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A Population-Based Case-Control Study

Gordon S. Smith, MB, ChB, MPH; Penelope M. Keyl, MSc, PhD; Jeffrey A. Hadley, PhD; Christopher L. Bartley, MA; Robert D. Foss, PhD; William G. Tolbert, MA; James McKnight, PhD

JAMA. 2001;286:2974-2980.

Context  Alcohol is increasingly recognized as a factor in many boating fatalities, but the association between alcohol consumption and mortality among boaters has not been well quantified.

Objectives  To determine the association of alcohol use with passengers' and operators' estimated relative risk (RR) of dying while boating.

Design, Setting, and Participants  Case-control study of recreational boating deaths among persons aged 18 years or older from 1990-1998 in Maryland and North Carolina (n = 221), compared with control interviews obtained from a multistage probability sample of boaters in each state from 1997-1999 (n = 3943).

Main Outcome Measure  Estimated RR of fatality associated with different levels of blood alcohol concentration (BAC) among boaters.

Results  Compared with the referent of a BAC of 0, the estimated RR of death increased even with a BAC of 10 mg/dL (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.2-1.4). The OR was 52.4 (95% CI, 25.9-106.1) at a BAC of 250 mg/dL. The estimated RR associated with alcohol use was similar for passengers and operators and did not vary by boat type or whether the boat was moving or stationary.

Conclusions  Drinking increases the RR of dying while boating, which becomes apparent at low levels of BAC and increases as BAC increases. Prevention efforts targeted only at those operating a boat are ignoring many boaters at high risk. Countermeasures that reduce drinking by all boat occupants are therefore more likely to effectively reduce boating fatalities.

Author Affiliations: Johns Hopkins Center for Injury Research and Policy, Baltimore, Md (Drs Smith, Keyl, and Hadley); Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore (Drs Smith and Keyl); Highway Safety Research Center, University of North Carolina at Chapel Hill (Dr Foss and Messrs Bartley and Tolbert); Pacific Institute for Research and Evaluation, Rockville, Md (Dr McKnight). Mr Tolbert is now at Rho Inc, Chapel Hill, NC. Dr Smith is now also at the Center for Safety Research, Liberty Mutual Research Center for Safety and Health, Hopkinton, Mass.

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