An assessment of court fees, surcharges, and penalties for alcohol-impaired driving in five midwestern U.S. states: implications for exacerbating poverty and health inequalities.

Driving under the influence (DUI) remains an important threat to public health in the United States, and a substantial literature has evaluated the effectiveness of state-mandated penalties. Researchers have overlooked accelerated use of obscured fees and surcharges levied by local and state court systems added to penalties in the past 15 years. We present data regarding DUI penalties for offenders with a blood alcohol content (BAC of 0.08) and the fees and surcharges attached to them in Minnesota, Illinois, Wisconsin, Michigan, and Iowa, and variation in these within Wisconsin at four BAC levels. In all states, surcharges and fees exceed penalty fines substantially. Variation within Wisconsin is also meaningful. Our data suggest that opaque costs in state court systems add a substantial financial burden to DUI penalties, particularly for those with lower incomes. An appraisal of the deterrent role of these added costs is warranted.

Understanding the characteristics of Latino individuals with first-time DUI offenses to facilitate effective interventions.

Literature shows that Latinos who drink are more likely to experience alcohol-related consequences and less likely to seek care for alcohol misuse than Whites. We aim to understand characteristics, consumption patterns, and openness to treatment among Latino first-time offenders driving under the influence. Latino participants were significantly younger (29.0 years) than non-Latinos (37.7 years). In adjusted models, Latino participants were significantly more likely than non-Latinos to binge drink, but there were no significant group differences in amount of alcohol consumed in a typical week. There was no significant difference in incidence of alcohol-related consequences, readiness to change drinking, and driving behaviors in this sample.

At-risk drinking, operant demand, and cross-commodity discounting as predictors of drunk driving in underage college women.

Behavioral economics offers unique tools for assessing value and motivation associated with college drinking. Tasks that model changes in consumption as a function of price (operant demand) or the decline in an outcome's subjective value as a function of time-to-occurrence (delay discounting) provide valuable information that may efficiently supplement clinical screening instruments when characterizing alcohol use severity. The first aim of this investigation was to examine the extent to which at-risk drinking, operant demand for alcohol, and single- and cross-commodity discounting of money and alcohol predict adverse consequences of past-month drinking in underage college women (N = 72). The second aim was to determine whether these clinical and behavioral economic measures could significantly predict the odds of past-month drunk driving, a serious public health concern due to the increasing prevalence of heavy episodic drinking among women in their first 1 - 2 years of college. Results showed that higher scores on the consumption factor of the Alcohol Use Disorder Identification Test (AUDIT-C), higher Persistence (consumption amidst constraint) and Amplitude (maximum consumption) of demand, as well as lower rates of discounting for choices between alcohol now or double the amount after a delay (choosing the larger amount of alcohol even when it is delayed) significantly predicted adverse consequences of past-month drinking. Moreover, higher scores on the AUDIT-C, higher Amplitude of demand, and greater discounting for choices between alcohol now and money later (choosing immediately available alcohol at the expense of double the equivalent in delayed money) significantly predicted past-month drunk driving. We contend that operant demand along with single- and cross-commodity discounting can be viewed as intersecting measures of reinforcer value with clinical relevance to college women.

In-Vehicle Alcohol Detection Using Low-Cost Sensors and Genetic Algorithms to Aid in the Drinking and Driving Detection.

Worldwide, motor vehicle accidents are one of the leading causes of death, with alcohol-related accidents playing a significant role, particularly in child death. Aiming to aid in the prevention of this type of accidents, a novel non-invasive method capable of detecting the presence of alcohol inside a motor vehicle is presented. The proposed methodology uses a series of low-cost alcohol MQ3 sensors located inside the vehicle, whose signals are stored, standardized, time-adjusted, and transformed into 5 s window samples. Statistical features are extracted from each sample and a feature selection strategy is carried out using a genetic algorithm, and a forward selection and backwards elimination methodology. The four features derived from this process were used to construct an SVM classification model that detects presence of alcohol. The experiments yielded 7200 samples, 80% of which were used to train the model. The rest were used to evaluate the performance of the model, which obtained an area under the ROC curve of 0.98 and a sensitivity of 0.979. These results suggest that the proposed methodology can be used to detect the presence of alcohol and enforce prevention actions.

