Video Abstract

Video Abstract

BACKGROUND:

Motor vehicle crashes (MVCs) continue to be the leading cause of death in youth 16 to 24 years old in the United States. Distracted driving has been shown to increase the risk of MVCs in all drivers, particularly teenagers. We aimed to determine the association between fatal MVC rates involving 16- to 19-year-old drivers and state distracted driving laws.

METHODS:

We conducted a retrospective time series analysis of fatal MVCs in the United States involving drivers and passengers 16 to 19 years old from 2007 to 2017 using the Fatality Analysis Reporting System. Multivariable negative binomial regression analysis was performed to compare MVC rates across states on the basis of different types and strengths of distracted driving laws.

RESULTS:

There were 38 215 drivers 16 to 19 years old involved in fatal MVCs from 2007 to 2017. Incidence of fatal MVCs was highest for 19-year-old drivers (27.2 out of 100 000 19-year-old persons) and lowest for 16-year-olds (10.7 out of 100 000). States with primarily enforced texting bans had lower MVC fatality rates overall involving 16- to 19-year-old drivers (adjusted incidence rate ratio: 0.71; 95% confidence interval: 0.67–0.76). Texting bans and handheld bans for all drivers were associated with decreased MVC fatalities in all age groups.

CONCLUSIONS:

In the United States, primarily enforced distracted driving laws are associated with a lower incidence of fatal MVCs involving 16- to 19-year-old drivers. Bans on all handheld device use and texting bans for all drivers are associated with the greatest decrease in fatal MVCs. Adoption of universal handheld cellphone bans in all states may reduce the incidence of distracted driving and decrease MVC fatalities.

What’s Known on This Subject:

Motor vehicle crashes are the leading cause of death in adolescents, and distracted driving significantly increases crash risk. States have enacted many different distracted driving laws, but little is known on their effects in teenage drivers.

What This Study Adds:

Primarily enforced distracted driving laws involving texting bans applicable to all drivers are associated with decreased incidence of fatal motor vehicle crashes involving teenage drivers.

Motor vehicle crashes (MVCs) continue to be the leading cause of death in adolescents 12 to 19 years old in the United States.1  In 2016, nearly 4000 children and adolescents 0 to 18 years old were killed in MVCs, accounting for 20% of all US pediatric deaths.2  Although widespread public health efforts have led to a remarkable decline in motor vehicle fatalities over the past 2 decades, recent data show mortality rates increasing annually between 2013 and 2016 in children and adolescents.2,3  This increase has been postulated to be secondary to the rising use of technology and mobile devices contributing to distracted driving.3 

Higher crash rates among teenagers have been attributed to many factors, including inexperience, risk-taking, and driver distraction.4  To address increased risk among the youngest drivers, all 50 states have implemented graduated driver licensing (GDL) laws. GDL in the United States allows full, unrestricted licensure for drivers <18 years old only after a predetermined “learner period” with supervised driving. The learner period is followed by an intermediate stage, typically including both nighttime driving and passenger restrictions.5,6  These laws have been associated with decreased MVC fatalities in younger drivers, but the degree of effectiveness varies on the basis of different state-level provisions.5,7,8 

The majority of states also have implemented multiple laws to improve motor vehicle safety among teenagers and the general population, including primary seatbelt laws, penalties for impaired driving, and reduced highway speed limits.9  These laws have been shown to be effective in decreasing motor vehicle fatalities in nearly all drivers.912  More-recent legislative efforts have focused on restrictions on the use of cellphones with the goal of decreasing driver distraction, including text messaging bans, handheld cellphone bans, and novice driver all-cellphone-use bans. Distractions while driving can come in several forms, including texting on a mobile device, talking on a cellphone, and other tasks requiring drivers to look away from the road and at the device.13 Naturalistic studies, including those using simulated driving conditions, have demonstrated texting can lead to decreased reaction time, less control of vehicle stability, and elevated injury risk to both vehicle occupants and pedestrians.14  Distracted driving has been shown in multiple studies to increase the risk of a crash in all drivers, particularly teenagers, leading to increased morbidity and mortality.4,1517  This risk is present even when not physically looking away from the road because cognitive distraction from conversing on a phone can also increase crash risk.18  Most concerning is that nearly half of all US high school teenagers older than 16 years reported texting while driving in the past 30 days.19 

