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CORK Bibliography: Driving

92 citations. September 2011 to present

Prepared: September 2012

Agius R; Nadulski T; Kahl HG; Dufaux B. Significantly increased detection rate of drugs of abuse in urine following the introduction of new German driving licence re-granting guidelines. Forensic Science International 215(1-3): 32-37, 2012. (24 refs.)

In this paper we present the first assessment of the new German driving licence re-granting medical and psychological assessment (MPA) guidelines by comparing over 3500 urine samples tested under the old MPA cut-offs to over 5000 samples tested under the new MPA cut-offs. Since the enzyme multiplied immunoassay technique (EMIT) technology used previously was not sensitive enough to screen for drugs at such low concentrations, as suggested by the new MPA guidelines, enzyme-linked immunosorbent assay (ELISA) screening kits were used to screen for the drugs of abuse at the new MPA cut-offs. The above comparison revealed significantly increased detection rates of drug use or exposure during the rehabilitation period as follows: 1.61, 2.33, 3.33, and 7 times higher for 11-nor-delta-9-tetrahydrocannabinol- 9-carboxylic acid (THC-COOH), morphine, benzoylecgonine and amphetamine respectively. The present MPA guidelines seem to be more effective to detect non-abstinence from drugs of abuse and hence to detecting drivers who do not yet fulfil the MPA requirements to regain their revoked driving licence.

Copyright 2012, Elsevier Science

Agius R; Nadulski T; Moore C. Validation of LUCIO (R)-Direct-ELISA kits for the detection of drugs of abuse in urine: Application to the new German driving licence re-granting guidelines. Forensic Science International 215(1-3): 38-45, 2012. (21 refs.)

LUCIO (R)-Direct-enzyme linked immunosorbent assay (ELISA) tests were validated for the screening of drugs of abuse cannabis, opiates, amphetamines and cocaine in urine for the new German medical and psychological assessment (MPA) guidelines with subsequent gas chromatographic-mass spectrometric (GC-MS) confirmation. The screening cut-offs corresponding to 10 ng/mL 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid (THC-COOH), 50 ng/mL amphetamine, 25 ng/mL morphine and codeine and 30 ng/mL benzoylecgonine were chosen at the point where the number of false negatives was lower than 1%. Due to their accuracy, ease of use and rapid analysis, these ELISA tests are very promising for cases where a large proportion of the tests are expected to be negative such as for abstinence monitoring as part of the driving licence re-granting process.

Copyright 2012, Elsevier Science

Asbridge M; Hayden JA; Cartwright JL. Acute cannabis consumption and motor vehicle collision risk: Systematic review of observational studies and meta-analysis. (review). British Medical Journal 344: article e536, 2012. (56 refs.)

Objective: To determine whether the acute consumption of cannabis (cannabinoids) by drivers increases the risk of a motor vehicle collision. Design: Systemematic review of observational studies, with meta-analysis. Data sources: We did electronic searches in 19 databases, unrestricted by year or language of publication. We also did manual searches of reference lists, conducted a search for unpublished studies, and reviewed the personal libraries of the research team. Review methods: We included observational epidemiology studies of motor vehicle collisions with an appropriate control group, and selected studies that measured recent cannabis use in drivers by toxicological analysis of whole blood or self report. We excluded experimental or simulator studies. Two independent reviewers assessed risk of bias in each selected study, with consensus, using the Newcastle-Ottawa scale. Risk estimates were combined using random effects models. Results: We selected nine studies in the review and meta-analysis. Driving under the influence of cannabis was associated with a significantly increased risk of motor vehicle collisions compared with unimpaired driving (odds ratio 1.92 (95% confidence interval 1.35 to 2.73); P=0.0003); we noted heterogeneity among the individual study effects (I-2=81). Collision risk estimates were higher in case-control studies (2.79 (1.23 to 6.33); P=0.01) and studies of fatal collisions (2.10 (1.31 to 3.36); P=0.002) than in culpability studies (1.65 (1.11 to 2.46); P=0.07) and studies of non-fatal collisions (1.74 (0.88 to 3.46); P=0.11). Conclusions Acute cannabis consumption is associated with an increased risk of a motor vehicle crash, especially for fatal collisions. This information could be used as the basis for campaigns against drug impaired driving, developing regional or national policies to control acute drug use while driving, and raising public awareness.

Copyright 2012, BMJ Publishing

Beck KH; Ahmed A; Farkas ZA. A descriptive analysis of the social context of drinking among first-time DUI offenders. Traffic Injury Prevention 12(4): 306-311, 2011. (39 refs.)

Objective: To understand the role of social context in contributing to the incidence of alcohol-impaired driving. Methods: Telephone interviews were conducted with 161 individuals who received a first-time DUI citation. They were predominantly white (70%), male (62%) and 21 to 45 years of age (62%). They were paid $25 for their participation. Questions were asked about their social network, the social context in which they typically drink, the specific location and circumstances where they were drinking at the time of their citation, risky driving behaviors, in the last month as well as the number of traffic tickets they received and crashes they have been involved in since they started to drive. Results: Two reliable social contexts of drinking were identified through principle components factors analysis: emotional pain and social facilitation. Analyses of variance showed that drinking in a context of emotional pain (eg, to deal with depression, stress) was related to drinking alone at this location and driving when they know they have had too much to drink. Drinking in a context of social facilitation (eg, with friends, to be sociable) was related to drinking more frequently and with others (versus alone) at this location. Social facilitation was also positively related to driving over the speed limit and running a red light/stop sign. Conclusions: The social context of drinking is important for understanding the social network of drinking drivers, because most (86%) said that someone from their social network was with them at this drinking location. The need to understand how significant others influence the context of drinking as well as the likelihood of impaired driving is critical for program development. These results suggest that different types of interventions are needed for offenders depending on their social context of drinking.

Copyright 2011, Taylor & Francis

Bergen G; Shults RA; Rudd RA. Vital Signs: Alcohol-impaired driving among adults --- United States, 2010. MMWR. Morbidity and Mortality Weekly Report 60(39): 1351-1356, 2011. (22 refs.)

Background: Alcohol-impaired driving crashes account for nearly 11,000 crash fatalities, or about one third of all crash fatalities in the United States. Methods: CDC analyzed data from the 2010 Behavioral Risk Factor Surveillance System survey to obtain the prevalence, episodes, and rates of alcohol-impaired driving (defined as driving "when you've had perhaps too much to drink" in the past 30 days) among U.S. adults aged �18 years who responded to the survey by landline telephone. Results: In 2010, an estimated 4 million U.S. adult respondents reported at least one episode of alcohol-impaired driving, for an estimated total of approximately 112 million alcohol-impaired driving episodes or 479 episodes per 1,000 adult population. From a peak in 2006, such episodes decreased 30% through 2010. Men accounted for 81% of all episodes with young men aged 21--34 years accounting for 32% of all episodes. Additionally, 85% of alcohol-impaired driving episodes were reported by persons who also reported binge drinking, and the 4.5% of the adult population who reported binge drinking at least four times per month accounted for 55% of all alcohol-impaired driving episodes. Episode rates were nearly four times higher among persons who reported not always wearing seatbelts compared with persons who reported always wearing seatbelts. Conclusions: Rates of self-reported alcohol-impaired driving have declined substantially in recent years. However, rates remain disproportionally high among young men, binge drinkers, and those who do not always wear a seat belt. Implications for Public Health: States and communities should continue current evidence-based strategies, such as sobriety checkpoints and enforcement of 0.08 g/dL blood alcohol concentration laws to deter the public from driving while impaired. Additionally, all states should consider requiring ignition interlocks on the vehicles of all persons convicted of alcohol-impaired driving. States without primary seatbelt laws should consider enacting them to reduce fatalities in alcohol-impaired driving crashes.

Public Domain

Birdsall WC; Reed BG; Huq SS; Wheeler L; Rush S. Alcohol-impaired driving: Average quantity consumed and frequency of drinking do matter. Traffic Injury Prevention 13(1): 24-30, 2012. (23 refs.)

Objective: The objective of this article is to estimate and validate a logistic model of alcohol-impaired driving using previously ignored alcohol consumption behaviors, other risky behaviors, and demographic characteristics as independent variables. Methods: The determinants of impaired driving are estimated using the US Centers for Disease Control and Prevention's (CDC) Behavioral Risk Factor Surveillance System (BRFSS) surveys. Variables used in a logistic model to explain alcohol-impaired driving are not only standard sociodemographic variables and bingeing but also frequency of drinking and average quantity consumed, as well as other risky behaviors. We use interactions to understand how being female and being young affect impaired driving. Having estimated our model using the 1997 survey, we validated our model using the BRFSS data for 1999. Results: Drinking 9 or more times in the past month doubled the odds of impaired driving. The greater average consumption of alcohol per session, the greater the odds of driving impaired, especially for persons in the highest quartile of alcohol consumed. Bingeing has the greatest effect on impaired driving. Seat belt use is the one risky behavior found to be related to such driving. Sociodemographic effects are consistent with earlier research. Being young (18-30) interacts with two of the alcohol consumption variables and being a woman interacts with always wearing a seat belt. Our model was robust in the validation analysis. Conclusions: All 3 dimensions of drinking behavior are important determinants of alcohol-impaired driving, including frequency and average quantity consumed. Including these factors in regressions improves the estimates of the effects of all variables.

Copyright 2012, Taylor & Francis

Bishop NJ. Predicting rapid DUI recidivism using the Driver Risk Inventory on a state-wide sample of Floridian DUI offenders. Drug and Alcohol Dependence 118(2-3): 423-429, 2011. (20 refs.)

Background: This project examined the ability of the popular DUI/DWI offender assessment instrument, the Driver Risk Inventory (DRI; Behavior Data Systems, Ltd., 1985), to identify short-term DUI recidivists in a sample of Floridian DUI offenders who were charged with DUI between January 1st, 2008 and December 31st, 2009. The DRI provides a number of behavioral risk scales, DSM-IV substance abuse and dependence classifications, as well as measurement of demographic and criminal history characteristics. Methods: Cox proportional hazards models were used to identify the demographic, criminal history, and behavioral characteristics most closely associated with the risk of rapid DUI recidivism. Follow-up analyses including ROC curves were used to further examine the ability of the DRI to identify short-term DUI recidivists. Results: In the final model controlling for all variables, the DRI driver risk scale was the single strongest predictor of rapid DUI recidivism. The DSM-IV substance abuse and dependence classifications were also significant predictors of DUI recidivism. A number of the DRI risk scales and the DSM-IV classifications exhibited significant predictive validity and exhibited sensitivity in identifying recidivists similar to other popular DUI offender assessment instruments. Conclusions: The DRI provides useful identification of DUI recidivists in a sample able to capture only the most rapid DUI recidivists. The results of this research warrant further examination of the DRI's ability to identify DUI recidivists using longer intervals of time between DUI arrests.

Copyright 2011, Elsevier Science

Blencowe T; Pehrsson A; Mykkanen S; Gunnar T; Lillsunde P. Cannabis findings in drivers suspected of driving under the influence of drugs in Finland from 2006 to 2008. Forensic Science International 217(1-3): 107-112, 2012. (43 refs.)

The authors examined driving under the influence of drugs (DUID) cases which were found to be positive in whole blood for cannabis in Finland from 2006 to 2008. Factors studied were the number of cases positive for any combination of Delta(9)-tetrahydrocannabinol (THC) and the metabolites 11-hydroxy-Delta(9)-tetrahydrocannabinol (THC-OH) and 11-nor-9-carboxy-Delta(9)-tetrahydrocannabinol (THC-COOH). Concurrent use of amphetamines, benzodiazepines and/or alcohol was also recorded, as well as the drivers' age and gender. Altogether 2957 cannabis positive cases were retrieved from the database of the Alcohol and Drug Analytics Unit, National Institute for Health and Welfare. Drug findings were examined in relation to the zero-tolerance policy operated towards DUID in Finland. The number of cannabis positive cases in each year was approximately 1000 and the main demographic of cases was males aged 20-30 years. In the majority of cases (51.6%) the inactive metabolite THC-COOH was the only indication of cannabis use, however, associated use of amphetamines (58.8% of all cases) and/or benzodiazepines (63.9%) in cannabis positive drivers was very common. Detections for amphetamines and/or benzodiazepines were especially common in drivers with THC-COOH only (92.8% of these cases). Combined use of alcohol (25.7%) was also prevalent. Suspect DUID cases generally arise from suspicion on behalf of the police and the zero-tolerance policy offers an expedient means to deal with the challenges presented in DUID, particularly in view of the high incidence of multiple drug use - the legislation is not unduly punitive when enforced in this manner.

Copyright 2012, Elsevier Science

Bosker WM; Kuypers KPC; Conen S; Kauert GF; Toennes SW; Skopp G et al. MDMA (ecstasy) effects on actual driving performance before and after sleep deprivation, as function of dose and concentration in blood and oral fluid. Psychopharmacology 222(3): 367-376, 2012. (30 refs.)

Experimental research has shown that 3,4-methylenedioxymethamphetamine (MDMA) can improve some psychomotor driving skills when administered during the day. In real life, however, MDMA is taken during the night, and driving may likely occur early in the morning after a night of "raving" and sleep loss. The present study assessed the effects of MDMA on road-tracking and car-following performance in on-the-road driving tests in normal traffic. Sixteen recreational MDMA users participated in a randomized double-blind placebo-controlled four-way cross-over design. They received single, evening doses of 0, 25, 50, and 100 mg MDMA on separate occasions. Actual driving tests were conducted in the evening when MDMA serum concentrations were maximal and in the morning after a night of sleep loss. The primary measure of driving, i.e., standard deviation of lateral position (SDLP, a measure of weaving) was significantly increased during driving tests in the morning in all treatment conditions, irrespective of MDMA dose and concentration. The increments in SDLP were of high clinical relevance and comparable to those observed for alcohol at blood alcohol concentrations > 0.8 mg/mL. These impairments were primarily caused by sleep loss. In general, MDMA did not affect driving performance nor did it change the impairing effects of sleep loss. It is concluded that MDMA cannot compensate for the impairing effects of sleep loss and that drivers who are under the influence of MDMA and sleep deprived are unfit to drive.

Copyright 2012, Springer

Brache K; Stockwell T. Drinking patterns and risk behaviors associated with combined alcohol and energy drink consumption in college drinkers. Addictive Behaviors 36(12): 1133-1140, 2011. (35 refs.)

Objective: In recent years the consumption of alcohol mixed with energy drinks (AmED) has become popular in young adults in North America. There have been few studies into the drinking patterns and risk behaviors that accompany this new form of alcoholic beverage consumption and more information is required to support harm reduction and prevention efforts. This paper goes beyond previous research by investigating risk behaviors associated with AmED use while (1) controlling for risk-taking propensity, (2) examining a range of outcomes (e.g. stimulant drug use), and (3) replicating previous findings in a Canadian sample. Method: In winter 2009/10, a web-based survey was completed by 465 students (56% female) attending a university in Western Canada. Regression analyses were used to investigate whether consumption of AmED is associated with heavy drinking, stimulant drug use, and alcohol-related consequences. Results: A total of 105 students (23%) reported consuming AmED in the past 30 days. These students were more likely to be heavier drinkers, than non-AmED users after controlling for risk-taking propensity. More frequent AmED drinkers had twice the odds of experiencing one or more negative consequences from AmED use (e.g. drinking and driving, being hurt or injured), compared to less frequent drinkers after controlling for risk-taking propensity and drinking behavior. Conclusions: Students who consume AmED are at increased risk for harms. Therefore, consuming AmED should be considered "high-risk drinking" for university students and efforts should be made to discourage combined consumption.

Copyright 2011, Elsevier Science

Bramness JG; Skurtveit S; Morland J; Engeland A. An increased risk of motor vehicle accidents after prescription of methadone. Addiction 107(5): 967-972, 2012. (50 refs.)

