Association between swimming lessons and drowning in childhood: a case-control study

Disparities in unintentional drowning fatalities in Texas, USA, 1999-2020

BACKGROUND

Drowning is the third-leading cause of unintentional injury death worldwide. Although the USA as a whole bears a heavy burden, with approximately 4000 drowning fatalities annually, Texas stands out as a high-risk state for drowning due to its large population, suitable climate for year-round aquatic activities and availability of water-related recreational opportunities.

METHODS

Using mortality data from the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research online database, this retrospective, cross-sectional study overviews the magnitude and patterns of fatal unintentional drownings among Texans from 1999 to 2020.

RESULTS

Over the 22-year period, 7737 Texans died from unintentional drowning. An average of 352 drowning deaths occurred annually, with a rate of 1.4 deaths per 100 000 population. The highest proportion of unintentional drownings occurred in natural water settings (eg, lakes, ponds or rivers), accounting for 40% of fatal drownings. Children aged 1-4 years had the highest drowning death rate compared with all other age groups. Male Texans had a drowning death rate three times higher than that of female Texans. Black Texans had a higher drowning death rate than White Texans and Asian or Pacific Islander Texans.

CONCLUSIONS

Drowning remains a significant public health issue in Texas. Data on high-risk groups and settings should be used to strengthen drowning prevention efforts and policy initiatives and encourage more research to address the multifaceted factors contributing to drowning.

Knowing how to swim and drowning prevention in children aged 10 to 14 years. Systematic review

PURPOSE

Drowning is 1 of the 10 leading causes of death due to unintentional injuries in children and adolescents worldwide. Knowing how to swim has been traditionally associated with water safety. However, its conceptualization may vary across studies, leading to different measurements and effects on the risk of drowning. This review sought to understand the current state of scientific evidence associating both issues.

OBJECTIVES

To identify conceptualizations of knowing how to swim and to analyze the evidence indicating whether "knowing how to swim" may be a protective or a risk factor for unintentional drowning in children aged 10 to 14 years.

METHOD

A systematic review of observational etiology studies was conducted, considering original peer-reviewed research published up to the year 2020. Databases including PubMed, Cochrane Central, Tripdatabase, Science Direct, Epistemonikos, Bvs and Bireme were searched for studies associating swimming skills as a risk or a protective factor for drowning (10-14 years). Study quality was assessed, and quantitative data were synthesized (without performing a meta-analysis).

RESULTS

A total of 6,508 results were identified, with only 6 studies meeting the criteria for inclusion in the final cohort. It was evidenced that the exclusive possession of swimming skills, without a concurrent understanding of water safety, is associated with increased exposure to aquatic environments. Consequently, this may increase the risk of drowning.

CONCLUSIONS

Among children aged 10 to 14 years, there is insufficient evidence regarding whether knowing how to swim serves as a protective factor against drowning compared to not knowing how to swim.

PRACTICAL APPLICATIONS

The insufficiency of evidence and a lack of consensus in the conceptualization of swimming as a form of knowledge underscores the need for further research. Such research is crucial for informing investments in drowning prevention interventions, particularly during early adolescence.

Conceptual definition for drowning prevention: a Delphi study

BACKGROUND

Expanding support for drowning prevention is evidenced by interlinked Resolutions at the United Nations (2021) and World Health Assembly (2023). While progress has accelerated, a universally agreed definition for drowning prevention remains absent. Here, we aim to develop a conceptual definition of drowning prevention using the Delphi method.

METHODS

First, we conducted a document review to guide our development and consensus-building process. Then, we formed an advisory group and recruited participants with diverse expertise to contribute to Delphi-method surveys. In the first round, participants selected from draft concepts to build a definition and delineate between the terms drowning prevention and water safety. In the second round, we presented a codeveloped definition, and three statements based on first-round findings. We then sought participant feedback where ≥70% support was considered consensus-based agreement.

RESULTS

Participants (n=134) were drawn from community (7.46%), policy (26.87%), research (40.30%) and technical backgrounds (25.37%), and low-income and middle-income countries (38.06%). In the first- round, half (50.74%) disagreed with the proposition that drowning prevention was synonymous to water safety, while 40.30% agreed. The second- round achieved consensus-based agreement (97.27%) for the definition: Drowning prevention is defined as a multidisciplinary approach that reduces drowning risk and builds resilience by implementing evidence-informed measures that address hazards, exposures and vulnerabilities to protect an individual, community or population against fatal and non-fatal drowning.

CONCLUSION

The Delphi method enabled the codevelopment of our conceptual definition for drowning prevention. Agreement on the definition forms the basis for strengthened multisectoral action, and partnerships with health and sustainable development agendas. Defining drowning prevention in terms of vulnerability and exposure might increase focus on social determinants and other upstream factors critical to prevention efforts.

Wilderness Medical Society Clinical Practice Guidelines for the Treatment and Prevention of Drowning: 2024 Update

The Wilderness Medical Society convened a panel to review available evidence supporting practices for acute management of drowning in out-of-hospital and emergency care settings. Literature about definitions and terminology, epidemiology, rescue, resuscitation, acute clinical management, disposition, and drowning prevention was reviewed. The panel graded available evidence supporting practices according to the American College of Chest Physicians criteria and then made recommendations based on that evidence. Recommendations were based on the panel's collective clinical experience and judgment when published evidence was lacking. This is the second update to the original practice guidelines published in 2016 and updated in 2019.

Hypothesized mechanisms of death in swimming: a systematic review

BACKGROUND

The study aims to update the specific classification of mechanisms of death in swimming and to demonstrate these categories are reasonable, by analyzing more characteristics of death cases, evaluating the available evidence and determining their quality.

METHODS

Original articles were queried from PubMed, Web of Science, Embase databases, Cochrane Library, and Scopus. Included studies, which were evaluated as level 4 evidence or higher according to the Oxford Centre for Evidence-Based Medicine, discussed hypothesized mechanisms of death in swimming. Parameters analyzed in this study included decedents' characteristics, outcome measures, findings, methodological index for non-randomized studies (MINORS), and critical evaluation of each study classified by death mechanism.

RESULTS

A total of twenty-five studies were included for further analysis: fourteen were associated with cardiovascular diseases, two were about cerebrovascular diseases, two contained respiratory diseases, seven were about hazardous conditions and three contained other drownings, which provided evidence for mechanisms of death.

CONCLUSIONS

It is found that cardiovascular disease is the main cause or contributing factor of death in swimming. Respiratory diseases and cerebrovascular diseases are difficult to be definitive mechanism categories due to insufficient evidence. Hazardous conditions appear to be one of the possible risk factors because there are more cases of deaths from unsafe environments in swimming, but further statistics and research are still needed to support this view. Our study may have important implications for developing potential prevention strategies for sports and exercise medicine.

TRIAL REGISTRATION

PROSPERO ID (CRD42021267330). Registered Aug 13th 2021.

Caregiver water safety knowledge and views of toddler water competency

BACKGROUND

Drowning is the leading cause of death for toddlers. When caregivers are knowledgeable about water safety, they can provide the best protection against drowning. The aim of this study is to survey caregivers of toddlers to better understand factors associated with water safety knowledge, attitudes about pool supervision, and toddler water competency skills.

