Effectiveness of mandatory alcohol testing programs in reducing alcohol involvement in fatal motor carrier crashes

Random drug and alcohol testing for preventing injury in workers

BACKGROUND

Drug- and alcohol-related impairment in the workplace has been linked to an increased risk of injury for workers. Randomly testing populations of workers for these substances has become a practice in many jurisdictions, with the intention of reducing the risk of workplace incidents and accidents. Despite the proliferation of random drug and alcohol testing (RDAT), there is currently a lack of consensus about whether it is effective at preventing workplace injury, or improving other non-injury accident outcomes in the work place.

OBJECTIVES

To assess the effectiveness of workplace RDAT to prevent injuries and improve non-injury accident outcomes (unplanned events that result in damage or loss of property) in workers compared with no workplace RDAT.

SEARCH METHODS

We conducted a systematic literature search to identify eligible published and unpublished studies. The date of the last search was 1 November 2020. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, two other databases, Google Scholar, and three trials registers. We also screened the reference lists of relevant publications known to us.

SELECTION CRITERIA

Study designs that were eligible for inclusion in our review included randomised controlled trials (RCTs), cluster-randomised trials (CRTs), interrupted time-series (ITS) studies, and controlled before-after (CBA) studies. Studies needed to evaluate the effectiveness of RDAT in preventing workplace injury or improving other non-injury workplace outcomes. We also considered unpublished data from clinical trial registries. We included employees working in all safety-sensitive occupations, except for commercial drivers, who are the subject of another Cochrane Review.

DATA COLLECTION AND ANALYSIS

Independently, two review authors used a data collection form to extract relevant characteristics from the included study. They then analysed a line graph included in the study of the prevalence rate of alcohol violations per year. Independently, the review authors completed a GRADE assessment, as a means of rating the quality of the evidence.

MAIN RESULTS

Although our searching originally identified 4198 unique hits, only one study was eligible for inclusion in this review. This was an ITS study that measured the effect of random alcohol testing (RAT) on the test positivity rate of employees of major airlines in the USA from 1995 to 2002. The study included data from 511,745 random alcohol tests, and reported no information about testing for other substances. The rate of positive results was the only outcome of interest reported by the study. The average rate of positive results found by RAT increased from 0.07% to 0.11% when the minimum percentage of workers who underwent RAT annually was reduced from 25% to 10%. Our analyses found this change to be a statistically significant increase (estimated change in level, where the level reflects the average percentage points of positive tests = 0.040, 95% confidence interval 0.005 to 0.075; P = 0.031). Our GRADE assessment, for the observed effect of lower minimum testing percentages associating with a higher rate of positive test results, found the quality of the evidence to be 'very low' across the five GRADE domains. The one included study did not address the following outcomes of interest: fatal injuries; non-fatal injuries; non-injury accidents; absenteeism; and adverse effects associated with RDAT.

AUTHORS' CONCLUSIONS

In the aviation industry in the USA, the only setting for which the eligible study reported data, there was a statistically significant increase in the rate of positive RAT results following a reduction in the percentage of workers tested, which we deem to be clinically relevant. This result suggests an inverse relationship between the proportion of positive test results and the rate of testing, which is consistent with a deterrent effect for testing. No data were reported on adverse effects related to RDAT. We could not draw definitive conclusions regarding the effectiveness of RDAT for employees in safety-sensitive occupations (not including commercial driving), or with safety-sensitive job functions. We identified only one eligible study that reflected one industry in one country, was of non-randomised design, and tested only for alcohol, not for drugs or other substances. Our GRADE assessment resulted in a 'very low' rating for the quality of the evidence on the only outcome reported. The paucity of eligible research was a major limitation in our review, and additional studies evaluating the effect of RDAT on safety outcomes are needed.

Primary health care and sustainable development goals

We examine the potential and limitations of primary health care in contributing to the achievement of the health-related sustainable development goals (SDGs), and recommend policies to enable a functioning primary health-care system. Governments have recently reaffirmed their commitment to the SDGs through the 2018 Declaration of Astana, which redefines the three functions of primary health care as: service provision, multisectoral actions and the empowerment of citizens. In other words, the health-related SDGs cannot be achieved by the provision of health-care services alone. Some health issues are related to environment, necessitating joint efforts between local, national and international partners; other issues require public awareness (health literacy) of preventable illnesses. However, the provision of primary health care, and hence achievement of the SDGs, is hampered by several issues. First, inadequate government spending on health is exacerbated by the small proportions allocated to primary health care. Second, the shortage and maldistribution of the health workforce, and chronic absenteeism in some countries, has led to a situation in which staffing levels are inversely related to poverty and need. Third, the health workforce is not trained in multisectoral actions, and already experiences workloads of an overwhelming nature. Finally, health illiteracy is common among the population, even in developed countries. We recommend that governments increase spending on health and primary health care, implement interventions to retain the rural health workforce, and update the pre-service training curricula of personnel to include skills in multisectoral collaboration and enhanced community engagement.

