The document discusses the relationship between alcohol sales hours and traffic injuries in Peru. It finds that restricting alcohol sales hours in La Victoria district from midnight to 3am on weeknights and 3am on weekends was associated with a 40.7% and 36.4% reduction in aggressions in 2007 and 2008 respectively compared to 2006. Traffic deaths did not initially decrease in La Victoria as many victims came from outside the district. However, one year after extending the restrictions to all of Lima, there was an 11% reduction in traffic accidents and homicides as well as a 28.5% reduction in alcohol-positive traffic deaths. Restricting alcohol sales hours was an effective strategy for reducing violence and traffic injuries in Peru.

1. The relation between the Number of Hours that authorize the
sale of liquors Beverages and traffic Injuries, the Peruvian
Experiences
Dr. Hernán Málaga
“Evaluación de intervenciones en seguridad vial: componente clave de la Década de Acción”.

2. The Peruvian problem
• During 2007, there were registered 76.928 wounded in traffic accidents in a population of
27.148.1014.
• 3510 fatal victims (12, 9 per 100 000).
• 78% of them male5.
• An index of 25 deaths every 10.000 vehicles6.
• Mortality rate of 21,5 per 100.000 inhabitants7.
2

3. The relation with alcohol consumption
• In middle-income countries between 33 to 69% of fatally injured drivers and between 8 to
29% of non fatally injured drivers, would have consumed alcohol before their crash12.
Evidenced based measures against alcohol consumption
To reduce the burden of disease caused by alcohol, there are at least 10 evidenced-based public
health measures:
• Reduction in hours for alcoholic beverages authorized selling.
• Reduction in the days for alcoholic beverages authorized selling.
• Limit the number of alcoholic beverages selling stores.
• Legal responsibility for the alcoholic beverages seller.
• Supervise the firm control of the already established law.
• Brief interventions in alcohol-positive traffic casualties.
• To restrict advertising and patrician of alcohol .
• Minimum age to buy alcoholic beverages
• Measures to control traffic accidents.13
3

4. External injuries by group on weekends
(FSS) or not (MTWT) - HNCH, 2004
Group 1 Group 2 Total
Day
n % n % n %
FSS 4 210 57.54 3 107 42.46 7 317 100
MTWT 4 943 66.80 2 456 33.19 7 399 100
Total 9 153 62.20 5 563 37.80 14 716 100
OR = 1.49 (1.39 – 1.59) 95%
External Injuries by group and hour of attention.
(00:01 - 5:59 vs 06:00 - 24:00), HNCH, 2004
Group 1 Group 2 Total
Hour of attention
n % n % n %
00:01- 05:59 814 37.91 1 333 62.09 2 147 100
06:00-24:00 8 339 66.35 4 230 33.65 12 569 100
Total 9 153 62.20 5 563 37.80 14 716 100
OR = 3.23 (2.94 – 3.55) 95%
Group 1: Occupational and recreational.
Group 2: Aggressions, and traffic accidents. 4

5. Violent deaths tree problem
HIGH INCIDENCE OF
VIOLENT DEATHS
Traffic accidents
and agrettions
Expuestos en
las madrugadas Disponibilidad
Alcohol and de arma
Drugs de fuego
Consumption
Conductores Acceso inadecuado
negligentes al alcohol y drogas
Inappropriate Use of Free Time y violentos
Varones
Controles
15-40 años
inadecuados
Vacations,
Holidays, Weekends,
Pay Half Cinturones
Verano Urbano
Desempleo
marginales
Política nacional Instituciones
posterga el desarticuladas y
Nocturnality medio rural desprestigiadas
Inadecuada
Baja
distribución
escolaridad
de riquezas
Bad habits Respuestas del
and life style Estado
Ambiental Biológico
y de la sociedad
5

6. Objectives tree: Reduction of violence
Violence Reduction
Reduction of traffic injuries and
aggressions
Monitory External Injuries
Limit Consume of Cases Restricción
Alcohol and Drugs porte de armas Control
Alcoholemia
Programa Desarrollo
Urbano-Marginal Cambio de Armas
Controles de velocidad
por Dinero?
Limit Nocturnality y buen estado de los
Equidad Distribución vehículos
Riqueza Disminuye
Fomentar
migración Priorizar
Empleo
Restriction on the campo- Desarrollo Fortalecer
hours of sell ciudad Población Instituciones
Incrementar Rural Excluida de control
Escolaridad Recreación
Change of habits and life Alternativa para jóvenes Respuestas Estado y de la
style Sociedad
Ambiental
Biológico
6

