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Teen perceptions of good drivers and safe
drivers: implications for reaching adolescents
F K Barg, S Keddem, K R Ginsburg, et al.
Inj Prev 2009 15: 24-29
doi: 10.1136/ip.2008.018572
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Original article
Teen perceptions of good drivers and safe drivers:
implications for reaching adolescents
F K Barg,1,2,3,7 S Keddem,5 K R Ginsburg,1,6 F K Winston1,7
1
Center for Injury Research &
Prevention, Children’s Hospital of
Philadelphia, Philadelphia,
Pennsylvania, USA;
2
Department of Family Medicine
and Community Health,
University of Pennsylvania
School of Medicine, Philadelphia,
Pennsylvania, USA;
3
Department of Anthropology,
University of Pennsylvania
School of Arts and Sciences;
Philadelphia, Pennsylvania, USA;
4
Penn Center for the Integration
of Genetic Healthcare
Technologies, Division of
Medical Genetics, University of
Pennsylvania School of
Medicine, Philadelphia,
Pennsylvania, USA; 5 CraigDalsimer Division of Adolescent
Medicine, The Children’s
Hospital of Philadelphia,
Philadelphia, Pennsylvania, USA;
6
Division of General Pediatrics,
Department of Pediatrics,
Leonard Davis Institute for
Health Economics, Philadelphia,
PA, USA; 7 Center for Public
Health Initiatives, University of
Pennsylvania, Philadelphia,
Pennsylvania, USA
Correspondence to:
Dr F K Barg, Family Medicine
and Community Health, 2 Gates,
Hospital of the University of
Pennsylvania, 3400 Spruce
Street, Philadelphia, PA 19104,
USA; [email protected].
edu
Accepted 14 August 2008
ABSTRACT
Objective: To understand definitions of the phrases
‘‘good driver’’ and ‘‘safe driver’’ among teen pre-drivers
and early drivers in order to appropriately tailor messages
about driving safety.
Design: Qualitative study using freelisting, an anthropological research technique, to explore nuances in the
ways that teens define a good driver and a safe driver
Setting: Classes in six high schools each in a different
state in the USA.
Subjects: 193 adolescent pre-drivers and early drivers,
aged 15–17.
Main outcome measures: Meaning of the phrase good
driver and safe driver was identified for subgroups of
adolescents.
Results: Teen pre-drivers and early drivers define a good
driver and a safe driver as one who is cautious, alert,
responsible, does not speed, obeys the law, uses
seatbelts, and concentrates. There are subtle and
potentially important differences in the way that
subgroups define a good driver and a safe driver.
Conclusions: Injury prevention experts need to attend
closely to the implicit meanings that teens attach to everyday
terms. Freelisting is a method that identifies perceptions
about the meaning of health communication messages and
suggests differences in meaning among subgroups.
Teen crash prevention strategies make frequent use
of the phrases ‘‘good driver’’ and ‘‘safe driver.’’ The
Teen Safe Driver Program1 and the Partners for Safe
Teen Driver Program2 offer interventions targeted at
reducing crashes among teen drivers. Many insurance
companies offer good-driver discounts. California
Governor Arnold Schwarzenegger recently signed a
teen driver safety law designed to ‘‘eliminate any
extra distractions so (teens) can focus on paying
attention to the road and being good drivers.’’3
Injury prevention specialists acknowledge the
importance of word choice in public health communications about teen driving,4–6 7 but little attention
has been paid to the use of the phrases good driver
and safe driver. In this paper, we explore teen
perceptions of these phrases using freelisting, a
technique used by anthropologists that generates
terms that define the domain of interest and delimits
the boundaries of that domain for specific subgroups. We have identified meanings that teens
ascribe to the phrases good driver and safe driver, and
we demonstrate how freelisting can be used to
clarify nuances in the meaning of words used in
injury prevention communication.
BACKGROUND
In an attempt to understand cultural phenomena,
anthropologists make the distinction between etic
24
and emic explanations.8 Expert ideas (etic explanations) about injury prevention are derived from
knowledge of best practices and solid reviews of
the literature. By contrast, the emic, or insider,
perspective represents what members of the target
group understand about the phenomenon. Emic
and etic notions do not always overlap. A core task
in anthropology as well as in public health is to
find ways to elicit the emic perspective to understand the meaning of concepts from the point of
view of the people with whom one wants to
communicate.
