Alcohol and Motorcycle Fatalities SUSAN P. BAKER, MPH, AND RUSSELL S. FISHER, MD
Abstract: A series of 99 fatal motorcycle crashes in Maryland was studied retrospectively, using police and medical examiner records. Blood alcohol concentrations were determined for 62 motorcycle drivers; measurable amounts of alcohol were found in twothirds (41), and one-half (31) had illegally high concen-
trations of 100 mg/100 ml or more. The police report mentioned alcohol in only 9 instances. High blood alcohol concentrations were found most commonly among drivers age 20-34. (Am. J. Public Health 67:246-249, 1977)
Approximately 3,200 motorcyclists were killed in the United States in 1975.1 The number of deaths per personmile of travel is about seven times as great for motorcyclists as for car occupants.2 Much of this difference in risk results from the motorcycle's lack of an enclosed occupant compartment to protect riders when a crash occurs. Prevention of the crash itself is therefore of special importance for motorcyclists, and various training and educational programs emphasize crash prevention. Almost no attention, however, is given to the fact that alcohol impairment can substantially increase a motorcyclist's likelihood of being involved in a crash. Indeed, most educational materials and reports describing important factors in motorcycle crashes make no mention of alcohol. The prevalence of alcohol usage in connection with motorcycling has not been measured. A recent magazine article, however, depicted the combination of beer drinking and motorcycling as common practice among members of a group of motorcyclists.3 Police reports indicate that the percentage of motorcycle operators who have been drinking is 3 per cent for those involved in Maryland crashes,4 4 per cent in North Carolina car-cycle crashes, and 14 per cent in North Carolina single vehicle crashes.5 These are probably underestimates, since police reports substantially underrepresent the involvement of alcohol in crashes of other types of vehi-
Alcohol intoxication can contribute to highway mortality in a variety of ways, including the obscuring of clinical signs in the injured patient.8 As a causal factor, its importance increases with crash severity.6 In a study of fatal motorcycle crashes in 1962-1966 in Los Angeles County, California, the medical examiner's office found that 35 per cent of the operators killed had blood alcohol concentrations of 100 mg/100 ml or more,9 i.e., concentrations considered evidence of intoxication in almost all states in the U.S. Our impression that high blood alcohol concentrations are more common in fatal motorcycle crashes than previous reports in the literature suggest, as well as the general lack of attention to the role of alcohol impairment in motorcycle crashes, prompted a retrospective study to determine the prevalence of alcohol among motorcycle operators killed in
cles.6' 7 From the Division of Forensic Pathology, Johns Hopkins School of Hygiene and Public Health, and the Chief Medical Examiner's Office, State of Maryland. Address reprint requests to Susan P. Baker, MPH, 111 Penn Street, Baltimore, MD 21201. This paper, submitted to the Journal October 21, 1976, was revised and accepted for publication December 3, 1976. 246
Maryland.
Methods Records at the Office of the Chief Medical Examiner of Maryland and the Maryland State Police were searched to identify fatal motorcycle crashes in Maryland from January 1973, through June 1975. Data relating to the circumstances of each crash were obtained from police records, and information on blood alcohol concentrations from medical examiner records.
