Parental influence on adolescent compliance with graduated driver licensing conditions and crashes as a restricted licensed driver: New Zealand Drivers Study

Aim

To examine the influence of parental knowledge of, and support for graduated driver licensing (GDL) conditions, parental management of adolescent driving and parental driving behaviour on adolescent compliance with GDL conditions and crashes as a restricted licence driver.

Method

This research was part of the New Zealand Drivers Study (NZDS), a prospective cohort study of 3992 newly licensed car drivers. NZDS participants were recruited at the learner licence stage, with follow-up aligned with the GDL stages. At the restricted licence stage 1200 parents of NZDS adolescents, aged 15–17 years at learner licensure, were recruited and completed interviews. 895 of these adolescents progressed to their full licence and completed the full licence interview. These 895 parent–adolescent pairs were the study population in this research. Topics examined included parental knowledge of, and support for GDL conditions, management of adolescent driving (driving rules, adolescent vehicle ownership, delaying licensure), and their own driving behaviours. Outcomes examined were adolescent compliance with GDL restricted licence conditions (night-time and passenger), and crashes as a driver during the restricted licence stage.

Results

After controlling for other variables, factors independently associated with adolescent low compliance with GDL conditions were: low parental knowledge of conditions, parents’ implementing few driving rules, adolescent vehicle ownership, and parent crash involvement. Factors independently associated with adolescents being a crash involved driver were: parents’ actively delaying licensure, adolescent vehicle ownership, and parent crash involvement.

Conclusion

There is increasing recognition of the importance of parental involvement in adolescent driving. The results show that parents are influential in determining adolescent compliance with GDL and risk of crash. Parents can have considerable positive influence on their adolescent's driving through ensuring compliance with the components of GDL, limiting vehicle ownership and by modelling safe driving behaviours.     

Prevalence of teen driver errors leading to serious motor vehicle crashes

Objectives

Motor vehicle crashes are the leading cause of adolescent deaths. Programs and policies should target the most common and modifiable reasons for crashes. We estimated the frequency of critical reasons for crashes involving teen drivers, and examined in more depth specific teen driver errors.

Methods

The National Highway Traffic Safety Administration's (NHTSA) National Motor Vehicle Crash Causation Survey collected data at the scene of a nationally representative sample of 5470 serious crashes between 7/05 and 12/07. NHTSA researchers assigned a single driver, vehicle, or environmental factor as the critical reason for the event immediately leading to each crash. We analyzed crashes involving 15–18 year old drivers.

Results

822 teen drivers were involved in 795 serious crashes, representing 335,667 teens in 325,291 crashes. Driver error was by far the most common reason for crashes (95.6%), as opposed to vehicle or environmental factors. Among crashes with a driver error, a teen made the error 79.3% of the time (75.8% of all teen-involved crashes). Recognition errors (e.g., inadequate surveillance, distraction) accounted for 46.3% of all teen errors, followed by decision errors (e.g., following too closely, too fast for conditions) (40.1%) and performance errors (e.g., loss of control) (8.0%). Inadequate surveillance, driving too fast for conditions, and distracted driving together accounted for almost half of all crashes. Aggressive driving behavior, drowsy driving, and physical impairments were less commonly cited as critical reasons. Males and females had similar proportions of broadly classified errors, although females were specifically more likely to make inadequate surveillance errors.

Conclusions

Our findings support prioritization of interventions targeting driver distraction and surveillance and hazard awareness training.     

Traumatic brain injury,driver aggression and motor vehicle collisions in Canadian adults

ObjectiveThis study examines the associations between lifetime traumatic brain injury (TBI), driver aggression, and motor vehicle collisions among a population sample of adults who reside in the province of Ontario, Canada.MethodA cross-sectional sample of 3993 Ontario adults, aged 18–97 were surveyed by telephone in 2011 and 2012 as part of Center for Addiction and Mental Health’s ongoing representative survey of adult mental health and substance use in Canada. TBI was defined as trauma to the head that resulted in loss of consciousness for at least five minutes or overnight hospitalization.ResultsAn estimated 91% (95% CI: 90.0, 91.9) of individuals in this sample held a valid Ontario driver’s license at the time of testing. Among those, 16.7% reported a history of lifetime TBI and 83.3% reported no TBI. The prevalence of TBI was higher among men than women. Relative to licensed adults without TBI, adults with a history of TBI had significantly higher odds of engaging in serious driver aggression in the past 12 months, such as making threats to hurt another driver, passenger or their vehicle (AOR = 4.39). These individuals also reported significantly higher odds (AOR = 1.74) of being involved in a motor vehicle collision that resulted in hurting themselves, their passenger(s) or their vehicle.ConclusionThis is the first population-based study to demonstrate a relationship between a history of TBI and higher rates of serious driver aggression and collision involvement. Given the large proportion of adult drivers with a history of TBI, these individuals may account for a disproportion burden of all traffic safety problems. Whether the increased road safety risk of adults with a history of TBI is reflective of neurocognitive deficits or is merely evidence of a cluster of unsafe activities produced by a higher risk lifestyles requires further research attention.     

