ABSTRACT

Objective

To estimate the prevalence of factors associated with drinking and driving in Northeastern Brazil.

Methods

This was a cross-sectional study conducted with participants from the 2019 National Health Survey, aged ≥ 18 years; the analysis of the association between sociodemographic variables and the outcome, stratified by sex, was performed using Poisson regression.

Results

The prevalence of drinking and driving was 21.0% ( 95%CI 19.9;23.2), with 24.6% ( 95%CI 22.7;26.5), in males and 10.1 % ( 95%CI 7.9;12.7), in females (p-value < 0.001); among men, younger age groups (PR = 1.70 – 95%CI 1.29;2.24), higher household income (PR = 1.74 – 95%CI 1.33;2.28), rural residence (PR = 1.48 – 95%CI 1.26;1.74) and motorcycle riding (PR = 1.29 – 95%CI 1.05;1.58) were associated with the event, while no association was observed among women.

Conclusion

Prevalence of drinking and driving was high in the Northeast region, especially among the male population; preventive measures targeting this group and intensified enforcement are necessary.

Palabras clave
Accidentes de Tránsito; Estudios Transversales; Consumo de Bebidas Alcohólicas; Conductas de Riesgo para la Salud; Encuestas Epidemiológicas

Study contributions

Main results

The prevalence of drinking and driving was high, significantly greater in males when compared to females; positive associations between sociodemographic variables and the event were observed only in the male population.

Implications for services

Intersectoral actions, involving health services and regulatory bodies, are essential to reduce the habit of drinking and driving, especially among males, in addition to promoting a safer road environment in the Northeast region.

Perspectives

It is necessary to strengthen enforcement measures for alcohol consumption and driving, especially in rural areas and among motorcycle riders, in addition to implementing traffic education programs and awareness campaigns.

Palabras clave
Accidentes de Tránsito; Estudios Transversales; Consumo de Bebidas Alcohólicas; Conductas de Riesgo para la Salud; Encuestas Epidemiológicas

RESUMEN

Objetivo

Estimar la prevalencia y analizar factores asociados al consumo de alcohol y conducir en el Nordeste de Brasil.

Métodos

Estudio transversal con participantes de la Encuesta Nacional de Salud 2019, ≥ 18 años; se analizó la asociación entre variables sociodemográficas y el resultado, estratificadas por sexo, mediante regresión de Poisson.

Resultados

La prevalencia de beber y conducir fue del 21,0% (IC95% 19,9;23,2), 24,6% (IC95% 22,7;26,5) en hombres y 10,1% (IC95% 7,9;12,7) en mujeres (p-valor < 0,001); en hombres, franja etaria más joven (RP = 1,70 – IC95%1,29;2,24), mayor ingreso familiar (RP = 1,74 –IC95% 1,33;2,28), en áreas rurales (RP = 1,48 – IC95% 1,26;1,74) y conducir motocicleta (RP = 1,29 – IC95% 1,05;1,58) se asociaron al evento; en las mujeres no se observaron asociaciones.

Conclusión

La prevalencia de beber y conducir fue alta en el Nordeste específicamente entre hombres. Son necesarias medidas preventivas para esta población e intensificación de la supervisión.

Palabras clave
Accidentes de Tránsito; Estudios Transversales; Consumo de Bebidas Alcohólicas; Conductas de Riesgo para la Salud; Encuestas Epidemiológicas

INTRODUCTION

Alcohol is a licit drug, widely used by both men and women across various cultures, associated with festivities, religious ceremonies and celebrations. The consumption of high amount of alcohol can cause damage to personal health and to society as a whole.¹1 Abreu MNS, Eleotério AE, Oliveira FDA, Pedroni LCBDR, Lacena EE de. Prevalência e fatores associados ao consumo excessivo episódico de álcool entre adultos jovens brasileiros de 18 a 24 anos. Rev Bras Epidemiol. 2020;23:e200092.,²2 WHO. Drink Driving: a road safety manual for decision-makers and practitioners. International Federation of Red Cross and Red Crescent Societies, editor. GENEVA; 2022.

Driving after consuming alcohol is one of the leading causes of traffic accidents in the world.²2 WHO. Drink Driving: a road safety manual for decision-makers and practitioners. International Federation of Red Cross and Red Crescent Societies, editor. GENEVA; 2022. In high-income countries, approximately 20% of fatally injured drivers had blood alcohol concentration, while in some low- and middle-income countries, this percentage was three times higher.²2 WHO. Drink Driving: a road safety manual for decision-makers and practitioners. International Federation of Red Cross and Red Crescent Societies, editor. GENEVA; 2022.

