Every year thousands of people in the U.S. die from motor vehicle crashes. Trying to prevent these crashes is one part of motor vehicle safety. Here are some things you can do to be safer on the road:

• Make sure your vehicle is safe and in working order
• Use car seats for children
• Wear your seat belt
• Don't speed or drive aggressively
• Don't drive impaired

Safety also involves being aware of others. Share the road with bicycles and motorcycles, and watch for pedestrians.

Driving a car can give you freedom. But it’s also one of riskiest things you do every day. More than 36,000 people died in car accidents in the U.S. in 2018. Millions more are injured each year.

Many things can make driving risky. Speeding, not paying full attention to the road, and driving while tired all increase your chances of a crash. Drinking or using drugs can be especially dangerous.

Fortunately, there are things you can do to keep yourself and others safe while in the car. Researchers are working to understand what causes crashes and how to prevent them.

Distracted Driving

You’ve likely seen ads reminding you to keep your eyes on the road. With cell phones and screens everywhere, distracted driving has become a major problem.

“Because we’re so phone driven, the tendency is when somebody calls us or texts us, we want to respond immediately,” says Dr. Bruce Simons-Morton, an NIH expert on teen driving. To drive safely, we have to overcome that powerful impulse, he explains.

Texting can take your eyes off the road for seconds at a time. In just five seconds, you travel the entire length of a football field at 55 miles per hour.

Distraction isn’t limited to phones. It’s anything that takes attention away from driving the car. Eating, playing with the radio, and adjusting your navigation system all distract from safe driving.

“Reaching for objects is also a big problem,” says Simons-Morton. You may take your eyes off the road when you reach for your sunglasses or something in the seat next to you.

People of any age can give in to distractions while driving. Many adults admit to texting, answering calls, and other dangerous behaviors. That’s a problem because teens are modeling their parents’ actions as they learn to drive.

Teen Drivers

Studies show that teen drivers are at greatest risk for crashes. Crashes are higher among 16- to 19-year-olds than any other age group. That’s because some driving skills get better with experience. Teens are also prone to distraction, especially with friends in the car.

“The first six months of driving on their own is the most dangerous,” says Dr. Ginger Yang, a teen driving expert at Nationwide Children’s Hospital and The Ohio State University. The risk of getting in an accident remains high until at least their early 20s.

To help keep new drivers safe, all states now use a graduated licensing system. The system has three stages. Teens first get their learner’s permit, where they are supervised by an adult driver. After passing their driving test, they receive a license that comes with restrictions, like limits on nighttime driving and passengers. After maintaining a safe driving record for a set period, they can get a standard driver’s license.

Yang explains that parents can sometimes become less engaged when their teens first start driving independently. But even after being handed the keys, teens are still looking to their parents.

“Parents need to be good role models, because teens are still watching and learning from how parents behave,” Yang says. She is currently researching how parents can communicate with their teens to help improve their driving.

Yang and her colleagues have been studying ways to help teens who already have a traffic violation. Her team teaches parents ways to strengthen their child’s motivation to drive more safely. Parents learn to use open-ended questions and be active listeners. This technique is called motivational interviewing.

Yang advises parents that “conversations about safe driving need to be small topics each time but be brought up multiple times.”

Timing is important. Both parent and teen need to be calm for conversations to be effective.

Her past studies suggest parents can make a difference. By motivating their teens to engage in safe driving behaviors early on, parents can help teens establish safe driving habits that they carry into adulthood.

Older Drivers

Younger drivers aren’t the only group at greater risk of crashes. As you age, physical and mental changes can make driving more dangerous.

“There’s a number of changes that happen in our vision as we grow older,” says Dr. Cynthia Owsley, who studies the impact of aging on vision at the University of Alabama at Birmingham.

Eye diseases, such as glaucoma, naturally get worse with age. Older adults are also more likely to have certain eye conditions that affect sight, like cataracts and age-related macular degeneration.

Problems distinguishing an object from its background, called contrast sensitivity, are also common. “Think of looking through a dirty windshield: Everything looks kind of washed out,” Owsley says.

Vision problems can also affect your ability to see to the side, or peripheral vision. This can make it harder to see cars in the lanes next to you.

