Preventing alcohol-related traffic injury: a health promotion approach

The conditions that give rise to drinking and driving are complex, with multiple and interrelated causes. Prevention efforts benefit from an approach that relies on the combination of multiple interventions. Health promotion provides a useful framework for conceptualizing and implementing actions to reduce drinking and driving since it involves a combination of educational, behavioral, environmental, and policy approaches. This review draws on data from a range of settings to characterize the effectiveness of various interventions embedded within the health promotion approach. Interventions considered part of the health promotion approach include: (1) economic interventions (2) organizational interventions, (3) policy interventions, and (4) health education interventions, including the use of media, school and community education, and public awareness programs. Effective health promotion strengthens the skills and capabilities of individuals to take action and the capacity of groups or communities to act collectively to exert control over the determinants of alcohol-impaired driving. There is strong evidence for the effectiveness of some components of health promotion, including economic and retailer interventions, alcohol taxation, reducing alcohol availability, legal and legislative strategies, and strategies addressing the servers of alcohol. There is also evidence for the effectiveness of sobriety checkpoints, lower BAC laws, minimum legal drinking age laws, and supportive media promotion programs. Other interventions with moderate evidence of effectiveness include restricting alcohol advertising and promotion, and actions involving counter advertising. Health education interventions alone that have insufficient evidence for effectiveness include passive server training programs, school drug and alcohol education programs, community mobilization efforts, and health warnings. Because each intervention builds on the strengths of every other one, ecological approaches to reducing alcohol-impaired driving using all four components of the health promotion model are likely to be the most effective. Settings such as schools, workplaces, cities, and communities offer practical opportunities to implement alcohol-impaired driving prevention programs within this framework.     

Can progress in reducing alcohol-impaired driving fatalities be resumed? Results of a workshop sponsored by the Transportation Research Board,Alcohol, Other Drugs,and Transportation Committee (ANB50)

Objective: Despite successes in the 1980s and early 1990s, progress in reducing impaired driving fatalities in the United States has stagnated in recent years. Since 1997, the percentage of drivers involved in fatal crashes with illegal blood alcohol concentration (BAC) levels has remained at approximately 20 to 22%. Many experts believe that public complacency, competing social and public health issues, and the lack of political fortitude have all contributed to this stagnation. The number of alcohol-related crashes, injuries, and fatalities is still unacceptable, and most are preventable. The public needs to be aware that the problem presented by drinking drivers has not been solved. Political leaders need guidance on which measures will affect the problem, and stakeholders need to be motivated once again to implement effective strategies.

Methods: The National Academy of Sciences (NAS) Transportation Research Board (TRB), Alcohol, Other Drugs, and Transportation Committee (ANB50) sponsored a workshop held at the NAS facility in Woods Hole, Massachusetts, on August 24–25, 2015, to discuss the lack of progress in reducing impaired driving and to make recommendations for future progress. A total of 26 experts in research and policy related to alcohol-impaired driving participated in the workshop. The workshop began by examining the static situation in the rate of alcohol-impaired driving fatal crashes to determine what factors may be inhibiting further progress. The workshop then discussed 8 effective strategies that have not been fully implemented in the United States. Workshop participants (16 of the 26) rated their top 3 strategies.

Results: 3 strategies received the most support: 1. Impose administrative sanctions for drivers with BACs = 0.05 to 0.08 g/dL.

2. Require alcohol ignition interlocks for all alcohol-impaired driving offenders.

3. Increase the frequency of sobriety checkpoints, including enacting legislation to allow them in the 11 states that currently prohibit them.

5 other important strategies included the following: (1) increase alcohol taxes to raise the price and reduce alcohol consumption; (2) reengage the public and raise the priority of impaired driving; (3) lower the illegal per se BAC limit to 0.05 for a criminal offense; (4) develop and implement in-vehicle alcohol detection systems; and (5) expand the use of screening and brief interventions in medical facilities.

