ICRC Research Projects 2019-2024

A Hybrid Effectiveness-Implementation Trial to Improve Safe Driving among Teen Drivers with Traffic Violations

Principal Investigator: Jingzhen (Ginger) Yang, PhD, MPH

Motor vehicle collisions (MVCs) are the leading cause of death among teenagers in the United States. Teen drivers who have committed a traffic violation are at an even greater risk for MVCs than their counterparts. Steering Teens Safe (STS), a parent-focused intervention developed by our team in collaboration with researchers from the University of Iowa, has been shown to reduce teens’ driving errors. Parents are provided individualized training in motivational interviewing to improve conservations about driving with their teens. However, evidence is lacking on the effectiveness of STS when translated and implemented among high-risk teen drivers such as those who committed a traffic violation. The objectives of this translation study are to (1) examine the effect of STS on driving outcomes among teen drivers who have committed a traffic violation and (2) assess the adoption and implementation of STS among these high-risk teen drivers and their parents.

We will test the following specific aims:

  1. Determine the effects of the intervention on parent-teen communications and risky driving outcomes (i.e., risky driving events, unsafe driving behaviors, and recidivism) among teen drivers with a traffic violation(s).
  2. Assess the adoption of the intervention and implementation fidelity.

We will enroll 90 parent-teen dyads, comprised of a teen driver aged 16 to 17 years who committed a moving violation and a parent/legal guardian. Participants will be recruited from the Franklin County Juvenile Traffic Court in Ohio following the teens’ mandatory court hearing. Enrolled dyads will be randomly assigned to one of two study groups with 45 dyads in each. The Control Group will have device installation only with no feedback nor communication training for parents. The Intervention Group will have device feedback to teens and parents and parents will also receive communication training.

By the completion of this study, we will establish the effectiveness and implementation of STS, augmented with driving feedback technology, among high-risk teen drivers and their parents. Our project is significant because it will translate the evidence-based STS intervention into a population of high-risk teen drivers (i.e., those who have committed a traffic violation) and their parents. This study is innovative because it partners with the local court system and utilizes novel, cutting-edge in-vehicle driving feedback technology to measure driving outcomes and to provide driving feedback to intervention teens. The findings of this study will have a significant impact on juvenile traffic court’s practices and policies aimed to improve teen driving safety by reducing MVC-related crashes, injuries, and deaths.

Opioid Overdoses and Child Abuse and Neglect

Co-Principal Investigators: Nichole L. Michaels, PhD and Bridget J. Freisthler, PhD, MSW  

Parental opioid use can be particularly detrimental to children. Importantly, both child abuse and neglect and parental substance misuse are considered Adverse Childhood Experiences (ACEs) that are known to negatively affect long-term physical and mental health. To the extent that we can develop and implement primary prevention programs to prevent children from being abused or neglected or growing up in the home of a parent who misuses substances, we can reduce the harms that come from experiencing these ACEs. The current study assesses the role of opioid overdoses and availability on rates of child maltreatment and seeks to understand how neighborhood structure, social processes, and resources can buffer families from the negative effects of opioid availability.

The specific aims for the current study are to: (1) Understand the neighborhood structural mechanisms by which opioid overdoses are related to changes in substantiated rates of child abuse and neglect in Census block groups over at least six years (2013 – 2018); (2) Identify ‘high’ and ‘low’ risk areas for child abuse and neglect, based on residuals from Aim 1; (3) Investigate differences in resources, social cohesion, collective efficacy, and other neighborhood social processes that may contribute to Census block groups doing better (or worse) than estimates from Aim 2.

As evidence supporting the effectiveness of community-based child abuse and neglect prevention programs has been limited by the availability of sufficient peer-reviewed evaluation, our work will add a much-needed theoretical framework for the development of these programs. Our study may also provide information on whether and how environmental prevention programs to reduce substance use, including overdoses, may have utility in preventing child abuse and neglect.

Behind the Wheel Smartphone Application: Utilizing Technology to Quantify Driving Behaviors and Promote Safe Driving in Adolescents

Principal Investigator: Motao Zhu, MD, MS, PhD

Traffic crashes are the leading cause of death for adolescents, and the death rate among drivers age 14-17 years hiked 17% from 2014 to 2016 nationally. Research on supervised driver training is limited. Specifically, there are to date no studies that have investigated interventions using smartphone technology and involving parents to improve supervised driving. Therefore, we propose a project with objectives to pilot test the feasibility and preliminary efficacy of an app (Behind The Wheel, BTW) to quantify driving behaviors and promote safe driving in adolescents.

