Fatal passenger vehicle crashes 1999 to 2004 with drivers under age 15: the impact in Texas and other southern and southwestern states.

Abstract: Texas has more fatal crashes involving unlicensed drivers under age 15 than does any other US state. Numbers and rates of such crashes are also above the national mean in many southern and Southwest states. Data on fatal passenger vehicle crashes from 1999 through 2004 were obtained from the online Fatality Analysis Reporting System (FARS). During the study period, there were 51 fatal passenger vehicle crashes in Texas in which drivers were under age 15. These crashes accounted for 12.3% of the US total. Nine southern states, including Texas, together accounted for 44% of all fatal crashes involving drivers under 15. Unlicensed crash rates per million inhabitants were higher in Texas than in other states with comparable populations but were much lower than those in other southern, southwest, and north central states. While Texas has recently improved its compliance with proposed graduated licensing models, state law explicitly prohibits police from stopping drivers based solely on age-related probable cause. This restriction may be a major barrier to effective detection and interdiction of under-age unlicensed driving.

Because of the relatively high number of fatal crashes involving drivers under age 15 occurring in Texas, preventive efforts targeted to this state could modestly reduce the national burden of deaths due to very young unlicensed drivers. Expanding these efforts to other southern and southwest states could further reduce numbers and rates of such crashes. Expanded use of graduated licensing and increased public awareness are likely to prove effective tools in this public health effort.

Key Words: motor vehicle crashes, young adolescents, graduated driver licensing, Texas

Case Report

At about noon on January 2, 2000, a 65-year-old male, was heading west on Texas Interstate 30, returning home after a hunting trip. A late model pickup truck careened across the median strip and rolled into the westbound lane. The pickup had been traveling at high speed on an approach to the interstate. Finding another vehicle in his path, the driver swerved, then overcorrected, sending his pickup out of control and onto the median. His truck struck the other vehicle as it overturned, sending it airborne and onto the back of his own pickup. When EMS arrived on the scene 30 minutes after initial impact, the driver and four passengers in the other truck were dead. The nature of their injuries was undisclosed; one passenger was ejected, none of the occupants were seatbelted. The driver was 14 years old and unlicensed. Four dead passengers, all cousins, were aged 14, 13, 12, and 12. The 65 year old survived his injuries and left the hospital without major physical impairment.

In 2000, the American Automobile Association Foundation offered the first comprehensive assessment of the impact of unlicensed driving on U.S. motor vehicle fatalities, finding that Texas (21,952), Florida (19,397), and California (26,776) together accounted for nearly a quarter of the 20% of fatal crashes that involve aberrantly licensed or unlicensed drivers. (1) Texas' rate of unlicensed drivers in fatal crashes (7.08%) was second only to that of New Mexico (7.7%) and greatly exceeded that of either Florida or California. (2) Although children under 15 years comprise only a small proportion of unlicensed drivers involved in fatal crashes, a subsequent study found Texas to have significantly more fatal passenger vehicle crashes with at least one driver under the age of 15 than did any other state. (3) The purpose of this article is to discuss what is known about fatal young-driver crashes in Texas and other populous southern states which together account for a substantial proportion of all such crashes in the United States.

Methods

Since 1996, the US Department of Transportation has maintained a Fatality Analysis Reporting System (FARS) "Web-Based Encyclopedia" which is a computer database of all public roadway vehicle crashes in which at least one fatality occurred. Data were downloaded from the FARS website http://www-fars.nhtsa.dot.gov/ and transferred to Microsoft Access and Excel. All fatal crashes occurring between January 1, 1999, and December 31, 2004 were selected in which at least one driver was under the age of 15 and was driving a conventional passenger vehicle (automobile, van, or small truck). The term "passenger vehicle" as used in this paper is operationally defined as a FARS "body type" code between 1 and 41. Motorcycles, all terrain vehicles, go-carts, buses, large trucks, farm machinery, motor homes, and snowmobiles were excluded from primary analysis. Census data were downloaded from the American Fact-finder website: http://factfinder.census.gov/servlet/DatasetMainPageServlet?_program=DEC&_lang=en. Data were further analyzed using SPSS version 12.0.1.

