August 14, 2017

Strong Policies Lower Drunk Driving Deaths

Stronger alcohol policies protect young people from dying in crashes caused by drunk driving according to researchers at Boston Medical Center. The study, which is published online in the journal Pediatrics, supports the importance of comprehensive alcohol control policies to reduce the number of young people who die in alcohol-related crashes.

Motor vehicle crashes are a leading cause of death among young people in the United States. Forty percent of deadly car crashes involve a drunk driver in Massachusetts, and the state falls within the top twenty-five percent for rates of young people killed in a drunk driving crash.

"Half of all young people who die in crashes are driven by someone who has been drinking," says lead author Scott Hadland, MD, a pediatrician at BMC and the study's corresponding author. "But with stronger alcohol policies at the state level, we saw a significantly lower likelihood of alcohol-related deaths."

The Alcohol Policy Environment

The study used an alcohol policy scale that assessed 29 alcohol policies across the United States, which were designed to reduce alcohol consumption or prevent impaired driving, and cross referenced them with the number of people under 21 who died in crashes involving alcohol, approximately 85,000, over the course of 13 years. States were ranked based on how restrictive their alcohol laws were, including higher alcohol taxes and zero-tolerance policies for young people drinking and driving.

"We've seen research that shows the relationship between specific alcohol laws and drunk driving deaths, but no one has looked at the broader picture of the policy environment in different states," said Timothy Naimi, MD, MPH, a general internal medicine physician and alcohol epidemiologist at BMC who served as senior author of the study.

More Restrictive Laws, Fewer Deaths

Researchers found as state alcohol laws became more restrictive, the likelihood of a young person being killed in a drunk driving crash decreased and led to less alcohol consumption as a whole. Additionally, almost half of underage youth who died in alcohol-related crashes were passengers, not drivers; and about 80% of those passengers were being driven by adults aged 21 or older who had been drinking.

Most of the deadly crashes happened during the weekend, in the evening or at night. The impact of state alcohol policies on drunk driving deaths was consistent for males and females, and generally held for both drivers and passengers.

Alcohol Control Clearly Matters

"When it comes to preventing impaired driving and deaths of young people, alcohol control policies clearly matter," says Hadland, who is also an assistant professor of pediatrics at Boston University School of Medicine. "We found that those policies don't have to necessarily be ones that prevent drunk driving, or that specifically target young people."

"Since most young people who died as passengers in a car were driven by an adult over 21 who had been drinking, alcohol laws that prevent adult drinking are also critical," said Naimi who is also an associate professor of medicine and public health at Boston University School of Medicine and Public Health. "We must also focus on strategies that reduce excessive drinking, rather than focusing exclusively on interventions to prevent driving among those who are already impaired."

Posted by Webmaster at 03:19 AM

Ignition Interlock Devices Reduce Fatal Crashes

State laws requiring ignition interlocks for all drunk driving offenders appear to reduce the number of fatal drunk driving crashes, a new study by Johns Hopkins Bloomberg School of Public Health and Colorado School of Public Health researchers suggests.

The study -- published in the American Journal of Preventive Medicine -- found that mandatory interlock laws were associated with a seven percent decrease in the rate of fatal crashes with at least one driver with a blood alcohol content over the legal limit. The decrease translates into an estimated 1,250 prevented fatal crashes in states with mandatory interlock laws since states first started passing such laws in 1993.

An ignition interlock is an alcohol-sensing device, connected to the ignition of a vehicle, which detects alcohol in the driver's breath. If alcohol in excess of a preset limit is detected by the sensor, the vehicle will not start. While all 50 states have some type of ignition interlock laws, 26 have mandatory laws requiring all individuals convicted of a DUI offense to use an interlock in order to drive legally, as of March 2016.

Mandatory Interlocks for All Are Most Effective

This is the first study to look at all the different types of interlock laws across all 50 states. The researchers found that interlock laws which are mandatory for all DUI offenders were much more effective than those applicable to only some offenders, such as only repeat offenders or those with a very high blood alcohol content.

In the United States in 2014, alcohol-involved fatal motor vehicle crashes caused approximately 10,000 deaths, about one-third of all motor vehicle crash deaths.

Interlock Laws Save Lives

"Our study demonstrates the value of mandatory ignition interlock laws across the United States," says study leader Emma E. "Beth" McGinty, PhD, MS, deputy director at the Johns Hopkins Center for Mental Health and Addiction Policy Research at the Bloomberg School. "We already know that alcohol plays a tragic role in the number of motor vehicle crash fatalities each year. Interlock laws which are mandatory for all DUI offenders save lives. "

To estimate the effects of existing ignition interlock laws, the researchers studied the effects of interlock laws on trends in alcohol-involved fatal crashes over a 32-year period, 1982 to 2013, and controlled for other motor vehicle safety laws and trends in crashes over time. The team assessed changes in pre- and post-interlock law rates of alcohol-involved fatal crashes with crash data obtained from the National Highway Traffic Safety Administration's Fatality Analysis Reporting System (FARS), and measured them against the different categories of interlock laws: permissive (at the discretion of a judge), partial (applicable to only some DUI offenders), and mandatory for all.

More States Adopting Interlock Laws

The researchers used two measures based on FARS data: alcohol-involved fatal crashes with a driver having a blood alcohol level of 0.08--the legal limit--and a second data set with a driver with a blood alcohol level greater than 0.15.

