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De Boni R.B.,Oswaldo Cruz Foundation | Bastos F.I.,Oswaldo Cruz Foundation | De Vasconcellos M.,Brazilian Geography and Statistics Institute | Oliveira F.,Federal University of Rio Grande do Sul | And 2 more authors.
Accident Analysis and Prevention

Background Driving under the influence of multiple substances is a public health concern, but there is little epidemiological data about their combined use and putative impact on driving in low and middle-income countries where traffic crashes have been clustering in recent years. The aim of this study is to estimate the prevalence of alcohol and drug use - as well as their associated factors - among drivers in the context of alcohol outlets (AOs). Methods A probability three-stage sample survey was conducted in Porto Alegre, Brazil. Individuals who were leaving AO were screened, with the selection of 683 drivers who met the inclusion criteria. Drivers answered a structured interview, were breathalyzed, and had their saliva collected for drug screening. Prevalences were assessed using domain estimation and logistic regression models assessed covariates associated with substance use. Findings Benzodiazepines 3.9% (SE 2.13) and cocaine 3.8% (SE 1.3) were the most frequently detected drugs in saliva. Among drivers who were going to drive, 11% had at least one drug identified by the saliva drug screening, 0.4% two, and 0.1% three drugs in addition to alcohol. In multivariable analyses, having a blood alcohol concentration (BAC) > 0.06% was found to be associated with a 3.64 times (CI 95% 1.79-7.39) higher chance of drug detection, compared with interviewees with lower BACs. Conclusions To drive under the influence of multiple substances is likely to be found in this setting, highlighting an association between harmful patterns of consume of alcohol and the misuse of other substances. © 2013 Elsevier Ltd. All rights reserved. Source

Boni R.,Federal University of Rio Grande do Sul | Silva P.L.d.,Brazilian Geography and Statistics Institute | Bastos F.I.,Oswaldo Cruz Foundation | Bastos F.I.,University of Rhode Island | And 3 more authors.

Drinking alcoholic beverages in places such as bars and clubs may be associated with harmful consequences such as violence and impaired driving. However, methods for obtaining probabilistic samples of drivers who drink at these places remain a challenge - since there is no a priori information on this mobile population - and must be continually improved. This paper describes the procedures adopted in the selection of a population-based sample of drivers who drank at alcohol selling outlets in Porto Alegre, Brazil, which we used to estimate the prevalence of intention to drive under the influence of alcohol. The sampling strategy comprises a stratified three-stage cluster sampling: 1) census enumeration areas (CEA) were stratified by alcohol outlets (AO) density and sampled with probability proportional to the number of AOs in each CEA; 2) combinations of outlets and shifts (COS) were stratified by prevalence of alcohol-related traffic crashes and sampled with probability proportional to their squared duration in hours; and, 3) drivers who drank at the selected COS were stratified by their intention to drive and sampled using inverse sampling. Sample weights were calibrated using a post-stratification estimator. 3,118 individuals were approached and 683 drivers interviewed, leading to an estimate that 56.3% (SE = 3,5%) of the drivers intended to drive after drinking in less than one hour after the interview. Prevalence was also estimated by sex and broad age groups. The combined use of stratification and inverse sampling enabled a good trade-off between resource and time allocation, while preserving the ability to generalize the findings. The current strategy can be viewed as a step forward in the efforts to improve surveys and estimation for hard-to-reach, mobile populations. © 2012 de Boni et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Source

De boni R.,Federal University of Rio Grande do Sul | De boni R.,Oswaldo Cruz Foundation | Pechansky F.,Federal University of Rio Grande do Sul | Silva P.L.N.,Brazilian Geography and Statistics Institute | And 2 more authors.
Alcohol and Alcoholism

Aims: This study aimed to estimate the prevalence of driving after drinking (DUI) and its associated factors in low and high alcohol outlet density areas (LAOD and HAOD) in Porto Alegre, Brazil. Methods: A probability 3-stage sampling survey was conducted, and 683 drivers who were leaving alcohol outlets (AOs) and had been drinking were interviewed, breathalyzed and saliva was collected for drug screening. Prevalences were assessed using domain estimation and DUI predictors were assessed using logistic models. Results: It was estimated that 151,573 drivers drank at the AO, and intention to DUI was more prevalent in LAOD (59.3 versus 46.1% in HAOD, P = 0.003). On the other hand, HAOD had higher proportions of interviewees with a blood alcohol concentration (BAC) of >0.06% (46.6 versus 30.7%, P = 0.002) as well as a more frequent use of cocaine (9.3 versus 2.4%, P = 0.086). In the logistic models, drinking in a LAOD stratum was found to be associated with DUI (OR 1.72 (1.17-2.5)) and the two AO density areas presented different factors independently associated with DUI: THC use was significantly associated with the outcome in the HAOD stratum (OR 17.7 (5.1-61.8)), whereas an AUDIT score of >20 was positively associated with DUI in LAOD (OR 23.75 (1.5-364.0)). Conclusions: High prevalences of driving under the influence of alcohol were evident in both the high and the low outlet density areas, although with different characteristics. Thorough enforcement of the legislation by random breath testing and sobriety checkpoints should be combined with AO licensing in order to reduce high levels of DUI and traffic accidents. © The Author 2012. Medical Council on Alcohol and Oxford University Press. All rights reserved. Source

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