Examination of a university-affiliated safe ride program.

Examination of a university-affiliated safe ride program. ABSTRACT A university-affiliated safe ride program was evaluated todetermine whether these programs can reduce drunk-driving related costs.Data was collected from 187 safe ride passengers during three nights ofoperation. Among the passengers, 93% were enrolled at a localUniversity, 31% were younger than 21, and 40% reported a prioralcohol-related citation. Mean BAC BACabbr.blood alcohol concentration was .11%. Seventy-five percent ofpassengers indicated their primary motive for utilizing the safe ridewas to reduce risks associated with driving under the influence.Evidence also suggested that utilization of the safe ride was notassociated with increased alcohol consumption or BAC. In terms ofcosts-savings, this program saves over $3 for every $1 spent.Implications are discussed in relation to a harm reduction framework. Keywords: safe ride, drunk driving, college students, harmreduction ********** In the United States United States,officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. rates of alcohol-related traffic fatalitiesdropped from 60% in 1982 to 32% in 2006 (NHTSA NHTSA National Highway Traffic Safety Administration (US government), 2003; NHTSA, 2008). Thisstatistical change is often attributed to large scale educational,policy, and enforcement efforts throughout the 1980's, 1990's,and 2000's (Elder, Shults, Sleet sleet,precipitation of small, partially melted grains of ice. As raindrops fall from clouds, they pass through layers of air at different temperatures. If they pass through a layer with a temperature below the freezing point, they turn into sleet. , Nichols, Thompson, & Rajab,2004; Hingson, 1993). Recent findings, however, indicate drunk drivingcontinues to be a significant problem. Over 13,000 individuals died in2006 from alcohol-related traffic incidents, and the national rate foralcohol-impaired-driving fatalities in motor vehicle crashes per 100million miles of travel has remained steady since 2004 (NHTSA, 2008).Drunk driving behavior is also not without significant financial costs.In 2000 alcohol-related crashes cost the American public $114.3 billiondollars in monetary costs and quality of life losses (NHTSA, 2002a). College students and young adults represent a population that is atincreased risk for alcohol-related traffic fatalities due to unremittingrates of heavy episodic episodicsporadic; occurring in episodes. e. falling a paroxymal disorder described in Cavalier King Charles spaniels in which affected dogs, starting at an early age, experience episodes of extensor rigidity, possibly brought on by stress. e. drinking (Wechsler et al., 2002; Wechsler, Lee,Nelson, & Lee, 2003). In fact, nearly half of all traffic-relatedfatalities within this cohort cohort/co��hort/ (ko��hort)1. in epidemiology, a group of individuals sharing a common characteristic and observed over time in the group.2. are associated with driving under theinfluence of alcohol (NHTSA, 2000). Within college environments a rangeof interventions has been developed to target drunk driving behavior.These measures move from policies and laws to restrict and punishunderage consumption of alcohol and drunk driving (Shults et al., 2001;Wechsler et al., 2003), to programs intended to increase the prevalenceof moderate and safe alcohol consumption (Fromme & Orrick, 2004;Timmerman, Geller, Glindemann, & Fournier, 2003). This spectrum ofintervention typically proves effective for reducing rates of drunkdriving, but each method of intervention is not without limitations. Forinstance, restrictive and punitive policies often produce immediatedeclines in frequency and numbers of individuals who drive whileintoxicated in��tox��i��cate?v. in��tox��i��cat��ed, in��tox��i��cat��ing, in��tox��i��catesv.tr.1. To stupefy or excite by the action of a chemical substance such as alcohol.2. (Voas, Tippetts, & Fell, 2003), yet their efficacy islimited by competing alcohol expectancies and social norms that sanction sanction,in law and ethics, any inducement to individuals or groups to follow or refrain from following a particular course of conduct. All societies impose sanctions on their members in order to encourage approved behavior. heavy alcohol use (Keeling keelingthe marking of ewes by the ram when they are mated by the marking on the ewe of paint or chalk from the sternum of the ram. , 2002; Wood, Read, Palfai, & Stevenson,2001; Workman WORKMAN. One who labors, one who is employed to do business for another. 