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Drowning in Inequalities Swimming and Social Justice

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The authors argue that age, sex, and racial differentials in swimming participation are conditioned by the availability of swimming infrastructure and the principle of social exclusivity that limits access of lower status groupings, even where pools and programs are available. In turn, the authors argue that participation in swimming and where that activity occurs (pool versus open water) affect life chances (accidental drowning rates) across status groups. Multiple data sources were used to operationalize measures of swimming participation, social exclusivity, conditions associated with the development of swimming infrastructure, risk for a place to drown, and age, sex, and racial accidental drowning and submersion rates. Given that some progress has been made toward lessening social exclusivity with lower status groups now participating in many sports, and the under-reporting of deaths from accidental drowning and submersion, the authors believe that the confirmation of their hypotheses is conservative.
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Drowning in Inequalities: Swimming and Social Justice
Author(s): Donald W. Hastings, Sammy Zahran and Sherry Cable
Source:
Journal of Black Studies,
Vol. 36, No. 6 (Jul., 2006), pp. 894-917
Published by: Sage Publications, Inc.
Stable URL: http://www.jstor.org/stable/40034351
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DROWNING IN INEQUALITIES
Swimming and Social Justice
DONALD W. HASTINGS
University of Tennessee
SAMMY ZAHRAN
Texas A &M University
SHERRY CABLE
University of Tennessee
The authors argue that age, sex, and racial differentials in swimming partic-
ipation are conditioned by the availability of swimming infrastructure and
the principle of social exclusivity that limits access of lower status group-
ings, even where pools and programs are available. In turn, the authors
argue that participation in swimming and where that activity occurs (pool
versus open water) affect life chances (accidental drowning rates) across
status groups. Multiple data sources were used to operationalize measures
of swimming participation, social exclusivity, conditions associated with
the development of swimming infrastructure, risk for a place to drown, and
age, sex, and racial accidental drowning and submersion rates. Given that
some progress has been made toward lessening social exclusivity with
lower status groups now participating in many sports, and the under-
reporting of deaths from accidental drowning and submersion, the authors
believe that the confirmation of their hypotheses is conservative.
Keywords: accidental drowning and submersion; social exclusivity; life
chances
Numerous researchers have documented the persistence of dif-
ferential life chances of Blacks versus Whites and of high- versus
low-income groups (Feagin & Feagin, 1986; Pinkney, 2000). Ana-
lysts have also demonstrated an intersection of race and class that
leaves Blacks disproportionately represented in lower strata. Con-
sequently, Blacks are more likely than Whites to suffer such in-
equalities as inferior health care, homelessness, crime victimiza-
JOURNAL OF BLACK STUDIES, Vol. 36 No. 6, July 2006 894-917
DOI: 10.1177/0021934705283903
© 2006 Sage Publications
894
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Hastings et al. / SWIMMING AND SOCIAL JUSTICE 895
tion, substance abuse, dead-end and menial jobs, police brutality,
prison, and exposure to environmental hazards. In this article, we
examine the risk of death by accidental drowning and submersion
for racial groups. We show that Black Americans are literally
drowning in inequalities; they are disproportionately victims of
accidental drowning.
Drowning is defined as death from asphyxia within 24 hours of
submersion in water. The World Health Organization (WHO, 2004)
estimates that each year between 400,000 and 700,000 accidental
drowning and submersion deaths occur globally. Furthermore, low
levels of economic and social development are associated with
higher rates of death by accidental drowning and submersion. Data
on death by unintentional drowning are underreported globally,
especially in low- and middle-income countries.
In the United States, death by accidental drowning and submer-
sion is relatively rare, accounting for less than 1% of all deaths
annually. Tragically, the rate of accidental drowning is highest
among children ages 1 to 4. Accidental drowning is the second
leading cause of injury-related death among children ages 1 to 14
(Centers for Disease Control [CDC], National Center for Health
Statistics, 1997). A substantial percentage of child deaths by
drowning occur because children accidentally fall or wander into a
pool or natural body of water. Public health officials insist that
drowning deaths are preventable (Fiore & Heidemann, 2004).
