Recreational tourism injuries among visitors to New Zealand: an exploratory analysis using hospital discharge data
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Tourism Management 22 (2001) 373}381
Recreational tourism injuries among visitors to New Zealand:
an exploratory analysis using hospital discharge data
Tim Bentley , Denny Meyer, Stephen Page *, David Chalmers
Centre for Occupational Human Factors Ergonomics, Forest Research, Sala Street, Private Bag 3020, Rotorua, New Zealand
Department of Statistics, Massey University-Albany, Private Bag 102 904, Auckland, New Zealand
Department of Marketing, University of Stirling, Stirling, Scotland FK9 4LA, UK
Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of Otago, PO Box 913, Dunedin, New Zealand
Received 8 November 1999; accepted 26 May 2000
Abstract
New Zealand Health Information Service (NZHIS) morbidity data for the 15-year period, 1982}1996, were analysed to determine
the role of recreational and adventure tourism in overseas visitor injuries, and identify recreational activities with greatest injury
occurrence. Approximately 19 per cent of all injuries involved recreational/adventure tourism activities, corresponding to 8.4 injuries
per 100,000 overseas visitor arrivals. This "gure can be compared to that for motor vehicle tra$c accidents (12), and suggests
a signi"cant recreational tourism injury problem in New Zealand. Injuries were concentrated in regions known to be major centres for
adventure tourism in New Zealand, and were most commonly sustained by overseas visitors aged between 20 and 40 years. Tourist
injuries were observed most frequently for activities that involve independent, unguided recreation, notably skiing, mountaineering
and tramping. Of the commercial adventure tourism activities, horse riding and cycling were the only signi"cant contributors to
overseas visitor injuries. 2001 Elsevier Science Ltd. All rights reserved.
Keywords: Adventure tourism; Recreational tourism; Tourist safety
1. Introduction Hargarten, Baker, & Guptill, 1991; Paixao, Dewar, Cos-
sar, & Reid, 1991; Nichol et al., 1996; Page & Meyer,
The health needs of international tourists place a con- 1996, 1997; Wilks, 1999). Moreover, tourists appear more
siderable burden on the health and safety services of likely to be injured or killed as a result of incidents while
tourism destinations (Wilks & Oldenburg, 1995; Nichol, overseas than when in their country of residence (Hargar-
Wilks, & Wood, 1996). As destinations such as Australia ten et al., 1991), and international visitors require hospi-
and New Zealand experience considerable growth in talisation due to injury more commonly than interstate
their tourism markets, there is an increasing need to visitors or local residents (Nichol et al., 1996). Despite
understand the health and safety needs of overseas tour- these "ndings, the tourist safety literature is very limited.
ists. Central to achieving this understanding is the identi- It does, however, o!er a number of explanations for this
"cation of health and safety problems most frequently increased injury risk amongst overseas travellers. These
experienced by overseas visitors (Wilks & Atherton, can be broadly grouped into the following factors:
1994; Bentley, Page, & Laird, 2000).
International research has consistently recognised E exposure to unfamiliar road, marine, mountain,
unintentional injury as a leading cause of tourist wilderness and built environments (Johnston, 1989;
morbidity and mortality (Hartung, Goebert, Taniguchi, Guptill et al., 1991; Philipp & Hodgkinson, 1994;
& Okamoto, 1990; Guptill, Hargarten, & Baker, 1991; Wilks & Atherton, 1994; Wilks & Watson, 1998);
E increased time spent engaged in activities for which
there is a risk of injury, particularly driving (Wilks,
* Corresponding author. Tel.: #44-1786-466451; fax: #44-1786- Watson, & Faulks, 1999);
464745. E exposure to unfamiliar activities such as driving on the
E-mail address: s.j.page@stir.ac.uk (S. Page). other side of the road (Guptill et al., 1991; Page
0261-5177/01/$ - see front matter 2001 Elsevier Science Ltd. All rights reserved.
