“Self-harm is a significant issue for young people in Australia. We now know that this also impacts considerably on young driver safety, as we found that those drivers who engaged in self-harm were at a 40% increased risk of a crash”, said author Dr Alexandra Martiniuk, The George Institute.

Self harm is the deliberate injuring of oneself and includes cutting, attempted hanging and poisoning. Internationally, research shows that up to 17% of people aged 14 and 25 years self-harm, although there is known to be significant under-reporting of self-harm behaviours.

The study reports that self-harm was more common among those study participants who were female, Australian-born, lived in rural or regional areas, spent more time driving per week, slept fewer hours compared to other drivers and those who reported high levels of drug and alcohol use.

According to Dr Martiniuk, “A particularly worrying trend shown in our findings is that most of the self-harm related crashes involved multiple vehicles. This amplifies the danger from these crashes, as it is not only the safety of young drivers who engage in self-harm at an increased risk, but the safety of all road users”, she added.

The results of this study highlight an important need for programs managing road behaviour in young people with poor mental health. Further research on this topic will be essential.  In the interim, the authors of this study (including psychiatrists and youth psychologists) believe the first step is raising awareness of the increased risk of crash for this sub-group by informing general practitioners, teachers, parents and youth groups, so that they can help identify self-harming behaviour and help young people seek appropriate treatment for this behaviour.

These results are part of a series of analyses from the DRIVE study, which is the largest study of young drivers ever undertaken and was funded by Australia’s National Health and Medical Research Council, NRMA Motoring and Services, and NRMA-ACT Road Safety trust and the Roads and Traffic Authority of NSW. The DRIVE study recruited over 20,822 young drivers holding red P-plates in NSW aged 17-24 years and prospectively examined their crashes reported to police for a two year period. The overall aim of the DRIVE study is to investigate the risk factors in motor vehicle-related crashes and injuries among young drivers and to find ways to improve the safety of young drivers and help make roads safer for all users.

This particular analysis investigated the risk that intentional self-harm poses for motor vehicle crashes among young drivers. Additional results due to be released from the DRIVE study during 2009/2010 include: rural and socioeconomic risk factors for young drivers, pre-licensing driving experience, training and education, poor mental health and subsequent crash risk, and sleep habits.

For further information, please contact:
Emma Orpilla – Public Relations Manager, The George Institute for International Health
Tel: +612 8238 2424/ Mobile: +61410 411 983
Fax: +612 9657 0301/ email: eorpilla@george.org.au
www.thegeorgeinstitute.org

The George Institute is a world renowned health and medical research institute, focused on the prevention and management of chronic disease and injury. The George conducts high-impact research across a broad health landscape and is a respected voice among global policy makers. The George has conducted major global applied research projects and innovative community-based programs from bases in Australia, China and India. In 2009, the Institute celebrates a decade of discovery, innovation and impact. www.thegeorgeinstitute.org

In Australia up to 4,700 young people are hospitalised per year following a crash.  There are 24,087 young people hospitalised per year following self harm.  But is there a link?
Young people are particularly at risk for mental health problems.  These problems may lead to self-harm and suicide.  Deliberate motor vehicle crashes may be caused by young drivers as a means of self-harm or suicide.  Other factors that are associated with self-harm also might increase the risk of crashing, e.g. alcohol, disturbed sleep, and poor impulse control.
To date, most studies have looked at young people who have died in crashes.  The mental health status of those drivers was determined after their deaths. However, a new Australian study has examined the mental health status of young drivers before they crash, and looked at associations between this and their risk of crashes not causing death.  In this study, newly licensed NSW drivers aged 17-24 were asked about their self-harm behaviour.  Of 20,822 surveyed, 871 (4%) of young drivers engaged in self-harm behaviours (such as cutting, burning, self-battering, poisoning and self-harm with lethal intent).  Self-harm was most commonly reported by:

• The youngest drivers (17 year olds)
• Females
• Those born in Australia
• Rural and regional drivers
• Those who had driven more
• Those reporting more risk taking behaviour
• Those with a history of drug or alcohol abuse
• Those with less hours of sleep per night.

