Alcohol-related Motor Vehicle Crashes Research Articles

Long-Term Effects of a Multi-Component Community-Level Intervention to Reduce Single Vehicle Nighttime Crashes: Follow up Findings from a 24-Community Randomized Trial.

This follow up study examines whether a multi-component, high-visibility alcohol enforcement intervention implemented in 12 California cities had long-term effects on alcohol-related motor vehicle crashes beyond the time period of the original study. Previous results indicated a significant reduction in single vehicle nighttime (SVN) crashes among 15 to 30-year-olds in intervention cities relative to controls (Saltz et al., 2021). A randomized trial was conducted with 24 randomly chosen California cities from 2012 to 2017 to evaluate a multi-component intervention to reduce excessive drinking and driving while impaired among adolescents and young adults. Twelve of the cities were randomly assigned to the intervention condition and implemented high-visibility alcohol enforcement operations and other components from April 2013 to March 2016. Multi-level negative binomial regression analyses were conducted with motor vehicle crash data from 2010 to 2021 to examine whether single vehicle nighttime (SVN) crashes among 15 to 30-year-olds decreased in intervention cities relative to controls after the multi-component intervention was implemented. Analyses controlled for community sociodemographic characteristics, the overall time trend, the COVID pandemic, and pre-intervention levels of SVN crashes and adjusted for correlation of repeated observations within cities over time. Regression analyses indicated a significantly lower level of monthly SVN crashes among 15-to-30-year-olds in intervention cities during post-intervention months through 2021 relative to control cities [Event Rate Ratio (95%CI) = 0.88 (0.79, 0.98), p<.05] when controlling for community sociodemographic characteristics, the overall time trend, COVID, and pre-intervention levels of SVN crashes. Study findings suggest that a multi-component, high-visibility alcohol enforcement intervention can have long-term effects on alcohol-related motor vehicle crashes and related injuries and fatalities among adolescent and young adult drivers.

Alcohol-related non-fatal motor vehicle crash injury in the US from 2019 to 2022

ABSTRACT Background: Information on recent alcohol-related non-fatal motor vehicle crash (MVC) injuries is limited. Objectives: To analyze alcohol-related non-fatal MVC injuries, 2019–2022, considering COVID-19 and Stay-at-Home policies. Methods: State-level counts of alcohol-related non-fatal MVC injuries (involving individuals age 15+) from Emergency Medical Services data in 18 US states, chosen for comprehensive coverage, were analyzed for the annual rate. The total non-fatal MVC injury count in each state served as the denominator. We used analysis of variance to evaluate annual rate changes from 2019 to 2022 and used robust Poisson regression to compare annual mean rates to the 2019 baseline, pre-pandemic, excluding Quarter 1 due to COVID-19’s onset in Quarter 2. Additional Poisson models compared rate changes by 2020 Stay-at-Home policies. Results: Data from 18 states were utilized (N = 1,487,626, 49.5% male). When evaluating rate changes of alcohol-related non-fatal MVC injuries from period 1 (Q2–4 2019) through period 4 (Q2–4 2022), the rate significantly increased from period 1 (2019) to period 2 (2020) by 0.024 (p = .003), then decreased from period 2 to period 4 (2022) by 0.016 (p = .04). Compared to the baseline (period 1), the rate in period 2 was 1.27 times higher. States with a 2020 Stay-at-Home policy, compared to those without, had a 30% lower rate (p = .05) of alcohol-related non-fatal MVC injuries. States with partial and mandatory Stay-at-Home policies had a 5.2% (p = .01) and 10.5% (p < .001) annual rate decrease, respectively. Conclusion: Alcohol-related non-fatal MVC injury rates increased initially (2019–2020) but decreased thereafter (2020–2022). Stay-at-home policies effectively reduced these rates.

