How much can you drink before driving? The influence of riding with impaired adults and peers on the driving behaviors of urban and rural youth

The association between single and dual use of cannabis and alcohol and driving under the influence and riding with an impaired driver in a large sample of Canadian adolescents

OBJECTIVE

Dual use of cannabis and alcohol has increased in adolescents, but limited research has examined how it relates to impaired driving or riding with an impaired driver (IDR) compared to single substance use. This study aimed to examine the odds of alcohol- and/or cannabis-IDR among adolescents based on their use of alcohol and/or cannabis, and whether associations differed by gender and age.

METHODS

Cross-sectional survey data were used from a sample of 69,621 students attending 182 Canadian secondary schools in the 2021/22 school year. Multilevel logistic regression estimated the odds of exclusive alcohol-IDR, exclusive cannabis-IDR, and both alcohol and cannabis IDR (alcohol-cannabis-IDR). Substance use interactions with gender and age were tested.

RESULTS

Overall, 14.7% of participants reported IDR; 7.5% reported exclusive alcohol-IDR, 3.2% reported exclusive cannabis-IDR, 4.0% reported alcohol-cannabis-IDR, and 7.4% were unsure if they had experienced IDR. The prevalence of IDR varied across substance use groups, 8.0% among nonuse, 21.9% among alcohol-only use, 35.9% among cannabis-only use, and 49.6% among dual use groups. Gender diverse, older, and students with lower socioeconomic status exhibited a higher likelihood of reporting alcohol-cannabis-IDR. Dual use was significantly associated with 9.5 times higher odds of alcohol-cannabis-IDR compared to alcohol-only use, and 3.0 times higher odds compared to cannabis-only use. Dual use was also associated with an increased likelihood of either alcohol- or cannabis-IDR.

CONCLUSIONS

This study highlights that all students, regardless of substance use, are at risk of IDR, but students engaged in dual use of alcohol and cannabis face an elevated risk compared to both peers who do not use substances and those who use only a single substance. These findings emphasize the importance of targeted interventions that address the risks associated with IDR.

Examining the Associations between Adverse Childhood Experiences, Health Risk Behaviours, and Psychological Well-Being in a Convenience Sample of Lithuanian University Students

This study examines the associations between adverse childhood experiences (ACEs), health risk behaviours, and psychological well-being among Lithuanian university students. A cross-sectional survey was carried out with a convenience sample of 393 students (80.7% females and 19.3% males) recruited from mostly undergraduate courses (96.4%) in Lithuanian universities. Participants, aged 18−25 years (21.07 ± 1.53), completed a web-based survey in which they were asked to retrospectively self-report on ACEs while answering questions on health risk behaviours (e.g., smoking, substance use, riding a car with a drunk driver) and psychological well-being. Only 8.7% of the study sample experienced no ACEs, and almost half of the sample (48.9%) experienced ≥4 ACEs. Findings from adjusted models showed that, compared with students with no ACEs, those who experienced ≥4 ACEs had higher odds of lifetime illicit drug use (AOR = 2.73, p < 0.05), riding with a drunk driver (AOR = 2.44, p < 0.05), suicidal ideation before age 18 (AOR = 28.49, p < 0.01) and in the past 12 months (AOR = 5.39, p < 0.01). An increased number of ACEs was also associated with lower psychological well-being (B = −3.94, p < 0.001). Findings from this study have implications for mental health professionals as well as university administrators, as students with a higher number of traumatic experiences may require greater levels of support and services.

Alcohol-related deaths among young passengers: An analysis of national alcohol-related fatal crashes

INTRODUCTION

There is consensus that riding with an impaired driver (RWI) constitutes a major threat to public health. The aim of this study was to characterize the factors contributing to the motor-vehicle deaths of 15-20 year-old (y/o) passengers that RWI with a peer.

METHOD

Secondary analyses of the 2010-2018 Fatality Analysis Reporting System. 5,673 passengers aged 15-20 y/o killed while riding in passenger cars with a driver aged 21 or older, 3,542 of these drivers also aged 15-20 y/o. Analyses were conducted between October 2019 and December 2020.

RESULTS

Sixty-three percent of the young passengers were killed while riding with a driver 15-20 y/o. Of these drivers, 26.8% had a blood alcohol concentration (BAC) >0.00 g/dL and 77.1% had a BAC ≥0.08 g/dL. Compared with those occurring during the day on weekdays, fatalities of young passengers who RWI with a peer driver with a BAC ≥ 0.08 g/dL often occurred on weekend nights (OR = 8.2) and weekday nights (OR = 5.2), and when the passenger and driver were both male (OR = 1.8). Race/ethnicity was not a significant contributor to RWI fatalities.

CONCLUSIONS

Most 15-20 y/o RWI fatalities occurred on weekends, at night, when the driver was a young peer with a high BAC, and the passenger and driver were male. The high prevalence of fatalities in these high-risk situations suggests that young driver-passenger dynamics may contribute to alcohol-related fatalities. Practical Applications: To curb RWI fatalities among underage passengers, countermeasures should focus not only on underage drinking drivers and riders, but also on drinking drivers of all ages. Prevention should increase focus on situations in which both the young passenger and young driver are males.

