Vehicle safety features aimed at preventing alcohol-related crashes.

This review focuses on the role of motor vehicles in the prevention of alcohol-related fatalities in the United States. Since alcohol significantly affects brain function, it is natural to make drivers the prime targets for impaired-driving-prevention programs. However, the prevalence, design, ease of operation, and safety features of motor vehicles, as well as state regulations of their operation, have an important influence on crash occurrences, particularly those involving alcohol. This review begins with a discussion of why the automobile became the central technological device in the alcohol-related fatality problem and then moves on to an overview of motor vehicle safety programs that have impacted impaired driving. The article then presents an extended discussion of the effectiveness of vehicle-based, alcohol-detecting ignition interlock devices (interlocks), which provided the principal specific vehicle-based effort in the 20th century to separate alcohol consumption from driving. The review ends with a commentary on the issues that will arise in managing operator impairment in autonomous (self-driving) vehicles-the probable principal 21st-century effort to reduce impaired driving and eliminate alcohol-related crashes by minimizing the role of the driver.

The relationship of 16 underage drinking laws to reductions in underage drinking drivers in fatal crashes in the United States.

The minimum legal drinking age 21 (MLDA 21) legislation in the United States (U.S.) has been documented as one of the most effective public health measures adopted in recent times. This study reports on an effort to evaluate and interrelate a basic set of 16 laws directed at younger than age 21 youth that are designed to (a) control the sales of alcohol to youth, (b) prevent possession and consumption of alcohol by youth, and (c) prevent alcohol impaired driving by those younger than age 21. The first objective of this study was to determine whether there was any relationship between the existence and strength of the various underage drinking laws in a State and the percentage of younger than age 21 drivers involved in fatal crashes who were drinking. After controlling for various factors, the only significant finding that emerged was for the existence and strength of the law making it illegal for an underage person to use fake identification ( p <0.016). The second objective was to determine if the enactment of two of the sixteen provisions (possession and purchase laws) was associated with a reduction in the rate of underage drinking driver involvements in fatal crashes. Analysis of variance (ANOVA) showed that there was a national 11.2% reduction ( p <0.05) in the ratio of underage drinking drivers to underage non-drinking drivers in fatal crashes after the possession and purchase laws were adopted in 36 States and the District of Columbia (DC). This suggests that the two mandatory elements of the Federal MLDA 21 law are having the desired effect of reducing underage alcohol-related highway deaths.

Issues in cross-national comparisons of crash data.

While national accident record systems appear to provide an attractive method of comparing the effectiveness of traffic safety programs, differences in definitions, data collection methods and file structure may lead to misleading conclusions. Variations in crash definitions and methods for measuring alcohol involvement are described and illustrated with data from US crash files. Examples of international comparisons are provided.

Drinking and driving prevention in the community: program planning and implementation.

This paper describes the rationale, development and implementation of the Drinking and Driving Component, which is one of five components of the Community Trials Project conducted by the Prevention Research Center, Berkeley, California (USA). It traces the background of drunk driving enforcement technology and practice against which the programs at the three sites were implemented. A conceptual model for the enforcement component of a comprehensive community alcohol-related trauma project is presented and its implementation at the three sites is described. Limitations in the available police department resources delayed the implementation of local programs. Media advocacy tied to specific operations proved to be successful in publicizing sensors and sobriety checkpoints were only partially accepted. Overall, the community trials sites increased or held steady their arrest rates in contrast to the comparison sites where DUI arrests declined.

Youth escaping limits on drinking: binging in Mexico.

