Getting to Zero Alcohol-Impaired Driving Fatalities A Comprehensive Approach to a Persistent Problem (2018) / Chapter Skim
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1 Introduction and Context
1 Introduction and Context
Pages 29-62
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. Alcohol-impaired driving is a growing public health and safety problem that transcends the transportation, law enforcement, and clinical systems.
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This report presents these interventions and opportunities. To accelerate progress to reduce alcohol-impaired driving fatalities, the National Highway Traffic Safety Administration (NHTSA)
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. Now the number of deaths from alcohol-impaired driving fatalities is beginning to rise again (although as a proportion of all traffic fatalities, the percentage has stayed about the same for alcohol-impaired driving)
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.2 In 2013, the United States had the second highest percentage of traffic fatalities attributed to alcohol-impaired driving (31 percent) when compared to 18 other high-income countries; other countries' 2 The Redelmeier and Detsky (2017)
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less of an outlier. Alcohol-impaired driving is an important health and social issue as it remains a major risk to Americans' health today, surpassing deaths per year of certain cancers,3 HIV/AIDS,4 and drownings,5 among others (CDC, 2016b, 2017b,c,f)
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• ural areas are disproportionately affected by alcohol-impaired driving crashes R and fatalities. • ike smoking, there are secondhand effects of alcohol-impaired driving in L which the injured have no voice in the harmful decision.
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and Subramanian (2002) , in 1982, which was the first year that alcoholimpaired driving was included in the current system for estimating the number of traffic fatalities in the United States, alcohol-impaired driving caused 26,173 deaths -- the highest number recorded to date (Voas and Lacey, 2011)
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Why Now? Social, technological, financial, and clinical changes provide a timely opportunity to reinvigorate successful efforts to reduce alcohol-impaired driving injuries and deaths.
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. ABOUT THIS REPORT The Committee's Approach Though recognizing that alcohol-impaired driving is a crime, and that enforcement and criminal justice approaches are critically important, the committee takes a holistic public health approach.
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There are many contextual factors that may affect alcohol use and driving, but for the purpose of this report the committee primarily discusses interventions directly related to the prevention of alcohol-impaired driving crash fatalities. This includes precrash interventions, such as alcohol policies that affect price and physical availability of alcohol and alcohol consumption, alternative transportation and ridesharing options that may affect whether an impaired person chooses to drive, and enforcement policies such as ignition interlocks for repeat offenders that may affect whether an impaired person drives once in his or her vehicle.
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However, the extensive literature on alcohol-impaired driving demonstrates a causal effect between impaired driving and increased risk for motor vehicle crashes and fatalities (Blomberg et al., 2005; Compton and Berning, 2015; Voas and Lacey, 2011)
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is also a useful framework for understanding alcohol-impaired driving and how to prevent it, as the model reflects the interactions among individual, interpersonal, community, institutional, and societal levels, and it presents opportunities for potential interventions in each level. Interventions for alcohol-impaired driving can target various points along the sequence at the bottom of the conceptual framework, and many FIGURE 1-6 The socioecological model.
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, there are social institutions with organizational characteristics and rules for operation that affect alcohol-impaired driving (e.g., MADD, the alcohol industry, and law enforcement)
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This entailed a systematic search of academic and governmental databases and websites for studies that evaluated or assessed the effects of interventions on any one of the following outcomes: alcohol consumption, binge drinking, alcohol-impaired driving, arrests, recidivism, and alcohol-impaired driving crashes, injuries, and fatalities.7 The sources of evidence spanned across 7 Search terms included alcohol terms (such as alcohol-impaired fatalities, alcohol impaired driving, alcohol-related deaths, binge drinking, blood alcohol concentration/
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paired with traffic terms (such as accidents, traffic fatalities, traffic safety, crashes) and intervention terms, among others.
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Examined outcomes and measurement of spillover effects Importantly, the outcomes measured (i.e., only considering alcohol-impaired driving crashes or fatalities, including only those in a car, not pedestrians) and how they are measured are critical, yet commonly differ from study to study.
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For example, sobriety checkpoints may be enhanced by a media campaign and vice versa. By the same token, an intervention that reduces alcoholimpaired driving crashes might affect other alcohol-related outcomes in similar or different ways (such as consequences of alcohol on families)
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In relation to alcohol-impaired driving, for example, impairment can be measured in several ways by a law enforcement officer (and all 50 states
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A balance inevitably needs to be struck based on the values of the community. Furthermore, reducing alcohol-impaired driving injuries and fatalities is difficult to separate from the broader public health rationale for reducing excessive alcohol consumption since drinking is the precursor for alcohol-impaired driving.
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Behavioral Insights Conventional behavior change models assume individuals consistently act in their own interest and form behavioral change intentions based on a rational assessment of the costs and benefits. Behavioral economics, for example, applies psychological insights to understand the many natural decisions people make that routinely deviate from their best interests.
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With these ideas and the conceptual model in mind, the committee recognizes the need for an overarching philosophy and process for improvement, tailored to local environments and involving a range of stakeholders motivated by a common goal to reduce alcohol-impaired driving fatalities. THE ROAD AHEAD Vision Zero NHTSA (the sponsor of this report)
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Achieving Vision Zero in the United States Other initiatives or programs aimed at achieving zero deaths from traffic fatalities in the United States include the Vision Zero Network, which is composed of U.S. cities that have made the pledge to pursue
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policy to reduce alcohol-impaired driving injuries and fatalities is an important step. To fulfill Vision Zero successfully, shared goals and continued progress toward reducing alcohol-impaired driving fatalities is essential.
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Introducing a goal of zero alcohol-impaired driving injuries or fatalities requires the country to adopt a new, multisector approach and system for improvement, driven by stakeholders motivated by a common goal. Throughout this report the Vision Zero philosophy is applied to alcohol-impaired driving with the aim of developing a comprehensive approach that involves stakeholders across sectors.
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b States may have lower BAC laws for individuals under the minimum legal drinking age of 21 and commercial drivers. c Of note, a crash involving a nonimpaired motor vehicle driver and an impaired pedes trian or cyclist is not counted as an alcohol-impaired motor vehicle crash fatality by NHTSA's FARS, which collects information about all motor vehicle crash fatalities occurring on U.S.
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. Additionally, genetic variations in enzymes affect the clearance of one of the by-products of alcohol metabolism, resulting in an intensified physiological reaction and altering the risk of developing alcohol dependence.
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Although the standard drink amounts are helpful for following health guidelines, they may not reflect customary serving sizes.
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The first, held in February 2017, focused on obtaining information on the history of alcohol-impaired driving and interventions currently being used in the United States. The second meeting, held in March 2017, focused on obtaining information on the current alcohol environment, stakeholder activities, relevant surveillance systems, and social movements.
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DOT HS 812 072. Washington, DC: National Highway Traffic Safety Administration.
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Washington, DC: National Highway Traffic Safety Administration.
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DOT HS 812 384. Washington, DC: National Highway Traffic Safety Administration.
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2007. Vision Zero -- Is it irrational?
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DOT HS 811 374. Washington, DC: National Highway Traffic Safety Administration.
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