Smoking is a marker of risky behaviors independent of substance abuse in injured drivers

OBJECTIVE: Smoking has been linked to disease and injury. The purpose of this study is to investigate the smoking habits of motor vehicular driver trauma center patients and their association with previous injury history and risky behaviors. METHODS: The studied population included 323 motor vehicular driver injury patients (123 smokers and 200 non-smokers) interviewed as part of a larger study of psychoactive substance use disorders at an adult Level I trauma center. Patients with head injuries, hospital stays of less than two days, and diminished cognition were excluded. Interviews included demographics (age, gender, race, marital status), socioeconomic status (SES; income, education, employment), risky behaviors (seatbelt non-use, drinking and driving, riding with drunk driver, binge drinking), and trauma history information (vehicular, assault, and other injuries). Substance abuse (alcohol and drug dependence) was evaluated in depth using DSM III-R criteria. Smokers and non-smokers were compared in relation to control and dependent variables using student's t test and chi-square (alpha = 0.05). Outcome variables included previous trauma history and risky behaviors. Multiple logistic regression models using step-down selection methods (alpha = 0.05) were constructed with risky behaviors and trauma history as dependent variables including demographics, SES and substance as independent variables. RESULTS: Smokers represented 38 percent of the 323 patients studied. Smokers (n = 123) were younger (34 vs. 43 years), more likely to be male (72 percent vs. 50 percent), not married (72 percent vs. 56 percent), and had higher rates of alcohol (29 percent vs. 9 percent) and drug dependence (14 percent vs. 3 percent) than non-smokers (n = 200). Educational achievement (20 percent vs. 15 percent less than high school) and income level (24 percent vs. 23 percent with less than $15,000 of yearly income) were not different between smokers and non-smokers. Smokers were more likely than non-smokers to have a history of prior vehicular trauma (48 percent vs. 26 percent), assault (25 percent vs. 9 percent), or other injury (50 percent vs 37 percent). The following injury-prone behaviors were also more common among the smokers than non-smokers: seatbelt non-use (49 percent vs. 29 percent), drinking and driving (38 percent vs. 15 percent), riding with drunk driver (38 percent vs. 13 percent), and binge drinking (68 percent vs. 26 percent). In multiple logistic regression models adjusting for demographics, SES, and substance abuse, smoking revealed significantly higher odds ratios (OR) for the following dependent variables: seatbelt non-use (OR = 2.9), riding with drunk driver (OR = 2.2), binge drinking (OR = 2.4), previous vehicular (OR = 2.0), and assault injuries (OR = 2.5). Smoking did not reach significance for drinking and driving and other (non-vehicular and non-assault) injury. CONCLUSION: Smoking is independently associated with risky behaviors and repeated history of vehicular or assault injury within the vehicular trauma population.     

Drink-driving and perceptions of legally permissible alcohol use

OBJECTIVE: The leading cause of death for young people in developed countries is road traffic crashes, a large proportion of which are attributable to drink-driving. The aims of the study were to estimate the prevalence of drink-driving and drink-riding in a sample of New Zealand university students, and to identify potential risk factors, in particular, students' perceptions of legally permissible consumption before driving. METHODS: Participants were 1,564 survey respondents (82% response, mean age = 20.5 years) who were asked to indicate whether they had driven after having "perhaps too much to drink to be able to drive safely," if they had been a passenger in a vehicle "where the driver had perhaps too much to drink to be able to drive safely," and how many standard drinks they could consume in one hour and legally drive a car. An estimated blood alcohol concentration was computed and compared with legal limits. RESULTS: Drink-driving (past four weeks) was reported by 3.4% of women and 8.4% of men. Drink-riding (past four weeks) was reported by 7.0% of women and 11.5% of men. Estimated blood alcohol concentrations from students' reports of how much they could drink in one hour and be below the legal limit of 0.08 g/ml, showed that most respondents dramatically underestimated permissible consumption; only 5.8% overestimated it. CONCLUSIONS: This may be a case where misperception of a public health message serves the public good. Further reductions in drink-driving/riding will require attention to transport needs, more visible enforcement of existing legislation, and modification of youth drinking behavior.     

