title: Driving following Kava Use and Road Traffic Injuries: A Population-Based Case-Control Study in Fiji (TRIP 14).
abstract: OBJECTIVE
  To 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.
  
  
  METHODS
  Data 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.
  
  
  RESULTS
  Overall, 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.
  
  
  CONCLUSIONS
  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. The precautionary principle would suggest road safety strategies should explicitly recommend avoiding driving following kava use, particularly in communities where recreational use is common.
authors.affiliation: School of Population Health, University of Auckland, Auckland, New Zealand.
authors.forename: Iris
authors.initials: I
authors.lastname: Wainiqolo
authors.affiliation: College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji.
authors.forename: Berlin
authors.initials: B
authors.lastname: Kafoa
authors.affiliation: School of Population Health, University of Auckland, Auckland, New Zealand.
authors.forename: Bridget
authors.initials: B
authors.lastname: Kool
authors.affiliation: School of Population Health, University of Auckland, Auckland, New Zealand.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Robinson
authors.affiliation: School of Population Health, University of Auckland, Auckland, New Zealand.
authors.forename: Josephine
authors.initials: J
authors.lastname: Herman
authors.affiliation: College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji.
authors.forename: Eddie
authors.initials: E
authors.lastname: McCaig
authors.affiliation: School of Population Health, University of Auckland, Auckland, New Zealand.
authors.forename: Shanthi
authors.initials: S
authors.lastname: Ameratunga
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D005367:Fiji; D006801:Humans; D020901:Kava / Q000737:chemistry*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D028321:Plant Preparations / Q000008:administration & dosage*; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D028321:Plant Preparations