Perceptions and Attitudes Related to Driving after Cannabis Use in Canadian and US Adults

BACKGROUND

This study examined the risk perceptions related to driving after cannabis use (DACU) among Canadian and US adults who used cannabis in the past six months.

METHODS

Perceptions of danger, normative beliefs, perceived likelihood of negative consequences, and other driving-related variables were collected via online surveys in Canadian (n = 158; 50.0% female, 84.8% White, mean age = 32.73 years [SD = 10.61]) and US participants (n = 678; 50.9% female, 73.6% White, mean age = 33.85 years [SD = 10.12]). Driving cognitions and DACU quantity/frequency were compared between samples using univariate analyses of variance, and Spearman's (ρ) correlations were performed to examine associations between driving cognitions and DACU quantity/frequency.

RESULTS

The two samples did not significantly differ in self-reported level of cannabis use, lifetime quantity of DACU, or the number of times they drove within two hours of cannabis use in the past three months (Ps > .12). Compared to US participants, Canadians perceived driving within two hours of cannabis use as more dangerous (P < 0.001, ηp2 = 0.013) and reported more of their friends would disapprove of DACU (P = 0.03, ηp2 = 0.006). There were no differences in the number of friends who would refuse to ride with a driver who had used cannabis (P = 0.15) or the perceived likelihood of negative consequences (Ps > 0.07). More favorable perceptions were significantly correlated with greater lifetime DACU and driving within two hours of use (ρ = 0.25-0.53, Ps < 0.01).

CONCLUSIONS

These findings reveal differences in distal risk factors for DACU between Canada and the US and may inform prevention efforts focusing on perceptions of risk and social acceptance of DACU.

Injunctive Norms and Driving Under the Influence and Riding With an Impaired Driver Among Young Adults in Washington State

PURPOSE

Alcohol- and cannabis-impaired driving behaviors remain a public health concern especially among young adults (i.e., ages 18-25). Limited updates to prevention efforts for these behaviors may be due, in part, to limited understanding of malleable psychosocial predictors. The current study assessed associations between perceived injunctive norms (i.e., acceptability) of driving under the influence of alcohol (DUI-A) and cannabis (DUI-C), and riding with a driver under the influence of alcohol (RWI-A) and cannabis (RWI-C) in Washington State young adults.

METHODS

Participants included 1,941 young adults from the 2019 cohort of the Washington Young Adult Health Survey. Weighted logistic regressions assessed the associations between peer injunctive norms and impaired driving-related behaviors.

RESULTS

A weighted total of 11.5% reported DUI-A, 12.4% DUI-C, 10.9% RWI-A, and 20.9% RWI-C at least once in the past 30 days. Overlap between the outcomes was observed, indicating some young adults had engaged in multiple impaired driving-related behaviors. After controlling for substance use frequency, weighted logistic regressions indicated more positive perceived injunctive norms were associated with nearly 2 ½ times higher odds of DUI-A, 8 times higher odds of DUI-C, 4 times higher odds of RWI-A and six and a half times higher odds of RWI-C.

DISCUSSION

Results increase the understanding of how injunctive norms-a potentially malleable psychosocial factor-are associated with four impaired driving-related outcomes. Prevention programs that focus on assessing and addressing the norms of these outcomes individually and collectively, such as normative feedback interventions and media campaigns, may be helpful in reducing these behaviors.

Decision strategies while intoxicated relate to alcohol-impaired driving attitudes and intentions

OBJECTIVE

Approximately 28 million individuals engage in alcohol-impaired driving (AID) every year. This study investigated individuals' AID decision making strategies under intoxication, their variability across the breath alcohol concentration (BrAC) curve, and the association between strategy and AID attitudes, intentions, and behavior.

METHOD

Seventy-nine adults (mean 23.9 years, 57% female) who drank alcohol ≥2 days per week and lived >2 miles away from their typical drinking locations completed an alcohol administration protocol and AID decision making task. AID attitudes, intentions, and behaviors were assessed repeatedly across the BrAC curve. Bayesian cognitive modeling identified decision strategies used by individuals on the AID decision making task, revealing whether alcohol consumption level and/or ride service cost factored into individuals' decisions to drive while impaired or obtain a ride. Additional analyses tested whether AID attitudes and intentions were related to individuals' decision strategies.

RESULTS

Two decision strategies were examined on the ascending and descending limbs of the BrAC curve: compensatory (both consumption level and ride service cost factored into AID decisions) and non-compensatory (only consumption level factored into AID decisions). Switching to a compensatory strategy on the descending limb was associated with lower perceived intoxication, perceiving AID as less dangerous, and being willing to drive above the legal BrAC limit.

CONCLUSIONS

Results suggest that risk for engaging in AID is higher for those using a cost-sensitive, compensatory strategy when making AID decisions under intoxication. Future research is needed to test whether AID countermeasures (e.g., subsidized ride services) are differentially effective according to decision strategy type. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Modeling the influence of 0.03%, 0.05% and 0.08% blood alcohol concentrations on lane positioning and steering control of Indian drivers

OBJECTIVE

Alcohol-impairment of drivers has significant influence on road traffic safety; however, no experimental research has been conducted on the lateral driving control of Indian drivers. Therefore, the present study investigates the effects of different Blood Alcohol Concentration (BAC) levels (0%, 0.03%, 0.05% and 0.08%) and driver attributes on the lane positioning and steering control of Indian drivers.

METHOD

A driving simulator experiment was designed where 82 adult licensed drivers (62 males, 20 females) completed driving on the simulated urban arterial road environment under the influence of varying BACs. Lateral driving performance measures associated with lane positioning (lane position variability) and steering control of drivers (steering angle variability and steering reversal rates (SRR)) were analyzed.

RESULTS

The findings reported that lane position variability was significantly influenced only at 0.08% BAC (5.8% increment); no significant influence was observed at 0.03% and 0.05% BACs. Compared to 0% BAC, steering angle variability increased by 0.105 degrees or 15.7%, 0.142 degrees or 21.4%, and 0.176 degrees or 25.7% at 0.03%, 0.05% and 0.08% BACs respectively. No significant differences were observed between the sober-state driving and alcohol-impaired driving at 1^ο and 5^ο SRR. However, 10^ο SRR was found to be higher by 36%, 65% and 92% at 0.03%, 0.05% and 0.08% BACs compared to 0% BAC. Among the driver attributes, male drivers displayed higher impairment in lane positioning behavior as compared to female drivers. One-year increase in drivers' age reduced the lane position variability by 0.6%. Drivers who performed regular physical exercise were found to have better lateral control on the vehicle, as observed in their steering angle variability. Prior crash history had negative association with the steering reversal rates, indicating that drivers who have previous experience of crash involvement show better steering control than the drivers without any crash experience.

CONCLUSION

In conclusion, the outcomes of this study provide novel insights into the alcohol-impaired lateral vehicle control of Indian drivers which can assist in policy interventions aiming to reduce crashes with alcohol as a major crash causation factor.

Can't simply roll it out: Evaluating a real-world virtual reality intervention to reduce driving under the influence

Driving under the influence (DUI) increases the risk of crashes. Emerging technologies, such as virtual reality (VR), represent potentially powerful and attractive tools for the prevention of risky behaviours, such as DUI. Therefore, they are embraced in prevention efforts with VR interventions primed to grow in popularity in near future. However, little is known about the actual effectiveness of such DUI-targeting VR interventions. To help fill the knowledge gap, this study explored the effects of one VR intervention as delivered in the real world. Using pre and post test design, including an intervention group (n = 98) and a control group (n = 39), the intervention evaluation examined young drivers’ (aged 18 to 25, no known history of DUI) intention and self-reported behaviour three months after the intervention as compared to the baseline. The results did not provide evidence for statistically significant effects of the VR intervention on self-reported DUI behaviour during the three months post intervention and DUI intention at three months post intervention. Such results might be due to the fact that the recruited participants generally self-reported little DUI behaviour, i.e. positively changing behaviour that is already positive is inherently challenging. Nevertheless, the results question the utility of funding the roll-out of arguably attractive technologies without a thorough understanding of their effectiveness in particular settings. To improve the potential for future positive outcomes of such interventions, we provide suggestions on how VR software might be further developed and, subsequently, leveraged in future research to improve the likelihood for behavioural change, e.g. by collecting, analysing and presenting objective driving performance data. Alternatively, future endeavours might focus on participants with known DUI history and examine the effects of the VR intervention for this particular higher-risk group.

Changes in Alcohol Use and Drinking and Driving Outcomes From Before Arrest for Driving Under the Influence to After Interlock Removal

BACKGROUND

Half of the offenders convicted of impaired driving in the United States are sentenced to install alcohol ignition interlock devices (IIDs), which prevent them from starting their vehicles if they have been drinking. No research has yet explored offenders' patterns of alcohol consumption and driving under the influence of alcohol (DUI) from the time before the arrest to the time period after the IID is installed. This study aims to fill that gap in knowledge.

METHODS

Using the Timeline Follow-back interview procedure, we assessed the daily drinking of 153 convicted DUI offenders' self-reported total alcohol consumption and rates of self-reported driving after drinking over 4 phases: before DUI arrest, between arrest and IID installation, during the phase on the interlock, and after the interlock is removed. Because information about behaviors in each period was not available for every participant, comparisons were made using paired-sample contrasts.

RESULTS

Compared with before the arrest, total alcohol use decreased by 50% in the 4-month phase following arrest and before IID installation, though it did not change much afterward. The frequency of drinking and driving decreased sharply after the arrest (-82%), with further decrease upon installation of the interlock (-58%, p = 0.05). The frequency of drinking and driving after the IID was removed returned to preinstallation drinking and driving status (+58%, p = 0.01).

CONCLUSIONS

Participants made significant adjustments to their drinking behavior by adhering to the traditional DUI driving restrictions in the postarrest phase. Although installation of an IID was not associated with a significant change in drinking, it further reduced the frequency of drinking and driving. Evaluations of the IID experience should take into account information on an individual's drinking and DUI behaviors not only before the IID was installed, but before the individual was arrested.

