Legal Alcohol Limit Research Articles

Lowering the legal alcohol limit in Belgium: Potential effects on the number of traffic victims

BackgroundSince 1994, the legal limit of Blood Alcohol Concentration (BAC) is 0.5 g/L for the general drivers’ population in Belgium. Since 2015, this limit has been lowered to 0.2 g/L for professional drivers. So far, no specific limitation has been adopted for novice drivers in Belgium. Recently, two bills were submitted to the House of Representatives: the first one proposed to impose a zero-limit for every driver, the second one proposed to restrict this zero-limit only to novice drivers. ObjectiveThe present study evaluated the potential impact of the two bills that aim to reduce the legal BAC limit from 0.5 to zero, either for all drivers or for novice drivers only. We elaborated three scenarios related to the BAC categories for which lowering the legal BAC limit to zero would affect drink-driving behaviour:“Targeted BAC levels” scenario assumed that the new policy would impact only the specifically targeted BAC category, i.e., drivers in the category BAC below 0.5 g/L.“Extended impact” scenario corresponded to the “Targeted BAC levels” scenario to which we added a “halo effect” on drivers in the BAC category “0.5 g/L ≤ BAC < 0.8 g/L”.“Broad range impact” scenario corresponded to the “Extended impact” scenario to where we extended the “halo effect” to drivers in the BAC category “0.8 g/L ≤ BAC < 1.2 g/L”. MethodsThe effect estimates were based on firstly, scientific literature on risks related to drink-driving at different BAC-levels, secondly data on crashes in Belgium and thirdly data on drink-driving behaviour in Belgium and in other European countries. ResultsIn case of a zero limit for all drivers, an annual reduction can be expected of 10 to 17 fatalities (i.e., a decrease of 2.4% to 3.9%), 8 to 20 severe injuries (i.e., a decrease of 0.3% to 0.8%) and 135 to 315 slight injuries (i.e., a decrease of 0.4% to 0.8%). In case a zero limit is only applied to novice drivers, an annual decrease can be expected by 2 to 4 fatalities (i.e., a decline of 3.7% to 6.2%), 8 to 16 serious injuries and 135 to 262 slight injuries (i.e., a decline of 1.7% to 3.2% in both cases). DiscussionThere is no clear evidence on which of the three scenarios would be the most plausible. As the relative risk of a car crash increases strongly with the BAC level, the success of either measure will strongly depend on its ability to also affect drink driving at concentrations that are forbidden already. This also means that most of the casualties could be prevented if compliance with current rules increased.

One for the road: the determinants of the road fatalities in the European Union

Abstract Traffic fatalities are a severe problem. The European Commission estimated that one in four road accidents are related to alcohol consumption. It is also shown that alcohol changes perceptions and is reflected in the driver’s reflexes. This study aims to determine the factors that lead to changes in the mortality rate due to car accidents. The dataset was retrieved from different official sources depending on the type of variable. For the time-invariant variables were used two official sources from which the drivers are informed with the main road rules from a certain country. Using the Arellano-Bover / Blundell-Bond linear dynamic panel-data estimation on 22 European Union countries between 2012 to 2018, the results showed that the road safety laws have a meaningful and significant impact on road fatalities. Alcohol legal limit has a positive impact on road fatalities, which shows that if the legal alcohol limit is non-zero, the road fatalities increase. Another important result is related to young people neither in employment nor in education and training (NEET), which directly influences road fatalities. This result shows the importance of investment in education. At the same time, the results underline the importance of investments in infrastructure, as the length of the highways increases leads to a decrease in road fatalities.

