Reducing the legal blood alcohol concentration limit for driving in developing countries: a time for change? Results and implications derived from a time-series analysis (2001-10) conducted in Brazil

Effectiveness of road safety interventions: An evidence and gap map

Background

Road Traffic injuries (RTI) are among the top ten leading causes of death in the world resulting in 1.35 million deaths every year, about 93% of which occur in low- and middle-income countries (LMICs). Despite several global resolutions to reduce traffic injuries, they have continued to grow in many countries. Many high-income countries have successfully reduced RTI by using a public health approach and implementing evidence-based interventions. As many LMICs develop their highway infrastructure, adopting a similar scientific approach towards road safety is crucial. The evidence also needs to be evaluated to assess external validity because measures that have worked in high-income countries may not translate equally well to other contexts. An evidence gap map for RTI is the first step towards understanding what evidence is available, from where, and the key gaps in knowledge.

Objectives

The objective of this evidence gap map (EGM) is to identify existing evidence from all effectiveness studies and systematic reviews related to road safety interventions. In addition, the EGM identifies gaps in evidence where new primary studies and systematic reviews could add value. This will help direct future research and discussions based on systematic evidence towards the approaches and interventions which are most effective in the road safety sector. This could enable the generation of evidence for informing policy at global, regional or national levels.

Search Methods

The EGM includes systematic reviews and impact evaluations assessing the effect of interventions for RTI reported in academic databases, organization websites, and grey literature sources. The studies were searched up to December 2019.

Selection Criteria

The interventions were divided into five broad categories: (a) human factors (e.g., enforcement or road user education), (b) road design, infrastructure and traffic control, (c) legal and institutional framework, (d) post-crash pre-hospital care, and (e) vehicle factors (except car design for occupant protection) and protective devices. Included studies reported two primary outcomes: fatal crashes and non-fatal injury crashes; and four intermediate outcomes: change in use of seat belts, change in use of helmets, change in speed, and change in alcohol/drug use. Studies were excluded if they did not report injury or fatality as one of the outcomes.

Data Collection and Analysis

The EGM is presented in the form of a matrix with two primary dimensions: interventions (rows) and outcomes (columns). Additional dimensions are country income groups, region, quality level for systematic reviews, type of study design used (e.g., case-control), type of road user studied (e.g., pedestrian, cyclists), age groups, and road type. The EGM is available online where the matrix of interventions and outcomes can be filtered by one or more dimensions. The webpage includes a bibliography of the selected studies and titles and abstracts available for preview. Quality appraisal for systematic reviews was conducted using a critical appraisal tool for systematic reviews, AMSTAR 2.

Main Results

The EGM identified 1859 studies of which 322 were systematic reviews, 7 were protocol studies and 1530 were impact evaluations. Some studies included more than one intervention, outcome, study method, or study region. The studies were distributed among intervention categories as: human factors (n = 771), road design, infrastructure and traffic control (n = 661), legal and institutional framework (n = 424), post-crash pre-hospital care (n = 118) and vehicle factors and protective devices (n = 111). Fatal crashes as outcomes were reported in 1414 records and non-fatal injury crashes in 1252 records. Among the four intermediate outcomes, speed was most commonly reported (n = 298) followed by alcohol (n = 206), use of seatbelts (n = 167), and use of helmets (n = 66). Ninety-six percent of the studies were reported from high-income countries (HIC), 4.5% from upper-middle-income countries, and only 1.4% from lower-middle and low-income countries. There were 25 systematic reviews of high quality, 4 of moderate quality, and 293 of low quality.

Authors' Conclusions

The EGM shows that the distribution of available road safety evidence is skewed across the world. A vast majority of the literature is from HICs. In contrast, only a small fraction of the literature reports on the many LMICs that are fast expanding their road infrastructure, experiencing rapid changes in traffic patterns, and witnessing growth in road injuries. This bias in literature explains why many interventions that are of high importance in the context of LMICs remain poorly studied. Besides, many interventions that have been tested only in HICs may not work equally effectively in LMICs. Another important finding was that a large majority of systematic reviews are of low quality. The scarcity of evidence on many important interventions and lack of good quality evidence-synthesis have significant implications for future road safety research and practice in LMICs. The EGM presented here will help identify priority areas for researchers, while directing practitioners and policy makers towards proven interventions.

Impact of the program life in traffic and new zero-tolerance drinking and driving law on the prevalence of driving after alcohol abuse in Brazilian capitals: An interrupted time series analysis

INTRODUCTION

Driving under the influence of alcohol is one of the main factors for morbidity and mortality from traffic accidents. In 2010 and 2013, the Program Life in Traffic was implemented in Brazil, including the international initiative "Road Safety in Ten Countries", which established actions to reduce one of the main risk factors for road traffic injuries, the driving under the influence of alcohol. In 2012, a new zero-tolerance drinking and driving law (new dry law) was implemented, establishing a zero-tolerance limit for the drivers' blood alcohol concentration, and increasing punitive measures. This study aimed at analyzing the impact of these measures on the prevalence of driving under the influence of alcohol abuse in Brazilian capitals.

METHODS

An interrupted time series study was conducted using the models of autoregressive integrated moving average or seasonal autoregressive integrated moving average. The main outcome was the prevalence of driving after alcohol abuse in the adult population (≥ 18 years). The model's predictors were the interventions "Program Life in Traffic" and "New Dry Law". The former was implemented in the first quarter of 2011, initially in five capitals: Belo Horizonte, Campo Grande, Palmas, Teresina, and Curitiba, being expanded to the other capitals in the first quarter of 2013. The latter was implemented in the country on the first quarter of 2013. Data source for the study was the records of the surveillance system for risk and protection factors of chronic diseases through telephone survey (Vigitel) from 2007 to 2016.

RESULTS

The time intervals considered in the study were the quarters. Thirty-eight units were considered in the analysis, corresponding to time series points. It was found that after the implementation of the Program Life in Traffic, in the first quarter of 2011, there was a reduction in the prevalence in Belo Horizonte and Curitiba. Because the introduction of the New Dry Law and the Program Life in Traffic took place in similar periods in the other cities, there was a significant reduction in the outcome prevalence in the cities of Aracaju, Belo Horizonte, Boa Vista, Fortaleza, João Pessoa, Maceió, Manaus, Palmas, Porto Alegre, Recife, Teresina, Rio Branco, and Vitória following the law application.

CONCLUSION

The present study identified an immediate impact of the Program Life in Traffic in two capitals (Belo Horizonte and Curitiba) and a joint impact of the New Dry Law in 13 capitals. The results of this study have implications for strengthening interventions aimed at reducing the burden of morbidity and mortality from traffic accidents in Brazil.

The absence of data on driving under the influence of alcohol in road traffic studies: a scoping review of non-randomized studies with vote counting based on the direction of effects of alcohol policies

BACKGROUND

Data on driving under the influence of alcohol (DUIA) are not always available, accurate, or reliable, making it difficult to study the effects of alcohol policies on road traffic outcomes. The objectives of our study were twofold: 1) to describe how road traffic outcomes of alcohol policies are assessed when DUIA data are missing, and 2) to explore the effects of alcohol policies when DUIA data are missing.

METHODS

We conducted a scoping review of non-randomized studies that assessed the road traffic outcomes of alcohol policies when DUIA data are missing. Until November 2021, we searched studies published between 2000 and 2021, in English or French, via MEDLINE, APA PsycInfo, CINAHL, and SocINDEX. We assessed the risk of bias in the included studies with the Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group. The selection process, data extraction, and the risk of bias assessment were conducted independently and in duplicate. We used vote counting based on the direction of the effects of alcohol policies as a synthesis method. The protocol for this review was published in PROSPERO under record number CRD42021266744.

RESULTS

Twenty-four eligible studies were included. Regarding objective 1, most studies used uncontrolled interrupted time series designs to assess road traffic fatalities resulting from night-time crashes. The reasons for missing DUIA data were generally not reported. Regarding objective 2, we found evidence for an association between alcohol policies and decreased road traffic fatalities. Subgroup analyses found no evidence for an association between methodological modifiers and positive effect directions for road traffic fatalities.

CONCLUSION

Caution is needed when interpreting road traffic outcomes associated with alcohol policies when DUIA data are missing. Greater efforts should be made to improve the reporting of outcomes assessments. Future studies must address several methodological issues (e.g., more granular data, well-defined intervention and implementation, and controlled designs). Our results should be compared to those from others reviews where DUIA data were available to confirm or recalibrate the associations found in studies where DUIA data were missing.

