Female drivers increasingly involved in impaired driving crashes: actions to ameliorate the risk

Impaired driving and other risky drug use and sex behaviors: a cross-sectional examination of high-risk rural women incarcerated in jail

Background: Despite women accounting for an increasing proportion of impaired drivers and higher rates of impaired driving and road fatalities in rural areas, little is known about rural women who drive impaired and their other risky behavior.Objective: The present study assessed the association between impaired driving history, risky substance use, and other drug- and sex-related risk behaviors in a sample of high-risk rural women incarcerated in jail.Methods: Four hundred women from three rural jails provided information about their impaired driving, drug use, injection drug use practices, and sex risk behaviors. Groups were stratified on whether they self-reported impaired driving in the year prior to incarceration. Impaired drivers (n = 260, M = 31.90 years old) were compared to women who did not drive impaired (n = 131, M = 34.42 years old) using MANCOVA and logistic regression analyses.Results: Impaired drivers had significantly (p < .05) higher substance use severity scores for cannabis, sedatives, and prescription opioids. Furthermore, impaired drivers were significantly (p < .05) more likely to have been the passenger of an impaired driver (78.08% vs. 53.44%), been an injection drug user (69.62% vs. 41.98%), had a casual sex partner (47.31% vs. 25.95%), and traded sex for drugs or money (31.15% vs. 15.27%) in the year prior to incarceration.Conclusions: This study found a consistent association between past year impaired driving and a range of drug- and sex-related risk behaviors in a sample of high-risk rural women incarcerated in jail. These findings highlight an opportunity to intervene in criminal justice settings to reduce multiple health risk behaviors.

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.

Differences in the risk profiles of drunk and drug drivers: Evidence from a mandatory roadside survey

BACKGROUND

The study assesses the prevalence rates of alcohol- and drug-involved driving in Catalonia (Spain).

METHOD

Drivers were randomly selected for roadside testing using a stratified random sampling procedure representative of all vehicles circulating on non-urban roads. Mandatory alcohol and drug tests were performed during autumn 2017. A sample of 6860 drivers were tested for alcohol use, of these 671 were also tested for drugs. Standard procedures were employed by traffic officers to detect alcohol and drug use. Alcohol breath tests were performed with breathalyser devices and on-site drug screening systems were used to test for drugs.

RESULTS

The prevalence of alcohol use above the legal limit and drug use were 1.2 % (95 % CI: 0.9-1.5 %) and 8.3 % (95 % CI: 5.8-11.2 %), respectively. The most frequent drugs detected were THC (5.6 %, 95 % CI: 3.7-8.0 %), cocaine (3.5 %, 95 % CI: 2.0-5.5 %) and amphetamines (1.6 %, 95 % CI: 0.6-3.4 %). Alcohol use was detected more frequently on conventional roads, at weekends and during night-time hours. Drug use was detected more frequently in young males during daytime hours.

CONCLUSIONS

Driver risk profiles associated with alcohol use and drug use differ. Positive alcohol use is not a predictor of drug use when controlling for all other factors.

Alcohol- and speeding-related fatal crashes among novice drivers age 18-20 not fully licensed at the time of the crash

INTRODUCTION

Some teens may intentionally delay their driving licensure until age 18 or later, thereby skipping the learning and driver safety benefits provided by graduated driver licensing (GDL) programs. Delaying driving initiation could elevate teen crash risk once they begin driving. This study compares the prevalence of alcohol use and speeding among individuals aged 18-20 y/o who were not fully licensed drivers (NFLD) at the time of the fatal crash with that of their fully licensed counterparts (FLD).

MATERIALS AND METHODS

Data came from the 2010-2017 Fatality Analysis Reporting System (FARS). Census data were added to measure mean household income at drivers' zip code. Bivariate (chi-square) and logistic regressions were used to assess the likelihood young drivers were alcohol-positive and/or speeding at the time of the crash as a function of drivers' license status, demographic, socioeconomic, and the strength of GDL programs in the state.

RESULTS

Compared with females and White drivers age 18-20 y/o, males, Latino, and Black drivers were more likely to be NFLD at the time of the fatal crash (p < .0001). Living in zip codes with low median household income (p < .001) and the strength of GDL restrictions (p < .0001) were associated with individuals being NFLD at the time of the fatal crash. Alcohol-related fatal crashes were more prevalent among NFLD than FLD (p < .02).

CONCLUSIONS

The study provides indirect evidence suggesting that alcohol use may be more detrimental for NFLD than for FLD.

Context, acute tolerance, and subjective response affect alcohol-impaired driving decisions

RATIONALE

Alcohol intoxication produces effects that can impair judgment and increase engagement in risky behaviors, including alcohol-impaired driving (AID). Real-world AID decisions are informed by contextual circumstances and judgments of associated risk. How individuals vary in their AID decision-making across contexts and whether subjective alcohol responses (stimulation, sedation, acute tolerance) differentially affect AID decisions are critical, but under-studied research questions.

