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Cost-Benefit Analysis of an Alcohol Ignition Interlock for Installation in all Newly Registered Vehicles
Abstract
This study conducted a cost-benefit analysis of an alcohol ignition interlock device in preventing alcohol-related fatalities and serious injuries when installed in all newly registered vehicles in Australia.
Benefit-cost ratios (BCRs) were calculated by comparing the benefits associated with the number of road injuries the interlock was predicted to save with the costs associated with installing the device in all newly registered vehicles. Four effectiveness levels were assumed for the interlock, given that the device was not expected to prevent 100 percent of alcohol-impaired driving. Unit benefits were computed for 4, 5, and 7 percent discount rates, and for fleet life periods of 15 and 25 years. ANALYSIS AND RESULTS: The BCRs ranged from 3.4:1 at best to 0.6:1, depending on the interlock effectiveness level, the discount rate, and the fleet life figure applied. It was estimated that the interlock could prevent between 97 (at the lowest effectiveness level of 23.8%) and 388 (at the highest effectiveness level of 95%) road fatalities per annum, with the corresponding range for serious injuries being 603 to 2414 casualties.
It was recommended that the installation of interlock devices in all newly registered vehicles in Australia could be an effective option, from a cost-benefit analysis perspective, depending upon its level of success in preventing alcohol-impaired driving. Therefore, although this primary prevention strategy is likely to obtain lower BCRs than targeting groups who are overrepresented in alcohol-related road crashes, a substantial number of road fatalities and serious injuries would be prevented, with up to 24 percent of all fatalities and up to 11 percent of all serious injuries saved in Australia per annum. Overall, it was concluded that due to the investigated interlock's user friendliness and relative affordability in comparison to other interlocks, the device should be considered as a countermeasure for curbing the drink driving problem in Australia.
... Unlicensed driving is a serious and multi-faceted problem in Australia, as people who illegally operate motor vehicles on the roads pose a greater risk to other legitimate drivers due to a higher crash rate [1]. More specifically, unlicensed drivers are also overrepresented in severe crashes [2], single vehicle crashes and those that involve non-traffic control [3]. Previous research has also linked unlicensed driving with recreational road use and drink-driving [4]. ...
... The BCR evaluation method used on this study is similar to the one found in papers like [2][3][4]13], and build up on the utilisation of the HARM estimates. The HARM method is particularly useful for assessing the injury mitigation effect of countermeasures installed in vehicles [2]. ...
... The BCR evaluation method used on this study is similar to the one found in papers like [2][3][4]13], and build up on the utilisation of the HARM estimates. The HARM method is particularly useful for assessing the injury mitigation effect of countermeasures installed in vehicles [2]. The BCR evaluation takes the annual HARM reduction that one can expect from implementing an EDLI and spread it over a certain period of time, then compare it to the costs associated with implementing such system. ...
Unlicensed driving is a serious problem in many Australian states, with unlicensed driving-related crashes (UDC) costing up to $304 million per year in Queensland, and $176 million in Victoria. In this paper, we present a Benefit-Cost Ratio (BCR) analysis of a set of Intelligent Transportation Systems technologies aimed at preventing unlicensed driving by verifying the driver’s identity through biometric technology, as well as the validity of their licence. Utilised together, the technology would essentially take the form of a licence interlock. The goal of this program of research (from which this paper stems) was to provide preliminary recommendations as to which technology is the most beneficial and should be implemented as part of a government-led program increasing the functionalities of electronic driving licences (EDL). The corresponding BCR analysis revealed that fingerprints and finger vascular patterns recognition technologies were found to systematically have the best BCRs. In regard to the most effective manner to implement the technology, a corresponding investigation with five scenarios revealed that the greatest benefits would be achieved with: (a) a mandatory system for all banned drivers (e.g., suspensions & disqualifications), and (b) a mandatory system for banned drivers under the age of 21 only. Scenario (b) performs extremely well, with returns of up to 16 times the investment with a simple fingerprint-based interlock. Although often more modest, all systems were found to have BCRs above 1 in all of the implementation scenarios except one. This paper further outlines the findings in regard to addressing the significant problem of unlicensed driving via emerging technologies.
... Deux analyses bénéfices-coûts ont été recensées et elles permettent d'évaluer l'impact de l'implantation universelle d'AE dans les véhicules motorisés destinés à l'ensemble de la population. La première étude a été menée à l'aide de données australiennes (Lahausse & Fildes, 2009 ...
... Bien que d'autres évaluations soient nécessaires, l'exemple suédois montre que l'AE peut prévenir la CFA auprès de conducteurs professionnels et que ces derniers ne semblent pas expérimenté d'inconvénient suite à l'installation du dispositif sur leur véhicule (Bjerre, 2005). Les analyses bénéfices-coûts montrent également qu'une utilisation accrue de l'AE au sein des véhicules diminue les coûts y étant associés tout en augmentant les bénéfices (Lahausse & Fildes, 2009;Vlakveld, Wesemann, Devillers, Elvik, & Veisten, 2005). De nouvelles études doivent toutefois être réalisées, notamment afin de développer des dispositifs passifs et moins intrusifs. ...
... Lorsque les technologies passives et nonintrusives seront disponibles, l'AE pourrait devenir obligatoire pour tous les nouveaux véhicules. Des études basées sur des scénarios montrent que l'installation obligatoire de l'AE sur tous les nouveaux véhicules serait suivie d'une baisse marquée des collisions liées à l'alcool et que les bénéfices dépasseraient largement les coûts (ETSC, 2014;Lahausse & Fildes, 2009). ...
Messages clés
La conduite avec les facultés affaiblies par l’alcool est la première cause de décès sur les routes du Québec.
Le pourcentage de conducteurs décédés avec une alcoolémie supérieure à la limite permise stagne autour de 30 % depuis le début des années 2000.
Une synthèse systématique a été menée afin d’estimer l’effet des programmes d’antidémarreur éthylométrique sur la conduite avec les facultés affaiblies et les collisions. Les principaux résultats sont les suivants :
La participation à un programme d’antidémarreur éthylométrique réduit significativement le risque de récidive, tant chez les contrevenants primaires que chez les récidivistes.
Une fois que l’antidémarreur éthylométrique est retiré du véhicule, le risque de récidive revient à un niveau comparable à celui des participants du groupe témoin. Cet effet est indépendant des critères d’admission (ex. : avoir purgé une partie de la période d’interdiction de conduire) ou autres mesures (ex. : traitements, suivis médicaux ou programmes éducatifs) ajoutés au programme.
En raison du nombre insuffisant d’études, il est impossible de conclure avec certitude quant à l’effet de l’antidémarreur éthylométrique sur le risque de collision.
Une seule évaluation a été menée sur une population de non-contrevenants. Il est donc impossible de conclure quant à l’effet de l’antidémarreur éthylométrique sur ce type de population.
Afin de maximiser l’effet préventif de l’antidémarreur éthylométrique, ce dernier devrait être offert à un nombre plus important de contrevenants de l’alcool au volant. Plus précisément, l’antidémarreur éthylométrique devrait être offert de façon systématique dès une première infraction et devrait être imposé à vie aux récidivistes.
