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Pacific Institute for Research and Evaluation, 7315 Wisconsin Avenue, Bethesda, Maryland 20814, USA
In many industrialized countries around the world, there has been a reduction in traffic crashes involving alcohol impaired drivers in the past decade. Unfortunately, this same reduction has not always occurred for alcohol-related fatal crashes involving adult pedestrians. These pedestrians tend to have very high blood alcohol levels and to be chronic alcohol abusers. Thus, prevention and intervention is challenging. Differences in culture, geography, and transportation alternatives lead to the need for different analyses of the problem and different strategies across countries.
In an attempt to define and deal with this problem, the International Council on Alcohol, Drugs and Traffic Safety (ICADTS) established an Alcohol-Involved Pedestrian Working Group. This ICADTS working group has been exploring the nature of the problem and what has occurred in different countries as well as the measures that are being taken or planned for dealing with this problem. Participating countries include Australia, Canada, Finland, France, Great Britain, India, and the United States. This paper briefly summarizes the findings of the working group thus far, in particular highlighting research carried out in the United States and Great Britain. Research on additional countries will be reviewed by the working group in the future.
Pedestrian deaths in the United States account for 14 percent of all traffic-related deaths and approximately three percent of all traffic-related injuries. In 1992, 5,546 pedestrians were killed and 96,000 were injured in traffic crashes (NHTSA, 1993). A significant portion of these pedestrians had consumed alcohol prior to the traffic crash. In 1982, 39 percent of pedestrians over the age of 14 were at or above a BAC of .10 percent. By contrast, only 20 percent of the drivers in these crashes were at or above this BAC level. By 1992, the percentage of pedestrians at or above .10 percent had declined somewhat, to 36 percent, while the percentage of drivers in these crashes at or above this level had declined much more -- to 12 percent (Centers for Disease Control and Prevention, 1993). Clearly, while some progress has been made in decreasing the number of intoxicated pedestrians who are fatally injured, this progress has not kept pace with decreases in impaired driving.
A landmark study carried out in New Orleans by Blomberg and his colleagues provides some insight into the nature of crashes involving impaired pedestrians (Blomberg et al., 1979). The study found that about half of adult pedestrians injured or killed had been drinking prior to their accidents. Of these, a high proportion had very high BACs -- equal to or above .20 percent, with many in the .30 to .40 percent range (significant higher than for fatally injured drunk drivers). The high BAC group was made up primarily of males. While some of the drivers involved were also impaired by alcohol, the crucial error leading to the crash was most often made by the pedestrian. Frequently the errors that led to the crash could be seen as evidence of gross intoxication, e.g, crossing in very dangerous locations or lying or sitting in the roadway. The crash most frequently occurred within three and one half miles of the victim's home.
The study also examined the characteristics of the intoxicated pedestrians. High BAC pedestrians were most commonly males between the ages of 30 and 59 [National figures reported by NHTSA indicate that in 1992, fatalities for pedestrians with BACs of .10 and above are most common in the 25 to 34 year old age group (57.1 percent) (NHTSA, 1993)] They tended to be poorly educated with a history of alcohol abuse, unemployment and an unstable family life. When employed, they tended to have blue collar, unskilled jobs. Many did not have a drivers license. Many had prior police records.
It is important to point out that alcohol involvement in pedestrian crashes in Britain has actually increased in recent years rather than decreased as in the United States. In 1982/83, 28 percent of adult pedestrian fatalities had BACs of .08 percent or greater. In 1990, this percentage had increased to 32 percent. During the same time period, alcohol impairment among drivers in fatal crashes declined precipitously (Clayton and Everest, 1994).
The findings of the Blomberg study described above can be compared to a similar study carried out by Everest in Great Britain (1992). In 1989, there were over 1,700 pedestrian fatalities, representing almost a third of the national total of traffic fatalities (as compared to only 14 percent in the United States). In the years 1985 to 1989, nearly 30 percent of the fatalities over 16 years of age had been drinking in excess of the legal limit for drivers (.08 percent in Great Britain). Nearly 16 percent were at or above .20 percent. The equivalent percentages for motor vehicle drivers in fatal crashes are 18 and seven percent respectively.
In contrast with findings in the U.S., where the most common age group for impaired pedestrians is 25 to 34, the peak incidence of death among impaired pedestrians in Great Britain is around age 21. Between 80 and 85 percent of the impaired pedestrians were men. At a BAC of .20, 95 percent were men. Fatally injured pedestrians were most commonly in the lower occupational groups or unemployed.
Crashes involving pedestrians not impaired by alcohol were most common in the late morning and in the evening rush hours. By contrast, crashes involving alcohol impaired pedestrians peak between 10:00 PM and midnight. The most common situations in which crashes occurred among the intoxicated pedestrians were when the pedestrian was stationary in the roadway or walking with his back to the traffic. There was little evidence that the presence of street lighting had a significant effect on the occurrence of crashes.
