ABSTRACT:

Objective:

To present the results of indicators of alcohol consumption and driving for Brazilian capitals based on two population surveys performed in Brazil in 2013.

Methods:

Cross sectional study with data from adults (≥ 18 years) participants of the Telephone Survey on Risk and Protective Factors for Chronic Diseases (Vigitel) and the National Health Survey (NHS). Prevalence for indicators of alcohol consumption and driving was then calculated.

Results:

The proportion of adult drivers who drove soon after drinking was significantly higher among males (29.3% - Vigitel and 24.4% - NHS), the young aging 18 to 29 years (31.6% - Vigitel and 24.1% - NHS) and among residents of the capitals of the Midwest (33.7% - Vigitel and 28.3% - NHS). The proportion of adults who reported drinking and driving was higher among males (9.4% - Vigitel and 7.4% - NHS) in the 18 to 29 age group (7.1% - Vigitel; 4.5% - NHS), and among residents of the capitals of the Midwest (7.9% - Vigitel and 6.1% - NHS).

Conclusion:

The study estimated the prevalence of the habit of driving after alcohol consumption among drivers and in the general population. There was consistency between the results from two nationwide surveys.

Keywords:
Alcohol drinking; Automobile driving; Accidents, traffic; Risk factors; Health surveys; Law enforcement.

INTRODUCTION

The consumption of alcoholic beverages is among practices and cultural habits of various civilizations for millennia. Thus, their intake is encouraged and associated with festivities, religious ceremonies, celebrations and moments of joy¹1. World Health Organization. International guide for monitoring alcohol consumption and related harm. Geneva: WHO; 2002. ²2. Monteiro MG. Alcohol y salud pública en las Américas: un caso para la acción. Washington, D.C: Organización Pan Americana de la Salud; 2007.. However, alcohol is also associated with deleterious effects. The World Health Organization (WHO) links alcohol to about 1.8 million deaths worldwide (3.2% of all deaths), and to 4% of diseases, which represents 58.3 million disability-adjusted life years (DALYs). Alcohol is the fifth leading risk factor when it comes to premature deaths and disabilities worldwide¹1. World Health Organization. International guide for monitoring alcohol consumption and related harm. Geneva: WHO; 2002.. In the Americas, alcohol consumption has been considered the most important risk factor for diseases²2. Monteiro MG. Alcohol y salud pública en las Américas: un caso para la acción. Washington, D.C: Organización Pan Americana de la Salud; 2007. ³3. Rehm J, Monteiro M. Alcohol consumption and burden of disease in the Americas -implications for alcohol policy. Rev Panam Salud Publica 2005; 18(4-5): 241-8..

The problems caused by alcohol intake can affect not only the consumer, but their family and social circle, as in cases of domestic violence, marital conflict, child abuse⁴4. Borges G, Cherpitel C, Orozco R, Bond J, Ye Y, MacDonald S, et al. Multicenter study of acute alcohol use and non-fatal injuries: data from the WHO collaborative study on alcohol and injuries. Bull World Health Organ 2006; 84(6): 453-60.. Alcohol consumption can result in social and health consequences, including reduced productivity at work, violent behavior, sports and leisure injuries, traffic deaths and injuries⁴4. Borges G, Cherpitel C, Orozco R, Bond J, Ye Y, MacDonald S, et al. Multicenter study of acute alcohol use and non-fatal injuries: data from the WHO collaborative study on alcohol and injuries. Bull World Health Organ 2006; 84(6): 453-60. ⁵5. MacDonald S, Cherpitel C, De Souza A, Stockwell T, Borges G, Giesbrecht N. Variations of alcohol impairment in different types, causes and contexts of injuries: results of emergency room studies from 16 countries. Accid Anal Prev 2006; 38(6): 1107-12., unsafe sex and use of other psychoactive substances⁶6. Oliveira-Campos M, Nunes ML, Madeira FC, Santos MG, Bregmann SR, Malta DC, et al. Comportamento sexual em adolescentes brasileiros, Pesquisa Nacional de Saúde do Escolar (PeNSE 2012). Rev Bras Epidemiol 2014; 17(Suppl. 1): 116-30..

