Using mobile technology to influence alcohol-impaired driving risk perceptions and decisions

OBJECTIVE

Despite significant individual and societal risk, alcohol-impaired driving (AID) remains prevalent in the United States. Our aim was to determine whether breathalyzer-cued warning messages administered via mobile devices in the natural drinking environment could influence real-world AID cognitions and behaviors.

METHOD

One hundred twenty young adults (53% women; mean age = 24.7) completed 6 weeks of ecological momentary assessment (EMA) and provided breathalyzer samples using a BACtrack Mobile Pro linked to their mobile device. On mornings after drinking episodes, participants reported their driving activities from the previous evening (787 episodes). Participants were randomly assigned to receive warning messages if they reached a breath alcohol concentration (BrAC) ≥ .05, or no messages. Participants in the warnings condition reported their willingness to drive and perceived danger of driving at EMA prompts (1,541 reports).

RESULTS

We observed a significant effect of condition, such that the association between cumulative AID engagement and driving after reaching a BrAC of .05 was dampened among individuals in the warnings condition, compared to those in the no warnings condition. Receiving a warning message was associated with increased momentary perceived danger of driving and decreased willingness to drive.

CONCLUSIONS

We found that BrAC-cued warning messages reduced the probability of AID and willingness to drive while impaired, and increased the perceived danger of driving after drinking. These results serve as proof-of-concept for the use of mobile technology to deliver an adaptive just-in-time intervention to reduce the probability of AID. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Trends in alcohol-impaired crashes in California, 2016 to 2021: A time series analysis for alcohol involvement and crash distribution among demographic subgroups

BACKGROUND

In 2020, the COVID-19 pandemic and control measures changed alcohol consumption in the United States (US) and globally. Before the pandemic, alcohol-impaired crashes contributed to approximately one-third of all road traffic crash injuries and fatalities nationally. We examined the impact of the COVID-19 pandemic on crashes and examined differences in alcohol-involved crashes across various subgroups.

METHODS

The University of California Berkeley Transportation Injury Mapping Systems provided information on all crashes reported to the California Highway Patrol from January 1, 2016 through December 31, 2021. Using autoregressive integrated moving average (ARIMA) models applied to weekly time series data, we estimated the effect of California's first mandatory statewide shelter-in-place order (March 19, 2020) on crashes per 100,000 population. We also examined crash subgroups according to crash severity, sex, race/ethnicity, age, and alcohol involvement.

RESULTS

In California, the mean crash rate per week before the pandemic (January 1, 2016-March 18, 2020) was 9.5 crashes per 100,000 population, and 10.3% of those were alcohol-involved. After the initiation of the COVID-19 stay-at-home order, the percentage of crashes that were alcohol-involved rose to 12.7%. Overall, the crash rate across California decreased significantly (-4.6 crashes per 100,000; 95% CI: -5.3, -3.9), including across all examined subgroups, with the greatest decrease among the least severe crashes. However, there was a 2.3% absolute increase in the proportion of crashes that were alcohol-involved (0.02 crashes per 100,000; 95% CI: 0.02, 0.03).

CONCLUSIONS

The initiation of a COVID-19 stay-at-home ordinance in California was associated with a substantial decrease in overall crash rates. While crashes have returned to pre-pandemic levels, alcohol-involved crashes remain elevated. The initiation of the stay-at-home order significantly increased alcohol-impaired driving, which has remained elevated.

Driving under the influence of substances and motor vehicle fatalities among older adults in the United States

OBJECTIVE

This study examines contribution of substance use (including alcohol, cannabinoids, stimulants, narcotics, depressants, and hallucinogens) on the probability of drivers being at-fault for a crash on U.S. public roads, with specific emphasis on older adult drivers.

METHODS

Data from the National Highway Traffic Safety Administration's Fatality Analysis Reporting System (FARS) for the years 2010-2018 were employed for 87,060 drivers (43,530 two-vehicle crash pairs) involved in two moving vehicle crashes. The quasi-induced exposure (QIE) method was used to compute the relative crash involvement ratios (CIRs) for each relevant substance and illicit drug. Mixed-effect generalized linear regression models were fit to examine the effect of substance use on the probability of a driver being at-fault for a crash.

