting laws to the adolescent drivers who are at elevated crash risk but also the other drivers who share the road with them.
Although state laws are important, they are not enough to address total risk reduction and behavior modification related to distracted driving in adolescent drivers. Cell phones have become ubiquitous in the lives of adolescents, acting as a mainstay of communication and connectedness and regularly used for navigation and music streaming.6,7 They have replaced features that were otherwise in the vehicle that provided information or audio entertainment. However, cell phones are not the equivalent to the radio or a map and include the added layers of social interaction, notifications, and entertainment information consumption.8 The intersection of impulsivity and perceived need to respond make cell phones a particularly dangerous entity for adolescents whose crash risk is already high because of inexperience.9,10
The risks of texting while driving are well known, yet nearly half of high school students do it anyway.11 Behavioral science suggests several strategies for breaking this risky habit.12–14 “Do not disturb while driving” settings can silence notifications and messages and send automatic replies yet still permit hands-free use of navigation and music applications. This feature can easily be set to come on automatically when driving, reducing temptation by disrupting impulsive cues. This automatic activation feature could be the factory default setting to increase adoption. In-vehicle technologies seek to make it easier to keep one’s hands off the phone and eyes on the road, such as dashboard systems that allow users to plug in the phone and provide a hands-free interface for managing music, navigation, calls, and messages. Motivation to reduce cell phone use while driving can be facilitated with applications that passively track phone use while driving, with opportunities for parents to be engaged and provide feedback on their adolescent’s risky driving.15 Applications that track driving behavior are being used by auto insurance companies to offer customers personalized rates. A survey of adolescent drivers found that providing financial incentives for reducing phone use while driving is a highly promising strategy for reducing this behavior.16
Parents also have an opportunity to model attentive driving for their adolescent. A parent who abstains from cell phone use while with their rear-seat, forward-facing child not only reduces MVC risk in the moment but sets a norm and expectation for safe driving behaviors for their later adolescent driver.17 Likewise, the all-driver handheld ban may be providing risk reduction now for adolescent drivers as well as long-term effects on the future generation of adolescent drivers who grow up with those environmental safety norms.
The basic concepts related to eyes on the road, hands on the wheel, and mind on the task of driving are fundamental to driver safety. There is no one cause to pinpoint for adolescent MVCs because there are multiple contributing factors, including inexperience, maturational development, and risk-taking. Likewise, there is no one effective measure that will eliminate adolescent fatal MVCs. In 2020, Montana is the only state without any laws for cell phone use or texting while driving, and in Missouri, it remains legal if the driver is older than 21. Currently, 29 states still could implement laws prohibiting all-driver handheld cell phone use.18,19 States can refine existing laws or implement new laws to help reduce MVC fatalities associated with adolescent drivers. In the meantime, other technological and behavioral approaches may be needed to encourage adolescent drivers to act in their own and society’s best interests and comply with the law.
Opinions expressed in these commentaries are those of the authors and not necessarily those of the American Academy of Pediatrics or its Committees.
COMPANION PAPER: A companion to this article can be found online at www.pediatrics.org/cgi/doi/10.1542/peds.2019-3621.
FUNDING: Funded by the National Institute of Child Health and Human Development (award number K23HD090272001, to M.K.D.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Funded by the National Institutes of Health (NIH).
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.