Truong, Khoa Dang, and Roland Sturm.. "Alcohol Environments and Disparities in Exposure Associated With Adolescent Drinking in California." American Journal of Public Health 99.2 (Feb. 2009): 264-270. MasterFILE Premier. EBSCO. [Library name], [City], [State abbreviation]. 5 Mar. 2009 <http://search.ebscohost.com/login.aspx?direct=true&db=f5h&AN=36300998&site=ehost-live>. Alcohol EnvironmentsandDisparities in Exposure Associated With AdolescentDrinkingin California Section:RESEARCH AND PRACTICE
Objectives. We investigated sociodemographic disparities in alcohol environments and their relationship with adolescentdrinking.
Methods. We geocoded and mapped alcohol license data with ArcMap to construct circular buffers centered at 14595 households with children that participated in the California Health Interview Survey. We calculated commercial sources of alcohol in each buffer. Multivariate logistic regression differentiated the effects of alcohol sales on adolescents'drinking from their individual, family, and neighborhood characteristics.
Results. Alcohol availability, measured by mean and median number of licenses, was significantly higher around residences of minority and lower-income families. Binge drinking anddriving after drinking among adolescents aged 12 to 17 years were significantly associated with the presence of alcohol retailers within 0.5 miles of home. Simulation of changes in the alcohol environment showed that if alcohol sales were reduced from the mean number of alcohol outlets around the lowest-income quartile of households to that of the highest quartile, prevalence of binge drinkingwould fall from 6.4% to 5.6% anddriving after drinking from 7.9% to 5.9%.
Conclusions. Alcohol outlets are concentrated in disadvantaged neighborhoods and can contribute to adolescentdrinking. To reduce underage drinking, environmental interventions need to curb opportunities for youth to obtain alcohol from commercial sources by tightening licensure, enforcing minimum-age drinking laws, or other measures. (Am J Public Health. 2009;99:264-270. doi: 10.2105/AJPH.2007. 122077)
Despite federal, state, and local interventions, underage drinking continues to be a serious problem. A national survey found that 17.6% of adolescents drank alcohol in the past 30 days, 11.1% were binge drinkers, and 2.7% were heavy drinkers.[1] Health and social problems associated with youths' drinking include motor vehicle crashes,[2][3] violence,[4] risky sexual behaviors,[5][6] assault and rapes,[7] and brain impairment[8-11] Adolescent alcohol use has substantial societal costs.[12] Drinking at an early age also increases the risk of addiction and other alcohol-related problems in adulthood.[13-15] In 2007, the surgeon general responded to this problem in the Call to Action to Prevent and Reduce Underage Drinking, which emphasized environmental contributions to the problem.[16]
Underage drinkers obtain their alcoholic beverages from a variety of sources, including parents' stocks, friends, parties,and commercial outlets.[17] In 1 study, buyers who looked underage were able to purchase alcohol with high success rates from both on-site (for consumption on the premises, such as bars and restaurants) and off-site (for consumption elsewhere, such as liquor stores) establishments.[18][19] Sales to minors have been found to be significantly associated with the percentage of Hispanic residents in a neighborhood and with population density.[20]
As long as adolescents can obtain alcohol from commercial sources, neighborhood outlets are likely to play a role in underage drinking. Rhee et al. argued that environment plays an essential role in drinking initiation and that genetics are important in developing alcohol dependence.[21] Perceived alcohol availability was significantly associated with higher levels of alcohol consumption among young men[22] and with drinking in public locations for adolescent girls.[23] Density of outlets for alcohol in dries was associated with youths' drinkinganddrivingand with riding in a car driven by a person under the influence of alcohol.[24]
Differences in alcohol environments may exacerbate health disparities across sociodemographic groups. LaVeist and Wallace found that in Baltimore, MD, predominantly Black and low-income census tracts have more liquor stores per capita than do tracts of other race and income groups.[25] Gorman andSpeer found retail liquor outlets abundantly located in poor and minority neighborhoods in a city in New Jersey.[26] Only 1 national study has been published, and it reported higher densities of liquor stores in zip codes with higher percentages of Blacks and lower-income non-Whites.[27] That study covered all urban areas in the United States, but the urban zip codes had a mean land area of 40.1 square miles and a mean population of 21920 persons,[27] arguably too large to represent neighborhoods. Even census tracts may be too large and too dissimilar to capture neighborhood effects: in Los Angeles County they can range from 0.04 square miles to 322 square miles.
The objectives of this study were (1) to describe the quantity and geographic pattern of alcohol retailers in small areas around individual homes and (2) to examine relationships between alcohol environments and adolescent drinking. We analyzed data from the entire state of California to investigate the effects of spatial accessibility on alcohol sales to adolescents. METHODS Data
Data on alcohol outlets came from the California Department of Alcoholic Beverage Control database and included addresses and license types of all alcohol retailers in the state.[28] We classified alcohol outlets by license type: off-site or on-site. In 2003, California had 30650 active on-site licenses and 21836 active off-site licenses.[28]
Participant data were obtained from the California Health Interview Survey, a computer-assisted telephone interview with a 2-stage, geographically stratified, random-digit-dialing design that attempts to interview 1 adult and 1 adolescent per household and to get information on 1 child in households with children. The survey is representative of the state's noninstitutionalized population living in households. Details are available elsewhere.[29]
The California Health Interview Survey 2003 included survey data for 42044 adults, 4010 adolescents, and 8526 children, who were linked by family identifiers. We excluded 3679 households in rural areas because their environments were not comparable. For our analysis of alcohol environments, we focused on 14595 households with children younger than 18 years (not all households with children participated in the child and adolescent surveys). For our analysis of adolescent drinking, we used data on 3660 adolescents aged 12 to 17 years. We used a subsample of 687 adolescents aged 16 to 17 years who had ever had a few sips of alcoholic drinks for our analysis of adolescent driving after drinking. Measures of Alcohol Environments
We defined alcohol environments by distance from homes. We used ArcMap version 9.1 (ESR1, Redlands, CA) to draw circles with radii of 0.1 miles, 0.5 miles, 1.0 mile, and 2.0 miles centered at respondents' residences. We first looked at immediate distances with 0.1-mile-radius circles and at circular bands between 0.1-mile and 0.5-mile radii. We considered that outlets in these areas might be the most problematic because of their proximity to adolescents' residences. A distance of 0.5 miles is approximately a 10-minute walk[30] and thus within the reach of adolescents. Outlets beyond easy walking distance were examined in circular bands between 0.5- and 1.0-mile radii and between 1.0- and 2.0-mile radii (all 4 constructed buffers were mutually exclusive). We mapped the business locations in the Department of Alcoholic Beverage Control database to the buffers around each household and calculated the number of alcohol retailers within each buffer.
Previous research focused on density measures, such as the number of establishments per city, per resident, or per roadway mile.[27][31-33] We used the raw count in each buffer rather than outlet-density measures in a predefined geographic area (such as census tracts) because individuals may live close to alcohol outlets in what is defined as a low-density area if that area includes large sections that are lightly populated, such as deserts or mountains. Similarly, in densely populated urban areas, population measures may yield low densities of alcohol outlets per resident even when most households are within walking distance of these outlets. Statistical Analyses
We compared the mean and median number of alcohol outlets (for all licenses and for on-site and off-site establishments separately) across racial/ethnic groups (non-Hispanic White, non-Hispanic Black, Hispanic, Asian/Pacific Islander, and other) and income groups (incomes quartiles derived from self-reported total household annual income before tax). We then stratified by both race/ethnicity and income. We also performed a zero-inflated Poisson regression with number of outlets as the dependent variable and race/ethnicity and income as the key explanatory variables, controlling for population density in the census tracts. We estimated this model separately for each definition of the dependent variable (all licenses, on-site, and off-site) within each buffer. The data included all households with children younger than 18 years.
We analyzed 3 dichotomous dependent variables for adolescent drinking with logistic regression: at least 1 alcoholic drink in the past 30 days, at least 1 heavy drinking episode (5 drinks in a row, also referred to as binge drinking) in the past 30 days, and ever driving after drinking. The primary explanatory variables were the number of alcohol outlets within the 0.5-mile radii, 0.5- to 1.0-mile bands, and 1.0- to 2.0-mile bands. For each dependent variable, we estimated 2 models that differed in the key explanatory variables. For the first model, total number of licenses was the key explanatory variable. For the second model, off-site and on-site establishments were the key explanatory variables. We used the latter model to determine what type of outlets had predictive power for adolescent drinking, because the underlying processes in illegally obtaining alcoholic beverages may differ.
Additional explanatory variables included in all models were adolescents' characteristics (gender, age, race, paid employment in the past 12 months, current smoking, and marijuana use in the past 30 days), family characteristics (household income and parents' marital status), parents' drinking behavior (self-reporting by parent or guardian of any heavy drinking episode, defined as 5 drinks in a row in the past 30 days, and excess drinking, defined as consuming more than 60 drinks per month), and neighborhood sociodemographic characteristics (census tract total population, tract median household income, and percentage of Whites and Blacks in the population, according to data extracted from the 2000 US Census).
In all regression models we used robust standard errors to account for clustering data caused by the survey's multistage sample design. First, the state was divided into 44 geographic sampling strata, including 41 single-county strata and 3 multicounty strata comprising the 17 remaining counties in California. Second, within each geographic stratum, residential telephone numbers were selected through random-digit-dialed sampling. The regression was also weighted to control for differential sampling rates within geographic stratum and racial/ethnic groups.
To improve the interpretation of logistic regression coefficients, we changed levels of alcohol availability in adolescents' neighborhoods and predicted the resulting prevalence of adolescent drinking in the estimated model. We changed only the key explanatory variable, retaining all other variables. This provided the adjusted difference in the prevalence of a drinking measure between 2 levels of alcohol availability, that is, it accounted for all individual, family, and neighborhood sociodemographic characteristics in the model except the alcohol environments. For the differences in alcohol environments, we compared the average number of outlets around Asian/Pacific Islander and White households and around low- and high-income households. RESULTS Disparities in Alcohol Environments
Table 1 provides descriptive statistics of the sample, divided into 4 quartiles of gross annual household income: less than $24000, $24000 to $49000, $50000 to $90000, and more than $90,000. Fewer than 11% of non-Hispanic Whites belonged to the bottom income quartile, compared with 32.0% of non-Hispanic Blacks, 50.4% of Hispanics, 20.8% of Asian/Pacific Islanders, and 32.9% of other groups. By contrast, 36.0% of non-Hispanic Whites, 15.1% of non-Hispanic Blacks, 4.7% of Hispanic, 29.1% of Asian/Pacific Islanders, and 13.2% of other groups were in the top income quartile.