Results Circumstances of the Crashes Ninety-nine fatal motorcycle crashes were identified for the two and one-half year period. There were 36 crashes in AJPH March, 1977, Vol. 67, No. 3
ALCOHOL AND MOTORCYCLE FATALITIES
which no other vehicles were involved (except parked vehicles, in two instances), and 63 involving other vehicles. The latter group included five cyclists who were struck after being thrown from their cycles and six cases in which other moving vehicles were involved without contacting the motorcycle or cyclist (e.g., the motorcycle left the road avoiding a left-turning car). Twenty-nine per cent of the other vehicles (18 of 63) were making a left turn into the path of a motorcycle. Ninety-four crashes occurred on public roads. Police reports indicated the road was curved in 32 cases that comprised 47 per cent of the single vehicle crashes and 24 per cent of the crashes involving other vehicles. The motorcyclists' ability to see or their visibility to other drivers may have been a factor in many instances. Twothirds of the crashes occurred between 6 PM and 6 AM. It was raining at the time of nine crashes, foggy in three. Circumstances of the crashes suggested that the other driver had not seen the motorcycle in 14 of the 24 collisions with other moving vehicles that occurred in the dawn, daylight, or dusk. Persons Killed One hundred and three motorcyclists were killed-91 drivers and 12 passengers. Ninety-six (93 per cent) were white. One driver and eight passengers were females. In 24 crashes, there were two riders on the motorcycle. In four cases both were killed, in 12 cases the driver, and in eight the passenger. Police reports described all 19 survivors as injured, 13 severely. Table I shows the age distribution of those killed: 86 per cent were age 18 or older; the median age was 25. Of four who were less than 16 years of age, one was illegally operating a motorcycle on a public road; two were passengers; the fourth, age eight, was riding on a back-yard track when he collided head-on with another motorcycle. Death occurred within an hour of injury in 62 per cent of all cases (Table 2); 81 per cent of the deaths occurred within 24 hours. Alcohol Blood alcohol concentrations (BACs) were determined for 62 motorcycle operators. For six others the post mortem TABLE 1-Age of Fatally Injured Motorcyclists Age
Number
1 hourto 6 hours to 24 hours 2 24 hours to 7 days 8 to 30 days 31 days or longer Total -
# Cases
Cumulative%
49 14 12 8
48 62 74 81 88 96 100
7
8 4 102*
*Excludes 1 case, survival time unknown.
blood sample was lost, contaminated, or not drawn. BACs were not determined for the remaining 23 fatally injured drivers because they survived longer than four hours. The drivers tested did not differ significantly from those not tested in age, time of crash, or whether they were responsible for the crash. Forty-one of the 62 drivers tested (66 per cent) had measurable BACs; 31 (50 per cent) had BACs of 100 mg/100 ml or greater. The median positive BAC was 140 mg/100 ml. Tests for alcohol were negative most commonly among motorcycle drivers who appeared not to have been responsible for causing the crashes, i.e., another vehicle failed to yield the right of way, struck the motorcycle in the rear, or was traveling in the wrong lane (Figure 1). BACs of 100 mg/ 100 ml or greater were found for 25 out of 42 drivers who were probably responsible in single- or multi-vehicle 10C
N=27
N=15
N=17
YO
80
z 0 I
70
Cb
BLOOD ALCOHOL CONCENTRATION IMG/100 MLI
m50 SO 100-°°140 150-190
40
cc3:
BR
23G240
30
250+ 20 _
10
SINGLE VEHICLE
MULTIVEHICLE
APPARENTLY RESPONSIBLE
APPARENTLY NOT RESPONSIBLE
FIGURE 1-Blood Alcohol Concentration of Motorcycle Drivers in Relation to Responsibility for Crash. Excludes 3 drivers for whom responsibility could not be determined, 29 not tested for alcohol (primarily because of prolonged survival), and 8 drivers not killed. 247
BAKER AND FISHER
crashes, compared to 5 of 17 drivers probably not responsible (p = 0.03, Fisher's exact test). Alcohol was present more often in nighttime crashes (Table 3). High BACs were especially common among drivers age 20-34: 26 of 38 had BACs of 100 mg/100 ml or more, compared with 5 of 24 who were younger than 20 or older than 34 (p = 0.003, Fisher's exact test). Police information on condition of the driver underreported alcohol use (Table 4). Of 31 drivers with BACs of 100 mg/100 ml or greater, police categorized nine as 'normal", nine as "had been drinking," and 13 as "condition unknown."
