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Alcohol Use and Aquatic Activities -- Massachusetts, 1988

More than 8000 drowning fatalities occur in the United States each year, making drowning the third most common cause of death from unintentional injury in the United States (1,2). Although 25%-50% of adult and adolescent drowning victims had consumed alcohol near the time of death (3), information regarding drinking behaviors during aquatic activities is limited. In September 1988, the Boston University School of Public Health surveyed Massachusetts adults aged greater than or equal to 20 years to determine in what settings and how often they consumed alcoholic beverages on or near the water during their most recent aquatic activity in August 1988.

A statewide probability sample was conducted through a random-digit-dialing procedure (4). Of 306 adults called, 294 (96%) participated in the survey. A total of 221 (75%; 107 (79%) men, 114 (72%) women) respondents reported a mean of 13 days of aquatic activities during August 1988. The most frequently reported aquatic activity was swimming (169 (76%)), followed by boating (55 (25%)), and fishing from shore (31 (14%)). The most frequently reported site of activity was the ocean (120 (54%)), followed by lakes or ponds (57 (26%)), pools (38 (17%)), rivers (five (2%)), and other settings (1 ( less than 1%)).

Of persons reporting aquatic activities, 38 (36%) men and 13 (11%) women reported that they had consumed alcohol on the last occasion. Among alcohol users, 15 (29%) reported having consumed greater than or equal to 4 drinks from 2 hours before until completion of the activity. Men who drank reported consuming more (mean: 3.5 drinks) than women (mean: 2.4 drinks) in an aquatic setting. The proportion of drinking did not vary substantially by location or activity. Respondents aged greater than or equal to 50 years were less likely than younger respondents to report drinking on the last occasion on or near the water (Table 1). Reported by: J Howland, PhD, R Hingson, ScD, S Levenson, MPH, M Winter, Boston Univ School of Public Health; T Mangione, PhD, Center for Survey Research, Univ of Massachusetts at Boston. Unintentional Injuries Section, Epidemiology Br, Div of Injury Control, Center for Environmental Health and Injury Control, CDC.

Editorial Note

Editorial Note: The relationship between alcohol use and water recreation fatalities has been documented in a variety of settings (1,5,6). For example, the National Transportation Safety Board estimated that alcohol use was associated with 32%-64% of recreational boating deaths in 1983 (7,8). In a North Carolina study of drownings from 1980 through 1984, 399 (46%) of 869 drowning victims greater than or equal to 15 years of age tested positive for blood alcohol, and 286 (33%) had blood alcohol concentrations (BACs) of greater than 0.1 g divided by L (1).

The ratio of male-to-female drowning rates in the United States is approximately 12:1 for drownings associated with boating and approximately 5:1 for other drownings (9); the gender difference in drowning rates does not change with age (10-12). The Massachusetts data suggest that differences by sex in aquatic-activity-related morbidity and mortality may be associated with differences in behaviors (e.g., use of alcohol, use of personal flotation devices, and participation in different types of water activities (13)) rather than exposure to aquatic environments. Men are more likely than women to drink alcohol on or near the water.

In the United States, more than 50 million persons engage in various recreational (noncommercial) boating activities on at least 8 days per year (5,6), and 90% of all deaths from recreational boating result from drowning. The prevalence of alcohol use during aquatic activities in Massachusetts was high when compared with the estimated prevalence of alcohol exposure among weekend nighttime drivers, who have the highest overall estimate known among U.S. drivers (8.3% of a 1983 U.S. driver sample had BACs of greater than or equal to 0.1 g divided by L) (2). This information suggests the need to 1) strengthen education about the risks of drowning in all aquatic environments and 2) clarify the relationship between alcohol use, drowning, and other water recreation injuries.


  1. Patetta MJ, Biddinger PW. Characteristics of drowning deaths

in North Carolina. Public Health Rep 1988;103:406-11.

2. Brooks JG. Near drowning. Pediatr Rev 1988;10:5-10. 3. Howland J, Hingson R. Alcohol as a risk factor for drowning: a review of the literature (1950-1985). Accid Anal Prev 1988;20:19-25.

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

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

6. Smith GS, Kraus JF. Alcohol and residential, recreational and occupational injuries: a review of the epidemiologic evidence. Annu Rev Public Health 1988;9:99-121.

7. Wright SJ. SOS: alcohol, drugs and boating. Alcohol Health and Research World 1985;9:28-33.

8. National Transportation Safety Board. Safety study: recreational boating safety and alcohol. Washington, DC: National Transportation Safety Board, 1983; publication no. NTSB no. SS-83-02.

9. Baker SP, O'Neill B, Karpf RS. The injury fact book. Lexington, Massachusetts: DC Heath and Co, 1984:156. 10. O'Carroll PW, Alkon E, Weiss B. Drowning mortality in Los Angeles County, 1976 to 1984. JAMA 1988;260:380-3. 11. Quan L, Gore EJ, Wentz K, Allen J, Novack AH. Ten-year study of pediatric drownings and near-drownings in King County, Washington: lessons in injury prevention. Pediatrics 1989;83:1035-40. 12. Wintemute GJ, Kraus JF, Teret SP, Wright MA. The epidemiology of drownings in adulthood: implications for prevention. Am J Prev Med 1988;4:343-8. 13. Gulaid JA, Sattin RW. Drownings in the United States, 1978-1984. In: Public health surveillance of 1990 injury control objectives for the nation. MMWR 1988;37(no. SS-1):27-33.

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