Even in small amounts, alcohol increases the risk of involvement in traffic accidents for both drivers and pedestrians, for it changes judgment capacity, vision, reaction time and motor coordination⁷7. Organización Mundial de la Salud. Drinking and driving: a road safety manual for decision-makers and practitioners. Genebra: OMS; 2007.. Studies conducted in Brazil show the high frequency of alcohol consumption among victims of car accidents and violence seen at emergency services⁸8. Mascarenhas MDM, Malta DC, Silva MMA, Gazal-Carvalho C, Monteiro RA, Morais Neto OL. Consumo de álcool entre vítimas de acidentes e violências atendidas em serviços de emergência no Brasil, 2006 e 2007. Ciênc Saúde Coletiva 2009; 14(5): 1789-96. ⁹9. Legay LF, Santos AS, Lovisi GM, Aguiar JS, Borges JC, Mesquita RM, et al. Acidentes de transporte envolvendo motocicletas: perfil epidemiológico das vítimas de três capitais de estados brasileiros, 2007. Epidemiol Serv Saúde 2012; 21(2): 283-92.. Even being preventable conditions, the combination of alcohol and driving may account for approximately 20 to 50% of traffic-related deaths¹1. World Health Organization. International guide for monitoring alcohol consumption and related harm. Geneva: WHO; 2002. ²2. Monteiro MG. Alcohol y salud pública en las Américas: un caso para la acción. Washington, D.C: Organización Pan Americana de la Salud; 2007. ¹⁰10. World Health Organization. Strategies to reduce the harmful use of alcohol.; Geneva: WHO 2008. Disponível em Disponível em http://apps.who.int/gb/ebwha/pdf_files/A61/A61_13-en.pdf . (Acessado em 10 de abril de 2013).
http://apps.who.int/gb/ebwha/pdf_files/A... .

Because of this evidence, the Brazilian Ministry of Health began to monitor alcohol consumption and driving among Brazilians through two major epidemiological surveys: the Telephone Survey on Risk and Protective Factors for Chronic Diseases (Vigitel)¹¹11. Brasil. Ministério da Saúde. Vigitel 2013: Vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico. Brasília: Ministério da Saúde; 2014., held since 2007 by the MoH, and the National Health Survey (NHS), conducted by the Brazilian Institute of Geography and Statistics (IBGE), in partnership with the MoH in 2013¹²12. Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional de Saúde 2013: percepção do estado de saúde, estilos de vida e doenças crônicas. Rio de Janeiro: IBGE; 2014..

The aim of this study was to present the results of indicators on alcohol consumption and driving obtained from two population surveys (Vigitel and NHS), held in 2013.

METHODS

Cross-sectional study with data from an adult population (≥ 18 years) participating in Vigitel and NHS surveys in 2013.

Vigitel data from adults (≥ 18 years) living in the capitals of the 26 Brazilian states and the Federal District were analyzed, all of them having a phone number. Vigitel is based on two-stage probabilistic sample draw:

The calculation of post-stratification weight was made by the rake method, considering gender, age and educational level, aiming to match the composition of the sample of the city to the socio-demographic composition of the whole adult population of each city in the year of survey¹¹11. Brasil. Ministério da Saúde. Vigitel 2013: Vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico. Brasília: Ministério da Saúde; 2014..

NHS was held in 2013, being an epidemiological home-based survey representative of the major regions of Brazil, federal units and capitals. Sample calculation was initially performed randomly based on census data from 2010. The planned sample was 81,167 households, considering those with residents; 69,994 households were eligible, and interviews were conducted in 64,348 households, with an 8.1% rate of non-response¹²12. Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional de Saúde 2013: percepção do estado de saúde, estilos de vida e doenças crônicas. Rio de Janeiro: IBGE; 2014..

The sampling plan of the NHS was made in three stages. The primary sampling units (PSUs) were the census sectors or set of sectors; secondary units were households; tertiary units were adult residents (≥ 18 years). Weighting factors were calculated for each sampling unit, considering probabilities of selection. The weighting factor for the resident selected for interview was also calculated considering the weight of the household, non-response adjustment for sex and balanced with total population by sex and age groups, estimated with the weight of all residents. Details about the sampling and weighting processes are provided in the publication of NHS results¹²12. Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional de Saúde 2013: percepção do estado de saúde, estilos de vida e doenças crônicas. Rio de Janeiro: IBGE; 2014..

Chart 1 shows the indicators analyzed in this study, with description of calculation method, source of the data and questions asked during the interviews.

