Ride hailing app use and drunk/drugged driving among young adult nightclub patrons

Abstract

Objective:

Nightclub patrons who consume alcohol and drugs in these venues would appear to be an important population to target with on-demand ride hailing app (RHA) services to reduce drunk/drugged driving (DUI). The present study is an exploratory examination of RHA use to avoid DUI behavior, as well as the perceived barriers and benefits of such RHA use, among young adult nightclub patrons in Miami who use drugs.

Methods:

Completers of a 2011–2015 randomized controlled trial of brief interventions to reduce health risk behaviors among young adult nightclub patrons were recruited to participate in a single self-administered computer-assisted interview about health risks, driving behaviors, and RHA perceptions and use. Recruitment (N = 123) began in June 2016 and ended in July 2017. Bivariable logistic regression and ANOVA models examined group differences between: (a) those who had used an RHA to avoid DUI vs. not; and (b) those who used RHAs as their primary mode of transportation to nightclubs vs. not.

Results:

About half were female (52.8%); median age was 29; 59.4% Hispanic, 31.7% Black, 8.1% white, 0.8% other race/ethnicity. Recent alcohol and marijuana use were almost universally endorsed, and more than half reported recent use/misuse of cocaine (72.4%), MDMA (63.4%), and prescription benzodiazepines (62.6%) and opioids (56.9%). More than 80% reported driving under the influence of alcohol and/or drugs in the past 12 months, and 17.1% experienced a DUI arrest in the prior two years. Almost two-thirds (65.9%) of participants had used an on-demand RHA to avoid DUI, but self-driving or riding in another’s car were the most common (76.4%) primary modes of transportation to clubs. RHAs were the primary mode of travel to clubs for 21 (17.1%) respondents. Participants whose friends strongly disapproved of DUI were more than twice as likely to have used RHAs for this reason compared to those who had not done so. Those reporting RHA use to avoid DUI were less likely than others to have driven under the influence in the past 12 months and were somewhat more likely to endorse DUI-related risks. Those who used alternate modes of transportation were more likely than those who used RHAs as their primary mode of transportation to clubs to endorse the expense of RHAs and the lack of RHA drivers near their favorite clubs as barriers to RHA use to travel to nightclubs.

Conclusions:

This novel study among a high-risk population points to the potential for on-demand RHAs to reduce DUI behaviors and arrests among young adult nightclub patrons who consume alcohol and/or drugs in the context of the club experience. Our findings point to key educational, peer support, and structural targets for intervention to increase the use of RHAs among this population, specifically, club-based incentives for increasing RHA availability and affordability. Research is needed to fully elucidate the findings of this exploratory study, including potential differences in intervention approaches depending on the location-specific public transportation options.

Introduction

Electronic dance music (EDM) and other nightclub venues are predominantly attended by young adults, many of whom report extensive alcohol and drug use in the context of the club experience (Kurtz et al. 2017). Although the term “club drugs” traditionally referred to illicit stimulant and hallucinogenic drugs commonly used to enhance the club experience, including MDMA, powder cocaine, LSD, ketamine and GHB, rohyponol and methamphetamine (National Institute on Drug Abuse 2020); these have expanded over the years to include psychoactive prescription medications, principally benzodiazepines and opioids (Kurtz et al. 2005, 2013).

Complex alcohol and polydrug use among young adult nightclub patrons often leads to severe health and social consequences, including driving under the influence of alcohol and/or drugs [DUI; drunk/drugged driving] (Voas et al. 2013; Sanchez et al. 2015), unlicensed driving (Buttram et al. 2017), and related arrests (Buttram et al. 2018). In addition to alcohol, the non-medical use of prescription medications and associated polydrug use contributes substantially to impaired driving by young adults (Benotsch et al. 2015). Young adults ages 21–34 accounted for 52% of the more than 10,000 fatal crashes involving alcohol impaired drivers in in 2018 (NHTSA 2019).

On-demand ride hailing software applications (apps; RHAs) such as Uber and Lyft have been examined for their potential to reduce DUI, crashes, and crash fatalities. Early nationwide studies using data collected prior to 2015, when Uber’s market penetration began to rapidly increase (CB Information Services and Inc 2020), found generally positive results on the effect of Uber’s introduction into a geographic area and changes in DUIs and fatal crashes (Dills and Mulholland 2018) and personal crime (Weber 2019); however, one study of 100 high density metropolitan statistical areas (MSAs) found no association between the introduction of Uber services and changes in drunk driving fatalities (Brazil and Kirk 2016). More recently, a study of DUI arrests in major California cities based on data through 2017 found reductions in DUI arrests ranging between 14 and 37% using a pre-post study design by city-specific year of RHA initiation (Richards 2018). A unique pilot partnership between a New Jersey municipality and Uber to provide free rides home for bar and restaurant patrons demonstrated the effectiveness of such a program in reducing DUI arrests (Levinsky 2019) and injury crashes (Humphreys et al. 2020). On balance, the literature points to positive effects of RHAs on DUI arrests and related outcomes.

