Guest speakers introduce students to diverse perspectives, share relevant experiences that reinforce course content, and demonstrate how skills and knowledge that students are learning can be applied in public health practice. Providing a monetary thank you gift is one way to recognize the valuable contributions of community-based guest speakers to students' learning. We describe the implementation and evaluation of a departmental pilot program to offer gift cards to guest speakers. During the 2022 to 2023 academic year, instructors could request a $100 gift card for one guest speaker outside of the university community per course per semester. We evaluated the program to assess the process for distributing gift cards, instructors' reasons for inviting guest speakers, and students' perceptions of guest speakers' contributions to their learning. Data were collected through tracking spreadsheets, an online survey to instructors, and anonymous student course evaluations. Thirty gift cards ($2525 covered by the department) were distributed. Evaluation findings indicate that the program is a feasible way to engage diverse perspectives in the classroom and share applied examples and professional development with students. Specific recommendations that we implemented in the continuation of this program include allowing flexibility in the number and denomination of gift cards, streamlining the process for requesting and distributing gift cards, and providing communications to facilitate consistent and clear information sharing. The Guest Speaker Thank You Gift Program complements and extends the diversity, equity, and inclusion work of the department by supporting the expansion of perspectives shared in classroom and directly acknowledging guest speakers' contributions.

Teaching Qualitative Data Analysis to graduate-level students requires experiential learning and hands-on approaches, but there is a paucity of qualitative datasets available for teaching purposes. Pedagogical literature has paid relatively little attention to best practices related to the use of datasets in qualitative data analysis courses. It is essential for course instructors to have more methods in their toolkits to effectively generate instructional qualitative datasets. This article outlines a blueprint for creation of instructional qualitative datasets, using four general principles: (1) research topic of interest to students and not requiring specialized knowledge; (2) short time frame and ease of data collection; (3) student engagement; and (4) protection of research participants. We consider examples of how these principles were applied to generate three different datasets and discuss pros and cons of each method. This article describes a flexible approach, allowing for easy generation of custom instructional datasets.

Rationale: Project UPLIFT is an evidence-based epilepsy self-management program shown to prevent and treat depression through an 8-session, group telehealth intervention. Since 2012, the program has been disseminated by training community-based providers to deliver UPLIFT to people with epilepsy (PWE). Limited research has described the adoption, implementation, and practice-based maintenance of self -management programs like UPLIFT. We sought to gain a better understanding of this process from trained program adopters.Methods: A cross-sectional evaluation of adoption and implementation experiences was conducted. An online survey with closed-and open-ended questions was distributed to 120 UPLIFT program adopters to collect information about reasons for being trained and experiences implementing the program. Survey items were developed based on the RE-AIM model to assess program reach, effectiveness, adop-tion, implementation, and maintenance. For closed-ended responses, frequencies and cross-tabs were calculated. Open-ended responses were reviewed and grouped by theme.Results: 41 respondents completed the survey (34% response rate). Respondents were from a variety of organizations including clinical (39%, n = 16), educational/research (17%, n = 7), and Epilepsy Foundation affiliates/chapters (12%, n = 5), among others. The most frequently endorsed reason for train-ing in UPLIFT was an interest in supporting PWE (73%, n = 30). Most respondents rated delivering UPLIFT as very important (49%, n = 20) or important (32%, n = 13) to the organization. Sixty-one percent (n = 25) of respondents reported implementing (implementors) UPLIFT. Of those who had not yet implemented UPLIFT, 50% (n = 8) planned on implementing it at some point. Among program implementors, the most frequently reported implementation facilitators included participant interest (68%, n = 17), training (68%, n = 17), and organizational support (64%, n = 16). Program implementors indicated having program champions (80%, n = 20). The most frequently reported implementation challenge reported was recruit-ment (72%, n = 18). In open-ended responses, funding was a key theme that would facilitate continued implementation, but 48% (n = 12) responded that did not have access to resources and/or funding to help continue offering UPLIFT. Developing partnerships was recommended to improve the reach and mainte-nance of the program. Despite challenges, implementors agreed (44%, n = 11) or strongly agreed (36%, n = 9) that UPLIFT was effective in addressing mental health problems among program participants, and 76% (n = 19) plan on continuing to offer UPLIFT.Conclusion: Implementation surveys increase understanding of program adoption and impact for dissem-ination trainees. Implementation benefits from program champions, strong partnerships, and sustained funding. Continued refinement of implementation support, such as developing a sustained referral sys-tem, maintaining relationships with trainees, supporting evaluation activities, and exploring opportuni-ties for program updates to further enhance adoption, implementation, and maintenance.(c) 2022 Elsevier Inc. All rights reserved.

