THE MASSACHUSETTS SAVING LIVES PROGRAM: SIX CITIES WIDEN THE FOCUS FROM DRUNK DRIVING TO SPEEDING

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1 THE MASSACHUSETTS SAVING LIVES PROGRAM: SIX CITIES WIDEN THE FOCUS FROM DRUNK DRIVING TO SPEEDING Ralph Hingson, Sc.D. Boston University School of Public Health, Boston, Massachusetts, U.S.A. Summary: During the 1980s in the United States, over 700 new laws were passed to reduce drunk driving. Single vehicle, night fatal crashes (those likely to involve alcohol) declined 20% between 1980 and However, since 1986, total fatal crashes in the U.S. and Massachusetts have increased. Six Massachusetts communities have initiated comprehensive education and enforcement programs to reverse this trend. An evaluation assessing traffic safety problems in each city at the outset of the program indicated that speeding was much more common than drunk driving was increasing statewide, and was disproportionately found in drivers who drive after heavy drinking. The program has developed a speeding reduction initiative to accompany its focus on drunk driving. Introduction: Legal Reform to Reduce Drunken Driving in the 1980s: In the United States between 1980 and 1986, a ground swell of public concern about drunken driving emerged. All states adopted 21 as the minimum legal drinking age. All but six states made it illegal per se to drive with blood alcohol levels above.08 or.10. Half of the U.S. states passed administrative per se laws allowing police to suspend the license until trial of persons caught driving with BAL's above the legal limit. Numerous other states increased fines, license suspensions and jail sentences for drunken driving. Drunk driving arrests doubled from 1975 to 1983, reaching 1.9 million arrests that year.^ Citizen groups, such as Mothers Against Drunk Driving (MADD) and Remove Intoxicated Drivers (RID) helped secure passage of these laws. Over 400 local chapters were established between 1980 and Further groups, such as Students Against ^riving Drunk (SADD) stimulated school educational programs across the U.S. Media coverage of drunk driving increased dramatically from 1980 to Increases in the legal drinking age were accompanied by 10-15% reduction in fatal crashes in the targeted age groups.2, 3, 4, 5, 6 Also, when compared to states not passing such laws, administrative and criminal per se laws were accompanied by 9% and 6% declines respectively in night fatal crashes.^ Several experimental studies indicated that increased police drunk driving enforcement also reduced night fatal crashes.^ Overall, from 1980 to 1988, fatal crashes in the U.S. declined 7% from 45,284 to 42,119. Single vehicle, night fatal crashes (those most likely to involve alcohol) declined 15%, from 18,277 to 15,563. Erosion of Drunk Driving Declines: Unfortunately, the fatal crash declines occurred prior to News coverage of drunk driving diminished after 1984, as did drunk driving arrests. Since 1985, overall and single vehicle, night fatal crashes have risen 11%. This pattern whereby fatal crashes decline 200

2 immediately after new drunk driving laws, but subsequently rebound to prelaw levels has been observed in Great Britain, France, the Netherlands,^ as well as in Canada c and the state of Maine. J Drunk Driving in Massachusetts: Between 1980 and 1989, Massachusetts experienced a similar pattern. The legal drinking age there was raised to 21, and major drunk driving laws were passed in 1982 and Also the Governor's Drug Alliance initiated education about drunk driving in most schools across the state. Annual drunk driving arrest totals also increased 29% from 1981 to 1984, but then tapered off slowly.^ From 1980 to 1988, fatal crashes declined 17%; and night fatal crashes, 32%. Annual telephone surveys revealed that from 1981 to 1988, the proportion of adult drivers who drove after five plus drinks in a given month had declined from 14% to 7%. Unfortunately after 1985, the decline to nighttime fatal crashes stopped. Further, overall fatal crashes actually increased 10% since Massachusetts Saving Lives Program: To further reduce drunk driving, related risky traffic behaviors and fatal crashes, the Massachusetts Governor's Highway Safety Bureau and the Commonwealth Fund of New York developed a program to initiate grass roots activities at the Community level. The Institute of