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4 Case Studies of Safety Interventions C hapter 3 described how successful traffic safety programs in other countries function effectively at three levels: the technical implementation of specific countermeasures, agency-level management and planning of the safety program, and maintenance of political and public support. Political leadership has been essential to successful safety initiatives in other countries, at the U.S. federal level, and in the U.S. states. Sustained, high-level political support provides resources, accountability, and buffering from opponents of rigorous interventions. Communication between political leaders and the professional and research communities also has been vital in ensuring that political initiatives lead to effective safety interventions. The experience of safety programs in the United States and abroad also shows that leadership and competence of senior public-sector executives are critical. Managers must define safety program objectives and strategies, budget and allocate resources, coordinate programs across agencies, evaluate the effectiveness of interventions and progress toward program objectives, and communicate expert advice to elected officials. To learn about the sources of leadership and management commitment, the committee examined case studies of the development and implementation of particular countermeasures in the United States. The cases focus on single categories of safety problems and countermeasures for the sake of simplicity, but it is recognized that traffic safety strategy must be comprehensive, integrating driver behavior regulation, road engineering, vehicle safety, and medical services. The objective of the case studies was to examine whether progress is being made in the United States against the selected categories of traffic hazards, to identify the sources of progress and obstacles to progress with regard to those hazards, and to compare the U.S. experience with experiences in other countries. If U.S. progress has been slower than abroad in any of the cases, the difference may be that other countries’ intervention techniques, or their management of interventions, are more effective than methods used in the United States. Alternatively, differences may reflect changes in risk factors such as travel patterns. The case studies do not constitute a comprehensive catalog or review of effectiveness of countermeasures. As Chapter 1 explained, the committee did not survey all categories of safety practice. Among the categories not examined in the cases are countermeasures aimed at distracted driving, aggressive driving, and drug-impaired driving; truck safety programs; driver training; vehicle safety rating; vehicle design improvements; graduated drivers’ licensing; and emergency medical response. The omitted categories include some areas of U.S. success and leadership (e.g., graduated licensing) as well as some (e.g., vehicle improvements) that probably account for important shares of recent traffic safety improvement in the benchmark countries. Some of the omitted categories can make important contributions in the future. For example, safety agencies worldwide have recognized the great potential of in-vehicle information technology applications for reducing crash risk (Farmer 2008). Technologies being tested can effectively and instantaneously warn drivers of external collision risks and of their own high-risk driving behavior (e.g., unsafe speed) and can intervene in vehicle control in high-risk situations. The five intervention cases selected were alcohol-impaired driving prevention, speed control, seat belt laws, motorcycle helmet laws, and practices with regard to roadway hazard 93

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94 Special Report 300: Achieving Traffic Safety Goals in the United States: Lessons from Other Nations elimination and safe road design. These five kinds of safety interventions present contrasting management, compliance, and legislative challenges. Seat belt laws and helmet laws are primarily state legislative issues; the laws are effective and relatively easy to enforce once enacted. Impaired driving prevention and speed control are ongoing management responsibilities of state and local law enforcement and highway agencies; the legislature is responsible for laws concerning limits, penalties, and enforcement techniques and for providing agency resources. Highway network screening (identification of high-hazard locations) has been largely a federally motivated activity, with federal grants partially paying for state capital improvements to correct high-hazard locations and for state data systems to identify locations; the legislature’s responsibility has been to provide resources for the program. In general, helmet laws are highly visible issues politically, impaired driving and speed control receive legislative attention when regulations are revised or automated enforcement is proposed, and highway network screening receives attention only when a particular hazard attracts local interest. For each of the case study topics, the sections below describe the following: • The value of the safety intervention: the magnitude of the safety problem addressed and the potential effectiveness of the intervention in reducing risk. It is important to know whether safety management and political leadership are steering safety practices in a productive direction. • Trends in crashes and fatalities that are related to the risks addressed and trends in government attention and resources devoted to the problem. • Benchmark nation comparisons: comparison of U.S. trends and practices with those of other countries with successful safety programs. • Illustrative histories of particular U.S. state or federal regulations and safety initiatives. Ideally, the histories would reveal the nature of the political forces that motivated actions of legislatures on safety laws, safety budgets, and oversight of safety programs; the relationship between public opinion and political leadership; and the importance of management leadership and skills within government agencies as sources of improved safety practices. • Conclusions on how political and public support and management commitment have been obtained. Although management practices and allocation of resources differ among the benchmark countries, a suite of countermeasures recognized as accepted practice and addressing the full range of risks is in general use in all the high-income countries. Application methods have been codified and scientific evaluations of many have been carried out (e.g., Hedlund et al. 2009; Dinh-Zarr et al. 2001; Shults et al. 2001; TRB 2003–2009). ALCOHOL-IMPAIRED DRIVING PREVENTION The sections below describe trends in measures of alcohol-impaired driving in the United States and in selected benchmark countries, interventions that are applied in the benchmark countries and in the United States to curtail alcohol-impaired driving, and the U.S. federal government role in impaired-driving prevention. The final section contains concluding observations.

