©
Annals of Advances in Automotive Medicine
Evaluation of Impaired Driving Assessments and Special Management Reviews in Reducing Impaired Driving Fatal Crashes in the United States James Fell, Amy Auld-Owens and Cecelia Snowden Pacific Institute for Research & Evaluation, Calverton, Maryland, USA __________________________________ ABSTRACT – Since 1991, State Impaired-Driving Assessments (IDAs) and Special Management Reviews (SMRs) have been conducted by the National Highway Traffic Safety Administration (NHTSA) to serve as a mechanism to assess the impaireddriving problem in the State, document the existing system, recommend improvements, and garner both political and public support to fund and implement improvements. Did these assessments and reviews serve the States as intended and provide a catalyst to reduce impaired driving? Almost half of the priority recommendations from IDAs in seven States and 60% of the priority recommendations in SMR States were implemented. Barriers to the implementation of some recommendations are discussed. IDAs and SMRs implemented at varying times were examined using logistic regression analyses of the Fatality Analysis Reporting System (FARS) for the years 1990 to 2008 to determine the effect they may have triggered on impaired driving rates in fatal crashes. States receiving IDAs and SMRs were compared to similar States not receiving them. Paired comparisons of similar States (e.g. IDA-State vs. non-IDA State) did not reveal any significant differences in impaired driving rates, but IDA and SMR States as a group showed significantly greater impaired driving declines in fatal crashes compared to non-IDA and non-SMR States as a group. IDAs and SMRs appear to provide a mechanism to examine the State’s impaireddriving program by an external team of experts and reveal areas where improvement is needed and confirm strategies that appear to be effective. __________________________________
INTRODUCTION Since 1982, impaired driving traffic crash fatalities have decreased from 21,113 to 10,228 in 2010, a 52 percent decrease. The impaired driving fatality rate has decreased even more, from 13.24 fatalities per billion vehicle miles traveled (VMT) in 1982 to 3.41 fatalities per billion VMT in 2010, a 74 percent reduction. The proportion of fatalities involving an impaired driver decreased from 48% to 31% during that time period, a 35 percent reduction in that proportion. Since 1997, the number and rate of impaired driving fatalities have continued to decline from 13,757 to 10,228 in 2010 (down 26%) and from a rate per billion miles travelled of 5.39 in 1997 to 3.45 in 2010 (down 36%). However, the percentage of drivers involved in fatal crashes with illegal per se blood alcohol concentration (BAC) levels (at or above 0.08) has remained at approximately 20 to 22 percent (Figure 1, see Appendix) (National Highway Traffic Safety Administration [NHTSA], 2012). There are many possible reasons for the substantial decrease in the percentage of impaired driving fatal CORRESPONDING AUTHOR: James Fell, Impaired Driving Center, Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Suite 900, Calverton, Maryland Email: [email protected]
crashes between 1982 and 1997 (Dang, 2008). These include (1) the adoption of five major impaired driving laws in the States (.10 blood alcohol concentration (BAC) per se; .08 BAC per se; administrative license revocation (ALR); minimum legal drinking age 21; and zero tolerance laws for youth), (2) the decreasing proportion of the population aged 18 to 34, (3) the increasing proportion of female drivers between 1982 and 1997, and (4) a reduction in per capita alcohol consumption during that time period. The number of impaired driving crashes, injuries, and fatalities continues to be unacceptable, and most are preventable. One measure of the recent extent of the problem and the wide variability in each State appears in Figure 2 (see Appendix). This figure shows the percentage of drivers in fatal crashes with illegal BAC levels Stateby-State averaged over a recent 5-year period (20022006). The percentages range from a low of 12% in Utah to a high of 31% in Montana. There are similar degrees of variability within States (i.e., at the local community level). The solutions to impaired driving lie mainly at the State and local community levels. That is where laws
57th AAAM Annual Conference Annals of Advances in Automotive Medicine September 22-25, 2013
33
Vol 57 • September 2013 are applied and enforced, where programs are implemented, and where changes in strategies can be made. Research has provided some evidence on what works to reduce impaired driving and should be translated and disseminated to the States. NHTSA’s “Uniform Guidelines for State Highway Safety Programs, Guideline No. 8 on Impaired Driving” (NHTSA, 2006) describes six components of a State impaired-driving program. Briefly, the main areas from that guideline are as follows: I. Program Management and Strategic Planning II. Prevention III. Criminal Justice System a. Laws b. Enforcement c. Publicizing High-Visibility Enforcement d. Prosecution e. Adjudication f. Administrative Sanctions and Driver Licensing Programs IV. Communication V. Alcohol and Other Drug Misuse: Screening, Assessment, Treatment, and Rehabilitation VI. Program Evaluation and Data NHTSA has developed two mechanisms to help State and local community leaders assess the local problem, document the existing system that deals with the problem, recommend improvements, and garner local political support and support from the public to fund and implement such improvements State Impaired Driving Assessments (IDAs) and Special Management Reviews (SMRs). Impaired Driving Assessments Since 1991, at the request of any State, NHTSA has helped initiate an IDA of that State. A team of experts, using NHTSA-developed guidelines, assesses the status of a States’ impaired-driving highway safety programs. The team is typically composed of individuals from a variety of backgrounds related to the assessment, including program management, adjudication, enforcement, prevention and treatment, and data records. The guidelines are contained in NHTSA’s “Impaired Driving Technical Assessment Program” (NHTSA, November 2004), which identifies the components of a comprehensive impaired-driving program in a State as including the following: • Strategic Planning and Program Management – DWI task forces, data, records, evaluation, and resources.
34
• Prevention – Communication strategies, responsible beverage service, alternative transportation, and community-based education programs. • Criminal Justice System – Achieve general and specific deterrence; use laws, local ordinances, enforcement, and publicity; and use prosecution, adjudication, and administrative sanctions. • Alcohol and Other Drug Misuse – Screening, assessment, treatment, rehabilitation, and monitoring of driving-while-intoxicated (DWI) offenders. The goal of the IDA is to develop State- and safetyprogram recommendations that address areas that need strengthening. These assessments usually involve interviews with the State- and communitylevel program directors, coordinators, advocates, and traffic safety offices. Other contacts may include enforcement, prosecution, and adjudication officials. The Assessment Team reviews findings, notes strengths and challenges, and makes recommendations for the State. The assessments are to be used as a tool for planning, setting priorities, and making decisions about how to best use available resources. The team also suggests approaches for measuring impaired-driving program progress. The main goals of these assessments are to (1) identify program strengths and accomplishments, (2) uncover challenging issues, and (3) suggest recommendations (including priority recommendations) for improvement. To achieve substantial and lasting declines in alcohol-impaired-driving crashes and fatalities, a combination of planning, coordination, criminal justice requirements, aggressive enforcement, public information, education, and adequate and sustained resources is usually necessary. Each year several States request IDAs of their programs, policies, and practices. Members of the NHTSA ID Division facilitate these assessments and coordinate extensively with NHTSA regional staff. NHTSA staff work with State Highway Safety Offices to select a team of usually five individuals who demonstrate expertise in various aspects of impaired-driving program development and implementation. With the knowledge of what programs and strategies work in other States, the assessment team reviews and documents the strengths and weaknesses of the requesting State’s programs. Examples of some selected priority recommendations from a recent IDA are contained in Table 1.
©
Table 1. Examples of Priority Recommendations Made in an Impaired Driving Assessment
PRIORITY RECOMMENDATIONS 1-C: Program Management • Develop and implement an e-grants system. 1-D: Resources • Institute user-based fees paid by DUI offenders to pay for DUI-specific services such as DUI courts. 2-B: Transportation Alternatives • Assure that both designated driver and safe ride programs avoid any consumption by underage individuals or unintentional enabling of overconsumption. 3-A: Impaired-Driving Laws • Increase the BAC test refusal sanction to be as strict as State’s highest BAC offense. 3-B: Enforcement • Develop and implement procedures for low staff checkpoints. 3-D: Prosecution • Recognize DUI probation before judgment as a prohibited diversion tactic. 4: Communication Program • Develop and implement a comprehensive communication plan in conjunction with Impaired Driving Coalition partners, subgrantees, and communication specialists. 5-B: Treatment and Rehabilitation • Establish research-based, standard screening, assessment, treatment, and monitoring protocols for all DUI offenders. 5-C: Monitoring Impaired Drivers • Improve oversight of noncompliance of ignition interlock restriction and other DUI sentence conditions. 6-B: Data and Records • Use data from the current citation form tracking system and the ADAA system as sources of data for a well-defined DUI Tracking System.
