摘要：Objectives. We evaluated the public health benefits of traffic laws targeting speeding and drunk drivers (British Columbia, Canada, September 2010). Methods. We studied fatal crashes and ambulance dispatches and hospital admissions for road trauma, using interrupted time series with multiple nonequivalent comparison series. We determined estimates of effect using linear regression models incorporating an autoregressive integrated moving average error term. We used neighboring jurisdictions (Alberta, Saskatchewan, Washington State) as external controls. Results. In the 2 years after implementation of the new laws, significant decreases occurred in fatal crashes (21.0%; 95% confidence interval [CI] = 15.3, 26.4) and in hospital admissions (8.0%; 95% CI = 0.6, 14.9) and ambulance calls (7.2%; 95% CI = 1.1, 13.0) for road trauma. We found a very large reduction in alcohol-related fatal crashes (52.0%; 95% CI = 34.5, 69.5), and the benefits of the new laws are likely primarily the result of a reduction in drinking and driving. Conclusions. These findings suggest that laws calling for immediate sanctions for dangerous drivers can reduce road trauma and should be supported. Motor vehicle crashes (MVCs) are a major public health problem that disproportionately affects youths and young adults. 1 Worldwide, more than 3300 people per day are killed in road trauma, 2 and many more are disabled. Crashes are caused by numerous factors, including faulty vehicles and poor road design, but the majority are attributed to driver-related factors, especially alcohol-impaired driving, 3,4 speeding, 5,6 and driver distraction. 7,8 In Canada, driving with a blood alcohol concentration (BAC) of 0.08% or more is a federal criminal offense. Most provinces have regulations that allow for administrative sanctions (fines or license suspension) for drivers with a BAC of 0.05% or more. Speed limits are set by the provinces and enforced through administrative sanctions. Before September 2010, drunk drivers in British Columbia were subject to fines and administrative driving prohibitions of 24 hours for a BAC of 0.05% or more and of 90 days for a BAC of 0.08% or more or failure to provide a breath sample. The 90-day driving ban came into effect after a 21-day period that allowed the driver to find alternative means of transportation or to appeal the decision. There were no vehicle impoundments for drunk drivers. In addition to administrative penalties, drivers with a BAC of 0.08% or more and those who refused to provide a breath sample were subject to possible penalties under the Criminal Code of Canada. Before September 2010, the penalty for street racing was vehicle impoundment for 2 days for a 1st offense and for 30 days for 2nd and subsequent offenses in addition to fines and possible criminal code charges. In September 2010, British Columbia introduced harsher penalties for drunk drivers and for excessive speeding (> 40 km/h over the speed limit) as well as for drivers caught street racing or stunt driving. Under these laws, which add to but do not replace the older laws, drivers with a BAC of 0.05% or more may be subject to license suspension of 3, 7, or 30 days; vehicle impoundment of 3, 7, or 30 days (discretionary with 3- or 7-day license suspensions, mandatory for 30-day license suspensions); and possible referral to remedial programs (including ignition interlock) for third-time offenders. Drivers with a BAC of 0.08% or more are subject to 30-day vehicle impoundment, 90-day license suspension, and possible referral to remedial programs (including ignition interlock). In addition, drunk drivers are subject to fees that include towing costs, vehicle storage costs, and a processing fee to have their license reinstated. License prohibitions and vehicle impoundments are issued immediately at the roadside on the basis of results of a handheld breathalyzer. The penalties for excessive speeding, street racing, and stunt driving include fees and mandatory vehicle impoundment of 7 to 60 days. 9,10 Table 1 summarizes penalties for drinking and driving and for speeding and related offenses under the old versus new traffic laws. TABLE 1— Comparison of British Columbia’s Old and New Speeding and Street Racing Laws Penalties Driving Offense Before September 2010a After September 2010b,c BAC level 0.0–0.049 12-h driving prohibition for drivers with restricted license 0.05–0.079 (1st offense) 24-h driving prohibition 3-d driving prohibition Possible 3-d vehicle impoundment Fees (≤ $600) 0.05–0.079 (2nd offense within 5 y) 24-h driving prohibition 7-d driving prohibition Possible 7-d vehicle impoundment Fees (≤ $780) 0.05–0.079 (3rd offense within 5 y)d 24-h driving prohibition 30-d driving prohibition 30-d vehicle impoundment Fees (≤ $1330) ≥ 0.08 or refuses breath testd 90-d driving prohibition beginning 21 d after the offense (this 21-d period was to allow driver to arrange alternate transportation or to appeal the decision) 90-d driving prohibition (immediate) Possible Criminal Code of Canada charges 30-d vehicle impoundment Fees (≤ $1450) Speeding and stunt driving Speeding ≤ 40 km over limit Fines and demerit points No change Speeding > 40 km per hour or stunt drivinge (first offense) Fines and demerit points 7-d vehicle impoundment Fees ≤ $210 Speeding > 40 km per hour or stunt drivinge (second offense within 2 y) Fines and demerit points 