Increased adult supervision, use of personal floatation devices,
instruction in basic life support, and efforts to enclose swimming
pools can significantly reduce incidences of child submersion in-
juries and death (American Academy of Pediatrics Committee on
Injury and Poison Prevention, 1993).
The risks of unintentional drowning are not shared equally
across populations. Inequalities obtain in rates of accidental
drowning and submersion by status groups (i.e., age, sex, race, and
class). Data presented in Table 1 show that 1 .2 per 100,000 persons
died from accidental drowning and submersion in the United States
in 2000 (CDC, 2003). For all races and both sexes, the accidental
and submersion death rate peaks in the 1-4 age group (3.2 per
100,000 persons). At this point in the life course, White males have
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896 JOURNAL OF BLACK STUDIES / JULY 2006
the greatest likelihood of dying by accidental drowning and sub-
mersion. As White males enter the ages in the life course at which
swimming and aquatic safety skills are learned, the rate declines
dramatically from 4.4 per 100,000 persons at ages 1 to 4 to 1 .0 by 5
to 9 years, and to .8 by ages 10 to 14 years.
A reverse trend exists for African American males. Overall, the
accidental drowning and submersion rate is significantly higher for
African Americans (2.7 per 100,000 persons). For African Ameri-
can males, death by accidental drowning and submersion increases
at the same ages it decreases for their White male counterparts. The
rate moves from 2.8 (1 to 4 years) to 2.7 (5 to 9 years) and then 3.2
(10 to 14 years).
For White and Black females, the accidental drowning and sub-
mersion rates are unstable due to small numbers of cases in various
age groups. White females have higher rates than Black females in
the 1 to 4 age group. For White females, the rates decrease from .5
to .3 in successive age groups. For Black females, no rates are re-
ported in ages 5 and older given small numbers of cases. In general,
Blacks have higher rates of accidental drowning and submersion
than do Whites. Males have higher rates of accidental drowning
and submersion than do females.
To explain why these data behave so differently for status groups
in the United States, we focus analytically on the mechanism of
social exclusivity. We argue that racial and socioeconomic differ-
entials in swimming participation are conditioned by the availabil-
ity of swimming infrastructure and the principle of social exclusiv-
ity that limit access of lower status groups. In turn, we argue that
participation in swimming and where that activity occurs (pool ver-
sus open water) affect life chances (accidental drowning rates)
across status groups. We hypothesize that patterns of accidental
drowning mortality by age, sex, and race are partially governed by
differential access to swimming participation and presumably the
aquatic safety skills that mitigate the risk of death. To test these
hypotheses, we examine data on swimming participation at the
individual and county level, accidental drowning and submersion
mortality rates for Whites and Blacks at the county level, and popu-
lation data at the county level.
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898 JOURNAL OF BLACK STUDIES / JULY 2006
Our article is organized in four sections. First, we define the
notion of social exclusivity and review literature on the intersection
of swimming participation and social status. Second, we discuss
our methodologies, noting data sources and variable operations.
Third, we present statistical results. Fourth, we recapitulate find-
ings in relation to the notion of social exclusivity and suggest strat-
egies to ameliorate differentials in rates of accidental drowning and
submersion.
SOCIAL EXCLUSIVITY AND SWIMMING
The negative effects of inequalities become social injustices
when public policies fail to adequately alleviate the conditions that
give rise to the inequality or when the conditions are neither pub-
licly defined as a social problem nor brought to policy makers'
attention. At first glance, the absence of a well-developed swim-
ming infrastructure or restricted access to swimming programs
may not appear to represent social injustices. But we argue that
absence of a swimming infrastructure or restricted access are social
injustices suffered by individuals in different countries or status
groups in a country under the following societal conditions: The
risk of drowning is a serious health concern because of the omni-
presence of bodies of water; the majority of the impoverished pop-
ulation lacks water safety knowledge and swimming skills; and
no policies are effected to counter the principle of social exclusiv-
ity that restricts access of low-income status groups to swimming
programs.