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Case Studies of Safety Interventions 95 Trends in Alcohol-Related Fatalities The best evidence of the success of national campaigns against alcohol-impaired driving would be a decline in the percentage of drivers on the road with a blood alcohol content (BAC) level above some threshold. However, data for a sample of all drivers are almost never available. Instead, data on BAC levels of persons involved in crashes usually are used to indicate the magnitude of the drunk driving problem and the success of interventions. For example, the National Highway Traffic Safety Administration (NHTSA) tabulates numbers of alcohol-related fatal crashes, defined as fatal crashes in which at least one driver or one involved pedestrian had a BAC exceeding 0.01 percent. A decline in the annual number of alcohol-related crashes is weak evidence of success of impaired-driving prevention efforts if the total of all crashes is declining at a similar rate. When such a trend is observed, it is possible that other factors (e.g., more general highway safety measures, speed reductions caused by increased congestion) are reducing the frequency of all kinds of crashes and that anti–drunk driving activities are having little effect. However, a faster rate of decline in the number of alcohol-related crashes than in all crashes is better evidence of the success of anti–drunk driving interventions. (On “related factors” in fatal crash statistics, see Box 4-1.) Another difficulty in measuring the impact of BAC programs is that only about 40 percent of U.S. drivers involved in fatal crashes receive BAC tests. Drivers who receive tests are unlikely to be representative of all drivers in fatal crashes. NHTSA estimates the total frequency of alcohol-related fatal crashes from the reported BAC data (Subramanian 2002), but the reliability of the estimates is difficult to judge. Comparisons among countries are complicated further by differences in definitions of an alcohol-related crash and in methods of data collection. Finally, crash records in the United States and other countries indicate the presence of an impaired driver or pedestrian, but not whether the impairment was a cause of the crash. Some fraction of the alcohol-related fatal crashes would have occurred even if none of the involved persons had been impaired. U.S. Trends NHTSA estimates show progress in reducing the share of traffic fatalities that are alcohol-related from the early 1980s until the mid-1990s. Since that time, progress appears almost to have ceased (Table 4-1). Roadside surveys of alcohol impairment conducted by NHTSA in 1973, 1997, and 2007 and by the Insurance Institute for Highway Safety (IIHS) in 1986 indicate continuous decline in the frequency of impaired driving throughout this period (Table 4-2). In these surveys, a random sample of drivers is stopped and asked to submit to an alcohol test voluntarily. The response rate in the 2007 survey was high, and the analysis included imputation of the impairment rate among nonrespondents on the basis of responses to supplementary survey questions. Eighty-six percent of drivers stopped provided a breath sample; BACs for 87 percent of those who refused could be estimated from a passive alcohol sensor reading (Compton and Berning 2009).

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96 Special Report 300: Achieving Traffic Safety Goals in the United States: Lessons from Other Nations Box 4-1 “Related Factors” in Fatalities The NHTSA Fatality Analysis Reporting System (FARS) traffic fatality database includes information on circumstances of crashes that are believed to be related to crash risk or to the expected severity of the crash. The numbers of fatalities in 2007 determined by NHTSA to be speeding-related and alcohol-related and the number of deaths of light-vehicle occupants who were not using restraints (seat belts or safety seats) were as follows: Type of Fatality Number Speeding-related fatalities 13,040 Fatalities in crashes in which a driver had BAC ≥ 0.01 percent 15,387 Car or light-truck occupants killed who were not wearing restraints 14,390 More than one of these factors were present in some fatal crashes. Total fatalities in 2007 were 41,259. NHTSA’s bases for these classifications are as follows: Speeding-related: A driver involved in the crash is charged with a speeding-related offense • or a police officer indicates that racing, driving too fast for conditions, or exceeding the posted speed limit was a contributing factor in the crash (NHTSA 2007d). As the section on speed in this chapter describes, the great variation among the states in the fraction of fatal crashes coded as speed-related suggests that this classification is not consistently coded in the FARS data. Restraint use: Use is determined by police reports. Of the 29,000 passenger car and light- • truck occupant deaths in 2007 in FARS, 7 percent are reported as as “restraint use unknown,” 42 percent as “restraint used,” and 49 percent as “restraint not used” (NHTSA 2008a, 40). Alcohol-related: Before 2008, NHTSA’s annual FARS summary (e.g., NHTSA 2007b, 32) • reported “total fatalities in alcohol-related crashes,” defined as the number of deaths in crashes in which a driver or involved nonoccupant (e.g., a pedestrian) had a BAC ≥ 0.01 percent. Starting with the FARS 2007 summary report, the term “alcohol-related crashes” is no longer used, and NHTSA tabulates only crashes in which a driver had BAC ≥ 0.01 percent (NHTSA 2008a, 7, 32). For fatal crashes in which alcohol test results are unknown, NHTSA estimates the distribution of driver BAC levels. (continued)