Evaluation of the national sobriety checkpoints program in Mexico: a difference-in-difference approach with variation in timing of program adoption

BACKGROUND

Up to a third of global road traffic deaths, and one in five in Mexico, are attributable to alcohol. In 2013, Mexico launched a national sobriety checkpoints program designed to reduce drink-driving in municipalities with high rates of alcohol-related collisions. Our study measured the association between the sobriety checkpoints program and road traffic mortality rates in 106 urban municipalities.

METHODS

We leveraged data from the Salud Urbana en America Latina (SALURBAL), which compiles health and environmental data from cities with over 100,000 residents. Death data from 2005 to 2019 (i.e., outcome) were from official vital statistics. Among 106 Mexican municipalities defined as priority areas for intervention, 54 adopted the program (i.e., treatment) in 2013, 16 municipalities did so in 2014, 16 in 2015, 10 in 2016, 7 in 2017, and 2 in 2019. We used a difference-in-difference approach with inverse probability weighting adapted to a context where program adoption is staggered over time.

RESULTS

There was a 12.3% reduction in road traffic fatalities per 10,000 passenger vehicles in the post-treatment period compared to the pre-treatment period (95% Confidence Interval, - 17.8; - 6,5). There was a clear trend of decline in mortality in municipalities that adopted the program (vs. comparison) particularly after year 2 of the program.

CONCLUSIONS

In this study of 106 municipalities in Mexico, we found a 12.3% reduction in traffic fatalities associated with the adoption of sobriety checkpoints. There was a clear trend indicating that this association increased over time, which is consistent with sustained changes in drink-driving behavior. These findings provide support and insight for efforts to implement and evaluate the impact of sobriety checkpoint policies across Latin America.

An assessment of the non-fatal crash risks associated with substance use during rush and non-rush hour periods in the United States

BACKGROUND

Understanding how substance use is associated with severe crash injuries may inform emergency care preparedness.

OBJECTIVES

This study aims to assess the association of substance use and crash injury severity at all times of the day and during rush (6-9 AM; 3-7 PM) and non-rush-hours. Further, this study assesses the probabilities of occurrence of low acuity, emergent, and critical injuries associated with substance use.

METHODS

Crash data were extracted from the 2019 National Emergency Medical Services Information System. The outcome variable was non-fatal crash injury, assessed on an ordinal scale: critical, emergent, low acuity. The predictor variable was the presence of substance use (alcohol or illicit drugs). Age, gender, injured part, revised trauma score, the location of the crash, the road user type, and the geographical region were included as potential confounders. Partially proportional ordinal logistic regression was used to assess the unadjusted and adjusted odds of critical and emergent injuries compared to low acuity injury.

RESULTS

Substance use was associated with approximately two-fold adjusted odds of critical and emergent injuries compared to low acuity injury at all times of the day and during the rush and non-rush hours. Although the proportion of substance use was higher during the non-rush hour period, the interaction effect of rush hour and substance use resulted in higher odds of critical and emergent injuries compared to low acuity injury.

CONCLUSION

Substance use is associated with increased odds of critical and emergent injury severity. Reducing substance use-related crash injuries may reduce adverse crash injuries.

Evidence From the Decade of Action for Road Safety: A Systematic Review of the Effectiveness of Interventions in Low and Middle-Income Countries

Objectives: To evaluate the effectiveness of road safety interventions in low and middle-income countries (LMICs), considering the principles of systems theory presented in the Global Plan for the Decade of Action for Road Safety.

Methods: We conducted a systematic review according to PRISMA guidelines. We searched for original research studies published during 2011–2019 in the following databases: Medline, Embase, PsycInfo, Scopus, Web of Science, Cochrane library, Global Health Library, ProQuest and TRID. We included studies conducted in LMICs, evaluating the effects of road traffic safety interventions and reporting health-related outcomes.

Results: Of 12,353 non-duplicate records, we included a total of 33 studies. Most interventions were related to legislation and enforcement (n = 18), leadership (n = 5) and speed management (n = 4). Overall, legislation and enforcement interventions appear to have the largest impact. Few studies were found for road infrastructure, vehicle safety standard and post crash response interventions.

Conclusion: Based on the currently available evidence, legislation and enforcement interventions appear most impactful in LMICs. However, many interventions remain understudied and more holistic approaches capturing the complexity of road transport systems seem desirable.

Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=197267, identifier CRD42020197267.

Alcohol and Alcohol Combined with Texting: Evaluation of Driving Impairment Effects in a Closed-Course Section

OBJECTIVE

Examine the driving impairment effects of alcohol alone and of alcohol combined with texting.

METHODS

Fifteen drivers (nine male, six female; mean age: 31.1 ± 6.9 years, range: 23 to 43 years) with similar drinking habit (i.e., social drinkers) completed a lap in a closed-course section in six different situations: (I) sober; (II) sober and while texting; (III) 30 minutes after ingesting a moderate dose of ethanol (0.50 g/kg); (IV) 30 minutes after drinking and while texting; (V) 60 minutes after drinking, (VI) 60 minutes after drinking and while texting. Driving performance was analyzed by means of maximum and mean speed, braking time and braking distance; and ability to control the car (i.e., evaluating if the drivers hit a traffic cone or exceeded the boundaries of the course). P values of < 0.05 were considered significant.

RESULTS

Pre and post-alcohol consumption results show a significant increase concerning the drivers' mean and maximum speed after drinking (p < 3.2x10^-8). However, neither alcohol nor texting had significant effects on braking parameters (p > 0.05). Traffic cones were knocked down only in texting experiments. In addition, when using the cell phone drivers tended to reduce the speed, and to accelerate abruptly right after they finish texting.

CONCLUSION

Our findings strengthen the hypothesis that even moderate alcohol doses may significantly impair the driving performance. Additionally, alcohol and texting have complementary effects on driving impairment, and their combination represents a significant risk factor for crashes.

Impact of the Dry Law on road traffic mortality in Brazilian states: an interrupted time series analysis

OBJECTIVE

To assess the impact of 2008 Public Law number 11,705, also known as Dry Law (DL-08), on mortality from road traffic accidents (RTA), in each of the 27 Brazilian Federative Units (BFUs).

METHODS

Ecological study of interrupted time series with RTA data from 2002 to 2015, totalizing 168 months. Data were obtained from the Mortality Information System, the Brazilian Institute of Geography and Statistics, and from the National Traffic Department. Autoregressive integrated moving average (ARIMA) models were adjusted to assess the impact of DL-08 in each BFUs.

RESULTS

After the implementation of the DL-08, there was a significant decrease in mortality from RTA in the state of Santa Catarina (pre DL-08 = 2.60 ± 0.30 and post DL-08 = 2.32 ± 0.35; p < 0.001) and in the Federal District (pre DL-08 = 2.22 ± 0.40 and post DL-08 = 1.76 ± 0.35; p = 0.002), a significant increase in mortality in the states of Acre, Amazonas, Rondônia, Maranhão, Piauí, Ceará, Rio Grande do Norte, Paraíba, Pernambuco, Alagoas, Sergipe and Mato Grosso, and a stability in the other states. The sensitivity analysis conducted over a shorter time series with 24 months showed results similar to those obtained with the 168-month series for most of the 27 BFUs.

CONCLUSION

The DL-08 had a heterogeneous impact on mortality from traffic accidents on BFUs.

Did "Conduce Sin Alcohol" a Program that Monitors Breath Alcohol Concentration Limits for Driving in Mexico City Have an Effect on Traffic-Related Deaths?

In September 2003, Mexico City introduced "Conduce sin Alcohol" (CSA)-drive without alcohol-a program that monitors breath alcohol concentration limits among drivers to reduce road traffic crashes. To our knowledge, no study has evaluated the impact of this program on mortality. We estimated the effect of CSA on the monthly rate of traffic-related deaths (deaths per one million people) in Mexico City. We applied interrupted time series analyses (ITSA) using monthly data from 1998 to 2016, adjusting for number of people covered by a public health insurance, monthly number of public health care facilities in the city, monthly average rain precipitation in milliliters, and number of vehicles registered. Our results show a statistically significant average reduction in the monthly trend of traffic-related deaths of 0.08 per 1 million people/per month after the program was implemented relative to the pre-intervention trend. The relative difference comparing pre- and post-intervention predicted values from the ITSA model shows that there was a 23.2% reduction in the fatality rate. Findings from this study can be used to scale up programs to monitor alcohol concentration limits among drivers in cities with high alcohol-related crashes and deaths where the program has not been implemented.

