Learning to drive is a major rite of passage for teens (and their parents). It's a time of exciting possibilities and achievements. It's also a time of grave risk.

Driving is fatal for almost 50,000 Americans every year. Those between ages 15 and 24 (especially males) have the highest rate of auto-related deaths, even though people in this age group may be smart, skilled, and have great reflexes. A collision is the most likely tragedy to kill or cripple a teenager.

In addition, automobile accidents are a leading cause of death in infants and children. (See: Child safety seats)

Cars have many important safety features -- seat belts, shoulder straps, headrests, air bags, padded dashes, safety glass, collapsible steering columns, anti-locking breaks, and a host of other less-recognized improvements.

Regardless, reckless driving still proves a danger to teens.

All new drivers should take a driver's education course. These courses have been proven to reduce accidents, but they are not enough. Teens often feel like serious accidents will not happen to them. But teens can take steps to change the odds in their favor.

Teenage-related driving deaths frequently occur in the following situations:

• After dark. Automatic reflexes and driving skills are just developing during the first months of driving. Darkness is an extra variable to cope with.
• When driving with friends. Teens are safer driving by themselves or with family. They should drive as much as possible with an experienced driver, who can help develop good driving habits. As tempting as it may be, new drivers should wait until they have a consistent, safe driving record before taking friends as passengers. Friends, to the new driver, are a big distraction and a significant liability. (This liability may extend to the parent.)
• With recreational driving. For the first 3 to 6 months after obtaining a license, new drivers should try to gain their experience driving for school and work, not for fun.
• When not buckled-up. Use safety gear like a pro.
• When drowsy. Anyone who is sleepy should stop driving until fully alert. Sleepiness may cause even more accidents than alcohol.
• After drinking alcohol. Drinking slows reflexes and impairs judgment. These effects happen to anyone who drinks. So, NEVER drink and drive. ALWAYS find someone to drive who has not been drinking -- even if this means an uncomfortable phone call.
• After use of marijuana or any other illegal drug or any prescription drug that is sedating. Drugs can be just as dangerous as alcohol.
• When distracted. Use of cell phones, eating, drinking, or putting on makeup while driving are dangerous for all drivers.

REDUCING ACCIDENTS

Parents should discuss "household driving rules" with their teens and help their new drivers stick to them. An excellent method to stimulate discussions and set expectations is actually to have parents and teens sign a written "driving contract". This document should specify the rules and consequences of breaking the rules. Be sure to state in the contract that parents have the final say. Consider all the issues above when writing the contract.

Parents should encourage their teens to call without consequence rather than get in a car with a driver who has been drinking. However, should the parents discover that their child has been driving and drinking, the parents should ask the state to suspend that teenager's license until the teen is 18. (In many states the parent must sign for a teenager under 18 to obtain a driver's license. At any time before the 18th birthday a parent can refuse responsibility and the state will take the license.)

A MESSAGE TO TEENS

These suggestions are not intended to be a punishment, but to prevent accidents, life-long disability, and death. You are worth far more than the inconvenience and hassle. You can set an example for friends on how to drive responsibly. You might even save a life.

Martinez R. Teen crash victims: who are these people and why are they here? Ann Emerg Med. 2005; 45(2): 155-156.

Gonzales MM. Student drivers: a study of fatal motor vehicle crashes involving 16-year-old drivers. Ann Emerg Med. 2005; 45(2): 140-146.