OBJECTIVES

We systematically investigated predictors of AID decisions at different hypothetical driving distances across the blood alcohol concentration (BAC) curve.

METHODS

Young adults (n = 40; 55% female) completed two laboratory sessions in a within-subjects alcohol/placebo design. At multiple points along the BAC curve (M peak BAC = 0.101 g%), participants rated their subjective intoxication, stimulation, sedation, and perceived dangerousness of driving prior to indicating their willingness to drive distances of 1, 3, and 10 miles. Multilevel mixed models assessed within- and between-person predictors of the maximum distance participants were willing to drive at matched BACs on the ascending and descending limb.

RESULTS

Under intoxication (but not placebo), participants were willing to drive greater distances on the descending versus ascending limb. At the momentary level, participants were willing to drive further when they felt less intoxicated, stimulated, and sedated, and perceived driving as less dangerous.

CONCLUSIONS

Individuals differed in the distance they were willing to drive as a function of indicators of intoxication, implicating driving distance as an important contextual factor relevant to AID decisions. Individuals may simultaneously perceive themselves as "unsafe" to drive, but "safe enough" to drive short distances, particularly when BAC is falling.

Gender Differences in the Epidemiology of Alcohol Use and Related Harms in the United States

Over the past century, differences in alcohol use and related harms between males and females in the United States have diminished considerably. In general, males still consume more alcohol and experience and cause more alcohol-related injuries and deaths than females do, but the gaps are narrowing. Among adolescents and emerging adults, gaps in drinking have narrowed primarily because alcohol use among males has declined more than alcohol use among females. Among adults, alcohol use is increasing for women but not for men. Rates of alcohol-related emergency department visits, hospitalizations, and deaths all have increased among adults during the past two decades. Consistent with the changing patterns of alcohol use, increases in these outcomes have been larger for women. Recent studies also suggest that females are more susceptible than males to alcohol-induced liver inflammation, cardiovascular disease, memory blackouts, hangovers, and certain cancers. Prevention strategies that address the increases in alcohol consumption and unique health risks for women are needed.

Gender differences in driving control of young alcohol-impaired drivers

BACKGROUND

Male and female drivers exhibit different degrees of vehicle control while driving under the influence of alcohol. However, this interaction between alcohol and gender is understudied. The present study examined the effects of different alcohol levels on the driving control of male and female drivers with the help of driving simulator experiments in heterogeneous traffic conditions.

METHOD

Forty young drivers (20 males and 20 females) completed simulated driving at four Blood Alcohol Concentration (BAC) levels: 0% (control), 0.03%, 0.05% and 0.08%. Driving impairment in vehicle control was measured in terms of average speed, acceleration variability and reaction time of drivers. Repeated-measures ANOVA tests were conducted and regression models were developed for male and female drivers to quantify the effects of BAC levels and driver characteristics on the driving control measures.

RESULTS

Significant effects of gender were observed for average speed (p <  0.001) and acceleration variability (p = 0.015) but not for reaction time of drivers (p =  0.891). Further, the effect of BAC was significant in all the three measures of vehicle control (p <  0.001). Driving control improved with increasing age of male drivers while caffeine consumption was observed as an alcohol-antagonizing factor in female drivers.

CONCLUSION

The findings suggest that vehicle control of female drivers is more likely to get affected even at low BAC levels, providing evidence that they belong to critical section of driving community in terms of alcohol-related impairment. The findings may help in discouraging drinking and driving among male and female drivers.

Trends in female and male drunken driving prevalence over thirty years: Triangulating diverse sources of evidence (1985-2015)

INTRODUCTION

Women have lower rates of drunken driving than men, but their share of arrests has been climbing since 1985. These trends may stem from changes in women's lives that lead to more drinking and driving, or to greater reductions in male drinking and driving. Alternatively, changes in policy and enforcement that focus on less intoxicated offenders may inadvertently target female-typical offending patterns. This paper tracked male and female drunken driving rates and the DUI sex ratio in the United States from 1985 to 2015 across three data sources.

METHODS

The sex ratio and prevalence estimates were derived from official arrest statistics from Uniform Crime Reports, self-reports from the Centers for Disease Control and Prevention, and traffic fatality data from the National Highway and Transportation Safety Administration. Rates were assessed for four age groups (18-20, 21-34, 35-49, and 50-64), and drunken driving trends tested using Augmented Dickey-Fuller time-series methods.

RESULTS

Decreases in DUI rates stagnated over the first decade of 2000, but have again begun to decline, according to self-reports and traffic fatality data, for all sex-by-age groups. Still, the gender gap in DUI arrests continues to narrow. From 1990 to the early 2000s, changes in social control that made female DUI more visible narrowed the gender gap in arrests. In more recent years, narrowing of the gap is due primarily to male rates declining more steeply than female rates.

