Is it time to apply a harm reduction approach to young driver education?

Highlights

• Young driver education that seeks to prevent risk behaviours has limited impact.

• Harm reduction approaches accept risks as inevitable and focus on reducing harm.

• Harm reduction has mitigated other youth health risks that cluster with road risks.

• It is time to debate and research harm reduction education for young drivers.

Abstract

Youth education on risky behaviours, such as alcohol and drug use, has long moved beyond a ‘just say no’ abstinence-only approach. While emphasising that abstinence is safest, guidance is extended to harm reduction approaches, advocating safer ways to engage in the behaviour should the risk occur. In contrast, youth road safety education generally remains abstinence-only (e.g., don't speed, don't use your phone while driving). This manuscript presents arguments in support of the premise that is time to explore applications of harm reduction approaches to young driver education. While acknowledging this is not without risk, without further debate and research there is no evidence base to determine the true potential of road safety education to contribute to reductions in road trauma.

Introduction

Youth road trauma is a leading public health issue globally, with significant economic and social costs (Sheehan et al., 2017; WHO, 2018). Despite some successes in reducing fatalities in recent decades, this varies across countries and is less evident for serious road injuries, with youth continuing to be over-represented in road trauma statistics (AIHW, 2019; Greenwood and Box, 2020). Risk-taking is an important feature of healthy neurobiologically-driven development during adolescence (Duell and Steinberg, 2020). While the majority of inflated road risk at this time is due to the onset of driving and inexperience errors, driver risk-taking also plays a role (McDonald et al., 2014a; Mitchell et al., 2015).

Nationally-representative survey research in the United States (AAAFTS, 2020), for example, found 16-18 year-olds commonly report speeding (e.g., 47% on residential roads), phone use while driving (44% reading only, 35% manual use), aggressive driving (31%) and more modestly driving when fatigued (25%), without a seatbelt (17%) and following cannabis use (9%). The only risk behaviours less prevalent than for the total sample average were driving over the alcohol limit (5% cf. 10%) and speeding on freeways (40% cf.48%).

The road safety community is increasingly applying broader systems thinking to widen preventive approaches to address risky road behaviours (Salmon et al., 2019; Senserrick and Kinnear, 2017), yet formal young driver education tends to remain focused on what not to do (i.e., don't’ speed, don't use your phone while driving). While, more positively, strategies on how to avoid these risks appear to be increasingly applied (Senserrick and Kinnear, 2017), the focus is still on preventing the behaviours.

In contrast, other youth health education has long moved beyond abstinence-only to a harm reduction (also known as risk or harm minimisation) approach (DOH, 2017). That is, there is a level of acceptance that the risk behaviour might still occur, and in some cases be inevitable, and therefore education includes development of strategies to reduce harm when engaging in the risk behaviour. An early example in youth health education is the shift from sex education in the 1960s to safe sex education in the 1980s (PPFA, 2016) in efforts to reduce teenage pregnancies and sexually transmissible infections. Education still focused on these risks and that abstinence was safest, yet rather than the ‘just say no’ strategy, young people began to receive education on use of condoms and other contraceptives.

Harm reduction is perhaps best known however, in relation to alcohol and drug use; as evident in policies of the World Health Organization (WHO, 2010), American Academy of Pediatrics (Ryan et al., 2019), and Australia's National Drug Strategy (DOH, 2017), to name a few. Early education included ensuring a trusted sober ally is at hand before use and only using clean needles. This was supported by needle exchange programs and, over time, now safe injecting rooms and pill-testing kits.

In this piece, initial arguments are provided with the intention to provoke debate and research towards adopting a harm reduction approach to young driver education.