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 Prognostic and Epidemiological; Level IV.