Convicted drinking and driving offenders: Comparing alcohol use before and after the pandemic outbreak.

BACKGROUND: Before the COVID-19 pandemic, very little was known about the impact of social isolation on individuals' alcohol use and misuse. This study examines how socially isolated individuals with a history of heavy drinking used alcohol during the pandemic. METHODS: Data for this study came from an add-on to the Managing Heavy Drinking (MHD) longitudinal study of drivers convicted of DWI that was conducted in Erie County, New York. Pre-COVID information (October 2019-March 2020) was augmented with a COVID-19 questionnaire collected between July and August 2020. A total of 92 participants completed the COVID-19 survey. RESULTS: The sample of problem drinkers showed a significant increase after the pandemic outbreak in the average number of drinking days from 1.99 to 2.49 per week (p = 0.047), but a significant decrease in the average number of drinks per drinking day, from 3.74 to 2.74 (p = 0.003). The proportion of individuals who drank more frequently was greater among those who, before the outbreak had an Alcohol Use Disorders Identification Test (AUDIT) score <8 (26% increase) compared with those with an AUDIT score of >8 (13%). Alcohol treatment was also associated with the frequency of drinking, with individuals who were not in alcohol treatment showing a 16% increase in frequency compared with a 10% increase among those in treatment. Further, individuals who, after the outbreak worried about their health (30%) or finances (37%) reported greater increases in the frequency of drinking than those who did not worry about their health (17%) or finances (10%). CONCLUSIONS: Overall, the individuals in our sample showed small changes in the frequency andheaviness of drinking after the outbreak of COVID-19, effects that opposite in direction from one another and thus resulted in no overall change in drinks consumed. Nonetheless, we identified factors that influenced the effects of the pandemic on drinking behavior among individuals convicted of DWI, which emphasizes the need to individualize these individuals' treatment, particularly in the context of dramatic environmental change.

Understanding non-installers of the ignition interlock device: A qualitative analysis.

INTRODUCTION: Literature notes the efficacious use of alcohol ignition interlock devices (IID) in reducing rates of drinking and driving while installed on the vehicle. Some drivers who are convicted of driving while intoxicated (DWI) elect to have their license suspended/revoked instead of installing the device. These individuals represent a high-risk subsample of drivers, yet limited literature has addressed this concern. The current study seeks to fill this gap using qualitative interviews addressing: (i) why do non-installers make the choice to not install a mandated IID; and (ii) how are non-installers managing without the IID? METHODS: The study utilises the Managing Heavy Drinkers study of drivers in Erie County, New York, USA. Participants were purposively sampled from a group of non-installers (n = 6; four females, two males) who completed semi-structured interviews. Constructed grounded theory was used to develop a theoretical understanding of participant's experiences. RESULTS: To understand why participants elect not to install the IID, thematic analysis revealed: alleviating constraints, predominantly the financial burdens associated with an IID, and institutional mistrust. Additionally, data revealed that participants are managing without the IID by mitigating apprehension. This included driving cautiously to avoid detection and utilising alternative transportation. DISCUSSION AND CONCLUSIONS: This study furthers understanding of why drivers convicted of a DWI elect not to install an IID. Future research should seek to identify barriers to IID installation. This work provides evidence for establishing institutional protocols that ensure drivers convicted of a DWI receive consistent and correct information about the IID process.

Changes in Alcohol Use and Drinking and Driving Outcomes From Before Arrest for Driving Under the Influence to After Interlock Removal.

