ArticlePDF AvailableLiterature Review

The effectiveness of reducing illegal blood alcohol concentration (BAC) limits for driving: Evidence for lowering the limit to .05 BAC

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  • National Opinion Research Center at the University of Chicago

Abstract and Figures

This scientific review provides a summary of the evidence regarding the benefits of reducing the illegal blood alcohol concentration (BAC) limit for driving and providing a case for enacting a .05 BAC limit. Fourteen independent studies in the United States indicate that lowering the illegal BAC limit from .10 to .08 has resulted in 5-16% reductions in alcohol-related crashes, fatalities, or injuries. However, the illegal limit is .05 BAC in numerous countries around the world. Several studies indicate that lowering the illegal per se limit from .08 to .05 BAC also reduces alcohol-related fatalities. Laboratory studies indicate that impairment in critical driving functions begins at low BACs and that most subjects are significantly impaired at .05 BAC. The relative risk of being involved in a fatal crash as a driver is 4 to 10 times greater for drivers with BACs between .05 and .07 compared to drivers with .00 BACs. There is strong evidence in the literature that lowering the BAC limit from .10 to .08 is effective, that lowering the BAC limit from .08 to .05 is effective, and that lowering the BAC limit for youth to .02 or lower is effective. These law changes serve as a general deterrent to drinking and driving and ultimately save lives. This critical review supports the adoption of lower illegal BAC limits for driving.
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The effectiveness of reducing illegal blood alcohol concentration (BAC)
limits for driving: Evidence for lowering the limit to .05 BAC
James C. Fell , Robert B. Voas
Pacific Institute for Research and Evaluation, 11710 Beltsville Drive, Suite 300, Calverton, MD 207053102, USA
Received 7 January 2005; received in revised form 2 June 2005; accepted 25 July 2005
Available online 7 July 2006
Abstract
Purpose: This scientific review provides a summary of the evidence regarding the benefits of reducing the illegal blood alcohol concentration
(BAC) limit for driving and providing a case for enacting a .05 BAC limit. Results: Fourteen independent studies in the United States indicate
that lowering the illegal BAC limit from .10 to .08 has resulted in 516% reductions in alcohol-related crashes, fatalities, or injuries.
However, the illegal limit is .05 BAC in numerous countries around the world. Several studies indicate that lowering the illegal per se limit
from .08 to .05 BAC also reduces alcohol-related fatalities. Laboratory studies indicate that impairment in critical driving functions begins at
low BACs and that most subjects are significantly impaired at .05 BAC. The relative risk of being involved in a fatal crash as a driver is 4 to
10 times greater for drivers with BACs between .05 and .07 compared to drivers with .00 BACs. Summary: There is strong evidence in the
literature that lowering the BAC limit from .10 to .08 is effective, that lowering the BAC limit from .08 to .05 is effective, and that lowering
the BAC limit for youth to .02 or lower is effective. These law changes serve as a general deterrent to drinking and driving and ultimately
save lives. Impact on Industry: This critical review supports the adoption of lower illegal BAC limits for driving.
© 2006 National Safety Council and Elsevier Ltd. All rights reserved.
Keywords: Blood alcohol concentration (BAC) limits; .05 BAC limit; Traffic safety; Impaired driving; Fatal crashes; General deterrent; Effectiveness;
Drinking drivers
1. Introduction
The international trend toward lowering BAC (blood
alcohol concentration) limits has been continuing for some
time now, with most industrialized nations reducing their
illegal limit to a BAC of .05 or lower. The illegal limit is .05
BAC in Australia, Austria, Belgium, Bulgaria, Croatia,
Denmark, Finland, France, Germany, Greece, Israel, Italy,
the Netherlands, Portugal, South Africa, Spain, and Turkey.
Norway, Russia, and Sweden have a limit of .02 BAC, and
Poland recently adopted .03 BAC. This trend has not
developed in a vacuum; a myriad of studies have indicated
that lowering illegal BAC limits is in the best interest of the
public. For example, laboratory studies indicate that impair-
ment in critical driving functions begins at low BACs
(Moskowitz & Fiorentino, 2000). Most subjects in labora-
tory studies are significantly impaired at .05 BAC regarding
visual acuity, vigilance, drowsiness, psychomotor skills, and
information processing, compared to their performance at
.00 BAC (Moskowitz, Burns, Fiorentino, Smiley, & Zador,
2000). The relative risk of being involved in a fatal crash as a
driver is 4 to 10 times greater for drivers with BACs between
.05 and .07, compared to drivers with .00 BACs (Zador,
Krawchuk, & Voas, 2000). A recent study by the National
Highway Traffic Safety Administration (NHTSA) in the
United States indicates that drivers at .05 BAC have a
significantly higher relative risk (ratio of 1.38 to 1.00) of
being involved in a traffic crash than drivers at .00 BAC
(Compton et al., 2002). Leading medical, crash prevention,
public health, and traffic safety organizations in the world
support BAC limits at .05 or lower, including the World
Journal of Safety Research 37 (2006) 233 243
www.nsc.org
Corresponding author. Tel.: +1 301 755 2746; fax: +1 301 755 2799.
E-mail address: Fell@pire.org (J.C. Fell).
www.elsevier.com/locate/jsr
0022-4375/$ - see front matter © 2006 National Safety Council and Elsevier Ltd. All rights reserved.
doi:10.1016/j.jsr.2005.07.006
Medical Association, the American and British Medical
Associations, the European Commission, the European
Transport Safety Council, the World Health Organization,
and the American College of Emergency Physicians
(Chamberlain & Solomon, 2002).
This article provides a critical review of the evidence
regarding the potential benefits of enacting a .05 BAC per se
limit. The first section discusses methodological issues
concerning studies of this nature. The second section
summarizes the evidence, including the most recent studies,
for lowering the BAC limit from .10 to .08. The third section
covers the available evidence for lowering the BAC limit to
.05. The fourth section reviews the evidence for lowering the
BAC limits for drivers younger than age 21. The last section
concludes that lowering BAC limits is an effective strategy
in reducing impaired-driving casualties.
