• D Alex Quistberg, Linda Quan, Beth E Ebel, Elizabeth E Bennett, and Beth A Mueller.
• Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington, USA Department of Pediatrics, University of Washington, Seattle, Washington, USA.
• Inj. Prev. 2014 Aug 1; 20 (4): 244-50.

ObjectiveTo identify barriers to life jacket use.DesignCross-sectional survey.SettingNine public boat ramps in western Washington State, USA, August-November, 2008.Participants675 adult boaters (>18 years) on motor boats <26 feet long.Main OutcomeLow or no life jacket use (0-50% of time) versus high life jacket use (51-100% of time).ResultsLow/no life jacket use (0-50% of time) was associated with longer boat length (per foot, risk ratio [RR] 1.03, 95% CI 1.02 to 1.05), alcohol use (RR 1.11, 95% CI 1.01 to 1.20), perception of life jackets as 'uncomfortable' (RR 1.29, 95% CI 1.09 to 1.52), perceived greater level of swimming ability (RR 1.25, 95% CI 1.03 to 1.53 for 'expert swimmer') and possibly with lack of confidence that a life jacket may save one from drowning (RR 1.13, 95% CI 0.96 to 1.32). Low life jacket use was less likely when an inflatable life jacket was the primary life jacket used by a subject (RR 0.77, 95% CI 0.63 to 0.94), a child was onboard (RR 0.88, 95% CI 0.79 to 0.99) or if the respondent had taken a boating safety class (RR 0.94, 95% CI 0.87 to 1.01).ConclusionsLife jacket use may increase with more comfortable devices, such as inflatable life jackets, and with increased awareness of their efficacy in preventing drowning. Boater education classes may be associated with increased life jacket use among adults.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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