Éventuellement, l’antidémarreur éthylométrique devrait devenir un équipement standard sur tous les véhicules automobiles. À cet effet, des projets pilotes pourraient être réalisés au sein de flottes de véhicules publics et commerciaux.
... Device cost was estimated at $400 based on previous literature estimates. 18,29 We tested the benefit per equipped vehicle curve at varying levels of interlock efficacy, using the assumption that if an interlock device worked 95% of the time, it would succeed in preventing 95% of preventable AI-MVCs. After adjusting to create a nationally weighted sample, this corresponded to 1 934 013 drinking drivers associated with nonfatal injuries. ...
... NHTSA previously showed that the installation ($100---$250) and monthly costs for monitoring ($65---90) were cost effective for multiple DWI offenders compared with costs associated with incarceration or electronic monitoring. 18 Using a $400 estimated cost from previous cost effectiveness analyses, 29 we found that the financial benefit realized by preventing injury-related costs outweighed the device costs after 3 years of mandatory interlock installation in all new vehicles. Lahausse and Fildes 29 previously conducted a cost---benefit analysis of installing interlocks in all newly registered vehicles in Australia, and found that at optimal effectiveness (approximately 95%), such a primary prevention program would be cost effective. ...
... However, they also found that the benefit dissipated as device effectiveness decreased below optimal levels. 29 Similarly, we found that as the optimal effectiveness decreases, the time to recoup the program costs lengthened, with more than 15 years required as device effectiveness diminished to less than 25%. Taken together, this suggests that the introduction of a mandatory US interlock program would be cost effective, but that the technology needs to be optimized before installation in all new vehicles and might require regular evaluations to ensure the devices are kept at peak effectiveness levels. ...
We estimated the injury prevention impact and cost savings associated with alcohol interlock installation in all new US vehicles.
We identified fatal and nonfatal injuries associated with drinking driver vehicle crashes from the Fatality Analysis Reporting System and National Automotive Sampling System's General Estimates System data sets (2006-2010). We derived the estimated impact of universal interlock installation using an estimate of the proportion of alcohol-related crashes that were preventable in vehicles < 1 year-old. We repeated this analysis for each subsequent year, assuming a 15-year implementation. We applied existing crash-induced injury cost metrics to approximate economic savings, and we used a sensitivity analysis to examine results with varying device effectiveness.
Over 15 years, 85% of crash fatalities (> 59 000) and 84% to 88% of nonfatal injuries (> 1.25 million) attributed to drinking drivers would be prevented, saving an estimated $342 billion in injury-related costs, with the greatest injury and cost benefit realized among recently legal drinking drivers. Cost savings outweighed installation costs after 3 years, with the policy remaining cost effective provided device effectiveness remained above approximately 25%.
Alcohol interlock installation in all new vehicles is likely a cost-effective primary prevention policy that will substantially reduce alcohol-involved crash fatalities and injuries, especially among young vulnerable drivers. (Am J Public Health. Published online ahead of print March 19, 2015: e1-e8. doi:10.2105/AJPH.2014.302445).
... 15,16 Interlocks have been shown to reduce drunk-driving recidivism by 50% to 90% while installed. 8,13,[17][18][19][20][21][22] However, past research has focused on recidivist arrests. To our knowledge, no studies have reported injuries or deaths as outcomes, and only 3 studies have assessed the impact of interlocks on crashes. ...
... 15,21 The other 2 studies found decreases in some types of crashes among interlocked drivers, but increases in others. 23,24 Interlock devices should prevent crashes by preventing intoxicated driving, and it has been estimated that installing ignition interlocks on all new vehicles could reduce drunk-driving fatalities by 85%, 14,18 but their effectiveness is not well established. Moreover, even if the devices themselves prevent crashes, challenges in implementation, enforcement, and monitoring could limit the impact of state interlock programs. ...
Objectives:
To investigate the impact on alcohol-involved crash deaths of universal ignition interlock requirements, which aim to prevent people convicted of driving under the influence of alcohol from driving while intoxicated.
Methods:
We used data from the National Highway Traffic Safety Administration for 1999 to 2013. From 2004 to 2013, 18 states made interlocks mandatory for all drunk-driving convictions. We compared alcohol-involved crash deaths between 18 states with and 32 states without universal interlock requirements, accounting for state and year effects, and for clustering within states.
Results:
Policy impact was apparent 3 years after implementation. The adjusted rate of alcohol-involved crash deaths was 4.7 (95% confidence interval [CI] = 4.0, 5.4) per 100 000 in states with the universal interlock requirement, compared with 5.5 (95% CI = 5.48, 5.53) in states without, an absolute reduction of 0.8 (95% CI = 0.1, 1.5) deaths per 100 000 per year.
Conclusions:
Requiring ignition interlocks for all drunk-driving convictions was associated with 15% fewer alcohol-involved crash deaths, compared with states with less-stringent requirements. Interlocks are a life-saving technology that merit wider use. (Am J Public Health. Published online ahead of print March 17, 2016: e1-e7. doi:10.2105/AJPH.2016.303058).
... Zo vereist het toestel op vooraf ingestelde intervallen een nieuw negatief ademstaal zodat het niet mogelijk is om een andere persoon dan de bestuurder zelf in dit toestel te laten blazen. De toestellen beschikken tevens over zogenaamde ademhandtekeningen die geen valse stalen zullen toelaten en enkel menselijke adem die niet op voorhand gefilterd of gealtereerd is zullen aanvaarden (3,5,6,7). ...
... Zo kan ingesteld worden dat de motor gedurende 10 minuten niet zal starten na 3 verschillende gefaalde testen. Dit tijdsinterval zal verlengen naarmate meerdere pogingen falen (3,5,6,7). ...
De toepassing van alcohol ontstekingsinterlocksystemen beter bekend als alcoholsloten is in opmars in de Westerse wereld alsook bij ons in België. De vraag is of deze systemen het doel bereiken waarvoor ze ontworpen zijn: namelijk een vermindering van het aantal verkeersongevallen en –slachtoffers door een daling van de recidivismegraad van rijden onder invloed (ROI). Om hier een bevestigend antwoord op te geven is verder onderzoek in de vorm van gerandomiseerde gecontroleerde studies noodzakelijk. De resultaten beschikbaar op dit moment tonen dat dit systeem in staat is een daling van het ROI te bewerkstelligen wanneer het toestel aanwezig is in de wagen; echter na verwijdering wordt geen langdurig effect gezien en hervallen de meeste overtreders. De combinatie met een omkaderingsprogramma zou wel in staat zijn een gedragsverandering te bereiken en zo ook een effect op lange termijn bewerkstelligen. Het is echter bijzonder moeilijk om een statistisch significant verschil aan te tonen en extrapolatie toe te laten gezien de lage participatiegraad van de overtreders, de selectiebias aanwezig in niet gerandomiseerde studies en het aantal geobserveerde dropouts.
