Skip to main content
NCBI home page
PLOS One logoLink to PLOS One
. 2022 Nov 4;17(11):e0276558. doi: 10.1371/journal.pone.0276558

Drinking and swimming around waterways: The role of alcohol, sensation-seeking, peer influence and risk in young people

J E Leavy 1,‡,*, M Della Bona 1,#, M Abercromby 2,#, G Crawford 1,‡
Editor: Jasmin C Lawes3
PMCID: PMC9635690  PMID: 36331939

Abstract

The role of individual and sociocultural factors contributing to drowning risk for young adults is complex and poorly understood. This study examined the relationship between behaviour in and around waterways and: 1) alcohol consumption; 2) resistance to peer influence; 3) sensation-seeking; 4) perception of risk among people aged 15–24 in Western Australia. A cross-sectional online survey was conducted at three time-points with a convenience sample. Predictor variables included: Alcohol Use Disorder Identification Test Consumption (AUDIT_C); Resistance to Peer Influence; Brief Sensation Seeking scale; Benthin’s Perception of risk. Pearson chi-squared tests determined the association between demographic and predictor variables. Logistic regression explored influence of potential predictor variables on behaviour in and around water. The final sample (n = 730) participants, consisted of females (n = 537, 74.5%), metropolitan dwelling (n = 616, 84.4%), and attended university (n = 410, 56.9%). Significant associations were found for those who swum after drinking alcohol compared with those that had not by age, gender, education. For every 1-unit increase in AUDIT-C participants were 60% more likely to swim after drinking (OR 95% CI 1.60 1.44–1.78). Participants who considered an adverse event serious were 15% less likely to have swum after drinking alcohol (OR 0.85 95% CI 0.73–0.99). The complex relationship between social participation in activities in and around waterways, higher drowning rates, propensity for risk, and the meaning young adults attach to risk locations and practices present unique challenges for drowning prevention research. Findings should be used to improve the awareness and education components of future youth water safety strategies in high-income settings.

Introduction

Adolescents and young people drowning is a preventable public health problem associated with a significant social burden [1, 2]. Drowning is among the ten leading causes of death for people aged between one and 24 years in every region of the world, with around one half of all drowning deaths occurring in young people under 24 years of age [3]. Risk factors for young people drowning vary by geographic location, for example, in high income country settings, gender, alcohol, supervision, proximity to water and swimming ability are well established risk factors together with social, environmental and structural factors [4]. In low and middle income country settings factors for young people may also include access to bodies of water, age and carrying capacity of the boat used for transport to and from work and school, weather and summer season [5].

In Australia a confluence of factors related to extensive coastline and waterways across Australia, the popularity of aquatic activities in this age group, and associated risk practices [1, 2, 4, 6–8] means young people are over-represented in water-related injury statistics and drowning deaths, a trend also seen internationally [1, 9–11]. Participation in recreational activities in and around beaches, rivers and waterways is often perceived to be part and parcel of an ‘Australian way of life’ [12, 13], and can be seen as a positive indicator of health and wellbeing, though continues to have fatal consequences, especially for males [7, 12, 14]. For example, in Australia in 2020/2021, there was a 21% increase in drowning deaths amongst young people aged 15–24 years; 77% of these deaths were males [9]. Deaths most frequently occurred in rivers and creeks, off rocks and at the beach [9].

Preventing young people from drowning is a multi-factorial issue [15]. Causes vary by individual (factors such as swimming skills [16] and personality traits including tendencies towards sensation-seeking) [14], environment (factors such as the aquatic setting and activity undertaken on the water) [15, 17] and social influence (factors such as peer norms) [18–21]. From a demographic perspective, young people and males are at increased risk of drowning [6], and more likely to use alcohol in the aquatic environment [2, 6, 9, 14, 15, 21]. In many countries, including Australia alcohol use around water is a risk factor for fatal and non-fatal drowning events especially amongst young adults [12]. However, these factors alone do not fully explain higher drowning rates for young adults. Accordingly, there has been a recent strategic focus on addressing a range of risk-taking behaviours underpinning these factors and associated behaviours in young people [2, 22].

Risk-taking is complex, dynamic and based on situated rationalities [23]. Recent research highlights the drowning prevention evidence has mostly focussed on males and children, as opposed to young adults [6, 13]. It has been established male drowning risk and risk perception are often associated with intentional activities described as ‘fun’ and recreational, often involving friends, fishing, jumping into water and boating [6, 14]. The literature suggests that young people, can underestimate the risk associated with aquatic activities and overestimate their ability to cope with that risk, partly explaining the higher rates of drowning amongst males [13, 15]. Research suggests that risk perception may play a protective role, motivating safer behaviours [14, 24]. However, research also suggests that young men may seek to protect a valued self or social identity through risk practices such as sensation-seeking, that may contribute to their sense of self-worth and build and sustain social networks and capital [20, 25]. Others’ views, normative comparisons, social networks and groups, and individuals’ audiences all influence risk practices among young people [16, 18, 26]. The complex relationship between social and physical desirability of participation in activities in and around waterways, higher drowning rates for males, propensity for risk, and the meaning young adults attach to risk locations and practices present unique challenges for drowning prevention research [14]. Greater understanding of the relationship between young adults and peer influence, decision making and risk perception may provide further insights into risk practices and account for different risk trajectories [27]. Accordingly, such information focussed on young adults in general, versus males specifically is critical for more effective interventions, particularly those that may benefit from a focus on settings, networks and key opinion leaders [28, 29].

The relative role of individual and sociocultural factors contributing to drowning risk for Australian adolescents and young adults is complex and poorly understood. Further exploration of the interaction of these factors and their influence on behaviour in and around water is warranted. This study aimed to examine the relationship between behaviour in and around water and: 1) alcohol consumption; 2) resistance to peer influence; 3) sensation-seeking; and 4) perception of risk among young people aged 15–24 years in Western Australia. Further, the research sought to examine potential predictors of these four factors separately and describe the extent to which they are associated with behavioural changes in and around water.

Materials and methods

Setting, survey participants, sample selection and recruitment

This study is part of a larger project evaluating an Australian youth water safety drowning prevention program. This research was undertaken in Perth, the state capital of Western Australia (WA) on the west coast of Australia. WA is Australia’s largest geographical state with a population of 2,660,026 mainly residing along the coast [30]. The southwest coastal area (where Perth is located) has a temperate climate and summer occurs between the months of December–March [31]. A cross-sectional online survey was conducted at three time points (October 2019: T1; February 2020: T2 and March 2021: T3) with a convenience sample of young people. The criteria for inclusion were: English speaking, aged 15–24 years and residing in WA. The sampling protocol required 20% of participants to be from regional or remote WA, and 40% of the sample to be aged 15–19 years and 60% to be aged 20–24 years. Eligible participants were invited to complete an online survey using Qualtrics survey software (2017). An information sheet provided background to the study and the option to withdraw from the study at any point. Participants under 18 years were approved for mature minor informed consent by the University Human Research Ethics Committee (HREC). All participants were asked to indicate consent via an online question before they were able to proceed to the survey. The survey was distributed via networks of the WA peak, non-government drowning prevention organisation. Written informed consent was obtained electronically from all participants included in the study. The study was approved by the University Human Ethics Committee (Approval no. HR201/2014).

Survey measures

The larger study uses a 53-item online survey. For the current analyses, a subset of data were derived from self-reported responses. The variables used in this study are described below and divided into Behaviour, Factors affecting behaviour, Perception of risk and behaviour.

Behaviour

Swimming after drinking alcohol. A single statement was used to measure water-related risk behaviour: “Have you swum after consuming alcohol?” [32]. Response options were Never, Sometimes and Always. The responses were dichotomised into ‘Yes’ (sometimes or always) and ‘No’ (Never).

Factors affecting behaviour

Alcohol consumption. The Alcohol Use Disorder Identification Test Consumption (AUDIT_C) [33] score assessed alcohol consumption. Three questions were included: 1) Frequency—How often do you have a drink containing alcohol? Response categories: Never; Monthly or less; 2–4 times a month; 2–3 times a week; 4 or more times a week; 2) Amount—How many standard drinks containing alcohol do you have on a typical day (when you are drinking alcohol)? Response categories: 1 or 2; 3 or 4; 5 or 6; 7 or 9; 10 or more; and 3) Frequency of high consumption—How often do you have six or more standard drinks on one occasion? Response categories: Never; Less than monthly; Monthly; Weekly; Daily or almost daily. Scores for each question ranged from 0 to 4 points and total scores ranged from 0–12 points, with higher scores equating to higher consumption rates.

