“Good passengers and not good passengers:” Adolescent drivers’ perceptions about inattention and peer passengers

Abstract

Purpose

The purpose of this qualitative focus group elicitation research study was to explore teen driver perceptions of peer passengers and driver inattention.

Design & Methods

We utilized focus groups for data collection and content analysis to analyze the data, both of which were guided by the Theory of Planned Behavior. We conducted 7 focus groups with 30 teens, ages 16–18, licensed for ≤1 year to examine attitudes, perceived behavioral control, and norms related to driving inattention and peer passengers.

Results

The sample was 50% male, mean age 17.39 (sd 0.52) with mean length of licensure 173.7 days (sd 109.2). Three themes emerged: 1) “Good and not good” passengers; 2) Passengers and technology as harmful and helpful; and 3) The driver is in charge.

Conclusions

While passengers can be a source of distraction, our participants also identified passenger behaviors that reduced risk, such as assistance with technology and guidance for directions.

Practical Implications

An understanding of teens’ perceptions of peer passengers can contribute to the development of effective interventions targeting teen driver inattention. Nurses are well-positioned to contribute to these teen crash prevention efforts.

Motor vehicle crashes (MVC) are the leading cause of teen death. Driving with passengers is associated with an increase in fatal crash risk for teen drivers (Ouimet et al., 2015). Tefft, Williams, & Grabowski (2012) found that for an increase in the number of peer passengers (under age 21), there is an increase in fatal crash risk (for one peer passenger, relative risk (RR) 1.44 [1.01–2.04]; two peer passengers RR 2.02 [1.36–2.99]; three or more peer passengers RR 4.39 [1.45–13.31]. Compared with drivers without passengers, Chen, Baker, Braver and Li (2000) found that the relative risk of death per 10 million trips was 1.39 (95% confidence interval [CI], 1.24–1.55) for 16-year-old drivers with 1 passenger, 1.86 (95% CI, 1.56–2.20) with 2 passengers, and 2.82 (95% CI, 2.27–3.50) with 3 or more passengers. Given the influence of peer passengers on teen driver crash risk, graduated driver licensure (GDL) provisions have implemented peer passenger restrictions (Williams, Tefft, & Grabowski, 2012).

The intersection of the practical processes associated with driving for teens (e.g. skill) with the presence of peers in a vehicle is multidimensional. Many newly licensed teen drivers lack the skill to drive safely in challenging driving environments (McDonald et al., 2015). The combination of lack of skill with peer social influence in the vehicle can contribute to MVC risk. For example, in a simulated driving task using fMRI, Chein and colleagues (2011) demonstrated that teens were more apt to have risk-taking tendencies when peers were present. Figner and colleagues (2009) showed that for teens, affective responses to situations (rewards or punishments) serve to increase the tendency for risky decision making more than adults. Peer influence is also associated with risk-taking behaviors like smoking and alcohol use (Go, Green, Kennedy, Pollard, & Tucker, 2010; Huang et al., 2014; Scalici & Schulz, 2014), and poor sexual decision-making (Doornwaard, Ter Bogt, Reitz, & van den Eijnden, 2015). However, the presence of peers can also exert a positive influence (Steinberg & Morris, 2001). Driving with peer passengers has the potential to influence the likelihood of risky driving in the context of driver inexperience, and therefore increase MVC risk in novice teen drivers.

Peer passengers can contribute to poor teen driver decision-making and unsafe driving. Curry and colleagues (2012) reported that, compared with males driving alone, males with peer passengers were more likely to perform an aggressive act (risk ratio, RR [95% CI] = 2.36 [1.29–4.32]) and perform an illegal maneuver (RR = 5.88 [1.81–19.10]) just before crashing. When assessing teen driving behavior of students leaving a school parking lot, Simons-Morton and colleagues (2005) found that teen males with male peer passenger exhibited more risky driving behaviors and females with male passengers had shorter headway times than teens without peer passengers. Experimental studies in a driving simulator also provide important information on the influence of peer passengers with teen drivers, particularly in relationship to social norms. A simulator study examined exposure of teen male drivers to a risk-accepting and risk-averse confederate peers. The risk-accepting confederate peer increased risky driving behavior (failed to stop and higher percentage of time spent in a red light) (Simons-Morton et al., 2014). A naturalistic longitudinal driving study of teens also found that drivers with more risk-taking friends had more risky driving than those with fewer risk-taking friends (Simons-Morton et al., 2011). In both simulated and naturalistic driving situations, the presence of peers, and in particular risk accepting peers, increases risky behaviors such as aggressive or illegal driving, speeding, and shortened headway time.

