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Association Between Swimming Lessons and Drowning in Childhood: A Case-Control Study
Abstract
To estimate the association between swimming lessons and the risk of drowning among children aged 1 to 19 years.
Case-control study.
Cases were identified from medical examiners'/coroners' offices between mid-2003 and mid-2005. Jurisdictions included the states of Maryland and North Carolina, 14 districts (33 counties) in Florida, 3 counties in California, 1 county in Texas, and 1 county in New York.
Cases were children and adolescents aged 1 to 19 years who died of unintentional drowning. Interviews were conducted with 88 families of children who drowned and 213 matched controls. Main Exposure Swimming lessons. Main Outcome Measure Death due to unintentional drowning. Drownings that were intentional, of undetermined intent, or that occurred under conditions in which swimming ability was unlikely to impact risk (eg, in ice water or bathtubs) were excluded.
Of the 61 cases in the 1- to 4-year age group, 2 (3%) had participated in formal swimming lessons vs 35 of 134 matched controls (26%) (adjusted odds ratio [OR], 0.12; 95% confidence interval [CI], 0.01-0.97). Among the 27 cases aged 5 to 19 years, 7 (27%) had ever taken formal swimming lessons vs 42 of 79 matched controls (53%) (adjusted OR, 0.36; 95% CI, 0.09-1.51). In adjusted analyses, there was no statistically significant association between informal instruction and drowning risk.
Participation in formal swimming lessons was associated with an 88% reduction in the risk of drowning in the 1- to 4-year-old children, although our estimates were imprecise and 95% CIs included risk reductions ranging from 3% to 99%.
... The ability to swim is a basic survival skill from water-related incidences. 33 Rahman et al 29 noted that considering health conditions, Bangladeshi children can start learning to swim from the age of six. However, a review of studies by Olivar and Moreno-Murcia suggested that for children of 10-14 years, knowing how to swim did not significantly reduce drownings compared with those who did not know how to swim. ...
Background
Drowning is the leading cause of death among children aged 0–17 years in rural Bangladesh, resulting in over 14 438 deaths annually—an average of 43 deaths per day. This study aims to identify socioeconomic, demographic and environmental factors linked to child drowning deaths in Northern Bangladesh—a region of high poverty, which is behind in overall socioeconomic indicators compared with other regions in the country.
Methods
We conducted a cross-sectional survey through purposive sampling to identify child fatal and non-fatal drownings among a total of 18 004 households, comprising 71 185 people, in 2 unions in Northern Bangladesh. Interviews were conducted between January and March 2024 with the households that experienced child drownings in the region. We employed a mixed-methods approach to data collection, using quantitative analysis to examine socioeconomic, demographic and environmental factors, alongside qualitative analysis to explore situational factors associated with drownings in the region.
Results
Through household visits, a total of 117 households were identified that faced child drowning incidents, comprising 84 fatal (71.8 %) and 33 non-fatal (28.2 %) drownings between 2018 and 2023. The households that faced drownings were comparatively of lower income groups, had lower rates of education and were mostly engaged in agriculture and other domestic work. In 2023, the number of drowning incidents was 34. Out of 117 drownings, 95% occurred between 9:00 and 15:00 hours, and more than 82% occurred between June and October. Out of 117 drowning incidents, approximately 97% of children did not know how to swim prior to the incident. Out of 117 respondents, 73.5% stated that they did not teach their child how to swim. Of those who taught their child to swim, the average age for learning to swim was 8.33 years. Out of 84 child drowning deaths, 75% were male and 25% were female, and the average age was 3.9 years. Out of the 84 fatal drowning deaths, 72.6% occurred in ponds.
Conclusion
Identification of socioeconomic, demographic and environmental factors associated with child drownings will help to develop feasible prevention strategies and interventions in the region.
... Participation in formal swimming lessons is associated with an 88% decrease in submersion injury risk among children aged 1 to 4 years. 15,16 ...
... Besides, the lack of knowledge about public perceptions of the risk may be contributing to the general lack of awareness of the situation as posited by Noor Hamzani, Rosnah, Kulanthayan KC Mani (2020). Additionally, a case-control study in the U.S. found a positive association between swimming lessons and lower drowning risk in children less than five years of age (Brenner, Taneja, Haynie, Trumble, Qian, Klinger et al., 2009). Importantly, according to Moran (2006), young people's theoretical comprehension of water safety concepts and knowledge is one of the least studied study fields, and what can be inferred from published studies is that young people lack this understanding. ...
