Spotlight on PIRE


Ted Miller manuscript chosen for the Articles of Public Interest page in an upcoming issue of Alcoholism: Clinical & Experimental Research (ACER)

How much does alcohol and other drug abuse cost Californians?

Use of alcohol and other drugs can create serious health, safety, and social problems. But how much do these problems cost taxpayers and individuals? How much do these problems vary from place to place? What are the relative costs of alcohol as compared to other drugs? A recent study conducted at the Prevention Research Center of Pacific Institute for Research and Evaluation was designed to answer these questions for all 58 California counties as well as 50 mid-sized cities in California.

Studies of economic and social costs related to alcohol and other drug use and abuse are usually made at state and national levels. The current study innovatively drills down to the county and city level, allowing for a more detailed understanding of how these problems vary from place to place and enabling local policy makers to assess the nature of problems in their jurisdiction.

The findings show that alcohol related problems are more common and costly than problems related to the use of other drugs. In California as a whole, alcohol misuse and use disorders cost $129 billion in 2010.  That is about three times the $44 billion bill for illicit drug use.  The cost for alcohol use and misuse works out to $3,450 for each California resident. The costs of these problems varied greatly from one area to another. Comparing the 58 counties, the counties with the highest rate of alcohol problems had per capita costs three times that of the counties with the lowest rate (ranging from $7,819 to $2,588). For drug related problems, the counties with the highest rate of problems had more than six times the per capita cost of counties with the lowest rate (ranging from $3,786 to $608). The variation is even greater from city to city. The highest per capita cost within a city was $10,734, 11 times higher than the city with the lowest cost for alcohol related problems. For drug related problems, the city with the highest per capita cost was $7,159, almost 19 times higher than the lowest cost city.

Impaired driving in California cost an estimated $26 billion in 2010, with crashes attributable to alcohol dominating these costs. Of the estimated $10 billion in violence costs linked to substance use, 73% were attributed to alcohol and 27% to illicit drugs. Similarly, 73% of the $127 billion in other illness and injury costs were attributed to alcohol. Conversely, 82% of the estimated $4 billion in non-violent crime costs were attributable to drugs as were 74% of the estimated $2 billion in treatment costs.

In 2010, alcohol caused or contributed to an estimated 22,281 deaths in California and drug abuse added another 5,533. Deaths (summed across the impaired driving, violence, and other mortality categories) accounted for 64% of the estimated $173 billion in substance misuse and use disorder costs in the state. Injury deaths alone – including impaired driving crashes, homicides, suicides, and overdoses among others – accounted for 28% of total costs. Long-term illness deaths associated with substance abuse accounted for the remaining 36%. In 2009, substance misuse and abuse in California caused or contributed to an estimated 514,000 violent crimes – rapes, robberies and assaults – with alcohol responsible for 350,000 and illicit drugs for 164,000.

The study emphasizes the usefulness of having more localized cost estimates. Lead study author Ted Miller stated, “We can provide cost estimates for any California county and for the 50 cities included in the study. We want to make this information available to policy makers and the public throughout the state to help them with planning and resource allocation.”  Study co-author, Paul Gruenewald stated, “Our research over many years indicates the importance of the local community environment in predicting and preventing alcohol and other drug problems.  This research provides an important tool to communities in California.”

The researchers based cost estimates on available data regarding the incidence of impaired driving crashes (including fatalities, injuries, and property damage), other alcohol related crimes and injuries, alcohol and drug abuse related medical conditions and costs of treatment for alcohol and other drug abuse disorders, fetal alcohol effects, child abuse and neglect related to alcohol and other drug use, and risky sex leading to sexually transmitted diseases among young people related to alcohol and drug use.

Costs for each type of alcohol and/or drug related problem included tangible costs, such as spending on medical care, property damage, public services (police, fire, etc.), adjudication, and sanctioning. Tangible costs can be direct (paid out of pocket) or indirect (e.g., the value of wages and fringe benefits not earned or the estimated cost of replacing household work not done, because people are killed, injured, or ill). Intangible costs put a value on things one cannot buy and sell -- pain, suffering, and lost quality of life.

The researchers used estimates of the incidence and prevalence of alcohol and other drug use, abuse and related problems to calculate costs in 2010 dollars for all 58 counties and a 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.

With regard to the geographic distribution of problems and costs, the more rural northern and central areas of the state (excluding the San Francisco Bay Area) had higher per capita costs resulting from alcohol and other drug problems. The geographic distribution of costs was generally similar for alcohol and drugs. But the cost related to alcohol was uniformly greater than that for other drugs. Alcohol burden was greatest in the north central valley, more rural southern counties and Los Angeles. Costs related to illicit drug use were most substantial in the state’s northern tier and San Francisco Bay area.

Costs related to substance abuse varied considerably between cities within counties, with some city areas exhibiting far greater costs than others. Although costs related to alcohol are dominant across the board, urban areas tend to have greater costs related to illicit drug use than do rural or suburban areas.

The estimates of cost provided by this research help convey the magnitude of alcohol and other drug use problems. These assessments also can help set priorities for allocation of scarce prevention and treatment resources, compare performance of prevention and treatment efforts, and quantify returns on prevention and treatment investments.

Dr. Miller concluded, “Efficient funding of substance abuse prevention, enforcement and treatment hinges upon understanding the variation of alcohol and other drug problems from place to place. For example, our data can inform local decisions about prioritizing police enforcement of impaired driving versus drug-related crime. Because estimated costs combine data across many health and social issues, they provide an effective, comprehensible, and comprehensive measure for use in understanding how communities shape their distinctive social environments and for monitoring the effectiveness of our intervention strategies.”

The full paper, Heterogeneous Costs of Alcohol and Drug Problems Across Cities and Counties in California, by Ted R. Miller,  Peter Nygaard, Andrew Gaidus, Joel W. Grube, William R. Ponicki, Bruce A. Lawrence, Ph.D., and Paul J. Gruenewald, Ph.D., , is published in the journal Alcoholism:Clinical and Experimental Research, http://onlinelibrary.wiley.com/doi/10.1111/acer.13337/epdf


The Pacific Institute for Research and Evaluation is an independent, nonprofit organization merging scientific knowledge and proven practice to create solutions that improve the health, safety, and well-being of individuals, communities, and nations around the world.

For further information, contact Diane Williams, Communications Officer,  Executive Services and Corporate Communications, Email: williamd@pire.org.

 

 

PIRE Senior Research Scientist, Raul Caetano, to receive the Lifetime Achievement Award from the Research Society on Alcoholism.
The Research Society on Alcoholism recently announced that the recipient of their 2016 Lifetime Achievement Award is Raul Caetano, MD, MPH, PhD., Senior Research Scientist at PIRE’s Prevention Research Center in Oakland, CA. Dr. Caetano is a psychiatrist and epidemiologist who has worked in public health for over 35 years. Dr. Caetano will receive the award at RSA’s Annual Scientific Conference in New Orleans, LA, June 25-29, 2016.

A native of Brazil, Dr. Caetano’s MD is from the School of Medical Sciences, State University of Rio de Janeiro. His MPH in behavioral sciences and Ph.D. in epidemiology are from the University of California at Berkeley. Before joining PIRE in 2015, Dr. Caetano was Dean of the Southwestern School of Health Professions at the University of Texas Southwestern Medical Center from 2006 to 2014 and Regional Dean and Professor of Epidemiology, Dallas Regional Campus, University of Texas School of Public Health from 1998 to 2014. He was recently appointed Professor of Epidemiology, Emeritus, at the UT School of Public Health. Dr. Caetano also served on the PIRE Board of Directors from 2004 to 2011. Dr. Caetano has written extensively about alcohol problems among U. S. ethnic minorities, especially among Hispanics. Other areas of research are psychiatric diagnosis and classifications, development of criteria for diagnosis of alcohol dependence, and the association between drinking and intimate partner violence. He has conducted numerous general population and clinical studies of alcohol problems among Whites, Blacks and Hispanics, and has more than 250 papers published in the peer reviewed literature. His research has been consistently supported by the NIH for over 30 years.

 

PIRE Senior Research Scientist, Jim Fell was presented with the GHSA James J. Howard Highway Safety Trailblazer award.
The James J. Howard Highway Safety Trailblazer Award is GHSA's highest award. The award honors an individual for sustained and outstanding leadership in endeavors that significantly improve highway safety.