Average age in the adolescent sample was 14.3 years, reflecting the period of drinking initiation. However, the survey did not ask for age at first alcoholic drink. Approximately 35% of adolescent respondents reported ever having more than just a few sips of alcoholic drinks. Fifteen percent reported having at least 1 drink, and 5.6% reported at least 1 heavy drinking episode in the past 30 days. Five percent reported they were current smokers (i.e., had had ≥ 1 cigarette per day in the past 30 days), and 5.0% reported marijuana use in the past 30 days. Of those aged 16 or 17 years who ever consumed alcohol, 6.0% reported ever driving after drinking.
Table 2 shows the mean number of alcohol outlets within different buffers, stratified by income and race/ethnicity. Compared with non-Hispanic Whites, people of other groups were surrounded by more alcohol outlets, regardless of the size of the buffers. For instance, within 0.1 mile, we found an average 0.21 outlets around residences of Whites; Blacks had 0.24, Hispanics 0.39, and Asian/Pacific Islanders 0.33 (P<.001). Participants who were in lower-income quartiles were surrounded by more alcohol outlets. We found this geographic pattern even within each racial/ethnic group. We observed the same distribution pattern across income groups within each racial/ethnic group. Our results were consistent in the sensitivity analyses: comparison of the median number of outlets, separation of off-site from on-site outlets, and zero-inflated Poisson regression model with income and race/ethnicity as key predictors of alcohol outlets.
=
=
=
=
=
=
=================================Durkin, Keith F., Scott E. Wolfe, and Ross W. May. "SOCIAL BOND THEORY AND DRUNK DRIVING IN A SAMPLE OF COLLEGE STUDENTS." College Student Journal 41.3 (Sep. 2007): 734-744. MasterFILE Premier. EBSCO. [Library name], [City], [State abbreviation]. 5 Mar. 2009 <http://search.ebscohost.com/login.aspx?direct=true&db=f5h&AN=26886005&site=ehost-live>.SOCIAL BOND THEORYANDDRUNKDRIVINGIN A SAMPLE OF COLLEGE STUDENTSThis paper reports the finding from a study that examined the relationship between social bond variables and drunkdriving in a sample of university students. A questionnaire containing indicators representing social bond variables, as well as a measure of drunk driving was administered to a sample of 1459 college students. The results of this study provide mixed support for social bond theory. On the one hand, commitment to conventional activities and acceptance of conventional beliefs were negatively related to drunk driving. On the other hand, neither the involvement component nor the attachment component were related to drinkinganddriving in the manner predicted by social bond theory.
The consumption of alcohol by college students has received a tremendous amount of scrutiny in recent years. Bingedrinking, or heavy episodic drinking, is a prevalent behavior that has been linked to a variety of problematic consequences for student drinkers. These include hangovers, blackouts, missing class, doing something they regret later, getting involved in physical fights and other arguments, and having trouble with the police (Wechsler, Davenport, Dowdall, Moeykens, & Castillo, 1995; Wechsler, Lee, Kuo, & H. Lee, 2000). Binge drinking is also associated with risky sexual behaviors, thus putting students at risk for contracting sexually transmitted diseases, such as HIV (Meilman, 1993; Smith & Brown, 1998). Recent research has also revealed that students who drink frequently have higher odds of becoming the victim of assault (Mustaine & Tewskbury, 2000). The tragic alcohol-related deaths of students at several schools illustrate the potentially fatal consequences of this activity. However, the negative consequences of this behavior are not limited to drinkers. Intoxicated students also have an adverse impact on the campus and surrounding community. Examples of these so-called "secondary binge effects" include being verbally insulted or abused, being physically assaulted, having one's property damaged, experiencing unwelcome sexual advances, and having sleep or studying disturbed because of intoxicated students (Wechsler, Davenport, Dowdall, et al. 1994). Community residents who live near college campuses often report a lower quality of life resulting from the behavior of student drinkers (e.g., noise disturbances, disorderly conduct, litter, vandalism) (Wechsler, Lee, Kuo, et al., 2002).
Drunk driving is a type of alcohol-related behavior that endangers drinkers as well as other members of the campus and general community. University students appear to be particularly susceptible to driving while intoxicated (Wechsler, Lee, Nelson, & H. Lee, 2003). In a recent study, Hingson, Heeren, Zakocs, Kopstein, and Wechsler (2002) estimated that at least two million students drove while intoxicated during the previous year. The fatal consequences of this behavior are well documented. The leading cause of death for young people is automobile accidents, many of which are alcohol-related (McCormick & Ureda, 1995). In fact, the most common cause of death in young adults (aged 17-24) is alcohol-related accidents (Ham & Hope, 2003). According to one estimate, about 1100 college students died in alcohol-related crashes in 1998 (Wechsler et al., 2003)
Although recent studies (e.g., Billingham, Wilson, & Gross, 1999; Grenier, 1993; Harford, Wechsler, & Muthen, 2002; McCormick & Ureda, 1995) have sought to identify demographic factors associated with drinkinganddriving by college students, only a few studies have examined other factors associated with this behavior. For example, Clapp, Shillington, Lange, and Voas (2003) investigated the relationship between substance use patterns (e.g., binge drinking, marijuana use) and drunk driving by university students. Also, Hingson, Heeren, Zakocs, Winter, and Wechsler (2003) examined the relationship between age at first intoxication and students driving while intoxicated. However, there have been relatively few attempts to apply the various sociological perspectives, particularly theories of deviant behavior, to this phenomenon. This is a serious oversight since sociological theories of deviance typically have strong explanatory value (Durkin, Wolfe, & Clark, 1999). Understanding the factors that cause the alcohol-related problems of college students can inform intervention and prevention efforts (Ham & Hope, 2003). A greater understanding of drunk driving is also of significant importance to the nation's public health agenda (O'Malley & Johnston, 1999). The purpose of this paper is to apply one of the most popular sociological explanations of deviance, social bond theory, to drinkinganddriving by university students.
According to Travis Hirschi (1969,p.82), the sociologist who formally introduced social bond theory, "we are moral beings to the extent we are social beings." Social bond theory assumes that the motivation for deviant behavior is present in everyone, and concerns itself with the factors that keep an individual from engaging in deviance. The social bond essentially "refers to the connection between the individual and society" (Shoemaker, 2005, p.176). When these bonds are weak or lacking, the individual has less at stake and is at higher risk for committing deviant acts (Faupel, Horowitz, & Weaver, 2004). Social bond theory was originally presented as an explanation of juvenile delinquency and is one of the leading social psychological perspectives on deviant behavior (Massey & Krohn, 1986), and is arguably the most frequently tested theory of deviance (Akers, 2000). This theory has received modest empirical support,and its explanatory value is typically described as good or moderate (Gardner & Shoemaker, 1989). It has been applied to a wide variety of deviant behaviors including academic cheating by university students, alcohol use, juvenile delinquency, and marijuana use (Durkin, S. Wolfe, & Lewis, 2006)
There are four elements of the social bond. The first is attachment. This refers to the ties that an individual has to significant others such as family members; particularly parents (Leonard & Decker, 1994). For college students, the relationship with one's parents would be an example of attachment. The second component of the social bond, commitment, refers to the aggregate investment of time, energy, and resources in conventional activities such as getting an education or a holding a job. These investments represent stakes in conformity (Akers, 2000). Indicators of commitment for university students include religiosity, church attendance, commitment to higher education, and grade point average. The third element of the social bond is involvement. This consists of the amount of time a person spends engaging in conventional activities such as doing schoolwork, participating in extracurricular activities such as clubs or athletics, and working at a part-time job. The final component of the social bond is belief. This is the acceptance of a conventional value system. The belief component includes a general acceptance of the rules of society as being morally valid and binding, as well as respect for authority and the legal system.
While we are not aware of any studies that have specifically applied social bond theory to drinkinganddriving among college students, a review of the relevant literature seems to suggest that it may be useful in explaining this behavior. First, two previous studies (Durkin et al., 1999; 2006) have explored the relationship between binge drinkingand the social bond in university students. These results suggest that both the commitment and belief components of social bond theory are negatively related to binge drinking. Binge drinking is a risky type of alcohol-related behavior that may be somewhat analogous to drunk driving. Therefore, there may be a similar relationship between the social bond and drunk driving. Second, Billingham et al. (1999) found higher rates of drinkinganddriving among students from divorced families. Social bond theory would posit that these students would have a lower-level of attachment to parents due to divorce. Finally, using data collected from high school seniors O'Malley and Johnston (1999) found a negative relationship between both religious commitment and grade point average (two indicators of the commitment component of the social bond) and drunk driving. Therefore, the same relationship might be expected for university students.
Several hypotheses were derived from social bond theory about the nature of drunk driving among college students. First, there should be an inverse relationship between attachment and drunk driving. Second, the likelihood of drinkinganddriving will increase as a student's commitments decrease. Third, involvement in conventional activities will decrease the likelihood of drunk driving. Finally, there will be a negative relationship between acceptance of conventional beliefs and drunk driving.
LINDSAY LOHAN Just 11 days after rehab, Lindsay Lohan is busted fordrivingdrunkandfound with cocaine. What happened-andwhy?
