Retail alcohol monopolies, underage drinking, and youth impaired driving deaths

OBJECTIVE: To explore associations of state retail alcohol monopolies with underage drinking and alcohol-impaired driving deaths. DATA: Surveys on youth who drank alcohol and binge-drank recently and their beverage choices; census of motor vehicle fatalities by driver blood alcohol level. METHODS: Regressions estimated associations of monopolies with under-21 drinking, binge drinking, alcohol-impaired driving deaths, and odds a driver under 21 who died was alcohol-positive. RESULTS: About 93.8% of those ages 12-20 who consumed alcohol in the past month drank some wine or spirits. In states with a retail monopoly over spirits or wine and spirits, an average of 14.5% fewer high school students reported drinking alcohol in the past 30 days and 16.7% fewer reported binge drinking in the past 30 days than high school students in non-monopoly states. Monopolies over both wine and spirits were associated with larger consumption reductions than monopolies over spirits only. Lower consumption rates in monopoly states, in turn, were associated with a 9.3% lower alcohol-impaired driving death rate under age 21 in monopoly states versus non-monopoly states. Alcohol monopolies may prevent 45 impaired driving deaths annually. CONCLUSIONS: Continuing existing retail alcohol monopolies should help control underage drinking and associated harms.     

Unlicensed driving and other related health risk behaviors: A study of Montana high school students

Purpose

Health risk behaviors tend to cluster in young people, not least among young drivers. Less is known about the health risk profile of young unlicensed drivers. This study investigates health risk behaviors among young unlicensed drivers compared to both their licensed and driving peers, and their non-driving peers.

Methods

High school students participating in the Youth Risk Behavior Surveillance System in Montana (US) and age-eligible to have a driver's license were studied (n = 5985), categorized according to their self-reported car driving and license practice (licensed driving, unlicensed driving, and non-driving). Ten health risk behaviors, of which four were related to car riding/driving, were considered. Multinomial logistic regression was used to compile sex-specific odds ratios (with 95% confidence intervals) of adopting those behaviors using licensed drivers as a reference and adjusting for age and race/ethnicity.

Results

Health risk behaviors tended to be more common among unlicensed drivers than other groups, although some behaviors were prevalent in all groups (i.e., alcohol use and lack of seat belt use). As a consequence, for both male and female students, there was a significant association between unlicensed driving and most health risk behaviors, except for being involved in a physical fight and riding with a drinking driver among female students.

Conclusions

Young unlicensed drivers are more likely than licensed drivers to adopt several health risk behaviors both in car driving/riding or otherwise, in particular alcohol use and cigarette smoking. This challenges any simplistic approach as unlicensed driving in youth is not an isolated act suggesting public health and traffic safety initiatives.     

Unsafe motor vehicle practices among substance-using college students

This study examines the relationship between substance use and behaviors that increase the risk for motor vehicle crashes and crash-related injuries. The investigation uses National College Health Risk Behavior Survey data collected in 1995 by the Centers for Disease Control and Prevention. These data are representative of 2- and 4-year undergraduate college students in private and public colleges and universities in the United States. Smokers, episodic heavy drinkers, marijuana users and users of illegal drugs in combination with alcohol were significantly more likely to drive after drinking alcohol and ride with a driver who had been drinking alcohol and significantly less likely to wear safety belts while driving or while riding in a car as a passenger. This study indicates that college students who are substance users are more likely to behave in a manner which increases their risk for motor vehicle crashes and motor vehicle crash injuries.     