Using words that mean one thing to experts and
another to the lay public can lead to unintended
(negative) consequences.6 For example, the injury
prevention literature notes that use of the word
‘‘accident’’ infers unpredictability in the minds of
the lay public.4 6 Arguing that the word accident
should be eliminated from the injury prevention
lexicon, Evans5 emphasizes that terminology alters
public perception. The Evans study also shows that
lay perceptions about the word accident differ
from those of injury prevention specialists. Word
choice also affects risk perception, which is often a
function of the emotions that the words evoke.9–11
Similarly, positive versus negative word choices
(message framing) in health communications, and
whether the message refers to the targeted
individual or their social group, has been shown
to affect the uptake of the message.12
Although experts use the phrases good driver
and safe driver frequently, little attention has been
paid to the meanings of these phrases in the minds
of teen drivers and pre-drivers. In a study examining teen and adult drivers’ perceptions of a good
driver, McCormick and colleagues13 used semantic
differential scales to ascertain how drivers viewed
themselves on eight characteristics of good drivers.
A ‘‘very good driver’’ was defined (in order) as
Table 1 Demographic and driving characteristics of
participants (n = 193)
Characteristic
Mean (SD) or %
Age (years)
Female
Ethnicity
African–American
White non-Hispanic
Hispanic
Other
Driver license
Setting
Urban
Small town
Rural
15.4 (0.6)
61
35
46
17
2
18
20
65
15
Injury Prevention 2009;15:24–29. doi:10.1136/ip.2008.018572
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Original article
Figure 1 Scree plots for salience scores
for terms elicited by freelisting for a safe
driver (A) and a good driver (B). Numbers
with a higher salience score (y axis) are
considered to be more salient, typical
responses to the question.
more safe, reliable, predictable, considerate, responsible, and
wise than an average driver. The concept of a safe driver was
not explored in the McCormick study. We used freelisting to
understand from the point of view of teens who are at the age
when they are learning to drive how they understand the
concepts of a good driver and a safe driver.
METHODS
Participant recruitment
Adolescents in grades 9–11 at six high schools, each in a
different state in the USA, were recruited to participate in
research to investigate ideas about teen driving. Schools (and
the states in which they were located) were stratified first by
whether they had low, medium, or high mortality of teen
drivers and then by the presence or absence of graduated driving
laws and type of seatbelt laws. Schools were also chosen on the
basis of whether they were located in urban, suburban, or rural
Injury Prevention 2009;15:24–29. doi:10.1136/ip.2008.018572
areas, by their ethnic make-up, and by poverty indices. Details
about the sample and the larger study can be found in Ginsburg
et al.14
Data gathering
Written individual freelists were collected from 18 classes of
high school students. Freelisting is a standard semi-structured
interviewing technique15 that is commonly used to identify the
elements and boundaries of a particular domain (in this case,
good drivers and safe drivers) and determines the relative
salience or importance of words defining the domain.16–18 A
salient word in a domain is one that is mentioned frequently
and spontaneously by members of the group.18 Respondents are
asked to list all the words that describe a specific concept.
Amalgamating lists across participants shows what words
members of that group typically use to describe the concept.
