Regional differences associated with drinking and driving in Brazil

Rev Bras Psiquiatr. 2012;34:306–313

Revista Brasileira de Psiquiatria Psychiatry

Ofﬁcial Journal of the Brazilian Psychiatric Association 7PMVNFt/VNCFSt0DUPCFS

ORIGINAL ARTICLE

Regional differences associated with drinking and driving in Brazil Raquel De Boni,1 Lisia von Diemen,1 Paulina do Carmo Arruda Vieira Duarte,2 Daniela Benzano Bumaguin,1 Juliana Balbinot Hilgert,3 Mary Clarisse Bozzetti,3 Anne Sordi,1 Flavio Pechansky1 1

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DESCRIPTORS Alcohol drinking; 7UDIÀFDFFLGHQWV *HRJUDSKLFORFDWLRQV

Abstract Objective: To evaluate regional differences and similarities associated with drinking and driving '8, LQWKHÀYH%UD]LOLDQPDFURUHJLRQVMethod: A roadside survey was conducted in the 27 %UD]LOLDQVWDWHFDSLWDOV$WRWDORIGULYHUVZHUHUDQGRPO\VHOHFWHGDQGJLYHQDVWUXFWXUHG LQWHUYLHZ DQG D EUHDWKDO\]HU WHVW 7R GHWHUPLQH WKH SUHGLFWRUV RI SRVLWLYH EORRG DOFRKRO FRQFHQWUDWLRQ%$& LQHDFKUHJLRQD0$129$ZDVSHUIRUPHGDQGJURXSVZHUHXVHGDVIROORZV 1RUWKDQG1RUWKHDVW 6RXWKDQG0LGZHVWDQG 6RXWKHDVW$3RLVVRQUREXVWUHJUHVVLRQPRGHO ZDVSHUIRUPHGWRDVVHVVWKHYDULDEOHVDVVRFLDWHGZLWKSRVLWLYH%$&LQHDFKJURXSResults:2I DOOVXUYH\HGGULYHUVKDGFRQVXPHGDOFRKROLQWKHSUHYLRXVPRQWKV0RVWZHUHPDOH ZLWKDPHGLDQDJHRI/HLVXUHDVWKHUHDVRQIRUWUDYHOZDVDVVRFLDWHGZLWKSRVLWLYH%$&LQDOO JURXSV/RZVFKRROLQJEHLQJROGHUWKDQGULYLQJFDUVRUPRWRUF\FOHVDQGKDYLQJEHHQJLYHQ DEUHDWKDO\]HUWHVWDWOHDVWRQFHLQWKHLUOLYHVSUHGLFWHG'8,LQDWOHDVWWZRGLIIHUHQWJURXSV Conclusions:)DFWRUVHVSHFLDOO\ORZVFKRROLQJDQGOHLVXUHDVDUHDVRQIRUWUDYHODVVRFLDWHGZLWK GULQNLQJDQGGULYLQJZHUHVLPLODUDPRQJUHJLRQVDOWKRXJKFHUWDLQUHJLRQVSHFLÀFIHDWXUHVZHUH REVHUYHG7KLVLQIRUPDWLRQLVLPSRUWDQWIRUDLPLQJWRUHGXFH'8,LQWKHFRXQWU\

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Regional differences on DUI

DESCRITORES: Consumo de bebidas DOFRyOLFDV Acidentes de trânsito; /RFDOL]Do}HV JHRJUiÀFDV

307

Diferenças regionais entre os fatores associados ao beber e dirigir no Brasil Resumo Objetivo: Avaliar diferenças e similaridades em relação a beber e dirigir (DUI) nas cinco macroregiões brasileiras. Método: Um roadside surveyIRLUHDOL]DGRQDVFDSLWDLVEUDVLOHLUDV)RUDP VHOHFLRQDGRVDOHDWRULDPHQWHFRQGXWRUHVTXHUHVSRQGHUDPDXPDHQWUHYLVWDHVWUXWXUDGDH IRUDPWHVWDGRVFRPXVRGHHWLO{PHWUR3DUDDFRQVWUXomRGHPRGHORVSUHGLWLYRVGHDOFRROHPLD SRVLWLYD%$& DVUHJL}HVIRUDPDJUXSDGDVGHDFRUGRFRPVXDVLPLODULGDGHREWLGDSRU0$129$ HP 1RUWHH1RUGHVWH 6XOH&HQWUR2HVWH 6XGHVWH(PFDGDJUXSRIRLUHDOL]DGRXP PRGHORGHUHJUHVVmRUREXVWDSDUDHVWLPDUDVYDULiYHLVDVVRFLDGDVD%$&Resultados: Dentre os FRQGXWRUHVLQJHULUDPEHELGDVDOFRyOLFDVQRVPHVHVDQWHULRUHVVHQGRDPDLRULDFRPSRVWD SRUKRPHQVFRPLGDGHPHGLDQDGHDQRV$~QLFDYDULiYHODVVRFLDGDD%$&HPWRGRVRVJUXSRV IRLWHUOD]HUFRPRPRWLYRGDYLDJHP%DL[DHVFRODULGDGHLGDGH!DQRVGLULJLUFDUURVPRWRVH WHUUHDOL]DGRWHVWHGHEDI{PHWURSUHYLDPHQWHIRUDPDVVRFLDGDVD%$&HPDRPHQRVGRLVJUXSRV Conclusões:2VIDWRUHVDVVRFLDGRVD'8,IRUDPVHPHOKDQWHVQDVUHJL}HVHVSHFLDOPHQWHRPRWLYR GDYLDJHPHDHVFRODULGDGHHPERUDDOJXPDVHVSHFLÀFLGDGHVUHJLRQDLVWHQKDPVLGRREVHUYDGDV (VWDVLQIRUPDo}HVVmRHVWUDWpJLFDVSDUDSROtWLFDVS~EOLFDVGHVWLQDGDVDUHGXomRGR'8,