Teaching adolescents safe driving and passenger behaviors: effectiveness of the You Hold the Key Teen Driving Countermeasure

PROBLEM: Unsafe driving and passenger behaviors place teens at increased risk for fatal and nonfatal crashes. This study evaluated the short-and long-term efficacy of the You Hold the Key (YHTK) Teen Driving Countermeasure. METHOD: A two-page survey was completed by high school students at pretest, posttest, and long-term (6-month) posttest. RESULTS: YHTK was associated with significant immediate and long-term improvements in teen seatbelt use, safe driving, and perceived confidence in preventing drunk driving. Compared to pretests, students at immediate and long-term posttest more frequently wore seatbelts when driving or riding, required passengers to wear seatbelts, and limited the number of passengers to the number of seatbelts in the vehicle. Students were more likely at both posttests to avoid drinking and driving and to say no to riding with a friend who had been drinking. SUMMARY: YHTK was associated with increases in safe teen driving and passenger behaviors. IMPACT ON INDUSTRY: Success of YHTK is most notably due to its comprehensive nature. Future programs should consider comprehensive strategies when attempting to modify teen behaviors.     

Motorists' knowledge,attitudes and practices toward alcohol-impaired driving/riding in Ghana

Objectives: The main objective of this study was to establish the knowledge, attitudes, and practices toward drink driving/riding as a risk factor for road traffic crashes in 3 regional capitals in Ghana.

Methods: The study used a face-to-face approach to randomly sample motorists who were accessing various services at fuel/gas stations, garages, and lorry terminals in 3 cities in Ghana.

Results: Over the previous 12 months, 24% of all motorists and 55% of motorists who were current alcohol users reported driving or riding a vehicle within an hour of alcohol intake. On average, motorists/riders who were current alcohol users consumed 4 standard drinks per drinking occasion. Generally, 83% of motorists who currently use alcohol walked, rode, or drove home after consuming alcohol away from their homes. Motorists/riders who reported drink driving were 4 times more likely to have had previous traffic violation arrests compared to those who reported no drink driving/riding (P =.001). Respondents were of the opinion that speeding was the major cause of traffic crashes, followed by driver carelessness, poor road conditions, inexperienced driving, and drink driving, in that order. Thirty-six percent of motorists who use alcohol had the perception that consuming between 6 and 15 standard drinks was the volume of alcohol that will take them to the legal blood alcohol concentration (BAC) limit of 0.08%. Compared to females, male motorists/riders were more likely to report drink driving (adjusted odds ratio [AOR] = 5.15; 95% confidence interval [CI], 2.31 to 11.47). Private motorists also reported a higher likelihood of drink driving compared to commercial drivers (AOR = 3.36; 95% CI, 1.88 to 6.02). Only 4% of motorists knew the legal BAC limit of Ghana and only 2% had ever been tested for drink driving/riding.

Conclusion: The volumes of alcohol that motorists typically consume per drinking occasion were very high and their estimates of the number of drinks required to reach the legal BAC limit was also very high. Provision of authoritative information advising motorists about safe, responsible, or low-risk levels of alcohol consumption is imperative. Many traffic violations including drink driving were reported, thus suggesting a need for enhanced policing and enforcement. However, given the low level of knowledge of the legal BAC limit, educating motorists about how many drinks will approximate the legal BAC should be intensified prior to an increase in enforcement; otherwise, the desired outcome of enforcement may not be achieved.     

Underage drinking: frequency, consequences, and interventions

OBJECTIVES: To examine the frequency of underage drinking, driving after drinking and alcohol-related crashes, trends in these behaviors, and promising interventions. METHODS: We examined drinking and drinking- and-driving behaviors reported in the United States in the 2001 U.S. National Household Survey of Drug Abuse, the Centers for Disease Control and Prevention 2001 Youth Risk Behavior Survey, the 1992 National Longitudinal Alcohol Epidemiologic Study, and the 1999 National Survey of Drinking and Driving conducted for the National Highway Traffic Administration. We also examined the 1999 European School Survey Project on Alcohol and Other Drugs. Alcohol-related fatal crashes were examined from the U.S. Fatality Analysis Reporting System. Evaluation of interventions to reduce teenage drinking and driving after drinking were reviewed. RESULTS: In the United States, 19% of youth ages 12-20 consumed five or more drinks on an occasion in the past 30 days. Although European nations have lower legal drinking ages (16-18) than in the United States (21), similar proportions engage in underage drinking. In two-thirds of European countries, a greater percentage of 15-16 year-olds drank five or more drinks on an occasion in the past month than in the United States. In both the United States and Europe, the earlier people begin to drink, the greater the likelihood of developing alcohol dependence and other alcohol-related problems, including alcohol-related crash involvement, during adolescence and adult years. During the past 20 years alcohol-related traffic deaths among people younger than 21 have been cut in half in the United States, but progress has halted since 1995 and the problem is still large. Interventions shown by research to reduce alcohol-related crashes among youth include raising the legal drinking age to 21, zero tolerance laws, and some interventions that are family, school, or community based. CONCLUSIONS: Despite research showing that a variety of interventions can reduce underage drinking and alcohol-related crash fatalities, the frequency of these behaviors remains high and the average age of drinking initiation is declining in the United States. Efforts are needed to enhance publicized enforcement of underage drinking laws. Comprehensive community interventions that include enforcement of these laws also are needed.     