Transportation Risk Behaviors Among High School Students - Youth Risk Behavior Survey, United States, 2019

Motor-vehicle crashes are a leading cause of death and nonfatal injury among U.S. adolescents, resulting in approximately 2,500 deaths and 300,000 nonfatal injuries each year. Risk for motor-vehicle crashes and resulting injuries and deaths varies, depending on such behaviors as seat belt use or impaired or distracted driving. Improved understanding of adolescents’ transportation risk behaviors can guide prevention efforts. Therefore, data from the 2019 Youth Risk Behavior Survey were analyzed to determine prevalence of transportation risk behaviors, including not always wearing a seat belt, riding with a driver who had been drinking alcohol (riding with a drinking driver), driving after drinking alcohol, and texting or e-mailing while driving. Differences by student characteristics (age, sex, race/ethnicity, academic grades in school, and sexual identity) were calculated. Multivariable analyses controlling for student characteristics examined associations between risk behaviors. Approximately 43.1% of U.S. high school students did not always wear a seat belt and 16.7% rode with a drinking driver during the 30 days before the survey. Approximately 59.9% of students had driven a car during the 30 days before the survey. Among students who drove, 5.4% had driven after drinking alcohol and 39.0% had texted or e-mailed while driving. Prevalence of not always wearing a seat belt was higher among students who were younger, black, or had lower grades. Riding with a drinking driver was higher among Hispanic students or students with lower grades. Driving after drinking alcohol was higher among students who were older, male, Hispanic, or had lower grades. Texting while driving was higher among older students or white students. Few differences existed by sexual identity. Multivariable analyses revealed that students engaging in one transportation risk behavior were more likely to engage in other transportation risk behaviors. Traffic safety and public health professionals can use these findings to reduce transportation risk behaviors by selecting, implementing, and contextualizing the most appropriate and effective strategies for specific populations and for the environment.

Substance use and sociodemographic correlates among adolescents in a low-income sub Saharan setting

BACKGROUND

The present study investigated the social and behavioral correlates of substance use, specifically bang or cocaine or similar drugs among a school-based sample of adolescents in a low-income urban setting.

METHODS

The study utilized data on 2,176 school-attending adolescents aged 11-16 years in Dar es Salaam (DES) to examine social and behavioral correlates for lifetime substance use. The correlates under investigation included, demographic - age and gender; social - poverty, parent-adolescent relationship; behavioral - truancy, aggressive behavior, injury risk; psychological - depression and suicide ideation. Bivariate and multivariate analyses were then carried out on several variables identified from the 2006 Tanzanian Global School-based Health Survey (GSHS) questionnaire.

RESULTS

Approximately seven percent of school-attending adolescents (n=144) reported having used an illicit substance at least once during their lifetime. After adding significantly associated covariates into a logistic regression model, we found that only truancy [OR= 2.29 (CI=1.07 - 4.90)], suicide ideation [OR=4.36 (2.32 - 8.19)] and parents who had checked their adolescents' homework (OR=0.56 (CI=0.32 - 1.00)] were significantly associated with reported substance use.

CONCLUSIONS

Our results suggest that health promotion programs should simultaneously target multiple factors associated with substance use behaviors among school-attending adolescents in Dar es Salaam. They should take into account the range of psychosocial characteristics of school-attending adolescents which may be impacted by or result from substance use.

Trajectories of Driving after Drinking among Marijuana-Using Youth in the Emergency Department: Substance Use, Mental Health, and Peer and Parental Influences

Background: The psychosocial correlates and longitudinal trajectories of driving after drinking (DAD) among youth remain understudied in at-risk populations. Objectives: We investigated the relationships of DAD trajectories and negative peer and parental influences, substance use, and mental health among predominantly marijuana-using youth seeking emergency department (ED) treatment. Methods: Data were from a 2-year prospective cohort study of drug-using patients (97.4% used marijuana) ages 14-24 seeking ED care for assault injury, or as part of a non-assaulted comparison group. Validated surveys measured DAD behaviors and correlates at baseline, 6, 12, 18, and 24 months. Latent class growth analysis identified characteristic DAD trajectory groups; baseline predictors were analyzed descriptively and using multinomial logistic regression. Results: Three DAD trajectory groups were identified among driving-age youth (n = 580): no DAD (NDAD; 55.2%), low-steady (LDAD; 29.0%), and high-declining (HDAD; 15.9%). In unadjusted analyses, HDAD youth were older, but otherwise similar to other groups demographically. Compared to NDAD, LDAD and HDAD group members had higher rates of drug and alcohol use disorders (p < .001). Further, HDAD group members had higher rates of anxiety symptoms and were more likely to be diagnosed with PTSD or depression than NDAD or LDAD youth (p < .05). Negative peer and parent influences were significantly higher in progressively more severe trajectory groups (p < .01). Adjusted effects from the multinomial model were analogous for peer and parental influences and substance use disorders, but not mental health. Conclusion: DAD is strongly associated with negative social influences and substance use disorders among marijuana-using youth, reinforcing their importance when developing interventions.