In previous studies, researchers have investigated the effects of various laws on MVC injuries and fatalities.15,16,20  Regarding distracted driving, in one study, investigators found a lower risk of fatal MVCs from 2000 to 2010 in all drivers in states with primary texting bans.21  What is less understood are the effects of distracted driving laws in novice drivers (16–19 years old), especially in recent years when cellphone use has increased substantially.22  The objective of our study is to examine the association of distracted driving laws on fatal MVCs involving teenage drivers 16 to 19 years old as well as on fatalities in 16- to 19-year-old passengers while controlling for other state-level laws and economic factors.

This is a retrospective, time series analysis of MVC fatalities in novice teenage drivers 16 to 19 years old. The study was deemed exempt from review from our institutional review board.

We obtained counts of all motor vehicle fatalities involving drivers and occupants 16 to 19 years old from passenger cars, light pickup trucks, vans, and sport utility vehicles from the Fatality Analysis Reporting System. The Fatality Analysis Reporting System contains data collected by the National Highway Traffic Safety Administration on all MVCs on public roadways in the United States resulting in a death within 30 days of the crash.23  This database contains detailed crash-related information on the vehicles, drivers, occupants, and circumstances. Counts of fatal crashes involving 40- to 55-year-old drivers were also obtained as a comparison group for the analyses. We used US Census Bureau data for the state mid-year age-specific population estimates to calculate population-based rates of fatal MVCs for each year per age group.24 

We collected data on individual state motor vehicle laws from the Governor’s Highway Safety Association, Insurance Institute for Highway Safety, and previous studies in which researchers documented dates of legislative enactment (Table 1).2527  Laws were considered active only if they were in effect for the entire year of the study. Distracted driving laws were categorized by 3 primary types as defined by the Governor’s Highway Safety Association: (1) Texting laws explicitly banning text messaging while driving. These laws were further coded as being primarily enforced (law enforcement able to pull over and issue citation for text messaging alone) or secondarily enforced (law enforcement can only cite drivers who are pulled over for another offense). (2) Handheld cellphone bans in which all handheld mobile electronic devices are prohibited from use while driving for drivers of all ages, but hands-free device use is allowed. Although law language is highly variable by state, we assumed these laws to include prohibition of texting as it would require use of the handheld device. (3) All-cellphone-use bans that prohibit the use of all hands-free and handheld devices only for novice drivers. Novice drivers were defined differently across all states, with the least restrictive applying only to drivers in their first year of licensure and the most restrictive applying to all drivers <21 years old. As of the end date of our study, no states banned all cellphone use for all drivers (handheld and hands-free) (Table 1, Fig 1). Arizona and Missouri have laws banning only text messaging while driving in only novice drivers; Therefore, they were coded as not having a primary or secondary texting ban and as having no handheld cellphone ban, as defined by our study.

TABLE 1

State Distracted Driving Laws, United States, 2007–2017

Type of LawNo. (%) (n = 550)n = 50
State-YearsUnique States
Texting ban, primary enforcement 261 (47.4) 40 
Texting ban, secondary enforcement 43 (7.8) 11 
Handheld cellphone ban, all drivers 89 (16.2) 12 
All-cellphone-use ban, novice drivers only 276 (50.2) 34 
Type of LawNo. (%) (n = 550)n = 50
State-YearsUnique States
Texting ban, primary enforcement 261 (47.4) 40 
Texting ban, secondary enforcement 43 (7.8) 11 
Handheld cellphone ban, all drivers 89 (16.2) 12 
All-cellphone-use ban, novice drivers only 276 (50.2) 34 

Each state contributed 1 observation per year of the study for a total of 550 state-years.

FIGURE 1

Changes in adoption of distracted driving laws in the United States, 2007–2017.

FIGURE 1

Changes in adoption of distracted driving laws in the United States, 2007–2017.