Evaluating the Computerized Assessment and Referral System (CARS) Screener: Sensitivity and Specificity as a Screening Tool for Mental Health Disorders among DUI Offenders.

Background/Purpose: A growing body of evidence suggests that people who are arrested for driving under the influence (DUI) of alcohol are more likely to screen positive for psychiatric disorders than the general population. Additionally, psychiatric comorbidity has been shown to increase vulnerability to criminal re-offense. However, DUI programs face many barriers to screening for psychiatric disorders. This paper evaluates the sensitivity and specificity of a screening tool developed for these programs, the Computerized Assessment and Referral System (CARS) Screener. Methods: We used data from 381 DUI offenders in Massachusetts, as well as a secondary data source, the National Comorbidity Survey-Replication (NCS-R: N = 9,282) to examine the accuracy of the CARS Screener when compared to full assessment. Results: Based on both sets of analyses, we found that the CARS Screener offers a sensitive and specific method to screen for many psychiatric disorders. Specifically, the CARS Screener has a high sensitivity and specificity for bipolar disorder, intermittent explosive disorder, depressive disorders, generalized anxiety disorder, alcohol and drug use disorders, gambling disorder, post-traumatic stress disorder, panic attacks, and social phobia. Conclusion: The CARS Screener appears to be an effective tool that will help DUI programs better understand and address the mental health issues facing their clients.

Modeling Repeat DUI Offender Probation Outcomes Using the Wisconsin Risk Need Assessment.

This multiyear study of felony driving while intoxicated (DWI) probationers explores the efficacy of the Wisconsin Risk Need Assessment tool along with sociodemographic factors as measures of probation outcomes. To date, few studies have explored the relationship between risk assessment data and technical violations as well as subsequent arrests of individuals on probation. The sample for this study consists of 596 chronic DWI offenders on community supervision in one county who either had been rearrested for a new offense, violated a technical condition of their probation, or committed no violations within the first 5 years of community supervision. The findings are that older defendants and those who had more dependents were more likely to have committed a technical violation compared with the other two groups. Those rearrested for a new offense were slightly younger compared with the other two groups, less likely to be employed and younger at the age of first adjudication of guilt. This study highlights the limited overall utility of the Wisconsin tool in determining probation outcomes and that static factors may be as important as dynamic factors when developing a supervision strategy for chronic DWI offenders.

Aetiology, prevalence, fracture site and management of maxillofacial trauma.

INTRODUCTION: Maxillofacial fractures are often associated with severe morbidity, functional deficit, disfigurement and significant financial implications. The aim of this review was to investigate whether the aetiology, prevalence and management modalities of facial trauma can identify the common causes of facial trauma with a view to recommending measures to the appropriate governing bodies to change the current practice wherever possible. METHODS: The records of 1,112 patients referred to our oral and maxillofacial unit in Andhra Pradesh, India, between February 2008 and October 2017 were analysed retrospectively. Data including age, sex, aetiology, fracture site and treatment were evaluated. RESULTS: Men aged 20-40 years were the most common victims of facial trauma. Road traffic accidents (RTAs) were responsible in 70% of cases. Mandibular fractures constituted 47% of the overall fractures, and 55% of the total fractures were treated with open reduction and internal fixation. CONCLUSIONS: The main cause of maxillofacial injury among patients reporting to our hospital was RTAs. Mandibular fractures were the most common, accounting for almost half of the cases. Over half (55%) of all maxillofacial fractures were treated with open reduction and internal fixation. Reasons for this high frequency may include the large number of poorly maintained, overloaded vehicles on unsuitable roads, violation of traffic regulations (particularly by inexperienced young drivers), abuse of alcohol or other intoxicating agents and the sociocultural behaviours of some drivers.

Are Countries' Drink-Driving Policies Associated With Harms Involving Another Driver's Impairment?