The study population consisted of adults aging 18-74 years, living in the capitals of Brazil and the Federal District. Prevalence and respective 95% confidence interval (95%CI) were calculated for each indicator, stratified by sex, age group (18-29, 30-59, 60-64, 65-74 years), educational level (uneducated and incomplete primary school; complete primary school and incomplete high school; complete high school and incomplete higher education; higher education), race/skin color (white, black and brown) and set of capitals by geographic regions (North, Northeast, Southeast, South and Midwest). Data were analyzed in Stata version 11.0 (StataCorp., CollegeStation, USA), using the command "survey" for complex samples.

The participation of adults in the survey was voluntary and confidentiality of information was guaranteed. Both surveys were approved by the National Research Ethics Committee, reports 13,081/2008 and 355,590/2013 (Vigitel) and 328,159/2013 (NHS).

RESULTS

In 2013, Vigitel and NHS interviewed, respectively, 52,929 and 60,202 people aged ≥18 years. The proportion of adult that conducted cars or motorcycles soon after drinking was significantly higher among males both in Vigitel (29.3%) and NHS (24.4%). As for the age group, proportion was significantly higher among young people aging 18-29 years, with 31.6% in Vigitel and 24.1% in NHS. Regarding educational level, the reference to such behavior was more common among those with complete primary school and incomplete high school, with similar values ​​in both surveys (25.9% in Vigitel and 25% in NHS) without significant differences compared to other educational levels. The habit of driving after drinking was more common among black and brown-colored people, but with no significant difference in both surveys, compared to whites (Table 1).

Table 1 also shows the habit of driving after consuming alcohol among residents of the state capitals and the Federal District reported by 26.3% of adults surveyed in Vigitel and 21.3% of the participants of NHS. Such behavior was mostly reported by residents of the capital of the Midwest Region (33.7% in Vigitel and 28.3% in NHS).

Table 2 presents the proportion of adults who reported drinking and driving in both surveys. The highest rates were obtained from male respondents (9.4% in Vigitel and 7.4% in NHS), with statistically significant difference compared to females. The age group 18-29 had the highest rate (7.1%), according to Vigitel, followed by the age group 30-59 (5.2%); in NHS, these groups reported 4.5% and 4.4%, respectively, with significant difference compared to other age groups. The habit of drinking and driving was more frequently reported among individuals who had completed higher education, with statistically significant difference as compared to other levels of education. The highest proportion was seen among white people, but no difference was verified in the distribution of this indicator according to race/skin color.

The habit of drinking and driving in the state capitals and the Federal District was reported by 5.2% of adults surveyed in Vigitel and 3.9% in NHS, reaching the highest frequency among residents of the Midwest region (7.9% in Vigitel and 6.1% in NHS), as shown in Table 2.

DISCUSSION

Both surveys analyzed allowed assessing the habit of driving after drinking alcohol in any amount in the Brazilian capitals reported by about a third of adult drivers, according to Vigitel, or a quarter drivers, according to NHS. Prevalence was higher among male drivers aged between 18 and 29 years, and residents of the capitals of the Midwest Region. In general, the habit of drinking any amount of alcohol was reported by about one-tenth of the total population according to Vigitel, and by 7.4% according to NHS. Driving was also more reported by men, especially for the age group 18-29 and residents in the capitals of Midwest Brazil in 2013. These results are higher than the prevalence in developed countries like the United States¹³13. Jewett A, Shults RA, Banerjee T, Bergen G. Alcohol-impaired driving among adults-United States, 2012. MMWR Morb Mortal Wkly Rep 2015; 64(30): 814-7. and Japan¹⁴14. Nakahara S, Katanoda K, Ichikawa M. Onset of a declining trend in fatal motor vehicle crashes involving drunk-driving in Japan. J Epidemiol 2013; 23(3): 195-204., which can be explained by cultural differences and the imposition of legal control over alcohol consumption¹⁵15. Sloan FA, Chepke LM, Davis DV. Addiction, drinking behavior, and driving under the influence. Subst Use Misuse 2014; 49(6): 661-76..

Despite the difficulty of obtaining data on the combination of drinking and driving, such information has been provided by recent surveys, which can support policies of prevention, especially educational measures about the harmful effects of this behavior. Vigitel and NHS are thus precious because their data reveal the extent of the problem. Based on NHS data, at least 6.4 million drivers do drive after drinking alcohol in Brazil, and about 1.4 million drivers in capitals¹²12. Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional de Saúde 2013: percepção do estado de saúde, estilos de vida e doenças crônicas. Rio de Janeiro: IBGE; 2014..

