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.     

Spatial relationships between alcohol outlet densities and drunk driving crashes: An empirical study of Tianjin in China

Introduction: Numerous studies have demonstrated the close relationship between alcohol availability and alcohol-related crashes. However, there is still a lack of spatial empirical analysis regarding this relationship, particularly in large cities of developing countries. Differences in alcohol outlets and drinking patterns in these cities may lead to quite different patterns of crash outcomes. Method: 3356 alcohol-related crashes were collected from the blood-alcohol test report of a forensic institution in Tianjin, China. Density of alcohol outlets such as retail locations, entertainment venues, restaurants, hotels, and companies were extracted based on 2114 Traffic Analysis Zones (TAZ) together with the residential and demographic characteristics. After applying the exploratory spatial data analysis, this research developed and compared the traditional Ordinary Least Square model (OLS), Spatial Lag Model (SLM), Spatial Error Model (SEM) and Spatial Durbin Model (SDM) to explore spatial effects of all the variables. Results: The results of incremental spatial autocorrelation show that the most significant distance threshold of alcohol-related roadway traffic crashes is 3 km. The SDM is found to be the optimal spatial model to characterize the relationship between alcohol outlets and crashes. The number of alcohol-involved traffic crashes is positively related to population density and retail density, but negatively related to the company density, hotel density, and residential density within the same TAZ. Meanwhile, dense population and hotels have reverse spillover effects in adjacent zones. Conclusions: The significant spatial direct effect and spillover effect of alcohol outlet densities on drunk driving crashes should not be neglected. These findings could help improve transportation planning, traffic law enforcement and traffic management for large cities in developing countries.     

Alcohol-impaired driving in the United States: contributors to the problem and effective countermeasures

Objective: To review the effectiveness of current countermeasures in alcohol-impaired driving. Method: This article provides an overview of the contributors to the alcohol-impaired driving problem in the United States and reviews the effectiveness of alcohol-impaired driving countermeasures. Results: Many effective countermeasures have been used during the past few decades both to deter drivers from driving when they are over the legal limit for alcohol and to discourage driving while intoxicated (DWI) offenders from reoffending once they have been caught and convicted. In recent years, greater attention has been given to the problem of "hardcore" drinking drivers, a term coined to refer to those who repeatedly drive with high blood alcohol concentrations and are resistant to changing their behavior. Although such individuals are a legitimate target for attention, focusing predominantly on this group will result in missed opportunities to address a large portion of alcohol-impaired driving crashes. This article provides a review of the primary countermeasures that have been used to reduce alcohol-impaired driving and summarizes evidence for their effectiveness. It asks the question of where, in an environment of limited resources, attention should be focused. Conclusions: General deterrent approaches, such as frequent and highly publicized sobriety checkpoints, have the greatest potential to save lives and should be the mainstay of state and local efforts. Specific deterrent approaches, aimed at deterring DWI offenders from reoffending, such as alcohol ignition interlocks, should be applied to all apprehended drivers, whatever their drinking history. Evidence suggests that they could benefit from them. In the future, advanced in-vehicle technologies that would prevent vehicles from being driven when their drivers are over the legal limit may hold the key to drastically reducing the alcohol-impaired driving problem.     

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.     

The effect of a campus-community environmental alcohol prevention initiative on student drinking and driving: results from the "a matter of degree" program evaluation

OBJECTIVE: Motor vehicle crashes involving alcohol are a major contributor to morbidity and mortality among college students in the United States. This study evaluates the effect on drinking and driving outcomes of the "A Matter of Degree" program, a campus-community coalition initiative to reduce college binge drinking. METHODS: We used a quasi-experimental longitudinal study design that compared student responses at 10 colleges participating in the program and students attending 32 similar colleges that did not participate in the program. We also divided the program sites into two groups of five according to their level of program implementation and compared each with the non-program colleges. We examined driving after any alcohol consumption and driving after five or more drinks among drinkers who drove one or more times a week per month and riding with a high or drunk driver among all students at these colleges beginning in 1997 through 2001. Outcomes were based on data collected from repeated cross-sectional surveys using the Harvard School of Public Health College Alcohol Study. Analyses were conducted using MLwiN multilevel statistical software. RESULTS: We found significant reductions in driving after drinking, driving after five or more drinks and riding with a high or drunk driver at the program colleges relative to the comparison colleges. Further analyses indicated that these reductions among the AMOD program colleges occurred at the sites with high program implementation relative to comparison sites, while no statistically significant change was noted at the program sites with low implementation. The program effect on the two drinking and driving outcomes appeared to be mediated by frequent binge drinking, while significant decline in the riding with an intoxicated driver outcome was not mediated by the individual's drinking. CONCLUSIONS: Campus-community based environmental alcohol prevention is a promising approach for reducing alcohol-impaired motor vehicle crashes among this population.     

