Harvard case study examines the origins of the CHC, lessons learned from the Designated Driver Campaign, and evidence of the campaign’s impact on alcohol-related traffic fatalities

Dr. Howard Koh and Pamela Yatsko, “Jay Winsten and the Designated Driver Campaign,” Harvard Business School Case Study, February 2017, #ALI013-PDF-ENG (https://hbsp.harvard.edu/home/)

[Excerpted With Permission (study’s evaluation section)]

The high level of media exposure generated by the Designated Driver Campaign over four TV seasons helped to rejuvenate an anti-drunk driving movement that had temporarily run out of steam. Moreover, findings from large-scale national surveys strongly suggest that the Designated Driver Campaign contributed to a sharp increase in the self-reported use of designated drivers in the United States and a marked decrease in the number of drinking drivers on roads, as measured directly in roadside surveys using breathalyzers and in other studies.

Perhaps the strongest evidence of the campaign’s influence came from the National Roadside Survey, a large-scale survey sponsored by the National Highway Traffic Safety Administration (NHTSA), in which a national sample of drivers were stopped for confidential breath testing on weekend nights (when drinking is most likely to occur). Approximately 95% of drivers who were stopped consented to a breath test and interview.[i] The percentage of tested drivers found to have positive BACs (blood alcohol levels) declined from 25.9% in 1986 to 16.9% in 1996. In the same surveys, the percentage of drivers who self-identified as designated drivers rose from 5% in 1986 to 24.7% in 1996. Notably, two-thirds of designated drivers in the 1996 roadside survey were found to have BACs of 0.0%.[ii]

The National Institute on Alcohol Abuse and Alcoholism (NIAAA), commenting on roadside survey findings in its 10th Special Report to the U.S. Congress on Alcohol and Health in 2000, stated:

The use of designated drivers has been widely promoted in the United States since 1988 when Jay Winsten at the Harvard School of Public Health initiated a national campaign with the television industry…In the 1996 National Roadside Survey, most of the designated drivers (82%) had BACs between zero and 0.02%. In all, about a third of designated drivers consumed some alcohol before driving, but most (95%) remained at BACs below the legal limit of 0.08% (Fell et al. 1997)…Thus, many people now use designated drivers, and most designated drivers in roadside surveys do not exceed the legal BAC limit. However, designated drivers who do exceed the legal limit, like any driver who does so, are at greater risk of crashing and endangering their passengers.[iii]

The uptake in the use of designated drivers was greatest among young adults. In the 1993 National Survey of Drinking and Driving Attitudes and Behavior, sponsored by NHTSA, 59% of young adults ages 19-20 reported serving as a designated driver during the previous 12 months, and 49% reported riding with a designated driver after drinking. Among young adults aged 21-29, some 54% reported serving as designated drivers, and 50% reported riding with a designated driver after drinking.[iv] Those gains were reinforced as young adults passed along the practice of choosing a designated driver from one generation to the next. In the 2008 survey, 72% of young adults aged 21-24 said they served as a designated driver during the previous 12 months, and 61% said they rode with a designated driver after drinking.[v]

Monitoring the Future, an ongoing national survey of the behaviors, attitudes, and values of American secondary school students, college students, and young adults conducted by the University of Michigan with funding from the National Institute on Drug Abuse, documented a decline in the prevalence of self-reported driving after drinking among high school seniors, and an increase in social disapproval of drinking and driving behavior within the same group. The study’s authors suggested that “the substantial decline in drinking and driving observed between 1984 and 1997 may have occurred largely because of a substantial change in the social acceptability of such behavior among young people themselves.” The researchers pointed to three larger societal trends to help account for the rising level of social disapproval of drinking and driving: “the substantial national attention given to the Mothers Against Drunk Driving efforts (which peaked around 1984), the increases in minimum drinking ages (which occurred primarily between 1984 and 1987), and the national campaign for ‘designated drivers’ (which occurred primarily between 1989 and 1992).”[vi]

By its nature, the evaluation of a national campaign like the Designated Driver Campaign is hampered by the absence of a carefully matched non-exposure control group, which precludes any definitive judgment on the campaign’s contribution to the decline in alcohol-related traffic fatalities. That said, the widespread adoption of the designated driver concept, fueled by heavy media exposure for the campaign’s message starting in late 1988, notably coincided with a dramatic decline in alcohol-related traffic fatalities. Between 1988-1992, the trend in alcohol-related traffic fatalities—after stagnating in the mid-1980s during a period of diminished media attention—turned sharply downward, declining by 25%, from 23,641 to 17,699; in comparison, non-alcohol-related traffic fatalities fell by only 5%.[vii] The steepest decline in this period occurred over a narrow two-year stretch from 1990-1992, when alcohol-related traffic fatalities declined by a whopping 20%—the largest two-year decline since 1982 when uniformly collected data on alcohol-related traffic fatalities first became available.[viii] The Center attributed this striking progress to the combined impact of new laws, enhanced enforcement, grassroots advocacy, and the massive publicity generated by the Designated Driver Campaign.[ix]

Most of the progress was achieved among social drinkers, and those gains proved to be stable over subsequent decades. In contrast, problem drinkers and alcoholics were highly resistant to change—and still are today. After 1992, the annual number of alcohol-related traffic fatalities leveled off at approximately 17,000 and remained stuck there for several years before gradually drifting downward over the ensuing two decades to 11,731 in 2014.[x] Interestingly, the two periods of maximum media interest in the drunk driving problem—MADD’s activities between 1980-1985 and Harvard’s Designated Driver Campaign between 1988-1993—coincided with rapid, large-scale reductions in alcohol-related traffic fatalities.