2. The obligations of a workman are to perform the work he has undertaken to do; to do it in proper time; to do it well to employ the things furnished him according to his contract. , 2004). A subset A group of commands or functions that do not include all the capabilities of the original specification. Software or hardware components designed for the subset will also work with the original. of evidence also suggests that somerestrictive and punitive policies may inadvertently result in anincreased risk of secondary alcohol-related harms when competingcultural norms/beliefs are not adequately addressed (Kilmer, Larimer,Parks, Dimeff, & Marlatt, 1999; Marlatt, 1998). Limitations havealso been observed in research examining the efficacy of programs thatencourage safe and responsible alcohol use, including designated driver designated driverPublic health A person at a social function who volunteers, or is 'volunteered' to chauffeur inebriated revellers chez elles at festivity's end. Cf Squash it. programs. For instance, Barr and MacKinnon (1998) found that just overone-third of college students use a designated driver every time it isappropriate, and many college students have ridden with designateddrivers who were operating a motor vehicle at or above a blood alcoholconcentration blood alcohol concentrationn.The concentration of alcohol in the blood, expressed as the weight of alcohol in a fixed volume of blood and used as a measure of the degree of intoxication in an individual. (BAC) where psychomotor psychomotor/psy��cho��mo��tor/ (si?ko-mo��ter) pertaining to motor effects of cerebral or psychic activity. psy��cho��mo��toradj.1. impairment Impairment1. A reduction in a company's stated capital.2. The total capital that is less than the par value of the company's capital stock.Notes:1. This is usually reduced because of poorly estimated losses or gains.2. is likely (Timmerman etal., 2003; Wechsler et al., 2003). These findings suggest the need foradditional, comprehensive interventions to further reduce rates of drunkdriving. One type of intervention that may prove effective for furtherreducing the negative consequences of drunk driving is the safe ride.The concept of a safe ride is to offer intoxicated persons a readilyavailable, free, or low cost method of transportation in lieu of Instead of; in place of; in substitution of. It does not mean in addition to. drivingintoxicated. This type of program falls within the realm of harmreduction (Marlatt, 1998; Marlatt & Witkiewitz, 2002). Harmreduction theory asserts that the most immediate harms arising fromsubstance use often do not include the direct effects of the substanceon the body; rather, they are secondary harms resulting from use (e.g.,alcohol-related motor vehicle crash). Therefore, it is important thatinterventions and prevention programs provide a means to reduce thepotential for secondary harm. Despite the potential for sate rideservices to reduce secondary harms associated with drunk driving and thepotential savings to communities, many community and universityadministrators are reluctant to support these programs (Harding,Caudill, Moore, & Frissell, 2001). Part of this reluctance likelystems from a lack of supporting research. To date, research concerning safe ride programs provides basicdescriptive data of passengers but has offered limited information tosupport the efficacy of such programs. For instance, Sarkar Sarkar could mean: Government in Urdu/Persian/Hindi. Colloquially in India, it is a Metonymy for the incumbent government. The Persian wordSarkar is derived from two words; 'Sar' meaning Head and 'Kar' meaning Work. , Andreas,and de Faria (2005) reported on the characteristics of 1,985 safe ridepassengers. They found that 44% of passengers stated they would havedriven home drunk if the safe ride service were not available. Caudill,Harding, and Moore (2000) employed survey methods in barrooms (N = 472)and collected BAC measurements among a small number of safe ridepassengers (N = 51). Participants who reported using a safe ride in thelast 12 months were more likely to drink outside the home, to have beenarrested for DWI An abbreviation for driving while intoxicated, which is an offense committed by an individual who operates a motor vehicle while under the influence of alcohol or Drugs and Narcotics. , and to engage in heavy drinking Heavy drinking may mean drinking large amounts of water or alcohol. Heavy drinking may also mean drinking alcohol to the point of Drunkenness. practices. Amongparticipants who provided a breathalyzer sample, BAC ranged from .031%to .24% with a mean of .14%. As a result, these authors concluded thatsafe ride programs are likely to attract a small proportion of at-riskdrinkers (e.g., patrons with