Effective
Publication Date: 12/07/2009
The Problem:
Tobacco use is a source of chronic and fatal illnesses for users and persons with secondary exposure. In the United States, cigarette smoking contributes to one in five deaths and costs more than $193 billion in annual lost productivity and healthcare expenditures. CDC: Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses—United States, 2000–2004.
The Law:
Smoking bans and restrictions prohibit smoking in specified areas. These restrictions aim to eliminate or reduce exposure to second hand smoke. Smoking bans and restrictions are found in state and local laws as well as regulations governing workplace safety. For examples of state smoking regulations, see ARS 36-601.01 (Arizona), Utah Health Code § 26.83.3 (Utah), VT Health Code § 1742 (Vermont), and RI Health & Safety Code § 23-20.10-3 (Rhode Island).
The Evidence:
In a systematic review, a Community Guide expert panel reviewed 10 studies that assessed the effectiveness of smoking bans and restrictions as means of reducing exposure to secondhand smoke in workplaces. Hopkins DP et al. Reviews of Evidence Regarding Interventions to Reduce Tobacco Use and Exposure to Environmental Tobacco Smoke. Am J Prev Med 2001; 20(2S). Some of the underlying studies measured the impact of specific smoking restriction laws; others measured the impact of policies initiated and enforced by private entities. The reviewers identified reductions in self-reported exposure or actual nicotine vapor in 9 of the 10 studies. Reductions in vapor measures ranged from 44 percent to 97 percent.
The Bottom Line:
In the judgment of a Community Guide expert panel, there is strong evidence supporting smoking bans and restrictions as effective public health interventions aimed at decreasing exposure to secondhand smoke.
Additional Information:
An interactive map from the Robert Wood Johnson Foundation gives policy-makers and advocates a nationwide picture of continuing state efforts on key tobacco control policies.
Additional Resources: Smoke-free Laws by State
Publication Date: 12/07/2009
The Problem:
The leading cause of death for people age 34 and below in the United States is motor vehicle crashes. CDC: Motor Vehicle Safety Factsheet. Crashes occur due to impaired driving, inexperience, faulty vision and general recklessness. In congested areas, pedestrian safety is major public health concern. Approximately 700 children are killed each year by motor vehicles while walking. CDC: Reducing Childhood Pedestrian Injuries: Summary of a Multidisciplinary Conference.
The Law:
Traffic laws are designed to minimize motor vehicle crashes and to improve driver, passenger and pedestrian safety. Enforcing traffic laws can be difficult. Red light cameras take a picture of any car that fails to appropriately abide by a red light thereby endangering other drivers and pedestrians. The pictures are used to issue traffic citations, which often include sizable mandatory fines ($446 in Los Angeles: Photo Red Light Program). Twenty-four states and the District of Columbia have red light programs operating somewhere within their jurisdiction authorized either through state or local law. Governors’ Highway Association: Red Light Cameras. For an example of a state law authorizing the use of red light cameras, see RI Stat 42-28.9
The Evidence:
In a systematic review, Aeron-Thomas and Hess reviewed ten studies measuring the impact of red light cameras on motor vehicle crashes. Aeron-Thomas A, Hess, S. Red-Light Cameras for the Prevention of Road Traffic Crashes. The Cochrane Library. 2009, v.2. The reviewers found that the studies generally identified an association between the red light cameras and reductions in fatal crashes. However, weaker and often statistically insignificant relationships were observed between the cameras and overall crashes. On this basis, the reviewers concluded that there was sufficient evidence to establish the effectiveness of red light cameras as an intervention aimed at reducing fatal crashes, but that additional research is needed to validate the impact of these cameras on overall crashes and reckless driving generally.
The Bottom Line:
In the judgment of a Cochrane Collaborative expert panel, sufficient evidence exists to support red light cameras as an effective public health intervention to reduce motor vehicle crash fatalities, but there is insufficient evidence to validate the effectiveness of the cameras in reducing overall crashes.
Additional Information:
The Governors’ Highway Association provides online access to a table indicating in which states red light cameras are authorized or prohibited under state law.
Additional Resources: Governors’ Highway Association
Publication Date: 12/07/2009
The Problem:
The operation of motor vehicles while intoxicated is a major public health problem. Each year in the United States roughly 13,400 people die and an additional 255,500 are injured in motor vehicle crashes involving an alcohol-impaired driver. These crashes account for 32 percent of all U.S. traffic-related deaths and cost roughly $51 billion a year. CDC: Impaired Driving Factsheet.
The Law:
Blood alcohol per se laws set a blood alcohol limit at which an individual is considered legally impaired (i.e., impairment is “per se” because actual inability to function need not be established). Currently, all states set their BAC limit at 0.08 percent; some previously set the BAC levels at 0.10 percent. For examples of BAC per se laws, see Cal. Veh. Code §23152 (California), Fla. Stat. §316.193 (Florida), K.S.A. §8-1567 (Kansas), M.R.S. §2411 (Maine), N.M. Stat. Ann. §66-8-102 (New Hampshire), N.M. Stat. Ann. §66-8-102 (New Mexico), N.C. Gen. Stat. §20-138.1 (North Carolina), O.R.S. 813.010 (Oregon), Utah Code §41-6a-502 (Utah), 23 V.S.A. §1201 (Vermont), and Va. Code Ann. §18.2-266 (Virginia).