METHODS

An online survey of 650 parents/caregivers of 1-4-year-old toddlers asked about the caregiver's water safety and swimming background and views on pool supervision. Surveys included a true/false section of ten basic water safety knowledge questions. Caregivers also reported on toddler swim lesson history and whether their toddler could perform six standard water competency skills. Linear regression identified factors predictive of water safety knowledge.

RESULTS

On average, caregivers selected the correct answer on six out of ten water safety knowledge questions. Water safety knowledge was predicted by the relationship of the caregiver to the toddler, gender, race, education, prior CPR training, caregiver swim capability, and reported pool supervision style. On average, caregivers reported that their toddler could perform half of the water competency skills. The majority of the toddlers had taken swimming lessons. One third of caregivers believed that after a toddler has had swimming lessons, they don't need to be watched as closely when they are in a pool.

CONCLUSIONS

Findings suggest that water safety knowledge is poor and that there are misconceptions about toddler supervision needs. Efforts are needed to improve water safety knowledge and to change perceptions about supervision among caregivers of toddlers.

Finding your lane: experiences and beyond for adults learning to swim

The purpose of this study was to examine experiences and impacts from participating in an adult swim instruction program. We conducted 20 semi-structured interviews with adults aged 18 + who had participated in an adult learn to swim program. Participants were interviewed through a virtual platform using a semi-structured protocol. Data were coded individually by each member of the research team for emerging thematic outcomes with final consensus among all those involved in the analysis. Participants expressed adult learn to swim programs had an effect in three areas: (a) life affordance, (b) emotional affect, and (c) interpersonal relationships. Public health experts and aquatics leaders should consider targeting programs aimed at teaching adults to learn how to swim, especially to marginalized individuals and those who did not grow up in the United States. The authors highlight how these programs can create life affordances well beyond lap swimming and even water safety.

Effect of baby swimming lessons on infants' avoidance of bodies of water

Despite the popularity of infant swimming programs, no evidence exists to determine whether they influence infants' judgments and behavior when confronted with bodies of water. We conducted two separate studies examining if the total number of swimming sessions an infant participated in predicted whether they avoided a body of water they could enter via an edge (Study 1-Water Cliff: n = 101 infants) or a slope (Study 2-Water Slope: n = 77 infants). The results revealed a significant interaction between number of sessions and type of entry into the water. Infants who participated in 10 or more sessions were more likely to avoid falling on the edge leading into the water but entered the water significantly more if they could access it via a slope. These findings suggest that while experience in baby swimming programs can promoted more adaptive behaviors on drop-offs leading into bodies of water, sloped entries may heighten drowning risks for young children with greater familiarity with water. Because we tested the two groups of infants in different countries, further research is warranted to determine if cultural differences in child rearing practices or variations in the content and/or teaching of the swimming programs might explain these intriguing findings.

Sociodemographic factors associated with paediatric out-of-hospital cardiac arrest: A systematic review

BACKGROUND

Paediatric out-of-hospital cardiac arrest (POHCA) is associated with poor survival and severe neurological sequelae. We conducted a systematic review on the impact of sociodemographic factors across different stages of POHCA.

METHODS

We searched MEDLINE, EMBASE, and Web of Science from database inception to October 2022. We included studies examining the association between sociodemographic factors (i.e., race, ethnicity, migrant status and socioeconomic status [SES]) and POHCA risk, bystander cardiopulmonary resuscitation (CPR) provision, bystander automated external defibrillator (AED) application, survival (at or 30-days post-discharge), and neurological outcome. We synthesized the data qualitatively.

RESULTS

We screened 11,097 citations and included 18 articles (arising from 15 studies). There were 4 articles reporting on POHCA risk, 5 on bystander CPR provision, 3 on bystander AED application, 13 on survival, and 6 on neurological outcome. In all studies on POHCA risk, significant differences were found across racial groups, with minority populations being disproportionately impacted. There were no articles reporting on the association between SES and POHCA risk. Bystander CPR provision was consistently associated with race and ethnicity, with disparities impacting Black and Hispanic children. The association between bystander CPR provision and SES was variable. There was little evidence of socioeconomic or racial disparities in studies on bystander AED application, survival, and neurological outcome, particularly across adjusted analyses.

CONCLUSIONS

Race and ethnicity are likely associated with POHCA risk and bystander CPR provision. These findings highlight the importance of prioritizing at-risk groups in POHCA prevention and intervention efforts. Further research is needed to understand underlying mechanisms.

A systematic review of demographic and background factors associated with the development of children's aquatic competence

BACKGROUND

Globally, drowning is a leading cause of unintentional injury and death among children. Teaching aquatic competencies (swimming skills and water safety knowledge) to children has been proposed as a prevention strategy. In Australia, however, many children are not meeting standard aquatic competency benchmarks. Exploration of the connection between demographic and background factors and aquatic competencies could provide insight into why differences in acquisition of aquatic knowledge and skills occur.

MAIN BODY

A systematic literature review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was performed to identify studies that reported on the association between demographic and background factors and aquatic competencies. Nine databases were searched for English language peer-reviewed studies published since 2000. Fourteen studies fulfilled all inclusion criteria. Studies were quasi-experimental or cross-sectional in design, which is considered quality level III-2 or IV, respectively, on the National Health and Medical Research Council Evidence Hierarchy. Study quality was moderate, and risk of bias was high. While aquatic competencies can be taught, this review found that factors including age, gender, geographic residence, medical conditions/disabilities, socioeconomic status, and swimming frequency were significantly associated with the demonstration and/or acquisition of aquatic competencies.

CONCLUSION

This review provides insight into demographic and background factors that are significantly associated with the development of aquatic competence. Whilst further investigation is required to increase the evidence base, these findings may assist in tailoring swimming and water safety programs to accommodate those at-risk of not achieving age-appropriate aquatic competencies.

Epidemiology, clinical aspects, and management of pediatric drowning

Drowning is the third leading cause of injury death in the pediatric population worldwide, with incidence peaking among those aged 1-4 years and again in adolescence.The purpose of this commentary is to review the basic pathophysiology of drowninginjury and factors that affect the outcome, such as submersion and hypothermia. We also discuss principles of prehospital and in-hospital management, comprising resuscitation and stabilization, administration of oxygen and intravenous liquids, and central reheating.Even though the mortality rate has decreased in recent years, further investments and safety measures are needed to prevent child drowning deaths.

Effects of Exposure to Formal Aquatic Activities on Babies Younger Than 36 Months: A Systematic Review

This systematic review investigated the possible effects of exposing infants to formal activities in aquatic environments. A literature search of eight databases was concluded on 12 December 2022. Studies were eligible if they: (i) focused on 0-36 months of age infants, (ii) addressed the exposure of infants to formal aquatic activities, and (iii) compared the 'same condition of aquatic exposure with the control' or 'before and after exposure'. The PRISMA protocol was used. Articles considered for inclusion (n = 18) were clustered in the health, development, and physiological outcome domains. The results show that research is focused on indoor activities, mainly in baby swimming programs and baby aquatic therapy interventions. Swimming and aquatic therapy practices are generally safe for babies' health, and there are benefits to preterm and newborns exposed to aquatic therapy once the physiological parameters are maintained in normal and safe patterns. A positive effect is also suggested in general gross and fine motor skills, visual motion perception, cognitive flexibility, and response selection accuracy for infants who participated in aquatic programs. Further investigation with high-quality experimental designs is required to establish the effect of exposure of infants to formal aquatic activities (Systematic Review Registration: CRD42021248054).