a high BAC and individuals with prioralcohol-related offenses). In a similar examination of retrospectivesurvey data, Harding et al. (2001) found most bar patrons who reportedprior use of a safe ride also reported increasing their mean BAC whenusing a safe ride. However, only a small percentage (24%) of theseindividuals reported consuming sufficient volumes of alcohol to increasetheir BAC risk from low to high (intoxicated above the legal limit fordriving). The current investigation is the first to examine a safe rideprogram funded by a university-affiliated organization and utilizedpredominantly by college students. This is an important investigationgiven the high rates of heavy alcohol consumption and drunk drivingreported by college students and young adults. Goals of this projectincluded: (a) identification of characteristics associated with saferide passengers who are primarily college students, (b) examiningwhether utilization of the safe ride service is associated with higherBAC and increased drinking behavior among passengers, and (c)determining the approximate cost-savings of a safe ride program. METHOD Participants One hundred ninety-four passengers were recruited from safe ridevehicles. All passengers were allowed to participate in the project andmeasures were administered to willing participants between pick-up anddrop-off. Participants were instructed to answer items in a forthright forth��right?adj.1. Direct and without evasion; straightforward: a forthright appraisal; forthright criticism.2. Archaic Proceeding straight ahead.adv.1. manner and to keep responses confidential from other passengers. Surveyswith incomplete responses and/or incomprehensible information were notincluded in analysis. Measures A brief measure was developed for use in the current project.Several items assessed basic demographic information (age, sex, studentstatus, ethnicity, on campus vs. off campus living arrangements) and keyphysiological measurements necessary for estimating BAC (body weight). Asingle item assessed frequency of typical drinking behavior (number ofdrinking occasions per week and month). Quantity and duration ofdrinking during the current episode were assessed by having participantsreport both the quantity (number of standard drinks consumed) andduration of drinking (number of hours drinking). Participants wereprovided with instructions for defining a standard drink (DHHS DHHS Department of Health & Human Services (US government)DHHS Dana Hills High School (Dana Point, California)DHHS Deaf and Hard of Hearing ServicesDHHS Deaf and Hard of Hearing Services and USDA USDA,n.pr See United States Department of Agriculture. ,1995) and estimating duration of consumption. Subsequent items assessedthe prevalence of prior alcohol-related legal problems (e.g., MUI, DUI,MIP MIPSee: Monthly income preferred security ), and whether participants believed they do in fact consume morealcohol when utilizing the safe-ride service. This latter construct wasmeasured using a "yes/no" response to the items: "Sincesafe ride is available, does that influence your drinking?" and"If safe ride was not available, would that alter your planstonight?" Participants were also asked to provide a briefexplanation of their yes/no responses. A single item also askedparticipants to rank order reasons for utilizing the safe ride service(no car, drinking, weather, friends ride, save gas money, other).Finally, participant knowledge for estimating and managing personal BACwas assessed using a single item asking participants to estimate howmany drinks could be consumed in one hour before surpassing a .08% BAC. Procedure At the time of investigation, the safe ride program consisted oftwo or three small passenger vans that ran Thursday,. Friday, andSaturday evenings from 7 p.m. to 2:30 a.m. Prior to 10 p.m. vanstraveled on a fixed route with designated stops. After 10 p.m. driversresponded to calls for pickup of passengers within the city limits andsubsequently dropped these passengers off at a desired location. Datacollection occurred after 10 p.m. on three nights over the course ofthree weeks, and the day of data collection was alternated. Researchersrode as volunteers and administered anonymous questionnaires to willingparticipants. All passengers were allowed to participate in the project,and measures were completed between pick-up and drop-off of individualpassengers. This method was approved by the Institutional Review Boardof the University of Wyoming UW is a national research university prominent in the fields of environment and natural resource research, specializing in agriculture, energy, geology, and water resource related