Central to the method is the idea that shared experiences (such
25
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Original article
Table 2 Frequency, position, and salience elicited by freelisting for phrases a good driver and a safe driver (n = 193)
A good driver
Frequency
Average rank
Smith’s S
A safe driver
Frequency
Average rank
Smith’s S
Cautious
Alert
Responsible
Doesn’t speed
Obeys the law
Seatbelts
Concentrates
Drives safely
Experienced
Patient
Smart
In control
Obeys signs
Calm
Knowledgeable
Quick reflex
No drinking
Courteous
Never wrecked
Not angry
Not on cell phone
Positive attitude
Knows the road
Uses signals
Takes their time
Female
Makes good turns
Mature
Stays in lane
Skillful
Defensive driver
Not reckless
Doesn’t swerve
Taken driving classes
Has common sense
Listens
Male
Thinks of passengers
Truthful
Good eyesight
Serious
No loud music
Determined
Doesn’t mess around
Headlights always on
Nervous
Nice car
Caring
Has a license
Prepared
70
83
45
48
41
38
32
24
19
20
19
13
13
16
15
12
12
15
10
10
9
11
6
6
7
7
4
6
4
7
6
6
4
4
4
4
6
5
3
3
5
4
3
3
3
3
3
5
3
3
2.343
3.145
2.533
3.125
2.976
3.079
2.688
3.25
3
2.95
3.211
3.077
3.231
3.875
3.667
3
3.667
3.933
4.1
3.3
2.667
5.182
2.333
2.167
2.571
4.143
1.25
3.333
1.5
4.286
3.833
2.833
2.5
2.75
4
3.5
5.167
4
2.333
3
4
4.25
3.333
3
3
7
6
4.8
4
5.333
0.277
0.253
0.17
0.155
0.128
0.117
0.105
0.081
0.069
0.065
0.059
0.042
0.039
0.038
0.038
0.036
0.034
0.033
0.026
0.026
0.025
0.024
0.023
0.023
0.022
0.021
0.02
0.019
0.019
0.018
0.017
0.017
0.014
0.013
0.012
0.012
0.012
0.012
0.012
0.011
0.011
0.01
0.009
0.009
0.009
0.007
0.007
0.006
0.006
0.006
Seatbelts
Alert
Cautious
Responsible
Obeys the law
Doesn’t speed
Concentrates
Obeys signs
Uses signals
No drinking
Calm
Patient
Courteous
Mirrors
Takes their time
Positive attitude
Smart
Thinks of passengers
Caring
Defensive driver
Knowledgeable
Has a license
Drives safely
Not on cell phone
No loud music
Mature
Experienced
Female
In control
Has common sense
Well rested
Prepared
Has insurance
Not reckless
Quick reflex
Male
Me
Never wrecked
Checks condition of car
Confident
Doesn’t swerve
Truthful
Discipline
Hard to influence
Serious
Drug free
Male or female
Doesn’t mess around
Headlights always on
78
96
82
44
55
49
30
24
17
18
22
12
19
13
11
14
12
12
12
9
11
8
9
10
10
7
8
12
5
5
8
7
5
4
4
6
3
4
5
4
3
3
5
4
4
3
3
3
3
2.23
3.05
2.81
2.39
3.11
2.94
3.8
3.63
3.35
3.78
4.27
2.75
4.63
3.46
2.82
4.86
3.58
3.67
3.67
3
3.82
3.13
3.78
3.3
4.2
3.43
3.75
5.75
3.2
2.4
4.63
3.86
3.2
1.75
2.75
5
2.67
3
4.4
4
3
2
5.4
4.25
3.75
4
4
3.67
5
0.318
0.31
0.296
0.175
0.165
0.156
0.084
0.068
0.052
0.049
0.048
0.042
0.039
0.039
0.038
0.034
0.034
0.034
0.032
0.03
0.029
0.027
0.026
0.026
0.024
0.022
0.021
0.02
0.02
0.019
0.019
0.017
0.016
0.016
0.014
0.013
0.013
0.013
0.012
0.012
0.012
0.012
0.011
0.011
0.01
0.009
0.009
0.008
0.008
Words unique to each list are in bold.
as the experience of learning to drive) or shared cultural values
will tend to yield a common notion about a domain among
members of that group.
Students in each class were asked by a facilitator to generate
two written lists: ‘‘What words do you think of when you think
of a good driver?’’ and ‘‘What words do you think of when you
think of a safe driver?’’ Classes were randomly assigned as to
whether they would first generate the list for ‘‘good’’ or ‘‘safe.’’
The study was approved by the Institutional Review Board of
The Children’s Hospital of Philadelphia. Students provided
26
written assent and their parents provided written consent
before study participation.
