Motor Vehicle Injury Alcohol-Impaired Driving: Publicized Sobriety Checkpoint Programs

The CPSTF finding is based on evidence from a Community Guide systematic review published in 2001 (Shults et al., 23 studies, search period January 1980 to June 2000) combined with more recent evidence (15 studies, search period July 2000 to March 2012). 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. This finding updates and replaces the 2000 Task Force finding on Sobriety Checkpoints

The following results are from studies identified during the updated search period.

Fourteen studies evaluated programs conducted in the United States.

• Crash fatalities thought to involve alcohol: median relative decrease of 8.9% associated with selective breath testing checkpoints (inter-quartile interval [IQI]: 16.5% to 3.5%; 10 studies)
• Ratio of alcohol-involved drivers to non-alcohol-involved drivers in fatal crashes: relative decrease of 14% (1 study)
• Fatal and non-fatal crashes thought to involve alcohol: relative decrease of 18.8% (1 study)
• Drivers with a BAC level above the legal limit: relative decreases of 28% and 64% (2 studies)
• Public awareness of checkpoints: the relative increase in the percentage of people from the intervention community who had seen or heard messages about drinking and driving or sobriety checkpoints ranged from 3.4% to 31.9% (5 studies)

One study evaluated a program conducted in New Zealand.

• Serious and fatal nighttime crashes, which serve as a proxy for alcohol-involved fatal crashes: relative decrease of 22.1% associated with random breath testing checkpoints (1 study)

Sixteen studies were included in the economic review (4 from the 2000 review and 12 from the updated search period). Evidence was combined because some of the studies from the updated search period evaluated sobriety checkpoint programs conducted during the period covered by the 2000 review.

Of the 16 included studies, seven reported cost and benefit findings on actual operation of the sobriety checkpoints alone, eight reported costs or cost-effectiveness information on media advertising and publicity alone, and one reported costs for both operations and media. All monetary values are reported in 2011 U.S. dollars using the Consumer Price Index and Purchasing Power Parities from the World Bank for international currencies.

• Cost-benefit estimates of sobriety checkpoint programs:
  • Benefit-to-cost ratios for selective breath testing checkpoint interventions: 6:1 and 23:1 (2 studies)
  • Benefit-to-cost ratios for random breath testing checkpoint interventions: 2:1 to 57:1 (3 studies)
• Cost-effectiveness estimates of sobriety checkpoint programs:
  • $5,787 per alcohol-involved motor vehicle crash averted (1 study)
  • $35,146 to $40,168 per percentage point reduction in nighttime drivers with BAC 0.08g/dl (1 study)
  • $1,723 per percentage point reduction in self-reported driving after drinking (1 study)
• Costs of media advertising and publicity ranged from $1 to $82 per 100 persons (9 studies).
• Estimated cost-effectiveness of media advertising and publicity ranged from $29 to $257 per additional 100 persons who became aware of the sobriety checkpoint program (5 studies).

Results should be applicable to various settings, jurisdictions, and populations. They may not, however, be applicable to implementations that consist of a small number of checkpoints conducted over a brief time period.

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?)

Prior to and during the literature review and data analysis, the review team and the Community Preventive Services Task Force attempted to address several evidence gaps identified in the 2000 review related to levels of enforcement and publicity. Too few studies included the details necessary to fully address these gaps, however, and several additional gaps were identified.

• More research is needed on the differing configurations of checkpoints (e.g., low staffing versus regular staffing, intermittent blitzes versus continuous) to judge their impact on effectiveness.
• More evaluations need to document useful process measures, such as the numbers of checkpoints conducted, vehicles stopped, or breath tests administered. With the technological advances in recent decades, electronic recording and reporting of this type of information is feasible, and these types of process measures are needed to assess more thoroughly the effectiveness of sobriety checkpoints at varying levels of enforcement.
• More information is needed about procedures and costs, including the use of technology (e.g., instruments such as passive alcohol sensors), staff needed, costs of checkpoint operations, and costs and quantities of different types of publicity used.
• Future publicized sobriety checkpoint programs should accommodate contextual changes such as potential shifts in alcohol-impaired driving patterns, new technologies to help identify alcohol-impaired drivers, and the rapid growth and diversification of media outlets. Working with law enforcement to understand and evaluate such changes, researchers could provide valuable information on the design of checkpoint programs to maintain and potentially increase their effectiveness.