Analysts have found that participation in amateur sport pro-
grams is significantly conditioned by a nation's level of economic
development, the degree of social development, the presence of
middle and upper classes, and size and degree of development in
the sports infrastructure (Bourdieu, 1984; Caritey, 1996; Hargreaves,
1986). Level of economic development refers to the nation's GDP
and the proportion of urbanized population. In general, the higher a
nation's level of economic development, the greater the degree of
social development as measured by life expectancy, adult literacy
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Hastings et al. / SWIMMING AND SOCIAL JUSTICE 899
rates, correspondence on adult and youth literacy rates, and GDP
per capita. Furthermore, the higher the levels of economic and
social development, the more likely the presence of middle and
upper classes with individuals who have the discretionary time,
disposable resources, and desire for participation in sport pro-
grams. Such individuals are likely to organize, operate, and partici-
pate in a variety of sports for children and adults, creating a well-
developed sports infrastructure - instructional and competitive
programs in venues that ideally are designed using state-of-the-art
technologies enhancing performance and safety.
We earlier reported our findings that these conditions account
for the international development and diffusion of amateur compet-
itive swimming programs for youths and adults (Hastings, Cable,
& Zahran, 2005). We found that nations in Europe, North America,
South America, and Oceania, which are characterized by higher
levels of economic and social development and sizable middle and
upper classes, also possess significant swimming infrastructures
(i.e., pools, learn-to-swim programs, and competitive swimming).
In the less economically and socially developed continents of
Africa and Asia, only the few countries with relatively high levels
of economic and social development had significant swim-
ming infrastructures. Our data indicate that the more economically
developed the nation, the larger the sports infrastructure.
Within a country, status groups that have access to a well-
developed swimming infrastructure and are not restricted from par-
ticipation by the principle of social exclusivity would have fewer
numbers of unintentional drowning (accidental drowning and sub-
mersion) than those status groupings that do not participate. In
other countries with less developed swimming infrastructures and
more restrictive social exclusivity in swimming, we would expect
to find higher numbers of unintentional drowning among disen-
franchised status groups. The use of U.S. data as a test case is a con-
servative test of these hypotheses. Swimming infrastructure is
well-developed in the United States in the availability of pools for
instruction and competition, although variation occurs in the
degree to which state-of-the-art technology is incorporated to
enhance competitive performances and, more especially, monitor
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900 JOURNAL OF BLACK STUDIES / JULY 2006
for aquatic accidents. Blacks do participate in swimming, but sig-
nificantly less than Whites. We suspect that differential rates of
swimming participation attributable to social exclusivity may ex-
plain the differences obtained by race on the rate of accidental
drowning and submersion.
METHOD
Data were obtained from numerous public and for-profit
sources. At the individual level, swimming participation data were
gathered from USA Swimming (2003) to estimate youth partici-
pation, and the DDB lifestyle database was used to estimate adult
participation in swimming. The county-level dataset is a match of
county records on swimming participation data from Applied Geo-
graphic Solutions, Inc., and Mediamark, Inc. Data on percentage
White, percentage urban, percentage water area in county, and
median household income were extracted from the U.S. Census
Bureau's Population and Housing Summary Tape Files, and acci-
dental drowning and submersion mortality rates by race were taken
from the CDC. FIPS codes and longitude and latitude coordinates
were used to merge data reliably. Below is an abbreviated discus-
sion of secondary data sources used in this study. Reliability and
validity concerns are addressed. Also, variables used in prediction
equations are discussed and presented in Table 2.
The U.S. Census Bureau's decennial census is the most compre-
hensive and important source of population and housing data in the
United States. In theory, a census is a complete enumeration of the
population. In reality, content and coverage errors occur. Post-
census analyses reveal that citizens and permanent residents are
uncounted or double-counted. Undercounts have decreased from
5.4% in 1940 to 1.1% of the population in 2000. Undercounted
populations are disproportionately minority and poor. From a
social scientific standpoint, the undercount of minorities intro-
duces a coverage error that may reduce the quality of studies that
use census data. With this caveat in mind, the following subset of
population and housing variables from the U.S. Census Bureau is
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Hastings et al. / SWIMMING AND SOCIAL JUSTICE 903
used: population density, median household income, percentage
water area, and percentage urban population. Also taken from the
U.S. Census Bureau is an indirect measure of risk for place to
drown - percentage water area in county.