The Evidence:
In a Community Guide systematic review, Shults et al. reviewed eight studies that examined the impact of lowering the BAC limit to 0.08 percent on the rate of alcohol-related motor-vehicle deaths. Shults, et al. Reviews of Evidence Regarding Interventions to Reduce Alcohol-Impaired Driving. Am J Prev Med. 2001;21(4S):66-88.According to the reviewers, the underlying studies reveal a considerable association between the adoption of 0.08 percent BAC laws and a decline in alcohol-related motor-vehicle deaths; the median reduction in motor vehicle fatalities after the laws were adopted was 7 percent. Shults et al view these studies as strong evidence of the effectiveness of 0.08 BAC laws as a public health intervention. However, they caution that most of the BAC laws analyzed were enacted along with, or were supplemented by, other preventive drunk-driving laws, such as Administrative License Revocation (ALR) laws, making it difficult to isolate the exact magnitude of the impact of BAC laws.
The Bottom Line:
In the judgment of a Community Guide expert panel, there is strong evidence that laws adopting decreased BAC levels effectively reduce alcohol-related motor-vehicle deaths.
Additional Information:
The Community Guide provides online access to a table summarizing the results of each study it reviewed.
Additional Resources: The Community Guide
Publication Date: 12/07/2009
The Problem:
The operation of motor vehicles while intoxicated is a major public health problem. Each year in the United States roughly 13,400 people die and an additional 255,500 are injured in motor vehicle crashes involving an alcohol-impaired driver. In 2006, these crashes accounted for almost a third of all U.S. traffic-related deaths. CDC: Impaired Driving Factsheet.
The Law:
In an effort to reduce drunk-driving recidivism, municipalities and states have experimented with ignition interlock programs. Ignition interlock devices disable a car’s ignition until the driver provides a breath sample that confirms that the driver’s blood alcohol content (BAC) is under the requisite limit. Participation in ignition interlock programs is sometimes required as a condition of sentences for violating drunk- driving laws. Initially, participation in the US was generally on a voluntary basis (e.g., violators could participate to regain their driving privileges earlier than otherwise provided) or was left to the court’s discretion and implemented only for repeat offenders. For examples of ignition interlock laws, see 75 Pa.C.S. §§ 88.1-88.8 (Pennsylvania), 90 MGL 24(c)(2) (Massachusetts), and A.R.S. §28-1381(I)(6) (Arizona).
The Evidence:
In a systematic review, Willis et al. reviewed 14 studies in the U.S. and Canada evaluating the effects of ignition interlock programs on drunk-driving recidivism. Willis et al. Alcohol ignition interlock programmes for reducing drink driving recidivism. Cochrane Database of Systematic Reviews. 2004; Issue 3. The underlying studies measured three types of outcomes: (1) recidivism rates while the driver participated in the ignition interlock program, (2) recidivism rates after the ignition interlock device was removed from the vehicle, and (3) recidivism rates during the entire study period. The reviewers found that interlock program participants were less likely to repeat offend than the control group. The impact was even more pronounced for repeat offenders. However, in each instance, recidivism returned to pre-intervention rates after the devices were removed. Though effective as a short term intervention, continued research on the effects of ignition interlock programs on drunk-driving recidivism over longer time periods is needed.
The Bottom Line:
In the judgment of a Cochrane Collaboration expert panel, ignition interlock programs reduce drunk-driving recidivism, but only while the devices are attached.
Additional Information:
Mothers Against Drunk Driving (MADD) maintains an online table listing the states with ignition interlock laws.
Additional Resources: Mothers Against Drunk Driving
Publication Date: 12/07/2009
The Problem:
The operation of motor vehicles while intoxicated is a major public health problem. Each year in the United States roughly 13,400 people die and an additional 255,500 are injured in motor vehicle crashes involving an alcohol-impaired driver. In 2006, these crashes accounted for almost a third of all U.S. traffic-related deaths. CDC: Impaired Driving Factsheet.
The Law:
Blood alcohol per se laws set a blood alcohol limit at which an individual is considered legally impaired (i.e., impairment is “per se” because actual inability to function need not be established). Currently, all states set their BAC limit at 0.08 percent; some previously set the BAC levels at 0.10 percent. For examples of BAC per se laws, see Cal. Veh. Code §23152 (California), Fla. Stat. §316.193 (Florida), K.S.A. §8-1567 (Kansas), M.R.S. §2411 (Maine), N.M. Stat. Ann. §66-8-102 (New Hampshire), N.M. Stat. Ann. §66-8-102 (New Mexico), N.C. Gen. Stat. §20-138.1 (North Carolina), O.R.S. 813.010 (Oregon), Utah Code §41-6a-502 (Utah), 23 V.S.A. §1201 (Vermont), and Va. Code Ann. §18.2-266 (Virginia).
The Evidence:
In a Community Guide systematic review, Shults et al. reviewed nine studies that examined the impact of lowering the BAC limit to 0.08 percent on the rate of alcohol-related motor-vehicle deaths. Shults, et al. Reviews of Evidence Regarding Interventions to Reduce Alcohol-Impaired Driving. Am J Prev Med. 2001;21(4S):66-88. According to the reviewers, the underlying studies reveal a considerable association between the adoption of 0.08 percent BAC laws and a decline in alcohol-related motor-vehicle deaths; the median reduction in motor vehicle fatalities after the laws were adopted was 7 percent. Shults et al view these studies as strong evidence of the effectiveness of 0.08 BAC laws as a public health intervention. However, they caution that most of the BAC laws analyzed were enacted along with, or were supplemented by, other preventive drunk-driving laws, such as Administrative License Revocation (ALR) laws, making it difficult to isolate the exact magnitude of the impact of BAC laws.
The Bottom Line:
In the judgment of a Community Guide expert panel, there is strong evidence that laws adopting decreased BAC levels effectively reduce alcohol-related motor-vehicle deaths.
