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INTRODUCTION Literature notes the efficacious use of alcohol ignition interlock devices (IID) in reducing rates of drinking and driving while installed on the vehicle. Some drivers who are convicted of driving while intoxicated (DWI) elect to have their license suspended/revoked instead of installing the device. These individuals represent a high-risk subsample of drivers, yet limited literature has addressed this concern. The current study seeks to fill this gap using qualitative interviews addressing: (i) why do non-installers make the choice to not install a mandated IID; and (ii) how are non-installers managing without the IID? METHODS The study utilises the Managing Heavy Drinkers study of drivers in Erie County, New York, USA. Participants were purposively sampled from a group of non-installers (n = 6; four females, two males) who completed semi-structured interviews. Constructed grounded theory was used to develop a theoretical understanding of participant's experiences. RESULTS To understand why participants elect not to install the IID, thematic analysis revealed: alleviating constraints, predominantly the financial burdens associated with an IID, and institutional mistrust. Additionally, data revealed that participants are managing without the IID by mitigating apprehension. This included driving cautiously to avoid detection and utilising alternative transportation. DISCUSSION AND CONCLUSIONS This study furthers understanding of why drivers convicted of a DWI elect not to install an IID. Future research should seek to identify barriers to IID installation. This work provides evidence for establishing institutional protocols that ensure drivers convicted of a DWI receive consistent and correct information about the IID process.

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.

INTRODUCTION: Alcohol ignition interlock devices (IID) reduce rates of drinking and driving. The interlock offers an opportune time for tailoring targeted interventions to develop habits to separate drinking from driving among this high-risk population. This study identified different types of IID users upon whom targeted interventions could be developed. METHODS: Participants (N = 114) were assessed at IID installation and again six months later. Latent class analysis (LCA) was conducted using drinking environment, drinking motivation, social support, drug use, and problem drinking behaviors as indicators. Multivariate regression analyses were conducted comparing latent class assignment with impaired driving attempts. RESULTS: LCA supported a 4-class model where 14.8% of participants fell into the low use/high awareness class; 30.6% fell into the heavy use/high awareness class; 30.6% fell into the mixed use/high awareness class; and 24.0% fell into the moderate use/low awareness class. Drivers in the moderate use/low awareness condition had increased early morning BAC lockouts. CONCLUSIONS: These typologies demonstrate important differences within high risk drivers. Indeed, drivers who fell into the moderate use/low awareness class may not have considered their alcohol-related behaviors problematic. This information could lend itself to the development of targeted interventions to address subgroups of drinking drivers.

BACKGROUND: Some alcohol interventions have been found to have the adverse outcome of increasing non-alcohol-related substance use. It is unknown, however, how changes in alcohol use over the course of alcohol ignition interlocks - a common DUI intervention - may impact other substance use. METHODS: Alcohol and cannabis use were measured using hair ethylglucuronide and Delta-9-Tetrahydrocannabinol concentrations in blood, respectively. Participants (N = 69) were measured at the interlock installation period and again 6-months later while the interlock was installed. A mixed ANOVA was conducted to examine changes in levels of ethanol and THC over time. RESULTS: On measures of marijuana use, there was a significant interaction effect between the group that increased alcohol use and time F(2, 66) = 7.863, p =.001; partial η(2) =.192; as well as a main effect for time F(2, 66) = 21.106, p

Background Before the COVID‐19 pandemic, very little was known about the impact of social isolation on individuals’ alcohol use and misuse. This study examines how socially isolated individuals with a history of heavy drinking used alcohol during the pandemic. Methods Data for this study came from an add‐on to the Managing Heavy Drinking (MHD) longitudinal study of drivers convicted of DWI that was conducted in Erie County, New York. Pre‐COVID information (October 2019–March 2020) was augmented with a COVID‐19 questionnaire collected between July and August 2020. A total of 92 participants completed the COVID‐19 survey. Results The sample of problem drinkers showed a significant increase after the pandemic outbreak in the average number of drinking days from 1.99 to 2.49 per week (p = 0.047), but a significant decrease in the average number of drinks per drinking day, from 3.74 to 2.74 (p = 0.003). The proportion of individuals who drank more frequently was greater among those who, before the outbreak had an Alcohol Use Disorders Identification Test (AUDIT) score 8 (13%). Alcohol treatment was also associated with the frequency of drinking, with individuals who were not in alcohol treatment showing a 16% increase in frequency compared with a 10% increase among those in treatment. Further, individuals who, after the outbreak worried about their health (30%) or finances (37%) reported greater increases in the frequency of drinking than those who did not worry about their health (17%) or finances (10%). Conclusions Overall, the individuals in our sample showed small changes in the frequency andheaviness of drinking after the outbreak of COVID‐19, effects that opposite in direction from one another and thus resulted in no overall change in drinks consumed. Nonetheless, we identified factors that influenced the effects of the pandemic ond rinking behavior among individuals convicted of DWI, which emphasizes the need to individualize these individuals’ treatment, particularly in the context of dramatic environmental change.

BACKGROUND: Alcohol ignition interlock devices (IIDs) reduce rates of drinking and driving when installed on the vehicles of offenders. While the IID is installed on their vehicle, some drivers adapt their drinking behaviors, while others cannot. Heavy alcohol use and mental health concerns reduce treatment adherence in clinical settings, but it has not yet known how they pertain to behavioral adaptation to IIDs. OBJECTIVES: This study focuses on identifying driver typologies as predictors of performance while on alcohol IIDs. METHODS: The study utilizes the Managing Heavy Drinking study of drivers in New York state. Participants (N = 101; 59 males, 42 females) completed questionnaires assessing demographic information, drinking behaviors, driving history and mental health measures. All participants had been convicted of a DUI, and installed an IID. Latent class analysis was used to establish typologies and predict lockout ratios. RESULTS: Four typologies emerged and drivers with elevations in mental health concerns had significantly worse lockout ratios than those in other classes. CONCLUSIONS: The current study may provide support for interventions designed to identify drivers with comorbid mental health concerns and tailor appropriate interventions to administer while the IID is installed with the aim of improving behavioral adaptation to the device.

OBJECTIVES: The purpose of this investigation was to compare the drinking patterns and experiences (both positive and negative) among DUI offenders who had installed an ignition interlock. The association between those experiences and interlock performance as measured by the number of times they had a lockout, was also assessed. METHODS: Over 300 DUI offenders who installed an interlocks in the State of Florida were recruited and completed an on-line survey at the beginning and end of their interlock restriction. A record of the interlock performance data from each was downloaded and used to determine how many lockouts they experienced during their interlock restriction period. Offenders were defined into two groups; successful cases (having 0 or 1 lockout) or poor performers (have 2 or more lockouts). Chi-square and binary regressions were used to assess differences between groups. RESULTS: Poor performers reported significantly more drinking and were more likely to drink in a context of emotional comfort, yet they were more likely to report positive experiences with the interlock, especially as to its ability to remind them to avoid another DUI by reducing their drinking and driving. No difference was found between these two groups for the interlock’s ability to reduce drinking. CONCLUSIONS: People with a more serious drinking pattern and who may be most at risk for recidivating may be more inclined to recognize the potential benefits of the interlock as a DUI preventive countermeasure. More research is needed to identify and influence high risk DUI offenders while on the interlock to increase its effectiveness once the interlock is removed.

This review focuses on the role of motor vehicles in the prevention of alcohol-related fatalities in the United States. Since alcohol significantly affects brain function, it is natural to make drivers the prime targets for impaired-driving-prevention programs. However, the prevalence, design, ease of operation, and safety features of motor vehicles, as well as state regulations of their operation, have an important influence on crash occurrences, particularly those involving alcohol. This review begins with a discussion of why the automobile became the central technological device in the alcohol-related fatality problem and then moves on to an overview of motor vehicle safety programs that have impacted impaired driving. The article then presents an extended discussion of the effectiveness of vehicle-based, alcohol-detecting ignition interlock devices (interlocks), which provided the principal specific vehicle-based effort in the 20th century to separate alcohol consumption from driving. The review ends with a commentary on the issues that will arise in managing operator impairment in autonomous (self-driving) vehicles-the probable principal 21st-century effort to reduce impaired driving and eliminate alcohol-related crashes by minimizing the role of the driver.