RESULTS

There were 75.51% males and 73.88% Non-Hispanic Whites in our sample. The CIR for those aged 70-79 years was 1.17, and more than double (2.56) for the ≥80 years old drivers, while being relatively low among drivers of ages 20 to 69. Substance use, in general, disproportionately increased the probability of being at-fault during a crash, regardless of driver's age. Though older drivers are less likely than other age groups to report substance use, presence of substances among older drivers increased the probability of their being at-fault two to four times during a crash across almost all substances. The regression models, after adjusting for driver's sex, road grade, weather, light conditions, distraction, and speeding at time of crash, revealed that older drug-impaired drivers were twice as likely to be at fault in a fatal crash (aOR = 1.947; 95% CI = 1.821, 2.082; <0.0001) compared to their middle-aged counterparts. Similarly, most substance use categories were responsible for the probabilities of higher CIRs among the drivers.

CONCLUSION

These findings necessitate continued efforts to bring awareness to the deadly consequences of "drugged driving," especially among older adult drivers.

law enforcement agencies

OBJECTIVE

Excessive alcohol consumption leads to a range of public health problems and social and financial burdens. Traffic crashes resulting from alcohol-involved driving are a major contributor to the overall health consequences of alcohol. Various laws and enforcement strategies aim to prevent alcohol-involved driving. The extent to which law enforcement agencies prioritize enforcement of alcohol-impaired driving laws can help to reduce alcohol-impaired driving. Among law enforcement agencies in the US, we examined prioritization of alcohol-impaired driving enforcement and how it is associated with use of specific enforcement strategies, as well as agency and community characteristics.

METHODS

We conducted a survey of a national sample of 1,024 US police and sheriff agencies in 2019. We assessed prioritization of alcohol-impaired driving enforcement, use of specific enforcement strategies (saturation patrols, sobriety checkpoints, open container law enforcement, training field officers to identify driving impairment), and agency and jurisdiction characteristics. We assessed how priority of enforcement (high vs. low) was associated with use of specific strategies, and agency and jurisdiction characteristics using regression models that accounted for agencies nesting within states.

RESULTS

A majority of agencies (68%) placed a high priority on alcohol-impaired driving enforcement. Almost all agencies (93%) reported performing at least one alcohol-impaired driving enforcement strategy and the most common strategy used was saturation patrols. Agencies that prioritized alcohol-impaired driving enforcement were more likely to use sobriety checkpoints and saturation patrols, conduct enforcement of open container laws and train field officers in identifying driving impairment (p < 0.05). They were also more likely to have an officer assigned primarily to alcohol enforcement, have an alcohol division, and serve jurisdictions that had fewer Black residents (p < 0.05).

CONCLUSIONS

Many law enforcement agencies utilize strategies to address alcohol-impaired driving, however, some strategies are underutilized and an opportunity exists for agencies to incorporate additional strategies to help prevent alcohol-impaired driving. Agencies that made alcohol-impaired driving enforcement a priority were more likely to conduct related enforcement strategies. Encouraging police and sheriff agencies to prioritize alcohol-impaired driving enforcement may be an effective approach for preventing alcohol-related harms.

Determining a dosage threshold of drink-driving enforcement operations: A systematic review

ISSUES

Policy enforcement is crucial to achieve impacts on alcohol-related harm. It is not clear what level of enforcement intensity or 'dosage' is necessary for addressing drink driving and related harms. Given competing enforcement demands and agencies' resource constraints, understanding how much enforcement is sufficient to deter drink driving is critical.

APPROACH

This systematic literature review followed Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) guidelines to examine research about dosage effects of enforcement and related visibility on drink-driving outcomes, including motor vehicle crashes and fatalities. Risk of bias was assessed using the Cochrane Collaboration Effective Practice and Organization of Care tool and the JBI checklist.