Even in small amounts, alcohol induces psychomotor changes, such as the deterioration of visual and motor functions, in addition to reducing the capacity for discernment, posing substantial risks to the driver, passengers, and pedestrians.³3 Malta DC, Bernal RTI, da Silva AG, Lima CM de, Machado ÍE, da Silva MMA. Temporal trend in the prevalence of indicators related to driving a motor vehicle after alcohol consumption, between 2007 and 2018. Rev Bras Epidemiol. 2020;23:1-12.,⁴4 Ribeiro LS, Damacena GN, Souza Junior PRB de, Szwarcwald CL. O hábito de beber e dirigir no Brasil: Pesquisa Nacional de Saúde, 2013 e 2019. Rev Saude Publica. 2022;56:115. Regarding the risk factors associated with drinking and driving, male gender, younger age groups, and higher income levels stand out.⁴4 Ribeiro LS, Damacena GN, Souza Junior PRB de, Szwarcwald CL. O hábito de beber e dirigir no Brasil: Pesquisa Nacional de Saúde, 2013 e 2019. Rev Saude Publica. 2022;56:115.,⁵5 Damacena GN, Malta DC, Boccolini CS, de Souza Júnior PRB, de Almeida W da S, Ribeiro LS, et al. Alcohol abuse and involvement in traffic accidents in the Brazilian population, 2013. Cienc e Saude Coletiva. 2016;21(12):3777-86.

In Brazil, traffic accidents were the leading cause of hospitalizations related to alcohol consumption in 2021 – 22.6% of the total – and the second most prevalent cause of mortality associated with the use of this substance – 15.8 % of total.⁶6 CISA. Álcool E a Saúde Dos Brasileiros: Panorama 2023. Cent Informações sobre Saúde e Álcool. 2023;104. The highest mortality rates from traffic accidents in the country were found in the North, Northeast and Midwest macro-regions, primarily affecting men, younger individuals and those with higher income.

There was a 43% reduction in mortality due to traffic accidents in Brazil between 1990 and 2019.⁶6 CISA. Álcool E a Saúde Dos Brasileiros: Panorama 2023. Cent Informações sobre Saúde e Álcool. 2023;104. Despite this significant progress, the goal of reducing deaths from traffic accidents by 50% in Brazil by 2030 may not be achieved .⁷7 Malta DC, Neto OL de M, Cardoso LS de M, Veloso GA, de Andrade FMD, Vasconcelos AMN, et al. Road traffic injuries and deaths and the achievement of UN Sustainable Development Goals in Brazil: results from the Global Burden of Disease Study, 1990 to 2019. Rev Soc Bras Med Trop. 2022;55(Suppl I):1-10.

In addition to high traffic mortality, especially among motorcyclists, Northeastern Brazil faces profound inequalities, especially related to social and economic conditions. The region is known for having lower levels of education and income, and poorer health conditions. These factors are not only associated with high alcohol consumption but also pose a risk for drinking and driving.⁸8 Abreu DR de OM, de Souza EM, Mathias TA de F. Impact of the brazilian traffic code and the law against drinking and driving on mortality from motor vehicle accidents. Cad Saude Publica. 2018;34(8).,⁹9 Rios PAA, Mota ELA, Ferreira LN, Cardoso JP, Ribeiro VM, Souza BS de. Fatores associados a acidentes de trânsito entre condutores de veículos: achados de um estudo de base populacional. Ciênc Saúde Colet (Impr) [Internet]. 2020;25(3):943–55. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232020000300943

High morbidity and mortality from traffic accidents due to alcohol consumption and their consequences extend beyond hospital expenses and health care costs. ⁴4 Ribeiro LS, Damacena GN, Souza Junior PRB de, Szwarcwald CL. O hábito de beber e dirigir no Brasil: Pesquisa Nacional de Saúde, 2013 e 2019. Rev Saude Publica. 2022;56:115.,¹⁰10 Coutinho ESF, Bahia L, Barufaldi LA, de Azevedo Abreu G, Malhão TA, Pepe CR, et al. Cost of diseases related to alcohol consumption in the Brazilian Unified Health System. Rev Saude Publica. 2016;50:1-8. This issue poses a public health challenge worldwide, and Northeastern Brazil is not immune to it.

