Motor Vehicle Injury Alcohol-Impaired Driving: Multicomponent Interventions with Community Mobilization

The CPSTF finding is based on evidence from a systematic review of 6 studies (search period through June 2000). The review was conducted on behalf of the CPST 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.

Six studies qualified for the systematic review.

• Fatal crashes outcomes:
  • 42% decrease in alcohol-related crashes (1 studies)
  • 9% decrease in likelihood that drivers are alcohol-impaired
• Nighttime injury crashes: decreased 10% (1 study)
• Alcohol-related crashes among drivers aged 16 20: decreased 45% (1 study)
• There was a small decrease in the rate of crashes among drivers under 21 years of age, however, the actual number of crashes was not reported and the percentage change could not be calculated (1 study).

• The systematic economic review identified three studies that estimated the returns from investment in two of the reviewed multicomponent programs.
• An analysis of the Massachusetts Saving Lives Program estimated $9.33 in savings for each dollar invested.
  • Six communities received $70,000 annually for 5 years, resulting in total funding of $2.1 million.
  • Based on societal costs of $6000 in hospital and medical claims per motor vehicle fatality (data obtained from the U.S. DOT) and $748,000 in lost productivity (adjusted for Massachusetts cost levels), the 26 alcohol-related deaths averted as a result of the program resulted in savings of approximately $20 million.
• The Community Trials Project returned an estimated $6.56 in savings for every dollar invested.
  • This estimate was based on a cost of $1,350,000 expended over a period of 5 years, for local prevention staff in three experimental communities, a net reduction of 222 alcohol-involved crashes in those communities, and an average cost per crash of $39,905.
  • The cost per crash included medical, legal, and insurance costs as well as lost wages during rehabilitation but not lost productive years associated with premature mortality.
• A comparative study performed of alcohol-related traffic injuries in one of the three Community Trials Project sites returned an estimated $15.72 in savings for each dollar invested.
  • The estimate was based on a cost of $450,000 over 5 years for local prevention staff, a net reduction of 116 nighttime injury crashes, and an average cost per injury of $61,000.
  • Average cost of an injury was based on the system of estimating cost used by the California Highway Patrol.
• The rate of return estimates from the above studies do not take into account the contributed value of time of many community volunteers, the cost of data collection, and the opportunity costs of taking law enforcement officers away from other duties to do alcohol-impaired driving enforcement.
• Considering further reductions in injuries and deaths over a longer time period, however, and other benefits from reduced speeding and alcohol-impaired driving, including reduced property damage and criminal justice expenditures, these multicomponent programs with community mobilization appear to be economically very attractive.

Results suggest that programs similar to those included in this review can be successfully implemented in a broad range of urban areas in the U.S. Because few of the communities would be considered rural, the applicability of these programs in rural areas is open to question.

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?)

• Does community mobilization actually increase the effectiveness of multicomponent programs, and if so, to what extent and through what mechanisms?
  • To what extent does community mobilization increase support among community leaders and the public for policy and environmental change?
  • Does community mobilization improve the likelihood that effective programs will be maintained long-term?
• To what extent does program effectiveness vary as a function of predominant ethnicity or SES of the community or as a function of the specific components included in the intervention?
• What is the potential impact of the changing media market, with increasing market segmentation, emerging technology to allow consumers to avoid exposure to broadcast messages, and opportunities for individually tailored message delivery via the Internet?

• All six of these programs were conducted in the U.S. between 1988 and 2001.
• Evaluation follow-up periods ranged from 2 to 10 years (median 4 years).
• The reviewed interventions addressed a range of alcohol-related concerns including alcohol-impaired driving, excessive drinking, underage drinking, alcohol-related injuries, and increasing access to alcohol treatment.
• Interventions included responsible beverage service programs and other efforts to limit access to alcohol, such as:
  • Regulations controlling alcohol outlet density and enforcement of minimum legal drinking age laws (6 studies)
  • Sobriety checkpoints (5 studies)
  • Awareness or educational campaigns (5 studies)
  • Attention to other driving risks, such as speeding (2 studies)
  • Improved access to alcohol treatment (2 studies)
• Most intervention communities had populations between 50,000 100,000. Two cities had populations greater than 500,000.

Effectiveness Review

Analytic Framework [PDF 378 kB] see Figure 1 on page 362

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 see Table 1 on page 364

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

Hingson R, McGovern T, Howland J, et al. Reducing alcohol-impaired driving in Massachusetts: the Saving Lives Program. Am J Public Health 1996;86(6):791 7.

Hingson RW, Zakocs RC, Heeren T, et al. Effects on alcohol related fatal crashes of a community based initiative to increase substance abuse treatment and reduce alcohol availability. Inj Prev 2005;11(2):84 90.

Holder HH, Gruenwald PJ, Ponicki WR, et al. Effect of community-based interventions on high-risk drinking and alcohol-related injuries. JAMA 2000;284:2341 7.

Rhode Island Department of Health. Final report of the Rhode Island Community Alcohol Abuse and Injury Prevention Project: Volume I, technical report. Providence RI: Rhode Island Department of Health, 1994.

Voas RB, Tippetts AS, Johnson MB, et al. Operation Safe Crossing: using science within a community intervention. Addiction 2002;97:1205 14.

Wagenaar AC, Murray DM, Toomey TL. Communities Mobilizing for Change on Alcohol (CMCA): effects of a randomized trial on arrests and traffic crashes. Addiction 2000;95(2):209 17.

Economic Review

Hingson R, McGovern T, Howland J, et al. Reducing alcohol-impaired driving in Massachusetts: the Saving Lives Program. Am J Public Health 1996;86(6):791 7.

Holder HD, Saltz RF, Grube JW, et al. Summing up: lessons from a comprehensive community trial. Addiction 1997;92(2S):S293 301.

Roeper PJ, Voas RB, Padilla-Sanchez L, et al. A long-term community-wide intervention to reduce alcohol-related traffic injuries: Salinas, California. Drugs: Educ Prev Policy 2000;17:51 60.

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 following considerations are drawn from studies included in the evidence review, the broader literature, and expert opinion.

• Multicomponent programs have the potential to reduce a wide variety of alcohol-related harms, including alcohol-impaired driving, underage drinking, and alcohol-related injuries and violence.
• Community mobilization can produce beneficial secondary effects by promoting individual and community empowerment and problem solving capacity that may be transferred to other situations. Community mobilization approaches, however, do not necessarily ensure that communities will select, implement, or sustain effective interventions.
• Multicomponent programs must contend with the barriers to implementing each individual intervention and the additional challenges of maintaining a vibrant, functioning community coalition.

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