Evaluation of the First Lap learn to swim voucher programme: protocol

INTRODUCTION

Swimming skills are an evidence-based component of drowning prevention. However, in Australia, many children miss out on learn to swim education. Voucher programmes may reduce swimming lesson cost and increase participation, especially among priority populations. The First Lap voucher programme provides two New South Wales state government-funded $100 vouchers for parents/carers of preschool children to contribute to swimming lesson costs. This evaluation aims to determine the effectiveness of the programme in meeting objectives of increasing preschool-aged children participating in learn to swim programmes and building parent/carer knowledge and awareness of the importance of preschool-aged children learning to swim.

METHODS AND ANALYSIS

A programme logic model was developed to explain the inputs, activities and intended outputs, and outcomes, which guided this mixed-methods evaluation design of quantitative and qualitative analysis within an impact/outcome evaluation. Baseline sociodemographic registration data will be provided by the parent/carer of each child participant and linked to swim school provider data on voucher redemption. Data will be collected on voucher use, knowledge, and attitudes to swimming lessons at registration and across two surveys. An economic evaluation will assess programme cost-effectiveness.

CONCLUSION

This evaluation will determine impacts on participation rates in learn to swim programmes, particularly within priority populations. It will examine whether the programme has influenced attitudes and motivations of parents and carers toward learn to swim programmes and water safety, whether the programme has impacted or enhanced the ability of the aquatics sector to deliver learn to swim programmes and assess its cost-effectiveness.

Unintentional Drownings in Pediatric Populations: Injury Prevention in the Post-COVID-19 Era

Unintentional injuries are one of the leading causes of death in Americans. A large proportion of these deaths are attributable to accidental drownings and falls, both of which oftentimes take place in or around swimming pools and swimming pool-related apparatuses such as diving boards. The American Academy of Family Physicians (AAFP) has reported drowning incidents as the most common injury-related cause of death in children ages one to four years. Although the AAFP has outlined steps to take to prevent drownings, there has not been a current large-scale study illustrating the effectiveness of these strategies with regard to their effect on the prevalence of swimming pool drowning cases in the last 10 years. Thus, we aim to utilize the National Electronic Injury Surveillance System (NEISS) database to uncover these rates, which can ultimately help aid in the reevaluation of current recommended guidelines.

Impact of caregiver swimming capability on perceptions of swimming pool supervision of toddlers

BACKGROUND

Drowning is a leading cause of unintentional injury-related death for toddlers within the USA. Keeping toddlers within arm's reach while swimming is recommended, yet many caregivers do not. Possibly, caregivers' attitudes are shaped by their expectations about whether they could quickly save a child. The aims of this study are to 1) explore caregivers' views of arm's reach pool supervision in various scenarios and 2) understand whether perceptions of arm's reach pool supervision are impacted by the caregiver's self-reported capability to swim the length of a standard pool.

RESULTS

Caregivers generally showed agreement with arm's reach pool supervision; however, arm's reach supervision was viewed as less necessary when a toddler was in shallow water, wearing a flotation device, or with an older child or teen. There was a significant effect of caregiver swimming capability on perceptions of arm's reach pool supervision, with non-swimmers and the strongest swimmers showing more positive perceptions of arm's reach pool supervision than caregivers reporting poor swimming capability. Female caregivers showed significantly more agreement with arm's reach pool supervision compared with male caregivers. Grandparents and parents showed significantly more agreement with arm's reach pool supervision than siblings.

CONCLUSIONS

Caregivers' views about what constitutes appropriate supervision are impacted by gender, the relationship to the toddler, and the caregiver's swimming capability. Findings suggest that a caregiver's ability to offer close supervision or respond in an emergency may influence their attitudes about what constitutes appropriate supervision. Caregivers may view arm's reach pool supervision as less necessary when additional layers of protection are in place.

Face and Content Validity of the Pictorial Scale of Perceived Water Competence in Young Children

An international group of experts have developed a pictorial tool to measure perceived water competence for children aged from 5 to 8 years old: the Pictorial Scale of Perceived Water Competence (PSPWC). The aim of the present study was to verify the validity of this tool. In the first part of the study, 120 children were interviewed to investigate face validity of the PSPWC to ensure that all pictorial items were understandable. In the second part of the study, 13 scientific and/or pedagogical international experts were invited to assess the tool's content validity via an online survey. Face validity results revealed that children were able to understand and sequence correctly the aquatic situations in 92% of the cases. The average Content Validity Index (CVI) of the PSPWC ranged from 0.88 to 0.95, showing acceptable content validity. Feedback from experts and children resulted in a major improvement of the "exit water" situation and minor improvements concerning some other items. Experts confirmed that the PSPWC was globally appropriate for different countries and cultures, except for the situation "water entry by slide" which was not considered usual practice in some countries. The PSPWC opens up to new fields of research; useful both for the prevention of drowning and for the support of children's aquatic education.

Análisis del riesgo de ahogamiento asociado al entorno acuático y competencia natatoria

Un alto nivel de natación puede ser un factor protector ante el ahogamiento, sin embargo, esta relación todavía no ha sido empíricamente demostrada, en base al nivel de habilidad y entorno acuático. Este estudio diseñó una matriz de riesgo de ahogamiento en base al análisis probabilístico de un cuestionario respondido por 3.181 participantes. Se analizó la ocurrencia de Estrés/Distrés acuático (EDA) en base a 5 niveles de competencia y tres entornos acuáticos: a) Piscina sin olas ni corrientes, b) Lagos, embalses, ríos y playas sin olas ni corrientes, c) Ríos, playas o piscinas con olas y/o corrientes. Los resultados se expresaron en Odds Ratio (OR). El riesgo de EDA superó el OR de 25 en el entorno más peligroso y se incrementó para todos los escenarios conforme la competencia acuática era peor. Tres de cada cuatro nadadores han sufrido EDA y este evento pudo ser un incentivo para mejorar sus competencias acuáticas.

Drowning Accidents in a Spanish Pediatric Intensive Care Unit: An Observational Study for 29 Years

INTRODUCTION

Drowning is one of the most frequent accidents in children. We aimed to describe demographic and epidemiological characteristics of drowned children who required admission to a pediatric intensive care unit (PICU) to identify risk factors to guide possible preventive measures to avoid severe drowning.

METHODS

We conducted an observational study for 29 years (retrospective between 1991 and 2004; prospective between 2005 and 2019) that included all children (0-15 years old) requiring PICU admission after drowning. Data regarding patient characteristics, accident circumstances, and neurological outcomes at PICU discharge were analyzed.

