The attitude-practice gap revisited: risk reduction beliefs and behaviors among owners of residential swimming pools.

Complete pool fencing and effective bystander resuscitation are both believed to reduce the risk of childhood drowning. The relationship between support for, and prevalence of, a complete pool barrier and current cardiopulmonary resuscitation certification was investigated among an equal probability sample of 795 owners of residential swimming pools in Sacramento County, California. Only 50% (95% confidence interval [CI] 44%, 56%) of respondents who favored a cardiopulmonary resuscitation certification requirement for pool owners represented a household with any members so certified. Only 35% (95% CI 26%, 44%) of respondents who endorsed a complete barrier requirement for all pools had a fence surrounding their own pool. Support for a cardiopulmonary resuscitation requirement was associated with a modestly higher prevalence of current cardiopulmonary resuscitation certification (46% vs 33%, difference = 13%, 95% CI for difference 2%, 24%). Endorsement of a pool barrier requirement was associated with a substantially higher prevalence of complete pool fencing (35% vs 7%, difference = 28%, 95% CI for difference 19%, 37%). The proportion of the pool-owning population endorsing these risk reduction behaviors is much larger than the proportion actually adopting them. The results suggest that an effective pool drowning-prevention program will rely primarily on legislative approaches, with health education serving as a useful adjunct.