For older adults, changes in the brain can make driving riskier, too. Owsley and others have shown that cognitive decline—problems with memory and other brain functions—increases the likelihood of a car crash.

Changes in physical ability, such as strength and reflexes, can also make driving more dangerous as you age. But getting older doesn’t necessarily mean you have to stop driving.

“I think the public worries about older drivers, but actually most older drivers are quite safe,” Owsley says. It’s older drivers with visual and cognitive impairments that are at greatest risk.

If you’re concerned about an older person’s driving, it’s important to start a conversation with them. Experts advise watching for the signs that driving is getting unsafe, like getting lost on familiar routes, experiencing a near-miss, or receiving a traffic ticket.

You can contact a driving assessment clinic as well. These clinics can provide a professional evaluation of a person’s driving ability. If driving is no longer safe, work with the older adult to develop a plan for getting around without a car.

Safer Driving

Whether you’re a new driver or have been driving for decades, it’s important to think about safe driving.

The good news is that advances in car design and safety technology are helping protect you behind the wheel. You can also do several things to reduce your risk of an accident. Always stay alert. Resist the urge to text or talk on the phone. For more safe driving tips, see the Wise Choices box.

Safe Driving Tips

• Always keep your eyes on the road and your hands on the wheel.
• Don’t multi-task, like talking or texting, eating and drinking, or fiddling with the stereo, entertainment, or navigation system.
• Wear your safety belt.
• Drive at the speed limit. It’s unsafe to drive too fast or too slowly.
• Obey all traffic signs.
• Keep enough distance between you and the car in front of you to avoid a crash.
• Don’t drink and drive.
• When you take a new medicine, ask your doctor or pharmacist about side effects. Some can affect your driving.
• If you have glasses or contact lenses, make sure you have a current prescription and wear them while driving.
• Don’t wear sunglasses or tinted lenses at night.

All drivers face risks, but the factor that contributes most to crashes and deaths for newly licensed and younger drivers appears to be inexperience. Newly licensed drivers, primarily teenagers, have the highest crash rates, but even drivers well into their twenties have higher crash rates than older drivers.

Risk factors for motor vehicle crashes that are particularly elevated among teenage drivers include:

• Inexperience
• Teenage passengers
• Distraction while driving, including from using cell phones and texting
• Driving at excessive speeds, close following, and other risky driving
• Drinking and driving. While drinking and driving is not very common among novices, it causes a disproportionate number of fatal crashes. In the later teen years and young adulthood, drinking and driving increases greatly.
• Driving at night
• Being male. Teenage boys, especially ones with male passengers, are involved in more car crashes than teenage girls. However, the number of females involved in car crashes is increasing.
• Social norms. Risky driving among teenage drivers is higher among teens who report that their friends drive in a risky manner.

Often, several of these risk factors are present: In particular, teens who text while driving are more likely to have other risky driving behaviors as well, compared with those who don’t text while driving. These additional risk factors include drinking and driving and not using a seat belt. In addition, young drivers who own their cars may take more risks. They are more likely to speed, especially at night, and have two or more teen passengers with them.

A positive factor for teen drivers is the presence of an adult passenger. One study showed that teen crash rates were 75% lower when an adult was in the car.

The population of people age 65 and older is the fastest growing demographic in the United States. Many of these older adults will be drivers. Right now, there are more than 30 million licensed drivers age 65 or older.
People between ages 25 and 75 have relatively low crash involvement. After age 75, risk increases because motorists may have health conditions or take medications that negatively affect their driving abilities.
Drivers may be unaware of these changes or unwilling to admit challenges to themselves or others, including family members. In the case of people with cognitive impairments, like dementia, they may be unable to recognize poor performance.

Many family members and caregivers wonder what to do when they think a loved one’s driving skills have diminished. Or, they may not know how to assess one’s driving abilities. They may dread approaching an older adult to discuss the need to modify driving habits or stop driving.

Older adults and their loved ones and caregivers should take a realistic, ongoing inventory of the driver’s skills and openly discuss them. Family members need to remember that many older drivers view driving as a form of independence. Bringing up the subject can make some people defensive, angry, hurt, or withdrawn. Be prepared with observations and questions, listen with an open mind, and be ready to offer transportation alternatives.
You may need to talk with an older driver if you answer “yes” to any of the following questions.