RESULTS

A total of 160 patients were included, with no significant decrease over the study period. There was a predominance of males (75%), young age (60%; 1-5 years), summer months (91.1%; May-September), tourists (14.12 [95% confidence interval, 9.2-21.7] times higher risk of drowning than residents), swimming pool accidents (88.8%), and inadequate supervision (77.9%). The mortality was 18.7%, and 7.5% of admitted children had severe neurological sequelae. The initial resuscitation maneuvers by accident witnesses were incorrect in nearly half of the patients in whom these could be analyzed.

CONCLUSIONS

Emphasis should be placed on implementing preventive measures, focused on the described risk groups, and insisting on adequate supervision, swimming training programs, and training of the general population in safe rescue and cardiopulmonary resuscitation.

Epidemiology of children's swimming competence and water safety

Introduction

The main purpose of this study was to investigate children's swimming competence in primary schools of districts in Vojvodina, Serbia.

Methods

Included subjects were primary school students from first to eighth grade (N = 2,778; male = 1,454, female = 1,324; age = 10.73 ± 2.1 years). We used Swimming Competence Questionnaire to acquire and analyze their swimming experience, non-fatal aquatic events, and demographics. For the statistical analysis, logistic regression and hierarchical multiple regression were used to evaluate if the factors and SC and NFAE were associated. The analyses were carried out by using SPSS® software version 24.0 (SPSS, Inc., Chicago, Illinois, USA).

Results

Families with more income and education generally have children with more swimming competence, experience, knowledge, and skills related to water safety. First step in analysis revealed that gender (β = 0.05, p < 0.01), education level (β = 0.06, p < 0.01) age (β = 0.171, p < 0.01), and family income (β = 0.04, p < 0.01) were significant swimming competence (SC) predictors (R2 = 0.04). Age (OR = 1.15, p < 0.01) was the only significant predictor in Step 1 predicting non-fatal aquatic events (NFAE). In Step 2, variables associated with SC were swimming location (ΔR2 = 0.06, p < 0.01), swimming experience (ΔR2 = 0.16, p < 0.01), swimming accessibility (ΔR2 = 0.05, p < 0.01), and learning experience (ΔR2 = 0.03, p < 0.01) (total R2 = 0.26 to 0.47, p < 0.01). Only a minority of participants reported that they could not swim further than 5 meters using general stroke (37.15%).

Conclusion

National education trainers programs must be prioritized with the primary strategy of transferring knowledge to swimming and water safety. Families with lower income must be included without exceptions. This is perhaps a key factor in preventing NFAE, increasing SC, and increasing water safety.

The Effect of Using Goggles and Snorkel for Aquatic Skills Acquisition in Youth Learn-to-Swim Programs

Our purpose in this study was to examine the effects of using goggles and snorkel during a learn-to-swim program on the aquatic skills of young non-swimmers with fear of water. 40 children volunteered to participate in the study and were randomly divided into two groups: one that used goggles and snorkel (GS) and one that did not (NGS). After four weeks (five sessions per week) of learn-to-swim interventions, both groups improved aquatic skills, but improvements in water entry, back gliding, and prone swimming were greater for the GS than for the NGS group. In contrast, the intervention effect on a blowing bubbles skill was smaller for the GS than for the NGS group. Thus, the use of goggles appears to be more beneficial in a learn to swim program for young swimmers with a fear of water than not using goggles for all lessons other than blowing bubbles.

How University Students Assess Their Water Skills

The aim of this study was to determine the gender differences between students' actual and perceived water abilities, how respondents assess risk in the described situations, and whether there are gender differences for those situations. The cross-sectional study was conducted on 150 students aged 19–20 years (males, n = 88; females, n = 62) from the faculty of sport and physical education, University of Novi Sad. Using calculated frequencies and estimates, students' self-assessment and actual measures of their swimming and survival skills and their perceived risk of drowning are described. Based on the results, Mann-Whitney U tests were applied. The differences between independent variables (gender) were analyzed according to dependent measures (water competency). To determine the significance of the relationship between actual and perceived skills, Spearman-rank correlation coefficients were calculated. The results of this study confirmed gender differences between students' actual and perceived water abilities, and that the male and female students had inaccurate perceptions of their own perceived and real water abilities. Both male and female students, with high precision, assessed their ability to swim long distances (rs = 0.601; rs = 0.694) just as female students assessed their ability to float (rs = 0.698). Male students greatly overestimated their backstroke swimming, while female students underestimated their ability to dive into the water. Both groups overestimated underwater swimming and underestimated their surface dive skill. Also, there was gender differences between students in assessing the risk for described situations.

Individual Determinants as the Causes of Failure in Learning to Swim with the Example of 10-Year-Old Children

Background: The purpose of the present study was to identify which, and to what extent, selected individual determinants of 10-year-old children may limit the final achievement in learning to swim. In view of the above, the research hypothesis was formulated that some children, despite regular attendance at swimming classes, do not achieve the learning outcomes set in the curriculum. The reason for this may be unfavorable (compared to their peers) morphological and functional characteristics, coordination motor abilities, and problems with fear of water. Methods: The study was conducted on a group of 271 students from the third grade of elementary schools who could not swim when they entered the physical education classes at the swimming pool and then participated in at least 25 swimming lessons during the school year. After these classes, the students performed swimming tests, and their somatic and functional characteristics and coordination motor abilities were measured. Results: In 46.1% of the participants, the final achievement level was lower than assumed in the school curriculum. The biggest problem for teachers and students in the initial teaching and learning to swim was the high fear of water, especially among girls. Furthermore, children characterized by lower body height and body weight, a lower sum of three skinfolds, and lower BMI had problems with progress in swimming. Despite the differences, these values did not correlate significantly with the final achievement level in swimming, except for body height in boys. Slower progress in swimming was also associated with lower vital capacity, whereas no relationship was found between final achievement level in swimming and trunk flexibility or foot mobility. However, significant correlations occurred for coordination motor abilities, as in almost all tests the participants characterized by the achievement level below the objectives set out in the curriculum performed significantly worse than children in the group with the achievement level meeting the objectives. Conclusions: In many cases, children who begin learning to swim from scratch make significant progress, but for many of them, the achievement levels are lower than the requirements set out in the school curriculum. The biggest problem for teachers and students in the initial teaching and learning to swim was the high fear of water, especially among girls.

Effects of Baby Swimming on Motor and Cognitive Development: A Pilot Trial

Contact with water, even from birth, may be an important experience for child development. In this work, we aimed to investigate if baby swimming might influence infant development in motor and cognitive domains. We assigned infants to either a 10-week baby swimming intervention (n = 12; M age = 13 months (SD) = 7) or a control group (n = 15; M age = 22 months (SD) = 6). We assessed motor development with the Peabody Developmental Motor Scales (2nd edition, PDMS-2) and cognitive development with core tests of executive functions: delayed response for working memory, object retrieval for inhibition, and A-not-B for response shifting. Non-parametric analyses revealed that infants in the baby-swimming group improved in gross, fine, and total motor skills, and showed marginally better inhibition speed and shifting accuracy, with associated gains of shifting accuracy and fine and total motor skills. Even with in this small-sized convenience sample, this pilot study revealed promising benefits from baby swimming on motor development that warrant further study. This preliminary work paves the way for replication and illustrates what effect sizes may be expected in sufficiently powered well-designed follow-up research targeted to aid the joint development of motor and cognitive skills as early as infancy.