Results

Over the 6-year study period, there were 412 fatal crashes involving at least one driver under the age of 15. These crashes led to 477 fatalities and involved 1201 persons in 604 vehicles. Sixty-six percent of the drivers were 14 years of age, 24% were 13, 7% were 12, and the remaining 3% ranged in age from 7 through 11. Five 14-year-old drivers held valid driving licenses (two in North Dakota and three in South Dakota), but none were driving with a learner's permit. Fatal crashes with under-15 drivers occurred in all states except Connecticut, Maine, and New Hampshire; however, the majority of these crashes occurred in southern states. Texas accounted for 51 crashes (12.3%), Florida 22 (5.3%), Arkansas 18 (4.4%), Arizona and North Carolina each 17 (4.1%), Missouri 16 (3.9%), and Georgia, Mississippi, and New Mexico each with 14 (3.4%). Crashes in these nine states comprised 44% of the US total. This proportion rose to 58% with the addition of fatalities in Kansas (n = 13), Oklahoma (n = 11), Alabama (n = 11), Louisiana (n = 9), South Carolina (n = 7), and Tennessee (n = 6). Michigan was the only Northern state to have as many as 14 fatal under-15 driver crashes during the study period.

The majority of involved vehicles were four door passenger cars (53%) and pickup trucks (22%), with the majority of the latter being full-sized trucks. Minivans, convertibles, and utility vehicles largely comprised the remainder. Weather was rarely cited as a contributing factor, and most crashes occurred during daylight hours. Only 34% of the drivers were female, but this proportion was seven percentage points higher than for fatal crashes involving drivers 16 to 25 years old. Crashes occurred predominantly on rural roads and were only occasionally reported to involve alcohol or drugs. Since Texas accounted for by far the largest number of total crashes during the study period, these crashes were examined in more detail. Crash distribution is illustrated in the Figure.

Thirty-three Texas crashes (65%) occurred on rural roadways. This is comparable to the national rate of rural crashes for under-15 drivers, but somewhat below the rural roadway proportion of older teen (16-19) crashes (59%) or all US passenger vehicle crashes (58%). The majority (18) occurred on local rural roads with an additional eight on rural major collector roads and a small number each on rural expressways, minor arterials, and minor collectors. There was a strong association between the Rural-Urban Continuum Code's (RUCC) measure of rurality (4,5) and crash rates. Ten crashes occurred in metro counties (RUCC 1-3). RUCC 1 to 3 counties in Texas have a combined population of nearly 18,000,000. The crash rate in these counties was 6/100,000 inhabitants. Seventeen crashes occurred in nonmetro counties (RUCC 6-9). RUCC 6-9 counties in Texas have a combined population of just under 2,000,000. The crash rate in these rural counties was 90/100,000, or fifteen times higher than in metro areas.

[FIGURE OMITTED]

In 2000, the Insurance Institute for Highway Safety rated all states on their compliance with model graduated licensing statutes. (6) Texas was one of nine states to garner a "poor" rating, although this was subsequently increased to "fair" after some elements of graduated licensing were adopted in 2002. (7) Georgia, Florida, Louisiana, New Mexico, Missouri, and Tennessee were the only southern states to gain "acceptable" or "good" (Tennessee only) ratings in 2000. Eight of nine low-ranking states have relatively high rates of fatal crashes involving unlicensed under-15 drivers (L. Frisch, unpublished data.).

Texas' six-year under-15 driver fatal crash rate per 1,000,000 total population (2000 census) was 2.45. While high compared with the rate for the entire US (1.46) and very much higher than the rate in California (0.59), New York (0.30), or New Jersey (0.12), Texas' rate was well below that of many south central, southwest, and north central states. Rates of fatal under-15 crashes per 1,000,000 inhabitants are summarized for selected states (mostly southern) in the Table.*

Discussion

Fatal crashes involving very young drivers have been studied little because they are rare and are overshadowed by the very large number of crashes involving older unlicensed drivers. (8) It is important to recognize that these crashes differ somewhat from crashes involving older teens. They are less likely to involve alcohol, more likely to occur during daylight hours, and somewhat more likely to occur on rural roadways. While the majority of drivers in these crashes are boys, girls are relatively over-represented compared with crashes involving older teen drivers. While by no means an exclusively southern concern, rates of under-15 fatal crashes are well above the national average in most southern states, and in the aggregate, these states account for over half of all under-15 fatal crashes. Tennessee (which maintains highly-rated graduated licensing laws (6,7)) is the only southern state with a low under-15 rate. In contrast, as can be seen from the Table, Tennessee's crash rate for older drivers is well above the US mean. Graduated licensing alone may not account for Tennessee's relatively low rate of under-15 fatal crashes, but it seems likely to have played some role in preventing young driver-associated fatalities.

