The survey also asked students about other behaviors, such as how often they wore a seatbelt and whether they drove after drinking alcohol or rode in a vehicle with a driver who had been drinking alcohol. Students younger than 14 and students who did not drive were excluded from the analysis.

Thirty-eight percent of students who drove reported texting while driving on at least one day; 22 percent sometimes texted, and 16 percent frequently texted. The prevalence of texting while driving increased with age: 15 percent of 14-year-olds sometimes or frequently texted, while 56 percent of teenagers 18 and older sometimes or frequently texted. There also was a wide range by state in the percentage of teenagers who texted while driving, with Maryland at the low end (26 percent) and South Dakota at the high end (64 percent).

In addition to South Dakota, four other states (Montana, Nebraska, North Dakota and Wyoming), had more than 50 percent of teenagers reporting having texted or emailed while driving at least once in the past 30 days. Several factors could account for this finding, the authors suggested:

all five states share one or more common borders;



all five are primarily rural states with populations of 2 million people or less; and



in all five states, the minimum age to obtain a learner's permit is 15 years or younger.

In addition, the percentage of teenagers in these five states who drove averaged more than 80 percent, the highest of any region in the country. Geography might play a role in this finding, the authors noted; because these states are mostly rural and not densely populated, teenagers are more likely to begin driving at a younger age and may drive longer distances, both of which could increase the odds of texting while driving.

Texting while driving also appeared to be associated with other risky behaviors. Teens who infrequently wore a seatbelt, for example, were 21 percent more likely to text or email while driving than teens who frequently wore a seatbelt. Students who reported drinking and driving were 91 percent more likely to text while driving than those who did not.

Tackling the Distracted Driving Epidemic

Unfortunately, said the researchers, the actual number of teenagers who use a smart phone or other device while driving may well be even higher than indicated.

In discussing their results, the study authors explained that the Youth Risk Behavior Survey only asked teenagers specifically about texting and emailing. It did not ask them about taking pictures, downloading music, making a call, or other activities while driving, so the study probably doesn't paint a complete picture of what teenagers may be doing with their phones and other devices while driving.

In addition, the survey didn't ask teenagers how many times a day they texted or emailed while driving, or for how long. And because some students may not have considered texting while a car was stopped the same as texting while driving, it's possible that those behaviors were not counted.

According to the Insurance Institute for Highway Safety, 47 states have enacted laws that prohibit or restrict text messaging while driving, and 38 states have banned cellphone use by novice drivers altogether. Arguably, most teenagers know that texting while driving is dangerous, not to mention illegal -- yet many of them do it anyway.

The best way to combat distracted driving, the authors suggested, is to approach the problem from several angles. For parents, this includes being a better role model (i.e, not using a cellphone or engaging in other forms of distracted driving themselves), establishing clear rules about how and when it's OK to use a cellphone in the car, and closely monitoring teenagers who are just starting to drive. For teenagers, this means being educated on the dangers of distracted driving and helping to clear up any myths they may have heard. Other suggestions include providing "monetary incentives" to teenagers to discourage cellphone use while driving and installing apps or other programs that would block cellphones from being used while in a car.

Regarding this latter suggestion, the authors noted that according to a 2015 study, installing a cellphone-blocking app significantly reduced the number of phone calls and texting-while-driving episodes among teenage drivers. However, about 15 percent of teens found ways to bypass the app's blocking function; others simply used another person's cellphone when they were unable to use theirs while driving.

For family physicians, helping to curb behaviors that put teens at risk, such as texting while driving, can be challenging. Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division, offered the following advice as to how family physicians can talk to teenagers and their parents about these types of behaviors.

"Family physicians routinely talk to adolescents and their parents about risky behaviors," Frost told AAFP News. "Today, most teens have their own cellphone, so the risks of using their cellphone while driving is an important topic.

"Family doctors should consider discussing the risks of distracted driving with the teen and their parents, encouraging parents to serve as good role models."

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