Correlation between modes of drinking and modes of driving as reported by students at two American universities

This paper examines the correlates and predictors of driving under the influence behaviors (DUIBs) during the past month by college students. Measures of heavy episodic drinking, monthly drinking frequency, monthly drinking variance, monthly drinks per occasion and reported marijuana use are compared as predictors net of other predictive factors. A cross-sectional telephone survey was conducted with college students by a university social science research laboratory. Respondents attended two large public universities located in the southwestern part of the US. Participants included 803 randomly selected college students. The interview schedule included items from the Core Alcohol and Drug Survey and the College Alcohol Risk Assessment Guide. Several additional last-drinking-event items were also developed for the interview. Bivariate analyses indicate that marijuana use (past year), heavy episodic drinking, reports of DUIBs (driving under the influence or riding with a driver who is under the influence) in the past year, monthly frequency of drinking, the average number of drinks consumed when drinking and age are correlates of DUIBs during the past month. Multivariate analyses indicate past year DUIBs, monthly frequency of drinking and monthly marijuana use predicted recent DUIB.     

Age of drinking onset, driving after drinking, and involvement in alcohol related motor-vehicle crashes.

This study assessed whether persons who begin drinking at younger ages are more likely to report drunk driving and alcohol-related crash involvement over the life course, even after controlling analytically for diagnosis of alcohol dependence, years of drinking alcohol, and other personal characteristics associated with the age respondents started drinking. A national survey asked 42,862 respondents the age that they started drinking, whether they drove after drinking too much, and whether they were in motor-vehicle crashes because of their drinking. This analysis focused on 27,081 (65%), who reported ever drinking in their lifetime. The earlier the age respondents started drinking, the more likely they were to report driving after drinking too much and being in a motor-vehicle crash because of their drinking even after adjusting for current/ever diagnosis of alcohol dependence, number of years respondents had been drinking, and other characteristics and behaviors associated with the age respondents started drinking. Particularly, among persons who were never alcohol-dependent, those who began drinking in each age group under 21, relative to those starting at age 21 or older, were more likely to report "ever" and "in the past year" being in a crash after drinking too much. The traffic safety benefits of delaying drinking may extend well beyond the legal drinking age of 21.     

Alcohol-impaired driving behavior and sensation-seeking disposition in a college population receiving routine care at campus health services centers

Accidents stemming from alcohol-impaired driving are the leading cause of injury and death among college students. Research has implicated certain driver personality characteristics in the majority of these motor vehicle crashes. Sensation seeking in particular has been linked to risky driving, alcohol consumption, and driving while intoxicated. This study investigated the effect of sensation seeking on self-reported alcohol-impaired driving behavior in a college student population while adjusting for demographics, residence and drinking locations. A total of 1587 college students over the age of 18 completed a health screening survey while presenting for routine, non-urgent care at campus heath services centers. Student demographics, living situation, most common drinking location, heavy episodic drinking, sensation-seeking disposition and alcohol-impaired driving behavior were assessed. Using a full-form logistic regression model to isolate sensation seeking after adjusting for covariates, sensation seeking remains a statistically significant independent predictor of alcohol-impaired driving behavior (OR = 1.52; CI = 1.19-1.94; p < 0.001). Older, white, sensation-seeking college students who engage in heavy episodic drinking, live off-campus, and go to bars are at highest risk for alcohol-impaired driving behaviors. Interventions should target sensation seekers and environmental factors that mediate the link between sensation seeking and alcohol-impaired driving behaviors.     

A population-based study on the prevalence and correlates of drinking and driving in Hong Kong

To examine the prevalence and correlates of drinking and driving in Hong Kong, an anonymous, random telephone survey was conducted on 9860 Chinese adults (18-70 years of age) from April to June 2006. Trained interviewers administered a structured interview consisting of questions on socio-demographic information, drinking pattern, drink-driving, and motor vehicle accidents. The census age-standardized past-year prevalence of driving within 2 h of drinking was 5.2% among males and 0.8% among females. The prevalence across age showed an inverted U-shaped trend for males peaking at 8.2% between 41 and 45 years. For females the prevalence was fairly stable between the ages of 20 and 55. The past-year prevalence of alcohol-related motor vehicle accidents was 0.1%, with the majority being in the 26-30 age group. For males who drank, the prevalence of drinking and driving was 5.0% among those without problem drinking, 14.8% among binge drinkers, 37.1% among alcohol abusers and 22.4% among the alcohol dependent. For females who drank, the corresponding figures were all lower at 1.2%, 6.9%, 12.1% and 12.5%, respectively. Higher socio-economic status, weekly drinking, binge drinking and alcohol abuse were independently associated with higher likelihood of drinking and driving in both genders. Among drinking drivers, having a job that required drinking was the only predictor of having had a motor vehicle accident. The elevated prevalence of drinking and driving among alcohol abusers, binge drinkers and the alcohol dependent may portend higher population-level rates of alcohol-related motor accidents in the future since the prevalence of problem drinking has previously been noted to be increasing rapidly in Hong Kong.     