Context and culture: Reasons young adults drink and drive in rural America

Montana, a large and rural U.S. state, has a motor vehicle fatality rate almost double the national average. For young adults, the alcohol-related motor vehicle fatality rate in the state is almost three times the national average. Yet little research has explored the underlying reasons that young people in rural areas drink and drive. Drawing from the theory of triadic influence (TTI) and a series of qualitative focus group discussions, the current study examined how aspects of the landscape and culture of rural America promote and hinder drinking and driving among young people. In 2015 and 2016, 72 young adults (36 females) aged 18-25 years old (mean age = 20.2) participated in 11 semi-structured focus groups in 8 rural counties in Montana. Discussions were transcribed, and two reviewers independently coded text segments. Themes were identified and an inductive explanatory model was created. The results demonstrated that aspects of the social context (e.g., peer pressure and parental modeling), rural cultural values (e.g., independence, stoicism, and social cohesion), and the legal and physical environment (e.g., minimal police presence, sparse population, and no alternative transportation) promoted drinking and driving. The results also identified salient protective factors in each of these domains. Our findings demonstrate the importance of examining underlying distal determinants of drinking and driving. Furthermore, they suggest that future research and interventions should consider the complex ways in which cultural values and environmental factors intersect to shape the risky health behaviors of rural populations.

Emerging Adults Riding With Marijuana-, Alcohol-, or Illicit Drug-Impaired Peer and Older Drivers

OBJECTIVE

The purpose of this study was to examine the prevalence and covariates among emerging adults of riding with an impaired peer or older adult driver (RWI) because of marijuana (MJ), alcohol (ALC), or illicit drugs (ID).

METHOD

Data were from Waves 4 (W4, N = 2,085) and 5 (W5, N = 2,116) of the NEXT Generation Health Study, collected in 2013-2014, 1 and 2 years after high school. W5 RWI was specified for substance-specific impaired peer and older adult (peer/older adult) drivers. Multinomial logistic regressions estimated W5 association of substance-specific RWI with W4 RWI, and W5 heavy episodic drinking, MJ use, and school/residence/work status.

RESULTS

At W5, 33% of the participants reported RWI in the past year, including riding with ALC- (21%), MJ- (17%), and ID- (5%) impaired peer drivers and ALC- (2%), MJ- (4%), and ID- (0.7%) impaired older adult drivers. W4 RWI was associated with W5 RWI with impaired peer/older adult drivers for ALC- (adjusted odds ratio [AOR] = 4.28, 2.69) and MJ-RWI (AOR = 2.34, 3.56). W5 heavy episodic drinking was positively associated with W5 peer ALC-related RWI (AOR = 2.16) and peer/older adult MJ-related RWI (AOR = 2.38, 5.45). W5 MJ use was positively associated with W5 peer ALC-related RWI (AOR = 2.23), peer/older adult MJ-related (AOR = 10.89, 2.98), and peer/older adult ID-related (AOR = 9.34, 4.26) RWI. ID-related RWI was higher among those not attending 4-year college (AOR = 3.38), attending technology school (AOR = 16.23), living on their own (AOR = 6.85), or living on campus (AOR = 11.50).

CONCLUSIONS

The high prevalence of RWI among emerging adults occurred mostly with ALC- or MJ-impaired peer drivers. The findings support the need for precisely tailored programs to prevent impaired driving according to substance use and age.

Risk and safety perception on urban and rural roads: Effects of environmental features, driver age and risk sensitivity

OBJECTIVE

The ability to detect changing visual information is a vital component of safe driving. In addition to detecting changing visual information, drivers must also interpret its relevance to safety. Environmental changes considered to have high safety relevance will likely demand greater attention and more timely responses than those considered to have lower safety relevance. The aim of this study was to explore factors that are likely to influence perceptions of risk and safety regarding changing visual information in the driving environment. Factors explored were the environment in which the change occurs (i.e., urban vs. rural), the type of object that changes, and the driver's age, experience, and risk sensitivity.

METHODS

Sixty-three licensed drivers aged 18-70 years completed a hazard rating task, which required them to rate the perceived hazardousness of changing specific elements within urban and rural driving environments. Three attributes of potential hazards were systematically manipulated: the environment (urban, rural); the type of object changed (road sign, car, motorcycle, pedestrian, traffic light, animal, tree); and its inherent safety risk (low risk, high risk). Inherent safety risk was manipulated by either varying the object's placement, on/near or away from the road, or altering an infrastructure element that would require a change to driver behavior. Participants also completed two driving-related risk perception tasks, rating their relative crash risk and perceived risk of aberrant driving behaviors.

