RESUMO
BACKGROUND: It is estimated that more than 270 000 people die yearly in alcohol-related crashes globally. To tackle this burden, government interventions, such as laws which restrict blood alcohol concentration (BAC) levels and increase penalties for drunk drivers, have been implemented. The introduction of private-sector measures, such as ridesharing, is regarded as alternatives to reduce drunk driving and related sequelae. However, it is unclear whether state and private efforts complement each other to reduce this public health challenge. METHODS: We conducted interrupted time-series analyses using weekly alcohol-related traffic fatalities and injuries per 1 000 000 population in three urban conglomerates (Santiago, Valparaíso and Concepción) in Chile for the period 2010-2017. We selected cities in which two state interventions-the 'zero tolerance law' (ZTL), which decreased BAC, and the 'Emilia law' (EL), which increased penalties for drunk drivers-were implemented to decrease alcohol-related crashes, and where Uber ridesharing was launched. RESULTS: In Santiago, the ZTL was associated with a 29.1% decrease (95% CI 1.2 to 70.2), the EL with a 41.0% decrease (95% CI 5.5 to 93.2) and Uber with a non-significant 28.0% decrease (95% CI -6.4 to 78.5) in the level of weekly alcohol-related traffic fatalities and injuries per 1 000 000 population series. In Concepción, the EL was associated with a 28.9% reduction (95% CI 4.3 to 62.7) in the level of the same outcome. In Valparaíso, the ZTL had a -0.01 decrease (95% CI -0.02 to -0.00) in the trend of weekly alcohol-related crashes per 1 000 000 population series. CONCLUSION: In Chile, concomitant decreases of alcohol-related crashes were observed after two state interventions were implemented but not with the introduction of Uber. Relationships between public policy interventions, ridesharing and motor vehicle alcohol-related crashes differ between cities and over time, which might reflect differences in specific local characteristics.
Assuntos
Acidentes de Trânsito/legislação & jurisprudência , Acidentes de Trânsito/prevenção & controle , Consumo de Bebidas Alcoólicas/efeitos adversos , Condução de Veículo/legislação & jurisprudência , Dirigir sob a Influência/legislação & jurisprudência , Dirigir sob a Influência/prevenção & controle , Política Pública , Acidentes de Trânsito/mortalidade , Adulto , Consumo de Bebidas Alcoólicas/sangue , Consumo de Bebidas Alcoólicas/epidemiologia , Concentração Alcoólica no Sangue , Chile/epidemiologia , Cidades , Dirigir sob a Influência/estatística & dados numéricos , Feminino , Humanos , Análise de Séries Temporais Interrompida , Masculino , Polícia , População Urbana , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/prevenção & controleRESUMO
Obligatoriedad de investigar el uso de alcohol y drogas en todo el personal de áreas vinculadas al transporte de pasajeros, sea cual fuere el medio de transporte. El resultado obligatorio requerido debe ser cero alcohol y test de drogas negativos. Luego de la existencia del consentimiento informado y explicitación de la política en la materia, el personal con una toma positiva de alcohol o drogas será retirado definitivamente de su función. (AU)
Mandatory requirement to investigate the use of alcohol and drugs in all personnel working in areas related to all passenger transportation. The mandatory required result should be "0" alcohol and negative drugs tests. After having confirmed consent of the given information as well as a proper explanation of the policy related to this matter, in case of drug or alcohol positive result, the personnel will be ceased in their function. (AU)
Assuntos
Humanos , Segurança , Consumo de Bebidas Alcoólicas , Acidentes de Trânsito/prevenção & controle , Transtornos Relacionados ao Uso de Substâncias , Uso de Medicamentos , Dirigir sob a Influência/prevenção & controle , Saúde Ocupacional , Consenso , Dirigir sob a Influência/legislação & jurisprudênciaRESUMO
Objective: The objective of this study was to estimate the effect of the Brazilian zero-tolerance drinking and driving law on mortality rates due to road traffic accidents according to the type of victim, sex, and age. Methods: An interrupted time series design was used to compare yearly mortality rates due to road traffic accidents in Rio de Janeiro, Brazil, before and after the zero-tolerance drinking and driving law came into effect on June 19, 2008. Yearly mortality rates were compared according to the type of victim: pedestrian, cyclist, motorcyclist, and vehicle occupant. We used the Prais-Winsten procedure of autoregression in the analysis of time series; the outcome of this analysis was the annual percentage change in the rates. Overall and stratified analyses were conducted to investigate whether the zero-tolerance drinking and driving law may have had a distributional effect on mortality rates due to road traffic accidents depending on sex and age group; a significance level of P < .01 was accepted. Results: From 1999 to 2016, there were 15,629 deaths due to road traffic accidents in Rio de Janeiro. The effect of the zero-tolerance drinking and driving law on overall mortality rates due to road traffic accidents in Rio de Janeiro was not statistically significant. However, among cyclists and motorcyclists aged ≥60 years and among pedestrians of both sexes and aged ≥20 years, the effect of the zero-tolerance drinking and driving law was to decrease mortality due to road traffic accidents at a yearly rate. Conclusion: There is evidence of reduced mortality rates due to road traffic accidents among cyclists and motorcyclists aged ≥60 years and among pedestrians of both sexes aged ≥20 years in the second major Brazilian capital 9 years after the zero-tolerance drinking and driving law was adopted.