The presence of peers can contribute to distracted driving, drawing a teen driver’s attention away from the roadway (Carney, Mcgehee, Harland, Weiss, & Raby, 2015). In order to decrease risky driving behaviors and subsequent crashes in teen drivers, behavioral interventions are needed to help teens manage how passengers affect their attention to the road. Theory-based interventions successful in other domains of teen risk behaviors (e.g. smoking, alcohol use, sexual risk behaviors) use elicitation research methods to identify key perceptions about the behavioral phenomenon for the target population. Nurses in a variety of community and acute clinical settings are well-positioned to deliver health promotion and risk reduction theoretically-based interventions for teens. Prior research has shown that nurse-led interventions with adolescents and young adults can lead to a reduction in risky behaviors (Borawski et al., 2015; Nyamathi et al., 2012; Sommers, McDonald, & Fargo, 2014).

The purpose of this qualitative study was to explore teens’ perceptions of peer passengers and how they relate to driver inattention. We utilized focus groups for data collection and content analysis to analyze the data, both of which were guided by the Theory of Planned Behavior (TPB). The results can be used to help inform the development of interventions targeting teen drivers that nurses can use in clinical practice.

Methods

We collected data through focus groups with teen drivers, ages 16–18, licensed for ≤1 year in Pennsylvania (PA) to elicit their attitudes, perceived behavioral control, and norms about peer passengers and inattention to the roadway. We previously reported on methods and focus group data on inattention related to cell phones (McDonald & Sommers, 2015). The results reported here provide unique information about teen driver inattention and peer passengers.

The interview guide and analysis were based on the Theory of Planned Behavior, which posits that the attitude toward a behavior, perceived behavioral control, norms and intentions shape behavioral intentions and the actual behavior (Ajzen & Fishbein, 1980; Ajzen, 1991). Ultimately, TPB can guide interventions to lead to behavioral change. The interventions can be directed toward one or more of its determinants: attitudes, perceived behavioral control, or norms. Changes in these factors are theorized to produce changes in behavioral intentions. Thus, the interactions of teen drivers with peer passengers that can lead to increased crash risk have the potential to change. After an intervention that targets attitudes, perceived behavioral control, or norms, the new intentions should be carried out under appropriate circumstances and lead to reduced crash risk. In this study, we used the TPB in the context of inattention to the roadway (see Figure 1) and focused analysis on attitudes, perceived behavioral control and norms of the teens about peer passengers.

Figure 1.

Theory of Planned Behaviour for Peer Passenger Engagement

Note: Adapted from Ajzen, 1991

The interview guide included open-ended questions and probes to examine teens’ perceptions of inattention related to peer passengers. Questions and probes were developed based on the theoretical constructs of attitudes, perceived behavioral control, and norms in TPB. Attitudes are the degree to which someone has a favorable or unfavorable evaluation of the behavior; perceived behavioral control is the perceived ease or difficulty in performing a behavior; norms are the perceived social pressure to perform or not perform a behavior (Ajzen, 1991). We focused on the teens’ attitudes about peer passengers as a potential contributor to inattention while driving, behavioral control around passengers drawing their attention away from the road and perceived norms of peer passenger behaviors related to inattention.

Drawing from these theoretical constructs in TPB, (attitudes, perceived behavioral control and norms), we then included questions in the interview guide such as: Do you think some passenger interactions take a drivers’ attention off the road? (Attitudes); “What are some good (bad) things about interacting with or having passengers while driving?” (Attitudes); “If a teen wants to keep their attention on the road, how can they let their peer passengers know?” (Perceived behavioral control); “Do you think that peer passengers sometimes take the drivers’ attention off the roadway on purpose? (Norms) and “How many peer passengers do you think is OK for a teen to have in a car while driving?” (Norms). We indicated to the participants that when we discussed “peer passengers” we were referring to passengers who were their own age, or a little younger or older (giving examples of ages 15 to 19).