PII: S 0 2 6 1 - 5 1 7 7 ( 0 0 ) 0 0 0 6 3 - 7374 T. Bentley et al. / Tourism Management 22 (2001) 373}381
& Meyer, 1996; Wilks et al., 1999), marine tourism dents (overseas visitors to New Zealand) over a 15-year
(Wilks & Atherton, 1994) and adventure tourism (Page period: 1982}1996. The aims of the study were to quan-
& Meyer, 1996, 1997; Bentley et al., 2000); tify the role of recreational activities in overseas visitor
E relaxed attitudes towards risk and reduced inhibitions hospital admissions, to compare recreational tourism
among holiday-makers (Cossar et al., 1990; Philipp with motor vehicle tra$c accidents as a major cause of
& Hodgkinson, 1994; Ryan, Robertson, & Page, 1996). overseas visitor morbidity, and to identify recreational
activities for which highest frequencies of injuries were
Tourist accidents can have a profound e!ect on the sustained.
image of a country's tourism industry, and the selection
of tourist destinations by potential holiday-makers
(Bovet, 1994; Wilks, Pendergast, & Service, 1996; World 2. Method
Tourism Organisation, 1996). Nowhere is this better il-
lustrated than in the adventure tourism industry, for The data source used was the Ministry of Health's
which major negative events, such as the 1999 canyoning New Zealand Health Information Service (NZHIS) pub-
incident in Switzerland, can have signi"cant long-term lic hospital morbidity data "les, routinely collated on all
social and economic impacts on the industry and com- discharges from public hospitals. The data set contained
munities whose economies are dependent upon tourism. information about all non-resident discharges from pub-
Adventure tourism is a rapidly expanding sector of the lic hospitals throughout New Zealand, for the period
New Zealand tourism industry (Berno & Moore, 1996), 1982}1996. The large majority of cases included in the
and an increasing number of visitors seek adventure analysis were tourist injuries, with a small but unknown
activity during their stay in New Zealand (Major, 1995). proportion of cases involving non-residents working o!-
There is growing evidence that adventure and recre- shore (mostly "shing and other vessel crew), and persons
ational injuries make a signi"cant contribution to over- working in New Zealand on overseas visitor work
seas visitor morbidity and mortality in New Zealand permits.
(Bentley et al., 2000; Page & Meyer, 1996, 1997). More- Table 1 gives details of variables considered in the
over, some New Zealand adventure activities, notably analysis, together with an explanation of how each vari-
white water rafting, scenic #ights and mountain recre- able was derived from the data set, and whether variables
ation, appear to present signi"cant risks of serious and had missing cases (variables were only considered where
fatal injury to clients (Johnston, 1989; Hall & data were available for more than 50 per cent of cases).
McArthur, 1991; McLaughlan, 1995; Greenaway, 1996). The circumstances of injuries were coded according to
Recent research by the present authors, however, has the International Classi"cation of Diseases: External
suggested that it is adventure activities with lower levels Causes of Injury and Poisoning (Commission on Profes-
of &perceived risk' associated with them which may have sional and Hospital Activities). The numerous 3-digit
highest &actual' injury risk, when all levels of injury sever- E-code values found within the data set were collapsed
ity are considered. Some 142 New Zealand adventure into 17 event groups, providing a variable more suitable
tourism operators, representing 21 di!erent activity sec- for analysis. For example, the event group &falls from
tors, were asked by postal questionnaire to document the a height' and &falls on the level' was derived from E-codes
number of minor and serious injuries experienced by 880}888, and included E-codes denoting &fall on or from
clients of their activity during the previous 12-month stairs or steps', &fall into hole or other opening in surface',
period. Using activity exposure data supplied by oper- and &fall from one level to another' and &fall on the same
ators (duration of activity and travel to and from activity level from slipping, tripping, or stumbling'.
location), client injury-incidence rates were determined Recreational tourism activities were identi"ed from
for each activity sector. Highest client injury-incidence content analysis of the &one-line' event descriptions. Thus,
rates were found for cycle touring, quad biking, horse for relevant event group categories (i.e. motor vehicle
riding and caving (Bentley et al., 2000). The authors note non-tra$c accidents; cycles; animals; watercraft; avi-
that operators reporting the highest incidence of injuries ation; falls from a height and on the level; struck by/strike
o!ered activities which involved the risk of falling from against object or person), the &one-line' descriptions of
a height whilst in motion. Furthermore, activities with accident circumstances were examined to determine the
highest reported incidence of injury came from sectors involvement of recreational activities. Where insu$cient
which did not have a high level of perceived risk asso- information was contained in the &one-line' event descrip-
ciated with them, did not come under the jurisdiction of tions, cases were recorded as &unspeci"ed' (e.g. &unspeci-
any government authority, and were not the subject of "ed boat/ship'; &unspeci"ed aircraft' as detailed later in
any regulatory code of practice. Table 3).
