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 7PMVNF

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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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Regional differences on DUI

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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

Regional differences on DUI

311

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

Drank in the day (%)

p

Adjusted RP (95%CI)

Drank in the day (%)

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

Drank in the day (%)

 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.

Regional differences on DUI

References 1. 2.

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