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Driving under the influence of alcohol: frequency, reasons, perceived risk and punishment
- Francisco Alonso 1 ,
- Juan C Pastor 1 ,
- Luis Montoro 2 &
- Cristina Esteban 1
Substance Abuse Treatment, Prevention, and Policy volume 10 , Article number: 11 ( 2015 ) Cite this article
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The aim of this study was to gain information useful to improve traffic safety, concerning the following aspects for DUI (Driving Under the Influence): frequency, reasons, perceived risk, drivers' knowledge of the related penalties, perceived likelihood of being punished, drivers’ perception of the harshness of punitive measures and drivers’ perception of the probability of behavioral change after punishment for DUI.
A sample of 1100 Spanish drivers, 678 men and 422 women aged from 14 to 65 years old, took part in a telephone survey using a questionnaire to gather sociodemographic and psychosocial information about drivers, as well as information on enforcement, clustered in five related categories: “Knowledge and perception of traffic norms”; “Opinions on sanctions”; “Opinions on policing”; “Opinions on laws” (in general and on traffic); and “Assessment of the effectiveness of various punitive measures”.
Results showed around 60% of respondents believe that driving under the influence of alcohol is maximum risk behavior. Nevertheless, 90.2% of the sample said they never or almost never drove under the influence of alcohol. In this case, the main reasons were to avoid accidents (28.3%) as opposed to avoiding sanctions (10.4%). On the contrary, the remaining 9.7% acknowledged they had driven after consuming alcohol. It is noted that the main reasons for doing so were “not having another way to return home” (24.5%) and alcohol consumption being associated with meals (17.3%).
Another important finding is that the risk perception of traffic accident as a result of DUI is influenced by variables such as sex and age. With regard to the type of sanctions, 90% think that DUI is punishable by a fine, 96.4% that it may result in temporary or permanent suspension of driving license, and 70% that it can be punished with imprisonment.
Conclusions
Knowing how alcohol consumption impairs safe driving and skills, being aware of the associated risks, knowing the traffic regulations concerning DUI, and penalizing it strongly are not enough. Additional efforts are needed to better manage a problem with such important social and practical consequences.
In Europe, traffic accidents are one of the main causes of mortality in people between 15 and 29 years old, and driving under the influence of alcohol (DUI) is a major risk factor in most crashes [ 1 , 2 ].
In the year 2001 in Spain, 40,174 people were treated in public hospitals for traffic injuries. Some 28% of these injuries were serious or very serious and drinking was involved in a high percentage of cases. According to the Spanish Directorate General of Traffic (DGT), alcohol is involved in 30-50% of fatal accidents and in 15 to 35% of crashes causing serious injury, constituting a major risk factor in traffic accidents. This problem is especially important among young people and worsens on weekend nights [ 3 , 4 ].
In more recent years, several studies have shown that more than a third of adults and half of teenagers admit they have driven drunk. We also know that most of them were not detected. Generally, the rate of arrests for driving under the influence is very low and even those drivers who were arrested were mostly “first-time” offenders [ 5 ].
Some studies show that many young people lack information or knowledge about the legislation regulating consumption of alcohol for drivers, as well as the effects of this drug on the user [ 6 - 8 ].
There are also some widespread beliefs and misconceptions regarding the actions the driver can take in order to neutralize the effects of alcohol before driving (for instance drinking coffee, having a cold shower or breathing fresh air). As suggested by Becker’s model of health beliefs [ 9 , 10 ], preventive behavior is unlikely to occur unless the subject considers the action necessary, hence the importance of providing adequate information and disproving false beliefs.
Drivers are not usually aware of the risk they assume when they drive under the influence of alcohol, as they do not suffer a traffic accident every time they drink and drive. Hence they tend to think there is no danger in driving under the influence of alcohol, incurring the same risk behavior once and again.
But the reality is quite different. Alcohol causes very obvious alterations in behavior, as it affects almost all the physical skills we need for safe driving. It can interfere with attention, perceptual functioning and motor skills, as well as in decision making while driving.
Drinking impairs the ability to drive and increases the risk of causing an accident. The effects of alcohol consumption on driving-related functions are modulated by some factors, such as form of consumption (regular or infrequent), expectations about their consumption, expertise in driving and driver’s age. The increased risk of accident starts at a lower blood alcohol level when drivers are inexperienced or they are occasional drinkers, and begins at a higher blood alcohol level when these are more experienced drivers or regular drinkers [ 11 , 12 ].
The BAC represents the volume of alcohol in the blood and is measured in grams of alcohol per liter of blood (g / l) or its equivalent in exhaled air.
Any amount of alcohol in blood, however small, can impair driving, increasing the risk of accident. Therefore, the trend internationally is to lower the maximum rates allowed.
After drinking, the rate of alcohol in blood that a driver is showing can vary widely due to numerous modulating variables. Among them, some important factors are the speed of drinking, the type of alcohol (fermented drinks such as beer or wine, or distilled beverages like rum or whisky) or the fact of having previously ingested some food, as well as the age, sex or body weight. Ideally, if everyone drank alcohol responsibly and never drove after drinking many deaths would be avoided. Accurate information about how driving under the influence effects traffic safety would be a positive step towards this goal.
Study framework
Research on enforcement of traffic safety norms has a long tradition. In 1979, a classic work [ 13 ] showed that increasing enforcement and toughening sanctions can reduce accidents as an initial effect, although the number of accidents tends to normalize later.
Justice in traffic is needed insofar as many innocent people die on the roads unjustly. This is our starting point and our central principle. In order to prevent traffic accidents, a better understanding is needed of the driver’s knowledge, perceptions and actions concerning traffic regulations. Drivers have to be aware of how important rules are for safety. The present study comes from a broader body of research on traffic enforcement, designed to develop a more efficient sanctions system [ 5 , 14 ].
Our research used a questionnaire to gain sociodemographic and psychosocial information about drivers, as well as additional information on enforcement clustered in five related categories: “Knowledge and perception of traffic norms”; “Opinions on sanctions”; “Opinions on policing”; “Opinions on laws” (general ones and traffic laws in particular); and “Assessment of the effectiveness of various punitive measures”.
A number of additional factors were also explored, including: driving too fast or at an improper speed for the traffic conditions, not keeping a safe distance while driving, screaming or verbal abuse while driving, driving under the influence, smoking while driving, driving without a seat belt and driving without insurance. For a more complete review, see the original study [ 14 ].
The aim of this study was to gain useful information to improve traffic safety, concerning the following aspects:
Frequency of driving under the influence of alcohol (DUI).
Reasons for either driving or not driving under the influence (DUI).
Perceived risk of DUI.
Drivers’ knowledge of DUI-related penalties.
The perceived likelihood of being punished for DUI.
Drivers’ perception of the harshness of punitive measures for DUI.
Drivers’ knowledge of the penalties for DUI.
Drivers’ perception concerning the probability of behavior change after punishment for DUI.
Sociodemographic and psychosocial factors related with alcohol consumption and driving.
Participants
The sample consisted of 1100 Spanish drivers: 678 men (61.64%) and 422 women (38.36%), between 14 and 65 years of age. The initial sample size was proportional by quota to segments of Spanish population by gender and age. The number of participants represents a margin of error for the general data of ± 3 with a confidence interval of 95% in the worst case of p = q = 50%; with a significance level of 0.05.
Drivers completed a telephone survey. 1100 drivers answered interviews, and the response rate was 98.5%; as it was a survey on social issues, most people consented to collaborate.
Procedure and design
The survey was conducted by telephone. A telephone sample using random digit dialing was selected. Every phone call was screened to determine the number of drivers (aged 14 or older) in the household. The selection criteria were possession of any type of driving license for vehicles other than motorcycles and driving frequently. Interviewers systematically selected one valid driver per home. The survey was carried out using computer assisted telephone interview (CATI) in order to reduce interview length and minimize recording errors, ensuring the anonymity of the participants at all times and emphasizing the fact that the data would be used only for statistical and research purposes. The importance of answering all the questions truthfully was also stressed.
In this article, we present the data on driving under the influence of alcohol. The first question raised was: How often do you currently drive after drinking any alcoholic beverage? Possible responses were: Almost always, Often, Sometimes, Rarely or Never.
If they answered either Almost always, Often or Sometimes, they were asked: What is the reason that leads you to drive under the influence? If they answered Rarely or Never, they were asked: What is the reason you rarely or never drive under the influence? In both cases, respondents had the option of an open answer.
Later they were asked to rate from 0 to 10 the risk that driving under the influence of alcohol can cause a traffic accident in their opinion (0 being the minimum risk and 10 the maximum risk of crash).
Then they were asked to rate from 0 to 10 the harshness with which they thought DUI sanctions should be administered.
They were also asked: Is driving exceeding alcohol limits punishable? In this case, participants had the chance of answering Yes or No . We would then compare the correct answers with the standard to determine the knowledge.
Drivers who were unaware that DUI is punishable were asked about the probability of being sanctioned for this reason using the following question: When driving exceeding the limits of alcohol, out of 10 times, how many times is it usually sanctioned?
Another question dealt with the type of penalties. The participants were asked if the penalties for DUI consisted of economic fines, imprisonment or license suspension, either temporary or permanent. The question raised was: Have you ever received any penalty for driving under the influence? Possible answers were Yes or No . Those drivers who answered affirmatively were then asked about the harshness of punishment: How do you consider the punishment for DUI? The response options were Hard enough, Insufficient or Excessive. Furthermore, they were asked whether or not they changed their behavior after the punishment.
The questionnaire was used to ascribe drivers to different groups according to demographic and psychosocial characteristics, as well as to identify driving habits and risk factors.
Demographic variables
Gender: male or female.
Age: 14-17, 18-24, 25-29, 30-44, 45-65 and over 65 years old.
Educational level.
Type of driver: professional or non-professional.
Employment status: currently employed, retired, unemployed, unemployed looking for the first job, homemaker or student.
Driving habits
Frequency: the frequency with which the participant drive, the possible choices being Every day, Nearly every day, Just weekends, A few days a week, or A few days per month.
Mileage: the total distance in number of kilometers driven or travelled weekly, monthly or annually.
Route: type of road used regularly, including street, road, highway or motorway, and tollway.
Car use: motives for car use, for instance, to work, to go to work and return home from work or study centre, personal, family, recreational, leisure and others.
Experience/risk
Experience: number of years the participant has held a driver license, grouping them as 2 years or less, 3-6, 7-10, 11-15, 16-20, 21-25, 26-30 and over 30 years.
Traffic offenses. Number of sanctions in the past three years (none, one, two, three or more).
Accidents. Number of accidents as driver throughout life (none, one or more than one), and their consequences (casualties or deaths, or minor damages).
Once data were collected, a number of statistical analyses were performed, using the Statistical Package for the Social Sciences (SPSS), in order to obtain relevant information according to the aims of the study.
74.7% of the sample said that they had never driven under the influence. 15.5% of drivers said they did it almost never, and only the remaining 9.7% (sometimes 9,1%, often 0,2% or always 0,5%) acknowledged that they had driven after consuming alcohol (Figure 1 ).
Frequency of DUI.
Regarding the main reasons that led the drivers to act this way, expressed among drivers who admitted to having driven under the influence of alcoholic beverages, 24.5% of them indicated that it was unavoidable, as “I had to go home and couldn’t do anything else”, while 17.3% claimed that the act of drink-driving was an unintentional consequence or “something associated with meals”, and only 16.4% admitted having done it “intentionally”. In addition, 12.7% considered that “alcohol doesn’t impair driving” anyway (Figure 2 ).
Reasons for DUI.
“In any case, 60% of the interviewees perceived driving under the influence of alcohol as the highest risk factor for traffic accidents.”