The safety of children near water is crucial to avoid drowning, a major cause of death among children worldwide. Drowning incidents are a significant issue in Malaysia, especially among young people. The greatest obstacle to the development of policy for water safety among school children is lack of
awareness or knowledge of water safety. This study represents an attempt to measure attitudes towards waters safety and risk of drowning in the District of Gombak in Malaysia. Given the urgency of the matter, immediate attention and action are required. Therefore, this paper seeks to highlight the pressing
nature of water safety concerns among school children and assess whether implementing a water safety education program can substantially enhance knowledge levels, thus reducing drowning incidents among children. Yet, drowning in Malaysia still doesn't get enough attention. The sample of the study
was 502 school children from a school in the district in Selangor. Purposive sampling was selected. The major findings that emerged were as below: a) the respondents prefer to swim alone. b) They are less favor in of wearing life jackets. c) They prefer to swim without having adults around them. d) They are prone to swim without learning to swim. e) No association between students’ attitudes towards water safety and sex. The urgency of this research is to address water safety issues among school children
Introduction
Swimming and water safety skills are essential for reducing drowning. Swimming and water safety programs primarily focus on children, despite adults accounting for over 80% of fatal drowning in Australia. This study aims to identify types of adult swimming programs in Australia, who attends these programs, and measure their swimming skill achievement against national benchmarks.
Methods
A retrospective cross‐sectional study of adults attending swimming programs between 2018 and 2021 was conducted. Participant assessment records were analysed against the [Australian] National Swimming and Water Safety Framework and national benchmarks to be achieved by 6 and 12 years old. Descriptive statistics and Chi‐square analysis were undertaken.
Results
Of 4914 adults attending swimming lessons, 44% were female, median age was 38 years, and 40% were from high socioeconomic areas. On average, adults attended nine lessons, averaging 4.5 h in the water. At their final assessment, 69% could swim at least 5 m (6‐year‐old benchmark), and 8% could swim 50 m continuously (12‐year‐old benchmark).
Conclusions
Adults of all ages are learning to swim; however, only 8% are achieving the 12‐year‐old benchmark of swimming 50 m. An equity issue exists, with adults from lower socioeconomic areas and men less likely to be attending swimming programs. Developing and maintaining water safety skills throughout the lifespan is vital for reducing drowning risk among adults.
So What?
Adults are spending time, money and effort learning to swim, however, more is needed to ensure that participants stay in lessons long enough to develop the necessary skills needed to be safe in the water.
Background
Since 2014, drowning has received increased political attention. Translating this political commitment to saving lives needs policy-supported evidence-informed interventions. An evidence gap map (EGM) was developed, which aims to facilitate the strategic prioritisation of future research and efficient commissioning of interventions.
Methods
Available evidence was sought by searching four electronic databases using drowning key terms from 2005 to 2023. Peer-reviewed studies, which measured the outcome of a drowning prevention intervention, were included in the EGM. Classification of interventions was guided by the WHO’s recommendations for drowning prevention interventions and strategies. Intervention outcomes were classified into health, social, economic, policy and other supporting outcomes.
Results
49 intervention studies were identified. Of these, 25 studies were conducted in high-income countries (HICs), 19 in low- and middle-income countries (LMICs), 3 in both HICs and LMICs and 2 were not country specific. Interventions, which used community education, were the most common (n=29, 27%), followed by teaching school-age children swimming and water safety skills (n=13, 12%) and others combined (n=66, 61%). Majority of interventions focused on process outcomes such as knowledge acquisition (n=42, 39%) in comparison with objective outcomes such as incidence of drowning mortality (n=21, 19%). No studies reported on interventions that manage flood risks.
Conclusions
Knowledge gaps of effective drowning prevention interventions were identified using an EGM, emphasising the need for methodological advancements reporting on outcomes measures, implementation research and targeted research among high-risk populations in LMICs.