Our swimming participation measure at the county level is
derived from the MRI Consumer Behavior database. Lifestyle and
psychographic data on U.S. adults are collected biannually by
Mediamark, Inc. Adults are selected randomly from a population
list of 90+ million households on an area probability basis. Each
wave is made up of 12,000+ field interviews, totaling 25,000 per
year since 1979 (about 550,000 in all). At the end of each interview,
a questionnaire is distributed. The data are weighted to reflect prob-
abilities in sampling design. Our swimming participation measure
at the county level estimates the percentage of persons residing in a
county area who reported participating in swimming in the past 12
months. This measure estimates the swimming infrastructure that
exists in a county area.
Researchers at Applied Geographic Solutions, Inc., have config-
ured MRI household records to various levels of political, adminis-
trative, and statistical scale. A Mosaic coding technology is used to
derive geodemographic profiles of block groups. The logic of
geodemographic segmentation is that people gravitate to commu-
nities with people of similar interests, means, and backgrounds.
Evidence on residential segregation by race, income, employment,
household size, family status, education, and religiosity supports
this logic (see Massey & Denton, 1993). The Mosaic system is dis-
cussed more thoroughly at www.appliedgeographic.com.
Swimming participation data at the individual level are derived
from USA Swimming and the DDB Needham Lifestyles Survey.
The DDB Needham Lifestyles Survey, according to Robert Putnam
(2000), "constitutes one of the richest known sources of data on
social change in America in the last quarter of the twentieth cen-
tury" (p. 420). Commissioned by DDB Needham Worldwide, a
quota sample of 3,500 to 5,000 residents is surveyed annually on a
range of social and political phenomena, including media and con-
sumer habits, political beliefs, religiosity, civic involvement, gen-
eral life satisfaction, psychographics, and sports participation. The
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904 JOURNAL OF BLACK STUDIES / JULY 2006
samples are generated from a panel of 500,000 cooperating house-
holds. We obtained longitudinal data from DDB Needham on
swimming participation for the years 1975 to 1999. Overall, this
data archive contains information on 87,000 respondents. Because
the DDB data are known to slightly underestimate adults younger
than 25, and because unintentional drowning crude mortality rates
have a bimodal age distribution that is skewed toward children and
young adults, we gathered data from USA Swimming on member-
ship history and child participation in officially sanctioned
swimming programs to triangulate our testing of hypotheses.
USA Swimming was created following the passage of the Ama-
teur Sports Act of 1978 that decentralized administration of Olym-
pic sports. As the national governing body for competitive swim-
ming, USA Swimming formulates and administers policies for
national competition and disseminates safety and sports medicine
information. USA Swimming also collects data annually on mem-
bership demographics and activities. To estimate sex, ethnic, and
age differentials in swimming participation for youth, we obtained
statistics from USA Swimming for year-round athlete membership
for 2003.
Accidental drowning and submersion data at the county level are
derived from the CDC. The CDC has created a comprehensive and
fully accessible public health data system called Wonder. CDC
Wonder enables users to search for specific data on occupational
health and safety, injury prevention, chronic and communicable
diseases, and cause-specific mortality. We used the Compressed
Mortality Data Request interface to obtain accidental drowning
and submersion data by race at the county level. The Compressed
Mortality File (CMF) data are based on records for all deaths
occurring in the United States. Deaths to foreign residents are
excluded. Cause of death on the CMF is the underlying cause of
death, which is defined by the WHO as "the disease or injury which
initiated the train of events leading directly to death, or the circum-
stances of the accident or violence which produced the fatal injury"
(http://wonder.cdc.gov/wonder/help/mort.html). Underlying
cause of death is selected from the conditions entered by the physi-
cian on the cause-of-death section of the death certificate. When
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Hastings et al. / SWIMMING AND SOCIAL JUSTICE 905
TABLE 3
USA Swimming Membership for Male and Female Youth, 2003
Female Male Female- Total
Age (in years) Membership Membership Male Membership
8 and younger 14,931 10,833 4,098 25,764
9 12,253 7,889 4,364 20,142
10 15,427 9,510 5,917 24,937
11 17,173 10,217 6,956 27,390
12 17,347 9,985 7,362 27,332
13 16,134 9,325 6,809 25,459
14 14,172 8,286 5,886 22,458
15 11,404 6,684 4,720 18,088
16 8,939 5,588 3,351 14,527
17 7,045 5,117 1,928 12,162
18 4,619 3,852 767 8,471
19 and older 3,847 4,436 -589 8,283
Total 143,291 91,722 51,569 235,013
more than one cause or condition is entered by the physician, the
underlying cause is determined by the sequence of conditions on
the certificate, provisions of the International Classification of
Disease (World Health Organization, 1992), and associated selec-
tion rules and modifications. Underlying cause of death is classi-
fied in accordance with the International Classification of Disease.