Among them, the perception of this risk (or dangerousness of driving under the influence) is greater in women [F (1, 1081) = 41.777 p <0.05], adults aged between 18 and 44 [F (5, 1075) = 4.140 p <0.05], drivers who have never been fined for this infraction [F (2, 1080) = 29.650 p <0.05], drivers who had never committed the offense [F (4, 1077) = 40.489 p <0.05], and drivers who have never been involved in an accident [F (1, 1081) = 12.296 p <0.05]. Table 1 shows the values for this perception by gender and age.
There appears to be no significant relationship between the perceived risk attributed to DUI and other variables such as educational level, type of driver, driving frequency, vehicle use and years of experience.
The main reasons put forward for not drinking and driving included not drinking in any circumstances (50,5%), to avoid accidents (28,3%) as opposed to avoiding sanctions (10,4%) - such as financial penalties (8,4%), withdrawal of driving license (1,8%) or jail (0,2%) - or other reasons related to attitudes to road safety (16,6%).
On a scale of 0-10, participants rated the risk of economic penalties when driving under the influence of the alcohol with an average of 5.2, in other words they estimate the probability of being fined as roughly half of the times one drives drunk.
The perception of this risk (penalty or financial punishment for driving under the influence) is also greater in women [F (1, 1095) = 30,966 p <0.05], drivers who have never been involved in an accident [F (1, 1095) = 8.479 p <0.05], and drivers who had never been fined for this infraction [F (2 1094) = 12.515 p <0.05].
There appears to be no significant relationship between the perceived risk of financial penalty and other variables such as educational level, employment, type of driver, driving frequency, vehicle use and years of experience.
Almost everyone (99.1%) thinks that DUI is punishable and only 0.9% of drivers think it is not.
On a scale of 0-10, participants assigned an average of 9.1 to the need to punish this traffic breach severely. The score is higher in women [F (1, 1086) = 29.474 p <0.05], adults aged 18 to 24 years [F (5, 1089) = 2.699 p <0.05], drivers who have never been involved in an accident [F (1, 1095) = 8.479 p <0.05], and people who had never been fined for this reason [F (2, 1085) = 26,745 p <0.05], which means that these groups are less tolerant of this kind of behavior. By age, college students are the least tolerant and retirees are the most tolerant.
There was no significant relationship between the perceived need to punish this behavior harshly and variables such as type of driver, driving frequency and vehicle use.
Regarding the type of sanctions, 89.5% of drivers think that driving under the influence is subject to an economic fine, almost 70% say it could even be punished by imprisonment, while 96.4% believe it can lead to a temporary or permanent suspension of the license (Figure 3 ).
Type of sanction the driver think DUI is subject to.
Among the drivers who had been fined for DUI, nearly 75% considered that the imposed punishment was adequate, while the remaining 25% saw it as excessive (Figure 4 ). Finally, 91.7% of this group found they had changed their behavior after punishment (Figure 5 ).
Perception of punishment harshness imposed for DUI.
Perception concerning behavior change after punishment for DUI.
Alcohol is a major risk factor in traffic accidents. From the objective standpoint, alcohol interferes with the skills needed to drive safely, as evidenced by numerous studies on driving under the influence of alcohol conducted to date. From the subjective point of view, drivers also perceive it as dangerous, as our study shows.
Around 60% of respondents believe that driving under the influence of alcohol is maximum risk behavior. A smaller percentage compared to those reported by other studies in which the percentage of people that saw drink-driving as a major threat to safety reached 81% [ 15 ].
First, we note a clear correlation between perceived risk and avoidance behavior. In general the higher the perceived risk, the lower the probability of committing the offense, and vice versa: the lower the perceived risk, the greater the likelihood of driving after consuming alcohol.
Thus, drivers who do not commit this offense perceive that the risk of accidents associated with DUI is very high. When it comes to drivers who commit the offense occasionally, the perceived risk is lower, and when it comes to drivers who often drive under the influence of the alcohol, the perception of risk is clearly inferior. Thus, the frequency of DUI and risk perception seem to be inversely related.
These results are related to the hypothesis of optimistic bias, which states that drinkers are overly optimistic about probabilities of adverse consequences from drink. In a study [ 16 ] about overconfidence about consequences of high levels of alcohol consumption, the authors established an alternative to the optimism bias hypothesis that could explain our findings, affirming that persons who drink frequently and consume large amounts of alcohol daily could be more familiar with the risks of such behaviors.
Another important finding is that the risk perception of traffic accident as a result of DUI is influenced by variables such as sex and age. In relation to gender, the perception of risk seems to be higher in women than in men. In relation to age, risk perception is higher in adults between 18 and 44 years old.
The finding about the reason for not drinking and driving supports the already evident need for an integrative approach to developing sustainable interventions, combining a range of measures that can be implemented together. In this way, sustainable measures against alcohol and impaired driving should continue to include a mix of approaches, such as legislation, enforcement, risk reduction and education, but focus efforts more closely on strategies aimed at raising awareness and changing behavior and cultural views on alcohol and impaired driving.
Almost all the drivers surveyed are well aware that driving after drinking any alcoholic beverage is a criminal offense. They also consider that this is a type of infraction that should be punished harshly. In this respect, they assign nine points on a scale of ten possible.
Finally, with regard to the type of sanctions, 90% of drivers think that driving drunk is punishable by a fine. 96.4% consider that it may result in temporary or permanent suspension of driving license, and 70% believe that it can be punished with imprisonment.
In any case, there are several limitations of this study. This was a population-based study of Spanish drivers; there is possibly a lack of generalizability of this population to other settings.
Another possible limitation of this study is the use of self-report questionnaires to derive information rather than using structured interviews. Similarly, self-reported instruments may be less accurate than objective measures of adherence as a result of social desirability bias.
In Spain, various traffic accident prevention programs have been implemented in recent years. Some of them were alcohol-focused, designed to prevent driving under the influence and to inform the Spanish population about the dangers associated with this kind of risk behavior.
As a result, many Spanish drivers seem to be sensitized to the risk of driving drunk. As revealed in our survey, many Spanish drivers never drive under the influence of alcohol, and many of them identify DUI as maximum risk behavior. This shows that a high percentage of the Spanish population know and avoid the risks of DUI.
In any case, the reality is far from ideal, and one out of four drivers has committed this offense at least once. When asked why they did it, the two major risk factors of DUI we identified were the lack of an alternative means of transport and the influence of meals on alcohol consumption. Both situations, especially the latter, occur frequently, almost daily, while it is true that the amount of alcohol consumed in the former is considerably higher and therefore more dangerous.
In addition, most drivers are aware of the dangers of driving under the influence, and they tend to avoid the risk of accident or penalty for this reason. Some drivers never drive under the influence, to avoid a possible accident. To a lesser extent, some do not drive under the influence to avoid a possible fine. They usually think that the possibility of sanction in the event of DUI is so high that they will be fined every two times they risk driving drunk.
Moreover, drivers know the legislation regulating DUI and they believe that the current penalty for DUI is strong enough. Nevertheless, even though almost all the drivers that were fined for this reason say they changed their behavior after the event, nine out of ten drivers would penalize this kind of offense even more strongly.
Knowing how alcohol consumption impairs safety and driving skills, being aware of the associated risks, knowing the traffic regulations concerning DUI and penalizing it strongly are not enough. Many drivers habitually drive after consuming alcohol and this type of traffic infraction is still far from being definitively eradicated.
Additional efforts are needed for better management of a problem with such important social and practical consequences. Efforts should be focused on measures which are complementary to legislation and enforcement, increasing their effectiveness, such as education, awareness and community mobilization; Alcolock™; accessibility to alcohol or brief interventions.
Abbreviations
- Driving under the influence
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Acknowledgements
The authors wish to thank the Audi Corporate Social Responsibility program, Attitudes, for sponsoring the basic research. Also thanks to Mayte Duce for the revisions.
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Francisco Alonso, Juan C Pastor & Cristina Esteban
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Correspondence to Francisco Alonso .
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Authors’ contributions
All authors contributed to the design of the study and also wrote and approved the final manuscript. FA drew up the design of the study with the help of CE; the rest of the authors also contributed. JCP and LM were in charge of the data revision. JCP and CE also drafted the manuscript. FA performed the statistical analysis. All authors read and approved the final manuscript.
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Alonso, F., Pastor, J.C., Montoro, L. et al. Driving under the influence of alcohol: frequency, reasons, perceived risk and punishment. Subst Abuse Treat Prev Policy 10 , 11 (2015). https://doi.org/10.1186/s13011-015-0007-4
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A Alcohol-Impaired Driving in the United States: Review of Data Sources and Analyses 1
Charles DiMaggio , Ph.D., M.P.H., Katherine Wheeler-Martin , M.P.H., and Jamie Oliver .
The consequences of alcohol-impaired driving continue to affect the United States. A review of the current literature and analyses of recent data indicate a need for renewed surveillance across the spectrum of potential interventions, including law enforcement, engineering and technology, education and behavioral change, built environment, enactment and evaluation of policies, and emergency trauma care. Among these so-called E s of motor vehicle crash injury prevention, alcohol itself (ethanol) remains critically important. There has been considerable success in addressing the role alcohol plays in motor vehicle crash injury risk in the United States, but alcohol has been persistently present in nearly a quarter of fatal crashes for the past two decades. Initial decreases of 30 to 40 percent dating from the 1990s have slowed to 5 to 10 percent or leveled off entirely.
Law enforcement has been, and remains, a cornerstone of alcohol-impaired driving control and prevention, but enforcement activity varies widely across states, and there is evidence of an overall decline in alcohol-impaired arrest rates across the nation. While alcohol-impaired driving accounts for over 10 percent of all arrests reported to the Federal Bureau of Investigation's (FBI's) National Incident-Based Reporting System (NIBRS), arrest rates and enforcement activity vary as much as 32-fold across states. The population-based rate of alcohol-impaired driving arrests reported to the NIBRS in 2014 decreased by 13 percent from a high in 2003.
Educational and behavioral interventions have been a foundational feature of the public health approach to alcohol-impaired driving since the earliest days of community-level activism that led to the formation of such groups as Mothers Against Drunk Driving. Identifying what behaviors are associated with which groups is essential to this effort. Some features of alcohol-impaired driving behavior remain unchanged. Men are still three to four times as likely to report recent incidents of alcohol-impaired driving, and the highest population-based rates continue to be among younger drivers. But there have been notable recent changes in behaviors among some groups, indicating an evolution in risks posed by alcohol-impaired driving.
Teens and young adults are driving less, which is reflected in decreases in alcohol-impaired driving arrests, crashes, and fatalities. However, this group may now be at increasing risk of injury as passengers, and behaviors leading to decisions to ride as a passenger with alcohol-impaired drivers deserve increasing attention. The rate of women in the United States reporting a recent arrest for alcohol-impaired driving increased 40 percent between 2002 and 2014. Statistics reported to the FBI over the same time period show a similar increase. This increase may reflect, in part, an increase in marketing of alcohol to women. Motorcyclists, particularly those 55 to 64 years old, have experienced a notable increase in alcohol-related crash fatalities in the United States. In Florida, between 2011 and 2013, the fatality rate for motorcyclist crashes in which alcohol was not involved was 5 percent; when alcohol was involved, the fatality rate was 21 percent. In Nebraska, between 2002 and 2013, all crashes with a driver suspected of using alcohol or with a positive blood alcohol concentration (BAC) report decreased 25 percent, but rates among motorcyclists remained stubbornly persistent. Surveys consistently indicate that alcohol-impaired driving is associated with other risky behaviors such as binge drinking and not using seat belts. Investigating and addressing these interactions may help better tailor interventions that result in decreased morbidity and mortality.