Teens were recruited through primary care clinics, flyers, email and word of mouth. The sample was purposive as we wanted to gather data on the experience of peer passengers and inattention to the roadway (Polit, 2004). Teens who had a PA license for up to a year were recruited because they could talk about their current experiences as well as think back to the different stages of when they were passengers or drivers. Participants provided written assent (<18 years) or consent (age 18 years). Verbal parental consent was obtained for participants under age 18. Focus groups lasted 60–90 minutes in a private room at a community center and were facilitated by the principal investigator. Self-reported quantitative demographic data were collected prior to the start of the focus group. Participants used celebrity names as pseudonyms during the focus group to help maintain confidentiality. Focus group data collection was completed when preliminary analysis indicated saturation had been reached (e.g. no new codes or themes were developed). Study procedures were approved by the institutional review board at the University of Pennsylvania with an administrative agreement with The Children’s Hospital of Philadelphia.

Audio-taped focus group responses were transcribed by a professional transcription company and checked for accuracy by the research team. Directed descriptive content analysis (Hsieh & Shannon, 2005) was used. Based on TPB and the empirical literature, key concepts of attitudes, perceived behavioral control and norms about peer passengers were identified as coding categories; definitions based on the TPB and the empirical literature were developed for the coding categories (Hsieh & Shannon, 2005). Table 1 outlines example coding categories and definitions. Coding categories and definitions were used by research team members to analyze the transcripts. Coding categories and definitions were refined after the first two transcripts were analyzed; additional categories were added that were not previously identified by the theoretical framework or empirical literature. Transcripts were reviewed by research team members in Atlas.ti (version 7.5) to apply coding categories to the sections of text (participant’s quotes). All focus groups were coded by the same two research team members and discrepancies were reconciled in a line by line comparison of coding, discussion of discrepancy and final agreement between the two team members. There was 81% congruence prior to reconciliation. Themes were developed based on the participants’ data in the coding categories. Demographic data were double data entered in SPSS and frequencies were used to describe the sample.

Table 1.

Example Coding Categories and Definitions

Coding Category	Definition for this study
Attitudes about Inattention with Passengers	Degree to which the teen has a likable or unlikable evaluation or estimation of inattention related to passenger engagement.
Perceived Behavior Control for Inattention with Passengers	Feeling that the teen can control and perceive the consequence of their inattention-related to passengers
Perceived Norms for Inattention with Passengers	Normative expectation of others related to inattention and passengers
Knowledge about Inattention	What teens describe as what they consider inattention while driving; for example cognitive, ears, external distractions, eyes, mobile devices, passengers.
Perceived Norms New Teen Driver	Normative expectations of others related to teen driving behaviors and skills
Teaching about Passengers	What information and how we should teach it about passengers

RESULTS

A total of 30 teens participated in the 7 focus groups, with attendance ranging from 3–6 participants (median=4) in each group. Teens had a mean age of 17.39 years (sd 0.52); were 50% male and predominately white (90%) and non-Hispanic (97%). The teens were licensed 4–364 days (IQR: 75–247) with a mean length of licensure 173.7 days (sd 109.2). Three themes emerged: 1) “Good and not good” passengers; 2) Passengers and technology as harmful and helpful; and 3) The driver is in charge.

Theme 1: “Good and not good” passengers

When asked if having peer passengers in the car took their attention off the roadway, many participants responded initially that they did not see their peer passengers as distracting. Upon probing, participants would discuss that it often depended on the scenario. As one participant said, “There can be good passengers and not good passengers.” (Girl AA, age 17). For example, in response questions about how peers may take attention off the road, participants in one group responded with a series of assertions that showed that they perceived the level of distraction varied by circumstance.

“It is never that much of a distraction.” (Boy BB, age 17)

“Yes, it’s not that bad.” (Girl AA, age 17)

“It is not crazy distracting.” (Girl CC, age 16)

“It depends on the personality and the kind of person or situation you are in.” (Girl AA, age 17)

Many participants listed good things about having peer passengers, including factors of fun, entertainment, and less feelings of loneliness. Some participants indicated they thought they were more attentive when their friends were in the car, citing safety and trust as reasons.

“I feel like when my friends are in the car, I am more attentive and stuff.” (Girl DD, age 17)

“And I think it is probably because you have a friend in the car. And it is like that is somebody else’s life that is in your hands.” (Boy EE, age 18)

Many talked about “good” passengers, who were helpful with directions, observing hazards, and monitoring driving tasks such as speed, obeying traffic laws or traffic. The participants also described how during poor weather conditions, passengers often behaved in ways that are helpful to the driver.

