Gina Stoduto

The effects of introducing or lowering legal per se blood alcohol limits for driving: an international review

In this review evidence on the impact of introducing or lowering legal blood alcohol limits on traffic safety measures is examined. There is substantial variability in the types and rigour of methods used to evaluate these legislative measures, and thus not surprisingly there is variability in the results observed. In most but not all cases where an evaluation of an introduced or lowered legal limit has been conducted, some beneficial effect on traffic safety measures has been reported. These effects are in some cases relatively small, and in other cases may be temporary. In some jurisdictions, lasting reductions in collision rates have been reported. Available evidence suggests that where beneficial effects are observed they are due to general deterrence, and not restricted only to drivers at blood alcohol concentrations (BAC) specifically affected by the legal change.

Anxiety and Mood Disorders and Cannabis Use

Background: Cannabis use has been linked to anxiety and mood disorders (AMD) in clinical cases, but little research on this relationship has been reported at the epidemiological level. Objectives: We examined the relationship between self-reported frequency of cannabis use and risk for AMD in the general Ontario adult population. Methods: Data were based on the CAMH Monitor survey of Ontario adults from 2001 to 2006 (n = 14,531). AMD was assessed with the 12-item version of the General Health Questionnaire (GHQ12). Frequency of cannabis use within the past year was grouped into five categories: No use (abstainer), less than once a month but at least once a year, less than once a week but at least once a month, less than daily but at least once a week, almost every day to more than once a day. Logistic regression analysis of AMD and cannabis use was implemented while controlling for demographics and alcohol problems. Results: AMD was most common among heavy cannabis users (used almost every day or more) (18.1%) and lowest for abstainers (8.7%). Compared to abstainers, the risk of AMD was significantly greater for infrequent cannabis users (OR = 1.43) and heavy cannabis users (OR = 2.04) but not for those in between. Conclusion: These data provide epidemiological evidence for a link between both light and heavy cannabis use and AMD. Scientific Significance: Recognizing the comorbidity of heavy cannabis use and AMD should facilitate improved treatment efforts. Our results also suggest the possibility that, for some individuals, AMD may occur at relatively low levels of cannabis use.

Alcohol and driving factors in collision risk.

In this study we examine the effect of several alcohol-related measures on self-reported collision involvement within the previous 12 months while controlling for demographic and driving exposure factors based on a large representative sample of adults in Ontario. Data are based on the 2002-2006 Centre for Addiction and Mental Health Monitor, an ongoing cross-sectional telephone survey of Ontario adults aged 18 and older (n=8542). Three logistic regressions of self-reported collision involvement in the past 12 months were implemented, each consisting of 3 steps: (1) demographic factors and driving exposure entered, (2) driving after drinking within the last 12 months entered, and (3) one of three alcohol-related measures (AUDIT subscales of alcohol consumption, dependence and problems) entered. In each step, measures from the preceding step were included in order to control for those variables. In Step 1, age (OR=0.989), region overall, Central East region (OR=0.71), West region (OR=0.67), and North region (OR=0.67), income overall and those who did not state income (OR=0.64), marital status overall and those married or living common law (OR=0.60), and number of kilometers driven in a typical week (OR=1.00) were found to be significant predictors of collision involvement. The analyses revealed that driving after drinking was a significant predictor of collision involvement in Step 2 (OR=1.51) and each of the Step 3 models (ORs=1.52, 1.37, 1.34). The AUDIT Consumption subscale was not a significant factor in collision risk. Both the AUDIT Dependence and AUDIT Problems subscales were significantly related to collision risk (ORs=1.13 and 1.10, respectively). These findings suggest that alcohol, in addition to its effects on collision risk through its acute impairment of driving skills, may also affect collision risk through processes involved when individuals develop alcohol problems or alcohol dependence.