Risky driving among young Australian drivers: trends, precursors and correlates

Young drivers are significantly over-represented among those injured or killed in road traffic accidents. Young adults' greater tendency to engage in risky driving behaviours has been implicated in their high crash involvement rate. While considerable research has examined the driving patterns of young adults and situational factors associated with their involvement in crashes, less is known about the characteristics or circumstances in young drivers' earlier lives that may have contributed to their current driving behaviour. This issue was explored using data from the Australian Temperament Project (ATP), a large longitudinal community-based study, which commenced in 1983 with 2443 families and has followed children's psychosocial development from infancy to early adulthood. During the most recent survey wave when participants were aged 19-20 years, information was collected from young adults about their driving experiences and behaviour. A series of analyses indicated that it was possible to distinguish a group of young adults who engaged in high risky driving behaviour (high group) from a group who engaged in low levels of risky driving behaviour (low group) from mid childhood. Young drivers with a tendency towards risky driving differed from others on aspects of temperament style, behaviour problems, social competence, school adjustment and interpersonal relationships. The implications of these findings for initiatives to reduce risky driving behaviour are discussed.     

Graduated driver license nighttime compliance in U.S. teen drivers involved in fatal motor vehicle crashes

Background

Examination of teen driver compliance with graduated driver licensing (GDL) laws could be instrumental in identifying factors associated with persistently high motor vehicle mortality rates.

Methods

Fatality analysis reporting system (FARS) data from the years 2006 to 2009 were used in this nation-wide cross-sectional study of drivers covered by a state nighttime GDL law (n = 3492). A new definition of weekend, based on the school night in relation to the teenage social landscape, redefined Friday night as a weekend night and Sunday night as a weekday/school night and compared it to previous weekend definitions. Multiple logistic regression was used to examine independent effects of demographic, behavioral, environmental, contextual, and other factors on compliance with nighttime GDL laws. All analyses were performed in Stata version 11.

Results

Given coverage under nighttime GDL laws, drivers aged 15–17 years were non-compliant in 14.9% of the fatal MVCs in which they were involved, and nearly one-fifth (18.8%) of all fatalities aged 15–17 years were associated with non-compliance. Mortality risk was 10% higher using a revised social (school night) versus traditional (Sat–Sun) weekend definitions. In multivariable analysis, drivers non-compliant with nighttime GDL laws were more likely to be drinking (OR = 4.97, 3.85–6.40), unbelted (OR = 1.58, 1.25–1.99), driving on the weekend (OR = 1.82, 1.47–2.24), and killed (OR = 1.31, 1.04–1.65).

Conclusion

GDL non-compliance contributes to teen motor vehicle mortality. Legislative and enforcement efforts targeting non-school night driving, seatbelt nonuse and alcohol have potential to further reduce teen driving mortality.     

Impaired driving and motor vehicle crashes among Swedish youth: an investigation into drivers' sociodemographic characteristics

Impaired driving is an important road safety problem, and the characteristics of drivers impaired by alcohol or drugs are relevant to targeted interventions. This study considers young drivers' sociodemographic attributes: age, sex, class of origin and educational attainment, based on a national cohort of young Swedish drivers (1988-2000) followed up in police registers for their first motor vehicle crash. Of all crashes reported for these drivers, 946 were where the driver was suspected of being under the influence of alcohol or other substances (corresponding to 6% of all first crashes). Impaired driving significantly increases the odds of severe and fatal injuries, regardless of sociodemographic attributes. Observed differences in the proportions of impaired drivers reveal significant excess risks among males, persons aged 18-19, those from households classified as "workers" and "others" (including, e.g. the long-term unemployed and those on long-term sick leave), and those with low educational attainment. Impaired driving is a risk factor in all sociodemographic strata among young people. Members of some groups are more likely to be found than others among impaired drivers on occasion of first motor vehicle crash.     