RESULTS

Driver age was not significantly associated with hazard ratings, but individual differences in perceived risk of aberrant driving behaviors predicted hazard ratings, suggesting that general driving-related risk sensitivity plays a strong role in safety perception. In both urban and rural scenes, there were significant associations between hazard ratings and inherent safety risk, with low-risk changes perceived as consistently less hazardous than high-risk impact changes; however, the effect was larger for urban environments. There were also effects of object type, with certain objects rated as consistently more safety relevant. In urban scenes, changes involving pedestrians were rated significantly more hazardous than all other objects, and in rural scenes, changes involving animals were rated as significantly more hazardous. Notably, hazard ratings were found to be higher in urban compared with rural driving environments, even when changes were matched between environments.

CONCLUSION

This study demonstrates that drivers perceive rural roads as less risky than urban roads, even when similar scenarios occur in both environments. Age did not affect hazard ratings. Instead, the findings suggest that the assessment of risk posed by hazards is influenced more by individual differences in risk sensitivity. This highlights the need for driver education to account for appraisal of hazards' risk and relevance, in addition to hazard detection, when considering factors that promote road safety.

Putting Adolescents at Risk: Riding With Drinking Drivers Who Are Adults in the Home

OBJECTIVE

Alcohol-related car crashes are a leading cause of adolescent death, and one in five U.S. adolescents reports recent riding in a car with a drinking driver. How often the driver is an adult in the home (e.g., parent) is unknown. Pediatric visits offer an opportunity to counsel families to reduce this risk. Our study aim was to determine the prevalence of recent riding with a drinking driver (RWDD) who was an adult in the home among adolescent primary care patients and to identify the demographic and environmental (substance use among family members) profiles of those at increased risk.

METHOD

We recruited 12- to 18-year-olds arriving for routine medical care between 11/2005 and 10/2008 from nine practices in New England. Computer self-administered questionnaires assessed demographics, past-3-month RWDD, driver characteristics, and parent/sibling substance use. We computed adjusted relative risk ratios using multiple logistic regression modeling.

RESULTS

Among 2,096 adolescents (86% participation rate; mean age = 15.8 years, SD = 2.0; 58% girls; 65% White non-Hispanic), 8.2% reported past-3-month RWDD who was an adult in the home (36.6% of those reporting any past-3-month RWDD). Risk was higher for girls, younger adolescents (<17 year olds), White non-Hispanic and Hispanic versus Black youth, those with non-college-graduate parents, and those with substance-involved parents.

CONCLUSIONS

For a substantial proportion of adolescent primary care patients RWDD, the driver is a parent or other household adult, suggesting an important target for screening and counseling.

Marijuana and other substance use among male and female underage drinkers who drive after drinking and ride with those who drive after drinking

The study sought to describe the occurrence of adolescent driving after drinking (DD) and riding with a driver who had been drinking (RWDD) and associations with substance use for both males and females. As part of screening for a randomized controlled trial, we surveyed 16-20year olds (N=3418) recruited from an emergency department (ED) and analyzed data from those reporting past-year alcohol consumption (n=2150, 58% females). DD was reported by 22% of females and 28% of males and RWDD was reported by 39% of females and 38% of males, also in the past year. In regression models, risky alcohol use and past-year marijuana use were associated with increased odds of DD and RWDD for females and males. Marijuana use was a strong predictor, with odds increased by 2.3 and 1.7 times for DD among females and males respectively and 1.4 times for RWDD for females and males. Prescription drug misuse was also associated with RWDD for females and for both males' and females' reported DD. The findings highlight the alarming rate of DD and RWDD among both males and females and suggest ED-based injury prevention efforts consider such risky road behavior as well as consider their substance use. Future research might also further examine the effects of driving under influence of substances, particularly marijuana, and the negative synergistic effects of co-ingestion prior to driving.

Passengers at risk: a multi-level analysis of the decision to travel with a drunk driver

AIMS

To assess the impact of demographic, intrapersonal and environmental factors on the likelihood in Chile of becoming a passenger of an alcohol-impaired driver (PAID).

DESIGN

Multi-level cross-sectional study.

SETTING

Data were acquired from two large-scale household surveys of representative samples of Chile's Metropolitan Region.

PARTICIPANTS

The study included 1341 individuals ≥ 16 years; 696 of them reported engaging in PAID.

MEASUREMENT

The primary outcome was self-reported frequencies of having accepted a ride with an alcohol-impaired driver.