The Designated Driver Campaign also yielded important side benefits. The international export of popular U.S. television series carrying the designated driver message helped to propagate widespread diffusion of the designated driver concept, as did international press coverage of the U.S. Designated Driver Campaign. In continental Europe, traffic safety agencies in sixteen countries, starting with Belgium in 1995, launched designated driver campaigns in conjunction with nonprofit and industry partners.[xi] In the U.K., the Coca-Cola Company joined with the British government in a highly publicized campaign that offered free nonalcoholic drinks to designated drivers in pubs and restaurants, crediting the Harvard Alcohol Project as the campaign’s inspiration.[xii] Many of these campaigns are still ongoing. Designated driver initiatives also were launched in Australia, New Zealand, and (more recently) China.

Based on lessons learned from the Distracted Driver Campaign, Winsten and his team subsequently developed a national media initiative to recruit volunteer mentors for at-risk youth. The foundation for this initiative was a landmark evaluation of the Big Brothers Big Sisters mentoring program, which found substantial beneficial effects of formal mentoring relationships in promoting positive youth development and preventing adolescent substance abuse and violence.[xiii] With funding from the MCJ Foundation and the Robert Wood Johnson Foundation, the Harvard Mentoring Project was launched in 1997 to promote the social role of “mentor” and recruit large numbers of volunteer mentors by mobilizing the Hollywood creative community and 17 broadcast and cable networks.[xiv] Conducted in collaboration with the nonprofit MENTOR: The National Mentoring Partnership, with General Colin Powell serving as lead spokesperson, the 15-year initiative won the support of Presidents George W. Bush, Bill Clinton, and Barack Obama, the U.S. Departments of Justice and Education, the federal Corporation for National and Community Service, governors and mayors across the country, and a wide array of grass-root nonprofit organizations. Winsten’s relationship with President Clinton helped to secure increased federal funding for mentoring programs, and the inclusion of references to youth mentoring in Clinton’s 2000 State of the Union Address. The campaign is credited with helping to greatly expand the number of young people receiving the benefits of a formal mentoring program.[xv] In 1997, an estimated 300,000 young people received formal mentoring program benefits, compared to 3 million in 2005.[xvi] The mentoring campaign continues today under MENTOR’s leadership.[xvii]

The Chronicle of Philanthropy reported in 1994 that the [designated driver] campaign’s success “persuaded many grant makers that skillful collaboration with news and entertainment industries could advance social transformation.”[xviii] Frank Karel III, vice president for communications at the Robert Wood Johnson Foundation, told the Chronicle, “It’s amazing, the sea change that’s happened in the past five years…Today, foundations that once rejected media work out of hand are using it very productively and systematically.” The Designated Driver Campaign likewise was cited for its influence on the direction of social science agenda-setting research.[xix]

The highly visible success of the Designated Driver Campaign also galvanized many advocacy groups to set up offices in Hollywood to lobby for inclusion of messages on issues such as recycling. Senior figures in Hollywood also organized their own efforts. For example, the New York Times reported that the “heads of the major television studios and the entertainment branches of the television networks embraced Mr. Winsten’s concept of sending a message through their medium and created an organization to promote environmental issues.”[xx] The organization, called the Environmental Media Association (EMA), successfully promoted recycling as environmentally responsible behavior, among its many other initiatives. From a communications perspective, the recycling issue shared key attributes of designated driver: the behavior was sharply defined and easy to depict. As TV writers portrayed popular characters engaging in recycling and pressuring others to do the same, the idea spread like wildfire and became a cultural norm.

Similarly, the U.S. Centers for Disease Control and Prevention established an ongoing presence in Hollywood, partnering with USC’s Norman Lear Center to create the Hollywood, Health & Society program. Between 2009-2015, the program provided expert consultations on a range of health issues, influencing the storylines of almost 900 TV episodes.[xxi] Media advocacy had become an industry, said the Lear Center’s [Founding Director Marty] Kaplan, adding, “Winsten was a pioneer.”