While these young driver crashes are not common and account for a small number of fatalities compared with other causes of accidental injury, they are important because they almost always represent a failure of driver licensing, a fundamental safety and law-enforcement function in every state. As drivers, we acknowledge that our roadways cannot be made completely safe, but we do not expect an oncoming vehicle to be driven by an unlicensed child--as was the case in the tragic crash described in the vignette above.

Although to our knowledge there have been no US studies of young driver crashes using any non-FARS sources, many of the characteristics of fatal crashes involving drivers under 15 might have commonsense explanations. For example, the relative rural preponderance (especially in the Northern Plains states) may reflect aspects of farming culture in which children may operate farm machinery on or off public roadways from a very early age. As noted earlier, the only fatal under-15 crashes involving licensed drivers occurred in North and South Dakota, two states which allow early driving in association with farm work or school attendance. ([dagger]) While a number of states have much higher rates of under-15 driver crashes than Texas, no state remotely approaches Texas' total number of such crashes. Reducing the number of Texas fatalities attributable to drivers under the age of 15 would have an impact on the overall US fatality rate for these crashes and could well be adopted as an important state, as well as national, public health goal. Texas regulations explicitly forbid police from using the graduated licensing law as a probable cause for traffic stops. (9) Although Texas has now adopted some important elements of graduated licensing, it seems likely that police identification of young unlicensed driving through probable-cause traffic stops will be among the tools needed to reduce young driver fatal crashes. It remains highly desirable for all states to adopt proposed graduated licensing recommendations. Of the 20 states listed in the Table, only California, Georgia, North Carolina, Oklahoma, and Tennessee have "good" ratings in the 2004 Insurance Institute for Highway Safety (IIHS) assessment. (7) A number of these states have only recently adopted more stringent licensing rules, and any benefit on under-age driving fatalities may take some time to become evident. As this study shows, automobiles in the hands of very young children can be fatal weapons. Parents should be advised to keep car keys locked away from child access. Children should not be allowed or encouraged to drive before the legal age, and parents should likely warn their children that if they drive before licensure, they will not be allowed to enter driver's training until well past the legal minimum age.

A major limitation of this study is that we were able to use only population as the denominator to compare states and counties. Fatal crashes per mile driven might be a much better choice, but for obvious reasons, this denominator is impossible to obtain. Driving by children under 15 is now illegal in most states, although (as was likely in the case presented earlier in this paper) sometimes condoned by parents. Parental and police recognition (and elimination) of nonfatal driving episodes is critically necessary for eliminating the impact of fatal crashes involving drivers under 15. This study is also potentially limited by the accuracy of FARS data. FARS relies on reports of local investigators and cautions researchers, for example, not to rely on its blood alcohol data because of potential incompleteness. While researchers report that matching FARS entries with registry death certificate data is successful in only about 80% of cases (10) (implying erroneous identifiers in one or both data sources) other audits of post-1999 FARS completeness have suggested relatively good data completeness. (11) Although there are undoubtedly individual discrepancies in FARS, we believe that the overall database is sufficiently sound to warrant making the conclusions reflected in this paper. There is enough evidence of the risk that underaged driving poses to children that we should now act to raise public awareness of this problem.

References

1. Griffin LI III, DeLaZerda S. Unlicensed to kill. Washington, DC: AAA Foundation for Traffic Safety 2000:1-58. Available at http://www.aaafoundation.org/pdf/unlicensed2kill.PDF. Accessed February 24, 2006.

2. Scopatz RA, Hatch CE, DeLucia BH, et al. Unlicensed to kill: the sequel. Washington, DC, AAA Foundation for Traffic Safety 2003:1-120. Available at http://www.aaafoundation.org/pdf/UnlicensedToKill2.pdf. Accessed February 24, 2006.

3. Frisch L, Choate Johnston S, Melhorn K, et al. In the hands of children: fatal car, van, and truck crashes involving drivers aged 7 through 14 years. Arch Pediatr Adolesc Med 2003;157:1032.