Discussion The present study indicates that 50 per cent of the motorcycle drivers killed in Maryland had consumed enough alTABLE 3-Alcohol by Time of Injury Blood alcohol concentration of drver mg/100 ml
Midnite -5:59
6 AM -11:59
Noon -5:59
6 PM -11:59
TOTAL
0 10-40 50-90 100-140 150-190 200+
2 1 1 7 3 2
2 0 0 0 0 0
8 3 0 0 4 1
9 2 3 4 7 3
21 6 4 11 14 6
Total, driver tested Unknown
16
2
16
28
62
5
3
12
17
37*
Total
21
5
28
45
99
Includes 8 drivers who were not killed, 23 who survived more than 4 hours, and 6 others.
TABLE 4-Blood Alcohol Concentration by Police Report of Driver Condition Driver Condition (Police Report) Blood alcohol concentration of driver, mg/i 00 ml
0 10-40 50-90 100-140 150-190 200+ Total, driver tested
Unknown Total
Apparently Normal
16 0 1 3 4 2
Had been drinking
1' 1 1 4 3 2
Condition Unknown
Total
4
21
5
6
2 4 7 2
4 11 14 6
26
12
24
62
20
8
9
37
46
20
33
99
*Police report said "Had been drinking, condition apparently normal"
248
cohol to reach or exceed an illegal blood alcohol concentration of 100 mg/100 ml; 66 per cent had measurable amounts of alcohol in the blood. The corresponding proportions reported for California motorcyclists killed a decade ago were 35 per cent and 46 per cent.9 The distribution of alcohol concentrations in the Maryland motorcylists was roughly similar to that previously reported for drivers of cars and trucks who were killed in Maryland.10 Estimating the degree to which alcohol contributed causally to these motorcycle crashes would require determination of the prevalence of alcohol among comparable motorcyclists not involved in crashes, a method that has been used to show the contribution of alcohol to other categories of fatal crashes.7 "I The causal role of alcohol is nevertheless suggested by the association between the presence and amount of alcohol and the degree to which motorcyclists appeared to be responsible for causing the crashes. Fatally injured motorcyclists were older, on average, than motorcycle drivers involved in all reported crashes in Maryland in 1973.4 Motorcyclists age 25 or older comprised 50 per cent of the dead motorcyclists (also, 50 per cent of the drivers of motorcycles on which people in this study were killed) but only 34 per cent of drivers in reported crashes. The larger proportion of older drivers in the fatal crashes may be due to less alcohol usage among younger drivers. The fact that 86 per cent of the motorcyclists killed were age 18 or older deserves attention because Congress recently enacted legislation forbidding the Department of Transportation to withhold any funds from states for failure to mandate helmet use by persons age 18 or older. Subsequent efforts to repeal helmet laws, although defeated in Maryland, have been successful in several states and can be expected to continue.'2 This is especially unfortunate since motorcycle helmet laws have been shown to increase helmet use and to reduce motorcyclist deaths by about 30 per cent.'3 While the helmet is the best available means of preventing death once a motorcycle crash occurs, preventing the crash is of extreme importance. In addition to alcohol, motorcycle visibility and road curvature frequently appeared to be relevant factors. Visibility could be improved by daytime use of lights, which has been shown to reduce crashes and is required by law in some states but not in Maryland.'3, 14 The problem of curves should be addressed both by motorcyclists' training and by environmental modifications; the latter would benefit others besides motorcyclists, since road curvature is also a major factor in fatal crashes of cars and trucks."5 Impairment by alcohol may well be the most important human factor contributing to fatal motorcycle crashes. Failure to recognize this is due in part to police underreporting. In the present study, less than one third of the motorcycle drivers with BACs of 100 mg/100 ml or greater were reported by the police to have been drinking. This emphasizes the need for chemical tests for alcohol in the case of all drivers (including surviving drivers) as soon as possible following all fatal crashes. Countermeasures directly related to alcohol include emphasizing the adverse effects of alcohol in all motorcycle education courses, identifying motorcylists with drinking problems and providing adequate treatment, and addressAJPH March, 1977, Vol. 67, No. 3
ALCOHOL AND MOTORCYCLE FATALITIES
ing the problems underlying acute and chronic alcoholism. Applied to other categories of road users, however, such strategies have yet to produce an undisputed reduction in the number of alcohol-related fatalities. Therefore attention also must be given to the wide variety of counter-measures16' 17 that can reduce the likelihood of death or injury for all motorcyclists, impaired or not.