Differences between occupational and non-occupational-related motor vehicle collisions in West Virginia: A cross-sectional and spatial analysis

BACKGROUND

Motor vehicle collisions comprise the majority of occupational-related fatalities in the United States and West Virginia has one of the highest occupational-related fatality rates in the nation. The purpose of this study was to compare work and non-work-related collisions, crash locations, and the characteristics of in-state and out-of-state drivers ≥18 years of age who were fatally injured in work-related collisions in West Virginia.

METHODOLOGY

Data were from the 2000-2017 Fatality Analysis Reporting System. Work and non-work-related crashes and characteristics in-state vs. out-of-state drivers were compared using binary and multivariable logistic regression analyses. Crash locations were compared via spatial analyses using kernel density estimations.

RESULTS

Among the 5,835 individuals fatally injured in crashes, 209 were designated 'at work'. The odds of being a work-related crash were 85% lower [Odds Ratio (OR) = 0.15; 95% confidence interval (CI): 0.04, 0.49] among those testing positive for alcohol, but 2.5 times greater (OR = 2.56; 95% CI: 1.16, 5.65) among those holding a commercial driver's license. The odds of being an in-state driver were 75% lower (OR = 0.25; 95% CI: 0.12, 0.53) among those wearing a safety belt, but 2.7 times greater among workers testing drug positive (OR = 2.67; 95% CI: 1.10, 6.52). In-state drivers were also less likely to be driving a large truck or be involved in single vehicle collisions and less likely to experience crashes on weekends, nights, or on highways. Spatial patterns of crash locations varied slightly between workers and non-workers.

CONCLUSIONS

Work-related crashes differed greatly from non-work-related crashes in West Virginia. Stark differences existed between in-state and out-of-state workers and their crashes. Various avenues for workplace safety interventions exist, including seatbelt initiatives and drug testing policies for non-commercial drivers, which could help mitigate West Virginia's elevated, occupational-related, traffic fatality rate.

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.

Associations Between Personality and Drinking Motives Among Abstinent Adult Alcoholic Men and Women

Aims

Men and women differ in personality characteristics and may be motivated to use alcohol for different reasons. The goals of the present study were to characterize personality and drinking motives by gender and alcoholism status in adults, and to determine how alcoholism history and gender are related to the associations between personality traits and drinking motivation.

Methods

Personality characteristics were assessed with the Eysenck Personality Questionnaire, which includes Extraversion, Neuroticism, Psychoticism and Lie (Social Conforming) scales. To evaluate drinking motivation, we asked abstinent long-term alcoholic men and women, and demographically similar nonalcoholic participants to complete the Drinking Motives Questionnaire, which includes Conformity, Coping, Social and Enhancement scales.

Results

Patterns of personality scale scores and drinking motives differed by alcoholism status, with alcoholics showing higher psychopathology and stronger motives for drinking compared with controls. Divergent gender-specific relationships between personality and drinking motives also were identified, which differed for alcoholics and controls.

Conclusion

Alcoholic and control men and women differed with respect to the associations between personality traits and motives for drinking. A better understanding of how different personality traits affect drinking motivations for alcoholic men and women can inform individualized relapse prevention strategies.

Short Summary

Men and women differed in their personality traits and their motivations for drinking, and these relationships differed for abstinent alcoholic and control groups. Additionally, alcoholics scored higher on Neuroticism and Psychoticism personality traits, and had lower Enhancement and Social Conformity drinking motives than nonalcoholic controls.

Child Restraint Use and Driver Screening in Fatal Crashes Involving Drugs and Alcohol

BACKGROUND

There are reports that the incidence of alcohol-involved crashes has remained stable among fatally injured drivers while drug involvement has increased in recent years.

