Perspectives on Recreational Boating Safety Dr. L. Daniel Maxim NASBLA 2017 Annual Conference

The views presented here are those of the author and do not necessarily reflect those of the United States Coast Guard (USCG), United States Coast Guard Auxiliary (USCGAUX), the National Boating Safety Advisory Council (NBSAC), or the National Association of State Boating Law Administrators (NASBLA)

Presentation outline Background What we can learn from statistics Key issues: Lifejackets and BUI Closing thoughts

Photo credit U. S. Coast Guard. background Background

Boating is very popular according to 2012 NRBS estimates 27.3% or 32.3 million of the estimated 118.1 million U.S. households had at least one member who boated 73.4 million persons representing almost a quarter (23.8%) of the U.S. population participated in recreational boating--this includes 57.9 million adults and 15.6 million children 3.6 billion person-hours were spent on board recreational boats taken out on the water The full copy of the National Recreational Boating Survey is available at https://www.uscgboating.org/library/recreational-boating-servey/2012survey%20report.pdf.

Boating is relatively safe and getting safer Between 1960 and 2016 fatality rates per 100,000 registered boats fell from 33.4 to 5.9—an 82% decrease The boating fatality rate per exposure hour is comparable to that for automobiles and substantially lower than comparable rates for many other recreational activities (e.g., hang gliding, scuba diving, general aviation, snowmobiles)

Nonetheless The rate of improvement in fatality rates has slowed in recent years In 2016, there were: 4,463 accidents, 701 deaths, 2,903 injuries and ~ $49 million dollars of damage to property as a result of recreational boating accidents (accident and injury counts likely to be substantially understated) Most accidents are preventable Photo Source: http://missouriboataccidentlawyer.com/. 7

The challenges Broadly—what are the opportunities to make boating yet more safe? What are the major causes/contributing factors to boating fatalities? What intervention strategies are likely to prove successful? We know some of the answers

What can we learn from statistics?

Some core concepts Stress on evidence-based decision making (PHA) We have a good understanding of the first two steps We are struggling with the third and fourth steps Surveillance: Problem definition Identification of risk factors: What are the causes? Intervention Evaluation: What works? Implementation: Who does what? 10

Progress over the years Can we sustain progress? Compared to 1960 rates, we have saved over 120,000 lives, equivalent to the population of a mid-sized city. Nonetheless, the rate of improvement has slowed in recent years and is below the long term trend.

Boating fatalities by cause of death 2016 Drowning continues to account for the majority of fatalities

Drowning accounts for ~ 70% of boating fatalities in a typical year ~85% of victims were not wearing life jackets, QED

Open motorboats account for the largest share of drownings (2016)

Fatalities by boat length (2016) Fatalities and Drownings greatest on small boats Proportion of drownings greatest on boats < 16 ft.

Drownings as % of total fatalities by boat type (2016) Reason(s) why drowning % is lower for PWC?

Fatalities by accident type (2016) How many of these accident types can be predicted in advance?

Fatalities by education (where known) 2016 The ‘scale’ problem, gradually reduced over time as more boaters become subject to mandatory requirements

Non-powered craft accident trends 2005-2015 Is it just demographics?

Data 2010-2014 % fatal accidents by month Boating activity peaks in summer months, but % of fatal accidents higher in colder months—this is the basis for seasonal wear requirements in some states

Other relevant boating accident statistics Although most accidents occur during afternoon hours, the fraction of accidents with fatalities is greatest in late evening or early morning hours Most accidents occur during relatively benign weather conditions and on lakes ponds, reservoirs, rivers, and gravel pits Only 8% occur on the gulf, Great Lakes, or oceans

Illustrative fact Photo courtesy of U.S. Coast Guard. 75% of drownings occurred on waters with wave heights < 2 feet; 50% with wave heights < 6 inches 22