The present study builds on this work, considering the The geographical location of overseas visitor injuries
role of recreational and adventure tourism in public within New Zealand had to be determined indirectly
hospital injury admissions for non-New Zealand resi- from information on the hospital to which the injuredT. Bentley et al. / Tourism Management 22 (2001) 373}381 375
Table 1
Variables considered in the analysis of overseas visitor injuries
Variables considered in the analysis Where data were derived Example of variable Missing
cases
Place of occurrence Location code Farm, road, place for sport or recreation, Yes
home
Event First 3 digits of E-code Motor vehicle tra$c accident, watercraft, No
fall on the level, animal
Recreational/adventure tourism Event description (&one-line' description &hang glider blown to ground'; &fell while No
activity of injury circumstances provided in skiing'; &thrown from a horse'
narrative "elds)
Hospital days Number of days stay in hospital 2 days No
Injury severity score Injury severity score code 1"minor, 2"moderate, 3"serious, Yes
4"severe
Geographical region Hosptial code of hospital injured visitor Hospital number (e.g. Dunedin, No
was admitted to Christchurch)
Year of injury Year of discharge 1982}1996 No
Month of injury Month of injury January Yes
Age group Age Precise age of injured visitor No
Gender Gender of injured visitor Male No
Table 2 Data on the nationality of injured overseas visitors
Overseas visitor injury incidence: 1982}1996 were insu$ciently complete to undertake a worthwhile
analysis, this being a major limitation of the study. Data
Year Overseas visitor Hospital Injury-incidence
arrivals admissions rate were prepared for analysis as described above, and de-
(;10) scriptive analysis of the data set was undertaken using
n % SAS Version 6.12. Crosstabular analysis and correspond-
ence analysis (Greenacre, 1984) were applied as appropri-
1982 472.6 173 3.0 37 ate to the variables described in Table 1. Correspondence
1983 487.7 245 4.2 50
1984 518.4 243 4.1 47 analysis is a multidimentional scaling method for spa-
1985 570.0 291 5.0 51 tially portraying categorical data, originally expressed
1986 689.1 304 5.2 44 as crosstabulations. Row and column labels are repre-
1987 763.2 379 6.5 50 sented as points in a joint space in which interpoint
1988 855.5 310 5.3 36 distances can be related to the row}column association
1989 867.5 383 6.5 44
1990 993.4 444 7.6 45 (Greenacre, 1984).
1991 967.1 423 7.2 44
1992 999.7 492 8.4 49
1993 1086.6 589 10.0 54 3. Results
1994 1213.3 606 10.3 50
1995 1343.0 454 7.7 34
1996 1441.8 527 9.0 37 3.1. Incidence of overseas visitor hospital admissions:
1982}1996
Total 13,268.9 5863 100 44
Some 5863 overseas visitors were admitted to New
Source: Statistics New Zealand. Zealand public hospitals as a result of injury during the
Injuries per 100,000 arrivals.
14-year period, 1982}1996. Injury-incidence rates (per
100,000 overseas visitor arrivals) were calculated for each
person was admitted. The many hospital codes found in year, 1982}1996, and are shown in Table 2.