During the 1990s when states were considering lowering their illegal blood alcohol concentration (BAC) limit for driving from .10 g/dL to .08 g/dL, Mr. Fell co-authored one of the first studies showing the effect of BAC levels on impaired driving fatal crashes. Subsequently, he was invited by officials in 12 states to provide expert testimony on the merits of lowering the BAC to .08 (DE, DC, IL, IN, MD, MN, MO, NE, NC, TN, TX, and WV). In 2000, President Clinton signed a bill providing a strong incentive for all states to lower the BAC limit to .08; all states and the District of Columbia eventually adopted the law. See: Johnson, D., & Fell, J.C. (1995). The impact of lowering the illegal BAC limit to .08 in five states in the U.S. 39th Annual Proceedings for the Association for the Advancement of Automotive Medicine, October 16-18, 1995 (pp. 45-64). Chicago, IL: Association for the Advancement of Automotive Medicine.

Currently, Mr. Fell is an advocate for lowering the BAC limit from .08 to .05g/dL. See: Fell, James C & Voas, Robert B (2014). The effectiveness of a 0.05 blood alcohol concentration (BAC) limit for driving in the United States. Addiction, 109; 869-874.

In 1994 while Mr. Fell worked at NHTSA, he developed a statement of work for the development of a statewide sobriety checkpoint program to determine its feasibility and its effectiveness in reducing impaired driving. The State of Tennessee provided the best proposal and was awarded a cooperative agreement from NHTSA. In 1996, Mr. Fell co-authored an article that was presented at the 40th Annual Meeting of the Association for the Advancement of Automotive Medicine showing a 20% reduction in impaired driving fatal crashes associated with the Tennessee checkpoint program. NHTSA published a more comprehensive report in 1999. The “Checkpoint Tennessee” program became the model for states to replicate. The program is still listed as one of SAMSHA’s Best Practices programs. See: Lacey, J.H., Jones, R.K., & Fell, J.C. (1996). The effectiveness of the "Checkpoint Tennessee" Program 40th Annual Proceedings of the Association for the Advancement of Automotive Medicine, October 7-9, 1996, Vancouver, British Columbia (pp. 275-282). Des Plaines, IL: Association for the Advancement of Automotive Medicine.

When John McCardell and his organization, Choose Responsibility, advocated for lowering the minimum legal drinking age (MLDA) from 21 to 18, Mr. Fell was invited to debate Dr. McCardell on the issue at 13 different venues (CSPAN—September 8, 2008; Manhattanville College, NY—November 13, 2008; Goucher College, MD—January 13, 2009; California Poly Tech, CA—January 29, 2009; University of Southern California, CA—February 25, 2009; Auburn University, AL—April 22, 2009; Alcohol Responsibility Conference, FL—October 1, 2009; Bridgewater College, VA—October 15, 2009; Eckerd College, FL—October 21, 2009; University of Kentucky, KY—November 12, 2009; Fairfield University, CT—January 27, 2010; Boston College, MA—March 10, 2010; Louisiana State University—June 3, 2010). Mr. FellI had science on his side—the studies of effectiveness of raising the MLDA to 21; the brain research, the European myth, the lives saved—while Dr. McCardell had college students on his side. To date, there has been no movement to rescind the federal legislation nor have any bills passed to lower the MLDA in any state. See: Fell, J.C. (2008). An Examination of the Criticisms of the Minimum Legal Drinking Age 21 Laws in the United States from a Traffic-Safety Perspective. Washington, DC: Pacific Institute for Research and Evaluation for the National Highway Traffic Safety Administration.
McCardell, J., & Fell, J.C. (2010). Federalism: Resolved, Congress should restore each state's freedom to set its drinking age. In R.J. Ellis & M Nelson (Eds.), Debating Reform: Conflicting Perspectives on How to Fix the American Political System (pp. 19-35). Washington, DC: CQ Press.

In 2009, Mr. Fell was lead author on an article published in Alcoholism: Clinical and Experimental Research (ACER), which showed that the minimum legal drinking age 21 (MLDA-21) laws were associated with significant reductions in underage drinking driver rates in fatal crashes. This study controlled for as many confounding factors as possible. It showed a 16% decrease in underage drinking driver fatal crashes associated with possession and purchase laws, a 5% reduction for zero tolerance laws, and a 5% reduction for use and lose laws. NIAAA features this article as proof that the MLDA-21 has been a successful policy. See: Fell, James C., Fisher, Deborah A., Voas, Robert B., Blackman, Kenneth, & Tippetts, A. Scott. (2009). The impact of underage drinking laws on alcohol-related fatal crashes of young drivers. Alcoholism: Clinical and Experimental Research, 33(7), 1208-1219.

Photo credit: https://twitter.com/GHSAHQ

 

Alcohol Prices Influence Crime and Crash Rates in British Columbia
A recent study found that increases in the price of alcohol resulted in reductions in alcohol related traffic crashes and crime following increases to alcohol prices in British Columbia, Canada.
The study, carried out by the Prevention Research Center of the Pacific Institute for Research and Evaluation in Oakland, California USA, and the Centre for Addictions Research in British Columbia, Canada, along with other institutions in the US and Canada also examined the effects of recent changes in alcohol laws in British Columbia. The study estimated the independent effects of increases in minimum alcohol prices and densities of private liquor stores on traffic safety and crime outcomes in British Columbia, following a change in alcohol control laws that partially privatized the off-premise sale of alcohol.

During the past century, government controls over alcohol sales in North America have been gradually dismantled. In the US, 18 states retain some form of control over the sale and distribution of alcohol. In Canada, only two provinces retain a complete monopoly over retail sales for off-premise consumption. With less state/province control usually comes an increase in the number of alcohol outlets, longer trading hours, and cheaper prices, along with measurable increases in alcohol-related harms. In British Columbia (BC), following a change in the law related to provincial monopoly, between 2002 and 2010 the number of private outlets increased from 543 to 1,045. During this time, minimum retail prices were also increased. For example, the minimum price per liter of distilled spirits was raised by 18% from $25.91 in 2004 to $30.66 in 2009. A study was conducted to explore associations between minimum alcohol prices, densities of liquor outlets, and crime outcomes across 89 local health areas of British Columbia between 2002 and 2010. Archival data on minimum alcohol prices, per capita alcohol outlet densities, and population characteristics were examined in relation to measures of crimes against persons, alcohol-related traffic violations, and non-alcohol-related traffic violations.

The results showed a positive relationship between alcohol prices, traffic crashes and crime. It was estimated that any 10% increase in provincial minimum alcohol prices would be associated with an 18.81% reduction in alcohol-related traffic violations, a 9.17% reduction in crimes against persons, and a 9.39% reduction in total rates of crime outcomes examined. While the direction of the results was clear, there were wide‘confidence intervals’ around the exact size estimated for these changes.

Densities of private liquor stores were not significantly associated with alcohol-involved traffic violations or crimes against persons in this study. However, previous research on the effects of increases in alcohol liquor outlet density has shown it to be related to alcohol related traffic crashes, some crimes and other outcomes.

Lead author, Dr. Timothy Stockwell commented, “These findings underline the importance of alcohol pricing as an influence on public health and safety. Policy makers should be aware of the importance of alcohol policies, including pricing, in preventing alcohol problems.”

Source: Relationships Between Minimum Alcohol Pricing and Crime During the Partial Privatization of a Canadian Government Alcohol, Tim Stockwell, Jinhui Zhao, Miesha Marzell, Paul Gruenewald, Scott MacDonald, William Ponicki, and Gina Martin, Journal of studies on alcohol and drugs 07/2015; 76(4):628-634.

