Ruth A Shults

• PhD, MPH
• Senior Epidemiologist at U.S. Department of Health and Human Services

Introduction Teen motor vehicle crash fatality rates differ by geographic location. Studies assessing teen transportation risk behaviors by location are inconclusive. Therefore, we explored the role of census region and metropolitan status for driving prevalence and four transportation risk behaviors among U.S. public high school students. Methods...

Background: We examined marijuana and alcohol use trends among drivers aged ≥16 years evaluated at Level I trauma centers before and after Arizona legalized medical marijuana in April 2011. Methods: We conducted interrupted time series (ITS) analysis of urine drug screens for marijuana metabolites and blood alcohol concentration (BAC) data from...

Objective: We examined alcohol and marijuana use among injured drivers aged 16–20 years evaluated at Arizona level 1 trauma centers during 2008–2014. Methods: Using data from the Arizona State Trauma Registry, we conducted a descriptive analysis of blood alcohol concentration (BAC) and qualitative test results (positive or negative) for delta-9-tet...

Purpose: Determine the prevalence and explore individual- and state-level factors associated with texting/emailing while driving (TWD) among adolescent drivers in the United States. Methods: Data from 35 states that administered the 2015 state Youth Risk Behavior Survey were analyzed. We used Poisson regression models with robust error variance...

Evidence-based information for nurses on the risks and benefits of prescription opioids.

Introduction: Ignition interlocks are effective in reducing alcohol-impaired driving recidivism for all offenders, including first-time offenders. Despite their effectiveness, interlock use among persons convicted of driving while intoxicated from alcohol (DWI) remains low. This cross-sectional survey of U.S. adults assessed public support for req...

Objective: Teens' crash risk is highest in the first years of independent driving. Circumstances surrounding fatal crashes have been widely documented, but less is known about factors related to nonfatal teen driver crashes. This study describes single vehicle nonfatal crashes involving the youngest teen drivers (15-17 years), compares these crash...

Introduction: The Monitoring the Future (MTF) survey provides nationally-representative annual estimates of licensure and driving patterns among U.S. teens. A previous study using MTF data reported substantial declines in the proportion of high school seniors that were licensed to drive and increases in the proportion of nondrivers following the r...

Context Motorcycle crashes account for a disproportionate number of motor vehicle deaths and injuries in the U.S. Motorcycle helmet use can lead to an estimated 42% reduction in risk for fatal injuries and a 69% reduction in risk for head injuries. However, helmet use in the U.S. has been declining and was at 60% in 2013. The current review examine...

Introduction: Parents play a critical role in preventing crashes among teens. Research of parental perceptions and concerns regarding teen driving safety is limited. We examined results from the 2013 Summer ConsumerStyles survey that queried parents about restrictions placed on their teen drivers, their perceived level of "worry" about their teen...

Fatal crash risk is higher at night for all drivers, but especially for young, inexperienced drivers (1). To help address the increased crash risk for beginner teen drivers, 49 states and the District of Columbia include a night driving restriction (NDR) in their Graduated Driver Licensing (GDL) system. NDRs have been shown to reduce crashes among...

Drinking and driving among adolescents and young adults remains a significant public health burden. Etiological research is needed to inform the development and selection of preventive interventions that might reduce alcohol-involved crashes and their tragic consequences. Youth assets—that is, skills, competencies, relationships, and opportunities—...

Objectives: We examined associations among race/ethnicity, socioeconomic factors and driving status in a nationally representative sample of >26,000 U.S. high school seniors. Methods: Weighted data from the 2012 and 2013 Monitoring the Future surveys were combined and analyzed. We imputed missing values using fully conditional specification mult...

Objective We examined the prevalence of and characteristics associated with drink-driving in China. We compared this study's drink-driving findings with those from the United States to explore how effective traffic safety interventions from Western cultures might be adapted for use in China.Methods Data from the 2010 China Chronic Disease and Risk...

Problem: Motor vehicle crashes kill more adolescents in the United States than any other cause, and often the teen is not wearing a seat belt. Methods: Using data from the 2011 Youth Risk Behavior Surveys from 38 states, we examined teens' self-reported seat belt use while riding as a passenger and identified individual characteristics and envir...

