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.     

Effectiveness of lowering the blood alcohol concentration (BAC) limit for driving from 0.10 to 0.08 grams per deciliter in the United States

Objective: The current study evaluates of the effects of lowering the blood alcohol concentration (BAC) limit from 0.10 to 0.08?g/dL across all 50 states in the United States. Our objectives were to (1) estimate the effects of the 0.08?g/dL BAC limit on drinking driver fatal crash rates; (2) compare the effects from early-adopting states to the effects of late-adopting states; (3) determine the effects on drivers with low BACs (0.01–0.07?g/dL) and high BACs (0.08+ g/dL); and (4) estimate the lives saved since 1983 due to the adoption of 0.08?g/dL BAC laws.

Methods: Our study examined annual data from the Fatality Analysis Reporting System (FARS) for each jurisdiction from 1982 through 2014. Our basic outcome measure was the ratio of drinking drivers (BAC ≥0.01?g/dL) to nondrinking drivers (BAC?=?0.00?g/dL). Covariates included 0.10 BAC laws, administrative license revocation (ALR) laws, seat belt laws, minimum legal drinking age (MLDA) laws, and unemployment rates. We utilized autoregressive integrated moving average (ARIMA) models for each state, where the implementation date of the law was modeled as a zero-order transfer function in the series, in addition to any extant trends that may have been occurring simultaneously. Before determining the specific impact of the implementation of 0.08?g/dL BAC laws, we conducted a time series analysis for each state. We tested for between-state mediating factors relating to our covariates.

Results: A total of 38 of the 51 jurisdictions showed that lowering the BAC limit was associated with reduced drinking driver fatal crash ratios, with 20 of those reductions being significant. The total effects showed a 10.4% reduction in annual drinking driver fatal crash rates, which is estimated to have saved an average of 1,736 lives each year between 1983 and 2014 and 24,868 lives in total. Implementing a BAC limit of 0.08?g/dL had significant impacts on both high- and low-BAC fatal crash ratios. Though early-adopting jurisdictions (1983–1999) demonstrated a larger decrease in fatal drinking driver crash ratios than did late-adopting jurisdictions (2000–2005), the results were not statistically significant (P?>?.05).

Conclusions: Our study of the effects of lowering the BAC from 0.10 to 0.08?g/dL in the United States from 1982 to 2014 showed an overall effect of 10.4% on annual drinking driver fatal crash rates, in line with other multistate studies. This research provides strong evidence of the relationship between lowering the BAC limit for driving and the general deterrent effect on impaired-driving fatal crash rates.     

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.     

The relationship between blood alcohol concentration (BAC), age, and crash risk

PROBLEM: The role of age (youth and driving inexperience) and alcohol as major risk factors in traffic crash causation has been firmly established by numerous studies over the past 50 years. Less well established is how the two variables interrelate to influence crash risk. Some investigations have hypothesized an interactive or synergistic effect in which young drivers with less experience and a greater tendency to take risks are more adversely affected at lower blood alcohol concentrations (BACs) than are older drivers. The evidence for this hypothesis is mixed. Resolution of this issue has important implication for developing countermeasures directed at the young driver crash problem. METHOD: Case control data previously collected in Long Beach and Fort Lauderdale were reanalyzed using a more sensitive method for detecting interaction effects than used in the original analysis. A conditional logistic regression analyses found a highly significant agexBAC interaction (P<.0001) involving differences between drivers under 21 and those 21 and older. DISCUSSION: The results clearly indicate that positive BACs in drivers under 21 are associated with higher relative crash risks than would be predicted from the additive effect of BAC and age. It is likely that two mechanisms are operating to cause the interaction. First, it seems likely that the crash avoidance skill of young novice drivers would be more adversely affected by alcohol due to their driving inexperience, immaturity, and less experience with alcohol. Second, drivers under 21 who choose to drink and to drive after drinking probably have pre-existing characteristics that predisposed them to risk taking and crash involvement apart from any increased vulnerability to alcohol impairment. IMPACT ON INDUSTRY: The results support increased enforcement of zero-tolerance BAC laws for minors.     