2. Discussion of methodologically rigorous studies
The effectiveness of any law is highly dependent on the
extent to which it is enforced and the intensity and publicity
surrounding that enforcement. When an evaluation of a new
impaired-driving law is conducted, it is difficult to control
for changes in enforcement activities, changes in public
information, changes in other laws, and changes in alcohol
consumption, all of which could affect the outcome. When
researchers study multiple applications of the same law, there
almost always are cases where one or two of the jurisdictions
will show no benefit or might even experience an increase in
the problem. These exceptions to the more general finding of
a benefit often will be seized by critics to use in opposing the
policy. Thus, it is important to consider the preponderance of
evidence provided by all the available studies.
New public health programs and policies go through
several development phases before reaching full implemen-
tation throughout a country (Holder et al., 1999). For
example, Canada adopted its current .08 BAC Criminal
Code limit in 1969, whereas in the United States, Utah and
Oregon were the first two states to lower their illegal limit
from .10 to .08 per se BAC in 1983. By 1999, 18 states and
the District of Columbia had lowered the illegal limit from
.10 to .08 BAC. During that time, nine evaluations of .08
laws involving 11 states had been conducted in the United
States. A scientific review by a committee of experts formed
by the U.S. Centers for Disease Control and Prevention
indicated that the median treatment effect detected by the
studies they reviewed was a 7% reduction in alcohol-related
fatal crashes (Shults et al., 2001). The evidence for the
effectiveness of lowering the illegal BAC limit produced a
consensus among highway safety advocates on the value of
the .08 law. This resulted in the U.S. Congress providing a
sanction that withheld a portion of a state's highway
construction funds for states not adopting .08 laws by
October 1, 2003.
Studies of the effects of lowering BAC limits have
various research designs and methodologies. The effective-
ness measure and the analysis procedure have varied from
investigator to investigator. Contemporaneous changes in
other laws and policiessuch as the enactment of an
administrative license suspension (ALS) or an administrative
license revocation (ALR) law permitting officers to seize the
licenses of impaired drivers at the time of arrestwere not
fully considered in some of the studies. A review by the U.S.
General Accounting Office (GAO, 1999) found that the .08
law was effective, but generally only when combined with an
ALS/ALR law. To test the significance of an ALS/ALR law,
Hingson, Heeren, and Winter (2000) compared states in
which the two laws were implemented at about the same time
with states where an ALS/ALR law had been in place for
some time before adoption of a .08 law. They found that the
.08 law made a significant difference in states where the
ALS/ALR law had been in place for some years. Because of
differences in effectiveness measures or analytical techni-
ques, Foss, Stewart, and Reinfurt (1999) found no significant
change because of the .08 law in North Carolina, whereas
Apsler, Char, Harding, and Klein (1999) didfinda
significant reduction in alcohol-related crashes in North
Carolina associated with the .08 BAC law. Research and
Evaluation Associates (REA, 1991) reported a reduction in
alcohol-related fatal crashes in California; conversely,
Rogers (1995), in a later analysis, did not find a significant
reduction in fatal crashes in California attributable to the .08
law but did find a reduction in nighttime injury crashes in
California due to the .08 law.
Voas, Tippetts, and Fell (2000) considered the .08 BAC
law as one of several alcohol safety measures in a study that
included all 50 states plus the District of Columbia over a 16-
year period. This study, which applied a common method-
ology to all the states from 1982 to 1997, found an 8%
treatment effect of the .08 BAC law that was very similar to
the Centers for Disease Control and Prevention (CDC; Shults
et al., 2001) finding of a 7% median treatment effect. The
Voas et al. (2000) study was the most comprehensive study
of lower BAC limits to date and did control for many
potentially confounding factors such as safety belt legislation
and the economy.
A significant limitation in the interpretation of all field
studies of the implementation of new laws is the varying
analytical methods and criterion measures used by different
investigators. With this in mind, Tippetts, Voas, Fell, and
Nichols (2005) conducted identical individual analyses of 19
U.S. jurisdictions with .08 laws using a common dataset, the
same effect measure, and an identical analytical procedure.
This permitted a more direct comparison of the effectiveness
of the .08 law in each jurisdiction where it was implemented
and supported a meta-analysis of the effect sizes in each of
the 19 jurisdictions to derive an overall effectiveness
measure for the .08 law. The meta-analysis provided an
estimate that the enactment of laws lowering the BAC limit
from .10 to .08 reduced the proportion of drivers in fatal
crashes who were drinking by 14.8%. Based on this
reduction, had the other U.S. states adopted a .08 law in
234 J.C. Fell, R.B. Voas / Journal of Safety Research 37 (2006) 233243
2000, 947 lives might have been saved. Bernat, Dunsmuir,
and Wagenaar (2004) examined the effects of .08 BAC laws
in the same 19 jurisdictions using changes in single-vehicle
nighttime (SVN) fatal crashes (when alcohol is most likely a
factor) as their measure. The mixed-model regression
analyses showed a significant 5.2% reduction in SVN fatal
crashes associated with the .08 BAC law across all states
after adjusting for ALS/ALR and trends. These methodo-
logically rigorous studies verified that lowering the illegal
BAC limit from .10 to .08 in the United States has had a
significant safety impact.
3. A summary of the evidence for lowering the BAC
limit from .10 to .08
At the start of the 1970s, when the first U.S. national effort
at controlling alcohol-impaired driving began, even those
states that based their laws on the BACs of drivers merely
specified BACs at which it was presumedthat a person was
intoxicated. The presumption could be rebutted by other
evidence. The presumptive levels generally were set at .15
BAC, although a few states had BAC levels of .12 or .10.
Beginning in the 1970s, the U.S. Department of Transpor-
tation (DOT) used its authority under the Highway Safety Act
of 1966 to encourage all states to adopt .10 BAC as the level
for intoxicated or impaired driving. DOT also urged the states
to enact laws that made it a violation per se to drive with a
BAC of .10 or higher. From the outset of the movement to
adopt .10 BAC as the national standard, there were advocates
for even lower BAC levels. By 1983, this sentiment had
resulted in the enactment of .08 BAC per se laws in Oregon
and Utah. A strong grassroots movement started in the early
1980s that has had a significant effect on state laws, including
.08 BAC laws. The most visible organization in this
movement was Mothers Against Drunk Driving (MADD),
founded in the United States in 1980 by a mother whose 13-
year-old daughter had been killed by a hit-and-run driver with
a long record of alcohol offenses. In 1986, DOT took its first
formal step toward advocating a lower illegal limit by
including a .08 BAC law as one of the regulatory criteria for a
supplemental alcohol traffic-safety grant under the program
authorized by the U.S. Congress (23 U.S.C. 408).
