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Despite greatly reduced roadway travel during the COVID-19 shelter-in-place orders, alcohol and drug use among seriously and fatally injured roadway users in the U.S. increased in 2020. Motor vehicle crashes are the leading cause of death for U.S. youth. As travel resumes to pre-pandemic levels, it remains essential to identify novel strategies to prevent driving while impaired (DWI) and riding with an impaired driver (RWI). This qualitative study explored how youth avoid DWI and RWI during and after high school to inform prevention efforts.
In 2020, virtual in-depth individual interviews were conducted with a geographically diverse sample of 105 young adults. Participants were purposively sampled from the NEXT Generation Health Study, a nationally representative longitudinal cohort study, and had varying levels of experience with DWI/RWI during and after high school (mean age 26.36±0.52 y/o, 47.7% ♀). A semi-structured interview guide explored pre-pandemic experiences with DWI/RWI. Using directed content analysis approaches, guided by ecodevelopment theory, a six-member multidisciplinary team systematically applied inductive and deductive codes to each transcript; agreement was achieved by team consensus. Themes were derived using data immersion (with coded data and transcripts), investigator reflexivity and team dialogue. We present themes derived from the codes “Chose not to DWI”, “Chose not to RWI”, and “Missed Opportunities for Prevention”.
Participants avoided DWI by trusting their self-assessment of impairment, defined as poor physical ability to drive, “I knew I could barely stand up and coherently walk through the sand …. [it’s] probably not the best idea for me to get behind the wheel.” Some relied on trusted, close friends to intervene: “My perspective is like ‘I'm good to drive but I'm swirling’. [My friends] will make those decisions for me to prevent what could happen”. Perceived police presence on the roadways also prevented potential DWI, “You always consider that there’s gonna be more cops on the road or not”. Additional factors included party pre-planning, past experiences with law enforcement, and easy access to alternative transportation or post-party housing. Participants described avoiding RWI by observing severe driver intoxication: “They were falling down trying to get in the truck --- that was a telltale sign”. They also described the need for “better options”, which more often included rides from sober friends than rides from family or ride-share. Bystander interventions were a common technique to avoid RWI (and prevent DWI) during high school. For example, when asked how they avoided RWI, one participant reported “I've stopped several of my friends that have been drinking and I told them they weren't going nowhere”.
As youth return to pre-pandemic levels of social activity, DWI/RWI prevention initiatives should bolster protective and prevention strategies that youth are already using, such as peer-to-peer bystander interventions and proactive planning for multiple transportation or housing options among peers. Youth may benefit from prevention and education efforts that enhance awareness of the cognitive impacts of alcohol and drug use on driving. Future research should identify optimal strategies for DWI/RWI prevention intervention delivery, both during and after high school.