Abstracts

Introduction

Traffic accidents (TA) represent a high cost to society, causing more than 1 million deaths worldwide each year, and an even greater number of hospitalizations, physical and psychological sequelae¹1 Peden M SR, Sllet D, Mohan D, Hyder AA, Jarawan E, Mathers C, editors. World report on traffic injury prevention. Geneva: World Health Organization; 2004.. Literature indicates that most TA involve young men, and they suffer such accidents especially as drivers, while women predominate as passengers and pedestrians²2 Andrade S, Jorge M. Victims' characteristics by road accidents in a city of Southern Brazil. Rev Saude Publica 2000;34(2):149-156.^,33 Gawryszewski V, Coelho H, Scarpelini S, Zan, Jorge M, Rodrigues E. Land transport injuries among emergency department visits in the state of São Paulo, in 2005. Rev Saude Publica 2009; 43(2):275-282..

Driving under the influence of alcohol (DUI) increases the risk of TA, and data from a study conducted in São Paulo showed a prevalence of 21.9% of positive of Blood alcohol concentration (BAC) readings on weekends in the city of Diadema⁴4 Duailib S PI, Laranjeira R. Prevalência do beber e dirigir em Diadema, estado de São Paulo. Rev Saude Publica 2007;41(5):1058-1061., which is much higher than other countries (usually less than 10%). Some of the DUI-associated factors include: being male, unmarried, binge drinking (five or more drinks on one occasion)⁵5 Caetano R, McGrath C. Driving under the influence (DUI) among U.S. ethnic groups. Accident Analyses and Prevention 2005;37(2):217-224.

6 Morrisson L, Begg DJ, Langley JD. Personal and situational influences on drink and driving and sober driving among a cohort of young adults. Injury Prevention 2002;8(2):111-115.^-77 Bingham C, Elliot M, Shope J. Social and Behavioral Characteristics of Young Adult Drink/Drivers Adjusted for Level of Alcohol Use. Alcohol Clin Exp Res 2007;31(4):655-664., having been a passenger of a DUI driver, little insight about punishment, low socioeconomic status, and low education⁶6 Morrisson L, Begg DJ, Langley JD. Personal and situational influences on drink and driving and sober driving among a cohort of young adults. Injury Prevention 2002;8(2):111-115.. Some studies also show that driving a vehicle alone increases the chance of TA involving alcohol⁶6 Morrisson L, Begg DJ, Langley JD. Personal and situational influences on drink and driving and sober driving among a cohort of young adults. Injury Prevention 2002;8(2):111-115.^,88 Nelson T, Isaac N, Kennedy BP, Graham JD. Factors associated with planned avoidance of alcohol-impaired driving in high-risk men. J Stud Alcohol 1999;60(3):407-412.^,99 Longo M, Hunter C, Lokan R, White J, White M. The prevalence of alcohol, cannabinoids, benzodiazepines and stimulants amongst injured drivers and their role in driver culpability Part I: the prevalence of drug use in drivers, and characteristics of the drug-positive group. Accid Anal Prev 2000;32(5):613-622.. This, however, does not apply to young people who usually DUI and have passengers in the car. In addition, drivers who suffer TA involving alcohol tend to drink more in bars, and on weekends⁶6 Morrisson L, Begg DJ, Langley JD. Personal and situational influences on drink and driving and sober driving among a cohort of young adults. Injury Prevention 2002;8(2):111-115.^,77 Bingham C, Elliot M, Shope J. Social and Behavioral Characteristics of Young Adult Drink/Drivers Adjusted for Level of Alcohol Use. Alcohol Clin Exp Res 2007;31(4):655-664..

Other psychoactive substances also affect driving skills, and may increase TA risk¹⁰10 Ojaniemi KK, Lintonen TP, Impinem AO, Lillsunde PM, Ostamo AI. Trends in driving under the influence of drugs: A register-based study of DUID suspects during 1977-2007. Accid Anal Prev 2009;41(1):191-196.. In a cohort study conducted in New Zealand involving 969 drivers who suffered TA, it was found that 24% of those who had drunk also consumed cannabis and LSD⁶6 Morrisson L, Begg DJ, Langley JD. Personal and situational influences on drink and driving and sober driving among a cohort of young adults. Injury Prevention 2002;8(2):111-115..

Consistently, the literature indicates that men have higher risk for both TA, and for DUI. However, there is no Brazilian data comparing risk behaviors associated with the TA between men and women. Thus, the aim of this study was to analyze the differences in alcohol and drugs consumption, as well as risk behaviors among men and women who were attended in emergencies of Porto Alegre after a traffic accident.

