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Taking the plunge: Diving risk practices and perceptions of New Zealand youth

DOI:10.1071/HE08068
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Kevin Moran at University of Auckland
Kevin Moran
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Abstract

In New Zealand, spinal cord injuries as a consequence of recreational diving have not been well investigated. From 1989-2004, 58 hospital admissions involved diving-related spinal injury. More than 70% were male and more than one-third (36%) were aged 10-19 years. Little is known, however, about the extent of risky diving beliefs and behaviours underpinning youth aquatic recreation. A New Zealand-wide sample of 2,202 Year 11 students completed a written questionnaire under supervision during school time. Diving behaviours and safety attitudes were analysed using a range of sociodemographic variables including gender, socio-economic status and ethnicity. Gender differences in risky behaviour and unsafe attitudes were pronounced, whereas the influence of socio-economic status and ethnic background were less evident. More females than males reported "never diving head first into water of unknown depth" (females 75%, males 59%). More males reported "diving head first knowing that the water was shallow" (males 25%, females 14%). More females disagreed that diving head first into shallow water was acceptable if you knew how to dive (females 82%, males 66%). Males, students from low decile schools and of Maori and Pacific Island backgrounds were most likely to hold unsafe attitudes towards diving and report risky diving behaviours.
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Health Promotion Journal of Australia 2008 : 19 (1)
68
Introduction
Recreational swimming is generally perceived as a positive
indicator of a healthy lifestyle. However, one potentially
serious health risk associated with it is spinal cord injury (SCI).
Such injury is often the consequence of recreational diving,
the act of entering the water head first during recreational
activity.
1
Although there are relatively few hospital admissions,
the financial cost to society of SCI is high given that those
most frequently affected are healthy young persons under
25 years of age.
3,4
In Australia, the Australian Spinal Cord Injury Register (ASCIR)
reported 125 SCI diving-related incidents between 1995-
2005 in the 15-44 years age group where victims required
hospitalisation (R. Cripps, RCIS, Flinders University, personal
communication, 7 November 2006). Of these, most (n=69;
88%) were male and almost two-thirds (n=78; 62%) were
Taking the plunge: diving risk practices
and perceptions of New Zealand youth
Kevin Moran
Abstract
Issue addressed: In New Zealand, spinal cord injuries as a consequence of recreational diving have not been
well investigated. From 1989-2004, 58 hospital admissions involved diving-related spinal injury. More than
70% were male and more than one-third (36%) were aged 10-19 years. Little is known, however, about the
extent of risky diving beliefs and behaviours underpinning youth aquatic recreation.
Method: A New Zealand-wide sample of 2,202 Year 11 students completed a written questionnaire under
supervision during school time. Diving behaviours and safety attitudes were analysed using a range of socio-
demographic variables including gender, socio-economic status and ethnicity.
Results: Gender differences in risky behaviour and unsafe attitudes were pronounced, whereas the influence
of socio-economic status and ethnic background were less evident. More females than males reported “never
diving head first into water of unknown depth” (females 75%, males 59%). More males reported “diving head
first knowing that the water was shallow” (males 25%, females 14%). More females disagreed that diving head
first into shallow water was acceptable if you knew how to dive (females 82%, males 66%).
Conclusions: Males, students from low decile schools and of Maori and Pacific Island backgrounds were most
likely to hold unsafe attitudes towards diving and report risky diving behaviours.
Key words: Recreational diving; spinal cord injury; water safety; at-risk male youth.
Health Promotion Journal of Australia 2008;19:68-71
So what?
Ways of reducing recreational diving risk through targeted education interventions may be best directed at
young males and, to a lesser extent, young people attending lower socio-economic schools and of Maori and
Pacific Islands backgrounds.
aged 15-24 years. In New Zealand, an analysis of hospital
admissions, where the principal diagnosis was SCI and the
principal mechanism of injury (E-code) was ‘Accident from
diving or jumping into water’, found 58 cases from 1989-
2004. Of these, more than 70% were male and more than
one-third (36%) were aged 10-19 years (D. Barson, IPRU,
University of Otago, personal communication, 21 November
2005).
While risk factors contributing to recreational diving injury
have been well reported,
1-8
the water safety attitudes
and behaviours that underpin unsafe diving are not well
understood. The purpose of this report is to examine the
attitudes and behaviours of New Zealand youth that underpin
dangerous diving practice. Such analysis will provide an
indication of what preventive strategies are needed and where
such initiatives may be best directed in order to counter
potentially dangerous diving practice.