Een alcoholslot heeft mogelijkheden in de aanpak van ROI. Om dit effect aan te tonen dient het op grotere schaal geïmplementeerd en geëvalueerd te worden. Op heden kan besloten worden dat dit middel effectief is in de preventie van ROI zolang het aanwezig is in het voertuig. Het heeft als belangrijk voordeel dat het overtreders niet limiteert in hun professionele en sociale activiteiten. Bovendien kan een positieve gedragsverandering met effect op lange termijn verwacht worden indien het geïmplementeerd wordt in combinatie met de reeds bestaande hulpprogramma’
... Breathalyzers have been available since the 1950s and for the last couple of decades have been available as hand held devices and as ignition interlocks in cars [5]. These devices require the driver to breath into the device and it then measures the drivers blood alcohol and can prevent the car from starting with the blood alcohol content is too high [6]. When installed in vehicles the breathalyzer is a deterrent but it will also pick up alcohol in the air from other passengers. ...
... This translates to at least 5,000 deaths that could have been prevented in 2016 if all drivers had driven sober (ETSC 2019). Finally, an Australian study (Lahausse et al. 2009) estimated that between 97-388 lives could be saved, and 603-2424 casualties could be avoided every year if the technology were installed in all new registered vehicles. ...
ABSTRACT
Introduction: Crashes involving drinking drivers represent as much as one-third of all fatal crashes around the world. Progress has been made in reducing this toll through a series of interventions that attempt to discourage driving while intoxicated (DWI) and reoffending among drivers who have been convicted of DWI. However, these approaches cannot eliminate the problem. In-vehicle technologies are being developed, such as the Driver Alcohol Detection System for Safety—commonly referred to as DADSS—that have the potential to prevent alcohol-impaired drivers from driving their vehicles. DADSS in-vehicle sensors are designed to quickly detect whether drivers have been drinking and accurately and precisely measure blood or breath alcohol concentration. If the driver’s alcohol concentration measures at or above a set limit, the vehicle will be prevented
from moving.
Method: The DADSS technology is expected to be ready for real-world applications in the next few years. The implementation of this technology in vehicles promises to prevent thousands of deaths and injuries every year. This paper investigates approaches that have been used in various countries to accelerate the deployment of innovative vehicle safety technologies beginning with its initial implementation in vehicles through to its more widespread use.
Results: Various approaches were identified that can smooth and accelerate the deployment of in-vehicle alcohol detection devices. Recommendations are made regarding the most promising approaches to use initially and over time, as the body of evidence regarding their effectiveness grows.
Conclusions: This paper provides guidelines for how best to stimulate the widespread adoption of in-vehicle alcohol-detection technology as a preventive measure so that its life-saving potential can be realized both in the United States and in other countries that may be open to the implementation of DADSS.
... An ALCOLOCK policy was observed to reduce recidivism, even for low-frequency users, 8,47 and a cost-benefit analysis in Australia supported its universal use. 48 However, in this study, ALCOLOCK was adopted by only a few high-income countries. This study suggests that comprehensive preemptive measures should be advocated in order to prevent drinking and driving, particularly in low-income countries and countries with risky drinking patterns. ...
Introduction:
Effective drunk-driving policies are not adopted consistently in many countries. To understand how drinking behaviors influence national drunk-driving policymaking, the associations between drunk-driving policies and country-level drinking volumes and patterns were examined.
Methods:
Data for 194 countries were obtained from the WHO 2012 Global Information System on Alcohol and Health. Country-level drinking behaviors were measured using average drinking volumes and patterns of drinking scores based on six attributes of risky drinking. Drunk-driving policies were categorized into preemptive measures (random breath testing, breath alcohol concentration limits for driving a vehicle, and sobriety checkpoints), penalties (community service, short- or long-term detention, fines, suspension or revocation of license, and vehicle impoundment), mandatory treatment, and ignition interlock. Data analysis was conducted in 2017. The percentages of each policy adoption were examined in countries with different drinking behaviors. The internal consistencies of preemptive measures were calculated using Cronbach's α. A structural equation model was established to examine the associations between drinking behaviors and drunk-driving policy categories, after adjusting for national income levels and general alcohol policies.
Results:
Mandatory treatment and preemptive measures were less commonly adopted than penalties were. The adoption of preemptive measures had a low consistency level, and the consistency level decreased with drinking pattern riskiness. Risky drinking patterns were negatively associated with mandatory treatment policy.
Conclusions:
Drinking patterns are associated with national drunk-driving policymaking. Accessible medical treatment and comprehensive preemptive measures should be advocated in countries with risky drinking patterns.
... Additionally, the identified ROI study [70] was reported as a cost-benefit analysis; however, the benefits considered were solely cost-savings and not monetised health, or other, benefits, therefore was not considered a true CBA by our definition [17]. CBA that either consider only cost-savings or very narrow benefits such as avoided fatalities (with no consideration of morbidity or quality of life) have been reported for policies and interventions that would be relevant to alcohol prevention and general public health in other sectors, such as transport economics [71,72]. Whilst it is noteworthy that CBA is a respected method of economic evaluation in these sectors, and provides scope for its use within alcohol prevention public health, decision-makers should be mindful of whether CBA accurately reflect all the relevant costs and benefits associated with an intervention. ...
Public health interventions have unique characteristics compared to health technologies, which present additional challenges for economic evaluation (EE). High quality EEs that are able to address the particular methodological challenges are important for public health decision-makers. In England, they are even more pertinent given the transition of public health responsibilities in 2013 from the National Health Service to local government authorities where new agents are shaping policy decisions.
Addressing alcohol misuse is a globally prioritised public health issue. This article provides a systematic review of EE and priority-setting studies for interventions to prevent and reduce alcohol misuse published internationally over the past decade (2006–2016). This review appraises the EE and priority-setting evidence to establish whether it is sufficient to meet the informational needs of public health decision-makers.
619 studies were identified via database searches. 7 additional studies were identified via hand searching journals, grey literature and reference lists. 27 met inclusion criteria. Methods identified included cost-utility analysis (18), cost-effectiveness analysis (6), cost-benefit analysis (CBA) (1), cost-consequence analysis (CCA) (1) and return-on-investment (1). The review identified a lack of consideration of methodological challenges associated with evaluating public health interventions and limited use of methods such as CBA and CCA which have been recommended as potentially useful for EE in public health. No studies using other specific priority-setting tools were identified.
... An Australian cost-benefit analysis estimated that ignition interlocks could prevent between approximately 100 to 400 road fatalities and approximately 600 to 2,500 serious injuries per year, with a range in benefit-cost ratios of 0.6:1 to 3.4:1 depending on the effectiveness level, discount rate and economic life of the vehicle figure applied (368). ...
Alcohol is a prominent commodity in the UK marketplace. It is widely used in numerous social situations. For many, alcohol is associated with positive aspects of life; however there are currently over 10 million people drinking at levels which increase their risk of health harm. Among those aged 15 to 49 in England, alcohol is now the leading risk factor for ill-health, early mortality and disability and the fifth leading risk factor for ill health across all age groups.