“Like today I was driving home on the freeway, and there was a lot of traffic and I needed to get from like all the way to the left, all the way to the right. And all my friends are in the back seat being like, okay, it is clear. Go now. And they were like actually helping me. So there are situations in which it can be good to have people.” (Girl FF, age 18)

Participants also noted that driving with peers can take their attention off the roadway, and indicated that some passengers are more distracting than others—or the “not good” passengers. The participants discussed that some passengers talk loudly or become rowdy. However, largely, participants indicated that peer passengers would not distract a driver on purpose.

“They would be putting themselves at risk too, if they were purposely distracting the driver when they were in the car.” (Girl AA, age 17)

Inexperienced drivers, either those without licenses or those newly licensed, were perceived as not always understanding the need for a driver’s attention on the roadway. Participants acknowledged that unlicensed peer passengers may not realize that some behaviors are distracting. In addition, as more teens in a peer group get their license, there is less pressure on those with a license to drive groups of teens (i.e. there are more drivers and less passengers).

“But there are times where I will have a car full of kids. But I think kids understand, especially if they are drivers as well, that it is hard to drive with a lot of noise and moving around. So now that a lot of kids are driving, it is not as bad. Obviously, they do add some distraction if they want to blast the music and you are trying to turn it down. It draws attention away from the road.” (Boy GG, age 17)

“It’s the year (sophomore) where like a third of the kids might have their license if they’ve done everything on time, and are old enough. So, there was more of a pressure for the four of us who are in this big group of people to drive three to four or five people at once. So, it gets harder to say no when there are so few options available.” (Boy HH, age 16)

Theme 2) Passengers and technology as harmful and helpful

In discussing peer passengers, participants also focused on use of technology, such as mobile phones, global positioning systems (GPS), and music systems when peers were in the car. In particular, participants talked about advantages of passengers managing the GPS to provide directions so the driver could maintain attention to the roadway. When peer passengers are present, the participants said that the driver does less texting while driving. The passenger not only provides someone for drivers to communicate with, but also an individual who can take over communications with the phone if texts, calls, or notifications are received.

“You feel less alone. And you do not have the urge to text or call anyone.” (Boy II, age 17)

“I mean, at least for me, like I kind of find it helpful, because they get to deal with the little stuff like the music and air conditioning and GPS, or like, I can be like hey, can you look this up for me. Or, my one friend texts my mom, like can you text my mom for me…just like easy stuff like that. So I feel like it can be helpful then…” (Girl JJ, age 16)

Not all participants were willing to delegate technology as they wanted to maintain control of phones. Likewise, participants described situations when, as passengers, they would offer to manage a phone for a driver, but the driver would resist.

Conversely, sometimes when passengers used technology, there could be a negative effect on drivers’ attention to the roadway. For example, some participants indicated the combination of loud music and passengers was distracting. In addition, there were instances where passengers would show drivers notifications, pictures or videos on phones.

“I know my one friend tries to show me things on her phone….while I am trying to drive. She will be like look at this, I am like, no, I am driving. And she will be like, all right, do it at a stop sign. And, sometimes I will look, but it depends what it is. Usually, it is just like a picture or something.” (Girl KK, age 17)

“There have been times actually where people are taking Snap Chats of me while I am driving too. And I will try not to (make) just a weird face while I am driving because I do not know how I look. And I will look over. There have been times when on the highway they are doing that. And I will try and look at it.” (Boy GG, age 17)

Theme 3: The driver is in charge

Participants described peer passengers rules, including state licensing laws, parental rules and unwritten rules that some teens enforce. However, participants described the driver having the final decision. Sometimes teens enact the restrictions that the state has on newly licensed drivers such as peer passenger limits or abide by parental rules; however it was not always clear if the parental rules aligned with the state restrictions. The majority of the participants viewed the driver as the person “in charge” and determined whether laws and parental rules were followed or broken.

Participants indicated that they thought the passenger restrictions in the state (in PA, limited to 1 passenger younger than 18 for drivers <6 months licensure) were often ignored. Participants described lack of understanding about the provisions, noted that parents were unfamiliar with the rules, and perceived that if teens were pulled over, they were not always cited for infractions.