Prevalence of alcohol impairment and odds of a driver injury or fatality in on-road farm equipment crashes

Objective: The objective of this article was to estimate the prevalence of alcohol impairment in crashes involving farm equipment on public roadways and the effect of alcohol impairment on the odds of crash injury or fatality.

Methods: On-road farm equipment crashes were collected from 4 Great Plains state departments of transportation during 2005–2010. Alcohol impairment was defined as an involved driver having blood alcohol content of ≥0.08 g/100 ml or a finding of alcohol impairment as a driver contributing circumstance recorded on the police crash report. Injury or fatality was categorized as (a) no injury (no and possible injury combined), (b) injury (nonincapacitating or incapacitating injury), and (c) fatality. Hierarchical multivariable logistic regression modeling, clustered on crash, was used to estimate the odds of an injury/fatality in crashes involving an alcohol-impaired driver.

Results: During the 5 years under study, 3.1% (61 of 1971) of on-road farm equipment crashes involved an alcohol-impaired driver. One in 20 (5.6%) injury crashes and 1 in 6 (17.8%) fatality crashes involved an alcohol-impaired driver. The non-farm equipment driver was significantly more likely to be alcohol impaired than the farm equipment driver (2.4% versus 1.1% respectively, P = .0012). After controlling for covariates, crashes involving an alcohol-impaired driver had 4.10 (95% confidence interval [CI], 2.30–7.28) times the odds of an injury or fatality. In addition, the non-farm vehicle driver was at 2.28 (95% CI, 1.92–2.71) times higher odds of an injury or fatality than the farm vehicle driver. No differences in rurality of the crash site were found in the multivariable model.

Conclusion: On-road farm equipment crashes involving alcohol result in greater odds of an injury or fatality. The risk of injury or fatality is higher among the non-farm equipment vehicle drivers who are also more likely to be alcohol impaired. Further studies are needed to measure the impact of alcohol impairment in on-road farm equipment 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.     

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.     

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.     

Attitudes toward mandatory ignition interlocks for all offenders convicted of driving while intoxicated

Introduction: Ignition interlocks are effective in reducing alcohol-impaired driving recidivism for all offenders, including first-time offenders. Despite their effectiveness, interlock use among persons convicted of driving while intoxicated from alcohol (DWI) remains low. This cross-sectional survey of U.S. adults assessed public support for requiring ignition interlocks for all convicted DWI offenders including first-time offenders. The goal was to update results from a similar 2010 survey in light of new state requirements and increased interlock installations. Methods: Questions were included in the Porter Novelli FallStyles survey, which was fielded from September 28 to October 16, 2015. Participants were the 3,536 individuals who provided an opinion toward requiring ignition interlocks for all offenders. For analyses, opinion toward requiring interlocks for all offenders was dichotomized into ‘agree’ and ‘neutral/disagree.’ To handle missing data, 10 imputed datasets were created and pooled using fully conditional specification (FCS). Results: Fifty-nine percent of adults supported requiring interlocks for all DWI offenders. Multivariate analysis revealed that persons who did not report alcohol-impaired driving (AID) were 60% more likely to support requiring interlocks than those who reported AID. Having heard of interlocks also increased support. Support was generally consistent across demographic subgroups. Conclusions: Interlocks for all offenders have majority support nationwide in the current survey, consistent with previous reports. Support is lowest among those who have reported alcohol-impaired driving in the past 30 days. These results suggest that communities with higher levels of alcohol-impaired driving may be more resistant to requiring ignition interlocks for all convicted DWI offenders. Future studies should examine this association further. Practical applications: These results indicate that the majority of adults recognize DWI as a problem and support requiring interlocks for all offenders.     