• Does he or she get lost on routes that should be familiar?
• Have you noticed new dents, scratches, or other damage to his or her vehicle?
• Has he or she been warned or ticketed by a police officer for poor driving?
• Has he or she experienced a close call or crash recently?
• Has a doctor advised him or her to limit or stop driving for health reasons?
• Is he or she overwhelmed by road signs, signals, markings, or other things while driving?
• Does he or she take any medication that might affect the capacity to drive safely?
• Does he or she stop inappropriately or drive too slowly, preventing the safe flow of traffic?
• Does he or she suffer from Alzheimer’s disease, dementia, glaucoma, cataracts, arthritis, Parkinson’s disease, diabetes, or another condition that may affect driving skills?

If you need to start a conversation about driving safety, it is important to be caring, respectful, and non-confrontational. Show genuine concern and understanding, and offer alternatives that will not injure the older driver’s self-respect and sense of independence. You might also consider riding with an older driver to observe, encouraging a vision and hearing evaluation, or suggesting a driving safety class. You and/or the older driver can also discuss concerns with a physician, who may have recommendations.

The good news is that, depending on the severity of the problem, older drivers may be able to adjust their driving habits to increase safety. For example, they may limit driving to daylight hours and good weather, or avoid highways and high-traffic areas.

Fatigue can result when you do not get enough sleep or do not get quality sleep. It can impair your driving, similar to alcohol impairment. A survey of the U.S population found that 37% of workers got less than the recommended minimum of 7 hours of sleep.

What causes fatigue?

• Being awake for many consecutive hours
• Not getting enough sleep over multiple days
• Time of day: Your body has a sleep/wake cycle that tells you when to be alert and when it’s time to sleep. The urge to sleep is the most intense in the early morning hours.
• Monotonous tasks or long periods of inactivity
• Health factors such as sleep disorders or medications that cause drowsiness

What are the effects of driver fatigue?

• Nodding off
• Reacting more slowly to changing road conditions, other drivers, or pedestrians
• Making poor decisions
• Drifting from your lane
• Experiencing “tunnel vision” (when you lose sense of what’s going on in the periphery)
• Experiencing “microsleeps” (brief sleep episodes lasting from a fraction of a second up to 30 seconds)
• Forgetting the last few miles you drove

What can employers and workers do to prevent driver fatigue on the job?

Employers:

• Implement policies that set overtime limits and maximum allowable consecutive shifts.
• Ensure sufficient staffing levels across operations.
• Provide employee training on sleep health and fatigue management.
• Implement a workplace sleep disorder screening and management program.
• Allow for rest breaks and napping during extended work shifts.
• Give supervisors and workers fatigue-symptom checklists and encourage self-reporting.
• Encourage peer monitoring of fatigue symptoms among co-workers.
• Review data from in-vehicle monitoring systems to detect signs of possible fatigue episodes, such as lane departures.
• Consider using wearables such as an instrumented wristband to monitor driver fatigue.
• Train incident investigators to assess the role of fatigue in incidents and near-miss incidents.

Workers:

• Get enough sleep (7-9 hours each day). If fatigue persists after adequate sleep, get screened for health problems that may be affecting your sleep.

• Plan your activities outside work to allow enough time for adequate sleep.
• Create a sleeping environment that helps you sleep well: a dark, quiet, cool room with no electronics.
• If you feel fatigued while driving: pull over, drink a cup of coffee, and take a 15-30 minute nap before continuing. The effects are only temporary – the only “cure” for fatigue is sleep.
• Watch yourself and your co-workers for signs of fatigue.
• Report instances of fatigue in yourself and others to your direct supervisor, who can help to determine the safest course of action.
• Speak honestly if you are questioned about a fatigue-related incident. Fatigue is a normal biological response – it is not a reflection of how well you do your job.

The bottom line:

No amount of experience, motivation, or professionalism can overcome your body’s biological need to sleep. Employers and workers can take steps to prevent the chain of events that could lead to a fatigue-related crash. Employers, learn more about starting a fatigue risk management system.