Analysis of drink-driving behavior: Considering the subjective and objective factors of drivers

OBJECTIVE

Drink-driving is one of the key behavioral risk factors in road traffic safety. The main purposes of this study are the identification of the influence of drivers' subjective and objective factors on drink-driving behavior and the correlation between subjective and objective factors to design targeted measures for the prevention and control of drink-driving behavior.

METHODS

To analysis the influence of the subjective and objective factors on the behavior of alcohol value simultaneously. A Bayesian structural equation model is conducted with the data collected via questionnaire issued on the Internet in China.

RESULTS

The results using the Bayesian structural equation model reveals that the subjective factors (e.g., drivers' behavior intention and perceived behavioral control) and objective factors (e.g., age, gender, and driving years of drivers) significantly affect drink-driving behaviors. Drivers' behavior intention is the strongest predictor, and perceived behavioral control also has a significant influence on drink-driving. Drivers who are male, older, lower driving years, driving a motorcycle or car and noncommercial vehicle have a higher probability in drink-driving. The results also suggest that there is a certain correlation between the driver's subjective and objective factors. For instance, male drivers have a more positive attitude toward drink-driving behaviors, drivers over thirty years old more cling to the region's alcohol culture and feel less guilty about drink-driving than youngsters, and truck or bus drivers perceived more disapproval of drink-driving behavior from their significant others.

CONCLUSIONS

A more nuanced understanding of the influence of drivers to drink-driving behavior can be found in these results. These results about the influence mechanism of subjective and objective factors on drink-driving behavior of this study have implications for governments and other interested bodies for better targeting and delivery of public education campaigns and interventions.

Validity and reliability of a driving simulator for evaluating the influence of medicinal drugs on driving performance

RATIONALE

Although driving simulators (DS) are receiving increasing attention due to concern over traffic accidents under the influences of drugs, few DS are recognized for their reliability and validity. Therefore, the development of an evaluation system using DS for driving performance is urgently needed.

OBJECTIVES

To investigate whether the standard deviation of lateral position (SDLP) increases with blood alcohol concentration (BAC) using a DS with reliability and calculate the SDLP threshold from the difference between BAC levels of 0 and 0.05%.

METHODS

Twenty healthy Japanese men performed the DS tasks up to 60 min in Study 1 and DS tasks twice at 1-week intervals in Study 2. Twenty-six healthy men conducted the same DS tasks under BAC level (0, 0.025, 0.05, and 0.09%) in double-blind, randomized, crossover trial in Study 3. The primary outcome was SDLP in a road-tracking test. The test-retest reliability of DS data was assessed, and the estimated difference in SDLP between BAC levels of 0 and 0.05% was calculated using a linear regression model.

RESULTS

The cumulative SDLP values at 5-min intervals were stable, and the intraclass correlation coefficient for its values was 0.93. SDLP increased with BAC in a concentration-dependent manner. The predicted ΔSDLP value for the difference between BAC levels of 0 and 0.05% was 9.23 cm. No participants dropped out because of simulator sickness.

CONCLUSIONS

The new DS used in these studies has reliability, validity, and tolerability and is considered suitable for evaluating the influence of drugs on driving performance.

Long-term effectiveness of the alcohol ignition interlock programme: A retrospective cohort study in the Netherlands

This article provides an evaluation of the long-term effectiveness of the Alcohol Ignition Interlock Programme (AIIP) on recidivism. A retrospective cohort design was used to compare the known reoffending behaviour of 1676 AIIP participants with that of 907 persons in a control group, consisting of offenders who committed an AIIP-worthy driving-under-the-influence (DUI) offence that was not reported to the Dutch driving license authority. Persons in the control group were not sanctioned with an AIIP, but had their case settled in the criminal court. Our outcome measure was the percentage of offenders who committed at least one new DUI offence within the follow-up period. Results indicate that the percentage of repeat offenders in the AIIP group was lower than in the control group. Additional analyses indicate that were an AIIP to be imposed alongside a criminal settlement, a recidivism reduction of 4 percentage points (4 % versus 8 %) could be expected. This would translate to a relative decrease of 54 %. Explanations for these findings are discussed.

Driving under the influence of drugs or alcohol: Predicting the intentions of young drivers

Objectives: Driving under the influence (DUI) of drugs or alcohol impairs driving performance and, as a result, increases the risk of crashes. The risk of DUI is five-fold higher for young drivers (aged 18-25 years), but little is known about what determines their DUI intentions. This study applied an extended model of the Theory of Planned Behavior (TPB) to address the research question of what factors might influence young drivers' future intentions to DUI. Methods: This study used a survey obtaining data from 329 young drivers (Mage = 20.92 years, SD = 2.16) in Australia. Beyond the standard TPB measures of attitudes, subjective norms and perceived behavioral control (PBC), the current study included demographic variables and additional predictors (i.e., moral norm, peers' norm, perceived risk, impulsivity and past DUI behavior). Results: A vast majority of the participants (85.1%) selected the maximum (9, never), meaning that they had no intention to DUI in the future. Overall, a stepwise multilevel logistic regression analysis (Step 1: demographics, Step 2: TPB measures, and Step 3: additional predictors) explained between 30.1% and 52.9% of the variance in DUI intentions. It showed past DUI behavior as the strongest predictor of DUI intention, followed by instrumental attitude and descriptive norms. Conclusions: This study explored an extended TPB model to understand young drivers' DUI intentions better. With this new knowledge of understanding the factors that influence DUI, researchers and practitioners can create interventions and strategies that are better tailored to the population of young drivers at higher risk.

A comparison of driving related skills impaired by ethanol and zopiclone

Objective: Ethanol and zopiclone are both sedating drugs that impair traffic relevant skills, but that show vast differences in epidemiological traffic risk. One explanation for this could be that they impair various kinds of skills differently, but this is less previously studied. The aim of this study was to compare effects of zopiclone and ethanol on a large battery of computerized psychomotor and cognitive tests according to different test classifications. Methods: Ethanol (50 grams), zopiclone 5 mg, zopiclone 10 mg or placebo was administered in a randomized trial with a cross-over design. Blood was sampled nine times after administration and analyzed for zopiclone and ethanol using fully validated methods. The computerized tests Connors Continuous Performance Test (CPT), Stockings of Cambridge (SOC) and choice reaction time (CRT) was performed at baseline and after administration. The three tests yielded fifteen different test components, which were categorized according to the three well-known behavior levels (automative behavior, control behavior and executive planning). Secondly, they were categorized into tests measuring "reaction time", "impulsivity" and "attention/cognition". Results: On all tests belonging to behavior level 1 and on all tests measuring "reaction time", more subjects were impaired by zopiclone than ethanol. On all tests measuring "impulsivity", more subjects were impaired by ethanol than zopiclone. Conclusion: Zopiclone and ethanol both lead to impairment, but have a different profile on what kind of tests and neurocognitive functions they mostly impair. This could be important in the understanding of the differences in traffic risk connected to these two drugs.

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.

Impact of cannabis and low alcohol concentration on divided attention tasks during driving

OBJECTIVE

To assess divided-attention performance when driving under the influence of cannabis with and without alcohol. Three divided-attention tasks were performed following administration of placebo, cannabis, and/or alcohol.

METHODS

Healthy adult cannabis users participated in 6 sessions, receiving combinations of cannabis (placebo/low-THC/high-THC) and alcohol (placebo/active) in randomized order, separated by washout periods of ≥1 week. At 0.5 hours post-dosing, participants performed simulator drives in the University of Iowa National Advanced Driving Simulator (NADS-1), a full vehicle cab simulator with a 360° horizontal field of view and motion base that provides realistic feedback. Drives contained repeated instances of three tasks: a side-mirror task (reaction to a triangle appearing in the side-mirrors), an artist-search task (select a specified artist from a navigable menu on the vehicle's console), and a message-reading task (read aloud a message displayed on the console). Blood THC and breath alcohol concentration (BrAC) were interpolated using individual power curves from samples collected approximately 0.17, 0.42, 1.4, and 2.3 hours post-dose. Driving measures during tasks were compared to equal-duration control periods occurring just prior to the task. Performance shifts, task completion, and lane departures were modeled relative to blood THC and BrAC using mixed-effects regression models.

RESULTS

Each 1 µg/L increase in blood THC concentration predicted increased odds of failing to complete the artist-search task (OR: 1.05, 95% CI: 1.01-1.11, p = 0.046), increased odds of selecting at least one incorrect response (OR: 1.05, 95% CI: 1.00-1.09, p = 0.041), declines in speed during the side-mirror task (0.005 m/s, 95% CI: 0.001-0.009, p = 0.023), and longer lane departure durations during the artist-search task (0.74% of task-period, 95% CI: 0.12-1.36 p = 0.020). BrAC (approximately 0.05%) was not associated with task performance, though each 0.01 g/210 L increase predicted longer departure durations during the side-mirror task (1.41% of task-period, 95% CI: 0.08-2.76, p = 0.040) and increased standard deviation of lane position in the message-reading task (0.61 cm, 95% CI: 0.14-1.08, p = 0.011).

CONCLUSIONS

With increasing medical and legal cannabis use, understanding the impact of acute cannabis use on driving performance, including divided-attention, is essential. These data indicate that impaired divided-attention performance is a safety concern.

EEG biomarkers acquired during a short, straight-line simulated drive to predict impairment from cannabis intoxication

OBJECTIVE

As cannabis use becomes more widely accepted, there is growing interest in its effects on brain function, specifically how it may impact daily functional activities such as driving, operating machinery, and other safety-related tasks. There are currently no validated methods for quantifying impairment from acute cannabis intoxication. The objective of this study was to identify neurophysiological correlates associated with driving simulator performance in subjects who were acutely intoxicated with cannabis. These signatures could help create an EEG-based profile of impairment due to acute cannabis intoxication.