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Case Studies of Safety Interventions 97 Box 4-1 (continued) The related-factors data may have use in setting priorities for enforcement of driver behavior regulations but must be interpreted with caution. Characterizing the alcohol and speeding data as tabulations of crash causes would be inaccurate, since there is little basis for estimating what fraction of alcohol- or speeding-involved fatalities would not have occurred if these related factors had not been present. Conversely, some crashes not coded as “speed- related” probably would have been avoided or mitigated if the vehicles involved had been traveling at lower speeds. The decline in the fraction of all fatalities determined to be alcohol-related is consistent with the pattern of enforcement effort in this period. Arrests for alcohol-impaired driving increased by 300 percent from 400,000 in 1970 to 1.6 million (1 arrest per 100 licensed drivers) in 1983, the period of rapid reduction in the fraction of crashes that are alcohol-related, and has since declined (Figure 4-1). TABLE 4-1 Trends in Alcohol-Related Crashes and Pedestrian Fatalities, 1982–2008 1982 1995 2005 2008 Fatalities in alcohol-related crashesa Number 24,200 16,000 16,100 13,900 Number as a percentage of all traffic fatalities 55 38 37 37 Percentage of pedestrians killed who had BAC > 0 49 41 39 42 a Before 2008, NHTSA defined an alcohol-related crash as one in which any involved driver or pedestrian had a BAC > 0. NHTSA tabulations no longer use this term. The values shown in the table for fatalities in alcohol-related crashes as a percent of all fatalities is the fraction of all fatalities that occurred in crashes in which any driver had a BAC > 0. SOURCE: NHTSA 2009c, Tables 13, 20. TABLE 4-2 Percentage of All Drivers with BAC ≥ 0.8 g/L 1973 1986 1997 2007 Weekend nighttime drivers 7.5 5.4 4.3 2.2 Drivers younger than legal drinking age 5.5 3.0 1.3 0.9 SOURCE: Compton and Berning 2009, Figures 1 and 5.

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98 Special Report 300: Achieving Traffic Safety Goals in the United States: Lessons from Other Nations 150 140 130 120 110 DUI arrests: index 100 2006=100 90 Pct. of fatalities occurring in crashes in which highest 80 BAC was 0 70 60 50 40 30 1970 1973 1976 1979 1982 1985 1988 1991 1994 1997 2000 2003 2006 FIGURE 4-1 Driving-under-the-influence arrests and alcohol-involved fatalities, 1970–2007. (SOURCE: Pastore and Maguire n.d., Tables 4.27.2007, 3.103.2006.) Since 1995, the decline in the percentage of pedestrians killed in traffic accidents who had positive BAC has been nearly as great as the decline in the percentage of all traffic fatalities that are alcohol-related. Because most intervention efforts are aimed at drivers, the similarity of the trends in driver and pedestrian alcohol involvement suggests that factors other than the interventions may be driving the trends. The percentage of traffic fatalities that are alcohol-related is close to the national average in most states, but some states are outliers. In NHTSA estimates for 2005, 45 percent or more of all fatalities were alcohol-related in 11 states and the District of Columbia (Alaska, Delaware, District of Columbia, Hawaii, Montana, North Dakota, Rhode Island, South Carolina, South Dakota, Texas, Washington, and Wisconsin). The highest shares were 55 percent in the District of Columbia and 51 percent in Hawaii. The lowest shares were 13 percent in Utah and 26 percent in Iowa (NHTSA 2007b, Table 114). International Comparisons Most of the benchmark countries track alcohol-related crashes by using measures similar to those of the United States. Trends are summarized below for four countries noted for strong anti– drunk driving controls. In general, experiences in the United States and internationally appear similar: slowing progress over the past decade in reducing the fraction of all crashes that are alcohol-related. In Great Britain the proportion of all fatally injured drivers who had BAC over the 0.08 percent (0.8 g/L) legal limit declined from the early 1970s through the mid-1990s but since has crept upward:

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Case Studies of Safety Interventions 99 1975 1995 2005 Percentage of all fatally injured drivers with BAC > 0.8 g/L 35 21 24 Fatalities in accidents involving illegal alcohol levels 1,500 540 550 In 2006, police administered 602,000 roadside screening breath tests in England and Wales. Authorities speculate that the cause of the recent lack of progress is a reduction in the frequency of tests. However, the number of tests in 2006 was greater than in any year before 1994 and the number of convictions resulting from the tests is unchanged from the 1990s (DfT 2008, 27–31; DfT 2007, 27–31; Sweedler et al. 2004). Since at least 1975, Germany has steadily reduced the proportions of all traffic injury crashes and of all traffic fatalities that are alcohol-related, defined as crashes in which at least one involved person had a BAC exceeding 0.3 g/L (data in all years include East Germany): 1975 1995 2005 Alcohol-related injury accidents Number 52,000 37,000 22,000 As percentage of all injury accidents 14 10 6 Alcohol-related fatalities Number 3,500 1,700 600 As percentage of all fatalities 20 18 11 Gains are still being made, although the trend appears nearly to have flattened after 2000, after a spike in the early 1990s followed by a steep decline in the late 1990s (Schoenebeck 2007; Sweedler et al. 2004). Recent traffic safety trends have been affected by the reunification of East and West Germany. The former Eastern bloc countries experienced rapid growth in automobile travel and have higher injury and fatality rates, but more rapid rates of improvement, than the West. In Australia, the fraction of all fatally injured drivers and motorcycle riders with BAC exceeding the 0.05 percent (0.5 g/L) legal limit fell from 44 percent in 1981 to 30 in 1992, but then fluctuated between 26 and 30 percent through 1998. The fraction of all fatalities that were alcohol-related fell from 43 percent in 1988 to 35 percent in 1992, then fluctuated between 35 and 38 percent from 1992 to 2001. More recent data are not available (IIHS 2005; Haworth and Johnston 2004; Sweedler 2007). In Sweden, the fraction of fatally injured drivers who had BAC exceeding 0.02 percent rose from 19 percent (43 out of 230 drivers killed) in 1998 to 27 percent (50 out of 187) in 2004, then declined to 24 percent (48 out of 200) in 2007 (Swedish Road Administration 2009, 32). In 1992 the legal BAC limit was changed from 0.05 percent to 0.02 percent. Enforcement, including random breath testing on a large scale, was intense for several years after 1992. Enforcement efforts have been reduced somewhat since their peak in the 1990s. Also, per capita alcohol consumption was increasing between 1996 and 2002 (Sweedler et al. 2004; Sweedler 2007). Swedish Road Administration officials interpret the recent increase in the percentage of drivers in fatal crashes who are alcohol-impaired as partly the consequence of the reduction in the total number of fatal crashes, while the frequency of impaired driving has remained constant (Breen et al. 2007, 30).