Conclusions: Each of these strategies is proven to be effective, yet all are substantially underutilized. Each is used in some jurisdictions in the United States or Canada, but none is used extensively. Any one of the 3 strategies implemented on a widespread basis would decrease impaired driving crashes, injuries, and fatalities. Based on the research, all 3 together would have a substantial impact on the problem.     

A comprehensive examination of U.S. laws enacted to reduce alcohol-related crashes among underage drivers

Introduction: To effectively address concerns associated with alcohol-related traffic laws, communities must apply comprehensive and well-coordinated interventions that account for as many factors as possible. The goal of the current research article is to examine and evaluate the simultaneous contribution of 20 underage drinking laws and 3 general driving safety laws, while accounting for demographic, economic, and environmental variables. Methods: Annual fatal crash data (1982 to 2010), policies, and demographic, economic, and environmental information were collected and applied to each of the 51 jurisdictions (50 states and the District of Columbia). A structural equation model was fit to estimate the relative contribution of the variables of interest to alcohol-related crashes. Results: As expected, economic factors (e.g., unemployment rate, cost of alcohol) and alcohol outlet density were found highly relevant to the amount of alcohol teens consume and therefore to teens' impaired driving. Policies such as those regulating the age of bartenders, sellers, or servers; social host civil liability laws; dram shop laws; internal possession of alcohol laws; and fake identification laws do not appear to have the same impact on teens' alcohol-related crash ratios as other types of policies such as those regulating alcohol consumption or alcohol outlet density. Conclusions: This effort illustrates the need for comprehensive models of teens' impaired driving. After simultaneously accounting for as many factors as possible, we found that in general (for most communities) further reductions in alcohol-related crashes among teens might be more rapidly achieved from efforts focused on reducing teens' drinking rather than on reducing teens' driving. Future efforts should be made to develop models that represent specific communities. Practical applications: Based on this and community-specific models, simulation programs can be developed to help communities understand and visualize the impact of various policy alternatives.     

Adolescent driving: Characteristics associated with single-vehicle and injury crashes

The high motor-vehicle crash rate of young drivers may be attributed to both driving inexperience and a greater tendency to engage in risk-taking behavior. This study examines risk-taking behavior, as indicated by single-vehicle crashes and injury crashes, and factors associated with these behaviors, based on measures of demographic, psychosocial, and substance use obtained from high school senior questionnaires. Because previous work indicated different predictors for young men and young women, separate logistic regression analyses were conducted. For young women, propensity toward cigarette use was associated with higher rates of single-vehicle crashes; while race, alcohol misuse, and friends' involvement with alcohol and marijuana were associated with injury crashes. For young men, availability of substances, driving frequency, alcohol misuse, and propensity toward marijuana use were associated with higher rates of single-vehicle crashes. Young men's living situation, availability of substances, and marijuana use were related to injury crashes.     

Hardcore drinking drivers and other contributors to the alcohol-impaired driving problem: need for a comprehensive approach

OBJECTIVE: Understanding the hardcore drinking driver concept in the context of the alcohol-impaired driving problem. METHOD: Review of the relevant literature. RESULTS: As progress against alcohol-impaired driving slowed in the early 1990s, public and political attention turned to "hardcore" drinking drivers, and they have been a priority for the past 15 years. Though intuitive, the hardcore concept has been difficult to conceptualize. Its definition of hard-to-change chronic heavy drinking drivers focuses on a group that is not easily identifiable and ignores many who account for a large portion of alcohol-impaired driving crashes. These include drivers who drink heavily on occasion and drivers who drink at more moderate levels that elevate crash risk. Emphasis on the hardcore has focused attention on the small proportion of drinking drivers who have been detected and arrested, whereas the vast majority of drinking drivers go undetected. Some countermeasures aimed at the hardcore group have been effective in reducing recidivism, but attention and resources also need to be given to general deterrent initiatives (e.g., 0.08 g/dL, sobriety checkpoints, administrative license suspension). There has been no reduction in the overall alcohol-impaired driving problem since the mid-1990s. CONCLUSION: Reductions in the alcohol-impaired driving problem require that attention be focused on all relevant target groups. Some benefits could accrue by recognizing that countermeasures developed for hardcore drinking drivers, such as alcohol ignition interlocks and vehicle or plate impoundment, might also be effective with more numerous first-time offenders. However, such strategies are likely to be most effective against recidivism (specific deterrence). Greater gains could be achieved through general deterrent efforts (increasing the real and perceived risk of arrest and punishment to all drinking drivers), along with application of public health measures designed to reduce overall consumption. Additional ways need to be found to separate drinking and driving, either through cultural changes in drinking and/or driving behavior or, in the future, with the use of technology that can make vehicles inoperable by drivers with illegal blood alcohol concentrations.     

