The effectiveness of alcohol control policies on alcohol-related traffic fatalities in the United States

The association between beverage-specific alcohol consumption and mortality among road users in Russia, 1965-2019

A vast body of literature suggests a relationship between alcohol consumption and road traffic fatalities. Despite an impressive downward trend in road traffic fatalities in Russia, the death rate is still unacceptably high. Far fewer studies have differentiated the association by road users and types of alcoholic beverages. This population-based study aims to estimate the associations of total and beverage-specific alcohol per capita (15+) consumption (APC) based on official alcohol sales statistics and road traffic mortality using police data on the number of deaths by road users. The study covers the period 1965-2019. We employed a first-order difference linear regression model with robust and autocorrelation consistent standard errors, controlling for a level of motorisation. To examine the possible evolution of the phenomenon, we repeated models separately for three consecutive periods (1965-1984, 1985-2002, 2003-2019). The findings suggest that an annual 1-litre increase in APC (in litres of pure alcohol) associated with a corresponding increase in the death rates (per 100,000 inhabitants) of both unprotected road users and motor vehicle occupants by about 0.3 (p < 0.01) and 0.4 (p < 0.05), respectively. A beverage-specific analysis for 1965-2019 revealed a positive and significant association between mortality of pedestrians and cyclists and the consumption of strong alcoholic beverages (p < 0.05) as well as mortality of drivers and passengers and the consumption of weaker alcoholic beverages, primarily beer (p < 0.01). Various road safety strategies should be applied to prevent road traffic fatalities of road users.

Capturing long-memory properties in road fatality rate series by an autoregressive fractionally integrated moving average model with generalized autoregressive conditional heteroscedasticity: A case study of Florida, the United States, 1975-2018

INTRODUCTION

Time series models play an important role in monitoring and understanding the serial dynamics of road crash exposures, risks, outcomes, and safety performance indicators. The time-series methods applied in previous studies on crash time series analysis assume that the serial dependency decays rapidly or even exponentially. However, this assumption is violated in most cases because of the existence of long-memory properties in the crash time series data. Ignoring the long-memory dependency could result in biased understanding of the dynamics of road traffic crashes.

METHOD

To fill this research gap, this study proposes an autoregressive fractionally integrated moving average model with generalized autoregressive conditional heteroscedasticity (ARFIMA-GARCH) to capture and accommodate the long-memory decencies in the road fatality rate time series. To further investigate how the factors influencing the fatality risks play a role in the long-memory dependence, the effects of exogenous variables are examined in this study. The analysis is conducted based on the road crash fatality data in Florida, USA over 44 years. Results' Conclusions: The case analysis confirmed the existence of long-memory property in the crash fatality time series data by both the joint tests of Augmented Dickey-Fuller and the Phillips-Perron, and the integer order of differencing (≤0.5) in the proposed models. The model results reveal that gasoline price and alcohol consumption per capita is positively associated with road fatality risks, whereas unemployment rate and rural/urban road mileage are negatively related to the road fatality risks.

PRACTICAL APPLICATIONS

The significant influential factors are also found to account for the long-memory serial correlations between road traffic fatalities to some extent.

Alcohol-impaired motorcyclists versus car drivers: A comparison of crash involvement and legal consequence from adjudication data

INTRODUCTION

Driving under the influence (DUI) increases the probability of motor-vehicle collisions, especially for motorcycles with less protections. This study aimed to identify commonalities and differences between criminally DUI offenses (i.e., with a blood alcohol concentration (BAC) of 80 mg/dL or higher) committed by motorcyclists and car drivers.

METHODS

A total of 10,457 motorcycle DUIs and 8,402 car DUIs were compared using a series of logistic regression models, using data extracted from the documents of adjudication decisions by the courts of Jiangsu, China.

RESULTS

The results revealed that offenders from the high-BAC group (i.e., 200 mg/dL or higher) accounted for more than 20% of the total DUI offenses, and were more likely to be involved in a crash and punished with a longer detention. Motorcyclists had a higher likelihood of crash involvement, and were also more likely to be responsible for single-vehicle crashes associated with higher odds of injury sustained, compared to alcohol-impaired car drivers. In the verdict, motorcycle offenders were more likely to receive a less severe penalty.