METHODS

Each subject completed a three-visit study protocol. Subjects were consented and screened on the first visit. On the second and third visits, subjects were administered either 500 mg of cannabis with 6.7% delta-9-tetrahydrocannabinol (THC) or placebo using a Volcano© Digit Vaporizer in a counterbalanced fashion. EEG was acquired from subjects as they performed a series of neurocognitive tasks and an approximately 45-minute simulated drive that included a rural straight-away absent of any other cars or obstacles during the final 10 minutes.EEG data was acquired using a STAT X24 wireless sensor headset during a simulated driving scenario from 10 subjects during the THC and placebo visits. Metrics of driving performance were extracted from the driving simulator and synchronized with EEG data using a common clock.

RESULTS

A within-subjects analysis showed that the standard deviation of lane position (SDLP) was significantly worse and heart rate was elevated during the dosed visit compared to the placebo visit. Consistent with our prior findings, EEG power in the Theta frequency band (4-7 Hz) in the dosed condition was significantly decreased from the placebo condition. Theta power was negatively correlated with the SDLP driving performance metric, while there were no significant correlations between any EEG measure and SDLP in the placebo condition.

CONCLUSIONS

These results, in combination with prior work on the effect of cannabis intoxication during neurocognitive tasks, suggest that neurophysiological signatures associated with acute cannabis intoxication are robust and consistent across tasks, and that these signatures are significantly correlated with impaired performance in a driving simulator. Taken together, EEG data acquired during a short neurocognitive testbed and during a simulated drive may provide specific profiles of impairment associated with acute cannabis intoxication. Further research is needed to establish the impaired cognitive processes associated with these EEG biomarkers.

Injury patients' perceptions of drink-driving: A qualitative assessment of drink-driving behavior in Moshi, Tanzania

BACKGROUND

Globally, about 2.3 billion people are current alcohol drinkers, and 283 million have an alcohol use disorder. Alcohol use while driving is a major contributor to road traffic injuries (RTI). We need to understand the culture and perception of drink-driving in this setting to understand why people continue to drink drive and allow policymakers to develop more effective ways to address drink-driving behavior. This study aims to qualitatively determine what injury patients, their families, and community advisory board members in Tanzania believe about drink-driving to help inform policies to address this problem.

METHODS

The semi-structured focus group was designed based on the grounded theory and assessed using thematic analysis. Focus groups participants were a convenience sample of injury patients, their families, and community advisory board (CAB) members. Analysis was iterative throughout the study. All transcripts were coded using a thematic narrative approach. Representative quotes for each theme were then selected based on comparative analysis of coding with input from research team members.

RESULTS

A total of ten focus groups were conducted (4 patient, 4 family, and 2 CAB) with a total of 104 participants (37 females and 67 males). The normalization of drinking among drivers has allowed this behavior to become ingrained in the culture. Participants expressed notions that passengers are responsible for their own safety, rather than drivers being responsible for their passengers. Most participants believe it is a citizen's duty to inform the police of suspected drink-driving, however there were differing opinions about how effective informed police officers can be in practice. Focus group discussions between all three population types highlighted major themes of 'drinking is ingrained in boda boda driver culture', 'individuals have a personal responsibility to address drink-driving', and a 'police enforcement on drink-driving is necessary'.

CONCLUSIONS

Normalization of drink-driving in commercial driver culture creates a dangerous environment for passengers which can be mitigated by education and health promotion. As most passengers already take personal responsibility for their own road traffic safety, they may be likely to make use of safe ride options, if available. While legislation is in place against drink-driving, police officers need to be empowered with appropriate training and funding to enforce them.

An investigation on the risk factors associated with driving errors under the influence of alcohol using structural equation modeling

Objective: Driving errors contribute to traffic crashes and thus the causal factors associated with driving errors are of great interest to the road safety researchers. The present study attempts to identify and quantify the effects of various risk factors that are likely to influence driving error with the application of structural equation modeling (SEM). These risk factors include blood alcohol concentration (BAC) levels (0%, 0.03%, 0.05%, and 0.08%), different driving environments (rural, urban), and driver attributes (such as age, gender, education).Method: Eighty-two licensed drivers participated in a driving simulator experiment. They completed driving under the influence of 4 BAC levels in the driving environments within the framework of a full-factorial within-subjects design. Driving error was modeled as an unobserved latent variable based on several driving simulator indicators. An SEM approach was utilized to examine the influence of BAC level, driving environment, and driver attributes on the latent variable pertaining to driving error.Results: The findings suggest the suitability of an SEM approach in the investigation of driving error. The results revealed that all 3 positive BACs (0.03%, 0.05%, and 0.08%) had a significant positive influence on driving error compared to 0% BAC, and the tendency toward driving error increased with increasing BAC (factor loadings for 0.03%, 0.05%, and 0.08% BAC were 0.22, 0.31, and 0.37, respectively). Moreover, driving in an urban environment led to more driving errors compared to a rural environment, including sober drivers. Among the driver attributes, gender and awareness about drink and drive laws were the only factors influencing driving error.Conclusion: This study highlights a novel approach to investigate driving error by modeling it as a latent variable instead of modeling individual performance measures. The successful execution of SEM in alcohol impairment research may serve as a significant step in the human factors field moving from piecemeal analysis to a combined analysis where interrelationships among numerous risk factors and driving error can be established. The study outcomes may serve as a reference while developing strategies to enhance road traffic safety where special emphasis can be given to the critical risk factors influencing driving error identified in the study.

The effects of alcohol dose, exposure to an in-vehicle alcohol feedback device, and subjective responses to alcohol on the decision to drink-drive in young drivers

BACKGROUND

Several factors may influence the decision to drink-drive (DD) in young drivers, such as the amount of alcohol consumed, exposure to an in-vehicle alcohol feedback device, and subjective responses to alcohol. Understanding of their influence on DD is lacking and may be key for targeted intervention. This randomized controlled, double-blinded, driving simulation experiment tested three main hypotheses; young drivers are more likely to engage in DD with: i) lower alcohol dose; ii) lack of exposure to an in-vehicle alcohol feedback (FB) device; and iii) lower subjective responses to alcohol intoxication (SR). Interactions between the decision to DD and SR, FB and sex were also explored.

METHODS

Males (n = 80) and females (n = 80) aged 20-24 years old were randomly assigned to two conditions: i) alcohol dose (0.45 g/kg or 0.65 g/kg); and ii) exposure to an in-vehicle alcohol feedback device (no or yes). Assessment of participants' SR following alcohol intake was based upon two measures: i) subjective intoxication measured by the discrepancy between an objective measure of intoxication and their subjective estimate of intoxication; and ii) perception of capacity to drive safely under alcohol (for both variables, a higher score represents lower SR). Participants were then asked to make either a negative or positive decision to DD while confronted with time-based contingencies related to their decision. Logistic regression and moderation analyses tested hypotheses.

RESULTS

Approximately 60 % of participants decided to DD. Higher odds of DD were found in participants reporting higher capacity to drive (adjusted odds ratio [β] = 1.03, 95 % confidence interval [CI] = 1.01-1.05) and who were males (β  = 7.70; 95 % CI = 1.34-5.57). A main effect of either FB exposure or alcohol dose was not detected. Moderation analysis showed that lower SR, represented by higher perceived capacity to drive safely under alcohol was selectively predictive of greater likelihood of a decision to DD in participants not exposed to FB (effect = .054, p < .001, 95 % CI = .026-.083).

CONCLUSIONS

Lower SR was found to be associated with a greater likelihood of the decision to DD in young drivers, while exposure to an in-vehicle FB device had no effect on DD. Importantly, FB exposure appeared to disrupt the relationship between lower SR and the decision to DD, signaling that FB may be selectively effective for young drivers possessing lower SR. Future studies are needed to clarify whether FB technology, and other interventions, can be targeted to deter DD in the young drivers most likely to benefit.

Examining interactions within the theory of planned behavior in the prediction of intentions to engage in cannabis-related driving behaviors

Objective: As marijuana use becomes more available to college students through increasing legal reform, this paper seeks to examine intentions for driving under the influence of cannabis (DUIC) and riding with a high driver (RWHD) through the lens of the theory of planned behavior (TPB) and assess potential interactions between personal attitudes, subjective norms, perceived behavioral control (PBC), and sex. Participants: Undergraduate college students (N = 311) completed online surveys in September, 2013. Method: Participants self-reported their attitudes toward DUIC, subjective norms, PBC, past DUIC and RWHD, and intentions to DUIC and RWHD. Results: Participants' attitudes toward DUIC, subjective norms, and PBC were strongly associated with intentions to DUIC and RWHD bivariately. In regression models, attitudes and PBC were both positively and significantly related to intentions to DUIC and RWHD. Conclusions: DUIC and RWHD are concerns for college populations. Targeting personal attitudes and perceived behavioral control via interventions may reduce these behaviors.

Past behaviours and future intentions: An examination of perceptual deterrence and alcohol consumption upon a range of drink driving events

INTRODUCTION

The threat of application of legal sanctions remains the prominent approach to reduce the prevalence of drink driving in a vast array of motoring jurisdictions. However, ongoing questions remain regarding: (a) the extent that such mechanisms impact upon offending behaviours, (b) the deleterious effect alcohol consumption has on decisions to drink and drive and (c) how best to operationalise (and measure) the concept of drink driving to enhance the accurate measurement of the dependent variable.

METHOD

This paper reports on an examination of 773 Queensland motorists' (across nine local government areas) perceptions of both legal and non-legal drink driving sanctions (as well as alcohol consumption) in order to gauge the deterrent impact upon a range of measures of drink driving: the driver thinking they are over the limit, the driver knowing they are over the limit, attempts to evade random breath testing, and intentions to re-offend. The sample completed an online or paper version of the questionnaire.

