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CORK Bibliography: Driving

75 citations. October 2010 to present

Prepared: September 2011

Ahlin EM; Zador PL; Rauch WJ; Howard JM; Duncan GD. First-time DWI offenders are at risk of recidivating regardless of sanctions imposed. Journal of Criminal Justice 39(2): 137-142, 2011. (48 refs.)

Objective: Research demonstrates that punitive approaches to DWI employed by the judiciary have failed to significantly reduce recidivism. However, little is known about the deterrent effects of administrative and diversion sanctions. We examine whether such sanctions deter first-time DWI offenders. Methods: We grouped combinations of administrative, judicial, and diversion sanctions routinely employed in the state of Maryland for processing drivers arrested for DWI into one of eight mutually exclusive disposition sequences. We applied this classification to Maryland drivers who had been licensed in the state and had precisely one DWI on their record prior to January 1, 1999. We then used a proportional hazards model to estimate the probability of remaining free of a new DWI during a 6-year period (January 1, 1999 - December 31, 2004) as a function of the disposition of the index violation, and of selected factors that could affect that probability. Results: Drivers with a prior DWI were at relatively high risk of recidivating regardless of how they were sanctioned. Those who received administrative and alternative sanctions had a risk of recidivating similar to that of drivers who were convicted. Conclusion: All dispositions sequences, not just convictions, indicate that first-time DWI offenders are at high risk of recidivating.

Albert D; Steinberg L. Judgment and decision making in adolescence. Journal of Research on Adolescence 21(1): 211-224, 2011. (94 refs.)

In this article, we review the most important findings to have emerged during the past 10 years in the study of judgment and decision making (JDM) in adolescence and look ahead to possible new directions in this burgeoning area of research. Three inter-related shifts in research emphasis are of particular importance and serve to organize this review. First, research grounded in normative models of JDM has moved beyond the study of age differences in risk perception and toward a dynamic account of the factors predicting adolescent decisions. Second, the field has seen widespread adoption of dual-process models of cognitive development that describe 2 relatively independent modes of information processing, typically contrasting an analytic (cold) system with an experiential (hot) one. Finally, there has been an increase in attention to the social, emotional, and self-regulatory factors that influence JDM. This shift in focus reflects the growing influence of findings from developmental neuroscience, which describe a pattern of structural and functional maturation that may set the stage for a heightened propensity to make risky decisions in adolescence.

Al-Samarraie MS; Karinen R; Morland J; Opdal MS. Blood GHB concentrations and results of medical examinations in 25 car drivers in Norway. European Journal of Clinical Pharmacology (10): 987-998, 2010. (29 refs.)

Information on the clinical effects associated with whole blood gamma-hydroxybutyrate (GHB) concentrations is sparse. We have investigated possible relationships between GHB blood concentrations and clinical effects in car drivers. In Norway, the police stop car drivers suspected of drug-driving. Medical doctors perform a clinical test of impairment (CTI) and blood samples are screened for drugs/medicines by immunological, enzymatic and chromatographic methods at the Division of Forensic Toxicology and Drug Abuse. GHB is a part of our extended drug-testing programme. GHB is standardly measured as GBL by gas chromatographic method. All the results were stored in a database. This database was searched between 2000 and 2007 for car drivers positive only for GHB, called GHB-drivers. A control group with a completely negative blood analysis, including GHB, called control-drivers, was included in the study. Twenty-five car drivers had only GHB in their blood. The police reported that 78% showed unsafe driving behaviour and seven were involved in car accidents, without serious injury. A total of 61% of the drivers were found to be sleepy or in an even more reduced state of consciousness. The median GHB blood concentration was 1,262 (range 592-2,191) mu mol/L, measured a median of 69 min after the police had stopped the driver from driving. The GHB blood concentration tended to increase with increasing impairment and reduced consciousness. Clinical findings were normal- to large-sized pupils (86%), impairment as the final conclusion (84%), impaired balance/nystagmus (62 and 54%, respectively), congested/shiny conjunctiva (67%), apathetic, aggressive or abnormal behaviour (65%), reduced short-term memory (67%), reduced/absent pupillar reaction to light (65%), heart rate a parts per thousand currency sign 70 beats/min (56%), and some level of reduced consciousness (56%). In the control-drivers, 15.6% were found by the medical doctors to have reduced consciousness or impaired. The median GHB blood concentration of the 25 car drivers was high. Most drivers had clinical impairment that was not explainable by injuries, with depressive effects on the central nervous system and sympathomimetic effects on eyes. Effects on impairment and consciousness tended to be concentration-dependent. The number of drivers who were impaired or had reduced consciousness was highly increased in GHB-drivers compared to controls. Based on these results, we conclude that the GHB-drivers most probably drove in an unsafe manner due to impairment by GHB.

Alvarez FJ; Gomez-Talegon T; Marcos A. Accident rates for drug-dependent patients in treatment for substance dependence: A pilot trial. Traffic Injury Prevention 11(5): 460-465, 2010. (26 refs.)

Objectives: To analyze accident rates among drug-dependent patients before and after treatment for substance dependence. Methods: Self-reported lifetime data and data from the year prior to the start of treatment were analyzed from a cohort including 53 drug-dependent patients, 48 men and 5 women, who had started treatment for substance dependence in an outpatient treatment center in Valladolid, Spain. We also obtained prospective information about treatment dropout and accident rates in the 3-month follow-up period after the start of drug-dependency treatment. Results: Twenty-two percent of drug-dependent patients had an accident in the year prior to starting treatment, and 64.2 percent had an accident in his or her lifetime. Road traffic accidents were the most frequent, with 11.3 percent of patients reporting at least one in the prior year and 45.3 percent reporting at least one road traffic accident in his or her lifetime. Furthermore, drug-dependent patients were frequently under the influence of drugs when driving (13.2%), as well as when performing dangerous activities at work (11.3%), at home (9.4%), and during sporting activities (5.7%) in the year prior to starting treatment. Of the 30 patients who were still undergoing treatment after 3 months, 2 had had accidents during this period (6.6%), one occurring at work and the other at home. Conclusions: Accident involvement, and especially involvement in road traffic accidents, was common among drug-dependent patients. Many accidents occurred in the year prior to treatment initiation. Furthermore, drug-dependent patients often undertook risky activities while under the influence of drugs. There is a need to implement accident prevention strategies, especially strategies that target road traffic accidents, in treatment programs for drug-dependent patients.

Assum T. Reduction of the blood alcohol concentration limit in Norway: Effects on knowledge, behavior and accidents. Accident Analysis and Prevention 42(6): 1523-1530, 2010. (21 refs.)

From January 1, 2001, the legal blood alcohol concentration (BAC) limit in Norway was reduced from 0.5 to 0.2 g/l. A before-and-after telephone survey concerning the effects of the reduced BAC limit was carried out. 3001 driver's license holders were interviewed before and after the amendment. The percentage of drivers claiming that they will drink no alcohol before driving has increased from 82 to 91 percent, thus the distinction between driving a motor vehicle and drinking alcohol has become clearer. Drivers influenced by alcohol and involved in accidents have on the average much higher BACs than 0.5 g/l. Statistics on alcohol-related accidents are not available for the years before and after the legal amendment, but single-vehicle night-time and weekend personal-injury and fatal crashes are used as surrogate measures. There are no significant decreases in these proxies from the six years before to the six years after the reductions of the legal limit.

Cartwright J; Asbridge M. Passengers' decisions to ride with a driver under the influence of either alcohol or cannabis. Journal of Studies on Alcohol and Drugs 72(1): 86-95, 2011. (48 refs.)

Objective: The purpose of the present study was to identify the risk factors associated with passenger decisions to ride with a driver who is under the influence of either alcohol or cannabis. Method: We analyzed data from the 2008 Canadian Alcohol and Drug Use Monitoring Survey (CADUMS), a nationally represented telephone sample of 16,672 Canadians age 15 and older, of whom 60.5% were female. Logistic regression analyses explored the effects of sociodemographic, substance use, and driving-behavior factors on the risk of riding with a drinking driver (RWDD) and riding with a cannabis-impaired driver (RWCD). Results: Risk factors for RWDD and RWCD were both shared and unique. Common risk factors were respondents' age, with young people at increased risk and those 65 years and older at decreased risk, and problematic alcohol use (as measured by Alcohol Use Disorder Identification Test subscales). Having previously driven under the influence of alcohol increased the risk of RWDD, while RWCD was associated with having previously driven under the influence of cannabis. Conclusions: Considerable legal and public health attention has been devoted to eliminating impaired driving, with particular focus on driver behavior. However, with the knowledge that impaired driving is strongly related to being a passenger of an impaired driver, prevention efforts to reduce the prevalence of impaired driving must be multifaceted, targeting passengers as well as drivers. Links between attitudes, beliefs, risk-taking behavior, and related structural conditions should be emphasized, with passengers being encouraged to recognize impairment in others and make sensible choices.

Chan DCN; Wu AMS; Hung EPW. Invulnerability and the intention to drink and drive: An application of the theory of planned behavior. Accident Analysis and Prevention 42(6): 1549-1555, 2010. (46 refs.)

The present study aims at an examination, based on the theory of planned behavior (TPB), of the psychological antecedents of young Chinese people's intentions to drive after drinking. One hundred and twenty-four licensed drivers (aged from 19 to 35 years) successfully completed an online questionnaire. Using path analysis, we found the most proximal predictors of intention to be attitudes and perceived behavioral control, whereas invulnerability as well as subjective norms indirectly influenced intention by promoting favorable attitudes toward and greater perceived behavioral control over driving after alcohol use. The total explained variances in the intention to drink and drive reached 79%. The present findings highlight irrational beliefs of invulnerability and the three TPB components as potentially valid targets for prevention and intervention efforts against drinking and driving among young Chinese drivers.

Chi GQ; Zhou XA; McClure TE; Gilbert PA; Cosby AG; Zhang L et al. Gasoline prices and their relationship to drunk-driving crashes. Accident Analysis and Prevention 43(1): 194-203, 2011. (41 refs.)

This study investigates the relationship between changing gasoline prices and drunk-driving crashes. Specifically, we examine the effects of gasoline prices on drunk-driving crashes in Mississippi by several crash types and demographic groups at the monthly level from 2004 to 2008, a period experiencing great fluctuation in gasoline prices. An exploratory visualization by graphs shows that higher gasoline prices are generally associated with fewer drunk-driving crashes. Higher gasoline prices depress drunk-driving crashes among young and adult drivers, among male and female drivers, and among white and black drivers. Results from negative binomial regression models show that when gas prices are higher, there are fewer drunk-driving crashes, particularly among property-damage-only crashes. When alcohol consumption levels are higher, there are more drunk-driving crashes, particularly fatal and injury crashes. The effects of gasoline prices and alcohol consumption are stronger on drunk-driving crashes than on all crashes. The findings do not vary much across different demographic groups. Overall, gasoline prices have greater effects on less severe crashes and alcohol consumption has greater effects on more severe crashes.

Colicchio D; Passos ADC. Traffic behavior of medical students. Revista da Associacao Medica Brasileira 56(5): 535-540, 2010. (17 refs.)

OBJECTIVES. To study the traffic behavior of medical students comparing current patterns with those observed in a study previously carried out in the same institution. METHODS. Standard questionnaires were completed by a sample of regularly registered medical students of the "Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo", Brazil, to collect data regarding demographic and economic information and also traffic behavior and accident involvement. Results were compared to those obtained in a similar investigation done in 1997. RESULTS. In 2008, 354 students were interviewed and 377 in 1997. Of all, 431 (59%) had driven right after alcohol ingestion and 21.5% of them had driven under severe influence of alcohol. while 10.5% referred to participation in "street races", with a large difference between genders (12.5% of men and 3.4% of women). Involvement in accidents with victims, fatal or not, was reported by 19.2% of participants. This percentage reached 31.1% among those who had driven under severe influence of alcohol and 42.9% among those who participated in "street races". The 2008 study showed increased use of helmets and seat belts in urban areas, as well as reduction of alcohol consumption before driving. On the other hand, it disclosed less continuous compliance with traffic lights. CONCLUSION. Risky traffic behavior was found to be very frequent among these participants directly involved in accidents with victims. Since this is a distinctive segment of the population, that is aware and has direct contact with the consequences of traffic accidents, we would hope to find a lower incidence of such high risk behavior Information provided by this investigation should lead to a reflection from the academic community intending to introduce educational programs to effectively change student behavior.

Dassanayake T; Michie P; Carter G; Jones A. Effects of benzodiazepines, antidepressants and opioids on driving: A systematic review and meta-analysis of epidemiological and experimental evidence. (review). Drug Safety 34(2): 125-156, 2011. (102 refs.)