CONCLUSIONS

Interventions are clearly required to focus on reducing in the high-BAC group of offenders. For alcohol-impaired motorcyclists, their risks of crash and injury against BAC climb more steeply than the risks for car drivers. The factors including frequent occurrences, uncertainty of detection, and short-term sentences may weaken the deterrence effect of the criminalization of motorcycle DUI. Practical Applications: The traffic-related adjudication data support traffic safety analysis. Strategies such as combating motorcycle violations (e.g., unlicensed operators or driving unsafe vehicles), undertaking education and awareness campaigns, are expected for DUI prevention.

Alcohol-related traffic laws and drunk-driving fatal accidents

In the United States, about 28 lives are lost daily in motor vehicle accidents that involve an alcohol-impaired driver. While most states have enacted various traffic laws to address this phenomenon, little consensus exists on the causal impact of these laws in reducing alcohol-induced fatalities. This paper exploits quasi-random variation in state-level laws to estimate the causal effect of alcohol-related traffic laws on the frequency of fatal accidents. This is identified from the discontinuities in traffic laws among contiguous counties that are separated by a shared state border. We present robust evidence that the conventional approaches that are typically utilized in the literature may erroneously estimate the effectiveness of several alcohol-related laws.

Association of designated open water swim area regulations and open water drowning rates

BACKGROUND

Although most persons over 5 years of age drown in open water, few laws have sought to regulate open water swim sites. We examined the association between regulations for designated open water swim sites and open water drowning death rates by state.

METHODS

Using International Classification of Disease (ICD)-10 codes in the CDC Web-based Injury Statistics Query and Reporting System (WISQARS), we identified and calculated open water drowning deaths involving all ages from 2012 to 2017 for 50 states and calculated open water drowning death rates. We then identified and categorised types of state regulations (lifeguards, water quality, rescue equipment, tracking/planning/reporting and signage) for open water swim sites in place in 2017 for a sample of 30 states (20 high-drowning, 10 low-drowning). Analyses evaluated associations between open water drowning rates in three groups (overall, youth and non-white) and the total number and types of state regulations.

RESULTS

Swim site regulations and open water drowning death rates for 10 839 victims were associated in all regression models. States with more types of regulations had lower open water drowning death rates in a dose-response relationship. States lacking regulations compared with states with all five types of regulations had open water drowning death rates 3.02 times higher among youth (95% CI 1.82 to 4.99) and 4.16 times higher among non-white residents (95% CI 2.46 to 7.05). Lifeguard and tracking/planning/reporting regulations were associated with a 33% and 45% reduction in open water drowning rates overall and among those aged 0-17 years.

CONCLUSION

States' open water swim area regulations, especially addressing tracking/planning/reporting and lifeguards, were associated with lower open water drowning death rates.

The effect of lowering the legal blood alcohol concentration limit on driving under the influence (DUI) in southern Taiwan: a cross-sectional retrospective analysis

OBJECTIVES

We aimed to profile the epidemiological changes of driving under the influence (DUI) in southern Taiwan after the legal blood alcohol concentration (BAC) limit was lowered from 50 to 30 mg/dL in 2013.

SETTING

Level 1 trauma medical centre in southern Taiwan.

PARTICIPANTS

Data from 7447 patients (4375 males and 3072 females) were retrieved from the trauma registry system of a single trauma centre to examine patient characteristics (gender, age and BAC), clinical outcome variables (Abbreviated Injury Score, Injury Severity Score and mortality) and vehicular crash-related factors (vehicle type, airbag use in car crashes, helmet use in motorcycle crashes and time of crash) before and after the BAC limit change.

RESULTS

Our results indicated that the percentage of DUI patients significantly declined from 10.99% (n=373) to 6.64% (n=269) after the BAC limit was lowered. Airbag use in car crashes (OR: 0.30, 95% CI 0.10 to 0.88, p=0.007) and helmet use in motorcycle crashes (OR: 0.20, 95% CI 0.15 to 0.26, p<0.001) was lower in DUI patients compared with non-DUI patients after the BAC limit change, with significant negative correlation. DUI behaviour increased crash mortality risk before the BAC limit change (OR: 4.33, 95% CI 2.20 to 8.54), and even more so after (OR: 5.60, 95% CI 3.16 to 9.93). The difference in ORs for mortality before and after the change in the BAC legal limit was not significant (p=0.568).

