Direct and indirect effects of marijuana use on the risk of fatal 2-vehicle crash initiation

Abstract

Background: Marijuana and alcohol each play a significant role in fatal crash initiation. We decomposed the total effect of marijuana use in the presence or absence of alcohol on fatal crash initiation into direct and indirect effects. Methods: Pair-matched data on 5856 culpable drivers (initiators) and 5856 nonculpable drivers (noninitiators) involved in the same fatal 2-vehicle crashes recorded in the Fatality Analysis Reporting System between 2011 and 2016 were analyzed using the conditional logistic regression model and the unified mediation and interaction analysis framework. Results: Crash initiators were more likely than noninitiators to test positive for marijuana (16.1% vs. 9.2%, P < 0.001), alcohol (28.6% vs. 9.7%, P < 0.001) and both substances (6.3% vs. 1.6%, P