Background: Many individuals in the community are prescribed psychoactive drugs with sedative effects. These drugs may affect their daily functions, of which automobile driving is a major component. Objective: To examine the association of three classes of commonly used psychoactive drugs (viz. benzodiazepines and newer non-benzodiazepine hypnotics, antidepressants and opioids) with (i) the risk of traffic accidents (as indexed by epidemiological indicators of risk); and (ii) driving performance (as indexed by experimental measures of driving performance). Methods: A literature search for material published in the English language between January 1966 and January 2010 in PubMed and EMBASE databases was combined with a search for other relevant material referenced in the retrieved articles. Retrieved articles were systematically reviewed, carrying out meta-analyses where possible. Twenty-one epidemiological studies (13 case-control and 8 cohort studies) fulfilled the inclusion criteria by estimating the accident risk associated with drug exposure (ascertained by blood/urine analysis or prescription records). Sixty-nine experimental studies fulfilled the inclusion criteria by testing actual or simulated driving performance after administering a single dose or multiple doses. Results: Two meta-analyses showed that benzodiazepines are associated with a 60% (for case-control studies: pooled odds ratio [OR] 1.59; 95% CI 1.10, 2.31) to 80% (for cohort studies: pooled incidence rate ratio 1.81; 95% CI 1.35, 2.43) increase in the risk of traffic accidents and a 40% (pooled OR 1.41; 95% CI 1.03, 1.94) increase in 'accident responsibility'. Co-ingestion of benzodiazepines and alcohol was associated with a 7.7-fold increase in the accident risk (pooled OR 7.69; 95% CI 4.33, 13.65). Subgroup analysis of case-control studies showed a lower benzodiazepine-associated accident risk in elderly (>65 years of age) drivers (pooled OR 1.13; 95% CI 0.97, 1.31) than in drivers <65 years of age (pooled OR 2.21; 95% CI 1.31, 3.73), a result consistent with age-stratified risk differences reported in cohort studies. Anxiolytics, taken in single or multiple doses during the daytime, impaired driving performance independent of their half-lives. With hypnotics, converging evidence from experimental and epidemiological studies indicates that diazepam, flurazepam, flunitrazepam, nitrazepam and the short half-life non-benzodiazepine hypnotic zopiclone significantly impair driving, at least during the first 2-4 weeks of treatment. The accident risk was higher in the elderly (>65 years of age) who use tricyclic antidepressants (TCAs); however, the evidence for an association of antidepressants with accident risk in younger drivers was equivocal. Sedative but not non-sedative antidepressants were found to cause short-term impairment of several measures of driving performance. Limited epidemiological research reported that opioids may be associated with increased accident risk in the first few weeks of treatment. Conclusions: Benzodiazepine use was associated with a significant increase in the risk of traffic accidents and responsibility of drivers for accidents. The association was more pronounced in the younger drivers. The accident risk was markedly increased by co-ingestion of alcohol. Driving impairment was generally related to plasma half-lives of hypnotics, but with notable exceptions. Anxiolytics, with daytime dosing, impaired driving independent of their half-lives. TCAs appeared to be associated with increased accident risk, at least in the elderly, and caused short-term impairment in driving performance. Opioid users may be at a higher risk of traffic accidents; however, experimental evidence is limited on their effects on driving.

Dhami MK; Mandel DR; Garcia-Retamero R. Canadian and Spanish youths' risk perceptions of drinking and driving, and riding with a drunk driver. International Journal of Psychology 46(2): 81-90, 2011. (31 refs.)

The present research compared Canadian and Spanish youths' perceptions of the potential benefits and drawbacks of driving under the influence of alcohol (DUI) and riding with a drunk driver (RDD). Eighty (41 female) Canadian and 87 (71 female) Spanish undergraduates completed a survey asking about their past and forecasted engagement in DUI and RDD, and their perceptions of the benefits and drawbacks of DUI and RDD. A sizeable proportion of both samples reported DUI and RDD in the past year. Past risk takers forecasted significantly greater chances of engaging in these behaviors in the following year compared to those who had not engaged in DUI and RDD. Both samples provided significantly more drawbacks than benefits of DUI and RDD. Whereas the benefits of both behaviors tended to refer to personal effects (e.g., save money, arrive faster) that occurred before, during, or after driving, the drawbacks referred to a range of outcomes (e.g., accident, kill/injure, penal sanction) that mostly occurred during driving. Although Canada and Spain differ in important respects (e.g., potential penalty for DUI), there were similarities in the two samples' perceptions of DUI and RDD. Young people are aware of the costs of these risky behaviors but nevertheless engage in them. These findings can inform theories of the co-occurrence of risky driving behaviors, and the development of prevention programs that focus on perceived outcomes.

DiStefano G; Hohman M. Selecting strategic counseling interventions for DUI clients. Journal of Social Work Practice in the Addictions 10(2): 180-196, 2010

Multiple driving under the influence (DUI) offenders present to DUI programs with a variety of needs, including alcohol and other drug use disorders, mood disorders, and psychosocial stressors. This article describes the paradigm developmental model of treatment (PDMT), developed for use with multiple DUI offenders along with accompanying scale and manualized brief interventions. Psychometrics of the PDMT scale are reported elsewhere, but this article describes a PDMT scale revalidation and application to 162 DUI clients. Four case examples are presented regarding the use of the scale by counselors in client assessment and intervention, demonstrating treatment matching for individual client counseling sessions.

dKasar M; Gleichgerrcht E; Keskinkilic C; Tabo A; Manes FF. Decision-making in people who relapsed to driving under the influence of alcohol. Alcoholism: Clinical and Experimental Research 34(12): 2162-2168, 2010. (47 refs.)

Background: Alcohol use has been previously associated with neurocognitive impairments, especially in decision-making cognition. However, some studies have shown little to no decision-making deficits in relation to different characteristics of people with drinking problems. Relapsing to driving under the influence (DUI) of alcohol is an important issue with legal and psychosocial aspects. We evaluated decision-making performance in second-time DUI offenders by using the Iowa Gambling Task (IGT). Method: Thirty-four male second-time DUI offenders who had been selected for an official psychoeducational rehabilitation program and 31 healthy controls that were matched for age, education, and alcohol use were included. Along with psychiatric assessment, we applied conventional neuropsychological testing comprising cognitive set-shifting, response inhibition, attention, and visuospatial abilities. Also, we used the Temperament and Character Inventory (TCI) to assess personality patterns. A computerized version of IGT was used. Results: No significant differences were found between the groups in regard to sociodemographics and conventional neuropsychological testing. DUI participants had significantly higher scores only in "self-transcendence'' subdomain of TCI. On the fifth block of the IGT, DUI participants had significantly lower net scores than controls (U = 380.0, p < 0.05). Also, DUI participants chose significantly more risky decks compared to controls. Conclusions: Our results suggest that there may be subtle decision-making deficits in DUI participants, which goes undetected on conventional neuropsychological testing and which is not correlated with TCI subdomains related with impulsivity patterns.

Dols ST; Gonzalez FJA; Aleixandre NL; Vidal-Infer A; Rodrigo MJT; Valderrama-Zurian JC. Predictors of driving after alcohol and drug use among adolescents in Valencia (Spain). Accident Analysis and Prevention 42(6): 2024-2029, 2010. (25 refs.)

Background: Driving under the influence of alcohol and drugs has been identified as a risk factor for road traffic crashes. We have assessed the prevalence and predictor factors for driving after alcohol and drug use by adolescents. Methods: A cross-sectional survey involving 11,239 students aged 14-18 years from 252 private and public schools in the Valencia region of Spain was conducted. The prevalence and predictors of driving after alcohol use, alcohol and drug use, or drug use during the previous 6 months were measured. Results: Of the students who reported driving (20%), 45.1% indicated driving after alcohol and drug use. The consumption of various drugs was higher among students who drove a vehicle compared with those who did not. The likelihood of driving after consuming alcohol, or alcohol and drugs, increased in line with the number of standard drink units per week, reports of any lifetime alcohol- or drug-related problems, and poor family relationship. In addition, masculine gender and early alcohol use increased the likelihood of driving after consuming alcohol. Conclusions: Driving after alcohol and drug use is quite prevalent among adolescents in the Valencia region of Spain. There is a need for implementation of targeted policies for adolescents. This should focus on education and information on alcohol/drug use and driving.

Duru OK; Xu HY; Tseng CH; Mirkin M; Ang A; Tallen L et al. Correlates of alcohol-related discussions between older adults and their physicians. Journal of the American Geriatrics Society 58(12): 2369-2374, 2010. (29 refs.)

OBJECTIVES: To identify predictors of alcohol-related patient-physician discussions. DESIGN Cross-sectional study using baseline data from a randomized controlled trial. SETTING: Community-based group practice. PARTICIPANTS: Thirty-one physicians in Project Senior Health and Alcohol Risk Education and 3,305 of their patients aged 60 and older who use alcohol and completed a survey that included the Comorbidity Alcohol Risk Evaluation Tool (CARET). MEASUREMENTS: At study baseline, older adults were asked whether alcohol-related discussions with a physician had occurred in the prior year. This outcome was modeled using logistic regression models with physician random effects. Predictor variables included patient-level variables such as demographics and seven CARET-defined risk factors, specifically a medical or psychiatric comorbidity that alcohol might worsen, a potentially alcohol-related symptom, use of a medication that may interact negatively with alcohol, excessive quantity or frequency of alcohol use, binge drinking, concern from others about drinking, and drinking and driving. Physician-level predictors (age, sex, years since graduation, specialty) were also included. RESULTS: The probability of reporting alcohol-related discussions declined with patient age (e.g., odds ratio (OR)=0.40 for patients aged >= 80) and was significantly lower for Latinos (OR=0.38). Drinking and driving (OR=1.69) or concern from others (OR=6.04) were significantly associated with alcohol-related discussions; having comorbidities or using medications that may interact with alcohol were not. CONCLUSION: Although patient demographics, including age and ethnicity, are associated with the occurrence of alcohol-related discussions, clinical factors that may negatively interact with alcohol to increase risk are not. This suggests that physicians may not be attuned to the entire spectrum of alcohol-related risks for older adults.

Feigelman W; Gorman BS. Prospective predictors of premature death: Evidence from the National Longitudinal Study of Adolescent Health. Journal of Psychoactive Drugs 42(3): 353-361, 2010. (45 refs.)

This study was based on data from the National Longitudinal Study of Adolescent Health (Add Health), which revealed that 96 of its original Wave I respondents died prior to the collection of the Wave III survey. We compared psychosocial and behavioral characteristics reported at Wave I among those who died and those who lived (n = 16,719) using chi-square tests, t-tests, and logistic regression analyses to determine the most important risk factors for premature death among adolescents and young adults. Results suggested that driving while drunk was the most important risk factor for premature death (adjusted odds ratio = 2.48; 95% confidence interval: 1.12-5.50). The prevalence of driving while drunk was 17.7% among decedents compared with 6.4% among the survivors. Decedents were also significantly more likely to report multiple risk behaviors than survivors. As the current study demonstrates the importance of alcohol use as a contributing factor to the three leading causes of youth deaths, renewed efforts are needed to prevent and reduce alcohol consumption and abuse among this vulnerable population.

Fierro I; Morales C; Alvarez FJ. Alcohol use, illicit drug use, and road rage. Journal of Studies on Alcohol and Drugs 72(2): 185-193, 2011. (51 refs.)

Objective: This article examines the relationship between the consumption of alcohol and illicit drugs and the experience of road-rage victimization and perpetration among drivers and nondrivers in the general population. Method: A cross-sectional survey was designed with 2,500 subjects, ages 14-70 years, living in Castile and Leon, Spain, of which 1,276 (51%) were males and 1,224 (49%) females. The Alcohol-Use And Drug-Use Survey of Castile and Leon, Spain 2008 focused on patterns of alcohol, tobacco, and illicit drug consumption. Potential risk factors for road-rage experience for the previous 12 months was assessed, including sociodemographics (7 variables), patterns of alcohol consumption (7 variables), and patterns of drug consumption (10 variables). Results: Among drivers, driving under the influence of alcohol and/or cannabis during the previous year was associated with being a perpetrator of road rage (odds ratio [OR] = 3.72, 95% CI [1.71, 8.10] and 6.77 [1.55, 29.48], respectively), being both a victim and perpetrator of road rage (OR = 1.80 [1.05, 3.07] for alcohol, 5.34 [1.64, 17.41] for cannabis, and 4.81 [1.09, 21.16] for alcohol and cannabis), and with serious road-rage perpetration (OR = 4.97 [2.40, 10.30] for alcohol and 17.75 [5.88, 53.56] for cannabis). Problem drinking (CAGE scores >= 2) was associated with being both a victim and perpetrator of road rage (OR = 2.74 [1.67, 4.50]) and with low (OR = 1.77 [1.09, 2.85]) and serious (OR = 3.47 [1.65, 7.30]) road-rage perpetration. Conclusions: Driving under the influence of alcohol or cannabis and being a problem drinker are associated with the perpetration of serious road-rage behavior, as well as experiencing road-rage victimization and perpetration.

Freeman J; Maxwell JC; Davey J. Unraveling the complexity of driving while intoxicated: A study into the prevalence of psychiatric and substance abuse comorbidity. Accident Analysis and Prevention 43(1): 34-39, 2011

Objective: Research is beginning to provide an indication of the co-occurring substance abuse and mental health needs for the driving under the influence (DUI) population. This study aimed to examine the extent of such psychiatric problems among a large sample size of DUI offenders entering treatment in Texas. Methods: This is a study of 36,373 past year DUI clients and 308,714 non-past year DUI clients admitted to Texas treatment programs between 2005 and 2008. Data were obtained from the State's administrative dataset. Results: Analysis indicated that non-past year DUI clients were more likely to present with more severe illicit substance use problems, while past year DUI clients were more likely to have a primary problem with alcohol. Nevertheless, a cannabis use problem was also found to be significantly associated with DUI recidivism in the last year. In regards to mental health status, a major finding was that depression was the most common psychiatric condition reported by DUI clients, including those with more than one DUI offence in the past year. This cohort also reported elevated levels of Bipolar Disorder compared to the general population, and such a diagnosis was also associated with an increased likelihood of not completing treatment. Additionally, female clients were more likely to be diagnosed with mental health problems than males, as well as more likely to be placed on medications at admission and more likely to have problems with methamphetamine, cocaine, and opiates. Conclusions: DUI offenders are at an increased risk of experiencing comorbid psychiatric disorders, and thus, corresponding treatment programs need to cater for a range of mental health concerns that are likely to affect recidivism rates.