Impact of alcohol driving-while-impaired license suspension duration on future alcohol-related license events and motor vehicle crash involvement in North Carolina, 2007 to 2016

Background/PurposeLicense suspensions are a strategy to address alcohol-impaired driving behavior and recidivism following an alcohol driving while impaired (alcohol-DWI) conviction. Little is known about the specific impacts of conviction-related suspensions on safety outcomes and given recent fluctuations in alcohol-impaired driving behavior, crashes, and suspension trends, updated and focused assessments of this intervention are necessary. This study aimed to 1) examine the association between type of recent alcohol-DWI suspension and having a secondary alcohol-related license outcome and/or future crash event in North Carolina (NC) between 2007 and 2016; and 2) assess potential modification of these associations by race/ethnicity. MethodsWe used linked NC licensing data, NC crash data, and county-level contextual data from a variety of data sources. We compared individuals ages 21 to 64 who sustained initial (1-year) versus repeat (4-year) suspensions for alcohol-related license and crash involvement outcomes. We estimated unadjusted and adjusted hazard ratios (aHRs) using Cox proportional hazards models and produced Kaplan-Meier (KM) survival curves using a three-year follow-up period. After observing statistically significant modification by race/ethnicity, we calculated stratified aHRs for each outcome (Black and White subgroups only, as other subgroups had low numbers of outcomes). Results122,002 individuals sustained at least one alcohol-DWI conviction suspension (117,244 initial, 4,758 repeat). Adjusted KM survival curves indicated that within three years of the index suspension, the predicted risks of having a license outcome and crash outcome were about 8 % and 15 %, respectively, among individuals with an initial suspension and 5 % and 10 %, respectively, among individuals with a repeat suspension. After adjusting for potential confounding, we found that compared to those with an initial suspension, those with repeat suspensions had a lower incidence of future license (aHR: 0.49; 95 % CI: 0.42, 0.57) and crash outcomes (aHR: 0.67; 95 % CI: 0.60, 0.75). Among Black individuals, license outcome incidence was 162 % lower among repeat versus initial index suspension groups (aHR: 0.38; 95 % CI: 0.26, 0.55), while for White individuals, the incidence was 87 % lower (aHR: 0.54; 95 % CI: 0.45, 0.64). Similarly, crash incidence for repeat versus initial suspensions among Black individuals was 56 % lower (aHR: 0.64; 95 % CI: 0.50, 0.83), while only 39 % lower among White individuals (aHR: 0.72; 95 % CI: 0.63, 0.81). ConclusionsDecreased incidence of both license and crash outcomes were observed among repeat versus initial index suspensions. The magnitude of these differences varied by race/ethnicity, with larger decreases in incidence among Black compared to White individuals. Future research should examine the underlying mechanisms leading to alcohol-impaired driving behavior, convictions, recidivism, and crashes from a holistic social-ecological perspective so that interventions are designed to both improve road safety and maximize other critical public health outcomes, such as access to essential needs and services (e.g., healthcare and employment).

A COVID-19 Public Health Silver Lining? Reductions in Driving under the Influence Arrests and Crashes in Miami-Dade County

ABSTRACT The health crisis that began in early 2020 has generated a large amount of interest in the effect of COVID-19 on public health. The majority of this work has centered around trying to better understand how the virus spreads, where it spreads, who is at risk and when, in order to provide evidence-based guidance to the public, and stop the pandemic. The Centers for Disease Control has continued to report the largely somber findings; however, there are silver linings. The temporary reduction in daily global CO2 emissions was one of these, but there are others. In this case study on Miami-Dade County, Fl, a regression discontinuity model is used to highlight reductions in both drunk driving crashes and driving under the influence arrests. While we observed immediate reductions in both crashes and arrests as a result of the March 2020 lockdown, more importantly over the duration of the year since the lockdown we observed a staggering reduction of over 800 fewer driving under the influence arrests and almost 150 alcohol-related motor-vehicle crashes.

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

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. 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 1week prior and 2weeks prior. 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 1week (IRR=0.88; 95%CI: 0.80, 0.97). We detected no differential associations according to checkpoint size or duration. Sobriety checkpoints are associated with fewer alcohol-related motor vehicle crashes for around 1week. Checkpoint size and duration do not appear to affect this relationship.

