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Purpose. Middle-aged males and females with diabetes are more likely to have poor physical (PH) and mental health (MH); however, there is limited research determining the relationship between MH and PH and routine check-up in diabetic middle-aged adults, especially by gender. The purpose of this study was to determine whether PH and MH status differ by routine check-up in middle-aged (age 45–64) adults with diabetes in the general population. Methods. This cross-sectional analysis used data from the 2017 BRFSS conducted by the CDC for adults aged 45–64 who reported having diabetes in Florida (N=1183), Kentucky (N=617), Maryland (N=731), New York (N=593), and Ohio (N=754). Multiple logistic regression by state and gender was used to determine the relationship between MH and PH status and routine check-up while controlling for health-related, socioeconomic, and demographic factors. Results. Across states, up to one-half reported good PH (32–50%), over one-half reported good MH (46–67%), and most reported having a routine check-up (87–93%). Adjusted analysis indicated that MH and PH were not significantly related to routine check-up, but both were inversely related to having diabetes plus two other health conditions. Conclusions. Overall, routine check-up was not related to good PH and MH in this target population; however, a number of health conditions were inversely related to good PH and MH status. In a primary care setting for this target population, there may be a low to moderate prevalence of good PH and MH and a high prevalence of having a routine check-up and having multiple health conditions. It is recommended to automatically screen this target population for PH, MH, other chronic conditions, and physical activity and treat concurrently.

As more public places are designated "non-smoking," chewing tobacco could be an alternative choice for tobacco use; however, controversy exists over the long-term health effects associated with it. This study assessed the relationship between chewing tobacco, cigarette smoking, and chronic health conditions in a representative sample of males 18-44 years of age, while controlling for other variables known to be related to tobacco use. This cross sectional analysis used 2013 data from the Behavioral Risk Factor Surveillance System (BRFSS). The results indicated that about 41% of males reported one or more chronic health conditions, and that about 15% used chewing tobacco only, 21% smoked cigarettes only, and 6% did both. From adjusted analyses, those who chewed tobacco only were 49% more likely to report one or more health conditions; those who smoked cigarettes only were 34% more likely to report one or more health conditions; and those who did both were 95% more likely to report at least one health condition. Overall, any combination of tobacco use was significantly and similarly related to the increased prevalence of chronic health conditions in males aged 18-44 years. Although chewing tobacco use may not be as prevalent in the general population as cigarette smoking, clinicians should be aware of the similar health risks associated with all tobacco use at ages younger than may be expected, and encourage cessation of any tobacco use.

Objectives: While physical activity is important for health, many women do not meet recommended levels, particularly mothers. The purpose of this study was to assess whether physical activity levels differ by number of children at home in women aged 25–44 in the general US population. Methods: This cross-sectional analysis used 2017 Behavioral Risk Factor Surveillance System data for females aged 25–44 (N = 6266) from California, Colorado, New York, Texas, and Utah. Ordered logistic regression analysis assessed the relationship between physical activity levels and number of children at home while controlling for state and demographic, socioeconomic, and health-related factors. Results: About half of participants reported “inactive” or “insufficiently active” physical activity levels and about two-thirds reported having one or more children at home. The results of adjusted analysis indicated that physical activity level was significantly related to having one child (adjusted odds ratio = 0.75, 95% confidence interval = 0.63, 0.89), two children (adjusted odds ratio = 0.79; 95% confidence interval = 0.67, 0.93), and three or more children (adjusted odds ratio = 0.80, 95% confidence interval = 0.67, 0.94) at home. Conclusion: Overall, physical activity levels were significantly related to presence of children at home for women aged 25–44, but increasing number of children at home did not impact effect size. For women aged 25–44 in a primary care setting, a moderate prevalence of inactive or insufficiently active physical activity may be expected. Providers should address physical activity with all patients in this target population during well-visits, but particularly for women with children at home; educate patients about the health benefits of regular physical activity; and provide resources that will help them integrate physical activity into their daily lifestyles.

Introduction: With limited research for mental health and alcohol use among veterans in the general population and none for elderly male veterans only, the purpose is to assess whether mental health differs by alcohol use in elderly male veterans in the general population. Method: This cross-sectional analysis uses 2017 Behavioral Risk Factor Surveillance System data for male veterans aged 65 and older in general population samples from Florida ( n = 1,700), Maryland ( n = 1,060), New York ( n = 552), and Washington ( n = 1,031). Multiple logistic regression by state assessed the relationship between mental health and alcohol use, after controlling for health-related, demographic, and socioeconomic factors. Results: Across states, most participants reported good mental health (80%-84%) and more than half reported drinking (53%-63%). Adjusted results indicated that mental health did not differ by alcohol use in any state; however, it was related to physical health and activity limitations across states. Conclusion: Overall, alcohol use was not related to mental health in elderly male veterans in the general population; however, physical health status and activity limitations were. Practitioners should always screen for alcohol use and should automatically screen for mental health, physical health, and activity limitations when symptoms present for any and assess concurrent treatment and management strategies.

Purpose. Research shows that smoking during pregnancy is related to mental health diagnoses. The purpose of this study was to assess whether current general mental health status is related to current smoking status in pregnant women after controlling for other factors related to both mental health and tobacco use during pregnancy. Methods. This cross-sectional analysis used 2017 Behavioral Risk Factor Surveillance Survey (BRFSS) data for 621 pregnant women aged 18-38 from Florida (N=136), Kansas (N=116), Minnesota (N=105), Nebraska (N=90), New York (N=78), and Utah (N=96). Multiple logistic regression analysis was used to assess the relationship between current mental health status and current tobacco use, while controlling for state, depression diagnosis, routine checkup, healthcare plan, age, marital status, ethnicity/race, education level, income level, and employment status. Results. Overall, very few participants reported current smoking (6%) and about one-third reported low or moderate mental health status in the past 30 days. Adjusted results indicated that those who reported high mental health status were about 3 times less likely (OR=0.29, 95% CI=0.09, 0.88) to report current smoking status compared to those who reported low mental health status. Conclusions. Overall, current mental health status was highly related to current smoking status in pregnant women. Clinicians in obstetrics may expect a very low proportion of pregnant women to report smoking and up to one-third to report low or moderate current general mental health status. Given that current mental health issues and current tobacco use may harm both mother and child, be highly related in pregnant women, and change throughout the pregnancy, pregnant women should be screened automatically for both at each visit.