To provide a foundation for mentoring, junior faculty participated in a mentor training workshop informed by the Mentoring Clinical and Translational Researchers curriculum. The goal was to develop skills and behaviors that engender more rewarding and inclusive mentoring practices. Attendees responded to baseline and follow-up surveys assessing perceived mentoring skills. Follow-up surveys included closed- and open-ended questions about the value and satisfaction of the training, and intended behavior changes. Junior faculty respondents (n = 39) reported significantly higher overall mentoring skills after the training (t = −2.6, p = 0.012) with a medium effect size (Cohen’s D = 0.59). Domains with statistically significant improvement from baseline to follow-up included aligning mentor–mentee expectations and assessing understanding. Thirty-eighty (97%) found the training valuable, and 32 (82%) indicated they would change mentoring-related behaviors because of the training. Intended behavior changes described in open-ended responses aligned with mentoring skills assessed (e.g., aligning expectations). An additional competency domain of evaluating mentoring relationships was also described. A mentor training workshop for junior faculty appeared to contribute to changes in mentoring skills and intended behaviors. Mentor training has the potential to enhance mentorship, which is critical to strengthening a diverse pipeline of clinical and translational science researchers.

Modern public health practice includes planning, implementation, and evaluation of programs targeting the structural and social determinants of health. To prepare graduate students to engage with theory in complex, practical, and innovative ways, a new model of course delivery was created to focus on developing and applying theorizing skills to the social ecological model. Throughout the semester, students engage in collaborative learning to apply theory to real-world public health interventions focused on high-profile public health issues. Data were gleaned from three course sections (N = 80) using a pre-post study design to evaluate students' ability to apply theory at various levels of the social ecological model and confidence to meet course objectives. The post-course survey also included questions about the helpfulness of specific course elements and asked for recommendations for improvement. Descriptive statistics were calculated and differences between pre- and post-ratings were tested with paired samples t-tests and Wilcoxon signed rank tests. Students improved in their ability to apply theory by the end of the semester (p < .001) and in their confidence in meeting all learning objectives (p < .001). Most students found that this new format of engaging with theory in complex, applied, and innovative ways by working in teams, completing in-class activities, and open poster presentations beneficial. Engaging students in a new course format led to critical reflection about various levels of influence on health and enhanced students' ability to apply theory at multiple levels of influence. Further refinement and course development will continue to facilitate developing theorizing skills.

Rationale: The promotion of evidence-based self-management support for people living with chronic conditions such as epilepsy is a public health priority. Epilepsy self-management encompasses three gen-eral areas: (1) treatment management, (2) seizure management, and (3) lifestyle management. Interventions focusing on self-management have increased quality of life and adherence to treatment. This study assesses and synthesizes the Managing Epilepsy Well Network (MEWN) program implemen-tation experiences using the RE-AIM framework. This research informs the quality and rigor of MEWN program dissemination and implementation efforts to assess whether these programs are being imple-mented and their scalability. Methods: The study data were derived from a MEWN Self-management Program Survey conducted with currently active MEWN researchers through an online survey and review of program publications and archival documents. Survey data were obtained from either the principal investigator or study team for the UPLIFT, HOBSCOTCH, SMART, MINDSET, TIME, and PACES programs. The survey questionnaire included 6 sections consisting of 68 questions and focused on the RE-AIM dimensions and respondent characteristics. The RE-AIM dimensions included: (1) Reach, (2) Effectiveness, (3) Adoption (number of and type of adopting sites), (4) Implementation (retention rate, barriers to implementation), and (5) Maintenance. Results: Across the MEWN programs, participation (44-120 individuals) and delivery methods (commu-nity, clinic, or asynchronous; group or individual) ranged with most programs predominantly reaching White or African American participants. Common program outcome measures included clinical outcomes (e.g., depression, quality of life, seizure frequency) and indicators of self-management behaviors (e.g., problem-solving; self-efficacy). Initial efficacy trials suggested programs were effective in changing some of their targeted outcomes (effectiveness). Most programs were implemented in clinical settings and sev-eral programs are being replicated or adapted to different geographical (e.g., urban, rural, suburban) or demographic (e.g., race, age) settings (adoption). Program delivery methods involved a mixture of pro-gram staff, peer educators, and researchers. Implementation enabling factors included partnerships with local epilepsy organizations and the inclusion of peer educators. Retention rates for all programs aver-aged 83.6%. Internal barriers included recruitment and lack of sufficient resources for participants. External barriers included clinical staff buy-in, staffing, and insufficient funding for support staff. Despite uncertain funding, all programs offered next steps to sustain their initiatives such as packaging their programs, initiating adoption with regional organizations, and supporting organizational readiness (maintenance). Dissemination efforts included partnering with other organizations, provision of training and technical assistance, and partnering with national organizations on grant opportunities to scale up existing programs. Conclusion: These data showcase the impact of the MEWN self-management interventions on health and quality of life. These programs are employing training, readiness assessment, technical assistance, and development of partnerships to increase program scalability. Finally, program adaptations are being con-ducted to expand the interventions to other populations to address health inequalities. The lessons learned are critical for other interventions attempting to increase the translation of their programs to other settings. (c) 2023 Elsevier Inc. All rights reserved.

