Reducing Alcohol-Impaired Driving: Sobriety Checkpoints – ARCHIVED

Twenty-three studies qualified for the review.

• Crashes thought to involve alcohol: median decrease of 18% for RBT checkpoints (interquartile interval: 22% to 13% decrease; 11 studies) and 20% for SBT checkpoints (interquartile interval: 27% to 13% decrease; 10 studies)
• Fatal crashes thought to involve alcohol: median decrease of 22% for RBT checkpoints (interquartile interval: 36% to 13% decrease; 6 studies) and decreases of 26% and 20% for SBT checkpoints (2 studies)
• Crashes declined regardless of the follow-up time of the study, with median decreases of 18% for follow-up times of less than one year and 17% for follow-up times of more than one year.

These results are based on a systematic review of all available studies led 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 reducing alcohol-impaired driving.

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

Results from the Community Guide review indicate that sufficient or strong evidence exists that the effectiveness of the five interventions reviewed reduces alcohol impaired driving. However, important issues related to the effectiveness of these interventions require further research.

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?

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?

Sobriety Checkpoints

• Does the use of passive alcohol sensors at sobriety checkpoints improve their deterrent effects?
• Are the deterrent effects of sobriety checkpoints diminished if warning signs are posted that allow drivers to avoid the checkpoints?
• How do various configurations of sobriety checkpoints (e.g., intermittent blitzes vs. continuous, weekend nights vs. random time periods, number of officers per checkpoint) affect deterrence?
• What level of enforcement and publicity about sobriety checkpoints is necessary to maintain effectiveness over time?

Server Intervention Training

• Are server intervention training programs delivered community-wide effective at decreasing alcohol-impaired driving and alcohol-related crashes?
• What essential content areas should be included in all server intervention training programs?
• What effect does the method by which training is delivered (e.g., videotapes, lectures, role-playing) have on the effectiveness of server training programs?
• How do mandatory vs. voluntary server training programs differ with respect to:
  • Management support for program goals?
  • Level of participation in training programs?
  • Overall effectiveness for decreasing patron BACs and drinking and driving?
• What specific management policies and practices are necessary to get the maximum benefits from server intervention training?
• What is the long-term effect of server intervention training programs? Are “booster sessions” required to maintain effectiveness?
• What effect does server intervention training have on alcohol sales, overall revenues, and tips?

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?

Shults RA, Elder RW, Sleet DA, et al. Reviews of evidence regarding interventions to reduce alcohol-impaired driving. American Journal of Preventive Medicine 2001;21(4S):66-88.

Task Force on Community Services. Recommendations to reduce injuries to motor vehicle occupants: increasing child safety seat use, increasing safety belt use, and reducing alcohol-impaired driving. American Journal of Preventive Medicine 2001;21(4S):16-22.

Centers for Disease Control and Prevention. Motor-vehicle occupant injury: strategies for increasing use of child safety seats, increasing use of safety belts, and reducing alcohol-impaired driving. MMWR 2001;50(RR-7):1-13. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5007a1.htm.

Elder RW, Shults RA, Sleet DA, Nichols JL, Zaza S, Thompson R. Effectiveness of sobriety checkpoints for reducing alcohol-involved crashes. Traffic Injury Prevention 2002;3(4):266-274. Available at: http://www.tandfonline.com/doi/abs/10.1080/15389580214623#.Vk8g0PLsnIU.

Zaza S, Sleet DA, Elder RW, Shults RA, Dellinger A, Thompson RS. Response to letter to the editor. American Journal of Preventive Medicine 2002;22:330-1.

Shults RA, Elder RW, Sleet DA, et al. Erratum to: Reviews of evidence regarding interventions to reduce alcohol-impaired driving. American Journal of Preventive Medicine 2001;21(4S):66-88. Available at: http://www.ajpmonline.org/article/S0749-3797(01)00381-6/abstract.

Sleet DA. Evidence based injury prevention: guidance for community action. In: Australian Third National Conference on Injury Prevention and Control. Australian Third National Conference on Injury Prevention and Control. Brisbane, Queensland, Australia; 1999.

Webb M. Research as an advocate’s toolkit to reduce motor vehicle occupant deaths and injuries. American Journal of Preventive Medicine 2001;21(4S):7-8.

Waller PF. Public health’s contribution to motor vehicle injury prevention. American Journal of Preventive Medicine 2001;21(4S):3-4.

Satcher D. Note from the Surgeon General. American Journal of Preventive Medicine 2001;21(4S):1-2.

Novick LF, Kelter A. Guide to Community Preventive Services: a public health imperative. American Journal of Preventive Medicine 2001;21(4S):13-15.

Moffat J. Motor vehicle occupant injury prevention: the states’ perspective. American Journal of Preventive Medicine 2001;21(4S):5-6.

Miller TR. The effectiveness review trials of Hercules and some economic estimates for the stables. American Journal of Preventive Medicine 2001;21(4S):9-12.