Resistance to peer influence. Participants were asked based on the Resistance to Peer Influence scale (RPI) [34] (a scale is a composite measure that is composed of several items that have a logical structure among them) [35]. Participants were asked “How true are the following statements about you?” and eight statements, including “I think it’s more important to be who I am than to fit in with the crowd” and “I would do something I know is wrong just to stay on my friends’ good side” (S1 Table for all eight statements). Each statement was coded as not true at all (1) to very true (4). Three items (1, 5 & 7) were reverse coded so that higher scores reflect greater susceptibility to peer influence. Mean Resistance to Peer Influence score (range from 1 through 4) were determined by averaging the individual statement scores.

Sensation-seeking. The Brief Sensation Seeking Scale (BSSS-4) [36] was used and participants were asked “How much do you agree or disagree” with each of the following statements: 1). I would like to explore strange places (identifying thrill and adventure-seeking); 2). I like to do frightening things (experience-seeking); 3). I like new and exciting experiences, even if I have to break the rules (disinhibition); and 4). I prefer friends who are exciting and unpredictable (boredom susceptibility).” The response scales were five-point Likert scales which ranged from ‘strongly agree = 5’ to ‘strongly disagree = 1’. Higher scores correspond with a higher level of sensation-seeking. Mean sensation-seeking scores (range from 1 through 5) were calculated by averaging the individual response for the four statements.

Perception of risk

Participants rated their perception of risk using nine of the 14 items identified in the Benthin’s Perception of Risk Scale [37]. The response used a seven-point Likert scale which varied for each of the nine items: 1) personal risk; 2) risk to peers; 3) benefit vs risk; 4) seriousness of effect; 5) information value; 6) perceived control; 7) peer influence; 8) admiration; and 9) avoidance. The perception of risk scores was calculated by averaging the individual response (1 through 7) for each item (see S2 Table for the full description of each of the nine items and their scales).

Demographics

The following demographic variables were collected: age, gender, location (by postcode used to categorise place of residence into two categories either Metropolitan (postcode 6000–6210) or Regional (postcode 6211–6999) WA), and current education level.

Analysis

Data were cleaned and participants with missing variables were removed (n = 312). A final sample of data (n = 730) was achieved (T1 (n = 374), T2 (n = 39) and T3 (n = 317)). Descriptive statistics summarised the participant demographic characteristics. Initially, a set of discrete bi-variate analyses were conducted for the variable–Behaviour (Have swum after drinking alcohol or Never swum after drinking alcohol) with the demographic variables (gender, age, place of residence, and education level) and each of the following four factors: AUDIT_C—alcohol consumption; sensation-seeking; resistance to peer influence; and perception of risk (personal risk, risk to peers, benefit versus risk, seriousness of effect, information value, personal control, peer influence, admiration, and avoidance). Associations were determined using Pearson chi-squared tests and t-tests. P-values <0.05 were considered statistically significant.

Separate forced entry binary logistic regression models then explored the influence of potential predictor variables on the dichotomous outcome: Behaviour (0 = Never swum after drinking alcohol 1 = Have swum after drinking alcohol). Only the variables that were significant in the Pearson chi-squared analyses were included in the final model. Assumption testing conducted before the analysis did not indicate violations of multi-collinearity, outliers, or logit linearity. At each step, non-significant variables were removed from the model. A p-value threshold of 0.05 was used to limit the total number of variables included in the final model. The first step assessed the null model of the overall probability of the behaviour (swimming whilst consuming alcohol) without adjustment for covariates. The second step included demographic variables age, gender and education. The third step included the three factors deemed likely to affect behaviour (AUDIT_C- alcohol consumption, resistance to peer influence and sensation-seeking). Whilst individually, gender, education, resistance to peer influence and risk perception involving personal risk, risk to peers, benefit versus risk, information value, personal control, admiration and avoidance showed an association with behaviour (Table 2), they were not significant when added to the model. Finally, the nine risk perception items were included in the model. The final logistic regression identified the impact of age, together with the predictor variables AUDIT_C–alcohol consumption, sensation-seeking; peer influence and seriousness of effect (risk perception items) on predicting swimming after drinking alcohol. The final model was statistically significant ϰ2 (df = 5, N = 623) = 242.625, p<0.001, Cox and Snell (R2 = 0.28), Nagelkerke (R2 = 0.32). The model was 74.8% accurate in its predictions of behaviour (participating in water-based activity whilst consuming alcohol). Hosmer and Lemeshow test confirmed that the model was a good fit for the data ϰ 2 (df = 8, N = 623) = 4.394, p = 0.820. Significance levels are reported if p-values <0.05. Analyses were completed using SPSS (SPSS version 26) [38].

Table 2. Bivariate analyses of behaviour and factors affecting behaviour (AUDIT-C- alcohol consumption, resistance to peer influence, sensation-seeking and risk perception).
Behaviour
Predictor variables p-value Have swum after drinking alcohol Never swum after drinking alcohol
ALL n (%) 294 (36.5) 436 (54.2)
FACTORS AFFECTING BEHAVIOUR M (SD)
AUDIT_C—Alcohol consumption p<0.001 5.52 (2.17) 3.50 (1.93)
Resistance to Peer Influence p<0.001 1.96 (0.46) 1.81 (0.43)
Sensation-seeking p<0.001 3.54 (0.76) 3.26 (0.75)
RISK PERCEPTION M (SD)
Peer Influence p<0.001 3.78 (1.85) 2.28 (1.55)
Seriousness of effect p<0.001 5.63 (1.33) 6.02 (1.18)
Personal risk p<0.001 3.16 (1.71) 2.35 (1.67)
Risk to peers p<0.001 2.40 (1.36) 1.84 (1.31)
Benefit vs risk p<0.001 2.27 (1.46) 1.65 (1.20)
Information value p<0.001 5.62 (1.42) 6.03 (1.23)
Personal control 0.002 3.89 (1.70) 3.47 (1.90)
Admiration 0.017 4.52 (1.58) 4.22 (1.78)
Avoidance 0.004 5.44 (1.60) 5.78 (1.44)
Open in a new tab

n-number; M–mean; SD- standard deviation

Results

The majority of the participants (n = 730) were female (n = 537, 74.5%), lived in metropolitan Perth (n = 616, 84.4%) and attended university (n = 410, 56.9%). The mean age of participants was 19.9 years (SD = 2.13). Significant associations were found when behavioural responses (those who reported they had swum after drinking alcohol compared with those that had not) were analysed by age (p<0.001), gender (p = 0.021) and current education (p = 0.001). Demographic characteristics and the association with the outcome variable of interest, ‘Behaviour’ are shown in Table 1.

Table 1. Demographics and association with the outcome variable ‘Behaviour’.

Behaviour
Demographic characteristics Have swum after drinking alcohol n (%) Never swum after drinking alcohol n (%)
p-value
ALL n (%) (n = 730) 294 (36.5) 436 (54.2)
Age M (SD) <0.001 20.54 (2.02) 19.48 (2.1)
Gender n (%) (n = 721) 0.021
    Male 88 (47.8) 96 (52.2)
    Female 205 (38.2) 332 (61.8)
Place of residence n (%) (n = 730) NS
    Metropolitan 240 (39.0) 376 (61.0)
    Regional 54 (47.4) 60 (52.6)
Current education n (%) (n = 721) 0.001
    Not currently studying 98 (43.0) 130 (57.0)
    High school 7 (13.5) 45 (86.5)
    TAFE 11 (35.5) 20 (64.5)
    University 170 (41.5) 240 (58.5)
Open in a new tab

n-number; M–mean; SD- standard deviation; NS- Not Significant; TAFE–Tertiary and Further Education

Analysis of behavioural responses by the four predictor variables also revealed significant associations across AUDIT_C—alcohol consumption, resistance to peer influence and sensation-seeking (p<0.001), and in all nine risk perception items (Table 2).