July 24 should have marked a new start for Lindsay Lohan. Eleven days after finishing a 46-day stint at Promises rehab clinic, the actress was sporting an electronic anklet as proof of a new sober life-and it seemed she might have straightened out. On her schedule: a taping of a Tonight Show segment to promote her new movie, I Know Who Killed Me, and an afternoon tango lesson to prepare for her next role in the romance Dare to Love Me. But she never made it to either appointment. Around 1:30 that morning, Lohan took the wheel of a white SUV in pursuit of a vehicle driven by Michelle Peck, the mother of Tarin Graham, one of her assistants-and seemingly crashed all hopes of a comeback. Responding to a call from Peck, claiming that someone-a someone who turned out to be Lohan-was chasing her through the streets of Santa Monica, Calif., local police later arrested Lohan for DUI (her blood alcohol level was .13; the legal limit is .08), driving with a suspended license and-after finding a small amount of the drug in her pocket during a search-cocaine possession. After posting $25,000 bail, Lohan was released. During the ordeal, says one cop, "she was crying and upset."
Later that day, Lohan was defending herself in an e-mail to Access Hollywood's Billy Bush. "I am innocent," she wrote. "Did not do drugs they're not mine … I was almost hit by my assistant Tarin's mom. I appreciate everyone giving me my privacy." Still, in the wake of her latest meltdown, those closest to Lohan, who turned 21 on July 2, are grappling with a basic rule of recovery: Getting sober comes one painful day at a time. "I thought everything was fine. Obviously everything wasn't," says a close friend, who spoke to her on July 23. "As a [substance abuser] maybe you hide things from the ones you love." Lohan's mother and former party pal, Dina, 44, told TV's The Insider, "We are doing everything in our power in support of Lindsay." Her father, Michael, 47, himself a recovering addict, said to PEOPLE, "I am heartbroken. It's tearing me apart."
While the L.A. District Attorney has yet to file charges for a previous DUI arrest in May, Lohan's new arrest seems likely to lead to a jail sentence (see box).And her once meteoric career has come to a standstill. "She's created serious problems for herself," says an industry source. "Producers don't want to take on such a risk." Right now there are more pressing issues. "Addiction is a terrible and vicious disease," said Lohan lawyer Blair Berk in a July 24 statement. For now, she added, "she is safe, she is out of custody, and receiving medical care."
Lohan is, in fact, already a rehab veteran; seven months before her stay at Promises, she spent time at L.A.'s Wonderland treatment center and publicly spoke of attending Alcoholics Anonymous meetings. "It's not uncommon for the newly sober to slip," says Beverly Hills addiction specialist Marty Brenner. "It's part of the disease." Before she went into Promises, a source close to Lohan told PEOPLE that her best chance for sobriety was to "really follow the directions of her sponsors and counselors." Those directions vary from person to person and center to center, but the bottom line is always the same. "If you want sobriety, you have to change everything," says Brenner. "You have to change your friends, your crowd, your lifestyle."
Those seem to be changes Lohan was unable to make. Even before she officially ended her treatment program, says a source, Lohan was surrounded by hangers-on who had no interest in the party being over: "If she went away and got [sober], they wouldn't have their late-night clubs, the bottle service, the parties." Some of those enablers, in fact, crashed Lohan's 21st-birthday party in Malibu on July 2. "She's naive and doesn't realize how these friends use her," says a close source who was at the party. A person who knows her well says that Lohan used to regularly ask friends to "pour mixed drinks in her water bottle" so that no one would know she was drinking. Another friend describes her as a lonely young woman who craves companionship so desperately that "she refuses to sleep alone. She'll make her friends stay the night."
Lohan relied increasingly on nightlife denizens like British party boy Calum Best, DJ Samantha Ronson and young female assistants, who serve as hired sorority sisters. A day after ending her program at Promises, she made it clear that she wasn't giving up such friendships, or taking herself off the club scene; she headed to Pure nightclub in Las Vegas with a new pal, socialite Dori Cooperman; assistant Jenni Muro; and lawyer Mike Heller. (He had negotiated a lucrative deal for her to celebrate her 21st birthday at Pure, but the party was canceled when she went to rehab.) Lohan danced and sipped water and Red Bull until 4:30 a.m. "There was no alcohol," says a source. Still, upon returning to L.A., Lohan made a quick reentry into the nightlife scene, showing up over the week leading up to her arrest at favorite haunts including Les Deux, where she hung with Ronson; Malibu's Polaroid Beach House; andLAX. "No one cared about Lindsay," the source who was at her birthday party angrily notes. "It was 'How soon should we get her in there to get press?' True friends don't do that."
Lohan also began removing her electronic anklet on occasion (see box), but ironically she was wearing it on the night of her DUI arrest. Dining with pals on the afternoon of July 23 at Coupa Cafe in Beverly Hills, Lohan "seemed really relaxed," says server Justin Carrasco. But the mood changed later that night when Lohan arrived at a pal's gathering. There, at least one person protested Lohan's partying-her assistant Tarin Graham. The two allegedly argued, andGraham declared she was quitting. Graham then apparently called her mother to pick her up, and Lohan gave chase.
What happened next may finally help Lohan turn a corner. "Forever people were talking about her wild and crazy ways, but she was still booking projectsand making movies," says a friend. With her life in ruins, "she's getting scared." Others worry it may be too late. Lohan's party buddies "are not friends," says a close source. "They are enemies. She's got to realize that and walk away. If she doesn't, she could be the next Anna Nicole Smith. That's what I'm afraid of."
DRINKING DRUGS & DRIVING Over the Influence
in spite of the best efforts of a lot of people, impaired drivers like Jeff continue driving up the body count on our streets andhighways.
It's more than disturbing--it's a disaster, aimed at each of us, just waiting to happen. Because the final, frustrating fact aboutdrinking, drugs, and driving is this: It's one problem that is totally preventable.
Still, preventing the potential disasters that every impaired driver represents is going to require a lot more than sobriety checkpoints and public service ads.
Because the real solution starts in the spot where each of us is standing (or sitting) right now--with a commitment not to drive if we're impaired--and not to let our friends or family members drive when they're impaired, either.
Because even though the decision to modify, mangle, or medicate your moods with booze or other chemicals may be your business, taking it to the streets is everybody's business.
Keep it your business. Facing Facts
the facts are already in. They've been in so long, in fact, that a lot of us don't pay much attention to them anymore.
But they're still real and they still have massive impact when you consider that they affect the lives of real people:
Fact: Alcohol figures into 41 percent of all traffic deaths. In 2006, 17,602 Americans were killed indrinking-related accidents.
Fact: Nobody knows how many deaths that drug abuse adds to the total, only that it does. In a study at the University of Maryland, a third of accident victims had smoked pot prior to a crash.
Fact: Three of every five of us will be involved in an alcohol-related accident in our lifetimes.
Don't like the facts--or the odds?
Changing them means changing more than our attitudes aboutdrivingunder the influence of alcohol or drugs (DUI). It means changing our actions,andhelping to change the actions of others.
That's why a new federal law required all states to adopt, by 2004, a uniform standard setting legal impairment at blood-alcohol content (BAC) levels of 0.08 percent, from the previous standard of 0.1 percent. Andthat's also why we put together this pamphlet: to put things on a more personal level--like, say, your personandyour level.
Because there's one more fact that many of us forget aboutdrinking, drugs,anddrivingthat we need to face: The next life that gets mangled by a driver who's smashed could be ours -- or someone we care about.
Alcohol is linked to 41% of all U.S. traffic fatalities -- or 17,602 deaths in 2006 alone. Nobody knows how many deaths drug abuse adds to the total -- only that it does. A Night in the Life Jeff is a social drinker. He likes beer better than the hard stuff, doesn't drink every day, doesn't "crave" alcohol,andnever gets falling-down drunk.
He especially likes going out for drinksanda few games of pool on Saturday night. He's driven home from the bar a thousand times without any trouble. Until tonight.
Fact: A 12-ounce beer, a glass of wine, and a shot of liquor all contain about the same amount of alcohol. Half of all DUI arrests involve beer alone.
Jeff started drinkingand shooting pool around 8 p.m., and closed out the bar at 1:00 a.m. About half a mile from his house, he was pulled over by an officer who noticed his car weaving. Jeff thought his driving was perfectly fine.
Fact: Alcohol affects higher-order brain skills (andturns a set of car keys into a potential weapon) long before a drinker "feels" drunk--or dangerous. As little as two drinks per hour can reduce alertnessandslow decision-making skills.
When the officer asked Jeff if he'd beendrinking, Jeff admitted that he'd had "a few," even though he'd been in the bar for five hoursandhad dropped more than $40.
Fact: Drinkers consistently underestimate how much they've had to drink and how intoxicated--and impaired--they actually are.
The officer ordered Jeff out of his car for a field sobriety test.
He flashed a light in Jeff's eyes, checked the color of his skin, and asked him to perform a few simple tasks, such as touching his nose with his eyes closed, standing on one foot, walking heel to toe, and reciting the alphabet. When Jeff failed the test, he protested, "I couldn't do that stuff even if I wasn't drinking."
Fact: Almost all healthy, sober adults are able to complete these tasks without difficulty. Inability to pass these tests is a reliable indicator ofdrivingimpairment.
The officer told Jeff he was under arrest fordrivingunder the influence of intoxicants. He was frisked, handcuffed,andtaken to the police station. His car was impounded.
At the station, Jeff was asked to take a breathalyzer test to determine if he was over the legal DUI limit (.10 percent blood alcohol in most states; .08 percent in other statesandCanada).
Fact: The amount of alcohol in a drinker's body can be accurately measured with a breath test. Breath tests do work.
Jeff was told that he had the right to refuse the breath test, but if he did, his driver's license would be automatically suspended for three months. Jeff was willing to take the test because he thought it would prove that he wasn't drunk.
Fact: Most drivers don't think they're drunk until they're beyond legal levels of intoxication, levels that seriously impairdrivingability.
Jeff's blood alcohol concentration (BAC) was .15 percent--almost double the legal limit in his state. But he still didn't consider himself too drunk to drive.
Fact:Driving skills begin to suffer at BAC levels below .10 percent. In the year 2000, 3,523 people died in accidents involving drivers with BAC levels lower than .10 percent.
Jeff was booked, fingerprinted, photographed, and strip-searched. Then he was allowed a phone call, and was locked up.
Three hours later, he was released when his wife paid the $500 bail.
It cost another $125 to get his car back from the impound lot.
He had to take a day off work to meet with his lawyer. He'd planned on pleading not guilty. The lawyer told Jeff that they didn't have much chance of winning, but that he'd take the case to trial if Jeff would pay his $1500 retainer--in advance. Jeff decided to plead guilty.