the data set were collapsed into 16 regional groups to No notable trends across time were observed for over-
allow for a manageable analysis of the spatial distribu- seas visitor hospital admissions, although data for 1995
tion of injury events. This method of identifying event and 1996 suggest that injury rates may be falling. The
location will have produced a small but unknown degree overall incidence rate of 44 injuries per 100,000 overseas
of error, as patients may, in some cases, have been trans- visitor arrivals indicates that approximately one in every
ferred to hospitals in other regions, or may have been 2300 overseas visitors was admitted to hospital with an
admitted to hospital later in their holiday as the extent of injury during their stay in New Zealand. Many of these
their injury became apparent. Nevertheless, it is reason- cases did not involve serious injuries, however. Indeed,
able to assume that the location of the incident would, in one-half of visitors were hospitalised for a period of two
most cases, correspond to the hospital of admission. days or less, while 80 per cent spent less than 10 days in376 T. Bentley et al. / Tourism Management 22 (2001) 373}381
Table 3
The role of recreational and adventure tourism in overseas visitor injury morbidity: 1982}1996
Event group n % Recreational/adventure n % % (all cases)
tourism activities
Motor vehicle tra$c 1604 27.4
Motor vehicle non-tra$c 59 1.0 Quad/farm bikes 18 30.5 0.3
Pedal cycle 165 2.8 Road cycling 95 57.6
Mountain biking 13 7.9 0.2
Other/unclassi"ed 57 34.5
Animal-related 174 3.0 Horse (fell from) 153 87.9 2.6
Horse (kicked by) 18 10.3 0.3
Bull (rodeo) 3 1.8 0.05
Watercraft-related 320 5.5 White water raft 46 14.5 0.8
Jet boat 21 6.6 0.4
Kayak/canoe 3 1.0 0.05
Diving 3 1.0 0.05
Crew/"shing boat 115 36.0
Unspeci"ed boat/ship 132 41.6
Aviation-related 100 1.7 Parapenting/gliding 27 27.0 0.5
Skydiving 23 23.0 0.4
Glider/unpowered 5 5.0 0.08
Hang glider 4 4.0 0.06
Crew/work-related 4 4.0
Unspeci"ed aircraft 24 24.0
Helicopter 13 13.0
Falls from a height/falls on the 2027 34.6 Skiing/snowboarding 344 17.0 5.9
same level Mountaineering/tramping 260 12.9 4.4
Luge 24 1.1 0.4
Flying fox 18 1.0 0.3
Parapenting 9 0.4 0.2
White water rafting 5 0.2 0.08
Playground activity 40 2.0
Swimming pool/spa 27 1.3
Struck by/strike against object 325 5.5 Skiing/snowboarding 20 6.2 0.3
or person Mountaineering/tramping 10 3.1 0.2
Rugby/other sports 108 33.2
Other (non-recreational events) 1089 18.6
Total 5863 100 Total estimated adventure tourism 1027 17.5
Recreational/adventure tourism activities determined from content analysis of &one-line' descriptions of accident circumstances provided in narrative
"elds. Recreational/adventure tourism activities shown in italics.
hospital. Just 10 per cent of cases required more than &unspeci"ed place'. It seems reasonable to assume, in the
15 days hospitalisation. These "ndings were re#ected in absence of any information from which injury location or
the distribution of injury severity scale classi"cations activity could be determined, that 15 per cent of these
(see Table 1), with just 17 per cent of cases classi"ed as unspeci"ed cases were recreational (i.e. the same propor-
&serious', and 1 per cent as &severe'. The majority of cases tion of cases are assumed to be recreational as observed
were classi"ed as &moderate' injuries (51 per cent). for the total &known' cases). Based on this assumption, it
is estimated that the actual proportion of overseas visitor
3.2. The role of recreational/adventure activity injuries occurring in a &place for recreation and sport' is
in overseas visitor injury likely to be approximately 22 per cent. This suggests an
overall sport and recreation injury-incidence rate of ap-
Approximately 15 per cent of overseas visitor injuries proximately 10 injuries per 100,000 overseas visitors.
