Roadside survey on alcohol and drug use among drivers in the Arctic county of Finnmark (Norway)

Objective: The objective of this study was to determine the prevalence of alcohol and potentially impairing drugs among the general driving population in Finnmark and to compare the prevalence among Norwegian, Russian, and other foreign drivers by analyzing samples of oral fluid.

Methods: In collaboration with local police, drivers were selected for a voluntary and anonymous study using a multistage cluster sampling procedure (selection of roads, time intervals, and drivers within each interval) from September 2014 to October 2015. Age, gender, citizenship, time, and geographical site were recorded. Samples of oral fluid were collected using the Quantisal device. The samples were analyzed for alcohol with an enzymatic method and for 12 illicit drugs and 16 medicinal drugs and some metabolites using ultra-high-performance liquid chromatography with tandem mass spectrometry detection.

Results: A total of 3,228 drivers were asked to participate in the study. The refusal rate was 6.2%. Of the 3,027 participants in the study, 111 (3.7%) were Russian and 204 (6.7%) had citizenship other than Norwegian or Russian. The total prevalence of psychoactive substances was 4.3%. Alcohol was detected in 0.3%, psychoactive medicinal drugs in 2.5%, and illicit drugs in 1.6% of the samples. The most commonly found substances were the sleeping agent zopiclone (1.1%), tetrahydrocannabinol (THC; 1.1%), and the analgesic agent codeine (0.6%). Illicit drugs were detected significantly more often in samples from drivers of citizenship other than Norwegian or Russian. The prevalence of alcohol was somewhat higher among Russian drivers but not statistically significant. There were large differences between age groups and genders concerning illicit drugs and psychoactive medicinal drugs; illicit drugs were more frequently in samples from young male drivers, whereas psychoactive medicinal drugs were more frequently in samples from elderly female drivers.

Conclusion: The total prevalence of alcohol and drugs among the general driving population in Finnmark was low and similar to previous Norwegian roadside surveys. Illicit drugs were detected significantly more often in samples from drivers with citizenship other than Russian and Norwegian and among young male drivers.     

Predominance of alcohol and illicit drugs among traffic accidents fatalities in an urban area of Brazil

Objective: The objective of this study was to determine the prevalence of alcohol and illicit drug use among victims of fatal traffic accidents in the Metropolitan Region of Vitória, Brazil, during the period 2011–2012.

Methods: Blood samples were collected and analyzed for the presence of drugs from 391 deceased victims of traffic crashes that occurred in the Metropolitan Region of Vitória, Brazil. The victims included drivers, passengers, and pedestrians. Sociodemographic variables such as age, gender, day of the week, and period of the year in which the accidents occurred were recorded. The analyses were performed by a gas chromatography–flame ionization method for alcohol and by a gas chromatography–mass spectrometry for amphetamines, cocaine, and cannabis.

Results: The results showed that 44.8% (n = 175) of all cases were positive for alcohol and/or illicit drugs. The detection of alcohol and/or drugs was more frequent in young males, aged 17 to 34, whose samples were positive in 46.8% of cases. Small differences among drivers, passengers, and pedestrians were observed (drivers = 45.9%, passengers = 46.4%, and pedestrians = 45.6%). In general, the most prevalent drug was alcohol, with 141 positive cases (36.1%), followed by cocaine, with 47 positive cases (12%). Amphetamines and cannabis had positivity rates of 4.1 and 4.3%, with 16 and 17 positive cases, respectively. The combined use of alcohol and other drugs was found in 36 cases (9.2%). Crack cocaine use was observed in 27.7% of the positive cases for cocaine.

Conclusions: For the effective reduction of traffic accidents related to driving under influence of drugs (DUID), we suggest the intensification of enforcement actions against the use of alcohol by drivers, the definition of which illicit drugs should be surveyed, as well the cutoff values, the promotion of changing legislation to oblige drivers to provide samples for toxicological testing, and the establishment of public information programs and specific actions aimed at young drivers to promote behavioral changes.     

