Association between state level drinking and driving countermeasures and self reported alcohol impaired driving.

OBJECTIVES: In 1999, alcohol related motor vehicle crashes in the United States claimed 15786 lives and injured more than 300000 persons. Drinking and driving behavior is shaped by individual and environmental level influences. In this study, the association between each state's driving under the influence of alcohol (DUI) countermeasures and self reported alcohol impaired driving was explored. METHODS: Mothers Against Drunk Driving's (MADD's) Rating the States 2000 survey, which graded states on their DUI countermeasures from 1996-99, was used as an index of each state's comprehensive DUI prevention activities. Information on alcohol impaired driving from residents of each state was obtained from the 1997 Behavioral Risk Factor Surveillance System (BRFSS) survey. The association between the MADD state grades and alcohol impaired driving was assessed using multiple logistic regression. RESULTS: Of the 64162 BRFSS respondents who reported drinking any alcohol during the past month, 2.1% of women and 5.8% of men reported at least one episode of alcohol impaired driving in the past month. Those living in states with a MADD grade of "D" were 60% more likely to report alcohol impaired driving than those from states with a MADD grade of "A" (odds ratio 1.6, 95% confidence interval 1.3 to 2.1). The association existed for men and women. CONCLUSION: These findings suggest that stronger state level DUI countermeasures are associated with lower rates of self reported alcohol impaired driving.

Methods for conducting systematic reviews of the evidence of effectiveness and economic efficiency of interventions to reduce injuries to motor vehicle occupants.

BACKGROUND: Motor vehicle occupant injury prevention is included in the Guide to Community Preventive Services because of the enormous health impact of these largely preventable injuries. This article describes the methods for conducting systematic literature reviews of interventions for three key injury prevention strategies: increasing child safety seat use, increasing safety belt use, and decreasing alcohol-impaired driving. METHODS: Systematic review methods follow those established for the Guide to Community Preventive Services and include: (1) recruiting a systematic review development team, (2) developing a conceptual approach for selecting interventions and for selecting outcomes that define the success of the interventions, (3) defining and conducting a search for evidence of effectiveness, (4) evaluating and summarizing the body of evidence of effectiveness, (5) evaluating other potential beneficial and harmful effects of the interventions, (6) evaluating economic efficiency, (7) identifying implementation barriers, (8) translating the strength of the evidence into recommendations, and (9) identifying and summarizing research gaps. RESULTS: The systematic review development team evaluated 13 interventions for the three strategic areas. More than 10,000 titles and abstracts were identified and screened; of these, 277 met the a priori systematic review inclusion criteria. Systematic review findings for each of the 13 interventions are provided in the accompanying articles in this supplement. CONCLUSION: The general methods established for conducting systematic reviews for the Guide to Community Preventive Services were successfully applied to interventions to reduce injuries to motor vehicle occupants.

Reviews of evidence regarding interventions to increase the use of safety belts.

BACKGROUND: The use of safety belts is the single most effective means of reducing fatal and nonfatal injuries in motor vehicle crashes. If all motor vehicle occupants consistently wore safety belts, an estimated 9553 deaths would have been prevented in 1999 alone. METHODS: The Guide to Community Preventive Services's methods for systematic reviews were used to evaluate the effectiveness of three interventions to increase safety belt use. Effectiveness was assessed on the basis of changes in safety belt use and number of crash-related injuries. RESULTS: Strong evidence was found for the effectiveness of safety belt laws in general and for the incremental effectiveness of primary safety belt laws relative to secondary laws. Strong evidence for the effectiveness of enhanced enforcement programs for safety belt laws was also found. Additional information is provided about the applicability, other effects, and barriers to implementation of these interventions. CONCLUSIONS: These reviews form the basis of the recommendations by the Task Force on Community Preventive Services presented elsewhere in this supplement. They can help decision makers identify and implement effective interventions that fit within an overall strategy to increase safety belt use.

Reviews of evidence regarding interventions to reduce alcohol-impaired driving.

BACKGROUND: Alcohol-related motor vehicle crashes are a major public health problem, resulting in 15,786 deaths and more than 300,000 injuries in 1999. This report presents the results of systematic reviews of the effectiveness and economic efficiency of selected population-based interventions to reduce alcohol-impaired driving. METHODS: The Guide to Community Preventive Services's methods for systematic reviews were used to evaluate the effectiveness of five interventions to decrease alcohol-impaired driving, using changes in alcohol-related crashes as the primary outcome measure. RESULTS: Strong evidence was found for the effectiveness of .08 blood alcohol concentration laws, minimum legal drinking age laws, and sobriety checkpoints. Sufficient evidence was found for the effectiveness of lower blood alcohol concentration laws for young and inexperienced drivers and of intervention training programs for servers of alcoholic beverages. Additional information is provided about the applicability, other effects, and barriers to implementation of these interventions. CONCLUSION: These reviews form the basis of the recommendations by the Task Force on Community Preventive Services presented elsewhere in this supplement. They can help decision makers identify and implement effective interventions that fit within an overall strategy to prevent impaired driving.