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100 Special Report 300: Achieving Traffic Safety Goals in the United States: Lessons from Other Nations Interventions Deaths and injuries caused by alcohol-impaired driving are one manifestation of the complex social and public health problem of alcohol abuse. Consequently, a range of interventions is needed, and strategies combine measures that attack the broader public health problem with more narrowly targeted traffic safety measures. A NHTSA report has categorized the available countermeasures as follows (Hedlund et al. 2007, 1-2–1-4): • Deterrence: action to enact, publicize, and enforce laws against alcohol-impaired driving: — Laws: administrative license revocation at time of BAC test failure, test refusal penalties, stronger sanctions for higher-BAC drivers, laws against open containers, young driver restrictions — Enforcement techniques: sobriety checkpoints, saturation patrols, integrated enforcement (e.g., combined seat belt and alcohol campaigns), preliminary and passive breath test devices — Adjudication: court sanctions (license revocation, fines, jail, community service), elimination of diversion programs and plea bargains that expunge alcohol-related offenses from offenders’ records, special driving-while-intoxicated (DWI) courts, citizen monitoring of court handling of impaired-driving cases — Offender monitoring: monitoring of sentence completion, alcohol interlocks • Prevention: actions to reduce drinking and to prevent drinkers from driving — Responsible beverage service (training of beverage servers) — Alternative transportation provision — Designated drivers — Alcohol screening and brief intervention in general medical practice — Underage drinking and other alcohol sales enforcement • Communications: establishment of positive social norms with regard to drinking and driving Mass-media campaigns — School and youth education programs — • Treatment to reduce alcohol dependency among drivers, including court assignment to treatment • General traffic safety measures that protect impaired drivers as well as others, for example, enforcement of seat belt laws Interventions in the Benchmark Countries The interventions used in the benchmark countries that are believed to have the greatest effectiveness are high-frequency roadside alcohol testing, low BAC limits, intensive follow-up on offenders through the judicial system, and the coupling of social marketing techniques with enforcement. Ignition interlocks that prevent an alcohol-impaired person from operating a motor vehicle are coming into use in several countries. Laws, enforcement methods, and intensity of enforcement against impaired driving in France, Australia, Sweden, and the United Kingdom are summarized in Chapter 3. Random alcohol test checkpoints (that is, enforcement in which all drivers stopped at a roadside

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Case Studies of Safety Interventions 101 checkpoint are tested, not only those for whom the enforcement officer has grounds to suspect impairment) are used in France, Australia, and Sweden and in most European countries except the United Kingdom, but they are illegal in the United States as a violation of the Fourth Amendment’s protection against unreasonable searches. As described in Chapter 3, rates of alcohol testing in many countries are high enough that a driver can expect to be tested at least once every few years [for example, 280 tests per 1,000 drivers annually in France (Table 3-1)] and appear much higher than U.S. test rates, although few U.S. data on enforcement effort are available. In nearly all of Europe except the United Kingdom and Ireland, and in Australia, the per se BAC limit is 0.05 percent or lower. The limit is 0.08 in the United States, Canada, and the United Kingdom. U.S. Intervention Priorities For transportation officials responsible for proposing or carrying out an impaired-driving prevention program, selecting from among the possible countermeasures to design a strategy depends on a balancing of effectiveness, cost, and political feasibility. Research has evaluated the effectiveness of many of the countermeasures listed above (Hedlund et al. 2009), and several national groups have identified combinations of actions that they believe should receive the highest priority. The priority lists indicate expert opinion about the most needed actions and generally reflect the findings of the body of scientific evaluation research. The lists suggest that a consensus exists on the need for certain measures. NHTSA, on the basis of the scope of federal government responsibilities and capabilities, has identified four strategies for special promotion through its technical assistance and coordination activities (NHTSA 2007a): • High-visibility enforcement, • Support for prosecutors and DWI courts, • Medical screening and brief intervention for alcohol abuse problems, and • Enactment of primary seat belt laws. NHTSA’s activities with regard to impaired driving are described in the section below on federal responsibilities. NHTSA’s high-priority strategies are consistent with the recommended actions to reduce alcohol-impaired driving of the Task Force on Community Preventive Services, a nongovernmental expert panel convened by the Centers for Disease Control and Prevention that publishes public health policy recommendations founded on rigorous reviews of research on effectiveness. Addressed to state and local governments and community organizations, the task force’s recommendations for measures that are not already generally applied are as follows (Task Force on Community Preventive Services n.d.): • Sobriety checkpoints: A sobriety checkpoint is a site where police systematically stop drivers, look for signs of impairment, and administer a breath test when there is reason to suspect impairment.