Special Management Reviews In 2004, NHTSA initiated the SMR, a different mechanism for evaluating States’ impaired-driving programs. An SMR “examines management and operational practices in specific program area(s) to determine other relevant information related to program performance and progress” according to
Annals of Advances in Automotive Medicine
NHTSA’s Special Management Review Guidelines. Similar to the IDAs, SMRs consist of (a) interviews with key personnel and/or representatives of the State; and (b) discussions with other relevant organizations. They also involve a review of relevant reports and data files. An important difference between IDAs and SMRs is that the assessment is voluntarily requested by the States, whereas the SMR is conducted because of a State’s “consistently worse-than-average performance and progress [is] less than half of that recorded by the Nation as a whole.” Also, an SMR is conducted by NHTSA Regional and Headquarters staff, while an IDA is coordinated by NHTSA staff, but is conducted by national and State experts. The chief focus of an SMR is on the Highway Safety Office management practices that affect the ID program in the State, while the main focus of the IDA is on activities conducted statewide that address the ID problem. Examples of priority recommendations from a recent SMR appear in Table 2. Table 2. Examples of Priority Recommendations Made in a Special Management Review
PRIORITY SMR RECOMMENDATIONS Enforcement • Implement saturation patrols and adopt stronger methods of enforcement as described in the saturation patrol countermeasure. Project Issues • Implement mass communication campaigns that use paid and earned media to deter the public from drinking and driving; effective when paired with highvisibility enforcement and a comprehensive communications strategy. Legislative Issues • Overhaul Ignition Interlock program to conform to the “best practices.” Evaluation Issues • Impaired-Driving Data—Further dissect the data to identify impaired driving issues and allocate funding based on that data.
A previous NHTSA report (Johnson, 2004) examined the number and type of recommendations that States received from 1991 to 2003 during their IDAs. A total of 2,982 recommendations were made during the assessments, which the report organized into 10 broad thematic areas. These areas included:
35
Vol 57 • September 2013 1.
Increasing the deterrence effect by prioritizing enforcement efforts and enhancing the arrest, prosecution, and adjudication process; 2. Providing or improving public information and education efforts related to prevention and deterrence; 3. Remedying problems involving DUI data and records (data reporting requirements, offender tracking systems, data linkages, uniform traffic citations, etc.); 4. Enacting new laws or revising existing laws aimed at increasing the deterrence and/or prevention of DUI; 5. Increasing or enhancing training for law enforcement, prosecution, and judicial personnel; 6. Evaluating programs and activities associated with the effort to combat impaired driving; 7. Providing sufficient resources for treatment and rehabilitation (screening, diagnosis, treatment, availability, trained treatment personnel); 8. Improving inter/intra-governmental coordination and cooperation regarding DUI efforts; 9. Providing funding (including selfsufficiency) to provide for adequate resources (personnel, equipment); and 10. Developing or increasing task forces and/or community involvement. One limitation of the Johnson study was that it did not follow up to determine how States actually used the recommendations, whether the recommendations were actually implemented, or whether there were positive or negative outcomes associated with the recommendations. One objective of this study was to determine the actions that took place in the States, such as changes in laws, enforcement or other impaired driving programs following the IDAs and SMRs, and to identify strengths and challenges in implementing the recommendations. A second objective of this study was to compare four different groups of States, based on whether they had received IDAs and/or SMRs: (1) those that had not received any IDAs or SMRs (8 States); (2) those that had received IDAs only (27 States); (3) those that had received IDAs and SMRs (13 States); and (4) those that had received SMRs only (3 States, plus the District of Columbia).
36
METHODS The criteria used to select States for study included the following: (a) States with similar demographics, population size, geographical location, ID fatality rates, and seat belt laws in the IDA (or SMR) States selected; (b) a mix of low-performing States (e.g., high ID fatality rates, low belt use) and highperforming States (e.g., low ID fatality rates, high belt use); (c) whether the States had demonstrated recent changes in some ID measures or rates; (d) whether the States had received an IDA and/or an SMR; (e) whether the States had received only one IDA or multiple IDAs; and (f) whether the States had received IDAs or SMRs within the same timeframe (past: before 2000; recent: since 2000). Qualitative To address the effectiveness and utility of the IDAs and SMRs, measures were defined (general and specific) for comparison among the selected States (IDA-State vs. similar non-IDA State; SMR State vs. similar non-SMR State). For IDA and SMR States, the following information was collected: number and type of recommendations that were made and when they were made; the identified strengths and challenges that were experienced in implementing the recommendations; and new strategies, approaches, or changes in ID programs, laws, or enforcement that were initiated following the assessments. For the comparison States, data collection focused on the legislative actions, collaboration with legislative participants, enforcement activities (especially the use of sobriety checkpoints), public awareness campaigns, new ID countermeasure programs, and collaboration with organizations and advocacy groups, such as Mothers Against Drunk Driving. Data were collected from Governors Highway Safety Office staff, law enforcement liaisons, criminal justice personnel, data records personnel, and State Impaired-Driving Task Force personnel. Information about impaired driving laws was collected using Lexis-Nexis. Once information about laws was collected, it was separated into categories: (1) upgrades in current laws; (2) downgrades in current laws; (3) new laws passed; (4) increases in DWI fines; and (5) increases or decreases in other sanctions. Quantitative The aim of the quantitative part of this study was to: •
analyze the trend for alcohol involvement of drivers in the IDA, SMR and comparison States and
©
•
determine whether the differences in the trends (over time) for various groups of States (based on whether they had received SMRs and/or IDAs) could have occurred by chance or was associated with the review process.
The study used data collected in the FARS, a census of all motor-vehicle crashes on public trafficways in the United States that result in a fatality within 30 days of the crash. FARS collects data for each of the 50 States and Washington, DC. The study population for this analysis consisted of crash-time data on all adult drivers, aged 21 years or older, throughout a 19year period (1990 to 2008). The FARS data include information on the driver’s BAC. Although testing for blood alcohol levels is less than 100%, imputation algorithms have been developed for estimating the missing alcohol values (Subramanian, 2002; Klein, 1986). The sample sizes in FARS are more than adequate for logistic regression models. In fact, the minimum sample sizes (number of drivers) for a year are 1,887 and 5,767 for the SMR State group and the comparison State group, respectively. Logistic regression procedures in SAS were used to conduct the analyses. If p equals the probability of driver alcohol involvement in a fatal crash, then (1) Log[ p/l-p]= a+b*year + c*pt* year + d*pt + e*X X is a vector of demographic characteristics, driving laws, and State control characteristics. The term (c*pt* year) is the interaction term, where pt*year =year for IDA/SMR States (p=1) for all years after the initial implementation and =0 otherwise. The slope for the IDA/SMR States is (b+c), and the slope for the comparison States is (b). Therefore, (c) measures the difference in the two slopes after controlling for all of the other variables in the model. The X vector also includes State dummy variables that control for differences in drivers involved in fatal crashes over time. Year ranges from 1990 to 2008 for SMR/IDA groups of States, and pt is a dummy variable for the intervention States—SMR, IDA, or both. In addition to dummy variables for five age categories, the vector X includes driver gender to control for higher likelihood of crashes for male versus female drivers and indicators for driving laws (i.e., the .08 BAC per se and seat belt laws), and other State-control characteristics. Model 1 is referred to as the full model. The term b represents the trend (percentage of decrease or increase) for the odds for the group of
Annals of Advances in Automotive Medicine
comparison State (non-IDA and non-SMR) drivers. The trend per 1-year decrease/increase for the IDA/SMR State drivers’ alcohol involvement is measured by (b+c). After controlling all of the other variables in the model, c is interpreted as the difference in trends. A reduced model (model 2) that only considered the years and IDA/SMR versus comparison pooled States also was examined. (2) Log[ p/l-p]= a+b*year + c*pt* year +d*pt The estimates for the parameters (b, c) were interpreted as stated above. The two models were examined for alcohol-involved versus non-alcoholinvolved drivers for the SMR and IDA States separately and jointly for the 19-year analysis period: 1. 2. 3.
SMR versus non-SMR and non-IDA States for years 1990 through 2008 IDA versus non-SMR and non-IDA States for years 1990 through 2008 SMR and IDA versus non-SMR and non-IDA States 1990 through 2008
RESULTS Qualitative Analyses There were a total of 583 recommendations made in IDAs to the seven selected IDA study States, with 218 of them (37%) reported by the States as implemented. One State implemented only 9 of the 98 (9%) recommendations from its 2006 IDA, whereas another State under study implemented 69 of the 105 (66%) recommendations from its 2000 IDA. Of the 158 priority recommendations made in the seven States with IDAs, 65 were implemented in the study States (41%). One State implemented 22 of the 30 (73%) priority recommendations; in contrast, another State implemented only 5 of the 23 (22%) priority recommendations. Several of these States established Impaired Driving Task Forces, adopted legislation for increased penalties for drivers convicted of DWI with BACs > .15 g/dL, and developed judicial education and training programs as part of their implementation. There were 82 recommendations made in the SMRs in the three selected States under study, with State officials reporting that 57 of them have been implemented (70%). One State reported implementing only 2 of the 22 (9%) recommendations from its SMR conducted in 2006, whereas another State reported implementing 30 of the 31 (97%) recommendations from its SMR in 2006. The remaining State reported implementing 25 of the 29 (86%) recommendations from its SMR conducted in
37
Vol 57 • September 2013
As expected, the recommendations that were relatively easy to implement or required no cost or additional resources tended to be implemented more often: •
“… continue to deliberate overall strategic planning including impaired driving ...”
