Alcohol and driving factors in collision risk

A Systematic Review of the Risks of Motor Vehicle Crashes Associated with Psychiatric Disorders

OBJECTIVE

Psychiatric disorders and their treatments have the potential to adversely impact driving skills. However, it is unclear to what extent this poses a public health risk by increasing the risk of motor vehicle crashes (MVCs). The aim of this systematic review was to synthesize and critically appraise evidence on the risk of MVC for drivers with psychiatric disorders.

METHOD

We conducted a systematic review of the MVC risk associated with psychiatric disorders using seven databases in November 2019. Two reviewers examined each study and extracted data. The National Heart, Lung, and Blood Institute Quality Assessment tools were used to assess each study's quality of evidence.

RESULTS

We identified 24 studies that met the inclusion criteria, including eight cohort, 10 case-control, and six cross-sectional designs. Quality assessment ratings were "Good" for four studies, "Fair" for 10, and "Poor" for 10. Self-report or questionnaires were used in place of objective measures of either MVC, psychiatric disorder, or both in 12 studies, and only seven adjusted for driving exposure. Fifteen studies reported an increased risk of MVC associated with psychiatric disorders, and nine did not. There was no category of disorder that was consistently associated with increased MVC risk.

CONCLUSION

The available evidence is mixed, not of high quality, and does not support a blanket restriction on drivers with psychiatric disorder. An individualized approach, as recommended by international guidelines, should continue. Further research should include objective assessments of psychiatric disorders and MVC risk and adjust for driving exposure.

Evaluation of Driver's Reaction Time Measured in Driving Simulator

This article evaluates the driver’s reaction times in a driving simulator environment. The research focused mainly on young drivers under the age of 26, who cause many accidents. Each participating driver provided basic information later used for mathematical-statistical analysis. The main advantage of driving simulators is limitless usage. It is possible to simulate situations that would be unacceptable in real road traffic. Therefore, this study is also able to examine drunk driving. The main goal of the article is to evaluate if gender, practice, or alcohol significantly affected the reaction time of 30 drivers. We also focused on drinking before driving for a smaller number of the drivers; ten of them performed driving under the influence of alcohol. For these mathematical-statistical purposes, we used a one-sample t-test, a paired-samples t-test, an independent-sample t-test, and a correlation analysis together with the assessment of its statistical significance.

Applications of brain imaging methods in driving behaviour research

Applications of neuroimaging methods have substantially contributed to the scientific understanding of human factors during driving by providing a deeper insight into the neuro-cognitive aspects of driver brain. This has been achieved by conducting simulated (and occasionally, field) driving experiments while collecting driver brain signals of various types. Here, this sector of studies is comprehensively reviewed at both macro and micro scales. At the macro scale, bibliometric aspects of these studies are analysed. At the micro scale, different themes of neuroimaging driving behaviour research are identified and the findings within each theme are synthesised. The surveyed literature has reported on applications of four major brain imaging methods. These include Functional Magnetic Resonance Imaging (fMRI), Electroencephalography (EEG), Functional Near-Infrared Spectroscopy (fNIRS) and Magnetoencephalography (MEG), with the first two being the most common methods in this domain. While collecting driver fMRI signal has been particularly instrumental in studying neural correlates of intoxicated driving (e.g. alcohol or cannabis) or distracted driving, the EEG method has been predominantly utilised in relation to the efforts aiming at development of automatic fatigue/drowsiness detection systems, a topic to which the literature on neuro-ergonomics of driving particularly has shown a spike of interest within the last few years. The survey also reveals that topics such as driver brain activity in semi-automated settings or neural activity of drivers with brain injuries or chronic neurological conditions have by contrast been investigated to a very limited extent. Potential topics in driving behaviour research are identified that could benefit from the adoption of neuroimaging methods in future studies. In terms of practicality, while fMRI and MEG experiments have proven rather invasive and technologically challenging for adoption in driving behaviour research, EEG and fNIRS applications have been more diverse. They have even been tested beyond simulated driving settings, in field driving experiments. Advantages and limitations of each of these four neuroimaging methods in the context of driving behaviour experiments are outlined in the paper.