were sustained at a &place for recreation and sport', with Sport and recreation injury-incidence rates were also
other signi"cant injury locations being &street or high- calculated for each year of the analysis. No notable
way' (13.5 per cent), &home' (7.1 per cent) and &public trends were observed in the annual incidence rates, which
building' (4.4 per cent). In a large number of cases closely correlated with those for all overseas visitor
(n"2785, 47.5 per cent) the injury location was coded as injuries shown in Table 2.T. Bentley et al. / Tourism Management 22 (2001) 373}381 377 Analysis by Event (determined from analysis of 3-digit groups involved hospital stays of over 10 days, compared event description E-codes and information extracted with between 5 and 10 per cent for the other event group from narrative "elds) allowed for a more detailed identi- categories. Shortest hospital stays were observed for "cation of the role of recreational/adventure activities in cycle and horse-riding injuries. Injury severity score clas- overseas visitor injury. Table 3 shows &event group' to- si"cations generally supported these "ndings, with rela- gether with a breakdown of recreational activities within tively high proportions of injuries classi"ed as &serious' or each event group. Recreational/adventure tourism &severe' found for motor vehicle tra$c accidents (seri- activities are presented in italics. ous"32 per cent; severe"2.0 per cent) and aviation- The largest event group category was falls (from related injuries (serious"23 per cent; severe"2.5 per a height and on the level), followed by motor vehicle cent). Surprisingly, some 27 per cent of horse riding tra$c accidents. The distribution of recreational/adven- injuries were classi"ed as &serious', this "gure being at ture tourism activities within &falls' and other non-tra$c odds with the relatively short hospital stays of overseas event groups, suggests that these activities make a signi"- visitors with horse riding-related injuries. cant contribution to hospital injury admissions among overseas visitors. The major recreational activities were 3.3. The spatial distribution of overseas visitor injuries skiing/snowboarding (n"364; 6.2 per cent of all injury cases), mountaineering/tramping (n"270; 4.6 per cent), The spatial distribution of overseas visitor injuries horse riding (n"171; 2.9 per cent) and cycling (n"165; within New Zealand was determined indirectly from hos- 2.8 per cent), although the proportion of cycle injuries pital codes (denoting the location of the hospital the sustained during organised cycle tours (rather than non- injured person was admitted to). Table 4 shows the commercial/organised use) cannot be precisely deter- distribution of geographical region and major place of mined from these data. Water-based activities included occurrence categories for each region. white water rafting (n"51; 0.8 per cent) and jet boating The region with the largest count of overseas visitor (n"21; 0.4 per cent), although the proportion of adven- hospital admissions was Auckland (n"1358; 23 per ture tourism-related injuries involving &unspeci"ed cent), followed by Otago (n"934; 15.9 per cent), Canter- boats/ships' cannot be determined. Aviation-related ac- bury (n"760; 13 per cent) and Rotorua (n"416; 7 per tivities included parapenting/gliding (n"36; 0.9 per cent) cent). These "gures re#ect the common pattern of travel and skydiving (n"23; 0.4 per cent). The incidence of by international tourists in New Zealand (Page & Thorn, scenic #ight injuries among helicopter and aircraft cases 1997). The high proportion of Auckland hospital admis- is unknown. sions is probably a re#ection of the fact that Auckland is The total contribution of recreational tourism activity the main gateway to New Zealand (Page & Hall, 1999), to overseas visitor injuries for the period 1982}1996 and the large numbers of overseas arrivals who stay with comprised some 1027 events, representing 17.5 per cent friends and relatives or undertake business trips in the of all overseas visitor injuries. It is likely that this total Auckland area. under-represents the true involvement of recreational Turning to the distribution of place of occurrence cat- activity in overseas visitor injury however, as an un- egories within these regional areas, it is notable that known proportion of unclassi"ed/unspeci"ed events higher proportions of sport and recreation injuries occur- (particularly &unspeci"ed' cycle, watercraft and aviation red in those regions known to be the major centres for events in Table 2) may have been recreational/adventure adventure tourism activity in New Zealand: Rotorua, tourism-related. Based on the assumption that 17 per Central North Island, Canterbury, Otago and South- cent of all such events were recreational/adventure land. In support of the role of recreational tourism in tourism-related, an adjusted total of 1109 recreational overseas visitor injury incidence, 8 per cent of all cases events was obtained, representing approximately 19 per were admitted to hospitals in the Queenstown (Central cent of overseas visitor injuries. This "gure suggests an Otago) area; Queenstown promotes itself as the capital of overall recreational tourism injury-incidence rate of ap- outdoor recreation and adventure tourism activity in New proximately 8.4 injuries per 100,000 overseas visitors. Zealand (Berno & Moore, 1996; Page & Hall, 1999). This contribution to overseas visitor morbidity is con- In order to consider the spatial distribution of speci"c siderable, as demonstrated when weighed against that for activities, a simple correspondence analysis (Greenacre, motor vehicle tra$c accidents (12 injuries per 100,000 1984) was undertaken on event group and place of occur- overseas visitors), an activity for which there is signi"- rence variables. Fig. 1 explains 77 per cent of the associ- cantly higher exposure amongst the tourist population. ation between these variables, and indicates a number of The event groups shown in Table 3 varied consider- regional &hot spots' for recreational/adventure tourism ably in terms of injury severity. Length of hospital stay event groups. The association between the event group data suggested that the most serious injuries were sus- and place of occurrence variables can be identi"ed using the tained in motor vehicle tra$c accidents and aviation proximity of labels. Labels which are close together suggest incidents. Some 25 per cent of injuries from these event associations between the corresponding categories.