INTRODUCTION: International drink-driving policy research generally focuses on aggregate outcomes (e.g., rates of crashes, fatalities) without emphasizing secondhand alcohol-related vehicular harms. In contrast, we investigate associations between drink-driving policies and harms involving another driver's impairment. METHODS: Alcohol's harms to others (AHTO) survey data from 12 countries (analytic N = 29,616) were linked to national alcohol policy data from the World Health Organization. We examined separately associations of two 12-month driving-related AHTOs (passenger with an impaired driver; vehicular crash involving someone else's drink driving) with 3 national drinking-driving policies-legal blood alcohol concentration (BAC) limits, use of random breath testing, use of sobriety checkpoints, and comprehensive penalties for drink-driving (community service, detention, fines, ignition interlocks, license suspension/revocation, mandatory alcohol treatment, vehicle impoundment, and penalty point system), plus 2 alcohol tax variables (having excise taxes and value-added tax [VAT] rate). Multilevel logistic regression addressed clustering of individuals within countries and subnational regions, while adjusting for individuals' gender, age, marital status, risky drinking, and regional drinking culture (% male risky drinkers in sub-national region). RESULTS: Controlling for national-, regional-, and individual-level covariates, comprehensive penalties were significantly and negatively associated with both outcomes; other vehicular policy variables were not significantly associated with either outcome. A society's VAT rate was negatively associated with riding with a drunk driver. Regional male drinking culture was positively associated with riding with an impaired driver, but was not significantly associated with being in a vehicular crash due to someone else's drinking. In both models, being male, being younger, and engaging in risky drinking oneself each were positively associated with vehicular harms due to someone else's drinking. CONCLUSIONS: Although results are associational and not causal, comprehensive penalties may be promising policies for mitigating driving-related harms due to another drinker. Higher VAT rate might reduce riding with a drunk driver.

The use of machine learning improves the assessment of drug-induced driving behaviour.

RATIONALE: Car-driving performance is negatively affected by the intake of alcohol, tranquillizers, sedatives and sleep deprivation. Although several studies have shown that the standard deviation of the lateral position on the road (SDLP) is sensitive to drug-induced changes in simulated and real driving performance tests, this parameter alone might not fully assess and quantify deviant or unsafe driving. OBJECTIVE: Using machine learning we investigated if including multiple simulator-derived parameters, rather than the SDLP alone would provide a more accurate assessment of the effect of substances affecting driving performance. We specifically analysed the effects of alcohol and alprazolam. METHODS: The data used in the present study were collected during a previous study on driving effects of alcohol and alprazolam in 24 healthy subjects (12 M, 12 F, mean age 26 years, range 20-43 years). Various driving features, such as speed and steering variations, were quantified and the influence of administration of alcohol or alprazolam was assessed to assist in designing a predictive model for abnormal driving behaviour. RESULTS: Adding additional features besides the SDLP increased the model performance for prediction of drug-induced abnormal driving behaviour (from an accuracy of 65 %-83 % after alprazolam intake and from 50 % to 76 % after alcohol ingestion). Driving behaviour influenced by alcohol and alprazolam was characterised by different feature importance, indicating that the two interventions influenced driving behaviour in a different way. CONCLUSION: Machine learning using multiple driving features in addition to the state-of-the-art SDLP improves the assessment of drug-induced abnormal driving behaviour. The created models may facilitate quantitative description of abnormal driving behaviour in the development and application of psychopharmacological medicines. Our models require further validation using similar and unknown interventions.

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.

Proximity to the Southern Border and Sociodemographic Correlates of Drinking and Driving Arrests in California.