Ethnicity, Immigration Status, And Driving Under The Influence Of Alcohol

BACKGROUND

Understanding risk factors for driving under the influence of alcohol (DUIA) informs development of effective interventions. This study examined the association between ethnicity, immigration status, and DUIA, exploring psychological distress and hazardous drinking as additional contributors.

METHOD

Data were derived from the 2003-2011 cycles of the Centre for Addiction and Mental Health (CAMH) Monitor of 16,101 adults from Ontario, Canada. Hierarchical binary logistic regression analysis assessed self-identified ethnicity and immigration status as predictors of DUIA, adjusting for sociodemographics and driving exposure (Model 1), psychological distress (Model 2), and hazardous drinking (Model 3).

RESULTS

In Model 1, respondents born outside of Canada had reduced odds of engaging in DUIA compared to those born in Canada (AOR = 0.72, 95%CI = 0.56 - 0.92). Relative to those identifying as Canadian, the odds of DUIA were significantly reduced for those identifying as East Asian (AOR = 0.28, 95%CI = 0.13 - 0.61) and South Asian (AOR = 0.52, 95%CI = 0.27 - 0.98). In Model 3, individuals who reported psychological distress (AOR = 1.69, 95%CI = 1.33 - 2.16) and those who reported hazardous drinking (AOR = 6.28, 95%CI= 5.13 - 7.69) were more likely to DUIA. Those identifying as East Asian continued to have reduced odds of DUIA compared to those identifying as Canadian (AOR = 0.38, 95%CI = 0.17 - 0.85).

CONCLUSION

Individuals born outside of Canada were less likely to engage in DUIA than individuals born in Canada. Drivers who self-identified as East Asian were less likely to DUIA than those who self-identified as Canadian. Understanding ethnic differences underlying divergent risks for DUIA will improve prevention initiatives and remedial measures programming.

Alcohol-impaired driving in rural and urban road environments: Effect on speeding behaviour and crash probabilities

Speeding behaviour is known to influence crash risk among alcohol-impaired drivers, but this relationship is scarcely explored. The present study investigated the effects of different Blood Alcohol Concentrations (BAC) levels on driving performance with respect to mean speed of drivers and their ability to avoid crashes during sudden events while driving. Eighty-two drivers participated in the simulation driving experiment at four BAC levels (0%, 0.03 %, 0.05 % and 0.08 % BAC) in rural and urban driving scenarios. Two sudden events (pedestrian crossing and road crossing by parked vehicles (a car and a truck) in the perpendicular direction of traffic) were designed to evaluate the crash probabilities in both the driving scenarios. Generalized linear mixed models were developed to analyse the effects of BAC levels and driver attributes (e.g., age, gender) on mean speeds and crash probabilities. Results for mean speed showed that, compared to sober state, drivers drove 3.5 kmph, 5.76 kmph and 8.78 kmph faster at 0.03 %, 0.05 % and 0.08 % BAC respectively in the rural environment and this increment was 3.6 kmph, 3.69 kmph and 4.13 kmph in the urban environment. The model results for crash probabilities revealed that 0.03 %, 0.05 % and 0.08 % BAC levels increased the crash probabilities by 1.9 times, 2 times and 3 times in case of the rural environment and 2 times, 2.3 times and 3.5 times respectively in the urban driving environment.

An investigation on the risk factors associated with driving errors under the influence of alcohol using structural equation modeling

Objective: Driving errors contribute to traffic crashes and thus the causal factors associated with driving errors are of great interest to the road safety researchers. The present study attempts to identify and quantify the effects of various risk factors that are likely to influence driving error with the application of structural equation modeling (SEM). These risk factors include blood alcohol concentration (BAC) levels (0%, 0.03%, 0.05%, and 0.08%), different driving environments (rural, urban), and driver attributes (such as age, gender, education).Method: Eighty-two licensed drivers participated in a driving simulator experiment. They completed driving under the influence of 4 BAC levels in the driving environments within the framework of a full-factorial within-subjects design. Driving error was modeled as an unobserved latent variable based on several driving simulator indicators. An SEM approach was utilized to examine the influence of BAC level, driving environment, and driver attributes on the latent variable pertaining to driving error.Results: The findings suggest the suitability of an SEM approach in the investigation of driving error. The results revealed that all 3 positive BACs (0.03%, 0.05%, and 0.08%) had a significant positive influence on driving error compared to 0% BAC, and the tendency toward driving error increased with increasing BAC (factor loadings for 0.03%, 0.05%, and 0.08% BAC were 0.22, 0.31, and 0.37, respectively). Moreover, driving in an urban environment led to more driving errors compared to a rural environment, including sober drivers. Among the driver attributes, gender and awareness about drink and drive laws were the only factors influencing driving error.Conclusion: This study highlights a novel approach to investigate driving error by modeling it as a latent variable instead of modeling individual performance measures. The successful execution of SEM in alcohol impairment research may serve as a significant step in the human factors field moving from piecemeal analysis to a combined analysis where interrelationships among numerous risk factors and driving error can be established. The study outcomes may serve as a reference while developing strategies to enhance road traffic safety where special emphasis can be given to the critical risk factors influencing driving error identified in the study.