We calculated unadjusted MVC fatality rates for crashes involving the combined 16- to 19-year-old age group of drivers as well as for each individual year of age (16, 17, 18, 19 years old). Additionally, we calculated MVC fatality rates for a comparison group of adult drivers 40 to 55 years old to compare the teenage group to a more-experienced driving population who may be less susceptible to distracted driving by cellphones.16  Next, we developed 4 age-specific regression models to estimate fatal MVC incident rate ratios (IRRs) with 95% confidence intervals (CIs) for crashes involving the 16-, 17-, 18-, and 19-year-old drivers. We compared these age-specific IRRs under each type of distracted driving law (Table 2) with states not having the specified law, accounting for the specific year(s) a law may or may not have been enacted. Additionally, we conducted the same analyses for the combined 16- to 19-year-old and 40- to 55-year-old driver age groups. We developed a separate multivariate model for crashes resulting in the fatality of a 16- to 19-year-old passenger.

TABLE 2

Distracted Driving Laws and MVC Fatalities Involving Drivers 16 to 19 Years Old, United States, 2007–2017

Law TypeNo. Fatal Crashes Involving DriversPopulationaUnadjusted Mean Fatal Crash Rate Per 100 000 PersonsIRR UnadjustedIRR AdjustedbIRR Adjusted 95% CI
16- to 19-y-old drivers (combined) 38 215 190 044 692 20.1 — — — 
 No texting law 21 480 87 756 898 24.5 Reference Reference — 
 Texting ban (primary enforcement) 13 952 87 785 549 15.9 0.65 0.71 0.67–0.76 
 Texting ban (secondary enforcement) 2783 14 502 245 19.2 0.77 0.85 0.77–0.95 
 No handheld cellphone ban (all drivers) 33 905 154 304 510 22.0 Reference Reference — 
 Handheld cellphone ban (all drivers) 4310 35 740 182 12.1 0.54 0.74 0.68–0.80 
 No all-cellphone-use ban (novice drivers) 21 088 95 690 748 22.0 Reference Reference — 
 All-cellphone-use ban (novice drivers) 17 127 94 353 944 18.1 0.76 0.97 0.91–1.02 
16-y-old drivers 5020 46 898 766 10.7 — — — 
 No texting law 2922 21 654 162 13.5 Reference — — 
 Texting ban (primary  enforcement) 1753 21 687 274 8.1 0.58 0.64 0.57–0.71 
 Texting ban (secondary enforcement) 345 3 557 330 9.7 0.78 0.74 0.61–0.90 
 No handheld cellphone ban (all drivers) 4556 38 022 183 12.0 Reference — — 
 Handheld cellphone ban (all drivers) 464 8 876 583 5.2 0.37 0.57 0.49–0.67 
 No all-cellphone-use ban (novice drivers) 2756 23 446 724 11.7 Reference — — 
 All-cellphone-use ban (novice drivers) 2264 23 452 042 9.6 0.76 1.11 1.00-1.23 
17-y-old drivers 8193 47 390 420 17.3 — — — 
 No texting law 4684 21 900 808 21.4 — — — 
 Texting ban (primary enforcement) 2919 21 892 506 13.3 0.62 0.67 0.61–0.72 
 Texting ban (secondary enforcement) 590 3 597 106 16.4 0.74 0.82 0.71–0.94 
