Motor Vehicle Injury Alcohol-Impaired Driving: 0.08% Blood Alcohol Concentration (BAC) Laws

The CPSTF finding is based on evidence from a systematic review of 9 studies (search period through June 2000). The review was conducted on behalf of the CPSTF by scientists from CDC’s Division of Unintentional Injury Prevention with input from a team of specialists in systematic review methods and experts in research, practice and policy related to motor vehicle injury prevention.

As of February 2015, all 50 states, the District of Columbia, and Puerto Rico have 0.08% BAC laws.

In support of .08 BAC laws, the U.S. Congress included a provision in the Fiscal Year 2001 Department of Transportation and Related Agencies Appropriations Act that required states to implement 0.08% BAC laws by October 2003 or risk losing federal highway construction funds.

Nine studies qualified for the systematic review.

• Fatalities due to alcohol-related motor vehicle crashes: median decrease of 7% following implementation of the law (interquartile range: 15% to 4% decrease; 7 studies)

An economic review of this intervention did not find any relevant studies.

Results should be applicable to all drivers in the U.S., though the review did not find information on the effectiveness of these laws in various subgroups.

CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

Research Issues Laws

• How do variations in enforcement levels influence the effectiveness of laws to reduce alcohol-impaired driving?
• What are the independent effects of publicity on the effectiveness of laws to reduce alcohol-impaired driving?
• Does public compliance with new laws change in a predictable manner over time?

General Research Issues

The following outlines evidence gaps for reviews of these interventions to reduce alcohol-impaired driving: 0.08% Blood Alcohol Concentration (BAC) Laws; Lower BAC Laws for Young or Inexperienced Drivers; Maintaining Current Minimum Legal Drinking Age (MLDA) Laws; Sobriety Checkpoints (archived); Intervention Training Programs for Servers of Alcoholic Beverages (archived).

General Questions

• How do interventions to reduce alcohol-impaired driving interact with each other (e.g., 0.08% BAC laws and administrative license revocation)?
• What effects do these interventions have on long-term changes in social norms about drinking and driving?

Applicability

Questions remain about possible differences in the effectiveness of each intervention for specific settings and subgroups. For example:

• Are these interventions equally effective in rural and urban settings?
• Are these interventions equally effective when applied to populations with different baseline levels of alcohol-impaired driving?
• Does targeting publicity efforts to specific subpopulations (e.g., young drivers, ethnic minorities, men) improve the effectiveness of interventions to reduce alcohol-impaired driving?

Other Positive or Negative Effects

Few other positive and negative effects were reported in this body of literature. Further research about the following questions would be useful:

• What proportion of youths charged with violating zero tolerance laws had BAC levels elevated enough to warrant a more serious drinking-driving offense?
• Do interventions to reduce alcohol-impaired driving reduce other forms of alcohol-related injury?

Economic Evaluations

Little economic evaluation information was available. Research is warranted to answer the basic economic questions:

• What are the cost-benefit, cost utility, and cost-effectiveness of interventions to reduce alcohol impaired driving?

Barriers to Implementation

Several of the interventions reviewed face barriers to effective implementation. Research into the following areas may help to overcome these barriers:

• What role can community coalitions play in removing barriers to implementing interventions designed to prevent alcohol-impaired driving?
• What are the most effective means of disseminating research findings about effectiveness to groups that want to implement interventions?
• What forms of incentives (e.g., insurance discounts) are most helpful for increasing management and owner support for server intervention training?
• How can the costs of interventions to prevent alcohol-impaired driving be shared or subsidized?
• What situational and environmental influences help or hinder the implementation of server intervention training?

• Each study evaluated 0.08% BAC laws in one or more of the 16 states that implemented the laws before January 1, 1998.
• Studies reviewed fatal injury crashes (8 studies) and fatal and nonfatal injury crashes (1 study).
• All of the included studies analyzed data from police incident reports of crashes occurring on public roadways.
• Post-law follow-up times for individual state laws ranged from 1 to 14 years (median, 5 years).
• The states studied were geographically diverse with varying population densities.

Effectiveness Review

Analytic Framework see Figure 1 on page 67

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Effectiveness Review

Summary Evidence Table

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Effectiveness Review

Apsler R, Char AR, Harding WM, Klein TM. The effects of .08 BAC laws. Washington, DC: U.S. Department of Transportation, National Highway Traffic Safety Administration, National Center for Statistics and Analysis, 1999. DOT HS 808 892.

Foss RD, Stewart JR, Reinfurt DW. Evaluation of the effects of North Carolina’s 0.08% BAC law. Chapel Hill, NC: University of North Carolina Highway Safety Research Center, 1998. DOT HS 808 893.

Hingson R, Heeren T, Winter M. Effects of recent 0.08% legal blood alcohol limits on fatal crash involvement. Inj Prev 2000;6:109 14.