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.     

Perceptions of alcohol-impaired driving and the blood alcohol concentration standard in the United States

IntroductionAlthough the number of alcohol-impaired driving (AID) fatalities has declined over the past several years, AID continues to be a serious public health problem. The purpose of this effort was to gain a better understanding of the U.S. driving population's perceptions and thoughts about the impacts of lowering the blood alcohol concentration (BAC) driving standard below.08% on AID, health, and other outcomes.MethodsA questionnaire was administered to a nationally representative sample of licensed drivers in the U.S. (n = 1011) who were of age 21 or older on driving habits, alcohol consumption habits, drinking and driving habits, attitudes about drinking and driving, experiences with and opinions of drinking and driving laws, opinions about strategies to reduce drinking and driving, general concerns about traffic safety issues, and demographics.ResultsOne-third of participants supported lowering the legal BAC standard, and participants rated a BAC standard of .05% to be moderately acceptable on average. 63.9% indicated that lowering 30 the BAC to .05% would have no effect on their decisions to drink and drive. Nearly 60% of respondents lacked accurate knowledge of their state's BAC standard.ConclusionsPublic support for lowering the BAC standard was moderate and was partially tied to beliefs about the impacts of a change in the BAC standard. The results suggest that an opportunity for better educating the driving population about existing AID policy and the implications for lowering the BAC level on traffic injury prevention.Practical applicationsThe study results are useful for state traffic safety professionals and policy makers to have a better understanding of the public's perceptions of and thoughts about BAC standards. There is a clear need for more research into the effects of lowering the BAC standard on crashes, arrests, AID behavior, and alcohol-related behaviors.     

Emerging technological approaches for controlling the hard core DUI offender in the U.S

Drivers convicted of impaired driving are substantially overrepresented in alcohol-related fatal crashes. Because many such offenders continue to drive with suspended operators' licenses, monitoring their postconviction driving is a significant problem for the criminal justice system. Technology for tracking the location and drinking of such offenders is a rapidly developing field, which promises to provide methods for monitoring offenders on a 24/7 basis. The status of traditional monitoring methods is reviewed and contrasted with the new technologies that are being implemented. Although those technologies offer considerable promise, they have not yet been evaluated in programs for impaired driving offenders. Eight issues related to the probability of rapid implementation of the new technologies are discussed.     

Potential effects of lowering the BAC limit on injuries,fatalities, and costs

IntroductionPotential health and cost impacts of lowering the BAC limit for U.S. drivers below .08% were explored through analyses of reductions in crash incidence, injury severity, and costs based on five scenarios with varying assumptions about how the change to a .05% BAC limit might affect alcohol-impaired driving.MethodsDistribution of crashes by injury level and highest driver or non-occupant BAC levels for 2010, together with unit crash costs provided a base for comparison. Scenario 1 assumed all alcohol-impaired driving ceased; scenario 2 assumed all drivers obeyed the law, and scenario 3 assumed decreases in driver BAC levels would be limited to those who had been driving near the legal limit before the change. Scenario 4 was based on changes in driver BAC levels associated with a 08% to .05% BAC limit change in Australia, and scenario 5 was based on changes in alcohol-related crashes associated with the change to the .08% BAC limit in the United States. The number of casualties prevented in each scenario was estimated using relative risks of crash involvement, and changes in societal costs were estimated using the unit costs.ResultsReductions ranging from 71% to 99% in fatalities, injuries, and costs related to alcohol-impaired driving were estimated in scenarios 1 and 2. Scenarios 3–5 produced smaller reductions ranging from 4% to 16% for alcohol-impaired fatalities, injuries, and costs.ConclusionThe wide difference between the outcomes of the two sets of scenarios reflects the sensitivity of BAC policy benefits to driver compliance behavior.Practical applicationThe quantification of the reduction in the number and costs of traffic crash casualties in the set of behavioral scenarios explored in this research can inform policymakers about the extent and limits of benefits achievable by lowering the BAC limits as they consider strategies to reduce alcohol-impaired driving.     