 No handheld cellphone ban (all drivers) 7225 38 386 404 18.8 — — — 
 Handheld cellphone ban (all drivers) 968 9 004 016 10.7 0.51 0.67 0.60–0.75 
 No all-cellphone-use ban (novice drivers) 4615 23 735 570 19.4 — — — 
 All-cellphone-use ban (novice drivers) 3578 23 654 850 15.1 0.75 0.95 0.88–1.03 
18-y-old drivers 11 966 47 734 958 25.1 — — — 
 No texting law 6714 22 004 280 30.5 — — — 
 Texting ban (primary enforcement) 4359 22 105 162 19.7 0.65 0.71 0.66–0.75 
 Texting ban (secondary enforcement) 893 3 625 516 24.6 0.77 0.90 0.80–1.01 
 No handheld cellphone ban (all drivers) 10 589 38 715 599 27.3 — — — 
 Handheld cellphone ban (all drivers) 1377 9 019 359 15.3 0.55 0.73 0.67–0.81 
 No all-cellphone-use ban (novice drivers) 6669 24 122 770 27.6 — — — 
 All-cellphone-use ban (novice drivers) 5297 23 612 188 22.4 0.75 0.95 0.89–1.02 
19-y-old drivers 13 036 47 832 646 27.2 — — — 
 No texting law 7160 22 010 891 32.5 — — — 
 Texting ban (primary enforcement) 4921 22 099 462 22.3 0.70 0.74 0.69–0.79 
 Texting ban (secondary enforcement) 955 3 722 293 25.7 0.75 0.87 0.76–0.98 
 No handheld cellphone ban (all drivers) 11 535 39 007 368 29.6 — — — 
 Handheld cellphone ban (all drivers) 1501 8 825 278 17.0 0.61 0.78 0.71–0.86 
 No all-cellphone-use ban (novice drivers) 7048 24 241 172 29.1 — — — 
 All-cellphone-use ban (novice drivers) 5988 23 591 474 25.4 0.81 0.99 0.92–1.06 
40- to 55-y-old drivers 137 615 755 710 947 18.2 — — — 
 No texting law 70 332 341 437 976 20.6 — — — 
 Texting ban (primary enforcement) 56 519 354 592 378 15.9 0.79 0.88 0.83–0.93 
 Texting ban (secondary enforcement) 10 764 59 680 593 18.0 0.92 0.96 0.86–1.07 
 No handheld cellphone ban (all drivers) 120 414 605 898 776 19.9 — — — 
 Handheld cellphone ban (all drivers) 17 201 149 812 171 11.5 0.61 0.76 0.71–0.82 
 No all-cellphone-use ban (novice drivers) 72 974 380 933 627 19.2 — — — 
 All-cellphone-use ban (novice drivers) 64 641 374 777 320 17.2 0.85 0.97 0.91–1.02 
Law TypeNo. Fatal Crashes Involving DriversPopulationaUnadjusted Mean Fatal Crash Rate Per 100 000 PersonsIRR UnadjustedIRR AdjustedbIRR Adjusted 95% CI
16- to 19-y-old drivers (combined) 38 215 190 044 692 20.1 — — — 
 No texting law 21 480 87 756 898 24.5 Reference Reference — 
 Texting ban (primary enforcement) 13 952 87 785 549 15.9 0.65 0.71 0.67–0.76 
 Texting ban (secondary enforcement) 2783 14 502 245 19.2 0.77 0.85 0.77–0.95 
 No handheld cellphone ban (all drivers) 33 905 154 304 510 22.0 Reference Reference — 
 Handheld cellphone ban (all drivers) 4310 35 740 182 12.1 0.54 0.74 0.68–0.80 
 No all-cellphone-use ban (novice drivers) 21 088 95 690 748 22.0 Reference Reference — 
 All-cellphone-use ban (novice drivers) 17 127 94 353 944 18.1 0.76 0.97 0.91–1.02 