Much of what we know about alcohol-impaired driving behavior comes from national surveys, such as the Centers for Disease Control and Prevention's (CDC's) Behavioral Risk Factor Surveillance System (BRFSS), which is among the most well-accepted and reliable sources of data on health-related behavior in the United States. Surveys can be enhanced to include questions, on alcohol-impaired driving on an annual basis. Additional survey questions. such as whether a person has been stopped at a sobriety checkpoint or been assigned to use an ignition interlock system, can provide information that may help track interventions. But there is a need for objective data to balance survey results. The FBI's NIBRS has the potential to provide important information on alcohol-impaired driving behavior and enforcement in the United States. It is limited in that it is not yet fully implemented across all states or representative of the entire United States. Roadside surveys conducted by the National Highway Traffic Safety Administration (NHTSA) provide perhaps the most valid and reliable estimates of alcohol-impaired driving behavior in the United States, but they are only conducted sporadically.
There is a need for additional, updated research addressing environmental factors associated with alcohol-impaired driving. Approximately 60 percent of alcohol-related motor vehicle crash deaths in the United States occur in rural areas. Adjusting for vehicle miles traveled indicates a risk three times greater than that of urban areas. Possible explanations for the rural–urban difference may include differences in access to alcohol on a per capita basis, and limited access to low-cost public transportation in rural areas. The availability of large data sources, which can be linked, and advances in small-area analyses can allow for better characterization of that risk and targeting of interventions. The NHTSA Fatality Analysis Reporting System (FARS), the premier and most successful source of alcohol-impaired driving fatality statistics in the United States, can contribute to that effort by consistently including geolocations. Most states participating in the NHTSA's State Data System (SDS) already collect and provide information about alcohol involvement in motor vehicle crashes. However, there is substantial variation in how this information has been collected over time and from state to state. Beginning in 2006, NHTSA began standardizing data elements across several of its data systems. Increased state participation in that system using consistent definitions will contribute to a better understanding of the actual incidence of alcohol-related motor vehicle crash fatalities in the United States.
There have been few studies looking explicitly at ethnic and racial patterns of alcohol-impaired driving behavior. More information is needed to better inform and target control efforts. Similarly, studies of the effectiveness of engineering and technological interventions for alcohol-impaired driving have been largely limited to ignition interlock systems. Despite the tremendous potential of self-driving and assisted driving technologies to affect alcohol-impaired driving outcomes, the research literature on the topic is virtually nonexistent. Lastly, while most analyses of alcohol-impaired driving in the United States rightly address the overall public health impact through absolute numbers of fatalities, additional analyses attempting to capture risk, as measured through rates of both crashes and fatalities, can better inform prevention and control through the use of estimates of vehicle miles driven to serve as denominators for analyses.
In summary, much has been achieved in controlling and preventing the consequences of alcohol-impaired driving in the United States, but much remains to be done. Recent evidence and analyses can help point the way to opportunities for additional advancements. Further success will require a renewed commitment to the prevention and control of alcohol-impaired driving in the United States with resources targeted at those individuals and areas most at risk.
- ABOUT DATA SOURCES
This paper reviews administrative secondary data sources with information relevant to alcohol-impaired driving. CDC's BRFSS is among the most well-accepted and reliable sources of health-related behavior in the United States, and it should be enhanced to include a question on alcohol-impaired driving on an annual basis. Summary information about key data sources is listed below.
- Behavioral data characterized by self-reports may be biased.
- The NIBRS has the potential to provide important information on alcohol-impaired driving behavior and enforcement in the United States. It is limited in that it is not yet fully implemented by all states nor representative of the entire United States.
- Most states participating in the NHTSA's SDS collect and provide information about alcohol involvement in motor vehicle crashes. However, there is substantial variation in how this information has been collected over time and from state to state. Consistent definitions and greater participation among states can provide valuable surveillance information.
- The NHTSA's FARS is the premier source of alcohol-impaired driving fatality statistics in the United States. Data have been collected in the FARS from all 50 states since 1975.
- Data on alcohol involvement in the FARS are often missing, resulting in likely undercounts of the actual incidence of alcohol-related motor vehicle crash fatalities.
- The U.S. Department of Transportation's National Household Travel Survey provides reasonable estimates of vehicle miles driven to serve as denominators for analyses.
Behavioral Data
The behavioral risk factor surveillance system.
The BRFSS is an annual nationwide survey conducted by CDC and is perhaps the most important, reliable, and long-standing source of information on health behavior in the United States. Since 2006, every other year, the BRFSS has included an explicit question on alcohol-impaired driving that asks, “During the past 30 days, how many times have you driven when you've had perhaps too much to drink?” Respondents answer with the number of times, from 0 to 76. There is an annual question on the number of alcoholic beverages a person consumes each day, which is used to calculate the total number of alcoholic beverages consumed in a month, and determine whether an individual can be considered a binge or heavy drinker. There is an annual question on seatbelt use (“How often do you use seat belts when you drive or ride in a car?”), which can be evaluated in relation to alcohol use.
Among the strengths of the BRFSS is the well-accepted reliability and validity of the results over a long period of time. Among the weaknesses are (1) because it is a phone-based survey, some of that strength is challenged by changes in phone use patterns, (2) self-report of what might be considered deviant behavior is likely to result in bias, (3) questions pertaining to alcohol-impaired driving are only present every other year and therefore provide data for 6 years, making it difficult to establish trends, and (4) results are only valid at the national and state levels, making local behavior patterns difficult to assess. The usefulness of the BRFSS to track alcohol-impaired driving in the United States can be enhanced by including a related question every year. Potential biases in self-reports can be at least partially addressed through the inclusion of such methods as randomized response or item count techniques ( Miller et al., 1986 ; Warner, 1965 ).
Similar to the BRFSS is the Youth Risk Behavior Surveillance System (YRBSS), which monitors health behaviors among U.S. youth and young adults. The survey is conducted every other year and dates to 1991. Separate versions of the survey are administered to high school and middle school students. Among the six specific health behaviors monitored are alcohol and other drug use, and there are two specific questions relating to alcohol-impaired driving:
Have you ever ridden in a car driven by someone who had been drinking alcohol?
During the past 30 days, how many times did you ride in a car or other vehicle driven by someone who had been drinking alcohol?
Among the strengths of the YRBSS are that it has consistently included questions on alcohol-impaired driving that allow for reliable estimates of trends and addresses risk among a vulnerable population. Weaknesses of the YRBSS include (1) data may not be available for all states, (2) limited geographic specificity similar to the BRFSS, and (3) biases associated with self-reported behavior likely similar to the BRFSS, although there may be some added level of anonymity in the way the YRBSS is administered.
National Survey on Drug Use and Health
The National Survey on Drug Use and Health is a yearly survey of “national and state-level estimates on the use of tobacco products, alcohol, illicit drugs (including nonmedical use of prescription drugs) and mental health in the United States” conducted by the Substance Abuse and Mental Health Services Administration. Included among the questions is “In the past 12 months, were you arrested and booked for driving under the influence of alcohol or drugs?” A strength of this data source is that it is a large survey of approximately 70,000 individuals conducted yearly since 1971, making it an effective resource to validly track trends at the state and national levels. Unlike the BRFSS, the survey includes individuals in institutional settings such as shelters, rooming houses, and dormitories. Like the BRFSS, the survey is subject to bias in that it relies on self-reported data and is not powered to assess outcomes at smaller geographic levels.
National Incident-Based Reporting System
The FBI maintains the NIBRS as a means of quantifying criminal activity in the United States. In contrast to the FBI's longer-standing traditional Uniform Crime Reporting (UCR) statistics, the NIBRS collects data on a wider array of crimes and goes into greater detail on the circumstances surrounding offenses. Unlike the UCR, and among its weaknesses, the NIBRS is not yet nationally representative. As of June 2012, 32 states were participating. According to the U.S. Department of Justice, “In 2015, 6,648 law enforcement agencies, representing coverage of more than 96 million U.S. inhabitants, submitted NIBRS data. While not yet nationally representative (there are no estimates for agencies that did not submit NIBRS data), this coverage represents 36.1 percent of all law enforcement agencies that participate in the UCR program” ( FBI, 2016 ). The target date for full national representation is 2021.
Among the strengths of these data are that they are (for the states represented) essentially a census of crimes, rather than a survey, and are less sensitive to statistical heterogeneity. Driving while impaired (DWI) has been a reportable offense since the inception of the NIBRS. It is classified as a so-called Group B offense for which only arrestee data are reported. Among the weaknesses of these data as a source of surveillance information on alcohol-impaired driving is that they are as much a reflection of enforcement activity and availability of resources as they are an estimate of actual behavior.
National Roadside Survey of Alcohol and Drugged Driving
NHTSA has conducted the National Roadside Survey of Alcohol and Drugged Driving five times since 1973. The most recent iteration was conducted in 2013 and 2014 and consisted of a sample size of approximately 9,000 persons in 60 U.S. cities. The major strength of this survey is that results are based on breath, saliva, and blood testing rather than self-reporting, increasing the validity of the conclusions. Among the weaknesses is the intermittent nature of the survey, making it difficult to assess trends.
The State Data System
The primary source of alcohol-related motor vehicle crash injury data is the NHTSA SDS. The SDS is based on data from police crash reports submitted by participating states. Police crash reports are completed by police officers at the scene of motor vehicle crashes and contain information about the crash, the vehicles involved, and the motorists and nonmotorists (e.g., pedestrians, cyclists) involved in the crash. Each state determines its own reporting criteria. Generally, crashes are reportable if they involve injuries or deaths. Other common reporting criteria include damages in excess of a designated cost or damages requiring a vehicle to be towed away from the scene. While the specific nature and quantity of information collected at the crash site varies from state to state (and over time within each state), the SDS applies a common nomenclature to field names when processing and storing state datasets to aid in research efforts across states.
As of June 15, 2017, there were 34 states participating in the SDS. Access to state data requires special permission from each individual state data owner. Not all states allow NHTSA to rerelease their data.
Most states participating in the SDS collect and provide information about alcohol involvement in motor vehicle crashes. However, there is substantial variation in how this information has been collected over time and from state to state. The range of language and specific indicators used to identify alcohol use include
- Individual had been drinking.
- Individual was/appeared to be under the influence of alcohol.
- Individual was/appeared to be intoxicated.
- Individual received an alcohol test.
- Individual BAC percentage ranging from 0.00% (0%) to 0.99% (9%).
- Alcohol was a contributing factor, circumstance, or cause of the crash.
- Alcohol was present in the vehicle/at the scene.
- Individual was issued a violation for alcohol use, being under the influence, etc.
Alcohol information is almost always available for drivers. Very few states collect or report alcohol information for passengers. Some states provide indicators at the crash level that may be used to readily identify crashes that involved alcohol on some level. Alcohol indicators are more commonly reported at the individual level, which can allow for analysis by role (driver, pedestrian/cyclist), age, and gender.
The strengths and weaknesses of alcohol-related motor vehicle crash data in the SDS vary considerably by state. For example, before 2011, Florida SDS datasets included alcohol information for individuals using the language “under the influence.” Beginning in 2011, Florida began including information about alcohol testing and test results, and added a flag for “alcohol use suspected,” which captures a wider range of crashes with alcohol involvement. By contrast, Nebraska data are based on “officer deemed alcohol related to crash,” with additional fields available for whether an alcohol test was performed and whether results are known.
By contrast, New York State SDS datasets identify alcohol information only in the context of violations issued, which essentially pertain to drivers only. Violation data files were added to New York's SDS files beginning as early as 2002. There are a number of different types of violations with language ranging from alcohol use , impairment , intoxication , BAC above 0.08% (CDL) or 0.1% (private vehicle) , and open container of alcohol .
Because SDS data include injuries as well as fatalities, an additional strength of this data source is that fatality rates can be calculated and compared across crash characteristics. Additionally, the number of participating states has grown over time and now covers the majority of the continental United States. Most states provide a substantial array of variables related to crash circumstances, vehicles involved, and some information about persons involved.
