Bridging a historical gap: can changes in perceptions of law enforcement and social deterrence accelerate the prevention of drunk driving in low and middle-income countries?
OBJECTIVE
The dangers of driving while under the influence of alcohol/drugs (DWI) have been well established. Many countries have successfully reduced the incidence of DWI through effective law enforcement. We aim to explore the links between how law enforcement is perceived in cultures with different socioeconomic indicators. Our hypothesis is that social norms around definitions of what constitutes "right" vs. "deviant" behavior related to DWI directly contribute to the mode and success of law enforcement.


METHODS
Road safety professionals from six countries with different levels of DWI rates and enforcement strategies were interviewed regarding the expected local response to a case vignette. Sociodemographic, mortality, and economic indicators for each of these countries were extracted from different sources.


RESULTS
The professionals interviewed described a continuum ranging from unequivocal enforcement and punishment (Australia and Norway) to inconsistent enforcement and punishment with the presence of many legal loopholes (Mexico and Brazil). For the six countries, no apparent correlation was identified purely between alcohol consumption and road traffic mortality. However, there seems to be a correlation between the time period of initial DWI legislation and current gross national income, perceptions of local safety, satisfaction with the local environment, and trust in the national government. Higher levels of these scores are seen in nations in which DWI laws were implemented prior to the 1960s.


CONCLUSIONS
Better performing countries seem to have achieved a level of societal agreement that DWI is deviant, generating social stigma against DWI that allows legislation to be enforced. Lessons learned from these countries could help developing countries reduce morbidity and mortality associated with DWI.
Centro de Pesquisa em Álcool e Drogas (CPAD), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS , Brazil, Centro de Pesquisa em Álcool e Drogas (CPAD), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
Flavio
F
Pechansky
Department of Epidemiology, Johns Hopkins Bloomberg School, Johns Hopkins Bloomberg School, Baltimore , USA, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Aruna
A
Chandran
Centro de Pesquisa em Álcool e Drogas (CPAD), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS , Brazil, Centro de Pesquisa em Álcool e Drogas (CPAD), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
Tanara
T
Sousa
D000063:Accidents, Traffic / Q000401:mortality / Q000517:prevention & control; D000428:Alcohol Drinking / Q000331:legislation & jurisprudence / Q000517:prevention & control / Q000523:psychology; D001118:Argentina; D001315:Australia; D001334:Automobile Driving / Q000331:legislation & jurisprudence* / Q000523:psychology; D001938:Brazil; D001944:Breath Tests; D003906:Developing Countries; D000066448:Driving Under the Influence / Q000331:legislation & jurisprudence / Q000517:prevention & control* / Q000523:psychology*; D006801:Humans; D035846:Law Enforcement / Q000379:methods*; D008800:Mexico; D009664:Norway; D010465:Perception; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States