Background:Diabetic foot ulcers (DFUs) are a major burden to patients and to the health-care systems of many countries. To prevent or treat ulcers more effectively, predictive biomarkers are needed. We examined temperature as a biomarker and as a causative factor in ulcer development.Methods:Thirty-seven individuals with diabetes were enrolled in this observational case-control study: nine with diabetic neuropathy and ulcer history (DFU), 14 with diabetic neuropathy (DN), and 14 nonneuropathic control participants (DC). Resting barefoot plantar temperatures were recorded using an infrared thermal camera. Mean temperatures were determined in four anatomical regions—hallux and medial, central, and lateral forefoot—and separate linear models with specified contrasts among the DFU, DN, and DC groups were set to reveal mean differences for each foot region while controlling for group characteristics.Results:The mean temperature reading in each foot region was higher than 30.0°C in the DFU and DN groups and lower than 30.0°C in the DC group. Mean differences were greatest between the DFU and DC groups, ranging from 3.2°C in the medial forefoot to 4.9°C in the hallux.Conclusions:Increased plantar temperatures in individuals with a history of ulcers may include acute temperature increases from plantar stresses, chronic inflammation from prolonged stresses, and impairment in temperature regulation from autonomic neuropathy. Diabetic foot temperatures, particularly in patients with previous ulcers, may easily reach hazard thresholds indicated by previous pressure ulcer studies. The results necessitate further exploration of temperature in the diabetic foot and how it may contribute to ulceration.

Purpose: Research shows conflicting findings for prevalence of alcohol use, binge drinking, and heavy drinking between veteran males and females, and as compared to civilians. The purpose of this study was to assess whether alcohol use, binge drinking, and heavy drinking differ by veteran and gender status in adults ages 25 and older in the general population. Methods: This cross-sectional analysis used 2015 data from the Behavioral Risk Factor Surveillance System (BRFSS) for males and females ages 25 and older in Alaska, Maine, Montana, Oregon, and South Carolina. Separate multiple logistic regression analyses by state were used to assess patterns in relationships between alcohol outcomes and veteran and gender status while controlling for demographic factors, depression, and tobacco use. Results: About half of male and female adults 25 and older reported alcohol use, and few reported binge drinking or heavy drinking. Across all states, both veteran and nonveteran males reported more alcohol use and binge drinking than female non-veterans. In addition, binge drinking and heavy drinking showed moderate to high relations to smoking in all 5 states. Conclusion: The results of adjusted analyses indicated that in all five states, alcohol use and binge drinking differed significantly by veteran and gender status. In addition, binge drinking and heavy drinking were significantly related to smoking in all 5 states. For adults ages 25 years and older in a primary care setting, providers may expect a moderate prevalence of alcohol use, and low prevalences of binge drinking, heavy drinking, and smoking. Standard of care is to automatically screen for alcohol use and tobacco use in all patients. However, if signs of either alcohol misuse or smoking are present, especially among males, providers should consider screening for alcohol misuse.

Purpose: Research linking health status and healthcare access does not clearly establish the relative impact of healthcare coverage versus healthcare cost for health status outcomes, especially for middle-aged women. Therefore, the purpose of this study was to determine whether general, physical, and mental health status outcomes differed by healthcare coverage or healthcare cost in multiple samples of middle-aged females. Methods: This cross-sectional analysis used 2015 data from the Behavioral Risk Factor Surveillance System (BRFSS) for females aged 35-54 from Alabama, Arkansas, Louisiana, and Mississippi. To establish patterns in relations, multiple logistic regression analysis by state assessed the relationships separately for general health, mental health, and physical health with healthcare coverage and healthcare cost while controlling for other health and demographic factors. Results: Most participants reported good general health status (73-79%), and about half reported good physical health status (54-59%) and good mental health status (54-58%) despite also reporting two or more health conditions (47-53%). In addition, most participants reported having healthcare coverage (82-92%) and not having cost preclude doctors’ visits (74-82%). The results of adjusted analysis indicated that good general, mental, and physical health status outcomes were inversely related to healthcare cost in three of four states and to two or more health conditions in all four states. In addition, good general health status and physical health status were related positively to income level in 3 of 4 states. Conclusion: Overall, general, physical, and mental health status outcomes in middle aged women showed consistent patterns of relations with healthcare cost across similar samples, but not to healthcare coverage. In addition, all three health status outcomes were related to multiple health conditions, and general and physical health were related to income level. Although this study lacked specific information for healthcare concerns and costs for middleaged women, providers and policy makers should consider the costs of health management for middle-aged female patients, especially in low income areas.

Purpose: Alcohol use and cholesterol are related in men and postmenopausal women but relations between alcohol use and cholesterol are unclear for premenopausal women. The purpose of this study was to determine whether alcohol use was related to cholesterol in women aged 40-51 years old. Methods: This cross-sectional analysis used 2015 data from the Behavioral Risk Factor Surveillance System (BRFSS) for females aged 40-51 years old from Louisiana, Michigan, Nevada, and Tennessee. Multiple logistic regression analysis was used to assess the relationship between high cholesterol and alcohol use while controlling for high blood pressure, diabetes, weight status, daily fruit and vegetable intake, physical activity, tobacco use, age, and ethnicity/ race. Results: Across states, approximately one-third of women reported being diagnosed with high cholesterol (25-36%) and about half reported any alcohol use (36-55%). The results of adjusted analysis indicated that high cholesterol was not significantly related to alcohol use in three of four states. However, high cholesterol was significantly related to blood pressure in all four states with moderate to large effect sizes, and to weight status and tobacco use in three of four states with moderate to large effect sizes. Conclusion: The results of this study indicate that high cholesterol is not related to alcohol use in females aged 40-51 years old, but is moderately to highly relate to high blood pressure, weight status, and tobacco use. For premenopausal women in a primary care setting, about one-third may have high cholesterol, and because high cholesterol, high blood pressure, overweight or obese, and smoking are moderately to highly related, it is recommended to screen for all four if symptoms of any are present and educate and treat as comorbid conditions.

