Down with DUIs1
Down with DUIs in Denver
Tanya Staton
MPH 584
Dr. Wheeler
08/15/2014
Down with DUIs in Denver
Driving under the influence (DUI) has been a common community health issue since before the advent of the automobile. People have been driving under the influence since man climbed on the back of an animal. However, it was not until 1897 that the first drunk driving arrest happened when George Smith crashed his cab into a building in London (drinking and driving, 2012).In 1939, Indiana became the first state to enact a blood alcohol content (BAC) law of 0.15 to determine if a driver was intoxicated (drinking and driving, 2012). Each state eventually adopted its own BAC requirements. Due to increased public awareness and legislation BACs have been standardized, and all states adopted a 0.8 BAC requirement in 2004 (drinking and driving, 2012). In an effort to make communities safer, anyone operating a vehicle with a BAC over 0.8 will be considered under the influence.
Unfortunately, driving while under the influence of alcohol is still problematic in our communities. There was an increase in driving-impaired-fatalities by 4.6 percent from 9,865 deaths in 2011 to 10,322 in 2012 (NHTSA, 2013). An alcohol impaired driving fatalityoccurs every 51 minutes in the United States (NHTSA, 2013).Out of the fatalities in 2012, 65 percent of the drivers had a BAC greater than 0.8 (NHTSA, 2013). The cost of a DUI death is staggering. Colorado lost $2 billion in the year 2000 due to monetary costs and costs associated with quality of life (DUI Colorado Law, 2014). Lately, with the recent legalization of marijuana in Colorado there is an increased concern with drugged driving. The National Survey on Drug Use and Health (NSDUH) concluded that 10.3 million people aged 12 or older reported driving under the influence of illicit drugs during the year prior to being surveyed (National Institute of Drug Abuse, 2013). In 2011, only 3.7 percent reported being under the influence of drugs compared to 3.9 percent in 2012 (National Institute of Drug Abuse, 2013). Colorado, the first state to legalize marijuana for recreational use, reported that 1,045 individuals were pulled over for driving while under the influence of marijuana (Colorado DOT, 2014). A community health problem that needs to be addressed in the state of Colorado is preventing DUIs from alcohol and drug use.
Literature Review
Joanne Brady and Li Guohua wrote a journal article that discussed the trends in alcohol and other drugs that were detected in fatally injured drivers in the United States from 1999 to 2010. Brady and Guohua examined six states (California, Hawaii, Illinois, New Hampshire, Rhode Island, and West Virginia) to address trends in alcohol and drugs in the drivers that were killed within one hour of a motor vehicle crash. These six states were chosen because they perform routine toxicology testing on 80 percent of their fatally injured drivers (Brady &Guohua, 2014). The results concluded that driving under the influence of drugs or alcohol does have an impact on increasing the chance of a motor vehicle crash and on one’s survival.
In the study, 23,591 drivers were tested for narcotics, depressants, stimulants, marijuana and alcohol (Brady et al., 2014). Out of the total drivers tested, 39.7 percent were positive for alcohol and 24.8 percent tested positive for other drugs (Brady et al., 2014). In 1999, only 16.6 percent of drivers showed drugs in their system at time of death, and in 2010 the percentage had increased to 28.3 percent (Brady et al., 2014). The greatest increase from drug use over the study period came from cannabinol use, which nearly tripled from 1999 to 2010 (Brady et al., 2014). The California Department of Motor Vehicles showed a 196 percent increase of cannaboids in drivers in fatal crashes since the implementation of medical marijuana (Brady et al., 2014). Cannabinol use increased among all age groups and was the most fatal among drivers under the age of 25 (Brady et al., 2014).