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.     

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.     

Potential risks of providing drinking drivers with BAC information

The objective of this paper is to discuss the benefits and risks of providing drinkers with tools that allow them to estimate their blood alcohol concentration (BAC), and to examine the field usability of one commercially available tool. Drinking and driving laws are specified in terms of the driver's BAC, and there is concern that the absence of a method for drivers to accurately estimate their BAC level limits their ability to determine whether they can drive legally. A number of devices that provide a method for the individual to estimate or measure their BAC have been developed. Although some of these devices--such as the "know your limit" (KYL) cards--have been widely distributed, their effectiveness in encouraging good driving decisions have rarely been tested. This article describes a pilot study on the field usability of the Guardian Angel (GA) personal alcohol test in a field setting. The GA test analyzes saliva samples from drinking and indicates under which BAC category they fall (.00 -.04;.04 -.08;.08+). The research examined whether drinkers could, in natural drinking environments, correctly administer and interpret the test results. The methodology involves sampling drinkers on a weekend night on and around the grounds of a large West Coast university as they traveled between off-campus parties, bars, and their dorms. They were asked to assess their own intoxication and impairment, then self-administer and interpret the Guardian Angel test. After interpreting the test, participants were asked to reassess their intoxication and impairment levels, and were given a breath BAC test using a calibrated unit. The results revealed that although the majority of drinkers' were able to administer the GA test, their interpretations did not correspond with actual BACs. The interpretations of the GA test produced false-negatives, underestimating actual BACs. Drinkers perceived themselves to be less intoxicated, on average, after interpreting the GA test results. In conclusion, this research addresses potential pros and cons of providing BAC information to drinkers. It underscores the importance of testing BAC estimation tools under field conditions and the potential risks associated with tests that do not produce accurate results.     

Implementation of Washington State's zero tolerance law: patterns of arrests, dispositions, and recidivism

OBJECTIVES: Zero tolerance (ZT) laws have been effective in reducing alcohol-related crashes among underage drivers. However, enforcement in some states has not been rigorous, and ZT offenses may not be viewed as serious offenses. On July 1, 1994, the state of Washington implemented a ZT law that allowed police to request a test for alcohol on suspicion of either a ZT or driving-under-the-influence (DUI) offense. The present study examined effects of the ZT law on arrests and case dispositions among underage offenders as a function of blood alcohol concentration (BAC) and post-law patterns of recidivism. METHODS: Times-series analyses examined the effects of the ZT law on trends in arrests of underage drivers between 1991 and 1999. Based on arrest records matched with driver's license records, the effects of the law on dispositions of alcohol-related offenses among underage drivers were examined, and rates of recidivism among underage offenders were examined for the period following the ZT law. RESULTS: There was a substantial increase in arrests of underage drivers beginning immediately after implementation of the ZT law, especially among drivers with low BACs. The types of court or administrative dispositions received by underage offenders changed markedly after the ZT law was implemented. Underage offenders with lower BACs became far more likely to receive alcohol-related convictions and/or license suspensions. However, the percentage of underage offenders with higher BACs receiving DUI convictions declined as some of these offenders received the lesser ZT disposition. After the ZT law, underage offenders with BACs of 0.10 g/dL or higher were more likely to recidivate than those with lower BACs, but appreciable proportions of drivers were re-arrested for another alcohol offense, whatever the BAC and however they were penalized. CONCLUSIONS: Implementation of Washington's law indicates that a ZT law can increase the likelihood that an underage person will be sanctioned for drinking and driving. However, recidivism remains an issue as more than one in four underage drivers arrested with low BACs subsequently were re-arrested.     

Effects of alcohol at 0.05% blood alcohol concentration (BAC) on low speed urban driving

ABSTRACT

Objective: Alcohol-impaired driving presents a continued risk for traffic safety and results in a significant proportion of fatalities on the roadway. We examined how alcohol at a 0.05% blood alcohol concentration (BAC) compares to 0.10% BAC (above the current U.S. legal limit) in terms of impact on driving performance.