What makes children learn how to swim? - health, lifestyle and environmental factors associated with swimming ability among children in the city of Malmö, Sweden

BACKGROUND

Swimming ability among children in the city of Malmö, Sweden is strongly affected by socioeconomic differences. We investigated to what extent mediating health and lifestyle factors, such as children's eating, sleeping and physical activity habits, as well as the characteristics of the social and working environment at both school and home, could explain the socioeconomic gradient in swimming ability.

METHODS

Our study population included children who started their first-grade school-year in 2012 or 2013 at any of the public primary schools of Malmö, Sweden. Cross-sectional, self-reported questionnaire-based data about health status and swimming ability in the fourth grade (age 10) were included from the Pupil Health Database (ELSA) for 3468 children.

RESULTS

Children's self-reported swimming ability was strongly associated with both individual- and school-based sociodemographic variables. Nine health, lifestyle and environmental variables were identified as potential mediators and included in the final model. Four of these variables, "Activity", "Outdoor time", "Social relationships at home and on the free time", and "Positivity about future", were significantly and positively associated with children's ability to swim.

CONCLUSIONS

Social support, optimism for the future and an active lifestyle were positively associated with children's swimming skills; however, compared to the socioeconomic factors, these health- and lifestyle factors contributed very little. It is possible, that interventions concerning children's swimming ability in lower socioeconomic neighbourhoods, should in addition to children's swimming lessons, target the whole families with the goal of increasing their possibilities for socialising and engaging in different kinds of recreational activities.

The Inter-Rater and Intra-Rater Reliability of the Actual Aquatic Skills Test (AAST) for Assessing Young Children's Motor Competence in the Water

As children’s actual aquatic skills are important for the prevention of drowning as well as their engagement in lifelong aquatic physical activity, researchers and practitioners should be able to assess this vital concept accurately and reliably. Therefore, this study aimed to investigate the inter-rater and intra-rater reliability of the Actual Aquatic Skills Test (AAST), consisting of 17 different test items for the assessment of young children’s motor competence in the water. Six raters received a training and evaluation session on scoring the AAST, after which five of them assessed four test videos (of various children (n = 38) performing the test items) twice, with one to two weeks in between (i.e., test and re-test). Inter-rater and intra-rater reliability were determined per test video and for the different AAST test items across videos using Gwet’s Agreement Coefficient 2 (Gwet’s AC2). The Gwet’s AC2 for inter-rater reliability at the test varied from 0.414 to 1.000, indicating a moderate to perfect agreement between raters. For intra-rater reliability, it ranged from 0.628 to 1.000, demonstrating a good to perfect agreement between test and re-test scoring. In conclusion, the AAST is a promising tool to reliably assess young children’s actual aquatic skills in an indoor swimming pool.

Prevention of Drowning

Drowning is a leading cause of injury-related death in children. In 2018, almost 900 US children younger than 20 years died of drowning. A number of strategies are available to prevent these tragedies. As educators and advocates, pediatricians can play an important role in prevention of drowning.

Descriptive Epidemiology of Pediatric Drowning Patients Presenting to a Large Southern US Children's Hospital

OBJECTIVES

Drowning is the leading cause of death for children ages 1 to 4, and it is among the leading causes of death for children of all ages. National data show disparities in drowning risk for certain racial groups. This study aimed to describe characteristics of patients presenting after a drowning event to guide focused drowning prevention outreach efforts.

METHODS

This was a retrospective chart review study designed to analyze the epidemiologic and demographic characteristics of drowning-related injuries and deaths that presented to a large, urban, southern US pediatric hospital from 2016 to 2019. All patients aged 0 to 19 years were identified using International Classification of Diseases, Ninth Revision and Tenth Revision codes for drowning or submersion injuries.

RESULTS

One hundred sixty-two patients met the inclusion criteria for the study. Submersion injuries were most common in the 1- to 5-year-old age group. Fifty-eight percent of patients were male. The analysis of race showed that 65% of patients were White and 33% of patients were Black. Pools were the setting for 78% of drowning events. Fifty-four percent of patients received cardiopulmonary resuscitation. Sixty-four percent of patients required hospitalization after the injury.

CONCLUSIONS

Characteristics of drowning victims may vary significantly from national data, depending on the area involved. This finding highlights the need for assessing local data to better inform local outreach. Further research is necessary to understand why such variance exists. Drowning prevention education, tailored toward pool safety and preschool-age children, should be a focus of injury prevention efforts.

Mapping Trends in Drowning Research: A Bibliometric Analysis 1995-2020

Drowning is public health issue requiring global, national and community responses. The multisectoral nature of drowning prevention reinforces the need for multidisciplinary research, which can play a key role in identifying patterns, factors and interventions and contributes to evidence-informed prevention. This study presents a biometric analysis of drowning research published in 1995–2020 and identifies temporal trends in research themes, journals, countries and authorship to assist in the planning of future research. This study identified 935 studies, representing authors from 80 countries. Publications grew 103-fold, and 41.2% (n = 385) were published since 2014. The top 20 journals are all injury prevention, public health, or medical journals. The top 5 accounted for 24.5% (n = 229) of total publications (TP). Research from the United States (TP = 313, 25.0%) and Australia (TP = 192, 15.3%) dominates the field. Growth is highest in low–middle-income countries (LMICs) including China (TP = 54, 4.3%, 32-fold), India (TP = 30, 2.4%, 17-fold) and Bangladesh (TP = 47, 3.7%, 7-fold). The study identifies significant growth in epidemiologic studies reporting burden and risk factors. Research in LMICs is increasing but lags relative to the burden. The role of multilateral and nongovernment organisations in evidence generation is evident and needs investigation, as do gaps in evidence for interventions and partnerships to progress the drowning prevention field.

Incidence and characteristics of drowning in Sweden during a 15-year period

AIM

Drowning is a global health problem and deeper knowledge about the extent and causes is of utmost importance for implementing preventative actions. The aim of this study was to describe the incidence and characteristics of drowning in Sweden over time, including both non-fatal and fatal cases.

METHODS

All cases identified as drowning (ICD-10 coding) at a national level in Sweden between 2003-2017 were collected. Three sources of data from the Swedish National Board of Health and Welfare were extracted via the Cause of Death Register and the National Patient Register.

RESULTS

Over 15 years, a total of 6609 cases occurred, resulting in an annual incidence of 4.66 per 100 000. The median age was 49 years (IQR 23-67) and 67% were males. Non-fatal drownings represented 51% (n = 3363), with an overall non-fatal to fatal ratio of 1:1, this being 8:1 for children (0-17 years of age). Non-fatal cases were more often female (36% vs. 30%; p < 0.001), younger 30 (IQR 10-56) vs. 60 (IQR: 45-72) (p < 0.001) and of unintentional nature (81% vs. 55%; p < 0.001). The overall incidence decreased over time from 5.6 to 4.1 per 100 000 (p < 0.001). The highest rate of 30-day survival was found in females 0-17 years (94%, 95% CI 91.1-95.5) and the lowest in males >66 years (28.7%, 95% CI 26.2-31.2). Although the incidence in children 0-4 years increased from 7.4 to 8.1 per 100 000 (p < 0.001), they demonstrated the highest non-fatal to fatal ratio (13:1).