Seat position and the risk of serious thoracoabdominal injury in lateral motor vehicle crashes

CONTEXT: Previous studies have suggested that motor vehicle occupants seated on the near-side of a lateral impact have a higher proportion of thoracoabdominal injuries. However, due to limitations in previous studies, the true association between seat position, side of lateral impact, and thoracoabdominal injury is unclear. OBJECTIVE: To assess the relationship between seat position (i.e., near-side, middle-seat, and far-side, regardless of row), side of lateral motor vehicle crash (MVC), and serious thoracoabdominal injury after adjusting for important crash factors. DESIGN: National population-based cohort of adult subjects involved in MVCs and included in the National Automotive Sampling System Crashworthiness Data System database (NASS CDS) from 1995 to 2003. PATIENTS: Occupants aged > or =16 years involved in MVCs where the highest external deformation of the vehicle was located on the right or left side (i.e., lateral). MAIN OUTCOME MEASURE: Serious thoracic or abdominal injury, defined as an Abbreviated Injury Scale (AIS) > or =3 in the thoracic or abdominal body region. RESULTS: Fifteen thousand, one hundred and sixty persons involved in primary lateral MVCs were represented in the NASS CDS database during the 9-year period. There were 1867 (2%) persons with serious thoracic injuries and 507 persons (0.5%) with serious abdominal injuries. In multivariable logistic regression models that adjusted for important crash factors and the NASS CDS sampling design, seat position was a strong effect modifier of the association between side of lateral impact and serious thoracic (p<0.0001) and abdominal (p=0.0009) injury, with the risk of serious thoracic and abdominal injury highest for occupants seated on the near-side of the crash. The mean probability of injury was higher for near-side and middle-seat occupants compared to far-side occupants, and the probability of thoracic injury was approximately four times higher than that of abdominal injury for all seat positions. CONCLUSIONS: There is a strong, synergistic relationship between seat position and side of lateral MVC in assessing risk of serious thoracic and abdominal injury among adult occupants. The probability of serious thoracoabdominal injury increases with increasing proximity of seat position to side of the crash and the risk of thoracic injury is higher than abdominal injury for all seat positions.     

Predictors of injury among younger and older adults in fatal motor vehicle crashes

With 2003 Fatality Analysis Reporting System data, we examined relationships among predictors of motor vehicle injury/fatality outcomes for younger (35–54 years) and older (65 years and older) drivers. Using the Precede-Proceed Model of Health Promotion as an organizing framework, we classified variables into person, vehicle and environment domains and conducted a multinomial logistic regression.Significant risk factors for older driver injuries were impact crashes at 1–3 o’clock (OR = 1.65; CI: 1.05–2.59), 7–9 o’clock angles (OR = 2.59; CI = 1.45–4.63), and driving with one passenger (OR = 2.25; CI: 1.58–3.20). Previous other motor vehicle convictions were significantly associated with reduced risk of injury (OR = 0.55; CI = 0.34–0.90). The 7–9 o’clock angle (OR = 3.06; CI: 1.83–5.12), and driving in daylight hours were risk factors for fatality among older drivers.Many risk factors (e.g., female gender, non-seatbelt use, rollover crashes, and vehicle body type), and protective factors (e.g., number of lanes and non-airbag deployment) were relevant for younger and older drivers. Findings showed relevant factors for drivers from both age groups, with some pointing to older adults, and set the stage for further research to develop injury and fatality prevention programs.     

Aggressive driving: an observational study of driver, vehicle, and situational variables

