Long-Term Change in Underage Drinking and Impaired Driving After the Establishment of Drinking Age Laws in New York State

This study depicts the long-term change in youths' alcohol use and impaired driving behaviors associated with the establishment of the drinking age laws. Five telephone surveys were conducted with youths aged 16 to 24 in 10 sampled New York State counties in 1982, 1983, 1985, 1986, and 1996. Analysis of the self-reported data showed that, 10 years after the enactment of the 21 drinking age law, alcohol use among la-, 19-, and 20-year-olds decreased by up to 58%. Alcohol purchase rates of 19- and 20-year-olds were reduced by ∼70% from 1985 to 1996. Although impaired driving rates declined over the survey years for each age group, ∼25% of all underage respondents in 1996 reported that they had ridden in a vehicle with an impaired driver. Findings from this research indicate that alcohol purchase, alcohol use, and impaired driving have declined among the targeted youth groups as a result of the 21 drinking age law. However, continued efforts need to focus on both underage drinking and impaired driving/riding with impaired drivers, because they remain serious public health risks among the youth population.     

Ethnic differences in driving after drinking and riding with drinking drivers among adolescents

BACKGROUND: This study examined the relationship between ethnicity and driving after drinking (DD) and riding with drinking drivers (RWDD) while controlling for drinking patterns, driving practices, and background demographic characteristics including age and gender. METHODS: Using random-digit dialing procedures, 1534 young adults ranging from 15- to 20-years of age(mean = 17.6) living in California were recruited to participate in a telephone survey. Latinos, African Americans, and Asian Americans were oversampled to allow cross-group comparisons. RESULTS: Rates of DD were lower for females than for males and were also lower for African Americans and Asian Americans than for whites. However, after we controlled for drinking patterns and driving practices, the results showed Latinos at greater risk for DD than white adolescents. Compared with whites and males, Asian American and female adolescents were less likely to report RWDD. When drinking patterns and driving practices were taken into account, Latino adolescents were nearly twice as more likely to ride with drinking drivers than whites. CONCLUSIONS: These findings indicate a greater need for directing prevention efforts to target Latino youth and youth at risk. Moreover, research aimed at elucidating the social and environmental factors involved in the low prevalence rates of DD and RWDD among Asian American youth may indicate possible protective factors to DD and RWDD operating within the Asian American community.     

Evidence of a structural effect for alcohol outlet density: a multilevel analysis

BACKGROUND: Ecological studies reveal that alcohol-related outcomes tend to occur in high alcohol outlet density neighborhoods. The ecological design of these studies limits the interpretation of the findings in terms of the level of the effect. The effect of alcohol outlet density could be related to greater individual access to alcohol, an individual level effect, or to the grouping of drinkers by neighborhood, a structural effect at the neighborhood level. METHODS: To differentiate between individual and neighborhood level possibilities, we conducted a multilevel study. Individual distance to the closest alcohol outlet was the individual level measure of the effect of alcohol outlet density, whereas the mean distance to the closest alcohol outlet for all individuals within a census tract was the neighborhood level measure for the effect of alcohol outlet density. We analyzed telephone surveys of 2604 telephone households within 24 census tracts stratified by poverty status and alcohol outlet density. Individual distance to alcohol outlets, age, sex, race/ethnicity, and level of education were entered as individual level covariates, and their corresponding aggregated means were entered as census tract level covariates (i.e., mean distance to outlets, mean age, percentage male, percentage Black, mean education). RESULTS: Analysis of variance revealed that 16.2% of the variance in drinking norms and 11.5% of the variance in alcohol consumption were accounted for at the census tract level. In multivariate hierarchical analysis, individual distance to the closest alcohol outlet was unrelated with drinking norms and alcohol consumption, whereas mean distance to the closest alcohol outlet demonstrated a negative relation with drinking norms (betae = -5.50+/-2.37) and with alcohol consumption (betae = -0.477+/-0.195); that is, the higher the mean distance to the closest alcohol outlet, the lower the mean drinking norms score and mean level of alcohol consumption. CONCLUSIONS: The findings suggest that the effect of alcohol outlet density on alcohol-related outcomes functions through an effect at the neighborhood level rather than at the individual level. Problem drinkers tend to be grouped in neighborhoods, an effect predicted by alcohol outlet density.     

