Impact of the program life in traffic and new zero-tolerance drinking and driving law on the prevalence of driving after alcohol abuse in Brazilian capitals: An interrupted time series analysis.

INTRODUCTION: Driving under the influence of alcohol is one of the main factors for morbidity and mortality from traffic accidents. In 2010 and 2013, the Program Life in Traffic was implemented in Brazil, including the international initiative "Road Safety in Ten Countries", which established actions to reduce one of the main risk factors for road traffic injuries, the driving under the influence of alcohol. In 2012, a new zero-tolerance drinking and driving law (new dry law) was implemented, establishing a zero-tolerance limit for the drivers' blood alcohol concentration, and increasing punitive measures. This study aimed at analyzing the impact of these measures on the prevalence of driving under the influence of alcohol abuse in Brazilian capitals. METHODS: An interrupted time series study was conducted using the models of autoregressive integrated moving average or seasonal autoregressive integrated moving average. The main outcome was the prevalence of driving after alcohol abuse in the adult population (≥ 18 years). The model's predictors were the interventions "Program Life in Traffic" and "New Dry Law". The former was implemented in the first quarter of 2011, initially in five capitals: Belo Horizonte, Campo Grande, Palmas, Teresina, and Curitiba, being expanded to the other capitals in the first quarter of 2013. The latter was implemented in the country on the first quarter of 2013. Data source for the study was the records of the surveillance system for risk and protection factors of chronic diseases through telephone survey (Vigitel) from 2007 to 2016. RESULTS: The time intervals considered in the study were the quarters. Thirty-eight units were considered in the analysis, corresponding to time series points. It was found that after the implementation of the Program Life in Traffic, in the first quarter of 2011, there was a reduction in the prevalence in Belo Horizonte and Curitiba. Because the introduction of the New Dry Law and the Program Life in Traffic took place in similar periods in the other cities, there was a significant reduction in the outcome prevalence in the cities of Aracaju, Belo Horizonte, Boa Vista, Fortaleza, João Pessoa, Maceió, Manaus, Palmas, Porto Alegre, Recife, Teresina, Rio Branco, and Vitória following the law application. CONCLUSION: The present study identified an immediate impact of the Program Life in Traffic in two capitals (Belo Horizonte and Curitiba) and a joint impact of the New Dry Law in 13 capitals. The results of this study have implications for strengthening interventions aimed at reducing the burden of morbidity and mortality from traffic accidents in Brazil.

Drunk driving policies and breath test refusal in Taiwan.

OBJECTIVE: Driving under the influence (DUI) is one of the major causes of traffic crashes in Taiwan, leading to huge medical expenditures and human capital loss. Although the authorities have enacted several policies to reduce drunk driving, most penalties are based on drunk drivers' alcohol levels. According to Taiwan regulations, drivers could pay a fine to refuse the breath test if they are not involved in a traffic collision, and there is no clear evidence showing that they are DUI. Therefore, increased sanctions for DUI may lead to increased breath test refusals. If breath tests for drunk driving could be refused with little or no punishments for drivers, then the detection of behavioral impairment would weaken, and the deterrent effect of DUI punishment would be limited. METHOD: This research uses interrupted time-series analysis (ITSA) to examine how policy reforms from 2007 to 2020 affected driver's breath refusal rate in Taiwan. RESULTS: We find that said reforms that exclusively increase the punishment of DUI offenders did raise the refusal rate immediately and persistently, suggesting that more drunk drivers would refuse a breath test to avoid more severe DUI punishment. Policy reforms that increase penalties for drivers refusing to take breath tests may instantly lower the refusal rate, but the long-term effects are contingent upon the DUI punishment. CONCLUSIONS: It appears that drunk drivers could still decide on breath test refusal to avoid a DUI conviction if the punishment for refusing the test is less severe than that for DUI. Aggravating penalties for refusing breath tests would decrease the refusal rate and help reinforce DUI's deterrent effect.

Daily level predictors of impaired driving behaviors in young adults: Protocol design for utilizing daily assessments.