AIMS: In Tijuana, Mexico, a loosely enforced age-18 law and inexpensive drinks have given rise to a nightclub district frequented by thousands of young Southern Californians each weekend night. Surveys were designed to characterize the extent of the cross-border binge-drinking traffic and to support and evaluate the community's response. DESIGN: Over 1 year, two anonymous and voluntary breath-test surveys were done. Drivers and pedestrians were pulled randomly from the stream of northbound border crossers and recruited to participate. SETTING: Surveys occurred between 12 a.m. and 4 a.m. on randomly selected Wednesdays, Fridays, and Saturdays. Participants were recruited within the Port of Entry building. PARTICIPANTS: Of the 5849 border crossers recruited, 87.4% participated in the survey. MEASUREMENTS: Information was obtained through a standardized verbal interview. All participants were asked to take an alcohol breath test. FINDINGS: On weekend nights, more than 6500 people cross back into the United States between 12 a.m. and 4 a.m. after drinking or visiting a bar or restaurant. Pedestrians represent the highest concentration of drinkers, with more than 30% having BACs of 0.08 or greater. Most of these pedestrians return to parked vehicles on the US side and drive or ride home. CONCLUSIONS: The flow of young binge drinkers at the Tijuana border is substantial and translates into a significant public health problem for the region as crossers use their vehicles to drive home. There are many such binge-drinking locales. However, the border is unique in that it is amenable to scientific estimations of the problem with relatively high precision.

Predicting underage drinking and driving behaviors.

A social-psychological model of underage drinking and driving (DUI) and riding with drinking drivers (RWDD) was tested with data from a random digit dial telephone survey of 706 16-20-year-old drivers from seven western states in the United States. Consistent with the model, a structural equations analysis indicated that DUI and RWDD were primarily predicted by (a) expectancies regarding the physical risks of DUI, (b) normative beliefs about the extent to which friends would disapprove of DUI, (c) control beliefs about the ease or difficulty of avoiding DUI and RWDD and (d) drinking. Expectancies concerning enforcement had a significant effect on RWDD, but not on DUI. Among the background and environmental variables included in the analysis, only night-time driving and age had significant direct effects on DUI and RWDD. Drinking and involvement in risky driving had indirect effects on DUI and RWDD that were mediated through expectancies and normative beliefs. Males, European Americans, Latinos, respondents who drove more frequently and respondents who were less educated held beliefs that were more favorable toward DUI and RWDD, drank more and engaged more frequently in risky driving. As a result, such individuals may be at greater risk for DUI and RWDD.

The effect of drinking and driving interventions on alcohol-involved traffic crashes within a comprehensive community trial.

The Drinking and Driving Component, one of five elements of the Community Trials Project, involved the implementation of a special drink driving countermeasure in the three experimental communities, one in Northern California, one in Southern California and another in South Carolina. This intensified enforcement of driving under the influence (DUI) was designed to deter potential drinking drivers by increasing their perception of the risk of being arrested leading to a reduction in the consumption of alcohol before driving. See component detailed description in Voas (1997, this issue). The evaluation found that media advocacy training and technical assistance resulted in increased DUI news coverage and that additional police officer hours for DUI enforcement, greater use of breathalyzer equipment, increased officer training and more checkpoints produced increased DUI enforcement. The combined effects of increased DUI news coverage and DUI enforcement yielded increased public perceived risk of arrest and subsequently less drinking and driving. Overall the evaluation found that alcohol-involved traffic crashes were reduced as a result of this component in the experimental communities as contrasted with the matched comparison communities.

The Alberta Interlock Program: the evaluation of a province-wide program on DUI recidivism.

AIMS: This study was designed to determine the efficacy of alcohol safety interlocks in reducing recidivism among first and second driving-under-the-influence (DUI) offenders. It also evaluates the overall effectiveness of interlock programs where typically only a small portion of DUI offenders elect to install interlocks. DESIGN: The driving records of DUI offenders participating in interlock programs for 6 months for first offenders and 2 years for second offenders were compared with similar offenders who chose not to participate. SETTING: A province-wide program in Alberta, Canada. PARTICIPANTS: Records of 35,132 drivers convicted of DUI between 1 July 1998 and 30 September 1996 were analyzed MEASUREMENTS: Repeat DUI offenses during and after the interlock period. FINDINGS: While the offenders had interlocks on their vehicles, DUI recidivism was substantially reduced. Once the interlock had been removed and the participants had been reinstated, their DUI rate was the same as other offenders indicating that the interlock reduced recidivism while in place. Because only 8.9% of eligible drivers elected to participate in the interlock program, the program did not significantly increase the overall effectiveness of the province's management of DUI offenders. CONCLUSIONS: Interlocks are associated with a major reduction in DUI recidivism while on the vehicle of the offender. However, because few offenders elect to participate, the program produces only a small (5.9%) overall reduction in the recidivism rate of all DUI offenders.