Effects of a Community-Level Intervention on Alcohol-Related Motor Vehicle Crashes in California Cities: A Randomized Trial

This trial assesses the effects of a community-level alcohol prevention intervention in California on alcohol-related motor vehicle crashes. The study is a group RCT with cities as the unit of assignment to condition and as the unit of analysis. A total of 24 California cities with populations between 50,000 and 450,000 were chosen at random and roughly matched into pairs before randomly assigning 12 each to the intervention and control conditions. The intervention, aimed at reducing excessive drinking among adolescents and young adults, included driving under the influence sobriety checkpoints, saturation patrols, and undercover operations to reduce service of alcohol to intoxicated patrons in bars, all including high visibility so the public would be aware of them. A measure of overall intervention intensity or dosage was created. The outcome was a monthly percentage of all motor vehicle crashes that were single vehicle nighttime crashes for drivers aged 15-30 years. Multilevel analyses were conducted to examine intervention effects on alcohol-related crashes among drivers aged 15-30 years. Crash data were obtained in 2018 with data preparation and analysis conducted in 2019. Intent-to-treat analyses indicated a 17% reduction in the percentage of alcohol-involved crashes among drivers aged 15-30 years relative to controls, which translates to about 310 fewer crashes. Dosage was found to have a statistically significant effect on crashes among this age group, although not in the expected direction. Enhanced alcohol enforcement operations involving both community health and law enforcement agencies can help to reduce alcohol-impaired driving and related consequences among young people. Including measures of intervention dosage raises interesting questions about the understanding of the impact of the community intervention. Future studies should continue to further develop implementation strategies that may more effectively and efficiently reduce community alcohol-related harm.

Deaths and Years of Potential Life Lost From Excessive Alcohol Use - United States, 2011-2015.

Excessive alcohol use is a leading cause of preventable death in the United States (1) and costs associated with it, such as those from losses in workplace productivity, health care expenditures, and criminal justice, were $249 billion in 2010 (2). CDC used the Alcohol-Related Disease Impact (ARDI) application* to estimate national and state average annual alcohol-attributable deaths and years of potential life lost (YPLL) during 2011-2015, including deaths from one's own excessive drinking (e.g., liver disease) and from others' drinking (e.g., passengers killed in alcohol-related motor vehicle crashes). This study found an average of 95,158 alcohol-attributable deaths (261 deaths per day) and 2.8 million YPLL (29 years of life lost per death, on average) in the United States each year. Of all alcohol-attributable deaths, 51,078 (53.7%) were caused by chronic conditions, and 52,921 (55.6%) involved adults aged 35-64 years. Age-adjusted alcohol-attributable deaths per 100,000 population ranged from 20.8 in New York to 53.1 in New Mexico. YPLL per 100,000 population ranged from 631.9 in New York to 1,683.5 in New Mexico. Implementation of effective strategies for preventing excessive drinking, including those recommended by the Community Preventive Services Task Force (e.g., increasing alcohol taxes and regulating the number and concentration of alcohol outlets), could reduce alcohol-attributable deaths and YPLL.†.

Impacts of confounding roadway characteristics on estimates of associations between alcohol outlet densities and alcohol-related motor vehicle crashes.

Previous research on alcohol-related motor vehicle crashes (AMVC) share a substantial limitation: sources of geographic variations in background crash risks may confound estimated spatial relationships between alcohol outlets and AMVCs. The aim of this study was to address this concern by examining, spatial-temporally, relationships between alcohol outlets and AMVCs adjusting for a set of six roadway characteristics that may be, independently, related to crash risks. While most similar studies focus on one metropolitan area, we use a unique sample of 50 cities. The spatial sample for this study consisted of 8726 Census 2000 block groups representing 50 mid-sized California cities. Dependent measures were counts of crashes located within Census block groups. Independent measures included socio-demographics, social disadvantage, alcohol outlets and roadway characteristics. We assessed relationships of crashes to independent measures using hierarchical generalised linear models. Greater roadway length, greater percentage of highways, greater average speeds, fewer T-intersections, greater curviness and less fragmentation were related to greater numbers of crashes as was alcohol outlet density. Above and beyond alcohol outlet type and density, we found that roadway characteristics were related to AMVC risks across a sample of 50 mid-sized cities. Measures of roadway characteristics are an essential component of any model of motor vehicle crashes that attempts to assess impacts of alcohol outlets on motor vehicle crashes risks.