378 T. Bentley et al. / Tourism Management 22 (2001) 373}381
Table 4
Place of occurrence categories by geographic region
Region Total Sport and Road Home Public building Other
recreation % % % %
n % %
North Island
Northland 400 6.8 9.4 28.1 11.2 3.9 47.5
Auckland 1358 23.2 9.3 13.7 15.0 6.7 55.3
Waikato 233 4.0 16.7 33.5 13.5 1.6 34.7
Bay of Plenty/Coromandel 173 3.0 14.8 16.3 20.7 1.5 46.7
Eastland/Rotorua 416 7.1 36.7 16.1 6.8 12.0 29.4
Central North Island 138 2.4 26.3 13.2 11.0 5.5 44.0
Hawkes Bay 119 2.0 14.3 28.6 8.6 4.3 44.2
Wairapapa/Wanganui/ 197 3.4 18.8 17.3 10.5 6.8 46.6
New Plymouth
Wellington 112 1.9 12.1 12.1 15.7 6.0 54.1
South Island
Marlborough/Abel Tasman 210 3.6 8.1 21.0 12.8 4.7 53.4
West Coast 267 4.6 8.7 31.6 1.0 5.1 53.6
Canterbury 760 13.0 25.5 14.4 5.7 5.5 48.9
Otago 934 15.9 35.5 12.1 6.7 6.6 41.4
Southland/Fiordland 483 8.2 26.2 27.7 2.1 4.4 39.6
Other 63 1.1 12.0 30.0 10.0 0.0 48.0
Total 5863 100
Fig. 1. Correspondence analysis showing association between event group and place of occurrence.
Otago, Canterbury and Southland appear to be asso- 3.3.1. The seasonal incidence of overseas visitor injury
ciated with slip, trip and fall accidents (many of which Almost one-half of injuries to overseas visitors occur-
involved skiing, mountaineering or tramping), watercraft red during the main summer months of December (11.7
and aviation accidents, while pedal cycle injuries are per cent of cases), January (12.2 per cent), February (12.3
most closely associated with Rotorua (home to several per cent) and March (11.2 per cent). Monthly injury-
mountain biking routes), and horse riding (animal) inju- incidence rates (per 100,000 overseas visitors) were deter-
ries with Marlborough. mined for the years 1989}1996. Highest injury rates were
No notable trends in the geographical distribution of observed for the peak summer months, with injury rates
overseas visitor injury over time were observed, except of at least "ve per 100,000 overseas visitors for Jan-
for a considerable increase in admissions to Otago hospi- uary}March. Interestingly, injury-incidence rates were
tals compared to other regions for the six-year period, signi"cantly lower for the month of December (3.6).
1985}1990, when between 16 and 22 per cent of all injury A second peak in injury-incidence rates was observed for
cases were located in Otago. the winter months, July (4), August (4.5) and SeptemberT. Bentley et al. / Tourism Management 22 (2001) 373}381 379
Table 5
Age group by gender of injured overseas visitor
Age group (year) Total Male Female
(%) (%) (%)
0}9 7.0 58.0 42.0
10}19 10.3 64.1 35.9
20}29 29.4 61.5 38.5
30}39 14.9 65.6 34.4
40}49 9.6 60.0 40.0
50}59 9.2 45.0 55.0
60# 19.8 31.9 68.1
Total 100 54.6 45.4
Fig. 2. Major place of occurrence categories by month of injury.