Ecological Associations of Alcohol Outlets With Underage and Young Adult Injuries

Objective: This paper argues that associations between rates of 3 specific problems related to alcohol (i.e., accidents, traffic crashes, and assaults) should be differentially related to densities of alcohol outlets among underage youth and young adults based upon age‐related patterns of alcohol outlet use. Methods: Zip code‐level population models assessed local and distal effects of alcohol outlets upon rates of hospital discharges for these outcomes. Results: Densities of off‐premise alcohol outlets were significantly related to injuries from accidents, assaults, and traffic crashes for both underage youth and young adults. Densities of bars were associated with more assaults and densities of restaurants were associated with more traffic crash injuries for young adults. Conclusions: The distribution of alcohol‐related injuries relative to alcohol outlets reflect patterns of alcohol outlet use.     

How much can you drink before driving? The influence of riding with impaired adults and peers on the driving behaviors of urban and rural youth

AIMS: Following an ecological model to specify risks for impaired driving, we assessed the effects of youth attitudes about substance use and their experiences of riding in cars with adults and peers who drove after drinking alcohol or smoking cannabis on the youths' own driving after drinking or using cannabis. DESIGN AND METHODS: Participants were 2594 students in grades 10 and 12 (mean age = 16 years and 2 months; 50% girls) from public high schools in urban (994) and rural communities (1600) on Vancouver Island in British Columbia, Canada; 1192 of these were new drivers with restricted licenses. Self-report data were collected in anonymous questionnaires. Regression analyses were used to assess the independent and interacting effects of youth attitudes about substance use and their experiences of riding in cars with adults or peers who drove after drinking alcohol or smoking cannabis on youth driving. FINDINGS: Youth driving risk behaviors were associated independently with their own high-risk attitudes and experiences riding with peers who drink alcohol or use cannabis and drive. However, risks were highest for the youth who also report more frequent experiences of riding with adults who drink alcohol or use cannabis and drive. CONCLUSIONS: Prevention efforts should be expanded to include the adults and peers who are role models for new drivers and to increase youths' awareness of their own responsibilities for their personal safety as passengers.     

The impact of alcohol outlet density on the geographic clustering of underage drinking behaviors within census tracts

Background: The regulation of alcohol outlet density has been considered as a potential means of reducing alcohol consumption and related harms among underage youth. Whereas prior studies have examined whether alcohol outlet density was associated with an individual’s alcohol consumption and related harms, this study examines whether it is related to the co‐occurrence, or clustering, of these behaviors within geographic areas, specifically census tracts. Methods: The Enforcing Underage Drinking Laws Randomized Community Trial provided cross‐sectional telephone survey data in 2006 and 2007 from 10,754 youth aged 14 to 20 from 5 states residing in 1,556 census tracts. The alternating logistic regression approach was used to estimate pairwise odds ratios between responses from youth residing in the same census tract and to model them as a function of alcohol outlet density. Results: Riding with a drinking driver, making an alcohol purchase attempt, and making a successful alcohol purchase attempt clustered significantly within census tracts with the highest off‐premise alcohol outlet density while frequent drinking clustered within census tracts with the greatest on‐premise density. Driving after drinking and experiencing nonviolent alcohol‐related consequences clustered marginally within census tracts with the greatest on‐premise and off‐premise alcohol outlet density, respectively. Conclusions: Although youth primarily receive alcohol from social sources, commercial alcohol access is geographically concentrated within census tracts with the greatest off‐premise outlet density. A potentially greater concern is the clustering of more frequent drinking and drinking and driving within census tracts with the greatest on‐premise outlet density which may necessitate alternative census tract level initiatives to reduce these potentially harmful behaviors.     

Alcohol outlets, youth drinking, and self-reported ease of access to alcohol: a constraints and opportunities approach

Background:  Despite recent research examining youth access to alcohol, the extent to which relative ease of access to alcohol from various sources translates into the use of these sources is not known.
Methods:  Patterns of adolescent alcohol access in California were studied using a hierarchical analysis of self-reported and archival measures. A survey of 30 youths age 14 to 16 in each of 50 zip codes selected to maximize variability in median household income and off-premise outlet densities was conducted.
Results:  (1) Both actual use of and perceived ease of access to formal sources were positively associated with off-premise outlet density (a measure of formal access). (2) Actual use of informal sources was negatively associated with outlet densities. (3) Perceived and realized informal access were associated positively with deviance and negatively with conventionality. (4) Deviance was associated with increased perceived and realized access from both formal and social sources, whereas conventionality was only associated with realized and perceived informal access.
Conclusions:  Correlates of perceived and actual alcohol access differ somewhat, and the differences between informal and formal access (both perceived and actual) are many, creating a complex picture of the patterns of underage access to alcohol. Youth drinking is affected by opportunities and constraints. Specifically, as one form of access becomes constrained, youth appear to circumvent restrictions by relying on other modes of access. Thus interventions targeting formal alcohol access by youth may result in a shift to reliance on social sources. This complex problem requires a multi-faceted intervention approach.     