 

Interactions of Borderline Personality Disorder and Anxiety Disorders Over Ten Years
The paper “Interactions of Borderline Personality Disorder and Anxiety Disorders Over Ten Years” comes some 20 years after the start of the Collaborative Longitudinal Study of Personality Disorders (CLPS).
This was a naturalistic longitudinal study of clients having one or more of four personality disorders (avoidant, borderline, OCPD, and schizotypal) recruited by investigators at Brown, Columbia, Harvard, or Yale Universities. The study followed these clients for ten years; the study so far has resulted in more than 100 peer-reviewed publications. The CLPS study has changed how clinicians view personality disorders, and has played a major part in the controversial latest revision of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-V). This latest paper confirms important relationships linking Borderline Personality Disorder with anxiety disorders and with PTSD. Years ago, clinicians perceived personality pathology as something aside from “Axis I” disorders such as major depression, bipolar disorder, or generalized anxiety disorder. We now know that these seemingly disparate disorders are linked much more intimately than we had imagined. PIRE Center Director, Robert Stout, was the senior statistician for this study, and directed all major analyses.

Information on many of these publications can be found at: http://www.pire.org/staffinfo.aspx?cid=364&dd=s&cnt=10&disp=a&#pubs

Below is a citation for an overview article that summarizes the study.
J Pers Disord. 2005 Oct; 19(5): 487–504.
doi: 10.1521/pedi.2005.19.5.487
PMCID: PMC3289284
NIHMSID: NIHMS349849
THE COLLABORATIVE LONGITUDINAL PERSONALITY DISORDERS STUDY (CLPS): OVERVIEW AND IMPLICATIONS Andrew E. Skodol, MD, John G. Gunderson, MD, M. Tracie Shea, PhD, Thomas H. McGlashan, MD, Leslie C. Morey, PhD, Charles A. Sanislow, PhD, Donna S. Bender, PhD, Carlos M. Grilo, PhD, Mary C. Zanarini, EdD, Shirley Yen, PhD, Maria E. Pagano, PhD, and Robert L. Stout, PhD

 

Not All States Have Adopted Effective Underage Drinking Laws
Evidence shows that many underage drinking laws are associated with significant reductions in the number of fatal crashes involving underage drinking drivers.
A new study finds that, despite the evidence, many states have not adopted these effective underage drinking laws. The study, by James Fell, Sue Thomas, Michael Scherer, Deborah Fisher and Eduardo Romano at the Pacific Institute for Research and Evaluation (PIRE) in Calverton, Maryland, was published in the March 2015 issue of World Medical and Health Policy.

While all 50 states have adopted a core minimum legal drinking age of 21 (MLDA-21) law, some states have also adopted expanded underage drinking laws that include additional restrictions. The authors identified 20 such expanded MLDA-21 laws and examined each law’s strengths and weaknesses in terms of coverage, sanctions for violations, exceptions, and ease of enforcement. Results showed wide variability in the strength of each underage drinking law and in the number of states that have adopted each law.

“We were surprised to find that nearly half of the states have adopted 13 or fewer laws, while only 1 state (Utah) has adopted all 20 laws,” said lead author James Fell, PIRE senior research scientist. “In fact, only 5 of the 20 MLDA-21 laws have been adopted by all states and the District of Columbia.” Strength scores (with 0 = no law and 1.0 = maximum strength) indicated that stronger laws result in greater reductions in fatal crashes caused by underage drinking drivers. The Use and Lose law and the Zero Tolerance law, for example, have both been shown to reduce the rate of fatal crashes caused by underage drinking drivers by 5% each. While all states have a Zero Tolerance law, not all have adopted a Use and Lose law (only 39 states and DC have these laws). This study demonstrated that the inclusion of a laws’ strength provides a more accurate understanding of the impact of laws on related outcomes. “Our earlier work shows that implementing core possession and purchase laws leads to significant decreases in the number of fatal crashes involving underage drinking drivers,” Fell said. “For example, we estimated that if all states adopted fake identification supplier laws, 30 lives a year would be saved—currently, 14 lives are being saved in the 24 states that have the law. Why would states not want such laws on their books?”

 

The Effects Underage Drinking Laws have on Underage Drinking Driver Fatal Crashes
One of PIRE's senior research scientists, Jim Fell, recently gave a presentation on the effects of underage drinking laws on underage drinking driver fatal crashes in Munich, Germany.
From an earlier study by Mr. Fell and his team, significant decreases in underage drinking driver fatal crash rates were associated with the implementation of the possession and purchase core laws (-16%, both laws treated together), the zero tolerance law (-5%), and the use and lose law (-5%). In the study presented at the AAAM Conference and published in October 2014 in the journal of Traffic Injury Prevention, the law prohibiting the transfer and/or production of fake identification was also related to a significant 1% reduction in underage drinking driver fatal crash rates. Mr. Fell and his team estimated if all states adopted these fake identification supplier laws, an additional 30 lives a year would be saved – of which 14 lives are currently being saved in the 24 states that have the law. They estimated from prior studies that the two core underage drinking laws (purchase and possession) and zero tolerance laws for drivers younger than aged 21 years (present in all states and DC) were currently saving 732 lives annually. In the 39 states and the District of Columbia that have adopted use and lose laws, an additional 132 lives are being saved each year. If all states adopted use and lose laws, an estimated 165 lives could be saved annually. This means that a total of 878 lives per year are being saved by the states which have enacted these MLDA-21 laws that were found to be effective. Thus, if all states adopted all five effective laws, up to 927 lives could be saved per year in preventing under age 21 drinking driver fatal crashes.

In November 2014, Mr. Fell was invited to San Diego, California to present the findings from a study on the effects of responsible beverage service training followed up by periodic enforcement before the Alcohol Policy Panel of San Diego County. Two communities—Monroe County, New York and Cleveland, Ohio—participated in a demonstration program and evaluation. The intervention integrated outreach and responsible beverage service (RBS) training, targeted enforcement and, as necessary, implemented corrective actions by the enforcement agency to a random sample of identified problem bars. The immediate goal of the RBS/enforcement program was to reduce the practice of overserving and serving to obviously intoxicated individuals in bars and restaurants in each community through training and enforcement. For the evaluation, data were collected on serving practices, bar patron intoxication, drinking and driving, and other alcohol-related harm from intervention and control bars or treatment and comparison communities, depending on the nature of the outcome. Overall, there were indications in both intervention communities that RBS training plus enforcement reduced the incidence of bar patron intoxication (and potential impaired driving). In Monroe County, New York, the percent of intervention bar patrons who were intoxicated decreased from 44% to 27% and the average blood alcohol concentration (BAC) of patrons decreased from .097 g/dL to .059 g/dL. In Cleveland, Ohio, the percent of pseudo-intoxicated patrons who were denied service in the intervention bars increased from 6% to 29%. It appears that when bar managers and owners are aware of the program and the enforcement of it, and servers are properly trained in RBS, fewer patrons become highly intoxicated (i.e., overserved) and an effort is made to deny service to obviously intoxicated patrons. Given that about half of arrested impaired drivers had their last drink at a licensed establishment, if this strategy is implemented on a widespread basis, it could have a significant impact on impaired driving.

 

PIRE Scientist, Abby Rudolph, wins 'Best Paper in the 2013 Annals of Epidemiology' award from the Publications Committee of the American College of Epidemiology (ACE)
The article titled, "Individual and neighborhood correlates of membership in drug using networks with a higher prevalence of HIV in New York City (2006-2009)" was selected by the Associated Editors to represent epidemiological research that was conducted in an excellent scientific manner.
Specific criteria implemented in the determination of this award also include originality, research design, statistical analysis, presentation, accuracy, coherence, review of literature, relevance, clarity, and organization.

Dr. Rudolph and her work will be honored at the Annual Meeting of the ACE in September where she will receive a plaque and monetary award.

Purpose
To identify individual- and neighborhood-level correlates of membership within high HIV prevalence drug networks.

Methods
We recruited 378 New York City drug users via respondent-driven sampling (2006–2009). Individual-level characteristics and recruiter–recruit relationships were ascertained and merged with 2000 tract-level U.S. Census data. Descriptive statistics and population average models were used to identify correlates of membership in high HIV prevalence drug networks (>10.54% vs. <10.54% HIV).

Results
Individuals in high HIV prevalence drug networks were more likely to be recruited in neighborhoods with greater inequality (adjusted odds ratio [AOR], 5.85; 95% confidence interval [CI], 1.40–24.42), higher valued owner-occupied housing (AOR, 1.48; 95% CI, 1.14–1.92), and a higher proportion of Latinos (AOR, 1.83; 95% CI, 1.19–2.80). They reported more crack use (AOR, 7.23; 95% CI, 2.43–21.55), exchange sex (AOR, 1.82; 95% CI, 1.03–3.23), and recent drug treatment enrollment (AOR, 1.62; 95% CI, 1.05–2.50) and were less likely to report cocaine use (AOR, 0.40; 95% CI, 0.20–0.79) and recent homelessness (AOR, 0.32; 95% CI, 0.17–0.57).