Since 1980, sales of alcohol in England and Wales have increased by 42%, from roughly 400 million litres in the early 1980s, with a peak at 567 million litres in 2008, and a subsequent decline. This growth has been driven by increased consumption among women, a shift to higher strength products, and increasing affordability of alcohol, particularly through the 1980s and 1990s. Over this period, the way in which alcohol is sold and consumed also changed. In 2016 there were 210,000 licensed premises in England and Wales, a 4% increase on 2010. There has been a shift in drinking location such that most alcohol is now bought from shops and drunk at home. Although consumption has declined in recent years, levels of abstinence have also
increased. Consequently, it is unclear how much of the decline is actually related to drinkers consuming less alcohol and how much to an increasing proportion of the population not drinking at all.
In recent years, many indicators of alcohol-related harm have increased. There are now over 1 million hospital admissions relating to alcohol each year, half of which occur in the lowest three socioeconomic deciles. Alcohol-related mortality has also increased, particularly for liver disease which has seen a 400% increase since 1970, and this trend is in stark contrast to much of Western Europe. In England, the average age at
death of those dying from an alcohol-specific cause is 54.3 years. The average age of death from all causes is 77.6 years. More working years of life are lost in England as a result of alcohol-related deaths than from cancer of the lung, bronchus, trachea, colon, rectum, brain, pancreas, skin, ovary, kidney, stomach, bladder and prostate, combined.
Despite this burden of harm, some positive trends have emerged over this period, particularly indicators which relate to alcohol consumption among those aged less than 18 years, and there have been steady reductions in alcohol-related road traffic crashes.
The public health burden of alcohol is wide ranging, relating to health, social or economic harms. These can be tangible, direct costs (including costs to the health, criminal justice and welfare systems), or indirect costs (including the costs of lost productivity due to absenteeism, unemployment, decreased output or lost working
years due to premature pension or death). Harms can also be intangible, and difficult to cost, including those assigned to pain and suffering, poor quality of life or the emotional distress caused by living with a heavy drinker. The spectrum of harm ranges from those that are relatively mild, such as drinkers loitering near residential streets, through to those that are severe, including death or lifelong disability. Many of these harms impact upon other people, including relationship partners, children, relatives, friends, coworkers
and strangers.
In sum, the economic burden of alcohol is substantial, with estimates placing the annual cost to be between 1.3% and 2.7% of annual GDP. Few studies report costs on the magnitude of harm to people other than the drinker, so the economic burden of alcohol consumption is generally underestimated. Crucially, the financial burden which alcohol-related harm places on society is not reflected in its market price, with taxpayers picking up a larger amount of the overall cost compared to the individual drinkers. This should provide impetus for governments to implement effective policies to reduce the public health impact of alcohol, not only because it is an intrinsically desirable societal goal, but because it is an important aspect of economic growth and competitiveness.
Reflecting three key influencers of alcohol consumption – price (affordability), ease of purchase (availability) and the social norms around its consumption (acceptability) – an extensive array of policies have been developed with the primary aim of reducing the public health burden of alcohol. The present review evaluates the effectiveness and cost-effectiveness of each of these policy approaches.
... Ignition interlocks reduce reoff ending in both fi rst-time and repeat off enders and can be costeff ective. [192][193][194] If the device is uninstalled, reoff ending rates return to those recorded before installation. ...
This paper reviews the evidence for the effectiveness and cost-effectiveness of policies to reduce alcohol-related harm. Policies focus on price, marketing, availability, information and education, the drinking environment, drink-driving, and brief interventions and treatment. Although there is variability in research design and measured outcomes, evidence supports the effectiveness and cost-effectiveness of policies that address affordability and marketing. An adequate reduction in temporal availability, particularly late night on-sale availability, is effective and cost-effective. Individually-directed interventions delivered to at-risk drinkers and enforced legislative measures are also effective.
Providing information and education increases awareness, but is not suffi cient to produce long-lasting changes in
behaviour. At best, interventions enacted in and around the drinking environment lead to small reductions in acute
alcohol-related harm. Overall, there is a rich evidence base to support the decisions of policy makers in implementing
the most eff ective and cost-eff ective policies to reduce alcohol-related harm
... Transportstyrelsen (2010) says: "Based upon the present accident statistics there is reason to think that the direct benefits of reduced casualties are not likely to be greater than the costs of installing alcolocks." Lahausse & Fildes (2009) found benefit to cost ratios between 3.4 and 0.6 for alcolocks in Australia depending on efficiency, interest rates and the kind of vehicles affected. ...
A prime objective of Intelligent Transport Systems (ITS) which are applied in road transportation is to reduce the number of accidents. A subset of ITS is Driver Support Systems (DSS), i.e. systems that support the driver in handling information, provide warnings, or interfere in the process of maneuvering the car. The present overview will provide ex ante estimates regarding the effects on accidents of Intelligent Speed Adaptation, Maximum Speed Governor, Alcolock, Seat-belt Lock, Sleep Warning Systems, Programmable Ignition Key, Adapative Cruise Control and Electronic Stability Control. The estimation methods will, except for ESC, be by proxy, i.e. assumed effect on certain accident types or other surrogate variables. Focus will be on systems that limit or hinder drivers in engaging in behaviours that are deliberate violations of traffic law. Estimates of lives saved are based on in-depth investigation of fatal accidents possibly prevented if respective systems had been installed in the cars when the accidents took place.
... Also noted was that some studies found evidence that interlocks protected against alcohol-related crashes. Additionally, in a study not included in the review by Lahausse and Fildes (2009), found that installing interlocks in all newly registered vehicles, in Australia, could reduce traffic fatalities up to 24% a year. ...
Alcohol-related fatal crashes are a costly public safety concern. Using vehicular fatality data and geographical variations across the USA, I examine the effectiveness of mandatory Ignition Interlock Programs for first time offenders in preventing fatal alcohol-related accidents. I observe that the program is most effective when it is applied to a broader cross-section of first time offenders. Specifically, states that adopt ignition interlock laws that require participation of first time offenders, with blood alcohol levels of.08 or higher, see fatal accidents involving a drunk driver decrease by 9%. The results provide evidence in support of current and future policy legislation that first time offenders should participate in ignition interlock programs, which will reduce alcohol-related fatal accidents and generate large benefits to society.
... Transportstyrelsen (2010) says: "Based upon the present accident statistics there is reason to think that the direct benefits of reduced casualties are not likely to be greater than the costs of installing alcolocks." Lahausse & Fildes (2009) found benefit to cost ratios between 3.4 and 0.6 for alcolocks in Australia depending on efficiency, interest rates and the kind of vehicles affected. ...