Alcohol-impaired driving crashes account for approximately one third of all crash fatalities in the United States. In 2013, 10,076 persons died in crashes in which at least one driver had a blood alcohol concentration (BAC) ≥0.08 grams per deciliter (g/dL), the legal limit for adult drivers in the United States. To estimate the prevalence, number o...

During 2004-2013, the number of passenger vehicle drivers aged 16-19 years involved in fatal crashes in the United States declined by 55% from 5,724 to 2,568.* In addition to graduated driver licensing (GDL) programs and safer vehicles,† other possible contributors to the decline include adolescents waiting longer to get their driver licenses and d...

Findings in published reports have suggested that drowsy driving is a factor each year in as many as 7,500 fatal motor vehicle crashes (approximately 25%) in the United States. CDC previously reported that, in 2009-2010, 4.2% of adult respondents in 19 states and the District of Columbia reported having fallen asleep while driving at least once dur...

Background National estimates of all-terrain vehicle (ATV) riding patterns among youth in the USA are lacking. Methods We analysed the 2011 YouthStyles survey to estimate the proportion of 12–17 year olds in the USA who had ridden an ATV at least once during the past 12 months and summarise their patterns of helmet use. Results Of the 831 youth res...

Approximately 1 in 5 child passenger deaths in the United States involves an alcohol-impaired driver, most commonly the child's own driver. The objective of this study was to document recent trends and state-specific rates of these deaths. A descriptive analysis of 2001-2010 Fatality Analysis Reporting System data for child passengers aged <15 year...

Publicized sobriety checkpoint programs deter alcohol-impaired driving by stopping drivers systematically to assess their alcohol impairment. Sobriety checkpoints were recommended in 2001 by the Community Preventive Services Task Force for reducing alcohol-impaired driving, based on strong evidence of effectiveness. Since the 2001 review, attention...

Objective: The objectives of this study were to estimate the prevalence of designated driving in the United States, compare these results with those from the 1996 National Roadside Survey, and explore the demographic, drinking, and trip characteristics of both designated drivers and their passengers. Methods: The data used were from the 2007 Nat...

Understanding the reasons for fluctuations in teenage driver crashes over time in the United States is clouded by the lack of information on licensure rates and driving exposure. We examined results from the Monitoring the Future survey to estimate the proportion of high school seniors who possessed a driver's license and the proportion of seniors...

OBJECTIVE: To estimate the numbers and rates of all-terrain vehicle (ATV)–related nonfatal injuries among riders aged #15 years treated in hospital emergency departments (EDs) in the United States during 2001–2010. METHODS: National Electronic Injury Surveillance System–All Injury Program data for 2001–2010 were analyzed. Numbers and rates of injur...

On November 5-7, 2002, the Symposium on Graduated Driver Licensing in Chatham, MA, brought together 75 researchers and practitioners from the United States, Canada, Australia, and New Zealand to document the current science of graduated driver licensing (GDL) and to outline research needs. Participants reviewed 12 background papers and discussed th...

Objective: To assess the prevalence of texting/e-mailing while driving (TWD) and association of TWD with other risky motor vehicle (MV) behaviors among US high school students. Methods: Data were used from the Centers for Disease Control and Prevention's 2011 national Youth Risk Behavior Survey, which assessed TWD during the 30 days before the s...

Motor vehicle crashes are the leading cause of death among teens in the United States. Graduated driver licensing (GDL) programs allow new drivers to gain driving experience while protecting them from high-risk situations. North Dakota was one of the last states to implement GDL, and the current program does not meet all of the best practice recomm...

Motor-vehicle crashes are a leading cause of death in the United States. Seatbelts are highly effective in preventing serious injury and death in the event of a crash. Not all states have primary enforcement of seatbelt laws. Data from the 2002, 2006, 2008, and 2010 Behavioral Risk Factor Surveillance System were used to calculate prevalence of sea...

Background Alcohol-impaired driving is a major contributor to motor vehicle crash deaths resulting in almost 270 000 deaths globally. In 2001, the Community Preventive Services Task Force recommended the use of sobriety checkpoints on the basis of a systematic review that showed sobriety checkpoints resulted in a median decline of about 20% in alco...

Background: Although every state prohibits persons aged <21 years from driving with any measurable amount of blood alcohol, many young persons still drink and drive. Additionally, fatal crash data indicate that most teen drivers with positive (>0.00%) blood alcohol concentrations (BACs) who are involved in fatal crashes have BACs ≥0.08%, the level...