BACKGROUND: Motor vehicle crashes remain a leading cause of death among young adults (ages 18-25) in the United States. Many drivers implicated in these crashes are under the influence of alcohol, cannabis, or the simultaneous use of alcohol and cannabis. Extremely limited research has assessed impaired driving behaviors and their predictors at the daily level. Perceived norms and motives to use substances have empirical support suggesting they may impact impaired driving-related behavior. Novel approaches to assess these associations at the daily level are needed and may inform future intervention and prevention programs. OBJECTIVE: The goal of the current study is to utilize electronic daily assessments to assess driving under the influence of alcohol, cannabis, or simultaneous use and riding with a driver impaired by these substances to assess variability and predictors of these impaired driving-related behaviors at the daily level. This present manuscript details a protocol, measures, and a plan of analyses to assess how within-person differences in perceived norms and motives to use are associated with the likelihood of engaging in impaired driving-related behaviors. METHODS: Participants include young adults in Washington State who report simultaneous use in the past month and either driving under the influence of alcohol, cannabis, or simultaneous use, or riding with a driver under the influence of both substances in the past 6 months. Individuals who verify their identity and meet eligibility requirements will complete a baseline assessment after which they will be scheduled for training on the daily assessment procedure via Zoom. Next, they will be invited to complete daily surveys on Thursday, Friday, Saturday, and Sunday every other week for 6 months and a 6-month follow up assessment. Analyses will utilize multilevel models with days nested within individuals. RESULTS: The study is currently recruiting participants. A total of 192 participants have been recruited and 100 have completed the study protocol. Data collection is expected to be completed in Fall 2022. CONCLUSIONS: This study utilizes a novel design to assess impaired driving and predictors at the daily level among young adults at high risk of impaired driving-related behaviors. Findings will provide unique data that will shape the knowledge base in the field of social science and public health substance use research and that may be helpful for future prevention and intervention efforts on impaired driving.

Predicting drunk driving using a variant of the implicit association test.

INTRODUCTION: Drunk driving is one of the primary causes of road traffic injuries and fatalities. A possible approach to reduce drunk driving rates is to identify which individuals are at risk of such behavior and establish targeted prevention. Simply asking individuals about drunk driving in real-world contexts would be problematic because of potential deception. The use of implicit measures such as the Implicit Association Test (IAT) could overcome this problem because they are less controllable than self-reports and thus less susceptible to deception. However, previous studies have shown poor predictive utility of implicit measures for drunk driving behavior. The current studies aimed to test the predictive utility of a variant of the IAT designed to assess beliefs about past driving under the influence (the P-DUI-IAT). METHOD: Study 1 (N = 216) tested whether the P-DUI-IAT could predict self-reported prior drunk driving and future likelihood of drunk driving. We also examined incremental predictive validity of the P-DUI-IAT for these outcomes. Study 2 (N = 159) examined whether results from Study 1 were reproducible. RESULTS: In both studies, results showed that the P-DUI-IAT discriminated well between participants who had engaged in drunk driving and participants who had not. The P-DUI-IAT also showed independent and incremental predictive validity for past drunk driving and future likelihood of drunk driving. CONCLUSIONS: These studies provided initial evidence for the predictive utility of the P-DUI-IAT for drunk driving. PRACTICAL APPLICATIONS: The P-DUI-IAT is a promising tool for identifying which individuals are at risk of drunk driving. The application of this measure could especially be valuable for identifying young novice drivers at risk for drunk driving-related accidents.

A systematic review of factors associated with illegal drug driving.

Drug driving is a serious problem worldwide that can increase the risk of road crashes. This systematic review seeks to identify factors associated with drug driving (i.e., driving after consuming drugs other than alcohol) to highlight gaps in existing knowledge and inform the design of more effective countermeasures. A search of the literature was conducted for the period January 1, 2005 to July 31, 2021 using six different databases. The search protocol followed PRISMA guidelines and was registered in PROSPERO (#CRD42021234616). Studies that met inclusion criteria compared drug drivers with either non-drug drivers, alcohol-only drivers or drug drivers from an earlier time period, to identify factors specifically associated with drug driving, rather than common to all drivers. Two hundred and nineteen publications met the inclusion criteria and were included within the review. Based on the findings, a logic model was developed that presents the factors associated with drug driving. Various sociodemographic, psychosocial and legal factors emerged as the main factors associated with illegal drug driving. At the sociodemographic and psychological levels, drug drivers were more likely to be single, young males who often drive after using cannabis and who score high on sensation-seeking and impulsivity scales. The key social factor found to be associated with drug driving was peer acceptance/disapproval of the behaviour. At the legal level, the review suggested that the effectiveness of current enforcement approaches to drug driving vary among jurisdictions around the world due to differences in the level of perceived certainty of apprehension and the chances of punishment avoidance. Future research into the anticipated and actual rewards for drug driving is needed to inform the development of more effective countermeasures.