Factors associated with driving under the influence of alcohol

Objective: This study examined the risk factors of driving under the influence of alcohol (DUI) among drivers of specific vehicle categories (DSC). On the basis of this research, the variables related to DUI and involvement in traffic crashes were defined. The analysis was conducted for car drivers, bicyclists, motorcyclists, bus drivers, and truck drivers. Method: The research sample included drivers involved in traffic crashes on the territory of Serbia in 2016 (60,666). Two types of analyses were conducted in this study. Logistic regression established the correlation between DUI and DSC and the The Technique for Order of Preference by Similarity to Ideal Solution (Multi-criteria decision making) method was applied to consider the scoring and explore the potential for the prevalence of DUI on the basis of 2 data sets (DUI and non DUI). Results: The study results showed that driver error and male drivers were the 2 most significant risk factors for DUI, with the highest scores and potential for prevalence. The nonuse of restraint systems, driver experience, and driver age are the factors with a significant prediction of involvement in an accident and an insignificant prediction of DUI. Conclusions: Following the development of the logistic prediction models for DUI drivers, testing of the model was conducted for 3 control driver groups: Car, motorcycle, and bicycle. The prediction model with a probability greater than 50% showed that 77% of car drivers were under the influence of alcohol. Similarly, the prediction percentage for motorcyclists and bicyclists amounted to 71 and 67%, respectively. The recommendation of the study is that drivers whose DUI probability is above 50% should be potentially suspected of DUI. The results of this study can help to understand the problem of DUI among specific driver categories and detect DUI drivers, with the aim of creating successful traffic safety policy.

The relationship between motor vehicle collisions and cigarette smoking in Ontario: Analysis of CAMH survey data from 2002 to 2016

Research has shown that tobacco users have an increased risk of collisions compared to nonsmokers. Studies from 1967 through 2013 documented a crude relative risk of collision involvement of about 1.5 among smokers compared to nonsmokers. In January 2009, in response to concerns about the health risks associated with potentially high concentrations of secondhand smoke resulting from smoking in vehicles, the provincial government in Ontario, Canada, introduced legislation restricting smoking in vehicles where children and adolescents are present. We examined the association between reported smoking and involvement in a motor vehicle collision in a large representative sample of adult drivers in Ontario, Canada, from 2002 and 2016, with particular focus on 2002-2008 and 2010-2016, periods before and after the legislation. Data are based on the Centre for Addiction and Mental Health (CAMH) Monitor. Among licensed drivers, prevalence of self-reported collision involvement within the past year for 2002-2008 was 9.39% among those who currently smoked compared to 7.08% of nonsmokers. Following implementation of the legislation, for 2010-2016, the prevalence of collisions for smokers was 7.01% and for nonsmokers was 6.02%. The overall difference for both smokers and nonsmokers between the two time periods was statistically significant; however, the difference between the two groups for the pre-legislation period was significant even after adjusting for potential confounders, while post legislation the difference was not significant. Prior to the legislation, the prevalence of collision was higher among smokers than nonsmokers; following the introduction of the legislation the prevalence was similar for the two groups.

