Alcohol Use by Rhode Island Recreational Boaters

There are over thirteen million recreational boats registered in the United States. Given alcohol's association with injury,2,3 it is hypothesized that alcohol use increases the risk of recreational boating accidents. Although boating under the influence of alcohol is illegal, many boaters are unaware of the potential negative effects of alcohol and the legal ramifications of alcohol use and boating. Previous research, as well as the laws concerning boating and alcohol, have focused mainly on boat operators. Taking into account the physiologic and psychological effects of alcohol, and considering that all onboard persons must navigate on a moving surface that is frequently wet and slippery it can be theorized that any passenger using even small amounts of alcohol is at independent risk of injury.5-7

This project was conducted to determine the use of alcohol by both recreational boat operators and passengers in the Rhode Island boating community.

METHODS

A database of registered Rhode Island boat owners was obtained from the Rhode Island Department of Environmental Management. One thousand registered boat owners (out of a total of 36,833) were randomly selected and were mailed a survey questioning the boat owner about boating use, alcohol use (quantity/frequency questions) while boating, and passengers' alcohol use (quantity/frequency questions) while boating. In an attempt to maximize recall accuracy, the questions regarding alcohol use addressed their behavior during the month just before they received the survey (July, 2000).

To increase compliance, an incentive (a coupon for a free ice cream cone) and a stamped addressed return envelope accompanied the survey. The survey packet also contained a stamped return addressed postcard. Participants were asked to send back the coded postcard separately documenting completion of the survey or opting out of the study. Mailing the survey answers separately insured the confidentiality of responders. Those who did not return the postcard in thirty days were sent another survey packet. Participants not responding to the first or second mailing were sent another survey packet thirty days after the second mailing. No incentives were included in the second or third mailings. Our institutional review board approved the research protocol.

Four hundred and seventy three surveys were returned with data that could be analyzed; 173 surveys were returned without usable data. This included 19 respondents refusing participation, 44 respondents classifying themselves as no longer recreational boat owners, 106 surveys returned undeliverable marked "no forwarding address", and 4 surveys returned marked that the boat owner was deceased. The final response rate was calculated to be 56% (473/846).

RESULTS

Respondents were mostly male (88%), with an average age of 51 years. (Table I) They reported that during the previous month they had used their boat on an average of 8.96 days. Most operated a powerboat (75.2%), and most reported more than 300 hours of boat-operating experience (69%). One third of the boat operators reported using alcohol while boating or within two hours of boating during the previous month and reported that almost half (46%) of their boating passengers drank alcohol while boating or just prior to boating. The amount of alcohol consumed by either operator or passenger was usually one or two drinks per occasion, but a small subset drank significantly larger amounts. (Table II) As the age of the respondents increased, the number of drinks by the boat operator decreased (p = 0.004) and the frequency of drinking decreased (p = 0.03). Those with more total boating experience drank more frequently (p = 0.04). In examining boat operators' drinking behaviors with those of boat passengers we found a positive correlation (p

DISCUSSION

All fifty states have laws regarding operating a boat while under the influence of alcohol. Federal regulations set a blood alcohol limit standard for recreational boaters of 100 mg/dl. Several states have stricter limits (generally 70-80 mg/dl), as well a behavioral standard. At the time of this project, Rhode Island law was 100 mg/dl; however, subsequent legislation has lowered it to 80 mg/dl. But the laws of alcohol use while boating are not well known to boaters. According to a survey of registered boaters in Massachusetts, "only 20% knew that an intoxicated boater was subject to a fine of up to $5000 and one year in jail, while 45% thought there was no federal boating and alcohol law."4

This study indicates that one third of boat operators who responded to the survey drank alcohol while boating or within two hours of boating. This rate of alcohol use while boating is consistent with previous research in other locals.8,9 These rates have consistently remained high. A subgroup of drinkers consumes large amounts of alcohol while operating a boat. If a third of motor vehicle operators were drinking alcohol while driving it would enlist more education and enforcement activities than are presently utilized for alcohol use while boating.