Mapping the complex causal mechanisms of drinking and driving behaviors among adolescents and young adults.

BACKGROUND: The proportion of motor vehicle crash fatalities involving alcohol-impaired drivers declined substantially between 1982 and 1997, but progress stopped after 1997. The systemic complexity of alcohol-impaired driving contributes to the persistence of this problem. This study aims to identify and map key feedback mechanisms that affect alcohol-impaired driving among adolescents and young adults in the U.S. METHODS: We apply the system dynamics approach to the problem of alcohol-impaired driving and bring a feedback perspective for understanding drivers and inhibitors of the problem. The causal loop diagram (i.e., map of dynamic hypotheses about the structure of the system producing observed behaviors over time) developed in this study is based on the output of two group model building sessions conducted with multidisciplinary subject-matter experts bolstered with extensive literature review. RESULTS: The causal loop diagram depicts diverse influences on youth impaired driving including parents, peers, policies, law enforcement, and the alcohol industry. Embedded in these feedback loops are the physical flow of youth between the categories of abstainers, drinkers who do not drive after drinking, and drinkers who drive after drinking. We identify key inertial factors, discuss how delay and feedback processes affect observed behaviors over time, and suggest strategies to reduce youth impaired driving. CONCLUSION: This review presents the first causal loop diagram of alcohol-impaired driving among adolescents and it is a vital first step toward quantitative simulation modeling of the problem. Through continued research, this model could provide a powerful tool for understanding the systemic complexity of impaired driving among adolescents, and identifying effective prevention practices and policies to reduce youth impaired driving.

Can't simply roll it out: Evaluating a real-world virtual reality intervention to reduce driving under the influence.

Driving under the influence (DUI) increases the risk of crashes. Emerging technologies, such as virtual reality (VR), represent potentially powerful and attractive tools for the prevention of risky behaviours, such as DUI. Therefore, they are embraced in prevention efforts with VR interventions primed to grow in popularity in near future. However, little is known about the actual effectiveness of such DUI-targeting VR interventions. To help fill the knowledge gap, this study explored the effects of one VR intervention as delivered in the real world. Using pre and post test design, including an intervention group (n = 98) and a control group (n = 39), the intervention evaluation examined young drivers' (aged 18 to 25, no known history of DUI) intention and self-reported behaviour three months after the intervention as compared to the baseline. The results did not provide evidence for statistically significant effects of the VR intervention on self-reported DUI behaviour during the three months post intervention and DUI intention at three months post intervention. Such results might be due to the fact that the recruited participants generally self-reported little DUI behaviour, i.e. positively changing behaviour that is already positive is inherently challenging. Nevertheless, the results question the utility of funding the roll-out of arguably attractive technologies without a thorough understanding of their effectiveness in particular settings. To improve the potential for future positive outcomes of such interventions, we provide suggestions on how VR software might be further developed and, subsequently, leveraged in future research to improve the likelihood for behavioural change, e.g. by collecting, analysing and presenting objective driving performance data. Alternatively, future endeavours might focus on participants with known DUI history and examine the effects of the VR intervention for this particular higher-risk group.

Driver monitoring systems (DMS): The future of impaired driving management?

OBJECTIVE: Driver monitoring systems (DMS) are the next generation of vehicle safety technology. Broadly, these refer to the embedded, aftermarket wearable or vehicle-mounted devices that collect observable information about the operator to make real-time assessment of their capacity to perform the driving task. Integrating biobehavioral monitoring (primarily ocular metrics) with driving performance assessments, these systems function to infer driver state in real time to identify operator conditions that negatively affect driving (such as fatigue, inattention, or distraction). METHOD: We review available methods used to infer driver state, as referenced against accepted models for optimal performance. Modeling our observations on deviation from predetermined performance thresholds used to trigger graded safety alerts, we suggest that many psychoactive substances produce alterations to biobehavioral processes including attentional and motor control, which affect performance indices in a manner already arguably captured by these technologies. RESULTS: Using these existing frameworks, there is considerable potential to similarly catalogue the effect of many common intoxicants known to negatively affect driving ability. This will provide safety-relevant and practical biological models for the development of next-generation multimodal DMS that integrate ocular and physiological variables sensitive to the effects of common and emergent psychoactive substances. CONCLUSION: These devices have tangible potential application across all areas of transportation, including aviation, rail, and all commercial and private vehicle systems.

