title: Alcohol and marijuana use while driving--an unexpected crash risk in Pakistani commercial drivers: a cross-sectional survey.
abstract: BACKGROUND
  A significant proportion of road traffic crashes are attributable to alcohol and marijuana use while driving globally. Sale and use of both substances is illegal in Pakistan and is not considered a threat for road traffic injuries. However literature hints that this may not be the case. We did this study to assess usage of alcohol and marijuana in Pakistani commercial drivers.
  
  
  METHODS
  A sample of 857 commercial bus and truck drivers was interviewed in October 2008 at the largest commercial vehicle station in Rawalpindi and Islamabad, Pakistan. Time location cluster sampling was used to select the subjects and a structured questionnaire was used to assess the basic demographic profile, substance abuse habits of the drivers while on the road, and reasons for usage of illicit substances while driving were recorded. Self reported information was collected after obtaining informed consent. Chi square and fisher exact tests were used to assess differences between groups and logistic regression was used to identify significant associations between driver characteristics and alcohol and marijuana use.
  
  
  RESULTS
  Almost 10% of truck drivers use alcohol while driving on Pakistani roads. Marijuana use is almost 30% in some groups. Statistically different patterns of usage are seen between population subgroups based on age, ethnicity, education, and marital status. Regression analysis shows association of alcohol and marijuana use with road rage and error behaviours, and also with an increased risk of being involved in road crashes. The reported reasons for using alcohol or marijuana show a general lack of awareness of the hazardous nature of this practice among the commercial driver population.
  
  
  CONCLUSIONS
  Alcohol and marijuana use is highly prevalent in Pakistani commercial drivers. The issue needs to be recognized by concerned authorities and methods such as random breath tests and sobriety check points need to be employed for proper law enforcement.
authors.affiliation: Department of Emergency Medicine, Aga Khan University Hospital, First floor Stadium Road, Karachi, Pakistan. umer.mir@aku.edu
authors.forename: Mohammed Umer
authors.initials: MU
authors.lastname: Mir
authors.forename: Imran
authors.initials: I
authors.lastname: Khan
authors.forename: Bilal
authors.initials: B
authors.lastname: Ahmed
authors.forename: Junaid
authors.initials: J
authors.lastname: Abdul Razzak
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology*; D001334:Automobile Driving; D003132:Commerce; D003430:Cross-Sectional Studies; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008385:Marijuana Smoking / Q000453:epidemiology*; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D012044:Regression Analysis; D018570:Risk Assessment; D055815:Young Adult