LJ 19 Conduct Life Jacket Awareness Campaigns Targeting High-Risk Groups

Key area

Develop and implement awareness campaigns based on national minimum life jacket educational standard to address the importance of life jacket use among high-risk groups who are boating, paddling, and/or swimming and/or recreating in the water.

Spectrum level: Promoting Community Education

Evidence level: Medium

Implementation levels: Community County National State

Rationale:

There is evidence that Increased life jacket wear correlates with decreased drownings rates. Based on 2020 U.S. Coast Guard boating accident statistical data, where the cause of death was known, 75% of fatal boating accident victims drowned. Of those drowning victims with reported life jacket usage, 86% were not wearing a life jacket.

Anticipated Impact:

After implementing this recommendation, you can expect to experience the following outcomes:

Developing and implementing awareness campaigns based on national minimum life jacket educational standard leads to to increased life jacket wear rates.
Increased life jacket wear rates leads to a reduction in drowning.

Evidence:

Research conducted among boaters, and data from boating observations, provides evidence that:

Communications are necessary to successfully implement mandatory wear and assist with enforcement.
Adult role modeling is highly effective.
There is a need to use influencers.
Addressing misperceptions and risk perception helps increase use.
Communication around life jacket use should be positive

Effective life jacket campaigns include:

Relatable information,
Testimonial/personal experiences,
Increasing risk awareness while not deterring the public from water-related activities due to fear. There is evidence that boaters conduct a mental assessment of risk to determine whether to wear a life jacket, and numerous drownings related to boating and swimming in open water occur on calm, sunny days when the perceived risk is low.

Cultural adaptation addresses important sociocultural factors and considers the historic-socio-political processes that influence indigenous people’s health. There are a few examples of interventions that have modeled cultural adaptation practices. One combined a culturally relevant message with flotation devices at a reduced cost. It lowered the drowning rate in the AN community by 53%. Another used bilingual interpreters, cultural role models, and language resources led to a significant increase in life jacket use among A/PI rock fishers.

Additionally, there are two forms of cultural adaptation, modifying content and modifying delivery. Both modifying content and modifying delivery are needed or interventions may be limited in their effectiveness. There are five communication strategies to enhance cultural relevance: peripheral, evidential, linguistic, constituent involving, socio-cultural. All five have been shown to be effective in previous water safety initiatives targeting Indigenous peoples or ethnic minorities. Constituent involving strategies should therefore be prioritized.

Canadian Red Cross suggests that boating safety initiatives for Aboriginal people in Canada reiterate the importance of using flotation devices and align with normative practices and beliefs.

Water safety initiatives that combine education and awareness, with the provision of life jackets for free or reduced costs, have demonstrated positive outcomes in Indigenous Communities (low-income communities as well). “Kids Don’t Float” in Alaska has seen increased wear at loaner board sites and has helped save 31 lives to date. Education alone, however, will not be effective approach. Community capacity, along with community involvement, is needed for long term change. It is important to give community leaders a leadership role, provide community members with the knowledge and skills to sustain initiative effects, respect local autonomy, etc.

Awareness campaigns using communication theory are more likely to be effective. There is evidence that a drowning prevention campaign to increase life jacket use that combined awareness, life jacket loan stations, discount coupons, education programs and other strategies to increase self-efficacy was effective. Policies need to be considered along with awareness campaigns. Consider issues like drowning during flooding events, awareness campaigns may be helpful alongside other mitigation strategies.

Evidence Sources:

Cox K.L., Bhaumik S., Gupta M., & Jagnoor J. (2022). Facilitators and barriers of life jacket use for drowning prevention: Qualitative evidence synthesis. Journal of Safety Research, Feb(80), 135-147. https://doi.org/10.1016/j.jsr.2021.11.010 World Health Organization. (2017). Preventing drowning: an implementation guide. https://www.who.int/publications/i/item/preventing-drowning-an-implementation-guide Maxim L.D. (2015). Summary of relevant life jacket research. https://cdn.ymaws.com/www.americancanoe.org/resource/resmgr/spp-documents/lifejacketreportDanMaxim.pdf

Quistberg D.A., Quan L., Ebel B.E., Bennett E.E., & Mueller B.A. (2014). Barriers to life jacket use among adult recreational boaters. Injury Prevention, 20(4), 244-50. http://dx.doi.org/10.1136/injuryprev-2013-040973 Moran K. (2019) Can you float? Part 2 - Perceptions and practice of lifejacket use among young adults. International Journal of Aquatic Research and Education, 11 (3) Article 4. https://doi.org/10.25035/ijare.11.03.04 Quan L. (2014). Personal flotation devices. In J. Bierens (Ed), Drowning Prevention, Rescue, Treatment (2nd ed, pp. 225-229). Springer-Verlag. https://doi.org/10.1007/978-3-642-04253-9_33 Responsive Management. (2001). Hunters’ and anglers’ attitudes toward boating safety, the use of personal flotation devices, and various messages that communicate the benefits of wearing personal flotation devices: Focus group results. www.responsivemanagement.com