Medicine has suggested that approaches used in community intervention programs to reduce cardiovascular disease risk factors (e.g., smoking, diet, hypertension, and sedentary live style) may be useful in reducing alcoholrelated health problems. ^ Large scale controlled s t u d i e s ^. ^ in Finland, California, Minnesota and Rhode Island assessed programs that targeting both high risk groups and the total community via the media, schools, work places, and civic organizations. Significant positive changes have been reported across socioeconomic and risk factor strata in the target relative to comparison communities. The Saving Lives Program borrowed concepts from these multistrategy interventions. From 50 eligible Massachusetts cities, six were competitively selected to receive three year grants. Communities were encouraged to 1) implement school-based and community-wide education about the dangers of drunk driving and risky traffic behaviors; 2) increase enforcement of drunken driving and other traffic laws at high risk times and locations; 3) encourage business involvement in programs to reduce drunken driving and increase safety belt use among employees; 4) establish alcohol server training programs; 5) form a series of community task forces coordinated by the Mayor's Office and comprised of public officials and private citizens to stimulate public interest and oversee the program. Communities were also encouraged to develop their own initiatives to meet their unique traffic safety needs. Further, communities will attempt to institutionalize their program after the initial three years of funding. Program Evaluation: A program evaluation is providing: 1) a pre program assessment of traffic safety problems in each community; 2) a process monitoring of initiatives started in each town; 3) an annual assessment of program progress; and 4) a summative evaluation of the program's overall effects on traffic injuries and deaths. A quasi-experimental design compares Saving Lives cities to other cities that submitted strong applications (but 201

3 were not funded) and the rest of the state. Intermediate behavior change is being assessed through a series of random digit dial telephone surveys of adolescents and adults (N=400 in each community, 600 in comparison communities, and a similar number statewide). Two subsequent surveys will be conducted at annual intervals and will probe whether exposure to school and public informational messages about traffic safety increased, knowledge and perceptions of police and court enforcement of traffic laws change, and whether respondents experience greater informal social pressures to avoid risky traffic behaviors. The surveys also query respondents about drunk driving, speeding, safety belt use, running red lights, illegal turns, and traffic crash involvement. A series of direct observational studies further explore speeding, safety belt use, illegal turns, and red light violations. Arrests and convictions for traffic violations are also being monitored as are the number of newspaper articles dealing with traffic safety in each community. Finally, injury and fatal crashes are being monitored for five years prior to and five years following program initiation. The balance of the paper 1) summarizes findings from the pre-program analysis of traffic trends in Saving Lives cities; 2) examines reasons for the recent increase in fatal and injury crashes in Massachusetts; and 3) offers suggestions for program response. Traffic Injuries and Deaths: Prior to the project from , trends in traffic injuries were nearly identical in Saving Lives cities, control cities, and statewide. Nighttime traffic injuries (those most likely to involve alcohol) declined 36% in Saving Lives cities, 35% in control cities, and 43% statewide. However, total traffic injuries increased 36% in Saving Lives cities, 19% in control Cities, and 17% statewide. During that time period, mileage driven in Massachusetts increased 10%. Telephone and Direct Observation Studies Drunk Driving: The telephone and observational studies provide some insight into these trends. Based on statewide telephone surveys since 1981, the proportion of adult drivers in Massachusetts who reported driving after five plus drinks during the month prior to the interview declined from 41% to 7%, and the proportion of teenage drivers who drove