In 1988, NHTSA released a review of the scientific
literature on the impairment of driving-related skills at low
BACs, based on laboratory testing of dosed subjects
(Moskowitz & Robinson, 1988). This report documented
that impairment of driving-related skills starts at very low
BACs. Additional states began to consider .08 BAC levels,
and three more states adopted the new level: Maine in 1988,
California in 1990, and Vermont in 1991. California's 1990
legislation lowered the state's per se limit from .10 to .08
BAC and established an ALR law a short time later. In 1991,
NHTSA conducted a study of the effects of these new laws in
California and found that the lower BAC level and the new
ALR law in combination resulted in a 12% decrease in
alcohol-related fatalities (REA, 1991).
Between 1992 and 1998, 10 additional states adopted .08
BAC per se laws: Kansas and North Carolina (1993);
Florida, New Hampshire, New Mexico, and Virginia (1994);
Alabama and Hawaii (1995); and Idaho and Illinois (1997).
The movement toward a national standard for .08 BAC
received renewed attention in the 105th Congress. On June
15, 2000, the Senate passed H.R. 4475 (the DOT Appro-
priations Bill for FY 2001) that included a general provision
sponsored by Senator Lautenberg from New Jersey encour-
aging states to adopt .08 BAC laws by withholding a portion
of a state's federal highway funds, beginning in FY 2004, for
states that do not adopt .08. The final .08 BAC bill (Section
351) was adopted by Congress and signed by the President
shortly after that.
3.1. Studies of the effectiveness of .08 BAC Laws
The following four early studies of the impact of lowering
the BAC limit to .08 were conducted before 1999:
A NHTSA study of the California .08 BAC law (REA,
1991).
A NHTSA staff study of California, Maine, Oregon,
Utah, and Vermont, five of the first states to enact .08
BAC laws (Johnson & Fell, 1995).
A California Department of Motor Vehicles study of its
.08 BAC and ALR laws (Rogers, 1995).
A Boston University study of the five early states to enact
.08 BAC laws (Hingson, Heeren, & Winter, 1996).
These studies controlled for many extraneous factors
and provided initial evidence of the benefit of .08 BAC
laws on alcohol-related crashes. One factor that was
confounded in these studies was the possible interaction of
.08 BAC and ALR laws enacted in close temporal
proximity in some states. However, these studies provided
credible evidence of the impact of the .08 law, particularly
in combination with the ALR law. NHTSA recognized the
need for more replications on which to base conclusions. It
recognized that in the two California studies, it was
difficult to isolate the effects of the .08 BAC and ALR
laws, which were implemented within 6 months of each
other.
In the Johnson and Fell (1995) study, it is noteworthy
that of the 30 different measures used to determine
effectiveness of the .08 BAC law in five states (6 measures
in each state), 26 of the measures showed decreases, with
10 of the decreases showing statistical significance. Sixteen
of the 20 changes in the measures that were not statistically
significant were decreases. Thus, this early study showed
directional changes that were indicative of .08 BAC having
an effect. This finding was very similar to findings of the
effects of ALR (Klein, 1989; Zador, Lund, Field, &
Weinberg, 1988) and minimum legal drinking age of 21
in the United States (DuMouchel, Williams, & Zador,
1987).
235J.C. Fell, R.B. Voas / Journal of Safety Research 37 (2006) 233243
Three additional studies of the effects of lowering the
limit to .08 BAC were sponsored and released by NHTSA in
early 1999:
A study of North Carolina's .08 BAC law (Foss et al.,
1999)
A study of 11 states with .08 BAC laws (Apsler et al.,
1999)
A 50-state study of three important impaired-driving laws
ALR, .08 BAC, and zero tolerance for youth (Voas &
Tippetts, 1999; see also Voas et al., 2000).
The results of these studies of the .08 BAC laws'
effects provided additional evidence to support the
effectiveness of .08 BAC laws. The 50-state study showed
a significant (8%) reduction in the involvement of low-and
high-BAC drivers in fatal crashes. The 11-state study
found that .08 BAC laws were associated with reductions
in alcohol-related fatalities in 7 of the 11 states studied,
either alone or in conjunction with ALR laws. Also in this
study, 32 of 39 outcomes directionally supported a
conclusion that .08 BAC laws, when added to existing
laws and programs, are associated with reductions in
alcohol-related traffic fatalities. The North Carolina study
found no clear effect of its .08 BAC law. However, several
of the study's outcomes were directionally consistent with
suggesting that the law had an effect greater than the
decline in alcohol-related fatalities that began before .08
BAC was enacted.
Hingson et al. (2000) analyzed the effectiveness of .08
BAC laws in six states enacting .08 laws in 1993 and 1994.
They found an overall 6% reduction in alcohol-related deaths
in these six states and estimated that 400 to 500 additional
lives could be saved each year if every state had had a .08
BAC law. This study took into account many of the
criticisms of previous studies by the same authors. Two
other studies of the effectiveness of lowering the illegal BAC
limit to .08 appeared in the literature about the same time
(Dee, 2001; Eisenberg, 2001). Dee used somewhat novel,
panel-based evaluations of .08 laws, which in many respects
addressed methodological limitations of previous studies.
Fourteen states that adopted .08 BAC laws between 1982
and 1998 were analyzed and compared to the rest of the
states that did not adopt .08 laws using traffic fatality rates as
the key measure. Alaska, Hawaii, and the District of
Columbia were excluded from the analyses. The regression
analyses controlled for the potential effects of .10 BAC laws,
ALR laws, dram shop laws, mandatory jail time for first DUI
offenses, zero tolerance laws for youth, mandatory seat belt
laws (primary and secondary enforcement, separately),
raising the speed limit on interstate highways to 65 and 70
miles per hour (mph), vehicle miles traveled in the state, state
unemployment rate, and state personal income per capita. A
statistically significant reduction of 7.2% in traffic fatality
rates was associated with the adoption of .08 BAC laws. Dee
estimated that 1,200 lives could be saved annually if the
additional 23 states with ALR laws also adopted .08 BAC
laws.