Aims: To investigate whether exposure to methadone affects the risk of motor vehicle accident with personal injury. Design: Cohort study linking three Norwegian administrative registries using unique person identifiers. Setting: Information was retrieved from the Norwegian Prescription Database on any prescriptions ever received by the individuals for methadone and all prescriptions for benzodiazepines. The Norwegian Road Accident Registry provided information about motor vehicle accidents involving personal injuries on Norwegian roads. The Central Population Registry provided demographic information on all residents in Norway. Participants: All Norwegian adults aged 18-69 years were observed for 2.5 years. Measurements Standardized incidence ratio (SIR) was calculated by comparing the incidence of traffic accidents with personal injuries in patients exposed to methadone with the incidence in those not exposed. Findings: During the 4626 person-years observed in patients exposed to methadone, there were 26 motor vehicle accidents. There were very few accidents among the females who received methadone and they had no increased risk of being involved in motor vehicle accidents (SIR 1.1; 95% CI 0.2-3.1). We observed an increased risk of involvement in accidents among males (SIR 2.4; 95% CI 1.5-3.6). This figure did not change significantly when exposure to benzodiazepines was excluded. Conclusions: Men exposed to methadone appear to have an increased risk of being involved in motor vehicle accidents involving personal injuries. This increased risk could not be explained by exposure of benzodiazepines.

Copyright 2012, Wiley-Blackwell

Breitenbach TC; Pechansky F; Benzano D; De Boni R. High rates of injured motorcycle drivers in emergency rooms and the association with substance use in Porto Alegre, Brazil. Emergency Medicine Journal 29(3): 205-207, 2012. (24 refs.)

Background: Although the fleet of motorcycles and the number of traffic accidents (TA) is increasing in the world, few studies have evaluated intoxication by alcohol and/or drugs in this group of drivers. This study aims to evaluate the prevalence of motorcycle riders among drivers who are victims of TA, and ascertain factors associated with drug and alcohol use. Methods: All TA victims admitted on a 24/7 routine between October and November 2008 to two trauma hospitals of Porto Alegre, Brazil were invited to participate, then submitted to an interview, breathalysed and had their saliva collected for drugs. Results: Among the overall sample of drivers, 78.4% were motorcycle riders. Toxicological analysis yielded a 15.3% prevalence of marijuana use, 9.2% of cocaine use, 3.2% benzodiazepine use and 7% of alcohol use. Factors associated with alcohol or drug intoxication were the diagnosis of alcohol abuse or dependence and history of previous TA. Conclusions: The prevalence of motorcycle riders among drivers who are victims of TA was alarming. The association of alcohol abuse or dependency and intoxication justify the need for therapeutic interventions specifically targeted to the treatment of drug dependency, as well as public policies directed to prevention of injuries-particularly among recidivist motorcycle riders.

Copyright 2012, BMJ Publishing Group

Brown TG; Dongier M; Ouimet MC; Tremblay J; Chanut F; Legault L. The role of demographic characteristics and readiness to change in 12-month outcome from two distinct brief interventions for impaired drivers. Journal of Substance Abuse Treatment 42(4): 383-391, 2012. (73 refs.)

Objectives: This study tested specific intervention responsivity to brief intervention in driving while impaired by alcohol and/or drugs recidivists based upon their demographic, substance use, and initial readiness to change characteristics. Methods: A nonclinical community-based sample of 184 male and female recidivists was randomly assigned to receive one of two 30-minute interventions: brief motivational interviewing (n = 92) or an information advice session (n = 92). Dependent variables were change at the 6- and 12-month follow-ups from baseline in percentage of risky drinking days and blood assay biomarkers of alcohol misuse. Independent variables were age, gender, education, past convictions for impaired driving, and baseline alcohol and drug misuse severity and readiness to change. Results: Recidivists who were younger, male, and exhibited more negative consequences and ambivalence towards their problem drinking improved more on alcohol-related outcomes, irrespective of intervention type. Conclusions: The results do not convincingly indicate specific intervention responsivity based upon participant characteristics but provide preliminary guidance about which recidivists are most apt to benefit from these brief approaches.

Copyright 2012, Elsevier Science

Catalano RF; Fagan AA; Gavin LE; Greenberg MT; Irwin CE; Ross DA et al. Adolescent health 3: Worldwide application of prevention science in adolescent health. Lancet 379(9826): 1653-1664, 2012. (115 refs.)

The burden of morbidity and mortality from non-communicable disease has risen worldwide and is accelerating in low-income and middle-income countries, whereas the burden from infectious diseases has declined. Since this transition, the prevention of non-communicable disease as well as communicable disease causes of adolescent mortality has risen in importance. Problem behaviours that increase the short-term or long-term likelihood of morbidity and mortality, including alcohol, tobacco, and other drug misuse, mental health problems, unsafe sex, risky and unsafe driving, and violence are largely preventable. In the past 30 years new discoveries have led to prevention science being established as a discipline designed to mitigate these problem behaviours. Longitudinal studies have provided an understanding of risk and protective factors across the life course for many of these problem behaviours. Risks cluster across development to produce early accumulation of risk in childhood and more pervasive risk in adolescence. This understanding has led to the construction of developmentally appropriate prevention policies and programmes that have shown short-term and long-term reductions in these adolescent problem behaviours. We describe the principles of prevention science, provide examples of efficacious preventive interventions, describe challenges and potential solutions to take efficacious prevention policies and programmes to scale, and conclude with recommendations to reduce the burden of adolescent mortality and morbidity worldwide through preventive intervention.

Copyright 2012, Elsevier Science

Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Administration. Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings. NSDUH Series H-41. Rockville MD: Substance Abuse and Mental Health Administration, 2011. (57 refs.)

This report presents the first information from the 2010 National Survey on Drug Use and Health (NSDUH), an annual survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA). The survey is the primary source of information on the use of illicit drugs, alcohol, and tobacco. In respect to illicit drug use, in 2010, an estimated 22.6 million Americans aged 12 or older were current (past month) illicit drug users. This estimate represents 8.9 percent of the population aged 12 or older. The rise in drug use is largely the result of the increasing use of marijuana. Following an introduction, the first chapters deal with illicit drugs, alcohol use, tobacco use, providing information on use patterns by demographics. The next three chapters examine the initiation of substance use, measures related to prevention (risk and protective factors), and substance dependence and abuse and their treatment. The concluding chapter deals with trends in substance use among adolescents and young adults. Data is summarized in 56 figures and 9 tables.

Public Domain

Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings. NSDUH Series H-41. Rockville MD: Substance Abuse and Mental Health Administration, 2011. (57 refs.)

This report presents the first information from the 2010 National Survey on Drug Use and Health (NSDUH), an annual survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA). The survey is the primary source of information on the use of illicit drugs, alcohol, and tobacco. In respect to illicit drug use, in 2010, an estimated 22.6 million Americans aged 12 or older were current (past month) illicit drug users. This estimate represents 8.9 percent of the population aged 12 or older. The rise in drug use is largely the result of the increasing use of marijuana. Following an introduction, the first chapters deal with illicit drugs, alcohol use, tobacco use, providing information on use patterns by demographics. The next three chapters examine the initiation of substance use, measures related to prevention (risk and protective factors), and substance dependence and abuse and their treatment. The concluding chapter deals with trends in substance use among adolescents and young adults. Data is summarized in 56 figures and 9 tables.

Public Domain

Chu M; Gerostamoulos D; Beyer J; Rodda L; Boorman M; Drummer OH. The incidence of drugs of impairment in oral fluid from random roadside testing. Forensic Science International 215(1-3): 28-31, 2012. (31 refs.)

Oral fluid (OF) has become a popular specimen to test for presence of drugs, particularly in regards to road safety. In Victoria, OF specimens from drivers have been used to test for the presence of methylamphetamine (MA) and Delta(9)-tetrahydrocannabinol (THC) since 2003 and 3, 4-methylenedioxy-N-methylamphetamine (MDMA) since 2006. LC-MS/MS has been used to test the most recent 853 submitted OF specimens from Victoria Police for 31 drugs of abuse including those listed in the Australian Standard AS4760-2006. At least one proscribed drug was detected in 96% of drivers, of which MA was the most common (77%), followed by THC (42%), MDMA (17%) and the combination of all three (3.9%). Opioids were detected in 14% of drivers of which 4.8% were positive for 6-acetylmorphine and 3.3% for methadone. The incidence of the opioids tramadol (1.2%) and oxycodone (1.1%) were relatively low. Cocaine (8.0%) was as commonly detected as benzodiazepines (8.0%), and was almost always found in combination with MA (7.9%). Samples positive to benzodiazepines were largely due to diazepam (3.5%) and alprazolam (3.4%), with only 0.2% of drivers combining the two. Ketamine was also detected in 1.5% of cases. While the incidences of the proscribed drugs itself are concerning, it is clear that many drivers are also using other drugs capable of causing impairment.

Copyright 2012, Elsevier Science

Comello MLG; Slater MD. Effects of adverts from a drug and alcohol prevention campaign on willingness to engage in alcohol-related risky behaviors. Journal of Health Psychology 16(8): 1268-1276, 2011. (26 refs.)

Behavioral willingness is conceptualized as a pathway to behavior that is non-deliberative, yet traditional measures require thoughtful deliberation to complete. This study explored non-deliberative measures of alcohol-related willingness to complement recent work on marijuana-related willingness. The study also examined whether adverts from a field-tested drug and alcohol prevention campaign may have operated by influencing alcohol-related willingness. Participants viewed campaign adverts or consumer adverts (control). Outcomes were reaction times to make speeded judgments about whether one would engage in risky alcohol-related behaviors. Results showed that campaign advertisements lowered willingness to play drinking games and (for males) to drive while intoxicated.

Copyright 2011, Sage Publications

Constant A; Encrenaz G; Zins M; Lafont S; Chiron M; Lagarde E et al. Why drivers start drinking and driving: A prospective study over a 6-year period in the GAZEL Cohort. Alcohol and Alcoholism 46(6): 729-33, 2011. (39 refs.)

To estimate the frequency with which a group of formerly safe drivers adopt driving while alcohol-intoxicated (DWI), and to determine the factors associated with DWI adoption. Participants were current employees or recent retirees of the French national electricity and gas company. An annual cohort questionnaire that includes two questions about overall alcohol consumption is sent each year to participants. A Driving Behaviour and Road Safety (DBRS) questionnaire was administered in 2001, 2004 and 2007. Only drivers who participated in the 2001 survey received the 2004 and 2007 questionnaires. More than 462 participants ceased DWI between 2001 and 2007, while 511 adopted this behaviour for the first time. Multivariate analysis showed that the risk of adopting DWI was associated with male gender and with several changes over the preceding years: increased alcohol consumption, increased number of close friends, decreased number of close relatives and decreased attitudes in favour of strict enforcement/regulations. A large number of offenders stopped DWI between 2001 and 2007, concomitantly with an increased crackdown on road violations in France. But this success was compromised by the occurrence of new drunk drivers. Preventive strategies should target factors that facilitate DWI adoption-in particular, increased alcohol consumption and low acceptance of law enforcement initiatives.

Copyright 2011, Medical Council on Alcoholism

Corsenac P; Lagarde E; Gadegbeku B; Delorme B; Tricotel A; Castot A. Road traffic crashes and prescribed methadone and buprenorphine: A French registry-based case-control study. Drug and Alcohol Dependence 123(1-3): 91-97, 2012. (47 refs.)

Background: Opioids have been shown to impair psychomotor and cognitive functioning in healthy volunteers with no history of opioid abuse. Few or no significant effects have been found in opioid-dependant patients in experimental or driving simulation studies. The risk of road traffic crash among patients under buprenorphine or methadone has not been subject to epidemiological investigation so far. The objective was to investigate the association between the risk of being responsible for a road traffic crash and the use of buprenorphine and methadone. Methods: Data from three French national databases were extracted and matched: the national health care insurance database, police reports, and the national police database of injurious crashes. Case-control analysis comparing responsible versus non responsible drivers was conducted. Results: 72, 685 drivers involved in an injurious crash in France over the July 2005-May 2008 period, were identified by their national health care number. The 196 drivers exposed to buprenorphine or methadone on the day of crash were young, essentially males, with an important co-consumption of other substances (alcohol and benzodiazepines). Injured drivers exposed to buprenorphine or methadone on the day of crash, had an increased risk of being responsible for the crash (odds ratio (OR) = 2.02, 95% confidence interval (CI): 1.40 and 2.91). Conclusions: Users of methadone and buprenorphine were at increased risk of being responsible for injurious road traffic crashes. The increased risk could be explained by the combined effect of risky behaviors and treatments.

Copyright 2012, Elsevier Science

Costa N; Silva R; Mendonca MC; Real FC; Vieira DN; Teixeira HM. Prevalence of ethanol and illicit drugs in road traffic accidents in the centre of Portugal: An eighteen-year update. Forensic Science International 216(1-3): 37-43, 2012. (40 refs.)

This study presents the prevalence of ethanol and illicit drugs in fatal road traffic accident victims in the Centre of Portugal between January 1990 and December 2007. Among the violent deaths, road traffic accidents presented the highest percentage (around 35%; n = 3095), but decreasing throughout the years. Accidents were preponderant in males (about 80%; n = 2402), between 21 and 30 years-old. Accidents involving drivers (55%; n = 1310) were of the most common, being the car the main vehicle (45%), followed by the motorcycle (40%). An alcohol analysis request was present in 50% of the cases (n = 1687), but increasing each year. Ethanol concentrations >1.2 g/L, the legal limit in Portugal, were found in 55% (n = 283) of the cases. Concerning drugs of abuse requests, only 4.4% (n = 137) and 17.3% (58 cases) of the cases included the analysis at the Forensic Pathology Department (FPD) and at the Medico-Legal Office (MLO), respectively. Among the road accident cases analysed, 18 were positive, mainly in men (84%), between 21 and 30 years-old; opiates (47.1%; n = 8) and cannabinoids (50%; n = 4) were the most found, at the FPD and at the MLO, respectively. In conclusion, ethanol was identified as a key factor to traffic accidents, which explains the definition of specific legislation and methods of enforcement to prohibit this form of impairing. Nevertheless, ethanol still remains the psychoactive substance most frequently identified in the blood of divers killed in road-traffic crashes, recommending additional actions of supervision and control.

Copyright 2012, Elsevier Science

Cox DJ; Madaan V; Cox BS. Adult attention-deficit/hyperactivity disorder and driving: Why and how to manage it. Current Psychiatry Reports 13(5): 345-350, 2011. (31 refs.)

Driving is a complex task that can be a significant challenge for individuals with attention-deficit/hyperactivity disorder (ADHD). A slight lapse in attention or inhibition while driving (not uncommon in individuals with ADHD) can result in hazardous consequences for these individuals and their families. This is also an interesting clinical scenario for the treating physician, who is always trying to optimize the various treatment options for the patient. Despite such potentially perilous consequences for society, this subject only recently has received researchers' attention. This review paper highlights the psychological differences between drivers with and without ADHD and examines differences between these groups in various driving simulation models. Research updates involving pharmacologic and nonpharmacologic interventions are discussed at length. Although the long-term effects of such interventions may not be clearly defined, there is enough evidence to suggest the public health significance of such interventions for optimally managing adult symptoms of ADHD.

Copyright 2011, Springer

da Conceicao TV; De Boni R; Duarte PDAV; Pechansky F. Awareness of legal blood alcohol concentration limits amongst respondents of a national roadside survey for alcohol and traffic behaviours in Brazil. International Journal of Drug Policy 23(2): 166-168, 2012. (13 refs.)

Background: In Brazil the legal blood alcohol content (BAC) allowed for driving was changed to zero in 2008. If the BAC found is above 0.6 g/L, drivers may be arrested. However, there are limited data on drivers' awareness of such limits. Methods: Drivers from 27 major metropolitan areas (n=3397) were randomly asked to participate in roadside survey from 12 a.m. to 12 p.m. on Fridays and Saturdays. They were breathalized by highway patrol officers, and after consent interviewers collected data on drinking behaviours, knowledge about the law, and breath tests results. Results: The mean age was 37.3 +/- 11.3 years; 94.3% were male and 26.5% had some college education. When asked about the BAC that could result in arrest, 34.5% of the subjects claimed to know it. However, only 23.5% (8.1% of the total sample) provided correct answers. Factors associated with the right answers were: male gender (p = 0.04; OR = 2.08; CI = 1.01-4.27); higher education (p < 0.0001); negative BAC or self-report of driving under the influence (DUI) (p = 0.02); higher family income (p = 0.01) and non-professional driving (p = 0.041). Age was not statistically different between groups. After multivariate analysis, male gender (p = 0.002), higher education (p < 0.0001) and negative BAC or DUI (p = 0.046) remained in the model. Conclusions: The knowledge that BAC levels over 0.6 g/L may result in arrest is sparse amongst Brazilian drivers, notably amongst women, the less educated and those who drink and drive. Educational programmes targeted at those specific groups may be necessary in order to increase awareness about the legal BAC limit and its consequences.