Associating ridesourcing with road safety outcomes: Insights from Austin, Texas.

Improving road safety and setting targets for reducing traffic-related crashes and deaths are highlighted as part of the United Nations sustainable development goals and worldwide vision zero efforts. The advent of transportation network companies and ridesourcing expands mobility options in cities and may impact road safety outcomes. We analyze the effects of ridesourcing use on road crashes, injuries, fatalities, and driving while intoxicated (DWI) offenses in Travis County, Texas. Our approach leverages real-time ridesourcing volume to explain variation in road safety outcomes. Spatial panel data models with fixed-effects are deployed to examine whether the use of ridesourcing is significantly associated with road crashes and other safety metrics. Our results suggest that for a 10% increase in ridesourcing trips, we expect a 0.12% decrease in road crashes, a 0.25% decrease in road injuries, and a 0.36% decrease in DWI offenses in Travis County. On the other hand, ridesourcing use is not significantly associated with road fatalities. This study augments existing work because it moves beyond binary indicators of ridesourcing availability and analyzes crash and ridesourcing trips patterns within an urbanized area rather than their metropolitan-level variation. Contributions include developing a data-rich approach for assessing the impacts of ridesourcing use on the transportation system's safety, which may serve as a template for future analyses for other cities. Our findings provide feedback to policymakers by clarifying associations between ridesourcing use and traffic safety and uncover the potential to achieve safer mobility systems with transportation network companies.

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.

Alcohol-involved motor vehicle crashes and the size and duration of random breath testing checkpoints.

OBJECTIVE: Sobriety checkpoints have strong empirical and theoretical support as an intervention to reduce alcohol-involved motor vehicle crashes. The purpose of this study was to examine whether checkpoint size (the number of police officers) and checkpoint duration (the amount of time in operation) affect associations between individual checkpoints and subsequent alcohol-related crash incidence. METHOD: Queensland Police Service provided latitude-longitude coordinates and date and time data for all breath tests that occurred in Brisbane, Australia, from January 2012 to June 2018. We applied hierarchical cluster analysis to the latitude-longitude coordinates for breath tests, identifying checkpoints as clusters of ≥25 breath tests conducted by ≥3 breath testing devices over a duration of 3 to 8 hours. Generalized linear autoregressive moving average (GLARMA) models related counts of alcohol-involved motor vehicle crashes to the number of checkpoints conducted per week, as well as 1 week prior and 2 weeks prior. RESULTS: A total of 3420 alcohol-related crashes occurred and 2069 checkpoints were conducted in Brisbane over the 6.5-year (339-week) study period. On average, checkpoints included a mean of 266.0 breath tests (SD = 216.3), 16.4 devices (SD = 13.7), and were 286.3 minutes in duration (SD = 104.2). Each 10 additional checkpoints were associated with a 12% decrease in crash incidence at a lag of 1 week (IRR = 0.88; 95%CI: 0.80, 0.97). We detected no differential associations according to checkpoint size or duration. CONCLUSIONS: Sobriety checkpoints are associated with fewer alcohol-related motor vehicle crashes for around 1 week. Checkpoint size and duration do not appear to affect this relationship.

Strategies for accelerating the implementation of non-intrusive alcohol detection systems in the vehicle fleet.

INTRODUCTION: Crashes involving drinking drivers represent as much as one-third of all fatal crashes around the world. Progress has been made in reducing this toll through a series of interventions that attempt to discourage driving while intoxicated (DWI) and reoffending among drivers who have been convicted of DWI. However, these approaches cannot eliminate the problem. In-vehicle technologies are being developed, such as the Driver Alcohol Detection System for Safety-commonly referred to as DADSS-that have the potential to prevent alcohol-impaired drivers from driving their vehicles. DADSS in-vehicle sensors are designed to quickly detect whether drivers have been drinking and accurately and precisely measure blood or breath alcohol concentration. If the driver's alcohol concentration measures at or above a set limit, the vehicle will be prevented from moving. METHOD: The DADSS technology is expected to be ready for real-world applications in the next few years. The implementation of this technology in vehicles promises to prevent thousands of deaths and injuries every year. This paper investigates approaches that have been used in various countries to accelerate the deployment of innovative vehicle safety technologies beginning with its initial implementation in vehicles through to its more widespread use. RESULTS: Various approaches were identified that can smooth and accelerate the deployment of in-vehicle alcohol detection devices. Recommendations are made regarding the most promising approaches to use initially and over time, as the body of evidence regarding their effectiveness grows. CONCLUSIONS: This paper provides guidelines for how best to stimulate the widespread adoption of in-vehicle alcohol-detection technology as a preventive measure so that its life-saving potential can be realized both in the United States and in other countries that may be open to the implementation of DADSS.