Table 3 presents the association between participation in swimming after drinking alcohol and age, AUDIT_C—alcohol consumption, sensation-seeking and risk perception (peer influence and seriousness of effect) after simultaneous adjustment for these variables. Participants were almost 50% more likely to swim after drinking alcohol with every year they got older (OR 1.46 95% CI 1.32–4.63). Similarly, participants were almost 40% more likely to swim after drinking alcohol with increasing sensation seeking and peer-influence scores (OR 1.46 95% CI 1.30–1.64 and OR 1.44 95% CI 1.09–1.89 per 1-unit increase in their respective scores). For every 1-unit increase in the AUDIT-C score participants were 60% more likely to swim after drinking alcohol (OR 95% CI 1.60 1.44–1.78). In contrast, those who more strongly considered the seriousness of an adverse event were 15% less likely to have swum after drinking alcohol (OR 0.85 95% CI 0.73–0.99 per 1-unit increase in the score).

Table 3. Predictor coefficients for the logistic regression model predicting participation in swimming after drinking alcohol.

Behaviour model–Swimming after drinking alcohol
Participant characteristic OR (95% CI) p
Age 1.46 (1.32–4.63) <0.001
Alcohol consumption 1.60 (1.44–1.78) <0.001
Sensation-seeking 1.44 (1.09–1.89) 0.010
Risk perception
    Peer Influence 1.46 (1.30–1.64) <0.001
    Seriousness of effects 0.85 (0.73–0.99) 0.045
Open in a new tab

CI—confidence intervals; SE—standard error

Discussion

We set out to explore the complex interaction of factors influencing the behaviour of young Western Australians aged 15–24 years (alcohol consumption, perception of risk, sensation- seeking and peer influence) in and around waterways. For many young Australians, alcohol and risk-taking is an inherent part of identity formation [39] occurring in a pervasive alcogenic environment [12, 40, 41]. An ‘aquatic alcogenic environment’ described in previous research [12], highlights the very commonplace practice of alcohol consumption in and around water. The findings in this study are novel and extend a small but growing body of literature that examines the complex socio-cultural relationships in and around waterways, and the meaning that both young male and female adults attach to these factors.

The findings in this study suggest that peer influence and sensation-seeking influenced swimming after drinking alcohol, a practice that those more likely to swim and drink felt would be admired by their peers. These findings are consistent with another Australian study that found young males who have positive attitudes towards drinking and swimming, consider their peers to hold similar attitudes towards drinking and swimming and would perform the action [20]. Of interest, in this study young females were over-represented providing an interesting and previously untapped insight into the female perspective on the role of peers and sensation seeking. Participants in our study who had swum after drinking alcohol reported more personal control over risk, less fear of risk to themselves and others, and less seriousness of effects, suggesting those who sensation seek or frequently drink may have a lower perceived susceptibility to drowning, a finding consistent with previous research [12, 20, 42]. Conversely, those who had never swum after drinking alcohol were more likely to consider the seriousness of an adverse event, and reported higher risk to both themselves and others, greater risks than benefits, and less personal control over risk. These contrasting behaviours amongst those who do drink and swim and those who do not have direct implications for the design and delivery of future drowning prevention interventions for young adults.

Our research reinforces previous findings that sensation-seeking increases when alcohol is consumed. It is well established that sensation-seeking, coupled with group norms are factors that may facilitate and amplify risk practices in young people, including those related to alcohol consumption [6, 21, 42–44]. Previous research has noted that males, specifically those who were younger and who scored highly on sensation-seeking tended to mix with peers who drink more frequently [20, 42, 43]; and may have lower self-efficacy around decision making [43]. Moran, 2011 describes ‘dangerous masculinities’ whereby aquatic recreational activity (fishing and surfing) is a masculinised and gendered pursuit, a notion that appears to be firmly entrenched in the social norms of young men. A recent review describes an Australian study that found females are also engaging in high-risk behaviours and activities in aquatic locations similar to males, especially when drinking around waterways [6, 44]. These are important insights for awareness raising and education endeavours targeting younger adults. Lupton & Tulloch [18] describe risk across a life-course trajectory that involves significant risk-taking by young people. Compared with their older peers, younger adults may have had less exposure to risk environments or to opportunities to build their skills and self-efficacy to reduce risks that may be inherent in sensation-seeking activities [42]. Accordingly, this research reinforces the opportunity to exploit and target peer group norms (e.g., peer education), skills and self-efficacy (e.g., assertiveness training) [42, 43] as part of the suite of strategies delivered to younger adults. The findings also suggest the need for segmented prevention messages that account for the differing peer roles that young people hold within their social networks given the moderating effect of social influence [28]. Like recommendations by Abercromby et al (2020) [12], Calverley et al (2020) [42], and Hamilton et al 2022 [21] our findings highlight the need for better understanding regarding the role of risk-taking and risk-averse peers in drowning prevention efforts. Identifying the wide range of reasons that young people participate in risk practices would be instructive in developing more targeted prevention measures for Australian and international drowning prevention practitioners and policy makers. This includes an awareness of the positive associations with risk and sensation-seeking and their role in achieving desired social outcomes including social capital, reputational and experiential gains [25].

A serious side effect or something bad happening was more likely to be front of mind for those who did not drink and swim in our study. This result is interesting considering recent findings from WA research with young people who dismissed media messages that emphasised the negative and serious consequences of drinking alcohol [12]. Hamilton and colleagues [20] found strategies that aim to increase the negative consequences (e.g. increasing the chance of injury/accidents) of drinking and swimming may be effective. However, the effectiveness of threatening messages appears dependent on the individual considering themselves vulnerable to the threat portrayed [20, 45], regardless of the severity of the risks involved. Previously it has been found that whilst young people are aware of the serious consequences of excessive alcohol consumption, they consider these to be the cost of perceived benefits [12]. Of interest is the role of the specific setting, with boats and boating quoted as the sites of serious injury, that had sustained and significant impacts and outcomes which included death [12]. Recent research suggests the use of passive messaging using to place drowning prevention top of mind [13]. For example, in the New Zealand Swim Reaper campaign, young people are specifically reached via geo-targeted messages using Instagram and other social channels. Safety signage is also placed at selected locations where drownings occur [46]. The targeted placement of media messages using digital technology together with environmental cues are vital to highlight the consequences of alcohol use during aquatic activities [13, 21].

However, it has also been suggested that whilst young Australian adults are aware of the seriousness of mixing alcohol and aquatic activities, their inexperience, short-term focus and impulsivity allows them to disassociate themselves from the possibility of experiencing any serious consequences for themselves or others [42, 47] which may be amplified by feelings of situational disinhibition [48]. Risk, in the context of alcohol, water and young people, may be seen as an important cultural practice which is reinforced by peers and the environment. Any interventions that are serious about tackling risk practices will need to confront this reality in their design and delivery.

We found alcohol consumption was significantly associated with activities in and around the water; not unexpected in an Australian state surrounded by almost 13,000 kilometres of coastline [49]. These findings are concerning given alcohol contributes to around 20% of drowning fatalities in WA [50]. Recent qualitative research [12] has indicated that young Australians regularly mix alcohol and activities around waterways, citing it as a cultural norm, despite acknowledging and knowing the risks [42]. Consequently strategies that focus only on awareness or knowledge about risk are unlikely to resonate with the target audience [51]. Our research strengthens the call for comprehensive interventions that not only encourage young people to consider the risks associated with drinking and swimming, and the seriousness of the effects of drinking and swimming, but provide environmental supports that seek to mitigate the pervasive effects of the aquatic alcogenic environment. Described earlier, where alcohol advertising widely promotes drinking in and around the water, and is ineffectually regulated [41, 52–54]. Increased advocacy efforts are required to remove alcohol advertising featuring water-based activities and restrict alcohol outlets near waterways as a key public health strategy in drowning prevention. In particular, this means highlighting and advocating for government intervention to counter the self-regulating nature of the Australian Alcohol Beverages Advertising Code and the relatively weak placement rules for alcohol advertising [52, 53, 55]. As has been suggested in the literature, it is doubtful that this strategy will have any material impact on alcohol marketing exposure to young people [55–57]. The focus has to include tackling the commercial determinants of health and the public health consequences arising from for-profit entities such as the alcohol industry, their activities, and the social structures that sustain them [58]. As Crawford and colleagues [59] have recently argued in relation to government intervention, that while less intrusive measures are usually the most acceptable to individuals, they are usually also the least effective. In other areas of health there is majority support for government intervention, particularly when it relates to children and young people and the impact of the commercial determinants on health.

