Drowning prevention knowledge and risk behaviors among children and adolescents in China: a cross-sectional study

Background: Drowning is a leading cause of death among children and adolescents worldwide, with China being one of the most affected countries. Despite relatively high levels of drowning prevention knowledge, many children and adolescents continue to engage in risky water-related behaviors. This study aimed to assess drowning prevention knowledge, the prevalence of risky behaviors, and demographic factors associated with these outcomes among children and adolescents in Ningbo, China. Methods: A cross-sectional survey was conducted with 4,759 adolescents from schools across Ningbo, China. Data were collected using a structured questionnaire that assessed sociodemographic characteristics, drowning prevention knowledge, and risky behaviors related to water activities. Statistical analyses, including chi-square tests and multivariate logistic regression, were used to identify factors influencing drowning knowledge and behavior. Results: The study found that while most participants (over 90%) demonstrated awareness of basic drowning prevention principles, such as the importance of adult supervision and not swimming alone, a significant proportion still engaged in risky behaviors. Males, older adolescents, students with non-local household registration, and boarding students exhibited significantly lower levels of drowning prevention knowledge. Multivariate logistic regression analysis indicated that males were more likely to engage in drowning-related risky behaviors, whereas mastery of drowning prevention knowledge served as a protective factor against such behaviors. Conclusion: Although awareness of drowning prevention is high, risky behaviors persist, particularly among high-risk groups such as males, students with non-local household registration. Targeted interventions that combine knowledge enhancement with behavioral and social strategies are needed to bridge the gap between awareness and safe practices. Future programs should prioritize practical safety education, swimming skills training, and community support to reduce drowning risk among vulnerable youth populations.