Conclusion
The relationship between exchange sex, crack use, and membership within high HIV prevalence drug networks may suggest an ideal HIV risk target population for intervention. Coupling network-based interventions with those adding risk-reduction and HIV testing/care/adherence counseling services to the standard of care in drug treatment programs should be explored in neighborhoods with increased inequality, higher valued owner-occupied housing, and a greater proportion of Latinos.

 

PIRE Scientists, Stephen Kennedy, MPH, MD, and Paul Jones, PhD., have been accepted as participant scholars for the NIMHD Translational Health Disparities Course: Integrating Principles of Science, Practice and Policy in Health Disparities Research
While admission for the course was extremely competitive, Dr. Kennedy and Dr. Jones’ work in addressing health disparities proved that they are highly qualified for admission to this course.
The course not only provides a translational approach to health disparities research, it also offers a cross-disciplinary perspective in the field that will inform innovative research, practice and policy interventions. The course will take place August 11-22, 2014 on the NIH Campus in Bethesda, Maryland.

This activity has been planned and implemented through the joint sponsorship of the National Institutes of Health’s National Institute on Minority Health and Health Disparities and the Johns Hopkins University School of Medicine.

 

PIRE Senior Research Scientists Investigate and Present to Legislative Committees Evidence for Lowering the Illegal Blood Alcohol Concentration (BAC)
James C. Fell and Robert B. Voas, both Senior Research Scientists in the Calverton Center, were asked to investigate the evidence behind lowering the illegal blood alcohol concentration (BAC) for driving from .08 g/dL to .05 g/dL, as far back as 2002, as many European countries and Australia had done.
Their review of the literature resulted in a journal article [Fell, JC & Voas, RB, 2006. The effectiveness of reducing illegal blood alcohol concentration limits for driving: Evidence for lowering the limit to .05 BAC. Journal of Safety Research, 37(3), 233-243] and a subsequent book chapter [Fell, JC & Voas, RB, 2009. Reducing illegal blood alcohol limits for driving: Effects on traffic safety. In J.C. Verster, S.R. Pandi-Perumal, J. G. Ramaekers & J.J. de Gier (Eds.), Drugs, Driving and Traffic Safety (Vol. II, pp. 415-437). Basel, Switzerland: Birkhäuser Verlag AG]. The evidence for a .05 BAC limit was very strong, so when the National Transportation Safety Board (NTSB) in May 2013 recommended that states in the US lower the illegal BAC limit to .05, the movement to do so in the US was revitalized.

A non-profit think-tank in Utah saw the articles by Mr. Fell and Dr. Voas and invited Mr. Fell to present the rationale behind lowering the BAC limit to .05 to three legislative committees in Salt Lake City on October 15-16, 2013: the Utah Substance Abuse Advisory Council DUI Committee; the Business and Labor Committee; and the Transportation Committee. While no bill to lower the limit has been introduced, there was much interest in the issue by committee members. Mr. Fell presented the key rationale behind lowering the BAC limit to each committee:

(1)Virtually all drivers are impaired with regard to driving performance at .05 BAC. Laboratory and test track research shows that the vast majority of drivers, even experienced drinkers who typically reach BACs of .15 or greater, are impaired at .05 BAC and higher with regard to critical driving tasks.

(2)The risk of being involved in a crash increases significantly at .05 BAC. The risk of being involved in a crash increases at each positive BAC level, but rises very rapidly after a driver reaches or exceeds .05 BAC compared to drivers with no alcohol in their blood systems. The relative risk of being killed in a single vehicle crash for drivers with BACs of .05 to .079 is at least 7 times that of drivers at .00 BAC (no alcohol).

(3)Lowering the illegal per se limit to .05 BAC is a proven effective countermeasure which has reduced alcohol-related traffic fatalities in other countries, most notably, Australia. The evidence is consistent and persuasive that fatal and injury crashes involving drinking drivers decrease on the order of at least 5% - 8% and up to 18% after a country lowers their illegal BAC limit from .08 to .05 BAC. If all States were to adopt the .05 BAC standard and it is enforced, an estimated 500-800 lives could be saved each year.

(4).05 BAC is a reasonable standard to set. A .05 BAC is not typically reached with a couple of beers after work or with a glass of wine or two with dinner. It takes at least 4 drinks for the average 170 lb. male to exceed .05 BAC in two hours on an empty stomach (3 drinks for the 137 lb. female). But no matter how many drinks it takes to reach .05 BAC, people at this level are too impaired to drive safely.

(5)The public supports levels below .08 BAC. Surveys show that most people would not drive after consuming two or three drinks in an hour and believe the limit should be no higher than the BAC level associated with that. That would be .05 BAC or lower for most drivers.

(6)Most other industrialized nations around the world have set BAC limits at .05 BAC or lower. At least 91 countries around the world have adopted a .05 BAC or lower limit for driving while 54 countries use limits from .06 to .12 BAC.

(7)Further progress is needed in reducing alcohol-impaired driving in the United States. Progress in reducing impaired driving has stalled over the past 15 years. Lowering the BAC limit from .08 to .05 will serve as a general deterrent to all those who drink and drive that the state is getting tougher on impaired driving and will not tolerate it. Such legislation typically reduces drinking drivers in fatal crashes at all BAC levels (BACs>.01; BACs>.05; BACs>.08; BACs>.15).

Typical questions asked by committee members were: “If I have two beers while eating a pizza, will my BAC be over .05?” The answer is “No.” If I have two glasses of wine with dinner, will I exceed .05 BAC? Answer is “No”, again. “How will lowering the illegal BAC limit to .05 affect driving under the influence (DUI) enforcement?” Answer: “There might be a slight increase in DUI arrests after the law is effective, but later on there will most likely be fewer arrests for DUI as fewer people will drive while impaired by alcohol. Enforcement procedures should not change. The horizontal gaze nystagmus (HGN) test that police give at the roadside to determine sobriety is valid at .05 BAC.”

It appears to be very possible that a Utah legislator will introduce a .05 BAC bill very soon. Typical questions asked by committee members were: “If I have two beers while eating a pizza, will my BAC be over .05?” The answer is “No.” If I have two glasses of wine with dinner, will I exceed .05 BAC? Answer is “No”, again. “How will lowering the illegal BAC limit to .05 affect driving under the influence (DUI) enforcement?” Answer: “There might be a slight increase in DUI arrests after the law is effective, but later on there will most likely be fewer arrests for DUI as fewer people will drive while impaired by alcohol. Enforcement procedures should not change. The horizontal gaze nystagmus (HGN) test that police give at the roadside to determine sobriety is valid at .05 BAC.”

It appears to be very possible that a Utah legislator will introduce a .05 BAC bill very soon.

 

PIRE Senior Scientist, Karen Friend, and her husband Jacob were featured on Rhode Island news to highlight the issue of early-onset Alzheimer's
Karen Friend and her husband Jacob were recently interviewed by a Rhode Island reporter, Mike Montecalvo from WPRI, on the challenges of dealing with early-onset Alzheimer’s. The illness is progressive and has few FDA-approved treatments and no cure.
Jake was diagnosed with this illness in roughly 2011 but has been showing symptoms for ten years. With a bachelor’s degree in engineering from Trinity and Dartmouth Colleges, he was a former manager at a datatech firm. Now, simple everyday tasks are a struggle. Somewhat ironically, he is otherwise very physically healthy and walks 2 – 5 miles each day with their dog.

While far more common in older individuals, the incidence of the illness in younger persons has been increasing, due in part to better diagnostic testing and in part to reasons not yet understood. Although there are individuals with the early-onset form of the illness with a strong family history of Alzheimer’s, most with early-onset do not, and the etiology remains elusive. The illness currently represents the sixth leading cause of death in this country and is expected to rise to the number one killer by 2050 unless more aggressive treatments, and ultimately a cure, are found.