Despite the evident relevance and potential negative impacts on individual health and society, there is a significant gap in the scientific literature investigating this phenomenon in the Northeast region. The scarcity of studies on alcohol consumption in the region limits the understanding of consumption patterns, the risk factors involved and the consequences for public health.

This study aimed to evaluate the prevalence and sociodemographic factors associated with drinking and driving among residents of Northeastern Brazil, stratified by sex.

METHODS

This was a cross-sectional study using data from the National Health Survey (Pesquisa Nacional de Saúde - PNS), 2019 edition,¹¹11 IBGE. Instituto Brasileiro de Geografia e Estatística. Questionário Pesquisa Nacional de Saúde. Diretoria de Pesquisas Coordenação de Trabalho e Rendimento 2019. 2019. p. 1-52. on adults living in the Northeast region of Brazil.

PNS 2019 data collection took place between August 2019 and March 2020. The survey adopted a three-stage cluster sampling design: census tracts; households; and an individual aged 15 years and older, residing in the household, randomly selected.¹¹11 IBGE. Instituto Brasileiro de Geografia e Estatística. Questionário Pesquisa Nacional de Saúde. Diretoria de Pesquisas Coordenação de Trabalho e Rendimento 2019. 2019. p. 1-52.,¹²12 Stopa SR, Szwarcwald CL, Oliveira MM de, Gouvea E de CDP, Vieira MLFP, Freitas MPS de, et al. Pesquisa Nacional de Saúde 2019: histórico, métodos e perspectivas. Epidemiol Serv Saúde. 2020;29(5):e2020315.

In total, the PNS 2019 included 91,683 respondents aged 18 years and older, of whom 31,800 were residents of the Northeast region.¹²12 Stopa SR, Szwarcwald CL, Oliveira MM de, Gouvea E de CDP, Vieira MLFP, Freitas MPS de, et al. Pesquisa Nacional de Saúde 2019: histórico, métodos e perspectivas. Epidemiol Serv Saúde. 2020;29(5):e2020315. In this study sample, those aged 18 years and older who answered questions about alcohol consumption, and those who drove cars or rode motorcycles were taken into consideration, totaling 6,339 individuals (Figure 1).

The dependent variable of the study was “drinking and driving” as a habit. This indicator was constructed based on the following PNS question: On any of these days when you consumed alcohol, did you drive shortly after drinking? The question had two response options, “yes” and “no”, asked only to individuals who reported consuming alcohol and those who drove a car or rode a motorcycle. Drivers were identified by the PNS using the following questions: Do you currently drive a car (including taxis, transportation apps and similar vehicles)? and Do you currently ride a motorcycle?

The analysis was stratified by the variable “sex” (male; female). Drinking and driving was analyzed according to sociodemographic characteristics:

1. age group (in years: 18 to 34; 35 to 59; 60 or more);

2. race/skin color (White and Black [Black and mixed-race]); Asian and Indigenous were excluded;

3. marital status (without a partner; with a partner);

4. education level (no education; elementary [incomplete/complete]; high school [incomplete/complete]; higher education [incomplete/complete]);

5. per capita household income (in minimum wages: ≤ ½; ½ to 1; >1 to 2; > 2);

6. place of residence (urban area; rural area);

7. drive a car (yes; no); and

8. ride a motorcycle (yes; no).

For data analysis, the Stata /SE software, version 15, and the survey module, which considers the complex sample design and sample weights. The prevalence of the event was calculated according to sociodemographic characteristics. Bivariate and adjusted analyses were performed, with prevalence ratios (PR) estimates and respective 95% confidence intervals (95%CI), using Poisson regression with robust variance. Multiple analysis was performed by means of the backward selection method, with all sociodemographic variables included; one variable at a time was eliminated from the model. Only variables with a p-value ≤ 0.05 were kept in the final model.

The 2019 National Health Survey project was approved by the National Research Ethics Committee of the National Health Council under opinion No. 3,529,376 of 23/08/2019; certificate of submission for ethical appraisal: 11713319.7.0000.0008.