Analysis of gaps in alcohol policies in Brazil using the Pan American Health Organization's Alcohol Policy Scoring

BACKGROUND

National alcohol policies need to be systematized and evaluated to identify the gaps that should be filled by future laws. This study aims to search for and classify Brazilian public alcohol policies at the federal and state levels, based on the ten Alcohol Policy Scoring (APS) domains used by the Pan American Health Organization (PAHO), to identify any gaps METHODS: Documental research was carried out in two phases: document identification and content analysis. The search included laws, decrees, and ordinances for alcohol referred to in this text as regulatory documents (RD), enacted until December 31, 2019, in Brazil and its 26 states and the Federal District. The APS was used to classify and score the RD, which consists of ten policy domains (including pricing, availability, marketing, and health services), weighted according to the level of scientific evidence of each strategy RESULTS: We identified and categorized 435 valid RD (21 national laws and 414 state laws). Overall, Brazilian alcohol policies account for 51.6% (255/494) of the APS score. In the pricing policy domain, the second most robust indicator of the APS, the policy gap reached 87% in 25 states, demonstrating a weakness. Only the federal laws against drink-driving include all the recommended dimensions. There are important legislative contradictions in the definition of an alcoholic beverage and in the content of the policies to control marketing CONCLUSION: At the national level, the federal government adopted alcohol policies in several of the PAHO policy domains but enacted RD with little practical effect. At the subnational level, despite the autonomy to complement federal laws, the states have not yet addressed the most important gaps.

Assessment of the impact of implementation of a zero blood alcohol concentration law in Uruguay on moderate/severe injury and fatal crashes: a quasi-experimental study

BACKGROUND AND AIMS

Debates regarding lowering the blood alcohol concentration (BAC) limit for drivers are intensifying in the United States and other countries, and the World Health Organization recommends that the limit for adults should be 0.05%. In January 2016, Uruguay implemented a law setting a zero BAC limit for all drivers. This study aimed to assess the effect of this policy on the frequency of moderate/severe injury and fatal traffic crashes.

DESIGN

A quasi-experimental study in which a synthetic control model was used with controls consisting of local areas in Chile as the counterfactual for outcomes in Uruguay, matched across population counts and pre-intervention period outcomes. Sensitivity analyses were also conducted.

SETTING

Uruguay and Chile.

CASES

Panel data with crash counts by outcome per locality-month (2013-2017).

INTERVENTION AND COMPARATOR

A zero blood alcohol concentration law implemented on 9 January 2016 in Uruguay, alongside a continued 0.03 g/dl BAC threshold in Chile.

MEASUREMENTS

Per-capita moderate/severe injury (i.e. moderate or severe), severe injury and fatal crashes (2013-2017).

FINDINGS

Our base synthetic control model results suggested a reduction in fatal crashes at 12 months [20.9%; P-value = 0.018, 95% confidence interval (CI) = -0.340, -0.061]. Moderate/severe injury crashes did not decrease significantly (10.2%, P = 0.312, 95% CI = -0.282, 0.075). The estimated effect at 24 months was smaller and with larger confidence intervals for fatal crashes (14%; P = 0.048, 95% CI = -0.246, -0.026) and largely unchanged for moderate/severe injury crashes (-9.4%, P = 0.302, 95% CI = -0.248, 0.058). Difference-in-differences analyses yielded similar results. As a sensitivity test, a synthetic control model relying on an inferior treatment-control match pre-intervention (measured by mean squared error) yielded similar-sized differences that were not statistically significant.

CONCLUSIONS

Implementation of a law setting a zero blood alcohol concentration threshold for all drivers in Uruguay appears to have resulted in a reduction in fatal crashes during the following 12 and 24 months.

Maxillofacial trauma in the gulf countries: a systematic review

PURPOSE

The objective of this review was to determine the prevalence, major causative factors and the most common sites of Maxillofacial Trauma in the Gulf Cooperation Council (GCC) Countries.

METHODS

All articles that were published in the English language in the databases such as Google Scholar, EBSCO, PubMed, NCBI, Medline, COCHRANE, ELSEVIER and SCOPUS were reviewed for MFT from GCC during the last 23 years.

RESULTS

A total of 19,151 patients (16,567 males and 2584 females) (86-14%) with an age range between 0 and 97 years were included in the study. In all of the Gulf countries males outnumber females in terms of maxillofacial injuries with a ratio of 6.4:1. The mandible was the most common site of trauma followed by the maxilla. Road Traffic Accidents (RTA) was the most common cause of injury in the GCC followed by falls.

CONCLUSION

Maxillofacial injuries are highly prevalent, distributed among the Gulf countries, and is mainly caused by RTAs especially among males who are highly prone to MFT in the gulf. The reasons are due to lack of road safety culture and weak enactment of traffic legislation, other possible factors include intrinsic car safety features, high speed driving and the amount/use of highways in these societies.

Comprehensive analysis of alcohol policies in the Latin America and the Caribbean

INTRODUCTION

The aim of this paper is to describe the context of alcohol use and problems in Latin America and the Caribbean (LAC), the environmental context for alcohol-related policy, drinking trends, harm and policy and to systematically review policies implemented to reduce alcohol-related burden.

METHODS

LAC-based studies relating to the existence and effects of public health-oriented alcohol policies are described. The review is informed by a literature search of alcohol policies in LAC in English and in Spanish in several platforms, and in publications of international organisations, including grey and scientific literature.

RESULTS

Only 30 documents measuring policy impact were identified for the policy analysis. Most of the policies are focused on brief interventions, and most have little evidence on their effectiveness. Alcohol taxation and drink-driving policies appear to have the highest impact if enforcement is adequately performed.

DISCUSSION AND CONCLUSIONS

The studies reviewed indicate a pattern of modelling policy interventions but implementing only a few, and a paucity of sustained or systematic evaluations. Although patterns of use indicate alcohol use should be a major public health priority, only a few countries in LAC have a national policy or plan dedicated to alcohol, representing a low political commitment to considering alcohol as a public health priority.

Vulnerable road-user deaths in Brazil: a Bayesian hierarchical model for spatial-temporal analysis

Reducing the road traffic injuries burden is relevant to many sustainable development goals (SDG), in particular SDG3 - to establish good health and well-being. To describe the spatial-temporal trends and identify hotspot regions for fatal road traffic injuries, a Bayesian hierarchical Poisson model was used to analyze data on vulnerable road users (bicyclist, motorcyclist and pedestrians) in Brazil from 1999 to 2016. During the study period, mortality rates for bicyclists remained almost unchanged (0.6 per 100,000 people) but rose dramatically for motorcyclists (from 1.0 in 1999 to 6.0 per 100,000 people in 2016) and decreased for pedestrians (from 6.3 to 3.0 per 100,000 people). Spatial analyses accounting for socio-economic factors showed that the central and northeastern microregions of Brazil are hotspot areas for fatal injuries among motorcyclists while the southern areas are for pedestrians.

Prevalence and Factors Associated with Driving Under the Influence of Alcohol in Brazil: An Analysis by Macroregion

Objective: To analyze the prevalence and factors associated with driving under the influence of alcohol (DUIA) in Brazil, according to macroregion. Methods: A cross-sectional study was conducted using data from individuals aged 18 years or older who participated in the 2013 National Health Survey in Brazil. Subjects were selected by probabilistic sampling and interviewed through home visits. Prevalence of DUIA was estimated according to the number of drivers and/or motorcyclists who reported consuming alcohol in the previous 30 days (n = 9537). Poisson regression was used to analyze the factors associated with DUIA to Brazil and in each macroregion of the country. Results: The prevalence of DUIA was 27.5%, 29.4%, 29.6%, 22.9%, and 20.8% in the North, Northeast, Central-West, South, and Southeast macroregions, respectively. The overall prevalence of Brazil was 24.3%. In most macroregions, the main predictors of DUIA were male sex, high educational level, living in outside the capital or metropolitan regions (other regions), and binge drinking in the previous 30 days. Depression was a predictor in Brazil and two macroregions. Conclusion: A high prevalence of DUIA was observed in Brazil, especially in the Central-West, Northeast and, North macro-regions. Factors associated with DUIA can be incorporated to develop effective interventions to reduce this behavior in Brazil.

Drink driving and speeding in Sao Paulo, Brazil: empirical cross-sectional study (2015-2018)

OBJECTIVES

To evaluate the prevalence of drink driving and speeding during 2015-2018 in Sao Paulo, Brazil.

DESIGN

Cross-sectional observational study.