Motorcycle crashes resulting in hospital admissions in South Australia: Crash characteristics and injury patterns

Motorcycle riders have a high risk of serious injury if they crash. To assist with identification of countermeasures, the present study examined records from the Royal Adelaide Hospital (RAH) in South Australia for 763 motorcyclists (including scooter riders) admitted between January 2008 and November 2010 and between April 2014 and December 2016. Records were linked with police-reported crash data and results of forensic blood tests for alcohol and drugs. When compared with 1617 car drivers admitted to the RAH over the same periods, motorcyclists were younger, were more commonly male, more likely to hold a learner permit, less likely to hold a provisional licence, less likely to be over the legal alcohol limit and less likely to be at-fault in multiple vehicle crashes. Their crashes were more likely to be single vehicle crashes (specifically roll over, left road – out of control and hit object/animal/pedestrian on road crashes) and were more common on weekends, during the afternoon, on sloping roads, on curved roads, on roads with speed limits of 50 and 80 km/h, during daylight hours, in dry weather and on dry roads. They had a higher severity of injury than car drivers, spent longer in hospital, and were more likely to sustain injuries to multiple body regions. Linear regression showed that older age, higher blood alcohol concentration and higher speed limit increased injury severity for motorcyclists. Based on present findings, motorcycling safety can be improved through countermeasures related to Graduated Licensing Systems, infrastructure, motorcycle technology and protective clothing.

Cannabis, alcohol and fatal road accidents.

IntroductionThis research aims to estimate the relative risks of responsibility for a fatal accident linked to driving under the influence of cannabis or alcohol, the prevalence of these influences among drivers and the corresponding attributable risk ratios. A secondary goal is to estimate the same items for three other groups of illicit drugs (amphetamines, cocaine and opiates), and to compare the results to a similar study carried out in France between 2001 and 2003.MethodologyPolice procedures for fatal accidents in Metropolitan France during 2011 were analyzed and 300 characteristics encoded to provide a database of 4,059 drivers. Information on alcohol and four groups of illicit drugs derived from tests for positivity and potential confirmation through blood analysis. The study compares drivers responsible for causing the accident, that is to say having directly contributed to its occurrence, to drivers involved in an accident for which they were not responsible, and who can be assimilated to drivers in general.ResultsThe proportion of persons driving under the influence of alcohol is estimated at 2.1% (95% CI: 1.4–2.8) and under the influence of cannabis at 3.4% (2.9%-3.9%). Drivers under the influence of alcohol are 17.8 times (12.1–26.1) more likely to be responsible for a fatal accident, and the proportion of fatal accidents which would be prevented if no drivers ever exceeded the legal limit for alcohol is estimated at 27.7% (26.0%-29.4%). Drivers under the influence of cannabis multiply their risk of being responsible for causing a fatal accident by 1.65 (1.16–2.34), and the proportion of fatal accidents which would be prevented if no drivers ever drove under the influence of cannabis is estimated at 4.2% (3.7%-4.8%). An increased risk linked to opiate use has also been found to be significant, but with low prevalence, requiring caution in interpreting this finding. Other groups of narcotics have even lower prevalence, and the associated extra risks cannot be assessed.ConclusionAlmost a decade separates the present study from a similar one previously conducted in France, and there have been numerous developments in the intervening years. Even so, the prevalence of drivers responsible for causing fatal accidents under the influence of alcohol or narcotics has stayed remarkably stable, as have the proportion of fatal accidents which could in theory be prevented if no drivers ever exceeded the legal limits. The overall number of deaths from traffic accidents has dropped sharply during this period, and the number of victims attributable to alcohol and/or cannabis declined proportionally. Alcohol remains the main problem in France. It is just as important to note that one in two drivers considered to be under the influence of cannabis was also under the influence of alcohol. With risks cumulating between the two, it is particularly important to point out the danger of consuming them together.