Methods: Utilizing a within-subjects design, we recruited 108 healthy experienced drivers who were moderate to heavy drinkers. In a double-blind, placebo-controlled crossover design, we administered placebo and alcohol at the 0.05% and 0.10% BAC levels in a standardized simulated driving protocol. Drives occurred on the descending limb of the blood alcohol curve. This analysis focuses on the urban portion of the drive

Results: The study observed clear differences in performance for lateral and longitudinal driving performance and glance behavior. Variability in lane keeping and average speed increased with BAC level, with degraded performance observed at 0.05% BAC. The frequency of lane departures and percentage of time focused on the forward roadway at 0.05% BAC did not differ from placebo but differed from the 0.10% BAC level.

Conclusions: Overall, our results show that there is degraded performance in the urban driving environment and that much of that begins at or below the 0.05% BAC level.     

The Long Beach/Fort Lauderdale relative risk study

Problem

The role of alcohol as a major factor in traffic crash causation has been firmly established. However, controversy remains as to the precise shape of the relative risk function and the BAC at which crash risk begins to increase.

Methods

This study used a case-control design in two locations: Long Beach, California, and Fort Lauderdale, Florida. Data were collected on 2,871 crashes of all severities and a matched control group of drivers selected from the same time, location, and direction of travel as the crash drivers. Of the 14,985 sample drivers, 81.3% of the crash drivers and 97.9% of the controls provided a valid BAC specimen.

Results

When adjusted for covariates and nonparticipation bias, increases in relative risk were observed at BACs of .04-.05, and the elevations in risk became very pronounced when BACs exceeded .10.

Discussion

The results provide strong support for .08 per se laws and for state policies that increase sanctions for BACs in excess of .15.

Impact on Industry

This study provides further precision on the deleterious effects of alcohol on driving and, by implication, on other complex tasks.     

Survey regarding the 0.05 blood alcohol concentration limit for driving in the United States

Background: On May 14, 2013, the National Transportation Safety Board (NTSB) proposed that states lower the blood alcohol concentration (BAC) illegal limit from 0.08 to 0.05 g/dL (also referred to as the 0.08 law and the 0.05 limit, respectively). In March 2017, this recommendation was signed into law in the State of Utah.

Objective: The objective of this survey is to investigate perceptions regarding enforcement of the 0.05 g/dL BAC limit.

Method: Opinions of law enforcement officers, prosecutors, and defense attorneys were obtained through a series of questionnaires and focus groups.

Results: Survey data were collected from 32 law enforcement officers, 20 prosecutors, and 4 defense attorneys. The participants rated the usefulness of the NHTSA's driving while intoxicated (DWI) driving cues lower for the 0.05 limit than for the 0.08 law. Some of the participants believed that training would be needed in regard to sobriety testing under the 0.05 limit. Participants also stated that adequately preparing for prosecution of drunk drivers would be more difficult under the 0.05 limit. In addition, it was believed that drunk driving cases are more likely to be withdrawn and fewer plea agreements and guilty pleas are likely under the 0.05 limit. Prosecutors were concerned that the 0.05 limit would result in poorly investigated cases and overburden the court system. Defense attorneys were concerned about the social and economic costs of a 0.05 limit.

Discussion: Overall, it appears that the 0.05 limit is viewed as enforceable and it will save lives; however, the usefulness of the NHTSA DWI Detection Guide and of the standardized field sobriety tests need to be established for lower BACs, and efforts must be made to educate people regarding the relationship between BAC and impairment and impairment and driving with the risk of injury and death.

Conclusion: Though the 0.05 limit offers promise in saving lives, the following issues associated with changing the limit to 0.05 need to be resolved prior to implementation: Validating the sobriety tests for the 0.05 limit; if needed, modifying the sobriety tests to make them effective and valid at the 0.05 limit; and training law enforcement personnel and educating the public regarding the 0.05 limit.     

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.     