Eisenberg (2001) conducted a baseline analysis of the
effects of .08 laws similar to that of Dee (2001), but with the
addition of controls for graduated driver licensing (GDL)
laws and the presence of MADD in the state. Eisenberg's
analysis showed that the .08 BAC limit is associated with a
5% reduction from the mean traffic fatality rate and that .10
BAC limit laws are associated with a 2.4% reduction. This
estimate suggests that lowering the limit from .10 BAC to .08
BAC would garner a further reduction of 2.6% from the
mean total fatal crash rate. This is a statistically significant
reduction (p< .05).
The two latest studies of the effectiveness of .08 BAC
laws were discussed in the first section (Bernat et al., 2004;
Tippetts et al., 2005).
Fig. 1. Percentage of change in alcohol-involved motor vehicle fatalities following enactment of .08 laws.
236 J.C. Fell, R.B. Voas / Journal of Safety Research 37 (2006) 233243
3.2. Studies of impairment and crash risk at .08 BAC
A 1988 review of 177 studies clearly documented
significant impairment at .08 BAC (Moskowitz & Robinson,
1988), and a 2000 review of 112 more recent studies
provided even stronger evidence of impairment at .08 BAC
(Moskowitz & Fiorentino, 2000). Together, these two
reviews have summarized the findings of nearly 300 studies
of impairment at low-BAC levels, and the findings are
remarkably consistent. A comprehensive laboratory study
examined driving skills among 168 subjects of both sexes
and various ages and drinking histories. This study not only
confirmed significant impairment in all measures of
performance at a .08 BAC, but also found that impairment
was present in relatively consistent levels across all age
groups, sexes, and drinker types (Moskowitz et al., 2000).
An epidemiological study, which compared data from a
national roadside survey with data from all drivers involved
in fatal crashes over a 2-year period, showed that the risk of
being killed in a single-vehicle fatal crash at .08 BAC is 11 to
52 times greater than at .00 BAC. That same study indicated
that the risk of dying in a single-vehicle crash at .05 BAC
was 4 to 17 times that of drivers at .00 BAC (Zador et al.,
2000).
3.3. Summary of .08 BAC laws
Fig. 1 (an update of Shults et al., 2001,Fig.2)
summarizes the effectiveness of .08 laws in graphic form.
It shows a consistency and direction in the change in alcohol-
related traffic fatalities that has occurred after .08 laws were
adopted in the various states.
Table 1 summarizes all of the studies of the effectiveness
of .08 BAC laws in the United States.
4. A summary of the evidence for lowering the BAC
limit to .05 or less
4.1. Effectiveness of .05 BAC laws
Several countries have conducted evaluations of lowering
their illegal BAC limits to .05 or less. A long-term study of
the .05 BAC law in the Netherlands (adopted in 1974)
concluded that it contributed to a sustained decline in the
Table 1
Studies of the effects of lowering the illegal BAC limit from .10 to .08 in the United States
Study Results
Research and Evaluation Associates (1991) The Effects Following the
Implementation of an 0.08 BAC Limit and an Administrative
Per Se Law in California.
12% reduction in alcohol-related traffic fatalities associated
with the .08 and ALR laws.
Johnson and Fell (1995) The Impact of Lowering the Illegal BAC Limit to .08
in Five States in the U.S.
Significant reductions in alcohol-related fatal crashes in
4 of 5 states ranging from 4 to 40%.
Rogers (1995) The General Deterrent Impact of California's 0.08% BAC Limit
and Administrative Per Se License Suspension Laws.
7% reduction in nighttime fatal and serious injury crashes.
No significant decrease in alcohol-related fatal crashes.
Hingson et al. (1996) Lowering State Legal Blood Alcohol Limits to 0.08 Percent:
The Effect on Fatal Motor Vehicle Crashes.
16 to 18% reduction in proportion of fatal crashes involving
fatally injured drivers with BACs .08 and BACs.15.
Apsler et al. (1999) The Effects of .08 BAC Laws.The .08 BAC law is associated with significant reductions in
alcohol-related fatal crashes, alone or in conjunction with ALR,
in 7 of 11 states.
Foss et al. (1999) Evaluation of the Effects of North Carolina's 0.08% BAC Law.No clear effect of .08 BAC law on already declining
alcohol-related fatalities.
Voas et al. (2000) The Relationship of Alcohol Safety Laws to Drinking
Drivers in Fatal Crashes.
The .08 BAC laws are associated with 8% reduction in fatal
crashes involving drinking drivers. If all states adopt a .08 BAC,
an estimated 590 lives could be saved each year.
Hingson et al. (2000) Effects of Recent 0.08% Legal Blood Alcohol Limits
on Fatal Crash Involvement.
6% reduction in alcohol-related fatal crashes associated with
.08 BAC laws in six states. If all states adopt .08 BAC,
an estimated 400 to 500 lives could be saved each year.
Voas, Taylor, Kelley Baker, & Tippetts (2000) Effectiveness of the Illinois
.08 BAC Law.Also see Voas, Tippetts and Taylor (2001) Effectiveness
of the Illinois .08 Law: An Update with the 1999 FARS Data.
The .08 law reduced the number of drinking drivers in fatal crashes
by 13.7% in first 12 months. Follow-up study confirmed 13.7%
reduction over 30 months after .08 law adopted in 1997.
Shults et al. (2001) Reviews of Evidence Regarding Interventions to
Reduce Alcohol-Impaired Driving.
Median 7% reduction in measures of alcohol-related fatal
crashes associated with .08 BAC laws. CDC strongly recommends
all states adopt .08 BAC laws.
Dee (2001) Does Setting Limits Save Lives? The Case of 0.08 BAC Laws.Statistically significant 7.2% reduction in the traffic fatality
rate associated with the adoption of .08 laws in 14 states.
Eisenberg (2001) Evaluating the Effectiveness of a 0.08% BAC Limit
and Other Policies Related to Drunk Driving.
Statistically significant reduction of 2.6% in the fatal crash
rate associated with .08 BAC laws in 14 states.
Bernat et al. (2004) Effects of Lowering the Legal BAC to 0.08 on
Single-Vehicle-Nighttime Fatal Traffic Crashes in 19 Jurisdictions.
Statistically significant reduction of 5.2% in SVN fatal
crashes associated with .08 law across all states.
Tippetts et al. (2005) A Meta-Analysis of .08 BAC Laws in 19
Jurisdictions in the United States.
Statistically significant decline of 14.8% in the rate of drinking drivers
in fatal crashes after the .08 laws were adopted in the 19 jurisdictions.