Self-selection Policing and the Disqualified Driver

AbstractPrevious research has identified those who commit serious driving offences, such as driving while over the legal limit for alcohol, dangerous and reckless driving, and driving while legally disqualified, as more likely to engage in other types of criminality, including serious offences, than their non-serious driving offender counterparts. Furthermore, those who continue to drive while disqualified have been singled out as the most likely group of serious driving offenders to be involved in a wide array of different types of offending and at rates more consistent with mainstream criminals than those who simply commit other driving-related offences. The present study builds on previous findings by focusing explicitly on the offending versatility of a sample of 50 disqualified drivers, the different categories of crime they commit, and the recency of other offences relative to the driving whilst disqualifying offence. With an overwhelming percentage of the sample found to have convictions for other types of offences, the study concludes with the suggestion that although driving while disqualified should be considered a trigger offence in self-selection policing, several anticipated obstacles to implementation must first be removed before it can be firmly integrated into current police practice.

The effectiveness of ID readers and remote age verification in enhancing compliance with the legal age limit for alcohol.

Currently, two different age verification systems (AVS) are implemented to enhance compliance with legal age limits for the sale of alcohol in the Netherlands. In this study, we tested the operational procedures and effectiveness of ID readers and remote age verification technology in supermarkets during the sale of alcohol. Following a trained alcohol purchase protocol, eight mystery shoppers (both underage and in the branch's reference age) conducted 132 alcohol purchase attempts in stores that were equipped with ID readers or remote age verification or were part of a control group. In stores equipped with an ID reader, 34% of the purchases were conducted without any mistakes (full compliance). In stores with remote age verification, full compliance was achieved in 87% of the cases. The control group reached 57% compliance, which is in line with the national average. Stores with ID readers perform worse than stores with remote age verification, and also worse than stores without any AVS. For both systems, in addition to effectiveness, public support and user friendliness need to be investigated. This study shows that remote age verification technology is a promising intervention that increases vendor compliance during the sales of age restricted products.

Drunk driving offenders’ knowledge and behaviour in relation to alcohol-involved driving in Yinchuan and a comparison with Guangzhou, China

ObjectiveThis study was conducted after a legislative amendment criminalising drunk driving (BAC>80mg/100ml) had been in force for a year and investigated whether drunk driving offenders in Yinchuan, China were aware of the law, and whether their knowledge of and exposure to enforcement and the existence of alcohol use disorders were related to their alcohol-involved driving behaviour. The results were compared with results from an earlier study in Guangzhou, China. MethodA survey was conducted from July to October 2012 in Yinchuan to collect information on drunk driving offenders’ knowledge and practice in relation to alcohol-involved driving. The Alcohol Use Disorders Identification Test (AUDIT) was used to assess hazardous drinking levels. In total, 106 drunk driving offenders were recruited while in detention. The findings were compared with those of the Guangzhou study, where the same procedure was used to recruit 101 drunk driving offenders. ResultsThe mean age of the sample was 31.7years (SD=8.1; range 17–59years). Males constituted 96% of the sample. The mean age at which offenders reported starting to drink alcohol was 18.7years (SD=3.2; range 10–26years). Driver’s licenses had been held for an average of 8.5years. The status of knowledge in relation to alcohol-involved driving in Yinchuan was slightly lower in proportion than in Guangzhou. The rate of alcohol-involved driving reported in the previous 12months in Yinchuan (43%) was slightly higher than in Guangzhou (39%). The proportion of recidivists in Guangzhou (21.8%) was higher than Yinchuan’s (10.4%). On average, offenders had experienced 1.6 police alcohol breath tests in the previous year (SD=1.3; range 1–10). AUDIT scores indicated that a substantial proportion of the offenders had high levels of alcohol use disorders. DiscussionLimited awareness of legal alcohol limits might contribute to drunk driving offences. The high level of alcohol consumption by many offenders suggests that hazardous drinking levels may be a contributor. Recidivist drivers also had higher AUDIT scores, which suggest there may be benefit in using the AUDIT to identify potential drink drivers and recidivists, subject to further research.

