The "are you driving yet?" talk should become part of every pediatrician's regular physical exam for teenagers, Hopkins Children's experts say.

Pediatrician Letitia Dzirasa, M.D., notes that car accidents kill more 15- to -20-year-olds than any disease, so teenage driving should be considered a risky behavior, in need of as much attention as unprotected sex or underage drinking.

"Pediatricians talk to their teen patients about eating disorders, alcohol, marijuana use," Dzirasa says, "but the one conversation that is not happening often enough is about the number-one killer of teenagers: car accidents."

The American Academy of Pediatrics advises pediatricians to:

• Ask 15-year-olds if they are applying for a driver's permit soon

• Discuss driving risks and ask probing questions about driving behavior

• Ask specific questions about medication use, use of alcohol, night-time driving, seatbelt use, use of a cell phone while driving.

• Encourage parents to place driving restrictions on their teenagers, such as making sure the novice driver is accompanied by an adult.

• Ask parents to consider a written contract with their children, establishing the rules of engagement and penalties for failure to follow them.

• Remind teens and parents that many state laws restrict cell phone use and nighttime driving for novice drivers.

Dzirasa also urges pediatricians to learn about their state's driving laws and discuss them with both teens and parents. Maryland has a graduated driver's licensing (GDL) law that eases novice drivers into driving in three stages: learner's permit, provisional license and driver's license. Research shows that graduated licensing reduces both the number of accidents and the number of severe injuries, Dzirasa says. For example, one study showed that graduated licensing led to 35 percent fewer crashes that require hospitalizations among 16-year-olds. Other studies have shown that the crash rate among 16-year-olds dropped by 26 percent to 41 percent in the first year after the adoption of a graduated licensing law.

High-risk behaviors or conditions among teen drivers include:

• Lack of experience

• Non-use of seatbelts

• Alcohol and other drug use

• Common pediatric conditions, such as ADHD, that increase accident risk

• Use of cell phones and audio equipment that distract drivers

• Night-time driving

• "It can't happen to me" syndrome, thinking that's typical of teenagers and youth.

In 2001 alone, 3,600 teens died in car accidents and 337,000 were injured, according to the National Highway Traffic Safety Administration.