Data analysis
The research team met to review freelists, to standardize word
forms, and to combine synonyms. For example, terms such as
‘‘seatbelts,’’ ‘‘buckles up,’’ and ‘‘wears a seat belt’’ were all
coded as ‘‘seatbelts.’’ The cleaned lists were entered into
Anthropac (version 4.0, 1996; Analytic Technologies, Natick,
MA, USA), a software program designed specifically to analyze
Injury Prevention 2009;15:24–29. doi:10.1136/ip.2008.018572
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Original article
Table 3 Unique and shared salient words elicited by
freelisting for phrases a good driver and a safe driver (all
respondents)
Table 4 Unique and shared salient words elicited by freelisting for
phrases a good driver and a safe driver by gender
Both good
Both good
Good driver
and safe driver
Safe driver
Drives safely
Experienced
Patient
Smart
Cautious
Alert
Responsible
Doesn’t speed
Obeys the law
Seatbelts
Concentrates
Obeys signs
freelists. Firstly, the output was examined to determine which
words were common to both lists and which words were
unique. For each word, Anthropac calculates a salience index
(Smith’s S) using the formula
S = ((S (L2Rj +1))/L)/N
where L is the length of each list, Rj is the rank of item J in the
list, and N is the number of lists in the sample.18 Salience
describes the words that prototypically19 define the domain of
interest among members of a group by taking into account both
the frequency and rank of the word on the list.
Salience scores were sorted from high to low and then plotted
as scree plots (see fig 1 for an example) using the salience scores
as values on the y axis. The scree plots were inspected to select a
natural breaking point, which demarcated a flattening of the
slope for the less-salient words. For each group’s list, all words
with salience scores above that breaking point were retained as
the list of salient terms. Because the range and distribution of
salience scores differed for each word list, the breaking point
also differed. Salience scores were generated for all adolescents,
and by gender and ethnicity.
RESULTS
Sample characteristics
A total of 193 15–17- year olds completed two freelists
enumerating characteristics of a good driver and a safe driver.
Table 1 presents the demographic characteristics and license
status of the study participants.
Freelisting results
Freelisting results were analyzed by looking at salient terms as
well as words that were either common or unique to the good
driver and safe driver lists. Table 2 contains the frequency of
words listed by at least three respondents, the average position
of each word on the list, and salience scores for a good driver
and a safe driver. Salient words are in bold. Overall, participants
used many of the same words to describe a good driver and a
safe driver: ‘‘cautious,’’ ‘‘concentrates,’’ ‘‘alert,’’ ‘‘responsible,’’
‘‘doesn’t speed,’’ ‘‘obeys the law,’’ and ‘‘seatbelts.’’ (Salient
words common and unique to the good driver and safe driver
lists can be found in table 3.)
Although the word ‘‘seatbelts’’ was mentioned on both lists,
it was mentioned 78 times on the safe driver list compared with
38 times on the good driver list. Words that were unique to the
good driver list included: ‘‘not angry,’’ ‘‘knows the road,’’
‘‘makes good turns,’’ ‘‘skillful,’’ ‘‘taken driving classes,’’ ‘‘listens,’’ ‘‘good eyesight,’’ ‘‘determined,’’ ‘‘nervous,’’ and ‘‘nice car.’’
Words that were unique to the safe driver list included: ‘‘(checks)
mirrors,’’ ‘‘well-rested,’’ ‘‘has insurance,’’ ‘‘me,’’ ‘‘checks condition
Injury Prevention 2009;15:24–29. doi:10.1136/ip.2008.018572
Good driver
and safe driver
Safe driver
Male
Drive safely
Experienced
Alert
Responsible
Cautious
Obeys the law
Concentrates
Doesn’t speed
Seatbelts
Calm
Courteous
Takes their time
Mirrors
Female
Uses signals
Female
Concentrates
Drives safely
Experienced
Patient
Smart
Cautious
Alert
Doesn’t speed
Responsible
Seatbelts
Obeys the law
Obeys signs
of car,’’ ‘‘confident,’’ ‘‘disciplined,’’ ‘‘hard to influence,’’ ‘‘drug
free,’’ ‘‘male,’’ and ‘‘female.’’ When the data were divided by
gender and ethnicity, different words became salient.
Gender
Males and females used many similar words to describe a good
driver and a safe driver (table 4). However, only females said
that a good driver ‘‘concentrates,’’ is ‘‘patient,’’ and ‘‘smart,’’
and a safe driver ‘‘obeys signs.’’ Only male respondents used the
words ‘‘female,’’ ‘‘courteous,’’ and ‘‘calm’’ and behaviors such as
‘‘takes their time,’’ ‘‘(checks) mirrors,’’ and ‘‘uses signals’’ to
illustrate a safe driver.