Identifying beliefs underlying pre-drivers’ intentions to take risks: An application of the Theory of Planned Behaviour

Novice motorists are at high crash risk during the first few months of driving. Risky behaviours such as speeding and driving while distracted are well-documented contributors to crash risk during this period. To reduce this public health burden, effective road safety interventions need to target the pre-driving period. We use the Theory of Planned Behaviour (TPB) to identify the pre-driver beliefs underlying intentions to drive over the speed limit (N=77), and while over the legal alcohol limit (N=72), talking on a hand-held mobile phone (N=77) and feeling very tired (N=68). The TPB explained between 41% and 69% of the variance in intentions to perform these behaviours. Attitudes were strong predictors of intentions for all behaviours. Subjective norms and perceived behavioural control were significant, though weaker, independent predictors of speeding and mobile phone use. Behavioural beliefs underlying these attitudes could be separated into those reflecting perceived disadvantages (e.g., speeding increases my risk of crash) and advantages (e.g., speeding gives me a thrill). Interventions that can make these beliefs safer in pre-drivers may reduce crash risk once independent driving has begun.

Knowledge and behaviors of drunk-driving offenders in Guangzhou, China

Jia, K., Fleiter, J., King, M., Sheehan, M., Ma, W., &amp; Zhang, J. (2015). Knowledge and behaviors of drunk-driving offenders in Guangzhou, China. The International Journal Of Alcohol And Drug Research, 4(2), 151-158. doi:http://dx.doi.org/10.7895/ijadr.v4i2.203Aims: To better understand the knowledge and behaviors of drunk-driving offenders relating to alcohol use and driving in thecontext of recently amended Chinese legislation, and to investigate the involvement of alcohol-use disorders.Design: The study was a cross-sectional survey conducted in 2012.Setting and participants: Data were collected at a local jail and 101 participants were recruited while in detention.Measures: Questionnaire items examined demographic characteristics as well as practices and knowledge relating to alcohol useand driving. The Alcohol Use Disorders Identification Test (AUDIT) was used to assess hazardous drinking levels.Findings: Knowledge about the two legal limits for “drink driving” and for “drunk driving” was low, at 28.3% and 41.4%,respectively. AUDIT scores indicated that a substantial proportion of the offenders had high levels of alcohol-use disorders.Higher AUDIT scores were found among the least experienced drivers, those who lacked knowledge about the legal limits, andrecidivist drunk drivers.Conclusions: Limited awareness of legal alcohol limits might contribute to offending; high AUDIT scores suggest thathazardous drinking levels may also contribute. This study provides important information to assist in refining communityeducation and prevention efforts.

Knowledge and behaviors of drunk-driving offenders in Guangzhou, China

Jia, K., Fleiter, J., King, M., Sheehan, M., Ma, W., &amp; Zhang, J. (2015). Knowledge and behaviors of drunk-driving offenders in Guangzhou, China. The International Journal Of Alcohol And Drug Research, 4(2), 151-158. doi:http://dx.doi.org/10.7895/ijadr.v4i2.203Aims: To better understand the knowledge and behaviors of drunk-driving offenders relating to alcohol use and driving in thecontext of recently amended Chinese legislation, and to investigate the involvement of alcohol-use disorders.Design: The study was a cross-sectional survey conducted in 2012.Setting and participants: Data were collected at a local jail and 101 participants were recruited while in detention.Measures: Questionnaire items examined demographic characteristics as well as practices and knowledge relating to alcohol useand driving. The Alcohol Use Disorders Identification Test (AUDIT) was used to assess hazardous drinking levels.Findings: Knowledge about the two legal limits for “drink driving” and for “drunk driving” was low, at 28.3% and 41.4%,respectively. AUDIT scores indicated that a substantial proportion of the offenders had high levels of alcohol-use disorders.Higher AUDIT scores were found among the least experienced drivers, those who lacked knowledge about the legal limits, andrecidivist drunk drivers.Conclusions: Limited awareness of legal alcohol limits might contribute to offending; high AUDIT scores suggest thathazardous drinking levels may also contribute. This study provides important information to assist in refining communityeducation and prevention efforts.