Trends in alcohol-impaired driving in Canada

While a general decreasing trend in the number of persons killed in a traffic crash involving a drinking driver has occurred in Canada since the 1980s, it is evident that much of this decrease occurred in the 1990s. Since 2002, less progress has been made as the number of persons killed in crashes involving drinking drivers remains high. To better understand the current situation, this paper describes trends in drinking and driving in Canada from 1998 to 2011 using multiple indicators based on data collected for the Traffic Injury Research Foundation's (TIRF) Road Safety Monitor (RSM), the National Opinion Poll on Drinking and Driving, and trends in alcohol-related crashes based on data collected for TIRF's national Fatality Database in Canada. There has been a continued and consistent decrease in the number of fatalities involving a drinking driver in Canada. This remains true when looking at the number of fatalities involving a drinking driver per 100,000 population and per 100,000 licensed drivers. This decreasing trend is also still apparent when considering the percentage of persons killed in a traffic crash in Canada involving a drinking driver although less pronounced. Data from the RSM further show that the percentage of those who reported driving after they thought they were over the legal limit has also declined. However, regardless of the apparent decreasing trend in drinking driving fatalities and behaviour, reductions have been relatively modest, and fatalities in crashes involving drivers who have consumed alcohol remain high at unacceptable levels.     

Driving under the influence of alcohol: Examining ethno-specific rates and the mediating effects of psychological distress and harmful and problematic drinking

This paper examines ethnic disparities in rates of driving under the influence of alcohol (DUIA) in a representative sample of Ontario adults. Data were drawn from the Centre for Addiction and Mental Health (CAMH) Monitor, a survey of 8276 Ontario adults aged 18 and older. We considered 19 distinct ethnic groups based on participants’ self-identification of ethno-cultural heritage. Differences in the prevalence of DUIA across ethnic groups were limited. Relative to other ethnic groups, those adults who identified as Irish had a significantly higher rate of DUIA, while those of Italian and Chinese ethnicity had significantly lower rates of DUIA. The mediating effects of psychological distress (General Health Questionnaire) and harmful and problematic drinking (Alcohol Use Disorders Identification Test [AUDIT] consumption, dependence and problems) on the direct relationship between ethnic identity and impaired driving were also considered. Mediation was observed as remaining ethnic differences in DUIA disappeared when AUDIT subscales were introduced. These findings are interpreted in the context of patterns of alcohol consumption among ethnic populations and their impact on DUIA. Implications of study findings are considered with respect to the role of ethnicity in impaired driving research and its impact on programs and policies directed at reducing impaired driving.     