Ignition interlocks are effective in reducing recidivism among driving while intoxicated (DWI) offenders while installed on their vehicles. However, the devices are not widely used in the USA. This survey gauged public support for requiring ignition interlocks for all convicted DWI offenders including first-time offenders. 69% of respondents suppor...

Alcohol-impaired driving caused 10,839 deaths in 2009. Alcohol-impaired driving fatalities as a percentage of all motor vehicle fatalities decreased from 1982 to 1999 but have remained stable since. Understanding characteristics of those who engage in this behavior is critical to achieving future reductions. The purpose of this study is to estimate...

The objective of this study was to provide a contemporary analysis of the alcohol-impaired driving problem among 16- to 17-year-olds and to consider the potential role of night and passenger restrictions in dealing with the alcohol problem by determining how many of the alcohol-related crashes take place at night or with passengers. The data were d...

In 2000, the USDHHS released Healthy People 2010 (HP2010), a series of disease prevention and health promotion objectives for the nation. Thirty-nine of these objectives were dedicated to injury prevention and six of these objectives related to adolescents, who were tracked through CDC's National Youth Risk Behavior Survey (YRBS). This paper uses n...

A systematic review of the literature to assess the effectiveness of ignition interlocks for reducing alcohol-impaired driving and alcohol-related crashes was conducted for the Guide to Community Preventive Services (Community Guide). Because one of the primary research issues of interest--the degree to which the installation of interlocks in offen...

The objective of the study was to compare national and state-level estimates of self-reported and observed seatbelt use for 2008. Self-reported seatbelt use from the 2008 Behavioral Risk Factor Surveillance System was compared with 2008 observed seatbelt use published by the National Highway Traffic Safety Administration. The ratio of self-reported...

The United States (US) Centers for Disease Control and Prevention (CDC), and key partners conducted a systematic review of the effectiveness of 0.08% blood alcohol concentration (BAC) laws on alcohol-related traffic mortality. Review findings of strong evidence of effectiveness were presented by partners during US Congressional hearings contributin...

We determined the proportion of all fatal crashes of 16- and 17-year-old drivers that involved the presence of teenage passengers from 2004 to 2008. Data on fatal crashes of 16- and 17-year-old drivers were derived from the Fatality Analysis Reporting System for the years 2004-2008. For both 16- and 17-year-old drivers, in each of the 5 years exami...

Background Alcohol-impaired driving crashes claim about 13 000 lives each year in the United States.Objective We estimated the prevalence of alcohol-impaired driving (AID) among adults using 2006 and 2008 data from the Behavioural Risk Factor Surveillance System (BRFSS).MethodsAID was assessed by asking, during the past 30 days, that is since ____,...

This case study examines the translation of evidence on the effectiveness of laws to reduce the blood alcohol concentration (BAC) of drivers into policy. It was reconstructed through discussions among individuals involved in the processes as well as a review of documentation and feedback on oral presentations. The Centers for Disease Control and Pr...

The evolution of graduated licensing systems in the past 25 years has resulted in dramatic growth in research on this topic. The most recent summary reports have covered the period up to 2007. In the present article more recent and ongoing research is categorized, summarized, and discussed.

Motor-vehicle crashes are a leading cause of death in the United States. In the event of a crash, seat belts are highly effective in preventing serious injury and death. Data from the 2006 Behavioral Risk Factor Surveillance System were used to calculate prevalence of seat belt use by state and territory and by type of state seat belt law (primary...

A systematic review was conducted to determine the effectiveness and economic efficiency of multicomponent programs with community mobilization for reducing alcohol-impaired driving. The review was conducted for the Guide to Community Preventive Services (Community Guide). Six studies of programs qualified for the review. Programs addressed a wide...

Alcohol-related emergency department (ED) that presents an opportunity to intervene to prevent future alcohol-related problems among adolescents and adults has been reported. The single greatest contributor to alcohol related mortality in the United States is unintentional injury, accounting for approximately 26,000 deaths per year and placing a su...

Seventy percent of unintentional injury-related fatalities--the leading cause of death among youth in the United States--are motor vehicle traffic related. Examining traffic-related safety, therefore, is crucial to public health. This study examines trends in traffic safety issues among US high school students: helmet use while riding a bicycle, se...