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.     

Evaluation of a responsible beverage service and enforcement program: Effects on bar patron intoxication and potential impaired driving by young adults

Objective: Studies of alcohol-related harm (violence, injury, illness) suggest that the most significant risk factors are the amount of alcohol consumed and whether obviously intoxicated patrons continue to be served. This study's objective was to investigate the effects of a responsible beverage service (RBS)/enhanced alcohol enforcement intervention on bars, bar patrons, and impaired driving.

Method: Two communities—Monroe County, New York, and Cleveland, Ohio—participated in a demonstration program and evaluation. The intervention applied RBS training, targeted enforcement, and corrective actions by law enforcement to a random sample of 10 identified problem bars in each community compared to 10 matched nonintervention problem bars. Data were collected over 3 waves on bar serving practices, bar patron intoxication, drinking and driving, and other alcohol-related harm from intervention and control bars and treatment and comparison communities.

Results: In Monroe County, New York, of the 14 outcome measures analyzed, 7 measures showed statistically significant differences from pre- to postintervention. Six of those measures indicated changes in the desired or positive direction and 2 measures were in the undesired or negative direction. Of note in the positive direction, the percentage of intervention bar patrons who were intoxicated decreased from 44 to 27% and the average blood alcohol concentration of patrons decreased from 0.097 to 0.059 g/dL pre- to postintervention. In Cleveland, Ohio, 6 of the 14 measures showed statistically significant changes pre- to postintervention with 6 in the positive direction and 4 in the negative direction. Of note, the percentage of pseudo-intoxicated patrons denied service in intervention bars increased from 6 to 29%.

Conclusions: Of the 14 outcome measures that were analyzed in each community, most indicated positive changes associated with the intervention, but others showed negative associations. About half of the measures showed no significance, the sample sizes were too small, or the data were unavailable. Therefore, at best, the results of these demonstration programs were mixed. There were, however, some positive indications from the intervention. It appears that when bar managers and owners are aware of the program and its enforcement and when servers are properly trained in RBS, fewer patrons may become intoxicated and greater efforts may be made to deny service to obviously intoxicated patrons. Given that about half of arrested impaired drivers had their last drink at a licensed establishment, widespread implementation of this strategy has the potential to help reduce impaired driving.     

Why is the rate of annual road fatalities increasing? A unit record analysis of New Zealand data (2010–2017)

IntroductionRecent increases in road crashes have reversed New Zealand’s formerly declining crash rates to produce annual fatal and serious injury counts that are 49% higher than the lowest rates achieved in 2013. Method: We model twenty-one factors in fatal and serious injury crashes, four years before and after 2013 using logistic regression. Three major factors are significantly different in the period after 2013, when crash rates increased: (1) alcohol as a cause, (2) learner licence holders, and (3) a regional effect for Auckland. Newly defined speed zones are a more common setting for crashes in the period of upturn but there is no coinciding elevated likelihood of ‘speed as a causal factor’. Three factors related to road safety were less common: aged under 25-years old, fatigue, and not wearing a seatbelt. Results: Results are compared to rates of prosecutions for alcohol-related driving offences over this period. It is possible that New Zealand’s successful road safety initiatives of the past have been undermined by reduced levels of enforcement and an unexpected outcome from the graduated driving licence system.     

Effects of legal BAC limits on fatal crash involvement: analyses of 28 states from 1976 through 2002

