Assessing the value of environmental prevention programmes in reducing driving under the influence (DUI) among college students

Abstract

There is increasing concern, particularly in Europe, at the high levels of drinking in young people of college age. This level is not only high, but is on the increase. A recent survey (2004) by the European School Survey Project on Alcohol and Other Drugs (ESPAD) focused on 35 countries [1]. The survey, which looked at the habits of teenagers, found 26% of boys and 29% of girls in the United Kingdom had indulged in binge drinking at least three times in the previous month. For the purposes of the study, binge drinking was classed as having more than five alcoholic drinks in a row. Correspondingly high levels of drinking were found in Central European and Nordic countries. In the United States [2] and elsewhere, this high level of drinking has been associated with increased levels of driving after drinking alcohol. A more recent study [3] found positive relationships between modes of drinking behaviours and driving under the influence (DUI) of alcohol. In that study, heavy episodic drinking, frequency of drinking, variance of drinking and drinks per occasion all predicted DUI. Notwithstanding the value of these studies in linking drinking behaviour with drinking and driving, it needs to be borne in mind that such studies are invariably based on self-report, and the definitions of drinking after driving and DUI are not always well defined or consistent. Furthermore, similar terms such as driving while intoxicated/impaired (DWI) are frequently used, but again inconsistently defined. Measurements of actual blood alcohol concentration (BAC) in drivers, where obtainable, are much to be preferred. In the past, DUI prevention efforts have rarely targeted college students, although environmental DUI prevention campaigns have been shown to be effective in community settings. In particular, the Community Trials Project [4, 5] used a model of increased enforcement of DUI laws supported by media advocacy to reduce alcohol-related accidents. Conceptually, the combination of media coverage/campaigns and DUI checkpoints result in increased perceptions of the risk of arrest for DUI in the general population which, in turn, leads to reduced DUI and accident rates. In this issue, Clapp and colleagues [6] report on the first study to test the efficacy of an environmental DUI prevention intervention in a college community. The results, which were again based on self-report surveys, compare reported drinking after driving of an experimental group of students at a college exposed to an intervention programme with those at a college without such a programme. The results reveal a considerable drop in self-reported driving after drinking following the DUI prevention campaign at the intervention campus. However, no similar drop was found at the comparison university. Furthermore, analysis of perceived risk for DUI arrest revealed a statistically significant increase in risk perception before and after survey at the experimental, but not in the control campus. Given the high levels of drinking world-wide among students of college age, account should also be taken of lessons from more general drink driving interventions. A recent special issue of the journal Traffic Injury Prevention[7] focused on alcohol and drug-impaired driving. This issue contains up-to-date international reviews of drink driving interventions, which although not specific to young college students, are likely to be widely applicable to this group of drivers. These include reviews of world-wide trends in drinking and driving, preventing drink driving using alcohol policy, preventing alcohol-related injury: a health promotion approach, sobriety checkpoints: evidence of effectiveness, and the prevention of young driver's DWI: a social–sequential model. Further studies are needed to test environmental DUI prevention campaigns across different college settings and student groups, both in the United States and in Europe. Ideally, these studies should use roadside surveys of blood alcohol concentration [8] rather than self-report surveys to assess actual DUI. Such surveys show that the levels of BAC vary widely across age and Socio-Economic group (SEG). These conclusions are also likely to be applicable to variations in the student population. Furthermore, measures of BAC level provide a much better measure of actual road safety risk associated with alcohol and this risk has been recently reassessed and documented [9]. Finally, the value of such surveys would be greatly enhanced if they were linked to attitudinal and behavioural studies of student drivers which could throw light on the aetiology of DUI in this very important group. Specific countermeasures and preventative programmes could then be drawn up to address the problem more effectively.