Will it Float? Mandatory PFD Wear Legislation in Canada

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2 Will it Float? Mandatory PFD Wear Legislation in Canada A Background Research Paper Presented to The Canadian Safe Boating Council By SMARTRISK Principal Authors Philip Groff, PhD Jennifer Ghadiali, MA Bibliographic Information: Groff, P. and Ghadiali, J Will it Float? Manadatory PFD Wear Legislation: A Background Research Paper. Toronto, ON: SMARTRISK ISBN: Canadian Safe Boating Council 2003

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4 TABLE OF CONTENTS TABLE OF CONTENTS...3 LIST OF FIGURES...5 ACKNOWLEDGEMENTS...7 EXECUTIVE SUMMARY...9 CHAPTER 1: INTRODUCTI0N Research Blocks Block One Block Two Block Three Block Four Methodologies Blocks 2 & 3: International/U.S. surveys Blocks 2 & 3: Key Informant Interviews with Canadian Stakeholders Block 3: Legal Issues Block 4: Public Opinion Poll Project Team Chapter Outline CHAPTER 2: MAGNITUDE OF THE PROBLEM Number of Recreational Boaters in Canada Incidence of Drowning While Engaging in Recreational Boating Profile of Recreational Boating Drowning Deaths Canadian Recreational Boating Drowning Deaths in International Context Incidence of Near-Drowning While Engaging in Recreational Boating Burden of Boating Drownings Economic Burden Potential Years of Life Lost CHAPTER 3: RISK FACTORS ASSOCIATED WITH BOATING-RELATED DROWNINGS Personal Factors Age and Gender Aboriginals Swimming Ability Lack of Boating Safety Training and Inexperience Environmental Factors Water Temperature Weather and Boating Conditions Behavioural Factors Alcohol Reckless Behaviour Wearing a Lifejacket or Personal Flotation Device CHAPTER 4: EFFICACY OF PFDS FOR PREVENTING DROWNINGS Principle Behind Lifejackets and Personal Flotation Devices Comparison of Lifejackets and Personal Flotation Devices Lifejackets Personal Flotation Devices

5 Effectiveness of Lifejackets and Personal Flotation Devices Rationale for Wearing Rather than Carrying PFDs Difficulties in Putting on a PFD Once in the Water Cold Water Initial Responses/Cold Shock (0-3 minutes) Short-Term Responses/Swimming Failure (3-30 minutes) Long-Term Responses/Hypothermia (After 30 minutes) CHAPTER 5: INCIDENCE OF PFD USE AND PUBLIC ATTITUDES TOWARDS WEARING PFDS Incidence of PFD Use Barriers to Wearing PFDs Perception That There is a Low Risk of Drowning Without a PFD Perception that PFDs Restrict Movement and Interfere with Ability to Perform Activities Perception that PFDs are Uncomfortable Perception that PFDs are Unattractive or Unfashionable Perception that Wearing PFDs are a Sign of Fear CHAPTER 6: EFFICACY OF VARIOUS METHODS OF ENCOURAGING PFD USAGE Current Regulations Education, Social Marketing, and Incentives Mandatory Boater Education Social Marketing / Education Campaigns Other Programs / Incentives Changes to Insurance Requirements Changes to PFD Designs and Standards Legislation Boating While Intoxicated Legislation Legislation in Other Injury Prevention Domains Seat-belt legislation Bicycle Helmet Legislation Importance of Legislation for Continuance of Safety Behaviour Legal Justification for Mandatory Wear Legislation in Canada CHAPTER 7: LIKELY EFFICACY OF MANDATORY WEAR LEGISLATION FOR ENCOURAGING PFD USAGE Impact of PFD Legislation Implemented in Other Countries United States Tasmania Anticipated Barriers and Opportunities for Introducing PFD Legislation According to International Stakeholders Barriers Opportunities Anticipated Barriers and Opportunities for Introducing PFD Legislation According to Canadian Stakeholders Barriers and Opportunities Cultural Attitudes Influential Stakeholders and Potential Supporters Communication Within Boating Community Communication to General Public

6 Statistical Evidence Enforcement Issues Political Context Economic Implications Degree of Overall Support for Introduction of PFD Wear Legislation Prospects for PFD Wear Legislation Anticipated Reaction of Canadians to PFD Legislation Reaction to Introduction of PFD Wear Legislation in Other Jurisdictions Past Canadian Research Opinion Poll CHAPTER 8: CONCLUSIONS AND RECOMMENDATIONS General Conclusions Boating Related Drownings Warrant Action PFD wear is the risk factor to address Mandatory Wear Legislation is the Intervention to Employ Such Legislation Should be Feasible in Canada Public Will Evidence that the Benefits Outweigh the Costs Evidence that the Regulation can be Enforced Recommendations REFERENCES APPENDICES LIST OF FIGURES Figure 1: Recreational Boating Drowning Deaths in Canada Figure 2: Recreational Boating Drowning Deaths in Canada by Activity and Type of Boat Figure 3: Recreational Boating Drownings in Canada by Injury Incident & Type of Boat, Figure 4: Rate and Number of Hospitalizations For Boating-Related Near- Drownings in Canada by Year, Figure 5: Economic Burden of Boating Drownings in Canada, Figure 6: Rates of Recreational Boating Drownings in Canada by Age and Sex, Figure 7: Age / Sex Distribution of Drowning Deaths in Canada Figure 8: Recreational Boating Drownings in Canada by Water Temperature Figure 9: Recreational Boating Drownings in Canada by Wind, Wave, Lighting Conditions, Figure 10: Blood Alcohol Levels for Recreational Boating Drownings in Canada Figure 11: Recreational Boating Drownings in Canada by Risk Factor Figure 12: Recreational Boating Drownings in Canada by Use of a PFD Figure 13: Minimum Buoyancy Required for Lifejackets and Figure 14: Types of Flotation Devices Used in Canada

7 Figure 15: Comparison of Canadian Lifejacket and Personal Flotation Device Characteristics Figure 16: Average Seasonal Water Temperatures in Canada Figure 17: PFD Wear Legislation by State Figure 18: Level of Support For Some Sort of Legislation Requiring Boaters to Wear a PFD At All Times When On The Water in a Small Watercraft (Under 6m) Figure 19: Level of Support For Legislation Requiring Specific Target Groups of Boaters to Wear a PFD At All Times When On The Water in a Small Watercraft (Under 6m) Figure 20: Hypothetical Compliance with PFD Legislation

8 ACKNOWLEDGEMENTS The principal authors of this report have to acknowledge their indebtedness to a number of people who made it possible. First and foremost we must thank the rest of the research team. Thanks to Dr. Eden Cloutier for his analyses on the economic burden of boating related drownings. Thanks to Mr. Victor Opara for his legal analysis presented in Appendix I and summarized by us in Chapter 6 of this report. Thanks to Ms. (soon to be Dr.) Na Koshie Lamptey for her efforts in interviewing the Canadian Stakeholders, as reported in Appendix E and summarized by us in Chapter 7. In addition, we must thank her for her assistance in the development of the international survey instruments employed in the project, and for her coining of the main title. Thanks to Dr. Chris Brooks for his unwavering support and dedication throughout this project, his patient instruction about all things related to buoyancy, and cold-water immersion, and his careful reading of several drafts of this report. We must also acknowledge our companions at SMARTRISK for their support on this project. In particular we must mention the patience of Michael Gemar who provided creative services and IT support in the production of this paper, including the development of the cover. Our thanks to Susan Mackenzie at Health Canada for providing the data for the economic burden analysis. We would also like to acknowledge our gratitude to the blind peer review volunteered by Jack Gallagher and Gordon Giesbrecht. We would also like to thank The Cook-Rees Memorial Fund for Water Search and Safety for their generous financial support of this research. Finally, we would like to acknowledge the members of the PFD Taskforce who provided much needed guidance. Without their oversight this paper could not have come to light. John Blaicher President Blaicher Marketing International John Gullick Deputy Executive Director Canadian Power & Sail Squadrons Roxanne Standefer Michael Vollmer Michael Vollmer Yacht Design Sue Phillips Manager, First Aid & Water Safety, Western Canada Canadian Red Cross B. R. (Brad) Schlorff, Sergeant Provincial Marine Coordinator, Provincial Traffic and Marine Safety Bureau Ontario Provincial Police Ted Rankine Vice President Dual Media Productions 7

9 And especially, Barbara Byers Public Education Director Lifesaving Society Who has been with us, every step of the way always ready to facilitate and support, yet never attempting to sway the direction or conclusions of the research. In acknowledging all the above help and support the principal authors in no way seek to shift responsibility for any errors and omissions the fault for these remains with us. Philip Groff, PhD Manager, Research Development and Evaluation SMARTRISK 18/09/03 Jennifer Ghadiali, MA Research Associate SMARTRISK 18/09/03

10 EXECUTIVE SUMMARY In 2002, the Canadian Safe Boating Council struck a Lifejacket/Personal Flotation Device (PFD) Taskforce to examine the advisability of advocating for legislation concerning mandatory PFD use for recreational boaters in small craft. In October 2002, the taskforce contracted with SMARTRISK, a national injury prevention organization, to develop a background research paper summarizing the best available evidence pertaining to mandatory lifejacket/pfd use. This background research paper would then be used to inform a position paper on the topic of mandatory PFD wear legislation by the taskforce. Several lines of evidence were considered in order to examine the case for mandatory wear of lifejackets/pfds for boaters in vessels under 6m while the vessel is underway. Four blocks of research were conducted. These dealt with, respectively: the magnitude of the issue, the risk factors involved with particular emphasis on the role of PFD wear and the methods used to encourage it, the political and legal context within which mandatory wear legislation must be considered, and the likely public response to the introduction of legislation. An assessment of the magnitude of the issue of boating related drownings revealed that on average 140 Canadian die each year in such incidents. This represents a societal burden of more than 2700 potential years of life lost to Canadians each year. An economic burden analysis conservatively estimated indirect costs in terms of lost productivity of $30 million annually, with total societal costs likely as high as $80 million or more. Several risk factors for these drowning were identified. Potential points of intervention in boating behaviour which could impact drowning rates include increasing swimming ability, decreasing alcohol consumption, decreasing reckless behaviour and increasing the use of floatation devices. Of these, it was found that low PFD wear rates accounted for the greatest percentage of drowning deaths, and that increasing their rate would have the additional benefit of reducing drownings related to all other risk factors as well. Literature reviews, an international environmental scan, surveys of international and US boating safety advocates, and key informant interviews with Canadian stakeholders indicated that most attempts to boost PFD wear rates were unsuccessful. While there was little in the way of direct evaluations of the potential of mandatory wear legislation to increase wear rates available, data from the US and from Tasmania suggest that the rate of wear is directly related to the regulatory climate. In addition an anlysis of two parallel cases from other domains of injury prevention: seat-belts and bicycle helmets, provide additional support to the notion that mandatory wear legislation has the potential to be effective. In the third block of research, literature reviews, an international environmental scan, surveys of international and US boating safety advocates, and key informant interviews with Canadian stakeholders highlighted potential barriers 9

11 and opportunities for the creation of mandatory wear legislation. The chief barriers highlighted involved the unwillingness of governments to institute an unpopular regulatory regime and the general perception that mandatory wear regulation would be extremely unpopular. An analysis of the legal context for such a regulatory regime was undertaken. A legal argument can be made for introducing mandatory wear legislation, which rests on the question of whether existing tort law clearly deals with the issue of liability in the event of a boating incident involving injury or death and how negligence for such incidents is determined. The present analysis suggests that judicial standards are inconsistent and various levels of Canadian courts have used different standards to determine the liability of boat owners. In particular, the courts are not agreed on some of the factors that determine liability of boat owners/operators: reasonable person test, emergency test, and the but-for test. Consequently, given the lack of clarity regarding the responsibility for safety gear in tort law, this lends some support to the argument for creating legislation since it would improve the consistency of decisions and would assist the courts in measuring the extent of a boat passenger s negligence. Specifically, mandatory wear legislation would ensure that boat users who fail to wear lifejackets or PFDs would be consistently judged to be guilty of contributory negligence. This would likely motivate small craft users to wear lifejackets or PFDs when on the water, which would in turn reduce drownings. In the fourth block of research a public opinion poll of 1000 Canadians was conducted. Far from demonstrating the anticipated resistance to mandatory wear legislation the vast majority (70-87%) of boaters and non-boaters of all ages supported the idea of mandatory wear legislation, with only 2-9% wanting it to be restricted to children, and only 5-7% being opposed. Additionally, Canadians surveyed indicated that if PFD wear legislation were enacted, the vast majority (84-93%) would comply with the law under all circumstances while only 2-5% claim they would defy a law that made wearing a PFD mandatory. Four general conclusions arise from this report namely: boating related drownings warrant action, PFD wear is the risk factor to address in preventing boating related drownings, mandatory wear legislation is the intervention to employ to increase PFD wear rates, and finally that such legislation should be feasible in Canada. It is thus the recommendation of these authors that the PFD Task Force, and the Canadian Safe Boating Council as a whole, work toward mandatory PFD wear legislation. However, given that there are still anticipated barriers to such an approach, specific recommendations related to the process of such work are also made. 10

12 CHAPTER 1: INTRODUCTI0N In 2002, the Canadian Safe Boating Council struck a Lifejacket/Personal Flotation Device (PFD) Taskforce to examine the advisability of advocating for legislation concerning mandatory PFD use for recreational boaters in small craft. In October 2002, the taskforce contracted with SMARTRISK, a national injury prevention organization, to develop a background research paper summarizing the best available evidence pertaining to mandatory lifejacket/pfd use. This background research paper would then be used to inform a position paper on the topic of mandatory PFD wear legislation by the taskforce. Several lines of evidence were considered in order to examine the case for mandatory wear of lifejackets/pfds for boaters in vessels under 6m while the vessel is underway. The current background research paper examines the following issues: First, it must be determined whether there is a problem that needs to be addressed. Second, that mandatory PFD use is likely to address this problem. Third, that it is possible to successfully work toward such a regulatory solution. And finally, that there is evidence that such legislation could be successfully implemented. Accordingly, the initial proposal was for four blocks of research (a copy of the proposal is provided in Appendix A). RESEARCH BLOCKS Block One First, there was a need to collect and analyze the general data pertaining to the magnitude of the problem. Incidence rates of drowning related to boating and PFD use were collected and compiled from a number of sources. A brief examination of the social and human costs of boating fatalities was made. Finally, the economic burden associated with these events was modelled using methods previously applied at SMARTRISK to all classes of injury in the country. Block Two There was a need for a series of systematic literature reviews to establish the current evidence base for a mandatory wear law. The literature on PFD use and efficacy in preventing drowning has been summarized. Any literature pertaining to the efficacy of legislative measures to mandate PFD use in jurisdictions where this has occurred were examined, in the context of other potential interventions to promote PFD use, and other legislative efforts to mandate the use of injury prevention gear. In addition, a survey was conducted of various legislative jurisdictions which have considered similar legislation in 11

13 order to determine what barriers and opportunities they encountered in their processes. Finally, an examination was made of parallel cases of legislative intervention to prevent injuries in Canada and elsewhere, specifically the cases of mandatory seatbelt legislation, and mandatory bicycle helmet legislation. Block Three The legislative and policy context for any proposed new regulation must be considered. A summary of current statutes and case law pertaining to personal liability of boat owners for drowning incidents involving their craft, whether the owner is present or not, has been made. In addition, key informant interviews were conducted with policy makers, researchers, drowning prevention advocates and other associated stakeholders, to ascertain the likely opportunities and barriers to successfully advocating for legislation on this matter. In addition, our international environmental scan and survey discussed in Block Two, provided insights into these issues in various U.S. states and abroad. Block Four Finally, the fourth block of research focused on public attitudes towards drowning prevention, PFD use, and mandatory wear regulation. A literature review was followed by a public opinion poll to determine the ripeness of the issue and societal will to accept new legislation on this matter. METHODOLOGIES Following are the specific methodologies employed in addressing the research questions in each of the above blocks. Blocks 2 & 3: International/U.S. surveys Several methods were used to gather input from a wide range of international experts on drowning and PFD legislation. The primary method of data collection was an online survey, which was completed by 45 respondents around the world. As well, a number of people contacted to participate in the international survey were unable to complete the survey online, but offered comments either by or in an semi-structured telephone interview. The information collected from these sources was supplemented with various searches using the Internet and PubMed (an online database of MEDLINE journal articles). A full description of the methodology used in conducting the international environmental scan, along with the findings, are provided in Appendix B. Copies of the introduction letters and surveys sent to potential U.S. and international respondents are provided in Appendices C and D. Blocks 2 & 3: Key Informant Interviews with Canadian Stakeholders To inform the planning and development of a putative program to work toward PFD legislation, 12 semi-structured interviews were conducted with a variety of Canadian informants such as researchers, policy makers, drowning prevention advocates, recreational organizations, and law enforcement. Details concerning the 12

14 methodology as well as the findings are provided in Appendix E, and the Interviewer s Guide used in conducting the semi-structured interviews is provided in Appendix F. Block 3: Legal Issues In order to understand the legal context for any potential legislative solutions to address recreational boating drownings in Canada, a memorandum was developed that summarizes the legal issues pertaining to personal liability of the owner of a small craft in the event of drowning during the operation of his craft. Canadian superior courts decisions and relevant statutory provisions on the issue were examined. Details regarding the methodology and findings for this legal memorandum are provided in Appendix I. Block 4: Public Opinion Poll In order to poll the Canadian public regarding their opinions on the notion of legislation requiring recreational boaters in small watercraft to wear a PFD while on the water, telephone interviews were conducted with 1,000 Canadians. A full description of the methodology and findings for this research are included in Appendix G. A copy of the survey is included in Appendix H. PROJECT TEAM The following people participated in the four blocks of research outlined above. Dr. Philip Groff is the Manager of Research Development and Evaluation at SMARTRISK. He has a background in the psychology of human problem solving and has worked as a researcher within the Health Network of Canadian Policy Research Networks, and "Health and Everything". He oversaw the project. Dr. Chris Brooks, internationally recognized authority on lifejacket/pfd use and cold water survival, served as a consultant on this project. Dr. Brooks has been a Navy captain, and head of the hospital at Canadian Forces Base Halifax. He is the author of Lifejackets Through the Ages. Dr. Eden Cloutier is a noted economist and co-author of SMARTRISK's The Economic Burden of Unintentional Injury in Canada as well as numerous provincial economic burden studies. He assisted with the calculation of the economic burden of recreational boating-related drowning. Ms. Jennifer Ghadiali, was a senior researcher for this project. She was responsible for the day-to-day administrative and logistic support of the project as well as collecting the literature for the reviews, developing and maintaining databases and synthesizing results. Ms. Ghadiali has an extensive background in both sociological research and marketing surveys and her expertise was invaluable in both the development and analysis of the various survey instruments and in the writing of this report. 13

15 Ms. Na-Koshie Lamptey was a senior medical student undertaking a research practicum with SMARTRISK during the tenure of the project. With a strong background and interest in healthy public policy, she conducted the primary key-informant interviews with Canadian stakeholders and also provided assistance with the general literature review. Mr. Victor Opara, a graduate level law student awaiting his Ontario Bar Exams, was hired on contract to assist with collecting materials and preparing documents for the legislative review in the third block of research. CHAPTER OUTLINE The remainder of this background research paper is organized into the following chapters: Chapter 2: Magnitude of the Problem The next chapter deals with the magnitude of the problem of recreational boating drownings in Canada, including a review of Canadian drowning statistics as well as trends and patterns in these statistics. An estimate of the economic burden associated with boating drowning deaths is provided. Chapter 3: Risk Factors Associated with Boating-Related Drownings The personal, environmental, and behavioural risk factors that are commonly linked to boating drownings are examined in the third chapter. Chapter 4: Efficacy of PFDs for Preventing Drownings Chapter Four provides an overview of the various types of flotation devices, including a brief explanation of how and why they work. The efficacy of PFDs in preventing drowning deaths is also explored, with particular emphasis on the importance of wearing PFDs versus carrying them on board watercraft. Chapter 5: Incidence of PFD Use and Public Attitudes Towards Wearing PFDs The incidence of PFD usage is examined in this chapter, along with a review of the research regarding boater attitudes towards wearing PFDs, and common perceptions that deter PFD usage. Chapter 6: Efficacy of Various Methods of Encouraging PFD Usage The effectiveness of various methods that have been used to stimulate PFD usage is explored in this chapter, including a discussion of the impact of each of the following: current legislation, educational and social marketing campaigns, incentive programs, and modifications to PFD designs and regulations. The impact of legislation that has been enacted to address other safety issues is also explored, along with the legal justification for introducing PFD wear legislation. Chapter 7: Likely Efficacy of Mandatory Wear Legislation for Encouraging PFD Usage In order to assess the likely efficacy of mandatory wear PFD legislation in Canada, the impact of legislation that has been introduced in other countries is 14

16 first reviewed. This is followed by a summary of comments from key international and Canadian informants regarding the barriers and opportunities for PFD wear legislation. Next, the probable reaction of the Canadian public is discussed, based upon findings from past research studies as well as an opinion poll conducted for this background research paper. Chapter 8: Conclusions and Recommendations This final chapter reviews the key issues surrounding the notion of creating mandatory wear PFD legislation, and concludes with recommendations for consideration by the PFD Taskforce. 15

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18 CHAPTER 2: MAGNITUDE OF THE PROBLEM NUMBER OF RECREATIONAL BOATERS IN CANADA Given that Canada is bordered to the east, west, and north by ocean, as well as the abundance of lakes, rivers, bays, and other waterways in Canada, it is not surprising that recreational boating is a very popular leisure activity among Canadians. Estimates suggest that as many as 10 million Canadians participate in recreational boating each year in Canadian waters. i1-3 INCIDENCE OF DROWNING WHILE ENGAGING IN RECREATIONAL BOATING Although recreational boating continues to grow in popularity, it does involve some degree of risk. Despite the efforts of various organizations that have mounted boating safety education campaigns, and the introduction of requirements for boat operators to obtain a Pleasure Craft Operators Card and to have an approved PFD or lifejacket of the appropriate size for each person on board, many recreational boaters continue to lose their lives unnecessarily every year. Most of these drowning incidents could have been prevented. In Canada, the primary source of information relating to drowning deaths is the Canadian National Surveillance System for Water-Related Fatalities, established in 1991 by the Canadian Red Cross, the Royal Lifesaving Society of Canada and the National Association of Coroners. All unintentional drownings and other water-related injury deaths in Canada are investigated by coroners or medical examiners, and an external cause of injury code (or E-code) should be assigned to each case. The Canadian National Surveillance System for Water-Related Fatalities contains statistics relating to drownings from various causes, including boating, aquatic activities, bathing, falls into water, and land/air transport. As well, boatingrelated drownings are further broken down into those related to recreational activities, activities of daily living, and occupational activities. The report also contains data regarding other water-related injury deaths, including deaths attributed to injuries sustained in collisions in the water, air emobolism, immersion hypothermia, injuries sustained in diving or jumping into water, and land or air transport injuries. However, as the focus of this background research paper is on recreational i Canadian recreational boaters utilize all sizes of vessels, from individual craft such as jet skis, to large vessels such as yachts. However, for the purposes of this background research paper, we have focused on vessels under six metres long. This would include personal watercraft (e.g., jet skis), kayaks, canoes, rowboats, rafts, small open powerboats, small sailboats, and sailboards. 17

19 boating drownings, the statistics presented in this report relate to drowning deaths sustained while engaging in recreational boating activities and assigned the following E-codes: 1. E830 - Accidents to Watercraft Causing Submersion, which includes: submersion and drowning due to boat overturning, boat submerging, falling or jumping from a burning ship, falling or jumping from a crushed watercraft, ship sinking, other accident to a watercraft 2. E832 - Other Accidental Submersion or Drowning in Water Transport Accident, which includes: submersion or drowning as the result of an accident other than an accident to the watercraft, such as falls from the gangplank or ship, being thrown overboard by the motion of the ship, or washed overboard. Cases in which submersion or drowning occurs when a swimmer or diver voluntarily jumps from a boat not involved in an accident are excluded. Data from 1991 to 1999 (the most recent year for which data are available) indicate that an average of 140 recreational boaters drown every year in Canada. 4 However, it is important to note that because boating drownings are frequently misclassified, it is suspected that the data underestimate the number of actual drowning deaths by up to 43%. 4 As shown in the chart below, in the last two years for which data are available, drowning deaths relating to recreational boating were lower than the nine-year average; which hopefully marks the beginning of a trend. Figure 1: Recreational Boating Drowning Deaths in Canada ii Recreational Boating Drownings

20 PROFILE OF RECREATIONAL BOATING DROWNING DEATHS As shown in the charts below, drowning victims both in 1999 and over the period from have primarily been engaged in fishing (39%) or powerboating (25%) when the incident occurred. 4, 5 Most recreational boating drowning fatalities were associated with small open powerboats less than 5.5m in length or canoes, although canoe-related fatalities made up a smaller share of all drownings in 1999 (13%) versus the last 10 years as a whole (22%), and there was a slight decrease in drownings involving small open powerboats in 1999 (34%) compared with the 10-year average (38%). 4, 5 Figure 2: Recreational Boating Drowning Deaths in Canada by Activity and Type of Boat iii By Activity: 1999 By Activity: kayaking 2% sailing 8% canoeing 8% other 8% fishing in boat/ canoe 39% kayaking 2% sailing 4% canoeing 15% other 8% fishing in boat/ canoe 39% hunting 10% powerboating 25% hunting 6% powerboating 25% By Type of Boat: 1999 By Type of Boat: kayak rowboat 2% 3% unpowered inflatable 4% sailboat/ sailboard 7% canoe 13% powerboat unspec. Size 13% PWC 2% unknown 7% small open powerboat (<5.5m) 34% large powerboat (>5.5m) 12% rowboat 4% unpowered inflatable 2% sailboat/ sailboard 7% kayak 3% PWC 2% canoe 22% powerboat unspec. Size 13% unknown 7% small open powerboat (<5.5m) 38% large powerboat (>5.5m) 6% ii Canadian Red Cross, Visual Surveillance Report: 2001 Edition, iii Canadian Red Cross, Visual Surveillance Report: 2001 Edition, Canadian Red Cross Society: What We Have Learned: 10 Years of Pertinent Facts About Drownings and Other Water-Related Injuries in Canada, ,

21 The majority of recreational boating drowning incidents take place on a lake. In 1999, 61% of all drowning fatalities occurred in a lake, 25% were in a river, and 15% were in the ocean. 4 The distribution is virtually identical when drowning statistics over the last 10 years are considered. 5 Statistics from 1999 show that about 17% of recreational boating incidents involved multiple victims as opposed to a single drowning victim, with an average of 2.9 deaths per incident. 4 Recreational boating drownings are frequently caused by the boat capsizing. As shown in the table below, in 1999, 34% of all recreational boating fatalities and 56% of canoe drowning fatalities occurred after the boat capsized. 4 The victim fell overboard in 20% of recreational boating drownings, and the boat became swamped in 13% of cases. 4 Figure 3: Recreational Boating Drownings in Canada by Injury Incident & Type of Boat, 1999 iv All Watercraft Small Powerboat Canoe Incident (<5.5m) Capsized 34% 27% 56% Fell overboard 20% 22% 6% Swamped 13% 10% 13% Unknown 18% 39% 25% Other 15% 2% - CANADIAN RECREATIONAL BOATING DROWNING DEATHS IN INTERNATIONAL CONTEXT According to the Canadian Red Cross Society, rates of drowning in Canada are nearly twice as high as those in the United States, approximately four times higher than in Scotland, seven times higher than in England, and 12 times higher than those in France. Yet, Canadian rates were about four times lower versus rates in Finland and Norway. 4 However, it is important to note that these drowning rates were calculated based upon population counts rather than boat ownership or boating participation or frequency. It is known that boat ownership varies dramatically by country. For instance, according to one source, estimates of the per-capita rates of boat ownership are relatively high in Canada (1:5), Norway (1:6), and Finland (1.7), which have higher rates of drowning. 6 Conversely, boat ownership is considerably less prevalent in other countries such as the U.S. (1:16), France (1:77), and U.K. (1:100), each of which have lower drowning rates. 6 iv Canadian Red Cross, Visual Surveillance Report: 2001 Edition,

22 A more reliable measure of international drowning rates for recreational boaters would be based upon exposure per million hours of boating. Unfortunately, this data is not readily available for many countries, which makes it difficult to gain a true understanding of how Canada s recreational boating drowning statistics compare to those in other countries. INCIDENCE OF NEAR-DROWNING WHILE ENGAGING IN RECREATIONAL BOATING Near-drownings are broadly defined as survival, at least temporarily, after aspiration of fluid into the lungs. 7 However, the Canadian authority on drownings, the Canadian Surveillance System for Water-Related Fatalities, defines near-drownings as when a drowning victim is rapidly resuscitated and survives to reach hospital. 4 Even a small amount of aspirated water can cause damage to the lungs, which could ultimately lead to serious respiratory difficulties or even death if not treated medically, 7 and some near-drowning victims sustain brain damage due to a lack of oxygen to the brain. 4 The chart below shows the rate and number of hospitalizations for survivors of near-drowning boating incidents, as well as the number of in-hospital deaths associated with boating-related near-drownings for It should be noted that boating incidents of all types are included (recreational, occupational, and daily living, though recreational drownings are far more prevalent). 21

23 Figure 4: Rate and Number of Hospitalizations For Boating-Related Near-Drownings in Canada by Year, v (Hospitalizations of Survivors of Near-Drownings, In-Hospital Deaths Excluded) Near drowning/100,000 population/year < Age Group < Hospitalizations of Near-Drowning Survivors Total Hospitali - zatio ns Near- Drowning In- Hospital Deaths However, not all near-drowning victims are hospitalized. Frequently, people who are rescued or resuscitated after a near-drowning incident are conscious and breathing on their own after rescue, and therefore may not immediately be transported to hospital as they may not appear to be in need of medical attention. Data are not yet available to quantify the number of people who are resuscitated after nearly drowning but are not hospitalized since Canada presently does not have any systematic recording of non-fatal water incidents. In part, to address this lack of information, a coalition of groups have formed an organization called the Water Incident Research Alliance (WIRA). The mission of WIRA is to provide timely and accurate information on water-related injuries and fatalities in Canada and they are actively involved in compiling information and v Canadian Red Cross, Visual Surveillance Report: 2001 Edition, Note: Rates are an average for the 4-year period; population denominators from the 1996 Census, and data are by fiscal year, April 1 to March

24 preparing a summary report on this topic. However, data is not yet available from this initiative. BURDEN OF BOATING DROWNINGS Economic Burden The social and human costs of the loss of human life in recreational boating drownings are incalculable. These tragic events have a devastating and longlasting impact on the family members and friends of the victims. However, it is possible to estimate the indirect economic costs of boating drownings by using the human capital approach. Using this methodology, indirect costs are calculated as the forgone market wages vi in the working years from ages 15 to 64 years, inclusive, due to premature death. In order to calculate the foregone market wages of drowning victims, the following data are required in addition to age-sex specific drowning statistics: the average annual wage, participation rate, average employment rate, real wage growth rate vii, discount rate, and age-sex specific mortality rates. The average annual wage used in the calculation of foregone wages was $31, 825 and was sourced from Statistics Canada (CANSIM, Matrix 4288). Data from Statistics Canada also provided the participation rate (75.87%) and the unemployment rate 7.64% (CANSIM, Matrix 3472) used in the calculations. The real wage growth rate was assumed to be 1% and the discount rate 3% for these calculations. And the age-sex specific mortality figures were obtained from Health Canada. The other data required for the calculations are Canadian drowning statistics by age and sex. In 1999, Canada was using a classification scheme for injury called ICD-9 (International Classification of Disease, 9 th Edition). In standard chart notation, all injuries are assigned a three-digit number from the E-Codes vi The estimate of foregone wages takes account of the fact that, for any individual, there is a probability that the individual could be a non-participant in the labour market or, if participating, that he or she is unemployed. Furthermore, the probability that an individual, had he or she not drowned, died from an unrelated cause during the working years is also taken into account. These are incorporated by adjusting the annual wage by the participation rate, one minus the unemployment rate and the probability of being alive at each future age, given an attained age at the time of the drowning. As is customary in these analyses, an average wage, participation rate and unemployment rate over the whole range 15 to 64 years was used. vii Future real wage levels are assumed to increase by a real wage growth factor over all future periods. The economic burden is then calculated as the discounted net present value of all foregone future adjusted wages, where the discount rate is also held constant over all periods. 23

25 supplemental chapter of the International Classification of Diseases, where E stands for External Causes. A fourth digit is provided in order to further specify the injury. The purpose of these codes is "to permit the classification of environmental events, circumstances, and conditions as the cause of injury, poisoning, and other adverse effects." For the purposes of this analysis of the economic burden of boating drownings, two E-Codes were utilized: 1) E830 - Accidents to Watercraft Causing Submersion, which includes: submersion and drowning due to boat overturning, boat submerging, falling or jumping from a burning ship, falling or jumping from a crushed watercraft, ship sinking, other accident to a watercraft 2) E832 - Other Accidental Submersion or Drowning in Water Transport Accident, which includes: submersion or drowning as the result of an accident other than an accident to the watercraft, such as falls from the gangplank or ship, being thrown overboard by the motion of the ship, or washed overboard. Cases in which submersion or drowning occurs when a swimmer or diver voluntarily jumps from a boat not involved in an accident are excluded. Using this model and the assumptions outlined above for calculating foregone wages of drowning victims, the total economic burden of drowning deaths in Canada was estimated at $30,156,553 for Please see the table below for further details including the economic burden by age and sex. Please note that this estimate of economic burden was calculated using only the drowning cases which were coded with the E-codes listed above. Unfortunately, the recording of ICD-9 codes is known to be incomplete, and many cases are not coded properly. According to the Canadian Red Cross, Visual Surveillance Report (2001 Edition), there were 122 recreational boating drowning deaths in Canada in However, only 86 drowning cases in 1999 were coded with either E830 or E832, and thus only these cases were included in this economic analysis. Consequently, the economic burden associated with the remaining 36 drowning cases that were not coded with either of the E-codes above is not captured in the estimated economic burden. 24

26 Figure 5: Economic Burden of Boating Drownings in Canada, 1999 TOTAL (MALES AND FEMALES COMBINED) Mortality Age Group Population Rates per 100,000 Deaths Economic Burden TOTAL 30,491, $30,156, MALES Age Group Population Mortality Rates per 100,000 Deaths Average Age Economic Burden 0 174, $ , $547, ,056, $1,185, ,040, $654, ,058, $2,709, ,052, $3,794, ,069, $1,164, ,181, $3,162, ,361, $3,266, ,283, $4,003, ,123, $982, , $2,232, , $1,449, , $452, , $ , $ , $ , $ , $0.00 MALES 15,103, $25,605, FEMALES Mortality Rates per 100,000 Deaths Average Age Economic Burden Age Group Population 0 165, $ , $556, ,004, $ , $665, ,003, $688, ,007, $ ,043, $ ,156, $1,070, ,341, $ ,283, $406, ,128, $998, , $ , $163, , $ , $ , $ , $ , $ , $0.00 FEMALES 15,387, $4,550,

27 It should be reiterated that the estimate above is an estimate only of the indirect economic costs of boating drownings. Other direct costs such as those related to search and rescue efforts or medical treatments on site are not included in this estimate, but are known to be substantial. In Canada, marine search and rescue (SAR) efforts are carried out by a wide variety of players, including the Canadian Coast Guard (CCG), Parks Canada, the Royal Canadian Mounted Police (RCMP) and provincial police forces, municipal police forces and fire departments, and a wide variety of volunteer organizations, including the Canadian Coast Guard Auxilliary (CCGA). 8 As well, the Department of National Defence also provides SAR support via its fleet of aircraft and naval vessels for marine incidents. 9 Thus, it is difficult to tabulate all of the associated costs of marine search and rescue across all jurisdictions in Canada. However, it is estimated that the Canadian Coast Guard fleet responds to 40% of marine SAR incidents in a typical year, so the costs borne by this agency will provide some indication of the magnitude of SAR costs across Canada. The Canadian Coast Guard is charged with the responsibility for SAR tasks in coastal waters, the St. Lawrence River, the Great Lakes, and the Arctic, an area that covers more than 5.3 million square kilometers, 10 and they respond to an average of 7,000 marine SAR incidents each year, of which 700 are distress and another 700 are potential distress incidents. 9 Typically, 3,000 people are saved, and another 20,000 are assisted in an average year. 9 When both the operating expenditures and capital expenditures are totaled, the Canadian Coast Guard spent over $70 million for SAR activities in the fiscal year 1998/ This figure does not include the costs of search and rescue efforts in inland rivers and lakes, which fall under the responsibility of the provinces. As well, the costs associated with SAR incidents within national parks also are not included in this total, as SAR activities within parks are the responsibility of Parks Canada. Volunteer organizations such as the Canadian Coast Guard Auxilliary also provide substantial search and rescue assistance. In fact, it is estimated that the CCGA responds to approximately 25% of all SAR incidents in a typical year, 9 which translates into about 200 lives saved across Canada. 11 The costs associated with SAR activities by the Central and Arctic region of the CCGA (which is just one of the five CCGA regions) for 1999 were approximately $75,000 according to one unreleased report. 12 Other information provided by the CCGA indicates that the incident costs in fuel and equipment (excluding the initial cost of the vessel, navigation and communication equipment) average about $174 per incident. 13 Thus, it is clear that the economic costs of search and rescue efforts in Canada every year are substantial. Unfortunately, it is not possible to estimate the cost of medical treatment for near-drowning in Canada due to the small sample size in a given year. However, medical treatments could range from an emergency room visit or a brief hospitalization for less severe cases, to much more extensive interventions 26