African American (AA) adults are 60% more likely to be diagnosed with diabetes mellitus (DM) and experience more complications than non-Hispanic White adults. Cognitive behavioral therapy (CBT) has shown to be an effective modality for helping patients improve health behaviors and regulate emotional states. Motivational interviewing (MI) addresses participant engagement and motivation. Therefore, MI was combined with CBT as an approach to the process of learning using CBT skills to promote healthy lifestyle choices. We aimed to assess the effects of a culturally tailored CBT/MI intervention on glycemic control in AA participants and understand their perspectives, attitudes, and experiences while participating in this intervention. Using a randomized, parallel design pilot study (web-based group vs in-person group), 20 participants aged ≥ 18 years, identifying as AA and having a glycosylated hemoglobin (HbA1c) > 8%, were recruited. A CBT/MI intervention was administered in six sessions over 3 months. Participants completed baseline and follow-up assessments on measures for diabetes control (HbA1c), self-efficacy, generalized anxiety, depression, perceived stress, health-related quality of life, and cognitive ability. Post-CBT/MI intervention focus groups were conducted to determine patient perspectives regarding the intervention. Fourteen participants completed the study, their mean HbA1c improved from 10.0 to 8.9% (t(26) = 0.5, p-value = 0.06). The Diabetes Distress Scale demonstrated decreased distress overall (t(26) = 2.6; p-value = 0.02). The Generalized Anxiety Disorder Scale demonstrated decreased generalized anxiety for all participants (t(26) = 2.2; p = 0.04). Themes identified in focus groups included (1) intervention group social support through information sharing, (2) mental health and personal identities in diabetes understanding and management, and (3) receptivity to CBT/MI intervention positively impacts self-efficacy through improved health literacy. This group-based, culturally tailored CBT/MI intervention for type 2 DM care was positively received by AA participants and helped improve diabetes control, as demonstrated by the change in HbA1c. There were additional benefits of social support through group interactions and a stronger sense of self-efficacy due to health education. A comprehensive treatment plan using a CBT/MI intervention may be useful in promoting healthy diabetes self-management. ClinicalTrials.gov , NCT03562767 . Registered on 19 June 2018

Managing one's own symptoms, medications, treatments, lifestyle, and psychological and social aspects of chronic disease is known as self-management. The Institute of Medicine has identified three categories of epilepsy self-management, including medication management, behavior management, and emotional support. Overall, there has been limited research of interventions measuring epilepsy self-management behaviors. The present study aimed to develop an abbreviated version of the full, previously published, Adult Epilepsy Self-Management Measurement Instrument (AESMMI) using confirmatory factor analysis. Data come from a cross-sectional survey of people with epilepsy. The sample included adults with epilepsy (n = 422), who reported that a clinician diagnosed them with epilepsy or a seizure disorder. We ran confirmatory factor analyses in testing the abbreviated scale. The scale was reduced using a theory-driven data-informed approach. The full AESMMI length was reduced by 40% (from 65 to 38 items) with an overall internal consistency of 0.912. The abbreviated AESMMI retained the 11 subdomains, with Cronbach's alphas from 0.535 to 0.878. This reduced item scale can be useful for assessing self-management behaviors for people with epilepsy or measuring outcomes in self-management research.(c) 2022 Elsevier Inc. All rights reserved.