RESULTS
Our analysis begins with descriptive data on youth participation
in swimming by race and sex. USA Swimming membership data
by sex for 2003 are presented in Table 3. More than 200,000 youths
participate in USA Swimming programs annually. Almost 70% of
these respondents are female. Data show that females participate in
swimming more than males across all youth categories. Adult
males (age 19 and older) participate in swimming slightly more
than adult females. Youth participation data appear to correlate
with age, sex, and racial accidental and submersion rates presented
in Table 1. As participation increases from ages 10 to 14, the acci-
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906 JOURNAL OF BLACK STUDIES / JULY 2006
TABLE 4
Frequency of Swimming Participation
in a Year by Race, 1975-1998
Frequency of Asian/
Swimming Pacific
in a Year White Black Islander Other
None count 17,763 1,632 155 123 19,673
% within race 39.2 72.2 46.3 40.2 40.8
1-4 times count 9,745 355 81 71 10,252
% within race 21.5 15.7 24.2 23.2 21.2
5-8 times count 5,590 109 44 40 5,783
% within race 12.3 4.8 13.1 13.1 12.0
9-11 times count 3,731 61 16 25 3,833
% within race 8.2 2.7 4.8 8.2 7.9
12-24 times count 4,124 52 19 27 4,222
% within race 9.1 2.3 5.7 8.8 8.8
25-51 times count 2,587 36 11 12 2,646
% within race 5.7 1.6 3.3 3.9 5.5
52+ times count 1,803 16 9 8 1,836
% within race 4.0 .7 2.7 2.6 3.8
dental and submersion rate contracts. Likewise, as participation in
swimming decreases significantly for the age categories of 15 to
19, the accidental and submersion rate doubles to 1.6 per 100,000
persons.
USA Swimming membership data on ethnicity for 2003 are dif-
ficult to assess because of missing values. The rank order on mem-
bership for athletes reporting ethnicity is Caucasian (106,083),
Asian Pacific Islander (7,478), Hispanic (5,079), African Ameri-
can (2,015), and Native American (552). Sex ratios for all ethnic
categories are feminine. Again, the lower rate of African American
participation, especially the disproportionately low rate among
African American males, appears to coincide with the higher
unintentional drowning rate for Blacks.
Because race and ethnicity data on membership in USA Swim-
ming are incomplete, we computed descriptive data on swimming
participation by race using data derived from the DDB Lifestyle
Survey. Table 4 cross-tabulates reported annual frequency of par-
ticipation in swimming by race/ethnicity for the survey years of
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Hastings et al. / SWIMMING AND SOCIAL JUSTICE 907
FIGURE 1 Rate of Participation in Swimming for Whites and Blacks, 1982-1994
1975 to 1998. Consistent with USA Swimming membership data,
participation is highest among Whites, with 60.8% of respondents
reporting to have engaged in swimming at least once in a given
year. The rate of nonparticipation is highest among African Ameri-
cans (72.2%). Figure 1 compares the rate of participation among
Whites and Blacks from 1982 to 1994. Difference in swimming
participation between Whites and Blacks is stable and persistent
longitudinally. Approximately two thirds of White respondents
engaged in swimming at least once a year over this time period,
whereas about one third of Black respondents reported participat-
ing in swimming. As a whole, these data suggest that differences
obtain between Blacks and Whites and between males and females
on participation in swimming. Such differences may partially gov-
ern differences in unintentional drowning mortality patterned by
age, race, and gender, insofar as greater participation translates into
greater aquatic skills that mitigate the risk of death by drowning.