28 for those who sustain permanent brain damage from a lack of oxygen while underwater. The estimates produced for this background research paper represent an extremely conservative estimate of the economic burden associated with boating drowning deaths; and this estimate only represents the economic impact and cannot touch on the social impact of boating drownings. Another economic analysis study has calculated the annual cost of recreational boating drownings for Canada, including both the indirect costs of loss of productivity as well as direct costs for medical treatment, funeral services, etc. 14 This study used cost estimates by age and sex from U.S. data and applied them to the Canadian recreational boating deaths for 1991 and 1992, with the assumption that the average costs per drowning would be similar in the two countries. This study estimated that the total average annual cost of all recreational boating drownings in Canada for 1991 and 1992 was about $80 million. 14 Potential Years of Life Lost Another way of examining the cost of boating drownings is to calculate the potential years of life lost due to these tragedies. This is calculated by subtracting the actual age at death from a standard age of death (usually age 75) and then multiplying this figure by the number of deaths. Using an average age of death for 1999 of 75 for both males and females (from Vital Statistics, Statistics Canada), there are a total of 2,353 potential years of life lost for male boating drowning victims, and 414 years for female victims. Thus, a grand total of 2,767 potential years of life were lost to Canadians in 1999 due to boating drownings. 27

29 28

30 CHAPTER 3: RISK FACTORS ASSOCIATED WITH BOATING-RELATED DROWNINGS PERSONAL FACTORS Age and Gender There are some very definite patterns in recreational boating drowning deaths in Canada. For instance, adult males comprise the vast majority of victims year after year. The distribution of recreational boating drownings by age and sex is presented in the chart below for the past 10 years. Though the rate of drownings among male recreational boaters has declined during the period compared with the period, drowning rates continue to be significantly higher for males than for females. In 1999, males accounted for 90% of all recreational boating drowning victims, 4 even though they accounted for only about 50-60% of all recreational boaters in Canada, according to some estimates. 15, 16 Stated another way, drowning is about 9 times more likely among males than females. Figure 6: Rates of Recreational Boating Drownings in Canada by Age and Sex, viii Drownings/100,000 Population/Year < Males (N=686) Males (N=579) Females (N=42) Females (N=55)

31 As shown in the chart below, it is adult males who are most at risk, particularly 4, 17 males between 16 and 54 years of age, with a peak period between years. Figure 7: Age / Sex Distribution of Drowning Deaths in Canada 1999 ix Number of Drownings -50 Male N=109 0 Female N= Age Group Aboriginals Another consistent finding is that aboriginals are over-represented in drowning deaths. 4 Although aboriginals make up only about 3% of the Canadian population according to Statistics Canada, 18 they comprised 11% of all recreational boating drowning victims in 1999, and the drowning rate for aboriginals was eight times higher than for other Canadians (9.0/100,000 population versus 1.2). 4 However, this likely underestimates the true total for aboriginals since coroners do not always report the ethnicity of victims in some provinces. 4 There are two important factors that contribute to the higher rate of drownings amongst the aboriginal population. One factor is alcohol. Alcohol was associated with at least 50% of the drowning deaths of aboriginals in 1999 compared to approximately 40% for non-aboriginals or those with unspecified ethnicity. 4 Aboriginals are also even less likely than other Canadians to wear a viii Canadian Red Cross Society: What We Have Learned: 10 Years of Pertinent Facts About Drownings and Other Water-Related Injuries in Canada, , 2003 ix Canadian Red Cross, Visual Surveillance Report: 2001 Edition,

32 PFD. While 10% of all Canadian drowning victims in 1999 wore a PFD, not a single aboriginal drowning victim was wearing a PFD in 1998 or Swimming Ability Interestingly, an examination of Canadian recreational boating fatalities in 1999 shows that only 14% of those who drowned were identified as non-swimmers or weak swimmers. 19 However, the swimming ability of a large percentage of victims was not known, and when only those drowning victims whose swimming ability was known are factored in, a larger proportion of the drowning victims in Canada in 1999 (59%) were swimmers than non-swimmers (41%). There is considerable evidence that even those who are good swimmers can experience great difficulty in cold water, so swimming ability in warm water is not necessarily a good indicator of survival in cold water. 7, 20 Clearly, increasing boaters' experience in the water, and level of swimming ability are not the only or necessarily best ways to reduce the incidence of recreational boating-related drowning. Lack of Boating Safety Training and Inexperience Although data relating to the link between boating safety training and boating drownings does not seem to be available in Canada, there is considerable evidence from an analysis of drowning reports in the United States to suggest that it can be a major contributing factor to boating fatalities. In a report outlining boating accident statistics for the year 2000, the United States Coast Guard reported that 47% of all boating fatalities occurred on boats where the operator had not completed a boating safety education course. And when only the cases in which the education of the operator is known are considered, 84% of the boating fatality victims had not received any boating safety training. 21 There is also evidence that boaters with more hours of experience on the water are less likely to be involved in a boating accident. According to the United States Coast Guard, the average recreational boater logs an average of 240 exposure hours per year. 22 Exposure hours are calculated based upon the number of days the boat is used per year, the number of hours per day the boat is used, and the number of occupants of the boat. The United States Coast Guard reported that when only the fatalities in which the victim s experience was known were factored in, 45% of boating fatality victims had under 100 hours of boating experience. 21 Another report by the U.S. Coast Guard focusing specifically on hours of experience also found that hours of experience is negatively correlated with boating fatalities. 22 Specifically, the study reports that boaters with less than 100 hours of operating experience had a fatality rate of 64 per million hours, which is three times higher than the rate of 22 fatalities for those with between 100 and 500 hours of experience. And the fatality rate for those with over 500 hours of experience is extremely low at.0018 deaths per million hours. 22 Another report based on California boating fatalities found that operator inexperience played a role in 40% of all boating fatalities

33 ENVIRONMENTAL FACTORS Water Temperature It is well-documented that immersion in cold water can cause various physiological responses, each of which can lead to drowning 7, 20 and this topic will be explored in greater depth in a later chapter. In brief, the cold shock in the first few minutes of immersion can cause severe hyperventilation, muscle spasms, and even lead to heart failure due to a substantial increase in heart rate and blood pressure. The cold water may also cause limbs and hands to become numb and impede swimming ability as well as any self-rescue attempts requiring manual dexterity or handgrip strength. As well, within the first few minutes, it may become increasingly difficult to control breathing, and breathing may even stop due to diving response. After being immersed for 30 minutes or more, body temperature will fall to hypothermic levels, resulting in a loss of consciousness. 20 Given the fact that water temperatures in Canada can be as low as 10 C in the summer (peak boating season), it is not surprising that the statistics show that cold water is a significant risk factor in drownings in Canada. For example, in 1999, 47% of all recreational boating drowning deaths (and 98% of drownings in which water temperature was known) occurred in cold or extremely cold water (under 20ºC). 4 It is interesting to note that, in 63% of drowning deaths over the period, the water temperature was not known. In 1999, the water temperature was known in 48% of cases, and it is even more apparent that drownings tend to occur in cold water. In 1999 (as well as the period ), only 1% of all recreational boating drownings took place in warm water above 20 C. Figure 8: Recreational Boating Drownings in Canada by Water Temperature x Unknown 52% Warm/Hot (>20 degrees Celsius) 1% Extremely Cold (<10 degrees Celsius) 29% Unknown Cold (10-20 degrees Celsius) 18% Extremely Cold (<10 degrees Celsius) 21% 63% Cold (10-20 degrees Celsius) 15% Warm/Hot (>20 degrees Celsius) 1% x Canadian Red Cross, Visual Surveillance Report: 2001 Edition, Canadian Red Cross Society: What We Have Learned: 10 Years of Pertinent Facts About Drownings and Other Water-Related Injuries in Canada, ,

34 Weather and Boating Conditions Wind, wave, and light conditions each may contribute to the likelihood of drowning, as they can affect the operator s ability to maneuver the watercraft, the stability of the craft and the likelihood of capsizing or a boat occupant falling overboard. As well, adverse conditions could affect a person s ability to stay afloat, locate and don flotation devices, and their ability to swim or assist in their own rescue. In 1999, 32% of all recreational boating drownings occurred during strong wind conditions, 28% occurred during rough or stormy wave conditions, and 20% occurred during twilight or after dark. 4 Figure 9: Recreational Boating Drownings in Canada by Wind, Wave, Lighting Conditions, 1999 xi Wind Conditions Wave Conditions Lighting Conditions unknown 52% calm 10% breeze 6% strong wind 32% unknown 49% calm 14% storm 3% choppy 9% rough 25% unknown 19% dark 11% twilight 9% light 61% BEHAVIOURAL FACTORS Alcohol In many ways, alcohol consumption is even more dangerous when operating a watercraft than a motor vehicle. In fact, research has shown that due to factors associated with the marine environment (such as motion, vibration, engine noise, sun, wind, and spray from the water), only one third of the amount of alcohol that makes a person legally impaired on the road is sufficient to make a person equally impaired on the water. 24 Drinking alcohol produces certain physiological responses, which clearly interfere with a person s ability to safely operate a watercraft. Alcohol consumption impairs judgment, the ability to focus and process information, as well as reaction time. 24 At the same time, peripheral xi Canadian Red Cross, Visual Surveillance Report: 2001 Edition,

35 vision, night vision and depth perception deteriorate after consuming alcohol. 24 It can also cause an inner-ear disturbance which can affect balance and can make it difficult to distinguish up from down, which would increase the likelihood of falling overboard and decrease the chance of self-rescue for those who do fall overboard. 24 Alcohol also reduces the body s ability to insulate itself against the cold, causing the effects of hypothermia to set in more quickly. 24 It is estimated that a boat operator with a blood alcohol concentration above.10 is more than 10 times as likely to be killed in a boating incident than boat operators with zero blood alcohol concentration. 24 Unfortunately, it seems the message about the danger of alcohol consumption while engaging in recreational boating has not been accepted by all boaters. Research with adult male recreational boaters in Western Canada suggests that the majority of recreational boaters recognize that drinking while operating a boat is just as dangerous as driving a car after drinking, 25, 26 and 78% of recreational boaters surveyed in another study agreed that it is necessary to wear a lifejacket when anyone on board has consumed alcohol. 27 Nevertheless, as shown in the chart below, alcohol continues to be a factor in many boating drownings, although the proportion of drowning victims with a blood alcohol content above the limit has actually declined in the past five years. However, in 1999, alcohol was detected in 32% of all drowning victims (23% were above the legal limit) and was suspected in another 7% of recreational boating drowning deaths in Thus, in total, alcohol was confirmed or suspected to be a factor in nearly a third of all recreational boating drowning deaths in Canada in It is important to note, however, that the blood alcohol levels of about one quarter of victims was unknown, so these figures may be an underestimate. According to another report which summarizes the literature relating to boating drownings suggests that alcohol (is) implicated in upwards of 45% of cases 17 Alcohol Suspected 7% Figure 10: Blood Alcohol Levels for Recreational Boating Drownings in Canada xii Above Limit 23% Below Limit 9% (Victims 15 Years of Age) Unknown 26% No Alcohol 35% Above Limit 26% Alcohol Suspected Unknown 30% 6% No Below Alcohol Limit 27% 11% Above Limit 23% Alcohol Suspected 7% xii Canadian Red Cross, Visual Surveillance Report: 2001 Edition, Canadian Red Cross Society: What We Have Learned: 10 Years of Pertinent Facts About Drownings and Other Water-Related Injuries in Canada, , Below Limit 8% Unknown 26% No Alcohol 36% 34

36 Reckless Behaviour Many drownings appear to be attributable more to recklessness or poor judgment than environmental factors. Investigation into the cause of all drowning fatalities in 1999 revealed that the boat was overloaded in 10% of all drowning incidents, someone stood in the boat in 8% of all drownings, the boat operator made an abrupt turn that may have contributed to 6% of the deaths, the boat itself was unsafe in 6% of all cases, and the boat was speeding prior to 2% of all drowning incidents. 4 Figure 11: Recreational Boating Drownings in Canada by Risk Factor xiii Cause of Incident 1999 % Strong winds 32 Rough waves 30 Boat overloaded 10 Standing up in boat 8 Engine trouble 7 Abrupt turn 6 Current 6 Unsafe boat 6 Fell overboard, boat kept going 4 Collision object/person 4 Collision boats 4 Embarking/disembarking 2 Speeding 2 Urinating 2 Note: There may be multiple risk factors per incident xiii Canadian Red Cross, Visual Surveillance Report: 2001 Edition,

37 Wearing a Lifejacket or Personal Flotation Device Although there are clearly many contributing factors, likely the most important and consistent risk factor in boating fatalities is the (non) usage of some sort of flotation device, whether lifejackets or a personal flotation device (PFD). In Canada, it is not currently mandatory to wear a lifejacket or PFD, although there is a requirement to have a PFD or lifejacket of the appropriate size on board for each person. 28 Since it is left up to the individual s discretion, not all boaters wear a PFD or lifejacket, and a large proportion of drowning deaths can be directly attributable to not wearing a PFD. In the vast majority of recreational boating drowning deaths, the victims were found not wearing a PFD. 17 As shown in the table below, approximately nine in 10 of the recreational boaters who drowned in 1999 were not wearing a PFD, and this statistic has remained roughly the same over the past ten years. 4, 5 Sadly, in many drownings, the victims actually had a PFD on board but were not wearing one, or they were wearing a PFD, but not in the correct manner. In 1999, for instance, a PFD was present, but not worn in 30% of all recreational boating drownings. Another 2% of victims were either wearing an unfastened PFD or a PFD that was the wrong size. 4 Figure 12: Recreational Boating Drownings in Canada by Use of a PFD xiv Presence / Absence of a PFD on Drowning Victim Victim was (properly) wearing PFD 11% 12% 11% Victim was not wearing PFD / wearing PFD improperly / unknown 89% 88% 89% Presence / Absence and Usage / Non Usage of a PFD On board Unknown if PFD Present 6% 23% 13% PFD Known to be Present 43% 36% 38% PFD present, worn properly 11% 12% 11% PFD present, worn improperly 2% 4% 3% PFD present, not worn 30% 20% 24% PFD Known to be Absent (not worn) 28% 27% 29% PFD Not Worn, Unknown if Present 24% 14% 22% Note: Figures do not add to 100% due to rounding. xiv Canadian Red Cross, Visual Surveillance Report: 2001 Edition, Canadian Red Cross Society: What We Have Learned: 10 Years of Pertinent Facts About Drownings and Other Water-Related Injuries in Canada, ,

38 There is also international evidence of the relationship between lack of PFD use and drowning incidence. In an epidemiological study in Denmark, it was found that half of all recreational boating drowning incidents involved someone not wearing a lifejacket. 29 In the state of Victoria in Australia, analysis of drowning statistics shows that 70% of boating drowning victims were not wearing a PFD in 2001/ In Tasmania, Australia, 78% of all boating drowning victims between 1987 and 1999 were not wearing PFDs. 31 In the United States, the proportion of drowning victims found not wearing a PFD was 85% in and 84% in

39 38

40 CHAPTER 4: EFFICACY OF PFDS FOR PREVENTING DROWNINGS As was discussed in the last chapter, the one thing that seems to be even more important than any other factor in contributing to boating drowning deaths in Canada (including weather and wave conditions, water temperature, alcohol use, and swimming ability) is whether or not a personal flotation device is worn. An analysis of drowning statistics between 1991 and 1999, indicates that roughly 90% of all drowning victims during that period were not wearing a PFD. 4 In this chapter, we examine whether or not PFDs are an effective way to prevent boating drownings. This will include information regarding the differences and similarities between various types of flotation devices and a brief summary outlining how flotation devices work. The efficacy of PFDs in preventing drownings is also examined in this chapter, including the rationale for wearing versus carrying PFDs. PRINCIPLE BEHIND LIFEJACKETS AND PERSONAL FLOTATION DEVICES Archimedes Principle states that the buoyant force on a submerged object is equal to the weight of the fluid that is displaced by the object. 34 This force is either expressed in pounds or Newtons. An average-sized adult requires about seven pounds of buoyancy to remain afloat with his or her mouth clear of the water. 34 As summarized in the chart below, each of the various styles of lifejackets and PFDs in Canada have differing degrees of buoyancy, though each is sufficient to keep an average-sized adult afloat. COMPARISON OF LIFEJACKETS AND PERSONAL FLOTATION DEVICES In some countries such as the United States, a lifejacket is one type of buoyancy device included the broader term personal flotation device. However, in Canada, lifejackets and Personal Flotation Devices (PFDs) are two different classes of buoyancy aids with differing requirements and purposes. 39

41 Figure 13: Minimum Buoyancy Required for Lifejackets and Personal Flotation Devices in Canada xv Adults (in Pounds/Newtons) Children (in Pounds/Newtons) SOLAS Lifejacket 30.6 lbs / 125 N 14.2 lbs / 58 N Standard Lifejacket 28 lbs / 125 N 13 lbs / 58 N Small Vessels Lifejacket 22.7 lbs / 93 N 14.2 lbs / 58 N or Inherently Buoyant PFD Inflatable PFD Manual - Vest / Suspender Style Inflatable PFD Manual - Pouch Style Inflatable PFD Automatic 7.6 lbs / 31 N 15.5 lbs / 69 N 10.8 lbs / 44 N or 8.8 lbs / 36 N or 6.6 lbs / 27 N 34 lbs / 150 N Not approved for children 22.5 lbs / 100 N Not approved for children 34 lbs / 150 N Not approved for children Lifejackets Lifejackets were originally designed for professional mariners in the event of emergencies at sea 34 and continue to be used more by those on commercial crafts versus recreational boating enthusiasts. In an emergency situation on a commercial craft, those who are either thrown overboard or forced to abandon ship may face extreme wave conditions, they may be injured or even unconscious, and rescue at sea may take some time. 35 Thus, lifejackets were designed to have the capability to not only keep a person afloat, but also turn the wearer (whether conscious or unconscious) onto his or her back, with the head supported and the mouth out of the water in order to protect the airway. 34 Because of the S-shaped curvature of the spine, the body more easily bends forwards rather than backwards, and this results in a facedown position in the water for an unconscious, injured, exhausted or incapacitated individual. 35 According to pathology reports, drowning victims consistently have abrasions on the forehead, and the backs of the hands and toes xv Sources: Brooks, C.J., A Few Words On Lifejackets and Personal Flotation Devices in Canada. report available online: PFD'S%20Web%20Site.pdf Brooks, C.J., Designed For Life, Lifejackets Through the Ages

42 consistent with a face-down position in the water. 35 As a result, lifejackets were designed specifically to counteract the forward face down position with a buoyant cell on the front of the upper chest to lift the chest out of the water and turn the body in a supine position to reach buoyant equilibrium. Lifejackets also contain another buoyant cell behind the head in order to keep the head clear of the water. 35 There are three different types of lifejackets (SOLAS, Standard, and Small Vessel), each with differing capabilities and uses. Both SOLAS and Standard Type lifejackets will automatically turn a person onto their back, but Small Vessel lifejackets will not necessarily be able to right a person in every instance. Both SOLAS and Standard Type lifejackets are equipped with retro-reflective tape and a whistle, whereas this equipment is not provided with some Small Vessel lifejackets. All three types of lifejackets are available in only three approved colours to improve visibility in a rescue situation: red, yellow, and orange. Each type of lifejacket is available in sizes appropriate for both adults and children. The three types of lifejackets are approved for particular types of vessels in Canadian waters. SOLAS lifejackets are approved by international standards for all vessels in Canadian waters, Standard Type lifejackets may be used on certain commercial vessels with a voyage limitation, while Small Vessel lifejackets are only approved for use on commercial vessels of less than 15 tons. Transport Canada is the approval authority for lifejackets in Canada. 34 Personal Flotation Devices The key differences between lifejackets and PFDs (which in many cases can look virtually identical) are that PFDs are less buoyant and have limited turning capability compared to lifejackets. However, since recreational boaters typically boat in congested waters, close to shore or to help/rescuers, the fact that they are less buoyant and are less effective at turning an unconscious person is not generally as large a concern as with professional mariners or those who boat on rough, open water. PFDs were designed for use in recreational boating, and are generally smaller, less bulky, and more comfortable than lifejackets. Another difference between PFDs and lifejackets is that PFDs are now approved in a wide variety of colours whereas lifejackets must still be red, orange, or yellow. PFDs must be approved by the Department of Fisheries and Oceans, specifically the Canadian Coast Guard. 34 There are two basic types of PFDs: inherently buoyant and inflatable. Inherently buoyant PFDs have buoyancy capabilities due to their construction from unicellular foam or macro cellular elements. 34 Inherently buoyant PFDs have less flotation than all three types of lifejackets, have very limited turning capability, and are available in several sizes. In contrast to inherently buoyant PFDs, inflatable PFDs are not made of inherently buoyant materials, but instead contain inflation devices that either automatically inflate when immersed in water, or must be inflated by the wearer using either an oral or manual inflation device. 34 Manual types of inflatable PFDs are available in vest, suspender, or pouch styles, although pouch PFDs are only approved for rowing and paddling, 41

43 not white water or other activities. Automatically inflatable PFDs are available in jacket styles only and contain a small cardboard element that disintegrates when wet, and this leads to a chain reaction of events that ultimately causes a CO 2 inflation cartridge to inflate the device. Automatically inflatable PFDs are not approved for sailboarding activities. 34 While the inflation time for inflatable PFDs is relatively short (usually less than five seconds), they are not appropriate for those who are weak swimmers, since even if an automatically inflating PFD is used, in the event of a failure in the inflation mechanism, the wearer would have to use the back up inflation system to inflate the PFD while staying afloat. Inflatable PFDs are not approved for white water paddling or personal water craft use, and they are not approved for use by those under the age of 16. Figure 14: Types of Flotation Devices Used in Canada Flotation Devices Lifejackets PFDs SOLAS Standard Small Vessel Inflatable Inherently Buoyant Foam-filled Inflatable Manual Automatic Vest/Suspender Style Pouch Style 42

44 Figure 15: Comparison of Canadian Lifejacket and Personal Flotation Device Characteristics Lifejackets SOLAS Standard Small Vessel all vessels all vessels Inherently Buoyant Personal Flotation Devices Inflatable Manual Manual Inflation - Inflation - Vest/ Pouch Suspender TYPE OF VESSELS APPROVED FOR small recreational commercial vessels vessels recreational vessels except PWCs, white water only paddling rowing Automatic Inflation recreational vessels except PWCs, white water, sailboards AVAILABLE IN CHILDREN S SIZES TURNING CAPABILITY limited very limited red yellow orange red yellow orange COLOURS APPROVED red all colours all colours all yellow colours orange all colours HAVE REFLECTIVE TAPE & WHISTLE some 30.6 lbs 125 N 28 lbs 125 N MINIMUM BUOYANCY FOR ADULT 22.7 lbs 15.5 lbs 34 lbs 22.5 lbs 93 N 69 N 150 N 100 N 34 lbs 150 N 43

45 EFFECTIVENESS OF LIFEJACKETS AND PERSONAL FLOTATION DEVICES Most in the boating community (including the Canadian Red Cross, the Canadian Lifesaving Society, the Canadian Coast Guard, the United States Coast Guard, and the National Association of Boating Law Administrators) promote the use of flotation devices for recreational boaters as they are believed to be effective in saving lives. However, there is some debate about whether it is necessary for recreational boaters to wear a PFD at all times on the watercraft, or whether it is sufficient to have PFDs readily accessible on board watercraft so that they can be donned in an emergency situation. RATIONALE FOR WEARING RATHER THAN CARRYING PFDS Research suggests that many boaters feel that simply carrying a PFD on board is sufficient. One survey of recreational boaters found that 64% of respondents felt safe as long as their PFD was in reach, 26 while another study reported that 29% of the recreational boaters surveyed agreed strongly or somewhat with the statement that it is unnecessary to wear a lifejacket if they have one close at hand. 27 Clearly, these boaters who do not feel it is necessary to actually wear a PFD at all times while on the water either believe that they would have sufficient time in the event of an emergency to locate, put on, and fasten a PFD before they enter the water or they believe that they would be able to locate, put on, and fasten a PFD once they are in the water. One problem with the theory that simply having a flotation device close at hand is sufficient, is the assumption that there will be time in an emergency to actually locate it and put it on. As has already been discussed, the majority of recreational boating drownings stem either from the vessel capsizing or the victim falling overboard. 4 Clearly, such drowning and near-drowning incidents typically occur with little or no warning, and consequently, there is little or no opportunity to don a flotation device, particularly if they are stowed in a cabin or enclosed space. One expert in cold-water drownings summarizes the situation as follows: A drowning accident occurs very suddenly, often within very close reach of land or assistance. The whole tragic event from start to finish typically occurs in under six minutes because very few people taken by surprise can remain afloat for much longer without a lifejacket: In nearly threequarters of the accidents, the victims are dead within 15 35, page 173 minutes. The results of an initiative in Rhode Island designed to illustrate to boaters the importance of wearing, not carrying, flotation devices provide further evidence 44

46 that it is unrealistic to assume that flotation devices can be donned in an emergency situation. In 2001, marine patrol officers in Rhode Island approached vessels and bet the occupants a gift certificate for BoatU.S. that they could not all put their lifejackets on and buckle them up in 30 seconds or less. According to an article written in a NASBLA newsletter, the outcome was almost comical as people scrambled around looking for their lifejackets. In many instances, the test ended with 36, page 1 adults trying to put on children s lifejackets or finding no lifejackets at all. In the end, they didn t give out many gift certificates, but hopefully made more boaters aware of how inadequate carrying PFDs on board, but not wearing them would be in an emergency situation. 36 Thus, although many boaters seem to feel that there is sufficient time to locate, put on, and fasten a personal flotation device of the appropriate size in an emergency situation, this is not typically true in most drowning incidents. And in fact, this misperception is dangerous, as this may provide boaters with a false sense of security. One United States Coast Guard Recreational Boating Safety Specialist draws a useful analogy to seat-belt use in motor vehicles to illustrate this point. As he says, keeping a lifejacket handy versus wearing one is like attempting to buckle a car seat-belt just before the car crashes. 36 Difficulties in Putting on a PFD Once in the Water Other boaters have the impression that it is unnecessary to wear a PFD at all times when on the water since they believe that they could locate and put on a PFD if they suddenly and unexpectedly found themselves in the water. However, this notion, that a person who is not already wearing a flotation device when he or she goes into the water can locate and put one on in the water is also flawed for several reasons. For instance, adverse wind and wave conditions and darkness could certainly impede a person s ability to locate and put on a flotation device while staying afloat and keeping their airway clear of the water. As discussed in Chapter Two, drowning statistics show that a significant percentage of boating incidents occur in poor weather, or in dim light conditions. 4 As well, in some drowning cases, it is apparent that a lone boater unexpectedly fell overboard and either there was no engine kill mechanism, or it was not activated, and therefore the boat either continued on without the operator or drove around in circles. 4 Thus, if the boater was stowing flotation devices on board but not wearing one, there is no possibility of putting one on once in the water. Cold Water The key reason why carrying a flotation device is far less effective than wearing one relates to water temperatures. Canadian coastal waters, lakes and rivers are so cold for most of the year that immersion can lead to strong physiological responses that would severely impair a person s ability to locate, put on, and fasten a personal flotation device in the water. As shown in the chart below, 45

47 water temperatures in Canada can be as low as 10 degrees Celsius in prime boating season (summer). A review of drowning statistics shows that cold water is a significant risk factor for drownings in Canada. For example, in 1999, 47% of all recreational boating drowning deaths occurred in cold or extremely cold water (under 20ºC). 4 Figure 16: Average Seasonal Water Temperatures in Canada xvi Winter Spring Summer Fall Lake Ontario 3º C 3º C 16º C 15º C Lake Erie 3º C 4º C 20º C 18º C Lake Huron 4º C 2º C 15º C 15º C Lake Michigan 4º C 3º C 16º C 15º C Lake Superior 3º C 1º C 10º C 12º C Coastal waters British n/a N/a 13º C n/a Columbia Coastal waters n/a N/a 13º C n/a Newfoundland and Labrador Coastal waters Nova n/a N/a 16º C n/a Scotia Powell River British Columbia n/a N/a 7º C n/a The physiological responses that are experienced when a person is suddenly immersed in cold water are generally divided into three stages according to length of time in the water: Initial Responses/Cold Shock, Short-Term Responses/Swimming Failure, Long-Term Responses/Hypothermia. Initial Responses/Cold Shock (0-3 minutes) The sudden lowering of skin temperature on immersion in cold water produces a number of significant physiological responses which begin immediately upon immersion, peak in the first 30 seconds, and last for two to three minutes. 7 One of the immediate effects of sudden immersion in cold water is a dramatic rise in heart rate and blood pressure. While this may pose little danger to relatively healthy individuals, those with medical conditions such as coronary 7, 37 artery disease or high blood pressure may experience a heart attack or stroke. xvi Sources: Great Lakes: Coastal Waters B.C.: Coastal Waters Newfoundland and Labrador: Coastal Waters Nova Scotia: Powell River: 46

48 Those with a pre-existing heart condition may be susceptible to cardiac arrest when suddenly immersed in water of 10 C or lower. 20 However, for most people who are suddenly immersed in cold water, respiratory problems are the more serious danger. 37 People immersed in water below 15 C will immediately experience breathing difficulties, beginning with a large inspiratory gasp 20, 37. During this initial gasp, the individual breathes in close to total lung capacity, which creates a sensation of breathing difficulty or suffocation that could contribute to a feeling of panic. 7 After this initial gasp of air, the individual experiences uncontrollable hyperventilation, which can cause 7, 20 dizziness and confusion, as well as muscle spasms. The other difficulty that those suddenly immersed in cold water experience is a difficulty in holding their breath. Typically, individuals can hold their breath for an average of over a minute in air, 7 but after being immersed in water below 25 C, the ability to breath hold is severely hindered. In 25 C water, respondents in one study were able to hold their breath for 38 seconds on average, whereas in 15 C, 10 C, and 5 C water, on average, respondents were only able to hold their breath for 28, 24, and 19 seconds respectively. 38 In situations in which a person is suddenly immersed in cold, choppy water where the individual s head may be repeatedly splashed or submerged by small waves, this inability to breath hold can lead to the aspiration of water. 7 This is very dangerous since aspiration of as little as 1/4 liters of water can impede the normal functioning of the lungs and can even lead to death. 7 According to one expert on drowning, the drastic reduction in the ability to breath hold on initial immersion in cold water is now considered the most dangerous risk for 7, page 64 otherwise healthy individuals. Another potential effect of immersion in cold water is known as the diving reflex or mammalian diving response. About 15% of people who are suddenly submerged in cool water reflexively stop breathing and their heart rate slows when cold water splashes on their face and the nerves around their eyes are stimulated. 7 This response is more common in children than in adults, and is more likely to occur in water around 20 C, or when the person is cold-habituated or wearing clothing such as a dry suit that prevents the cooling of the skin. 7 reflex is what allows mammals such as seals to be submerged underwater without breathing for as long as 30 minutes. The diving response is sometimes credited as being responsible for the survival of near-drowning victims after being submerged for extended periods of time in cold water, 7 although other research does not support this theory. 38 The dive response can also trigger 20, 37 cardiac arrest. This For these reasons, the initial cold shock in the first few minutes of immersion probably accounts for the majority of near-drowning incidents and drowning deaths following accidental immersion in open water below 15 C. 7, page 59 Clearly, if a person was wearing a PFD (properly fastened) before being immersed in cold water, his or her chances of surviving the cold shock phase of immersion 47

49 would be significantly higher. A PFD would help the individual to stay afloat and keep their airway clear of water while he or she experiences confusion or disorientation and struggles to regain control of his or her breathing. Obviously, the physiological responses that take place during the initial cold shock phase would also make locating and donning a PFD in the water exceedingly difficult. Short-Term Responses/Swimming Failure (3-30 minutes) After the first three minutes of immersion in cold water in which the individual experiences a rapid cooling of the skin associated with the respiratory and cardiovascular responses difficulties outlined above, next the nerves, muscles, and joints in the limbs are affected. Limbs tend to cool quickly because they have a high surface area, include little heat-containing mass and, because of 7, page 66 vasoconstriction, rapidly lose their major source of heat, blood flow. Research studies show that the ability of muscles to contract, grip strength, and manual dexterity all deteriorate quickly after being immersed in cold water and the body literally becomes numb with cold. 7, 20 For instance, one research study found that the ability of muscle to contract or exert force may become seriously impaired within 20 minutes of being immersed in 12 C water, while grip strength may fall by 20% after being immersed for five minutes in 5 C water. 39 Other research suggests that grip strength is significantly reduced in the first two minutes of immersion. 40 Thus, clearly a person s ability to manipulate either a manually or orally-inflatable flotation device, tighten the straps or buckle a flotation device, climb out of the water, or engage in any other self-rescue activities requiring manual dexterity, muscle coordination, or handgrip strength will become increasingly difficult in frigid water. 7 Those not wearing a flotation aid will also either have to keep themselves afloat to wait for a rescuer by treading water or they may attempt to swim to rescue themselves. However, those who unexpectedly find themselves in frigid water typically find that it is extremely difficult to swim in cold water. Even those who are considered to be good swimmers in warm water are often unable to swim distances even two to three metres in cold water. 7 In one experiment, ten fit and fully clothed individuals were able to swim for 10 minutes in water at 25 C, but only three of these ten were able to swim for 10 minutes in 5 C water. 7 This phenomenon is known as swim failure, and the issue seems to be related to controlling breathing and coordinating breathing with swimming strokes. 7 This can lead to aspiration of water, and drowning. At the same time, swimming strokes often become inefficient since frequently the swimmer will assume a more upright position while attempting to keep his or her mouth clear of the water and this results in rapid, yet relatively ineffective paddling movements. The upright position increases sinking force and drag, and can contribute to a feeling of panic. 7 In those immersed for longer periods, the cooling of the body also contributes as the swimmer gradually loses control of the muscles in the arms and hands as they become numb with cold, and shivering impairs movement and causes fatigue. 7 The fact that swimming increases the rate of body cooling by 30-40% exacerbates the situation and leads to a vicious circle in which swimming 48

50 becomes increasingly difficult as the body cools down, and increased swimming efforts lead to greater body cooling. 20 Long-Term Responses/Hypothermia (After 30 minutes) If a person who has been unexpectedly immersed in cold water survives the first two phases of physiological responses, the next threat is hypothermia. Water is an excellent conductor of heat, so a person in cold water will cool two to five times faster than in the same air temperature, and this cooling is worsened by waves, currents, or swimming. 7 After being immersed in water below body temperature (37 C), deep body temperature will begin to fall until eventually reaching hypothermic levels. 20 As the deep body temperature falls, death may occur either because the victim lapses into unconsciousness and drowns or due to cardiac arrest. 20 However, even before hypothermia sets in, a decline in deep body temperature from 37 C to 35 C can result in a significant decline in physical and mental capabilities that could interfere with self-rescue efforts. The rate that this decline in core body temperature occurs depends on a number of factors such as the water temperature, clothing insulation, state of physical fitness, amount of body fat, body mass, rate of agitation of the water, and diet prior to immersion. 20 However, typically the body temperature will not cool to hypothermic levels in the first 30 minutes of immersion. 7 In 5 C water, the deep body temperature of a lightly dressed adult will fall 2 C to 35 C in about one hour. 7 In water that is 10 C, a 2 C drop in body temperature would take approximately two hours, and in 15 C water, core body temperature would reach 35 C in three to six hours. 7 Although there have been some remarkable cases of victims being resuscitated after being accidentally immersed in cold water and their deep body temperatures falling to extremely low levels (as low as 13.7 C in one case), more typically, death occurs from cardiac arrest once the core temperature of the victim falls to about 24 C. 20 Thus, a person s ability to put on a personal flotation device after being unexpectedly immersed in cold water could be severely impeded. Depending upon the water temperature and the length of time they are immersed, the person could experience: hyperventilation, inability to breath hold, numbing of the limbs with reduction in grip strength, manual dexterity, and muscle coordination, swimming difficulties, and feelings of panic or confusion. One expert in drowning prevention, summarizes the situation very concisely: A regulation that requires passengers and operators of small vessels to carry lifejackets in the boat, but not wear them is ineffective, and does not prevent drowning. As has clearly been demonstrated as the victim is suddenly immersed in cold water, the cold shock causes a huge inspiratory gasp and s/he starts to hyperventilate while struggling to 49

51 keep the oronasal cavity out of the water to prevent drowning. At this 41, page 59 time, it is quite impossible to don any form of flotation device. Thus, for various reasons, the feasibility of locating and donning a PFD in the event of an emergency is highly questionable. Canadian organizations such as the Red Cross, Lifesaving Society and Coast Guard strongly recommend that boaters wear their PFDs at all times, as opposed to carrying flotation devices on the watercraft. A review of the statistics certainly suggests that wearing PFDs is more effective than carrying PFDs in terms of saving lives. As mentioned in an earlier chapter, nine in 10 boating drowning victims in Canada in 1999 were found not wearing a flotation device and 30% of the drowning victims had not been wearing a PFD even though one was known to be present on board the vessel. 4 Presumably, if locating and donning a flotation device in an emergency situation were more feasible, there would be fewer cases of drownings when flotation devices were on board. However, some opponents of wearing a flotation device justify their actions by saying that wearing a flotation device will not necessarily save their lives, and indeed, in about 10% of boating drownings in Canada, the victim is found wearing a fastened PFD of the appropriate size. 4 In the United States, the National Transportation Safety Board (NTSB) undertook a thorough review of the circumstances surrounding the deaths of those who drowned despite wearing a flotation device of some sort. 32 This report found that, in most of the cases where the victim drowned despite wearing a PFD, the majority were likely attributable to hypothermia induced by prolonged exposure to cold water. In other cases, the victims were either caught under water or were likely unconscious, in which case a PFD would not have saved them. Overall, the study concluded that in at least 84% of the drownings in which the victim was wearing a PFD, the drowning is not attributable to a failure of the PFD. The NTSB report also contained an in-depth analysis of the circumstances surrounding the drownings in which the victims were not wearing a PFD and determined that about 85% of the victims would likely have survived had they been wearing a flotation device. 32 In the remaining 15% of cases in which the NTSB concluded the victim would probably not have been saved by usage of a flotation device, the majority likely died from exposure to cold water and several others were either caught under water or unconscious. 32 Thus, overall, the evidence suggests that flotation devices such as PFDs can be very effective in saving lives, since in most cases, they are able to keep a person afloat until help arrives. However, as stated in a NASBLA newsletter, it is not lifejackets that save lives it s people wearing lifejackets that saves lives. 36 Simply put, keeping a flotation device on board but not wearing it is not enough to prevent drownings they must be worn. 50