Is there a link between motor vehicle collisions and being a cigarette smoker in Canada? Analysis of survey data from Ontario from 2002 to 2014

OBJECTIVE

Although most research on drugs and driving has focused on the use of alcohol and cannabis, research that has been conducted on cigarette smoking and collisions has found that smokers have an increased collision involvement. Studies dating from 1967 through 2013 have shown a crude relative risk of about 1.5 among smokers compared to nonsmokers. In Canada, the association between smoking and collisions has not been recently investigated. Studies that have examined the association between smoking and collisions often did not control for all confounding factors, such as alcohol use and driving exposure, which have been associated with increased collision rates. Additionally, a number of these studies were examined in countries and at times when prevalence of smoking was much higher than is currently the case in Canada. The purpose of this research is to examine the association between self-reported current smoking and past-year collision involvement, controlling for confounding factors, in a large representative sample of adult drivers in Ontario, Canada, from 2002 and 2014.

METHOD

Data are based on the Centre for Addiction and Mental Health (CAMH) Monitor, an ongoing, rolling telephone survey of Ontario adults that provides epidemiological surveillance of indicators related to alcohol, tobacco, and other drug use, as well as physical and mental health. The survey uses random-digit-dialing methods via Computer-Assisted Telephone Interview, with response rates over 50%.

RESULTS

Prevalence of self-reported collision involvement within the past year for 2002-2014 was 8.6% among those who currently smoke compared to 6.5% of nonsmokers. Logistic regression analysis, controlling for the potential confounding effects of sociodemographics, driving exposure measures, drinking frequency, and hazardous alcohol use, found that the overall odds for collision involvement in the preceding year among current smokers for 2002-2014 was 1.27 (95% confidence interval [CI], 1.06-1.53) times that of nonsmokers.

CONCLUSIONS

These findings indicate that despite a substantial reduction in overall prevalence of smoking in Canada, smokers still have a significantly increased odds of collision involvement, even when controlling for alcohol and exposure. Additionally, the results are consistent with the increased odds/risks of motor vehicle collisions found in other countries.

Intercorrelation of Alcohol and Other Drug Use Disorders among a National Sample of Drivers

This study examined the relationship between alcohol, marijuana, cocaine, and painkiller use disorders in a sample of drivers. We studied nighttime drivers aged 16 to 87 (n = 4,277) from the 2007 National Roadside Survey who reported substance use behaviors and provided breath tests for alcohol. Logistic regression analyses assessed the relationships between (1) substance (i.e., alcohol/marijuana/cocaine/pain killer) use disorders; (2) demographic characteristics; and (3) BAC levels. Overall, 13.2% of participants met criteria for marijuana use disorder, 7% met criteria for cocaine use disorder, and 15.4% met criteria for extra-medicinal painkiller use disorder. When self-report data were analyzed, three reciprocal associations emerged: (1) marijuana use disorders and alcohol use disorders were correlated; (2) marijuana use disorders and cocaine use disorders were correlated; and (3) cocaine use disorders and painkiller use disorders were correlated. BAC data revealed that marijuana and cocaine use disorders were both associated with positive BAC levels, but only cocaine use disorders were associated with BAC levels over the legal limit. Results suggest significant poly-substance use disorders in a sample of nighttime drivers, with variations by demographic characteristics. The individual and public health consequences of multiple substance use disorders among drivers are significant.

How to quantitatively evaluate safety of driver behavior upon accident? A biomechanical methodology

How to evaluate driver spontaneous reactions in various collision patterns in a quantitative way is one of the most important topics in vehicle safety. Firstly, this paper constructs representative numerical crash scenarios described by impact velocity, impact angle and contact position based on finite element (FE) computation platform. Secondly, a driver cabin model is extracted and described in the well validated multi-rigid body (MB) model to compute the value of weighted injury criterion to quantitatively assess drivers’ overall injury under certain circumstances. Furthermore, based on the coupling of FE and MB, parametric studies on various crash scenarios are conducted. It is revealed that the WIC (Weighted Injury Criteria) value variation law under high impact velocities is quite distinct comparing with the one in low impact velocities. In addition, the coupling effect can be elucidated by the fact that the difference of WIC value among three impact velocities under smaller impact angles tends to be distinctly higher than that under larger impact angles. Meanwhile, high impact velocity also increases the sensitivity of WIC under different collision positions and impact angles. Results may provide a new methodology to quantitatively evaluate driving behaviors and serve as a significant guiding step towards collision avoidance for autonomous driving vehicles.