CONCLUSION

This study revealed that lowering the BAC limit to 30 mg/dL significantly reduced the number of DUI events, but failed to result in a significant reduction in mortality in these trauma patients.

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.

New Estimates of the Mean Ethanol Content of Beer, Wine, and Spirits Sold in the United States Show a Greater Increase in Per Capita Alcohol Consumption than Previous Estimates

BACKGROUND

Recent increases in alcohol-related morbidity and mortality have not occurred alongside notable increases in per capita alcohol consumption (PCC). This discrepancy may be partially due to U.S. PCC estimates not including annual estimates of the percentage of alcohol by volume (%ABV) of beer, wine, and spirits, but rather relying on time-invariant %ABV values.

METHODS

Building on a prior study covering 1950 to 2002, estimates of the annual mean %ABV of beer, wine, and spirits sold in the United States were calculated using the %ABV of major brands and sales of each beverage type for each state and nationally for the period 2003 to 2016. We applied these estimates to the calculation of annual beverage-specific and total PCC, and made descriptive comparisons between our PCC estimates and those estimates using invariant %ABV values.

RESULTS

For all beverage types, our mean %ABV estimates increased nationally and for all but 5 states. The PCC estimates from wine and spirits utilizing variable %ABV values were lower than estimates using invariant %ABV, and consumption from beer was higher. Our total PCC estimates were also lower than %ABV-invariant estimates; however, the percent change for %ABV-invariant estimates was 5.8% compared to a 7.9% change in our %ABV-variant estimates over the 2003 to 2016 period.

CONCLUSIONS

Given the application of PCC estimates to understand changes in alcohol-related morbidity and mortality, the inclusion of annual estimates of the %ABV of alcoholic beverages sold in the United States is necessary to ensure the precision of PCC measures such that the conclusions drawn from these applications are accurate and valid.

A systematic review of the effectiveness of interventions to reduce motor vehicle crashes and their injuries among the general and working populations

OBJECTIVE

To summarize the best available international scientific evidence on the effectiveness of interventions to reduce motor vehicle collisions and their consequences among the working and general populations.

METHODS

A broad and systematic review was conducted of the literature available in biomedical databases and grey literature. At least two investigators working in parallel performed data extraction, synthesis, and risk of bias analysis.

RESULTS

Forty-one studies with low to moderate risk of bias were included. Of these, 18 had an ecological design (time series), 10 were quasi-experimental, one was a population survey, one was a randomized clinical trial, and 11 were systematic reviews.

CONCLUSIONS

The interventions that most consistently show a positive effect on incidence, morbidity, and mortality due to motor vehicle collisions are national policies or programs that: regulate, enforce, and penalize driving under the influence of alcohol; improve driving safety and driver conditions; improve road infrastructure with the purpose of preventing collisions; and educate and penalize drivers with a history of road violations.

Prevalence of alcohol among nonfatally injured road accident casualties in two level III trauma centers in northern Ghana

BACKGROUND

Alcohol use is pervasive among motorists on the road in Ghana; however, we do not know the extent to which this behavior is implicated in road accidents in this country.

OBJECTIVES

The main objective of this research was to establish the prevalence of alcohol in the blood of nonfatally injured casualties in the emergency departments (EDs) in northern Ghana.

METHOD

Participants were injured road traffic crash victims, namely, pedestrians, cyclists, motorcyclists, and drivers seeking treatment at an ED. The study sites were 2 level III trauma centers located in Wa and Bolgatanga. Participants were screened for alcohol followed by breath tests for positive participants using breathalyzers.

RESULTS

Two hundred and sixty-two accident victims visited EDs, 58% of whom were in Wa. Among the victims, 41% were hospitalized and 57% experienced slight injuries. The vast majority (76%) of the casualties were motorcyclists, 13% were pedestrians, 8% were cyclists, and 2% were drivers. Casualties who had detectable alcohol in their blood were predominantly vulnerable road users. In all, 34% of participants had detectable blood alcohol concentrations (BACs) and the mean BAC for all casualties who tested positive and could give definitive BACs was 0.2265 (226 mg/dl). The prevalence of alcohol use was 53% among cyclists, 34% among motorcyclists, 21% among pedestrians, and 17% among drivers. Male casualties were more likely to test positive for alcohol than females. In addition, the prevalence of alcohol was significantly higher among injured casualties in Bolgatanga compared to Wa.