REFERENCES 1. National Transportation Safety Board. Transportation accidents in 1975. Washington, DC: National Transportation Safety Board, 1976. 2. Haddon, W. Jr., Baker, S. P. Injury control. in Preventive Medicine. Second edition. Clark, D. W. and MacMahon, B. Eds. Boston: Little, Brown, and Company. To be published. 3. Kelly, F. Motorcyclists with business cards. Baltimore SUN Magazine. October 4, 1975, pp 5-14. 4. Reiss, M. L., Berger, W. G., Valette G. R. Analysis of Motorcycle Accidents and Statistics. Elkridge, MD: Motorcycle Safety Foundation, 1974. 5. Griffin, L. I. III. Motorcycle Accidents: Who, When, Where, and Why. Chapel Hill, NC: Highway Safety Research Center, 1974. 6. U.S. Department of Transportation: 1%8 Alcohol and Highway Safety Report. Washington: Govt. Printing Office, 1968. 7. Baker, S. P. Alcohol in fatal tractor trailer crashes. Proceedings of the 19th Conference of AAAM. Morton Grove, IL: American Association for Automotive Medicine, 1975.
I
8. Champion, H. R., Caplan, Y. H., Baker, S. P., et al. Alcohol intoxication and serum osmolality. Lancet 1:1402-1404, 1975. 9. Graham, J. W. Fatal Motorcycle Accidents. J. Forensic Sci. 14:79-86, 1969. 10. Baker, S. P., Spitz, W. U. Age effects and autopsy evidence of disease in fatally injured drivers. JAMA 214:1079-1088, 1970. 11. McCarroll, J. R., Haddon, W. Jr. A controlled study of fatal automobile accidents in New York City. J. Chronic Dis. 15:811826, 1962. 12. Kelley, A. B. Motorcycles and public apathy. Am. J. Public Health 66:475-476, 1976. 13. Robertson, L. S. An instance of effective legal regulation: motorcyclist helmet and daytime headlamp use laws. Law and Society Review, in press. 14. Griffin, L. I., Waller, P. F. The impact of a motorcycle "lightson" law. Highway Safety Highlights 9:12:2-3, 1976. Chapel Hill, NC: Highway Safety Research Center. 15. Wright, P., Robertson, L. S. Priorities for roadside hazard modification: A study of 300 fatal roadside object crashes. Traffic Engineering 46:8:24-30, 1976. 16. Drysdale, W. F., Kraus, J. F., Franti, C. E., et al. Injury patterns in motorcycle collisions. J. Trauma 15:99-115, 1975. 17. Kraus, J. F., Riggins, R. S., Franti, C. E. Some epidemiologic features of motorcycle collision injuries. Am. J. Epidemiology 102:74-98, 1975.
ACKNOWLEDGMENTS This study was supported by the Insurance Institute for Highway Safety and the Maryland Medical-Legal Foundation. The cooperation of the Maryland State Police is greatly appreciated.