fields. . Analysis Blood alcohol estimates were achieved by utilizing the Widmarkequation for Blood Alcohol Concentration (Weingardt, Baer, Kivlahan,Roberts, Miller, & Marlatt, 1998), where BAC = [(quantityconsumed/2.0) x (gender constant/weight)] - (hours drinking x .016). Inthis equation, the gender constant for males = 7.5, and for females =9.0. This method of measurement for estimating BAC was chosen over theuse of a breathalyzer for several reasons. First, data collection wastime-limited, and many passengers were making rapid, short trips and hadconsumed alcohol just prior to pickup. Use of a breathalyzer requiresthat participants abstain from abstain fromverb refrain from, avoid, decline, give up, stop, refuse, cease, do without, shun, renounce, eschew, leave off, keep from, forgo, withhold from, forbear, desist from, deny yourself, kick ( consumption of alcohol for a period oftime in order to obtain valid measurements. Additionally, use ofquestionnaires was a more efficient method of data collection due tospace issues inside the van and the volume of passengers. A cost-savings analysis was completed by comparing operationalcosts of the safe ride program versus savings associated with preventingintoxicated individuals from driving. According to according toprep.1. As stated or indicated by; on the authority of: according to historians.2. In keeping with: according to instructions.3. the National HighwayTraffic Safety Administration (2002b), every alcoholic beverage consumedcosts citizens of the state of Wyoming approximately $1.20 in drunkdriving-related costs (NHTSA, 2002b). This estimate includes costsassociated with medical expenses, mental health expenses, propertydamage, legal fees, and quality of life losses. Data regarding theoperational costs of the safe ride program and total number ofpassengers served were retrieved from Associated Students of theUniversity of Wyoming (ASUW ASUW Associated Students of the University of WashingtonASUW Antisurface Warfare (US Navy)ASUW Anti-Surface Ship WarfareASUW Antisurface Unit Warfare , 2006). Total program costs include staffsalary, insurance, and fuel/maintenance. Total estimated savings malcohol-related costs was calculated by entering these values into anequation, where total savings = ($1.20 x mean number of drinks consumedby safe ride passengers x total passengers per year [N = 22,910]) /(total operational costs of the safe ride program [$69,124.83]).Independent samples t-tests were used to examine group differences indrinking behavior, BAC, and sale ride utilization. Independent multipleregression analyses were employed to examine the predictive relationshipbetween frequency of safe ride utilization, and a) BAC and b) frequencyof drinking behavior. Participant sex and self-report of how use of thesafe ride service impacted personal drinking behavior (e.g., increasesalcohol consumption vs. no change) were included as covariates. Thesevariables were intended to control for possible confounding confoundingwhen the effects of two, or more, processes on results cannot be separated, the results are said to be confounded, a cause of bias in disease studies.confounding factor effects fromdifferences in male vs. female drinking patterns, and for thepossibility that some individuals may purposefully pur��pose��ful?adj.1. Having a purpose; intentional: a purposeful musician.2. Having or manifesting purpose; determined: entered the room with a purposeful look. consume more alcoholwhen utilizing the safe ride. RESULTS Participants Of the 194 questionnaires administered, 187 provided valid andreliable information. Forty-two percent of passengers were female and58% of were male. Ninety-three percent of participants identifiedthemselves as college students (N = 173), and 7% identified themselvesas students of a local technological school (N = 7) or as non-studentcommunity members (N = 7). Mean age of passengers was 21.4 years (SD =2.6), and approximately 31% of riders (N = 57) were below the legaldrinking age The legal drinking age is a limit assigned by governments to restrict the access of children and youth to alcoholic beverages. In most countries the legal age to purchase alcohol is at least 18, but there are notable exceptions. of 21. Among college students, 35% (N = 61) lived inon-campus housing and 68% (N = 117) lived off-campus. Utilization o[Safe Ride Service Passengers reported riding the safe ride a mean of 4.1 times permonth (SD = 3.2). Approximately 75% (N = 141) of passengers indicatedtheir primary reason for riding safe ride was to avoid drunken drunk��en?adj.1. Delirious with or as if with strong drink; intoxicated.2. Habitually