Limitations and strengths

Our study had several limitations. First, data collection used the existing networks of the peak drowning prevention agency in one Australian state, consequently, the findings may not reflect the general young adult population. This study was undertaken in WA and care should be taken when extrapolating findings to other locations. Data were self-reported and subject to recall and social desirability bias. WA COVID 19 border shutdowns and social distancing policy in March-April, 2021 impacted recruitment and data collection at T2. Females, and those who lived in the metropolitan area were over-represented in the final sample, and more than one-half of participants had attended a tertiary institution. The use of a single item for behaviour item analysed swimming after consuming alcohol, limits generalisability of the findings. The strengths of this study include the novel use of predictor variables to examine behaviour in and around waterways. To the best of the authors’ knowledge, this is the first study to examine the specific predictor variables in the drowning prevention literature; and the findings contribute to a small but growing evidence base examining the individual and sociocultural factors contributing to drowning risk for young adults.

Conclusion

This study adds to and extends the small body of literature that examines risk and risk perception in young people as important predictors for a range of practices in and around waterways in high-income countries. The significant influence of alcohol, sensation seeking, peers and perceived seriousness of injury are important but underutilised considerations in the development of prevention programs designed to discourage alcohol use in, on, or around waterways. Our novel findings that include both a male and female perspective should be used to improve the awareness and education components of young adult water safety strategies with the addition of supporting structural and environmental strategies to reduce the significant physical, social, and economic burden associated with drowning in Australia and other locations with large coastlines such as Canada and New Zealand.

Supporting information

S1 Table. Resistance to Peer Influence scale (RPI).

(TIF)

Click here for additional data file. (876.8KB, tif)
S2 Table. Benthin’s perception of risk scale.

(TIF)

Click here for additional data file. (217.9KB, tif)

Acknowledgments

We would like to acknowledge the young people of Western Australia who consent to being part of our research endeavours and the Royal Life Saving Society of Western Australia (RLSSWA) for their support in data collection and manuscript preparation.

Data Availability

Data cannot be shared publicly because of ethical and contractual requirements between Curtin University, Royal Life Saving Society Western Australia and Department of Health, Western Australia. Data are available from the Curtin University Human Research Ethics Committee (HREC) contact via hrec@curtin.edu.au for researchers who meet the criteria for access to confidential data.

Funding Statement

This research was supported by Royal Life Saving Society Western Australia (WA) via an evaluation and research contract with Curtin University’s Collaboration for Evidence, Research and Impact in Public Health (CERPIH) (JEL) (Contract Number 13834/RES-61536). URL: https://www.royallifesavingwa.com.au/ The funders supported data collection and the preparation of the manuscript.