Introduction 'ULYLQJXQGHUWKHLQÁXHQFHRIDOFRKRO'8, LVDVLJQLÀFDQW SXEOLFKHDOWKSUREOHPZRUOGZLGH6RPHIDFWRUVDVVRFLDWHG ZLWK'8,DUHVLPLODUDFURVVFXOWXUHVVXFKDVEHLQJPDOHDQG EHLQJ \RXQJ2 DV SDWWHUQV RI DOFRKRO XVH HVSHFLDOO\ ELQJH GULQNLQJLHPRUHWKDQÀYHGRVHVLQRQHRFFDVLRQ 3 The ULVNIRUWUDIÀFDFFLGHQWVLQFUHDVHVIRUGULYHUVXQGHU\HDUV RIDJHZKHQGULYLQJDWQLJKWDQGGULYLQJRQOHVVFURZGHG URDGV7KHULVNDOVRVHHPVWREHDVVRFLDWHGZLWKFRQVXPSWLRQ of beer in younger drivers.(QYLURQPHQWDOIDFWRUVVXFKDV VRFLRHFRQRPLFVWDWXVSROLWLFDODQGOHJDOLVVXHVDQGWKHGHQVLW\RIDOFRKRORXWOHWVDOVRSOD\DUROHLQWKH'8,VFHQDULR Laws that focus on the reduction of alcohol drinking by GULYHUVFDQEHDVHIIHFWLYHDVLQGLYLGXDOL]HGLQWHUYHQWLRQVIRU DOFRKROXVHUVZKRDOUHDG\SXWWKHPVHOYHVDWULVN+RZHYHU PRVWODZVDUHLPSOHPHQWHGDWDQDWLRQDOOHYHODQGWKHUH is a scarcity of information about how regional differences LQÁXHQFHWKHHIÀFDF\RIWKRVHSXEOLFPHDVXUHVLQPRVWFRXQWULHVRUKRZWRXVHVXFKUHJLRQDOGHPRJUDSKLFLQIRUPDWLRQ WR SURYLGH IHHGEDFN IRU SROLF\PDNHUV 6WXGLHV VKRZ WKDW WKHUHGXFWLRQLQWUDIÀFDFFLGHQWVUHODWHGWR'8,LVKLJKHULQ SODFHVZKHUHWKHODZLVSURSHUO\DSSOLHGDQGHQIRUFHG $6ZHGLVKVWXG\VKRZHGWKDWWKHFRQVXPSWLRQRIDOFRKROLF EHYHUDJHVLVKLJKHULQUHJLRQVWKDWDUHFORVHUWRWKH(XURSHDQ FRQWLQHQWPRVWOLNHO\EHFDXVHRISROLWLFDOPHDVXUHVUHODWHG WRWKHSULFHRIWKHSURGXFWVWKHFRQWURORIDOFRKROLQWDNHDQG the availability of alcohol and other drugs.12)XUWKHUPRUH DVWXG\FRQGXFWHGLQ(XURSHFRQFOXGHGWKDWGLIIHUHQFHVLQ DOFRKROFRQVXPSWLRQSDWWHUQVGLGQRWYDU\VLJQLÀFDQWO\DFURVV the regions studied.13 ,Q%UD]LOWKHUHZHUHGHDWKVUHODWHGWRWUDIÀFDFFLGHQWVLQ14DQGVWXGLHVKDYHHVWLPDWHGWKDWWKHSUHYDOHQFHRISRVLWLYHEORRGDOFRKROFRQFHQWUDWLRQDPRQJWUDIÀF DFFLGHQWYLFWLPVYDULHVIURPQRQIDWDOYLFWLPV WR (fatal victims).)DFWRUVDVVRFLDWHGZLWK'8,LQ%UD]LOKDYH VKRZQVLPLODULWLHVZLWKSUHYLRXVVWXGLHVIRULQVWDQFHLQD KLJKHUSURSRUWLRQRIPDOHGULYHUV16+RZHYHUWKHSUHYDOHQFH

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Materials and Methods Geographical area and sampling ,Q D FURVVVHFWLRQDO GHVLJQ GULYHUV ZHUH VHOHFWHG from among drivers on federal highways that crossed the PHWURSROLWDQDUHDRI%UD]LOLDQFDSLWDOFLWLHV7KHVDPSOH ZDVVWUDWLÀHGE\W\SHRIYHKLFOHFDUVPRWRUF\FOHVEXVHV DQGWUXFNVZLWKUDQGRPVHOHFWLRQLQSURSRUWLRQWRWKHÁHHW VL]HRIHDFKVWDWH )RUJHRJUDSKLFDODQGORJLVWLFUHDVRQV