CONCLUSION

There was a high prevalence of alcohol use among nonfatally injured casualties in northern Ghana and injury severity increased with BAC. AUDIT screening in the hospital, alcohol consumption guideline, road safety education with an emphasis on minimizing or eliminating alcohol consumption, and enhanced enforcement of the BAC limit among motorists are recommended.

The impact of alcohol policies on alcohol-attributable diseases in Taiwan-A population-based study

BACKGROUND

Taiwan has some of the strictest alcohol-related driving laws in the world. However, its laws continue to be toughened to reduce the ever-increasing social cost of alcohol-related harm.

AIM

This study assumes that alcohol-related driving laws show a spillover effect such that behavioral changes originally meant to apply behind the wheel come to affect drinking behavior in other contexts. The effects of alcohol driving laws and taxes on alcohol-related morbidity are assessed; incidence rates of alcohol-attributable diseases (AAD) serve as our measure of morbidity.

METHODS

Monthly incidence rates of alcohol-attributable diseases were calculated with data from the National Health Insurance Research Database (NHIRD) from 1996 to 2011. These rates were then submitted to intervention analyses using Seasonal Autoregressive Integrated Moving Average models (ARIMA) with multivariate adaptive regression splines (MARS). ARIMA is well-suited to time series analysis while MARS helps fit the regression model to the cubic curvature form of the irregular AAD incidence rates of hospitalization (AIRH).

RESULTS

Alcoholic liver disease, alcohol abuse and dependence syndrome, and alcohol psychoses were the most common AADs in Taiwan. Compared to women, men had a higher incidence of AADs and their AIRH were more responsive to changes in the laws governing permissible blood alcohol. The adoption of tougher blood alcohol content (BAC) laws had significant effects on AADs, controlling for overall consumption of alcoholic beverages.

CONCLUSION

Blood alcohol level laws and alcohol taxation effectively reduced alcohol-attributable morbidities with the exception of alcohol dependence and abuse, a disease to which middle-aged, lower income people are particularly susceptible. Attention should be focused on this cohort to protect this vulnerable population.

Sanction changes and drunk-driving injuries/deaths in Taiwan

Driving under the influence (DUI) is one of the major causes of traffic accidents in Taiwan. About 5% of injuries involve DUI, and nearly 20% of deaths are due to alcohol-related crashes. During early 2006 to the end of 2014, the authorities in Taiwan increased the severity of fine and jail penalties for DUI offenders three times. At the same time, the monthly drunk-driving injures decreased nearly 40% and the monthly alcohol-related traffic death dropped more than 80%. In this paper, we examine the effects of sanction changes on the reduction of drunk-driving casualties during this period. We find that drunk-driving injuries and deaths significantly dropped after the statutory changes. The reduction was immediate following all sanction changes that raised the maximum fines or jail terms of DUI offenders. Policies that increased the maximum jail terms of DUI offenders seem to have a better gradual effect on the reduction of alcohol-related traffic casualties. Although increased sanctions are found to be effective in reducing drunk-driving casualties, we need more future research to examine the policy-to-perception and the policy-to-behavior links.

Effect of Maryland's 2011 Alcohol Sales Tax Increase on Alcohol-Positive Driving

INTRODUCTION

The 2011 Maryland alcohol sales tax increase from 6% to 9% provided an opportunity to evaluate the impact on rates of alcohol-positive drivers involved in injury crashes.

METHODS

Maryland police crash reports from 2001 to 2013 were analyzed using an interrupted time series design and a multivariable analysis employing generalized estimating equations models with a negative binomial distribution. Data were analyzed in 2014-2015.

RESULTS

There was a significant gradual annual reduction of 6% in the population-based rate of all alcohol-positive drivers (p<0.03), and a 12% reduction for drivers aged 15-20 years (p<0.007), and 21-34 years (p<0.001) following the alcohol sales tax increase. There were no significant changes in rates of alcohol-positive drivers aged 35-54 years (rate ratio, 0.98; 95% CI=0.89, 1.09). Drivers aged ≥55 years had a significant immediate 10% increase in the rate of alcohol-positive drivers (rate ratio, 1.10; 95% CI=1.04, 1.16) and a gradual increase of 4.8% per year after the intervention. Models using different denominators and controlling for multiple factors including a proxy for unmeasured factors found similar results overall.

