Drinking and driving is a deadly combination for all age groups (Shope & Bingham, 2008), but the risk of involvement in a motor vehicle crash is greater for teens than for older drivers at all levels of blood alcohol concentration. According to the Youth Risk Behavior Surveillance Survey conducted by the Centers for Disease Control and Prevention (CDC), 9.7 percent of youth in high school reported driving after drinking alcohol. The rate of driving after drinking was higher for boys (11.6 percent) and older students (15.4 percent of 12th graders and 11.4 percent of 11th graders) compared to girls (7.6 percent) and younger students (5 percent of 9th graders and 8.7 percent of 10th graders) (CDC, 2010). Being a passenger in a car in which the driver is under the influence also increases the risk of death or injury related to alcohol. In just one month, the CDC states that 28.3 percent of high school students reported that they had ridden in a car driven by someone who had been drinking (2010).

Of the 3,967 drivers under the age of 20 who were involved in fatal car crashes, 16 percent (619 drivers) were distracted when the crash occurred. Distracted driving can involve a number of different activities that take the driver’s full attention from driving. There are three main types of distraction:

• Visual — taking your eyes off the road
• Manual — taking your hands off the wheel
• Cognitive — taking your mind off what you’re doing (NHTSA, 2010b)

Common practices associated with distracted driving include using a cell phone or GPS; eating or drinking; or adjusting the radio, CD player, or mp3 player. Of those who were distracted, 22 percent were using a cell phone (NHTSA 2010a). According to the National Occupant Protection Use Survey (NOPUS), the percent of 16- to 24-year-old drivers using a hand-held cell phone has remained steady at about eight percent since 2006. After a peak of 1.7 percent in 2008, the percentage of 16- to 24-year-olds texting or manipulating an electronic device has decreased significantly to 1.1 percent. Both use of a hand-held cell phone and manipulating an electronic device remains higher for 16- to 24-year-olds than for all other age groups (NHTSA, 2010c). Inexperienced drivers under the age of 20 have the highest proportion of distraction-related fatal crashes (NHTSA, 2010a). Higher usage of technological devices such as cell phones and less experience multitasking while driving may increase the likelihood that the teen will be distracted (NHTSA, 2008c).

Driving, which provides teens with autonomy from their parents and can be seen as a means for increasing social standing, is often a social event for teens (Allen & Brown, 2008). Because of this, teen drivers often have other teens in the car with them (Shope & Bingham, 2008). Teen passengers increase the crash risk for unsupervised teen drivers (Chen, Baker, Braver, & Li, 2000) and increase the likelihood that the crash is the fault of the teen driver (Shope & Bingham, 2008). Additionally, Chen et al. (2000) found that cars that had more teen passengers were at a higher risk for crashes. This risk is unique to teens. Adult drivers do not show a similar pattern of risk (Shope & Bingham, 2008).
In exploring how teen passengers may influence teen drivers, Allen and Brown (2008) suggest adolescent development and structural restrictions imposed by driving may lead to the increased risk of crashes with peer passengers. They suggest that youth are influenced by

• their drive to engage in risky situations,
• their desire to please peers, and
• the cost associated with alienating peers.

They also suggest that the act of driving imposes restrictions on how youth can interact with peers who are pressuring them. While the driver is held accountable and legally responsible for what happens when he or she is driving, peers who suggest risky behavior are not held responsible for the consequences that occur. Young drivers also have to deal with the inability to gather visual cues from their peers and understand whether they are serious or joking, the inability to joke around or act unconventionally when they are driving, and the inability to focus on addressing peer pressure because they must attend to driving. A national survey found that 94 percent of teens reported seeing passengers, at least sometimes, acting in ways that would distract the driver: 69 percent indicated that they had witnessed teen passengers acting wildly, 53 percent indicated that they had seen passengers who had been drinking alcohol or smoking marijuana, and 45 percent indicated that they had heard passengers urging the driver to speed (Winston et al., 2007).

Allen and Brown (2008) suggest that youth have a higher propensity toward participating in risky behaviors, including those related to driving. Research suggests that teenage drivers are more likely to pull into traffic with less space, make illegal lane changes, maintain less distance between cars, and drive faster (Shope & Bingham, 2008; Ivers et al., 2009). This risky behavior increases with the presence of peers, especially male passengers (Simons-Morton, Lerner, & Singer, 2005; Allen & Brown, 2008) and boys are more likely to be involved in speed-related fatal crashes than girls (NHTSA, 2008a). From 2004-2008, 36 percent of 16- and 17-year-old drivers (3,429 individuals) were reportedly speeding at the time of the crash. The risk of speeding is higher for youth who have also been drinking. In 2008, 27 percent of youth under 21 and 50 percent of youth 21-24 involved in fatal crashes while speeding had a blood alcohol content of .08 or higher (NHTSA, 2008a).

Teens have the lowest rate of seat belt use of all age groups (CDC, 2010). For example, in 2009, ten percent of high school students reported they rarely or never wore seat belts when riding with someone else. In 2006, 63 percent of the 4,842 youth ages 16 to 20 killed in motor vehicle crashes were not wearing a seat belt (NHTSA, 2008a). The rate of seat belt use is even lower when coupled with other risk factors such as driving at night or after drinking (NHTSA, 2008b). In 2009, 60 percent of young drivers involved in crashes while under the influence were not wearing seat belts, and 70 percent who died were unrestrained (NHTSA, 2011).

There is a higher crash risk associated with driving at night and on the weekends for all drivers, but the risk is even higher for youth (Shope & Bingham, 2008). In 2009, the highest percent of crashes for teens occurred between 6 and 9 p.m. (18 percent), 9 p.m. and midnight (17 percent), and midnight and 3 a.m. (16 percent) (Insurance Institute for Highway Safety (IIHS), 2009). Further, the 2009 data suggests that 55 percent of fatal crashes for teens occurred on the weekends; 16 percent of crashes occurred on Friday, 21 percent on Saturday, and 18 percent on Sunday (IIHS, 2009). Limited visual information, fatigue, alcohol use, risk-taking, and the presence of teen passengers in the car all lead to increased crash risk for young drivers.

A higher number of young drivers are involved in fatal crashes on rural roads compared to urban roads. According to the National Highway Traffic Safety Administration (NHTSA), crashes on rural roads represent 56 percent of fatal crashes and 57 percent of fatalities for young drivers (2009).