Deaths and Years of Potential Life Lost From Excessive Alcohol Use - United States, 2011-2015.

Excessive alcohol use is a leading cause of preventable death in the United States (1) and costs associated with it, such as those from losses in workplace productivity, health care expenditures, and criminal justice, were $249 billion in 2010 (2). CDC used the Alcohol-Related Disease Impact (ARDI) application* to estimate national and state average annual alcohol-attributable deaths and years of potential life lost (YPLL) during 2011-2015, including deaths from one's own excessive drinking (e.g., liver disease) and from others' drinking (e.g., passengers killed in alcohol-related motor vehicle crashes). This study found an average of 93,296 alcohol-attributable deaths (255 deaths per day) and 2.7 million YPLL (29 years of life lost per death, on average) in the United States each year. Of all alcohol-attributable deaths, 51,078 (54.7%) were caused by chronic conditions, and 52,361 (56.0%) involved adults aged 35-64 years. Age-adjusted alcohol-attributable deaths per 100,000 population ranged from 20.3 in New Jersey and New York to 52.3 in New Mexico. YPLL per 100,000 population ranged from 613.8 in New York to 1,651.7 in New Mexico. Implementation of effective strategies for preventing excessive drinking, including those recommended by the Community Preventive Services Task Force (e.g., increasing alcohol taxes and regulating the number and concentration of alcohol outlets), could reduce alcohol-attributable deaths and YPLL.†.

Using Rural⁻Urban Continuum Codes (RUCCS) to Examine Alcohol-Related Motor Vehicle Crash Injury and Enforcement in New York State.

Rural areas of New York State (NYS) have higher rates of alcohol-related motor vehicle (MV) crash injury than metropolitan areas. While alcohol-related injury has declined across the three geographic regions of NYS, disparities persist with rural areas having smaller declines. Our study aim was to examine factors associated with alcohol-related MV crashes in Upstate and Long Island using multi-sourced county-level data that included the Crash Outcome Data Evaluation System (CODES) with emergency department visits and hospitalizations, traffic citations, demographic, economic, transportation, alcohol outlets, and Rural–Urban Continuum Codes (RUCCS). A cross-sectional study design employed zero-truncated negative binominal regression models to assess relative risks (RR) with 95% confidence interval (CI). Counties (n = 57, 56,000 alcohol-related crashes over the 3 year study timeframe) were categorized by mean annual alcohol-related MV injuries per 100,000 population: low (24.7 ± 3.9), medium (33.9 ± 1.7) and high (46.1 ± 8.0) (p < 0.0001). In multivariable analyses, alcohol-related MV injury was elevated for non-adjacent, non-metropolitan counties (RR 2.5, 95% CI: 1.6–3.9) with higher citations for impaired driving showing a small, but significant protective effect. Less metropolitan areas had higher alcohol-related MV injury with inconsistent alcohol-related enforcement measures. In summary, higher alcohol-related MV injury rates in non-metropolitan counties demonstrated a dose–response relationship with proximity to a metropolitan area. These findings suggest areas where intervention efforts might be targeted to lower alcohol-related MV injury.

Space-Time Analyses of Alcohol Outlets and Related Motor Vehicle Crashes: Associations at City and Census Block-Group Levels.