Nine people in the United States are killed every day in crashes that are reported to involve a distracted driver.

Distracted driving is doing another activity that takes the driver’s attention away from driving. Distracted driving can increase the chance of a motor vehicle crash.

There are three types of driving distractions

Anything that takes your attention away from driving can be a distraction. Sending a text message, talking on a cell phone, using a navigation system, and eating while driving are a few examples of distracted driving. Any of these distractions can endanger you, your passengers, and others on the road.

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 driving

Distracted driving impacts thousands of Americans each year

• In the United States, over 3,100 people were killed and about 424,000 were injured in crashes involving a distracted driver in 2019.
• About 1 in 5 of the people who died in crashes involving a distracted driver in 2019 were not in vehicles―they were walking, riding their bikes, or otherwise outside a vehicle.

You can visit the National Highway Traffic Safety Administration (NHTSA) website for more information on how data on motor vehicle crash deaths are collected and the limitations of distracted driving data.

Some groups are more at risk for distracted driving

Young adult and teen drivers

• Among fatal crashes involving distracted drivers in the U.S. in 2019:
  • A higher percentage of drivers ages 15–20 were distracted than drivers age 21 and older.
  • Among these younger drivers, 9% of them were distracted at the time of the crash.
• A 2019 survey of U.S. high school students found:
  • 39% of high school students who drove in the past 30 days texted or emailed while driving on at least one of those days.
  • Texting or emailing while driving was more common among older students than younger students (see figure below) and more common among White students (44%) than Black (30%) or Hispanic students (35%).
  • Texting or emailing while driving was as common among students whose grades were mostly As or Bs as among students with mostly Cs, Ds, or Fs.
  • Students who texted or emailed while driving were also more likely to report other transportation risk behaviors. They were:
    • more likely to not always wear a seat belt;
    • more likely to ride with a driver who had been drinking alcohol; and
    • more likely to drive after drinking alcohol.

Distracted driving is preventable

What drivers can do

• Do not multitask while driving. Whether it’s adjusting your mirrors, selecting music, eating, making a phone call, or reading a text or email―do it before or after your trip, not during.
• You can use apps to help you avoid cell phone use while driving. Consider trying an app to reduce distractions while driving.

What passengers can do

• Speak up if you are a passenger in a car with a distracted driver. Ask the driver to focus on driving.
• Reduce distractions for the driver by assisting with navigation or other tasks.

What parents can do

• Talk to your teen or young adult about the rules and responsibilities involved in driving. Share stories and statistics related to teen/young adult drivers and distracted driving.
  • Remind them driving is a skill that requires the driver’s full attention.
  • Emphasize that texts and phone calls can wait until arriving at a destination.

• Familiarize yourself with your state’s graduated driver licensing system and enforce its guidelines for your teen.
• Know your state’s laws on distracted driving. Many states have novice driver provisions in their distracted driving laws. Talk with your teen about the consequences of distracted driving and make yourself and your teen aware of your state’s penalties for talking or texting while driving.
• Set consequences for distracted driving. Fill out CDC’s Parent-Teen Driving Agreement together to begin a safe driving discussion and set your family’s rules of the road. Your family’s rules of the road can be stricter than your state’s law. You can also use these simple and effective ways to get involved with your teen’s driving: Parents Are the Key.
• Set an example by keeping your eyes on the road and your hands on the wheel while driving.
• Learn more: visit NHTSA’s website on safe teen driving.

States are working to prevent distracted driving

• Many states have enacted laws to help prevent distracted driving. These include banning texting while driving, implementing hands-free laws, and limiting the number of young passengers who can ride with teen drivers.
  • The Insurance Institute for Highway Safety tracks cell phone use laws and young passenger restrictions by state.
• While the effectiveness of cell phone and texting laws requires further study, high-visibility enforcement (HVE) efforts for distracted driving laws can be effective in reducing cell phone use while driving. From 2010 to 2013, NHTSA evaluated distracted driving HVE demonstration projects in four communities. These projects increased police enforcement of distracted driving laws and increased awareness of distracted driving using radio advertisements, news stories, and similar media. After the projects were complete, observed driver cell phone use fell from:
  • 4.1% to 2.7% in the Sacramento Valley Region in California,
  • 6.8% to 2.9% in Hartford, Connecticut,
  • 4.5% to 3.0% in the state of Delaware, and
  • 3.7% to 2.5% in Syracuse, New York.