FINDINGS

PAID was associated significantly with 'age' [odds ratio (OR) = 0.99, 95% confidence interval (CI) = 0.98-0.99, P = 0.03], 'traffic safety beliefs' (OR = 0.17, 95% CI = 0.078-0.44, P = 0.00), 'time exposure as passenger' (OR = 1.00, 95% CI = 1.00-1.01, P = 0.00) and 'sex' (OR = 0.67, 95% CI = 0.53-0.87, P = 0.00). In women, PAID was associated with 'age' (OR = 0.98, 95% CI = 0.97-0.99, P = 0.02), 'traffic safety beliefs' (OR = 0.17, 95% CI = 0.05-0.59, P = 0.00) and 'low quality of public bus stops' (OR = 0.97, 95% CI = 0.98-0.99, P = 0.01). Younger women with high education levels were more likely to engage in PAID than younger women with low education levels. In men, PAID was associated with 'traffic safety beliefs' (OR = 0.13, 95% CI = 0.02-0.63, P = 0.01) and 'time exposure as passenger' (OR = 1.00, 95% CI = 1.00-1.01, P = 0.02).

CONCLUSIONS

In Chile, men are at higher risk of becoming a passenger of an alcohol-impaired driver (PAID) than women. In women, PAID appears to be associated with lower traffic safety beliefs, lower quality of public bus stations and an interaction between education and age. In men, PAID is associated with lower traffic safety beliefs and higher time exposure as passenger.

Under the influence: examination of prevalence and correlates of alcohol and marijuana consumption in relation to youth driving and passenger behaviours in Canada. A cross-sectional study

BACKGROUND

Consequences of alcohol- and drug-impaired driving affect youth disproportionately. We describe individual- and area-level characteristics associated with risky driving and passenger behaviours among grade 9-12 students in Canada.

METHODS

The 2014-2015 Canadian Student Tobacco, Alcohol and Drug Survey was administered to 24 650 students in provincially generalizable samples. Dichotomous outcomes included ever and last-30-day driving after drinking alcohol, ever and last-30-day driving after using marijuana, and ever and last-30-day reporting of being a passenger with a driver who had been drinking or using marijuana.

RESULTS

A total of 9.1% (99% confidence interval 7.9-10.3) of grade 11-12 students reported ever driving after drinking, and 9.4% (99% confidence interval 8.3-10.4) reported ever driving after using marijuana. Almost half (48%) of grade 11-12 students reported ever participating in any risky driving or passenger behaviour. Over one-third (35%) of grade 9-12 students reported ever riding with a driver who had been drinking, and 20% reported ever riding with a driver who had been using marijuana. Logistic regression models showed that boys had higher odds of risky driving behaviours relative to girls, whereas girls had higher odds of risky passenger behaviours relative to boys. Students from rural schools had higher odds of drinking and driving and of riding with a driver who had drunk relative to students from urban schools. There were significant differences in risky driving and passenger behaviours by province.

INTERPRETATION

A substantial number of Canadian youth reported risky driving and passenger behaviours, which varied by individual and area-level characteristics. Federal marijuana policy should aim to reduce the prevalence of drug-impaired driving. Additional provincial policies to prevent impaired driving are needed.

Frequent marijuana use and driving risk behaviours in Canadian youth

Background

A better understanding of the relations between patterns of marijuana use and driving risks in young adulthood is needed.

Methods

Secondary analyses of self-report data from the Victoria Healthy Youth Survey. Youth (baseline ages 12 to 18; N=662; 52% females) were interviewed biannually (on six occasions) from 2003 to 2013 and classified as abstainers (i.e., used no marijuana in past 12 months), occasional users (i.e., used at most once per week), and frequent users (i.e., used more than once a week).

Results

In the frequent user group, 80% of males and 75% of females reported 'being in a car driven by driver (including themselves) using marijuana or other drugs in the last 30 days', 64% of males and 33% of females reported that they were 'intoxicated' with marijuana while operating a vehicle and 50% of males and 42% of females reported being in a car driven by a driver using alcohol. In addition, 28% of occasional users and also a small proportion of abstainers reported 'being in a car driven by a driver using marijuana or other drugs in the last 30 days'.

Interpretation

The high frequency of driving risk behaviours, particularly for frequent users, suggest that plans for legalization of recreational use should anticipate the costs of preventive education efforts that present an accurate picture of potential risks for driving. Youth also need to understand risks for dependence, and screening for and treatment of marijuana use disorders is needed.

Marijuana-, alcohol-, and drug-impaired driving among emerging adults: Changes from high school to one-year post-high school

INTRODUCTION

Driving while impaired (DWI) increases the risk of a motor vehicle crash by impairing performance. Few studies have examined the prevalence and predictors of marijuana, alcohol, and drug-specific DWI among emerging adults.

METHODS

The data from wave 3 (W3, high school seniors, 2012, N=2407) and wave 4 (W4, one year after high school, N=2178) of the NEXT Generation Health Study with a nationally representative cohort. W4 DWI (≥1day of past 30days) was specified for alcohol-specific, marijuana-specific, alcohol/marijuana-combined, illicit drug-related DWI. Multinomial logistic regression models estimated the association of W4 DWI with W3 covariates (perceived peer/parent influence, drinking/binge drinking, marijuana/illicit drug use), and W4 environmental status variables (work/school/residence) adjusting for W3 overall DWI, demographic, and complex survey variables.