“I know a lot of parents, like of my friends a ton of parents just do not care or they do not know or they do not just research to find out. So, the kids drive immediately after they get their license, they will drive, like they will fill up the car and go to a store or something.” (Girl DD, age 17)

“I think the reason no one cares about the law because no one cares about the law. I was in a car that got pulled over at school at winter formal. We had six people in the car. And when I got in my accident, I had four people in the car. And every time, the cop just did not care. It was just like no, that law is not real.” (Boy II, age 17)

Some teens described abiding by the rules and finding it helpful and important as they started driving. They cited that having fewer teens in the car decreased distractions and this is important for newer drivers who need more experience driving.

“I think it is good how it is right now. I definitely think, I mean, they should at least try to enforce the whole one passenger thing, because I definitely, I have never had more than one passenger in the car, and I have only had it for like two and a half months. But, I definitely can see how having more people could just like double and triple the chances of you being distracted. So, I definitely think to start off as a new driver with one is a good number.” (Girl JJ, age 16)

There was an overwhelming emphasis on the importance of seatbelts among participants. Participants often described that the number of passengers they would have in the car was dictated by the number of seatbelts in the vehicle. It was not clear from the data whether this norm of seatbelts was influenced by the law or parental rules.

Even given the written and unwritten rules about driving, participants described the driver as in control. Having a teen driver make decisions about in-car behaviors can increase or decrease risk. For example, drivers could be explicit that if peers were riding with them, they were expected to follow the rules, such as quieting down when asked. Unfortunately, this sometimes had a negative effect, where passengers did not feel confident to speak up in an unsafe situation, such as when drivers were texting while driving, or when peer pressure-filled situations involved risky driving.

“I think that (passengers) is in your control too. You did not have to let them in your car. You can tell them to be quiet or whatever. You can really control how that situation goes if you want.” (Girl DD, age 17)

“I have a cousin who is an avid texter and driver and she is a very, she has a lot of road rage. So she will be going like 70 and texting and driving on a road where the speed limit is like 25. And running every stop sign she comes near. So it is really pretty dumb…and so just seeing like how she is a little bit slower to react with while she is texting. Like she is trying to text and watch the road at the same time so she is constantly going like this. It just makes me kind of want to slap the phone out of her hand and tell her to stop. But I know she is just going to be like no. It is my car.” (Boy LL, age 16)

“I think peer pressure is a lot to do with it. Last year was…my sophomore year and I was on the school’s (sport) team and they actually had the kids drive us to the place. And, like I was one of only I think three sophomores and the seniors would drive, and they were nuts…. But, they were insane, but like, you could not really speak up, because like I was a sophomore and they were all like juniors and seniors. And, I was just like, like whatever.” (Boy MM, age 17)

Discussion

The elicitation research with the use of focus groups to collect data helped us understand perceptions and experiences of teens related to peer passengers and inattention to the roadway. These data bring to light important information about what teens think about peer passengers and have the potential to serve as the foundation for safe driving interventions. When discussing passengers, the teens described ways that they try to balance risk with staying safe in the car (Buckley, Chapman, & Sheehan, 2014). Teens in the sample could identify when peer passengers were distracting, how peer passengers typically engaged with the driver, as well as acknowledge that the driver could be in control of how passengers behaved. These attitudes, norms and perceived behavioral control are key to addressing the crash risks associated with inattention and peer passengers (Ajzen & Fishbein, 1980; Ajzen, 1991).

Participants did not always recognize that peer passengers can draw attention away from the roadway, nor did they understand the reasons behind peer passenger restrictions. With GDL passenger restriction provisions, there is a missed opportunity to connect with teens as to why these provisions exist and how they protect them as new drivers. Some teens saw benefit when reflecting back on experiences of driving with passengers or abiding by passenger limits. Teens may need a better understanding that peer passengers are a contributor to motor vehicle crashes (Chen, 2000; Tefft et al., 2012).

Among the sample of teen drivers within one year of licensure, there appeared to be normative behaviors around seatbelt use and emerging norms around passengers handling phones for driver (passengers can help handle the phone). Teens are not always reliable users of seatbelts (Bao, Xiong, Buonarosa, & Sayer, 2015; National Highway Traffic Safety Administration, 2009), but in this discussion of seatbelt use, they were considered a useful and important safety mechanism. In contrast, limiting passengers is not considered a normative behavior. Next steps in establishing positive teen driving norms should focus on safe passenger behaviors such as one peer passenger, use of technology by passengers that would not distract the driver (such as GPS), and encouragement of passengers who speak up when the driver is being unsafe.