CONCLUSION

Drowning is declining but remains a consistent and underestimated public-health problem. Non-fatal drowning cases represent about half of the burden and characteristics differ from fatal drowning cases, being younger, more often female and of unintentional nature.

Adolescent Water Safety Behaviors, Skills, Training and Their Association with Risk-Taking Behaviors and Risk and Protective Factors

Background: Drowning remains the third leading cause of unintentional injury death for adolescents in the United States. Aims: This study described adolescent swimming lessons, behaviors (life jacket wear while boating) and comfort (swimming in deep water) and their association with protective and risk factors and risk-taking behaviors reported by Washington State students in Grades 8, 10, 12, primarily comprised of youth ages 13 to 18 years. Methods: This study used the 2014 Washington State Healthy Youth Survey (HYS), a publicly available dataset. Results: Most students reported having had swimming lessons, using life jackets, and comfort in deep water. Differences reflected racial, ethnic and socioeconomic disparities: being White or Caucasian, speaking English at home and higher maternal education. Lowest rates of comfort in deep water were among Hispanics or Latino/Latinas followed by Blacks or African Americans. Greater life jacket wear while boating was reported by females, those in lower grades and negatively associated with alcohol consumption, sexual activity and texting while driving. Having had swimming lessons was associated with fewer risk-taking behaviors. Conclusions: The HYS was useful to benchmark and identify factors associated with drowning risk among adolescents. It suggests a need to reframe approaches to promote water safety to adolescents and their families. Multivariate analysis of this data could identify the key determinants amongst the racial, ethnic, and socioeconomic disparities noted and provide stronger estimation of risk-taking and protective behaviors.

Descriptive epidemiology and correlates of children's swimming competence

This study examined the swimming competence of primary school children, and how it was related to swimming activity, non-fatal aquatic events, and demographic factors. Primary school students (N = 4959; female = 2705, male = 2241; age range = 5 to 14 years) across 28 schools in the 15 districts of Hong Kong completed the Swimming Competence Questionnaire, and questions about their swimming experience, non-fatal aquatic events, and demographic variables. Descriptive statistics showed that over 60% of children could swim more than 5m, but less than 50% could swim over 25m. Over 50% of children were able to perform some basic swimming skills (e.g., holding breath underwater, floating, poolside/kickboard kicking, and treading water). Swimming competence was positively predicted by the demographic factors (i.e., age, sex, family income, and parents' highest education level), swimming experience, learning experience, and swimming location. Treading water was the only factor of swimming competence that established asignificant negative association with non-fatal aquatic events. Current results can be used to target key groups to improve children's swimming competence and reduce non-fatal aquatic events; children from lower socio-economic backgrounds and with less swimming experience should be encouraged to participate in more formal learn to swim lessons.

Anthropometric and Motor Competence Classifiers of Swimming Ability in Preschool Children-A Pilot Study

Swimming is a form of physical activity and a life-saving skill. However, only a few studies have identified swimming ability classifiers in preschool children. This pilot cross-sectional study aimed to find anthropometric (AM) and motor competence (MC) predictors of swimming ability in preschool children, by building classifiers of swimming ability group (SAG) membership. We recruited 92 children (girls n = 45) aged 5-6 years and took the AM and MC measurements in accordance with the reference manual and using the KTK battery test (motor quotient, MQ), respectively. A linear discriminant analysis tested a classification model of preschoolers' swimming ability (SAG: POOR, GOOD, EXCELLENT) based on gender, age, AM, and MC variables and extracted one significant canonical discriminant function (model fit: 61.2%) that can differentiate (group centroids) POOR (-1.507), GOOD (0.032), and EXCELLENT (1.524). The MQ total was identified as a significant classifier, which absolutely contributed to the discriminant function that classifies children's swimming ability as POOR (standardized canonical coefficient: 1.186), GOOD (1.363), or EXCELLENT (1.535) with an accuracy of 64.1%. Children with higher MQ total ought to be classified into higher SAG; thus, the classification model of SAG based on the MQ total is presented.

Need for consistent beach lifeguard data collection: results from an international survey

BACKGROUND

Lifeguards are integral to beach safety and collect data which is used for a variety of purposes, although guidelines and best practice have yet to be established. This study served to identify and characterise existing beach lifeguard service provider (BLSP) data collection procedures in order to identify the degree of uniformity and areas for improvement.

METHODS

The 'International Beach Lifeguard Data Collection and Reporting' online survey was distributed via the International Drowning Researchers' Alliance to BLSP supervisors and managers. The survey included questions on beach conditions and lifeguard activity data collection practices, and respondent's opinions on their own BLSP's methods.

RESULTS

Variability in data collection practices was evident in surveys obtained from 55 lifeguard leaders in 12 countries. Discrepancies exist in definitions for 'rescue' among BLSPs, a significant amount of information related to beach conditions are recorded and beach visitation is primarily obtained by visual estimate. Respondents expressed challenges with getting frontline staff to collect information in the field and ensuring reporting consistency between recorders. They identified rescue victim demographic factors as key data they would like to collect in the future.

CONCLUSIONS

Inconsistencies in lifeguard data collection present challenges to operations, safety education and prevention efforts, research and policy relying on these data. Variation in definitions, methods and collected variables generally restricts analysis to a single BLSP with limited generalisability to other beach settings. Some gaps in lifeguard data collection may soon be addressed by technology, but developing uniform, internationally acceptable standards and definitions should be prioritised.

Aquatic Competencies and Drowning Prevention in Children 2–4 Years: A Systematic Review

Aquatic competencies have been proposed as a prevention strategy for children aged 2–4 years who are over-represented in drowning statistics. For this recommendation to be made, exploration of the connection between aquatic competencies and drowning is required. This review critically analyzed studies exploring aquatic competencies and their effect on drowning and/or injury severity in children 2–4 years. English language peer-reviewed literature up to 31 July 2019 was searched and the PRISMA process utilized. Data were extracted from twelve studies that fulfilled the inclusion criteria. Findings from this study included that aquatic competencies were not found to increase risk of drowning and demonstrated children aged 2–4 years are capable of developing age-appropriate aquatic competencies. Age-appropriate aquatic competencies extracted were propulsion/locomotion, flotation/buoyancy, water familiarization, submersion and water exits. The acquisition of these competencies holds benefit for the prevention of drowning. No evidence was found relating to injury severity. There was limited exploration of the relationship between aquatic competencies attainment and age-related developmental readiness. The review highlights the need for consistent measures of exposure, clarity around skills acquisition, better age-specific data (2 years vs. 3 years vs. 4 years), studies with larger sample sizes, further exploration of the dose–response relationship and consistent skill level testing across age groups. Further investigation is required to establish the efficacy of aquatic competencies as a drowning prevention intervention, as well as exploring the relationship between aquatic competencies and age-related developmental readiness. In conclusion, early evidence suggests aquatic competencies can help to reduce drowning.

