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Original Investigation |

Effect of the Teen Driving Plan on the Driving Performance of Teenagers Before Licensure: A Randomized Clinical Trial

Jessica H. Mirman, PhD1; Allison E. Curry, PhD, MPH1,2; Flaura K. Winston, MD, PhD1,3; Wenli Wang, MS1; Michael R. Elliott, PhD4,5; Maria T. Schultheis, PhD6; Megan C. Fisher Thiel, MPH1; Dennis R. Durbin, MD, MSCE1,2,3
[+] Author Affiliations
1Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
2Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
3Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
4Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor
5Survey Methodology Program, Institute for Social Research, University of Michigan, Ann Arbor
6Department of Psychology, Drexel University, Philadelphia, Pennsylvania
JAMA Pediatr. 2014;168(8):764-771. doi:10.1001/jamapediatrics.2014.252.
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Importance  Many studies have failed to show an effect of parent-supervised practice driving on the driving performance of teenagers; nevertheless, most Graduated Driver Licensing programs have provisions that require supervised practice.

Objective  To determine whether a web-based intervention, the Teen Driving Plan (TDP), can improve the driving performance of teenagers before licensure as measured by the Teen On-road Driving Assessment (tODA).

Design, Setting, and Participants  Randomized, single-blind, clinical trial among 217 dyads (1 parent: 1 teenaged learner’s-permit holder) to test TDP effectiveness on increasing the quantity and diversity of supervised practice and improving the teenagers’ prelicensed driving performance. The study was conducted from December 2011 through January 2013 in Southeastern Pennsylvania.

Interventions  Dyads were randomized (3:2) to receive the TDP or the Pennsylvania driver’s manual (control group). The TDP is a psychoeducational intervention designed to increase the quantity and diversity of parent-supervised practice. Materials are grouped by the following driving environments: empty parking lots, suburban residential streets, intermediate (1- or 2-lane) roads, highways, rural roads with curves and elevation changes, and commercial districts.

Main Outcomes and Measures  The main outcomes were self-reported practice driving across 6 environments and 2 conditions and driving performance as measured by the teenagers’ completion of the standardized and validated tODA 24 weeks after enrollment. Certified professional driving evaluators blinded to randomization status terminated the tODA if they determined that the teenager could not safely complete it. We examined mean differences in the quantity of supervised practice, differences in the overall proportion of teenagers in each group that had assessments terminated for unsafe driving, and the point of termination during the assessment.

Results  The TDP dyads reported more practice in 5 of the 6 environments and at night and in bad weather compared with the control dyads. Overall, 5 of 86 TDP teenagers (6%) had the tODA terminated compared with 10 of 65 control teenagers (15%) (risk difference [TDP − control], −9% [95% CI, −21% to 2%]; P = .06). The hazard ratio for exposure to TDP was 0.35 (95% CI, 0.12-1.03; P = .05, log-rank test).

Conclusions and Relevance  Preliminary evidence suggests that the TDP improves supervised practice and the driving performance of prelicensed teenaged drivers. Future studies can explore how to revise the TDP to enhance the treatment effect and how best to disseminate the TDP without compromising implementation fidelity.

Trial Registration  clinicaltrials.gov Identifier: NCT01498575

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Figure 1.
CONSORT Diagram of Derivation of Study Sample

TDP indicates Teen Driving Plan; tODA, Teen On-road Driving Assessment.aIndicates withdrew before taking the primary outcome assessment at 24 weeks; an as-treated analysis was not indicated.bIndicates did not take the tODA due to noncompliance with the administrative protocol (ie, lost the hard-copy version of the learner’s permit, already received an intermediate license, or reasons were not documented).cIndicates sick/injured on day of the scheduled tODA, cancellation due to a death in the family, or reasons were not documented.

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Figure 2.
Kaplan-Meier Failure Curves for Termination

We compared termination rates among teenagers randomized to receive the Teen Driving Plan intervention (TDP group) (n = 86) and the usual practice (control group) (n = 65) using the log-rank test. The x-axis represents the modules assessed in the 24-week Teen On-road Driving Assessment, and the y-axis shows the cumulative termination rate at each module. Modules are described in the Outcome Assessments subsection of the Methods section. Censored observations are plotted with circles.

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