Behavioral monitoring of DUI offenders with the Alcohol Ignition Interlock Recorder.

AIMS: To evaluate patterns of blood alcohol concentration (BAC) and driving logged on the ignition interlock recorder and to assess whether this event record is a useful outcome measure for a behavioral intervention. DESIGN: Descriptive analyses of recorder data and multivariate analysis of the predictors of high BACs associated with a motivational intervention for driving-under-the-influence (DUI) offenders using an interlock. SETTING: Two interlock service centers in Alberta, Canada. PARTICIPANTS: 1309 first-time and multiple DUI offenders who agreed to participate during interlock installation. INTERVENTION: A human-services (supportive guidance) intervention based on motivational interviewing and pragmatic counseling was delivered to interlock users in Calgary, but not to interlock users in Edmonton, Canada. MEASUREMENTS: This report summarizes the patterns and predictors of BAC warnings (0.02-0.039%) (20-39 mg/dl) and failures (> or = 0.04) (> or = 40 mg/dl) from more than 3 million in-vehicle breath tests. Data come from three sources: driver records, questionnaires and the interlock. FINDINGS: From the beginning to the end of the interlock use period, there was a significant linear decline in the proportion of positive BAC driving to total driving. After controlling for prior offenses, demographics and reported drinking levels, offenders in the intervention site (Calgary) were less likely to have recorded fail BACs than were offenders in the control site (Edmonton). The temporal patterns of BAC fails with the interlock mimic the high-risk periods for DUI arrests and alcohol-involved fatal crashes. CONCLUSIONS: The interlock successfully blocks drinking and driving during high-risk periods. Preliminary recorder data suggest the services intervention may be affecting DUI behavior.

A community prevention trial to reduce alcohol-involved accidental injury and death: overview.

The 5-year "Preventing Alcohol Trauma: A Community Trial" project in the United States was designed to reduce alcohol-involved injuries and death in three experimental communities. The project consisted of five mutually reinforcing components: (1) Community Mobilization Component to develop community organization and support, (2) Responsible Beverage Service Component to establish standards for servers and owner/managers of on-premise alcohol outlets to reduce their risk of having intoxicated and/or underage customers in bars and restaurants, (3) Drinking and Driving Component to increase local DWI enforcement efficiency and to increase the actual and perceived risk that drinking drivers would be detected, (4) Underage Drinking Component to reduce retail availability of alcohol to minors, and (5) Alcohol Access Component to use local zoning powers and other municipal controls of outlet number and density to reduce the availability of alcohol. This paper gives an overview of the rationale and causal model, the research design and outline of each intervention component for the entire prevention trial.

Summing up: lessons from a comprehensive community prevention trial.

This paper presents the findings and lessons from a community prevention trial involving three experimental communities in the United States to reduce alcohol-involved trauma. The paper provides recommendations for other community prevention efforts. Effectiveness was demonstrated by: (a) 78 fewer alcohol-involved traffic crashes as a result of the Drinking and Driving Component alone (approximately a 10% reduction); (b) a significant reduction in underage sales of alcohol, i.e. off-premise outlets sold to minors about one-half as often as in comparison communities; (c) increased implementation of responsible beverage service policies by bars and restaurants; and (d) increased adoption of local ordinances and regulations to reduce concentrations of alcohol outlets.

MADD rates the states: a media advocacy event to advance the agenda against alcohol-impaired driving.