The emergency care setting for screening and intervention for alcohol use problems among injured and high-risk drivers: a review

Each year thousands of people are treated in emergency departments and trauma centers for alcohol-related injuries, including those sustained in drinking driving crashes. Emergency departments and trauma centers provide an opportunity to screen for alcohol use problems and intervene with injured or high-risk drivers to reduce future alcohol-related traffic and injury risk. Recently physicians have expressed interest in exploring screening and intervention for alcohol use problems in these venues as a means of improving clinical care. This article reviews the literature that has examined screening and brief interventions in acute care settings to reduce future alcohol consumption and alcohol-related injury. The methodological and practical issues inherent in conducting these studies as well as in actual practice are discussed. The chaotic environment of acute care, the large numbers of patients required to be screened to obtain an adequate study sample, and high attrition rates make study in these settings difficult at best and are methodological problems that should be addressed in future research. A basic question that has not been adequately answered by research to date is whether reduction in alcohol consumption will translate to reduced alcohol-related harm, such as driving while impaired, or injurious or fatal crashes. Long-term studies that assess records-based outcomes in addition to alcohol-consumption levels are needed.     

Marijuana trajectories and associations with driving risk behaviors in Canadian youth

Objective: Research on risky driving practices involving marijuana use among youth and young adults often relies on cross-sectional data, which fail to account for longitudinal changes in substance use patterns. A better understanding of the longitudinal patterns of marijuana use and its effect on risky driving practices during young adulthood is needed in order to better inform prevention efforts. The current study examined whether different longitudinal patterns of marijuana use across the transition from adolescence to young adulthood are associated with impaired driving risks in young adulthood.

Methods: Data were from the longitudinal Victoria Healthy Youth Survey, which interviewed youth biennially on 6 occasions across 10 years (2003 to 2013).

Results: Youth who reported consistently high levels of marijuana use from adolescence to young adulthood (chronic users) and youth who reported increasing levels of use across this period (increasers) were more likely to engage in risky impaired driving behaviors compared to the other 3 user groups (occasional users, decreasers, and abstainers). Frequency of marijuana use was also predictive of impaired driving risks in young adulthood after controlling for individual characteristics (age, sex, socioeconomic status, age of onset of marijuana use), frequency of other substance use (heavy episodic drinking and illicit drug use), and simultaneous use of marijuana and other substances (alcohol and illicit drugs). By young adulthood, youth who use marijuana more than once a week are more likely to simultaneously use alcohol and engage in heavy episodic drinking. They are also more likely take driving risks.

Conclusions: Harm reduction strategies and legislative approaches targeting impaired driving risks associated with marijuana use should include approaches to target these high-risk groups and to reduce simultaneous use of alcohol.     

The effectiveness of alternative transportation programs in reducing impaired driving: A literature review and synthesis