Implications Night boating presents greater risks (in part because reported alcohol prevalence is higher in these times) While boating in bad weather or offshore waters may present greater risks, boating in “benign” environmental conditions offers no guarantee of safety

Importance of human factors (2014 data) Proportions have not changed materially over the years

“Top ten” individual contributing factors 2014 Substance impairment is the leading factor in boating fatalities

“Take home” facts We have made good progress, but more remains to be done Drowning is the major cause of fatalities; 85% of victims not wearing life jackets Small boats account for the majority of fatalities Capsizing and falls overboard are major causes of fatalities Non-powered craft account for an increasing share of fatalities Most fatalities occur in relatively benign environmental conditions Human error accounts for about 2/3rds of fatalities BUI is the largest single contributing factor to fatalities

Key issues at a glance: 2016 data All Fatalities 701 Alcohol Related 133 Drownings 509 Drowning and alcohol-involved fatalities account for about 80% of total boating fatalities! These are the latest data available in Boating Statistics. However, percentages have remained relatively constant in the past several years.

Implications We need to identify ways (outreach, regulation) to convince boaters to wear life jackets—at least on smaller boats We need to reduce the prevalence of alcohol consumption on the water We need a better understanding of human factors and paddlecraft accidents

First Key Issue: Life Jackets Photo credits: U. S. Coast Guard. First Key Issue: Life Jackets

Life jacket basics Life jackets do not prevent accidents, but substantially increase the likelihood of survival in the event of capsizing or falls overboard It is difficult to predict the circumstances where life jackets will be required beforehand, and therefore, Life jackets need to be worn, not just carried—particularly for small boats

Studies show that increased wear rates could reduce boating fatalities dramatically 31

Efficacy of life jacket wear supported by studies Cummings et al. (2010) matched cohort design U.S.: authors estimated that wearing a life jacket reduced the risk of drowning by 49% (95% CI 26% to 65%) Maxim (2010) U. S.: For open motorboats, canoes, kayaks, and rowboats the incremental lives saved if wear rates could be increased to 70% were estimated to be approximately 125 annually, a 34% reduction Cummings, P., Mueller, B.A., and Quan, L., (2011). Association between wearing a personal floatation device and death by drowning among recreational boaters: a matched cohort analysis of United States Coast Guard data. Inj Prev, 17:156–9. Maxim, L. D., (2010). Drownings Avoided by Increased Lifejacket Wear: Suggested Models and Illustrative Calculations (Unpublished, but peer-reviewed Working Paper).

Efficacy of life jacket wear supported by studies Gungor and Viauroux (2014) U. S.: the expected number of drownings per vessel would decrease by about 80% if the operator wears a life jacket O’Connor and O’Connor (2005) Australia: probability of surviving was 34/50 = 0.68 (95% CI 0.5317 - 0.8007) if the person was wearing a life jacket compared to 128/257 = 0.50 (95% CI 0.4355 - 0.5607) if not Bugeja et al., (2014) Victoria Australia: 67% decrease in drownings after regulation requiring life jacket wear went into effect Gungor and Viaroux later published as: Viauroux, C. and Gungor, A., (2015). An Empirical Analysis of Life Jacket Effectiveness in Recreational Boating. Risk Analysis. doi: 10.1111/risa.12449. O’Connor, P., and O’Connor, N., (2005). Causes and prevention of boating fatalities. Accident Analysis and Prevention, 37, 4: 689-698. Bugeja, L., Cassell, E., Brodie, L. R., and Walter, S. J., (2014). Effectiveness of the 2005 compulsory personal flotation device (PFD) wearing regulations in reducing drowning deaths among recreational boaters in Victoria, Australia. Inj Prev, 0:1-6.