• “... require PI&E plans as a component of Task Force Grant requests ...” Recommendations that were difficult or complicated, required substantial resources, or required legislation often were reported as not yet implemented (as of the date of this report): • “… overhaul ignition interlock program to conform with best practices ...”
•
Lack of interest from State legislators to sponsor a bill; failure to enact a sponsored bill in the State legislature; lack of political motivation (in the State legislature or the Governor’s office).
•
Complexity of the issue.
•
Lack of cooperation from various State agencies.
Quantitative Analyses A significantly greater proportion of drivers in fatal crashes had BACs > .08 g/dL in the IDA and SMR States as a group compared to the States without either an IDA or SMR as a group (see Figures 3, 4 and 5). 0.35 0.3
Proportion of drivers
2005. The three SMR study States reported implementing 6 of the 10 (60%) priority recommendations. One State implemented 6 of its 7 (86%) priority recommendations, whereas another State has not implemented any of the 3 priority recommendations to date. Examples of recommendations implemented included a review of the State sobriety checkpoint program and the establishment of saturation and directed ID patrols. The implementation rate of recommendations depended upon the amount of time since the IDA or SMR was conducted. Other factors affecting these implementation rates included the ease of implementing the recommendations, political motivation, and the priority the State assigned to the recommendations.
In some States, a Task Force was established to coordinate and monitor the implementation process. In other States, that responsibility was delegated to the Governor’s Highway Safety Representative or a staff member of the State Highway Safety Office. General barriers to implementation of the recommendations as reported by State officials included: •
38
Lack of State resources.
0.15 0.1
0
Intervention ID States Comparison non-ID and non-SMR States
Year
Figure 3. Proportion of Drivers in Fatal Crashes with BAC = .08 or Greater (versus 0), by Type of Group and Year: IDA States versus Non-IDA and Non-SMR States
0.4 0.35
Proportion of Drivers
In many instances, State officials indicated that they were “working on” getting these implemented.
0.2
0.05
• “…establish a DWI Tracking System ...” • “… enact legislation allowing the conduct of sobriety checkpoints ...”
0.25
0.3 0.25 0.2 0.15 0.1 0.05
Intervention SMR for States Comparison non-ID and non-SMR States
0
Year
Figure 4. Proportion of Drivers in Fatal Crashes with BAC = .08 or Greater (versus 0), by Type of Group and Year: SMR States versus Non-IDA and Non-SMR States
©
Table 3. Beta Coefficients* and Odds Ratios from Logistic Regression Model of the Probability that a Driver in a Fatal Crash will be Alcohol Impaired: SMR States versus Non-IDA and Non-SMR States, 1990-2008
0.35
Proportion of Drivers
0.3 0.25
Trend Reduced Model Trend Comparison States Trend SMR States
0.2 0.15 0.1 0.05
Annals of Advances in Automotive Medicine
Intervention ID & SMR states Comparison non-ID and non-SMR states
0
Year
Figure 5. Proportion of Drivers in Fatal Crashes with BAC = .08 or Greater (versus 0), by Type of Group and Year: IDA and SMR States versus Non-IDA and NonSMR States
Analysis of SMR States versus Non-SMR and Non-IDA States A stronger decline in fatal crashes was observed among drivers in the SMR States as a group than among the drivers in the comparison States as a group. Table 3 shows the results from the full model and a reduced model that provides analyses only for year of the crash and an indicator for SMR States versus comparison States. The full model for drivers in SMR States versus non-SMR and non-IDA States shows that the odds of alcohol impairment for drivers in SMR States declined annually by 2.4% (95% confidence interval (CI)= -3.1%, -1.7%) compared to the annual decline of 1.2 percent (95% CI= -1.6%, 0.7%) for drivers in the respective comparison States. The net reduction in the trends was 1.2% (95% CI = 1.8%, -0.6 %), a statistically significant difference that can be associated with the SMR process. The net reduction for the reduced model was 1.1% (95% CI= -1.5%, -0.6%), also statistically significant. Analysis of IDA States versus Non-SMR and NonIDA States As with the SMR States, the decline for drivers in the IDA States was steeper than the decline for drivers in the comparison States (Table 4). The full model shows a statistically significant net reduction in trend of 0.5% (95%CI= -0.8%, -0.2%) that can be associated with the IDA. The annual trends were 0.9% (95% CI= -1.1%, -0.7%) and -0.4 % (95% CI=0.7%, 0.1%) for IDA States and comparison States, respectively. The comparable net reduction for the reduced model was 0.6% (95% CI= -0.9%, -0.3%), also statistically significant.
Effect (trend SMR States—trend comparison States) Full Model Trend Comparison States Trend SMR States Effect (trend SMR States—trend comparison States) *for log odds
Beta
Odds Ratio
-0.011 [-0.014, -0.008] -0.022 [-0.026, -0.018]
0.989 [0.986, 0.992] 0.978 [0.975, 0.982]
-0.011 [-0.015, -0.006]
0.989 [0.985, 0.994]
-0.012 [-0.016, -0.007] -0.024 [-0.031, -0.017]
0.988 [0.984, 0.993] 0.976 [0.970, 0.983]
-0.012 [-0.018, -0.006]
0.988 [0.982, 0.994]
Table 4. Beta Coefficients* and Odds Ratios from Logistic Regression Model of the Probability that a Driver in a Fatal Crash will be Alcohol Impaired: IDA States versus Non-IDA and Non-SMR States, 1990-2008 Trend Reduced Model Trend Comparison States Trend IDA States Effect (trend IDA States—trend comparison States) Full Model Trend Comparison States Trend IDA States Effect (trend IDA States—trend comparison States) *for log odds
Beta
Odds Ration
-0.011 [-0.014, -0.008] -0.017 [-0.019, -0.016] -0.006 [-0.009, -0.003]
0.989 [0.986, 0.992] 0.983 [0.981, 0.984] 0.994 [0.991, 0.997]
-0.004 [-0.007, -0.001] -0.009 [-0.011, -0.007] -0.005 [-0.008, -0.002]
0.996 [0.993, 0.999] 0.991 [0.989, 0.993] 0.995 [0.992, 0.998]
Analysis of IDA and SMR States versus Non-SMR and Non-IDA States For IDA and SMR States combined, the full model shows a statistically significant net reduction in trend of 0.8% (95%CI= -1.1%, -0.4%) that is associated with the IDA and SMR. The annual trends were 1.0% (95% CI= -1.3%, -0.7%) and -0.3% (95% CI=0.6%, 0.1%), for IDA plus SMR States and comparison States, respectively (Table 5). The comparable net reduction for the reduced model was 0.6% (95% CI= -0.9%, -0.2%), also statistically significant.
39
Vol 57 • September 2013 The FARS analyses for individual State comparisons (IDA State vs. similar non-IDA State and SMR State vs. similar non-SMR State) showed no significant differences in impaired driving rates in fatal crashes. Table 5. Beta coefficients* and Odds Ratios from Logistic Regression Model of the Probability that a Driver in a Fatal Crash will be Alcohol Impaired: IDA and SMR States versus Non-IDA and Non-SMR States, 1990-2008 Trend Reduced Model Trend Comparison States Trend IDA plus SMR States Effect (trend IDA/SMR States— trend comparison States) Full Model Trend Comparison States Trend IDA plus SMR States Effect (trend IDA/SMR States— trend comparison States) *for log odds
Beta
OR
-0.011 [-0.014, -0.008] -0.017 [-0.019, -0.015]
0.989 [0.986, 0.992] 0.983 [0.981, 0.986]
-0.006 [-0.009, -0.002]
0.994 [0.991, 0.998]
-0.003 [-0.006, 0.001] -0.010 [-0.013, -0.007]
0.997 [0.994, 1.001] 0.990 [0.987, 0.993]
-0.008 [-0.011, -0.004]
0.992 [0.989, 0.996]
DISCUSSION Based on discussions with officials in the selected study States and the analyses of trend data in fatal crashes, it appears that States receiving an IDA and/or SMR have had some benefits. Officials in the study States receiving IDAs unanimously supported the process and concluded that it helped them implement recommendations that until then, had not been given priority in their States. Officials in States receiving SMRs were not quite as supportive about the process; nevertheless, they did note that it helped their impaired-driving program. As would be desired, a greater percentage of priority recommendations were implemented by the States receiving IDAs relative to the percentage of all recommendations (priority and non-priority) that were implemented. This was not quite the case for the three SMR study States, where a lower percentage of priority recommendations were implemented. It could be that motivation to implement these recommendations was lower in SMR States compared to IDA States, since SMRs are imposed on States and IDAs are voluntary. Alternatively, the SMR recommendations may have been more difficult to implement.
