• Proportion of drivers, 16 years and over, that drove a motor vehicle after having 2 or more drinks in the hour before they drove in the past 12 months.
• Proportion of population, 12 years and over, that drove a recreational vehicle after having 2 or more drinks in the hour before they drove in the past 12 months.

Specific Indicators

• Prevalence of drinking and driving a motor vehicle among motor vehicle drivers
• Prevalence of drinking and driving a recreational vehicle among total population

Ontario Public Health Standards (OPHS)

• The Ontario Public Health Standards (OPHS) establish requirements for the fundamental public health programs and services carried out by boards of health, which include assessment and surveillance, health promotion and policy development, disease and injury prevention, and health protection. The OPHS consist of one Foundational Standard and 13 Program Standards that articulate broad societal goals that result from the activities undertaken by boards of health and many others, including community partners, non-governmental organizations, and governmental bodies. These results have been expressed in terms of two levels of outcomes: societal outcomes and board of health outcomes. Societal outcomes entail changes in health status, organizations, systems, norms, policies, environments, and practices and result from the work of many sectors of society, including boards of health, for the improvement of the overall health of the population. Board of health outcomes are the results of endeavours by boards of health and often focus on changes in awareness, knowledge, attitudes, skills, practices, environments, and policies. Boards of health are accountable for these outcomes. The standards also outline the requirements that boards of health must implement to achieve the stated results.

Outcomes Related to this Indicator

• Societal Outcome (Prevention of Injury and Substance Misuse): There is reduced incidence and severity of substance misuse and substance-related injuries, hospitalizations, disabilities, and deaths.
• Societal Outcome (Prevention of Injury and Substance Misuse): Sustained behaviour change by the public contributes to the prevention of injury and substance misuse.

Assessment and/or Surveillance Requirements Related to this Indicator 

• The board of health shall conduct epidemiological analysis of surveillance data...in the area of alcohol and other substances; road and off-road safety, (Prevention of Injury and Substance Misuse).

http://www.ontario.ca/publichealthstandards

Corresponding Health Indicator(s) from Statistics Canada and CIHI

• None

Data Sources

Numerator & Denominator: Canadian Community Health Survey (CCHS)
Original source: Statistics Canada
Distributed by:
1. Ontario Ministry of Health and Long-Term Care (MOHLTC)
2. Statistics Canada
Suggested citation (see Data Citation Notes):
1. Canadian Community Health Survey [year], Statistics Canada, Share File, Ontario MOHLTC
2. Canadian Community Health Survey [year], Statistics Canada, Public Use Microdata File, Statistics Canada

Survey Questions

The Canadian Community Health Survey (CCHS) contains an optional module called Driving and Safety. This module was selected by Ontario in 2003, 2009 and 2010.

Alternative Data Source

The Rapid Risk Factor Surveillance System (RRFSS) contains a module called Alcohol - Drinking and Driving. This module was core in 2001 and 2002. It has been optional since 2003. Note: There are slight differences between the CCHS and RRFSS definitions and skip patterns for recreational vehicles. The CCHS asks about being the driver of a "snowmobile, motor boat, seadoo or ATV." The wording of the RRFSS question is “recreation vehicles such as a snowmobile, boat or all terrain vehicle". The CCHS asks information on drinking and driving from drivers and passengers of recreational vehicles whereas RRFSS captures this information only for drivers. 

