title: Low life jacket use among adult recreational boaters: a qualitative study of risk perception and behavior factors.
abstract: BACKGROUND
  Life jackets may prevent one in two drowning deaths, however, 85% of recreational boating-related drowning victims in the United States in 2012 did not wear a life jacket. This study explored behavioral factors and strategies to encourage consistent life jacket use among adult recreational boaters.
  
  
  METHODS
  We conducted a qualitative study among boat owners who boat regularly, and explored factors associated with life jacket use by adults and child or adolescent passengers. Sixteen boaters participated in four focus groups.
  
  
  RESULTS
  Most boaters reported inconsistent use of life jackets, using them only when conditions were poor. Each described episodes of unpredictable boating risk which occurred despite favorable conditions. Most required younger child passengers to wear a life jacket, but reported resistance among older children. Barriers to consistent life jacket use included discomfort and the belief that life jacket use indicated inexperience or poor swimming ability. Participants stated that laws requiring life jacket use would change behavior especially for children. The only demonstrated behavior change among group members was associated with use of inflatable life jacket devices.
  
  
  CONCLUSIONS
  Boating risk is inherently unpredictable; therefore interventions should focus on strategies for increasing consistent use of life jackets. Passage and enforcement of life jacket legislation for older children and adults is likely a promising approach for behavior change. Designing more comfortable, better-fitting, more appealing life jackets will be paramount to encouraging consistent use.
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WA, USA; Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA. Electronic address: aquistbe@uw.edu.
authors.forename: Duane Alex
authors.initials: DA
authors.lastname: Quistberg
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bennett
authors.forename: Linda
authors.initials: L
authors.lastname: Quan
authors.forename: Beth E
authors.initials: BE
authors.lastname: Ebel
mesh_terms: D000328:Adult; D000368:Aged; D001290:Attitude; D004332:Drowning / Q000517:prevention & control*; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D011481:Protective Clothing / Q000706:statistics & numerical data*; D011482:Protective Devices / Q000706:statistics & numerical data; D036301:Qualitative Research; D011998:Recreation; D012306:Risk; D012309:Risk-Taking; D012767:Ships
keywords: Boats/*Recreation; Drowning; Personal flotation devices; Qualitative research; Risk assessment; Swimming/*Education