drunk.3. Of, involving, or occurring during intoxication: a drunken brawl. driving,while 19% (N = 35) indicated their primary reason for utilizing saferide was transportation (e.g., lack of vehicle). Sixteen percent (N =29) and 34% (N = 64), respectively, indicated their secondary reason forutilizing safe ride was due to weather-related issues and because theyhave friends who utilize the service. With regard to items assessingwhether or not safe ride influenced drinking behavior, 35 passengers(19%) indicated they consume more alcohol because a safe ride isavailable. The remaining 81% of passengers (N = 152) indicated safe rideutilization does not influence their drinking behavior, and 60% of theseparticipants (N = 91) provided a qualitative response suggesting thesafe ride provides a method of reducing secondary harm associated withdriving under the influence. Examples of typical statements made bythese participants included: "I would drink anyway, but safe ridekeeps me from drunk driving.", and "I would be drunk anddriving my three friends around." Drinking Behavior Approximately 96% of passengers identified themselves as a drinker(N = 179). Overall mean BAC was. 11% (SD = .08), and estimated BAC didnot differ between males (M =. 11, SD = .08) and females (M = .11, SD =.07) [t (185) = .54, p = .54]. Males reported consuming a mean of 10.10(SD = 4.5) standard drinks and females reported consuming a mean of 5.89(SD = 3.0) standard drinks on the night of their participation [t (185)= 3.17, p <.001, [Eta.sup.2] = .051]. Male participants also reporteddrinking a mean of 3.10 (SD = 1.2) days per week and females reporteddrinking a mean of 1.90 (SD = 1.2) days per week [t (185) = 2.90, p<.01, [Eta.sup.2] = .043]. Based on the equation for calculating thetotal savings in alcohol-related costs, it was estimated that this saferide service saves the local community approximately $3.10 for every $1spent. Results of direct multiple regression analyses indicated thatfrequency of sate ride utilization was a significant predictor of BACirrespective of irrespective ofprep.Without consideration of; regardless of.irrespective ofpreposition despiteparticipant sex and self-report with regard to whetheror not safe ride increases drinking behavior F(3,184) = 4.17, p < .01(see Table 1). Frequency of safe ride utilization, however, was notpredictive of frequency of alcohol consumption; rather, passengers'sex was a significant predictor of frequency of alcohol consumptionregardless of how frequently participants utilized the safe ride,F(3,184) = 3.34, p < .05 (see Table 1). Results of independentsamples t-tests also indicated that those passengers who reportedconsuming higher levels of alcohol when riding safe ride were not foundto have a greater BAC [t(185) = .52, p = .56], consume more alcoholicbeverages [t(185) = .56, p = .58], consume alcoholic beverages morefrequently [t(185) = .60, p = .66], or utilize the safe ride more oftenthan other passengers [t(185) = 1.87, p = .13] (see Table 2 for meanvalues). Approximately 40% (N = 74) of participants reported prior citationson account of their drinking, with approximately 35% (N = 26) of theseindividuals reporting a history of multiple citations. Forty-two percent(N = 31) of those reporting a previous citation indicated that they hadbeen cited for Minor Under the Influence (MUI), 62% (N = 46) reported acitation for a Minor In Possession (MIP), and approximately 20% (N = 15)reported a citation for Driving Under the Influence (DUI). Malesaccounted for 58% of those receiving citations (N= 43). No significantdifferences were observed in BAC [t(181 = - 1.87, p =. 18], frequency ofdrinking behavior [t(181) = - 1.92, p = .06], and safe ride utilizationIt(181) = .88, p = .51] among participants with a history as opposed towithout a history of alcohol-related citations. Mean BAC amongparticipants with a history of citations was. 13% (SD = .07), and meanBAC among participants with no citation history was. 11% (SD = .06).Participants with a history of citations also reported consumption ofalcohol on a mean of 2.83 (SD = 1.30) days per week and utilizing thesafe ride 4.37 (SD = 3.24) times per month. Participants with nocitation history reported consumption of alcohol on a mean of 2.44 (SD =1.12) days per week and utilizing the safe ride 3.92 (SD = 3.52) timesper month. A majority of participants (55%, N = 103) underestimated the numberof alcoholic beverages that could be consumed before reaching a .08%BAC. Those who overestimated this value did so by a mean of 2.54 drinks(SD = 2.3), and those who underestimated this value did so by a mean of1.34 drinks (SD = 1.1). Underestimators did not differ fromoverestimators in terms of BAC [t(185) = - 1.46, p =. 