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102 Special Report 300: Achieving Traffic Safety Goals in the United States: Lessons from Other Nations • Intervention training programs for servers of alcoholic beverages: These programs teach servers ways to prevent intoxication among their patrons (for example, by delaying or denying service). • Mass-media campaigns: The evidence for effectiveness applies mainly to media campaigns that use pretested messages; attain high exposure through paid advertising; and complement local-level, high-visibility enforcement. • School-based instructional programs aimed at discouraging students from riding with drinking drivers. • Multicomponent intervention with community mobilization: This strategy involves recruiting participation of community coalitions or task forces in the design and execution of interventions such as those listed above. • Ignition interlocks: An alcohol ignition interlock is a device installed in a vehicle that prevents a driver with BAC above a preset level from starting the engine. Use of an interlock may be required by the court as a condition of probation for an impaired-driving offender. The task force also recommends retention of three laws that are already in force in all states: the 0.08 percent BAC limit, lower legal BAC limits for young or inexperienced drivers, and the minimum legal drinking age of 21 years. The task force’s research review found that these three laws are effective in reducing motor vehicle occupant injuries. Finally, the National Transportation Safety Board has published a list of recommended actions to reduce fatalities and injuries involving “the hard core drinking driver,” a category defined to include repeat offenders and high-BAC offenders. The recommendations include special penalties for high-BAC offenders, lower BAC limits for repeat offenders, administrative license revocation, sobriety checkpoints, vehicle sanctions including impoundment and interlocks, alternatives to confinement involving strict supervision, restriction of plea bargaining, and elimination of diversion programs (NTSB 2000). Reviews of evaluation studies have concluded that random sobriety checkpoints and checkpoints conducted under U.S. rules [which allow police to stop all vehicles (or vehicles selected according to some rule, such as every third vehicle) at a preannounced location and time period, observe their drivers, and administer sobriety tests to those that show signs of intoxication] were both effective in reducing alcohol-related fatal crashes. Furthermore, U.S. methods, applied with sufficient intensity and efficiently managed, can equal the effectiveness of random testing enforcement (Shults et al. 2001, 76; Elder et al. 2002). Research evidence also indicates that lowering the U.S. BAC limit from 0.08 percent to the 0.05 percent limit prevailing elsewhere would be an effective safety measure. A comprehensive review of research studies concluded that lowering the BAC limit from 0.10 to 0.08 in the United States reduced alcohol-related crashes and casualties. The review concluded that lowering the limit from 0.08 to 0.05 in other countries reduced alcohol-related fatalities and that this effect cannot be accounted for solely by changes in publicity or enforcement that were introduced in some countries simultaneously with the lowering of the BAC limit. Research has found that crash risk is substantially higher for drivers with BAC of 0.05 than for drivers with 0.00 BAC and that lowering the limit to 0.05 can reduce the incidence of impaired driving at much higher BAC levels (i.e., at BAC over 0.15 percent). The authors conclude that the introduction of more stringent laws serves as a general deterrent to drinking and driving (Fell and Voas 2006).

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Case Studies of Safety Interventions 103 Implementation and Obstacles The federal requirements described in the following section have contributed to a progressive strengthening of state laws with regard to the legal drinking age, BAC limits, and other alcohol control measures. IIHS rates the adequacy of the laws of all the states concerning alcohol- impaired driving. In the 2009 survey, 19 states earned an overall “good” rating for their laws and one state was rated as “poor.” The remainder received “fair” or “marginal” ratings. In comparison, 16 states were rated good and one poor in 2006, and in the 2000 survey eight were good and five poor. A good rating means the state has a 0.08 percent BAC limit, has an administrative license revocation law and a “zero tolerance” law (imposing a stricter impaired- driving standard on new drivers) that IIHS judges to be effective, and allows sobriety checkpoints. A poor rating means that no more than one of these laws is adequate (IIHS 2009a; IIHS 2006; IIHS 2000). State legislative actions on impaired driving are monitored by the National Conference of State Legislatures (NCSL). In the 2009 review, NCSL reported that 229 impaired-driving bills were introduced in legislatures in 2009 and that 25 states enacted laws relating to impaired driving (Savage et al. 2010). Contents of legislative activity reported by NCSL included the following: • High-BAC countermeasures: By 2009, 43 states and the District of Columbia had laws providing stronger sanctions for high-BAC offenses (offenses in which the driver has BAC above a threshold ranging from 0.15 to 0.20 percent). Two states enacted high-BAC laws in 2009. • Ignition interlocks: As of November 2009, nine states required ignition interlock devices on the vehicles of all convicted drunk drivers, including two states that passed such laws in 2009. [The total rose to 12 states in 2010 (GHSA n.d. a).] Thirty-two states considered some form of ignition interlock legislation during the year. Much less information is available on the level of effort the states devote to implementation of countermeasures than on the laws in place in each state. The NHTSA report that presented the categorization of countermeasures summarized above (Hedlund et al. 2007) also attempted to judge the extent of use of each countermeasure, with ratings ranging from “high use” to “low use.” Among the effective measures with low or unknown use are DWI courts (low), citizen monitoring of court performance in impaired-driving cases (low), and passive breath sensors (unknown). Sobriety checkpoints are rated “medium use” on the basis of the number of states that allow checkpoints; however, it is noted that few states make regular use of checkpoints and that a 2003 survey found only 11 states that conduct checkpoints on a weekly basis (Hedlund et al. 2007, 1-15). In 10 states (Idaho, Iowa, Michigan, Minnesota, Oregon, Rhode Island, Texas, Washington, Wisconsin, and Wyoming), sobriety checkpoints are not permitted under state law, and two states (Alaska and Montana) never use checkpoints as a matter of policy (MADD n.d.).