BACKGROUND: About 30% of all motor vehicle fatalities in the United States are associated with alcohol-impaired motor vehicle crashes. Arrests for drinking and driving (Driving under the influence [DUI]) are 1 of the most important deterrence actions to minimize DUI. This paper examines trends and population-level correlates of drinking driving arrests (DUI) from 2005 to 2017 in California. METHODS: Arrest data come from the Monthly Arrest and Citation Register compiled by the California Department of Justice. Sociodemographic and community characteristic data from the U.S. Census, alcohol outlet density, and distance to the U.S.-Mexico border from Law Enforcement Reporting Areas (LERA) centroids were aggregated at the level of 499 LERA contributing to the report. Reported arrest rates were related to area sociodemographic characteristics using hierarchical Bayesian Poisson space-time models. RESULTS: Both among men and women rates showed an upward trend until 2008, decreasing after that year. DUI arrest rates were greater among Hispanics than Whites for the 2 younger age groups, 18 to 29 (p < 0.001) and 30 to 39 years (p < 0.001). DUI arrest rates in LERA areas are positively related to proximity to the California/Mexico border; a higher percent of bar/pub outlets; a higher percent of Hispanic population; a higher percent of population 18 to 29, 30 to 39, and 40 to 49 years of age; a higher percent of US-born population; a higher percent of population with annual income of $100,000 or more; a higher percent of population 150% below the federal poverty line; and a higher level of law-enforcement activities. CONCLUSIONS: Results of this analysis of spatial correlates of DUI arrests overlap well with the literature on individual-level data and arrest rates. The decrease in arrest rates as distance to the California/Mexico border increases is potentially associated with the greater availability of alcohol in the border area.

Injury patients' perceptions of drink-driving: A qualitative assessment of drink-driving behavior in Moshi, Tanzania.

BACKGROUND: Globally, about 2.3 billion people are current alcohol drinkers, and 283 million have an alcohol use disorder. Alcohol use while driving is a major contributor to road traffic injuries (RTI). We need to understand the culture and perception of drink-driving in this setting to understand why people continue to drink drive and allow policymakers to develop more effective ways to address drink-driving behavior. This study aims to qualitatively determine what injury patients, their families, and community advisory board members in Tanzania believe about drink-driving to help inform policies to address this problem. METHODS: The semi-structured focus group was designed based on the grounded theory and assessed using thematic analysis. Focus groups participants were a convenience sample of injury patients, their families, and community advisory board (CAB) members. Analysis was iterative throughout the study. All transcripts were coded using a thematic narrative approach. Representative quotes for each theme were then selected based on comparative analysis of coding with input from research team members. RESULTS: A total of ten focus groups were conducted (4 patient, 4 family, and 2 CAB) with a total of 104 participants (37 females and 67 males). The normalization of drinking among drivers has allowed this behavior to become ingrained in the culture. Participants expressed notions that passengers are responsible for their own safety, rather than drivers being responsible for their passengers. Most participants believe it is a citizen's duty to inform the police of suspected drink-driving, however there were differing opinions about how effective informed police officers can be in practice. Focus group discussions between all three population types highlighted major themes of 'drinking is ingrained in boda boda driver culture', 'individuals have a personal responsibility to address drink-driving', and a 'police enforcement on drink-driving is necessary'. CONCLUSIONS: Normalization of drink-driving in commercial driver culture creates a dangerous environment for passengers which can be mitigated by education and health promotion. As most passengers already take personal responsibility for their own road traffic safety, they may be likely to make use of safe ride options, if available. While legislation is in place against drink-driving, police officers need to be empowered with appropriate training and funding to enforce them.

Association between state-level alcohol availability and taxation policies on the prevalence of alcohol-related harms to persons other than the drinker in the USA, 2000-2015.

INTRODUCTION AND AIMS: Alcohol-related harms to others (AHTO) are consequences of alcohol use borne by persons other than the drinker. This study assessed whether the odds of experiencing AHTO are associated with alcohol availability and taxation policies. DESIGN AND METHODS: This study pooled data from four waves of the National Alcohol Survey (n = 20656 adults). We measured past-year AHTO exposure using three binary variables: physical (pushed/hit/assaulted or property damage by someone who had been drinking), family or financial (family/marital problems or financial harms by someone who had been drinking) and driving AHTO (riding in a vehicle with a drink-driver or being in a drink-driving crash). Policies included bar and off-premise alcohol outlet density (separately), alcohol retail hours, beer and spirits taxes (separately) and monopoly on retail/wholesale alcohol purchases. RESULTS: Monopolies were associated with 41.2% lower odds of physical harms [adjusted odds ratio (aOR) = 0.59, 95% confidence interval (CI) 0.45, 0.77, q < 0.001 correcting for multiple analyses], and a 10% increase in bar density was associated with a 1.2% increase in odds of driving-related harms ( e ln(1.1) * ß =1.01, 95% CI 1.00, 1.02, q = 0.03). Among men, beer taxes were associated with lower odds of physical harms ( eln(1.1) * ß =0.93, 95% CI 0.88, 0.98 q = 0.03) and monopolies were associated with lower odds of physical (aOR = 0.45, 95% CI 0.35, 0.59, q < 0.001) and driving harms (aOR = 0.66, 95% CI 1.00, 1.02, q = 0.03). DISCUSSION AND CONCLUSIONS: Monopolies, taxes and outlet density are associated with odds of some AHTO. Future longitudinal research should test whether physical availability and taxation policies may be protective for bystanders as well as drinkers.