The "Rating the States" (RTS) Program of Mothers Against Drunk Driving (MADD) is designed to bring public attention to the status of State government efforts to combat alcohol-impaired driving. MADD's 1993 report, which evaluated each State with a grade from A to D, brought renewed visibility to MADD's fight for new prevention policies and helped to advance key State legislation. Because of MADD's national press conference and other media activities, more than 60 million Americans saw or heard a news story related to the program. This article outlines the program's objectives and methodology, efforts to publicize the results, and what was achieved in terms of news media coverage and in advancing public policy change. The RTS Program is a proven media advocacy strategy for prompting State legislatures and Governors to enact new policies. The article concludes with guidelines for other public health advocacy groups that may want to emulate this strategy.

Defining binge drinking quantities through resulting blood alcohol concentrations.

Binge drinking as a researchable construct has generally been defined as 5 or more drinks on one occasion. However, no study has been conducted to determine whether the binge concept that implies excessive drunkenness is being optimally captured within that level. Random interviews of drinkers returning from visiting bars in Tijuana, with breath tests, provided both blood alcohol concentration (BAC) measurements and the self-reported number of drinks consumed. Results indicate that currently used definitions of binge drinking predict relatively low BACs and may not be capturing the excessive-drunkenness quality of the term. Consumption duration may explain the lower BACs.

Age differences of arrested and crash-involved drinking drivers.

Studies were reviewed to determine the extent to which drivers arrested for driving while intoxicated (DWI) and crash-involved drivers impaired by alcohol are similar in age. Data indicate that younger drivers are substantially underrepresented in the DWI arrest population relative to their presence in the alcohol-related crash population. Overall, the proportion of arrested drivers less than age 20 was only one-fourth to one-third the proportion of these drivers involved in fatal crashes, and for those aged 20-29 it was two-thirds to three-fourths. The reasons for the underrepresentation of young drivers in the arrested population are not fully known and require further study. Youthful drivers constitute the major part of the alcohol-related crash problem, and effective ways to address this population most at risk should be sought.

Alcohol consumption measured at roadside surveys and variations in traffic injury crashes.

This analysis examines whether roadside surveys that measure changes in the prevalence of driving after drinking can be used to evaluate the impact of interventions designed to reduce alcohol-related traffic crashes. Using data collected at a roadside survey over a 4-year period in two California communities (N = 33,614), this analysis examines the relationship of BAC and drinks since 5 P.M., aggregated on a monthly basis, with nighttime injury crash data from the California Highway Patrol aggregated on a monthly basis. A regression analysis was used in which daytime injury and drinking style were covariates. The data demonstrate that temporal changes in drinking and driving collected at a roadside survey reflect temporal changes in nighttime injury rates. Hence, this study substantiates the use of roadside surveys as an appropriate methodology to evaluate drinking and driving interventions.

Deterring the drinking driver: the Stockton experience.

The effectiveness of drunk driving enforcement patrols is generally assumed. However, few adequate evaluations are available in the traffic safety literature. The U.S. Department of Transportation funded a special program in Stockton, a city with a population of 120,000 in the central valley of California, to test the effectiveness of special drunk driving patrols on weekend evenings, applied within a setting in which no other major alcohol safety programs were present. The objective of this effort was to determine the effectiveness of a "traditional" approach to enforcing driving while impaired (DWI) laws; one in which innovative procedures such as sobriety checkpoints were not used. The results indicated that nighttime collisions in Stockton were reduced during the three and a half year period of the special enforcement program.

Temporary vehicle impoundment in Ohio: a replication and confirmation.

