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..on substance use and driving
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www.ProjectCork.org
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Fall 2003
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Identifying factors that predict persistent driving after
drinking, unsafe driving after drinking, and driving after
using cannabis among young adults.
Begg DJ; Langley JD; Stephenson S. Accident Analysis and Prevention 35(5):
669-675, 2003. (25 refs.)
The main aim of this study was to identify adolescent/ young adulthood factors
that predicted persistent driving after drinking, persistent unsafe driving after
drinking, and persistent cannabis use and driving among young adults. It was
a longitudinal study of a birth cohort (n=933, 474 males and 459 females) and
was based on data collected at ages 15, 18, 21 and 26 years. At each of these
ages members of the cohort attended the research unit for a personal interview
by a trained interviewer, using a standardised questionnaire. For this study,
the data for the outcome measures (persistent driving after drinking, persistent
unsafe driving after drinking, and persistent driving after using cannabis) were
obtained at ages 21 and 26 years. The main explanatory measures were collected
at ages 15, 18, 21 years and included demographic factors (academic qualifications,
employment, parenting); personality measures; mental health measures (substance
use, cannabis dependence, alcohol dependence, depress-ion); anti-social behaviour
(juvenile arrest, aggressive behaviour, court convictions); early driving behaviour
and experiences (car and motorcycle licences, traffic crashes). The analyses
were conducted by gender. The results showed that females who persisted in driving
after drinking (13%, n=61) were more likely than the others to have a motorcycle
licence at 18. The males who persisted in driving after drinking (28%, n=135)
were more likely than the other males to have some school academic qualifications
and to be employed at age 26. Compared to the other males, those who persisted
in unsafe driving after drinking (4%, n=17) were more likely to be aggressive
at 18 and alcohol dependent at 21. Only six (1%) females persisted in unsafe
driving after drinking so regression analyses were not conducted for this group.
For persistent driving after using cannabis, the univariate analyses showed that
females who persisted with this behaviour tended to have high substance use at
18, cannabis dependence at 21, police contact as a juvenile, and to be a parent
at 21. For this group, because of the small numbers (3%, n=13) multivariate analyses
were not appropriate. For the males who persisted in driving after using cannabis
(14%, n=68) a wide range of variables were significant at the univariate stage.
The multivariate analysis showed that the most important factors were dependence
on cannabis at 21, at least one traffic conviction before 21, a non traffic conviction
before 18, and low constraint at 18. Conclusion: These results show different
characteristics were associated with persistence in each of these outcome behaviours.
This indicates that different approaches would be required if intervention programmes
were to be developed to target these behaviours.
Copyright 2003, Elsevier Science.
Effect of lowering the alcohol limit in Denmark.
Bernhoft IM; Behrensdorff I. Accident Analysis and Prevention 35(4): 515-525,
2003. (8 refs.)
On I March 1998, the Danish per se limit was lowered from 0.08 to 0.05% blood
alcohol concentration (BAC) for motor vehicle drivers. Based on accident data
and drivers' drinking habits before and after the amendment, the effect of the
new limit has been evaluated. Interviews revealed a significant decrease in the
number of drinks that drivers allow themselves to drink within a 2-h period before
driving. The proportion of drivers, who would not drink at all or only have one
drink, increased from 71% before the amendment to 80% after the amendment. Drivers
with changed drinking habits most often stated the lower limit as the main reason
for having less alcohol. However, based on accident data from the first year
after the amendment, this has not resulted in a marked decrease in the proportion
of injury accidents with impaired motor vehicle drivers (BAC greater than or
equal to 0.05%) compared to all injury accidents. On the contrary, the proportion
of fatal accidents with drink-drivers compared to all fatal accidents has increased
in the after-period. The total number of drink-driving sentences were a little
larger in 1999 than in 1997 because of the lower limit, but a significant change
from higher towards lower alcohol levels can be seen.
Copyright 2003, Elsevier Science Ltd.