While the SDS provides a common naming structure and language, as noted, a limitation is that there are many differences in how variables are defined and how information is collected and reported from state to state. Also, states have also changed their coding and reporting practices over time, requiring careful attention to the coding manuals. In particular, as noted above, alcohol involvement is recorded in numerous ways and makes state-to-state comparisons problematic. Finally, geographical information in the SDS is limited to city and county.
National Automotive Sampling System General Estimates System
NHTSA's National Automotive Sampling System General Estimates System (NASS GES) is based on a sample of police crash reports. The data are used to track trends and identify emerging issues. Starting in 2006, NHTSA began standardizing data elements across the FARS and the NASS GES, increasing the usefulness of the system.
Fatality Data
Fatality analysis reporting system.
The primary data source available in the United States for traffic-related mortality is the NHTSA's FARS. When combined with U.S. Census population estimates, or person-miles traveled estimates such as those available from the National Household Travel Survey, and vehicle miles traveled estimates from the Federal Highway Administration, reliable motor vehicle mortality-related rates can be calculated.
The FARS is a national census of fatal motor vehicle crashes (MVCs) and is maintained by the National Center for Statistics and Analysis, a component of NHTSA. Initially established in 1975, the FARS contains detailed information on all crashes that occur on U.S. public roadways that result in the death of one or more motorists or nonmotorists within 30 days. FARS data are acquired from police reports, state administrative files, and medical records from all 50 states and are analyzed by data analysts using standardized protocols. As a result, FARS data elements generally have relatively little missing data and are well documented and maintained.
For each fatal crash, the FARS provides detailed information related to the crash circumstances as well as the people and vehicles involved in that crash. The FARS lists the county, city, state, and longitude and latitude of each crash and also includes roadway information (road surface type, number of lanes, speed limit, traffic control device), and light and atmospheric conditions. The time of the crash and emergency medical services transportation information (arrival at the scene and to the hospital) are also included. In addition, driving maneuvers avoiding and contributing to each crash are documented. Data on each vehicle involved include the make, model, and model year as well as less detailed variables to aggregate and compare crashes by vehicle type.
Data on all motorists and nonmotorists involved in each crash, including age, sex, seating position, vehicle occupant restraint use, and injury severity, are provided. For drivers, information on prior crashes, license suspensions, and other driving violations within 3–5 years preceding the crash is available. Of note, certain information such as race and ethnicity, which is collected from death certificates, is only available for fatally injured individuals.
The FARS also has data on alcohol and drug intoxication that are gathered from breath, blood, and urine tests, as well as police behavioral assessments. Since these data are based on the extent of testing performed by law enforcement, alcohol involvement data are often missing. As a result, the FARS may undercount the actual incidence of alcohol-related motor vehicle crashes, and testing rates are a potential confounding variable for regional comparisons of alcohol-related crashes.
Strengths of the FARS The various strong points of the FARS are listed below.
- Data have been collected in the FARS from all 50 states since 1975, allowing for long-term trend analysis.
- Significant data are available to analyze crashes at the crash level, vehicle level, and person level, and these data are quite detailed at every level.
- For drivers, detailed information is available on a driver's previous traffic and driving violations prior to the crash.
- Data elements are well documented and maintained.
- The majority of FARS variables have very little missing data.
Weaknesses of the FARS The various weak points of the FARS are listed below.
- The FARS only has information on crashes resulting in at least one fatality within 30 days of the crash.
- Data on alcohol involvement are often missing, meaning the FARS may undercount the actual incidence of alcohol-related motor vehicle crashes.
- Police testing for illicit substances may vary between different states and regions and is a confounding variable for state-level comparisons.
- Data on race and ethnicity are collected from death certificates, meaning that it is only available for individuals fatally injured in crashes. Even among deceased individuals in alcohol-related crashes, race and ethnicity information is missing for 14 percent of persons.
- The FARS occasionally has errors in data element coding, but these errors are well documented and can be worked around.
Multiple imputation of alcohol data in FARS Missing data are an issue in most rigorous data analyses and are particularly problematic in alcohol-related crash analyses. While it is the standard for such analyses, more than half of FARS records are missing BAC data ( Subramanian and Utter, 2003 ). Over the years, NHTSA has taken several approaches to estimating missing BAC values in the FARS. Prior to 2001, a linear discriminant method was used to estimate the probability that a driver or nondriver (pedestrian or cyclist) had a BAC of 0.0, 0.01−0.09, or >0.10 g/dl. Starting in 2001, NHTSA moved to multiple imputation methods ( Subramanian, 2002 ). The algorithm generates 10 estimates for BAC values for each missing BAC observation. The models used to estimate missing values include variables such as age, sex, injury severity, and day and time of crash that are likely to be associated with BAC. The final imputed value is a combination of the 10 estimates and includes a measure of the uncertainty, which is added to variances for overall point prevalence. Multiple imputation methods are superior to some other missing data methods, and the methods pioneered by NHTSA have been applied to missing drug testing data in truck crashes ( Brady et al., 2009 ). However, they cannot substitute for actual testing results. Data imputation is least biased when values are missing at random, which is unlikely in the case of alcohol-related fatalities. It is important to evaluate results based on imputed values in comparison to complete-case analyses and explain any discrepancies ( Sterne et al., 2009 ).
Clinical Data
Nationwide emergency department sample.
The Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) maintains the Nationwide Emergency Department Sample (NEDS) ( AHRQ, 2015 ). The HCUP is a group of inpatient and outpatient files created by AHRQ. NEDS is the largest single publicly available emergency department (ED) database in the United States. It is based on a 20 percent stratified single-cluster sample of all U.S. hospital-based EDs. As of 2012, 30 states participated in NEDS, accounting for 66 percent of all national ED visits. Each year's core file contains 100 percent of visits from sampled hospitals. The most recent NEDS database contains about 30 million ED records. Hospitals are defined as nonfederal general and specialty hospitals, including public hospitals and academic medical centers. Additional stratification variables include geographical area, urban/rural, ownership, trauma center and teaching status, and bed size.
Motor vehicle crashes can be identified using external cause of injury e-codes. Alcohol intoxication can be determined using International Classification of Diseases (ICD)-9 diagnostic codes. Combining the two variables can allow for the identification of alcohol-related motor vehicle crashes. Among the strengths of the NEDS is the large, comprehensively representative sample with few missing data that can allow for the analysis of rare outcomes. Among the weaknesses is the difficulty in working with the large datasets required for multiyear analyses. An important bias common to clinical datasets based on administrative diagnostic codes is that diagnoses of alcohol intoxication are almost invariably limited to the most intoxicated individuals, resulting in important selection bias.
Web-Based Injury Statistics Query and Reporting System
CDC's Web-based Injury Statistics Query and Reporting System (WISQARS) is an online, publicly available resource for both fatal and nonfatal injury-related statistics. Fatality data are drawn from CDC's National Center for Health Statistics, National Vital Statistics System Mortality Data, which are themselves based on death certificate ICD-10 assignments. The ICD-10 coding system allows for inclusion of alcohol as an attributable cause (Codes X45, Y15, T51.0, T51.1, T51.9) of motor vehicle crashes (Codes E820–E825), but this combination is not routinely reported as part of the WISQARS. Injury data are drawn from the National Electronic Injury Surveillance System All Injury Program (NEISS-AIP) operated by the Consumer Protection Safety Commission. The NEISS is a national probability sample of approximately 100 hospitals in the United States and its territories drawn from a commercially purchased sampling frame ( Schroeder and Ault, 2001 ).
Data Linkage: Crash Outcome Data Evaluation System
NHTSA developed the Crash Outcome Data Evaluation System (CODES) to help researchers link crash records with clinical records. The CODES uses a match weight test statistic and has been used in a number of motor vehicle crash injury studies (see, for example, Clark et al., 2004 ; Loo and Tsui, 2007 ; Lopez et al., 2000 ). Advances in probabilistic and fuzzy matching methods offer additional approaches to matching datasets ( Lujic et al., 2008 ).
The CODES was created by NHTSA in the early 1990s to inform motor vehicle safety legislation. NHTSA initially funded 16 states to develop and implement the probabilistic data linkage algorithms for motor vehicle crash data sources. Some states expanded their efforts to link crash data with hospital discharge records, emergency medical transport call reports, and trauma registry records. Many of these efforts rely on deterministic linkage using identifiers not generally available to nongovernment researchers. Commercial software that replicates the CODES methodology is also available.
Denominator Data
Among the more challenging aspects of measuring alcohol-related motor vehicle crashes in the United States is determining an appropriate denominator to use to calculate comparable rates across time and place. While absolute numbers of fatalities, crashes, and incidents provide important information on the effect of alcohol-impaired driving in the United States, additional attention to normalizing such numerators by appropriate denominators can help better define risk at a time when resources need to be most efficiently deployed. A common approach is to use census data for population denominators, but other approaches based on travel patterns are possible.
National Household Travel Survey
The U.S. Department of Transportation conducts periodic national surveys about how people travel across the United States in their daily lives; the most relevant to alcohol-impaired driving is the National Household Travel Survey (NHTS). Data are available online for the years 1995, 2001, and 2009. The 2016 survey was recently administered and should be available in the near future. Data collected include
- Purpose of the trip (work, shopping, etc.);
- Means of transportation used (car, bus, subway, walk, etc.);
- How long the trip took (i.e., travel time);
- Time of day when the trip took place;
- Day of the week when the trip took place;
- If a private vehicle trip, number of people in the vehicle (i.e., vehicle occupancy);
- Driver characteristics (age, sex, worker status, education level, etc.); and
- Vehicle attributes (make, model, model year, amount of miles driven in 1 year).
The 1995 and 2001 surveys provide national estimates, and the 2009 survey provides both national- and state-level estimates, as it included a larger sample size. A full description of the NHTS methods and data use considerations may be found online.
To account for intervening years one can apply linear regression to NHTS point estimates from 1995, 2001, and 2009 to create annual estimates of drivers, vehicle miles driven, and person-miles traveled (total and subdivided miles traveled in privately owned vehicles, walking, and biking). Each estimate was stratified by age and sex and by race and ethnicity, and linear interpolation was conducted separately for each stratum.
Among the strengths of the NHTS is that it allows analysis of driver counts, miles driven, and person-miles traveled across a range of household and person characteristics as well as vehicle and trip characteristics, and that it is a large sample—a nationally representative survey.
Among its limitations are that race and ethnicity are applied to driver and household persons based on the primary household respondent. In one stratum, the linear regression produced a negative value for the first observation. In this case (bicycling miles traveled by men ages 75 and older), the intercept was manually adjusted such that the first value was the actual 1995 estimated value.
While 2009 survey estimates are valid at the state level and may be further stratified by demographic characteristics within state, some strata may contain small numbers and aggregation may be required. Because state-level data are not available before 2009, linear interpolation was only conducted at the national level to produce annual estimates.
Federal Highway Administration Highway Vehicle Miles Traveled
The Federal Highway Administration (FHWA) highway vehicle miles traveled (HVMT) provides annual summary statistics at the national and state level on registered vehicles, drivers' licenses, highway miles traveled, and highway user taxation. FHWA compiles the data as submitted by individual states. The data have been collected annually since 1945.
This paper uses annual highway miles traveled by state for SDS analyses at the state level. Urban and rural highway miles traveled were also used with FARS data on urban and rural fatal alcohol-related crashes.
Among the strengths of FHWA highway statistics is that the survey provides a nationally consistent measure of vehicle miles traveled. Among its limitations are that data are based on vehicle counts and therefore demographics of miles traveled are unavailable. A full description of FHWA highway statistics data use considerations may be found online.
