Penalizing underage alcohol use is associated with lower mortality for young drivers: Use/lose laws and their association with motor vehicle collision mortality

Background: Motor vehicle collisions (MVC) continue to be a leading cause of mortality for youth in the United States. Since 2010, seven states have revoked mandatory laws that suspended licenses for underage alcohol use, also known as use/lose laws. This study analyzed whether each state's policy change was associated with increased youth MVC mortality.

Methods: State mortality data for youth ages 15 years to 20 years in MVCs involving a young driver (i.e., ages 15-20 years) were obtained from the Fatality Analysis Reporting System. Population data was retrieved from the Centers for Disease Control and Prevention's Wide-ranging ONline Data for Epidemiologic Research. Motor vehicle collisions mortality rates were calculated for each state with a law change per 1,000,000 persons. For difference-in-difference analysis, each state's youth MVC mortality rates from 3 years prior to the law change were compared with rates from 3 years post-law changes, relative to a national average compiled of states with no law changes.

Results: From 2010 to 2020, seven states revoked one or more of their mandatory use/lose laws. For all states, young driver MVC mortality rates significantly increased after removal of use/lose legislation (South Dakota: 5.4 excess deaths per million (EDPM), Indiana: 5.6 EDPM, Georgia 28.0 EDPM, Oregon: +41.9 EDPM, Pennsylvania: +10.4 EDPM, Delaware: +45.4 EDPM, Illinois +29.2 EDPM, all p < 0.001).

Conclusion: Examining mortality rates at the state reveals a significant negative association between penalizing underage alcohol use and young driver MVC deaths. Future legislation and health outcomes analysis should consider state-level differences to retain and develop effective policies that reduce injury-related mortality.

Level of evidence: Epidemiological; Level IV.