ROAD RAGE EXPERIENCE AND BEHAVIOR: VEHICLE, EXPOSURE, AND DRIVER FACTORS

Road rage has generated increasing public concern. Research has shown that victimization and perpetration of road rage is more common among males and younger drivers. We aimed to extend the understanding of determinants of road rage to driving exposure and vehicle factors, based on a 2002–2003 population survey of 1,631 regular drivers in Ontario, Canada. Regression analyses revealed that number of times drivers reported experiencing road rage in the previous 12 months was significantly greater for males, younger respondents, and those residing in Toronto. Also, victimization was significantly greater for drivers who did all their driving on busy roads and increased with number of kilometers driven on a typical week; however, type of vehicle driven was not significant. Number of times road rage perpetration was reported in the past 12 months was significantly greater for males, younger respondents, and those residing in Toronto, and lower for those in the Eastern and Northern region. Road rage perpetration increased significantly with number of weekly kilometers driven and was significantly greater for drivers who are always on busy roads and lower for those who never drive on busy roads, and higher for high-performance vehicle drivers. Even after controlling for driving exposure, road rage victimization and perpetration were highest for drivers in Toronto, where the pace of life may be more demanding. As expected, high-performance vehicle drivers reported more road rage perpetration. These individuals may experience more frustration when they are prevented from using the full performance capacities of their vehicles by crowded urban roadways.

Blood alcohol testing of motor vehicle crash admissions at a regional trauma unit.

Motor vehicle crashes remain a leading cause of death and injury in the industrialized world. Alcohol consumption is implicated as a major factor in fatal motor vehicle crashes (MVCs), but only poor estimates of blood alcohol concentrations among nonfatally injured crash victims are available. A 3-year study was undertaken at a Regional Trauma Unit to determine the demographics, injury severity, and alcohol positivity of motor vehicle crash victims. Between August 1, 1986 and July 31, 1989, 825 motor vehicle crash victims were available for study; 368 drivers were admitted to the unit within a period of 4 hours. Of 715 patients tested for alcohol, 31.0% were positive. A total of 333 drivers were tested for blood alcohol; 128 (38.4%) were positive. The mean blood alcohol concentration (BAC) at admission for the drivers was 145.6 mg/100 ml; the estimated mean BAC at crash was 180.9 mg/100 ml. The mean age of BAC positive drivers was 31.4 years, compared to a mean age in the BAC negative drivers of 35.2 years (p less than 0.02). Male patients represented 76.6% of the drivers, yet represented 83.6% of the BAC positive drivers (p less than 0.05). There was a marked seasonal variation in BAC positivity, with 46.1% of drivers positive during the summer months. Alcohol appears to be a significant factor in nonfatal MVCs.

Adding a Choice-Based Program for Tobacco Smoking to an Abstinence-Based Addiction Treatment Program

A smoking program that provides awareness education about smoking to all chemical dependency (CD) clients and staff, while allowing treatment for smoking to be optional, was developed at an abstinence-based addiction treatment center. This study measured the effects of introducing this mixed model for treatment of smoking and other substances on clients and staff. Attitude and program utilization data were collected, and CD clients were followed-up. The value of offering a smoking program during CD treatment and of framing it within a choice-based philosophy was strongly endorsed by staff and CD clients. Smoking program CD clients did not report major problems with other clients continuing to smoke. Most (55.6%) of the staff who smoked (n = 18) entered the smoking program during the first year of implementation; 38.0% of CD clients who smoked (n = 424) actively joined the smoking program; and of CD clients who chose cessation, 17.5% were abstinent at follow-up.

Self-Reported Collision Risk Associated With Cannabis Use and Driving After Cannabis Use Among Ontario Adults

Objective: This study examined the effects of cannabis use and driving after cannabis use on self-reported collision involvement within the previous 12 months while controlling for demographics, driving exposure, binge drinking, and driving after drinking based on a large representative sample of adults in Ontario. Methods: Data are based on the CAMH Monitor, an ongoing cross-sectional telephone survey of Ontario adults aged 18 and older, conducted by the Centre for Addiction and Mental Health. Data on drivers who reported driving at least one kilometer per week and who responded to the collision item from 2002 to 2007 were merged into one data set (n = 8481). Logistic regression analysis of self-reported collision risk posed by cannabis use (lifetime and past 12 months), driving after cannabis use (past 12 months), and driving after drinking among drinkers (past 12 months) was implemented, controlling for the effects of gender, age, region, income, education, marital status, kilometers driven in a typical week, and consuming five or more drinks of alcohol on one occasion (past 12 months). Due to list-wise deletion of cases the logistic regression sample was reduced (n = 6907). Results: Several demographic factors were found to be significantly associated with self-reported collision involvement. The logistic regression model revealed that age, region, income, marital status, and number of kilometers driven in a typical week, were all significantly related to collision involvement, after adjusting for other factors. Respondents who reported having driven after cannabis use within the past 12 months had increased risk of collision involvement (odds ratio [OR] = 1.84) compared to those who never drove after using cannabis, a greater risk than that associated with having reported driving after drinking within the past 12 months (OR = 1.34). Conclusion: Further investigation of the impact of driving after cannabis use on collision risk and factors that may modify that relationship is warranted.