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140 Special Report 300: Achieving Traffic Safety Goals in the United States: Lessons from Other Nations highway network screening programs. Nonetheless, its results challenge standard assumptions in highway design. A research program sponsored by the U.S. Department of Transportation and by the states through AASHTO has increased understanding of the safety effects of highway design and traffic control features and has developed new knowledge and organized existing knowledge into tools for application in project development (see Box 3-7 in Chapter 3). The Highway Safety Manual published by AASHTO in 2010 is a first step in providing a methodology that quantifies the expected safety effects of proposed highway improvement projects and allows highway designers to compare the expected safety performance of design alternatives. Software tools to implement the Highway Safety Manual procedures include the SafetyAnalyst and the Interactive Highway Safety Design Model. To achieve safety improvement, the Highway Safety Manual procedures and the available software tools will need to be institutionalized in the safety management process and the project development process. U.S. Practices The two subsections below describe a representative state highway network screening program and the main federal grant program for state and local highway hazard elimination projects. Funding for hazard elimination in most states is mainly from grants from the federal-aid highway program specifically provided for the purpose [formerly the Hazard Elimination and Highway– Rail Grade Crossings Programs, now the Highway Safety Improvement Program (HSIP) defined in the 2005 federal surface transportation act (SAFETEA-LU)]. Projects eligible for federal funding assistance are defined as follows [23 U.S.C. Section 148(a)]: In general.—The term “highway safety improvement project” means a project described in the State strategic highway safety plan that (i) corrects or improves a hazardous road location or feature; or (ii) addresses a highway safety problem. The act also lists categories of eligible projects. The state strategic highway safety plans that the act requires are described in Chapter 3. Example of a State Highway Network Screening Program The following outline of Oregon’s Highway Safety Program (ODOT 2007) is presented to illustrate the procedures in a representative state program to identify and correct high-hazard locations. The Oregon Department of Transportation (ODOT) currently spends approximately $28 million annually on its Highway Safety Program. Funding includes $14 million from the federal HSIP and an equal amount from state funds and other federal funds. The state probably is unusual in doubling its federal HSIP grant; the minimum required state matching share is 10 percent. For comparison, the ODOT highway budget is approximately $1 billion annually. The Highway Safety Program funds mainly small infrastructure improvement projects at high-hazard locations. For example, eligible improvements include alignment adjustments, signal installation, guardrails, barriers, illumination, pavement markings, signs, roadside fixed- object removal, and traffic calming features. With a few exceptions, noninfrastructure

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Case Studies of Safety Interventions 141 treatments such as increased enforcement are funded through other programs. Projects may be on any public road in the state owned by state or local government. Each of ODOT’s five regions receives a funding allocation, and projects are developed and nominated by the regions. The department conducts statewide analyses to identify high- hazard locations. The Safety Priority Index System (SPIS) evaluates the state highway system in 0.1-mile segments to identify problem locations on the basis of crash frequency, severity, and rate. Each region is given a list of the sites in its territory to which the SPIS has assigned a priority in the top 5 percent of all sites statewide. The regions then evaluate these sites for possible corrective action. A separate analysis [the Safety Investment Program (SIP)] ranks 5- mile segments of the state highway system according to the frequency of fatal and serious injury crashes in a 3-year period. Local governments may also nominate projects to their regional office for inclusion in the Highway Safety Program. Each region assembles a package of project requests, limited by its funding allocation and prioritized according to criteria specified by ODOT (including SPIS ranking, SIP ranking, and benefit–cost ratio). The Oregon Transportation Commission makes the final decision on which safety projects are included in the Statewide Transportation Improvement Program. A noteworthy component of Oregon safety activities is the state’s safety corridor program, which constitutes a more comprehensive and systematic approach to reducing the risk of travel on a particular road than the traditional, infrastructure-oriented hazard elimination program. The state publishes an annual Safety Corridor Plan that identifies corridors on state highways that have been given high priority for crash reduction. The plan also reports on progress in meeting crash reduction objectives in each corridor. Corridor treatments are designed that combine enforcement, education (including publicity campaigns and school programs), engineering (traffic control devices and capital improvements to the roads in the corridor), and emergency medical services (EMS) improvements. Coordination is required with local governments on enforcement and EMS and with the state’s capital programming process where capital improvements are called for. Other states also conduct corridor safety programs. For example, the California program, which has treated 123 corridors since 1993, depends on cooperation of the highway patrol, the state highway agency, local police, and local EMS. Federal HSIP The federal HSIP established in SAFETEA-LU (Section 1401) is the current version of a grant program that has been in operation since at least 1975. The law authorizes $1.2 billion annually for 2006–2009 for projects to correct high-hazard locations on any public road. Funds are allocated by formula to the states. Within the program, the law sets aside $220 million annually for rail–highway grade crossing projects and $90 million annually for improvements on high-risk rural roads. A new provision requires each state to coordinate its hazard elimination program with the state’s federally required Strategic Highway Safety Plan. The intent of the strategic plan is to identify critical highway safety problems and opportunities. The plan must be based on accurate and timely safety data; be developed in consultation with local governments and private stakeholders; specify performance-based goals; and incorporate strategies involving infrastructure improvement, driver behavior regulation, education, and emergency services. State data systems supporting the plan must be capable of identifying high-hazard locations and