Over 2000 aggressive driving behaviors were observed over a total of 72 h at six different sites. The behaviors selected for observation were those that are commonly included in "aggressive driving" lists, and they consisted of honking, cutting across one or more lanes in front of other vehicles, and passing on the shoulders. In addition, an exposure sample of 7200 drivers were also observed at the same times and places. Relative risks (RRs) and odds ratios (ODs) were calculated to show the relative likelihood that different drivers under different conditions will commit aggressive behaviors. The rate of aggressive actions observed in this study decreased from the most frequent behavior of cutting across a single lane, through honking, and to the least frequent behaviors of cutting across multiple lanes and passing on the shoulders. Relative to their proportion in the driving population, men were more likely than women to commit aggressive actions, and the differences increased as the severity of the action increased. Drivers who were 45 years old or older were less likely to drive aggressively than younger ones. The presence of passengers was associated with a slight but consistent reduction in aggressive driving of all types; especially honking at other drivers. There was a strong linear association between congestion and the frequency of aggressive behaviors, but it was due to the number of drivers on the road. However, when the value of time was high (as in rush hours), the likelihood of aggressive driving--after adjusting for the number of drivers on the road--was higher than when the value of time was low (during the non-rush weekday or weekend hours). The results have implications for driver behavior modifications and for environmental design.     

Acceptability and concurrent validity of measures to predict older driver involvement in motor vehicle crashes: an Emergency Department pilot case-control study

INTRODUCTION: Older drivers have one of the highest motor vehicle crash (MVC) rates per kilometer driven, largely due to the functional effects of the accumulation, and progression of age-associated medical conditions that eventually impact on fitness-to-drive. Consequently, physicians in many jurisdictions are legally mandated to report to licensing authorities patients who are judged to be medically at risk for MVCs. Unfortunately, physicians lack evidence-based tools to assess the fitness-to-drive of their older patients. This paper reports on a pilot study that examines the acceptability and association with MVC of components of a comprehensive clinical assessment battery. OBJECTIVES: To evaluate the acceptability to participants of components of a comprehensive assessment battery, and to explore potential predictors of MVC that can be employed in front-line clinical settings. METHODS: Case-control study of 10 older drivers presenting to a tertiary care hospital emergency department after involvement in an MVC and 20 age-matched controls. RESULTS: The measures tested were generally found to be acceptable to participants. Positive associations (p相似文献   

Risky driving related to driver and vehicle characteristics

This investigation was performed to determine relationships between driver and vehicle characteristics and risk taking in everyday driving, as measured by close following in freeway traffic. A total of 12,000 observations were made of headways (time intervals between successive vehicles) in high flow freely moving freeway traffic at two sites, one in Michigan, the other in Toronto, Canada. The headways were measured using a photographic technique which allowed vehicle and occupant characteristics to be recorded, including type of vehicle and sex and seat belt use. For the Michigan observations, the vehicle license number was recorded, from which additional information on the vehicle and owner (usually the driver) was obtained from state files, including the vehicle mass and model year and the owner's age. sex and history of recorded accidents and traffic violations. Shorter headways, corresponding to higher risk, were found for drivers with prior accidents or violations, young drivers, male drivers, drivers with no passengers. and drivers who did not wear a seat belt. Vehicles associated with shorter headways included newer cars and cars of intermediate mass (1600–1900 kg).     

An analysis of driving and working hour on commercial motor vehicle driver safety using naturalistic data collection

Current hours-of-service (HOS) regulations prescribe limits to commercial motor vehicle (CMV) drivers’ operating hours. By using naturalistic-data-collection, researchers were able to assess activities performed in the 14-h workday and the relationship between safety-critical events (SCEs) and driving hours, work hours, and breaks. The data used in the analyses were collected in the Naturalistic Truck Driving Study and included 97 drivers and about 735,000 miles of continuous driving data. An assessment of the drivers’ workday determined that, on average, drivers spent 66% of their shift driving, 23% in non-driving work, and 11% resting. Analyses evaluating the relationship between driving hours (i.e., driving only) and SCE risk found a time-on-task effect across hours, with no significant difference in safety outcomes between 11th driving hour and driving hours 8, 9 or 10. Analyses on work hours (i.e., driving in addition to non-driving work) found that risk of being involved in an SCE generally increased as work hours increased. This suggests that time-on-task effects may not be related to driving hours alone, but implies an interaction between driving hours and work hours: if a driver begins the day with several hours of non-driving work, followed by driving that goes deep into the 14-h workday, SCE risk was found to increase. Breaks from driving were found to be beneficial in reducing SCEs (during 1-h window after a break) and were effective in counteracting the negative effects of time-on-task.     