[i] Robert B. Voas, Joann Wells, Diane Lestina, Allan Willimas, and Michael Greener, “Drinking and Driving in the United States: The 1996 Roadside Survey,”  Accident Analysis & Prevention, Vol. 30, No. 2, pp. 267-275, 1998.
[ii] Fell, J.; Voas, R.B.; and Lange, J.E. Designated driver concept: Extent of use in the USA. J Traffic Med 25(3–4):109–114, 1997. Lund, A.K., and Wolfe, A.C. Changes in the incidence of alcohol-impaired driving in the United States, 1973–1986. J Stud Alcohol 52(4):293–301, 1991.  Cited in Voas, R.B.; Wells, J.K.; Lestina, D.C.; Williams, A.F.; and Greene, M.A. Drinking and Driving in the U.S.: The 1996 National Roadside Survey. NHTSA Traffic Task No. 152. Arlington, VA: Insurance Institute for Highway Safety, 1997,  pp. 389-390.
[iii] 10th Special Report to the U.S. Congress on Alcohol and Health, June 2000,  U.S. Department of Health and Human Services, Public Health Service National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism.
[iv] Timothy L. Jones and John M. Boyle, “National Survey of Drinking and Driving Attitudes and Behaviors: 1995,” National Highway Traffic Safety Administration, July 1996, https://ntl.bts.gov/lib/25000/25900/25912/DOT-HS-808-438.pdf, accessed February 2017.
[v] “National Survey of Drinking and Driving Attitudes and Behaviors: 2008, Volume II, Findings Report,” National Highway Traffic Safety Administration, p. 39,  https://ntrl.ntis.gov/NTRL/dashboard/searchResults/titleDetail/PB2011102413.xhtml, accessed February 2017.
[vi] Patrick O’Malley and Lloyd D. Johnston, “Drinking and Driving Among U.S, High School Seniors, 1984-1997,” American Journal of  Public Health, May 1999, Volume 89, Number 5, p. 684, http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.89.5.678, accessed February 2017.
[vii] “Reduction in Alcohol-Related Traffic Fatalities — United States, 1990-1992,” MMWR Weekly, Centers for Disease Control, December 3, 1993, https://www.cdc.gov/mmwr/preview/mmwrhtml/00022270.htm, accessed January 2017.
[viii]  Ibid.
[ix] “Harvard Alcohol Project,” op. cit.
[x]  “Traffic Safety Facts: Alcohol-Impaired Driving,” National Highway Traffic and Safety Administration website, December 2015,   https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/812231, accessed February 2017.
[xi] De Neve, P. (n.d.). Bob in Europe, Presentation, Belgian Road Safety Institute. “BOB campaign: development and evolution,” http://ec.europa.eu/transport/road_safety/pdf/projects/euro-bob_2003–2004.pdf, accessed May 2014.
[xii] “Designated Driver: A 30 year History of Campaigning for Road Safety,” Coca Cola Co UK website, December 15, 2016,  http://www.coca-cola.co.uk/stories/who-were-the-first-designated-drivers-exploring-30-years-of-heroes, accessed February 2017.
[xiii] Jean Baldwin Grossman, Nancy Resch, Joseph P. Tierney, “Making a Difference: An Impact Study of Big Brother/Big Sisters  (Reissue of 1995 Study), Issuelab website, September 15, 2000, http://ppv.issuelab.org/resource/making_a_difference_an_impact_study_of_big_brothers_big_sisters_re_issue_of_1995_study, accessed February 20, 2017.
[xiv] Stuart Elliot, “All Aboard for the Campaign for a Few Good Mentors,” New York Times, November 7, 1997, http://www.nytimes.com/1997/11/07/business/media-business-advertising-all-aboard-for-campaign-for-few-good-mentors.html, accessed February 20, 2017; and “General Colin Powell to Headline National Mentoring Month 2010,” Youth.gov website, http://youth.gov/feature-article/general-colin-l-powell-headline-national-mentoring-month-2010, accessed February 2017.
[xv] “Media Campaign Focuses National Attention on Mentoring Program for At-Risk Youths,” Robert Wood Johnson Foundation website, February 13, 2004,  http://www.rwjf.org/content/dam/farm/reports/program_results_reports/2004/rwjf14096, accessed February 2017.
[xvi] “Mentoring in America 2005: A Summary of New Research,” MENTOR National Mentoring Partnership, 2006,https://www.nationalservice.gov/sites/default/files/documents/06_0503_mentoring_factsheet.pdf, accessed February 2017.
[xvii] “President Obama Declares Januaryb2016 National Mentoring Month, Mentor website, https://globenewswire.com/news-release/2016/01/04/799309/10158867/en/PRESIDENT-OBAMA-DECLARES-JANUARY-2016-NATIONAL-MENTORING-MONTH.html, accessed February 2017.
[xviii] Bailey, Anne Lowery Bailey, “The Media Age Comes to Philanthropy,” Chronicle of Philanthropy, Vol. VI, No. 11, March 22, 1994, pp. 6-9.
[xix] J.W. Dearing and E.M. Rogers, Agenda-setting, 1996, Thousand Oaks, CA: Sage, p. 28.
[xx]Joseph B. Treaster, “From Toys to TV, Drug Fight Grows,” New York Times, March 18, 1991, http://www.nytimes.com/1991/03/16/us/from-toys-to-tv-drug-fight-grows.html, accessed January 2017.
[xxi] “History/ HH&S By the Numbers,” Hollywood, Health & Society website,  https://hollywoodhealthandsociety.org/about-us/history-hhs-numbers, accessed February 2017.