Efficacy and cost-effectiveness of subsidized ridesharing as a drunk driving intervention in Columbus, OH.

BACKGROUND: No economic evaluations exist of free or subsidized ridesharing services designed to reduce impaired driving. OBJECTIVES: To evaluate the effects and economics of a 17-weekend program that provided rideshare coupons good for free one-way or round trips to/from the hospitality zones in Columbus, Ohio, coupled with a modest increase in enforcement and a media campaign that used messaging about enforcement to promote usage. METHODS: Web surveys of riders and intercept surveys of foot traffic in the hospitality zones yielded data on the reduction in driving after drinking and the change in alcohol consumption associated with coupon use. We estimated crash changes from trip data using national studies, then confirmed with an ARIMA analysis of monthly police crash reports. Costs and output data came from program and rideshare company records. RESULTS: 70.8% of 19,649 responding coupon redeemers said coupon use reduced the chance they would drive after drinking. An estimated 1 in 4,310 drink-driving trips results in an alcohol-attributable crash, so the coupons prevented an estimated 3.2 crashes. Consistent with that minimal change, the ARIMA analysis did not detect a drunk-driving crash reduction. Self-reports indicated alcohol consumption rose by an average of 0.4 drinks per coupon redeemer, possibly with an equal rise among people who rode with the redeemer. The program cost almost $650,000 and saved an estimated 1.8 years of healthy life. Across a range of discount rates and values for a year of healthy life, it cost $366,000 to $791,000 per year of healthy life saved. Its estimated benefit-cost ratio was between 0.31 and 0.59, meaning it cost far more than it saved. CONCLUSIONS: Ridesharing, coupled with a media campaign and increased enforcement, was not a cost-effective drunk-driving intervention. Although it reduced drink-driving crashes and saved years of healthy life, those savings were modest and expensive. Moreover, the self-reported increase in participant drinking imposed countervailing risks. Even sensitivity analyses that potentially overestimate the benefits and underestimate the costs indicate a significant imbalance between program costs and savings. Any funding devoted to ridesharing would divert scarce resources from interventions with benefit-cost ratios above 1. Thus, our evaluation suggests that governments should not devote energy or resources to ridesharing programs if their primary objective is to reduce drink-driving or harmful alcohol use.

Mandating Treatment Based on Interlock Performance: Evidence for Effectiveness.

BACKGROUND: Vehicle alcohol ignition interlocks reduce alcohol-impaired driving recidivism while installed, but recidivism reduction does not continue after removal. It has been suggested that integrating alcohol use disorder (AUD) treatment with interlock programs might extend the effectiveness of interlocks in reducing recidivism beyond their removal. This study evaluated the first implementation of a Florida policy mandating AUD treatment for driving under the influence (DUI) offenders on interlocks. Treatment was required when the offender accumulated 3 violations (defined as 2 "lockouts" within 4 hours; a lockout occurs when the device prevents a drinking driver from starting the vehicle). METHODS: Cox regression was used to compare alcohol-impaired driving recidivism during the 48 months following the interlock removal between 2 groups: (i) 640 multiple DUI offenders who received AUD treatment while interlocks were installed; and (ii) 806 matched offenders not mandated to treatment while interlocks were installed. RESULTS: The ignition interlock plus treatment group experienced 32% lower recidivism, 95% confidence interval [9, 49], following the removal of the interlock during the 12 to 48 months in which they were compared with the nontreatment group. We estimated that this decline in recidivism would have prevented 41 rearrests, 13 crashes, and almost 9 injuries in crashes involving the 640 treated offenders over the period following interlock removal. CONCLUSIONS: This study provides strong support for the inclusion of AUD treatment for offenders in interlock programs based on the number of times they are "locked out." The offenders required to attend treatment demonstrated a one-third lower DUI recidivism following their time on the interlock compared to similar untreated offenders.

The effects of primary enforcement laws and fine levels on seat belt usage in the United States.

