Kava use and risk of car crash injury: a population-based case control study in Fiji

Studies from high income countries attest to the significant contribution of recreational drugs to the risk of road traffic crashes. While rates of road crashes in Pacific Island countries are high, the contribution of kava (a commonly consumed drink with sedative and anaesthetic properties) has received little attention. Using data from the TRIP Project, we aimed to quantify the relationship between acute kava use and car crash injuries in Fiji. We conducted a population-based case-control study in Viti Levu, Fiji. The study included drivers of all four-wheeled vehicles involved in crashes on public roads where at least one person died or was hospitalised (cases) and a random sample of drivers recruited on public roads in the region during the study period (controls). The drivers or their proxies completed a structured interview eliciting data on putative risk and protective factors including kava use, and relevant confounding factors. 154(77%) of the 199 eligible cases and 752 (84%) of the eligible controls completed interviews. Approximately 23% (32/140) of case drivers and 7% (54/749) of control drivers reported drinking kava in the previous 12 hours. After adjustment for major confounders including self-reported alcohol use, consuming kava within 12 hours of driving was associated with a three-fold increase in the odds of crash involvement (OR = 3.15, 95% CI: 1.22 – 8.16). Kava use by drivers appears to be an important contributor to serious injury-involved motor vehicle crashes in Fiji and should be an explicit target in road safety strategies in Pacific Island countries where kava use is common. While further studies are required to identify concentrations of kava and patterns of use that pose the greatest risk, this study illustrates the importance of investigating context-specific factors that account for a substantially greater burden of road crashes in some less-resourced settings than currently appreciated.