Biomedical subjects

Robert B Voas

Publications and source records attributed to Robert B Voas.

At least 19 recordsLinked to original sources

PubMed2006

The effectiveness of reducing illegal blood alcohol concentration (BAC) limits for driving: evidence for lowering the limit to .05 BAC.

PURPOSE: This scientific review provides a summary of the evidence regarding the benefits of reducing the illegal blood alcohol concentration (BAC) limit for driving and providing a case for enacting a .05 BAC limit. RESULTS: Fourteen independent studies in the United States indicate that lowering the illegal BAC limit from .10 to .08 has resulted in 5-16% reductions in alcohol-related crashes, fatalities, or injuries. However, the illegal limit is .05 BAC in numerous countries around the world. Several studies indicate that lowering the illegal per se limit from .08 to .05 BAC also reduces alcohol-related fatalities. Laboratory studies indicate that impairment in critical driving functions begins at low BACs and that most subjects are significantly impaired at .05 BAC. The relative risk of being involved in a fatal crash as a driver is 4 to 10 times greater for drivers with BACs between .05 and .07 compared to drivers with .00 BACs. SUMMARY: There is strong evidence in the literature that lowering the BAC limit from .10 to .08 is effective, that lowering the BAC limit from .08 to .05 is effective, and that lowering the BAC limit for youth to .02 or lower is effective. These law changes serve as a general deterrent to drinking and driving and ultimately save lives. IMPACT ON INDUSTRY: This critical review supports the adoption of lower illegal BAC limits for driving.

Accidents, Traffic↗

PubMed2006

Drug and alcohol-impaired driving among electronic music dance event attendees.

BACKGROUND: Drug-impaired driving has received increased attention resulting from development of rapid drug-screening procedures used by police and state laws establishing per se limits for drug levels in drivers. Venues that host electronic music dance events (EMDEs) provide a unique opportunity to assess drug-impaired driving among a high proportion of young adult drug users. EMDEs are late-night dance parties marked by a substantial number of young adult attendees and elevated drug involvement. No studies to date have examined drug-impaired driving in a natural environment with active drug and alcohol users. METHODS: Six EMDEs were sampled in San Diego, California, and Baltimore, Maryland. A random sample of approximately 40 attendees per event were administered surveys about alcohol and other drug (AOD) use and driving status, given breath tests for alcohol, and asked to provide oral fluid samples to test for illicit drug use upon entering and exiting the events. RESULTS: Driving status reduced the level of alcohol use (including abstaining) but the impact on drug-taking was not significant. However, 62% of individuals who reported their intention to drive away from the events were positive for drugs or alcohol upon leaving. This suggests that these events and settings are appropriate ones for developing interventions for reducing risks for young adults.

Adolescent↗

PubMed2006

Mothers Against Drunk Driving (MADD): the first 25 years.

Mothers Against Drunk Driving (MADD) has arguably been one of the most successful public-health grassroots citizen advocacy organizations in the United States in the past century. In 2005, MADD celebrated the 25th anniversary of its founding. Based on a national poll by the Gallup Organization in 2005, MADD is recognized by 94% of citizens. It is generally given credit for changing American attitudes toward drinking and driving. Since MADD's founding in 1980, alcohol-related traffic deaths in the United States have decreased from an estimated 30,000 to 16,694 in 2004, according to the National Highway Traffic Safety Administration. This article examines the growth of MADD since its founding and attempts to gauge its contribution to the public's understanding of the impaired-driving problem and to the reductions in alcohol-related highway deaths and injuries that have occurred in the first 25 years of its existence.

Accidents, Traffic↗

PubMed2006

The sidewalk survey: a field methodology to measure late-night college drinking.