40
FARS data revealed that significantly more drivers in the IDA and SMR States were at BACs ≥ .08 than in the non-IDA and non-SMR States overall throughout the period from 1990 to 2008. This was expected for SMR States, since States are selected for SMRs based on higher than average rates and poorer than average progress. The implications of this finding are unclear regarding IDA States. Perhaps States with a greater proportion of impaired driving fatal crashes chose to conduct IDAs as a means to address this problem. A stronger decline in the rate of drivers with BACs ≥ .08 was observed among drivers in the SMR States than among drivers in the non-SMR and non-IDA States, and the difference was statistically significant. Similarly, a stronger decline in the rate of drivers with BACs ≥ .08 was observed also among drivers in the IDA States than among drivers in the non-IDA and non-SMR States, and this difference also was statistically significant. When combining SMR and IDA States as a group, compared to non-SMR and non-IDA States as a group, the net reduction for the SMR and IDA States was modest, but also statistically significant. There was not sufficient information available for this study to demonstrate a causal link between IDAs or SMRs and reductions in impaired driving in fatal crashes. However, based upon the FARS analyses of trends over a number of years, it appears there is an association with reductions in impaired driving in fatal crashes when SMRs and IDAs are conducted. It seems logical that reductions in impaired driving in fatal crashes may be dependent on State implementation of recommendations emanating from IDAs and SMRs, rather than from the IDAs and SMRs themselves. Thus, relative effects on the rate of impaired drivers in fatal crashes may not occur immediately, but rather may have an effect after a longer period of time (after the recommendations are implemented). Most IDAs were conducted between 2001 and 2008. Six States had them conducted before 2000. SMRs were all conducted between 2005 and 2008. Some recommendations made by IDAs and SMRs can be implemented relatively quickly (e.g., develop and implement procedures for low staff sobriety checkpoints) while others may take two or more years to implement (e.g., overhaul ignition interlock program to conform to the best practices). Some may never be implemented (e.g., requiring legislation that is outside the control of a State highway safety office). Some ID countermeasures may impact impaired driving rates immediately (e.g. intensive
©
enforcement); other measures may take years to show an effect (e.g., changes in impaired driving records systems). Consequently, it may be more informative to examine the effects of IDAs and SMRs over a longer time period. In conclusion, IDAs and SMRs seem to be beneficial to the States. At the very least, they provide an examination of a State’s impaired-driving program by a team of experts outside the State, reveal areas where improvement is needed in the State, confirm strategies that appear to be effective and should be initiated or continued, and provide independent support for initiating or continuing those strategies. There is room for improvement in every State. Sometimes, a “fresh look” at the problem, as IDAs and SMRs are accomplishing, can be the catalyst for change. LIMITATIONS There were some limitations to this study. Every State has a unique impaired-driving program, different impaired-driving laws, a different culture, different alcohol consumption rates, different unemployment rates, a different mix of urban and rural roads, and different strategies to counter impaired driving. All of these issues affect impaired-driving rates in fatal crashes. The results found in the comparisons must therefore be interpreted with caution. This study sought to analyze in greater depth the recommendations that were and were not implemented and the timing of implementation. However, information about these actions was difficult to obtain, especially due to the passage of time and staff changes in the study States. The relationship found in FARS with groups of States with SMRs and IDAs relative to groups of States without these interventions was informative and supportive of the program. However, there may be many other reasons (some of which are noted above) why these groups of intervention States fared better in the trend analyses other than the IDA or SMR, not the least of which are socioeconomic factors. Even with these limitations, the cumulative evidence of this study points to positive impacts associated with IDAs and SMRs and it is recommended that they be continued as appropriate. REFERENCES Dang, J.N. (2008). Statistical Analysis of AlcoholRelated Driving Trends, 1982-2005. (DOT HS
Annals of Advances in Automotive Medicine
810 942). Washington, DC: National Highway Traffic Safety Administration. Fell, J. C., Langston, E. A., Lacey, J. H., Tippetts, A. S., & Cotton, R. (2008). Evaluation of Seven Publicized Enforcement Programs to Reduce Impaired Driving: Georgia, Louisiana, Pennsylvania, Tennessee, Indiana, Michigan, and Texas (DOT HS 810 941). Washington, DC: National Highway Traffic Safety Administration. Fell, J. C., Tippetts, A. S., & Voas, R. B. (2009). Fatal traffic crashes involving drinking drivers: What have we learned? Annals of Advances in Automotive Medicine, 53, 63-76. Johnson, D. W. (2004). Impaired-driving program assessments: A summary of recommendations (1991 to 2003) (DOT HS 809 815). Washington, DC: National Highway Traffic Safety Administration. Klein, T. (1986, July). A method for estimating posterior BAC distributions for persons involved in fatal traffic accidents (DOT HS 807 094). Washington, DC: National Highway Traffic Safety Administration. National Highway Traffic Safety Administration. (2006). Uniform Guidelines for State Highway Safety Programs: Highway Safety Program Guideline No. 8. Washington, DC: National Highway Traffic Safety Administration. (Availhttp://www.nhtsa.dot.gov/nhtsa/ able online: whatsup/tea21/tea21programs/pages/ImpairedDriv ingPDF.pdf). National Highway Traffic Safety Administration. (2008). Traffic Safety Facts 2007 Data: AlcoholImpaired Driving (DOT HS 810 985). Washington, DC: National Highway Traffic Safety Administration. National Highway Traffic Safety Administration. (2010). Fatality Analysis Reporting System (FARS). U.S. Department of Transportation, National Highway Traffic Safety Administration. Accessed, 2012, from the World Wide Web: ftp://ftp.nhtsa.dot.gov/fars/. National Highway Traffic Safety Administration. Fatality Analysis Reporting System (FARS). In: National Highway Traffic Safety Administration; 2012. National Highway Traffic Safety Administration. (November 2004). Impaired Driving Technical Assessment Program (Working draft). Washington, DC: National Highway Traffic Safety Administration. Subramanian, R. (2002, January). Transitioning to multiple imputation - A new method to estimate missing blood alcohol concentration (BAC) values in FARS (DOT HS 809 403). Washington, DC: Mathematical Analysis Division, National Center
41
Vol 57 • September 2013 for Statistics and Analysis, National Highway Traffic Safety Administration, U.S. Department of Transportation. (Available online: http://wwwnrd.nhtsa.dot.gov/Pubs/809-403.PDF). APPENDIX The appendix contains Figure 1. Figure 1 shows the proportion of all drivers involved in fatal crashes estimated to have been legally intoxicated (BAC ≥ .08 g/dL).