Sleep and mental health complaints are prevalent in the elderly and share common risk factors. We assessed the relationship between sleep and mental health in three representative samples of elderly women while controlling for multiple risk factors common to both. We performed this cross sectional secondary data analysis in 2015 using 2013 data from the Behavioral Risk Factor Surveillance System (BRFSS) for females ages 65 years and older from California (N = 1912), Florida (N = 9120), and Pennsylvania (N = 2429). We conducted multiple logistic regression analysis to assess the relationship between sleep duration group (short, moderate/reference, or long) and mental health issues in the past 30 days (yes or no) in elderly females, while controlling for multiple covariates. About 25% of the elderly females reported mental health issues and 20% reported short or long sleep durations. In adjusted analysis, compared to the elderly females in the moderate sleep duration group (averaging 6-8 h of sleep per day), those in the short and long sleep duration groups had increased prevalence of mental health issues by 66% and 26%, respectively. Mental health was also related to physical health issues including general health status, activity limitations, and chronic health conditions. Overall, sleep was related to mental health in representative samples of elderly females even after controlling for risk factors common to both. Even though we could not determine the direction of influence, the findings indicate a need for clinicians to screen their elderly female patients for both sleep and mental health issues, especially in those with physical health comorbidities.

Purpose: Many veterans face difficulties related to physical and mental health issues, but little is known about how these are related within veterans in the general population. The purpose of this study was to examine the association between current mental health, health problems, and activity limitations in population-based samples of veterans aged 25 years and older. Methods: This cross sectional analysis used 2015 data from the Behavioral Risk Factor Surveillance System (BRFSS) for veterans aged 25 and older from Oklahoma, Virginia, and Washington. Multiple logistic regression analysis was used to assess the relationship between current mental health, health conditions, and activity limitations after controlling alcohol use and demographic variables. Results: Across states, most veterans aged 25 and older reported good current mental health (77-81%), about half reported 3 or more health conditions (40-54%), and about one-fourth reported activity limitations (17-28%). After controlling for alcohol use and demographic factors, good current mental health was inversely related to health conditions and activity limitations in all three states with moderate to high effect sizes. Conclusion: The results of this study indicated that current mental health among veterans aged 25 years and older in general populations is significantly related to health conditions, activity limitations, and gender. Because of moderate to high relations, primary care practitioners should screen for mental health, health conditions, and activity limitations if a veteran, especially a female veteran, presents with any of these, and then educate, treat, and provide referral services as comorbid conditions versus separate issues.

Purpose: There is limited research surrounding how mental health in post-myocardial infarction (MI) patients differs by gender and ethnicity. Therefore, the purpose of this study was to determine whether mental health differs by ethnicity in post-MI older adult females with coronary artery disease (CAD). Methods: This cross-sectional analysis used 2015 BRFSS data for post-MI females 50 years of age and older from Arkansas, Kentucky, and Tennessee. Multiple logistic regression analysis was used to assess the relationship between mental health and ethnicity/race while controlling for age, education level, income level, marital status, physical activity, and depression. Results: About half of post-MI older adult females reported good mental health in the last month (56-58%) and most were White, non-Hispanic (73-80%), followed by Black, non- Hispanic (15-17%), and other ethnic/racial groups (4-11%). The results of this study indicated that mental health did not differ significantly by ethnicity/race in any of the three states after controlling for demographic factors, physical activity, and depression. However, good mental health was inversely related to depression in all three states and positively related to age in two of three states. Conclusion: Mental health did not differ significantly by ethnicity/race in post-MI older adult females. However, within this target population, good mental health was less likely in those with a previous diagnosis of depression in all three states and more likely in those aged 65 and older in two of three states. Although there was no information in this study regarding mental health progression following a myocardial infarction, primary care providers and cardiologists should screen all post-MI female patients, despite their ethnicity/race, for good mental health, especially those who have a previous diagnosis of depression and those ages 50-64 years. Mental health education and referrals should be provided to post-MI older adult females of all ethnicities as needed.

Purpose: Skin cancer is a major health concern in the general population, but there are conflicting findings regarding its relationship to where people live. The purpose of this study was to determine whether skin cancer differs by metropolitan status in the general population of U.S. adult males and females aged 18 and older. Methods: This cross sectional analysis used 2015 data from the Behavioral Risk Factor Surveillance System (BRFSS) for males and females aged 18 years and older. Multiple logistic regression analysis was used to assess the relationship between skin cancer and metropolitan status separately by gender while controlling for other cancers, general health, educational level, employment status, income level, ethnicity, and age. Results: Across states, 20% of males and 15% of females reported skin cancer and roughly 20% of both males and females lived in rural areas, 40% in suburban areas, and 40% in urban areas. After controlling for health, socioeconomic and demographic factors, skin cancer and metropolitan status were significantly related for both males and females. Skin cancer was also related to other cancers, income level, ethnicity/race, and age for both genders. Conclusion: This study found that skin cancer significantly differed by metropolitan status with both males and females living in suburban areas reporting more cancer than those living in urban or rural areas. Limitations to this study include a broad definition of skin cancer and no lifestyle variables specific to sun exposure. It is recommended that general practitioners screen, educate, and provide referral services as necessary for both males and females, especially those who live in suburban areas, have a history of cancer, are 65 or older, and are white, non-Hispanic.

