Long-term effects of the German zero tolerance law for novice drivers.

INTRODUCTION: In 2007, the German legislature introduced a zero tolerance law (ZTL) for novice drivers to reduce the number of alcohol-related crashes. The purpose of our study was to evaluate the long-term effects of this law on current and former novice drivers. METHOD: Our approach was threefold: first, we used individual data of police records from 2003-2018 and conducted a cohort analysis to examine how the first cohort affected by the law responded in the long-term. Second, we analyzed the influence of the ZTL on alcohol-related traffic offenses by current novice drivers. Third, we conducted a survey to examine if the acceptance, knowledge, and behavior regarding the ZTL have changed compared to a decade ago. RESULTS: The number of alcohol-related crashes was significantly lower in the first affected cohort than in earlier cohorts. Moreover, current novice drivers had lower levels of alcohol-related crashes and alcohol-related traffic offenses than did novice drivers before the ZTL became effective. The survey showed a high level of acceptance and knowledge in both current and first cohort and a decreased importance of drinking and driving. CONCLUSION: The ZTL is associated with a long-term increase of traffic safety in Germany. Former novice drivers appear to have retained learned behavior toward drinking and driving. Thus, the ZTL might have an impact on perceived norms resulting in less acceptance of drinking and driving. Changes in society, like lower alcohol consumption and decreased importance of passenger cars among young people, further accelerated these effects. Practical applications: ZTL for novice drivers are an effective way to improve traffic safety. It is associated with a positive effect on traffic safety even when drivers were no longer directly affected by the measure. These findings suggest that policies are an effective tool to improve traffic safety and help towards achieving Vision Zero.

The case-area targeted rapid response strategy to control cholera in Haiti: a four-year implementation study.

BACKGROUND: In October 2010, Haiti was struck by a large-scale cholera epidemic. The Haitian government, UNICEF and other international partners launched an unprecedented nationwide alert-response strategy in July 2013. Coordinated NGOs recruited local rapid response mobile teams to conduct case-area targeted interventions (CATIs), including education sessions, household decontamination by chlorine spraying, and distribution of chlorine tablets. An innovative red-orange-green alert system was also established to monitor the epidemic at the communal scale on a weekly basis. Our study aimed to describe and evaluate the exhaustiveness, intensity and quality of the CATIs in response to cholera alerts in Haiti between July 2013 and June 2017. METHODOLOGY/PRINCIPAL FINDINGS: We analyzed the response to 7,856 weekly cholera alerts using routine surveillance data and severity criteria, which was based on the details of 31,306 notified CATIs. The odds of CATI response during the same week (exhaustiveness) and the number of complete CATIs in responded alerts (intensity and quality) were estimated using multivariate generalized linear mixed models and several covariates. CATIs were carried out significantly more often in response to red alerts (adjusted odds ratio (aOR) [95%-confidence interval, 95%-CI], 2.52 [2.22-2.87]) compared with orange alerts. Significantly more complete CATIs were carried out in response to red alerts compared with orange alerts (adjusted incidence ratio (aIR), 1.85 [1.73-1.99]). Over the course of the eight-semester study, we observed a significant improvement in the exhaustiveness (aOR, 1.43 [1.38-1.48] per semester) as well as the intensity and quality (aIR, 1.23 [1.2-1.25] per semester) of CATI responses, independently of funds available for the strategy. The odds of launching a CATI response significantly decreased with increased rainfall (aOR, 0.99 [0.97-1] per each accumulated cm). Response interventions were significantly heterogeneous between NGOs, communes and departments. CONCLUSIONS/SIGNIFICANCE: The implementation of a nationwide case-area targeted rapid response strategy to control cholera in Haiti was feasible albeit with certain obstacles. Such feedback from the field and ongoing impact studies will be very informative for actors and international donors involved in cholera control and elimination in Haiti and in other affected countries.