308

R. De Boni et al.

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e) Reason for traveling: 2SWLRQVIRUWUDYHOPRWLYDWLRQZHUH FDWHJRUL]HGLQWR ZRUNDQG OHLVXUHRWKHU f) Favorite drink: 2SWLRQVIRUIDYRULWHGULQNZHUHFDWHJRUL]HG LQWR EHHU DQG RWKHUV EHFDXVH SUHYLRXV UHVHDUFK KDV LQGLFDWHGWKDWDSUHIHUHQFHIRUEHHUFDQEHDVVRFLDWHGZLWK drinking and driving.22 g) Binge: The variable binge drinkingLHHSLVRGLFFRQVXPSWLRQRIDOFRKRO ZDVDVVHVVHGE\WKHIROORZLQJTXHVWLRQ´,Q WKHSUHYLRXV\HDUGLG\RXGULQNPRUHWKDQGRVHVPHQ RU GRVHVZRPHQ RQRQHRFFDVLRQ"µ23 K $OFRKROFRQVXPSWLRQSDWWHUQ $OFRKROFRQVXPSWLRQSDWWHUQZDVHVWDEOLVKHGDVGHVFULEHGLQWKH1(6$5&24 study. The XVXDOIUHTXHQF\RIDOFRKROLFEHYHUDJHFRQVXPSWLRQHJWKH QXPEHURIWLPHVZKHQEHHUZDVFRQVXPHG ZDVPXOWLSOLHG E\WKHYROXPHRIGULQNVWDNHQRQHDFKRFFDVLRQ,QWKLVZD\ WKHDQQXDOYROXPHRIHDFKW\SHRIDOFRKROLFEHYHUDJHFRQsumed by the driver was obtained. We then calculated the WRWDOTXDQWLW\RIHWKDQROFRQVXPHGLQD\HDUIRUHDFKW\SHRI EHYHUDJHDQGWKLVYDOXHZDVGLYLGHGE\GD\V7KHQWKH TXDQWLW\RIGDLO\HWKDQROLQWDNHIRUHDFKW\SHRIEHYHUDJH consumed by the driver was added to obtain an estimate of WKHWRWDOGDLO\HWKDQRODPRXQW7RIDFLOLWDWHGDWDDQDO\VLV the total daily amount of alcohol was converted into standard GRVHVRIDOFRKRODVIROORZV OLJKWOHVVWKDQGRVHVSHU ZHHN PRGHUDWHEHWZHHQDQGGRVHVZHHNIRUDPDQ RUDQGGRVHVZHHNIRUDZRPDQDQG KHDY\PRUHWKDQ GRVHVGD\IRUPHQRUPRUHWKDQGRVHGD\IRUZRPHQ L '8,PRQWKV 2EWDLQHGE\WKHTXHVWLRQ´,QWKHSDVW PRQWKVGLG\RXGULYHDIWHU\RXKDGFRQVXPHGDQ\DOFRKROLF EHYHUDJH"µ M %UHDWKDO\]HUOLIHWLPH 0HDVXUHGE\WKHTXHVWLRQ´+DYH \RXHYHUEHHQVWRSSHGWREHJLYHQDEUHDWKDO\]HU"µ k) Positive Blood Alcohol Concentration (BAC): Considered to EHDQ\PHDVXUHDERYHHVWLPDWHGIURPEUHDWKVDPSOHV REWDLQHGXVLQJFDOLEUDWHG$OFR6HQVRU,9E\,QWR[LPHWHUV,QF 6W/RXLV0286$ l) Previous DUI accidents: 0HDVXUHGE\WKHIROORZLQJTXHVWLRQ ´LQ\RXUOLIHKDYH\RXHYHUKDGDFFLGHQWVDIWHUGULQNLQJ"µ

Measures

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Inclusion criteria

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ÀFDQWO\WRWKHPRGHO S! ZHUHHOLPLQDWHGDQGDQHZPRGHOZDVFDOFXODWHG ,QWKH6RXWKHDVWUHJLRQWKHUHZDVFROLQHDULW\EHWZHHQWKH YDULDEOHVGULQNLQJDQGGULYLQJLQWKHSDVWPRQWKVEHHU DVDIDYRULWHGULQNDQGELQJHGULQNLQJDVZHOODVEHWZHHQ ELQJHGULQNLQJDQGEHHUDVDIDYRULWHGULQNGULQNHUDQGELQJH GULQNLQJEHHUDVDIDYRULWHGULQNDQGGULQNLQJDQGGULYLQJLQ WKHSDVWPRQWKV,QWKH0LGZHVWHUQDQG6RXWKHUQUHJLRQ there was co-linearity between drinking and driving in the SDVWPRQWKVDQGELQJHGULQNLQJELQJHGULQNLQJDQGEHHU DVDIDYRULWHGULQNGULQNHUDQGELQJHGULQNLQJEHHUDVDIDYRULWHGULQNDQGGULQNLQJDQGGULYLQJLQWKHSDVWPRQWKV ,QWKH1RUWKDQG1RUWKHDVWUHJLRQVWKHUHZDVFROLQHDULW\ EHWZHHQGULQNLQJDQGGULYLQJLQWKHSDVWPRQWKVDQGELQJH GULQNLQJELQJHGULQNLQJDQGEHHUDVDIDYRULWHGULQNGULQNLQJ DQGGULYLQJLQWKHSDVWPRQWKV