Copyright 2012, Elsevier Science

Dassanayake TL; Jones AL; Michie PT; Carter GL; McElduff P; Stokes BJ et al. Risk of road traffic accidents in patients discharged following treatment for psychotropic drug overdose: A self-controlled case series study in Australia. CNS Drugs 26(3): 269-276, 2012. (25 refs.)

Background: Use of psychotropic drugs is known to impair driving and increase the risk of road traffic accidents. They are also the most common drugs taken in overdose in hospital-treated episodes of self-poisoning. Most patients who take psychotropic drug overdoses are discharged within 48 hours, while they still have possible subclinical drug effects. Objective: Using a self-controlled case series design, we aimed to determine whether patients with psychotropic drug overdose are at a higher risk of a traffic accident in the period following discharge compared with a control period not associated with hospital-treated drug overdose. Methodology: Using the New South Wales (NSW) Admitted Patient Data Collection (APDC) as the primary source, we retrieved 40 845 hospital separation records dated between 1 July 2000 and 30 June 2008 (8 years) in patients aged 18-80 years admitted to a hospital in NSW following an intentional self-poisoning with a psychotropic drug (coded X61 or X62 as the International Classification of Diseases, 10th Edition, [ICD-10] external cause of injury). Of these, 33,459 hospital separations (i.e. discharges, transfers and deaths) involving 24,284 patients were considered eligible as the patients were discharged directly into the community where they could have driven a motor vehicle. We selected three separate post-admission periods (3 days, 1 week and 4 weeks), subtracted the number of inpatient days from each and calculated three separate post-discharge periods (immediate, intermediate and extended, respectively) for each episode of overdose. The control period was the duration of the study period where the individual was aged 18 years or older, excluding the total person-days in the post-discharge period/s and the index inpatient period/s. The APDC dataset was linked to the NSW Roads and Traffic Authority Crash Link dataset to identify any accidents in which each patient was involved as a motor-vehicle driver during the followup period. Incidence rate ratio (IRR) for matched post-discharge and control periods was found using random effects Poisson regression. Results: Seventy-two percent of the subjects were discharged within 2 days following their admission with overdose. Compared with the corresponding control periods the risk of a traffic accident was 3.5 times higher (IRR = 3.49; 95% CI 1.66, 7.33; p = 0.001) during the immediate, 1.9 times higher (IRR = 1.88; 95% CI 1.09, 3.25; p = 0.023) during the intermediate and 1.6 times higher (IRR = 1.65; 95% CI 1.27, 2.15; p = 0.0002) during the extended post-discharge period. Conclusions: Self-poisoning with psychotropic drugs is associated with a markedly increased risk of a traffic accident during the first few days following discharge. These findings raise clinical and medico-legal implications concerning fitness-to-drive during this period. The risk reduces with time but remains significantly elevated after 4 weeks post-overdose. Further research is necessary to find out the factors contributing to this ongoing risk.

Copyright 2012, Adis International

De Boni R; Silva PLD; Bastos FI; Pechansky F; de Vasconcellos MTL. Reaching the hard-to-reach: A probability sampling method for assessing prevalence of driving under the influence after drinking in alcohol outlets. PLoS ONE 7(4): e-article 34104, 2012. (57 refs.)

Drinking alcoholic beverages in places such as bars and clubs may be associated with harmful consequences such as violence and impaired driving. However, methods for obtaining probabilistic samples of drivers who drink at these places remain a challenge - since there is no a priori information on this mobile population - and must be continually improved. This paper describes the procedures adopted in the selection of a population-based sample of drivers who drank at alcohol selling outlets in Porto Alegre, Brazil, which we used to estimate the prevalence of intention to drive under the influence of alcohol. The sampling strategy comprises a stratified three-stage cluster sampling: 1) census enumeration areas (CEA) were stratified by alcohol outlets (AO) density and sampled with probability proportional to the number of AOs in each CEA; 2) combinations of outlets and shifts (COS) were stratified by prevalence of alcohol-related traffic crashes and sampled with probability proportional to their squared duration in hours; and, 3) drivers who drank at the selected COS were stratified by their intention to drive and sampled using inverse sampling. Sample weights were calibrated using a post-stratification estimator. 3,118 individuals were approached and 683 drivers interviewed, leading to an estimate that 56.3% (SE = 3,5%) of the drivers intended to drive after drinking in less than one hour after the interview. Prevalence was also estimated by sex and broad age groups. The combined use of stratification and inverse sampling enabled a good trade-off between resource and time allocation, while preserving the ability to generalize the findings. The current strategy can be viewed as a step forward in the efforts to improve surveys and estimation for hard-to-reach, mobile populations.

Copyright 2012, Public Library of Science

Dermody SS; Cheong J; Walther CA. A study of alcohol use by designated drivers among college students. Journal of American College Health 60(4): 310-315, 2012. (24 refs.)

Objective: College students tend to drink while serving as a designated driver (DD). The predictors of alcohol use by DDs among college students were examined. Participants: Participants were 119 undergraduate students in introductory psychology courses who had experience with DD use. Methods: Survey data were analyzed to examine the predictors of planning components of DD use, such as choosing a DD before drinking and choosing an abstinent DD, and the relations of these components to alcohol use by DDs. Results: History of DD use, friends' willingness to be the DD, frequency of riding with a driver who drank and drove, and age of drinking onset were associated with planning components of DD use. Among the planning components of DD use, choosing a DD before drinking was significantly related to less alcohol use by DDs. Conclusions: Increasing awareness of the planning components of DD use could deter alcohol use by DDs among college students.

Copyright 2012, Taylor & Francis

Drummer OH; Kourtis I; Beyer J; Tayler P; Boorman M; Gerostamoulos D. The prevalence of drugs in injured drivers. Forensic Science International 215(1-3): 14-17, 2012. (24 refs.)

In mid 2009 Victoria introduced compulsory drug testing of blood taken from all injured drivers taken to hospital. Delta(9)-Tetrahydrocannabinol (THC), methylamphetamine (MA) and 3, 4-methylenedioxy-methylamphetamine (MDMA) are prohibited and if drivers are positive to any amount an automatic penalty is enforced. Laboratory screens were conducted on preserved blood using ELISA testing for cannabis metabolite and methylamphetamines and a fully validated LC-MS/MS method for 105 drugs including THC, amphetamines, opioids, benzodiazepines, antidepressants and antipsychotics and a number of other psychoactive substances using a minimum of two transitions per drug. Conventional GC-testing for ethanol was used to screen and quantify the presence of alcohol. 1714 drivers were tested and showed alcohol in 29% (>= 0.01 g/100 mL) and drugs in 35%. The positive rate for the three drugs prohibited by legislation was 12.5%. The prevalence of THC, MA and MDMA was 9.8%, 3.1%, and 0.8%, respectively. The range of THC concentrations in blood was 2-42 ng/mL (median 7) of which 70% had a concentration of 10 ng/mL or higher. The range of concentrations for MA and MDMA was 0.02-0.4 and 0.03-0.3 mg/L (median for both drugs was 0.05 mg/L). Drugs of any type were detected in 35% of cases. The other drugs were largely prescribed drugs such as the antidepressants (9.3%) and benzodiazepines (8.9%). Neither 6-acetylmorphine nor cocaine (or benzoylecgonine) was detected in these cases.

Copyright 2012, Elsevier Science

Dupont RL; Voas RB; Walsh JM; Shea C; Talpins SK; Neil MM. The need for drugged driving per se laws: A commentary. Traffic Injury Prevention 13(1): 31-42, 2012. (72 refs.)

Objective: Triggered by the new federal commitment announced by the Office of National Drug Control Policy (ONCDP) to encourage states to enact drugged driving per se laws, this article reviews the reasons to establish such laws and the issues that may arise when trying to enforce them. Methods: A review of the state of drunk driving per se laws and their implications for drugged driving is presented, with a review of impaired driving enforcement procedures and drug testing technology. Results: Currently, enforcement of drugged driving laws is an adjunct to the enforcement of laws regarding alcohol impairment. Drivers are apprehended when showing signs of alcohol intoxication and only in the relatively few cases where the blood alcohol concentration of the arrested driver does not account for the observed behavior is the possibility of drug impairment pursued. In most states, the term impaired driving covers both alcohol and drug impairment; thus, driver conviction records may not distinguish between the two different sources of impairment. As a result, enforcement statistics do not reflect the prevalence of drugged driving. Conclusions: Based on the analysis presented, this article recommends a number of steps that can be taken to evaluate current drugged driving enforcement procedures and to move toward the enactment of drug per se laws.

Copyright 2012, Taylor & Francis

Elliott MR; Jacobsohn L; Winston FK; Ginsburg KR. Determining subgroups of teens for targeted driving injury prevention strategies: A latent class analysis approach. Traffic Injury Prevention 13(3): 258-264, 2012. (28 refs.)

Objective: To utilize teen traffic safety belief profiles to improve targeting of resources and messages to young novice drivers. Methods: The National Young Driver Survey is a nationally representative sample 5665 of 9th to 11th graders in the United States. Using latent class analysis, we grouped beliefs about 25 safety-relevant behaviors into a summary set of belief profiles and related these profiles to demographics and driver/passenger experience. Results: We determined 5 safety belief profiles of teens: "everything" (rated most of the 25 behaviors as important to safety); "drivers/personal responsibility" (rated driver-related behaviors but few others as important); "driver drinking" (rated only driver alcohol use as always important); "distractions/external forces" (rated predominantly passenger rather than driver issues as important); and "nothing" (rated no issues as important). Three key groups emerged who were more likely than their counterparts to belong to the distractions/external forces than the everything class and for whom targeted messaging might be effective: males, non-white adolescents, and teens who had experienced an injury crash as a driver. Conclusions: The classes appear to organize around the locus of control (LOC) social learning framework, with some teens perceiving crashes resulting primarily from their own behavior and others believing that forces in their environment determine the events that result in a crash. Designing interventions that help young drivers understand their role in crashes may help improve the safety behavior of young drivers. In particular, for those involved in crashes, interventions designed to help them understand that the crash was a result of their actions, rather than a random or externally driven event, may influence them to take control with safety-oriented behaviors.

Copyright 2012, Taylor & Francis

Fischer B; Dawe M; Mcguire F; Shuper PA; Jones W; Rudzinski K et al. Characteristics and predictors of health problems from use among high-frequency cannabis users in a Canadian university student population. Drugs: Education, Prevention and Policy 19(1): 49-58, 2012. (68 refs.)

Aims: Assess key cannabis use, risk and outcome characteristics among high-frequency cannabis users within a university student sample in Toronto, Canada. Methods: N = 134 active universities students (ages of 18-28) using cannabis at least three times per week were recruited by mass advertisement, telephone-screened and anonymously assessed by an interviewer-administered questionnaire. Relevant descriptive statistics are presented; subsequent univariate and multivariate logistic regression analyses (MLRA) identified independent predictors of experiencing physical or mental health problems. Findings: The majority of respondents used cannabis >5 years, almost daily and >1 times/day, socially and medically on occasion. In past 30 days, 79% used cannabis by deep inhalation, 38% drove a car after use, 45% had difficulty controlling or limiting use and 52% experienced negative mental/physical health effects, with few respondents reporting any past treatment. The MLRA identified 'difficulty controlling or limiting use' (OR = 3.40, 95% CI = 1.58-7.30), 'non-white ethnicity' (OR = 2.78, 95% CI = 1.13-6.83), and 'living with others' (OR = 2.37, 95% CI = 1.02-5.55) as independent predictors (p < 0.01) of negative health problems. Conclusions: Our sample was characterized by several use-related risks and problems, which may result in long-term burden of disease. University environment may offer suitable settings for targeted interventions. Determinants of future cannabis use and problems should be assessed in this population.

Copyright 2012, Informa Healthcare

Furr-Holden CD; Voas RB; Lacey J; Romano E; Jones K. The prevalence of alcohol use disorders among night-time weekend drivers. Addiction 106(7): 1251-1260, 2011. (36 refs.)

Aims: The objective of this study was to establish the extent of alcohol use disorders (AUDs) among drivers at risk for alcohol-related crashes. The prevalence of drivers with AUDs on US roads on weekend evenings when alcohol-related crashes are most frequent is unknown. This study will inform laws and programs designed to reduce alcohol-involved crashes. Design: Interviews using a 15-item AUD questionnaire with a stratified random sample of non-commercial drivers at 60 primary sampling locations in the 48 contiguous states on Fridays and Saturdays between 10 p. m. and 3 a. m. from July to November 2007. Setting Off-road locations into which a police officer directed a random selection of motorist passing the site. Participants A total of 4614 drivers of non-commercial vehicles. Measurements AUDs, including heavy drinking, alcohol abuse, and alcohol dependence. Findings: Of the participating drivers, 73.7% were current drinkers (reported drinking in the last year). Among those drinkers, 14% were classifiable either as dependent drinkers or as abusive drinkers based on self-reports of drinking. Another 10% of the drivers were classified as heavy drinkers. Nearly half of the drivers in the survey who had blood alcohol concentrations (BACs) at or higher than the 0.08 g per deciliter legal limit fell into one of those three AUD categories. Conclusions: Survey data suggest that the majority of high-blood alcohol concentration drivers on US roads show no clinical signs of an alcohol use disorder, but they are categorized as heavy drinkers. This suggests that environmental programs directed at reducing heavy drinking and brief behavioral interventions aimed at reducing episodes of excessive consumption have promise for reducing alcohol-related crashes.

Copyright 2011, Society for the Study of Addiction

Glover M; Scragg R; Min S; Kira A; Nosa V; McCool J et al. Driving kids to smoke? Children's reported exposure to smoke in cars and early smoking initiation. Addictive Behaviors 36(11): 1027-1031, 2011. (29 refs.)

The health risks associated with second hand smoke (SHS) are well-known. However, little is known about exposure to SHS in cars and risk of smoking uptake. This paper investigates the association between pre-adolescents reported exposure to smoking in cars and prevalence of early stage smoking activity. Data from Keeping Kids Smokefree baseline surveys of students were used to investigate smoking status and reported exposure to smoking in cars. Log binomial regression analyses were used to investigate if reported exposure to SHS in cars was associated with smoking prevalence. 83% of 5676 students invited took part. After controlling for all variables reported exposure to smoking in cars and homes were significantly associated with increased risk of initiated smoking (RR 1.87, 95% CI 1.43-2.44, and RR 1.5, 95% CI 1.13-1.97, respectively). Exposure to smoking in cars was substantially and significantly associated with risk of current smoking (RR 3.21, 95% CI 1.45-7.08). Early smoking uptake is associated with students' reported exposure to smoking in cars which confirms the importance of protecting children from SHS. Smoking in cars is under parental control and therefore modifiable. Moreover, children's reports of SHIS exposure offer a simple way of identifying families who can be targeted for tobacco control interventions.

Copyright 2011, Elsevier Science

Hall W. Driving while under the influence of cannabis. (editorial). British Medical Journal 344: article e595, 2012. (10 refs.)

Hitchman SC; Guignard R; Nagelhout GE; Mons U; Beck F; van den Putte B et al. Predictors of car smoking rules among smokers in France, Germany and the Netherlands. European Journal of Public Health 22(Supplement): 17, 2012. (40 refs.)

Background: As exposure to tobacco smoke pollution (TSP) has been identified as a cause of premature death and disease in non-smokers, and studies have demonstrated that smoking in cars produces high levels of TSP, this study will investigate smokers' rules for smoking in their cars, and predictors of car smoking rules, including potentially modifiable correlates. Methods: Data were drawn from nationally representative samples of current smokers from the International Tobacco Control Policy Evaluation Project surveys in France (2007), Germany (2007), and the Netherlands (2008). Smokers in France and Germany were asked about smoking rules in their cars, and smokers in the Netherlands were asked about smoking rules in cars carrying children. Results: In France and Germany, 59% and 52% of smokers respectively, allowed smoking in their cars. In the Netherlands, 36% of smokers allowed smoking in cars carrying children. Predictors of allowing smoking in cars included: being a daily vs. non-daily smoker, being younger vs. older age, having no (young) children in the home, being a heavier smoker, and allowing smoking in the home. In the Netherlands, smokers who agreed that TSP is dangerous to non-smokers were less likely to allow smoking in cars carrying children. Conclusion: Overall, a sizeable proportion of smokers allowed smoking in their cars across the three countries. Media campaigns with information about the dangers of TSP may increase the adoption of smoke-free cars. These media campaigns could target smokers who are most likely to allow smoking in cars.