The risk of harm from alcohol use while operating a boat is most likely found at low levels of alcohol use as well. Research done with maritime cadets with low levels of alcohol (blood alcohol concentration (BAC) 40-50 mg/dl or about half of the current RI law) using a simulated ship emergency scenario and piloting of a commercial ship showed decreased performance.5,7 Therefore educational efforts aimed at boat operators must also focus on the effects of any alcohol use not only excessive use.

This study also found that almost half of the passengers drank alcohol while boating or just prior to boating. Smith 6 has reported that the increased risk of fatal injury is the same for both boat operators and passengers if they had been drinking alcohol. This increased relative risk of fatal injury while boating "becomes apparent at low levels of BAC and increases as BAC increases."6 Others 7 have also suggested that that the "designated driver" analogy used between alcohol use while boating and alcohol use while driving a motor vehicle does not hold since passengers are still at significant risk of drowning. For example, the physiological effects of alcohol would be the same for both operators and passengers that would put them at increased risk for both falls overboard and subsequent drowning. Certainly there is a need for increased education about the dangers of alcohol use while boating and an increase in the enforcement of existing laws prohibiting intoxication by boat operators. Focusing only on boat operators' use of alcohol places passengers at continued risk. This study points to subgroups of boaters who are most at risk. For example, since our data show that older boaters drank alcohol less often and consumed less amounts when drinking than younger boaters, interventions should be targeted at younger boaters.

Our study was limited in that it was based on a self-administered questionnaire. Respondents had to read English, follow the survey directions, and recall events that occurred one day to three months earlier. Despite our assurance of confidentiality, respondents may have been reluctant to admit to illegal use of alcohol while boating in fear of legal reprimand. However, since we hypothesize that this would lead to an underestimation of alcohol use it would not adversely effect our conclusions.

Alcohol continues to be widely used by boat operators and their passengers. This continuing problem requires more intensified interventions that are directed at both boat operators and passengers.

REFERENCES

1. Carter E, Moore C, Sarver R. National Association of State Boating Law Administrators' Law Enforcement Reference Guide to State Boating Laws-Sixth Edition. National Association of State Boating Law Adminlstrators, Lexington, KY, 2000.

2. Cherpital CJ. Alcohol and injuries: A review of international emergency room studies. Addiction 1993;88:651-65.

3. Becker B, Woolard R, Nirenberg T, et al. Alcohol use among sub-critically injured emergency department patients. Acad Emerg Med 1995; 2: 784-90.

4. Howland J, Mangione T, Minsky S. Perceptions of risks of drinking and boating among Massachusetts boaters. Public Health Reports 1996; 111: 372-77.

5. Howland J, Rohsenow DJ, Cote J, et al. Effects of low-dose alcohol exposure on simulated merchant ship piloting by maritime cadets. Accid Anal Prev 2001;33:257-65.

6. Smith GS, Keyl PM, Hadley JA, et al. Drinking and recreational boating fatalities. JAMA 2001; 286:2974-80.

7. Howland J, Rohsenow DJ, Cote J, et al. Effects of low-dose alcohol exposure on simulated merchant ship handling power plant operation. Addiction 2000 May;95:719-26.

8. Logan P, Sacks J, Branche C, et al. Alcohol-influenced recreational boat operation in the United States, 1994. Am J Prev Med 1999; 16:278-82.

9. CDC. Alcohol use and aquatic activities-Massachusetts, 1988. MMWR 1990; 39; 320-34.

10. Howland J, Smith G, Mangione, T, et al. Missing the boat on drinking and boating. JAMA 1993;270:91-2.

Michael J. Mello, MD, MPH, and Ted D. Nirenberg, PhD

Michael J. Mello M.D., M.P.H, is Director, Injury Prevention Center, Rhode Island Hospital, and Clinical Assistant Professor, Medicine, Brown Medical School.

Ted D. Nirenberg, PhD, is Co-Director, Injury Prevention Center, Rhode Island Hospital, and Associate Professor of Psychiatry and Human Behavior, Brown Medical School.

CORRESPONDENCE:

Michael J. Mello, MD, MPH

Injury Prevention Center

Rhode Island Hospital, 110 Lockwood Street, POB-Suite 334

Providence, RI 02903

Phone: (401) 444-2685

Fax: (401) 444-2249

E-mail: mjmello@lifespan.org

Copyright Rhode Island Medical Society Jan 2004
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