Hingson R, Heeren T, Winter M. Lowering state legal blood alcohol limits to 0.08%: the effect on fatal motor vehicle crashes. Am J Public Health 1996;86:1297 9.

Johnson D, Fell J. The impact of lowering the illegal BAC limit to .08 in five states. 39th Annual Proceedings, Association for the Advancement of Automotive Medicine, October 16 18, 1995, Chicago, Illinois.

Research and Evaluation Associates. The effects following the implementation of an 0.08 BAC limit and administrative per se law in California. Washington, DC: U.S. Department of Transportation, National Highway Traffic Safety Administration, National Center for Statistics and Analysis, 1991. DOT HS 807 777.

Rogers PN. The general deterrent impact of California’s 0.08% blood alcohol concentration limit and administrative per se license suspension laws, Volume 1. Sacramento, CA: California Department of Motor Vehicles, Research and Development Section, 1995. No. CAL-DMV-RSS-95-158.

Scopatz RA. Methodological study of between-states comparisons, with particular application to .08% BAC law evaluation. Paper presented at the Transportation Research Board 77th annual meeting, January 11 15, 1998, Washington, DC.

Voas RB, Tippets AS, Fell J. The relationship of alcohol safety laws to drinking drivers in fatal crashes. Accid Anal Prev 2000;32:483 92.

The following outlines the search strategy used for reviews of these interventions to reduce alcohol-impaired driving: 0.08% Blood Alcohol Concentration (BAC) Laws; Lower BAC Laws for Young or Inexperienced Drivers; Maintaining Current Minimum Legal Drinking Age (MLDA) Laws; Mass Media Campaigns; Multicomponent Interventions with Community Mobilization; Ignition Interlocks; School-Based Programs; Designated Driver Promotion Programs; Sobriety Checkpoints (archived); Intervention Training Programs for Servers of Alcoholic Beverages (archived).

The reviews of interventions to reduce motor vehicle-related injury reflect systematic searches of multiple databases as well as reviews of reference lists and consultations with experts in the field. The team searched six computerized databases (MEDLINE, Embase, Psychlit, Sociological Abstracts, EI Compendex, and Transportation Research Information Services [TRIS]), which yielded 10,958 titles and abstracts for articles, book chapters, reports, and published papers from the Association for the Advancement of Automotive Medicine proceedings about safety belts, alcohol-impaired driving or child passenger safety. Studies were eligible for inclusion if:

• They were published from the originating date of the database through June 2000 (March 1998 for child safety seat interventions)
• They involved primary studies, not guidelines or reviews
• They were published in English
• They were relevant to the interventions selected for review
• The evaluation included a comparison to an unexposed or less-exposed population
• The evaluation measured outcomes defined by the analytic framework for the intervention

For alcohol-impaired driving reviews, supplementary searches were conducted to address specialized questions and to update searches for reviews published after 2001. The final search using the primary alcohol-impaired driving search strategy was conducted through December 2004. For the most recent review in this series, “Effectiveness of Multicomponent Programs with Community Mobilization for Reducing Alcohol-Impaired Driving,” this database was supplemented by a hand search of the “Alcohol and Other Drugs” and “Transportation” sections of the SafetlyLit injury literature update service for the period from January through June 2005.

Effectiveness Review

Primary Search Strategy

1. S MOTOR(W)VEHICLE? OR CAR OR CARS OR AUTOMOBILE? OR MOTORCYCLE? OR TRUCK? OR TRAFFIC(2N)ACCIDENT? OR DRIVING OR DRIVER?
2. S ALCOHOL OR ALCOHOLIC(W)BEVERAGE? OR ALCOHOL(3N)DRINKING OR ETHANOL OR ALCOHOLISM OR DWI OR DUI OR (DRIVING(3N)(INTOXICATED OR INFLUENCE OR DRUNK OR DRINKING OR IMPAIRED))
3. S INTERVENTION? OR OUTREACH? OR PREVENTION OR (COMMUNITY(3N)(RELATION? OR PROGRAM? OR ACTION)) OR DETERRENT? OR PROGRAM? OR LEGISLATION OR LAW? OR EDUCATION OR DETERENCE OR COUNSELING OR CLASS OR CLASSES OR HEALTH(W)PROMOTION
4. S FOOD(W)INDUSTRY OR AIRPLANE? OR AIRCRAFT? OR PILOT? OR SOLVENT? OR SLEEP(W)APNEA OR EMISSION? OR AIR(W)QUALITY OR POLLUTION
5. S (S1 AND S2 AND S3 ) NOT S4

