Preventing alcohol-impaired driving through community self-regulation training

Self-Report Survey Measures of Alcohol-Impaired Driving: A Systematic Review

OBJECTIVE

Alcohol-impaired driving is a major contributor to motor vehicle crash deaths and injury. Many survey studies include self-report measures of alcohol-impaired driving, but no guidance is available to help researchers select from among available measures. The aims of this systematic review were to compile a list of measures that researchers have used previously, to compare performance between measures, and to identify the measures with highest validity and reliability.

METHOD

Literature searches of PubMed, Scopus, and Web of Science identified studies that assessed alcohol-impaired driving behavior through self-report. The measures from each study and, if available, indices of reliability or validity were extracted. Using the measures' text, we developed 10 codes to group similar measures and compare them. For example, the "alcohol effects" code refers to driving while feeling dizzy or lightheaded after drinking, and the "drink count" code pertains to the number of drinks someone consumed before driving. For measures with multiple items, each item was categorized separately.

RESULTS

After screening according to the eligibility criteria, 41 articles were included in the review. Thirteen articles reported on reliability. No articles reported on validity. The self-report measures with the highest reliability coefficients contained items from multiple codes, namely alcohol effects and drink count.

CONCLUSIONS

Self-report alcohol-impaired driving measures with multiple items evaluating distinct aspects of alcohol-impaired driving show better reliability than measures using a single item. Future work investigating the validity of these measures is needed to determine the best approach for conducting self-report research in this area.

Similarities and Differences Across Cultures: Questions to Inform a Third Generation for Health Promotion Research

The increasing diversity of American communities raises an important question about the efficiency, appropriateness, and feasibility of tailoring messages and intervention strategies to target groups identified by race and ethnicity. To explore this issue, This article distinguishes race and ethnicity from culture and then discusses four questions: (1) What is the meaning of culture in health promotion? (2) What is the role of culture in understanding health behavior? (3) What is the role of culture in the design of interventions? and (4) What do the relationships of culture to behavior and to intervention mean for cultural tailoring? Based on this analysis, the authors suggest that effective health promotion will tailor interventions by culture as necessary but reach across cultures when possible and appropriate. A framework is presented to assess the need for cultural tailoring, and a new generation of health promotion research is proposed to facilitate cross-cultural comparisons.

Evaluation of 3 Behavioral Theories for Application in Health Promotion Strategies for Hispanic Women

Hispanic/Latina women often fare poorly when attempting to access the health care that they need in the United States. Using an established criterion, this article analyzes the application of the health belief model (HBM), social cognitive theory (SCT), and health promotion model (HPM) in the context of Hispanic women's limited access to, and use of, health resources to promote their health. An individual's perceptions and the likelihood of taking action are the focus of HBM. SCT is regarded as important sociostructural and personal determinants in the regulation of human behavior. Finally, HPM centers on the unique characteristics and experiences of an individual that motivate him or her toward positive health behavior. The analysis suggests that HPM is a better fit to explore the relationship among sociocultural factors, lifestyle practices, and the positive perceived affect of Hispanic women engaging in healthy behaviors and utilizing health care in the United States. HPM can guide the design of both health-enhancing and disease-prevention strategies that specifically address Hispanic women's unique health needs.

Applying Psychological Theories to Promote Healthy Lifestyles

Over the past few decades, researchers have been developing and refining psychological theories and models to provide solid behavioral frameworks for evidence-based research. Each year new theories and models are created; however, a select few appear to have withstood the test of time and continue to be frequently utilized in present-day research. The objectives of this review are to highlight these psychological theories and models and describe their application to various public health issues and behaviors. Descriptions and example applications of the following theories and models are described in this review: health belief model, theory of reasoned action/planned behavior, social cognitive theory, transtheoretical model, and socioecological model.

Avoiding DWI Among Bar-room Drinkers: Strategies and Predictors

We examined the prevalence and predictors of 11strategies to avoid driving when feeling intoxicated among 561 bar-room patrons in two medium-sized Maryland communities. Logistic regression analyses identified demographic, behavioral, and attitudinal predictors of avoidance strategies and interactions among predictors. Overall, 89% reported one or more DWI avoidance actions in the past year, and 38% reported driving intoxicated during that time. Average frequencies of avoidance behavior and intoxicated driving increased significantly as drinking level increased. However, the higher the drinking level, the smaller the ratio of avoidance actions to DWI experiences, highlighting the vulnerability of heavy drinkers who had driven intoxicated.