Copyright 2012, Oxford University Press

Hjalmdahl M; Vadeby A; Forsman A; Fors C; Ceder G; Woxler P et al. Effects of d-amphetamine on simulated driving performance before and after sleep deprivation. Psychopharmacology 222(3): 401-411, 2012. (49 refs.)

Stimulant drugs are commonly abused and also used to promote wakefulness, yet their effects on driving performance during sleep deprivation have not been thoroughly researched in experimental studies. The aims were to assess the effects on fundamental driving parameters during simulated driving of two doses of d-amphetamine and further to assess the interaction between d-amphetamine and sleep deprivation. A double-blind, placebo-controlled experiment including 18 healthy male volunteers was conducted. The participants felt more alert when taking a dose of d-amphetamine than when taking placebo, and the effect was stronger for the higher dose. However, the data did not show any evidence that taking d-amphetamine prevented the subjects from becoming successively sleepier during the night. A significant main effect of the dose was found for three out of the five primary indicators where the lower dose led to improved driving. These indicators were crossing-car reaction time, and coherence and delay from a car-following event. Regarding sleep deprivation, a main effect was found for four of the primary indicators and three of the secondary indicators. The results showed overall impaired driving with respect to standard deviation of lateral position and delay in reaction time when the sleep-deprived conditions were compared to the alert condition. We found no interactions between dose and sleep deprivation for any of the performance indicators. Our results suggest that administration of d-amphetamine does not compensate for impairment of driving due to fatigue. The positive effects of 10 mg were not further improved or even sustained when increasing the dose to 40 mg.

Copyright 2012, Springer

Hou CC; Chen SC; Tan LB; Chu WY; Huang CM; Liu SY et al. Psychoactive substance use and the risk of motor vehicle crash injuries in southern Taiwan. Prevention Science 13(1): 36-42, 2012. (33 refs.)

The purpose of this study was to examine the association between psychoactive drug use and motor vehicle crash (MVC) injuries requiring hospitalization in southern Taiwan. A case-control study was conducted in southern Taiwan from January 2009 to December 2009. The cases included car or van drivers who were involved in MVCs and required hospitalization. Demographic and trauma-related data were collected from questionnaires and hospital and ambulance records. Urine and/or blood samples were collected on admission. The controls consisted of drivers who were randomly recruited while driving on public roads. Study subjects were interviewed and asked to provide urine samples. All blood and urine samples were tested for alcohol and a number of other legal and illegal drugs. Only those subjects who provided urine and/or blood specimens were included in the study. During the study period, 254 case patients and 254 control drivers were enrolled. The analysis showed an odds ratio (OR) of 3.41 (95% confidence intervals (95% CI), 1.76-6.70; p < 0.001) for persons taking benzodiazepines, and an OR of 3.50 (95% CI, 1.81-6.85; p < 0.001) for those taking alcohol (blood alcohol concentrations (BAC) a parts per thousand Euro parts per thousand 0.8 g/l) with regard to hospitalizations due to MVCs. For persons taking combinations of benzodiazepines and alcohol, the OR increased to 5.12 (95% CI: 1.77-15.91, p < 0.001). This study concluded that drug use among motor vehicle drivers increases the risk of MVCs that require hospitalization. From a public health perspective, the high risk ratios are concerning, and preventive measures are warranted.

Copyright 2012, Springer

Impinen A; Makela P; Karjalainen K; Haukka J; Lintonen T; Lillsunde P et al. The association between social determinants and drunken driving: A 15-year register-based study of 81,125 suspects. Alcohol and Alcoholism 46(6): 721-728, 2011

The aim of the study was to examine the association between social background and drunken driving. A Finnish register on suspected drunken driving was combined with data on social background. There were 81,125 drivers arrested for drunken driving and 86,279 references from 1993 to 2007. A low level of education, unemployment, living alone and divorce were strongly associated with drunken driving. In addition, for persons aged 15-24 years, low parental education and income, high own income and possession of a car correlated with higher odds of drunken driving. For working-aged men and women, low income was associated with a higher risk of drunken driving. For working-aged women, also possession of a car was a risk factor. Social factors are associated with drunken driving. In general, people with a lower social position are more prone to drive after drinking. Social differences are visible already in youth, whereas working and own income of young persons signal different risk mechanisms for youth than for working-aged people. Measures for preventing drunken driving are needed within public health policies.

Copyright 2011, Medical Council on Alcoholism.

Johnson M. Assessing a country's drink driving situation: An overview of the method used in 6 low- and middle-income countries. Traffic Injury Prevention 13(2): 96-100, 2012. (7 refs.)

The International Center for Alcohol Policies (ICAP) has developed an international program to reduce drink driving as part of its strategy for Global Actions on Harmful Drinking. The program focuses on capacity building, training, and the implementation, monitoring, and evaluation of regional and local pilot projects in 6 participating low-and middle-income countries. The first step in developing an effective program that addresses specific problems in a region or country is to assess the current drink driving situation. In order to meet this key requirement, ICAP developed a situation assessment approach based largely on the recommendations of Chapter 2 of the good practice manual on drinking and driving produced by the Global Road Safety Partnership (GRSP) under the auspices of the United Nations (UN) Road Safety Collaboration. The aim of the assessment was to provide the foundation for preparing a prioritized and effective suite of projects using the good practice recommended by the GRSP/UN manual. Its output is intended to assist with determining program objectives, design, and evaluation so that the benefits from the investments in drink driving programs can be maximized and data led, focusing on the priorities identified by the assessment. The situation assessment approach was produced as a set of guidelines containing a detailed and structured list of questions. The questions are organized into 6 main groups or elements and they enable a comprehensive and systematic collection of existing information about the extent and nature of the drink driving problem, the strengths and weaknesses of the current prevention practices, and the capacity for improvements. Situation assessments using these guidelines have been completed in the 6 focus countries and the resulting information is now being used for capacity building and developing appropriate and relevant pilot projects, taking into consideration the country's culture with respect to transportation, enforcement, health care, and alcohol consumption.

Copyright 2012, Taylor & Francis

Johnson MB; Kelley-Baker T; Voas RB; Lacey JH. The prevalence of cannabis-involved driving in California. Drug and Alcohol Dependence 123(1-3): 105-109, 2012. (19 refs.)

Background: Various national surveys suggest that cannabis use is rising nationally and many States have passed legislation that has potential to increase usage even further. This presents a problem for public roadways, as research suggests that cannabis impairs driving ability. Methods: Anonymous oral fluid samples and breath tests were obtained from more than 900 weekend nighttime drivers randomly sampled from six jurisdictions in California. Oral fluid samples were assayed for the presence of Schedule I drugs. Drivers also completed information on self-reported drug use and possession of a medical cannabis permit. Data from the 2007 National Roadside Survey (collected using comparable methods) were used as a comparison. Results: Using the 2010 data, a total of 14.4% of weekend nighttime drivers tested positive for illegal drugs, with 8.5% testing positive for delta-9-tetrahydrocannabinol (THC). THC-positive rates varied considerably among jurisdictions, from a low of 4.3% in Fresno to a high of 18.3% in Eureka. A comparison with the 2007 NRS data found an increase in THC-positive drivers in 2010, but no increase in illegal drugs other than cannabis. Drivers who reported having a medical cannabis permit were significantly more likely to test positive for THC. Conclusions: Cannabis-involved driving has increased in California since 2007. Nearly 1-in-10 weekend, nighttime drivers tested positive for THC, and in some jurisdictions, the rate was nearly 1-in-5. The possible contribution of cannabis legislation, such as decriminalization and medical cannabis usage, is discussed.

Copyright 2012, Elsevier Science

Jones AW; Holmgren A; Ahlner J. Concentrations of free-morphine in peripheral blood after recent use of heroin in overdose deaths and in apprehended drivers. Forensic Science International 215(1-3): 18-24, 2012. (55 refs.)

The concentration of free-morphine was determined in peripheral (femoral) blood from heroin-related deaths and compared with the concentration in venous blood from impaired drivers. The presence of 6-MAM in blood or urine served as a biomarker for recent use of heroin. Males dominated over females (p < 0.001) in both the autopsy cases (88%) and the drivers (91%), although their mean age was about the same 33-35 y (p > 0.05). Concentrations of free-morphine in blood were not associated with age of heroin users in Sweden (p > 0.05). The median concentration of free-morphine was higher in autopsy cases (0.24 mg/L, N = 766) compared with apprehended drivers with 6-MAM in blood (0.15 mg/L, N = 124, p < 0.05), and appreciably higher than in drivers with 6-MAM in urine but not in blood (0.03 mg/L, N = 1823, p < 0.001). The free-morphine concentration was above 0.20 mg/L in 65% of autopsy cases, 36% of drivers with 6-MAM in blood but only 1.4% of drivers with 6-MAM in urine. Poly-drug deaths had about the same concentrations of free-morphine in blood (0.24 mg/L, N = 703) as heroin-only deaths (0.25 mg/L, N = 63). The concentration of morphine in drug overdose deaths (median 0.25 mg/L, N = 669) was about the same as in traumatic deaths among heroin users (0.23 mg/L, N = 97). However, the concentration of morphine was lower when the deceased had consumed alcohol (0.18 mg/L, N = 104) compared with taking a benzodiazepine (0.32 mg/L, N = 94). The concentration distributions of free-morphine in blood in heroin-related deaths overlapped with the concentrations in impaired drivers, which makes the interpretation of toxicology results difficult without knowledge about tolerance to opiates in any individual case.

Copyright 2012, Elsevier Science

Jou RC; Yeh TH; Chen RS. Risk factors in motorcyclist fatalities in Taiwan. Traffic Injury Prevention 13(2): 155-162, 2012. (35 refs.)

Objective: To assess the impact of the following factors on rider fatality: rider's age, gender, licensing status, accident liability, use of helmet, alcohol consumption, vehicle class, road conditions, presence of passengers, and passenger injuries. Methods: Data on motorcycle accidents in Taiwan between 2006 and 2008 were analyzed. A logistic regression model was used to establish a fatality risk model for motorcyclists and investigate high-risk factors for motorcyclist fatality. Results: Higher fatality rates among motorcycle riders correlate with the following factors: male, older, unlicensed, not wearing a helmet, riding after drinking, and driving heavy (i.e., above 550 cc) motorcycles. In addition, motorcyclists involved in nighttime, nonurban single-vehicle accidents have a higher risk of death, and lone riders have a higher risk of death in accidents than do riders carrying passengers. The seriousness of passenger injury also correlates positively with the rider's risk of death. Conclusions: Nearly 60 percent of all driving fatalities in Taiwan involve motorcycles. Consideration of factors behind the high frequency and risk of motorcycle deaths, specifically rider age above 60 years, not wearing a motorcycle helmet, riding after drinking, and driving without a valid license, could help in the development of effective traffic safety management measures.

Copyright 2012, Taylor & Francis

Kaestner R; Yarnoff B. Long-term effects of minimum legal drinking age laws on adult alcohol use and driving fatalities. Journal of Law & Economics 54(2): 365-388, 2011. (37 refs.)

We examine whether adults' alcohol consumption and traffic fatalities are associated with the legal drinking environment those adults experienced between the ages of 18 and 20. We find that the difference between an environment in which a person was never allowed to drink legally at those ages and one in which a person could always drink legally is associated with a 20-33 percent increase in alcohol consumption and a 10 percent increase in fatal accidents for adult males. There are no statistically significant or practically important associations between the youths' legal drinking environment and adult females' alcohol consumption and driving fatalities.

Copyright 2011, University of Chicago Press

Kerlikowske RG; Sabet K. Commentary on Voas et al. (2011): Drug-free roadways - can we get there from here? Steps to reducing drugged driving in the United States. (editorial). Addiction 106(7): 1228-1229, 2011. (3 refs.)

King BA; Dube SR; Tynan MA. Secondhand smoke exposure in cars among middle and high school students -- United States, 2000-2009. Pediatrics 129(3): 446-452, 2012. (43 refs.)

Objective: Exposure to secondhand smoke (SHS) from cigarettes poses a significant health risk to nonsmokers. Among youth, the home is the primary source of SHS. However, little is known about youth exposure to SHS in other nonpublic areas, particularly motor vehicles. Methods: Data were obtained from the 2000, 2002, 2004, 2006, and 2009 waves of the National Youth Tobacco Survey, a nationally representative survey of US students in grades 6 to 12. Trends in SHS exposure in a car were assessed across survey years by school level, gender, and race/ethnicity by using binary logistic regression. Results: From 2000 to 2009, the prevalence of SHS exposure in cars declined significantly among both nonsmokers (39.0%-22.8%; trend P < .001) and smokers (82.3%-75.3%; trend P < .001). Among nonsmokers, this decline occurred across all school level, gender, and race/ethnicity subgroups. Conclusions: SHS exposure in cars decreased significantly among US middle and high school students from 2000 to 2009. Nevertheless, in 2009, over one-fifth of nonsmoking students were exposed to SHS in cars. Jurisdictions should expand comprehensive smoke-free policies that prohibit smoking in worksites and public places to also prohibit smoking in motor vehicles occupied by youth.

Copyright 2012, American Academy of Pediatrics

Lapham S; England-Kennedy E. Convicted driving-while-impaired: Offenders' views on effectiveness of sanctions and treatment. Qualitative Health Research 22(1, special issue): 17-30, 2012. (66 refs.)

In this article we analyze qualitative data from a multiple-method, longitudinal study drawn from 15-year follow-up interviews with a subsample of 82 individuals arrested for driving while intoxicated in a southwestern state (1989-1995). We explore reactions to the arrest and court-mandated sanctions, including legal punishments, mandated interventions, and/or participation in programs aimed at reducing recidivism. Key findings include experiencing certain negative emotional reactions to the arrest, reactions to being jailed, experiencing other court-related sanctions as deterring driving-while-intoxicated behavior, and generally negative opinions regarding court-mandated interventions. We discuss interviewees' complex perspectives on treatment and program participation and their effects on lessening recidivism, and we offer suggestions for reducing recidivism based on our findings.

Copyright 2012, Sage Publications Inc

Lapham SC; Stout R; Laxton G; Skipper BJ. Persistence of addictive disorders in a first-offender driving while impaired population. Archives of General Psychiatry 68(11): 1151-1157, 2011. (51 refs.)

Context: We compared the prevalence of alcohol use and other psychiatric disorders in offenders 15 years after a first conviction for driving while impaired with a general population sample. Objective: To determine whether high rates of addictive and other psychiatric disorders previously demonstrated in this sample remain disproportionately higher compared with a matched general population sample. Design: Point-in-time cohort study. Setting: Pacific Institute for Research and Evaluation, Albuquerque, New Mexico. Participants: We interviewed convicted first offenders using the Composite International Diagnostic Interview 15 years after referral to a screening program in Bernalillo County, New Mexico. We calculated rates of diagnoses for non-Hispanic white and Hispanic women (n=362) and men (n=220) adjusting for missing data using multiple imputation and compared psychiatric diagnoses with findings from the National Comorbidity Survey Replication by sex and Hispanic ethnicity. Results: Eleven percent of non-Hispanic white women and 12.8% of Hispanic women in the driving while impaired sample reported 12-month alcohol abuse or dependence, compared with 1.0% and 1.8%, respectively, in the National Comorbidity Survey Replication (comparison) sample. Almost 12% of non-Hispanic white men and 17.5% of Hispanic men in the driving while impaired sample reported 12-month alcohol abuse or dependence, compared with to 2.0% and 1.8%, respectively, in the comparison sample. These differences were statistically significant. Rates of drug use disorders and nicotine dependence were also elevated compared with the general population sample, while rates of major depressive disorder and posttraumatic stress disorder were similar. Conclusion: In this sample, high rates of addictive disorders persisted over 10 years among first offenders and greatly exceeded those found in a general population sample.

Copyright 2011, American Medical Association

Li MC; Brady JE; DiMaggio CJ; Lusardi AR; Tzong KY; Li GH. Marijuana use and motor vehicle crashes. Epidemiologic Reviews 34(1): 65-72, 2012. (76 refs.)