Alcohol use is highly prevalent among U.S. college students, and alcohol-related problems are often considered the most serious public health threat on American college campuses. Although empirical examinations of college drinking have relied primarily on self-report measures, several investigators have implemented field studies to obtain objective measures of alcohol consumption (blood alcohol concentration) from students in ecologically valid settings. This article describes the methodology of breath-test field survey that is being conducted on the grounds of San Diego State University. Descriptive summaries of the data collected through spring 2003 are provided, and limitations to methodology are discussed.

Adolescent↗

PubMed2006

Portal surveys of time-out drinking locations: a tool for studying binge drinking and AOD use.

Portal surveys, defined as assessments occurring proximal to the entry point to a high-risk locale and immediately on exit, can be used in different settings to measure characteristics and behavior of attendees at an event of interest. This methodology has been developed to assess alcohol and other drug (AOD) use at specific events and has included measuring intentions to use collected at entry and reported use on exit, as well as chemical tests for AOD consumption at both entrance and exit. Recent applications of the portal survey procedure to electronic music dance events that occur in established venues (e.g., bars or nightclubs) are discussed.

Adolescent↗

PubMed2006

Language, income, education, and alcohol-related fatal motor vehicle crashes.

This paper investigates the role of race/ethnicity, language skills (a proxy for acculturation among Hispanics in Arizona, California, New Mexico, and Texas), income, and education level on alcohol-related fatal motor vehicle crashes. Using the Fatality Analysis Reporting System (FARS), we confirmed previous state-based studies showing that high income and education levels have a protective influence on alcohol-related fatal motor vehicle crashes. We also confirmed that language proficiency/acculturation tends to increase the vulnerability of Hispanic women to alcohol-related fatalities. Differences in alcohol-related fatality rates across Hispanic subgroups are observed. Future reductions in alcohol-related traffic fatalities may require prevention policies that take into account existent variations in acculturation, income, and education among racial/ethnic groups and subgroups.

Accidents, Traffic↗

PubMed2006

The efficacy of experimental interventions designed to reduce drinking among designated drivers.

OBJECTIVE: Designated drivers are a popular strategy for avoiding drunk driving. However, studies have demonstrated that the strategy is often implemented poorly, resulting in diminished risk-reduction effectiveness. The purpose of this study was to test the efficacy of six interventions designed to reduce alcohol consumption among designated drivers. METHOD: A total of 376 groups consisting of 1,412 pedestrians (57.8% men) were recruited as they crossed into Tijuana, Mexico, from San Diego, CA. Before crossing into Mexico, each group was assigned at random to one of six experimental conditions or to one control condition. The six interventions were designed to (1) cue the use of designated drivers, (2) change attitudes about designated drivers, (3) provide monetary rewards for driver sobriety, and (4) increase group supportive norms for proper designated driver use. Participant breath alcohol concentrations (BrACs) were collected before entering Mexico and on return to the United States. RESULTS: Using group members to deliver pro-designated driver messages significantly decreased driver and passenger BrACs relative to controls. Male drivers were more likely to return from Mexico with BrACs of zero if they were rewarded. Among female drivers, wearing a bracelet with the printed words "designated driver" in addition to cuing resulted in 9 of 10 drivers returning with BrACs equal to zero. CONCLUSIONS: These results demonstrate that designated driver sobriety can be enhanced through brief interventions, and proper use of the designated driver concept did not increase the risk of excessive alcohol consumption for passengers.

Accidents, Traffic↗

PubMed2006

Validity of the passive alcohol sensor for estimating BACs in DWI-enforcement operations.

