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.     

Effects of enhanced sanctions for high-BAC DWI offenders on case dispositions and rates of recidivism

Implemented January 1, 1998, Minnesota's high-BAC law mandates more severe administrative pre-conviction penalties and more severe post-conviction penalties for offenses with BACs > or = 0.20%. Most notably, the law provides for the administrative impoundment of the license plate of first-time DWI offenders with BACs > or = 0.20. During the three years after the law took effect, a large majority of first-time and repeat offenders with BACs > or = 0.20% did, in fact, receive high-BAC administrative dispositions and/or high-BAC court convictions, which carried more severe penalties. For example, in 1998 85.6% of first offenders with BACs > or = 0.20% received a high-BAC administrative disposition and/or a high-BAC court conviction; 65.0% received both high-BAC administrative and high-BAC court dispositions. The proportion of high-BAC first-time offenders who received the statutory high-BAC dispositions declined from 1998 to 1999 and 2000. Based on survival analysis, the one-year recidivism rate among first offenders arrested in 1998 with BACs > or = 0.20% was significantly lower than for offenders with BACs 0.17-0.19% (who also had relatively high BACs but were not subject to enhanced sanctions), after controlling for age and gender. There were similar, but not significant, results for first offenders arrested in 1999.     

Mandating interlocks for fully revoked offenders: the New Mexico experience

OBJECTIVE: In New Mexico, between July 1999 and December 2002, the installation of an ignition interlock was an optional judicial sanction for second and third driving-while-impaired (DWI) offenders. This is a study of the recidivism of 437 offenders who were convicted and installed interlocks for an average of 322 days during that period. METHODS: The comparison group was a stratified random sample (N = 12,554) of the 20,949 offenders who were convicted during the same period but did not install interlocks. DWI arrest and conviction data for all study participants were received from the Motor Vehicle Department's Citation Tracking System. RESULTS: Only 11 (2.5%) of the interlock offender group were rearrested for DWI while interlocks were installed, whereas 1,017 (8.1%) of the comparison group were rearrested during an equivalent 322-day period. Survival graphs and Cox proportional hazard regression analyses were used to compare the interlock and noninterlock groups during installation, after installation, and for the entire period up to December 2004. Results indicate a reduction in recidivism of 65% during installation. After removal, there was no significant difference in recidivism rates in a 3-year follow-up period. Following all offenders for 4 years, including both the period while the interlock was installed and the period after its removal, indicates that the difference in recidivism achieved during installation, though not increased, is maintained, so at the end of 4 years, interlock users still have lower total recidivism than nonusers. CONCLUSIONS: The magnitude of interlock effectiveness reported here is similar to those in other published studies with comparable samples.     

Comparison of recidivism rates for a teenage trauma prevention program after the addition of high-fidelity patient simulation

Objectives: We evaluated the benefits of adding high-fidelity simulation to a teenage trauma prevention program to decrease recidivism rates and encourage teens to discuss actionable steps toward safe driving.

Methods: A simulated pediatric trauma scenario was integrated into an established trauma prevention program. Participants were recruited because they were court-ordered to attend this program after misdemeanor convictions for moving violations. The teenage participants viewed this simulation from the emergency medical services (EMS) handoff to complete trauma care. Participants completed a postsimulation knowledge assessment and care evaluation, which included narrative data about the experience. Qualitative analysis of color-coded responses identified common themes and experiences in participants' answers. Court records were reviewed 6 years after course completion to determine short- and long-term recidivism rates, which were then compared to our program's historical rate.

Results: One hundred twenty-four students aged 16–20 years participated over a 2-year study period. Narrative responses included general reflection, impressions, and thoughts about what they might change as a result of the course. Participants reported that they would decrease speed (30%), wear seat belts (15%), decrease cell phone use (11%), and increase caution (28%). The recidivism rate was 55% within 6 years. At 6 months it was 8.4%, at 1 year it was 20%, and it increased approximately 5–8% per year after the first year. Compared with our programs, for historical 6-month and 2-year recidivism rates, no significant difference was seen with or without simulation.

Conclusions: Adding simulation is well received by participants and leads to positive reflections regarding changes in risk-taking behaviors but resulted in no changes to the high recidivism rates This may be due to the often ineffectiveness of fear appeals.     

呼吸性职业健康危害预防对策的研究

针对我国职业健康现状，依据预防为主的原则，论述了预防劳动疾病的重点和预防工作中的薄弱环节。提出了减少呼吸吸入引起的职业病的措施。     

A note on the effectiveness of the house-arrest alternative for motivating DWI offenders to install ignition interlocks

Introduction

The effectiveness of ignition interlocks at reducing drunk driving has been limited by the ability of driving-while-intoxicated (DWI) offenders to avoid court orders to install the devices.

