Recent Publications

Research-Supported Intervention and Discretion among Frontline Workers Implementing Home Visitation Services
   Research on Social Work Practice (2017)
    Willging, CE ; Trott, E ; Fettes, D; Gunderson, L ; Green, A; Hurlburt M; Aarons G
Objective: We examine how frontline workers and supervisors delivering a research-supported intervention (RSI) to reduce child neglect negotiated system-related challenges, the pragmatics of RSI implementation, and their professional identities and relationships with clients. Methods: We conducted semi-structured interviews, small group discussions, and focus groups with frontline workers and supervisors in one large county over two time periods. We used iterative coding to analyze qualitative data. Results: Frontline workers navigated several aspects of RSI implementation and sustainment: (1) contract requirements and information dissemination, (2) fidelity, (3) competing demands and crises, (4) structure versus creativity, and (5) relationships with clients. Conclusions: Workers dynamically negotiated multiple system- and provider-level (or outer- and inner-contextual) demands influencing RSI provision for clients with complex service needs. Results affirm the need to attend to the unintended consequences of implementing new contract, reimbursement, and other system or organizational processes and to address the “committed work” supporting RSI delivery.

Drinking, Alcohol Use Disorder, and Treatment Access and Utilization Among U.S. Racial/Ethnic Groups
   Alcoholism, Clinical And Experimental Research (2017)
    Vaeth, Patrice A. C. ; Wang-Schweig, Meme ; Caetano, Raul
Data from approximately 140 articles and reports published since 2000 on drinking, alcohol use disorder (AUD), correlates of drinking and AUD, and treatment needs, access, and utilization were critically examined and summarized. Epidemiological evidence demonstrates alcohol-related disparities across U.S. racial/ethnic groups. American Indians/Alaska Natives generally drink more and are disproportionately affected by alcohol problems, having some of the highest rates for AUD. In contrast, Asian Americans are less affected. Differences across Whites, Blacks, and Hispanics are more nuanced. The diversity in drinking and problem rates that is observed across groups also exists within groups, particularly among Hispanics, Asian Americans, and American Indians/Alaska Natives. Research findings also suggest that acculturation to the United States and nativity affect drinking. Recent studies on ethnic drinking cultures uncover the possible influence that native countries' cultural norms around consumption still have on immigrants' alcohol use. The reasons for racial/ethnic disparities in drinking and AUD are complex and are associated with historically rooted patterns of racial discrimination and persistent socioeconomic disadvantage. This disadvantage is present at both individual and environmental levels. Finally, these data indicate that admission to alcohol treatment is also complex and is dependent on the presence and severity of alcohol problems but also on a variety of other factors. These include individuals' sociodemographic characteristics, the availability of appropriate services, factors that may trigger coercion into treatment by family, friends, employers, and the legal system, and the overall organization of the treatment system. More research is needed to understand facilitators and barriers to treatment to improve access to services and support. Additional directions for future research are discussed.

Enduring enrollments in West Virginia’s Medicaid programme due to severe injury
   Injury Prevention (2017)
   Smith, Michael; Miller, Ted R ; Zaloshnja, Eduard
Objective: To assess frequency, duration and costs of Medicaid conversions that occur when severe injury causes patients to enrol in Medicaid to pay their hospital bills. Once enrolled, Medicaid pays all their medical bills, not simply their injury bill. Data sources 2000–2005 West Virginia Medicaid claims data and 2000–2006 eligibility data for new enrollees under the age of 65. To model national costs, published Medicaid conversion rates across 14 states for 2003 and 2008 Healthcare Cost and Utilization Program Nationwide Inpatient Sample data. Methods: We identified enrollees who had hospital inpatient claims for injury within 30 days of enrolment, then tabulated eligibility duration and payments by year and in aggregate. For those with open-ended eligibility, we assumed future annual claims payments would equal average payments in eligibility years 5–6. We multiplied the mean payments data adjusted to national prices with the estimated conversions nationally. Results: Overall, 5.4% of hospitalised patients with injury in West Virginia converted to Medicaid, with 17% of conversions on Medicaid 7?years post injury. In 2010 dollars, Medicaid payments averaged $93?900 per conversion for non-injury medical care before the age of 65. Conversions added an estimated $87 in payments for non-injury care to governments’ medical payments per medically treated injury in the USA. They added 14% to governments’ gunshot and assault medical payments, 7.5% to its road crash medical payments and 6% to its total injury medical payments. Conclusions: These findings increase the rationale for governments to partner in injury prevention efforts.