Cannabis effects on driving lateral control with and without alcohol

BackgroundEffects of cannabis, the most commonly encountered non-alcohol drug in driving under the influence cases, are heavily debated. We aim to determine how blood Δ9-tetrahydrocannabinol (THC) concentrations relate to driving impairment, with and without alcohol. MethodsCurrent occasional (≥1×/last 3 months, ≤3days/week) cannabis smokers drank placebo or low-dose alcohol, and inhaled 500mg placebo, low (2.9%)-THC, or high (6.7%)-THC vaporized cannabis over 10min ad libitum in separate sessions (within-subject design, 6 conditions). Participants drove (National Advanced Driving Simulator, University of Iowa) simulated drives (∼0.8h duration). Blood, oral fluid (OF), and breath alcohol samples were collected before (0.17h, 0.42h) and after (1.4h, 2.3h) driving that occurred 0.5–1.3h after inhalation. We evaluated standard deviations of lateral position (lane weave, SDLP) and steering angle, lane departures/min, and maximum lateral acceleration. ResultsIn N=18 completers (13 men, ages 21–37years), cannabis and alcohol increased SDLP. Blood THC concentrations of 8.2 and 13.1μg/L during driving increased SDLP similar to 0.05 and 0.08g/210L breath alcohol concentrations, the most common legal alcohol limits. Cannabis-alcohol SDLP effects were additive rather than synergistic, with 5μg/L THC+0.05g/210L alcohol showing similar SDLP to 0.08g/210L alcohol alone. Only alcohol increased lateral acceleration and the less-sensitive lane departures/min parameters. OF effectively documented cannabis exposure, although with greater THC concentration variability than paired blood samples. ConclusionsSDLP was a sensitive cannabis-related lateral control impairment measure. During drive blood THC ≥8.2μg/L increased SDLP similar to notably-impairing alcohol concentrations. Despite OF's screening value, OF variability poses challenges in concentration-based effects interpretation.

Impact of alcohol checks and social norm on driving under the influence of alcohol (DUI)

This study investigated the influence of alcohol checks and social norm on self-reported driving under the influence of alcohol above the legal limit (DUI). The analysis was based on the responses of 12,507 car drivers from 19 European countries to the SARTRE-4 survey (2010). The data were analysed by means of a multiple logistic regression-model on two levels: (1) individual and (2) national level.On the individual level the results revealed that driving under the influence (DUI) was positively associated with male gender, young age (17–34), personal experience with alcohol checks, the perceived likelihood of being checked for alcohol, perceived drunk driving behaviour of friends (social norm) and was negatively associated with higher age (55+). On a national level, the results showed a negative association with a lower legal alcohol limit (BAC 0.2g/l compared with BAC 0.5g/l) and the percentage of drivers checked for alcohol. DUI was positively associated with the percentage of respondents in the country that reported that their friends drink and drive (social norm). The comparison of the results obtained on national and individual levels shows a paradoxical effect of alcohol checks: Countries with more alcohol checks show lower DUI (negative association) but respondents who have been personally checked for alcohol show a higher chance of DUI (positive association). Possible explanations of this paradox are discussed. The effects of the social norm variable (perceived drunk driving behaviour of friends) are positively associated with DUI on both levels.

Self-reported risk-taking behavior during matched-frequency sessions of alcohol versus combined alcohol and energy drinks consumption: does co-ingestion increase risk-taking?