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908 JOURNAL OF BLACK STUDIES / JULY 2006
TABLE 5
Binary Logistic Regression Predicting Swimming Participation
in a Year (None & 1+ per annum), 1975-1998
B SE Wald Sig. Exp(B)
White .727 .092 62.518 .000 2.070
Black -.899 .106 72.431 .000 .407
Sex .039 .024 2.729 .099 1.040
Age -.050 .001 4227.498 .000 .951
Household income .106 .003 1002.255 .000 1.112
(Constant) 1.400 .106 173.277 .000 4.054
Nagelkerke /?2 .240
Model x2 7215.591
-2 log likelihood 42734.296
To see if gender and race differences persist with the application
of statistical controls, we produced a logistic regression equation
predicting swimming participation. Table 5 shows that probability
of voluntary participation in swimming is significantly higher for
Whites than for Blacks. In fact, being Black reduces the odds of
participation in swimming by approximately 60%, even while ad-
justing for age, sex, and household income. Overall, the model per-
forms decently, explaining about 24% of variation in swimming
participation at the individual level. Now that we have established
that participation differences between Blacks and Whites are real
and not an artifact of statistical chance, suggesting that the mecha-
nism of social exclusivity is at play, we shift our investigation to
whether or not swimming participation partially predicts race-
specific accidental drowning and submersion mortality rates.
To examine this hypothesis, a data file was constructed that con-
tained data of deaths due to unintentional drowning by county and
race, and selected population and household variables, as well as
percentages on swimming participation by county. Data files were
matched using FIPS county codes. Analyses connecting swimming
participation and mortality by unintentional drowning are con-
ducted at the county level because publicly available mortality rec-
ords are only available at this level of geographic resolution. A
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Hastings et al. / SWIMMING AND SOCIAL JUSTICE 909
FIGURE 2 National Distribution of Swimming Participation at the County Scale,
2003
series of maps was produced to see if accidental drowning and sub-
mersion rates have a geographic logic. For all maps, county units
are divided equally into quintiles and colored accordingly.
The map in Figure 2 shows the distribution of swimming partici-
pation at the county level for 2003. The "dark zones" represent
areas where participation in swimming is comparatively low, sug-
gesting that infrastructures for swimming are relatively less devel-
oped. The map suggests that rates of participation are lower in the
Southeast and Southwest United States, where African American
and Hispanic residents are disproportionately concentrated. The
"light zones," indicating relatively high participation in swimming,
are located in Middle Atlantic, New England, and Midwest states.
With the exception of a thin band of high participation along the
Southeast coast of Florida, swimming is a predominantly Northern
activity. Consistent with USA Swimming data, Figure 2 shows that
the regions of the country with strong competitive age group pro-
grams have higher participation rates than other regions.
Figure 3 is a visual model of accidental drowning and submer-
sion mortality rates for all persons at the county level for 2001 . Hie
dark zones are counties with comparatively higher rates of mortal-
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9 1 0 JOURNAL OF BLACK STUDIES / JULY 2006
FIGURE 3 Accidental Drowning and Submersion Mortality Rate for all Persons at
the County Scale, 2001
ity. Mortality rates tend to cluster in the Southeast and the relatively
rural Mountain states of Wyoming, Utah, Idaho, and Nevada. Fig-
ures 4 and 5 unpack accidental drowning and submersion mortality
rates by race. Figure 4 indicates that Black mortality rates concen-
trate in the Southeast stretching from South Virginia to East Texas
to the southern tip of Florida. Figure 5 shows that White mortality
rates are also concentrated in the same Southeast region but also in
the Mountain West, Northern Minnesota, and South Maine. Over-
all, these maps suggest a negative correlation between swimming
participation and patterns of unintentional drowning. Mortality
rates are lower in areas where rates of swimming participation are
comparatively high. Insofar as rates of swimming participation are
a partial reflection of swimming infrastructure, residents in areas of
comparatively lower rates of unintentional drowning have greater
access to swimming instruction.