The impact of retail beverage service training and social host laws on adolescents’ DUI rates in San Diego County, California
   Traffic Injury Prevention (2017)
    Scherer, Michael ; Romano, Eduardo ; Caldwell, Susan; Taylor, Eileen
Introduction: Driving under the influence (DUI) citations are still a serious concern among drivers aged 16-20 years and have been shown to be related to increased risk of fatal and non-fatal crashes. A battery of laws and policies has been enacted to address this concern. While numerous studies have evaluated these policies, there is still a need for comprehensive policy evaluations that take into account a variety of contextual factors. Previous effort by this research team examined the impact of 20 minimum legal drinking age (MLDA)-21 laws in the state of California, as they impacted alcohol-related crash rates among drivers under 21 years of age while at the same time accounting for alcohol and gas taxes, unemployment rates, sex distribution among drivers, and sobriety checkpoints. The current research seeks to expand this evaluation to the county level (San Diego, County). More specifically, we evaluate the impact of measures subject to County control such as Retail Beverage Service (RBS) laws and Social Host (SH) laws, as well as media coverage, city employment, alcohol outlet density, number of sworn officers, alcohol consumption, and taxation policies to determine the most effective point of intervention for communities seeking to reduce underage DUI citations. Methods: Annual DUI citation data (2000 to 2013), RBS and SH policies, and city-wide demographic, economic, and environmental information were collected and applied to each of the 20 cities in San Diego County, California. A structural equation model was fit to estimate the relative contribution of the variables of interest to DUI citation rates. Results: Alcohol consumption and alcohol outlet density both demonstrated a significant increase in DUI rates, while RBS laws, SH laws, alcohol tax rates, media clusters, gas tax rates and unemployment rates demonstrated significant decreases in DUI rates. Conclusions: At the county level, although RBS, SH laws, and media efforts were found to contribute to a significant reduction in DUI rates, the largest significant contributors to reducing DUI rates were alcohol and gas taxation rates. Policy makers interested in reducing DUI rates among teenagers, should examine these variables within their specific communities and consider conducting community-specific research to determine the best way to do so. Future efforts should be made to develop models that represent specific communities who are interested in reducing DUI rates among drivers aged 16-20 years.

Intercorrelation of alcohol and other drug use disorders among a national sample of drivers
   Journal of Psychoactive Drugs (2017)
    Scherer, M. ; Canham, S.; Voas, R.B. ; Furr-Holden, C.D.
This study examined the relationship between alcohol, marijuana, cocaine, and painkiller use disorders in a sample of drivers. We studied nighttime drivers aged 16 to 87 (n = 4,277) from the 2007 National Roadside Survey who reported substance use behaviors and provided breath tests for alcohol. Logistic regression analyses assessed the relationships between (1) substance (i.e., alcohol/marijuana/cocaine/pain killer) use disorders; (2) demographic characteristics; and (3) BAC levels. Overall, 13.2% of participants met criteria for marijuana use disorder, 7% met criteria for cocaine use disorder, and 15.4% met criteria for extra-medicinal painkiller use disorder. When self-report data were analyzed, three reciprocal associations emerged: (1) marijuana use disorders and alcohol use disorders were correlated; (2) marijuana use disorders and cocaine use disorders were correlated; and (3) cocaine use disorders and painkiller use disorders were correlated. BAC data revealed that marijuana and cocaine use disorders were both associated with positive BAC levels, but only cocaine use disorders were associated with BAC levels over the legal limit. Results suggest significant poly-substance use disorders in a sample of nighttime drivers, with variations by demographic characteristics. The individual and public health consequences of multiple substance use disorders among drivers are significant.