Alcohol-impaired driving (AID) continues to be a major public health problem in the U.S. The objective of this study was to estimate the number of annual driver- and passenger-reported episodes of AID and explore the effect of sociodemographic characteristics and drinking patterns on both behaviors. Data from a nationally representative random-digi...

This article summarizes what is known about trafffic injury and alcohol-impaired driving, and suggests evidence-based interventions to reduce impaired driving and to reduce traffic injuries that result from alcohol-impaired and drug-impaired driving

Alcohol-related motor vehicle crashes kill approximately 17,000 Americans annually and were associated with more than $51 billion in total costs in 2000. Relatively little is known about the drinking patterns of alcohol-impaired (AI) drivers in the United States. 2006 Behavioral Risk Factor Surveillance System (BRFSS) was analyzed for alcohol consu...

In 2004, more than 180,000 child passengers aged <or=12 years sought care in U.S. hospital emergency departments (EDs) for injuries sustained in motor-vehicle crashes (MVCs). We expanded the National Electronic Injury Surveillance System-All Injury Program for 635 injured children aged <or=12 years treated at 15 hospital EDs in 2004 by collecting m...

secondary enforcement laws (police may issue a safety belt citation only if the vehicle has been stopped for another reason). We analyzed 2002 Behavioral Risk Factor Surveillance System data from 50 states and the District of Columbia. We performed multivariable, log-linear regression analyses to assess the effect of sociodemographic characteristic...

Motor-vehicle-related deaths and injuries take a heavy toll on health in the United States, and motor vehicle crashes result in more than 40,000 deaths and more than three million nonfatal injuries each year. They are the leading cause of death among children, youth, and young adults (Centers for Disease Control and Prevention [CDC], 2005). Motor-...

This is the third update of research on graduated driver licensing (GDL) and related teenage driver issues. It briefly summarizes research published since or not included in the 2005 update (Hedlund, J., & Compton, R. (2005). Graduated driver licensing research in 2004 and 2005. Journal of Safety Research, 36(2), 109-119.), describes research in pr...

All-terrain vehicles (ATVs) have gained in popularity in recent years, and this rise in use has been accompanied by increases in the number of ATV-related injuries. Because children often lack the physical strength, cognitive abilities, and fine motor skills to operate ATVs properly, their risk for injury is greater. Furthermore, most children ride...

A systematic review of the literature to assess the effectiveness of school-based programs for reducing drinking and driving and riding with drinking drivers was conducted for The Guide to Community Preventive Services (Community Guide). Thirteen peer reviewed papers or technical reports, which met specified quality criteria and included evaluation...

Motor vehicle-related injury is the leading cause of death in the United States for people aged 1 to 34 years. In 2002, 17,419 (41%) of 42,815 traffic deaths were alcohol related. To estimate trends in alcohol-impaired driving among U.S. adults from 1993 through 2002. The Behavioral Risk Factor Surveillance System, a random-digit telephone survey o...

The purpose of this study was to determine the prevalence of counseling to wear seat belts during pregnancy and seat belt use among women of reproductive age. Self-reported data from 2 population-based surveys were used to examine counseling to wear seat belts during pregnancy and seat belt use among reproductive-aged women. The prevalence of couns...

A systematic review of the effectiveness of mass media campaigns for reducing alcohol-impaired driving (AID) and alcohol-related crashes was conducted for the Guide to Community Preventive Services (Community Guide). In eight studies that met quality criteria for inclusion in the review, the median decrease in alcohol-related crashes resulting from...

A recent systematic literature review found that primary enforcement laws are more effective at increasing seat belt use than secondary laws in the United States. This report re-examines the studies included in the systematic review to explore whether the benefits of a primary law differ based on: (1) the baseline seat belt use rate; or (2) whether...

Data from a large, nationally representative sample of hospital emergency departments (EDs) were used to assess the prevalence and characteristics of alcohol-related ED visits among people ages 13 to 25 years in the United States. Emergency department visits recorded in the National Electronic Injury Surveillance System-All Injury Program were code...

Little population-based information exists about the long-term effects of motor-vehicle crash-related injuries. We analyzed data from the 1995 National Health Interview Survey Disability (NHIS-D) Supplement to estimate the prevalence of crash-related disability among noninstitutionalized U.S. adults aged 18 years and older. More than 1.2 million ad...