We conducted a series of regression models to test our claims
that rates of swimming participation at the county level are racially
determined and that the presence of well-developed swimming
infrastructure for the teaching of aquatic safety mitigates the risk of
death by unintentional drowning. Table 6 shows that higher rates of
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Hastings et al. / SWIMMING AND SOCIAL JUSTICE 9 1 1
FIGURE 4 Accidental Drowning and Submersion Mortality Rate for Blacks at the
County Scale, 2001
FIGURE 5 Accidental Drowning and Submersion Mortality Rate for Whites at the
County Scale, 2001
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9 1 2 JOURNAL OF BLACK STUDIES / JULY 2006
TABLE 6
Ordinary Least Squares Regression Predicting
Percentage Swimming Participation at the County Level
B SE P t Sig.
Percentage urban population .024 .001 .241 19.895 .000
Population density .000 .000 -.002 -.234 .815
Median household income .000 .000 .618 51.685 .000
Percentage White, 2000 .001 .000 .271 24.925 .000
(Constant) .066 .002 32.870 .000
R2 .671
Ftest 1584.15
swimming participation appear in urbanized counties with higher
median income and a greater percentage of White residents (and,
conversely, a lower percentage of African American residents).
The variable pool predicts almost 70% of variation in swimming
participation at the county level. This model suggests that swim-
ming is an activity that attracts elements of the population that
occupy positions of higher status in stratified America. In other
words, swimming appears to be a socially exclusive phenomenon.
Does this social exclusivity have implications for race- specific
mortality by unintentional drowning?
Table 7 shows ordinary least squares (OLS) regression models
predicting unintentional drowning rates at the county level for
racial groups. Column 1 shows that for the total population, the un-
intentional drowning rates are lower in areas with higher levels of
population density, urbanization, and swimming infrastructure.
Swimming is the strongest predictor of unintentional drowning
(P = -.369, p = .000). As percentage of water area increases, so do
unintentional drowning rates.
Column 2 and column 3 disaggregate mortality rates for White
and Black. In column 2, the variables behave similarly for Whites
as for the total population. Because unintentional drowning rates
increase with percentage of water area, we may infer that Whites
are more likely than Blacks to drown elsewhere than in pools (in-
cludes indoor and outdoor). This inference is indirectly supported
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914 JOURNAL OF BLACK STUDIES / JULY 2006
by Cordell, Betz, Green, and Mou (2004). The National Survey of
Recreation and the Environment in 1994-1995 and 2000-2001 lists
the top 10 most popular outdoor activities by racial and ethnic
groups. For White non-Hispanics, swimming in lakes occupies 9th
position in 1994-1995 but drops out of the top 10 in 2000-2001. For
White non-Hispanics, swimming in outdoor pools is in 7th position
in 1994-1995 and drops out of top 10 in 2000-2001 . For Black non-
Hispanics, swimming in lakes is not even included in the top 10
activities in either 1994-1995 or 2000-2001; swimming in outdoor
pools is in 10th position in 1994-1995 and drops out of the top 10 in
2000-2001.
Brenner, Trumble, Smith, Kessler, and Overpeck's (2001) study
of age-sex-race-site-specific unintentional drowning rates shows
that Blacks drown in pools more so than Whites. They found the
following patterns. For ages 1 to 4, White males and females have
higher drowning rates than their Black counterparts. Black males
and females ages 5 to 19 have higher rates of drowning in pools
than their White counterparts. In column 3, for Blacks, higher pop-
ulation density and percentage urban (presence of swimming infra-
structure) reduces the rate of unintentional drowning. Increase in
percentage water is not related to unintentional drowning for
Blacks. In column 3, we also see that for Blacks, an increase in the
rate of swimming participation is associated with increases in the
rate of unintentional drowning. The risk of accidental drowning
increases for Blacks as opportunities for swimming increase. This
puzzle is perhaps explained by the fact that Blacks do not swim as
many times a year as Whites (see Table 4). This difference in expe-
rience produces differences in ability, such as technical skill and
knowledge of aquatic safety to handle life-threatening situations
in crowded public recreational pools or pools with drop-offs
(Gilchrist, Sacks, & Branche, 2000).
CONCLUSION
Age, sex, and racial differentials in swimming participation are
conditioned by the availability of instructional and competitive
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Hastings et al. / SWIMMING AND SOCIAL JUSTICE 915
programs and the principle of social exclusivity that limits access
even where a swimming infrastructure is available. Cordell et al.