KEY FINDINGS

The 21 studies that met the inclusion criteria for this review differed in measures of enforcement dosage and outcomes, making it difficult to synthesise results across studies and draw conclusions about a threshold or optimal level of enforcement. Although most included studies found that sustained enforcement was associated with reductions in drink driving or related harms, only two studies tested an optimal dosage. Due to study design limitations, a substantial percentage of these studies must be considered with caution.

IMPLICATIONS

Additional research with rigorous study designs with appropriate controls is needed to determine an optimal high visibility enforcement dosage level to help law enforcement agencies make realistic decisions about allocating enforcement resources to address drink driving.

CONCLUSION

Consistent evidence about a drink-driving enforcement dosage threshold is lacking, partly due to an insufficient number of well-designed studies. Addressing challenges of conducting rigorous studies in community settings is crucial.

Applying Bayesian cognitive models to decisions to drive after drinking

BACKGROUND AND AIMS

Despite widespread negative perceptions, the prevalence of alcohol-impaired driving (AID) in the United States remains unacceptably high. This study used a novel decision task to evaluate whether individuals considered both ride service cost and alcohol consumption level when deciding whether or not to drive, and whether the resulting strategy was associated with engagement in AID.

DESIGN

A two-sample study, where sample 1 developed a novel AID decision task to classify participants by decision strategy. Sample 2 was used to cross-validate the task and examine whether decision strategy classifications were predictive of prior reported AID behavior.

SETTING

A laboratory setting at the University of Missouri, USA.

PARTICIPANTS

Sample 1 included 38 student participants from introductory psychology classes at the University of Missouri. Sample 2 included 67 young adult participants recruited from the local community.

MEASUREMENTS

We developed a decision task that presented hypothetical drinking scenarios that varied in quantity of alcohol consumption (one to six drinks) and the cost of a ride service ($5-25). We applied a Bayesian computational model to classify choices as consistent with either: integrating both ride cost and consumption level (compensatory) or considering only consumption level (non-compensatory) when making hypothetical AID decisions. In sample 2, we assessed established AID risk factors (sex, recent alcohol consumption, perceived safe limit) and recent (past 3 months) engagement in AID.

FINDINGS

In sample 1, the majority of participants were classified as using decision strategies consistent with either a compensatory or non-compensatory process. Results from sample 2 replicated the overall classification rate and demonstrated that participants who used a compensatory strategy were more likely to report recent AID, even after accounting for study covariates.

CONCLUSIONS

In a hypothetical alcohol-impaired driving (AID) decision task, individuals who considered both consumption level and ride service cost were more likely to report recent AID than those who made decisions based entirely on consumption level.

Social Support and the Rehabilitation of Alcohol-Impaired Drivers: Drinking Motives as Moderators

Alcohol-impaired driving is a common and costly public health problem associated with alcohol misuse. This investigation aims to understand the role of social support and drinking motives in motivating alcohol-impaired drivers to reduce alcohol use. One hundred nineteen participants with a history of driving-while-intoxicated arrest were recruited from either a correctional treatment facility (n = 59) or the community (n = 60) and asked about their motivation to change alcohol use. Motivation to change was tested in relationships with two types of social support (i.e. Abstinence-Specific Social Support and General Social Support) and drinking motives (Coping, Enhancement, and Social Motives). The results showed: (1) only Abstinence-Specific Social Support was positively associated with motivation to change; (2) Coping and Social Motives had a negative association with motivation to change; (3) the impact of Abstinence-Specific Social Support on motivation to change was greater among those with a stronger Enhancement Motives. In other words, those who drink primarily for pleasure showed a greater increase in motivation to change when more Abstinence-Specific Social Support is available, compared to those with lower Enhancement Motives. The findings of this investigation contribute to our knowledge of the roles of communication in the rehabilitation of alcohol-impaired drivers.

Alcohol and marijuana use among young injured drivers in Arizona, 2008-2014

OBJECTIVE

We examined alcohol and marijuana use among injured drivers aged 16-20 years evaluated at Arizona level 1 trauma centers during 2008-2014.