16-y-old drivers 5020 46 898 766 10.7 — — — 
 No texting law 2922 21 654 162 13.5 Reference — — 
 Texting ban (primary  enforcement) 1753 21 687 274 8.1 0.58 0.64 0.57–0.71 
 Texting ban (secondary enforcement) 345 3 557 330 9.7 0.78 0.74 0.61–0.90 
 No handheld cellphone ban (all drivers) 4556 38 022 183 12.0 Reference — — 
 Handheld cellphone ban (all drivers) 464 8 876 583 5.2 0.37 0.57 0.49–0.67 
 No all-cellphone-use ban (novice drivers) 2756 23 446 724 11.7 Reference — — 
 All-cellphone-use ban (novice drivers) 2264 23 452 042 9.6 0.76 1.11 1.00-1.23 
17-y-old drivers 8193 47 390 420 17.3 — — — 
 No texting law 4684 21 900 808 21.4 — — — 
 Texting ban (primary enforcement) 2919 21 892 506 13.3 0.62 0.67 0.61–0.72 
 Texting ban (secondary enforcement) 590 3 597 106 16.4 0.74 0.82 0.71–0.94 
 No handheld cellphone ban (all drivers) 7225 38 386 404 18.8 — — — 
 Handheld cellphone ban (all drivers) 968 9 004 016 10.7 0.51 0.67 0.60–0.75 
 No all-cellphone-use ban (novice drivers) 4615 23 735 570 19.4 — — — 
 All-cellphone-use ban (novice drivers) 3578 23 654 850 15.1 0.75 0.95 0.88–1.03 
18-y-old drivers 11 966 47 734 958 25.1 — — — 
 No texting law 6714 22 004 280 30.5 — — — 
 Texting ban (primary enforcement) 4359 22 105 162 19.7 0.65 0.71 0.66–0.75 
 Texting ban (secondary enforcement) 893 3 625 516 24.6 0.77 0.90 0.80–1.01 
 No handheld cellphone ban (all drivers) 10 589 38 715 599 27.3 — — — 
 Handheld cellphone ban (all drivers) 1377 9 019 359 15.3 0.55 0.73 0.67–0.81 
 No all-cellphone-use ban (novice drivers) 6669 24 122 770 27.6 — — — 
 All-cellphone-use ban (novice drivers) 5297 23 612 188 22.4 0.75 0.95 0.89–1.02 
19-y-old drivers 13 036 47 832 646 27.2 — — — 
 No texting law 7160 22 010 891 32.5 — — — 
 Texting ban (primary enforcement) 4921 22 099 462 22.3 0.70 0.74 0.69–0.79 
 Texting ban (secondary enforcement) 955 3 722 293 25.7 0.75 0.87 0.76–0.98 
 No handheld cellphone ban (all drivers) 11 535 39 007 368 29.6 — — — 
 Handheld cellphone ban (all drivers) 1501 8 825 278 17.0 0.61 0.78 0.71–0.86 
 No all-cellphone-use ban (novice drivers) 7048 24 241 172 29.1 — — — 
 All-cellphone-use ban (novice drivers) 5988 23 591 474 25.4 0.81 0.99 0.92–1.06 
40- to 55-y-old drivers 137 615 755 710 947 18.2 — — — 
 No texting law 70 332 341 437 976 20.6 — — — 
 Texting ban (primary enforcement) 56 519 354 592 378 15.9 0.79 0.88 0.83–0.93 
 Texting ban (secondary enforcement) 10 764 59 680 593 18.0 0.92 0.96 0.86–1.07 
 No handheld cellphone ban (all drivers) 120 414 605 898 776 19.9 — — — 
 Handheld cellphone ban (all drivers) 17 201 149 812 171 11.5 0.61 0.76 0.71–0.82 
 No all-cellphone-use ban (novice drivers) 72 974 380 933 627 19.2 — — — 
 All-cellphone-use ban (novice drivers) 64 641 374 777 320 17.2 0.85 0.97 0.91–1.02 