CONCLUSIONS

The 2011 Maryland alcohol sales tax increase led to a significant reduction in the rate of all alcohol-positive drivers involved in injury crashes especially among drivers aged 15-34 years. This is the first study to examine the impact of alcohol sales taxes on crashes; previous research focused on excise tax. Increasing alcohol taxes is an important but often neglected intervention to reduce alcohol-impaired driving.

Sobriety checkpoint and open container laws in the United States: Associations with reported drinking-driving

OBJECTIVE

The objective of this study was to assess how 2 types of drinking-driving laws-permitting sobriety checkpoints and prohibiting open containers of alcohol in motor vehicles-are associated with drinking-driving and how enforcement efforts may affect these associations.

METHODS

We obtained 2010 data on state-level drinking-driving laws and individual-level self-reported drinking-driving from archival sources (Alcohol Policy Information System, NHTSA, and Behavioral Risk Factor Surveillance System). We measured enforcement of the laws via a 2009 survey of state patrol agencies. We computed multilevel regression models (separate models for each type of law) that first examined how having the state law predicted drinking-driving, controlling for various state- and individual-level covariates; we then added the corresponding enforcement measure as another potential predictor.

RESULTS

We found that states with a sobriety checkpoint law, compared with those without a law, had 18.2% lower drinking-driving; states that conducted sobriety checks at least monthly (vs. not conducting checks) had 40.6% lower drinking-driving (the state law variable was not significant when enforcement was added). We found no significant association between having an open container law and drinking-driving, but states that conducted open container enforcement, regardless of having a law, had 17.6% less drinking-driving.

CONCLUSION

Our results suggest that having a sobriety checkpoint law and conducting checkpoints as well as enforcement of open containers laws may be effective strategies for addressing drinking-driving.

Determinants of road traffic safety: New evidence from Australia using state-space analysis

This paper examines the determinants of road traffic crash fatalities in Queensland for the period 1958-2007 using a state-space time-series model. In particular, we investigate the effects of policies that aimed to reduce drink-driving on traffic fatalities, as well as indicators of the economic environment that may affect exposure to traffic, and hence affect the number of accidents and fatalities. The results show that the introduction of a random breath testing program in 1988 was associated with a 11.3% reduction in traffic fatalities; its expansion in 1998 was associated with a 26.2% reduction in traffic fatalities; and the effect of the "Safe4life" program, which was introduced in 2004, was a 14.3% reduction in traffic fatalities. Reductions in economic activity are also associated with reductions in road fatalities: we estimate that a one percent increase in the unemployment rate is associated with a 0.2% reduction in traffic fatalities.

Uber and Metropolitan Traffic Fatalities in the United States

Uber and similar rideshare services are rapidly dispersing in cities across the United States and beyond. Given the convenience and low cost, Uber has been characterized as a potential countermeasure for reducing the estimated 121 million episodes of drunk driving and the 10,000 resulting traffic fatalities that occur annually in the United States. We exploited differences in the timing of the deployment of Uber in US metropolitan counties from 2005 to 2014 to test the association between the availability of Uber's rideshare services and total, drunk driving-related, and weekend- and holiday-specific traffic fatalities in the 100 most populated metropolitan areas in the United States using negative binomial and Poisson regression models. We found that the deployment of Uber services in a given metropolitan county had no association with the number of subsequent traffic fatalities, whether measured in aggregate or specific to drunk-driving fatalities or fatalities during weekends and holidays.

One for the Road: A Comparison of Drinking and Driving Behavior Among Younger and Older Adults Involved in Fatal Crashes

Driving while intoxicated has been widely studied, but little is known about the differences in driving behaviors between the youngest and oldest drivers who consume alcohol but are not intoxicated. This study examined factors leading to fatal crashes in younger and older drivers who consumed alcohol, with a focus on drivers whose blood alcohol concentration was less than 0.08%. This was a secondary analysis of the Fatality Analysis Reporting System. Mean blood alcohol for both age groups was nearly double the legal limit. Within the low alcohol group, a higher proportion of older drivers crashed compared with younger drivers. Continued efforts are needed to screen and educate drivers regarding drinking and driving.