Examination of factors determining fault in two-vehicle motorcycle crashes

Motorcycle crashes frequently involve a combination of high-risk behaviors by the motorcyclist or the other crash-involved driver. Such behaviors may include riding or driving without appropriate licensure or while under the influence of alcohol, as well as deciding not to use a safety device such as a helmet or safety belt. Given that these factors frequently occur in combination with one another, it is difficult to untangle the specific effects of individual factors leading up to the crash outcome. This study assesses how various rider-, driver-, and other crash-specific factors contribute to at-fault status in two-vehicle motorcycle crashes, as well as how these same factors affect the propensity for other high-risk behaviors. Furthermore, the interrelationships among fault status and these other behaviors are also examined using a multivariate probit model. This model is developed using police-reported crash data for the years 2006–2010 from the State of Ohio. The results show that younger motorcyclists are more likely to be at-fault in the event of a collision, as are riders who are under the influence of alcohol, riding without insurance, or not wearing a helmet. Similarly, motorcyclists were less likely to be at-fault when the other driver was of younger age or was driving under the influence of alcohol, without insurance, or not wearing their safety belt. Crash-involved parties who engaged in one high-risk behavior were more likely to engage in other such behaviors, as well, and this finding was consistent for both motorcyclists and drivers. The results of this study suggest that educational and enforcement strategies aimed at addressing any one of these behaviors are likely to have tangential impacts on the other behaviors, as well.     

Impaired driving and motor vehicle crashes among Swedish youth: an investigation into drivers' sociodemographic characteristics

Impaired driving is an important road safety problem, and the characteristics of drivers impaired by alcohol or drugs are relevant to targeted interventions. This study considers young drivers' sociodemographic attributes: age, sex, class of origin and educational attainment, based on a national cohort of young Swedish drivers (1988-2000) followed up in police registers for their first motor vehicle crash. Of all crashes reported for these drivers, 946 were where the driver was suspected of being under the influence of alcohol or other substances (corresponding to 6% of all first crashes). Impaired driving significantly increases the odds of severe and fatal injuries, regardless of sociodemographic attributes. Observed differences in the proportions of impaired drivers reveal significant excess risks among males, persons aged 18-19, those from households classified as "workers" and "others" (including, e.g. the long-term unemployed and those on long-term sick leave), and those with low educational attainment. Impaired driving is a risk factor in all sociodemographic strata among young people. Members of some groups are more likely to be found than others among impaired drivers on occasion of first motor vehicle crash.     

Drinking and driving among Mexican American and non-Hispanic white males in Long Beach,California

Although drinking and driving in the United States has declined substantially during the past two decades, this trend has not been seen among Hispanic drivers. Higher rates of driving while impaired (DWI) arrests and alcohol-related crashes, particularly among Mexican Americans, also have been noted. The extent to which this reflects a lack of understanding of DWI laws rather than a disregard for them is unknown. A survey was conducted among Mexican American and non-Hispanic white male DWI arrestees in Long Beach, California, to ascertain alcohol use, attitudes toward drinking and drinking and driving, and knowledge of DWI laws. The findings were compared with those of Mexican American and non-Hispanic white males recruited from the local community. Mexican American males, both DWIs and those from the community, reported heavier drinking than non-Hispanic white males. All four groups of respondents tended to underestimate the number of drinks needed to achieve the blood alcohol concentration (BAC) threshold at or above which it is illegal to drive under California law. Estimations were around 2-3 drinks rather than a more realistic estimate of 4-5 drinks. However, Mexican American DWIs and their comparison group vastly overestimated the number of drinks to make them unsafe drivers (8- 10 drinks). Furthermore, fewer than half were aware of the BAC threshold in California (0.08%) compared with between 60 and 78% of non-Hispanic whites. This study is limited in scope and needs to be replicated in other communities and with other racial/ethnic groups. However, the clear lack of knowledge of the DWI law in California and a lack of understanding of the relationship between number of drinks and BAC point to the need for culturally sensitive programs that are developed and implemented within the Mexican American community.     