52 CHAPTER 5: INCIDENCE OF PFD USE AND PUBLIC ATTITUDES TOWARDS WEARING PFDS As discussed in the previous chapter, PFDs can be an effective tool for preventing drownings, but only if they are worn, not carried on board. This chapter will focus on the incidence of PFD usage as well as attitudes of Canadian recreational boaters towards wearing PFDs, focusing on the key reasons why some boaters choose not to wear flotation devices. INCIDENCE OF PFD USE Unfortunately, while there is little doubt of the efficacy of lifejackets or personal flotation devices (PFDs) in keeping someone afloat, there is little evidence that they are, in fact, being worn by the group at-risk. One study comprised of males aged 15 to 35 in Western Canada reports that nearly half (47%) of the respondents claimed they wore a PFD or lifejacket at all times while they were on the water during their last outing. Another 16% said they wore a PFD or lifejacket for some of the time during their last outing but took it off for comfort reasons, to engage in activities such as swimming, or when they did not perceive a high risk of drowning, such as when the boat was not moving. The remaining 37% admitted they usually do not wear a lifejacket. 26 However, other research found that, overall, only 33% of recreational boaters wear a PFD while on watercraft under 6m in length. 2 Another national study provided a considerably lower estimate of PFD usage in Canada. An observational study undertaken by the Coast Guard found that only 21% of boaters in Canada wear a lifejacket or PFD. 2 The wide disparity in estimates of PFD usage may relate to methodological differences in these studies. For instance, one of the telephone studies cited above was conducted with males aged in Western Canada, the other telephone study was national and conducted with adults of both genders, and the observational study was national and included both male and female recreational boaters of all ages. There were also differences in time of year these research studies were conducted as well as how recreational boaters were defined. However, perhaps the most important methodological distinction between these studies is the fact that the telephone studies were based upon selfreported data while the other study consists of observational data. Thus, there is always the possibility that respondents of the telephone studies may have overreported their PFD usage and provided socially acceptable answers as opposed to answers that are 100% accurate. At the same time, while the observational study conducted by the Coast Guard was based upon a fairly sizeable sampling of recreational boaters (N=4,806 persons), and efforts were made to ensure that a representative sample was observed (observations took place on a variety of 51

53 water systems, over a six week period, under a variety of weather conditions, at different times of the week and different times of the day in different regions of the country), this sample may not provide a true reflection of PFD usage in Canada as the Coast Guard cannot observe all boaters at all times. The percentage of PFD usage is not uniform in the population, as there is a clear gradient of lifejacket/pfd wear by age. Nearly 85% of children aged five or less regularly wear their lifejackets/pfds. This rate drops below 70% for children aged six to nine, and by the teen years has dropped to 37%. Adults are the least likely to wear a lifejacket/pfd, with year olds using one only 16.5% of the time, and those between 36 and 60 only 13% of the time. 2 Thus the people in the age group with the highest incidence rate of drowning, are also those who are not wearing any buoyant gear. Similar results have been found internationally. For example, one study in the American Northwest found 25% of boaters wore PFDs, but that the rate was highest, over 90%, for those under the age of five, and that usage sharply dropped off in the teen years to just 13% for those older than A National Association of Safe Boating Law Administrators survey, using marine law enforcement officers making either direct observations from a distance or during routine boardings, found that 80.5% of adults weren't wearing lifejackets, while only 23.9% of children were unequipped. 43, 44 However, PFD usage in other parts of the world is more common. For instance, a survey of recreational boat owners in Tasmania found that about 49% of adults and 88% of children typically wore PFDs while boating even before legislation was passed making PFD wear compulsory. 31 In addition to age, there is also an association between use and the nature of the craft being operated. One national telephone research study found that the proportion who claimed they always wore a lifejacket ranged from a low of 58% for those who fished from a non-motorized boat, to a high of 92% amongst those who used a PWC. 27 Other research suggests that over 95% of kayak operators wear a PFD, while the use for those in canoes or small utility/skiffs drops to 62.5% and 42.4% respectively. 2 One U.S. study of personal water craft (PWC) operators found that 97% wear lifejackets, and that this likely contributes to the lower drowning rates of the operators of this class of vehicle. It is noteworthy that again, those who do not use a PFD while operating their PWC are at a much higher risk of drowning: 77% of PWC-related drownings involve an operator not wearing a lifejacket. 8 There is evidence of modelling behaviour in lifejacket/pfd use, with a demonstrated correlation between one person wearing a PFD in a boat and others in the same boat wearing one. 26 One research study found that 20% of recreational boaters interviewed admitted they would feel uncomfortable wearing a lifejacket if no one else on board was wearing one. 27 This modeling effect is even more pronounced for children. In one study, it was found that when a child less than 15 years old was in a boat with an adult or adults, PFD use by the child was 65% if no adult wore a PFD, and 95% if at least 52

54 one accompanying adult wore a PFD. 42 Similarly, other research also found that children were much more likely to be observed wearing a PFD when an adult on board was also wearing a PFD. 45 However, it is unclear whether the reverse is true, and adults are more likely to wear a PFD when children are on board. One research study with Canadian recreational boaters found that the majority (68%) of adult respondents indicated that they are willing to set a good example for children by always wearing a lifejacket when children are on board. 27 Yet a U.S. study based on observational data found that adults were no more likely to be observed wearing a PFD if children were also on board than those observed on watercraft with no children were present. 45 Similarly, it seems that the operator of the boat sets the tone for passengers. One research study with Canadian recreational boaters reports that 58% strongly agreed that they always wear a lifejacket if the operator of the boat is wearing one, and 89% claim they definitely would wear a PFD or lifejacket if they were requested to do so by the boat operator. 27 This is consistent with the findings of an observational research study which reported that if the operator of the boat was observed wearing a PFD, the passengers were more likely to be wearing a PFD, and if the operator was not wearing a PFD, any passengers observed were also unlikely to be wearing a PFD. 2 Unfortunately, though one research study found that while 88% of boaters claim to always carry a PFD or lifejacket for every person on board, only 52% insist that everyone wears one. 27 BARRIERS TO WEARING PFDS Reasons for not wearing a flotation device while participating in recreational boating seem to be based upon boater perceptions about PFDs that fall into five broad categories: 1) there is a low risk of drowning 2) wearing a PFD restricts movement and interferes with performance of activities 3) wearing a PFD is uncomfortable 4) PFDs are unattractive or unfashionable 5) wearing a PFD is a sign of fear Perception That There is a Low Risk of Drowning Without a PFD There is little doubt that perception of risk and attitudes toward risk-taking play as important a role in this issue as in other injury prevention issues. Telephone interviews conducted with male recreational boaters between the ages of 15 and 35 found that about nine in 10 were looking for a physical challenge and about three in four believe that taking risks is part of living. However, about four in five agreed that taking unnecessary risks is foolish and a little over one in four claimed that there is no sense worrying about things that probably won t 53

55 happen. 26 Thus, this research would suggest that most male recreational boaters are willing to accept some degree of risk, and that they use their judgment and experience in determining the danger associated with a given situation. Unfortunately, perceptions do not always coincide with reality. For example, despite the fact that there seems to be little evidence that swimming ability is a strong predictor of the outcome, in many of these recreational boating related drownings, 19 people seem to feel that lifejackets or PFDs are only for those who have not yet learned to swim. In a survey of young men in the demographic group most at-risk, the vast majority felt they did not need a PFD because they can swim well. 46 Other research with adult males aged found that 15% of those who do not always wear a lifejacket while on the water justify this behaviour with the argument that they are strong swimmers. 26 Similarly, a large percentage of younger males in another study felt very comfortable around the water and did not feel they were at risk for drowning, mainly because of their swimming ability. 46 There is also a perception that experienced boaters are not at risk. Focus groups studying boaters who operate small craft frequently (at least 6 times in the previous season) found that the majority feel lifejackets are not required if a boater is skilled, and that they are really only for children who are still learning. 47 While there have been findings suggesting a role for boater experience in safety, experience has not been consistently shown to reduce the risk of drowning. 48 Recreational boaters also frequently have the misperception that they are safe from harm if the boat is not far from shore or in shallow water. In research with males in the target demographic, 40% agreed that they felt safe without a lifejacket as long as the shoreline was within sight. 25, 26 Similarly, nearly a third of respondents in the same surveys felt that wearing a lifejacket is only necessary 25, 26 when the boat is moving. Weather conditions also tend to have a big impact on the perceived risk of not wearing a flotation device. While 84% of males in the target demographic agreed that they would be more inclined to wear a lifejacket when the weather is rough, only 50% claim they always wear a lifejacket when the weather is calm and clear, and only 47% will wear one when it is hot and sunny out. 26 This is consistent with the findings of an observational study that found that PFD use increases as water conditions worsen. In calm water, 23% of boaters were observed wearing a PFD, compared with 33% on days where there were ripples in the water, and 37% on days when there were definite waves on the water. 45 Perception that PFDs Restrict Movement and Interfere with Ability to Perform Activities There is a common perception that PFDs and lifejackets can be so bulky and cumbersome that they would restrict freedom of movement and thus would interfere with performance of sports that demand a great range of movement such as fishing or canoeing. They are also seen as incompatible with swimming 54

56 and sun tanning activities by some. 47 One study reports that 30% of the recreational boaters interviewed agreed (either strongly or at least somewhat) that wearing a lifejacket restricts movement too much. 27 Improving the design of lifejackets and PFDs to improve freedom of movement would clearly have a positive effect on likelihood of usage. Research with male recreational boaters in the target demographic shows that about three in four agree that more people would wear a lifejacket if they weren t so bulky and 25, 26 restrictive. Perception that PFDs are Uncomfortable The most common reason given by those who do not wear lifejackets or PFDs is that they are uncomfortable. 25, 26, 46, 47 Primarily, it is the bulkiness of PFDs that contributes to the perception that PFDs are uncomfortable. 25, 26, 47 However, some of the complaints relate to body temperature. Some feel that wearing PFDs is too warm on a hot and sunny day 25, 26, and 28% of those in another study agree strongly or somewhat that wearing one makes me too hot. 27 Observational reports provide support for these complaints about wearing a PFD in the heat. When the temperature was below 65ºF, 33% of boaters observed in one U.S. study were wearing a PFD in contrast with 29% when the temperature was between 65º and 80ºF. 45 Others dislike wearing PFDs because they say PFDs feel cold and clammy when wet or because they say that it is too bulky to wear a jacket over a PFD, and thus they find it uncomfortable to wear a PFD in cool or windy weather. 47 One study with males in the target demographic found that 10% of those who do not personally wear a lifejacket under all circumstances while boating claimed that they would always wear a lifejacket if it was more comfortable. 26 Another national study of Canadian recreational boaters reports that 74% of all respondents suggested that making lifejackets more comfortable, easier to fasten, and less bulky would be the best way to encourage usage. 27 Unfortunately, there seems to be only limited awareness of new styles of lifejackets and PFDs that are 27, 47 more comfortable. Perception that PFDs are Unattractive or Unfashionable Another complaint about PFDs and lifejackets that is offered as a reason for not 26, 27, 46, wearing them is that they are unfashionable, unattractive, and unflattering. 47 Although concern about esthetics does not seem to be a significant barrier to wearing a PFD or lifejacket for the majority of recreational boaters (or at least few are willing to admit it), there is a segment for whom it is influential. This view is particularly prevalent amongst younger boaters who may be more self-conscious about how they look in a PFD or lifejacket. 27 Some research suggests that improving the attractiveness of lifejackets and PFDs would likely improve wear rates. In a study that examined the attitudes of males aged 15 to 35 regarding PFD use, 49% were in agreement with the statement that more people would wear a lifejacket if they were more attractive. 26 Similarly, 55

57 29% of all respondents in another study and 46% of those aged 16 to 24 stated that making lifejackets more attractive would encourage people to wear them. 27 Another study in which one-on-one interviews were conducted with male recreational boaters states that there is an opportunity to position lifejackets/pfds based on function, fashion and comfort rather than fear of drowning. 46 Findings of this study indicate that if lifejackets and PFDs could be designed and promoted as offering extra warmth and added protection for wipe outs for those who participate in water sports, young men would be more inclined to wear a flotation device. This study also reports that PFD designs with a lot of pockets had some appeal with respondents. The authors of two different surveys with recreational boaters speculate that there may even be an opportunity for PFDs and lifejackets to become viewed as simply a part of the gear for water sports, in much the same way as safety equipment has become an accepted part of participating in other high-risk sports 27, 46 such as hockey, downhill skiing, and rock-climbing. Marketing efforts for lifejackets and PFDs might be more effective if they are positioned as an innovative and fashionable product rather than focusing on the safety issue. 27 The authors of one study of the attitudes of recreational boaters in Canada theorize that this sort of approach might appeal to a particular segment of recreational boaters that they call Adrenaline Seekers, who are traditionally difficult to sway with mass marketing techniques. 27 Perception that Wearing PFDs are a Sign of Fear Unfortunately, wearing a PFD or lifejacket seems to be perceived to be an indication of fear or weakness by some. For example, participants in focus groups frequently associated wearing a PFD with childhood, lack of confidence, and wimpishness. 47, p. 15 And other research suggests that young males, the very group most at risk for drowning, are particularly likely to be concerned about presenting an image of fearlessness, and believe that wearing a PFD or lifejacket 46, p. 4 is equivalent to wearing a sign that says I m afraid. 56

58 CHAPTER 6: EFFICACY OF VARIOUS METHODS OF ENCOURAGING PFD USAGE As was discussed in previous chapters, PFDs can be an effective tool for preventing drownings, but only if they are worn, not carried on board, and there are numerous reasons why boaters resist wearing PFDs. This chapter will focus on the efficacy of various methods of encouraging boaters to wear PFDs, and thus reduce their risk of drowning. The chapter begins with review of the current legislative requirement in Canada for carrying PFDs on board recreational watercraft and the impact of this legislation for encouraging PFD usage. This chapter will also summarize the success of various educational and social marketing initiatives, incentive programs, and changes to PFD designs and regulations in terms of persuading boaters to wear PFDs. Next, the efficacy of legislative efforts will be explored, including a summary of the legal justification for introducing mandatory PFD wear legislation in Canada. There have been a number of proposals for encouraging PFD wear. CURRENT REGULATIONS In Canada, as well as in many other countries around the world, the law requires that personal flotation devices be carried aboard recreational watercraft. Specifically, the Small Vessel Regulations require that there be a sufficient number of Canadian approved flotation devices of the appropriate size for each person on board a pleasure craft. 49 However, there is no law requiring occupants, on board watercraft, to actually wear a flotation device. As was discussed in a previous chapter, while the vast majority of recreational boaters do comply with the law and carry flotation devices for all persons on board, 27 observational studies suggest that only 21% of adult recreational boaters actually wear a PFD. 2 Thus, the current legislation does not seem to be sufficient to encourage the majority of recreational boaters to wear rather than just carry PFDs while on the water. EDUCATION, SOCIAL MARKETING, AND INCENTIVES Mandatory Boater Education Given the ability of lifejackets/pfds to potentially save lives, and the evidence that those at risk are not using them, an obvious strategy to encourage usage is to better educate boaters about the risks they are undertaking. For instance, it might reasonably be hypothesized that those who take a training course on boating safety might be more likely to engage in safety precautions such as wearing a lifejacket or PFD. In Canada, operator competency 57

59 requirements xvii have been phased in over a 10-year period for operators of motorized pleasure boats less than four metres in length (including PWCs). One of the goals of introducing this mandatory proof of competency initiative was to improve the safety of all boaters, and the course strongly promotes wearing PFDs. However, evidence from one national telephone survey with recreational boaters suggests that there is very little difference in the PFD wear rates of those who have taken a boating safety course versus those who have not. 27 Thus, mandatory boater safety education alone may not have a dramatic impact on PFD wear rates. Social Marketing / Education Campaigns Another common approach to encouraging PFD usage is the use of social marketing or educational campaigns. This approach assumes that by providing more information to the public regarding the dangers of drowning and the efficacy of PFDs, this will increase their awareness of the issue, change attitudes, and will influence their behaviour. Specifically, it is hoped that the campaign will motivate boaters to purchase and wear PFDs while boating. However, this approach has some drawbacks. Because people are bombarded with so many messages today, it is increasingly difficult for social marketing campaigns to both reach the target audience as well as capture and hold the attention of the public long enough to educate them and influence their behaviour. 36 Due to limited resources, social marketing campaigns frequently consist of unpaid public service announcements or other methods that do not have the same reach or impact as paid, professionally produced advertising. Unfortunately, reaching the public is very competitive in today s world, and it is difficult to break through the clutter of messages aimed at a target audience. One evaluation of social marketing/public education campaigns illustrates this difficulty of reaching the target audience. 50 Though impact was higher for TV spots than radio spots, the campaign suffered low exposure partly due to costs of advertising in prime time and poor time slots offered for charity PSAs. 50 Even if educational campaigns are successful in reaching the target audience, the next hurdle for campaigns to overcome is key message recall. There is some evidence to suggest that boating safety messages are recalled by a significant proportion of the target group. For instance, a telephone survey conducted in western Canada found that 84% of the target group in one campaign recalled having seen boating safety messages, and the most commonly recalled message was to wear a lifejacket. 51 As well, a two-year advertising campaign in Idaho xvii Operators of pleasure craft must pass a Canadian Coast Guard accredited test of boating safety skills (boaters have the choice of taking the test either with or without completing an approved boating safety course). All operators of recreational watercraft will be required to have proof of competency on board once the requirements have been fully implemented. 58

60 called Sport the Vest that used paid advertising and professionally produced television commercials, was fairly successful in communicating key messages. 36 Survey results with members of the general public found that 60% recalled the key message of the campaign at the end of each summer the campaign ran. 36 However, reaching the target group and message recall may not necessarily translate into behaviour change. Despite the multitude of social marketing and public education campaigns designed to increase PFD wear rates in Canada, wear rates remain relatively low. The findings of one research study suggest that campaigns that simply provide proof that PFDs and lifejackets save lives will not be sufficient to motivate many recreational boaters to wear them. In this study, such solid proof of the efficacy of flotation devices would be persuasive for less than one half of the boating population. 27 There are numerous examples of social and marketing campaigns producing only marginal increases in PFD wear rates, although there is clearly a great need for more rigorous evaluations of educational campaigns. In one evaluation of a drowning prevention campaign using educational strategies to target children in King County, Washington, it was found that after the campaign, ownership had increased from 69% to 75% but PFD use had increased from 20% to only 29%. 52 However, it is unclear whether this increase can be linked to the campaign. As well, one evaluation in Washington found that PFD use increased slightly following an educational campaign focused on increasing PFD wear rates, from 20% in 1992 to 31% in But, it has not been established whether this increase is PFD usage is related to the educational campaign. Evaluation of the Stay on Top of It campaign in the King County, Washington area suggested that children s life vest use did not increase significantly following this three-year education multi-media campaign since life vest use was already very high amongst children prior to the campaign. 52 Another evaluation of this same social marketing campaign in King County, Washington, concluded that while PFD use for children did not increase significantly following the intervention, adult PFD wear rates increased somewhat, from 14% to 25%. 45 As well, comparison of the findings of U.S. PFD Wear Rate Studies conducted in 1997 and 1999 reveals that there was no significant change in wear rates between 1997 and 1999, despite the fact that numerous organizations had specifically focused on the importance of wearing PFDs in their safety messages to boaters. 55 In Minnesota, one report suggests that observational studies indicate that PFD wear rates have increased from 13% in 1984 to 51% in 2002, and during this period, public service announcements were run on television and the radio and weekly press releases were released during boating season, each highlighting the importance of wearing a PFD. 36 However, it is not known whether this increase in PFD usage is attributable to the educational efforts. Educational efforts in Australia have also been discouraging. In the community of Victoria in Australia, in spite of the implementation of a comprehensive, 59

61 multi-dimensional public education campaign called Play it Safe by the Water, boating drownings have actually increased in recent years. 53 According to the Royal Life Saving Society, despite increased education and public awareness campaigns, many Australians continue to underestimate or be unaware of the dangers associated with recreational boating, and many do not wear a PFD or combine alcohol with aquatic participation. 54 Thus, overall, even if campaigns successfully reach the target audience and key messages are recalled, the research findings presented above suggest that educational campaigns alone may not be sufficient to effect behaviour change and significantly increase PFD wear rates. However, as mentioned, there is a need for more rigorous evaluations of campaigns and programs in order to properly assess the impact of these educational efforts. Other Programs / Incentives Some jurisdictions have initiated other types of programs or incentives in order to increase PFD usage, with mixed results. Many states in the U.S. operate lifejacket loaner programs or participate in a loaner program managed by the BoatU.S. Foundation for Boating Safety & Clean Water. 36 There is some limited evidence to suggest that a PFD loaner program in Alaska has had a positive impact on children s PFD usage. The program, called Kids Don t Float began in 1998, and by late in 2002, over 3,500 lifejackets had been loaned out at more than 300 sites in Alaska. 56 The Coast Guard conducted a PFD wear rate study in 2001, and although the sample sizes are small, they found that there was a 50% wear rate amongst recreational boating passengers under the age of 18 at nonloaner sites versus a wear rate of 75% at Kids Don t Float sites, suggesting that the program may have had an impact. 56 However, running a program such as this obviously requires a great deal of coordination, cooperation, and financial support. This particular program is a partnership between the Coast Guard, Alaska s Department of Health and Social Services, and the Department of Natural Resources, and the program is dependent upon funding from community sponsors, and the participation of community volunteers, and donations of used PFDs from members of the community. As part of a drowning prevention campaign, called Stay on Top of It, in the King County, Wash., area, $5 discount coupons for children s life vests were distributed over the three-year campaign period. 52 During each year of the campaign, the life vest manufacturer showed a 25% to 50% increase in children s life vest sales. 52 Although coupon redemption was not tracked, the fact that reported ownership of vests increased from 69% in the pre-campaign survey with parents in the King County area to 75% in the post-campaign survey suggests that the coupons may have been responsible for this increase in PFD ownership. States in the U.S. have used a wide variety of marketing methods to try to increase PFD wear rates, although the effectiveness of each in encouraging PFD usage is unknown. In California, the Department of Boating and Waterways will either provide a new replacement flotation device or coupons for a new PFD to 60

62 those who bring in old/worn-out PFDs. 36 California also places safety posters advertising safety messages at marina entrances, launch ramps, on docks and other strategic locations to reach recreational boaters. 36 Oregon provides lifejacket safety information online and publicizes drowning statistics, highlighting how many of the victims were not wearing PFDs. 36 In Kentucky and Mississippi, messages about PFDs are delivered via television shows. 36 Texas uses a poster/video public service announcement to remind people that drownings occur very quickly ( it only takes a second ). 36 Connecticut presents a PFD Fashion Show every year to publicize the range of PFDs available for different sports and activities. 36 In Maryland, the annual Christmas Boat parades include a float with a sign stating Lifejackets Save Lives, and the patrol boat contains PFD Panda and people wearing lifejackets. 36 Montana distributes water safety packages to families containing information, stickers and an iron-on decal for kids. 36 In Vermont, marine enforcement officers distribute water bottles with slogans such as Paddle Smart and Wear Your Lifejacket to recreational boaters. A number of other initiatives were also mentioned by National Association of State Boating Law Administrators representatives when they were asked in a recent survey for this background research paper to indicate any non-legislative methods that successfully encouraged PFD use (see Appendices B and C for a copy of the questionnaire as well as a full discussion of methodology and findings). NASBLA representatives from Oregon, Alaska, and Wisconsin claimed that the provision of coupons for free ice cream to children who were spotted wearing a PFD stimulated PFD usage. Similarly, a representative from Georgia indicated that they were able to increase PFD usage by printing slogans on Lifesavers candy and handing it out to children wearing their PFDs. Other giveaways were apparently effective as well at increasing wear rates. In Georgia, t-shirts were given to children found wearing their PFDs, while in Nevada, cash and prizes were awarded to vessels in which all occupants were voluntarily wearing their PFDs (in a promotion called it pays to wear your lifejacket ). The NASBLA representatives had the impression that these efforts were effective in encouraging the usage of flotation devices, but they did not offer any specifics regarding the degree to which wear rates increased to support these claims. Other NASBLA representatives in Idaho, West Virginia, California indicated that they believe that public service announcements (via radio, TV, newspapers) successfully increased PFD usage in their respective states. A NASBLA representative from Maine suggested that boating safety education courses had stimulated PFD usage in that state. As well, NASBLA representatives from Georgia, Massachusetts, Montana, New Hampshire, California, and New Mexico also claimed that educational efforts had paid off in terms of encouraging recreational boaters to wear PFDs. In California, children in grades K-12 receive education about the importance of wearing PFDs, and adults are targeted at boat shows. In New Mexico, K-12 students are exposed annually to a boat safety education program with an emphasis on how little time is required to drown in a boating accident and the time that it actually takes to put on a PFD in a boating accident. These messages are also reinforced for younger children in a colouring 61

63 and activities book. However, details were not provided to corroborate the degree of success of these educational campaigns. CHANGES TO INSURANCE REQUIREMENTS Another possible approach to increasing usage of PFDs is via changes to insurance requirements. It is thought that boaters might be more inclined to wear a PFD if there were insurance implications and by not wearing a flotation device, they were ineligible for insurance (accident, health, and life) in the event of a boating accident. One Canadian research study found that 64% of respondents surveyed claim they would always wear a PFD for insurance purposes, and another 31% claim they sometimes would wear a PFD in order to be covered by insurance. 27 CHANGES TO PFD DESIGNS AND STANDARDS Another approach to encourage more people to wear PFDs is to change the products themselves to increase their appeal and motivate boaters to wear them. For instance, in order to make PFDs more attractive or fashionable-looking, the number of approved colours for PFDs in Canada was expanded considerably in July 1996 beyond the traditional yellow, red, or orange. 17, 49 Newer PFDs that are more light-weight and less bulky have also been introduced in order to address the perception that PFDs are uncomfortable and restrict movement. Unfortunately, while research suggests that the vast majority of those who are aware of recent changes to PFD design feel that they are a significant improvement over earlier designs, there seems to be very little awareness of the new designs. 27 One study found that nearly four in five recreational boaters were not even aware that new PFDs had been approved. 27 In a public opinion poll conducted for this background research paper, awareness of new PFDs was very low among non-boaters, but slightly higher amongst those who use watercraft for recreational purposes at least once in an average year. Only 8% of respondents in the sample who do not use water craft in a typical year claimed to have heard a fair amount about the new PFD designs, 13% had heard a bit about the new designs, and the remaining 79% were not at all familiar with the new PFDs. Awareness was somewhat higher among the recreational boaters in the sample, with 22% claiming to have heard a fair amount and 29% a bit about the new designs. However, nearly half (48%) of the recreational boaters had not heard anything about the new designs. While the introduction of more comfortable, lightweight PFD designs is a good idea in terms of increasing PFD wear rates, clearly there must be a great deal more awareness of these design changes before any significant increases in PFD wear rates and corresponding decline in drowning rates can be observed. 62

64 In 1997, PFD standards were changed to allow inflatable PFDs to be used for rowing and paddling. 28 This change was implemented in order to increase usage of PFDs among these target groups since both lifejackets and Inherently Buoyant PFDs are considered by some to interfere with rowing and paddling activities that require full range of motion. It is not yet clear whether this change in standards has had the desired impact, namely increasing PFD wear rates and decreasing the number of drowning deaths. Further changes to the standards, such as lowering somewhat the minimal buoyancy requirements might also combat the public opinion that PFDs must be bulky and uncomfortable and thus boost wear rates. LEGISLATION Another approach that could be considered in order to address the issue of increasing PFD wear rates is introducing legislation that would make it mandatory for persons on board small recreational watercraft to wear a PFD while on the water. Aside from the potential to increase PFD wear rates, some argue that another benefit of this approach would be that enforcement of mandatory wear legislation would actually be simpler, faster, less intrusive, and less expensive than regulations that stipulate that a PFD of the appropriate size must be present for each person on board a recreational boat. 4 The reasoning is that compliance could be verified from a distance rather than by stopping boats to check whether flotation devices are present. However, it should be noted that there are multiple purposes for enforcement on the water, such as verification of operator sobriety, and competency training, which would still require stopping boats and interacting with occupants. Some jurisdictions have introduced mandatory wear PFD legislation, and this will be discussed in depth in the next chapter. However, it is useful to first examine the impact of other types of safety legislation as perhaps one can estimate the likely success from similar measures to legislate protective gear to prevent other classes of injury. These include Boating While Intoxicated legislation, mandatory helmet use for cyclists, or seat-belt laws for motor vehicles. Boating While Intoxicated Legislation Many of the states in the United States have introduced Boating While Intoxicated (BWI) legislation, although some laws are more stringent than others, which provides an opportunity to evaluate the impact of legislation by examining boating fatality statistics both before and after legislation was introduced among states with strict legislation versus those with more lenient legislation. The National Association of State Boating Law Administrators conducted a research study in 1990, after many states had introduced BWI legislation, in order to assess the impact of this legislation. The report concluded that there was a higher percentage of decline in accident fatalities in states with more stringent BWI laws versus those with more lenient BWI laws (for example, less stringent blood alcohol content standards or less rigorous enforcement). 32 This finding suggests that the boating community may adapt and change their 63

65 behaviour in response to the enactment of boating legislation. It should be noted that it is already an offense under the Criminal Code of Canada to operate a boat while intoxicated. Legislation in Other Injury Prevention Domains Seat-belt legislation Canada s seat-belt laws for motor vehicle occupants also provide an appropriate pre/post legislation example to consider. In a report by the Institute for Behavioral Research at York University prior to the introduction of mandatory seat-belt legislation in Ontario, the authors state that: seat-belt utilization can be viewed as a classic public good in which all individuals benefit from lower health care costs associated with aggregate increases in seat-belt use, but few individuals see a direct marginal benefit to their voluntary use of seat-belts. In such situations, legislative coercion is typically required to assure compliance with the public interest. 57 Based on a review of the statistics of seat-belt use both before and after introduction of the legislation, it would appear that their assessment was correct. According to the author of one study, the Ontario government had tried to increase seat-belt usage via education campaigns and public education efforts, but seat-belt use remained unchanged at 17%. 57 Thus, education campaigns alone were insufficient to effect a change in behaviour though it must be noted that the majority of campaigns at that time were based upon raising awareness, and that more modern and sophisticated social marketing techniques based on behaviour modification would likely prove more effective. The first Canadian provinces to enact legislation requiring occupants of motor vehicles to wear a seat-belt were Ontario (January 1976), Quebec (August 1976), Saskatchewan (July 1977), and British Columbia (October 1977). In each of these provinces, essentially the same pattern of seat-belt use was observed: seat-belt use increased from between 20 and 30 percent before legislation, to about 60 to 70% in the first year following the legislation, then subsequently declined to between 40 and 50 percent in the next several years. 58 However, according to the latest national survey of seat-belt use in 2001, Transport Canada found that 90% of all occupants of cars, passenger vans, and light trucks were wearing seatbelts. 59 A review of the pattern of compliance suggests that the degree of enforcement of the legislation was crucial in increasing wear rates after the initial impact of legislation wore off and seat-belt use rates started to decline. After implementation of the legislation, seat-belt usage in Ontario rose to 77%, subsequently fell to a low of 49% in 1977, and then increased to 65% in 1978 after enforcement efforts were increased. 57 In another example of the impact of enforcement on compliance rates, police in Ottawa conducted an experiment in 64

66 October 1979 in which they enforced the seat-belt legislation to the limit, and this was publicized via the news media. The result was an increase in seat-belt usage from 58.5% to 80%. 57 Another potential barrier for any safety legislation to overcome is public opinion. Some research suggests that although a large segment of the Canadian population initially objected to the creation of mandatory wear legislation for seat-belts on the grounds that it violated their rights, this opposition was relatively short-lived. As an example, public support for the mandatory seat-belt laws in Saskatchewan increased from 54% prior to the enactment of the law to 75% 13 months after the law was proclaimed. 57 Presumably this shift in public opinion came about partially because the public became accustomed to wearing a seat-belt and also thanks to education campaigns publicizing the reduction in deaths and injuries attributable to increased seat-belt usage. It should be noted that the segment of the population that Ontario s seat-belt legislation had the smallest impact on initially was teenagers. 60 According to one observational study, shoulder belt use by teenaged drivers and teenaged or younger passengers was only slightly and temporarily affected by the law. 60 Bicycle Helmet Legislation The impact of bicycle helmet legislation provides another useful comparison. In 1996, British Columbia enacted a law requiring bicyclists of all ages to wear a helmet when riding on a public roadway. An evaluation based on observational data conducted in 1995 (the year preceding the legislation) and 1999 (three years after the law was introduced) suggests that this legislation had a significant impact on helmet use in the province. This study reports that the likelihood of a cyclist wearing a helmet in 1999 was double to triple the likelihood in 1995 for males and females, adults and children, those in metropolitan and nonmetropolitan areas, and for all classes of bicycles. 61 Helmet usage among commuters was already high before the legislation, with 60% observed wearing a helmet in This increased to 75% in Usage by cyclists in recreational areas increased from 48% in 1995 to 74% in And the most dramatic increase in helmet usage was amongst those observed in neighbourhoods. For this group, helmet usage increased from 39% in 1995 to 72% in Similar legislation was enacted in Halifax in An evaluation of this legislation found that the rate of helmet use climbed from 36% in 1995 and 38% in 1996 to 75% in 1997, 86% in 1998 and 84% in This impact was sustained, even though no helmet-promoting media education campaigns were mounted in the jurisdiction after The evidence above indicates that legislation increases the rate of helmet use. The more important question is does helmet legislation decrease head injury rates? There are two studies that have reported a reduction in head injury rates after helmet legislation. They both used a time series design without a concurrent comparison group and therefore, the criticism is that the reduction 63, 64 could have been due to a general downward trend in head injury rates. 65

67 There is one study that has head injury as the primary outcome and also utilized a concurrent comparison group. Using Canadian Institute for Health Information (CIHI) data on all Canadian children (5-19 years) who were hospitalized for bicycle-related injuries from , this study found a statistically significant greater decline in the bicycle-related head injury rate in provinces where legislation had been adopted (from 18.27/100,000 in to 9.96/100,000 in ), compared with provinces that did not adopt legislation (from 18.35/100,000 in to 13.33/100,000 in ). 65 The reduction in the head injury rate in legislation provinces was 45% vs. 27% in no-legislation provinces over the 4-year period. It has been postulated that the reduction in head injury after legislation may be due to children cycling less. In particular, there was a time series study in Australia where there was a reduction in cycling in the first two years after the introduction of helmet legislation. 66 However, the study cited above used a methodology that controlled for potential differences in children s cycling habits by comparing bicycle-related head injuries with bicycle-related other injuries. This research found that legislation was associated with a reduction in head injuries but not in bicycling-related other injuries. Therefore, the protective effect of helmet legislation seen only on bicycle-related head injuries in the study was likely not due to a reduction in bicycling by children, since if there were fewer people cycling, all types of injuries would be expected to decrease equally. The evidence in the literature shows that bike helmet legislation is effective in increasing the use of helmets, decreasing the rate of head injuries and not decreasing the number of people who ride bicycles. Importance of Legislation for Continuance of Safety Behaviour It is important to note that not only does the enactment of legislation tend to have an impact on safety behaviour, but the abolishment of legislation also may change behaviour that had seemed to be ingrained. The repeal of the adult helmet law for motorcyclists in Arkansas is one example. Prior to Arkansas repeal of its mandatory helmet law, 97% of motorcyclists wore helmets. 67 Nine months after the law was abolished, that proportion dropped to 52%, and nine months after that, only 30% of motorcyclists wore helmets. 67 In the three years before the repeal, deaths of non-helmeted riders accounted for 40% of all crash fatalities in the state, whereas in the three years after the repeal of the law, this figure rose to 76%. 67 This suggests that legislation can have a powerful effect on safety behaviour. However, the repeal of legislation has not had the same impact in other jurisdictions. 68 Legal Justification for Mandatory Wear Legislation in Canada Currently, there are no civil laws or statutes that would delineate the legal responsibilities of a boat owner to passengers in the event of a boating incident involving injury or death. However, in all provinces of Canada aside from Quebec, this issue of negligence in a boating incident would be resolved using common law. 69 Common law is essentially the summation of all historical legal precedents developed over hundreds of years of court cases. 70 Thus, the decisions 66

68 handed down by judges in earlier court cases that are similar would be examined, and then the principles of earlier decisions would then be applied to the case in question in order to formulate a judgement. 69 Civil liability is determined by a branch of common law, known as tort law. 69 Tort law refers to that body of the law that specifies the circumstances in which an individual is likely to be found liable for any damages that result from their actions, whether intentional or through negligence. 70 Legal recourse based on tort law is oriented towards compensation for damages suffered. 69 The legal justification for introducing mandatory wear legislation rests on the question of whether existing tort law clearly deals with the issue of liability in the event of a boating incident involving injury or death and how negligence for such incidents is determined. This issue was examined in great detail for the purposes of this background research paper. (For a more detailed summary of the findings, please refer to Appendix I.) In tort law, it is necessary to establish several interrelated factors in order to determine the liability of the boat owner/operator in any incident involving injuries or death to a passenger: 1. Establishment of duty of care 2. Establishment of whether standard of care was breached a) reasonable person test b) emergency test 3. Establishment of injury suffered 4. Establishment of rational connection between owner/operator s conduct and user s injury a) but for test In order to illustrate these factors that determine liability, it is useful to examine a particular case from 1966: Horsley et al vs. MacLaren et al. 71 The boat owner/operator was MacLaren, and he had six guests aboard his 30-foot cabin cruiser at 6:30 p.m. on May 7, One of the passengers, Matthews, got up from his seated position at the bow of the boat, walked along the cat-walk of the vessel, lost his balance, and then fell into the water. One of the other passengers alerted the others that Matthews was overboard, and upon hearing the news, the boat owner/operator, MacLaren, put the engine controls in neutral, then in reverse, backing to within an estimated five feet of Matthews. Other passengers attempted to throw a life-ring to Matthews, and to reach out to him using a sixfoot pike pole. However, Matthews appeared to be unconscious and did not respond to these efforts. Meanwhile, the boat had drifted further from Matthews, and then was again reversed to a closer position. At this point, after three or four minutes had elapsed since Matthews went overboard, Matthews was seen to be face-forward in the water, and disappeared under the surface. In response, two other passengers, Horsley and Jones, dove into the water to attempt to rescue Matthews. Jones spouse then took over control of the boat and swung the boat around until she could be retrieved from the water. MacLaren then resumed the controls and manoeuvred the boat so that Horsley could be pulled out of the water. However, Horsley was unconscious and was unable to 67