Driver's alcohol and passenger's death in motor vehicle crashes

OBJECTIVE: Previous studies on alcohol involvement associated with fatal injury in traffic crashes have focused on the drivers, but the passenger's view is not well known. This study (1) analyzes the relationship between passenger's death and alcohol inebriation of the driver and (2) estimates the role of alcohol as the cause of a crash by examining who was at fault, sober, or inebriated. METHOD: The study includes all motor vehicle passengers (n = 420) who died in crashes in Sweden 1993 through 1996 and were medicolegally autopsied. Autopsy reports from the Departments of Forensic Medicine, including toxicological analyses, and police reports were studied. Presence of alcohol among drivers was based on blood and breath tests. RESULTS: One-fifth of the fatally injured passengers and one-fifth of the tested drivers were under the influence of alcohol. The youngest drivers had the highest prevalence of drunken driving. Drivers at fault were alcohol positive in 21% of these crashes and drivers were not at fault in 2% of these crashes. In 53% of the crashes where both the passenger and driver were alcohol positive, the passenger had a lower alcohol concentration than the driver. Children (<16 years) comprised 15% of the killed passengers. Notably, the children were riding with a driver who was under influence of alcohol in 13% of these crashes. Alcohol involvement was not tested in half of the surviving drivers. CONCLUSIONS: The data show that 20% of both passengers and drivers were under the influence of alcohol. Increased testing of surviving drivers regarding alcohol and other drugs is recommended.     

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.     

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.     

Early impacts of alcoholic beverage warning labels: national study findings relevant to drinking and driving behavior

After November, 1989 Federal law required a standard health warning label on all alcoholic beverage containers sold for consumption in the U.S. Results are reported from a cross-sectional national household telephone interview survey of adults, occurring approximately 6 months after implementation of the warning labels (N=2000). Implications for health warnings with respect to information processing theory, the Health Belief Model, and other theories relevant to precaution adoption are briefly reviewed and two derivative hypotheses are tested using log-linear analysis. Relationships between various personal characteristics and (a) seeing the label and (b) recalling the driving impairment message are examined for consistency with theoretical expectations. We also examine associations between message recall, drinking style, and two precautionary behaviors undertaken to avoid drinking and driving. Adjusting for apparent false positives, approximately a quarter of the sample have noticed the label 6 months after its introduction; 16% recalled the specific driving impairment message. As hypothesized, exposure to the warning was predicted primarily by consumption pattern but also was associated with a personal salience factor, that is, ever having drunk alcohol so as to be at risk when driving. About a quarter of the heavy drinkers (5 drinks or more per occasion sometime and drinking at least weekly) who ever drank and drove saw the specific warning. Of two self-regulation strategies — limiting driving after drinking and limiting drinking when about to drive — the latter was the more prevalent. Both strategies were reported more by those who were heavy drinkers, those recalling the driving impairment message, and those perceiving driving after drinking to be very dangerous, than by other individuals.     

The effects of minimum legal drinking age 21 laws on alcohol-related driving in the United States

Objective

To examine trends in alcohol consumption and alcohol-related crashes among people younger than 21 in the United States and to review evidence on the effects of minimum legal drinking age (MLDA) laws.

Methods

Trends in alcohol-related crashes and alcohol consumption among young people were examined, and studies on the effects of lowering and raising the drinking age were reviewed.

Results

MLDA laws underwent many changes during the 20th century in the United States. Since July 1988, the MLDA has been 21 in all 50 states and the District of Columbia. Surveys tracking alcohol consumption among high school students and young adults found that drinking declined since the late 1970 s, and most of the decline occurred by the early 1990 s. These were the years when states were establishing, or reinstating, a MLDA-21. Among fatally injured drivers ages 16-20, the percentage with positive BACs declined from 61% in 1982 to 31% in 1995, a bigger decline than for older age groups; declines occurred among the ages directly affected by raising MLDAs (ages 18-20) and among young teenagers not directly affected (ages 16-17). Almost all studies designed specifically to gauge the effects of drinking age changes show MLDAs of 21 reduce drinking, problematic drinking, drinking and driving, and alcohol-related crashes among young people. Yet many underage people still drink, many drink and drive, and alcohol remains an important risk factor in serious crashes of young drivers, especially as they progress through the teenage years. Stepped-up enforcement of MLDA and drinking and driving laws can reduce underage drinking. Recent efforts to lower MLDAs to 18 and issue licenses to drink upon completion of alcohol education have gained local and national media attention. There is no evidence that alcohol education can even partially replace the effect of MLDA-21.