 

Two PIRE Researchers Win Prestigious Awards
Two Senior Research Scientists from the Pacific Institute for Research and Evaluation in Calverton, Maryland, received prestigious awards at the recent 20th International Conference on Alcohol, Drugs and Traffic Safety held in Brisbane, Queensland, Australia, on August 27, 2013.
James C. Fell received the Widmark Award for outstanding, sustained and meritorious contributions to the field of alcohol, drugs and traffic safety. Mr. Fell has 46 years of experience in alcohol and drug impaired driving research and has authored over 100 articles in peer-reviewed publications. In addition to his research, he has testified before State legislatures on the merits of several impaired driving laws and conducted workshops for citizen activist groups such as Mothers Against Drunk Driving (MADD).

Dr. Robert B. Voas received the Borkenstein Award which recognizes individuals who have made outstanding contributions to international cooperation in alcohol and drug-related countermeasure programs. Dr. Voas has 45 years of research experience in alcohol and drug research and has numerous awards from the field, including the Widmark Award in 2000.

The awards were presented by the International Council on Alcohol, Drugs and Traffic Safety (ICADTS), an independent nonprofit organization whose only goal is to reduce mortality and morbidity brought about by the misuse of alcohol and other drugs by operators of vehicles in all modes of transportation. To accomplish this goal, ICADTS sponsors international and regional conferences to collect, disseminate and share essential information among professionals in the fields of law, medicine, public health, economics, law enforcement, public information and education, human factors and public policy.

The Pacific Institute for Research and Evaluation (PIRE) is an independent, nonprofit organization merging scientific knowledge and proven practice to create solutions that improve the health, safety and well-being of individuals, communities and nations around the world.

 

Mixed-Use Zoning to Increase Neighborhood Walkability
Mixed-use zoning is one public health strategy to create more walkable neighborhoods by shortening the distance between daily destinations like school, work, home and businesses like banks or grocery stores.
By reducing the distance, people are encouraged to walk or bike between locations. A large body of literature supports the idea that municipal zoning laws, such as mixed-use zoning, have a positive impact on public health outcomes, and in particular those that are directly tied to physical activity, such as obesity, heart disease, diabetes and some cancers.

THE STUDY
Carol L. Cannon, MA, Sue Thomas, PhD, and their team at the Pacific Institute for Research and Evaluation used a novel methodology to test the effects of mixed-use zoning decisions across zones and cities. They examined 168 mixed-use zoning ordinances across 22 California cities to identify the types of daily use activities permitted, not permitted or conditionally permitted. Destinations such as entertainment, financial services, health care, offices, schools, residences, retail, recreation, business, and personal services were included. After rating each ordinance by its adherence to the American Planning Association’s (APA) mixed-use zone model, the ordinance score was compared to the mixture of daily use activities found in the zones—the higher the ordinance score, the higher the potential for walking found in the zone.

THE FINDINGS
Zoning laws that mix residential units with commercial and public/civic destinations have the potential to increase walkability. The study finds that significant relationships exist between the range and precision with which the zoning ordinances have been written and the mixture of walking destinations that result within the areas. The authors find that the closer city zoning ordinances adhere to the APA’s mixed-use zone model, the greater the potential for walking opportunities. The ideal mixed-use zone encourages living, working, and doing business in the same geographical area—promoting greater physical activity and improved public health.

IMPLICATIONS FOR POLICY
Cities wishing to establish ordinances that enhance the built environment and provide citizens with opportunities to conduct their daily life in ways that can enhance health and environmental quality could establish ordinances that adhere closely to the APA model for mixed-use zoning.

This research summary is from:
Cannon C, Thomas S, Treffers R, Paschall M, Heumann L, Mann G, Dunkell D, Nauenberg S. Measuring Municipal Ordinance Effectiveness: Do Mixed Land Use Zone ordinances Improve Walkability Potential? Journal of Health Politic, Policy and Law. 2013;vol(2208612). 10.1215/03616878-2208612.

 

CONGRATULATIONS to Bob Saltz
Bob Saltz has just accepted the position of chairperson of the Community Influences on Health Behavior Study Section of the Center for Scientific Review at NIH for a term beginning July 1, 2013 – June 30, 2015.
Richard Nakamura, Ph.D., Director of the Center for Scientific Review , said in a letter addressed to PIRE CEO, Bernie Murphy,

“As you know, membership on a study section represents a major commitment of professional time and energy as well as a unique opportunity to contribute to the national biomedical research effort. Members are selected on the basis of their demonstrated competence and achievement in their scientific discipline as evidenced by the quality of research accomplishments, publications in scientific journals, and other significant scientific activities, achievements and honors. Service on a study section also requires mature judgment and objectivity as well as the ability to work effectively in a group. The skill and leadership offered by the chairperson determine to a significant extent the effectiveness and efficiency of the review group.

I want to take this opportunity to emphasize the importance of Dr. Saltz’s participation in assuring the quality of the NIH peer review process, express the NIH’s appreciation of your institution’s support of its activities, and indicate the hope and expectation that institutional officials will provide continued support.”

 

Commentary on NTSB Recommendation to lower the blood alcohol limit for driving from .08 to .05 in the United States
Researchers at the Pacific Institute for Research and Evaluation (PIRE) say that the recommendation by the National Transportation Safety Board (NTSB) today to lower the illegal blood alcohol concentration (BAC) limit for driving from .08 to .05 in states has a strong evidence-based foundation.
  • The risk of being involved in a crash increases significantly at .05 BAC. The risk of being involved in a crash increases at each positive BAC level, but rises rapidly after a driver reaches or exceeds .05 BAC compared to drivers with no alcohol in their blood systems (Blomberg, Peck, Moskowitz, Burns, & Fiorentino, 2005).
  • Recent studies indicate that the relative risk of being killed in a single-vehicle crash for drivers with BACs of .05 to .079 is at least 7 times that of drivers at .00 BAC (no alcohol), and could be as much as 21 times that of drivers at .00 BAC, depending upon the age of the driver. These risks are significant (Voas, Torres, Romano, & Lacey, 2012).
CALVERTON, MD – Researchers at Pacific Institute for Research and Evaluation (PIRE) say that the recommendation by the National Transportation Safety Board (NTSB) today to lower the illegal blood alcohol concentration (BAC) limit for driving from .08 to .05 in states has a strong evidence-based foundation. Most industrialized nations have already enacted a .05 illegal BAC limit. A review of the literature by PIRE researchers examines the effects of various BACs on driving and crashes. The review reveals important reasons why a .05 illegal BAC limit is a sound strategy.

“There is clear, solid, scientific evidence that lowering the illegal BAC limit to .05 is a strategy that states should strongly consider” said James Fell, a PIRE researcher. He points to laboratory evidence showing that most subjects are significantly impaired at .05 BAC (Ferrara, Zancaner, & Georgetti, 1994; Moskowitz & Fiorentino, 2000; Moskowitz, Burns, Fiorentino, Smiley, & Zador, 2000). Drivers with .05 to .07 BACs are also much more likely to be involved in a fatal crash than drivers who haven’t been drinking (Voas, et al., 2012). The review was co-authored with Robert Voas, Ph.D., a PIRE senior research scientist. The researchers’ rationale is described in the following paragraphs.

The driving performance of virtually all drivers is impaired at .05 BAC. Laboratory and test track research shows that most drivers, even experienced drinkers who typically reach BACs of .15 or greater, are impaired at .05 BAC regarding critical driving tasks. There are significant reductions in performance in areas such as braking, steering, lane changing, judgment and divided attention at a .05 of BAC. Some studies report that inadequate or reduced or compromised performance decrements in some of these tasks are as high as 30% to 50% at .05 BAC (Ferrara, et al., 1994; Howat, Sleet, & Smith, 1991; Moskowitz & Fiorentino, 2000; Moskowitz, et al., 2000).

