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36 APPENDIX B Effectiveness Estimates for Twenty-Three Proven Countermeasures Class 1: Voluntary Action School Pedestrian Training for Children: Estimated effect 12% reduction in child pedestrian injuries (Blomberg, Preusser, Hale et al., 1983); applicable population: elementary school pedestrians; effects limited unless program is ongoing (low cost). The effect of this countermeasure is an estimated 12% reduction in child pedestrian injuries. Its primary target is school-aged children, which we define as children between 6 and 12 years of age. The pedestrian fatality-to-injury ratio will be used in all calculations. School-aged pedestrian fatalities represent 0.3% of all fatalities, resulting in an estimated 2 fatalities per state. As there are an estimated 31 injuries per fatality, the example state is estimated to have 57 child pedestrian injuries per year, for a total estimated cost of $3,750,385. School pedestrian training for children has an estimated 12% reduction in injuries, resulting in savings of $450,046. Table B1. Estimated savings for school pedestrian training countermeasure. Total fatalities 42,642 Child pedestrian fatalities (U.S.) 129 % total fatalities (U.S.) 0.303% Median fatalities (state) 600 Est. child ped. fatalities (state) 1.82 Pedestrian Death-to-Injury Ratio 31.43 ESTIMATED SAVINGS FOR AN EXAMPLE STATE No. $ Fatalities $ Injuries $ Total Fatalities 1.82 $ 2,025,338 School pedestrian training Injuries 57 $ 1,725,047 $ 3,750,385 Reduction Loss reduced by: 12% Fatalities 1.60 $ 1,782,298 Injuries 50.2 $ 1,518,041 $ 3,300,339 Savings $ 450,046 Booster Seat Promotions: Effect varies according to type of program and baseline use. Programs have involved education directed at children, parents, or physicians, delivered through traditional channels or via home visits; plus discounts for booster seat purchase. Increases in booster seat use have been reported: from 61 to 75%, 0 to 22%, 43 to 67%; 13 to 26% (Ehiri, King, Ejere et al., 2006). Durbin, Elliott, Winston et al. (2003) estimate a 59% reduction in injury for children in a booster seat rather than an adult seat belt; applicable population: children ages 4-8 not traveling in booster seats; effects limited to duration of program (medium cost). Booster seat promotions increase use by 13% and the effect of putting children in booster seats rather than adult seat belts is an estimated 59% reduction in injuries. Thus, this countermeasure reduces injuries by an estimated 8%. Its primary target is

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37 children between 4 and 8 not traveling in booster seats in passenger vehicles. The child occupant fatality-to-injury ratio will be used in all calculations. Children 4 to 8 not traveling in booster seats represent 0.6% of all fatalities, resulting in an estimated 4 fatalities per state. As there are an estimated 656 injuries per fatality, the example state is computed to have 2,530 injuries per year, for a total estimated cost of $80,794,661. Booster seat programs have an estimated 8% reduction in injuries, resulting in savings of $6,140,394. Table B2. Estimated savings for booster seat programs countermeasure. Total fatalities 42,642 Fatals child occ age 4-8 not in seat 274 % total fatalities 0.643% Median fatalities (state) 600 Est. children occ. 4-8 fatals (state) 3.86 Child occupants death-to-injury ratio 656.15 ESTIMATED SAVINGS FOR AN EXAMPLE STATE No. $ Fatalities $ Injuries $ Total Fatalities 3.86 $4,301,881 Booster seat programs Injuries 2,530 $76,492,780 $80,794,661 Reduction Loss reduced by: 8% Fatalities 3.56 $3,974,938 Injuries 2,337.4 $70,679,328 $74,654,266 Savings $ 6,140,394 Class 2: Laws, Regulations, Policies Bike Helmet Laws for Children: Grant and Rutner (2004) estimate a 15% reduction in child bicyclist fatalities attributable to bike helmet laws; applicable population: child bikers under age 12; permanent effects (medium cost). The effect of this countermeasure is an estimated 15% reduction in fatalities. Its primary target is bicyclists under the age of 12. The bicyclist fatality-to-injury ratio will be used in all calculations. Cyclists under age 12 not wearing a helmet represent 0.1% of all fatalities, resulting in an estimated 1 fatality per state. As there are an estimated 106 injuries per fatality, the example state is computed to have 91 injuries per year, for a total estimated cost of $3,719,434. Bike helmet laws for cyclists under age 12 have an estimated 15% reduction in fatalities, resulting in savings of $557,519. Table B3. Estimated savings for child bike helmet law countermeasure. Total fatalities 42,642 Bicyclists under 12, no helmet 61 % total fatalities 0.143% Median fatalities (state) 600 Est. child cyclist fatalities (state) 0.86 Cyclist death-to-injury ratio 106.41 ESTIMATED SAVINGS FOR AN EXAMPLE STATE No. $ Fatalities $ Injuries $ Total Fatalities 0.86 $ 957,718 Bike helmet law for children Injuries 91 $ 2,761,716 $ 3,719,434 Reduction Loss reduced by: 15% Fatalities 0.73 $ 814,060 Injuries 77.6 $ 2,347,459 $ 3,161,519 Savings $ 557,915