Results 7KHUHZHUHQRVWDWLFDOO\VLJQLÀFDQWGLIIHUHQFHVLQWKHSURSRUWLRQRIUHIXVDOVEHWZHHQWKHWKUHHVWXGLHGUHJLRQVZLWK UHIXVDO LQ WKH 6RXWKHDVW LQ WKH 6RXWK0LGZHVW DQGLQWKH1RUWK1RUWKHDVWUHJLRQVS 7DEOH shows that individuals who refused were younger in two of WKHVWXGLHGUHJLRQV6RXWK0LGZHVWDQG1RUWK1RUWKHDVW 7KHVDPSOHFRPSULVHGGULYHUVZKRKDGWDNHQ DW OHDVWRQHGRVHRIDOFRKROLQWKHSDVWPRQWKV7KHPHGLDQ DJHZDVLQWHUTXDUWLOHUDQJH\HDUVROG 0RVWLQGLYLGXDOVZHUHPDOH ZLWKDPHGLDQIDPLO\LQFRPHRI 5SHUPRQWK

LQWHUTXDUWLOHUDQJH5DQG5 DQGKDGFRPSOHWHGKLJKVFKRRO 7KHUHZHUHQRVLJQLÀFDQWVWDWLVWLFDOGLIIHUHQFHVLQDJHKDYLQJEHHQVWRSSHG IRU D EUHDWKDO\]HU WHVW DQG KLVWRU\ RI SUHYLRXV DFFLGHQWV after drinking between regions (Table 2). ,Q WKH 1RUWK1RUWKHDVWHUQ UHJLRQ ORZHU VFKRROLQJ 35 &, '8,PRQWKVSULRU35 &, DQG OHLVXUH DV WKH UHDVRQ IRU WUDYHOLQJ 35 &, ZHUHDVVRFLDWHGZLWKSRVLWLYHEORRG DOFRKROFRQFHQWUDWLRQ,QWKH6RXWK0LGZHVWUHJLRQSRVLWLYH blood alcohol concentration was associated with being older WKDQ35 &, GULYLQJFDUV35 &, DQGGULYLQJDPRWRUF\FOH35 &, DVZHOODVKDYLQJEHHQJLYHQDEUHDWKDO\]HUWHVWDW OHDVWRQFHSUHYLRXVO\35 &, KDYLQJEHHU