BACKGROUND: Seat belt use in the United States increased from 11 percent in 1979 to 86 percent in 2012. Most of this increase has been attributed to seat belt laws, primary law upgrades, and highly visible enforcement. There has been less research on the effect of fines on seat belt usage. METHODS: We examined law type and fine levels as predictors of seat belt use among fatally injured occupants of passenger vehicles from 1997 through 2008 using data from the Fatality Analysis Reporting System (FARS). Fine levels used were the statutory maximum base fines for a first offense. RESULTS: Having a primary enforcement law was associated with a 9 to 10 percentage point increase in seat belt use. An increase in the fine amount, from the current median level of $25 to a level of $60, was associated with a 3 percentage point increase in usage. An increase in fine from $25 to $100 was associated with a 6- to 7-point increase. Such increases were in addition to the effects of a shift from secondary to primary enforcement. DISCUSSION: The results of this study suggest that, in addition to current emphases on primary law upgrades and high-visibility enforcement of seat belt usage, increasing fine levels provides another viable strategy for increasing seat belt use. In addition, based on these results, states should consider publicizing such increases just as they publicize enforcement efforts.

Ethylglucuronide in hair is a top predictor of impaired driving recidivism, alcohol dependence, and a key marker of the highest BAC interlock tests.

OBJECTIVES: This study focuses on the predictive and comparative significance of ethyl glucuronide measured in head hair (hEtG) for estimating risks associated with alcohol-impaired driving offenders. Earlier work compared different alcohol biomarkers for estimating rates of failed blood alcohol concentration (BAC) tests logged during 8 months of interlock participation. These analyses evaluate the comparative performance of several alcohol markers including hEtG and other markers, past driver records, and psychometric assessment predictors for the detection of 4 criteria: new driving under the influence (DUI) recidivism, alcohol dependence, and interlock record variables including fail rates and maximal interlock BACs logged. METHODS: Drivers charged with alcohol impairment (DUI) in Alberta, Canada (n = 534; 64% first offenders, 36% multiple offenders) installed ignition interlock devices and consented to participate in research to evaluate blood-, hair-, and urine-derived alcohol biomarkers; sit for interviews; take psychometric assessments; and permit analyses of driving records and interlock log files. Subject variables included demographics, alcohol dependence at program entry, preprogram prior DUI convictions, postenrollment new DUI convictions, self-reported drinking assessments, morning and overall rates of failed interlock BAC tests, and maximal interlock BAC readings. Recidivism, dependence, high BAC, and combined fail rates were set as criteria; other variables were set as predictors. Area under the receiver operating characteristics (ROC) curve (A') estimates of sensitivity and specificity were calculated. Additional analyses were conducted on baseline hEtG levels. Driver performance and drinking indicators were evaluated against the standard hEtG cutoff for excessive drinking at (30 pg/mg) and a higher criterion of 50 pg/mg. HEtG splits were evaluated with the Mann-Whitney rank statistic. RESULTS: HEtG emerged as a top overall predictor for discriminating new recidivism events that occur after interlock installation, for entry alcohol dependence, and for the highest interlock BACs recorded. Together, hEtG and phosphatidylethanol (PEth) were the top predictors of all criterion measures. By contrast, the hair-derived alcohol biomarkers hEtG and hFAEE (fatty acid ethyl esters) were poorer than other alcohol biomarkers as detectors of interlock BAC test fail rates. CONCLUSIONS: This study showed that hEtG, an objective alternative to often unreliable self-reported past representation of drinking levels, yields crucial insight into driver alcohol-related risks early in an interlock program and is a top predictor of new recidivist events. Together with PEth, these markers would be excellent anchors in a panel for detecting alcohol consumption.

An Evaluation of Three Driving-Under-the-Influence Courts in Georgia.

Following the model of Drug Courts, three Georgia Driving-Under-the-Influence (DUI) Courts (established in Chatham, Clarke, and Hall Counties in 2003) were designed to address the underlying alcohol problems of repeat DUI offenders through continuous and frequent judicially supervised treatment, periodic alcohol and other drug testing, the use of graduated sanctions, and other appropriate rehabilitative services. A team comprised of a judge, court personnel, probation officials, and treatment providers met regularly to assess offender progress, and offenders met biweekly with the judge to report their progress. An impact evaluation showed after 4 years of exposure that when the DUI Court graduates were combined with the DUI Court terminated offenders (Intent to Treat Group), the DUI Court offenders had significantly lower recidivism rates: 38 percent lower than a Contemporary Group of offenders and 65 percent lower than a Retrospective Group of offenders. The DUI Court Intent to Treat Group had a significantly lower recidivism rate: 15 percent compared to 24 percent for a group of matched offenders from three similar counties in Georgia (Contemporary Group) and a 35 percent rate for matched offenders from the same counties as the DUI Court who would have been eligible for the DUI Court had it been in existence (Retrospective Group). Offenders who were terminated from the DUI Courts for various reasons had a recidivism rate of 26 percent. It is estimated that the DUI Courts prevented between 47 and 112 repeat arrests during a four year period due to the reduced recidivism associated with them.