42
©
Annals of Advances in Automotive Medicine
Figure 1. Proportion of All Drivers Involved in Fatal Crashes Estimated to Have Been Legally Intoxicated (BAC ≥ .08 g/dL), 1982-2010 (-37%) (Source: NHTSA, FARS, 2012)
43
Vol 57 • September 2013
.122
Utah Georgia Iowa Kentucky Indiana New York New Jersey North Carolina Michigan Maryland Florida Maine California Oklahoma Vermont Arkansas Nebraska Delaware Ohio Minnesota Idaho Oregon Arizona Nevada West Virginia Virginia Alaska Tennessee Kansas Colorado New Hampshire Pennsylvania New Mexico Alabama Illinois Missouri Wyoming Dist of Columbia Louisiana Mississippi Washington Massachusetts Hawaii Texas Connecticut South Carolina Wisconsin South Dakota Rhode Island North Dakota Montana U.S. Total
0.000
.158 .166 .170 .170 .179 .182 .183 .184 .185 .186 .189 .190 .194 .201 .201 .202 .202 .202 .204 .204 .205 .209 .210 .211 .212 .213 .215 .217 .218 .218 .222 .222 .223 .226 .232 .237 .237 .238 .241 .244 .249 .251 .254 .256 .268 .269 .279 .291 .296 .309 .209
0.050
0.100
0.150
0.200
0.250
0.300
0.350
Figure 2. Percentage of Drivers Involved in Fatal Crashes with BACs >.08 g/dL, 5-Year Average (2002-2006), Ranked by State (Source: NHTSA, FARS, 2012)
44
Annals of Advances in Automotive Medicine
Evaluation of Impaired Driving Assessments and Special Management Reviews in Reducing Impaired Driving Fatal Crashes in the United States James Fell, Amy Auld-Owens and Cecelia Snowden Pacific Institute for Research & Evaluation, Calverton, Maryland, USA __________________________________ ABSTRACT – Since 1991, State Impaired-Driving Assessments (IDAs) and Special Management Reviews (SMRs) have been conducted by the National Highway Traffic Safety Administration (NHTSA) to serve as a mechanism to assess the impaireddriving problem in the State, document the existing system, recommend improvements, and garner both political and public support to fund and implement improvements. Did these assessments and reviews serve the States as intended and provide a catalyst to reduce impaired driving? Almost half of the priority recommendations from IDAs in seven States and 60% of the priority recommendations in SMR States were implemented. Barriers to the implementation of some recommendations are discussed. IDAs and SMRs implemented at varying times were examined using logistic regression analyses of the Fatality Analysis Reporting System (FARS) for the years 1990 to 2008 to determine the effect they may have triggered on impaired driving rates in fatal crashes. States receiving IDAs and SMRs were compared to similar States not receiving them. Paired comparisons of similar States (e.g. IDA-State vs. non-IDA State) did not reveal any significant differences in impaired driving rates, but IDA and SMR States as a group showed significantly greater impaired driving declines in fatal crashes compared to non-IDA and non-SMR States as a group. IDAs and SMRs appear to provide a mechanism to examine the State’s impaireddriving program by an external team of experts and reveal areas where improvement is needed and confirm strategies that appear to be effective. __________________________________
INTRODUCTION Since 1982, impaired driving traffic crash fatalities have decreased from 21,113 to 10,228 in 2010, a 52 percent decrease. The impaired driving fatality rate has decreased even more, from 13.24 fatalities per billion vehicle miles traveled (VMT) in 1982 to 3.41 fatalities per billion VMT in 2010, a 74 percent reduction. The proportion of fatalities involving an impaired driver decreased from 48% to 31% during that time period, a 35 percent reduction in that proportion. Since 1997, the number and rate of impaired driving fatalities have continued to decline from 13,757 to 10,228 in 2010 (down 26%) and from a rate per billion miles travelled of 5.39 in 1997 to 3.45 in 2010 (down 36%). However, the percentage of drivers involved in fatal crashes with illegal per se blood alcohol concentration (BAC) levels (at or above 0.08) has remained at approximately 20 to 22 percent (Figure 1, see Appendix) (National Highway Traffic Safety Administration [NHTSA], 2012). There are many possible reasons for the substantial decrease in the percentage of impaired driving fatal CORRESPONDING AUTHOR: James Fell, Impaired Driving Center, Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Suite 900, Calverton, Maryland Email: [email protected]
crashes between 1982 and 1997 (Dang, 2008). These include (1) the adoption of five major impaired driving laws in the States (.10 blood alcohol concentration (BAC) per se; .08 BAC per se; administrative license revocation (ALR); minimum legal drinking age 21; and zero tolerance laws for youth), (2) the decreasing proportion of the population aged 18 to 34, (3) the increasing proportion of female drivers between 1982 and 1997, and (4) a reduction in per capita alcohol consumption during that time period. The number of impaired driving crashes, injuries, and fatalities continues to be unacceptable, and most are preventable. One measure of the recent extent of the problem and the wide variability in each State appears in Figure 2 (see Appendix). This figure shows the percentage of drivers in fatal crashes with illegal BAC levels Stateby-State averaged over a recent 5-year period (20022006). The percentages range from a low of 12% in Utah to a high of 31% in Montana. There are similar degrees of variability within States (i.e., at the local community level). The solutions to impaired driving lie mainly at the State and local community levels. That is where laws
57th AAAM Annual Conference Annals of Advances in Automotive Medicine September 22-25, 2013
33
Vol 57 • September 2013 are applied and enforced, where programs are implemented, and where changes in strategies can be made. Research has provided some evidence on what works to reduce impaired driving and should be translated and disseminated to the States. NHTSA’s “Uniform Guidelines for State Highway Safety Programs, Guideline No. 8 on Impaired Driving” (NHTSA, 2006) describes six components of a State impaired-driving program. Briefly, the main areas from that guideline are as follows: I. Program Management and Strategic Planning II. Prevention III. Criminal Justice System a. Laws b. Enforcement c. Publicizing High-Visibility Enforcement d. Prosecution e. Adjudication f. Administrative Sanctions and Driver Licensing Programs IV. Communication V. Alcohol and Other Drug Misuse: Screening, Assessment, Treatment, and Rehabilitation VI. Program Evaluation and Data NHTSA has developed two mechanisms to help State and local community leaders assess the local problem, document the existing system that deals with the problem, recommend improvements, and garner local political support and support from the public to fund and implement such improvements State Impaired Driving Assessments (IDAs) and Special Management Reviews (SMRs). Impaired Driving Assessments Since 1991, at the request of any State, NHTSA has helped initiate an IDA of that State. A team of experts, using NHTSA-developed guidelines, assesses the status of a States’ impaired-driving highway safety programs. The team is typically composed of individuals from a variety of backgrounds related to the assessment, including program management, adjudication, enforcement, prevention and treatment, and data records. The guidelines are contained in NHTSA’s “Impaired Driving Technical Assessment Program” (NHTSA, November 2004), which identifies the components of a comprehensive impaired-driving program in a State as including the following: • Strategic Planning and Program Management – DWI task forces, data, records, evaluation, and resources.
34
• Prevention – Communication strategies, responsible beverage service, alternative transportation, and community-based education programs. • Criminal Justice System – Achieve general and specific deterrence; use laws, local ordinances, enforcement, and publicity; and use prosecution, adjudication, and administrative sanctions. • Alcohol and Other Drug Misuse – Screening, assessment, treatment, rehabilitation, and monitoring of driving-while-intoxicated (DWI) offenders. The goal of the IDA is to develop State- and safetyprogram recommendations that address areas that need strengthening. These assessments usually involve interviews with the State- and communitylevel program directors, coordinators, advocates, and traffic safety offices. Other contacts may include enforcement, prosecution, and adjudication officials. The Assessment Team reviews findings, notes strengths and challenges, and makes recommendations for the State. The assessments are to be used as a tool for planning, setting priorities, and making decisions about how to best use available resources. The team also suggests approaches for measuring impaired-driving program progress. The main goals of these assessments are to (1) identify program strengths and accomplishments, (2) uncover challenging issues, and (3) suggest recommendations (including priority recommendations) for improvement. To achieve substantial and lasting declines in alcohol-impaired-driving crashes and fatalities, a combination of planning, coordination, criminal justice requirements, aggressive enforcement, public information, education, and adequate and sustained resources is usually necessary. Each year several States request IDAs of their programs, policies, and practices. Members of the NHTSA ID Division facilitate these assessments and coordinate extensively with NHTSA regional staff. NHTSA staff work with State Highway Safety Offices to select a team of usually five individuals who demonstrate expertise in various aspects of impaired-driving program development and implementation. With the knowledge of what programs and strategies work in other States, the assessment team reviews and documents the strengths and weaknesses of the requesting State’s programs. Examples of some selected priority recommendations from a recent IDA are contained in Table 1.
©
Table 1. Examples of Priority Recommendations Made in an Impaired Driving Assessment
PRIORITY RECOMMENDATIONS 1-C: Program Management • Develop and implement an e-grants system. 1-D: Resources • Institute user-based fees paid by DUI offenders to pay for DUI-specific services such as DUI courts. 2-B: Transportation Alternatives • Assure that both designated driver and safe ride programs avoid any consumption by underage individuals or unintentional enabling of overconsumption. 3-A: Impaired-Driving Laws • Increase the BAC test refusal sanction to be as strict as State’s highest BAC offense. 3-B: Enforcement • Develop and implement procedures for low staff checkpoints. 3-D: Prosecution • Recognize DUI probation before judgment as a prohibited diversion tactic. 4: Communication Program • Develop and implement a comprehensive communication plan in conjunction with Impaired Driving Coalition partners, subgrantees, and communication specialists. 5-B: Treatment and Rehabilitation • Establish research-based, standard screening, assessment, treatment, and monitoring protocols for all DUI offenders. 5-C: Monitoring Impaired Drivers • Improve oversight of noncompliance of ignition interlock restriction and other DUI sentence conditions. 6-B: Data and Records • Use data from the current citation form tracking system and the ADAA system as sources of data for a well-defined DUI Tracking System.