BACKGROUND: Half of the offenders convicted of impaired driving in the United States are sentenced to install alcohol ignition interlock devices (IIDs), which prevent them from starting their vehicles if they have been drinking. No research has yet explored offenders' patterns of alcohol consumption and driving under the influence of alcohol (DUI) from the time before the arrest to the time period after the IID is installed. This study aims to fill that gap in knowledge. METHODS: Using the Timeline Follow-back interview procedure, we assessed the daily drinking of 153 convicted DUI offenders' self-reported total alcohol consumption and rates of self-reported driving after drinking over 4 phases: before DUI arrest, between arrest and IID installation, during the phase on the interlock, and after the interlock is removed. Because information about behaviors in each period was not available for every participant, comparisons were made using paired-sample contrasts. RESULTS: Compared with before the arrest, total alcohol use decreased by 50% in the 4-month phase following arrest and before IID installation, though it did not change much afterward. The frequency of drinking and driving decreased sharply after the arrest (-82%), with further decrease upon installation of the interlock (-58%, p = 0.05). The frequency of drinking and driving after the IID was removed returned to preinstallation drinking and driving status (+58%, p = 0.01). CONCLUSIONS: Participants made significant adjustments to their drinking behavior by adhering to the traditional DUI driving restrictions in the postarrest phase. Although installation of an IID was not associated with a significant change in drinking, it further reduced the frequency of drinking and driving. Evaluations of the IID experience should take into account information on an individual's drinking and DUI behaviors not only before the IID was installed, but before the individual was arrested.

Alcohol-Related Risk of Driver Fatalities in Motor Vehicle Crashes: Comparing Data From 2007 and 2013-2014.

OBJECTIVE: Using data from 2013-2014, this article aims to update alcohol-related fatal crash relative risk estimates, defined as the risk of dying in those crashes at different blood alcohol concentrations (BACs) relative to the risk of dying in a crash when sober (BAC = .00 g/dl), and to examine any change in risk that could have taken place between 2007 and 2013-2014. More specifically, we examine changes in risk among BAC = .00 g/dl drivers and among BAC > .00 g/ dl drivers. METHOD: We matched and merged crash data from the Fatality Analysis Reporting System (FARS) and exposure data from the National Roadside Survey (NRS). To the matched database we applied logistic regression to estimate the changes in relative risk. RESULTS: We found that among sober (BAC = .00 g/dl) drivers, the risk of dying in a fatal crash decreased between 2007 and 2013-2014. For drinking drivers, however, no parallel reduction in the overall contribution of alcohol to the fatal crash risk occurred. Compared with 2007, in 2013-2014 the oldest group of drivers (age ≥ 35 years) were at an elevated crash risk when driving at low BACs (.00 g/dl < BAC < .02 g/dl). CONCLUSIONS: Although the decrease in crash risk for drivers with a BAC of .00 g/dl is encouraging, the consistency of the alcohol-related risk estimates over the last two decades suggests the need to substantially strengthen current efforts to abate drinking and driving.

Methods for investigating crash risk: Comparing case-control with responsibility analysis.

OBJECTIVE: There are 2 primary methods for establishing relative risk: case-control studies, in which crash and matched control data are collected separately, and responsibility analysis, which exploits a single existing crash database by using nonresponsible drivers as an "induced exposure" control group (which is less expensive and therefore more feasible for examining the large number of substances that can impact driving behavior). Though both approaches are scientifically sound and methodologically valid, each approach has its own inherent obstacles to overcome. In this article, we examine in detail how different criteria for the development of control cases influence the accuracy of crash risk estimates for drivers with positive blood alcohol concentrations (BACs). METHODS: We applied responsibility analysis to crash-involved drivers in a recent crash case-control study, thereby providing 2 sets of control cases: Those from responsibility analysis and those from the case control study. RESULTS: Case-control and responsibility analysis crash risk curves did not differ significantly, indicating that both systems generate valid estimates of the relative crash risk of drivers on the road. CONCLUSIONS: The results suggest that when researchers are faced with finance or time constraints that make case-control studies infeasible, responsibility analysis should be considered a viable alternate methodological approach.

Association of State Alcohol Policies With Alcohol-Related Motor Vehicle Crash Fatalities Among US Adults.