—, not applicable.

a

Population includes the sum of all state age-based population for that group for all years in which a law was or was not coded for.

b

Multivariate binomial regression model included the following: texting law type (none, primary, secondary), handheld cellphone ban, all-cellphone-use ban for novice drivers,21  GDL law type (weak, moderate, strong),20  rural interstate highway speed limit law (≤65 or >65 miles per hour), primary enforcement seatbelt laws, immediate ALR law, annual unemployment rate, and annual motor fuel usage.2427 .

The natural logarithm of age-specific state population was used as an offset term in the models. Our data showed overdispersion and a conditional variance higher than the conditional mean, and thus we used a negative binomial regression model. In the adjusted regression models to control for possible confounding from differences in other state-level factors, we included other motor vehicle traffic safety laws.9,11,28  These indicator variables based on previous literature included the following: annual changes made to the following motor vehicle safety–related laws, rural interstate speed limits (≤65 or >65 miles per hour), primary enforcement seatbelt laws, immediate administrative license revocation (ALR) for driving with a blood alcohol concentration that exceeds the legal limit, and GDL laws.29  The GDL laws were labeled as “weak,” “moderate,” or “strong” on the basis of categorization by the Insurance Institute for Highway Safety.25  To account for possible differences in macroeconomic factors and crude changes in driving patterns among states, we also included in the multivariate model annual unemployment rates (linear annual unemployment rate for each state) and annual motor fuel usage (a linear term to adjust for annual state-specific highway motor fuel use).30,31  We used a pooled longitudinal analysis whereby each state contributed 1 observation per year for a total of 550 observations.7  Because all covariates were measured annually, they also varied within states over time. A P ≤ .05 was considered statistically significant. All analyses were conducted by using SAS version 9.2 (SAS Institute, Inc, Cary, NC).

Between 2007 and 2017, there were 38 215 fatal MVCs involving 16- to 19-year-old drivers, for an overall fatal MVC rate of 20.1 out of 100 000. The mean fatal MVC rate for the comparison adult drivers was 18.2 out of 100 000 40- to 55-year-old persons between 2007 and 2017. Over the study period, the rate of MVCs involving 16- to 19-year-old drivers combined decreased from 29.5 out of 100 000 persons in 2007 to 18.7 out of 100 000 persons in 2017. For 40- to 55-year-old drivers, the rate of fatal MVCs decreased from 21.2 out of 100 000 persons in 2007 to 19.3 out of 100 000 persons in 2017. In 2007, only 15 states had any form of distracted driving law (1 primary enforcement texting ban, 10 all-cellphone-use bans for novice drivers, and 4 handheld cellphone bans for all drivers) (Fig 1). By 2017, 40 states had primary enforcement texting bans, 6 states had secondary enforcement texting bans, 34 states banned all cellphone use for novice drivers, and 12 banned handheld cellphones for all drivers (Table 1, Fig 1).

Fatal crashes involving teenage drivers increased with each year of age, from a low of 10.7 out of 100 000 persons 16 years old to a high of 27.2 out of 100 000 persons 19 years old (Table 2). When comparing by type of distracted driving law, the unadjusted MVC fatality rate for 16- to 19-year-olds combined was lowest in states with primarily enforced texting bans at 15.9 out of 100 000 persons. It was higher in states with secondarily enforced texting bans at 19.2 out of 100 000 persons and the highest in states with no texting bans at 24.5 out of 100 000 persons (Table 2).

In age-specific, adjusted models when compared with states with no texting law, states with primarily enforced texting bans were associated with decreased incidence rates of fatal MVCs involving drivers of all age groups, with 16-year-old teenagers demonstrating the lowest rates (adjusted incidence rate ratio [aIRR]: 0.64; 95% CI: 0.57–0.71) (Table 2). This association was also observed in adults 40 to 55 years old but to a lesser degree (aIRR: 0.88; 95% CI: 0.83–0.93). Secondarily enforced texting laws were also associated with lower fatal crash rates involving 16-, 17-, and 19-year-old drivers when compared with states with no texting bans, with no association seen in 18-year-olds or the combined 40- to 55-year-old driver age groups.

Similar to the texting ban laws, states with handheld device ban laws for all drivers compared with states with no handheld device ban laws were associated with lower MVC fatality rates in all combined and age-specific models. As with the texting ban laws, the 16-year-old age group demonstrated the greatest reduction (aIRR: 0.57; 95% CI: 0.49–0.67). Of note, novice driver all-cellphone-use bans (n = 276 state-years, Table 1) showed no association with fatal crashes in any age group.

Among teenage passengers 16 to 19 years old, there were 10 300 MVC fatalities in the United States between 2007 and 2017. Primarily enforced texting laws were associated with a 38% reduction in passenger fatalities in teenagers 16 to 19 years old (aIRR: 0.62; 95% CI: 0.57–0.67). Secondarily enforced texting laws were associated with a 27% reduction in teenage passenger fatalities (aIRR: 0.73; 95% CI: 0.64–0.83), and handheld cellphone bans in all drivers were associated with a 25% reduction (IRR: 0.75; 95% CI: 0.67–0.84) (Table 3). There was no association between novice driver all-cellphone-use bans and passenger fatalities in this age group.