Let’s see now… Drowning accounts for the majority of fatalities Most drownings occur in benign environmental conditions, not offshore or on the great lakes Most drownings occur as a result of unpredictable circumstances (capsizing, falls overboard, flooding/swamping) Wearing (not merely carrying) a life jacket can reduce fatalities substantially

Therefore… Wearing a life jacket, particularly on small craft ought to be a “no-brainer” and so Life jacket wear rates should be high But, Lets look at data on actual wear rates Photo credit: U. S. Coast Guard

JSI Research and Training Institute studies Wear rate studies under CG grant from 1999 forward Based on actual observations, not interviews Data collected include wear rates by age and gender of boater, type, and length of boat

Life jacket wear rates: all boats excluding PWCs What will it take to move the needle for adults? The latest JSI wear rate study is available at https://uscgboating.org/library/national-live-jacket-wear-study/2015-life-jacket-wear-rate-observation-study-report.pdf.

Adult wear rates by boat type 2015 Regulation and risk perception? But what about powerboats?

Wear rates by age 2015 (excluding PWCs) Children subject to mandatory wear requirements Do teen-agers view freedom from legal wear requirements a “rite of passage?” Adults: the primary behavioral target group

Several studies on attitudes towards life jacket wear

CliffsNotes summary: why don’t adults wear life jackets? Boating is safe enough Life jackets are not comfortable Life jackets are un-attractive Wearing a life jacket is a sign of fear I’m a good swimmer I can anticipate situations where life jackets might be needed—or don one in the water if I fall overboard Life jackets won’t save my life Many of these are factually incorrect! Several studies point to these attitudes, see e.g., Groff, P. and Ghadiali, J., (2003). Will it Float? Mandatory PFD Wear Legislation: A Background Research Paper prepared for the Canadian Safe Boating Council. SMARTRISK Toronto, Ontario, Canada, 286 pp. Isaacs, J. C., and Lavergne, D. R., (2010). The Louisiana Department of Wildlife and Fisheries Survey of Louisiana Recreational Boaters, Louisiana Department of Wildlife and Fisheries Socioeconomic Research and Development Section, 99pp. Available electronically at http://www.wlf.louisiana.gov/sites/default/files/pdf/page/34691-ldwf-boating-strategic-plan/ldwf-boaters-survey-report.pdf. Turner, S., Wylde, J., Langham, M., Sharpe, S., and Jackson, K., (2009). MCA Lifejacket Wear-Behavioural Change. Report prepared for the Maritime Coastguard Agency and the Royal National Lifeboat Institution, 101pp. University of South Florida, Center for Social Marketing, (2009). Social Marketing and Boating Safety: A Project to Increase Personal Floatation Device Use – Literature Review. USF Center for Social Marketing, 13pp.

About user perceptions Can’t simply claim “you are misinformed:” To the consumer, perception = reality; understanding barriers is a key to success Some obviously flawed (e.g., good swimmer, don’t go far offshore, won’t save lives, will wear when in potentially “dangerous” conditions) Need to reinforce correct perceptions and counter incorrect perceptions (well researched FAQs)

Strategies to increase life jacket wear Outreach Options Design Regulation 43

Outreach efforts Materials, pamphlets, print articles, and campaigns (e.g., NSBW) Vessel Safety Checks and other one-on-one educational opportunities Life jacket loaner stations PSAs including PSAs on social media Cell phone Apps

Outreach materials 45

Additional comments on outreach efforts Clearly well intentioned and successful to various degrees (e.g., awareness), but thus far have had only a limited impact on behavior, despite having spent $ millions in past 20 years Need to determine messages that resonate, identify target audience(s), and choose the right PSAs and media mix to optimize likelihood of success

Life jacket design Designs have evolved over time, but is there still room for further improvement? Style Function Reliability Comfort Design competitions (e.g., BoatUS, NMMA, LJA) potentially valuable

Regulation Mandatory life jacket wear policies In Australia and Ireland In certain seasons in seven US states (CT, MA, MD, ME, NY, PA, and WV) In certain bodies of water (e.g., USACE) For certain types of craft (PWC) For people of certain ages (youth) Typically successful where implemented