OBJECTIVE: There is a substantial body of evidence that the recidivism of impaired-driving offenders is reduced while an ignition interlock device (IID) is on their vehicles. This study examines changes in driving behaviors and drinking behaviors used by DWI offenders to manage driving with the IID. METHODS: A total of 166 IID participants who completed two surveys covering the period from arrest to IID installation (T1) and during IID use (T2) were examined. Four domains were covered: demographics, driving environments and transportation needs, reported driving activity, and reported drinking activities. Participants were on average 38 years old, 43% were female, 35% completed college, 34% had an income of more than $50,000, and 83% were employed. For those who provided it, the mean blood alcohol content (BAC) at arrest was .184 g/dL, with only 8 (5%) individuals below .08 g/dL, and 93 (56%) at over .18 g/dL. About 45% were repeat DWI offenders. RESULTS: Between T1 and T2 there was a slight increase in acknowledging public transportation was available (p=.001), an increase in other individuals driving the interlock-equipped vehicle (p=.002), an increase in the number of vehicles in the household not registered to the DWI offender (p< .001), and an increase in the number of participants who reported that driving was important to their lifestyle (p=.008). Initial (T1) expectations about whether the interlock would be a problem were significantly different from actual experiences reported in T2 (p

There is a growing interest in how extensively the use of marijuana by drivers relates to crash involvement. While cognitive, lab-based studies are consistent in showing that the use of cannabis impairs driving tasks, epidemiological, field-based studies have been inconclusive regarding whether cannabis use causes an increased risk of accidents. There is ample evidence that the presence of cannabis among drivers with a BAC≥0.08g/dL highly increases the likelihood of a motor vehicle crash. Less clear, however, is the contribution of cannabis to crash risk when drivers have consumed very little or no alcohol. This effort addresses this gap in knowledge. We took advantage of a unique database that merged fatal crashes in the California Statewide Integrated Traffic Records System (SWITRS) and the Fatality Analysis Reporting System (FARS), which allows for a precise identification of crash responsibility. To account for recent increase in lab testing, we restricted our sample to cover only the years 1993-2009. A total of 4294 drivers were included in the analyses. Descriptive analyses and logistic regressions were run to model the contribution of alcohol and drugs to the likelihood of being responsible in a fatal crash. We found evidence that compared with drivers negative for alcohol and cannabis, the presence of cannabis elevates crash responsibility in fatal crashes among drivers at zero BACs (OR=1.89) and with 0BAC0.05g/dL (OR=3.42), suggesting that emphasis on curbing impaired driving should not be solely focused on heavy-drinking drivers. Data limitations however caution about the generalizability of study findings. Special efforts to understand the effect of cannabis on fatal crashes, in particular in the absence of alcohol, are needed.

This study examined the relationship between alcohol, marijuana, cocaine, and painkiller use disorders in a sample of drivers. We studied nighttime drivers aged 16 to 87 (n = 4,277) from the 2007 National Roadside Survey who reported substance use behaviors and provided breath tests for alcohol. Logistic regression analyses assessed the relationships between (1) substance (i.e., alcohol/marijuana/cocaine/pain killer) use disorders; (2) demographic characteristics; and (3) BAC levels. Overall, 13.2% of participants met criteria for marijuana use disorder, 7% met criteria for cocaine use disorder, and 15.4% met criteria for extra-medicinal painkiller use disorder. When self-report data were analyzed, three reciprocal associations emerged: (1) marijuana use disorders and alcohol use disorders were correlated; (2) marijuana use disorders and cocaine use disorders were correlated; and (3) cocaine use disorders and painkiller use disorders were correlated. BAC data revealed that marijuana and cocaine use disorders were both associated with positive BAC levels, but only cocaine use disorders were associated with BAC levels over the legal limit. Results suggest significant poly-substance use disorders in a sample of nighttime drivers, with variations by demographic characteristics. The individual and public health consequences of multiple substance use disorders among drivers are significant.

Nightclubs are a setting in which young adults purposefully seek out experiences, such as drug use and alcohol intoxication that can expose them to physical harm. While physical harm occurs fairly frequently within clubs, many patrons have safe clubbing experiences. Further, not all patrons experience potential harms the same way, as there are differences in aggression and intoxication. In this article we draw on data from a research study in which we sought to better understand the role of social drinking groups in experiences of risk within nightclubs, as the majority of patrons attend with others. We collected data from 1,642 patrons comprising 615 social drinking groups as they entered and exited nightclubs in a major U.S. city. We focused on six experiences that might cause physical harm: alcohol impairment, alcohol intoxication, drug use, physical aggression, sexual aggression, and impaired driving. We aggregated patron responses across social groups and used latent class statistical analysis to determine if and how experiences tended to co-occur within groups. This analysis indicated there were five distinct classes which we named Limited Vulnerability, Aggression Vulnerability, Substance Users, Impaired Drivers and Multi-Issue. We assessed the groups within each class for distinctions on characteristics and group context. We found differences in the groups in each class, such as groups containing romantic dyads experienced less risk, while those groups with greater familiarity, greater concern for safety, and higher expectations for consumption experienced more risk. Group composition has an impact on the experiences within a club on a given night, in particular when it comes to risk and safety assessment.

Objective. Despite successes in the 1980s and early 1990s, progress in reducing impaired driving fatalities in the United States has stagnated in recent years. Since 1997, the percentage of drivers involved in fatal crashes with illegal blood alcohol concentration (BAC) levels has remained at approximately 20% to 22%. Many experts believe that public complacency, competing social and public health issues, and the lack of political fortitude have all contributed to this stagnation. The number of alcohol-related crashes, injuries, and fatalities is still unacceptable, and most are preventable. The public needs to be aware that the problem presented by drinking drivers has not been solved. Political leaders need guidance on which measures will affect the problem, and stakeholders need to be motivated once again to implement effective strategies. Methods. The National Academy of Sciences (NAS) Transportation Research Board (TRB) Alcohol, Other Drugs, and Transportation Committee (ANB50) sponsored a workshop held at the NAS facility in Woods Hole, MA, on August 24-25, 2015, to discuss the lack of progress in reducing impaired driving and to make recommendations for future progress. A total of 26 experts in research and policy related to alcohol-impaired driving participated in the workshop. The workshop began by examining the static situation in the rate of alcohol-impaired driving fatal crashes to determine what factors may be inhibiting further progress. The workshop then discussed eight effective strategies that have not been fully implemented in the United States. Workshop participants (16 of the 26) rated their top three strategies. Results. Three strategies received the most support: 1. Impose administrative sanctions for drivers with BACs = .05 to .08 g/dL.2. Require alcohol ignition interlocks for all alcohol-impaired driving offenders.3. Increase the frequency of sobriety checkpoints, including enacting legislation to allow them in the 11 states that currently prohibit them. Impose administrative sanctions for drivers with BACs = .05 to .08 g/dL. Require alcohol ignition interlocks for all alcohol-impaired driving offenders. Increase the frequency of sobriety checkpoints, including enacting legislation to allow them in the 11 states that currently prohibit them. Five other important strategies included the following: (a) increase alcohol taxes to raise the price and reduce alcohol consumption; (b) re-engage the public and raise the priority of impaired driving; (c) lower the illegal per se BAC limit to .05 for a criminal offense; (d) develop and implement in-vehicle alcohol detection systems; and (e) expand the use of screening and brief interventions in medical facilities. Conclusions. Each of these strategies is proven to be effective, yet all are substantially underutilized. Each is used in some jurisdictions in the United States or Canada, but none is used extensively. Any one of the three strategies implemented on a widespread basis would decrease impaired driving crashes, injuries, and fatalities. Based on the research, all three together would have a substantial impact on the problem.