Assuntos
Acidentes de Trânsito/mortalidade , Dirigir sob a Influência/legislação & jurisprudência , Adolescente , Adulto , Distribuição por Idade , Ciclismo/estatística & dados numéricos , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Análise de Séries Temporais Interrompida , Masculino , Pessoa de Meia-Idade , Motocicletas/estatística & dados numéricos , Pedestres/estatística & dados numéricos , Distribuição por Sexo , Adulto JovemRESUMO
Recomenda ao Conselho Nacional de Trânsito (CONTRAN) e ao Departamento Nacional de Trânsito (DENATRAN) que suspendam administrativamente, em atenção à legislação referida nesta recomendação, a obrigatoriedade do exame toxicológico "de larga janela", até que se obtenha evidências científicas mais concretas que justifique sua aplicação. Que o debate em torno dessa matéria seja ampliado com toda a sociedade, por meio da realização de seminários, audiências públicas, com participação de todas as instituições e segmentos envolvidos; e que articule a proposição de Projeto de Lei substitutivo ao PL nº 6187/2016 contendo proposição de revogação do exame nos termos dispostos na Lei nº 13.103, de 02 de março de 2015.
Assuntos
Exame para Habilitação de Motoristas/legislação & jurisprudência , /legislação & jurisprudência , Dirigir sob a Influência/legislação & jurisprudênciaRESUMO
OBJECTIVE: The aim of the study was to evaluate whether the current legislation would encourage drunk drivers to refrain from taking a breathalyzer and thus avoid jail time. METHOD: Brazilian traffic laws currently have 3 possible punishments for drivers suspected of driving under the influence: A fine and suspension of license for 12 months if the breathalyzer result is under 0.3 mg/L (by law; a result up to 0.33 mg/L would receive the same punishment due to a later regulatory document) but positive; the same punishment for refusal to take a breathalyzer test; and up to 3 years of jail time and license cancellation if over 0.3 mg/L. Analysis was done using decision tree analysis as well as game theory to evaluate the rational choice for drunk drivers according to possible financial loss. RESULTS: The authors have found that the rational choice for a drunk driver is not taking the breathalyzer test to avoid heavier penalties. This, in turn, contributes to the inefficacy of the law. CONCLUSION: The authors have also calculated that the fine for refusing should be around 2.5 times higher so that the economic equilibrium would shift toward encouraging drivers to take the test. This should also be accompanied by other incentives to promote safe behavior while driving.
Assuntos
Condução de Veículo/estatística & dados numéricos , Testes Respiratórios , Dirigir sob a Influência/legislação & jurisprudência , Consumo de Bebidas Alcoólicas/epidemiologia , Brasil , Teoria dos JogosRESUMO
Recomenda à Sua Excelência Alexandre de Moraes, Ministro do Supremo Tribunal Federal relator da ADI nº 5322/2015 que considere as razões apresentadas pelo controle social em saúde no que se refere à inadequação da obrigatoriedade e generalização do exame toxicológico nos moldes que estão propostos no Projeto de Lei 6187/2016 e que aprecie com brevidade as razões apresentadas na ADI nº 5322/2015, que questiona a constitucionalidade da Lei nº 13.103/2015.
Assuntos
Exame para Habilitação de Motoristas/legislação & jurisprudência , Governo Federal , /legislação & jurisprudência , Dirigir sob a Influência/legislação & jurisprudência , Empregados do GovernoRESUMO
The objective was to analyze the impact of the Brazilian Traffic Code and the Law Against Drinking and Driving on mortality from traffic accidents in the State of Paraná, Brazil, from 1980 to 2014. This was an ecological time series study on mortality from traffic accidents in residents 15 to 49 years of age, stratified by the sex, age, and categories of victims, with data from the Mortality Information System. The time trend study used a segmented linear regression model and the Cochrane-Orcutt iterative procedure. The assumption of independence of residuals was verified by correlograms and the Box-Pierce test. The highest mortality rates during the period were in males 20 to 29 years of age. After enactment of the Brazilian Traffic Code, there was a decrease of 9.69 deaths/100,000 inhabitants per year for all categories of traffic accidents (p < 0.001), 6.90 for pedestrians (p = 0.001), and 1.96 for vehicle occupants (p < 0.001). As for age bracket, the greatest impact on mortality was in pedestrians 15 to 19 years of age (p < 0.001) and all victims 20 to 29 years of age (p < 0.001). Following enactment of the Drinking and Driving Law, the data displayed variability and the trends were not significant. However, there was a decrease in overall and pedestrian mortality. The rates for motorcyclists and vehicle occupants stabilized. The results showed an impact on traffic accident mortality after enactment of the new Brazilian Traffic Code and Drinking and Driving Law, followed by an increase in the rates. The study evidenced the need for more effective enforcement and progress with public policies in order to avoid a reversal of the gains achieved.
