The epidemiology of drinking and driving: results from the Behavioral Risk Factor Surveillance System, 1986. Behavioral Risk Factor Surveillance Group

Speaking about accidents: the ideology of auto safety

Discourses about traffic accidents are limited by an ideology of automobility that has accompanied increased auto dependence and the hegemony of the automobile over social space. Risk analyses swing back and forth from targeting either human error or technical improvement. While both are important, the attribution of accident causation to systemic factors remains largely ignored. Even in targeting human error, focus is often restricted to causes that are manageable within the existing system, e.g. drunken driving. In reality, there are many human errors and impairments that are implicated in road accidents. Thus, what is significant is that because auto-centered transport depends upon the constant ‘sobriety’ of all traffic participants, impaired driving, walking and cycling are inevitable. Another salient feature of auto-centered transport systems neglected by safety experts is the dominance of ‘hard’ means of mobility. Many argue that larger and heavier vehicles are safer, but the question is for whom and in what traffic and social contexts. In auto-centered transport, some participants, e.g. children and cyclists, who use ‘soft’ means of mobility are particularly disadvantaged. Safety is also differentiated by status (e.g. social class) factors; for example, poorer persons drive poorer vehicles. The lack of attention to systemic factors in safety discourses is congruent with the general culture of individual automobility, which assumes the superiority of auto-centered transport over other, more diversified, structures of movement.

Alcohol-impaired driving: average quantity consumed and frequency of drinking do matter

OBJECTIVE

The objective of this article is to estimate and validate a logistic model of alcohol-impaired driving using previously ignored alcohol consumption behaviors, other risky behaviors, and demographic characteristics as independent variables.

METHODS

The determinants of impaired driving are estimated using the US Centers for Disease Control and Prevention's (CDC) Behavioral Risk Factor Surveillance System (BRFSS) surveys. Variables used in a logistic model to explain alcohol-impaired driving are not only standard sociodemographic variables and bingeing but also frequency of drinking and average quantity consumed, as well as other risky behaviors. We use interactions to understand how being female and being young affect impaired driving. Having estimated our model using the 1997 survey, we validated our model using the BRFSS data for 1999.

RESULTS

Drinking 9 or more times in the past month doubled the odds of impaired driving. The greater average consumption of alcohol per session, the greater the odds of driving impaired, especially for persons in the highest quartile of alcohol consumed. Bingeing has the greatest effect on impaired driving. Seat belt use is the one risky behavior found to be related to such driving. Sociodemographic effects are consistent with earlier research. Being young (18-30) interacts with two of the alcohol consumption variables and being a woman interacts with always wearing a seat belt. Our model was robust in the validation analysis.

CONCLUSIONS

All 3 dimensions of drinking behavior are important determinants of alcohol-impaired driving, including frequency and average quantity consumed. Including these factors in regressions improves the estimates of the effects of all variables.

Alcohol and driving: is the 0.05% blood alcohol concentration limit justified?

This paper reviews the findings of experimental and laboratory research to determine whether there is sufficient evidence to support a uniform 0.05% blood alcohol concentration (BAC) as the legal limit for driving. Statistically significant and meaningful decrements in driving-related performance were identified at 0.05% BAC or below in many studies. Younger and inexperienced drinkers and drivers appear to be at greatest risk for alcohol-related traffic crashes. It is concluded that on scientific grounds, there is support for setting the legal limit at 0.05%. The setting of a uniform 0.05% BAC statutory limit should be but one effort within a comprehensive approach including other legal, social, behavioural and environmental strategies to deal with the drink driving problem.

Twelve-month prevalence and changes in driving after drinking: United States, 1991-1992 and 2001-2002

BACKGROUND

Drinking and driving has been identified as one of the most important contributors of motor vehicle fatalities. This paper addressed the existing gap in our public health knowledge regarding the current prevalence of driving after drinking and how this has changed over the past decade.

METHODS

Prevalence rates of drinking and driving in 2001-2002, and changes in those prevalence rates between 1991-1992 and 2001-2002 were examined in two large nationally representative surveys of the U.S. population.