Introduction: Studies have shown that approximately half of arrested intoxicated drivers had their last alcoholic drink at a licensed bar or restaurant. Current efforts to prevent intoxicated patrons from leaving licensed establishments and driving home have been only partially successful. Since a high proportion of drinkers drive to their drinking destination, promoting the use of alternative transportation (AT) – including safe ride shuttles, free or subsidized taxi and ridesharing services, voluntary or paid designated driver programs, and more accessible public transportation – is an important strategy for preventing impaired driving. The primary goal of this study was to review and synthesize the findings of research studies designed to test the effectiveness of AT programs in reducing alcohol-impaired driving. A secondary goal was to report if using AT has led to any unintended consequences, in particular greater alcohol consumption. Method: We identified relevant academic articles, new articles, government reports, and other documents (English only) through the University of Chicago library, Google Scholar, and Google Search. We also included published articles recommended by peers. Key search terms included: alternative transportation; safe rides; designated driver; alcohol-impaired driving; alcohol consumption, cost effectiveness; and reduce drunk driving. Initially, we identified 168 potentially relevant sources, of which only 57 were academic articles. After a thorough review, we narrowed down the number of relevant articles to 125 including some background articles and government reports. Results: Some AT programs produced reductions in one or more of the following outcomes: (1) impaired driving; (2) impaired driving crashes; (3) driving under the influence (DUI) arrests; and (4) traffic crashes in general, but others were not shown to be effective. A few programs resulted in greater self-reported alcohol use, but there were no significant findings indicating that drinking when using AT led to an increase in alcohol-related harms such as public intoxication, assaults, or other alcohol-related crime. Of the studies that conducted a cost-benefit analysis, most showed that AT programs yielded a positive benefit, but these studies did not include a sufficient number of variables to be considered true cost-benefit analyses. Conclusions: There is mixed evidence regarding the effectiveness of AT programs. Evaluations with more rigorous quasi-experimental and experimental designs are needed to identify which types of AT programs work best for different types of communities and target groups. Practical Applications: The literature review and synthesis revealed that the most successful AT programs typically have some of these attributes: (1) social acceptance; (2) high level of public awareness; (3) low cost; (4) year-round availability; (5) provide rides to and from drinking venues; (6) several sponsors that provide funding); (7) user convenience; and (8) perceived safety.     

Associations between driving under the influence or riding with an impaired driver and future substance use among adolescents

Objective: Risky driving behaviors among adolescents, such as riding with a drinking or impaired driver (RWID) or driving while under the influence (DUI) of alcohol or drugs, are significant public health concerns. Few studies have examined associations of RWID and DUI with future substance use and problems after controlling for baseline substance use. Given that the DUI/RWDD event may be a teachable moment to prevent future consequences (e.g., when injured or arrested), it is important to understand how this risk behavior relates to subsequent use and problems. This study therefore examined characteristics of adolescents who reported DUI and RWID and assessed their risk of future alcohol and marijuana use and consequences 6 months later.

Methods: Participants were 668 adolescents aged 12 to 18 (inclusive) recruited at 1 of 4 primary care clinics in Pittsburgh and Los Angeles as part of a larger randomized controlled trial. They completed surveys about their health behaviors at baseline and 6 months after baseline. We examined baseline characteristics of adolescents who reported DUI and RWID and then assessed whether past-year DUI and RWID at baseline were associated with alcohol and marijuana use and consequences 6 months after baseline.

Results: Fifty-eight percent of participants were female, 56% were Hispanic, 23% were Black, 14% were White, 7% were multiethnic or other, and the average age was 16 years (SD?=?1.9). At baseline, participants who reported RWID or DUI were more likely to be older, report past-year use of alcohol and marijuana, and more likely to have an alcohol use disorder or cannabis use disorder versus those who did not report RWID or DUI, respectively. At 6-month follow-up and after controlling for baseline demographics and baseline alcohol use, RWID was associated with more frequent drinking episodes in the past 3 months and greater number of drinks in the past month when they drank heavily. DUI at baseline was associated with more frequent heavy drinking episodes and alcohol and marijuana consequences 6 months later.

Conclusions: RWID and DUI are significantly associated with greater alcohol and marijuana use over time. This study highlights that teens may be at higher risk for problem substance use in the future even if they ride with someone who is impaired. Prevention and intervention efforts for adolescents need to address both driving under the influence and riding with an impaired driver to prevent downstream consequences.     

