Passenger Presence and the Relative Risk of Teen Driver Death.

PURPOSE: This study examines the relative risk of death among crash-involved teenage drivers in relation to the number and ages of passengers present. METHODS: We performed cross-sectional analysis of police-reported crashes in the United States in years 2016-2019 to estimate rate ratios for death among drivers aged 16-17 years by passenger composition (no passengers, one teen, ≥two teens, teens and adults aged 20-34 years, adults aged 20-34 years only, ≥one adult aged 35-64 years). Models were adjusted for confounding and effect modification related to driver, crash, and environmental factors. RESULTS: Crash-involved teen drivers carrying ≥2 teen passengers were twice as likely to die as teens driving alone. The driver was seven times as likely to die when carrying a mix of teen and young adult passengers compared with teens driving alone. Teen drivers' risk of death was lowest in the presence of an adult passenger aged 35-64 years. Carrying one teen passenger presents greater risk of death than driving alone for male teen drivers but not for females. DISCUSSION: When teen drivers crash, they are more likely to die if they are carrying teen and/or young adult passengers than if they are driving alone or with a mature adult. The results support the current graduated licensing policies restricting young novice drivers from carrying teenage passengers. Results also help to clarify why previous studies have found that young passengers are associated with increased risk of fatal crashes, but not nonfatal crashes: it appears that passengers may have an effect on crash severity.

Prevalence of alcohol among drivers, riders and pedestrians injured in road traffic crashes in Cameroon: a cross-sectional study.

The use of alcohol among road users injured in road traffic crashes and admitted to three major hospitals in Cameroon was studied. Alcohol use was measured using breathalyzers, and data on age, gender, education level, religion, type of road user, time of the crash, crash characteristics, and injury severity were recorded using a questionnaire. Of the 350 participants, 30.9% had blood alcohol concentrations (BACs) above 0.08% (legal limit for drivers); the proportion was highest among motorcycle riders (36.5%), followed by pedestrians (24.8%) and motor vehicle drivers (18.9%). The proportion with BAC above 0.08% was highest on weekend nights and among those who were most seriously injured. Those who reported being Muslims had a lower prevalence of alcohol. Multivariable logistic regression analysis confirmed those associations. Many road traffic injuries could have been avoided if the patient had not consumed alcohol. Actions should therefore be taken to reduce the proportion of alcohol-impaired road users.Supplemental data for this article is available online at https://doi.org/10.1080/17457300.2022.2030365 .

Crossing a border for a low-cost, high-risk environment: smoking status and excessive drinking among young adults in Tijuana.

This study examines the drinking and smoking behavior of 2,311 college-age adults traveling from San Diego, California, to Tijuana, Mexico (December 2006 to December 2008). We describe this Border sample's drinking history and smoking status and estimate multivariate models of evening drinking participation and, conditional on drinking, blood alcohol concentration. Noting limitations, we present implications for identifying young adults at high risk for alcohol and tobacco use, particularly females, and lay the foundation for further research examining young adults? alcohol and tobacco use in reduced price scenarios.

Cannabis and crash risk among older drivers.

The purpose of this research was to reanalyze data collected from the National Highway Traffic Safety Administration's Drug and Alcohol Crash Risk Study to investigate whether driving under the influence of cannabis (THC-positive) was associated with elevated crash risk for younger and older drivers. The data came from a case-control relative risk study collected from Virginia Beach, VA, over a 20-month period. Data collectors gathered driver information from the scene of vehicle crashes and, in some cases, from hospitals. Non-crash controls were sampled from the same locations, days, and times as crashes. Key data items included driver demographics and oral fluid and blood samples, which were assayed for licit and illicit drugs. We found no overall association between cannabis use and risk of crash involvement. However, when age and age2 were allowed to interact with THC, significant interaction effects emerged. THC was associated with increased risk of crash involvement for older drivers. Difference between THC-positive and sober drivers emerged as significant at age 64. The research underscores the value of examining drugged driving in the context of driver age. Age-related declines in neurocognitive and psychomotor functioning were not measured but might be important in explaining the results.

Roadside surveys of drinking and driving in Cameroon.

