Bethesda, Maryland. If multiple city departments and private citizens join together to implement comprehensive traffic safety strategies, they can significantly reduce traffic deaths and injuries, according to an article by Ralph Hingson, Sc.D., M.P.H., and colleagues at Boston University in the June American Journal of Public Health (Volume 86, No. 6). The Saving Lives program reduced traffic deaths by 25 percent and alcohol-related traffic deaths by 42 percent, according to a decade-long project assessing the effectiveness of combined community interventions against drinking and driving and associated problems.

Drinking and driving claims more than 15,000 lives annually, according to National Institute on Alcohol Abuse and Alcoholism Director Enoch Gordis, M.D. "Dr. Hingson and his colleagues have demonstrated that comprehensive community strategies can lessen that toll. As has been the case for reducing cardiovascular mortality, cigarette smoking, blood pressure, and cholesterol levels, research now has documented a proven mechanism whereby communities can act to remedy a major public health problem involving alcohol."

The researchers examined trends in fatal crashes and injuries from March 1988 through February 1993 relative to the previous 5 years in six Massachusetts cities that instituted the Saving Lives program. They found that fatal crashes declined by 25-percent and fatal crashes involving alcohol by 42-percent greater margins in the Saving Lives cities than in the rest of Massachusetts. Vehicles observed speeding and teenagers who drove after drinking declined by 40-percent greater margins in the program cities than elsewhere in the state.

The reductions were achieved even though, during the Saving Lives program years, Massachusetts had the lowest traffic fatality rate of any state per vehicle miles driven. "If the Saving Lives program had been instituted throughout the state, we would have experienced 681 fewer fatal crashes over the 5 years," said Terrance D. Schiavone, president of the National Commission Against Drunk Driving and head of the Massachusetts Governor's Highway Safety Bureau at the time the study was initiated. "The community remains the logical delivery system for highway safety initiatives," according to current executive director Nancy J. Luther.

"By improving traffic safety, this program has saved lives, prevented injuries, and saved millions of dollars in hospital and medical costs," said James Hedlund, Associate Administrator for Highway Safety Programs, National Highway Traffic Safety Administration. "The results should inspire others to form similar community coalitions."

Due in part to drinking age increases, more than 2000 new state drunk driving laws stimulated during the 1980s by groups such as Mothers Against Drunk Driving, increased enforcement practices, and the more recent advent of so-called zero tolerance laws and administrative license revocation, alcohol-related fatal traffic crashes have declined since 1986 from 43.6 percent to 37.4 percent of U.S. fatal crashes. While research has linked each of these measures to fatal crash declines, post-law declines sometimes have been followed by a return to pre-law levels.

By involving local governments and their citizens, programs such as Saving Lives may increase the effectiveness of laws designed to reduce drunk driving, the authors suggest. Although the Massachusetts program cities received approximately $1 per resident annually from the Massachusetts Governor's Highway Safety Bureau and the Commonwealth Fund to undertake comprehensive, multistrategy programs, the local communities developed most of the initiatives. To reduce drunk driving and speeding, communities introduced media campaigns, police training, high school peer-led education, college prevention programs, and increased liquor outlet surveillance, among other measures. To increase pedestrian safety and seat belt use, program communities undertook police checkpoints, preschool education programs, and training of clinical personnel, among other measures.

"Fatal crash declines were more marked than injury declines, probably because alcohol-impaired driving and speeding were foci of the Saving Lives program. Alcohol-impaired driving and speeding are more often factors in fatal than injury crashes," said Dr. Hingson.

To measure effects of the Saving Lives program, the researchers used a quasi-experimental design that involved a combination of public records review, annual roadside surveys of speeding and safety belt use, and telephone surveys to monitor self-reported driving after drinking.

Research has shown that laws designed to reduce traffic deaths are most effective when accompanied by active education and enforcement at the local level. However, most community traffic safety interventions have focused solely on drunk driving enforcement and publicity, according to MADD national president Katherine Prescott: "The Saving Lives results suggest that comprehensive community action can enhance reductions in alcohol-related fatal crashes, above and beyond the passage of drunk driving laws. These findings reinforce the importance of what we can all accomplish as private citizens."

The study was supported by research grants from the National Institutes of Health's NIAAA, the Commonwealth Fund, the Massachusetts Governor's Highway Safety Bureau, the National Highway Traffic Safety Administration, and the Centers for Disease Control and Prevention.

For interviews and reprints, Dr. Hingson can be reached at 617/638-5160 or, on Monday, June 24 only, through the Research Society on Alcoholism annual meeting press room at 202/582-1234.

To receive NIAAA's "Alcohol Alert" No. 31, entitled "Drinking and Driving" telephone 301/443-3860 or order online: http://www.niaaa.nih.gov.