Past research has linked alcohol outlet densities to drinking, drunken driving, and alcohol-related motor vehicle crashes (MVCs). Because impaired drivers travel some distances from drinking places to crash locations, spatial relationships between outlets and crashes are complex. We investigate these relationships at 3 geographic levels: census block groups (CBGs), adjacent (nearby) areas, and whole cities. We examined risks of all injury MVCs as well as "had been drinking" (HBD) and single-vehicle-nighttime (SVN) subgroups using data from the Statewide Integrated Traffic Records System across CBGs among 50 California cities from 2001 to 2008. Relationships between outlet densities at the city level, within CBGs, and in adjacent CBGs and crashes were examined using Bayesian Poisson space-time analyses controlling for population size income and other demographics (all as covariates). All injury MVCs were positively related to adjacent CBG population size (relative rate [RR]=1.008, 95% credible interval (CI)=1.004, 1.012), and outlet densities at CBG (RR=1.027, CI=1.020, 1.035), nearby area (RR=1.084, CI=1.060, 1.106) and city levels (RR=1.227, CI=1.147, 1.315), and proportion of bars or pubs at the city level (RR=2.257, CI=1.187, 4.125). HBD and SVN crashes were comparatively less frequent in high outlet density CBG (RR=0.993, CI=0.987, 0.999; RR=0.963, CI=0.951, 0.975) and adjacent areas (RR=0.979, CI=0.962, 0.996; RR=0.909, CI=0.883, 0.936), but positively associated with city-level proportions of bars (RR=3.373, CI=0.736, 15.644; RR=10.322, CI=1.704, 81.215). Overall, a 10% increase in alloutlets was related to 2.8% more injury crashes (CI=2.3, 3.3) and 2.5% more HBDs (CI=1.7, 3.3). A10% increase in bars was related to 1.4% more crashes, 4.3% more HBDs, and 10.3% more SVNs. Population size and densities of bars or pubs were found to be associated with crash rates, with population effects appearing across cities and outlet effects appearing within dense downtown areas. Summary estimates of outlet and population impacts on MVCs must consider varying contributions at multiple spatial scales.

The location of late night bars and alcohol-related crashes in Houston, Texas

A study in the City of Houston, Texas, related the location of establishments primarily serving alcohol (“bars”) after midnight to late night alcohol-related motor vehicle crashes. There were three data sets for 2007–09: 1) 764bars that were open after midnight; 2) 1660 alcohol-related crashes that occurred within the City of Houston between midnight and 6 am; and 3) 4689 modeling network road segments to which bars and alcohol-related crashes were assigned.Forty-five percent of the late night alcohol-related crashes were within a quarter mile of a late night bar. The bars were highly concentrated in 17 small bar clusters. Using the modeling network, Poisson-Gamma-CAR and Poisson-Lognormal-CAR spatial regression models showed a positive exponential relationship between late night alcohol-related crashes and the number of late nights bars and bar clusters, and a negative exponential relationship to distance to the nearest late night bar controlling for the type of road segment (freeway, principal arterial, minor arterial). A more general model dropped the bar cluster variable.Further, the Poisson-Gamma-CAR model appeared to produce a better representation than the Poisson-Lognormal-CAR model though the errors were different. The general Poisson-Gamma-CAR model showed that each late night bar increased the frequency of alcohol-related crashes on a segment by approximately 190%. For each mile closer a segment was to a late night bar, the likelihood increased by 42%.

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

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. 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. 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. 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.

Alcohol misuse, firearm violence perpetration, and public policy in the United States

ObjectiveFirearm violence is a significant public health problem in the United States, and alcohol is frequently involved. This article reviews existing research on the relationships between alcohol misuse; ownership, access to, and use of firearms; and the commission of firearm violence, and discusses the policy implications of these findings. MethodNarrative review augmented by new tabulations of publicly-available data. ResultsAcute and chronic alcohol misuse is positively associated with firearm ownership, risk behaviors involving firearms, and risk for perpetrating both interpersonal and self-directed firearm violence. In an average month, an estimated 8.9 to 11.7 million firearm owners binge drink. For men, deaths from alcohol-related firearm violence equal those from alcohol-related motor vehicle crashes. Enforceable policies restricting access to firearms for persons who misuse alcohol are uncommon. Policies that restrict access on the basis of other risk factors have been shown to reduce risk for subsequent violence. ConclusionThe evidence suggests that restricting access to firearms for persons with a documented history of alcohol misuse would be an effective violence prevention measure. Restrictions should rely on unambiguous definitions of alcohol misuse to facilitate enforcement and should be rigorously evaluated.