Development and Validity of the Fear of Water Assessment Questionnaire

Fear of water is the strongest predictor for no or low swimming competencies. Some individuals will never learn to swim due to their complete avoidance of water, whereas others might have difficulty with learning due to the fact that they cannot sufficiently relax their body to facilitate floating or swimming. Therefore, it is important to identify these people and to establish effective teaching strategies that can best help this specific population. Recognizing this, there is a clear need for an assessment tool which can help swim teachers and coaches identify people with a fear of water. The study aimed to first develop and then validate a fear of water assessment questionnaire (FWAQ). 2074 male and female people participated in the creation of a 40-item questionnaire. The exploratory factor showed that a 3 factor solution including 20 items was most sensible - such a solution accounted for 31.69% of explained variance and the Cronbach's alpha α was 0.831, which makes for a reliable enough solution. A subsequent discriminant function analysis correctly classified 98.2% of participants. We concluded that the findings from this study support that the FWAQ is a valid scale that effectively identify people with fear of water.

Perceived Versus Real Swimming Skills of Adolescents Under Standard and Challenging Conditions: Exploring Water Competencies as an Approach to Drowning Prevention

In this study, we compared adolescents’ actual (expert assessed) front crawl swimming skills to their self-assessment in two conditions: in standard swimming (wearing a swimsuit and goggles) and in a simulated risk scenario (swimming in plain clothes without goggles). We postulated that education focused on water competencies is fundamental in preventing drownings. Experts evaluated the skills of 21 female and 21 male adolescents in both standard and challenging conditions. All were low-skilled swimmers aged 14–15 years. Participants were asked to self-assess their skills before and after each trial. Boys and girls covered the same distance in both trials. Their self-assessment did not change regardless of the difficulty of the conditions. Girls assessed themselves more accurately than boys. However, boys who underestimated their skills showed greater ability to utilise the experience gained from performing the task for a more accurate self-assessment. In conclusion, adolescents should be educated in total water competencies, and not merely in swimming skills. For girls, “water readiness” is thought to broaden their ability to adapt their swimming skills to nonstandard conditions. Aquatic education for boys should focus on developing self-reflection in order to create a long-lasting responsibility using their own swimming skills.

Learning to Swim: An Exploration of Negative Prior Aquatic Experiences among Children

Learning to swim via a structured program is an important skill to develop aquatic competencies and prevent drowning. Fear of water can produce phobic behaviors counterproductive to the learning process. No research examines the influence of negative aquatic experiences on learning to swim. This study explored the influence of children’s negative prior aquatic experiences (NPAE) on learn-to-swim achievement via swim school data. Children’s enrolment records (5–12 years) in the Australian Capital Territory were analyzed via demographics, level achieved and NPAE. NPAE was recorded as yes/no, with free text thematically coded to 16 categories. Of 14,012 records analyzed (51% female; 64% aged 6–8 years), 535 (4%) reported a NPAE at enrolment. Males, children with a medical condition and attending public schools were significantly more likely (p = 0.001) to report a NPAE. Children reporting a NPAE achieved a lower average skill level at each year of age. The largest proportion (19%) of NPAE reported related to swimming lessons. NPAE have a detrimental influence on aquatic skill achievement. We recommend increased adult supervision to reduce likelihood of an NPAE occurring, while also encouraging swim instructors to consider NPAE when teaching swimming and develop procedures to ensure a NPAE does not occur during instruction.

Validation of the swimming competence questionnaire for children

Two studies were employed to test the reliability and validity of the Swimming Competence Questionnaire (SCQ) among primary school children. Study 1 was a cross-sectional survey in 4959 primary school children. Study 2 was a pre-post-test quasi-experiment among 1609 primary school children who underwent a 20-lesson learn-to-swim programme. In Study 1, exploratory structural equation modelling revealed excellent goodness-of-fit and scale reliability for a two-factor model comprising distance and skill factors, which supported the construct and convergent validity. SCQ scores were significantly and positively correlated with swimming outcomes (i.e., self-efficacy, intention, swimming frequency), which supported SCQ's concurrent and criterion validity. Average variance extracted for the SCQ factors exceeded cut-off criteria supporting discriminant validity. In Study 2, pre-test SCQ scores correlated significantly and positively with the SCQ scores, self-efficacy, intention, and swimming frequency at post-test, which supported SCQ's test-retest reliability and predictive validity. Positive intraclass correlation between SCQ scores and coach ratings at post-test provided evidence for SCQ's inter-rater reliability. SCQ scores significantly improved at post-test, which supported SCQ's ecological validity. In conclusion, findings indicate that the SCQ is a valid and reliable measure to assess primary school children's swimming competence, in terms of swimming distance and basic water survival skills.

Preventing injuries must be a priority to prevent disease in the twenty-first century

Injuries continue to be the leading cause of morbidity and mortality for children, adolescents, and young adults aged 1-24 years in industrialized countries in the twenty-first century. In this age group, injuries cause more fatalities than all other causes combined in the United States (U.S.). Importantly, many of these injuries are preventable. Annually in the U.S. there are >9 million emergency department visits for injuries and >16,000 deaths in children and adolescents aged 0-19 years. Among injury mechanisms, motor vehicle crashes, firearm suicide, and firearm homicide remain the leading mechanisms of injury-related death. More recently, poisoning has become a rapidly rising cause of both intentional and unintentional death in teenagers and young adults aged 15-24 years. For young children aged 1-5 years, water submersion injuries are the leading cause of death. Sports and home-related injuries are important mechanisms of nonfatal injuries. Preventing injuries, which potentially cause lifelong morbidity, as well as preventing injury deaths, must be a priority. A multi-pronged approach using legislation, advancing safety technology, improving the built environment, anticipatory guidance by clinical providers, and education of caregivers will be necessary to decrease and prevent injuries in the twenty-first century.

An enjoyable school-based swimming training programme improves students' aquaticity

AIM

The main objectives of this research were to a) examine the test-retest reliability of aquaticity test (study 1), b) investigate the efficacy of 'swimming lesson', during the physical education course, in the aquaticity (study 2) and c) examine enjoyment from the 'swimming lesson' (study 3) in primary school students of the 3rd grade.

METHODS

In the first study, 23 students performed 2 assessment sessions for the evaluation of aquaticity, separated by 1 week. In the second study, 30 students followed a short-term swimming training programme (9 sessions). Before and after the programme, students' aquaticity was assessed. In the third study, enjoyment was examined in 273 students who followed the short-term swimming programme.

RESULTS

The test-retest reliability for the assessment of students' aquaticity was high (ICC = 0.87-0.99). Paired t tests, also, revealed significant improvement (28-62.7%) in the aquaticity of the children following the swimming programme. A great percentage of students reported high levels of enjoyment (92.2%).