Alcohol availability as a predictor of youth drinking and driving: A hierarchical
analysis of survey and archival data.
Treno AJ; Grube JW; Martin SE. Alcoholism: Clinical and Experimental Research 27(5):
835-840, 2003. (23 refs.)
Background: Much attention has recently been directed toward developing preventive
interventions to reduce drinking and driving through efforts to limit the numbers
and locations of alcohol outlets at the community level. Although evaluations
of these efforts have suggested linkages between alcohol outlets and problem
outcomes, they have not addressed the linkage between outlets and drinking and
driving among youth. The analysis reported here investigates the relationship
between alcohol outlet densities and underage drinking and driving as self-reported
on two telephone surveys conducted in California. Methods: These analyses were
based on data obtained from two telephone surveys conducted by the Prevention
Research Center and archival data collected by the California Department of Alcoholic
Beverage Control and the US Census Bureau. The sample for the first survey consisted
of 15- to 20-year-old adolescents and young adults contacted by telephone, using
a random digit dialing of exchanges in the greater San Francisco Bay Area. A
second set of survey data was similarly collected by a random sample of households
throughout California, and the Bay Area subset was also used for this analysis.
Results: At the individual level, older respondents were more likely to report
drinking and driving and riding with drinking drivers, whereas females and Asians
were less so. At the aggregate or city-level, alcohol outlet density, as measured
by the number of on- and off-premises establishments licensed to sell alcohol,
was associated with both drinking and driving and riding with drinking drivers.
These effects were moderated by a number of individual level effects, with younger
respondents and females more likely to be affected by outlet densities. Conclusions:
The findings here provide support for the implementation of policies targeting
alcohol outlet density reductions. Areas with large numbers of such outlets provide
ample opportunities to youth for alcohol purchases.
Copyright 2003, Research Society on Alcoholism.
Motorcycle casualties sustained during Daytona Beach bike week 2000: Lessons
learned.
Kanny D; Schieber RA; Jones BH; Ryan GW; Sorensen BJ. Annals of Emergency
Medicine 41(6): 792-797, 2003. (3 refs.)
Study objective: In March 2000, an estimated 500,000 people attended an annual
motorcycle rally in Daytona Beach, FL, where approximately 64,000 residents live
year-round. The media reported 15 deaths during this 10-day event. To more, comprehensively
assess the extent of trauma and need for emergency medical care we, investigated
all motorcycle crashes, regardless of outcome. Methods: Motorcycle-related crash
data from local medical examiner, hospital, emergency medical services (EMS),
and police sources were linked. Frequencies of crashes, injuries, hospitalizations,
and deaths were determined, and EMS use data were analyzed. Results: During Bike
Week 2000, 570 people were involved in 281 motorcycle-related crashes. Two hundred
thirty (40%) people were injured, of which 147 (64%) sought treatment in emergency
departments, 72 (31%) were hospitalized, and 11 (5%) died. In crashes between
motorcycles and passenger cars, individuals exposed as motorcycle occupants were
8.7 times more likely to be injured than car occupants (95%, confidence limit
1.7, 15.7). Of 205 EMS dispatches for motorcycle-related crashes, two thirds
resulted in transport to an ED. Data needed to assess known risk factors (eg,
alcohol use, speed, lack of helmet use) were not routinely ascertained at either
the Crash site or ED. Conclusion: Although fatalities first called attention
to the problem, nonfatal injuries outnumbered deaths 20:1. The manpower resources
of civil service and health resources could become overwhelmed or exhausted in
circumstances in which many people are injured or killed throughout a relatively
long period. The situation deserves future study. Better risk factor surveillance
is needed to help prevent crashes.
Copyright 2003, American College of Emergency Physicians.
Alcohol-related crashes and alcohol availability in grass-roots communities.
McCarthy P. Applied Economics 35(11): 1331-1338, 2003. (13 refs.)