References

  • 1.Peden AE, Mahony AJ, Barnsley PD, Scarr J. Understanding the full burden of drowning: a retrospective, cross-sectional analysis of fatal and non-fatal drowning in Australia. BMJ Open. 2018;8(11):e024868. doi: 10.1136/bmjopen-2018-024868 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Peden AE, Scarr JP, Mahony AJ. Analysis of fatal unintentional drowning in Australia 2008–2020: implications for the Australian Water Safety Strategy. Australian and New Zealand Journal of Public Health. 2021. [DOI] [PubMed] [Google Scholar]
  • 3.Meddings DR, Scarr J-P, Larson K, Vaughan J, Krug EG. Drowning prevention: turning the tide on a leading killer. The Lancet Public Health. 2021;6(9):e692–e5. doi: 10.1016/S2468-2667(21)00165-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Leavy JE, Crawford G, Leaversuch F, Nimmo L, McCausland K, Jancey J. A review of drowning prevention interventions for children and young people in high, low and middle income countries. Journal of community health. 2016;41(2):424–41. doi: 10.1007/s10900-015-0105-2 [DOI] [PubMed] [Google Scholar]
  • 5.Miller L, Alele FO, Emeto TI, Franklin RC. Epidemiology, Risk Factors and Measures for Preventing Drowning in Africa: A Systematic Review. Medicina. 2019;55(10):637. doi: 10.3390/medicina55100637 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Roberts K, Thom O, Devine S, Leggat PA, Peden AE, Franklin RC. A scoping review of female drowning: an underexplored issue in five high-income countries. BMC Public Health. 2021;21(1):1072. doi: 10.1186/s12889-021-10920-8 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.Peden AE, Demant D, Hagger MS, Hamilton K. Personal, social, and environmental factors associated with lifejacket wear in adults and children: A systematic literature review. PLoS One. 2018;13(5):e0196421. doi: 10.1371/journal.pone.0196421 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Stallman RK, Moran K Dr, Quan L, Langendorfer S. From swimming skill to water competence: Towards a more inclusive drowning prevention future. International Journal of Aquatic Research and Education. 2017;10(2):3. [Google Scholar]
  • 9.Royal Life Saving Society Australia. Royal Life Saving National Drowning Report 2021,. Sydney Australia: 2021.
  • 10.Croft JL, Button C. Interacting factors associated with adult male drowning in New Zealand. PLoS One. 2015;10(6):e0130545. doi: 10.1371/journal.pone.0130545 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Howland J, Hingson R, Mangione TW, Bell N, Bak S. Why are most drowning victims men? Sex differences in aquatic skills and behaviors. American Journal of Public Health. 1996;86(1):93–6. doi: 10.2105/ajph.86.1.93 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Abercromby M, Leavy JE, Tohotoa J, Della Bona M, Nimmo L, Crawford G. “Go hard or go home”: exploring young people’s knowledge, attitudes and behaviours of alcohol use and water safety in Western Australia using the Health Belief Model. International Journal of Health Promotion and Education. 2021;59(3):174–91. [Google Scholar]
  • 13.Lawes JC, Ellis A, Daw S, Strasiotto L. Risky business: a 15-year analysis of fatal coastal drowning of young male adults in Australia. Injury Prevention. 2021;27(5):442. doi: 10.1136/injuryprev-2020-043969 [DOI] [PubMed] [Google Scholar]
  • 14.McCool J, Ameratunga S, Moran K, Robinson E. Taking a risk perception approach to improving beach swimming safety. International Journal of Behavioral Medicine. 2009;16(4):360–6. doi: 10.1007/s12529-009-9042-8 [DOI] [PubMed] [Google Scholar]
  • 15.Hamilton K, Keech JJ, Peden AE, Hagger MS. Alcohol use, aquatic injury, and unintentional drowning: a systematic literature review. Drug and Alcohol Review. 2018;37(6):752–73. doi: 10.1111/dar.12817 [DOI] [PubMed] [Google Scholar]
  • 16.Willcox-Pidgeon S, Kool B, Moran K. Perceptions of the risk of drowning at surf beaches among New Zealand youth. International Journal of Injury Control and Safety Promotion. 2018;25(4):365–71. doi: 10.1080/17457300.2018.1431939 [DOI] [PubMed] [Google Scholar]
  • 17.Gulliver P, Begg D. Usual water-related behaviour and ‘near-drowning’ incidents in young adults. Australian and New Zealand Journal of Public Health. 2005;29(3):238–43. doi: 10.1111/j.1467-842x.2005.tb00761.x [DOI] [PubMed] [Google Scholar]
  • 18.Lupton D, Tulloch J. ’Life would be pretty dull without risk’: Voluntary risk-taking and its pleasures. Health, Risk & Society. 2002;4(2):113–24. doi: 10.1080/13698570220137015 [DOI] [Google Scholar]
  • 19.Moran K. Parents, pals, or pedagogues? How youth learn about water safety. International Journal of Aquatic Research and Education. 2009;3(2):4. [Google Scholar]
  • 20.Hamilton K, Schmidt H. Drinking and swimming: investigating young Australian males’ intentions to engage in recreational swimming while under the influence of alcohol. Journal of Community Health. 2014;39(1):139–47. doi: 10.1007/s10900-013-9751-4 [DOI] [PubMed] [Google Scholar]
  • 21.Hamilton K, Keech JJ, Willcox—Pidgeon S, Peden AE. An evaluation of a video-based intervention targeting alcohol consumption during aquatic activities. Australian Journal of Psychology. 2022;74(1):2029221. doi: 10.1080/00049530.2022.2029221 [DOI] [Google Scholar]
  • 22.Australian Water Safety Council. Australian Water Safety Strategy 2030. Sydney: 2021.
  • 23.Bloor M. The sociology of HIV transmission: Sage; 1995. [Google Scholar]
  • 24.Millstein SG, Halpern-Felsher BL. Perceptions of risk and vulnerability. Journal of Adolescent Health. 2002;31(1):10–27. doi: 10.1016/s1054-139x(02)00412-3 [DOI] [PubMed] [Google Scholar]
  • 25.Crawford G. Investigating Australian Male Expatriate, Longer-Term and Frequent Traveller Social Networks in Thailand to Determine Their Potential to Influence HIV and Other STI Risk Behaviour. Perth: Curtin University; 2019. [Google Scholar]
  • 26.Lupton D, Tulloch J. `Risk is Part of Your Life’: Risk Epistemologies Among a Group of Australians. Sociology. 2002;36(2):317–34. doi: 10.1177/0038038502036002005 [DOI] [Google Scholar]
  • 27.Berkman ET, Livingston JL, Kahn LE. Finding the “self” in self-regulation: The identity-value model. Psychological Inquiry. 2017;28(2–3):77–98. doi: 10.1080/1047840X.2017.1323463 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Bevelander KE, Smit CR, van Woudenberg TJ, Buijs L, Burk WJ, Buijzen M. Youth’s social network structures and peer influences: study protocol MyMovez project–Phase I. BMC Public Health. 2018;18(1):1–13. doi: 10.1186/s12889-018-5353-5 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29.Bywood P, Lunnay B, Roche A. Effectiveness of opinion leaders for getting research into practice in the alcohol and other drugs field: Results from a systematic literature review. Drugs: Education, Prevention and Policy. 2009;16(3):205–16. doi: 10.1080/09687630902880546 [DOI] [Google Scholar]
  • 30.Australian Bureau of Statistics. Western Australia 2021 All persons Quick Stats. Canberra2021.
  • 31.Australian Bureau of Meterology. Nyoongar Weather Calendar. 2016.
  • 32.Moran K. (Young) Men behaving badly: dangerous masculinities and risk of drowning in aquatic leisure activities. Annals of Leisure Research. 2011;14(2–3):260–72. [Google Scholar]
  • 33.Bradley KA, DeBenedetti AF, Volk RJ, Williams EC, Frank D, Kivlahan DR. AUDIT‐C as a brief screen for alcohol misuse in primary care. Alcoholism: Clinical and Experimental Research. 2007;31(7):1208–17. doi: 10.1111/j.1530-0277.2007.00403.x [DOI] [PubMed] [Google Scholar]
  • 34.Meldrum RC, Miller HV, Flexon JL. Susceptibility to peer influence, self‐control, and delinquency. Sociological Inquiry. 2013;83(1):106–29. [Google Scholar]
  • 35.Loewenthal KM, Lewis CA. What is a good psychological measure? An introduction to psychological tests and scales (3rd ed)2020. p. 1–22. [Google Scholar]
  • 36.Vallone D, Allen JA, Clayton RR, Xiao H. How reliable and valid is the Brief Sensation Seeking Scale (BSSS‐4) for youth of various racial/ethnic groups? Addiction. 2007;102:71–8. doi: 10.1111/j.1360-0443.2007.01957.x [DOI] [PubMed] [Google Scholar]
  • 37.Benthin A, Slovic P, Severson H. A psychometric study of adolescent risk perception. Journal of Adolescence. 1993;16(2):153–68. doi: 10.1006/jado.1993.1014 [DOI] [PubMed] [Google Scholar]
  • 38.IBM Corp. IBM SPSS Statistics for Windows 26.0. Armonk, NY: IBM Corp; 2019. [Google Scholar]
  • 39.Sinkinson M. Having a good time: young people talk about risk and fun when combining alcohol consumption and water activities. International Journal of Health Promotion and Education. 2014;52(1):47–55. [Google Scholar]
  • 40.Hill KM, Foxcroft DR, Pilling M. “Everything is telling you to drink”: understanding the functional significance of alcogenic environments for young adult drinkers. Addiction Research & Theory. 2018;26(6):457–64. doi: 10.1080/16066359.2017.1395022 [DOI] [Google Scholar]
  • 41.Petticrew M, Shemilt I, Lorenc T, Marteau T, Melendez-Torres G, O’Mara-Eves A, et al. Alcohol advertising and public health: systems perspectives versus narrow perspectives. J Epidemiol Community Health. 2017;71(3):308–12. doi: 10.1136/jech-2016-207644 [DOI] [PubMed] [Google Scholar]
  • 42.Calverley H, Petrass L, Blitvich J. Alcohol Focused Drowning Prevention Campaigns: What Do We Know and What Should We Do Now? International Journal of Aquatic Research and Education. 2020;12(2):7. [Google Scholar]
  • 43.Cicognani E, Zani B. Alcohol use among Italian university students: The role of sensation seeking, peer group norms and self-efficacy. Journal of Alcohol and Drug Education. 2011:17–36. [Google Scholar]
  • 44.Peden AE, Franklin RC, Leggat PA. Breathalysing and surveying river users in Australia to understand alcohol consumption and attitudes toward drowning risk. BMC Public Health. 2018;18(1):1–18. doi: 10.1186/s12889-018-6256-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 45.Tannenbaum MB, Hepler J, Zimmerman RS, Saul L, Jacobs S, Wilson K, et al. Appealing to fear: A meta-analysis of fear appeal effectiveness and theories. Psychological Bulletin. 2015;141(6):1178. doi: 10.1037/a0039729 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 46.Water Safety New Zealand. Swim Reaper [Webpage]. 2016. Available from: https://swimreaper.co.nz/the%20campaign?src=nav.
  • 47.Gray RJ, Hoek J, Edwards R. A qualitative analysis of ‘informed choice’among young adult smokers. Tobacco Control. 2016;25(1):46–51. doi: 10.1136/tobaccocontrol-2014-051793 [DOI] [PubMed] [Google Scholar]
  • 48.Eiser JR, Ford N. Sexual relationships on holiday: a case of situational disinhibition? Journal of Social and Personal Relationships. 1995;12(3):323–39. [Google Scholar]
  • 49.Commonwealth of Australia. Coastline Lengths. Available from: http://www.ga.gov.au/education/geoscience-basics/dimensions/coastline-lengths.html.
  • 50.Royal Life Saving Society Western Australia. Western Australian Drowning Report 2020. Perth, Western Australia: 2020.
  • 51.Zinn JO. The meaning of risk-taking–key concepts and dimensions. Journal of Risk Research. 2019;22(1):1–15. [Google Scholar]
  • 52.Pettigrew S, Jongenelis MI, Jongenelis G, Pierce H, Stafford J, Keric D. Get Them Laughing to Get Them Drinking: An Analysis of Alcohol Advertising Themes Across Multiple Media in Australia. Journal of Studies on Alcohol and Drugs. 2020;81(3):311–9. doi: 10.15288/jsad.2020.81.311 . [DOI] [PubMed] [Google Scholar]
  • 53.Pierce H, Stafford J, Daube M. Developing an alternative alcohol advertising complaint review system: lessons from a world-first public health advocacy initiative. Public Health Research & Practice. 2017;27(3). [DOI] [PubMed] [Google Scholar]
  • 54.Room R, O’Brien P. Alcohol marketing and social media: A challenge for public health control. Drug and Alcohol Review. 2021;40(3):420. doi: 10.1111/dar.13160 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 55.Pierce H, Stafford J, Pettigrew S, Kameron C, Keric D, Pratt IS. Regulation of alcohol marketing in Australia: A critical review of the Alcohol Beverages Advertising Code Scheme’s new Placement Rules. Drug and Alcohol Review. 2019;38(1):16–24. doi: 10.1111/dar.12872 [DOI] [PubMed] [Google Scholar]
  • 56.Alcohol and Drug Foundation. Alcohol Advertising, Social Media and Young People. 2021.
  • 57.Noel JK, Sammartino CJ, Rosenthal SR. Exposure to digital alcohol marketing and alcohol use: A systematic review. Journal of Studies on Alcohol and Drugs, Supplement. 2020;(s19):57–67. doi: 10.15288/jsads.2020.s19.57 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 58.Lee K, Freudenberg N. Public Health Roles in Addressing Commercial Determinants of Health. Annual Review of Public Health. 2022;43(1):375–95. doi: 10.1146/annurev-publhealth-052220-020447 . [DOI] [PubMed] [Google Scholar]
  • 59.Crawford G, Connor E, Scuderi M, Hallett J, Leavy JE. Framing the nanny (state): an analysis of public submissions to a parliamentary inquiry on personal choice and community safety. Australian and New Zealand Journal of Public Health. 2021. doi: 10.1111/1753-6405.13178 [DOI] [PubMed] [Google Scholar]