15]. Mean BACamong overestimators was. 13% (SD = .08) and mean BAC amongunderestimators was .11% (SD = .07). Additionally, overestimators andunderestimators did not differ with regard to frequency of drinkingbehavior [t(185) = -.26, p = .79]. Overestimators reported consumptionof alcohol on 2.69 (SD = 1.21) days per week and underestimatorsreported consumption of alcohol on 2.61 (SD = 1.21) days per week. DISCUSSION The current investigation was the first of its kind to examine asafe ride program sponsored by a university-affiliated organization andutilized predominantly by college students. Using estimates provided bythe NHTSA (2002b), results indicated that the current program saves thelocal community over $3 in drunk driving-related costs for every $1spent. This suggests financial costs and associated secondary harmslinked with drunk driving may be reduced through implementation of saferide services. Similar to prior research findings (Caudill, et al.,2000), it also appears that this safe ride program attracts a smallproportion of highrisk drinkers. This conclusion is supported by thefinding that individuals who ride the safe ride more frequently tendedto have a higher BAC. However, given the small number of high-riskdrinkers that participated in this safe ride service and the serviceexamined by Caudill et al., there is a clear need for expansion andincreased utilization of these programs. One method for increasing utilization of existing safe rideprograms includes the use of effective marketing. Research has shownthat social influence and expectancies are important components inmaintaining heavy episodic consumption of alcohol (Orford, Krishnan,Balaam, Everitt, & Van Der Graaf, 2004). Consequently, it might beuseful to market safe ride programs as a "social" method ofharm reduction, as the current investigation found a number ofpassengers utilized the safe ride because they had friends who also usedthe service. Qualitative data from this investigation also indicatedthat many passengers utilized this safe ride service in order to reducerisk of secondary harms to themselves and others. This finding isconsistent with data showing college students are open to interventionsand prevention efforts that include a harm reduction focus (Snow,Wallace, Staiger, & Stolz-Grobusch, 2003). In fact, Snow et al.reported that college students tend to oppose restrictive alcoholpolicies but endorse prevention efforts that allow students to exerciseresponsibility. It is therefore recommended that future marketingefforts for safe ride services emphasize a "personalresponsibility" and "harm reduction" message. It is alsorecommended that marketing efforts make use of literature on messageframing (e.g., Gerend & Cullen, 2008) and regulatory focus theory(e.g., Molden, Lee, & Higgins, 2008) to further capitalize on Cap´i`tal`ize on`v. t. 1. To turn (an opportunity) to one's advantage; to take advantage of (a situation); to profit from; as, to capitalize onan opponent's mistakes s>. theseprinciples. Techniques and concepts reported in the message framing andregulatory focus theory literature have been successful in improving theeffectiveness of preventive health campaigns and advertisements andwould likely increase the ability of safe ride programs to resonate res��o��nate?v. res��o��nat��ed, res��o��nat��ing, res��o��natesv.intr.1. To exhibit or produce resonance or resonant effects.2. witha larger proportion of at-risk drinkers. Reluctance to initiate safe ride programs and other harm reductionprograms often exists within university administrations and othercommunity organizations that determine public policy. In addition to anoverall lack of research, this reluctance may stem from a fear that harmreduction programs will increase rates of heavy alcohol consumption,and, as a result, increase liability. Results from this investigation donot support this assumption, as a majority of passengers surveyed didnot report drinking more frequently or consuming alcohol in greaterquantity due to the availability of a safe ride. Additionally, mean BACand mean number of drinks consumed among individuals who indicateddrinking more when utilizing sate ride did not differ from passengerswho reported no change in drinking behavior. It is notable that thesefindings differ slightly from that of Harding et al. (2001). Theseauthors found that bar patrons who reported having utilized a safe rideservice in the past were likely to also report increased consumption ofalcohol on those occasions. This difference may be attributable toseveral factors, including differences in samples and the fact