Parental emotion regulation plays a major role in parent-child interactions, and in turn, neural plasticity in children, particularly during sensitive developmental periods. However, little is known about how parental emotion dysregulation is associated with variation in children's brain structure, which was the goal of this study. Forty-five Black American mother-child dyads were recruited from an intergenerational trauma study; emotion regulation in mothers and their children (age 8-13 years) was assessed. Diffusion-weighted images were collected in children; deterministic tractography was used to reconstruct pathways of relevance to emotion regulation. Metrics of white matter connectivity [fractional anisotropy (FA), mean diffusivity (MD)] were extracted for pathways. Socio-economic variables were also included in statistical models. Maternal emotion dysregulation was the strongest predictor of child fornix MD (r = .35, p = .001), indicating that more severe emotion dysregulation in mothers corresponded with lower fornix connectivity in children. Maternal impulsivity was a strong predictor of child fornix MD (r = .51, p < .001). Maternal emotion dysregulation may adversely influence connectivity of the child.s fornix, a hippocampal-striatal pathway implicated in reward processes; these associations remained even after accounting for other socio-environmental factors. Dysregulated maternal emotions may uniquely impact children's adaptation to trauma/stress by affecting networks that support appetitive processing.

Unemployed and underemployed emerging adults (EAs) are at increased risk for depression. However, limited research has examined resilience and coping in this population. This study tested the resilience process by examining whether coping processes mediate the relationship between perceived stress and depression among unemployed and underemployed EAs. Data from 193 unemployed and underemployed EAs (ages 18–25) were collected through an online questionnaire. Path analysis tested the mediation model. Post hoc moderation analyses tested whether coping buffered the impact of stress on depression. The sample was diverse, consisting of Black (37%), White (37%), and other race/ethnicity (26%) participants. The proposed mediating model did not fit the data well. Of four interaction terms tested, one was significant (Perceived Stress × Coping Self-Efficacy [CSE]; p = .043). As CSE increased, the relationship between perceived stress and depression decreased. The interaction results suggest that CSE buffers the relationship between perceived stress and depression.

•This study was a cross-sectional survey of African American adults with epilepsy•Sixty percent of African Americans PWE had visited a neurologist in the past year•Participants more frequently conducted behaviors in the areas of proactivity, medication adherence and health communications•They performed behaviors related to treatment, stress management, and safety less frequently

Purpose: Seizures have a variety of significant physical, cognitive, and social effects upon the individual. Depression has been linked to an increase in seizure activity, and Project Using Practice and Learning to Increase Favorable Thoughts (UPLIFT) was shown to reduce depressive symptoms. Project UPLIFT, based upon mindfulness-based cognitive therapy (MBCT), provides distance delivery of depression management skills to groups of people with epilepsy. Because Project UPLIFT reduces depression and depression is linked to seizure activity, the current analysis was designed to determine the impact of Project UPLIFT upon seizure frequency and severity. Method: Participants (n 107) were adults ages 21-70 with epilepsy and mild-to-moderate depressive symptoms from the states of Georgia, Michigan, Texas, and Washington. The eight-session Project UPLIFT intervention was group-delivered weekly via the web or telephone. Participants were randomly assigned to condition ( i.e., Project UPLIFT or a treatment-as-usual [TAU] waitlist) and assessed at baseline, and after intervening in the Project UPLIFT group (similar to 10 weeks). Assessments included valid self-report measures of seizure frequency and severity and depression. Results: Mediation analysis found that there was a significant negative direct relationship between condition and number of seizures at posttest; the mean number of seizures decreased by 32 in the Project UPLIFT group, but increased by 23 in the TAU group. The indirect path from condition to number of seizures through change in depression was not significant. Conversely, there was no significant negative direct relationship between condition and seizure severity at posttest, although the seizure severity decreased by 22 points in the UPLIFT group and increased by 2.7 points in the TAU group. The indirect path from condition to seizure severity through depression was significant, however, demonstrating that change in depression mediated the effect of Project UPLIFT on seizure severity. Conclusions: This study found that participating in Project UPLIFT directly reduced the number of seizures experienced by participants with epilepsy. This was not mediated by the change in depression. Participation in Project UPLIFT also reduced their perceived seizure severity indirectly, through reducing their depressive symptoms. This suggests Project UPLIFT may have the potential to impact the health, healthcare costs, and well-being of people with epilepsy. (C) 2019 Elsevier Inc. All rights reserved.