O objetivo foi analisar o impacto do Código de Trânsito Brasileiro (CTB) e da Lei Seca na mortalidade por acidentes de trânsito no Estado do Paraná, Brasil, no período de 1980 a 2014. Estudo ecológico de séries temporais das taxas de mortalidade por acidentes de trânsito de residentes de 15 a 49 anos por sexo, idade e categorias das vítimas, com dados do Sistema de Informações sobre Mortalidade. O estudo da tendência foi realizado por meio do modelo de regressão linear segmentada e pelo procedimento iterativo de Cochrane-Orcutt. O pressuposto de independência dos resíduos foi verificado por correlogramas e teste de Box-Pierce. Em todo o período, as maiores taxas de mortalidade foram observadas para sexo masculino, motociclistas e faixa etária de 20 a 29 anos de idade. Após a implantação do CTB, houve redução de 9,69 óbitos, por ano, para todas as categorias de acidentes de trânsito (p < 0,001), de 6,90 para pedestres (p = 0,001) e de 1,96 para ocupantes de veículo (p < 0,001). Quanto à faixa de etária, o maior impacto na mortalidade foi observado de 15 a 19 anos para pedestres (p < 0,001) e entre 20 a 29 anos para todas as categorias (p < 0,001). Após a Lei Seca, os dados apresentaram variabilidade e as tendências não foram significativas. Entretanto, houve diminuição da mortalidade para a categoria geral e pedestre. Para as categorias de motociclista e veículo, houve estabilização das taxas. Os resultados mostram impacto nas taxas de mortalidade por acidentes de trânsito após a implantação do CTB e da Lei Seca, com posterior aumento destas. Evidencia-se a demanda por efetividade na fiscalização das leis e avanço nas políticas públicas para que não haja retrocesso no já realizado.
El objetivo fue analizar el impacto del Código de Tráfico Brasileño (CTB) y la Ley Seca en la mortalidad por accidentes de tráfico, en el Estado de Paraná, Brasil, durante el período de 1980 a 2014. Se trata de un estudio ecológico de series temporales sobre las tasas de mortalidad por accidentes de tráfico, de residentes de 15 a 49 años, por sexo, edad y categorías de las víctimas, con datos del Sistema de Informaciones sobre Mortalidad. El estudio de la tendencia se realizó mediante un modelo de regresión lineal segmentada y por el procedimiento interactivo de Cochrane-Orcutt. El presupuesto de independencia de los residuos se verificó mediante correlogramas y el test de Box-Pierce. Durante todo el período, las mayores tasas de mortalidad se observaron para el sexo masculino, motociclistas y una franja de edad de 20 a 29 años de edad. Tras la implantación del CTB, hubo una reducción de 9,69 óbitos por año, en todas las categorías de accidentes de tráfico (p < 0,001), de 6,90 en peatones (p = 0,001) y de 1,96 en ocupantes de vehículo (p < 0,001). En cuanto a la franja de edad, el mayor impacto en la mortalidad se observó desde los 15 a los 19 años en peatones (p < 0,001) y entre 20 a 29 años en todas las categorías (p < 0,001). Tras la Ley Seca, los datos presentaron variabilidad y las tendencias no fueron significativas. No obstante, hubo una disminución de la mortalidad en la categoría general y peatones. En las categorías de motociclista y vehículo, hubo una estabilización de las tasas. Los resultados muestran impacto en las tasas de mortalidad por accidentes de tráfico, tras la implantación del CTB y la Ley Seca, con un posterior aumento de las mismas. Se evidencia una demanda de efectividad en la fiscalización de las leyes y el avance en las políticas públicas para que no haya retroceso en lo ya realizado.
