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

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What the Task Force Found

About The Systematic Review

The Task Force 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 Task Force 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.

Context

There is no information for this section.

Summary of Results

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).

Summary of Economic Evidence

  • 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.

Applicability

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.

Evidence Gaps

Each Community Preventive Services Task Force (Task Force) review identifies critical evidence gaps—areas where information is lacking. Evidence gaps can exist whether or not a recommendation is made. In cases when the Task Force finds insufficient evidence to determine whether an intervention strategy works, evidence gaps encourage researchers and program evaluators to conduct more effectiveness studies. When the Task Force recommends an intervention, evidence gaps highlight missing information that would help users determine if the intervention could meet their particular needs. For example, evidence may be needed to determine where the intervention will work, with which populations, how much it will cost to implement, whether it will provide adequate return on investment, or how users should structure or deliver the intervention to ensure effectiveness. Finally, evidence may be missing for outcomes different from those on which the Task Force recommendation is based.

Identified Evidence Gaps

The programs evaluated in this review may serve as a preliminary guide for planning effective multicomponent programs with community mobilization to reduce alcohol-impaired driving, but research questions remain unanswered.

  • 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?

Study Characteristics

  • 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.

Publications

Shults RA, Elder RW, Nichols JL, Sleet DA, Compton R, Chattopadhyay SK, Task Force on Community Services. Effectiveness of multicomponent programs with community mobilization for reducing alcohol-impaired driving. American Journal of Preventive Medicine. 2009;37(4):360-371.

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