METHODS

Data from the Fatality Analysis Reporting System (FARS) from 2010 to 2013 were used to examine drug and alcohol status of drivers (N = 10 864) of 4-wheeled passenger vehicles involved in a fatal crash while transporting a passenger aged 0 to 14 years (N = 17 179). Mixed effect multivariable logistic regression used SAS GLIMMIX to control for clustering. Odds ratios are reported with 95% confidence intervals (CIs).

RESULTS

Only 28.9% of drivers were screened for both alcohol and drugs, and 56.7% were not tested for either. The total proportion of unrestrained child passengers increased nearly linearly by age. Findings ranged as high as 70% for 13- to 14-year-olds with drivers positive for drugs and alcohol. In multivariable adjusted models, inappropriate child seating with drivers who tested positive was as follows: alcohol, 1.30 (95% CI, 0.92-1.82); drugs, 1.54 (95% CI, 1.24-1.92); and for both drugs and alcohol, 1.88 (95% CI, 1.38-2.55). More than one-fourth were unrestrained with drivers positive for cannabis (27.7%). Overall mortality was approximately triple for unrestrained versus restrained (33.5% vs 11.5%; P < .0001) and was higher in front-seated than rear-seated passengers (40.7% vs 31.5%; P < .0001).

CONCLUSIONS

Passengers were less likely to be appropriately seated and to be restrained when transported by a driver positive for drugs and alcohol, but this finding varied according to passenger age and drug/alcohol category.

NIOSH national survey of long-haul truck drivers: Injury and safety

Approximately 1,701,500 people were employed as heavy and tractor-trailer truck drivers in the United States in 2012. The majority of them were long-haul truck drivers (LHTDs). There are limited data on occupational injury and safety in LHTDs, which prompted a targeted national survey. The National Institute of Occupational Safety and Health conducted a nationally representative survey of 1265 LHTDs at 32 truck stops across the contiguous United States in 2010. Data were collected on truck crashes, near misses, moving violations, work-related injuries, work environment, safety climate, driver training, job satisfaction, and driving behaviors. Results suggested that an estimated 2.6% of LHTDs reported a truck crash in 2010, 35% reported at least one crash while working as an LHTD, 24% reported at least one near miss in the previous 7 days, 17% reported at least one moving violation ticket and 4.7% reported a non-crash injury involving days away from work in the previous 12 months. The majority (68%) of non-crash injuries among company drivers were not reported to employers. An estimate of 73% of LHTDs (16% often and 58% sometimes) perceived their delivery schedules unrealistically tight; 24% often continued driving despite fatigue, bad weather, or heavy traffic because they needed to deliver or pick up a load at a given time; 4.5% often drove 10miles per hours or more over the speed limit; 6.0% never wore a seatbelt; 36% were often frustrated by other drivers on the road; 35% often had to wait for access to a loading dock; 37% reported being noncompliant with hours-of-service rules (10% often and 27% sometimes); 38% of LHTDs perceived their entry-level training inadequate; and 15% did not feel that safety of workers was a high priority with their management. This survey brings to light a number of important safety issues for further research and interventions, e.g., high prevalence of truck crashes, injury underreporting, unrealistically tight delivery schedules, noncompliance with hours-of-service rules, and inadequate entry-level training.

Exposé sur les conséquences éthiques des tests aléatoires de dépistage des drogues en milieu de travail

Le présent article traite des répercussions scientifiques et éthiques des tests aléatoires de dépistage des drogues en milieu de travail. Ces tests sont pratique courante, particulièrement dans les secteurs constituant un risque pour la sécurité, mais s'appuient sur peu d'analyses critiques. J'en conclus que ces programmes s'associent à des défis éthiques importants. Les employeurs doivent s'assurer que chaque aspect de leurs politiques repose sur des données scientifiques, est lié rationnellement à l'objectif de la sécurité en milieu de travail et est justifié sur le plan éthique.

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.

A discussion of the ethical implications of random drug testing in the workplace

This article discusses the scientific and ethical implications of random drug testing in the workplace. Random drug testing, particularly in safety-sensitive sectors, is a common practice, yet it has received little critical analysis. My conclusion is that there are important ethical challenges with these programs. Employers must ensure that every aspect of their policies are rooted in scientific evidence, linked rationally to the goal of workplace safety, and are ethically justifiable.

An example of the usefulness of joinpoint trend analysis for assessing changes in traffic safety policies

AIM

To show the usefulness of joinpoint trend analysis for assessing changes in traffic safety policies.