7KHHTXLYDOHQWRI86

Table 1&KDUDFWHULVWLFVRILQGLYLGXDOVZKRUHIXVHGRUSDUWLFLSDWHGE\UHJLRQ 1RUWKDQG1RUWKHDVWUHJLRQV

7\SHRIYHKLFOH

,QWHUYLHZDIWHUSP

&KLVTXDUHWHVW

$FFHSWHG Q

S

Refused Q

$FFHSWHG Q

S

6RXWKHDVWUHJLRQ Refused Q

$FFHSWHG Q

S

100.0

0.116

\HDUV

7.7

-

0.001

2.7

-

0.001

-

-

0.001

\HDUV

40.4

\HDUV

43.7

24.3

41.1

42.3

\HDUV

7.7

7.6

7.0

7.7

0DOH Age

Refused Q

6RXWKDQG0LGZHVWUHJLRQV

Car

63.6

71.2

Bus

11.6

7.0

-

10.3

Truck

-

14.2

7.7

0RWRUF\FOH

27.3

21.1

21.2

26.6

41.7

36.3

0.722

0.626

310

R. De Boni et al.

Table 2'HPRJUDSKLFFKDUDFWHULVWLFVDQGULVNEHKDYLRUIRUWUDIÀFDFFLGHQWVDPRQJ%UD]LOLDQGULYHUVVWUDWLÀHGE\UHJLRQ 1RUWK Q

1RUWKHDVW Q

6RXWK Q

0LGZHVW Q

6RXWKHDVW Q

S

6H[

Female

3.1

7.3

Age

\HDUVROG

40.2

32.2

33.0

0.104

6FKRROLQJ

,QFRPSOHWHFRPSOHWHFROOHJH

23.7

26.1

27.0

+LJK6FKRROWHFKQLFLDQFRPSOHWHLQFRPSOHWH

41.2

47.3

43.6

1HYHUVWXGLHGXSWRWKJUDGH

30.0

23.6

31.2

30.7

24.1

14.7

24.6

32.3

24.4

20.4

26.2

24.6

24.6

24.3

24.7

26.2

36.3

%XVWUXFN

16.6

Car

0RWRUF\FOH

27.6

Time of collection

$IWHUSP

32.6

32.7

0.022

Place of origin

+RPHZRUNVFKRROFKXUFKVWRUHVKRSSLQJ mall

0.122

5HVWDXUDQWKRPHEDUFOXEJDVVWDWLRQKRWHO

10.0

7.1

12.1

Reason for travel

Work

/HLVXUHRWKHU

46.0

Favorite drink

Beer

70.7

0.001

Binge

At least once a year

71.1

62.3

64.6

$OFRKROFRQVXPSWLRQSDWWHUQ

Light

73.0

73.6

0RGHUDWH

12.1

Heavy

7.3

7.4

Previous DUI accident

Yes

4.1

4.3

4.2

6WRSSHGWREHEUHDWKDO\]HG

Yes

10.3

10.0

11.0

Positive BAC

Yes

6.1

6.1

4.4

3RVLWLYH%$&RUKDVGUXQNKDJR

Yes

10.3

13.7

10.3

0.100

)DPLO\LQFRPH

7\SHRIYHKLFOH

0.01

9DOXHLQ%UD]LOLDQFXUUHQF\5HDO (TXLYDOHQWWR888²!8

&KLVTXDUH

DVDIDYRULWHGULQN35 &, OHLVXUHDVWKH UHDVRQIRUWUDYHOLQJ35 &, FRPLQJIURPD EDUUHVWDXUDQWKRPHFOXEJDVVWDWLRQKRWHO35 &, DQGEHLQJDSSURDFKHGDIWHUSP35 &, ,QWKH6RXWKHDVWUHJLRQVLJQLÀFDQWYDULDEOHVLQ WKHÀQDOPRGHOZHUHDVIROORZVEHLQJPRUHWKDQ\HDUV ROG35 &, GULYLQJFDUV35 &, DQGPRWRUF\FOHV35 &, ORZ VFKRROLQJ 35 &, KDYLQJ EHHQ JLYHQ D EUHDWKDO\]HUWHVWDWOHDVWRQFHSUHYLRXVO\35 &, ELQJHGULQNLQJ35 &, DQGOHLVXUH DVWKHUHDVRQIRUWUDYHOLQJ35 &, 7DEOH

Discussion

7KLVLVWKHÀUVW%UD]LOLDQVWXG\WRDQDO\]HIDFWRUVDVVRFLDWHG ZLWKGULQNLQJDQGGULYLQJVWUDWLÀHGE\UHJLRQ0RVWIDFWRUV ZHUH VLPLODU DPRQJ UHJLRQV HVSHFLDOO\ ORZ VFKRROLQJ DQG leisure as a reason for traveling. 8QOLNHSUHYLRXVLQWHUQDWLRQDOVWXGLHVEXWLQDJUHHPHQW ZLWK SUHYLRXV %UD]LOLDQ VWXGLHV individuals older than ZHUHPRUHSURQHWR'8,WKDQWKRVHXQGHUPRVWOLNHO\ EHFDXVHRIGLIIHUHQWDOFRKROXVDJHSDWWHUQVLQWKH%UD]LOLDQ SRSXODWLRQ%LQJHGULQNLQJSUHYDOHQFHVHHPVWREHKLJKHYHQ DIWHU DJH 27 and there is a lower availability of cars for \RXQJHUGULYHUVLQ%UD]LO8QOLNHRWKHUFRXQWULHVZKHUHSURgressive licensing combined with a high median socioeconomic background allow for the licensing of drivers from the age of %UD]LOLDQODZVDOORZLQJIRUSURJUHVVLYHOLFHQVLQJDUHUHFHQW as are changes in the economy that allow for a young driver to


311

Table 3)DFWRUVDVVRFLDWHGWRSRVLWLYHEORRGDOFRKROFRQFHQWUDWLRQRIGULYHUVDSSURDFKHGLQ%UD]LOLDQUHJLRQV EHWZHHQ North and Northeast regions Adjusted RP (95%CI)

Drank in the day (%)

p

Adjusted RP (95%CI)


p

Adjusted RP (95%CI)

7.1

-

1

2.2

1

1.0 (0.3-2.7)

11.0

0.467

1

6.4

1

7.3

Female1 0DOH

Age

\HDUV

)DPLO\LQFRPH

7\SHRI9HKLFOH

Time of collection

Place of origin

Reason for traveling

Favorite drink2

Binge $OFRKROFRQVXPSWLRQSDWWHUQ3

Previous DUI accident

Southeast region

p

6H[

6FKRROLQJ

South and Midwest regions


0.013

0.012

1

\HDUV

6H[

10.3

1.9 (1.1-3.2)

1.7 (1.1-2.6)

6XSHULRULQFRPSOHWHFRPSOHWH

1

1

1

+LJK6FKRROWHFKQLFLDQ FRPSOHWHLQFRPSOHWH

0.072

1HYHUVWXGLHGXSWRWKJUDGH

12.6

0.011

15.6 (1.9-127.8)

12.1

16.2

2.3 (1.5-3.6)

1

10.3

12.2

12.0

6.3

7.6

0.624

-

-

0.631

%XVWUXFN

3.6

1

4.0

1

6.2

Car

10.6

10.4

0.002

3.4 (1.6-7.3)

11.3

0.011

2.4 (1.2-4.7)