Purpose: Physical activity could help prevent or slow deficits in cognition as an individual age; however, little is known about this relationship in females ages 55 to 64. The purpose of this study was to assess the relationship between physical activity levels and cognitive decline in females ages 55 to 64. Methods: This cross sectional analysis used 2015 data from the Behavioral Risk Factor Surveillance System (BRFSS) for females ages 55 to 64 in Connecticut, Montana, and Oregon. Logistic regression was used to assess the relationship between physical activity levels and cognitive decline while controlling for health and demographic factors. Results: Across states, few participants reported cognitive decline (10-14%), and only one-fifth reported being inactive (18-29%), while twice as many reported being highly active (34-48%). Adjusted results indicated that cognitive decline was not found to be significantly related to physical activity levels in any state, but cognitive decline was significantly related to number of health conditions, mental health, and substance use (all with moderate to large effect sizes) in two or three of three states. Conclusion: Across states, cognitive decline was not related to physical activity levels in females ages 55 to 64. The measurement for cognitive decline provided a limited scope of the condition and this study was unable to control for menopause and hormone replacement therapy, which may affect the outcome. Primary providers should not screen for physical activity levels related to cognitive decline in this population, but should screen for cognitive decline, multiple health conditions, current mental health issues, and substance use, if symptoms present for any of these in this target population. Providers should educate patients about the overall benefits of physical activity, but should focus on concurrently managing health conditions and discontinuing tobacco use as related to cognitive decline in females ages 55 to 64.

Objectives: Fruit and vegetable consumption may impact development of diabetes, but limited research has addressed whether daily consumption of fruits and vegetables differs by those with and without diabetes, especially within high-risk groups. Thus, the purpose of this study was to determine whether daily fruit and vegetable consumption differs by diabetes status in middle-aged females in the general US population. Methods: This cross-sectional analysis used 2017 Behavioral Risk Factor Surveillance System data for females ages 45–64 years old in Arizona (n = 2609), Florida (n = 3768), Georgia (n = 1018), and Texas (n = 2092). Multiple logistic regression analysis by state assessed the relationship between the daily consumption of fruit (fruit, 100% fruit juice) and vegetables (green leafy or lettuce salad, potatoes, other vegetables) and diabetes status, while controlling for health status, health behaviors, demographic factors, and socioeconomic status. Results: Across states, relatively similar proportions of participants with and without diabetes reported daily fruit consumption (with: 58%–63%; without: 61%–68%) and daily vegetable consumption (with: 58%–63%; without: 61%–68%). The results of adjusted analyses indicated that daily fruit and vegetable consumption did not differ by diabetes status across states. Conclusion: Across states, daily fruit and vegetable consumption did not differ by diabetes status in middle-aged females. In the primary care setting, providers should educate all females ages 45–64 on the importance of eating fresh fruits and vegetables and may consider sharing information about flavonoid-rich fruit and vegetable consumption for diabetes.

Plantar shear stress has been held accountable as a causative factor in diabetic foot ulcers (DFU) (1,2). Delbridge et al. (2) recognized shear stress as a major causative factor by stating that it is shear rather than vertical load that is responsible for tissue breakdown that occurs deep to the skin. Historically, research in this area has been hampered by an underestimation of the importance of shear stress and the lack of technology to measure it. Emerging evidence within the past decade has demonstrated the clinical significance of shear to foot ulceration (3–5). We previously revealed that individuals with diabetic neuropathy (DN) experience higher plantar shear compared with control subjects (5). However, to our knowledge, no study has compared peak shear in individuals with a history of DFU to those patients with DN but no history of DFU. We quantified peak plantar shear (PS) in 9 subjects with (DFU) and 16 DN subjects without (DN) previous ulcers …

Teenagers have the lowest rate of safety belt use and the highest crash rate compared to other age groups. Past studies on teenagers' belt use have mostly been cross-sectional. The first goals of this study were to examine, at licensure, teenagers' and parents' perceptions of risk of crash/injury for newly licensed teenagers when driving unbelted and teenagers' perceived and parents' intended consequences for safety belt rule violations. In addition, the comparability of these variables to other risky driving behaviors was explored. The second goal was to evaluate the importance of these variables in the prediction of teenagers' belt use during the first year of licensure, relative to other factors related to belt use, including demographics and substance use.More than 2,000 parent-teenager dyads were interviewed by telephone, parents at permit and licensure and teenagers at permit, licensure, and 3, 6, and 12 months after licensure.Approximately a third of the teenagers reported at least once at 3, 6, or 12 months post-licensure not always using their safety belt in the past week. At licensure, participants' perceived risk of safety belt non-use was high and ranked among the behaviors most related to crash/injury for newly licensed teenagers, behind driving under the influence of alcohol or drugs. Parent-imposed consequences for safety belt rule violations were not as highly rated as parent-imposed consequences for driving under the influence of alcohol or drugs. Sequential logistic regression modeled the relationship between safety belt use and perceived risk and consequences of non-use, as well as other prospective predictors assessed at permit and licensure, and driving correlates measured after licensure. Teenagers' extreme perceived risk and parents' intended sure consequences for non-use were significant prospective predictors of regular use during the first year of licensure. Other significant predictors and correlates were race (White), high school grade average of "A," not smoking cigarettes, driving a passenger vehicle, and never receiving a traffic citation or engaging in risky driving behaviors, including driving under the influence of alcohol or drugs and running a red light.While the effect size was small for perceived risk of non-use, it is a modifiable factor and focused intervention contrived to enhance perceived risk could increase teenagers' belt use. Perceived risk is discussed as a target for intervention in relation to the Protection Motivation Theory. This theory appears helpful in guiding future research into the modifiable factors studied here as well as other factors, including perceived rewards and costs associated with non-use.