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.     

Epidemiology of alcohol and other drug use among motor vehicle crash victims admitted to a trauma center

The objectives of this research were to (1) determine the incidence and prevalence of alcohol and other drug use among motor vehicle crash (MVC) victims admitted to a regional Level-I trauma center, and (2) to examine the utility of using a rapid point-of-collection (POC) drug-testing device to identify MVC patients with drug involvement. Blood and urine specimens were routinely collected per clinical protocol for each MVC victim at the time of admission. Blood alcohol concentration (BAC) levels were determined per standard clinical protocol. Clinical urine specimens were routinely split so that a POC drug-testing device for the detection of commonly abused drugs (Marijuana, Cocaine, Amphetamines, Methamphetamines, and Opiates) could be compared to that of the standard hospital laboratory analysis of each urine specimen (which also included Barbiturates and Benzodiazepines). In the six-month period of this study, nearly two-thirds of trauma center admissions were victims of motor vehicle crashes. During this time, blood and urine was collected from 322 MVC victims. Toxicology results indicated that 59.3% of MVC victims tested positive for either commonly abused drugs or alcohol. More patients tested positive for drug use than tested positive for alcohol, with 33.5% testing positive for drug use only, 15.8% testing positive for alcohol use only, and 9.9% testing positive for both drugs and alcohol. Less than half (45.2%) of the substance-abusing patients in this study would have been identified by an alcohol test alone. After alcohol, marijuana and benzodiazepines were the most frequently detected drugs. Point of collection (POC) test results correlated well with laboratory results and provide important information to initiate rapid intervention/treatment for substance use problems among injured patients.     

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.     

Trends in the use of psychoactive substances by truck drivers in São Paulo State,Brazil: A time-series cross sectional roadside survey (2009–2016)

Objective: Truck drivers represent a group that is susceptible to the use of stimulant substances to reduce the symptoms of fatigue, which may be caused by a stressful and exhausting work environment. The use of psychoactive substances may increase the risk for involvement in road traffic crashes. Previous studies have demonstrated that amphetamine, cocaine, and cannabis are the 3 main drugs used by Brazilian truck drivers. We studied the prevalence of amphetamine, benzoylecgonine (indicating use of cocaine), and Δ-9-tetrahydrocannabinol-9-carboxylic acid (THC-COOH; indicating use of cannabis) in urine samples from truck drivers in the state of São Paulo, Brazil, using the same methodology during 8 years (2009–2016).

Methods: Samples were collected during a health program supported by the Federal Highway Police. Toxicological analyses were performed using immunoassays and gas chromatography–mass spectrometry.

Results: The total prevalence of illicit drugs was 7.8%. Benzoylecgonine was the most prevalent substance (3.6%), followed by amphetamine (3.4%) and THC-COOH (1.6%). We found the highest drug prevalence in 2010 (11.3%) and the lowest in 2011 (6.1%). We could detect a slight change in the pattern of stimulant use: until 2010, amphetamine was the most prevalent substance; however, in 2011 benzoylecgonine became the most frequently detected substance. This lasted until 2015, probably due to changes in Brazilian legislation regarding appetite suppressants; the most common one is metabolized to amphetamine.

Conclusion: These data show that the use of psychoactive substances by truck drivers in Brazil did not decrease during the study period. This reinforces the need for further preventive measures to reduce drug use among drivers, which could lead to a decrease in traffic crashes in Brazil.     

Characterization of drug and alcohol use among senior drivers fatally injured in U.S. motor vehicle collisions, 2008–2012

Objective: Adults 65 years of age and older comprise the fastest growing demographic in the United States. As substance use is projected to increase in this population, there is concern that more seniors will drive under the influence of impairing drugs. The purpose of this analysis was to characterize the drug and alcohol usage among senior drivers fatally injured (FI) in traffic collisions.