Importance: Motor vehicle crashes are a leading cause of mortality. However, the association between the restrictiveness of the alcohol policy environment (ie, based on multiple existing policies) and alcohol-related crash fatalities has not been characterized previously to date. Objective: To examine the association between the restrictiveness of state alcohol policy environments and the likelihood of alcohol involvement among those dying in motor vehicle crashes in the United States. Design, Setting, and Participants: This investigation was a repeated cross-sectional study in which state alcohol policies (operationalized by the Alcohol Policy Scale [APS]) from 1999 to 2014 were related to motor vehicle crash fatalities from 2000 to 2015 using data from the Fatality Analysis Reporting System (1-year lag). Alternating logistic regression models and generalized estimating equations were used to account for clustering of multiple deaths within a crash and of multiple crashes occurring within states. The study also examined independent associations of mutually exclusive subgroups of policies, including consumption-oriented policies vs driving-oriented policies. The study setting was the 50 US states. Participants were 505 614 decedents aged at least 21 years from motor vehicle crashes from 2000 to 2015. Main Outcomes and Measures: Odds that a crash fatality was alcohol related (fatality stemmed from a crash in which ≥1 driver had a blood alcohol concentration [BAC] ≥0.08%). Results: From 2000 to 2015, there were 505 614 adult motor vehicle crash fatalities in the United States, of which 178 795 (35.4%) were alcohol related. Each 10-percentage point increase in the APS score (corresponding to more restrictive state policies) was associated with reduced individual-level odds of alcohol involvement in a crash fatality (adjusted odds ratio [aOR], 0.90; 95% CI, 0.89-0.91); results were consistent among most demographic and crash-type strata. More restrictive policies also had protective associations with alcohol involvement among crash fatalities associated with BACs from greater than 0.00% to less than 0.08%. After accounting for driving-oriented policies, consumption-oriented policies were independently protective for alcohol-related crash fatalities (aOR, 0.97; 95% CI, 0.96-0.98 based on a 10-percentage point increased APS score). Conclusions and Relevance: Strengthening alcohol policies, including those that do not specifically target impaired driving, could reduce alcohol-related crash fatalities. Policies may also protect against crash fatalities involving BAC levels below the current legal limit for driving in the United States.

Drivers with alcohol use disorders and their risks of crash involvement.

BACKGROUND: The relationship between driver blood alcohol concentration (BAC) and crash involvement is well understood. However, the role of alcohol use disorders (AUDs) (i.e., dependence or abuse) in crash occurrence, as distinguished from non-clinical heavy alcohol consumption, has not been adequately explored. METHODS: Data from the 2010-2011 Crash Risk Study conducted in Virginia Beach, VA, were used in this study. Drivers involved in crashes were compared with control drivers, and four drinker groups were examined: alcohol dependent, alcohol abusers, heavy drinkers, and all other current (i.e., normative) drinkers. Logistic regression analyses were conducted on two outcomes: having a moderate BAC (≥0.05 g/dl), and crash involvement. RESULTS: Overall, 2411 crash-involved and 5514 control drivers provided useable data, 52.4% of which were men and 70.8% Whites. The prevalence of drivers with AUDs was lower for the crash-involved drivers (8.7%) than for the control drivers (12.7%). Only heavy drinkers, but not abusive or dependent drinkers, were over four times more likely to drive with moderate BACs at nighttime. More important, at nighttime, the odds of crash involvement for dependent drinkers were only one third of those for normative drinkers. Daytime crashes, however, were more likely to involve normative drinkers than any of the other three drinker types. CONCLUSIONS: Drivers with AUDs are not more likely than normative drinkers to drive with moderate BACs at night. After accounting for the influence of BAC, dependent drinkers have a lower risk of being involved in a crash, at any time of the day.

Intercorrelation of Alcohol and Other Drug Use Disorders among a National Sample of Drivers.