Assuntos
Acidentes de Trânsito/mortalidade , Consumo de Bebidas Alcoólicas/legislação & jurisprudência , Dirigir sob a Influência/legislação & jurisprudência , Motocicletas/estatística & dados numéricos , Adolescente , Adulto , Brasil/epidemiologia , Feminino , Humanos , Sistemas de Informação , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Pedestres , Fatores de Risco , Adulto JovemRESUMO
OBJECTIVE: To estimate lives saved during 2008-2023 by traffic safety laws passed in six developing countries while participating in the Bloomberg Road Safety Program (BRSP). METHODS: BRSP-funded local staff identified relevant laws and described enforcement to the study team. We analyzed road crash death estimates for 2004-2013 from the Global Burden of Disease and projected estimates absent intervention forward to 2023. We amalgamated developing country and US literature to estimate crash death reductions by country resulting from laws governing drink driving, motorcycle helmets, safety belt use, and traffic fines. RESULTS: BRSP helped win approval of traffic safety laws in Brazil, China, Kenya, Mexico, Turkey, and Vietnam. In 2008-2013, those laws saved an estimated 19,000 lives. Many laws only took effect in 2014. The laws will save an estimated 90,000 lives in 2014-2023. Of the 109,000 lives saved, drink driving laws will account for 84%, increased motorcyclist protection for 13%, increased fines and penalty points for 2%, and safety belt usage mandates for 1%. Drink driving reductions in China will account for 56% of the savings and reduced drink driving and motorcycling deaths in Vietnam for 35%. The savings in China will result from a narrow intervention with just 4% estimated effectiveness against drink driving deaths. As a percentage of deaths anticipated without BRSP effort, the largest reductions will be 11% in Vietnam and 5% in Kenya. CONCLUSIONS: Viewed as a public health measure, improving traffic safety provided large health gains in developing nations.
Assuntos
Acidentes de Trânsito/prevenção & controle , Condução de Veículo/legislação & jurisprudência , Países em Desenvolvimento , Regulamentação Governamental , Motocicletas/legislação & jurisprudência , Segurança/legislação & jurisprudência , Acidentes de Trânsito/legislação & jurisprudência , Acidentes de Trânsito/mortalidade , Brasil , China , Dirigir sob a Influência/legislação & jurisprudência , Dispositivos de Proteção da Cabeça/estatística & dados numéricos , Humanos , Quênia , Aplicação da Lei , México , Equipamentos de Proteção/estatística & dados numéricos , Turquia , VietnãRESUMO
INTRODUCTION AND AIMS: A 2010 World Health Assembly resolution called on member states to intensify efforts to address alcohol-related harm. Progress has been slow. This study aims to determine the magnitude of public support for 12 alcohol policies and whether it differs by country, demographic factors and drinking risk (volume consumed). DESIGN AND METHODS: Data are drawn from seven countries participating in the International Alcohol Control Study which used country-specific sampling methods designed to obtain random, representative samples. The weighted total sample comprised 11 494 drinkers aged 16-65 years. RESULTS: Drinking risk was substantial (24% 'increased' risk and 16% 'high' risk) and was particularly high in South Africa. Support varied by alcohol policy, ranging from 12% to 96%, but was above 50% for 79% of the possible country/policy combinations. Across countries, policy support was generally higher for policies addressing drink driving and increasing the alcohol purchase age. There was less support for policies increasing the price of alcohol, especially when funds were not earmarked. Policy support differed by country, and was generally higher in the five middle-income countries than in New Zealand. It also differed by age, gender, education, quantity/frequency of drinking, risk category and country income level. DISCUSSION AND CONCLUSIONS: We found a trend in policy support, generally being highest in the low-middle-income countries, followed by high-middle-income countries and then high-income countries. Support from drinkers for a range of alcohol policies is extensive across all countries and could be used as a catalyst for further policy action.
Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Transtornos Relacionados ao Uso de Álcool/prevenção & controle , Política de Saúde , Política Pública , Adolescente , Adulto , Fatores Etários , Idoso , Consumo de Bebidas Alcoólicas/economia , Consumo de Bebidas Alcoólicas/prevenção & controle , Bebidas Alcoólicas/economia , Comércio/legislação & jurisprudência , Comparação Transcultural , Coleta de Dados , Dirigir sob a Influência/legislação & jurisprudência , Feminino , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Resumo: O objetivo foi analisar o impacto do Código de Trânsito Brasileiro (CTB) e da Lei Seca na mortalidade por acidentes de trânsito no Estado do Paraná, Brasil, no período de 1980 a 2014. Estudo ecológico de séries temporais das taxas de mortalidade por acidentes de trânsito de residentes de 15 a 49 anos por sexo, idade e categorias das vítimas, com dados do Sistema de Informações sobre Mortalidade. O estudo da tendência foi realizado por meio do modelo de regressão linear segmentada e pelo procedimento iterativo de Cochrane-Orcutt. O pressuposto de independência dos resíduos foi verificado por correlogramas e teste de Box-Pierce. Em todo o período, as maiores taxas de mortalidade foram observadas para sexo masculino, motociclistas e faixa etária de 20 a 29 anos de idade. Após a implantação do CTB, houve redução de 9,69 óbitos, por ano, para todas as categorias de acidentes de trânsito (p < 0,001), de 6,90 para pedestres (p = 0,001) e de 1,96 para ocupantes de veículo (p < 0,001). Quanto à faixa de etária, o maior impacto na mortalidade foi observado de 15 a 19 anos para pedestres (p < 0,001) e entre 20 a 29 anos para todas as categorias (p < 0,001). Após a Lei Seca, os dados apresentaram variabilidade e as tendências não foram significativas. Entretanto, houve diminuição da mortalidade para a categoria geral e pedestre. Para as categorias de motociclista e veículo, houve estabilização das taxas. Os resultados mostram impacto nas taxas de mortalidade por acidentes de trânsito após a implantação do CTB e da Lei Seca, com posterior aumento destas. Evidencia-se a demanda por efetividade na fiscalização das leis e avanço nas políticas públicas para que não haja retrocesso no já realizado.