Analysis Check List

• The prevalence of drinking and driving a motor vehicle (car, truck, van and motorcycle) is based on four CCHS questions: ALCn_1 (alcohol drinking in the past 12 months), DRVn_01A (motor vehicle driving in the past 12 months), DRVn_01B (motorcycle driving in the past 12 months) and DRVn_07 (drinking and driving in the past 12 months).
• The specific indicator for drinking and driving a motor vehicle (car, truck, van and motorcycle) is calculated with the following: 
• ”Yes” for drinking and driving a motor vehicle: DRVn_07=1
• ”No” for drinking and driving a motor vehicle: DRVn_07=2 OR ((DRVn_01A=1 or DRVn_01B=1) & ALCn_1=2)
• Respondents who drove a motor vehicle (car, truck, van and motorcycle) (DRVn_01A = Yes or DRVn_01B=Yes) but did not drink any alcoholic beverage in the past 12 months (ALCn_1 = No) were coded as Not Applicable for drinking and driving in the past 12 months (DRVn_07 = Not Applicable). They should, however, be coded as No for drinking and driving in the past 12 months (DRVn_07= No).
• The denominator for the ‘Prevalence of Drinking and Driving a Recreational Vehicle' is the weighted total population aged 12+, since the proportion of recreational vehicle drivers cannot be obtained from the CCHS. The CCHS combines drivers and passengers of recreational vehicles.
•  As the denominator for the “Prevalence of Drinking and Driving a Recreational Vehicle” indicator was changed to total population, there is no Not Applicable category. People who did not consume an alcoholic beverage in the past 12 months should be recoded from ‘Not Applicable' to ‘No' for DRVn_14. The remaining records with Not Applicable response for DRVn_14 were those who were either not recreational vehicle users or those whose alcohol consumption status were unknown in the past 12 months. These records should be coded as Don't know for DRVn_14.
• Based on the CCHS 2003, the prevalence of drinking and driving a motor vehicle are unreportable for several health units, and the prevalence of drinking and driving a recreational vehicle are unreportable for over half of the health units.

CCHS

• It is recommended that public health units use the Share File provided by the Ministry of Health and Long-Term Care rather than public use file (PUMF) provided by Statistics Canada. The Share File has a slightly smaller sample size because respondents must agree to share their information with the province to be included; however, the share file has more variables and fewer grouped categories within variables. The Share File is a cleaner dataset for Ontario analysis because all variables that were not common content, theme content or optional content for Ontario have been removed.
• There may be slight differences between results from the share file and data published on the Statistics Canada website for the Health Indicators because rates calculated for Health Indicators use the master CCHS data file.
• Users need to consider whether or not to exclude the ‘Refusal, 'Don't Know' and ‘Not Stated' response categories in the denominator. Rates published in most reports, including Statistics Canada's publication Health Reports generally exclude these response categories. In removing not stated responses from the denominator, the assumption is that the missing values are random, and this is not always the case. This is particularly important when the proportion in these response categories is high. 
• Estimates must be appropriately weighted (generally the share weight for the CCHS) and rounded. Users of the CCHS Ontario Share File must adhere to Statistics Canada's release guidelines for the CCHS data when publishing or releasing data derived from the file in any form. Refer to the appropriate user guide for guidelines for tabulation, analysis and release of data from the CCHS. In general, when calculating the CV from the share file using the bootstrap weights, users should not use or release weighted estimates when the unweighted cell count is below 10. For ratios or proportions, this rule should be applied to the numerator of the ratio.  Statistics Canada uses this approach for the tabular data on their website. When using only the Approximate Sampling Variability (CV) lookup tables for the share file, data may not be released when the unweighted cell count is below 30. This rule should be applied to the numerator for ratios or proportions. This provides a margin of safety in terms of data quality, given the CV being utilized is only approximate
• Before releasing and/or publishing data, users should determine the CV of the rounded weighted estimate and follow the guidelines below:
• Acceptable (CV of 0.0 - 16.5) Estimates can be considered for general unrestricted release. Requires no special notation.
• Marginal (CV of 16.6 - 33.3) Estimates can be considered for general unrestricted release but should be accompanied by a warning cautioning subsequent users of the high sampling variability associated with the estimates. Such estimates should be identified by the letter E (or in some other similar fashion).
• Unacceptable (CV greater than 33.3) Statistics Canada recommends not to release estimates of unacceptable quality. However, if the user chooses to do so then estimates should be flagged with the letter F (or in some other fashion) and the following warning should accompany the estimates: "The user is advised that...(specify the data)...do not meet Statistics Canada's quality standards for this statistical program. Conclusions based on these data will be unreliable and most likely invalid". These data and any consequent findings should not be published. If the user chooses to publish these data or findings, then this disclaimer must be published with the data.