RESULTS

Overall DWI prevalence from W3 to W4 changed slightly (14% to 15%). W4 DWI consisted of 4.34% drinking-specific, 5.02% marijuana-specific, 2.41% drinking/marijuana combined, and 3.37% illicit drug-related DWI. W3 DWI was significantly associated with W4 alcohol-related and alcohol/marijuana-combined DWI, but not other DWI. W3 marijuana use, binge drinking, and illicit drug use were positively associated with W4 marijuana-specific, alcohol/marijuana-combined, and illicit drug-related DWI, respectively. W3 friend drunkenness and marijuana use were positively associated with W4 alcohol-specific and marijuana-related DWI, respectively. W3 peer marijuana use was negatively associated with W4 alcohol-specific DWI.

CONCLUSIONS

Driving under the influence of alcohol, marijuana, and illicit drugs is a persistent, threatening public health concern among emerging U.S. adults. High school seniors' binge drinking as well as regular alcohol drinking and marijuana/illicit drug use were independently associated with respective DWI one year after high school. Peer drunkenness and marijuana use in high school may be related to subsequent DWI of emerging adults.

PRACTICAL APPLICATIONS

The results support the use of injunctive peer norms about getting drunk and smoking marijuana in guiding the development of prevention programs to reduce youth DWI.

Transitions in Riding With an Alcohol/Drug-Impaired Driver From Adolescence to Emerging Adulthood in the United States

OBJECTIVE

The purpose of this study was to examine changes and predictors of changes in riding with an alcohol/drug-impaired driver (RWI) from 10th grade through the first post-high school year.

METHOD

Transition models were used to estimate the association of four waves (W1-W4) of RWI with W4 environmental-status variables and time-varying covariates in the NEXT Generation Health Study, a nationally representative cohort of U.S. 10th graders (N = 2,785).

RESULTS

Overall, 33% (weighted) of adolescents reported RWI in the past 12 months in W1, and slightly declined in W2 (24%), W3 (27%), and W4 (26%). Across time, transition models with generalized estimating equations showed that RWI was more likely among those who previously reported RWI (ORs from 3.62 to 3.66, p < .001), substance use (ORs from 1.81 to 1.82, p < .001), and heavy episodic drinking (ORs from 1.85 to 1.86, p < .001). Those living on college campuses were somewhat more likely to engage in RWI (OR = 1.38, .05 < p <.10) than those living at home. The effects of parental monitoring knowledge and peer alcohol/substance use on RWI were suppressed when individual substance use and heavy episodic drinking were taken into consideration.

CONCLUSIONS

Substance use and heavy episodic drinking in previous waves and the history of RWI were persistent factors of RWI in a dynamic pattern. The setting in which emerging adults live during their first post-high school year could affect their engagement in RWI. The findings suggest that harm-reduction strategies should focus on the identification of early RWI coupled with reduction of substance use and heavy episodic drinking.

Drinking and driving among Italian adolescents: Trends over seven years (2007-2013)

In recent years, increasing attention has been paid to the issue of driving under the influence of alcohol (DUI), especially among young people. The aims of the present study were (1) to analyse the trends of DUI, riding with a driver under influence of alcohol (RWDUI) and alcohol-related road crashes (A-rC) in a nationally representative sample of students in the period 2007-2013, (2) to assess how different drinking patterns were associated with DUI and RWDUI, (3) to evaluate other influential factors (such as gender, older siblings' and friends' behaviour with alcohol) on DUI and RWDUI. Data were drawn from the cross-sectional European School Survey Project on Alcohol and Other Drugs (ESPAD) carried out annually in Italy. The sample size ranged from 25,555 to 40,390 students (15-19 years old). Results were stratified for students <18 years and ≥18 years old. Although a significant decreasing trend for alcohol consumption was observed only in the younger group, a significant decrease in DUI [APC (annual percent change) -9.7 in the younger and -6.4 in the older group] and in RWDUI (APC -6.7 in the younger and -4.8 in the older group) was detected. A significant decreasing trend of A-rC was observed only in the older group (APC -3.4). Three specific drinking patterns were identified: "Drinking to Excess" (DE), "Drinking with Intoxication" (DI) and "Drinking but Not to Excess" (DNE). In both age groups, the DE pattern significantly increased the likelihood of DUI, whereas the DI pattern was negatively associated, and the DNE pattern was not associated. Different results were found for RWDUI: the DE and DI patterns where significantly associated with RWDUI, whereas the DNE pattern was negatively associated. Overall, illegal substance use, parental monitoring, peers' and siblings' influence were associated with DUI and RWDUI. The change in behaviour towards DUI and RWDUI suggests a cumulative effectiveness of current alcohol policies, although further actions (greater attention to social context, law enforcement, and promotion of good practice) are needed to substantially reduce alcohol-related crashes.

Association between riding with an impaired driver and driving while impaired

OBJECTIVE

To examine the association between driving while alcohol/drug impaired (DWI) and the timing and amount of exposure to others' alcohol/drug-impaired driving (riding while impaired [RWI]) and driving licensure timing among teenage drivers.