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38 Graduated Driver Licensing (GDL): For three-stage systems, 20-40% reduction in crashes (Shope, 2007; Baker, Chen, and Li, 2007); applicable population: 16-year-old drivers; permanent effects (medium cost). The effect of this countermeasure is an estimated 20% reduction in crashes involving 16-year-old drivers. Its primary target is 16-year-old drivers. The 16-year-old driver fatality-to-injury ratio will be used in all calculations. Sixteen-year-old drivers are involved in 2% of all fatalities, resulting in an estimated 12 fatalities per state. As there are an estimated 268 injuries per fatality, the example state is computed to have 3,318 injuries per year, for a total estimated cost of $114,143,621. GDL has an estimated 20% reduction in crashes, resulting in savings of $22,828,724. Table B4. Estimated savings for GDL countermeasure. Total fatalities 42,642 Fatalities involving 16 y/o driver 880 % total fatalities 2.064% Median fatalities (state) 600 Est. fatals inv. 16 y/o drivers (state) 12.38 Death-to-injury ratio inv 16 y/o driver 267.96 ESTIMATED SAVINGS FOR AN EXAMPLE STATE No. $ Fatalities $ Injuries $ Total GDL 3 stages Fatalities 12.38 $13,816,260 Injuries 3,318 $ 100,327,361 $114,143,621 Reduction 20% Loss reduced by: Fatalities 9.91 $11,053,008 Injuries 2,654.3 $ 80,261,889 $ 91,314,897 Savings $ 22,828,724 Extended Learner Permit: Reduction of 22-33% in 16-year-old crashes if minimum permit age 16 and 6-month minimum holding period (Agent, Steenbergen, Pigman et al., 1998; Ulmer, Ferguson, Williams et al., 2001; Mayhew, Simpson, Desmond et al., 2003); applicable population: 16-year-old drivers; permanent effects (low cost). The effect of this countermeasure is an estimated 22% reduction in crashes involving 16-year-old drivers if the minimum permit age is 16 with a 6-month minimum holding period. Its primary target is 16-year-old drivers. The 16-year-old driver fatality-to- injury ratio will be used in all calculations. Sixteen-year-old drivers are involved in 2% of all fatalities, resulting in an estimated 12 fatalities per state. As there are an estimated 268 injuries per fatality, the example state is computed to have 3,318 injuries per year, for a total estimated cost of $114,143,621. The extended learner permit has an estimated 22% reduction in crashes, resulting in savings of $25,111,597. Table B5. Estimated savings for extended learner permit countermeasure. Total fatalities 42,642 Fatalities involving 16 y/o driver 880 % total fatalities 2.064% Median fatalities (state) 600 Est. fatals inv. 16 y/o drivers (state) 12.38 Death-to-injury ratio involving 16 y/o driver 267.96 ESTIMATED SAVINGS FOR AN EXAMPLE STATE No. $ Fatalities $ Injuries $ Total Fatalities 12.38 $13,816,260 Extended learner permit Injuries 3,318 $100,327,361 $114,143,621 Reduction Loss reduced by 22% Fatalities 9.66 $10,776,683 Injuries 2,588 $ 78,255,342 $ 89,032,024 Savings $ 25,111,597

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39 Night Restrictions: On average, 50% reduction in nighttime crashes (9 P.M. to 6 A.M.) (Williams, 2007b); applicable population: 16-year-old drivers; permanent effects (low cost). The effect of this countermeasure is an estimated 50% reduction in nighttime crashes (9 P.M. to 6 A.M.) involving 16-year-old drivers. Its primary target is 16-year-old drivers. The 16-year-old driver fatality-to-injury ratio will be used in all calculations. Nighttime fatalities involving 16-year-old drivers represent 0.6% of all fatalities, resulting in an estimated 4 fatalities per state. As there are an estimated 268 injuries per fatality, the example state is computed to have 954 injuries per year, for a total esti- mated cost of $32,816,291. The nighttime (9 P.M. to 6 A.M.) restrictions have an estimated 50% reduction in nighttime crashes, resulting in savings of $16,408,146. Table B6. Estimated savings for night restrictions