He had to take another day off work to go to court.
There, the judge fined him $500, ordered Jeff to attend a special DUI traffic school, and sentenced him to 24 hours in jail (suspended, if Jeff performed 20 hours of community service work). His driver's license was revoked for six months. Driving when you're loaded is like firing a gun on a busy street. You don't have to hit someone to be a hazard to everybody.
Fact: In recent years, every state has toughened its penalties for DUI offenses. Most automatically suspend the license of first-time offenders,andmany impose finesandjail sentences.
Second time offenders can lose their license for up to a yearandspend 10 or more days in jail.
Before his arrest, Jeff never thought of himself as anything but a social drinker.Andhe never considered himself a danger on the road.
His arrest made him mad. His trial was expensiveandhumiliating. Andhe still wasn't convinced he'd been too drunk to drive.
He cooled his heels at home for a few weeks, but within a month he was back to his old tricks,drinkinganddancingandshooting pool on weekend nights--anddrivinghome.
Fact: Continuing to drink and drive after a DUI arrest is a sign of a potentially serious drinking problem.
Experts say that three-fourths of people arrested two or more times for DUI are alcoholics.
A year later, Jeff was arrested again. This time he lost his license for a year, was placed on probation, and fined $1,000.
He was lucky.
He hadn't had an accident and he hadn't created major problems for anyone but himself and his family.
Hopefully, this time Jeff will learn that driving when he's loaded is like firing a loaded gun in the middle of a busy street.
You don't have to hit someone to be a hazard to everybody.
It's 12:30 a.m. Do you know where your designated driver is?
probably the best way to avoid problems is to go the "designated driver" route during a night out. You know the drill: One member of a group volunteers to not drink anddo all the driving.
There's only one tricky part: You have to pick the driver before you paint the town. That way there's no question about who's drinking club soda--and who's drivinghome.
Other tips for a safe trip:
Drink responsibly. Space your drinksandwait at least an hour after your last one beforedriving.
Know your limit. By the time you start to feel drunk, you already are. Stop before you get there.
Don't mix alcohol and drugs. Even an antihistamine or a cold pill can be a problem when combined with a few drinks.
If you're aloneand** you're determined to get bombed, at least make sure you have a parachute: cab fare. Or ask a (sober) friend for a ride. It's trite, but it's true: Friends don't let friends drive drunk--or otherwise wasted.
EVALUATION OF AN UNDERAGE DRINKINGANDDRIVING PREVENTION PROGRAM
Underage drinkingand its associated consequences, including driving after drinkingand riding with a drinking driver, remain a major public health concern to this nation. Underage drinking is also a major contributor to motor-vehicle injuries andfatalities among persons age 15 to 20. School-based alcohol prevention programs are essential in helping to prevent drinkinganddriving among adolescents. This paper will present methods and results of a preliminary evaluation conducted on a school-based drinkinganddriving prevention program for high school students that simulates alcohol-related consequences andinvolves various community elements.
Recent epidemiological studies suggest that alcohol remains the primary drug of choice among adolescents, with the average age of first use being 13.2 years (Arata, Stafford, & Tims, 2003; Harris, Jolly, Runge, & Knox, 2000; Maney, Higham-Gardill & Mahoney, 2002; Stewart, 1999). The National Center on Addiction and Substance Abuse (CASA) at Columbia University estimates that 20% of alcohol consumption occurs among persons less than 21 years of age (2003). According to the Centers for Disease Control and Prevention (CDC) (2004), approximately 75% of high school students nationwide reported using alcohol at least once during their lifetime (i.e. one more drinks on one or more occasions) while 45% reported being current alcohol users (one or more drinks on one or more occasions within the last 30 days). In regards to heavy alcohol use, 28% of high school students reported binge drinking (five or more drinks in a row on one or more occasions) and between 18% and 31 % reported being drunk within the last 30 days (CDC, 2004; Johnston, O'Malley, Bachman, & Schulenberg, 2003).
Alcohol also significantly contributes to motor vehicle crashes, which remain the leading cause of death for persons 15-20 years of age (CDC, 2004, Lazy, Wiliszowski, & Jones, 2004). According to the Office of Applied Studies at the Substance Abuse andMental Health Services Administration (2004), in 2003, 21 % of persons aged 16 to 20 reported that they had driven within the past year while under the influence of alcohol or illicit drugs. The National Highway Traffic Safety Administration (NHTSA) reports that in 2003, a quarter of young drivers ages 15 to 20 years killed in motor vehicle crashes were intoxicated (NHTSA, 2004). Young male drivers are also at higher risk for being killed in an alcohol-related motor-vehicle crash. In 2003, 28% of the young male drivers involved in fatal crashes had been drinking at the time of the crash, compared with 13% of the young female drivers involved in fatal crashes (NHTSA). Exposure to alcohol-related injuries and fatalities among adolescents are also enhanced by a series of other driving risks which include limited drivingand road experience, nighttime driving, speeding,and failure to use proper safety restraints.
The objectives of this study are to (a) describe the process of an evaluation conducted on an underage drinkinganddrivingprevention program for high school students, (b) report whether participants expressed changes in expectancy scores regarding underage alcohol use, and (c) develop programmatic recommendations that will strengthen the future design, implementation,and evaluation of this experiential underage drinkingand driving prevention program. SHATTERED DREAMS
Elemental to effective school-based alcohol prevention programs are integrated community wide initiatives to raise awareness of the consequences of underage alcohol use and to deter access through a combination of countermeasures including legal, enforcement, medical, media, and political entities. Shattered Dreams is a model of both school and community-based alcohol prevention that incorporates simulated alcohol-related consequences with 14 community elements that include students, parents, educators, school administrators, health systems, and law enforcement personnel (Burandt, Guerra, Villarreal, Ramirez, & Harding, 1998)
In 1998, the Bexar County DWI Task Force Advisory Board on Underage Drinking, in response to an increase in alcohol-related motor vehicle fatalities, established a program that would enhance awareness and understanding of the relationship between alcohol use and the occurrence of motor vehicle-related injuries and fatalities among adolescents. Shattered Dreams was modeled after Every 15 Minutes, a similar program developed and implemented in 1996 by the Chico, California Police Department (Burandt et al., 1998). This programs tide symbolized the death of a person every 15 minutes as a result of an alcohol-related traffic crash (Burandt et al., 1998).
The comprehensive nature of Shattered Dreams requires substantial community effort from the volunteers and planning committees involved in sponsorship. School personnel, parents, and community volunteers plan the event at least six months in advance and must organize and develop specific program teams to solicit participation and support from various local public safety and health care professionals (Beer, Price, Villarreal, & Salazar, 2002). Program teams include assembly, counseling, death notification, debriefing, historian, living dead, mock crash, retreat, scholarship, video production, and public information.
This intensive two-day experiential program visually demonstrates the social, physical and emotional consequences that underage drinkinganddriving can have both on a school and a community. The programs target audience includes high school juniors and seniors (a segment of the adolescent population in which a majority have fulfilled the legal requirements to operate a vehicle and a group that is at a higher risk to engage in alcohol-related risk behavior). This program requires participation from the various elements located within and outside the high school setting including students, educators, and counselors, as well as medical, law, and various other emergency service entities (Burandt et al., 1998). A significant portion of this simulation occurs on the campus of the participating high school to dramatize and reinforce among me student body the significance of an alcohol-related fatality.
The first day begins with an enactment of an alcohol-related motor-vehicle crash involving direct participants (student volunteers) in various stages of trauma including deceased passengers and the injured drunk driver. Law enforcement and emergency response follows (i.e., paramedics, state and local law enforcement officers, airand fire rescue) and includes the transporting of surviving passengers via ground and air to a local medical facility for emergency treatment while the deceased are taken to a local funeral home. The intoxicated driver is given a field sobriety test, arrested, and men delivered to the local juvenile detention center to await arraignment. During this rime, local and state enforcement agents are dispatched to the participating students' homes to notify parents that their son or daughter has been killed in an alcohol-related crash. The loss of life as a result of underage drinkinganddriving is dramatized throughout the day as a student or adult volunteer dressed as a Grim Reaper enters selected classrooms and removes a student volunteer to symbolize the number of persons killed by alcohol within a designated time interval. The reading of a obituary to the entire class immediately follows the student's departure. The student volunteers return to their individual classrooms and are identified as, "Living Dead." Their faces are covered in white makeup to reinforce the notion of death and finality of a life cut short as a result of alcohol. The Living Dead do not speak nor make eye contact with fellow students for the remainder of the day.
Direct student participants (usually numbering around twenty-five) attend an overnight retreat where the central focus is skill-building activities that promote andreinforce healthy behaviors and choices that reduce the likelihood of alcohol use. Other activities focus on team-building, task and goal completion, promoting alternative patterns of communication that include redirection, reinforcement of positive peer influence, leadership development and reflection, and reinforcement andstrengthening of familial relationships. Retreat activities use a mixed-method approach of interactive, video and personal presentations by a series of community, medical, and law enforcement personnel. These presentations include personal experience or knowledge-based topics regarding underage drinkinganddriving. Additional retreat activities stimulate youth leadership development that incorporates group discussions regarding personal power, identity, and the impact of drinkinganddriving on both friends and family (Beer et al., 2002; Burandt et al., 1998).
On the second day, both direct participants and observers (students exposed to the living dead and mock crash) attend a school-wide assembly with a mock funeral anda series of presentations by various medical, and law enforcement personnel, students, parents, and educators. Supportive debriefing sessions are held afterwards for students, parents, and volunteers who are interested in talking about issues or topics that might have been raised as a result of their involvement in the program. An optional follow-up activity enacts a mock trial of the drunk driver involved in the simulated alcohol-related motor-vehicle crash (Burandt et al., 1998).
Alcohol Environments and Disparities in Exposure Associated With Adolescent Drinking in California
Section: RESEARCH AND PRACTICE
Objectives. We investigated sociodemographic disparities in alcohol environments and their relationship with adolescentdrinking.