Obviously, the nature of the impaired pedestrian problem in any given country or geographic area can vary greatly depending on a variety of factors. For example, within Great Britain, the proportion of pedestrian deaths involving alcohol, especially at high BACs, is significantly higher in Scotland and Wales than in other areas of Great Britain (Everest, 1992). Geographic and social conditions can have an effect: In some areas of the United States that include Indian reservations, a significant proportion of intoxicated pedestrian deaths are due to hypothermia rather than to traffic crashes because the residents of the reservations often must walk long distances to return home in inclement weather (American Medical News, 1992). In developing countries, pedestrian problems, including impaired pedestrians, may have many aggravating factors. For example, there may be many more pedestrians than in countries where private automobiles or public transportation are easily accessible. Roads may be more likely to be narrow and lack walkways, thus increasing the likelihood of crashes. A fuller understanding of the nature of the intoxicated pedestrian problem in different countries and regions of countries is needed if appropriate countermeasures are to be implemented. Unfortunately, there is often a lack of detailed data to allow for a full analysis of the impaired pedestrian problem.
As summarized above, the problem of alcohol impaired pedestrians poses serious challenges for possible interventions:
Despite these challenges, a number of possible interventions have been suggested.
Traffic engineering countermeasures are changes that improve pedestrian safety by modifying the physical environment in ways that reduce the probability of crashes (NHTSA, undated). These countermeasures can be helpful in reducing deaths and injuries among all pedestrians (whether alcohol impaired or not). Roadway and walkway designs that separate pedestrians from vehicle traffic and that increase the safety of pedestrian crossings might have an impact on the impaired pedestrian problem.
Increased awareness and knowledge may be helpful in decreasing the impaired pedestrian problem. Information campaigns aimed at the general public can increase support for all the other countermeasures (Sadoff, 1992). Campaigns aimed at drivers, especially those in high risk areas, might make drivers more able to avoid crashes with impaired pedestrians. Educational programs for servers and sellers of alcohol could make these people more aware of the dangers of serving intoxicated patrons -- even if they are not driving. Servers and sellers can also be educated to recognize the potential dangers in recommending that intoxicated patrons walk home instead of driving. Rather, they should help such patrons find alternative transportation. Dram shop liability laws can reinforce the motivation of servers and sellers to act responsibly with regard to the safety of patrons. It may be possible to design safety messages for the alcoholics and abusive drinkers most likely to become impaired pedestrians that alert them to the dangers of walking while intoxicated and presenting strategies for avoiding this situation.
There is some evidence that appropriate ordinances prohibiting walking while intoxicated can reduce impaired pedestrian crashes. A program in Puerto Rico, which included a statute, public information campaign, special police training, and a pedestrian "sweeper" program, resulted in a seven percent drop in alcohol-related pedestrian crashes between 1978 and 1986 (Sadoff, 1992).
Programs to provide transportation to intoxicated drivers (e.g., free or reduced price taxi rides or transportation by volunteer drivers) could be expanded to include pedestrians who might otherwise walk while intoxicated. Bus or van sweeper programs could also be implemented in which volunteers would travel routes most likely to be frequented by intoxicated pedestrians during critical nighttime hours in order to pick up pedestrians and provide safe transportation. It may also be possible to change the policies of public transportation so that buses and subways are more accessible, including making sure that public transportation is available after bar closing times.
Little evaluation has been carried out to indicate whether these or other strategies can reduce deaths and injuries among alcohol-impaired pedestrians. A project funded by the National Highway Traffic Safety Administration is currently being carried out to implement and evaluate some countermeasures. As we make progress in reducing impaired driving, the time may be right to draw increased attention to this aspect of traffic safety and to work towards implementing the most promising techniques to decrease alcohol impaired pedestrian crashes.
American Medical News, Indian alcohol policy on reservations questioned: Risk for hypothermia, pedestrian deaths, 1992.
Blomberg, R., Preusser, D., Hale, A., and Ulmer, R. A Comparison of Alcohol Involvement in Pedestrians and Pedestrian Casualties. NHTSA, DOT HS 805 248, 1979.
Clayton, A., and Everest, J., Decline in drinking ad driving crashes, fatalities,\ and injuries in Great Britain, in The Nature of and the Reasons for the Worldwide Decline in drinking and Driving, Transportation Research Circular Number 422, Transportation Research Board, Washington, D.C., 1994.
Centers for Disease Control and Prevention, Alcohol Involvement in Pedestrian Fatalities -- United States, 1982-1992, Journal of the American Medical Association, Vol 270, No. 16, p. 1916, 1993.
Everest, J., The Involvement of Alcohol in Fatal Accidents to Adult Pedestrians, Transportation Research Laboratory, Research Report 343, 1992.
National Highway Traffic Safety Administration, Traffic Safety Facts 1992: Pedestrians, U.S. Department of Transportation, 1993.
Sadoff, M., What Needs to be Done to Prevent Alcohol/Drug Related Pedestrian and Bicycle Crashes, Wisconsin Department of Transportation, 1992.
Szabo, P. BALs up in injured pedestrians: Suicide attempts a possibility, research shows, Journal of the Addiction Research Foundation, p. 3, 1 January 1990.