countermeasure. Total fatalities 42,642 Fatalities involving 16 y/o drivers in nighttime crashes 253 % total fatalities 0.593% Median fatalities (state) 600 Estimated fatalities involving 16 y/o drivers in nighttime crashes (state) 3.56 Death-to-injury ratio involving 16 y/o drivers 267.96 ESTIMATED SAVINGS FOR AN EXAMPLE STATE $ No. Fatalities $ Injuries $ Total Fatalities 3.56 $3,972,175 Night restrictions (9 P.M. to 6 A.M.) Injuries 954 $28,844,116 $32,816,291 Reduction Loss reduced by: 50% Fatalities 1.78 $1,986,087 Injuries 477.0 $14,422,058 $16,408,146 Savings $16,408,146 Passenger Restrictions: About a 33% reduction in 16-year-old fatal crashes in which teen passengers are injured or killed (Williams, 2007b); applicable population: 16-year-old drivers, permanent effects (low cost). The effect of this countermeasure is an estimated 33% reduction in 16-year-old driver fatal crashes in which a teen passenger was injured or killed. Its primary target is 16-year-old drivers with teen passengers. The 16-year-old driver fatality-to-injury ratio will be used in all calculations. Table B7. Estimated savings for passenger restrictions countermeasure. Total fatalities 42,642 Fatalities involving 16 y/o drivers with teen passengers 504 % total fatalities 1.182% Median fatalities (state) 600 Est. fatalities involving 16 y/o drivers with teen passenger (state) 7.09 Death-to-injury ratio involving 16 y/o drivers 267.96 ESTIMATED SAVINGS FOR AN EXAMPLE STATE $ No. Fatalities $ Injuries $ Total Fatalities 7.09 $7,912,949 Passenger restrictions Injuries 1,900 $57,460,216 $65,373,165 Reduction Loss reduced by: 33% Fatalities 4.75 $5,301,676 Injuries 1,273.2 $38,498,345 $43,800,020 Savings $21,573,144

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40 Fatalities involving 16-year-old drivers with teen passenger(s) represent 1% of all fatalities, resulting in an estimated 7 fatali- ties per state. As there are an estimated 268 injuries per fatality, the example state is computed to have 1,900 injuries per year, for a total estimated cost of $65,373,165. The passenger restrictions have an estimated 33% reduction in the above described crashes, resulting in savings of $21,573,144. Administrative License Revocation Law: Reduction of 13-15% in alcohol-related crashes (Wagenaar, Zobek, and Williams, 2000; Ross, 1987, 1991; Zador, Lund, and Weinberg, 1989; Voas and Tippetts, 1999); applicable population: alcohol-impaired drivers; permanent effects (high cost). Table B8. Estimated savings for administrative license revocation countermeasure. Total fatalities 42,642 Fatalities involving alcohol- impaired drivers 15,121 % total fatalities 35.460% Median fatalities (state) 600 Estimated alcohol-impaired related fatalities (state) 212.76 Alcohol-related death-to-injury ratio 46.7 ESTIMATED SAVINGS FOR AN EXAMPLE STATE No. $ Fatalities $ Injuries $ Total Fatalities 212.76 $237,404,168 Administrative license revocation Injuries 9,936 $300,444,419 $537,848,587 Reduction Loss reduced by: 13% Fatalities 185.10 $206,541,626 Injuries 8,644.3 $261,386,645 $467,928,271 Savings $ 69,920,316 The effect of this countermeasure is an estimated 13% reduction in alcohol-related crashes. Its primary target is alcohol- impaired drivers (BAC .08). The alcohol related fatality-to-injury ratio will be used in all calculations. Fatalities involving alcohol-impaired drivers represent 35% of all fatalities, resulting in an estimated 213 fatalities per state. As there are an estimated 47 injuries per fatality, the example state is computed to have 9,936 injuries per year, for a total estimated cost of $537,848,587. Administrative license revocation law has an estimated 13% reduction in crashes, resulting in savings of $69,920,316. Primary Seat Belt Law: Reduction of 7-8% in fatalities (Farmer and Williams, 2005; Chaudhary and Solomon, under review); applicable population: front seat occupants in passenger vehicles; permanent effects (low cost). Table B9. Estimated savings for primary seat belt law countermeasure. Total fatalities 42,642 Front seat occupants unbelted 13,173 % total fatalities 30.892% Median fatalities (state) 600 Estimated front seat occupant fatalities (state) 185.35 Front seat occupants >13 death- to-injury ratio 156.21 ESTIMATED SAVINGS FOR AN EXAMPLE STATE No. $ Fatalities $ Injuries $ Total Fatalities 185.35 $206,819,992 Primary seat belt law Injuries 28,954 $875,508,308 $1,082,328,300 Reduction Loss reduced by: 7% Fatalities 172.38 $192,342,593 Injuries 26,927.1 $814,222,726 $1,006,565,319 Savings $ 75,762,981