Decision Letter 0

Jasmin C Lawes

22 Aug 2022

PONE-D-22-18336Drinking and swimming around waterways: the role of alcohol, sensation-seeking, peer influence and risk in young people.PLOS ONE

Dear Dr. Leavy,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

==============================

Editor comments:1) I understand that you cannot share raw data but you will need to update the data sharing statement so that it fulfils the criteria as suggested. you need to let people know how they could access the data if they really wanted to. For example, data cannot be shared publicly because of XXX. Data are available from XXX (contact via XXX) for researchers who meet the criteria. General comments:This paper provides a new contribution to understanding behaviours and perceptions of alcohol consumption and swimming within young people in Western Australia. The tools used are appropriate and interpretation is meaningful. Some concerns around interpretation and context development provided using young men but the sample population tested is predominantly females. Also manuscript could benefit from broader international relevance, presenting WA as a case study, and relate back to national and international scope. Some minor comments are provided below. Abstract:Line 43: meaning young men attach to risk locations - not sure this can be part of your interpretation when most of your sample were female - suggest change to young adults?Introduction:General: much of the context is framed around young males, and yes they are a high risk demographic, your research would be stronger if it were framed more about young adults given the sample. Or even highlight that most research has been on young men - as opposed to young adults in general. I also think for an international scope, a broader context would be more beneficial before going into Australia and then WA. Also need to highlight that WA may not be representative of Australia etc..   Line 58: and at the beach (grammatical error) Methods:General:  Are the headings starting each paragraph?? i.e. Alcohol consumption. (line 123) may be better as a sub-heading?  Similar for resistance to peer influence and sensation seeking.Behaviour Scales would benefit from a brief overview of what they measure for readers who are not familiar with psychology.Line 112: Ethics approval numbers need to be added.Line 114: Subset (remove hyphen)Line 120: Why were sometimes and always combined? Line 157: Can you describe the score determination and direction of the score as you have for previous scales i.e. high score means greater risk perception??Line 164: Were there any collinearity issues across the three time points? Were responses similar in breadth etc. I can imagine that there may have been some diffferences between the 2019/20 cohort to the 2021 cohort? How did you account for this given the challenges experienced over this timeframe i.e. pandemic, bushfires etc... Line 174 onwards: Why select multiple separate forced binary logistic regressions? Were there benefits to this over say a multiple/hierachical/stepwise logistic regression analyses?  Results:Please report data in line with PLOSONE reporting guidelines https://journals.plos.org/plosone/s/submission-guidelines#loc-statistical-reporting . You cannot present 0 as a p-value. Please change to p<0.001. Please rectify this in the results text and the tables.    Discussion: The discussion seems to show how the results support previous research. However this missed the opportunity to demonstrate how the results extend what the previous research found. Again much focus on male behaviours and perceptions but your study is more than just men. In fact it is more the opposite thanks to your sample. I think your findings would be more novel if it capitalised on this, and showed how it could benefit Australia/international drowning practitioners.   Lines 280-300: This paragraph/s is/are great but, especially since current media is dismissed and seriousness of an event is not front of mind for participants who drank, i think it could be improved with the proposal of alternative messaging approaches that may differ e.g. swim reaper (Water Safety New Zealan), passive education at less chaotic developmental times (e.g. early childhood/primary school; see Lawes et al 2020 Risky business) , etc. For example how should intervention design and delivery differ in the context of these results.  Similarly, i have found mostly that, in an australian context alcohol is not just a young adult issue - it spans all ages... so effective messaging is so important and impact can be far reaching.  Line 306: waterways (needs an s)Line 311: do you mean mitigate instead of ameliorate?   ==============================

Please submit your revised manuscript by Oct 06 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

  • A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

  • A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

  • An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Jasmin C. Lawes, Ph.D.

Academic Editor

PLOS ONE

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at 

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and 

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. Please amend your current ethics statement to address the following concerns:

a) Did participants provide their written or verbal informed consent to participate in this study?

b) If consent was verbal, please explain i) why written consent was not obtained, ii) how you documented participant consent, and iii) whether the ethics committees/IRB approved this consent procedure.

3. In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. PLOS defines a study's minimal data set as the underlying data used to reach the conclusions drawn in the manuscript and any additional data required to replicate the reported study findings in their entirety. All PLOS journals require that the minimal data set be made fully available. For more information about our data policy, please see http://journals.plos.org/plosone/s/data-availability.

"Upon re-submitting your revised manuscript, please upload your study’s minimal underlying data set as either Supporting Information files or to a stable, public repository and include the relevant URLs, DOIs, or accession numbers within your revised cover letter. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. Any potentially identifying patient information must be fully anonymized.

Important: If there are ethical or legal restrictions to sharing your data publicly, please explain these restrictions in detail. Please see our guidelines for more information on what we consider unacceptable restrictions to publicly sharing data: http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Note that it is not acceptable for the authors to be the sole named individuals responsible for ensuring data access.

We will update your Data Availability statement to reflect the information you provide in your cover letter.

4. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: No

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: this manuscript aims to bring light to an important and still poorly understood issue regarding youth safety around water. I congratulate the authors for studying this subject in a very robust way providing evidence to base further decisions on intervention to prevent drowning in this age group.

Reviewer #2: Thanks for the opportunity to review Manuscript ID PONE-D-22-18336 entitled “Drinking and swimming around waterways: the role of alcohol, sensation-seeking,

peer influence and risk in young people” which was submitted for potential publication in PLOS ONE. This study uses a survey to explore young adults and their relationship with alcohol, peer influence, sensation seeking and perception of risk around waterways. This study is novel and a valuable contribution to the literature. It is well written but I have some specific suggestions for minor revisions. I look forward to seeing the publication in print in due course.

Abstract

Line 35 – incomplete sentence starting with – the final sample

Its such a heavily female sample, unsure about the specific reference to males in line 43

Introduction

Generally well written and referenced however, I didn’t see this study cited – it may be of relevance for the introduction and also the discussion - https://www.tandfonline.com/doi/full/10.1080/00049530.2022.2029221

Materials and methods

In the first section might be worth describing WA in more detail as PLOSONE is an international journal with an international audience

Survey measures – survey tool provided as supplementary?

Analysis – is there a brief explanation regarding why the T2 sample is so low compared to the others?

Results

Line 203 and again at line 210 and Table 2 and Table 3 – should p=0.000 for age not be reported as p<0.001?

Discussion

Line 235 – check and correct reference format here

Line 272 and 273 – needs references to named studies?

Line 306 – waterways not waterway

Strengths and limitations section – doesn’t appear to have any strengths? Perhaps the novel approach is a strength, if so expand upon this as currently written to make it clearer. It’s a novel combination of measures used in the survey so would encourage authors to highlight this!

Limitations – very female (mentioned), check if these are also adequately addressed. metro and highly educated sample. Were there covid or some other impacts on recruitment, especially T2?

Conclusions – no comments.

**********

6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PLoS One. 2022 Nov 4;17(11):e0276558. doi: 10.1371/journal.pone.0276558.r002

Author response to Decision Letter 0

21 Sep 2022

21092022

We have added the statement in Methods indicating written informed consent was obtained from the participants included in the study see line: 129-130. Thank-you

Response to reviewer comments

Thank-for to the Editor and both reviewers for your thoughtful comments and feedback. Each comment has been addressed below and in the attached updated manuscript (highlighted in yellow in the updated version). We look forward to your reply in due course.