Legal consequences for alcohol-impaired drivers injured in motor vehicle collisions: A systematic review

The treatment of alcohol-impaired drivers injured in a motor vehicle collision (MVC) is a complex public health issue. We conducted a systematic review to describe the legal consequences for alcohol-impaired drivers injured in a MVC and taken to a hospital or trauma center. Methods We searched MEDLINE, Embase, and CINAHL databases from inception until August 2014. We included studies that reported legal consequences including charges or convictions of injured drivers taken to a hospital or trauma center after a MVC with a blood alcohol concentration (BAC) exceeding the legal limit.Results Twenty-six studies met inclusion criteria; twenty studies were conducted in the USA, five in Canada, and one in Sweden. All were cohort studies (23 retrospective, 3 prospective) and included 11,409 patients overall. A total of 5,127 drivers had a BAC exceeding the legal limit, with legal consequences reported in 4937 cases. The median overall DUI/DWI conviction rate was 13% (range 0-85%). The median percentage of drivers with a previous conviction on their record for driving under the influence (DUI) or driving while intoxicated (DWI) was 15.5% (range 6-40%). The median percentage of drivers convicted again for DUI/DWI during the study period was 3.5% (range 2-10%). Heterogeneity between study designs, legal jurisdictions, institutional procedures and policies for obtaining a legally admissible BAC measurement precluded a meta-analysis. Conclusions The majority of intoxicated drivers injured in MVCs and seen in the emergency department are never charged or convicted. A substantial proportion of injured intoxicated drivers had more than one conviction for DUI/DWI on their police record.

Youth Drinking in the United States: Relationships With Alcohol Policies and Adult Drinking

BACKGROUND

The relationship between the alcohol policy environment (ie, the combined effectiveness and implementation of multiple existing alcohol policies) and youth drinking in the United States has not been assessed. We hypothesized that stronger alcohol policy environments are inversely associated with youth drinking, and this relationship is partly explained by adult drinking.

METHODS

Alcohol Policy Scale (APS) scores that characterized the strength of the state-level alcohol policy environments were assessed with repeated cross-sectional Youth Risk Behavior Survey data of representative samples of high school students in grades 9 to 12, from biennial years between 1999 and 2011.

RESULTS

In fully adjusted models, a 10 percentage point increase in APS scores (representing stronger policy environments) was associated with an 8% reduction in the odds of youth drinking and a 7% reduction in the odds of youth binge drinking. After we accounted for youth-oriented alcohol policies, the subgroup of population-oriented policies was independently associated with lower odds of youth drinking (adjusted odds ratio 0.94; 95% confidence interval 0.92-0.97) and youth binge drinking (adjusted odds ratio 0.96; 95% confidence interval 0.94-0.99). State-level per capita consumption mediated the relationship between population-oriented alcohol policies and binge drinking among youth.

CONCLUSIONS

Stronger alcohol policies, including those that do not target youth specifically, are related to a reduced likelihood of youth alcohol consumption. These findings suggest that efforts to reduce youth drinking should incorporate population-based policies to reduce excessive drinking among adults as part of a comprehensive approach to preventing alcohol-related harms. Future research should examine influence of alcohol policy subgroups and discrete policies.

Do preferences of drinker-drivers differ?

Why people engage in illegal activities is not well understood. Using data collected for this research from eight cities in four states, this study investigates alternative explanations as to why people drive while intoxicated (DWI). We find that preferences and subjective beliefs about arrest/incarceration of persons who drink and drive do differ systematically from others in terms of benefits and costs of drink and driving, and in their risk tolerance. While most findings imply that DWI is a deliberate choice, we do find that drinker drivers tend to be more impulsive and lack self-control in their drinking.

Impacts of the minimum legal drinking age on motor vehicle collisions in Québec, 2000-2012

BACKGROUND

International debates are occurring about the effectiveness of minimum legal drinking age laws. Most minimum legal drinking age evaluation studies have focused on motor vehicle collision outcomes, but this literature is primarily based on naturalistic experiments involving legislation changes in the U.S. in the mid-1980s. Few studies have provided up-to-date estimates of the impacts of Canadian drinking age laws on motor vehicle collisions to inform current policy discussions.

PURPOSE

To estimate the impacts of minimum legal drinking age legislation on motor vehicle collisions occurring in 2000-2012 in Québec, a province with a minimum legal drinking age of 18 years.