Nightclub patrons who consume alcohol and drugs in these venues would appear to be a viable and important population to target with RHA services to reduce DUI. No studies of RHA use among young adult nightclub patrons are apparent in the research literature, however. The present study is an exploratory examination of RHA use to avoid DUI behavior, as well as the perceived barriers and benefits of such RHA use, among young adult nightclub patrons in Miami who use drugs. RHA services were initiated in Miami in 2014 but were subject to criminal prosecution until legal settlements were made with RHA services in 2016 (Hanks 2017). Data collection was initiated at the time of legalization, with the goal of collecting pilot data to inform intervention approaches to increase the use of RHA services to reduce DUI and related harms among this population.

Methods

Data are drawn from a convenience subsample of participants in a National Institute on Drug Abuse-funded randomized controlled trial (RCT) of brief interventions designed to reducing drug use, sexual risk behaviors, and related health consequences among not-in-treatment adults ages 18 to 39 who use drugs in the context of EDM events. The RCT protocol is registered with ClinicalTrials.gov #NCT01362634; details of the study design and main findings may be found at Kurtz et al. (2017; also available online).

Sampling plan

The study was conducted in Miami, Florida, which has a county population of 2.7 million; 69.4% identify as Hispanic, 16.0% Black non-Hispanic and 12.9% White non-Hispanic (US Census Bureau 2019). A respondent-driven sampling (RDS; Heckathorn 1997) approach was employed to recruit the sample of 750 participants for the RCT study during the period September 2011 through November 2014. Initial respondents were recruited through community advertisements and website postings; subsequent waves of recruitment were through referral from earlier participants. To be eligible to enroll, participants were ages 18–39; attended well-known EDM nightclubs at least once per month; and reported the following health risk behaviors in the past 90 days: three days or more club drug use (i.e., powder cocaine, MDMA, LSD, methamphetamine, GHB, and/or ketamine); non-medical prescription drug use (i.e., opioids, sedatives, or stimulants); and unprotected heterosexual vaginal and/or anal sex. The sexual behavior eligibility criterion was deemed necessary to ensure the relevance of the intervention items targeting sexual risk reduction; enrollees who also reported same-gender sex were included. Substance use eligibility criteria matched those in the investigators’ prior natural history study (Kurtz et al. 2013), and were designed to produce a sample with clinically significant levels of drug use. Any potential participant currently enrolled in a substance abuse treatment program was excluded. Outcome measures for the RCT were collected at baseline, 3-, 6-, and 12 months after study enrollment.

The present study, funded by the Center for Applied Research on Substance Use and Health Disparities at Nova Southeastern University, was designed as a fourth wave of follow-up for the original RCT outcomes, and also to assess new measures focused on DUI behaviors and the use of RHAs to avoid DUI. Participants in the RCT study who approved recontact on their written consent form were contacted by research staff using their last known email or social media addresses. Recruitment began in June 2016 and continued, in order of successful contact, until the target funded study sample (N = 128) was reached in July 2017. The median time between enrollment in the RCT study and in the current study was 3.5 years. Tests for differences between the present study sample and the larger baseline sample (N = 750) revealed that the present study sample had larger proportions of female (53% vs. 44%) and Black (32% vs. 20%) participants compared to the baseline sample. No differences by age, education, income, drug use frequencies, club attendance frequency, or RCT arm assignment at baseline were found.

Procedures

The project field office was housed in a commercial office building located near main streets and highways of the City of Miami. All enrollees were provided written, signed informed consent to participate, and then administered an audio computer-assisted self-administered survey that assessed demographics; recent nightclub attendance and substance use frequencies; DUI behaviors and risk perceptions; and RHA use to travel to clubs. Upon survey completion, participants were provided $50 for their time and travel expenses. Data collected for the present study were merged with data from the RCT study using a unique numeric identifier. Human subjects protocols were approved by Nova Southeastern University’s Institutional Review Board.

Measures

Demographic measures included age, gender, race/ethnicity, education, and income. Substance use was measured as frequencies, in days, of use of alcohol, marijuana, powder cocaine, and MDMA (ecstasy), as well as the non-medical use of prescription benzodiazepines and opioids, in the past 90 days. Because all participants used multiple substances, for analysis we measured club drug intensity frequency as the sum of past 90-day use of the four almost universally endorsed drugs at baseline: powder cocaine, MDMA, and prescription benzodiazepines and opioids. This measure also served as the primary substance use outcome for the clinical trial study (Kurtz et al. 2017).