Using a sober driver or one who allegedly drank less than the respondent were the most popular and frequent strategies, but paying for a cab, walking, and using a bus or free cab were relatively unpopular. Higher drinking levels predicted significantly higher odds of using avoidance approaches, as did intoxicated driving. Confidence in driving safely when intoxicated was positively related to drinking level and intoxicated driving, but it tended to predict lower odds of avoidance actions. Similarly, marital status, age, gender, and location influenced the odds of avoidance behaviors. Interventions should be strategically tailored to exploit or counter drinker predilections among avoidance options.

The impact of a self-help pamphlet on reducing risk drinking among 30- to 49-year-old men in Helsinki, Finland

This study evaluates the impact of a self-help pamphlet designed to support self-control of drinking. It was conducted in Helsinki, Finland, in 2001 and 2002 and focused on men between 30 and 49 years of age. The respondents were randomly selected in an intervention and a control area and compared with each other before and after the intervention using independent samples (N = 4418) The results support previous findings showing that interventions like this serve as a supplement to other prevention and early treatment measures. Although the results were encouraging, there is a need for more in-depth studies in the field.

Potential risks of providing drinking drivers with BAC information

The objective of this paper is to discuss the benefits and risks of providing drinkers with tools that allow them to estimate their blood alcohol concentration (BAC), and to examine the field usability of one commercially available tool. Drinking and driving laws are specified in terms of the driver's BAC, and there is concern that the absence of a method for drivers to accurately estimate their BAC level limits their ability to determine whether they can drive legally. A number of devices that provide a method for the individual to estimate or measure their BAC have been developed. Although some of these devices--such as the "know your limit" (KYL) cards--have been widely distributed, their effectiveness in encouraging good driving decisions have rarely been tested. This article describes a pilot study on the field usability of the Guardian Angel (GA) personal alcohol test in a field setting. The GA test analyzes saliva samples from drinking and indicates under which BAC category they fall (.00 -.04;.04 -.08;.08+). The research examined whether drinkers could, in natural drinking environments, correctly administer and interpret the test results. The methodology involves sampling drinkers on a weekend night on and around the grounds of a large West Coast university as they traveled between off-campus parties, bars, and their dorms. They were asked to assess their own intoxication and impairment, then self-administer and interpret the Guardian Angel test. After interpreting the test, participants were asked to reassess their intoxication and impairment levels, and were given a breath BAC test using a calibrated unit. The results revealed that although the majority of drinkers' were able to administer the GA test, their interpretations did not correspond with actual BACs. The interpretations of the GA test produced false-negatives, underestimating actual BACs. Drinkers perceived themselves to be less intoxicated, on average, after interpreting the GA test results. In conclusion, this research addresses potential pros and cons of providing BAC information to drinkers. It underscores the importance of testing BAC estimation tools under field conditions and the potential risks associated with tests that do not produce accurate results.

A meta-analysis of the effect of mediated health communication campaigns on behavior change in the United States

A meta-analysis was performed of studies of mediated health campaigns in the United States in order to examine the effects of the campaigns on behavior change. Mediated health campaigns have small measurable effects in the short-term. Campaign effect sizes varied by the type of behavior: r=.15 for seat belt use, r=.13 for oral health, r=.09 for alcohol use reduction, r=.05 for heart disease prevention, r=.05 for smoking, r=.04 for mammography and cervical cancer screening, and r=.04 for sexual behaviors. Campaigns with an enforcement component were more effective than those without. To predict campaign effect sizes for topics other than those listed above, researchers can take into account whether the behavior in a cessation campaign was addictive, and whether the campaign promoted the commencement of a new behavior, versus cessation of an old behavior, or prevention of a new undesirable behavior. Given the small campaign effect sizes, campaign planners should set modest goals for future campaigns. The results can also be useful to evaluators as a benchmark for campaign effects and to help estimate necessary sample size.

Prevention research and its actual application to health services

The effectiveness of alcohol abuse programs, whether to treat or to prevent, is of major importance to health services research. Demonstrating effectiveness has been appropriate to establish a sound scientific basis for these programs and to increase public acceptance. Analysis of the costs of prevention efforts in terms of their demonstrated effectiveness in reducing health services demand also is essential. In the end, health services policy deliberations are optimally based on what effect is delivered for the cost of the service, not simply on a determination of which service is the most effective. However, in a time of scarce resources prevention should be studied with the same rigor as treatment in order to determine the best return on investment.