Second Key Issue: alcohol use Photo credit: U. S. Coast Guard. Second Key Issue: alcohol use

BUI basics Alcohol consumption impairs balance and judgement and slows reaction time Alcohol consumption increases the likelihood of an accident and lowers the chance of survival after an accident Alcohol consumption increases the risk ratio for fatalities at levels well below present BUI legal limits (Smith et al., 2001)

Risk ratios (Smith et al., 2001) Some points on this graph BAC 0.03; RR = 2.2 BAC 0.05; RR = 3.7 BAC 0.08; RR = 7.1 BAC 0.10; RR = 10.4

Impairments as function of BAC for auto drivers .01 .02 .03 .04 .05 .06 .07 .08 .09 .10 Driving Simulator Lane Deviations, Divided Attention Drowsiness Vigilance Perception, Visual Functions Tracking The complete reference is Moskowitz, H. and Fiorentino, D., (2000). A review of the scientific literature regarding the effects of alcohol on driving-related behavior at blood alcohol concentrations of 0.08 grams per deciliter and lower. DOT HS 809 028. U. S. Dept. of Transportation, NHTSA, Washington, DC: 62 pp. Cognitive Tasks, Psychomotor Skills, Choice Reaction Time Simple Reaction Time, Critical Flicker Fusion (From Moskowitz and Fiorentino, 2000; cited by NTSB)

What’s been done to date? Increased enforcement More publicity of enforcement efforts Prohibition of alcohol use on certain waters Outreach efforts Research NTSB recommendation for automobiles The NTSB report is available at https://www.ntsb.gov/safety/safety-studies/Documents/SR1301.pdf.

Limited progress to date Whether measured as a % of total fatalities or to numbered boats, there has been little progress ERAC looking at ways to improve data Data from Boating Statistics 2003-2016.

Why is it a hard problem? Social acceptability of drinking and boating Lack of success of certain strategies (e.g., utility of “designated driver”) Difficulty of enforcement efforts—you can’t have enforcement 24/7 on all bodies of water Emerging issue—drug use Prevalence of drinking when boating is reportedly quite high. For example, according to one reference: ““Surveys conducted over the last two decades have consistently shown that 30% to 40% of boaters drink while on their vessels.” See Howland, J., Smith, G.S., Mangione, T., Hingson, R., DeJong, W., and Bell, N., (1993). Missing the boat on drinking and boating. JAMA 270(1): 91-92. Estimates are even higher for some populations.

Closing thoughts

Challenges: Life Jacket wear Regulatory options may be difficult to implement on national level USACE efforts noteworthy, possible opportunities with other government agencies or individual states Outreach efforts; limited success for adults—time for a coordinated effort to create an impactful campaign

Challenges: BUI Difficult to measure accurately—how can role of alcohol consumption as contributing factor be assessed? Role of alcohol probably understated—efforts to develop improved measurements valuable Need for authoritative “backgrounder” to provide a common understanding Search for effective intervention strategies from other transportation modes potentially worthwhile

Other challenges Can we increase the extent and effectiveness of boater education? The scale problem: Not all boaters required to take boating courses (solved over time) The scope problem: Presently no requirements for on-the-water skills training or testing Should content of boating courses be changed to include or focus on human factors and risk management?

Time to modify the scope of boating instruction? FAA Aviation Instructor’s Handbook and Risk Management Handbook have large discussion of human factors, errors, error management Could these be a model for boating instruction? Here is a convenient web site for the Aviation Instructor’s Handbook. https://www.faa.gov/regulations_policies/handbooks_manuals/aviation/aviation_instructors_handbook/media/FAA-H-8083-9A.pdf. Here is the web site for the Risk Management Handbook: https://www.faa.gov/regulations_policies/handbooks_manuals/aviation/media/faa-h-8083-2.pdf.

Use this meeting to develop your own ideas 61