METHODS

Using data from the Arizona State Trauma Registry, we conducted a descriptive analysis of blood alcohol concentration (BAC) and qualitative test results (positive or negative) for delta-9-tetrahydrocannabinol (THC) by year of age, sex, race, ethnicity, injury severity, seat belt use, motorcycle helmet use, and type of vehicle driven. To explore compliance with Arizona's motorcycle helmet law requiring helmet use for riders <18 years old, we examined helmet use by age.

RESULTS

Data on 5,069 injured young drivers were analyzed; the annual number of injured drivers declined by 41% during the 7-year study period. Among the 76% (n = 3,849) of drivers with BAC results, 19% tested positive, indicating that at least 15% of all drivers had positive BACs. Eighty-two percent of the BAC-positive drivers had BACs ≥0.08 g/dL, the illegal threshold for drivers aged ≥21 years. Among the 49% (n = 2,476) of drivers with THC results, 30% tested positive, indicating that at least 14% of all drivers were THC-positive. American Indians and blacks had the highest proportion of THC-tested drivers with positive THC results (38%). In addition, 28% of tested American Indians had positive results for both substances, more than twice the proportion seen in all other race or ethnic groups. Crude prevalence ratios suggested that drivers who tested positive for alcohol or THC were less likely than those who tested negative to wear a helmet or seat belt, further increasing their injury risk. Helmet use among motorcyclists was lower among 16- and 17-year-old riders compared to 18- to 20-year-olds, despite Arizona's motorcycle helmet law requiring riders aged <18 years to wear a helmet.

CONCLUSIONS

About 1 in 4 injured drivers aged 16-20 years tested positive for alcohol, THC, or both substances. Most drivers with positive BACs were legally intoxicated (BAC ≥0.08 g/dL). All substance-using young drivers in this study were candidates for substance abuse screening and possible referral to treatment. Broader enforcement of existing laws targeting underage access to alcohol and alcohol-impaired driving could further reduce injuries among young Arizona drivers. To further reduce crash-related injuries and fatalities among all road users, the state could consider implementing a primary enforcement seat belt law and a universal motorcycle helmet law.

Effects of Washington State's alcohol ignition interlock laws on DUI recidivism: An update

OBJECTIVE

The objective of this study was to examine the effects of changes to Washington State's alcohol ignition interlock laws: moving issuance of interlock orders from the courts to the driver licensing department (July 2003); extending the interlock order requirement to all persons convicted of driving under the influence (DUI; June 2004); allowing an interlock in lieu of an administrative driver's license suspension (January 2009); and requiring proof of interlock installation to reinstate the driver's license (January 2011).

METHOD

Trends in conviction types, interlock installation rates, and 2-year cumulative recidivism rates were examined for first-time and repeat offenders with convictions stemming from DUI arrests during 1999-2012. Autoregressive integrated moving average (ARIMA) models examined the association between law changes and installation rates, law changes and recidivism rates, and installation rates and recidivism rates.

RESULTS

During the study period, there was a large increase in the proportion of first-time DUI arrests reduced to alcohol-related negligent/reckless driving convictions, offenses not requiring interlock orders. The interlock installation rate increased substantially and the recidivism rate declined substantially among both first and repeat offenders. Based on the ARIMA models for first offenders, the 2004 and 2009 law changes were associated with increased interlock installation rates and lower recidivism rates. For first offenders arrested during the last quarter of 2012, the model estimates a 26% reduction in the recidivism rate (from an expected 7.7% without the 4 laws to 5.6%). A 1 percentage point increase in the interlock installation rate was associated with a 0.06 percentage point decline in the recidivism rate among first offenders. If the association carried forward and if the installation rate had been 100% rather than 38% in the last quarter of 2012, the 2-year recidivism rate would have been reduced from 5.6 to 2%. Among repeat offenders, the 2003 and 2009 law changes were associated with increased interlock installation rates, and the 2009 law change was associated with a nonsignificant decline in recidivism.

CONCLUSIONS

In Washington, rates of interlock installations increased as interlock laws were strengthened, and the increase was associated with reductions in recidivism among first DUI offenders. Washington's experience suggests that states can reduce DUI recidivism by requiring interlock orders for all offenders, allowing offenders to install interlocks in lieu of an administrative driver's license suspension, and closing statutory loopholes that allow plea reductions to convictions without interlock orders.