Postdoctoral Training Program in Mental Health Services
I
Applications are now being received for Yale University's postdoctoral training program designed to develop skills to engage in professional careers as investigators and teachers in the field of mental health program evaluation and research. The program consists of course work and opportunities for interdisciplinary research and can be structured for a period of two years. Applicants must have a doctoral degree in medicine, epidemiology, public health, nursing, social work, or the behavioral or administrative sciences. The program is funded by the Alcohol, Drug Abuse, and Mental Health Administration of HEW, and provides for a limited number of stipends between $10,000 and $13,200. The deadline for applications is April 15, 1977. Notification of admission will be made by May 30, 1977. For information write: Lee D. Brauer, MD, Program Coordinator, Program in Mental Health Services Evaluation and Research, Center for the Study of Health Services, Institution for Social and Policy Studies, Yale University, 77 Prospect Street, New Haven, CT 06520
AJPH March, 1977, Vol. 67, No. 3
249
Abstract: A series of 99 fatal motorcycle crashes in Maryland was studied retrospectively, using police and medical examiner records. Blood alcohol concentrations were determined for 62 motorcycle drivers; measurable amounts of alcohol were found in twothirds (41), and one-half (31) had illegally high concen-
trations of 100 mg/100 ml or more. The police report mentioned alcohol in only 9 instances. High blood alcohol concentrations were found most commonly among drivers age 20-34. (Am. J. Public Health 67:246-249, 1977)
Approximately 3,200 motorcyclists were killed in the United States in 1975.1 The number of deaths per personmile of travel is about seven times as great for motorcyclists as for car occupants.2 Much of this difference in risk results from the motorcycle's lack of an enclosed occupant compartment to protect riders when a crash occurs. Prevention of the crash itself is therefore of special importance for motorcyclists, and various training and educational programs emphasize crash prevention. Almost no attention, however, is given to the fact that alcohol impairment can substantially increase a motorcyclist's likelihood of being involved in a crash. Indeed, most educational materials and reports describing important factors in motorcycle crashes make no mention of alcohol. The prevalence of alcohol usage in connection with motorcycling has not been measured. A recent magazine article, however, depicted the combination of beer drinking and motorcycling as common practice among members of a group of motorcyclists.3 Police reports indicate that the percentage of motorcycle operators who have been drinking is 3 per cent for those involved in Maryland crashes,4 4 per cent in North Carolina car-cycle crashes, and 14 per cent in North Carolina single vehicle crashes.5 These are probably underestimates, since police reports substantially underrepresent the involvement of alcohol in crashes of other types of vehi-
Alcohol intoxication can contribute to highway mortality in a variety of ways, including the obscuring of clinical signs in the injured patient.8 As a causal factor, its importance increases with crash severity.6 In a study of fatal motorcycle crashes in 1962-1966 in Los Angeles County, California, the medical examiner's office found that 35 per cent of the operators killed had blood alcohol concentrations of 100 mg/100 ml or more,9 i.e., concentrations considered evidence of intoxication in almost all states in the U.S. Our impression that high blood alcohol concentrations are more common in fatal motorcycle crashes than previous reports in the literature suggest, as well as the general lack of attention to the role of alcohol impairment in motorcycle crashes, prompted a retrospective study to determine the prevalence of alcohol among motorcycle operators killed in
cles.6' 7 From the Division of Forensic Pathology, Johns Hopkins School of Hygiene and Public Health, and the Chief Medical Examiner's Office, State of Maryland. Address reprint requests to Susan P. Baker, MPH, 111 Penn Street, Baltimore, MD 21201. This paper, submitted to the Journal October 21, 1976, was revised and accepted for publication December 3, 1976. 246
Maryland.
Methods Records at the Office of the Chief Medical Examiner of Maryland and the Maryland State Police were searched to identify fatal motorcycle crashes in Maryland from January 1973, through June 1975. Data relating to the circumstances of each crash were obtained from police records, and information on blood alcohol concentrations from medical examiner records.
