Transportation Risk Behaviors Among High School Students — Youth Risk Behavior Survey, United States, 2019
Supplements / August 21, 2020 / 69(1);77–83
Merissa A. Yellman, MPH1; Leah Bryan, MPH2; Erin K. Sauber-Schatz, PhD1; Nancy Brener, PhD2 ( View author affiliations )
Motor-vehicle crashes are a leading cause of death and nonfatal injury among U.S. adolescents, resulting in approximately 2,500 deaths and 300,000 nonfatal injuries each year. Risk for motor-vehicle crashes and resulting injuries and deaths varies, depending on such behaviors as seat belt use or impaired or distracted driving. Improved understanding of adolescents’ transportation risk behaviors can guide prevention efforts. Therefore, data from the 2019 Youth Risk Behavior Survey were analyzed to determine prevalence of transportation risk behaviors, including not always wearing a seat belt, riding with a driver who had been drinking alcohol (riding with a drinking driver), driving after drinking alcohol, and texting or e-mailing while driving. Differences by student characteristics (age, sex, race/ethnicity, academic grades in school, and sexual identity) were calculated. Multivariable analyses controlling for student characteristics examined associations between risk behaviors. Approximately 43.1% of U.S. high school students did not always wear a seat belt and 16.7% rode with a drinking driver during the 30 days before the survey. Approximately 59.9% of students had driven a car during the 30 days before the survey. Among students who drove, 5.4% had driven after drinking alcohol and 39.0% had texted or e-mailed while driving. Prevalence of not always wearing a seat belt was higher among students who were younger, black, or had lower grades. Riding with a drinking driver was higher among Hispanic students or students with lower grades. Driving after drinking alcohol was higher among students who were older, male, Hispanic, or had lower grades. Texting while driving was higher among older students or white students. Few differences existed by sexual identity. Multivariable analyses revealed that students engaging in one transportation risk behavior were more likely to engage in other transportation risk behaviors. Traffic safety and public health professionals can use these findings to reduce transportation risk behaviors by selecting, implementing, and contextualizing the most appropriate and effective strategies for specific populations and for the environment.
Motor-vehicle crashes are predictable and preventable. However, in the United States, they remain the second leading cause of death among adolescents and the fourth leading cause of nonfatal injury. During 2018, approximately 2,500 adolescents (persons aged 12–19 years) died in motor-vehicle crashes; of those deaths, >75% were occupants of passenger vehicles (i.e., cars, pickup trucks, vans, or sport utility vehicles) (1). Motor-vehicle crashes also resulted in approximately 297,000 nonfatal injuries among adolescents during 2018. Moreover, fatal and nonfatal motor-vehicle–crash injuries among adolescents resulted in approximately $12 billion in medical and work-loss costs during 2018 ( https://www.cdc.gov/injury/wisqars ).
Passenger-related transportation risk behaviors (e.g., nonuse of seat belts or riding with a driver who had been drinking alcohol) increase the risk for injury or death in a crash or risk for a crash itself. Seat belt use among adolescents and young adults is typically lower than among adults of other age groups (1) ( https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/812781external icon ). For instance, the National Occupant Protection Use Survey Controlled Intersection Study uses a probability-based sample of observational surveys conducted on an annual basis to produce estimates of seat belt use nationwide at a typical daylight moment. Results during 2016–2018 indicate that seat belt use among adolescents and young adults aged 16–24 years was approximately 87% each year, whereas seat belt use among adults aged ≥25 years was 90% or higher ( https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/812781external icon ). Previous research also demonstrates that high school students put themselves at risk by riding with drivers who have been drinking alcohol (2).
Per mile driven, drivers aged 16–19 years have crash rates approximately four times greater than those of drivers aged ≥20 years (1); a leading contributor is driver inexperience (1,3). Because of this elevated crash risk, engagement in driver-related transportation risk behaviors (e.g., driving after drinking alcohol or texting or e-mailing while driving) puts adolescents at even higher risk. For example, drinking alcohol negatively affects a person’s ability to drive safely regardless of age. However, even at the same blood alcohol concentration (BAC), drivers aged 16–20 years have a much higher risk for being involved in a crash than older drivers (1,4). Similarly, the negative effects of driver inexperience on driving performance are worsened by cell phone–related driver distraction (5).
