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

<div><p><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.</p><p><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.</p><p><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> <.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).</p><p><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.</p>