汽车驾驶员注意品质与行车安全性关系的研究

借助心理测验方法，分析了事故与无事故汽车驾驶员在注意品质方面存在的差异。结果表明，事故驾驶员比无事故驾驶员的注意范围小，注意转移分配的能力差并且注意力不易集中。此外，驾驶员的注意品质受年龄因素的影响。     

Risky driving and lifestyles in adolescence

Several studies have shown that risky driving is especially prevalent among young drivers and recent research has pointed out that driving in adolescence should be investigated in the more general context of adolescent development. The first aim of this contribution was to analyze involvement in risky driving in a normative sample of 645 Italian adolescents, boys and girls, aged 14-17, through a self-report questionnaire. A second aim was to evaluate the association between risky driving and lifestyle, defined as involvement in other health risk behaviors and leisure activities. The main results showed that many adolescents drove cars and motorcycles without the required driving license and the most frequent offences were speeding and failure to maintain a safe braking distance. Gender and age differences were also investigated. Results concerning the association between risky driving and lifestyle showed that risky driving was not an isolated behavior. Boys who displayed risky driving practices were more likely to adopt a lifestyle characterized by high involvement in antisocial behaviors, tobacco smoking, comfort eating and time spent in non-organized activities with friends. Girls involved in risky driving were more likely to be involved in other risk-taking behaviors, antisocial behaviors and drug use.     

The multidimensional driving style inventory a decade later: Review of the literature and re-evaluation of the scale

The Multidimensional Driving Style Inventory (MDSI; Taubman - Ben-Ari, Mikulincer, & Gillath, 2004a), a self-report questionnaire assessing four broad driving styles, has been in use for the last ten years. During that time, numerous studies have explored the associations between the MDSI factors and sociodemographic and driving-related variables. The current paper employs two large data sets to summarize the accumulated knowledge, examining MDSI factors in samples of young drivers aged 17–21 (Study 1, n = 1436) and older drivers aged 22–84 (Study 2, n = 3409). Findings indicate that driving-related indicators are coherently and systematically related to the four driving styles in the expected directions, revalidating the structure of the MDSI. The results also help clarify the relationships between the driving styles and variables such as gender, ethnicity, car ownership, age, and experience, and suggest that driving styles are largely unaffected by sociodemographic characteristics, except for gender and ethnicity, and appear to represent a relatively stable and universal trait. The two studies highlight the validity and reliability of the MDSI, attesting to its practical value as a tool for purposes of research, evaluation, and intervention.     

Predicting severe head injury after light motor vehicle crashes: implications for automatic crash notification systems

Motor vehicle crashes (MVC) are a leading public health problem. Improving notification times and the ability to predict which crashes will involve severe injuries may improve trauma system utilization. This study was undertaken to develop and validate a model to predict severe head injury following MVC using information readily incorporated into an automatic crash notification system. A cross-sectional study with derivation and validation sets was performed. The cohort was drawn from drivers of vehicles involved in MVC obtained from the National Automotive Sampling System (NASS). Independent multivariable predictors of severe head injury were identified. The model was able to stratify drivers according to their risk of severe head injury indicating its validity. The areas under the receiver-operating characteristic (ROC) curves were 0.7928 in the derivation set and 0.7940 in the validation set. We have developed a prediction model for head injury in MVC. As the development of automatic crash notification systems improves, models such as this one will be necessary to permit triage of what would be an overwhelming increase in crash notifications to pre-hospital responders.     

Validation of the Behaviour of Young Novice Drivers Scale (BYNDS) in a New Zealand young driver population

The Behaviour of Young Novice Drivers Scale, the BYNDS (Scott-Parker et al., 2010), is a reliable and valid self-report 44-item instrument which explores the frequency of a breadth of risky driving behaviours which appear to place young and novice drivers at an increased risk of road crash injury. As part of a larger collaborative research project, the Australian-developed BYNDS was piloted in a sample of 20 young New Zealand drivers n = 14 aged 16–18 years, 9 males; n = 6 aged 19–24 years, 2 males. The wording of 21 BYNDS items was modified to reflect the cultural context of the participating New Zealand drivers. The refined BYNDS was applied in a sample of 325 young drivers n = 116 aged 16–18 years, 65 males; n = 209 aged 19–24 years, 98 males, and the factor structure examined, including exploratory factor analysis for each gender. The 5-factor structure of the BYNDS was supported, with young drivers reporting considerable engagement in risky driving exposure, moderate engagement in transient violations and mood-related driving, and less fixed violations and driving misjudgements. Risky driving exposure was predictive of self-reported crash involvement for both males and females, suggesting targeted intervention regarding when, and the circumstances under which, the young driver is on the road.     