Field Evaluation of the PAS III Passive Alcohol Sensor

Passive alcohol sensors (PAS) are screening devices designed to sample nonintrusively the ambient air around a driver's mouth to determine the presence of alcohol. Studies have shown that PAS devices can aid police officers in the identification of unpaired drivers, particularly at sobriety checkpoints. Data from a 1996 nationwide survey, in which 5,392 drivers were evaluated for alcohol using both the PAS III (a passive sensor housed in a flashlight) and evidential breath test devices, have allowed the determination of appropriate criteria at various blood alcohol concentrations (BAC) for detecting impaired drivers in the field. Using the appropriate criteria, the PAS III can identify about 75% of the drivers with BACs at or above 0.10%, and 70% at or above 0.08%. This is a vast improvement over the 40-50% detection rate currently achieved by police officers at checkpoints not using sensors. Using the PAS III few drivers would be identified inappropriately. At the criterion recommended for detecting BACs at or above 0.08%, about 14% of drivers with BACs of 0.02-0.05% would be incorrectly identified as having a higher BAC. Field studies have shown that when police officers rely on observation alone about 20% of drivers with low BACs are detained for further evaluation. More widespread use of passive sensors by police officers would aid in the detection of drinking drivers. Sensors also could provide an additional deterrent to the general public if they believe that when stopped by the police after drinking they will be detained for further evaluation.     

Effect of alcohol use on accelerating and braking behaviors of drivers

Objective: The present study examines the accelerating and braking behaviors of drivers at different blood alcohol concentrations (BACs) in heterogeneous driving conditions using driving simulator experiments.

Methods: Eighty-two licensed drivers performed simulated driving in a rural road environment designed in the driving simulator at 4 BAC levels: 0.00, 0.03, 0.05, and 0.08%. Driving performance was analyzed using vehicle control variables such as mean acceleration and mean brake pedal force. Generalized linear mixed models were developed to quantify the effect of different alcohol levels and explanatory variables such as driver’s age, gender, and other factors on the driving performance indicators.

Results: Alcohol use was reported as a significant factor affecting the accelerating and braking performance of drivers. The acceleration model results indicated that drivers’ mean acceleration increased by 0.013, 0.026, and 0.027 m/s² for BAC levels of 0.03, 0.05, and 0.08%, respectively. Results of the brake pedal force model showed that drivers’ mean brake pedal force increased by 1.09, 1.32, and 1.44 N for BAC levels of 0.03, 0.05, and 0.08%, respectively. Age was a significant factor in both the models where a 1-year increase in driver age resulted in a 0.2% reduction in mean acceleration and a 19% reduction in mean brake pedal force. Driving experience could compensate for the negative effects of alcohol to some extent while driving.

Conclusions: The findings of the present study revealed that drivers tend to be more aggressive and impulsive under the influence of alcohol, which deteriorates their driving performance. Impairment in accelerating and braking behaviors of drivers under the influence of alcohol leads to increased crash probabilities. The conclusions may provide reference in making countermeasures against drinking and driving and contribute to traffic safety.     

Low-manpower checkpoints: can they provide effective DUI enforcement in small communities?

OBJECTIVE: Sobriety checkpoints can be effective in reducing alcohol-impaired driving. Checkpoints are underutilized, however, partially because police believe a large number of officers are required. This study evaluated the feasibility and impact of conducting small-scale checkpoints in rural communities. METHODS: Law enforcement agencies in two counties agreed to conduct weekly checkpoints for one year. Two nonadjacent counties did not undertake additional checkpoints. Evaluation included public-awareness surveys and roadside surveys (including blood alcohol concentration [BAC] measurements) of weekend nighttime drivers. RESULTS: Relative to drivers in the comparison counties, the proportion of drivers in the experimental counties with BACs >0.05% was 70% lower. Drivers surveyed at driver's license offices in the experimental counties after program implementation were more likely to report seeing or passing through a checkpoint and were more aware of publicity on driving under the influence (DUI) enforcement. CONCLUSIONS: Small rural communities can safely and effectively conduct low-staff sobriety checkpoints on a weekly basis. Such programs can be expected to result in large reductions in drivers operating at higher BACs.     