Density of alcohol outlets and teenage drinking: living in an alcogenic environment is associated with higher consumption in a metropolitan setting

Aim This study examines the relationship between physical, socio‐economic and social environments and alcohol consumption and drunkenness among a general population sample of drinkers aged 12–17 years. Design, setting, participants and measures The study was conducted in Auckland, New Zealand. The design comprised two components: (i) environmental measures including alcohol outlet density, locality‐based measure of willingness to sell alcohol (derived from purchase surveys of outlets) and a locality‐based neighbourhood deprivation measure calculated routinely in New Zealand (known as NZDEP); and (ii) the second component was a random telephone survey to collect individual‐level information from respondents aged 12–17 years including ethnicity, frequency of alcohol supplied socially (by parents, friends and others), young person's income; frequency of exposure to alcohol advertising; recall of brands of alcohol and self‐reported purchase from alcohol outlets. A multi‐level model was fitted to predict typical‐occasion quantity, frequency of drinking and drunkenness in drinkers aged 12–17 years. Findings Typical‐occasion quantity was predicted by: frequency of social supply (by parents, friends and others); ethnicity and outlet density; and self‐reported purchasing approached significance. NZDEP was correlated highly with outlet density so could not be analysed in the same model. In a separate model, NZDEP was associated with quantity consumed on a typical drinking occasion. Annual frequency was predicted by: frequency of social supply of alcohol, self‐reported purchasing from alcohol outlets and ethnicity. Feeling drunk was predicted by frequency of social supply of alcohol, self‐reported purchasing from alcohol outlets and ethnicity; outlet density approached significance. Age and gender also had effects in the models, but retailers' willingness to sell to underage patrons had no effects on consumption, nor did the advertising measures. The young person's income was influential on typical‐occasion quantity once deprivation was taken into account. Conclusion Alcohol outlet density was associated with quantities consumed among teenage drinkers in this study, as was neighbourhood deprivation. Supply by family, friends and others also predicted quantities consumed among underage drinkers and both social supply and self‐reported purchase were associated with frequency of drinking and drunkenness. The ethnic status of young people also had an effect on consumption.     

Alcohol outlet policies and practices concerning sales to underage people

Little is known about the relationship between alcohol outlet policies and practices in the United States and the likelihood that outlets will sell alcoholic beverages to persons under the legal drinking age. This study assessed the prevalence of such outlet-level policies and practices, and analyzed the relationships between outlet variables and outlets' actual propensity to sell alcoholic beverages to youth. The sample consisted of all outlets licensed for off-premise and a 40% random sample of outlets licensed for on-premise sale of alcoholic beverages in 15 small to medium-sized communities in Minnesota and Wisconsin (USA). Data on outlet characteristics, policies and practices were collected by a telephone survey of the owner or manager of each outlet. In addition, alcohol purchase attempts were conducted at each outlet by youthful-appearing study confederates. Generally, policies and practices that may reduce the likelihood of sales to youth were reported by a minority of outlets. Purchase success was found to be associated with a number of outlet characteristics, policies and practices. The implications of these findings for policy and future research are discussed.     

Alcohol outlet density and university student drinking: a national study

AIMS: To examine the geographic density of alcohol outlets and associations with drinking levels and related problems among university students. DESIGN: Cross-sectional survey study using geospatial data, with campus-level and individual-level analyses. PARTICIPANTS: A total of 2550 students (mean age 20.2, 60% women) at six university campuses in New Zealand (63% response). MEASUREMENTS: Counts of alcohol outlets within 3 km of each campus were tested for their non-parametric correlation with aggregated campus drinking levels and related problems. Generalized estimating equations were used to model the relation between outlet counts within 1 km and 3 km of student residences and individual drinking levels/problems, with control for gender, age, ethnicity and high school binge drinking frequency, and adjustment for campus-level clustering. FINDINGS: Correlations for campus-level data were 0.77 (P = 0.07) for drinking and personal problems, and 0.31 (P = 0.54) for second-hand effects. There were consistent significant associations of both on- and off-licence outlet densities with all outcomes in student-level adjusted models. Effects were largest for 1 km densities and off-licence outlets. CONCLUSIONS: There are positive associations between alcohol outlet density and individual drinking and related problems. Associations remain after controlling for demographic variables and pre-university drinking, i.e. the associations are unlikely to be due to self-selection effects. Increasing alcohol outlet density, and particularly off-licences, may increase alcohol-related harm among university students.     