237J.C. Fell, R.B. Voas / Journal of Safety Research 37 (2006) 233243
total number of drinking drivers involved in crashes
(Noordzij, 1994). Another study from France evaluated the
impact of lowering its BAC limit from .08 to .05 in 1996.
Annual alcohol-related crash fatalities fell from approxi-
mately 100 before the legal change to 64 in 1997 in the
province of Haute-Savoie, where the study was conducted
(Mercier-Guyon, 1998).
In 1988, the illegal BAC limit was lowered from .08 to
.05 in Austria. A study of the law found that there was an
overall 9.4% decrease in alcohol-related crashes relative to
the total number of crashes (Bartl & Esberger, 2000).
However, they noted that intense media and enforcement
campaigns also occurred around the time that the limit was
lowered, making it nearly impossible to attribute the
reductions to any one of these factors, at least in the short
term. Bartl and Esberger concluded that lowering the [il]
legal BAC limit from .08% to .05% in combination with
intensive police enforcement and reporting in the media
leads to a positive short-term effect.This provided support
for the view that a .05 BAC illegal limit, as part of a
comprehensive approach to fighting impaired driving, can
have beneficial effects.
Henstridge, Homel, and Mackay (1995) conducted a
rigorous time-series analysis of random breath testing
(RBT) and .05 BAC laws in Australia, controlling for
many factors including seasonal effects, weather, economic
trends, road use, alcohol consumption, and day of the week.
Although the primary focus of the Australian study was the
impact of RBT, the findings on the effect of .05 BAC laws
were also significant. The study statistically accounted for
the effect of other alcohol countermeasures to determine the
specific values of the declines that were attributable directly
to either RBT or the lower .05 BAC limit. The study
analyzed traffic data for periods ranging from 13 to 17
years and found that those Australian states lowering their
BAC limits from .08 to .05 experienced meaningful
declines in alcohol-related crash measures. After Queens-
land, Australia, reduced their per se BAC limit to .05 in
1982, they experienced an 18% reduction in fatal collisions
and a 14% reduction in serious collisions. These results
were not confounded by the effects of RBT, as it was not
introduced until 8 years later. Similarly, the .05 BAC limit
in New South Wales was estimated to have reduced serious
collisions by 7%, fatal collisions by 8%, and SVN
collisions by 11%. This translated into the averting of an
estimated 605 serious, 75 fatal, and 296 SVN collisions per
year. Although the .05 BAC limit was introduced only 2
years before RBT in New South Wales, the authors
accounted for this in their analyses and attempted to
determine the crash reductions specifically attributable to
each of the interventions.
Smith (1988) evaluated the effects of lowering the BAC
limit in Queensland from .08 to .05 BAC. The proxy
measure of changes in nighttime crashes as compared to
daytime crashes was used. There was a significant 8.2%
reduction in nighttime serious injury crashes (requiring
hospitalization) and a 5.5% reduction in nighttime property
damage crashes associated with the .05 BAC limit in the
first year. Smith partially attributes some of the crash
reductions in the second and third years after the adoption
of .05 BAC to increased enforcement. When lowering the
illegal BAC limit stimulates increased enforcement, it
should be considered a benefit of the law, not a drawback,
as concluded by Smith.
In South Australia, the illegal BAC limit was not lowered
to .05 until 1991. Kloeden and McLean (1994) reported that
the number of nighttime drivers who had been drinking was
reduced by 14.1% following adoption of the law. A second
study of South Australia found that the .05 BAC limit did
not significantly affect the number of fatally injured drivers
who were legally impaired (McLean, Kloeden, McColl, &
Laslett, 1995). However, it did find that the proportion of
impaired drivers at BACs of .15 or greater declined from
1991 to 1993. This last finding supports other Australian
research indicating that the lower BAC limit has a
substantial effect on drivers with BACs higher than .15
(Brooks & Zaal, 1992). It has been estimated that drivers
with BACs higher than .15 are 244 times more likely to be
involved in a fatal crash than drivers with zero BACs
(Simpson, Mayhew, & Beirness, 1996). The recent study by
Zador et al. (2000) found that male drivers aged 21 to 34
with BACs of .15 or higher are 573 times more likely to be
killed in a single-vehicle crash than sober drivers of the
same age. Thus, even though a .05 BAC limit would appear
to be aimed at drivers with moderate BACs, its potential
effect on the behavior of high-BAC drivers has important
traffic safety implications.
Sweden's more recent lowering of its limit to .02 BAC
also showed positive results. Although Sweden adopted a .05
BAC limit in the 1950s, the move to an even lower limit in
1990 further improved traffic safety. Norström and Laurell
(1997) reported that in the 6 years following the introduction
of the .02 BAC limit, there was a 9.7% reduction in fatal
crashes, an 11% reduction in single-vehicle crashes, and a
7.5% reduction in all crashes. Norström and Laurell noted
that the most significant effects occurred in fatal and single-
vehicle crashes, the two categories in which alcohol is most
likely to be involved. This suggests that crash reductions
cannot be attributed solely to existing trends but were
caused, in part, by the lower BAC limit. These results were
supported by another study that estimated that the .02 BAC
limit resulted in an approximate 10% decrease in fatal
crashes and a 12% decrease in severe personal injury crashes
(Borschos, 2000).
Table 2 summarizes the research on lowering the BAC
limit to .05.
4.2. Impairment and crash risk at .05 BAC
Howat, Sleet, and Smith (1991) conducted a review of the
literature from experimental and laboratory research on the
impairment effects at .05 BAC. Many of the studies reviewed
238 J.C. Fell, R.B. Voas / Journal of Safety Research 37 (2006) 233243
showed statistically significant decrements in driving
performance at a BAC of .05 or lower. The authors
concluded that young and inexperienced drinkers appear to
be at the greatest risk at .05 BAC. They recommended that
setting a uniform .05 BAC statutory limit should be one
measure in a comprehensive approach to reducing impaired
driving including other legal, social, behavioral, and
environmental strategies to deal with the problem.
Moskowitz and Fiorentino (2000) reviewed 112 scientific
articles regarding the effects of alcohol on driving-related
skills published between 1981 and 1997. They concluded
that, by the time subjects reach .05 BAC, the majority of
experimental studies examined reported significant impair-
ment. After testing 168 drivers, Moskowitz et al. (2000)
concluded that the majority of the driving population is
impaired in at least some important measures at BACs as low
as .02 BAC.