Nightclub-related behavior measures included monthly frequency of attendance at clubs and the primary mode of transportation to travel to clubs. We also queried whether participants had ever used an on-demand RHA to avoid DUI. Those who endorsed this question were selected to respond to six additional questions about their perceptions of RHA safety (“Using RHAs when I have been drinking or using drugs is safer than other means of transportation”); accessibility (three items: “RHAs are too expensive for me to use to avoid DUI,” “there are not many drivers near my home,” “there are not many drivers near my favorite clubs”), and the effect of RHA use on participants’ DUI behaviors (two items: “My preferred way to avoid DUI is to use RHAs,” “Since using RHAs the number of times I have engaged in DUI has decreased”). Response choices for each of the RHA perception questions were on a 4-point scale ranging from “strongly agree” = 1 to “strongly disagree” = 4. The questionnaire also included driving history questions about DUI in the past 12 months and DUI arrest in the past two years; response choices were “yes” vs. “no.”

Finally, we queried DUI risk perceptions (three items: “How likely is it that drivers who have had too much to drink/drug to drive safely will have an accident?”; “… will be stopped by the police?”; “… will be arrested?) and peer norms (“How do you think your close friends feel about you driving tipsy or after having taken club drugs?”). Each risk perception question was measured on a 4-point scale ranging from “very likely” = 1 to “very unlikely” = 4. Peer norms were measured on a 3-point scale ranging from “they would be okay with it” = 1 to “they would strongly disapprove” = 3.

Analyses

All analyses were conducted using IBM® SPSS^® Statistics version 26. Analyses include 123 study enrollees who reported ongoing nightclub participation. Descriptive statistics were calculated for the variables of interest, including gender, race/ethnicity, age, income, and education; recent substance use; DUI behaviors, peer norms, and risk perceptions; and the use and accessibility of RHAs for attending nightclubs. Bivariable logistic regression models examined relationships between demographic, substance use, and DUI variables and the use of RHAs to travel to nightclubs. For regression analyses, continuous measures of age, education level, drunk/driving risk perceptions, and peer norms were dichotomized for easier interpretation of odds ratios. Age and education were dichotomized at the respective median number of years. DUI risk perceptions were dichotomized as “very/somewhat likely” vs. “somewhat/very unlikely.” The “unlikely” category ranged from 18 to 25% of the sample for the three questions. Peer norms were dichotomized as “they would be okay with it” (N = 36)/“they somewhat disapprove” (N = 38) vs. “they would strongly disapprove” (N = 49). Dichotomization did not meaningfully change the results. Among participants who had used RHAs to avoid DUI, ANOVA models compared perceptions of RHA safety, accessibility, and utility between those who did and did not use RHAs as their primary mode of transportation to nightclubs. Due to the small sample size, significance statistics are reported at both the p < .05 standard and the p < .10 trend levels.

Results

Sample characteristics

Sample characteristics are shown in Table A1 in the Online Appendix. About half were female (52.8%); median age was 29. The racial/ethnic makeup of the sample reflected the diversity of Miami’s population. Recent alcohol and marijuana use were almost universally endorsed, and more than half reported recent use/misuse of cocaine (72.4%), MDMA (63.4%), and prescription benzodiazepines (62.6%) and opioids (56.9%).

Median frequency of nightclub attendance was 4 times per month. Almost two-thirds (65.9%) of participants had used an on-demand RHA to avoid DUI, but self-driving or riding in another’s car were the most common (76.4%) primary modes of transportation to clubs. RHAs were the primary mode of travel to clubs for 21 (17.1%) respondents, while just 8 participants reported the use of other modes, including walking and various forms of public transportation. More than 80% reported driving under the influence of alcohol and/or drugs in the past 12 months, and 17.1% experienced a DUI arrest in the prior two years.

Ride hailing app use

Differences in demographics, recent substance use frequencies, and DUI behavior, risk perceptions and peer norms of participants who reported past use of an RHA to avoid DUI compared to those who had never done so are shown in the left side of Table 1. Those who had used RHAs for this reason were more than twice as likely to be 28 years of age or younger, but much less likely to be of Black race/ethnicity, than those who had not. No differences in use of RHAs to avoid DUI were found by gender, education level, or alcohol or club drug use frequency.

Table 1.

Bivariable logistic regression models predicting ride hailing app (RHA) use (N = 123).