69 be revived despite attempts at resuscitation. Thus, both the passenger who originally fell overboard, Matthews, and one of his rescuers, Horsley, both died. The water temperature that day was extremely cold, and both victims likely died from the shock of the icy water. First, the duty of care principle must be examined. Specifically, it must be established whether or not the boat owner/operator owes any duty of care to all those on board his or her boat (including both passengers and crew). Individuals in society are generally expected to conduct themselves without injuring others. 70 People in certain roles in society are further bound legally to ensure they do not injure others via their own actions. For instance, home owners have a duty of care to visitors to their home, doctors have a duty of care for their patients, and teachers have a duty of care to their students. It is a fundamental principle of international maritime law that the boat owner/operator is responsible for the safety of the passengers aboard his or her watercraft. As well, based upon a review of the decisions of Canadian judges in relevant case law, including judgments by the Ontario High Court and the Supreme Court of Canada, the current position of tort law is that such duty is owed to a passenger by the owner/operator, and other passengers may voluntarily assume that duty if they so choose. Specifically, a boat owner/operator is legally required to rescue a drowning passenger. Canadian tort law further indicates that this duty of the boat owner/operator is not affected by whether or not the passengers are fee-paying or guests, nor the passengers seamanship expertise or skills. Accordingly, in our test case of Horsley et al vs. MacLaren et al, the Ontario High Court held that a passenger on a pleasure boat who falls overboard through no fault of the master was nevertheless owed a duty by the boat master to make reasonable efforts at effecting a rescue. This decision was upheld in an appeal to the Supreme Court of Canada. Next, the principle of standard of care must be examined, in conjunction with the underlying concepts of the reasonable person test and emergency test. The Ontario Court of Appeal established that the standard of care that is to be applied in determining whether or not a defendant has been negligent is an objective one, and is the standard of conduct of a reasonable and prudent person, i.e., a person of normal intelligence who makes prudence a guide to his or her conduct. Thus, it is expected that, given the circumstances in a specific situation, individuals will use the skills and abilities that a reasonable person of normal intelligence would and act accordingly. The reasonable person concept has been applied by various courts, including the Supreme Court of Canada. Duty of care is breached when a person s actions do not meet the standard of care. In our test case, the reasonability test centred on whether the boat owner, MacLaren, has applied the correct rescue procedures in his rescue attempts after one of his passengers, Matthews, fell overboard. The Court of Appeal was of the opinion that MacLaren, who had to rely upon the cooperation of other passengers in effecting the rescue of Matthews, fell short of the standard of 68

70 reasonableness. The Court had to consider the question of whether the manoeuvre undertaken by MacLaren followed appropriate rescue procedures, and whether or not this affected the likelihood of Matthews surviving. The Court observed that MacLaren had failed to comply with the man overboard rescue procedure. However, two experts who testified estimated that the appropriate rescue method would have taken two minutes or more. The approximate time from the moment that Matthews fell overboard until his body disappeared beneath the water was three or four minutes. Thus, the Court concluded that MacLaren s rescue efforts did not significantly worsen Matthews chances of survival, citing the fact that had Matthews been conscious, he could have grasped a lifejacket thrown to him when the boat was first reversed and a lifejacket was thrown. The Supreme Court of Canada also approved this decision. Another concept, known as the emergency test, must be considered in determining an appropriate standard of care. Specifically, this concept suggests that errors in judgment may be excusable and understandable in moments of extreme stress in an emergency. Accordingly, both the Ontario Court of Appeal and Supreme Court of Canada have frequently taken the context into account and have overlooked conduct that would normally be considered below the required standard of a reasonable person. Thus, it is noteworthy that the emergency test lowers the acceptable standard of care which boat owners/operators owe to their passengers, thus limiting their duty of care to passengers. This lowering of acceptable standard and limitation of duty makes it difficult to ascertain whether the boat owner would be found negligent in any case involving an injured or drowned passenger on his or her watercraft. In the test case, Horsley et al vs. MacLaren et al, the emergency test appears to have played a prominent role in the decisions at both the Ontario Court of Appeal and the Supreme Court of Canada. One of the most important determinants of the owner/operator s liability in this case was whether the application of the wrong rescue procedure (backing toward the victim rather than approaching him bow-on) amounted to negligence. If this was deemed to be negligence, the owner-operator would therefore be liable. However, if MacLaren s actions were judged to be an error of judgment excusable by the extenuating circumstances in the emergency, MacLaren would not be held liable. The majority of both courts decided that MacLaren s method of rescue, though an error in judgment, did not constitute negligence given the confusion of the sudden and tragic occurrence. The next issues that must be resolved in determining the boat owner/operator s negligence in an incident involving his or her watercraft are the establishment of injury suffered by a passenger and the connection between the boat owner/operator s conduct and the passenger s injury. In tort law, it must first be proven that a passenger sustained a material injury, and second, that this injury was a direct result of the actions (or inaction) of the boat owner/operator. Typically, establishing whether or not an injury was sustained by a passenger is easily accomplished. However, proving a causal connection between the actions 69

71 of the boat owner/operator and the injury sustained by a passenger is less straightforward. A general inquiry into the theory of causation requires the application of the but for test, which demands that the passenger show that but for the negligence of the boat owner/operator, the injury would not have occurred. However, some cases in various Canadian courts in recent years have called the passengers actions into question and suggested that they were contributorily negligent by not wearing a lifejacket or PFD at the time of the incident, thereby lowering the owner s share of liability and associated damages. Yet, other courts have rejected this notion that the passengers involved in drowning incidents were partially legally responsible by not wearing a PFD, and have held the owner liable. In the test case of Horsley et al vs. MacLaren et al, the but for test was applied in relation to the death of Horsley, the passenger who dove into the water in an attempt to rescue the passenger who fell overboard, Matthews. Specifically, the issue was whether or not there was such negligence in MacLaren s attempts at rescuing Matthews that Horsley endangered himself by diving into the water in order to expedite the rescue attempt. The Supreme Court decided that although MacLaren did not follow the most appropriate rescue procedures, the evidence did not justify the notion that this induced Horsley to risk his life by diving into the water to attempt his own rescue effort. Generally, it seems that judicial standards are inconsistent and various levels of Canadian courts have used different standards to determine the liability of boat owners. In particular, the courts are not agreed on some of the factors that determine liability of boat owners/operators: reasonable person test, emergency test, and the but for test. Consequently, given the lack of clarity regarding the responsibility for safety gear in tort law, this lends some support to the argument for creating legislation since it would improve the consistency of decisions and would assist the courts in measuring the extent of a boat passenger s negligence. Specifically, mandatory wear legislation would ensure that boat users who fail to wear lifejackets or PFDs would be consistently judged to be guilty of contributory negligence. This would likely motivate small craft users to wear lifejackets or PFDs when on the water, which would in turn reduce drownings. Returning once more to the test case of Horsley et al vs. MacLaren et al, it is interesting to note that the courts who reviewed this case noted that had Matthews not been unconscious, he would have used the flotation device thrown to him by the other passengers and would have presumably assisted in his own rescue. In recognizing this, the courts acknowledge the link between flotation devices and personal safety. By extension, it is possible to argue that, had Matthews been wearing a PFD at the time he went overboard, he likely would have been kept afloat long enough to give the other passengers the opportunity to rescue him from the water. Thus, by wearing a PFD, he likely would not have been killed in this incident. 70

72 CHAPTER 7: LIKELY EFFICACY OF MANDATORY WEAR LEGISLATION FOR ENCOURAGING PFD USAGE In the previous chapter, various approaches to increasing PFD wear rates were reviewed, including the introduction of safety legislation. Since mandatory PFD wear legislation has not been introduced in Canada, it is not possible to conduct an evaluation in order to assess its efficacy in increasing PFD usage. However, other jurisdictions have introduced legislation mandating recreational boaters wear a PFD while on the water in small recreational watercraft (though legislation requirements vary considerably from jurisdiction to jurisdiction, and many laws pertain only to children). Thus, in this chapter, we will review the legislation that has been implemented elsewhere and then will discuss the impact of this legislation, based upon available evaluation studies as well as feedback from international informants. This chapter will also contain a summary of what has been learned from key Canadian informants about the anticipated barriers and opportunities for introducing mandatory PFD wear legislation in Canada. We will conclude this chapter with a discussion of the probable reaction of Canadians to the notion of mandatory PFD wear legislation based upon previous research as well as research that was conducted specifically for the purposes of this background research paper. This opinion poll included many topics, including current watercraft and PFD usage, the degree of support or opposition for PFD wear legislation, and whether or not respondents would comply with PFD wear legislation if it were introduced. IMPACT OF PFD LEGISLATION IMPLEMENTED IN OTHER COUNTRIES Given the inability of educational campaigns alone to change behaviour, a number of jurisdictions have adopted regulatory measures, mandating the use of lifejackets or PFDs for some groups. Many of the states in the United States and the states of Victoria and Tasmania in Australia have each adopted some form of legislation mandating PFDs be worn on recreational watercraft (often for certain defined ages, for watercraft of a defined size, and for certain defined circumstances such as when not in an enclosed cabin or while the vessel is underway). United States As shown in the table below, most (40) U.S. states have legislated mandatory PFD use for children in small craft. However, some states PFD wear laws are applicable only for vessels of a particular size, some are dependent upon whether or not the vessel is underway, and some exempt children who are in an enclosed cabin or below decks. As well, age requirements vary widely from state to state. Some states, such as Florida and Maryland, permit children as young as six or seven to ride in a recreational watercraft without wearing a PFD. 71

73 Figure 17: PFD Wear Legislation by State xviii State State PFD Wear Legislation for Children Circumstances and Age Requirements of State PFD Wear Legislation Alabama Yes Children under 8; within 800 feet below a hydroelectric dam or navigational lock Alaska Yes Children under 13 while on open deck or water skiing Arizona Yes Children under 13; PWC operators and passengers Arkansas Yes Children under 13; PWC occupants California Yes Children under 12 on vessels 26 feet or under unless in enclosed cabin; PWC operators and passengers; water skiers Colorado No Water skiers; PWC occupants; persons aboard outfitters vessels Connecticut Yes Children under 12 when on deck and underway; PWC riders; water skiers; canoeists Oct 1 to May 31 Delaware Yes Children under 13; PWC operators; water skiers District of Columbia Yes When the operator of a vessel is under 18, all others under 18 must wear PFDs Florida Yes Children under 6 on vessels under 26 feet while underway; PWC operators; water skiers Georgia Yes Children under 10 in moving vessel except when in enclosed cabin; PWC operators and passengers; water skiers; in designated hazardous area xviii Sources: NASBLA Reference Guide to State Boating Laws, 6 th Edition, question/regulate/rules/nmac172.pdf ;

74 PFD Wear Legislation By State (cont d) State State PFD Wear Legislation for Children Circumstances and Age Requirements of State PFD Wear Legislation Hawaii No None Idaho Yes Children under 15 on boats less than 20 feet when boat is underway; PWC operators and passengers; water skiers Illinois Yes Children under 13; PWCs Indiana No PWC operators and passengers; water skiers Iowa No PWC operators and passengers; water skiers Kansas Yes Children under 13; PWC operators and passengers; water skiers Kentucky Yes Children under 12 when vessel is underway; PWC operators and passengers; water skiers Louisiana Yes Children under 13 on vessels less than 26 feet Maine Yes Children under 11; PWC operators and passengers; water skiers Maryland Yes Children under 7 when vessel under 21 feet is underway except when below deck or in an enclosed cabin; PWC operators and passengers; water skiers Massachusetts Yes Children under 12; PWC operators and passengers; water skiers; canoeists/kayakers mid-september to mid-may Michigan Yes Children under 6; PWC operators and passengers; water skiers Minnesota No PWC operators and passengers Mississippi Yes Children under 13 in boats under 26 feet while underway Missouri Yes Children under 7; PWC operators and passengers Montana Yes Children under 12 when vessel is in motion; PWC operators and passengers; water skiers Nebraska Yes Children under 12; PWC operators and passengers; water skiers Nevada Yes Children under 12 when vessel is underway and not in an enclosed cabin or below decks; PWC operators and passengers; water skiers New Hampshire Yes Children under 6; PWC operators and passengers; water skiers New Jersey Yes Children under 13 when underway and not in an enclosed cabin; PWC operators and passengers New Mexico No PWC operators and passengers; water skiers; kayakers; canoeists; operators of rubber rafts 73

75 PFD Wear Legislation By State (cont d) State State PFD Wear Legislation for Children Circumstances and Age Requirements of State PFD Wear Legislation New York Yes Children under 12 on boats less than 65 feet when not in an enclosed cabin; PWC operators and passengers; water skiers North Carolina No PWC operators and passengers; water skiers North Dakota Yes Children under 11 on a boat less than 65 feet while in operation; Children under 16 while board sailing; PWC operators and passengers; water skiers Ohio Yes Children under 10 on boats les than 18 feet; PWC operators and passengers; water skiers Oklahoma Yes Children under 13 when vessel is underway; PWC operators and passengers; water skiers Oregon Yes Children under 13 when boat is underway unless below decks; PWC operators and passengers Pennsylvania Yes Children under 13; PWC operators and passengers; PWC operators and passengers; water skiers; sailboarders Rhode Island Yes Children under 10 on Class A vessels while underway; PWC operators and passengers South Carolina Yes Children under 12 on Class A boats; PWC operators and passengers South Dakota No PWC operators and passengers Tennessee Yes Children under 13; PWC operators and passengers; when below dams or in areas marked Texas Yes Children under 13; PWC operators and passengers Utah Yes Children under 13 except when in an enclosed cabin on boats 19 feet or more; all boaters on river except at designated flat water areas; PWC operators and passengers; water skiers; sailboarders Vermont Yes Children under 12 on an open deck or while vessel is underway Virginia No PWC operators and passengers; water skiers Washington Yes Children under 13 on vessels under 19 feet while underway unless below deck or in an enclosed cabin; PWC operators and passengers; water skiers West Virginia Yes Children under 13; PWC operators and passengers; persons on white water Wisconsin No PWC operators and passengers Wyoming No PWC operators and passengers 74

76 According to a National Transportation Safety Board report, the varying age requirements from state to state do not appear to be based on accident data or scientific research. 32 The age of 12 has repeatedly been linked to operator maturity in the marine community, and NASBLA has repeatedly called for children under the age of 13 to be required to wear a PFD based upon research regarding the physiological, emotional and motor skill changes that occur around the age of However, the age requirements for some states seem to have been chosen based on other factors such as the age at which children are required to wear seat-belts. In other states, the age stipulated in state legislation was the result of a compromise between those who oppose any age requirement and those who favour stricter laws. 32 More recently, state PFD wear laws have been subsumed under an American federal statute. Effective as of March 29, 2002 there is a Federal Rule requiring any child under 13 to wear a PFD when on any type and size of recreational boating vessel. 72 The Federal legislation does not supercede state legislation, but instead adopts the applicable age set by a State statute within that state/territory/district. It is noteworthy that the above American legislation does not address the target group most at risk for drowning while operating a recreational boat, namely young adult men. There seem to be few formal evaluations of the impact of legislation requiring children to wear a PFD. However, one U.S. Coast Guard study of PFD wear rates concluded that the wearing of lifejackets was directly proportional to current mandatory wear laws. 73 As well, analysis of drowning statistics reveals that the rate of children drowning in states that require children to wear lifejackets (1.22 for every 1,000 accidents) is lower than that of states that do not mandate PFD wear for children (1.31 drownings for every 1,000 accidents). Although these findings are not conclusive, the results suggest that PFD wear legislation increases the likelihood of wearing a PFD, and this may in turn have led to a decrease in the number of drownings in states with PFD wear legislation. Comments from many NASBLA representatives in states with PFD wear legislation for children provide at least anecdotal support for the idea that the introduction of state PFD wear laws have increased PFD wear rates. When asked in a survey for the purposes of this background research paper (see Appendices B and C for a copy of the questionnaire as well as a full discussion of methodology and findings), comments from many NASBLA representatives in states with PFD wear legislation for children seem to suggest that PFD wear rates have increased following the introduction of legislation. U.S. respondents from 11 states said that they believe that PFD usage has increased considerably due to the introduction of mandatory PFD wear laws for children in their state. And representatives from another 11 states believed that PFD usage had increased slightly after enactment of PFD wear legislation for children. None of those interviewed held the belief that legislation had not had any impact or a negative impact on wear rates. Unfortunately, none of the respondents cited any formal research studies or evaluations to corroborate their contention that legislation had made an impact. 75

77 However, some provided anecdotal evidence or information to support their standpoint. NASBLA representatives in Oregon, Arkansas, Alaska, Washington, and Maine suggested that observational studies or informal feedback from Marine officers indicate that PFD wear rates have increased since legislation was introduced. As well, representatives from Idaho, Nevada, Ohio, Vermont, and California attributed a decrease in fatalities or injuries to the introduction of legislation (although a formal evaluation was not conducted, and causality cannot be determined). Respondents of the survey were also asked to describe any issues or difficulties that may have arisen regarding enforcement of the legislation, and the majority of NASBLA representatives indicated that there were no such problems. However, four respondents did mention that some minor issues related to enforcement have emerged. One respondent stated that while most boaters are aware that there are child PFD laws in place, some are confused about the age cut-off for their state since the laws vary from state to state. Another survey participant claimed that the only issue that enforcement officers occasionally have relates to determining the age of children on board watercraft, and that officers must use their judgment. Apparently in another state there has also been some confusion surrounding some of the terms used in the legislation such as the definition of underway and enclosed deck that have led to some enforcement issues. As well, the lack of infant devices was seen as problematic for enforcement for this same respondent. Another NASBLA representative mentioned that their only enforcement issue relates to the fact that boaters from states without PFD wear laws for children occasionally raise complaints when they are fined by enforcement officers for having children on board not wearing PFDs. NASBLA representatives were also asked about the likely impact of the new federal law for their state, and nearly half of those who responded to the question (15/27) felt that the federal law would not have any appreciable impact on their state s drowning rates or PFD wear rates. Most argued that the federal law would have no impact since their state had already introduced legislation which will not be superceded by federal law. Some also suggested that if the federal law will have any impact, it will only be in federal waters, beyond state lines of jurisdiction. One representative from West Virginia was optimistic that the federal law would lead to a decline in drownings and the representative from New Mexico stated that he believed the impact could be minimal but positive under the assumption that more children will wear a PFD because of confusion over jurisdictional waters. The representative from Virginia also shared the opinion that the introduction of federal legislation would be confusing to the boater. NASBLA representatives from Wisconsin, Massachusetts, Ohio, and Maine suggested that the introduction of the federal law could eventually prompt their state legislature to revisit state boating laws and perhaps change existing regulations to parallel the federal law. 76

78 Tasmania The only other country that has introduced PFD wear legislation is Australia. The state of Victoria has enacted a PFD law that requires children under the age of ten to wear a PFD while the vessel is underway and when not in an enclosed cabin. 74 The state of Tasmania has introduced legislation that makes it mandatory for boaters of all ages to wear a PFD while on-board vessels under six metres in length while the vessel is under power and when not in an enclosed cabin or below deck. 31 A representative from Tasmania participated in the international survey circulated to gather input from the international community for this background research paper. The sole Tasmanian respondent indicated that PFD wear rates have increased considerably since the enactment of mandatory wear legislation in Unfortunately, no details regarding evaluation results were provided, although the Tasmanian respondent claims that Tasmania now has a 95% compliance rate overall. Research conducted prior to the introduction of the legislation suggests that wear rates were already relatively high before the law was enacted (49% of adults and 88% of children routinely wore PFDs while boating). 31 Moreover, this respondent claimed to be pleasantly surprised that Tasmania has not encountered any significant issues or problems with enforcement of the legislation. ANTICIPATED BARRIERS AND OPPORTUNITIES FOR INTRODUCING PFD LEGISLATION ACCORDING TO INTERNATIONAL STAKEHOLDERS In order to determine the potential barriers to the introduction of mandatory wear legislation for recreational boaters in Canada, a number of international experts from drowning prevention and recreational boating organizations were consulted, and this was supplemented by literature searches (see Appendices B, C, and D for a more detailed discussion of methodology and findings). Barriers According to respondents from jurisdictions that have already enacted PFD wear legislation, the biggest barrier they had to overcome pertained to a reluctance on the part of the government to create legislation. In fact, all of the respondents who have already introduced legislation indicated that the lack of enthusiasm from the government was at least a small barrier. For instance, one respondent said that the biggest barrier they had to overcome was that legislators did not see it as a major issue. This individual said several years of lobbying and effective presentations at legislative hearings resulted in (our) success. Another person noted that while public resistance to PFD wearing was a barrier to creating state PFD legislation, it seemed that there was more legislative resistance than public resistance. As well, most jurisdictions also had to deal with either resistance or a lack of enthusiasm from the general public. The majority (84%) indicated that, in their 77

79 jurisdiction, the public strongly believes in personal freedoms and that this was either a small or big barrier to creating legislation. Several respondents noted that there is considerable resistance to legislation making it compulsory for adults to wear PFDs because it is viewed as a violation of their personal freedoms. One respondent referred to the fact that it took four years to get the mandatory seat-belt law passed in his state to illustrate the importance of personal freedom to people within that state and to explain the resistance that they encountered when trying to introduce PFD legislation. As well, 79% said that the lack of public pressure for PFD legislation was also a barrier to some degree. One respondent claimed that the lack of public support prevented the passage of legislation when it was initially proposed, but that efforts they made to garner support from individuals, boat dealers, boating groups, and nurses aided in the passage of legislation on their second attempt. Some jurisdictions indicated that the absence of champions for the legislation or conflict relating to the issue of what ages should be mandated to wear flotation devices were barriers, although most jurisdictions rated these factors as smaller barriers. Only one of the representatives from jurisdictions with PFD wear legislation indicated that the fact that drowning prevention was not as high a priority as other political issues was a big barrier, although seven respondents suggested that this was a small barrier to the creation of legislation. One person in particular noted that the decline in boating fatalities in the past 20 years contributed to a lack of a sense of urgency regarding boating safety. Virtually all of the jurisdictions with existing legislation indicated that there was little or no conflict surrounding other aspects of the legislation such as the type of flotation device or what level of government should be responsible for introducing legislation, and very few had any concerns about enforcement of the law. The respondents who represented jurisdictions that have not enacted PFD wear legislation also rated both a lack of public pressure as well as resistance amongst the public due to the value they place on personal freedoms as being the key barriers to introducing legislation. In fact, each of the jurisdictions who have not enacted legislation suggested that the value that the general public places on freedom has been a barrier to creating legislation. To illustrate this point, one respondent said that citizens in his state do not appreciate any laws that restrict their personal choice. As well, 95% characterized the fact that the public is not pushing for legislation as a barrier. One respondent stated that the lack of support from voters and interest groups was a key factor in a recent failure to pass legislation that would make it mandatory for children to wear a PFD. In explaining the absence of legislation in another state, one respondent noted that adults don t want to wear PFDs (because they are perceived to limit movement, and are seen as being hot, uncomfortable, unattractive, and expensive) and thus this opposition prevents legislators from trying to create adult PFD wear laws. This respondent also made the point that most children are already wearing 78

80 PFDs despite the absence of legislation, which therefore provides little incentive to enact a law. A lack of enthusiasm from the government also was rated as a critical barrier by some (60% identified this factor as a big barrier), but for others, this had nothing to do with the absence of PFD legislation in their jurisdiction. One respondent described the lack of government enthusiasm for PFD legislation in this way, the current political climate within our (legislature) would not enact a bill such as this proposal. Respondents from one country without PFD wear legislation suggested that their government was seeking to reduce the amount of legislation in general and holds the view that water safety is up to individual boaters and is not a responsibility of the government. Interestingly, concerns about enforcement of the legislation appear to be a much bigger issue among those jurisdictions that have not created PFD wear legislation compared to those that have. As one respondent noted, enforcement takes a lot of effort at the same time that enforcement capacity is very small. Priority is low! Otherwise, it does not seem as if conflicts or concerns about various aspects of legislation are key barriers preventing these jurisdictions from introducing legislation. Some respondents from jurisdictions without PFD wear legislation cited a number of reasons why they believe that legislation is not required. For instance, some pointed to the relatively small number of drowning cases and suggested that the statistics do not merit the creation of legislation that would make it compulsory for all boaters to wear flotation devices. In the U.K. for example, one respondent commented that incidents and accidents are not at a level to indicate that further legislation for the compulsory carriage of PFDs is required. One Dutch respondent mentioned that swimming lessons had formerly been part of the school curriculum, and as a result, the majority of Dutch people in a certain age bracket know how to swim. This respondent concluded that this widespread swimming ability makes it unnecessary to create legislation mandating PFDs be worn by recreational boaters (although this clearly does not address the issue of water temperature and the effect of cold water on swimming ability). As well, one German respondent mentioned that due to insurance requirements, individuals are forced to wear flotation devices so that they do not lose coverage. Another German survey participant suggested that the owner of the vessel is legally responsible for the safety of the crew or guests, and this essentially means that it is up to the owner to ensure that flotation devices are worn by passengers. Otherwise, he or she will be held responsible in the event of an incident. Opportunities Survey respondents were asked about what factors could or did facilitate the creation of PFD legislation. For those jurisdictions in which PFD legislation has already been introduced, having champions that could bring attention to the 79

81 issue was apparently the most important factor that aided in bringing about the law. Of all jurisdictions with existing PFD wear legislation, 92% described the impact of champions as either a big or small factor in creating the legislation. One NASBLA representative said that the fact that key individuals spoke out to legislation about specific incidents was critical to their success in creating legislation, while another suggested that having grass roots supporters contact legislators and appear at legislative committee meetings was instrumental in achieving the passage of the legislation. One respondent claimed that pressure from the National Transportation Safety Board was very helpful in ensuring legislation was passed in the respondent s state. The NASBLA representative from Nevada mentioned that the joint efforts of one particular legislator and the students in a high school government class led to the introduction of PFD wear legislation in that state. The legislator offered to introduce a bill on a topic chosen by the high school class, and they selected the child wear PFD issue. The second most important factor that helped in terms of getting PFD wear legislation passed was the occurrence of drowning incidents which raised the profile of this issue. Nearly all jurisdictions with legislation (92%) said that the publicity surrounding drowning incidents played either a big or a small role in creating the legislation. One respondent said that a few drowning incidents involving children was a factor that aided in the creation of legislation, and that even though the absolute number of drownings involving children was not high, any is too many. Another NASBLA representative claimed that state PFD wear legislation was created in response to one high profile incident in which two children were killed. For others (79%), generating enthusiasm from the government for the issue was either a big or a small factor that led to creation of the law, and 71%, support or pressure from the general public was a factor. In fact, one respondent suggested that the legislation must be heavily endorsed by the boating public and noted that it is important to develop grass roots support for creating legislation. Other respondents echoed the importance of grass roots initiatives or suggested public education (and targeting boaters specifically) as a means of generating support for the legislation amongst the general public. Similarly, other individuals from states that have PFD wear legislation recommended involving as many stakeholders as possible, and seeking support from boating clubs and organizations and fishing lobby groups. The respondent from Tasmania credited the thorough public consultation as being the key reason the legislation passed without difficulty. In fact, Tasmania conducted an extensive survey of over 8,000 registered boat owners as part of their public consultation process, held a number of public meetings across the state to seek input, and invited over 150 boating clubs and organizations from the boating community to make a submission regarding their views on the mandatory wear legislation. 31 Another respondent emphasized the importance of obtaining the support of marine dealers, as they have a powerful lobby group in the respondent s state, and they were initially resistant to the law due to concerns about personal freedoms of boaters being violated. 80

82 Governments awareness of either legal or economic rationale for legislation apparently was less influential in creating the mandatory wear law. Jurisdictions that do not currently have laws requiring boaters to wear a PFD believe that the publicity from one or more drowning incidents could bring enough attention to the issue of drowning that it could pave the way for the introduction of legislation. Specifically, 95% speculated that drowning incidents in which PFDs were not used could play some role in facilitating the creation of PFD wear legislation. As one respondent said, a media storm about an incident or series of incidents can provoke both a political will and pressure from the public... some high profile incident might trigger the motivation to bring about legislation. Pressure or enthusiasm from the general public and interest from the government in creating legislation were also perceived to be important in building momentum for legislation. Seventy-nine percent of all respondents from jurisdictions without PFD wear legislation consider support from the public as well as the government to be factors that could lead to the creation of legislation. One respondent suggested that most boaters feel safe in their boat without wearing a PFD and nobody expects to end up in the water. This respondent noted that canoe, kayak and PWC enthusiasts have a greater expectation of ending up in the water, so they are more likely to accept legislation that would make it compulsory for them to wear a flotation device. The implication is that by educating users of other types of watercraft about their chances of unexpectedly capsizing or falling overboard, this may increase their acceptance of PFD wear legislation. Seventy-eight percent also felt that if individuals or groups opted to become champions for legislation and brought attention to this issue, this could play some role the creation of mandatory wear legislation. One respondent from a country without any PFD wear legislation suggested that children tend to be very successful in the role of safety ambassadors. Again, as with the respondents from jurisdictions who have already introduced PFD wear legislation, those without such laws contend that making the government aware of the legal and economic arguments for the law is less influential than other factors. One respondent from a state that already has enacted PFD wear legislation for children suggested that it is far easier to first introduce legislation targeting children before considering legislation that would also pertain to adults. The reasoning of this respondent is that compliance is nearly universal and objections few. Another respondent in a state with child PFD wear legislation echoed this view and said that we chose not to try for mandatory adult wearage because we know our legislators and the public would speak out against such a proposal. One other respondent from a state that has already introduced PFD legislation for children suggested being prepared early on to compromise. It is presumed that this respondent is suggesting that it may be necessary to 81

83 compromise by introducing PFD wear legislation for children only rather than all ages. Several respondents commented on the importance of gathering and presenting statistics to support any legislative efforts, particularly statistics relevant to the target age group. The respondent from Tasmania indicated that they relied heavily on coroners reports to make the case for legislation. However, a couple of respondents emphasized the importance of telling the human side of boating tragedies and playing on emotions as they believe that providing statistics without making them more personal is not compelling enough to justify making the wearing of PFDs compulsory. Another respondent cautioned that the fact that absolute numbers of child boating fatalities are low can be a barrier to creating PFD wear legislation for children. Thus, this individual suggested building the argument for legislation around the notion that children are not capable of putting on a flotation device themselves in an emergency situation rather than making the case based on statistics. One respondent indicated that the perception that PFDs are hot, unattractive, uncomfortable, limit movement etc., is a barrier to the introduction of PFD legislation. This individual highlighted the importance of changing PFDs to address these complaints in order to make mandatory wear legislation more viable for adults. Another respondent suggested that it is crucial that the availability of low cost, comfortable PFDs is emphasized in the hearing process for legislation. As well, the importance of educating the legislators before introducing legislation was stressed by one respondent. This person commented that not sufficiently educating the legislators was a critical mistake the first time legislation was proposed in the respondent s state. A NASBLA representative from a state that does not yet have any PFD wear legislation suggested that an effective approach to consider in obtaining state legislation would be to pass a federal law and then tie grant funding from the Coast Guard to the passage of state legislation. ANTICIPATED BARRIERS AND OPPORTUNITIES FOR INTRODUCING PFD LEGISLATION ACCORDING TO CANADIAN STAKEHOLDERS A variety of Canadian stakeholders from diverse backgrounds were also consulted regarding the potential barriers and opportunities for the introduction of mandatory wear legislation for recreational boaters in Canada. Representatives from various organizations and fields were consulted, including policy makers, researchers, advocates, recreational boating organizations, and law enforcement (see Appendices E and F for a more detailed discussion of methodology and findings). These experts were also asked about their level of support for a legislative solution to the problem of boating drownings as well as their opinion regarding the likely success of introducing such legislation. 82

84 Barriers and Opportunities Cultural Attitudes The cultural attitudes of both Canadians in general, but particularly recreational boaters, will have important implications for the likely success of the introduction of PFD wear legislation. Canadian stakeholders were asked whether Canada s cultural context and the cultural attitudes of recreational boaters would facilitate or hinder the introduction of legislation, and responses were somewhat mixed. While some respondents suggested that Canadians generally tend to be accepting of legislative solutions to social problems, or at least to legislation that is perceived to be justified and appropriate, others characterized Canadians as being resistant to legislation due to the value placed on freedom and independence. These individuals referred to the controversy that surrounded the introduction of gun registration, seat-belt laws, and bicycle helmet legislation as examples. The willingness of recreational boaters to accept legislation also evoked differences in opinion. One respondent suggested that boating may be one of the last frontiers to experience regulation, and therefore, boaters may resist the introduction of any sort of legislation that would impinge upon their freedom and independence. However, another respondent held the opinion that recreational boaters are relatively accepting of legislation and cited the relative absence of opposition to Pleasure Craft Operator Cards as evidence. One other respondent claimed that previous boating regulations (such as the introduction of safe powering limits and regulation requiring mandatory flotation of boats under 6m) have contributed to declines in boating fatalities, which suggests that boaters must have accepted and complied with these regulations. There was some discussion regarding the attitudes of recreational boaters towards wearing PFDs and implications for the prospect of PFD legislation. It was noted that PFD wear rates are much higher among users of watercraft such as kayaks and personal watercraft compared with other watercraft, and various explanations were offered. One respondent suggested that the recent trend toward colour coordination of PFDs with kayaks and PWCs has made wearing PFDs fashionable. Others suggested that these groups are more likely to wear PFDs based upon practical reasons such as lack of storage space to carry a PFD (in order to be compliant with existing legislation) and the expectation of PWC users and kayakers that they will be immersed in the water. The inference is that these watercraft users are unlikely to resist legislation. However, other respondents argued that some boaters have a sense of ownership over boating activities and would therefore be resistant to losing the right to choose whether or not to wear a PFD. Similarly, other older boaters who do not ordinarily wear a PFD may also be resistant to legislation simply because they are accustomed to boating without wearing one. 83

85 Thus, there is a wide disparity in opinion regarding the cultural climate for legislation with some arguing that Canadians in general are accepting of reasoned legislation, while others believe Canadians tend to be more resistant of initiatives that limit their freedom. Similarly, some Canadian experts had the impression that recreational boaters would oppose PFD wear legislation while others contended that they would likely accept this regulation if it is presented in a reasoned fashion to generate support. Influential Stakeholders and Potential Supporters One important consideration in weighing the likely success of PFD is the existence and influence of various stakeholders. Many of the Canadian informants interviewed mentioned the Canadian Safe Boating Council as an influential body in drowning prevention in Canada. This organization is believed to represent many key groups within the boating community, including vessel and safety equipment manufacturers and the powerboating community, which could potentially aid in disseminating information about legislation. However, respondents noted that other organizations of influence that may not have CSBC membership include angling and hunting organization, cottage organizations, and the Canadian General Standards Board. According to those interviewed, there are other key government agencies with influence that would need to support a regulatory initiative in order for it to proceed expeditiously. These include: Fisheries and Oceans Canada including the Canadian Coast Guard and the Rescue, Safety and Environmental Response Unit; Transport Canada including Marine Safety; Health Canada; Heritage Canada; the Solicitor General s Office; and Human Resources and Development Canada. Identifying parties with influence in the boating and policy creation communities is an early step in formulating a strategic push to implement a preventive initiative, but as one respondent noted, working toward a mandatory wear policy requires a leader respected by parties with influence. Several organizations that were mentioned by more than one participant as candidates for a leadership role were the Red Cross, SMARTRISK, the Life Saving Society, the Canadian Power and Sails Squadron, and the Canadian Safe Boating Council. Other organizations mentioned included the Canadian Yachting Association, the Ontario Federation of Anglers and Hunters, and the Canadian Parks and Recreation Association. Some respondents stated that these organizations have experience in working with policy makers that would make them ideal candidates to lead a promotion initiative for mandatory wear legislation, though others questioned their depth of lobbying experience and available resources for this initiative. Overall, although there were some respondents with some reservations, it seems the majority of those interviewed believe that there are some Canadian organizations that have influence and some that could potentially act as a leader or champion in advocating for PFD legislation. However, it is clear that respondents have some valid concerns about resources and involving other influential stakeholders such as key government agencies that must be addressed should it be determined that mandatory wear legislation is the most appropriate means for reducing boating drownings in Canada. 84

86 Communication Within Boating Community Clearly, if the boating community itself could come to some degree of consensus regarding the need for mandatory wear legislation, this common voice would aid in any lobbying efforts. In order to achieve consensus, it is necessary to stakeholders in the boating community to communicate with each other and advance options (such as legislation) for drowning prevention. Three respondents mentioned the national Recreational Boating Advisory Council as a forum where stakeholders can discuss options such as legislation. Respondents also mentioned the Canadian Marine Advisory Council, the regional Recreational Boating Councils, and the Canadian Safe Boating Council as important communication forums. Each of these forums are perceived to have broad and overlapping memberships which would allow for discussion regarding legislation amongst a large number of interested parties which would clearly facilitate the creation of legislation. Several respondents also suggested that the World Congress on Drowning and the Italian Conference on Safety and Transportation would offer other opportunities for Canadian stakeholders to discuss the issues, with the added benefit that stakeholders could also learn from approaches taken in other countries. One respondent suggested that Canada could consider hosting the second annual World Conference on Drowning, which would present an opportunity to bring attention to the issue and possibly advance the pace of the policy process. However, some respondents cautioned that other groups would not be represented in these boating related councils, such as: cottage owners, Northern Canadians, hunters and fishers, and other small vessel owners (many may not even perceive themselves as boaters as boating may be perceived more as a means to participate in some other activity for these groups). Thus, reaching this diverse group of boaters may be challenging, and may necessitate more costly strategies such as public announcements in print media, town hall meetings, notices in public spaces or canvassers in cottage areas. Reaching these diverse groups and building a consensus for mandatory wear legislation could therefore be a potential barrier to creating this legislation. While some expressed concerns about assuring participation from some difficultto-reach boating groups, for the most part, it seems that informants shared the opinion that the boating community has the ability to communicate with one another through various forums, which would facilitate the creation of legislation. Communication to General Public Generally, the Canadian informants interviewed shared the opinion that any legislative efforts must be accompanied by initiatives to educate the general public, and boaters in particular, about the need for mandatory wear legislation. Some supported the idea of public education on the basis that public support (of taxpayers and end users) must be well documented before an issue is placed on the policy-making agenda since politicians are driven by voter support. As well, one respondent supported the notion of public education since s(he) believes that an informed public would make wise safety decisions. Thus, public education 85