Methods: Data from the Fatality Analysis Reporting System were analyzed from 2008 to 2012. Commonly used classes and specific drugs were explored. Rates of drug use, multiple drugs, concomitant drug and alcohol use, and alcohol use alone were generated using Poisson regression with robust error variance estimation. Rates were compared to a reference population of FI middle-aged drivers (30 to 50 years old) using rate ratios.

Results: Drug use among FI senior drivers occurred in 20.0% of those tested. Among drug-positive FI senior drivers, narcotics and depressants were frequent. The prevalence of testing positive for any drug, multiple drugs, combined drug and alcohol, and alcohol use alone among FI seniors were 47% less (relative risk [RR] = 0.53, 95% confidence interval [CI], 0.47, 0.62), 59% less (RR = 0.41, 95% CI, 0.34, 0.51), 87% less (RR = 0.13, 95% CI, 0.09, 0.19), and 77% less (RR = 0.23, 95% CI, 0.19, 0.28), respectively, compared to FI middle-aged drivers.

Conclusions: Though overall drug use is less common among FI senior drivers relative to FI middle-aged drivers, driving under the influence of drugs may be a relevant traffic safety concern in a portion of this population.     

Driving under the influence of alcohol and drugs in the eastern part of Denmark in 2015 and 2016: Abuse patterns and trends

Objectives: The objective of this study was to examine the frequency of psychoactive drugs and alcohol in drivers under suspicion of driving under the influence of drugs and alcohol in 2015 and 2016 in the eastern part of Denmark. The trends in the number of traffic cases sent for drug analysis since 2000 and alcohol analysis since 2011 are also discussed.

Methods: Blood samples from drivers suspected of being under the influence of alcohol and/or medication and/or illicit drugs in 2015 and 2016 were investigated as requested by the police. The blood samples were screened for alcohol and/or tetrahydrocannabinol (THC) alone, for other drugs (covering all drugs, except THC, listed in the Danish list of narcotic drugs), or for THC and other drugs. Age and gender were also recorded. The number of drug traffic cases since 2000 and the number of alcohol cases since 2011 were extracted from our Laboratory Information Management System (LIMS).

Results: In total, 11,493 traffic cases were investigated. Alcohol and/or drugs exceeded the legal limit in 9,657 (84%) cases. Men constituted 95% of the drivers investigated for drugs and 88% of the alcohol cases. The drivers investigated for drugs consisted primarily of young men, whereas drivers investigated for alcohol were older.

The frequency was higher for positive alcohol cases above the legal limit (87%) than for drug cases (76%) above the fixed concentration limit. THC (67–69%) was the most frequently detected drug above the legal limit, followed by cocaine (27–28.5%), amphetamine (17%), and clonazepam (6–7%) in both years. Morphine (5.4%), included among the 5 most frequent drugs in 2015, was replaced by methadone (4.6%) in 2016. Few new psychoactive drugs (NPS) were detected.

The number of traffic cases sent for drug analysis has increased more than 30-fold since 2000–2006, and the number of traffic cases submitted in 2016 for drug analysis was higher than the number for alcohol analysis; the latter has decreased since 2011.

Conclusion: Overall, alcohol was the most frequent compound detected above the legal limit in both years, followed by the well-known illicit drugs THC, cocaine, and amphetamine. NPS were seldom seen. One consequence of the increased focus on drugs in traffic has been an immense increase in drug traffic cases sent for analysis since 2006 in the eastern part of Denmark. Although this survey revealed only minimal changes compared to earlier investigations, surveys like this are invaluable for monitoring abuse patterns and trends in drugged and drunken driving.     

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.     