This Australian study found that young drivers, who had previously reported self-harm behaviours, were at a 42% higher risk of crash than those who didn’t report the behaviours.  This increased risk remained (37% higher risk) even after accounting for other factors  such as age, sex, average driving hours per week, previous crashes, psychological distress, and amount of sleep.  Of the 871 young drivers who reported self-harm, 88 (10%) had at least one crash and 84% of those who had a crash were involved in multiple-vehicle incidents affecting other road users.
Reducing the risk of crash in young drivers is important.  The results of this study highlight a need for programs managing road behaviour in young people with poor mental health.  There is some evidence that programs designed to improve the general resilience of young people can also reduce the risk of road-related risky behaviours.  Further research on this topic will be essential.  In the interim, general practitioners, teachers, parents and youth groups need to identify self-harming behaviour so that they can help self-harmers seek appropriate treatment.

Factbase Recomendations

Young drivers who engage in self-harm are at increased risk of crash.  Effective interventions to address self-harm should be expanded to include potential vehicle-related risk.  These interventions should be assessed to determine if they decrease the risk of crash in this group of young drivers.

References

Australian Institute of Health and Welfare (AIHW). Young Australians: their health and well-being 2007. Available: http://www.aihw.gov.au/publications/index.cfm/title/10451  (accessed 11 Nov 2009).

Blows S, Ivers RQ, Connor J, Ameratunga S, Woodward M & Norton R. Marijuana use and car crash injury. Addiction 2005;100:605-11.

Connor J, Norton R, Ameratunga S & Jackson R.  The contribution of alcohol to serious car crash injuries. Epidemiology 2004;15:337-44.

Connor J, Norton R, Ameratunga S, Robinson E, Civil I, Dunn R, Bailey J & Jackson R. Driver sleepiness and risk of serious injury to car occupants: population based case control study. British Medical Journal, 2002;324:1125.

Dahl RE. Biological, developmental and neurobehavioral factors relevant to adolescent driving risks. American Journal of Preventive Medicince, 2008;35:S278-84.

Evans J, Platts H, Liebenau A.  Impulsiveness and deliberate self-harm: a comparison of “first timers” and “repeaters”. Acta Psychiatrica Scandinavica, 1996;93:378-80.

Griffin KW, Botvin GJ, Nichols TR.  Long-term follow-up effects of a school-based drug abuse prevention program on adolescent risky driving. Prevention Science 2004;5:207-12.

Herman H, Saxena S, Moodie R, editors. Promoting mental health: concepts, emerging evidence, practice. Report of the World Health Organization Department of Mental Health and Substance Abuse in collaboration with the Victorian Health Promotion Foundation and the University of Melbourne. 2005. Available: http://www.who.int/mental_health/evidence/en/ (accessed 2008 Nov 11).

Hilakivi I, Veilahti J, Asplund P, Sinivuo J, Laitinen L & Koskenvuo K.  A sixteen-factor personality test for predicting automobile driving accidents of young drivers. Accident Analysis and Prevention, 1989;21:413-8.

Ivers RQ, Blows SR, Stevenson MR, Norton RN, Williamson A, Eisenbruch M, Woodward M, Lam L, Palamara P & Wang J. A cohort study of 20 822 young drivers: the DRIVE study methods and population. Injury Prevention, 2006;12:385-9.

Martiniuk ALC, Ivers RQ, Glozier N, Patton GC, Lam LT, Boufous S, Senserrick T, Williamson A, Stevenson M & Norton R. Self-harm and risk of motor vehicle crashes in youth: the DRIVE prospective cohort study. Canadian Medical Association Journal( accepted 25 June 2009 in press).

Ohberg A, Penttila A, Lonnqvist J. Driver suicides. British Journal of Psychiatry 1997;171:468-72.
Skegg K. Self-harm. Lancet 2005;366:1471-83.

School-based driver education programs have a long and ill-famed history in Australia. They began to grow popular and spread widely in the United States in the 1930s and 1940s and soon began to feature in Australia, although typically not within the actual schools, but as courses that school-based learners and newly-licensed drivers could attend.

By the 1970s, driver education programs had grown in popularity when research in the United States cast doubt on their effectiveness. The landmark “DeKalb county study” at first seemed to show that students of the driver education program in DeKalb county schools went on to gain a licence and had fewer crashes than students who did not attend the program. However, an incentive or “bonus” for participating in the program was that graduates could get their licence six months earlier than non-participants. When this extra “exposure” time was taken into account, those participants actually had a higher risk of crash.

Some research was also done in Australia (Victoria) around the same time to see if there was any benefit of having programs at a specialist facility – which were costly to build and maintain. The results found no improvements over teaching students on-the-road in “real world” traffic. This led to a withdrawal of Government funding and support for the facilities.