Special Management Reviews In 2004, NHTSA initiated the SMR, a different mechanism for evaluating States’ impaired-driving programs. An SMR “examines management and operational practices in specific program area(s) to determine other relevant information related to program performance and progress” according to
Annals of Advances in Automotive Medicine
NHTSA’s Special Management Review Guidelines. Similar to the IDAs, SMRs consist of (a) interviews with key personnel and/or representatives of the State; and (b) discussions with other relevant organizations. They also involve a review of relevant reports and data files. An important difference between IDAs and SMRs is that the assessment is voluntarily requested by the States, whereas the SMR is conducted because of a State’s “consistently worse-than-average performance and progress [is] less than half of that recorded by the Nation as a whole.” Also, an SMR is conducted by NHTSA Regional and Headquarters staff, while an IDA is coordinated by NHTSA staff, but is conducted by national and State experts. The chief focus of an SMR is on the Highway Safety Office management practices that affect the ID program in the State, while the main focus of the IDA is on activities conducted statewide that address the ID problem. Examples of priority recommendations from a recent SMR appear in Table 2. Table 2. Examples of Priority Recommendations Made in a Special Management Review
PRIORITY SMR RECOMMENDATIONS Enforcement • Implement saturation patrols and adopt stronger methods of enforcement as described in the saturation patrol countermeasure. Project Issues • Implement mass communication campaigns that use paid and earned media to deter the public from drinking and driving; effective when paired with highvisibility enforcement and a comprehensive communications strategy. Legislative Issues • Overhaul Ignition Interlock program to conform to the “best practices.” Evaluation Issues • Impaired-Driving Data—Further dissect the data to identify impaired driving issues and allocate funding based on that data.
A previous NHTSA report (Johnson, 2004) examined the number and type of recommendations that States received from 1991 to 2003 during their IDAs. A total of 2,982 recommendations were made during the assessments, which the report organized into 10 broad thematic areas. These areas included:
35
Vol 57 • September 2013 1.
Increasing the deterrence effect by prioritizing enforcement efforts and enhancing the arrest, prosecution, and adjudication process; 2. Providing or improving public information and education efforts related to prevention and deterrence; 3. Remedying problems involving DUI data and records (data reporting requirements, offender tracking systems, data linkages, uniform traffic citations, etc.); 4. Enacting new laws or revising existing laws aimed at increasing the deterrence and/or prevention of DUI; 5. Increasing or enhancing training for law enforcement, prosecution, and judicial personnel; 6. Evaluating programs and activities associated with the effort to combat impaired driving; 7. Providing sufficient resources for treatment and rehabilitation (screening, diagnosis, treatment, availability, trained treatment personnel); 8. Improving inter/intra-governmental coordination and cooperation regarding DUI efforts; 9. Providing funding (including selfsufficiency) to provide for adequate resources (personnel, equipment); and 10. Developing or increasing task forces and/or community involvement. One limitation of the Johnson study was that it did not follow up to determine how States actually used the recommendations, whether the recommendations were actually implemented, or whether there were positive or negative outcomes associated with the recommendations. One objective of this study was to determine the actions that took place in the States, such as changes in laws, enforcement or other impaired driving programs following the IDAs and SMRs, and to identify strengths and challenges in implementing the recommendations. A second objective of this study was to compare four different groups of States, based on whether they had received IDAs and/or SMRs: (1) those that had not received any IDAs or SMRs (8 States); (2) those that had received IDAs only (27 States); (3) those that had received IDAs and SMRs (13 States); and (4) those that had received SMRs only (3 States, plus the District of Columbia).
36
METHODS The criteria used to select States for study included the following: (a) States with similar demographics, population size, geographical location, ID fatality rates, and seat belt laws in the IDA (or SMR) States selected; (b) a mix of low-performing States (e.g., high ID fatality rates, low belt use) and highperforming States (e.g., low ID fatality rates, high belt use); (c) whether the States had demonstrated recent changes in some ID measures or rates; (d) whether the States had received an IDA and/or an SMR; (e) whether the States had received only one IDA or multiple IDAs; and (f) whether the States had received IDAs or SMRs within the same timeframe (past: before 2000; recent: since 2000). Qualitative To address the effectiveness and utility of the IDAs and SMRs, measures were defined (general and specific) for comparison among the selected States (IDA-State vs. similar non-IDA State; SMR State vs. similar non-SMR State). For IDA and SMR States, the following information was collected: number and type of recommendations that were made and when they were made; the identified strengths and challenges that were experienced in implementing the recommendations; and new strategies, approaches, or changes in ID programs, laws, or enforcement that were initiated following the assessments. For the comparison States, data collection focused on the legislative actions, collaboration with legislative participants, enforcement activities (especially the use of sobriety checkpoints), public awareness campaigns, new ID countermeasure programs, and collaboration with organizations and advocacy groups, such as Mothers Against Drunk Driving. Data were collected from Governors Highway Safety Office staff, law enforcement liaisons, criminal justice personnel, data records personnel, and State Impaired-Driving Task Force personnel. Information about impaired driving laws was collected using Lexis-Nexis. Once information about laws was collected, it was separated into categories: (1) upgrades in current laws; (2) downgrades in current laws; (3) new laws passed; (4) increases in DWI fines; and (5) increases or decreases in other sanctions. Quantitative The aim of the quantitative part of this study was to: •
analyze the trend for alcohol involvement of drivers in the IDA, SMR and comparison States and
©
•
determine whether the differences in the trends (over time) for various groups of States (based on whether they had received SMRs and/or IDAs) could have occurred by chance or was associated with the review process.
The study used data collected in the FARS, a census of all motor-vehicle crashes on public trafficways in the United States that result in a fatality within 30 days of the crash. FARS collects data for each of the 50 States and Washington, DC. The study population for this analysis consisted of crash-time data on all adult drivers, aged 21 years or older, throughout a 19year period (1990 to 2008). The FARS data include information on the driver’s BAC. Although testing for blood alcohol levels is less than 100%, imputation algorithms have been developed for estimating the missing alcohol values (Subramanian, 2002; Klein, 1986). The sample sizes in FARS are more than adequate for logistic regression models. In fact, the minimum sample sizes (number of drivers) for a year are 1,887 and 5,767 for the SMR State group and the comparison State group, respectively. Logistic regression procedures in SAS were used to conduct the analyses. If p equals the probability of driver alcohol involvement in a fatal crash, then (1) Log[ p/l-p]= a+b*year + c*pt* year + d*pt + e*X X is a vector of demographic characteristics, driving laws, and State control characteristics. The term (c*pt* year) is the interaction term, where pt*year =year for IDA/SMR States (p=1) for all years after the initial implementation and =0 otherwise. The slope for the IDA/SMR States is (b+c), and the slope for the comparison States is (b). Therefore, (c) measures the difference in the two slopes after controlling for all of the other variables in the model. The X vector also includes State dummy variables that control for differences in drivers involved in fatal crashes over time. Year ranges from 1990 to 2008 for SMR/IDA groups of States, and pt is a dummy variable for the intervention States—SMR, IDA, or both. In addition to dummy variables for five age categories, the vector X includes driver gender to control for higher likelihood of crashes for male versus female drivers and indicators for driving laws (i.e., the .08 BAC per se and seat belt laws), and other State-control characteristics. Model 1 is referred to as the full model. The term b represents the trend (percentage of decrease or increase) for the odds for the group of
Annals of Advances in Automotive Medicine
comparison State (non-IDA and non-SMR) drivers. The trend per 1-year decrease/increase for the IDA/SMR State drivers’ alcohol involvement is measured by (b+c). After controlling all of the other variables in the model, c is interpreted as the difference in trends. A reduced model (model 2) that only considered the years and IDA/SMR versus comparison pooled States also was examined. (2) Log[ p/l-p]= a+b*year + c*pt* year +d*pt The estimates for the parameters (b, c) were interpreted as stated above. The two models were examined for alcohol-involved versus non-alcoholinvolved drivers for the SMR and IDA States separately and jointly for the 19-year analysis period: 1. 2. 3.
SMR versus non-SMR and non-IDA States for years 1990 through 2008 IDA versus non-SMR and non-IDA States for years 1990 through 2008 SMR and IDA versus non-SMR and non-IDA States 1990 through 2008
RESULTS Qualitative Analyses There were a total of 583 recommendations made in IDAs to the seven selected IDA study States, with 218 of them (37%) reported by the States as implemented. One State implemented only 9 of the 98 (9%) recommendations from its 2006 IDA, whereas another State under study implemented 69 of the 105 (66%) recommendations from its 2000 IDA. Of the 158 priority recommendations made in the seven States with IDAs, 65 were implemented in the study States (41%). One State implemented 22 of the 30 (73%) priority recommendations; in contrast, another State implemented only 5 of the 23 (22%) priority recommendations. Several of these States established Impaired Driving Task Forces, adopted legislation for increased penalties for drivers convicted of DWI with BACs > .15 g/dL, and developed judicial education and training programs as part of their implementation. There were 82 recommendations made in the SMRs in the three selected States under study, with State officials reporting that 57 of them have been implemented (70%). One State reported implementing only 2 of the 22 (9%) recommendations from its SMR conducted in 2006, whereas another State reported implementing 30 of the 31 (97%) recommendations from its SMR in 2006. The remaining State reported implementing 25 of the 29 (86%) recommendations from its SMR conducted in
37
Vol 57 • September 2013
As expected, the recommendations that were relatively easy to implement or required no cost or additional resources tended to be implemented more often: •
“… continue to deliberate overall strategic planning including impaired driving ...”