Two recent epidemiological studies (Compton et al.,
2002; Zador et al., 2000) of the relative risk of being
involved in a crash at various positive BAC levels indicate
that the risk of crashing is substantially higher at .05 BAC
compared to drivers at .00 BAC. Zador et al. (2000)
estimated that the risk of being involved in a fatal crash for
drivers at BACs as low as .02.04 is anywhere from two
times to five times higher than for drivers with BACs = .00,
depending upon age and gender. That same study concluded
that the risk of being killed as a driver in a single-vehicle
crash is 6 to 17 times greater for drivers at BACs between .05
and .07 compared to drivers with BACs of .00, and that the
risk of just being involved as a driver in a fatal crash is 4 to
10 times greater at BACs between .05 and .07 than drivers
with BACs = .00. As mentioned earlier, Compton et al.
(2002) concluded that the risk of being involved in any crash
for drivers with BACs at .04 or higher was significant.
Further, drivers with a BAC of .05 have a 38% higher risk of
crashing than drivers with BACs=.00. At .06 BAC, that risk
is 63% higher, and at .07 BAC, the risk is 109% higher than
for drivers with BACs = .00.
5. A summary of the evidence for lowering BAC limits
for youth
The United States has taken the lead in adopting lower
BAC limits for underage youth. In 1984, the U.S. Congress
adopted measures to sanction states that did not adopt 21 as
their minimum legal drinking age. By 1988, all states had
enacted such laws. Because it was illegal for those younger
than 21 to drink any alcohol, it seemed logical that underage
drivers should have no alcohol in their systems when they
drove. In 1995, the U.S. Congress passed a law requiring
states to adopt so-called zero tolerance laws for drivers
younger than 21. By 1998, all states had passed laws making
it illegal for any driver younger than 21 to have a positive
BAC. In some states, any BAC at .02 or greater is illegal for
youth; in other states, the level is set at .01 BAC or greater; in
the remaining states, any BAC higher than .00 is considered
illegal for drivers younger than 21. These zero tolerance laws
for youth lowered the illegal BAC limits for that population
and have proven to be effective in reducing the number of
fatal crashes involving underage drinking drivers.
A recent study of zero tolerance laws in Florida, Maine,
Oregon, and Texas was conducted by Lacey, Jones, and
Wiliszowski (2000) under a NHTSA contract. Nighttime
single-vehicle crashes were reduced by as much as 36% in
Maine and 40% in Oregon, as little as 5% in Florida, and not
at all in Texas for drivers subject to the new zero tolerance
laws. Maine and Oregon, which had more experience with
the law and had higher levels of enforcement and publicity,
had the higher levels of effectiveness, as would be expected.
The Maryland .02 BAC law for drivers younger than 21
was evaluated by Dunlap and Associates, Inc., under a
NHTSA contract with the primary objective of determining
the effects of the law. The law went into effect on January 1,
1989. The number of drivers younger than 21 who were
involved in crashes and had been drinkingwas collected
from 1985 through 1990. An 11% decrease was found
comparing the before-and-after crash data associated with
Table 2
Studies of the effects of lowering the illegal BAC limit to .05
Study Results
Noordzij (1994) Decline in Drinking and Driving
in the Netherlands.
Percentage of drivers with BACs> .05 from roadside surveys decreased from more than 15%
in the years before the .05 limit to 2% in the first year and then leveled off at 12% for
10 years after the law change.
Mercier-Guyon (1998) Lowering the BAC Limit
to 0.05: Results of the French Experience.
Alcohol-related traffic crash fatalities decreased from 100 before the limit was lowered to
64 in 1997 right after the law change in the French Province where the study was conducted.
Bartl and Esberger (2000) Effects of Lowering the
Legal BAC Limit in Austria.
Found 9.4% decrease in alcohol-related crashes. Lowering the legal BAC-limit from .08%
to .05% in combination with intense police enforcement and reporting in the media
leads to a positive short-term effect.
Henstridge et al. (1995) The Long-Term Effects of
Random Breath Testing in Adelaide.
Queensland experienced an 18% reduction in fatal crashes and a 14% reduction in serious
crashes associated with lowering the BAC limit to .05. These results were not confounded
with the effects of random breath testing. New South Wales showed an 8% reduction in fatal
cases, a 7% reduction in serious crashes, and an 11% reduction in SVN crashes associated
with lowering the BAC limit to .05.
Smith (1988) Effect on Traffic Safety of Introducing a
0.05% Blood Alcohol Level in Queensland, Australia.
Significant 8.2% reduction in nighttime serious injury crashes and a 5.5% reduction in
nighttime property damage crashes associated with lowering the limit from .08 to .05.
Partly the result of increased enforcement.
239J.C. Fell, R.B. Voas / Journal of Safety Research 37 (2006) 233243
the zero tolerance law. Further, this 11% reduction was in
addition to a general reduction in alcohol-involved crashes
and a reduction in all crashes (alcohol and nonalcohol)
involving drivers younger than 21 (Blomberg, 1992).
Hingson, Howland, Heeren, and Winter (1992) compared
four states that passed zero tolerance laws before 1989
(Maine, New Mexico, North Carolina, and Wisconsin) with
four nearby states that had no such law (Massachusetts,
Arizona, Virginia, and Minnesota). Equal numbers of pre-
and post-law years were examined in each of the four pairs of
states monitoring nighttime fatal crashes involving teenage
drivers in the age groups targeted by the law. Study states set
different ages for the BAC law: New Mexico and North
Carolina, younger than 18; Wisconsin, younger than 19; and
Maine, younger than 20. As a group, the states that lowered
their BAC levels for youth had significantly greater post-law
reductions in nighttime fatal crashes among adolescents
relative to adults (34% teens vs. 7% adults) than the
comparison states (26% teens vs. 9% adults).
In a follow-up study, Hingson, Heeren, and Winter (1994)
compared 12 states (North Carolina, Wisconsin, Oregon,
Arizona, Maine, Maryland, Ohio, Vermont, New Mexico,
California, Rhode Island, and Georgia) that lowered illegal
BACs for youth before 1991 with 12 comparison states
(Virginia, Minnesota, Washington, Utah, Massachusetts,
Pennsylvania, Indiana, New Hampshire, Colorado, Texas,
Connecticut, and Alabama). During the post-law period, the
proportion of fatal crashes that involved single vehicles at
night declined 16% among young drivers targeted by those
laws, while it rose 1% among drivers the same age in
comparison states where BAC limits were not changed.