Issues and Limitations of Denominator Data
While vehicle miles traveled (VMT) provides a valid approach to estimating risk based on a direct measurement of exposure, there are some methodological challenges in its use (see Table A-1 ). The NHTS and the FHWA measures are structured differently and cannot be easily or reliably combined. The NHTS, for example, may allow for age stratification, while the FHWA estimates can be broken down by urban or rural geography. More granular stratifications, such as combining age groups and urban versus rural status, are not a trivial problem and require careful use of one dataset or the other. Measuring change over time will generally require interpolation over a limited number of measurements (in some cases just two), with an underlying assumption of linearity that may not be supported.
Strengths and Limitations of Denominator Data.
BRFSS Data Analysis
- The number of adults in the United States reporting an instance of alcohol-impaired driving over the previous 30 days decreased about 38 percent from 2006 to 2014. There was an approximate 10 percent decrease between 2010 and 2014.
- Men were three times more likely to report recent alcohol-impaired driving.
- The youngest age groups were more likely to experience a decline in recent alcohol-impaired driving.
- Much of the decrease in reported rates of alcohol-impaired driving in the past 30 days for all age groups (≥18 years) occurred between 2006 and 2008.
The mean number of times an adult (≥18 years of age) reported alcohol-impaired driving over the past 30 days for all the data years and all states was 0.09 (standard error [s.e.] = 0.02, 95% confidence interval [CI] 0.09, 0.10). This represented 189.9 persons (≥18 years old), per 10,000 surveyed U.S. adult population members (s.e. = 2.0, 95% CI 185.6, 194.1), reporting that they drove while alcohol impaired during the previous 30 days. This population-based count decreased 38.4 percent (s.e. = 0.07) from 251.4 per 10,000 in 2006 (95% CI 238.3, 264.4) to 154.9 per 10,000 in 2014 (95% CI 147.5, 162.3). There was a 10.5 percent (s.e. = 0.5) decline from 2010 to 2014.
The overall rate of respondents reporting at least one incident of DWI in the previous month varied by U.S. state and territory, with the highest rate of 414.1 per 10,000 (95% CI 334.6, 493.6) in Guam and the lowest of 62.7 per 10,000 in Utah (95% CI 51.9, 73.6) (see Figure A-1 ). There was some graphical indication of clustering of higher rates in the northern United States (see Figure A-2 ). There was some variation, but the general geographic patterns prevailed over time.
Number of respondents reporting at least one instance of alcohol-impaired driving in the past 30 days per 10,000 target adult survey population by state or territory. SOURCE: BRFSS data, 2006–2014.
Choropleth number of respondents reporting alcohol-impaired driving in the past 30 days per 10,000 target adult survey population by state. SOURCE: BRFSS data, 2006–2014.
More than three times more male (293.9 per 10,000; 95% CI 286.0, 301.7) than female (91.5 per 10,000; 95% CI 87.8, 95.2) respondents reported at least one incident of DWI in the previous 30 days. There was a decline during the study period in the number of both male and female respondents reporting at least one incident of DWI. The rate per 10,000 of respondents reporting at least one incident of DWI in the previous 30 days was inversely related to age group. All age groups experienced a decline from 2006 to 2014 in the rate per 10,000 of respondents reporting at least one incident of DWI in the previous 30 days, with the steepest declines among the youngest age groups (see Figure A-3 ).
Number of respondents reporting alcohol-impaired driving in the past 30 days per 10,000 target adult survey population by age group over time. SOURCE: BRFSS data, 2006–2014.
National Survey on Drug Use and Health Data Analysis
- There was a 27 percent decrease from 2002 to 2014 in the rate of persons reporting an arrest for alcohol-impaired driving in the past month, with a more modest and more variable decline of approximately 10 percent since 2011.
- Men were four times more likely to report a recent arrest for alcohol-impaired driving.
- The rate of women reporting a recent arrest for alcohol-impaired driving increased 40 percent between 2002 and 2014.
There were 723,283 entries in the National Survey on Drug Use and Health for the years 2002 to 2014, representing a survey-adjusted total of 3,250,847,536 (s.e. = 9,889,020) observations. The yearly survey count mirrored the total U.S. population for the years 2002 to 2014.
The overall rate of persons responding yes to questions regarding whether they had been arrested for DWI in the preceding 12 months was 57.8 per 10,000 survey-adjusted target population (s.e. = 0.0001). The rate per 10,000 of responses of yes to questions regarding arrest for DWI showed a fairly steady pattern from 2002 to 2010, after which there was evidence of a decline. The rate declined 26.7 percent (s.e. = 8.9) from 65.9 per 10,000 in 2002 to 47.9 per 10,000 in 2014. The decline between 2011 and 2014 was more modest (9.4 percent) and more subject to chance (s.e. = 12.4). The rates for 19- to 29-year-olds were nearly three times those for other age groups, although there was graphical evidence of a decrease among 19- to 21-year-olds.
The rate for men answering yes to questions regarding recent DWI arrests was nearly four times that of women, 94.0 per 10,000 target population men (95% CI 88.7, 99.3) versus 23.9 per 10,000 women (95% CI 21.8, 26.0). There was graphical evidence that the rates for men responding yes to questions regarding DWI declined over the study period, while rates among women appeared to be increasing. The rate for male respondents declined 38.6 percent (s.e. = 10.6) from 118.2 per 10,000 in 2002 to 73.1 per 10,000 in 2014, while the rate for female respondents increased 43.7 percent (s.e. = 28.9), from 17.1 per 10,000 target population in 2002 to 24.4 per 10,000 in 2014.
The age-gender category with the highest overall rate of responding yes to questions regarding DWI in the previous year was men aged 18–25, which at 213.8 per 10,000 target population (95% CI 200.3, 227.2) was over three times that of the next highest category. It was also the age category with the steepest decline in rates over the study period, decreasing 43.3 percent (s.e. = 11.6) from 296.1 per 10,000 in 2002 to 169.6 per 10,000 in 2014.
Rates of positive responses to questions regarding DWI were higher in less population-dense core-based statistical areas (CBSAs). These differences were statistically significant (p = 0.0001) in a survey-adjusted analysis of variance comparing CBSAs for a positive response to DWI questions. CBSAs of greater and less than 1 million people both experienced declines between 2002 and 2014 in the rates of individuals responding yes to questions about DWI. Although non-CBSA geographic segments had a 38.8 percent (s.e. = 44.2) increase in the rate of positive responses to questions regarding DWI from 2002 to 2014, there was considerable variability in the yearly data.
NIBRS Data Analysis
- There were more than 4.5 million arrests for alcohol-impaired driving reported to the FBI between 1995 and 2014, accounting for more than 10 percent of all reported arrests.
- Alcohol-impaired driving arrest rates varied 32-fold across states.
- The population-based rate of alcohol-impaired driving arrests reported to the FBI in 2014 decreased 13 percent from a high in 2003.
- There has been a decrease in alcohol-impaired driving arrests as a proportion of all arrest activity in the United States.
- There has been a notable and sustained increase in the percentage of female alcohol-impaired driving arrestees over the past 20 years.
There were 4,681,475 recorded DWI arrests reported to the NIBRS over the years 1995 to 2014, which accounted for 10.2 percent of all 45,978,155 reported arrests during that period. The overall population-based rate of DWI arrests for the entire 20-year period was 526.5 arrests per 100,000 persons covered by the reporting agencies. The average age of an arrestee was 34.4 years old (95% CI 34.3, 34.4), and listed ages ranged from 7 to 99 years old. Approximately 78.0 percent (95% CI 78.0, 78.1) of arrestees were male.
The median annual arrest rate for alcohol-impaired driving was 503.4 per 100,000 covered population. While a linear increasing trend line could be fit to the annual arrest rates, the data were more consistent with a period of increased enforcement from a low of 458.1 arrests per 100,000 covered population in 2003 to a high of 563.6 in 2009, followed by a 12.7 percent decline (95% CI 10.2, 15.8) to 491.9 in 2014.
When examined as the percentage of all arrests, there was an apparent decline in alcohol-impaired driving arrests as a proportion of all enforcement activity from 10 percent in 1995 to 9 percent in 2005, with evidence of some recovery in activity to approximately 10 percent of all arrests in 2014. The overall trend, though, indicated a significant decrease in alcohol-impaired driving arrests as a proportion of all arrest activity in the United States.
There was a slight increase in the mean age of arrestees for alcohol-impaired driving from approximately 34 years old in 1995 to 35.8 years old in 2014, with much of the increase occurring after 2010. Women were a rapidly increasing proportion of persons arrested for alcohol-impaired driving during the study period, increasing 40.0 percent (95% CI 22.0, 60.1) from 15.32 percent of all arrestees in 1995 to 25.56 percent in 2014 (see Figure A-4 ). There was a significant linear increase in the percentage of female arrestees of approximately 0.6 percent each year.
Proportion of women arrestees with overlying LOESS line, incidents of driving under the influence of alcohol. SOURCE: NIBRS data, 1995–2014.
Rates of reported arrests for alcohol-impaired driving varied considerably by state from a low of 30.9 per 100,000 covered population in Delaware to a high of 960.8 in Kansas, with most states clustered around a median of approximately 490 arrests per 100,000 covered population and some evidence of regional variation. The percentage of all arrests represented by alcohol-impaired driving also varied across states, ranging from a low of 0.43 per 100,000 covered population in the District of Columbia to 21.87 in Vermont but with less overall heterogeneity. Persons arrested for alcohol-impaired driving were on average 5 years younger than the state median for every state except Delaware and Utah, where they were 2 to 3 years older. States also varied considerably in the percentage of women among alcohol-impaired driving arrestees, from a low of 6.98 percent of all arrestees in Georgia to 29.37 percent in Maine.
NHTS Analysis
The NHTS estimates that the overall number of drivers increased 20 percent from 176,331,000 in 1995 to 212,309,000 in 2009, although growth was slower between 2001 and 2009 than between 1995 and 2001. The overall rate of growth varied by age group, and in fact there was an estimated decline in drivers in the 21- to 25-year-old and 26- to 35-year-old age groups (both men and women) between 1995 and 2009. By race and ethnicity, Hispanic drivers experienced the largest rate of growth, approximately 75 percent over the time period, followed by Asian drivers (66 percent), non-Hispanic blacks (33 percent), other non-Hispanic drivers (21 percent), and non-Hispanic whites (11 percent).
Estimates of total vehicle miles driven increased between 1995 and 2001 and decreased from 2001 to 2009, for a net change of +8.8 percent overall from 2.063 trillion in 1995 to 2.245 trillion in 2009. Patterns by age corresponded with driver trends; that is, there were declines in vehicle miles driven for adults 21 to 35 years of age. Vehicle miles driven by race and ethnicity mirrored the aforementioned rates of growth among drivers by race and ethnicity.
Estimated total miles per person of travel across all modalities (private vehicle, walking, biking, transit, air, and other) likewise increased between 1995 and 2001 and decreased between 2001 and 2009, with a net increase of 9 percent from 3.411 trillion to 3.732 trillion. By modality, private vehicle miles accounted for the majority of travel, increasing 6 percent from 3.110 trillion in 1995 to 3.298 trillion in 2009. A decline in overall vehicular travel was observed among 25- to 34-year-olds, similar to the observations above for drivers and vehicle miles driven. Men 16 to 24 years of age also experienced less overall vehicular travel from 1995 to 2009. While a smaller fraction of total travel, walking and biking estimates meanwhile increased both between 1995 and 2001 and between 2001 and 2009. Walking miles increased remarkably by 160 percent from 10.821 billion in 1995 to 27.943 billion in 2009. Estimated total biking miles likewise grew sharply by 95 percent from 4.585 billion in 1995 to 8.956 billion in 2009. Increases in miles walked were observed across all categories of age and gender. Biking trends by age and gender had some fluctuations likely as a result of smaller numbers.