30-d vehicle impoundment Fees ≤ $700 Speeding > 40 km per hour or stunt drivinge (third offense within 2 y) Fines and demerit points 60-d vehicle impoundment Fees ≤ $1200 Street racing 1st offense Fines and demerit points (street racing only) 7-d vehicle impoundment 48-h vehicle impoundment Fees ≤ $210 2nd offense within 2 y Fines and demerit points (street racing only) 30-d vehicle impoundment 30-d vehicle impoundment Fees ≤ $700 3rd and subsequent offense within 2 y Fines and demerit points (street racing only) 60-d vehicle impoundment 30-d vehicle impoundment Fees $1200 Open in a separate window Note. BAC = blood alcohol concentration; IRP = immediate roadside prohibitions. aAll penalties that existed before September 2010 remain in effect. Starting September 2010, IRPs provided an additional tool for police to use at their discretion. bSince September 2010, police usually apply immediate penalties under the new laws. However, they still have the option of using the preexisting laws instead. Therefore, the 3 typical outcomes for drivers with BAC ≥ 0.05% or who refuse a breath test are as follows: (1) most get an IRP, (2) some get a 24-h (or 12-h) driving prohibition, and (3) some get a 90-d driving prohibition plus criminal code charges. cNote that the penalties for excessive speeding (> 40 km over limit), street racing, and stunt driving are identical under the new laws. dDrivers with 3 offenses for BAC = 0.05%–0.079% or 1 offense for BAC > 0.08% may be referred to the responsible driver program, the ignition interlock program, or both. eThe new laws expanded the vehicle impound program to introduce and define “stunt driving,” something that was not specifically covered under the old laws. British Columbia’s laws were designed to deter drinking and driving by increasing the severity, certainty, and speed of punishment for drunk drivers with a BAC of 0.05% or more. Deterrence is effective in laws against traffic violations, 11 and increased likelihood of punishment acts as a greater deterrent than increased severity. 12,13 The speed with which a punishment is applied is an additional deterrent. 14 For drivers with a BAC of 0.08% or more, the administrative sanctions under the new laws are actually less severe than those associated with a criminal code conviction for drunk driving. However, the new sanctions are applied immediately at roadside and are less subject to legal challenge, making punishment more swift and certain. Not all drunk drivers are deterred by threat of punishment, 15 but through vehicle impoundment and license suspension, British Columbia’s new laws remove more dangerous drivers from the roads quicker. High-risk drunk drivers can also be mandated to undergo therapy, install an alcohol interlock device on their vehicle, or both. These laws were promoted through public awareness and educational campaigns and received considerable media coverage. Opinion and roadside surveys in 2012 found that majority of drivers were aware of the new measures 16 and that public perception of police commitment to traffic enforcement had increased. 17 During the first 12 months, British Columbia police used the new laws to issue 22 734 roadside license prohibitions for drinking and driving. At the same time, the number of criminal code convictions for impaired driving fell from 8221 per year in the 5 years preceding the new laws to 1853 in the subsequent 12 months ( Figure 1 ). The new laws were associated with change in driver behavior. In the 2012 British Columbia roadside surveys, 6.5% of evening and nighttime drivers tested positive for BAC compared with 9.9% in 2010 before the new laws were introduced. 16 Telephone surveys found that the percentage of British Columbia drivers reporting driving while over the legal limit was above the national average in 2009 and 2010 but fell below the national average in 2011 and 2012. 18 The new laws included harsher penalties for excessive speeding but, unlike the case with drinking and driving, the number of sanctions for speeding or for excessive speeding did not increase ( Figure 1 ). Open in a separate window FIGURE 1— Monthly charges for (a) impaired driving, (b) speeding, and (c) excessive speeding: British Columbia, September 2007–September 2011. Note . ADPs = administrative driving prohibitions; IRPs = immediate roadside prohibitions. In part (a), an abrupt decrease occurred in the number of criminal code charges and 90-day ADPs for impaired driving after the introduction of the new laws accompanied by an even greater increase in the number of IRPs issued under the new laws (note that, under the old laws, drivers with criminal code charges were typically also given a 90-day driving prohibition). In parts (b) and (c), the new laws were not associated with a change in the number of charges for speeding or for excessive speeding. However, under the new laws, excessive speeding resulted in mandatory vehicle impoundment for 7 days. We previously reported a reduction in alcohol-related fatal crashes in the 2 years after introduction of British Columbia’s new laws. 19 In this study, we investigated the effects of the new laws on total fatal crashes, hospital admissions, and ambulance calls. We drew on police, ambulance, and hospital data from British Columbia and on police data from adjacent jurisdictions in which similar legislative changes were not implemented.
