licensing
Publication Date: 12/07/2009
The Problem:
In the United States, motor vehicle–related accidents are the leading cause of death for all people under the age of 34. In 2000, motor vehicle crashes cost roughly $230 billion. CDC: Motor vehicle safety. The number of licensed drivers over the age of 65 has increased dramatically over the last decade. Drivers ages 80 and over have a higher rate of fatal crashes per miles driven than all other demographic groups except teenagers. The impact of aging on vision, cognitive functions, and other physical capacities has been identified as a contributing factor in motor vehicle crashes. CDC Website – Older Adult Drivers: Fact Sheet.
The Law:
State transportation and safety laws require different procedures and apply different standards in screening the vision of older drivers. For instance, to renew a license in California, an individual must have visual acuity of 20/40 with both eyes together and at least 20/40 in the stronger eye and 20/70 in the weaker eye, California Department of Motor Vehicles, CA Vehicle Code §12805; in Arizona, a minimum of 20/40 in one eye is required. Arizona Administrative Code: R17-4-502, R17-4-503. The age at which vision tests are required for renewal also varies (e.g., 40 years in Maryland (Maryland Transportation Code 16-115(h)) to 80 years in Virginia. Va. Code Ann. § 46.2-330 (C)). For another example of a state law requiring vision screening for individuals above a specified age, see FL Rev. State 322.18(5) (Florida).
The Evidence:
A Cochrane Collaboration Task Force attempted to conduct a systematic of studies assessing the impact of vision screenings for older drivers on motor vehicle crashes, but did not find any studies meeting its criteria. Subzwari S et al. Vision screening of older drivers for preventing road traffic injuries and fatalities. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.:CD006252. The task force accordingly concluded that there is insufficient evidence to determine whether vision screening programs for individuals above a specified age are effective in reducing crashes among older adults.
The Bottom Line:
In the judgment of a Cochrane Collaborative expert panel, laws requiring vision screening are a plausible means of reducing crashes involving older drivers, but there is insufficient evidence to rigorously assess their effectiveness at this time.
Additional Information:
The Physician’s Guide to Assessing and Counseling Older Drivers, created by the American Medical Association (AMA) with support from the National Highway Traffic Safety Administration (NHTSA), is available online and provides substantial information about state policies regarding vision screening.
The International Council of Ophthalmology provides online access to a table of vision requirements for the fifty US states.
Additional Resources: Physician’s Guide to Assessing and Counseling Older Drivers, AMA, NHTSA, International Council of Ophthalmology
IMPACT:
ORIGIN: Community Guide systematic review
Publication Date: 11/14/2009
The Problem:
Firearms are the second leading cause of injury deaths in the United States accounting for 30,896 deaths and 71,417 injuries in 2006. CDC: WISQUARS. Annually, firearm injuries generate life-time medical costs of roughly $2.3 billion. Cook PJ, Lawrence BA, Ludwig J, Miller TR. The medical costs of gunshot injuries in the United States. JAMA. 1999;282:447-454.
The Law:
State and local legislators have sought to reduce the use and illegal possession of firearms by implementing firearm registration and licensing requirements. Firearm registration requires that a record of firearm ownership be kept. Firearm licensing requires individuals to obtain government authorization before purchasing a firearm. For examples of state gun registration laws, see ARS § 13-3101 (Arizona) and N.Y. PEN § 400.00 (New York). For examples of state licensing laws, see 430 ILCS 65 (Illinois) and MGL c.140, § 131, 131 F (Massachusetts).
The Evidence:
Hahn et al. reviewed five studies that measured the impact of licensing laws and or registration laws on violent outcomes. Hahn, et al. Firearms laws and the reduction of violence: a systemic review. Am J Prev Med. 2005;28(2S1):40-71. The review defined violent outcomes as specific violent crimes (all murder, aggravated assault, robbery, and rape), firearm-related suicide, and unintentional firearm injury. Due to inconsistent and statistically insignificant findings in the limited underlying studies, the reviewers concluded that there is currently not enough evidence to determine the effectiveness of registration and licensing requirements as public health interventions aimed at reducing gun-related harms.
The Bottom Line:
In the judgment of a Community Guide expert panel, there is insufficient evidence to validate the effectiveness of firearm licensing and registration requirements as legal interventions aimed a reducing fire-arm related harms.
Additional Information:
The Bureau of Alcohol, Tobacco and Firearms provides online access to firearm laws for the fifty states.
Additional Resources: Bureau of Alcohol, Tobacco and Firearms
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