28 April 2022 In Drinking & Driving

BACKGROUND: Road traffic crashes (RTCs) are among the eight-leading causes of death globally. Strategies and policies have been put in place by many countries to reduce RTCs and to prevent RTCs and related injuries/deaths.

METHODS: In this review, we searched the following databases Ovid Medline, Embase, Cochrane Database of Systematic Reviews, Epistemonikos, Web of Science, and LILACS for reviews matching our inclusion criteria between periods January 1950 and March 2020. We did not apply language or publication restrictions in the searches. We, however, excluded reviews that focused primarily on injury prevention and reviews that looked at crashes not involving a motor vehicle.

RESULTS: We identified 35 systematic reviews matching our inclusion criteria and most of the reviews (33/35) included studies strictly from high-income countries. Most reviews were published before 2015, with only 5 published between 2015 and 2020. Methodological quality varied between reviews. Most reviews focused on enforcement intervention. There was strong evidence that random breath testing, selective breath testing, and sobriety checkpoints were effective in reducing alcohol-related crashes and associated fatal and nonfatal injuries. Other reviews found that sobriety checkpoints reduced the number of crashes by 17% [CI: (- 20, - 14)]. Road safety campaigns were found to reduce the numbers of RTCs by 9% [CI: (- 11, - 8%)]. Mass media campaigns indicated some median decrease in crashes across all studies and all levels of crash severity was 10% (IQR: 6 to 14%). Converting intersections to roundabouts was associated with a reduction of 30 to 50% in the number of RTCs resulting in injury and property damage. Electronic stability control measure was found to reduce single-vehicle crashes by - 49% [95% CI: (- 55, - 42%)]. No evidence was found to indicate that post-license driver education is effective in preventing road traffic injuries or crashes.

CONCLUSION: There were many systematic reviews of varying quality available which included studies that were conducted in high-income settings. The overview has found that behavioural based interventions are very effective in reducing RTCs.

26 January 2022 In Drinking & Driving
BACKGROUND: Worldwide, alcohol-related road traffic accidents represent a major avoidable health risk. The aim of this study was to evaluate the accuracy of self-estimating the degree of acute alcohol intoxication regarding the legal driving limit, and to identify risk factors for misjudgement. METHODS: In this prospective randomised controlled crossover trial, 90 social drinkers (mean age 23.9 +/- 3.5 years, 50% female) consumed either beer or wine. Study group subjects were made aware when exceeding the legal driving limit (BrAC = 0.05%). Controls received no information about their BrAC. For crossover, beer or wine were consumed in the opposite order. RESULTS: 39-53% of all participants exceeded the legal driving limit whilst under the impression to be still permitted to drive. Self-estimation was significantly more accurate on study day 2 (p = 0.009). Increasing BrAC positively correlated with self-estimation inaccuracy, which was reproducible during crossover. Multiple regression analysis revealed fast drinking and higher alcohol levels as independent risk factors for inaccurate self-estimation. CONCLUSIONS: Social drinkers are commonly unaware of exceeding the legal driving limit when consuming alcohol. Self-estimating alcohol intoxication can be improved through awareness. Dedicated awareness programs, social media campaigns and government advice communications should be utilised to address this avoidable hazard. Trial registration The trial was registered prospectively at the Witten/Herdecke University Ethics Committee (trial registration number 140/2016 on 04/11/2016) and at the DRKS-German Clinical Trials Register (trial registration number DRKS00015285 on 08/22/2018-Retrospectively registered). Trial protocol can be accessed online.
26 May 2021 In Drinking & Driving
Alcohol is the most frequently detected substance in drivers involved in road traffic collisions. Given that up to 35% of fatal road collisions are alcohol-related, it is important to determine the influence of alcohol intoxication on driving-related skills. This review provides an updated and systematic evaluation of the available research concerning the effect of alcohol intoxication on cognitive functions critical for driving. Databases EBSCOhost, PsycInfo, PubMed, Scopus, Transport Research International Documentation (TRID) and Web of Science were searched for controlled trials examining the effect of alcohol on divided attention, executive functioning, perception, psychomotor skills, reaction time and/or vigilance. Fourteen studies met the inclusion criteria and were included in this review. We found that each of the cognitive domains assessed in this review showed impairment at blood alcohol concentrations equal to or below the legal driving limit in many jurisdictions. Future research could determine the effects of alcohol on cognitive functioning with greater accuracy by employing more consistent, reliable and comparable measures while considering the translation of deficits to real-life driving.
22 February 2019 In Drinking & Driving

BACKGROUND: Drink driving is an important risk factor for road traffic accidents (RTAs), which cause high levels of morbidity and mortality globally. Lowering the permitted blood alcohol concentration (BAC) for drivers is a common public health intervention that is enacted in countries and jurisdictions across the world. In Scotland, on Dec 5, 2014, the BAC limit for drivers was reduced from 0.08 g/dL to 0.05 g/dL. We therefore aimed to evaluate the effects of this change on RTAs and alcohol consumption.

METHODS: In this natural experiment, we used an observational, comparative interrupted time-series design by use of data on RTAs and alcohol consumption in Scotland (the interventional group) and England and Wales (the control group). We obtained weekly counts of RTAs from police accident records and we estimated weekly off-trade (eg, in supermarkets and convenience stores) and 4-weekly on-trade (eg, in bars and restaurants) alcohol consumption from market research data. We also used data from automated traffic counters as denominators to calculate RTA rates. We estimated the effect of the intervention on RTAs by use of negative binomial panel regression and on alcohol consumption outcomes by use of seasonal autoregressive integrated moving average models. Our primary outcome was weekly rates of RTAs in Scotland, England, and Wales. This study is registered with ISRCTN, number ISRCTN38602189.

FINDINGS: We assessed the weekly rate of RTAs and alcohol consumption between Jan 1, 2013, and Dec 31, 2016, before and after the BAC limit came into effect on Dec 5, 2014. After the reduction in BAC limits for drivers in Scotland, we found no significant change in weekly RTA rates after adjustment for seasonality and underlying temporal trend (rate ratio 1.01, 95% CI 0.94-1.08; p=0.77) or after adjustment for seasonality, the underlying temporal trend, and the driver characteristics of age, sex, and socioeconomic deprivation (1.00, 0.96-1.06; p=0.73). Relative to RTAs in England and Wales, where the reduction in BAC limit for drivers did not occur, we found a 7% increase in weekly RTA rates in Scotland after this reduction in BAC limit for drivers (1.07, 1.02-1.13; p=0.007 in the fully-adjusted model). Similar findings were observed for serious or fatal RTAs and single-vehicle night-time RTAs. The change in legislation in Scotland was associated with no change in alcohol consumption, measured by per-capita off-trade sales (-0.3%, -1.7 to 1.1; p=0.71), but a 0.7% decrease in alcohol consumption measured by per-capita on-trade sales (-0.7%, -0.8 to -0.5; p<0.0001).

INTERPRETATION: Lowering the driving BAC limit to 0.05 g/dL from 0.08 g/dL in Scotland was not associated with a reduction in RTAs, but this change was associated with a small reduction in per-capita alcohol consumption from on-trade alcohol sales. One plausible explanation is that the legislative change was not suitably enforced-for example with random breath testing measures. Our findings suggest that changing the legal BAC limit for drivers in isolation does not improve RTA outcomes. These findings have significant policy implications internationally as several countries and jurisdictions consider a similar reduction in the BAC limit for drivers.

FUNDING: National Institute for Health Research Public Health Research Programme.

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