87 can be viewed as a factor that could help to facilitate the creation of mandatory wear legislation. However, a number of concerns were raised regarding appropriate targets, message frequency, and message content for public education campaigns that could potentially be barriers to legislation if they are not addressed. One individual cautioned that the effectiveness of a public education campaign will be affected by whether boaters are truly unaware of the importance of flotation devices or whether they knowingly choose not to wear PFDs. Other participants indicated that the effectiveness of campaigns could be improved by targeting campaigns at specific groups within the boating audience or at a female audience (under the assumption that they can persuade children and spouses about the worthiness of prevention initiatives). As well, it was suggested that campaigns would be more effective if the public is exposed to educational messages on a more regular basis over the course of a year rather than just over a short period in the summer. Others expressed concern that campaigns must not stereotype boaters as lawbreakers or portray boating as a dangerous activity. A key issue cited as a potential barrier to legislation is the financial resources necessary to mount an effective public education campaign. Two respondents explained that an education campaign to accompany a regulatory initiative would entail print, radio and television media, which could require millions of dollars of funding. However, respondents suggested that co-operative advertising pooling financial contributions of stakeholders and proactive consultations with the media including the national associations of broadcasters in print, radio, and television could potentially reduce these costs, and thus this barrier to legislation. As well, there was some discussion regarding the fact that organizations such as the Red Cross and Life Saving Society have extensive communication networks that include media such as Web sites, print newsletters, and television programming that could be utilized in educational campaigns. Thus, most informants emphasized the need for public education campaigns to facilitate the legislative process, and some expressed some concerns with past educational efforts that could be barriers to enacting legislation. However, others suggested some strategies that would address some of the barriers. Statistical Evidence Many respondents stated that the argument for mandatory wear legislation must be made using solid statistical evidence gleaned from academically based research studies. However, respondents were divided in their opinions on the current state of this statistical evidence. Four respondents felt that sufficient statistics currently exist to make a case in favour of legislation, and in fact, one of these individuals believed that the depth of Canadian drowning research actually distinguishes Canada from other countries contemplating PFD legislation. In contrast, some informants identified specific gaps in knowledge that they feel require further study. Two respondents noted that nonfatal drowning 86

88 consequences such as injury or property damage have not been sufficiently studied. There was also some disagreement among respondents regarding whether or not sufficient research has been conducted regarding boater attitudes towards PFDs and whether or not mandatory wear legislation would actually impact wear rates and reduce drowning fatalities. One other respondent emphasized the need for the boating community to be educated regarding the physiological phenomenon of cold-water shock and how wearing a PFD can help to reduce the effects of cold water. While many respondents believed that sufficient statistical evidence supporting the creation of mandatory wear legislation has been collected, others identified gaps in knowledge that they perceived should be addressed. However, the barrier may not be the absence of statistical evidence, but rather the vastness of the research. Perhaps condensing the drowning research and creating materials that would be appropriate for various audiences would facilitate the legislative process. Enforcement Issues Since Canada is such a vast country geographically, this could make enforcement of mandatory wear laws challenging. One respondent held the view that Canadian bodies of water exceed the capacity of enforcement agencies to effectively enforce all boating laws. However, it is evident that this geographical context does not negate the utility of regulations in the boating environment since Canada has not left this sphere unregulated and PFD carriage regulations currently exist. Enforcement could prove challenging in light of resource issues raised by other respondents. Two respondents observed that marine law enforcement is not currently evenly distributed across the country, with most enforcement centred in Ontario. Respondents also explained that limited resources of police departments have contributed to a deficit in personnel to apply existing boating laws. Two respondents stated that the Coast Guard does not play an enforcement role, although one respondent suggested that the Coast Guard should be granted some responsibility in that domain. Thus, most respondents have identified either human resource or financial issues regarding the enforceability of mandatory wear legislation that will need to be addressed since laws must be enforceable to be perceived to be legitimate. Political Context The current political context may also influence the success of any legislative initiative. Several informants expressed the view that politicians are driven by voter support and are wary of any legislative initiatives that may prove politically unpopular. Further, two respondents speculated that recent reactions to the federal gun registry will make policy- makers reluctant to initiate a policy process for PFD legislation. As well, two respondents mentioned that the limited budgets of the Coast Guard and Office of Boating Safety may negatively impact legislative efforts. One other respondent raised the uncertainty around Coast Guard management of vessel licensing as a concern. Specifically, this individual 87

89 anticipated public resistance to the fees associated with licensing, which s(he) theorized would make the agency unpopular and would make them reluctant to engage in other potentially unpopular measures. However, other respondents believed that the current political environment is favourable for introducing mandatory wear legislation. One respondent cited the reform of the Canada Shipping Act, which will presumably increase attention and energy directed at boating regulation in general. Another respondent argued that recent efforts of the Canadian and American Safe Boating Councils has influenced thinking on regulation and that communication with PFD manufacturers and users have built momentum. As well, one other respondent suggested that the recent introduction of federal legislation for PFD wear amongst children on small watercraft in the United States contributes to the impetus for regulation. Thus, overall, respondents were divided with respect to whether or not the current political climate is favourable for making mandatory wear legislation a priority on the policymaking agenda. Some believe that current and past events in the political landscape make it a less than ideal time to bring this issue to the attention of policymakers while others contend that the current environment actually represents a window of opportunity for regulation. Economic Implications One respondent argued that the marginal cost to recreational boaters of complying with mandatory wear PFD legislation would be zero because of existing carriage requirements. However, a peer suggested that legislation may prompt some boaters to upgrade their existing PFDs. Respondents believed that the federal government, and the Canadian public, would bear the broader costs of preparing and implementing mandatory legislation through general revenues. Specifically, respondents anticipated federal government resources directed towards public education and management of the legislative process. Respondents identified startup costs associated with consultation and preparing draft regulations, although respondents varied in their assumptions surrounding these costs. However, a couple of alternate funding sources were suggested by respondents. One researcher suggested that the injury prevention network may have employment grants that could be applied for a position to advance the cause of mandatory wear legislation. Another respondent pointed to the dedication of a portion of boat fuel taxes to marine law enforcement in the U.S. as a model that Canada could consider. Thus, while there was some disagreement regarding the costs that would be borne by recreational boaters, the anticipated cost to the federal government may be a barrier to the creation of legislation unless alternate funding sources such as those suggested by respondents are considered. 88

90 Degree of Overall Support for Introduction of PFD Wear Legislation The informants interviewed for this background research paper were asked about whether federal regulation is the best policy alternative to the problem of recreational boating drownings. Three respondents indicated that they were in support of mandatory PFD legislation as they strongly believe that PFDs save lives. Two respondents argued for greater enforcement of existing boating laws rather than the creation of new regulatory proposals. However, even if enforcement was strengthened and this effort increased PFD carriage rates on boats, there is no guarantee that this would also increase wear rates. Three respondents stated that legislation cannot stand alone but has to be integrated with other interventions to influence boating behaviour. Many respondents raised the issue of the importance of public education regarding the safety benefits and rationale for mandatory PFD wear, and maintained that this would increase public acceptance of the legislation. One respondent interpreted the federal regulatory policy guidelines to mean that regulation should be a last resort in social interventions. Another informant stated emphatically that society cannot (and should not) legislate common sense. Respondents also offered opinions regarding specific aspects of the legislation. For instance, three respondents envisioned that mandatory wear legislation would require PFD use in all conditions for all ages. However, some respondents interviewed were in favour of specifying conditions under which PFDs were required. Conditions suggested by respondents included depth of water, distance from shore, weather conditions, watercraft type, time of year, and swimming ability. The rationale for specifying conditions in which PFD wear is required varied. One person feared that a strict policy without exemptions would yield poor compliance. Four respondents argued that regulation should apply to small open vessels and singled out powerboats and canoes particularly in cold water in the spring and fall. Two respondents expressed a concern that any conditions specified by mandatory wear legislation would have to be logical to prevent mockery of the overall regulatory intent. On the other hand, two individuals expressed the view that specifying particular conditions for PFD wear would make enforcement more difficult. Another respondent also raised the concern that creating legislation requiring PFD use in bad weather does not address the issue of the safety of boaters who are unexpectedly immersed in good weather. Interestingly, none of the respondents interviewed favoured regulations for children only, which is the approach taken by the United States and one of the states in Australia. Four respondents justified this opposition to legislation for 89

91 children on the basis that children constitute a small proportion of fatal drownings. Respondents also pointed out that children receive PFD messaging in water safety programs such as the Red Cross swimming courses. Furthermore, some argued that children already have high PFD wear rates and receive scrutiny from their parents. One respondent proposed a policy formulation that would allow provinces with sufficient enforcement resources to opt into legislation. Although the respondent believed that mandatory wear legislation should be federal, this individual raised the possibility of allowing differential provincial engagement. The respondent referred to the Contraventions Act as a regulatory example that permits willing provinces to opt into an initiative without being delayed by the resource constraints of other jurisdictions. Prospects for PFD Wear Legislation Respondents were asked to provide a prediction regarding how far Canada will have come in the policy creation process for mandatory wear legislation in two years. Two respondents optimistically believed that mandatory wear legislation could be achieved in two years. Three respondents predicted that the safety community would still be educating the public and policy makers about the drowning problem. One respondent believed that the safety community would still be learning about the policy process and another believed that the gathering and presentation of materials would still be proceeding. The least optimistic respondent stated that the safety community would still be thinking about the appropriateness of legislation. One informant stated pragmatically that the safety community would need to establish a long-term goal with coordinated efforts at different levels across the country to achieve any prevention objective. ANTICIPATED REACTION OF CANADIANS TO PFD LEGISLATION In order to assess the likely reaction of Canadians to the introduction of legislation that would make wearing a PFD compulsory, a review of the public reaction to similar legislation that has been introduced in other jurisdictions may provide some useful insights. As well, past research with the Canadian public has probed their likely reaction to PFD wear legislation, and an opinion poll was conducted with Canadians regarding their support for PFD wear legislation for the purposes of this background research paper. Reaction to Introduction of PFD Wear Legislation in Other Jurisdictions Public reaction to the introduction of PFD wear legislation for children in the United States and for all ages in Tasmania, Australia may provide some indication of the likely response of Canadians to PFD wear legislation. In a survey conducted with NASBLA representatives for this background research paper (see Appendices G and H for a copy of the survey as well as a full discussion of methodology and findings), respondents were asked how supportive the general public was with respect to the introduction of state 90

92 legislation mandating PFD wear for children. A total of 23 respondents submitted a response to the question, and 13 of the 23 (57%) claimed that, overall, the general public had been very supportive of the legislation. The other 10 respondents (43%) characterized the response of the general public as being somewhat supportive. However, some respondents indicated in open-ended questions that the enactment of PFD wear legislation targeted at children faced very little opposition, but that legislation that included adults would be a much tougher sell for both legislators as well as the general public. It is interesting to note that prior to introducing mandatory wear legislation in Tasmania, research with recreational boat owners indicated that 59% were opposed to legislation requiring adults to wear a PFD and only 39% supported such an initiative. 31 However, the same research study found that 91% of boat owners in Tasmania were in favour of compulsory wearing of PFDs by children prior to the creation of such PFD legislation for all ages. 31 And yet, the Tasmanian respondent who completed the survey for this background research paper indicated that the general public was very supportive of the introduction of state PFD wear legislation despite the public s initial misgivings. The Tasmanian respondent mentioned that Tasmania conducted careful public consultations which he characterized as being important before this legislation was introduced. This may have contributed to what he described as the fabulous response from boaters. Past Canadian Research As well, there have been a few studies conducted in Canada to determine what the public response to framing such a law would be. Focus groups conducted in Canadian cities on the general issue of low lifejacket/pfd usage rates have suggested an acknowledgement among boaters that legislation is likely the only way to increase use. It was suggested that this would be the most effective strategy as most boaters are inclined to obey the law. 47 Several research studies conducted in Canada have questioned respondents about whether or not they would agree with legislation requiring the wearing of PFDs or lifejackets for recreational boaters, and the proportion in favour of legislation ranged from 23% to 62%. One telephone survey in western Canada showed that 50% of the male respondents would support a law requiring lifejackets or PFDs. 51 Another study showed that 62% of the male recreational boaters surveyed agree that wearing a lifejacket should be mandatory by law and 11% of those who do not currently wear a lifejacket in all circumstances claim they would always wear a lifejacket if it was required by law. 26 Other Canadian research found that 59% of the recreational boaters surveyed agreed that boaters should be required by law to wear a lifejacket at all times on the water, and another 27% agreed that boaters should be required to wear a lifejacket under certain conditions (such as poor weather or for high-risk activities). 27 Only 11% of respondents in this study were opposed to lifejacket/pfd legislation entirely. However, a telephone survey conducted on behalf of the Canadian Red Cross Society in 1998 found that only 23% of the recreational boaters interviewed 91

93 strongly agreed that boaters should be legally required to wear a flotation device, and 38% strongly disagreed with this proposition. 16 Opinion Poll In order to further explore likely reaction to PFD wear legislation, an opinion poll with 1,000 Canadians was conducted for the purposes of this background research paper. (See Appendices G and H for a copy of the questionnaire as well as a full discussion of methodology and findings.) Respondents were asked to indicate their support for PFD legislation for various types of watercraft (high performance boat, powered runabout/cruiser, fishing boat/utility boat/skiff, pontoon boat, sailboat, canoe, kayak, rowboat/dinghy, personal watercraft) and for various groups of people (all people on board, just minors aged 17 and under, just children aged 12 and under, one person on board). Although support for legislation varied slightly by type of watercraft and by region, gender, and age, overall, support for mandatory PFD wear legislation of some sort was extremely high amongst both watercraft users and non-users. Moreover, the vast majority supported legislation for all ages of occupants, not just children or minors. As shown in the charts below, support for PFD wear legislation for all occupants on board ranged from 70% for pontoon boats to 87% for personal watercraft, while support for legislation targeting children aged 12 and under ranged from 2% for personal watercraft to 9% for powered runabouts/cruisers. The proportion of the sample that were opposed to PFD wear legislation for any age group varied slightly by type of watercraft, from 5% for personal watercraft and sailboats, to 7% for rowboats/dinghies, fishing boats/utility boats/skiffs, and pontoon boats. 92

94 Figure 18: Level of Support For Some Sort of Legislation Requiring Boaters to Wear a PFD At All Times When On The Water in a Small Watercraft (Under 6m) Personal Watercraft High Performance Powerboat/Jet Boat Sailboat Canoe Powered Runabout/Cruiser Kayak Rowboat/Dinghy Fishing Boat/Utility Boat/Skiff Pontoon Boat 93% 93% 93% 93% 92% 92% 91% 90% 88% 5% 2% 6% 1% 5% 2% 6% 1% 6% 2% 6% 2% 7% 2% 7% 3% 7% 5% Support Legislation of Some Sort Opposed to Legislation of Any Sort Undecided Figure 19: Level of Support For Legislation Requiring Specific Target Groups of Boaters to Wear a PFD At All Times When On The Water in a Small Watercraft (Under 6m) % Support Legislation For Just Just Aged Aged 17 & 12 & Under Under All On board (All Ages) One Person On board % Opposed to Legislation (for Any Group) % Undecided Personal Watercraft Kayak Canoe High Performance Powerboat/Jet Boat Sailboat Rowboat/Dinghy Powered Runabout/ Cruiser Fishing Boat/Utility Boat/Skiff Pontoon Boat

95 This opinion poll with Canadians also indicated that if PFD wear legislation were enacted, the vast majority (84% to 93%, depending upon type of watercraft) claim they would comply with the law under all circumstances. A small segment (between 5% and 10%) said they would only wear a PFD under certain circumstances, and an even smaller minority (ranging from 2% to 5%) claim they would defy a law that made wearing a PFD mandatory. Figure 20: Hypothetical Compliance with PFD Legislation Personal Watercraft 93% 5% 2% 1% Kayak High Performance Powerboat/Jet Boat Sailboat 91% 89% 89% 5% 3% 1% 8% 3% 1% 7% 3% 1% Canoe 88% 7% 3% 1% Powered Runabout/Cruiser 86% 9% 4% 1% Rowboat/Dinghy 86% 8% 4% 1% Fishing Boat/Utility Boat/Skiff 85% 9% 5% 1% Pontoon Boat 84% Would Wear Under All Circumstances Would Wear Under Certain Circumstances Would Not Wear A PFD Don't Know/No Answer 10% 4% 2% 94

96 CHAPTER 8: CONCLUSIONS AND RECOMMENDATIONS GENERAL CONCLUSIONS The initial purpose of this research project was to develop a background research paper articulating more fully the issues surrounding mandatory PFD wear legislation for recreational boaters in small craft. The results of the four blocks of research conducted are somewhat complex and this in turn speaks to the complexity of the issues involved in seeking change in public policy. Four general conclusions due arise from the research: 1. Boating related drownings warrant action 2. PFD wear is the risk factor to address to prevent these drownings 3. Mandatory wear legislation is the intervention to employ to increase PFD wear 4. Such legislation should be feasible in Canada Boating Related Drownings Warrant Action Data from 1991 to 1999 indicate that an average of 140 recreational boaters drown every year in Canada. 4 Boating related drownings resulted in 2,767 potential years of life were lost to Canadians in The true magnitude of the problem may be greater still. It has been estimated, that up to 43% of drownings are misclassified. 4 In comparison to the rest of the developed world, Canada s drowning rates are nearly twice as high as those in the United States, approximately four times higher than in Scotland, seven times higher than in England, and 12 times higher than those in France, 4 although it must be remembered that Canada has the highest boat ownership rates for those countries. Future research relating drowning to hours of boating exposure in Canada is thus warranted. The burden of these drowning fatalities is far from insignificant. The present study calculated indirect costs associated with boating drownings at over $30 million a year. This estimate is based on only the two thirds of the drowning deaths for 1999 for which accurate e-codes could be obtained and thus is a significant underestimate of the true burden. In addition, other costs such as search and rescue would also need to figure into an overall measure of economic burden. For example, one voluntary organization, the CCGA indicates that the incident costs in fuel and equipment (excluding the initial cost of the vessel, navigation and communication equipment) average about $174 per incident they participate in. 13 Thus the final economic burden must be quite high indeed. One study estimating the total to be about $80 million per year

97 PFD wear is the risk factor to address Numerous risk factors for drowning have been identified in the literature: however many of these, such as age and gender, aboriginal heritage, weather and water temperature are not amenable to direct intervention. Potential points of intervention in boating behaviour which could impact drowning rates include increasing swimming ability, decreasing alcohol consumption, decreasing reckless behaviour and increasing the use of floatation devices. An examination of Canadian recreational boating fatalities in 1999 shows that only 14% of those who drowned were identified as non-swimmers or weak swimmers. 19 There is considerable evidence that even those who are good swimmers can experience great difficulty in cold water, so swimming ability in warm water is not necessarily a good indicator of survival in cold water. 7, 20 In 1999, only 1% of all recreational boating drownings took place in warm water above 20 C. 4 Thus increasing swimming ability does not hold much promise for preventing the majority of boating related drownings. Alcohol was detected in 32% of all drowning victims (23% were above the legal limit) and was suspected in another 7% of recreational boating drowning deaths in It is estimated that a boat operator with a blood alcohol concentration above.10 is more than 10 times as likely to be killed in a boating incident than boat operators with zero blood alcohol concentration. 24 Alcohol consumption impairs judgment, the ability to focus and process information, as well as reaction time. 24 At the same time, peripheral vision, night vision and depth perception deteriorate after consuming alcohol. 24 It is clear that an intervention aimed at reducing alcohol consumption has the potential to save lives, however, only in the minority of cases. Reckless behaviour is involved in some drowning incidents. The boat was overloaded in 10% of all drowning incidents, someone stood in the boat in 8% of all drownings, the boat operator made an abrupt turn that may have contributed to 6% of the deaths, the boat itself was unsafe in 6% of all cases, and the boat was speeding prior to 2% of all drowning incidents in Limiting such reckless behaviour would doubtless save lives, however, as can be seen in the majority of cases there has been no evidence found of reckless behaviour. PFD wear is known to be quite low among those who have drowned. In the United States, the proportion of drowning victims found not wearing a PFD was 85% in and 84% in Similar data from Canada in 1999 show that 89% of boaters who drowned were not wearing a life jacket or PFD, and this ratio has been quite consistent throughout the past ten years of surveillance. 4 Thus of the ready points of leverage for drowning prevention, increasing PFD wear has the greatest potential to affect drowning rates. In addition, the use of floatation devices has the potential to be effective for preventing drowning in the presence of each of the other risk factors as well. In Canada, it is not currently mandatory to wear a lifejacket or PFD, although there is a requirement to have a PFD or lifejacket of the appropriate size on board 96

98 for each person. 28 One survey of recreational boaters found that 64% of respondents felt safe as long as their PFD was in reach, 26 while another study reported that 29% of the recreational boaters surveyed agreed strongly or somewhat with the statement that it is unnecessary to wear a lifejacket if they have one close at hand. 27 The evidence suggests that they are wrong. In 1999, 34% of all recreational boating fatalities and 56% of canoe drowning fatalities occurred after the boat capsized. 4 The victim fell overboard in 20% of recreational boating drownings, and the boat became swamped in 13% of cases. 4 Thus, unlike the situation with larger vessels, where there might be a period of time after the onset of an emergency to don a floatation device prior to immersion, in small vessels the event of involuntarily entering the water is often quite swift. It is thus, perhaps not surprising to learn that in 1999 a PFD was present, but not worn in 30% of all recreational boating drownings and that another 2% of victims were either wearing an unfastened PFD or a PFD that was the wrong size. 4 There simply wasn t time to locate, don and fasten the proper PFD before entering the water. In addition for most people who are suddenly immersed in cold water, where most Canadian boating takes place, respiratory problems are a serious danger. 37 People immersed in water below 15 C will immediately experience breathing difficulties, beginning with a large inspiratory gasp. 20, 37 During this initial gasp, the individual breathes in close to total lung capacity, which creates a sensation of breathing difficulty or suffocation that could contribute to a feeling of panic. 7 After this initial gasp of air, the individual experiences uncontrollable hyperventilation, which can cause dizziness and confusion, as well as muscle spasms. 7, 20 For these reasons, the initial cold shock in the first few minutes of immersion probably accounts for the majority of near-drowning incidents and drowning deaths following accidental immersion in open water below 15 C. 7, page 59 Clearly, if a person was wearing a PFD (properly fastened) before being immersed in cold water, his or her chances of surviving the cold shock phase of immersion would be significantly higher. Finally, research studies show that the ability of muscles to contract, grip strength, and manual dexterity all deteriorate quickly after being immersed in cold water and the body literally becomes numb with cold. 7, 20 Thus, clearly a person s ability to manipulate either a manually or orally-inflatable flotation device, tighten the straps or buckle a flotation device, climb out of the water, or engage in any other self-rescue activities requiring manual dexterity, muscle coordination, or handgrip strength will become increasingly difficult in frigid water. 7 Given that most Canadian water is cold, for most of the year, and that it is in cold water where most Canadians lose their lives, PFDs must be worn and not merely carried if they are to have any chance to prevent drowning. Mandatory Wear Legislation is the Intervention to Employ While the vast majority of recreational boaters do comply with the law and carry flotation devices for all persons on board, 27 observational studies suggest that only 21% of adult recreational boaters actually wear a PFD. 2 Reasons for not 97

99 wearing a flotation device while participating in recreational boating seem to be based upon boater perceptions about PFDs that fall into four broad categories: the perception that there is a low risk of drowning and that usage of a PFD is therefore unnecessary, the perception that wearing a PFD restricts movement and interferes with performance of activities, the perception that wearing a PFD is uncomfortable, the perception that wearing a PFD is a sign of fear. Numerous attempts have been made to increase wear rates including: Mandatory boater education, social marketing, incentive programs, Redesign of PFDs and standards, and legislation. Evidence suggests that there is very little difference in the PFD wear rates of those who have taken a boating safety course versus those who have not. 27 Similarly, in the United States, some research suggests that there is only a six to seven percent decrease in the accident rates of those who have taken a boating education course. 32 Thus, mandatory boater safety education alone may not have a dramatic impact on PFD wear rates. Most social marketing and incentive programs have not been evaluated, however when they have, the results are often disappointing. One survey conducted in western Canada found that 84% of the target group recalled having seen boating safety messages, and the most commonly recalled message was to wear a lifejacket. 51 Of course the low prevalence of lifejacket and PFD use noted above speaks to the ultimate success of these efforts. Changes to the design and standards for PFDs to address some of the concerns noted by boaters above, have the potential to impact on wear rates. However, prior research, as well as the current study, found that the vast majority of boaters are unaware of these developments. Finally, there are a few jurisdictions, which have attempted to make PFD wear mandatory through legislation. There seem to be few formal evaluations of the impact of legislation requiring children to wear a PFD. However, one U.S. Coast Guard study of PFD wear rates concluded that the wearing of lifejackets was directly proportional to current mandatory wear laws. 73 As well, analysis of drowning statistics reveals that the rate of children drowning in states that require children to wear lifejackets (1.22 for every 1,000 accidents) is lower than that of states that do not mandate PFD wear for children (1.31 drownings for every 1,000 accidents). Although these findings are not conclusive, the results suggest that PFD wear legislation increases the likelihood of wearing a PFD, and this may in turn have led to a decrease in the number of drownings in states with PFD wear legislation. It is claimed that Tasmania, the one jurisdiction with across the board legislation mandating PFD wear for all boaters, now has a 95% compliance rate overall a significant increase over the already relatively high wear rates before the law was enacted (49% of adults and 88% of children routinely wore PFDs while boating). 31 Thus, while there is a paucity of good evaluation data for any interventions designed to promote PFD use, it does seem that legislation is potentially a 98

100 powerful intervention. Legislation has been effective in other injury prevention domains, such as seat-belts 57, 58 61, 62, and bicycle helmets. Such Legislation Should be Feasible in Canada A legal argument can be made for introducing mandatory wear legislation, which rests on the question of whether existing tort law clearly deals with the issue of liability in the event of a boating incident involving injury or death and how negligence for such incidents is determined (See APPENDIX I). The present study found that judicial standards are inconsistent and various levels of Canadian courts have used different standards to determine the liability of boat owners. In particular, the courts are not agreed on some of the factors that determine liability of boat owners/operators: reasonable person test, emergency test, and the but-for test. Consequently, given the lack of clarity regarding the responsibility for safety gear in tort law, this lends some support to the argument for creating legislation since it would improve the consistency of decisions and would assist the courts in measuring the extent of a boat passenger s negligence. Specifically, mandatory wear legislation would ensure that boat users who fail to wear lifejackets or PFDs would be consistently judged to be guilty of contributory negligence. This would likely motivate small craft users to wear lifejackets or PFDs when on the water, which would in turn reduce drownings. In addition to legal justification, any regulatory proposal must address certain considerations such as: public will, the existence of a problem warranting federal intervention, evidence that regulation is the best alternative, evidence that benefits of regulation would outweigh costs, and that any regulation has the potential to be enforced (See APPENDIX E). We have addressed the existence of the problem, and the evidence that regulation is the best alternative above. We turn now to the issues of public will, benefits and costs of regulation and enforcement. Public Will In our survey of international stakeholders the biggest barrier identified to obtaining legislation for jurisdictions that have it, were a reluctance on the part of the government to create legislation related to resistance or lack of enthusiasm on the part of the public toward such legislation (See APPENDIX B). Similarly, respondents who represented jurisdictions that have not enacted PFD wear legislation also rated both a lack of public pressure as well as resistance amongst the public due to the value they place on personal freedoms as being the key barriers to introducing legislation. There is a general belief among stakeholder groups both within Canada and abroad that the general public will be strongly opposed to any mandatory wear legislation. Our current survey demonstrated no such reaction. The vast majority (70-87%) of boaters and non-boaters of all ages supported the idea of mandatory wear legislation, with only 2-9% wanting it to be restricted to children, and only 5-7% being opposed (See APPENDIX G). Additionally, Canadians surveyed indicated that if PFD wear legislation were enacted, the vast majority (84-93%) would comply with the law under all 99

101 circumstances while only 2-5% claim they would defy a law that made wearing a PFD mandatory. However, in order to demonstrate public will, it will be insufficient to present findings that the majority of people wouldn t oppose legislation. Rather it will be important to demonstrate that the public has been consulted at each stage of the policy process. Accordingly, it will be important to engage the public in open consultations, either through existing bodies for public participation in the regulator process or through highly visible special-purpose consultations (e.g. town hall meetings, additional surveys, etc.). This process was identified as a crucial step to success by our Tasmanian informant(s). 31 Evidence that the Benefits Outweigh the Costs The current paper presents an estimate of the indirect costs associated with boating related drowning in Canada. However, this is inadequate justification on its own for a regulatory response. What is needed is a good estimate of the likely costs associated with regulation. Such an estimate (which might ultimately be obtainable from other jurisdictions, such as Tasmania) could then inform a cost-benefit, or cost-effectiveness study. In the interim, it can probably be argued, at least on common sense grounds, that it shouldn t be any more expensive to regulate mandatory wear of PFDs than the current regulations requiring that they be carried on board the craft. Thus, with just the improved evaluation data of the impact of legislation on drowning rates proposed above, it should be possible to make a provisional cost-benefit, or cost-effectiveness argument. Finally, the argument can be made that any additional resources committed to the enforcement of this regulation, can have spin-off benefits in terms of enforcement of other maritime regulations, already identified as underenforced. Evidence that the Regulation can be Enforced One of the most common arguments from various stakeholders opposing mandatory wear legislation is that given the vastness of Canadian waterways over which this law would apply, it would simply be impractical to enforce. Of course a similar argument could be made against any maritime law, and yet we have not left this domain unregulated. Some additional research may aid arguments in this area. For example, as part of collecting evaluation data from jurisdictions in which legislation has been enacted, it should be possible to gain estimates of the degree of enforceability of such legislation. In the meantime, two additional arguments can be made. First, it was felt similarly impractical to enforce seat-belt legislation in the early 1970s, yet that legislation has had a demonstrable effect on motorist behaviour in this country in the past 30 years. It has been suggested that in that instance, it was as much the public education campaign attending the enactment of the legislation, coupled with some high visibility enforcement, which had a greater impact on Canadian motorists than any ongoing program of enforcement. Second, it can again be argued, on the basis of common sense, that mandatory wear legislation can t be 100

102 any harder to enforce than the current mandatory carry legislation, as the former requires carrying the PFDs in a more visible location than the latter. RECOMMENDATIONS Four general conclusions arise from this report namely: boating related drownings warrant action, PFD wear is the risk factor to address in preventing boating related drownings, mandatory wear legislation is the intervention to employ to increase PFD wear rates, and finally that such legislation should be feasible in Canada. It is thus the recommendation of these authors that: The PFD Task Force, and the Canadian Safe Boating Council as a whole, work toward mandatory PFD wear legislation. However, the research also suggests that the climate is not quite ready for adoption of such legislation, at least among key stakeholder groups. Thus should the Canadian Safe Boating Council decide to move forward in promoting legislation, it is recommended that they develop a strategy of research and public education in support of (and in parallel to) working toward this end. Specifically we recommend that the PFD Taskforce: Craft a timeline for achieving milestones in the policy creation process. The timeline should incorporate the meeting schedules of recreational boating forums so that deliberations on mandatory PFD legislation can proceed in a concerted fashion. Identify a champion organization respected by stakeholders in recreational boating and identified as an experienced lobby group to lead a promotion initiative for mandatory wear legislation. The CSBC is likely the best candidate for this role. Partner with their counterparts in other jurisdictions such as Tasmania to conduct evaluations of the efficacy and cost-benefits associated with mandatory wear legislation, where it has been enacted. Assess the feasibility of hosting a future World Congress on Drowning as a way to raise the public profile for the issue Draft a list of stakeholders that should be included in policy consultations For example, consider deeper engagement with the healthcare, public health and injury prevention networks in development of an policy coalition Demonstrate voter support for a legislative initiative to policy makers through public consultations, such as town hall meeting, and through involvement of public representatives in any coalitions that would work toward legislation Strategize on methods to capture the input of boating constituents who do not have representation in existing boating organizations and councils 101

103 Place PFD legislation on the agenda of existing federal consultation bodies Develop a communications strategy including: Developing a position paper arguing for mandatory wear legislation. Developing briefing notes based upon the position paper. Developing new communications vehicles to educate the public and policy makers about issues not currently widely understood, such as: the physical realities faced by unexpected immersion including the physiology of cold water shock, recent changes to standards and design for PFDs, etc. Identifying stakeholders that should be updated on new developments in the study of drowning Including media representatives in any coalitions that would work toward legislation Employing good social marketing principles to present positive boating safety messages that posit PFD wear as an integrated part of aquatic activity Promote the broad enforcement of boating regulations to yield untapped benefits of existing legislation and to engage stakeholders who are unsatisfied with the enforcement of existing regulations In addition, during the preparation of this report several research gaps surfaced. Addressing some or all of these gaps would inform the work toward mandatory wear legislation and also prove useful for the design of any future preventive efforts and also. Therefore, in addition to the above recommendations the authors would like to recommend that the boating safety community seriously consider conducting or commissioning research on the following questions: Why Canada s drowning rate differs from the other countries surveyed. Is it simply a matter of greater boat ownership, or more hours of exposure? Alternatively is there a different approach Canadians take to boating that accounts for this difference? How many of the previously launched social marketing campaigns have been based upon best practices in behaviour modification. Would better educational initiatives lead to higher wear rates? How do those at highest risk approach for drowning approach the activity of boating. Are there effective techniques for changing their approach? What was the outcome of the mandatory operator proficiency requirements. Has enforcement been successful? Have boaters been compliant? 102

104 Given the large proportion of boating related drownings involving alcohol, are there parallel approaches that could be taken to pursuing mandatory wear legislation, with this particular at-risk group. Would lowering some of the buoyancy standards to create even more comfortable PFDs or other floatation aids boost wear rates? Could this be done without compromising safety? Given the low general knowledge about recent changes to PFD standards and designs, what impact would increasing public awareness of the new designs have on wear rates? 103

105 104

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107 18. Statistics Canada. Census of Population: Immigration, Birthplace and Birthplace of Parents, Citizenship, Ethnic Origin, Visible Minorities and Aboriginal Peoples. Vol. 2003, The Canadian Red Cross Society. National Drowning Report, Visual Surveillance Report: 2000 Edition: The Canadian Red Cross Society, Brooks CJ. Survival in Cold Waters. Ottawa: Transport Canada, United States Coast Guard DoT. Boating Statistics: 2000., United States Coast Guard OoBS. Using Exposure Data to Assess Boating Risk, Department of Boating and Waterways SoC California Boating Safety Report, United States Coast Guard Auxiliary. Boats-N-Booze, MarkTrend Research. Canadian Red Cross Society Boating Safety Study. Vancouver, BC: The Canadian Red Cross Society, Market Facts/MarkTrend. Red Cross Boating Safety Study Vancouver, BC: The Canadian Red Cross Society, Environics Research Group. Canadian Boater Attitudes Toward Personal Flotation Devices: Final Report: Environics Research Group, for Office of Boating Safety, Canadian Coast Guard, Fisheries and Oceans Canada, Canadian Legal Information Institute. Small Vessel Regulations: Mininum Equipment Requirements for Pleasure Craft - Personal Flotation Devices, Steensberg J. Epidemiology of accidental drowning in Denmark. Accident Analysis and Prevention 1998; 30: The Royal Life Saving Society Australia. The Victorian Drowning Summary: 1 July 2001 to 30 June 2002, Marine and Safety Tasmania. Recreational Boating: Safety Equipment, National Transportation Safety Board. Safety Study: Recreational Boating Safety. Washington, D.C., United States Coast Guard. Boating Statistics: 2001, Brooks CJ. Survival in Cold Waters, Staying Alive: Transport Canada, Brooks CJ. Designed For Life, Lifejackets Through the Ages: Mustang Engineered Technical Apparel Corp., National Association of State Boating Law Administrators. Small Craft Advisory, Volume 17 March/April, Tipton MJ. The Initial Responses to Cold-Water Immersion in Man. Clinical Science 1989; 77:

108 38. Hayward JS, Hay, C., Matthews, B.R., Overweel, C.H., Radford, D.D. Temperature Effect on the Human Dive Response in Relation to Cold Water Near-Drowning. Journal of Applied Physiology: Respiration, Environmental and Exercise Physiology 1984; 56: Barcroft H, Edholm, O.G. Temperature and Blood Flow in the Human Forearm. Journal of Physiology 1946; 104: Vincent MJ, Tipton, M.J. The Effects of Cold Immersion and Hand Protection on Grip Strength. Aviation, Space, and Environmental Medicine 1988; 59: Brooks CJ. Survival in Cold Water (presentation), Quan L, Bennet E, Cummings P, Trusty MN, Treser CD. Are life vests worn? A multiregional observational study of personal flotation device use in small boats. Injury Prevention 1998; 4: National Association of State Boating Law Administrators. Personal Flotation Device Wearability Study: NASBLA, National Association of State Boating Law Administrators. NASBLA Personal Flotation Devices Survey Summary of State Legislation: NASBLA, Treser CD, Trusty, M.N., Yang, P.P. Personal Flotation Device Usage: Do Educational Efforts Have an Impact? Journal of Public Health Policy 1997; 18: Inter-link Research Consulting. Water safety study: Full results. Toronto, ON: Royal Life Saving Society, Canada: Ontario Branch, Butler Research Associates Inc. Motivating PFD Usage among small craft operators: A Qualitative Research Report: Office of Boating Safety, Canadian Coast Guard, McCarthy P, Talley WK. Evidence on risk compensation and safety behaviour. Economics Letters 1999; 62: Fisheries and Oceans Canada. Canadian Coast Guard Acts & Regulations, Omnitel. 'Lifejackets-Get in the habit for life!' Impact Evaluation: Canadian Coast Guard, MarkTrend Research. Boating Safety Advertising Evaluation Study. Vancouver, BC: The Canadian Red Cross Society, Bennett E, Cummings P, Quan L, Lewis FM. Evaluation of a drowning prevention campaign in King County, Washington. Injury Prevention 1999; 5: Government of Victoria. Victorian Water Safety Week Launched In Lakes Entrance, Australian Royal Life Saving Society. National Drowning Report for 2002,