Electronic music dance events (EMDEs) in nightclubs are settings where young adults tend to engage in high-risk behaviors, such as heavy alcohol and drug use. Consequences of these behaviors may be prevented if young adults engage in protective strategies with their drinking group. It is important to identify drinking group characteristics that predict willingness to intervene with peers. Objectives of this study were to (a) examine whether young adults at EMDEs would be willing to intervene with members of their drinking group and (b) identify both individual and group characteristics of drinking groups that predict willingness to intervene. Nightclub patrons (N = 215 individuals; 80 groups) were surveyed anonymously as they entered clubs. Individual- and group-level characteristics were measured in relation to willingness to intervene with peers. Mixed-model regressions were conducted, accounting for nesting by drinking group. Analyses show that participants were willing to intervene with their peers. Groups that knew each other well and had lower expectations for members' drinking were more willing to intervene. Women, younger, and older participants were also more willing to intervene. Findings show that club patrons are willing to intervene with their drinking groups to protect them from harmful consequences of heavy drinking and drug use. Findings indicate characteristics of both individuals and drinking groups that could be targeted in interventions among young adults largely not being reached by college interventions.

OBJECTIVE: Using data from 2013–2014, this article aims to update alcohol-related fatal crash relative risk estimates, defined as the risk of dying in those crashes at different blood alcohol concentrations (BACs) relative to the risk of dying in a crash when sober (BAC = .00 g/dl), and to examine any change in risk that could have taken place between 2007 and 2013–2014. More specifically, we examine changes in risk among BAC = .00 g/dl drivers and among BAC > .00 g/dl drivers. METHOD: We matched and merged crash data from the Fatality Analysis Reporting System (FARS) and exposure data from the National Roadside Survey (NRS). To the matched database we applied logistic regression to estimate the changes in relative risk. RESULTS: We found that among sober (BAC = .00 g/dl) drivers, the risk of dying in a fatal crash decreased between 2007 and 2013–2014. For drinking drivers, however, no parallel reduction in the overall contribution of alcohol to the fatal crash risk occurred. Compared with 2007, in 2013–2014 the oldest group of drivers (age ≥ 35 years) were at an elevated crash risk when driving at low BACs (.00 g/dl < BAC < .02 g/dl). CONCLUSIONS: Although the decrease in crash risk for drivers with a BAC of .00 g/dl is encouraging, the consistency of the alcohol-related risk estimates over the last two decades suggests the need to substantially strengthen current efforts to abate drinking and driving.

There are 2 primary methods for establishing relative risk: case-control studies, in which crash and matched control data are collected separately, and responsibility analysis, which exploits a single existing crash database by using nonresponsible drivers as an "induced exposure" control group (which is less expensive and therefore more feasible for examining the large number of substances that can impact driving behavior). Though both approaches are scientifically sound and methodologically valid, each approach has its own inherent obstacles to overcome. In this article, we examine in detail how different criteria for the development of control cases influence the accuracy of crash risk estimates for drivers with positive blood alcohol concentrations (BACs).We applied responsibility analysis to crash-involved drivers in a recent crash case-control study, thereby providing 2 sets of control cases: Those from responsibility analysis and those from the case control study.Case-control and responsibility analysis crash risk curves did not differ significantly, indicating that both systems generate valid estimates of the relative crash risk of drivers on the road.The results suggest that when researchers are faced with finance or time constraints that make case-control studies infeasible, responsibility analysis should be considered a viable alternate methodological approach.

OBJECTIVE: Polydrug users have been shown to be at higher risk for alcohol consumption and crash involvement. However, research has shown that polydrug groups differ in some important ways. It is currently unknown how polydrug-using groups differ in terms of crash involvement and alcohol consumption. METHOD: The current study used latent class analysis to examine subgroups of polydrug users (n = 384) among a sample of drivers in Virginia Beach, Virginia (N = 10,512). A series of logistic regression analyses were conducted to determine the relationship between polydrug use categories and crash involvement and alcohol consumption. RESULTS: Four distinct subclasses of users were identified among polydrug-using drivers: Class 1 is the “marijuana-amphetamines class” and accounts for 21.6% of polydrug users. Class 2 is the “benzo-antidepressant class” and accounts for 39.0% of polydrug users. Class 3 is the “opioid-benzo class” and accounts for 32.7% of polydrug users. Finally, Class 4 is the “marijuana-cocaine class” and accounts for 6.7% of the study sample. Drivers in the opioid-benzo class were significantly more likely than those in any other class as well as non–drug users and single-drug users to be involved in a crash and were more likely than those in most other conditions to consume alcohol. No significant difference was found between marijuana-amphetamine users or benzo-antidepressant users and non–drug users on crash risk. CONCLUSIONS: Some polydrug users are indeed at greater risk for crash involvement and alcohol consumption; however, not all polydrug users are significantly worse than single-drug users and/or non–drug users, and the practice of lumping polydrug users together when predicting crash risk runs the risk of inaccurately attributing crash involvement to certain drivers.

OBJECTIVE: This research examined the relationship between the intragroup familiarity among peers visiting nightclubs and the likelihood of experiencing negative outcomes. We hypothesized, based on our prior work, that members who are more familiar with their group would be more likely to experience sexual and physical aggression while at the club. METHOD: The study involved 1,765 young adults (within 654 natural groups) sampled at nightclubs in the San Francisco Bay area. Participants were interviewed about their clubbing history and expectations before entering the club and about their experiences in the club as they exited. Breath samples were collected at both entry and exit to obtain objective measures of alcohol use. RESULTS: Using generalized linear mixed modeling to accommodate correlated data, we found that, to the extent that club patrons were familiar with more of their peer group, the more likely they were to experience sexual and physical aggression, although this was moderated by participant gender. CONCLUSIONS: Although in many circumstances group cohesion can be a protective factor, the results of this study suggest that greater group familiarity might sometimes be associated with less concern for safety, reduced vigilance, and an increase in negative experiences. Language: en

Research measuring levels of enforcement has investigated whether increases in police activities (e.g., checkpoints, driving-while-intoxicated [DWI] special patrols) above some baseline level are associated with reduced crashes and fatalities. Little research, however, has attempted to quantitatively measure enforcement efforts and relate different enforcement levels to specific levels of the prevalence of alcohol-impaired driving.The objective of this study was to investigate the effects of law-enforcement intensity in a sample of communities on the rate of crashes involving a drinking driver. We analyzed the influence of different enforcement strategies and measures: (1) specific deterrence - annual number of driving-under-the-influence (DUI) arrests per capita; (2) general deterrence - frequency of sobriety checkpoint operations; (3) highly visible traffic enforcement - annual number of traffic stops per capita; (4) enforcement presence - number of sworn officers per capita; and (5) overall traffic enforcement - the number of other traffic enforcement citations per capita (i.e., seat belt citations, speeding tickets, and other moving violations and warnings) in each community.We took advantage of nationwide data on the local prevalence of impaired driving from the 2007 National Roadside Survey (NRS), measures of DUI enforcement activity provided by the police departments that participated in the 2007 NRS, and crashes from the General Estimates System (GES) in the same locations as the 2007 NRS. We analyzed the relationship between the intensity of enforcement and the prevalence of impaired driving crashes in 22-26 communities with complete data. Log-linear regressions were used throughout the study.A higher number of DUI arrests per 10,000 driving-aged population was associated with a lower ratio of drinking-driver crashes to non-drinking-driver crashes (p=0.035) when controlling for the percentage of legally intoxicated drivers on the roads surveyed in the community from the 2007 NRS. Results indicate that a 10% increase in the DUI arrest rate is associated with a 1% reduction in the drinking driver crash rate. Similar results were obtained for an increase in the number of sworn officers per 10,000 driving-age population.While a higher DUI arrest rate was associated with a lower drinking-driver crash rate, sobriety checkpoints did not have a significant relationship to drinking-driver crashes. This appeared to be due to the fact that only 3% of the on-the-road drivers were exposed to frequent sobriety checkpoints (only 1 of 36 police agencies where we received enforcement data conducted checkpoints weekly). This low-use strategy is symptomatic of the general decline in checkpoint use in the U.S. since the 1980s and 1990s when the greatest declines in alcohol-impaired-driving fatal crashes occurred. The overall findings in this study may help law enforcement agencies around the country adjust their traffic enforcement intensity in order to reduce impaired driving in their community.

