Around the world, nearly 16,000 people die every day as a result of injuries. According to the World Health Report 1999 Database (WHO 1999), road traffic injuries are the leading cause of injury-related deaths for all ages worldwide. In high-income countries, motor vehicle-related injuries kill more children and young adults than any other single cause of death. According to the World Health Organization's 2004 World Report on Road Traffic Injury Prevention (WHO 2004), alcohol impairment increases the chance both that a motor vehicle crash will happen and that death or serious injury will occur in a crash. Research has shown that the risk of crash involvement starts to increase significantly at a blood alcohol concentration (BAC) of 0.04 g/dl of blood (Compton 2002). A review of studies in low-income and middle-income countries showed that alcohol was present in the blood of 33-69% of fatally injured drivers and in 8-29% of drivers involved in non-fatal crashes (Odero 1995). Research from South Africa (Peden 1996) showed alcohol to be a factor in 47% of driver deaths and 27% of non-fatal crashes; BAC levels exceeding legal limits were found in 52% of the people with trauma who had been involved in motor vehicle crashes (Peden 2000). One study in New Delhi, India (Mishra 1984) found that one third of motorized two-wheeler riders who had been hospitalized admitted to riding under the influence of alcohol. Differences in legal BAC levels and types of enforcement make international comparisons of the incidence of alcohol-impaired driving difficult to interpret. Nevertheless, studies from a range of countries suggest a global problem. An analysis of surveys done in European Union countries (ETSC 1995) revealed that 1% to 3% of drivers were driving while impaired, varying by country. In a national survey in the United States, 3% of respondents reported having driven while impaired in the preceding 30 days (Dellinger 1999). Research in Croatia found that the percentage of alcohol-impaired drivers was over 4% (Gledec 2004). Another study from Ghana (Mock 2001) demonstrated that over 7% of drivers were found to have BAC levels in excess of 0.08 g/dl. Several studies (Homel 1988; Ross 1984; Sweedler 1995) illustrate that increasing the perceived risk of being arrested for driving while under the influence of alcohol is more effective in deterring impaired driving than increasing the severity of the penalty after arrest. In actuality, both the perceived risk and the actual likelihood of being arrested are low in most countries. A variety of interventions designed to increase the perceived or actual likelihood of being caught have been tested. Providing objective data about BAC using breath-alcohol testing devices is one such intervention that has been shown to be an excellent enforcement tool. Both selective and random breath testing at sobriety checkpoints, in which law enforcement officers systematically stop drivers to assess impairment, reduce alcohol-impaired driving, alcohol-related crashes, and associated injuries (Shults 2001). Reviews of the effectiveness of sobriety checkpoints have been performed recently (Shults 2001; Fell 2004). While apparently effective, sobriety checkpoints may not be conducted in some locales for legal or policy reasons (Fell 2004). The intervention of enhanced law enforcement by means of increased ('saturation') police patrols as a primary intervention will be the focus of this review. Enhanced enforcement using increased patrols is an intervention in which the number of officers and/or the time spent by officers on patrol is augmented to increase the likelihood that impaired drivers will be identified and evaluated. It has been posited that the effects of targeted enforcement efforts, such as increased patrols, can be further augmented by mass media campaigns. These campaigns increase public perception of the risk of being caught, decrease public acceptance of drinking and driving and enhance public acceptance of enforcement (Elder 2004). In some cases, such patrols are also combined with sobriety checkpoints. The aim of this systematic review is to evaluate the effects of enhanced enforcement programs involving increased patrols, either implemented alone or combined with additional strategies, such as sobriety checkpoints or strong public information and education efforts. (Author/publisher)
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