Objective:
Drowning is a leading cause of injury-related death in the pediatric and adolescent population. This epidemiologic study describes the trends in emergency department (ED) visits for pediatric drowning injury in North Carolina and the impact of the coronavirus disease 2019 (COVID-19) pandemic on incidence rate.
Methods:
Data were obtained using the North Carolina Disease Event Tracking and Epidemiologic Collection Tool, a public health surveillance system, to identify ED visits for drowning injury from 2016 to 2022. We performed a chart review on a subset of patients to further characterize injury.
Results:
A total of 1285 ED encounters were identified. In North Carolina, the incidence rate of pediatric drowning has been decreasing, abruptly in 2019 and again in 2020. The postpandemic rate continued in the same downward trend, suggesting that the COVID-19 pandemic did not affect the overall statewide incidence rate of pediatric drowning (P = 0.14). The age distribution of children treated in the ED for drowning injury in North Carolina changed following the pandemic.
Conclusions:
This study is limited by the fortunate rarity of pediatric drowning events. Injuries may be underreported because these are only ED presentations. This study relied on provider documentation in electronic health records. The definition of postpandemic is not well defined, and sequelae of the COVID-19 pandemic may not yet be fully appreciated. The incidence of North Carolina ED encounters for drowning injury in the pediatric population has decreased, and the COVID-19 pandemic had a noticeable, although not statistically significant, effect.
A new conception of sensation seeking is presented, along with a new scale [the Arnett Inventory of Sensation Seeking (AISS)]. The new conception emphasizes novelty and intensity as the two components of sensation seeking. Two studies were conducted to validate the new scale. In the first study, the AISS was found to be more strongly related to risk behavior than Zuckerman's Sensation Seeking Scale (SSS) among 116 adolescents aged 16–18 years, although the new scale contains no items related to risk behavior (in contrast to the SSS). In the second study, involving 139 adolescents, similar relations were found between the AISS and risk behavior, and the new scale was also found to be significantly correlated with the Aggression subscale of the California Psychological Inventory (CPI). In addition, adults (N = 38) were found to be lower in sensation seeking than adolescents. In both studies, males were higher in sensation seeking than females.
To describe the epidemiology of domestic swimming pool drowning and near-drowning in Brisbane and to examine the efficacy of a broad range of preventive options, including pool fences.
A prospective, hospital-based, injury surveillance system to describe the epidemiology of drowning and near-drowning and a community survey to describe pool fencing.
The surveillance questionnaire was completed at presentation in the Emergency Department by the parent, nurse and doctor. Personal interviews in households that were randomly selected by means of a stratified sampling scheme provided the pool fencing description.
All 139 children suffering from an immersion injury resulting in presentation at a hospital in the catchment area of The Mater Children's Hospital were included. There were 204 households with a swimming pool in the 1024 households interviewed in the community survey.
The 100 domestic pool drownings and near-drownings were equivalent to 15.5 incidents per year per 100,000 children aged 0-13 years and 64.9 per year per 100,000 for the critical 1-3 years age group. Of 72 children who gained unintended access to a domestic pool, 88.9% were less than 3 years of age and 52.8% were less than 2 years. All 10 of the children who drowned and five who were severely brain damaged (age range, 12-32 months) were in this group. The risk of a drowning or near-drowning involving unintended access to an unfenced pool is 3.76 times higher than the risk associated with a fenced pool (95% confidence limits for relative risk: 2.14, 6.62).
Pool fences are an effective method of preventing child drownings and near-drownings. This effectiveness can be further improved if compliance with gate closure can be enhanced. This should be emphasised in health promotion accompanying the introduction of universal pool fencing.
This research investigated the effects of aquatic training on the swimming performance of 126 children, ages 2.5 to 5.5 yr., over 8 mo. Two groups of children were enrolled in an aquatic training program. Group 1 were returning program participants at the beginning of this study, and Group 2 were new participants. The control children (Group 3) received no aquatic training during the research. Subjects performed six categories of swimming tasks at three points in time—1st mo., 4th mo., and 8th mo. The categories were Locomotion: Front, Locomotion: Back, Kicking, Entry: Jump, Diving, and Ring Pick-up. A2 × 3 × 2 × 3 (sex × group × age × time) repeated-measures analysis of variance procedure showed that returning participants performed each category of swimming tasks at a more advanced level than the other groups at each time of measurement. New participants after training performed five of the categories of tasks at a more advanced level than the control group. Amount of training significantly influenced swimming, and training effects were task-specific when data were interpreted in terms of specific movement characteristics.