Depression and worse quality of life (QOL) are significantly associated with epilepsy. However, limited descriptive data on depression and quality of life among African Americans with epilepsy are available. This study sought to describe the prevalence of depression among African Americans with epilepsy participating in self-management studies and to examine the relationship between depression and QOL. Using data from the Managing Epilepsy Well (MEW) research network, a subgroup of African Americans with epilepsy were selected for the analytic sample. Descriptive statistics indicated the prevalence of depression (Patient Health Questionnaire-9 [PHQ-9]) and reports of epilepsy-specific QOL (Quality of Life in Epilepsy-10 [QOLIE-10]) in the sample. Multiple linear regression examined the relationship between depression and QOL while controlling for sociodemographic characteristics and seizure frequency. The prevalence of depression (PHQ-9 ≥; 10) was 47.7%. Quality of life was the only variable significantly associated with depressive symptoms in multivariable analyses, suggesting that depressive symptoms have a stronger relationship with QOL than seizure frequency. With the high levels of depression and the significant relationship with QOL, regular screening of depression is needed among African Americans with epilepsy. Self-management programs that improve mood may also play an important role in improving the lives of African Americans with epilepsy.

Mobile health app developers increasingly are interested in supporting the daily self-care of people with chronic conditions. The purpose of this study was to review mobile applications (apps) to promote epilepsy self-management. It investigates the following: 1) the available mobile apps for epilepsy, 2) how these apps support patient education and self-management (SM), and 3) their usefulness in supporting management of epilepsy. We conducted the review in Fall 2017 and assessed apps on the Apple App Store that related to the terms “epilepsy” and “seizure”. Inclusion criteria included apps (adult and pediatric) that, as follows, were: 1) developed for patients or the community; 2) made available in English, and 3) less than $5.00. Exclusion criteria included apps that were designed for dissemination of publications, focused on healthcare providers, or were available in other languages. The search resulted in 149 apps, of which 20 met the selection criteria. A team reviewed each app in terms of three sets of criteria: 1) epilepsy-specific descriptions and SM categories employed by the apps and 2) Mobile App Rating Scale (MARS) subdomain scores for reviewing engagement, functionality, esthetics, and information; and 3) behavioral change techniques. Most apps were for adults and free. Common SM domains for the apps were treatment, seizure tracking, response, and safety. A number of epilepsy apps existed, but many offered similar functionalities and incorporated few SM domains. The findings underline the need for mobile apps to cover broader domains of SM and behavioral change techniques and to be evaluated for outcomes.

In-Depth Analysis of Pedestrian Crashes in Riyadh Naif Al-Shammari a , Salaheddine Bendak b & Saad Al-Gadhi c a Department of Mechanical and Manufacturing Engineering, College of Engineering , The University of Birmingham , Edgbaston, Birmingham, United Kingdom b Department of Industrial Engineering, College of Engineering , King Saud University , Riyadh, Saudi Arabia c Department of Civil Engineering, College of Engineering , King Saud University , Riyadh, Saudi Arabia Published online: 13 Nov 2009.

The purpose of this qualitative study was to understand how college students have responded, at any point in their lifetime, to a suicidal friend or family member. College students completed an online survey in which they described, in their own words, what they have done when a friend or family member disclosed being suicidal. These responses included providing social support, information, telling someone, and crisis support. Future studies are needed to determine how common these responses are, identify factors that predict certain responses, and examine the impact responding to a suicidal person can have on college student wellbeing.

Background: In trials of Project UPLIFT, a distance-delivered, mindfulness-based cognitive therapy intervention, there was improvement in the mental health of people with epilepsy/seizure disorder. In these trials, however, African Americans have been few. Thus, as this program is disseminated, it is desirable to ensure that it is culturally appropriate for minority populations. Methods: To determine the appropriateness of Project UPLIFT for African Americans, we engaged in three main research activities: 1) the formation and involvement of an epilepsy community advisory board; 2) qualitative interviews with healthcare providers who serve this community; and 3) focus groups with African American adults living with epilepsy or seizure disorder and main support persons of African American adults living with epilepsy or seizure disorder. Results: The epilepsy community advisory board provided recommendations for the most appropriate language to use when engaging and recruiting the target population. Healthcare providers indicated that psychosocial concerns of African American persons living with epilepsy seemed to be different from those among patients of other racial groups. They indicated that Project UPLIFT might be useful for this group. Focus groups revealed experiences of living with and supporting someone with epilepsy and provided favorable feedback on the UPLIFT intervention. Conclusions: Formative feedback indicates that Project UPLIFT may be useful for African Americans with epilepsy. These data will be used to guide a forthcoming randomized, controlled trial to assess the acceptability and feasibility of the intervention with this group.