CONCLUSION

A short-term swimming programme, incorporated into the physical education course, is an enjoyable exercise modality that may be used for the improvement of children's aquaticity. We, also, found that the testing protocol may be reliably used for the evaluation of aquaticity in the paediatric population.

Identifying Risk Factors Associated with Fatal Drowning Accidents in the Paediatric Population: A Review of International Evidence

INTRODUCTION

Evidence from Ireland's Childhood Mortality Register demonstrates that drowning is the second leading cause of death in children. It occurs more commonly in adolescent males engaged in summer water-based activities and in children aged 1-4 years with access to swimming pools/unprotected water sources. Despite being an island nation, a significant lack of guidelines exists to reduce drowning accidents in these at-risk populations.

AIM

Review international evidence surrounding risk factors associated with drowning accidents in the paediatric population and existing risk-reduction guidelines.  Methods: Structured review of Cochrane, Cinahl, Pubmed Web of Science databases performed using search terms: ("risk factors" AND "drowning"), ("risk reduction" OR "prevention" OR "swim ability" AND "drowning"). Studies were included if satisfied age criteria (0-18 years).

RESULTS

Evidence suggests that boys are at highest risk of drowning (1-4 yrs in swimming pools; adolescents in freshwater) with inadequate surveillance, inadequate availability of first responders, certain clinical diagnoses (developmental delay and seizure disorders), lack of swimming ability, and substance misuse in adolescents all posing an increased risk. Formal swimming education in those aged 4+ years, training of supervising adults in safe rescue, installation of isolation barriers, enforcing water safety guidelines, and regulations are all recommended by International Advisory Groups for prevention of drowning.

CONCLUSION

In Ireland, drowning is the second leading cause of accidental paediatric death in the post-neonatal period, and an important cause of childhood fatalities globally. Risk factors increasing the likelihood of fatal paediatric drownings include gender and distinct age peaks. Certain modifiable risk factors relate to peri-event factors such as lack of supervision, to post-event responses, in particular including lack of trained personnel at the scene. There is a poverty of guidelines specifically targeting the paediatric populations; guidelines generally tend to be included into adult drowning reduction strategies. Specific targeting is required to protect those most at risk.

Wilderness Medical Society Clinical Practice Guidelines for the Treatment and Prevention of Drowning: 2019 Update

The Wilderness Medical Society convened a panel to review available evidence supporting practices for acute management and treatment of drowning in out-of-hospital and emergency medical care settings. Literature about definitions and terminology, epidemiology, rescue, resuscitation, acute clinical management, disposition, and drowning prevention was reviewed. The panel graded available evidence supporting practices according to the American College of Chest Physicians criteria and then made recommendations based on that evidence. Recommendations were based on the panel's collective clinical experience and judgment when published evidence was lacking. This is the first update to the original practice guidelines published in 2016.

Advancing the Health of Populations Across the Life Course: 50 Years of Discoveries in the Division of Intramural Population Health Research

In 2017, the Division of Intramural Population Health Research (DIPHR), within the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), reached a significant milestone: 50 years in existence. DIPHR celebrated this anniversary with a scientific program that reviewed past accomplishments and reflected on future directions in support of promoting the health of populations across the life course. Extending from the scientific program, the impetus of this article is to contribute to archiving and consolidating the legacy of intramural population health research at NICHD over the past 50 years. We present a brief history of the origin and evolution of intramural population health research at NICHD. Next, we conduct an empirical assessment of the scientific impact and evolving scope of this research over the past five decades and present specific key discoveries emerging from topics spanning the life course: (1) reproductive health, (2) the health of pregnant women and fetuses, (3) the health of children, and (4) associated methodologies. We also explore the Division's service to the profession in the form of mentorship of the next generation of scientists in population health research. Finally, we conclude with thoughts about future directions of population health research and reaffirm the DIPHR's commitment to promoting the health and well-being of the many populations we serve, both locally and globally.

S.A.F.E.R. Near Water: An Intervention Targeting Parent Beliefs About Children's Water Safety

OBJECTIVE

The current study aimed to develop, implement, and evaluate the S.A.F.E.R. Near Water program, an evidence-based and theory-driven intervention targeting parent beliefs relevant to keeping children safe around water.

METHODS

A nonrandomized trial was conducted. Parents with children aged two through five years who were enrolled in lessons either at a public or private swim organization in Ontario, Canada were recruited and nonrandomly assigned to either an Intervention (N = 92) or Control (N = 150) condition. All parents completed the same questionnaire measures two times over the course of their child's swim lesson session period, once at the beginning (preintervention) and again at the end (postintervention; approximately 9-15 weeks later). Questionnaires assessed parents' perceptions related to supervision, child drowning risk, water safety, and optimism bias. Parents in the Intervention condition participated in S.A.F.E.R. Near Water, an educational water safety program comprising in-person seminars, informational handouts, and posters.

RESULTS

The S.A.F.E.R. Near Water program was associated with increased knowledge in targeted areas and effectively communicated most of the intended messages. A series of primary regression analyses revealed that parents receiving S.A.F.E.R. Near Water demonstrated improvements in: beliefs about the value of supervision; judgments about children's swim skills and drowning risk; and perceptions related to swim lessons and children's supervision needs (sr2 range: 0.22-0.38).

CONCLUSION

These findings provide support for the feasibility and usefulness of a multifaceted, parent-focused, educational program delivered alongside children's swim programming to promote closer adult supervision of children around water.

Enabling factors and barriers to the sustainability and scale-up of drowning reduction interventions in Vietnam: a qualitative assessment

BACKGROUND

Vietnam has some of the highest rates of drowning deaths in the Western Pacific Region, particularly among children aged 19 years or younger. Several policies aimed at drowning prevention have been developed over the last decade; however, despite policy support, generally these have not been sustained beyond a pilot phase or have been limited to small geographical regions. The present study aims to explore barriers and facilitators for sustainability and scale-up of drowning prevention initiatives in Vietnam, identifying ways forward for future implementation.

METHODS

This was a qualitative study using semistructured indepth interviews with key stakeholders (n=12) engaged in drowning prevention in Vietnam. The Framework Method was used to analyse the data drawing on Schell's theoretical framework for public health programme sustainability. The Framework Method is most commonly used for the thematic analysis of semistructured interview transcripts, particularly as the data were fairly homogeneous.

RESULTS

Four key factors were identified that facilitated implementation of drowning reduction activities in Vietnam. Strong political support at all levels, underpinned by policy; effective partnerships with the community; widespread communication; and programme adaptation to local contexts and application of innovative approaches, for example, strengthening organisational capacity in limited resource settings, were the key enablers. Barriers include the instability of the funding sources; inadequate programme evaluations to generate evidence of effectiveness and lack of consistent and timely data collection; and insufficient strategic planning for long-term implementation of drowning prevention interventions.

CONCLUSION

Ensuring the sustainability and scale-up of drowning prevention programmes in Vietnam requires a continued focus on enablers such as on community engagement, communication activities and partnership approaches, and importantly concerted efforts to mobilise resources for continued long-term funding, improvements in planning and intersectoral coordination, and ensuring that future programmes are robustly evaluated for effectiveness.