Conclusions

The cause and effect relationship between MLDAs of 21 and reductions in highway crashes is clear. Initiatives to lower the drinking age to 18 ignore the demonstrated public health benefits of MLDAs of 21.

Impact on Industry

Lowering the drinking age to 18 will increase highway crash deaths among young people.     

The effects of graduated driver licensing on hospitalization rates and charges for 16-and 17-year-olds in North Carolina

OBJECTIVE: To mitigate the high risk of motor vehicle crashes for young beginning drivers, over 40 states and the District of Columbia have implemented graduated driver licensing (GDL) systems that gradually and systematically ease teen drivers into higher risk driving conditions. Evaluations of GDL programs using motor vehicle crash data have demonstrated marked declines in crashes. The objective of this study is to examine the association between the implementation of the North Carolina GDL program and the rate of hospitalization, as well as hospital charges, for 16-and 17-year-old drivers. METHODS: Data were obtained from the North Carolina Hospital Discharge Database for the 26 months before and 46 months after the December 1, 1997, implementation of the GDL program. ARIMA interrupted time series analyses were used to model monthly hospitalization rates, controlling for the hospitalization rates of 25-to 54-year-old drivers. ARIMA analyses were also used to determine whether changes occurred in monthly total hospital charges. RESULTS: Among the 568 16-year-old hospitalized drivers, GDL was associated with a 36.5% decline in the hospitalization rate per population and a 31.2% decline in the total monthly driver hospitalization charges. Although a 12% reduction in the rate of hospitalizations was observed among the 615 17-year-old drivers, the analysis lacked sufficient power to be statistically reliable. No consistent change was observed in the 16-year-old driver total monthly hospital charges. CONCLUSIONS: The North Carolina GDL program was associated with a marked decline in the rate of hospitalizations and hospital charges for 16-year-old drivers. Following the implementation of GDL, over $650,000 in hospital charges have been averted each year for 16-year-old drivers. Analyses suggest these reductions were primarily the result of reduced exposure rather than an improvement in teen driving.     

Temporal patterns of crashes of 16-to 17-year-old drivers in Fairfax County, Virginia

OBJECTIVE: To develop a better understanding of the frequency and characteristics of teenage driver crashes occurring during school commute times. METHOD: Data were obtained from police reports of crashes involving drivers ages 16-17 that occurred between September 2001 and August 2004 in Fairfax County, Virginia. Temporal patterns and other characteristics of crash involvement during the school year were examined, and crashes during school commute times were compared with those at other times. RESULTS: Teenage driver crash involvement spiked during weekday school commute times. Compared with other times, crashes during school commute times were significantly more likely to involve multiple vehicles but less likely to result in injuries or involve drivers who were male, made driving errors, or had been drinking alcohol. Crashes during school commute times were more likely to involve more than one teenage driver and occur close to schools. CONCLUSIONS: Crashes involving teenage drivers are prevalent during school commute times. Many of these crashes involve multiple teenage drivers and occur near schools. Schools and communities should consider programs and policies that reduce teenage driving to school and enhance the safety of teenagers that do drive.     

The effect of extending graduated driver licensing to older novice drivers in Indiana

Introduction: Graduated driver licensing (GDL) systems have been shown to reduce rates of crashes, injuries, and deaths of young novice drivers. However, approximately one in three new drivers in the United States obtain their first driver’s license at age 18 or older, and thus are exempt from most or all provisions of GDL in most states. Method: In July 2015, the state of Indiana updated its GDL program, extending its restrictions on driving at night and on carrying passengers during the first 6 months of independent driving, previously only applicable to new drivers younger than 18, to all newly-licensed drivers younger than 21 years of age. The current study examined monthly rates of crashes per licensed driver under the affected conditions (driving at night and driving with passengers) among Indiana drivers first licensed at ages 18, 19, and 20 under the updated GDL system compared with drivers licensed at the same ages under the previous GDL system. We used Poisson regression to estimate the association between the GDL system and crash rates, while attempting to control for other factors that might have also influenced crash rates. We used linear regression to estimate the association between the GDL system and the proportion of all crashes that occurred under conditions restricted by the GDL program. Results: Results showed, contrary to expectations, that rates of crashes during restricted nighttime hours and with passengers were higher among drivers licensed under the updated GDL system. This mirrored a statewide increase in crash rates among drivers of all ages over the study period and likely reflected increased overall driving exposure. The proportions of all crashes that were at night or with passengers did not change. Practical Applications: More research is needed to understand how older novice drivers respond when GDL systems originally designed for younger novice drivers are applied to them.     