Results Circumstances of the Crashes Ninety-nine fatal motorcycle crashes were identified for the two and one-half year period. There were 36 crashes in AJPH March, 1977, Vol. 67, No. 3
ALCOHOL AND MOTORCYCLE FATALITIES
which no other vehicles were involved (except parked vehicles, in two instances), and 63 involving other vehicles. The latter group included five cyclists who were struck after being thrown from their cycles and six cases in which other moving vehicles were involved without contacting the motorcycle or cyclist (e.g., the motorcycle left the road avoiding a left-turning car). Twenty-nine per cent of the other vehicles (18 of 63) were making a left turn into the path of a motorcycle. Ninety-four crashes occurred on public roads. Police reports indicated the road was curved in 32 cases that comprised 47 per cent of the single vehicle crashes and 24 per cent of the crashes involving other vehicles. The motorcyclists' ability to see or their visibility to other drivers may have been a factor in many instances. Twothirds of the crashes occurred between 6 PM and 6 AM. It was raining at the time of nine crashes, foggy in three. Circumstances of the crashes suggested that the other driver had not seen the motorcycle in 14 of the 24 collisions with other moving vehicles that occurred in the dawn, daylight, or dusk. Persons Killed One hundred and three motorcyclists were killed-91 drivers and 12 passengers. Ninety-six (93 per cent) were white. One driver and eight passengers were females. In 24 crashes, there were two riders on the motorcycle. In four cases both were killed, in 12 cases the driver, and in eight the passenger. Police reports described all 19 survivors as injured, 13 severely. Table I shows the age distribution of those killed: 86 per cent were age 18 or older; the median age was 25. Of four who were less than 16 years of age, one was illegally operating a motorcycle on a public road; two were passengers; the fourth, age eight, was riding on a back-yard track when he collided head-on with another motorcycle. Death occurred within an hour of injury in 62 per cent of all cases (Table 2); 81 per cent of the deaths occurred within 24 hours. Alcohol Blood alcohol concentrations (BACs) were determined for 62 motorcycle operators. For six others the post mortem TABLE 1-Age of Fatally Injured Motorcyclists Age
Number
1 hourto 6 hours to 24 hours 2 24 hours to 7 days 8 to 30 days 31 days or longer Total -
# Cases
Cumulative%
49 14 12 8
48 62 74 81 88 96 100
7
8 4 102*
*Excludes 1 case, survival time unknown.
blood sample was lost, contaminated, or not drawn. BACs were not determined for the remaining 23 fatally injured drivers because they survived longer than four hours. The drivers tested did not differ significantly from those not tested in age, time of crash, or whether they were responsible for the crash. Forty-one of the 62 drivers tested (66 per cent) had measurable BACs; 31 (50 per cent) had BACs of 100 mg/100 ml or greater. The median positive BAC was 140 mg/100 ml. Tests for alcohol were negative most commonly among motorcycle drivers who appeared not to have been responsible for causing the crashes, i.e., another vehicle failed to yield the right of way, struck the motorcycle in the rear, or was traveling in the wrong lane (Figure 1). BACs of 100 mg/ 100 ml or greater were found for 25 out of 42 drivers who were probably responsible in single- or multi-vehicle 10C
N=27
N=15
N=17
YO
80
z 0 I
70
Cb
BLOOD ALCOHOL CONCENTRATION IMG/100 MLI
m50 SO 100-°°140 150-190
40
cc3:
BR
23G240
30
250+ 20 _
10
SINGLE VEHICLE
MULTIVEHICLE
APPARENTLY RESPONSIBLE
APPARENTLY NOT RESPONSIBLE
FIGURE 1-Blood Alcohol Concentration of Motorcycle Drivers in Relation to Responsibility for Crash. Excludes 3 drivers for whom responsibility could not be determined, 29 not tested for alcohol (primarily because of prolonged survival), and 8 drivers not killed. 247
BAKER AND FISHER
crashes, compared to 5 of 17 drivers probably not responsible (p = 0.03, Fisher's exact test). Alcohol was present more often in nighttime crashes (Table 3). High BACs were especially common among drivers age 20-34: 26 of 38 had BACs of 100 mg/100 ml or more, compared with 5 of 24 who were younger than 20 or older than 34 (p = 0.003, Fisher's exact test). Police information on condition of the driver underreported alcohol use (Table 4). Of 31 drivers with BACs of 100 mg/100 ml or greater, police categorized nine as 'normal", nine as "had been drinking," and 13 as "condition unknown."
Discussion The present study indicates that 50 per cent of the motorcycle drivers killed in Maryland had consumed enough alTABLE 3-Alcohol by Time of Injury Blood alcohol concentration of drver mg/100 ml
Midnite -5:59
6 AM -11:59
Noon -5:59
6 PM -11:59
TOTAL
0 10-40 50-90 100-140 150-190 200+
2 1 1 7 3 2
2 0 0 0 0 0
8 3 0 0 4 1
9 2 3 4 7 3
21 6 4 11 14 6
Total, driver tested Unknown
16
2
16
28
62
5
3
12
17
37*
Total
21
5
28
45
99
Includes 8 drivers who were not killed, 23 who survived more than 4 hours, and 6 others.