Fatally injured pedestrians and bicyclists in the United States with high blood alcohol concentrations

IntroductionLittle research has focused on the problem of alcohol impairment among pedestrians and bicyclists in the United States. The aim of the current study was to investigate the prevalence, trends, and characteristics of alcohol-impaired fatally injured pedestrians and bicyclists.MethodData from the Fatality Analysis Reporting System (FARS) were analyzed for fatally injured passenger vehicle drivers, pedestrians, and bicyclists 16 and older during 1982–2014. Logistic regression models examined whether personal, roadway, and crash characteristics were associated with high blood alcohol concentrations (BACs) among fatally injured pedestrians and bicyclists.ResultsFrom 1982 to 2014, the percentage of fatally injured pedestrians with high BACs (≥ 0.08 g/dL) declined from 45% to 35%, and the percentage of fatally injured bicyclists with high BACs declined from 28% to 21%. By comparison, the percentage of fatally injured passenger vehicle drivers with high BACs declined from 51% in 1982 to 32% in 2014. The largest reductions in alcohol impairment among fatally injured pedestrians and bicyclists were found among ages 16–20. During 2010–2014, fatally injured pedestrians and bicyclists ages 40–49 had the highest odds of having a high BAC, compared with other age groups.ConclusionsA substantial proportion of fatally injured pedestrians and bicyclists have high BACs, and this proportion has declined less dramatically than for fatally injured passenger vehicle drivers during the past three decades. Most countermeasures used to address alcohol-impaired driving may have only limited effectiveness in reducing fatalities among alcohol-impaired pedestrians and bicyclists.Practical applicationsEfforts should increase public awareness of the risk of walking or bicycling when impaired. Results suggest the primary target audience for educational campaigns directed at pedestrians and bicyclists is middle-age males. Further research should evaluate the effectiveness of potential countermeasures, such as lowering speeds or improving lighting in urban areas.     

Alcohol-related deaths among young passengers: An analysis of national alcohol-related fatal crashes

Introduction: There is consensus that riding with an impaired driver (RWI) constitutes a major threat to public health. The aim of this study was to characterize the factors contributing to the motor-vehicle deaths of 15–20 year-old (y/o) passengers that RWI with a peer. Method: Secondary analyses of the 2010–2018 Fatality Analysis Reporting System. 5,673 passengers aged 15–20 y/o killed while riding in passenger cars with a driver aged 21 or older, 3,542 of these drivers also aged 15–20 y/o. Analyses were conducted between October 2019 and December 2020. Results: Sixty-three percent of the young passengers were killed while riding with a driver 15–20 y/o. Of these drivers, 26.8% had a blood alcohol concentration (BAC) >0.00 g/dL and 77.1% had a BAC ≥0.08 g/dL. Compared with those occurring during the day on weekdays, fatalities of young passengers who RWI with a peer driver with a BAC ≥ 0.08 g/dL often occurred on weekend nights (OR = 8.2) and weekday nights (OR = 5.2), and when the passenger and driver were both male (OR = 1.8). Race/ethnicity was not a significant contributor to RWI fatalities. Conclusions: Most 15–20 y/o RWI fatalities occurred on weekends, at night, when the driver was a young peer with a high BAC, and the passenger and driver were male. The high prevalence of fatalities in these high-risk situations suggests that young driver-passenger dynamics may contribute to alcohol-related fatalities. Practical Applications: To curb RWI fatalities among underage passengers, countermeasures should focus not only on underage drinking drivers and riders, but also on drinking drivers of all ages. Prevention should increase focus on situations in which both the young passenger and young driver are males.     