Since 1996, 16 states and the District of Columbia in the United States have enacted legislation to decriminalize marijuana for medical use. Although marijuana is the most commonly detected nonalcohol drug in drivers, its role in crash causation remains unsettled. To assess the association between marijuana use and crash risk, the authors performed a meta-analysis of 9 epidemiologic studies published in English in the past 2 decades identified through a systematic search of bibliographic databases. Estimated odds ratios relating marijuana use to crash risk reported in these studies ranged from 0.85 to 7.16. Pooled analysis based on the random-effects model yielded a summary odds ratio of 2.66 (95% confidence interval: 2.07, 3.41). Analysis of individual studies indicated that the heightened risk of crash involvement associated with marijuana use persisted after adjustment for confounding variables and that the risk of crash involvement increased in a dose-response fashion with the concentration of 11-nor-9-carboxy-delta-9-tetrahydrocannabinol detected in the urine and the frequency of self-reported marijuana use. The results of this meta-analysis suggest that marijuana use by drivers is associated with a significantly increased risk of being involved in motor vehicle crashes.

Copyright 2012, Oxford University Press

Li Y; Xie DH; Nie GM; Zhang JH. The drink driving situation in China. Traffic Injury Prevention 13(2): 101-108, 2012. (30 refs.)

Objective: China has been concerned about the serious problem of drinking and driving road crashes, and it has made good progress by establishing strict laws, imposing serious penalties, and initiating a rigorous enforcement program since 2008. This study has assessed the magnitude and nature of the problem and reviewed the legislation, current practices, and institutional capacities for preventing drinking and driving. Methods: Data and information were collected using existing reports and by consulting officials and experts from a number of agencies. Results: Although there were no national statistics on levels of drinking and driving, random breath test surveys in 2 southern cities showed that between 4.5 and 4.6 percent of drivers were driving over the minimum legal blood alcohol concentration (BAC) limit of 20 mg/100 mL. Preliminary results from crash data also showed that at least 20 percent of serious road crashes were alcohol related in these cities. The national published figure for fatal crashes caused by drinking and driving was much lower, only 4 percent, but alcohol was not often identified as the main cause because of measurement difficulties. China's legislation sets 2 BAC limits that are comparable with international norms. It has recently increased the penalties for drunk driving, the more serious of the 2 offenses, with a minimum driving ban of 5 years. The police are actively enforcing the laws through frequent roadside checking but they need more resources. Alcohol breath tests before and after a combined publicity and enforcement campaign indicated reductions of 87 and 68 percent of drivers over the legal limit in 2 southern cities. Conclusions: China has made progress in strengthening its approach to preventing drinking and driving, particularly in the area of law enforcement. However, it is not possible to evaluate the potential benefits because of data issues. Recommendations for the future include the need to improve the national road crash and injury database, strengthen the coordination of key agencies, and provide more effective and sustained public information campaigns that target vulnerable drivers and are integrated with enforcement strategies. Evaluation and research are important to improve future prevention programs.

Copyright 2012, Taylor & Francis

Maenhout TM; Baten G; De Buyzere ML; Delanghe JR. Carbohydrate deficient transferrin in a driver's license regranting program. Alcohol and Alcoholism 47(3): 253-260, 2012. (32 refs.)

Aims: Carbohydrate deficient transferrin (CDT) is a common diagnostic marker for detecting chronic alcohol abuse. For over 2.5 years, it has been used in traffic medicine among subjects applying for driver's license renewal or regranting in Belgium. We report on data collected during the program and provide an estimation of an applicable cut-off point in forensic situations. Using this cut-off, the success of the driver's license regranting program is evaluated. Methods: CDT was assayed at Ghent University Hospital by capillary zone electrophoresis, measured on the Capillarys 2 (TM) system, in 3977 subjects applying for driver's license regranting. Determination of a cut-off was done by using Bhattacharya statistics and by adding a measurement uncertainty interval. The outcome of the program was evaluated by monitoring CDT values for 163 subjects during one entire year. Results: In 3977 subjects (3481 males and 496 females), CDT values were significantly higher in men compared with women, but there is no need for a gender-specific cut-off value. Drunk drivers under the age of 30 have significantly lower CDT values than older subjects, and a separate cut-off could be calculated. A general cut-off of 2.3% CDT was calculated for the entire study population. Using this cut-off value for evaluating the outcome of the program for 163 subjects, the percentage offenders at the beginning (29%) decreased to 8% after 1 year. Conclusion: Applying a marker for chronic alcohol abuse such as CDT for driver's license renewal or regranting is a powerful tool. Analysis of data collected over 2.5 years reveals a favorable outcome of the program and a useful cut-off point could be determined.

Copyright 2012, Oxford University Press

Marczinski CA; Fillmore MT; Henges AL; Ramsey MA; Young CR. Effects of energy drinks mixed with alcohol on information processing, motor coordination and subjective reports of intoxication. Experimental and Clinical Psychopharmacology 20(2): 129-138, 2012. (47 refs.)

The consumption of alcohol mixed with energy drinks (AmED) has become a popular and controversial practice among young people. Increased rates of impaired driving and injuries have been associated with AmED consumption. The purpose of this study was to examine if the consumption of AmED alters cognitive processing and subjective measures of intoxication compared with the consumption of alcohol alone. Eighteen participants (nine men and nine women) attended four test sessions where they received one of four doses in random order (0.65g/kg alcohol, 3.57 ml/kg energy drink, AMedicine, or a placebo beverage). Performance on a psychological refractory period (PRP) task was used to measure dual-task information processing and performance on the Purdue pegboard task was used to measure simple and complex motor coordination following dose administration. In addition, various subjective measures of stimulation, sedation, impairment, and level of intoxication were recorded. The results indicated that alcohol slowed dual-task information processing and impaired simple and complex motor coordination. The coadministration of the energy drink with alcohol did not alter the alcohol-induced impairment on these objective measures. For subjective effects, alcohol increased various ratings indicative of feelings of intoxication. More importantly, coadministration of the energy drink with alcohol reduced perceptions of mental fatigue and enhanced feelings of stimulation compared to alcohol alone. In conclusion, AmED may contribute to a high-risk scenario for a drinker. The mix of behavioral impairment with reduced fatigue and enhanced stimulation may lead AmED consumers to erroneously perceive themselves as better able to function than is actually the case.

Copyright 2012, American Psychological Association

Marko TL; Watt T. Employing a youth-led adult-guided framework "Why Drive High?" social marketing campaign. Family & Community Health 34(4): 319-330, 2011. (10 refs.)

The "Drugged Driving Kills project: Why Drive High?" social marketing campaign was developed and implemented by youth leaders and adult facilitators from public and community health to increase youth awareness of the adverse effects ofmarijuana on driving. The youth-led adult-guided project was founded on the Holden's youth empowerment conceptual model. This article reports on the results of the focus group evaluation, conducted to determine to what extent the tailored youth-led adult-guided framework for the " Why Drive High?" social marketing campaign provided an environment for youth leadership development.

Copyright 2011, Lippincott, Williams & Wilkins

Matsubara K; Asari M; Suno M; Awaya T; Sugawara M; Omura T et al. Estimation of the duration after methamphetamine injection using a pharmacokinetic model in suspects who caused fatal traffic accidents. Legal Medicine 14(4): 191-196, 2012. (12 refs.)

When the population parameters of drug pharmacokinetics in the human body system are known, the time-course of a certain drug in an individual can generally be estimated by pharmacokinetics. In the present two cases where methamphetamine abusers were suspected to have inflicted mortalities in traffic accidents, the time-elapse or duration immediately after methamphetamine injection to the time when the accidents occurred became points of contention. In each case, we estimated the time-course of blood methamphetamine after the self-administration in the suspects using a 2-compartment pharmacokinetic model with known pharmacokinetic parameters from the literatures. If the injected amount can be determined to a certain extent, it is easy to calculate the average time-elapse after injection by referring to reference values. However, there is considerable individual variability in the elimination rate based on genetic polymorphism and a considerably large error range in the estimated time-elapse results. To minimize estimation errors in such cases, we also analyzed genotype of CYP2D6, which influenced methamphetamine metabolism. Estimation based on two time-point blood samples would usefully benefit legal authorities in passing ruling sentences in cases involving similar personalities and circumstances as those involved in the present study.

Copyright 2012, Elsevier Science

Maxwell JC. Drunk versus drugged: How different are the drivers? Drug and Alcohol Dependence 121(1-2): 68-72, 2012. (33 refs.)

Background: Driving under the influence (DUI) of drugs is increasing in the U.S., but little is known about the differences based on their patterns of use and abuse of alcohol and other drugs. Methods: This paper uses a large dataset to study patients admitted to Texas substance abuse treatment programs with one or more past-year DUI arrests. t-Tests are used for comparisons between normally distributed continuous data and chi square for categorical data. Results: First-time DUI offenders not only differ from those reporting more than one past-year DUI, but they differ among themselves in terms of demographics, treatment participation, substance use problems, and mental health disorders. Those with primary problems with methamphetamine, crack cocaine, powder cocaine, other opiates, sedatives, and heroin reported more days of problems and more daily use than those with problems with alcohol, while offenders with primary problems with cannabis were less impaired. Conclusions: The most impaired clients were less likely to be referred to treatment from the justice system, and the differences in drug and alcohol offenders show the need to tailor approaches with education and treatment programs. More attention should be given to the needs of drivers impaired through use of prescription drugs such as the opiates and sedatives, as well as female drivers, and the role of acculturation should be recognized in programs for Hispanic drivers. In addition, specific programs should be targeted to young cannabis abusers and underage offenders. All first-time DUI arrestees should be assessed for their levels of impairment.

Copyright 2012, Elsevier Science

Mets MAJ; de Vries JM; Domis LMD; Volkerts ER; Olivier B; Verster JC. Next-day effects of ramelteon (8 mg), zopiclone (7.5 mg), and placebo on highway driving performance, memory functioning, psychomotor performance, and mood in healthy adult subjects. Sleep 34(10): 1327-1334, 2011. (43 refs.)

Study Objectives: To evaluate the next-morning residual effects of ramelteon (8 mg), zopiclone (7.5 mg), and placebo on driving performance, memory functioning, psychomotor performance, and mood in healthy adult subjects following bedtime dosing and a middle of the night awakening. Design: Single-center, randomized, double-blind, double-dummy, placebo-controlled, crossover study. Setting: Utrecht University, The Netherlands. Participants: 30 healthy volunteers (15 males and 15 females). Interventions: a single dose of ramelteon (8 mg), zopiclone (7.5 mg), and placebo, administered at bedtime. Measurements: A balance test was performed at night. Other tests were performed the following morning, 8.5 h after administration. Subjects performed a 100-km highway driving test in normal traffic. Primary outcome measure was the standard deviation of the lateral position (SDLP), i.e., the weaving of the car. After driving, cognitive, memory, and psychomotor tests were performed and mood was assessed. Results: SDLP was significantly increased after the intake of ramelteon (+2.2 cm) and zopiclone (+2.9 cm). Ramelteon and zopiclone produced significant impairment on reaction time (P < 0.024) in the Sternberg Memory Scanning Test, slow (P < 0.007) and fast (P < 0.010) tracking, reaction speed (P < 0.015) and tracking (P < 0.001) in the Divided Attention Test, and delayed recall (P < 0.032) in the Word Learning Test. In contrast to ramelteon, zopiclone additionally impaired performance on the Digit Symbol Substitution Test (P < 0.001) and the balance test (P < 0.001). Conclusions: Ramelteon (8 mg) and zopiclone (7.5 mg) significantly impaired driving performance, cognitive, memory, and psychomotor performance the morning following bedtime administration. In contrast to zopiclone, ramelteon produced no balance impairments.

Copyright 2011, American Academy of Sleep Medicine

Meuleners LB; Duke J; Lee AH; Palamara P; Hildebrand J; Ng JQ. Psychoactive medications and crash involvement requiring hospitalization for older drivers: A population-based study. Journal of the American Geriatrics Society 59(9): 1575-1580, 2011. (46 refs.)

Objectives: To determine the association between psychoactive medications and crash risk in drivers aged 60 and older. Design: Retrospective population-based case-crossover study. Setting: A database study that linked the Western Australian Hospital Morbidity Data System and the Pharmaceutical Benefits Scheme. Participants: Six hundred sixteen individuals aged 60 and older who were hospitalized as the result of a motor vehicle crash between 2002 and 2008 in Western Australia. Measurements: Hospitalization after a motor vehicle crash. Results: Greater risk for a hospitalization crash was found for older drivers prescribed benzodiazepines (odds ratio (OR) = 5.3, 95% confidence interval (CI) = 3.6-7.8, P < .001), antidepressants (OR = 1.8, 95% CI = 1.0-3.3, P = .04), and opioid analgesics (OR = 1.5, 95% CI = 1.0-2.3, P = .05). Crash risk was significantly greater in men prescribed a benzodiazepine (OR = 6.2, 95% CI = 3.2-12.2, P < .001) or an antidepressant (OR = 2.7, 95% CI = 1.1-6.9, P = .03). Women prescribed benzodiazepines (OR = 4.9, 95% CI = 3.1-7.8, P < .001) or opioid analgesics (OR = 1.8, 95% CI = 1.1-3.0, P = .03) also had a significantly greater crash risk. Subgroup analyses further suggested that drivers with (OR = 4.0, 95% CI = 2.9-8.1, P < .001) and without (OR = 6.0, 95% CI = 3.8-9.5, P < .001) a chronic condition who were prescribed benzodiazepines were at greater crash risk. Drivers with a chronic condition taking antidepressants (OR = 3.4, 95% CI = 1.3-8.5, P = .01) also had a greater crash risk. CONCLUSION: Psychoactive medication usage was associated with greater risk of a motor vehicle crash requiring hospitalization in older drivers.

Copyright 2011, Wiley-Blackwell

Monras M; Aparicio A; Lopez JA; Pons I. Prevalence of alcohol consumption related disorders in a prison population convicted of crimes against road safety. Actas Espanolas de Psiquiatria 39(3): 163-167, 2011. (18 refs.)

Introduction. Alcohol consumption is a major cause of traffic accidents, so that stricter laws have been enacted to avoid it. Despite this, there are still persons who break the law and go to prison because of driving under the effects of alcohol. We have investigated if these persons are occasionally alcohol drinkers or if they are alcoholics with difficult to modify alcohol patterns. Material and methods. A cross-sectional study including 50 inmates from two prisons who had committed traffic crimes were interviewed about their alcohol consumption habits and their criminal and psychopathological backgrounds. Results. 88% had indicators of alcoholism and most consumed other drugs. Previous psychopathology signs were only detected in 10% of the sample. A total of 72% had previous criminal records, half because of violent offences. They were socially adapted, with mean age 39 years, Spanish (86%), had a stable job and family (76%). Conclusions. Most of the inmates due to traffic crimes are alcoholic, but very few are detected. Their alcohol consumption generates other criminal conduct, treatment being necessary in order to avoid relapse and social exclusion.

Copyright 2011, Juan Jose Lopez-Ibor Foundation

Morland J; Steentoft A; Simonsen KW; Ojanpera I; Vuori E; Magnusdottir K et al. Drugs related to motor vehicle crashes in northern European countries: A study of fatally injured drivers. Accident Analysis and Prevention 43(6): 1920-1926, 2011. (32 refs.)

The aim of this study was to find which drugs and drug combinations were most common in drivers who died, in particular, in single vehicle crashes where the responsibility for the crash would be referred to the driver killed. The study included all available blood samples from drivers, who died within 24h of the accident, in the years 2001 and 2002 in the five Nordic countries (total population about 24 million inhabitants). The samples were analysed for more than 200 different drugs in addition to alcohol, using a similar analytical programme and cut-off limits in all countries. In three countries (Finland, Norway and Sweden) blood samples were available for more than 70% of the drivers, allowing representative prevalence data to be collected. 60% of the drivers in single vehicle crashes had alcohol and/or drug in their blood samples, compared with 30% of drivers killed in collisions with other vehicles. In single vehicle accidents, 66% of the drivers under 30 years of age had alcohol and/or drugs in their blood (alcohol only - 40%; drugs only - 12%; alcohol and drugs - 14%). The drugs found were mostly illicit drugs and psychoactive medicinal drugs with warning labels (in 57% and 58% respectively of the drivers under 30 with drugs present). Similar findings were obtained for drivers 30-49 years of age (63% with alcohol and/or drugs). In drivers aged 50 years and above, killed in single vehicle crashes (48% with alcohol and/or drugs) illicit drugs were found in only one case, and psychoactive medicinal drugs were detected less frequently than in younger age groups. In 75% of single vehicle crashes, the driver was under 50 years. Thus, the majority of accidents where the drivers must be considered responsible, occurred with drivers who had recently used alcohol, or drugs, alone or in combination. The drugs involved were often illicit and/or psychoactive drugs with warning labels. Therefore a large proportion of single vehicle accidents appear to be preventable, if more effective measures against driving after intake of alcohol and drugs can be implemented.