An Evaluation of Three Driving-Under-the-Influence Courts in Georgia.

Following the model of Drug Courts, three Georgia Driving-Under-the-Influence (DUI) Courts (established in Chatham, Clarke, and Hall Counties in 2003) were designed to address the underlying alcohol problems of repeat DUI offenders through continuous and frequent judicially supervised treatment, periodic alcohol and other drug testing, the use of graduated sanctions, and other appropriate rehabilitative services. A team comprised of a judge, court personnel, probation officials, and treatment providers met regularly to assess offender progress, and offenders met biweekly with the judge to report their progress. An impact evaluation showed that after 4 years of exposure, the DUI Court graduates (Treatment Group) had a significantly lower recidivism rate: 9 percent compared to 24 percent for a group of matched offenders from three similar counties in Georgia (Contemporary Group) and a 35 percent rate for matched offenders from the same counties as the DUI Court who would have been eligible for the DUI Court had it been in existence (Retrospective Group). Offenders who were terminated from the DUI Courts for various reasons had a recidivism rate of 26 percent. When the DUI Court graduates were combined with the DUI Court terminated offenders, the DUI Court offenders still had significantly lower recidivism rates: 38 percent lower than the Contemporary Group and 65 percent lower than the Retrospective Group. It is estimated that the DUI Courts prevented between 47 and 112 repeat arrests during a four year period due to the reduced recidivism associated with them.

An Evaluation of Three Intensive Supervision Programs for Serious DWI Offenders.

There are many variations of supervision and probation programs for driving-while-intoxicated (DWI) offenders. These programs include case-specific restrictions (e.g., individualized conditions to probation), unsupervised probation, basic supervision probation (e.g., regularly scheduled visits to probation services with varying frequency), and intensive supervision probation (which may involve many program components and close monitoring). Offenders who receive monitoring through intensive supervision programs (ISPs) have more contact with probation officers, a judge, or other designated authorities compared to standard (nonintensive) probation programs. Three ISPs were evaluated: the Minnesota Staggered Sentencing Program, the Westchester County New York DWI Enforcement Program, and the Oregon Driving Under the Influence of Intoxicants (DUII) Intensive Supervision Program (DISP). The Minnesota program appeared to be successful in reducing offender recidivism in a relatively small ISP (n=200 offenders in the program). Compared to a similar matched group of DWI offenders, the staggered sentencing offenders had a significant 30.6% lower recidivism rate (p=.017) up to 4 years postoffense. The program prevented an estimated 15 to 23 re-arrests for DWI. Compared to a matched group of offenders, the Westchester County program appeared to be effective in the short term (18.1% lower recidivism in 5 years postoffense [p<.001]) but not in the long term (only 5.4% [p=.171] lower recidivism in 15 years postoffense). This program resulted in an estimated 78 fewer re-arrests for DWI in the first 5 years. The Oregon DISP intervention group had 54.1% lower recidivism up to 8 years postindex offense than both of the stratified matched-sample comparison groups, adjusting for the demographic covariates (Wald=51.50; p>.001). The program prevented 67 re-arrests for DWI in the first 8 years. The benefit/cost of ISPs appears to be very good for the prevention of re-arrests.

DUI offenders delay license reinstatement: a problem?