• “... require PI&E plans as a component of Task Force Grant requests ...” Recommendations that were difficult or complicated, required substantial resources, or required legislation often were reported as not yet implemented (as of the date of this report): • “… overhaul ignition interlock program to conform with best practices ...”
•
Lack of interest from State legislators to sponsor a bill; failure to enact a sponsored bill in the State legislature; lack of political motivation (in the State legislature or the Governor’s office).
•
Complexity of the issue.
•
Lack of cooperation from various State agencies.
Quantitative Analyses A significantly greater proportion of drivers in fatal crashes had BACs > .08 g/dL in the IDA and SMR States as a group compared to the States without either an IDA or SMR as a group (see Figures 3, 4 and 5). 0.35 0.3
Proportion of drivers
2005. The three SMR study States reported implementing 6 of the 10 (60%) priority recommendations. One State implemented 6 of its 7 (86%) priority recommendations, whereas another State has not implemented any of the 3 priority recommendations to date. Examples of recommendations implemented included a review of the State sobriety checkpoint program and the establishment of saturation and directed ID patrols. The implementation rate of recommendations depended upon the amount of time since the IDA or SMR was conducted. Other factors affecting these implementation rates included the ease of implementing the recommendations, political motivation, and the priority the State assigned to the recommendations.
In some States, a Task Force was established to coordinate and monitor the implementation process. In other States, that responsibility was delegated to the Governor’s Highway Safety Representative or a staff member of the State Highway Safety Office. General barriers to implementation of the recommendations as reported by State officials included: •
38
Lack of State resources.
0.15 0.1
0
Intervention ID States Comparison non-ID and non-SMR States
Year
Figure 3. Proportion of Drivers in Fatal Crashes with BAC = .08 or Greater (versus 0), by Type of Group and Year: IDA States versus Non-IDA and Non-SMR States
0.4 0.35
Proportion of Drivers
In many instances, State officials indicated that they were “working on” getting these implemented.
0.2
0.05
• “…establish a DWI Tracking System ...” • “… enact legislation allowing the conduct of sobriety checkpoints ...”
0.25
0.3 0.25 0.2 0.15 0.1 0.05
Intervention SMR for States Comparison non-ID and non-SMR States
0
Year
Figure 4. Proportion of Drivers in Fatal Crashes with BAC = .08 or Greater (versus 0), by Type of Group and Year: SMR States versus Non-IDA and Non-SMR States
©
Table 3. Beta Coefficients* and Odds Ratios from Logistic Regression Model of the Probability that a Driver in a Fatal Crash will be Alcohol Impaired: SMR States versus Non-IDA and Non-SMR States, 1990-2008
0.35
Proportion of Drivers
0.3 0.25
Trend Reduced Model Trend Comparison States Trend SMR States
0.2 0.15 0.1 0.05
Annals of Advances in Automotive Medicine
Intervention ID & SMR states Comparison non-ID and non-SMR states
0
Year
Figure 5. Proportion of Drivers in Fatal Crashes with BAC = .08 or Greater (versus 0), by Type of Group and Year: IDA and SMR States versus Non-IDA and NonSMR States
Analysis of SMR States versus Non-SMR and Non-IDA States A stronger decline in fatal crashes was observed among drivers in the SMR States as a group than among the drivers in the comparison States as a group. Table 3 shows the results from the full model and a reduced model that provides analyses only for year of the crash and an indicator for SMR States versus comparison States. The full model for drivers in SMR States versus non-SMR and non-IDA States shows that the odds of alcohol impairment for drivers in SMR States declined annually by 2.4% (95% confidence interval (CI)= -3.1%, -1.7%) compared to the annual decline of 1.2 percent (95% CI= -1.6%, 0.7%) for drivers in the respective comparison States. The net reduction in the trends was 1.2% (95% CI = 1.8%, -0.6 %), a statistically significant difference that can be associated with the SMR process. The net reduction for the reduced model was 1.1% (95% CI= -1.5%, -0.6%), also statistically significant. Analysis of IDA States versus Non-SMR and NonIDA States As with the SMR States, the decline for drivers in the IDA States was steeper than the decline for drivers in the comparison States (Table 4). The full model shows a statistically significant net reduction in trend of 0.5% (95%CI= -0.8%, -0.2%) that can be associated with the IDA. The annual trends were 0.9% (95% CI= -1.1%, -0.7%) and -0.4 % (95% CI=0.7%, 0.1%) for IDA States and comparison States, respectively. The comparable net reduction for the reduced model was 0.6% (95% CI= -0.9%, -0.3%), also statistically significant.
Effect (trend SMR States—trend comparison States) Full Model Trend Comparison States Trend SMR States Effect (trend SMR States—trend comparison States) *for log odds
Beta
Odds Ratio
-0.011 [-0.014, -0.008] -0.022 [-0.026, -0.018]
0.989 [0.986, 0.992] 0.978 [0.975, 0.982]
-0.011 [-0.015, -0.006]
0.989 [0.985, 0.994]
-0.012 [-0.016, -0.007] -0.024 [-0.031, -0.017]
0.988 [0.984, 0.993] 0.976 [0.970, 0.983]
-0.012 [-0.018, -0.006]
0.988 [0.982, 0.994]
Table 4. Beta Coefficients* and Odds Ratios from Logistic Regression Model of the Probability that a Driver in a Fatal Crash will be Alcohol Impaired: IDA States versus Non-IDA and Non-SMR States, 1990-2008 Trend Reduced Model Trend Comparison States Trend IDA States Effect (trend IDA States—trend comparison States) Full Model Trend Comparison States Trend IDA States Effect (trend IDA States—trend comparison States) *for log odds
Beta
Odds Ration
-0.011 [-0.014, -0.008] -0.017 [-0.019, -0.016] -0.006 [-0.009, -0.003]
0.989 [0.986, 0.992] 0.983 [0.981, 0.984] 0.994 [0.991, 0.997]
-0.004 [-0.007, -0.001] -0.009 [-0.011, -0.007] -0.005 [-0.008, -0.002]
0.996 [0.993, 0.999] 0.991 [0.989, 0.993] 0.995 [0.992, 0.998]
Analysis of IDA and SMR States versus Non-SMR and Non-IDA States For IDA and SMR States combined, the full model shows a statistically significant net reduction in trend of 0.8% (95%CI= -1.1%, -0.4%) that is associated with the IDA and SMR. The annual trends were 1.0% (95% CI= -1.3%, -0.7%) and -0.3% (95% CI=0.6%, 0.1%), for IDA plus SMR States and comparison States, respectively (Table 5). The comparable net reduction for the reduced model was 0.6% (95% CI= -0.9%, -0.2%), also statistically significant.
39
Vol 57 • September 2013 The FARS analyses for individual State comparisons (IDA State vs. similar non-IDA State and SMR State vs. similar non-SMR State) showed no significant differences in impaired driving rates in fatal crashes. Table 5. Beta coefficients* and Odds Ratios from Logistic Regression Model of the Probability that a Driver in a Fatal Crash will be Alcohol Impaired: IDA and SMR States versus Non-IDA and Non-SMR States, 1990-2008 Trend Reduced Model Trend Comparison States Trend IDA plus SMR States Effect (trend IDA/SMR States— trend comparison States) Full Model Trend Comparison States Trend IDA plus SMR States Effect (trend IDA/SMR States— trend comparison States) *for log odds
Beta
OR
-0.011 [-0.014, -0.008] -0.017 [-0.019, -0.015]
0.989 [0.986, 0.992] 0.983 [0.981, 0.986]
-0.006 [-0.009, -0.002]
0.994 [0.991, 0.998]
-0.003 [-0.006, 0.001] -0.010 [-0.013, -0.007]
0.997 [0.994, 1.001] 0.990 [0.987, 0.993]
-0.008 [-0.011, -0.004]
0.992 [0.989, 0.996]
DISCUSSION Based on discussions with officials in the selected study States and the analyses of trend data in fatal crashes, it appears that States receiving an IDA and/or SMR have had some benefits. Officials in the study States receiving IDAs unanimously supported the process and concluded that it helped them implement recommendations that until then, had not been given priority in their States. Officials in States receiving SMRs were not quite as supportive about the process; nevertheless, they did note that it helped their impaired-driving program. As would be desired, a greater percentage of priority recommendations were implemented by the States receiving IDAs relative to the percentage of all recommendations (priority and non-priority) that were implemented. This was not quite the case for the three SMR study States, where a lower percentage of priority recommendations were implemented. It could be that motivation to implement these recommendations was lower in SMR States compared to IDA States, since SMRs are imposed on States and IDAs are voluntary. Alternatively, the SMR recommendations may have been more difficult to implement.