(4). Lowest overseas injury-incidence rates were observed
for May, October and November (all 3.1).
Further analysis considered the relationship between
the month in which the injury occurred and the place of
injury occurrence. Fig. 2 shows the distribution of major
place of occurrence categories for each month.
Sport and recreation injuries increased sharply over
the winter sports season (July}September), peaking at
over 22 per cent of all injuries in August. It is interesting
to note the inverse relationship between sport and recre-
ational injuries and those sustained on the road and at Fig. 3. Major place of occurrence categories by age group.
home, with a marked increase in home and road acci-
dents during peak visitor periods: December through ysis revealed that 25 per cent of injuries to males occurred
February. Further analysis highlighted the role of winter in a &place for recreation and sport', compared to just 15
sports in overseas visitor injury incidence, with highest per cent of female injuries.
counts of winter injuries found for the major skiing/moun- Fig. 3 shows the distribution of injuries for the major
tain recreation locations. These were Central North Is- place of occurrence categories by age group. Peaks in
land, Canterbury, Otago and Southland/Fiordland, while sport and recreation injuries (40 per cent of sport and
other tourist destinations (e.g. Auckland and Rotorua) had recreation injuries) and road injuries (30 per cent of road
highest injury incidence during the summer months. injuries) were observed for overseas visitors in the 20}29
years age group. By contrast, elderly visitors more com-
3.4. The incidence of injury in overseas visitor population monly experienced injuries in the home.
groups The distribution of event groups by gender suggests
a clear delineation between the types of adventure
The highest incidence of injury was found for overseas tourism-related activities male and female overseas visi-
visitors in the 20}30 years age range (29 per cent of all tors were undertaking at the time of their injury. Fe-
hospital admissions), while about one-"fth of all overseas males, for example, were considerably over-represented
visitor injuries were experienced by those aged 60 years amongst horse riding accidents, contributing some 72 per
and over. Table 5 shows the distribution of cases by age cent of injuries resulting from falls from horses. Male
group and gender of injured person. A marked relation- overseas visitors, on the other hand, were over-represent-
ship between age and gender is evident, with young and ed in cycle (65 per cent of all cycle injuries); watercraft (70
middle-aged males and older female overseas visitors per cent); aviation (64 per cent) and struck by/strike
sustaining higher proportions of injuries. The greater against events (many of which were contact sports inju-
incidence of injuries among younger male visitors can ries) (72 per cent). These "ndings, together with those for
probably be explained by greater male participation in age distribution reported above, suggest the most appro-
recreational and sporting activities. Indeed, further anal- priate targets for safety communications and other380 T. Bentley et al. / Tourism Management 22 (2001) 373}381
measures to reduce the incidence of speci"c adventure The "ndings of this research support those of previous
tourism and recreational injuries. studies considering adventure tourism safety in New Zea-
land (Bentley et al., 2000), indicating that activities for
which there is a lower &perceived risk' but a relatively
4. Discussion high &actual risk' (e.g. horse riding and cycle tours) should
be the focus of industry attention to improve the stan-
Recreational and adventure tourism injuries made dards of safety for participants. The best means of achiev-
a signi"cant contribution to overseas visitor morbidity ing higher standards of safety in these sectors is to
over the 15-year period up to December 1996, with one in introduce regulatory codes of practice, detailing issues
every 12,000 visitors to New Zealand (8.4 injuries per such as level of training, quali"cations and experience
100,000 arrivals) being admitted to hospital following required for guides, appropriate client}guide ratios,
a recreational/adventure tourism-related incident. It can equipment speci"cations and the use of personal protec-
be argued that this "gure is unacceptable given the rela- tive equipment. While industry-led voluntary codes of
tively low exposure of tourists to recreational tourism practice for these and other adventure tourism activity
activities in comparison to road travel, an activity for sectors have recently been put in place, these data indi-
which approximately 1 in every 8300 overseas visitors cate the need to revisit the issue of regulation versus
was injured during the same period (12 injuries per industry self-regulation in the New Zealand adventure
100,000 arrivals). tourism industry (Ministry of Commerce, 1996; Page
Skiing, mountaineering and tramping together com- & Meyer, 1996).