Methods

This was a cross-sectional study with consecutive sampling conducted in the two hospitals that attend more than 90% of trauma victims of the city of Porto Alegre, the southernmost state capital of Brazil. All TA victims who were over 18 years of age and who suffered TA either as drivers, pedestrians or riders, between ouctober-november 2009, were approached after initial evaluation. The study was approved by the Ethics Committee in Research of Hospital de Clinicas de Porto Alegre, and methodological details are described elsewhere¹¹11 Soibelman M, Benzano D, Von Diemen L, De Boni R, Pechansky F. Consumo de álcool e outras drogas entre vítimas de acidentes de trânsito atendidas em emergências de Porto Alegre. Uso de bebidas alcoolicas e outras drogas nas rodovias brasileiras e outros estudos. Porto Alegre: Secretaria Nacional de Politicas sobre Drogas; 2010..

Demographic data and data related to risk behaviors were collected through structured interviews. BAC was measured using breath test (model ALCO-SENSOR IV^(TM), Intoximeters Inc, Devon, UK) and substance use (cannabis, cocaine and benzodiazepines) through saliva test (Quantisal^TM, Immunalysis Corporation, Pomona, CA, USA), analyzed by ELISA. Drug abuse and dependence were evaluated using the Mini International Neuropsychiatric Interview (MINI).

Data were analyzed with SPSS.16, chi-square test for categorical variables and Student t test for quantitative variables were used.

Results

The sample comprised 441 men (72.4%) and 168 (27.6%) women with a mean age of 32 and 34 years, respectively. 92.6% of those eligible were approached, and 10.9% refused. Women had higher education, lower proportion of driver's license, and were injured mainly as passengers and pedestrians (p <0.001), as can be seen in Table 1.

There was no statistical difference between gender neither for alcohol abuse/ dependence nor for positive BAC. Men reported more binge drinking and used more cocaine and THC, while women used more benzodiazepines (p < 0.05) (Table 2).

Discussion

According to the literature, regardless of the type of accident, the men are always more involved¹²12 Golias A, Caetano R. Acidentes entre motocicletas: análise dos casos ocorridos no estado do Paraná entre julho de 2010 e junho de 2011. Cien Saude Colet 2013;18(5):1235-1246.. The larger number of women passengers and pedestrians in our sample is consistent with the literature, and may reflect social norms in driving²2 Andrade S, Jorge M. Victims' characteristics by road accidents in a city of Southern Brazil. Rev Saude Publica 2000;34(2):149-156.^,33 Gawryszewski V, Coelho H, Scarpelini S, Zan, Jorge M, Rodrigues E. Land transport injuries among emergency department visits in the state of São Paulo, in 2005. Rev Saude Publica 2009; 43(2):275-282.^,1313 Marmor M, Parnes N, Aladgem D, Birshan V, Sorkine P, Halpern P. Characteristics of Road Traffic Accidents Treated in an Urban Trauma Center. Isr Med Assoc J 2005;7(1):9-12.,¹⁴14 Rodrigues CS, Ladeira RM, Pereira JC, Paula IM. Saúde em trânsito: Pesquisa de acompanhamento de vítimas de acidentes de trânsito em Belo Horizonte. Belo Horizonte: Secretaria de Saúde de Belo Horizonte -SM-SA-BH; [2005]. Empresa de Transportes e Trânsito de Belo Horizonte - BHTRANS, 2005. which men usually takes the . These standards may also be associated with differences in substance use among men and women. Studies have shown that in developing countries, where the social norms are more traditional, women have higher rates of abstinence from alcohol while men drink more and have more binge drinking¹⁵15 Almeida-Filho N, Lessa I, Magalhães L, Araújo M, Aquino E, Kawachi I, James SA. Alcohol drinking patterns by gender, ethnicity, and social class in Bahia, Brazil. Rev Saude Publica 2004;38(1):45-54.^,1616 Wilsnack R, Vogeltanz N, Wilsnack S, Harris T, Ahlström, S, Bondy S, Csémy L, Ferrence R, Ferris J, Fleming J, Graham K, Greenfield T, Guyon L, Haavio-Mannila E, Kellner F, Knibbe R, Kubicka L, Loukomskaia M, Mustonen H, Nadeau L, Narusk A, Neve R, Rahav G, Spak F, Teichman M, Trocki K, Webster I, Weiss S. Gender differences in alcohol consumption and adverse drinking consequences: cross-cultural patterns. Addiction 2008;95(2):251-265.. In communities where women have less conservative attitudes, their drinking patterns are similar to men, as well as the woman's role in society. This difference may also be associated with the lower proportion of women with driver's license in the sample, which is consistent with data from the general population, where 75% of drivers are men¹⁷17 Denatran AdI. Dia Nacional do Motorista 2006. [cited 2010 out 14]. Available from: http://www.denatran.gov.br/ultimas/20060725_diamotorista.htm
http://www.denatran.gov.br/ultimas/20060... .