• Graduated driver licensing (GDL) is a system which helps new drivers gain experience under low-risk conditions by granting driving privileges in stages. Comprehensive GDL systems include five components, one of which addresses distracted driving: the young passenger restriction. CDC’s GDL Planning Guide can assist states in assessing, developing, and implementing actionable plans to strengthen their GDL systems.
• Some states have installed rumble strips on highways to alert drowsy, distracted, or otherwise inattentive drivers that they are about to go off the road. These rumble strips are effective at reducing certain types of crashes.

The Federal Government is working to prevent distracted driving

• CDC has developed the Parents Are the Key campaign, which helps parents, pediatricians, and communities help keep teen drivers safe on the road.
• In 2022, the U.S. Department of Transportation released the National Roadway Safety Strategy. Part of the strategy includes supporting vehicle technology systems that detect distracted driving.
• In 2021, Congress provided resources to add distracted driving awareness as part of driver’s license exams as part of the Bipartisan Infrastructure Law.
• Several federal regulations target distractions for workers:
  • In 2009, President Obama issued an Executive Order prohibiting federal employees from texting while driving government-owned vehicles or when driving privately owned vehicles on official government business.
  • In 2010, the Federal Railroad Administration banned cell phone and electronic device use for railroad operating employees on the job.
  • In 2010, the Federal Motor Carrier Safety Administration banned commercial vehicle drivers from texting while driving.
  • In 2011, the Federal Motor Carrier Safety Administration and the Pipeline and Hazardous Materials Safety Administration banned all hand-held cell phone use by commercial drivers and drivers carrying hazardous materials.
• NHTSA has several campaigns to raise awareness of the dangers of distracted driving, including their annual “U Drive. U Text. U Pay.” campaign, which began in April 2014.
• NHTSA has issued voluntary guidelines to promote safety by discouraging the introduction of both original, in-vehicle and portable/aftermarket electronic devices in vehicles.

Infant Car Seats

Car crashes are the number one killer of children ages 1 to 12 years in the United States. Proper use of car seats helps keep children safe. The type of seat your child needs depends on several things, including your child's size and the type of vehicle you have. With so many different car seats on the market, many parents find the job of choosing a car seat to be confusing.

The National Highway Traffic Safety Administration provides a set of guidelines regarding infant car seats. The guidelines are consistent with the recommendations of the American Academy of Pediatrics (AAP) about choosing the most appropriate car seat for your child. AAP provides a listing of car seats and safety seat manufacturers.

Newer cars and trucks are equipped with the LATCH system for installing child safety seats (LATCH stands for Lower Anchors and Tethers for Children). Special anchors, instead of safety belts, keep the seat safely in place. If your car or safety seat does not use the LATCH system, you will have to use the vehicle's safety belts to secure an appropriate car seat.

Be sure that everyone who transports your infant uses an approved safety seat that is properly installed—every time.

Hyperthermia and Heat-Related Illness

The term hyperthermia (pronounced high-purr-THER-mee-yah) refers to heat-related illness—or those illnesses associated with exposure to high temperatures in the environment, causing high body temperature.

When the body is exposed to high temperatures, as on a hot day, the body normally cools itself using different mechanisms, such as heavy sweating and losing heat through the skin. But in certain situations, such as when a person is inside a parked car when it is warm or sunny, sweating and other mechanisms may not be enough to cool high body heat. As a result, the body's temperature rises quickly and may damage the brain and other organs in the body. Normal body temperature is 98.6 degrees Fahrenheit.

Hyperthermia occurs when the body heats up to 104 degrees Fahrenheit. A body temperature of 107 degrees is usually fatal.

Infants' immature body systems are not able to cope with high temperatures, and infants are not able to communicate if they are too warm. That's why they are at especially high risk of hyperthermia.