Brief Reports
Health Promotion Journal of Australia 2008 : 19 (1)
69
Method
A nationwide sample of 2,202 Year 11 students was selected
using a multi-stage, stratified random sample process from a
target population of approximately 50,000 youth aged 16-
19 years.
9
A nationwide survey consisting of a self-complete
written questionnaire on aquatic recreational activities, water
safety knowledge, attitudes and behaviours was conducted
over a six-week period during May-June 2003.
Data from the completed questionnaires were entered into
Microsoft Excel X for statistical analysis using SPSS Version
12.0 in Windows. Responses were analysed using the socio-
demographic variables of gender, socio-economic status via
the school decile rating (a composite score of social indices
in which a low decile ranking reflects low socio-economic
status), and ethnicity. Mann Whitney U tests and chi-square
analyses were conducted to determine levels of significance.
Detailed analysis of youth aquatic recreational activity, their
associated water safety knowledge, attitudes and behaviours
was published in a report entitled New Zealand Youth Water
Safety Survey 2003.
10
Results
1. Risky diving behaviours
One-third of respondents (n=715; 33%) reported that they
had dived head first into water of unknown depth in the
previous year. Mann Whitney U testing revealed significant
differences between males and females (U=500927.00,
p<0.001) with almost twice as many males reporting having
dived into water of unknown depth (males 40%, females
24%) (see Table 1).
Significantly more students from low-decile schools (36%)
than high-decile schools (30%) reported diving into water
of unknown depth (U=273965.50, p=0.005). Maori and
Pacific Islands youth were twice as likely as European, Asian
or ‘other’ ethnicities to report having often dived into water
of unknown depth (15% and 13% compared with 8% and
7% each respectively).
Table 2 shows that, in the previous year, one-fifth (n=441;
20%) of participants had dived head first into shallow water.
Respondents were able to make their own interpretation of the
term ‘shallow water’. Significantly more males than females
(U=528039.00, p<0.001) reported knowingly diving into
shallow water (males 26%, fema1es 14%). More Maori youth
(27%) than non-Maori youth (20%) reported having dived into
shallow water (U=339362.5, p=0.002).
To ascertain the extent of risk-taking diving practices among
their peers, students were asked if they had seen friends
performing risky diving behaviours. More than one-quarter
of students (n=580; 29%) who had been with friends during
aquatic recreation had observed them dive into shallow water.
Significantly more males than females (38% vs. 17%) had
observed their male friends diving into shallow water head
first (U=492835.00, p<0.001).
Although the study did not directly ask students whether
they had consumed alcohol before diving into water, some
evidence of an association between risky diving practice and
alcohol consumption during aquatic recreation was found. Of
the 325 males (28%) who reported having consumed alcohol
during swimming activity, many had also dived into water
without knowing the depth (57%) or had dived head first
knowing the water to be shallow (41%). Of the 161 females
(19%) who reported drinking alcohol, proportionally fewer
reported diving into water of unknown depth (15%) or diving
Brief Reports Diving risk practices and perceptions of New Zealand youth
Table 1: Number and percentage of youth who, in the previous year, had dived into water of unknown depth, by gender, socio-
economic status via decile rating of school attended, and ethnicity.
Dived head first into unknown depth of water Never Sometimes Often
n % n % n %
Gender
Male (n=1,154) 688 59.6 320 27.7 146 12.7
Female (n=1,023) 774 75.7 189 18.5 60 5.8
Socio-economic status
Low-decile school (n=618) 396 64.1 149 24.1 73 11.8
Mid-decile school (n=634) 425 67.0 144 22.7 65 10.3
High-decile school (n=925) 641 69.3 216 23.4 68 7.3
Ethnicity
European (n=1,328) 919 69.2 309 23.3 100 7.5
Maori (n=404) 230 56.9 112 27.7 62 15.3
Pacific Island (n=202) 124 61.3 51 25.3 27 13.4
Asian (n=198) 153 77.3 31 15.7 14 7.0
Other (n=45) 36 80.0 6 13.3 3 6.7
Total (n=2,177) 1,462 67.2 509 23.4 206 9.5
Health Promotion Journal of Australia 2008 : 19 (1)
70
Table 2: Number and percentage of youth who, in the previous year, had dived into shallow water by gender, socio-economic
status via decile rating of school attended, and ethnicity.