The focus group data showed that the presence of passengers may act as a protective factor for teen drivers—particularly when they help with technology. Mobile technology is an important source of connectivity and communication for teens (Lenhart, Ling, Campbell, & Purcell, 2010) and the intersection of peers and technology in the vehicle clearly has advantages and disadvantages. Peers in the car can handle the text messages, social media notifications, music, GPS, and calls. There needs to be an advocacy for safely using peers to manage technology but not so it interferes with the driving task. However, with teens pervasively using their phones as a primary source of communication, passengers using their own phones can also act as a distraction.

GDL restrictions have shown to have important effects on teen driver crash reduction (Williams et al., 2012). However, the perception that enforcement of the passenger restrictions does not occur is a missed opportunity with new drivers. Teens in the sample seemed to know at a cursory level that rules exist, but there did not appear to be compliance within families, peer groups, and even law enforcement. Restrictions and provisions can be reinforced with parental knowledge and norms. Research from 2003 showed that newly licensed teens are at a higher risk for citations in the first few months of licensure, and males and those with poor grades had a higher risk of citation (McCartt, Shabanova, & Leaf, 2003). More recently and specific to enforcement of new driver provisions, Curry and colleagues (2013) found that GDL specific citations in New Jersey (included restrictions on passengers, nighttime driving, mandatory seatbelt, wireless communication devices and violations on probationary license) ranged from 22.7 per 10,000 drivers to 48.5 per 10,000 drivers from 2009 to 2010. Given that citations can be administered for violation of GDL provisions, addressing the legal ramifications of violation and risk to health that can occur with crashes may be beneficial in interventions. Parents can also be more informed of local laws regarding passenger restrictions and use that as an opportunity to enforce the law.

This study has important implications for nursing science and practice. Pediatric nurses in diverse settings interface with adolescents and families, having an important opportunity to play a role in MVC prevention efforts. The pediatric primary care, emergency department and school settings are just a few practice areas that are well-suited for nursing intervention with teens related to safe driving behaviors. Given that nurses screen adolescents in the emergency department for risky behaviors such as binge drinking and unprotected sex, they also might ask if teens drive regularly, wear seat belts, maintain attention to the road without distractions and how many passengers they have in the car while driving. Nurses also have an opportunity to screen adolescents as they enter the learning to drive process, such as while they have their permit or even before; eliciting information from teens prior to independent licensure may stimulate conversations about how to prevent later risky driving. Additionally, there are opportunities for nurses to educate both teens and families about their driving safety goals, rules that will govern driving privileges and state laws. Nurses can encourage communication between teens and their parents at very early stages of learning-to-drive or licensure that can establish expectations around driving and passengers (D’Angelo et al., 2010; Ford et al., 2004). Lastly, these data about perceptions are important for the development of individually-targeted behavior change interventions for teens addressing driver inattention.

Limitations

Our sample was relatively small, predominately white and non-Hispanic, thus limiting the generalizability of findings. Our median focus group size was 4, whereas the optimal size for focus groups is 6–10 participants (Morgan, 1996). We had difficulty scheduling teens because of after school and weekend activities and family summer vacations. By focus group number 7, preliminary analysis with the data indicated saturation was reached, with no new codes or themes emerging from the data. Therefore we completed the focus group data collection after 7 groups and 30 participants. Although the sample was 50% male, 50% female, we were not able to make gender comparisons because of limited sample size. While we had a range of licensure of 4–364 days, subgroup analysis based on length of licensure was not possible. Even though we asked about peer passengers and gave example age range, participants often talked about driving with siblings or parents as passengers. We attempted to account for this in our analysis by focusing on responses that were about peers.

Conclusions

Novice drivers are an important source of information about their safe and risky driving behaviors. While passengers can be a source of distraction, our participants also identified passenger behaviors that reduced risk, such as assistance with technology and guidance for directions. Interestingly, they also noted that neither parents nor law enforcement paid particular notice to the number of passengers in the vehicle, even when that number exceeded those allowed by licensing laws. The perceptions of novice drivers are useful when developing and testing behavioral interventions to promote safe driving in newly licensed drivers.

Highlights.

• While passengers can be distracting, they are sometimes perceived as reducing risk.

• The driver is the person “in charge” and can make decisions about passengers.

• Perceptions about inattention contribute to development of effective interventions.

• Nurses are well-positioned to promote safe driving in teens.