Effects of a 2009 Illinois Alcohol Tax Increase on Fatal Motor Vehicle Crashes.

We examined the effects of a 2009 increase in alcohol taxes in Illinois on alcohol-related fatal motor vehicle crashes. We used an interrupted time-series design, with intrastate and cross-state comparisons and measurement derived from driver alcohol test results, for 104 months before and 28 months after enactment. Our analyses used autoregressive moving average and generalized linear mixed Poisson models. We examined both population-wide effects and stratifications by alcohol level, age, gender, and race. Fatal alcohol-related motor vehicle crashes declined 9.9 per month after the tax increase, a 26% reduction. The effect was similar for alcohol-impaired drivers with positive alcohol levels lower than 0.15 grams per deciliter (-22%) and drivers with very high alcohol levels of 0.15 or more (-25%). Drivers younger than 30 years showed larger declines (-37%) than those aged 30 years and older (-23%), but gender and race stratifications did not significantly differ. Increases in alcohol excise taxes, such as the 2009 Illinois act, could save thousands of lives yearly across the United States as part of a comprehensive strategy to reduce alcohol-impaired driving.

Child passengers killed in reckless and alcohol-related motor vehicle crashes

IntroductionAbout 20years ago, concern was raised about the dangers that children face when driven by drinking drivers in the United States. During the last decade, the pace of research on this topic subsided. Yet in 2010, every day three children younger than age 15 were killed, and 469 were injured in motor-vehicle crashes. MethodThe aim of this effort is to describe the status of the problem in the United States and suggest lines of research. From the Fatality Analysis Reporting System (FARS), we selected crashes in which a driver aged 21 or older was driving at least one child younger than age 15. We identified crashes that occurred at different times of the day in which the driver was speeding, ran a red light, or was alcohol positive. We described the drivers' demographics and examined how they relate to the different crash types. ResultsWe found that, although driving a child seems to protect against the studied forms of risky driving, such protection varies sharply depending upon the drivers' and children's demographics and the crash type. There is no clear reason to explain the drivers' decision to endanger the children that they drive. The percent of children killed in speeding-related and red-light running motor-vehicle crashes has remained relatively stable during the last decade. Future research must (a) examine the effectiveness of current child endangerment laws; (b) examine crashes other than fatal; and (c) be more targeted, looking at specific drivers' age and gender, specific children's ages, the time of the crash, and the type of crash. Practical applicationsSignificant attention needs to be given towards improving state laws on child endangerment. Policymakers’ reaction to this problem is tentative because of our limited understanding of the problem; therefore, further research is needed. With unfocused countermeasures and prevention efforts, we have been restricted in our ability to evaluate these responses. The findings of this report should be informative to policy makers.

Alcohol-Related Motor Vehicle Crash Risk and the Location of Alcohol Purchase

In this study, we examine how the probability of driving after a binge-drinking episode varies with the location of consumption and type of alcohol consumed. We also investigate the relationship between the location of alcohol purchase and the number of alcohol-related fatal motor vehicle crashes. We find that binge-drinkers are significantly more likely to drive after consuming alcohol at establishments that sell alcohol for on-premises consumption, e.g., from bars or restaurants, particularly after drinking beer. Further, per capita sales of alcohol for off-premises consumption are unrelated to the rate of alcohol-related fatal motor vehicle crashes. When disaggregating alcohol types, per capita sales of beer for off-premises consumption are negatively associated with the rate of alcohol-related fatal motor vehicle crashes. In contrast, total per capita sales of alcohol from all establishments (on- and off-premises) are positively related to the rate of alcohol-related fatal motor vehicle crashes and the magnitude of this relationship is strongest for beer sales. Thus, policies that shift consumption away from bars and restaurants could lead to a decline in the number of motor vehicle crashes.