Methods. We geocoded and mapped alcohol license data with ArcMap to construct circular buffers centered at 14595 households with children that participated in the California Health Interview Survey. We calculated commercial sources of alcohol in each buffer. Multivariate logistic regression differentiated the effects of alcohol sales on adolescents'drinking from their individual, family, and neighborhood characteristics.
Results. Alcohol availability, measured by mean and median number of licenses, was significantly higher around residences of minority and lower-income families. Binge drinking and driving after drinking among adolescents aged 12 to 17 years were significantly associated with the presence of alcohol retailers within 0.5 miles of home. Simulation of changes in the alcohol environment showed that if alcohol sales were reduced from the mean number of alcohol outlets around the lowest-income quartile of households to that of the highest quartile, prevalence of binge drinkingwould fall from 6.4% to 5.6% and driving after drinking from 7.9% to 5.9%.
Conclusions. Alcohol outlets are concentrated in disadvantaged neighborhoods and can contribute to adolescentdrinking. To reduce underage drinking, environmental interventions need to curb opportunities for youth to obtain alcohol from commercial sources by tightening licensure, enforcing minimum-age drinking laws, or other measures. (Am J Public Health. 2009;99:264-270. doi: 10.2105/AJPH.2007. 122077)
Despite federal, state, and local interventions, underage drinking continues to be a serious problem. A national survey found that 17.6% of adolescents drank alcohol in the past 30 days, 11.1% were binge drinkers, and 2.7% were heavy drinkers.[1] Health and social problems associated with youths' drinking include motor vehicle crashes,[2][3] violence,[4] risky sexual behaviors,[5][6] assault and rapes,[7] and brain impairment[8-11] Adolescent alcohol use has substantial societal costs.[12] Drinking at an early age also increases the risk of addiction and other alcohol-related problems in adulthood.[13-15] In 2007, the surgeon general responded to this problem in the Call to Action to Prevent and Reduce Underage Drinking, which emphasized environmental contributions to the problem.[16]
Underage drinkers obtain their alcoholic beverages from a variety of sources, including parents' stocks, friends, parties,and commercial outlets.[17] In 1 study, buyers who looked underage were able to purchase alcohol with high success rates from both on-site (for consumption on the premises, such as bars and restaurants) and off-site (for consumption elsewhere, such as liquor stores) establishments.[18][19] Sales to minors have been found to be significantly associated with the percentage of Hispanic residents in a neighborhood and with population density.[20]
As long as adolescents can obtain alcohol from commercial sources, neighborhood outlets are likely to play a role in underage drinking. Rhee et al. argued that environment plays an essential role in drinking initiation and that genetics are important in developing alcohol dependence.[21] Perceived alcohol availability was significantly associated with higher levels of alcohol consumption among young men[22] and with drinking in public locations for adolescent girls.[23] Density of outlets for alcohol in dries was associated with youths' drinking and driving and with riding in a car driven by a person under the influence of alcohol.[24]
Differences in alcohol environments may exacerbate health disparities across sociodemographic groups. LaVeist and Wallace found that in Baltimore, MD, predominantly Black and low-income census tracts have more liquor stores per capita than do tracts of other race and income groups.[25] Gorman andSpeer found retail liquor outlets abundantly located in poor and minority neighborhoods in a city in New Jersey.[26] Only 1 national study has been published, and it reported higher densities of liquor stores in zip codes with higher percentages of Blacks and lower-income non-Whites.[27] That study covered all urban areas in the United States, but the urban zip codes had a mean land area of 40.1 square miles and a mean population of 21920 persons,[27] arguably too large to represent neighborhoods. Even census tracts may be too large and too dissimilar to capture neighborhood effects: in Los Angeles County they can range from 0.04 square miles to 322 square miles.
The objectives of this study were (1) to describe the quantity and geographic pattern of alcohol retailers in small areas around individual homes and (2) to examine relationships between alcohol environments and adolescent drinking. We analyzed data from the entire state of California to investigate the effects of spatial accessibility on alcohol sales to adolescents.
METHODS Data
Data on alcohol outlets came from the California Department of Alcoholic Beverage Control database and included addresses and license types of all alcohol retailers in the state.[28] We classified alcohol outlets by license type: off-site or on-site. In 2003, California had 30650 active on-site licenses and 21836 active off-site licenses.[28]
Participant data were obtained from the California Health Interview Survey, a computer-assisted telephone interview with a 2-stage, geographically stratified, random-digit-dialing design that attempts to interview 1 adult and 1 adolescent per household and to get information on 1 child in households with children. The survey is representative of the state's noninstitutionalized population living in households. Details are available elsewhere.[29]
The California Health Interview Survey 2003 included survey data for 42044 adults, 4010 adolescents, and 8526 children, who were linked by family identifiers. We excluded 3679 households in rural areas because their environments were not comparable. For our analysis of alcohol environments, we focused on 14595 households with children younger than 18 years (not all households with children participated in the child and adolescent surveys). For our analysis of adolescent drinking, we used data on 3660 adolescents aged 12 to 17 years. We used a subsample of 687 adolescents aged 16 to 17 years who had ever had a few sips of alcoholic drinks for our analysis of adolescent driving after drinking.
Measures of Alcohol Environments
We defined alcohol environments by distance from homes. We used ArcMap version 9.1 (ESR1, Redlands, CA) to draw circles with radii of 0.1 miles, 0.5 miles, 1.0 mile, and 2.0 miles centered at respondents' residences. We first looked at immediate distances with 0.1-mile-radius circles and at circular bands between 0.1-mile and 0.5-mile radii. We considered that outlets in these areas might be the most problematic because of their proximity to adolescents' residences. A distance of 0.5 miles is approximately a 10-minute walk[30] and thus within the reach of adolescents. Outlets beyond easy walking distance were examined in circular bands between 0.5- and 1.0-mile radii and between 1.0- and 2.0-mile radii (all 4 constructed buffers were mutually exclusive). We mapped the business locations in the Department of Alcoholic Beverage Control database to the buffers around each household and calculated the number of alcohol retailers within each buffer.
Previous research focused on density measures, such as the number of establishments per city, per resident, or per roadway mile.[27][31-33] We used the raw count in each buffer rather than outlet-density measures in a predefined geographic area (such as census tracts) because individuals may live close to alcohol outlets in what is defined as a low-density area if that area includes large sections that are lightly populated, such as deserts or mountains. Similarly, in densely populated urban areas, population measures may yield low densities of alcohol outlets per resident even when most households are within walking distance of these outlets.
Statistical Analyses
We compared the mean and median number of alcohol outlets (for all licenses and for on-site and off-site establishments separately) across racial/ethnic groups (non-Hispanic White, non-Hispanic Black, Hispanic, Asian/Pacific Islander, and other) and income groups (incomes quartiles derived from self-reported total household annual income before tax). We then stratified by both race/ethnicity and income. We also performed a zero-inflated Poisson regression with number of outlets as the dependent variable and race/ethnicity and income as the key explanatory variables, controlling for population density in the census tracts. We estimated this model separately for each definition of the dependent variable (all licenses, on-site, and off-site) within each buffer. The data included all households with children younger than 18 years.
We analyzed 3 dichotomous dependent variables for adolescent drinking with logistic regression: at least 1 alcoholic drink in the past 30 days, at least 1 heavy drinking episode (5 drinks in a row, also referred to as binge drinking) in the past 30 days, and ever driving after drinking. The primary explanatory variables were the number of alcohol outlets within the 0.5-mile radii, 0.5- to 1.0-mile bands, and 1.0- to 2.0-mile bands. For each dependent variable, we estimated 2 models that differed in the key explanatory variables. For the first model, total number of licenses was the key explanatory variable. For the second model, off-site and on-site establishments were the key explanatory variables. We used the latter model to determine what type of outlets had predictive power for adolescent drinking, because the underlying processes in illegally obtaining alcoholic beverages may differ.
Additional explanatory variables included in all models were adolescents' characteristics (gender, age, race, paid employment in the past 12 months, current smoking, and marijuana use in the past 30 days), family characteristics (household income and parents' marital status), parents' drinking behavior (self-reporting by parent or guardian of any heavy drinking episode, defined as 5 drinks in a row in the past 30 days, and excess drinking, defined as consuming more than 60 drinks per month), and neighborhood sociodemographic characteristics (census tract total population, tract median household income, and percentage of Whites and Blacks in the population, according to data extracted from the 2000 US Census).
In all regression models we used robust standard errors to account for clustering data caused by the survey's multistage sample design. First, the state was divided into 44 geographic sampling strata, including 41 single-county strata and 3 multicounty strata comprising the 17 remaining counties in California. Second, within each geographic stratum, residential telephone numbers were selected through random-digit-dialed sampling. The regression was also weighted to control for differential sampling rates within geographic stratum and racial/ethnic groups.
To improve the interpretation of logistic regression coefficients, we changed levels of alcohol availability in adolescents' neighborhoods and predicted the resulting prevalence of adolescent drinking in the estimated model. We changed only the key explanatory variable, retaining all other variables. This provided the adjusted difference in the prevalence of a drinking measure between 2 levels of alcohol availability, that is, it accounted for all individual, family, and neighborhood sociodemographic characteristics in the model except the alcohol environments. For the differences in alcohol environments, we compared the average number of outlets around Asian/Pacific Islander and White households and around low- and high-income households.
RESULTS Disparities in Alcohol Environments
Table 1 provides descriptive statistics of the sample, divided into 4 quartiles of gross annual household income: less than $24000, $24000 to $49000, $50000 to $90000, and more than $90,000. Fewer than 11% of non-Hispanic Whites belonged to the bottom income quartile, compared with 32.0% of non-Hispanic Blacks, 50.4% of Hispanics, 20.8% of Asian/Pacific Islanders, and 32.9% of other groups. By contrast, 36.0% of non-Hispanic Whites, 15.1% of non-Hispanic Blacks, 4.7% of Hispanic, 29.1% of Asian/Pacific Islanders, and 13.2% of other groups were in the top income quartile.