TABLE 4-Blood Alcohol Concentration by Police Report of Driver Condition Driver Condition (Police Report) Blood alcohol concentration of driver, mg/i 00 ml
0 10-40 50-90 100-140 150-190 200+ Total, driver tested
Unknown Total
Apparently Normal
16 0 1 3 4 2
Had been drinking
1' 1 1 4 3 2
Condition Unknown
Total
4
21
5
6
2 4 7 2
4 11 14 6
26
12
24
62
20
8
9
37
46
20
33
99
*Police report said "Had been drinking, condition apparently normal"
248
cohol to reach or exceed an illegal blood alcohol concentration of 100 mg/100 ml; 66 per cent had measurable amounts of alcohol in the blood. The corresponding proportions reported for California motorcyclists killed a decade ago were 35 per cent and 46 per cent.9 The distribution of alcohol concentrations in the Maryland motorcylists was roughly similar to that previously reported for drivers of cars and trucks who were killed in Maryland.10 Estimating the degree to which alcohol contributed causally to these motorcycle crashes would require determination of the prevalence of alcohol among comparable motorcyclists not involved in crashes, a method that has been used to show the contribution of alcohol to other categories of fatal crashes.7 "I The causal role of alcohol is nevertheless suggested by the association between the presence and amount of alcohol and the degree to which motorcyclists appeared to be responsible for causing the crashes. Fatally injured motorcyclists were older, on average, than motorcycle drivers involved in all reported crashes in Maryland in 1973.4 Motorcyclists age 25 or older comprised 50 per cent of the dead motorcyclists (also, 50 per cent of the drivers of motorcycles on which people in this study were killed) but only 34 per cent of drivers in reported crashes. The larger proportion of older drivers in the fatal crashes may be due to less alcohol usage among younger drivers. The fact that 86 per cent of the motorcyclists killed were age 18 or older deserves attention because Congress recently enacted legislation forbidding the Department of Transportation to withhold any funds from states for failure to mandate helmet use by persons age 18 or older. Subsequent efforts to repeal helmet laws, although defeated in Maryland, have been successful in several states and can be expected to continue.'2 This is especially unfortunate since motorcycle helmet laws have been shown to increase helmet use and to reduce motorcyclist deaths by about 30 per cent.'3 While the helmet is the best available means of preventing death once a motorcycle crash occurs, preventing the crash is of extreme importance. In addition to alcohol, motorcycle visibility and road curvature frequently appeared to be relevant factors. Visibility could be improved by daytime use of lights, which has been shown to reduce crashes and is required by law in some states but not in Maryland.'3, 14 The problem of curves should be addressed both by motorcyclists' training and by environmental modifications; the latter would benefit others besides motorcyclists, since road curvature is also a major factor in fatal crashes of cars and trucks."5 Impairment by alcohol may well be the most important human factor contributing to fatal motorcycle crashes. Failure to recognize this is due in part to police underreporting. In the present study, less than one third of the motorcycle drivers with BACs of 100 mg/100 ml or greater were reported by the police to have been drinking. This emphasizes the need for chemical tests for alcohol in the case of all drivers (including surviving drivers) as soon as possible following all fatal crashes. Countermeasures directly related to alcohol include emphasizing the adverse effects of alcohol in all motorcycle education courses, identifying motorcylists with drinking problems and providing adequate treatment, and addressAJPH March, 1977, Vol. 67, No. 3
ALCOHOL AND MOTORCYCLE FATALITIES
ing the problems underlying acute and chronic alcoholism. Applied to other categories of road users, however, such strategies have yet to produce an undisputed reduction in the number of alcohol-related fatalities. Therefore attention also must be given to the wide variety of counter-measures16' 17 that can reduce the likelihood of death or injury for all motorcyclists, impaired or not.
