Association between states' boating regulations and children's rate of life jacket use

Background. During 1999-2011, about 3.3% of boating-related fatalities annually in the United States involved children under age 13; many resulted from drowning. Since 2003, federal law mandated life jacket wear among children age<13 on boats underway to cover states without wear regulations. The federal law did not supersede state statutes, so variations in coverage by age and boat size exist. Methods. Using US National Life Jacket Wear Observation Study data (1999-2012), we examine life jacket wear rates by different levels of regulation (no law, coverage age<6 only, <10 only, or coverage <13), stratified by children's age. Results. Children age<5 had significantly higher wear rates when there were laws than when there were none (93% v. 83%). Among children age 6-12, rates differed significantly by level of mandate: 63% when no laws exist, 73% when coverage age<6, 82% when coverage age<10, and 83% when coverage <13. Overall, 86% of children age<13 wore life jackets if mandated versus 71% not mandated. Also, children covered by mandates without boat size exceptions had the highest wear (87%), followed by mandates that only apply to certain boat categories (86%), and children otherwise covered but exempted due to boat size had lower wear (81%). Conclusions. In all age categories <13, greater restrictions in boating regulations were associated with higher life jacket wear. Mandates are complex, multi-layered and their effectiveness potentially impacted by varying levels of enforcement. Policymakers should consider how mandate specifications influence behavior when developing regulations to reduce boating-related fatalities and protect this vulnerable population.