This paper employs a unique panel data from 111 small non-metropolitan incorporated
cities in California during a 108 month period from January 1981 to December
1989 in order to analyse the effect of alcohol availability on highway safety.
Negative binomial regression models are estimated which include alcohol licences
per square mile as a measure of alcohol availability. Theoretically, the sign
of the alcohol licence density is indeterminate as it reflects a trade-off of
its effect on traffic exposure and on the time price alcohol. Among the findings,
increases in the density of general alcohol licences for off-site (on-site) alcohol
consumption are beneficial (detrimental) to highway safety whereas increasing
the density of beer/wine licences have non-uniform effects. Additional findings
important to municipal policymakers are that DUI arrests and increasing the price
of alcohol reduce alcohol-related crashes.
Copyright 2003, Routledge.
Comparison of the prevalence of alcohol, cannabis and other drugs between
900 injured drivers and 900 control subjects: Results of a French collaborative
study.
Mura P; Kintz P; Ludes B; Gaulier JM; Marquet P; Martin-Dupont S et al. Forensic
Science International 133(1-2): 79-85, 2003. (24 refs.)
A collaborative case-control study was conducted in France in order to determine
the prevalence of alcohol, cannabinoids, opiates, cocaine metabolites, amphetamines
and therapeutic psychoactive drugs in blood samples from drivers injured in road
accidents and to compare these values with those of a control population. Recruitment
was performed in emergency departments of six university or general hospitals
and comprised 900 drivers involved in a non-fatal accident and 900 patients (controls)
who attended the same emergency units for a non-traumatic reason. Drivers and
controls were matched by sex and age. Alcohol was determined by flame ionization-gas
chromatography, drugs of abuse (DOA) by gas chromatography-mass spectrometry
with the same analytical procedures in the six laboratories, and medicines by
high performance liquid chromatography with diode array detection. Blood alcohol
concentration exceeding 0.5 g/l (i.e. the legal French threshold) was found in
26% of drivers and 9% of controls. In the 18-27 years age range, alcohol was
the only toxic found in blood samples of 17% drivers and 5% controls, leading
to an odds-ratio (OR) of 3.8. A significant relationship was found between alcohol
blood concentrations and OR values. All age groups confounded, the main active
substance of cannabis, Delta(9) tetrahydrocannabinol (THC), was found in 10%
of drivers and 5% of controls. In the less than 27 years old, THC (>1 ng/ml)
was detected alone in the blood of 15.3% drivers and of 6.7% controls, giving
OR = 2.5, whereas there was no link between THC blood concentrations and OR value.
THC was found alone in 60% of cases and associated with alcohol in 32%, with
OR = 4.6 between drivers and controls for this association. The difference in
morphine prevalence between drivers (2.7%) and controls (0.03%) was highly significant
(P < 0.001), with OR = 8.2. The number of positive cases for amphetamines and
cocaine metabolites was too low for reaching any interpretation. The most frequently
observed psychoactive therapeutic drugs were by far benzodiazepines, that were
found alone in 9.4% of drivers and 5.8% of controls, which led to OR = 1.7 (P < 0.01).
This study demonstrates a higher prevalence of opiates, alcohol, cannabinoids
and the combination of these last two compounds in blood samples from drivers
involved in road accidents than in those from controls, which suggests a causal
role for these compounds in road crashes.
Copyright 2003, Elsevier Scientific Publishers Ireland.
The incidence of drugs in drivers killed in Australian road traffic crashes.
Drummer OH; Gerostamoulos J; Batziris H; Chu M; Caplehorn JRM; Robertson MD;
Swann P. Forensic Science International 134(2-3): 154-162, 2003. (38 refs.)