DUID prevalence in Colorado's DUI citations

IntroductionThere are limited studies that measure the prevalence of driving under the influence of drugs (DUID) based upon impairment measures because most prevalence studies are based on drug tests. The aim of this study was to provide the first estimate of DUID prevalence in Colorado using data collected by Colorado law enforcement officers in vehicular homicide (VH) and vehicular assault (VA) cases, and reported in court records.MethodsThe four research questions of this study were answered by completing independent t-tests or Mann–Whitney U tests, Pearson chi-square analyses or Fisher's exact tests, and Kruskal–Wallis tests.ResultsSeventy percent (119 out of 170) of the cases involved alcohol only and 30% (51 out of 170) involved drugs. Of the latter cases, 32 cases involved a combination of alcohol and drugs and 19 cases identified drugs only, with no alcohol. Marijuana was the most commonly cited drug (23 cases); however, it was the sole impairing substance identified in only three cases.ConclusionPolydrug use was very common among DUID cases, which makes it difficult to identify which drug or drugs caused the impairment responsible for the Driving Under the Influence citation. This study revealed tha (a) drugged driving is a frequent cause of DUI citations in cases charged with VH or VA; (b) that polydrug use, rather than marijuana, is the most common cause of drugged driving in Colorado; and (c) that current warrant procedures render blood test results meaningless in cases of marijuana-impairment.Practical applicationStates should collect and analyze DUID data to ensure legislators focus on the right DUID problems to improve biological testing for drugs, adopt more appropriate roadside testing, and enact stronger DUID laws to protect the public.     

Prevalence of alcohol among nonfatally injured road accident casualties in two level III trauma centers in northern Ghana

Background: Alcohol use is pervasive among motorists on the road in Ghana; however, we do not know the extent to which this behavior is implicated in road accidents in this country.

Objectives: The main objective of this research was to establish the prevalence of alcohol in the blood of nonfatally injured casualties in the emergency departments (EDs) in northern Ghana.

Method: Participants were injured road traffic crash victims, namely, pedestrians, cyclists, motorcyclists, and drivers seeking treatment at an ED. The study sites were 2 level III trauma centers located in Wa and Bolgatanga. Participants were screened for alcohol followed by breath tests for positive participants using breathalyzers.

Results: Two hundred and sixty-two accident victims visited EDs, 58% of whom were in Wa. Among the victims, 41% were hospitalized and 57% experienced slight injuries. The vast majority (76%) of the casualties were motorcyclists, 13% were pedestrians, 8% were cyclists, and 2% were drivers. Casualties who had detectable alcohol in their blood were predominantly vulnerable road users. In all, 34% of participants had detectable blood alcohol concentrations (BACs) and the mean BAC for all casualties who tested positive and could give definitive BACs was 0.2265 (226 mg/dl). The prevalence of alcohol use was 53% among cyclists, 34% among motorcyclists, 21% among pedestrians, and 17% among drivers. Male casualties were more likely to test positive for alcohol than females. In addition, the prevalence of alcohol was significantly higher among injured casualties in Bolgatanga compared to Wa.

Conclusion: There was a high prevalence of alcohol use among nonfatally injured casualties in northern Ghana and injury severity increased with BAC. AUDIT screening in the hospital, alcohol consumption guideline, road safety education with an emphasis on minimizing or eliminating alcohol consumption, and enhanced enforcement of the BAC limit among motorists are recommended.     

Prevalence and concentrations of drugs in older suspected drugged drivers

Objective: Older drivers are somewhat more likely to be involved in car crashes than middle-aged drivers but less likely to be involved than younger drivers. This study aimed to assess the extent of drug use in older suspected drunk and drugged drivers, with respect to which drugs were detected and at which concentrations.

Methods: Blood samples from older suspected drunk and drugged drivers taken between February 1, 2012, and May 22, 2013, were identified from the database at the Norwegian Institute of Public Health and were retrospectively analyzed for a broad repertoire of drugs relevant for impairment. The prevalence of different drugs among the suspected drunk and drugged drivers was studied. Regarding drug concentrations, the findings in older drivers (>65 years) were compared to a reference group of apprehended drivers aged 20–40 years.