Based on our review of the FHWA HVMT, across the United States, vehicle miles traveled increased between 1995 and 2008, declined somewhat between 2007 and 2009, and then increased again between 2010 and 2015.
FARS Data Analysis
- From 1995 to 2015 there was a 30 percent decrease in the absolute number of alcohol-related motor vehicle crash deaths in the United States, while there was a population increase of 40 percent and a 35 percent increase in VMT.
- The greatest declines in alcohol-related motor vehicle crash mortality occurred among the youngest drivers and passengers.
- Men accounted for 77 percent of all alcohol-related motor vehicle crash deaths in the United States.
- Approximately 60 percent of alcohol-related motor vehicle crash deaths in the United States occur in rural areas.
- Adjusted for VMT, the risk of an alcohol-related motor vehicle crash fatality in rural areas is nearly three times that of urban areas.
- Non-Hispanic Asians had population-adjusted alcohol-related motor vehicle crash fatality rates more than three times lower than any other racial and ethnic group.
- Motorcyclists, particularly those 55 to 64 years old, experienced a marked increase in alcohol-related crash fatalities.
This paper analyzes the FARS data from the years 1995 to 2015, acquired online from NHTSA. The FARS is a nationwide U.S. census providing annual data on all fatalities suffered from MVCs. Specifically, this study examines MVC fatalities with documented alcohol use. Fatal car crashes were considered alcohol related if any motor vehicle driver had police-reported alcohol intoxication or a positive laboratory BAC (BAC = 0.01 g/dL). Alcohol use by passengers, pedestrians, and cyclists did not classify a crash as an alcohol-related MVC.
Analyses focused on persons fatally injured from these crashes. Data were analyzed over this 21-year interval in terms of age, sex, race, and ethnicity. In addition, analyses compared urban and rural crash rates as well as crash rates between different states. Subanalyses were also performed on fatally injured cyclists, pedestrians, and motor vehicle occupants. Crash and fatality rates were adjusted in terms of census population counts obtained from the HCUP website as well as estimates of person-miles traveled obtained from the NHTS website. Results are presented as tables and time series plots. 3 Analyses were completed using R .
Throughout the 1995–2015 study period, deaths from alcohol-related MVCs decreased by 29 percent. This decline was even greater after adjusting for population increases (41 percent) and person-miles traveled (37 percent). The greatest reductions were observed in younger persons, with 16- to 20-year-olds and children under 16 experiencing 56 and 66 percent decreases in alcohol-related MVC fatalities, respectively. The age group most frequently fatally injured in alcohol-related MVCs, 21- to 24-year-olds, experienced a 34 percent decrease in fatalities from 2,118 deaths in 1995 to 1,393 in 2015. Interestingly, individuals from 45 to 64 years of age experienced a 30 percent increase in alcohol-related MVC fatalities over the study period, but after adjusting for population increases this group also experienced a modest decline (15 percent).
Men accounted for 77 percent of all alcohol-related MVC fatalities. Despite this, both men and women experienced a decline in alcohol-related MVC fatalities of similar proportion, with male fatalities decreasing 29 percent from 10,667 deaths in 1995 to 7,545 in 2015, and female fatalities also decreasing 29 percent from 3,270 in 1995 to 2,312 in 2015. Non-Hispanic whites accounted for 68 percent of alcohol-related MVC fatalities from 2000 to 2015. However, after accounting for population size, non-Hispanic whites had approximately equal alcohol-related MVC fatalities per 100,000 population (3.52) as Hispanics (3.41) and non-Hispanic blacks (3.44) from 2000 to 2015. Non-Hispanic Asians, on the other hand, had population-adjusted fatality rates more than three times lower than all other racial and ethnic groups (1.08). During this period, non-Hispanic whites experienced a 24 percent decline in population-adjusted, alcohol-related MVC fatalities, compared to declines of 10, 56, and 41 percent in non-Hispanic blacks, non-Hispanic Asians, and Hispanics, respectively.
From 1995 to 2014, 60 percent of alcohol-related MVC fatalities occurred in rural areas. After adjusting for VMT, rural areas had a fatality rate of 7.24 deaths per billion VMT, 2.67 times greater than that of urban areas (2.71 deaths per billion VMT). This was relatively constant over the study period (see Figure A-5 ). During this period rural areas also experienced a greater decline in alcohol-related MVC fatalities (41 percent) compared to urban areas. However, after adjusting for VMT, the declines in MVC fatalities of urban areas (38 percent) and rural areas (40 percent) were similar. Of note, declines in rural fatalities were disproportionately reduced in individuals under 45 years of age (52 percent decrease), with the largest decreases in those under 21 years of age (64 percent). Rural individuals 45 and older had a slight increase in fatalities (4 percent). Changes in urban fatalities had less variance by age between individuals under 45 years of age (22 percent decline) and 45 years of age or older (22 percent increase).
Deaths from alcohol-related crashes by year per billion vehicle miles traveled—urban versus rural. SOURCE: FARS data, 1995−2014.
Of all those fatally injured in alcohol-related motor vehicle crashes, 95.4 percent were occupants of motor vehicles, 4.0 percent were pedestrians, and 0.6 percent were cyclists. After adjusting for person-miles traveled, pedestrians had the highest fatality rate (22.2 fatalities per billion person-miles traveled), followed by cyclists (11.2) and then motorists (5.2). Over the study period, pedestrians had the greatest reduction in fatalities (36 percent) compared to motor vehicle occupants (29 percent) and cyclists (22 percent). Motorcyclists, particularly those 55 to 64 years old, experienced a marked increase in both number and rate of alcohol-impaired fatalities, with a specific increase following 2010.
From 1995 to 2015 the yearly rate of alcohol-related MVC fatalities was 4.44 persons per 100,000 population. Fatality rates differed substantially between states with the highest population-adjusted fatality rates in Montana, New Mexico, North Dakota, South Carolina, and Wyoming (8.13–11.38 yearly deaths per 100,000 population) and the lowest fatality rates in the District of Columbia, Massachusetts, New Jersey, New York, and Utah (1.73–2.38). Four states, Maine, North Dakota, Rhode Island, and South Dakota, experienced increases in population-adjusted fatalities from 1995 to 2015 (from 1 to 28 percent), while the District of Columbia, Hawaii, Kansas, New Mexico, and Vermont had the greatest declines in population-adjusted fatality rates, with reductions ranging from 58 to 69 percent.
Limitations
In this FARS database analysis, MVCs were considered alcohol related if a motor vehicle driver had police-reported alcohol intoxication or a positive laboratory BAC (BAC greater than 0.01 g/dL). Specifically, this information was obtained from the DR_DRINK variable from the FARS vehicle data files. Of note, the FARS crash-level DRUNK_DR variable was miscoded in the database for the years 1999–2007. While every crash within the database with driver alcohol involvement was included in this study, alcohol data are often missing from the database, meaning that this analysis may undercount the actual number of alcohol-related fatalities.
While the entire study period ranged from 1995 to 2015, analyses of race and ethnicity were from the years 2000 to 2015, since the FARS database did not begin recording race until 1999, and the U.S. Census significantly modified how it recorded race and ethnicity starting in 2000. As a result, the year 2000 was selected as the starting point for race and ethnicity subanalyses. Importantly, because the FARS obtains race and ethnicity information from death certificates, data are only available for individuals who were fatally injured. Even in this group, race or ethnicity information was missing in 14 percent of those persons reported to have died. This led to reduced fatality rates in the study's analyses by race and ethnicity. Though the FARS had a small degree of missing data for other data elements, none of the absent data significantly affected analyses since the information was missing in well below 1 percent of persons fatally injured.
The FARS database is updated every year with several new and recoded variables, and this recoding did limit the urban and rural sub-analysis to a minor extent. While rural and urban designation was previously a dichotomous variable, in 2015, the FARS recoded its road classification data element to include a third interstate category. Since this led to reduced rural and urban crash rates, 2015 data were excluded and only the years 1995–2014 were examined. In addition, because the HCUP census uses a different criterion to distinguish rural and urban populations from the FARS, only adjusted fatality rates by VMT could be obtained for these urban and rural subanalyses.
- AHRQ (Agency for Healthcare Research and Quality). Introduction to the Healthcare Cost and Utilization Project's (HCUP) Nationwide Emergency Department Sample (NEDS), 2013. 2015. [October 24, 2017]. https://www .hcup-us.ahrq .gov/db/nation/neds /NEDS2013Introduction.pdf .
- Brady JE, Baker SP, Dimaggio C, McCarthy ML, Rebok GW, Li G. Effectiveness of mandatory alcohol testing programs in reducing alcohol involvement in fatal motor carrier crashes. American Journal of Epidemiology. 2009; 170 (6):775–782. [ PMC free article : PMC2800261 ] [ PubMed : 19692328 ]
- Clark DE, Anderson KL, Hahn DR. Evaluating an inclusive trauma system using linked population-based data. Journal of Trauma-Injury, Infection, and Critical Care. 2004; 57 (3):501–509. [ PubMed : 15454794 ]
- FBI (Federal Bureau of Investigation). FBI releases 2015 crime statistics from the national incident-based reporting system, encourages transition. Washington, DC: FBI National Press Office; 2016. [March 7, 2018]. https://www .fbi.gov/news /pressrel/press-releases /fbi-releases-2015-crime-statistics-from-the-national-incident-based-reporting-system-encourages-transition .
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- Subramanian R. Transitioning to multiple imputation—A new method to estimate missing blood alcohol concentration (BAC) values in FARS. Washington, DC: National Center for Statistics and Analysis; 2002.
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This background paper was commissioned at the direction of the Committee on Accelerating Progress to Reduce Alcohol-Impaired Driving Fatalities to offer insight into the data and surveillance systems that could inform alcohol-impaired driving interventions in the United States. In addition, this paper provides the descriptive epidemiology of fatal and nonfatal alcohol-involved crashes in the United States over time, describes trends in patterns of alcohol consumption and alcohol-impaired driving over time, and identifies the strengths and weaknesses of existing data sources that inform this epidemiology.
This is an abridged version of the paper. A full version including all tables and figures can be found in the public access file for the Committee on Accelerating Progress to Reduce Alcohol-Impaired Driving Fatalities. Available by request from the National Academies of Sciences, Engineering, and Medicine's Public Access Records Office (PARO@nas.edu).
Available by request from the National Academies of Sciences, Engineering, and Medicine's Public Access Records Office (PARO@nas.edu).
- Cite this Page DiMaggio C, Wheeler-Martin K, Oliver J. Alcohol-Impaired Driving in the United States: Review of Data Sources and Analyses. In: National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on Accelerating Progress to Reduce Alcohol-Impaired Driving Fatalities; Negussie Y, Geller A, Teutsch SM, editors. Getting to Zero Alcohol-Impaired Driving Fatalities: A Comprehensive Approach to a Persistent Problem. Washington (DC): National Academies Press (US); 2018 Jan 17. A.
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Composing A Research Paper Title On Drunk Driving: Tips And Examples
In America laws in different states are very strict to handle DUI (drunk under influence) cases. Especially, college goers and inexperienced vehicle drivers consume alcohol when they drive vehicles on roads. They are reckless and ill tempered. They meet with car accidents due to the overconsumption of country liquor. Therefore, government in America has had to bring some new changes in enforcing the DUI related rules to prevent accidents and casualties. In your academic paper, give tips and examples to avoid street accidents. Your dissertation paper must have some user-friendly tips and techniques to rescue vehicle drivers who are addicted to alcohol.