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41 The effect of this countermeasure is an estimated 7% reduction in fatalities. Its primary target is unbelted front seat outboard occupants of passenger vehicles (age 13 and up). The front seat occupant fatality-to-injury ratio will be used in all calculations. Unbelted front seat occupants age 13 and over represent 31% of all fatalities, resulting in an estimated 185 fatalities per state. As there are an estimated 156 injuries per fatality, the example state is computed to have 28,954 injuries per year, for a total estimated cost of $1,082,328,300. Primary seat belt law has an estimated 7% reduction in fatalities, resulting in savings of $75,762,981. Motorcycle Helmet Use Law: Reduction of 20-40% in fatalities (GAO, 1991); applicable population: motorcyclists; perma- nent effects (low cost). The effect of this countermeasure is an estimated 20% reduction in fatalities. Its primary target is motorcyclists. The motor- cyclist fatality-to-injury ratio will be used in all calculations. Table B10. Estimated savings for universal helmet use law countermeasure. Total fatalities 42,642 Motorcyclists (all) 4654 % total fatalities 10.914% Median fatalities (state) 600 Est. motorcyclist fatalities (state) 65.48 Motorcyclist death-to-injury ratio 34.53 ESTIMATED SAVINGS FOR AN EXAMPLE STATE No. $ Fatalities $ Injuries $ Total Fatalities 65.48 $73,069,175 Universal helmet use law Injuries 2,261 $ 68,373,798 $ 141,442,973 Reduction Loss reduced by: 20% Fatalities 52.39 $58,455,340 Injuries 1,809.0 $ 54,699,038 $ 113,154,379 Savings $ 28,288,595 Motorcyclists represent 11% of all fatalities, resulting in an estimated 65 fatalities per state. As there are an estimated 35 injuries per fatality, the example state is computed to have 2,261 injuries per year, for a total estimated cost of $141,442,973. Universal helmet laws for motorcyclists have an estimated 20% reduction in fatalities, resulting in savings of $28,288,595. Reduced Speed Limit: Reduction of 25-30% in pedestrian fatalities associated with a reduction in speed limit from 60 km/h to 50 km/h in urban areas (Fieldwick and Brown, 1987; Preston, 1990; Walz, Hoefliger, and Fehlmann, 1983); applicable popu- lation: pedestrians of all ages in urban areas; permanent effects (low cost). Table B11. Estimated savings for reduced speed limit countermeasure. Total fatalities 42,642 Ped. fatalities in 60km/h urban zones 1,106 % total fatalities 2.594% Median fatalities (state) 600 Estimated pedestrian fatalities in 60 km/h urban zones (state) 15.56 Pedestrian death-to-injury ratio 31.43 ESTIMATED SAVINGS FOR AN EXAMPLE STATE No. $ Fatalities $ Injuries $ Total Fatalities 15.56 $17,364,527 Reduced speed limit Injuries 489 $14,789,935 $32,154,461 Reduction Loss reduced by: 25% Fatalities 11.67 $13,023,395 Injuries 366.8 $11,092,451 $24,115,846 Savings $ 8,038,615

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42 The effect of this countermeasure is an estimated 25% reduction in pedestrian fatalities when urban speed limit is reduced from 60 km/h to 50 km/h. Its primary target is pedestrians in urban areas with a speed limit of 60 km/h. We define urban areas with speed limits between 35 mph and 40 mph as the target zones. The pedestrian fatality-to-injury ratio will be used in all calculations. Pedestrian fatalities in the target zones represent 3% of all fatalities, resulting in an estimated 16 fatalities per state. As there are an estimated 31 injuries per fatality, the example state is estimated to have 489 urban pedestrian injuries per year, for a total estimated cost of $32,154,461. Reducing speed limits from 60 km/h to 50 km/h in urban areas has an estimated 25% reduction in pedestrian fatalities, resulting in savings of $8,038,615. Class 3: Laws Plus Enhancements Sobriety Checkpoints: Reduction of 20% in alcohol-related fatal and injury crashes (Elder, Shults, Sleet et al., 2002); applica- ble population: alcohol impaired; effects only for duration of checkpoints (high cost). The effect of this countermeasure is an estimated 20% reduction in alcohol-related fatal and injury crashes. Its primary target is impaired drivers (BAC .08). The alcohol-related fatality-to-injury ratio will be used in all calculations. Fatalities involving alcohol-impaired drivers represent 35% of all fatalities, resulting in an estimated 213 fatalities per state. As there are an estimated 47 injuries per fatality, the example state is computed to have 9,936 injuries per year, for a total esti- mated cost of $537,848,587. Sobriety checkpoints have an estimated 20% reduction in crashes, resulting in savings of $107,569,717. Table B12. Estimated savings for sobriety checkpoints countermeasure. Total fatalities 42,642 Fatalities involving alcohol- impaired drivers 15,121 % total fatalities 35.460% Median fatalities (state) 600 Estimated alcohol-impaired- related fatalities (state) 212.76 Alcohol-related death-to-injury ratio 46.7 ESTIMATED SAVINGS FOR AN EXAMPLE STATE No. $ Fatalities $ Injuries $ Total Fatalities 212.76 $237,404,168 Sobriety checkpoints Injuries 9,936 $300,444,419 $537,848,587 Reduction Loss reduced by: 20% Fatalities 170.21 $189,923,334 Injuries 7,948.8 $240,355,535 $430,278,870 Savings $107,569,717 Short, High-Visibility Belt Law Enforcement: Increase of 4-6 percentage points in belt use; applicable population: unbelted front seat occupants; effects primarily while program is ongoing (high cost). The effect of this countermeasure is an estimated increase of 4 percentage points in belt use. NHTSA estimates that for every 1-percentage-point increase in belt use, an additional 270 lives are saved (2004 data). If belt use were to increase by 4 percent- age points, 1,070 lives would be saved. Based on 2004 FARS data, this would represent a 2.52% decrease in fatalities. The pri- mary target for this countermeasure is unbelted front seat outboard occupants (13 and over in passenger vehicles). The front seat occupant fatality-to-injury ratio will be used in all calculations. Unbelted front seat occupants age 13 and over represent 31% of all fatalities, resulting in an estimated 185 fatalities per state. As there are an estimated 156 injuries per fatality, the example state is computed to have 28,954 injuries per year, for a total estimated cost of $1,082,328,300. Short, high-visibility law enforcement has an estimated 3% reduction in fatalities, resulting in savings of $27,274,673.

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43 Table B13. Estimated savings for short, high-visibility belt law enforcement countermeasure. Total fatalities 42,642 Unbelted front seat occupants fatalities 13,173 % total fatalities 30.892% Median fatalities (state) 600 Est. unbelted front seat occupant fatalities (state) 185.35 Front seat occupants >13 death-to-injury ratio 156.21 ESTIMATED SAVINGS FOR AN EXAMPLE STATE No. $ Fatalities $ Injuries $ Total Short, high-visibility belt law Fatalities 185.35 $206,819,992 enforcement Injuries 28,954 $875,508,308 $1,082,328,300 Reduction Loss reduced by: 3% Fatalities 180.68 $201,608,129 Injuries 28,224.3 $853,445,498 $1,055,053,627 Savings $ 27,274,673 Automated Enforcement for Speed, Red Light Running: Speed cameras: on average, 20-40% reduction in crashes, based on studies in Canada, Australia, and Europe (Pilkington and Kinra, 2005); red-light cameras: 16% reduction in all injury crashes, 24% reduction in right-angle crashes, no significant increase in rear-end crashes (Aeron-Thomas and Hess, 2005); applicable populations: drivers running red lights or speeding; permanent effects where used (high cost). The effect of this countermeasure (speed cameras) is an estimated 20% reduction in crashes. Its primary target is speed-related crashes. The speed-related fatality-to-injury ratio will be used in all calculations. Table B14. Estimated savings for speed cameras countermeasure. Total fatalities 42,642 Speed-related fatalities 11,518 % total fatalities 27.011% Median fatalities (state) 600 Est. speed-related fatalities (state) 162.07 Speed-related death-to-injury ratio 87.48 ESTIMATED SAVINGS FOR AN EXAMPLE STATE No. $ Fatalities $ Injuries $ Total Fatalities 162.07 $180,836,003 Speed cameras Injuries 14,177 $428,699,124 $609,535,127 Reduction Loss reduced by: 20% Fatalities 129.65 $144,668,803 Injuries 11,342.0 $342,959,299 $487,628,102 Savings $121,907,025 Speed-related fatalities represent 27% of all fatalities, resulting in an estimated 162 fatalities per state. As there are an estimated 87 injuries per fatality, the example state is computed to have 14,177 injuries per year, for a total estimated cost of $609,535,127. Speed cameras have an estimated 20% reduction in crashes, resulting in savings of $121,907,025. Mass Media Supporting Alcohol Enforcement (Top-Line Programs): Reduction of 13% in alcohol-related crashes, with the caution that this is based on top-line programs (Elder, Shults, Sleet et al., 2002); applicable population: alcohol-impaired driv- ers; effects while program ongoing (high cost).

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44 The effect of this countermeasure is an estimated 13% reduction in alcohol-related crashes (note that this estimate is based on top-line programs only). Its primary target is alcohol-impaired drivers (BAC .08). The alcohol-related fatality-to-injury ratio will be used in all calculations. Fatalities involving alcohol-impaired drivers represent 35% of all fatalities, resulting in an estimated 213 fatalities per state. As there are an estimated 47 injuries per fatality, the example state is computed to have 9,936 injuries per year, for a total esti- mated cost of $537,848,587. Mass media supporting alcohol enforcement has an estimated 13% reduction in crashes, resulting in savings of $69,920,316. Table B15. Estimated savings for mass media support of alcohol enforcement countermeasure. Total fatalities 42,642 Fatalities involving alcohol- impaired drivers 15,121 % total fatalities 35.460% Median fatalities (state) 600 Estimated alcohol-impaired- related fatalities (state) 212.76 Alcohol-related death-to-injury ratio 46.7 ESTIMATED SAVINGS FOR AN EXAMPLE STATE No. $ Fatalities $ Injuries $ Total Mass media supporting alcohol Fatalities 212.76 $237,404,168 enforcement Injuries 9,936 $300,444,419 $537,848,587 Reduction Loss reduced by: 13% Fatalities 185.10 $206,541,626 Injuries 8,644.3 $261,386,645 $467,928,271 Savings $ 69,920,316 Community Programs Including Age-21 Enforcement: Reduction of 10-25% in crashes, based on a study by Holder, Gruenewald, Ponicki et al. (2000), who found that single-vehicle nighttime crashes decreased 10-11% more than in comparison communities, and a study by Hingson, McGovern, Howland et al. (1996), where there was a 25% greater reduction in fatal crashes in study communities than in the rest of Massachusetts (programs were vastly different but both incorporated age-21 enforcement); applicable population: alcohol users under age 21; effects while program ongoing (high cost). Table B16. Estimated savings for community programs countermeasure. Total fatalities 42,642 Fatalities involving drivers <21, BAC .01 2785 % total fatalities 6.531% Median fatalities (state) 600 Estimated fatalities involving drivers <21, BAC .01 (state) 39.19 Alcohol-related death-to-injury ratio 46.7 ESTIMATED SAVINGS FOR AN EXAMPLE STATE No. $ Fatalities $ Injuries $ Total Community programs including age- Fatalities 39.19 $43,725,323 21 enforcement Injuries 1,830 $55,336,136 $99,061,459 Reduction Loss reduced by: 10% Fatalities 35.27 $39,352,791 Injuries 1,647.0 $49,802,522 $89,155,313 Savings $ 9,906,146

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45 The effect of this countermeasure is an estimated 10% reduction in crashes. Its primary target is drivers under 21 with BAC .01. The alcohol-related fatality-to-injury ratio will be used in all calculations. Fatalities involving drivers under 21 with BAC .01 represent 7% of all fatalities, resulting in an estimated 39 fatalities per state. As there are an estimated 47 injuries per fatality, the example state is computed to have 1,830 injuries per year, for a total estimated cost of $99,061,459. Community programs including age-21 enforcement have an estimated 10% reduction in crashes, resulting in savings of $9,906,146. Class 4: Sanctions and Treatments Aggressive Driving/Speeding Penalties: Crash reduction effects for license suspension 17%, individual meetings 8%, group meetings 5%, and warning letters 4% (Masten and Peck, 2004); applicable population: apprehended traffic violators; effects while sanctions are in force, may not last (medium cost). These countermeasures' primary target is apprehended traffic violators. For this project, we will define the target as drivers with previous speeding convictions since data regarding previous aggressive driving convictions are not available in FARS. License Suspension (Medium Cost) The effect of this countermeasure is an estimated 17% reduction in crashes. Its primary target is drivers with previous speed con- victions involved in aggressive-driving-related crashes. The aggressive driving fatality-to-injury ratio will be used in all calculations. Aggressive-driving-related fatalities involving drivers with previous speed convictions represent 8% of all fatalities, resulting in an estimated 47 fatalities per state. As there are an estimated 90 injuries per fatality, the example state is computed to have 4,250 injuries per year, for a total estimated cost of $181,293,587. License suspension has an estimated 17% reduction in crashes, resulting in savings of $30,819,910. Table B17. Estimated savings for license suspension countermeasure. Total fatalities 42,642 Fatalities involving aggressive drivers with prev. speed conv. 3,362 % total fatalities 7.884% Median fatalities (state) 600 Est. fatalities involving prev. speed conv. (state) 47.31 Aggressive driving death-to- injury ratio 89.84 ESTIMATED SAVINGS FOR AN EXAMPLE STATE No. $ Fatalities $ Injuries $ Total Fatalities 47.31 $52,784,393 License suspension Injuries 4,250 $128,509,194 $181,293,587 Reduction Loss reduced by: 17% Fatalities 39.26 $43,811,047 Injuries 3,527.4 $106,662,631 $150,473,678 Savings $ 30,819,910 Individual Meetings (Low Cost) The effect of this countermeasure is an estimated 8% reduction in crashes. Its primary target is apprehended traffic violators involved in aggressive-driving-related crashes. The aggressive driving fatality-to-injury ratio will be used in all calculations. Aggressive-driving-related fatalities involving drivers with previous speed convictions represent 8% of all fatalities, resulting in an estimated 47 fatalities per state. As there are an estimated 90 injuries per fatality, the example state is computed to have 4,250 injuries per year, for a total estimated cost of $181,293,587. Individual meetings have an estimated 8% reduction in crashes, resulting in savings of $14,503,487.

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46 Table B18. Estimated savings for individual meetings countermeasure. Total fatalities 42,642 Fatalities involving aggressive drivers with prev. speed conv. 3,362 % total fatalities 7.884% Median fatalities (state) 600 Est. fatalities involving prev. speed conv. (state) 47.31 Aggressive driving death-to- injury ratio 89.84 ESTIMATED SAVINGS FOR AN EXAMPLE STATE No. $ Fatalities $ Injuries $ Total Fatalities 47.31 $52,784,393 Individual meetings Injuries 4,250 $128,509,194 $181,293,587 Reduction Loss reduced by: 8% Fatalities 43.52 $48,561,642 Injuries 3,909.9 $118,228,458 $166,790,100 Savings $ 14,503,487 Group Meetings (Medium Cost) The effect of this countermeasure is an estimated 5% reduction in crashes. Its primary target is apprehended traffic violators involved in aggressive-driving-related crashes. The aggressive driving fatality-to-injury ratio will be used in all calculations. Aggressive-driving-related fatalities involving drivers with previous speed convictions represent 8% of all fatalities, resulting in an estimated 47 fatalities per state. As there are an estimated 90 injuries per fatality, the example state is computed to have 4,250 injuries per year, for a total estimated cost of $181,293,587. Group meetings have an estimated 5% reduction in crashes, resulting in savings of $9,064,679. Table B19. Estimated savings for group meetings countermeasure. Total fatalities 42,642 Fatalities involving aggressive drivers with prev. speed conv. 3,362 % total fatalities 7.884% Median fatalities (state) 600 Est. fatalities involving prev. speed conv. (state) 47.31 Aggressive driving death-to- injury ratio 89.84 ESTIMATED SAVINGS FOR AN EXAMPLE STATE No. $ Fatalities $ Injuries $ Total Fatalities 47.31 $52,784,393 Group meetings Injuries 4,250 $128,509,194 $181,293,587 Reduction Loss reduced by: 5% Fatalities 44.94 $50,145,174 Injuries 4,037.4 $122,083,734 $172,228,908 Savings $ 9,064,679 Warning Letters (Medium Cost) The effect of this countermeasure is an estimated 4% reduction in crashes. Its primary target is apprehended traffic violators involved in aggressive-driving-related crashes. The aggressive driving fatality-to-injury ratio will be used in all calculations.