However, the study did have limitations. Most importantly, there is no set tolerance level for drug impairment. An individual is considered legally intoxicated if their blood alcohol exceeds 0.08 percent, but there is no fast and effective way to determine drug levels in the bloodstream when someone is pulled over for suspicion. Crash risk can also vary by drug type, dosage and the user’s tolerance and physiological response (Brady et al., 2014). Another limitation of the study was that it only included six states that consistently measure toxicology among fatal drivers. The number of drivers impaired from drugs could increase if the state of Colorado was included in the study, since the state has now legalized recreational marijuana. If more states continue to push and legalize recreational marijuana then it is inevitable that there will be more fatalities from drugged driving. There has not been much research conducted on drugged driving, but understanding the effects of drugs ondriving is a public health concern for all because of the morbidity and mortality associated with it. A Healthy People 2020 objective is to decrease the rate of alcohol-impaired driving by five percent and to discourage adolescents from trying marijuana (McKenzie et al., 2012). Decreasing drugged driving needs to be a 2020 objective as well. Down with DUIs is a pilot program Denver, Colorado will initiate to reduce impaired driving due to drugs and alcohol.
The Community Selected and the Stakeholders Involved
Down with DUI will affect everyone living or visiting the city of Denver, not just DUI offenders. By restructuring previous laws, enforcing new policy and establishing new preventative measures, a reduction in DUIs can occur, and everyone from drivers to passengers can be better protected from impaired driving. Partnerships are a significant part of the Down with DUI program. When developing a health promotion program it is important to get the right stakeholders, committee members and investors involved in the planning and implementation of the program. Stakeholders are crucial in health promotion planning because they are the ones that are showing a vested interest in the program’s implementation (McKenzie, Neiger& Thackeray, 2013).The stakeholders that will be involved in Down with DUI include members from the Colorado Police Department, a Department of Transportation representative, the governor of Colorado, support from Mothers Against Drunk Driving and Remove Intoxicated Drivers, a representative from Substance Abuse and Mental Health Services Administration (SAMHSA)and input from the Office of National Drug Control Policy.
There will be obstacles for decreasing DUIs from drug and alcohol use. Keeping drugged drivers off the road will be a challenge since the state has now legalized marijuana. A Breathalyzer is used to test for intoxication from alcohol, but there is no quick and easy way to test for drugged driving unless a blood or urine sample is given. Determining whether or not the driver is actually “high” and does not just have lingering metabolites in their blood stream will be a major obstacle. THC metabolites can be detected in an individual’s urine or bloodstream days after smoking, and chronic smokers can still be detected even weeks after smoking (Sullum, 2014). Many chronic users of marijuana have become accustomed to its effects and can perform daily tasks without a problem. This goes the same for functioning alcoholics. The legal age that was established to purchase marijuana for recreational use was set at 21 (Martinez, 2014). Since marijuana is more easily accessible there is fear that the drug will get into the hands of adolescents. Individuals that are under the age of 21 are already inexperienced drivers, adding drugs to their system will only make them more susceptible to fatal wrecks.
Mission, Vision and Objectives for the Down with DUIs in Denver Program
The mission of the Down with DUI program is tooptimize the health and safety of the community by decreasing the number of DUIs that occur from alcohol and drug related innocents. Down with DUI’s vision is to improve awareness within the city of Denver so preventive measures will be taken which will lead to a 20 percent reduction of DUIs related to drugs and alcohol over the next two years. The current philosophy of the program is to provide a health promotion program that is SMART: specific, measurable, achievable, realistic and time specific (McKenzie et al). Having clearly defined goals and objectives is a way to achieve this. The program will be centered on five core objectives: lowering the BAC, more education in schools, establishing a dial-a-ride service, limiting number of sales per day and limiting number of dispensaries per area.
A goal of the program is to lower the BAC content for arrest and set a standard for marijuana in the system. The objective would be to set the BAC to 0.05 by 2016 for the state of Colorado. There are currently 100 countries that already have their BAC set at this limit, so lowering the BAC would be on par with standards that are already set globally (Ahlers, 2013). Increasingeducation in schools on the dangers of driving under the influence of alcohol and drugs is another goal of the program.By 2015, the program’s aim is to increase the effectiveness of all high school driver’s education courses so that 80 percent of students can relay the dangers of DUI information back to their peers.