Results: Four hundred and ten older suspected drunk and drugged drivers were included. Any drug (including ethanol) was detected in 92% of blood samples, and ethanol was detected in 81%. Benzodiazepines were found in 15% of the older drivers and z-hypnotics (zopiclone or zolpidem) were detected in 13%. The most frequent single legal drugs found in blood samples taken from older impaired drivers were zopiclone (9.8%) and diazepam (9.3%). Regarding drug combinations, older drivers used a mean number of 1.4 drugs, and 20% of ethanol-positive cases showed at least one other drug. High drug concentrations of clonazepam and diazepam were more frequently seen in the younger group.

Conclusions: This study showed that drugs were detected in the vast majority of older drivers suspected for drunk or drugged driving. Ethanol was the most frequent drug detected, followed by zopiclone and diazepam. Older drivers combine drugs to a lesser degree than younger drivers, but their combination of ethanol and other drugs represents a considerable traffic risk. Lower concentrations of benzodiazepines are seen in older compared to younger drivers.     

Fatigue and beyond: patterns of and motivations for illicit drug use among long-haul truck drivers

OBJECTIVES: The present study aimed to investigate the illicit drug use patterns of long-distance truck drivers. This population is considered to be a special interest group in terms of drug-driving research and policy due to high rates of use, involvement of drugs in truck accidents, and the link between drug use and work-related fatigue. METHODS: Qualitative interview data were collected from 35 long-haul truck drivers in Southeast Queensland and analyzed through grounded theory techniques. Interviews were conducted at truck stops and loading facilities in both metropolitan and regional cites throughout Queensland. RESULTS: High rates of licit and illicit drug use (particularly amphetamines) were reported by the majority of the sample. However, unlike previous studies that focus on fatigue, this research found overlapping and changing motivations for drug use during individual lifetimes. Becker's model of a drug use "career" was utilized to reveal that some drivers begin illicit drug use before they commence truck driving. As well as fatigue, powerful motives such as peer pressure, wanting to fit the trucking "image," socialization, relaxation, and addiction were also reported as contributing factors to self-reported drug driving. CONCLUSIONS: The results indicate that these additional social factors may need to be considered and incorporated with fatigue factors when developing effective drug prevention or cessation policies for truck drivers.     

Marijuana use and driving in Washington State: Risk perceptions and behaviors before and after implementation of retail sales

Objective: Washington is among the first states to legalize recreational use of marijuana. This study examined marijuana use and risk perceptions before and after retail sales of recreational marijuana began in July 2014, the relationship between risk perceptions and marijuana use, and the relationship between self-reported marijuana use and drug test results.

Methods: Roadside surveys were conducted in 3 waves: June 2014, the month before retail sales of marijuana began; 5–6 months later (November–December 2014); and 1 year later (June 2015). A total of 2,355 drivers completed a marijuana questionnaire about their past and current marijuana use and perceived risks associated with driving after using marijuana. Data collection also included biological specimens (oral fluid and/or blood for marijuana testing and breath for alcohol testing). Drivers who tested positive for delta-9-tetrahydrocannabinol or 11-hydroxy-delta-9-tetrahydrocannabinol in oral fluid or blood were defined as THC-positive.

Results: The proportion of drivers who reported recent marijuana use was similar across the 3 surveys. However, the proportion of THC-positive daytime drivers increased from 8% before retail sales to 23% 6 months after retail sales; this proportion did not change among nighttime drivers (19 and 20%). Drivers’ perceived risk of impairment by marijuana and perceived risk of being arrested for marijuana-impaired driving were similar before and after retail sales. The odds of being THC-positive were 40% lower among drivers who perceived that marijuana was very likely to impair driving, compared to other drivers. Drivers’ perceived risk of being arrested for marijuana-impaired driving was not predictive of THC-positive driving.