BACKGROUND: We examined the extent to which driving under the influence (DUI) offenders delay reinstatement, the reasons for that delay, and the relationship of the delay to recidivism. Analyzed were the driving records of 40 million drivers (3 million convicted of DUI) from 7 of the largest states spanning 7 to 14 years. License suspension effectively reduces, but does not eliminate, impaired driving. Apparently, many feel they can avoid apprehension for unlicensed driving; the limited research to date suggests that up to 75% of convicted offenders continue to drive and up to 84% delay reinstatement for 3 or more years. METHODS: ANOVA and regression procedures were used to determine the relationship of prior driving record and sentence length to the DUI offender's delay in reinstatement. Meta-analysis was used to summarize results across the 7 states and survival analysis to determine the effect of the delay on recidivism. RESULTS: Forty-two percent of first offenders and 55% of multiple offenders convicted for DUI delay reinstatement for more than a year. For a third of the offenders, there were no records of their having reinstated within 5 years of becoming eligible. Both factors-more than one prior offense and the length of suspension imposed-were related to delay in reinstatement. Offenders who delayed reinstatement were more likely to recidivate both while they delayed before reinstating and after they reinstated. CONCLUSIONS: DUI offenders who delay reinstatement after they become eligible are high-risk drivers. Offenders who reinstate, however, have lower recidivism rates than those who do not. This suggests that encouraging reinstatement but with continued controls, as some states have provided through laws requiring interlocks as a condition of reinstatement, may be effective if they do not motivate extended delays.

The impact of underage drinking laws on alcohol-related fatal crashes of young drivers.

BACKGROUND: This study used a pre- to post-design to evaluate the influence on drinking-and-driving fatal crashes of 6 laws directed at youth aged 20 and younger and 4 laws targeting all drivers. METHODS: Data on the laws were drawn from the Alcohol Policy Information System data set (1998 to 2005), the Digests of State Alcohol Highway Safety Related Legislation (1983 to 2006), and the Westlaw database. The Fatality Analysis Reporting System data set (1982 to 2004) was used to assess the ratio of drinking to nondrinking drivers involved in fatal crashes [fatal crash incidence ratio (CIR)]. The data were analyzed using structural equation modeling techniques. RESULTS: Significant decreases in the underage fatal CIR were associated with presence of 4 of the laws targeting youth (possession, purchase, use and lose, and zero tolerance) and 3 of the laws targeting all drivers (0.08 blood alcohol concentration illegal per se law, secondary or upgrade to a primary seat belt law, and an administrative license revocation law). Beer consumption was associated with a significant increase in the underage fatal CIR. The direct effects of laws targeting drivers of all ages on adult drinking drivers aged 26 and older were similar but of a smaller magnitude compared to the findings for those aged 20 and younger. It is estimated that the 2 core underage drinking laws (purchase and possession) and the zero tolerance law are currently saving an estimated 732 lives per year controlling for other exposure factors. If all states adopted use and lose laws, an additional 165 lives could be saved annually. CONCLUSIONS: These results provide substantial support for the effectiveness of under age 21 drinking laws with 4 of the 6 laws examined having significant associations with reductions in underage drinking-and-driving fatal crashes. These findings point to the importance of key underage drinking and traffic safety laws in efforts to reduce underage drinking-driver crashes.

Fatal traffic crashes involving drinking drivers: what have we learned?

Alcohol involvement in fatal crashes (any driver with a blood alcohol concentration [BAC] = .01g/dL or greater) in 2007 was more than three times higher at night (6 p.m.-6 a.m.) than during the day (6 a.m.-6 p.m.) (62% versus 19%). Alcohol involvement was 35% during weekdays compared to 54% on weekends. Nearly one in four drivers (23%) of personal vehicles (e.g., passenger cars or light trucks) and more than one in four motorcyclists (27%) in fatal crashes were intoxicated (i.e., had a BAC equal to or greater than the .08 g/dL illegal limit in the United States). In contrast, only 1% of the commercial drivers of heavy trucks had BACs equal to .08 g/dL or higher. More than a quarter (26%) of the drivers with high BACs (>or=.15 g/dL) did not have valid licenses. The 21- to 24-age group had the highest proportion (35%) of drivers with BACs>or=.08 g/dL, followed by the 25- to 34-age group (29%). The oldest and the youngest drivers had the lowest percentages of BACs>or= .08 g/dL: those aged 75 or older were at 4%, and those aged 16 to 20 were at 17%. Utah had the lowest rate of intoxicated drivers in fatal crashes at one in every eight drivers (12%), followed by Kentucky, Indiana, Iowa, New Hampshire, and Kansas, all at 17%. Montana (31%), South Carolina (31%), and North Dakota (39%) all had more than 3 in 10 drivers in fatal crashes who were intoxicated in 2007. The United States enjoyed a remarkable downward trend in alcohol-related crashes between 1982 and 1995, which has since leveled off. That trend coincided with a period during which per capita national alcohol consumption declined, the number of young drivers decreased, and the proportion of female drivers increased. Those factors alone, however, did not appear to account for the overall reduction. This provides further evidence that impaired-driving laws and safety program activity may have been responsible for at least some of the decline. However, there was a general worldwide decline in alcohol-related crashes during the same period, and other socioeconomic factors may have played a role. Proven effective strategies that could reduce impaired driving further in the United States include more frequent highly publicized enforcement efforts, such as sobriety checkpoints; lowering the illegal BAC limit for driving to .05g/dL; and mandating alcohol ignition interlocks for all convicted impaired drivers.