Lowering the illegal BAC limit to .05 is a proven effective countermeasure that has reduced alcohol-related traffic fatalities in other countries, most notably Australia. Although studies in Europe and Australia each use a different methodology to evaluate these effects, the evidence is consistent and persuasive that fatal and injury crashes involving drinking drivers decrease on at least 5% to 8% and up to 18% after a country lowers their illegal BAC limit from .08 to .05 illegal BAC (Bartl & Esberger, 2000; Brooks & Zaal, 1992; Henstridge, Homel, & Mackay, 1995; Homel, 1994; Noordzij, 1994; Smith, 1988). If all states were to adopt the .05 illegal BAC limit, and it is enforced, an estimated 500-800 lives could be saved each year in the United States (Tippetts, Voas, Fell, & Nichols, 2005; Wagenaar, Maldonado-Molina, Ma, Tobler, & Komro, 2007).

Most other industrialized nations around the world have set illegal BAC limits at .05 BAC or lower. All states in Australia now have a .05 illegal BAC limit. France, Austria, Italy, Spain, and Germany lowered their limit to .05 illegal BAC; and Sweden, Norway, Japan, and Russia have set their limit at .02 illegal BAC (World Health Organization [WHO], 2013).

A reasonable standard to set is .05 illegal BAC. A .05 illegal BAC is not typically reached with a couple of beers after work or with a glass of wine or two with dinner. It takes at least four drinks for an average 170-pound male to exceed .05 BAC in 2 hours on an empty stomach (three drinks for a 137-pound female). The illegal BAC level reached depends upon a person’s age, gender, and weight, as well as the food in their stomach and their metabolism rate (NHTSA, 2005). No matter how many drinks it takes to reach .05 BAC, people at this level are too impaired to drive safely.

The public supports levels below .08 BAC. The National Highway Traffic Safety Administration (NHTSA) surveys show that most people would not drive after consuming two or three drinks in an hour and believe the limit should be no higher than the BAC level associated with that (Moulton, Peterson, Haddix, & Drew, 2010). That would be .05 BAC or lower for most drivers.

Further progress is needed to reduce alcohol-impaired driving in the United States. It has been 30 years since the first two states adopted a .08 illegal BAC limit (Utah and Oregon in 1983) and 13 years since federal legislation provided a strong incentive to adopt a .08 illegal BAC limit. Progress to reduce impaired driving has stalled over the past 15 years (see Figure 1). Lowering the illegal BAC limit from .08 to .05 will serve as a general deterrent to all those who drink and drive that the state is getting tougher on impaired driving and will not tolerate it. Such legislation typically reduces drinking drivers in fatal crashes at all BAC levels (BACs>.01; BACs>.05; BACs>.08; BACs>.15) (Brooks & Zaal, 1992; Hingson, Heeren, & Winter, 2000; Hingson, Heeren, & Winter, 1996; Tippetts, et al., 2005; Wagenaar, et al., 2007).
Alcohol Driving Limits
Figure 1. Proportion of All Drivers Involved in Fatal Crashes Estimated to Have Been Legally Intoxicated (BAC = .08 g/dL), 1982-2010 (-37%) (Source: NHTSA, FARS, 2013)

The World Medical Association, the American Medical Association, the British Medical Association, the European Commission, the European Transport Safety Council, the World Health Organization, the Canadian Medical Association, the Centre for Addiction and Mental Health and the Association for the Advancement of Automotive Medicine all have policies supporting a .05 blood alcohol concentration (BAC) or lower as the illegal limit per se for drivers aged 21 and older. At least 91 countries around the world have adopted a .05 illegal BAC or lower limit for driving while 54 countries use limits from .06 to .12 illegal BAC (WHO, 2013).

The evidence is clear—lowering the BAC limit to .05 has saved lives in other countries and can do so in the United States. It is time we learned from our European and global partners in achieving further declines in impaired driving fatalities (Transportation Research Board, 2010).

To arrange an interview with the PIRE Researchers, Dr. Voas or Mr. Fell, please contact PIRE Communications at communications@pire.org or (888) 846-7473.

###

References

Bartl, G., & Esberger, R. (2000). Effects of lowering the legal BAC limit in Austria. In H. Laurell & F. Schlyter (Eds.), Proceedings of the 15th International Conference on Alcohol, Drugs and Traffic Safety - T'2000; May 22-26, 2000. Stockholm, Sweden: International Council on Alcohol, Drugs and Traffic Safety (ICADTS).

Blomberg, Richard D., Peck, Raymond C., Moskowitz, Herbert, Burns, Marcelline, & Fiorentino, Dary. (2005). Crash Risk of Alcohol Involved Driving: A Case-Control Study. Stamford, CT: Dunlap & Associates, Inc., from http://www.dunlapandassociatesinc.com/crashriskofalcoholinvolveddriving.pdf.

Brooks, C., & Zaal, D. (1992). Effects of a 0.05 Alcohol Limit in the Australian Capital Territory. Canberra, Australia: Federal Office of Road Safety MR 10.

Ferrara, S.D., Zancaner, S., & Georgetti, R. (1994). Low blood alcohol levels and driving impairment. A review of experimental studies and international legislation. International Journal of Legal Medicine, 106(4), 169-177.

Henstridge, J., Homel, R., & Mackay, P. (1995). The long-term effects of random breath testing in Adelaide. In C.N. Kloeden & A.J. McLean (Eds.), Proceedings of the 13th International Conference on Alcohol, Drugs and Traffic Safety - T'95, Aug 13-18, 1995. Adelaide, Australia: International Council on Alcohol, Drugs and Traffic Safety (ICADTS).

Hingson, R., Heeren, T., & Winter, M. (1996). Lowering state legal blood alcohol limits to 0.08 percent: The effect on fatal motor vehicle crashes. American Journal of Public Health, 86(9), 1297-1299.

Hingson, R., Heeren, T., & Winter, M. (2000). Effects of recent 0.08% legal blood alcohol limits on fatal crash involvement. Injury Prevention, 6(2), 109-114.

Homel, R. (1994). Drink-driving law enforcement and the legal blood alcohol limit in New South Wales. Accident Analysis and Prevention, 26(2), 147-155.

Howat, P., Sleet, D., & Smith, I. (1991). Alcohol and driving: Is the 0.05% blood alcohol concentration limit justified? Drug and Alcohol Review, 10, 151-166.

Moskowitz, H., Burns, M., Fiorentino, D., Smiley, A., & Zador, P. (2000). Driver characteristics and impairment at various BACs. (DOT HS 809 075). Washington, DC: U.S. Department of Transportation, National Highway Traffic Safety Administration.

Moskowitz, H., & Fiorentino, D. (2000). A review of the literature on the effects of low doses of alcohol on driving-related skills. (DOT HS 809 028). Washington, DC: U.S. Department of Transportation, National Highway Traffic Safety Administration.

Moulton, B.E., Peterson, A., Haddix, D., & Drew, L. (2010). National Survey of Drinking and Driving Attitudes and Behaviors: 2008 (Volume II: Findings Report). (DOT HS 811 343). Washington, DC: U.S. Department of Transportation, National Highway Traffic Safety Administration.

National Highway Traffic Safety Administration. (2005). The ABCs of BAC: A guide to estimating blood alcohol concentration and alcohol impairment. (DOT HS 809 844). Washington, DC: Department of Transportation.

National Highway Traffic Safety Administration. (2013). Fatality analysis reporting system data files, 1982-2010. U.S. Department of Transportation, National Highway Traffic Safety Administration: Washington, DC

Noordzij, P.C. (1994). Decline in drinking and driving in the Netherlands. Transportation Research Circular, 422, 44-49.

Smith, D.I. (1988). Effect on traffic safety of introducing a 0.05% blood alcohol level in Queensland, Australia. Medicine, Science and Law, 28(2), 165-170.

Tippetts, A.S., Voas, R.B., Fell, J.C., & Nichols, J.L. (2005). A meta-analysis of .08 BAC laws in 19 jurisdictions in the United States. Accident Analysis and Prevention, 37(1), 149-161.

Transportation Research Board. (2010). Achieving traffic safety goals in the United States: Lessons from other nations. Washington, DC: Transportation Research Board of the National Academies of Science, Committee for the Study of Traffic Safety Lessons from Benchmark Nations. (Special Report 300).

Voas, Robert B., Torres, Pedro, Romano, E., & Lacey, John H. (2012). Alcohol-related risk of driver fatalities: An update using 2007 data. Journal of Studies on Alcohol and Drugs, 73(3), 341-350.