This study examined the relationship between alcohol, marijuana, cocaine, and painkiller use disorders in a sample of drivers. We studied nighttime drivers aged 16 to 87 (n = 4,277) from the 2007 National Roadside Survey who reported substance use behaviors and provided breath tests for alcohol. Logistic regression analyses assessed the relationships between (1) substance (i.e., alcohol/marijuana/cocaine/pain killer) use disorders; (2) demographic characteristics; and (3) BAC levels. Overall, 13.2% of participants met criteria for marijuana use disorder, 7% met criteria for cocaine use disorder, and 15.4% met criteria for extra-medicinal painkiller use disorder. When self-report data were analyzed, three reciprocal associations emerged: (1) marijuana use disorders and alcohol use disorders were correlated; (2) marijuana use disorders and cocaine use disorders were correlated; and (3) cocaine use disorders and painkiller use disorders were correlated. BAC data revealed that marijuana and cocaine use disorders were both associated with positive BAC levels, but only cocaine use disorders were associated with BAC levels over the legal limit. Results suggest significant poly-substance use disorders in a sample of nighttime drivers, with variations by demographic characteristics. The individual and public health consequences of multiple substance use disorders among drivers are significant.

Cannabis and crash responsibility while driving below the alcohol per se legal limit.

There is a growing interest in how extensively the use of marijuana by drivers relates to crash involvement. While cognitive, lab-based studies are consistent in showing that the use of cannabis impairs driving tasks, epidemiological, field-based studies have been inconclusive regarding whether cannabis use causes an increased risk of accidents. There is ample evidence that the presence of cannabis among drivers with a BAC≥0.08g/dL highly increases the likelihood of a motor vehicle crash. Less clear, however, is the contribution of cannabis to crash risk when drivers have consumed very little or no alcohol. This effort addresses this gap in knowledge. We took advantage of a unique database that merged fatal crashes in the California Statewide Integrated Traffic Records System (SWITRS) and the Fatality Analysis Reporting System (FARS), which allows for a precise identification of crash responsibility. To account for recent increase in lab testing, we restricted our sample to cover only the years 1993-2009. A total of 4294 drivers were included in the analyses. Descriptive analyses and logistic regressions were run to model the contribution of alcohol and drugs to the likelihood of being responsible in a fatal crash. We found evidence that compared with drivers negative for alcohol and cannabis, the presence of cannabis elevates crash responsibility in fatal crashes among drivers at zero BACs (OR=1.89) and with 0

Marijuana and the Risk of Fatal Car Crashes: What Can We Learn from FARS and NRS Data?

Lab studies have shown that marijuana can severely impair driving skills. Epidemiological studies, however, have been inconclusive regarding the contribution of marijuana use to crash risk. In the United States, case-control studies based on the merging of comparable crash Fatality Analysis Reporting System (FARS) and non-crash National Roadside Survey (NRS) data have been applied to assess the contribution of drugs to crash risk, but these studies have yielded confusing, even contradictory results. We hypothesize that such a divergence of results emanates from limitations in the databases used in these studies, in particular that of the FARS. The goal of this effort is to examine this hypothesis, and in doing so, illuminate the pros and cons of using these databases for drugged-driving research efforts. We took advantage of two relatively recent cannabis crash risk studies that, despite using similar databases (the FARS and the NRS) and following similar overall approaches, yielded opposite results (Li, Brady, & Chen, 2013; Romano, Torres-Saavedra, Voas, & Lacey, 2014). By identifying methodological similarities and differences between these efforts, we assessed how the limitations of the FARS and NRS databases contributed to contradictory and biased results. Because of its limitations, we suggest that the FARS database should neither be used to examine trends in drug use nor to obtain precise risk estimates. However, under certain conditions (e.g., based on data from jurisdictions that routinely test for drugs, with as little variation in testing procedures as possible), the FARS database could be used to assess the contribution of drugs to fatal crash risk relative to other sources of risk such as alcohol.

Alcohol Policies and Alcohol-Related Motor Vehicle Crash Fatalities Among Young People in the US.