prised 10 per cent of all overseas visitor injuries. It is There is also considerable scope for adventure tourism
noted these activities most commonly involve indepen- operators and providers of recreational activities to take
dent adventure activity, rather than organised commer- action to raise the standard of client safety. Operators
cial/guided adventure tourism. These "ndings are in-line should ascertain whether their clients have su$cient
with those reported for mountain recreation fatalities knowledge, experience, "tness levels and understanding
(Johnston, 1989; Bentley et al., 2000), and suggest that the of potential dangers, before allowing participation in
independent adventurer should be the major target for their activity. Communicating safety instructions may be
safety communications and other interventions to reduce particularly problematic due to language and cultural
injury risk amongst overseas visitors to New Zealand di$culties. The challenge for operators is to ensure all
and other countries. Such information should target key safety information is fully understood by participants
high-risk travellers (i.e. travellers in the 18}35 age range), in their activity, as it may be too late to relay safety
and should contain messages about the risks of travelling instructions to a client once the activity is underway.
alone or without a guide, the level of experience and skill Further measures that operators of adventure and recre-
required to participate safely, and the fast-changing na- ational activities can take to improve client safety include
ture of New Zealand's mountain and marine environ- careful choice of route and terrain to minimise the risk of
mental conditions. There are a number of opportunities slip, trip and fall injuries (the most common accident type
to present safety information regarding potentially haz- in adventure pursuits, Bentley et al., 2000), and ensuring
ardous recreational pursuits to targeted travellers. These all participants are provided with footwear and clothing
include: at country of origin medical centres (often visited appropriate for prevailing underfoot and weather condi-
for pre-travel vaccination); at airports and in in-#ight tions. The application of operational risk management
entertainment and information literature; at destination (McKay, 1998) to adventure activities should ensure all
visitor centres, accommodation and travel o$ces (i.e. risks are identi"ed, assessed and, where potential for
backpacker establishments, overnight huts and ski injury exists, removed or ameliorated.
lodges); and at the point at which activities are provided The study methodology is subject to a number of
or commenced. limitations, the most important of which is that the data
Other activities making notable contributions to tour- on which it relies (NZHIS mobidity data) represent only
ist injury morbidity included horse riding (2.6 per cent of those injuries resulting in visits to New Zealand public
all injuries) and cycling (2.8 per cent of all injuries), hospitals. The extent of unreported injuries, or injuries
although the proportion of cycle accidents involved or- that resulted in treatment in the injured person's country
ganised cycle tours or mountain biking activities is un- of origin, is unknown. Furthermore, it is likely that cer-
known. White water rafting, jet boating and kayaking tain visitor groups will be less likely to report injuries
together contributed just 1.2 per cent of all overseas than others, notably the young and other &budget' travel-
visitor injuries, this "gure being somewhat surprising lers who are less likely to carry travel insurance and
given government "gures which suggest that between hence less inclined to visit a New Zealand hospital. Des-
100,000 and 200,000 overseas visitors participate in these pite this potential source of bias in the "ndings reported
water-based activities annually (New Zealand Tourism here, tourists most likely to fall within the &budget travel-
Board, 1993). ler' age group (i.e. 20}30 years) are over-represented inT. Bentley et al. / Tourism Management 22 (2001) 373}381 381
sport and recreation injury statistics, suggesting further Greenaway, R. (1996). Thrilling not killing: Managing the risk tourism
evidence for this being a high-risk population. business. Management, 46}49.
The unavailability of data for overseas visitor morbid- Guptill, K., Hargarten, S., & Baker, T. (1991). American travel deaths in
Mexico: Causes and prevention strategies. West Journal of Medicine,
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ity to determine whether patterns and trends in injury Australia. Australian Journal of Leisure and Recreation, 1, 25}30.
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international travel. Annals of Emergency Medicine, 20(6), 622}626.
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system, albeit somewhat slow in its ability to provide Kai'. Hawaii Medical Journal, 49, 52}56.
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Zealand, should help us better understand the health and tourism industry: Voluntary and regulatory approaches. Wellington:
safety needs of overseas visitors to New Zealand, and Ministry of Commerce.
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