Lab studies have shown that marijuana can severely impair driving skills. Epidemiological studies, however, have been inconclusive regarding the contribution of marijuana use to crash risk. In the United States, case–control studies based on the merging of comparable crash Fatality Analysis Reporting System (FARS) and non-crash National Roadside Survey (NRS) data have been applied to assess the contribution of drugs to crash risk, but these studies have yielded confusing, even contradictory results. We hypothesize that such a divergence of results emanates from limitations in the databases used in these studies, in particular that of the FARS. The goal of this effort is to examine this hypothesis, and in doing so, illuminate the pros and cons of using these databases for drugged-driving research efforts. We took advantage of two relatively recent cannabis crash risk studies that, despite using similar databases (the FARS and the NRS) and following similar overall approaches, yielded opposite results (Li, Brady, & Chen, 2013; Romano, Torres-Saavedra, Voas, & Lacey, 2014). By identifying methodological similarities and differences between these efforts, we assessed how the limitations of the FARS and NRS databases contributed to contradictory and biased results. Because of its limitations, we suggest that the FARS database should neither be used to examine trends in drug use nor to obtain precise risk estimates. However, under certain conditions (e.g., based on data from jurisdictions that routinely test for drugs, with as little variation in testing procedures as possible), the FARS database could be used to assess the contribution of drugs to fatal crash risk relative to other sources of risk such as alcohol.

BACKGROUND: Motor vehicle crashes (MVCs) are a leading cause of death among young people in the United States. We examined the relationship between states’ alcohol policy environments and alcohol-related MVC fatalities among children, adolescents, and young adults under the minimum legal drinking age of 21 years. METHODS: We used the Alcohol Policy Scale (APS), an assessment of 29 alcohol policies across 50 states and Washington, DC, developed with the assistance of an interdisciplinary Delphi panel. Using the Fatality Analysis Reporting System, we examined APS scores in relation to fatalities of people ≤20 years old from 2000 to 2013 occurring in crashes in which ≥1 involved driver had a blood alcohol content ≥0.08%. Logistic regression was used with a 1-year lag between policies and MVC fatalities and adjusted for potential confounders. RESULTS: Of 84 756 MVC fatalities of those ≤20 years old during the study period, 23 757 (28.0%) were alcohol related, including deaths of 11 006 (46.3%) drivers, 10 212 (43.0%) passengers, and 2539 (10.7%) pedestrians, cyclists, and others. People killed in alcohol-related MVCs were predominantly male (72.7%) and older (65.5% were 18–20 years old), and 51.2% were non-Hispanic white. Restrictive policy environments were associated with fewer fatalities (adjusted odds ratio, 0.91 per 10-percentage-point increase in APS score; 95% confidence interval, 0.89–0.94). The association was observed for drivers and passengers, male and female decendents, and children, adolescents, and young adults. CONCLUSIONS: More restrictive alcohol policies are associated with reduced alcohol-related MVC mortality among young people. Studies should scrutinize the relationship between policies and fatalities to highlight mechanisms.

To examine the social drinking group’s influence on the individual’s experiences of physical or sexual aggression at clubs, data were collected from 368 groups (N = 986 individuals). Both group and individual level indicators were examined for impact on self-reports of physical and sexual aggression experiences while at the club. Recent aggressive experiences and perpetration, concerns for group safety, one’s own plans and assessment of other group members’ plans to drink to the point of intoxication, and personal characteristics were examined, using both individual and group indicators. At exit, participants reported experiencing physical aggression (12.3 %) and sexual aggression (12.6 %) at the club. Using generalized linear mixed modeling to account for nested data (club, event, and group), group level indicators predicted both the individual’s physical and sexual aggression experiences. Especially for experiences of physical aggression, group effects are notable. Being in a group whose members recently experienced physical aggression increased the risk for the individual. Interestingly, groups that had higher levels of planned intoxication decreased risks of experiencing aggression, while a discrepancy in these intentions among group members increased the risks. Group effects were also noted for experiencing sexual aggression. High levels of prior experiences for sexual aggression in the group increased the risks for the individual during the event. Also, being in a group that is identified as having at least one member who is frequently drunk increases the risk for experiencing sexual aggression. These findings inform prevention strategies for young adults engaged in high-risk behaviors by targeting social drinking groups who frequent clubs.

Electronic music and dance events in nightclubs attract patrons with heavy alcohol/drug use. Public health concerns are raised from risks related to these behaviors. Practices associated with increased risk in these club settings need to be identified.The relationship between club management practices and biological measures of patrons' alcohol/drug use is examined.Observational data from 25 events across six urban clubs were integrated with survey data (N = 738 patrons, 42.8% female) from patrons exiting these events, 2010-2012. Five indicators of club management practices were examined using mixed model regressions: club security, bar crowding, safety signs, serving intoxicated patrons, and isolation.Analyses revealed that serving intoxicated patrons and safety signs were related to substance use. Specifically, serving intoxicated patrons was related to heavy alcohol and drug use at exit, while safety signs were marginally related to less exit drug use. CONCLUSIONS/IMPORTANCE: Findings indicate observable measures in nightclubs provide important indicators for alcohol/drug use, suggesting practices to target. Study strengths include the use of biological measures of substance use on a relatively large scale. Limitations and future directions are discussed.

Numerous studies have demonstrated that vehicle alcohol ignition interlocks installed on the cars of impaired-driving offenders reduce recidivism by approximately two-thirds in comparison to similar offenders whose licenses have been suspended. An unresolved issue is the extent to which the effectiveness of interlock programs can be improved by close monitoring of the offenders' performance while in the program. This article describes 5 types of monitoring currently being used in interlock programs in the United States.The programs reviewed vary from those that simply ensure that the interlock is on the offender's vehicle and functioning, to those that use the interlock log data to extend the length of time the offender is required to be in the interlock program, and those that use the interlock data to initiate special monitoring and treatment programs that must be completed before removal of the interlock device. The strengths and limitations of each type of program are described. Also reviewed are current technological developments that appear to be leading to the development of fully automated interlock monitoring systems.Initial evidence shows that more intensive monitoring provides benefits in improved performance on the interlock, as indicated by fewer high blood alcohol concentration (BAC) breath tests when attempting to drive. Although effective, supervision that is more intensive increases government program costs.The relative cost-effectiveness of the differing types of monitoring requires investigation. Treatment programs need to be integrated with the interlock installation period. New technologies can potentially reduce interlock offender monitoring costs and effectiveness. Integrating treatment with the interlock could have postinterlock benefits.