Task Force on Community Services, Zaza S, Briss PA, Harris KW. Motor vehicle occupant injury. In: The Guide to Community Preventive Services: What Works to Promote Health? Atlanta (GA): Oxford University Press; 2005:329-84.

• Analytic Framework* see Figure 1 on page 67

• Summary Evidence Tables* [PDF – 113 kB]

Included Studies – Selective Breath Testing

Castle SP, Thompson JD, Spataro JA, et al. Early evaluation of a statewide sobriety checkpoint program. 39th annual proceedings, Association for the Advancement of Automotive Medicine, October 16 18, 1995, Chicago, IL. pp. 65 78.

Jones R, Joksch H, Lacey J, Wiliszowski C, Marchetti L. Site report: Wichita, Kansas field test of combined speed, alcohol, and safety belt enforcement strategies. Washington, DC: U.S. Department of Transportation, National Highway Traffic Safety Administration, 1995. DOT HS 808 244.

Lacey JH, Jones RK, Smith RG. Evaluation of checkpoint Tennessee: Tennessee’s statewide sobriety checkpoint program. Washington, DC: U.S. Department of Transportation, National Highway Traffic Safety Administration, 1999. DOT HS 808 841.

Lacey JH, Stewart JR, Marchetti LM, Popkin CK, Murphy PV. Enforcement and public information strategies for DWI (driving-while-intoxicated) general deterrence: ARREST DRUNK DRIVING the Clearwater and Largo, Florida experience. Chapel Hill, NC: University of North Carolina Highway Safety Research Center, 1986.

Levy DT, Asch P, Shea D. An assessment of county programs to reduce driving while intoxicated. Health Educ Res 1990;5:247 56.

Mercer GW. The relationships among driving while impaired charges, police drinking-driving roadcheck activity, media coverage and alcohol-related casualty traffic accidents. Accid Anal Prev 1985;17:467 74.

Mercer GW, Cooper PJ, Kristiansen LA. A cost/benefit analysis of a 5-month intensive alcohol-impaired driving road check campaign. 40th annual proceedings of the Association for the Advancement of Automotive Medicine, October 7 9, 1996, Vancouver, British Columbia. pp. 283 92.

Stuster JW, Blowers PA. Experimental evaluation of sobriety checkpoint programs. Washington, DC: U.S. Department of Transportation, National Highway Safety Traffic Administration, 1995. DOT HS 808 287.

Voas RB, Holder HD, Gruenewald PJ. The effect of drinking and driving interventions on alcohol-involved traffic crashes within a comprehensive community trial. Addiction1997;92:S221 S236.

Voas RB, Rhodenzer E, Lynn C. Evaluation of Charlottesville checkpoint operation: Final report, December 30, 1983 to December 31, 1984. Washington, DC: U.S. Department of Transportation, National Highway Traffic Safety Administration, 1985. US DOT Contract no. DTNH 22-83-C-05088.

Wells JK, Preusser DF, Williams AF. Enforcing alcohol-impaired driving and seat belt use laws, Binghamton, NY. J Safety Res 1992;23:63 71.

Included Studies – Random Breath Testing

Armour M, Monk K, South D, Chomiak G. Evaluation of the 1983 Melbourne random breath testing campaign: interim report, casualty accident analysis. Melbourne, Australia: Victoria Road Traffic Authority, 1985. N8-85.

Arthurson RM. Evaluation of random breath testing. Sydney: Traffic Authority of New South Wales, 1985. Research Note RN 10/85.

Cameron M, Diamantopolou K, Mullan N, Dyte D, Gantzer S. Evaluation of the country random breath testing and publicity program in Victoria, 1993 1994. Melbourne: Monash University Accident Research Center, 1997. Report 126.

Cameron MH, Cavallo A, Sullivan G. Evaluation of the random breath testing initiative in Victoria, 1989 1991: multivariate time series approach. Melbourne, Australia: Monash University Accident Research Centre, 1992. Report 38.

Hardes G, Gibberd RW, Lam P, Callcott R, Dobson AJ, Leeder SR. Effects of random breath testing on hospital admissions of traffic-accident casualties in the Hunter Health Region. Med J Aust 1985;142:625 6.

Henstridge J, Homel R, Mackay P. The long-term effects of random breath testing in four Australian states: a time series analysis. Canberra, Australia: Federal Office of Road Safety, 1997. No. CR 162.

Homel R, Carseldine D, Kearns I. Drink-driving countermeasures in Australia. Alcohol Drugs Driving 1988;4:113 44.

McCaul KA, McLean AJ. Publicity, police resources and the effectiveness of random breath testing. Med J Aust 1990;152:284 6.

McLean AJ, Clark MS, Dorsch MM, Holubowycz OT, McCaul KA. Random breath testing in South Australia: effects on drink-driving. Adelaide, South Australia: NHMRC Road Accident Research Unit, University of Adelaide, 1984. HS 038 357.

Ross HL, McCleary R, Epperlein T. Deterrence of drinking and driving in France: an evaluation of the law of July 12, 1978. Law Soc Rev 1981;16: 345 74.

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.

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