Blood alcohol concentration in fatally injured drivers and the efficacy of alcohol policies of the new law on road traffic safety: A retrospective 10-year study in autonomous province of Vojvodina,Republic of Serbia

Objective: The aim of this study was primarily to evaluate inebriated fatally injured drivers (FIDs) according to blood alcohol concentration (BAC) in a 10-year period (2004–2013) in Autonomous Province (AP) of Vojvodina, Republic of Serbia, to analyze the efficacy of alcohol polices in the new law on road traffic safety through changes in the number of inebriated FIDs before and after implementation of the law, as well as to identify factors that influence the occurrence of FIDs with BACs above the legal limit.

Methods: All data for this retrospective study were obtained from the Centre of Forensic Medicine, Toxicology and Molecular Genetics of Clinical Centre of Vojvodina, Novi Sad. Autopsy records for each case included age, gender, BAC, type of vehicle, and date of accident (year, month, and recalculated day of the week). BAC was determined by gas chromatography with flame ionization detection. Statistical analysis was carried out by chi-square tests and Student's t test, with P < .05 as a statistical significance, and multiple binary logistic regression.

Results: Of the 354 inebriated FIDs (60% of all FIDs), the majority had BACs between of 0.031 and 0.3 mg/ml (28%), followed by those with BAC > 2.01 mg/ml (23%). The average BAC of those driving under the influence of alcohol (DUIA) for the whole period was 1.235 ± 1.00 mg/ml and the average number of DUIA/year was 35. Among the total number of FIDs there were significantly more males (93.7%; P < .001) than females (6.3%), though the distribution of intoxicated men and women was not different (P > .05). There was a statistically significant difference in the distribution of sober and inebriated FIDs according to age (P < .001) with the predominance of inebriated FIDs between 21 and 30 years. Although gender and age were found to be significant predictors of BAC above legal limit in FIDs, the area under the receiver operating characteristics (ROC) curve showed that the model had poor discrimination (ROC = 0.673). Of all observed FIDs, 65 cases per year were attributed to the first 5-year period (2004–2009) and 49 to the second 5-year (2010–2013) period, which indicates that there was no statistically significant decrease in the number of FIDs after implementation of the new law.

Conclusion: The highest number of intoxicated FIDs during the period in AP Vojvodina were mildly and completely inebriated. In the 4-year post-policy period (2010–2013), the number of FIDs and average BAC levels of inebriated FIDs did not significantly change. The abolition of a permissible BAC should be considered.     

Prevalence of alcohol-impaired driving and riding in northern Ghana

Objective: The objective of this study was to determine the roadside prevalence of alcohol-impaired driving among drivers and riders in northern Ghana. The study also verifies motorists' perceptions of their own alcohol use and knowledge of the legal blood alcohol concentration (BAC) limit in Ghana.

Method: With the assistance of police, systematic random sampling was used to collect data at roadblocks using a cross-sectional study design. Breathalyzers were used to screen whether motorists had detectable alcohol in their breath and follow-up breath tests were conducted to measure the actual breath alcohol levels among positive participants.

Results: In all, 9.7% of the 789 participants had detectable alcohol, among whom 6% exceeded the legal BAC limit of 0.08%. The prevalence of alcohol-impaired driving/riding was highest among cyclists (10% of all cyclists breath-tested) followed by truck drivers (9%) and motorcyclists (7% of all motorcyclists breath-tested). The occurrence of a positive BAC among cyclists was about 8 times higher (odds ratio [OR] = 7.73; P < .001) and it was 2 times higher among motorcyclists (OR = 2.30; P = .039) compared to private car drivers. The likelihood for detecting a positive BAC among male motorists/riders was higher than that among females (OR = 1.67; P = .354). The odds for detecting a positive BAC among weekend motorists/riders was significantly higher than on weekdays (OR = 2.62; P = .001).

Conclusion: Alcohol-impaired driving/riding in Ghana is high by international standards. In order to attenuate the harmful effects of alcohol misuse such as alcohol-impaired driving/riding, there is the need to educate road users about how much alcohol they can consume and stay below the legal limit. The police should also initiate random breath testing to instill the deterrence of detection, certainty of apprehension and punishment, and severity and celerity of punishment among drink-driving motorists and riders.