Alcohol Storylines in Television Episodes: The Preventive Effect of Countering Epilogues
   Journal of Health Communication (2017)
   Russell, Cristel Antonia; Russell, Dale Wesley; Grube, Joel W. ; McQuarrie, Edward
This experimental study assessed whether alcohol television storylines impact youth drinking attitudes and intentions and whether corrective epilogues can potentially moderate this impact. Television episodes were professionally produced to depict heavy drinking leading to either positive or negative consequences. The pro- and anti-alcohol episodes were shown alone or with an epilogue where a main character discussed the deleterious effects of excessive drinking. Attitudes toward drinkers and drinking intentions were measured subsequently, along with reactions to the episode and demographic data, among participants aged 14–17 using an online study. Exposure to the pro-alcohol episode was related to more positive attitudes toward drinkers. Including an epilogue after a pro-alcohol episode was related to more negative viewers’ attitudes toward drinkers and lower drinking intentions compared to a pro-alcohol episode with no epilogue. By contrast, including an epilogue after an anti-alcohol episode was unrelated to attitudes toward drinkers or drinking intentions. Viewing a single television episode with a pro-alcohol message may lead to more positive attitudes toward drinkers. The finding that a brief epilogue may reduce the impact of the pro-alcohol storyline suggests easily implemented preventive strategies to counter the adverse impact of substance use portrayals in entertainment programming.

Cannabis and crash responsibility while driving below the alcohol per se legal limit
   Accident Analysis & Prevention (2017)
    Romano, Eduardo ; Voas, Robert B ; Camp, Bayliss
There is a growing interest in how extensively the use of marijuana by drivers relates to crash involvement. While cognitive, lab-based studies are consistent in showing that the use of cannabis impairs driving tasks, epidemiological, field-based studies have been inconclusive regarding whether cannabis use causes an increased risk of accidents. There is ample evidence that the presence of cannabis among drivers with a BAC=0.08g/dL highly increases the likelihood of a motor vehicle crash. Less clear, however, is the contribution of cannabis to crash risk when drivers have consumed very little or no alcohol. This effort addresses this gap in knowledge. We took advantage of a unique database that merged fatal crashes in the California Statewide Integrated Traffic Records System (SWITRS) and the Fatality Analysis Reporting System (FARS), which allows for a precise identification of crash responsibility. To account for recent increase in lab testing, we restricted our sample to cover only the years 1993-2009. A total of 4294 drivers were included in the analyses. Descriptive analyses and logistic regressions were run to model the contribution of alcohol and drugs to the likelihood of being responsible in a fatal crash. We found evidence that compared with drivers negative for alcohol and cannabis, the presence of cannabis elevates crash responsibility in fatal crashes among drivers at zero BACs (OR=1.89) and with 0<BAC<0.05g/dL (OR=3.42), suggesting that emphasis on curbing impaired driving should not be solely focused on heavy-drinking drivers. Data limitations however caution about the generalizability of study findings. Special efforts to understand the effect of cannabis on fatal crashes, in particular in the absence of alcohol, are needed.