0RWRUF\FOH

12.0

0.667

11.3

4.0 (1.9-8.7)

0.023

2.4 (1.1-5.1)

%HIRUHSP

-

-

$IWHUSP

12.3

+RPHZRUNVFKRROFKXUFK VWRUH

-

5HVWDXUDQWKRPHEDUFOXE JDVVWDWLRQKRWHO

Work

Leisure or other

Beer

2WKHUV

1RWRQFHDQ\HDU

At least once an year

Light

14.2 0.336

-

1

3.2 (1.4-7.0)

-

11.1

12.1

1

2.0 (1.2-3.4)

14.2

0.006

1 2.0 (1.3-2.9)

1

2.0 (1.2-3.2)

3.5 (1.7-7,3)

11,7

1

0.433

-

7.7

-

0.001

-

-

0RGHUDWH

11.7

16.7

Heavy

10.0

10.2

1R

Yes

6.2

6WRSSHGWREHEUHDWKDO\]HG

Yes

1R

Drinking and driving -12m

Yes

1R

-

-

7.1 0.063

1

0.010

2.7 (1.3-5.8) 1

10.1

1 1.9 (1.3-2.8)

-

0.003

1

12.7

1

1.7 (1.2-2.4)

-

0.322

-

2.4 (1.6-3.6)

0.001

2.5 (1.5-4.1) 1

0.7 (0.4-1.1)

10.1

1

1 0.202

7KHUHJLRQVZHUHJURXSHGE\WKHLUVLPLODULWLHVDFFRUGLQJWRWKHIROORZLQJYDULDEOHVJHQGHUDJHVFKRROLQJLQFRPHW\SHRIYHKLFOHWHVWHGWKURXJKRXW0$129$

9DOXHLQ%UD]LOLDQFXUUHQF\5HDO (TXLYDOHQWWR888²!8 1

7KHYDULDEOHJHQGHUZDVQRWLQVHUWHGDVDFRQWURORQWKH1RUWK1RUWKHDVWUHJLRQGXHWRDVPDOOQXPEHURIZRPHQQ )DYRULWHGULQNZDVQRWLQVHUWHGRQWKHÀQDOPRGHORQWKH6RXWKHDVWUHJLRQGXHWRLWVFROOLQHDULW\ZLWKELQJH 3 $OFRKROFRQVXPSWLRQSDWWHUQZDVQRWLQVHUWHGRQWKHÀQDOPRGHORQWKH6RXWKHDVWUHJLRQGXHWRLWVFROOLQHDULW\ZLWKELQJHIDYRULWHGULQNDQG'8,PRQWKV 2

7KHYDULDEOHVZLWKWKHVPDOOHU$,&DUHWKHRQHVWKDWHQWHUHGWKHÀQDOPRGHO

SXUFKDVHKLVKHURZQFDU:HEHOLHYHWKLVLVUHÁHFWHGLQWKH DJHÀQGLQJV7KHFRUUHODWLRQEHWZHHQELQJHGULQNLQJDQGEHHU DVDIDYRULWHGULQNLVLPSRUWDQWIRUSXEOLFKHDOWKZLWKSDUWLFXODU\EHFDXVHRIWKHHPSKDVLVLQ%UD]LOLDQFXOWXUHRQEHHU$V KDVEHHQVWXGLHGLQGHSWKE\3LQVN\DQGFROOHDJXHVEHHUKDV DVSHFLÀF´JROGQLFKHµLQWKHFXOWXUHRIGULQNLQJLQ%UD]LOGXH

WRDGDSWDWLRQVLQ%UD]LOEHFDXVHRIDGDSWDWLRQVRI%UD]LOLDQODZ WKDWDOORZIRUEHHUWREHDGYHUWLVHGLQDPRUHÁH[LEOHPDQQHU than beverages of higher alcohol content. Both binge drinkLQJDQGEHHUDVDIDYRULWHGULQNZHUHDVVRFLDWHGZLWKSRVLWLYH EORRGDOFRKROFRQFHQWUDWLRQZKLFKLVLQDJUHHPHQWZLWKWKH international literature. This correlation could be useful