Motor vehicle crashes are highly elevated among newly licensed teenage drivers. Limits on high-risk driving conditions by driver licensing policies and parents can protect novice teens from negative driving outcomes, while they experience and driving proficiency. The purpose of this research was to evaluate the effects of strict parent-imposed driving limits on driving outcomes during the first year of licensure.A sample of 3,743 Connecticut teens was recruited and randomized to the Checkpoints Program or comparison condition. Assessments conducted at baseline, licensure, 3-, 6-, and 12-months postlicensure included parent-imposed driving limits, traffic violations, and crashes. Bivariate and multivariate analyses were conducted to assess the effects of strict parent limits on traffic violations and crashes during the first year of licensure.Thirty percent of teens reported at least one traffic violation and 40% reported at least one crash. More strict parent-imposed limits at licensure, 3-, 6-, and 12-months postlicensure, were associated with fewer violations and crashes in multivariate analyses. Notably, adherence to recommended night curfew was consistently associated with fewer violations and crashes.The findings indicate that strict parent-imposed limits may protect novice teen drivers from negative driving outcomes.

This report describes intervention effects on parent-imposed driving limits on novice young drivers at licensure. Parent-adolescent dyads (4,344) completed baseline surveys at permit and were randomly assigned to intervention or comparison groups. Intervention families received persuasive communications related to protection motivation theory variables including threat appraisal regarding high-risk adolescent driving and coping appraisal regarding restrictions on high-risk driving conditions during the early months of adolescent licensure. Comparison families received standard information on driving, vehicles, and road safety. Among the 4,344 families, 3,786 adolescents obtained licenses, and 3,398 parent-adolescent dyads completed surveys at licensure. Significant treatment group differences favoring the Checkpoints Program were found at licensure for driving limits, perceived risk, expected limits, and outcome expectations. Perceived risk and outcome expectations partially mediated and expected limits fully mediated treatment effects. The results provide evidence that persuasive materials can alter threat and coping appraisal and expectations, thereby increasing parent-imposed driving limits at licensure.

PROBLEM: There is limited information about how parents view teen driving risks and intend to handle these risks during the licensing process, and how they will respond to graduated licensing provisions. METHODS: Parents in Connecticut were interviewed when their teens got their learner's permit. The survey was undertaken when the state did not have a midnight restriction or a passenger restriction. RESULTS: Generally, parents were well aware of teen driving risks, thought parents should be thoroughly involved in the licensing process, and plan to be active participants themselves. DISCUSSION: Parents were concerned about the risk of driving after midnight and already restrict that behavior. However, parents do not seem to see or understand the risks of having even one teen passenger in the vehicle. IMPACT ON INDUSTRY: The views and existing practices of parents need to be taken into account in deciding on the provisions of graduated licensing legislation and how to best ensure acceptance and compliance.

Research and education aimed at reducing the crash risk of young drivers has become a top priority to researchers and educators around the world. This panel provides an overview of some of these recent and ongoing efforts. To that end, the purpose of this panel is to: 1) raise awareness of human factors and ergonomics researchers of research needs and problems relevant to teen drivers and education, 2) provide a forum for discussion in this area, and 3) provide a paper summarizing key issues including teenage drivers, driver education, and driver licensing.

The purpose of this study was to determine the extent to which parents intend to place driving limits on adolescents approaching unsupervised driving. A total of 658 parents and their 16-year-old adolescents were recruited from a local Maryland Motor Vehicle Administration site as adolescents successfully tested for provisional licenses. Parents completed written surveys about parent-adolescent relations and anticipated adolescent unsupervised driving. The results indicated that parents reported high levels of intended limits on adolescents’ unsupervised driving, especially for trip conditions (e.g., getting permission) when compared with risk conditions (e.g., at night). Almost one third of parents reported completing driving agreements. Overall, intended driving limits and completed driving agreements were more likely when parents reported high levels of parental monitoring (2 times more likely), discussion of driving rules (2 to 4 times more likely), risk perception (2 times more likely), and vehicle access (2 to 3 times more likely). Completed driving agreements were not related to intended driving limits.

The research examined the influence of parent and school variables on minor aggression among early adolescents. Sixth-grade students ( N = 1,081) were interviewed at the beginning of the school year (Time 1) about aggressive behaviors and selected psychosocial variables and at the end of the year (Time 2) about aggressive behaviors. Aggression increased over time and was greater for boys than girls at both time points. In path analyses, Time 1 aggression was directly associated with Time 2 aggression and indirectly associated through affiliation with Time 2 problem-behaving friends. School engagement was associated indirectly with Time 2 aggression through affiliation with problem-behaving friends. Parenting behavior was negatively and directly associated with Time 2 aggression and indirectly through Time 2 affiliation with problem-behaving friends. The findings indicated that selection and previous behavior predicted peer affiliation and parenting and school engagement protected against early adolescent aggression.

An analysis is presented of adolescent driving risk, the advantages of graduated licensing programs, and the potential for parent-based programs to moderate teen driving risks. Risk factors associated with youthful driving illustrate the potential importance and benefits of limiting the amount and conditions under which teens can drive. State policies, such as graduated driver licensing systems that formalize restrictions on youthful driving, have been shown to be effective. However, teen driving risks remain elevated. Parents are in a prime position to extend the benefits of state restrictions by developing and implementing their own tailored family policies on adolescent driving. Unfortunately, parents of adolescent drivers are often under-aware of the need to do so and fail to impose effective driving restrictions. An ongoing parent-based intervention to increase parental restriction on teen driving is described, and issues involved in implementing and evaluating family-centered approaches to reduce teen driving risk are raised.