Dived head first knowing that it was shallow water Never Sometimes Often
n % n % n %
Gender
Male (n=1,154) 856 74.2 230 19.9 68 5.9
Female (n=1,023) 880 86.0 122 11.9 21 2.1
Socio-economic status
Low-decile school (n=618) 486 78.6 99 16.0 33 5.3
Mid-decile school (n=634) 509 80.3 101 15.9 24 3.8
High-decile school (n=925) 741 80.1 152 16.4 32 3.5
Ethnicity
European (n=1,327) 1,079 81.3 208 15.7 40 3.0
Maori (n=405) 297 73.3 83 20.5 25 6.2
Pacific Island (n=202) 154 76.2 35 17.3 13 6.4
Asian (n=198) 170 85.9 20 10.1 8 4.0
Other (n=45) 36 80.0 6 13.3 3 6.6
Total (n=2,177) 1,736 79.7 352 16.2 89 4.1
head first into shallow water (17%). Proportionally fewer
non-consumers of alcohol than those who had consumed
alcohol during aquatic recreation reported diving into water
of unknown depth (27% vs. 53%) or diving into water knowing
that it was shallow (15% vs. 37%).
2. Attitudes towards diving
Students were asked their view on diving head first into
shallow water in a question that used a four-point scale
ranging from strongly agree to strongly disagree. A quarter
of students (n=581; 26%) agreed/strongly agreed that diving
into shallow water was acceptable if you knew how to dive.
Significantly more females than males (U=508944.00,
p<0.001) disagreed/strongly disagreed that diving head first
into shallow water was acceptable (82% vs. 66%).
More youth from low-decile schools (31%) than high-decile
schools (23%) agreed/strongly agreed that diving into shallow
water was acceptable (U=264314.00, p<0.001). More Maori
and Pacific Islands youth than those from European, Asian
or ‘other’ ethnic backgrounds (35% and 37% compared
with 22%, 29% and 22%) agreed/strongly agreed that diving
into shallow water was acceptable. More Maori than non-
Maori youth (U=3223318.00, p<0.001) and more Pacific
Islands youth than non-Pacific Islands youth (U=186911.00,
p=0.043) were likely to hold this view.
Discussion
Results of this study suggest that risky diving practices and
unsafe attitudes towards diving are commonplace among New
Zealand youth. Results also indicate significant differences in
diving attitudes and behaviours within the youth population,
especially with regard to gender. Although not as pronounced
as gender differences, some differences were also evident
when recreational diving was analysed by socio-economic
status and ethnicity.
The prevalence of unsafe diving attitudes and behaviours
among males, those from lower socio-economic backgrounds
and those from particular ethnic groups may indicate that the
risks associated with diving are either not be well understood
among these groups or that they are less concerned about the
risk. Diving education, aimed at enhancing youth decision-
making about risky behaviours and targeted at high-risk groups
such as those identified in this study, may effectively promote
recreational diving injury prevention. Moreover, because of
the frequent observation of risky diving practice among peers
reported in this study and the prevalence of unsafe attitudes
among youth, such programs may benefit from a peer-
oriented pedagogical approach that contextualises dangerous
diving practices in a social, peer-group setting.
The indirect association of alcohol consumption and risky
diving practices, especially among male participants in the
study, tends to reinforce previous findings of an association
between alcohol use and diving injury.
1,2,8
The clustering
of unsafe behaviours such as dangerous diving and alcohol
consumption found in this study of youth suggests that New
Zealand media campaigns to discourage alcohol use in and
around water should not only continue but be intensified,
especially among male youth. Furthermore, creating greater
synergy between alcohol education and water safety
education programs may be more effective among at-risk
youth than addressing either topic in isolation.
Conclusion
This study has provided new evidence on the extent of unsafe
attitudes and risky behaviours that underpin recreational
diving practice among an age group at high risk of sustaining
Moran Brief Report
Health Promotion Journal of Australia 2008 : 19 (1)
71
SCI. While this evidence suggests relatively widespread
unsafe diving beliefs and behaviours among youth and
identifies particular at-risk groups, further research is required
to substantiate the findings of this study. Further in-depth
qualitative analysis of youth diving beliefs and practices,
especially with regard to the diving habits of young males in a
social setting, might be a logical next step towards enhanced
understanding of the vexed issue of diving-related SCI among
youth.
Acknowledgements
Funding from Water Safety New Zealand and the Massey
University Graduate Research Fund supported this study.
The author has no conflict of interest directly relevant to the
content of this manuscript.