The aims of this project are (1) To test the feasibility of the BTW app on acceptance and retention and identify facilitators and barriers for compliance. (2) To determine the preliminary efficacy of the BTW app with a teen-parent dyad intervention on driving performance after 6 months (the length of required supervised driving period in Ohio). (3) To investigate the app’s effects on driving performance and attitudes on safe driving behaviors after 18 months, and establish the feasibility of obtaining the number of traffic crashes and tickets to evaluate the long-term effects

We propose a prospective, randomized, controlled, parallel-group, three-arm trial. Ninety drivers (15.5-17 years) beginning their learner period of licensure will be randomized to receive: (1) BTW app which tracks driving performance while providing individualized feedback and educational materials on driving errors and a driving safety score with incentive- (e.g. gift cards) and gamification-based (e.g., driving badges) rewards (BTW app with reward-based feedback); (2) BTW app with reward-based feedback plus situational supervised driving activities and interactions for teen-parent dyads (BTW app with situational supervised driving practice); or (3) An active control group to only track driving performance paired with passive education materials on car maintenance (sham BTW app).

We hypothesize that it is feasible to implement this smartphone-based intervention. We also hypothesize that teens randomized to using the BTW app with reward-based feedback as well as the situational supervised driving practice will both show a decrease in high-risk driving events compared to the sham BTW app. Participants will be studied for 18 months. The outcomes will include: (1) high-risk driving events as measured by the BTW app; (2) self-reported driving errors and violations; (3) attitudes on safe driving. We will conduct process evaluation and estimate preliminary efficacy of BTW app in reducing high-risk driving events, decreasing self-reported driving errors, and improving safety attitudes. Guided by preliminary data, this study is also innovative. For example, an innovative phone app is used as a partner to improve driver learning and parent-teen interaction, and to identify high-risk driving events. This study is significant, because it will provide preliminary data for a larger trial (R01 project) to investigate more definitively the efficacy of the BTW app to improve supervised driving and reduce high-risk driving behaviors and crashes in adolescents.

TAILOR: Targeting Adolescent Insomnia to Lessen Overall Risk of Suicidal Behavior

Co-Principal Investigators: Jeffrey A. Bridge, PhD and Jack H. Stevens, PhD

Accumulating evidence implicates sleep disturbances as an important modifiable risk factor for suicidal ideation, suicide attempts, and death by suicide. Currently, no evidence-based sleep-focused interventions exist for adolescents with insomnia at elevated risk for a suicide attempt. This application tests an innovative suicide prevention strategy by addressing insomnia in adolescents presenting for outpatient behavioral health services. In this unique 2.5-year project, investigators from Nationwide Children’s Hospital will recruit and randomize 190 adolescents with recent insomnia and suicidal ideation but no history of suicide attempts to (1) the TAILOR (Targeting Adolescent Insomnia to Lessen Overall Risk of Suicide) intervention or (2) enhanced usual care (EUC) as a comparison condition. EUC consists of systematic social worker telephone contact with each family four times over two months to complete a brief suicide risk screen and lethality assessment (if warranted) without discussion regarding the adolescent’s sleep.

The TAILOR intervention adds the following components to the EUC condition: (1) cognitive-behavioral treatment, given that this type of intervention has been found to have promising results for adult insomnia; (2) motivational interviewing, given that these adolescents will often have ambivalence and reluctance to desist in certain sleep-interfering behaviors; and (3) telephone-based assistance, given that this may be among the most feasible ways of interacting with these families over time. The application builds on promising findings in adults in which sleep-focused interventions have resulted in improved sleep and reduced suicidal ideation compared with EUC. Secondary aims include: (1) examining potential socio-demographic and clinical moderators of the intervention effect, (2) testing whether changes in sleep at two months mediates the intervention effect on suicidal ideation at four months, and (3) testing whether TAILOR is superior to EUC in reducing suicide attempts at four months.

The rationale is that the combination of evidence-based behavioral change approaches is expected to be beneficial in improving adolescent sleep, which in turn will reduce suicidal ideation and prevent suicidal behavior. If successful, the TAILOR intervention has the potential for broader public health significance beyond suicidal ideation and behavior, given the strong link between sleep problems and a diverse array of risk-taking behaviors in youth. This study will contribute to the mission of the CDC by testing a practical primary suicide prevention strategy that targets a selected high-risk population (youth with recent insomnia and suicidal ideation) in the pediatric behavioral health care setting.