BACKGROUND: Motor vehicle crashes (MVCs) are a leading cause of death among young people in the United States. We examined the relationship between states' alcohol policy environments and alcohol-related MVC fatalities among children, adolescents, and young adults under the minimum legal drinking age of 21 years. METHODS: We used the Alcohol Policy Scale (APS), an assessment of 29 alcohol policies across 50 states and Washington, DC, developed with the assistance of an interdisciplinary Delphi panel. Using the Fatality Analysis Reporting System, we examined APS scores in relation to fatalities of people ≤20 years old from 2000 to 2013 occurring in crashes in which ≥1 involved driver had a blood alcohol content ≥0.08%. Logistic regression was used with a 1-year lag between policies and MVC fatalities and adjusted for potential confounders. RESULTS: Of 84 756 MVC fatalities of those ≤20 years old during the study period, 23 757 (28.0%) were alcohol related, including deaths of 11 006 (46.3%) drivers, 10 212 (43.0%) passengers, and 2539 (10.7%) pedestrians, cyclists, and others. People killed in alcohol-related MVCs were predominantly male (72.7%) and older (65.5% were 18-20 years old), and 51.2% were non-Hispanic white. Restrictive policy environments were associated with fewer fatalities (adjusted odds ratio, 0.91 per 10-percentage-point increase in APS score; 95% confidence interval, 0.89-0.94). The association was observed for drivers and passengers, male and female decendents, and children, adolescents, and young adults. CONCLUSIONS: More restrictive alcohol policies are associated with reduced alcohol-related MVC mortality among young people. Studies should scrutinize the relationship between policies and fatalities to highlight mechanisms.

Social Drinking Groups and Risk Experience in Nightclubs: Latent Class Analysis.

Nightclubs are a setting in which young adults purposefully seek out experiences, such as drug use and alcohol intoxication that can expose them to physical harm. While physical harm occurs fairly frequently within clubs, many patrons have safe clubbing experiences. Further, not all patrons experience potential harms the same way, as there are differences in aggression and intoxication. In this article we draw on data from a research study in which we sought to better understand the role of social drinking groups in experiences of risk within nightclubs, as the majority of patrons attend with others. We collected data from 1,642 patrons comprising 615 social drinking groups as they entered and exited nightclubs in a major U.S. city. We focused on six experiences that might cause physical harm: alcohol impairment, alcohol intoxication, drug use, physical aggression, sexual aggression, and impaired driving. We aggregated patron responses across social groups and used latent class statistical analysis to determine if and how experiences tended to co-occur within groups. This analysis indicated there were five distinct classes which we named Limited Vulnerability, Aggression Vulnerability, Substance Users, Impaired Drivers and Multi-Issue. We assessed the groups within each class for distinctions on characteristics and group context. We found differences in the groups in each class, such as groups containing romantic dyads experienced less risk, while those groups with greater familiarity, greater concern for safety, and higher expectations for consumption experienced more risk. Group composition has an impact on the experiences within a club on a given night, in particular when it comes to risk and safety assessment.

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.

Assessing the Impact of Twenty Underage Drinking Laws.

OBJECTIVE: Over the last two decades, many states have adopted several of the 20 laws that aim to control youth access to and possession of alcohol and prevent underage drinking in the United States. However, many of these laws have not been evaluated since their adoption. The objective of this study was to determine which minimum legal drinking age 21 (MLDA-21) laws currently have an effect on underage drinking-and-driving fatal crashes. METHOD: We updated the effective dates of the 20 MLDA-21 laws examined in this study and used scores of each law's strengths and weaknesses. Our structural equation model included the 20 MLDA-21 laws, impaired driving laws, seat belt safety laws, economic strength, driving exposure, beer consumption, and fatal crash ratios of drinking-to-nondrinking drivers under age 21. RESULTS: Nine MLDA-21 laws were associated with significant decreases in fatal crash ratios of underage drinking drivers: possession of alcohol (-7.7%), purchase of alcohol (-4.2%), use alcohol and lose your license (-7.9%), zero tolerance .02 blood alcohol concentration limit for underage drivers (-2.9%), age of bartender ≥21 (-4.1%), state responsible beverage service program (-3.8%), fake identification support provisions for retailers (-11.9%), dram shop liability (-2.5%), and social host civil liability (-1.7%). Two laws were associated with significant increases in the fatal crash ratios of underage drinking drivers: prohibition of furnishing alcohol to minors (+7.2%) and registration of beer kegs (+9.6%). CONCLUSIONS: The nine effective MLDA-21 laws are estimated to be currently saving approximately 1,135 lives annually, yet only five states have enacted all nine laws. If all states adopted these nine effective MLDA-21 laws, it is estimated that an additional 210 lives could be saved every year.