Self-reported driving under the influence of alcohol and cannabis among Ontario students: Associations with graduated licensing, risk taking, and substance abuse

OBJECTIVE

This article describes the patterns of self-reported driving under the influence of alcohol (DUIA) and driving under the influence of cannabis (DUIC) among licensed Ontario students in 2009 and examines their associations with graduated licensing, risk taking, and substance use problems for understanding DUIA and DUIC behaviors. Ontario's graduated licensing system requires new drivers to hold a G1 license for a minimum of 8 months and a G2 license for a minimum of 12 months before a full and unrestricted G license can be obtained. Among other restrictions, G1 drivers must maintain a 0 blood alcohol content (BAC), have an experienced driver in the passenger seat, not drive on any high-speed expressways, and not drive between the hours of midnight and 5 a.m. A G2 license is more similar to a G license, with fewer restrictions.

METHOD

This study analyzed data from the 2009 Ontario Student Drug Use and Health Survey (OSDUHS). The OSDUHS is a biennial population-based survey of students (grades 7 to 12) in Ontario, Canada.

RESULTS

The results showed that 16.3% of licensed students in Ontario reported DUIC and 11.5% reported DUIA during the past year. After controlling for the effect of age, type of license emerged as a robust predictor for both DUIA and DUIC behavior, because students with a G2 and full license were significantly more likely to report DUIA and DUIC than drivers with a G1 license. Multivariate analyses suggested that risk-seeking behaviors were more important for understanding DUIA behavior than for DUIC behavior. Elevated problem indicators for alcohol and for cannabis were associated with DUIA and DUIC, respectively.

CONCLUSIONS

Though much attention has been paid to drinking and driving among adolescents, this research shows that more Ontario students now report driving after cannabis use than after drinking alcohol. The results identify important correlates of both behaviors that may be useful for prevention purposes.

Under the influence: examination of prevalence and correlates of alcohol and marijuana consumption in relation to youth driving and passenger behaviours in Canada. A cross-sectional study

BACKGROUND

Consequences of alcohol- and drug-impaired driving affect youth disproportionately. We describe individual- and area-level characteristics associated with risky driving and passenger behaviours among grade 9-12 students in Canada.

METHODS

The 2014-2015 Canadian Student Tobacco, Alcohol and Drug Survey was administered to 24 650 students in provincially generalizable samples. Dichotomous outcomes included ever and last-30-day driving after drinking alcohol, ever and last-30-day driving after using marijuana, and ever and last-30-day reporting of being a passenger with a driver who had been drinking or using marijuana.

RESULTS

A total of 9.1% (99% confidence interval 7.9-10.3) of grade 11-12 students reported ever driving after drinking, and 9.4% (99% confidence interval 8.3-10.4) reported ever driving after using marijuana. Almost half (48%) of grade 11-12 students reported ever participating in any risky driving or passenger behaviour. Over one-third (35%) of grade 9-12 students reported ever riding with a driver who had been drinking, and 20% reported ever riding with a driver who had been using marijuana. Logistic regression models showed that boys had higher odds of risky driving behaviours relative to girls, whereas girls had higher odds of risky passenger behaviours relative to boys. Students from rural schools had higher odds of drinking and driving and of riding with a driver who had drunk relative to students from urban schools. There were significant differences in risky driving and passenger behaviours by province.

INTERPRETATION

A substantial number of Canadian youth reported risky driving and passenger behaviours, which varied by individual and area-level characteristics. Federal marijuana policy should aim to reduce the prevalence of drug-impaired driving. Additional provincial policies to prevent impaired driving are needed.

Characterization of victims of aggression and transportation accidents treated at the Forensic Medicine and Dentistry Institute - Campina Grande, Paraíba, Brazil - 2010

The objective of this cross-sectional census study was to characterize agression and land-based transport accidents in a city in the Northeast of Brazil. Data was analyzed from live victims who were treated at a forensic service (N = 2.379). In the descriptive analysis, the majority of events were represented by aggression (71.6%); which occurred on weekdays (65%), with 35.1% at night. Trauma occurred to the whole body (63.6%) and to soft tissue (74.2%). On the basis of multiple correspondence analysis, two dimensions were formed: the first dimension (internal reliability = 0.654) was formed by the cause of the event, the trauma and the age group and the second dimension (reliability = 0.514), by age group, occupation and civil status. Three groups with distinct profiles were formed for accidents and aggression: young women who suffered aggression, with trauma to the face and soft tissues during the evening and at weekends; adult men who suffered car accidents, in the morning and on work days; and retired elderly widowers, who were run over.