Motor vehicle crashes are the leading cause of death and injury to teenagers. Crash risks result from their age, inexperience, and risky driving. The purpose of this study was to determine whether parent-imposed delayed licensure and restricted driving are related to fewer teenage risky driving behaviors. At baseline, 275 teenagers with a learner's permit and one of their parents were interviewed about driving attitudes and teenage behaviors. One year later, 161 of the teenagers had since obtained a provisional license and were reinterviewed about time of licensure, parental restrictions on driving, and driving attitudes and behaviors. The results indicated that parents delayed licensure until teens were “ready,” and limited their driving in terms of trip and risk conditions. Higher levels of risky driving behaviors were predicted by younger ages at licensure and fewer limits on driving in the first month, in addition to male gender, higher conflict over driving, lower perceptions of dangers related to driving, more problem behaviors at baseline, and more high-risk driving (e.g., at night, teenage passengers). Overall, the results indicate that a combination of being older at licensure and restricting driving under high-risk conditions at licensure may be an effective way to curb teens' risky driving behaviors.

The goal of this study was to examine the relations among mothers’ awareness of their adolescents’ stressors, mother-adolescent communication, maternal monitoring, and adolescent adjustment in single-parent families. Measures of adolescent stress, communication, monitoring, and adolescents’ anxious/depressed and aggressive behaviors were completed by 82 adolescents and their single mothers. The findings indicated that single mothers were aware of about half of their adolescents’ stressors and not as aware of the importance to their adolescents. Adolescents in the group characterized by high stress/low agreement reported more problem behaviors. Moreover, monitoring mediated the relationship between awareness group membership and adolescent adjustment as high agreement groups reported more monitoring and fewer problem behaviors than did low agreement groups. Thus, during early adolescence when adolescent stress increases and family communication and monitoring change, monitoring by single mothers may increase awareness of adolescent stress, which in turn may buffer the negative effects of stress on adolescent adjustment.

An important research finding is that parent–adolescent communication is related to adolescent adjustment. However, when using self-report measures with multiple reporters, adolescent and parent reports do not correlate highly, and within-rater reports correlate higher than cross-rater reports. This limits the utility of traditional methods of aggregation across raters. The present study used canonical correlation to examine if and how mother and adolescent reports for communication and problem behaviors are related. With reports from 161 adolescents and their mothers, the results indicated that the relationship between mother and adolescent reports differed by problem behavior area. Within-rater reports dominated the dimensions for communication related to aggressive behaviors. For anxious/depressed behaviors, both mother and adolescent reports contributed to the dimensions, with 1 dimension reflecting opposite perceptions of communication and adjustment by mothers and adolescents.

The goal of this study was to examine relations among problem-driving practices and parenting practices. Three hundred adolescents licensed 2 years or less were interviewed about driving behaviors, parenting practices, and orientations toward deviance. Factors significantly related to risky driving behaviors, traffic violations, and motor vehicle crashes included lower levels of parental monitoring and control, and lenient parental restrictions on driving (i.e., friends as passengers and driving curfews). Parental monitoring was among the subset of variables most useful in predicting risky driving behaviors. Violations were 4 times more likely with lenient restrictions related to frequency of friends as passengers and 2 times more likely with low parental control. Crashes were 7 times more likely with lenient restrictions related to frequency of friends as passengers. Overall, the findings suggest that adolescent problem driving is related to parenting practices.

The objective of this study was to determine how accurately teens can report miles driven. Participants were 118 drivers in Connecticut (average age 17(1/2) years; average time licensed 11 months). Half had their own vehicle; half shared family vehicles. Teens completed a telephone survey about their preceding week's driving, then completed a daily trip log for the next week and a second survey about the details of the logged week's trips and miles. Teens with their own vehicle provided odometer readings. Summing the miles for every trip was generally consistent with estimates from odometer readings. Overall mileage estimates were 20-30% lower than those from trip-by-trip listings, except for very low estimates for the first week by teens who shared vehicles. The results indicate that single overall estimates frequently understate total miles driven, but that prompted reviews of each trip can provide valid and detailed information.

The goal of this study was to examine relations among mothers'awareness of their early adolescents' stressors, mother/adolescent communication, and adolescent problem behaviors. Ninth-graders and their mothers completed a stress inventory for high school students, a parent/adolescent communication scale, and a checklist for adolescents' anxious/depressed and aggressive behaviors. The results showed that adolescents reported experiencing more stress for eight content areas than mothers reported for their adolescents. Mother/adolescent communication was related inversely and significantly to adolescent problem behaviors, whether reported by mothers or by adolescents. Mothers' awareness of adolescent stress was related significantly and positively to adolescent reports of mother/adolescent communication and significantly and negatively to adolescents `reports of their anxious/depressed and aggressive behaviors. he findings indicated that mothers were only minimally aware of their adolescents' stressors and that adolescents whose mothers were more aware of their adolescents' stressors and who communicated more with their adolescents reported better adjustment.

The widespread adoption of graduated driver licensing (GDL) policies has effectively reduced crash risk for young drivers; however, parents must support, reinforce, and enforce GDL for it to be effective, and research indicates that parents need better information and instruction for adhering to GDL requirements, conducting supervised practice driving, and restricting independent teenage driving. Because teenagers in most states must take driver education to enter the licensing process prior to age 18, integrating parent involvement into driver education may be an effective way to inform and instruct parents on a large scale about teen driver safety. This study assessed parent attitudes (overall and by rural status, minority status, and income level) toward integrating parent involvement into teenage driver education classes.In this study, 321 parents of teenagers enrolled in driver education classes across the state of Montana completed surveys about current involvement in driver education and attitudes toward required involvement.The results indicated that parents were not very involved currently in their teenagers' driver education classes, but 76% reported that parents should be required to be involved. If involvement were required, parents would prefer having written materials sent home, access to information over the Internet, or discussions in person with the instructor; far fewer would prefer to attend classes or behind-the-wheel driving instruction. There were few differences in parent attitudes by rural or minority status but many by income level. Compared to higher income parents, lower income parents were more likely to endorse required parent involvement in teenage driver education classes and to want parent information from driver education about many teen driving issues.That the majority of parents are open to required involvement in their teenagers' driver education classes is promising because doing so could better prepare parents to understand and adhere to GDL policies, supervise teenagers' practice driving, and manage teen independent driving, all of which could further increase teen driver safety.