METHODS

Trends in driver death rates from traffic injury stratified by alcohol involvement in Spain during 2001-2011 were characterized with joinpoint regression to observe how changes in these rates match in time with the implementation of traffic regulations and interventions.

RESULTS

Both alcohol-related (blood alcohol concentration >0.3g/l) and non-alcohol-related rates decreased similarly (10-11% annually) during 2001-2011, although the former showed an earlier (2003 joinpoint) acceleration of the downward trend than the latter (2006 joinpoint); both joinpoints matched in time with relevant road safety interventions.

CONCLUSIONS

These results, which are consistent with results from previous analytical studies, show that joinpoint trend analysis, although not valid for causal inference, is useful for assessing changes in traffic safety policies. This methodology can be easily extended to other risk factors, such as excessive speeding or not wearing a seat belt.

Driving under the influence of alcohol in Cali, Colombia: prevalence and consumption patterns, 2013

This study's goal was to establish the prevalence of driving under the influence of alcohol (DUI) and alcohol consumption patterns among drivers in Cali, Colombia, in 2013. A cross-sectional study based on a roadside survey using a stratified and multi-stage sampling design was developed. Thirty-two sites were chosen randomly for the selection of drivers who were then tested for blood alcohol concentration (BAC) and asked to participate in the survey. The prevalence of DUI was 0.88% (95% confidence intervals [95% CI] 0.26%-1.49%) with a lower prevalence when BAC was increasing. In addition, a higher prevalence was found during non-typical checkpoint hours (1.28, 95% CI -0.001%-0.03%). The overall prevalence is considered high, given the low alcohol consumption and vehicles per capita. Prevention measures are needed to reduce DUI during non-typical checkpoints and ongoing studies are required to monitor the trends and enable the assessment of interventions.

Alcohol-related hospitalisations of trauma patients in Southern Taiwan: a cross-sectional study based on a trauma registry system

OBJECTIVES

To provide an overview of the demographic characteristics of patients with positive blood alcohol concentration (BAC) and to investigate the performance of brain CT scans in these patients.

DESIGN

Cross-sectional study.

SETTING

Taiwan.

PARTICIPANTS

2192 patients who had undergone a test for blood alcohol of 13,233 patients registered in the Trauma Registry System between 1 January 2009 and 31 December 2012. A BAC level of 50 mg/dL was defined as the cut-off value. Detailed information was retrieved from the patients with positive BAC (n=793) and was compared with information from those with a negative BAC (n=1399).

MAIN OUTCOME MEASURES

Glasgow Coma Scale (GCS) and Injury Severity Score (ISS) as well as the performance and findings of obtained brain CT scans.

RESULTS

Patients with positive BAC had a higher rate of face injury, but a lower GCS score, a lower rate of head and neck injury, a lower ISS and New Injury Severity Score. Alcohol use was associated with a shorter length of hospital stay (8.6 vs 11.4 days, p=0.000) in patients with an ISS of <16. Of 496 patients with positive BAC who underwent brain CT, 164 (33.1%) showed positive findings on CT scan. In contrast, of 891 patients with negative BAC who underwent brain CT, 389 (43.7%) had positive findings on CT scan. The lower percentage of positive CT scan findings in patients with positive BAC was particularly evident in patients with an ISS <16 (18.0% vs 28.8%, p=0.001).

CONCLUSIONS

Patients who consumed alcohol tended to have a low GCS score and injuries that were less severe. However, given the significantly low percentage of positive findings, brain CT might be overused in these patients with less severe injuries.

How effective is drug testing as a workplace safety strategy? A systematic review of the evidence

The growing prevalence of workplace drug testing and the narrow scope of previous reviews of the evidence base necessitate a comprehensive review of research concerning the efficacy of drug testing as a workplace strategy. A systematic qualitative review of relevant research published between January 1990 and January 2013 was undertaken. Inclusion criteria were studies that evaluated the effectiveness of drug testing in deterring employee drug use or reducing workplace accident or injury rates. Methodological adequacy was assessed using a published assessment tool specifically designed to assess the quality of intervention studies. A total of 23 studies were reviewed and assessed, six of which reported on the effectiveness of testing in reducing employee drug use and 17 which reported on occupational accident or injury rates. No studies involved randomised control trials. Only one study was assessed as demonstrating strong methodological rigour. That study found random alcohol testing reduced fatal accidents in the transport industry. The majority of studies reviewed contained methodological weaknesses including; inappropriate study design, limited sample representativeness, the use of ecological data to evaluate individual behaviour change and failure to adequately control for potentially confounding variables. This latter finding is consistent with previous reviews and indicates the evidence base for the effectiveness of testing in improving workplace safety is at best tenuous. Better dissemination of the current evidence in relation to workplace drug testing is required to support evidence-informed policy and practice. There is also a pressing need for more methodologically rigorous research to evaluate the efficacy and utility of drug testing.