TABLE 3

Distracted Driving Laws and MVC Fatalities Involving Passengers 16 to 19 Years Old, United States, 2007–2017

Law TypeNo. FatalitiesIRR AdjustedaIRR Adjusted 95% CI
16- to 19-y-old passengers (combined) 10 300 — — 
 No texting law 6057 Reference — 
 Texting ban (primary enforcement) 3586 0.62 0.57–0.67 
 Texting ban (secondary enforcement) 657 0.73 0.64–0.83 
 No handheld cellphone ban (all drivers) 9132 Reference — 
 Handheld cellphone ban (all drivers) 1168 0.75 0.67–0.84 
 No all-cellphone-use ban (novice drivers) 5736 Reference — 
 All-cellphone-use ban (novice drivers) 4564 1.01 0.93–1.08 
Law TypeNo. FatalitiesIRR AdjustedaIRR Adjusted 95% CI
16- to 19-y-old passengers (combined) 10 300 — — 
 No texting law 6057 Reference — 
 Texting ban (primary enforcement) 3586 0.62 0.57–0.67 
 Texting ban (secondary enforcement) 657 0.73 0.64–0.83 
 No handheld cellphone ban (all drivers) 9132 Reference — 
 Handheld cellphone ban (all drivers) 1168 0.75 0.67–0.84 
 No all-cellphone-use ban (novice drivers) 5736 Reference — 
 All-cellphone-use ban (novice drivers) 4564 1.01 0.93–1.08 

—, not applicable.

a

Multivariate binomial regression model included the following: texting law type (none, primary, secondary), handheld cellphone ban, all-cellphone-use ban for novice drivers,21  GDL law type (weak, moderate, strong),20  rural interstate highway speed limit law (≤65 or >65 miles per hour), primary enforcement seatbelt laws, immediate ALR law, annual unemployment rate, and annual motor fuel usage2427 .

In our study, it is suggested that implementation of distracted driving laws over the past 11 years has been associated with a lower rate of fatal MVCs involving teenage drivers in the United States as well as lower teenage passenger fatalities. Over the study period, the number of states with any type of distracted driving law increased from 15 in 2007 to 47 in 2017 (Fig 1). During this time, rates of fatal MVCs involving 16- to 19-year-old drivers decreased by nearly one-third. Among crashes involving the combined group of 16- to 19-year-old drivers, primary enforcement texting laws were associated with a 29% lower adjusted incidence rate of fatalities. Secondary enforcement texting laws and handheld bans for all drivers were associated with a 20% lower adjusted MVC fatality rate. For specific age groups, all distracted driving laws were associated with a lower incidence of fatal crashes, except for novice driver all-cellphone bans.

Our findings are consistent with previous studies in which researchers examined the effects of texting and handheld cellphone ban legislation on fatal MVCs in adults. Self-reported cellphone use in adolescents has been found to be lower after handheld device bans32  as well as in adults.3335  In many of these studies, however, researchers did not examine if decreased cellphone use was due to an increased use in using cellphones as texting devices rather than as handheld phones. An early national study of the impact of texting bans found those applying to all drivers were associated with decreases in single-vehicle, single-occupant car crashes.36  Another study demonstrated primary enforcement texting laws were associated with greater reductions in MVC fatalities than secondary enforcement laws, particularly in younger drivers ages 15 to 21. This study also concluded handheld bans were most effective in drivers 22 to 64.21  Our study is the first to analyze each teenage driving age group separately and found a stronger association with handheld cellphone bans in 16- and 17-year-olds compared with other driver ages, although all age groups saw a reduction in association with universal handheld cellphone bans. Each of these different laws has inherent challenges in enforcement. Texting bans are particularly difficult to enforce because law enforcement are often unable to ascertain whether a driver was texting or using a phone for other purposes (eg, for directions).37,38  Nevertheless, the very presence of such laws may independently deter teenage drivers from the behavior.