A Random,Roadside Breathalyzer Survey of Alcohol Impaired Driving in Ghana

To ascertain the prevalence and pattern of alcohol impaired driving in an African nation, we conducted a random, roadside, breathalyzer survey of drivers in Ghana. A total of 149 (21%) of 722 drivers tested had a detectable blood alcohol concentration (BAC). In addition, 7.3% of drivers had a BAC ≥ 80 mg/dl. The prevalence of impaired driving (BAC ≥ 80) was higher among private drivers (9.8%) than commercial drivers (6.4%). However, due to a higher volume, the majority (64%) of impaired drivers were commercial drivers. Alcohol use was higher among uneducated (11%) compared to educated drivers (5.4%) and was higher among middle aged drivers (30 - 49 years, 9.1% impaired) compared with younger (< 30 years; 5.0%) or older drivers (≥ 50 years; 0%). Alcohol impaired driving is a significant problem in this African nation. Anti-drunk driving measures should be an important component of road safety efforts. Such measures may need to be different than industrialized nations and will need to target less educated drivers, middle aged drivers, and commercial drivers.     

Examining motor vehicle crash involvement and readiness to change on drinking and driving behaviors among injured emergency department patients

Objective: To measure the effect of motor vehicle crash (MVC) involvement and readiness to change drinking and driving behaviors on subsequent driving and drinking behaviors among injured emergency department (ED) patients who use alcohol at harmful levels.

Methods: This was a secondary analysis of a randomized controlled trial of injured ED patients who screened positive for harmful alcohol use, who at recruitment reported driving in the past 12 months and received at least one of the intended intervention sessions (brief behavioral intervention versus attention placebo control; N = 407). Outcome variables were as follows: (1) change in 6 impaired driving behaviors and (2) report of MVCs and traffic violations in the 12 months following recruitment; predictor variables were as follows: (1) treatment assignment, (2) MVC involvement at recruitment, and (3) baseline readiness to change alcohol use and drinking and driving.

Results: Modeling of change in the 6 impaired driving variables indicated that neither the recruitment visits being MVC related nor baseline readiness to change alcohol use and drinking and driving behaviors predicted greater changes in impaired driving over time. Baseline reports of past moving traffic violations and the ED visit being MVC related predicted a greater likelihood of each behavior at 12 months following study recruitment.

Conclusions: This study and others have demonstrated that ED patients with harmful alcohol use are willing to engage in behavioral interventions directed at changing risky behaviors. However, this study did not demonstrate that patients considered having the potential to be more engaged with the intervention because their ED visit was MVC related and/or they had expressed intent to change their risky alcohol use and drinking and driving behaviors were more likely to change these risky behaviors.     

Traffic environment and demographic factors affecting impaired driving and crashes

IntroductionData availability has forced researchers to examine separately the role of alcohol among drivers who crashed and drivers who did not crash. Such a separation fails to account fully for the transition from impaired driving to an alcohol-related crash.MethodIn this study, we analyzed recent data to investigate how traffic-related environments, conditions, and drivers’ demographics shape the likelihood of a driver being either involved in a crash (alcohol impaired or not) or not involved in a crash (alcohol impaired or not). Our data, from a recent case–control study, included a comprehensive sampling of the drivers in nonfatal crashes and a matched set of comparison drivers in two U.S. locations. Multinomial logistic regression was applied to investigate the likelihood that a driver would crash or would not crash, either with a blood alcohol concentration (BAC) = .00 or with a BAC ≥ .05.ConclusionsTo our knowledge, this study is the first to examine how different driver characteristics and environmental factors simultaneously contribute to alcohol use by crash-involved and non-crash-involved drivers. This effort calls attention to the need for research on the simultaneous roles played by all the factors that may contribute to motor vehicle crashes.     