CONCLUSION

Results indicate that we need more research to understand why female declines have not kept pace with male declines and perhaps more targeted prevention efforts aimed at women.

A Comparison of QTc Intervals in Alcohol Withdrawal Patients Versus Acute Coronary Syndrome Patients

OBJECTIVES

Patients with an alcohol use disorder experiencing acute intoxication or withdrawal may be at risk for electrocardiograph (ECG) abnormalities, including prolongation of repolarization (long QTc [corrected QT]) that may contribute to arrhythmias and may be associated with a threefold increase in the likelihood of sudden cardiac events. Patients with acute coronary syndrome may have prolonged QTc as well. To our knowledge, no previous studies have compared the QTc of ACS with acute ethanol (EtOH) withdrawal syndromes in the emergency department (ED). The purpose of our study was to compare the QTc of those with EtOH withdrawal emergencies with patients with ACS in our ED. Our hypothesis was that the QTc would be similarly prolonged in the two cohorts.

METHODS

The study compared two cohort groups, those with ACS and those with EtOH withdrawal-related ED visits over a 1-year period. We compared ECG QTc, cardiac medication use, and electrolyte differences. We considered a QTc of >450 ms elevated for men and >470 ms elevated for women based on the literature. Fifty subjects in whom an ECG, serum osmolality, and EtOH level were recorded within 2 hours of one another and who were administered a Clinical Institute Withdrawal Assessment protocol were compared with 203 patients with ACS during the same period. We excluded patients with incomplete data. Medications compared included clopidogrel, acetylsalicylic acid, β-blockers, angiotensin-converting enzyme inhibitors, and statins. ECG QT and QTc, as well as electrolytes, were recorded and compared. Data were extracted by two investigators with a 20% sample re-evaluated by the other extractor as a reliability measure. Descriptive statistics including medians and interquartile ranges were measured for continuous variables. Comparisons were made using two-tailed t tests for parametric data and the Mann-Whitney U test for nonparametric data.

RESULTS

Agreement in the 20% sampling between investigators was high (96%). The mean QTc in the ACS group was 457 ms and the mean QTc in the EtOH withdrawal-related group was 468 ms (diff 11, not significant). Significantly more patients had a prolonged QTc in the EtOH withdrawal group than in the ACS group 62% vs 46%; diff 16; 95% CI (0.1, 30). There was significantly more use of clopidogrel, acetylsalicylic acid, angiotensin-converting enzyme inhibitors, and statins (P < 0.05 for all) in the ACS group compared with the EtOH withdrawal group; however, there was no difference in β-blocker usage. There was a significantly higher admission rate: 100% of ACS compared with 76% of the EtOH withdrawal group (P < 0.01, diff 24, 95% confidence interval 18-29). Electrolytes were not significantly different in the two groups.

CONCLUSIONS

More patients with EtOH withdrawal-related ED visits had a long QTc than patients presenting with ACS. ED physicians should carefully monitor patients experiencing EtOH withdrawal for cardiac arrhythmias and obtain an ECG. If any medications that prolong the QTc are considered, then an ECG should be obtained before administering medications that may affect the myocardium to make medication safer for the patient.

Impacts of drinking-age legislation on alcohol-impaired driving crimes among young people in Canada, 2009-13

BACKGROUND AND AIM

In Canada, the minimum legal drinking age (MLDA) is 18 years in Alberta, Manitoba and Québec and 19 in the rest of the country. Given that public health organizations have not only recommended increasing the MLDA to 19 years, but also have identified 21 years as ideal, the current study tested whether drivers slightly older than the MLDA had significant and abrupt increases in alcohol-impaired driving (AID) crimes, compared with their counterparts just younger than the MLDA.

DESIGN

Regression-discontinuity approach.

SETTING

Canada.

SAMPLE

AID criminal incidents by drivers aged 15-23 years (female, n = 10 706; male, n = 44 973).

MEASUREMENTS

Police-reported AID incidents from the Canadian 2009-13 Uniform Crime Reporting Survey.

FINDINGS

Significant gender × MLDA effects supported gender-specific models. Compared with males slightly younger than the MLDA, those just older had abrupt increases in AID incidents of 42.8% [95% confidence interval (CI) = 20.4-66.3%, P < 0.001], 28.1% (95% CI = 16.0-40.7%, P < 0.001) and 35.1% (95% CI = 22.4-48.4%, P < 0.001) in provinces with an MLDA of 18 years, 19 years and across the country, respectively. Among females, AID incidents increased by 39.9% (95% CI = 1.9-79.6%, P = 0.040) in provinces with an MLDA of 18 years, and by 19.4% (95% CI = 2.1-37.4%, P = 0.028) at the national level.

CONCLUSION

Release from drinking-age restrictions appears to be associated with increases in alcohol-impaired driving offenses among young drivers in Canada, ranging from 28 to 43% among males and from 19 to 40% among females.