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142 Special Report 300: Achieving Traffic Safety Goals in the United States: Lessons from Other Nations evaluating countermeasures. The state’s HSIP is to be developed within the framework of the strategic plan, presumably to ensure that interested parties are consulted in forming the program and that the full range of countermeasures is considered (FHWA 2005). Practices in the Benchmark Countries The four benchmark country safety programs described in Chapter 4, and probably the programs of all the high-income countries, include a traditional hazard elimination component. In addition, all countries have design standards for new construction and reconstruction that are intended to provide for safety. However, a shift in design emphasis appears to be emerging in some of the benchmark countries’ road programs that departs from conventional practice in three ways. First, designs are based on a new and more firmly researched-based understanding of the relationship of design to crash and casualty risk (for example, an appreciation of the influence of geometric design on driver behavior, especially selection of speed). Second, risk reduction is given higher priority and earlier attention in the design of projects and in project programming. Finally, designs show a willingness to trade a degree of traveler convenience for the sake of safety. The new approach entails greater road agency accountability for the safety consequences of road designs—the designer is expected to quantify the expected crash frequency on the new or improved road and to justify the design level of risk as acceptable. Activities such as the road safety audit and the road assessment programs described below reinforce accountability. This design philosophy is an ideal articulated in national safety plans that has yet to be fully realized in practice; nonetheless, it is influencing practice in some countries. Several of the benchmark countries highlight road design as central to their long-term safety strategies. Examples are the following: • In Sweden, the Vision Zero policy described in Chapter 3 emphasizes road design. Roads are to be built or reconstructed with features that ensure low casualty risk, and risk reduction opportunity is a factor in project selection. Safety design features include roundabouts replacing intersections, barriers separating opposing lanes, and the 2+1 lane design. • In Australia, the most recent Australian Transport Council Action Plan, described in Chapter 3, endorses a “safe system” framework, which has been adopted in several of the Australian state safety plans. The framework embodies a systems perspective, that is, a design philosophy that seeks to optimize the performance of the road system as a whole, with consideration of the characteristics of vehicles, roads, and users. The safety plans acknowledge that, now that Australia has made large safety improvements through intensified enforcement, greater focus on safe infrastructure design will be necessary to sustain improvement in the future. • In the Netherlands, the strategy of the “sustainable safety” policy has similarities with the Swedish Vision Zero strategy. It adopts the systems perspective and emphasizes road design as a means of regulating driver behavior. The road system is classified by function, and design features identified as appropriate to each function are being introduced, for example, traffic calming features in built-up areas and alignment and lane width adjustments on two-lane roads that signal appropriate speeds to drivers. This design technique is referred to as the self- explaining road (Kraay 2002, 2–3, 6–7). Because these strategies involve road reconstruction, they can only be brought to fruition gradually over time. In addition, fully implementing them will require the analytical ability to

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Case Studies of Safety Interventions 143 design a road to meet a quantitative crash risk standard (i.e., a specified expected crash risk on a road, given stated assumptions about traffic characteristics). This ability is not yet fully in place in the United States or other countries, although, as described above, some of the necessary analytical tools have been under development in the United States. Road Assessment Programs A new evaluation practice, the Road Assessment Program (RAP), in operation in Europe and Australia and under development in the United States, is bringing greater attention to the problem of upgrading the inherent safety of road infrastructure. RAPs assemble and publicize crash data and other safety information for individual road segments. The programs publish maps that indicate the relative safety of each of the roads in a jurisdiction. Leadership in creating and managing the programs has come from the national automobile clubs in those countries, in cooperation with governmental agencies. In the United States, the AAA Foundation is organizing pilot implementations of usRAP in cooperation with eight states (Iowa, Michigan, Florida, New Jersey, Illinois, Kentucky, New Mexico, and Utah) (usRAP 2008; Harwood et al. 2010). The creation of RAP was inspired by the success of the European New Car Assessment Program (NCAP), which was organized in the mid-1990s as a joint effort of automobile clubs, governments, and the European Commission to conduct new-car crash tests and publish the results as consumer information. The NCAP is believed to have influenced vehicle designs strongly as manufacturers competitively seek higher ratings for their new models. In Europe, the RAP maps attract considerable public attention, which exerts pressure on road agencies to act on the high-crash locations. RAP is a potentially significant experiment in highway safety action. A nongovernmental initiative, it aims to increase public demand for safety and to make public officials more accountable for safety performance of highways by revealing and publicizing hazards. The road protection scores and star ratings produced by the RAP assessments (Harwood et al. 2010, 113–150) are useful as intermediate output measures of state hazard elimination programs. Road Safety Audits A second evaluation practice in use in the benchmark nations and in some U.S. states, road safety audits, is increasing awareness of the potential for reducing casualty risk through changes in road design and is reinforcing public accountability of road agency managers. A road safety audit is a formal, independent examination of the safety of the design of a road construction or reconstruction project. A similar procedure, called a road safety audit review in the United States, has been developed for roads already in use. Road safety audits originated in the United Kingdom, where they have been compulsory since 1991 for major projects, and are practiced in Canada, Australia, New Zealand, Germany, and some U.S. states (Wilson and Lipinski 2004, 1– 4, 21–25; ETSC 2005). FHWA identifies critical differences between a road safety audit and conventional methods of checking the safety of a road design (FHWA n.d. b). The audit • Is performed by a team independent of the project;

