Abstract
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.
Highlights
The harmful use of alcohol is the leading risk factor for death among men aged 15–59 years, and road traffic accidents rank second on global alcohol-attributable deaths [1]
Survey Population The survey population corresponds to individuals aged 18 years or more, who live in Porto Alegre, who have been driving cars or other motor vehicles in the last 12 months and who have drunk on the premises of an AO during the survey reference period
We emphasize that the aim of the study was to estimate driving under the influence of alcohol (DUI) prevalence among drivers who drank at AOs
Summary
The harmful use of alcohol is the leading risk factor for death among men aged 15–59 years, and road traffic accidents rank second on global alcohol-attributable deaths [1]. In Brazil, traffic crashes (TC) caused 38,737 fatal victims in 2008 [2], and a few studies conducted in the country indicate that between 30–50% of these victims had a positive blood alcohol concentration (BAC) [3,4]. Despite such disquieting figures, victims of TC are not systematically examined with the help of breathalyzers, rendering the report of non-fatal accidents associated with the misuse of alcohol probably underestimated. Enforcement through random breath testing and sobriety checkpoints has been erratically implemented across the different Brazilian regions and localities and remains a formidable challenge in a continental-sized and deeply heterogeneous country
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