The contribution of passengers versus mobile phone use to motor vehicle crashes resulting in hospital attendance by the driver

There is evidence that mobile phone use while driving (including hands-free) is associated with motor vehicle crashes. However, whether the effects of mobile phone use differ from that of passengers in the vehicle remains unclear. The aim of this research was to estimate the risk of crash associated with passenger carriage and compare that with mobile phone use. A case-control study (‘passenger study’) was performed in Perth, Western Australia in 2003 and 2004. Cases were 274 drivers who attended hospital following a motor vehicle crash and controls were 1096 drivers (1:4 matching) recruited at service stations matched to the location and time and day of week of the crash. The results were compared with those of a case-crossover study (‘mobile phone study’) undertaken concurrently (n = 456); 152 cases were common to both studies. Passenger carriage increased the likelihood of a crash (adjusted odds ratio (adj. OR), 95% confidence interval (95% CI), 1.6, 1.1–2.2). Drivers carrying two or more passengers were twice as likely to crash as unaccompanied drivers (adj. OR 2.2, 95% CI 1.3–3.8). By comparison, driver's use of a mobile phone within 5 min before a crash was associated with a fourfold increased likelihood of crashing (OR 4.1, 95% CI 2.2–7.7). Passenger carriage and increasing numbers of passengers are associated with an increased likelihood of crash, though not to the same extent as mobile phone use. Further research is needed to investigate the factors underlying the increased risks.     

Risky driving and recorded driving offences: A 24-year follow-up study

Permanent individual differences in driver behavior and accident risk have long been under active debate. Cognitive and personality factors have correlated with risky driving indicators in cross-sectional studies, and prospective cohort studies are now increasingly revealing early antecedents of risky behavior and injury mortality in adult age, with connections to stable personality traits. However, long-term stability in driver behavior or accident involvement has not been documented in a general driver population.This study reports 24-year follow-up data from a study that compared the recorded offenses between 134 drivers stopped by the police because of sustained risky driving and 121 control drivers stopped at the same locations at the same time in 1987 (Rajalin, 1994. Accid. Anal. Prev., 26, 555–562). Data were compiled from national driver records and accident statistics for the same drivers again 24 years later, and their yearly mileage and speed behavior was requested in a mail survey. The results showed that the two groups of drivers sampled on one trip a quarter of a century ago still differ from each other. The offenders still have more entries in their driver record, also when adjusted for age and mileage (OR = 1.59, CI = 1.03–2.46), they still report in the survey that they drive faster and overtake other cars more often. The results show that individual differences in driver behavior persist for decades, perhaps for life. However, in this on-road sample, the effect seems to be moderated by occupation which also presumably explains the lower mortality among the offenders during this 24-year follow-up.     

Reducing older driver motor vehicle collisions via earlier cataract surgery

Older adults who undergo cataract extraction have roughly half the rate of motor vehicle collision (MVC) involvement per mile driven compared to cataract patients who do not elect cataract surgery. Currently in the U.S., most insurers do not allow payment for cataract surgery based upon the findings of a vision exam unless accompanied by an individual's complaint of visual difficulties that seriously interfere with driving or other daily activities and individuals themselves may be slow or reluctant to complain and seek relief. As a consequence, surgery tends to occur after significant vision problems have emerged. We hypothesize that a proactive policy encouraging cataract surgery earlier for a lesser level of complaint would significantly reduce MVCs among older drivers. We used a Monte Carlo model to simulate the MVC experience of the U.S. population from age 60 to 89 under alternative protocols for the timing of cataract surgery which we call “Current Practice” (CP) and “Earlier Surgery” (ES). Our base model finds, from a societal perspective with undiscounted 2010 dollars, that switching to ES from CP reduces by about 21% the average number of MVCs, fatalities, and MVC cost per person. The net effect on total cost – all MVC costs plus cataract surgery expenditures – is a reduction of about 16%. Quality Adjusted Life Years would increase by about 5%. From the perspective of payers for healthcare, the switch would increase cataract surgery expenditure for ages 65+ by about 8% and for ages 60–64 by about 47% but these expenditures are substantially offset after age 65 by reductions in the medical and emergency services component of MVC cost. Similar results occur with discounting at 3% and with various sensitivity analyses. We conclude that a policy of ES would significantly reduce MVCs and their associated consequences.