RESULTS

Overall, the prevalence of driving after drinking was 2.9% in 2001-2002 representing approximately six million U.S. adults. This rate was about three quarters of the rate observed in 1991-1992 (3.7%), reflecting a 22% reduction. Generally, the male-female differentials in the rate of driving after drinking decreased over the past decade. However, the sex ratios increased substantially for under-aged youth over the past decade, reflecting the sharp decrease in prevalence of driving after drinking among 18-20-year-old women. Constant and emerging subgroups at high risk for drinking and driving included Whites, Native Americans, males, under-aged young adults and 21-25-year-olds.

CONCLUSIONS

The results of this study highlighted the need to continue to monitor prevalence and changes in driving after drinking. Results are discussed in the context of strengthening existing prevention and intervention efforts and developing new programs with the sociodemographic differentials observed in this study in mind.

Motor vehicle crash fatalities by race/ethnicity in Arizona, 1990-96

OBJECTIVE

To compare rates of motor vehicle crash (MVC) fatalities among different race/ethnic groups in urban and rural Arizona.

METHOD

Using the Fatality Analysis Reporting System and the National Center for Health Statistics Multiple Cause of Death file, MVC fatalities in Arizona from 1990-96 inclusive were classified by gender, race/ethnicity, and urban or rural residence. Age adjusted rates of total, occupant, pedestrian, and alcohol related fatalities were calculated. The total MVC fatality rate for each race/ethnic group was then adjusted for proportion of rural residence.

RESULTS

Compared with non-Hispanic whites (NHWs), American Indians had raised relative risks for MVC fatality in all gender and residence subgroups. Hispanic females and rural Hispanic males had lower relative risks, as did rural African-American men. Raised relative risks for American Indian men and women included all subgroups: total, occupant, pedestrian, and alcohol related. Hispanic and African-American men both had raised relative risks of pedestrian related fatalities, and Hispanic men had a slightly higher relative risk while Hispanic women had a lower relative risks, for alcohol related fatality. Hispanic men and women and African-American men had lower occupant fatality rates. Close to half (45%) of the excess MVC fatality among American Indians can be attributed to residence in rural areas, where MVC fatality rates are higher. There were 1.85 occupants in crashes involving NHW deaths compared with 2.51 for Hispanics and 2.71 for American Indians (p<0.001). The proportion of occupants not using a seatbelt was higher in Hispanics and American Indians in both urban and rural areas.

CONCLUSION

The major disparity in MVC fatality in Arizona is among American Indians. The higher MVC fatality rates among American Indians occur in all age groups, in both urban and rural areas, and among occupants and pedestrians. Rural residence, lower rates of seatbelt use, higher rates of alcohol related crashes, a greater number of occupants, and higher rates of pedestrian deaths all contribute to the American Indian MVC fatality disparity. High rates of pedestrian fatality occur in men in all three race/ethnic minorities in Arizona and among American Indian women. In contrast to other studies, African-Americans and Hispanics did not have raised total MVC fatality rates and compared to NHWs actually had lower rates in the rural areas of the state.

Women, alcohol, and driving

Alcohol-related crashes and fatalities have shown a dramatic decrease over the last decade. While males continue to account for most alcohol-related crashes, females are an increasing proportion of alcohol-involved drivers in both fatal and nonfatal crashes. Although most research has not addressed the possibility of gender differences in the effects of alcohol on driving performance, available evidence suggests that such differences may exist. Alcohol appears to have greater effects on females in terms of biomedical damage and impaired performance, although these effects have not been systematically investigated in relation to driving. Effective prevention programs for women require more focused research to understand gender-related factors in the effects of alcohol on driving.

Expectancies for driving under the influence of alcohol among Hispanics and non-Hispanic Whites

A random sample of 1418 (40.8% male) Hispanics and 501 (46.1% male) non-Hispanic Whites were surveyed about their behavioral expectations for driving under the influence of alcoholic beverages (DUI). Hispanics reported more often than Whites that the effects of DUI would be driving carelessly, being angry at other drivers, feeling nervous, losing the respect of friends, feeling guilty, feeling too tired to drive, and losing their self-respect. There were gender differences among Hispanics but not among Whites. Hispanic abstainers reported the likelihood of the various outcomes more frequently than drinkers although drinking status produced no statistically significant differences among non-Hispanic Whites.

The risk of dying in alcohol-related automobile crashes among habitual drunk drivers

BACKGROUND

Reports suggest that people who drive while intoxicated by alcohol may do so repeatedly. We hypothesized that persons arrested for driving while impaired might be at increased risk for death in an alcohol-related motor vehicle crash. To evaluate this possibility, we studied the deaths of drivers in alcohol-related motor vehicle accidents in North Carolina over a 10-year period.

