Table 1

Effectiveness of drowning interventions using education (included studies)

Study characteristics (quality)Intervention descriptionKey elementsMeasuresResults
 Bennett et al, 199917: Life Vest community-wide awareness campaign and evaluation

Evidence level: III-3
No control

Parents of children 1–14 years
Media awareness campaign and evaluation county-wide over three summers 1992–1994 (print, promotions and special events). Life Vest retail programme (discount and loan options)
Telephone surveys at baseline (n=332), twice during (n=400 each) and once after (n=480).
“Wear a life vest” “Supervise children around water”
“Learn guidelines for water safety”


Evaluation: recall of campaign messages during and 12 months after campaign
Self-report knowledge surveys by telephone.

Life vest ownership and use at beach/pool/boats.

Drowning fatality rates. 3 years prior to vs 3 years during campaign.

Other variables: Demographics, parent confidence. child swimming ability, perceived susceptibility of child to drowning, perceived life vest efficacy.
Life vest ownership 11% (95% CI 3% to 17%).*
Life vest use (OR=1.6; 95% CI 1.1 to 2.5) (self-reported).*

Drowning fatalities: 12 deaths in 3 years among 1–14 years prior to campaign, and 8 deaths in 3 years during campaign (inc bathtubs).†

Life vest use significantly associated with:

child ownership of a vest (OR=2.6 95% CI 1.5 to 4.4)
parent <40 years (OR=2.3 95% CI 1.5 to 3.6)
child's poor swimming ability (OR=1.6 95% CI 1.1 to 2.4)
parent confident fitting a vest (OR=3.2 95% CI 1.5 to 7)
parent recalling campaign (OR=1.6 95% CI 1.1 to 2.5).
Gresham et al, 200119 Injury prevention curriculum delivered in schools—water safety component only
Randomised controlled trial (RCT)
Evidence level: II

Intervention vs no intervention

Grades 1–3
(6–9 years)
Integrated curricula and evaluation on injury and risk behaviour. Classroom delivery over 6-week period in fall 1997. 15 schools (8 intervention and 7 control), randomly allocated to control (n=1126) or Intervention (n=851) matched on SES, reading scores and race.Trained teachers and school nurses delivered 6-week injury prevention curriculum. Water safety one of 6 topics.

Self-report pre- and postintervention surveys.
Self-report knowledge surveys completed at school within 10 days.

Knowledge of hazard of brain and spinal cord injury in different bodies of water.
Knowledge of safety rules.Awareness of preventing water-related injury and drowning.
Individual responsibility in prevention.
Water safety knowledge improved from pre- to postintervention (p<0.01 for each grade).*

Note: self-report rather than injury reduction or observation.
Contamination possible through community activities and media.
Posner et al, 200422 Injury prevention home-based safety information for parents attending ED
Evidence level: II

Intervention vs no intervention

Parents of children <5 years
Child presentations to ED with unintentional injury sustained at home September–December 2001. Randomly assigned to (intervention=49; control=47) Telephone survey 2months after ED visit.Trained RAs delivered to caregivers, usual care (injury focused) vs comprehensive home safety education.
Drowning one of 7 topics), a free home safety kit (a non-slip bath decal was the only water safety related device).
Knowledge of caregivers surveyed on 51-item multichoice home safety questionnaire to obtain overall safety score. (submersion category=4 items).

Other: demographics and injury characteristic information.
No significant improvement (p>0.05) observed for drowning prevention.†

Significant improvement (p<0.01) in overall safety scores in intervention group vs control group, attributed to increase in use of safety devices (p<0.001).*

Self-reported use.
  • *Statistically significant association.

  • †No association not statistically significant.

  • ED, emergency department; SES, socioeconomic status.