Emerging evidence indicates that consumers of alcohol mixed with energy drink (AmED) self-report lower odds of risk-taking after consuming AmED versus alcohol alone. However, these studies have been criticized for failing to control for relative frequency of AmED versus alcohol-only consumption sessions. These studies also do not account for quantity of consumption and general alcohol-related risk-taking propensity. The aims of the present study were to (i) compare rates of risk-taking in AmED versus alcohol sessions among consumers with matched frequency of use and (ii) identify consumption and person characteristics associated with risk-taking behavior in AmED sessions. Data were extracted from 2 Australian community samples and 1 New Zealand community sample of AmED consumers (n=1,291). One-fifth (21%; n=273) reported matched frequency of AmED and alcohol use. The majority (55%) of matched-frequency participants consumed AmED and alcohol monthly or less. The matched-frequency sample reported significantly lower odds of engaging in 18 of 25 assessed risk behaviors in AmED versus alcohol sessions. Similar rates of engagement were evident across session type for the remaining behaviors, the majority of which were low prevalence (reported by <15%). Regression modeling indicated that risk-taking in AmED sessions was primarily associated with risk-taking in alcohol sessions, with increased average energy drink (ED) intake associated with certain risk behaviors (e.g., being physically hurt, not using contraception, and driving while over the legal alcohol limit). Bivariate analyses from a matched-frequency sample align with past research showing lower odds of risk-taking behavior after AmED versus alcohol consumption for the same individuals. Multivariate analyses showed that risk-taking in alcohol sessions had the strongest association with risk-taking in AmED sessions. However, hypotheses of increased risk-taking post-AmED consumption were partly supported: Greater ED intake was associated with increased likelihood of specific behaviors, including drink-driving, sexual behavior, and aggressive behaviors in the matched-frequency sample after controlling for alcohol intake and risk-taking in alcohol sessions. These findings highlight the need to consider both personal characteristics and beverage effects in harm reduction strategies for AmED consumers.

Nothing good ever happens after midnight: Observed exposure and alcohol use during weekend nights among young male drivers carrying passengers in a late licensing country

Similar to other countries, also in the Netherlands young male drivers (ages between 18 and 24 years) are overrepresented in crashes during weekend nights, thereby fatally injuring one or more of their passengers. This overrepresentation may be due to two contributing factors: (a) a higher exposure-to-risk because of dangerous trip condition, and (b) a higher tendency to take risks. Studies on these factors, mostly carried out in jurisdictions where youngsters are licensed at an earlier age than in Europe, suggest a strong –often negative– influence from peer-aged passengers. Given that in adolescence susceptibility to peer pressure reduces with age, these findings may not be applicable to late licensing countries, such as in Europe. In the Netherlands –a late licensing country– youngsters are licensed after the age of 18 years, followed by a 5 year probation period with a legal alcohol limit of 0.2g/L. Further, designated driver schemes are in place since 2001, alcohol limits are enforced by random breath testing schemes, and no passenger and night time restrictions are in force. Against this background, we examined the incidence of dangerous trip conditions and risk taking among young male drivers and compared those with a reference group with a low passenger fatality rate. To that end, data on trip conditions and risk behavior were obtained from a data base on 18,608 randomly selected drivers during weekend nights in 2010, between 22:00 and 06:00. This data base held information for each randomly selected on breath alcohol concentration (BAC), license status, driver characteristics (age and gender), number of passengers, time of night, and level of urbanization. Binary logistic regression analysis confirmed the overrepresentation of young male drivers in traffic, carrying more frequently passengers than the reference group, especially after midnight. Urbanization level was not a modifying factor, but ‘time of night’ was, with riskier conditions after midnight in terms of: (a) a higher young male driver presence, (b) young male drivers carrying more frequently multiple passengers and (c) a higher prevalence of illegal BACs. After midnight, no evidence was found for a protective effect of the presence of one passenger on alcohol use. Of the young male drivers, 5% were over the legal limit and 3 in 5 young males who were over the limit carried passengers. However, the indicative result that young male drivers with multiple passengers were less likely to have been drinking than solo drivers or drivers with just one passenger, is suggestive of a protective effect of multiple passengers. These results may guide preventive strategies, including police enforcement and designated driver programmes.

