Background Especially in middle-income countries, crash intervention and burden analyses/policymaking often rely on assumptions supported by data from the United States (US).

Objective Using survey data, to compare driver behavior and crash characteristics in the US, Belgium, Brazil, China, Mexico, and South Africa.

Data Sources In each country, we conducted face-to-face interviews with the same highway safety questions (translated into six languages) using stratified samples of 1300 to 6000 adult respondents spread across two mid-sized cities, except the US survey was by mail. The survey primarily focused on alcohol consumption patterns. Survey dates: 2018/19 or 2023.

Methods Survey data weighted to match local censuses. Differences between countries assessed with Fishers exact test, t-tests, logit regression.

Results Driving without a license was rare except in Mexico (30%) and a Brasilia exurb (26%). Among those who drove, self-reported alcohol-impaired driving rates were: 15% Belgium, 20% Brazil, 5% China, 9% Mexico, 20% South Africa, 14% US. The percentage of those who drove drunk in the past year who police stopped for drunk driving varied widely: 53% Belgium, 21% Brazil, 60% China and Mexico, 93% South Africa, 3% (sic) in the US. Drivers passing through a sobriety checkpoint were: 27% Belgium, 53% Brazil and China, 38% Mexico, 5% US. Use of an app or social media to avoid police when driving after drinking was most common in Brazil (17% of drivers) and South Africa (13%), lowest in the US (1%). The percentage of respondents riding with someone they thought was intoxicated in the past year was: 26% Belgium, 9% China. 18%-19% Brazil and Mexico, 12% US.

Crash data were not collected in South Africa. The surveys yielded data on 380 crashes. Police crash reporting rates were: 56% Brazil , 69% US, 61%-63% elsewhere. The percentage of crashes involving death or injury was: 16% US, 24% Mexico, 31%-34% elsewhere. Perceived crash alcohol involvement rates were: 19% Belgium, 32% Brazil, 41% China, 57% Mexico, 13% US.

Conclusions US data are poor surrogates for driving parameters elsewhere, notably urban police crash reporting. US impaired driving enforcement is far worse than in these comparison countries.