According to the AAP, deaths from hyperthermia have increased in the last decade, especially among children and pets, mainly as a result of their being left alone in a car for even short periods of time. Even when the air outside is at "room temperature" (about 72 degrees Fahrenheit), the temperature inside a car can increase to more than 100 degrees Fahrenheit in just 30 minutes. One study showed that on a sunny, 72-degree day, the temperature inside a car can reach 117 degrees Fahrenheit, and cracking the windows did not decrease the rate of the rise in temperature. Thus, even when the weather is comfortable outside, children are at high risk for heat stroke and death from being left alone in a car.

Parents and caregivers should never leave a child alone in a car, not even with the windows down, and not even for a minute. In addition, parents and caregivers should develop plans for getting everyone out of the car to ensure that they all exit the car safely and no one is left in the car accidentally.

If you see a child left alone in a parked car, you should call 911 to request emergency help. It could mean the difference between life and death for that child.

Make sure children ages 12 and younger are always properly buckled in the back seat in a car seat, booster seat, or seat belt—whichever is appropriate for their age, weight, and height.

Reduce Their Risk

Motor vehicle crashes are a leading cause of death among children in the United States. In 2020, 607 child passengers* ages 12 and younger were killed in motor vehicle crashes, and more than 63,000 were injured. Of the children who were killed in a crash, 38%^† were not buckled up. Parents and caregivers can make a lifesaving difference by ensuring that their children are properly buckled on every trip.

Data show:

• Car seat use reduces the risk for injury in crashes by 71–82% for children, compared with seat belt use alone.
• Booster seat use reduces the risk for serious injury by 45% for children ages 4–8, compared with seat belt use alone.
• Seat belt use reduces the risk for death and serious injury by about half for older children and adults.

Know the Stages

Make sure children are properly buckled in a car seat, booster seat, or seat belt—whichever is appropriate for their age, weight, and heigh

Install and use car seats and booster seats according to the car seat/booster seat manual. You can get help installing them from a certified child passenger safety technician.

Buckle all children ages 12 and younger in the back seat.

• Buckle children in the middle of the back seat, when possible (using a lap and shoulder belt), because it is typically the safest position in the vehicle.
• Air bags can kill young children riding in the front seat. Never place a rear-facing car seat in front of an air bag.
• Buckle children in car seats, booster seats, or seat belts on every trip—no matter how short the trip.
• Set a good example and help protect everyone in the car by always using a seat belt.

1M: Americans spend more than 1 million days in the hospital each year from crash injuries.

$18B: Crash injuries in 2012 totaled $18 billion in lifetime medical costs. More than 75% of costs occur during the first 18 months following the crash injury.

$33B: Lifetime work lost because of 2012 crash injuries cost an estimated $33 billion.

More than 2.5 million Americans went to the emergency department (ED)—and nearly 200,000 were then hospitalized—for crash injuries in 2012. On average, each crash-related ED visit costs about $3,300 and each hospitalization costs about $57,000 over a person's lifetime. The best way to keep people safe and reduce medical costs is to prevent crashes from happening in the first place. But if a crash does occur, many injuries can still be avoided through the use of proven interventions. More can be done at every level to prevent crashes and reduce injuries, but state-level changes are especially effective.

State officials can:

• Consider using proven interventions that increase the use of car seats, booster seats, and seat belts; reduce drinking and driving; and improve teen driver safety.
• Support traffic safety laws with media campaigns and visible police presence, such as those used with sobriety checkpoints.
• Link medical and crash data to better understand why crashes happen, the economic cost of those crashes, and how to prevent future crashes.

Problem

Motor vehicle crashes are a leading cause of injury in the US—harmful and expensive.

What works to prevent crash injuries?

• Using primary enforcement seat belt laws that cover everyone in the car. A primary enforcement law means a police officer can pull over and ticket a driver or passenger for not wearing a seat belt. A secondary enforcement law means a police officer can ticket a driver or passenger for not wearing a seat belt only if the driver has been pulled over for some other offense.
• Having child passenger restraint laws that require car seat or booster seat use for children age 8 and under, or until 57 inches tall, the recommended height for proper seat belt fit.
• Using sobriety checkpoints, where police systematically stop drivers to check if they are driving under the influence of alcohol.
• Requiring ignition interlocks for people convicted of drinking and driving, starting with their first conviction. Ignition interlocks check and analyze a driver's breath and prevent the car from starting if alcohol is detected.
• Using comprehensive graduated driver licensing (GDL) systems, which help new drivers gain skills in low-risk conditions. As drivers move through the different stages, they receive more driving privileges, such as driving at night or with passengers. Every state has GDL, but the specific rules vary.