312

WRSURPRWHWKHSUHYHQWLRQRIELQJHGULQNLQJ%HFDXVHLQGLYLGXDOV ZKRGULQNLQDELQJHSDWWHUQXVXDOO\GULQNEHHUPHDVXUHVWR UHVWULFWLWVDYDLODELOLW\LQFOXGLQJLQFUHDVHGWD[HVFXUIHZVDQG UHVWULFWLRQRIDYDLODELOLW\²ZRXOGKHOS7KHVHPHDVXUHVKDYH EHHQHIIHFWLYHLQSUHYHQWLQJDOFRKRODEXVHLQFOXGLQJGULQNLQJ DQGGULYLQJLQRWKHUSDUWVRIWKHZRUOG 2QO\LQWKH6RXWKDQG0LGZHVWUHJLRQVZDVWKHWLPHRI FROOHFWLRQDIWHUSP DQGFRPLQJIURPEDUVUHVWDXUDQWV DVVRFLDWHG ZLWK SRVLWLYH %$& 7KH OLWHUDWXUH LQGLFDWHV WKDWWKHIUHTXHQF\RI'8,LVKLJKHUDWQLJKW as is the FRQVXPSWLRQRIDOFRKROLFEHYHUDJHVLQEDUV as was found LQWKHVHUHJLRQV7KHVHGLIIHUHQFHVFRXOGEHH[SODLQHGLQ various ways: surveillance and law enforcement could ocFXULQDPRUHV\VWHPDWLFZD\LQWKH1RUWK1RUWKHDVWHUQ 6RXWKHDVWUHJLRQVGHFUHDVLQJIUHTXHQFLHVDWQLJKWDQGLQ DUHDVZLWKKLJKFRQFHQWUDWLRQRIDOFRKROFRQVXPSWLRQSRLQWV LWLVZRUWKFRQVLGHULQJWKDWGDWDFROOHFWLRQZDVFRPSOHWHG VKRUWO\DIWHUWKHLPSOHPHQWDWLRQRIDODZWKDWORZHUHGWKH OHJDO%$&LQ-XQHZKLFKFRXOGUHVXOWLQLQFUHDVHGVXUveillance in certain regions of the country); and urban areas FRXOGGLIIHULQWKHLUURDGVLQWKHVHUHJLRQVZKLFKZHGLG QRWHYDOXDWHLQWKLVVWXG\2XUFROOHFWLRQSHULRGEHWZHHQ SPDQGSP FRXOGEHWRRVKRUWWRGHWHFWGLIIHUHQFHVUHODWHGWRWLPHRIDOFRKROFRQVXPSWLRQLQWKHRWKHU UHJLRQV7RLQYHVWLJDWHDQ\RIWKHVHK\SRWKHVHVLWZRXOG EHQHFHVVDU\WRFRQGXFWDQHZVWXG\WKDWZRXOGH[SOLFLWO\ model these variables. 'ULYHUV ZKR UHSRUWHG KDYLQJ EHHQ SUHYLRXVO\ JLYHQ D EUHDWKDO\]HUWHVWZHUHPRUHOLNHO\WRKDYHFRQVXPHGDOFRKRO RQ WKH GD\ RI GDWD FROOHFWLRQ DQG WKLV ÀQGLQJ ZDV HYHQO\ GLVWULEXWHG WKURXJKRXW WKH GLIIHUHQW UHJLRQV RI %UD]LO 7KLV ÀQGLQJLVGLIIHUHQWIURPWKDWRIWKHLQWHUQDWLRQDOOLWHUDWXUH36 DDQGLWPD\UHÁHFWVRPHSHFXOLDUDVSHFWVRI%UD]LOLDQODZ 3ULRUWRWKHODZRIWKHXVHRIEUHDWKDOFRKROWHVWVZDV UDUHRQWKHFRXQWU\·VKLJKZD\VZKLFKZDVUHÁHFWHGLQWKH ORZSUHYDOHQFHIRXQGIRUWKLVYDULDEOHLQRXUVDPSOH'ULYHUV who had already submitted to the test might have shown ULVN EHKDYLRUV RQ SUHYLRXV RFFDVLRQV RU ZHUH SURIHVVLRQDO GULYHUVZKRDUHPRUHRIWHQWHVWHG,WLVSRVVLEOHWKDWZHZLOO VHH FKDQJHV LQ WKLV W\SH RI EHKDYLRU LQ WKH IXWXUH EHFDXVH of increased enforcement and breath alcohol test use in the country in the coming years. 5HJDUGLQJWKHSUHYDOHQFHRISRVLWLYH%$&VZHIRXQGQR VLJQLÀFDQW GLIIHUHQFHV EHWZHHQ UHJLRQV +RZHYHU LQ WKH 6RXWKHDVWUHJLRQWKHSHUFHQWDJHZDVZKHUHDVLQWKH 0LGZHVWLWZDVVXJJHVWLQJWKDWVLJQLÀFDQWUHJLRQDOGLIIHUHQFHVFRXOGKDYHEHHQPLVVHGEHFDXVHRIWKHVPDOOVDPSOH VL]H,QGHSHQGHQWO\RIWKHGLIIHUHQFHVEHWZHHQUHJLRQVWKH SUHYDOHQFHZDVKLJKHVSHFLDOO\LIZHFRQVLGHUWKDWSHULRGVRI KLJKHUULVNHJDIWHUPLGQLJKWRURQPDMRUKROLGD\V ZHUH QRWLQFOXGHGDQGWKHUHODWLYHO\ORZULVNSHULRGIURPSPWR PLGQLJKW7KLVSUHYDOHQFHLVVLPLODUWRRWKHUVIRXQGLQVWXGLHV FRQGXFWHGLQWKH86IURPSPWRSPRQZHHNHQGV36 %HOJLXP1RUZD\DQG1RUWK$PHULFDQDQG(XURSHDQVWDWHV LQJHQHUDOHVWLPDWHWKHSUHYDOHQFHRI'8,DVKLJKHVWIRUFDU drivers.2XUÀQGLQJVDOVRVKRZKLJKSUHYDOHQFHLQPRWRUF\FOHSURIHVVLRQDOGULYHUVKLJKOLJKWLQJWKHQHHGWREHEHWWHU informed of the characteristics of these drivers with regard WRGULQNLQJDQGGULYLQJ,QDURDGVLGHVXUYH\LQ7KDLODQGWKH SUHYDOHQFHRISRVLWLYH%$&LQPRWRUF\FOHGULYHUVZDVVLPLODUWR WKDWIRXQGIRUFDUGULYHUVDQGDPRQJSURIHVVLRQDO