The Norwegian Public Roads Administration has asked for estimates of selected driver support systems with a potential to reduce the number of fatalities. The driver support systems considered were: Intelligent Speed Adaptation (ISA), maximum speed governor, Alcolock, seat-belt lock, sleep/fatigue warning system, programmable electronic ignition lock (“Smartcard”), adaptive cruise control (ACC), and electronic stability control (ESC). Estimates of lives saved are for the most part based on in-depth investigations of fatal accidents that may have been prevented if respective systems had been activated. The most effective is ISA with an estimated 41 lives saved per year in Norway, the least effective system is a maximum speed governor with an estimate of 8 lives saved per year. Estimates of lives saved for the other seven systems vary between 14.9 and 37.5 lives saved per year.
... Benefit cost ratios are greater than one for trucks and motorcycles. The BCR for passenger cars is 0.4, but note that an alcohol interlock described by Lahausse and Fildes (2009) is priced less than the break-even cost shown below. (Lahausse and Fildes also found that the device might be generally cost-beneficial.) ...
... At the same time, there is evidence for a strong social norm against drunk driving in several countries (Williams et al. 2012), including Sweden (Svensson 2005). In an Australian cost-benefit study of ignition interlock devices, it was concluded that mandatory installation in passenger vehicles is cost-effective (Lahausse and Fildes 2009). These authors also found that an investigated device's affordability and convenience of use may be regarded as a countermeasure for minimizing drink driving behavior within the general public and that the ignition interlock devices may be viewed more positively by the general public compared to other types of ignition interlock devices. ...
Introduction: There is a common understanding that driving under the influence of alcohol is associated with higher risk of being involved in crashes with injuries and possible fatalities as the outcome. Various countermeasures have therefore from time to time been taken by the authorities to prevent drunk driving. One of them has been the alcohol interlock. Up to now, interlocks have mainly been used by previously convicted drunk drivers and in the commercial road transport sector, but not in private cars.
Objective and Method: New technology has today reached a level where broader implementation might be possible. To our knowledge, however, little is known about different stakeholders’ opinions of a broader implementation of such systems. In order to increase that knowledge, we conducted a focus group study to collect in-depth thoughts from different stakeholders on this topic. Eight focus Groups representing a broad societal span were recruited and conducted for the purpose.
Results and Conclusions: The results show that most stakeholders thought that an integrated system for alcohol detection in vehicles might be beneficial in lowering the number of drunk driving crashes. They said that the system would probably mainly prevent driving by people who unintentionally and unknowingly drive under the influence of alcohol. The groups did, however, not regard the system as a final solution to the drunk driving problem, and believed that certain groups, such as criminals and alcoholics, would most likely find a way around the system. Concerns were raised about the risk of increased sleepy driving and driving just under the legal blood alcohol concentration (BAC) limit. The results also indicate that stakeholders preferred a system that provides information on the BAC up to the legal limit, but not for levels above the limit; for those, the system should simply prevent the car from starting. Acceptance of the system depended on the reliability of the system, on its ability to perform fast sampling, and on the analytical process, as well as the system’s more or less
inconspicuous placement and user-friendliness. The stakeholders thought that drivers would probably not voluntarily demand the system. So if broad implementation was desired, it would have to be made compulsory by legislation. As an incentive to increase demand, lower taxes and insurance premiums were suggested.
... Raising the minimum legal drinking age from 18 to 21 has been modelled as being more cost-effective than random breath-tests or mass media campaigns in Australia, with both better outcomes and reduced costs (Cobiac et al., 2009). There is increasing evidence that alcohol ignition interlocks can be cost-effective, as shown in mandatory use in commercial vehicles in Sweden (Magnusson, Jakobsson & Hultman, 2011) and all new cars in Australia (Lahausse & Fildes, 2009). Vehicle modifi cations, including ultraviolet headlights to increase visibility at night (Lestina et al., 2002) and daytime running lights (European Transport Safety Council, 2003), have shown positive economic impacts. ...
Executive summary
A core question for policy-makers will be the extent to which investments
in preventive actions that address some of the social determinants of health
represent an effi cient option to help promote and protect population health.
Can they reduce the level of ill health in the population? How strong is the
evidence base on their effectiveness and, from an economic perspective,
how do they stack up against investment in the treatment of health problems?
Are there potential gains to be made by reducing or delaying the need for the
consumption of future health care resources? Will they limit some of the wider
costs of poor health to society, such as absenteeism from work, poorer levels of
educational attainment, higher rates of violence and crime and early retirement
from the labour force due to sickness and disability?
This policy summary provides an overview of what is known about the economic
case for investing in a number of different areas of health promotion and
non-communicable disease prevention. It focuses predominantly on addressing
some of the risk factors for health: tobacco and alcohol consumption, impacts
of dietary behaviour and patterns of physical activity, exposure to environmental
harm, risks to mental health and well-being, as well as risks of injury on
our roads.
It highlights that there is an evidence base from controlled trials and welldesigned
observational studies on the effectiveness of a wide range of health
promotion and disease prevention interventions that address risk factors to
health. Moreover, the cost–effectiveness of a number of health promotion and
disease prevention interventions has been shown in multiple studies. Some of
these interventions will be cost-saving, but most will generate additional health
(and other) benefi ts for additional costs.
In many cases combinations of actions, for example in the areas of tobacco,
alcohol and road injury prevention, are often more cost-effective than
relying on one action alone. In terms of individual actions the use of taxes to
infl uence individual choices on the use of tobacco and alcohol, as well as the
consumption of food, is consistently seen as a cost-effective intervention to
promote better lifestyle choices. Media-based campaigns, in contrast, are not
always effective or cost-effective. Interventions targeted at children often have
the most potential to be cost-effective because of the longer time-frame over
which health benefi ts can be realized.
While some interventions may take several decades to be seen to be costeffective,
for example impacts on the risk of obesity, there are some health
promotion and disease prevention actions that are cost-effective in the
short term, for instance related to the protection of mental health in the
workplace. There are opportunities to invest in cost-effective health promoting
interventions that can be delivered universally as well as to target population
groups, for instance in schools or workplaces.
However, this evidence base must be treated with caution, given that many
interventions have only been assessed in a small number of settings, and
different economic methods and assumptions are made in different studies.
Most of the economic evidence identifi ed has been undertaken in highincome
countries, with very few studies applied to other settings in the
WHO European Region.
Moreover, much of the evidence on the long-term costs and benefi ts of
interventions has been estimated using simulation modelling approaches
synthesizing data on effectiveness, epidemiology and costs. This refl ects the
lack of long-term observed effectiveness data for many public health and health
promoting interventions. It also means that policy-makers need to be cautious
on assumptions made about the persistence of effect of health promoting
interventions, for example the likelihood of long-term behaviour change.
The issue of equity is also a particularly important consideration. If the uptake
of a public health intervention is higher in more affl uent groups in society then
one unintended consequence of investment in a public health programme
could be to inadvertently widen health inequalities. We have little data from
our review on the impact of interventions on health inequalities. Finally there
are also challenges to be met to in order to help encourage the implementation
of cost-effective health promotion and disease prevention actions.