Evaluation of seven publicized enforcement demonstration programs to reduce impaired driving: Georgia, Louisiana, Pennsylvania, Tennessee, Texas, Indiana, and Michigan.

Between 2000 and 2003, the National Highway Traffic Safety Administration (NHTSA) of the United States Department of Transportation (USDOT) funded demonstration projects designed to reduce impaired driving through well-publicized and frequent enforcement in seven States: Georgia, Louisiana, Pennsylvania, Tennessee, Texas, Indiana, and Michigan. Significant reductions in fatal crashes in the intervention States relative to surrounding States were obtained in Georgia, Tennessee, Indiana and Michigan when an interrupted time-series analysis of Fatality Analysis Reporting System (FARS) data was used comparing the ratio of drinking to non-drinking drivers in fatal crashes. Significant reductions in a second measure, alcohol-related fatalities per 100 million vehicle miles traveled (VMT), were also obtained in Indiana and Michigan. The other three States showed only marginal, non-significant changes relative to their comparison jurisdictions or States. As compared to surrounding States, fatal crash reductions in Georgia, Tennessee, Indiana, and Michigan ranged from 11 to 20 percent. In these four States, the programs were estimated to have saved lives ranging from 25 in Indiana to 43 in Tennessee to 57 in Michigan to 60 in Georgia. Some common features of the programs that experienced significant reductions included the use of paid media to publicize the enforcement (in three States), using a statewide model rather than selected portions of the State (all four States), and the use of highly visible and frequent sobriety checkpoints (in three States). In summary, it appears that a variety of media and enforcement procedures that supplement ongoing statewide efforts can yield meaningful crash reduction effects among alcohol impaired drivers.

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

This study reports on an effort to evaluate and interrelate the existence and strength of two core laws and 14 expanded laws designed to (a) control the sales of alcohol, (b) prevent possession and consumption of alcohol, and (c) prevent alcohol impaired driving by youth aged 20 and younger. Our first analysis determined if the enactment of the possession and purchase laws (the two core minimum legal drinking age laws) was associated with a reduction in the ratio of drinking to nondrinking drivers aged 20 and younger who were involved in fatal crashes controlling for as many variables as possible. The ANOVA results suggest that in the presence of numerous covariates, the possession and purchase laws account for an 11.2% (p=0.041) reduction in the ratio measure. Our second analysis determined whether the existence and strength of any of the 16 underage drinking laws was associated with a reduction in the percentage of drivers aged 20 and younger involved in fatal crashes who were drinking. In the regression analyses, making it illegal to use a false identification to purchase alcohol was significant. From state to state, a unit difference (increase) in the strength of the False ID Use law was associated with a 7.3% smaller outcome measure (p=0.034).

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.

Alcohol involvement in fatal crashes under three crash exposure measures.