METHODS

We compared drivers who died in motor vehicle crashes from 1980 through 1989 and who had blood alcohol concentrations of at least 20 mg per deciliter (4.3 mmol per liter), referred to as the case drivers, with those who died in crashes but had blood alcohol concentrations below 20 mg per deciliter, referred to as the control drivers. We identified case drivers and control drivers through the state Medical Examiner System. We then searched North Carolina driver-history files for the five years before each death to identify arrests for driving while impaired.

RESULTS

We linked a total of 1646 case drivers and 1474 control drivers to their driver-history files. Case drivers were more likely than control drivers to have been arrested for driving while impaired (26 percent vs. 3 percent). After we controlled for potential confounding variables, case drivers 21 to 34 years of age were 4.3 times more likely (95 percent confidence interval, 2.7 to 6.8) than control drivers to have been arrested for driving while impaired; case drivers 35 years of age or older were 11.7 times more likely (95 percent confidence interval, 6.8 to 20.1). The strength of the association appeared to increase with the number of prior arrests. Case drivers were also more likely than the general population of currently licensed drivers to have been arrested.

CONCLUSIONS

Arrests for driving while impaired substantially increase the risk of eventual death in an alcohol-related crash. Aggressive intervention in the cases of people arrested for driving while impaired may decrease the likelihood of a future fatal alcohol-related crash.

The effect of adult belt laws and other factors on restraint use for children under age 11

We used data from 11 states (5,449 respondents) to examine the association between self-reported consistent use of occupant restraints for children under 11 years of age and presence of adult belt-use laws while controlling for other factors. Self-reported safety belt use by adults, age of youngest child in the household (child restraint use decreased with increasing age), and adult educational attainment were significant predictors of child restraint use; respondent age, race/ethnicity, sex, marital status, household income, and employment status were not. Adult and child occupant restraint use was higher in states with an adult safety belt law than in states without such a law.

Fuzzy dice, dream cars, and indecent gestures: correlates of driver behavior?

In 1989 the Los Angeles Times conducted a telephone survey of over 1,800 Southern California motorists. We analyzed the data to determine whether personality and demographic characteristics were related to driver behavior. Fourteen percent of drivers were involved in a motor vehicle accident in the previous year, 8% reported driving when they had too much to drink, 20% ran at least one red light in the previous month, and nearly half said they often drove faster than the speed limit. Motorists under 30 years of age are especially likely both to engage in the three risk-taking behaviors and to be involved in a crash, even holding other factors constant. Drivers over 65 years of age take fewer risks, but have the same likelihood of having an accident per mile driven as middle-aged motorists. Surprisingly, drivers with more than a high school education are more likely to both speed and be involved in a crash. Those with fuzzy dice or bumper stickers are not readily distinguishable from other motorists in terms of accidents or risk-taking behaviors. Individuals driving their dream car are somewhat less likely than others to run red lights and drive after drinking. Motorists who made indecent gestures at other drivers, and particularly those who argue with other motorists tend to be unlawful and dangerous drivers. Youth and hostility toward other motorists are two of the most significant and important correlates of bad driving.

Etiology of drinking and driving among adolescents: implications for primary prevention

A prospective study was conducted to investigate what factors are predictive of self-reported drinking and driving (DD) among adolescents. The study employs a theoretical framework taken from Problem Behavior Theory; environmental, personality, and behavioral factors are explored for their predictability of DD. A cohort of 1482 high school students completed a written survey in spring of 1986 and again in fall of 1986. The findings confirm that Problem Behavior Theory provides a useful theoretical framework with which to identify etiological factors predictive of DD among adolescents. Identified personality, perceived environmental, behavioral, and demographic factors accounted for approximately 50% of the reported variance in DD at baseline. The same factors accounted for approximately 40% percent of the variance in follow-up DD and were predictive both among the students who did not drink and drive at baseline (incidence cases), and among those students who did drink and drive at baseline (continuation versus discontinuation of the behavior). Based on these etiological data, we recommend that school-based, peer-led educational prevention programs be designed to reach young adolescents prior to the age at which a driver's license is obtained. We further recommend that the programs be broad-based and consider DD within the larger context of drinking and driving related behaviors and traffic safety in general.