Abstract: The objective was to analyze the impact of the Brazilian Traffic Code and the Law Against Drinking and Driving on mortality from traffic accidents in the State of Paraná, Brazil, from 1980 to 2014. This was an ecological time series study on mortality from traffic accidents in residents 15 to 49 years of age, stratified by the sex, age, and categories of victims, with data from the Mortality Information System. The time trend study used a segmented linear regression model and the Cochrane-Orcutt iterative procedure. The assumption of independence of residuals was verified by correlograms and the Box-Pierce test. The highest mortality rates during the period were in males 20 to 29 years of age. After enactment of the Brazilian Traffic Code, there was a decrease of 9.69 deaths/100,000 inhabitants per year for all categories of traffic accidents (p < 0.001), 6.90 for pedestrians (p = 0.001), and 1.96 for vehicle occupants (p < 0.001). As for age bracket, the greatest impact on mortality was in pedestrians 15 to 19 years of age (p < 0.001) and all victims 20 to 29 years of age (p < 0.001). Following enactment of the Drinking and Driving Law, the data displayed variability and the trends were not significant. However, there was a decrease in overall and pedestrian mortality. The rates for motorcyclists and vehicle occupants stabilized. The results showed an impact on traffic accident mortality after enactment of the new Brazilian Traffic Code and Drinking and Driving Law, followed by an increase in the rates. The study evidenced the need for more effective enforcement and progress with public policies in order to avoid a reversal of the gains achieved.
Resumen: El objetivo fue analizar el impacto del Código de Tráfico Brasileño (CTB) y la Ley Seca en la mortalidad por accidentes de tráfico, en el Estado de Paraná, Brasil, durante el período de 1980 a 2014. Se trata de un estudio ecológico de series temporales sobre las tasas de mortalidad por accidentes de tráfico, de residentes de 15 a 49 años, por sexo, edad y categorías de las víctimas, con datos del Sistema de Informaciones sobre Mortalidad. El estudio de la tendencia se realizó mediante un modelo de regresión lineal segmentada y por el procedimiento interactivo de Cochrane-Orcutt. El presupuesto de independencia de los residuos se verificó mediante correlogramas y el test de Box-Pierce. Durante todo el período, las mayores tasas de mortalidad se observaron para el sexo masculino, motociclistas y una franja de edad de 20 a 29 años de edad. Tras la implantación del CTB, hubo una reducción de 9,69 óbitos por año, en todas las categorías de accidentes de tráfico (p < 0,001), de 6,90 en peatones (p = 0,001) y de 1,96 en ocupantes de vehículo (p < 0,001). En cuanto a la franja de edad, el mayor impacto en la mortalidad se observó desde los 15 a los 19 años en peatones (p < 0,001) y entre 20 a 29 años en todas las categorías (p < 0,001). Tras la Ley Seca, los datos presentaron variabilidad y las tendencias no fueron significativas. No obstante, hubo una disminución de la mortalidad en la categoría general y peatones. En las categorías de motociclista y vehículo, hubo una estabilización de las tasas. Los resultados muestran impacto en las tasas de mortalidad por accidentes de tráfico, tras la implantación del CTB y la Ley Seca, con un posterior aumento de las mismas. Se evidencia una demanda de efectividad en la fiscalización de las leyes y el avance en las políticas públicas para que no haya retroceso en lo ya realizado.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Motocicletas/estatística & dados numéricos , Consumo de Bebidas Alcoólicas/legislação & jurisprudência , Acidentes de Trânsito/mortalidade , Dirigir sob a Influência/legislação & jurisprudência , Brasil/epidemiologia , Sistemas de Informação , Modelos Lineares , Fatores de Risco , PedestresRESUMO
This paper analyzes the effects of lowering the legal blood alcohol content limit for drivers from 0.05 to 0.03 grams of alcohol per deciliter of blood (g/dL) and increasing license suspension periods for offenders. We take advantage of a rich data set of administrative records that allow us to identify direct measures of accidents involving alcohol including fatalities and injuries. Results show a significant decrease of 32% in alcohol-related car accidents right after the law was approved but the effects moderate over time (15% after three years). There is also a significant reduction in injuries (31% right after the approval and 11% after three years) but no statistically significant effects on deaths. Complementary analysis of blood samples shows that the law had an effect on blood alcohol content (BAC) of male drivers up to the 90th percentile of the BAC distribution.
Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Dirigir sob a Influência/legislação & jurisprudência , Dirigir sob a Influência/estatística & dados numéricos , Acidentes de Trânsito/mortalidade , Consumo de Bebidas Alcoólicas/legislação & jurisprudência , Concentração Alcoólica no Sangue , Chile/epidemiologia , Feminino , Humanos , Licenciamento/estatística & dados numéricos , Masculino , Análise de Regressão , Distribuição por SexoRESUMO
BACKGROUND: In Chile, a new law introduced in March 2012 decreased the legal blood alcohol concentration (BAC) limit for driving while impaired from 1 to 0.8 g/l and the legal BAC limit for driving under the influence of alcohol from 0.5 to 0.3 g/l. The goal is to assess the impact of this new law on mortality and morbidity outcomes in Chile. METHODS: A review of national databases in Chile was conducted from January 2003 to December 2014. Segmented regression analysis of interrupted time series was used for analyzing the data. In a series of multivariable linear regression models, the change in intercept and slope in the monthly incidence rate of traffic deaths and injuries and association with alcohol per 100,000 inhabitants was estimated from pre-intervention to postintervention, while controlling for secular changes. In nested regression models, potential confounding seasonal effects were accounted for. All analyses were performed at a two-sided significance level of 0.05. RESULTS: Immediate level drops in all the monthly rates were observed after the law from the end of the prelaw period in the majority of models and in all the de-seasonalized models, although statistical significance was reached only in the model for injures related to alcohol. After the law, the estimated monthly rate dropped abruptly by -0.869 for injuries related to alcohol and by -0.859 adjusting for seasonality (P < 0.001). Regarding the postlaw long-term trends, it was evidenced a steeper decreasing trend after the law in the models for deaths related to alcohol, although these differences were not statistically significant. CONCLUSIONS: A strong evidence of a reduction in traffic injuries related to alcohol was found following the law in Chile. Although insufficient evidence was found of a statistically significant effect for the beneficial effects seen on deaths and overall injuries, potential clinically important effects cannot be ruled out.
Assuntos
Acidentes de Trânsito/mortalidade , Concentração Alcoólica no Sangue , Dirigir sob a Influência/legislação & jurisprudência , Política Pública/legislação & jurisprudência , Ferimentos e Lesões/epidemiologia , Acidentes de Trânsito/estatística & dados numéricos , Chile/epidemiologia , Bases de Dados Factuais , Humanos , Análise de Séries Temporais Interrompida , Modelos Lineares , Análise de Regressão , Ferimentos e Lesões/prevenção & controleRESUMO
BACKGROUND: In Chile, a new law introduced in March 2012 lowered the blood alcohol concentration (BAC) limit for impaired drivers from 0.1% to 0.08% and the BAC limit for driving under the influence of alcohol from 0.05% to 0.03%, but its effectiveness remains uncertain. The goal of this investigation was to evaluate the effects of this enactment on road traffic injuries and fatalities in Chile. STUDY DESIGN: A retrospective cohort study. METHODS: Data were analyzed using a descriptive and a Generalized Linear Models approach, type of Poisson regression, to analyze deaths and injuries in a series of additive Log-Linear Models accounting for the effects of law implementation, month influence, a linear time trend and population exposure. A review of national databases in Chile was conducted from 2003 to 2014 to evaluate the monthly rates of traffic fatalities and injuries associated to alcohol and in total. RESULTS: It was observed a decrease by 28.1 percent in the monthly rate of traffic fatalities related to alcohol as compared to before the law (P<0.001). Adding a linear time trend as a predictor, the decrease was by 20.9 percent (P<0.001).There was a reduction in the monthly rate of traffic injuries related to alcohol by 10.5 percent as compared to before the law (P<0.001). Adding a linear time trend as a predictor, the decrease was by 24.8 percent (P<0.001). CONCLUSIONS: Positive results followed from this new 'zero-tolerance' law implemented in 2012 in Chile. Chile experienced a significant reduction in alcohol-related traffic fatalities and injuries, being a successful public health intervention.