RESULTS

Of the total respondents (n = 6,339 individuals), 79.0% were male and 21.0% were female; the prevalence of drinking and driving was 21.0% (95%CI 19.9;23.2); among men it was 24.6% (95%CI 22.7;26.5) and among women, 10.1% (95%CI 7.9;12.7; p-value < 0.001). Among females, 4.8% of those who maintained this habit were motorcycle riders, 3.4% were car drivers and 1.9% were both car drivers and motorcycle riders; for males, 10.8% were both car drivers and motorcycle riders, 9.0% were car drivers and 4.8% were motorcycle riders (Figure 2).

The highest proportion of males were aged 35 to 59 years (49.3%), of Black race/skin color (Black and mixed-race: 73.8%), living without a partner (61.5%), with elementary education (39.8%) and per capita household income of up to ½ minimum wage (36.7%). The majority of men (73.7%) lived in urban areas and reported riding motorcycles (75.7%) and driving cars (65.6%). The highest prevalence of drinking and driving was observed in younger age groups, for those who reported living without a partner, those living in rural areas and those who reported riding a motorcycle (Table 1).

Among females, 50.5% were aged 18 to 34 years, 66.9% self-identified as Black and 70.5% lived without a partner. A greater proportion had higher education (42.4%) and per capita household income of up to ½ minimum wage (29.9%). The majority of them (81.6%) lived in urban areas, rode motorcycles (60.4%) and drove cars (54.1%) (Table 1). Sociodemographic characteristics were not associated with drinking and driving among women.

Multiple regression analysis was performed only for males and showed a higher habit of drinking and driving in the age groups of 18 to 34 years (PR = 1.70 – 95%CI 1.29;2.24) and 35 to 59 years (PR = 1.34 – 95%CI 1.02;1.74), per capita household income greater than ½ minimum wage up to one minimum wage (PR = 1.33 – 95%CI 1.10-1.61), greater than one minimum wage up to two minimum wages (PR = 1.45 – 95%CI 1.17;1.79) and greater than two minimum wages (PR = 1.74 – 95%CI 1.33;2.28). Living in a rural area (PR = 1.48 – 95%CI 1.26;1.74) and riding a motorcycle (PR = 1.29 – 95%CI 1.05;1.58) were also factors positively associated with the habit of drinking and driving (Table 2).

DISCUSSION

The prevalence of drinking and driving was significantly higher among men when compared to women. Among males, younger age, higher income, living in rural areas and riding motorcycles were positively associated with drinking and driving. Among females, no significant associations were observed between sociodemographic characteristics and the outcome.

This study was based on self-reported variables, which may result in underestimation of the habit of drinking and driving. The PNS, in order to mitigate possible failures, implemented standardization procedures and provided training to interviewers responsible for data collection to ensure the quality of the data obtained.¹²12 Stopa SR, Szwarcwald CL, Oliveira MM de, Gouvea E de CDP, Vieira MLFP, Freitas MPS de, et al. Pesquisa Nacional de Saúde 2019: histórico, métodos e perspectivas. Epidemiol Serv Saúde. 2020;29(5):e2020315.

The prevalence of drinking and driving identified, above 20%, was higher than that found among Brazilians (5.4%).⁶6 CISA. Álcool E a Saúde Dos Brasileiros: Panorama 2023. Cent Informações sobre Saúde e Álcool. 2023;104. A study focusing on the macro-regions of Brazil regarding driving under the influence of alcohol, also found a high prevalence of drinking and driving in the Northeast region (29.4%), significantly higher than the prevalence in other regions of the country.¹³13 Guimarães RA, Neto OLM. Prevalence and factors associated with driving under the influence of alcohol in Brazil: An analysis by macroregion. Int J Environ Res Public Health. 2020;17(3). The existing regional disparities, such as socioeconomic characteristics, access to education and cultural nuances, may justify the different prevalence of this risky behavior among the five macro-regions.¹³13 Guimarães RA, Neto OLM. Prevalence and factors associated with driving under the influence of alcohol in Brazil: An analysis by macroregion. Int J Environ Res Public Health. 2020;17(3). Additionally, the existing weaknesses of laws and policies for monitoring alcohol consumption and life in traffic in Brazil, must be taken into consideration.¹⁴14 Oliveira CWL, Mendes CV, Kiepper A, Monteiro MG, Wagner GA, Sanchez ZM. Analysis of gaps in alcohol policies in Brazil using the Pan American Health Organization’s Alcohol Policy Scoring. Int J Drug Policy [Internet]. 2021;97:103322. Available from: https://doi.org/10.1016/j.drugpo.2021.103322
https://doi.org/10.1016/j.drugpo.2021.10... ,¹⁵15 Oliveira CWL, Mendes C V., Wagner GA, Sanchez ZM. Have countries offered the best data to the Pan American Health Organization? Evidence of potential inconsistencies found in a study on alcohol policies in Brazil. Public Health [Internet]. 2021;195:39-41. Available from: https://doi.org/10.1016/j.puhe.2021.03.013
https://doi.org/10.1016/j.puhe.2021.03.0...