SETTING

Roads representing the five main regions of the city of Sao Paulo in Brazil, one of the world's largest urban areas.

PARTICIPANTS

Drivers (N=10 294) stopped at routine roadside breath testing checkpoints and those driving in selected roads for speeding measurement (N=414 664).

PRIMARY AND SECONDARY OUTCOME MEASURES

Microwave radar guns were used to measure the speed of vehicles, while the prevalence of drivers under the influence of alcohol was observed in police checkpoints. Data were collected during three consecutive years (2016-2018) following a baseline study established in 2015 using a city-level representative sample of observational data representing all days of the week.

RESULTS

Alcohol-related fatalities kept at a constantly high percentage, with 39% of road traffic deaths involving alcohol in 2016. Drivers testing above the legal breath alcohol concentration limit showed a decreasing trend, from 4.1% (95% CI 2.9% to 5.5%) at baseline to 0.6% (95% CI 0.2% to 1.2%) in the end of 2018 (p<0.001); however, more than half of drivers refused breath tests at checkpoints despite steep legal penalties. The prevalence of speeding among all vehicles decreased from 8.1% (95% CI 7.9% to 8.2%) to 4.9% (95% CI 4.7% to 5.1%) by the end of 2016 (p<0.001), but then increased again to 13.5% (95% CI 13.2% to 13.9%) at the end of the study period (p<0.001).

CONCLUSIONS

Drink driving rates have reduced, likely due to an increase in drivers refusing breath alcohol tests, while speeding rates have increased significantly by the end of the study period, particularly among motorcycles. Future strategies aiming at reducing road traffic injuries in the major Brazilian city should tailor drink driving and speeding enforcement based on the new evidence provided here.

Comparison of traffic data and blood alcohol concentration among fatally injured drivers in Norway and Sao Paulo, Brazil, 2005-2015

Objective: Road traffic crashes (RTCs) are responsible for a large number of deaths worldwide, but low- and middle-income countries frequently present higher rates of deaths; for example, Norway, a high-income country, has a rate of 2.0 drivers killed per 100,000 inhabitants, whereas Brazil, a middle-income country, has a rate of 18.4. A significant fraction of RTCs are related to use of psychoactive substances, especially alcohol, due to its availability, legality, and relatively low price. The aim of the present study was to evaluate differences in alcohol-related fatal RTCs in Sao Paulo, the largest city in Brazil, and Norway during an 11-year period (2005-2015). Methods: The authors compared databases of drivers killed in RTCs in Sao Paulo and in Norway, a country renowned for its success in reducing traffic fatalities and keeping them at a low level. Results: In total, 772 victims from Norway (11 years, 2005 to 2015) and 584 victims from Sao Paulo (2 years, 2005 and 2015) were analyzed. Sao Paulo presented higher proportions of motorcycle drivers, men involved in RTCs, and blood alcohol concentration (BAC)-positive cases. The mean BAC for alcohol-positive cases was similar in both sites. For both regions, the percentage of alcohol-positive cases decreased during the study period (from 45.6% to 35.3% in Sao Paulo and from 24.4% to 15.8% in Norway) but remained higher for Sao Paulo. Conclusions: The study shows a different profile of RTC victims and higher alcohol consumption among drivers in Sao Paulo. The differences between the sites can possibly be attributed to public policies regarding traffic safety and alcohol control, which could be further improved by following the Norwegian model in Sao Paulo.

Alcohol Use Disorder among Patients Suffered from Road Collisions in a Vietnamese Delta Province

Traffic collisions have continuously been ranked amongst the top causes of deaths in Vietnam. In particular, drinking has been recognized as a major factor amplifying the likelihood of traffic collisions in various settings. This study aims to examine the relationship between alcohol use and traffic collisions in the current context of Vietnam. A cross-sectional study was conducted on 413 traffic collisions patients in six health facilities in the Thai Binh Province to investigate the level of alcohol consumption and identify factors influencing alcohol use among these patients. The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) scale was used to determine the problematic drinking behavior of the participants. The percentage of patients having problematic drinking was more than 30%. Being male, having a high household income, and working as farmer/worker were risk factors for alcohol abuse. People causing accidents and patients with a traumatic brain injury had a higher likelihood of drinking alcohol before the accidents. This study highlights the necessity of more stringent laws on reducing drink-driving in Vietnam. In addition, more interventions, especially those utilizing mass media like educational campaign of good behavior on social networks, are necessary to reduce alcohol consumption in targeted populations in order to decrease the prevalence and burden of road injuries.

Reduced Road Traffic Injuries for Young People: A Preliminary Investment Analysis

PURPOSE

Deaths and serious injuries from road accidents remain a serious issue in developing countries, including for young people, for whom they are the largest cause of death. This article provides an assessment of interventions to reduce these deaths and injuries for adolescents in 75 developing countries.

METHODS

We draw on new data on deaths and injuries by age, gender, and accident type for the 75 countries and on the road safety experience of developed and, more recently, developing countries. Critical tasks are to identify key interventions in road safety and estimate their impact and cost. We incorporate these impact and cost estimates in a modeling framework to calculate the reduction in deaths and serious injuries achieved out to 2030, relative to the base case. Finally, established methods are used to value the economic and social benefits arising from these reductions, and hence to calculate benefit-cost ratios.

RESULTS

For the unchanged policy case, we estimate that there will be about 3 million deaths and 7.4 million serious injuries from road accidents for persons aged 10-24 years in the 75 countries to 2030. The preferred interventions avert one million of these deaths and 3 million serious injuries, at a cost of $6.5 billion per annum over 2016-2030, or $1.2 per capita across the total population of these countries. After valuing the benefits of the deaths and serious injuries averted, we find a benefit-cost ratio of 7.6 for 2016-2030, but of 9.9 if the interventions continue to 2050.

CONCLUSIONS

Proven methods, suitably adjusted to local conditions, are available to reduce the tragic toll of road accidents in developing countries. These initiatives are likely to have strong economic and social returns, and should be given high priority.

Effect of the zero-tolerance drinking and driving law on mortality due to road traffic accidents according to the type of victim, sex, and age in Rio de Janeiro, Brazil: An interrupted time series study

Objective: The objective of this study was to estimate the effect of the Brazilian zero-tolerance drinking and driving law on mortality rates due to road traffic accidents according to the type of victim, sex, and age. Methods: An interrupted time series design was used to compare yearly mortality rates due to road traffic accidents in Rio de Janeiro, Brazil, before and after the zero-tolerance drinking and driving law came into effect on June 19, 2008. Yearly mortality rates were compared according to the type of victim: pedestrian, cyclist, motorcyclist, and vehicle occupant. We used the Prais-Winsten procedure of autoregression in the analysis of time series; the outcome of this analysis was the annual percentage change in the rates. Overall and stratified analyses were conducted to investigate whether the zero-tolerance drinking and driving law may have had a distributional effect on mortality rates due to road traffic accidents depending on sex and age group; a significance level of P < .01 was accepted. Results: From 1999 to 2016, there were 15,629 deaths due to road traffic accidents in Rio de Janeiro. The effect of the zero-tolerance drinking and driving law on overall mortality rates due to road traffic accidents in Rio de Janeiro was not statistically significant. However, among cyclists and motorcyclists aged ≥60 years and among pedestrians of both sexes and aged ≥20 years, the effect of the zero-tolerance drinking and driving law was to decrease mortality due to road traffic accidents at a yearly rate. Conclusion: There is evidence of reduced mortality rates due to road traffic accidents among cyclists and motorcyclists aged ≥60 years and among pedestrians of both sexes aged ≥20 years in the second major Brazilian capital 9 years after the zero-tolerance drinking and driving law was adopted.

A trauma registry experience from the main referral center of Honduras: A call for action

BACKGROUND

Honduras is one of the most violent countries in the world and it has limited epidemiological data that describes the extent of intentional and unintentional injuries. This research is needed to develop and inform prevention programs in Honduras, as well as to spread international awareness.

METHODS

A cross-sectional study was carried out on a paper-based injury surveillance system (InSS) with the help of Honduras' University Medical School Hospital (UMSH), the main referral medical center in Tegucigalpa-Honduras. Descriptive statistics and bivariate analysis were carried out using data from all registered injuries in 2013.