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144 Special Report 300: Achieving Traffic Safety Goals in the United States: Lessons from Other Nations • Is performed by a multidisciplinary team (for example, expertise of team members may include traffic engineering, road design, traffic enforcement, roadway maintenance, and crash investigation); • Considers interactions of motor vehicles, bicycles, and pedestrians; • Considers especially human factors issues in the design, that is, the demands the road environment places on the driver’s attention, reactions, and judgment; • Generates a formal audit report; and • Requires a formal response to the audit from the parties responsible for the audit. The requirements for independence of the audit and for a formal report and response reinforce accountability of the agency conducting the project. The interdisciplinary approach ensures that features affecting risk that road designers have not been technically prepared to recognize in the past are not overlooked. Summary Observations Although hazard elimination programs are prominent in the safety strategies of most state transportation programs, the overall performance of these programs is difficult to assess. A systematic comparative evaluation to determine how much the programs contribute to safety improvement and to identify the attributes of the most effective programs would be worthwhile. In-depth examinations of hazard elimination programs in a sample of states (possibly supplemented with international comparisons) would seek to answer the following questions: • Do the state hazard elimination programs produce appreciable reductions in crashes at reasonable cost? Especially, are there state programs that are much more effective than the average, or practices in other countries that are more effective than U.S. programs? Overall evaluations of the effectiveness of these programs have been rare and have used imperfect methodologies. • Do states successfully manage the interagency coordination that an effective hazard elimination program requires? The parties that may be involved include several offices within the highway agency (which administers the federal HSIP funds), the state agency responsible for administering NHTSA highway safety grants (which may fund enforcement, data systems, public information programs, or EMS improvements), state and local police, local governments, and interested private groups. Participation of all of these parties may be needed to identify the highest-priority locations and to carry out the most effective remedies. • Does the highway network screening process have any influence on the overall state highway capital and maintenance programs? For example, when the state plans and designs its major highway capacity projects or its pavement resurfacing program, does information about high-hazard locations influence priorities and project designs? Or, alternatively, is the screening used solely to direct the spending of earmarked safety funds? • Does highway network screening influence the priorities and practices of agencies outside the state department of transportation—state police, local police, local roads programs, and metropolitan planning organizations? • Have state hazard elimination programs achieved an appropriate balance between spot safety improvements (i.e., improvements to short segments or individual intersections) and

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Case Studies of Safety Interventions 145 corridor-based safety improvements (i.e., broadly based improvement packages for extended road sections with the highest identified risk levels)? • How can the impact of the hazard elimination program and related safety analysis and planning activities be evaluated, either on a project-by-project basis or cumulatively over a period of years for an entire state? • If evidence from the states with the best programs or from other countries shows that hazard eliminations could make a much greater contribution to reducing traffic injuries, what strategy can be used to reform the lagging programs and increase the resources available to them? The restructured HSIP of SAFETEA-LU was intended to raise the stature of the program by increasing funding and by linking it to comprehensive state highway safety plans. Has the new federal structure enhanced the performance of the state programs? REFERENCES Abbreviations ABATE Alliance of Bikers Aimed Toward Education ACEM Association des Constructeurs Européens des Motocycles DfT Department for Transport ECMT European Council of Ministers of Transport ERSO European Road Safety Observatory ETSC European Transport Safety Council FHWA Federal Highway Administration GAO General Accounting Office GHSA Governors Highway Safety Association IIHS Insurance Institute for Highway Safety MADD Mothers Against Drunk Driving NHTSA National Highway Traffic Safety Administration NTSB National Transportation Safety Board ODOT Oregon Department of Transportation OECD Organisation for Economic Co-operation and Development ONISR Observatoire National Interministériel de Sécurité Routière TRB Transportation Research Board USDOT U.S. Department of Transportation Aarts, L., and I. van Schagen. 2006. Driving Speed and the Risk of Road Crashes: A Review. Accident Analysis and Prevention, Vol. 38, No. 2, pp. 215–224. ABATE of California. n.d. History of ABATE. http://www.abate.org/aboutus/history/. ACEM. 2006. Safety Innovations by Industry: Indicative Overview. http://www.acem.eu/media/d_Annex3IndicativeoverviewofSafetyInnovations_61541.pdf. ACEM. 2009a. Contribution to the Public Consultation on a Proposal for a Framework Regulation of the European Parliament and of the Council on Type-Approval of Two- and Three-Wheel Motor Vehicles. Feb. 23. ACEM. 2009b. News from the Motorcycle Industry in Europe. No. 18, Feb. www.acem.eu. ACEM. 2010. Protective Equipment for Riders. March. Arizona Department of Public Safety. n.d. Photo Enforcement Program. http://www.azdps.gov/Services/Photo_Enforcement/.

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