Can progress in reducing alcohol-impaired driving fatalities be resumed? Results of a workshop sponsored by the Transportation Research Board, Alcohol, Other Drugs, and Transportation Committee (ANB50).

OBJECTIVE: Despite successes in the 1980s and early 1990s, progress in reducing impaired driving fatalities in the United States has stagnated in recent years. Since 1997, the percentage of drivers involved in fatal crashes with illegal blood alcohol concentration (BAC) levels has remained at approximately 20 to 22%. Many experts believe that public complacency, competing social and public health issues, and the lack of political fortitude have all contributed to this stagnation. The number of alcohol-related crashes, injuries, and fatalities is still unacceptable, and most are preventable. The public needs to be aware that the problem presented by drinking drivers has not been solved. Political leaders need guidance on which measures will affect the problem, and stakeholders need to be motivated once again to implement effective strategies. METHODS: The National Academy of Sciences (NAS) Transportation Research Board (TRB), Alcohol, Other Drugs, and Transportation Committee (ANB50) sponsored a workshop held at the NAS facility in Woods Hole, Massachusetts, on August 24-25, 2015, to discuss the lack of progress in reducing impaired driving and to make recommendations for future progress. A total of 26 experts in research and policy related to alcohol-impaired driving participated in the workshop. The workshop began by examining the static situation in the rate of alcohol-impaired driving fatal crashes to determine what factors may be inhibiting further progress. The workshop then discussed 8 effective strategies that have not been fully implemented in the United States. Workshop participants (16 of the 26) rated their top 3 strategies. RESULTS: 3 strategies received the most support: 1. Impose administrative sanctions for drivers with BACs = 0.05 to 0.08 g/dL. 2. Require alcohol ignition interlocks for all alcohol-impaired driving offenders. 3. Increase the frequency of sobriety checkpoints, including enacting legislation to allow them in the 11 states that currently prohibit them. 5 other important strategies included the following: (1) increase alcohol taxes to raise the price and reduce alcohol consumption; (2) reengage the public and raise the priority of impaired driving; (3) lower the illegal per se BAC limit to 0.05 for a criminal offense; (4) develop and implement in-vehicle alcohol detection systems; and (5) expand the use of screening and brief interventions in medical facilities. CONCLUSIONS: Each of these strategies is proven to be effective, yet all are substantially underutilized. Each is used in some jurisdictions in the United States or Canada, but none is used extensively. Any one of the 3 strategies implemented on a widespread basis would decrease impaired driving crashes, injuries, and fatalities. Based on the research, all 3 together would have a substantial impact on the problem.

Drinking group characteristics related to willingness to engage in protective behaviors with the group at nightclubs.

Electronic music dance events (EMDEs) in nightclubs are settings where young adults tend to engage in high-risk behaviors, such as heavy alcohol and drug use. Consequences of these behaviors may be prevented if young adults engage in protective strategies with their drinking group. It is important to identify drinking group characteristics that predict willingness to intervene with peers. Objectives of this study were to (a) examine whether young adults at EMDEs would be willing to intervene with members of their drinking group and (b) identify both individual and group characteristics of drinking groups that predict willingness to intervene. Nightclub patrons (N = 215 individuals; 80 groups) were surveyed anonymously as they entered clubs. Individual- and group-level characteristics were measured in relation to willingness to intervene with peers. Mixed-model regressions were conducted, accounting for nesting by drinking group. Analyses show that participants were willing to intervene with their peers. Groups that knew each other well and had lower expectations for members' drinking were more willing to intervene. Women, younger, and older participants were also more willing to intervene. Findings show that club patrons are willing to intervene with their drinking groups to protect them from harmful consequences of heavy drinking and drug use. Findings indicate characteristics of both individuals and drinking groups that could be targeted in interventions among young adults largely not being reached by college interventions.