Driving while suspended by individuals who have been convicted of an impaired driving offense is a significant highway safety problem. Such offenders present four times the risk of involvement in a fatal crash at a blood alcohol concentration (BAC) over 0.10. A previous report by the authors demonstrated that a vehicle immobilization program in Franklin County (Columbus), Ohio, significantly reduced driving-under-the-influence (DUI) recidivism rates for multiple DUI offenders. This study evaluated a somewhat different application of the same law in Hamilton County (Cincinnati), Ohio, where vehicles were impounded rather than immobilized, and obtained similar results--a reduction in repeat DUI offenses by multiple offenders both while their vehicles were being held by the police and after they were returned to the offenders.

Temporary vehicle immobilization: evaluation of a program in Ohio.

Driving while suspended is a growing problem in most states. To deal with this problem, a number of jurisdictions are impounding and/or immobilizing the vehicles of driving while suspended or multiple driving under the influence offenders. This study evaluates the first 2 years of the implementation of this type of law in Franklin County (Columbus), OH. Variations in police enforcement and judicial sentencing policies resulted in some offenders, though eligible for impoundment or immobilization, not receiving the sanction. The recidivism rates of these offenders were compared with offenders who did receive a vehicle sanction. Tracking these two groups of offenders for up to 2 years demonstrated that the offenders who received the sanction had lower recidivism rates, both before and after they reclaimed their vehicles.

The relationship of alcohol safety laws to drinking drivers in fatal crashes.

This paper presents an analysis of the relationships between the passage of key alcohol safety laws and the number of drinking drivers in fatal crashes. The study evaluated three major alcohol safety laws--administrative license revocation laws, 0.10 illegal per se, and 0.08 illegal per se laws--on the proportion of drinking drivers in fatal crashes. Drivers aged 21 and older in fatal crashes at two BAC levels--0.01-0.09 and 0.10 or greater--were considered separately. Drivers under age 21 were not included because they are affected by the Minimum Legal Drinking Age (MLDA) law. This study used data on drinking drivers in fatal crashes from the Fatality Analysis Reporting System (FARS) covering 16 years (1982-1997) for all 50 states and the District of Columbia. Also included in the study were such variables as per capita alcohol consumption and annual vehicle miles traveled (VMT), which could affect the number of alcohol-related crashes. The results indicate that each of the three laws had a significant relationship to the downward trend in alcohol-related fatal crashes in the United States over that period. This paper points out that this long-term trend is not the product of a single law. Instead, it is the result of the growing impact of several laws over time plus the affect of some factors not included in the model tested (such as the increasing use of sobriety checkpoints and the media's attention to the drinking-and-driving problem).

Alcohol-related relative risk of driver fatalities and driver involvement in fatal crashes in relation to driver age and gender: an update using 1996 data.

OBJECTIVE: To re-examine and refine estimates for alcohol-related relative risk of driver involvement in fatal crashes by age and gender as a function of blood alcohol concentration (BAC) using recent data. METHOD: Logistic regression was used to estimate age/gender specific relative risk of fatal crash involvement as a function of the BAC for drivers involved in a fatal crash and for drivers fatally injured in a crash, by combining crash data from the Fatality Analysis Reporting System with exposure data from the 1996 National Roadside Survey of Drivers. RESULTS: In general, the relative risk of involvement in a fatal vehicle crash increased steadily with increasing driver BAC in every age/gender group among both fatally injured and surviving drivers. Among 16-20 year old male drivers, a BAC increase of 0.02% was estimated to more than double the relative risk of fatal single-vehicle crash injury. At the midpoint of the 0.08% - 0.10% BAC range, the relative risk of a fatal single-vehicle crash injury varied between 11.4 (drivers 35 and older) and 51.9 (male drivers, 16-20). With only very few exceptions, older drivers had lower risk of being fatally injured in a single-vehicle crash than younger drivers, as did women compared with men in the same age range. When comparable, results largely confirmed existing prior estimates. CONCLUSIONS: This is the first study that systematically estimated relative risk for drink-drivers with BACs between 0.08% and 0.10% (these relative risk estimates apply to BAC range midpoints at 0.09%.) The results clearly show that drivers with a BAC under 0.10% pose highly elevated risk both to themselves and to other road users. 2000)