Adult attention deficit hyperactivity disorder symptom profiles and concurrent problems with alcohol and cannabis: sex differences in a representative, population survey

BACKGROUND

Adult attention deficit hyperactivity disorder (ADHD) shows a robust association with alcohol and cannabis misuse, and these relationships are expressed differently in males and females. Manifestation of specific ADHD symptom profiles, even in the absence of the full disorder, may also be related to problems with alcohol and cannabis, although these relationships have not been investigated in epidemiological studies. To address this question, we studied the sex-specific associations of ADHD symptomatology with problematic alcohol and cannabis use in a representative sample of adults aged 18 years and older residing in Ontario, Canada.

METHODS

Data were obtained from the Centre for Addiction and Mental Health Monitor, an ongoing cross-sectional telephone survey, between January 2011 and December 2013. Respondents (n =  5080) reported on current ADHD symptomatology, measured using the Adult ADHD Self-Report Version 1.1 Screener (ASRS-V1.1) and four additional items, and alcohol and cannabis use, which were measured using the Alcohol Use Disorders Identification Test (AUDIT) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), respectively. Logistic regression analyses were conducted in men and women to test the association of each ADHD symptom cluster (hyperactivity, inattentiveness, impulsivity) with problematic alcohol and cannabis use.

RESULTS

After controlling for age, education, and comorbid internalizing and externalizing psychopathology, hyperactive symptoms were associated with problematic alcohol use in both men and women and with problematic cannabis use in men. Impulsive symptoms were independently associated with problematic cannabis use in men. By contrast, inattentive symptomatology predicted problems with alcohol and cannabis only in women. In all models, age was negatively associated with substance misuse and externalizing behavior was positively correlated and the strongest predictor of hazardous alcohol and cannabis use.

CONCLUSIONS

ADHD symptom expression in adulthood is related to concurrent hazardous use of alcohol and cannabis. Distinctive ADHD symptom profiles may confer increased risk for substance misuse in a sex-specific manner.

Attention Deficit Hyperactivity Disorder Symptoms, Comorbidities, Substance Use, and Social Outcomes among Men and Women in a Canadian Sample

Background. Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that can persist in adolescence and adulthood. Aim. To examine prevalence of ADHD symptoms and correlates in a representative sample of adults 18 years and older living in Ontario, Canada. Method. We used the Centre for Addiction and Mental Health Monitor, an ongoing cross-sectional telephone survey, to examine the relationships between ADHD positive symptoms and comorbidities, substance use, medication use, social outcomes, and sociodemographics. Results. Of 4014 residents sampled in 2011-2012, 3.30% (2.75%–3.85%) screened positively for ADHD symptoms (women = 3.6%; men = 3.0%). For men, distress, antisocial symptoms, cocaine use, antianxiety medication use, antidepressant medication use, and criminal offence arrest were associated with positive ADHD screen. For women, distress, cocaine use, antianxiety medication use, antidepressant medication use, pain medication use, and motor vehicle collision in the past year were associated with positive ADHD screen. Conclusions. ADHD symptoms are associated with adverse medical and social outcomes that are in some cases gender specific.

Alcohol: Pharmacology and Disposition

Alcohol is the most common drug detected in forensic cases, is often associated with increased aggression and other disinhibitory behaviors in criminal matters, and frequently contributes to the cause of death in medical examiner cases. Significant adverse effects of alcohol generally manifest at blood alcohol concentrations above 100 mg/dL. In postmortem cases, a number of factors can affect the accuracy of the blood measurement, including site of sampling and putrefactive formation. This paper provides an overview of the pharmacology, pharmacokinetics, and interpretation of alcohol and its concentrations in key specimens, with application to forensic medical cases.