OBJECTIVE: This study aimed to assess the prevalence of drinking and driving on roadways in urban areas and highways in Cameroon, and to determine the associations between drinking and driving and socio-demographic factors. METHODS: A cross-sectional study of motor vehicle drivers was performed on Fridays, Saturdays, and Sundays between May and September 2020 with three driver groups: (1) random motor vehicle drivers (including riders) on major highways, (2) drivers recruited at car stations in Yaoundé, and (3) at fuel stations in Douala. Alcohol was measured using breathalyzers, and a questionnaire collected socio-demographic data. RESULTS: In total, 2402 motor vehicle drivers were asked to participate in the study and 1701 (70.8%) gave informed consent. The vast majority (98.6%) were men. Drivers aged 30-39 years constituted the largest age group on highways and in Yaoundé, whereas 18-29 years was the largest age group in Douala. The highest prevalence of alcohol was observed among drivers in Yaoundé, which included mainly clandestine taxi car drivers and motorcycle taxi riders, where about 30% had blood alcohol concentrations (BAC) above the legal limit of 0.08%. The proportion with BACs above the legal limit was about 6% among the drivers in Douala, which included mainly motorcycle taxi riders, and about 4% among drivers on highways. CONCLUSIONS: The findings indicate that drinking and driving is a major traffic safety problem on Cameroonian public roads, especially among motorcycle taxi riders and clandestine taxi drivers in towns, which represent the major mass transportation means in the country. Drinking and driving education and legislation should be better developed and enforced in order to reduce the number road traffic crashes.

Potentially Inappropriate Medication Use and Hard Braking Events in Older Drivers.

Potentially inappropriate medications (PIMs) identified by the American Geriatrics Society should generally be avoided by older adults because of ineffectiveness or excess risk of adverse effects. Few studies have examined the effects of PIMs on driving safety measured by prospectively and objectively collected driving data. Data for this study came from the Longitudinal Research on Aging Drivers study, a multisite naturalistic driving study of older adults. Multivariable negative binominal modeling was used to estimate incidence rate ratios and 95% confidence intervals of hard braking events (proxies for unsafe driving behavior defined as events with a deceleration rate ≥0.4 g) associated with PIM use among older drivers. The study sample consisted of 2932 drivers aged 65-79 years at baseline, including 542 (18.5%) who used at least one PIM. These drivers were followed through an in-vehicle recording device for up to 44 months. The overall incidence of hard braking events was 1.16 per 1000 miles. Use of PIMs was associated with a 10% increased risk of hard braking events. Compared to drivers who were not using PIMs, the risk of hard braking events increased 6% for those using one PIM, and 24% for those using two or more PIMs. Use of PIMs by older adult drivers is associated in a dose-response fashion with elevated risks of hard braking events. Reducing PIM use in older adults might help improve driving safety as well as health outcomes.

Measuring Drug Use Among Drivers: How Accurate Is Self-Reported Use?

OBJECTIVE: There has been considerable work validating self-reported drug use with bioassays, but these studies have not been conducted with respondents on the roadway. The objective of this study was to assess the validity of drivers' self-reported drug use. METHOD: This study analyzed 2007 and 2013-2014 data from nationally representative roadside surveys of U.S. drivers. Using phi coefficients, the study examined the association between self-reported, past-24-hour drug use and bioassays (based on oral fluid and/or blood) for cannabis, opioids, cocaine, antidepressants, and benzodiazepines. Logistic regression models examined the association of various factors with the odds of reporting specific drug types. RESULTS: Overall phi coefficients by drug type ranged from .17 to .34 in 2007 and .30 to .54 in 2013-2014. The odds of reporting cannabis, cocaine, and benzodiazepine use were significantly higher among drivers who used these substances in 2013-2014 (odds ratio [OR] = 1.92, 2.97, and 3.25, respectively), compared with 2007. Opioid and antidepressant reporting did not differ significantly among users of these substances across survey years (OR = 1.01 and OR = 1.44, respectively). CONCLUSIONS: Roadside surveys of drivers are an important method for gathering the types of data needed to monitor trends in drug use. The findings reinforce the importance of gathering multiple types of data to understand drug use among drivers. The many factors that influence self-reporting, as well as the limitations of biological measures, both pose challenges to accurately measuring drug use. Future studies should investigate ways to improve measurement of drug use in this population.

To drive or not to drive? A study of travel behavior for a recent drinking occasion.

Despite decades of education and enforcement campaigns, alcohol-impaired driving persists as a social problem in the U.S. Are there other factors influencing decisions to drive after alcohol consumption that may be amenable to change? We conducted a roadside survey in California in 2012 to assess whether residential accessibility, travel attitudes (indicated by ratings of convenience and safety for travel options), and perceptions of arrest risk affect travel choices made subsequent to alcohol consumption. We conducted hybrid choice modeling for 580 participants. Mode-specific travel attitudes were valid constructs and predictive of travel behavior. Perceived level of service (speed) increased the utility for taxi and getting a ride. Perceiving high risk of arrest affected mode choice through travel attitudes. Not everyone assessed their mode options in the same way. For example, frequent binge drinkers appear to be more willing to consider taxis, men had stronger preferences towards active modes, and younger drivers were less pro-driving in this context. Past drinking and driving behavior affected one's attitude towards driving, while the number of drinks was related to mode choice. While our accessibility measure was not significantly related to attitudes or choice, decreasing urbanicity corresponded with stronger preferences for driving. This pilot study suggests that improving level of service (speed), convenience, and overall safety are considerations for public health in terms of promoting alternatives to drinking and driving. This line of research also has implications for emerging options, such as ride hailing, and how these might be optimized for specific segments of the population.