• Fourteen studies evaluated SBT checkpoint programs in the U.S. and one evaluated an RBT program in New Zealand.
• Programs studied in this review were implemented at the city, county, state, and national levels, and were conducted in rural, urban, and mixed rural and urban areas.
• Most of the evaluated programs either were funded by the National Highway Traffic Safety Administration or followed NHTSA guidelines for conducting sobriety checkpoints.
• All evaluated programs involved a series of checkpoints conducted over time, typically 1 to 3 years.

Bergen G, Pitan A, Qu S, et al. Publicized sobriety checkpoint programs: a Community Guide systematic review. American Journal of Preventive Medicine. 2014;46(5):529-39.

Community Preventive Services Task Force. Publicized sobriety checkpoint programs to reduce alcohol-impaired driving. Recommendation of the Community Preventive Services Task Force. American Journal of Preventive Medicine. 2014;46(5):540-1.

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 – Effectiveness Review – see Table 1 on pages 533-534

Economic Review

Summary Evidence Table Economic Review

The Community Preventive Services Task Force recommendation on publicized sobriety checkpoints to reduce alcohol-impaired driving is based on evidence from two systematic reviews.

• 11 studies on selective breath testing and 12 studies on random breath testing published between January 1980 – June 2000 (2000 Community Guide review)
• 15 studies in 10 papers published between July 2000 March 2012 (listed below)

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

Studies From the Updated Search (search period July 2000 March 2012)

Clapp JD, Johnson M, Voas RB, Lange JE, Shillington A, Russell C. Reducing DUI among US college students: results of an environmental prevention trial. Addiction 2005;100(3):327 34.

Fell JC, Langston EA, Tippetts AS. Evaluation of four state impaired driving Enforcement demonstration programs: Georgia, Tennessee, Pennsylvania and Louisiana. In: 49th Annual Proceedings, Association for the Advancement of Automotive Medicine, Boston (MA): September 12-14, 2005.

Lacey JH, Jones RK. Evaluation of changes in New Mexico’s anti-DWI efforts. Washington (DC): U.S. Department of Transportation, National Highway Traffic Safety Administration; 2000. Available at URL: www.nhtsa.gov/people/injury/research/newmexico_dwi/newmexico_DWI.html.

Lacey JH, Ferguson SA, Kelley-Baker T, Rider RP. Low-Manpower Checkpoints: Can they provide effective DUI enforcement in small communities? Traffic Inj Prev 2006; 7(3):213 8.

Lacey JH, Kelly-Baker T, Brainard K, Tippetts AS, Lyakhovich M. Evaluation of the Checkpoint Strikeforce Program, DOT HS 811 056. Washington (DC): U.S. Department of Transportation, National Highway Traffic Safety Administration; 2008.

Miller T, Blewden M, Zhang JF. Cost savings from a sustained compulsory breath testing and media campaign in New Zealand. Accid Anal and Prev 2004;36(5):783 94.

Nunn S, Newby W. The geography of deterrence: exploring the small area effects of sobriety checkpoints on alcohol-impaired collision rates within a city. Eval Rev 2011; 35(4):354-78.

Stuster J. Creating impaired driving general deterrence: eight case studies of sustained, high-visibility, impaired-driving enforcement. DOT HS 809 950. Washington (DC): U.S. Department of Transportation, National Highway Traffic Safety Administration; 2006.

Syner J, Jackson B, Dankers L, Naff B, Hancock S, Siegler J. Strategic evaluation states initiative case studies of Alaska, Georgia, and West Virginia. Impaired Driving Report. DOT HS 810 923. Washington (DC): U.S. Department of Transportation, National Highway Traffic Safety Administration, Office of Impaired Driving & Occupant Protection; 2006.

Zwicker TJ, Chaudhary NK, Maloney S, Squeglia R. Connecticut’s 2003 impaired-driving high-visibility enforcement campaign. DOT HS 810 689. Washington (DC): U.S. Department of Transportation, National Highway Traffic Safety Administration; 2007.