Notwithstanding these caveats, it is clear that there is an economics evidence
base for health promotion and disease prevention. The challenge now is to
strengthen this evidence base further and look at ways in which it may be used
to translate evidence-based knowledge into routine everyday practice across all
of the WHO European Region. For instance, given that these actions are often
delivered outside of the health system it is helpful to speak the same language
and highlight the economic benefi ts of most interest to the sectors that are
responsible for funding each action.
Background:
Health economic evaluation studies (e.g., cost-effectiveness analysis) can provide insight into which injury prevention interventions maximize available resources to improve health outcomes. A previous systematic review summarized 48 unintentional injury prevention economic evaluations published during 1998-2009, providing a valuable overview of that evidence for researchers and decisionmakers. The aim of this study was to summarize the content and quality of recent (2010-2019) economic evaluations of unintentional injury prevention interventions and compare to the previous publication period (1998-2009).
Methods:
Peer-reviewed English-language journal articles describing public health unintentional injury prevention economic evaluations published January 1, 2010 to December 31, 2019 were identified using index terms in multiple databases. Injury causes, interventions, study methods, and results were summarized. Reporting on key methods elements (e.g., economic perspective, time horizon, discounting, currency year, etc.) was assessed. Reporting quality was compared between the recent and previous publication periods.
Results:
Sixty-eight recent economic evaluation studies were assessed. Consistent with the systematic review on this topic for the previous publication period, falls and motor vehicle traffic injury prevention were the most common study subjects. Just half of studies from the recent publication period reported all key methods elements, although this represents an improvement compared to the previous publication period (25 %).
Conclusion:
Most economic evaluations of unintentional injury prevention interventions address just two injury causes. Better adherence to health economic evaluation reporting standards may enhance comparability across studies and increase the likelihood that this type of evidence is included in decision-making related to unintentional injury prevention.
Drunk drivers are a major threat for traffic safety. One of the most effective technical solution to prevent alcohol-impaired driving is an alcohol ignition interlock (AII). It requires a breath test before the engine starts. If the blood alcohol level is above the limit, the vehicle cannot be started. At a higher level the driver should learn to separate drinking and driving through this measure. So far, AIIs are used for the prevention of drunk driving of convicted drivers. The goal of the project was to provide an overview of the current state of research on AII programmes. First of all, the different implementations for the worldwide AII programmes should be reviewed in order to take account of changes in recent years. In addition, the acceptance of AII programmes and their effectiveness in preventing driving under influence (DUI) were investigated.
First, a comprehensive literature search was conducted in order to gain an overview of the worldwide AII programs. Based on another literature review, 20 studies dealing with the acceptance of AIIs and 62 studies investigating the effectiveness of AIIs were found. Various
indicators such as recidivism rates or crashes were considered for the evaluation of the effectiveness of AIIs. Subsequently, the relevant studies were extracted based on elaborated quality criteria.
The overview of the worldwide AII programmes showed that, especially in North America, but also in Australia, it has been an integral part of rehabilitation measures for offenders for many
years. In Europe, Sweden is a pioneer in this field. They use AIIs in primary prevention e.g., in transport companies as well as in secondary prevention with convicted drivers. Meanwhile, several other European countries have also introduced corresponding legislation. However, the installation rates for AIIs vary considerably from country to country. Some European countries have very low installation rates. It strongly depends on the alternatives, such as the length of the driving bans or which groups of offenders are allowed to participate in the AII program. The more comprehensive the legislation, the higher the installation rates. However, the acceptance of AlI is very high among the general population as well as among the offenders. The benefit for road safety is seen as the greatest advantage. The offender
particularly emphasise that they can remain mobile while their driving licence is suspended. Even if the high costs for maintenance and installation are adverse, many convicted drivers would be willing to accept them in order to remain mobile. Otherwise, their job is often under threat.
The results of the literature review on the effectiveness of AIIs show that the effect of AIIs is limited only to the time of installation or to a short period thereafter. After removal of the AII, the recidivism rates or crashes reach a similar level as before or without the intervention. The
AII therefore does not seem to have the desired effect of a permanent change in drinking behaviour of the offenders. Studies have shown that it would be effective to combine the use of an AII with a psychological intervention. Furthermore, it is discussed to install AIIs in all new cars, which is a very comprehensive measure and the only way to prevent DUI in general. However, monetary and social costs should be considered. Nevertheless the equipment of all new vehicles with AIIs seems to be the most effective measure to prevent drunk driving and consequently to improve traffic safety.
Introduction:
Alcohol-involved motor vehicle crashes are a major cause of preventable mortality in the U.S., leading to more than 10,000 fatalities in 2013. Ignition interlocks, or alcohol-sensing devices connected to a vehicle's ignition to prevent it from starting if a driver has a predetermined blood alcohol content (BAC) level, are a promising avenue for preventing alcohol-involved driving. This study sought to assess the effects of laws requiring ignition interlocks for some or all drunk driving offenders on alcohol-involved fatal crashes.
Methods:
A multilevel modeling approach assessed the effects of state interlock laws on alcohol-involved fatal crashes in the U.S. from 1982 to 2013. Monthly data on alcohol-involved crashes in each of the 50 states was collected in 2014 from the National Highway Traffic Safety Administration Fatality Analysis Reporting System. Random-intercept models accounted for between-state variation in alcohol-involved fatal crash rates and autocorrelation of within-state crash rates over time. Analysis was conducted in 2015.
Results:
State laws requiring interlocks for all drunk driving offenders were associated with a 7% decrease in the rate of BAC >0.08 fatal crashes and an 8% decrease in the rate of BAC ≥0.15 fatal crashes, translating into an estimated 1,250 prevented BAC >0.08 fatal crashes. Laws requiring interlocks for segments of high-risk drunk driving offenders, such as repeat offenders, may reduce alcohol-involved fatal crashes after 2 years of implementation.
Conclusions:
Ignition interlock laws reduce alcohol-involved fatal crashes. Increasing the spread of interlock laws that are mandatory for all offenders would have significant public health benefit.
On May 14, 2013, the National Transportation Safety Board (NTSB) recommended lowering the legal blood-alcohol limit to 0.05 g/dL for motor vehicle operators in the United States, in an effort to reduce the risk of injuries and deaths caused by a driver's alcohol impairment (NTSB/SR-13/01). This recommendation has prompted other organizations and agencies, including the National Safety Council, to evaluate and consider supporting this action. In order to determine the scientific and legal feasibility and advisability of lowering or establishing 0.05 per se laws, we examined 554 alcohol-related publications. Risk factors, instrument reliability, law enforcement, and adjudication issues were considered in this overview of the literature. The extensive scientific literature reviewed provides ample support for lowering the operation of motor vehicle alcohol limits to 0.05, and for supporting the NTSB recommendations. Research clearly demonstrates that impairment begins at very low concentrations, well below the recommended NTSB limit, and increases with concentration. Lowering the limit to 0.05 will save many lives and prevent injuries. Breath, blood, and saliva samples have proved to be accurate and reliable specimens for legal acceptability in a court of law.
Copyright © 2014 Central Police University.