The Relationship between in-Vehicle Technologies and Self-Regulation among Older Drivers.

The study sought to understand the relationship between in-vehicle technologies (IVTs) and self-regulatory behaviors among older drivers. In a large multi-site study of 2990 older drivers, self-reported data on the presence of IVTs and avoidance of various driving behaviors (talking on a mobile phone while driving, driving at night, driving in bad weather, and making left turns when there is no left turn arrow) were recorded. Self-reports were used to identify whether avoidance was due to self-regulation. Hierarchical logistic regressions were used to determine whether the presence of a particular IVT predicted the likelihood of a given self-regulatory behavior after controlling for other factors. Results suggest that the presence of Integrated Bluetooth/Voice Control systems are related to a reduced likelihood of avoiding talking on a mobile phone while driving due to self-regulation (OR= 0.37, 95% CI= 0.29-0.47). The presence of a Navigation Assistance system was related to a reduced likelihood of avoiding talking on a mobile phone while driving (OR= 0.65, 95% CI= 0.50-0.84) and avoiding driving at night due to self-regulation (OR= 0.80, 95% CI = 0.64-1.00). Present findings suggest in-vehicle technologies may differently influence the self-regulatory behaviors of older drivers.

Patterns of Self-Reported Driving While Intoxicated Among Older Adults.

Objective: This study examines the prevalence of self-reported driving while intoxicated (DWI) among drivers aged 65 and older. Method: This cross-sectional study was based on baseline data from the AAA Longitudinal Research on Aging Drivers (LongROAD) study, a multisite prospective cohort study of 2,990 older adult drivers. Alcohol-related variables from the baseline questionnaire were examined in relation to demographics, health status, and driving behaviors. A logistic regression model assessed variables associated with DWI. Results: Of the 2,990 participants, 72.7% reported consuming alcohol, 15.0% reported high-risk drinking, and 3.3% reported DWI. High-risk drinking (OR = 12.01) and risky driving behaviors (OR = 13.34) were significantly associated with at least occasional DWI. Avoidance of hazardous driving conditions (OR = 0.71) and higher level of comfort during challenging driving scenarios (OR = 0.65) were less likely to be associated with DWI. Conclusion: A large number of older adults engage in high-risk drinking and DWI. Public health education and DWI-related interventions should include older adults.

Medication use and driving patterns in older drivers: preliminary findings from the LongROAD study.

BACKGROUND: The potential for impaired driving due to medication use can occur at any age, though older adults are more likely to take multiple prescribed medications and experience side effects that may affect driving ability. The purpose of this study was to characterize the relationship between medications and driving safety behaviors. METHODS: Data for this study came from the five-site Longitudinal Research on Aging Drivers (LongROAD) project. Participants were active drivers, age 65-79 years at enrollment, and patients at one of the 5 participating sites. Medication names and doses were obtained at baseline based on the "brown-bag review" method. Medications were coded using the American Hospital Formulary Service system. Driving data were collected by a GPS accelerometer installed in the study participants' main vehicles. RESULTS: Medication data were available for 2949 (98.6%) of the 2990 participants, and 2898 (96.9% of all participants) had both medication data and at least 30 recorded days of driving. The median number of medications taken per study participant was seven, with a range of 0-51. Total number of medications was significantly associated with a higher rapid deceleration rate. Certain medication classes were significantly associated with other driving outcomes, including central nervous system agents (more speeding events), hormones and gastrointestinal medications (more rapid decelerations), electrolytes (fewer rapid decelerations), and antihistamines (greater right to left turn ratio). CONCLUSIONS: Older adult drivers are taking large quantities of prescription and non-prescription medications that may affect their driving safety. Certain medication classes are associated with potentially adverse driving patterns, such as speeding and rapid decelerations, while others are associated with potentially protective maneuvers, such as right hand turning. Further research is warranted to identify and mitigate potential adverse effects of such medications on driving safety in older adults.

Social Support Moderates the Negative Association Between Reduced Driving and Life Satisfaction in Older Adults.

