About

Flaura K. Winston, MD PhD, is a Professor of Pediatrics (General Pediatrics) at the University of Pennsylvania's Perelman School of Medicine, affiliated with the Department of Pediatrics and the Center for Injury Research and Prevention at The Children's Hospital of Philadelphia. She is a board-certified pediatrician, a doctorally-trained biomechanical engineer, and a public health researcher. Her research focuses on the interface of child and adolescent health, injury, engineering, and behavioral science, with particular emphasis on addressing the leading causes of death and acquired disability in children and adolescents, such as traffic crashes. Her work spans prevention of teen driver crashes, child passenger safety, and secondary prevention of posttraumatic stress disorder after injury. She directs a major initiative at the Children's Hospital of Philadelphia aimed at building capacity, connections, and community around academic entrepreneurship, including a virtual driving assessment tool for young drivers. Dr. Winston has contributed to the field through her research, publications, and leadership in initiatives that promote safety and injury prevention among youth.

Research topics

• Medicine
• Psychology
• Engineering
• Computer science
• Medical emergency

Selected publications

• Approaches and Strategies for Pediatric Injury Prevention

  Pediatric Clinics of North America · 2025-09-18

  reviewSenior author
  PublisherDOI

• Association between Young New Drivers’ Skills and Driver Training, Home Neighborhood Income Level, and Urbanicity: Evidence from the State of Ohio

  Transportation Research Record Journal of the Transportation Research Board · 2025-09-07 · 1 citations

  articleOpen access

  The disproportionately high crash rates among young drivers in the U.S. stem from a complex interaction of individual maturity, driving skills, vehicle dynamics, social and financial backgrounds, and environmental factors. Research has found that some of these factors disproportionately affect economically disadvantaged groups in various rural/urban settings. Driver education and training have been employed in many states as mandatory for under-18-years-old drivers to secure junior licenses to equip them with safe driving skills. However, there is a gap in understanding how driver training, economic factors, and urbanicity correlate with developing specific driving skills among young drivers. This study leverages a unique dataset from Ohio, comprising Virtual Driving Assessment (VDA)-measured skills, driver licensing data, and home Census tract characteristics from 2017 to 2019 to analyze 22,490 young drivers aged under 25 years. We analyzed the data using visualization tools and inferential statistics to understand the differences in young drivers’ new skills by three separate variables: their completion of driver training and young driver licensure (DTYL) (licensed before 18 years old), urbanicity of residence, and home neighborhood income level. Results indicated that formal DTYL correlated with better adherence to traffic regulations, consistent braking, and lane position control. Young drivers from lower-income neighborhoods exhibited skill deficiencies in traffic rule compliance, throttle control, and lane management, potentially because of limited access to quality training and vehicle safety features. Conversely, rural young drivers excelled in consistent speed management and traffic rule adherence. These insights underscore the necessity to reevaluate driver education curricula and roadway design to align more closely with comprehensive safety outcomes, and to enhance young drivers’ safety awareness and skill proficiency.

  PublisherOA PDFDOI

• Old Threats, New Risks, and Opportunities: The Evolving Challenge of Pediatric Injury Prevention

  Pediatric Clinics of North America · 2025-09-05

  editorialSenior authorCorresponding
  PublisherDOI

• Preventing Unintentional Injuries among Children and Youth

  Pediatric Clinics of North America · 2025-11-04

  articleSenior author
  PublisherDOI

• 337: EPIDEMIOLOGY AND OUTCOMES OF PATIENTS WITH INJURIES ADMITTED TO THE PICU: A SINGLE-CENTER STUDY

  Critical Care Medicine · 2025-01-01

  article
  PublisherDOI

• Addressing the Gap: Examining the Role of Multiple Executive Function Constructs and Associated Factors in Risky Driving Performance in Young Drivers

