title: Changing mobility patterns and road mortality among pre-license teens in a late licensing country: an epidemiological study.
abstract: BACKGROUND
  Whereas the safety of teens in early licensing countries has been extensively studied, little is known about the safety of pre-license teens in late licensing countries, where these teens also may be at risk. This risk exists because of the combination of a) increasing use of travel modes with a high injury risk, such as bicycles and mopeds, b) inexperience, and c) teens' developmental stage, known to be associated with risk taking and novelty seeking, especially among males. To explore the magnitude and nature of pre-license road risk, this study analysed epidemiological data from the Netherlands, and hypothesized that in this late licensing country, 'independent travel' and the use of riskier modes of transport increase among pre-license teens 10 to 17 years of age, resulting in higher fatality rates, with 'experience' and 'gender' as risk modifying factors.
  
  
  METHODS
  National travel and fatality data of pre-license adolescents in the Netherlands were analysed by traffic role (cyclist, pedestrian, car passenger and moped rider), and compared to a younger age group (0-9 years) and an older age group (18+ years).
  
  
  RESULTS
  The study of travel data showed that teens migrate from being car occupants to being users of riskier modes of transport, specifically bicycles and mopeds. This migration resulted in a strong rise in road fatalities, illustrating the importance of mobility patterns for understanding changes in road fatalities in this age group. The data further suggested a protective role of early cycle experience for young adolescent cyclists, particularly for young males. But further study into the underlying mechanism is needed to confirm this relationship. Moped risk was extremely high, especially among young males, and even higher than that of young male car drivers.
  
  
  CONCLUSIONS
  The study confirmed the importance of changes in mobility patterns for understanding the rising road mortality when youngsters enter into their teens. The focus on fatalities has led to an underestimation of the magnitude of the problem because of the physical resilience of young adolescents that leads to high survival rates but probably also to long term disabilities. In addition, to explore the generalizability of these results, international comparisons among and between early and late licensing countries are necessary, especially in relation to moped riding as an alternative for car driving.
authors.affiliation: SWOV Institute for Road Safety Research, PO Box 1090, Leidschendam, 2260 BB, The Netherlands. divera.twisk@swov.nl
authors.forename: Divera
authors.initials: D
authors.lastname: Twisk
authors.forename: Niels
authors.initials: N
authors.lastname: Bos
authors.forename: Jean T
authors.initials: JT
authors.lastname: Shope
authors.forename: Gerjo
authors.initials: G
authors.lastname: Kok
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality* / Q000517:prevention & control; D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008004:Licensure; D008297:Male; D008875:Middle Aged; D018986:Motor Vehicles / Q000706:statistics & numerical data; D009426:Netherlands / Q000453:epidemiology; D018570:Risk Assessment; D014195:Travel / Q000706:statistics & numerical data / Q000639:trends*; D016138:Walking / Q000706:statistics & numerical data