Another objective of the program is to establish a dial-a-ride program for communities. The community will have a number to call where anyone under the influence of alcohol or drugs could call and have a free or severely discounted ride home. The dial-a-ride program will be funded by repeat DUI offenders and private sponsors. Dial-a-ride will also be marketed in high-risk areas like bars and clubs to increase the chance that people will utilize the service. The objective of the dial-a-ride program is to see a decrease in DUIs by 15 percent in the first year the program is established.Decreasing the number of dispensaries that are available will hopefully reduce the amount of marijuana that is sold. This will then reduce drugged driving from users.
Structural Model of Behavior
The Down with DUI program will be modeled after the Structural Model of Behavior. This model emphasizes how one’s environment shapes one’s behavior (Crosby, DiClemente& Salazar, 2013). It is based on four categories of environmental factors: availability/accessibility;physical structures; social structures and policy; and media and cultural influences (Crosby et al., 2013).
The model suggests that behavior is influenced by access. Therefore, the greater the access, the greater the chance for positive or negative behaviors to occur. Communities with increased alcohol sales are more likely to have alcohol-related problems like vehicle accidents (Crosby et al., 2013). By hindering the availability of the product one will likely decrease the problems associated with it (Crosby et al., 2013). Currently, the state of Colorado only allows residents to purchase marijuana anounce of at a time, and out of state individuals can only buy ¼ of an ounce at a time (Flatow, 2014). The Down with DUI program will limit the number of purchases an individual can make daily for alcohol or marijuana. As of now, an individual can purchase these goods and immediately return to the same store to purchase more. Down with DUI would like to change the amount of purchases to once a day in an effort to decrease impaired driving. To prevent users from driving to multiple locations to purchase these goods, a confidential electronic log will be developed that consumers will have to sign once the product is purchased.
Physical structures are designed to improve health outcomes. A classic example is the addition of fluoride in drinking water to help prevent tooth decay or making railings a requirement on high-rise structures.Denver has 102 dispensaries that have been approved to sell recreational marijuana (Flatow, 2014). This seems a bit excessive for a city that is only 153 square miles (United States Census Bureau, 2014). Down with DUI would like to have specific restrictions on where markets that sell alcohol and marijuana can be built. For instance, a marijuana dispensary cannot be built within five miles of any school or government facility. By limiting the number of dispensaries, the product will be harder to purchase and health outcomes will hopefully improve.
Social structures are the rules and organizations that shape the world we live in (Crosby et al., 2013). Polices and legislation are developed to protect the health of this nation’s citizens. Seat belt use was less than 40 percent until seat belt laws were established in the 1980s (Crosby et al., 2013). Since enacting seat belt laws, millions of lives have been saved in traffic accidents. Down with DUI would like to change the BAC from 0.08 to 0.05 in efforts to decrease DUIs from alcoholic consumption. There are currently 100 countries that already have their BAC set at this limit (Ahlers, 2013).In 2004, Delaware became the last state to adopt a BAC of 0.08 percent (McKenzie et al., 2012). By adopting a BAC of 0.08 percent it is estimated that seven percent of fatal crashes will be decreased; this is equivalent to saving 400 to 600 lives annually from impaired driving (McKenzie et al., 2012). Drivers that have a BAC between 0.02 and 0.04 percent are 1.4 times more likely than sober drivers to be involved in a fatal accident, and those with a BAC 0.05 to 0.09 are 11.1 times more likely to be involved in a fatal crash (McKenzie et al., 2012). Lowering the legal limit to under 0.05 will only decrease adverse health outcomes from impaired driving.