Conclusions: The prevalence of daytime THC-positive drivers increased substantially a few months after retail sales of marijuana were legal. Daytime and nighttime prevalence of THC-positive drivers was similar after retail sales. This pattern differs from that typically found for alcohol use, which is consistently higher among drivers at nighttime, compared to daytime. Reports of marijuana use were not always consistent with drug test results, which suggests that comparisons of self-reported marijuana use before and after legalization could be biased. This study examined marijuana use and risk perceptions over the course of 1 year. However, law changes may influence cultural norms gradually over a longer period of time. Future studies should continue to monitor marijuana use over time, as well as identify ways to determine whether drivers are impaired by marijuana.     

Sleepiness among night-time drivers: relationship to blood alcohol concentration and other factors

OBJECTIVE: The study aimed to explore the distribution and correlates of subjective sleepiness among the general night-time driving population. METHODS: The survey took place in three British Columbia communities in June 2003 between 21:00 hours to 03:00 hours. Sites and vehicles were selected randomly. Surveyors obtained information on several demographic and situational variables including self-assessed degree of sleepiness and self-reported hours asleep and awake, as well as an objective measure of blood alcohol concentration obtained from a hand-held breath-testing device. RESULTS: The total compliance rate among intercepted drivers was 85%. Among the 2335 drivers responding to the questionnaire, 68.4% indicated that they were wide awake, 27.6% were somewhat sleepy, and 4.1% were very sleepy. Logistic regression quantified the independent contributions of the various factors to subjective sleepiness. Male drivers with positive blood alcohol concentrations under 50 mg% were more likely to report feeling sleepy than those with either higher or with zero blood alcohol concentration. Greater relative risk of sleepiness was also associated with being female, being under age 55, and advanced hour of night. Driving with passengers of the same gender was associated with lower reported sleepiness. CONCLUSIONS: A substantial proportion of night-time drivers are driving while sleepy, especially at late night and early morning hours. The combination of alcohol and sleepiness compounds impairment in experimental studies and deserves greater attention in crash risk studies and as a topic for public education and awareness.     

Epidemiology of alcohol and drug screening among pedestrian fatalities in the United States, 2014–2016

Objective: U.S. pedestrian fatalities increased by 25% between 2010 and 2015. Risk factors include distractions, the built environment, urbanization, economic variables, and weather conditions. Of interest is the role of alcohol and drugs in premature death among pedestrians. This study sought to explore the prevalence of substance use screenings among pedestrian fatalities in the United States between 2014 and 2016.

Methods: Data were collected from the Fatality Analysis Reporting System provided by the NHTSA. Pedestrian crash variables included demographics as well as information regarding alcohol or drug testing status. Frequency and cross-tabulation tables were constructed to assess the prevalence of screening by person, place, and time. Log-linear analyses were completed to explore age, race, and sex differences. A 3-year examination period was used to control for yearly fluctuations and to incorporate an increasing trend in cases.

Results: Pedestrian fatalities accounted for 84% of all deaths among vulnerable road users during the examination period. Those most at risk were white males between the ages of 45 and 64. Over all states, 74.7% of fatalities were tested for alcohol and 67.1% were tested for drugs; further, 66.5% of cases were tested for both alcohol and drugs and 24.8% were tested for neither substance. Cases screened for both alcohol and drugs ranged from 2.9% in North Carolina to 95.7% in Nevada and those testing for neither substance ranged from a high of 68.9% in Indiana to a low of 1.1% in Maryland. Log-linear regression revealed significant differences in alcohol screening by age and race but not by sex. Differences in drug screening were not identified for any demographic variable. Fatalities tested for alcohol were significantly more likely to be tested for drugs; only 8.2% were screened solely for alcohol and 0.05% were screened for drugs alone.

Conclusions: Preventive strategies become more important as pedestrian crashes and fatalities increase. Risk reduction in the form of policy change, alterations to the built environment, or interdisciplinary approaches to injury prevention is dependent upon best evidence supported in part by more deliberate and consistent screening.