Brazilian policies for alcohol consumption and enforcement have some gaps that could contribute to risk mitigation. Regarding pricing policies, the minimum taxation of undistilled alcoholic beverages favors their commercialization, as the sales prices of these products can be reduced and, combined with advertising and exposure strategies, induce early consumption among young people, including an increase in its frequency. There are significant legislative contradictions concerning the physical availability of alcohol, such as the lack of laws controlling retail sales of alcoholic beverages, in the essence of policies to control their commercialization that do not cover all types of alcoholic beverages, and consumption policies, favoring the acquisition and consumption of alcoholic beverages, especially by younger people.¹⁴14 Oliveira CWL, Mendes CV, Kiepper A, Monteiro MG, Wagner GA, Sanchez ZM. Analysis of gaps in alcohol policies in Brazil using the Pan American Health Organization’s Alcohol Policy Scoring. Int J Drug Policy [Internet]. 2021;97:103322. Available from: https://doi.org/10.1016/j.drugpo.2021.103322
https://doi.org/10.1016/j.drugpo.2021.10... ,¹⁵15 Oliveira CWL, Mendes C V., Wagner GA, Sanchez ZM. Have countries offered the best data to the Pan American Health Organization? Evidence of potential inconsistencies found in a study on alcohol policies in Brazil. Public Health [Internet]. 2021;195:39-41. Available from: https://doi.org/10.1016/j.puhe.2021.03.013
https://doi.org/10.1016/j.puhe.2021.03.0... Despite the existence of laws and policies that monitor and regulate alcohol consumption, most of them, despite reinforcing the need for prevention and treatment interventions, do not provide the means for implementation.¹⁴14 Oliveira CWL, Mendes CV, Kiepper A, Monteiro MG, Wagner GA, Sanchez ZM. Analysis of gaps in alcohol policies in Brazil using the Pan American Health Organization’s Alcohol Policy Scoring. Int J Drug Policy [Internet]. 2021;97:103322. Available from: https://doi.org/10.1016/j.drugpo.2021.103322
https://doi.org/10.1016/j.drugpo.2021.10... ,¹⁵15 Oliveira CWL, Mendes C V., Wagner GA, Sanchez ZM. Have countries offered the best data to the Pan American Health Organization? Evidence of potential inconsistencies found in a study on alcohol policies in Brazil. Public Health [Internet]. 2021;195:39-41. Available from: https://doi.org/10.1016/j.puhe.2021.03.013
https://doi.org/10.1016/j.puhe.2021.03.0...

Although federal laws against driving under the influence of alcohol are up-to-date and more severe and punitive actions are in place,¹⁴14 Oliveira CWL, Mendes CV, Kiepper A, Monteiro MG, Wagner GA, Sanchez ZM. Analysis of gaps in alcohol policies in Brazil using the Pan American Health Organization’s Alcohol Policy Scoring. Int J Drug Policy [Internet]. 2021;97:103322. Available from: https://doi.org/10.1016/j.drugpo.2021.103322
https://doi.org/10.1016/j.drugpo.2021.10...

