This study, the largest to our knowledge involving state driving records of patients with AD, does not confirm the previously reported excessive crash rate among drivers with AD relative to an appropriate comparison population. Reduced driving exposure of patients with AD probably kept their crash adverse equal to that of comparison subjects. Intervention by physicians and family members was major factor in reducing driving exposure. These findings affirm that the mere diagnosis of AD does not justify license revocation.

It is well established that alcohol (ethanol) is associated with increased probability of traumatic injury. This relationship has been attributed to alcohol's impairment of judgment and psychomotor performance, leading to increased probability of an injury-producing mishap. Once an accident occurs, it is widely believed that alcohol may protect against injury. However, controlled laboratory studies using animal models indicate that alcohol exacerbates the injurious effects of trauma. In this study, detailed analysis of data from more than 1 million drivers involved in motor vehicle crashes indicates that when the effects of injury-related variables such as safety belt use, vehicle deformation, vehicle speed, driver age, and vehicle weight are taken into account, the drinking driver is more likely to suffer serious injury or death compared with the nondrinking driver. These findings do not support the widespread belief that alcohol is protective against injury, but rather indicate that alcohol increases vulnerability to injury in any given crash.

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Older drivers constitute the most rapidly growing segment of the driving population in number of drivers licensed, miles driven, and proportion of the driving population. Yet the highway transportation system has not been designed for these drivers. This lack of fit is reflected in the accelerating rate of crashes per mile driven experienced by older drivers beginning around age 55. Furthermore, older persons are more vulnerable to injury once a crash occurs and as a group experience a higher fatality rate. The increasing proportion of our population consisting of older persons, in conjunction with a relative decrease in the young adult population, underscores the need for research to develop a greater understanding of the needs and capabilities of this age group and to develop system improvements that will enable as many older persons as possible to continue to meet their own transportation needs safely.

These findings suggest that a high school-based alcohol prevention program can positively affect subsequent driving, particularly that of students who do not use alcohol regularly. The results highlight the need to start prevention efforts early and extend them beyond the initial exposure to driving. Programs should incorporate the differing backgrounds of the students.

ABSTRACT. Objective:The primary aim of this article is to assess young drivers' gender differences in the associations between substance use/environmental influences and high-risk driving behavior. Method: We determine the association of 12th-grade self-reported substance use/ environmental influences with high-risk driving behavior as quantified by the number of offenses, serious offenses, crashes, and single-vehicle crashes on state driving records during subjects' (N = 3,607; 51% male) first 4 years of licensure. Results: The associations between high-risk driving and substance use/environmental influences were generally stronger among women than among men. When matched by substance-use profiles, women had fewer risky-driving incidents than men. Conclusions: The results indicate that young women who exhibit high-risk driving behavior deviate more from the general population of young women with respect to alcohol use, alcohol misuse, and marijuana use than highrisk-driving young men differ from other young men. In addition, findings indicate that even if young men and women were to eventually have equal levels of substance use, women would likely retain their lowerrisk driving profiles. These findings suggest the need for (1) future research to understand the differential associations, and (2) prevention programs that consider these gender differences. (J. Stud. Alcohol 67: [252][253][254][255][256][257][258][259][260] 2006)

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