Author
Kevin Moran, Faculty of Education, University of Auckland, New Zealand
Correspondence
Dr Kevin Moran, Faculty of Education, University of Auckland, Private Bag 92601, Symonds Street, Auckland, New Zealand.
Tel: +64 9623 8899; fax: +64 9623 8836; e-mail: k.moran@auckland.ac.nz
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Author: check phone numbers. Is the area code
missing?
Brief Reports Diving risk practices and perceptions of New Zealand youth
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... This overestimation of competency is consistent with the findings of previous studies (for example, Moran et al., 2012;Petrass et al., 2012) although, perhaps surprisingly, no gender differences were evident. While other studies have found that, in comparison to females, males were more likely to overestimate a range of water competencies (for example, Gulliver & Begg, 2005;McCool et al., 2008;Moran, 2008Moran, , 2011Moran, , 2014cMoran, , 2015Moran et al., 2012;Moran & Stanley, 2013;Rejman et al., 2020), for the water entry competencies in the current study, this was not the case. The inaccuracy in predicting personal competency is concerning given most participants considered they were proficient swimmers (78%) and most reported having been taught to enter the water safely (80%). ...
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... Other studies have shown that youth and young adult males are most likely to engage in high-risk entries from height (Moran, 2014a) and to adopt unsafe entry behaviours (Moran, 2008;2011). As a way of promoting safe entry learning and teaching, Langendorfer (2010) suggested the use of a dynamical constraints model to help focus attention on the constraints associated with the person-task-environment triad that influence entry risk and safety. ...
... This overestimation of competency is consistent with the findings of previous studies (for example, Moran et al., 2012;Petrass et al., 2012) although, perhaps surprisingly, no gender differences were evident. While other studies have found that, in comparison to females, males were more likely to overestimate a range of water competencies (for example, Gulliver & Begg, 2005;McCool et al., 2008;Moran, 2008Moran, , 2011Moran, , 2014cMoran, , 2015Moran et al., 2012;Moran & Stanley, 2013;Rejman et al., 2020), for the water entry competencies in the current study, this was not the case. The inaccuracy in predicting personal competency is concerning given most participants considered they were proficient swimmers (78%) and most reported having been taught to enter the water safely (80%). ...
... Most respondents also held mainly positive attitudes toward safe entry practice, especially with regards to acknowledging that diving without checking water depth can be dangerous and that you should never dive/jump into water of unknown depth. Previous studies involving school age youth reported males especially more likely to hold at-risk views on these practices (Moran 2008(Moran , 2011. Interestingly, most respondents disagreed (87%) that dive entries should be banned in public pools. ...
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In high income countries, jumping and diving into water are a small but persistent cause of death and serious injury especially among male youth and young adults. Although water entries maintain a high media profile, little is known about what entry competencies and underlying water safety knowledge youth bring to this practice. Undergraduates enrolled in aquatics (N= 76) completed a survey before attempting 7 entry jumping and diving tasks. While safety attitudes and self-reported behaviours were generally good, considerable variation in practical entry competence was evident. Most completed a deep-water compact jump (87%) and PFD jump (88%) with ease. Many completed a crouch dive (57%) and standing dive (53%) into deep water with ease, but only 33% completed a standing dive from a block/bulkhead (<1m height) with ease. Ways of addressing weaknesses in knowledge, attitudes, and behaviours are discussed and recommendations made to enhance the teaching of safe water entry.
View
... It can only be assumed that men are much more willing to take risks than women when diving into unfamiliar waters. This is also indicated by a survey of young people in New Zealand, in which more young women than young men stated that they never dive headfirst into unfamiliar waters [27] . Several studies have shown that 37-47% of all accidents occur under the influence of alcohol [ 13 , 16 , 26 , 28 ]. ...
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... Water safety education is considered to impart knowledge and skills of water safety in foreign countries and can form positive attitudes, concepts, and behaviors of water safety in the water environment [39]. In addition, some scholars believe that water safety education should be carried out when children are 6 years old, so that they can engage in activities related to water under the premise of ensuring safety, and we must provide rescue techniques needed to assist others in water emergencies as much as possible and cardiopulmonary resuscitation skills [5]. ...