RESULTS

The majority of participants reported "never" engaging in "possible" (74.5 %) or "acknowledged" (83.4 %) drink driving events, although a considerable proportion of the sample reported engaging in "possible" (25.5 %) or "acknowledged" (16.6 %) drink driving and attempting to evade RBT (18 %) events, as well as possible intentions to drink and drive in the future (22 %). Males were more likely to report such events. Perceptions of both legal sanctions (certainty, severity and swiftness) as well as non-legal sanctions (fear of social, internal or physical harm) were relatively high and consistent with previous research. Interestingly, non-legal sanctions were reported as stronger deterrents than legal sanctions. However, multivariate analysis revealed that legal deterrents had limited utility predicting offending behaviours, but rather, demographic characteristics (e.g., younger motorists, males) as well as risky drinking behaviour were better predictors. In regards to intentions to offend, a past conviction for drink driving was also a predictor of re-offending.

PRACTICAL APPLICATIONS

These results highlight the ongoing challenges of addressing the problem of drink driving and that some motorists: (a) have entrenched behaviour and/or (b) make the decision to drink and drive before they are under the influence of alcohol.

Perceived safety of cannabis intoxication predicts frequency of driving while intoxicated

Driving under the influence of cannabis (DUIC) is a public health concern, and data are needed to develop screening and prevention tools. Measuring the level of intoxication that cannabis users perceive as safe for driving could help stratify DUIC risk. This study tested whether intoxication levels perceived as safe for driving predicted past-month DUIC frequency. Online survey data were collected in 2017 from a national sample of n = 3010 past-month cannabis users with lifetime DUIC (age 18+). Respondents indicated past-month DUIC frequency, typical cannabis intoxication level (1-10 scale), and cannabis intoxication level perceived as safe for driving (0-10 scale). Approximately 24%, 38%, 13%, and 24% of respondents engaged in DUIC on 0, 1-9, 10-19, and 20-30 days respectively in the past month. Among these four DUIC frequency groups, median typical intoxication varied little (5-6), but median intoxication perceived as safe for driving varied widely (3-8). Higher intoxication levels perceived as safe for driving corresponded to frequent DUIC (Spearman's rho: 0.46). For each unit increase in intoxication level perceived as safe for driving, the odds of past-month DUIC increased 18% to 68% (multinomial logistic regression odds ratio - MOR1-9 days: 1.18, 95% CI: 1.13-1.23; MOR10-19 days: 1.40, 95% CI: 1.30-1.50; MOR20-30 days: 1.68, 95% CI: 1.57-1.80). In this targeted sample of past-month cannabis users, DUIC frequency varied widely, but daily/near-daily DUIC was common (24%). Measuring intoxication levels perceived as safe for driving permits delineation of past-month DUIC frequency. This metric has potential as a component of public health prevention tools.

Gender-Specific Predictors of Recidivism Among DUI Offenders

OBJECTIVE

Women are less likely than men to be arrested for driving under the influence (DUI) of alcohol or another drug, yet their proportion of DUI offenders is growing. Understanding how DUI recidivism risk varies for men and women is of practical utility for DUI assessment and intervention programs. The goals of the current study are to determine if there are different sets of predictors for men and women and whether gender-specific DUI recidivism risk scales perform better than a single recidivism scale for both men and women.

METHOD

We rely on statistically driven techniques to develop gender-specific and total sample recidivism risk scales. We then test the ability of the scales to predict recidivism within 12 months among a large sample (N = 10,827, 22.3% female) of DUI offenders court mandated to a DUI intervention in Mississippi.

RESULTS

Predictors of recidivism were drawn from measures of criminal history, substance use disorders, driving behaviors, and accidents. Gender-specific models yielded different sets of recidivism risk factors for men and women, with minimal overlap between the two. Male risk factors were criminal history and heavy alcohol consumption. For women, evidence of a substance use disorder was a unique predictor. Having a prior DUI arrest, driving behaviors, and a physical health consequence of alcohol or drug use (i.e., weight loss) were shared predictors for both sexes.

CONCLUSIONS

Findings suggest that within broad categories of risk factors, the predictive validity of specific assessment items may vary by sex. Our methods represent progression toward more efficient prediction of DUI recidivists.

College students' use of transportation networking companies: An opportunity to decrease substance-impaired driving

Objective: To examine the use of transportation networking companies (TNCs) (eg, Uber) among substance-using students in rural and urban college settings. Participants: Students at two large state universities were randomly selected and screened for substance use. Participants reported use of TNCs generally and after substance use and whether TNC use was on or near campus or in other environments. Methods: Data were evaluated using chi-square test, t-tests, and Fisher's exact tests. Results: Most (85%) participants (n = 99, 61% response rate) had used a TNC. Among students who used TNCs on/near campus, 98% of rural students used them after substance use compared to 85% of urban students (p = .037). We did not detect differences in TNC use by gender or age. Conclusions: Results indicate that TNC use is common after college student substance use and may play a particularly important role in preventing impaired driving for rural campuses where existing transportation options are limited.

Alcohol and risky behavior in traffic among motorcyclists involved in accidents in a city in northeastern Brazil

Objective: The objective of this study was to analyze the association between consumption of alcoholic drinks and adoption of other risky forms of behavior in traffic among motorcyclists involved in accidents. Methods: This was an exploratory cross-sectional study among injured motorcyclists who were hospitalized in the traumatology department of the "Governador Paulo Guerra" Restoration Hospital (Hospital da Restauração Governador Paulo Guerra), Recife, Pernambuco, Brazil. A questionnaire containing items relating to sociodemographic, occupational, and behavioral factors and aspects of the accident and road conditions was applied. Descriptive and bivariate analyses were performed and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. The significance level was set at 5%. Results: One hundred seventy individuals were investigated. Consumption of alcohol prior to the accident was reported by 32.9% of motorcyclists. This behavior was positively associated with the following risky forms of behavior in traffic: speeding (OR = 4.08; 95% CI, 1.15-9.48); failure to use a helmet (OR = 2.41; 95% CI, 1.15-5.02); and not having a motorcycle driver's license (OR = 2.68; 95% CI, 1.31-5.45). Conclusion: This study showed that, in the population studied, riding a motorcycle under the effects of alcoholic drinks was associated with other risky forms of behavior in traffic: speeding, not using a helmet, and not having a motorcycle driver's license. We believe that the interaction between these behaviors may lead to greater occurrence and greater severity of accidents.

Sex differences in the association between impulsivity and driving under the influence of alcohol in young adults: The specific role of sensation seeking

INTRODUCTION

There is an outstanding need to identify predictors of driving under the influence of alcohol (DUI) among young adults, particularly women. Impulsivity, or the tendency to act without thinking, is a predictor of DUI, but the specific facets of impulsivity that predict DUI and their interaction with sex differences remain unclear. We aimed to investigate sex differences in the link between impulsivity facets and DUI. Moreover, we sought to replicate previous findings regarding sex differences on impulsivity, and associations between impulsivity facets and DUI.

METHOD

A total of 506 university students participated in the study (males, n = 128; females, n = 378). Participants completed measures of impulsivity (UPPS-P short version), alcohol use (AUDIT-C), frequency of DUI episodes and related perception of risk. The UPPS-P assesses five facets of impulsivity: sensation seeking, (lack of) premeditation and perseverance and positive and negative urgency.

RESULTS

Men showed higher sensation seeking and lack of perseverance, alcohol use and DUI frequency and lower risk perception than women. DUI frequency was negatively associated with perception of risk and positively associated with alcohol use and the five impulsivity facets. After controlling for alcohol use and risk perception, only lack of premeditation was associated with DUI frequency in the whole sample. Sensation seeking was positively associated with DUI frequency only in women.

DISCUSSION

The link between lack of premeditation and DUI suggest that pre-drinking planning strategies can contribute to prevent risky driving. In women, specific links between sensation seeking and DUI suggest the need for personality-tailored prevention strategies.

Predictive factors associated with driving under the influence among Brazilian drug-using drivers

The incidence of driving under the influence of psychoactive substances (DUI) and its recidivism can be curtailed by the proper identification of specific and predictive characteristics among drug users. In this sense, interpersonal violence (IV), psychiatric comorbidity and impulsivity seem to play an important role in DUI engagement according to previous studies. There are, however, limited data originated from low and middle income countries. In the present study, drug-using Brazilian drivers reporting DUI (n = 75) presented a higher prevalence of bipolar disorders (BD; DUI: 8% vs. non-DUI: 0%, p < 0.001), lower prevalence of obsessive-compulsive disorder (OCD; DUI: 0% vs. non-DUI: 12.6%, p < 0.001), and higher prevalence of childhood trauma (DUI: 65.3% vs. non-DUI: 46.8%, p = 0.022) than those not reporting DUI (n = 79). The evaluation of impulsivity though the Barratt Impulsivity Scale, which give impulsivity scores ranging from 30 to 120, showed higher impulsivity scores in the DUI group (80.4 ± 8) than in the non-DUI group (77.2 ± 10, p = 0.045). In general, subjects were young adults (mean age of 36 ± 9 years), Caucasians (58.4%), not married (61.0%), and with elementary schooling (40.3%) with no significant differences in demographic characteristics between drivers with and without DUI behavior. A multiple Poisson regression model showed that individuals reporting IV as perpetrators and history of childhood trauma were more likely to report DUI (PR: 1.66, 95%CI 1.22-2.7; PR: 1.57, 95%CI 1.02-2.42, respectively). The overlapping of violent situations (childhood trauma, IV and DUI) in some individuals presented here corroborates literature data suggesting that DUI can be an externalizing expression of a range of risky behavior, such as impulsiveness and aggressiveness. Moreover, while BD and higher impulsivity scores seem to act as risk factors for DUI, OCD was shown as a protective factor. These results corroborate the hypothesis that individuals with high risk for DUI could probably be identified by multidimensional assessment of cognitive, risky taking, and personality traits, which perhaps could facilitate the development of focused interventions.

