The results found by Andreuccetti and colleagues  bring to light the need of an evidence-based debate on drink and drive policy and law enforcement in Brazil and other low- and middle-income countries. It is indeed ‘a time for change’, as the authors claimed; however, this change cannot target only BAC (blood alcohol concentration).
Policy makers had already shown interest in tackling this issue in 1998, when the Brazilian traffic code was reviewed and established drinking and driving as a traffic crime, leading to more severe penalties. Even though the population favoured the change , this initial move failed to provoke improvements in public attitude or behaviour, due most probably to the complete lack of enforcement put into place at the time [2,3]. According to the first Brazilian national survey on patterns of alcohol consumption conducted between 2005/06 before the second change in the legislation, only 40% of drivers were ever stopped in road-check operations in their lives. One-third of those participants drove after drinking any amount of alcohol , and more than 60% had driven at least three times in the last year after having more than 3 units of alcohol.
The radical change in BAC limit enacted in 2008 was somewhat unexpected by the population and specialists alike, as there was no notable public debate on the subject or appropriate media coverage until the law was actually approved. None the less, once the law was endorsed the public was exposed to large media campaigns as well as active enforcement in most states. The data shown in Andreuccetti's study confirm the positive results of this change in São Paulo.
It is tempting to attribute results uniquely to the BAC decrease. Andreuccetti's study takes state versus capital as a proxy for differences in law enforcement, but one must take into account that in an immense country such as Brazil, the variability between states is huge and the enforcement in São Paulo was probably among the highest. It is true that, along with this change, a remarkable increase in enforcement (as never seen in the country before) was adopted all over the country, if only temporarily. Therefore, it seems that stronger law enforcement and media coverage during the period surrounding the change in legislation was an important mediating factor for the causal relation between lowering the BAC limit and reduced traffic fatalities.
The Brazilian Health Department performed a telephone survey in 2009, and found that in cities where enforcement was steadily maintained during the 2 years following the change in legislation the reduction in traffic fatalities was sustained (i.e. Rio de Janeiro) . However, in 2011 the public perception is that such change was only temporary in most states, as enforcement only lasted as long as the subject was discussed on the media.
Further, São Paulo is a growing ‘mega-city’ with increasing mobility problems, as public services are not expanding sufficiently rapidly. The combination of poor public transport and overpriced taxi services must be taken into consideration as underlying factors in preventing attitude changes and public awareness regarding drink and driving. Easy and unrestricted access to alcoholic beverages, plus the lack of specific policies limiting its sale (i.e. a licence is not required to sell alcohol in the country), must also be pointed out as obstacles for long-term improvements [6,7].
Finally, to achieve long-term results concerning traffic injuries and fatalities in Brazil it is fundamental that the government steps up to the task of expanding the law enforcement. The endorsement of road checks as routine in the traffic police practice is essential. In addition, improvements of public transport and search for affordable alternatives in transportation are also crucial to allow the change in attitudes regarding drinking and driving.