Ride hailing app use and drunk/drugged driving among young adult nightclub patrons.

OBJECTIVE: Nightclub patrons who consume alcohol and drugs in these venues would appear to be an important population to target with on-demand ride hailing app (RHA) services to reduce drunk/drugged driving (DUI). The present study is an exploratory examination of RHA use to avoid DUI behavior, as well as the perceived barriers and benefits of such RHA use, among young adult nightclub patrons in Miami who use drugs. METHODS: Completers of a 2011-2015 randomized controlled trial of brief interventions to reduce health risk behaviors among young adult nightclub patrons were recruited to participate in a single self-administered computer-assisted interview about health risks, driving behaviors, and RHA perceptions and use. Recruitment (N = 123) began in June 2016 and ended in July 2017. Bivariable logistic regression and ANOVA models examined group differences between: (a) those who had used an RHA to avoid DUI vs. not; and (b) those who used RHAs as their primary mode of transportation to nightclubs vs. not. RESULTS: About half were female (52.8%); median age was 29; 59.4% Hispanic, 31.7% Black, 8.1% white, 0.8% other race/ethnicity. Recent alcohol and marijuana use were almost universally endorsed, and more than half reported recent use/misuse of cocaine (72.4%), MDMA (63.4%), and prescription benzodiazepines (62.6%) and opioids (56.9%). More than 80% reported driving under the influence of alcohol and/or drugs in the past 12 months, and 17.1% experienced a DUI arrest in the prior two years. Almost two-thirds (65.9%) of participants had used an on-demand RHA to avoid DUI, but self-driving or riding in another's car were the most common (76.4%) primary modes of transportation to clubs. RHAs were the primary mode of travel to clubs for 21 (17.1%) respondents. Participants whose friends strongly disapproved of DUI were more than twice as likely to have used RHAs for this reason compared to those who had not done so. Those reporting RHA use to avoid DUI were less likely than others to have driven under the influence in the past 12 months and were somewhat more likely to endorse DUI-related risks. Those who used alternate modes of transportation were more likely than those who used RHAs as their primary mode of transportation to clubs to endorse the expense of RHAs and the lack of RHA drivers near their favorite clubs as barriers to RHA use to travel to nightclubs. CONCLUSIONS: This novel study among a high-risk population points to the potential for on-demand RHAs to reduce DUI behaviors and arrests among young adult nightclub patrons who consume alcohol and/or drugs in the context of the club experience. Our findings point to key educational, peer support, and structural targets for intervention to increase the use of RHAs among this population, specifically, club-based incentives for increasing RHA availability and affordability. Research is needed to fully elucidate the findings of this exploratory study, including potential differences in intervention approaches depending on the location-specific public transportation options.

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.

Potential lives saved by in-vehicle alcohol detection systems.