  Transportation Research Record Journal of the Transportation Research Board · 2025-07-09

  article

  Young drivers are disproportionately involved in motor vehicle crashes compared with other age groups. One potential contributing risk factor is the ongoing development of executive functions (EFs) with maturation of the frontal lobe through adolescence and into early adulthood. However, EF consists of distinct constructs, some of which have been studied more than others, and which have rarely been measured together in relation to objective driving performance on ecological and complex simulated driving tasks. This study recruited 16 to 24 year-old drivers ( N = 93) and measured their performance on an EF battery targeting key constructs (working memory, inhibitory control, and set-shifting), as well as speed of processing, and related it to performance on a validated virtual driving assessment (VDA) that exposes drivers to common crash-risk scenarios, while considering EF-related covariates. Univariate analysis identified independent variables associated with VDA performance, and multivariate regression models revealed that better set-shifting performance (i.e., cognitive flexibility/task-switching ability) was associated with a 43% decrease in the likelihood of unsafe driving. Higher sensation-seeking tendencies were also associated with a 17% lower likelihood of unsafe driving. There is limited prior work examining set-shifting in young drivers, however, these results suggest it may help in explaining safe driving performance in young drivers. Clarifying the underlying mechanisms of young driver crash-risk may lead to new opportunities for interventions that aim to reduce crashes.

  PublisherDOI

• A contemporary examination of the effect of driver training for reducing crash risk in novice adolescent drivers: protocol for the DRIVER study, a random assignment trial

  Injury Epidemiology · 2025-12-01 · 1 citations

  articleOpen accessSenior author

  BACKGROUND: Motor vehicle crashes and resultant fatalities remain disproportionately high among young drivers, with crash risk peaking immediately after licensure. Although graduated driver licensing laws (GDL) for young novice drivers have reduced such fatalities, driver error remains a leading cause; thus, prevention efforts that target improving skills in novice teen drivers before licensure are a strong candidate for reducing crash risk early in licensure. States with more comprehensive driver licensing laws that include mandated driver training before licensure in addition to GDL show lower crash rates post-licensure, but these effects were not determined through rigorous controlled studies of driver training. This paper describes the DRIVER study, a phase III randomized trial that tests the effectiveness of two different driver training programs in reducing young driver crash risk early in licensure in Pennsylvania, a state like many others that does not require formal training for young drivers. METHODS: Learner drivers age 16 and 17 years will be recruited and followed through the GDL learner phase and for six months post-licensure. Participants will be randomly assigned to one of three interventions: professional behind-the-wheel training (n = 333), online hazard training (n = 333), or an active control online vehicle and driver safety course, unrelated to hazard skills training (n = 333). The primary outcomes are on-road crash risk post-licensure (via kinematic hard braking events tracked through a smartphone-based app) and state license examination performance. Secondary outcomes include change in simulated driving performance from baseline to the time of license examination, self-reported and kinematically tracked risky driving behavior (e.g. cell phone use, speeding) and self-reported crashes. Participants will complete baseline surveys and cognitive assessments to determine potential moderating effects of cognitive maturation and risk-taking tendencies. DISCUSSION: Findings from the DRIVER study will provide insights into training effectiveness generally, and an evidence base for recommendations to policy makers, while also revealing for whom these interventions are less effective. TRIAL REGISTRATION: The study was registered on ClinicalTrials.gov Registry (NCT06413927) in May 2024, https://clinicaltrials.gov/study/NCT06413927 and last updated on August 11th, 2025. This protocol was developed per the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) Checklist.

  PublisherDOI

• A novel paradigm for identifying eye-tracking metrics associated with cognitive control during driving through MEG neuroimaging

  Transportation Research Part F Traffic Psychology and Behaviour · 2025-11-08

  articleOpen access

  • A novel paradigm that combines MEG neuroimaging, eye-tracking, and simulated driving was developed. • This novel paradigm demonstrated that eye-tracking can potentially proxy measures of cognitive control during driving. • Fixation count, mean gaze position, spread of search, and saccade amplitude differed between Hi and Lo periods. • These findings support a path toward in-vehicle driver monitoring systems that infer cognitive deficits in real time. Understanding the neurocognitive underpinnings of driving behavior in adolescents is critical to improving road safety. To address this, we established a novel paradigm linking magnetoencephalography (MEG)-recorded frequency-specific brain activity to simulated driving performance, identifying periods of increased cognitive control. However, this initial paradigm did not incorporate eye-tracking – a potentially scalable proxy for cognitive control that could be leveraged by in-vehicle driver monitoring systems. This proof-of-concept study expands our paradigm by integrating eye-tracking to identify scanning behavior metrics associated with periods of increased cognitive control validated by MEG. Typically developing adolescents (n = 11; mean age = 15.1 ± 1.5 yrs) completed three driving tasks of varying cognitive demand, and MEG frequency specific analysis confirmed periods of high (Hi) and low (Lo) cognitive control via the established biomarker of frontal midline theta (FMT). Fixation count, fixation duration, horizontal/vertical mean gaze position, saccade amplitude, and horizontal/vertical spread of search were compared between Hi vs. Lo periods of cognitive control. Task-specific differences in fixation count (p < 0.05), mean gaze position (p < 0.01), saccade amplitude (p < 0.05), and spread of search (p < 0.01) were observed between Hi compared to Lo cognitive control periods. These differences corresponded to expected task-specific changes in scanning behavior that would accompany cognitive control over behavior, suggesting a signal that eye-tracking may serve as a proxy for underlying neurocognitive processes. This integrated approach demonstrates methodological rigor and offers a promising framework for further research and informing development of in-vehicle driver monitoring systems for detecting cognitive deficits in real time, with implications for enhancing teen driver safety.