A survey of the San Diego-Tijuana cross-border binging. Methods and analysis

On a typical weekend night between 12:00 a.m. and 4:00 a.m., about 4 thousand Americans 25 or younger cross back into the United States from a night in Tijuana, Mexico, clubs. More than 40% of the drinkers return the next morning with an illegal blood-alcohol concentration (.08 or higher). To study this phenomenon and to provide data with which to evaluate the community effort in San Diego County, a border research effort involving two separate surveys of individuals entering and leaving Mexico was established in June 1997. This article briefly reviews past roadside survey studies and reports on the survey methods developed to conduct these surveys and the procedure required to analyze the data collected.

Prevalence and effectiveness of self-regulatory techniques used to avoid drunk driving

Research suggests that drinkers often use personal self-regulatory techniques to avoid drunk driving. A population-representative sample of 427 people at high risk of drunk driving were interviewed to examine the extent to which they used self-regulatory techniques. Most popular techniques were limiting drinks to a predetermined number, organizing another driver, catching a taxi, and spontaneously delaying or avoiding driving after alcohol has been consumed. After controlling exposure to demographic and drinking behavior variables, limiting drinks to a predetermined number was the only technique associated with a reduced likelihood of drunk driving. Respondents who used taxis and drank low-alcohol beer were more likely to report drunk driving, as were those who spontaneously decided to delay or avoid driving after drinking. Although interpretation of the findings is constrained by the cross-sectional survey methodology, further investigations may lead to the development of countermeasures which promote the use of appropriate techniques.

Similarities and Differences across Cultures: Questions to Inform a Third Generation for Health Promotion Research

The increasing diversity of American communities raises an important question about the efficiency, appropriateness, and feasibility of tailoring messages and intervention strategies to target groups identified by race and ethnicity. To explore this issue, this article distinguishes race and ethnicity from culture and then discusses four questions: (1) What is the meaning of culture in health promotion? (2) What is the role of culture in understanding health behavior? (3) What is the role of culture in the design of interventions? and (4) What do the relationships of culture to behavior and to intervention mean for cultural tailoring? Based on this analysis, the authors suggest that effective health promotion will tailor interventions by culture as necessary but reach across cultures when possible and appropriate. A framework is presented to assess the need for cultural tailoring, and a new generation of health promotion research is proposed to facilitate cross-cultural comparisons.

Using a passive alcohol sensor to detect legally intoxicated drivers

OBJECTIVES

We examined whether a passive alcohol sensor could be used for mass screening of motorists to accurately and quickly detect drivers whose blood alcohol concentration exceeded a variety of levels often established as per se evidence of legal intoxication.

METHODS

In a voluntary roadside survey, 1181 late-night drivers in Minnesota were interviewed. Breath measurements were taken with both a passive alcohol sensor and an evidentiary quality portable breath-test device.

RESULTS

Measurements could be taken much more easily and quickly with the passive sensor, whose readings correlated very strongly (r = .87) with the evidentiary device. Moreover, for criterion blood alcohol concentration levels ranging from 100 mg/dL to 20 mg/dL, a large proportion of motorists could be accurately identified as being above or below the criterion, with relatively few false-negative or false-positive identifications.

CONCLUSIONS

The use of passive alcohol sensors at sobriety checkpoints should allow motorists to be processed very quickly with minimal inconvenience. At the same time, detection of legally intoxicated motorists will probably be substantially increased and the general deterrent value of per se alcohol-impaired driving laws enhanced.

Paradoxical effects of blood alcohol concentration charts

BACKGROUND

This study was designed to determine the association between alcohol drinking and the possession of blood alcohol concentration charts.

METHOD

A total of 30 college-age subjects participated in the study. Subjects were randomly assigned to either an experimental or a control group. All subjects answered a short entrance questionnaire to determine their height and weight. Those assigned to the experimental group were supplied a copy of a blood alcohol concentration chart and instructed in its use. The volume of alcoholic beverages consumed was surreptitiously counted for all subjects. Prior to leaving the premises the subjects completed an exit questionnaire which asked them to estimate the amount of alcohol they had consumed, whether they had driven to the pub, and whether they intended to drive away. The time spent in the pub was noted for each subject.

RESULTS

Among those in the control group there was a tendency to overestimate the volume consumed, and for those in the experimental group, a tendency to more accurately estimate their consumption. Those given blood alcohol concentration charts consumed alcohol at a significantly higher rate than did those in the control group.

CONCLUSION

A likely explanation for this outcome is that the chart served as a stimulus to prompt a drinker to more quickly achieve a blood alcohol level consistent with his/her drinking expectancies.