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To establish benchmark normative data for dive entries performed by young adults of the age range most likely to sustain a diving spinal cord injury. Data acquired from analysis of the dives performed, along with survey information, were used to determine which factors make the most contribution to the level of risk in diving. To identify influential variables which could contribute to risk of spinal cord injury for each of four types of dives. The types of dives investigated were: dive entries from deck level to tread water (Treadwater); deck level to swim 25 m (Deck); starting block height to swim 25 m (Block); and a running dive entry to swim 25 m (Running). Victoria, Australia. Ninety-five first year university students (average age 19.9 years) performed three or four dives which were video-recorded for later analysis. Maximum depth reached was used as an indicator of risk, and velocity at maximum depth, distance at maximum depth, angle of entry and flight distance were measured for each dive. Participants also completed a questionnaire designed to elicit information about their swimming and diving background. Unlike previous diving studies, participants were recreational rather than competitive swimmers. They were not aware that the dive was the focal point, assuming that the researchers were investigating their swimming and treadwater ability. A stepwise multiple regression was applied to predict depth for each dive condition, and demonstrated that four variables were able to account for 56% of the variance for Treadwater, 68% for Deck; 73% for Running and 79% for Block. In all conditions involving swimming after the dive (ie Deck, Block and Running), beta weights showed that distance at maximum depth had the greatest influence on the depth of a dive. Flight distance and angle of entry were the next most influential variables. For the Treadwater condition, beta weights showed angle of entry was the most influential variable, followed by velocity at maximum depth, distance at maximum depth and swim rank. It is recommended that divers strive to surface in as short a distance as possible by maximising flight distance and aiming for a low entry angle. Implementation of steering-up techniques will assist in minimising dive depth.
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Re-thinking drowning risk: The role of water safety knowledge, attitudes and behaviours in the aquatic recreation of New Zealand youth
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  • Aug 2009
The risk of drowning associated with aquatic recreation is the consequence of many underlying water safety influences that operate at intrapersonal, interpersonal and community levels. A nationwide survey was completed by New Zealand youth (n=2202, 15–19 year olds) to obtain comprehensive data on what young people know, think and do about their safety during aquatic recreation. Almost all respondents had taken part in some swimming (98%) in the previous year. Risk of drowning was exacerbated among many students because they had poor safety skills and knowledge, held unsound attitudes, and often reported risky behaviours. For example, many students estimated that they could not swim more than 100 m (54%), had swum outside surf patrol flags (61%) or never wore lifejackets (19%) during aquatic recreation. Taken separately, any of these dispositions is capable of heightening drowning risk; taken collectively they offer strong explanation as to why some youth are at greater risk of drowning than others. When analysed by gender, a lack of male water safety knowledge, a prevalence of unsafe attitudes, and at-risk behaviours was consistent and pronounced.
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Water recreation-related spinal injuries: Risk factors in natural bodies of water
Article
Spinal cord injuries are a major public health problem, and costs to society may total $6.2 billion per year. Using a case-control design, we investigated risk factors for spinal injury in male Wisconsin residents who sustained their injuries during water recreational activity. Compared with the controls, the people who sustained spinal injury were more likely to have entered the water from a pier or dock; to have dived into water; and to have used alcohol. Injury prevention programs for water recreation enthusiasts should address the topics of the hazards of combining alcohol with these activities, how to enter natural bodies of water safely, and safe water levels for diving.
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Diving Accidents: Mechanism of Injury and Treatment of the Patient
Article
Diving accidents that result in cervical spinal injuries most often occur in young adult males who have access to alcohol and water. A C-5 injury with permanent neurologic deficit is the most common pattern of injury in these patients. Recommended treatments include emergent alignment, an intravenous bolus of methylprednisolone, and spinal stabilization. Recovery is a function of the severity of the initial neurologic injury.
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A survey of spinal injuries from diving. A study of patients in Pretoria and Cape Town
Article
  • Jun 1981
A highly significant feature emerged from a study of patients with spinal injuries from diving treated at the H.F. Verwoerd Hospital and the Conradie Hospital, namely an area specificity with regard to cause of injury, circumstances and social habits. The typical patient presenting with spinal injuries from diving is a young male, the injury often being the result of the facing of a 'challenge' at a social gathering where alcohol consumption played an important role. The injurious dive is usually not a first attempt and is often into a pool of some sort or at a location well known to the patient. The forehead or vertex may strike either the bottom of the pool, a rock, or a sandbank, without any additional injuries, e.g. to the hands. The radiographs reveal a flexion-axial compression injury to the C4-C6 region of the spine, leaving the majority of such patients in a state of permanent and complete tetraplegia. Although many of these catastrophes are truly accidental, a large number of patients admit to a careless attitude which was the direct cause of their misfortune.
