369 - A Disparity Analysis of Driving Intentions and Licensure in Adolescents

Poster Number: 369
Publication Number: 369.1281

Background: Low-income teens are more likely to delay driver licensing to 18 or older. It is not known whether this delay reflects disparities in intentions to drive or barriers to licensure. The Childhood Opportunity Index (COI) is a multi-dimensional indicator of neighborhood opportunity conducive to healthy child development that may be associated with driving intention and licensure. Little is known on the intersection of COI and these outcomes.

Objective: Describe the disparity in driving intentions and licensure among adolescents by neighborhood opportunity.

Design/Methods: We conducted a cross-sectional analysis of electronic health data for adolescents aged 15-18 years seen within the Children’s Hospital of Philadelphia 31-site Primary Care Network from February 2022-October 2023. Adolescents were included if they completed their annual Adolescent Health Questionnaire (AHQ). The AHQ assesses health risks, including self-reported driving intention and licensure status. Neighborhood opportunity was measured using score quintiles of the Childhood Opportunity Index (COI) based on adolescents’ addresses. Mixed effects logistic regression separately estimated the association between neighborhood COI and driving intention for 15-year-olds and licensure status of 17-18-year-olds. Regression models were adjusted for adolescent sex, race/ethnicity, health insurance payor, and urbanicity (address being within or outside Philadelphia County).

Results: Adolescents (n=17,622) were 51% Non-Hispanic White, 70% privately insured, and 65% lived in neighborhoods with “high” or “very high” COI (Table 1). 77% of 15-year-olds from “low” or “very low” COI neighborhoods planned to learn to drive within the next year, compared to 83% from “high” or “very high” COI neighborhoods (Figure 1). 38% of 17-18-year-olds from “low” or “very low” COI neighborhoods reported having a permit or license, compared to 84% in “high” or “very high” COI neighborhoods. In adjusted models, being in the lowest two vs the highest two COI quintile neighborhoods was not significantly associated with intention to start driving in 15-year-olds (OR: 0.85, 95% CI: 0.62, 1.16), but was associated with 58% lower odds of 17-18-year-olds having their permit or license (OR: 0.42, 95% CI: 0.34, 0.51)(Table 2).

Conclusion(s): Although driving intentions are similar in 15-year-olds from neighborhoods with lower vs higher COI, our findings indicate a large disparity in licensure at age 17-18. Future studies should examine barriers that limit progress from driving intention to licensure in order to develop approaches to address this disparity.