Freeman J; Watling C; Davey J; Palk G. Perceptual deterrence versus current behaviours: A study into factors influencing drug driving in Queensland. Road & Transport Research 19(3): 3-13, 2010. (29 refs.)

A range of interventions are being implemented in Australia to apprehend and deter drug driving behaviour in particular the recent implementation of random roadside drug testing procedures in Queensland. Given this countermeasure has a strong deterrence foundation it is of interest to determine whether deterrence-based perceptual factors are influencing this offending behaviour or whether self reported drug driving is heavily dependent upon illicit substance consumption levels and past offending behaviour. This study involves a sample of Queensland motorists (N = 898) who completed a self report questionnaire that collected a range of information including drug driving and drug consumption practices conviction history and perceptual deterrence factors The aim was to examine what factors influence current drug driving behaviours. Analysis of the collected data revealed that approximately 20% of participants reported drug driving at least once in the last six months. Overall there was considerable variability in the respondents perceptions regarding the certainty severity and swiftness of legal sanctions although the largest proportion of the sample did not consider such sanctions to be certain severe or swift In regard to predicting those who intended to drug drive again in the future a combination of perceptual and behavioural based factors were associated with such intentions. However a closer examination revealed that behaviours rather than perceptions proved to have a greater level of influence on the current sample's future intentions to offend. This paper further outlines the major findings of the study and highlights that multi modal interventions are most likely required to reduce the prevalence of drug driving on public roads

Fromme K; Wetherill RR; Neal DJ. Turning 21 and the associated changes in drinking and driving after drinking among college students. Journal of American College Health 59(1): 21-27, 2010. (34 refs.)

Objective: The authors examined drinking and driving after drinking before and after turning 21. Participants: Participants were drawn from first time college students who were taking part in a 4-year longitudinal study of alcohol use and behavioral risks. Methods: Web-based longitudinal surveys collected data on drinking and driving after drinking from August 2004 through November 2007 (n = 1,817). A subset of participants (n = 224) also monitored their daily behavior during the month they turned 21 (January through May, 2007). Results: Typical frequency and quantity of alcohol use increased from ages 18 to 21 years, whereas quantity decreased between 21 and 23 years of age. Driving after drinking showed a 72% relative increase (6% absolute increase) in the 2 weeks after turning 21. Conclusions: Reaching the legal drinking age is associated with decreases in the amount of alcohol consumed per drinking occasion, but an increase in driving after drinking.

Gjerde H; Normann PT; Christophersen AS; Samuelsen SO; Morland J. Alcohol, psychoactive drugs and fatal road traffic accidents in Norway: A case-control study. Accident Analysis and Prevention 43(3): 1197-1203, 2011. (50 refs.)

A case-control study was conducted on 204 drivers fatally injured in road traffic accidents in southeastern Norway during the period 2003-2008. Cases from single vehicle accidents (N = 68) were assessed separately. As controls, 10 540 drivers selected in a roadside survey in the same geographical area during 2005-2006 were used. Blood samples were collected from the cases and oral fluid (saliva) samples from the controls. Samples were analysed for alcohol, amphetamines, cannabis, cocaine, opioid analgesics, hypnotics, sedatives and a muscle relaxant; altogether 22 psychoactive substances. Equivalent cutoff concentrations for blood and oral fluid were used. The risk for fatal injury in a road traffic accident was estimated using logistic regression adjusting for gender, age, season of the year, and time of the week. The odds for involvement in fatal road traffic accidents for different substances or combination of substances were in increasing order: single drug < multiple drugs < alcohol only < alcohol + drugs. For single substance use: medicinal drug or THC < amphetamine/methamphetamine < alcohol. For most substances, higher ORs were found when studying drivers involved in single vehicle accidents than for those involved in multiple vehicle accidents, but confidence intervals were wider.

Gjerde H; Normann PT; Christophersen AS; Morland J. Prevalence of driving with blood drug concentrations above proposed new legal limits in Norway: Estimations based on drug concentrations in oral fluid. Forensic Science International 210(1-3): 221-227, 2011. (44 refs.)

Aim: To estimate the prevalence of driving with blood drug concentrations above the recently proposed Norwegian legal limits for drugged driving in random traffic. The results from a roadside survey of 10,816 drivers was used as basis for the estimation, and the most prevalent drugs were included. Methods: Three approaches were used to estimate the prevalence of drug concentrations above the proposed legal limits in blood based on drug concentrations in oral fluid: comparison with drug concentrations observed in oral fluid and blood in pharmacokinetic studies, estimating the prevalence of drug concentrations in blood by calculating the prevalence of drug concentrations in oral fluid that were larger than the limit in blood multiplied with mean oral fluid/blood ratios, and a mathematical simulation mimicking the relationship between drug concentration distributions in blood and oral fluid for populations of drug users. Results: In total, alcohol or drugs were detected in 5.7% of the samples of oral fluid from drivers in normal traffic; 3.8% (n = 410) were positive for the drugs that we included in the assessment. The estimation of drug concentrations in blood suggested that about 1.5% had concentrations above the proposed legal limits in blood for the studied drugs, which is about 40% of those who were positive for the drugs in oral fluid. Conclusion: The estimated prevalence of driving with concentrations of psychoactive drugs in blood above the proposed legal limits was for illegal drugs 0.4% and for medicinal drugs 1.1%. These may be regarded as minimum estimates as some drugs were not included in the assessment. These prevalences are higher than the prevalence of driving with blood alcohol concentrations above the legal limit of 0.2 g/kg in Norway.

Gray TR; Dams R; Choo RE; Jones HE; Huestis MA. Methadone disposition in oral fluid during pharmacotherapy for opioid-dependence. Forensic Science International 206(1-3): 98-102, 2011. (31 refs.)

Introduction: Oral fluid testing is widely used for detecting drug exposure, but data describing methadone and metabolites in oral fluid during pharmacotherapy for opioid-dependence are relatively limited. Methods: 414 oral fluid specimens from 16 opioid-dependent pregnant women receiving daily methadone were analyzed for methadone, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), and methadol by liquid chromatography-mass spectrometry. Results: All oral fluid specimens contained methadone greater than 1 ng/mL; 88% were positive for EDDP and 12% for methadol. Over 95% of oral fluid specimens exceeded the 20 ng/mL methadone cutoff set by the European Driving Under the Influence of Drugs, Alcohol and Medicines (DRUID) study. Methadone and EDDP oral fluid concentrations were highly variable within and between participants, did not predict methadone dose, but were negatively correlated with pH. Conclusion: Methadone was readily identified in oral fluid at concentrations greater than 20 ng/mL following daily 30-110 mg/day methadone pharmacotherapy. As no specimens contained only EDDP or methadol, there was no advantage to including these analytes for identification of methadone exposure. As nearly all oral fluid specimens from methadone-maintained patients exceeded the DRUID guideline, the 20 ng/mL cutoff appears to be sensitive enough to detect daily methadone exposure; however, additional indicators of behavioral and/or motor impairment would be necessary to provide evidence of driving impairment.

Gustavsen I; Hjelmeland K; Bernard JP; Morland J. Psychomotor performance after intake of zopiclone compared with intake of ethanol a randomized, controlled, double-blinded trial. Journal of Clinical Psychopharmacology 31(4): 481-488, 2011. (31 refs.)

The sleep medicine zopiclone (eszopiclone) is commonly used in most Western countries. The focus on legislation for possible traffic-impairing nonalcohol drugs have caused a need for comparing traffic relevant behavior after intake of commonly used psychoactive drugs to blood alcohol concentrations (BACs). We aimed to compare psychomotor effects at 3 levels of behavior at different blood zopiclone concentrations to effects seen at different BACs. We performed a randomized double-blinded trial on 16 healthy volunteers who received either 10 or 5 mg zopiclone, 50 g ethanol or placebo in a crossover design. The volunteers performed computerized tests at baseline, 1, 3.5, and 6.5 hours after intake, accompanied by blood sampling. Impairment was found at all 3 behavior levels. For zopiclone, impairment was most pronounced at behavior level 1 (automotive behavior); a mean blood zopiclone concentration at 39 mu g/L achieved 1 hour after intake of 10 mg zopiclone was accompanied by more impairment than BAC 0.074 %. At behavior levels 2 (control behavior) and 3 (executive planning), the psychomotor impairment accompanying approximately 39 mu g/L zopiclone seemed comparable to a BAC of approximately 0.074%. No test components were impaired at 6.5 hours after intake.

Heatherley SV. Caffeine withdrawal, sleepiness, and driving performance: What does the research really tell us? Nutritional Neuroscience 14(3): 89-95, 2011. (38 refs.)

As a psychostimulant, caffeine is thought to reduce road accidents by keeping drivers alert and wakeful. Studies have found that caffeine can improve performance on vigilance tasks and in driving simulators under normal sleeping conditions and after sleep restriction or deprivation. However, there is increasing evidence that these beneficial effects of caffeine are due to withdrawal reversal. Studies comparing the effects of caffeine versus placebo on driving performance have tested habitual caffeine consumers deprived of caffeine from the evening before the test day. The conclusion from this review is, therefore, that improvements in driving performance and alertness after caffeine are likely to represent withdrawal reversal rather than a net beneficial effect of caffeine. Further research using designs that control for caffeine withdrawal are necessary and, accordingly, advice given to the public on use of caffeine as an antidote to tiredness and impaired performance should be reviewed.

Howland J; Rohsenow DJ; Arnedt JT; Bliss CA; Hunt SK; Calise TV et al. The acute effects of caffeinated versus non-caffeinated alcoholic beverage on driving performance and attention/reaction time. Addiction 106(2): 335-341, 2011. (37 refs.)

Aims: Marketing that promotes mixing caffeinated 'energy' drinks with alcoholic beverages (e.g. Red Bull with vodka) targets young drinkers and conveys the expectation that caffeine will offset the sedating effects of alcohol and enhance alertness. Such beliefs could result in unwarranted risk taking (e.g. driving while intoxicated). The aim of this study was to assess the acute effects of caffeinated versus non-caffeinated alcoholic beverages on a simulated driving task and attention/reaction time. Design: We conducted a 2 x 2 between-groups randomized trial in which participants were randomized to one of four conditions: beer and non-alcoholic beer, with and without caffeine added. Caffeine was added in the same proportion as found in a commercially available caffeinated beer (69 mg/12 oz of beer at 4.8% alc. by vol). Participants: Participants were 127 non-dependent, heavy episodic, young adult drinkers (age 21-30) who were college students or recent graduates. The target breath alcohol level was 0.12 g%. Measures: Driving performance was assessed with a driving simulator; sustained attention/reaction with the Psychomotor Vigilance Task (PVT). Findings: Across the driving and attention/reaction time we found main effects for alcohol, with alcohol significantly impairing driving and sustained attention/reaction time, with mainly large statistical effects; however, the addition of caffeine had no main or interaction effects on performance. Conclusion: The addition of caffeine to alcohol does not appear to enhance driving or sustained attention/reaction time performance relative to alcohol alone.

Humensky JL. Are adolescents with high socioeconomic status more likely to engage in alcohol and illicit drug use in early adulthood? Substance Abuse Treatment, Prevention, and Policy 5(e-journal 19), 2010. (37 refs.)

Background: Previous literature has shown a divergence by age in the relationship between socioeconomic status (SES) and substance use: adolescents with low SES are more likely to engage in substance use, as are adults with high SES. However, there is growing evidence that adolescents with high SES are also at high risk for substance abuse. The objective of this study is to examine this relationship longitudinally, that is, whether wealthier adolescents are more likely than those with lower SES to engage in substance use in early adulthood. Methods: The study analyzed data from the National Longitudinal Survey of Adolescent Health (AddHealth), a longitudinal, nationally-representative survey of secondary school students in the United States. Logistic regression models were analyzed examining the relationship between adolescent SES (measured by parental education and income) and substance use in adulthood, controlling for substance use in adolescence and other covariates. Results: Higher parental education is associated with higher rates of binge drinking, marijuana and cocaine use in early adulthood. Higher parental income is associated with higher rates of binge drinking and marijuana use. No statistically significant results are found for crystal methamphetamine or other drug use. Results are not sensitive to the inclusion of college attendance by young adulthood as a sensitivity analysis. However, when stratifying by race, results are consistent for white non-Hispanics, but no statistically significant results are found for non-whites. This may be a reflection of the smaller sample size of non-whites, but may also reflect that these trends are driven primarily by white non-Hispanics. Conclusions: Previous research shows numerous problems associated with substance use in young adults, including problems in school, decreased employment, increases in convictions of driving under the influence (DUI) and accidental deaths. Much of the previous literature is focused on lower SES populations. Therefore, it is possible that teachers, parents and school administrators in wealthier schools may not perceive as great to address substance abuse treatment in their schools. This study can inform teachers, parents, school administrators and program officials of the need for addressing drug abuse prevention activities to this population of students.