15 Oliveira CWL, Mendes C V., Wagner GA, Sanchez ZM. Have countries offered the best data to the Pan American Health Organization? Evidence of potential inconsistencies found in a study on alcohol policies in Brazil. Public Health [Internet]. 2021;195:39-41. Available from: https://doi.org/10.1016/j.puhe.2021.03.013
https://doi.org/10.1016/j.puhe.2021.03.0... -¹⁶16 Brasil. Lei n° 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, 2012. a high prevalence of drinking and driving is observed in Brazil, with the Northeast region standing out in this regard. The region is particularly known for its popular festivities and traditional events. Active participation in alcohol consumption during these social events, combined with the habit of driving home after these celebrations, may contribute to the high prevalence of drinking and driving in the region.¹³13 Guimarães RA, Neto OLM. Prevalence and factors associated with driving under the influence of alcohol in Brazil: An analysis by macroregion. Int J Environ Res Public Health. 2020;17(3).,¹⁷17 Garcia GAF, Da SIlva EKP, Giatti L, Barreto SM. The intersection race/skin color and gender, smoking and excessive alcohol consumption: Cross sectional analysis of the Brazilian National Health Survey, 2013. Cad Saude Publica. 2021;37(11).,¹⁸18 Wendt A, Costa CS, Costa FS, Malta DC, Crochemore-Silva I. Time trend in inequalities in smoking and abusive alcohol consumption in Brazil’s state capitals. Cad Saude Publica. 2021;37(4):1-14. Despite the traffic enforcement actions, proposed nationwide, which have led to a reduction in the habit of driving under the influence of alcohol,¹⁹19 Nunes HR de C, Murta-Nascimento C, Lima MCP. Impact of the dry law on road traffic mortality in brazilian states: An interrupted time series analysis. Rev Bras Epidemiol. 2021;24:1-13. the Northeast region and its enforcement agencies still face challenges in this regard. Among these challenges are the low number of municipalities integrated into the National Traffic System, changes in driver behavior, such as blood alcohol level and reckless driving, low enforcement and the need for more traffic education actions.²⁰20 Brasil. Ministério da Infraestrutura. 5° Encontro de Educadores de Trânsito, Região Nordeste. 2020. 19 p. These factors reinforce the inequalities in the implementation of the Brazilian Traffic Code among the macro-regions of the country, especially the need to expand actions aimed at the Northeast region.

In this study, drinking and driving was more frequent among males. It is common knowledge that this population group not only shows a higher frequency of alcohol consumption but also greater involvement in traffic accidents.⁴4 Ribeiro LS, Damacena GN, Souza Junior PRB de, Szwarcwald CL. O hábito de beber e dirigir no Brasil: Pesquisa Nacional de Saúde, 2013 e 2019. Rev Saude Publica. 2022;56:115.,¹⁵15 Oliveira CWL, Mendes C V., Wagner GA, Sanchez ZM. Have countries offered the best data to the Pan American Health Organization? Evidence of potential inconsistencies found in a study on alcohol policies in Brazil. Public Health [Internet]. 2021;195:39-41. Available from: https://doi.org/10.1016/j.puhe.2021.03.013
https://doi.org/10.1016/j.puhe.2021.03.0... This association can be explained by men’s greater historical exposure to vehicle driving, combined with a cultural identification of virility in adopting aggressive behaviors behind the wheel.¹⁰10 Coutinho ESF, Bahia L, Barufaldi LA, de Azevedo Abreu G, Malhão TA, Pepe CR, et al. Cost of diseases related to alcohol consumption in the Brazilian Unified Health System. Rev Saude Publica. 2016;50:1-8. Furthermore, the influence of alcohol tends to increase impulsivity and risky behavior while driving, promoting reckless driving.²¹21 Filmore MT, Dyke N Van. DUI Offenders Display Reduced Perception of Intoxication and Heightened Impulsive Choice in Response to Alcohol. 2021;28(3):337-47.

Younger individuals from the Northeast region also showed higher prevalence of drinking and driving. Previous studies indicate an increase in the reporting of such behavior in this age group, followed by a decrease as age advances.⁴4 Ribeiro LS, Damacena GN, Souza Junior PRB de, Szwarcwald CL. O hábito de beber e dirigir no Brasil: Pesquisa Nacional de Saúde, 2013 e 2019. Rev Saude Publica. 2022;56:115.,⁵5 Damacena GN, Malta DC, Boccolini CS, de Souza Júnior PRB, de Almeida W da S, Ribeiro LS, et al. Alcohol abuse and involvement in traffic accidents in the Brazilian population, 2013. Cienc e Saude Coletiva. 2016;21(12):3777-86.,²²22 Macinko J, Mullachery P, Silver D, Jimenez G, Neto OLM. Patterns of alcohol consumption and related behaviors in Brazil: Evidence from the 2013 National Health Survey (PNS 2013). PLoS One. 2015;10(7):1-12. The literature has already addressed the increase in alcohol consumption among young adults.¹1 Abreu MNS, Eleotério AE, Oliveira FDA, Pedroni LCBDR, Lacena EE de. Prevalência e fatores associados ao consumo excessivo episódico de álcool entre adultos jovens brasileiros de 18 a 24 anos. Rev Bras Epidemiol. 2020;23:e200092.,²³23 Freitas MG de, Stopa SR, Silva EN da. Consumo de bebidas alcoólicas no Brasil: estimativa de razões de prevalências – 2013 e 2019. Rev Saude Publica. 2023;57(1):17. The lack of monitoring alcohol consumption, combined with the alcohol industry’s marketing strategies targeting this specific population, justifies the adoption of this risky behavior in this group.²⁴24 Machado ÍE, Monteiro MG, Malta DC, Lana FCF. Pesquisa Nacional de Saúde 2013: Relação entre uso de álcool e características sociodemográficas segundo o sexo no Brasil. Rev Bras Epidemiol. 2017;20(3):408-22.

