Lack of consensus in blood alcohol concentration legal limits: a dilemma for health educators.

Recently the world lost Robert F. Borkenstein who was the inventor of the Breath Analyser, the first practical instrument to measure breath alcohol. He is also well known for his Grand Rapids Study conducted in 1963-64 that led to the establishment of legal standard for determining impaired driving in many states in the US (Borkenstein, 1976, 1978; Heifer, 1991). As we pay tribute to this professor for forensic studies from Indiana University, let us also explore the current status of using blood alcohol concentration legal limits in prevention and control of alcohol-related injuries.

It is well established that elevated levels of alcohol impair driving (Grant & Litvak, 1998; Heifer, 1991). As a consequence, legal authorities around the world have established some norms to prevent drunk driving and its harmful consequences. The legal limits for acceptable blood alcohol levels vary from country-to-country and even within the United States from state-to-state (International Center for Alcohol Policies, 2002). For example, in countries such as Hungary, Romania, and the Czech Republic there is a zero tolerance policy (0.0mg/ml of BAC). The most liberal policy is found in some states in the United States that allow up to 1.0 mg/ml of BAC as the permissible limit (International Center of Alcohol Policies, 2002). In Finland, the BAC limit is 0.5 mg/ml while in US it varies from 0.8 mg/ml to 1.0 mg/ml (International Center for Alcohol Policies, 2002). Borkenstien (1976) found that in the US the alcohol involvement in highway deaths was about 50% while in Finland it was only 27%. Similar comparisons can be made with other countries and it will generally be found that the more rigorous the BAC limit the less deadly the consequences. Furthermore, it is well documented in scientific literature that even a minimal trace of blood alcohol can influence driving ability (Heifer, 1991). This evidence behooves to the need for setting more rigorous BAC legal limits in the United States. A rigorous domestic and international consensus would be quite useful for professionals in health education and promotion and also serve to reduce the morbidity and mortality related to this preventable problem. While such consensus would be nice to achieve, it is a dilemma that it is the responsibility of health educators to facilitate development of such consensus at domestic and international fronts. This task is especially daunting given the fact that health educators do not have much clout. So how can health educators help? Is it realistic to aspire for a more rigorous consensus at the domestic front and then for an international consensus with regard to the BAC levels? What measures need to be in place for such international consensus? Is zero tolerance policy viable and pragmatic? Or do we need a more liberal policy? Indeed one of the pieces to solve this puzzle would be more research.

Besides biomedical behavioral research in determining these legal limits, complex socio-political and economic factors also play a significant influential role. Some of these factors include historical policies, perceived risk by the public being less compared to the inconvenience perceptions, cultural acceptance of alcohol, lack of alternative public transportation means and other practical issues, inability to recognize early signs of intoxication by staff at licensed facilities serving alcohol, and alcohol-use related values in the community (Rehn, Room, & Edwards, 2001). It is in regard to addressing some of the more modifiable factors that health educators can play an important role. There is a need to devise and evaluate theory-based educational campaigns that enhance public awareness on this issue and generate a "critical" mass of informed citizens who demand for a more rigorous consensus. More effective and efficacious means need to be evolved that sway the needle toward greater public unacceptability of alcohol use and more importantly drunk driving. There is also a need for training public and staff at licensed facilities to detect early signs of intoxication and implement preventive measures. Health educations researchers also need to conduct research to explore barriers to behavior change. Finally, more interdisciplinary work by all public health professionals will need to be done in completing all the pieces of this puzzle to arrive at a consensus. After tackling the issue of consensus with regard to BAC legal levels, consensus with regard to issues of enforcement, punishment, and treatment would also need to be addressed.

Dreams well worth pursing!

Manoj Sharma, MBBS, CHES, Ph.D. Editor

References

Borkenstien, R.F. (1976). Efficacy of law enforcement procedures concerning alcohol, drugs, and driving. Modern Problems in Pharmacopsychiatry. 11, 1-10.

Borkenstien R.F. (1978). [Role of alcohol in accident etiology]. [Article in German]. Hefte Unfalheilkd, 130, 191-195.

Grant, M., & Litvak, J. (1998). Drinking patterns and their consequences. Washington, DC: Taylor & Francis.

Heifer, U. (1991). [Blood alcohol concentration and effect, traffic medicine characteristics and legal traffic relevance of alcohol limit values in road traffic]. [Article in German]. Butalkohol, 28, 121-145.

International Center for Alcohol Policies (ICAP). (2002). Blood alcohol concentration limits worldwide. ICAP Report No 11. Washington, DC: Author.

Rehn, N., Room, R. & Edwards, G. (2001). Alcohol in European region: Consumption, harm, and policies. Copenhagen: World Health Organization Regional Office for Europe.