109 55. United States Coast Guard. Operation BoatSmart: Planning and Implementation Guide, Coast Guard Public Affairs. Loaner Life Jackets Saving Alaskan Children's Lives, Henry S. Seat-Belt Legislation: Buckling Down on Traffic Injuries. Canadian Medical Association Journal 1980; 122: Jonah BA, Lawson, J. J. The Effectiveness of the Canadian Mandatory Seat Belt Use Laws. Accident Analysis and Prevention 1984; 16: Tranport Canada. Results of Transport Canada's July 2001 Survey of Seat Belt Use in Canada, Robertson LS. The Seat Belt Use Law in Ontario: Effects on Actual Use. Canadian Journal of Public Health 1978; 69: Foss RD, Beirness, Douglas J. Bicycle Helmet Use in British Columbia: Effects of the Helmet Use Law: Traffic Injury Research Foundation, University of North Carolina Highway Safety Research Center, LeBlanc JC, Beattie TL, Culligan C. Effect of legislation on the use of bicycle helmets. Canadian Medical Association Journal 2002; 166: Vulcan P C, MH, Watson WL,. Mandatory bicycle helmet use: experience in Victoria, Australia. World Journal of Surgery 1992; 16: Scuffham P AJ, Cryer C, Langley D.,. Head injuries to cyclists and the New Zealand bicycle helmet law. Accident Analysis and Prevention 2000; 32: Macpherson et.al. Impact of Mandatory helmet legislation on bicyclerelated head injuries in children: a population-based study. Pediatrics 2002; 110:e Robinson D. Head Injuries and Bicycle Helmet Laws. Accident Analysis and Prevention 1996; 7: Bledsoe GH, et. al.,. The Negative Impact of the Repeal of the Arkansas Motorcycle Helmet Law. The Journal of Trauma: Injury, Infection, and Critical Care. 2002; 53: Stolzenberg L, D'Alessio, S. Born To Be Wild: The Effect of the Repeal of Florida's Mandatory Motorcycle Helmet-Use Law on Serious Injury and Fatality Rates. Evaluation Review 2003; 27: Industry Canada. Civil Liability Regimes in Canada, Duhaime L. Duhaime's Law Dictionary, Matthews et al. v. MacLaren et al. and Horsley et al. v. MacLaren et al. D.L.R. 3d. Vol. 4: (Ont H.C.), 1969: United States Coast Guard DoT. Wearing of Personal Flotation Devices (PFDs) by certain children aboard recreational vessels. USCG Vol. RIN 2115-AG04,

110 73. National Association of State Boating Law Administrators. Participating States and Territories for PFD Wearability Study: NASBLA, Government of Victoria. Sink or Swim? Your Water Safety Guide,

111 110

112 APPENDICES APPENDIX A: PROPOSAL APPENDIX B: INTERNATIONAL ENVIRONMENTAL SCAN APPENDIX C: INTERNATIONAL ENVIRONMENTAL SCAN SURVEY FOR U.S. RESPONDENTS APPENDIX D: INTERNATIONAL ENVIRONMENTAL SCAN SURVEY FOR INTERNATIONAL RESPONDENTS APPENDIX E: KEY INFORMANT INTERVIEWS WITH CANADIAN STAKEHOLDERS APPENDIX F: KEY INFORMANT INTERVIEWS WITH CANADIAN STAKEHOLDERS INTERVIEW GUIDE APPENDIX G: OPINION POLL RESULTS APPENDIX H: OPINION POLL SURVEY APPENDIX I: LEGAL ISSUES 111

113 112

114 APPENDIX A: Proposal By P. Groff, PhD 113

115 Background Drowning In 1998 there were 362 drowning fatalities in Canada. Of these, 30% involved recreational boating. 1 One half of all recreational boating drownings involve small open power boats (shorter than 5.5m) and canoes. 1 The vast majority of incidents involved males between 16 and 54 years of age with a peak period between years. 2 Interestingly, an examination of these recreational boating fatalities shows that only 14% of those who drowned were identified as nonswimmers. 1 Clearly, increasing boaters' experience in the water, and level of swimming ability are not the only or necessarily best ways to reduce the incidence of recreational boating-related drowning. Lifejacket/PFD Use One alternative approach is to encourage the wearing of buoyant gear to keep a person afloat after they've left a boat involuntarily. While there is little doubt of the efficacy of lifejackets or personal floatation devices (PFDs) in keeping someone afloat, there is little evidence that they are, in fact, being worn by the group at-risk. A national observational study undertaken by the Coast Guard found that only 21% of boaters in Canada wear a lifejacket or PFD. 3 This percentage is not uniform in the population, as there is a clear gradient of lifejacket/pfd wear by age. Nearly 85% of children aged five or less regularly wear their lifejackets/pfds. This rate drops below 70% for children aged six to nine, and by the teen years has dropped to 37%. Adults are the least likely to wear a lifejacket/pfd, with year olds only using one 16.5% of the time, and those between 36 and 60 only 13% of the time. 3 Thus the people in the age group with the highest incidence rate of drowning, are also those who are not wearing any buoyant gear. As might be expected, in the vast majority of cases for which data on PFD use are available, those that drowned were not wearing a PFD. 2 Similar results have been found internationally. For example one study in the American Northwest found 25% of boaters wore PFDs, but that the rate was highest, over 90%, for those under the age of five, and that usage sharply dropped off in the teen years to just 13% for those older than A National Association of Safe Boating Law Administrators (NASBLA) survey, using marine law enforcement officers making either direct observations from a distance or during routine boardings, found that 80.5% of adults weren't wearing lifejackets, while only 23.9% of children were unequipped. 5;6 Not only are use patterns similar, but there is also international evidence of the relationship between lack of use and drowning incidence. In an epidemiological study in Denmark, it was found that half of all recreational boating drowning incidents involved someone not wearing a lifejacket

116 In addition to age, there is also an association between use and the nature of the craft being operated. For example, over 95% of kayak operators do wear a PFD, while the use for those in canoes or small utility/skiffs drops to 62.5% and 42.4% respectively. 3 One US study of personal water craft (PWC) operators found that 97% wear lifejackets, and that this likely contributes to the lower drowning rates of the operators of this class of vehicle. It is noteworthy that again, those who do not use a PFD while operating their PWC are at a much higher risk of drowning: 77% of PWC-related drownings involve an operator not wearing a lifejacket. 8 In general, with the exceptions of kayaks and PWCs, such as SeaDoos, lifejackets and PFDs are infrequently worn. Overall, their use in boats under 6m in length averages 32.8%. 3 Despite the above-cited literature it has been suggested that several gaps remain in the database with regard to prevalence and determinants of PFD wear. 2 Attitudes and Behaviour There is little doubt that perception of risk and attitudes toward risk-taking play as important a role in this issue, as in other injury prevention issues. For example, despite the fact that there seems to be little evidence that swimming ability is a strong predictor of the outcome, in many of these recreational boating related drownings, 1 people seem to feel that lifejackets or PFDs are only for those who have not yet learned to swim. In a survey of young men in the demographic group most at-risk, the vast majority felt they did not need a PFD because they can swim well. 9 There is also a perception that experienced boaters are not at risk. Focus groups studying boaters who operate small craft frequently (at least 6 times in the previous season) found that the majority feel lifejackets are not required if a boater is skilled, and that they are really only for children who are still learning. 10 This is in spite of findings that neither past boating experience nor formal training have been shown to uniformly enhance boating safety. 11 Additionally, there is the sense with small craft operators, as is accepted practice on larger ships, that the important thing is that lifejackets or PFDs be present, not that they be worn. A survey of boaters in the target demographic found that 64% feel safe as long as their PFD is "in reach". 12 The most common reasons given by the young men, most at risk for a boatingrelated drowning, for not wearing lifejackets or PFDs is that they are uncomfortable and unfashionable. 9 Finally, there is evidence of modeling behaviour in lifejacket/pfd use, with a demonstrated correlation between one person wearing a PFD in a boat and others in the same boat wearing one. 12 This modeling effect is even more 115

117 pronounced for children. In one study, it was found that when a child less than 15 years old was in a boat with an adult or adults, PFD use by the child was 65% if no adult wore a PFD, and 95% if at least one accompanying adult wore a PFD. 4 Education and Social Marketing Given the ability of lifejackets/pfds to potentially save lives, and the evidence that they are not being used by those at risk, an obvious strategy is to better educate boaters about the risks they are undertaking. Unfortunately, this has not been an entirely successful approach. One evaluation of social marketing / public education campaigns found low impact of the campaigns overall. Though impact was higher for TV spots than radio spots, the campaign suffered low exposure partly due to costs of advertising in prime time and poor time slots offered for charity PSAs. 13 Thus there is a question of whether an educational campaign will even reach the target audience. More concerning, however, is the evidence that even if there is adequate exposure to the message, it may not significantly alter attitudes or behaviour. A telephone survey conducted in western Canada found that 84% of the target group recalled having seen boating safety messages, and the most commonly recalled message was to wear a lifejacket. 14 Of course the low prevalence of lifejacket and PFD use noted above speaks to the ultimate success of these efforts. Similar results have been found when evaluating education and social marketing efforts directed at children's use. In one evaluation of a drowning prevention campaign using educational strategies to target children, it was found that after the campaign, ownership had increased from 69% to 75% but use had increased from 20% to only 29%. 15 Legislation In the absence of effective educational initiatives, a number of jurisdictions have adopted regulatory measures, mandating the use of lifejackets or PFDs for some groups. A survey conducted in 2001 found that 77% of US states have legislated mandatory PFD use for children in small craft. While there are few formal evaluations of these efforts, it was noted in the survey that children in these jurisdictions have more than 50% higher wear rates than adults do. Additionally it was found that the wearing of lifejackets was directly proportional to current mandatory wear laws. 5;16 More recently, these state laws have been subsumed under an American federal statute. Effective as of March 29, 2002 there is a Federal Rule requiring any child under 13 to wear a PFD when on any type of recreational boating vessel

118 It is noteworthy that the above American legislation does not address the target group most at risk for drowning while operating a recreational boat, namely young adult men. There have been a few studies conducted in this country to determine what the public response to framing such a law would be. Focus groups conducted in Canadian cities on the general issue of low lifejacket/pfd usage rates have suggested an acknowledgement among boaters that legislation is likely the only way to enforce use. It was suggested that this would be the most effective strategy as most boaters are inclined to obey the law. 10 A telephone survey in western Canada showed that 50% of the target group (young males) would support a law requiring lifejackets or PFDs. 14 As noted above, there have been no thorough evaluations to date of legislative measures for lifejacket/pfd use. However, perhaps one can estimate the likely success from similar measures to legislate protective gear to prevent other classes of injury. An evaluation was conducted of legislation requiring bicycle helmet use enacted in Halifax in It found that the rate of helmet use climbed from 36% in 1995 and 38% in 1996 to 75% in 1997, 86% in 1998 and 84% in This impact was sustained, even though no helmet-promoting media education campaigns were mounted in the jurisdiction after The CSBC Lifejacket/PFD Taskforce The Canadian Safe Boating Council has expressed a desire to develop a position paper that will provide the evidence base addressing the need for mandatory wear among small boat operators in Canada. They have constructed a Lifejacket/PFD Taskforce to examine this issue and to solicit the writing of this position paper. Proposal The current proposal is to address the needs of the Taskforce for a position paper summarizing the best available evidence pertaining to mandatory lifejacket/pfd use. In order to build the case for mandatory wearing of lifejackets/pfds for boaters in vessels under 6m while the vessel is underway, several lines of evidence will have to be considered. In general, this position paper will need to make the following arguments. First, that there is a problem that needs to be addressed. Second, that mandatory PFD use is likely to address this problem. Third, that it is possible to successfully advocate for such a regulatory solution. And finally, that there is evidence that such legislation will be acceptable to the general public. Accordingly, we are proposing four blocks of research to address each of these issues. 117

119 Block One First, there is a need to collect and analyze the general data pertaining to the magnitude of the problem. Incidence and prevalence rates of drowning related to boating and PFD use will need to be collected and compiled from a number of sources. In addition, similar rates of near-drowning events will need to be compiled from a number of agencies. An examination of the social and human costs of boating fatalities will be made. Finally, the economic burden associated with these events will need to be modeled using methods previously applied at SMARTRISK to all classes of injury in the country. Block Two There is a need for a series of systematic literature reviews to establish the current evidence base for a mandatory wear law. The literature on PFD use and efficacy in preventing drowning needs to be summarized, and quantitative estimates of the reduction in relative risk attributable to proper use of a PFD need to be made. Any literature pertaining to the efficacy of legislative measures to mandate PFD use in jurisdictions where this has occurred will need to be examined, in the context of other potential interventions to promote PFD use, and other legislative efforts to mandate the use of injury prevention gear. Block Three The legislative and policy context for any proposed new regulation must be considered. A summary of current statutes and case law pertaining to personal liability of boat owners for drowning incidents involving their craft, whether the owner is present or not, will need to be made. In addition, key informant interviews with policy makers, researchers, drowning prevention advocates and other associated stakeholders will need to be made, to ascertain the likely opportunities and barriers to successfully advocating for legislation on this matter. For example, there will need to be consultation with individuals knowledgeable in enforcement issues, to determine the enforceability of mandatory wear legislation. Block Four Finally, the fourth block of research will focus on public attitudes towards drowning prevention, PFD use, and mandatory wear regulation. A literature review will be conducted of the relevant psychological, sociological and marketing literature. This will be followed by a public opinion poll to determine the ripeness of the issue and societal will to accept new legislation on this matter. Dependencies and Assumptions 118

120 The above proposal is predicated upon a number of dependencies and assumptions. Among these are the availability of adequate data speaking to the various issues concerned. Another dependency will be the ability of the project team to develop effective partnerships with and solicit the assistance of key stakeholders in the area of water-safety. Finally, there would be the need to be free to consider other alternatives should the preponderance of the evidence turn out to argue against mandatory wear legislation. Project Team Dr. Philip Groff is the manager of research development and evaluation at SMARTRISK. He has a background in the psychology of human problem solving and has worked as a researcher within the Health Network of Canadian Policy Research Networks, and "Health and Everything". He will oversee the project. Dr. Chris Brooks, internationally recognized authority on lifejacket/pfd use and cold water survival, will serve as a consultant on this project. Dr. Brooks has been a Navy captain, and head of the hospital at Canadian Forces Base Halifax. He is the author of Lifejackets Through the Ages. Dr. Eden Cloutier, noted economist and co-author of SMARTRISK's The Economic Burden of Unintentional Injury in Canada as well as numerous provincial economic burden studies, will assist with the calculation of the economic burden of recreational boating related drowning. Dr. John Lewko, Director for the Centre for Research in Human Development, Laurentian University, and chair of SMARTRISK's Research Advisory Committee, will assist with the collection and analysis of the behavioural information. An experienced evaluator, Dr. Lewko will also assist with the metaevaluation issues identified in this project. Mr. Terry Albert, Director of Policy and Planning at the Canadian Medical Association, and former senior researcher with the Health Network, Canadian Policy Research Networks, will assist with the analysis of the policy context for the proposed legislative intervention. Ms. Hope Russell, a student of health policy and management with a specialty in health informatics, will be the research assistant for this project. She will be responsible for the day-to-day administrative and logistic support of the project as well as collecting the literature for the reviews, developing and maintaining databases and synthesizing results. A medical student undertaking a research practicum with SMARTRISK during the tenure of the project will provide additional support. A law student will be 119

121 hired on a contract basis to assist with the collection of materials and preparation of documents for the third block of research. Advisory Committee A project advisory committee will be struck to provide oversight and accountability for the project. It will consist of the Taskforce, representatives of SMARTRISK's research advisory committee, and from and additional stakeholder organizations not covered by either of the above. The committee will provide strategic oversight as well as direct and indirect access to necessary expertise for completion of the project. For just one example, Mr. Michael Vollmer of the CSBC has expertise in political change. Deliverables and Timeline The deliverables for this project will be the position paper submitted to the Lifejacket/PFD Taskforce. The timeline will be eight months following project launch. Budget Project Team 32, Travel, Communications, and Meeting 3, Expenses for Project Team Data Acquisition 1, Supplies (including photocopying) Market Research / Polling costs 3, TOTAL 42, Justification The project team expenses will cover the consultancy fees for Dr. Brooks, Dr. Cloutier and Mr. Albert, as well as the cost of the contract for the law student and partial salary coverage for Dr. Groff and Ms. Russell. The latter includes support from SMARTRISK's Financial and Admin departments in overseeing the grant, such as preparing budgets, handling payments to subcontractors, and preparing audited financial statements. 120

122 The travel, communications and meeting expenses were based upon at least one trip for Dr. Groff and one for Ms. Russell to visit Dr. Brooks to consult his data holdings, and library of lifejacket/pfd literature. In addition, conference calls will be held occasionally to keep the team connected, while a project listserv and Web site will serve for more frequent updates and document sharing. Any meeting expenses for the project advisory committee will also be included in this figure. Data acquisition expenses refer to costs to retrieve necessary data from the Canadian Institutes of Health Information, and Health Canada Vital Statistics. Supply costs include computer supplies, office supplies, photocopying expenses, postage, and any miscellaneous expenses incurred, not specifically covered by other budget items. Market research expenses cover the direct expenses of polling through a national research institute such as Omnitel, and is based upon current rates for 3 closed and 1 open-ended question to be administered to a random sample of 1000 individuals, nationwide as part of another regular polling event. Reference List 1. The Canadian Red Cross Society. National Drowning Report, Visual Surveillance Report: 2000 Edition The Canadian Red Cross Society. 2. Forrester, L and Hotz, S. Issues concerning the wearing of personal flotation devices: A literature review The Starr Group Inc. in association with SCS Consultants. National PFD Observational Wear Rate Study for the 2000 Boating Season Canadian Coast Guard. 4. Quan, L., Bennet, E., Cummings, P., Trusty, M.N., and Treser, C.D. Are life vests worn? A multi-regional observational study of personal flotation device use in small boats. Injury Prevention 4, (1998). 5. National Association of State Boating Law Administrators. NASBLA Personal Flotation Devices Survey Summary of State Legislation NASBLA. 6. National Association of State Boating Law Administrators. Personal Flotation Device Wearability Study. 97. NASBLA. 7. Steensberg, J. Epidemiology of accidental drowning in Denmark. Accident Analysis and Prevention 30, (1998). 8. National Transportation Safety Board. Safety Study: Personal Watercraft 121

123 Safety. 98. Washington, D.C., National Transportation Safety Board. 9. Inter-link Research Consulting. Water safety study: Full results. 94. Toronto, ON, Royal Life Saving Society, Canada: Ontario Branch. 10. Butler Research Associates Inc. Motivating PFD Usage among small craft operators: A Qualitative Research Report. 99. Office of Boating Safety, Canadian Coast Guard. 11. McCarthy, P. and Talley, W.K. Evidence on risk compensation and safety behaviour. Economics Letters 62, (1999). 12. Market Facts/MarkTrend. Red Cross Boating Safety Study Vancouver, BC, The Canadian Red Cross Society. 13. Omnitel. "Lifejackets-Get in the habit for life!" Impact Evaluation. 97. Canadian Coast Guard. 14. MarkTrend Research. Boating Safety Advertising Evaluation Study. 96. Vancouver, BC, The Canadian Red Cross Society. 15. Bennett, E., Cummings, P., Quan, L., and Lewis, F.M. Evaluation of a drowning prevention campaign in King County, Washington. Injury Prevention 5, (1999). 16. National Association of State Boating Law Administrators. Participating States and Territories for PFD Wearability Study. 97. NASBLA. 17. United States Coast Guard, Department of Transportation. Wearing of Personal Flotation Devices (PFDs) by certain children aboard recreational vessels. RIN 2115-AG04, 33 CFR Part USCG LeBlanc, J.C., Beattie, T.L., and Culligan, C. Effect of legislation on the use of bicycle helmets. Canadian Medical Association Journal 166, (2002). Appendix Items not covered in the proposal of August 28, As noted in the above revised proposal, $ has been added to the budget to help offset direct expenses to SMARTRISK, including Dr. Groff's time in overseeing the project, as well as the added efforts of the Finance and Admin departments. 2. While it was anticipated that the issue of enforceability would be considered in Block 3 of the research it was not anticipated that this would be a primary focus of the research project. If a significant study of the issue of enforceability were to be required by the Advisory committee, included focus groups and interviews with sociologists, penologists, and criminologists, as well as surveys of police departments, there would be additional resources 122

124 required, on the order of $ This has not been reflected in the above budget. 123

125 124

126 APPENDIX B: International Environmental Scan By P. Groff, PhD J. Ghadiali, MA 125

127 International Environmental Scan In order to learn about the opinions of boating and drowning prevention experts worldwide regarding the notion of legislation requiring recreational boaters to wear a PFD, as well as what sort of legislation other nations have created and what their experience has been, an environmental scan was conducted by SMARTRISK. This environmental scan was comprised of several components, including an online survey sent to international respondents in the boating and drowning prevention communities, telephone interviews and exchanges with key informants, and searches for articles and reports on the topic of PFD legislation on the Internet as well as PubMed, a searchable online database of health-related articles. Methodology Telephone Interviews and A number of people contacted to participate in the international survey were unable to complete the survey online, but offered comments either by or in an unstructured telephone interview. Internet and PubMed Searches Various searches were conducted via the Internet regarding the legislative requirements for PFDs in various countries around the world. As well, searches were conducted using PubMed, an online database of National Library of Medicine that provides access to over 12 million MEDLINE journal articles from the mid-1960's to the current day. Keywords such as flotation devices, personal flotation devices, PFDs, lifejackets, life vests, legislation, and law were used as search terms for both PubMed and the Internet. Online Survey A number of research methodologies were considered to collect input from experts in the drowning prevention and recreational boating communities around the world regarding PFD wear legislation. However, it was decided that ing international contacts and providing a link to an online survey was the most cost-effective and timely option given the fact that respondents are scattered around the world geographically, and thus, it may not be very feasible to interview respondents by telephone. The survey was conducted using a service called Zoomerang, which allows members to create and customize surveys and then provide survey participants with a link to the survey which is hosted a secure internet website (Zoomerang.com). As each participant completes the survey, the results are captured and tabulated in real-time, and at any time the member can print out a summary of the research findings in a graphical format. 126

128 Questionnaire Two surveys were developed, one for the United States, and one for respondents in other countries around the world. The two surveys were very similar, although the wording was modified in the survey for the United States to be appropriate for collecting information about state rather than federal legislation since most individual states have their own PFD wear legislation. As well, an additional question was added to the U.S. survey to address the impact of the recent introduction of federal PFD legislation for children under the age of 13. The surveys were designed to be approximately 15 minutes in length and include the following topics. For all respondents: whether or not there is currently any legislation requiring recreational boaters to wear PFDs, or whether such legislation is being developed or considered relative importance of various factors that are or were barriers to creating PFD wear legislation suggestions for overcoming barriers to legislation relative importance of factors that would help or already helped to create PFD wear legislation description of other non-legislative initiatives that have successfully encouraged PFD use For those with state/national PFD wear legislation: when legislation was enacted type of watercraft legislation pertains to age groups legislation pertains to type of flotation device required by legislation whether legislation was modified during review phase before being finalized, and if so, in was it made more stringent/less stringent rating of how supportive general public has been regarding PFD legislation rating of what impact legislation has had on usage of PFDs description of results of any evaluations conducted after introduction of legislation description of any enforcement issues encountered A copy of the surveys sent to respondents in the United States and in other nations is included in Appendices C and D. Participants Sample Selection 127

129 A preliminary list of suggested international contacts was provided by a member of the task force, Dr. Chris Brooks. Many of these potential respondents had attended the World Congress of Drowning in Amsterdam in June 2002, while others were drowning prevention experts that Dr. Brooks had met during the course of his career. As well, some of these international contacts made suggestions regarding other potential respondents for the survey, and contact names found via searches on the internet also supplemented the international contact list. Another task force member, Barbara Byers, was instrumental in securing the support of the former president of the National Association of State Boating Law Administrators (NASBLA) in the United States. The past president s endorsement and assistance both facilitated distribution of the survey to NASBLA members in each state, and also increased the response rate for the survey. Sample Size and Composition In total, the survey was administered to a total of 45 respondents around the world (30 in the United States, 15 in other countries) between March 3 rd and May 22 nd, 2003, and other input was collected (via , fax, or telephone) from 12 boating or drowning prevention experts around the world. The countries and states that completed the survey or provided other information are listed below: Survey Participants and Key Informants Country/State Number Who Completed Online Survey Number Who Provided Information Via / Telephone/Fax Australia 1 2 Finland 1 Germany 2 Iceland 1 Ireland 1 1 Netherlands 3 New Zealand 1 1 Norway 1 Singapore 1 Spain 1 1 Sweden 2 128

130 Country/State Number Who Completed Online Survey Number Who Provided Information Via / Telephone/Fax United Kingdom 2 1 United States 30 4 Alabama 1 Alaska 1 Arizona 1 Arkansas 1 1 California 1 1 Colorado 1 Connecticut Delaware 1 District of Columbia 1 Florida Georgia 1 Hawaii Idaho 1 Illinois Indiana Iowa Kansas 1 Kentucky Louisiana Maine 1 Maryland Massachusetts 1 Michigan Minnesota Mississippi 1 Missouri 1 Montana 1 Nebraska Nevada 1 New Hampshire 1 New Jersey New Mexico 1 1 New York North Carolina 1 North Dakota Ohio 1 Oklahoma Oregon 1 Pennsylvania 1 129

131 Country/State Number Who Completed Online Survey Rhode Island South Carolina South Dakota 1 Tennessee 1 Texas Utah Vermont 1 Virginia 1 Washington 1 West Virginia 1 Wisconsin 1 Wyoming 1 Number Who Provided Information Via / Telephone/Fax Results Current Legislative Requirements The environmental scan undertaken by SMARTRISK, including Internet research, information provided by informants, and response to the online survey revealed that only two countries have any laws that require recreational boaters to wear a PFD while pleasure boating. (However, many countries and states require that operators of personal watercraft wear a PFD.) Jurisdictions with PFD Carriage Legislation As is the case in Canada, most countries (including Norway, Singapore, Finland, Denmark, the Netherlands, New Zealand, Spain, and Ireland) require recreational boaters to carry an approved PFD of the appropriate size for each person on-board recreational vessels. Many of these countries stipulate that PFDs must be readily accessible, but boaters are not required to wear the flotation device. 130

132 Jurisdictions Without Either PFD Carriage or Wear Legislation Other countries, such as the United Kingdom, Sweden, and Germany have very little regulation for leisure boating, and do not even require that flotation devices are carried on-board, let alone worn, by recreational boaters. In the United Kingdom, leisure boats under 13.7 m in length are not even required to carry flotation devices. 1 As a representative of the Royal Yachting Association (RYA), a national association for leisure boating in the UK, observed: There is a very strong perception of the importance of personal freedoms in the UK and very particularly in the leisure boating world. There is no perception in the UK at the moment that further legislation regarding PFDs is required. This is largely due to the fact that incidents and accidents regarding leisure boats are not at a level to indicate that further legislation for the compulsory carriage of PFDs is required. Further, according to the representative of the RYA, education, not legislation is the approach favoured in the UK, and this was echoed by a representative of the Royal Life Saving Society (RLSS). The RYA respondent noted that this approach has successfully encouraged many leisure boaters to voluntarily wear a PFD, and stated that it is common practice in the UK among all boaters, windsurfers etc. to wear PFDs for everything but calm weather cruising on large keeled boats during daylight hours. In Germany, a high-ranking individual in the German Lifesaving Federation notes that voluntary donning of lifejackets is a widespread behaviour. This respondent suggested that due to insurance requirements, individuals are forced to wear flotation devices so that they do not lose coverage. Another respondent from Germany also suggested that the owner of the vessel is legally responsible for the safety of the crew or guests. Thus, according to this respondent, in case of accident, he will be prosecuted if he has not acted according to common sense. This means for example not having used or made available type-approved lifejackets. One Swedish respondent explained the lack of regulations requiring boaters to either carry or wear PFDs by saying we strongly believe in voluntary actions. As well, this individual suggested that voluntary compliance is now too low to consider introducing legislation as there would be too much opposition. The view of this respondent was that voluntary compliance must be in the 50-60% range before legislation can successfully be introduced. Jurisdictions with PFD Wear Legislation The United States and Australia are the only countries in which some states have chosen to create legislation mandating PFD use amongst boaters. However, all of the state laws in the U.S. mandating that approved PFDs be worn pertain only to children of a specified age, not to adults. As well, in many states, the child is 131

133 only required to wear a PFD when on a craft under a certain size, when the craft is underway, or when not in an enclosed cabin. In Australia, the state of Victoria also has legislation that makes it compulsory for children under the age of 10 to wear an approved PFD while on-board a recreational vessel that is underway and not in an enclosed cabin. 2 The only jurisdiction which mandates the wearing of PFDs amongst adult recreational boaters is the state of Tasmania in Australia. In Tasmania, all persons, regardless of age, must wear a PFD when on-board a recreational motor boat or motor-propelled tender that is under six metres in length and under power, when not in a deckhouse, cabin or secure enclosed space. 3 Tasmanian law also makes it compulsory for children under the age of 12 to wear a PFD on recreational motor boats or motor-propelled tenders of any length while they are under power and when they child is not in an enclosed space. 3 Factors that Would be/were Barriers to the Creation of PFD Legislation As shown in the tables below, amongst those jurisdictions that have already enacted PFD wear legislation, the biggest barrier they had to overcome pertained to a reluctance on the part of the government to create legislation. In fact, all of the respondents who have already introduced legislation indicated that the lack of enthusiasm from the government was at least a small barrier. For instance, one respondent said that the biggest barrier they had to overcome was that legislators did not see it as a major issue. This individual went on to say that several years of lobbying and effective presentations at legislative hearings resulted in (our) success. Another person noted that while public resistance to PFD wearage was a barrier to creating state PFD legislation, it seemed that there was more legislative resistance than public resistance. As well, most jurisdictions also had to deal with either resistance or a lack of enthusiasm from the general public. The majority (84%) indicated that, in their jurisdiction, the public strongly believes in personal freedoms and that this was either a small or big barrier to creating legislation. Several respondents noted that there is considerable resistance to legislation making it compulsory for adults to wear PFDs because it is viewed as a violation of their personal freedoms. One respondent referred to the fact that it took four years to get the mandatory seatbelt law passed in his state to illustrate the importance of personal freedom to people within that state and to explain the resistance that they encountered when trying to introduce PFD legislation. As well, 79% said that the lack of public pressure for PFD legislation was also a barrier to some degree. One respondent claimed that the lack of public support prevented the passage of legislation when it was initially proposed, but that efforts they made to garner support from individuals, boat dealers, boating groups, and nurses aided in the passage of legislation on their second attempt. A representative from a country without PFD wear legislation for any age group 132

134 noted that courses in water safety and educational messages are delivered via the school curriculum and he believes that this has resulted in high PFD wear rates amongst children. However, this respondent concludes that since adults were not exposed to similar educational efforts in their childhood, they are consequently more resistant to wearing flotation devices. Thus, the implication is that if adults were better educated about water safety and the importance of wearing PFDs, they may be less resistant to PFD wear legislation. Accordingly, this respondent suggested that the approach that may be chosen in his country given the current resistance to legislation is to focus on education of adult boaters rather than legislation. Some jurisdictions indicated that the absence of champions for the legislation or conflict relating to the issue of what ages should be mandated to wear flotation devices were barriers, although most jurisdictions rated these factors as smaller barriers. Only one of the representatives from jurisdictions with PFD wear legislation indicated that the fact that drowning prevention was not as high a priority as other political issues was a big barrier, although seven respondents suggested that this was a small barrier to the creation of legislation. One person in particular noted that the decline in boating fatalities in the past 20 years contributed to a lack of a sense of urgency regarding boating safety. Virtually all of the jurisdictions with existing legislation indicated that there was little or no conflict surrounding other aspects of the legislation such as the type of flotation device or what level of government should be responsible for introducing legislation, and very few had any concerns about enforcement of the law. Figure 1: Relative Importance of Various Barriers for Jurisdictions Who Have Already Introduced PFD Wear Legislation There is little enthusiasm for legislation from the government at the federal or provincial/state levels (N=6) The public strongly believes in personal freedoms and would be resistant to this legislation (N=24) There is little public pressure or enthusiasm for legislation (N=24) There is no individual or group that is trying to bring attention to this issue (N=24) There is conflict about who the legislation would apply to (e.g. children only vs. adults) (N=24) Drowning prevention is not as high a priority as other issues (N=24) Big Barrier % Small Barrier % No Barrier %

135 There is conflict about other aspects of the legislation (N=24) There is conflict about the type of flotation device that would be mandatory (e.g. lifejacket vs. PFD) (N=24) There is a concern that legislation could not effectively be enforced (N=24) There is conflict about whether the legislation would be national, state/provincial, or local (N=24) The respondents who represented jurisdictions that have not enacted PFD wear legislation also rated both a lack of public pressure as well as resistance amongst the public due to the value they place on personal freedoms as being the key barriers to introducing legislation. In fact, each of the jurisdictions who have not enacted legislation suggested that the value that the general public places on freedom has been a barrier to creating legislation. To illustrate this point, one respondent said that citizens in his state do not appreciate any laws that restrict their personal choice. As well, 95% characterized the fact that the public is not pushing for legislation as a barrier. One respondent stated that the lack of support from voters and interest groups was a key factor in a recent failure to pass legislation that would make it mandatory for children to wear a PFD. In explaining the absence of legislation in another state, one respondent noted that adults don t want to wear PFDs (because they are perceived to limit movement, and are seen as being hot, uncomfortable, unattractive, and expensive) and thus this opposition prevents legislators from trying to create adult PFD wear laws. This respondent also made the point that most children are already wearing PFDs despite the absence of legislation. A lack of enthusiasm from the government also was rated as a critical barrier by some (60% identified this factor as a big barrier), but for others, this had nothing to do with the absence of PFD legislation in their jurisdiction. One respondent described the lack of government enthusiasm for PFD legislation in this way, the current political climate within our (legislature) would not enact a bill such as this proposal. Respondents from one country without PFD wear legislation suggested that their government was seeking to reduce the amount of legislation in general and holds the view that water safety is up to individual boaters and is not a responsibility of the government. Interestingly, concerns about enforcement of the legislation appear to be a much bigger concern amongst those jurisdictions that have not created PFD wear legislation compared to those that have. As one respondent noted, enforcement takes a lot of effort at the same time that enforcement capacity is very small. Priority is low! Otherwise, it does not seem as if conflicts or concerns about various aspects of legislation are key barriers preventing these jurisdictions from introducing legislation. 134

136 Figure 2: Relative Importance of Various Barriers for Jurisdictions Who Have Not Already Introduced PFD Wear Legislation There is little public pressure or enthusiasm for legislation (N=20) The public strongly believes in personal freedoms and would be resistant to this legislation (N=20) There is little enthusiasm for legislation from the government at the federal or provincial/state levels (N=10) There is a concern that legislation could not effectively be enforced (N=20) There is no individual or group that is trying to bring attention to this issue (N=20) There is conflict about other aspects of the legislation (N=20) Drowning prevention is not as high a priority as other issues (N=20) There is conflict about whether the legislation would be national, state/provincial, or local (N=20) There is conflict about who the legislation would apply to (e.g. children only vs. adults) (N=20) There is conflict about the type of flotation device that would be mandatory (N=19) Big Barrier % Small Barrier % No Barrier % Other Barriers to Creating PFD Legislation Some respondents from jurisdictions without PFD wear legislation cited a number of reasons why they believe that legislation is not required. For instance, some pointed to the relatively small number of drowning cases and suggested that the statistics do not merit the creation of legislation that would make it compulsory for all boaters to wear flotation devices. In the U.K. for example, one respondent commented that incidents and accidents are not at a level to indicate that further legislation for the compulsory carriage of PFDs is required. One Dutch respondent mentioned that swimming lessons had formerly been part of the school curriculum, and as a result, the majority of Dutch people in a certain age bracket know how to swim. This respondent concludes that this widespread swimming ability makes it unnecessary to create legislation mandating PFDs be worn by recreational boaters (although this clearly does not address the issue of water temperature and the effect of cold water on swimming ability). 135

137 As well, one German respondent mentioned that due to insurance requirements, individuals are forced to wear flotation devices so that they do not lose coverage. Another German survey participant suggested that the owner of the vessel is legally responsible for the safety of the crew or guests, and this essentially means that it is up to the owner to ensure that flotation devices are worn by passengers otherwise he or she will be held responsible in the event of an incident. Factors that Would/Did Facilitate the Creation of PFD Legislation Respondents in the survey were asked about what factors could or did facilitate the creation of PFD legislation. For those jurisdictions in which PFD legislation has already been introduced, having champions that could bring attention to the issue was apparently the most important factor that aided in bringing about the law. Of all jurisdictions with existing PFD wear legislation, 92% described the impact of champions as either a big or small factor in creating the legislation. One NASBLA representative said that the fact that key individuals spoke out to legislation about specific incidents was critical to their success in creating legislation, while another suggested that having grass roots supporters contact legislators and appear at legislative committee meetings was instrumental in achieving the passage of the legislation. One respondent claimed that pressure from the National Transportation Safety Board was very helpful in ensuring legislation was passed in the respondent s state. The NASBLA representative from Nevada mentioned that the joint efforts of one particular legislator and the students in a high school government class led to the introduction of PFD wear legislation in that state. The legislator offered to introduce a bill on a topic chosen by the high school class, and they selected the child wear PFD issue. The second most important factor that helped in terms of getting PFD wear legislation passed was the occurrence of drowning incidents which raised the profile of this issue. Nearly all jurisdictions with legislation (92%) said that the publicity surrounding drowning incidents played either a big or a small role in creating the legislation. One respondent said that a few drowning incidents involving children was a factor that aided in the creation of legislation, and that even though the absolute number of drownings involving children was not high, any is too many. Another NASBLA representative claimed that state PFD wear legislation was created in response to one high profile incident in which two children were killed. For others (79%), generating enthusiasm from the government for the issue was either a big or a small factor that led to creation of the law, while for 71%, support or pressure from the general public was a factor. In fact, one respondent suggested that the legislation must be heavily endorsed by the boating public and noted that it is important to develop grass roots support for creating legislation. Other respondents echoed the importance of grass roots initiatives or suggested public education (and targeting boaters specifically) as a means of generating support for the legislation amongst the general public. Similarly, other individuals from states that have PFD wear legislation advocated involving 136

