LAUSR

PURPOSE Motor-vehicle crashes continue to be the leading cause of death for teenagers in the United States. The United States has some of the youngest legal driving ages worldwide. The objective of this study was to determine rates and factors associated with injury crashes among 14- and 15-year-old drivers and how these varied by rurality. METHODS Data for this cross-sectional study of 14- and 15-year-old drivers were obtained from the Iowa Department of Transportation from 2001 to 2013. Crash and injury crash rates were calculated by rurality. The relationship between crash and driver factors and injury was assessed using logistic regression. FINDINGS Teen drivers, aged 14 and 15 years, had a statewide crash rate of 8 per 1,000 drivers from 2001 to 2013. The majority of crashes occurred in urban areas (51%), followed by in town (29%), remote rural areas (13%), and suburban areas (7%). Crash and injury crash rates increased as level of rurality increased. The odds of an injury crash increased more than 10-fold with the presence of multiple other teens as passengers, compared to no passengers (OR = 10.7, 95% CI: 7.1-16.2). CONCLUSIONS Although 14- and 15-year-old drivers in Iowa have either limited unsupervised (school permits) or supervised only driving restrictions, they are overrepresented in terms of crashes and injury crashes. Rural roads and multiple teen passengers are particularly problematic in terms of injury outcomes. Practical applications: Results from this study support passenger restrictions and teen driving interventions designed with a rural focus.