This study presents a discussion on alcohol interlocks in terms of their use,
effectiveness and contribution to road safety. While summarising the most
recent road safety developments and providing an account of the drink-driving
phenomenon, the study outlines the technical requirements for the use of these
devices and the various methods of use currently established in EU Member
States. The study concludes with an analysis of their cost-effectiveness in
relation to their deployment in the commercial road transport sector and specific
users categories.
Objective:
To discuss the implications of widespread implementation of alcohol ignition interlocks.
Method:
We base our discussion on data from Finland including crash statistics and surveys collected from criminal justice professionals and general driving population.
Results:
Alcohol ignition interlocks are an effective preventive measure against drunk driving when installed in the vehicles of convicted drunk drivers. However, once they are removed from the vehicles, drivers typically return to their habit of drinking and driving. Furthermore, for a number of reasons, the proportion of convicted drunk drivers that install an interlock in their vehicles is quite small. Therefore, many stakeholders believe that the solution to the drunk driving problem will come when interlocks become standard equipment in all new vehicles. However, drunk driving is a complex sociopsychological problem, and technology can rarely offer a solution to such complex problems. Consequently, many aspects of such interventions might be difficult to identify and include in cost-benefit analysis.
Conclusion:
We express caution about requiring an interlock as standard equipment in all new vehicles.
To determine the cost-effectiveness of interventions to reduce road traffic injuries caused by driving under the influence of alcohol in Thailand.
We used generalized cost-effectiveness analysis and included costs from a health sector perspective. The model considered road traffic crash victims who were injured, disabled, or died. We obtained proportions of alcohol-related crashes from the Thai Injury Surveillance system. Intervention effectiveness was derived from published reviews and a study in one province of Thailand. Random breath testing, selective breath testing, and mass media campaigns, both current and intervention scenarios, were compared with a "do-nothing" scenario. We calculated intervention costs and cost offsets of prevented treatment costs in 2004 Thai baht (US $1 = 41 baht) and measured benefits in terms of disability-adjusted life-years averted. Interventions with incremental cost-effectiveness ratios below 110,000 Thai baht (1×gross domestic product per capita) per disability-adjusted life-year (US $2,680) were considered very cost-effective.
Compared with doing nothing, mass media campaigns, random breath testing, and selective breath testing are all cost saving. When averted treatment costs are ignored and only intervention costs are included, all three interventions are very cost-effective, with incremental cost-effectiveness ratios of 10,300, 14,300 and 13,000 baht/disability-adjusted life-year, respectively. The current mix of mass media campaigns and sobriety checkpoints is therefore also cost-effective, but underinvestment in checkpoints limits its overall effect.
A greater intensity of conducting sobriety checkpoints in Thailand is recommended to complement the investment in mass media campaigns. Together these interventions have the potential to reduce the burden of alcohol-related road traffic injuries by 24%.
To review and assess the quality of economic evaluation studies on injury prevention measures.
Systematic review.
Electronic databases searched included Medline (Pubmed), EMBASE, Web of Science, PsycINFO, and Safetylit.
Empirical studies published in English in international peer-reviewed journals in the period 1998-2009. The subject of the study was economic evaluation of prevention of unintentional injury. Cost-effectiveness (CEA), cost-benefit (CBA) and cost utility (CUA) analyses were included.
Methodological details, study designs, and analysis and interpretation of results of the included articles were reviewed and extracted into summary tables. Study quality was judged using the criteria recommended by the Panel on cost-effectiveness in health and medicine and the British Medical Journal (BMJ) checklist for economic evaluations.
Forty-eight studies met the inclusion criteria of our review. Interventions assessed most frequently were hip protectors and exercise programs for the elderly. A wide variety of methodological approaches was found, including differences in type of economic evaluation, perspective, time horizon, study design, cost categories, effect outcomes, and adjustments for timing and uncertainty used. The majority of studies performed a cost-effectiveness analysis from a societal perspective with a time horizon of one to five years, in which the effect was expressed in terms of injuries prevented and only direct health care costs were included. Most studies deviated from one or more of the Panel recommendations or BMJ guidelines; e.g. not adopting the societal perspective, not including all relevant costs, no incremental analysis.
This review has shown that approaches to economic evaluation of injury prevention vary widely and most studies do not fulfill methodological rigour. Improving quality and harmonization of economic evaluation studies in the field of injury prevention is needed. One way of achieving this would be to establish international guidelines on economic evaluation for injury prevention interventions, based on established economic evaluation checklists, to assist researchers in the design and reporting of economic evaluations.
In order to study the psychological, sociological, behavioural and practical impact of alcolocks on five different groups of thirty drivers (Spanish and Norwegian public transport drivers, German goods transport drivers, Belgian recidivists and Belgian alcohol dependent patients) alcolocks will be installed in these drivers' vehicles for a period of one year. Before, during and after this period participants' attitudes towards driving, drinking and drink driving will be investigated by means of questionnaire-based interviews and compared to the data recorded by the alcolock. At the same time a sample of related subjects of these groups (respectively passengers, company owners and persons living together with the driver for the last two groups) will also be interviewed. All together these data will provide an in-depth exploration of people's real life experiences with alcolocks in a European context. The recommendations resulting from this research, and the hypotheses it generates, will serve as a necessary step towards further quantitative trials and the legal implementation of alcolocks in Europe.
Drink driving continues to be a serious problem on Australian roads, as alcohol-related crashes result in substantial injuries, fatalities and property damage. While legal sanctions such as fines and licence disqualification periods have been effective in preventing a large proportion of the population from drink driving, sanctions have been relatively ineffective in reducing alcohol-impaired driving among 'hard-core' repeat offenders (Marques, Voas and Hodgins 1998). As a result, drink driving rehabilitation programs and alcohol ignition interlocks are being employed as additional countermeasures to reduce the prevalence of alcohol-related injuries and fatalities on public roads. This report aims to review the current evidence regarding the effectiveness of rehabilitation and interlock programs, and to provide support for the expansion of upcoming Australian interlock trials to include (a) screening and matching procedures, (b) intervention and/or support programs and (c) formative evaluations that focus on a number of measurement outcomes.
The growing recognition of the problem presented by illicit vehicle operation by those whose license has been suspended for driving while intoxicated (DWI) has led to the increasing use of vehicle sanctions. These sanctions include vehicle impoundment and forfeiture, vehicle registration cancellation, and vehicle interlocks as penalties for DWI and driving while suspended (DWS). This article reviews the current information available on the use and effectiveness of vehicle sanctions for reducing offender recidivism. In the United States, 14 states have impoundment laws that are widely used as sanctions for both DWI and DWS, with the length of the impoundment increasing with the number of previous offenses. These laws have been shown to reduce recidivism while the vehicle is in custody and, to a lesser extent, even after the vehicle has been released. Vehicle impoundment is also widely used in Canada and New Zealand. Although a larger number of U.S. states have laws providing for vehicle forfeiture for DWI or DWS, this sanction tends to be limited to multiple offenders and therefore impacts fewer drivers. Cancellation of the vehicle registration and the confiscation of the vehicle plates are increasing in popularity because the vehicle tags are the property of the state, rather than the vehicle owner. Vehicle alcohol interlocks have proven to be an effective method for reducing DWI offender recidivism while they are on the car, but appear to produce only limited post-treatment behavior change. Interlocks are widely used in the United States and Canada and are beginning to be implemented in Europe and Australia. The issues that arise in implementing vehicle sanction programs are discussed and the actions taken by states to deal with them are described.