Average age in the adolescent sample was 14.3 years, reflecting the period of drinking initiation. However, the survey did not ask for age at first alcoholic drink. Approximately 35% of adolescent respondents reported ever having more than just a few sips of alcoholic drinks. Fifteen percent reported having at least 1 drink, and 5.6% reported at least 1 heavy drinking episode in the past 30 days. Five percent reported they were current smokers (i.e., had had ≥ 1 cigarette per day in the past 30 days), and 5.0% reported marijuana use in the past 30 days. Of those aged 16 or 17 years who ever consumed alcohol, 6.0% reported ever driving after drinking.
Table 2 shows the mean number of alcohol outlets within different buffers, stratified by income and race/ethnicity. Compared with non-Hispanic Whites, people of other groups were surrounded by more alcohol outlets, regardless of the size of the buffers. For instance, within 0.1 mile, we found an average 0.21 outlets around residences of Whites; Blacks had 0.24, Hispanics 0.39, and Asian/Pacific Islanders 0.33 (P<.001). Participants who were in lower-income quartiles were surrounded by more alcohol outlets. We found this geographic pattern even within each racial/ethnic group. We observed the same distribution pattern across income groups within each racial/ethnic group. Our results were consistent in the sensitivity analyses: comparison of the median number of outlets, separation of off-site from on-site outlets, and zero-inflated Poisson regression model with income and race/ethnicity as key predictors of alcohol outlets.
=
=
=
=
=
=
=================================Durkin, Keith F., Scott E. Wolfe, and Ross W. May. "SOCIAL BOND THEORY AND DRUNK DRIVING IN A SAMPLE OF COLLEGE STUDENTS." College Student Journal 41.3 (Sep. 2007): 734-744. MasterFILE Premier. EBSCO. [Library name], [City], [State abbreviation]. 5 Mar. 2009 <http://search.ebscohost.com/login.aspx?direct=true&db=f5h&AN=26886005&site=ehost-live>.SOCIAL BOND THEORY AND DRUNK DRIVING IN A SAMPLE OF COLLEGE STUDENTSThis paper reports the finding from a study that examined the relationship between social bond variables and drunkdriving in a sample of university students. A questionnaire containing indicators representing social bond variables, as well as a measure of drunk driving was administered to a sample of 1459 college students. The results of this study provide mixed support for social bond theory. On the one hand, commitment to conventional activities and acceptance of conventional beliefs were negatively related to drunk driving. On the other hand, neither the involvement component nor the attachment component were related to drinking and driving in the manner predicted by social bond theory.The consumption of alcohol by college students has received a tremendous amount of scrutiny in recent years. Bingedrinking, or heavy episodic drinking, is a prevalent behavior that has been linked to a variety of problematic consequences for student drinkers. These include hangovers, blackouts, missing class, doing something they regret later, getting involved in physical fights and other arguments, and having trouble with the police (Wechsler, Davenport, Dowdall, Moeykens, & Castillo, 1995; Wechsler, Lee, Kuo, & H. Lee, 2000). Binge drinking is also associated with risky sexual behaviors, thus putting students at risk for contracting sexually transmitted diseases, such as HIV (Meilman, 1993; Smith & Brown, 1998). Recent research has also revealed that students who drink frequently have higher odds of becoming the victim of assault (Mustaine & Tewskbury, 2000). The tragic alcohol-related deaths of students at several schools illustrate the potentially fatal consequences of this activity. However, the negative consequences of this behavior are not limited to drinkers. Intoxicated students also have an adverse impact on the campus and surrounding community. Examples of these so-called "secondary binge effects" include being verbally insulted or abused, being physically assaulted, having one's property damaged, experiencing unwelcome sexual advances, and having sleep or studying disturbed because of intoxicated students (Wechsler, Davenport, Dowdall, et al. 1994). Community residents who live near college campuses often report a lower quality of life resulting from the behavior of student drinkers (e.g., noise disturbances, disorderly conduct, litter, vandalism) (Wechsler, Lee, Kuo, et al., 2002).
Drunk driving is a type of alcohol-related behavior that endangers drinkers as well as other members of the campus and general community. University students appear to be particularly susceptible to driving while intoxicated (Wechsler, Lee, Nelson, & H. Lee, 2003). In a recent study, Hingson, Heeren, Zakocs, Kopstein, and Wechsler (2002) estimated that at least two million students drove while intoxicated during the previous year. The fatal consequences of this behavior are well documented. The leading cause of death for young people is automobile accidents, many of which are alcohol-related (McCormick & Ureda, 1995). In fact, the most common cause of death in young adults (aged 17-24) is alcohol-related accidents (Ham & Hope, 2003). According to one estimate, about 1100 college students died in alcohol-related crashes in 1998 (Wechsler et al., 2003)
Although recent studies (e.g., Billingham, Wilson, & Gross, 1999; Grenier, 1993; Harford, Wechsler, & Muthen, 2002; McCormick & Ureda, 1995) have sought to identify demographic factors associated with drinking and driving by college students, only a few studies have examined other factors associated with this behavior. For example, Clapp, Shillington, Lange, and Voas (2003) investigated the relationship between substance use patterns (e.g., binge drinking, marijuana use) and drunk driving by university students. Also, Hingson, Heeren, Zakocs, Winter, and Wechsler (2003) examined the relationship between age at first intoxication and students driving while intoxicated. However, there have been relatively few attempts to apply the various sociological perspectives, particularly theories of deviant behavior, to this phenomenon. This is a serious oversight since sociological theories of deviance typically have strong explanatory value (Durkin, Wolfe, & Clark, 1999). Understanding the factors that cause the alcohol-related problems of college students can inform intervention and prevention efforts (Ham & Hope, 2003). A greater understanding of drunk driving is also of significant importance to the nation's public health agenda (O'Malley & Johnston, 1999). The purpose of this paper is to apply one of the most popular sociological explanations of deviance, social bond theory, to drinking and driving by university students.
According to Travis Hirschi (1969,p.82), the sociologist who formally introduced social bond theory, "we are moral beings to the extent we are social beings." Social bond theory assumes that the motivation for deviant behavior is present in everyone, and concerns itself with the factors that keep an individual from engaging in deviance. The social bond essentially "refers to the connection between the individual and society" (Shoemaker, 2005, p.176). When these bonds are weak or lacking, the individual has less at stake and is at higher risk for committing deviant acts (Faupel, Horowitz, & Weaver, 2004). Social bond theory was originally presented as an explanation of juvenile delinquency and is one of the leading social psychological perspectives on deviant behavior (Massey & Krohn, 1986), and is arguably the most frequently tested theory of deviance (Akers, 2000). This theory has received modest empirical support,and its explanatory value is typically described as good or moderate (Gardner & Shoemaker, 1989). It has been applied to a wide variety of deviant behaviors including academic cheating by university students, alcohol use, juvenile delinquency, and marijuana use (Durkin, S. Wolfe, & Lewis, 2006)
There are four elements of the social bond. The first is attachment. This refers to the ties that an individual has to significant others such as family members; particularly parents (Leonard & Decker, 1994). For college students, the relationship with one's parents would be an example of attachment. The second component of the social bond, commitment, refers to the aggregate investment of time, energy, and resources in conventional activities such as getting an education or a holding a job. These investments represent stakes in conformity (Akers, 2000). Indicators of commitment for university students include religiosity, church attendance, commitment to higher education, and grade point average. The third element of the social bond is involvement. This consists of the amount of time a person spends engaging in conventional activities such as doing schoolwork, participating in extracurricular activities such as clubs or athletics, and working at a part-time job. The final component of the social bond is belief. This is the acceptance of a conventional value system. The belief component includes a general acceptance of the rules of society as being morally valid and binding, as well as respect for authority and the legal system.
While we are not aware of any studies that have specifically applied social bond theory to drinking and driving among college students, a review of the relevant literature seems to suggest that it may be useful in explaining this behavior. First, two previous studies (Durkin et al., 1999; 2006) have explored the relationship between binge drinking and the social bond in university students. These results suggest that both the commitment and belief components of social bond theory are negatively related to binge drinking. Binge drinking is a risky type of alcohol-related behavior that may be somewhat analogous to drunk driving. Therefore, there may be a similar relationship between the social bond and drunk driving. Second, Billingham et al. (1999) found higher rates of drinking and driving among students from divorced families. Social bond theory would posit that these students would have a lower-level of attachment to parents due to divorce. Finally, using data collected from high school seniors O'Malley and Johnston (1999) found a negative relationship between both religious commitment and grade point average (two indicators of the commitment component of the social bond) and drunk driving. Therefore, the same relationship might be expected for university students.
Several hypotheses were derived from social bond theory about the nature of drunk driving among college students. First, there should be an inverse relationship between attachment and drunk driving. Second, the likelihood of drinking and driving will increase as a student's commitments decrease. Third, involvement in conventional activities will decrease the likelihood of drunk driving. Finally, there will be a negative relationship between acceptance of conventional beliefs and drunk driving.
=
=
=
=============================================================
Schneider, Karen S., et al. "Falling Apart. (cover story)." People 68.6 (06 Aug. 2007): 56-60. MasterFILE Premier. EBSCO. [Library name], [City], [State abbreviation]. 5 Mar. 2009 <http://search.ebscohost.com/login.aspx?direct=true&db=f5h&AN=25940795&site=ehost-live>.=
=Falling Apart
LINDSAY LOHANJust 11 days after rehab, Lindsay Lohan is busted for driving drunk and found with cocaine. What happened-and why?
July 24 should have marked a new start for Lindsay Lohan. Eleven days after finishing a 46-day stint at Promises rehab clinic, the actress was sporting an electronic anklet as proof of a new sober life-and it seemed she might have straightened out. On her schedule: a taping of a Tonight Show segment to promote her new movie, I Know Who Killed Me, and an afternoon tango lesson to prepare for her next role in the romance Dare to Love Me. But she never made it to either appointment. Around 1:30 that morning, Lohan took the wheel of a white SUV in pursuit of a vehicle driven by Michelle Peck, the mother of Tarin Graham, one of her assistants-and seemingly crashed all hopes of a comeback. Responding to a call from Peck, claiming that someone-a someone who turned out to be Lohan-was chasing her through the streets of Santa Monica, Calif., local police later arrested Lohan for DUI (her blood alcohol level was .13; the legal limit is .08), driving with a suspended license and-after finding a small amount of the drug in her pocket during a search-cocaine possession. After posting $25,000 bail, Lohan was released. During the ordeal, says one cop, "she was crying and upset."