(2004) show that as income and education (less than high school
through college graduate) increase, swimming in lakes or pools is a
top 10 outdoor activity and remains so from 1994-1995 to 2000-
2001.
Public health officials and students of sport have long recog-
nized that differentials in swimming participation affect life
chances (morbidity and mortality) across status groups. Four
themes arise when debating policy change, suggesting programs to
reduce deaths from accidental drowning and submersions and
working to ameliorate age, sex, and racial differentials in life
chances. First, programs are needed to develop the swimming
infrastructure by building state-of-the-art instructional and recre-
ation pools without deep-water drop-offs where swimmers can
silently slip underwater and drown. Second, drowning incidences
in multiple-use pools would decrease with the installation of sen-
sors and underwater cameras to monitor for swimmers in distress
(Conway, 2001). Third, programs and policies are needed to up-
grade water safety knowledge of swimmers, emergency personnel,
and supervisory adults that target status groups that disproportion-
ately die from accidental drowning and submersion. Fourth, citi-
zens and public officials must ensure that cases of accidental
drowning and submersion are accurately identified. Officials must
be held accountable for accurate classification of cause of fatality
and recordkeeping (Fletemeyer, 2003; Green, 1985). Drowning
must become a public event and not be misclassified. Any fatality
in which drowning or submersion is one of the conditions leading
to a death should be included under the primary rubric of drowning
and not officially counted as a secondary drowning fatality (e.g.,
automobile, boating, or not reported; drowning of immigrants
illegally crossing borders).
Given available funds, policy makers are likely to consider these
four means of reducing drowning deaths in pools over which they
can exercise control. Learn-to-swim programs must include an
emphasis on water safety and swimming skills. High-risk status
groups should be actively recruited to participate if policy makers
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9 1 6 JOURNAL OF BLACK STUDIES / JULY 2006
truly want to reduce differentials in rates of drowning and to redress
injustices due to past exclusion of the disenfranchised.
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Donald W. Hastings is a professor of sociology at the University of Tennessee, Knox-
ville. His research interests include environmental sociology, applied demography,
and sociology of sport.
Sammy Zahran is a postdoctoral fellow with the Institute for Science, Technol-
ogy, and Public Policy, George Bush School of Government and Public Service, Texas
A&M University. His current interests include evaluation of public policy, diffusion
of scientific knowledge, and contextual factors affecting risk perceptions and
behaviors.
Sherry Cable is an associate professor of sociology at the University of Tennessee,
Knoxville. She is an expert in anti-toxics and the environmental justice movement and
activism, with a focus on working-class and poor communities in the Southeastern
United States.
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Drowning is the second leading cause of unintentional injury death among children ages 1 to 19 years. Details about the specific site of submersion are important for implementation of primary prevention efforts, but are not routinely available from national data. To provide national data about the specific sites of drowning among US children and to examine site-specific drowning rates by age, race, and gender. United States, 1995. Information was abstracted from death certificates for unintentional drownings among children <20 years of age. The site of drowning was coded from free text on death certificates. Proportional distributions of the site of drowning by age, region, gender, and race were examined. Site-specific drowning rates were calculated by age, race, and gender. Denominators were based on US Census Bureau, June 1995 estimates of the US population. For 1995, death certificates were obtained for 1420 unintentional drownings among children <20 years of age, 98% of the number of drowning deaths reported by the National Center for Health Statistics for the same year. Site of drowning was specified on 1308 (92%) death certificates. Fifty-five percent of infant drownings were in bathtubs. Among children between the ages of 1 to 4 years, 56% of drownings were in artificial pools and 26% were in other bodies of freshwater. Among older children, 63% of drownings were in natural bodies of freshwater. Site-specific drowning rates varied by race. Importantly, after the age of 5 years, the risk of drowning in a swimming pool was greater among black males compared with white males with rate ratios of 15.1 (95% confidence interval: 6.7-38.5) among 10- to 14-year-olds and 12.8 (95% confidence interval: 6.5-26.9) among 15- to 19-year-olds. The variety of sites in which children drown, even within specific age groups, emphasizes the need for a multifaceted approach to prevention. Reductions in the relatively high rates of drowning among black adolescent males will require targeted interventions to prevent swimming pool drownings among this group.
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