7. Reduction in hours for alcoholic beverages authorized selling
The Latin American Experience
• This police was originally designed to reduce Violence in Colombia and Brazil.
• Bogota, Cali and Medellin in Colombia, Asunción in Paraguay, and Diadema in Brazil 14-17, have
applied successfully, restrictions of schedules for alcoholic beverages authorized selling, in
order to reduce violence and traffic accidents.
7

8. Ley Zanahoria in La Victoria
• In the District of La Victoria, due to the serious violence problem, in January 2007, a local
restriction was established, in this regard. Alcohol beverage is sold until midnight on Sunday,
Monday, Tuesday and Wednesday, and until 3:00 am on Thursdays, Fridays and Saturdays 18, 19.
La Victoria Studies
• The study should be considered as ecological 20 with a chronological and geographical
comparison between two districts: La Victoria, with the restriction and Cercado de Lima
without the ban.
Materials and Method
• The participants in the study were all the patients from a local National Hospital, with
aggressions, from fighting, or were wounded in traffic accidents. There are other hospitals
that could receive patients from those districts, but there’s an early study that shows that an
important quantity of those lesions are being attended there21. For the violent deaths:
homicides, suicides and deaths in traffic accidents that occur in both districts we use data
from the Institute of Forensic Medicine, as numerator.
8

9. Results of the study on injuries of external cause admitted to a
National Hospital
• In La Victoria there was a reduction of the aggressions of 40.7% in 2007 and 36.4% in
2008, with regard to 2006 ,with a significant negative tendency (P≤ 0,014). In
Cercado, although aggressions declined in 2007 in 16%, in 2008, they increased in 7%, with
regard to the 2006. They were more frequent in men in 2006 than in the 2007 and 2008
(Pearson chi 2(1) = 4.4260 Pr ≤ 0,035), OR=1.2 (95% CI 1, 0-1.4%) (P ≤0,035) in 2006.(Table
N°1).
• The male aggressions diminish in all ages, especially in younger’s. In Cercado, the behavior is
similar in the 3 years (Figure Nº 1). Woman has almost one fifth of aggressions less, than
men and diminished it at all ages after the restriction. No changes where observed in
Cercado.
9

10. Rate of men aggressions x 10.000 according to ages groups
Cercado – La Victoria 2006 – 2008, HN2DM
10

11. Age and sex specific homicide rates /100.000
Cali. 1994 - 1997 - 2001
500
+
+ ++
+
400
1994
300
+ 500
200
+ 400
1997
++ ++
100 + 300
+
+ +
, , , , +
+ + , , , , ,
+
+ ,
, ,
, , +
0 200
15-19
5-9
<5
10-14
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
>65 100 + +
+
500
+
++ 0
,,
+ ,
+ , , , , , ,
+ , , , , ,
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
>65
<5
400
+ 2001
300
++
+
200 +
++ + Males
100
+ , Females
+
0
+++,, ,,,,,,,,
,,, , Rate/100.000 Inhabitants
5-9
>65
<5
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
11
88: Sistema de Vigilancia de Violencia y Accidentalidad . CISALVA Con datos de: Med. Legal, Policia,Fiscalia, Sijin, Cdav

12. Relationship between the sales of liquors measured on fraction
of day and aggressions in La Victoria
30
25
20
Y 11.25 27.32 X
15
10
5
.75 .8 .85 .9 .95 1
Weights
Frequency of Aggressions Fitted values
12

13. Source: Sanchez A. et al 2011
• Numbers and crude incidence rates per 100.000 person-years of interpersonal violence and unintentional injury
deaths during the periods of days when the alcohol control policies were in effect. Cali, Colombia, 2004-08. (The
most restrictive policies prohibited alcohol consumption and sales between 2 a.m. and 10a.m. The moderately
restrictive policies prohibited alcohol consumption and sales between 3 a.m. and 10 a.m. The lax policies
prohibited alcohol consumption and sales between 4 a.m. and 10 a.m. 13

14. How to explain that deaths by traffic accidents did not decline
• The dead by traffic accidents increased 5.5% in Cercado and 11.2% in La Victoria.
The difference of La Victoria, with Bogota and Asunción13, 36, 37 could be related to:
• The victims came mainly from people that does not leave in La Victoria.
• The time of occurrence.
Frequency distribution of deaths, on traffic accidents for the periods 2005-06 and 2007-08, by hour
of occurrence, in La Victoria District.
2005-06 2007-08
Hour of Ocurrence
n % n %
0-2 8 7.1% 8 6.5%
3-5 11 9.7% 11 8.9%
6-8 16 14.2% 28 22.6%
9-11 10 8.8% 21 16.9%
12-14 15 13.3% 14 11.3%
15-17 18 15.9% 16 12.9%
18-20 23 20.4% 14 11.3%
21-23 12 10.6% 12 9.7%
Total 113 100% 124 100%
14
Source: Institute of Forensic Medicine, 2009