The Impact of Underage Drinking Laws on Alcohol-Related Fatal Crashes of Young Drivers

Background: This study used a pre‐ to post‐design to evaluate the influence on drinking‐and‐driving fatal crashes of 6 laws directed at youth aged 20 and younger and 4 laws targeting all drivers. Methods: Data on the laws were drawn from the Alcohol Policy Information System data set (1998 to 2005), the Digests of State Alcohol Highway Safety Related Legislation (1983 to 2006), and the Westlaw database. The Fatality Analysis Reporting System data set (1982 to 2004) was used to assess the ratio of drinking to nondrinking drivers involved in fatal crashes [fatal crash incidence ratio (CIR)]. The data were analyzed using structural equation modeling techniques. Results: Significant decreases in the underage fatal CIR were associated with presence of 4 of the laws targeting youth (possession, purchase, use and lose, and zero tolerance) and 3 of the laws targeting all drivers (0.08 blood alcohol concentration illegal per se law, secondary or upgrade to a primary seat belt law, and an administrative license revocation law). Beer consumption was associated with a significant increase in the underage fatal CIR. The direct effects of laws targeting drivers of all ages on adult drinking drivers aged 26 and older were similar but of a smaller magnitude compared to the findings for those aged 20 and younger. It is estimated that the 2 core underage drinking laws (purchase and possession) and the zero tolerance law are currently saving an estimated 732 lives per year controlling for other exposure factors. If all states adopted use and lose laws, an additional 165 lives could be saved annually. Conclusions: These results provide substantial support for the effectiveness of under age 21 drinking laws with 4 of the 6 laws examined having significant associations with reductions in underage drinking‐and‐driving fatal crashes. These findings point to the importance of key underage drinking and traffic safety laws in efforts to reduce underage drinking‐driver crashes.     

The impact of alcohol beverage container warning labels on alcohol-impaired drivers, drinking drivers and the general population in northern California

Using data collected in a random-digit dial telephone survey in a northern California county, an examination of the impact of alcohol beverage container warning labels was conducted. In a broadly conceived approach to the possible impact of warning labels we examined recall and content as well as risk assessment and the use of warning labels as public policy to combat drunk driving. In a repeated measures pre- and post-design, respondents reported significantly higher recall of labels and their content in the post-introduction period. Evidence from a multivariate analysis of post-introduction data indicate that both drinking drivers and impaired drivers (based on self-reports) were more likely to recall the labels and their content, an indication that wanting labels are reaching “at risk” individuals. In addition, increases in the perceived risk of driving and drinking are consistent with the notion that warning labels, as one part of a larger social movement, are helping to create an atmosphere in which drinking and driving is less acceptable. However, our findings also indicate that, at least among at risk drinking and impaired drivers, increased use of public policies such as warning labels in an effort to reduce the negative consequences of drinking and driving may generate a public opinion backlash.     

Predicting underage drinking and driving behaviors

A social-psychological model of underage drinking and driving (DUI) and riding faith drinking drivers (RWDD) was tested with data from a random digit dial telephone survey of 706 16-20-year-old drivers from seven western states in the United States. Consistent with the model, a structural equations analysis indicated that DUI and RWDD were primarily predicted by (a) expectancies regarding the physical risks of DUI, (b) normative beliefs about the extent to which friends would disapprove of DUI, (c) control beliefs about the ease or difficulty of avoiding DUI and RWDD and (d) drinking. Expectancies concerning enforcement had a significant effect on RWDD, but not on DUI. Among the background and environmental variables included in the analysis, only night-time driving and age had significant direct effects on DUI and RWDD. Drinking and involvement in risky driving had indirect effects on DUI and RWDD that were mediated through expectancies and normative beliefs. Males, European Americans, Latinos, respondents who drove more frequently and respondents who were less educated held beliefs that were more favorable toward DUI and RWDD, drank more and engaged more frequently in risky driving. As a result, such individuals may be at greater risk for DUI and RWDD.     