Reaction times of young alcohol-impaired drivers

Young individuals who drive under the influence of alcohol have a higher relative risk of crash involvement; as such, the literature has extensively investigated the factors affecting such involvement through both post-accident surveys and simulator experiments. The effects of differentiated breath alcohol concentrations (BrAC) on young driver behavior, however, have been largely unaddressed, mainly as a result of the difficulty in collecting the necessary data. We explore young driver behavior under the influence of alcohol using a driving simulator experiment where 49 participants were subjected to a common pre-defined dose of alcohol consumption. Comparing reaction times before and after consumption allows for interesting insights and suggestions regarding policy interventions. As expected, the results indicate that increased reaction times before consuming alcohol strongly affect post-consumption reaction times, while increased BrAC levels prolong reaction times; a 10% increase in BrAC levels results in a 2% increase in reaction time. Interestingly, individuals with faster alcohol absorption times perform better regardless of absolute BrAC level, while recent meals lead to higher reaction times and regular exercising to lower.

Alcohol use disorders and mortality: a systematic review and meta-analysis

AIMS

To conduct a systematic review and meta-analysis on all-cause mortality in people with alcohol use disorders.

METHODS

Using the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines, studies were identified through MEDLINE, EMBASE, and Web of Science up to August, 2012. Prospective and historical cohort studies including a comparison of alcohol use disorder with a control group investigating all-cause mortality risk were included.

RESULTS

This meta-analysis included 81 observational studies with 221 683 observed deaths among 853 722 people with alcohol use disorder. In men, the relative risk (RR) among clinical samples was 3.38 (95% confidence interval [CI]: 2.98-3.84); in women it was 4.57 (95% CI: 3.86-5.42). Alcohol use disorders identified in general population surveys showed a twofold higher risk compared with no alcohol use disorder in men; no data were available for women. RRs were markedly higher for those ≤40 years old (ninefold in men, 13-fold in women) while still being at least twofold among those aged 60 years or older.

CONCLUSIONS

Mortality in people with alcohol use disorders is markedly higher than thought previously. Women have generally higher mortality risks than men. Among all people with alcohol use disorders, people in younger age groups and people in treatment show substantially higher mortality risk than others in that group.

Prevalence and key covariates of non-medical prescription opioid use among the general secondary student and adult populations in Ontario, Canada

INTRODUCTION AND AIMS

To assess the prevalence and key covariates of non-medical prescription opioid use (NMPOU) in two representative surveys of adults (Centre for Addiction and Mental Health Monitor, CM) and secondary-school students (Ontario Student Drug Use and Health Survey, OSDUHS).

DESIGN AND METHODS

Data from the 2010 and 2011 cycles (n = 4023) of CM--a stratified, multi-stage, random-digit-dialling telephone survey of adults (18 years and older)--and the 2011 cycle of OSDUHS (n = 3266)--a self-administered written questionnaire-based survey of grade 7-12 public system students--were used. Besides NMPOU prevalence, associations were assessed by univariate and multi-step multivariate (logistic regression) analyses. NMPOU and key socioeconomic (i.e. sex, age, Aboriginal ethnicity, household location, income, subjective social status), health indicators (physical health status, psychological distress, suicidal ideation), drug use (cigarette smoking, binge drinking, cannabis use, other drug use) were measured.

RESULTS

NMPOU (past year) prevalence was 15.5% in students and 5.9% in adults. Various univariate associations with social, health and drug use factors were found in both populations, with differences by sex. Based on multivariate analyses, other drug use (male students) and rural residence, subjective social status, other drug use and suicidal ideation (female students); marital status and cannabis use (male adults) and binge drinking (female adults) were independently associated with NMPOU in the respective study populations.

DISCUSSION AND CONCLUSIONS

NMPOU was high in adults and especially students. Independent predictors of NMPOU were largely inconsistent by sex. Notably, NMPOU is widely distributed across socio-demographic and -economic strata, and thus requires broad-based interventions.

Street racing video games and risk-taking driving: An Internet survey of automobile enthusiasts

PURPOSE

The purpose of this study was to examine the relationships among risky driving attitudes, self-perceptions as a risky driver, playing of "drive'em up" (which rewarded players for frequent traffic and other violations) and "circuit" racing video games as well as self-reported risky driving through a web-based survey of car and racing club members in relation to a socio-cognitive model of the effects of racing video game playing.

METHOD

An Internet questionnaire was developed and included: (1) self-perceptions as a risky driver scales (Driver Thrill Seeking and Competitive Attitude Toward Driving); (2) attitudes regarding street racing; (3) street racing video game playing, and (4) self-reported risky driving (Risk-Taking Driving Scale). A sequential logistic regression was performed entering age and driving exposure as control variables in the first block, self-perceptions as a risky driver in the second block, attitudes in the third block and playing "drive'em up" and "circuit" racing games in the last block to examine their effects on self-reported risk-taking driving.