Some Tips for Alcoholic Car Drivers to Drive Cars
One of the best tips to drive vehicles under influence of alcohol is to run the vehicle at slow speed. If a driver takes alcohol to shrug off depression, he must control his emotion. If he increases the speed of his car, he can lose control over the vehicle. He should hold the steering wheel properly to drive the car. Modern street nav tools are installed into vehicles for road mapping. Drivers watch and monitor the road condition on a small displaying screen. Drivers who are habituated to drive the cars consuming alcohol should install these advanced tools for street navigation. Old vehicles must be upgraded by placing hi-tech weather checking tool, tachometer, a digital speedometer and satellite supported road mapping system. In this connection, provide some good examples which must prove the usefulness of the installation of advanced street navigating tools inside cars and large vehicles. Young drivers should have licenses to drive their vehicles. They have to honor traffic laws. However, at the same time, they must be careful when they choose strong country liquor to consume. If they travel by cars on weekends, they must reach their destinations before the coming of evening. Their intoxicated nature makes them wild to drive cars through highways. Therefore, they must not plan to take their vehicles to the street at night. It will put them in danger. They should avoid congested areas to run their vehicles. The bottle necked corners and lanes are risky for a drunkard who is on the driving seat to drive his vehicle.
During emergency, many experienced drivers lose patience. They have to contact vehicle repairing service providers to have assistance. Before starting their journeys, they should take all contact details about the road side vehicle repairing outlets. If they drink wine, they are not able to go to the local car repairing shops. Therefore, they need to use their cell phones to contact the best car refurbishing service provider. Your thesis generates easy techniques and tips for alcoholic people who need to be alert at the time of car driving.
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- Alcohol-impaired driving among adults—USA, 2014–2018
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- http://orcid.org/0000-0002-8711-8268 Vaughn Barry ,
- Amy Schumacher ,
- Erin Sauber-Schatz
- Division of Injury Prevention, National Center for Injury Prevention and Control , CDC , Atlanta , Georgia , USA
- Correspondence to Dr Vaughn Barry, Division of Injury Prevention, National Center for Injury Prevention and Control, CDC, Atlanta, GA 30329-4018, USA; fvd5{at}cdc.gov
Introduction Alcohol-impaired driving (AID) crashes accounted for 10 511 deaths in the USA in 2018, or 29% of all motor vehicle-related crash deaths. This study describes self-reported AID in the USA during 2014, 2016 and 2018 and determines AID-related demographic and behavioural characteristics.
Methods Data were from the nationally representative Behavioral Risk Factor Surveillance System. Adults were asked ‘During the past 30 days, how many times have you driven when you have had perhaps too much to drink?’ AID prevalence, episode counts and rates per 1000 population were estimated using annualised individual AID episodes and weighted survey population estimates. Results were stratified by characteristics including gender, binge drinking, seatbelt use and healthcare engagement.
Results Nationally, 1.7% of adults engaged in AID during the preceding 30 days in 2014, 2.1% in 2016 and 1.7% in 2018. Estimated annual number of AID episodes varied across year (2014: 111 million, 2016: 186 million, 2018: 147 million) and represented 3.7 million, 4.9 million and 4.0 million adults, respectively. Corresponding yearly episode rates (95% CIs) were 452 (412–492) in 2014, 741 (676–806) in 2016 and 574 (491–657) in 2018 per 1000 population. Among those reporting AID in 2018, 80% were men, 86% reported binge drinking, 47% did not always use seatbelts and 60% saw physicians for routine check-ups within the past year.
Conclusions Although AID episodes declined from 2016 to 2018, AID was still prevalent and more common among men and those who binge drink. Most reporting AID received routine healthcare. Proven AID-reducing strategies exist.
- motor vehicle - occupant
- surveillance
Data availability statement
Data are available in a public, open access repository. Not applicable.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .
https://doi.org/10.1136/injuryprev-2021-044382
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INTRODUCTION
Motor vehicle crashes in the USA are a significant public health issue that causes death and injury, burden health systems and have negative economic impacts. In 2018, traffic crashes on public roadways in the USA caused 36 560 motor vehicle-related deaths 1 and an additional 2.7 million non-fatal emergency department visits. 2 These statistics include drivers, passengers and non-occupants such as pedestrians and bicyclists. Alcohol-impaired driving (AID) is a major risk factor for traffic crashes. Of the 36 560 motor vehicle crash deaths that occurred in 2018, 29% (n=10 511) involved an alcohol-impaired driver. 1 Both the yearly number of deaths and the number that involved an alcohol-impaired driver have either held steady or increased annually from 2014 through 2018, 1 3–6 suggesting that a renewed effort to confront and reduce AID is needed. 7–9
Efforts to reduce AID in the past have been successful. Between 1982 and 1997, there was a 43% decrease in the proportion of alcohol-impaired drivers involved in fatal crashes. 10 This corresponded with a time when many US states implemented laws making it illegal to drive with a blood alcohol concentration of 0.08 g/dL or higher and grassroots organisations like Mothers Against Drunk Driving (MADD) were formed to promote policies to reduce AID. 11 Strategies addressing AID have the potential to substantially reduce motor vehicle crashes and deaths. 12 Effective strategies to prevent AID exist, including drunk driving laws, sobriety checkpoints, ignition interlocks, mass media campaigns and increasing alcohol taxes. 9 13 However, implementation of these strategies varies across states and communities. 14–16
The total number of self-reported AID episodes among adults in the USA per year has been estimated to range from 110 to 160 million during 1993 through 2012 with no clear decrease over time. 17 18 In 2012, an estimated 1.8% of adults in the USA reported at least one AID episode during the previous 30 days, which translated to 4.2 million adults engaging in 121 million annual AID episodes (a rate of 505 per 1000 population). 18 An update to these estimates is needed to illustrate the continued call for universal implementation of prevention efforts using both established and promising strategies.
This study estimated the annual prevalence, number of episodes and rates of AID among adults in the USA during 2014, 2016 and 2018. We also examined how these outcomes varied by certain demographic and behavioural characteristics.
Data were from the 2014, 2016 and 2018 Behavioral Risk Factor Surveillance System (BRFSS) surveys. BRFSS is a nationally representative, cross-sectional, ongoing, random-digit-dialled telephone survey. State health departments in collaboration with the US Centers for Disease Control and Prevention use trained interviewers to collect reported health-related behaviours from a representative sample of civilian, non-institutionalised adults aged ≥18 years residing in any US state or territory. BRFSS participants are recruited via landline and cellular telephone numbers. All BRFSS questionnaires and data are available online. 19 Because the BRFSS is a surveillance system, the Centers for Disease Control and Prevention’s Institutional Review Board has determined that the BRFSS is exempt from its review.
Nearly half a million adults completed the interview in each year (456 664 in 2014; 486 303 in 2016 and 437 436 in 2018). We limited the analysis to adults residing in the 50 US states or the District of Columbia that had information recorded for the AID survey question. The median response rates for the 19 BRFSS 2014, 2016 and 2018 surveys were 47% (49% landline, 41% cell phone), 47% (48% landline, 46% cell phone) and 50% (53% landline, 43% cell phone), respectively.
Survey questions
In even-numbered years, BRFSS respondents who reported having had at least one alcoholic beverage in the past 30 days were asked ‘During the past 30 days, how many times have you driven when you have had perhaps too much to drink?’ Responses were recorded as whole numbers ≥0 and were considered to be the number of AID episodes. Those who reported no alcohol in the past 30 days were coded as having zero AID episodes. We created a binary variable for AID (yes/no) categorising people reporting zero episodes as ‘no’ and those with ≥1 episodes as ‘yes’.
Respondent demographic characteristics collected included age in years at the time of the survey, race and ethnicity, highest level of education obtained, current marital status and household income. Reported behavioural characteristics collected included binge drinking and seatbelt use. Binge drinking was defined as having on at least one occasion five or more drinks for men and four or more drinks for women during the past 30 days. Seatbelt use was ascertained by asking ‘How often do you use seatbelts when you drive or ride in a car? Would you say—always, nearly always, sometimes, seldom or never?’ Responses were categorised into a binary variable: always versus less than always. AID prevalence, episodes and rates were described across demographic and behavioural characteristic categories. Healthcare utilisation was assessed to estimate the percentage of adults who engaged in AID who also had recently accessed healthcare for a routine check-up. This was measured by the question ‘About how long has it been since you last visited a doctor for a routine check-up? (A routine check-up is a general physical examination, not an examination for a specific injury, illness or condition.)’ Answers were recorded as being within the past 12 months, 2 years, 5 years or ≥5 years ago.
Statistical analyses
Analyses were carried out separately for each year. Results were weighted using the BRFSS-provided weights, cluster and stratification variables to make results nationally representative. National AID 30-day prevalence was estimated using the percentage of respondents who reported any AID in the previous 30 days. Annual estimates of AID episodes per respondent were calculated by multiplying the respondent’s reported episodes in the preceding 30 days by 12. For the 28 respondents (8 in 2014, 6 in 2016 and 14 in 2018) who reported more than one AID episode daily, annualised AID episodes were truncated at 360 (which is equivalent to 30 AID episodes per month). Annual rates of AID episodes and corresponding 95% CIs were then calculated by dividing the annual number of AID episodes by the respective weighted population estimate from BRFSS for the respective year (2014, 2016 or 2018). Each rate’s SE was used to calculate CIs and was approximated using Taylor series linearisation (also called the ‘delta method’). 20 Annual AID episode rates were reported per 1000 population. National AID prevalence, number of episodes and rates per 1000 population were stratified by demographic and behavioural characteristics. Data analysis was completed using the complex sampling survey procedures in SAS V.9.4.
Participants
The analysis included over 1 million respondents from the 50 US states and District of Columbia who had non-missing AID information (426 910 in 2014, 448 062 in 2016 and 405 074 in 2018).
AID prevalence, number of episodes and rates
Nationally, 1.7%, 2.1% and 1.7% of adults in the years 2014, 2016 and 2018 reported having engaged in AID during the previous 30 days ( tables 1–3 ).
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Percentage of adults reporting recent alcohol-impaired driving, annual episodes and episode rates per 1000 population*: 2014
Percentage of adults reporting recent alcohol-impaired driving, annual episodes and episode rates per 1000 population*: 2016
Percentage of adults reporting recent alcohol-impaired driving, annual episodes and episode rates per 1000 population*: 2018
On average, 57% of those who reported AID indicated one episode in the past 30 days, 24% indicated two episodes, 12% indicated 3–5 episodes and 7% reported that they had driven impaired ≥6 times over the past 30 days (data not shown). The estimated national annual number of AID episodes varied across years (2014: 111 million, 2016: 186 million, 2018: 147 million) and represented 3.7 million, 4.9 million and 4.0 million adults, respectively. The rate of AID episodes per 1000 population was highest in the year 2016 (rate=741, 95% CI 676 to 806) compared with 2014 (rate=452, 95% CI 412 to 492) and 2018 (rate=574, 95% CI 491 to 657).
AID by demographic and behavioural characteristics
In each year, AID was most common among men, people who binge drink and people who did not always use a seatbelt ( tables 1–3 ). Men accounted for an overwhelming percentage of AID episodes (80% in 2014, 70% in 2016 and 80% in 2018; data not shown). Similarly, people who engaged in recent binge drinking accounted for 85%, 80% and 86% of all AID episodes in 2014, 2016 and 2018, respectively (data not shown). Those who reported more binge drinking reported more AID episodes. For example, in 2014, the 4% of adults who reported binge drinking at least four times per month accounted for 58% of AID episodes. This was true in 2016 and 2018 where 4% and 5% of those who reported binge drinking at least four times a month accounted for 55% and 65% of AID episodes in each respective year. People who reported not always wearing a seatbelt had an annual AID rate four times higher in 2014 and 2016 and six times higher in 2018 than those who always wore a seatbelt.
