Drowning Interventions

Decreased Alcohol Use/Intoxication Programs

Alcohol use is commonly associated with a boating and a variety of water related activities (ref 1 & 2). Among adolescents, alcohol use around large bodies of water has been found to be associated with as many as half of all drowning incidents (ref 3 & 4).

We found two articles, which evaluated the effect of alcohol legislation on drowning deaths. New references: (1) Howland J, Hingson R, Heeren T, et al. Alcohol use in aquatic settings-United States, 1991. Morb Mortal Wkly Rep, 1993; 42, 657-83. (2) Howland J, Mangione T, Hingson R, et al. Alcohol as a risk factor for drowning and other aquatic injuries. Alcohol and drug abuse review: alcohol and accidents, Watson RR ed., Totowa, NJ: Humana Press, 1995. (3) Howland J, Hingson R. Alcohol as a risk factor for drownings: a review of the literature. Accid Anal Prev, 1988; 20, 19-25. (4) Howland J, Mangione T, Beel N, et al. Why are most drowning victims men? Sex differences in aquatic skills and behaviors. Am J Public Health, 1996; 86, 93-96.


Review of Decreased Alcohol Use/Intoxication Programs:
 

Author

Howland et al., 1998

Study design and target population

Ecological time trend study; United States Adolescents 18-20; younger adolescents 15-17; and young adults 21-23

Intervention

Minimum legal drinking age laws (MLDA) 1970-1990. 3 time periods analyzed: (1970-77, 1978-90, & 1970-90)

Outcomes

Drownings per state per year in 3 age groups. Data from National Health Statistics Mortality files.

Results

No significant association between MLDA and drowning for any of the 3 age groups in any time period.

Analysis: Poisson maximum likelihood regression, fixed effect model.

Controlled for urbanicity, unemployment, poverty, education, divorce, proxy measures for enforcement and cross border alcohol purchases.

Study quality and conclusions

Carefully analyzed ecological study. Strong secular trend, 51% decrease in rates per 100,000.

Authors concluded that MLDA laws are not an important public policy strategy and suggest that increasing urbanization has reduced unsupervised exposure.



Author

Lunetta P, 1998

Study design and target population

Ecological time series; Finland, 1969-1995; 7 age groups, <1, 1-4, 5-14, 15-24, 25-44, 45-65, >or=65.

Intervention

Legislation BAC for boat operators 1.5% (1976) and 1.0% (1994).

Outcomes

Age and sex specific rates and trends in water-transport accidents (WTA) & alcohol related deaths.

Data from Central Statistical Office; alcohol data available 1987-95.

Results

WTA deaths 2.7/100,000 per year. 60% of WTA drownings are alcohol related.

WTA related deaths & deaths associated with alcohol declined significantly (-4% & -6% per year).

Secular decline for all water related deaths. 97% of victims are 15 or older, M:F RR (20.4:1). PFD use 3.5% among drowning victims.

Study quality and conclusions

Authors feel legislation & prevention campaigns reduced alcohol use in all aquatic settings.

Reduction of legal BAC limits inadequate. Rec campaign aimed at operators & passengers combined with increase PFD use.

Summary of alcohol legislation studies

The Howland study found no relation between MLDA laws and all drownings. The Finnish study found a significant decrease in alcohol-related drownings as well as all drownings.

Recommendations on effectiveness of alcohol legislation

Evidence from these two studies is inclusive. In both the United States and Finland there was strong secular trend in declining drowning rates over the 20-year period covered by the two studies. In the United States drowning rates decreased 51% from 3.9 to 1.9 per 100,000. A 21 year longitudinal study of drowning in Washington State found a larger decrease in drowning deaths attributable to alcohol use, 81% (95%CI, -91% to -57%) compared to an overall decline in drowning deaths of 59% (95%CI, -70% to -46%) Cummings P & Quan L, 1999. This suggests a decrease in submersion episodes possibly due to a reduction in alcohol use around water.

Recommendations for future research

Evaluation of a multifaceted education campaign aimed at boat drivers and passengers designed to deter drinking and boating. The campaign should target teens and young adults, the group at greatest risk. Outcome measures should include alcohol-related drownings. Given that boating incidents might serve a useful proxy for drowning, the possible association of alcohol and boating accidents should also be examined.