For this report, 2019 data from the Youth Risk Behavior Survey (YRBS) were analyzed by student characteristics to determine the prevalence of four transportation risk behaviors among U.S. high school students. Associations between engagment in multiple transportation risk behaviors also were calculated. This study provides an update on which adolescent groups have an elevated prevalence of engaging in transportation risk behaviors and reveals the extent to which adolescents engage in multiple transportation risk behaviors. The findings can help traffic safety and public health professionals appropriately select, tailor, and implement effective strategies to have a greater impact on reducing risk behaviors, thereby preventing crashes, injuries, and deaths among adolescents.
This report includes data from CDC’s 2019 YRBS, a cross-sectional, school-based survey conducted biennially since 1991. Each survey year, CDC collects data from a nationally representative sample of public and private school students in grades 9–12 in the 50 U.S. states and the District of Columbia. Additional information about YRBS sampling, data collection, response rates, and processing is available in the overview report of this supplement (6). The prevalence estimates for all unintentional injury questions for the overall study population and by sex, race/ethnicity, grade, and sexual orientation are available at https://nccd.cdc.gov/youthonline/App/Default.aspx . The full YRBS questionnaire is available at https://www.cdc.gov/healthyyouth/data/yrbs/pdf/2019/2019_YRBS-National-HS-Questionnaire.pdfpdf icon .
This study examined two passenger- and two driver-related transportation risk behaviors among U.S. high school students. The overall analytic sample was used for the passenger-related risk behaviors, which included not always wearing a seat belt when riding in a car driven by someone else and riding with a driver who had been drinking alcohol (riding with a drinking driver). Not always wearing a seat belt was assessed with the question, “How often do you wear a seat belt when riding in a car driven by someone else?” Response options included “always,” “most of the time,” “sometimes,” “rarely,” or “never,” with any response other than “always” being defined as not always wearing a seat belt. Riding with a drinking driver was assessed with the question, “During the past 30 days, how many times did you ride in a car or other vehicle driven by someone who had been drinking alcohol?” Responses were dichotomized (0 times versus ≥1 time). Students who reported riding with a drinking driver at least once during the previous 30 days were classified as having engaged in the behavior.
Driver-related transportation risk behaviors included driving when they had been drinking alcohol (driving after drinking alcohol) and texting or e-mailing while driving (texting while driving). Driving after drinking alcohol was assessed with the question, “During the past 30 days, how many times did you drive a car or other vehicle when you had been drinking alcohol?” Texting while driving was assessed with the question, “During the past 30 days, on how many days did you text or e-mail while driving a car or other vehicle?” Students who indicated they had not driven a car or other vehicle during the past 30 days on each respective question were excluded from the analysis for these questions. Responses among drivers were categorized as 0 times or days versus ≥1 time or day.
An approximation of driving prevalence among students is presented to provide context for the driver-related behaviors. However, driving prevalence is not directly captured in the 2019 YRBS. For this approximation, students who chose a response other than “I did not drive a car or other vehicle during the past 30 days” for both driver-related questions (driving after drinking alcohol and texting while driving) were classified as drivers, and students who indicated that they did not drive a car or other vehicle during the past 30 days were classified as nondrivers. Driver classification was independent of students’ responses to the two questions about passenger-related transportation risk behaviors because students who drove during the past 30 days could also be passengers when they were not driving during the same 30-day period.
All transportation risk behaviors were analyzed by self-reported student characteristics, including age (14, 15, 16, 17, or ≥18 years), sex (male or female), race/ethnicity (non-Hispanic white [white]; non-Hispanic black [black]; or Hispanic or Latino of any race [Hispanic]), academic grades in school (mostly As or Bs versus mostly Cs, Ds, or Fs), and sexual identity (heterosexual; lesbian, gay, or bisexual; or not sure). Although data from students in other or multiple racial/ethnic groups were collected, the numbers were too small to produce statistically stable estimates specific to other or multiple racial/ethnic groups; therefore, these data are not presented as a separate group in this report but were retained in the analytic sample. In addition, students aged