CONTEXT. Implementation of graduated driver licensing programs is associated with reductions in crash rates of young drivers, but graduated driver licensing programs vary in their components. The impact of programs with different components is unknown.OBJECTIVE. The purpose of this work was to determine which graduated driver licensing programs are associated with the greatest reductions in fatal motor vehicle crashes involving 16-year-old drivers.METHODS. We conducted a retrospective study of all 16-year-old drivers involved in fatal crashes in the United States from 1994 through 2004 using data from the Fatality Analysis Reporting System and the US Census Bureau. We measured incidence rate ratios of fatal motor vehicle crashes involving 16-year-old drivers according to graduated driver licensing programs, adjusted for state and year.RESULTS. Compared with state quarters with no graduated driver licensing program components, reductions of 16% to 21% in fatal crash involvement rates of 16-year-old drivers occurred with programs that included Ն3-month mandatory waiting period, nighttime driving restriction, and either Ն30 hours of supervised driving or passenger restriction. Reductions of 18% to 21% occurred in state quarters with programs that included Ն5 of the 7 components examined. Drivers aged 20 to 24 or 25 to 29 years did not experience significant reductions.CONCLUSION. Comprehensive graduated driver licensing programs are associated with reductions of ϳ20% in 16-year-old drivers' fatal crash involvement rates. The greatest benefit seems to be associated with programs that include age requirements and Ն3 months of waiting before the intermediate stage, nighttime driving restriction, and either Ն30 hours of supervised driving or passenger restriction. Evaluations of GDL programs comparing rates before and after GDL implementation in individual states have reported reductions in crash rates of novice drivers that ranged from 11% to 32%. 2-10 However, previous evaluations have not taken advantage of the unique environment of the United States that makes it possible to compare programs among states, with attention to their specific components. Recently, Dee et al 11 reported a 6% reduction nationally in crash fatalities of 15-to 17-yearolds associated with GDL programs. The greatest reductions (19%) were in states with programs ranked "good" by the Insurance Institute for Highway Safety using a system based on the presence and strength of components considered as desirable. 11,12 The type of analysis used by Dee et al 11 does not make it possible to compare programs with different combinations of program components.State GDL programs differ with respect to which components are included and in the specific requirements of each component, such as the required number of hours of supervised driving. Evaluation of the separate components of GDL is not possible, because in most states, several components have been introduced or changed simultaneously, making it impossible to separate their effects. Therefor...