Among many problems resulting from the harmful use of alcohol, driving under the effects of this drug increases the risk of traffic accidents¹1. World Health Organization. International guide for monitoring alcohol consumption and related harm. Geneva: WHO; 2002.. In Brazil, studies have shown the relationship between the harmful effects of alcohol and driving. The review by Carlini Cotrim and Matta Chasin¹⁶16. Carlini-Cotrim B, da Matta Chasin AA. Blood alcohol content and death from fatal injury: a study in the metropolitan area of São Paulo, Brazil. J Psychoactive Drugs 2000; 32(3): 269-75. showed a study conducted in four Brazilian cities where alcohol was present in 92% (n = 865) of victims of traffic accidents' blood in a typical week. Any amount of alcohol was found in 61% of the sample and 16.6% of the total sample had this value higher than 0.6 g/L. In Recife, during Carnival, 80.7% of victims of traffic accidents had positive blood alcohol testings¹⁷17. Oliveira E, Melcop AG. Uso de álcool nas vítimas de acidentes de transito no Carnaval. In: Álcool e trânsito. Recife: Instituto RAID; 1997. P. 72-86.. In São Paulo, a study conducted in the emergency room of a public hospital found that 21.8% of victims of traffic accidents had any alcohol concentration in blood¹⁸18. Gazal-Carvalho C, Carlini-Cotrim B, Silva OA, Sauaia N. Prevalência de alcolemia em vítimas de causas externas admitidas em centro urbano de atenção ao trauma. Rev Saúde Pública 2002; 36(1): 47-54.. In Diadema, São Paulo, 30% of drivers were under the influence of alcohol and 22% had blood alcohol concentrations above 0.6 g/L¹⁹19. Duailibi S, Pinsky I, Laranjeira R. Prevalência de beber e dirigir em Diadema. Rev Saúde Pública 2007; 41(6): 1058-61..

The concentration of alcohol in blood produces several neuromotor changes even at low doses, since there is a reduction of attention, false perception of speed, euphoria and difficulty in perceiving different luminosities¹⁰10. World Health Organization. Strategies to reduce the harmful use of alcohol.; Geneva: WHO 2008. Disponível em Disponível em http://apps.who.int/gb/ebwha/pdf_files/A61/A61_13-en.pdf . (Acessado em 10 de abril de 2013).
http://apps.who.int/gb/ebwha/pdf_files/A... .

Policies and legal restriction actions on alcohol consumption and driving, as the control of alcohol ads, the ban on sales to minors and laws that regulate the operation of alcohol outlets are important to reduce risk and, especially, to save lives¹1. World Health Organization. International guide for monitoring alcohol consumption and related harm. Geneva: WHO; 2002. ²2. Monteiro MG. Alcohol y salud pública en las Américas: un caso para la acción. Washington, D.C: Organización Pan Americana de la Salud; 2007. ⁴4. Borges G, Cherpitel C, Orozco R, Bond J, Ye Y, MacDonald S, et al. Multicenter study of acute alcohol use and non-fatal injuries: data from the WHO collaborative study on alcohol and injuries. Bull World Health Organ 2006; 84(6): 453-60. ¹⁰10. World Health Organization. Strategies to reduce the harmful use of alcohol.; Geneva: WHO 2008. Disponível em Disponível em http://apps.who.int/gb/ebwha/pdf_files/A61/A61_13-en.pdf . (Acessado em 10 de abril de 2013).
http://apps.who.int/gb/ebwha/pdf_files/A... .

The literature shows significant reductions in the number of deaths and injuries in countries that have adopted strict laws for alcohol consumption and driving, including the United States²⁰20. National Highway Traffic Safety Administration. A review of the literature on the effects of low doses of alcohol on driving-related skills. Disponível em: http://www.nhtsa.dot.gov (Acessado em 22 de janeiro de 2008).
http://www.nhtsa.dot.gov... , Cali, Colombia, among others²2. Monteiro MG. Alcohol y salud pública en las Américas: un caso para la acción. Washington, D.C: Organización Pan Americana de la Salud; 2007.. Overall, the most effective measures are strict legislation, systematic and continued supervision, and a strong law system to ensure that the offenders are penalized¹⁰10. World Health Organization. Strategies to reduce the harmful use of alcohol.; Geneva: WHO 2008. Disponível em Disponível em http://apps.who.int/gb/ebwha/pdf_files/A61/A61_13-en.pdf . (Acessado em 10 de abril de 2013).
http://apps.who.int/gb/ebwha/pdf_files/A... .