Ethnic group comparisons
African–American, white, and Hispanic teens used the words
‘‘cautious,’’ ‘‘alert,’’ ‘‘obeys the law,’’ and ‘‘responsible’’ to
describe a good driver and a safe driver. However, there were
differences in both the number of unique terms and the types of
terms used to describe a safe driver and a good driver (table 5).
African–American respondents identified many more unique
terms (‘‘experienced,’’ ‘‘smart,’’ ‘‘stays in lane,’’ ‘‘knowledgeable,’’ ‘‘female,’’ ‘‘takes their time,’’ ‘‘in control’’) for a good
driver than the white (‘‘drive safely’’) and Hispanic (‘‘truthful’’)
respondents. Hispanics named ‘‘seatbelts’’ on the safe driver list,
but not the good driver list.
DISCUSSION
This study was the first application of freelisting to injury
prevention research. We identified definitions of a good driver
and a safe driver among various groups of teens. Teens described
good drivers and safe drivers using the words ‘‘cautious,’’
‘‘alert,’’ ‘‘responsible,’’ ‘‘doesn’t speed,’’ ‘‘obeys the law,’’
‘‘seatbelts,’’ and ‘‘concentrates.’’ Injury prevention messages
that use the phrases good driver or safe driver would likely
invoke these positive traits in the minds of teens.
There are slight nuances in meaning between the two phrases
as well. A good driver (but not a safe driver) was described by
teens with words connoting positive personal characteristics
such as ‘‘experienced,’’ ‘‘patient,’’ and ‘‘smart.’’ A safe driver
(but not a good driver) was described as ‘‘compliant’’ (obeys
signs). Words that were unique to the good driver list infer a
driver who is in control and skilled at navigating the road (eg,
‘‘not angry,’’ ‘‘knows the road,’’ ‘‘makes good turns,’’ ‘‘skillful’’). Some of the words unique to the safe driver list (eg,
27
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Table 5 Unique and shared salient words for a good driver and a safe
driver by ethnicity
Both good
African–American
White
Hispanic
c
Good driver
and safe driver
Safe driver
Experienced
Smart
Stays in lane
Knowledgeable
Female
Drives safely
Takes their time
Courteous
In control
Cautious
Seatbelts
Concentrates
Alert
Patient
Obeys the law
Doesn’t speed
Responsible
No drinking
Positive attitude
Calm
Has a license
Alert
Cautious
Responsible
Doesn’t speed
Obeys the law
Concentrates
Seatbelts
Obeys signs
Uses signals
Alert
Cautious
Obeys the law
Courteous
Responsible
Obeys signs
Seatbelts
Drives safely
Concentrates
Truthful
c
c
c
c
‘‘checks mirrors,’’ ‘‘well-rested,’’ ‘‘has insurance,’’ ‘‘checks car,’’
‘‘disciplined,’’ ‘‘hard to influence,’’ ‘‘drug free’’) describe a driver
who is careful. These may not be trivial distinctions.
Subtle messages in health promotion communication can
have paradoxical effects. In response to the mandates from the
Master Settlement Agreement to conduct non-smoking campaigns among adolescents, the tobacco company Philip Morris
produced a program called ‘‘Think. Don’t Smoke,’’ which
presented words and images of smoking as an ‘‘adult choice’’,
‘‘a forbidden fruit,’’ and an ‘‘act of rebellion’’.20 21 Although on
the surface this subtle messaging conveyed disapproval of
youth smoking, these advertisements may have appealed to
developmental imperatives that encourage teens to challenge
restrictions and appear competent enough to assume adult
roles,22 and there is evidence that these ads promoted protobacco outcomes.23 In evaluating the ‘‘boomerang’’ effect of
anti-smoking messages in the ‘‘Think. Don’t Smoke’’ campaign,
Hendriksen and colleagues24 discuss how psychological reactance theory helps to explain adolescents’ reactions.
Psychological reactance theory states that objects that are
forbidden or restricted for a particular group will tend to be
more attractive to members of that group.