138 as many stakeholders as possible, and seeking support from boating clubs and organizations and fishing lobby groups, and the respondent from Tasmania credited the thorough public consultation as being the key reason the legislation was passed without difficulty. Another respondent emphasized the importance of obtaining the support of marine dealers, as they have a powerful lobby group in the respondent s state, and they were initially resistant to the law due to concerns about personal freedoms of boaters being violated. Governments awareness of either legal or economic rationale for legislation apparently was less influential in creating the mandatory wear law. Figure 3: Relative Importance Various Factors Played in Facilitating Creation of Legislation for Jurisdictions Who Have Already Introduced PFD Wear Legislation Key individuals or groups bringing attention to this issue (N=24) An incident or series or incidents that bring attention to drowning prevention (N=24) Enthusiasm for legislation from the government at the federal or state/provincial levels (N=24) Pressure or enthusiasm from the public to create legislation (N=24) If policy makers or the government were informed about the legal argument that requiring boaters to wear lifejackets or PFDs is the prudent and responsible thing to do (N=24) If policy makers or the government were informed about the economic/financial costs of boating drownings (N=24) Big Factor % Small Factor % Not a Factor % As shown in the table below, jurisdictions that do not currently have laws requiring boaters to wear a PFD believe that the publicity from one or more drowning incidents could bring enough attention to the issue of drowning that it could pave the way for the introduction of legislation. Specifically, 95% speculated that drowning incidents in which PFDs were not used could play some role in facilitating the creation of PFD wear legislation. As one respondent said, a media storm about an incident or series of incidents can provoke both a political will and pressure from the public... some high profile incident might trigger the motivation to bring about legislation. Pressure or enthusiasm from the general public and interest from the government in creating legislation were also perceived to be important in building momentum for legislation. Seventy-nine percent of all respondents from jurisdictions without PFD wear legislation consider support from the public 137

139 as well as the government to be factors that could lead to the creation of legislation. One respondent suggested that most boaters feel safe in their boat without wearing a PFD and nobody expects to end up in the water. This respondent noted that canoe, kayak and PWC enthusiasts have a greater expectation of ending up in the water, so they are more likely to accept legislation that would make it compulsory for them to wear a flotation device. The implication is that by educating users of other types of watercraft about their chances of unexpectedly capsizing or falling overboard, this may increase their acceptance of PFD wear legislation. Seventy-eight percent also feel that if individuals or groups opted to become champions for legislation and brought attention to this issue, this could play some role the creation of mandatory wear legislation. One respondent from a country without any PFD wear legislation suggested that children tend to be very successful in the role of safety ambassadors. Again, as with the respondents from jurisdictions who have already introduced PFD wear legislation, those without such laws contend that making the government aware of the legal and economic arguments for the law is less influential than other factors. Figure 4: Relative Importance That Various Factors Would Play in Facilitating Creation of Legislation for Jurisdictions Who Have Not Introduced PFD Wear Legislation An incident or series or incidents that bring attention to drowning prevention (N=19) Pressure or enthusiasm from the public to create legislation (N=19) Enthusiasm for legislation from the government at the federal or state/provincial levels (N=19) Key individuals or groups bringing attention to this issue (N=18) If policy makers or the government were informed about the economic/financial costs of boating drownings (N=19) If policy makers or the government were informed about the legal argument that requiring boaters to wear lifejackets or PFDs is the prudent and responsible thing to do (N=19) Big Factor % Small Factor % Not a Factor % Other Suggestions for Aiding in the Creation of PFD Legislation One respondent from a state that already has enacted PFD wear legislation for children suggested that it is far easier to first introduce legislation targeting 138

140 children before considering legislation that would also pertain to adults. The reasoning of this respondent is that compliance is nearly universal and objections few. Another respondent in a state with child PFD wear legislation echoed this view and said that we chose not to try for mandatory adult wearage because we know our legislators and the public would speak out against such a proposal. One other respondent from a state that has already introduced PFD legislation for children advocated being prepared early on to compromise. It is presumed that this respondent is suggesting that it may be necessary to compromise by introducing PFD wear legislation for children only rather than all ages. Others commented on the importance of gathering and presenting statistics to support any legislative efforts, particularly statistics relevant to the target age group. The respondent from Tasmania indicated that they relied heavily on coroners reports to make the case for legislation. However, a couple of respondents emphasized the importance of telling the human side of boating tragedies and playing on emotions as they believe that providing statistics without making them more personal is not compelling enough to justify making the wearing of PFDs compulsory. Another respondent cautioned that the fact that absolute numbers of child boating fatalities are low can be a barrier to creating PFD wear legislation for children. Thus, this individual suggested building the argument for legislation around the notion that children are not capable of putting on a flotation device themselves in an emergency situation rather than making the case based on statistics. One respondent who indicated that the perception that PFDs are hot, unattractive, uncomfortable, limit movement etc. is a barrier to the introduction of PFD legislation highlighted the importance of changing PFDs to address these complaints. This individual noted that the PFDs that are comfortable and attractive looking are expensive, and that these barriers must be overcome in order to make mandatory wear legislation more viable for adults. Another suggestion was to ensure that the availability of low cost, comfortable PFDs is emphasized in the hearing process for legislation. As well, the importance of educating the legislators before introducing legislation was stressed by one respondent. This person commented that sufficiently educating the legislators was a critical mistake the first time legislation was proposed in the respondent s state. A NASBLA representative from a state that does not yet have any PFD wear legislation suggested that an effective approach to consider in obtaining state legislation would be to pass a federal law and then tie grant funding from the Coast Guard to the passage of state legislation. 139

141 Modification of PFD Legislation During Review Phase Respondents of the survey were asked whether or not the legislation was modified in any way during the review phase before it was finalized. The majority of those who responded said that it was not modified in any way it was approved as it had been proposed. However, another large proportion of respondents admitted that they were unsure whether the legislation was modified as the law was created many years ago. Only four respondents indicated that the legislation was modified while it was being reviewed. Apparently, in two jurisdictions, the law was made less stringent by adding in exemptions for those in an enclosed cabin, and in another case, the law was made less stringent by allowing PFDs that do not meet the standard to be used in lakes if light sticks and reflective tape are also used. Another person recalled that the legislation was modified but was uncertain about the details. Support for PFD Legislation Amongst General Public Survey respondents were asked about how supportive the general public was regarding the introduction of PFD wear legislation. A total of 24 respondents submitted a response to the question, and 14 of the 24 (58%) claimed that, overall, the general public had been very supportive of the legislation. The other 10 respondents (42%) characterized the response of the general public as being somewhat supportive. However, some respondents indicated in open-ended questions that the enactment of PFD wear legislation targeted at children faced very little opposition, but that legislation that included adults would be a much tougher sell for both legislators as well as the general public. Impact of PFD Legislation on PFD Wear Rates Comments from many NASBLA representatives in states with PFD wear legislation for children seem to suggest that PFD wear rates have increased following the introduction of legislation. NASBLA representatives from 11 states said that they believe that PFD usage has increased considerably due to the introduction of mandatory PFD wear laws for children in their state. And representatives from another 11 states believed that PFD usage had increased slightly after enactment of PFD wear legislation for children. None of those interviewed held the belief that legislation had not had any impact or a negative impact on wear rates. The sole respondent from Tasmania also held the opinion that PFD legislation has increased PFD usage considerably. Unfortunately, none of the respondents cited any formal research studies or evaluations to corroborate their contention that legislation had made an impact. However, some provided anecdotal evidence or information to support their standpoint. NASBLA representatives in Oregon, Arkansas, Alaska, Washington, and Maine suggested that observational studies or informal feedback from Marine officers indicate that PFD wear rates have increased since legislation was 140

142 introduced. As well, representatives from Idaho, Nevada, Ohio, Vermont, and California attributed a decrease in fatalities or injuries to the introduction of legislation (although a formal evaluation was not conducted, and causality cannot be determined). 141

143 Issues With Enforcement of PFD Wear Legislation Survey respondents from jurisdictions that have introduced PFD wear legislation were also questioned regarding issues with enforcement. Very few respondents provided any input regarding enforcement problems, and two respondents indicated that enforcement had been easier than anticipated. However, four respondents did mention that some minor issues related to enforcement have emerged. One respondent stated that while most boaters are aware that there are child PFD laws in place, some are confused about the age cut-off for their state since the laws vary from state to state. Another survey participant claimed that the only issue that enforcement officers occasionally have relates to determining the age of children on-board watercraft, and that officers must use their judgement. Apparently in another state there has also been some confusion surrounding some of the terms used in the legislation such as the definition of underway, enclosed deck that have led to some enforcement issues. As well, the lack of infant devices was seen as problematic for enforcement for this same respondent. Another NASBLA representative mentioned that their only enforcement issue relates to the fact that boaters from states without PFD wear laws for children occasionally raise complaints when they are fined by enforcement officers for having children on-board not wearing PFDs. Impact of Introduction of Federal PFD Wear Legislation in United States NASBLA representatives were also asked about the likely impact of the new federal law for their state, and nearly half of those who responded to the question (15/27) felt that the federal law would not have any appreciable impact on their state s drowning rates or PFD wear rates. Most argued that the federal law would have no impact since their state had already introduced legislation which will not be superceded by federal law. Some also suggested that if the federal law will have any impact, it will only be in federal waters, beyond state lines of jurisdiction. One representative from West Virginia was optimistic that the federal law would lead to a decline in drownings and the representative from New Mexico stated that he believed the impact could be minimal but positive under the assumption that more children will wear a PFD because of confusion over jurisdictional waters. The representative from Virginia also shared the opinion that the introduction of federal legislation would be confusing to the boater. NASBLA representatives from Wisconsin, Massachusetts, Ohio, and Maine suggested that the introduction of the federal law could eventually prompt their state legislature to revisit state boating laws and perhaps change existing regulations to parallel the federal law. Methods Other than Legislation That Have Improved PFD Use A number of initiatives other than legislation were cited by respondents as successfully encouraged PFD use. NASBLA representatives from Oregon, Alaska, and Wisconsin claimed that the provision of coupons for free ice cream 142

144 to children who were spotted wearing a PFD stimulated PFD usage. Similarly, a representative from Georgia indicated that they were able to increase PFD usage by printing slogans on Lifesavers candy and handing it out to children wearing their PFDs. Other giveaways were apparently effective as well at increasing wear rates. In Georgia, t-shirts were given to children found wearing their PFDs, while in Nevada, cash and prizes were awarded to vessels in which all occupants were voluntarily wearing their PFDs (in a promotion called it pays to wear your lifejacket ). The NASBLA representatives had the impression that these efforts were effective in encouraging the usage of flotation devices, they did not offer any specifics regarding the degree to which wear rates increased to support these claims, however. Other NASBLA representatives in Idaho, West Virginia, California indicated that they believe that public service announcements (via radio, TV, newspapers) successfully increased PFD usage in their respective states. A NASBLA representative from Maine suggested that boating safety education courses had stimulated PFD usage in that state. As well, NASBLA representatives from Georgia, Massachusetts, Montana, New Hampshire, California, and New Mexico also claimed that educational efforts had paid off in terms of encouraging recreational boaters to wear PFDs. In California, children in grades K-12 receive education about the importance of wearing PFDs, and adults are targeted at boat shows. In New Mexico, K-12 students are exposed annually to a boat safety education program with an emphasis on how little time is required to drown in a boating accident and the time that it actually takes to put on a PFD in a boating accident. These messages are also reinforced for younger children in a colouring and activities book. However, details were not provided to corroborate the degree of success of these educational campaigns. References: 1. Government of United Kingdom. (2003). 2. Government of Victoria. (2002). 3. Marine and Safety Tasmania. (2003). 143

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146 APPENDIX C : International Environmental Scan Survey For U.S. Respondents By P. Groff, PhD J. Ghadiali, MA 145

147 March 3, 2003 Regarding Lifejacket/Personal Flotation Device Legislation Canada is considering the pros and cons to mandating the wearing of personal flotation devices for boaters in small water craft (under 20 feet). My name is Jennifer Ghadiali, and I have been asked by the Canadian Safe Boating Council and the Canadian injury prevention organization called SMARTRISK to ask the opinion of the drowning prevention community outside Canada. We would very much like to include your opinions about legislation requiring boaters in small water craft to wear a personal flotation device. We would also like to hear about your state s experience, including whether your state has considered or already developed legislation for mandatory personal flotation device usage, how easy or difficult creating such legislation would be in your state and why, and for states who have developed legislation, how effective it has been. As well, we would like to hear about how the new federal legislation requiring children under the age of 13 to wear a personal flotation device will impact your state. Any information you could provide would be very helpful to us. We have attached a short survey for you to review. We would like to receive completed surveys as soon as possible, ideally by March 21st, You may complete the survey online by clicking on the following link: Or you may print out the attached survey, complete it and then fax it to Or you may type in your responses in the attached survey, re-save the document, and then attach your completed survey and it to jghadiali@smartrisk.ca. If you would prefer to discuss it by telephone, please contact me and we can schedule a telephone call. The information gathered will be used by SMARTRISK to develop a position paper for the Canadian Safe Boating Council. With your permission, some of your statements may be quoted and credited to your organization in the position paper, which will be issued as a public document. If you choose to participate in this survey, we will also send you a brief report summarizing the responses of all respondents once the research is completed if you wish. Thank you for your time. Your comments will contribute to policy efforts to reduce drowning in Canada. Sincerely, Jennifer Ghadiali Research Associate, SMARTRISK 146

148 Lifejacket/PFD Legislation Survey 1. Does your state currently have legislation requiring boaters in small water craft to wear lifejackets/pfds? If not, is legislation being considered or developed? PLEASE WRITE OR TYPE AN X BESIDE YOUR RESPONSE BELOW My state has already created lifejacket/pfd legislation No legislation is being considered currently Legislation is being considered at this time Legislation is being developed at this time Other PLEASE DESCRIBE: 2. Whether or not your state has created legislation requiring boaters in small water craft to wear a lifejacket or PFD, what are or were the barriers to creating this legislation? For each of the potential barriers to creating legislation listed below, please indicate whether it is or was a big barrier, small barrier, or not a barrier at all. PLEASE WRITE OR TYPE AN X BESIDE YOUR RESPONSE FOR EACH STATEMENT BELOW a) Drowning prevention is not as high a priority as other issues Big Barrier Small Barrier Not a Barrier b) There is little public pressure or enthusiasm for legislation Big Barrier Small Barrier Not a Barrier c) There is little enthusiasm for legislation from the government at the federal or provincial/state levels Big Barrier Small Barrier Not a Barrier d) The public strongly believes in personal freedoms and would be resistant to this legislation Big Barrier Small Barrier Not a Barrier e) There is no individual or group that is trying to bring attention to this issue Big Barrier Small Barrier Not a Barrier f) There is a concern that legislation could not effectively be enforced Big Barrier Small Barrier Not a Barrier g) There is conflict about whether the legislation would be national, state, or local Big Barrier Small Barrier Not a Barrier 147

149 h) There is conflict about the type of flotation device that would be mandatory (e.g. lifejacket versus PFD) Big Barrier Small Barrier Not a Barrier i) There is conflict about who the legislation would apply to (e.g. children only versus adults) Big Barrier Small Barrier Not a Barrier j) There is conflict about other aspects of the legislation Big Barrier Small Barrier Not a Barrier 3. If you indicated that any of the potential barriers listed in the previous question could be or already was a barrier to creating lifejacket/pfd legislation in your state, please provide details below. Please also describe any other barriers to creating lifejacket/pfd legislation that exist in your state. PLEASE DESCRIBE BELOW 4. Whether or not your state has created legislation requiring boaters in small water craft to wear a lifejacket or PFD, please describe any suggestions you may have for overcoming barriers to creating lifejacket/pfd legislation. PLEASE DESCRIBE BELOW 5. Whether or not your state has created legislation requiring boaters in small water craft to wear a lifejacket or PFD, what are or were the biggest factors that would help or already helped to create this legislation? For each of the potential factors listed below, please indicate whether it is or was a big factor, small factor, or not a factor at all. PLEASE WRITE OR TYPE AN X BESIDE YOUR RESPONSE FOR EACH STATEMENT BELOW a) Key individuals or groups bringing attention to this issue Big Factor Small Factor Not a Factor b) Pressure or enthusiasm from the public to create legislation Big Factor Small Factor Not a Factor c) Enthusiasm for legislation from the government at the federal or provincial/state levels Big Factor Small Factor Not a Factor d) An incident or a series of incidents that brought attention to drowning prevention Big Factor Small Factor Not a Factor e) If policy makers or the government were informed about the economic/financial costs of boating drownings Big Factor Small Factor Not a Factor 148

150 f) If policy makers or the government were informed about the legal argument that requiring boaters to wear lifejackets or PFDs is the prudent and responsible thing to do Big Factor Small Factor Not a Factor 6. If you indicated that any of the potential factors listed in the previous question could or did help to create lifejacket/pfd legislation in your state, please provide details below. Please also describe any other factors that would help or already helped to create lifejacket/pfd legislation. PLEASE DESCRIBE BELOW 7. Are there any other methods other than legislation that have successfully encouraged lifejacket/pfd use in your state? If so, please provide details below. PLEASE DESCRIBE BELOW IF YOUR STATE ALREADY HAS LEGISLATION: PLEASE ANSWER REMAINING QUESTIONS IF YOUR STATE DOES NOT CURRENTLY HAVE LEGISLATION: PLEASE SKIP TO LAST PAGE AND COMPLETE QUESTIONS For those of you who live in a state that has already created legislation making lifejacket/pfd use mandatory for boaters in small water craft, we would like to ask several more questions in order to understand the sort of legislation your state has adopted. 8. What month and year was this legislation created for your state? Year: Month (if known): 9. What sort of boat or water craft does this state legislation apply to (e.g. boats under a certain length)? PLEASE DESCRIBE BELOW 10. What age groups does this state legislation apply to (e.g. children versus adults)? PLEASE DESCRIBE BELOW 149

151 11. Does this state legislation apply to all occupants of the watercraft or just the driver/operator of the watercraft? PLEASE WRITE OR TYPE AN X BESIDE YOUR RESPONSE FOR EACH STATEMENT BELOW All occupants of water craft Operator of water craft Other PLEASE DESCRIBE: 12. What sort of flotation device is required by this state legislation (e.g. certain buoyancy or design)? PLEASE DESCRIBE BELOW 13. After the state legislation was proposed, was it modified in any way during the review phase before it was finalized? If so, was the state legislation made more stringent/restrictive or less stringent/restrictive before it was finalized? PLEASE DESCRIBE BELOW 14. Overall, how supportive have the general public been about this state legislation? PLEASE WRITE OR TYPE AN X BESIDE YOUR RESPONSE FOR EACH STATEMENT BELOW Very supportive Somewhat supportive Not very supportive Not at all supportive 15. Overall, what impact has this state legislation had on the usage of lifejackets/pfds amongst boaters in small water craft? Has this legislation. PLEASE WRITE OR TYPE AN X BESIDE YOUR RESPONSE FOR EACH STATEMENT BELOW increased lifejacket/pfd usage considerably increased lifejacket/pfd usage slightly had little or no impact on lifejacket/pfd usage decreased lifejacket/pfd usage 150

152 16. Please describe any evaluation results that may have been collected regarding this state legislation since it was created. PLEASE DESCRIBE BELOW 17. Please describe any problems or issues your state has experienced with enforcing this legislation. PLEASE DESCRIBE BELOW 18. Would it be possible for you to send us a copy of your state s legislation, or could you tell us how we can obtain a copy on the internet or from another source? will send a copy of legislation obtain legislation on internet SPECIFY: obtain legislation from another source SPECIFY: ALL RESPONDENTS: 19. In March 2002, a new federal legislation was created that would make it mandatory for children under the age of 13 to wear a personal flotation device while a recreational vessel is under way (when not below deck or in an enclosed cabin). What impact, if any, has this federal legislation had on your state, and what impact do you anticipate it will have in the future? 20. Please add any further comments you wish. 21. Please fill in your name and address information below: Name: Organization/Company: Address: City/Town: State/Province: ZIP/Postal Code: Country: address: 151

153 22. Would you like to receive a brief report (via ) summarizing the responses of all respondents once the research is comlete? PLEASE WRITE OR TYPE AN X BESIDE YOUR RESPONSE BELOW. Yes No Thank-you for your responses. Instructions for returning surveys: You may return your survey by or fax if you do not complete it via the internet. If you are replying by , type in your responses in the survey itself, re-save the document, and then attach your completed survey to your and it to jghadiali@smartrisk.ca If you are replying by fax, please fax it to Jennifer Ghadiali at SMARTRISK (416)

154 APPENDIX D: International Environmental Scan Survey For International Respondents By P. Groff, PhD J. Ghadiali, MA 153

155 March 3, 2003 Regarding Lifejacket/Personal Flotation Device Legislation Canada is considering the pros and cons to mandating the wearing of personal flotation devices for boaters in small water craft (under 6 metres/20 feet). My name is Jennifer Ghadiali, and I have been asked by the Canadian Safe Boating Council and the Canadian injury prevention organization called SMARTRISK to ask the opinion of the drowning prevention community outside Canada. We are contacting you because of your participation in the World Congress on Drowning, in Amsterdam, in June A Canadian researcher, Dr. Chris Brooks, also attended this conference and suggested we contact you. We would very much like to include your opinions about legislation requiring boaters in small water craft to wear a personal flotation device. We would also like to hear about your country s experience, including whether your country has considered or already developed legislation for mandatory personal flotation device usage, how easy or difficult creating such legislation would be in your country and why, and for countries who have developed legislation, how effective it has been. Any information you could provide would be very helpful to us. We have attached a short survey for you to review. We would like to receive completed surveys as soon as possible, ideally by March 21st, You may complete the survey online by clicking on the following link: Or you may print out the attached survey, complete it by hand and then fax it to Or you may type in your responses in the attached survey, re-save the document, and then attach your completed survey and it to jghadiali@smartrisk.ca. If you would prefer to discuss it by telephone, please contact me and we can schedule a telephone call. The information gathered will be used by SMARTRISK to develop a position paper for the Canadian Safe Boating Council. With your permission, some of your statements may be quoted and credited to your organization in the position paper, which will be issued as a public document. If you choose to participate in this survey, we will also send you a brief report summarizing the responses of all respondents once the research is completed if you wish. Thank you for your time. Your comments will contribute to policy efforts to reduce drowning in Canada. Sincerely, Jennifer Ghadiali Research Associate, SMARTRISK 154

156 Lifejacket/PFD Legislation Survey 1. Does your country/state/jurisdiction currently have legislation requiring boaters in small water craft to wear lifejackets/pfds? If not, is legislation being considered or developed? PLEASE WRITE OR TYPE AN X BESIDE YOUR RESPONSE BELOW My country/state/jurisdiction has already created lifejacket/pfd legislation No legislation is being considered currently Legislation is being considered at this time Legislation is being developed at this time Other PLEASE DESCRIBE: 2. Whether or not your country/state/jurisdiction has created legislation requiring boaters in small water craft to wear a lifejacket or PFD, what are or were the barriers to creating this legislation? For each of the potential barriers to creating legislation listed below, please indicate whether it is or was a big barrier, small barrier, or not a barrier at all. PLEASE WRITE OR TYPE AN X BESIDE YOUR RESPONSE FOR EACH STATEMENT BELOW a) Drowning prevention is not as high a priority as other issues Big Barrier Small Barrier Not a Barrier b) There is little public pressure or enthusiasm for legislation Big Barrier Small Barrier Not a Barrier c) There is little enthusiasm for legislation from the government at the federal or provincial/state levels Big Barrier Small Barrier Not a Barrier d) The public strongly believes in personal freedoms and would be resistant to this legislation Big Barrier Small Barrier Not a Barrier e) There is no individual or group that is trying to bring attention to this issue Big Barrier Small Barrier Not a Barrier f) There is a concern that legislation could not effectively be enforced Big Barrier Small Barrier Not a Barrier g) There is conflict about whether the legislation would be national, state, or local Big Barrier Small Barrier Not a Barrier 155

157 h) There is conflict about the type of flotation device that would be mandatory (e.g. lifejacket versus PFD) Big Barrier Small Barrier Not a Barrier i) There is conflict about who the legislation would apply to (e.g. children only versus adults) Big Barrier Small Barrier Not a Barrier j) There is conflict about other aspects of the legislation Big Barrier Small Barrier Not a Barrier 3. If you indicated that any of the potential barriers listed in the previous question could be or already was a barrier to creating lifejacket/pfd legislation in your country/state/jurisdiction, please provide details below. Please also describe any other barriers to creating lifejacket/pfd legislation that exist in your country/state/jurisdiction. PLEASE DESCRIBE BELOW 4. Whether or not your country/state/jurisdiction has created legislation requiring boaters in small water craft to wear a lifejacket or PFD, please describe any suggestions you may have for overcoming barriers to creating lifejacket/pfd legislation. PLEASE DESCRIBE BELOW 5. Whether or not your country/state/jurisdiction has created legislation requiring boaters in small water craft to wear a lifejacket or PFD, what are or were the biggest factors that would help or already helped to create this legislation? For each of the potential factors listed below, please indicate whether it is or was a big factor, small factor, or not a factor at all. PLEASE WRITE OR TYPE AN X BESIDE YOUR RESPONSE FOR EACH STATEMENT BELOW a) Key individuals or groups bringing attention to this issue Big Factor Small Factor Not a Factor b) Pressure or enthusiasm from the public to create legislation Big Factor Small Factor Not a Factor c) Enthusiasm for legislation from the government at the federal or provincial/state levels Big Factor Small Factor Not a Factor d) An incident or a series of incidents that brought attention to drowning prevention Big Factor Small Factor Not a Factor e) If policy makers or the government were informed about the economic/financial costs of boating drownings Big Factor Small Factor Not a Factor 156

158 f) If policy makers or the government were informed about the legal argument that requiring boaters to wear lifejackets or PFDs is the prudent and responsible thing to do Big Factor Small Factor Not a Factor 6. If you indicated that any of the potential factors listed in the previous question could or did help to create lifejacket/pfd legislation in your country/state/jurisdiction, please provide details below. Please also describe any other factors that would help or already helped to create lifejacket/pfd legislation. PLEASE DESCRIBE BELOW 7. Are there any other methods other than legislation that have successfully encouraged lifejacket/pfd use in your country/state/jurisdiction? If so, please provide details below. PLEASE DESCRIBE BELOW IF YOUR COUNTRY/STATE/JURISDICTION ALREADY HAS LEGISLATION: PLEASE ANSWER REMAINING QUESTIONS IF YOUR COUNTRY/STATE/JURISDICTION DOES NOT CURRENTLY HAVE LEGISLATION: PLEASE SKIP TO LAST PAGE AND COMPLETE QUESTIONS For those of you who live in a country/state/jurisdiction that has already created legislation making lifejacket/pfd use mandatory for boaters in small water craft, we would like to ask several more questions in order to understand the sort of legislation your country/state/jurisdiction has adopted. 8. Has your country created lifejacket/pfd legislation at the national, state/provincial, or local level? PLEASE WRITE OR TYPE AN X BESIDE ALL RESPONSES BELOW THAT APPLY National State/Provincial Local 9. Which jurisdiction(s) in your country have created lifejacket/pfd legislation? PLEASE WRITE OR TYPE YOUR RESPONSES BELOW State(s)/Province(s): Local Jurisdiction(s): 157

159 10. What month and year was this legislation created? Year: Month (if known): 11. What sort of boat or water craft does this legislation apply to (e.g. boats under a certain length)? PLEASE DESCRIBE BELOW 12. What age groups does this legislation apply to (e.g. children versus adults)? PLEASE DESCRIBE BELOW 13. Does this legislation apply to all occupants of the watercraft or just the driver/operator of the watercraft? PLEASE DESCRIBE BELOW 14. What sort of flotation device is required by this legislation (e.g. certain buoyancy or design)? PLEASE DESCRIBE BELOW 15. After the legislation was proposed, was it modified in any way during the review phase before it was finalized? If so, was the legislation made more stringent/restrictive or less stringent/restrictive before it was finalized? PLEASE DESCRIBE BELOW 16. Overall, how supportive have the general public been about this legislation? PLEASE WRITE OR TYPE AN X BESIDE YOUR RESPONSE FOR EACH STATEMENT BELOW Very supportive Somewhat supportive Not very supportive Not at all supportive 158

160 17. Overall, what impact has this legislation had on the usage of lifejackets/pfds amongst boaters in small water craft? Has this legislation. PLEASE WRITE OR TYPE AN X BESIDE YOUR RESPONSE FOR EACH STATEMENT BELOW increased lifejacket/pfd usage considerably increased lifejacket/pfd usage slightly had little or no impact on lifejacket/pfd usage decreased lifejacket/pfd usage 18. Please describe any evaluation results that may have been collected regarding this legislation since it was created. PLEASE DESCRIBE BELOW 19. Please describe any problems or issues your country has experienced with enforcing this legislation. PLEASE DESCRIBE BELOW 20. Would it be possible for you to send us a copy of your country/state/jurisdiction s legislation, or could you tell us how we can obtain a copy on the internet or from another source? will send a copy of legislation obtain legislation on internet SPECIFY: obtain legislation from another source SPECIFY: ALL RESPONDENTS: 21. Please add any further comments you wish. 22. Please fill in your name and address information below: Name: Organization/Company: Address: City/Town: 159

161 State/Province: ZIP/Postal Code: Country: address: 23. Would you like to receive a brief report (via ) summarizing the responses of all respondents once the research is completed? PLEASE WRITE OR TYPE AN X BESIDE YOUR RESPONSE BELOW Yes No Thank-you for your responses. Instructions for returning surveys: You may return your survey by or fax if you do not complete it via the internet. If you are replying by , type in your responses in the survey itself, re-save the document, and then attach your completed survey to your and it to jghadiali@smartrisk.ca If you are replying by fax, please fax it to Jennifer Ghadiali at SMARTRISK (416)

162 APPENDIX E: Key Informant Interviews with Canadian Stakeholders By N. Lamptey, MPH P. Groff, PhD J. Ghadiali, MA 161

163 Key Informant Interviews with Canadian Stakeholders In order to learn about the feasibility of successfully advocating for a regulatory solution to the problem of recreational boating drownings in Canada, key informant interviews were conducted with a variety of Canadian stakeholders such as policy makers, researchers, drowning prevention advocates, recreational organizations, and law enforcement. Methodology This project amounted to a barrier and feasibility assessment to inform the planning and development of a putative program to advocate for PFD legislation. We gathered qualitative data on the factors that could affect the success of health promotion regulation mandating PFD usage for small vessel boating safety. The study employed qualitative methodologies because the drowning prevention community does not currently have a priori hypotheses about PFD legislation to test quantitatively, but needs informative evidence to generate greater understanding of the utility and possibility of a regulatory approach to prevention. Data was collected through 12 semi-structured interviews with key informants such as researchers, policy makers, and drowning prevention advocates. The rationale for this purposeful sampling stems from the knowledge of these constituents who are versed in the processes and logic of policy making and the issues of PFD and drowning. These respondents can provide the vocabulary and thought processes that will elaborate the basis for legislation informed by economic and epidemiological evidence. In addition to the conceptual evolution of PFD legislation, these informants can provide different sectoral perspectives that may triangulate and corroborate each other. However purposive sampling does have the limitation that salient perspectives may not be captured by the informants recognized as stakeholders with influence. The initial list of potential survey informants was drafted from the personal contacts of Dr. Chris Brooks an expert on the history of lifejackets and author of Lifejackets Through the Ages. Some of these individuals were in attendance at the World Conference on Drowning held in Amsterdam June Other candidates were suggested by the Canadian Safe Boating Council s PFD Taskforce members. Their contributions expanded the list and helped refine the list of potential respondents from the preliminary list of role-defined stakeholders. In the taskforce s judgment, their suggested interview candidates had intimate knowledge of the study topic. In other words, rather than a list of candidates based on job titles, the taskforce identified participants with meaningful understanding of drowning prevention who could create a rich purposeful sample. This is in accordance with standard sampling procedures in qualitative research. Sampling in qualitative research is not concerned with ensuring that the findings can be statistically generalised to the whole population. Rather, sampling is 162

164 purposive. The aim is to describe the processes involved in a phenomenon, rather than its distribution. A sample will aim, for example, to identify cases that will provide a full and sophisticated understanding of all aspects of the phenomenon. The aim is to select information-rich cases for studying in depth 1 p.42 Finally, every respondent was asked to suggest further potential informants for the study. Sample Size The validity or generalizability of qualitative research hinges more on the illustration of concepts rather than individuals or the roles they represent. In contrast to a quantitative survey, sample size determination was a component of the iterative process of analysis. The endpoint, is not a predetermined sample size, but the collection of data to saturation for each category.this study succeeded in consulting 12 individuals representing 10 organizations. One respondent refused to participate and scheduling difficulties prevented a secured interview with two other candidates who were approached. Sample Composition The project sought the perspective of professionals and community groups that have a stake in the design of PFD legislation. Thus, the target populations for this study are the very actors whose efforts will shape the nature of drowning prevention. The organizational roles of interviewed individuals are listed below. Policy Makers Researchers Advocates Stakeholder Organization Regulations and Standards, Office of Boating Safety, (Canada Coast Guard) Red Cross Survival Systems National Life Saving Society Ontario Life Saving Society Individual boat entrepeneur Recreational Organizations Canadian Power and Sails Squadrons Ontario Federation of Anglers and Hunters Law Enforcement RCMP OPP 163

165 Analysis After transcription, the identification of conceptual categories through coding was the first step of data analysis. These conceptual codes were based on the elements of coalition advocacy outlined by Labonté and categories that respondents used to arrange their understanding of the issues probed by the interview. 2 This initial coding was then collapsed into categories Saccording to the Government of Canada regulatory policy. Thus this analysis does not approach the complex analysis of relationships between codes embedded in the data, outlined by grounded theory.instead, the writer searched for themes with particular reference to the concepts articulated by the federal regulatory requirements. The variables used in the initial coding stem from Labonté s empowerment continuum, which identifies the following components of coalition advocacy: Lobbying For Healthy Public Policy Collaboration Interaction between groups and community organizations Agenda Setting Achieving Strategic Consensus Conflict Resolution Political Voice Initiation of Actions to Influence Policy Choices Legitimation Of Health Concerns The federal regulatory requirements stipulate that the issues listed below should be addressed in consideration of a regulatory proposal. 3 The initial codes collapsed into these broader categories are highlighted in bold font. 1. Consult Canadians [group interaction, influence, political voice, strategic consensus] 2. Demonstrate existence of a problem, [legitimation of health concern] justify federal intervention [culture, prospects, pace of reform] demonstrate regulation is the best alternative [alternatives, conditions] 3. Demonstrate that benefits outweigh costs [economics] ensure that government resources are used where they do the most good 6. Manage regulatory resources effectively compliance and enforcement policies are articulated and that resources are adequate to discharge enforcement responsibilities effectively and ensure compliance [enforcement] 164

166 Findings Policy Agenda: Is mandatory wear PFD legislation on the policy agenda? Media coverage of drowning fatalities stimulates increased attention to drowning but between these events, drowning and drowning mitigation strategies have less potential to capture a position on the public agenda without activity directed at influencing opinion-makers. Survey research can indicate to what extent drowning concerns the public, but the agenda of other stakeholders may be impacted by factors other than high-profile drowning events. For example, law enforcement agencies triage their activities based on the potential and immediacy of harm posed by societal phenomena over which they have jurisdiction. Drowning is usually fatal and on that basis may be perceived as deserving of high priority; but the proximal activity of drowning prevention through enforcement of mandatory wear of PFDs would present most law enforcement agencies with activity of less emergence than for example threats to security posed by illegal transport of goods and people. Agenda setting within the executive branch of the federal government apparently has explicit rationale as articulated by the Government of Canada Regulatory Policy. According to the Regulatory Policy, regulations do not emerge from a vacuum or the unilateral will of the government. The first requirement of the policy is consultation with Canadians so that the development of regulation includes public participation. Thus placement of a legislative strategy on the government agenda would likely have to begin with an appearance of the issue in the consultative bodies of the government relevant to boating safety such as the Canadian Marine Advisory Council and the Recreational Boating Advisory Councils. Although two respondents anticipated support of a legislative initiative by the Canadian Coast Guard, politicians (in particular parliamentarians and federal ministers), enact legislation rather than agencies in the executive branch. Three respondents noted that politicians are driven by voter support and are wary of legislative initiatives that may prove politically unpopular. One respondent mentioned the historical experience with vessel licensing, which included opposition from northern and tourism industry constituencies. The vessel licensing proceedings may influence politicians support for a legislative initiative. The respondents who optimistically expect a favourable reaction to a legislative proposal by the Coast Guard, might be cautioned by their colleague who remarked that the Coast Guard would not determine its position without strong data indicating public support and the life-saving potential of legislation. This assessment is in fact intimated in the Government of Canada Regulatory Policy, which requires any regulation to demonstrate a net benefit and efficient use of government resources such that they are employed where they might do the most good. Moreover, although advocates of legislation might expect a particular stance by regulators, the personal views of members of the executive branch theoretically is irrelevant because regulation is supposed to be based on the positions of stakeholders. Politically, the machinations of the legislative process may be facilitated by bureaucratic approval, but it is not supposed to be the starting point of the legislative process. 165