Riding with impaired drivers among recent Latino immigrants in southern Florida
   Journal of Immigrant and Minority Health (2017)
    Romano, E. ; de la Rosa, M.; Sanchez, M.; Babino, R.
In a previous effort we showed that compared with immigrants who are permanent residents, undocumented immigrants are more likely to binge drink, but less likely to drink while impaired (DWI) partly due to their limited amount of driving. This report examines a related risk: riding with an impaired driver (RWI). Data came from an ongoing longitudinal sample of Latino immigrants to Miami-Dade County, FL. Descriptive analyses and regression techniques were applied. While DWI rates among Latino immigrants is heavily limited by their access to a car, RWI rates were not restricted by driving limitations, nor related to participants' legal immigration status (LIS). RWI rates were linked only to heavy drinking. Because it is not affected by driving limitations, RWI for these Latino immigrants is perhaps a more immediate risk than DWI. Addressing RWI among Latino immigrants should be a priority for traffic safety to Miami/Dade country.

Forty years of state alcohol and pregnancy policies in the USA: Best practices for public health or efforts to restrict women’s reproductive rights?
   Alcohol and Alcoholism (2017)
   Roberts, Sarah; Thomas, Sue ; Treffers, Ryan ; Drabble, Laurie
Short Summary: The number of states with alcohol and pregnancy policies has increased since 1970 (1 in 1974 and 43 in 2013). Alcohol and pregnancy policies are becoming increasingly punitive. These punitive policies are associated with efforts to restrict women’s reproductive rights rather than policies that effectively curb alcohol-related public health harms. Aims: Alcohol consumption during pregnancy remains a public health problem despite >40 years of attention. Little is known about how state policies have evolved and whether policies represent public health goals or efforts to restrict women’s reproductive rights. Methods: Our data set includes US state policies from 1970 through 2013 obtained through original legal research and from the National Institute for Alcohol Abuse and Alcoholism’s (NIAAA)’s Alcohol Policy Information System. Policies were classified as punitive to women or supportive of them. The association between numbers of punitive policies and supportive policies in 2013 with a measure of state restrictions on reproductive rights and Alcohol Policy Effectiveness Scores (APS) was estimated using a Pearson’s correlation. Results: The number of states with alcohol and pregnancy policies has increased from 1 in 1974 to 43 in 2013. Through the 1980s, state policy environments were either punitive or supportive. In the 1990s, mixed punitive and supportive policy environments began to be the norm, with punitive policies added to supportive ones. No association was found between the number of supportive policies in 2013 and a measure of reproductive rights policies or the APS, nor was there an association between the number of punitive policies and the APS. The number of punitive policies was positively associated, however, with restrictions on reproductive rights. Conclusion: Punitive alcohol and pregnancy policies are associated with efforts to restrict women’s reproductive rights rather than effective efforts to curb public health harms due to alcohol use in the general population. Future research should explore the effects of alcohol and pregnancy policies.

The significance of benefit perceptions for the ethics of HIV research involving adolescents in Kenya
   Journal of Empirical Research on Human Research Ethics (2017)
   Rennie, S; Groves, AK; Hallfors, DD ; Iritani, BJ ; Odongo, FS; Luseno, WK
Assessment of benefits is traditionally regarded as crucial to the ethical evaluation of research involving human participants. We conducted focus group discussions (FGDs) with health and other professionals engaged with adolescents, caregivers/parents, and adolescents in Siaya County, Kenya, to solicit opinions about appropriate ways of conducting HIV research with adolescents. Our data revealed that many focus group participants have a profoundly positive conception of participation in health research, including studies conferring seemingly few benefits. In this article, we identify and analyze five different but interrelated types of benefits as perceived by Kenyan adolescent and adult stakeholders in HIV research, and discuss their ethical significance. Our findings suggest that future empirical and conceptual research should concentrate on factors that may trigger researcher obligations to improve benefit perceptions among research participants.