BACKGROUND: Young adulthood (ages 18-25 years) represents a time when high-risk behaviors, including alcohol and drug use, peak. Electronic music dance events (EMDEs) featured at clubs provide an ecologic niche for these high-risk behaviors. PURPOSE: This paper examines the prevalence of alcohol and drug use among EMDE patrons. Examination of personal characteristics associated with exit levels of alcohol and drug use identifies important indicators of risk taking for prevention strategies. METHODS: Data were collected anonymously during 2010-2012 from 2028 patrons as they entered and exited clubs in the San Francisco Bay area featuring EMDEs. Nearly half were aged ≤25 years. Biological measures of drug and alcohol and self-reported personal characteristics were attained. Analyses were completed in 2012. RESULTS: At entrance, more than one fifth of patrons were positive for drug use and one fourth arrived either impaired (blood alcohol concentration [BAC]: 0.05%-0.079%) or intoxicated (BAC: >0.08%) by alcohol. At exit, one fourth tested positive for drugs, and nearly half were impaired or intoxicated by alcohol. Individual characteristics that were important for levels of risk included prior alcohol use behaviors, sexual identity, ethnic/racial identity, and transportation to the event. Gender did not differentiate for alcohol use but fewer women used drugs. CONCLUSIONS: Findings confirm the importance of targeting EMDEs for prevention efforts. EMDEs attract young working adults who are engaged in heavy alcohol and/or drug use. Targeting these social settings for delivering public health prevention strategies regarding alcohol and drug use and related harm is indicated by the findings. Language: en

The National Transportation Safety Board recently recommended that states establish a per se blood alcohol concentration (BAC) limit of 0.05 or lower for all drivers who are not already required to adhere to lower BAC limits in a national effort to reduce alcohol-impaired driving. There is strong evidence for adopting this recommendation. A comprehensive review of the literature on BAC limits was conducted. The research indicates that virtually all drivers are impaired regarding at least some driving performance measures at a 0.05 BAC. The risk of being involved in a crash increases significantly at 0.05 BAC and above. The relative risk of being killed in a single-vehicle crash with BACs of 0.05-0.079 is 7-21 times higher than for drivers at 0.00 BAC. Lowering the BAC limit from 0.08 to 0.05 has been a proven effective countermeasure in numerous countries around the world. Most Americans do not believe a person should drive after having two or three drinks in 2 hours. It takes at least four drinks for the average 170-pound male to exceed 0.05 BAC in 2 hours (three drinks for the 137-pound female). Most industrialized nations have established a 0.05 BAC limit or lower for driving. Progress in reducing the proportion of drivers in fatal crashes with illegal BACs has stalled over the past 15 years. Lowering the BAC limit for driving from the current 0.08 to 0.05 has substantial potential to reduce the number of people who drink and drive in the United States and get involved in fatal crashes.

BACKGROUND: Clubs that feature electronic music dance events (EMDEs) draw young adults aged 18-34 who are at high-risk for alcohol-related crashes to locations where alcohol sales are the principal source of revenue. Up to 30% of these attendees may also use drugs. This provides an important context in which to study driving arrangements that reflect concern with impaired driving. We explored whether drivers were using less alcohol and fewer drugs at exit than their passengers were and whether a driver for the group ever changed after consuming too much during the evening. METHODS: Using biological measures of alcohol consumption (breath tests) and drug use (oral fluid tests), 175 drivers and 272 passengers were surveyed among young adults arriving at and departing from EMDEs in San Francisco. RESULTS: Upon exit from the drinking locations, only 20% of the drivers, compared to 47% of the passengers, had a high breath alcohol concentration (defined as a BrAC of .05g/dL or greater). Further, there was evidence that drivers with high BrACs switched to passenger status on exit and former passengers with lower BrACs replaced those drivers. However, there were no differences in the prevalence of drug use among drivers and passengers. CONCLUSIONS: These findings suggest that the effort by young adult drivers to avoid alcohol-impaired driving appears to be reducing the number of drivers with high BrACs returning from drinking locations, such as EMDEs, by about one third. However, there is no similar pattern for drugged driving. Language: en

Despite the adverse effects associated with marijuana abuse and dependence, marijuana is becoming more common-place in activities such as driving. Previous literature has discussed the high rates of cocaine, opioid and benzodiazepine use among users of marijuana, but no research has addressed the rates of concurrent use among drivers meeting abuse or dependence criteria. Each of these substances may produce effects detrimental to driving safety which may be compounded by concurrent substance use. This research examines rates of marijuana use, abuse, and dependence among an active sample of drivers (N = 7,734) in the 2007 National Roadside Survey. Mean age of participants was 36.89 years, and the majority were male (60.1%) and identified as White (59.2%). Participants who used marijuana but did not meet diagnostic criteria for abuse (n = 165) or dependence (n = 112) were significantly more likely to test positive for all substances than were those who did not use marijuana. Further, those that met criteria for marijuana abuse or dependence were more likely than those who did not meet criteria to test positive for THC, cocaine, and benzodiazepines and THC, cocaine, and opioids, respectively. The current research has implications for policy development and drugged driving interventions.

Background Studies of drinking drivers in alcohol-related crashes have shown that high breath-alcohol concentrations (BrACs) are associated with illegal drug use. Until the 2007 National Roadside Survey (NRS), the prevalence of drugs among drinking drivers on U.S. roads was unknown. Using NRS data, we explore how many drivers with positive BrACs may also be using drugs and their significance to current drinking-driving enforcement procedures. Methods Based on a stratified, random sample covering the 48 U.S. contiguous states, we conducted surveys on weekend nights from July–November 2007. Of the 8384 eligible motorists contacted, 85.4% provided a breath sample; 70.0%, an oral fluid sample; and 39.1%, a blood sample. We conducted regression analyses on 5912 participants with a breath test and an oral fluid or blood test. The dependent variables of interest were illegal drugs (cocaine, cannabinoids, street drugs, street amphetamines, and opiates) and medicinal drugs (prescription and over-the-counter). Results 10.5% of nondrinking drivers were using illegal drugs, and 26 to 33% of drivers with illegal BrACs (≥0.08 g/dL) were using illegal drugs. Medicinal drug use was more common among nondrinking drivers (4.0%) than among drivers with illegal BrACs (2.4%). Conclusions The significant relationship between an illegal BrAC and the prevalence of an illegal drug suggests as many as 350,000 illegal drug-using drivers are arrested each year for DWI by U.S. alcohol-impaired driving enforcement. These drug-using drivers need to be identified and appropriate sanctions/treatment programs implemented for them in efforts to extend per se laws to unapprehended drug users.

Dugosh, Festinger, and Marlowe’s (2013, this issue) study is an important pilot study aimed at the development of a brief screening device that contains objective items to predict recidivism. We must continue to develop criteria that will help us distinguish between driving-under-the-influence (DUI) offenders who are at significant risk of repeating the offense in contrast to those offenders who learn their lesson from the first offense and never repeat the offense, no matter what sanction they experience. The identification of offenders with a high risk of repeating the offense will help prosecution and adjudication officials assign appropriate sanctions for the offense and implement appropriate monitoring of the offenders to prevent recidivism. Studies have shown that approximately one third of all offenders arrested for DUI are repeat offenders (Fell, 1995; Fell, Tippetts, and Voas, 2010) and that drivers with a DUI offense are at approximately four times the risk of being alcohol positive in a fatal crash (Fell, 1992). If we can accurately identify those firsttime DUI offenders at high risk of repeating, then countermeasures can be implemented to prevent the recidivism. This approach will improve public safety. Although identifying high-risk offenders is certainly important, it must be recognized that, as Dugosh et al. (2013) note, the criminal justice system continues to apply remedial programs based primarily on prior offenses and the blood-alcohol concentration (BAC) at the time of arrest. This process occurs despite the availability of screening tests with reasonable validity. The use of such assessment instruments was popularized 40 years ago by the National Highway Traffic Safety Administration’s (NHTSA’s) national Alcohol Safety Action Program (ASAP) implemented in 35 communities in the United States between 1969 and 1975. Currently, however, using these instruments has been restrained, not by the lack of useful test instruments but by the lack of court personnel resources to administer them (Voas and Fisher, 2001). As an example, it has been difficult to persuade adjudication

Over the last two decades, many states have adopted several of the 20 laws that aim to control youth access to and possession of alcohol and prevent underage drinking in the United States. However, many of these laws have not been evaluated since their adoption. The objective of this study was to determine which minimum legal drinking age 21 (MLDA-21) laws currently have an effect on underage drinking-and-driving fatal crashes.We updated the effective dates of the 20 MLDA-21 laws examined in this study and used scores of each law's strengths and weaknesses. Our structural equation model included the 20 MLDA-21 laws, impaired driving laws, seat belt safety laws, economic strength, driving exposure, beer consumption, and fatal crash ratios of drinking-to-nondrinking drivers under age 21.Nine MLDA-21 laws were associated with significant decreases in fatal crash ratios of underage drinking drivers: possession of alcohol (-7.7%), purchase of alcohol (-4.2%), use alcohol and lose your license (-7.9%), zero tolerance .02 blood alcohol concentration limit for underage drivers (-2.9%), age of bartender ≥21 (-4.1%), state responsible beverage service program (-3.8%), fake identification support provisions for retailers (-11.9%), dram shop liability (-2.5%), and social host civil liability (-1.7%). Two laws were associated with significant increases in the fatal crash ratios of underage drinking drivers: prohibition of furnishing alcohol to minors (+7.2%) and registration of beer kegs (+9.6%).The nine effective MLDA-21 laws are estimated to be currently saving approximately 1,135 lives annually, yet only five states have enacted all nine laws. If all states adopted these nine effective MLDA-21 laws, it is estimated that an additional 210 lives could be saved every year.