  PublisherDOI

• A randomized trial of behavioral interventions yielding sustained reductions in distracted driving

  Proceedings of the National Academy of Sciences · 2024-07-29 · 7 citations

  articleOpen access

  Distracted driving is responsible for nearly 1 million crashes each year in the United States alone, and a major source of driver distraction is handheld phone use. We conducted a randomized, controlled trial to compare the effectiveness of interventions designed to create sustained reductions in handheld use while driving (NCT04587609). Participants were 1,653 consenting Progressive® Snapshot® usage-based auto insurance customers ages 18 to 77 who averaged at least 2 min/h of handheld use while driving in the month prior to study invitation. They were randomly assigned to one of five arms for a 10-wk intervention period. Arm 1 (control) got education about the risks of handheld phone use, as did the other arms. Arm 2 got a free phone mount to facilitate hands-free use. Arm 3 got the mount plus a commitment exercise and tips for hands-free use. Arm 4 got the mount, commitment, and tips plus weekly goal gamification and social competition. Arm 5 was the same as Arm 4, plus offered behaviorally designed financial incentives. Postintervention, participants were monitored until the end of their insurance rating period, 25 to 65 d more. Outcome differences were measured using fractional logistic regression. Arm 4 participants, who received gamification and competition, reduced their handheld use by 20.5% relative to control ( P &lt; 0.001); Arm 5 participants, who additionally received financial incentives, reduced their use by 27.6% ( P &lt; 0.001). Both groups sustained these reductions through the end of their insurance rating period.

  PublisherOA PDFDOI

• Testing a New Care Model: Implementing a Virtual Driving Assessment in Primary Care

  The Annals of Family Medicine · 2024-07-01

  articleOpen access

  Motor vehicle crashes are a leading cause of death for adolescents, and a leading cause of crashes is driver error.1 Studies have quantified that 75% of young novice driver crashes are due to skill deficits (recognition, decision, or performance errors),2 with reckless behaviors (eg, speeding, drunk

  PublisherDOI

Recent grants

• AIR: Engineering the Evaluation of Online Health and Wellness Promotion Applications

  NSF · $1.2M · 2011–2014

• Determining critical skill deficits that predict novice driver crashes: A prospective study using a novel virtual driving test at point of licensure, state licensing data and crash outcomes

  NIH · $210k · 2019–2021

• Center for Child Injury Prevention Studies (CChIPS)

  NSF · $982k · 2010–2016

• I/UCRC Phase III: Center for Child Injury Prevention Studies

  NSF · $496k · 2015–2020

• Determining critical skill deficits that predict novice driver crashes: A prospective study using a novel virtual driving test at point of licensure, state licensing data and crash outcomes

  NIH · $295k · 2019–2021

Frequent coauthors

• Dennis R. Durbin

  Nationwide Children's Hospital

  197 shared

• Nancy Kassam‐Adams

  Children's Hospital of Philadelphia

  108 shared

• Kristy B. Arbogast

  University of Pennsylvania

  97 shared

• Michael J. Kallan

  University of Pennsylvania

  71 shared

• Elizabeth A. Walshe

  Children's Hospital of Philadelphia

  68 shared

• Andrew E. Lincoln

  Special Olympics

  63 shared

• Catherine C. McDonald

  Philadelphia University

  61 shared

• Meghan L. Marsac

  57 shared

Awards & honors

• Academic Entrepreneurship for Medical & Health Scientists (2…
• Seemed Like a Good Idea: Alchemy Versus Evidence-based Appro…
• Accessible Training for Academic Clinicians and Researchers…
• Driving skills at licensure and time to first crash (2023)
• Testing a New Care Model: Implementing a Virtual Driving Ass…