METHODS

Using Québec Ministry of Transportation records of police-reported motor vehicle collisions in 2000-2012, regression-discontinuity analyses were employed to assess the impacts of the minimum legal drinking age on motor vehicle collisions. All data were analyzed in 2013.

RESULTS

Relative to individuals slightly younger than the minimum legal drinking age, male and female drivers just older than the minimum legal drinking age had a significant and abrupt increase of approximately 6% (men, 6.3%, p=0.003; women, 5.9%, p=0.047) in population-level motor vehicle collisions, as well as a significant 11.1% (p=0.001) rise in nighttime motor vehicle collisions (a proxy for alcohol-related collisions).

CONCLUSIONS

Drinking-age laws continue to be an integral component of contemporary alcohol-control and driving-related policies designed to limit motor vehicle collisions among youth. In addition, the regression-discontinuity approach can guide future work to estimate potential minimum legal drinking age impacts on other health outcomes.

Do alcohol excise taxes affect traffic accidents? Evidence from Estonia

OBJECTIVE

This article examines the association between alcohol excise tax rates and alcohol-related traffic accidents in Estonia.

METHODS

Monthly time series of traffic accidents involving drunken motor vehicle drivers from 1998 through 2013 were regressed on real average alcohol excise tax rates while controlling for changes in economic conditions and the traffic environment. Specifically, regression models with autoregressive integrated moving average (ARIMA) errors were estimated in order to deal with serial correlation in residuals. Counterfactual models were also estimated in order to check the robustness of the results, using the level of non-alcohol-related traffic accidents as a dependent variable.

RESULTS

A statistically significant (P <.01) strong negative relationship between the real average alcohol excise tax rate and alcohol-related traffic accidents was disclosed under alternative model specifications. For instance, the regression model with ARIMA (0, 1, 1)(0, 1, 1) errors revealed that a 1-unit increase in the tax rate is associated with a 1.6% decrease in the level of accidents per 100,000 population involving drunk motor vehicle drivers. No similar association was found in the cases of counterfactual models for non-alcohol-related traffic accidents.

CONCLUSIONS

This article indicates that the level of alcohol-related traffic accidents in Estonia has been affected by changes in real average alcohol excise taxes during the period 1998-2013. Therefore, in addition to other measures, the use of alcohol taxation is warranted as a policy instrument in tackling alcohol-related traffic accidents.

A new scale of the U.S. alcohol policy environment and its relationship to binge drinking

BACKGROUND

Of outcomes related to excessive drinking, binge drinking accounts for approximately half of alcohol-attributable deaths, two thirds of years of potential life lost, and three fourths of economic costs. The extent to which the alcohol policy environment accounts for differences in binge drinking in U.S. states is unknown.

PURPOSE

The goal of the study was to describe the development of an Alcohol Policy Scale (APS) designed to measure the aggregate state-level alcohol policy environment in the U.S. and assess the relationship of APS scores to state-level adult binge drinking prevalence in U.S. states.

METHODS

Policy efficacy and implementation ratings were developed with assistance from a panel of policy experts. Data on 29 policies in 50 states and Washington DC from 2000-2010 were collected from multiple sources and analyzed between January 2012 and January 2013. Five methods of aggregating policy data to calculate APS scores were explored; all but one was weighted for relative policy efficacy and/or implementation. Adult (aged ≥18 years) binge drinking prevalence data from 2001-2010 was obtained from the Behavioral Risk Factor Surveillance System surveys. APS scores from a particular state-year were used to predict binge drinking prevalence during the following year.

RESULTS

All methods of calculating APS scores were significantly correlated (r >0.50), and all APS scores were significantly inversely associated with adult binge drinking prevalence. Introducing efficacy and implementation ratings optimized goodness of fit in statistical models (e.g., unadjusted beta=-3.90, p<0.0001, R(2)=0.31).

CONCLUSIONS

The composite measure(s) of the alcohol policy environment have internal and construct validity. Higher APS scores (representing stronger policy environments) were associated with less adult binge drinking and accounted for a substantial proportion of the state-level variation in binge drinking among U.S. states.

The impact of a national alcohol policy on deaths due to transport accidents in Russia

AIMS

To determine the impact of a suite of 2006 Russian alcohol control policies on deaths due to traffic accidents in the country.