Later that day, Lohan was defending herself in an e-mail to Access Hollywood's Billy Bush. "I am innocent," she wrote. "Did not do drugs they're not mine … I was almost hit by my assistant Tarin's mom. I appreciate everyone giving me my privacy." Still, in the wake of her latest meltdown, those closest to Lohan, who turned 21 on July 2, are grappling with a basic rule of recovery: Getting sober comes one painful day at a time. "I thought everything was fine. Obviously everything wasn't," says a close friend, who spoke to her on July 23. "As a [substance abuser] maybe you hide things from the ones you love." Lohan's mother and former party pal, Dina, 44, told TV's The Insider, "We are doing everything in our power in support of Lindsay." Her father, Michael, 47, himself a recovering addict, said to PEOPLE, "I am heartbroken. It's tearing me apart."
While the L.A. District Attorney has yet to file charges for a previous DUI arrest in May, Lohan's new arrest seems likely to lead to a jail sentence (see box).And her once meteoric career has come to a standstill. "She's created serious problems for herself," says an industry source. "Producers don't want to take on such a risk." Right now there are more pressing issues. "Addiction is a terrible and vicious disease," said Lohan lawyer Blair Berk in a July 24 statement. For now, she added, "she is safe, she is out of custody, and receiving medical care."
Lohan is, in fact, already a rehab veteran; seven months before her stay at Promises, she spent time at L.A.'s Wonderland treatment center and publicly spoke of attending Alcoholics Anonymous meetings. "It's not uncommon for the newly sober to slip," says Beverly Hills addiction specialist Marty Brenner. "It's part of the disease." Before she went into Promises, a source close to Lohan told PEOPLE that her best chance for sobriety was to "really follow the directions of her sponsors and counselors." Those directions vary from person to person and center to center, but the bottom line is always the same. "If you want sobriety, you have to change everything," says Brenner. "You have to change your friends, your crowd, your lifestyle."
Those seem to be changes Lohan was unable to make. Even before she officially ended her treatment program, says a source, Lohan was surrounded by hangers-on who had no interest in the party being over: "If she went away and got [sober], they wouldn't have their late-night clubs, the bottle service, the parties." Some of those enablers, in fact, crashed Lohan's 21st-birthday party in Malibu on July 2. "She's naive and doesn't realize how these friends use her," says a close source who was at the party. A person who knows her well says that Lohan used to regularly ask friends to "pour mixed drinks in her water bottle" so that no one would know she was drinking. Another friend describes her as a lonely young woman who craves companionship so desperately that "she refuses to sleep alone. She'll make her friends stay the night."
Lohan relied increasingly on nightlife denizens like British party boy Calum Best, DJ Samantha Ronson and young female assistants, who serve as hired sorority sisters. A day after ending her program at Promises, she made it clear that she wasn't giving up such friendships, or taking herself off the club scene; she headed to Pure nightclub in Las Vegas with a new pal, socialite Dori Cooperman; assistant Jenni Muro; and lawyer Mike Heller. (He had negotiated a lucrative deal for her to celebrate her 21st birthday at Pure, but the party was canceled when she went to rehab.) Lohan danced and sipped water and Red Bull until 4:30 a.m. "There was no alcohol," says a source. Still, upon returning to L.A., Lohan made a quick reentry into the nightlife scene, showing up over the week leading up to her arrest at favorite haunts including Les Deux, where she hung with Ronson; Malibu's Polaroid Beach House; andLAX. "No one cared about Lindsay," the source who was at her birthday party angrily notes. "It was 'How soon should we get her in there to get press?' True friends don't do that."
Lohan also began removing her electronic anklet on occasion (see box), but ironically she was wearing it on the night of her DUI arrest. Dining with pals on the afternoon of July 23 at Coupa Cafe in Beverly Hills, Lohan "seemed really relaxed," says server Justin Carrasco. But the mood changed later that night when Lohan arrived at a pal's gathering. There, at least one person protested Lohan's partying-her assistant Tarin Graham. The two allegedly argued, andGraham declared she was quitting. Graham then apparently called her mother to pick her up, and Lohan gave chase.
What happened next may finally help Lohan turn a corner. "Forever people were talking about her wild and crazy ways, but she was still booking projectsand making movies," says a friend. With her life in ruins, "she's getting scared." Others worry it may be too late. Lohan's party buddies "are not friends," says a close source. "They are enemies. She's got to realize that and walk away. If she doesn't, she could be the next Anna Nicole Smith. That's what I'm afraid of."
=
========================================================================================
"D.U.I." DUI: Drinking, Drugs & Driving (Aug. 2007): 1-2. MasterFILE Premier. EBSCO. [Library name], [City], [State abbreviation]. 5 Mar. 2009 <http://search.ebscohost.com/login.aspx?direct=true&db=f5h&AN=27947890&site=ehost-live>.D.U.I.
DRINKING DRUGS & DRIVING Over the Influencein spite of the best efforts of a lot of people, impaired drivers like Jeff continue driving up the body count on our streets andhighways.
It's more than disturbing--it's a disaster, aimed at each of us, just waiting to happen. Because the final, frustrating fact aboutdrinking, drugs, and driving is this: It's one problem that is totally preventable.
Still, preventing the potential disasters that every impaired driver represents is going to require a lot more than sobriety checkpoints and public service ads.
Because the real solution starts in the spot where each of us is standing (or sitting) right now--with a commitment not to drive if we're impaired--and not to let our friends or family members drive when they're impaired, either.
Because even though the decision to modify, mangle, or medicate your moods with booze or other chemicals may be your business, taking it to the streets is everybody's business.
Keep it your business.
Facing Facts
the facts are already in. They've been in so long, in fact, that a lot of us don't pay much attention to them anymore.
But they're still real and they still have massive impact when you consider that they affect the lives of real people:
- Fact: Alcohol figures into 41 percent of all traffic deaths. In 2006, 17,602 Americans were killed in drinking-related accidents.
- Fact: Nobody knows how many deaths that drug abuse adds to the total, only that it does. In a study at the University of Maryland, a third of accident victims had smoked pot prior to a crash.
- Fact: Three of every five of us will be involved in an alcohol-related accident in our lifetimes.
Don't like the facts--or the odds?Changing them means changing more than our attitudes about driving under the influence of alcohol or drugs (DUI). It means changing our actions, and helping to change the actions of others.
That's why a new federal law required all states to adopt, by 2004, a uniform standard setting legal impairment at blood-alcohol content (BAC) levels of 0.08 percent, from the previous standard of 0.1 percent.
And that's also why we put together this pamphlet: to put things on a more personal level--like, say, your person and your level.
Because there's one more fact that many of us forget about drinking, drugs, and driving that we need to face: The next life that gets mangled by a driver who's smashed could be ours -- or someone we care about.
Alcohol is linked to 41% of all U.S. traffic fatalities -- or 17,602 deaths in 2006 alone. Nobody knows how many deaths drug abuse adds to the total -- only that it does.
A Night in the Life
Jeff is a social drinker. He likes beer better than the hard stuff, doesn't drink every day, doesn't "crave" alcohol, and never gets falling-down drunk.
He especially likes going out for drinks and a few games of pool on Saturday night. He's driven home from the bar a thousand times without any trouble. Until tonight.
- Fact: A 12-ounce beer, a glass of wine, and a shot of liquor all contain about the same amount of alcohol. Half of all DUI arrests involve beer alone.
Jeff started drinking and shooting pool around 8 p.m., and closed out the bar at 1:00 a.m. About half a mile from his house, he was pulled over by an officer who noticed his car weaving. Jeff thought his driving was perfectly fine.- Fact: Alcohol affects higher-order brain skills (and turns a set of car keys into a potential weapon) long before a drinker "feels" drunk--or dangerous. As little as two drinks per hour can reduce alertness and slow decision-making skills.
When the officer asked Jeff if he'd been drinking, Jeff admitted that he'd had "a few," even though he'd been in the bar for five hours and had dropped more than $40.- Fact: Drinkers consistently underestimate how much they've had to drink and how intoxicated--and impaired--they actually are.
The officer ordered Jeff out of his car for a field sobriety test.He flashed a light in Jeff's eyes, checked the color of his skin, and asked him to perform a few simple tasks, such as touching his nose with his eyes closed, standing on one foot, walking heel to toe, and reciting the alphabet. When Jeff failed the test, he protested, "I couldn't do that stuff even if I wasn't drinking."
- Fact: Almost all healthy, sober adults are able to complete these tasks without difficulty. Inability to pass these tests is a reliable indicator of driving impairment.
The officer told Jeff he was under arrest for driving under the influence of intoxicants. He was frisked, handcuffed, and taken to the police station. His car was impounded.At the station, Jeff was asked to take a breathalyzer test to determine if he was over the legal DUI limit (.10 percent blood alcohol in most states; .08 percent in other states and Canada).
- Fact: The amount of alcohol in a drinker's body can be accurately measured with a breath test. Breath tests do work.
Jeff was told that he had the right to refuse the breath test, but if he did, his driver's license would be automatically suspended for three months. Jeff was willing to take the test because he thought it would prove that he wasn't drunk.- Fact: Most drivers don't think they're drunk until they're beyond legal levels of intoxication, levels that seriously impair driving ability.
Jeff's blood alcohol concentration (BAC) was .15 percent--almost double the legal limit in his state. But he still didn't consider himself too drunk to drive.- Fact: Driving skills begin to suffer at BAC levels below .10 percent. In the year 2000, 3,523 people died in accidents involving drivers with BAC levels lower than .10 percent.
Jeff was booked, fingerprinted, photographed, and strip-searched. Then he was allowed a phone call, and was locked up.Three hours later, he was released when his wife paid the $500 bail.
It cost another $125 to get his car back from the impound lot.
He had to take a day off work to meet with his lawyer. He'd planned on pleading not guilty. The lawyer told Jeff that they didn't have much chance of winning, but that he'd take the case to trial if Jeff would pay his $1500 retainer--in advance. Jeff decided to plead guilty.