OBJECTIVE: The effectiveness of driving while intoxicated (DWI) operations in deterring impaired driving depends on the ability of police officers to detect heavy drinkers. The passive alcohol sensor (PAS), which can detect alcohol in expired breath at a distance of 6 inches from the face, provides a means for detecting heavy drinking within 15-30 seconds. The objective of this study was to determine the accuracy of the PAS unit for estimating the blood alcohol concentration (BAC) of drivers and study its potential use as a screening device for estimating BAC in relation to several factors related to its use (age, gender, light conditions, and police confidence in the PAS measure). METHOD: A recent study funded by the National Highway Traffic Safety Administration of the BAC levels of crash-involved and randomly stopped drivers as a control group for comparison provided 12,587 cases in which both a breath test and a PAS measure of BAC were obtained for each driver studied. This research involved a secondary analysis of that data set using regression and receiver operator curves methodology to determine the accuracy and utility of the PA S for use as a screening device for DWI violations. RESULTS: PAS scores were a strong predictor of a driver's BAC status. The only other variable having a significant and consistent relationship independent of PA S was police confidence. Detection sensitivity and specificity for each PA S cut-point score were estimated. CONCLUSIONS: By selecting a PAS cut-point score appropriate to the enforcement operation being undertaken, the PA S can be an effective tool for officers when deciding whether to initiate a DWI investigation.

Adult↗

PubMed2006

Drinking status and fatal crashes: which drinkers contribute most to the problem?

OBJECTIVE: The object of this study was to estimate the relative contribution of various classes of drinkers (including those with alcohol-use disorders) to alcohol-related fatal motor vehicle crashes. METHOD: Using the National Epidemiologic Survey on Alcohol and Related Conditions conducted in 2000, the percentage of state residents falling into six nonoverlapping alcohol-user categories-dependent drinkers, abusive drinkers, dependent and abusive drinkers, heavy episodic drinkers, current normative drinkers, and current nondrinkers- was determined based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, classifications. The percentage of residents in each state in each of these user categories and their relationships to the number of drinking drivers involved in fatal crashes in that state were determined through regression analysis using data from the Fatality Analysis Reporting System. RESULTS: The proportion of drinkers in a state in each of the six consumption categories was positively related to the number of drinking drivers in fatal crashes in that state. Conversely, the percentage of the state's population who were current nondrinkers was negatively related to the number of drinking road users in crashes. CONCLUSIONS: Although alcohol abusive and heavy episodic drinkers had substantially higher associations with impaired drivers in fatal crashes, half of such drivers were associated with the percentage of current nominative drinkers in the state. Despite the relevancy of these findings, they must be qualified by statistical limitations associated with the use of state as the unit of analysis.

Accidents, Traffic↗

PubMed2006

A partial ban on sales to reduce high-risk drinking South of the border: seven years later.

OBJECTIVE: On weekend evenings, thousands of youths (ages 20 and younger) and young adults (ages 21-25) residing in communities along the U.S. border cross into Mexico to patronize all-night bars where the drinking age is 18, rather than 21, and where the price of alcohol is considerably less than in the United States. On January 1, 1999, Juárez, Mexico, implemented a 2 AM (instead of 5 AM) bar-closing policy. The number of crossers and their blood alcohol concentration levels on return were reduced in the year following this policy change. The present study's objective was to determine the long-term (7-year) effect of the earlier-closing bar policy on cross-border drinking in Mexico. METHOD: Analyzed data (1998 to August 2005) were from quarterly breath-test surveys at the El Paso (Texas)/Juárez (Mexico) border, bar observations in Juárez, and trauma data in El Paso. RESULTS: Bar surveys in Juárez show that the 2 AM closing policy, initiated 7 years ago, continues to be enforced, as has the reduction (89%) in youthful crossers returning after 3 AM. The number of underage youths returning earlier in the evening (before 3 AM), however, unchanged for 2 years after the policy change, has doubled recently. CONCLUSIONS: The early closing of bars in Juárez has a continuing positive impact on the reduction of the number of those returning after 3 AM. Although initially there appeared to be no displacement of the late returnees into the early hours (before 3 AM), the number of bar visitors crossing and returning earlier has been steadily increasing. Suggestions for reducing cross-border heavy episodic drinking are described.

Adolescent↗

PubMed2005

The impact of a novel educational curriculum for first-time DUI offenders on intermediate outcomes relevant to DUI recidivism.