DESIGN, SETTING AND PARTICIPANTS

We used autoregressive integrated moving average (ARIMA) interrupted time-series techniques to model the impact of the intervention on the outcome series. The time-series began in January 2000 and ended in December 2010. The alcohol policy was implemented in January 2006, providing 132 monthly observations in the outcome series, with 72 months of pre-intervention data and 60 months of post-intervention data.

MEASUREMENTS

The outcome variables were the monthly number of male- and female-specific deaths of those aged 15+ years due to transport accidents in Russia.

FINDINGS

The 2006 set of alcohol policies had no impact on female deaths due to traffic accidents (ω0  = -50.31, P = 0.27). However, the intervention model revealed an immediate and sustained monthly decrease of 203 deaths due to transport accidents for males (ω0  = -203.40, P = 0.04), representing an 11% reduction relative to pre-intervention levels.

CONCLUSION

The implementation of the suite of 2006 Russian alcohol control policies is partially responsible for saving more than 2400 male lives annually that would otherwise have been lost to traffic accidents.

Variation in U.S. traffic safety policy environments and motor vehicle fatalities 1980-2010

OBJECTIVE

To examine the impact of variation in state laws governing traffic safety on motor vehicle fatalities.

STUDY DESIGN

Repeated cross sectional time series design.

METHODS

Fixed effects regression models estimate the relationship between state motor vehicle fatality rates and the strength of the state law environment for 50 states, 1980-2010. The strength of the state policy environment is measured by calculating the proportion of a set of 27 evidence-based laws in place each year. The effect of alcohol consumption on motor vehicle fatalities is estimated using a subset of alcohol laws as instrumental variables.

RESULTS

Once other risk factors are controlled in statistical models, states with stronger regulation of safer driving and driver/passenger protections had significantly lower motor vehicle fatality rates for all ages. Alcohol consumption was strongly associated with higher MVC death rates, as were state unemployment rates.

CONCLUSIONS

Encouraging laggard states to adopt the full range of available laws could significantly reduce preventable traffic-related deaths in the U.S. - especially those among younger individuals. Estimating the relationship between different policy environments and health outcomes can quantify the result of policy gaps.

The effectiveness of drinking and driving policies for different alcohol-related fatalities: a quantile regression analysis

To understand the impact of drinking and driving laws on drinking and driving fatality rates, this study explored the different effects these laws have on areas with varying severity rates for drinking and driving. Unlike previous studies, this study employed quantile regression analysis. Empirical results showed that policies based on local conditions must be used to effectively reduce drinking and driving fatality rates; that is, different measures should be adopted to target the specific conditions in various regions. For areas with low fatality rates (low quantiles), people’s habits and attitudes toward alcohol should be emphasized instead of transportation safety laws because “preemptive regulations” are more effective. For areas with high fatality rates (or high quantiles), “ex-post regulations” are more effective, and impact these areas approximately 0.01% to 0.05% more than they do areas with low fatality rates.

Population drinking and drink driving in Norway and Sweden: an analysis of historical data 1957-89

AIM

Research suggests an association between population drinking and a large number of outcomes. However, driving while under the influence of alcohol (DWI) is conspicuously absent from this list of outcomes. The aim of this study was to estimate the relation between DWI and total consumption of alcohol on annual time-series data for Norway and Sweden. DESIGN, SETTING, AND MEASUREMENTS: For Norway, we used data on convictions for DWI per 100 000 inhabitants (aged 15-69 years). The DWI proxy for Sweden comprised the proportion (%) of all police-reported traffic accidents with personal injuries where the driver was under the influence of alcohol. Data on total alcohol sales in litres of pure alcohol per inhabitant (aged 15 years and older) were used as proxy for total alcohol consumption. We focused on the period 1957-89, during which the legislation concerning DWI remained unchanged in Norway as well as in Sweden. The statistical analyses were based on co-integrated models.

FINDINGS

The estimates of the association between DWI and per capita alcohol consumption were strongly significant in Norway as well as in Sweden. For Norway, the estimated elasticity equalled 2 (P < 0.001) and for Sweden 1.5 (P < 0.001).

CONCLUSIONS

In Norway and Sweden, as total population level of alcohol consumption increases or decreases so does the incidence of driving while intoxicated.