40
FARS data revealed that significantly more drivers in the IDA and SMR States were at BACs ≥ .08 than in the non-IDA and non-SMR States overall throughout the period from 1990 to 2008. This was expected for SMR States, since States are selected for SMRs based on higher than average rates and poorer than average progress. The implications of this finding are unclear regarding IDA States. Perhaps States with a greater proportion of impaired driving fatal crashes chose to conduct IDAs as a means to address this problem. A stronger decline in the rate of drivers with BACs ≥ .08 was observed among drivers in the SMR States than among drivers in the non-SMR and non-IDA States, and the difference was statistically significant. Similarly, a stronger decline in the rate of drivers with BACs ≥ .08 was observed also among drivers in the IDA States than among drivers in the non-IDA and non-SMR States, and this difference also was statistically significant. When combining SMR and IDA States as a group, compared to non-SMR and non-IDA States as a group, the net reduction for the SMR and IDA States was modest, but also statistically significant. There was not sufficient information available for this study to demonstrate a causal link between IDAs or SMRs and reductions in impaired driving in fatal crashes. However, based upon the FARS analyses of trends over a number of years, it appears there is an association with reductions in impaired driving in fatal crashes when SMRs and IDAs are conducted. It seems logical that reductions in impaired driving in fatal crashes may be dependent on State implementation of recommendations emanating from IDAs and SMRs, rather than from the IDAs and SMRs themselves. Thus, relative effects on the rate of impaired drivers in fatal crashes may not occur immediately, but rather may have an effect after a longer period of time (after the recommendations are implemented). Most IDAs were conducted between 2001 and 2008. Six States had them conducted before 2000. SMRs were all conducted between 2005 and 2008. Some recommendations made by IDAs and SMRs can be implemented relatively quickly (e.g., develop and implement procedures for low staff sobriety checkpoints) while others may take two or more years to implement (e.g., overhaul ignition interlock program to conform to the best practices). Some may never be implemented (e.g., requiring legislation that is outside the control of a State highway safety office). Some ID countermeasures may impact impaired driving rates immediately (e.g. intensive
©
enforcement); other measures may take years to show an effect (e.g., changes in impaired driving records systems). Consequently, it may be more informative to examine the effects of IDAs and SMRs over a longer time period. In conclusion, IDAs and SMRs seem to be beneficial to the States. At the very least, they provide an examination of a State’s impaired-driving program by a team of experts outside the State, reveal areas where improvement is needed in the State, confirm strategies that appear to be effective and should be initiated or continued, and provide independent support for initiating or continuing those strategies. There is room for improvement in every State. Sometimes, a “fresh look” at the problem, as IDAs and SMRs are accomplishing, can be the catalyst for change. LIMITATIONS There were some limitations to this study. Every State has a unique impaired-driving program, different impaired-driving laws, a different culture, different alcohol consumption rates, different unemployment rates, a different mix of urban and rural roads, and different strategies to counter impaired driving. All of these issues affect impaired-driving rates in fatal crashes. The results found in the comparisons must therefore be interpreted with caution. This study sought to analyze in greater depth the recommendations that were and were not implemented and the timing of implementation. However, information about these actions was difficult to obtain, especially due to the passage of time and staff changes in the study States. The relationship found in FARS with groups of States with SMRs and IDAs relative to groups of States without these interventions was informative and supportive of the program. However, there may be many other reasons (some of which are noted above) why these groups of intervention States fared better in the trend analyses other than the IDA or SMR, not the least of which are socioeconomic factors. Even with these limitations, the cumulative evidence of this study points to positive impacts associated with IDAs and SMRs and it is recommended that they be continued as appropriate. REFERENCES Dang, J.N. (2008). Statistical Analysis of AlcoholRelated Driving Trends, 1982-2005. (DOT HS
Annals of Advances in Automotive Medicine
810 942). Washington, DC: National Highway Traffic Safety Administration. Fell, J. C., Langston, E. A., Lacey, J. H., Tippetts, A. S., & Cotton, R. (2008). Evaluation of Seven Publicized Enforcement Programs to Reduce Impaired Driving: Georgia, Louisiana, Pennsylvania, Tennessee, Indiana, Michigan, and Texas (DOT HS 810 941). Washington, DC: National Highway Traffic Safety Administration. Fell, J. C., Tippetts, A. S., & Voas, R. B. (2009). Fatal traffic crashes involving drinking drivers: What have we learned? Annals of Advances in Automotive Medicine, 53, 63-76. Johnson, D. W. (2004). Impaired-driving program assessments: A summary of recommendations (1991 to 2003) (DOT HS 809 815). Washington, DC: National Highway Traffic Safety Administration. Klein, T. (1986, July). A method for estimating posterior BAC distributions for persons involved in fatal traffic accidents (DOT HS 807 094). Washington, DC: National Highway Traffic Safety Administration. National Highway Traffic Safety Administration. (2006). Uniform Guidelines for State Highway Safety Programs: Highway Safety Program Guideline No. 8. Washington, DC: National Highway Traffic Safety Administration. (Availhttp://www.nhtsa.dot.gov/nhtsa/ able online: whatsup/tea21/tea21programs/pages/ImpairedDriv ingPDF.pdf). National Highway Traffic Safety Administration. (2008). Traffic Safety Facts 2007 Data: AlcoholImpaired Driving (DOT HS 810 985). Washington, DC: National Highway Traffic Safety Administration. National Highway Traffic Safety Administration. (2010). Fatality Analysis Reporting System (FARS). U.S. Department of Transportation, National Highway Traffic Safety Administration. Accessed, 2012, from the World Wide Web: ftp://ftp.nhtsa.dot.gov/fars/. National Highway Traffic Safety Administration. Fatality Analysis Reporting System (FARS). In: National Highway Traffic Safety Administration; 2012. National Highway Traffic Safety Administration. (November 2004). Impaired Driving Technical Assessment Program (Working draft). Washington, DC: National Highway Traffic Safety Administration. Subramanian, R. (2002, January). Transitioning to multiple imputation - A new method to estimate missing blood alcohol concentration (BAC) values in FARS (DOT HS 809 403). Washington, DC: Mathematical Analysis Division, National Center
41
Vol 57 • September 2013 for Statistics and Analysis, National Highway Traffic Safety Administration, U.S. Department of Transportation. (Available online: http://wwwnrd.nhtsa.dot.gov/Pubs/809-403.PDF). APPENDIX The appendix contains Figure 1. Figure 1 shows the proportion of all drivers involved in fatal crashes estimated to have been legally intoxicated (BAC ≥ .08 g/dL).
42
©
Annals of Advances in Automotive Medicine
Figure 1. Proportion of All Drivers Involved in Fatal Crashes Estimated to Have Been Legally Intoxicated (BAC ≥ .08 g/dL), 1982-2010 (-37%) (Source: NHTSA, FARS, 2012)
43
Vol 57 • September 2013
.122
Utah Georgia Iowa Kentucky Indiana New York New Jersey North Carolina Michigan Maryland Florida Maine California Oklahoma Vermont Arkansas Nebraska Delaware Ohio Minnesota Idaho Oregon Arizona Nevada West Virginia Virginia Alaska Tennessee Kansas Colorado New Hampshire Pennsylvania New Mexico Alabama Illinois Missouri Wyoming Dist of Columbia Louisiana Mississippi Washington Massachusetts Hawaii Texas Connecticut South Carolina Wisconsin South Dakota Rhode Island North Dakota Montana U.S. Total
0.000
.158 .166 .170 .170 .179 .182 .183 .184 .185 .186 .189 .190 .194 .201 .201 .202 .202 .202 .204 .204 .205 .209 .210 .211 .212 .213 .215 .217 .218 .218 .222 .222 .223 .226 .232 .237 .237 .238 .241 .244 .249 .251 .254 .256 .268 .269 .279 .291 .296 .309 .209
0.050
0.100
0.150
0.200
0.250
0.300
0.350
Figure 2. Percentage of Drivers Involved in Fatal Crashes with BACs >.08 g/dL, 5-Year Average (2002-2006), Ranked by State (Source: NHTSA, FARS, 2012)
44
