{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T18:57:02Z","timestamp":1774465022583,"version":"3.50.1"},"reference-count":18,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T00:00:00Z","timestamp":1774396800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Drowning remains a leading but neglected cause of injury-related death worldwide. While some forms of regulation, such as pool fencing, have demonstrated clear effectiveness, less is known about the broader influence of legislation and regulatory measures on drowning mortality. This study provides the first global analysis of drowning\u2010prevention legislative coverage, utilising secondary analysis of cross-sectional data, to explore country\u2010level associations between legislation\/regulation and drowning rates. Utilising the World Health Organization (WHO) Global and Regional Status Reports on Drowning, alongside economic, environmental, governance, and health-system indicators, we assembled a cross-section of 127 countries. We estimated several models that included the full set of national legislation indicators and nine covariates, complemented by a random-forest analysis. Across specifications, we observed no consistent association at the country level between the presence or count of legal measures and lower drowning mortality. By contrast, structural determinants were repeatedly implicated. For example, in our main models, higher per-capita alcohol use was positively associated with drowning mortality (IRR\u2009=\u20091.18, 95% CI [0.99, 1.40]), while better access to safe water\/sanitation was protective (IRR\u2009=\u20090.84, 95% CI [0.71, 0.99]). Exploratory interactions examining the influence of institutional\/governance capacity suggested that public-pool fencing and, more tentatively, alcohol restrictions near water, were more protective where institutional capacity was stronger. Our findings support the idea that legalisation\/regulation is likely to be most effective when embedded within broader investments in infrastructure, service delivery, and enforcement capacity.<\/jats:p>","DOI":"10.1371\/journal.pgph.0005337","type":"journal-article","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T17:37:17Z","timestamp":1774460237000},"page":"e0005337","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["An analysis of global legislation and regulation related to drowning prevention"],"prefix":"10.1371","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3497-3137","authenticated-orcid":true,"given":"Ryan","family":"Essex","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jagnoor","family":"Jagnoor","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,3,25]]},"reference":[{"issue":"4","key":"pgph.0005337.ref001","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1076\/icsp.10.4.227.16783","article-title":"Prevention of drowning in home pools--lessons from Australia","volume":"10","author":"I Scott","year":"2003","journal-title":"Injury Control and Safety Promotion"},{"key":"pgph.0005337.ref002","doi-asserted-by":"crossref","DOI":"10.62977\/84910","article-title":"Analysis of unintentional drowning in Australia 2002-2022: progress, challenges, and data to inform prevention","author":"L Miller","year":"2023"},{"issue":"6","key":"pgph.0005337.ref003","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1136\/injuryprev-2014-041169","article-title":"Effectiveness of the 2005 compulsory personal flotation device (PFD) wearing regulations in reducing drowning deaths among recreational boaters in Victoria, Australia","volume":"20","author":"L Bugeja","year":"2014","journal-title":"Inj Prev"},{"issue":"3","key":"pgph.0005337.ref004","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1080\/03088830110048880","article-title":"Maritime legislation: new areas for safety of life at sea","volume":"28","author":"KX Li","year":"2001","journal-title":"Maritime Policy & Management"},{"key":"pgph.0005337.ref005","unstructured":"Essex R, Beri D, Jagnoor J. A scoping review of the literature on effectiveness of legislative and regulatory measures to prevent drowning. Under review."},{"issue":"1","key":"pgph.0005337.ref006","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1136\/injuryprev-2019-043464","article-title":"Association of designated open water swim area regulations and open water drowning rates","volume":"27","author":"L Quan","year":"2021","journal-title":"Inj Prev"},{"key":"pgph.0005337.ref007","article-title":"Global status report on drowning prevention","author":"World Health Organization","year":"2024"},{"key":"pgph.0005337.ref008","unstructured":"World Health Organization. Regional status report on drowning in South-East Asia. 2021."},{"key":"pgph.0005337.ref009","unstructured":"World Health Organization. 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Global report on drowning: preventing a leading killer. 2014."},{"issue":"4","key":"pgph.0005337.ref015","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1076\/icsp.10.4.227.16783","article-title":"Prevention of drowning in home pools\u2013lessons from Australia","volume":"10","author":"I Scott","year":"2003","journal-title":"Injury Control and Safety Promotion"},{"issue":"2","key":"pgph.0005337.ref016","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1057\/jphp.2013.51","article-title":"Changing life jacket wearing behavior: an evaluation of two approaches","volume":"35","author":"T Mangione","year":"2014","journal-title":"J Public Health Policy"},{"issue":"1","key":"pgph.0005337.ref017","doi-asserted-by":"crossref","first-page":"10916","DOI":"10.1038\/s41598-025-95486-w","article-title":"Global burden of drowning and risk factors across 204 countries from 1990 to 2021","volume":"15","author":"Z Xie","year":"2025","journal-title":"Sci Rep"},{"issue":"4","key":"pgph.0005337.ref018","article-title":"Change in global burden of unintentional drowning from 1990 to 2019 and its association with social determinants of health: findings from the Global Burden of Disease Study 2019","volume":"13","author":"H Tan","year":"2023","journal-title":"BMJ Open"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0005337","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T17:37:24Z","timestamp":1774460244000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0005337"}},"subtitle":[],"editor":[{"given":"Alex","family":"Joseph","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,3,25]]},"references-count":18,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3,25]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0005337","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,25]]}}}