A study of random digit dialing as a method of control selection was conducted as part of a matched case-control study of risk factors for neuroblastoma. The study was conducted in 1981–1982 in the Greater Delaware Valley region. Participation involved parents submitting to a 2–4-hour telephone interview. Potential control telephone numbers were selected by substituting the last two digits of the case family's telephone number with randomly selected digits. Successive random telephone numbers were called until a family with a child matching the case by year of birth plus or minus three years and race who agreed to participate was identified. A total of 3,245 telephone numbers were dialed to select controls for 101 cases, an average of 32.1 telephone numbers per case. Among 1,908 residential households contacted, 25.5% refused to give information about household characteristics. Of households with known characteristics, 45% had children under 25 years of age and 14.9% had a child eligible for the study. Among 181 households invited to participate, 101 agreed. For 18.6% of all calls, residential respondents were randomly offered $10 as an inducement to participate. This inducement did not significantly Influence participation rates among families invited to participate.
Control groups selected by random digit dialing are frequently used in case-control studies. Concern about the potential for bias in these control groups has been expressed, primarily because of low response rates. This study compares the characteristics of a hypothetical control group consisting of 341 men and women aged 40-74 years, selected by random digit dialing and participating in an interview in 1990, with the characteristics of 15,563 men and women aged 40-74 years who participated in a privately conducted census in the same upstate New York county in 1989. For most measures, no differences were seen between the random digit dialing sample and the census population. However, the hypothetical control group was more likely to have had their cholesterol checked in the past 2 years and was somewhat more likely to have had other screening tests as well. In addition, the hypothetical control group was somewhat better educated. The results suggest that, at least in this setting, control groups selected by random digit dialing are representative of the general population in most respects; however, caution should be used when studying the relation between screening tests and disease occurrence by means of case-control studies using controls selected by random digit dialing.
There is a need for practical and cost-effective measures of the behavioral characteristics that predict subsequent injury in children. Previous research has focused on the predictive power of child problem behavior (e.g., hyperactivity, aggression, noncompliance) and has found reliable, but relatively weak associations with injury frequency. In an effort to improve upon this level of prediction using child behavioral measures, a care-giver report checklist of specific "risky" behaviors was developed for toddlers and preschoolers, called the Injury Behavior Checklist (IBC). A preliminary test of the reliability and validity of this instrument was undertaken in a sample of middle-class families (N = 253). Results indicated that the IBC has acceptable reliability (internal consistency = .87; 1-month test-retest correlation = .81) and is able to significantly discriminate children with two or more injuries from those with one or none (p less than .001). Multiple regression analyses indicated that the IBC was a better predictor of injury than parent-reported levels of child problem behavior using the Conners Parent Rating Scale.
Abstract A revised validated version of the Toddler Temperament Scale (TTS) was used to develop normative data for temperament in Australian toddlers. Results confirm the accepted practice of dividing the group into younger and older toddlers, with normative data reported for those younger and older than 24 months. The TTS can be used above the normal cut-off age of 36 months. Care must be taken with interpretation of temperament scores, especially when comparing children of different backgrounds.
The initial development of the Toddler Temperament Scale (TTS) for determining temperamental characteristics in 1- to 3-year-old children is reported. The 97-item questionnaire was based on the conceptualization of Thomas, Chess, and associates in the New York Longitudinal Study and standardized on 309 children in two pediatric practices. Test-retest reliability (1 month) and alpha reliability are both satisfactory, with median correlations of .81 and .70, respectively, for the nine categories. Preliminary evidence of external validity is presented. The instrument should provide more objective and organized temperament data for research and clinical purposes. Language: en
A method for estimating the risks of drowning in fenced and unfenced domestic swimming pools is presented. Application of this method suggests that the probability of drowning occurring in an unfenced pool is between two to five times higher than that of a fenced pool. It is also estimated that the introduction of pool fencing would reduce the number of drownings in domestic swimming pools by 40% to 67%.