RRFSS

• Users should refer to the most recent RRFSS Manual of Operations for a complete list of RRFSS analysis guidelines.
• Denominator Data - cell size less than 30 not to be released (based on unweighted data).
• Numerator Data - cell size less than 5 not to be released (based on unweighted data).
• Coefficients of variation (CV) should be calculated for every estimate. The following categories determine the release of the data: 
• CV between 0 and 16.5: estimate can be released without qualification.
• CV between 16.6 and 33.3: estimate can be released with qualification: interpret with caution. High variability
• CV greater than 33.3: estimate should not be released, regardless of the cell size.
• 95% confidence intervals should accompany all released estimates. In general the simple computation of the C.I. for a proportion assuming SEp = sqrt(pq/n) and CI95% = p +/- 1.96*SEp is sufficient. However, if estimates are close to 0 or 100% and the simple computation confidence intervals include values less than zero or greater than 100 then the Fleiss 2nd edition computation for skewed estimates should be employed.
• Weighting:
• General household weight will be applied for questions related to the individual.
• Household weight is to be applied for questions about households when we wish to determine the population/number of people affected.
• Household weight is not to be applied for child proxy questions (bicycle helmet use, car seat safety), dog and cat immunization modules, or other questions that relate to the household rather than the respondent. o Household weights are not required to be recalculated for sub-population based questions; for example mammography in women ages 35+ years and 50-74 years.
• If the weights supplied with the data set (health unit wave specific, health unit cumulative total, all health units combined wave specific, all health units combined cumulative total) are not appropriate for the required analysis, then a time-specific weight must be calculated. For example, a new weight is required for all seasonal modules.
• If the cell size of ‘Don't Know' responses is 5% or greater, ‘Don't Know' responses should be included in the denominator of the analyses and reported separately.
• If the cell size of ‘Refusal' responses is 5% or greater, ‘Refusal' responses should be included in the denominator of the analyses and reported separately.
• When an indicator is being compared between groups (e.g. health units, time periods, gender), if any one group has ‘Don't Know' and/or ‘Refusal' responses that are 5% or greater, ‘Don't Know' and/or ‘Refusal' responses should be included in the denominator of the analyses and reported separately for all groups.
• A provincial sample is not available with the RRFSS.
• Refer to the RRFSS Data Dictionaries at http://www.rrfss.ca/ for more information about module questions and indicators.

Method of Calculation

Prevalence of Drinking and Driving a Motor Vehicle:

Weighted number of people aged 16 and over who drove a motor vehicle one or more times in the past 12 months after having 2 or more drinks in the hour before they drove  Weighted total population of motor vehicle drivers aged 16 and over in the past 12 months

X 100

Prevalence of Drinking and Driving a Recreational Vehicle:

Weighted number of drivers aged 12 and over who drove a recreational vehicle one or more times in the past 12 months after having 2 or more drinks in the hour before they drove  Weighted total population aged 12 and over

X 100

Basic Categories

• Sex: male, female
• Geographic areas for: Public Health Unit; RRFSS - participating health units that chose the drinking and driving module.