4. Anonymous. Rural Urban Continuum Codes Washington, DC, US Department of Agriculture. 2003. Available at http://www.ers.usda.gov/Data/RuralUrbanContinuumCodes/2003/. Accessed January 6, 2007.

5. Isserman AM. In the national interest: defining rural and urban correctly in research and public policy. Int Reg Science Rev 2005;28:465-499.

6. Anonymous. Best and worst traffic safety laws: some states do a better job than others. Arlington, VA: Insurance Institute for Highway Safety. 2000. Available at http://www.iihs.org/news/2000/iihs_news_122000.pdf. Accessed February 24, 2006.

7. Anonymous. Graduated licensing: a blueprint for North America. Arlington, Insurance Institute for Highway Safety. 2004. Available at http://www.iihs.org/laws/state_laws/pdf/blueprint.pdf. Accessed February 24, 2006.

8. Begg DJ, Langley JD, Cahlmers D. Motor vehicle road crashes during the fourteenth and fifteenth years of life. N Z Med J 1992;105:150-151.

9. Anonymous. Graduated Driver Licensing Program. Austin, Texas Department of Safety. Available at http://www.txdps.state.tx.us/director_staff/public_information/pr122101.htm. Accessed January 6,2007.

10. Campos-Outcalt D, Bay C, Dellapenna A, et al. Pedestrian fatalities by race/ethnicity in Arizona, 1990-1996. Am J Prev Med 2002;23:129-135.

11. Bridges NC, Levine RS, Haliburton WP, et al. The fatality analysis reporting system as a tool for investigating racial and ethnic determinants of motor vehicle crash fatalities. Accid Anal Prev 2005;37:641-649.

Larry Frisch, MD, MPH

From the Department of Community Health Sciences, Northeastern Ohio Universities College of Medicine, Rootstown, OH.

Reprint requests to Dr. Larry Frisch, Department of Community Health Sciences, Northeastern Ohio Universities College of Medicine, State Route 44, PO Box 95, Rootstown, OH 44272. Email: [e-mail]

Accepted July 3, 2006.

*2004 fatal crash numbers for drivers 16 and older were obtained from FARS and then multiplied by six to calculate a six-year rate.

([dagger]) Other states allowing driving before the age of 15 include Iowa, Kansas, Alaska, Arkansas, Idaho, Michigan, and Montana.

RELATED ARTICLE: Key Points

** Unlicensed driving accounts for up to 20% of fatal motor vehicle crashes nationally.

** A small proportion of unlicensed drivers are under 15 years of age.

** Texas has the highest number of fatal passenger vehicle crashes involving drivers under 15 in the US.

** Crash rates/100,000 inhabitants are fifteen times higher in Texas nonmetro compared to metro counties.

** Successful prevention of fatal very young driver crashes in Texas would reduce the national impact of these events but may require legalization of probable-cause police stops for underage driving.

** Similar efforts in a number of other southern and southwest states could significantly reduce the number of fatalities due to unlicensed underage driving.

Table. Fatal crash numbers and rates for selected states and the US

          Fatal
          crashes                                    % of all fatal
          driver   Fatal crashes   Rate              crashes with
          under    driver over     under  Rate over  drivers under
State     15       15 (2004 only)  15     15         15

AL         11        937            2.47  210.70     1.2
AZ         17        815            3.31  158.87     2.1
AR         18        540            6.73  202.02     3.3
CA         20       3278            0.59   96.78     0.6
FL         22       2568            1.38  160.68     0.9
GA         14       1319            1.71  161.13     1.1
KS         13        354            4.84  131.70     3.7
LA          9        736            2.01  164.69     1.2
MO         16        924            2.86  165.15     1.7
MT          5        176            5.54  195.12     2.8
NM         14        375            7.70  206.16     3.7
MS         14        733            4.92  257.64     1.9
NC         17       1261            2.11  156.67     1.3
ND          7         79           10.90  123.05     8.9
OK         11        590            3.19  171.01     1.9
SC          7        853            1.74  212.61     0.8
SD         11        133           14.57  176.16     8.3
TN          6       1051            1.05  184.74     0.6
TX         51       2819            2.45  135.20     1.8
US total  412      33863            1.46  120.38     1.2