Down with DUI would also like to have an increased driver education course on the dangers of drivingimpaired. The National Highway Traffic Safety Administration (NHTSA) found thatin 2011, roughly one in eight high school seniors reported that in the two weeks prior to the survey they had driven after smoking marijuana (Office of National Drug Control Policy, n.d). There were more cases of drugged driving than reported driving after consuming alcohol.Driver’s education courses need to have an impaired exercise so teens can experience how dangerous and difficult it can be to see the road while high or drunk. Providing impaired-goggles will provide students with a good idea of what it is like to feel impaired. If impaired goggles are not available for the students to use, instructors can substitute them with dark sunglasses smeared with Vaseline (Office of National Drug Control Policy, n.d).
The final component of theStructural Model of Behavior is the effect that media has on one’s beliefs. Advertising is known to shape attitudes, beliefs and behaviors about health conditions (Crosby et al., 2013). Media has the effect of producing negative or positive feelings about a product. Joe Camel was banned after being used for 23 years because the cartoon image was appealing to adolescents (Elliott, 1997).Down with DUI wants to increase media attention on driving under the influence of drugs and alcohol. Dispensaries and spirit stores will be required to hang informative posters and have pamphlets printed on the negative effects the products can have on one’s body, especially while driving. Each city will be required to have an informative billboard about alcohol and drugged driving during the pilot programin an effort to reduce DUIs. Availability/accessibility,physical structures, social structures and policy and media combined will help reduce DUIs and provide better health outcomes for the state of Colorado. Figure 1 summarizes the Down with DUI program utilizing the Structural Model of Behavior.
Figure 1
Another great use of logic models is that they help health promotion programs and organizations define the objectives of their health promotion program. Inputs and outputs are utilized to develop outcomes for their programs (McKenezie et al, 2013). The inputs are the various resources that go into a health promotion program. Outputs involve activities and participation, while outcomes focus on the short term, intermediate and long term goals of the program. Figure 2 displaysthe inputs, outputs and outcomes for the Down with DUIs in Denver program.
Down with DUIs1
Figure 2: Structural Model of Behavior: Down with DUIs in Denver
Inputs / / Outputs / /- Outcomes -- Impact
Activities / Participation /
- Short
- Medium
- Long
The Various resources that go into a program:
~ Private Stakeholders
~ The Colorado police department
~ A Department of Transportation representative
~ The governor of Colorado
~support from Mothers Against Drunk Driving and Remove Intoxicated Drivers
~a representative from Substance Abuse and Mental Health Services Administration (SAMHSA)
~Input from the Office of National Drug Control Policy. / Down with DUI Plan:
~ Get legislation passed to lower the BAC
~ More education in schools on impaired driving
~ Establish a dial-a-ride service
~ Limit number of sales per day
~ Limit number of dispensaries per area
~ Increase media attention on dangers of impaired driving / ~ If we can get federal legislation approved then the BAC will be lowered to 0.05 in the state of Colorado.
~ If we receive funding for educational courses then impaired driving materials will be distributed in driver’s education courses in public schools, and impaired goggles will be utilized for the students to understand what it is like to drive intoxicated.
~ If approved than previous DUI offenders will provide funds for the dial-a-ride program as part of their probation.
~If we limit the number of sales per day then DUI rates will decrease / Decrease DUIs by including an extensive range of stakeholders.
Start legislative lobbying to decrease the BAC
Start the dial-a ride program in Denver
Provide educational materials in Denver schools on impaired driving.
Place posters and brochures in dispensaries and spirit stores on the dangers of their use while driving / Continue to increase lobbying efforts to decrease the BAC
Dial-a-ride is up and running, and being utilized regularly in Denver
80% of high school students in Denver can relay the dangers of impaired driving to their peers
Limit number of purchases to once per day for alcohol and marijuana / There is a 20% reduction in DUIs over two years.
The pilot program is successful and can be implemented into other cities.
There are restrictions on where a dispensary or spirit store can build.
Down with DUIs1