Abstract
ObjectiveTo investigate the association between kava use and the risk of four-wheeled motor vehicle crashes in Fiji. Kava is a traditional beverage commonly consumed in many Pacific Island Countries. Herbal anxiolytics containing smaller doses of kava are more widely available.MethodsData for this population-based case-control study were collected from drivers of ‘case’ vehicles involved in serious injury-involved crashes (where at least one road user was killed or admitted to hospital for 12 hours or more) and ‘control’ vehicles representative of ‘driving time’ in the study base. Structured interviewer administered questionnaires collected self-reported participant data on demographic characteristics and a range of risk factors including kava use and potential confounders. Unconditional logistic regression models estimated odds ratios relating to the association between kava use and injury-involved crash risk.FindingsOverall, 23% and 4% of drivers of case and control vehicles, respectively, reported consuming kava in the 12 hours prior to the crash or road survey. After controlling for assessed confounders, driving following kava use was associated with a four-fold increase in the odds of crash involvement (Odds ratio: 4.70; 95% CI: 1.90–11.63). The related population attributable risk was 18.37% (95% CI: 13.77–22.72). Acknowledging limited statistical power, we did not find a significant interaction in this association with concurrent alcohol use.ConclusionIn this study conducted in a setting where recreational kava consumption is common, driving following the use of kava was associated with a significant excess of serious-injury involved road crashes. The precautionary principle would suggest road safety strategies should explicitly recommend avoiding driving following kava use, particularly in communities where recreational use is common.
Highlights
Of the approximately 1.24 million road deaths each year, almost 95% occur in low and middle income countries [1]
In this study conducted in a setting where recreational kava consumption is common, driving following the use of kava was associated with a significant excess of serious-injury involved road crashes
We were concerned that while alcohol, some medicines and drugs [1, 4,5,6,7] are well-recognised risk factors in high-income countries, little is known of the possible contribution to crashes from kava, a traditional soporific substance commonly consumed in several small island developing states in the Pacific region
Summary
Of the approximately 1.24 million road deaths each year, almost 95% occur in low and middle income countries [1]. The burden of road traffic injuries in many of these countries is projected to increase sharply in coming decades imposing substantial demands on poorly resourced healthcare systems, compromising the development of fragile economies, and making millions of people vulnerable to increased poverty and on-going suffering [1]. These inequitably borne consequences highlight the importance of implementing effective road safety strategies that take particular account of risk factors in less-resourced settings [1,2,3]. These doses (e.g., 180–300 mg kavalactones) are consistent with the concentrations of kava found in dietary supplements that are becoming more widely available in Western countries as herbal remedies for the relief of anxiety, menopausal symptoms and other putative health benefits [10,11,12]
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