Each of these strategies can prevent injuries and save medical costs. Much has been done to help keep people safe on the road, but no state has fully implemented all of these proven interventions.

What Can Be Done

1. Federal government is

• Evaluating and encouraging use of proven programs and policies.
• Educating the public about how to stay safe on the road, such as through Click It or Ticket campaigns.
• Encouraging states to monitor serious injuries from motor vehicle crashes.
• Tracking the nation's progress in reducing crash injuries and deaths.

2. State officials can

• Consider using proven interventions to reduce crashes and injuries. These include:
  • Increasing seat belt use through primary enforcement seat belt laws that cover everyone in the car.
  • Improving child passenger safety with restraint laws that require car seat or booster seat use for children age 8 and under or until 57 inches tall, the recommended height for proper seat belt fit.
  • Reducing drinking and driving by using sobriety checkpoints and requiring ignition interlock use for people convicted of drinking and driving, starting with their first conviction.
  • Improving teen driver safety through the use of comprehensive GDL systems.
• Support traffic safety laws with media campaigns and visible police presence, such as those used with sobriety checkpoints.
• Link medical and crash data to better understand why crashes happen, the economic cost of those crashes, and how to prevent future crashes.

3. Employers can

• Require seat belt use at all times in company vehicles, and in personal cars and trucks while on company business.
• Monitor the costs and causes of crashes in their workforce to support and guide motor vehicle safety programs.
• Arrange work schedules to reduce distracted driving, fatigue, and speeding.
• Select company vehicles with advanced safety features such as electronic stability control, lane departure warning systems, and collision avoidance systems.

4. Everyone can

• Use seat belts on every trip, no matter how short. Make sure passengers buckle up too.
• Buckle children in age- and size-appropriate car seats, booster seats, and seat belts. Those 12 and under should be buckled in the back seat.
• Choose not to drive after drinking alcohol or using drugs, and help others do the same.
• Know your state's GDL laws and consider using tools like parent-teen driving agreements, if you are the parent of a teen.

Road safety depends on the drivers' good judgment and a reduced willingness to take risks, which, like most habits, develop over time. Anything that improves road safety for all drivers improves safety for young drivers. Some strategies are designed specifically for young drivers to limit exposure to risk while they are developing good judgment and safe driving habits.

Graduated Licensing Laws

Laws in all 50 states and the District of Columbia establish graduated licensing requirements for new drivers. Specific requirements vary from state to state, but each licensing program has three stages:

• Learner stage. In most states, drivers in this stage must always be supervised by an adult. At the end of the learner stage, the driver must pass a test to move to the next stage.
• Intermediate stage. Laws during this stage establish a minimum age requirement and place restrictions on nighttime driving and the number of passengers.
• Full privilege stage. Laws mandate a minimum age, usually 18, for unrestricted driving.

The number of car crashes decreased in states with stronger licensing programs, particularly those with more restrictions.

The most effective legislation has at least five of the following seven elements:

• A minimum age of 16 for the learner's permit
• A restriction requiring a young driver to have a learner's permit for at least six months before he or she could apply for a provisional license
• A requirement for 50 to 100 hours of supervised driving
• A minimum age of 17 for an intermediate stage license
• Restrictions on driving at night
• A limit on the number of teenage passengers allowed in the car
• A minimum age of 18 for a full-privilege license

Parents play an important role in the success of graduated licensing. They can determine when teens may test for a learner's permit or a license. They may also supervise practice driving for the provisional driver. In addition, they can help enforce certain conditions, such as no driving at night. Research shows that in families where parents impose stricter limits, teens are less likely to exhibit risky driving behavior.

Checkpoints Program

NICHD researchers developed the national Checkpoints Program — a driver education program that encourages parents to supervise their newly licensed teens and to model good driving behavior.