Racial and ethnic differences in patients involved in alcohol-impaired motor vehicle crashes and its related clinical outcomes among various age groups in the U.S.

Objective(s): 1) to determine whether the proportion of alcohol-impaired patients involved in motor vehicle crashes (MVCs) varies by race/ethnicity within different age groups; 2) to explore the relationship between alcohol impairment, race/ethnicity and clinical outcomes among patients involved in MVCs across age groups.Methods: The 2012 National Trauma Data Bank (NTDB) queried for patients aged 16-55 involved in MVCs who received a blood ethanol test on admission.Results: Of the 44,216 patients involved in MVC, 68% were White, 14% Black, and 13% were Hispanic. About 36% were 16-25 years old, and 19% were 46-55 years old. Alcohol-impaired patients constituted 34% of the patients. The multiple logistic regression analysis of HLOS ≥ 2 days revealed that, when controlling for age, gender, race/ethnicity, insurance status, and the interaction between alcohol impairment and age as well as alcohol impairment and race/ethnicity, alcohol impairment positivity carried a 15% increase in probability of HLOS ≥ 2 days (OR 1.15, p < 0.0001). Additionally, using the 16-25 age group as reference, each of the older age groupings showed an increased probability of HLOS ≥ 2 days with ORs of 1.15, 1.32, and 1.51 for ages 26-35, 36-45, and 46-55, respectively (p-values < 0.0001). Blacks, Hispanics, and Asians/others were less likely than Whites to have HLOS ≥ 2 days with OR of 0.88, 0.89, and 0.88, respectively (p < 0.05). There was no statistically significant difference in the clinical outcome of mortality between races/ethnicities and alcohol-impaired driving.Conclusions: This study demonstrates that the proportions of alcohol-impaired driving and the associated clinical outcomes vary among race/ethnic groups in different age groups. More research is needed to determine the reasons for the observed differences in these vulnerable sub-groups.

Breath tests in Western Australia: Examining the economic dividends and effectiveness of general deterrence.

In this paper, we examine the relationship between traffic enforcement (in the form of roadside breath testing for alcohol) and traffic outcomes (alcohol-related traffic crashes) to identify an optimal point of traffic enforcement. In Western Australia (WA), Police are authorised to stop any driver and measure their blood alcohol concentration via a sample of their breath. Using a metric employed by Ferris et al. (2013) and a methodology analogous to that utilised by Cameron (2013), we model the relationship between alcohol related traffic crashes and the saturation of breath testing in WA from January 2008 to April 2018. Our analysis suggests that given the saturation of breath testing in 2018 (1.2 tests per licenced driver), a 10 % increase in breath testing would be associated with a decline of 0.34 alcohol related traffic crashes (ARTC) per 100,000 drivers per month, equating to six fewer crashes per month, state-wide. In addition, using 'willingness to pay' and human capital cost metrics to approximate the social costs of ARTC, we employ a cost-benefit analysis to estimate the point at which the social costs of ARTC equal the economic costs of breath tests. Our analysis suggests that an increase in the number of tests to 143 % of all licensed WA drivers (an increase of 450,000 breath tests from the 2017/18 financial year) would be anticipated to save the state AUD$13.3 million annually in the human capital costs of ARTC. Our findings suggest that a further increase in breath tests to 154% of all licensed WA drivers (an increase of 650,000 breath tests from 2017/18) may save the state AUD$31.0 million annually in willingness to pay costs. The analytics below present a novel combination of methods to approximate the relative economic merits of increases in traffic enforcement. Furthermore, the findings outlined here have practical applications for operational policing, while providing an analytical perspective for policy makers faced with making recommendations regarding the volume and saturation of breath tests.