The incidence of alcohol and drugs in fatally injured drivers were determined
in three Australian states; Victoria (VIC), New South Wales (NSW) and Western
Australia (WA) for the period of 1990-1999. A total of 3398 driver fatalities
were investigated which included 2609 car drivers, 650 motorcyclists and 139
truck drivers. Alcohol at or over 0.05 g/100 ml (%) was present in 29.1% of all
drivers. The highest prevalence was in car drivers (30.3%) and the lowest in
truckers (8.6%). WA had the highest rate of alcohol presence of the three states
(35.8%). Almost 10% of the cases involved both alcohol and drugs. Drugs (other
than alcohol) were present in 26.7% of cases and psychotropic drugs in 23.5%.
These drugs comprised cannabis (13.5%), opioids (4.9%), stimulants (4.1%), benzodiazepines
(4.1%) and other psychotropic drugs (2.7%). 8.5% of all drivers tested positive
for Delta(9)-tetrahydrocannabinol (THC) and the balance of cannabis positive
drivers were positive to only the 11-nor-Delta(9)-tetrahydrocannabinol-9-carboxylic
acid (carboxy-THC) metabolite. The range of THC blood concentrations in drivers
was 0.1-228 ng/ml, with a median of 9 ng/ml. Opioids consisted mainly of morphine
(n = 84), codeine (n = 89) and methadone (n = 33), while stimulants consisted
mainly of methamphetamine (n = 51), MDMA (n = 6), cocaine (n = 5), and the ephedrines
(n = 61). The prevalence of drugs increased over the decade, particularly cannabis
and opioids, while alcohol decreased. Cannabis had a larger prevalence in motorcyclists
(22.2%), whereas stimulants had a much larger presence in truckers (23%).
Copyright 2003, Elsevier Science.
Alcohol and/or benzodiazepine use in injured road users.
Kurzthaler I; Wambacher M; Golser K; Sperner G; Sperner-Unterweger B; Haidekker
A et al. Human Psychopharmacology: Clinical and Experimental 18(5): 361-367,
2003. (13 refs.)
Blood samples of all patients (269) involved in a traffic accident and admitted
to the Emergency Room of the University Hospital of Trauma Surgery in Innsbruck
were analysed for alcohol and benzodiazepines. The large majority were drivers
(55%) followed by passengers (19.7%), cyclists (12.6%) and pedestrians (12.3%).
Alcohol was obviously the most commonly found drug in all groups (drivers: 36.9%;
passengers: 15.1%; cyclists: 29.4%; pedestrians: 18.2%), with a mean BAC (blood
alcohol concentration) high above the legal limit at the time of the study in
Austria of 0.8 g/l (drivers: 1.49 +/- 54 g/l; passengers: 1.52 +/- 71 g/l; cyclists:
1.72 +/- 51 g/l; pedestrians: 1.67 +/- 25 g/l). The percentage of alcohol users
was highest in drivers. Concerning BAC levels no significant differences were
found between the groups. The most commonly detected benzodiazepine was diazepam.
Benzodiazepine consumption (drivers: 8.1%; passengers: 5.7%; cyclists: 8.8%;
pedestrians: 3%) as well as plasma levels (drivers: 68.7 +/- 62.6 mug/l; passengers:
61.0 +/- 69.3 mug/l; cyclists: 135.7 +/- 118.3 mug/l; pedestrians: 18 mug/1)
were nearly equal in all groups. Concerning alcohol or benzodiazepine use, females
showed lower frequencies of both alcohol and benzodiazepine positive blood samples.
The frequency of alcohol use was higher in patients less than or equal to 60
years of age.
Copyright 2003, John Wiley Sons, Ltd.
Do the designated drivers of college students stay sober?
Timmerman MA; Geller ES; Glindemann KE; Fournier AK. Journal of Safety Research34(2):
127-133, 2003. (32 refs.)