Despite these findings, driver education programs have remained popular in Australia and are often sought out by young people and their parents. Almost every decade since those early studies, reviews have been conducted to see if the situation has changed, but there has still been limited support to suggest driver education has any impact on crashes. Unfortunately, the lack of clearly findings is mostly due to a lack of good quality research, so it is still unclear whether any recent advances have improved outcomes.

Support for driver education

Many road safety practitioners question why driver education is expected to reduce crashes. Behaviour change is what is really needed – not just increased awareness, knowledge and understanding, which tends to be the focus of driver education. Sometimes just knowing the risks is not enough to prevent the risk behaviour – think about smoking and binge drinking.

This does not mean that driver education is unimportant, however. Driver education works well in teaching learners about road rules, how to manage their car in traffic and how to pass the driving tests for licensure – which most learners do on the first attempt.

Further, many new programs have tried to take on board the criticisms and recommendations of the reviews. This includes going beyond a focus on knowledge to a focus on changing behaviour. These programs teach strategies and tips on how to avoid risks or deal with pressure to take risks, such as “safe partying” programs that also teach young people to look out for their friends and make sure a designated driver stays sober. This also includes “whole-of-community” programs, where sectors of the whole community engage in the program’s delivery and demonstrate that everyone shares responsibility for safety on the roads, with learners sharing part of that responsibility.

These “best practice” programs have recently been shown to reduce the likelihood of having traffic violations in a large, good quality study in the United States. An Australian study of over 20,000 new drivers in New South Wales has also found that those who participated in one example of such a program in Year 10 or 11 went on to have fewer crashes early on their provisional licence compared to others in the study. Volunteer bias for participating in the program was unlikely as students attended as part of a regular school day. It was not possible to know however whether those who had completed the program and then had crashes were not well-represented in the study. Therefore, there is still a need for high quality research to demonstrate whether there truly are crash reduction benefits.

Potential issues

A great concern in relation to driver education programs is regarding courses at specialty facilities that teach learners how to manage high speeds or get them into a skid and teach them how to correct it. While this “makes senses” as many young driver crashes involve loss of control, there have been very strong studies demonstrating that this approach is more likely to increase crash risk. When drivers feel confident in managing certain situations, they will no longer avoid those situations or just won’t slow down enough as they feel in control of the situation. This seems to be a particular concern for newly-licensed young drivers – if they don’t feel comfortable they will driver slower and take extra care and this is really what is needed. These “advanced skills” course can actually counter this caution and instead exposure the young driver to a higher crash risk.

Another great concern is regarding programs that will still give a time discount to licensing – like the early DeKalb study. Despite repeated research showing that this greatly increases crash risk, over 20 states in the United States still allow young people to get their licence early in they take a driver education program. There is no known program that could come close to protecting these young people from crashes enough to allow such a time discount. Thankfully this has been a rare approach in Australia.

Factbase recommendation

School-based driver education can be very successful in increasing knowledge of road rules and driving risks, as well as teaching how to manage a car in traffic and how to pass the driving tests. There is insufficient evidence, however, to support driver education programs as a means of reducing crash risk. There are new promising approaches, including whole-of-community programs that focus on teaching strategies to avoid risk behaviour, but more research is needed.

References

Christie R (2001). The effectiveness of driver training as a road safety measure: A review of the literature (Report No 01/03). Melbourne, Victoria: Royal Automobile Club of Victoria.

Griffin KW, Botvin GJ, Nichols TR (2004). Long-term follow-up effects of a school-based drug abuse prevention program on adolescent risky driving. Prevention Science, 5(3), 207-212.

Insurance Institute for Highway Safety (2009). US licensing systems for young drivers [available at http://www.iihs.org/laws/pdf/us_licensing_systems.pdf].

Ivers R, Senserrick T, Boufous S, Stevenson M, Chen H-Y, Woodward M, Norton R. Novice drivers’ risky driving behavior, risk perception, and crash risk: findings from the DRIVE study. American Journal of Public Health. Sep 2009;99(9):1638-1644.

Jones B (1993). The effectiveness of skid-car training for teenage novice drivers in Oregon. Drive and Motor Vehicle Services, Salem OR.

Katila A, Keskinen E, Hatakka M (1996). Conflicting goals of skid training. Accident Analysis and Prevention, 28(6), 785-789.

Ker K, Roberts I, Collier T, Renton F & Bunn F (2003). Post-licence driver education for the prevention of road traffic crashes (Cochrane Review). In: The Cochrane Library, Issue 3. Oxford: Update Software.