Young people driving after drinking and riding with drinking drivers: drinking locations--what do they tell us?

OBJECTIVE: The present study investigated the extent to which drinking in specific locations and heavy drinking mediated the effects of overall alcohol use on driving after drinking (DD) and riding with drinking drivers (RWDD) among young people. Additionally, this study examined the relationships among ethnicity, gender, drinking in specific locations, and DD and RWDD. METHOD: Using random-digit dialing procedures, participants were recruited to take part in a telephone survey in California, United States of America. Participants were 1,534 youth, ages 15-20 years (mean age = 17.6). Latinos, African Americans, and Asian Americans were over-sampled to allow cross-group comparisons. Along with background characteristics, overall alcohol use, heavy drinking, drinking in specific locations, DD, and RWDD were measured. RESULTS: Latent variable structural equation modeling showed that European Americans, males, older adolescents, those who have a driver license, and those who drive more often were more likely to report drinking alcohol in the past year. Heavy episodic drinking and drinking in cars increased both DD and RWDD. Drinking in restaurants also increased DD. The effects of overall alcohol consumption on DD were entirely mediated through heavy episodic drinking and drinking in restaurants and cars. Alcohol consumption had both direct and indirect effects on RWDD. With the exception of being Latino and frequency of driving, the effects of the background variables on RWDD were all entirely mediated through alcohol consumption. CONCLUSIONS: Heavy drinking and drinking in specific locations appeared to be important unique predictors of both DD and RWDD. In light of the relationship between drinking in restaurants and in cars, and DD, prevention programs and policies aimed at underage drinking should focus on developing more effective responsible beverage service programs, increasing compliance with laws limiting alcohol sales to youth, and enforcing graduated driver licensing and zero tolerance laws.     

Patterns of drinking four weeks prior to an alcohol-related vehicular crash

OBJECTIVE: The primary objective of the study was to determine if drinking patterns on the days immediately prior to an alcohol-related motor vehicle crash (ARMVC) were significantly different than drinking patterns in the weeks prior to the crash. METHODS: Following ARMVC, 187 hospitalized non-alcohol dependent young-adults (43 females, 144 males) were enrolled. Mean age was 29.03 years, mean blood alcohol level was 165.18 mg/dL, and mean injury severity score was 10.50. When alcohol-free, subjects were interviewed by nurse clinicians to determine the quantity/frequency of alcohol consumption during the 28 days prior to the crash. Subjects reported the number of standard drinks using the Timeline Followback procedure. Total drinks/day were determined, with day 1 considered 4 weeks prior to the crash and day 28 the day of the crash. A random-intercepts general linear mixed model (GLMM) was used to test the effect of several covariates (segment 1 [days 1-26], segment 2 [days 27-28], age, sex, race, holiday/non-holiday period, driver/passenger status, and weekend/weekday crash) on the amount of standard drinks/day. RESULTS: There was no significant interaction among the covariates. The only significant predictors of drinks/day were segment 2 (b = .322, p < .0001) and gender (b = -.221, p = .016). The positive, statistically significant slope for segment 2 indicated an increase in consumption of drinks/day in the two-day period prior to the ARMVC and the negative slope for gender indicated greater consumption of drinks/day for men than women. CONCLUSION: Persons injured in an ARMVC had a significant increase in alcohol consumption on the day before and the day of vehicular crashes (days 27 and 28) as compared to the first 26 days in the 28-day period preceding the crash. When non-alcohol-dependent subjects are counseled to reduce their risk of traffic crashes, they should be alerted that when their patterns of drinking change, they are at higher risk than usual for a crash.     

Hard core drinking drivers

The term "hard core" has been used extensively over the past 15 years to identify persons who drink and drive regularly, typically at high blood alcohol levels. This article discusses how the term arose and clarifies what it means, both as a concept and in practice. It describes the characteristics of hard core drinking drivers and estimates their contribution to drinking driver trips, arrests, and crashes. It summarizes current knowledge and recommendations on the most effective means to affect their behavior and reduce their drinking and driving.     