Higher income was also positively associated with drinking and driving among males. A possible explanation for this would be a higher purchasing power, greater ease in acquiring motor vehicles and the habit of alcohol consumption; ⁴4 Ribeiro LS, Damacena GN, Souza Junior PRB de, Szwarcwald CL. O hábito de beber e dirigir no Brasil: Pesquisa Nacional de Saúde, 2013 e 2019. Rev Saude Publica. 2022;56:115. additionally, there is greater participation in social events involving the presence of alcoholic beverages, their consumption and driving home afterward.¹⁷17 Garcia GAF, Da SIlva EKP, Giatti L, Barreto SM. The intersection race/skin color and gender, smoking and excessive alcohol consumption: Cross sectional analysis of the Brazilian National Health Survey, 2013. Cad Saude Publica. 2021;37(11).,¹⁸18 Wendt A, Costa CS, Costa FS, Malta DC, Crochemore-Silva I. Time trend in inequalities in smoking and abusive alcohol consumption in Brazil’s state capitals. Cad Saude Publica. 2021;37(4):1-14.

Men who lived in rural areas had a higher prevalence of drinking and driving, whose motivations in rural areas may differ from those in urban areas. It is possible that long, sparsely traveled roads, with few transport alternatives, and a lack of enforcement explain the high prevalence of drinking and driving in rural contexts.²⁵25 Greene KM, Murphy ST, Rossheim ME. Context and culture: Reasons young adults drink and drive in rural America. Accid Anal Prev [Internet]. 2018; 121(April):194-201. Available from: https://doi.org/10.1016/j.aap.2018.09.008 In this same context, particularly in the Northeast region, the lack of education, associated with an intense urbanization process, plays a significant role in the prevalence of drinking and driving. Low level of education not only hinders the understanding of traffic rules, but also prevents the acquisition and regularization of the National Driver’s License, an essential legal requirement for driving vehicles.⁹9 Rios PAA, Mota ELA, Ferreira LN, Cardoso JP, Ribeiro VM, Souza BS de. Fatores associados a acidentes de trânsito entre condutores de veículos: achados de um estudo de base populacional. Ciênc Saúde Colet (Impr) [Internet]. 2020;25(3):943–55. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232020000300943,²⁶26 Brasil. Código de Trânsito Brasileiro. Secr Espec Ed e Publicações. 2009;2. Another contributing factor in the rural world to the event studied: the advancement of tools used in agricultural activities and the increased use of agricultural machinery, causing many residents in these areas, even without formal training, to take on driving vehicles.⁸8 Abreu DR de OM, de Souza EM, Mathias TA de F. Impact of the brazilian traffic code and the law against drinking and driving on mortality from motor vehicle accidents. Cad Saude Publica. 2018;34(8).