that thecurrent investigation assessed active alcohol consumption and activeintent associated with safe ride use versus retrospective recall of pastdrinking events. It is also worth mentioning that, although Harding etal. found prior safe ride utilization was associated with self-reportedincreases in alcohol consumption, these increases generally did notraise participants' BAC risk level from low to high. Overall, thesefindings suggest that utilization and availability of a safe rideservice is unlikely to result in increased consumption of alcohol formost individuals, and the relative risk associated with increasedalcohol consumption by a minority of passengers is likely limited andcan be addressed through appropriate means. Findings also showed that safe ride passengers exhibited a generallack of knowledge with regard to understanding the relationship betweenamount of alcohol consumed and one's personal BAC. This finding wassurprising given that the university associated with participantrecruitment provides empirically-based alcohol education and preventionprogramming (e.g., BASICS and ASTP ASTP Apollo Soyuz Test ProjectASTP Army Specialized Training ProgramASTP Advanced Space Transportation Program (NASA)ASTP Association of European Science & Technology Transfer ProfessionalsASTP American Society of Transplant Physicians ; see Dimeff, Baer, Kivlahan, &Marlatt, 1999, Miller, Kilmer, Kim, Weingardt, & Marlatt, 2001, andMurphy et al., 2001). The apparent lack of knowledge, however, is usefulin that it reinforces the fact that there are limitations toindividual-level education and prevention efforts, especially ifprevention programs are forced to compete with opposing cultural beliefsand norms. Limited evidence from this investigation further suggestsrestrictive and punitive policies had little effect on rates of drinkingbehavior or safe ride utilization for those previously cited foralcohol-related violations. In fact, harm reduction theory asserts thatrestrictive and punitive laws, although a deterrent for some, will notcompletely eliminate risky substance use. This premise is supported byempirical data showing that punitive policies do little to deterrecidivism recidivism:see criminology. of drunk driving (Taxman & Piquero, 1998) or heavyconsumption by young adults and underage individuals (Wechsler, Kelley,Weitzman, San Giovanni San Giovanni, the Italian form of "Saint John" (q.v.), a name that may refer to dozens of saints.At least 58 comuni in Italy are named San Giovanni, and at least 49 more are named San Giovanni... , & Seibring, 2000; Wechsler et al., 2002). Given the apparent limitations of individual-based preventionprogramming and the fact that punitive and restrictive policies do noteliminate risky drinking behavior, use of an ecological harm-reductionframework is recommended to further address the problem of drunkdriving. In fact, Marlatt (I 998) suggests that successful interventionefforts are dependent not only on reducing harms at the individual levelof behavior (Level 1 strategies), but also reducing harm via synchronous Refers to events that are synchronized, or coordinated, in time. For example, the interval between transmitting A and B is the same as between B and C, and completing the current operation before the next one is started are considered synchronous operations. Contrast with asynchronous. and complementary intervention strategies within the immediateenvironment (Level 2 strategies; e.g., safe ride), and throughmodification of cultural norms and policies (Level 3 strategies). It isthis point about synchronization (1) See synchronous and synchronous transmission.(2) Ensuring that two sets of data are always the same. See data synchronization.(3) Keeping time-of-day clocks in two devices set to the same time. See NTP. of intervention strategies, across acontinuum of both restrictive and harm reduction-based prevention, thatmakes integration of safe ride services into existing drunk-drivingprevention efforts and policies important for consideration. Several limitations exist within the current study and should beaddressed in future research. First, BAC was based on selfreport ofdrinking duration, body weight, and drinks consumed. Structured use of abreathalyzer might address concerns about the reliability of BACmeasurements. Lack of a control group or comparative sample also limitsa definitive conclusion that utilization of a safe ride does not promoteincreases in alcohol consumption. Future research may want to revisit re��vis��it?tr.v. re��vis��it��ed, re��vis��it��ing, re��vis��itsTo visit again.n.A second or repeated visit.re this analysis and recruit a comparative