	Used RHA for alcohol/drug use (N = 81)			RHA primary way to nightclubs (N = 21)
	p	OR	95% CI	p	OR	95% CI
Demographic characteristics
Age 28 and under	.039*	2.263	1.042, 4.917	.279	1.689	0.654, 4.361
Gender (ref. male)	.286	.663	0.312, 1.411	.599	.777	0.303, 1.990
Race (ref. Hispanic)	.001**			.228
White non-Hispanic	.356	2.732	0.323, 23.131	.356	.366	0.043, 3.099
Black non-Hispanic	<.001***	.190	0.082, 0.441	.051#	.275	0.075, 1.004
Education > high school	.115	1.838	0.863, 3.915	.499	1.387	0.538, 3.576
Substance use (past 90 days)
Days alcohol	.966	1.000	0.986, 1.014	.087#	1.015	0.998, 1.033
Days club drugs	.539	.998	0.993, 1.004	.123	.993	0.984, 1.002
DUI behaviors/risk perceptions/peer norms
DUI in past 12 months	.052#	.321	0.102, 1.011	.005**	.230	0.083, 0.640
DUI arrest in past 2 years	.118	2.523	0.790, 8.056	.792	1.176	0.352, 3.935
DUI – likely to have an accident	.079#	1.426	0.960, 2.118	.998	–	–
DUI – likely to be stopped by police	.072#	1.372	0.972, 1.938	.433	1.221	0.741, 2.010
DUI – likely to be arrested	.109	1.361	0.934, 1.983	.112	1.916	0.860, 4.266
Friends strongly disapprove of DUI	.019*	2.625	1.174, 5.871	.653	.795	0.291, 2.169

^***p < .001

^**p < .01

^*p < .05

^#p < .10.

Participants whose friends strongly disapproved of DUI were more than twice as likely to have used RHAs for this reason compared to those who had not done so. There were several differences in DUI behaviors and risk perceptions that were significantly different between groups at the trend level: those reporting RHA use to avoid DUI were less likely than others to have driven under the influence in the past 12 months, and were somewhat more likely to endorse having an accident and being stopped by the police as likely risks of DUI.

Differences in demographics, recent substance use frequencies, and DUI behavior, risk perceptions and peer norms of participants who used RHAs as their primary way to travel to nightclubs compared to those who used other modes of transportation are shown in the right side of Table 2. Demographic differences between groups were not noted, except that non-Black race/ethnicity was associated with higher odds of using RHAs to travel to clubs at the trend level. Higher frequency of recent alcohol use was associated with RHA use to travel to clubs at the trend level. Participants who used RHAs as their primary mode of transportation to clubs were much less likely to report past-year DUI compared to those who used other forms of transportation. Differences in DUI arrest history, risk perceptions and peer norms were not noted.

Table 2.

Ride hailing app perception differences by preference for ride apps to get to nightclubs (N = 81).

	Have used ride app but not primary way to nightclubs N = 60)	Ride app is primary way to get to nightclubs (N = 21)
	Mean (SD)	Mean (SD)	P
Ride hailing app perception 1
Safer way to get to clubs	1.30 (0.59)	1.11 (0.32)	.174
Too expensive	3.23 (1.16)	3.79 (0.54)	.046*
Not many drivers near my home	3.25 (1.19)	3.63 (0.76)	.193
Not many drivers near favorite clubs	3.12 (1.28)	3.89 (0.32)	.011*
Ride app is preferred way to avoid DUI	1.33 (0.60)	1.00 (0.00)	.019*
Ride app has reduced my DUI behavior	1.78 (0.98)	1.21 (0.54)	.017*

^*p < .05.

¹Scale range: 1 = strongly agree; 4 = strongly disagree.

Ride hailing app perceptions

Table 2 compares perceptions of RHA safety and accessibility, and the effect of app use on drunk/driving behavior, between participants who use RHAs as their primary mode of transportation to nightclubs vs. those who have used RHAs to avoid DUI in the past but who usually self-drive, ride in another person’s car, walk, or use public transportation to get to clubs. No differences between groups were found as to the perceived safety of RHAs or the availability or app drivers near their homes. Those who use RHAs as their primary way to travel to nightclubs were more likely than others to agree that the apps were their preferred way to avoid DUI, and that app use actually reduced such behavior. Those who used alternate modes of transportation were more likely to endorse the expense of RHAs and the lack of app drivers near their favorite clubs as barriers to RHA use to travel to nightclubs.