One important feature of the Checkpoints Program is a written agreement signed by both parents and teens. In this agreement, parents and teens commit to the conditions under which the new driver will develop good driving judgment. These include not driving in conditions that place drivers at increased risk for car crashes Learning to drive is a process of developing good judgment behind the wheel; the first six months after new drivers receive their licenses are considered the most dangerous.

With a driving agreement, the parent and teen establish a "checkpoint" in one month. At that point, they will assess the new driver's comfort level with driving on local roads in different situations. In the first checkpoint, these include situations in daylight, when roads are dry, and with no other passenger in the car. After each additional checkpoint, the parent agrees to remove restrictions as long as the teen demonstrates good driving judgment. In addition, the parent commits to providing the teen rides as needed until all of the checkpoints are achieved.

Preventing Distracted Driving

Inattention is a leading cause of crashes. Anything that takes a driver's attention from the road, including dialing, texting, and adjusting cell phones and other electronic devices, increases the risk of car crashes. In addition, tasks that require thought reduce the driver's ability to identify and react to potential road hazards. Currently, 31 states ban all cell phone use by novice drivers. Only 10 states, the District of Columbia, Guam, and the Virgin Islands ban the use of handheld cell phones by drivers of all ages. In all but two of these states, the use of the phone alone is sufficient for a police officer to stop a driver. Texting while driving is now banned in 37 states, the District of Columbia, and Guam.

In addition to laws regulating the use of cell phones and other electronic devices, general improvements in the driving environment can reduce crash rates. These include:

• "Rumble strips" (strips of ridged pavement that cause rumbling when driven over) on both the centerline and shoulders of the road
• Wide and visible edge lines
• Easily visible road signs
• Better lighting at night

Countering Speeding and Risky Driving

More than half of fatal crashes involve risky driving, with speeding being the most common factor. Strategies to combat these problems fall into four categories:

• Laws. Speed limit laws are effective when they are enforced. Laws that target aggressive or risky driving are not considered effective and are not used frequently.
• Enforcement. Automated enforcement, such as speed cameras, can effectively reduce speeding and crash prevalence. Other types of enforcement, even high-visibility police enforcement, are only moderately effective.
• Penalties and adjudication. These strategies work only moderately well at best.
• Communications and outreach. Public information campaigns on enforcement are effective, but the costs can be high.

Use of Safety Belts

Seat belts protect drivers as well as passengers from injury and death.When worn by some in the front seat, a safety belt reduces fatal injuries by more than one-half. In vehicles with both safety belts and air bags, both safety features are more effective when used together. Thanks to these and other safety features, passenger vehicles are safer now than they've ever been, and injuries from serious crashes are less severe now than they used to be.

The use of safety belts is at an all-time high; however, teenage drivers are less likely to use them than adult drivers

As of September 2013, 33 states and the District of Columbia allow officers to stop a driver solely for violation of a safety belt use law. In 16 states, officials can cite violators only when they are stopped for some other traffic violation. One statehas no requirement for safety belt use.

In addition to enforcing safety belt laws, the Click It or Ticket campaign spreads awareness of the importance of wearing seat belts and is effective in increasing safety belt use. Safety belt use is highest in states that allow officers to stop a driver solely for violating safety belt laws and that publicize their enforcement of these laws.

Preventing Drinking and Driving

Drinking and driving has declined greatly in the past decade. In combination with the approaches below, social norms about the acceptability of drinking and driving have changed due to public information campaigns. However, drinking and driving and drinking and riding remain high among teenagers. The following three approaches can help prevent people from drinking and driving:

• Sobriety checkpoints. These checkpoints give police officers the chance to judge whether a driver is under the influence of alcohol and test the blood alcohol level of an individual if he or she shows signs of intoxication. Expanded use of such checkpoints could save 1,500 to 3,000 lives each year.
• Minimum legal drinking age laws. These laws dramatically lowered the rate of teens driving while intoxicated. Keeping the legal drinking age at 21 and enforcing it helps prevent young, inexperienced drivers from drinking and driving.
• Driving-prevention devices. Devices called "ignition interlocks" can be installed in cars to prevent them from starting when the driver's blood alcohol level exceeds the limit. These devices are used to prevent drivers convicted of alcohol-impaired driving from drinking and driving. Studies show they reduce re-arrest rates for drinking and driving by about two-thirds.