Effects of Dram Shop, Responsible Beverage Service Training, and State Alcohol Control Laws on Underage Drinking Driver Fatal Crash Ratios

<b>Objectives:</b> In this study, we aimed to determine whether three minimum legal drinking age 21 (MLDA-21) laws—dram shop liability, responsible beverage service (RBS) training, and state control of alcohol sales—have had an impact on underage drinking and driving fatal crashes using annual state-level data, and compared states with strong laws to those with weak laws to examine their effect on beer consumption and fatal crash ratios.<b>Methods:</b> Using the Fatality Analysis Reporting System, we calculated the ratio of drinking to nondrinking drivers under age 21 involved in fatal crashes as our key outcome measure. We used structural equation modeling to evaluate the three MLDA-21 laws. We controlled for covariates known to impact fatal crashes including: 17 additional MLDA-21 laws; administrative license revocation; blood alcohol concentration limits of.08 and.10 for driving; seat belt laws; sobriety checkpoint frequency; unemployment rates; and vehicle miles traveled. Outcome variables, in addition to the fatal crash ratios of drinking to nondrinking drivers under age 21 included state per capita beer consumption.<b>Results:</b> Dram shop liability laws were associated with a 2.4% total effect decrease (direct effects: β =.019, <i>p</i> =.018). Similarly, RBS training laws were associated with a 3.6% total effect decrease (direct effect: β =.048, <i>p</i> =.001) in the ratio of drinking to nondrinking drivers under age 21 involved in fatal crashes. There was a significant relationship between dram shop liability law strength and per capita beer consumption, <i>F</i> (4, 1528) = 24.32, <i>p</i> &lt;.001, partial η² =.016, showing states with strong dram shop liability laws (<i>Mean (M)</i> = 1.276) averaging significantly lower per capita beer consumption than states with weak laws (<i>M</i> = 1.340).<b>Conclusions:</b> Dram shop liability laws and RBS laws were both associated with significantly reduced per capita beer consumption and fatal crash ratios. In practical terms, this means that dram shop liability laws are currently associated with saving an estimated 64 lives in the 45 jurisdictions that currently have the law. If the remaining 6 states adopted the dram shop law, an additional 9 lives could potentially be saved annually. Similarly, RBS training laws are associated with saving an estimated 83 lives in the 37 jurisdictions that currently have the laws. If the remaining 14 states adopted these RBS training laws, we estimate that an additional 28 lives could potentially be saved.

<b>研究目的:</b> 本研究旨在明确三项法定最低饮酒年龄21岁（minimum legal drinking age 21, MLDA-21）相关法律——酒馆责任法（dram shop liability）、酒类责任服务培训（responsible beverage service, RBS）以及酒类销售州管控法案——是否对未成年人饮酒后驾车致命车祸产生影响，采用年度州级数据开展分析，并通过对比强执法州与弱执法州的情况，探究上述法律对人均啤酒消费量及致命车祸比例的作用。<b>研究方法:</b> 本研究借助事故死亡分析报告系统（Fatality Analysis Reporting System），将致命车祸中涉及的21岁以下饮酒驾车者与未饮酒驾车者的比例作为核心结局指标。我们采用结构方程模型（structural equation modeling）对三项MLDA-21相关法律进行评估，并对已知会影响致命车祸发生的协变量进行控制，包括：17项额外的MLDA-21相关法律、行政驾照吊销制度、血液酒精浓度0.08与0.10的驾车阈值、安全带使用法规、酒驾检查站布设频次、失业率以及车辆行驶里程。除21岁以下饮酒与未饮酒驾车者致命车祸比例外，本研究的结局变量还包括州级人均啤酒消费量。<b>研究结果:</b> 酒馆责任法可使核心结局指标出现2.4%的总效应下降（直接效应：β = 0.019，P = 0.018）。类似地，酒类责任服务培训法可使该核心结局指标出现3.6%的总效应下降（直接效应：β = 0.048，P = 0.001）。酒馆责任法的执法强度与人均啤酒消费量间存在显著关联：F(4, 1528) = 24.32，P < 0.001，偏Eta方(partial η²) = 0.016，结果显示实施强酒馆责任法的州（均值(M) = 1.276）人均啤酒消费量显著低于弱执法州（均值(M) = 1.340）。<b>研究结论:</b> 酒馆责任法与酒类责任服务培训法均与人均啤酒消费量及致命车祸比例的显著降低相关。从实际应用角度而言，当前已有45个司法辖区实施酒馆责任法，该法律年均可挽救约64条生命；若剩余6个州采纳该法律，预计每年可额外挽救9条生命。同理，当前已有37个司法辖区实施酒类责任服务培训法，该法律年均可挽救约83条生命；若剩余14个州采纳该类法律，预计每年可额外挽救28条生命。