Wagenaar, A., Maldonado-Molina, M., Ma, L., Tobler, A., & Komro, K. (2007). Effects of legal BAC limits on fatal crash involvement: Analyses of 28 states from 1976 through 2002. Journal of Safety Research, 38, 493-499.

World Health Organization. (2013). List of countries' BAC limits for driving. World Health Organization: Geneva, Switzerland. Retrieved May 9, 2013, from http://apps.who.int/gho/athena/data/GHO/SA_0000001520.html?profile=ztable&filter=COUNTRY:*;BACGROUP:*

 

PIRE Board Member, Dr. Lawrence Green, to be honored with the AAHB Lifetime Achievement Award
The American Academy of Health Behavior has announced that Dr. Lawrence Green will be honored with the AAHB Lifetime Achievement Award on March 17, 2013 at their annual meeting. The mission of The Academy is to promote excellence in health behavior research and in the application of research to improve public health.
The Lifetime Achievement award was established in 2000 and has only been given twice; first to Dr. Elbert Glover, the founder and first president of the AAHB and Dr. Albert Bandura for his significant theoretical contributions to health behavior research.

R. Scott Olds, HSD, President of the American Academy of Health Behavior, advised Bernie Murphy, via email, that "The award honors individuals who have made significant fundamental contributions to health behavior research, theory or practice. Dr. Green is exemplary because he has made significant contributions in all three of these areas. These accomplishments must also demonstrate a lifetime commitment and have had a lasting impact on the field. From his prolific and influential writing, notably the ubiquitously cited and practitioner-adopted PRECEDE/PROCEED planning model with Marshal Kreuter, to his academic, non-profit and governmental posts over his 40+year career, Dr. Green’s work is both widely recognized and respected. Much of his recent career has been focused on federal policy development, and work with professional organizations and agencies to facilitate the translation and dissemination of research to practice. This has led to the often referenced quote from Dr. Green, "If we want more evidence-based practice, we need more practice-based evidence." There are few individuals conducting health behavior research today who could not link Dr. Green to some aspect of their professional preparation, research or career development."

 

The Cost of Gun Violence
Firearm Injuries Cost $174 Billion in the United States in 2010 Government's firearm injury bill alone exceeded $12 billion. PIRE researcher Ted Miller estimates annual firearm injury costs average $645 per gun in America.
The costs include medical and mental health care costs, criminal justice costs, wage losses, and the value of pain, suffering and lost quality of life. Violence - assaults and suicide acts - dominated the costs. These estimates are based on the latest injury data from the Centers for Disease Control and unit costs from PIRE's widely cited injury cost model.

Click here for detailed cost tables.

Gun Insurance Proposals Stall as Critics Cite Obamacare - November 19, 2013

 

The Journal of Studies on Alcohol and Drugs Top Downloads of 2012
The Journal of Studies on Alcohol and Drugs, which is the oldest substance-abuse journal published in the United States, recently came out with their top downloads of original research/reviews for 2012. The top two downloads are research projects conducted by PIRE.
The two reseach projects are:
  • Exploring the ecological association between crime and medical marijuana dispensaries Kepple NJ, Freisthler B J Stud Alcohol Drugs. 2012 Jul;73(4):523-30
  • Alcohol-related risk of driver fatalities: An update using 2007 data Voas RB, Torres P, Romano E, Lacey JH J Stud Alcohol Drugs. 2012 May;73(3):341-50
Exploring the Ecological Association Between Crime and Medical Marijuana Dispensaries
Routine activities theory purports that crime occurs in places with a suitable target, motivated offender, and lack of guardianship. Medical marijuana dispensaries may be places that satisfy these conditions, but this has not yet been studied. The current study examined whether the density of medical marijuana dispensaries is associated with crime.

Alcohol-related risk of driver fatalities: An update using 2007 data
Past relative risk studies have provided lawmakers with a scientific basis for the design and implementation of several alcohol-related traffic safety policies, programs, and laws. Per se laws (initially at a BAC of .10, now .08) and zero-tolerance (ZT) laws for underage drivers are examples of laws that have been shown to be effective in reducing alcohol-related crash fatalities. Although the existing laws continue to restrain the number of alcohol-related crashes, impaired-driving fatalities are no longer declining in the United States. It has been suggested that risk-taking attitudes might have changed over the last decade, making some groups of drivers unexpectedly vulnerable to crashes (Romano, Kelley-Baker, and Voas, 2009). The existing battery of laws and policies might be failing to accommodate such changes in risk-taking attitudes. It is therefore apparent that alcohol-related crash risk estimates need to be updated.

Funded by the NIAAA (R21AA018158-01A2, Romano PI), a team of PIRE researchers was set to produce such update. By linking the 2007 National Roadside Survey (NRS) data to the Fatality Analysis Reporting System (FARS) a census of all fatal crashes in the United States, the researchers estimated alcohol-related crash risk for different demographic groups of drivers and compared them with the risk levels for 1996 reported by Zador et al. (2000).

The study found that he overall relative risk (RR) level for adults in 2007 was slightly elevated over that of 1996, but the difference was not statistically significant. Both studies found the expected reduction in RR associated with increased age. The primary differences between the 1996 and 2007 analyses involved underage drivers. The 2007 analysis found that compared with drivers aged 21 to 34, sober underage drivers were at higher risk than estimated in the 1996 study. This finding seems somewhat surprising as the 1996 to 2007 period was marked by the trend for the states to enact graduated driver licensing (GDL) laws, which increase the age of licensing and extend the period of adult supervision of the novice driver. Furthermore, the study found young female drivers to be at an increased risk in 2007. Back in 1996, the U.S. had a gender split when it came to underage drinkers’ odds of being involved in a fatal car crash: at any given blood-alcohol level, young men had a higher risk of a fatal crash than young women did. But by 2007, that gender gap had closed. The total number of young men involved in fatal alcohol-related wrecks is still greater because men drink more. But at a given blood-alcohol level, young women now appear to have the same risk of a fatal crash as their male peers do. The exact reasons are not clear. But it’s possible that young women are drinking are taking greater risks on the road in 2007 than in 1996.

The study also turned up another concerning pattern, sober (BAC=.00) male drivers ages 16–20 showed a doubling in the risk of a fatal car crash between 1996 and 2007. Again, it’s not clear why, but the authors speculate that it may have a lot to do with distraction. Sober kids are more at risk, and the authors think it may be related to texting and the other new technologies they are using so much. If so, that points to a need not only for drunk-driving prevention, but also efforts to curb distracted driving.

 

2011 American Journal of Public Health Paper of the Year
A PIRE paper reporting the effects of an HIV prevention intervention for Zimbabwe orphan adolescent girls, published in the American Journal of Public Health (AJPH), was recognized for excellence as 2011 AJPH Paper of the Year. Denise Hallfors is the lead author and Principal Investigator of the study; Co-Investigator Hyunsan Cho and Study Coordinator Bonita Iritani are PIRE co-authors, along with Professor Carolyn Halpern from the University of North Carolina at Chapel Hill, MCH Dept. All were recognized at the annual American Public Health Association Awards Ceremony on October 30, 2012 in San Francisco.
The full paper citation is:

Hallfors, D., Cho, H., Rusakaniko, S., Iritani, B., Mapfumo, J., Halpern, C. (2011). Supporting Adolescent Orphan Girls to Stay in School as HIV Risk Prevention: Evidence from a Randomized Controlled Trial in Zimbabwe. American Journal of Public Health.; 101:1082-1088.

The paper reported study findings from a cluster randomized controlled trial testing whether providing school fees, uniforms, and school supplies could help keep orphan adolescent girls in school and prevent HIV risk behaviors. After two years, the intervention significantly reduced school dropout by 82% and early marriage by 63%. Compared with control participants, the intervention group also reported greater school bonding, better future expectations, more equitable gender equity attitudes, and more concerns about the consequences of sex. Study participants lived in rural areas and were, on average, 13-14 years old at follow-up. A cost effectiveness analysis (CEA), led by PIRE Co-Investigator Ted Miller, found that support for day school, but not for boarding school, was cost effective; boarding school was much more expensive and did not improve benefits. The CEA paper is in press at Prevention Science:

Miller, T., Hallfors, D., Cho, H., Luseno, W., Waehrer, G. (2012). Cost-Effectiveness of School Support for Orphan Girls to Prevent HIV Infection in Zimbabwe. Prevention Science. In press.