RESULTS

A total of 503 survey respondents were included in the analyses and only 20% reported any risk-taking driving. Higher score on the Competitive Attitude Toward Driving Scale, more positive attitudes toward street racing, and more frequent reported playing of "drive'em up" video games were associated with higher odds on the self-reported Risk-Taking Driving Scale. However, the Driver Thrill Seeking Scale and "circuit" video game playing failed to predict self-reported risk-taking driving.

CONCLUSIONS

Self-perceptions as a risky driver, positive attitudes toward risky driving and "drive'em up" street-racing games, but not "circuit" racing games, are associated with increased risk-taking driving. These findings are congruent with experimental studies in which games that reward driving violations increased risk taking, suggesting that risk taking may be a function of type of street racing game played by affecting self-perceptions as a risky driver.

Examining the link between collision involvement and cocaine use

BACKGROUND

Cocaine is one of the more commonly found illicit drugs in injured drivers. In this work, we examine the association between self-reported past year cocaine use and past year collision involvement in a large representative sample of adult drivers in Ontario.

METHODS

Data are based on the CAMH Monitor, an ongoing cross-sectional telephone survey of Ontario adults aged 18 and older. Five years of data (2002, 2003, 2004, 2006, 2008) were merged for this study (N=8107) due to survey item availability. Logistic regression analysis was performed to identify the risk of self-reported collision involvement within the past 12 months associated with past year use of cocaine, while controlling for sociodemographic, driving exposure and drinking-driving (as a function of drinking status) factors. Due to listwise deletion, the logistic regression model was based on a reduced sample (N=7284).

RESULTS

The prevalence of self-reported collision involvement within the past year was 18.9% among those who used cocaine in the past year compared to 7.4% of non-users. Logistic regression analysis, controlling for the potential confounding effects of age, gender, income, driving exposure and drinking-driving measures, found the odds of collision involvement in the preceding year among cocaine users was over twice that of non-users (OR=2.11, 95% CI=1.06-4.18).

CONCLUSIONS

This study suggests that cocaine users are significantly more likely to report collision involvement in the past year. Additional work to confirm these observations, and to assess possible causal pathways, is needed.

Does gender moderate the relationship between driver aggression and its risk factors?

AIM

The current study assessed gender as a potential moderator of the relationship between self-reported driver aggression and various demographic variables, general and driving-related risk factors.

METHODS

Using data from a general-population telephone survey conducted from July 2002 through June 2005, two approaches to binary logistic regression were adopted. Based on the full dataset (n=6259), the initial analysis was a hierarchical-entry regression examining self-reported driver aggression in the last 12 months. All demographic variables (i.e., gender, age, income, education, marital status), general risk factors (i.e., psychological distress, binge drinking, cannabis use), and driving-related risk factors (i.e., driving exposure, stressful driving, exposure to busy roads, driving after drinking, driving after cannabis use) were entered in the first block, and all two-way interactions with gender were entered stepwise in the second block. The subsequent analysis involved dividing the sample by gender and conducting logistic regressions with main effects only for males (n=2921) and females (n=3338) separately.

RESULTS

Although the prevalence of driver aggression in the current sample was slightly higher among males (38.5%) than females (32.9%), the difference was small, and gender did not enter as a significant predictor of driver aggression in the overall logistic regression. In that analysis, difficulty with social functioning and being older were associated with a reduced risk of driver aggression. Marital status and education were unrelated to aggression, and all other variables were associated with an increased risk of aggression. Gender was found to moderate the relationships between driver aggression and only three variables: income, psychological distress, and driving exposure. Separate analyses on the male and female sub-samples also found differences in the predictive value of income and driving exposure; however, the difference for psychological distress could not be detected using this separate regression approach. The secondary analysis also identified slight differences in the predictive value of four of the risk factors, where the odds ratios for both males and females were in the same direction but only one of the two was statistically significant.

CONCLUSIONS

The results demonstrate the importance of conducting the gender analysis using both regression approaches. With few exceptions, factors that were predictive of driver aggression were generally the same for both male and female drivers.