after any drinking declined from 41% to 19%. In 1988 in Saving Lives cities, comparison cities, and statewide, only 7% of teens and 6% of adults reported driving after five plus drinks, enough to be legally intoxicated. Speeding: In contrast, speeding increased. In a 1985 statewide survey, 12% of respondents reported speeding twenty plus miles over the limit at least weekly. By 1988, that increased to 29%. That year in Saving Lives cities, 47% of adolescents (16-19) and 23% of adults reported speeding. In the direct observation survey, over 8000 vehicles were monitored using radar from unmarked cars. Thirty six percent of vehicles were traveling at least ten miles over the posted speed. Five percent were traveling fifteen or more miles over the posted limit. On roadways posted at 20 miles per hour, 47% of drivers exceeded the limit by 15 mph or more. In other words, the most densely populated roadways, with the most intersections and the one most likely to be near school grounds, were precisely the roadways where speeding violations were most likely 202

4 to occur. In 1988 in Massachusetts, in 37% of fatal crashes, either a speeding citation was issued, the reporting officer indicated speeding contributed to the crash, or one of the vehicles was traveling twenty plus miles over the limit. Over 80% of the fatal speeding crashes occurred on local roadways posted at 45 mph or less. That means community efforts are needed to address this problem. Speeders often kill other people. Over half the people killed in speeding crashes were persons other than the speeding driver. Teenagers are disproportionately involved in fatal speeding crashes. One third of fatal speed crashes involve a teenage driver even though they comprise on 7% of the driving population. Speeding and drunk driving often go together. In Saving Lives cities, drivers who drove after five plus drinks at least once per week were three times more likely to report speeding twenty plus miles over the limit, and speeders were four times more likely to report driving after five plus drinks. In 1988, half the fatal crashes in Massachusetts involving speeding also involved a drunk driver. At higher speeds, drunk drivers are particularly dangerous because of their poorer sensory motor coordination and reaction time. Between 1983 and 1987, speeding fatalities increased 34% in Massachusetts. Speeding was compromising the benefits of the state's drunk driving efforts. Between 1983 and 1987, while fatal crashes involving a speeding driver declined 16%, those involving both drunk driving and speeding increased 36%, and those involving speed alone increased 39%. Implications for the Saving Lives Program: The Saving Lives Program was initiated at a time when nationally and locally a great deal of attention focused on reducing drunk driving. In Massachusetts and Program towns, night injuries likely to involve an intoxicated driver had been declining for several years. However, an overall increase in traffic fatalities and injuries raised concern about other crash contributors. A relaxation of attention to traffic speed appears to have been occurring nationwide. While a national survey in 1982 found the majority of the U.S. public supportive of retaining the 55 mph limit,^ in 1987, thirty eight states raised speed limits on rural interstate highways. In 1988, fatalities on those roadways increased by one third compared to the annual average from On urban interstates in the same states where speed limits were not raised, fatalities increased only 9%, and on the other roads in the same states, fatalities decreased by 4%. It has been estimated that 700 persons nationwide have died as a result of raising the limit to sixty five. 0 In Massachusetts where the interstate speed limit of 55 was retained, speeding nonetheless increased, and fatal crashes involving speed increased 34% from Reported speeding was much more common in Saving Lives cities and statewide than reports of driving after five plus drinks. So too were speed related behaviors, such as accelerating at lights turning yellow and running red lights. In Saving Lives cities and statewide prior to the Saving Lives Program, only 203