Externalizing and self-medicating: Heterogeneity among repeat DUI offenders

AIM

Despite significant reductions in Driving Under the Influence (DUI) in the United States during recent decades, DUI continues to be a major public health threat. The current study investigated the intersection of two domains known to influence DUI: criminal history and psychiatric comorbidity.

METHODS

DUI recidivists (N = 743) attending a court-mandated two-week inpatient DUI program completed a computerized mental health assessment as part of their intake to that program. Participants' criminal records were obtained 4-5 years after program attendance.

FINDINGS

This study identified three primary repeat DUI offender subtypes with distinct patterns of criminal behavior and psychiatric comorbidity: (Type I) those whose DUI emerges from a pattern of drinking to cope with mood and anxiety problems, (Type II) those whose DUI emerges as part of a larger pattern of externalizing and criminal behavior, and (Type III) those whose DUI offenses reflect more acute triggers and isolated episodes of excessive drinking.

CONCLUSION

These findings suggest that current treatment models used in DUI programs are inadequate to address the heterogeneity in the population of DUI recidivists and that earlier and more comprehensive screening would allow for better targeting of resources to DUI offender subtypes.

Context and culture: Reasons young adults drink and drive in rural America

Montana, a large and rural U.S. state, has a motor vehicle fatality rate almost double the national average. For young adults, the alcohol-related motor vehicle fatality rate in the state is almost three times the national average. Yet little research has explored the underlying reasons that young people in rural areas drink and drive. Drawing from the theory of triadic influence (TTI) and a series of qualitative focus group discussions, the current study examined how aspects of the landscape and culture of rural America promote and hinder drinking and driving among young people. In 2015 and 2016, 72 young adults (36 females) aged 18-25 years old (mean age = 20.2) participated in 11 semi-structured focus groups in 8 rural counties in Montana. Discussions were transcribed, and two reviewers independently coded text segments. Themes were identified and an inductive explanatory model was created. The results demonstrated that aspects of the social context (e.g., peer pressure and parental modeling), rural cultural values (e.g., independence, stoicism, and social cohesion), and the legal and physical environment (e.g., minimal police presence, sparse population, and no alternative transportation) promoted drinking and driving. The results also identified salient protective factors in each of these domains. Our findings demonstrate the importance of examining underlying distal determinants of drinking and driving. Furthermore, they suggest that future research and interventions should consider the complex ways in which cultural values and environmental factors intersect to shape the risky health behaviors of rural populations.

Exploring substance use and impaired driving among adults aged 21 years and older in the United States, 2015

INTRODUCTION

Alcohol- or drug-impaired driving can cause motor vehicle crashes, injuries, and death. Estimates of drug-impaired driving are difficult to obtain. This study explores self-reported prevalence of and factors associated with alcohol, marijuana, and prescription opioid use and impaired driving among adults aged 21 years and older in the United States.

METHODS

Self-reported data from 3,383 adults in the 2015 Fall ConsumerStyles survey were analyzed. Respondents were asked about alcohol, marijuana, and prescription opioid use and driving while impaired in the last 30 days. Weighted prevalence estimates were calculated. Prevalence ratios and Poisson log-linear regressions were used to identify factors associated with substance use and impaired driving.

RESULTS

Alcohol use was reported by 49.5% (n = 1,676) of respondents; of these, 4.9% (n = 82) reported alcohol-impaired driving. Marijuana use was reported by 5.5% (n = 187) of respondents; of these, 31.6% (n = 59) reported marijuana-impaired driving. Prescription opioid use was reported by 8.8% (n = 298) of respondents; of these, 3.4% (n = 10) reported prescription opioid-impaired driving. Polysubstance use of alcohol and marijuana (concurrent use) was reported by 2.7% (n = 93) of respondents. Among those, 10.8% (n = 10) reported driving impaired by both alcohol and marijuana.

CONCLUSIONS

Impaired driving was self-reported among alcohol, marijuana, and prescription opioid users. This article demonstrates the need for more robust alcohol- and drug-related data collection, reporting, and analyses, as well as the emerging need for surveillance of marijuana and prescription opioid-impaired driving. States can consider using proven strategies to prevent impaired driving and evaluate promising practices.

Effects of chronic marijuana use on driving performance

OBJECTIVES

The effects of marijuana on driving pose a significant public health concern. More studies on chronic marijuana use in driving are needed. The study objectives were to (1) assess differences in the Standardized Field Sobriety Test (SFST) and driving performance outcomes between chronic medical marijuana users and nonusers and (2) identify a cutoff tetrahydrocannabinol (THC) concentration above which chronic medical marijuana users demonstrate driving impairment.

METHODS

This prospective cross-sectional study assessed 31 chronic marijuana users and 41 nonusers. Rapid Detect Saliva Drug Screen 10-panel was administered to all participants. Participants were given a simple visual reaction time test (SVRT) and SFST consisting of the horizontal gaze nystagmus (HGN), the one leg stand (OLS), and the walk and turn (WAT) tests. The STISIM Drive M100 driving simulator assessed driving performance. Driving parameters included standard deviation of speed (SDS), deviation of mean lane position, off-road accidents, collisions, pedestrians hit, and car-following modulus, delay, and coherence. Cannabinoid blood plasma was obtained from marijuana users.

RESULTS

Marijuana users and nonusers did not differ in age (40.06 ± 13.92 vs. 41.53 ± 15.49, P = .6782). Marijuana users were more likely to fail the SFST (P = .005) and the WAT (P = .012) and HGN (P = .001) components. Marijuana users had slower SVRT (P = .031), less SDS (P = .039), and lower modulus (P = .003). Participants with THC >2 ng/mL (P = .017) and TCH >5 ng/mL (P = .008) had lower SDS. Participants with THC >2 ng/mL (P = .021) and THC >5 ng/mL (P = .044) had decreased modulus.

CONCLUSION

Chronic marijuana users had slower reaction times, deviated less in speed, and had difficulty matching a lead vehicle's speed compared to nonusers. The effects on SDS and modulus were present at cutoffs of 2 and 5 ng/mL.

Substance abuse at early age as a potential risk factor for driving under the influence of substance in Jeddah, Saudi Arabia: A cross-sectional study

OBJECTIVE

Worldwide, trauma is a major health problem, and road traffic accidents (RTAs) are the primary cause of death among young men in Saudi Arabia. The aim of our study was to estimate the extent of driving under the influence of an abused substance in Saudi Arabia and to explore the associated factors.

METHODS

This is a cross-sectional survey conducted between May and September 2016 at Al-Amal Hospital in Jeddah, Saudi Arabia, a referral center for addiction. We included all patients who were admitted for additional education and rehabilitation and had no psychotic symptoms. We used a standardized and pretested questionnaire to collect data regarding sociodemographic and socioeconomic characteristics, history of and current substance abuse, driving under the influence of an abused substance, injuries, imprisonment, and fatalities under the influence of an abused substance. Whenever possible, we compared self-reported data with medical records and resolved any conflict by discussion with the patient.

RESULTS

A total of 101 out of 112 invited patients participated in our study (90.2%). The mean age of the participants was 33.28 years (SD = 9.46 years). Of the total, 93.1% (n = 94) drove under the influence of an abused substance. Amphetamines and alcohol were the first substance abused (56.4% [n = 57] and 25.7% [n = 26] of patients, respectively). As currently abused substances, amphetamines and cannabis were reported in 38.6% (n = 39) and 24.8% (n = 25) of participants, respectively. The mean age at the time of the first substance abuse was 18.76 years (SD = 4.99 years). In the univariate regression (odds ratio [OR] = 0.86; 95% confidence interval [CI], 0.75-0.99; P = .046) but not the multivariate regression (OR =0.87; 95% CI, 0.75-1.00; P = .056), a younger age at the time of the first substance abuse was associated with a higher probability of driving under the influence of an abused substance.

CONCLUSIONS

Our study showed that among individuals hospitalized due to substance abuse problems, driving under the influence of drugs and alcohol was common. Preventive measures to reduce driving under the influence should be introduced in addition to specialized hospitals. Further research is required to investigate the factors associated with driving under the influence of abused substances in Saudi Arabia.

Differences in patterns of cannabis use among youth: Prevalence, perceptions of harm and driving under the influence in the USA where non-medical cannabis markets have been established, proposed and prohibited

INTRODUCTION AND AIMS

Cannabis use is the most widely used illicit substance in the USA. Currently, over half of US jurisdictions have legalised medical cannabis and nine US jurisdictions (and Washington DC) have legalised non-medical cannabis. Comparisons across jurisdictions can help to evaluate the impact of these policies. The current study examined patterns of cannabis use among youth in three categories: (i) states that have legalised non-medical cannabis with established markets; (ii) jurisdictions that recently legalised non-medical cannabis without established markets; and (iii) all other jurisdictions where non-medical cannabis is prohibited.

DESIGN AND METHODS

Data come from an online survey conducted among 4097 US youth aged 16-19 recruited through a commercial panel in July/August 2017. Regression models were fitted to examine differences between regulatory categories for cannabis consumption, perceived access to cannabis, modes of use, perceptions of harm and cannabis-impaired driving. All estimates represent weighted data.

RESULTS

States that had legalised non-medical cannabis had higher prevalence, easier access and lower driving rates than non-legal states. There were few differences between states with established non-medical cannabis markets and those that had recently legalised.

DISCUSSION AND CONCLUSIONS

Cannabis use among youth was higher in states that have legalised non-medical cannabis, regardless of how long the policy had been implemented or whether markets had been established. This suggests that differences between states with and without legal non-medical cannabis may partly be due to longer-term patterns established prior and highlights the importance of longitudinal evidence to evaluate the impact of cannabis policies.

Differences in alcohol cognitions, consumption, and consequences among first-time DUI offenders who co-use alcohol and marijuana

BACKGROUND

A significant portion of alcohol-related DUI offenders engage in co-use of alcohol and marijuana (AM). Given expanding marijuana legalization and the impaired driving risks associated with co-use, it is of increased importance to understand how characteristics of AM co-users compare to those who use alcohol only (AO) in order to inform DUI interventions and prevent recidivism.