METHODS

The data were from waves 1, 2, and 3 (W1, W2, and W3, respectively) of the NEXT Generation Study, with longitudinal assessment of a nationally representative sample of 10th graders starting in 2009-2010. Multivariate logistic regression was used for the analyses.

RESULTS

Teenagers exposed to RWI at W1 (adjusted odds ratio [AOR] = 21.12, P < .001), W2 (AOR = 19.97, P < .001), and W3 (AOR = 30.52, P < .001) were substantially more likely to DWI compared with those reporting never RWI. Those who reported RWI at 1 wave (AOR = 10.89, P < .001), 2 waves (AOR = 34.34, P < .001), and all 3 waves (AOR = 127.43, P < .001) were more likely to DWI compared with those who never RWI. Teenagers who reported driving licensure at W1 were more likely to DWI compared with those who were licensed at W3 (AOR = 1.83, P < .05).

CONCLUSIONS

The experience of riding in a vehicle with an impaired driver increased the likelihood of future DWI among teenagers after licensure. There was a strong, positive dose-response association between RWI and DWI. Early licensure was an independent risk factor for DWI. The findings suggest that RWI and early licensure could be important prevention targets.

Peer influence on speeding behaviour among male drivers aged 18 and 28

Despite extensive research, preventive efforts and general improvements in road safety levels, the accident risk of young male drivers remains increased. Based on a standardized survey of a random sample of 2018 male drivers at the age of 18 and 28, this study looked into attitudes and behaviours related to traffic violations of male drivers. More specifically, the role of peer influence on speeding was examined in both age groups. In regression analyses it could be shown that the descriptive subjective norm, i.e., the perception of friends' speeding, was the most important predictor of speeding in both age groups. Other significant factors were: negative attitude towards speed limits, injunctive subjective norm, and the perceived risk of having an accident when speeding. In the older age group it was more common to drive faster than allowed and their speeding was largely in line with the perceived level of their friends' speeding. In the younger age group a higher discrepancy between own and friends' speeding was found indicating that young male drivers are socialized into increased speeding behaviour based on peer pressure. By contrast for the 28-year-olds peer pressure mainly seems to maintain or justify individual speeding behaviour. It is suggested that preventive measures should take these different influences of peer pressure into account by using a peer-based approach for the 18-year-olds and a more individual approach for the 28-year-olds.

Driving under the influence of alcohol or drugs among adolescents: the role of urban and rural environments

This study aimed to describe driving under the influence of alcohol or drugs (DUIAD) and riding in a vehicle with a driver under the influence of alcohol or drugs (RDUIAD) and their associated factors among rural and urban adolescents in Spain. We performed a cross-sectional study including 2067 students from Barcelona and a rural area 60 km north of this city. The prevalences of ever DUIAD and RDUIAD were 17% and 41% among 17-18 year-old adolescents. DUIAD was more common in boys. Living in the rural area was independently associated with these behaviours. Exposure to these behaviours is common among Spanish adolescents, especially in rural areas.

Adolescent exposure to drink driving as a predictor of young adults' drink driving

The purpose of this study was to investigate the influence of exposure to others' drink driving during adolescence on self-reported driving under the influence (DUI) of alcohol in young adulthood. Data were drawn from 1956 participants with a driving license enrolled in the International Youth Development Study from Victoria, Australia. During 2003 and 2004, adolescents in Grades 7, 9 and 10 (aged 12-17) completed questionnaires examining whether they had ridden in a vehicle with a driver who had been drinking, as well as other demographic, individual, peer and family risk factors for DUI. In 2010, the same participants (aged 18-24) then reported on their own DUI behaviour. 18% of young adults with a driving license reported DUI in the past 12 months. Exposure to others' drink driving during adolescence was associated with an increased likelihood of DUI as a young adult (OR=2.13, 95% CI 1.68-2.69). This association remained after accounting for the effects of other potential confounding factors from the individual, peer and family domains (OR=1.62, 95% CI 1.23-2.13). Observing the drink driving behaviours of others during adolescence may increase the likelihood of DUI as a young adult. Strategies to reduce youth exposure to drink driving are warranted.