Ilgen MA; McLouth C; Barry KL; Walton M; Cole PA; Dabrowski MP et al. Pain interference in individuals in driver intervention programs for driving under the influence offenders. Substance Use & Misuse 45(9): 1406-1419, 2010. (26 refs.)

Pain-related problems among individuals in court-mandated Driver Intervention Programs (DIPs) for "driving under the influence" (DUI) offenders have not been well studied. This project examines 3,189 individuals from a DIP in Dayton, Ohio. Over 11% of participants reported significant pain-related interference in the past 4 weeks. Pain was significantly more likely in those with depression, more childhood conduct problems, and recent use of multiple illicit drugs. Many individuals seen in court-mandated DIP programs for DUI offenders also report difficulties with pain. DIP programming should address pain in relation to substance use and mental health issues.

Johnson MB; Clapp JD. Impact of providing drinkers with "Know Your Limit" information on drinking and driving: A field experiment. Journal of Studies on Alcohol and Drugs 72(1): 79-85, 2011. (16 refs.)

Objective: Given that most effective alcohol harm-reduction laws specify the blood alcohol concentration (BAC) that constitutes illegal behavior (e.g., the .08% breath alcohol concentration legal limit), interventions that allow drinkers to accurately estimate their BACs, and thus better assess their risk, have potential importance to long-term driving-under-the-influence prevention efforts. This study describes a field experiment designed to test the impact on drinking of providing "Know Your Limit" (KYL) BAC estimation cards to individuals in a natural drinking environment. Method: We randomly sampled 1,215 U.S. residents as they entered Mexico for a night of drinking, interviewed them, and randomly assigned them to one of six experimental conditions. Participants were reinterviewed and breath-tested when they returned to the United States. The experimental conditions included providing generic warnings about drinking and driving, giving out gender-specific BAC calculator cards (KYL cards), and providing incentives to moderate their drinking. Results: Cueing participants about the risks of drunk driving resulted in significantly lower BACs (relative to control) for participants who indicated that they would drive home. Providing KYL matrixes did not reduce BACs, and, in fact, some evidence suggests that KYL cards undermined the effect of the warning. Conclusions: KYL information does not appear to be an effective tool for reducing drinking and driving. Implications for prevention and future research are discussed.

Khallad Y. Health risk behaviors among college youths: A cross-cultural comparison. Journal of Health Psychology 15(6): 925-934, 2010. (41 refs.)

The present study examined the frequency of smoking, seatbelt use, and vehicular speeding among American and Jordanian college students, and assessed the relationship between these risk behaviors and gender, socioeconomic status, and religiosity. Significantly more Jordanian students were smokers. Jordanian students were less likely than American students to buckle up, but American students were more likely to engage in vehicular speeding. Female students, especially among Jordanians, were less likely than male students to engage in risky behaviors. Among Jordanian participants, smoking and passenger seatbelt use were positively associated with indices of socioeconomic status, and smoking was negatively associated with religiosity.

Kieling RR; Szobot CM; Matte B; Coelho RS; Kieling C; Pechansky F et al. Mental disorders and delivery motorcycle drivers (motoboys): A dangerous association. European Psychiatry 26(1): 23-27, 2011. (32 refs.)

Objective. - Low and middle-income countries experience an expressive growth in the number of circulating motorcycles, paralleled by an increasing number of traffic accidents. Delivery motorcycles drivers ("motoboys") are generally perceived as accountable for this scenario. Although traffic accidents have a multivariate etiology, mental disorders, such as substance use disorders (SUD) and attention deficit/hyperactivity disorder (ADHD), are often involved. This paper aims at investigating the prevalence of ADHD, SUD and other mental disorders in a sample of Brazilian motoboys, and additionally, to evaluate the association between psychiatric diagnoses, motorcycle accidents and traffic violation tickets. Method. - A convenient sample of subjects was invited to participate in a cross-sectional assessment including an inventory of traffic accidents and violations. Psychiatric diagnoses were based on semi-structured and clinical interviews. Results. - A sample of 101 motoboys was assessed. Overall, 75% of subjects had a positive lifetime history of at least one psychiatric disorder. SUD was the most frequent diagnosis (43.6% for alcohol, 39.6% for cannabis). ADHD was associated with a higher number of traffic accidents (p = 0.002), and antisocial personality disorder (APD) was associated with a greater number of traffic violations (p = 0.007). Conclusions. - The prevalence of mental disorders was much higher in our sample than in the general population. ADHD and APD, but not SUD, were associated with negative traffic outcomes. These findings have implications for public mental health planning since mental disorders can be both prevented and treated, improving driving behavior and increasing road safety.

Kim JK; Ulfarsson GF; Shankar VN; Mannering FL. A note on modeling pedestrian-injury severity in motor-vehicle crashes with the mixed logit model. Accident Analysis and Prevention 42(6): 1751-1758, 2010. (26 refs.)

Pedestrian-injury severity has been traditionally modeled with approaches that have assumed that the effect of each variable is fixed across injury observations. This assumption ignores possible unobserved heterogeneity which is likely to be particularly important in pedestrian injuries because unobserved physical health, strength, and behavior may significantly affect the pedestrians' ability to absorb collision forces. To address such unobserved heterogeneity, this research applies a mixed logit model to analyze pedestrian-injury severity in pedestrian-vehicle crashes. Using police-reported collision data from 1997 through 2000 from North Carolina, several factors were found to more than double the average probability of fatal injury for pedestrians in motor-vehicle crashes including: darkness without streetlights (400% increase in fatality probability), vehicle is a truck (370% increase), freeway (330% increase), speeding involved (360% increase), and collisions involving a motorist who had been drinking (250% increase). It was also found that the effect of pedestrian age was normally distributed across observations, and that as pedestrians became older the probability of fatal injury increased substantially. Heterogeneity in the mean of the random parameters for the freeway and pedestrian-solely-at-fault collision indicators was related to pedestrian gender, and heterogeneity in the mean of the random parameters for the traffic-sign and motorist-back-up indicators was related to pedestrian age.

Kriikku P; Wilhelm L; Schwarz O; Rintatalo J. New designer drug of abuse: 3,4-Methylenedioxypyrovalerone (MDPV). Findings from apprehended drivers in Finland. Forensic Science International 210(1-3): 195-200, 2011. (23 refs.)

Starting in 2008 a new designer drug, 3,4-methylenedioxypyrovalerone (MDPV) appeared among users of illegal drugs in Finland. Since then there have been several seizures of MDPV by police and customs and it has been connected to many crimes of different types. In this study the incidence and impact of the use of MDPV in drivers suspected of being under the influence of drugs (DUID) in Finland was assessed. Since autumn 2009, blood samples from drivers suspected of DUID in Finland have been analysed for the presence of MDPV. A new LC-MS/MS method for the determination of MDPV in serum was established. In order to assess the impact of MDPV on driving performance, drug and alcohol findings of positive MDPV cases were compared with data from the clinical examination carried out while the suspect was under arrest. In a period of one year there were 259 positive MDPV cases from apprehended drivers (5.7% of all confirmed DUID cases). In 80% of the cases in which MDPV was found, amphetamine was also present. Benzodiazepines were also frequently found together with MDPV, which was to be expected since in Finland, in our experience, stimulants are very often used together with benzodiazepines. In most cases it remained unclear whether the observed psycho-physical achievement deficiency was induced by MDPV because the concentrations of other drugs, especially other stimulants, were often high. However, in some subjects, MDPV, or MDPV in combination with other substances was the most probable cause of the impairment. The concentrations of MDPV varied from 0.016 mg/L to over 8.000 mg/L. Little is known about the pharmacology of MDPV. However, based on our findings it is clear that MDPV has a serious impact on traffic safety in Finland.

Lapham SC; McMillan GP. Open-label pilot study of extended-release naltrexone to reduce drinking and driving among repeat offenders. Journal of Addiction Medicine 5(3): 163-169, 2011. (32 refs.)

Objectives: A high proportion of persons convicted of driving while impaired repeat the offense. Many continue drinking and driving, even when faced with long jail terms. Hence, they pose a serious public health threat. This preliminary study evaluated extended-release, injectable naltrexone suspension (XR-NTX) and supportive therapy in reducing (1) drinking and (2) attempts to drive after drinking among repeat driving while impaired offenders with an ignition interlock device installed in their vehicles. Methods: Treatment-seeking volunteers received medical management therapy and 3 monthly injections of XR-NTX. We compared data on alcohol consumption, alcohol biomarkers, and interlock information before, during, and after treatment using summary measures and Sign tests. Results: Of 12 consented subjects, 10 received at least 1 injection, and 7 received all 3 injections. All subjects receiving medication reported a decrease in average drinks per day (P < 0.01) and abstinent days (P = 0.02) while on treatment versus pretreatment levels. Average daily drinks decreased by 77%, from 3.0 to 0.69 (P < 0.01), during treatment with XR-NTX. Average drinks per drinking day also declined by 39% during treatment, from 6.6 to 4.0 (P = 0.04). Percent days abstinent increased by 31%, from 56.8 to 81.96 (P = 0.02), which persisted after treatment completion. Biomarkers were consistent with reduced drinking. The percentage of vehicular failures to start due to elevated breath alcohol decreased from 3.1% of tests to 1.29% of tests. Conclusions: A randomized, controlled clinical trial is needed to demonstrate the efficacy of this promising treatment regimen for repeat offenders.

Lapham SC; Skipper BJ. Does screening classification predict long-term outcomes of DWI offenders? American Journal of Health Behavior 34(6, special issue): 737-749, 2010. (44 refs.)

Objectives: To determine the usefulness of a screening classification system in predicting treatment use, current substance abuse disorders (SUD), and driving over the alcohol limit (DOL) at 15-year follow-up. Methods: Interviewed 583 driving while imparied (DWI) first offenders with SUDs. Univariate and multivariate statistics were used to determine predictors of long-term outcomes. Results: Screening classification defined groups with different treatment histories and 15-year outcomes. Current SUDs were reported by 21% and DOL by 10%, of subjects. Conclusions: Group differences suggest that screening data could be used more effectively to triage and treat DWI offenders.

Leung SY. Benzodiazepines, opioids and driving: An overview of the experimental research. Drug and Alcohol Review 30(3): 281- 286, 2011. (53 refs.)

Issues. Road crashes contribute significantly to the total burden of injury in Australia, with the risk of injury being associated with the presence of drugs and/or alcohol in the driver's blood. Increasingly, some of the most commonly detected drugs include prescription medicines, the most notable of these being benzodiazepines and opioids. However, there is a paucity of experimental research into the effects of prescribed psychoactive drugs on driving behaviours. Approach. This paper provides an overview of experimental studies investigating the effects of prescribed doses of benzodiazepines and opioids on driving ability, and points to future directions for research. Key Findings. There is growing epidemiological evidence linking the therapeutic use of benzodiazepines and opioids to an increased crash risk. However, the current experimental literature remains unclear. Limitations to study methodologies have resulted in inconsistent findings. Implications. Limited experimental evidence exists to inform policy and guidelines regarding fitness-to-drive for patients taking prescribed benzodiazepines and opioids. Conclusion. Further experimental research is required to elucidate the effects of these medications on driving, under varying conditions and in different medical contexts. This will ensure that doctors prescribing benzodiazepines and opioids are well informed, and can appropriately advise patients of the risks associated with driving whilst taking these medications.

Liu S; Zhu Y. A case study of exposure to ultra-fine particles from secondhand tobacco smoke in an automobile. Indoor Air 20(5): 412-423, 2010. (38 refs.)

Secondhand tobacco smoke (SHS) in enclosed spaces is a major source of potentially harmful airborne particles. To quantify exposure to ultrafine particles (UFP) because of SHS and to investigate the interaction between pollutants from SHS and vehicular emissions, number concentration and size distribution of UFP and other air pollutants (CO, CO2, and PM2.5) were measured inside a moving vehicle under five different ventilation conditions. A major interstate freeway with a speed limit of 60 mph and an urban roadway with a speed limit of 30 mph were selected to represent typical urban routes. In a typical 30-min commute on urban roadways, the SHS of one cigarette exposed passengers to approximately 10 times the UFP and 120 times the PM2.5 of ambient air. The most effective solution to protect passengers from SHS exposure is to abstain from smoking in the vehicle. Opening a window is an effective method for decreasing pollutant exposures on most urban roadways. However, under road conditions with high UFP concentrations, such as tunnels or busy freeways with high proportion of heavy-duty diesel trucks (such as the 710 Freeway in Los Angeles, CA, USA), opening a window is not a viable method to reduce UFPs.

Liu YC; Ho CH. Effects of different blood alcohol concentrations and post-alcohol impairment on driving behavior and task performance. Traffic Injury Prevention 11(4): 334-341, 2010. (38 refs.)