Copyright 2011, Elsevier Science

Musshoff F; Madea B. Driving under the influence of amphetamine-like drugs. Journal of Forensic Sciences 57(2): 413-419, 2012. (62 refs.)

Scientific opinions differ whether the use of stimulants causes deterioration in driving skills. In 1857 of 8709 cases of driving under the influence of drugs, amphetamine-like drugs (amphetamine, methamphetamine, and methylendioxyamphetamine) were present either alone or together with other licit or illicit drugs. In 338 cases, amphetamines were the only psychoactive substance group in plasma at mean, median, and highest concentrations of 0.18, 0.12, and 1.05 mg/L, respectively. A widespread opinion is that after the consumption of amphetamines, centrally stimulating effects with corresponding consequences on safe driving are expected. In contrast, many cases were observed that rather suggested an influence of centrally sedating substances when considering the psycho-physical conditions. Relations between concentration and effect could not be established. The apparent sedation is probably the consequence of sleep deprivation during an amphetamine binge and the after-effects of the drug.

Copyright 2012, Wiley-Blackwell

Ngoc LB; Thieng NT; Huong NL. The drink driving situation in Vietnam. Traffic Injury Prevention 13(2): 109-114, 2012. (14 refs.)

Objective: To identify the extent and nature of the problem and the main contributing factors to drink driving crashes; determine the current mechanisms in place, particularly in terms of legislation and its enforcement; and identify baseline data and relevant stakeholders. Methods: The situational assessment was based on the collection of secondary data from available reports and documents, in-depth interviews with key representatives at a central level, and field surveys in provinces. Results: Vietnam has experienced phenomenal growth in motor vehicles, especially motorcycles, in the last decade (400%). This initially led to an increase in deaths from road crashes, but since 2006 the number has stayed fairly level according to police statistics. However, comparisons with health data suggest that the number of deaths is much higher and there are clearly a number of problems with the relevant data systems. Data on the percentage of drivers exceeding legal limits are not available, but police statistics indicated that drinking alcohol was a contributory factor in 7 percent of motor vehicle crashes. This is likely to be an underestimate, because the police and health services do not have the equipment to measure the blood alcohol concentration (BAC) levels of all drivers in crashes. Motorcycle riders and young people are in the high-risk groups. There are strict BAC limits starting at over zero and severe punishments for drunk drivers involved in serious crashes. However, the police do not have adequate manpower or equipment to conduct regular and frequent roadside checking for drivers who have been drinking. There have also been a number of education programs on road safety including drinking and driving, but these have not included sustained and intensive campaigns targeting the high-risk groups. The National Traffic Safety Committee (NTSC) is responsible for coordinating the relevant agencies but there is still a problem with lack of information sharing between agencies. Conclusions: This study completed a comprehensive situational assessment that examined the problem of drinking and driving and identified some of the weaknesses in the current prevention system. Vietnam currently has 2 international projects on road safety and it is hoped that these together with support from the International Center for Alcohol Policies (ICAP) Global Actions program will provide opportunities for strengthening drinking and drive prevention initiatives by improving the road crash and injury database, building the capacity of the key organizations, strengthening the coordination mechanisms, and implementing and evaluating trial drink-drive interventions.

Copyright 2012, Taylor & Francis

Ogazi C; Edison E. The drink driving situation in Nigeria. Traffic Injury Prevention 13(2): 115-119, 2012. (17 refs.)

Objective: This study was carried out to assess the magnitude and nature of the drink-drive problem in Nigeria and evaluate the institutional capacities for preventing drinking and driving, using the methodology developed by the International Center for Alcohol Policies (ICAP) described in the overview article in this issue (Johnson 2012). Methods: Data and information were collected using existing reports and by consulting officials and experts from a number of key agencies. Results: In 2008, 9572 people died in road crashes according to police statistics. However, according to World Health Organization statistical modeling, this figure is likely to be much higher, with deaths ranging from 34,000 to 78,000 in 2007 and a mortality rate of 32.3 percent. Not only is it likely that the police data underestimate the road crash problem but it was also found that the data from the police and the Federal Road Safety Commission (FRSC) were inadequate for estimating the extent of the drink-drive problem mainly because of the lack of alcohol testing equipment. One research study highlighted the problem of drivers of commercial vehicles; 67.2 percent of drivers admitting to drinking alcohol during the working day. Nigeria sets a legal limit of 0.05 g/100 mL blood alcohol concentration (BAC), but enforcement of the law is weak because alcohol testing equipment is unavailable. The FRSC is a federal agency dedicated to improving road safety and the clear lead agency in Nigeria. It runs publicity campaigns against drinking and driving with private sector support, especially toward the end of the year when there is increased vehicular traffic due to people travelling to celebrate the Christmas and New Year holidays, but these have not been evaluated. However, its combined enforcement and public education roles give it considerable potential for tackling the drink-drive problem in the future. Conclusions: This study recommended that priority should be given to strengthening the road crash and injury database and drink-drive enforcement, especially for drivers of commercial vehicles, and that the opportunities provided by the World Bank project supporting safe road corridors should be maximized.

Copyright 2012, Taylor & Francis

Pawson R; Wong G; Owen L. Known knowns, known unknowns, unknown unknowns: The predicament of evidence-based policy. American Journal of Evaluation 32(4): 518-546, 2011. (66 refs.)

The authors present a case study examining the potential for policies to be "evidence-based." To what extent is it possible to say that a decision to implement a complex social intervention is warranted on the basis of available empirical data? The case chosen is whether there is sufficient evidence to justify banning smoking in cars carrying children. The numerous assumptions underpinning such legislation are elicited, the weight and validity of evidence for each is appraised, and a mixed picture emerges. Certain propositions seem well supported; others are not yet proven and possibly unknowable. The authors argue that this is the standard predicament of evidence-based policy. Evidence does not come in finite chunks offering certainty and security to policy decisions. Rather, evidence-based policy is an accumulative process in which the data pursue but never quite capture unfolding policy problems. The whole point is the steady conversion of "unknowns" to "knowns."

Copyright 2011, Sage Publications

Pressman MR. Sleep driving: Sleepwalking variant or misuse of z-drugs? (review). Sleep Medicine Reviews 15(5): 285-292, 2011. (55 refs.)

Sleep driving is most often classified as a variant of sleepwalking, but should be distinguished from impaired driving due to misuse or abuse of sedative/hypnotic drugs. Z-drugs; zolpidem and zopiclone in particular, have been associated with the majority of reported cases of impaired driving. Numerous studies have found z-drugs in driving under influence (DUI) related police stops, arrests and accidents. Impaired drivers are reported to have 1) blood levels of z-drugs that exceed therapeutic ranges 2) failed to take the medication at the correct time or remain in bed for sufficient time and/or 3) combined z-drugs with other central nervous system (CNS) depressants and/or alcohol. Consistent with CNS depression, z-drug-impaired drivers may demonstrate cognitive function at low levels with drivers still able to understand and respond to questions while sleepwalkers are completely unable to understand or interact with police. Z-drug-impaired drivers are often severely physically impaired, unable to stand up or maintain balance while sleepwalkers are able to stand and walk unaided. Sleep driving and impaired driving due to z-drugs may overlap. Sleep driving and drug-impaired driving are statistically rare events, but due to the billions of doses prescribed each year may still result in numerous DUI related arrests and accidents.

Copyright 2011, W B Saunders

Pulido J; Barrio G; Lardelli P; Bravo MJ; Regidor E; de la Fuente L. Association between cannabis and cocaine use, traffic injuries and use of protective devices. European Journal of Public Health 21(6): 753-755, 2011. (10 refs.)

The effect of cannabis and cocaine use on non-fatal traffic injuries and use of motorcycle helmets or car seatbelts was assessed in a nationwide sample of 17 484 car or motorcycle drivers surveyed in 2005 in Spain. Logistic regression was used to adjust for distance driven and potential confounders. Cocaine use epsilon 1 day/week and cannabis use > 4 days/week were associated with more traffic injuries. A positive dose-response relationship was found between frequency of cocaine use and lack of consistent use of protective devices. Interventions to avoid driving under the influence of drugs and to increase use of protective devices among drug users are needed.

Copyright 2011, Oxford University Press

Ramaekers JG; Kuypers KPC; Bosker WM; Brookhuis KA; Veldstra JA; Simons R et al. Effects of stimulant drugs on actual and simulated driving: Perspectives from four experimental studies conducted as part of the DRUID research consortium. (editorial). Psychopharmacology 222(3): 413-418, 2012. (20 refs.)

Rao M; Ramachandra SS. Cars: Beating a new addiction. (editorial). Journal of Public Health 33(2): 173-174, 2011. (12 refs.)

Background: Public health must continually respond to new threats reflecting wider societal changes. Ecological public health recognizes the links between human health and global sustainability. We argue that these links are typified by the harms caused by dependence on private cars. Methods: We present routine data and literature on the health impacts of private car use; the activities of the �car lobby' and factors underpinning car dependence. We compare these with experience of tobacco Results: Private cars cause significant health harm. The impacts include physical inactivity, obesity, death and injury from crashes, cardio-respiratory disease from air pollution, noise, community severance and climate change. The car lobby resists measures that would restrict car use, using tactics similar to the tobacco industry. Decisions about location and design of neighbourhoods have created environments that reinforce and reflect car dependence. Car ownership and use has greatly increased in recent decades and there is little public support for measures that would reduce this. Conclusions: Car dependence is a potent example of an issue that ecological public health should address. The public health community should advocate strongly for effective policies that reduce car use and increase active travel. The closing question is whether cars are the new tobacco.

2011, Faculty of Public Health of the Royal Colleges of Physicians

Rapoport MJ; Zagorski B; Seitz D; Herrmann N; Molnar F; Redelmeier DA. At-fault motor vehicle crash risk in elderly patients treated with antidepressants. American Journal of Geriatric Psychiatry 19(12): 998-1006, 2011. (44 refs.)

Objective: To assess whether antidepressant treatment is associated with a temporary increase in the risk of a motor vehicle crash among older adults. Design: Population-based case-only time-to-event analysis. Setting and Subjects: Data from transportation and healthcare databases for adults age 65 and older in Ontario, Canada, between January 1, 2000, and October 31, 2007. Consecutive adults who had a motor vehicle crash anytime following their 66th birthday. Measurements: The primary exposure variable was treatment with antidepressant medication, and the primary outcome measure was a motor vehicle crash. Results: A total of 159,678 individuals had a crash during the study, of whom 7,393 (5%) received an antidepressant in the month prior to the crash. The hazard ratio (HR) of crash associated with second-generation antidepressants was 1.10 (95% confidence interval [CI]: 1.07-1.13, chi(2) = 41.77, df = 1, p < 0.0001), adjusted for gender, license suspensions, and other medications, but the risk for first-generation antidepressants was not significant. The increased risk was restricted to those who were also concurrently prescribed a benzodiazepine (adjusted HR: 1.23, 95% CI: 1.17-1.28, chi(2) = 85.28, df = 1, p < 0.0001) or a strong anticholinergic medication (adjusted HR: 1.63, 95% CI: 1.57-1.69, chi(2) = 627.31, df = 1, p < 0.0001), and was confined to crashes where the patient was at fault. The increased risk was apparent for the first 3-4 months following initiation of an antidepressant and returned to baseline thereafter. Conclusions: Prescriptions for second-generation antidepressants in older adults are associated with a modest increased risk of motor vehicle crashes, when combined with other medications that can impair cognition.

Copyright 2011, Lippincott, Williams & Wilkins

Rauch WJ; Ahlin EM; Zador PL; Howard JM; Duncan GD. Effects of administrative ignition interlock license restrictions on drivers with multiple alcohol offenses. Journal of Experimental Criminology 7(2): 127-148, 2011. (61 refs.)

This study investigated, under real-world conditions, whether a statewide 2-year administrative ignition interlock license restriction program in Maryland was effective in reducing subsequent alcohol-related traffic violations among multiple offenders and whether any reductions in recidivism could be maintained after the program ended and interlock license restrictions were removed. A total of 1,927 drivers eligible for relicensure were randomly assigned to either the 2-year interlock license restriction program or the normal and customary sanctions afforded multiple offenders in Maryland. Recidivism was defined as incurring a subsequent alcohol-impaired driving violation during the 2-year intervention or 2-year postintervention periods. Compared to the control group, participation in the interlock license restriction program reduced drivers' hazard (or risk) of a subsequent alcohol-impaired driving offense by a statistically significant 36% during the 2-year intervention, 26% during the 2-year postintervention period, and 32% during the entire 4-year study period. This investigation of interlock program effectiveness is the first to report significantly lower recidivism among the interlock group than its control group after the ignition interlock license restriction program ended. Possible reasons for this novel finding and areas for future research are discussed.

Copyright 2011, Springer

Ravera S; van Rein N; de Gier JJ; de Jong-van den Berg LTW. Road traffic accidents and psychotropic medication use in the Netherlands: A case-control study. British Journal of Clinical Pharmacology 72(3): 505-513, 2011. (57 refs.)

Aim: To examine the association between the use of commonly prescribed psychotropic medications and road traffic accident risk. Methods: A record-linkage database was used to perform a case-control study in the Netherlands. The data came from three sources: pharmacy prescription data, police traffic accident data and driving licence data. Cases were defined as drivers, who had a traffic accident that required medical assistance between 2000 and 2007. Controls were defined as adults, who had a driving licence and had no traffic accident during the study period. Four controls were matched for each case. The following psychotropic medicine groups were examined: antipsychotics, anxiolytics, hypnotics and sedatives, and antidepressants stratified in the two groups, SSRIs and other antidepressants. Various variables, such as age, gender, medicine half-life and alcohol use, were considered for the analysis. Results: Three thousand nine hundred and sixty-three cases and 18 828 controls were included in the case-control analysis. A significant association was found between traffic accident risk and exposure to anxiolytics (OR = 1.54, 95% CI 1.11, 2.15), and SSRIs (OR = 2.03, 95% CI 1.31, 3.14). A statistically significant increased risk was also seen in chronic anxiolytic users, females and young users (18 to 29 years old), chronic SSRI users, females and middle-aged users (30 to 59 years old), and intermediate half-life hypnotic users. Conclusions: The results of this study support previous findings and confirm that psychoactive medications can constitute a problem in traffic safety. Both health care providers and patients should be properly informed of the potential risks associated with the use of these medicines.

Copyright 2011, Wiley-Blackwell

Rivara FP; Boisvert D; Relyea-Chew A; Gomez T. Last Call: Decreasing drunk driving among 21-34-year-old bar patrons. International Journal of Injury Control and Safety Promotion 19(1): 53-61, 2012. (32 refs.)

Any effort to decrease the toll of drunk driving must include efforts directed at people who drink in bars, particularly young adults who use motor vehicles after drinking. We designed a multifaceted social marketing campaign, Last Call, to increase the use of designated drivers and safe rides homes among 21-34-year olds. There were three components to the intervention: (1) use of taxi stands to promote taxi use; (2) point-of-sale information to patrons at partner bars and (3) a mass media campaign to support the designated driver/safe ride home message. Among the heaviest drinkers, the programme significantly increased the use of designated drivers and increased the use of taxis by 63%.

Copyright 2012, Taylor & Francis Ltd

Rowland B; Toumbourou JW; Allen F. Reducing alcohol-impaired driving in community sports clubs: Evaluating the Good Sports Program. Journal of Studies on Alcohol and Drugs 73(2): 316-327, 2012. (58 refs.)