Economic Review

Sixteen studies were included in the economic review (4 studies from the 2000 review and 12 studies from the updated search period). Evidence was combined because some of the studies from the updated search period evaluated sobriety checkpoint programs conducted during the period covered by the 2000 review.

Studies From the 2000 Review (search period January 1980 June 2000)

Arthurson RM. Evaluation of random breath testing. Sydney, Australia: Traffic Authority of New South Wales; 1985.

Miller TR, Galbraith MS, Lawrence BA. Costs and benefits of a community sobriety checkpoint program. J Stud Alcohol 1998;59(4):462 8.

Stuster JW, Blowers PA. Experimental evaluation of sobriety checkpoint programs, DOT HS 208 887. Washington (DC): U.S. Department of Transportation, National Highway Safety Traffic Administration; 1995.

Wessemann P. Costs and benefits of police enforcement in the Netherlands. In: Proceedings of the 11th International Conference on Alcohol, Drugs & Traffic Safety, Chicago (IL): October 24 27, 1989.

Studies From the Updated Search (search period July 2000 March 2012)

Clapp JD, Johnson M, Voas RB, Lange JE, Shillington A, Russell C. Reducing DUI among US college students: results of an environmental prevention trial. Addiction 2005;100(3):327 34.

Lacey JH, Jones RK, Smith RG, Evaluation of checkpoint Tennessee: Tennessee’s statewide sobriety checkpoint program. Contract #DTNH22-94-C-05064. Washington (DC): U.S. Department of Transportation, National Highway Safety Traffic Safety Administration; 1999.

Lacey JH, Ferguson SA, Kelley-Baker T, Rider RP. Low-Manpower Checkpoints: Can they provide effective DUI enforcement in small communities? Traffic Inj Prev 2006; 7(3):213 8.

Lacey JH, Kelly-Baker T, Brainard K, Tippetts AS, Lyakhovich M. Evaluation of the Checkpoint Strikeforce Program, DOT HS 811 056. Washington (DC): U.S. Department of Transportation, National Highway Traffic Safety Administration; 2008.

Miller T, Blewden M, Zhang JF. Cost savings from a sustained compulsory breath testing and media campaign in New Zealand. Accid Anal and Prev 2004;36(5):783 94.

Syner J, Jackson B, Dankers L, Naff B, Hancock S, Siegler J. Strategic evaluation states initiative case studies of Alaska, Georgia, and West Virginia. Impaired Driving Report. DOT HS 810 923. Washington (DC): U.S. Department of Transportation, National Highway Traffic Safety Administration, Office of Impaired Driving & Occupant Protection; 2006.

Zwicker TJ, Chaudhary NK, Maloney S, Squeglia R. Connecticut’s 2003 impaired-driving high-visibility enforcement campaign. DOT HS 810 689. Washington (DC): U.S. Department of Transportation, National Highway Traffic Safety Administration; 2007

The Task Force finding is based on evidence from a Community Guide systematic review published in 2001 (Shults et al., 23 studies, search period January 1980 to June 2000) combined with more recent evidence (15 studies, search period July 2000 to March 2012). The search strategy for the 2000 review is presented separately.

For the updated review, the following databases were searched from July 2000 to March 2012: Medline+, EMBASE, PsycInfo, TRIS, NTIS (Dialog 6), and EICompendex (Dialog 288). The search was limited to articles written in English.

Search Terms

MEDLINE, EMBASE AND PSYCINFO (Ovid)

(A and B and C) not D

A. motor vehicles
motor vehicle* or car or cars or automobile* or motorcycle* or truck* or (traffic adj2 accident*) or driving or driver*

B. alcohol
alcohol or alcoholic beverage* or (alcohol adj3 drinking) or ethanol or alcoholism or dwi or dui or (driving adj3 (intoxicated or influence or drunk or drinking or impaired))

C. interventions
intervention* or outreach* or prevention or (community adj3 (relation* or program* or action)) or deterrent* or program* or legislation or law* or education or deterrence or counseling or class or classes or health promotion

D. Exclusions
food industry or airplane* or aircraft* or pilot* or solvent or sleep apnea or emission* or air quality or pollution