He had to take another day off work to go to court.
There, the judge fined him $500, ordered Jeff to attend a special DUI traffic school, and sentenced him to 24 hours in jail (suspended, if Jeff performed 20 hours of community service work). His driver's license was revoked for six months.
Driving when you're loaded is like firing a gun on a busy street. You don't have to hit someone to be a hazard to everybody.
- Fact: In recent years, every state has toughened its penalties for DUI offenses. Most automatically suspend the license of first-time offenders, and many impose finesand jail sentences.
Second time offenders can lose their license for up to a year and spend 10 or more days in jail.Before his arrest, Jeff never thought of himself as anything but a social drinker. And he never considered himself a danger on the road.
His arrest made him mad. His trial was expensive and humiliating.
And he still wasn't convinced he'd been too drunk to drive.
He cooled his heels at home for a few weeks, but within a month he was back to his old tricks, drinking and dancing and shooting pool on weekend nights--anddriving home.
- Fact: Continuing to drink and drive after a DUI arrest is a sign of a potentially serious drinking problem.
Experts say that three-fourths of people arrested two or more times for DUI are alcoholics.A year later, Jeff was arrested again. This time he lost his license for a year, was placed on probation, and fined $1,000.
He was lucky.
He hadn't had an accident and he hadn't created major problems for anyone but himself and his family.
Hopefully, this time Jeff will learn that driving when he's loaded is like firing a loaded gun in the middle of a busy street.
You don't have to hit someone to be a hazard to everybody.
It's 12:30 a.m. Do you know where your designated driver is?
probably the best way to avoid problems is to go the "designated driver" route during a night out. You know the drill: One member of a group volunteers to not drink anddo all the driving.
There's only one tricky part: You have to pick the driver before you paint the town. That way there's no question about who's drinking club soda--and who's drivinghome.
Other tips for a safe trip:
- Drink responsibly. Space your drinks and wait at least an hour after your last one before driving.
- Know your limit. By the time you start to feel drunk, you already are. Stop before you get there.
- Don't mix alcohol and drugs. Even an antihistamine or a cold pill can be a problem when combined with a few drinks.
If you're alone and** you're determined to get bombed, at least make sure you have a parachute: cab fare. Or ask a (sober) friend for a ride. It's trite, but it's true: Friends don't let friends drive drunk--or otherwise wasted.==================================================================================================
Salazar, Camerino I., et al. "EVALUATION OF AN UNDERAGE DRINKING AND DRIVING PREVENTION PROGRAM." American Journal of Health Studies 21.1/2 (Mar. 2006): 49-56. MasterFILE Premier. EBSCO. [Library name], [City], [State abbreviation]. 5 Mar. 2009 <http://search.ebscohost.com/login.aspx?direct=true&db=f5h&AN=25219314&site=ehost-live>.
EVALUATION OF AN UNDERAGE DRINKING AND DRIVING PREVENTION PROGRAM
Underage drinking and its associated consequences, including driving after drinking and riding with a drinking driver, remain a major public health concern to this nation. Underage drinking is also a major contributor to motor-vehicle injuries andfatalities among persons age 15 to 20. School-based alcohol prevention programs are essential in helping to prevent drinkingand driving among adolescents. This paper will present methods and results of a preliminary evaluation conducted on a school-based drinking and driving prevention program for high school students that simulates alcohol-related consequences andinvolves various community elements.Recent epidemiological studies suggest that alcohol remains the primary drug of choice among adolescents, with the average age of first use being 13.2 years (Arata, Stafford, & Tims, 2003; Harris, Jolly, Runge, & Knox, 2000; Maney, Higham-Gardill & Mahoney, 2002; Stewart, 1999). The National Center on Addiction and Substance Abuse (CASA) at Columbia University estimates that 20% of alcohol consumption occurs among persons less than 21 years of age (2003). According to the Centers for Disease Control and Prevention (CDC) (2004), approximately 75% of high school students nationwide reported using alcohol at least once during their lifetime (i.e. one more drinks on one or more occasions) while 45% reported being current alcohol users (one or more drinks on one or more occasions within the last 30 days). In regards to heavy alcohol use, 28% of high school students reported binge drinking (five or more drinks in a row on one or more occasions) and between 18% and 31 % reported being drunk within the last 30 days (CDC, 2004; Johnston, O'Malley, Bachman, & Schulenberg, 2003).
Alcohol also significantly contributes to motor vehicle crashes, which remain the leading cause of death for persons 15-20 years of age (CDC, 2004, Lazy, Wiliszowski, & Jones, 2004). According to the Office of Applied Studies at the Substance Abuse andMental Health Services Administration (2004), in 2003, 21 % of persons aged 16 to 20 reported that they had driven within the past year while under the influence of alcohol or illicit drugs. The National Highway Traffic Safety Administration (NHTSA) reports that in 2003, a quarter of young drivers ages 15 to 20 years killed in motor vehicle crashes were intoxicated (NHTSA, 2004). Young male drivers are also at higher risk for being killed in an alcohol-related motor-vehicle crash. In 2003, 28% of the young male drivers involved in fatal crashes had been drinking at the time of the crash, compared with 13% of the young female drivers involved in fatal crashes (NHTSA). Exposure to alcohol-related injuries and fatalities among adolescents are also enhanced by a series of other driving risks which include limited driving and road experience, nighttime driving, speeding,and failure to use proper safety restraints.
The objectives of this study are to (a) describe the process of an evaluation conducted on an underage drinking and drivingprevention program for high school students, (b) report whether participants expressed changes in expectancy scores regarding underage alcohol use, and (c) develop programmatic recommendations that will strengthen the future design, implementation,and evaluation of this experiential underage drinking and driving prevention program.
SHATTERED DREAMS
Elemental to effective school-based alcohol prevention programs are integrated community wide initiatives to raise awareness of the consequences of underage alcohol use and to deter access through a combination of countermeasures including legal, enforcement, medical, media, and political entities. Shattered Dreams is a model of both school and community-based alcohol prevention that incorporates simulated alcohol-related consequences with 14 community elements that include students, parents, educators, school administrators, health systems, and law enforcement personnel (Burandt, Guerra, Villarreal, Ramirez, & Harding, 1998)
In 1998, the Bexar County DWI Task Force Advisory Board on Underage Drinking, in response to an increase in alcohol-related motor vehicle fatalities, established a program that would enhance awareness and understanding of the relationship between alcohol use and the occurrence of motor vehicle-related injuries and fatalities among adolescents. Shattered Dreams was modeled after Every 15 Minutes, a similar program developed and implemented in 1996 by the Chico, California Police Department (Burandt et al., 1998). This programs tide symbolized the death of a person every 15 minutes as a result of an alcohol-related traffic crash (Burandt et al., 1998).
The comprehensive nature of Shattered Dreams requires substantial community effort from the volunteers and planning committees involved in sponsorship. School personnel, parents, and community volunteers plan the event at least six months in advance and must organize and develop specific program teams to solicit participation and support from various local public safety and health care professionals (Beer, Price, Villarreal, & Salazar, 2002). Program teams include assembly, counseling, death notification, debriefing, historian, living dead, mock crash, retreat, scholarship, video production, and public information.
This intensive two-day experiential program visually demonstrates the social, physical and emotional consequences that underage drinking and driving can have both on a school and a community. The programs target audience includes high school juniors and seniors (a segment of the adolescent population in which a majority have fulfilled the legal requirements to operate a vehicle and a group that is at a higher risk to engage in alcohol-related risk behavior). This program requires participation from the various elements located within and outside the high school setting including students, educators, and counselors, as well as medical, law, and various other emergency service entities (Burandt et al., 1998). A significant portion of this simulation occurs on the campus of the participating high school to dramatize and reinforce among me student body the significance of an alcohol-related fatality.
The first day begins with an enactment of an alcohol-related motor-vehicle crash involving direct participants (student volunteers) in various stages of trauma including deceased passengers and the injured drunk driver. Law enforcement and emergency response follows (i.e., paramedics, state and local law enforcement officers, airand fire rescue) and includes the transporting of surviving passengers via ground and air to a local medical facility for emergency treatment while the deceased are taken to a local funeral home. The intoxicated driver is given a field sobriety test, arrested, and men delivered to the local juvenile detention center to await arraignment. During this rime, local and state enforcement agents are dispatched to the participating students' homes to notify parents that their son or daughter has been killed in an alcohol-related crash. The loss of life as a result of underage drinking and driving is dramatized throughout the day as a student or adult volunteer dressed as a Grim Reaper enters selected classrooms and removes a student volunteer to symbolize the number of persons killed by alcohol within a designated time interval. The reading of a obituary to the entire class immediately follows the student's departure. The student volunteers return to their individual classrooms and are identified as, "Living Dead." Their faces are covered in white makeup to reinforce the notion of death and finality of a life cut short as a result of alcohol. The Living Dead do not speak nor make eye contact with fellow students for the remainder of the day.
Direct student participants (usually numbering around twenty-five) attend an overnight retreat where the central focus is skill-building activities that promote andreinforce healthy behaviors and choices that reduce the likelihood of alcohol use. Other activities focus on team-building, task and goal completion, promoting alternative patterns of communication that include redirection, reinforcement of positive peer influence, leadership development and reflection, and reinforcement andstrengthening of familial relationships. Retreat activities use a mixed-method approach of interactive, video and personal presentations by a series of community, medical, and law enforcement personnel. These presentations include personal experience or knowledge-based topics regarding underage drinking and driving. Additional retreat activities stimulate youth leadership development that incorporates group discussions regarding personal power, identity, and the impact of drinkingand driving on both friends and family (Beer et al., 2002; Burandt et al., 1998).
On the second day, both direct participants and observers (students exposed to the living dead and mock crash) attend a school-wide assembly with a mock funeral anda series of presentations by various medical, and law enforcement personnel, students, parents, and educators. Supportive debriefing sessions are held afterwards for students, parents, and volunteers who are interested in talking about issues or topics that might have been raised as a result of their involvement in the program. An optional follow-up activity enacts a mock trial of the drunk driver involved in the simulated alcohol-related motor-vehicle crash (Burandt et al., 1998).