Assuntos
Acidentes de Trânsito/prevenção & controle , Consumo de Bebidas Alcoólicas/efeitos adversos , Condução de Veículo/legislação & jurisprudência , Concentração Alcoólica no Sangue , Dirigir sob a Influência/legislação & jurisprudência , Etanol/efeitos adversos , Política Pública/legislação & jurisprudência , Adulto , Chile/epidemiologia , Humanos , Incidência , Mortalidade , Distribuição de Poisson , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/prevenção & controleRESUMO
BACKGROUND: Brazil has a strict drinking and driving law known as the Brazilian "Dry Law". The aim of the present study was to investigate characteristics associated with the breaking of the Brazilian traffic law, on drinking and driving, at nightclub exit among a representative sample of nightclub patrons in the city of São Paulo, Brazil. METHODS: Portal survey realized with a two-stage cluster sampling survey design to collect data from 2422 patrons at the entrance and 1822 patrons at the exit of 31 nightclubs in the city of São Paulo, Brazil. Patrons' breath alcohol concentrations (BrACs) at the entrance and exit of the nightclubs were categorized according to the law as either a "traffic offense" or a "traffic offense and crime". Weighted multinomial logistic regression was used to analyze factors associated with different patterns of drinking and driving offenses. RESULTS: Of the subjects, 16.5% (n=369) were identified as driving patrons at the entrance and exit of the nightclubs. At entry, 80.1% of the patrons had a zero BrAC, 14.9% had a BrAC meeting the traffic offense criteria and 5.0% had a BrAC meeting the traffic offense and crime criteria. Women were less likely to have BrACs meeting the traffic offense criteria. At nightclub exit, 63.4% of patrons had maintained a zero BrAC, 24.7% had a BrAC that had increased and now met the traffic offense and crime criteria, and 11.9% had a decreased or stable BrAC. An increased BrAC was more frequently identified in patrons who were men, were single, and had used illicit drugs inside the nightclub. CONCLUSION: Despite the existence of a strict law regarding drinking and driving, a significant proportion of nightclub patrons in the city of São Paulo had violated this law, suggesting a perception of impunity and need for law enforcement.
Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Condução de Veículo/estatística & dados numéricos , Dirigir sob a Influência/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/legislação & jurisprudência , Condução de Veículo/legislação & jurisprudência , Brasil/epidemiologia , Testes Respiratórios , Análise por Conglomerados , Crime/estatística & dados numéricos , Dirigir sob a Influência/legislação & jurisprudência , Feminino , Humanos , Drogas Ilícitas , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Inquéritos e Questionários , Adulto JovemRESUMO
Globally, 49% of deaths from traffic crashes occur among vulnerable road users, including pedestrians, bicyclists, and motorcyclists. Approximately, a quarter of those killed are motorcyclists. The authors carried out a systematic review of the literature to evaluate the effectiveness of interventions to prevent motorcycle crashes and the associated morbidity and mortality. The studies included in this review provide evidence for the effectiveness of helmet use, protective clothing, training, and penalties for alcohol consumption and speeding in preventing injury and death to motorcyclists. The use of helmets is effective, especially if it is universally required by law for drivers and passengers. Training to obtain a license also has positive effects but not when it is totally voluntary. There is limited but consistent evidence that strengthening laws for penalties related to alcohol consumption or speeding has an impact on risk. Traffic calming interventions could help reduce crashes in urban areas. In jurisdictions where there is limited regulation or adherence to effective measures, such as the use of helmets, efforts should be directed primarily at expanding such practices. In other areas, efforts can focus on approaches based on alternative effective measures or on more innovative interventions adapted to local conditions.
Assuntos
Acidentes de Trânsito/prevenção & controle , Dirigir sob a Influência/legislação & jurisprudência , Licenciamento/normas , Motocicletas , Segurança , Ferimentos e Lesões/prevenção & controle , Dirigir sob a Influência/prevenção & controle , Desenho de Equipamento , Dispositivos de Proteção da Cabeça/estatística & dados numéricos , Humanos , Motocicletas/legislação & jurisprudência , Motocicletas/normas , Roupa de Proteção/estatística & dados numéricosRESUMO
OBJECTIVE: A zero tolerance alcohol restriction law was adopted in Brazil in 2008. In order to assess the effectiveness of this intervention, the present study compares specific mortality in 2 time series: 1980-2007 and 2008-2013. METHODS: Data on mortality and population were gathered from official Brazilian Ministry of Health information systems. Segmented regression analyses were carried out separately for 3 major Brazilian capitals: Belo Horizonte, Rio de Janeiro, and São Paulo. RESULTS: In 2 cities (Belo Horizonte and Rio de Janeiro) there were no significant changes in mortality rate trends in 2 periods, 1980 to 2007 and 2008 to 2013, where the observed rates did not differ significantly from predicted rates. In São Paulo, a decreasing trend until 2007 unexpectedly assumed higher levels after implementation of the law. CONCLUSION: There is no evidence of reduced traffic-related mortality in the 3 major Brazilian capitals 5.5 years after the zero tolerance drinking and driving law was adopted.