Adult crashes declined only 5% and 6% in the two groups
during the post-law period. The study found that significant
declines in the proportion of nighttime single-vehicle crashes
among young drivers occurred only in states that lowered the
underage BAC limit to .02 or lower. In other states that
reduced the young driver BAC limit to .04, .05, or .06, there
was no significant difference from states that did not lower
the limit at all. (Note: All states have subsequently lowered
their limits to .02 or lower.) The decline was only noticed for
states that dropped the BAC level to .00 or .02, true zero
tolerance laws rather than the mixed-message laws for youth.
Zwerling and Jones (1999) conducted a systematic review
of zero tolerance laws and their effect on alcohol-related
injuries and fatalities. Six studies met their strict selection
criteria. All six studies showed reductions in injuries and
fatalities associated with the implementation of zero
tolerance laws, and in three studies, the reductions were
statistically significant. The greatest reduction (22%) was
reported in one study for SVN fatal crashes involving
underage drivers in those states adopting zero tolerance laws.
Despite some methodological difficulties cited by the
authors, the six studies presented accumulating evidence
in support of the effectiveness of these laws.The total
evidence is strengthened even more because similar results
were found in different countries (Australia and the United
States) using different methods and different outcome
measures.
Voas, Tippetts, and Fell (2003) used data on all drivers
younger than 21 involved in fatal crashes in the United States
from 1982 through 1997. Quarterly ratios of BAC-positive to
BAC-negative drivers in each of the 50 states were analyzed
in a pooled cross-sectional time-series approach. After
accounting for differences among the 50 states in various
background factors, changes in economic and demographic
factors within states over time, and the effects of other related
laws, results indicated a significant 24.4% reduction in
alcohol-positive drivers younger than 21 who were involved
in fatal crashes associated with the zero tolerance laws. The
policy in the United States of making it illegal for underage
drivers to have any alcohol in their systems appears to have
been effective in reducing the proportion of fatal crashes
involving youthful drinking drivers.
Before the adoption of zero tolerance laws, young drivers
were under the same BAC limit standards as adults.
Adopting zero tolerance laws is the same as lowering the
Table 3
Studies of the effectiveness of lowering the BAC limit for youth
Study Results
Blomberg (1992) Lower BAC Limits for Youth:
Evaluation of the Maryland .02 Law.
A significant 11% decrease in police-reported alcohol crashes involving drivers younger
than 21 associated with the .02 law. Decrease was 50% in six communities that highly
publicized the law and the enforcement of it.
Hingson et al. (1992) Reduced BAC Limits for
Young People (Impact on Night Fatal Crashes).
As a group, states that lowered BAC limits for youth had significantly greater postlaw
reductions in nighttime fatal crashes among drivers younger than 21 relative to drivers older
than 21 (34% for teens; 7% for adults) than the comparison states that
did not lower the limit (26% for teens; 9% for adults).
Hingson et al. (1994) Lower Legal Blood
Alcohol Limits for Young Drivers.
SVN fatal crashes declined 16% in 12 states that lowered the limit for youth while it
rose 1% in 12 comparison states that did not lower the limit for youth. Adult nighttime
fatal crashes declined 5% and 6%, respectively, in the two groups.
Zwerling and Jones (1999) Evaluation of the Effectiveness
of Low BAC Laws for Younger Drivers.
Systematic review of the effects of zero tolerance laws indicate that all six studies
showed significant reductions in injuries or fatalities associated with the implementation
of lower BAC limits for youths younger than 21.
Voas et al. (2003) Assessing the Effectiveness of Minimum
Legal Drinking Age and Zero Tolerance Laws in the U.S.
Lower limits for youth have resulted in an average 24.4% reduction in alcohol-positive
drivers younger than 21 involved in fatal crashes since their implementation in the
United States.
240 J.C. Fell, R.B. Voas / Journal of Safety Research 37 (2006) 233243
BAC limit from .10 (or .08) to .02 for drivers younger than
21. Young drivers perceive this change the same way that
adults perceive lowering the limit to .08 BACthat the state
is getting tougher on impaired driving.
Table 3 summarizes the research on lowering the BAC
limit for youth.
6. Public support for lower BAC limits
Surveys in the United States indicate that most people
believe they should not drive after two or three drinks
(Royal, 2000). This is equivalent to a BAC of .05 for many
people (NHTSA, 1994). Considering this reported attitude,
the public favors a BAC limit of .05. The countries that have
already adopted .05 BAC as their limit do not report any
public outcry that the limit is too strict.
7. Conclusion
Mann, Macdonald, Stoduto, Bondy, and Shaikh (1998)
reviewed all of the available scientific evidence in assessing
the potential impact of lowering the BAC limit to .05. They
assessed research on the effects of alcohol on driving
performance; epidemiological research on the risk of
collision involvement at various BACs; research on the
impact of lowering the BAC limit in other countries and
jurisdictions; and other possible issues such as public
acceptance, police discretion, and judicial outcomes. This
review concluded that the adoption of a .05 BAC could
potentially reduce the motor- vehicle crash fatalities by 6%
to 18%.
Chamberlain and Solomon (2002) conducted an extensive
review of all of the issues surrounding a .05 BAC limit. The
review summarized the effects of low doses of alcohol on
driving behavior, the relative risk of a crash at various BAC
levels, and the experience in other countries with lowering
BAC limits, and presented a compelling case for a .05 BAC
limit.
The scientific evidence accumulated over the past 50
years indicates a direct relationship between rising BAC
levels and the risk of being involved in a motor-vehicle crash
and documents that driving performance begins to deterio-
rate significantly at .05 BAC (Moore and Gerstein, 1981;
Transportation Research Board [TRB], 1987; U.S. Depart-
ment of Health and Human Services [DHHS], 1987).
Because alcohol has been shown to have a wide variation
of effects from subject to subject, special attention needs to
be given to the selection of a BAC level in which the vast
majority of drinking drivers are likely to be affected. This
level appears to be .05 BAC. When all of the international
evidence on lowering BAC limits is assembled, reviewed,
and summarized, we have concluded that lowering the illegal
BAC limit to .05 is an effective strategy in reducing impaired
driving.