RESULTS

Of the 17,971 injuries reported, intentional injuries made up 18.14% of all injuries. Interpersonal violence from gun violence, robberies, and physical altercations accounted for 14.68%. Self-inflicted injuries made up 3.46% of injuries, with suicide falls and poison intoxications being the most frequent (1.9% and 1.2%, respectively). Sexual harassment was minimally reported (0.27%, n = 48). Unintentional injuries made up 81.79% of the total injuries. The most common causes of unintentional injuries were falls (38.01%) and road traffic injuries (16.65%). Motorocyclists made up 35.4% of those injured by road traffic accidents. In general, injuries occured during the weekend and mainly affected men during the ages when they would be most likely to work and maintain jobs. The modified Kampala trauma score (M-KTS) showed that most of the injuries were mild (range 3-11), with 59.59% of the patients with a M-KTS of 9, and an overall mortality rate of 0.65% (n = 117).

CONCLUSION

The description of injuries provides the basis for prevention. The disproportionate number of unintentional injuries (4:1) seen in Honduras' referral hospital calls for further research in: 1) trauma care logistics and emergency systems, 2) mortality and lethality of intentional injuries, and 3) analysis of the types of unintentional injuries. Further research is necessary to evaluate interventions and identify the socioeconomic effects of injuries in the region.

Multiple "Lower BAC" offenders: Characteristics and response to remedial interventions

BACKGROUND

In recent years, there has been increasing attention to "lower BAC" drinking drivers, typically those whose blood alcohol content (BAC) is under the legal limits defined in criminal law. In 2009, legislation was enacted in Ontario, Canada that enabled police to issue roadside license suspensions to individuals caught driving with BAC between 0.05% and 0.08%, known as the "warn range". Multiple warn range (MWR) offenders are required to attend the Back on Track (BOT) remedial measures program. This study aimed to provide: (1) a preliminary characterization of MWR drivers charged under warn range legislation; and (2) an initial assessment of outcomes associated with BOT participation among MWR offenders.

METHODS

A subsample of 727 MWR offenders was drawn from program records, and compared to samples of 3597 first-time Criminal Code (CC) offenders (those caught driving with a BAC of 0.08% or higher) and 359 second-time CC offenders. To provide an initial assessment of outcomes associated with BOT participation, another subsample consisted of 394 MWR participants from whom pre- and post-workshop questionnaires were collected and successfully matched using probabilistic matching processes.

RESULTS

Similarities in demographic profile and driving history between MWR and first-time CC participants were apparent. MWR offenders scored higher on risk of problem drinking and drink-driving recidivism than either of the CC offender groups. Second-time CC offenders scored higher on these measures than first-time CC offenders. Following BOT participation, MWR participants demonstrated positive change including improved knowledge of and intentions to avoid drink-driving.

CONCLUSIONS

MWR offenders share a similar demographic profile to that of first-time CC offenders and they report significantly higher risk of problem drinking and recidivism. MWR offenders may include high-functioning problem drinkers who are likely to continue drink-driving and who may escalate to a CC drink-driving offense. Like CC offenders, MWR offenders benefited from BOT participation.

Lives saved by laws and regulations that resulted from the Bloomberg road safety program

OBJECTIVE

To estimate lives saved during 2008-2023 by traffic safety laws passed in six developing countries while participating in the Bloomberg Road Safety Program (BRSP).

METHODS

BRSP-funded local staff identified relevant laws and described enforcement to the study team. We analyzed road crash death estimates for 2004-2013 from the Global Burden of Disease and projected estimates absent intervention forward to 2023. We amalgamated developing country and US literature to estimate crash death reductions by country resulting from laws governing drink driving, motorcycle helmets, safety belt use, and traffic fines.

RESULTS

BRSP helped win approval of traffic safety laws in Brazil, China, Kenya, Mexico, Turkey, and Vietnam. In 2008-2013, those laws saved an estimated 19,000 lives. Many laws only took effect in 2014. The laws will save an estimated 90,000 lives in 2014-2023. Of the 109,000 lives saved, drink driving laws will account for 84%, increased motorcyclist protection for 13%, increased fines and penalty points for 2%, and safety belt usage mandates for 1%. Drink driving reductions in China will account for 56% of the savings and reduced drink driving and motorcycling deaths in Vietnam for 35%. The savings in China will result from a narrow intervention with just 4% estimated effectiveness against drink driving deaths. As a percentage of deaths anticipated without BRSP effort, the largest reductions will be 11% in Vietnam and 5% in Kenya.

CONCLUSIONS

Viewed as a public health measure, improving traffic safety provided large health gains in developing nations.

Alcohol-attributed disease burden and alcohol policies in the BRICS-countries during the years 1990-2013

BACKGROUND

We aimed to assess alcohol consumption and alcohol-attributed disease burden by DALYs (disability adjusted life years) in the BRICS countries (Brazil, Russia, India, China and South Africa) between 1990 and 2013, and explore to what extent these countries have implemented evidence-based alcohol policies during the same time period.

METHODS

A comparative risk assessment approach and literature review, within a setting of the BRICS countries. Participants were the total populations (males and females combined) of each country. Levels of alcohol consumption, age-standardized alcohol-attributable DALYs per 100 000 and alcohol policy documents were measured.

RESULTS

The alcohol-attributed disease burden mirrors level of consumption in Brazil, Russia and India, to some extent in China, but not in South Africa. Between the years 1990-2013 DALYs per 100 000 decreased in Brazil (from 2124 to 1902), China (from 1719 to 1250) and South Africa (from 2926 to 2662). An increase was observed in Russia (from 4015 to 4719) and India (from 1574 to 1722). Policies were implemented in all of the BRICS countries and the most common were tax increases, drink-driving measures and restrictions on advertisement.

CONCLUSIONS

There was an overall decrease in alcohol-related DALYs in Brazil, China and South Africa, while an overall increase was observed in Russia and India. Most notably is the change in DALYs in Russia, where a distinct increase from 1990-2005 was followed by a steady decrease from 2005-2013. Even if assessment of causality cannot be done, policy changes were generally followed by changes in alcohol-attributed disease burden. This highlights the importance of more detailed research on this topic.

Estimation of the Potential Effectiveness of Lowering the Blood Alcohol Concentration (BAC) Limit for Driving from 0.08 to 0.05 Grams per Deciliter in the United States

BACKGROUND

In 2013, the National Transportation Safety Board (NTSB) issued a report recommending that states lower the illegal blood alcohol concentration (BAC) limit for driving from 0.08 to 0.05 g/dl. The NTSB concluded that there is a strong evidence-based foundation for a BAC limit of 0.05 or lower. Most industrialized nations have already enacted a 0.05 illegal BAC limit. This study was undertaken to contribute to the scientific evidence as to whether lowering the BAC limit to 0.05 will be an effective alcohol policy in the United States.

METHODS

We accomplished our objective by: (i) conducting a meta-analysis of qualifying international studies to estimate the range and distribution of the most likely effect size from a reduction to 0.05 BAC or lower; (ii) translating this synthesis toward estimating the effects of reducing the current 0.08 BAC limit to 0.05 in the United States; and (iii) estimating the life-saving benefits of the proposed 0.03 reduction in the driving limit from 0.08 to 0.05 BAC.

RESULTS

In our meta-analysis of studies on lowering the BAC limit in general, we found a 5.0% decline in nonfatal alcohol-related crashes, a 9.2% decline in fatal alcohol-related crashes from lowering the BAC to 0.08, and an 11.1% decline in fatal alcohol-related crashes from lowering the BAC to 0.05 or lower. We estimate that 1,790 lives would be saved each year if all states adopted a 0.05 BAC limit.

CONCLUSIONS

This study provides strong evidence of the relationship between lowering the BAC limit for driving and the general deterrent effect on alcohol-related crashes.

Joinpoint regression analysis to evaluate traffic public health policies by national temporal trends from 2000 to 2015

In the past 16 years, a variety of factors might have impacted traffic accidents in Chile. In order to identify and quantify differential rates of change over time this study employed a novel analytic method to assess temporal trends in traffic morbi-mortality. Overall death and injury rates and associated to alcohol per 100,000 inhabitants were monitored between 2000 and 2015. Joinpoint regression was used to calculate annual percent changes (APCs) and average APCs. Permutation tests were used to determine joinpoints. P < 0.05 was considered statistically significant. The rate of traffic deaths related to alcohol declined from 2006 until 2015 at a rate of 9.53% per year. The rate of traffic injuries related to alcohol decreased at a rate of 4.32% per year since 2008 to 2015. The use of the most sensitive approach to trend analysis brings new ele-ments to form the epidemiological analyses in Chile and similar countries.

