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Association of Alcohol With Fatal Snowmobile Accidents

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To the Editor:

Case-control studies have yielded valuable contributions to injury epidemiology.1, 2 In such a study, controls should be drawn from the same underlying population at risk for the outcome as the cases.3 A control should represent those who might have become a case in the study had the outcome of interest developed in them.4 Thus, if we wish to know whether alcohol is associated with the risk of death while driving a snowmobile in Ontario, we would like the cases to be those who died while

In Reply:

Dr Cummings argues that we should have performed a different study, such as attending the scene of the fatal snowmobile crash sites across Ontario and testing other snowmobilers for alcohol intake. The study he suggests would involve standing along remote snowmobile routes (in the late evening and early morning to match the time of injury) in northern Ontario (approximate average winter temperature –10°C), hoping that the occasional snowmobiler who happened by would participate in the study and

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