Reported AID varied by other characteristics as well. Regardless of gender and year, AID rates were highest among people aged 21–34 years and then decreased with age. Married adults, particularly married male adults, tended to have lower AID rates compared with those who were coupled, previously married or never married. There were no significant differences in AID rates by race/ethnicity, education level or household income no matter the year or gender. Among those engaging in AID, 60% reported seeing a doctor for a routine check-up within the past year (data not shown). Another 16% had a check-up between 1 and 2 years prior (data not shown). Among respondents who reported recent binge drinking, 62% reported a routine check-up within the past year (data not shown). Finally, among those reporting recent AID and recent binge drinking, 57% had a check-up within the past year (data not shown).
Discussion and public health implication
AID continues to be prevalent in the USA, and the majority of AID episodes during 2014–2018 occurred among men and those who engaged in recent binge drinking. AID prevalence and episode rates were also higher among those aged 21–34 years compared with older ages and among those who did not always wear seatbelts compared with those who always wear seatbelts.
These 2014, 2016 and 2018 BRFSS results are similar to previously published 2012 BRFSS results. In 2012, 2014, 2016 and 2018, 1.8%, 1.7%, 2.1% and 1.7% of adults engaged in AID. This translated to 4.2 million adults, 3.7 million adults, 4.9 million adults and 4.0 million adults engaging in 121 million annual AID episodes, 111 million episodes, 186 million episodes and 147 million episodes during each of the 4 years. 18 Rates across the 4 years were 505, 452, 741 and 574 per 1000 population. 18 Similar to 2014–2018, in 2012, men accounted for 80% of AID episodes and respondents who reported binge drinking accounted for 85% of episodes. 18 Taken all together, there were slight differences in AID across these years with a peak in AID prevalence and number of episodes in 2016, but no clear trend across the years 2012, 2014, 2016 and 2018. This roughly correlates with national annual motor vehicle crash death data that suggest crash deaths and the percentage of them related to AID have remained relatively constant over the years 2012–2018. 1 3–6 It is unclear what might be behind the peak in AID in 2016. Changes in AID can be influenced by changing economic and societal factors (like economic recessions). Preliminary data show an increase in AID-related crash deaths in 2020 (during the COVID-19 pandemic), which might signify an associated increase in 2020 BRFSS AID rates. 21
AID-related deaths are preventable via proven strategies. To reduce AID, states and communities can consider implementing or scaling up effective interventions such as expanding the use of publicised sobriety check points; enforcing blood alcohol concentration (BAC) laws and minimum legal drinking age laws; requiring ignition interlocks for all persons convicted of AID and increasing alcohol taxes. 22 Because a significant proportion of adults engaging in AID also does not always wear a seatbelt, primary seatbelt laws that cover all passengers might decrease AID-related crash mortality. Increasing seatbelt use among those engaging in AID is particularly important because alcohol not only increases the risk of a crash but also increases the risk of injury or death in a crash. 23–25
Promising strategies that have shown effectiveness in other countries, when implemented, could decrease AID and subsequent crash deaths. The National Transportation Safety Board recommended lowering the BAC limit in the USA for drivers from 0.08 to 0.05 to reduce crashes, injuries and deaths caused by AID. 26 A meta-analysis estimated that 1790 lives would be saved each year if all US states adopted a 0.05 BAC limit. 27 Most high-income nations have already enacted a 0.05 illegal BAC limit, and these nations have lower motor vehicle crash fatality rates than the USA. 28 Because our results showed that AID rates were highest among people aged 21–24 years (followed closely by people aged 25–34 years), future strategies that work among young adults are warranted. Although consuming alcohol is generally illegal in the USA for anyone under the age of 21 years, 1.1%, 1.5% and 1.5% of people aged 18–20 years reported engaging in AID during 2014, 2016 and 2018, suggesting the need to support strategies that prevent alcohol use and AID among young adults. It is unclear what effects ride share companies (eg, Uber and Lyft) might have on AID, and this topic deserves evaluation. Studies have shown mixed results with one showing that rideshare operations decreased alcohol-involved crashes only in certain cities 29 while another showed no impact of rideshare services on alcohol-specific crash deaths. 30
We found that three-quarters of people who engaged in AID attended a routine check-up with a doctor within the previous 2 years. This was also true for those who engaged in recent binge drinking and those who engaged in binge drinking and AID. Although not all people will accurately report their alcohol use, routine check-ups offer opportunities for healthcare providers to inquire about and discuss alcohol use and alcohol-related risky behaviours like AID. Alcohol screening and brief intervention (SBI), recommended by the US Preventive Services Task Force for all adults in primary care, is effective at identifying and reducing risky drinking behaviours in the primary care setting. 31 Alcohol SBI guidelines recommend either of two brief screens. 32 33 Healthcare staff can then initiate conversations on drinking limits and apply brief interventions 34 tailored to individual patients’ motivations. The SBI intervention step is important but often overlooked. Although most people visiting their doctor are asked about alcohol consumption and binge drinking, most who report binge drinking receive no advice about how to reduce their drinking. 35
The AID prevalence, episodes and rates reported here are likely underestimates of true AID prevalence in the USA for several reasons. First, BRFSS surveys only those aged ≥18 years, so AID episodes of younger drivers are not included. Second, BRFSS respondents were asked about times when they thought they had had too much to drink, and it is possible that respondents had times where they were impaired but did not recognise it. This might be particularly true for those with a history of AID. 36 Third, respondents could have felt a social stigma associated with AID, which caused them to underreport AID. The 2018 National Survey on Drug Use and Health reported that 8% of the US population aged ≥16 years (which is an estimated 20.5 million people) reported driving under the influence of alcohol in 2018. 37 This estimate is roughly five times greater than the 2018 BRFSS estimate. This is likely partly because the National Survey on Drug Use and Health included 16 and 17-year-old participants and partly because it used Audio Computer-Assisted Self-Interview software (ie, computer-administered survey) methodology, which might heighten respondents’ sense of privacy and, thereby, increase their willingness to report AID compared with BRFSS’s telephone survey methodology. 38 39 Another study similarly found that passengers who report riding with a drinking driver might provide a more accurate prevalence of AID than drivers. 40 Although BRFSS estimates are likely underestimates, they can help describe the magnitude of AID in the USA. Additionally, other characteristics that BRFSS collects can help describe those who report AID to facilitate prevention efforts.
There are other limitations to this analysis. First, we assumed that what people reported over the past 30 days represented their experience over the past 12 months. This might not be a reasonable assumption, especially because AID is more common during certain seasons and holidays. However, BRFSS interviews took place year-round, likely minimising any seasonal bias. Second, BRFSS only asked about the number of times a person drove after consuming too much alcohol and not the total miles travelled or length of trip time, which might be more relevant but less precise (because it might be harder for people to self-report accurately) measures of exposure. Third, the BRFSS AID question asked whether respondents perceived that they had had too much to drink before driving, and it is unclear how this might relate to crash risk or blood alcohol concentrations. In the USA, it is illegal for a driver to have a blood alcohol concentration of 0.08 g/dL or higher, except in Utah where it is illegal to have a blood alcohol concentration of 0.05 g/dL or higher. However, studies have shown that even small amounts of alcohol (eg, <0.08 g/dL) can reduce motor skills and reaction time. 22 41 Finally, there could be unknown differences between people who report AID and people who die or are injured in an AID-related crash.
AID during the years 2014, 2016 and 2018 was prevalent and linked to other risky behaviours including binge drinking and not always wearing seatbelts. AID is preventable. Because 29% of motor vehicle deaths in 2018 involved an alcohol-impaired driver, eliminating or reducing AID could potentially reduce crash-related deaths by 20%–30%, saving roughly 7000 to 11 000 lives each year. 1 In addition to saving lives, the impact would also be felt by reduced injuries and burdens on healthcare and emergency response systems. States and communities can consider enacting and enforcing AID-reducing strategies at a population-level while healthcare providers in primary care settings can consider addressing AID at an individual level.
What is already known on the subject?
Alcohol-impaired driving is a risk factor for traffic crashes and their resulting injuries and deaths.
In 2012, an estimated 1.8% of adults (or 4.2 million adults) in the USA reported alcohol-impaired driving within the past 30 days
What this study adds
More recent estimates from the years 2014–2018 indicate that reported alcohol-impaired driving remains prevalent. An estimated 1.7%, 2.1% and 1.7% of adults (or 3.7 million, 4.9 million and 4.0 million adults) in the USA reported alcohol-impaired driving in 2014, 2016 and 2018.
Alcohol-impaired driving was more common among men and among people who binge drink.
Ethics statements
Patient consent for publication.
Not applicable.
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Contributors Author EKSS conceived of and designed the study. Authors VB and ACS performed the statistical analyses. Author VB wrote the manuscript. Authors VB, ACS, and EKSS critically revised the manuscript. VB is the guarantor for this work.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Disclaimer The findings and conclusions in this paper are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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reflect the views of the National Bureau of Economic Research. NBER working papers are circulated for discussion and comment purposes. They have not been peer- ... accident data in 1975, drunk driving was a factor in 585,136 tra¢ c fatalities.1 Over a similar time period, 725,347 murders occurred in the United States. ...
Title Page Acknowledgements Abstract Table of Contents Chapters I. Introduction a. Statement of the problem i. Brief Discussion of Drunk Driving ii. Alcohol Effects on an Individual iii. Drunk Driving Effects on the Roadway iv. Statistics v. Methods of Control b. Purpose of the Research c. Significance of Research II. Literature Review a.
Background The aim of this study was to gain information useful to improve traffic safety, concerning the following aspects for DUI (Driving Under the Influence): frequency, reasons, perceived risk, drivers' knowledge of the related penalties, perceived likelihood of being punished, drivers' perception of the harshness of punitive measures and drivers' perception of the probability of ...
Driving under the influence of alcohol, such as drunk driving, constitutes a global public health crisis. In the United States alone, an average of 29 individuals lose their lives daily due to road traffic accidents involving intoxicated drivers (National Highway Traffic Safety Administration [NHTSA], 2019).Driving with a blood alcohol concentration (BAC) equal to or over 0.08 g of alcohol per ...
This research paper by: Rebecca . s. Lavenz Entitled: ELIMINATING . DRUNK DRIVING: A CONTEMPORARY PROBLEM has been approved as meeting the research paper requirement for the Degree of Master of Arts. Dttte !pproved Date 'App Date Received Head, Department of Educ, ional Administration and Counseling . J. F. Kimball Bill Kline Norman McCumsey
The research aims to improve the existing knowledge by: (1) systematizing the largest possible number of risk factors associated with drink-driving in the literary review, as well as the meta-research whose subject is the strength of association of factors and driving under the influence of alcohol; (2) conducting research into the frequency of ...
The consequences of alcohol-impaired driving continue to affect the United States. A review of the current literature and analyses of recent data indicate a need for renewed surveillance across the spectrum of potential interventions, including law enforcement, engineering and technology, education and behavioral change, built environment, enactment and evaluation of policies, and emergency ...
Composing A Research Paper Title On Drunk Driving: Tips And Examples. In America laws in different states are very strict to handle DUI (drunk under influence) cases. Especially, college goers and inexperienced vehicle drivers consume alcohol when they drive vehicles on roads. They are reckless and ill tempered.
murder and rape, for example. In fact, drunk driving has been considered a rather non-emphatic offense, a "junk crime" (Ross, 1984). The authors of this treatise argue for greater attention to the crime of drunk driving among social scientists and public educators. This paper will focus upon several key issues associated with drinking and ...
Introduction Alcohol-impaired driving (AID) crashes accounted for 10 511 deaths in the USA in 2018, or 29% of all motor vehicle-related crash deaths. This study describes self-reported AID in the USA during 2014, 2016 and 2018 and determines AID-related demographic and behavioural characteristics. Methods Data were from the nationally representative Behavioral Risk Factor Surveillance System ...