Quan L, & Gilchrist J. (2022). The epidemiology and prevention of drowning. Boulton M.L., & Wallace R.B.(Eds.), Maxcy-Rosenau-Last Public Health & Preventive Medicine (16th ed.). McGraw Hill. https://accessmedicine.mhmedical.com/content.aspx?bookid=3078&sectionid=257531213

Phillips M.T., Spitzer N., Chow W., & Mangione T.W. (2019) Risk factors associated with life jacket wear among adult canoeists and kayakers in the United States, 1999-2017. International Journal of Injury Control and Safety Promotion, 26(2),176-184. https://doi.org/10.1080/17457300.2019.1576207

Spitzer N., Mangione T.W., Chow W., Quan L., & Bennett E. (2019). Parental choices of flotation devices for children and teen swimmers and waders: A survey at beaches in Washington State. International Journal of Aquatic Research and Education, 12(1), Article 2, 1-16. https://doi.org/10.25035/ijare.12.01.02

Giles A.R., Castleden H., & Baker A.C. (2010). We listen to our elders. You live longer that way: Examining aquatic risk communication and water safety practices in Canada's north. Health Place, 16(1), 1-9. https://doi.org/10.1016/j.healthplace.2009.05.007

Crozier M., & Giles A.R.. (2020). Promising practices for boating safety initiatives that target indigenous peoples in New Zealand, Australia, the United States of America, and Canada. International Journal of Aquatic Research and Education, 12, (4), Article 8. https://doi.org/10.25035/ijare.12.04.08

Mangione T. (ed). (2021). Summary of suggestions for increasing life jacket use. Unpublished survey notes from online survey conducted with persons indicating interest in life jackets via https://www.watersafetyusa.org/nwsap.html

Aldoory L, Bonzo S. (2005). Using communication theory in injury prevention campaigns. Injury Prevention, 11(5), 260-263. https://doi.org/10.1136/ip.2004.007104

Bennett E., Cummings P., Quan L., & Lewis F.M. (1999). Evaluation of a drowning prevention campaign in King County, Washington. Injury Prevention, 5,109-113. http://dx.doi.org/10.1136/ip.5.2.109

Francis E. (2023). A drowning prevention policy framework. Doctoral dissertation, Royal Roads University, Canada. http://dx.doi.org/10.25316/IR-19179

Jonkman S. N., & Kelman I. (2005). An analysis of the causes and circumstances of flood disaster deaths. Disasters, 29(1), 75-97. https://doi.org10.1111/j.0361-3666.2005.00275.x

Yale J. D., Cole T. B., Garrison H. G., Runyan C. W., & Ruback J. K. R. (2003). Motor vehicle—related drowning deaths associated with inland flooding after Hurricane Floyd: A field investigation. Traffic Injury Prevention, 4(4), 279-284. https://doi.org/10.1080/714040485

High Risk Populations Addressed:

Populations whose risk of drowning decreases the most with the implementation of this recommendation may have one or more of the following characteristics:

Teenage and adult males
Open water recreational swimmers
Latinx and Black communities
New boaters
New parents

Evaluation Metrics:

Indicator of long-term impact:

Decreased drownings among new and novice boaters

Indicators of intermediate impact:

Increased education, awareness, and use of life jackets by new and novice boaters
Increased use of life jacket use by all boaters

Implementation:

Consider the following to ensure successful implementation:

Determine which existing campaigns and resources are providing accurate information from creditable sources and have had some degree of evaluation.
Make best practices for tailoring communications campaigns for specific groups available for consideration.
Use or tailor existing campaigns and resources from creditable sources, or develop new campaigns, to provide life jacket messaging to high-risk boater and swimmer groups utilizing peer-to-peer role modeling and key influencers focused on misperception, risk perception, and preparedness.
Partner with media, manufacturers, and retailers to model safe practice of life jacket wear in visuals including advertising, news photography, and product informational materials.
Educate people on existing life jacket laws and their inadequacy in addressing the existing volume of open water drownings.
Through data, facts, and real-world stories, demonstrate the importance of wearing a buoyancy device not only in a boat, but also while swimming and participating in other aquatic activity.
Focus on specific high-risk groups such as males (teens and adults) and minority groups.
Provide messaging to high-risk groups, influencers, parents, boat manufacturers, dealers, lake homeowners, schools, and managing organizations of beaches, marinas, swimming pools, and other water facilities.
Include the importance of life jackets as a layer of safety, along with supervision, and the need for life jackets regardless of swimming ability, etc.<.li>
Communicate the importance of implementing and enforcing mandatory life jacket wear requirements.
Increase point of sale education online and in brick and mortar stores.
Include life jacket education and drowning prevention awareness and risks as part of Boater Safety Education Training at the state level.
Instill among parents and caregivers that life jackets do not remove the need for supervision.
Recommend inclusion of water safety and appropriate PFD use in K-12 Schools, Parks and Recreation, and state level messaging across all levels (developmentally appropriate).
Encourage the development of state level water safety task forces ( i.e. Washington State- Multisectoral Approach to Water Safety )
- Use a public health approach
- Use research-based strategies to shape materials and products and to select the channels that deliver them to the intended audience.
- Understand conventional wisdom, concepts, language, and priorities for different cultures and settings.
- Consider health literacy, internet access, media exposure, cultural competency.
- Develop materials such as brochures, billboards, newspaper articles, television broadcasts, radio commercials, public service announcements, newsletters, pamphlets, videos, digital tools, case studies, group discussions, health fairs, field trips, and workbooks among others media outlets.
- Use a variety of communication channels to allow health messages to shape mass media or interpersonal, small group, or community level campaigns.

Challenges to Implementation:

When implementing this recommendation, you might encounter challenges related to the following factors:

Increasing funding to adequately run campaigns year round, or seasonally, may be difficult to obtain.
Increased funding to enhance campaign reach (TV spots, radio ads, billboards, etc.) may be difficult.
Accessing funding for development and implementation of tailored resources for specific at risk groups may be a challenge.
Resourcing evaluation for initiatives at the local level may be difficult.
Changing the perceptions of some retailers or organizations that may not think showing safety practices promotes sales.

Potential Facilitators:

The following factors might facilitate the implementation of this recommendation:

Agencies or organizations that are interested in promoting water safety and saving lives on our nation’s waterways (federal and state agencies, local communities, non-profit foundations, etc.) could be valuable partners in campaign work.
Alaska Kids Don’t Float program has shown efficacy in increasing life jacket use and could be used as a model strategy.
Groups working on this type of campaign have emphasized the importance of changing social norms to promote life jacket wear.
Refer to seat belt campaigns for ideas on effective approaches.
Make sure information is culturally and linguistically relevant.
Partner with boating groups and parks departments.
National Safe Boating Council recommends including awareness of ‘saved by the jacket’ stories as motivators for those who rarely or never wear life jackets.

GAP Recommendation:

Evaluate the impact of communication strategies and current campaigns encouraging life jacket use for boating and nonboating activities such as swimming, wading and playing in the water. There’s a need to assess changes in knowledge, attitudes, pre-contemplation, contemplation and intention/readiness for action to wear a life jacket, increases in life jacket use and ultimately a decrease in drowning fatalities. Campaigns should use theoretical models to help better assure success and so they can be evaluated based on theoretical constructs. We recommend partnering with a health behavior theory/injury prevention research expert to guide the application of a theoretical framework for the evaluation. Stages of Change, Protection Motivation Theory, Health Belief Model and Theory of Reasoned Action all have constructs that are applicable to this gap evaluation. Within this evaluation strategy, we need to include impact for specific groups who are at heightened risk including teenage and adult males, Alaska Natives, immigrant populations and African American communities. This evaluation strategy can be used for campaigns at the national, state, and local levels. Examples of national level campaigns include the National Safe Boating Council's "Wear It" Safe Boating Campaign and the U.S. Army Corps of Engineers Life Jackets Worn...Nobody Mourns campaign. This gap is not intended to address effectiveness of water safety program education or swim lesson education on life jacket choice, fit and use. That evaluation should be embedded in those recommendations and in those programs. The intent of this recommendation is to focus on media and other outreach campaigns vs educational programs. HP 2010 defines health communication as the art and technique of informing, influencing, and motivating individual, institutional and public audiences about important health issues. Choosing, fitting and using life jackets as part of learn to swim and water safety programs also focuses on a skill component or the ‘how’ of life jacket wear. Reference: Wallis BA, Watt K, Franklin RC, Taylor M, Nixon JW, Kimble RM. Interventions associated with drowning prevention in children and adolescents: systematic literature review. Inj Prev. 2015 Jun;21(3):195-204. doi: 10.1136/injuryprev-2014-041216. Epub 2014 Sep 4. PMID: 25189166.

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