OBJECTIVE: A common method of normalizing crash fatality data for comparing subgroups of drivers has been the estimated vehicle miles traveled (VMT). Unfortunately, the VMT method fails to provide for exposure to risks such as those related to alcohol consumption (among others). Recently, the "crash incidence ratio" (CIR) has been introduced to address some of these limitations. The goals of this study are first, to show that the CIR method is intrinsically similar to an increasingly popular quasi-induced method: the relative accident involvement ratio (RAIR); second, to compare the VMT-based, the CIR, and the RAIR methods when applied to the evaluation of alcohol-related crash fatalities across racial/ethnic groups. METHODS: We use the 1990-1996 Fatal Accident Reporting System (FARS) with information on the drivers' race/ethnicity and alcohol involvement (BAC). Descriptive and statistical ratio tests were applied. RESULTS: The RAIR and CIR are indeed closely related measures that, when used for comparisons against a reference group, yield exactly the same numerical estimates. Strikingly different outcomes were obtained depending on using the VMT or the CIR/RAIR. CONCLUSION: Choosing one measure over another should depend on the questions to be answered. The implication of this finding for researchers and policy makers is discussed.

Drinking status and fatal crashes: which drinkers contribute most to the problem?

OBJECTIVE: The object of this study was to estimate the relative contribution of various classes of drinkers (including those with alcohol-use disorders) to alcohol-related fatal motor vehicle crashes. METHOD: Using the National Epidemiologic Survey on Alcohol and Related Conditions conducted in 2000, the percentage of state residents falling into six nonoverlapping alcohol-user categories-dependent drinkers, abusive drinkers, dependent and abusive drinkers, heavy episodic drinkers, current normative drinkers, and current nondrinkers- was determined based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, classifications. The percentage of residents in each state in each of these user categories and their relationships to the number of drinking drivers involved in fatal crashes in that state were determined through regression analysis using data from the Fatality Analysis Reporting System. RESULTS: The proportion of drinkers in a state in each of the six consumption categories was positively related to the number of drinking drivers in fatal crashes in that state. Conversely, the percentage of the state's population who were current nondrinkers was negatively related to the number of drinking road users in crashes. CONCLUSIONS: Although alcohol abusive and heavy episodic drinkers had substantially higher associations with impaired drivers in fatal crashes, half of such drivers were associated with the percentage of current nominative drinkers in the state. Despite the relevancy of these findings, they must be qualified by statistical limitations associated with the use of state as the unit of analysis.

A partial ban on sales to reduce high-risk drinking South of the border: seven years later.

OBJECTIVE: On weekend evenings, thousands of youths (ages 20 and younger) and young adults (ages 21-25) residing in communities along the U.S. border cross into Mexico to patronize all-night bars where the drinking age is 18, rather than 21, and where the price of alcohol is considerably less than in the United States. On January 1, 1999, Juárez, Mexico, implemented a 2 AM (instead of 5 AM) bar-closing policy. The number of crossers and their blood alcohol concentration levels on return were reduced in the year following this policy change. The present study's objective was to determine the long-term (7-year) effect of the earlier-closing bar policy on cross-border drinking in Mexico. METHOD: Analyzed data (1998 to August 2005) were from quarterly breath-test surveys at the El Paso (Texas)/Juárez (Mexico) border, bar observations in Juárez, and trauma data in El Paso. RESULTS: Bar surveys in Juárez show that the 2 AM closing policy, initiated 7 years ago, continues to be enforced, as has the reduction (89%) in youthful crossers returning after 3 AM. The number of underage youths returning earlier in the evening (before 3 AM), however, unchanged for 2 years after the policy change, has doubled recently. CONCLUSIONS: The early closing of bars in Juárez has a continuing positive impact on the reduction of the number of those returning after 3 AM. Although initially there appeared to be no displacement of the late returnees into the early hours (before 3 AM), the number of bar visitors crossing and returning earlier has been steadily increasing. Suggestions for reducing cross-border heavy episodic drinking are described.

Language, income, education, and alcohol-related fatal motor vehicle crashes.

This paper investigates the role of race/ethnicity, language skills (a proxy for acculturation among Hispanics in Arizona, California, New Mexico, and Texas), income, and education level on alcohol-related fatal motor vehicle crashes. Using the Fatality Analysis Reporting System (FARS), we confirmed previous state-based studies showing that high income and education levels have a protective influence on alcohol-related fatal motor vehicle crashes. We also confirmed that language proficiency/acculturation tends to increase the vulnerability of Hispanic women to alcohol-related fatalities. Differences in alcohol-related fatality rates across Hispanic subgroups are observed. Future reductions in alcohol-related traffic fatalities may require prevention policies that take into account existent variations in acculturation, income, and education among racial/ethnic groups and subgroups.