Studies on Vigitel data²¹21. Moura EC, Malta DC, Morais Neto OL, Penna GO, Temporão JG. Direção de veículos motorizados após consumo abusivo de bebidas alcoólicas, Brasil, 2006 a 2009. Rev Saúde Pública 2009; 43(5): 891-4. ²²22. Malta DC, Bernal RTI, Silva MMA, Claro RM, Silva-Júnior JB, Reis AAC. Consumo de bebidas alcoólicas e direção de veículos, balanço da lei seca, Brasil 2007 a 2013. Rev Saúde Pública 2014; 48(4): 692-6. show improvements over the habit of drinking abusively and driving, which shows a change in the habits of the population, with decline in the trend of drinking and driving between 2007 and 2013 among men of all educational levels in most regions of the country. Thus, the importance of prohibition of alcohol consumption before driving is confirmed, coinciding with the publication of laws 11,705/2008²³23. Brasil. Lei nº 11.705, de 19 de junho de 2008. Dispõe sobre o consumo de bebida alcoólica por condutor de veículo automotor, e dá outras providências. Diário Oficial da União, Brasília, 20 jun. 2008. and 12,760/2012²⁴24. Brasil. Lei nº 12.760, de 20 de dezembro de 2012. Altera a Lei nº 9.503, de 23 de setembro de 1997, que institui o Código de Trânsito Brasileiro. Diário Oficial da União, Brasília, 21 dez. 2012., reinforcing the importance of the regulatory framework prohibiting drinking and driving. In 2012, the new law improved and contributed to the reduction of driving after alcohol abuse when other testimonial evidence and extensive sanctions to the offender were established²⁴24. Brasil. Lei nº 12.760, de 20 de dezembro de 2012. Altera a Lei nº 9.503, de 23 de setembro de 1997, que institui o Código de Trânsito Brasileiro. Diário Oficial da União, Brasília, 21 dez. 2012.. More recently, other initiatives such as the Life in Traffic Program²⁵25. Morais Neto OL, Silva MMA, Lima CM, Malta DC, Silva-Junior JB. Grupo Técnico de Parceiros do Projeto Vida no Trânsito. Projeto Vida no Trânsito: avaliação das ações em cinco capitais brasileiras, 2011-2012. Epidemiol Serv Saúde 2013; 22(3): 373-82. resulted in reduction of mortality in capitals where it was initially implemented.

The prevalence estimated by Vigitel was higher ​​than that of NHS. The survey used questions that are able to calculate similar indicators. Vigitel used four issues and the NHS used two, besides adopting different filters, which may explain such differences. In NHS, the question about frequency of alcohol consumption was added a filter that excludes reports of people drinking less than once a month. Thus, Vigitel considered any level of alcohol consumption, while NHS only considered consumption once or more per month. These variations in questions and filters can justify the differences in estimates' values. However, the values ​​were very similar. Another possible difference between the results of surveys may result from interview approaches: while Vigitel takes telephone interviews, NHS does it face-to-face. A face-to-face interview can cause the interviewee to feel embarrassed when reporting something that is considered illegal.

Among the limitations of this study, we point the fact that data were restricted to capital cities, where more rigorous supervision is expected. The studies adopted different methodologies and samples. While Vigitel was held with a population with telephone lines in the capitals, NHS was conducted in households. These methodological issues can affect comparability of surveys, for they use different strategies for sampling, with face-to-face data collection in NHS and by phone in Vigitel, also with different questions and filters. The use of weighting factors in Vigitel enables correction of estimates for factors studied in the adult population of all the cities¹¹11. Brasil. Ministério da Saúde. Vigitel 2013: Vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico. Brasília: Ministério da Saúde; 2014..

However, the results were similar and point out the importance of the problem of drinking and driving in Brazilian capitals, confirming the need to monitor and establish punishment measures.

CONCLUSION

The study allowed us to estimate the prevalence of the habit of driving after alcohol consumption among drivers and in the general population with two epidemiological surveys nationwide. Although distinct in methodology, both are useful to monitor this risky condition for morbidity and mortality resulting from the combination of alcohol intake and driving in Brazil.

References

Publication Dates

History