5 about one third of surveyed drivers believed police are very likely to stop speeders in their cities. Yet even more favored more speeding enforcement than drunk driving roadblocks. Among adolescents, over two thirds in Massachusetts reported being taught in school about the dangers of drunk driving. In contrast, only one quarter received instruction about the dangers of speeding or failure to wear belts. Because speeding, drunk driving, and red light running are highly interrelated behaviors and because persons who engage in these risky behaviors are much less likely to wear safety belts, focusing only on drunk driving may be insufficient to reduce traffic injuries and deaths in the long run. The Saving Lives program cities have expanded the focus of their efforts to include a speed reduction program. Massachusetts also increased its speeding fines from $50 to $50 for the first ten miles over the speed limit and $10 for each additional mile over the limit, making Massachusetts speed fines the steepest in New England. The experience in the U.S. and Massachusetts suggests that grass roots concern and legal efforts can reduce drunk driving. Similar efforts are also needed concerning related traffic behaviors, such as speeding if optimal long-term reductions are to be achieved in drunk driving and other traffic deaths. Supported by grants from the National Institute on Alcoholism and Alcohol Abuse and the Massachusetts Governor's Highway Safety Bureau. References 1. Voas, R. Lacey J.: Issues in the Enforcement of Impaired Driving Laws in the U.S. Surgeon General's Workshop on Drunk Driving. U.S. Department of Health and Human Services. pp , McCarthy, J., Wolfson, M., and Barker, D.: The Founding of Local Citizen Groups Opposing Drunken Driving. in Ecological Models of Organization, ed. G. R. Carroll, Ballinger Press, Cambridge, MA. pp Williams, A., Zador, P., and Harris S., Karpf, R.: The Effect of Raising the Legal Minimum Drinking Age on Involvement in Fatal Crashes. J Legal Studies 12: Hingson, R., et al.: Impact of Legislation Raising the Drinking Age from in Massachusetts. Am J of Public Health. 73: Du Mouchel, W.; Williams, A.; Zador, P.: Raising the Alcohol Purchase Age: Its Effects on Fatal Motor Vehicle Crashes in 26 States. Insurance Institute for Highway Safety, Washington, D.C U.S. General Accounting Office: Drinking Age Laws - An Evaluation Synthesis of Their Impact on Highway Safety. Publication No. GAL/PEMD-87-10, Washington, D.C

6 7. Zador, P.; Lund, A.; Fields, M.; and Weinberg, K.: Fatal Crash Involvement and Laws Against Alcohol Impaired Driving. Insurance Institute for Highway Safety. Washington, D.C Lacey, J. et al.: Enforcement and Public Information Strategies for DWI General Deterrence: Arrest Drunk Driving - The Clearwater and Largo, Florida Experience. Pub. No. DOT HS , U.S. Department of Transportation, Washington, D.C Voas, R., Rhodenizer, A.; Lyon, C.: Evaluation of Charlottesville Checkpoint Observation. Final Report to the National Highway Traffic Safety Administration. Charlottesville, VA. April, Voas, R. and Hause, J.: Deterring the Driving Driver: The Stockton Experience. Accident Analysis and Prevention. 19: Ross, H.: Deterring the Drinking Driver: Legal Policy and Social Control. D.C. Heath and Company, Lexington, MA Liben, D., Vingilis, E., Dlefgen, H.; The Canadian Drinking Driving Countermeasure Experience. Accident Analysis and Prevention. 19: Hingson, R., et al.: Effects of Maine's 1981 and Massachusetts' 1982 Driving Under the Influence Legislation. Am J of Public Health 77: Senate Committee on Post Audit and Oversight: The Commonwealth of Massachusetts: The State's Drunk Driving Law Appraising Performance; Planning the Future Institute of Medicine: Prevention and Treatment of Alcohol Problems: Research Opportunities. National Academy Press, Washington, D.C Pushka, P., et al.: Change in Risk Factors for Coronary Heart Disease During 10 Years of a Community Intervention Programme (North Karelia Project). British Medical Journal 287: Dec. 17, Farquar, J.: The Community-Based Model of Lifestyle Intervention Trials. Am J Epidemiology 108: Perry, C.; Murray, D.; Klepp, K.: Predictors of Adolescent Smoking and Implications for Prevention. In Psychological Predictors of Smoking Among Adolescents. MMRW (Suppl) 36:41s-45s. Sept Institute of Medicine: 55 A Decade of Experience. National Academy Press, Washington, D.C Braun, H.; Wells, J.; Lund, A.: Motor Vehicle Crash Fatalities in the Second Year of 64 MPH Speed Limits. Journal of Safety Research 21: