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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Getting to Zero Alcohol-Impaired Driving Fatalities: A Comprehensive Approach to a Persistent Problem. Washington, DC: The National Academies Press. doi: 10.17226/24951.
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Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Gett ting to Zero Alcohol-Im o o mpaire ed Driving Fata g alities: A Compr C rehens A sive Approa to a ach Peersiste Pro m ent oblem Steven M. Teutsch Amy Ge M h, eller, and Y Yamrot Ne egussie, Ed ditors Commmittee on Acceleratin Progress to A ng s Reduce Alcohol-Im A mpaired Dr riving Fata alities Boa on Popu ard ulation He ealth and Pu ublic Heal Practice lth e Health and Medicine D H Division A Consensus Study R Report of PR REPUBLICA ATION CO OPY: UNCO ORRECTED PROOFS D S

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 This activity was supported by the National Highway Traffic Safety Administration (Contract No. 10002951). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13: 978-0-309-XXXXX-X International Standard Book Number-10: 0-309-XXXXX-X Digital Object Identifier: https://doi.org/10.17226/24951 Library of Congress Control Number: Additional copies of this publication are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2018 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2018. Getting to zero alcohol-impaired driving fatalities: A comprehensive approach to a persistent problem. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/24951 . PREPUBLICATION COPY: UNCORRECTED PROOFS

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org. PREPUBLICATION COPY: UNCORRECTED PROOFS

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process, and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo. PREPUBLICATION COPY: UNCORRECTED PROOFS

COMMITTEE ON ACCELERATING PROGRESS TO REDUCE ALCOHOL- IMPAIRED DRIVING FATALITIES STEVEN M. TEUTSCH (Chair), Adjunct Professor, University of California, Los Angeles, Fielding School of Public Health; Senior Fellow, Public Health Institute; Senior Fellow, Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California JULIE A. BALDWIN, Professor, Department of Health Sciences, Director, Center for Health Equity Research, Northern Arizona University LINDA C. DEGUTIS, Executive Director, Defense Health Horizons, Henry M. Jackson Foundation; Adjunct Professor, Rollins School of Public Health, Emory University MUCIO KIT DELGADO, Assistant Professor of Emergency Medicine and Epidemiology, Perelman School of Medicine, University of Pennsylvania DAVID H. JERNIGAN, Associate Professor, Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University KATHERINE KEYES, Associate Professor of Epidemiology, Mailman School of Public Health, Columbia University RICARDO MARTINEZ, Chief Medical Officer, Adeptus Health; Assistant Professor of Emergency Medicine, Emory School of Medicine TIMOTHY S. NAIMI, Associate Professor of Medicine, Boston University School of Medicine, Boston University School of Public Health; Clinician-Investigator, Section of General Internal Medicine, Boston Medical Center JEFF NIEDERDEPPE, Associate Professor, Department of Communication, Cornell University CHARLES P. O’BRIEN, Kenneth Appel Professor and Founding Director, Center for Studies of Addiction, University of Pennsylvania JODY L. SINDELAR, Professor, Public Health (Policy) and Economics, Yale University, School of Public Health JOANNE E. THOMKA, Program Counsel, National Association of Attorneys General DOUGLAS WIEBE, Associate Professor of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Study Staff AMY GELLER, Study Director YAMROT NEGUSSIE, Research Associate AIMEE MEAD, Research Associate (from June 2017) SOPHIE YANG, Research Assistant (from June 2017) MARJORIE PICHON, Senior Program Assistant (until September 2017) JENNIFER COHEN, Program Officer (from July 2017) HOPE HARE, Administrative Assistant MISRAK DABI, Financial Associate BERNARDO KLEINER, Associate Division Director, Transportation Research Board ROSE MARIE MARTINEZ, Senior Board Director, Board on Population Health and Public Health Practice v PREPUBLICATION COPY: UNCORRECTED PROOFS

REVIEWERS This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We thank the following individuals for their review of this report: KRISTINE M. GEBBIE, Torrens Resilience Institute, Flinders University NORMAN GIESBRECHT, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health RALPH HINGSON, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health ANNE McCARTT, formerly with Insurance Institute for Highway Safety SCOTT C. RATZAN, AB InBev Foundation EDUARDO ROMANO, Pacific Institute for Research and Evaluation (PIRE) RUTH SHULTS, Centers for Disease Control and Prevention MICHAEL D. SLATER, The Ohio State University FRANK A. SLOAN, Duke University GORDON SMITH, West Virginia University SRINIVASAN SUNDARARAJAN, Ford Motor Company STEPHEN K. TALPINS, Rumberger Kirk & Caldwell and National Partnership on Alcohol Misuse and Crime LAWRENCE WALLACK, Portland State University Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final draft before its release. The review of this report was overseen by ROBERT B. WALLACE, The University of Iowa, and RICHARD J. BONNIE, University of Virginia. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies. vii PREPUBLICATION COPY: UNCORRECTED PROOFS

ACKNOWLEDGMENTS The Committee on Accelerating Progress to Reduce Alcohol-Impaired Driving Fatalities wishes to acknowledge the many people whose contributions and support made this report possible. The committee benefited from presentations made by a number of experts. The following individuals shared their research, experience, and perspectives with the committee: Nadia Anderson, Douglas Beirness, Nancy Bill, Jessica Cicchino, Phillip Cook, James C. Fell, Debra Furr-Holden, Jacqueline Gillan, Thomas Greenfield, J. T. Griffin, Frank Harris, Ralph Hingson, Tara Kelley-Baker, Bill Kerr, Russ Martin, Jim McDonnell, Jeff Michael, Keith Nothacker, M. J. Paschall, Francesca Polletta, Rebecca Ramirez, Craig Reinarman, Lawrence Robertson, Steve Schmidt, Clint Shrum, Brooke Stringer, Steve Taylor, Anne Teigen, Nick Van Dyke, Robert Voas, Diane Wigle, and Thomas Woodward. The following individuals were important sources of information, generously giving their time and knowledge to further the committee’s efforts: Thomas F. Babor, Charles DiMaggio, Lori Dorfman, Deborah Fisher, Adnan Hyder, Jonathan Noel, Jamie Oliver, Katherine Robaina, Robert Strassburger, Andres Vecino-Ortiz, and Katherine Wheeler-Martin. The committee is thankful to the study staff for their support of this study: Amy Geller, Yamrot Negussie, Aimee Mead, Sophie Yang, Marjorie Pichon, Jennifer Cohen, Bernardo Kleiner, and Rose Marie Martinez. The committee also acknowledges the support of other National Academies of Sciences, Engineering, and Medicine staff, especially Daniel Bearss, Clyde Behney, Misrak Dabi, Iliana Espinal, Chelsea Frakes, Greta Gorman, Hope Hare, Nicole Joy, Sarah Kelley, Ellen Kimmel, Dana Korsen, Rebecca Morgan, Tina Ritter, Doris Romero, Barbara Schlein, Lauren Shern, Elizabeth Tyson, and Taryn Young. The committee also benefited from past National Academies studies relevant to this report, particularly the 2004 report Reducing Underage Drinking: A Collective Responsibility. Finally, funding for this project was provided by the National Highway Traffic Safety Administration. The committee extends special thanks for that support. ix PREPUBLICATION COPY: UNCORRECTED PROOFS

CONTENTS ACRONYMS AND ABBREVIATIONS xiii GLOSSARY xvii PREFACE xxi SUMMARY S-1 1 INTRODUCTION AND CONTEXT 1-1 Introduction, 1-1 About This Report, 1-7 The Road Ahead, 1-16 What Is Alcohol Impairment?, 1-18 Overview of the Study Process, 1-21 Conclusion, 1-22 References, 1-22 2 CURRENT ENVIRONMENT: ALCOHOL, DRIVING, AND DRINKING AND DRIVING 2-1 Introduction, 2-1 The Alcohol Environment, 2-1 Alcohol-Impaired Driving Trends, 2-8 Patterns of Alcohol Use and Demographics, 2-12 Situational Factors for Alcohol-Impaired Driving, 2-18 The Driving Environment, 2-20 Impacts of Alcohol-Impaired Driving, 2-23 Alcohol-Impaired Driving Interventions, 2-24 References, 2-27 3 INTERVENTIONS TO REDUCE DRINKING TO IMPAIRMENT 3-1 Introduction, 3-1 Policies to Maintain or Increase Price, 3- 2 Policies to Address Physical Availability, 3-11 Policies to Reduce Illegal Alcohol Sales, 3-16 Policies to Reduce the Harmful Effects of Alcohol Marketing, 3-24 Education and Awareness, 3-26 Technological Interventions, 3-32 Concluding Observations, 3-35 References, 3-36 4 ALCOHOL-IMPAIRED DRIVING INTERVENTIONS 4-1 Introduction, 4-1 Policies and Laws, 4-1 Enforcement and Arrest, 4-20 xi PREPUBLICATION COPY: UNCORRECTED PROOFS

CONTENTS xii Technology and Vehicle Factors, 4-27 Physical Environment and Transportation, 4-38 Research Needs, 4-46 References, 4-47 5 POSTCRASH AND ARREST INTERVENTIONS 5-1 Introduction, 5-1 Legal System Interventions: Enforcement, 5-2 Legal System Interventions: Adjudication, 5-5 Improving Emergency Medical and Trauma System Services, 5-40 References, 5-44 6 DATA AND SURVEILLANCE NEEDS AND OPPORTUNITIES 6-1 Introduction, 6-1 Overview of Available Data Sources on Alcohol-Impaired Driving, 6-2 Gaps and Barriers, 6-17 Public Health and Hospital Data Sets, 6-19 Opportunities for Data Collection and Surveillance, 6-20 Data Transparency, Access, and Stakeholders, 6-28 Future Data and Surveillance Needs, 6-29 References, 6-31 7 GENERATING ACTION 7-1 Introduction, 7-1 The Role of Social Movements, 7-1 Recent Community-Based Approaches, 7-5 The Media Environment and Media Advocacy, 7-11 Stakeholder Action, 7-14 Concluding Observations, 7-22 References, 7-22 8 CONCLUSION 8-1 References, 8-6 APPENDIXES A Alcohol-Impaired Driving in the United States: Review of Data Sources and Analyses, Charles DiMaggio, Katherine Wheeler-Martin, and Jamie Oliver A-1 B Content Analysis of Alcohol-Impaired Driving Stories in the News, Deborah Fisher B-1 C The Role of the Alcohol Industry in Policy Interventions for Alcohol-Impaired Driving, Thomas Babor, Katherine Robaina, and Jonathan Noel C-1 D Reducing Alcohol-Impaired Driving: Lessons from a Global Review, Adnan Hyder and Andres Vecino D-1 E Committee Meeting Agendas E-1 F Committee Biographical Sketches F-1 PREPUBLICATION COPY: UNCORRECTED PROOFS

ACRONYMS AND ABBREVIATIONS AASHTO American Association of State Highway and Transportation Officials ABI American Beverage Institute ABV alcohol by volume ACEP American College of Emergency Physicians ACTS Automotive Coalition for Traffic Safety AHA American Hospital Association AI/AN American Indian/Alaska Native AIS Abbreviated Injury Scale ALR administrative license revocation ALS administrative license suspension AMERSA Association for Medical Education and Research in Substance Abuse APIS Alcohol Policy Information System ASSIST American Stop Smoking Intervention Study AUD alcohol use disorder BAC blood alcohol concentration/content BrAC breath alcohol concentration BRFSS Behavioral Risk Factor Surveillance System CADCA Community Anti-Drug Coalitions of America CBA cost-benefit analysis CBT cognitive behavioral therapy CDC Centers for Disease Control and Prevention CEA cost-effectiveness analysis CI confidence interval CIREN Crash Injury Research and Engineering Network CODES Crash Outcome Data Evaluation System CPSTF Community Preventive Services Task Force CVD cardiovascular disease DADSS Driver Alcohol Detection System for Safety DMV Department of Motor Vehicles DOT Department of Transportation DUI driving under the influence DWI driving while impaired ED emergency department EMS emergency medical services ESV Enhanced Safety of Vehicles EUDL enforcing underage drinking laws FARS Fatality Analysis Reporting System xiii PREPUBLICATION COPY: UNCORRECTED PROOFS

ACRONYMS AND ABBREVIATIONS xiv FAST Fixing America’s Surface Transportation FBI Federal Bureau of Investigation FDA Food and Drug Administration FHWA Federal Highway Administration FMCSA Federal Motor Carrier Safety Administration FY fiscal year GHSA Governors Highway Safety Association GIS geographic information system HGN Horizontal Gaze Nystagmus HVMT highway vehicle miles traveled IGI intervention-generated inequality IIHS Insurance Institute for Highway Safety ITE Institute of Transportation Engineers MADD Mothers Against Drunk Driving MAP-21 Moving Ahead for Progress in the 21st Century Act MLDA minimum legal drinking age NCSA National Center for Statistics and Analysis NCSL National Conference of State Legislators NEISS National Electronic Injury Surveillance System NESARC National Epidemiologic Survey on Alcohol-Related Conditions NHTS National Household Travel Survey NHTSA National Highway Traffic Safety Administration NIAAA National Institute on Alcohol Abuse and Alcoholism NIBRS National Incident-Based Reporting System NRS National Roadside Survey of Alcohol and Drug Use by Drivers NSC National Safety Council NSDUH National Survey on Drug Use and Health NTDB National Trauma Data Bank NTSB National Transportation Safety Board NTX Naltrexone OECD Organisation for Economic Co-operation and Development OR odds ratio PAHO Pan American Health Organization PAR police accident report PAS passive alcohol sensor PBT preliminary breath test POLD place of last drink RBS responsible beverage service PREPUBLICATION COPY: UNCORRECTED PROOFS

xv ACRONYMS AND ABBREVIATIONS RID Remove Intoxicated Drivers ROADS SAFE Research of Alcohol Detection Systems for Stopping Alcohol-Related Fatalities Everywhere RR relative risk SAMHSA Substance Abuse and Mental Health Services Administration SBIRT screening, brief intervention, and referral to treatment SCC Safe Communities Coalition SDLP standard deviation of lane position SDOH social determinant of health SDS State Data System SDSP standard deviation of speed SES socioeconomic status SFST standardized field sobriety test SHS secondhand smoke SIP sales to intoxicated persons STRADA Swedish Traffic Accident Data Acquisition TAC transdermal alcohol content UCR Uniform Crime Reporting System UPPL Uniform Accident and Sickness Policy Provision Law V2I vehicle to infrastructure V2V vehicle to vehicle VMT vehicle miles traveled WHO World Health Organization WISQARS Web-based Injury Statistics Query and Reporting System YRBSS Youth Risk Behavior Surveillance System xv PREPUBLICATION COPY: UNCORRECTED PROOFS

GLOSSARY Alcohol-impaired driving crash/fatality—In all U.S. states1 drivers are considered legally impaired to drive when their blood alcohol concentration (BAC) is greater than or equal to 0.08 grams per deciliter (g/dL, often expressed as %, as in 0.08%).2 Thus, in the United States, any crash involving one or more drivers with a BAC of 0.08% or higher is typically referred to by the National Highway Traffic Safety Administration (NHTSA) as an alcohol-impaired driving crash, and fatalities stemming from those crashes are defined as be alcohol-impaired driving crash fatalities. Of note, however, is that impairment begins below 0.08%, so this is an underestimate relative to all crash fatalities in which impairment from alcohol may have contributed.3 Alcohol-related crash/fatality—A crash or a fatality from a crash that involves one or more drivers of a motor vehicle with any alcohol in their system (i.e., a BAC greater than 0.00%). This term also subsumes alcohol-impaired driving crashes. It is a useful umbrella term for all motor vehicle crashes that involve any alcohol. Some have also used the alcohol-involved term to convey the same thing. Alcohol use disorder (AUD)—The current Diagnostic and Statistical Manual of Mental Disorders (DSM-5) combines previously separate disorders (alcohol abuse and alcohol dependence) into one alcohol use disorder with a continuum of mild, moderate, and severe subclassifications. A patient is diagnosed with AUD if he or she displays 2 of the 11 symptoms during a 12-month period; the subclassifications are based on the number of symptoms the patient has (mild AUD = 2–3 of the symptoms, moderate AUD = 4–5 symptoms, and severe AUD = 6 or more symptoms). Binge drinking—Used to connote drinking at or above levels during a drinking occasion/episode that typically results in impairment-level BACs (i.e., ≥ 0.08%) for most men and women drinking at typical drinking rates. This corresponds to drinking 5 or more drinks for men, and 4 or more drinks for women in about 2 hours. Most public health and epidemiologic studies use 5/4 thresholds, and members of the general public interpret the binge drinking term to mean drinking to the point of impairment or intoxication. Blood alcohol concentration/content (BAC)—The percentage (%) of ethanol in the blood, based on the mass of alcohol per mass of blood. For instance, a BAC of 0.10 (0.10%, or one- tenth of 1 percent) means that there are 0.10 grams of alcohol for every deciliter (100 ml) of blood. Blood alcohol concentrations can also be derived from breath tests or transcutaneous 1 Utah recently passed legislation to lower the BAC law to 0.05% beginning December 2018. 2 States may have lower BAC laws for individuals under the minimum legal drinking age of 21 and for commercial drivers. 3 Of note, a crash involving a non-impaired motor vehicle driver and an impaired pedestrian or cyclist is not counted as an alcohol-impaired motor vehicle crash fatality by NHTSA’s Fatality Analysis Reporting System (FARS), which collects information about all motor vehicle crash fatalities occurring on U.S. public roadways. xvii PREPUBLICATION COPY: UNCORRECTED PROOFS

GLOSSARY xviii monitors. This is sometimes expressed in milligrams per deciliter, in which case a BAC of 0.1% is expressed as 100 mg/dL. Driver—Refers to the operator of any motor vehicle, including a motorcycle or motorboat. For surveillance purposes (e.g., NHTSA), this is usually restricted to motor vehicles operating on land, meaning motor vehicles, including motorcycles and related vehicles, operating on public roadways. Driving under the influence (DUI), driving while impaired (DWI)—These are legal terms that refer to operating a motor vehicle while one’s blood alcohol concentration is above the limit set by state law, or on the basis of field sobriety tests or observed behavior. Colloquial terms for DUI and DWI include Drink-driving—Refers to driving or operating a motor vehicle while impaired or while one’s blood alcohol concentration is above the limit set by law (more commonly used in the United Kingdom). Drunk driving crash/fatality—Widely used and recognized, and generally refers to driving or crashes or fatalities that are related to alcohol impairment (in most U.S. states based on BAC levels ≥ 0.08%; see footnote 1). Impairment—Refers to the deterioration of an individual’s judgment and/or physical ability. Physiologic and cognitive impairment begin at BAC levels below those that are associated with intoxication. As a legal standard, impairment and driving under the influence laws are based on a person’s physical or mental impairment as judged on the basis of BAC level, performance in standardized field sobriety tests, or observed behavior. Although this report is focused on impairment from alcohol, impairment can result from other substance use, distracted driving, and so on. Intoxication—Refers to the condition of having physical or mental control markedly diminished by the effects of alcohol or drugs. This is usually based on a subjective determination (one feels the sensation, or observes a behavior in another person). Physiologic impairment begins at BAC levels below those that are associated with intoxication. Intoxication is not a legal standard. Motor vehicle crash fatality—NHTSA defines a motor vehicle crash fatality as one that (1) involves at least one motor vehicle (e.g., car, motorcycle); (2) results in the death of a driver, passenger, cyclist, pedestrian, or occupant of a vehicle in transit within 30 days of the crash; and (3) occurs on a public U.S. roadway. Per se laws—Per se laws in DUI or DWI cases generally establish that once an individual is shown to have a BAC at or above a certain limit (e.g., 0.08%) that person will be considered impaired by law. In such circumstances, no further evidence of intoxication or impairment need be demonstrated for the purpose of a DUI case. Currently, all states have per se DUI laws. U.S. standard drink—In the United States, a standard drink is 14 grams or 0.6 ounces of pure ethanol (a weight-based measure). This is the amount of ethanol in 12 ounces of 5 percent PREPUBLICATION COPY: UNCORRECTED PROOFS

xix GLOSSARY alcohol-by-volume (ABV) beer, 5 ounces of 12 percent ABV wine, or 1.5 ounces of 40 percent ABV liquor (40 percent ABV, or 80 proof, is the concentration in most brands of whiskey, vodka, rum, gin, etc.). PREPUBLICATION COPY: UNCORRECTED PROOFS

PREFACE More than 10,000 people are killed in the United States each year from alcohol-impaired driving, and that number is on the rise. After decades of progress, the number of alcohol- impaired driving deaths first stagnated and is now actually increasing. Alcohol-impaired driving remains the greatest single cause of motor vehicle fatalities, significantly exceeding the number of deaths from distracted driving and drugged driving. Passengers, pedestrians, cyclists, and occupants of other vehicles—who make up almost 40 percent of alcohol-impaired driving fatalities1—are secondhand victims, and their fatalities are just as intolerable as those of the victims of cigarette secondhand smoke. For each death, hundreds more are injured or disabled. Our apathy toward 29 alcohol-impaired driving deaths per day is unacceptable, particularly because these tragic events can be prevented. This report describes how this can be accomplished with the tools already at our disposal and on the near-term horizon. By marshalling real-time, comprehensive data and the collective action of all the relevant stakeholders, we can make step-by-step progress toward eliminating these needless deaths and injuries. Vision Zero— the framework for eliminating motor vehicle deaths—provides the road map. Policy makers can enact and implement evidence-based policies, the clinical care system can identify and manage those at risk, the enforcement and legal systems can identify and manage offenders, the alcohol beverage industry can support and implement effective actions grounded in evidence and take steps to reduce harmful drinking, engineers and the private sector can partner to develop and incorporate effective technologies into vehicles and devices, government agencies can provide the leadership and research to enact and enforce policies to reinvigorate progress, and the public can advocate for effective actions. These collaborations can establish processes for the actions that need to be taken, determine the entities primarily responsible, assess progress toward implementation, and develop mechanisms to identify problems, investigate them, and take effective action. As some Organisation for Economic Co-operation and Development nations have demonstrated, alcohol-impaired driving deaths can be virtually eliminated. This report provides the science base to do so. I want to extend my gratitude to the National Highway Traffic Safety Administration for stimulating and sponsoring this report. It is another step in its continued leadership in making our roadways safer. Thanks, too, to the committee, staff, and consultants for their creativity and energy in bringing this report to fruition. Steven M. Teutsch, Chair Committee on Accelerating Progress to Reduce Alcohol-Impaired Driving Fatalities 1 NCSA. 2016. Alcohol-impaired driving: 2015 data. DOT HS 812 350. Washington, DC: National Highway Traffic Safety Administration. xxi PREPUBLICATION COPY: UNCORRECTED PROOFS

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Alcohol-impaired driving is an important health and social issue as it remains a major risk to Americans’ health today, surpassing deaths per year of certain cancers, HIV/AIDS, and drownings, among others, and contributing to long-term disabilities from head and spinal injuries. Progress has been made over the past decades towards reducing these trends, but that progress has been incremental and has stagnated more recently.

Getting to Zero Alcohol-Impaired Driving Fatalities examines which interventions (programs, systems, and policies) are most promising to prevent injuries and death from alcohol-impaired driving, the barriers to action and approaches to overcome them, and which interventions need to be changed or adopted. This report makes broad-reaching recommendations that will serve as a blueprint for the nation to accelerate the progress in reducing alcohol-impaired driving fatalities.

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