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Aetiology and Occurrence of Diving Injuries
Article
  • Apr 1997
This paper examines multifaceted aspects of diving entries into water which are the cause of many critical injuries (costed at $A150 million) and therefore have important safety ramifications. Wedge and compression fractures are most commonly found in the cervical area of the spine with off-centre impacts with the pool or sea bottom. Diving-related injuries range from 2.3 in a South African study to 21% of spinal cord injuries in Poland. Alcohol and diving do not mix because of diminished awareness and information processing. Children aged under 13 years suffer fewer cervical injuries (1 to 4%), but complication rates are relatively high for this group. Sports trauma (diving-related in particular) is one of the more prevalent causes of spinal cord injury in children aged 6 to 15 years. The highest incidence occurs among those aged 10 to 14, followed by the group aged 5 to 9 years. This contradicts the common perception that 15-to 19-year-olds comprise the highest risk group. Boys are more frequently injured, and swimming pools are more common as an injury location then is the case with adults. The role played by water depth has been conclusively ascertained; technique, and therefore education, appear to be more important considerations in injury prevention. Although 89% of injuries occur in water < 1.52m, injuries are rare in water of 0.46 to 0.61m. Care with pool design to avoid sudden depth changes and the resultant "spinal wall' is necessary. Minimum depth values for diving vary from 1 to 1.52 m. Velocities and angles of entry are considered to ascertain the body's decelerative capacity upon entry. The scoop, racing start dive has been shown to require at least 1.22 m of water even when practised by trained divers; the risks involved must therefore be weighed against the fact that it may be no faster than more conventional dives. While it may be safe to perform kneeling and crouching dives into shallowers water, standing dives by untrained divers require a greater margin of error. Lack of education is an issue which needs to be addressed and this paper makes recommendations for safety practices such as steering up to the surface, head protection with the arms and only diving when absolutely necessary.
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The Australian Institute of Health and Welfare
Article
This overview has described the AIHW role in Australia's health information which is highly relevant to communicable disease surveillance. The AIHW provides statistics and information on the nation's health and welfare within local, state, national and international settings. It has established an expertise in the collection, standards and dissemination of information. Given these qualities, the AIHW has a wealth of expertise and welcomes the use of its publications and data sources. Details of the Institute's work can be found on its website (www.aihw.gov.au).
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Epidemiology of Non-Submersion Injuries in Aquatic Sporting and Recreational Activities
Article
  • Feb 2003
Although the issues of drowning and near-drowning in aquatic sporting and recreational activities receive considerable attention in the epidemiological literature, there is not a recognised literature on non-submersion injuries occurring in these activities. This review draws together the epidemiological literature on non-submersion injuries and describes the incidence, nature and causes of these injuries, common risk factors, and strategies for prevention. Activities covered by the review include swimming, diving, boating, surf sports, fishing, water polo and water sliding. For most activities there is a dearth of good quality descriptive studies, with most involving cases-series designs and few providing estimates of incidence. Inconsistencies in inclusion criteria and the reporting of incidence rates makes comparisons within and between activities difficult. Incidence rates were identified for most activities and in general the incidence of injury was low, especially for more serious injury. However, some activities were associated with severely disabling injury, such as spinal cord injury (diving) and amputation (from propeller strikes in water skiing and swimming). Only three studies reporting the significance of postulated risk factors were identified. Lack of knowledge about the water being entered and alcohol consumption are significant risk factors in recreational diving; increased blood alcohol concentrations were reported to increase the risk of death in boating; and obesity and tandem riding were reported to increase the risk of injury on public water slides. Few evaluations of preventive measures were identified. Two studies reported reductions in the incidence of water slide injuries following the introduction of design changes and supervision, but neither had a non-intervention comparison group. Improvements in swimming and diving skills were reported in three studies, but these were not designed to measure changes in the risk of injury. This review demonstrates that there is a need for well-designed epidemiological research on non-submersion injury in aquatic sporting and recreational activities. The first priority should be for studies designed to describe accurately the incidence, nature, severity and circumstances of these injuries, followed by research on the significance of postulated risk factors. Once this research has been undertaken, interventions targeted at reducing the incidence of injury in aquatic sporting and recreational activities can be designed and evaluated.
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Aetiology and occurrence of diving injuries. A review of diving safety
  • Jan 1997
  • 228-274
  • Ba Blanksby
  • Fk Wearne
  • Bc Elliott
  • Jd Blitvich
Blanksby BA, Wearne FK, Elliott BC, Blitvich JD. Aetiology and occurrence of diving injuries. A review of diving safety. Sports Med. 1997;23(4):228-46.