Multisectoral Actions for Health: Challenges and Opportunities in Complex Policy Environments

Multisectoral actions for health, defined as actions undertaken by non-health sectors to protect the health of the population, are essential in the context of inter-linkages between three dimensions of sustainable development: economic, social, and environmental. These multisectoral actions can address the social and economic factors that influence the health of a population at the local, national, and global levels. This editorial identifies the challenges, opportunities and capacity development for effective multisectoral actions for health in a complex policy environment. The root causes of the challenges lie in poor governance such as entrenched political and administrative corruption, widespread clientelism, lack of citizen voice, weak social capital, lack of trust and lack of respect for human rights. This is further complicated by the lack of government effectiveness caused by poor capacity for strong public financial management and low levels of transparency and accountability which leads to corruption. The absence of or rapid changes in government policies, and low salary in relation to living standards result in migration out of qualified staff. Tobacco, alcohol and sugary drink industries are major risk factors for non-communicable diseases (NCDs) and had interfered with health policy through regulatory capture and potential law suits against the government. Opportunities still exist. Some World Health Assembly (WHA) and United Nations General Assembly (UNGA) resolutions are both considered as external driving forces for intersectoral actions for health. In addition, Thailand National Health Assembly under the National Health Act is another tool providing opportunity to form trust among stakeholders from different sectors.

Capacity development at individual, institutional and system level to generate evidence and ensure it is used by multisectoral agencies is as critical as strengthening the health literacy of people and the overall good governance of a country.

Evaluating the Brazilian zero tolerance drinking and driving law: Time series analyses of traffic-related mortality in three major cities

OBJECTIVE

A zero tolerance alcohol restriction law was adopted in Brazil in 2008. In order to assess the effectiveness of this intervention, the present study compares specific mortality in 2 time series: 1980-2007 and 2008-2013.

METHODS

Data on mortality and population were gathered from official Brazilian Ministry of Health information systems. Segmented regression analyses were carried out separately for 3 major Brazilian capitals: Belo Horizonte, Rio de Janeiro, and São Paulo.

RESULTS

In 2 cities (Belo Horizonte and Rio de Janeiro) there were no significant changes in mortality rate trends in 2 periods, 1980 to 2007 and 2008 to 2013, where the observed rates did not differ significantly from predicted rates. In São Paulo, a decreasing trend until 2007 unexpectedly assumed higher levels after implementation of the law.

CONCLUSION

There is no evidence of reduced traffic-related mortality in the 3 major Brazilian capitals 5.5 years after the zero tolerance drinking and driving law was adopted.

Impact of a New Law to Reduce the Legal Blood Alcohol Concentration Limit– A Poisson Regression Analysis and Descriptive Approach

Background: In Chile, a new law introduced in March 2012 lowered the blood alcohol concentration (BAC) limit for impaired drivers from 0.1% to 0.08% and the BAC limit for driving under the influence of alcohol from 0.05% to 0.03%, but its effectiveness remains uncertain. The goal of this investigation was to evaluate the effects of this enactment on road traffic injuries and fatalities in Chile.

Study design: A retrospective cohort study.

Methods: Data were analyzed using a descriptive and a Generalized Linear Models approach, type of Poisson regression, to analyze deaths and injuries in a series of additive Log-Linear Models accounting for the effects of law implementation, month influence, a linear time trend and population exposure. A review of national databases in Chile was conducted from 2003 to 2014 to evaluate the monthly rates of traffic fatalities and injuries associated to alcohol and in total.

Results: It was observed a decrease by 28.1 percent in the monthly rate of traffic fatalities related to alcohol as compared to before the law (P<0.001). Adding a linear time trend as a predictor, the decrease was by 20.9 percent (P<0.001).There was a reduction in the monthly rate of traffic injuries related to alcohol by 10.5 percent as compared to before the law (P<0.001). Adding a linear time trend as a predictor, the decrease was by 24.8 percent (P<0.001).

Conclusions: Positive results followed from this new ‘zero-tolerance’ law implemented in 2012 in Chile. Chile experienced a significant reduction in alcohol-related traffic fatalities and injuries, being a successful public health intervention.

Prevalence of drugs in oral fluid from truck drivers in Brazilian highways

Traffic accidents are responsible for 1.25 million deaths worldwide and are the most common cause of death among those aged 15-29 years. In Brazil, traffic accidents caused more than 44,000 deaths in 2014. The use of psychoactive drugs is an important risk factor for being involved in traffic accidents. Previous studies have found that psychoactive substances are commonly used by truck drivers in Brazil to maintain their extensive work schedule and stay awake while driving during nighttime hours. The state of Sao Paulo is one of the most important states regarding goods transportation. Important highways cross through Sao Paulo to other regions from Brazil and to other countries in Latin America. This study aims to determine the prevalence of illicit drug use by truck drivers in the state of Sao Paulo through toxicological analyses of oral fluid. Truck drivers were randomly stopped by police officers on federal roads during morning hours. Oral fluid samples were collected using the Quantisal™ device. In addition, a questionnaire concerning sociodemographic characteristics and health information was administered. Oral fluid samples were screened for amphetamine, cocaine, and tetrahydrocannabinol (Δ9-THC) by ELISA and the confirmation was performed using ultra performance liquid chromatography with tandem mass spectrometry detection (UPLC-MS/MS). Of the 764 drivers stopped, 762 agreed to participate. The participants were driving an average of 614km and 9.4h a day. Of the total samples, 5.2% (n=40) tested positive for drugs. Cocaine was the most frequently found drug (n=21), followed by amphetamine (n=16) and Δ9-THC (n=8). All drivers were men with an average age of 42.5 years. With these results we were able to verify that many truck drivers were still consuming psychoactive drugs while driving, and cocaine was the most prevalent one. This reinforces the need for preventive measures aimed at controlling the use of illicit drugs by truck drivers in Brazil.

Examination of personality traits and social problem-solving skills of individuals whose driving licenses have been confiscated due to drunk driving

OBJECTIVE

Drunk driving is one of the major behavioral issues connected with problematic alcohol consumption. The objective of this study was to evaluate the relationship between personality traits and social problem-solving skills of individuals who drive while intoxicated.

METHOD

One hundred forty-four individuals apprehended twice while driving drunk and sent to a driver behavior training program (9 females and 135 males) participated in our study. The Eysenck Personality Questionnaire Revised-Abbreviated (EPQ-RA) composed of 4 subscales (Extroversion, Neuroticism, Psychoticism, and Lying) and the Social Problem Solving Inventory (SPSI) composed of 7 subscales (Cognitive, Emotion, Behavior, Problem Definition and Formulation, Creating Solution Options, Solution Implementation and Verification, and Decision Making) were used to evaluate the participants.

RESULTS

A positive relationship was found between the Extroversion subscale of the EPQ-RA and the Cognition subscale (P <.01), Emotion subscale (P <.01), Behavior subscale (P <.01), Generation of Alternatives subscale (P <.01), Decision Making subscale (P <.05), and Solution Implementation and Verification subscale (P <.01). For individuals who repeated intoxicated driving, all subscales of the EPQ-RA (Extroversion, Lying, Neuroticism, and Psychoticism subscales) explained 12% of the scores of the Cognition subscale and 16.2% (P <.001) of the Emotion subscale of the SPSI. There was no significant relationship between the first and second incident alcohol blood levels (P >.05).

CONCLUSION

Drinking and driving behaviors appear to be negative or maladaptive behaviors closely related to personality traits and may represent an effort to avoid negative emotions. Evaluation of negative emotions may have an important place in training programs intended to change drunk driving behavior.

Regional disparities in road traffic injuries and their determinants in Brazil, 2013

BACKGROUND

In recent decades middle-income countries have experienced a rapid increase in the number of cars and motorcycles. Increased deaths and hospitalizations due to road traffic injuries (RTI) has been observed in several countries as a result. In this study we assessed the determinants of RTIs in Brazil by mode of transportation and compared differences in RTI rates among macro-regions.

METHODS

We used data from the National Health Survey (NHS) conducted in 2013 by the Brazilian Institute of Geography and Statistics and the Ministry of Health. NHS is a comprehensive household survey which includes a representative sample (N = 60,198) of individuals aged 18 years or older. The prevalence and determinants of RTI were estimated according to different modes of transport (car/van, motorcycle, and other) and regions of the country. Bivariate and multivariable logistic regression models were applied to assess crude and adjusted odds ratios, respectively, and their 95 % CI for RTI determinants.

