The relationship of 16 underage drinking laws to reductions in underage drinking drivers in fatal crashes in the United States

The minimum legal drinking age 21 (MLDA 21) legislation in the United States (U.S.) has been documented as one of the most effective public health measures adopted in recent times. This study reports on an effort to evaluate and interrelate a basic set of 16 laws directed at younger than age 21 youth that are designed to (a) control the sales of alcohol to youth, (b) prevent possession and consumption of alcohol by youth, and (c) prevent alcohol impaired driving by those younger than age 21. The first objective of this study was to determine whether there was any relationship between the existence and strength of the various underage drinking laws in a State and the percentage of younger than age 21 drivers involved in fatal crashes who were drinking. After controlling for various factors, the only significant finding that emerged was for the existence and strength of the law making it illegal for an underage person to use fake identification ( p <0.016). The second objective was to determine if the enactment of two of the sixteen provisions (possession and purchase laws) was associated with a reduction in the rate of underage drinking driver involvements in fatal crashes. Analysis of variance (ANOVA) showed that there was a national 11.2% reduction ( p <0.05) in the ratio of underage drinking drivers to underage non-drinking drivers in fatal crashes after the possession and purchase laws were adopted in 36 States and the District of Columbia (DC). This suggests that the two mandatory elements of the Federal MLDA 21 law are having the desired effect of reducing underage alcohol-related highway deaths.

Enforcement of Zero Tolerance in the State of Washington - Evidence from Breath-Test Records

Several studies have demonstrated the effectiveness of zero tolerance (ZT) laws that make it illegal for drivers younger than 21 years to have any measurable alcohol in their bodies when operating a vehicle. All 50 states in the United States now have such laws. However, there is some question as to the extent they are being enforced. Because it has a centralized file of all breath tests performed by police in that state, Washington provided a special opportunity to evaluate the extent of ZT enforcement. Analyses were performed on arrests and alcohol-related fatal crashes of drivers younger than 21 years using data from the Washington State Patrol Breath Test Section and from the National Highway Traffic Safety Administration Fatality Analysis Reporting System, respectively. The results indicate that low blood alcohol concentration citations increased and crashes were reduced for drivers younger than 21 years, but crashes for drivers older than 21 years also declined. This suggests that the decline in underage drinking drivers in fatal crashes could not be unequivocally attributed to the ZT law.

Plasma alkalinization for tricyclic antidepressant toxicity: a systematic review

OBJECTIVE

To review the evidence that plasma alkalinization improves the outcome in tricyclic antidepressant toxicity.

METHODS

Medline search from 1966 to October 2000 (articles in all languages were included) and examination of bibliographies. Published papers including animal studies, in vitro studies, human case reports, case series and retrospective studies were reviewed.

RESULTS

Our search identified 115 publications, all of which were retrieved. Human studies included eight case reports, four case series, one controlled study and two retrospective chart reviews. No randomized controlled human trials were found. Twelve animal studies were identified that investigated pH manipulation or saline load and their effects on physiological parameters in tricyclic antidepressant toxicity.

CONCLUSIONS

The practice of alkalinization for tricyclic antidepressant toxicity is based on animal studies, case reports and opinion. The mechanism of action appears to be multifaceted and may vary between different tricyclic antidepressants. Significant interspecies variation makes extrapolation from animal studies to humans difficult. Alkalinization therapy appears reasonable in patients with compromising dysrhythmias and shock when supportive interventions have been ineffective; however, the available evidence does not support prophylactic alkalinization in the absence of life-threatening cardiovascular toxicity.

Mortality among United States Coast Guard marine inspectors

Work history records and fitness reports were obtained for 1,767 marine inspectors of the U.S. Coast Guard between 1942 and 1970 and for a comparison group of 1,914 officers who had never been marine inspectors. Potential exposure to chemicals was assessed by one of the authors (RP), who is knowledgeable about marine inspection duties. Marine inspectors and noninspectors had a deficit in overall mortality compared to that expected from the general U.S. population (standardized mortality ratios [SMRs = 79 and 63, respectively]). Deficits occurred for most major causes of death, including infectious and parasitic diseases, digestive and urinary systems, and accidents. Marine inspectors had excesses of cirrhosis of the liver (SMR = 136) and motor vehicle accidents (SMR = 107), and cancers of the lymphatic and hematopoietic system (SMR = 157), whereas noninspectors had deficits for these causes of death. Comparison of mortality rates directly adjusted to the age distribution of the inspectors and noninspectors combined also demonstrated that mortality for these causes of death was greater among inspectors than noninspectors (directly adjusted ratio ratios of 190, 145, and 198) for cirrhosis of the liver, motor vehicle accidents, and lymphatic and hematopoietic system cancer, respectively. The SMRs rose with increasing probability of exposure to chemicals for motor vehicle accidents, cirrhosis of the liver, liver cancer, and leukemia, which suggests that contact with chemicals during inspection of merchant vessels may be involved in the development of these diseases among marine inspectors.