Minimum purchasing age for alcohol and traffic crash injuries among 15- to 19-year-olds in New Zealand.

OBJECTIVES: In 1999, New Zealand lowered the minimum purchasing age for alcohol from 20 to 18 years. We tested the hypothesis that this increased traffic crash injuries among 15- to 19-year-olds. METHODS: Poisson regression was used to compute incidence rate ratios for the after to before incidence of alcohol-involved crashes and hospitalized injuries among 18- to 19-year-olds and 15- to 17-year-olds (20- to 24-year-olds were the reference). RESULTS: Among young men, the ratio of the alcohol-involved crash rate after the law change to the period before was 12% larger (95% confidence interval [CI]=1.00, 1.25) for 18- to 19-year-olds and 14% larger (95% CI=1.01, 1.30) for 15- to 17-year-olds, relative to 20- to 24-year-olds. Among young women, the equivalent ratios were 51% larger (95% CI=1.17, 1.94) for 18- to 19-year-olds and 24% larger (95% CI=0.96, 1.59) for 15- to 17-year-olds. A similar pattern was observed for hospitalized injuries. CONCLUSIONS: Significantly more alcohol-involved crashes occurred among 15-to 19-year-olds than would have occurred had the purchase age not been reduced to 18 years. The effect size for 18- to 19-year-olds is remarkable given the legal exceptions to the pre-1999 law and its poor enforcement.

Evaluation of four state impaired driving enforcement demonstration programs: Georgia, Tennessee, Pennsylvania and Louisiana.

This study provided a consolidated evaluation of four separate demonstration projects aimed at reducing impaired driving through well-publicized enforcement. Each of the four demonstration projects used different enforcement approaches in an effort to reduce impaired driving crashes in the State. Georgia experienced a significant decrease in drinking-and-driving fatal crashes (14 percent using a ratio measure in a time series analysis). The program in Georgia (2800 checkpoints) saved an estimated 60 lives in the first year. While Louisiana experienced a raw decrease in the ratio of drinking drivers to nondrinking drivers in fatal crashes, when the control parishes and the comparison States were taken into consideration, the apparent decrease was neutralized. Although Pennsylvania's selected counties showed relative decreases across a variety of measures when compared to control counties and surrounding States, these decreases were not significant. In Tennessee, the ratio measure showed a significant decrease (-10.6 percent) compared to surrounding States with an estimated 43 lives saved in the first year. In summary, it appears that if States use a sobriety checkpoint model that includes (a) a statewide effort, (b) numerous sobriety checkpoints conducted each weekend throughout the year, (c) intensive publicity about the enforcement, and (d) properly trained law enforcement officials, significant decreases in impaired driving fatalities can be realized.

A meta-analysis of .08 BAC laws in 19 jurisdictions in the United States.

More than a dozen studies on the effectiveness of the .08 blood alcohol concentration (BAC) laws have been published; however, those studies have varied both in the statistical methods and the type of outcome measure used, so it is difficult to integrate the findings into an overall estimate of the effectiveness of the law. This study used a consistent outcome measure, drinking drivers in fatal crashes and an identical methodology time-series analysis, to analyze the introduction of the .08 law in 18 states and the District of Columbia from 1982 to 2000. Each analysis accounted for other key safety laws (administrative license suspension/revocation and safety belt laws), as well as economic conditions that might influence the effectiveness of the .08 law. This provided 19 independent evaluations in which the effectiveness (treatment effect) of the law could be measured in the same quantitative terms. The number of drinking drivers in fatal crashes declined in 16 of the 19 jurisdictions after the .08 law was adopted. Nine of the 16 reductions were statistically significant (p < .05). The effect size combined across all 19 locations showed statistically significant decline (p < .005) of 14.8% in the rate of drinking drivers in fatal crashes after the .08 laws were introduced. The reduction was greater in states that had an administrative license suspension/revocation law and implemented frequent sobriety checkpoints. This analysis suggests that 947 lives might have been saved, had all 50 states and the District of Columbia had the .08 law throughout the year 2000.