Occupational fatalities among driver/sales workers and truck drivers in the United States, 2003-2008

BACKGROUND

This study provides a national profile of occupational fatalities among truck drivers and driver-sales workers.

METHODS

Data from the 2003-2008 Census of Fatal Occupational Injuries were used. Cases were extracted specifically for occupational subcategories included in the Driver/Sales Workers and Truck Drivers occupational category: Driver/Sales Workers, Heavy and Tractor-Trailer Truck Drivers, and Light Truck or Delivery Services Drivers.

RESULTS

In 2003-2008, the group Driver/Sales Workers and Truck Drivers had 5,568 occupational fatalities, representing 17% of all occupational fatalities in the United States. The majority of these fatalities were in the subgroup Heavy and Tractor-Trailer Truck Drivers (85%) and due to transportation incidents (80%). Older and male drivers had higher fatality rates than their counterparts.

CONCLUSIONS

Findings suggest a need for targeted interventions to reduce highway fatalities among heavy truck drivers. Better employment data are needed to separate the three occupational subcategories by worker characteristic and employment history for use in research and prevention efforts.

Epidemiologia e políticas públicas

Este ensaio trata das relações entre a epidemiologia e as políticas públicas, destacando inicialmente a posição da disciplina no campo da saúde coletiva, analisando os impactos de políticas públicas sobre o perfil epidemiológico e as contribuições da epidemiologia para a formulação, implementação e avaliação de políticas públicas de saúde. No primeiro tópico são discutidos os vínculos da disciplina com o campo da saúde coletiva, o modelo de determinantes sociais e de ação política formulados pela Comissão de Determinantes Sociais em Saúde da OMS, e diferentes enfoques de políticas de saúde. O segundo tópico analisa a redução da desnutrição infantil no Brasil como um exemplo de políticas públicas com impacto no perfil epidemiológico. No terceiro tópico são apresentados três temas estratégicos para a ação das políticas públicas em saúde: redução das desigualdades sociais em saúde, promoção da saúde e regulação sobre bens e serviços com impacto na saúde. O quarto tópico discute as possibilidades e dificuldades de incorporação dos conhecimentos epidemiológicos na formulação, implementação e avaliação de políticas públicas e, finalmente, são apresentados exemplos concretos dessa relação entre epidemiologia e políticas públicas.

Strengthening impaired-driving enforcement in the United States

OBJECTIVE

Progress in reducing alcohol-impaired driving crash fatalities in the United States has stagnated over the last 15 years. This article reviews 2 current U.S. driving-while-intoxicated (DWI) laws and their enforcement with an aim toward generating opportunities to improve their enforcement approaches.

METHODS

Impaired-driving enforcement methods in Europe and Australia are compared with those in the United States, and the legal basis for current DWI criminal procedures is examined.

RESULTS

An examination of relevant U.S. Supreme Court decisions and current legal practices indicates that the requirements for use of breath test technology to determine blood alcohol concentrations of drivers on public roads are not entirely clear. Several potential methods for using field breath test technology to improve the detection of impaired drivers are suggested. These include (a) breath testing all drivers stopped for certain violations that have a high probability of involving an impaired driver, (b) breath testing all drivers at sobriety checkpoints, and (c) breath testing all drivers involved in fatal and serious injury crashes.

CONCLUSIONS

Breath test technology has enabled other countries around the world to adopt and implement enforcement strategies that serve as both general and specific deterrents to alcohol-impaired driving. Many of these enforcement strategies have been shown to be effective. If any one of these strategies can be adopted in the United States, further progress in reducing impaired driving is probable. It may be necessary to provide the U.S. Supreme Court with a test case of breath testing all drivers at a sobriety checkpoint, depending upon whether or not a police agency is willing to use that strategy.

Prevalence of alcohol and other drugs in fatally injured drivers

AIM

This study aims to examine the prevalence of alcohol and/or other drugs (AOD) in a large sample of fatally injured drivers.

