TABLE 2.

Underlying Influences on Drinking and Driving (DAD) in Rural Areas

Description	Example Risk Factors	Example Protective Factors
SOCIAL: Interactions and relationships with peers, family, and community members	Peers encouraged one another to drink heavily. When no one was sober, the least drunk person was pressured to drive. Peers and parents modeled DAD; families transmitted the behavior intergenerationally.	Friends, family, and community members monitored the behavior of young adults and intervened to stop DAD (e.g., by collecting car keys from party attendees or guilt tripping friends to not drive). Community tragedies (e.g., a friend dying in an alcohol-related car crash) deterred young people from DAD.
CULTURAL: Shared values and attitudes in rural areas	Self-reliance and maintaining composure were valued, so asking for a ride when intoxicated was undesirable and could be a source of ridicule. In tight-knit communities, leaving one’s car overnight or walking home intoxicated could result in judgment or damage to one’s reputation as an upstanding community member, leading young people to DAD.	Young people were encouraged by their parents to “be smart when you’re being stupid” and mitigate alcohol-related harms (e.g., by calling a friend for a ride). In tight-knit communities, everyone knows when someone receives a citation or harms another person while driving intoxicated. This fear of public shame deterred DAD.
ENVIRONMENTAL: Aspects of the physical environment and connections with larger institutions	The perceived risk of harming someone else while driving intoxicated was low because of few other drivers on the road in rural areas. The perceived likelihood of getting caught DAD was low because rural residents often knew local law enforcement and a small number of officers patrolled large areas.	Although the most rural areas did not have transportation options, some small towns had public buses. These buses were frequently used by young people to avoid DAD. Some rural young people feared legal consequences because they recognized that it could harm their careers or educational opportunities.