R. De Boni et al.

drivers. +RZHYHU GDWD ZHUH QRW FROOHFWHG VROHO\ LQ SHDN risk hours. Prevalence may still be underestimated if the inGLYLGXDOVZKRUHIXVHGVWXG\SDUWLFLSDWLRQKDGDSRVLWLYH%$& +RZHYHUEHFDXVHUHIXVDOVZHUHVLPLODUDQGORZLQWKHWKUHH VWXGLHG UHJLRQV VHOHFWLRQ ELDV PLJKW QRW KDYH VLJQLÀFDQWO\ LQÁXHQFHGWKHPDLQVWXG\FRPSDULVRQV 7KLV VWXG\ KDG VRPH OLPLWDWLRQV WKDW PD\ LQÁXHQFH WKH JHQHUDOL]DELOLW\ RI WKH GDWD REWDLQHG WKH VDPSOH LV QRQ SUREDELOLVWLFDOWKRXJKUDQGRPLQQDWXUHWKHUHIRUHZHFDQQRWJHQHUDOL]HWKHÀQGLQJVWRDOOGULYHUVZKRGULYHRQIHGHUDO KLJKZD\V GDWD ZHUH REWDLQHG RQ IHGHUDO KLJKZD\V RQO\ which did not always intersect urban or suburban areas directly; WKHUHIRUHRXUGDWDPD\GLIIHUIURPWKRVHLQSXUHXUEDQHQYLURQPHQWVIRUH[DPSOHGRZQWRZQDUHDV ZKHUHSUHYLRXVVWXGLHV KDYHGHPRQVWUDWHGPXFKKLJKHUUDWHVRISRVLWLYH%$&V16 3) data FROOHFWLRQZDVSUHGRPLQDQWO\SHUIRUPHGGXULQJWKHGD\ZKLFK PD\KDYHXQGHUHVWLPDWHGWKHRYHUDOOSRVLWLYHSUHYDOHQFHDV SUHYLRXVO\PHQWLRQHGDQG VRPHGLIIHUHQFHVLQWKH1RUWK 1RUWKHDVWUHJLRQZHUHQRWVLJQLÀFDQWPRVWOLNHO\EHFDXVHRIWKH VPDOOVDPSOHVL]H1HYHUWKHOHVVFRQVLGHULQJWKDWSUHGLFWRUVRI '8,ZHUHVLPLODUDPRQJWKHWKUHHUHJLRQVGDWDREWDLQHGLQWKLV VWXG\LQGLFDWHWKDW'8,SUHYHQWLRQHVSHFLDOO\E\ODZHQIRUFHPHQWRUE\WKHSXQLVKPHQWRIRIIHQGHUVZKLFKDUHZHOONQRZQ PHDVXUHVIRUGHFUHDVLQJ'8,LQWKHLQWHUQDWLRQDOOLWHUDWXUH33 remain necessary throughout the country.

Acknowledgments 7KHDXWKRUVZRXOGOLNHWRDFNQRZOHGJHWKHGR]HQVRIPHPEHUV RI WKH %UD]LOLDQ 3ROLFLD 5RGRYLiULD )HGHUDO 3ROtFLD )HGHUDO DQGLQSDUWLFXODURIÀFHUVFRGHQDPHV 5XELQ5RVV\*HWXOLR DQG8HOEHUIRUWKHLUHIIRUWVLQWKHGDWDFROOHFWLRQSURFHGXUHV

Disclosures Raquel De Boni Employment: Center for Drug and Alcohol Research of the Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil. Lisia von Diemen Employment: Center for Drug and Alcohol Research of the Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil. Paulina do Carmo Arruda Vieira Duarte Employment: Secretaria Nacional de Políticas sobre Drogas (Brazilian Secretariat for Drug Policies), Brazil. Daniela Benzano Bumaguin Employment: Center for Drug and Alcohol Research of the Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil. Juliana Balbinot Hilgert Other: Postgraduate Program of Epidemiology, Universidade Federal do Rio Grande do Sul, Brazil. Mary Clarisse Bozzetti Other: Postgraduate Program of Epidemiology, Universidade Federal do Rio Grande do Sul, Brazil. Anne Sordi Employment: Center for Drug and Alcohol Research of the Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil. Flavio Pechansky Employment: Center for Drug and Alcohol Research of the Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil. This study was funded by the Secretaria Nacional de Políticas sobre Drogas TC 004/2007 and FIPE /HCPA. * Modest

6LJQLÀFDQW

6LJQLÀFDQW$PRXQWVJLYHQWRWKHDXWKRU·VLQVWLWXWLRQRUWRDFROOHDJXHIRU research in which the author has participation, not directly to the author.


References 1. 2.

3.

4.

6. 7.

10.

11.

12.

13.

14.

16.

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