Discussion

This is the first apparent examination of on-demand RHA use to avoid DUI, and RHA acceptability and accessibility perceptions, among young adult nightclub attendees who use/misuse alcohol and multiple illicit and prescription drugs in the context of the club experience. Our sample was diverse as to gender and race/ethnicity. Although enrollment in the present study was a median 3.5 years after enrollment in the original RCT, 96.1% (N = 123) of enrollees continued to patronize nightclubs about once per week. Of those participants included in these analyses, large majorities continued to use club drugs (83.7%) and/or misuse prescription medications (79.9%). More than 80% reported past year DUI and more than 17% a DUI arrest in the prior two years. As such, this is an important high-risk population in need of interventions to reduce DUI behaviors, as well as related injury to themselves and others and criminal justice system involvement.

Limitations

Some limitations of our study merit attention. First, while our sample was representative of the gender and racial/ethnic composition of the region, it is unclear whether the study findings generalize to not-in-treatment young adult nightclub patrons who have lower multi-drug use. The sample recruited for this study exhibited very high levels of drug involvement and other health and social problems. We also note that the study sample was small, and that we found racial/ethnic and gender differences in rates of participation in this Wave 4 study compared to the original RCT. It is not possible to assess whether these differences were systematic or would have resolved if recruitment into Wave 4 had been extended for a longer period. We did not find differences in other demographic measures or in drug use or club patronage behaviors between the Wave 4 and baseline samples, suggesting that systematic differences were non-significant.

Second, cities vary as to important structural characteristics related to this population, including nightclub closing times and the geographic coverage and hours of operation of public transit networks. RHA structural interventions may show less promise in urban areas with dense public transportation networks that operate through the nighttime hours. Finally, all data are based on self-report, such that substance use and DUI behaviors were not independently verified. Given the long-term familiarity of the participants with the research team, as well as the high levels of risk behaviors we found, however, underreporting of stigmatized behaviors would appear to be minimal.

Key findings

This novel study points to the potential for on-demand RHAs to reduce DUI behaviors and arrests among young adult nightclub patrons who consume alcohol and/or drugs in the context of the club experience. We found that about two-thirds of study participants had used an RHA at least once to avoid DUI, indicating fairly broad knowledge of the apps among this population. The most significant factor predicting RHA use to avoid DUI was strong disapproval of DUI among participants’ peers. The data also pointed toward heightened DUI risk perceptions among RHA users; moreover, RHA-users reported actual reductions in their DUI behavior as a result of their use. Although the samples may not necessarily be comparable, a study of college students also found that factors contributing to DUI included reduced perceptions of DUI-related risk as well as greater acceptance of DUI among peers (Benotsch et al. 2015). Thus, our data point to increased education efforts within the club culture about the risks of DUI, the importance of friends looking out for each other when leaving the club, and promoting RHAs as perhaps the most convenient way to avoid DUI and associated consequences when traveling to and from nightclubs. This may be especially the case in a large, medium-density city like Miami that developed around the automobile as the primary means of transport. Although public transportation initiatives have taken root, there remain significant parts of the county that are not conveniently served by busses, trolleys, and trains.

Among participants who had used an RHA to avoid DUI in the past, just over one-quarter endorsed RHAs as their primary mode of transport to nightclubs. Those who did so were much less likely to report past-year DUI, but did not generally differ from others on demographics, DUI peer norms or DUI risk perceptions. Rather, the main differences among the groups were perceptions of RHA accessibility and affordability. Primary and non-primary RHA users reported similarly high perceptions of RHA safety and accessibility near their homes. However, non-primary RHA users were more likely than primary users to say that RHAs were too expensive, and that there were not many RHA drivers available near their favorite nightclubs. Although we did not collect in-depth interview data to inform these issues further, it may be the case that RHA drivers tend be unavailable around nightclubs at closing time, which in Miami is generally 5:00AM or later in the morning.

These barriers may best be addressed by structural interventions to promote RHA availability and affordability in the early hours of the morning. One such approach might be for clubs to include a $5 RHA voucher in their admission fee, the cost of which could be subsidized by local governments, non-profits, or even by research initiatives that might provide such coupons in exchange for brief survey participation. Another potential intervention would be for clubs to incentivize RHA services at club closing times. RHAs could or might already use nighttime and surge pricing to incentivize such service, but the apparent sensitivity of club patrons to RHA cost likely reduces the effectiveness of such an approach. Of note in this regard is a successful partnership (currently suspended) between a New Jersey municipality and Uber to provide free rides home to bar and restaurant patrons to avoid DUI (Levinsky 2019; Humphreys et al. 2020). Finally, we note that in-depth qualitative research and surveys of larger samples will be important to more fully understanding the barriers and facilitators of RHA use to avoid DUI among young adult nightclub patrons, and that comparative research across different urban contexts is also needed.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.