Indicator Comments

• Alcohol is associated with a number of adverse health consequences, including injuries and deaths from impaired driving. The largest number of alcohol-related deaths (more than from chronic diseases) stem from impaired-driving collisions. These collisions also result in a large number of potential years of life lost because of the relatively young age of people killed in alcohol-related traffic collisions.¹
• According to section 253 of the Criminal Code of Canada, impaired driving means driving a car, truck, boat, snowmobile, aircraft, train or other motor vehicle when the ability to operate the motor vehicle is impaired by alcohol or drugs. A person can be convicted of the criminal offence of impaired driving when there is proof beyond a reasonable doubt of the person's impairment. Evidence might show, for example, that the person was driving very slowly or too fast, was not driving in a straight line, could not manage simple physical tasks, had slurred speech or bloodshot eyes or had breath that smelled of alcohol. A person who is actually impaired by alcohol can be convicted of impaired driving, whether or not the person's blood alcohol content was over the "legal limit." ²
• According to section 253 of the Criminal Code of Canada, when the alcohol content in a person's blood is more than 80 mg of alcohol in 100 ml of blood, the person can be convicted of being "over the legal limit" (being "over 80"). A person whose blood alcohol content is over the legal limit could be convicted even if the person didn't act drunk or seem to be impaired. The punishment for this criminal offence is the same as the punishment for driving while impaired.²
• As of May 1, 2009, Ontario has targeted measures to help take more drinking drivers off the roads. Drivers with a blood alcohol content from 50 mg to 80 mg of alcohol in 100 ml of blood (known as the "warn range") will have their license suspended for 3 days for a first occurrence, 7 days for a second occurrence, and 30 days for a third or subsequent occurrence.
• Individuals react differently to the same alcohol levels depending upon sex, body size and alcohol tolerance.
• The perception of social approval/disapproval by respondents may affect the responses to survey questions on drinking and driving. ³
• According to a report on impaired driving ⁴, in Canada:
• In 1997, 1 in every 278.6 licensed drivers was charged with an impaired driving offence and it had fallen to 1 in every 345.6 licensed drivers by 2003.
• In 1999, 2,969 road users were killed in Canada and another 17,500 were seriously injured in traffic collisions. Alcohol was a factor in more than 1,200 of the fatalities (about 40%) and more than 3,600 of the serious injuries (about 21%).
• In 2001, 38% of the fatally-injured drivers who were tested had been drinking and of these, almost 85% had blood-alcohol concentration over 80mg/100ml.
• Males accounted for 86.8% of the alcohol-positive, fatally-injured drivers and 85.8% of them were legally impaired.
• Studies show that people convicted of impaired driving offenses come from many different backgrounds, age categories and income groups. Most convicted drivers are male, a high proportion are "heavy" drinkers, many have an "antisocial attitude " (lack respect for the law and the safety of others) and of those convicted, almost all report having driven while under the influence many times before. ⁵
• There were extensive changes in question wording from CCHS 1.1 to CCHS 2.1. The CCHS 1.1 asked "In the past 12 months, how many times did you drive when you perhaps had too much to drink?" The wording was made more specific in CCHS 2.1 to "In the past 12 months, have you driven a motor vehicle after having 2 or more drinks in the hour before you drove?"
• Variable DUIA_3 from the CCHS 1.1, relating to the number of times the respondent drove when perhaps he/she had too much to drink, was unusable due to coding errors, possibly because respondents were answering it as a yes/no question rather than the number of times they were drinking and driving.
• The driving and safety module in CCHS 2.1 was also expanded to include questions for drivers and passengers of snowmobiles, motor boats, seadoos and all-terrain vehicles.
• Based on the Ontario Highway Traffic Act, a person must be at least 16 years old in order to drive a motor vehicle in the province. As a result, persons under 16 years old are excluded from the Drinking and Driving a Motor Vehicle indicator.

Definitions

• Motor vehicle = Include cars, trucks, vans and motorcycles. Exclude off-road vehicles.
• Recreational vehicle = Snowmobile, motor boat, seadoo or all-terrain vehicle
• CCHS defines an alcoholic drink as: one bottle or can of beer or a glass of draft, one glass of wine or a wine cooler, one drink or cocktail with 1 and a 1/2 ounces of liquor.  This is similar to the definition from the Centre for Addiction and Mental Health (CAMH) which defines one standard drink as 13.6 g of alcohol or:
• 5 oz or142 mL of wine (12% alcohol)
• 1.5 oz or 43 mL of spirits (40% alcohol)
• 12 oz or 341 mL of regular strength beer (5% alcohol)

Cross-References to Other Indicators

• Alcohol-related injury and mortality from motor vehicle traffic collisions (Section 4C: Injury Prevention and Substance Abuse Prevention)

Cited References

1. Single E, Rehm J, Robson L, Van Truong M. The relative risk and etiologic fractions of different cause of death and disease attributable to alcohol, tobacco and illicit drug use in Canada. CMAJ 2000;162(12):1669-1675.
2. The CAMH Research Document Series. Centre for Addiction and Mental Health. Available online at: http://www.camh.net/Publications/CAMH_Publications/research_pubsindex.html (Accessed April 2, 2009).
3. St-Pierre, M. et Béland, Y. Mode effects in the Canadian Community Health Survey : a Comparison of CAPI and CATI. Proceedings of the American Statistical Association Meeting, Survey Research Methods 2004. Toronto, Canada: American Statistical Association, 2004.
4. Alcohol, Trauma and Impaired Driving . Mothers Against Drunk Driving & Centre for Addiction and Mental Health., 2006. Available online at:  http://www.madd.ca/english/research/real_facts.pdf (Accessed April 2, 2009).
5. "Do You Know... Alcohol, Other Drugs and Driving". Centre for Addiction and Mental Health, 2008. Available online at:   http://www.camh.net/About_Addiction_Mental_Health/Drug_and_Addiction_Information/alchohol_drugs_driving_dyk.html (Accessed April 2, 2009).

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