Prevalence of drink-driving among adults in China: A nationally representative survey in 2010

OBJECTIVE

We examined the prevalence of and characteristics associated with drink-driving in China. We compared this study's drink-driving findings with those from the United States to explore how effective traffic safety interventions from Western cultures might be adapted for use in China.

METHODS

Data from the 2010 China Chronic Disease and Risk Factor Survey were analyzed to describe the prevalence and characteristics associated with drink-driving in China.

RESULTS

Overall, 1.5% of Chinese adults reported drink-driving in the past 30 days-3% of males and 0.1% of females. However, among males who had driven a vehicle in the past 30 days and consumed at least one alcoholic beverage in the past 30 days, 19% reported drink-driving during the 30-day period. Excessive drinking, binge drinking, nonuse of seat belts, and having been injured in a road traffic crash in the past year were most strongly associated with drink-driving among males.

CONCLUSIONS

Drink-driving is prevalent among male drivers in China. Although large differences exist between China and the United States in the proportion of adults who drive, the proportion who consume alcohol, and some of the personal characteristics of those who drink and drive, similarities between the 2 countries are present in patterns of risk behaviors among drink-driving. To reduce injuries and deaths from drink-driving, effective interventions from Western cultures need to be tailored for adoption in China.

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.

Alcohol policies and impaired driving in the United States: Effects of driving- vs. drinking-oriented policies

AIMS

To test the hypotheses that stronger policy environments are associated with less impaired driving and that driving-oriented and drinking-oriented policy subgroups are independently associated with impaired driving.

DESIGN

State-level data on 29 policies in 50 states from 2001-2009 were used as lagged exposures in generalized linear regression models to predict self-reported impaired driving.

SETTING

Fifty United States and Washington, D.C.

PARTICIPANTS

A total of 1,292,245 adults (≥ 18 years old) biennially from 2002-2010.

MEASURES

Alcohol Policy Scale scores representing the alcohol policy environment were created by summing policies weighted by their efficacy and degree of implementation by state-year. Past-30-day alcohol-impaired driving from 2002-2010 was obtained from the Behavioral Risk Factor Surveillance System surveys.

FINDINGS

Higher Alcohol Policy Scale scores are strongly associated with lower state-level prevalence and individual-level risk of impaired driving. After accounting for driving-oriented policies, drinking-oriented policies had a robust independent association with reduced likelihood of impaired driving. Reduced binge drinking mediates the relationship between drinking-oriented policies and impaired driving, and driving-oriented policies reduce the likelihood of impaired driving among binge drinkers.

CONCLUSIONS

Efforts to reduce alcohol-impaired driving should focus on reducing excessive drinking in addition to preventing driving among those who are impaired.

Effects of admission and treatment strategies of DWI courts on offender outcomes

PURPOSE

The purpose of this study is to classify DWI courts on the basis of the mix of difficult cases participating in the court (casemix severity) and the amount of involvement between the court and participant (service intensity). Using our classification typology, we assessed how casemix severity and service intensity are associated with program outcomes. We expected that holding other factors constant, greater service intensity would improve program outcomes while a relatively severe casemix would result in worse program outcomes.

METHODS

The study used data from 8 DWI courts, 7 from Michigan and 1 from North Carolina. Using a 2-way classification system based on court casemix severity and program intensity, we selected participants in 1 of the courts, and alternatively 2 courts as reference groups. Reference group courts had relatively severe casemixes and high service intensity. We used propensity score matching to match participants in the other courts to participants in the reference group court programs. Program outcome measures were the probabilities of participants': failing to complete the court's program; increasing educational attainment; participants improving employment from time of program enrollment; and re-arrest.

RESULTS

For most outcomes, our main finding was that higher service intensity is associated with better outcomes for court participants, as anticipated, but a court's casemix severity was unrelated to study outcomes.

CONCLUSIONS

Our results imply that devoting more resources to increasing duration of treatment is productive in terms of better outcomes, irrespective of the mix of participants in the court's program.