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NEW YORK (Reuters Health) - Dr. Linda Quan lost count of the number of children she watched slowly die from drowning. But she will never forget the pain on the faces of her patients' parents when she broke the news to them.
That pain spurred the Seattle emergency room pediatrician to advocate for a Washington state law that now requires children 12 years and younger to wear life vests aboard small recreational boats.
In a new study published in the journal Injury Prevention, Quan and her colleagues find that boaters mandated to wear life jackets were the most likely to wear them. She calls on policymakers to extend the law to children between 13 and 17 years old.
"It's just as bad to lose a 17-year-old as it is to lose a three-year-old," she told Reuters Health. "So why aren't we trying to protect them?"
Drowning is the second leading cause of unintentional injury-related deaths of U.S. children ages one to 14, second only to motor vehicle accidents, according to the Centers for Disease Control and Prevention.
In 2012, U.S. Coast Guard statistics show 459 boaters drowned. More than 82 percent of them were not wearing life jackets.
"This is a preventable injury," said Quan, from Seattle Children's Hospital. "Life jackets make sense. They save lives."
Her team's study included 5,157 Washington boaters on 33 waterways throughout the state over two summer weekends in 2010. Observers viewed boaters through high-powered binoculars and recorded their gender, their estimated age, type and length of boat, weather and water conditions and life-jacket use.
Washington law requires life jackets to be worn by water skiers and others being towed and by boaters on personal watercraft, or jet skis, as well as by children 12 and under in small vessels.
Federal law mandates that boats carry life jackets for all passengers, but it does not require that they be worn. A patchwork of state laws governs life-jacket wear.
Quan's study found the average rate of life-jacket use overall was only 31 percent and just 21 percent in motorboats.
When legally mandated, however, boaters were two to three times more likely to wear life jackets, the study found. Life vest use was 80 percent among children six to 12 years old, 89 percent among children five and younger and nearly 97 percent among jet skiers.
"In other words, they listen to the law," Quan said.
The study also found that teenagers were more likely to put on life jackets if an adult on the boat wore one. Adolescents were twice as likely to wear life jackets as adult boaters - a finding Quan attributes to the teens having to wear life jackets when they were younger.
Quan believes her study shows that efforts to educate boaters - when not accompanied by legal mandates - may largely fall on deaf ears. National life-jacket use rates have hovered between 21 and 23 percent since the late 1990s, despite a concerted effort to convince boaters of the importance of personal flotation devices, the study says.
All states except Virginia and Wisconsin require child boaters to wear life jackets, with the cutoff age varying from six to 12 years old, Thomas Mangione told Reuters Health. Mangione, who works for the nonprofit JSI Research and Training Institute in Boston, was not involved in the current research but has studied the issue for the Coast Guard.
He said Quan's findings mirror his.
"Basically, Americans are law-abiding," he said. "When there are regulations, people comply."
Quan said she would look for a Washington state legislator to write a law to extend life jacket regulations up to age 17.
"We really are very interested in not just protecting the toddler but the adolescent and young adult because they have the next highest risk of dying," she said.
Chris Edmonston, president of the BoatU.S. Foundation for Boating Safety and Clean Water, told Reuters Health he could not comment on legislation that has not yet been drafted. But his group, based in Annapolis, Maryland and Alexandria, Virginia, has lobbied against life-jacket laws and promotes education over regulation.
"My opinion is that not many children are dying in boating accidents because they weren't wearing a life jacket in Washington," he said.
"Some people say that if you save one life, it's worth having a new law," Edmonston said. "But looking at the statistics for the past decade, some would say it's hard to make an argument that a new law is needed."
Efforts to educate boaters about the importance of wearing life jackets are working, Edmonston said.
But Quan's investigation and another recent study suggest otherwise, researchers said.
In a study published last month in the Journal of Public Health Policy, Mangione compared the results of a California campaign to educate boaters to wear life jackets with the results of a Mississippi demonstration project mandating life jackets on some lakes.
Adult life-jacket use skyrocketed from less than 14 percent to nearly 76 percent during the first year of the Mississippi law requiring the vests, Mangione's study found. At the same time, the California educational program showed only a modest gain, from 8.5 percent to 12 percent in the first year.
"We think the best situation is where there would be mandatory regulations and education to support these regulations," Mangione said.
"Education's really important," Quan said. "But there's no question it has limited effectiveness."
SOURCE: bit.ly/1nzLsjH Injury Prevention, online February 10, 2014.
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