TRIS

(“motor vehicle*” or car or cars or automobile* or motorcycle* or truck* or traffic or driving or driver*) AND (alcohol* or ethanol or dwi or dui or ((driving) and (intoxicated or influence or drunk or drinking or impaired)) AND (intervention* or outreach* or prevention or ((community) and (relation* or program* or action)) or deterrent* or program* or legislation or law* or education or deterrence or counseling or class or classes or health promotion)

NOT (food industry or airplane* or aircraft* or solvent or sleep apnea or emission* or air quality or pollution) (REMOVED IN ENDNOTE)

NTIS and EICOMPENDEX (Dialog)

b 6,288

S MOTOR(W)VEHICLE? OR CAR OR CARS OR AUTOMOBILE? OR MOTORCYCLE? OR TRUCK? OR TRAFFIC(2N)ACCIDENT? OR DRIVING OR DRIVER?

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))

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 DETERRENCE OR COUNSELING OR CLASS OR CLASSES OR HEALTH(W)PROMOTION

S FOOD(W)INDUSTRY OR AIRPLANE? OR AIRCRAFT? OR PILOT? OR SOLVENT? OR SLEEP(W)APNEA OR EMISSION? OR AIR(W)QUALITY OR POLLUTION

S (S1 AND S2 AND S3) NOT S4

la=english
py=2000:2012
rd

Economic Review

For the updated review, the following databases were searched from July 2000 to March 2012: PubMed, EconLit, JSTOR, social sciences citation index (SSCI), databases at the Centre for Reviews & Dissemination at the University of York, and the Health Economic Evaluations Database (HEED) from Wiley.

Search Terms

Economic-focused terms: (economic*) or (cost) or (benefit) or (cost-benefit) or (benefit-cost)or (utility) or (cost-utility)or (expenditure) or (cost effectiveness) or (cost of illness) or (burden of illness) or (funding*) or (efficiency) or ($) or (dollar*)

Shults RA, Elder RW, Sleet DA, et al. Reviews of evidence regarding interventions to reduce alcohol-impaired driving. Am J Prev Med 2001;21(4S):66 88.

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

• As of April 2014, there are legal restrictions against using checkpoints in 12 states: Alaska, Idaho, Iowa, Michigan, Minnesota, Montana, Oregon, Rhode Island, Texas, Washington, Wisconsin, Wyoming. These states have decided that checkpoints are illegal under either the state law or constitution, not authorized by state law, or illegal under the state’s interpretation of the federal constitution.
• An integral part of publicized sobriety checkpoint programs is the use of media, either paid ads or news stories (i.e. “earned” media), to publicize the program and increase the population’s perceived risk of arrest for alcohol-impaired driving.
  • Six of the included studies reported increases ranging from 4% to 32% in the percent of people from a targeted community who had seen or heard messages about drinking and driving or checkpoints following implementation.
• Securing the necessary law enforcement staff to implement sobriety checkpoints may present a challenge to implementation. Law enforcement agencies are often understaffed and their attention and resources are divided.
• Sobriety checkpoints are typically conducted during times when alcohol-impaired drivers are most likely to be on the roads, such as weekend evenings, and staff overtime is often required.
• Sobriety checkpoints are harder and potentially more dangerous to implement during adverse weather conditions as checkpoints require law enforcement personnel to stand outside.
• Law enforcement may be less supportive of sobriety checkpoints because they can result in fewer arrests of impaired drivers compared to other forms of high visibility enforcement, such as saturation patrols.
• The National Highway Traffic Safety Administration published Saturation Patrols & Sobriety Checkpoints: A How-to Guide for Planning and Publicizing Impaired Driving Enforcement Effects. This guide recommends selecting a site for conducting checkpoints by identifying locations that have a high incidence of impaired driving-related crashes or fatalities and are safe for both law enforcement and motor vehicle occupants. Vehicles are randomly selected (e.g., every fifth vehicle) for driver assessment and standardized methods are used for determining who and how to test for alcohol. These precautions can help avoid implementation concerns about racial profiling by ensuring that sites, vehicles, and drivers are selected based on standardized procedures, and that the methods used to detect impaired drivers are not left up to an individual officer’s discretion.

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