Problem: By numerous accounts, alcohol abuse is considered the number one drag
problem facing young people today. Alcohol consumption and its negative consequences,
especially those due to drinking and driving, continue to have devastating effects
on the college student population. Method: This field study examined the blood
alcohol concentration (BAC) levels of male and female designated drivers (DD),
non-DD, and their respective passengers as they were leaving drinking establishments
in a university town. Also investigated were the effects of group size and gender
on DD use. Results: A 2 Gender X 2 Driver type (DD vs. non-DD) analysis of variance
(ANOVA) for BAC indicated significant main effects for Gender and Driver type,
with higher BAC for men and non-DD (p's<.001). A significant Gender X Driver
type interaction (p <.05) was primarily due to female DD having lower BAC than
male DD. In addition, larger groups were more likely to have a DD. Impact on
Industry: Results indicate that the success of DD programs may be influenced
by group size and a DD's gender. While larger groups are more likely to have
a DD, students riding home with a male DD may still be at risk for the negative
consequences of drunk driving.
Copyright 2003, National Safety Council and Pergamon Press.
Unsafe driving by high school senior's: National trends from 1976 to 2001
in tickets and accidents after use of alcohol, marijuana and other illegal
drugs.
O'Malley PM; Johnston LD. Journal of Studies on Alcohol64(3): 305-312,
2003. (20 refs.)
Objective: This study reports trends from 1976 to 2001 in the number of tickets
or warnings that high school seniors receive, the number of vehicle accidents
in which they are drivers and the number of these events that occur after use
of alcohol, marijuana or other illegal drugs. Method: The data come from the
Monitoring the Future study, in which nationally representative samples of high
school seniors have been surveyed annually since 1976. Results: Results demonstrate
that the problem of unsafe or inappropriate driving among American youth is of
considerable magnitude, although there has been a downward trend when adjusted
for number of miles driven. The frequency of tickets received and vehicle accidents
that occurred after use of alcohol has diminished markedly compared to the incidence
of tickets and accidents after use of marijuana over the interval from 1976 to
2001. Conclusions: Despite the decline in the number of vehicle accidents occurring
and tickets received after drinking or using illicit drugs, aggressive policies
are still needed to deter youths from engaging in such risky behaviors.
Copyright 2003, Alcohol Research Documentation, Inc.
Medication and fitness to drive.
Del Rio MC; Alvarez FJ. Pharmacology and Drug Safety 12(5): 389-394, 2003.
(17 refs.)
Purpose: The aim of this study is to analyze the consumption patterns of medicaments
among motor vehicle drivers who attend 'Medical Driving Test Centres' and the
relation between habitual consumption of medicaments and fitness to drive. Methods:
The study was carried out on 8043 drivers who attended 25 Medical Driving Test
Centres. Results: 24.7% of drivers chronically consume medicaments while 6.8%
consume medicaments along with alcohol every day. Of those who chronically consume
medicaments with a warning about the medications on driving, 65.8% were considered
'fit' to drive, 27.3% 'fit with restrictions', 5.1% 'suspended' and 0.4% 'unfit'.
Conclusions The results show how frequent the consumption of medicaments along
with alcohol is and that the great majority of drivers who take medicaments are
considered fit to drive.
Copyright 2003, John Wiley Sons, Ltd.
Why do they do it? A qualitative study of adolescent drinking and driving.
Waiters ED; Grube JW; Keefe D. Substance Use & Misuse 38(7): 835-863,
2003. (21 refs.)
Despite a decline in the prevalence of fatal traffic crashes involving adolescent
drinking drivers in recent years, underage drinking and driving (DD) and riding
with drinking drivers (RWDD) remain serious problems. This article reports the
findings of a qualitative study investigating the influence of beliefs and expectancies
on adolescents' decisions to participate in DD or RWDD. Forty-four adolescents,
who in a previous survey admitted to having been involved in either DD or RWDD,
were interviewed in 2000 about their experiences concerning either driving after
drinking or getting into a car with a driver who had been drinking. Findings
indicate that adolescent DD and RWDD are complex behaviors. Expectancies and
control beliefs do not seem to influence the decision, whereas normative beliefs
to some extent do. However, findings also indicate that increased enforcement
of the laws may be helpful in preventing young people from getting involved in
drinking and driving.
Copyright 2003, Marcel Dekker, Inc.
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