REFERENCES 1. National Transportation Safety Board. Transportation accidents in 1975. Washington, DC: National Transportation Safety Board, 1976. 2. Haddon, W. Jr., Baker, S. P. Injury control. in Preventive Medicine. Second edition. Clark, D. W. and MacMahon, B. Eds. Boston: Little, Brown, and Company. To be published. 3. Kelly, F. Motorcyclists with business cards. Baltimore SUN Magazine. October 4, 1975, pp 5-14. 4. Reiss, M. L., Berger, W. G., Valette G. R. Analysis of Motorcycle Accidents and Statistics. Elkridge, MD: Motorcycle Safety Foundation, 1974. 5. Griffin, L. I. III. Motorcycle Accidents: Who, When, Where, and Why. Chapel Hill, NC: Highway Safety Research Center, 1974. 6. U.S. Department of Transportation: 1%8 Alcohol and Highway Safety Report. Washington: Govt. Printing Office, 1968. 7. Baker, S. P. Alcohol in fatal tractor trailer crashes. Proceedings of the 19th Conference of AAAM. Morton Grove, IL: American Association for Automotive Medicine, 1975.
I
8. Champion, H. R., Caplan, Y. H., Baker, S. P., et al. Alcohol intoxication and serum osmolality. Lancet 1:1402-1404, 1975. 9. Graham, J. W. Fatal Motorcycle Accidents. J. Forensic Sci. 14:79-86, 1969. 10. Baker, S. P., Spitz, W. U. Age effects and autopsy evidence of disease in fatally injured drivers. JAMA 214:1079-1088, 1970. 11. McCarroll, J. R., Haddon, W. Jr. A controlled study of fatal automobile accidents in New York City. J. Chronic Dis. 15:811826, 1962. 12. Kelley, A. B. Motorcycles and public apathy. Am. J. Public Health 66:475-476, 1976. 13. Robertson, L. S. An instance of effective legal regulation: motorcyclist helmet and daytime headlamp use laws. Law and Society Review, in press. 14. Griffin, L. I., Waller, P. F. The impact of a motorcycle "lightson" law. Highway Safety Highlights 9:12:2-3, 1976. Chapel Hill, NC: Highway Safety Research Center. 15. Wright, P., Robertson, L. S. Priorities for roadside hazard modification: A study of 300 fatal roadside object crashes. Traffic Engineering 46:8:24-30, 1976. 16. Drysdale, W. F., Kraus, J. F., Franti, C. E., et al. Injury patterns in motorcycle collisions. J. Trauma 15:99-115, 1975. 17. Kraus, J. F., Riggins, R. S., Franti, C. E. Some epidemiologic features of motorcycle collision injuries. Am. J. Epidemiology 102:74-98, 1975.
ACKNOWLEDGMENTS This study was supported by the Insurance Institute for Highway Safety and the Maryland Medical-Legal Foundation. The cooperation of the Maryland State Police is greatly appreciated.
Postdoctoral Training Program in Mental Health Services
I
Applications are now being received for Yale University's postdoctoral training program designed to develop skills to engage in professional careers as investigators and teachers in the field of mental health program evaluation and research. The program consists of course work and opportunities for interdisciplinary research and can be structured for a period of two years. Applicants must have a doctoral degree in medicine, epidemiology, public health, nursing, social work, or the behavioral or administrative sciences. The program is funded by the Alcohol, Drug Abuse, and Mental Health Administration of HEW, and provides for a limited number of stipends between $10,000 and $13,200. The deadline for applications is April 15, 1977. Notification of admission will be made by May 30, 1977. For information write: Lee D. Brauer, MD, Program Coordinator, Program in Mental Health Services Evaluation and Research, Center for the Study of Health Services, Institution for Social and Policy Studies, Yale University, 77 Prospect Street, New Haven, CT 06520
AJPH March, 1977, Vol. 67, No. 3
249