The Preventing Alcohol-Related Convictions (PARC) program is a novel educational curriculum for first-time DUI offenders, with the ultimate goal of reducing DUI recidivism. It differs from traditional DUI education and prevention programs in that it does not suggest to DUI offenders that they must abstain from alcohol entirely or control their drinking to prevent a future DUI; rather, it teaches students to prevent a future DUI by not driving their cars to drinking events. Thus, the emphasis of the curriculum is on controlling driving rather than controlling drinking to avoid future DUI convictions. The implementation of the program is ongoing throughout the state of Florida. The current randomized study focused on intermediate outcomes relevant for DUI recidivism; specifically, individuals' readiness for change regarding drinking and driving, and their endorsement of a PARC planning and action approach (controlling driving) versus a traditional approach (controlling drinking). The current research demonstrated that the PARC program is effective in moving participants toward more readiness for change and toward a strategy of planning ahead to avoid driving to any venue in which drinking may occur. Future research will assess the ultimate effect on DUI recidivism.

Alcoholic Intoxication↗

PubMed2005

Minimum purchasing age for alcohol and traffic crash injuries among 15- to 19-year-olds in New Zealand.

OBJECTIVES: In 1999, New Zealand lowered the minimum purchasing age for alcohol from 20 to 18 years. We tested the hypothesis that this increased traffic crash injuries among 15- to 19-year-olds. METHODS: Poisson regression was used to compute incidence rate ratios for the after to before incidence of alcohol-involved crashes and hospitalized injuries among 18- to 19-year-olds and 15- to 17-year-olds (20- to 24-year-olds were the reference). RESULTS: Among young men, the ratio of the alcohol-involved crash rate after the law change to the period before was 12% larger (95% confidence interval [CI]=1.00, 1.25) for 18- to 19-year-olds and 14% larger (95% CI=1.01, 1.30) for 15- to 17-year-olds, relative to 20- to 24-year-olds. Among young women, the equivalent ratios were 51% larger (95% CI=1.17, 1.94) for 18- to 19-year-olds and 24% larger (95% CI=0.96, 1.59) for 15- to 17-year-olds. A similar pattern was observed for hospitalized injuries. CONCLUSIONS: Significantly more alcohol-involved crashes occurred among 15-to 19-year-olds than would have occurred had the purchase age not been reduced to 18 years. The effect size for 18- to 19-year-olds is remarkable given the legal exceptions to the pre-1999 law and its poor enforcement.

Accidents, Traffic↗

PubMed2005

A meta-analysis of .08 BAC laws in 19 jurisdictions in the United States.

More than a dozen studies on the effectiveness of the .08 blood alcohol concentration (BAC) laws have been published; however, those studies have varied both in the statistical methods and the type of outcome measure used, so it is difficult to integrate the findings into an overall estimate of the effectiveness of the law. This study used a consistent outcome measure, drinking drivers in fatal crashes and an identical methodology time-series analysis, to analyze the introduction of the .08 law in 18 states and the District of Columbia from 1982 to 2000. Each analysis accounted for other key safety laws (administrative license suspension/revocation and safety belt laws), as well as economic conditions that might influence the effectiveness of the .08 law. This provided 19 independent evaluations in which the effectiveness (treatment effect) of the law could be measured in the same quantitative terms. The number of drinking drivers in fatal crashes declined in 16 of the 19 jurisdictions after the .08 law was adopted. Nine of the 16 reductions were statistically significant (p < .05). The effect size combined across all 19 locations showed statistically significant decline (p < .005) of 14.8% in the rate of drinking drivers in fatal crashes after the .08 laws were introduced. The reduction was greater in states that had an administrative license suspension/revocation law and implemented frequent sobriety checkpoints. This analysis suggests that 947 lives might have been saved, had all 50 states and the District of Columbia had the .08 law throughout the year 2000.

Accidents, Traffic↗

PubMed2005

Reducing DUI among US college students: results of an environmental prevention trial.