Exploring the perceptions of psychiatric patients regarding marijuana use

There is limited understanding on marijuana use by psychiatric patients, specifically with regard as to why they continue to smoke marijuana despite the negative consequences, such as readmittance to psychiatric hospitals following marijuana-induced psychosis. It is, therefore, important to understand why psychiatric patients continue to use marijuana, despite experiencing its negative effects. The purpose of this study was to explore and describe the perceptions of psychiatric patients with regard to marijuana use in Potchefstroom, North West Province, as well as to formulate recommendations for nursing education, nursing research and nursing practice, with the aim of reducing the readmission of psychiatric patients following marijuana-induced psychosis. A qualitative, exploratory, descriptive and contextual research design was followed in order to give ‘voice’ to the perceptions of psychiatric patients about marijuana use. Purposive sampling was utilised to identify participants who complied with selection criteria. The sample size was determined by data saturation, which was reached after 10 individual interviews with psychiatric patients. Unstructured individual interviews were utilised to gather data after written approval from the Ethics committee of the North-West University (Potchefstroom Campus), North West Provincial Department of Health, the clinical manager of the psychiatric hospital where data were collected, as well as from the psychiatric patients. The co-coder and the researcher analysed the data independently. The findings of this study include perceptions of psychiatric patients on the use of marijuana, the negative effects of marijuana use, marijuana use and mental illness, and quitting marijuana. Recommendations were formulated for nursing education, nursing research as well as for nursing practice.OpsommingInsig in die gebruik van marijuana deur psigiatriese pasiënte is beperk, spesifiek met betrekking tot hulle redes vir voortgesette marijuana verbruik ten spyte van die negatiewe gevolge daarvan, byvoorbeeld hertoelating tot psigiatriese hospitale na marijuanageïnduseerde psigotiese episodes. Dit is dus belangrik om te verstaan waarom psigiatriese pasiënte voortgaan om marijuana te gebruik ten spyte van die negatiewe uitwerking daarvan. Hierdie navorsing was ten doel om die persepsies van psigiatriese pasiënte in verband met die gebruik van marijuana in Potchefstroom in die Noordwesprovinsie te verken en te beskryf. So kan aanbevelings gemaak word vir verpleegonderrig, verpleegnavorsing en verpleegpraktyk om meer toepaslike versorging en behandeling te verseker en uiteindelik die heropname van psigiatriese pasiënte as gevolg van marijuana-geïnduseerde psigose te verminder. ‘n Kwalitatiewe, verkennende, beskrywende en kontekstuele navorsingsontwerp is gevolg om ‘n ‘stem’ te gee aan die persepsies van psigiatriese pasiënte aangaande die gebruik van marijuana. Doelgerigte steekproefneming is gebruik om deelnemers te identifiseer wat sou voldoen aan seleksiekriteria. Die steekproefgrootte is bepaal deur dataversadiging, wat bereik is na 10 individuele onderhoude met psigiatriese pasiënte. Ongestruktureerde individuele onderhoude is gebruik om data te versamel ná geskrewe toestemming van die Etiekkomitee van die Noordwes-Universiteit (Potchefstroom Kampus), van die Noordwes Provinsiale Departement van Gesondheid, die Kliniese bestuurder van die psigiatriese hospitaal waar die data versamel is, sowel as van die psigiatriese pasiënte. Die medekodeerder en die navorser het die data onafhanklik van mekaar geanaliseer. Die bevindings van hierdie studie het die persepsies wat psigiatriese pasiënte het oor die gebruik van marijuana, die negatiewe effekte van die gebruik van marijuana, die gebruik van marijuana en psigiatriese toestande, en die staking van die gebruik van marijuana, uitgelig. Aanbevelings is geformuleer vir verpleegonderrig en verpleegnavorsing, sowel as vir die praktyk van verpleegkunde.

“My Son Is Reliable”

The high crash rates among teenage drivers are of great concern across nations. Parents’ involvement is known to help increase their young drivers’ driving safety. In particular, parents can place restrictions on their son’s/daughter’s driving (e.g., restrict night time driving), which can enable the young driver to gain driving experience in safer conditions. Yet little is known about what do parents think about parental responsibility regarding young drivers’ driving. This study aimed to address this question. It draws on both quantitative and qualitative data obtained through a phone survey of 906 Israeli parents of young drivers that included both open- and closed-ended items and 20 semistructured interviews with parents. The main findings were that parents tended to be optimistic about their own child’s driving compared with other young drivers and were relatively unconcerned about speeding. Whereas most parents thought restrictions regarding driving at night or talking on the phone should be placed on young drivers, most believed many parents do not enforce them. Most also believed many parents feel they are unable to influence young drivers’ driving. The exception, however, was they believed most parents restrict young drivers driving when they are tired. Two contrasting conceptions of parental responsibility were identified and presented as a model. Potential implications for road safety campaigns from a social norms perspective are discussed.

Invulnerability and the intention to drink and drive: an application of the theory of planned behavior

The present study aims at an examination, based on the theory of planned behavior (TPB), of the psychological antecedents of young Chinese people's intentions to drive after drinking. One hundred and twenty-four licensed drivers (aged from 19 to 35 years) successfully completed an online questionnaire. Using path analysis, we found the most proximal predictors of intention to be attitudes and perceived behavioral control, whereas invulnerability as well as subjective norms indirectly influenced intention by promoting favorable attitudes toward and greater perceived behavioral control over driving after alcohol use. The total explained variances in the intention to drink and drive reached 79%. The present findings highlight irrational beliefs of invulnerability and the three TPB components as potentially valid targets for prevention and intervention efforts against drinking and driving among young Chinese drivers.