Association of Prior Convictions for Driving Under the Influence With Risk of Subsequent Arrest for Violent Crimes Among Handgun Purchasers.

Importance: Alcohol use is a risk factor for firearm-related violence, and firearm owners are more likely than others to report risky drinking behaviors. Objective: To study the association between prior convictions for driving under the influence (DUI) and risk of subsequent arrest for violent crimes among handgun purchasers. Design: In this retrospective, longitudinal cohort study, 79 678 individuals were followed up from their first handgun purchase in 2001 through 2013. The study cohort included all legally authorized handgun purchasers in California aged 21 to 49 years at the time of purchase in 2001. Individuals were identified using the California Department of Justice (CA DOJ) Dealer's Record of Sale (DROS) database, which retains information on all legal handgun transfers in the state. Exposures: The primary exposure was DUI conviction prior to the first handgun purchase in 2001, as recorded in the CA DOJ Criminal History Information System. Main Outcomes and Measures: Prespecified outcomes included arrests for violent crimes listed in the Crime Index published by the Federal Bureau of Investigation (murder, rape, robbery, and aggravated assault), firearm-related violent crimes, and any violent crimes. Results: Of the study population (N=79 678), 91.0% were males and 68.9% were white individuals; the median age was 34 (range, 21-49) years. The analytic sample for multivariable models included 78 878 purchasers after exclusions. Compared with purchasers who had no prior criminal history, those with prior DUI convictions and no other criminal history were at increased risk of arrest for a Crime Index-listed violent crime (adjusted hazard ratio [AHR], 2.6; 95% CI, 1.7-4.1), a firearm-related violent crime (AHR, 2.8; 95% CI, 1.3-6.4), and any violent crime (AHR, 3.3; 95% CI, 2.4-4.5). Among purchasers with a history of arrests or convictions for crimes other than DUI, associations specifically with DUI conviction remained. Conclusions and Relevance: This study's findings suggest that prior DUI convictions may be associated with the risk of subsequent violence, including firearm-related violence, among legal purchasers of handguns. Although the magnitude was diminished, the risk associated with DUI conviction remained elevated even among those with a history of arrests or convictions for crimes of other types.

Alcohol control policy and changes in alcohol-related traffic harm.

AIMS: To study the impact of alcohol control policy measures (i.e. increases in taxation, restrictions on availability, including minimum purchasing age regulations, legislation on drink driving and advertisement bans) on alcohol-related traffic harm in Lithuania between January 2004 and February 2019. DESIGN: Analyses of trend data on the proportion of alcohol-related collisions and crashes, injury and mortality, adjusting for secular trends, seasonality, periods of alcohol control measure implementation and economic development. Generalized additive mixed models were used. Multiple sensitivity analyses were conducted. SETTING: Lithuania. CASES: Monthly number of alcohol-related cases of traffic collisions and crashes, injuries and deaths. INTERVENTIONS AND COMPARATORS: Periods of time during which new alcohol control measures were implemented and/or augmented compared to periods when they were not. MEASUREMENTS: Monthly data for 2004 to 2019 from routine statistics of the Lithuanian Road Police Service. FINDINGS: All indicators decreased consistently and significantly after the implementation of alcohol control measures, including increased taxation, reduction of availability and a ban on advertisement, starting in 2014. On average, each implemented policy measure permanently reduced the proportion of alcohol-attributable crashes by 0.55% [95% confidence interval (CI) = 0.21-0.90%; P = 0.002], the proportion of alcohol-attributable injuries by 0.60% (95% CI = 0.24-0.97%; P = 0.001) and the proportion of alcohol-attributable deaths by 0.13% (95% CI = 0.10-0.15%; P < 0.001). CONCLUSIONS: Alcohol control policy measures, including measures to reduce overall level of alcohol consumption, were associated with a marked decrease in alcohol-related traffic harm.

How did a lower drink-drive limit affect bar trade and drinking practices? A qualitative study of how alcohol retailers experienced a change in policy.