Alcohol problems among Swedish drunk drivers: differences related to mode of detection and geographical region

OBJECTIVE: To investigate the prevalence of alcohol problems in a representative sample of Swedish drivers suspected of drunk driving in comparison with control drivers and the general Swedish population in relation to mode and time of detection. Is the time of day or night or the detection mode important for the prevalence of alcohol problems and which are the best predictors for identifying alcohol problems among DUI offenders? METHODS: Two thousand and one hundred drivers (169 females) suspected of DUI offence during 1997-2001 who agreed to respond to the AUDIT questionnaire (Alcohol Use Disorders Identification Test) and 785 control drivers (266 females) not suspected of DUI recruited at general traffic controls were investigated. RESULTS: Both mode and time of detection were found to be important. The greatest impact on the prevalence of alcohol problems emanated from the predictors in the following order: high BAC; unlicensed driving; detection hours between 12.00 and 18.00, and age under 26 years. Age over 55 years and detection in general traffic controls were the two strongest factors negatively correlated to alcohol problems prevalence. The differences between regions with regard to alcohol problems incidence could only partly be explained by police routines and resources. CONCLUSIONS: Mode and time of detection affect the prevalence of DUI offenders with alcohol problems, and to a lesser degree also BAC level. Both the detection mode and the time of detection are significant for the proportion of identified DUIs with alcohol problems. Because the majority of committed DUI offenses are never identified, it is important to optimize the detection strategies of the police with the purpose of minimizing public damage and expenses.     

Sobriety checkpoints: evidence of effectiveness is strong, but use is limited

There is substantial and consistent evidence from research that highly publicized, highly visible, and frequent sobriety checkpoints in the United States reduce impaired driving fatal crashes by 18% to 24%. Although checkpoints are not conducted in 13 states for legal or policy reasons, there is strong evidence that if conducted appropriately, checkpoints would save lives in the other states. However, a recent survey of checkpoint use has demonstrated that despite the efforts of the U.S. Department of Transportation to encourage checkpoint use through publications, providing funds for equipment, and for officer overtime expenses, only about a dozen of the 37 states that conduct checkpoints do so on a weekly basis. The survey found that lack of local police resources and funding, lack of support by task forces and citizen activists, and the perception that checkpoints are not productive or cost effective are the main reasons for their infrequent use. This article discusses each of these problems and suggests a method for local communities to implement checkpoints without depending on state or federal funds. Low-staffing sobriety checkpoints conducted by as few as three to five officers have been shown to be just as effective as checkpoints conducted by 15 or more officers. A modified sobriety checkpoint program using passive alcohol sensors ("PASpoints") can be implemented by small- to moderate-sized communities in the United States to deter impaired driving. If implemented in a majority of communities, this strategy has a potential level of effectiveness similar to the high level achieved by several Australian states in their random breath-test (RBT) programs. The PASpoint system calls for a small group of three to five officers on traffic patrol duty to converge on a preset site and conduct a mini-checkpoint, returning to their standard patrol duties within two hours. Within this framework, the PASpoint operation would become a standard driving under the influence (DUI) enforcement technique regularly used within the community's jurisdiction. As a standard traffic enforcement activity, the cost would be covered by the normal enforcement budget.     

Both texting and eating are associated with impaired simulated driving performance

Objective: Distracted driving is a known contributor to traffic accidents, and many states have banned texting while driving. However, little is known about the potential accident risk of other common activities while driving, such as eating. The objective of the current study was to examine the adverse impact of eating/drinking behavior relative to texting and nondistracted behaviors on a simulated driving task. Methods: A total of 186 participants were recruited from undergraduate psychology courses over 2 semesters at Kent State University. We utilized the Kent Multidimensional Assessment Driving Simulation (K-MADS) to compare simulated driving performance among participants randomly assigned to texting (N = 45), eating (N = 45), and control (N = 96) conditions. Multivariate analyses of variance (MANOVA) were conducted to examine between-group differences on simulated driving indices. Results: MANOVA analyses indicated that groups differed in simulated driving performance, F(14, 366) = 7.70, P < .001. Both texting and eating produced impaired driving performance relative to controls, though these behaviors had approximately equal effect. Specifically, both texting and eating groups had more collisions, pedestrian strikes, and center line crossings than controls. In addition, the texting group had more road edge excursions than either eating or control participants and the eating group missed more stop signs than controls. Conclusions: These findings suggest that both texting and eating are associated with poorer simulated driving performance. Future work is needed to determine whether these findings generalize to real-world driving and the development of strategies to reduce distracted driving.     