15. Local Ban 1568 Secure Hour
C: First we have to finish the beers handsome prince... After
midnight I will give you my crystal shoe and every thing else...
P: Cheers Cinderella!
R: By midnight her car will be transformed in a carrot.
Objectives
• Analyze date of homicides, suicides and deaths on traffic accidents, after the local ban 1568
• To coordinate efforts between: National Forensic Institute, Peruvian National Police, Direction
of Epidemiology, Health of Person MINSA,DEVIDA, and Gerencial Structures of the
Metropolitan City Hall of Lima.
• To design interventions for different institutions that will contribute to our common goal.
15

16. First week and injuries due to traffic accidents in three hospitals
by day and hour of occurrence in Metropolitan Lima
24
14 15 15 14
11 10
7 8
5 6
11 4
Domingo Lunes Martes Miércoles Jueves Viernes Sábado
Antes Después
40
31
4 5 5
2 2 3 3 2
0 0 1 1 0 1
00:00 - 02:59 03:00 - 05:59 06:00 - 08:59 09:00 - 11:59 12:00 - 14:59 15:00 - 17:59 18:00 - 20:59 21:00 - 23:59
Antes Después
Source: DGE 16

17. Deaths in traffic accidents by day of the week
Dec-2010 vs Dec-2011
Source: IML
17

18. Behavior of violent deaths, one year after
• Reduction on Deaths by traffic accidents and homicides by 11%,
• Reduction on death bodies with alcohol of traffic accidents of 28.5% and in homicides of
19%.
• The reduction occurs all days of the week except on Fridays.
• The reduction occurs at all hours of the day, but specially by 00:00 and 02:59 am
Deaths by External Cause lesion with or without alcohol in their bodies
Dec-10 to Nov-12
Dec-10 to Nov-11 Dec-11 to Nov-12
Death cause Alcohol Alcohol
N° of cases % N° of cases %
Positives Positives
Homicide 344 105 31 307 86 28
Traffic Accidents 480 130 27 427 93 22
Suicides 271 42 15 265 53 20
Total 1 095 277 25 999 232 23
Source: IML - Lima Metropolitana. 2011 - 2012
18

19. District of occurrence injuries by traffic accidents The injuries by
traffic have
2011 vs 2012 decreased by 43%.
Districts 2011 2012 Districts 2011 2012
Ancon 66 55 Pueblo Libre 119 0
Ate 1782 720 Puente Piedra 901 667
Barranco 162 13 Punta Hermosa 1 0
Breda 101 0 Punta Negra 2 1
Breña 0 80 Rimac 307 165
Carabayllo 321 331 San Bartolo 7 0
Chaclacayo 13 22 San Borja 83 19
Chorrillos 344 53 44 14
San Isidro
Cieneguilla 0 1 1 0
San Juan de
Comas 796 865
San Juan de Luri 76 41
El Agustino 75 46
San Juan de Mira 216 26
Independencia 160 93
San Luis 84 51
Jesus Maria 79 55
San Martin de P 0 298
La Molina 33 29
San Martin de Po 1149 110
La Victoria 568 400
Lima 918 786 San Miguel 73 98
Lince 67 48 Santa Anita 43 21
Los Olivos 278 211 Santa Rosa 5 1
Lurigancho 101 48 Santiago de 1 1
Lurin 15 1 Santiago de Surc 469 177
Magdalena del M 1 0 Surquillo 182 22
Magdalena del Ma 35 65 Villa el Sa 47 35
Magdalena Vieja 0 93 Villa el Salvado 79 22
Miraflores 333 22 Villa Maria 15 2
Pachacamac 6 4 Villa Maria del 127 32
Pucusana 9 0 (en blanco) 26 1
Source: DGE 2013 Total general 10320 5845 i 19

20. Relationship between the sales of liquors measured on fraction
of day and traffic accidents deaths in Metropolitan Lima
Dec-2010 Aug-2011 Dec-2011 Aug-2012
20