Effects of Dram Shop, Responsible Beverage Service Training, and State Alcohol Control Laws on Underage Drinking Driver Fatal Crash Ratios.

OBJECTIVES: In this study, we aimed to determine whether three minimum legal drinking age 21 (MLDA-21) laws-dram shop liability, responsible beverage service (RBS) training, and state control of alcohol sales-have had an impact on underage drinking and driving fatal crashes using annual state-level data, and compared states with strong laws to those with weak laws to examine their effect on beer consumption and fatal crash ratios. METHODS: Using the Fatality Analysis Reporting System, we calculated the ratio of drinking to nondrinking drivers under age 21 involved in fatal crashes as our key outcome measure. We used structural equation modeling to evaluate the three MLDA-21 laws. We controlled for covariates known to impact fatal crashes including: 17 additional MLDA-21 laws; administrative license revocation; blood alcohol concentration limits of.08 and.10 for driving; seat belt laws; sobriety checkpoint frequency; unemployment rates; and vehicle miles traveled. Outcome variables, in addition to the fatal crash ratios of drinking to nondrinking drivers under age 21 included state per capita beer consumption. RESULTS: Dram shop liability laws were associated with a 2.4% total effect decrease (direct effects: ß =.019, p =.018). Similarly, RBS training laws were associated with a 3.6% total effect decrease (direct effect: ß =.048, p =.001) in the ratio of drinking to nondrinking drivers under age 21 involved in fatal crashes. There was a significant relationship between dram shop liability law strength and per capita beer consumption, F (4, 1528) = 24.32, p <.001, partial η(2) =.016, showing states with strong dram shop liability laws (Mean (M) = 1.276) averaging significantly lower per capita beer consumption than states with weak laws (M = 1.340). CONCLUSIONS: Dram shop liability laws and RBS laws were both associated with significantly reduced per capita beer consumption and fatal crash ratios. In practical terms, this means that dram shop liability laws are currently associated with saving an estimated 64 lives in the 45 jurisdictions that currently have the law. If the remaining 6 states adopted the dram shop law, an additional 9 lives could potentially be saved annually. Similarly, RBS training laws are associated with saving an estimated 83 lives in the 37 jurisdictions that currently have the laws. If the remaining 14 states adopted these RBS training laws, we estimate that an additional 28 lives could potentially be saved.

Method of transportation and drinking among club patrons.

OBJECTIVE: The current study examines the variation in alcohol use among nightclub patrons under three transportation conditions: those who departed from a club using modes of transportation other than cars or motorcycles (e.g., pedestrians, bicyclists, subway riders); those who were passengers of drivers (auto/taxi passenger patrons); and those who drove from the club (driving patrons). We seek to determine whether patrons' choice for how to leave the club contributes to their risk, as assessed by blood alcohol concentrations (BAC), after controlling for other factors that may contribute to their BAC including demographic characteristics and social drinking group influences. METHODS: Data were collected from social drinking groups as they entered and exited clubs for 71 different evenings at ten clubs from 2010 through 2012. Using portal methodology, a research site was established proximal to club entrances. Each individual participant provided data on themselves and others in their group. The present analyses are based upon 1833 individuals who completed both entrance and exit data. Our outcome variable is blood alcohol content (BAC) based upon breath tests attained from patrons at entrance and exit from the club. Independent variables include method of transportation, social group characteristics, drug use, and personal characteristics. We use step-wise multiple regressions to predict entrance BAC, change in BAC from entrance to exit, and exit BAC: first entering individual demographic characteristics, then entering group characteristics, then drug use, and finally entering method of transportation (two dummy coded variables such that drivers are the referent category). RESULTS: In sum, in all three of our analyses, only three variables are consistently predictive of BAC: presence of a group member who is frequently drunk and non-driving modes of transportation, either being the passenger or taking alternate methods of transportation. In particular, taking an alternate form of transportation was consistently and strongly predictive of higher BAC. CONCLUSIONS: Additional public health messages are needed to address patrons who are no longer drinking and driving but who are nonetheless engaged in high levels of drinking that may lead to various risky outcomes, for example: being targeted for physical and/or sexual assault, pedestrian accidents, and other adverse consequences. These risks are not addressed by the focus on drinking and driving. Key messages appropriate for patrons who use alternate transportation might include devising a safety plan before entering the club and a focus on sobering up before leaving.