IntroductionThe high rate of unemployment among emerging adults (aged 18 to 25 years) is a public health concern. The risk of depression is higher among the unemployed than among the employed, but little is known about the relationship between unemployment and mental health among emerging adults. This secondary data analysis assessed the relationship between unemployment and depression among emerging adults.MethodsData from the 2010 Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. Responses to the Patient Health Questionnaire-8 provided data about the prevalence of depression. Bivariate relationships were assessed using.2 tests, and multivariable adjusted odds ratios were calculated with logistic regressions. Sociodemographic variables were sex, race/ethnicity, marital status, and education. In addition, logistic regression models adjusted for health insurance status, disability, smoking, and body mass index. The analyses were completed using SAS 9.3 survey procedures to account for the complex sampling design.ResultsAlmost 12% of emerging adults were depressed (PHQ- 8 >= 10) and about 23% were unemployed. Significantly more unemployed than employed emerging adults were classified with depression. In the final model, the odds of depression were about 3 times higher for unemployed than employed emerging adults.ConclusionThe relationship between unemployment and depression is significant among emerging adults. With high rates of unemployment for this age group, this population may benefit from employment-and mental-health-focused interventions.

The purpose of this study was to test the psychometric properties of an enhanced Adult Epilepsy Self-Management Measurement Instrument (AESMMI). An instrument of 113 items, covering 10 a priori self-management domains, was generated through a multiphase process, based on a review of the literature, validated epilepsy and other chronic condition self-management scales and expert input. Reliability and exploratory factor analyses were conducted on data collected from 422 adults with epilepsy. The instrument was reduced to 65 items, converging on 11 factors: Health-care Communication, Coping, Treatment Management, Seizure Tracking, Social Support, Seizure Response, Wellness, Medication Adherence, Safety, Stress Management, and Proactivity. Exploratory factors supported the construct validity for 6 a priori domains, albeit with significant changes in the retained items or in their scope and 3 new factors. One a priori domain was split in 2 subscales pertaining to treatment. The configuration of the 11 factors provides additional insight into epilepsy self-management behaviors. Internal consistency reliability of the 65-item instrument was high (α=.935). Correlations with independent measures of health status, quality of life, depression, seizure severity, and life impact of epilepsy further validated the instrument. This instrument shows potential for use in research and clinical settings and for assessing intervention outcomes and self-management behaviors in adults with epilepsy.

Objective: This study was designed to investigate the 15-year impact of Georgia's graduated drivers' licensing (GDL) law, the "Teenage and Adult Driver Responsibility Act" (TADRA), on fatality crashes among young drivers.Methods: Fatality Analysis Reporting System (FARS) data for Georgia and Census denominators were used to determine fatal crash rates (FCRs) of drivers ages 16 through 19 who passed through the Georgia GDL system during the 5.5 years prior to through 15.5 years after TADRA's implementation. FCRs of younger drivers were compared to those of drivers ages 20-54 and 55-75 and compared by gender. Attention was given to speeding- and alcohol-related crashes, 2 foci of TADRA.Results: The decline in FCRs has been maintained and even increased through 15.5 years after passage of the law. Extending the curfew and further limiting passengers (passed in 2001) and driver's education and supervised driving requirements (added in 2007) may have contributed. The greatest declines were among 16- and 17-year-olds; most of the gains were among male drivers. The changes were greatest for alcohol- and speeding-related crashes. Those 18 and 19 years old did not demonstrate an increase in FCR over the period studied.Conclusion: Georgia's graduated licensing law, TADRA, has maintained and in some instances increased in effectiveness over the 15.5 years since its inception. Though national research suggests that GDL laws are associated with increased crash rates among 18- to 19-year-old drivers, this has not occurred in Georgia; 18- and 19-year-olds demonstrated no change or reductions in FCR over the 20.5-year period evaluated. Declines were greatest for those driving behaviors targeted by the law.