Objective: A study using simulator methodology was conducted to investigate the effects of (1) different blood alcohol concentrations (BAC) of 0, 0.05, 0.08, and 0.10 percent and (2) post-alcohol impairment (where BAC 0%) on driving behavior and subsidiary cognitive task performance. Methods: Two driving sessions were investigated, that is, drunk driving and post-alcohol driving, with each requiring approximately 20 min of driving. In addition to driving safely, participants were instructed to perform the critical flicker fusion (CFF) test and completed the NASA-TLX mental workload questionnaire. Eight licensed drivers (6 males, 2 females) participated in this 2 (road complexities) x 2 (simulated driving sessions) x 4 (levels of BAC) within-subjects experiment. Results: The study revealed that higher BAC levels were associated with lower performing driving behavior. The driver's mental workload reached the highest values in the post-alcohol session. In terms of tasks involving divided attention, the traffic sign distance estimation showed significant deterioration with increased BAC levels. Conclusions: The relationship between drunk-driving behavior and alcohol dosage was supported in this study. Noticeably, no significant difference was found between drunk driving and post-alcohol driving, indicating that even in the post-alcohol situation, the impairment still remained significant enough to jeopardize traffic safety as much as it does in the case of drunk driving. In real-life situations, adopting a rest-time strategy to avoid post-alcohol impairment effects may not be the most appropriate solution by drivers; rather, drivers should be given some tests to verify the probability of post-alcohol effects on driving.

Luckin B. Anti-drink driving reform in Britain, c. 1920-80. (editorial). Addiction 105(9): 1538-1544, 2010. (51 refs.)

Aim: The: goal of this report is to provide a framework for understanding and interpreting political, scientific and cultural attitudes towards drink driving in 20th-century Britain. Exploring the inherent conservatism of successive governments, Members of Parliament (MPs) and the public towards the issue during the interwar years, the contribution seeks to explain the shift from legislative paralysis to the introduction of the breathalyser in 1967. Design: Based on governmental, parliamentary and administrative records, the report follows a mainly narrative route. It places particular emphasis on connections between post-war extra-parliamentary and parliamentary movements for reform. Setting: The paper follows a linear path from the 1920s to the 1970s. Britain lies at the heart of the story but comparisons are made with nations-particularly the Scandinavian states-which took radical steps to prosecute drinking and dangerous drivers at an early date. Findings: The report underlines the vital post-war role played by Graham Page, leading parliamentary spokesman for the Pedestrians' Association; the centrality of the Drew Report (1959) into an 'activity resembling driving'; the pioneering Conservative efforts of Ernest Marples; and Barbara Castle's consolidating rather than radically innovative activities between 1964 and 1967. Conclusion: Both before and after the Second World War politicians from both major parties gave ground repeatedly to major motoring organizations. With the ever-escalating growth of mass motorization in the 1950s, both Conservative and Labour governments agonized over gridlock and 'murder on the roads'. Barbara Castle finally took decisive action against drink drivers, but the ground had been prepared by Graham Page and Ernest Marples.

Maldonado-Molina MM; Reingle JM; Jennings WG; Prado G. Drinking and driving among immigrant and US-born Hispanic young adults: Results from a longitudinal and nationally representative study. Addictive Behaviors 36(4): 381-388, 2011. (49 refs.)

Objective: To evaluate the risk factors associated with the initiation of driving under the influence (DUI) among Hispanics in a longitudinal and nationally-representative sample of adolescents and young adults. Specifically, this study tests the effect of demographic variables, individual-level risk factors, and eco-processes (e.g., peer drug use, parental involvement) during adolescence on DUI among Hispanic young adults. Methods: Data were derived from 1734 Hispanic adolescents surveyed for the National Longitudinal Study of Adolescent Health (Add Health). Survey logistic regression procedures were used to examine the effects of nativity status on DUI initiation, to evaluate the independent effect of each risk factor (demographic, individual-level, and eco-processes), and to identify whether and to what extent these factors are associated with the initiation of DUI. Results: The overall prevalence of DUI initiation was 18.3%. Differences were observed in the rates of DUI initiation by nativity status: first-generation immigrants reported the lowest rates of DUI initiation (15.4%) when compared with second-generation US-born Hispanic youth (17.4%) and third-generation and beyond US-born Hispanic youth (21.5%). US-born Hispanic youth were also more likely to report higher frequency of alcohol use (t = 3.46, p = 0.001) and marijuana use (t = 2.34, p = 0.021) compared to immigrant adolescents. After adjusting for a number of risk factors, men (OR = 2.86), marijuana users (OR = 1.98), and those who reported feeling safe in their neighborhoods (OR = 2.02) were at an increased risk DUI initiation. Conclusions: Findings provide support for the "immigrant paradox": immigrant youth reported lower rates of DUI initiation and other high-risk behaviors when compared with US-born Hispanic youth.

Mann RE; Stoduto G; Butters J; Ialomiteanu A; Boase P; Asbridge M et al. Age group differences in collision risk. Journal of Safety Research 41(5): 445-449, 2010. (26 refs.)

Introduction: The purpose of the current study was to examine differences in factors associated with self-reported collision involvement of three age groups of drivers based on a large representative sample of Ontario adults. Method: This study was based on data from the CAMH Monitor, an ongoing cross-sectional telephone survey of Ontario adults 18 years and older from 2002 to 2005. Three age groups were examined: 18-34 (n = 1,294), 35-54 (n = 2,428), and 55+ (n = 1,576). For each age group sample, a logistic regression analysis was conducted of self-reported collision involvement in the last 12 months by risk factor measures of driving exposure (kilometers driven in a typical week, driving is stressful, and driving on busy roads), consuming five or more drinks of alcohol on one occasion (past 12 months), cannabis use (lifetime, and past 12 months), and driving after drinking among drinkers (past 12 months), controlling for demographics (gender, region, income, and marital status). Results: The study identified differences in factors associated with self-reported collision involvement of the three age groups of adult drivers. The logistic regression model for the youngest group revealed that drivers who reported that driving was stressful at least some of the time, drank five or more drinks on an occasion, and drove after drinking had an increased risk of collision involvement. For the middle age group, those who reported using cannabis in the last 12 months had significantly increased odds of reporting collision involvement. None of the risk factor measures showed significant associations with collision risk for older drivers (aged 55+). Impact: The results suggest potential areas for intervention and new directions for future research.

Mann RE; Stoduto G; Vingilis E; Asbridge M; Wickens CM; Ialomiteanu A et al. Alcohol and driving factors in collision risk. Accident Analysis and Prevention 42(6): 1538-1544, 2010. (51 refs.)

In this study we examine the effect of several alcohol-related measures on self-reported collision involvement within the previous 12 months while controlling for demographic and driving exposure factors based on a large representative sample of adults in Ontario. Data are based on the 2002-2006 Centre for Addiction and Mental Health Monitor, an ongoing cross-sectional telephone survey of Ontario adults aged 18 and older (n = 8542). Three logistic regressions of self-reported collision involvement in the past 12 months were implemented, each consisting of 3 steps: (1) demographic factors and driving exposure entered, (2) driving after drinking within the last 12 months entered, and (3) one of three alcohol-related measures (AUDIT subscales of alcohol consumption, dependence and problems) entered. In each step, measures from the preceding step were included in order to control for those variables. In Step 1, age (OR = 0.989), region overall, Central East region (OR = 0.71), West region (OR = 0.67), and North region (OR = 0.67), income overall and those who did not state income (OR = 0.64), marital status overall and those married or living common law (OR = 0.60), and number of kilometers driven in a typical week (OR = 1.00) were found to be significant predictors of collision involvement. The analyses revealed that driving after drinking was a significant predictor of collision involvement in Step 2 (OR = 1.51) and each of the Step 3 models (ORs = 1.52, 1.37, 1.34). The AUDIT Consumption subscale was not a significant factor in collision risk. Both the AUDIT Dependence and AUDIT Problems subscales were significantly related to collision risk (ORs 1.13 and 1.10, respectively). These findings suggest that alcohol, in addition to its effects on collision risk through its acute impairment of driving skills, may also affect collision risk through processes involved when individuals develop alcohol problems or alcohol dependence.

Mason A; Monk-Turner E. Factors shaping the decision of college students to walk or drive under the influence of alcohol: A test of rational choice theory. Drugs: Education, Prevention and Policy 17(5): 560-572, 2010. (30 refs.)

Aims: Rational Choice theory was tested to better understand the differences in behaviour regarding walking and driving under the influence of alcohol. Methods: Students at a residential college campus in Virginia were surveyed. Findings: Results show that students were less likely to walk or drive while intoxicated if they believed such behaviour was morally wrong and if they knew few others who had engaged in such behaviour without negative consequences ( a measure of punishment avoidance). If students reported that driving while intoxicated was a serious problem, which would result in like punishment, they were less likely to drive under the influence all else equal. Notably, certainty of punishment did not significantly impact differences between students with regard to the likelihood of driving under the influence. Conclusions: We found limited support for Rational Choice theory in understanding differences in the likelihood of walking and driving under the influence of alcohol.

Maxwell HG; Dubois S; Weaver B; Bedard M. The additive effects of alcohol and benzodiazepines on driving. Canadian Journal of Public Health 101(5): 353-357, 2010. (25 refs.)

Objectives To examine the relationship between the combination of alcohol and benzodiazepines and the risk of committing an unsafe driver action, Methods: We used data from the Fatality Analysis Reporting Systemem (1993 2006) on drivers aged 20 or older who were tested for both alcohol and drugs Using a case control design, we compared drivers who had at least one unsafe driver action (UDA, e g, weaving) recorded in relation to the crash (cases) to drivers who did not (controls). Results: Drivers who tested positive for intermediate and long acting benzodiazepines in combination with alcohol had significantly greater odds of a UDA compared to those under the influence of alcohol alone, up to blood alcohol concentrations (BACs) of 0 08 and 0 05 g/100 ml respectively. The odds of a UDA with short acting benzodiazepines combined with alcohol were no different than for alcohol alone. Conclusions: This study demonstrates that the combination of alcohol and benzodiazepines can have detrimental effects on driving beyond those of alcohol alone. By describing these combined effects in terms of BAC equivalencies, this study also allows for the extrapolation of simple, concrete concepts that communicate risk to the average benzodiazepine user

McGuire F; Dawe M; Shield KD; Rehm J; Fischer B. Driving under the influence of cannabis or alcohol in a cohort of high-frequency cannabis users: Prevalence and reflections on current interventions. Canadian Journal of Criminology and Criminal Justice 53(2): 247- 259, 2011. (39 refs.)

Driving under the influence of alcohol or cannabis is a major public health concern, as both are major risk factors for motor vehicle accidents (MVAs). Prevalence levels for both driving-risk behaviours have increased in Canada in recent years, despite punitive laws and enforcement aimed at impaired driving. Young drivers are a major risk group, due to their common substance use and MVA involvement. Data from a cohort of N = 102 high-frequency cannabis users [18-28 years old, 70 males and 32 females] who were also active alcohol users, recruited by mass advertising from university student populations in Toronto, indicated that a significantly (p = 0.009) higher proportion of the sample [35.0%] had driven a car while under the influence of cannabis than had driven while under the influence of alcohol [4.9%] or of a combination of cannabis and alcohol [3.9%] in the 30 days prior to the assessment. Multiple explanations of this finding are possible. First, law-enforcement and practical deterrence effects for alcohol- versus cannabis-impaired driving in Canada may be substantially different. Second, cannabis users may generally believe that the impairment effects of cannabis are limited, and frequent users may specifically believe in their ability to control cannabis's effects on driving. Implications for interventions and policy are discussed.

McNeilly B; Ibrahim JE; Bugeja L; Ozanne-Smith J. The prevalence of work-related deaths associated with alcohol and drugs in Victoria, Australia, 2001-6. Injury Prevention 16(6): artice DOI: 10.1136/ip.2010.027052, 2010. (18 refs.)

To describe the presence of alcohol, cannabis and amphetamines in work-related injury deaths in Victoria, 2001-6, an observational study of work-related deaths reported to the State Coroner's Office, Victoria, Australia was conducted. Case and postmortem forensic toxicology data were obtained from the National Coroner's Information System for work-related injury deaths with positive toxicology screens. Over 6 years there were 43 worker deaths in a total of 355 unintentional work-related injury deaths. The coroner mentioned the presence of alcohol/drugs in 22 of the 43 worker deaths with positive toxicology screens. Toxicology screens were positive for alcohol and/or drugs in 79 work-related deaths overall. Overall, alcohol was present in 26 (7%) work-related deaths and cannabis or amphetamines in 20 (6%). Incidents were mainly transport related. Alcohol and/or drugs were present in a significant portion of work-related deaths. Research is needed to determine the relative contribution of alcohol and drugs compared with other contributing factors to work-related deaths.

Naumann RB; Dellinger AM; Zaloshnja E; Lawrence BA; Miller TR. Incidence and total lifetime costs of motor vehicle-related fatal and nonfatal injury by road user type, United States, 2005. Traffic Injury Prevention 11(4): 353-360, 2010. (36 refs.)

Objectives: To estimate the costs of motor vehicle-related fatal and nonfatal injuries in the United States in terms of medical care and lost productivity by road user type. Methods: Incidence and cost data for 2005 were derived from several data sources. Unit costs were calculated for medical spending and productivity losses for fatal and nonfatal injuries, and unit costs were multiplied by incidence to yield total costs. Injury incidence and costs are presented by age, sex, and road user type. Results: Motor vehicle-related fatal and nonfatal injury costs exceeded $99 billion. Costs associated with motor vehicle occupant fatal and nonfatal injuries accounted for 71 percent ($70 billion) of all motor vehicle-related costs, followed by costs associated with motorcyclists ($12 billion), pedestrians ($10 billion), and pedalcyclists ($5 billion). Conclusions: The substantial economic and societal costs associated with these injuries and deaths reinforce the need to implement evidence-based, cost-effective strategies. Evidence-based strategies that target increasing seat belt use, increasing child safety seat use, increasing motorcyclist and pedalcyclist helmet use, and decreasing alcohol-impaired driving are available.

