In the United States, an estimated 30 million persons ride horses each year (1). Total injury-related morbidity and mortality associated with horseback riding in the United States is unknown; however, during 1976-1987, 205 such fatalities occurred in 27 states (2). Even though alcohol use is a risk behavior for many types of injury, its role in horseback-riding-associated deaths has not yet been established. This report summarizes a study by the North Carolina Office of the Chief Medical Examiner (OCME) to characterize all horseback-riding-associated deaths during 1979-1989 and to determine what proportion of riders had used alcohol before death.