21. Deaths by traffic accidents
Dec-2010 to Nov-2011 against Dec-2011 to Nov-2012
• Reduction on Deaths by traffic accidents of 11.04%.
• Reduction in both sexes, and in all ages with the exception of the older than 50 years.
• Reduction of alcoholized bodies in males of 27%.
• Reduction occurs mainly in Bachelors.
• The largest increase comes from Puente Piedra and Comas.
• Reduction occurs all the days of the week, excepted on Fridays.
21

22. Deaths by traffic accidents by sex and age
Dec-2010 to Nov-2012
Sex
Deaths in traffic accidents 2011 2012 Variation (%)
Male 357 313 -12.32
Female 123 114 -7.32
Total 480 427 -11.04
Age
Deaths in traffic accidents 2011 2012 Variation (%)
0-9 32 21 -34.38
10-24 54 45 -16.67
25 - 49 183 131 -28.42
+ 50 211 230 9.00
Total 480 427 -11.04
Source: IML - Lima Metropolitana, Period 2011 - 2012
22

23. Alcoholized bodies that came from traffic accidents
Dec-2010 to Nov-2012
Deaths in traffic accidents 2011 2012 Variation (%)
With alcohol 130 93 -28.46
Whitout alcohol 350 334 -4.57
Total 480 427 -11.04
Male
Male Deaths in traffic accidents 2011 2012 Variation (%)
With alcohol 121 88 -27.27
Without alcohol 236 225 -4.66
Total 357 313 -12.32
Source: IML - Lima Metropolitana, Period 2011 - 2012
23

24. Deaths by traffic accidents by day of the week
Dec-10 to Nov-12
80
70
60
50
40
30
20
10
0
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
2011 70 56 30 43 56 38 63
2012 56 45 29 39 43 43 38
Source: IML - Lima Metropolitana, Period 2011 - 2012
24

26. Occurrence of violent deaths
Dec-2010, Dec-2011 and Dec-2012
Dec-10 Dec-11 Dec-12
Death cause
Alcohol Alcohol Alcohol
N° of cases % N° of cases % N° of cases %
Positives Positives Positives
Homicide 33 9 27% 30 7 23% 21 6 29%
Traffic Accidents 60 17 28% 32 10 31% 30 9 30%
Suicide 31 10 32% 19 5 26% 28 7 25%
Total 124 36 29% 81 22 27% 79 22 28%
Source: IML - Lima Metropolitana, Dec-2011 to Dec-2012
26

27. Saving in health in one year
Cost per Medical
Kind of Intervention n %
Attention
Hospitalized 94 2.1% $2,277.00 $214,038.00
Emergency 4328 97.9% $62.00 $268,336.00
Total 4422 100% - $482,374.00
Deaths 53 1.2% $514.00 $27,242.00
Total 4475 100% - $509,616.00
Note
According to Bambaren on 2003, in Lima, the unit cost of:
• An emergency, is US$ 62.00.
• An hospitalized ,is US$ 2 277.00.
• A death, is US$ 514.00.
Being a total of 2.1% injuries, that require hospitalization.
27

28. Local Ban 1568 Secure Hour
Conclusions
• Is possible that the ban has had an effect in the diminished of the deaths by traffic
accidents, specially on those that were occasioned by alcohol. The main diminish came from
the alcoholized death.
• The ban has possible diminished the deaths by traffic accidents in all days of the week, except
Friday, This was possible due to the fact ,that the ban permit the sale of liquors on the night of
the Thursday until 03:00am of Friday , and by this reason there has not been a cultural change.
• The initial effect of December 2011 and January 2012,was not sustained for the hole
year, possible due to the initial display of announcements.
28

29. Amigos de la ley zanahoria
http://www.facebook.com/home.php?sk=group_176654789042977&ap=1
https://www.facebook.com/ley.zanahoria?fref=ts
References
• Málaga, H. - Horarios de venta de bebidas alcohólicas y su efecto en Violencia.
Editorial Académica Española. LAP LAMBERT Academic Publishing GmbH&Co.KG.
Saarbrücken, Alemania 2012.
• Malaga,H.; Gonzalez, M.; Huaco, C.; Sotelo, M. (2012) - The Relation between the
Number of Hours That Authorize the Sale of Alcoholic Beverages and Violence.
Health Promotion Perspectives, Vol. 2, No.1; P: 60-71
• Cisneros G; Bambaren, C. Málaga H, González M. Lesiones de Causa Externa en el
Municipio de San Martín de Porres. Lima-Perú. 9a Conferencia Mundial sobre
prevención de lesiones y promoción de la seguridad; 2008 Marzo 15-18; Mérida,
México; 2008.
29