Orriols L; Delorme B; Gadegbeku B; Tricotel A; Contrand B; Laumon B et al. Prescription medicines and the risk of road traffic crashes: A French registry-based study. PLoS Medicine 7(11): e-article 1000366, 2010. (32 refs.)

Background: In recent decades, increased attention has been focused on the impact of disabilities and medicinal drug use on road safety. The aim of our study was to investigate the association between prescription medicines and the risk of road traffic crashes, and estimate the attributable fraction. Methods and Findings: We extracted and matched data from three French nationwide databases: the national health care insurance database, police reports, and the national police database of injurious crashes. Drivers identified by their national health care number involved in an injurious crash in France, between July 2005 and May 2008, were included in the study. Medicines were grouped according to the four risk levels of the French classification system (from 0 [no risk] to 3 [high risk]). We included 72,685 drivers involved in injurious crashes. Users of level 2 (odds ratio [OR] = 1.31 [1.24-1.40]) and level 3 (OR = 1.25 [1.12-1.40]) prescription medicines were at higher risk of being responsible for a crash. The association remained after adjustment for the presence of a long-term chronic disease. The fraction of road traffic crashes attributable to levels 2 and 3 medications was 3.3% [2.7%-3.9%]. A within-person case-crossover analysis showed that drivers were more likely to be exposed to level 3 medications on the crash day than on a control day, 30 days earlier (OR = 1.15 [1.05-1.27]). Conclusion: The use of prescription medicines is associated with a substantial number of road traffic crashes in France. In light of the results, warning messages appear to be relevant for level 2 and 3 medications and questionable for level 1 medications. A follow-up study is needed to evaluate the impact of the warning labeling system on road traffic crash prevention.

Orriols L; Philip P; Moore N; Castot A; Gadegbeku B; Delorme B et al. Benzodiazepine-like hypnotics and the associated risk of road traffic accidents. Clinical Pharmacology & Therapeutics 89(4): 595-601, 2011. (20 refs.)

The aim of the study was to investigate the association between the use of benzodiazepine or benzodiazepine-like hypnotics and the risk of road traffic accidents. Data from three French national databases were matched: the health-care insurance database, police reports, and the police database of injury-related traffic accidents. A total of 72,685 drivers involved in injury-related road traffic accidents in France, from 2005 to 2008, were included in the study. The risk of being responsible for a traffic accident was higher in users of benzodiazepine hypnotics (odds ratio (OR) = 1.39 (1.08-1.79)) and in the 155 drivers to whom a dosage of more than one pill of zolpidem a day had been dispensed during the 5 months before the collision (OR=2.46 (1.70-3.56)). No association was found between the use of zopiclone and risk of traffic accidents. Although this study did not find any association between the use of zolpidem as recommended and causation of traffic accidents, the potential risk related to possible abuse of the drug and risky driving behaviors should be further investigated. The results related to benzodiazepine hypnotics are consistent with those of previous studies.

Pereira RE; Perdona GDC; Zini LC; Cury MBS; Ruzzene MAM; Martin CCS et al. Relation between alcohol consumption and traffic violations and accidents in the region of Ribeirao Preto, Sao Paulo State. Forensic Science International 207(1-3): 164-169, 2011. (37 refs.)

In recent years, alcohol consumption has been considered an important public health problem. Ethanol, the alcohol used in beverages, is a drug that affects the central nervous system (CNS) and impairs driving skills and co-ordination, increasing risk of deaths and injuries derived from crashes and road accidents. Consumption of alcoholic beverages is implicated with premature deaths, injuries and damages caused by motor vehicle crashes, which result in high costs to government and society. Considering that alcohol consumption is the main responsible factor for deaths and disabilities in young people, the aim of this work was to evaluate the prevalence of blood alcohol in offenders and/or fatal and non-fatal victims of traffic occurrences in the region of Ribeirao Preto, Sao Paulo State, from 2005 to 2007. The results revealed that in 2134 cases investigated, blood alcohol positivity was generally found in young adults, 25-45 years old and male. The study showed the high risk of drinking and driving and the importance in establishing actions of prevention and intervention to promote the reduction in the number of traffic occurrences related to consumption of alcoholic beverages.

Perkins HW; Linkenbach JW; Lewis MA; Neighbors C. Effectiveness of social norms media marketing in reducing drinking and driving: A statewide campaign. Addictive Behaviors 35(10): 866-874, 2010. (31 refs.)

This research evaluated the efficacy of a high-intensity social norms media marketing campaign aimed at correcting normative misperceptions and reducing the prevalence of drinking and driving among 2i-to-34year-olds in Montana. A quasi-experimental design was used, such that regions of Montana were assigned to one of three experimental groups: social norms media marketing campaign, buffer, and control. Four random samples of Montanans between the ages of 21 and 34 were assessed at four time points over 18 months via phone surveys. Findings suggest that the social norms media campaign was successful at exposing the targeted population to social norms messages in the counties within the intervention region. Moreover, results demonstrate the campaign reduced normative misperceptions, increased use of designated drivers, and decreased drinking and driving among those young adults in counties within the intervention region. Social norms media marketing can be effective at changing drinking-related behaviors at the population level. This research provides a model for utilizing social norms media marketing to address other behaviors related to public health.

Phillips DP; Brewer KM. The relationship between serious injury and blood alcohol concentration (BAC) in fatal motor vehicle accidents: BAC=0.01% is associated with significantly more dangerous accidents than BAC=0.00%. Addiction 106(9): 1614-1622, 2011. (34 refs.)

Aim: To analyze the severity of automotive injuries associated with blood alcohol concentration (BAC) in increments of 0.01%. Design/setting: Epidemiological study using the Fatality Analysis Reporting System. Participants: All people in US fatal automotive accidents, 1994-2008 (n = 1 495 667). Measurements The ratio of serious: non-serious injuries for drivers, by BAC. Findings Accident severity increases significantly even when the driver is merely 'buzzed', a finding that persists after standardization for various confounding factors. Three mechanisms mediate between buzzed driving and high accident severity: compared to sober drivers, buzzed drivers are significantly more likely to speed, to be improperly seatbelted and to drive the striking vehicle. In addition, there is a strong 'dose-response' relationship for all three factors in relation to accident severity (e. g. the greater the BAC, the greater the average speed of the driver and the greater the severity of the accident). Conclusions: The severity of life-threatening motor vehicle accidents increases significantly at blood alcohol concentrations (BACs) far lower than the current US limit of 0.08%. Lowering the legal limit could save lives, prevent serious injuries and reduce financial and social costs associated with motor vehicle accidents.

Porath-Waller AJ; Beirness DJ. Simplifying the process for identifying drug combinations by drug recognition experts. Traffic Injury Prevention 11(5): 453-459, 2010. (16 refs.)

Objective: The purpose of this study is to statistically identify the set of drug-related cues from Drug Evaluation and Classification (DEC) evaluations that significantly predict the categories of drugs used by suspected drug-impaired drivers. Methods: Data from 819 completed Canadian DEC evaluations of combinations of central nervous system (CNS) stimulants with cannabis, CNS stimulants with narcotic analgesics, cannabis with alcohol, and no-drug cases were analyzed using a multinomial logistic regression procedure. Results: Eleven clinical indicators from the DEC evaluations significantly enhanced the prediction of drugs used by suspected drug-impaired drivers, including condition of the eyes, lack of convergence, rebound dilation, reaction to light, mean pulse rate, presence of visible injection sites, performance on the Horizontal Gaze Nystagmus Test, pupil size in darkness, performance on the One-Leg Stand Test, muscle tone, and performance on the Walk-and-Turn Test. Conclusions: The findings from this study will facilitate the process of identifying the correct categories of drugs ingested by suspected drug-impaired drivers by focusing on critical signs and symptoms of drug influence. This work will have direct and immediate relevance to the training of drug recognition experts (DREs) by providing the foundation for an innovative, statistically based approach to drug classification decisions by DREs. This research will also facilitate the enforcement of drug-impaired driving laws in Canada to help make Canadian roadways safer for all.

Ronen A; Chassidim HS; Gershon P; Parmet Y; Rabinovich A; Bar-Hamburger R et al. The effect of alcohol, THC and their combination on perceived effects, willingness to drive and performance of driving and non-driving tasks. Accident Analysis and Prevention 42(6): 1855-1865, 2010. (37 refs.)

Background: Driving under the influence of drugs (DUID) is one of the main causes of car accidents. Alcohol and marijuana are the most popular drugs among recreational users. Many classify these drugs as "Light" drugs and therefore allow themselves to drive after consuming them. Objective: The study had two main objectives: 1) to investigate the effect of alcohol (BAC = 0.05%), THC (13 mg) and their combination on driving and non-driving tasks. 2) to investigate the extent to which people are willing to drive based on their subjective sensations and their perceived effects of the drugs. Method: 7 healthy men and 5 healthy women, ages 24-29, all recreational users of alcohol and marijuana, completed 5 experimental sessions. Sessions included: drinking and smoking placebo, drinking alcohol and smoking placebo, drinking placebo and smoking THC, drinking alcohol and smoking THC, drinking placebo and smoking placebo 24 hours after drinking alcohol and smoking THC. Three types of measures were used: subjective perceptions (with questionnaires), performance parameters of the driving and non-driving tasks (arithmetic task and a secondary target detection task) and physiological changes (heart rate). Results: Overall, the combination of alcohol and THC had the most intense effect after intake. This effect was reflected in performance impairments observed in the driving and non-driving tasks, in the subjective sensations after intake, and in the physiological measures. Despite significant differences in the size of the effects after the various treatments, there were no differences in the distances subjects were willing to drive while under the influence on each of the treatments.

Rosenbloom T; Beigel A; Perlman A; Eldror E. Parental and offspring assessment of driving capability under the influence of drugs or alcohol: Gender and inter-generational differences. Accident Analysis and Prevention 42(6): 2125-2131, 2010. (53 refs.)

The current study set to examine whether there are inter-generational and gender-based differences between family members self-assessing their ability to drive under normal conditions and while under the influence of either alcohol or drugs. Participants were 135 young-adults and both their parents, consisting 45 family triads, who received self-assessment questionnaires relating to their driving skills in various road scenarios. Each family triad was randomly assigned to one of three groups: either requested to base the assessments on normal driving conditions, or under the influence of either drugs or alcohol, thus forming a control group, and two experimental groups (alcohol and drugs), respectively. The findings indicate the assessments of both the alcohol and drugs groups were more severe than those of the control group. The alcohol group assessments were less strict than the drug group assessment (non-significantly). Inter-generational differences indicated that the parents' driving-skills assessments were lower than those of their offspring, corresponding with previous findings (Elkind, 1967; Finn and Bragg, 1986). A significant within-subject interaction has been found between the respondent's gender and familial relations regarding the self-assessment of driving skills: male respondents assessed better driving skills compared to the self estimates of both parents (which did not significantly differ). In contrast, female respondents' estimates did not differ from their fathers' and both fathers' and daughters' estimates were significantly higher than that of the mothers in each family.

Sohn H; Lee K. Impact of smoking on in-vehicle fine particle exposure during driving. Atmospheric Environment 44(28): 3465-3468, 2010. (19 refs.)

Indoor smoking ban in public places can reduce secondhand smoke (SHS) exposure. However, smoking in cars and homes has continued. The purpose of this study was to assess particulate matter less than 2.5 mu m (PM2.5) concentration in moving cars with different window opening conditions. The PM2.5 level was measured by an aerosol spectrometer inside and outside moving cars simultaneously, along with ultrafine particle (UFP) number concentration, speed, temperature and humidity inside cars. Two sport utility vehicles were used. Three different ventilation conditions were evaluated by up to 20 repeated experiments. In the pre-smoking phase, average in-vehicle PM2.5 concentrations were 16-17 mu g m(-3). Regardless of different window opening conditions, the PM2.5 levels promptly increased when smoking occurred and decreased after cigarette was extinguished. Although only a single cigarette was smoked, the average PM2.5 levels were 506-1307 mu g m(-3) with different window opening conditions. When smoking was ceased, the average PM2.5 levels for 15 min were several times higher than the US National Ambient Air Quality Standard of 35 mu g m(-3). It took longer than 10 min to reach the level of the pre-smoking phase. Although UFP levels had a similar temporal profile of PM2.5, the increased levels during the smoking phase were relatively small. This study demonstrated that the SHS exposure in cars with just a single cigarette being smoked could exceed the US EPA NAAQS under realistic window opening conditions. Therefore, the findings support the need for public education against smoking in cars and advocacy for a smoke-free car policy.

Son CH; Topyan K. The effect of alcoholic beverage excise tax on alcohol-attributable injury mortalities. European Journal of Health Economics 12(2): 103-113, 2011. (51 refs.)

This study examines the effect of state excise taxes on different types of alcoholic beverages (spirits, wine, and beer) on alcohol-attributable injury mortalities-deaths caused by motor vehicle accidents, suicides, homicides, and falls-in the United States between 1995 and 2004, using state-level panel data. There is evidence that injury deaths attributable to alcohol respond differently to changes in state excise taxes on alcohol-specific beverages. This study examines the direct relationship between injury deaths and excise taxes without testing the degree of the association between excise taxes and alcohol consumption. The study finds that beer taxes are negatively related to motor vehicle accident mortality, while wine taxes are negatively associated with suicides and falls. The positive coefficient of the spirit taxes on falls implies a substitution effect between spirits and wine, suggesting that an increase in spirit tax will cause spirit buyers to purchase more wine. This study finds no evidence of a relationship between homicides and state excise taxes on alcohol. Thus, the study concludes that injury deaths attributable to alcohol respond differently to the excise taxes on different types of alcoholic beverages.

