Personal flotation devices, PFDs (community interventions to increase use)

Conclusion: Indications for effectiveness

There are only a few studies on increasing personal flotation device use and they indicate that these interventions tend to achieve modest levels of behavioural change. It seems that a large program is needed to induce actual behavioural change. Although no rigorous research has been done into the effective components of these interventions some that have been mentioned as effective are promoting the wearing of PFDs by toddlers whenever they are near water and making PFDs available at little or no costs. The following authors have reported on the effect of interventions on lifejacket use;

Bergman et al. 1991;
Although the evidence is not strong there are indications that promoting the wearing of PFDs by toddlers and making PFDs available at little or no costs contributed to a decreased drowning rate in children.

Treser et al. 1997;
A two year campaign focused on drowning prevention which included the production of a boating safety video for use in elementary schools, a PFD loaner program for local beaches, and community events, fliers, brochures and celebrity sports cards. An observational study showed a significant increase in PFD wearing rates. Although this indicates a positive effect of the campaign this study does not give definite proof that the increase in wearing rates was caused by the campaign. Therefore the overall conclusion is that this campaign has probably contributed to the increase in PFD usage by boaters as observed in this study. However there was no effect on wearing rates for children.

Bennet et al. 1999;
Based on self reported data, there are indications that a three year drowning prevention campaign in Washington, USA contributed to an increase in use of life vests at beaches, docks, and pools among children age 1-14 years. Life vest ownership by children increased among families aware of the campaign. PFD use for children on boats was already high in their research so there was little improvement following the campaigns.

Turner et al. 2009;
A safety poster designed to educate and warn about cold water shock to increase the use of lifejackets has only a small potential to increase the intention to wear a lifejacket.

Recommendations (for research & practice)

Recommendations for interventions
Training on Personal Flotation Device fitting and maintenance is important because there are indications that in case of incorrect use death can occur, despite the wearing of a PFD (Turner et al., 2009).

Only approved safety equipment should be used for children and it should not be a substitute for adequate supervision (Peden et al., 2008).

It is recommended that future PFD wearing campaigns consider providing personal experience of initial phases of cold water immersion (Turner et al. 2009).

Recommendations for research (Turner et al. 2009)
The possible increase in risk taking behaviour when wearing a PFD should be assessed.
Incident data should be gathered that enables investigation of the cause of accidents to be conducted in order to develop more cost-effective interventions.

Review Date: 20/09/2011
Version: 1.0
Status: Publish

Articles (reviews) and reports were included that were published between 1990 and 2010, in English and Dutch. The outcomes of the study were reviewed by the Dutch Consumer Safety Institute.

Strategy: An online literature search was performed by a researcher of the Consumer Safety Institute and after this a more thorough search was performed by the documentation centre of CSI (Catalog CenV, Pubmed, Injury lit, Google, Websites, 'Grey' literature). Results of each search were compared on differences and potential missed studies were added. First the titles and then abstracts were scanned in order to include relevant studies. In the case of insufficient information obtained from abstracts the full text articles were obtained. Relevant articles were scrutinized and background documents were created. In addition, relevant references of included articles were checked on new and relevant articles (i.e., snowball search).

The outcomes of the study were reviewed by an expert in the field of child safety in the spring of 2011.

Background documents

A new definition of drowning : towards documentation and prevention of a global public health problem (version 1.0)
E.F. van Beeck, C.M. Brache, D. Szpilman ... [et al.] (2005)

Evaluation of a drowning prevention campaign in King County, Washington (version 1.1)
Elizabeth Bennett, Peter Cummings, Linda Quan ... [et al.] (1999)

A guide to personal flotation devices and basic open water safety for pediatric health care practitioners (version 1.1)
P. Yuma, J. Carroll, M. Morgan (2006)

MCA lifejacket wear : behavioural change (version 1.1)
Sally Turner, Julie Wylde, Martin Langham ...[et al.] (2009)

Personal flotation device usage: do educational efforts have an impact? (version 1.0)
C.D. Treser, M.N. Trusty, P.P. Yang (1997)

Sweden's experience in reducing childhood injuries (version 1.0)
Abraham B. Bergman, Frederick P. Rivara (1991)

MCA lifejacket wear : behavioural change (version 1.1)
Sally Turner, Julie Wylde, Martin Langham ...[et al.] (2009)