to determine access to vehicles, vehicle ownership and its correlates, and types of vehicles driven by teenagers during their first year of licensure.About 3,500 Connecticut teenagers and their parents recruited at DMV offices participated in a study aimed at persuading parents to impose and maintain driving restrictions on their sons and daughters. Telephone interviews with teens and parents, which included questions on vehicles driven, were conducted upon licensure and at intervals throughout the year.The majority of both male and female teens owned vehicles immediately upon licensure. Family income and number of vehicles in the family were associated with early ownership. A year later 74% owned vehicles. Small cars, which provide inferior crash protection, were the most popular vehicle; the percent driving small cars increased from 36% to 42% over the year. About 25% were driving SUVs, pickups, or sports cars, which may increase crash risk for young beginners. One year after licensure, only 35% of teens were driving midsize or large passenger cars, the types of vehicles recommended for them, and about one-third of these vehicles were 10 or more years old. Owners were more likely than non-owners to drive older and smaller vehicles, to drive more miles, do more risky driving, and to have more traffic violations and crashes.Many teenagers in Connecticut were driving vehicles that rank low in crash protection or may increase crash risk. Attention to the young driver problem has been focused primarily on managing driving risks through graduated licensing systems. More attention needs to be given to the vehicles teens drive, and how decisions about vehicle type and ownership are made. Parents exert control over what vehicles their sons and daughters drive, and may benefit from information on how to make choices that better balance cost, safety, and other factors that go into these decisions.

Crash rates among teenagers are highly elevated during the first months of licensure. Parent-imposed driving restrictions on initial driving privileges can reduce exposure to high-risk driving conditions, thus reducing crash risk while teens’ driving proficiency develops. This report describes the effect of the Checkpoints Program on driving limits and outcomes. Connecticut teens who obtained a learners permit over a 9-month period were recruited, providing a final sample of 3743 who obtained driver licenses. Families were randomized to the intervention or comparison condition. Intervention families received by mail a series of persuasive communications related to high-risk teen driving and a parent-teen driving agreement, while comparison families received on the same schedule general information on driving and vehicle maintenance. Relative to the comparison group, teens and parents in the Checkpoints Program reported significantly greater limits on high-risk teen driving conditions at licensure, 3-, and 6-months post-licensure; and intervention teens reported significantly less risky driving at each reporting period. By the 12-month follow up teens in the intervention group were significantly less likely than those in the comparison group to have had a traffic violation. However, no treatment group effect was found for crashes. This is the first study to report significant effects on teen driving behavior and performance of education designed to increase parental-imposed teen driving limits.

The purpose of the investigation was to determine if parent-teen discordance for parent-imposed restrictions on driving conditions, driving rules, and the consequences for driving rule violations were related to risky teen driving. A total of 579 parents and their newly licensed teens were interviewed by telephone, 1 month after teens obtained provisional licenses. In multiple regression analyses, the degree of disagreement with parent restrictions on driving conditions and parent-imposed consequences for driving rule violations were negatively associated with a composite measure of teen risky driving. Female parents were negatively associated and male teens were positively associated with risky driving, but discordance with restricted driving conditions was the most important predictor. Discordance may reflect poor parent-teen relations or inadequate communication about parental expectations. The findings suggest that increasing parent-teen concordance on parent-imposed driving restrictions may help reduce risky teen driving.

Introduction Because crash rates are highly elevated during the first months of licensure, it is advisable for parents to limit teen driving so that teens can gain independent driving experience under less dangerous driving conditions. This report describes the effect of the Checkpoints Program on parent limits on novice teen driving through six months post-licensure. Methods Nearly one-quarter of all Connecticut teens who obtained a learner's permit over a 9-month period were recruited, providing a final sample of 3,743 who obtained licenses within the next 16 months. Families were randomized to the intervention or comparison condition. Intervention families received by mail a series of persuasive communications related to high-risk teen driving and a parent-teen driving agreement, while on the same schedule comparison families received standard information on driver safety. Results Families who participated in the Checkpoints Program reported significantly greater limits on teen driving at licensure, 3-months, and 6-months post-licensure. However, there were no differences in reported risky driving behavior, violations, or crashes. Conclusion This is the first statewide study testing the efficacy of the Checkpoints Program. The results indicate that it is possible to foster modest increases in parental restrictions on teen driving limits during the first six months of licensure using passive persuasive communications, but that the levels of restriction obtained were not sufficient to protect against violations and crashes.

Objectives. We describe intervention effects on parent limits on novice teenage driving. Methods. We recruited parents and their 16-year-old children (n = 469) with learner’s permits and randomized them from August 2000 to March 2003. Intervention families received persuasive newsletters related to high-risk teenage driving and a parent‐teenager driving agreement; comparison families received standard information on driver safety. We conducted interviews when the adolescents obtained a learner’s permit, upon licensure, and at 3, 6, and 12 months postlicensure. Results. Intervention parents and teenagers reported stricter limits on teen driving compared with the comparison group at 12 months, with direct effects through 3 months and indirect effects through 12 months postlicensure. Conclusions. A simple behavioral intervention was efficacious in increasing parental restriction of high-risk teen driving conditions among newly licensed drivers. (Am J Public Health. 2005;95:447‐452. doi: 10.2105/AJPH.2003.023127)

The purpose of this study was to determine whether parent-imposed limits on 16-year-old high-risk driving are stricter in Maryland (MD), a state with graduated driver licensing (GDL) than in Connecticut (CT), a non-GDL state. In both states, parents and adolescents completed telephone surveys about the restrictions that parents placed on their adolescents' driving at night, with adolescent passengers, and at high speeds. In Maryland, surveys took place 1 month (294 parent-adolescent pairs) and 4 months (292 parent-adolescent pairs) after provisional licensure. In Connecticut, surveys took place the first month (132 pairs) and the third month (108 pairs) after adolescent licensure. The findings indicated that after controlling for demographic characteristics, Maryland parents and adolescents reported stricter parent-imposed limits for adolescent passengers, high-speed roads, weekend night driving, and overall limits. Parents in GDL states appear better able to establish and enforce adolescent driving restrictions when the licensing state stipulates, favors, and supports regulated adolescent driving.