Although most drivers used seat belts, contrary to international studies women in our sample used tended to use less¹⁸18 Ouimet MC, Morton BGS, Noelcke EA, Williams AF, Leaf WA, Preusser DF, Hartos JL. Perceiveid risk and other predictors and correlates of teenagers safety belt use during the first year of licensure. Traffic Inj Prev 2008;9(1):1-10.. We do not know whether these women were in the backseat of the cars - and therefore did not use the device, which is common practice in Brazil. Another explanation would be the high prevalence of substance use, since individuals who drink and drive adopt less safety behaviors even when sober⁷7 Bingham C, Elliot M, Shope J. Social and Behavioral Characteristics of Young Adult Drink/Drivers Adjusted for Level of Alcohol Use. Alcohol Clin Exp Res 2007;31(4):655-664..

Alcohol was the most frequent drug used by victims, followed by cannabinoids. Although the prevalence of positive BAC measured by breathalyzer was 7.22%, 27.8% of patients reported drinking within 24 hours prior to the TA. This value is consistent with another Brazilian study, where the prevalence of reported alcohol use was 27.7 %¹⁴14 Rodrigues CS, Ladeira RM, Pereira JC, Paula IM. Saúde em trânsito: Pesquisa de acompanhamento de vítimas de acidentes de trânsito em Belo Horizonte. Belo Horizonte: Secretaria de Saúde de Belo Horizonte -SM-SA-BH; [2005]. Empresa de Transportes e Trânsito de Belo Horizonte - BHTRANS, 2005.. This difference can be justified by the time between the accident and sample collection. A Brazilian study that aimed to describe the frequency of reports of alcohol consumption among emergency room care (victims of accidents and violence) found the proportion of alcohol consumption among men was three times greater than among women¹⁹19 Mascarenhas M, Malta D, Silva M, Gazal-Carvalho C, Monteiro R. Consumo de álcool entre vítimas de acidentes e violências atendidas em serviços de emergência no Brasil, 2006 e 2007. Cien Saude Colet 2009;14(5):17896-1796..

Consistent with previous studies, women had used more benzodiazepines and men had more cannabis and alcohol⁹9 Longo M, Hunter C, Lokan R, White J, White M. The prevalence of alcohol, cannabinoids, benzodiazepines and stimulants amongst injured drivers and their role in driver culpability Part I: the prevalence of drug use in drivers, and characteristics of the drug-positive group. Accid Anal Prev 2000;32(5):613-622.^,2020 Blows S, Ivers R, Connor J, Ameratunga S, Woodward M, Norton R. Marijuana use and car crash injury. Addiction 2005;100(5):605-611.. Even though Brazilian studies on drug use conducted in emergency departments are scarce, and generally restricted to the use of alcohol, a study in São Paulo found the following prevalence of substance abuse: THC 13.6%, cocaine 3.3% and benzodiazepines 4.2%²¹21 Reis A, Figlie N, Laranjeira R. Prevalence of substance use among trauma patients treated in a Brazilian emergency room. Rev Bras Psiquiatr 2006;28(3):191-195.. Data are similar to those we found, but draw attention to the high prevalence of cocaine use among the men in our sample, which may be associated to the increase in crack use in Brazil²²22 Ferri C, Laranjeira R, Silveira Dd, Dunn J, Formiconi M. Aumento da procura de tratamento por usuários de crack em dois ambulatórios na cidade de São Paulo, nos anos de 1990 a 1993. Rev. Assoc Médica Brasil 1997;43(1):25-28.^,2323 Duailibi L, Ribeiro M, Laranjeira R. Profile of cocaine and crack users in Brazil. Cad Saude Publica 2008;24(4):545-557..

This is the first Brazilian study to compare risk behaviors among men and women with traffic accidents, and it must be read under the scope of its limitations: 1) the sample was consecutive and cannot be generalized to all TA victims; 2) individuals under 18 years were excluded, which may have underestimated the use of substances; 3) The time between the TA and the collection of material for analysis may have underestimated drug use prevalence. However, data confirm international studies, and point to the need of specific prevention strategies that consider gender differences in Brazil.

References

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