RELATIVE AND ATTRIBUTABLE RISKS OF FATAL CRASHES ASSOCIATED WITH DRUG USE

BackgroundWhile alcohol-related motor vehicle crashes have declined in recent years, driving under the influence of illicit drugs and prescription drugs has become a major safety concern. The influence of drugs...

Dram Shop Liability and Overservice Law Enforcement Initiatives: A Commentary

Candy Lightner, responding to the senseless death of her daughter caused by a repeat drunk driving offender, organized Mothers Against Drunk riving (MADD) in 1980 to bring attention to the trageies associated with alcohol-related motor-vehicle crashes. er one-person crusade touched a nerve across the counry and prompted a national grassroots movement that esulted in a sea change in social norms, public percepions, and public policy regarding the problem. The reforms, however, left a major contributing factor to the drinking driving problem largely untouched—the role of retail alcohol establishments. As documented by Rammohan et al. and the Task Force on Community reventive Services (the Task Force), approximately 50% of binge drinking occurs in on-sale establishments (e.g., bars and restaurants). Various studies suggest that approximately 50% of drinking driving incidents originate in these venues. The lack of attention to the role of alcohol retailers in the national debate is perplexing because 47 of the 50 states prohibit sales to obviously intoxicated people, and most states recognize dram shop liability to at least some degree (laws that hold retailers potentially liable for injuries caused by their intoxicated or underage patrons). Retailers have both a legal and ethical responsibility as well as the tools to reduce intoxication among their patrons, a responsibility that is too often ignored.

Effects of Dram Shop Liability and Enhanced Overservice Law Enforcement Initiatives on Excessive Alcohol Consumption and Related Harms: Two Community Guide Systematic Reviews

Dram shop liability holds the owner or server(s) at a bar, restaurant, or other location where a patron, adult or underage, consumed his or her last alcoholic beverage responsible for harms subsequently inflicted by the patron on others. Liability in a state can be established by case law or statute. Overservice laws prohibit the sale of alcoholic beverages to intoxicated patrons drinking in on-premises retail alcohol outlets (i.e., premises where the alcohol is consumed where purchased); enhanced enforcement of these laws is intended to ensure compliance by premises personnel. Both of these interventions are ultimately designed to promote responsible beverage service by reducing sales to intoxicated patrons, underage youth, or both. This review assesses the effectiveness of dram shop liability and the enhanced enforcement of overservice laws for preventing excessive alcohol consumption and related harms. Studies assessing alcohol-related harms in states adopting dram shop laws were evaluated, as were studies assessing alcohol-related harms in regions with enhanced overservice enforcement. Methods previously developed for systematic reviews for the Guide to Community Preventive Services were used. Eleven studies assessed the association of state dram shop liability with various outcomes, including all-cause motor vehicle crash deaths, alcohol-related motor vehicle crash deaths (the most common outcome assessed in the studies reviewed), alcohol consumption, and other alcohol-related harms. There was a median reduction of 6.4% (range of values 3.7% to 11.3% reduction) in alcohol-related motor vehicle fatalities associated with the presence of dram shop liability in jurisdictions where premises are licensed. Other alcohol-related outcomes also showed a reduction. Only two studies assessed the effects of enhanced enforcement initiatives on alcohol-related outcomes; findings were inconsistent, some indicating benefit and others none. According to Community Guide rules of evidence, the number and consistency of findings indicate strong evidence of the effectiveness of dram shop laws in reducing alcohol-related harms. It will be important to assess the possible effects of legal modifications to dram shop proceedings, such as the imposition of statutes of limitation, increased evidentiary requirements, and caps on recoverable amounts. According to Community Guide rules of evidence, evidence is insufficient to determine the effectiveness of enhanced enforcement of overservice laws for preventing excessive alcohol consumption and related harms.