Objective: The Good Sports program uses a systematic accreditation process to implement gradual alcohol-related harm-reduction strategies in Australian community sports clubs that aim to reduce the incidence of harmful alcohol-related behaviors, such as drink driving. This study tested whether the Good Sports program reduced the incidence of drink driving and whether reductions are related to the level of program implementation. Method: An adoption versus nonadoption pilot study was undertaken with 65 cricket and 48 Australian Football League clubs (N = 1, 968 individuals). Associations between the stage of accreditation (Stage 1 and Stage 2) and the likelihood of driving with an illegal blood alcohol concentration (BAC) were examined. Alcohol-use diary accounts were used to calculate BAC before driving home from the club. Results: The percentage of club members driving at least once in the previous week with a BAC estimate greater than .05% (the legal limit in Australia) was lower in clubs that had achieved Stage 2 Good Sports accreditation (7%, 95% CI [5%, 9%]) than those that had not (8%, 95% CI [6%, 9%]), but this was not significantly different. However, multilevel modeling identified a larger number of the safe-transport strategies, implemented as part of Stage 2 accreditation, which were associated with a significantly lower probability of drink driving. Being a risky drinker at the club, and the average number of risky drinkers at the club, was also predictive of drink driving. Conclusions: The findings of this pilot study suggest that implementation of the Good Sports program is likely to have a significant effect on harms associated with drink driving in Australia and elsewhere. Further community studies will be required, however, to examine precisely how the program is achieving improvements and whether it can be refined to have a greater impact in both Australia and overseas.

Copyright 2012, Alcohol Research Documentation

Saber EM; Bazargan M. Dynamic behavior modeling of cigarette smoke particles inside the car cabin with different ventilation scenarios. International Journal of Environmental Science and Technology 8(4): 747-764, 2011. (43 refs.)

Dynamic behavior of cigarette smoke particles inside the cabin of cars is investigated and the respirable suspended particles concentration during and after smoking cigarette is predicted in this study. This model is based on mass balance equations. Mechanisms of deposition on the surfaces and the exchange of air in the cabin are considered as sinks for emitted particles. The coagulation is accounted as a sink for smaller particles and as a source for larger particles. The various scenarios of smoking in the cars available in the literature are simulated in this study. Good agreement between the results of the present model and the experimental data, as well as the predictions of other available models, is achieved. The mean respirable suspended particle concentration in different scenarios is estimated and compared with Environmental Protection Agency's health-based standards in order to specify the situations with respirable suspended particles concentrations exceeding the allowable limits. The results show that the concentration of particles due to the smoke of a single cigarette in a stationary medium sized car with the air conditioner off is 33.6 mu g/m(3) and nearly reaches the limits appointed by the Environmental Protection Agency for a 24 h incremental exposure (35 mu g/m(3)). Corresponding values for moving cars have also been calculated and compared with the standards.

Copyright 2011, Centre for Environment & Environmental and Energy Research & Studies

Sansone RA; Lam C; Wiederman MW. Prevalence of criminal behaviors in an internal-medicine-resident clinic population. Southern Medical Journal 104(10): 695-698, 2011. (16 refs.)

Objective: Few, if any, US studies have examined rates of criminal behaviors among patients in clinical samples. According to findings from non-US studies, mostly in psychiatric samples, rates of criminal behavior are higher than in the general population. In this study, we examined the prevalence of criminal behaviors in an internal medicine outpatient sample from a resident-provider clinic. Method: In a consecutive sample of internal medicine outpatients, 380 participants were surveyed in October of 2010 regarding 27 criminal offenses as delineated by the crime categorization schema used by the Federal Bureau of Investigation. Results: In this sample, 22.1% reported at least one criminal charge. The most commonly self-reported criminal charge was driving under the influence of alcohol or drugs (10.3%), followed by disorderly conduct (7.1%), drug abuse violations (5.8%), simple assault (5.3%), drunkenness (4.5%), and aggravated assault (3.2%). Conclusions: Like previous non-US studies among psychiatric samples, there appears to be a higher prevalence of criminal behavior among outpatients in an internal medicine training clinic than in the general population. These behaviors may be inter-related through alcohol/substance-use disorders.

Copyright 2011, Lippincott, Willaims & Wilkins

Schlauch RC; O'Malley SS; Rounsaville BJ; Ball SA. Internalizing and externalizing dimensions and alcohol use in first time DWI Offenders: Indirect effects through coping self-efficacy. Psychology of Addictive Behaviors 26(1): 133-139, 2012. (40 refs.)

Using cross-sectional data and structural equation modeling, we evaluated whether coping self-efficacy to abstain from drinking in various situations accounted for the relationship between internalizing (depression, anxiety) and externalizing (aggression, low socialization) dimensions with problematic alcohol use in 292 first-time DWI offenders. Results indicated that an internalizing dimension indirectly predicted problematic alcohol use through coping self-efficacy in negative situations only, whereas an externalizing dimension indirectly predicted problematic alcohol use through coping self-efficacy in positive situations only. These findings support two potential pathways to problematic drinking behavior among DWI offenders and suggest that internalizing and externalizing dimensions may differentially predict high risk drinking situations due to one's inability to abstain in specific situations.

Copyright 2012, American Psychological Association

Shmygalev S; Damm M; Weckbecker K; Berghaus G; Petzke F; Sabatowski R. The impact of long-term maintenance treatment with buprenorphine on complex psychomotor and cognitive function. Drug and Alcohol Dependence 117(2-3): 190-197, 2011. (50 refs.)

Introduction: Despite the fact that buprenorphine is effective, well tolerated and due to its pharmacological profile a very safe drug, the impact of long-term buprenorphine substitution therapy on complex psychomotor and cognitive function predicting driving ability is not yet clear. Therefore, a prospective comparison between patients receiving sublingual buprenorphine and a control group of untreated, healthy volunteers was performed. Methods: Treated and untreated subjects were matched for age and sex, with three control subjects selected for every buprenorphine patient. Patients using unreported drugs were included in the intention-to-treat (HT) analysis; the remaining patients were analysed as the per-protocol (PP) group. The test battery comprised the assessment of: performance during stress, visual orientation, concentration, attention, vigilance and reaction time. The primary endpoint was defined as the sum of the relevant scores of the tests after z-transformation of the individual scores. Results: 30 patients with sublingual buprenorphine treatment (7.7 +/- 3.9 mg per day) were matched to 90 controls. 19 patients were excluded from the PP-analysis because of additional unreported drug intake. Significant non-inferiority could be demonstrated for the PP-group (p < 0.05) as well as for the HT-group (p < 0.001). Conclusion: Patients receiving a stable dose of sublingual buprenorphine showed no significant impairment of complex psychomotor or cognitive performance as compared to healthy controls. However intake of illicit drugs as well as the lack of social reliability are major problems in this specific patients group. Despite of the absence of a relevant impact of the drug on driving ability, those patients do not seem to be qualified for getting their driving license.

Copyright 2011, Elsevier Science

Silber BY; Croft RJ; Downey LA; Camfield DA; Papafotiou K; Swann P et al. The effect of d,l-methamphetamine on simulated driving performance. Psychopharmacology 219(4): 1081-1087, 2012. (26 refs.)

Rationale Illicit drugs such as methamphetamine are commonly abused drugs that have also been observed to be prevalent in drivers injured in road accidents. The exact effect of methamphetamine or its specific isomers on driving and driving behaviour have yet to be thoroughly investigated. Methods: Twenty healthy recreational illicit stimulant users (ten males, ten females), aged between 21 and 34 years (mean=24.3 years, SD=3.4 years), attended two testing sessions involving oral consumption of 0.42 mg/kg d,l-methamphetamine or a matching placebo. The drug administration was counterbalanced, double-blind, and medically supervised. At each session, driving performance was assessed 2.5 h post-drug administration. Results: Mean blood and saliva d,l-methamphetamine concentrations of approximately 90 and 400 ng/ml, respectively, at 2 h and 95 and 475 ng/ml at 3 h were observed. These levels of d,l-methamphetamine were found not to significantly impair, or improve, driving performance at the 2.5-h post-drug administration time point. Conclusions: The findings of this study illustrate that d,l-methamphetamine has no significant effect on simulated driving performance.

Copyright 2012, Springer

Silber BY; Croft RJ; Downey LA; Papafotiou K; Camfield DA; Stough C. The effect of d-methamphetamine on simulated driving performance. Human Psychopharmacology: Clinical and Experimental 27(2): 139-144, 2012. (23 refs.)

Objectives: Methamphetamine is considered to be one of the most popularly abused drugs by drivers; however, its exact effect on driving and driving behaviour has yet to be thoroughly investigated. This being despite methamphetamine's increased prevalence in injured and deceased drivers. Methods Twenty healthy recreational illicit stimulant users (10 male and 10 female), aged between 21 and 32 years (mean = 25.4 years, SD = 3.3 years) attended two testing sessions involving oral consumption of 0.42 mg/kg d-methamphetamine or a matching placebo. The drug administration was counter-balanced, double-blind, and medically supervised. At each session driving performance was assessed 2.5 h post drug administration. Results: d-methamphetamine (0.42 mg/kg) did not significantly impair overall simulated driving performance 2.5 h post drug administration. At the individual driving variable level, participants in the d-methamphetamine condition were observed to be driving slower when an emergency situation occurred (T = 44, p < 0.05), but interestingly, participants in both conditions recorded average speeds in excess of the speed limit (100 km/h) when the emergency situations occurred. The d-methamphetamine condition did also produce four times more infringements where participants did not stop at red traffic light in comparison to the placebo, but this effect was only evident at a trend level (T = 7, p = 0.11). Conclusions: The findings presented herein suggest that d-methamphetamine administered at the levels supplied did not impair driving performance in a manner consistent with epidemiological evidence. Further research is certainly required to elucidate the effects of various doses of methamphetamine, alone and in combination with other legal and illicit substances.

Copyright 2012, Wiley-Blackwell

Simons R; Martens M; Ramaekers J; Krul A; Klopping-Ketelaars I; Skopp G. Effects of dexamphetamine with and without alcohol on simulated driving. Psychopharmacology 222(3): 391-399, 2012. (38 refs.)

In party circuits dexamphetamine is frequently used in combination with alcohol. It is hypothesized that co-administration of dexamphetamine to alcohol might reduce the sedative effects of alcohol, but may potentiate risk-taking behaviour. The study was aimed at assessing the effects of alcohol, dexamphetamine and the combination of both on simulated driving and cognitive performance. Eighteen subjects participated in a randomized, crossover, placebo-controlled study employing four conditions: 10 mg dexamphetamine, 0.8 g/kg alcohol, 10 mg dexamphetamine + 0.8 g/kg alcohol, and placebo. Fundamental driving skills and risk-taking behaviour were assessed in a driving simulator. Subjects also completed vigilance and divided attention tasks, and subjective ratings. Mean BAC levels during simulated driving were between 0.91aEuro degrees and 0.64aEuro degrees. Subjects using alcohol showed a significantly larger mean standard deviation of lateral position and shorter accepted gap time and distance. Use of alcohol or dexamphetamine + alcohol was associated with a higher frequency of red light running and collisions than the dexamphetamine or placebo conditions. Performance of vigilance and divided attention tasks was significantly impaired in the alcohol condition and, to a lesser degree, in the dexamphetamine + alcohol condition. Single doses of 0.8 g/kg alcohol increased risk-taking behaviours and impaired tracking, attention and reaction time during a 3-h period after drinking when BACs declined from 0.9 to 0.2 mg/ml. The stimulatory effects of co-administration of dexamphetamine 10 mg were not sufficient to overcome the impairing effects of alcohol on skills related to driving.

Copyright 2012, Springer

Song EY; Smiler AP; Wagoner KG; Wolfson M. Everyone says it's OK: Adolescents' perceptions of peer, parent, and community alcohol norms, alcohol consumption, and alcohol-related consequences. Substance Use & Misuse 47(1): 86-98, 2012. (50 refs.)

An adolescent's perception of norms is related to her or his engagement in alcohol-related behaviors. Norms have different sources, such as parents, peers, and community. We explored how norms from different sources were simultaneously related to different alcohol-related behaviors (current drinking, drunkenness, heavy episodic drinking, driving under the influence or riding with a impaired driver, and alcohol-related nonviolent consequences) using data collected in 2004 from 6,958 adolescents from 68 communities in five states. Results revealed that parent, friend, and community norms were related to adolescents' alcohol-related behavior, but the strength of these impacts varied across behaviors. The pattern of results varied when the analysis relied on all adolescents or just those who had consumed alcohol in the last year.

Copyright 2012, Informa Healthcare

Stewart K; Silcock D; Wegman F. Reducing drink driving in low- and middle-income countries: Challenges and opportunities. Traffic Injury Prevention 13(2): 93-95, 2012. (9 refs.)

A great deal of progress has been made in reducing alcohol-impaired driving crashes and the related injuries and deaths in countries around the world. Unfortunately, this progress has not been shared by many low-and middle-income countries. In response to this disparity, a variety of international efforts have been undertaken, including the Drink Driving Initiative of Global Actions on Harmful Drinking, being carried out with a focus on 6 low- and middle-income countries where drink driving is a significant issue. These countries are China, Colombia, Mexico, Nigeria, Russia, and Vietnam. This article provides an overview of situational assessments that describe the current drink driving problems in these countries and the laws, policies, enforcement efforts, and public attitudes related to drink driving. These descriptions show clearly that there are particular challenges faced by the countries discussed here. Some, such as a lack of reliable traffic safety data, are common to most of the countries. This lack of data may be interrelated with the lack of well-developed drink driving policies. Other challenges vary depending on the particular geographic, economic, cultural, and social situations in each country. The assessments indicate the need for a focus on capacity building at the organizational and individual level in the target countries. The assessments also indicate that a long-term commitment to strengthening policies, implementation, and evaluation will be needed. This deeper understanding of the situations in each of these countries is already being put to use in what we hope is the beginning of an important and lifesaving process.

Copyright 2012, Taylor & Francis

Stoduto G; Mann RE; Ialomiteanu A; Wickens CM; Brands B. Examining the link between collision involvement and cocaine use. Drug and Alcohol Dependence 123(1-3): 260-263, 2012. (26 refs.)

Background: Cocaine is one of the more commonly found illicit drugs in injured drivers. In this work, we examine the association between self-reported past year cocaine use and past year collision involvement in a large representative sample of adult drivers in Ontario. Methods: Data are based on the CAMH Monitor, an ongoing cross-sectional telephone survey of Ontario adults aged 18 and older. Five years of data (2002, 2003, 2004, 2006, 2008) were merged for this study (N = 8107) due to survey item availability. Logistic regression analysis was performed to identify the risk of self-reported collision involvement within the past 12 months associated with past year use of cocaine, while controlling for sociodemographic, driving exposure and drinking-driving (as a function of drinking status) factors. Due to listwise deletion, the logistic regression model was based on a reduced sample (N = 7284). Results: The prevalence of self-reported collision involvement within the past year was 18.9% among those who used cocaine in the past year compared to 7.4% of non-users. Logistic regression analysis, controlling for the potential confounding effects of age, gender, income, driving exposure and drinking-driving measures, found the odds of collision involvement in the preceding year among cocaine users was over twice that of non-users (OR = 2.11, 95% CI = 1.06-4.18). Conclusions: This study suggests that cocaine users are significantly more likely to report collision involvement in the past year. Additional work to confirm these observations, and to assess possible causal pathways, is needed.

Copyright 2012, Elsevier Science

Sullman MJM. An observational study of driver distraction in England. Transportation Research. Part F, Traffic Psychology and Behaviour 15(3): 272-278, 2012. (26 refs.)

This study set out to investigate the proportion of UK drivers who engage in some form of distracting behaviour whilst driving. Data were collected by roadside observation in six urban centres in the South of England. The observations took place on randomly selected roads at three different time periods during two consecutive Tuesdays. The data revealed that 14.4% of the 7168 drivers observed were found to be engaged in a distracting activity. The most frequently observed distraction was talking to a passenger, followed by smoking and using a mobile phone. Younger drivers were significantly more likely to be distracted in general and by talking to passengers, while older drivers were less likely to be distracted by adjusting controls or using a mobile phone.

Copyright 2012, Elsevier Science

Veldstra JL; Brookhuis KA; de Waard D; Molmans BHW; Verstraete AG; Skopp G et al. Effects of alcohol (BAC 0.5 parts per thousand) and ecstasy (MDMA 100 mg) on simulated driving performance and traffic safety. Psychopharmacology 222(3): 377-390, 2012. (48 refs.)