Keskinen E, Hatakka M, Katila A, Laapotti S (1002). Was the renewal of the driver-training successful? Psychological report, No. 94. University of Turku, Turku, Finland.

Lund AK, Williams AF & Zador P (1986). High school driver education: further evaluation of the DeKalb County study, Accident Analysis & Prevention, 18, 349-357.

Mayhew DR & Simpson HM (2002). The safety value of driver education and training. Injury Prevention, 8(Supp II), 3-8.

Mayhew DR (2007). Driver education and graduated licensing in North America: past, present, and future. Journal of Safety Research, 38, 229-235.

Redshaw S (2001). Changing driving behaviour – A cultural approach. Australian Journal of Social Issues, 36(4), 315-331.

Roberts I, Kwan I & the Cochrane Injuries Group Driver Education Reviewers (2003). School based driver education for the prevention of traffic crashes (Cochrane Review). In: The Cochrane Library, Issue 3. Oxford: Update Software.

Sanders N & Keskinen E (Eds) (2004). EU NovEV PROJECT. Evaluation of post-licence training schemes for novice drivers, final report. CIECA (International Commission of Driver Testing Authorities).

Senserrick TM (2007). Recent developments in young driver education and training in Australia. Journal of Safety Research, 38, 237-244.

Senserrick T, Haworth NL (2005). Review of literature regarding national and international young driver training, licensing and regulatory systems. MUARC Report 239. Monash University Accident Research Centre, Clayton VIC, June.

Senserrick T, Ivers R, Boufous S, Chen H-Y, Stevenson M, Norton R (2009). Young driver education programs that build resilience have potential to reduce road crashes: DRIVE prospective cohort study. Pediatrics, 124, 1287-1292. [Please note an erratum for this article: the website provided for additional details on the driver-focused program is incorrect; the program is different to that evaluated at the time of our study.]

Stock JR, Weaver JK, Ray HW, Brink JR & Sadoff MG (1983). Evaluation of safe performance secondary school driver education curriculum project: final report. DOT-HS-806-568. Washington, DC: U.S. Department of Transportation.

Strang PM, Deutsch KB, James RS & Manders SM (1982). A comparison of on-road and off-road driver training (Report No. 1/82 SR). Hawthorn, Victoria: Road Safety & Traffic Authority.

Williams AF (2006). Young driver risk factors: successful and unsuccessful approaches for dealing with them and an agenda for the future. Injury Prevention, 12 (Suppl 1), i4-i8.

Woolley J (2000). In-car driver training at high schools: A literature review (Report No. 6/2000). Adelaide, Australia: Transport SA.

Motor vehicle crashes are the single leading cause of death of youth in Australia, and driver education programs are often sought by parents and young drivers to improve safety. But to date, there is little evidence that such programs reduce road crashes. Researchers from The George Institute assessed the impact of the Reduce Risk Increase Student Knowledge (RRISK) program on risk of crash in subsequent years.

“We found that young drivers in our study who attended the RRISK program had a 44% reduced risk of a car crash compared to others in the study. The program doesn’t just educate young people, but helps them to adopt safe behaviours. It arms them with strategies that ensure safe driving, such as managing pressure from peers, checking how much a designated driver has had to drink, planning a safe return from parties and generally encouraging them to make informed decisions about road safety,” said Dr Teresa Senserrick, The George Institute.

The program incorporates a whole-of-community approach that is broadly focused on reducing youth risk-taking rather than driving risks only. The program includes factual presentations, drama, peer education, real life experience with strong support from local businesses, university, police, ambulance, radio broadcaster and road safety organisations.

“This research suggests that such programs may be effective tools in managing risk in young drivers. However, while this research is indicating some promise, there is a need for further rigorous evaluation of such programs before they can be rolled out on a large scale,” added Dr Senserrick.

These results are part of a series of analyses from the DRIVE study, which is the largest survey of young drivers ever undertaken and was funded by Australia’s National Health and Medical Research Council, NRMA Motoring and Services, and NRMA-ACT Road Safety trust and the Roads and Traffic Authority of NSW. The DRIVE study recruited over 20,822 young drivers holding red P-plates in NSW aged 17-24 years and examined their crashes reported to police. The overall aim of the study is to investigate the risk factors in motor vehicle-related crashes and injuries among young drivers and to find ways to improve the safety of young drivers and help make roads safer for all users. The education program assessed comprised well-attended one-day courses supplemented with prior training workshops and on-going activities focused on reducing risk-taking or building resilience (see www.rrisk.com.au for more information).

