title: Alcohol policies and impaired driving in the United States: Effects of driving- vs. drinking-oriented policies.
abstract: OBJECTIVE
  To test the hypotheses that stronger policy environments are associated with less impaired driving and that driving-oriented and drinking-oriented policy subgroups are independently associated with impaired driving.
  
  
  METHODS
  State-level data on 29 policies in 50 states from 2001-2009 were used as lagged exposures in generalized linear regression models to predict self-reported impaired driving.
  
  
  METHODS
  Fifty United States and Washington, D.C.
  
  
  METHODS
  A total of 1,292,245 adults (≥ 18 years old) biennially from 2002-2010.
  
  
  METHODS
  Alcohol Policy Scale scores representing the alcohol policy environment were created by summing policies weighted by their efficacy and degree of implementation by state-year. Past-30-day alcohol-impaired driving from 2002-2010 was obtained from the Behavioral Risk Factor Surveillance System surveys.
  
  
  RESULTS
  Higher Alcohol Policy Scale scores are strongly associated with lower state-level prevalence and individual-level risk of impaired driving. After accounting for driving-oriented policies, drinking-oriented policies had a robust independent association with reduced likelihood of impaired driving. Reduced binge drinking mediates the relationship between drinking-oriented policies and impaired driving, and driving-oriented policies reduce the likelihood of impaired driving among binge drinkers.
  
  
  CONCLUSIONS
  Efforts to reduce alcohol-impaired driving should focus on reducing excessive drinking in addition to preventing driving among those who are impaired.
authors.affiliation: Department of Community Health Sciences, Boston University School of Public Health, Boston, MA.
authors.forename: Ziming
authors.initials: Z
authors.lastname: Xuan
authors.affiliation: Section of General Internal Medicine, Boston Medical Center, Boston, MA.
authors.forename: Jason G
authors.initials: JG
authors.lastname: Blanchette
authors.affiliation: Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN.
authors.forename: Toben F
authors.initials: TF
authors.lastname: Nelson
authors.affiliation: Department of Biostatistics, Boston University School of Public Health, Boston, MA.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Heeren
authors.affiliation: Department of Community Health Sciences, Boston University School of Public Health, Boston, MA.
authors.forename: Thien H
authors.initials: TH
authors.lastname: Nguyen
authors.affiliation: Department of Community Health Sciences, Boston University School of Public Health, Boston, MA; Section of General Internal Medicine, Boston Medical Center, Boston, MA.
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Naimi
keywords: Alcohol policy; alcohol-impaired driving; binge drinking; public health law