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47 Aggressive-driving-related fatalities involving drivers with previous speed convictions represent 8% of all fatalities, resulting in an estimated 47 fatalities per state. As there are an estimated 90 injuries per fatality, the example state is computed to have 4,250 injuries per year, for a total estimated cost of $181,293,587. Warning letters have an estimated 4% reduction in crashes, resulting in savings of $7,251,743. Table B20. Estimated savings for warning letters countermeasure. Total fatalities 42,642 Fatalities involving aggressive drivers with prev. speed conv. 3,362 % total fatalities 7.884% Median fatalities (state) 600 Est. fatalities involving prev. speed convictions (state) 47.31 Aggressive driving death-to- injury ratio 89.84 ESTIMATED SAVINGS FOR AN EXAMPLE STATE No. $ Fatalities $ Injuries $ Total Fatalities 47.31 $52,784,393 Warning letters Injuries 4,250 $128,509,194 $181,293,587 Reduction Loss reduced by: 4% Fatalities 45.41 $50,673,018 Injuries 4,079.9 $123,368,826 $174,041,844 Savings $ 7,251,743 Mandatory Attendance at Alcohol Treatment Programs: Reduction in alcohol-related crashes, 7-9% on average (Wells-Parker Banger-Drowns, McMillen et al., 1995); applicable population: DUI-convicted population; effect duration unknown (medium cost). The effect of this countermeasure is an estimated 7% reduction in alcohol-related crashes. Its primary target is drivers with previous DWI convictions involved in alcohol-related crashes (i.e., BAC .01). The alcohol-related fatality-to-injury ratio will be used in all calculations. Alcohol-related fatalities involving drivers with previous DWI represent 3% of all fatalities, resulting in an estimated 16 fatalities per state. As there are an estimated 47 injuries per fatality, the example state is computed to have 767 injuries per year, for a total estimated cost of $41,509,775. Alcohol treatment programs have an estimated 7% reduction in crashes, resulting in savings of $2,905,684. Table B21. Estimated savings for alcohol treatment program countermeasure. Total fatalities 42,642 Alcohol-related fatalities involving drivers with previous DWI 1,167 % total fatalities 2.737% Median fatalities (state) 600 Est. alcohol-related fatalities inv. drivers with prev. DWI (state) 16.42 Alcohol related death-to-injury ratio 46.7 ESTIMATED SAVINGS FOR AN EXAMPLE STATE No. $ Fatalities $ Injuries $ Total Fatalities 16.42 $18,322,245 Alcohol treatment program Injuries 767 $23,187,530 $41,509,775 Reduction Loss reduced by: 7% Fatalities 15.27 $17,039,688 Injuries 713.2 $21,564,403 $38,604,090 Savings $ 2,905,684

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48 Alcohol Interlocks: Reduction of 37-90% in recidivism (Willis, Lybrand, and Bellamy, 2004; Beirness and Marques, 2004); appli- cable population: DUI convicted population; duration of effect limited to period when interlock is present (medium cost). The effect of this countermeasure is an estimated 37% reduction in recidivism. Its primary target is drivers with previous DWI convictions involved in alcohol-related crashes. The assumption is that 37% of previously convicted drivers with an installed alcohol interlock system would not drink and drive, and thus would not be involved in alcohol-related crashes. The alcohol- related fatality-to-injury ratio will be used in all calculations. Alcohol-related fatalities involving drivers with previous DWI represent 3% of all fatalities, resulting in an estimated 16 fatalities per state. As there are an estimated 47 injuries per fatality, the example state is estimated to have 767 alcohol- related injuries per year, for a total estimated cost of $41,509,775. Alcohol interlocks for convicted DWI drivers have an esti- mated 37% reduction in recidivism, resulting in savings of $15,358,617. Table B22. Estimated savings for alcohol interlock countermeasure. Total fatalities 42,642 Alcohol-related fatalities inv. drivers with previous DWI 1,167 % total fatalities 2.737% Median fatalities (state) 600 Est. alcohol-related fatalities inv. drivers with prev. DWI (state) 16.42 Alcohol related death-to-injury ratio 46.7 ESTIMATED SAVINGS FOR AN EXAMPLE STATE No. $ Fatalities $ Injuries $ Total Fatalities 16.42 $18,322,245 Alcohol interlock Injuries 767 $23,187,530 $41,509,775 Reduction Loss reduced by: 37% Fatalities 10.34 $11,543,014 Injuries 483.1 $14,608,144 $26,151,158 Savings $15,358,617