Motor Vehicle Injury Alcohol-Impaired Driving: School-Based Programs Instructional Programs

The CPSTF finding is based on evidence from a systematic review of nine studies (search period through December 2002).

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.

More details about study results are available in the published evidence review.

The systematic review included nine studies.

Self-reported drinking and driving (5 studies) and riding with drinking drivers (4 studies) both decreased.

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

The broader literature evaluating school-based programs to prevent substance abuse suggests instructional programs are likely to be most effective in reducing RDD and other relevant outcomes if they include resistance and other skill training and require student interaction.

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?)

• To what extent are the outcomes of school-based education programs dependent on the following?
  • Content, delivery method, and the perceived status of the person delivering the intervention
  • Characteristics of the students
• What effect do interventions have on alcohol-related traffic violations and crashes?
• Are interventions cost-effective?
• How consistent are objective outcome measures with self-reported outcomes?
• How can studies reduce attrition to increase power and validity?

• Most of the studies used before-and-after comparisons or time series designs with a concurrent comparison group.
• The total number of students included in analyses ranged from 60 to more than 4600, with a median size of 853.
• Nearly all of the studies targeted junior or senior high school students; five included multiple grades. The median grade targeted was the 10th grade.
• Follow-up periods ranged from 1 to 84 months, though most studies had follow-up periods of 6 months or less.
• Attrition provided one of the greatest threats to the validity of these studies, particularly those involving relatively long follow-up periods. Attrition ranged from zero for very short-term follow-ups to nearly two thirds of the baseline sample.
• The content and level of interaction varied considerably across the instructional programs reviewed.
  • Three studies evaluated programs with informational or affective content that involved didactic presentations
  • Six studies provided information and focused on skills development (e.g., refusal skills, life skills) or reducing risk-taking behavior.
• Many of the evaluated programs involved considerable student interactivity (e.g., discussion, feedback, role playing, planning activities).

Effectiveness Review

Analytic Framework see Figure 1 on page 289

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
Contains evidence from reviews of school-based instructional programs, peer organizations, and social norming campaigns

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

D’Amico EJ, Fromme K. Brief prevention for adolescent risk-taking behavior. Addiction 2002;97:563 74.

Harre N, Field J. Safe driving education programs at school: lessons from New Zealand. Aust NZ J Public Health 1998;22:447 50.

Klepp K, Kelder SH, Perry CL. Alcohol and marijuana use among adolescents: long-term outcomes of the Class of 1989 Study. Ann Behav Med 1995;17:19 24.

Newman IM, Anderson CS, Farrell KA. Role rehearsal and efficacy: two 15-month evaluations of a ninth-grade alcohol education program. J Drug Educ 1992;22:55 67.

Sheehan M, Najman J, Schofield F, et al. The development and implementation of the ‘Plan a Safe Strategy’ drink driving prevention program. Canberra: Australian Government Publishing Service, 1990 (National Campaign Against Drug Abuse Monograph Series no. 13).

Shope JT, Copeland LA, Maharg R, Dielman TE. Effectiveness of a high school alcohol misuse prevention program. Alcohol Clin Exp Res 1996;20:791 8.

Singh A. Evaluation of the four films on drinking and driving known as ‘One for the Road’ series. J Traffic Med1993;21:65 72.

Wilkins TT. The “Stay Alive From Education” (SAFE) program: description and preliminary pilot testing. J Alcohol Drug Educ 2000;45:1 11.

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.

• School-based interventions should be part of a larger community effort.
• A universal approach that targets all students may offer greater potential to positively influence the school social environment and societal norms than a tailored approach that target high-risk individuals. All of the included studies used a universal approach.

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