Effects of telephone versus face-to-face interview modes on reports of alcohol consumption

Aims and design: In order to assess the effects of survey modality on alcohol consumption estimates, data from two surveys using different interview modes (face-to-face and telephone) were compared on several alcohol measures. Setting and participants: Face-to-face survey data were drawn from the 1990 National Alcohol Survey, while the telephone data came from the 1990 Warning Labels Survey. Both surveys used a probability sampling of the US adult general population in the 48 contiguous states. Measurements: Measures of alcohol use derived from an identical graduated frequencies series included estimates of any drinking in the past 12 months, overall volume, and heavy (5+) drinking days. Findings: Abstention rates did not differ by survey mode, nor did distributions of alcohol consumption by volume and reported frequency of drinking five or more drinks in a day. Multiple regression models including demographic-mode interaction terms were used to examine how mode effects might differ across demographic subgroups. Lower income respondents were under-represented in the telephone sample, and were associated with lower reports of volume and (5+) days, compared to respondents in the face-to-face mode. Conclusions: The results suggest that although there are few differences in alcohol consumption estimates by interview mode, telephone samples may need to be supplemented or estimates adjusted by income level in order to attain equivalent results.     

Access to alcohol outlets and harmful alcohol consumption: a multi-level study in Melbourne, Australia

Aims To assess the association between access to off‐premises alcohol outlets and harmful alcohol consumption. Design, setting and participants Multi‐level study of 2334 adults aged 18–75 years from 49 census collector districts (the smallest spatial unit in Australia at the time of survey) in metropolitan Melbourne. Measurements Alcohol outlet density was defined as the number of outlets within a 1‐km road network of respondents' homes and proximity was the shortest road network distance to the closest outlet from their home. Using multi‐level logistic regression we estimated the association between outlet density and proximity and four measures of harmful alcohol consumption: drinking at levels associated with short‐term harm at least weekly and monthly; drinking at levels associated with long‐term harm and frequency of consumption. Findings Density of alcohol outlets was associated with increased risk of drinking alcohol at levels associated with harm. The strongest association was for short‐term harm at least weekly [odds ratio (OR) 1.10, 95% confidence interval (CI) 1.04–1.16]. When density was fitted as a categorical variable, the highest risk of drinking at levels associated with short‐term harm was when there were eight or more outlets (short‐term harm weekly: OR 2.36, 95% CI 1.22–4.54 and short‐term harm monthly: OR 1.80, 95% CI 1.07–3.04). We found no evidence to support an association between proximity and harmful alcohol consumption. Conclusions The number of off‐premises alcohol outlets in a locality is associated with the level of harmful alcohol consumption in that area. Reducing the number of off‐premises alcohol outlets could reduce levels of harmful alcohol consumption.     

Community alcohol outlet density and underage drinking

Aim This study examined how community alcohol outlet density may be associated with drinking among youths. Methods Longitudinal data were collected from 1091 adolescents (aged 14–16 at baseline) recruited from 50 zip codes in California with varying levels of alcohol outlet density and median household income. Hierarchical linear models were used to examine the associations between zip code alcohol outlet density and frequency rates of general alcohol use and excessive drinking, taking into account zip code median household income and individual‐level variables (age, gender, race/ethnicity, personal income, mobility and perceived drinking by parents and peers). Findings When all other factors were controlled, higher initial levels of drinking and excessive drinking were observed among youths residing in zip codes with higher alcohol outlet densities. Growth in drinking and excessive drinking was, on average, more rapid in zip codes with lower alcohol outlet densities. The relation of zip code alcohol outlet density with drinking appeared to be mitigated by having friends with access to a car. Conclusion Alcohol outlet density may play a significant role in initiation of underage drinking during early teenage, especially when youths have limited mobility. Youth who reside in areas with low alcohol outlet density may overcome geographic constraints through social networks that increase their mobility and the ability to seek alcohol and drinking opportunities beyond the local community.     

A comparison of results from an alcohol survey of a prerecruited Internet panel and the National Epidemiologic Survey on Alcohol and Related Conditions