AIMS: Driving under the influence (DUI) of alcohol is among the most common and serious alcohol-related problems experienced by US college students. Community-based prevention trials using environmental approaches to DUI prevention have been effective in reducing DUI. Such interventions remain untested in college settings. This study is the first to test the efficacy of an environmental prevention campaign to reduce DUI among college students. DESIGN: We used a quasi-experimental non-equivalent comparison group design to test the efficacy of the DUI prevention intervention. Students at the experimental university were exposed to a DUI prevention intervention that included a social marketing campaign, a media advocacy campaign and increased law enforcement (DUI checkpoints and roving DUI patrols). SETTING: Students from two large public universities located along the US/Mexico border participated in the seven-semester study. PARTICIPANTS: In total, 4832 college students took part. MEASURES: Using telephone interviews of randomly selected students, we took pre- and postintervention measures of self-reported DUI. FINDINGS: Self-reported DUI (past year) decreased significantly from pre-test to post-test (odds ratio = 0.55) at the intervention school, whereas rates at the comparison campus remained stable. The campus-intervention interaction was statistically significant (P < 0.05), suggesting that the campaign led to the observed change in DUI. CONCLUSIONS: Environmental DUI campaigns similar to those validated in community prevention trials can be effective in college settings. Further research, however, is needed to determine the robustness of the changes associated with such campaigns.

Adult↗

PubMed2004

Tijuana alcohol control policies: a response to cross-border high-risk drinking by young Americans.

Several thousand young Americans visit the bars in Tijuana, Mexico, each weekend night, raising concerns on both sides of the border. Measures implemented in San Diego, California, and Tijuana have successfully reduced the number of American visitors to Mexican bars. Although San Diego policies have been well-documented, this is the first article on investigation of measures enacted south of the border. Information on Tijuana alcohol policies was obtained from a survey of 29-36 bars from 1997 to 1999. The Tijuana police provided data on Americans arrested in Tijuana from 1998 to 1999. Our study found alcohol regulations are poorly enforced in Tijuana, suggesting that regulatory agencies are captured by bar owners. However, such a capture may be weakening. The importance of identifying and supporting Mexican interest groups, as opposed to the bar owners, as a mechanism to impede the capture of Tijuana's regulatory agencies is discussed. The number of Americans involved in alcohol-related crimes in Tijuana sharply decreased over time. However, such a success is largely related to the success of the San Diego efforts in reducing the number of American visitors to Tijuana. Also, by demonstrating the racial/ethnic heterogeneity of American visitors to Tijuana bars, our study points out the need for prevention policies designed north of the border to take such heterogeneity into account.

Alcohol Drinking↗

PubMed2004

Living dangerously: driver distraction at high speed.

Recent research indicates that cell phone use can distract drivers from safe vehicle operation. However, estimates of the prevalence of cell phone use while driving have been limited to daytime hours and low-speed roadways. This paper describes the results of a study to estimate rates of cell phone use and other distractions by examining approximately 40,000 high-quality digital photographs of vehicles and drivers on the New Jersey Turnpike. The photographs, which originally were collected as part of a separate study, were taken both during the day and during the night and at different locations across the span of the Turnpike. A radar gun linked to the camera recorded the speeds of vehicles as they passed. This provided us with the speeds of every vehicle photographed, and allowed us to determine population counts of vehicles. A panel of three trained coders examined each photograph and recorded the presence of cell phone use by the drivers or any other distracting behavior. Demographic information on the driver was obtained during previous examinations of the photographs for an unrelated study. A rating was considered reliable when two out of the three coders agreed. Population estimates (and confidence intervals) of cell phone use and other distractions were estimated by weighting the cases by the inverse probability of vehicle selection. Logistic regression was used to predict cell phone use from demographic and situational factors. The results indicated that the most frequent distraction was cell phone use: 1.5% of the drivers on the Turnpike were using cell phones compared to the 3 to 4% use rates reported in the National Occupant Protection Use Survey (NOPUS) surveys conducted during the daytime on lower speed roadways. The Turnpike survey indicated that cell phones were used less on weekends and at night, and when the driver was exceeding the speed limit or had a passenger in the car.