The use of safety belts is the single most effective means of reducing fatal and nonfatal injuries in motor-vehicle crashes. This paper summarizes the systematic reviews of two interventions to increase safety belt use: primary enforcement safety belt laws and enhanced enforcement of safety belt laws. The reviews were previously published in the Am...

On November 13-14, 2003, a symposium on high-visibility safety belt use enforcement in Raleigh, NC: (a) celebrated the 10th anniversary of North Carolina's Click It or Ticket program; (b) documented current knowledge regarding safety belt use; (c) proposed strategies to increase use further; and (d) discussed research to support these strategies.

On November 5-7, 2002, the Symposium on Graduated Driver Licensing in Chatham, MA, brought together 75 researchers and practitioners from the United States, Canada, Australia, and New Zealand to document the current science of graduated driver licensing (GDL) and to outline research needs. Participants reviewed 12 background papers and discussed th...

The goal of sobriety checkpoints is to deter drinking and driving by systematically stopping drivers for assessment of alcohol impairment, thus increasing the perceived risk of arrest for alcohol-impaired driving. This review examines the effectiveness of random breath testing (RBT) checkpoints, at which all drivers stopped are given breath tests f...

In 1999, alcohol related motor vehicle crashes in the United States claimed 15786 lives and injured more than 300000 persons. Drinking and driving behavior is shaped by individual and environmental level influences. In this study, the association between each state's driving under the influence of alcohol (DUI) countermeasures and self reported alc...

Motor vehicle occupant injury prevention is included in the Guide to Community Preventive Services because of the enormous health impact of these largely preventable injuries. This article describes the methods for conducting systematic literature reviews of interventions for three key injury prevention strategies: increasing child safety seat use,...

The use of safety belts is the single most effective means of reducing fatal and nonfatal injuries in motor vehicle crashes. If all motor vehicle occupants consistently wore safety belts, an estimated 9553 deaths would have been prevented in 1999 alone. The Guide to Community Preventive Services's methods for systematic reviews were used to evaluat...

Alcohol-related motor vehicle crashes are a major public health problem, resulting in 15,786 deaths and more than 300,000 injuries in 1999. This report presents the results of systematic reviews of the effectiveness and economic efficiency of selected population-based interventions to reduce alcohol-impaired driving. The Guide to Community Preventi...

To examine national trends in transportation-related injury risk and safety behaviors among U.S. high school students. To examine secular trends in riding with a driver who had been drinking, driving after drinking, and using seat belts, bicycle helmets, and motorcycle helmets, we used logistic regression to analyze data from national Youth Risk Be...

We examined the effects of short interpregnancy intervals on small-for-gestational age and preterm births in a biracial population using North Carolina birth certificate data from 1988 to 1994. We defined small-for-gestational age birth as being below the 10th percentile on a race-, sex-, and parity-specific growth curve after a gestation of 37-42...

Seventy percent of U.S. residential fire deaths occur in homes without a working smoke detector. To help prevent residential fire deaths, many programs have distributed or installed detectors in unprotected homes. Because persons receiving a detector may not install it and because detector batteries require annual replacement, the enduring effectiv...

Aerosolized ribavirin is administered frequently to treat severe respiratory syncytial virus infections. The drug's potential reproductive effects in occupationally exposed workers remains a concern among health care workers. In this evaluation, we measured urinary ribavirin concentrations in occupationally exposed health care workers. Ribavirin wa...

In response to a confidential request from employees at Boise Cascade, Timber and Wood Products Division, Kettle Falls, Washington, an evaluation was conducted of exposure to fly ash and smoke emissions from veneer dryers at the facility and around two fluidized bed combustors located adjacent to the site. A case of manganese poisoning had been rep...

The National Institute for Occupational Safety and Health (NIOSH) Division of Surveillance, Hazard Evaluations and Field Studies (DSHEFS) conducts investigations of health hazards in the workplace under the NIOSH Health Hazard Evaluation (HHE) program. In September 1990, the International Association of Fire Fighters (IAFF) requested that NIOSH ass...

On the basis of evidence from animal studies, polychlorinated biphenyls (PCBs) are considered potentially carcinogenic to humans. However, the results of studies in human populations exposed to PCBs have been inconsistent. The authors conducted a retrospective cohort analysis (1957-1986) comparing the mortality of 3,588 electrical capacitor manufac...