Lifetime cost of abusive head trauma at ages 0–4, USA
   Prevention Science (2017)
    Miller, Ted R. ; Steinbeigle, Ryan; Lawrence, Bruce A. ; Peterson, Cora; Florence, Curtis; Barr, Marilyn; Barr, Ronald G.
This paper aims to estimate lifetime costs resulting from abusive head trauma (AHT) in the USA and the break-even effectiveness for prevention. A mathematical model incorporated data from Vital Statistics, the Healthcare Cost and Utilization Project Kids’ Inpatient Database, and previous studies. Unit costs were derived from published sources. From society’s perspective, discounted lifetime cost of an AHT averages $5.7 million (95% CI $3.2–9.2 million) for a death. It averages $2.6 million (95% CI $1.0–2.9 million) for a surviving AHT victim including $224,500 for medical care and related direct costs (2010 USD). The estimated 4824 incident AHT cases in 2010 had an estimated lifetime cost of $13.5 billion (95% CI $5.5–16.2 billion) including $257 million for medical care, $552 million for special education, $322 million for child protective services/criminal justice, $2.0 billion for lost work, and $10.3 billion for lost quality of life. Government sources paid an estimated $1.3 billion. Out-of-pocket benefits of existing prevention programming would exceed its costs if it prevents 2% of cases. When a child survives AHT, providers and caregivers can anticipate a lifetime of potentially costly and life-threatening care needs. Better effectiveness estimates are needed for both broad prevention messaging and intensive prevention targeting high-risk caregivers.

Heterogeneous costs of alcohol and drug problems across cities and counties in California
   Alcoholism: Clinical and Experimental Research (2017)
    Miller, Ted R. ; Nygaard, Peter ; Gaidus, Andrew ; Grube, Joel W. ; Ponicki, William R. ; Lawrence, Bruce A. ; Gruenewald, Paul J.
Background: Estimates of economic and social costs related to alcohol and other drug (AOD) use and abuse are usually made at state and national levels. Ecological analyses demonstrate, however, that substantial variations exist in the incidence and prevalence of AOD use and problems including impaired driving, violence, and chronic disease between smaller geopolitical units like counties and cities. This study examines the ranges of these costs across counties and cities in California. Methods: We used estimates of the incidence and prevalence of AOD use, abuse, and related problems to calculate costs in 2010 dollars for all 58 counties and an ecological sample of 50 cities with populations between 50,000 and 500,000 persons in California. The estimates were built from archival and public-use survey data collected at state, county, and city levels over the years from 2009 to 2010. Results: Costs related to alcohol use and related problems exceeded those related to illegal drugs across all counties and most cities in the study. Substantial heterogeneities in costs were observed between cities within counties. Conclusions: AOD costs are heterogeneously distributed across counties and cities, reflecting the degree to which different populations are engaged in use and abuse across the state. These findings provide a strong argument for the distribution of treatment and prevention resources proportional to need.

Non-economic damages due to physical and sexual assault: Estimates from civil jury awards
   Forensic Science and Criminology (2017)
    Miller, Ted ; Cohen, Mark; Hendrie, Delia
This paper presents a detailed study of jury awards for compensatory damages to victims of crime. Such awards typically result when victims sue third parties who are responsible for some form of negligence such as inadequate security or alcohol over-service. We obtained nationwide data on jury awards to crime victims and examined the relationship between physical losses, medical costs, offender and victim characteristics, and the ultimate compensatory jury award. Despite the large variability in jury awards, we were able to explain 45%-50% of the variation in the natural log of jury awards for physical assault. The awards systematically vary with the severity of physical injuries sustained by the victim. Considerably more variation is found in the case of sexual assault. We use our regressions to construct estimates of noneconomic damages – the pain, suffering and reduced quality of life endured by the average victim of violent crime in the U.S.