Effects of alcohol and other drugs on driver performance

In the past century we have learned that driving performance is impaired by alcohol even in low dosage, and that many other drugs are also linked to impairment. This paper is a summary of some of the more relevant studies in the past fifty years--an overview of our knowledge and unanswered questions. There is no evidence of a threshold blood alcohol (BAC) below which impairment does not occur, and there is no defined category of drivers who will not be impaired by alcohol. Alcohol increases not only the probability of collision, but also the probability of poor clinical outcome for injuries sustained when impaired by alcohol. This review samples the results of the myriad studies that have been performed during the last half century as experiments have moved from examination of simple sensory, perceptual and motor behaviours to more complex measures of cognitive functioning such as divided attention and mental workload. These more sophisticated studies show that significant impairment occurs at very low BACs (< 0.02 gm/100 ml). However, much remains to be determined regarding the more emotional aspects of behaviour, such as judgment, aggression and risk taking. Considering that the majority of alcohol related accidents occur at night, there is a need for increased examination on the role of fatigue, circadian cycles and sleep loss. The study of the effects of drugs other than alcohol is more complex because of the number of substances of potential interest, the difficulties estimating drug levels and the complexity of the drug/subject interactions. The drugs of current concern are marijuana, the benzodiazepines, other psychoactive medications, the stimulants and the narcotics. No one test or group of tests currently meets the need for detecting and documenting impairment, either in the laboratory or at the roadside.     

Relationship between traffic fatalities and drunk driving in Japan

OBJECTIVE: The present study was performed to clarify the relation between alcohol use and traffic fatalities in accidents involving motor vehicles in Japan. METHODS: Data on traffic accidents were collected from Fukuoka Prefectural Police records of traffic accidents which occurred in that prefecture between 1987 and 1996. Multiple logistic regression models were used to assess the effect of alcohol use on the risk of traffic-accident death. RESULTS: The data showed that 58,421 male drivers were involved in traffic accidents during the 10-year study period, and that 271 of these were killed as a result of the accident. Alcohol use was significantly associated with speed, seat belt use, time, and road form. Among male motorcar drivers, the odds ratio of alcohol use before driving, after adjusting for age, calendar year, time, and road form, was 4.08 (95% confidence interval, 3.08-5.40), which means that about 75% of fatalities (attributable risk percent among exposed) might have been prevented if drivers had not drunk before driving. CONCLUSIONS: Alcohol use before driving resulted in a 4.08-fold increase in the risk of death in a traffic accident. It is suggested that alcohol use is considered an important risk factor for fatality in traffic accidents.     

Driving while impaired (DWI) by alcohol convictions among alcohol, cocaine, and cannabis clients in treatment

OBJECTIVE: Although studies have demonstrated that clients in treatment for alcohol abuse are more at risk of driving while impaired (DWI) by alcohol than normal licensed drivers from the general population, no research was found on DWI convictions among those in treatment for abusing cannabis or cocaine. The purpose of this article is to compare DWI convictions among clients in treatment for alcohol, cannabis, cocaine, or various combinations of these substances, compared to a matched population control group. METHOD: A stratified random sample of driver records was drawn from seven client groups who sought treatment in 1994 for alcohol, cannabis, cocaine, or any combination of these substances (n = 445). A random sample of drivers, frequency matched by age and sex (n = 566), served as control subjects. RESULTS: Logistic regression analysis, controlling for sex and age, was conducted to assess whether DWI convictions were elevated for each of the client groups, compared to controls. Two sets of analyses were conducted, before treatment (from 1985 to 1993) and after treatment (from 1995 to 2000). In the time period before treatment, every drug group except the "cannabis only" group had significantly more DWI convictions than controls (p < .05). In the period after treatment, the "alcohol only," "cocaine only," "alcohol and cocaine," and the "cocaine and cannabis" groups still had significantly more DWI convictions than controls (p < .05). CONCLUSION: The results show that DWI convictions are elevated among those who abused cocaine but not among those who abused cannabis. The results suggest that cross-addiction of alcohol and cocaine is common, and problematic drinking among cocaine clients can go undetected when clients are being diagnosed for treatment.