INTRODUCTION AND AIMS: Reducing the legal drink-drive limit from 0.08% to 0.05% blood alcohol concentration (BAC) can reduce road traffic accidents and deaths if properly enforced. Reduced limits may be opposed by alcohol retail and manufacturing industries on the basis of commercial impact. Our aim was to qualitatively explore how a reduction in the drink-drive limit from 0.08% to 0.05% BAC in Scotland, was experienced by bar owners or managers, including any resultant changes in customer drinking or business practice. This is the first study of this type. DESIGN AND METHODS: Semi-structured interviews were conducted with 16 owners and managers of on-trade premises in Scotland in 2018, approximately three years after the drink-drive limit was reduced. Data were analysed using thematic analysis. RESULTS: Most participants reported no long-term financial impact on their business, but a few, mainly from rural areas, reported some reduction in alcohol sales. Observed drinking changes included fewer people drinking after work or leaving premises earlier on weekdays. Adaptations to businesses included improving the range of no/low-alcohol drinks and food offered. Changes such as these were seen as key to minimising economic impact. DISCUSSION AND CONCLUSIONS: Opposition to legislative measures that impact on commercial interests is often strong and receives significant public attention. This study found that Scottish businesses that adapted to the drink-drive limit change reported little long-term economic impact. These findings are of international relevance as potential BAC limit reductions in several other jurisdictions remain the subject of debate, including regarding the impact on business.

"Everyone Has the Right to Drink Beer": A Stakeholder Analysis of Challenges to Youth Alcohol Harm-Reduction Policies in Lebanon.

BACKGROUND: Alcohol use is a major risk factor in premature death and disability, especially among youth. Evidence-based policies to prevent and control the detrimental effect of alcohol use have been recommended. In countries with weak alcohol control policies-such as Lebanon, stakeholder analysis provides critical information to influence policy interventions. This paper assesses the views of stakeholders regarding a national alcohol harm reduction policy for youth. METHODS: We interviewed a total of 22 key stakeholders over a period of 8 months in 2015. Stakeholders were selected purposively, to include representatives of governmental and non-governmental organizations and industry that could answer questions related to core intervention areas: affordability, availability, regulation of marketing, and drinking and driving. We analyzed interview transcripts using thematic analysis. RESULTS: Three themes emerged: Inadequacy of current alcohol control policies; weak governance and disregard for rule of law as a determinant of the status quo; and diverting of responsibility towards 'other' stakeholders. In addition, industry representatives argued against evidence-based policies using time-worn strategies identified globally. CONCLUSIONS: Our findings indicate that alcohol harm reduction policies are far from becoming a policy priority in Lebanon. There is a clear need to shift the narrative from victim blaming to structural conditions.

Classification of Fatigued and Drunk Driving Based on Decision Tree Methods: A Simulator Study.

It is a commonly known fact that both alcohol and fatigue impair driving performance. Therefore, the identification of fatigue and drinking status is very important. In this study, each of the 22 participants finished five driving tests in total. The control condition, serving as the benchmark in the five driving tests, refers to alert driving. The other four test conditions include driving with three blood alcohol content (BAC) levels (0.02%, 0.05%, and 0.08%) and driving in a fatigued state. The driving scenario included straight and curved roads. The straight roads connected the curved ones with radii of 200 m, 500 m, and 800 m with two turning directions (left and right). Driving performance indicators such as the average and standard deviation of longitudinal speed and lane position were selected to identify drunk driving and fatigued driving. In the process of identification, road geometry (straight segments, radius, and direction of curves) was also taken into account. Alert vs. abnormal and fatigued vs. drunk driving with various BAC levels were analyzed separately using the Classification and Regression Tree (CART) model, and the significance of the variables on the binary response variable was determined. The results showed that the decision tree could be used to distinguish normal driving from abnormal driving, fatigued driving, and drunk driving based on the indexes of vehicle speed and lane position at curves with different radii. The overall accuracy of classification of "alert" and "abnormal" driving was 90.9%, and that of "fatigued" and "drunk" driving was 94.4%. The accuracy was relatively low in identifying different BAC degrees. This experiment is designed to provide a reference for detecting dangerous driving states.