OBJECTIVES: The objective of this study was to estimate the number of crash deaths specifically attributable to alcohol-impaired driving, with a focus on various strategies for introducing vehicle-based solutions. If alcohol detection systems are standard in all new vehicles, how many lives could be saved in the near term, and how long will it take to essentially eliminate alcohol-impaired driving? Alternatively, if such systems are offered as an option, how many lives could be saved? METHODS: Fatal crashes in the United States during 2015-2018 were classified by the highest driver blood alcohol concentration (BAC) and the corresponding age category of that driver. Based on the estimates of relative risk (RR) for a given driver group, eliminating alcohol in the driver's blood should lower risk by the attributable proportion, 1 - 1/RR. Multiplying this quantity by the number of deaths for the driver group yielded the estimated number of lives potentially saved if the BACs were reduced to zero. RESULTS: Systems that restrict drivers with any BAC could prevent nearly 12,000 deaths per year, while systems that restrict BAC to less than 0.08 g/dL could prevent more than 9,000 deaths. Within 3 years of a mandate for vehicle-based alcohol detection systems, it is expected that the annual lives saved would be between 1,000 and 1,300. Within 6 years, it would be between 2,000 and 2,600 lives saved per year, and within 12 years it would be between 4,600 and 5,900 lives saved per year. A system required only for those convicted of alcohol-impaired driving could save between 800 and 1,000 lives per year. A system available only to fleets of vehicles could save between 300 and 500 lives per year. CONCLUSIONS: Vehicle-based interventions will not immediately solve the problem of alcohol-impaired driving, but they are an important component of the overall strategy. Even if required as standard equipment in all new vehicles, it will take 12 years before there are enough to reach more than half of their potential. If vehicle-based interventions are instead voluntary or introduced as options, then progress toward a solution will be much slower.

Long-term effectiveness of the alcohol ignition interlock programme: A retrospective cohort study in the Netherlands.

This article provides an evaluation of the long-term effectiveness of the Alcohol Ignition Interlock Programme (AIIP) on recidivism. A retrospective cohort design was used to compare the known reoffending behaviour of 1676 AIIP participants with that of 907 persons in a control group, consisting of offenders who committed an AIIP-worthy driving-under-the-influence (DUI) offence that was not reported to the Dutch driving license authority. Persons in the control group were not sanctioned with an AIIP, but had their case settled in the criminal court. Our outcome measure was the percentage of offenders who committed at least one new DUI offence within the follow-up period. Results indicate that the percentage of repeat offenders in the AIIP group was lower than in the control group. Additional analyses indicate that were an AIIP to be imposed alongside a criminal settlement, a recidivism reduction of 4 percentage points (4 % versus 8 %) could be expected. This would translate to a relative decrease of 54 %. Explanations for these findings are discussed.

The effectiveness of alternative transportation programs in reducing impaired driving: A literature review and synthesis.

INTRODUCTION: Studies have shown that approximately half of arrested intoxicated drivers had their last alcoholic drink at a licensed bar or restaurant. Current efforts to prevent intoxicated patrons from leaving licensed establishments and driving home have been only partially successful. Since a high proportion of drinkers drive to their drinking destination, promoting the use of alternative transportation (AT) - including safe ride shuttles, free or subsidized taxi and ridesharing services, voluntary or paid designated driver programs, and more accessible public transportation - is an important strategy for preventing impaired driving. The primary goal of this study was to review and synthesize the findings of research studies designed to test the effectiveness of AT programs in reducing alcohol-impaired driving. A secondary goal was to report if using AT has led to any unintended consequences, in particular greater alcohol consumption. METHOD: We identified relevant academic articles, new articles, government reports, and other documents (English only) through the University of Chicago library, Google Scholar, and Google Search. We also included published articles recommended by peers. Key search terms included: alternative transportation; safe rides; designated driver; alcohol-impaired driving; alcohol consumption, cost effectiveness; and reduce drunk driving. Initially, we identified 168 potentially relevant sources, of which only 57 were academic articles. After a thorough review, we narrowed down the number of relevant articles to 125 including some background articles and government reports. RESULTS: Some AT programs produced reductions in one or more of the following outcomes: (1) impaired driving; (2) impaired driving crashes; (3) driving under the influence (DUI) arrests; and (4) traffic crashes in general, but others were not shown to be effective. A few programs resulted in greater self-reported alcohol use, but there were no significant findings indicating that drinking when using AT led to an increase in alcohol-related harms such as public intoxication, assaults, or other alcohol-related crime. Of the studies that conducted a cost-benefit analysis, most showed that AT programs yielded a positive benefit, but these studies did not include a sufficient number of variables to be considered true cost-benefit analyses. CONCLUSIONS: There is mixed evidence regarding the effectiveness of AT programs. Evaluations with more rigorous quasi-experimental and experimental designs are needed to identify which types of AT programs work best for different types of communities and target groups. Practical Applications: The literature review and synthesis revealed that the most successful AT programs typically have some of these attributes: (1) social acceptance; (2) high level of public awareness; (3) low cost; (4) year-round availability; (5) provide rides to and from drinking venues; (6) several sponsors that provide funding); (7) user convenience; and (8) perceived safety.

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.