"Until recently, there hasn't been any evidence on whether these laws prevent alcohol-involved fatal crashes, and specifically whether mandatory/all laws are more effective than permissive and partial laws," McGinty says. "Our study suggests that they are effective, and it's encouraging to see more and more states moving towards this evidence-based policy change. Since 2005, we've seen over 20 states adopt interlock laws for all drunk-driving offenses. We'd like to see the remaining states follow suit."

Posted by Webmaster at 03:06 AM

August 13, 2017

Delay in License Reinstatement Signals High Risk

Driver's license suspension has become the most widely used as well as effective method for incapacitating individuals who have been convicted of driving under the influence (DUI). A new study has found that encouraging license reinstatement with continued controls, such as interlocks as a condition of reinstatement, may be effective as long as they do not extend delays.

Results were published in Alcoholism: Clinical & Experimental Research.

Driver's License Suspension Reduces Recifivism

"Suspension of driving privileges is the major standard sanction for an impaired driving offense in the western world," explained Robert B. Voas, senior scientist and director of the Impaired Driving Center at the Pacific Institute for Research and Evaluation (PIRE). "Jail is used in most countries for multiple offenders and problem cases such as involvement in a crash causing injuries. But jail terms are generally too short to significantly reduce the risk the driver presents to the driving public. Research clearly shows that suspension reduces recidivism when compared to not suspending the offender, but it is far from a perfect system since studies show that up to 75 percent of offenders report illicit driving."

"The value of the sanction partly depends on drivers regarding a proper driving license as having great value," observed Paul R. Marques, senior research scientist with the Impaired Driving Center at PIRE. "Unfortunately it seems in recent years there are many more drivers who find the benefit of driving unlicensed to be an acceptable low-risk thing to do, probably because the perceived risk of consequences is small. This becomes a public danger for several reasons, not least of which is that an unlicensed driver is usually an uninsured driver. If we cannot adequately enforce license suspension, and if drivers do not feel threatened by loss of their licenses, then suspension cannot serve its intended purpose of restricting road use to those who abide by the laws."

50 Percent Delay Getting License Back

Researchers analyzed the driving records of 40 million drivers three million of whom were convicted of DUI from seven of the largest U.S. states during a seven-to14-year period of time.

"We found that 50 percent of second offenders delay reinstating for more than a year," said Voas. "Those that delay have higher recidivism rates after they are reinstated, suggesting but not demonstrated in this study that they will have higher crash rates. Additionally, one third of second offenders will never reinstate."

Alcohol-Involved Driving

"Maybe the single most interesting finding from this study is the relationship between risk indicators of impaired driving and the longer time delay in reinstatement after becoming eligible to reinstate," said Marques. "Drivers with more alcohol citations are less likely to reinstate promptly when eligible. What can we do to reduce the risk these drivers pose to the average road user? We need to either substantially increase monitoring and enforcement, and/or use other ways to control alcohol-involved driving."

Who are the DUI offenders who delay reinstatement after they become eligible? "It is probable that those who delay may do so because they have not satisfied other requirements such as attending and completing treatment, paying their fine, or meeting with their probation officer," said Voas. "Research suggests that failure to meet these responsibilities is an indication that they are more likely to resist conforming to rules and regulations generally, including traffic laws. They may also have more serious drinking problems which make it less likely that they can separate their drinking from their driving."

Repeat Offenders More Likely to Delay

"The delay in reinstatement is also correlated with having had more prior DUI convictions multiple offenders are more likely to delay than first-time offenders and those with more prior convictions generally have more future convictions," added Marques. "But also, there are usually more conditions placed on reinstatement for those perceived as having higher risk. There may be a break point where some offenders just do not want to bother with the burden of proper relicensing. We should not be making the relicensing process so onerous that we force people out of compliance with the laws."

Conversely, who are the DUI offenders who do reinstate? "Conforming to the requirements imposed by the courts and motor vehicle departments in a timely manner suggest that these individuals have taken advantage of treatment and other intervention programs provided by the state and have better control over their own behavior," said Voas. "The fact that first offenders, who have fewer drinking problems, are less likely than multiple offenders to delay suggests that the level of the offenders' drinking problem plays a role."

Driving While Suspended

People have different reasons to conform, observed Marques. "If you have a certain satisfaction with your life and want to retain privileges, conveniences, and fulfill responsibilities, then meeting the administrative and legal expectations around reinstatement is a no-brainer," he said. "Simply enough, those more invested in social norms are more apt to do things that are normative. For those who are more marginalized, whether through choice, income or opportunity, the risk-benefit ratio of either not relicensing, or choosing to drive while suspended, will be different."

"Our findings suggest that more attention should be given to DUI sanctions that maintain contact with the offender following reinstatement such as vehicle alcohol interlocks," said Voas. "The results also suggest that offenders who have delayed several months beyond their nominal reinstatement date might be reminded of the importance of reinstating, and of the sanctions for illicit driving."

"Our roadways are the national commons," added Marques. "It is silly to imagine that we can bring DUI behavior under control just by making laws that are more punitive or restrictive. The evidence developed by Voas and colleagues provides an estimate of problem magnitude and should ideally form the basis for policy innovations."

Posted by Webmaster at 09:34 AM