sample of intoxicatedindividuals who do not use a safe ride or intend to drive home.Additionally, the limited power of the economic model used to estimatecost-savings of this safe ride program would be important to address infuture studies. The estimated cost to society of $1.20 per drinkconsumed is limited to the assumption that those riding the safe ridewould likely be driving (NHTSA, 2002b). Future cost estimates shouldinclude costs to others who are not driving and utilize estimatesassociated with total miles driven while under the influence. Finally,the majority of participants were college students, which may limit thegeneralizability of these conclusions to the general population. It istherefore recommended that future research also explore thecost-effectiveness of safe ride programs utilized by the general publicand other sub-populations. In summary, there is a significant need to reduce harms associatedwith drunk driving. Although policy makers are often reluctant toimplement harm reduction strategies, the current study indicates thatsafe ride programs may prove highly cost-effective. To date, mostintervention efforts within university communities have focused onindividual-level behaviors and development of restrictive policies(Wechsler et al., 2000). There is a clear need to consider use of asynchronous, ecological approach to managing drunk driving that includesa range of policies and strategies from both a restrictive and harmreduction perspective. It is recommended that future research continueto document the cost-effectiveness of safe ride programs and other harmreduction approaches across multiple levels of influence, as use ofcost-savings and cost-benefit analyses will likely play an importantrole in increasing the acceptability of harm reduction methods. AUTHOR NOTE: D. Joseph Gieck was a doctoral candidate at the University ofWyoming at the time of this project. Author is now affiliated with theVeteran Affairs Medical Center, Salem, Virginia Salem is an independent city in Virginia, USA, bordered by the city of Roanoke to the east but otherwise adjacent to Roanoke County. The population was 24,747 at the 2000 census. . Daivd M. Slagle was a doctoral candidate at the University ofWyoming at the time of this project. Author is now affiliated with theVeteran Affairs Puget Sound Puget Sound(py`jĕt), arm of the Pacific Ocean, NW Wash., connected with the Pacific by Juan de Fuca Strait, entered through the Admiralty Inlet and extending in two arms c. Health Care System. All work is original in its nature and both authors are the solecontributors to this project and manuscript. Data from this project hasnot been presented elsewhere. Additionally, the authors did not receivecompensation and/or contributions for this work, and neither author isdirectly tied to the program under evaluation. All correspondence concerning this article should be addressed to:D. Joseph Gieck, Ph.D., Salem VA Medical Center (11AC/ CL1), 1970Roanoke Boulevard, Salem, VA 24153; Phone: (540) 982-2463, ext. 3757;Email: donald.gieck@va.gov. REFERENCES Associated Students of the University of Wyoming. (2006). ASUWBudget and Final Report FY 2006. Barr, A. & MacKinnon, D.P. (1998). Designated driving amongcollege students. 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Slagle University of WyomingTABLE 1Multiple Regression: Is Frequency of Safe Ride UtilizationInfluenced by Participant BAC and Frequency of Drinking?Variable [beta] pr (a) t pRegression Model: Safe Ride Utilization and passenger BAC(sex and age as control variables) Sex .059 .060 .73 .466 Self report of how safe ride .021 .021 .26 .795 influences drinking behavior Utilization (b) .273 .271 3.41 .001Adj [R.sup.2] for model = .064[R.sup.2] for model = .082Regression Model: Safe Ride Utilization and Frequency of Drinking(sex and age as of control variables) Sex .309 .306 2.92 .004 Self report of how safe ride .083 .085 0.77 .439 influences drinking behavior Utilization (b) .124 .128 1.18 .242Adj [R.sup.2] for model = .081[R.sup.2] for model = .113(a) = part correlation(b) = utilization of safe ride per monthTABLE 2BAC, Alcohol Consumption, and Frequency of Safe Ride Use:Passengers Reporting to Drink More When Utilizing Safe Ride vs.Passenger Reporting No Change in Drinking Behavior Drink More No ChangeDomain M SD M SD t (df) pBAC (a) .12 .12 .11 .08 .52 (185) .56Drinks consumed 4.76 .84 4.30 .37 .56 (185) .58Frequency of 2.68 .79 2.52 1.29 .60 (185) .66 consumption (b)Frequency of SR 5.10 3.95 3.93 3.00 1.87 (185) .13 use (c](a) = Value is based on percentage value of particles(b) = Frequency of consumption per week(c) = Based on frequency of use per month