An increasing number of fatal road-accidents have been reported in which ecstasy was found in the blood of drivers. Although, ecstasy is frequently found to have been used in combination with alcohol, studies on the acute effects of ecstasy co-administered with alcohol on driving performance are relatively rare. The present study was designed to establish the extent of driver impairment as a consequence of ecstasy or combined ecstasy and alcohol use as compared to driving under the influence of 0.3aEuro degrees, 0.5aEuro degrees and 0.8aEuro degrees alcohol. Furthermore, subjective performance was also assessed. Alcohol and ecstasy mainly influenced automated driving performance such as lateral and speed control. However, small to no effects of the substances were found on more complex driving behaviour. Overall, variance within the different driving measures was high especially when participants were treated with 3.4-methylenedioxy-methamphetamine (MDMA) and alcohol. Furthermore, equivalence testing showed that combined use may lead to impaired driving for some, but not all, drivers. Participants rated their own performance to be slightly worse than normal in both studies. Since driving was actually seriously deteriorated, this was a falsely positive assessment of their condition. The dissociation between subjective perceptions and objective performance decrements are important notions for traffic safety since this may affect a driver's judgement of whether or not it is safe to drive. For example, an intoxicated individual might decide to drive because the feelings of alertness caused by MDMA cloud the impairing effects of other drugs such as alcohol, thereby creating a potentially serious risk for traffic safety.

Copyright 2012, Springer

Vindenes V; Jordbru D; Knapskog AB; Kvan E; Mathisrud G; Slordal L et al. Impairment based legislative limits for driving under the influence of non-alcohol drugs in Norway. (review). Forensic Science International 219(1-3): 1-11, 2012. (138 refs.)

Aims: When non-alcohol drugs are detected in blood samples from apprehended drivers in Norway, individualised expert opinions are required to evaluate degree of impairment. For alcohol, legislative limits have been in use since 1936. To harmonize the current practice for driving under the influence of alcohol and non-alcohol drugs, a judicial reform with legislative limits for non-alcohol drugs has been suggested. Methods: Impairment limits, representing drug concentrations in blood likely to be accompanied by a degree of impairment comparable to a blood alcohol concentration (BAC) of 0.02%, were proposed for 20 psychotropic drugs, including the most prevalent benzodiazepines, cannabis, GHB, hallucinogens and opioids. Limits for graded sanctions, representing drug concentrations in blood likely to induce impairment comparable to BACs of 0.05% and 0.12%, were defined for 13 of the 20 substances. The suggested limits were based on assessments of impairment after single doses of the drugs in naive individuals. The proposed limits will not apply to individuals with valid prescriptions for medicinal drugs, where the present system with individualised expert evaluations will be maintained. Conclusion: Norway is the first country planning to implement legislative limits for non-alcohol drugs corresponding to impairment seen at increasing BACs. The background and justification for the suggested limits are presented herein.

Copyright 2012, Elsevier Science

Vindenes V; Lund HME; Andresen W; Gjerde H; Ikdahl SE; Christophersen AS et al. Detection of drugs of abuse in simultaneously collected oral fluid, urine and blood from Norwegian drug drivers. Forensic Science International 219(1-3): no page number, 2012. (42 refs.)

Blood and urine samples are collected when the Norwegian police apprehend a person suspected of driving under the influence of drugs other than alcohol. Impairment is judged from the findings in blood. In our routine samples, urine is analysed if morphine is detected in blood to differentiate between ingestion of heroin, morphine or codeine and also in cases where the amount of blood is too low to perform both screening and quantification analysis. In several cases, the collection of urine might be time consuming and challenging. The aim of this study was to investigate if drugs detected in blood were found in oral fluid and if interpretation of opiate findings in oral fluid is as conclusive as in urine. Blood, urine and oral fluid samples were collected from 100 drivers suspected of drugged driving. Oral fluid and blood were screened using LC-MS/MS methods and urine by immunological methods. Positive findings in blood and urine were confirmed with chromatographic methods. The analytical method for oral fluid included 25 of the most commonly abused drugs in Norway and some metabolites. The analysis showed a good correlation between the findings in urine and oral fluid for amphetamines, cocaine/benzoylecgonine, methadone, opiates, zopiclone and benzodiazepines including the 7-amino-benzodiazepines. Cocaine and the heroin marker 6-monoacetylmorphine (6-MAM) were more frequently detected in oral fluid than in urine. Drug concentrations above the cut-off values were found in both samples of oral fluid and urine in 15 of 22 cases positive for morphine, in 18 of 20 cases positive for codeine and in 19 of 26 cases positive for 6-MAM. The use of cannabis was confirmed by detecting THC in oral fluid and THC-COOH in urine. In 34 of 46 cases the use of cannabis was confirmed both in oral fluid and urine. The use of cannabis was confirmed by a positive finding in only urine in 11 cases and in only oral fluid in one case. All the drug groups detected in blood were also found in oral fluid. Since all relevant drugs detected in blood were possible to find in oral fluid and the interpretation of the opiate findings in oral fluid was more conclusive than in urine, oral fluid might replace urine in driving under the influence cases. The fast and easy sampling is time saving and less intrusive for the drivers.

Copyright 2012, Elsevier Science

Vingilis E; Wilk P. Medical conditions, medication use, and their relationship with subsequent motor vehicle injuries: Examination of the Canadian National Population Health Survey. Traffic Injury Prevention 13(3): 327-336, 2012. (55 refs.)

Purpose: To examine the effects of various medical conditions and medications on subsequent motor vehicle injuries (MVIs). Method: The National Population Health Survey, a large, nationally representative, longitudinal study of Canadians, included self-reported medical conditions of asthma, arthritis/rheumatism, back problems excluding arthritis, high blood pressure, migraine headaches, diabetes, heart disease and distress, and medication use during the past month for asthma, high blood pressure, diabetes, heart, codeine/pethidine (Demerol)/morphine, other pain relievers, antidepressants, tranquilizers, and sleeping medication. Path analyses were used to examine the odds of subsequent MVI for different medical conditions and medication use reported prior to the MVI (in the previous wave of the survey) while controlling for age and sex. Results: Increased odds of subsequent MVIs were found for asthma (odds ratio [OR]: 1.864, 95% confidence interval [CI]: 1.281, 2.713), arthritis/rheumatism (OR: 1.659, 95% CI: 1.163, 2.365), back problems (OR: 2.169, 95% CI: 1.624, 2.895), and migraines (OR: 1.631, 95% CI: 1.125, 2.364) but not for high blood pressure (OR: 1.435, 95% CI: 0.944, 2.181), diabetes (OR: 1.479, 95% CI: 0.743, 2.944), heart disease (OR: 2.627, 95% CI: 0.941, 7.334) or distress (OR: 1.153, 95% CI: 0.840, 1.581). Except for migraine with codeine/pethidine/morphine, this effect persisted regardless of whether medication was used to treat the condition. Respondents who reported using certain medications, namely, codeine/pethidine/morphine (OR: 2.215, 95% CI: 1.274, 3.850), other pain medication (OR: 1.630, 95% CI: 1.242, 2.139), antidepressants (OR: 2.664. 95% CI: 1.602, 4.429), and sleeping medication (OR: 2.059, 95% CI: 1.161, 3.651), had increased odds of subsequent MVI, independent of related medical condition, whereas tranquillizers showed no increased odds of subsequent MVIs. Conclusions: This study suggests that the relationship between medical conditions, medications, and MVIs is complex but consistent with other studies.

Copyright 2012, Taylor & Francis

Voas RB; DuPont RL; Talpins SK; Shea CL. Towards a national model for managing impaired driving offenders. (review). Addiction 106(7): 1221-1227, 2011. (38 refs.)

Aims: To describe a proposed national model for controlling the risk presented by offenders convicted of driving while impaired (DWI) and promoting behavioral change to reduce future recidivism. Setting: Traditional methods of controlling the risk they present to the driving public are not adequate, as indicated by the fact that approximately 1000 people are killed each year-in alcohol-related crashes involving drivers convicted of DWI in the previous three years. However, stimulated by the success of special drug courts for substance abusers and new technological methods for monitoring drug and alcohol use, new criminal justice programs for managing impaired driving offenders are emerging. Intervention A national model for a comprehensive system applicable to both drug and alcohol impaired drivers is proposed. The program focuses on monitoring offender drinking or the offender driving employing vehicle interlocks with swift, sure but moderate penalties for non-compliance in which the ultimate sanction is based on offender performance in meeting monitoring requirements. Findings: Several new court programs, such as the 24/7 Sobriety Project in South Dakota and North Dakota and the Hawaii's Opportunity Probation with Enforcement (HOPE) Project, which feature alcohol/drug consumption monitoring, have produced evidence that indicates even dependent drinkers can conform to abstinence monitoring requirements and avoid the short-term jail consequence for failure. Conclusions: Based on the apparent success of emerging court monitoring systems, it appears that the cost of incarcerating driving-while-impaired offenders can be minimized by employing low-cost community correction programs paid for by the offender.

Copyright 2011, Society for the Study of Addiction

Voas RB; Fell JC. Preventing impaired driving: Opportunities and problems. Alcohol Research & Health 34(2): 225-235, 2011. (72 refs.)

Impaired driving remains a significant public health problem in the United States. Although impressive reductions in alcohol-related fatalities occurred between 1982 and 1997, during which all 50 States enacted the basic impaired-driving laws, progress has stagnated over the last decade. Substantial changes in the laws and policies or funding for the enforcement of the criminal offense of driving while intoxicated (DWI) are needed for further substantial progress in reducing alcohol-related crash injuries. However, research indicates that evidence-based laws in the 50 States and current best practices in DWI enforcement are not being fully adopted or used. It seems, however, that effective operations, such as the low-staff check points that are routinely applied in many communities, could be extended to many more police departments. In addition, several enforcement methods have been proposed but never fully tested.

Copyright 2011, National Institute on Alcohol Abuse and Alcoholism

Voas RB; Torres P; Romano E; Lacey JH. Alcohol-related risk of driver fatalities: An update using 2007 data. Journal of Studies on Alcohol and Drugs 73(3): 341-350, 2012. (31 refs.)

Objective: The purpose of this study was to determine whether the relative risk of being involved in an alcohol-related crash has changed over the decade from 1996 to 2007, a period during which there has been little evidence of a reduction in the percentage of all fatal crashes involving alcohol. Method: We compared blood-alcohol information for the 2006 and 2007 crash cases (N = 6,863, 22.8% of them women) drawn from the U.S. Fatality Analysis Reporting System (FARS) with control blood-alcohol data from participants in the 2007 U.S. National Roadside Survey (N = 6,823). Risk estimates were computed and compared with those previously obtained from the 1996 FARS and roadside survey data. Results: Although the adult relative risk of being involved in a fatal alcohol-related crash apparently did not change from 1996 to 2007, the risk for involvement in an alcohol-related crash for underage women has increased to the point where it has become the same as that for underage men. Further, the risk that sober underage men will become involved in a fatal crash has doubled over the 1996-2007 period. Conclusions: Compared with estimates obtained from a decade earlier, young women in this study are at an increased risk of involvement in alcohol-related crashes. Similarly, underage sober drivers in this study are more at risk of involvement in a crash than they were a decade earlier.

Copyright 2012, Alcohol Research Documentation

Weg MWV; Cai XY. Variability in veterans' alcohol use by place of residence. American Journal on Addictions 21(1): 31-37, 2012. (45 refs.)

Rates of risky alcohol use appear to be elevated among active duty and veteran military personnel. Little is known, however, about characteristics associated with alcohol misuse in these groups. Furthermore, although there is evidence to suggest that patterns of alcohol use differ according to place of residence, no prior studies have investigated variability in alcohol use according to level of rurality and geographic region in US military veterans. The present study evaluated variations in alcohol use (ie, past 30-day use, heavy use, and binge drinking) and drinking and driving according to place of residence among 55,452 US military veterans participating in the Behavioral Risk Factor Surveillance System. Veterans residing in rural areas were significantly less likely than those from suburban and urban areas to have consumed alcohol in the past 30 days (p < .001). Conversely, rural-dwelling veterans who did drink alcohol had higher odds of binge drinking (p < .005) and (relative to urban residents) drinking and driving (p = .013). Veterans residing in the South were significantly less likely than those from other geographic regions to report past 30-day alcohol use (p < .001). In addition, veterans living in the Midwest were significantly more likely than those from the South to report drinking and driving (p = .017). No differences in heavy alcohol use were observed based on location of residence.

Copyright 2012, American Academy of Addiction Psychiatry

Zacny JP; Paice JA; Coalson DW. Characterizing the subjective and psychomotor effects of carisoprodol in healthy volunteers. Pharmacology, Biochemistry and Behavior 100(1): 138-143, 2011. (59 refs.)

Carisoprodol is a centrally acting drug used to relieve skeletal muscle spasms and associated pain in acute musculoskeletal conditions. There is evidence from different sources that this oral muscle relaxant is abused and that it is associated with impairment leading to arrests for "driving under the influence" as well as increased risk of automobile accidents. Its subjective and psychomotor effects in healthy volunteers at therapeutic and supratherapeutic doses have not been well-characterized, and form the basis of this report. Fifteen healthy volunteers (8 males, 7 females) were administered 0, 350, and 700 mg of carisoprodol in separate sessions and for 6 h afterwards they completed a battery of tests at fixed time intervals so as to assess the subjective and psychomotor effects of the drug. The supratherapeutic dose, 700 mg, increased visual analog scale ratings of terms that were more reflective of sedation (e.g., "sleepy," "heavy, sluggish feeling") than those of abuse liability, and produced impaired performance on several psychomotor tests. The therapeutic dose, 350 mg, while producing few and mild subjective effects, still produced psychomotor impairment. The fact that the therapeutic dose of carisoprodol produced minimal subjective effects while adversely affecting performance is of concern in that patients prescribed this drug may feel relatively normal and engage in tasks (driving) that could put themselves and others at risk.

Copyright 2011, Elsevier Science

Zador PL; Howard JM; Rauch WJ; Ahlin EM; Duncan GD. Latency periods between alcohol-related traffic violations: Implications for recidivism. Traffic Injury Prevention 12(4): 297-305, 2011. (38 refs.)

Objective: Before October 1, 2002, Maryland's regulations for relicensing drivers with 2 recorded alcohol-related traffic violations distinguished between offenders with 5 or more years between their first and second violations and those with less than 5 years. Our research examined whether this policy was supported by differential probabilities of recidivism and violation-free survival. Methods: We compared recidivism rates and survival probabilities among the 2 latency subgroups and 2 control groups (first offenders and drivers with no previous alcohol-related traffic violation). Data were extracted from Maryland's driver record database and segregated files and analyzed by age quintiles using Cox proportional hazards models containing identifiers for risk factors, including prior violations. All drivers (N = 64,536) were matched on age quintile. gender, and month of offenders' index violations. Effects of violation histories on survival and recidivism probabilities were measured by contrasts of regression coefficients. Results: Among second offenders, the shorter latency subgroup consistently had higher recidivism and lower violation-free survival than the longer latency subgroup, whose rates fell between those of first offenders and the shorter latency subgroup. Although highly significant, the subgroup differences were small and paled by comparison to differences between first and zero offenders in probability of a subsequent violation. Conclusions: An earlier study that showed similar overall recidivism for these latency subgroups helped encourage Maryland to change its regulations governing license reinstatement. New regulations issued October 1, 2002, focused on 2 alcohol violations "during any period of time" where investigation indicated alcoholism or unaddressed alcohol problems. To obtain relicensure, these offenders could be required to enter or complete a lengthy certified alcohol treatment program. Our current results are consistent with these requirements. License reinstatement should be primarily guided by the extent of alcohol impairment, especially because both latency subgroups showed higher risks of recidivism than first offenders, who themselves had comparatively high risk.

Copyright 2011, Taylor & Francis

Zhang LN; Wieczorek WF; Welte JW. Early onset of delinquency and the trajectory of alcohol-impaired driving among young males. Addictive Behaviors 36(12): 1154-1159, 2011. (39 refs.)

Building upon the literature in developmental and life-course criminology, the present study assesses the possible association of age onset of delinquency with the trajectory of alcohol-impaired driving using data collected from the three waves of the Buffalo Longitudinal Survey of Young Men (BLSYM). It is argued that as a unique form of delinquency, alcohol-impaired driving among adolescents may be better understood in a broad context of adolescent delinquency involvement. The study adopts the general approach for the analysis of early onset of delinquency and criminal careers in developmental and life-course criminology and hypothesizes that early onset of delinquency is associated with a higher growth of alcohol-impaired driving over time among adolescents when age onsets of alcohol-impaired driving, drinking, and drug use are controlled. Our analysis with the HLM growth modeling method provides support for the hypothesis. Respondents who had an early start in delinquency were likely to have a faster growth of alcohol-impaired driving over the three waves of BLSYM, which implies that these respondents were likely to have a longer path of alcohol-impaired driving in their transition to adulthood. The implication of this finding is discussed.

Copyright 2011, Elsevier Science