Full length articlePrevalence of at-risk drinking among Brazilian truck drivers and its interference on the performance of executive cognitive tasks
Introduction
The World Health Organization (WHO) stated that 5.9% of all global deaths were attributable to the harmful use of alcohol, as well as 5.1% of the world’s diseases and injuries (World Health Organization; WHO, 2014). Traffic crashes are categorized as one of the unintentional injuries caused by the harmful use of alcohol (WHO, 2014). In this scenario, over 1.2 million people die each year over the world’s roads and up to 50 million incur nonfatal injuries each year because of road traffic crashes (WHO, 2015). Fifteen per cent of all deaths and 13% of all injuries and disabilities caused by traffic crashes have been attributable to alcohol (WHO, 2013), in such a way that alcohol continues to be the main substance found in biological samples of victims of traffic accidents, especially among the ones who died in these accidents (Legrand et al., 2013).
Estimating the pattern of alcohol use has been an important parameter to assess its related injuries and harms (WHO, 2014). In this regard, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) pointed out that binge drinking is a pattern of drinking that leads blood alcohol concentration (BAC) to 0.08% gram-percent or above, which means that, for a typical adult this pattern corresponds to the consumption of five or more drinks (male) or 4 or more drinks (female) in about 2 h (NIAAA, 2016).
Binge drinking has been associated with an increase in the risk of alcohol-related injuries (Chou et al., 2012, Rossow et al., 2013). A study by Chou et al. (2012) pointed out that 46% of the patients admitted to emergency rooms reported having engaged in binge drinking at least once a month in the previous year. Also, Rossow et al. (2013) suggested that those who reported binge drinking at least once a month had a 9.5 higher chance to be involved in crash accidents compared to those who did not report such use, an association that resembled a linear risk function.
Consistently, binge drinking has been associated with self-reported reckless driving behaviors, such as drinking and driving, getting speeding tickets for high-speed driving, taking rides with drunk drivers, and, mainly, undergoing traffic accidents (Aston et al., 2014, Gonçalves et al., 2012, Valencia-Martín et al., 2008).
Among the alcohol-related effects, it has been observed that there is a progressive reduction in frontal executive functioning with increasing BAC values among drivers (Domingues et al., 2009). In this regard, executive functioning is part of a system that supervises the overall hierarchy of brain processing and encompasses the necessary skills for purposeful, goal-directed behavior, exerting top-down, volitional control over cognition and behaviors (Daffner and Searl, 2008, Strauss et al., 2006). Considering that driving is a complex task in which the driver continuously receives information, having to analyze it and react to it, one may consider that executive functioning must be preserved for safe driving.
In Brazil, traffic accidents are among the main causes of death. The mortality rate in the country due to traffic accidents is 22.5 deaths/100,000 inhabitants, higher than in middle income countries and in the Americas (WHO, 2015). In this scenario, truck drivers seem to be a population of special concern, since they are involved in 33.4% of all traffic accidents registered in federal highways, i.e., three of every ten traffic accidents involved cargo vehicles. The situation is worsened when noted that accidents that involved trucks contributed to 43% of the total deaths on these roads (Brasil, 2015). These data are even more concerning considering that trucks represent only 3% of the national vehicle fleet (Jorge, 2013).
Alcohol continues to be the main substance consumed by truck drivers and the average frequency of self-reported alcohol use among them is 54.3% (Girotto et al., 2014). It is possible that truck drivers may be engaging in binge drinking and that it may be interfering in their cognitive functioning, mediating the high prevalence of traffic accidents among them. However, to the best of our knowledge, no previous study has focused on the issue, since binge drinking is a drinking pattern commonly described among adolescents and young people (Hermens et al., 2013).
Therefore, the aim of this study was to estimate the prevalence of binge drinking and its interference in cognitive functioning in a sample of truck drivers interviewed in the highways of the State of Sao Paulo, Brazil, controlling for the confounding effects of demographic variables, use of illicit drugs, and psychiatric and sleep disorders.
Section snippets
Participants
A non-probabilistic sample of 684 truck drivers was recruited at truck stops in three highways of the State of Sao Paulo, Brazil. These truck stops are part of the SEST-SENAT (SEST: Social Transportation Service; SENAT: National Transportation Learning Service) stations, a Brazilian agency that develops, supports, and manages social programs with a focus on the well-being of the workers involved in transportation. In this context, the drivers approached to participate in the research were
Results
A total of 684 drivers agreed to participate in this study, 149 of them being excluded due to the presence of at least one of the following conditions: (a) color-blindness (N = 9), (b) therapeutic problems with need for psychotropic medications (N = 6), (c) TBI in their lifetime (N = 41), (d) loss of consciousness for at least five minutes in their lifetime (N = 68), (e) history of neurological diseases that could interfere in their cognitive assessment (N = 12), (f) HIV positive (N = 0), (g) less than
Discussion
This study aimed to estimate the prevalence of binge drinking among truck drivers and its effect on their performance on executive cognitive functioning tests.
Almost 17.5% of the drivers reported binge drinking at least once during the last 30 days. This estimate is higher than the one presented in a study on binge drinking in the general Brazilian population; roughly 10% of the sample reported binge drinking at least once a month (Castroand et al., 2012). These outcomes are consistent with the
Contributors
LGO, PARG, DRM, and VL had the initial idea and designed the study. LGO, KL, and MJCG participated actively in the data collection carried out inside the truck stop facilities. LPB conducted the data analysis. LGO, KL, and MJCG managed the literature searches to write the first draft of the manuscript. PARG, DRM, and VL contributed to deepen the interpretations of data. Finally, all authors reviewed and approved the final version of this manuscript.
Role of funding source
This work was supported by the Foundation for Research Support of the State of São Paulo (Fundação de Amparo à Pesquisa do Estado de São Paulo-FAPESP; grant number 2011/11682-0). The funding source had no involvement in study design; in the data collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.
Conflict of interest
The authors declare no conflict of interest.
Acknowledgments
The authors thank the financial support of the Foundation for Research Support of the State of São Paulo, FAPESP (Fundação de Amparo à Pesquisa do Estado de São Paulo-FAPESP; grant number 2011/11682-0); the civil organizations Social Transport Service (SEST) and the National Transport Learning Service (SENAT) for authorization to use three of its service stations for access to the target population and, finally, the LIM-40 USP.
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