METHODS

Participants were 277 first-time DUI offenders enrolled in a first-time DUI offender program across three locations. Using well-established measures, we evaluated differences in alcohol-related cognitions (positive expectancies and self-efficacy), frequency and quantity of alcohol consumption, and alcohol-related consequences between AO users and AM co-users by running a series of multivariate generalized linear models.

RESULTS

Compared to AO users, AM co-users reported lower self-efficacy to achieve abstinence and avoid DUI. Differences in abstinence self-efficacy largely explain higher relative rates of average and peak drinking quantity and higher odds of binge drinking among AM co-user. Despite lower self-efficacy and higher drinking quantity, there were no significant differences between AM and AO-users on alcohol-related consequences and past month reports of drinking and driving.

CONCLUSIONS

Our results provide preliminary evidence that DUI offenders who co-use alcohol and marijuana have higher alcohol use and lower self-efficacy than AO-users, and long-term consequences for this group should be monitored in future research. DUI programs may screen and identify co-users and consider tailoring their interventions to build self-efficacy to address the risks associated with AM co-use uniquely.

Women judging: Is a young male drunk driver perceived as more negligent than a young female drunk driver?

OBJECTIVE

It is well established that young men are the riskiest group of all drivers, and men in general more often drive under the influence of alcohol. However, potentially oversimplified representations such as a "young male problem" and "drunk driving as a male problem" can influence action and reinforce existing attitudes by selectively directing attention to stereotypically consistent behavior. The purpose of this study was to test the hypothesis of possible bias toward young male drivers in the context of drunk driving.

METHODS

We have created a scenario study investigating whether the sex of an imaginary young drunk driver would be associated with a different perceived negligence (ranging from 0 = not negligent at all to 10 = extremely negligent) among our participants. These participants were a representative sample of Finnish female driver's license holders. The data for the study were gathered as part of a larger survey study on women's drinking and driving culture.

RESULTS

Perceptions of how negligent a person was depended on the age of the respondents such that the older the respondent, the higher the perceived negligence. Perceived negligence was similar for male and female drivers in the scenario; however, there was an interaction effect between driver sex and the age of respondents. The youngest (20-29 years) and 2 oldest (50-69 years) groups of our respondents found the young woman to be more negligent, whereas the opposite occurred for the other 2 groups.

CONCLUSIONS

The results of our imaginary scenario study of a representative sample of Finnish female driver's license holders do not support a hypothesis that there would be a negative bias toward young male drivers in the context of drunk driving behavior.

A Longitudinal Examination of Decisions to Ride and Decline Rides with Drinking Drivers

BACKGROUND

Riding with a drinking driver (RWDD) is a serious concern that leads to numerous preventable deaths every year. There is a significant gap in research on empirically tested predictors of RWDD that could be implemented in prevention efforts. College students are in need of such prevention efforts, as they have some of the highest rates of alcohol-related crash fatalities and may engage in RWDD more than their noncollege peers. This study utilized behavioral decision-making approach to examine predictors of RWDD and declining a ride from a drinking driver (Decline) in older college students.

METHODS

Students (n = 791) in their third year of college were enrolled from 3 large and diverse universities. Psychosocial (e.g., expectancies, norms) and decision-making variables (willingness to RWDD and intentions to use alternatives) were assessed in the fall of their third year. One year later, RWDD and Decline behaviors were assessed. Zero-inflated Poisson analyses were used to assess how decision-making variables predicted RWDD and Decline behavior. Associations between psychosocial and decision-making variables were also assessed.

RESULTS

Thirteen percent of students reported RWDD and ~28% reported Decline behavior. Willingness to RWDD and typical weekly drinking were both associated with increases in RWDD (odds ratio [OR] = 1.58 and 1.40, respectively), whereas intentions to use alternatives, sex, and ethnicity were not associated with RWDD. Only weekly drinking was associated with Decline, with an increase in drinking associated with increased Decline (OR = 1.48). All psychosocial variables were significantly associated with the decision-making variables except positive expectancies.

CONCLUSIONS

Results provide evidence that willingness to RWDD is a predictor of future RWDD, even if students intend to use safe alternatives. Future research is needed to better understand decision-making factors that influence Decline. Results also suggest prevention and interventions efforts, such as brief motivational intervention, Parent-Based Interventions, and normative feedback interventions could be adapted to reduce RWDD.

Differential development of acute tolerance may explain heightened rates of impaired driving after consumption of alcohol mixed with energy drinks versus alcohol alone

Consumers of alcohol mixed with energy drinks (AmED) are more likely to drive while impaired when compared to alcohol alone consumers. In addition, acute tolerance to the internal cues of feelings of intoxication is known to contribute to maladaptive decisions to drive while impaired. Therefore, the purpose of this study was to determine whether there is differential development of acute tolerance for AmED versus alcohol alone for ratings of willingness to drive after alcohol consumption. Social drinkers (n = 12) attended 4 separate sessions where they received alcohol and energy drinks, alone and in combination. The development of acute tolerance to alcohol was assessed for several objective (a computerized cued go/no-go reaction time task) and subjective measures at matched breath alcohol concentrations (BrACs) for the ascending and descending limbs of the BrAC curve. The results indicated that alcohol administration decreased willingness to drive ratings. Acute tolerance was observed in the AmED dose condition for only the willingness to drive ratings that were significantly higher on the descending versus ascending test. Alcohol-induced impairments of the computer task performance did not exhibit any acute tolerance. Therefore, the differential development of acute tolerance may explain why many studies observe higher rates of impaired driving for AmED consumers compared to alcohol alone consumers. Because drunk driving is a major public health concern, alcohol consumers should be warned that the use of energy drink mixers with alcohol could lead to a false sense of security in one's ability to drive after drinking. (PsycINFO Database Record

Prevalence and motives for drugged driving among emerging adults presenting to an emergency department

OBJECTIVES

Drugged driving [DD] is a public health concern, particularly among emerging adults who have the highest rates of drug use. Understanding involvement with DD could inform prevention efforts for this population. We evaluated the prevalence of, motives for, and correlates of past-year DD among emerging adults from an urban, under-resourced community.

METHODS

Emerging adults (N=586) ages 18-25years (54% male, 56% African American, 34% European American) seeking care in an urban emergency department completed past-year surveys of demographics, frequency of DD within 4h of substance use, reasons for DD, and substance use.

RESULTS

DD was reported by 24% of participants (with 25% of those engaging in high frequency DD). DD after cannabis use was most common (96%), followed by prescription opioids, sedatives, and stimulants (9%-19%). Common reasons for DD were: needing to go home (67%), not thinking drugs affected driving ability (44%), not having to drive far (33%), and not feeling high (32%). Demographics were not associated with DD, but, as expected, those with DD had riskier substance use.

CONCLUSIONS

In this clinical sample, using a conservative measure, DD, particularly following cannabis use, was relatively common among emerging adults. Based on these data, clinical interventions for cannabis and other drug use should include content on prevention of DD, with particular attention to motives such as planning ahead for alternatives to get home safely and weighing benefits and risks of DD.

Prospective prediction of arrests for driving under the influence from relationship patterns with family and friends in adolescence

Driving under the influence (DUI) is dangerous and costly, yet there are few prospective studies on modifiable risk and protective processes that would inform prevention. Middle adolescence, when most individuals are first learning to drive and first using alcohol, may be a particularly salient period for family and friendship influences on DUI risk. In the present study, youth's family and friendship environments were observed and measured at age 16 in a diverse community sample (n=999), and then court records were used to document arrest for DUI through the age of 32years. We first examined the univariate effects of family and friendship variables on later DUI and then fit more comprehensive structural equation models to test predictive effects on the level of construct (e.g., parental monitoring) and environment (e.g., family). Results indicate that parental monitoring (Odds Ratio [OR]=0.77), positive family relations (OR=0.84), prosocial peer affiliation (OR=0.77), and deviant peer affiliation (OR=1.43) at age 16 were individually predictive of arrests for DUI from ages 16 to 32, even after controlling for both teen and parent alcohol use. The comprehensive, multivariate models indicated that the friendship environment was most predictive of arrests for DUI during the follow-up period. Together, these results are consistent with a model in which attenuated family ties contribute to substance-use-based friendships at age 16, which in turn contribute to an increased likelihood of arrest for DUI in later adolescence and early adulthood. Implications for prevention are discussed.

Drivers with alcohol use disorders and their risks of crash involvement

BACKGROUND

The relationship between driver blood alcohol concentration (BAC) and crash involvement is well understood. However, the role of alcohol use disorders (AUDs) (i.e., dependence or abuse) in crash occurrence, as distinguished from non-clinical heavy alcohol consumption, has not been adequately explored.

METHODS

Data from the 2010-2011 Crash Risk Study conducted in Virginia Beach, VA, were used in this study. Drivers involved in crashes were compared with control drivers, and four drinker groups were examined: alcohol dependent, alcohol abusers, heavy drinkers, and all other current (i.e., normative) drinkers. Logistic regression analyses were conducted on two outcomes: having a moderate BAC (≥0.05 g/dl), and crash involvement.

RESULTS

Overall, 2411 crash-involved and 5514 control drivers provided useable data, 52.4% of which were men and 70.8% Whites. The prevalence of drivers with AUDs was lower for the crash-involved drivers (8.7%) than for the control drivers (12.7%). Only heavy drinkers, but not abusive or dependent drinkers, were over four times more likely to drive with moderate BACs at nighttime. More important, at nighttime, the odds of crash involvement for dependent drinkers were only one third of those for normative drinkers. Daytime crashes, however, were more likely to involve normative drinkers than any of the other three drinker types.

CONCLUSIONS

Drivers with AUDs are not more likely than normative drinkers to drive with moderate BACs at night. After accounting for the influence of BAC, dependent drinkers have a lower risk of being involved in a crash, at any time of the day.