Spaanjaars NL; Spijkerman R; Engels RCME. Do smooth waters run deep? Alcohol intoxication and the effects of water consumption on driving-related cognitions and behavior. European Addiction Research 17(1): 21-28, 2011. (33 refs.)

The present study tested the effect of the combined use of alcohol and water on driving-related cognitions and behavior. Seventy-four female students performed a driving simulator task after having consumed alcohol or a placebo. Additionally, half of the participants consumed 0.5 liter of water. It was hypothesized that combining alcohol and water could lead to an underestimated perceived intoxication level resulting in more favorable driving cognitions and increased risk behavior. Our findings showed that the combined use of water and alcohol did not affect cognitions or behavior. Surprisingly, in the placebo condition, water intake increased risky driving cognitions and behavior in women with a history of accident involvement. Lacking a clear counterproductive effect when combined with alcohol, water could be a useful tool in limiting alcohol use among female drinkers.

Steentoft A; Simonsen KW; Linnet K. The frequency of drugs among Danish drivers before and after the introduction of fixed concentration limits. Traffic Injury Prevention 11(4): 329-333, 2010. (15 refs.)

Objective: Until July 2007, the driving under the influence of drugs (DUID) legislation in Denmark was based on impairment, evaluated on the basis of a clinical investigation and toxicological analyses, but in 2007 fixed concentration limits were introduced into the Danish traffic legislation. The objective for this study was to investigate the prevalence of medication and illicit drugs among Danish drivers before and after 2007. Methods: Blood samples from drivers suspected of being under the influence of medication and/or illicit drugs were investigated as requested by the police. The results for a 10-year period before and for one year after the introduction of fixed concentration limits are presented. Results: A total of 2340 blood samples were analyzed for the presence of medications and/or illicit drugs for the period 1997-2006. The average number of cases per year was 234 (213-283), and on average 87 percent of the investigated cases were positive for one or more drugs. For 2008 the number of investigated traffic cases was increased to 1176. Seventy-three percent of the cases from 2008 were positive for one or more drugs. Benzodiazepines, cannabis (THC), amphetamine, heroin/morphine, methadone, cocaine, and ecstasy were the most frequently detected drugs for the period 1997-2006 and also in 2008. The number of these cases in which an ethanol level was detected above 0.5 mg/g (the Danish legal limit) was on average 18 percent (9-26%) for the period 1997-2006 and 19 percent for 2008. The average age of the drivers ranged from 31 to 34 years for the period 1997-2006 and was 31 years for 2008. The percentage of females per year ranged from 3 to 20 percent. Conclusion: The number of traffic cases investigated for substances other than ethanol were consistently low, in the range of 200 to 300 per year during the period from 1997 to 2006, but after the introduction of fixed concentration limits in 2007 a 5-fold increase was seen already in 2008.

Stehr MF. The effect of sunday sales of alcohol on highway crash fatalities. Contributions to Economic Analysis & Policy 10(1): article 73, 2010. (18 refs.)

A large body of evidence indicates that increased alcohol availability leads to increased consumption of alcohol. From 1995 to 2008, fourteen states relaxed or repealed their bans on the Sunday sale of packaged alcohol. This paper leverages these repeals to provide quasi-experimental evidence on the effect of Sunday sales bans on alcohol related crash fatalities. Previous published studies in this area have found conflicting results regarding the effect of Sunday sales on traffic accidents and fatalities, but these studies have focused on repeals in single states, cities, or provinces; are outdated; or have failed to control for underlying changes in traffic fatalities that may be correlated with repeals but are due to other factors affecting traffic safety. Drawing upon data from the lower 48 states from the Fatality Analysis Reporting System (FARS), this paper finds that only the repeal in New Mexico led to an increase in fatalities. The effect is evident only in New Mexico because this repeal led to larger increases in drinking in New Mexico than in other states, residents of New Mexico drive more than residents of the other repeal states, and there is a greater fraction of traffic fatalities involving alcohol in New Mexico than in the other repeal states.

Stevens-Watkins D; Rostosky SStevens-Watkins D; Rostosky SZhao GZ; Wu CX; Houston RJ; Creager W. The effects of binge drinking and socio-economic status on sober driving behavior. Traffic Injury Prevention 11(4): 342-352, 2010. (65 refs.)

Objective: Drinking and driving is a primary cause of traffic fatalities and it has been suggested that binge drinkers comprise a major portion of those drivers involved in drinking and driving accidents. Although several experimental studies have investigated the driving behavior of binge drinkers (particularly college students and/or young adults) under the influence of alcohol, few studies have focused on a comparison of sober driving behavior of the general population between binge and non-binge drinkers with a consideration of drivers' income levels. In addition, these studies have not taken other potentially influential factors into account such as socio economic status. Methods: A driving simulator study was conducted with a 2 x 2 factorial design (binge vs. non-binge drinker; low vs. high income). Sixty-two participants who were not under the influence of alcohol or drugs were asked to operate a driving simulator following traffic rules. Multiple aspects of participants' driving behaviors were measured in a sober driving situation. To control the potential effects of confounding factors, factors (e.g., age, gender, etc.) that were significantly correlated to the driving behavior were all entered into the multivariate analysis of variance (MANOVA) as covariates. Results: Significant interaction effects were found between effects of binge drinking and income levels. Analyses indicated that binge drinkersindependent of their income levelsexhibited more speeding exceedances and longer speeding duration than those of non-binge drinkers with a high income. Individuals characterized as non-binge drinkers with a low income also exhibited more speeding behaviors. Conclusion: Cognitive deficits and problems in vehicle control resulting from chronic alcohol consumption may impact binge drinkers' abilities to perform adequately, even in a sober driving situation. In addition, non-binge drinkers with a low income were more prone to make unsafe choices compared to non-binge drinkers with a high income. Further implications of the results in transportation safety and alcohol addiction were also discussed.

Swift W; Jones C; Donnelly N. Cannabis use while driving: A descriptive study of Australian cannabis users. Drugs: Education, Prevention and Policy 17(5): 573-586, 2010. (44 refs.)

Aims: There is a limited literature and policy response to the issue of driving under the influence of cannabis. This article focuses on attitudes, beliefs and driving strategies among cannabis users to improve our understanding of the motivations for this behaviour and potential ameliorative strategies. Methods: Participants were 320 recent cannabis users in New South Wales, Australia. A structured interview assessed self-reported driving behaviour, attitudes, risk perceptions and harm reduction strategies associated with driving under the influence of cannabis (DUIC), cannabis and any alcohol (DUICA) and cannabis and other drugs (DUICO). Findings: Last year DUIC was reported by 78% of participants, with 27% doing so at least weekly. Approximately one-third reported DUICA (29%) and DUICO (30%), typically less than weekly. While participants strongly believed that driving under the influence of alcohol and DUICA increased accident risk (497%), fewer believed their own (53%) or others' (68%) risk was increased by DUIC. The most common strategies for reducing DUIC-related risk involved compensating for perceived impairments, whereas strategies involving forward planning were more frequently implemented for DUICA. Cannabis dependence was related to greater DUIC frequency, permissive attitudes towards DUIC and a tendency not to implement driving risk reduction strategies. Conclusions: These findings suggest that attempts to address DUIC face significant challenges, particularly using non-deterrence-based strategies.

Tam TW; Greenfield TK. Do alcohol warning labels influence men's and women's attempts to deter others from driving when intoxicated? Human Factors and Ergonomics In Manufacturing & Service Industries 20 special issue(6): 538-546, 2010. (29 refs.)

Research on the federally mandated alcohol warning label has found mixed results, but some findings are consistent with a modest influence on precautionary behaviors to reduce drinkers' self-reported drunk driving. We hypothesized that warnings would also influence the likelihood of intervening to deter others' driving after drinking. Using data from 1,376 adult drinkers in a U.S. national survey, a conceptual model reflecting effects of exposure to the label's drunk driving message on taking actions to avert another's driving under the influence was tested in a structural equation modeling framework. For men and women, in structural models with drinking and handling of alcoholic beverages potentially affecting both message recall and intervening, the predicted relationships were found between message recall and actions to deter another's drinking driving. This finding suggests that an important preventive effect of the alcohol warning label may be to legitimate collateral attempts to avert another's drunk driving.

Thombs DL; O'Mara RJ; Hou W; Wagenaar AC; Dong HJ; Merves ML et al. 5-HTTLPR genotype and associations with intoxication and intention to drive: Results from a field study of bar patrons. Addiction Biology 16(1): 133-141, 2011. (27 refs.)

The serotonin transporter promoter polymorphism (5-HTTLPR) has been linked to a number of human behavioral traits and disorders. The variants of 5-HTTLPR are commonly reported in three forms, L/L, S/L and S/S, with the latter most often associated with emotional distress and/or behavioral dysfunction. Missing from the research literature are investigations that assess event-level associations between 5-HTTLPR genotype and specific incidents of risk behavior in natural drinking settings. This study reports associations between 5-HTTLPR, alcohol intoxication and intention to drive among young adult patrons exiting on-premise drinking establishments (i.e. bars) at night. Self-report measures, breath alcohol concentration (BrAC) readings and saliva samples for DNA analysis were collected from 477 bar patrons. Analyses were performed on 225 patrons likely to be near their peak intoxication level for the night. Results from a linear regression revealed that the 5-HTTLPR genotype was associated with exiting patron BrAC, after adjusting for random and fixed effects of other variables. An interaction effect involving 5-HTTLPR and bar-sponsored drink specials also had an independent association with BrAC, suggesting that selection of price-discounted alcoholic beverages increased intoxication in patrons with an L allele. In addition, results from logistic regression indicated that patrons with the S/S genotype were three times more likely to intend to drive a motor vehicle (after drinking on the night of study participation) compared with those with the L/L genotype. The 5-HTTLPR genotype may play an important role in the etiology of problems associated with on-premise drinking establishments.

Thompson I; Williams G; Caldwell B; Aldington S; Dickson S; Lucas N et al. Randomised double-blind, placebo-controlled trial of the effects of the 'party pills' BZP/TFMPP alone and in combination with alcohol. Journal of Psychopharmacology 24(9): 1299-1308, 2010. (34 refs.)

The objective of this study was to determine the clinical effects of party pills containing benzylpiperazine (BZP) and trifluoromethylphenylpiperazine (TFMPP) when taken alone and in combination with alcohol. The study was a randomised, double-blind, placebo-controlled trial conducted in a hospital-based clinic in Wellington, New Zealand. Thirty-five volunteers who had previously used party pills containing BZP were included in this trial. Participants received one of the following four treatments: 300 mg/74 mg BZP/TFMPP and placebo, 300 mg/74 mg BZP/TFMPP and 57.6 g (6 units) alcohol, placebo and 57.6 g (6 units) alcohol and double placebo. The primary outcome variable was a measure of driving performance, the standard deviation of lateral position (SDLP) measured at 6.5 h. Secondary measures included adverse events, cardiovascular effects, psychological function and delayed effects on sleep. The study was stopped early, after 35 of the planned 64 subjects had undertaken testing, because of severe adverse events that occurred in four of 10 BZP/TFMPP-only subjects, three of seven combined BZP/TFMPP and alcohol subjects, none of the 6 placebo subjects, and none of the 12 alcohol-only subjects. The overall rate of severe adverse events (defined as causing considerable interference with usual activity and/or rated by subject as severe) in those receiving BZP/TFMPP was seven of 17 (41.2%, 95% CI 18.4-67.1). The severe events included agitation, anxiety, hallucinations, vomiting, insomnia and migraine. BZP/TFMPP significantly improved the driving performance, decreasing SDLP at -4.2 cm (95% CI-6.8 to -1.6, P = 0.002). The effect of alcohol was to increase SDLP: 2.3 cm (95% CI-0.3 to 4.9, P = 0.08). BZP/TFMPP also resulted in increased heart rate and blood pressure and in difficulty in getting to sleep. BZP/TFMPP alone or with alcohol carries a significant risk of severe adverse events when taken in similar doses to those recommended by manufacturers. [Note: BZP, despite being described as a natural product or herbal preparation is a synthetic drug, a stimulant with amphetamine-like properties. In is banned in the US Schedule I controlled substanance and over the past decade has been similarly banned in other countries. Canada is an exception.]

Thygerson SM; Merrill RM; Cook LJ; Thomas AM. Comparison of factors influencing emergency department visits and hospitalization among drivers in work and nonwork-related motor vehicle crashes in Utah, 1999-2005. Accident Analysis and Prevention 43(1): 209-213, 2011. (20 refs.)