Assuntos
Acidentes de Trânsito/mortalidade , Dirigir sob a Influência/legislação & jurisprudência , Consumo de Bebidas Alcoólicas/legislação & jurisprudência , Condução de Veículo/legislação & jurisprudência , Brasil/epidemiologia , Cidades , Dirigir sob a Influência/prevenção & controle , Humanos , Mortalidade/tendências , Análise de Regressão , Conglomerados Espaço-Temporais , Análise EspacialRESUMO
Abstract This paper involved a cross-sectional study that evaluated the results and refusals to take the breathalyzer test among drivers intercepted by the Driving Under the Influence (DUI) Spot-Check Campaign (Operação Lei Seca) in the capital of Rio de Janeiro and Baixada Fluminense. It was conducted using data provided by the State Government which were collected from drivers intercepted in the months of December 2013 and January 2014. Descriptive analysis was conducted of the sample and of the association between gender, age and location variables with the result of the breathalyzer test and refusal to take the test using a logistic regression model. Of the 4756 (100%) drivers intercepted, 59 (1.2%) failed the breathalyzer test and 229 (4.8%) refused to take it. Only the location of interception variable was statistically significant with greater chances of failing (OR = 4.01) and refusal to take the test (OR = 5.14) among drivers intercepted in the Baixada Fluminense. Systematic monitoring actions taken by the DUI Spot-Check Campaign that have occurred for longer in the capital appear to have a positive impact on the drinking and driving behavior of drivers.
Assuntos
Consumo de Bebidas Alcoólicas/legislação & jurisprudência , Testes Respiratórios , Dirigir sob a Influência/legislação & jurisprudência , Recusa de Participação/estatística & dados numéricos , Adolescente , Adulto , Condução de Veículo/legislação & jurisprudência , Estudos Transversais , Dirigir sob a Influência/prevenção & controle , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
OBJECTIVES: The dangers of driving while under the influence of alcohol/drugs (DWI) have been well established. Many countries have successfully reduced the incidence of DWI through effective law enforcement. We aim to explore the links between how law enforcement is perceived in cultures with different socioeconomic indicators. Our hypothesis is that social norms around definitions of what constitutes "right" vs. "deviant" behavior related to DWI directly contribute to the mode and success of law enforcement. METHODS: Road safety professionals from six countries with different levels of DWI rates and enforcement strategies were interviewed regarding the expected local response to a case vignette. Sociodemographic, mortality, and economic indicators for each of these countries were extracted from different sources. RESULTS: The professionals interviewed described a continuum ranging from unequivocal enforcement and punishment (Australia and Norway) to inconsistent enforcement and punishment with the presence of many legal loopholes (Mexico and Brazil). For the six countries, no apparent correlation was identified purely between alcohol consumption and road traffic mortality. However, there seems to be a correlation between the time period of initial DWI legislation and current gross national income, perceptions of local safety, satisfaction with the local environment, and trust in the national government. Higher levels of these scores are seen in nations in which DWI laws were implemented prior to the 1960s. CONCLUSION: Better performing countries seem to have achieved a level of societal agreement that DWI is deviant, generating social stigma against DWI that allows legislation to be enforced. Lessons learned from these countries could help developing countries reduce morbidity and mortality associated with DWI.
Assuntos
Condução de Veículo/legislação & jurisprudência , Países em Desenvolvimento , Dirigir sob a Influência/prevenção & controle , Dirigir sob a Influência/psicologia , Aplicação da Lei/métodos , Acidentes de Trânsito/mortalidade , Acidentes de Trânsito/prevenção & controle , Consumo de Bebidas Alcoólicas/legislação & jurisprudência , Consumo de Bebidas Alcoólicas/prevenção & controle , Consumo de Bebidas Alcoólicas/psicologia , Argentina , Austrália , Condução de Veículo/psicologia , Brasil , Testes Respiratórios , Dirigir sob a Influência/legislação & jurisprudência , Humanos , México , Noruega , Percepção , Fatores Socioeconômicos , Inquéritos e Questionários , Estados UnidosRESUMO
Objective: To explore high-risk behaviors and experiences with traffic law among night drivers in Curitiba, Brazil. Method: Data from 398 drivers on sociodemographic parameters, high-risk behaviors, experiences with traffic law, and traffic law violations were collected through interviews conducted at sobriety checkpoints. Exploratory-descriptive and analytical statistics were used. Results: The mean age of the participants was 32.6±11.2 years (range, 18 to 75 years). Half of the drivers reported having driven after drinking in the last year, predominantly single men aged 18 to 29 years who drive cars and drink alcohol frequently. Only 55% of the drivers who had driven after drinking in the last year self-reported some concern about being detected in a police operation. Conclusions: A significant association was found between sociodemographic variables and behavior, which can help tailor public interventions to a specific group of drivers: young men who exhibit high-risk behaviors in traffic, such as driving after drinking alcohol, some of whom report heavy alcohol consumption. This group represents a challenge for educational and enforcement interventions, particularly because they admit to violating current laws and have a low perception of punishment due to the low risk of being detected by the police.