Editor comments:

Comment 1:

1) I understand that you cannot share raw data but you will need to update the data sharing statement so that it fulfils the criteria as suggested. you need to let people know how they could access the data if they really wanted to. For example, data cannot be shared publicly because of XXX. Data are available from XXX (contact via XXX) for researchers who meet the criteria.

Reply 1: Thank-you. This has been amended and updated as suggested by the Editor in the submission portal.

General comments:

This paper provides a new contribution to understanding behaviours and perceptions of alcohol consumption and swimming within young people in Western Australia. The tools used are appropriate and interpretation is meaningful. Some concerns around interpretation and context development provided using young men but the sample population tested is predominantly females. Also manuscript could benefit from broader international relevance, presenting WA as a case study, and relate back to national and international scope. Some minor comments are provided below.

Response General comments:

Introduction: Paragraph 1 lines 49-55 an international context for drowning and young adults has been added to the opening paragraph. Please see the yellow highlighted text.

Paragraph 4: lines 79-81 highlight a recent review which has found most research is focused on males and children and this is an area that needs to expand to young adults. Where appropriate, overuse of the word males has been removed, and young adult has been used to provide a more balanced perspective. Lines 98-99, as per your suggestion we have added that more research on young adults, in general, is required.

Abstract:

Comment 1

Line 43: meaning young men attach to risk locations - not sure this can be part of your interpretation when most of your sample were female - suggest change to young adults?

Response 1: Thank-you this has been changed to young adults. See Abstract, line 43.

Introduction:

Comment 2

General: much of the context is framed around young males, and yes they are a high risk demographic, your research would be stronger if it were framed more about young adults given the sample. Or even highlight that most research has been on young men - as opposed to young adults in general.

Response 2: Thank-you we have changed the text to reflect those observations and added a recent review [1] which highlights a lack of research around females in HICs. See lines 79-81.

Comment 3

3a: I also think for an international scope, a broader context would be more beneficial before going into Australia and then WA. 3b: Also need to highlight that WA may not be representative of Australia etc..

Response 3a: Please see above. Paragraph 1 lines 49-55 an international context for drowning and young adults has been added to the opening paragraph. Please see yellow highlighted text.

Response 3b: Thank-you for the observation we had noted that in the limitations section. See lines 366-368, ‘First, data collection used the existing networks of the peak drowning prevention agency in one Australian state, consequently, the findings may not reflect the general young adult population’.

Comment 4

Line 58: and at the beach (grammatical error)

Response 4: This has been corrected see line now 67.

Methods:

Comment 5

General: Are the headings starting each paragraph?? i.e. Alcohol consumption. (line 123) may be better as a sub-heading? Similar for resistance to peer influence and sensation seeking.

Response 5: We have made these changes as suggested.

Comment 6

Behaviour Scales would benefit from a brief overview of what they measure for readers who are not familiar with psychology.

Response 6: A brief description has been added at lines 153-155 it reads (a scale is a composite measure that is composed of several items that have a logical structure among them) [2].

Comment 7

Line 112: Ethics approval numbers need to be added.

Response 7: These have been added see line 130 HR201/2014.

Comment 8

Line 114: Subset (remove hyphen)

Response 8: This has been removed. See subset – now line 132.

Comment 9

Line 120: Why were sometimes and always combined?

Response 9: The responses for “always’ (n=13) and ‘sometimes’ (n=281) were deemed appropriate to combine as we were interested if participants had ever taken part in the behaviour or not. The variable was from an existing scale which was also two categories (yes/no) see Moran K., 2011 [3].

Comment 10

Line 157: Can you describe the score determination and direction of the score as you have for previous scales i.e. high score means greater risk perception??

Response 10: All nine items from the Benthin scale were used as individual items only (i.e. an overall risk perception score was not calculated). The scale used and how each of the items are scored is described in full in the supplementary table S2, whereby 1 through 7 varies depending on the specific item, therefore a generic description 1 = low and 2 = high in the methods will not be helpful, it is better to refer the reader to the table. Please see lines 177-179. “The perception of risk score was calculated by averaging the individual response (1 through 7) for each item (see S2 Table for the full description of each of the nine items and their scales).” We are happy to include the S2 table into the methods if the Editor would prefer.

Comment 11

Line 164: Were there any collinearity issues across the three time points? Were responses similar in breadth etc. I can imagine that there may have been some diffferences between the 2019/20 cohort to the 2021 cohort? How did you account for this given the challenges experienced over this timeframe i.e. pandemic, bushfires etc...

Response 11: Thank you for the questions. The preliminary analysis confirmed there were no significant differences in behaviour by timepoint, thus, timepoints were combined for this paper. Whilst the response rate at T2 is smaller (potentially due to a short, one-off lockdown imposed in WA) responses were not significantly different from responses obtained at T1 or T3. Fortunately, WA did not experience the events seen on the east coast, i.e. bushfires, flooding and extended lockdowns.

Comment 12

Line 174 onwards: Why select multiple separate forced binary logistic regressions? Were there benefits to this over say a multiple/hierachical/stepwise logistic regression analyses?

Response 12: During preliminary analysis, several approaches to the logic regression were tested, including multiple and hierarchical logistic regression. Forced logistic regression provided the strongest and more refined predictive model.

Results:

Comment 13

Please report data in line with PLOSONE reporting guidelines https://journals.plos.org/plosone/s/submission-guidelines#loc-statistical-reporting . You cannot present 0 as a p-value. Please change to p<0.001. Please rectify this in the results text and the tables.

Response 13: Thank you for noting this. It has been updated in the text and tables. See lines 226, and 233 and Tables 1 and 2.

Discussion:

Comment 14

The discussion seems to show how the results support previous research. However this missed the opportunity to demonstrate how the results extend what the previous research found. Again much focus on male behaviours and perceptions but your study is more than just men. In fact it is more the opposite thanks to your sample. I think your findings would be more novel if it capitalised on this, and showed how it could benefit Australia/international drowning practitioners.

Response 14: Thank you for the suggestion. We have used our findings together with the suggested references Lawes et al 2020 (14 in text) [4] and Hamilton et al 2022 (22 in text) [5] to add text to the Discussion to better describe how future drowning prevention interventions could benefit from these insights. See lines 297, 303 and 323, 328.

Specific changes: Discussion paragraph 1 – lines 261 to 263 additional text added that the study findings are novel as it includes both a male and female perspective. Now reads ‘The findings in this study are novel, and extend a small but growing body of literature that examines the complex socio-cultural relationships in and around waterways, and the meaning that both young male and female adults attach to these factors’.

Paragraph 2 –females were overrepresented in the study, we have added a recent systematic review and Australian study that found females were increasing their risk taking when consuming alcohol around waterways to complement the male perspective in this paragraph. See lines 269 to 271 ‘Of interest, in this study young females were over-represented providing an interesting and previously untapped insight into the female perspective on the role of peers and sensation seeking’ and Paragraph 3 lines 290- 291 ‘Females are also engaging in high-risk behaviours and activities in aquatic locations similar to males, such as ingesting alcohol in aquatic locations [1, 6]’

Comment 15

Lines 280-300: This paragraph/s is/are great but, especially since current media is dismissed and seriousness of an event is not front of mind for participants who drank, i think it could be improved with the proposal of alternative messaging approaches that may differ e.g. swim reaper (Water Safety New Zealan), passive education at less chaotic developmental times (e.g. early childhood/primary school; see Lawes et al 2020 Risky business), etc. For example how should intervention design and delivery differ in the context of these results.

Response 15: Thank-you for these suggestions. We have added your reference Lawes et al. 2020 [4] to both the introduction and the discussion. Please see lines 322 – 328 for additional text to address alternative messaging including environmental cues and the Swim Reaper NZ campaign as a novel and appropriate approach. It now reads “Recent research suggests the use of passive messaging using to place drowning prevention top of mind (14). For example, in the New Zealand Swim Reaper campaign, young people are specifically reached via geo-targeted messages using Instagram and other social channels. Safety signage is also placed at selected locations where drownings occur (47). The targeted placement of media messages using digital technology together with environmental cues are vital to highlight the consequences of alcohol during aquatic activities (14, 22).”

Comment 16

Similarly, i have found mostly that, in an australian context alcohol is not just a young adult issue - it spans all ages... so effective messaging is so important and impact can be far reaching.