RESULTS

The prevalence of RTI for the Southeast, South, Central-West, Northeast and North regions of Brazil was 2.4 %, 2.9 %, 4.4 %, 3.4 % and 4.8 %, respectively, pointing to important differences among regions. High percentages of motorcyclists were observed in the Northeast and North regions. For motorcyclists, factors associated with RTIs were being male (OR = 2.6;95 % CI:2.3;3.0), aged 18-29 (OR = 3.2; 95 % CI:2.7;3.8) and 30-39 years (OR = 2.0;95 % CI:1.7;2.5), black (OR = 1.4;95 % CI:1.1;1.7), having elementary educational (OR = 1.5;95 % CI:1.1;1.9), reporting binge drinking behavior (OR = 1.3;95 % CI:1.1;1.5), and living in the Central-West (OR = 2.0;95 % CI:1.6;2.5), Northeast (OR = 1.8;95 % CI:1.5;2.1) and North (OR = 2.0;95 % CI:1.6; 2.5) regions of the country. The independent variables associated with RTI for car/van occupants were being male (OR = 1.7;95 % CI:1.4;2.1), aged 18-29 (OR = 1.5;95 % CI:1.1;2.0) and 30-39 years (OR = 2.5;95 % CI:1.9;3.2), reporting binge drinking behavior (OR = 2.0;95 % CI:1.6;2.5) and living in the South region (OR = 1.6;95 % CI:1.3;2.1).

CONCLUSIONS

There were considerable regional disparities in RTI rates across Brazil's regions. Motorcyclists contributed to the high RTI rates in these regions as did demographic factors and behaviors such as alcohol use. These findings can help guide interventions to reduce the burden of RTIs in Brazil.

The disabled and Public Policy: the gap between intentions and actions

This is a cross-sectional study with a quantitative approach, establishing the epidemiological profile of people with physical disabilities resident in the municipality of Florianópolis, in the Southern Brazilian state of Santa Catarina, and analyzing it in relation to the public policies related to that population. The minimum sample was determined by a statistical calculation, considering the population of the municipality with disabilities, according to data from the 2010 Population Census. The data were collected using an electronic form installed in mobile devices and stored at an online provider. The data were analyzed and handled with the software Statistical Package for the Social Sciences. A total of 139 questionnaires were processed. A separation of the results was made using these categories: Individual attributes; Social attributes; and Characteristics related to disability. As well as the descriptive profile of the disabled people, the study analyses and discusses the distance, worldwide and in Brazil, between the proposals for public policies and the actual actions of care directed towards the rights of these people. The conclusion is that there is a fundamental need to act in relation to the real needs of this population and consolidate proposals for health promotion, health protection and health rehabilitation for them.

The Legal Limit: Differences in Injury Severity Score for Vehicular Crashes

In 2013, the National Transportation Safety Board advised lawmakers in the United States to reduce the legal limit of blood alcohol content (BAC) from 0.08% to 0.05%. The purpose of this research was to evaluate the rationale for reducing the legal limit of BAC to 0.05% through analysis of the relationship between BAC and injury severity. A correlational study was conducted on patients with positive BAC involved in a motor vehicular collision. Retrospective review of 446 trauma patients (aged 18-80 years) injured in a vehicular collision routinely screened for BAC was conducted. Two groups were compared: Group 1, patients with nonzero blood alcohol concentration (n = 101); and Group 2, patients with zero blood alcohol (n = 345). Standard statistical analyses were utilized. A total of 101 patients (23%) had a detectable BAC on admission. Patients with a detectable BAC were younger (33 and 44 years) and more likely to be male (27% and 16%). There was no statistically significant association between both injury severity score (ISS) and BAC or between ISS and age. There was no significant correlation between higher BAC and a higher ISS. Positive BAC alone may not affect ISS, but the potential for risk-taking behaviors by drivers under the influence may increase injury severity.

A intenção de evitar o consumo de álcool ao dirigir

Resumo O objetivo deste estudo foi identificar os preditores da intenção comportamental de evitar ingerir álcool e dirigir em universitários da cidade do Recife, Pernambuco. Trata-se de dois estudos não probabilísticos do tipo acidental com 488 estudantes, sendo um a construção do questionário e o outro o levantamento da intenção de abster-se de beber e dirigir. Este último permitiu verificar o efeito das variáveis: crenças normativas, atitude e crenças comportamentais, como preditoras da intenção de adotar o comportamento preventivo. Um dos dados obtidos sugere que os universitários não são indiferentes quanto às informações recebidas, construindo uma postura crítica; as autoridades, os pais e os pares são importantes no que diz respeito a evitar o comportamento de beber e dirigir, sendo que a variável gênero mostrou diferenças entre homens e mulheres. A pesquisa apontou a necessidade da realização de projetos de prevenção sobre evitar o consumo de álcool ao dirigir.

A Ten year review of alcohol use and major trauma in a Canadian province: still a major problem

Background

Alcohol plays a significant role in major traumatic injuries. While the role of alcohol in motor vehicle trauma (MVT) is well described, its role and approaches to prevention in other injury mechanisms is less defined.

Methods

A 10 year retrospective examination of Alberta Trauma Registry (ATR) data was conducted on all major trauma patients (age ≥ 9 and ISS ≥ 12) from 2001–2010. The role and prevalence of alcohol is examined.

Results

Of 22,457 patients included in our study, only 60 %(n = 13,552) were screened for alcohol use. Of those screened, 38 %(n = 5,170) tested positive for alcohol with a mean blood alcohol concentration (BAC) of 39.4 ± 21.1 mmol/L. Of the positive screening tests, 82.3 % had BAC levels greater than the common legal driving limit of 17.4 mmol/L (0.08 %). Testing positive was associated with male gender (p < 0.001) and younger age (p < 0.001). The rate of positive alcohol use in major trauma increased from 20.3 % in 2001 to 24.3 % in 2010, corresponding with a screening rate increase from 51.3 % to 61.2 % over the same period. Railway incidents have the highest rate of alcohol involvement (65 %), followed by undetermined-if-accidental/self-inflicted (53.5 %) and assault (49 %); motor vehicle traffic (MVT) incidents had a frequency of 25.4 %.

Conclusions

The prevalence of alcohol use in major trauma appears to be increasing in Alberta but the true extent is still underappreciated. Furthermore, the role of alcohol in non-MVT injuries is significant and deserves further attention. The vast majority of patients involved in alcohol-related trauma are legally intoxicated. Alcohol use continues to be a substantial contributor to major trauma in Alberta, and represents an important opportunity to reduce preventable injuries.

Road Traffic Injury Prevention Initiatives: A Systematic Review and Metasummary of Effectiveness in Low and Middle Income Countries

Background

Road traffic injuries (RTIs) are a growing but neglected global health crisis, requiring effective prevention to promote sustainable safety. Low- and middle-income countries (LMICs) share a disproportionately high burden with 90% of the world’s road traffic deaths, and where RTIs are escalating due to rapid urbanization and motorization. Although several studies have assessed the effectiveness of a specific intervention, no systematic reviews have been conducted summarizing the effectiveness of RTI prevention initiatives specifically performed in LMIC settings; this study will help fill this gap.

Methods

In accordance with PRISMA guidelines we searched the electronic databases MEDLINE, EMBASE, Scopus, Web of Science, TRID, Lilacs, Scielo and Global Health. Articles were eligible if they considered RTI prevention in LMICs by evaluating a prevention-related intervention with outcome measures of crash, RTI, or death. In addition, a reference and citation analysis was conducted as well as a data quality assessment. A qualitative metasummary approach was used for data analysis and effect sizes were calculated to quantify the magnitude of emerging themes.

Results

Of the 8560 articles from the literature search, 18 articles from 11 LMICs fit the eligibility and inclusion criteria. Of these studies, four were from Sub-Saharan Africa, ten from Latin America and the Caribbean, one from the Middle East, and three from Asia. Half of the studies focused specifically on legislation, while the others focused on speed control measures, educational interventions, enforcement, road improvement, community programs, or a multifaceted intervention.

Conclusion

Legislation was the most common intervention evaluated with the best outcomes when combined with strong enforcement initiatives or as part of a multifaceted approach. Because speed control is crucial to crash and injury prevention, road improvement interventions in LMIC settings should carefully consider how the impact of improvements will affect speed and traffic flow. Further road traffic injury prevention interventions should be performed in LMICs with patient-centered outcomes in order to guide injury prevention in these complex settings.