Acute impairing effects of morphine related to driving: A systematic review of experimental studies to define blood morphine concentrations related to impairment in opioid-naïve subjects

OBJECTIVE

The objective of this study was to look for dose- and concentration-effect relationships in experimental studies on single-dose administration of morphine on traffic-relevant behavioral tests by a systematic literature review and possibly to see whether a dose/concentration could be defined below which few or no tests would be affected.

METHODS

Searches for corresponding literature were conducted using MEDLINE, EMBASE, and PsycINFO, throughout March of 2016. The search strategy consisted of words colligated to cognitive and psychomotor functions of relevance to driving, in relation to morphine administration. The tests were arranged in main groups, and tests showing impairment were categorized by doses as well as calculated plasma concentrations.

RESULTS

Fifteen studies were included in the review. Impairment after the administration of a single intravenously dose of morphine was found in some of the tests on reaction time, attention, and visual functions. No impairment was observed in tests on psychomotor skills and en-/decoding. Tests on reaction time appeared to be less sensitive to the morphine administration, whereas tests on visual functions and attention appeared to be the most sensitive to the morphine administration. Single-dose administration of morphine with dosages up to 5 mg appeared to cause very few effects on traffic-relevant performance tasks. At higher dosages, impairment was found on various tasks but with no clear dose-effect relationship. Plasma morphine concentrations less than 50 nmol/L are most probably accompanied by few effects on traffic-relevant performance tasks.

CONCLUSIONS

A plasma morphine concentration of 50 nmol/L (approximately 14.3 ng/mL) could represent an upper level, under which there is little accompanying road traffic risk. A single dose of 5 mg morphine IV and analgetic equivalence doses of fentanyl, hydromorphone, oxycodone, and oxymorphone are presented with the suggestion that few traffic-relevant effects will appear after such doses.

Does getting away with it count? An application of stafford and warr's reconceptualised model of deterrence to drink driving

Drink drivers continue to be disproportionately represented in road mortalities and morbidities. Given these costs, countermeasures that effectively reduce the behaviour (and its consequences) are imperative. Research has produced inconsistent findings regarding the deterrent effects of some countermeasures on drink driving behaviour, namely legal sanctions, suggesting other factors may be more influential. This study aimed to determine which deterrence measures based on Classical Deterrence Theory and Stafford and Warr's (1993) reconceptualised model of deterrence influence the propensity to drink and drive over the legal blood alcohol content limit of 0.05. In total, 1257 Australian drivers aged from 16 to 85 years completed a questionnaire assessing their self-reported drink driving behaviour and perceptions of legal sanctions. Consistent with previous research, past experiences of direct punishment avoidance was the most significant predictor of drink driving. Additionally, perceptions of personal certainty of apprehension were a significant (albeit weak) negative predictor of drink driving. Counterintuitively, experiences of indirect punishment were predictive of self-reported drink driving. Similarly, penalty severity produced mixed results as those who considered a penalty would be severe were less likely to drink and drive. However those that considered the penalty would cause a considerable impact on their lives, were more likely to drink and drive. Taken together, these findings suggest that while the threat of apprehension and punishment may influence self-reported drink driving behaviours, committing and offence while avoiding detection is a significant influence upon ongoing offending. This paper will further elaborate on the findings in regards to developing salient and effective deterrents that produce a lasting effect.

The effects of licence disqualification on drink-drivers: Is it the same for everyone?

Drink-driving remains a major road safety concern that creates a significant social burden. Licence disqualification continues to play a key role in drink driving deterrence and sanctions together with police enforcement to address the problem in most motorised countries. However, on-going questions remain regarding the differing effect of licence disqualification periods between first time and repeat offenders, and between other sub-groups of offenders. As a result, this study aimed to determine whether: (a) differences exist in re-offence rates of convicted drink-drivers between: the period between committing the drink-driving offence and licence disqualification (pre-licence disqualification), during the period of licence disqualification, and after being re-licensed (post-licence restoration); and (b) differential effects of offence rates are evident based on Blood Alcohol Content (BAC), gender, age, repeat offender status and crash involvement at the time of offence. The sample consisted of 29,204 drink-driving offenders detected in Victoria, Australia between 1 January 1996 and 30 September 2002. The analysis indicated that licence disqualifications were effective as drink-driving offenders had a significantly lower rate of offending (both drink-driving and other traffic offences) during licence disqualifications compared to pre-licence disqualification and post-licence restoration periods. The influence of licence disqualification appeared to extend beyond the disqualification period, as offence rates were lower during post-licence restoration than during pre-licence disqualification. Interestingly, the highest rate of offending (both for drink-driving and other traffic offences) was during the pre-licence disqualification period, which suggests offenders are particularly vulnerable to drink and drive while waiting to be sanctioned. A consistent pattern of results was evident across genders and age groups. Additionally, those who were involved in a crash at the same time as their index offence had lower offence rates (compared to those who were not involved in a crash) for all periods, although for general traffic offences, the offence rate was highest in the post-licence restoration period for those who had a crash at index offence. This indicates that being involved in a crash may deter these offenders, at least in the short-term. The implications of the results for managing both first time and repeat offenders are discussed.

Driving under the influence of drugs: Perceptions and attitudes of New Zealand drivers

This study explored the patterns of drug driving in New Zealand by investigating 1) drivers' perceptions about impairment caused by legal and illegal drugs 2) countermeasures employed by drivers when under the influence of drugs (e.g., decisions not to drive) 3) drivers' attitudes about police enforcement of drug driving and 4) the factors that predict the likelihood of engaging in drug driving. Participants (n=434) were licensed drivers who completed an online questionnaire. Results of the questionnaire indicated that drivers rated hallucinogens and opiates as being the illegal drugs producing the highest level of driving impairment and cannabis the lowest. For legal drugs, sedatives were rated as having the highest driving impairment and anti-nausea and anti-depressants the lowest. Respondents' drug use history had an effect on their ratings of impairment for anti-anxiety drugs, anti-depressants, kava, sedatives, cannabis and hallucinogens such that drug users reported higher impairment ratings than Non-user. Making a decision not to drive after taking drugs was reported by users of alcohol (73.6%), cannabis (57.0%), strong painkillers (42.5%), and anti-depressants (10.0%). Respondents who reported drink driving were 3.26 times more likely to report drug driving than those reporting no drink driving. Respondents also showed greater acceptance towards driving under the influence of legal drugs (43.5%) compared to illegal drugs (10.3%). Those who did not have favourable attitudes about drug driving were less likely to report having driven under the influence of drugs. Drivers in this sample were less aware of the potential negative effects of legal drugs on driving compared to illegal drugs. More than half the respondents from this study acknowledged drug driving as a road safety issue which needs more resources dedicated to it.

Canadian drivers' attitudes regarding preventative responses to driving while impaired by alcohol

BACKGROUND

In many jurisdictions, a risk assessment following a first driving while impaired (DWI) offence is used to guide administrative decision making regarding driver relicensing. Decision error in this process has important consequences for public security on one hand, and the social and economic well being of drivers on the other. Decision theory posits that consideration of the costs and benefits of decision error is needed, and in the public health context, this should include community attitudes. The objective of the present study was to clarify whether Canadians prefer decision error that: i) better protects the public (i.e., false positives); or ii) better protects the offender (i.e., false negatives).

METHODS

A random sample of male and female adult drivers (N=1213) from the five most populated regions of Canada was surveyed on drivers' preference for a protection of the public approach versus a protection of DWI drivers approach in resolving assessment decision error, and the relative value (i.e., value ratio) they imparted to both approaches. The role of region, sex and age on drivers' value ratio were also appraised.

RESULTS

Seventy percent of Canadian drivers preferred a protection of the public from DWI approach, with the overall relative ratio given to this preference, compared to the alternative protection of the driver approach, being 3:1. Females expressed a significantly higher value ratio (M=3.4, SD=3.5) than males (M=3.0, SD=3.4), p<0.05. Regression analysis showed that both days of alcohol use in the past 30days (CI for B: -0.07, -0.02) and frequency of driving over legal BAC limits in the past year (CI for B=-0.19, -0.01) were significantly but modestly related to lower value ratios, R²(adj.)=0.014, p<0.001. Regional differences were also detected.

CONCLUSIONS

Canadian drivers strongly favour a protection of the public approach to dealing with uncertainty in assessment, even at the risk of false positives. Accounting for community attitudes concerning DWI prevention and the individual differences that influence them could contribute to more informed, coherent and effective regional policies and prevention program development.

Drinking and driving and perceptions of arrest risk among California drivers: Relationships with DUI arrests in their city of residence

OBJECTIVE

Addressing drinking and driving remains a challenge in the United States. The present study aims to provide feedback on driving under the influence (DUI) in California by assessing whether drinking and driving behavior is associated with the DUI arrest rates in the city in which the driver lives; whether this is due to perceptions that one can get arrested for this behavior; and whether this differed by those drivers who would be most affected by deterrence efforts (those most likely to drink outside the home).

METHODS

This study consisted of a 2012 roadside survey of 1,147 weekend nighttime drivers in California. City DUI arrest rates for 2009-2011 were used as an indicator of local enforcement efforts. Population average logistic modeling was conducted modeling the odds of perceived high arrest likelihood for DUI and drinking and driving behavior within the past year.

RESULTS

As the DUI arrest rates for the city in which the driver lives increased, perceived high risk of DUI arrest increased. There was no significant relationship between either city DUI arrest rates or perceived high risk of DUI arrest with self-reported drinking and driving behavior in the full sample. Among a much smaller sample of those most likely to drink outside the home, self-reported drinking and driving behavior was negatively associated with DUI arrests rates in their city of residence but this was not mediated by perceptions.

CONCLUSION

The results of the present study suggest that perceptions are correlated with one aspect of DUI efforts in one's community. Those who were more likely to drink outside the home could be behaviorally influenced by these efforts.