In general, the literature reveals that lowering the BAC
illegal limit reduces drinking driver fatal crashes, whether it
is from .10 BAC to .08 BAC or from .08 BAC to .05 BAC
for adults, or from some higher BAC level to .02 BAC (or
lower) for youth. The public does not think people should
drive after two or three drinks. This translates to .05 BAC for
most people. Laboratory research shows that most people's
critical driving skills are significantly impaired at .05 BAC.
The World Health Organization (2004) recommends an
upper limit of .05 BAC for the general driving population
and .02 BAC for young drivers as the best practice at this
time.
Acknowledgement
The authors would like to thank MADD Canada and, in
particular, Andrew Murie, Executive Director, for support-
ing this critical review of the evidence for lower BAC
limits.
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James C. Fell presently is a Senior Program Director at the Pacific Institute
for Research and Evaluation (PIRE). He has been at PIRE since May, 2001.
He is presently involved in managing projects evaluating the effectiveness
of traffic safety enforcement programs, particularly highly visible, highly
publicized and frequent sobriety checkpoints, in reducing impaired driving.
Mr. Fell formerly worked at the National Highway Traffic Safety
Administration (NHTSA) from 1969 to 1999 and has 36 years of traffic
safety and research experience. At NHTSA, he was Chief of Research and
Evaluation for Traffic Safety Programs and Manager of the Fatality
Analysis Reporting System (FARS). He has authored over 80 scientific
publications in the areas of highway safety, alcohol impairment and human
factors research. Mr. Fell served on the National Board of Directors for
Mothers Against Drunk Driving (MADD) from 19992006 and is a
member of the International Council on Alcohol, Drugs and Traffic Safety
(ICADTS), the Association for the Advancement of Automotive Medicine
(AAAM), and the Human Factors and Ergonomics Society (HFES). He has
both a Bachelor's and Master's degree in Human Factors Engineering from
the State University of New York at Buffalo.
Robert Voas, a senior scientist with the Pacific Institute for Research and
Evaluation (PIRE), has been involved in research on alcohol and highway
safety for 30 years, initially as director of the National Highway Traffic
Safety Administration's Office of Program Evaluation and more recently as
Principal Investigator for government research programs in drinking-
driving and community alcohol problem prevention. Dr. Voas has served
two terms on the MADD National Board and is currently on the MADD
National Advisory Board. Dr. Voas is a Fellow of the American
Psychological Association and a Past President of the International Council
on Alcohol, Drugs, and Traffic Safety. He is also a member of the
Committee on Alcohol and Drugs, the National Safety Council, and the
Committee on Alcohol and Other Drugs of the National Transportation
Research Board and has served on the National Board of Mothers Against
Drunk Driving (MADD). His recent research projects have included an
evaluation of programs to reduce college student binge drinking and studies
of underage binge drinkers crossing the border at San Diego and El Paso to
drink in Mexico, where the drinking age is 18. He has recently conducted
national studies of the impact of .08 laws, the zero tolerance laws, vehicle
impoundment laws, and interlock laws.
243J.C. Fell, R.B. Voas / Journal of Safety Research 37 (2006) 233243
... The most recent figures for each jurisdiction are shown in Table 3.3. (2021) Internationally, many governments have found that lowering the legal BAC limit resulted in significant reductions in alcohol-related crashes and fatalities (Fell & Scherer, 2017;Fell & Voas, 2006). This was observed when: ...
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... Driving under the influence of alcohol is an important problem. While the chances of getting in a traffic accident involving death under the condition that the blood alcohol concentration (BAC) is 0.2 promil (20 mg/dl) is two times more, it is reported that this rate increases between approximately four and ten times at 0.5-0.7 promil (50-70 mg/dl) (Fell & Voas, 2006). Increase in the amount of alcohol consumed leads to lengthening of reaction time and impairment of the ability to follow. ...
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... To date, it is established that any amount of alcohol could impair driving ability and behaviour, with risks increasing exponentially when 0.5 g/L is exceeded for the general driving population [1]. In this respect, it has been suggested that reducing BAC from 1.0 to 0.5 g/L can help reduce traffic fatalities by 6-18% [33], and that BAC 0.5 g/L drivers are two-times more likely to be involved in crashes than sober drivers [22]. Therefore, the WHO on this subject suggests that the best at this time is to propose legal limits of 0.5 g/L in the general population and 0.2 g/L for novice drivers, motivated by a greater susceptibility to related impairment in the latter population: to such criteria more and more countries are adhering [1]. ...
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... En Estados Unidos, una revisión sistemática realizada en el año 2006, basada en catorce estudios acerca de la efectividad de reducir la concentración de alcohol en sangre permitida para el manejo, demostró que la reducción de un 0.02 g/dl (pasando de 0.10 g/ dl a 0.08 g/dl) logró disminuir entre un 5-10 % los choques, muertes o lesiones relacionadas con el consumo de alcohol y el manejo de vehículos (Fell y Voas, 2006). Otra revisión sistemática, realizada en el mismo país, aporta fuerte evidencia acerca de la efectividad de disminuir a 0.08 g/dl la concentración permitida de alcohol en sangre y agrega, como medida efectiva, el aumento del mínimo de la edad permitida para consumir alcohol de 18 a 21 años, lo cual reduce la frecuencia de accidentes de tránsito en un rango que oscila entre un 6 a un 33 % (Shults et al., 2001). ...
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... The correlation between the behavioral impairments and BEC observed in this study supports the notion that ethanol-induced behavioral impairments are a function of BEC, as shown by previous studies (Brick & Erickson, 2009;Brumback, Cao, & King, 2007;Liu & Ho, 2010;Perry et al., 2006). Progressive alcohol intoxication has been shown to produce impairment in the motor control and balance with a BEC as low as 5 mg/dL (Fell & Voas, 2006). One caveat of the current study was that only male mice were used. ...
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... High visibility enforcement programs (e.g., strategies which pair police enforcement and publicity in order to increase the public's perception of risk) produce significant, although local and temporary, reductions in drunk driving (Elder et al., 2002(Elder et al., , 2004Goodwin et al., 2015;Johnson, 2016). Furthemore, information on drinking and driving risks is being deseminated more widely than ever (Fell & Voas, 2006;Walters et al., 2005;NHTSA, 2006). The public clearly is aware of the risks associated with drinking and driving (Ander & Swift, 2015;MacLeod et al., 2015). ...
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Thesis
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