The goal of this article was to identify characteristics of drivers and passengers that predicted peer groups whose drivers exit dance clubs with alcohol levels indicative of impairment (blood alcohol content [BAC] ≥ 0.05 g/dL).We used the portal survey methodology to randomly sample groups of electronic music dance event (EMDE) patrons as they entered and exited a club. From May through November 2010, data were collected from 38 EMDEs hosted by 8 clubs in the San Francisco Bay area. Data included in these analyses are results from breath samples for measuring BAC and self-report data on demographics, recent drinking history drinking, drinking intentions, travel to and from the clubs, and the familiarity/experience with other group members. These data were collected from a subset of 175 drivers and 272 passengers.Although drivers drank less than passengers, one driver in 5 groups had a BAC indicative of elevated crash risk (BAC ≥ 0.05 g/dL). Groups of drivers and/or passengers with a recent history of binge drinking were more likely to have drivers with BACs ≥ 0.05 g/dL. One unanticipated finding was that drivers who knew more group members relatively well were more likely to exit the club with a BAC ≥ 0.05 g/dL. Additionally, we found that groups with all female passengers were at greater risk for having a driver whose BAC was ≥ 0.05 g/dL.Some group characteristics predicted drivers who exit clubs with BACs ≥ 0.05 g/dL. One intervention strategy to promote safety might be to encourage group members to reconsider who is sober enough to drive away from the club; for some groups, a change of drivers would be a safer choice, because a passenger may have a relatively safe BAC. Groups of females appear to have a particularly elevated risk of having a driver whose BAC exceeds 0.05 g/dL, and new intervention efforts should be particularly directed to these at-risk groups.

BACKGROUND: There is considerable evidence that heavy episodic drinking (HED) is a serious problem among college students. Concern with this problem has led 135 college presidents to endorse the Amethyst Initiative, which promotes the lowering of the minimum legal drinking age (MLDA) from 21 to 18. The Amethyst Initiative claims that the current MLDA of 21 encourages underage college students to drink in unsupervised locations where they adopt misconceptions regarding the normative level of student drinking that leads to excessive consumption or HED. The study by Fitzpatrick and colleagues (2012) in this issue challenges this hypothesis by contrasting the potential reduction in misapprehension of the drinking norm against the increase in consumption that would be expected if the MLDA was lowered to 18. METHODS: This commentary places the Fitzpatrick study within the larger context of the MLDA, noting that full consideration of the lowering the MLDA requires the inclusion of 18- to 20-year-old noncollege youths in the work force and 15- to 17-year-old high school students who will have increased access to alcohol through their 18-year-old peers. RESULTS: Research suggests that alcohol consumption and its associated problems will increase for 15- to 20-year-olds if the MLDA was lowered. This commentary also identifies alternative strategies for reducing college student HED that do not require lowering the MLDA. CONCLUSIONS: Although college binge drinking is a significant problem, reducing the drinking age is unlikely to be effective. Instead, it will increase the risk of alcohol problems faced by even younger high school students. Language: en

Introduction There is substantial evidence that heavy drinking is associated with aggression and violence. Most managers of drinking establishments are required to maintain a security staff to deal with disruptive patrons who threaten an organization's business or legal status. However, managers may focus little on minor instances of aggression even though these may escalate into more serious events. We hypothesize that proactive security efforts may positively affect patrons' perceptions of nighttime safety and influence their decisions to return to the club, thereby affecting the club's bottom line. Method Data for this study were collected from entry and exit surveys with 1714 attendees at 70 electronic music dance events at 10 clubs in the San Francisco Bay Area (2010–2012). Participants were asked to report on observations and experiences with aggressive behavior while in the club, their overall perception of club safety, and their plans to return to the same club in the next 30 days. Mediational multiple regression analysis was used to relate observations of club security to perceptions of personal safety and plans to return to the club. Results Reported observations of an active club security staff were positively related to perceptions of personal safety. Safety perceptions, in turn, were significantly related to plans to return to the club. The indirect path between perceptions of security and plans to return was significant as well. Conclusions The results suggest that an active security presence inside clubs can encourage club attendance by providing an environment where minor altercations are minimized, contributing to the perception of club safety. Practical Applications Evidence that proactive security efforts appear to increase return customers might motivate managers to implement better security policies.

INTRODUCTION: The high crash rate of youthful novice drivers has been recognized for half a century. Over the last decade, graduated driver licensing (GDL) systems, which extend the period of supervised driving and limit the novice's exposure to higher-risk conditions (such as nighttime driving), have effectively reduced crash involvements of novice drivers. METHOD: This study used data from the Fatality Analysis Reporting System (FARS) and the implementation dates of GDL laws in a state-by-year panel study to evaluate the effectiveness of two key elements of GDL laws: nighttime restrictions and passenger limitations. RESULTS: Nighttime restrictions were found to reduce 16- and 17-year-old driver involvements in nighttime fatal crashes by an estimated 10% and 16- and 17-year-old drinking drivers in nighttime fatal crashes by 13%. Passenger restrictions were found to reduce 16- and 17-year-old driver involvements in fatal crashes with teen passengers by an estimated 9%. CONCLUSIONS: These results confirm the effectiveness of these provisions in GDL systems. Impact on Public Health. States without the nighttime or passenger restrictions in their GDL law should strongly consider adopting them. IMPACT ON INDUSTRY: The results of this study indicate that nighttime restrictions and passenger limitations are very important components of any GDL law. Keywords: Driver distraction; Language: en

Aims: The objective of this study was to establish the extent of alcohol use disorders (AUDs) among drivers at risk for alcohol-related crashes. The prevalence of drivers with AUDs on U.S. roads on weekend evenings when alcohol-related crashes are most frequent is unknown. This study will inform laws and programs designed to reduce alcohol-involved crashes. Design: Interviews using a 15-item AUD questionnaire with a stratified random sample of noncommercial drivers at 60 primary sampling locations in the 48 contiguous states on Fridays and Saturdays between 10 PM and 3 AM from July to November 2007. Setting: Off-road locations into which a police officer directed a random selection of motorist passing the site. Participants: 4614 drivers of noncommercial vehicles. Measurements: AUDs, including heavy drinking, alcohol abuse, and alcohol dependence. Findings: Seventy-four percent of the participating drivers were current drinkers (reported drinking in the last year). Among those drinkers, 14% were classifiable either as dependent drinkers or as abusive drinkers based on self-reports of drinking. Another 10% of the drivers were classified as heavy drinkers. Forty-six percent of the drivers in the survey who had BACs at or higher than the 0.08 grams per deciliter legal limit fell into one of those three AUD categories. Conclusions: Survey data suggest that the majority of high-BAC drivers on U.S. roads show no clinical signs of an alcohol use disorder, but they are categorized as heavy drinkers. This suggests that environmental programs directed at reducing heavy drinking and brief behavioral interventions aimed at reducing episodes of excessive consumption have promise for reducing alcohol-related crashes. Language: en

Aims To describe a proposed national model for controlling the risk presented by offenders convicted of driving while impaired (DWI) and promoting behavioral change to reduce future recidivism. Setting Traditional methods of controlling the risk they present to the driving public are not adequate, as indicated by the fact that approximately 1000 people are killed each year-in alcohol-related crashes involving drivers convicted of DWI in the previous three years. However, stimulated by the success of special drug courts for substance abusers and new technological methods for monitoring drug and alcohol use, new criminal justice programs for managing impaired driving offenders are emerging. Intervention A national model for a comprehensive system applicable to both drug and alcohol impaired drivers is proposed. The program focuses on monitoring offender drinking or the offender driving employing vehicle interlocks with swift, sure but moderate penalties for non-compliance in which the ultimate sanction is based on offender performance in meeting monitoring requirements. Findings Several new court programs, such as the 24/7 Sobriety Project in South Dakota and North Dakota and the Hawaii’s Opportunity Probation with Enforcement (HOPE) Project, which feature alcohol/drug consumption monitoring, have produced evidence that indicates even dependent drinkers can conform to abstinence monitoring requirements and avoid the short-term jail consequence for failure. Conclusions Based on the apparent success of emerging court monitoring systems, it appears that the cost of incarcerating driving-while-impaired offenders can be minimized by employing low-cost community correction programs paid for by the offender.

A systematic review of the literature to assess the effectiveness of ignition interlocks for reducing alcohol-impaired driving and alcohol-related crashes was conducted for the Guide to Community Preventive Services (Community Guide). Because one of the primary research issues of interest--the degree to which the installation of interlocks in offenders' vehicles reduces alcohol-impaired driving in comparison to alternative sanctions (primarily license suspension)--was addressed by a 2004 systematic review conducted for the Cochrane Collaboration, the current review incorporates that previous work and extends it to include more recent literature and crash outcomes. The body of evidence evaluated includes the 11 studies from the prior review, plus four more recent studies published through December 2007. The installation of ignition interlocks was associated consistently with large reductions in re-arrest rates for alcohol-impaired driving within both the earlier and later bodies of evidence. Following removal of interlocks, re-arrest rates reverted to levels similar to those for comparison groups. The limited available evidence from three studies that evaluated crash rates suggests that alcohol-related crashes decrease while interlocks are installed in vehicles. According to Community Guide rules of evidence, these findings provide strong evidence that interlocks, while they are in use in offenders' vehicles, are effective in reducing re-arrest rates. However, the potential for interlock programs to reduce alcohol-related crashes is currently limited by the small proportion of offenders who participate in the programs and the lack of a persistent beneficial effect once the interlock is removed. Suggestions for facilitating more widespread and sustained use of ignition interlocks are provided.

Importance Motor vehicle crashes are a leading cause of mortality. However, the association between the restrictiveness of the alcohol policy environment (ie, based on multiple existing policies) and alcohol-related crash fatalities has not been characterized previously to date. Objective To examine the association between the restrictiveness of state alcohol policy environments and the likelihood of alcohol involvement among those dying in motor vehicle crashes in the United States. Design, Setting, and Participants This investigation was a repeated cross-sectional study in which state alcohol policies (operationalized by the Alcohol Policy Scale [APS]) from 1999 to 2014 were related to motor vehicle crash fatalities from 2000 to 2015 using data from the Fatality Analysis Reporting System (1-year lag). Alternating logistic regression models and generalized estimating equations were used to account for clustering of multiple deaths within a crash and of multiple crashes occurring within states. The study also examined independent associations of mutually exclusive subgroups of policies, including consumption-oriented policies vs driving-oriented policies. The study setting was the 50 US states. Participants were 505 614 decedents aged at least 21 years from motor vehicle crashes from 2000 to 2015. Main Outcomes and Measures Odds that a crash fatality was alcohol related (fatality stemmed from a crash in which ≥1 driver had a blood alcohol concentration [BAC] ≥0.08%). Results From 2000 to 2015, there were 505 614 adult motor vehicle crash fatalities in the United States, of which 178 795 (35.4%) were alcohol related. Each 10–percentage point increase in the APS score (corresponding to more restrictive state policies) was associated with reduced individual-level odds of alcohol involvement in a crash fatality (adjusted odds ratio [aOR], 0.90; 95% CI, 0.89-0.91); results were consistent among most demographic and crash-type strata. More restrictive policies also had protective associations with alcohol involvement among crash fatalities associated with BACs from greater than 0.00% to less than 0.08%. After accounting for driving-oriented policies, consumption-oriented policies were independently protective for alcohol-related crash fatalities (aOR, 0.97; 95% CI, 0.96-0.98 based on a 10–percentage point increased APS score). Conclusions and Relevance Strengthening alcohol policies, including those that do not specifically target impaired driving, could reduce alcohol-related crash fatalities. Policies may also protect against crash fatalities involving BAC levels below the current legal limit for driving in the United States.

Aims To evaluate a new method being used by some states for motivating interlock installation by requiring it as a prerequisite to reinstatement of the driver's license. Design The driving records of Florida DWI offenders convicted between July 2002 and June 2008 were analyzed to determine the proportion of offenders subject to the interlock requirement who installed interlocks. Setting Most driving-while-impaired (DWI) offenders succeed in avoiding state laws requiring the installation of a vehicle alcohol interlock. Participants A total of 82 318 Florida DWI offenders. Findings Due to long periods of complete suspension when no driving was permitted and the failure to complete all the requirements imposed by the court, only 21 377 of the 82 318 offenders studied qualified for reinstatement, but 93% of those who qualified did install interlocks to be reinstated. Conclusions Because of the lengthy license suspensions and other barriers that the offenders face in qualifying for reinstatement, it is not clear that requiring a period on the interlock as a prerequisite to reinstating will greatly increase the current installment rate. Language: en

Individuals convicted of driving while impaired (DWI) are high risks. They are two and a half times more likely than the average driver to be the drinking driver in a fatal crash and are responsible for approximately 1,000 alcohol-related fatalities each year. According to traditional means of control, DWI offenders have received jail time and have had their licenses suspended, but jail is expensive, and license suspension has not proved sufficiently effective. Recently, aided by new technologies, courts of law have begun to monitor offenders to ensure abstinence from alcohol and to control their driving through vehicle alcohol interlocks, which require a breath test to start a car. This paper describes these new monitoring programs and discusses the safety, health, and legal issues that they present. Aside from vehicle interlocks, most of these new technological methods have yet to be evaluated, but initial data appear promising. They suggest that even individuals dependent on alcohol can meet the requirements of alcohol-monitoring programs. However, the need for counseling assistance is likely to increase the role of court treatment programs to handle DWI offenders. If monitoring programs prevent recidivism, a new era may begin: current emphasis on license suspension and jail time for drivers convicted for drinking may give way to monitoring programs to control risky driving, with the potential to lower costs to government and reduce intrusion into the lives of offenders.

Introduction The effectiveness of ignition interlocks at reducing drunk driving has been limited by the ability of driving-while-intoxicated (DWI) offenders to avoid court orders to install the devices. Methods In a pilot program in New Mexico, four Santa Fe County judges imposed home confinement (via electronic monitoring bracelets) on offenders who claimed to have no car or no intention to drive. Interlock installation rates for Santa Fe County were compared with all other counties in New Mexico over a 2-year program and 2-year post-program period. Results During the two program years, 70% of the drivers convicted of DWI in Santa Fe County installed interlocks, compared to only 17% in the other counties, but when the program was terminated, the Santa Fe installation rate fell by 18.8 percentage points. Summary Mandating the alternative sanction of house arrest led to the highest reported interlock installation rate for DWI offenders. Impact on Industry Impaired driving is a substantial expense to employers, particularly when it bars driving that interferes with employment. Interlocks provide a method of protecting the public while permitting the offender to drive sober. This study was directed at increasing interlock use by DWI offenders.

To determine whether drivers contacted at the roadside can be screened for alcohol use disorders (AUDs). Secondarily, to produce preliminary estimates of AUDs among drivers and estimate the relationship between AUD status and BAC measured at the roadside.A two-phase survey program was undertaken. In phase 1, 206 motorists were interviewed at the roadside using a 15-item AUD Survey derived from a condensed version of the AUDADIS and the AUDIT-C. One hundred sixty-seven of these motorists were invited, for a $25 incentive, to call the research team within 48 h of the roadside assessment to repeat the questionnaire and complete a more detailed AUD assessment. Phase 2 involved a 6-state pilot test of the AUD Survey as an add-on to the 2005 National Roadside Survey Pilot Program. The setting for both phases of the survey program was US roadways on weekends between 10 p.m. and 3 a.m.Ninety-seven percent of all eligible drivers completed the AUD questionnaire. The correlation between roadside and telephone interview results was 0.3 for alcohol abuse, 0.6 for alcohol dependence and heavy drinking, and 0.7 for binge drinking. Alcohol abuse and dependence diagnoses had 0.6 and 0.7 correlations with diagnoses derived from the full AUDADIS and the AUDIT-C had a 0.8 correlation with the full AUDIT. There was also a statistically significant and positive relationship between having a positive BAC at the roadside and meeting criteria for heavy drinking.AUD status can be effectively measured at the roadside. The poor reliability for alcohol abuse is related to underreporting of drinking and driving during roadside assessments, compared to telephone follow-up. Other measures of hazardous alcohol use should be used in the roadside context to measure alcohol abuse.

Environmental prevention strategies in club settings where music and dance events are featured could provide an important new arena for the prevention of drug use and other risky behaviors (e.g., sexual risk taking, intoxication and drug use, aggression, and driving under the influence). Electronic music dance events (EMDEs) occur in clubs that attract young, emerging adults (18-25 years of age) and attract individuals who engage in various types of drug use. Borrowing from the environmental prevention studies that focus on reducing alcohol use and related problems, a model for drug prevention in the club setting is proposed. Initially, an overview of the relationships between EMDEs and drug use and other risky behaviors are presented. Next, rationales for environmental strategies are provided. Finally, an environmental approach to prevention of drug use and risky behaviors in clubs is described. This comprehensive set of environmental strategies, is designed to be mutually supportive and interactive. Environmental strategies are believed to provide potential for developing an efficacious prevention strategy. The environmental prevention approach presented here is composed of three intervention domains: (1) Mobilization, (2) Strategies for the Exterior Environment, and (3) Strategies for the Interior Environment.

Aims Universities are striving to raise funds, often attracting spectators by selling alcohol at campus events. This study evaluates the effect of a policy change on student drinking at a large western university that had historically banned alcohol on campus but transitioned to permitting the sale of alcohol in some of its facilities. Methods Surveys of student drinking and perceptions of other students' drinking were conducted before, during and after the policy change at the transition university (TU) and compared to similar data from a control university (CU). Surveys of student drinking at on-campus and off-campus venues and observations of alcohol service practices were also conducted. Results The policy change at the TU was introduced cautiously, and sales to underage drinkers were relatively well controlled. Despite this, student drinking rose initially, then declined after 1 year. Perceptions of the amount of drinking by other students increased slightly, but there was no overall measurable increase in student drinking during the first 3 years of the new policy. Conclusions The conservative TU policy-to sell alcohol only at select events and to control sales to minors-may have limited the impact of on-campus alcohol sales on student consumption. Although the study results did not find a stable increase in student drinking, they do not necessarily support the liberalization of campus alcohol policy, because the transition is still 'in progress' and the final outcome has not been evaluated. Language: en

Objective: Seasonality in alcohol consumption has implications for epidemiology and prevention. In this research we examined seasonal, temporal, and contextual variation in drinking among college students at a large West Coast university. Method: We used a field survey (across a 3-year period) to collect anonymous breath alcohol concentrations from students sampled randomly as they walked on and near the campus on weekend nights. Results: After controlling for student demographics, we found that the breath alcohol concentration samples we collected during the spring and winter were significantly higher than those collected during the fall. Subsequent analyses indicated that this difference could be attributed to fewer students drinking in the fall rather than to students consuming smaller quantities of alcohol. Conclusions: Seasonal trends in college student drinking mirror seasonal trends demonstrated in the general population. This research may help guide future intervention or prevention efforts. Language: en

The role of age (youth and driving inexperience) and alcohol as major risk factors in traffic crash causation has been firmly established by numerous studies over the past 50 years. Less well established is how the two variables interrelate to influence crash risk. Some investigations have hypothesized an interactive or synergistic effect in which young drivers with less experience and a greater tendency to take risks are more adversely affected at lower blood alcohol concentrations (BACs) than are older drivers. The evidence for this hypothesis is mixed. Resolution of this issue has important implication for developing countermeasures directed at the young driver crash problem.Case control data previously collected in Long Beach and Fort Lauderdale were reanalyzed using a more sensitive method for detecting interaction effects than used in the original analysis. A conditional logistic regression analyses found a highly significant agexBAC interaction (P.0001) involving differences between drivers under 21 and those 21 and older.The results clearly indicate that positive BACs in drivers under 21 are associated with higher relative crash risks than would be predicted from the additive effect of BAC and age. It is likely that two mechanisms are operating to cause the interaction. First, it seems likely that the crash avoidance skill of young novice drivers would be more adversely affected by alcohol due to their driving inexperience, immaturity, and less experience with alcohol. Second, drivers under 21 who choose to drink and to drive after drinking probably have pre-existing characteristics that predisposed them to risk taking and crash involvement apart from any increased vulnerability to alcohol impairment.The results support increased enforcement of zero-tolerance BAC laws for minors.

Zero tolerance (ZT) laws have been effective in reducing alcohol-related crashes among underage drivers. However, enforcement in some states has not been rigorous, and ZT offenses may not be viewed as serious offenses. On July 1, 1994, the state of Washington implemented a ZT law that allowed police to request a test for alcohol on suspicion of either a ZT or driving-under-the-influence (DUI) offense. The present study examined effects of the ZT law on arrests and case dispositions among underage offenders as a function of blood alcohol concentration (BAC) and post-law patterns of recidivism.Times-series analyses examined the effects of the ZT law on trends in arrests of underage drivers between 1991 and 1999. Based on arrest records matched with driver's license records, the effects of the law on dispositions of alcohol-related offenses among underage drivers were examined, and rates of recidivism among underage offenders were examined for the period following the ZT law.There was a substantial increase in arrests of underage drivers beginning immediately after implementation of the ZT law, especially among drivers with low BACs. The types of court or administrative dispositions received by underage offenders changed markedly after the ZT law was implemented. Underage offenders with lower BACs became far more likely to receive alcohol-related convictions and/or license suspensions. However, the percentage of underage offenders with higher BACs receiving DUI convictions declined as some of these offenders received the lesser ZT disposition. After the ZT law, underage offenders with BACs of 0.10 g/dL or higher were more likely to recidivate than those with lower BACs, but appreciable proportions of drivers were re-arrested for another alcohol offense, whatever the BAC and however they were penalized.Implementation of Washington's law indicates that a ZT law can increase the likelihood that an underage person will be sanctioned for drinking and driving. However, recidivism remains an issue as more than one in four underage drivers arrested with low BACs subsequently were re-arrested.

Portal survey techniques involve multimodal assessments (e.g., self-report, biologic, and observational) in high-risk drinking and drug-use settings. Our investigation expanded the portal survey methodology to include follow-up assessments of emerging adult women recruited at the border as they cross to and from Mexico south of San Diego, California. The feasibility of the follow-up procedure was established, and the limitations of the technique clarified. Follow-up participants and nonparticipants did not differ by age or reported victimization. Data indicated that 8% of women experience negative events on their return to the United States after a night of binge drinking. These experiences could only be captured in a follow-up survey, as they happened after participants left the border area.