According to the study, the profile of injured rural drivers differs from that of urban drivers in several respects.
Rural youth aged 16 to 18 accounted for 6 per cent of hospitalizations, compared with 3.4 per cent in urban areas. Daoust believes the difference is due in part to widespread use of off-road vehicles in rural areas. The 6 per cent figure may even be an underestimate: the study did not cover drivers under 16, and it is not uncommon for rural teens under 16 to drive off-road vehicles.
“Accidents involving an all-terrain vehicle or similar vehicle, whether it is being used for recreational or practical purposes, are four times more common in rural than in urban areas—9.6 per cent versus 2.2 per cent—and it is mainly young people who drive them,” Daoust said.
Accidents in which only one vehicle was involved were also more common in rural areas, at 56.2 per cent compared with 39.4 per cent in urban areas. The researchers attributed this to the combined effect of low traffic density, the roads, the lack of alternative transportation and limited police presence.
The consequences of road accidents are more severe in rural areas. Rural drivers were hospitalized in 55.3 per cent of cases, compared with 33.4 per cent for urban drivers. Researchers attributed this significant difference to generally more serious injuries, compounded by the distance from trauma centres and longer lags in emergency response in rural areas.
Troubling use of multiple substances
Daoust was struck by the fact that 28.8 per cent of injured rural drivers had two or more classes of substances in their blood, compared with 19.6 per cent for urban drivers.
However, he does not consider this finding entirely surprising: “If there is greater alcohol consumption, there is a higher risk that it will be combined with other drugs. The logic is simple: the more people use substances, the more likely they are to combine them.”
The use of multiple substances can be particularly dangerous. A number of studies have shown that the alcohol-cannabis combination impairs driving ability more than each substance taken separately. Even levels of intoxication that seem to present a limited risk when substances are consumed in isolation can have a major effect on driving when they are combined.
“We know that alcohol above the 0.08 limit impairs driving ability,” Daoust noted. “But even below that, any amount of alcohol has some effect, and when combined with THC or other substances, there can be a multiplier effect.”
Here too, the research team believes that the figures reported in their study are probably conservative. The longer time lapse between the collision and the collection of a blood sample in rural areas—because of the time it takes for emergency responders to arrive and for the driver to be transported—means that substances are more likely to metabolize.
“If a driver has a BAC of 0.082 at the time of the accident, it may be 0.075 by the time they reach the hospital,” Daoust pointed out. “This moves the driver to a different category in our classification. The actual prevalence of some substances at the time of the accident could therefore be higher than the data indicate.”
Furthermore, cases in which it took more than six hours after the accident to collect a blood sample were excluded from the study, and this was more likely to occur in rural areas.
Targeting rural youth
According to the study’s authors, their findings make a compelling case for more targeted public health interventions, particularly for rural youth aged 16 to 18 who are overrepresented in serious accidents, are more likely to drive off-road vehicles, and live in an environment where alcohol consumption may be more culturally acceptable.
The researchers also point to structural factors—geographic isolation, lack of public transit, limited police presence and different social norms—that create an environment where risk factors accumulate.
They therefore advocate an approach that combines public health initiatives with increased law enforcement and community mobilization. “Otherwise,” Daoust warned, “prevention messages may not reach those who need them the most.”