This particular analysis investigated the benefits of young driver education programs. Additional results due to be released during 2009/2010 includes rural and socioeconomic factors for young drivers, pre-licensing driving experience, ethnicity, mental health, and sleep habits. Review the evidence on this topic in the youngdriverfactbase.

For further information, please contact:
Emma Orpilla – Public Relations, The George Institute for International Health
Tel: +612 9993 4500/ Mobile: +61410 411 983
Fax: +612 9993 4501/ email: eorpilla@george.org.au
www.thegeorgeinstitute.org.au

The George Institute is a world renowned health and medical research institute, focused on the prevention and management of chronic disease and injury. The George is affiliated with the University of Sydney and conducts high-impact research across a broad health landscape and is a respected voice among global policy makers. The George has conducted major global applied research projects and innovative community-based programs from bases in Australia, China and India. In 2009, the Institute celebrates a decade of discovery, innovation and impact. www.thegeorgeinstitute.org

The Young Driver Factbase is an online resource, containing up-to-date information on young driver safety and provides recommendations based on the best available research evidence. Visit www.youngdriverfactbase.com to see an overview of all the issues facing young drivers and the latest evidence investigating these factors such as high powered vehicles, driver distraction and restrictions.

Already the DRIVE study has released findings on the risky driving behaviours that young drivers undertake, putting them at an increased risk of crashing.

These results and other young driver issues will be discussed today at the launch of the Young Driver Factbase – www.youngdriverfactbase.com - a new online resource of young driver issues and research evidence.

Overall, young city drivers are more likely to crash due to the high-density of vehicles within urban settings. However, after conducting a survey of more than 20,000 young drivers, researchers identified young rural drivers to be at a far greater risk of single-vehicle crashes, which are more likely to result in serious injury than other crash types.

“We know that urban crashes with multiple vehicles take place more often due to the high volume cars on city roads. What we didn’t know was that young drivers in rural locations are actually at a much higher risk of having single-vehicle crashes, which are often fatal and in many cases avoidable”, said author Associate Professor Rebecca Ivers, The George Institute.

“Since our study found that young drivers on rural roads were more likely to crash as a result of curved roads and speeding,  efforts to reduce speeding behaviour and manage driving at curved road sections, such as speed cameras, and greater use of engineering measures to slow traffic are needed on rural roads”, Associate Professor Ivers added. The research was conducted by Huei-Yang Chen, PhD student in the Sydney School of Public Health, the University of Sydney.

These results are part of a series of analyses from the DRIVE study, which is the largest survey of young drivers undertaken, both in Australia and internationally.

Review the evidence on this topic on the youngdriverfactbase

The DRIVE study was funded by Australia’s National Health and Medical Research Council, NRMA Motoring and Services, and NRMA-ACT Road Safety trust and the Roads and Traffic Authority of NSW. The DRIVE study recruited over 20,822 young drivers holding red P-plates in NSW aged 17-24 years and followed all 20,822 young drivers for police-recorded crashes occurring over 2 years. The overall aim of the study is to investigate the risk factors in motor vehicle-related crashes and injuries among young drivers and to find ways to improve the safety of young drivers and help make roads safer for all users.

This particular analysis investigated the risk of various type of crash, by urban, regional and rural settings.

These results will be discussed from 9.30am Tuesday 22 September 2009 at the launch of the Young Driver Factbase – an online resource of all the issues facing young drivers, which presents the best research evidence. Interviews available from 11.30am.

For further information and to arrange interviews, please contact:

Emma Orpilla – Public Relations, The George Institute for International Health

Tel: +612 9993 4500/ Mobile: +61410 411 983

Fax: +612 9993 4501/ email: eorpilla@george.org.au

www.thegeorgeinstitute.org.au

The George Institute is a world renowned health and medical research institute, focused on the prevention and management of chronic disease and injury. The George conducts high-impact research across a broad health landscape and is a respected voice among global policy makers. The George has conducted major global applied research projects and innovative community-based programs from bases in Australia, China and India. In 2009, the Institute celebrates a decade of discovery, innovation and impact. www.thegeorgeinstitute.org

The Young Driver Factbase is an online resource, containing up-to-date information on young driver safety and provides recommendations based on the best available research evidence. Visit www.youngdriverfactbase.com to see an overview of all the issues facing young drivers and the latest evidence investigating these factors such as high powered vehicles, driver distraction and restrictions.

Already the DRIVE study has released findings on the risky driving behaviours that young drivers undertake, putting them at an increased risk of crashing.