Pathways from witnessing parental violence during childhood to involvement in intimate partner violence in adult life: The roles of depression and substance use
   Drug and Alcohol Review (2017)
   Madruga, Clarice S.; Viana, Maria Carmen; Abdalla, Renata Rigacci; Caetano, Raul ; Laranjeira, Ronaldo
Introduction and Aims: The aims of this study were to determine the prevalence of witnessing parental violence (WPV) during childhood and of current intimate partner violence (IPV) victimisation and aggression in a Brazilian sample, in order to verify pathways between WPV and involvement in IPV as an adult. Design and Methods: The mediating roles of substance use and depression were investigated. Data came from the Second Brazilian National Alcohol and Drugs Survey, a multi-cluster probabilistic household survey, which gathered information on the use of psychoactive substances, current depressive disorder, history of childhood direct and indirect exposure to domestic violence and IPV in a nationally representative sample. A subsample of 2120 individuals aged 14 years or older was analysed. Weighted prevalence rates, adjusted odds ratio and conditional path models were performed. Results: Being a victim of IPV was reported by 6% of the sample. Thus being, 4.1% reported being IPV perpetrators; these rates were 16.6% and 7.3%, respectively, among those who reported WPV (13%). WPV was associated with being a victim of IPV in adult life, but not with becoming a perpetrator, regardless of being a victim of physical violence during childhood. There was a direct effect of WPV on IPV mediated by depressive symptoms. Alcohol and cocaine consumption and age of drinking initiation mediated only when combined with depressive symptoms. Discussion and Conclusions: Intergenerational transmission models of IPV through exposure during childhood can help to explain the high rates of domestic violence in Brazil. Our findings provide evidence to implement targeted prevention strategies where they are needed most: the victims of premature adverse experiences.

Adolescents, alcohol, and marijuana: Context characteristics and problems associated with simultaneous use
   Drug And Alcohol Dependence (2017)
    Lipperman-Kreda, Sharon ; Gruenewald, Paul J. ; Grube, Joel W. ; Bersamin, Melina
We investigated contexts of simultaneous use of alcohol and marijuana and the impact of simultaneous use on problems among adolescents. Ecological momentary assessment data were obtained over two weekends from 150 adolescents in California (47% female, M age=16.36years), using smartphone surveys administered early and late in the evening and again the following morning. We assessed whether, in what context, and with whom adolescents drank alcohol and used other substances over 3 evening hours. We assessed problems they experienced each evening on the following morning. Results showed that greater adult supervision in every context was associated with a 55% lower risk of simultaneous use (RRR=0.45, p=.05). Contexts with no other underage drinkers were associated with 99% lower risk of simultaneous use (RRR=0.01, p=.005). Each occasion of simultaneous use was related to 110% increase in the number of problems (IRR=2.10, p=.005), with 83%, 221% and 311% greater odds of violence (OR=1.83, p=.05), driving under the influence or riding with a drunk driver (OR=3.21, p=.05), or being drunk (OR=4.11, p=.005). Additional analyses showed that these problems may be attributed largely to the alcohol consumed in each context. Results demonstrate that it is essential to consider situational and social characteristics of substance use contexts to better understand adolescent simultaneous use of alcohol and drugs and problems.

Economic Recession, Alcohol, and Suicide Rates: Comparative Effects of Poverty, Foreclosure, and Job Loss
   American Journal Of Preventive Medicine (2017)
   Kerr, William C.; Kaplan, Mark S.; Huguet, Nathalie; Caetano, Raul ; Giesbrecht, Norman; McFarland, Bentson H.
Introduction: Suicide rates and the proportion of alcohol-involved suicides rose during the 2008-2009 recession. Associations between county-level poverty, foreclosures, and unemployment and suicide rates and proportion of alcohol-involved suicides were investigated. Methods: In 2015, National Violent Death Reporting System data from 16 states in 2005-2011 were utilized to calculate suicide rates and a measure of alcohol involvement in suicides at the county level. Panel models with year and state fixed effects included county-level measures of unemployment, foreclosure, and poverty rates. Results: Poverty rates were strongly associated with suicide rates for both genders and all age groups, were positively associated with alcohol involvement in suicides for men aged 45-64 years, and negatively associated for men aged 20-44 years. Foreclosure rates were negatively associated with suicide rates for women and those aged =65 years but positively related for those aged 45-64 years. Unemployment rate effects on suicide rates were mediated by poverty rates in all groups. Conclusions: Population risk of suicide was most clearly associated with county-level poverty rates, indicating that programs addressing area poverty should be targeted for reducing suicide risk. Poverty rates were also associated with increased alcohol involvement for men aged 45-64 years, indicating a role for alcohol in suicide for this working-aged group. However, negative associations between economic indicators and alcohol involvement were found for four groups, suggesting that non-economic factors or more general economic effects not captured by these indicators may have played a larger role in alcohol-related suicide increases.