Methods

In a pilot program in New Mexico, four Santa Fe County judges imposed home confinement (via electronic monitoring bracelets) on offenders who claimed to have no car or no intention to drive. Interlock installation rates for Santa Fe County were compared with all other counties in New Mexico over a 2-year program and 2-year post-program period.

Results

During the two program years, 70% of the drivers convicted of DWI in Santa Fe County installed interlocks, compared to only 17% in the other counties, but when the program was terminated, the Santa Fe installation rate fell by 18.8 percentage points.

Summary

Mandating the alternative sanction of house arrest led to the highest reported interlock installation rate for DWI offenders.

Impact on Industry

Impaired driving is a substantial expense to employers, particularly when it bars driving that interferes with employment. Interlocks provide a method of protecting the public while permitting the offender to drive sober. This study was directed at increasing interlock use by DWI offenders.     

Impact of primary safety belt laws on alcohol-related front-seat occupant fatalities: five case studies

OBJECTIVE: Impaired drivers and other high-risk road users are less likely to use their safety belts, thus increasing the risk of fatal injury in the event of a crash. Although safety belt laws have been shown to increase wearing rates for daytime non-crash-involved drivers and their front-seat passengers, little evidence is available on the effect these laws have on belt usage by crash-involved drinking drivers and their passengers. METHODS: This study evaluated the influence of primary safety belt law upgrades from secondary laws on front-seat occupants of passenger cars driven by drinking drivers in fatal crashes in five states: California, Illinois, Maryland, Michigan, and Washington. The outcome measures used to evaluate these law upgrades were (1) the change in safety belt usage rates of front-seat occupants in passenger cars driven by drinking drivers in fatal crashes and (2) the change in alcohol-related front-seat occupant fatalities in passenger cars driven by drinking drivers. RESULTS: Four of the five states demonstrated increases in safety belt use by front-seat occupants of passenger cars of drinking drivers in fatal crashes following the upgrade to primary safety belt laws. Three states (California, Michigan, and Washington) experienced significant reductions in the number of front-seat occupant fatalities in vehicles driven by drinking drivers. CONCLUSIONS: The adoption of primary law upgrades was associated with significant increases in safety belt use (four of five states) and significant reductions in fatalities among high-risk occupants (i.e., front-seat occupants involved in fatal crashes in vehicles driven by drinking drivers) in three of the five states studied.     

An evaluation of Washington's driving while intoxicated law: Effect on drunk driving recidivism

The 1980 Washington driving while intoxicated (DWI) law was evaluated to determine its impact on the subsequent driving behavior of persons convicted of DWI. The major provisions of this law were mandatory jail sentences for conviction of DWI and a change in the definition of DWI. The law made it illegal per se for a person to drive with a blood alcohol level of .10% or more. The law was intended to reduce the drunk driving and accidents of individuals convicted of DWI as well as deter such behavior among the general driving population. The study assessed the deterrence effect of the law on convicted DWI offenders. It was found that individuals convicted under the provisions of this law had higher accident rates and drunk driving recidivism rates than individuals convicted under the previous law. These increases suggest that mandatory jail sentences may fail to deter subsequent acts of drunk driving. It was concluded that alternative legal sanctions for DWI (such as license suspensions or revocations) may be sufficiently stringent to produce both general and specific deterrence of drunk driving.     

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.     

Preventing highway crashes by raising the legal minimum age for drinking: An empirical confirmation

In recent years there has been increased interest in reducing the massive social costs due to alcohol-related motor vehicle crashes. Raising the legal minimum age for purchase and consumption of alcohol beverages has been proposed as one way to reduce alcohol-related crashes among young drivers. Currently, many states are raising the legal age, in contrast to the trend towards lower legal drinking ages in the early 1970s. Recent studies of the effects of raising the drinking age are reviewed, and results from a controlled multiple time-series evaluation of the experience in Michigan are presented. Significant 11 to 28% reductions in alcohol-related crash involvements are shown to be attributable to the raised drinking age in Michigan. Suggestions for further research and discussion of policy implications are included.     

The effect of turnover on work satisfaction and mental health: Support for a situational perspective

This study finds support for the situational approach to affect determination in a prospective, two-year longitudinal field study. Specifically, turnover was shown to predict changes in subsequent job measures of work satisfaction and mental health. Employees who changed jobs and occupations showed greater increases in both work satisfaction and mental health than employees who only changed jobs or employees who remained in their initial positions. Further research directions are introduced.