The purpose of this study was to determine whether exposure to a brief intervention administered at the Motor Vehicle Administration (MVA) increases parental limits on teen driving. A total of 658 parents and their 16-year-old adolescents were recruited from a local MVA site as adolescents successfully tested for provisional licenses. At the MVA, participating parents completed written surveys about expected teen driving during the 1st month of provisional licensure. One month later, 579 parent-teen dyads completed follow-up telephone interviews about teen driving within the past month. On weeks assigned as intervention, parents were exposed to a video and given the video and a driving agreement to take home. In multivariate linear regression analyses, the results indicated that when controlling for selected demographic and baseline psychosocial variables, intervention parents reported more driving rules, restricted driving, limits for high-speed roads, weekend night restrictions, and overall driving limits than did parents in the control group. When compared to control teens, intervention teens reported more limits on passengers, high-speed roads, and night driving, and on overall driving limits, but there were no differences for overall driving or driving under high-risk conditions. In addition, intervention parents were about 3 times, and intervention teens were about 5 times, more likely than controls to report using a parent-teen driving agreement. These results indicate that brief exposure to intervention at an MVA office may help increase parental limits on teen driving.

Introduction: With a growing interest in increasing parental involvement in teen driving, it is important to find out what parents are already doing. Method This study assessed the content, delivery, rigidity, and consequences of 143 driving rules reported by 24 parent-teen dyads. Results: Strengths included that driving rules covered the full range of concerns, especially night driving limits and passenger limits, and most parents and teens reported that violations would be followed by consequences, especially talk/warn or no driving. Weaknesses included that many rules were not very strict and only half showed parent-teen agreement on content. Conclusions: These findings suggest that teen driving rules are not clearly defined.

This investigation sought to determine if Maryland’s new graduated licensing programwas associated with greater levels of parental involvement in, and restriction on, teens’ unsupervised driving. Separate samples of teens with provisional licenses were interviewed by telephone before ( n= 424) and after ( n= 600) the new program took effect. The findings indicated that teens in the new program reported significant increases in the frequency of parental driving instruction and supervised driving during the permit phase. There were no differences in amounts of instruction or supervised driving after provisional licensure. Also, teens in the new program reported greater overall amounts of parental restriction on their driving; however, few specific restrictions showed increases. Programs that encourage parents to regulate, restrict, monitor, and supervise the driving privileges of their teens during their provisional period of licensure are recommended. Graduated licensing laws and programs benefit from specific behavioral interventions targeted to, and implemented by, parents.

Objective: The purpose of this study was to determine the extent to which effects of exposure to a brief intervention designed to increase parental restrictions on teen driving privileges persisted over time. Design: A total of 658 parents and their 16 year old adolescents were recruited from a local motor vehicle administration (MVA) site as adolescents successfully tested for provisional licenses. At the MVA, parents completed written surveys about expected teen driving during the first month of provisional licensure. Afterwards, on weeks assigned as intervention, parents watched a video and were given the video and a driving agreement to take home. Both parents and teens completed follow up telephone interviews about communication, amounts, and limits on teen driving at one month (579 dyads), four months (529 dyads), and nine months (528 dyads). Results: The results indicated that both intervention parents and teens were much more likely to report using a driving agreement at each follow up during the nine month period. Significant treatment group differences persisted for communication about driving, but effects related to limits on teen driving that were evident at one month declined over time. Reports for passenger, road, and overall limits remained significant at four months; fewer were present at nine months. There were no differences in amounts of teen driving at four or nine months. Conclusions: It is possible to reach parents through brief interventions at the MVA and successfully promote increases in initial parental restrictions on teen driving with modest persistence for at least four months.

Motor vehicle crashes are extremely high among young drivers during at least the first year of licensure. Crash risks decline with increased experience, but the more newly licensed teenagers drive, the greater their risk exposure. Hence, the dilemma facing policy makers and parents is how to provide young drivers with driving experience without unduly increasing their crash risk. Graduated driver licensing policies serve to delay licensure and then limit exposure to the highest risk conditions after licensure, allowing young drivers to gain experience only under less risky driving conditions. A similar strategy is needed to guide parents. Parents do not appear to appreciate just how risky driving is for novice drivers and tend to exert less control over their teenage children's driving than might be expected. Recent research has demonstrated that simple motivational strategies can persuade parents to adopt driving agreements and impose greater restrictions on early teen driving.

Background: Parent-teen driving agreements are potentially important tools to facilitate parental management of teen driving and reduce adolescent driving risk. The Checkpoints Parent-Teen Driving Agreement (Checkpoints P-TDA) was designed so that parents could initially impose strict limitations on teen driving in high-risk driving conditions (e.g., at night and with teen passengers) and gradually increase driving privileges over time as teens demonstrate responsible driving behavior. Methods: To assess the acceptability of the format and content of the Checkpoints P-TDA, it was pilot tested with a convenience sample of 47 families recruited as their teens tested for a driver’s license at five private driving schools in Connecticut. Family members were interviewed at the driving schools about potential limits on teen driving, asked to use the driving agreement, and re-interviewed within 3 months about acceptability of the driving agreement and initial driving limits placed on teens. Results: Most families (38 of 47) used and liked the agreement. In addition, most parents placed the recommended strict initial limits on teen driving related to driving unsupervised at night, with teen passengers, and on high-speed roads. Moreover, parents reported placing more strict limits on their teens’ driving than they originally intended. Conclusions: The results showed promise for the acceptability of the Checkpoints P-TDA, which will be tested statewide.