In other studies, researchers have found less-promising results from distracted driving laws. A North Carolina study examining the effect of a cellphone restriction on teenagers found no effect on rates of cellphone use 5 months and 2 years after implementation.39,40  Interestingly, there was a 24% decrease in the likelihood drivers were observed holding a phone to their ear but a 39% increase in the likelihood drivers were observed physically manipulating a phone.40  As texting has increased in popularity, more states have responded by implementing universal texting bans. This is supported in our study by the finding that 30 out of 50 states implemented primary enforcement texting laws in 2010 or afterward. In addition to laws, automobile manufacturers, the technology industry, and insurers also have contributed to applications and incentives, which makes it more difficult and less desirable to use a mobile device while driving.41  Our results provide the most recent and robust data on the longer-term effect of more recently implemented texting laws and their effects on fatal crashes involving teenage drivers and passengers.

Among other distracted driving law analyses, little data exist on the outcome of teenage passenger fatalities in states with varying distracted driving laws. It has been well documented that the presence of passengers can have an effect on driver crash risk, prompting passenger restrictions to be a part of most GDL laws.42  However, it is unknown whether specific distracted driving laws affecting drivers reduce the risk of death in passengers. The largest mortality benefit among passengers in our study was seen in 18- and 19-year-olds in states with primarily enforced texting laws. There was overall a lower incidence of fatal injuries in passengers of all age groups in states with texting laws and universal handheld device bans. These results have important implications for future legislation and the aim of reducing overall MVC-related fatalities in the United States.

As with other traffic law analyses, our study has limitations. We only included MVC fatalities, and not nonfatal MVCs or injuries, because no state-specific database exists with complete nonfatal crash data. Fatal crashes represent the most severe end of the spectrum and are likely to underestimate the effects of traffic safety laws on overall crash risk. No publicly accessible national database of licensed drivers in each state is available. Crash rates differ substantially on the basis of different age combinations and denominators, and we were unable to account for driver experience among these novice drivers.4  Population as a denominator allows for changes in overall exposure and has been used in other analyses of novice drivers.7  We were unable to assess enforcement of the distracted driving laws or diversion of resources away from other public safety issues as a result of their enactment. As an ecologic study, conclusions about causality cannot be definitively made, but associations can be reported. Although our models were adjusted for additional changes in socioeconomic measures and other driving policies, the findings could be explained by additional factors that were not measured, such as changes in teenage alcohol consumption, numbers of teenage drivers, and technological improvements in automobile safety.

In the United States, primarily enforced distracted driving laws are associated with lower fatality rates in crashes involving 16- to 19-year-old drivers and in teenage passengers. Handheld cellphone bans were effective in all age groups, with the greatest decrease in fatality rates observed in MVCs involving 16-year-old drivers. Novice driver all-cellphone-use bans were not associated with any decreases in fatal MVCs involving 16- to 19-year-old drivers. As rates of MVC fatalities are rising in teenagers, advocating for and implementing effective primary legislation banning handheld cellphone use for all ages will be an important part of reversing this trend. Additionally, practitioners caring for adolescents should continue to counsel on the dangers of driving while distracted to aid in awareness of this important cause for injury and death.

Dr Flaherty conceptualized and designed the study, coordinated data collection and acquisition of data, analyzed and interpreted data, and drafted the initial manuscript; Mr Kim coordinated data collection and acquisition of data and reviewed and revised the manuscript; Dr Salt analyzed and interpreted the data and reviewed and revised the manuscript; Dr Lee conceptualized and designed the study, coordinated data collection and acquisition of data, and drafted the initial manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

FUNDING: No external funding.

COMPANION PAPER: A companion to this article can be found online at www.pediatrics.org/cgi/doi/10.1542/peds.2020-0419

     
  • aIRR

    adjusted incidence rate ratio

  •  
  • ALR

    administrative license revocation

  •  
  • CI

    confidence interval

  •  
  • GDL

    graduated driver licensing

  •  
  • IRR

    incident rate ratio

  •  
  • MVC

    motor vehicle crash

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Competing Interests

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.