Higher Education-based Interventions

S1 MOTOR(W)VEHICLE? OR CAR OR CARS OR AUTOMOBILE? OR MOTORCYCLE? OR TRUCK? OR TRAFFIC(2N)ACCIDENT? OR DRIVING OR DRIVER?
S2 ALCOHOL OR ALCOHOLIC(W)BEVERAGE? OR ALCOHOL(3N)DRINKING OR ETHANOL OR ALCOHOLISM OR DWI OR DUI OR (DRIVING(3N)(INTOXICATED OR INFLUENCE OR DRUNK OR DRINKING OR IMPAIRED))
S3 UNIVERSIT? OR COLLEGE? OR CAMPUS? OR (EDUCATION?(2N)(HIGER OR INSTITUTION? OR FACILIT? OR PROGRAM? OR SURVEY?))
S4 S1 AND S2 AND S3
S5 CURRICULUM OR INSTRUCTION OR EDUCATION OR TRAINING OR WORKSHOPS OR PROGRAMS OR COURSE? OR TEACH? OR (SOCIAL(W)NORM?)
S6 STUDENT? OR YOUTH? OR TEEN? OR (YOUNG(W)ADULT?)
S7 S4 AND S5 AND S6

School-based Interventions

S1 MOTOR(W)VEHICLE? OR CAR OR CARS OR AUTOMOBILE? OR MOTORCYCLE? OR TRUCK? OR TRAFFIC(2N)ACCIDENT? OR DRIVING OR DRIVER?
S2 ALCOHOL OR ALCOHOLIC(W)BEVERAGE? OR ALCOHOL(3N)DRINKING OR ETHANOL OR ALCOHOLISM OR DWI OR DUI OR (DRIVING(3N)(INTOXICATED OR INFLUENCE OR DRUNK OR DRINKING OR IMPAIRED))
S3 SCHOOL?(5N)(BASED OR SETTING OR PROGRAM? OR PRIMARY OR ELEMENTARY OR SECONDARY OR ((JUNIOR OR SENIOR)(W)HIGH) OR MIDDLE) OR (EDUCATION?(2N)(INSTITUTION? OR FACILIT? OR PROGRAM? OR SURVEY?))
S4 S1 AND S2 AND S3
S5 CURRICULUM OR INSTRUCTION OR EDUCATION OR TRAINING OR WORKSHOPS OR PROGRAMS OR COURSE? OR TEACH?
S6 STUDENT? OR ADOLESCENT? OR YOUTH? OR TEEN? OR CHILD? OR TEACHER?
S7 525 S4 AND S5 AND S6

Cost Analyses

1. S MOTOR(W)VEHICLE? OR CAR OR CARS OR AUTOMOBILE? OR MOTORCYCLE? OR TRUCK? OR TRAFFIC(2N)ACCIDENT? OR DRIVING OR DRIVER?
2. S ALCOHOL OR ALCOHOLIC(W)BEVERAGE? OR ALCOHOL(3N)DRINKING OR ETHANOL OR ALCOHOLISM OR DWI OR DUI OR (DRIVING(3N)(INTOXICATED OR INFLUENCE OR DRUNK OR DRINKING OR IMPAIRED))
3. S INTERVENTION? OR OUTREACH? OR PREVENTION OR COMMUNITY(3N)(RELATION? OR PROGRAM? OR ACTION)) OR DETERRENT? OR PROGRAM? OR LEGISLATION OR LAW? OR EDUCATION OR DETERENCE OR COUNSELING OR CLASS OR CLASSES OR HEALTH(W)PROMOTION
4. S FOOD(W)INDUSTRY OR AIRPLANE? OR AIRCRAFT? OR PILOT? OR SOLVENT? OR SLEEP(W)APNEA OR EMISSION? OR AIR(W)QUALITY OR POLLUTION
5. S COST? OR ECONOMIC? OR ECONOMETRIC?
6. S (S1 AND S2 AND S3 AND S5) NOT S4

The CPSTF recommendation and evidence from this review may be used to inform decisions about maintaining 0.08% BAC laws. Following are considerations drawn from studies included in the evidence review, the broader literature, and expert opinion.

• Engage partners throughout the process. Building support from the ground up can help secure policies that reinforce healthy behaviors in the community.
• Demonstrate why the policy is important. Use Task Force findings and recent surveillance data to show partners how policies have been effective.
• Educate stakeholders. Keep the media, community influencers, and policymakers informed about BAC laws to help communicate messages that are accurate and timely.
  • Keep messages brief and to the point. Use graphics, figures, or infographics to clearly demonstrate how the intervention can improve health outcomes.
  • Extend your communication reach by working through partners who have the most credibility with key audiences.
• Pay attention to sustainability. Continue to conduct surveillance related to alcohol-impaired driving and disseminate findings.

Healthy People 2030

Healthy People 2030 includes the following objectives related to this CPSTF recommendation.

• Reduce the proportion of motor vehicle crash deaths that involve a drunk driver — SU‑11