Although there was considerable agreement in the definition
of a good driver and a safe driver among African–American,
white, and Hispanic respondents, there were also substantial
differences in these lists as well. The use of different words by
race or ethnicity suggests that more research needs to be carried
out to elucidate ways in which culture plays a role in the
interpretation and integration of health promotion messages.
Insight into these mechanisms may lead to a better understanding of some of the observed national differences in safety
belt use, crash rates, and fatality rates among African–
Americans, Hispanics, and American Indians.25
28
Key points
Injury prevention specialists argue for the importance of word
choice in the development of messages about teen driver
safety.
Although the phrases are used frequently, little is known about
how teens define a good driver and a safe driver.
In this study, teen pre-drivers and early drivers define a good
driver and a safe driver as one who is cautious, alert,
responsible, doesn’t speed, obeys the law, uses seatbelts, and
concentrates.
There are subtle differences in the ways that subgroups define
a good driver and a safe driver.
Freelisting is a method that can be used by injury prevention
specialists to identify ‘‘local’’ meanings of words or phrases
that are used in health communication messages.
The same is true about gender. Males and females use many
similar words to describe a good driver and a safe driver. Yet
there are numerous examples in the lists of words that only
males or only females use to describe a good driver or a safe
driver. Males described safe driving with words that denote a
slower pace (‘‘calm,’’ ‘‘courteous,’’ ‘‘takes their time’’), and
some included ‘‘female’’ in their list of characteristics of safe
drivers, thus reinforcing the gendered notion of safe driving.
Because crash rates do indeed differ for male and female
adolescents,26 further research needs to explore whether
‘‘female’’ in this context, when used by male adolescents, has
positive, neutral, or negative connotations.
Freelisting allows researchers a glimpse into how a target
audience might interpret a word. In our case, it demonstrated
that, while the meanings of ‘‘good’’ and ‘‘safe’’ overlap, there are
nuanced differences that hold the possibility of influencing a
teenager’s response to motor vehicle injury prevention messages.
Some of these differences exist on a population level, whereas
others vary by subgroups. Just as injury prevention experts have
eschewed the word accident because of its unintended interpretation, we need to learn to test concepts such as good drivers and
safe drivers with teenagers before incorporating words into safety
campaigns. Freelisting would be a first step toward developing
messages that could be tested through other techniques including
focus groups and conjoint analysis before the implementation of
targeted social marketing campaigns.
Limitations
There are several limitations to this study. Freelists are only
strings of words that participants generate in response to a
specific command. They were not recorded or observed in a
natural driving environment. Secondly, freelists were collected
in discussions in which teens were aware that the topic was
teen driver safety. This awareness is likely to affect responses in
unknown ways. Finally, although these data provide insights
into how teens perceive language related to driving, they do not
reflect actual behavior of teens.
IMPLICATIONS FOR PREVENTION
As health communications about teen driver safety are
developed, it is important to ensure that the messages have
the intended meaning for the target group. Experts need to
attend closely to the implicit meanings that teens attach to
everyday terms. Freelisting is a useful tool to help uncover those
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Original article
meanings. This method would also be useful for evaluating
whether injury prevention messages are heard by the target
group in the way that they are intended.
9.
10.
11.
Acknowledgements: This paper was written as part of the Youthful Driver Research
Initiative, a collaborative research program between the Center for Injury Research and
Prevention at The Children’s Hospital of Philadelphia (CHOP) and State Farm Insurance
Companies TM (State Farm). The views presented are those of the authors and not
necessarily the views of CHOP or State Farm. We would like to acknowledge the
important contributions made to this paper by Danielle Erkoboni, Dr J Felipe GarciaEspaña, and Dr Lela Jacobsehn.
Contributorship: FKB, KRG, and FKW conceptualized the study. FKW and KRG
conceptualized and implemented the parent study upon which this paper is based.
Data collection was by KRG, FKW, and SK. Data management was by SK and FKB.
Data analysis was performed by FKB, KRG, FKW, SK. FKB wrote the paper, and KRG,
FKW, and SK added substantially to subsequent drafts of the paper.
Funding: External funding was provided by the State Farm Insurance Companies TM
(State Farm).
Competing interests: None.
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