This study identified contributing factors in the occurrence of motor vehicle crashes (MVCs) and the severity of crashes according to work-related status in Utah. Analyses were based on probabilistically linked data involving police crash reports and hospital inpatient and emergency department (ED) records for the years 1999-2005. Of 643,647 drivers involved in crashes, 73,437 (11.4%) went to the emergency department (ED) and 4989 (0.8%) were hospitalized. Of the drivers in crashes visiting the ED, 2330 (3.2%) were working at the time of the crash and of drivers in crashes who were hospitalized, 235 (4.7%) were working at the time of the crash. There was no significant difference between those working versus not working at the time of the crash in safety belt use (82%[53,947/66,188] for ED cases and 60% [2,489/4,176] for hospitalized cases) or fatigue (4%[ 2,697/70,536] for ED cases and 9% [450/4,824] for hospitalized cases) among drivers in crashes, but there was a significant difference with respect to alcohol drinking between workers versus nonworkers (ED: 1% [31/2,237] vs. 5% [3,455/68,299], P < 0.001; hospitalized: 3% [7/228] vs. 15% [673/4,596], P < 0.001). Of those attending the ED because of a crash, workers were significantly more likely to have broken bones, bleeding wounds, or to die. Of those hospitalized because of a crash, workers were significantly less likely to have caused the crash (65% [145/223] vs. 73% [3,315/4,566], P < 0.001). Yet although those drivers who were working at the time of the crash compared with those not working were less likely to have alcohol involved or to have caused the crash, there remains room for improvement among workers with respect to these factors, as well as safety belt use and fatigue.

Timko C; Desai A; Blonigen DM; Moos BS; Moos RH. Driving while intoxicated among individuals initially untreated for alcohol use disorders: One- and sixteen-year follow-ups. Journal of Studies on Alcohol and Drugs 72(2): 173-184, 2011. (80 refs.)

Objective: This study examined associations between frequency of driving while intoxicated (DWI) at baseline and obtaining alcohol-related help at follow-up, and between obtaining help and subsequent reductions in DWI. It also examined improvements on personal functioning and life context indices as mediators between obtaining help and reduced occurrences of DWI. Method: A total of 628 individuals who were initially untreated for alcohol use problems completed a baseline inventory; follow-ups were 1, 3, and 16 years later. Results: More extended participation in outpatient treatment and Alcoholics Anonymous (AA) during Year I was associated with a lower likelihood of DWI at the 1-year follow-up. More extended participation in AA through Year 3 was associated with a lower likelihood of DWI at the 16-year follow-up. Improvement on personal functioning and life context indices was associated with reduced risk of subsequent occurrences of DWI. Decreases in drinking-related problems, impulsivity, and drinking to reduce tension mediated associations between more AA participation and reductions in DWI at I year. Conclusions: Among initially untreated individuals, sustained mutual help may be associated with a reduced number of occurrences of DWI via fewer drinking consequences and improved psychological functioning and coping. Treatment providers should attend to these concomitants of DWI and consider actively referring individuals to AA to ensure ongoing AA affiliation.

Vaughn MG; Define RS; DeLisi M; Perron BE; Beaver KM; Fu QA et al. Sociodemographic, behavioral, and substance use correlates of reckless driving in the United States: Findings from a national sample. Journal of Psychiatric Research 45(3): 347-353, 2011. (29 refs.)

This study examined the sociodemographic, behavioral, psychiatric, and substance use correlates of three forms of reckless driving using a nationally representative sample of U.S. adults. Participants were 43,093 adults from the National Epidemiologyogic Survey on Alcohol and Related Conditions (NESARC). Interviewers administered the Alcohol Use Disorder and Associated Disabilities Interview Schedule - DSM-IV version (AUDADIS-IV). This measure provides extensive sociodemographic data as well as diagnoses for mood, anxiety, personality, and substance use disorders. Reckless driving was significantly associated with male gender, lower levels of income, being born in the U.S., and numerous forms of antisocial behaviors. Fully adjusted models revealed significant effects with respect to substance use disorders across categories of reckless drivers with those having their licenses revoked or suspended being particularly more likely to be diagnosed with antisocial (AOR = 3.35, 95% CI = 2.54, 4.42) and paranoid personality disorder (AOR = 1.56, 95% CI = 1.07, 2.29). All three reckless driving groups were more likely to have a family history of antisocial behavior than non-reckless drivers. Study findings provide information from which targeted behavioral interventions can be applied.

Wang P; Rau PLP; Salvendy G. Chinese drivers' risky driving and risk taking in other life situations. International Journal of Occupational Safety and Ergonomics 17(2): 155-164, 2011. (42 refs.)

The first aim of this study was to investigate Chinese drivers' preferences to risk-taking behaviors encountered in daily life, including safety and health, finance, recreation, social areas, and ethics. The second aim was to evaluate the association between Chinese risky driving and other risk-taking behaviors. A questionnaire survey was conducted with the 324 Chinese drivers who responded. Through a principal component analysis an 8-factor structure was created to interpret different domains of risk-taking behaviors. They were risks in driving, ethics, recreation, gambling, abused health (voluntarily engaging in smoking and binge drinking), investment, ignored health. (ignoring personal health, such as eating expired food), and monetary social areas. The result of multiple regression analysis showed that drivers who were likely to engage in driving risks were also likely to take risks in domains of ethics, abused health, gambling, investment, recreation, and ignored health.

Webster JM; Dickson MF; Duvall JL; Clark DB. Rural and urban differences in Kentucky DUI offenders. Journal of Addiction Medicine 4(3): 186-190, 2010. (26 refs.)

Objectives: Recent national data suggest that the prevalence of driving under the influence (DUI) is higher in rural areas than in more urbanized areas of the United States. However, little is known about rural DUI offenders, particularly those living in very remote areas. This study was conducted to examine the similarities and differences between rural and urban DUI offenders. Based on recent research, it was expected that few differences would be found between rural and urban DUI offenders. Methods: This study examined a total of 21,135 substance abuse assessment records for persons convicted of DUI in Kentucky and who concluded treatment in 2005. Assessment records included demographic characteristics, Alcohol Use Disorders Identification Test scores, Drug Abuse Screening Test scores, and the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision substance use disorder checklist. Beale codes based on county of residence were used to create comparison groups. Results: Positive, and statistically significant, associations were found between rurality and Drug Abuse Screening Test scores, Diagnostic and Statistical Manual of Mental Disorders Fourth Edition substance abuse and dependence disorders, and rates of education/treatment noncompliance. Alcohol Use Disorders Identification Test scores were negatively associated with rurality. Conclusions: The study suggests that the problem severity among DUI offenders may be greater in rural areas. Given the lack of treatment services in rural areas, practitioners may face greater challenges in assessing and providing appropriate treatment for this group of DUI offenders, which may put them at greater risk for continued impaired driving.

Wester AE; Verster JC; Volkerts ER; Bocker KBE; Kenemans JL. Effects of alcohol on attention orienting and dual-task performance during simulated driving: An event-related potential study. Journal of Psychopharmacology 24(9): 1333-1348, 2010. (73 refs.)

Driving is a complex task and is susceptible to inattention and distraction. Moreover, alcohol has a detrimental effect on driving performance, possibly due to alcohol-induced attention deficits. The aim of the present study was to assess the effects of alcohol on simulated driving performance and attention orienting and allocation, as assessed by event-related potentials (ERPs). Thirty-two participants completed two test runs in the Divided Attention Steering Simulator (DASS) with blood alcohol concentrations (BACs) of 0.00%, 0.02%, 0.05%, 0.08% and 0.10%. Sixteen participants performed the second DASS test run with a passive auditory oddball to assess alcohol effects on involuntary attention shifting. Sixteen other participants performed the second DASS test run with an active auditory oddball to assess alcohol effects on dual-task performance and active attention allocation. Dose-dependent impairments were found for reaction times, the number of misses and steering error, even more so in dual-task conditions, especially in the active oddball group. ERP amplitudes to novel irrelevant events were also attenuated in a dose-dependent manner. The P3b amplitude to deviant target stimuli decreased with blood alcohol concentration only in the dual-task condition. It is concluded that alcohol increases distractibility and interference from secondary task stimuli, as well as reduces attentional capacity and dual-task integrality.

Wong LP. Socio-demographic and behavioural characteristics of illegal motorcycle street racers in Malaysia. BMC Public Health 11(e-article 446), 2011. (30 refs.)

Background: This study sought to understand the factors associated with street racing among the illegal motorcycle racers in Malaysia or known as the "Mat Rempit". Methods: Street outreach interviewer-administered surveys were conducted from June 2008 to January 2009 in this multi-state study. Results: A total of 2022 participants were surveyed, the mean +/- SD age of the participants was 20.5 +/- 3.4 years (age range: 12 to 35 years). Mean duration of street racing was 2.65(SD +/- 1.77) years (range: 2 months to 12 years), with 50.1% and 35.8% reporting stunt riding and alcohol drinking while racing, respectively. With regard to risk behaviours, cigarette smoking was highly prevalent among the study participants (78.3%), followed by alcohol drinking (27.8%) and recreational drug use (18.8%). Participants scored high on the masculinity scale (15.7 +/- 4.0 out of 21.0). The results of the logistic regression analysis showed that socio-demographic variables, risk behaviour and masculinity scores were associated with racing frequency. Conclusion: Given these associations, tailoring family-centered interventions to the needs of the lower socioeconomic groups and interventions recognizing the negative consequences of health risk behaviours related to street racing as an expression of traditional masculinity should be emphasized.

Yang YH; Lai JN; Lee CH; Wang JD; Chen PC. Increased risk of hospitalization related to motor vehicle accidents among people taking zolpidem: A case-crossover study. Journal of Epidemiology 21(1): 37-43, 2011. (21 refs.)

Background: Several epidemiological and experimental studies have found a positive association between the risk of motor vehicle accidents (MVAs) and use of zopiclone and benzodiazepines. There is, however, little evidence of any risk of MVA attributable to the use of zolpidem 1 day before such accidents. We attempted to determine whether the use of zolpidem 1 day before is associated with an increased risk of an MVA. Methods: Using a 1-million-person randomly sampled cohort from the Taiwan National Health Insurance reimbursement database, 12 929 subjects were identified as having been hospitalized between 1998 and 2004 due to an MVA. Using a case-crossover design, we selected the day before an MVA as the case period for each subject, and the 91st, 182nd, and 273rd days before the case period as 3 retrospective control periods. Conditional logistical regression models were constructed to calculate the odds ratio (OR) of having an MVA and the exposure of zolpidem 1 day before. We calculated doses of benzodiazepines, zopiclone, and zolpidem based on their defined daily dose. Results: The adjusted OR for involvement in an MVA after taking 1 defined daily dose of zolpidem was 1.74 (95% confidence interval: 1.25-2.43). There were also positive effects for different washout periods and cumulative doses at 7, 14, 21, and 28 days before the occurrence of an MVA. Conclusions: Use of zolpidem 1 day before might be associated with an increased risk of MVA. Thus, precautionary warnings should be provided when prescribing zolpidem.

Zhang LN; Wieczorek WF; Welte JW; Colder C; Nochajski TH. Delinquency and alcohol-impaired driving among young males: A longitudinal study. Journal of Criminal Justice 38(4): 439-445, 2010. (31 refs.)

The present study assessed how the trajectory of delinquency affects the growth curve of alcohol-impaired driving using three-waves of data collected from the Buffalo Longitudinal Survey of Young Men (BLSYM). Using the structural equation modeling method, latent growth modeling was utilized to assess four age cohorts of sixteen, seventeen, eighteen, and nineteen years of age at the first wave. The data indicated that the growth rate of delinquency significantly and positively affects the growth rate of alcohol-impaired driving for the respondents who were sixteen at the first wave. The growth rate of drinking was also significantly and positively associated with the growth rate of alcohol-impaired driving for this age cohort. Although the growth rate of delinquency had no significant effect on the growth rate of alcohol-impaired driving for the age cohort which was seventeen at Wave 1, the growth rates of both drinking and drug use did affect for this age cohort. The data, however, showed that alcohol-impaired driving had a significant increase across the waves for the eighteen year old cohort, but there was no significant variation in the rate across respondents. Finally, for the nineteen year old cohort there was no significant increase in alcohol-impaired driving across the waves, and also no significant variation of the growth rate of alcohol-impaired driving across the respondents. These findings indicated that interventions focused on reducing delinquency, alcohol and drug use by sixteen and seventeen year old male adolescents will also reduce their alcohol-impaired driving.

Zhuo XY; Cang Y; Yan H; Bu J; Shen BH. The prevalence of drugs in motor vehicle accidents and traffic violations in Shanghai and neighboring cities. Accident Analysis and Prevention 42(6): 2179-2184, 2010. (28 refs.)

The objective of this study was to determine the prevalence of psychoactive drug use among motor vehicle drivers in Shanghai and its neighboring cities. We selected 10,002 drivers involved in a traffic accident or violation between 2007 and 2008 in Shanghai. Suzhou and Wuxi. We checked for the presence of psychoactive drugs from blood samples using liquid chromatography tandem mass spectrometry (LC-MS-MS). Of the 10,002 drivers, 10.5% tested positive for drugs (excluding alcohol). Cold medicines were the most frequently detected drugs including chlorpheniramine (4.78%), pseudoephedrine (2.15%) and paracetamol (1.32%). The use of multiple cold medicines was common. Illegal drugs such as methamphetamine (0.15%), ketamine (0.03%) and MDMA (0.01%) were also detected. The prevalence of psychoactive drugs among drivers involved in traffic accidents or violations in Shanghai and its neighboring cities was lower compared to previous reports in Europe. Furthermore, cannabis which has been reported to be the most widely used psychoactive drug after alcohol was not commonly encountered among Shanghai drivers.