Age and gender differences in substance screening may underestimate injury severity: a study of 9793 patients at level 1 trauma center from 2006 to 2010

BackgroundAlthough the relationship between psychoactive substance use and injury is known, evidence remains conflicting on the impact of substance use on clinical outcomes after injury. We hypothesized that preinjury substance use would negatively impact clinical outcomes. MethodsNational Trauma Registry American College of Surgeons identified patients (n = 9793) presenting to Duke Hospital from 2006 to 2010. Logistic regression models assessed potential predictors of receiving substance screening, mortality, length of stay, ventilator requirement, intensive care admission, or emergency department disposition. ResultsForty-seven percent (4607/9793) of patients received blood alcohol screen (BAS) and 31% (3017/9793) received urine drug screen (UDS). Men were more likely to receive both BASs (P < 0.001) and UDSs (P = 0.001) than women after controlling for potential confounders. There was no significant difference between men and women over the legal limit for alcohol (OLLA; 27.2%, 95% confidence interval [CI]: 25.7%–28.8% versus 24.8%, 95% CI: 22.3%–27.5%). Similarly, younger patients more likely received both BASs (P < 0.001) and UDSs (P < 0.001) compared with older patients. The proportion of patients aged ≤45 y OLLA (26.5 %, 95% CI: 24.9%–28.2%) was similar to those aged >45 y OLLA (26.8%, 95% CI: 24.5%–29.3%). After controlling for potential confounders neither alcohol, nor tetrahydrocannabinol, nor cocaine was predictive of mortality, ventilator requirement, length of stay, or emergency department disposition, but a higher alcohol level (P = 0.0174) predicted intensive care admission. ConclusionsFemales and those aged >45 y are less likely to receive BASs and UDSs. Differential screening that is biased may place patients at risk for receiving inadequate care.

Influence of traffic enforcement on the attitudes and behavior of drivers

Traditionally, traffic enforcement has been an important means of improving traffic safety. Many studies have provided evidence of connections between the level of police enforcement and both driving behavior and the number of traffic accidents. In Northern Kosovo, there has been little, if any, traffic enforcement during the last 13 years. This situation has created a very rare research opportunity – it is now possible to directly study the influence of traffic enforcement on the attitudes and behavior of drivers by comparing two regions, one with traffic enforcement and one without it (Serbia vs. Northern Kosovo). The sample in the present study consisted of 424 drivers (204 from Serbia and 220 from Northern Kosovo). Questionnaires included items about the behaviors of the drivers (e.g., speeding, seat belt, drunk driving) and their attitudes. We also conducted field observations of driving behavior. The results indicated that the lack of enforcement affects almost every type of behavior that we examined. Compared with drivers in Serbia, drivers in Northern Kosovo drive faster, exceed speed limits more frequently, use seat belts less frequently, drive after exceeding the legal limit for alcohol more often, commit aggressive and ordinary violations more frequently and are generally involved in more risky situations.

Alcohol-Impaired Driving in the United States: Contributors to the Problem and Effective Countermeasures

Objective: To review the effectiveness of current countermeasures in alcohol-impaired driving. Method: This article provides an overview of the contributors to the alcohol-impaired driving problem in the United States and reviews the effectiveness of alcohol-impaired driving countermeasures. Results: Many effective countermeasures have been used during the past few decades both to deter drivers from driving when they are over the legal limit for alcohol and to discourage driving while intoxicated (DWI) offenders from reoffending once they have been caught and convicted. In recent years, greater attention has been given to the problem of “hardcore” drinking drivers, a term coined to refer to those who repeatedly drive with high blood alcohol concentrations and are resistant to changing their behavior. Although such individuals are a legitimate target for attention, focusing predominantly on this group will result in missed opportunities to address a large portion of alcohol-impaired driving crashes. This article provides a review of the primary countermeasures that have been used to reduce alcohol-impaired driving and summarizes evidence for their effectiveness. It asks the question of where, in an environment of limited resources, attention should be focused. Conclusions: General deterrent approaches, such as frequent and highly publicized sobriety checkpoints, have the greatest potential to save lives and should be the mainstay of state and local efforts. Specific deterrent approaches, aimed at deterring DWI offenders from reoffending, such as alcohol ignition interlocks, should be applied to all apprehended drivers, whatever their drinking history. Evidence suggests that they could benefit from them. In the future, advanced in-vehicle technologies that would prevent vehicles from being driven when their drivers are over the legal limit may hold the key to drastically reducing the alcohol-impaired driving problem.