Child passengers injured in motor vehicle crashes

IntroductionDuring 2010, 171,000 children aged 0–14 were injured in motor vehicle crashes. Despite the severity of the problem, research has been limited, and most of what we know about these children emanates from fatal crash databases.MethodUsing information from the General Estimates System, this effort examines the occurrence of non-fatal crashes among children aged 0–14 over the last decade.ResultsWe found that about 1% of the non-injured children in the file had been driven by a driver who was positive for alcohol. This percentage climbed to about 2% among children who had suffered injuries. Compared with the proportion of alcohol-positive drivers at the time of the crash, the proportion of drivers who sped or failed to obey a traffic signal was significantly higher.Practical applicationsThe finding that drinking and driving with children did not decrease over time questions the adequacy of the extant child endangerment laws.     

Do the designated drivers of college students stay sober?

PROBLEM: By numerous accounts, alcohol abuse is considered the number one drug problem facing young people today. Alcohol consumption and its negative consequences, especially those due to drinking and driving, continue to have devastating effects on the college student population. METHOD: This field study examined the blood alcohol concentration (BAC) levels of male and female designated drivers (DD), non-DD, and their respective passengers as they were leaving drinking establishments in a university town. Also investigated were the effects of group size and gender on DD use. RESULTS: A 2 Gender x 2 Driver type (DD vs. non-DD) analysis of variance (ANOVA) for BAC indicated significant main effects for Gender and Driver type, with higher BAC for men and non-DD (p's<.001). A significant Gender x Driver type interaction (p<.05) was primarily due to female DD having lower BAC than male DD. In addition, larger groups were more likely to have a DD. IMPACT ON INDUSTRY: Results indicate that the success of DD programs may be influenced by group size and a DD's gender. While larger groups are more likely to have a DD, students riding home with a male DD may still be at risk for the negative consequences of drunk driving.     

Preventing alcohol-related convictions: the effect of a novel curriculum for first-time offenders on DUI recidivism

OBJECTIVE: To determine whether DUI offenders can better avoid future drinking and driving by controlling their vehicle usage rather than by controlling their drinking. METHODS: Using a randomized experimental post-test only design, 9,571 first-time DUI offenders were randomly assigned to receive one of two 12-hour educational programs: a traditional DUI curriculum or the PARC (Preventing Alcohol-Related Convictions) curriculum, which uses a novel theoretical approach to preventing DUI recidivism. Whereas traditional programs focus on participants controlling their drinking to avoid future drinking and driving, the PARC curriculum focuses on participants controlling their driving. Instead of trying to control alcohol consumption after driving to a drinking venue (previously found to be a flawed strategy), PARC teaches students to make a decision before leaving home not to drive to a drinking event, thus greatly limiting the possibility of drinking and driving. Driving records were obtained from the Florida Department of Motor Vehicles using driver's license numbers to assess DUI recidivism rates among the students in the PARC and Traditional curricula for the first year following program participation and again at 2 years post-intervention. RESULTS: Binary logistic regression analyses revealed that offenders receiving the PARC curriculum exhibited significantly lower 1-year and 2-year recidivism rates than those receiving the Traditional curriculum. The effect was consistent across two different measures of recidivism, and across gender, race, ethnicity, and location. CONCLUSION: Results suggest that the PARC educational approach may be more effective than the traditional approach in reducing DUI recidivism.     

The prevention of young driver's DWI (driving while intoxicated) and RWDI (riding with a driver under influence) in Europe: a social-sequential model

Inspired by the "critical incident technique" of McKnight et al. (1995) who analyzed 12,000 drivers' decisions leading to (or not to) DWI, and identified the influence of social, motivational, and economic factors, we have developed a social-sequential model of young drivers' DWI (driving while intoxicated) and RWDI (riding with a driver under influence) prevention. DWI or RWDI may be analyzed as a four-stage process: (1) the decision to drink and to associate leisure activities with drinking; (2) the management of alcohol consumption during the evening; (3) the decision to drive after drinking; and (4) the behavioral adaptation, once the decision to drive is taken (disinhibition of risk-taking or risk compensation). At each of these four stages, preventive action can reflect the intervention of two types of actors: (1) formal social control of behavior is influenced by professionals involved in accident prevention, and (2) informal social control of behavior is influenced by the proximal environment of the subject.