Psychosocial sequelae of motor vehicle collisions: a follow-up study

One-hundred-and-forty-nine motor vehicle collision trauma victims were interviewed one year after discharge from a Regional Trauma Unit. Follow-up data indicated major post trauma problems such depression, anxiety, family stress, financial problems and driving fears. Almost 40% reported drinking driving after the crash with a greater proportion of alcohol (blood alcohol content) positive drivers engaging in drinking driving than blood alcohol content negative drivers. Notably, almost 16% of the blood alcohol content positive and 13% of the blood alcohol content negative reported involvement in another crash in the year since discharge.

Psychosocial characteristics of alcohol-involved and nonalcohol-involved seriously injured drivers☆

This study compared two groups of alcohol-positive and alcohol-negative, seriously injured, crash-involved drivers on demographics, personality characteristics, driving-related attitudes, prior driving history, lifestyle, substance use, and antecedent driver condition. The study sample was drawn from motor vehicle accident admissions to the Sunnybrook Health Science Centre Regional Trauma Unit. One hundred and six interviews were completed between August 1986 and November 1989, with blood alcohol concentration (BAC) data available for 96 drivers. These data suggest no driving-related attitude differences between the two groups. Self-reported driving histories indicated significantly fewer graduates of driving schools and more licence suspensions for the BAC-positive group. The only consistently significant differences were found for the drinking-related variables, with a greater percentage of the BAC-positive group reporting: lower age of first intoxication; a greater self-perceived drinking problem; a greater frequency of intoxication in the month before the accident; and greater self-reported drinking-driving in the month before the accident. Principal-components factor analysis revealed a four-factor solution labelled: Alcohol Use, Deviant/Illicit Drug Use, Aggression, and Neuroticism. Alcohol Use was the only factor found to contribute substantially to the discriminant function, together with the job-related stress item. These data suggest that seriously injured, alcohol-positive and alcohol-negative crashed drivers are similar except that the alcohol-positive drivers show more signs of an alcohol problem.

Does gender moderate the relationship between driver aggression and its risk factors

AIM The current study assessed gender as a potential moderator of the relationship between self-reported driver aggression and various demographic variables, general and driving-related risk factors. METHODS Using data from a general-population telephone survey conducted from July 2002 through June 2005, two approaches to binary logistic regression were adopted. Based on the full dataset (n=6259), the initial analysis was a hierarchical-entry regression examining self-reported driver aggression in the last 12 months. All demographic variables (i.e., gender, age, income, education, marital status), general risk factors (i.e., psychological distress, binge drinking, cannabis use), and driving-related risk factors (i.e., driving exposure, stressful driving, exposure to busy roads, driving after drinking, driving after cannabis use) were entered in the first block, and all two-way interactions with gender were entered stepwise in the second block. The subsequent analysis involved dividing the sample by gender and conducting logistic regressions with main effects only for males (n=2921) and females (n=3338) separately. RESULTS Although the prevalence of driver aggression in the current sample was slightly higher among males (38.5%) than females (32.9%), the difference was small, and gender did not enter as a significant predictor of driver aggression in the overall logistic regression. In that analysis, difficulty with social functioning and being older were associated with a reduced risk of driver aggression. Marital status and education were unrelated to aggression, and all other variables were associated with an increased risk of aggression. Gender was found to moderate the relationships between driver aggression and only three variables: income, psychological distress, and driving exposure. Separate analyses on the male and female sub-samples also found differences in the predictive value of income and driving exposure; however, the difference for psychological distress could not be detected using this separate regression approach. The secondary analysis also identified slight differences in the predictive value of four of the risk factors, where the odds ratios for both males and females were in the same direction but only one of the two was statistically significant. CONCLUSIONS The results demonstrate the importance of conducting the gender analysis using both regression approaches. With few exceptions, factors that were predictive of driver aggression were generally the same for both male and female drivers.