 2011 American Journal of Public Health Paper of the Year

 

John Lacey receives the James J. Howard Highway Safety Trailblazer Award
The James J. Howard Highway Safety Award, the Governors Highway Safety Association’s most prestigious award, was awarded to John Lacey, Pacific Institute for Research and Evaluation (PIRE) Center Director. Mr. Lacey has worked as a "trailblazer" for over 40 years implementing programs, evaluating projects, and working on policy advocacy.
While most of Mr. Lacey’s research accomplishments have been in the evaluation of programs to reduce alcohol-impaired driving, he has also conducted pioneering studies in other areas of highway safety. His résumé includes some of the first studies of distracted driving. It also includes studies on aggressive driving; combined seat belt, speed, and alcohol enforcement strategies; fatal crashes involving older women; and underage drinking prevention. He led the nation’s first effort to assess the prevalence of drugged drivers on U.S. highways. He developed and implemented methods to obtain breath tests, saliva, and blood samples from drivers on the roads in 300 locations in the United States as part of the 2007 National Roadside Survey. In that survey, he persuaded close to 90% of 11,000 drivers stopped on the roadways on weekend nights to give a breath sample to measure blood alcohol concentration (BAC), more than 70% to give a saliva sample to test for the presence of drugs other than alcohol, and 40% to give a blood sample for further analyses of drugs. This pioneering effort showed that 12% of the drivers on our roads at night had alcohol present in their bodies, and 15% had drugs other than alcohol in their systems while driving. One out of five drivers with drugs in their system also had alcohol on board. This survey has opened up a renewed focus on the relationship of drugs other than alcohol to highway safety. Mr. Lacey has followed that pioneering effort with the nation’s first attempt to assess the relative risk of being in a crash as a function of the type and amount of drugs consumed by a driver. He also recently completed a study of the prevalence of cannabis-involved driving in California and that relationship with medical marijuana laws in that state.

Mr. Lacey is probably best known for his groundbreaking evaluation of the Checkpoint Tennessee program in 1995. That statewide checkpoint program produced a 20% reduction in impaired-driving fatal crashes and became the model for future programs sponsored by the National Highway Traffic Safety Administration (NHTSA). Mr. Lacey has not only conducted excellent research studies over his career, but he also has developed and tested innovative countermeasures in the studies, disseminated the results to appropriate officials, and advocated for proven-effective strategies. He has authored or co-authored more than 150 articles to peer-reviewed journals and reports to federal government agencies, State Highway Safety Offices, and other traffic safety organizations, such as the Insurance Institute for Highway Safety.

Although there have been many, long-time, distinguished highway safety researchers over the past 40 to 50 years, what sets Mr. Lacey apart from most of them is his ability to get effective programs implemented. He does not stop his work when his research report is written. He presents the findings at Lifesavers conferences, Governors Highway Safety Association conferences, and numerous scientific conferences to “get the word out.” He was an early advocate of lowering the illegal BAC limit to .08 and combining seat-belt and impaired-driving enforcement. He has not merely stood on his laurels throughout his career, but also has exercised leadership in promoting “research to practice” in highway safety to get programs implemented and to save lives.

Because of Mr. Lacey’s research, many lives are being saved each year. His recent pioneering research has led to a new focus on drugs other than alcohol and their impairing effects on driving. In his 42 years of activity, Mr. Lacey has developed a network of practitioners in the field of impaired driving at the national, state, and local levels. His efforts have been realized in the substantial reduction in impaired driving that we have witnessed over the past 30 years.

 John Lacey receives the James J. Howard Highway Safety Trailblazer Award

 

Friends Don't Let Problem Drinkers Drink
"Friends don't let friends drive drunk!" We all know that campaign, but researchers have given us a new message about the role of friends and drinking: Friends don't let problem drinkers drink.
The attitude of friends, and family, makes a difference for people trying to sustain recovery from addiction to alcohol. That is the message of recent research, which demonstrates that people who make positive changes in their social relationships can improve their chances of success following treatment.

Using innovative statistical techniques to overcome some of the methodological flaws of previous research, this study, published in the May edition of the Journal of Studies on Alcohol and Drugs, shows that social networks can have a powerful and lasting effect on how well people are able to cope following treatment for alcohol abuse. These effects can last for at least three years after treatment.

In the study, participants who had friends or family who forthrightly advocated that they abstain from drinking alcohol tended to be more successful. Conversely, those who had someone who encouraged them to drink (a pro-drinker) usually had a more difficult time quitting alcohol. "Most of us have an image of a 'pro-drinker' as someone who drinks heavily. Often, however, pro-drinkers are people who may be abstainers or light drinkers, but who don’t believe their friend who is struggling with an alcohol problem has a drinking problem that requires treatment," said Dr. Robert Stout of the Pacific Institute for Research and Evaluation (PIRE). In the study, Stout and his colleagues argue that intervening with pro-drinkers to make them advocates for abstention may present an important opportunity in helping people to recover from addictions.

While it can be difficult to make changes in personal relationships, especially when people are stressed by trying to recover from an addiction, modifications may be necessary to sustain their efforts. According to Stout, "It can be intimidating to reach out to new people, or to explain to one’s current friends and family that they need their support during recovery. Breaking off old relationships can also be hard, but equally important." Although this study and previous research shows that social influences are very important for recovery, researchers still want to learn more about ways that family, friends, and treatment providers can help those with alcohol problems make the changes needed for their recovery.

The paper, entitled “Association Between Social Influences and Drinking Outcomes Across Three Years,” supports the development of treatments that promote positive social changes and the need for additional research on the determinants of social network changes.

The first author of the paper is Dr. Robert Stout, Senior Scientist at Pacific Institute for Research and Evaluation. Co-authors include Drs. John Kelly of Massachusetts General Hospital, Molly Magill of Brown University, and Maria Pagano of Case Western Reserve University. The research was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

 

Drinking and driving risk increases for young women, study finds
"Young women who drink and drive may be behaving more like young men who drink and drive," said study researcher Robert B. Voas. Eduardo Romano of the Impaired Driving Center at the Pacific Institute for Research and Evaluation and coauthor of the report, says cultural changes since 1996 are likely to blame for the rise in fatal accidents.
Comparing the BACs of drivers in fatal crashes with a random sample of similar drivers on the road who have not been involved in a crash is a standard method for estimating the extent to which driving after drinking raises of risk of being in a crash relative to sober drivers. In 1996, the third national roadside survey provided a random sample of drivers using US roads which was compared with drivers in fatal crashes using the fatality analysis reporting system (FARS) maintained by the National Highway Traffic Safety Administration (NHTSA). That study showed that at a given BAC the relative risk of being in a crash was the same for adult men and women. However fewer women than men reach the high BAC levels(.08 and greater) which are typical of drinking drivers in fatal crashes so fewer women are involved in alcohol related crashes. In contrast to adults, the 1996 study found that men under age 21 were at greater risk at a given BAC than young women under 21, Suggesting that young women were more careful drivers an drove les at high risk time such as late at night.

The national roadside survey conducted 10 years later in 2007 provided another opportunity to compute the relative risk of crash involvement based on BAC. As in 1996, adult men and women were found to exhibit the same level of relative risk at any given BAC. However in contrast in 1996, there was no difference between young men and young women in the relative risk of being involved in an alcohol-related crash, given that they had the same BAC. We found that the relative risk for young women had increased over the decade since 1996 apparently reflecting an increase in risk taking and risk exposure through more nighttime driving and perhaps more drinking and more high-risk driving. While the relative risk for young female drinking drivers increased, the risk of crash involvement for non-drinking young men under 21 increased. The data from the surveys do not indicate why these changes occurred. but perhaps the increase in crash involvement of sober young drivers is related to the increasing use of cell phones while driving.

Another opportunity to study potential changes in the relative risk of crashing will occur in 2013 within the next national roadside survey will be conducted. The 2007 survey has provided a number of clues to the changing impaired driving scene in the US. We will use this experience to add questions to the 2013 survey to help clarify why we are seeing changes in the relative risk of crashing of drivers under 21. For a full copy of the article go to web site of the Journal of Studies on Alcohol and Drugs