Prevalence of self-reported prescription drug use in a national sample of U.S. drivers
   Journal of Studies on Alcohol and Drugs (2017)
    Kelley-Baker, Tara ; Waehrer, Geetha ; Pollini, Robin A.
Objective: Drug-involved driving has become an increasing concern. Although the focus has been on illegal drugs, there is evidence that prescribed medications can impair driving ability. The purpose of this study was to determine the self-reported prevalence of prescription drug use, including medical and nonmedical use, among a nationally representative sample of drivers and to report related driver characteristics. Method: As part of the 2013–2014 National Roadside Survey, drivers from 60 sites were randomly recruited and asked to complete a survey on prescription drug use. Results: Almost 20% of drivers reported using a prescription drug within the past 2 days, with the most common drug class being sedatives (8.0%), followed by antidepressants (7.7%), narcotics (7.5%), and stimulants (3.9%). Drivers who reported prescription drug use were significantly more likely to be female, older, non-Hispanic White, and report disability. Three of four drivers who reported medication use (78.2%) said the drug was prescribed for their use; the odds of using without a prescription were significantly higher for males, Black/African American, and Hispanic drivers, and lower for older drivers. Among those with a prescription, taking more than prescribed was most common for narcotics (6.8%), followed by sedatives (4.8%), stimulants (3.8%), and antidepressants (1.5%). Conclusions: These findings help to identify drivers using potentially impairing prescription drugs, both medically and nonmedically, and may inform the targeting of interventions to reduce impaired driving related to medications.

The National Violent Death Reporting System: Use of the Restricted Access Database and Recommendations for the System's Improvement
   American Journal Of Preventive Medicine (2017)
   Kaplan, Mark S.; Caetano, Raul ; Giesbrecht, Norman; Huguet, Nathalie; Kerr, William C.; McFarland, Bentson H.; Nolte, Kurt B.

The unintended effects of providing risk information about drinking and driving
   Health Psychology (2017)
    Johnson, Mark B. ; Kopetz, Catalina E.
Objective: Alcohol-impaired driving remains a serious public health concern despite the fact that drinking and driving risks are widely disseminated and well understood by the public. This research examines the motivational conditions under which providing risk information can exacerbate rather than decrease potential drinking drivers' willingness to drive while impaired. Method: In a hypothetical drinking and driving scenario, 3 studies investigated participants' self-reported likelihood of drinking and driving as a function of (a) accessibility of information regarding risk associated with drinking and driving, (b) motivation to drive, and (c) need for cognitive closure (NFC). Results: Across the 3 studies, participants self-reported a higher likelihood of driving when exposed to high-risk information (vs. low-risk information) if they were high in NFC. Risk information did decrease self-reported likelihood of driving among low-NFC participants (Studies 1-3). Furthermore, this effect was exacerbated when the relevant motivation (to get home conveniently) was high (Study 3). Conclusions: These findings have important implications for impaired-driving prevention efforts. They suggest that at least under some circumstances, risk information can have unintended negative effects on drinking and driving decisions. The results are consistent with the motivated cognition literature, which suggests that people process and use information in a manner that supports their most accessible and important motivation despite potentially negative consequences.

Environmental approaches to prevention: Communities and contexts
   Principles of Addiction Medicine (2017)
    Gruenewald, P.J. ; Grube, J.W. ; Saltz, R. ; Paschall, M.J.