Drive-up liquor windows and convicted drunk drivers: a comparative analysis of place of purchase

This study examined alcohol purchase locations of convicted drunk drivers to determine the characteristics and arrest circumstances of offenders who bought alcohol at a drive-up liquor window compared with those who obtained alcohol elsewhere. Logistic regression analyses were used to assess the relationship between purchase location and the characteristics of 2,544 drunk drivers convicted in Santa Fe, NM, from 1986 to 1995. Analyses were performed to determine whether the place of purchase was related to arrest circumstances. The results revealed that drive-up windows were the preferred place of purchase of package liquor by offenders who bought the alcohol that they drank prior to arrest. The odds of being Hispanic (p<0.0001), a high-risk problem drinker (p<0.01), and drinking in the vehicle prior to arrest (p<0.01) were significantly higher for drive-up window users than for offenders who purchased package liquor elsewhere. Based on these analyses, this study concludes that a statistically significant relationship exists between the use of drive-up windows and certain high-risk drinking behaviors. This increased use among vulnerable populations suggests that drive-up windows may facilitate alcohol misuse in these populations and thereby contribute to drunk driving.     

Evaluating a model linking assessed parent factors to four domains of youth risky driving

Motor vehicle collisions are the leading cause of death in youth aged 15–19. Research has consistently shown that driver education programs do not result in safer youth driving. Indeed, the biggest predictor of collisions involving youth is parental history of collisions. The current study examined how parental modeling of and teaching about risky driving behaviors related to youth practices within four domains of risky driving (aggressive, substance use, distracted, moving violations), and evaluated whether the Prototype-Willingness Model explains links from parent to teen driving practices. Participants (N = 432) were undergraduate students (mean age 18 years, age range 17–22 years) who had obtained their G2 driver's license within the past year; the G2 driver's license allows youth to drive alone on all municipal roads, with some restrictions on their blood alcohol level and the number of passengers they can carry. Results revealed that parental modeling was more predictive than parental teaching for all domains of risky driving examined. Youth whose parents modeled risky driving behaviors were found to be more likely to have engaged in those risky driving behaviors in the past, as well as to be more willing to engage in the behaviors in the future. The Prototype-Willingness Model was not a good fit to explain these relations. Findings from this study highlight the role parents play in the development of youth risky driving practices.     

Identifying social mechanisms for the prevention of adolescent drinking and driving

This study identifies social mechanisms that might help prevent youth from being involved in driving under the influence of alcohol (DUI) and riding with drinking drivers (RWDD). Data collected through telephone surveys with 1534 adolescents and young adults aged 15-20 years (mean=17.6, S.D.=1.6) in California, USA, were analyzed. Structural equation modeling analyses showed that DUI and RWDD were strongly related to drinking in unstructured situations, modeling of DUI by peers and parents, and perceived peer approval or disapproval of DUI. DUI outcome expectancies were indirectly related to DUI and RWDD through situational drinking. Parental monitoring and DUI law enforcement were also indirectly related to DUI and RWDD through DUI expectancies and other mechanisms. The findings, overall, suggest that parental influence remains important even through late adolescence. Parental monitoring, in particular, might help to reduce unstructured socializing with peers, drinking, and affiliation with peers who engage in DUI. Parental monitoring may also foster beliefs about the risks of DUI. Conversely, parents' own DUI behavior may normalize drinking and DUI behaviors, thus countering monitoring efforts.     

Is an armed society a polite society? Guns and road rage

BACKGROUND: While concerns about road rage have grown over the past decade, states have made it easier for motorists to carry firearms in their vehicles. Are motorists with guns in the car more or less likely to engage in hostile and aggressive behavior? METHODS: Data come from a 2004 national random digit dial survey of over 2,400 licensed drivers. Respondents were asked whether, in the past year, they (1) made obscene or rude gestures at another motorist, (2) aggressively followed another vehicle too closely, and (3) were victims of such hostile behaviors. RESULTS: Seventeen percent admitted making obscene or rude gestures, and 9% had aggressively followed too closely. Forty-six percent reported victimization by each of these behaviors in the past year. Males, young adults, binge drinkers, those who do not believe most people can be trusted, those ever arrested for a non-traffic violation, and motorists who had been in a vehicle in which there was a gun were more likely to engage in such forms of road rage. CONCLUSION: Similar to a survey of Arizona motorists, in our survey, riding with a firearm in the vehicle was a marker for aggressive and dangerous driver behavior.     

Driving under the influence of alcohol or drugs among adolescents: The role of urban and rural environments

This study aimed to describe driving under the influence of alcohol or drugs (DUIAD) and riding in a vehicle with a driver under the influence of alcohol or drugs (RDUIAD) and their associated factors among rural and urban adolescents in Spain. We performed a cross-sectional study including 2067 students from Barcelona and a rural area 60 km north of this city. The prevalences of ever DUIAD and RDUIAD were 17% and 41% among 17–18 year-old adolescents. DUIAD was more common in boys. Living in the rural area was independently associated with these behaviours. Exposure to these behaviours is common among Spanish adolescents, especially in rural areas.     

Temporal distribution of motorcyclist injuries and risk of fatalities in relation to age, helmet use, and riding while intoxicated in Khon Kaen, Thailand

This study investigated the temporal distribution of risky behaviors among injured motorcyclists, that is, riding unhelmeted or while intoxicated, and showed how they are associated with risk of fatal injuries. Data of motorcyclists injured in Khon Kaen municipality in northeastern Thailand and transferred to Khon Kaen Regional Hospital were obtained from the trauma registry system of the hospital. Case fatalities were compared by time of day, age group, helmet use, and alcohol intoxication. Unhelmeted riding peaked late in the evening and riding while intoxicated peaked around midnight. Both were associated with increased fatality risk after stratification by time of day; the odds ratios were 3.49 (95% confidence interval (CI) = 1.48-9.36) and 3.01 (CI = 1.71-5.19), respectively. Nighttime injuries were not significantly associated with increased fatality risk after stratification by helmet use or alcohol intoxication. Unhelmeted driving was prevalent and associated with higher fatality risk among younger drivers, whereas intoxicated driving was less prevalent among teens but associated with increased risk among those aged 20-39 years. This study shows that riding unhelmeted or while intoxicated can explain the increased fatality risk at night, suggesting that safety education or enforcements should be targeted at specific age groups and appropriate times.     

Race,Hispanic origin,and socioeconomic status in relation to motor vehicle occupant death rates and risk factors among adults

Black and Hispanic adults travel less in motor vehicles than whites but may be at greater risk when they do travel. Passenger vehicle occupant deaths per 10 million trips among persons ages 25-64 were computed by race, Hispanic origin, gender, and socioeconomic status (SES) using 1995 data from the Fatality Analysis Reporting System (FARS) and Nationwide Personal Transportation Survey. Educational level was used as the indicator of SES. Blacks, particularly black men, were at increased risk of dying relative to whites when traveling in motor vehicles (rate ratio (RR) for black men=1.48; 95% confidence interval (CI)=1.42-1.54). Hispanic men, but not Hispanic women, also had elevated occupant death rates, but their risk was less than that of black men (RR=1.26; 95% CI=1.20-1.31). SES was the strongest determinant of occupant deaths per unit of travel; RRs among those who had not completed high school were 3.52 (95% CI=3.39-3.65) for men and 2.79 (95% CI=2.69-2.91) for women, respectively. Whites without high school degrees had the highest death rates per 10 million trips. After adjustment for SES, the elevated risk of occupant fatalities persisted among black men and women, but not among Hispanic men. Seat belt use and alcohol-impaired driving were examined among fatally injured passenger vehicle drivers. Among those with no education beyond high school, higher percentages were reported as having high blood alcohol concentrations (BACs) or having not used belts. Reported belt use rates were lower among black men and women, even after controlling for SES, whereas Hispanic men and women had belt use rates similar to those of whites. High BACs were more common among Hispanic men, which appeared largely to be an effect of SES because most Hispanic men killed in crashes had not completed high school, the education level with the highest percentage that drove while impaired by alcohol. More effective public health efforts are needed to reduce occupant deaths among persons of lower SES, blacks, and Hispanics, including measures to increase use of seat belts and reduce alcohol-impaired driving.