Alcohol consumption and cycling in contrast to driving

In Germany, the legal blood alcohol limit for cyclists is much higher (0.16 percent) than the limit for drivers (0.05 percent) - as long as no crash has occurred. The proportion of police-recorded crashes with personal damage under the influence is higher for cyclists than drivers, and the blood alcohol concentrations are higher for cyclists than drivers. 63 women and 204 men who drive a car and use a bike and drink alcohol participated in the online study. In the sample, cycling under the influence (CUI) was more frequent and was observed more frequently among friends than driving under the influence (DUI). Persons who use a particular vehicle type more often in general and when they visit friends also use it more often after alcohol consumption. Persons who drink alcohol more often cycle more often after alcohol consumption. In all aspects covered, drink cycling was seen as more acceptable and less dangerous than drink driving. Persons who cycle more often under the influence observe drink cycling more often among their friends. They think they are less of a danger to themselves and others when cycling after alcohol consumption, and they agree less with the statement that one should leave one's bike parked after alcohol consumption. The attitudes that drinking is unsafe for one's own driving and that one should leave one's car parked are important predictors of (non-)drink driving. For cycling, the most important predictors are bike use frequency and observing drink cycling among friends.

The effects of drug and alcohol consumption on driver injury severities in single-vehicle crashes

OBJECTIVE

It is well known that alcohol and drugs influence driving behavior by affecting the central nervous system, awareness, vision, and perception/reaction times, but the resulting effect on driver injuries in car crashes is not fully understood. The purpose of this study was to identify factors affecting the injury severities of unimpaired, alcohol-impaired, and drug-impaired drivers.

METHOD

The current article applies a random parameters logit model to study the differences in injury severities among unimpaired, alcohol-impaired, and drug-impaired drivers. Using data from single-vehicle crashes in Cook County, Illinois, over a 9-year period from January 1, 2004, to December 31, 2012, separate models for unimpaired, alcohol-impaired, and drug-impaired drivers were estimated. A wide range of variables potentially affecting driver injury severity was considered, including roadway and environmental conditions, driver attributes, time and location of the crash, and crash-specific factors.

RESULTS

The estimation results show significant differences in the determinants of driver injury severities across groups of unimpaired, alcohol-impaired, and drug-impaired drivers. The findings also show that unimpaired drivers are understandably more responsive to variations in lighting, adverse weather, and road conditions, but these drivers also tend to have much more heterogeneity in their behavioral responses to these conditions, relative to impaired drivers. In addition, age and gender were found to be important determinants of injury severity, but the effects varied significantly across all drivers, particularly among alcohol-impaired drivers.

CONCLUSIONS

The model estimation results show that statistically significant differences exist in driver injury severities among the unimpaired, alcohol-impaired, and drug-impaired driver groups considered. Specifically, we find that unimpaired drivers tend to have more heterogeneity in their injury outcomes in the presence potentially adverse weather and road surface conditions. This makes sense because one would expect unimpaired drivers to apply their full knowledge/judgment range to deal with these conditions, and the variability of this range across the driver population (with different driving experiences, etc.) should be great. In contrast, we find, for the most part, that alcohol-impaired and drug-impaired drivers have far less heterogeneity in the factors that affect injury severity, suggesting an equalizing effect resulting from the decision-impairing substance.

Examining motor vehicle crash involvement and readiness to change on drinking and driving behaviors among injured emergency department patients

OBJECTIVE

To measure the effect of motor vehicle crash (MVC) involvement and readiness to change drinking and driving behaviors on subsequent driving and drinking behaviors among injured emergency department (ED) patients who use alcohol at harmful levels.

METHODS

This was a secondary analysis of a randomized controlled trial of injured ED patients who screened positive for harmful alcohol use, who at recruitment reported driving in the past 12 months and received at least one of the intended intervention sessions (brief behavioral intervention versus attention placebo control; N = 407). Outcome variables were as follows: (1) change in 6 impaired driving behaviors and (2) report of MVCs and traffic violations in the 12 months following recruitment; predictor variables were as follows: (1) treatment assignment, (2) MVC involvement at recruitment, and (3) baseline readiness to change alcohol use and drinking and driving.

RESULTS

Modeling of change in the 6 impaired driving variables indicated that neither the recruitment visits being MVC related nor baseline readiness to change alcohol use and drinking and driving behaviors predicted greater changes in impaired driving over time. Baseline reports of past moving traffic violations and the ED visit being MVC related predicted a greater likelihood of each behavior at 12 months following study recruitment.

CONCLUSIONS

This study and others have demonstrated that ED patients with harmful alcohol use are willing to engage in behavioral interventions directed at changing risky behaviors. However, this study did not demonstrate that patients considered having the potential to be more engaged with the intervention because their ED visit was MVC related and/or they had expressed intent to change their risky alcohol use and drinking and driving behaviors were more likely to change these risky behaviors.

Reckless Self-Destructive Behavior and PTSD in Veterans: The Mediating Role of New Adverse Events

The addition of self-destructive and reckless behavior as a symptom of posttraumatic stress disorder (PTSD) in DSM-5 has stimulated renewed interest in understanding relationships between these behaviors and trauma-related psychopathology. This study examined the relationship between reckless and self-destructive behaviors (RSDB), intervening exposure to new adverse events, and later PTSD severity in a sample of trauma-exposed veterans. At baseline, participants were assessed for RSDB (past 5 years) and current PTSD severity (N = 222). PTSD severity was then reassessed approximately 4 years later (N = 148). Overall, RSDB were reported by 74.4% of the sample, with 61.3% engaging in multiple forms of RSDB. The most commonly endorsed behaviors included alcohol/drug abuse (42.8%), driving while intoxicated (29.4%), gambling (24.7%), and aggression (23.1%). There was a positive correlation between RSDB and PTSD severity at both the baseline (r = .16, p = .031) and follow-up assessment (r = .24, p = .005). Path models indicated that exposure to new adverse events fully mediated the effect of Time 1 RSDB on PTSD symptoms at Time 2 (indirect association: β = .05, p = .046). Results suggest that RSDB are common among trauma-exposed veterans and may perpetuate PTSD symptoms by increasing exposure to new adverse events.

Laboratory analysis of risky driving at 0.05% and 0.08% blood alcohol concentration

BACKGROUND

The public health costs associated with alcohol-related traffic crashes are a continuing problem for society. One harm reduction strategy has been to employ per se limits for blood alcohol concentrations (BACs) at which drivers can legally operate motor vehicles. This limit is currently 0.08% in all 50 US states. Recently, the National Transportation Safety Board proposed lowering the legal limit to 0.05% (NTSB, 2013). While research has well-validated the ability of alcohol to impair driving performance and heighten crash-risk at these BACs, relatively little is known about the degree to which alcohol might increase drivers' risk-taking.

METHODS

Risk-taking was examined in 20 healthy adults who were each tested in a driving simulator following placebo and two doses of alcohol calculated to yield peak BACs of 0.08% and 0.05%, the respective current and proposed BAC limits. The drive test emphasized risk-taking by placing participants in a multiple-lane, high-traffic environment. The primary measure was how close drivers maneuvered relative to other vehicles on the road (i.e., time-to-collision, TTC).

RESULTS

Alcohol increased risk-taking by decreasing drivers' TTC at the 0.08% target BAC relative to placebo. Moreover, risk-taking at the 0.05% target was less than risk-taking at 0.08% target BAC.

CONCLUSIONS

These findings provide evidence that reducing the legal BAC limit in the USA to 0.05% would decrease risk-taking among drivers. A clearer understanding of the dose-response relationship between various aspects of driving behaviors, such as drivers' accepted level of risk while driving, is an important step to improving traffic safety.

Motorists' knowledge, attitudes and practices toward alcohol-impaired driving/riding in Ghana

OBJECTIVES

The main objective of this study was to establish the knowledge, attitudes, and practices toward drink driving/riding as a risk factor for road traffic crashes in 3 regional capitals in Ghana.

METHODS

The study used a face-to-face approach to randomly sample motorists who were accessing various services at fuel/gas stations, garages, and lorry terminals in 3 cities in Ghana.

RESULTS

Over the previous 12 months, 24% of all motorists and 55% of motorists who were current alcohol users reported driving or riding a vehicle within an hour of alcohol intake. On average, motorists/riders who were current alcohol users consumed 4 standard drinks per drinking occasion. Generally, 83% of motorists who currently use alcohol walked, rode, or drove home after consuming alcohol away from their homes. Motorists/riders who reported drink driving were 4 times more likely to have had previous traffic violation arrests compared to those who reported no drink driving/riding (P =.001). Respondents were of the opinion that speeding was the major cause of traffic crashes, followed by driver carelessness, poor road conditions, inexperienced driving, and drink driving, in that order. Thirty-six percent of motorists who use alcohol had the perception that consuming between 6 and 15 standard drinks was the volume of alcohol that will take them to the legal blood alcohol concentration (BAC) limit of 0.08%. Compared to females, male motorists/riders were more likely to report drink driving (adjusted odds ratio [AOR] = 5.15; 95% confidence interval [CI], 2.31 to 11.47). Private motorists also reported a higher likelihood of drink driving compared to commercial drivers (AOR = 3.36; 95% CI, 1.88 to 6.02). Only 4% of motorists knew the legal BAC limit of Ghana and only 2% had ever been tested for drink driving/riding.

CONCLUSION

The volumes of alcohol that motorists typically consume per drinking occasion were very high and their estimates of the number of drinks required to reach the legal BAC limit was also very high. Provision of authoritative information advising motorists about safe, responsible, or low-risk levels of alcohol consumption is imperative. Many traffic violations including drink driving were reported, thus suggesting a need for enhanced policing and enforcement. However, given the low level of knowledge of the legal BAC limit, educating motorists about how many drinks will approximate the legal BAC should be intensified prior to an increase in enforcement; otherwise, the desired outcome of enforcement may not be achieved.