Impaired-Driving Prevalence Among US High School Students: Associations With Substance Use and Risky Driving Behaviors

Objectives. We examined the prevalence of impaired driving among US high school students and associations with substance use and risky driving behavior.Methods. We assessed driving while alcohol or drug impaired (DWI) and riding with alcohol- or drug-impaired drivers (RWI) in a nationally representative sample of 11th-grade US high school students (n = 2431). We examined associations with drinking and binge drinking, illicit drug use, risky driving, and demographic factors using multivariate sequential logistic regression analysis.Results. Thirteen percent of 11th-grade students reported DWI at least 1 of the past 30 days, and 24% reported RWI at least once in the past year. Risky driving was positively associated with DWI (odds ratio OR] = 1.25; P < .001) and RWI (OR = 1.09; P < .05), controlling for binge drinking (DWI: OR = 3.17; P < .01; RWI: OR = 6.12; P < .001) and illicit drug use (DWI: OR = 5.91; P < .001; RWI: OR = 2.29; P = .05). DWI was higher for adolescents who drove after midnight (OR = 15.7), drove while sleepy or drowsy (OR = 8.6), read text messages (OR = 11.8), sent text messages (OR = 5.0), and made cell phone calls (OR = 3.2) while driving.Conclusions. Our findings suggest the need for comprehensive approaches to the prevention of DWI, RWI, and other risky driving behavior.Motor vehicle crashes are the leading cause of mortality for US adolescents.1 In general, alcohol and drug use impairs driving performance in proportion to the amount consumed and contributes significantly to motor vehicle crashes,2,3 particularly among younger drivers.4 In 2008, 31% of young drivers who were killed in motor vehicle crashes had been drinking5; in 2009, half of the child passengers who died in crashes involving alcohol were riding with an alcohol-impaired driver.6 Illicit drug use also contributes to a large portion of fatal motor vehicle crashes involving adolescents and adults.7–10 Despite downward trends among adolescents in rates of drinking and driving (from 17% in 1991 to 10% in 2009) and riding with drinking drivers (from 40% in 1991 to 28% in 2009), rates remain alarmingly high.11 Therefore, better understanding of the current prevalence, variability, and determinants of adolescent driving while intoxicated (DWI) and riding with alcohol- or drug-impaired drivers (RWI) is needed to guide the development of prevention strategies.Adolescence, the transition period from childhood to emerging adulthood, is a time of increased sensation seeking and risk behavior.12,13 During this transition, learning to drive and obtaining a license are major rites of passage for entering adulthood. However, adolescent drivers have high crash rates and tend to drive in a deliberately risky manner, typified by speeding, close following, sharp cornering, and hard stops.14–18 At the same time, drinking and drug use increase during adolescence, and vehicles become a primary means of transportation and provide a somewhat private place for adolescents to drink and use illicit drugs.19,20Previous research indicates that the prevalence of DWI and RWI among adolescents is higher for male than female adolescents and for Latinos than Whites.21–24 Concurrent and longitudinal research has shown that drinking, binge drinking, cigarette use, and marijuana use are associated with adolescent DWI and RWI.20,25–28 Similarly, drinking, drug use, and traffic violations are associated with adolescent risky driving.17,26 It has been shown in a few regional studies that risky driving covaries with other problem behaviors,17,26,29 but no national studies have reported associations between risky driving and DWI and RWI among adolescents.Using a national probability sample, we examined the following: (1) the variability in the prevalence of DWI and RWI among adolescents by demographic factors; (2) the association between risky driving and DWI and RWI; and (3) the independent contribution of binge drinking, illicit drug use, and risky driving to DWI and RWI.