When older adults reduce their driving, there can be subsequent decreases in life satisfaction. In this cross-sectional study, we used baseline data from the multi-site Longitudinal Research on Aging Drivers (LongROAD) study to examine whether social support moderates the negative association between reduced driving and life satisfaction. The outcome variable was life satisfaction, and the main predictor variable was past-year reduced driving (yes/no). Emotional, instrumental, and informational social support were measured using PROMIS v2.0 (Patient-Reported Outcomes Measurement Information System) items. We used generalized linear regression models to examine how social support moderated the association between reduced driving and life satisfaction. Statistical adjustment for social support attenuated the negative effect of reduced driving on life satisfaction by ~10% for all three types of social support.

The utility of delta 9-tetrahydrocannabinol (THC) measures obtained from oral fluid samples in traffic safety.

Objective: Blood and/or urine are typical drug detection matrices used by law enforcement. There are some concerns about using oral fluid (OF) in the identification of drivers potentially impaired by cannabis, particularly regarding their accuracy when compared to blood. The study objectives were to (1) examine the accuracy of predicting delta 9-tetrahydrocannabinol (THC) in blood from THC measured in OF and (2) examine factors influencing prediction accuracy. Methods: Using data from the 2007 and 2013-2014 National Roadside Survey (NRS) of Alcohol and Drug Use, 7,517 drivers with known laboratory results in both OF and blood were included in this study. OF samples were collected using the Quantisal® device and analyzed at the same private laboratory in both the 2007 and 2013-2014 NRS. The Quantisal device has consistently shown to collect 1 mL ±10%. Descriptive statistical analyses were used to examine and compare the distribution of THC concentrations in OF and blood. A hurdle model was applied to examine factors influencing the accuracy of the THCblood predictions based on THCOF while accounting for the decisions of cannabis consumption. We estimated the number of true positives (TPs), false positives (FPs), true negatives (TNs), false negatives (FNs), sensitivity, specificity, and positive predicted value (PPV). Results: This study found that THC measured in OF (THCOF) is a good predictor of THC measured in blood (THCblood), in particular when THCOF > 0 ng/mL is used to predict being positive for THCblood (THCblood > 0 ng/mL). However, as blood and OF concentrations depart from 0 ng/mL, the proportion of TPs (sensitivity) decreases, which might be a concern for law enforcement. The likelihood of accurately predicting THCblood from THCOF is lower for drivers who were simultaneously using cannabis and other drugs. Conclusions: The findings of this study are based on THC measures obtained in a laboratory, which may not be the same as those conducted by police using point-of-care devices. However, this study is unique due to its large sample of drivers obtained in similar roadside locations and times to actual law enforcement activities. Though a positive THCOF may assist law enforcement in probable cause for a blood draw, efforts to develop reliable methods to detect drug impairment based on OF should continue.

Use of Alcohol and Cannabis Among Adults Driving Children in Washington State.

OBJECTIVE: It is unknown how many drivers are impaired by alcohol or cannabis with children as passengers (a situation known as driving under the influence child endangerment [DUI-CE]). This study examines the prevalence and patterns of alcohol and cannabis use among drivers with children on weekend nights and risk perceptions among these drivers. METHOD: Data came from 2,056 drivers (1,238 male) who participated in the Washington State Roadside Survey between June 2014 and June 2015. Oral fluid, blood, and breath samples were used to measure cannabis and alcohol use. Self-reported data were used to assess risk perceptions. Descriptive tabulations, weighted prevalence estimates, and chi-square tests were conducted. RESULTS: Compared with other drivers, those who drove with a child were more likely to be driving during the daytime (46.6% vs. 36.3%, p = .03), less likely to be alcohol positive (0.2% vs. 4.5%, p < .0001), but as likely to be positive for Δ-9-tetrahydrocannabinol (THC) (14.1% vs. 17.7%, p = .29). Drivers with a child were less likely to report moderate to severe marijuana problems (3.3%) than those without a child (8.4%) (p < .02). Most drivers reported that cannabis use was very likely to impair driving. Among those who did not perceive any risk, 40.6% of drivers with a child and 28.9% of drivers without a child tested positive for THC. CONCLUSIONS: Although most drivers with children did not drink and drive, many tested positive for cannabis, although it is unclear how many drivers may have been impaired. There is a need to examine driving situations that may put children at risks beyond those related to alcohol.

Physician and Family Discussions about Driving Safety: Findings from the LongROAD Study.