The aim of this report has been to use information contained in the alcohol ignition interlock recorder to determine whether systematic analysis of it can be used to predict which DUI offenders will recidivate during the first 2 years after the interlock is removed. The interlock record was accumulated during a 4-year intervention study in Alberta, Canada. Data from more than 5.5 million breath tests collected during interlock use were analyzed retrospectively after allowing repeat DUI offenses to accumulate for up to 2 years post-interlock. The rate of interlock warns at low BAC (0.02-0.04%) and fails at higher BAC ( > 0.04%) were found to be predictive of later repeat DUI. The interlock record was used along with selected driver record variables and questionnaire data to identify predictor sets. CHAID segmentation analysis was used to identify combinations of predictor variables; these were joined with sensitivity analysis to compare different predictor combinations. Several variables, but primarily more prior DUIs and more interlock warns and fails logged during the first 5 months of interlock usage predict greater than 60% of repeat DUI with a false positive rate of less than 10%.
Approximately 30,000 alcohol ignition interlocks, which are designed to prevent the operation of a vehicle if the driver has been drinking, are in use in the US and Canada. Ignition interlock programs are also being initiated in Sweden and Australia. The best-controlled studies that are currently available suggest that ignition interlocks are effective in reducing impaired driving recidivism while on the vehicle. However, in the US, the practical effectiveness of these devices is limited because only a small number of offenders are willing to install them in order to drive legally. This paper reports on a study of a court policy that created a strong incentive for impaired driving offenders to install interlocks by making traditional penalties, such as jail or electronically monitored house arrest, the alternative to participation in an interlock program. Comparison of the recidivism rates of offenders subject to this policy with offenders in similar, nearby courts, not using interlocks, indicated that the policy was producing substantial reductions in DUI recidivism.
To prevent drinking and driving, alcolock (or alcohol-interlock) devices and programs were introduced in Sweden in 1999. Two types of prevention programs were begun. A primary prevention strategy was initiated to prevent alcohol impaired driving by individuals not pre-selected for having prior DWI offences. This approach was first applied as a pilot project in three commercial transport companies (buses, trucks, taxis). Also a secondary prevention trial was begun as a voluntary 2-year program for DWI offenders involving strict medical requirements, including counseling and regular checkups by a medical doctor. The program did not require a prior period of hard suspension and focused on changing alcohol use habits.
This study compares the recidivism rates of two groups of Illinois drivers who had their driver's licenses revoked for alcohol-impaired driving and who received restricted driving permits. Drivers in both groups had more than two driving under the influence (DUI) actions against their record within 5 years or were classed as level III alcohol dependents. Drivers in one group were required to install breath alcohol ignition interlock devices in their vehicles and drivers in the other group were not. The research found that drivers with the interlock were one-fifth as likely to be arrested for DUI during the 1 year the device was installed as the comparison group, which did not have the device. However, once the ignition interlock was removed, drivers in this group rapidly returned to DUI arrest rates similar to those in the comparison group. These findings echo previous literature. Additionally, the study showed that this voluntary program in Illinois reached only 16% of the drivers who met the requirements for installing the interlock device. Finally, this study found that individuals who were removed from the interlock program and returned to revoked status continued to drive. Within 3 years, approximately 50% of this latter group were involved in a crash or were arrested for DUI or with an invalid driver's license. Conclusions drawn from the study suggest that the breath alcohol ignition interlock device is effective in preventing continued driving while impaired. However, the large-scale effectiveness of the device is limited since most of the drivers eligible for the device do not have it installed. To have a significant impact, the interlock device must represent a better alternative to drivers whose licenses were suspended or revoked because of alcohol arrests compared to remaining on revoked status without having the device installed. Finally the research suggests that, given the rapid return to predevice recidivism, the devices should remain installed until drivers can demonstrate an extended period of being alcohol free.
This project evaluates health outcomes following an alcohol ignition interlock programme (AIIP) by assessing hospital care utilization and sick-leave register data relative to controls with revoked licences, but with no comparable opportunity to participate in an AIIP.
In Sweden, driving while impaired (DWI) offenders can now select voluntarily a 2-year AIIP in lieu of 12 months' licence revocation. The AIIP includes regular medical check-ups designed to alter alcohol use.
The study is a quasi-experimental intent-to-treat design; accordingly, the intervention group includes 48% of the participants who were dismissed from the AIIP before completion.
The control group (865 individuals) showed increased hospital care and sick leave after licence revocation following the DWI. Among the 1266 people in the AIIP, however, significantly fewer needed hospital care relative to controls, and relative to their own care utilization before the DWI offence. This occurred whether care reflected all diagnosis or only alcohol-related diagnosis. Also, sick-leave data showed significantly fewer AIIP group individuals using sick leave relative to the control group, and relative to their own pre-treatment period. These significant health benefits disappear in the post-treatment period. However, among those who actually do complete the entire AIIP, sustained positive health effects are observed 3 and 4 years after the DWI offence.
Voluntary participation in an AIIP has favourable effects with less need for hospital care or sick leave. This is probably linked to reduced alcohol consumption during the programme and to the ability to continue driving.
This report reviews breath test data captured by the alcohol ignition interlock, a device that prevents a car from starting when BAC (breath alcohol concentration) is elevated.
The predictors were elevated BAC test rates from ignition interlock equipped cars of traffic offenders convicted of DUI (driving under the influence of alcohol) and who used interlocks for 6-18 months. Outcome data were future DUI convictions.
Québec and Alberta, Canada.
Approximately 10000 interlock users from these two culturally distinctive English- and French-speaking Provinces.
Predictor patterns were analyzed from among 23 million breath tests. Repeat DUI convictions accumulated up to several years after interlock removal were studied as an outcome to be predicted by the rate of BAC tests > or = 20 mg/dl (0.02%) while the interlock was installed. Data were analyzed with sensitivity and survival methods.
A median of eight interlock breath tests per day per driver were logged (a rate of 3000 tests/year). Less than 1% of all tests were over 0.02%, but the rate of elevated BAC tests, particularly those taken at 7-9 a.m., strongly predicts repeat DUI offenses 2 years hence. The interlock record is an unobtrusive measure of drinking behavior and can be used to profile driver risk.
With new legal mandates, North American use of these DUI control devices is increasing rapidly from the current 5% penetration rate. Interlock data may eventually come to serve as a useful adjunct for patient monitoring by alcohol counselors as well as by courts and motor vehicle authorities.
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An Emerging Technology: Noninvasive Alcohol Testing With Identity Verification
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Alcohol Interlock Programs: Enhancing Acceptance, Participation and Compliance
- D Beirness
- R Robertson