Response 16: Thank-you for your insights.

Comment 17

Line 306: waterways (needs an s)

Response 17: This has been corrected see line 342 now reads …waterways.

Comment 18

Line 311: do you mean mitigate instead of ameliorate?

Response 18: Thank-you for the pickup. Replaced with mitigate see line 348 now.

--------------------------------------------------------------------------------------------------------------------------------------------------------------------

Reviewer #1: this manuscript aims to bring light to an important and still poorly understood issue regarding youth safety around water. I congratulate the authors for studying this subject in a very robust way providing evidence to base further decisions on intervention to prevent drowning in this age group.

Response: Thank-you for your comments on our paper, they are most appreciated.

--------------------------------------------------------------------------------------------------------------------------------------------------------------------

Reviewer #2: Thanks for the opportunity to review Manuscript ID PONE-D-22-18336 entitled “Drinking and swimming around waterways: the role of alcohol, sensation-seeking, peer influence and risk in young people” which was submitted for potential publication in PLOS ONE. This study uses a survey to explore young adults and their relationship with alcohol, peer influence, sensation seeking and perception of risk around waterways. This study is novel and a valuable contribution to the literature. It is well written but I have some specific suggestions for minor revisions. I look forward to seeing the publication in print in due course.

Response 1: Thank-you for your comments on our paper, please see our specific responses below.

Abstract

Comment 2

Line 35 – incomplete sentence starting with – the final sample

Response 2a: Line 35-37 has been updated to read ‘ The final sample (n =730) participants, consisted of females (n=537, 74.5%), metropolitan dwelling (n=616, 84.4%) and attended university (n=410, 56.9%).

Its such a heavily female sample, unsure about the specific reference to males in line 43

Response 2b: We agree and is consistent with the Editor’s comment has been changed to young adults see line 43

Introduction

Comment 3

Generally well written and referenced however, I didn’t see this study cited – it may be of relevance for the introduction and also the discussion - https://www.tandfonline.com/doi/full/10.1080/00049530.2022.2029221

Response 3: Thank-you for the additional reference which we have used in the introduction line 71, 73 ( is ref 22 [5] in Introduction) lines 327-329 highlighting the need for digital and app based strategies to highlight the consequences of alcohol use around waterways. See (ref 22 also used in the Discussion)

Materials and methods

Comment 4

In the first section might be worth describing WA in more detail as PLOSONE is an international journal with an international audience

Response 4: Thank-you for your comment, we have added some Western Australian specific context lines 114 to 118 , see ‘This research was undertaken in Perth, the state capital of Western Australia (WA) on the west coast of Australia. WA is Australia’s largest geographical state with a population of 2,660,026 mainly residing along the coast [7]. The southwest coastal area (where Perth is located) has a temperate climate and summer occurs between the months of December–March [8]’.

Comment 5:

Survey measures – survey tool provided as supplementary?

Response 5: The authors may be contacted for a copy of the full survey.

Comment 6:

Analysis – is there a brief explanation regarding why the T2 sample is so low compared to the others?

Response 6: T2 data collection commenced during the Western Australian COVID19 lockdown in March 2021. All borders remained closed for an extended period, social distancing impacted recruitment methods e.g. public outdoor events for young adults, Orientation days at universities and aquatic industry events were shut-down making recruitment very difficult. Now added as a limitation, see lines 370-371.

Results

Comment 7

Line 203 and again at line 210 and Table 2 and Table 3 – should p=0.000 for age not be reported as p<0.001?

Response 7: Thank you for noting this. It has been updated and corrected in the text and the tables in the manuscript. Please see the comment above.

Discussion

Line 235 – check and correct reference format here Response: The Sinkinson, 2014 reference has been updated and is now ref 40

Line 272 and 273 – needs references to named studies? Response: We have added the number however I am not 100% sure they are needed here. Refs 13 and 43 are now in the text. Now line 302 and we have also added Hamilton et al., 2022 to this sentence.

Line 306 – waterways not waterway Response: Thank you the s has been added to waterways now at line 342

Comment 8.

Strengths and limitations section – doesn’t appear to have any strengths? Perhaps the novel approach is a strength, if so expand upon this as currently written to make it clearer. It’s a novel combination of measures used in the survey so would encourage authors to highlight this!

Response 8: Thank you for your suggestion. This section has been rewritten and the strengths highlighted, see lines 375 – 379. The text now reads “The strengths of this study include the novel use of predictor variables to examine behaviour in and around waterways. To the best of the authors’ knowledge, this is the first study to examine the specific predictor variables in the drowning prevention literature; and the findings contribute to a small but growing evidence base examining the individual and sociocultural factors contributing to drowning risk for young adults”

Comment 9:

Limitations – very female (mentioned), check if these are also adequately addressed. metro and highly educated sample. Response 9a: please see line we mention 371-372 where we mention metropolitan dwelling and university educated were over represented.

Were there covid or some other impacts on recruitment, especially T2?

Response 9b: We have now added COVID 19 border shutdowns in March-April, 2021 as a limitation for data collection at T2. See lines 370-371.

Conclusions – no comments.

Thank-you.

References

1. Roberts K, Thom O, Devine S, Leggat PA, Peden AE, Franklin RC. A scoping review of female drowning: an underexplored issue in five high-income countries. BMC Public Health. 2021;21(1):1072. doi: 10.1186/s12889-021-10920-8.

2. Loewenthal KM, Lewis CA. What is a good psychological measure? An introduction to psychological tests and scales (3rd ed)2020. p. 1-22.

3. Moran K. (Young) Men behaving badly: dangerous masculinities and risk of drowning in aquatic leisure activities. Annals of Leisure Research. 2011;14(2-3):260-72.

4. Lawes JC, Ellis A, Daw S, Strasiotto L. Risky business: a 15-year analysis of fatal coastal drowning of young male adults in Australia. Injury Prevention. 2021;27(5):442. doi: 10.1136/injuryprev-2020-043969.

5. Hamilton K, Keech JJ, Willcox - Pidgeon S, Peden AE. An evaluation of a video-based intervention targeting alcohol consumption during aquatic activities. Australian Journal of Psychology. 2022;74(1):2029221. doi: 10.1080/00049530.2022.2029221.

6. Peden AE, Franklin RC, Leggat PA. Breathalysing and surveying river users in Australia to understand alcohol consumption and attitudes toward drowning risk. BMC Public Health. 2018;18(1):1-18.

7. Australian Bureau of Statistics. Western Australia 2021 All persons Quick Stats. Canberra2021.

8. Australian Bureau of Meterology. Nyoongar Weather Calendar. 2016.

Attachment

Submitted filename: Reviewer reply R1_14092022.docx

Click here for additional data file. (34.5KB, docx)

Decision Letter 1

Jasmin C Lawes

10 Oct 2022

Drinking and swimming around waterways: the role of alcohol, sensation-seeking, peer influence and risk in young people.

PONE-D-22-18336R1

Dear Dr. Leavy,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Jasmin C. Lawes, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Acceptance letter

Jasmin C Lawes

13 Oct 2022

PONE-D-22-18336R1

Drinking and swimming around waterways: the role of alcohol, sensation-seeking, peer influence and risk in young people.

Dear Dr. Leavy:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

If we can help with anything else, please email us at plosone@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Jasmin C. Lawes

Academic Editor

PLOS ONE

Associated Data

    This section collects any data citations, data availability statements, or supplementary materials included in this article.

    Supplementary Materials

    S1 Table. Resistance to Peer Influence scale (RPI).

    (TIF)

    Click here for additional data file. (876.8KB, tif)
    S2 Table. Benthin’s perception of risk scale.

    (TIF)

    Click here for additional data file. (217.9KB, tif)
    Attachment

    Submitted filename: Reviewer reply R1_14092022.docx

    Click here for additional data file. (34.5KB, docx)

    Data Availability Statement

    Data cannot be shared publicly because of ethical and contractual requirements between Curtin University, Royal Life Saving Society Western Australia and Department of Health, Western Australia. Data are available from the Curtin University Human Research Ethics Committee (HREC) contact via hrec@curtin.edu.au for researchers who meet the criteria for access to confidential data.

    Articles from PLOS ONE are provided here courtesy of PLOS

    RESOURCES