title: Effect of the teen driving plan on the driving performance of teenagers before licensure: a randomized clinical trial.
abstract: OBJECTIVE
  Many studies have failed to show an effect of parent-supervised practice driving on the driving performance of teenagers; nevertheless, most Graduated Driver Licensing programs have provisions that require supervised practice.
  
  
  OBJECTIVE
  To determine whether a web-based intervention, the Teen Driving Plan (TDP), can improve the driving performance of teenagers before licensure as measured by the Teen On-road Driving Assessment (tODA).
  
  
  METHODS
  Randomized, single-blind, clinical trial among 217 dyads (1 parent: 1 teenaged learner's-permit holder) to test TDP effectiveness on increasing the quantity and diversity of supervised practice and improving the teenagers' prelicensed driving performance. The study was conducted from December 2011 through January 2013 in Southeastern Pennsylvania.
  
  
  METHODS
  Dyads were randomized (3:2) to receive the TDP or the Pennsylvania driver's manual (control group). The TDP is a psychoeducational intervention designed to increase the quantity and diversity of parent-supervised practice. Materials are grouped by the following driving environments: empty parking lots, suburban residential streets, intermediate (1- or 2-lane) roads, highways, rural roads with curves and elevation changes, and commercial districts.
  
  
  METHODS
  The main outcomes were self-reported practice driving across 6 environments and 2 conditions and driving performance as measured by the teenagers' completion of the standardized and validated tODA 24 weeks after enrollment. Certified professional driving evaluators blinded to randomization status terminated the tODA if they determined that the teenager could not safely complete it. We examined mean differences in the quantity of supervised practice, differences in the overall proportion of teenagers in each group that had assessments terminated for unsafe driving, and the point of termination during the assessment.
  
  
  RESULTS
  The TDP dyads reported more practice in 5 of the 6 environments and at night and in bad weather compared with the control dyads. Overall, 5 of 86 TDP teenagers (6%) had the tODA terminated compared with 10 of 65 control teenagers (15%) (risk difference [TDP - control], -9% [95% CI, -21% to 2%]; P = .06). The hazard ratio for exposure to TDP was 0.35 (95% CI, 0.12-1.03; P = .05, log-rank test).
  
  
  CONCLUSIONS
  Preliminary evidence suggests that the TDP improves supervised practice and the driving performance of prelicensed teenaged drivers. Future studies can explore how to revise the TDP to enhance the treatment effect and how best to disseminate the TDP without compromising implementation fidelity.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT01498575.
authors: Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors: Jessica H
authors: JH
authors: Mirman
authors: Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania2Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors: Allison E
authors: AE
authors: Curry
authors: Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania3Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors: Flaura K
authors: FK
authors: Winston
authors: Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors: Wenli
authors: W
authors: Wang
authors: Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor5Survey Methodology Program, Institute for Social Research, University of Michigan, Ann Arbor.
authors: Michael R
authors: MR
authors: Elliott
authors: Department of Psychology, Drexel University, Philadelphia, Pennsylvania.
authors: Maria T
authors: MT
authors: Schultheis
authors: Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors: Megan C
authors: MC
authors: Fisher Thiel
authors: Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania2Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia3Department of Pediatri.
authors: Dennis R
authors: DR
authors: Durbin
mesh_terms: D000293:Adolescent; D001334:Automobile Driving / Q000193:education*; D003194:Computer-Assisted Instruction; D004521:Educational Measurement; D005260:Female; D006801:Humans; D020407:Internet; D008004:Licensure; D008297:Male; D010287:Parent-Child Relations; D010414:Pennsylvania; D015397:Program Evaluation; D016037:Single-Blind Method; D014481:United States