A higher prevalence of drinking and driving was observed in men who reported riding motorcycles. Riding motorcycles after consuming alcoholic beverages is one of the leading causes of traffic accidents in Brazil, as indicated by the Ministry of Health in 2023.²⁶26 Brasil. Código de Trânsito Brasileiro. Secr Espec Ed e Publicações. 2009;2. Between 2019 and 2021, 13,415 deaths from this cause were recorded in the Northeast region,²⁷27 Ministério da Saúde. Cenário brasileiro das lesões de motociclistas no trânsito de 2011 a 2021. 2023;54. with a large population immersed in contexts of socioeconomic vulnerability, marked by high unemployment rates. For many individuals, the motorcycle has become an alternative for income generation,¹⁰10 Coutinho ESF, Bahia L, Barufaldi LA, de Azevedo Abreu G, Malhão TA, Pepe CR, et al. Cost of diseases related to alcohol consumption in the Brazilian Unified Health System. Rev Saude Publica. 2016;50:1-8.,²⁸28 Dantas MNP, Silva M de F dos S, Barbosa IR. Reflections on the COVID-19 mortality among the Black population and racial inequality in Brazil. Saude e Soc. 2022;31(3):1-13. especially in informal work. Informal workers, and a paradigmatic example of this condition, app delivery riders, depend on motorcycles for their daily activities, mainly due to the agility, mobility and low operating cost of these vehicles.²⁹29 Macedo AR, Costa FTB, Justo JS. O Mototaxista no mundo do Trabalho: Precarização, Desemprego e Informalidade. Rev Subjetividades. 2019;19(1):1. The delivery service is driven by the increase in online services and fast delivery. However, the expansion of these services brings challenges, such as social protection deficiencies, lack of benefits and, consequently, concrete harm to these workers’ lives.²⁹29 Macedo AR, Costa FTB, Justo JS. O Mototaxista no mundo do Trabalho: Precarização, Desemprego e Informalidade. Rev Subjetividades. 2019;19(1):1.

Moto-taxi riders and motorcycle couriers often work in precarious conditions, paid based on production. Working hours exceeding ten hours a day, speeding and the use of cell phones while riding significantly increase the chances of accidents and deaths among this population.³⁰30 Souza CDF, Machado MF, Quirino TRL, Leal TC, de Paiva JPS, de Magalhães APN, et al. Spatial and temporal patterns of mortality among motorcyclists in a state of the Brazilian northeast in the 21st century. Cienc e Saude Coletiva. 2021;26(4):1501-10. Under these working conditions, socioeconomic factors such as low level of education and low pay, more pronounced in the Northeast region, can lead to risky behaviors, including alcohol consumption.¹⁰10 Coutinho ESF, Bahia L, Barufaldi LA, de Azevedo Abreu G, Malhão TA, Pepe CR, et al. Cost of diseases related to alcohol consumption in the Brazilian Unified Health System. Rev Saude Publica. 2016;50:1-8.,³⁰30 Souza CDF, Machado MF, Quirino TRL, Leal TC, de Paiva JPS, de Magalhães APN, et al. Spatial and temporal patterns of mortality among motorcyclists in a state of the Brazilian northeast in the 21st century. Cienc e Saude Coletiva. 2021;26(4):1501-10.

Northeastern Brazil stands out for presenting a worrying scenario regarding accidents involving motorcyclists. The roots of this problem are complex, encompassing educational and macroeconomic determinants that directly influence the adoption of risky behaviors in traffic. This finding reiterates the inherent inequalities in the region.⁹9 Rios PAA, Mota ELA, Ferreira LN, Cardoso JP, Ribeiro VM, Souza BS de. Fatores associados a acidentes de trânsito entre condutores de veículos: achados de um estudo de base populacional. Ciênc Saúde Colet (Impr) [Internet]. 2020;25(3):943–55. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232020000300943

Taking into consideration the social and economic implications of the health conditions attributed to the alcohol use and driving vehicles,⁹9 Rios PAA, Mota ELA, Ferreira LN, Cardoso JP, Ribeiro VM, Souza BS de. Fatores associados a acidentes de trânsito entre condutores de veículos: achados de um estudo de base populacional. Ciênc Saúde Colet (Impr) [Internet]. 2020;25(3):943–55. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232020000300943,²⁵25 Greene KM, Murphy ST, Rossheim ME. Context and culture: Reasons young adults drink and drive in rural America. Accid Anal Prev [Internet]. 2018; 121(April):194-201. Available from: https://doi.org/10.1016/j.aap.2018.09.008 it is suggested that intersectoral actions be established in order to reduce this risky behavior, expanding investments in health and education, aimed to target all population groups. More effective enforcement measures and health and traffic education actions must be reinforced to prevent this practice, especially among young people.

In conclusion, the results of this study strengthen the need for the implementation of more effective public policies focused on young people. It is worth highlighting the crucial importance of increasing traffic enforcement by the authorities. These are imperative measures to mitigate the negative impacts of accidents, especially those involving motorcyclists, and contribute to the construction of a safer and more equitable road environment in the Northeast region of Brazil.

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