Adolescent↗

PubMed2004

Potential risks of providing drinking drivers with BAC information.

The objective of this paper is to discuss the benefits and risks of providing drinkers with tools that allow them to estimate their blood alcohol concentration (BAC), and to examine the field usability of one commercially available tool. Drinking and driving laws are specified in terms of the driver's BAC, and there is concern that the absence of a method for drivers to accurately estimate their BAC level limits their ability to determine whether they can drive legally. A number of devices that provide a method for the individual to estimate or measure their BAC have been developed. Although some of these devices--such as the "know your limit" (KYL) cards--have been widely distributed, their effectiveness in encouraging good driving decisions have rarely been tested. This article describes a pilot study on the field usability of the Guardian Angel (GA) personal alcohol test in a field setting. The GA test analyzes saliva samples from drinking and indicates under which BAC category they fall (.00 -.04;.04 -.08;.08+). The research examined whether drinkers could, in natural drinking environments, correctly administer and interpret the test results. The methodology involves sampling drinkers on a weekend night on and around the grounds of a large West Coast university as they traveled between off-campus parties, bars, and their dorms. They were asked to assess their own intoxication and impairment, then self-administer and interpret the Guardian Angel test. After interpreting the test, participants were asked to reassess their intoxication and impairment levels, and were given a breath BAC test using a calibrated unit. The results revealed that although the majority of drinkers' were able to administer the GA test, their interpretations did not correspond with actual BACs. The interpretations of the GA test produced false-negatives, underestimating actual BACs. Drinkers perceived themselves to be less intoxicated, on average, after interpreting the GA test results. In conclusion, this research addresses potential pros and cons of providing BAC information to drinkers. It underscores the importance of testing BAC estimation tools under field conditions and the potential risks associated with tests that do not produce accurate results.

Adult↗

PubMed2004

Sobriety checkpoints: evidence of effectiveness is strong, but use is limited.

There is substantial and consistent evidence from research that highly publicized, highly visible, and frequent sobriety checkpoints in the United States reduce impaired driving fatal crashes by 18% to 24%. Although checkpoints are not conducted in 13 states for legal or policy reasons, there is strong evidence that if conducted appropriately, checkpoints would save lives in the other states. However, a recent survey of checkpoint use has demonstrated that despite the efforts of the U.S. Department of Transportation to encourage checkpoint use through publications, providing funds for equipment, and for officer overtime expenses, only about a dozen of the 37 states that conduct checkpoints do so on a weekly basis. The survey found that lack of local police resources and funding, lack of support by task forces and citizen activists, and the perception that checkpoints are not productive or cost effective are the main reasons for their infrequent use. This article discusses each of these problems and suggests a method for local communities to implement checkpoints without depending on state or federal funds. Low-staffing sobriety checkpoints conducted by as few as three to five officers have been shown to be just as effective as checkpoints conducted by 15 or more officers. A modified sobriety checkpoint program using passive alcohol sensors ("PASpoints") can be implemented by small- to moderate-sized communities in the United States to deter impaired driving. If implemented in a majority of communities, this strategy has a potential level of effectiveness similar to the high level achieved by several Australian states in their random breath-test (RBT) programs. The PASpoint system calls for a small group of three to five officers on traffic patrol duty to converge on a preset site and conduct a mini-checkpoint, returning to their standard patrol duties within two hours. Within this framework, the PASpoint operation would become a standard driving under the influence (DUI) enforcement technique regularly used within the community's jurisdiction. As a standard traffic enforcement activity, the cost would be covered by the normal enforcement budget.

Accidents, Traffic↗