PROBLEM: Hundreds of laws have been implemented in the United States over the past few decades designed to reduce alcohol-impaired driving and the crashes that often result. One approach has been to lower the legally allowable alcohol concentration for drivers. We examined the effects of changes in legal BAC limit in 28 U.S. states from January, 1976 to December, 2002. METHOD: An interrupted time-series quasi-experimental design was used, incorporating non-alcohol-related crashes as comparisons. Four outcome measures of alcohol-related crash involvement were examined: single-vehicle nighttime, BAC=0.01-0.07, BAC=0.08-0.14, and BAC>/=0.15. Missing BAC test result data were handled by using multiple imputations. Analyses involved estimation of state-specific ARIMA models, controlling for other factors affecting overall crash rates and other major DUI policy changes. Inverse variance weighting methods were used to pool results across states for the most precise underlying estimate of effect of legal BAC limits. RESULTS: Considerable state by state variability in estimated effects was observed, but results from the pooled analyses were clear and consistent. Changes in legal BAC limits significantly affected alcohol-related fatal crash involvement for both the SVN and BAC test result measures, and the laws affected drivers at all drinking levels. SUMMARY: An estimated 360 deaths are prevented each year in the United States as a result of the move from a 0.10 to 0.08 legal limit in recent years, and an additional 538 lives could be saved each year if the United States reduced the limit to 0.05, consistent with limits in most countries worldwide. IMPACT ON INDUSTRY: Given the significant effects of lower legal BAC limits on fatal crash involvement, businesses should support implementation of laws that further reduce the legal BAC limit for all drivers. Furthermore, all companies should set higher standards for employees, such as a zero allowable BAC limit for driving during work time.     

A comparison of contributing effects on 2-vehicle alcohol-related crashes between impaired and nonimpaired operators

Objective: Driving under the influence of alcohol is a crime that places the lives of all motorists in danger. Though it is a largely preventable act, impaired driving has accounted for 31 to 38% of fatal crashes across the country over the last decade. When an impaired operator crashes his or her vehicle, there is often a second unit, of which the operator is not impaired, involved in the crash.

Methods: This research looks at approximately 14,000 2-unit crashes involving an impaired operator in the State of Ohio from 2008 through 2012. The research is focused on determining the effects of crash and operator characteristics in 2-unit alcohol-related crashes through the use of 2 mixed logit models.

Results: It is found that several factors have similar effects on the injury severities of both the impaired and nonimpaired operators, including head-on crashes, the use of seat belts, and the deployment of airbags. There are, however, several factors that affect the 2 operators differently. It is found that the impaired operator's injury severity is based on the type and, more important, the size of the vehicle he or she is driving, the roadway geometry, and the speed of the vehicle driven by the nonimpaired operator. The nonimpaired operator is equally affected by the speed of the impaired vehicle as much as his or her own speed, and the nonimpaired operator's injury severity is virtually independent of the type of vehicle being driven.

Conclusions: Researchers may disseminate the results to community groups such as Mothers Against Drunk Driving and Safe Communities to increase awareness of the dangers of drunk driving in an effort to reduce the number of alcohol-related crashes.     

Evaluating impaired drivers confidence and intention to "(Please) drink responsibly"

Introduction

Currently, alcohol industry-sponsored advertisements subsume traditional designated driver and don't drink and drive messages within responsible drinking campaigns. Yet, to date, there remains a dearth of literature specifically examining the attitudinal beliefs impaired drivers attach to the responsible drinking message.

Objective

This investigation sought to examine the responsible drinking attitudes and beliefs of impaired drivers, specifically examining their confidence and intention to drink responsibly the next time they consumed alcohol.

Methods

A random sample of 729 students attending a large, public Texas university completed a web-based administration of the Characteristic of Responsible Drinking Survey (CHORDS).

Results

Participants in this sample who had driven while impaired by alcohol exhibited significantly less confidence in refraining from drinking and driving and reported significantly lower intentions to designate a driver, take a taxi, or use a safe-ride program the next time they consumed alcohol. Additionally, they also reported less confidence, and lower intentions, to ensure their blood alcohol concentrations remained below the legal limit (0.08%) the next time they consumed alcohol.

Conclusions

Drivers who had driven while impaired significantly differed in their confidence and intention to drink responsibly the next time they consumed alcohol. Logistic regression results indicate that by increasing one's confidence in responsible drinking, and increasing their intention to drink responsibly, the likelihood of impaired driving can be decreased.

Impact on industry

Results from this investigation demonstrate one’s responsible drinking attitudinal beliefs accounts for a significant amount of the variance associated with one’s alcohol-related behaviors. Thus, further research should examine and establish how individuals conceptualize and practice responsible drinking.