evidence
Publication Date: 12/07/2009
The Problem:
Vaccine coverage for vaccine preventable disease is an essential public health goal. Vaccination against specific diseases is particularly important for high risk populations, which may include individuals of a certain age (e.g., greater than 68 years for Pneumococcal Polysaccharide) or with specified medical conditions (e.g., HIV/AIDS for influenza). CDC: General Recommendations on Immunization.
The Law:
Laws and policies require vaccination (subject to enumerated exceptions) as a condition of certain jobs. In some states, state law or hospital policies require hospital staff to be vaccinated against influenza. In Rhode Island, for example, health care workers with direct patient contact must be vaccinated for measles, mumps, and rubella. RI Code R. 14-090-007. Illinois requires rubella vaccinations for nursery workers. Ill. Admin. Code tit. 77, § 250.1820.
The Evidence:
In a systematic review, a Community Guide expert panel attempted to systematically review the evidence concerning the impact of requiring vaccinations outright or as a condition of specified activities such as employment as a healthcare worker. Ndaiye SM, Hopkins DP, Shefer AM, et al. Interventions to improve influenza, pneumococcal polysaccharide, and hepatitis B vaccination coverage among high-risk adults: a systematic review. Am J Prev Med 2005;28(5S):248-79. The reviewers were unable to locate any studies that measured the impact of these laws in the U.S. As a result, the reviewers concluded there is insufficient evidence to currently evaluate the effectiveness of these laws and policies as public health measures aimed at protecting vulnerable populations against specific diseases.
The Bottom Line:
In the judgment of a Community Guide expert panel, there is insufficient evidence to assess the effectiveness of requiring vaccinations as a condition for specified jobs as a means of reducing incidence of specific diseases among particularly vulnerable populations.
Additional Information:
The Centers for Disease Control and Prevention has compiled and provided online access to state laws requiring or encouraging vaccination of health care workers.
Additional Resources: Centers for Disease Control and Prevention
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.
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:
At selective breath testing (SBT) checkpoints, law enforcement officials may require a driver to submit to a breath test if the officer has a reasonable suspicion that the driver is intoxicated. As of September 2009, law enforcement agencies in 38 U.S. states and the District of Columbia may conduct sobriety checkpoints. Governors Highway Safety Association. Law enforcement agencies in 11 states are either not authorized by the state to conduct checkpoints or are prohibited from conducting checkpoints by interpretations of state constitutions or by statutes (e.g., Wisconsin, Wis. Stat. § 349.02(2)(a)). Law enforcement officers follow established procedures in conducting checkpoints, including using objective criteria to determine checkpoint locations and using a predetermined system for stopping cars (e.g., every fourth vehicle at a checkpoint is stopped). For examples of laws authorizing checkpoints, see Utah Code Ann. §§ 77-23-101 et seq (Utah) and Nev. Rev. Stat. § 484.359 (Nevada).
The Evidence:
In a systematic review, Shults et al. reviewed 13 studies on SBT checkpoints. Shults, et al. Reviews of Evidence Regarding Interventions to Reduce Alcohol-Impaired Driving. Am J Prev Med. 2001;21(4S):66-88. The reviewers found that the use of SBT checkpoints is effective in reducing fatal and nonfatal injuries involved in motor vehicle accidents and in the reduction of total alcohol related crashes. SBT checkpoints were found to reduce fatal and nonfatal injuries during crashes by a median 20 percent. An ancillary benefit noted in the underlying studies of SBT checkpoints is the increased policing of other illegal activity behavior such as driving with a suspended license.
The Bottom Line:
In the judgment of a Community Guide expert panel, there is strong evidence supporting the effectiveness of SBT sobriety checkpoints as a public health intervention aimed at reducing the harms associated with alcohol impaired driving.
Additional Information:
The Community Guide provides online access to a table summarizing the studies used in the review.
The Insurance Institute for Highway Safety provides online access to a table listing statutes and judicial interpretations authorizing or prohibiting sobriety checkpoints.
Additional Resources: The Community Guide , Insurance Institute for Highway Safety