167 I) Policy Consultation Discussion Fora: Does the recreational boating community have opportunities to communicate with one another? It is perhaps demonstrative of the Canadian problem-solving approach that the first requirement of the federal regulatory policy is consultation with Canadians to give them the opportunity to participate in the development and modification of regulation. Three respondents mentioned the national Recreational Boating Advisory Council as a forum where stakeholders can communicate with each other and advance options for drowning prevention. Similarly, respondents identified the Canadian Marine Advisory Council and the regional recreational boating councils created by the Coast Guard, as opportune meetings for discourse on drowning prevention. The frequency with which these bodies were mentioned and their broad and overlapping memberships suggest that discussion of a regulatory approach to drowning prevention during these conferences would be significant engagements for exploration of prevention alternatives. Respondents who noted these governmental bodies simultaneously named the Canadian Safe Boating Council (CSBC) itself, as an important communication forum. Despite the familiarity of many stakeholders with these councils, gaps in representation of boating constituents exist in these formal groups. Small vessel owners who do not belong to formal boating organizations, in particular cottage owners, may not have their perspective captured by the usual attendants of these boating related councils. Although many boating organizations have representatives that participate in multiple councils, the bodies may not reach a position on a prevention option at the same pace and they do not necessarily have an opportunity to formally connect with each other beyond the networks of individual memberships. Advocates should consider the ties between these bodies and the timing of their deliberations because they need explicit recognition if communication and consultation on a regulatory approach is to proceed in a concerted fashion. International discussions ostensibly have an educational function as they allow researchers and other stakeholders to learn about the drowning conditions and prevention approaches in other countries. For example respondents mentioned the World Congress on Drowning and the Italian Conference on Safety and Transportation. However one respondent suggested an interesting possibility that a forum like the World Congress on Drowning could advance the policy process beyond the usual introduction of stakeholders to each other and the exchange of academic information. A respondent suggested that Canada could host the second annual World Congress on Drowning so that stakeholders could be invited to present papers and also contribute to a formal consideration of a regulatory approach. An event of the magnitude of the World Congress on Drowning would likely consume more resources for planning and execution than the established governmental advisory bodies and would require a generous financial sponsor. However if stakeholders are interested in raising the profile of drowning, hosting the World Congress on Drowning would garner international as well as national attention. 166

168 Influential Stakeholders: Who has influence in the boating community? In line with the recognition of the CSBC as an important forum for discussion, respondents cited the Canadian Safe Boating Council as an influential body in drowning prevention. Respondents noted that the members represented large groups of people in the boating community. Within its membership, respondents named vessel and safety equipment manufacturers, and the powerboating community as notable constituencies. Respondents cited other organizations of influence that may not have CSBC membership including angling and hunting organizations, cottage organizations and the Canadian General Standards Board. In contrast to the dictates of the Government of Canada Regulatory policy, which names the Canadian public as the key influential party in policy creation, respondents mentioned several federal government agencies and their employees as influential parties that would need to support a regulatory initiative in order for it to proceed expeditiously. In particular, respondents spoke of Fisheries and Oceans Canada including the Canada Coast Guard and the Rescue, Safety and Environmental Response Unit; Transport Canada including Marine Safety; Health Canada; Heritage Canada; the Solicitor General s Office; and Human Resources and Development Canada. At the provincial level, a respondent mentioned ministries of health and transportation as bodies that may need to receive more information about drowning. Another respondent stated that the boating community has not previously accessed the injury prevention network, health promotion experts, and health care providers. Thus the public health community might not consider the boating aspects of water safety in its programming. The recipients of the Red Cross Drowning Report may not be on the boating community s radar as stakeholders in a regulatory approach, but their interest in the publication suggests they may have contributions to deliberations. These organizations include regional health units, Offices of the Coroner, the Canadian Institute of Child Health, the Canadian Youth Foundation, Fitness Canada, the YMCA, outdoor sports shows, and the Diving Association. Finally, national enforcement agencies, the media, and corporate interests such as the insurance and the alcoholic beverage industry round out interested parties noted by respondents. 167

169 Advocacy Capacity and Lobbying: Are boating organizations capable of launching a concerted campaign to influence the public and policy makers? Identifying parties with influence in the boating and policy creation communities is an early step in formulating a strategic push to implement a preventive initiative, but efforts oriented towards various groups dissipate without direction. A participant stated that advocacy for a mandatory wear policy would require a leader respected by parties with influence. The leader of an initiative would in turn have to be considerate towards constituents but firm enough to encourage and achieve a compromise position between extreme views. Organizations that were named by more than one participant as candidates for a leadership role were the Red Cross, SMARTRISK, the Life Saving Society, the Canadian Power and Sails Squadron, and the Canadian Safe Boating Council. These organizations were named because of their apparent experience in advocacy and lobbying of policy makers. Other organizations that were suggested to have experience working with government include the Canadian Yachting Association, the Ontario Federation of Anglers and Hunters and the Canadian Parks and Recreation Association. Nevertheless two respondents questioned the depth of lobbying experience possessed by these organizations and the magnitude of resources at their command. They remarked that policy involvement represents novel territory for many organizations and others may have only one or two issues worth of advocacy experience. Indeed, certain safety-related organizations rely on a policy of neutrality in their work outside of boating topics. Others have structural restrictions that might prevent them from lobbying under the name of the Canadian Safe Boating Council. Curiously, one respondent characterized advocacy in injury prevention as apolitical, distinct from situations like armed conflict that necessitates a neutral stance. Another respondent rationalized that informing the federal government about possible mandatory wear legislation would not count as lobbying if it was presented as distribution of information about public safety rather than as a stated desire for a specific form of legislation. However any lobbying for mandatory wear legislation is inherently political because it affects the distribution of power between individuals and the state over personal activity. Do information channels exist to communicate a concerted message to the public, policy makers and recreational boaters? Apart from the novelty of communicating the nature of the drowning problem to the public and policy makers, potential barriers to achievement of desired lobbying outcomes include the appropriateness of messaging strategies and content. Two respondents disagreed about how effective advocates have been to date in their communication with external audiences. Interestingly, the respondent who described advocates as having done a great job at delivering messages, surmised that previous advertisements about the importance of wearing PFDs have exhibited ominous tones that do not appeal to the public. [S]he continued that positive approaches, which integrate PFDs with aquatic activity, such as the colour coordination of PFDs in the personal watercraft 168

170 community have more potential to retain public attention. In addition to the suitability of content, the orientation of a concerted prevention message to particular audiences can impact its efficacy. One respondent suggested that one way to help build the momentum necessary to persuade politicians would be to initially target groups who are least accepting of a policy option. If these resistant groups decide to support the option then their representation could help build the critical mass of stakeholders who could advance the political process. Another respondent suggested that the female population who persuades children and spouses about the worthiness of prevention initiatives, is another constituency to consider in strategic public relations. Limited resources count as one explanation for deficiencies in communication with the public and policy makers. Consistent public education to encourage PFD wear would require multimillion-dollar media campaigns for which the prevention community does not have sufficient financing. Two respondents explained that an education campaign to accompany a regulatory initiative would require print, radio and television media to inform the public of the regulatory expectations and enforcement. Suggested strategies for managing some of the cost associated with such a campaign include co-operative advertising and inclusion of media representatives in the prevention initiative. Co-operative advertising would pool the creative input and financial contributions of stakeholders. Media involvement would help uncover how the media could be engaged to support the initiative. Rather than merely responding to media calls after a drowning fatality, proactive consultation with media could help sustain drowning prevention messages and identify what elements of the drowning problem are likely to garner media coverage. A respondent offered that the national associations of broadcasters in radio, print and television could be engaged to use their networks in these opportune ways. Dialogue with the law enforcement community may warrant special attention because of particular federal institutional changes. Restructuring of the marine and migratory bird enforcement unit of the RCMP in 1988 has left the federal agency without a full-time national marine coordinator. The ten provincial RCMP marine coordinators do not necessarily have formal chances to communicate with one another in national meetings. The jurisdictions of the provincial sections differ in how many bodies of water they encompass and the effective duration of the boating season. Therefore, marine activities naturally differ in emphasis between sections. Without a national marine section, consultation with the RCMP may have to incorporate correspondence through conventional or electronic mail with marine section coordinators to concurrently acquire input that is national in scope. In contrast, the Ontario Provincial Police force has a full-time marine coordinator. Thus solicitation of input from that organization may be more straightforward because the marine portfolio has an associated centralized position. In addition to the law enforcement community, another group that may prove difficult to reach is the diffuse and diverse boaters who do not belong to a formal boating organization. Respondents identified northern Canadians, hunters and fishers, and small powerboat owners, particularly cottagers, as groups who may 169

171 not be represented by the usual associations who attend the RMACs and similar councils. Reaching these boaters may have to include strategies such as public announcements in print media, town hall meetings, notices in public spaces or canvassers in cottage areas. The standard policy conferences held in major urban centers, can fail to capture the input of these diverse people. Finally, given the necessary considerations about messaging content, strategy and logistics, the question about who should lead communication with public audiences remains. One respondent felt that the federal government had a responsibility in public education around drowning prevention but that the government s responsibility did not mean they should do the public education themselves. The respondent believed that safety organizations like the Red Cross and the Lifesaving Society, and recreational boating associations could perform the actual education function. Some of these recreational organizations have extensive communication networks with their members that include media such as websites, print newsletters, and even television programming. Even if boating and safety organizations educate the public about primary prevention of drowning, another respondent concurred that the role of the federal government remains significant. The respondent explained that the body that will gain most financially by the aversion of a drowning death is the federal government. Strategic Consensus Two respondents articulated what they believed to be necessary elements to create a strategic consensus on the value of mandatory wear legislation. One respondent delineated that several equally important components are necessary for stakeholders to form a position on legislation. These items include evidence about whether or not legislation will produce the desired outcome of reduced mortality at acceptable cost-benefit ratios. Another respondent explained that mandatory wear legislation would need to be supported by the public: taxpayers and endusers. They continued that few groups would render complete opposition to some form of mandatory wear legislation. Although this sample of interviews with respondents can not evaluate the evidence base or extent of opposition to legislation, one respondent hoped that this research would ascertain the general orientation by represented parties towards mandatory wear legislation. 170

172 II) Demonstration of need for federal intervention and regulation Legitimation of a health concern: Do fatal recreational boating drownings represent a health risk? The second requirement of the national regulatory policy involves justification of federal regulatory intervention. This includes demonstration of the existence of a risk or problem and elucidation of regulation as the best policy option. This study s respondents can not conclusively define the risks of boat-related drownings but can sketch how various stakeholders perceive the risk of boatrelated drowning. As one respondent emphasized, every human activity has some degree of risk. Therefore, the presence of a risk may not be as salient as its interpretation. Interpretations by different stakeholders of the magnitude of boat-related drownings will affect what responses they generate to address this risk. One respondent strongly opposed characterizing the risk of boat related drowning as a phenomenon that rendered recreational boating unsafe. Another respondent explained that vessel manufacturers may express resistance to messages promoting PFD or lifejacket wear because such promotions may imply that boating is an unsafe activity. In contrast, both respondents described recreational boating as a safe activity. One of the components of risk interpretation is comparative assessment of activities. One respondent was not aware of the statistics of backyard pool and bathtub drownings and believed that the latter category represented a larger problem than recreational boat drownings. This misinterpretation suggests two possibilities. First, stakeholder knowledge of the fact that boat related drownings constitute the largest category of drownings in Canada will influence their perception of the magnitude of boat related drownings. This statement seems obvious. However, researchers whose work is entrenched in the epidemiology of drownings may not realize that stakeholders have different levels of exposure to drowning data. The detailed drowning statistics are theoretically widely available from the Red Cross Drowning Reports and accessible from the Red Cross website to anyone with an internet connection. Nevertheless drowning advocates can not expect everyone with an interest in boating to be similarly versed in the drowning epidemiology, because recreational pursuits that involve boating place different weights on the boating itself during the leisure activity. Second, the respondent has highlighted an opportunity for drowning prevention advocates to condense the vast drowning research into pertinent pearls to inform stakeholders as debate on legislation unfolds. Respondents offered a wide array of opinions on the research that would frame discussions on mandatory wear legislation. Two respondents emphasized that a position paper on mandatory wear legislation would have to rest on facts gleaned from academically based research and connect the themes from prior studies. Four respondents felt that sufficient statistics currently exist to make a case in favour of legislation. One of these individuals believed that the strength of the Canadian drowning research actually distinguishes Canada from other countries contemplating drowning prevention options. Despite the strong 171

173 endorsement of the statistical picture by these four individuals, one respondent disagreed that there was enough statistical evidence and others identified specific areas they felt more information could be gathered. Two respondents noted that despite the strong statistics on fatal drownings, nonfatal drowning consequences such as injury or property damage have not been sufficiently studied. In contrast, a stakeholder believed that injuries from boat drownings were rare. Another respondent identified attitudes towards PFDs and lifejackets as an area for more research. A stakeholder stated that attitudinal research indicates that boaters at highest risk of drowning believe that having a PFD close by in the boat is sufficient protection despite the challenges of donning the device in the water. If those findings are corroborated then explanation of the relative utility of a PFD on person versus in the boat during unexpected immersion could help change that belief among boaters. The respondent believed that the drowning research demonstrates that if boaters wore their PFDs, the number of fatal drownings could be substantially reduced. In contrast a peer wondered whether mandatory wear would impact the wear rates among individuals who are predisposed to be risk-takers. The respondent also questioned whether mandatory wear legislation would increase wear rates and save lives rather than merely aiding search and recovery operations. The respondent noted that in some conditions PFDs are not ideal life-saving devices and that it is possible to drown in a PFD. This observation does not necessarily negate the value of PFDs because as one respondent countered, family members of drowning victims value retrieval operations, because the family can receive some closure with a successful recovery, which can be aided by PFDs. These comments underscore the societal costs that surround drowning injury and fatalities resulting from inadequate protective gear. Thus the choice to wear a PFD has ramifications beyond the individual. The respondent emphasized that education campaigns need to highlight the broader impact of PFD wear and that a boater is the sole proprietor of PFD associated risk only when they are the only person in the world that cares about themselves. In addition to identifying areas for further inquiry, respondents disclosed emerging insights generated from new research. The physiological phenomenon of cold- water shock was reported to be only recently understood in Canada. A respondent believed that the new concept has not been fully explained to the boating community. Furthermore, the respondent believed that PFD wear could be helfpful in situations where cold-water shock is a concern. Beyond this discovery in drowning physiology, consolidation of existing information on drowning could advance understanding if salient trends are extracted. For example, the Red Cross data on drowning extends retrospectively to 1991 and a ten-year review of drowning statistics is in preparation. The latest available statistics from 1999 suggest a fall on the order of 25% in fatal recreational boating drownings since If the decline is confirmed by continued surveillance, the circumstances would be encouraging in the face of increased boating intensity and frequency. Although a respondent pointed out that the apparent mortality decline and the increase in pleasure craft operators suggests a stable drowning rate, this does not preclude the opportunity for further gains in drowning reduction. A respondent mused that there will likely never be a year without a boating fatality but the mortality can be significantly reduced. 172

174 Is federal intervention justified: are there cultural imperatives concerning legislation? The Canadian geographical and cultural context paints the backdrop of any discussion about whether federal intervention is justified. Cultural imperatives are one of the factors that affect the appropriateness and efficacy of policy options. First, one respondent noted the unique northern location of the country, which creates conditions of cold water and poor weather are situations that Canadian boaters could potentially face out of proportion to other nations. Despite climactic limitations, respondents stated that boating is a popular leisure activity that serves more than a transportation function. One respondent passionately characterized recreational boating activities as an integral component of the quality of life for some Canadians. The respondent explained that recreational boaters who want to pass on their pastimes to their children inherently desire the activity to be as safe as practically possible. In addition to inspiring devotion, boating in Canada perhaps contributes to less evident subtext in Canadian culture. One respondent believed that boating is so widely and frequently engaged by Canadians that it is not necessarily consciously thought about by participants. For example, fishing and hunting, were mentioned by two respondents as activities in which boating is secondary to the main pursuit. Although boating is involved in these pursuits, participants may not designate these recreational activities as boating. Thus in activities where boating is not specified as the prominent recreational component, injury prevention may not be focused on the boating component but other aspects of the activity. In contrast, some boaters identify themselves primarily as boaters and may have sought supplementary training in boating technique and safety. Various notions of boating identity are not merely academic curiosities because they may affect how different groups of boaters respond to messaging on safety device wear. For example, one respondent commented that the stylishness and color coordination between recent generations of PFDs and personal watercraft (PWC) and kayaks, has contributed to high wear rates in those boating groups. The improved function and fashion appeal tailored to the specific needs of these vessels feed into the boating identity of kayakers and PWC operators. The same respondent also acknowledged that practical considerations of limited storage on these vessels may have initiated the high wear rates. Another respondent explained that immersion is expected in personal watercraft use. The pragmatic wear of PFDs in these conditions may have been reinforced by the cool factor associated with stylishly designed gear. In contrast, one respondent stated that young adult males who represent a high risk group for recreational boat drownings do not seem to find PFD or lifejacket wear appealing. The respondent was not sure whether the discomfort with PFD wear in this population was a cultural or psychological position of individual boaters. Another respondent ascribed this to participants sense of ownership of boating activities and the right to decide whether to wear a PFD. The respondent believes that this attitude is prevalent among young people who may be carefree 173

175 and difficult to influence through any prevention intervention. The respondent added that a different group of older boaters who display similar reluctance may be motivated by a familiarity with the way they have boated for many years without wearing PFDs or lifejackets. In addition to the attitudes specific to those demographic groups, one respondent offered a more general description of the boating culture as one of the last frontiers to experience regulation. The respondent referenced the fact that pleasure craft operator cards were only introduced in Thus boaters may be used to a lack of imposition on their freedom and independence and may associate it with the relaxing feeling of getting away from it all. Apart from interpretations of boating culture, respondents provided perspectives on broader Canadian culture. One respondent found a problematic inclination of Canadians to turn to legislative responses to social problems. A colleague observed that Canadians tend to be law abiding; this remark was echoed by a respondent who contrasted the Canadian tendency with American behaviour. The respondent continued that Canadians would agree with directives that prescribe activities but another respondent clarified that Canadians support for legislated activity rests on reasoned legislation. Two respondents disagreed with the assessment that Canadians are oriented towards legislative policy actions. They characterized Canadians as resistant to regulation and cited the experiences with seatbelt and bicycle helmet legislation as well as gun registration. They argued that Canadian desire for freedom and independence surpasses support for regulation. One of the respondents clarified that some of the groups who opposed the seatbelt, helmet and gun registration regulations were philosophically against legislation because of a belief that Canadians are sufficiently legislated in all spheres. A third respondent further explained that the federal government s reluctance to impose restrictions on citizens compounds the cultural resistance to legislation. The respondent stated that this traditional trepidation exhibited by the federal government stems from a philosophy that people will independently choose particular activities if those activities make sense. In contrast to these general predictions of public response to legislation, another respondent disagreed with those who characterized Canadians as averse to regulation. Instead of the history with bike and automobile safety legislation, this respondent employed the reaction to the pleasure operator card to support their position. The respondent felt that this boating regulation did not generate much opposition and that a similarly introduced and explained regulation would generate public acceptance. Thus regardless of the level of aversion to regulation in the Canadian culture, mandatory wear PFD legislation would have to be presented in a reasoned fashion to generate support. Even without mandatory wear legislation some boating groups are advancing wear in their own spheres where they have influence. A respondent stated that the Ontario Camping Association and sailing associations have introduced policies of mandatory wear during sanctioned events. These actions can help shape cultural attitudes towards PFD wear because individual choices are in some measure socially determined to the extent that community expectations frame the behaviours individuals take for granted. 174

176 The Canadian Political Context In addition to the cultural attitudes and practices of the Canadian public the political landscape also affects the suitability of a regulatory approach to drowning prevention. A respondent described Canadian policy making as consultative, which mirrors the sentiments outlined in the federal regulatory requirements. However, the respondent remarked that this approach that is inclusive of different viewpoints results in a slow policy creation process. Two respondents claimed that recent reactions to the federal gun registry will render policy makers reluctant to initiate a policy process for PFD legislation. Other developments more specific to the boating context were cited as politically salient. Two respondents believed that the limited budgets of the Coast Guard and Office of Boating Safety are current political problems. In addition, another respondent raised the uncertainty around Coast Guard management of vessel licensing as a pertinent issue. The respondent predicted public discomfort with the fees associated with licensing. The respondent continued that the impact on the popularity of the agency would make them reluctant to engage in other potentially unpopular measures. Finally, a peer described the effects of previous boating regulations on boating fatalities. Although the pleasure operator card experience is too nascent to evaluate, the respondent believes that safe powering limits, mandatory flotation of boats under 6m, and the development of wearable lifejackets and PFDs have contributed to declines in boating fatalities. Although proximal political events may seize attention and breed wariness of legislation, this respondents observation suggests that the historical outcomes of boating regulations have positively improved the safety of recreational boat users. While some respondents believed the particulars of the political context were barriers to regulation, two respondents believed that the current environment actually represents a window of opportunity. One respondent cited the reform of the Canada Shipping Act, which will presumably increase attention and energy directed at boating regulation in general. Another respondent believed that efforts of the Canadian and American Safe Boating Councils have influenced thinking on regulation, and that communication with PFD manufacturers and users have built momentum. Finally the national PFD legislation enacted in United States contributes to the putative impetus for regulation. Whether or not momentum exists towards regulation, one respondent expressed frustration with the current situation given a decade s worth of drowning statistics. Nevertheless, other respondents cautioned that there would be negative repercussions if the production of legislation was rushed. They explained that the policy process might not engage all interested groups if legislation was adopted too quickly. Another respondent added that a rushed legislative decision would likely be rejected. They explained that without investments in consensus-building, legislative proponents would have difficulty documenting voter support to wary politicians. A colleague believed that legislation would stall if complimentary initiatives such as boater education were not simultaneously implemented. Finally a respondent predicted that a successful policy creation process would require an explicit time- table with sufficient time allotted to each stage and meeting to prevent unravelling of efforts. 175

177 Two respondents optimistically believed that mandatory wear legislation could be achieved in two years. Three respondents predicted that the safety community would still be educating the public and policy makers about the drowning problem. One respondent believed that the safety community would still be learning about the policy process and another believed that gathering and presentation of information on drowning would still be proceeding. The least optimistic respondent stated that the safety community would still be thinking about the appropriateness of legislation. A colleague stated pragmatically that the advocacy community would need to establish a long-term goal with coordinated efforts at different levels across the country to achieve any prevention objective. Finally, a respondent remarked somewhat facetiously that legislation would be a done deal if Paul Martin ran for election donning a lifejacket. Humour aside, the remark points to the potential influence of a high profile political champion on the prospects for legislation. Is federal regulation the best policy alternative? Three respondents opened their comments in support of mandatory PFD wear legislation with explanations that PFDs save lives. The validity of these claims are explored elsewhere but respondents provided many examples of alternative approaches to reducing drowning fatalities. A respondent identified an intrinsic benefit to the presence of law enforcement personnel on the water through their education and reinforcement of safety matters. Two respondents expressed a desire for greater enforcement of existing boating laws to enhance the safety of boating. One respondent based this position on an association between substance impairment and drownings, which the respondent felt demonstrated a causal relationship between drownings and lack of compliance with existing boating laws. The respondent continued that addressing concerns about enforcement of existing regulations should be considered before new regulatory proposals. Another respondent suggested that returning ticket revenue to enforcement agencies would be one way to bolster law enforcement capacity. On reflection, the respondent retracted the idea because they felt it would result in undesirable ticket quotas. On balance, even if enforcement was strengthened to reinforce existing regulations, they could increase the required PFD carriage rates on boats, without necessarily increasing wear of PFDs. Five respondents spoke about public education because of public unawareness about drowning, its prevention, and the challenging reality faced by individuals unexpectedly immersed without a PFD. A respondent expressed trust that an informed boating public would make wise safety decisions. The respondent continued that the effectiveness of an education campaign on PFD wear in high risk groups, will be affected by whether these individuals are truly unaware of the importance of the gear or whether they knowingly disregard their use. The respondent concluded that the federal and provincial governments, safety organizations and recreational boating groups could work more closely together to educate the public. Three other respondents cited room for improvement in the conduct of safety promotion campaigns. Specifically, they stated that the 176

178 targeting of campaigns could be matured and the continuity of campaigns could be improved throughout the year. One respondent also expressed concern with the content of safety messaging and cautioned that campaigns should not stereotype boaters as lawbreakers. Three respondents argued that providing evidence to the public about the safety benefits and rationale for mandatory PFD wear would increase public acceptance of the idea. Respondents named statistical evidence and anecdotal demonstration of benefit as persuasive and referred to the historical experience with seatbelt legislation as a model. Respondents also pointed out that ticketing contributed to the development of seatbelt- wear habits. However salient differences with the seatbelt situation include the relative intrusion of a seatbelt on the act of driving compared to the restrictions imposed on boating activities by a PFD. Comparisons with the seatbelt experience should not overlook the time it took to increase compliance to current rates. Finally, one respondent posited that the marginal step to mandatory wear is smaller with PFDs than it was for seatbelts because the mandatory carriage requirements have already introduced users and manufacturers to the gear s presence in vessels. The disclosures of opportunities for improvements in alternative measures are important because of their potential synergies with a regulatory option. Three respondents stated that legislation cannot stand alone but has to be integrated with other interventions to influence boating behaviour. One respondent interpreted the federal regulatory policy guidelines to mean that regulation should be a last resort in social interventions. Another respondent stated emphatically that society cannot legislate common sense. Is regulation a preferred option under particular conditions? Three respondents envisioned mandatory wear legislation that would require PFD use in all conditions for all ages. A colleague expressed concern that a strict policy without exceptions would yield poor compliance. Similarly, two respondents felt that any conditions specified by mandatory wear legislation should be logical to prevent mockery of the overall regulatory intent. In contrast, two respondents felt that specifying particular conditions for PFD wear would make enforcement more difficult. Respondents identified depth of water, distance from shore, weather conditions, swimming ability, body height and drowning risk as elements that could be considered in the specification of conditions requiring PFD wear. Two respondents stated that individuals on docked boats should be exempted from mandatory wear and that the regulation should apply to vessels underway at a rate greater than a troll speed. Four respondents felt that regulation should apply to small open vessels and singled out powerboats and canoes particularly in cold water in the spring and fall. However a peer questioned whether bad weather prepares boaters any more for the conditions encountered on unexpected immersion. Four respondents commented that legislation directed solely at children would be inappropriate because children constitute a small proportion of fatal boat 177

179 drownings. Respondents pointed out that children receive PFD messaging in water safety programs such as Red Cross swimming courses. Furthermore, respondents argued that children already have high PFD wear rates and receive scrutiny from their parents. One respondent added that they would rather support mandatory wear for vessel operators than legislation directed at children. Finally, one respondent proposed a policy formulation that would allow provinces with sufficient enforcement resources to opt into legislation. Although the respondent believed that mandatory wear legislation should be federal, they raised the possibility of allowing differential provincial engagement. The respondent referred to the Contraventions Act as a regulatory example that permits willing provinces to opt into an initiative without being delayed by the resource constraints of other jurisdictions. III) Economics One respondent believed that the marginal cost to recreational boaters of complying with mandatory wear PFD legislation would be zero because of existing carriage requirements. However, a peer suggested that legislation may prompt some boaters to upgrade their existing PFDs. Respondents believed that the federal government and by implication the Canadian public would bear the broader costs of preparing and implementing mandatory wear legislation through general revenues. Specifically, respondents anticipated federal government resources directed towards public education and management of the legislative process. Respondents identified startup costs associated with consultation and preparing draft regulations. These processes would require funds to assist the participation of stakeholders located in remote communities and those without institutional resources to attend consultation meetings. Three respondents anticipated that these consultation costs would be modest with the accessibility to electronic communication technology. They added that the marginal costs of drafting legislation could be lowered through exploitation of established boating related assemblies and existing resources dedicated to boating safety. This assessment was based on the presumption that most participants in the policy collaboration would donate the labour and travel costs associated with their attendance at existing boating forums. Similarly, one respondent assumed that current bureaucratic staff would implement the federal management of the policy consultation. Although the respondent described these human resources as sunk costs, the projected work by federal personnel on mandatory PFD wear legislation still represents an opportunity cost from other boating efforts, especially since other boating regulations cited above are undergoing reform. Only a couple of funding sources alternative to the federal general revenue fund were mentioned by respondents. One researcher suggested that the injury prevention network may have employment grants that could be applied for a position to advance the cause of mandatory wear legislation. Another respondent pointed to the dedication of a portion of boat fuel taxes to marine law enforcement in the United States. However, the same respondent noted that the 178

180 Canadian cultural approach to social distribution has favoured centralized allocation rather than dedicated funding streams. These perspectives on the economic considerations of legislation consistently point to the federal government, but the costs associated with drowning including rehabilitation from non-fatal injury, and search and rescue on land and water are largely borne by that very entity. IV) Enforcement The federal regulatory policy requires the articulation of enforcement policies and the assurance of adequate resources for enforcement in proposed regulatory regimes. Thus the document sketches a position that laws must be enforceable to be legitimate. However one respondent observed that Canadian bodies of water exceed the capacity of enforcement agencies to effectively enforce all boating laws. Evidently, this situation does not negate the utility of regulations in the boating environment since Canada has not left this sphere unregulated. Two respondents observed that marine law enforcement is largely centred in Ontario and in particular Southern Ontario and the Great Lakes. Six respondents identified the RCMP, five identified the provincial forces (OPP and Sûreté de Québec) and four identified municipal police departments as the main enforcers of boating regulations. Two respondents explained that persons designated by the minister can also apply small vessel regulations. This suggests an opportunity to address funding concerns raised by respondents. Respondents explained that limited resources of police departments have contributed to a deficit in personnel to apply existing boating laws. Federal funds to address the social costs of drowning could support not only existing enforcement agencies but additional ministerially designated entities. Two respondents stated that the Coast Guard does not play an enforcement role and one of these observers believed that the Coast Guard should be granted some responsibility in that domain. References: 1. Rice, P. L. & Ezzy, D. Qualitative Research Methods: A Health Focus (Oxford University Press, South Melbourne, 1999). 2. Labonte, R. & Little, S. (Registered Nurses Association of British Columbia, Vancouver, 1992). 3. Privy Council. (Government of Canada). 179

181 180

182 APPENDIX F: Key Informant Interviews with Canadian Stakeholders Interview Guide By N. Lamptey, MPH P. Groff, PhD 181

183 Questions for Most Respondents 1. Would you support the creation of legislation mandating the use of personal flotation devices in recreational water craft? Why, Why not? 2. What factors do you think must develop to promote PFD legislation? For example, Emergence of an advocacy figure for PFD legislation? Public pressure to create legislation? Epidemiological evidence for legislation? A high-profile event influencing cultural attitudes on drowning prevention? Please explain. 3. What barriers do you think Canada would face in trying to draft PFD legislation. For example, Describing the drowning problem from recreational boating Developing a consensus on the need for legislation Placing drowning prevention on the policymaking agenda Managing conflict about national or state jurisdiction over PFD legislation Please explain. 4. Does Canada have a particular cultural context that facilitates or hinders injury prevention legislation? For example A strong state public health infrastructure Cultural attitudes towards personal freedom Please explain. 5. What is your overall assessment of the prospects for PFD legislation? 6. In the next two years, where do you expect Canada to be in the policy creation process for PFD legislation? Researching the problem of drowning Communicating the nature of the problem to the public and policy makers Persuading key figures to act on drowning prevention Implementing and enforcing PFD legislation Evaluating the results of PFD legislation Promoting replication of PFD legislation in other jurisdictions 182

184 Role Specific Questions Who would be responsible for PFD legislation enforcement? What would be the most appropriate form of legislation? What are the consequences of moving too quickly for legislation? Who are the key actors with influence? Does Canada s federalist character affect the prospects for legislation? Will legislation have to cross jurisdictions? Is there momentum for regulation of PFDs? Is there a window of opportunity for creating legislation? Is drowning prevention on the agenda of policymakers? Why/Why not? Is legislation the appropriate tool for drowning prevention? Has the problem of boat related drowning been well described? Is there an aspect of the case for legislation that has not been made? Do information channels exist to communicate a concerted message for legislation to policy makers? To the public? To recreational boaters? Do stakeholders have a forum to communicate with each other? What does it cost to rescue individuals in small vessels at risk of drowning? Should there be cost-sharing for the use of PFDs? Who should participate in the division of costs? 183

185 184

186 APPENDIX G: Opinion Poll Results By P. Groff, PhD J. Ghadiali, MA 185

187 Custom Research Canadian Public Opinion Poll In order to understand present public attitudes in Canada regarding the notion of legislation requiring recreational boaters to wear a PFD, SMARTRISK conducted an opinion poll with Canadians. Since it is clear that PFD wear rates and attitudes towards PFDs are strongly related to boater age and the type of recreational boating activity undertaken, the research instrument was designed in such a way as to explore attitudes towards legislation for various ages of boaters and various types of watercraft. Methodology Telephone Interview A number of research methodologies were considered for the opinion poll. However, it was decided that telephone interviewing, using a custom research supplier, was the most cost-effective and timely option. Consideration was given to using an Omnibus in which the costs of research are shared among a number of clients, each with research questions on a different topic. While this method is considerably less expensive than custom research, it is also less flexible and could not accommodate the number of opinion poll survey questions we wished to include. Marketing Research Field Supplier SMARTRISK worked with an independent marketing research field supplier called Network Research Field Services who conducted and tabulated the telephone interview on our behalf. This firm is a national data collection company with offices in Toronto and Montreal and a call-centre in Montreal. This firm was selected for a number of reasons, including the fact that they conduct computer-assisted telephone interviewing (CATI) which minimizes interviewer errors and speeds up data processing. This type of interviewing is particularly effective for complicated surveys with numerous skip patterns in a survey (meaning that respondents are asked different questions based upon the responses they have provided). CATI surveys are pre-programmed so that the interviewer automatically sees the next appropriate survey question on his or her computer screen based upon answers the respondent has already provided. The fact that Network Research Field Services has a bilingual call-centre is also an asset when conducting a national survey. The call-centre interviewers are trained to handle all types of interviews in both official languages across Canada and they were able to provide French translations of questionnaires and English translations of French verbatims. 186

188 In addition, this firm uses a number of quality control measures to ensure high quality results, including survey pre-testing, project briefings, practice interviews, and monitoring by study supervisors and the call-centre manager. Questionnaire The survey was designed to be approximately 15 minutes in length and includes topics such as: current boating participation and PFD usage awareness of new PFD designs level of support or opposition to PFD legislation for various ages and types of watercraft probable compliance with PFD legislation (if it were enacted) for various types of watercraft demographics A copy of the opinion poll questionnaire is appended to this report. Participants Sample Selection In order to attain a representative sample of Canadians aged 18 and over (including all provinces and territories), households were randomly selected using Random Digit Dialing (RDD) sampling. A disproportionate sample was used to decrease the margin of error in Canada s smallest provinces and territories, although the regions were weighted back to their true proportion of the Canadian population for analysis. Thus, quotas were developed to over-represent the population of some provinces/territories (Nunavut, Northwest Territories, Yukon, Prince Edward Island, New Brunswick, Newfoundland and Labrador, Nova Scotia, Manitoba, and Saskatchewan). Sample Size and Composition In total, the telephone survey was administered to a total of 1,009 Canadians aged 18 and over between February 28 h and March 10, The margin of error for this sample size is ±3.1 percentage points, at a 95 percent level of confidence. (The margin of error is higher for regional and demographic sub-samples.) The composition of the sample (age, sex, urban/rural residence) is compared to the composition of Canada s population as a whole in the graphs that follow (based on statistics from Statistics Canada s website 187

189 Figure 5 - Age Composition of Sample Vs. Canadian Population Aged 15 and Over / % 14% Age % 31% 36% 24% % 13% Sample Canada 0% 20% 40% 60% 80% 100% Percentage As shown in the graph above, the research sample is comprised of a disproportionate number of respondents in the and age categories, and slightly under-represents those under the age of 25 and those 65 and over. However, the vast majority of drowning victims in Canada fall within the and age groups, so it is appropriate that the views of respondents from these age groups are slightly over-represented. 188

190 Figure 6 - Gender Composition of Sample Vs. Canadian Population Aged 15 and Over Sample (Ages 18+) Canada (Ages 15+) Female 59% Male 41% Female 50% Male 50% As the graphs above illustrate, the research sample slightly over-represents the female population, which is common in marketing research studies without gender quotas. However, this over-representation of female opinions should be kept in mind in interpreting results since both this research study and past research suggests that females are typically slightly more supportive of the notion of PFD legislation versus males. The shown below, the research sample is slightly more urban than the Canadian population as a whole. This should be taken into account when the results are analyzed since urban and rural residents frequently hold differing views, and this may be the case with the topic of PFD legislation Figure 7 - Urban/Rural Distribution of Sample Vs. Canadian Population Sample 86% 14% Canada 78% 22% 0% 20% 40% 60% 80% 100% Percentage Urban Rural 189

191 The unweighted and weighted sample sizes are shown in the map below. A minimum of 50 respondents were interviewed from each province/territory, although the sample was weighted to reflect the true distribution of population across the regions and territories of Canada. The responses of some smaller regions are grouped together for the purposes of analysis: Prairies (Alberta, Saskatchewan, Manitoba), Atlantic Provinces (New Brunswick, Prince Edward Island, Nova Scotia, Newfoundland and Labrador). However, since the weighted sample size of the North (Yukon, Northwest Territories, Nunavut) is too small for any meaningful analysis (N=3), throughout the report, the unweighted data for the Northern territories (Yukon, Northwest Territories, Nunavut) will be presented. Figure 8 - Weighted and Unweighted Sample Sizes Across Canada W: N=5 U: N=51 W: N=1 U: N=50 W: N=129 U: N=10 0 W: N=1 U: N=52 W: N=93 U: N=75 W: N=34 U: N=51 W: N=1 U: N=50 W: N=38 U: N=50 W: N=373 U: N=250 W: N=248 U: N=127 W: N=19 U: N=5 1 W = Weighted Sample U = Unweighted W: N=26 U: N=50 W: N=32 U: N=52 Table 1 - Weighted and Unweighted Sample Sizes Across Canada BC AB SK MB ON QC NB NS PE NL YK NT NU Unweighted Sample Weighted Sample