DUI offenders' experience with an ignition interlock program: comparing those who have and have not adapted from their primary drinking location.

OBJECTIVE: The purpose of this study was to compare driving under the influence (DUI) offenders on an alcohol ignition interlock program who had or had not changed their primary drinking context from a bar/restaurant where they might be required to drive after drinking before the interlock was installed to drinking at home where driving would not be likely to be required following interlock installation. METHODS: A total of 171 DUI offenders who were on an ignition interlock program completed a web-based survey. All of these offenders reported that they drank primarily in a bar/restaurant before the interlock was installed. These offenders were classified into 2 groups: adapters who said they currently drink at home and nonadapters who said they still drink in a bar/restaurant. Measures were made of their reported drinking, driving patterns, perceptions of the likely outcomes of being on the interlock, perceived effectiveness of various prevention strategies, and demographic characteristics. Chi-square and t-test analyses were used to compare these 2 groups. RESULTS: Adapters and nonadapters did not differ with regard to any of the demographic characteristics, whether they were a first-time DUI offender, the length of time in the interlock program, number of lockouts (being blocked from starting their cars) they had experienced, miles driven per week, or current driving patterns since being on the interlock program. Adapters were more likely to report changing their drinking plans and habits. Currently they reported fewer drinks per occasion than nonadapters. They were more likely to report reducing the amount they drink, solo drinking or only drinking with a spouse/significant other, and changing their drinking plans and habits. They were also more likely to say that the interlock reminded them to limit their drinking after it is removed and that it might have longer term benefits in preventing future DUIs. They were also more receptive to interventions that might help them separate their drinking from their driving. CONCLUSIONS: Interlock clients who report that they have altered their drinking context and a willingness to receive programs that help them separate their drinking from their driving may be more receptive to and benefit from ignition interlock programs.

Relationship of impaired-driving enforcement intensity to drinking and driving on the roads.

BACKGROUND: It is principally the area of enforcement that offers the greatest opportunity for reducing alcohol-impaired driving in the near future. How much of a reduction in drinking and driving would be achieved by how much improvement in enforcement intensity? METHODS: We developed logistic regression models to explore how enforcement intensity (6 different measures) related to the prevalence of weekend nighttime drivers in the 2007 National Roadside Survey who had been drinking (blood alcohol concentration [BAC] ≥ 0.00 g/dl), who had BACs ≥ 0.05 g/dl, and who were driving with an illegal BAC ≥ 0.08 g/dl. RESULTS: Drivers on the roads in our sample of 30 communities who were exposed to fewer than 228 traffic stops per 10,000 population aged 18 and older had 2.4 times the odds of being BAC positive, 3.6 times the odds of driving with a BAC ≥ 0.05, and 3.8 times the odds of driving with a BAC ≥ 0.08 compared to those drivers on the roads in communities with more than 1,275 traffic stops per 10,000 population. Drivers on the roads in communities with fewer than 3.7 driving under the influence (DUI) arrests per 10,000 population had 2.7 times the odds of BAC-positive drivers on the roads compared to communities with the highest intensity of DUI arrest activity (>38 DUI arrests per 10,000 population). CONCLUSIONS: The number of traffic stops and DUI arrests per capita were significantly associated with the odds of drinking and driving on the roads in these communities. This might reflect traffic enforcement visibility. The findings in this study may help law enforcement agencies around the country adjust their traffic enforcement intensity to reduce impaired driving in their community.