Biomarkers of recent drinking, retrograde extrapolation of blood-alcohol concentration and plasma-to-blood distribution ratio in a case of driving under the influence of alcohol

This case report describes the police investigation of a road-traffic accident involving a collision at night (01.00 am) between a car and a truck in which a passenger in the car was killed. The driver of the truck was found responsible for the crash although a roadside breath-alcohol test was negative (<0.1 mg/L breath or 20 mg/100 mL blood). Because of injuries sustained in the crash, the female driver of the car was not breath-tested at the time but was transported to a local hospital for emergency treatment. After swabbing the skin with isopropanol an indwelling catheter was inserted at 01.40 am. A blood sample was taken at 02.10 am and the plasma portion contained 8 mmol/L ethanol according to analysis at the hospital clinical laboratory using a gas chromatographic method. Another blood sample was taken at 05.45 am for analysis of ethanol at a forensic toxicology laboratory, although the result was negative (<10 mg/100 mL). The police authorities wanted an explanation for the discrepancy between the clinical and forensic laboratory results and inquired whether the driver of the car was above the legal alcohol limit (>20 mg/100 mL) at the time of the crash. The scientific basis for converting a plasma-ethanol concentration into a blood-ethanol concentration and back extrapolation of the driver’s blood-alcohol concentration (BAC) is explained. The risk of contaminating a blood sample by swabbing the skin with isopropanol is discussed along with the use of alcohol biomarkers (ethyl glucuronide and ethyl sulphate) as evidence of recent drinking.

Risk factors for injury accidents among moped and motorcycle riders

ObjectiveTo study and quantify the effect of factors related to the riders of powered two-wheelers on the risk of injury accident involvement. MethodologyBased on national data held by the police from 1996 to 2005, we conducted a case–control study with responsibility for the accident as the event of interest. We estimated the odds ratios for accident responsibility. Making the hypothesis that the non-responsible riders in the study are representative of all the riders on the road, we thus identified risk factors for being responsible for injury accidents. The studied factors are age, gender, helmet wearing, alcohol consumption, validity of the subject's driving licence and for how long it has been held, the trip purpose and the presence of a passenger on the vehicle. Moped and motorcycle riders are analyzed separately, adjusting for the main characteristics of the accident. ResultsFor both moped and motorcycle riders, being male, not wearing a helmet, exceeding the legal limit for alcohol and travelling for leisure purposes increased the risk of accident involvement. The youngest and oldest users had a greater risk of accident involvement. The largest risk factor was alcohol, and we identified a dose–effect relationship between alcohol consumption and accident risk, with an estimated odds ratio of over 10 for motorcycle and moped riders with a BAC of 2g/l or over. Among motorcycle users, riders without a licence had twice the risk of being involved in an accident than those holding a valid licence. However, the number of years the rider had held a licence reduced the risk of accident involvement. One difference between moped and motorcycle riders involved the presence of a passenger on the vehicle: while carrying a passenger increased the risk of being responsible for the accident among moped riders, it protected against this risk among motorcycle riders. ConclusionThis analysis of responsibility has identified the major factors contributing to excess risk of injury accidents, some of which could be targeted by prevention programmes.

Translating research to practice: effective strategies to reduce motor vehicle injuries among American Indian tribes

BackgroundAmerican Indians/Alaska Natives have the highest motor vehicle-related death rates of all racial and ethnic groups in the United States. The Centers for Disease Control and Prevention's Injury Center worked...