Background: Given today’s telecommunications environment, random digit dial (RDD) telephone surveys face declining response rates and coverage, and increasing costs. As an alternative to RDD, we surveyed participants in a randomly recruited standing Internet panel supplemented with a randomly sampled telephone survey of nonpanel members for a study of associations between onset of alcohol use and later alcohol‐related problems. The purpose of this paper was to compare results from our survey with results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a face‐to‐face probability sample survey of 43,093 adults, with a focus on associations between demographics, age of drinking onset, and alcohol dependence. Methods: Demographic and drinking characteristics from our survey of 4,021 ever‐drinkers between the ages of 18 and 39 years were compared with the characteristics of 11,549 similarly aged ever‐drinkers from the NESARC. Weighted analyses accounting for sampling design compared these 2 samples on drinking characteristics over the past year and during a respondent’s heaviest period of drinking, and in multivariate models examining associations between demographics, age of drinking onset, and lifetime alcohol dependence. Results: Participants in the supplemented Internet panel were similar to the national population of 18‐ to 39‐year‐old ever drinkers on gender, education, and race/ethnicity, while adults who were aged 18 to 25 years were under‐represented in the Internet panel. The supplemented Internet panel reported higher rates of moderate risk drinking over the past 12 months, lifetime high‐risk drinking, and lifetime (ever) alcohol dependence. Estimates of the associations between alcohol dependence and age of drinking onset, risky drinking, and family history of alcohol problems did not significantly differ between the supplemented Internet sample and the NESARC survey. Conclusions: Randomly recruited Internet‐based panels may provide an alternative to random digit dial telephone surveys and in‐person surveys for some studies of factors associated with alcohol‐related problems.     

Effects of Early Drinking and an Antisocial Orientation on the Alcohol Use of Young Russians

Drawing upon data from the Survey of Deviant Behavior Among Youth in the Moscow Region of Russia, this paper examines the effects of early drinking behavior and an antisocial orientation on the use of alcohol by young Russians. Using available data from the U.S. National Household Survey of Drug Abuse, the use of alcohol and the effects of early drinking among youth in the Moscow Region and the United States are compared. The analysis of the data from the two surveys indicates that a greater proportion of Russian youth began drinking by the age of 12 but that early drinking is associated with subsequent alcohol use among both Russian and American youth. Although there are no data on an antisocial orientation from the U.S. survey, there are such data from the Russian survey and an analysis of this data indicates that the greatest alcohol use is found among young Russians who began drinking by the age of 12 and who have an antisocial orientation.     

Alcohol outlet density and intimate partner violence-related emergency department visits

Background: Previous research has identified risk factors for intimate partner violence (IPV) severity, injury, and emergency department (ED) visits. These risk factors have been shown at both the individual level (heavy drinking and other substance use on the part of 1 or both partners) and the neighborhood level (residence in an area characterized by poverty and social disadvantage). Alcohol outlet density has been linked with assaultive violence in community settings, but has not been analyzed in relation to IPV‐related ED visits. This study examined the effects of outlet densities on IPV‐related ED visits throughout California between July 2005 and December 2008. Methods: Half‐yearly counts of ED visits related to IPV (E‐code 967.3) were computed for each zip code from patient‐level public data sets. Alcohol outlet density measures, calculated separately for bars, off‐premise outlets, and restaurants, were derived from California Alcohol Beverage Control records. Census‐based neighborhood demographic characteristics previously shown to be related to health disparities and IPV (percent black, percent Hispanic, percentage below 150% of poverty line, percent unemployed) were included in models. This study used Bayesian space–time models that allow longitudinal analysis at the zip code level despite frequent boundary redefinitions. These spatial misalignment models control for spatial variation in geographic unit definitions over time and account for spatial autocorrelation using conditional autoregressive (CAR) priors. The model incorporated data from between 1,686 (2005) and 1,693 (2008) zip codes across California for 7 half‐year time periods from 2005 through 2008 (n = 11,836). Results: Density of bars was positively associated with IPV‐related ED visits. Density of off‐premise outlets was negatively associated with IPV‐related ED visits; this association was weaker and smaller than the bar association. There was no association between density of restaurants and IPV‐related ED visits. Conclusions: Further research is needed to understand the mechanisms by which environmental factors, such as alcohol outlet density, affect IPV behaviors resulting in ED visits.     

Young driver risk taking: a description of dangerous driving situations among 16- to 19-year-old drivers

Dangerous drinking and driving situations contribute heavily to morbidity and mortality among older adolescents. One hundred ninety-two high school drivers related 662 dangerous driving incidents (430 by males, 232 by females) in which they were involved in the preceding 6 months. Dangerous driving incidents were characterized by reckless intent, driving late at night, riding with other peers involving alcohol and drugs, reporting impaired driving, and distractions in the car. Adolescent drivers are commonly involved in dangerous drinking-driving situations with peers and without significant consequences. There are points along the continuum leading up to, during, and after such events that offer opportunities for significant prevention and intervention. Such strategies are reviewed.