A systematic review was conducted to assess the evidence of effectiveness of designated driver programs for reducing alcohol-impaired driving and alcohol-related crashes. Two types of programs were evaluated for this review: population-based campaigns that encourage designated driver use, and programs conducted in drinking establishments that provide incentives for people to act as designated drivers. Peer-reviewed papers or technical reports that met quality criteria and evaluated outcomes of interest were included in the review. A single study of a populationbased designated driver promotion campaign was identified. Survey results indicated a 13 percentage point increase in respondents "always" selecting a designated driver, but no signifcant change in self-reported alcohol-impaired driving or riding with an alcoholimpaired driver. Eight studies of incentive programs at drinking establishments met inclusion criteria. Seven of these evaluated the number of patrons who identified themselves as designated drivers before and after programs were implemented, with a mean increase of 0.9 designated drivers per night (interquartile range: 0.3 to 3.2 designated drivers per night). The eighth study reported a 6 percentage point decrease (p 0.01) in self-reported driving or riding in a car with an intoxicated driver among respondents exposed to an incentive program. The present evidence is insufficient to draw conclusions about the effectiveness of either type of designated driver promotion program evaluated. More carefully controlled studies are needed of the effects of population-based, designated driver promotion efforts. For incentive programs, the public health impact of the small observed increases in the number of self-identified designated drivers at each drinking venue is unknown. Furthermore, it is apparent that consistent, concerted promotional efforts are needed to obtain and maintain small increases in the number of self-reported designated drivers. Suggestions are provided regarding future research issues and needs raised by this review.