DESIGN

Using data from the Fatality Analysis Reporting System for 2005-09, the authors examined the prevalence of AOD detected in fatally injured drivers in the United States.

SETTING

Fatal motor vehicle crashes occurring on public roads.

PARTICIPANTS

Drivers who died within 1 hour of the crash in 14 states that performed toxicological testing on more than 80% of these drivers.

MEASUREMENTS

The prevalence of AOD and multivariable-adjusted prevalence ratios (aPR).

FINDINGS

Of the 20,150 fatally injured drivers studied, 57.3% tested positive for AOD, including 19.9% being positive for two or more substances. Alcohol was the most commonly detected substance, present in 40.2% of the fatally injured drivers, followed by cannabinols (10.5%), stimulants (9.0%), narcotics (5.7%) and depressants (4.0%). Multivariable analysis revealed that AOD was significantly more prevalent among drivers who died in single-vehicle crashes [aPR 1.69, 95% confidence interval (CI): 1.62-1.76] or night-time crashes (aPR 1.43, 95% CI: 1.39-1.47), or who had a driving-while-intoxicated conviction within the past 3 years (aPR 1.41, 95% CI: 1.35-1.47), and less prevalent among drivers who were 65 years or older (aPR 0.45, 95% CI: 0.42-0.49), Asian (aPR 0.47, 95% CI 0.41-0.53) or female (aPR 0.88, 95% CI: 0.85-0.91) or who were operating a motor carrier (aPR 0.41, 95% CI 0.34-0.48).

CONCLUSIONS

More than half of fatally injured drivers in the United States had been using AOD and approximately 20% had been using polydrugs. The prevalence of AOD use varies significantly with driver and crash characteristics.

The need for drugged driving per se laws: a commentary

OBJECTIVE

Triggered by the new federal commitment announced by the Office of National Drug Control Policy (ONCDP) to encourage states to enact drugged driving per se laws, this article reviews the reasons to establish such laws and the issues that may arise when trying to enforce them.

METHODS

A review of the state of drunk driving per se laws and their implications for drugged driving is presented, with a review of impaired driving enforcement procedures and drug testing technology.

RESULTS

Currently, enforcement of drugged driving laws is an adjunct to the enforcement of laws regarding alcohol impairment. Drivers are apprehended when showing signs of alcohol intoxication and only in the relatively few cases where the blood alcohol concentration of the arrested driver does not account for the observed behavior is the possibility of drug impairment pursued. In most states, the term impaired driving covers both alcohol and drug impairment; thus, driver conviction records may not distinguish between the two different sources of impairment. As a result, enforcement statistics do not reflect the prevalence of drugged driving.

CONCLUSIONS

Based on the analysis presented, this article recommends a number of steps that can be taken to evaluate current drugged driving enforcement procedures and to move toward the enactment of drug per se laws.

Validity of suspected alcohol and drug violations in aviation employees

AIMS

In the United States, transportation employees who are suspected of using alcohol and drugs are subject to reasonable-cause testing. This study aims to assess the validity of suspected alcohol and drug violations in aviation employees.

METHODS

Using reasonable-cause testing and random testing data from the Federal Aviation Administration for the years 1995-2005, we calculated the positive predictive value (PPV) and positive likelihood ratio (LR+) of suspected alcohol and drug violations. The true status of violations was based on testing results, with an alcohol violation being defined as a blood alcohol concentration of ≥0.04 mg/dl and a drug violation as a test positive for marijuana, cocaine, amphetamines, phencyclidine or opiates.

RESULTS

During the 11-year study period, a total of 2284 alcohol tests and 2015 drug tests were performed under the reasonable-cause testing program. The PPV was 37.7% [95% confidence interval (CI), 35.7-39.7%] for suspected alcohol violations and 12.6% (95% CI, 11.2-14.1%) for suspected drug violations. Random testing revealed an overall prevalence of 0.09% for alcohol violations and 0.6% for drug violations. The LR+ was 653.6 (95% CI, 581.7-734.3) for suspected alcohol violations and 22.5 (95% CI, 19.6-25.7) for suspected drug violations.

CONCLUSION

The discriminative power of reasonable-cause testing suggests that, despite its limited positive predictive value, physical and behavioral observation represents an efficient screening method for detecting alcohol and drug violations. The limited positive predictive value of reasonable-cause testing in aviation employees is due in part to the very low prevalence of alcohol and drug violations.