Comparison of the effects of two legal blood alcohol limits: the presence of alcohol in traffic accidents according to category of driver in Izmir, Turkey

OBJECTIVES

Under existing Turkish road traffic law, there are 2 different blood alcohol concentration (BAC) limits allowed for drivers in 2013: zero blood alcohol and ≤0.50 g/L. All public transport, taxi, commercial, and official vehicle drivers must maintain a zero blood alcohol concentration while driving. Private vehicle drivers must maintain a BAC of 0.50 g/L or lower. The aim of the recent study was to evaluate the effect of these 2 legal blood alcohol limits on nonfatal traffic accidents that occurred due to the driver being under the influence of alcohol.

METHODS

This retrospective study was performed to evaluate the blood alcohol concentration of 224 drivers in nonfatal road accidents between June 2010 and July 2011 using headspace gas chromatography at the Izmir Forensic Medicine Group Presidency, Turkey. All cases evaluated by the toxicology department were entered into a database. We used descriptive statistics, χ(2) test, and independent sampling test to analyze the data.

RESULTS

The total number of drivers involved in nonfatal traffic accidents was 224; 191 were private vehicle drivers and 33 were public transport, taxi, commercial, and official vehicle drivers. In the present study, alcohol was detected in the blood of about 27.2% (n = 61) of the 224 drivers. Sixty (31.4%) private vehicle drivers involved in nonfatal traffic accidents tested positive for alcohol. BAC values were also above the legal limit (0.50 g/L) in 27.7% (n = 53) of private vehicle drivers. However, the BAC was above the legal limit in only 3% (n = 1) of public transport, commercial, and official vehicle drivers involved in nonfatal traffic accidents. These results showed that private vehicle drivers subject to a BAC limit of ≤0.50 g/L were significantly associated with an increased risk of nonfatal accident involvement than drivers subject to a zero BAC limit (odds ratio [OR] = 12.29, 95% confidence interval [CI], 1.64-92.22; Fisher's exact test, P <.001). Mean BAC in private vehicle drivers subject to a 0.50 g/L level (52.60 mg/dl ± 94.84) was significantly higher than that of drivers subject to a zero alcohol level (10.76 mg/dl ± 61.80; t = 2.44, P <.001).

CONCLUSION

In light of our results, lowering the BAC limit for private vehicle drivers may reduce the level of driving under the influence of alcohol. A change in the law will decrease the rates of alcohol-related road accidents in Turkey.

[Short-term impact of changes in drinking-and-driving legislation in Guadalajara and Zapopan, Jalisco, Mexico]

The municipalities of Guadalajara and Zapopan, Jalisco State, Mexico, have participated in efforts to reduce road traffic injuries. They have participated actively in the Mexican Road Safety Initiative since 2008. As a result, in September 2010 they passed laws to reduce the legal alcohol levels for driving motor vehicles. To assess the short-term impact of these measures on rates and severity of alcohol-related collisions and injuries, we conducted a secondary analysis of official databases on mortality, morbidity, and collisions. We performed a time-series analysis to assess the trend. Significant changes were observed in the monthly proportion of alcohol-related deaths and collision rates following these interventions. The article concludes with recommendations to improve the reform's enforcement and results.

Óbitos por acidentes de transporte terrestre em município do noroeste do Paraná - Brasil

Introdução: os problemas relacionados aos acidentes de trânsito não são atributos exclusivos das grandes cidades; o crescimento do número de veículos circulantes, acrescido ao fato de os veículos serem incorporados no cotidiano das comunidades, faz com que até mesmo os municípios de pequeno e médio porte evidenciem nesses eventos um complexo e importante problema social. Objetivo: o objetivo do estudo foi o de descrever as características dos óbitos por acidente de transporte terrestre (ATT) no município de Cianorte-PR, no período de 2000 a 2010. Métodos: trata-se de um estudo descritivo. O instrumento utilizado para coleta de dados foram as declarações de óbito obtidas do Sistema de Informação de Mortalidade (SIM), incluídos nas categorias V01 a V89 do CID-10-capítulo XX. Resultados: foram estudados 224 óbitos. No ano de 2010, foi registrada a maior taxa de mortalidade (45,7/100.000 hab), e em 2008 a menor (16,7/100.000 hab). Os homens foram 79% (n=177) das vítimas, e a razão de sexo foi 3,7:1. A maior proporção das mortes foi no grupo de 20 a 39 anos (n=95;42%). Motociclistas, ciclistas e pedestres foram os mais vulneráveis (n=127; 57%); no local do acidente, ocorreram 59% dos óbitos (n=132). Os óbitos predominaram nas rodovias (n=139; 62%), no horário das 18 às 24h (n=45; 34,1%) e nos finais de semana (n=70;54%). Conclusão: os ATT configuram-se em uma questão atual de saúde dessa população. Homens adultos jovens são os mais atingidos. Idosos também são vulneráveis. Estratégias de intervenção são intensamente apresentadas na literatura, mas, no cotidiano dos serviços, isso continua um desafio a ser enfrentado.

Reduction in fatalities, ambulance calls, and hospital admissions for road trauma after implementation of new traffic laws

OBJECTIVES

We evaluated the public health benefits of traffic laws targeting speeding and drunk drivers (British Columbia, Canada, September 2010).

METHODS

We studied fatal crashes and ambulance dispatches and hospital admissions for road trauma, using interrupted time series with multiple nonequivalent comparison series. We determined estimates of effect using linear regression models incorporating an autoregressive integrated moving average error term. We used neighboring jurisdictions (Alberta, Saskatchewan, Washington State) as external controls.

RESULTS

In the 2 years after implementation of the new laws, significant decreases occurred in fatal crashes (21.0%; 95% confidence interval [CI]=15.3, 26.4) and in hospital admissions (8.0%; 95% CI=0.6, 14.9) and ambulance calls (7.2%; 95% CI=1.1, 13.0) for road trauma. We found a very large reduction in alcohol-related fatal crashes (52.0%; 95% CI=34.5, 69.5), and the benefits of the new laws are likely primarily the result of a reduction in drinking and driving.

CONCLUSIONS

These findings suggest that laws calling for immediate sanctions for dangerous drivers can reduce road trauma and should be supported.

Are alcohol policies associated with alcohol consumption in low- and middle-income countries?

AIMS

To examine the associations between alcohol control policies in four regulatory domains with alcohol consumption in low- and middle-income countries (LAMICs), controlling for country-level living standards and drinking patterns.

DESIGN

Cross-sectional analyses of individual-level alcohol consumption survey data and country-level alcohol policies using multi-level modeling.

SETTING

Data from 15 LAMICs collected in the Gender, Alcohol, and Culture: an International Study (GENACIS) data set.

PARTICIPANTS

Individuals aged 18-65 years.

MEASUREMENTS

Alcohol policy data compiled by the World Health Organization; individual-level current drinking status, usual quantity and frequency of drinking, binge drinking frequency and total drinking volume; gross domestic product based on purchasing power parity (GDP-PPP) per capita; detrimental drinking pattern scale; and age and gender as individual-level covariates.

FINDINGS

Alcohol policies regulating the physical availability of alcohol, particularly those concerning business hours or involving a licensing system for off-premises alcohol retail sales, as well as minimum legal drinking age, were the most consistent predictors of alcohol consumption. Aggregate relative alcohol price levels were associated inversely with all drinking variables (P < 0.05) except drinking volume. Greater restrictions on alcohol advertising, particularly beer advertising, were associated inversely with alcohol consumption (P < 0.05). Policies that set legal blood alcohol concentration (BAC) limits for drivers and random breath testing to enforce BAC limits were not associated significantly with alcohol consumption.

CONCLUSIONS

Alcohol policies that regulate the physical availability of alcohol are associated with lower alcohol consumption in low- and middle-income countries.

Divided attention in young drivers under the influence of alcohol

INTRODUCTION

The present research evaluates driving impairment linked to divided attention task and alcohol and determines whether it is higher for novice drivers than for experienced drivers.

METHOD

Novice and experienced drivers participated in three experimental sessions in which blood alcohol concentrations (BACs) were 0.0 g/L, 0.2 g/L, and 0.5 g/L. They performed a divided attention task with a main task of car-following task and an additional task of number parity identification. Driving performance, response time and accuracy on the additional task were measured.

RESULTS

ANOVA showed a driving impairment and a decrease in additional task performance from a BAC of 0.5 g/L, particularly for novice drivers. Indeed, the latter adopt more risky behavior such as tailgating. In the divided attention task, driving impairment was found for all drivers and impairment on information processing accuracy was highlighted, notably in peripheral vision.

PRACTICAL APPLICATIONS

The divided attention task used here provides a relevant method for identifying the effects of alcohol on cognitive functions and could be used in psychopharmacological research.