BACKGROUND: Older adult drivers may experience decreases in driving safety with age or health status change. Discussing driving safety may help them plan for driving restriction and eventual cessation. Here, we sought to examine conversations between older adults and their family members and physicians. METHODS: In this multi-site cross-sectional analysis of baseline data from the AAA Longitudinal Research on Aging Drivers (LongROAD) cohort study, we measured the prevalence and characteristics of family and physician driving discussions. We examined associations between having driving discussions and participant characteristics using multivariate logistic regression. RESULTS: Of 2990 current drivers aged 65 to 79 years (53% female, 85.5% White), only 14.2% reported discussing driving safety with family and 5.5% had discussions with physicians. Men (adjusted OR, 1.32; 95% CI, 1.05 to 1.66) and those with Master's degrees or higher (adjusted OR, 1.65; 95% CI, 1.27 to 2.13) more often had family discussions. Those with at least a Master's degree were also more likely to speak with their physician (adjusted OR, 1.77; 95% CI, 1.17 to 2.68). CONCLUSION: Few older adults had driving safety conversations with their family or physicians. Practical and effective interventions are needed to engage family and physicians in assisting older adults with risk assessment and driving cessation planning to maintain mobility and well-being.

A Night in Tijuana: Female Victimization in a High-Risk Environment.

We examine the epidemiology of victimization among females crossing the U.S. border to drink in Tijuana, Mexico, with the purpose of creating a framework for an intervention to improve safety among female youth in drinking settings. Drinking history, history of victimization, evening drinking experience, and environmental factors are assessed.Among female crossers surveyed in 2005-2006, 53% reported experiencing some type of victimization, with 29% experiencing moderate physical aggression and 38% experiencing unwanted moderate sexual incidents. Youth and reported history of verbal abuse were consistently associated with victimization with more participants frequently reporting incidents of victimization. Predictors of victimization among young females (aged 16-20) generally included environmental factors, whereas evening drinking was associated with victimization among women aged 21 and older.

Developing a theoretical foundation to change road user behavior and improve traffic safety: Driving under the influence of cannabis (DUIC).

OBJECTIVES: This study explored a theoretical model to assess the influence of culture on willingness and intention to drive under the influence of cannabis (DUIC). This model is expected to guide the design of strategies to change future DUIC behavior in road users. METHODS: This study used a survey methodology to obtain a nationally representative sample (n = 941) from the AmeriSpeak Panel. Survey items were designed to measure aspects of a proposed definition of traffic safety culture and a predictive model of its relationship to DUIC. RESULTS: Although the percentage of reported past DUIC behaviors was relatively low (8.5%), this behavior is still a significant public health issue-especially for younger drivers (18-29 years), who reported more DUIC than expected. Findings suggest that specific cultural components (attitudes, norms) reliably predict past DUIC behavior, general DUIC willingness, and future DUIC intention. Most DUIC behavior appears to be deliberate, related significantly to willingness and intention. Intention and willingness both appear to fully moderate the relationship between traffic safety culture and DUIC behavior. CONCLUSIONS: This study explored a theoretical model to understand road user behavior involving drug (cannabis)-impaired driving as a significant risk factor for traffic safety. By understanding the cultural factors that increase DUIC behavior, we can create strategies to transform this culture and sustain safer road user behavior.

Preventing alcohol-related convictions: the effect of a novel curriculum for first-time offenders on DUI recidivism.

OBJECTIVE: To determine whether DUI offenders can better avoid future drinking and driving by controlling their vehicle usage rather than by controlling their drinking. METHODS: Using a randomized experimental post-test only design, 9,571 first-time DUI offenders were randomly assigned to receive one of two 12-hour educational programs: a traditional DUI curriculum or the PARC (Preventing Alcohol-Related Convictions) curriculum, which uses a novel theoretical approach to preventing DUI recidivism. Whereas traditional programs focus on participants controlling their drinking to avoid future drinking and driving, the PARC curriculum focuses on participants controlling their driving. Instead of trying to control alcohol consumption after driving to a drinking venue (previously found to be a flawed strategy), PARC teaches students to make a decision before leaving home not to drive to a drinking event, thus greatly limiting the possibility of drinking and driving. Driving records were obtained from the Florida Department of Motor Vehicles using driver's license numbers to assess DUI recidivism rates among the students in the PARC and Traditional curricula for the first year following program participation and again at 2 years post-intervention. RESULTS: Binary logistic regression analyses revealed that offenders receiving the PARC curriculum exhibited significantly lower 1-year and 2-year recidivism rates than those receiving the Traditional curriculum. The effect was consistent across two different measures of recidivism, and across gender, race, ethnicity, and location. CONCLUSION: Results suggest that the PARC educational approach may be more effective than the traditional approach in reducing DUI recidivism.

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.