Alcohol Use and Aquatic Activities -- United States, 1991

Drowning, a leading cause of death from unintentional injury in the United States, accounted for approximately 4600 fatalities in 1991 (1,2). Although 25%-50% of adolescents and adults who drowned had consumed alcohol near the time of death (3), information regarding drinking behaviors during aquatic activities is limited. To assist in refining strategies for prevention of alcohol-related injury in aquatic settings, during July 15- September 30, 1991, the Boston University School of Public Health surveyed a national sample of adolescents and adults regarding their participation in aquatic activities and associated alcohol use. This report summarizes these findings.

The two-stage Waksberg random-digit-dialing telephone procedure was used to obtain a probability sample of working residential telephone numbers in the continental United States (4,5). One randomly designated respondent aged greater than or equal to 16 years was selected from each household. Of 3042 households contacted, 2706 persons (89%; 1255 {46%} men; 1451 {54%} women) reported participation in at least one activity on or near the water during the year preceding the interview and participated in the survey. Respondents were aged 16-94 years (mean: 42 years; median: 39 years). The standard error does not exceed plus or minus 2% for any given point estimate in this study. The most frequently reported aquatic activities were swimming (75%) and boating (72%).

Respondents were asked about alcohol use during participation in aquatic activities during the year preceding the interview. Of the 2706 respondents, 1889 (70%; 926 {74%} males; 963 {66%} females) reported alcohol use, and 817 (30%) abstained. Of the 1889 alcohol users, 1156 (61%; 656 {52%} males; 500 {34%} females) had consumed alcohol on at least one occasion while participating in an aquatic activity. The likelihood of having consumed alcohol varied by type of aquatic activity: of 2031 swimmers and 1943 boaters, 487 (24%) and 630 (32%), respectively, reported having used alcohol during those activities during the preceding year.

Respondents who participated in an aquatic activity during the 30 days preceding the interview (n=1877) were asked about associated alcohol use during their last day on or near the water. Of the 1877 respondents, 522 (28%) reported consuming alcohol during their last day of water recreation: 366 (70%) drank beer; 112 (21%), wine; 82 (16%), liquor; and 16 (3%), some other alcoholic beverage. Men who drank reported consuming more (mean: 4.5 alcoholic beverages) than did women (mean: 2.9 alcoholic beverages) on this occasion (p less than 0.0001) (Figure_1).

Of respondents who reported ever consuming alcohol during their lifetimes during aquatic activities (n=1183), 108 (9%) reported that they always or often drank on these occasions, 426 (36%) that they sometimes drank; and 649 (55%) that they rarely drank during aquatic activities. Two percent reported that alcohol consumption substantially increased their enjoyment of being on or near the water; 18%, "somewhat;" 23%, "a little;" and 56% reported that alcohol did not increase their enjoyment of being on or near the water.

Of the 3042 respondents, 2213 (73%) recalled at least one exposure to information (i.e., hearing or reading) about the risks of drinking during aquatic activities. A total of 2889 (95%) respondents strongly or somewhat favored laws for their own states that prohibit operation of recreational and commercial water vessels while intoxicated. In comparison, 34% and 42% of all respondents and respondents who had participated in boating, respectively, had knowledge of the 1984 legislation amending Title 46, United States Code, Chapter 23 (Operation of Vessels Generally), to include specific prohibitions regarding the operation of a vessel while intoxicated. Reported by: J Howland, PhD, R Hingson, ScD, T Heeren, PhD, S Bak, MPH, Boston Univ School of Public Health; T Mangione, PhD, JSI Research and Training Institute. Epidemiology Br, National Center for Injury Prevention and Control, CDC.

Editorial Note

Editorial Note: The determination that alcohol use is a risk factor for water-recreation-related fatalities is well documented (6,7). Alcohol use is a risk factor for injury and death in aquatic settings for a variety of reasons. For example, alcohol can reduce body temperature and, through its effect on the central nervous system, can impair swimming ability (3). In the national study described in this report, one third of boaters reported consuming alcohol while boating -- a finding similar to one reported in the 1989 American Red Cross National Boating Survey (8), in which 29% of all boaters reported consuming alcohol during a typical boat outing. Because alcohol affects balance, movement, and vision, its use represents a risk for injury and death for boat operators and passengers, who can fall overboard while intoxicated (3,9).

The male-to-female ratio of drowning rates in the United States is approximately 14:1 for drownings associated with boating and 5:1 for other drownings (1). Alcohol use contributes largely to the sex differential in annual drowning rates. In the findings in this report, half of men and one third of women reported alcohol use during aquatic activities, and men reported consuming significantly more alcohol than did women, suggesting that sex differences in drowning may be related to differences in alcohol use and consumption.

More than half of all respondents reported that drinking did not increase their enjoyment of aquatic activities, and nearly all favored legislation that prohibits alcohol use in aquatic settings. These findings should assist in planning or refining strategies for prevention of alcohol-related injury in aquatic settings. In addition, only one third of respondents were aware of federal laws prohibiting the operation of a recreational boat while under the influence of alcohol, suggesting that alcohol advertisements involving aquatic settings may contribute to misconceptions about the safety and legality of combining alcohol use with swimming and boating (1).

Possible strategies for the prevention of alcohol-related aquatic injuries include 1) public service announcements by federal and state government agencies and community-based organizations warning about the dangers of combining alcohol use with water recreation: such messages should be tailored to swimming and boating; 2) elimination of advertisements that encourage the use of alcohol during boating activities; 3) restriction of sale of alcoholic beverages at aquatic facilities; and 4) passage and enforcement of federal and state legislation restricting water-recreation activities during alcohol consumption.

References

1. Baker SP, O'Neill B, Ginsburg MJ, Li G. The injury fact book. 2nd ed. New York: Oxford University Press, 1992.

2. National Safety Council. Accident facts. 1992 ed. Itasca, Illinois: National Safety Council, 1992.

3. Howland J, Hingson R. Alcohol as a risk factor for drowning: a review of the literature (1950-1985). Accid Anal Prev 1988;20:19-

5. CDC. Alcohol use and aquatic activities -- Massachusetts, 1988. MMWR 1990;39:332-4.

6. Waksberg J. Sampling methods for random digit dialing. J Am Stat Assoc 1978;73:40-6.

7. Howland J, Mangione T, Hingson R, Levenson S, Winter M. A pilot survey of aquatic activities and related consumption of alcohol, with implications for drowning. Public Health Rep 1990;105:415-9.

8. CDC. Recreational boating fatalities -- Ohio, 1983-1986. MMWR 1987;36:321-4.

9. American Red Cross. American Red Cross National Boating Survey: a study of recreational boats, boaters, and accidents in the United States. Washington, DC: American Red Cross, 1991.

10. Howland J, Smith GS, Mangione T, Hingson R, DeJong W, Bell N. Missing the boat on drinking and boating. JAMA 1993;270:91-2.

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