Under the influence : identifying determinants of young adults' involvement in alcohol-influenced aquatic activity to improve drowning prevention efforts

BACKGROUND: Young adults are an at-risk group for experiencing an alcohol-related drowning incident. Investigations and drowning prevention efforts have aimed to address young adults’ prevalence in alcohol-related drownings and contribute to understanding their level of risk. Some explanations have concluded young adults’ need for autonomy and independence coincides with their exposure to alcohol and social norm pressures. However, gaps in knowledge remain, specifically young adults’: behaviours, knowledge and attitudes towards alcohol-influenced aquatic activity and the associated risks; and, their awareness and perceptions of alcohol-themed drowning prevention campaigns. METHODS: This PhD, completed with publications, aimed to address these gaps through four interlinked projects: (i) a systematic review of alcohol education programs to determine evidence-based quality criteria necessary for inclusion in programs to successfully change young adults’ alcohol-related behaviours, knowledge and attitudes; (ii) a program audit of alcohol-themed drowning prevention campaigns to establish current prevention efforts in high-income countries and areas for improvement; (iii) a survey among young adults from Australia and the United Kingdom to establish their knowledge, attitudes and predictors of intentions and involvement in alcohol-influenced aquatic activities; and, (iv) interviews to deepen understanding of young adults’ knowledge, attitudes and behaviours relating to alcohol-influenced aquatic activity, their awareness of alcohol-themed drowning prevention campaigns and their suggestions for improvement. Six publications resulted from this research. RESULTS: Friends influenced frequency of young adults’ involvement in alcohol-influenced aquatic activity, but involvement was dependent on the characteristics of the peer group, self-confidence and risk disassociation. Attitudes were neutral towards alcohol-influenced aquatic activity, but when participants perceived personal control over the risks it was deemed more acceptable. Alcohol-related safety strategies from other contexts (e.g., driving) were applied to aquatic settings, but specific water safety knowledge/education was low. Stronger swimmers, Australian young adults and those who had received alcohol-specific water safety education displayed more knowledge of alcohol and its effects in aquatic contexts. Participants lacked awareness of alcohol-themed drowning prevention campaigns, and used campaign logos and names to interpret key messages. Little information was available on the alcohol-themed drowning prevention campaigns identified in the program audit and only two had evidence of evaluation, limiting progress of future prevention efforts. Ten quality criteria identified from evidence-based literature were considered to be necessary for inclusion in alcohol education programs. Programs included in the systematic review which incorporated these criteria were more likely to report success in influencing behaviour changes among the participants. CONCLUSIONS: To decrease the incidence of alcohol-related drowning among young adults, the findings of the projects included within this thesis result in the following recommendations. For enhanced likelihood of successful outcomes, alcohol-themed drowning prevention campaigns should align campaign design, implementation and evaluation with best-practice literature. The identified influencers on young adults’ involvement in alcohol-influenced aquatic activity, such as their peers, should be incorporated into prevention efforts and appropriate information provided to encourage informed decision making. Alcohol education programs (e.g., drink driving education) should include information about alcohol use in aquatic settings to clarify the risks associated with transferring safety strategies between drinking contexts, and appropriate information should be provided about alcohol consumption in aquatic settings.Doctor of Philosoph