Environmental and Behavioral Risk Factors for Childhood Drowning
Condition: Drowning
MeSH terms: Drowning
Study type: Observational

Summary: 
      This study will examine the relationship between swimming lessons, swimming ability, and
      other risk factors or protective factors, and the risk of drowning among children. The
      study's primary focus is on children between 1 and 4 years of age, with a secondary focus on
      older children up to 19 years of age. Drowning is the second leading cause of accidental
      death among children under 5 years of age, with drowning rates peaking among 1- to 2-
      year-olds.

      The study will examine the circumstances of cases of children between 1 and 19 years of age
      who have drowned in a body of water where swimming ability might have been a risk factor,
      such as a pool, Jacuzzi, hot tub, pond, lake, river, canal quarry, irrigation ditch, dam, or
      ocean. (Drowning is defined as death from asphyxia while submerged, or within 24 hours of the
      submersion.)

      The victims' parents or guardians will be interviewed about their child's general health,
      temperament, motor development, swimming ability, history of swimming lessons, and exposure
      to water. In addition, they will be asked about environmental factors related to the child's
      drowning, such as if a lifeguard was present or if, in the case of a pool drowning, there was
      a fence around the pool. They will be asked about parental norms regarding child supervision
      and pool-provider advice regarding swimming instruction. Parents of older children will be
      asked about their child's risk-taking and sensation-seeking behaviors. Information on
      additional risk factors, such as the remoteness of the site of the drowning and the victim's
      blood alcohol level will also be obtained.

      The above information will be compared with similar information gathered from parents of
      control subjects-that is, children who are the same age as the victims and who live in the
      same geographic area. For adolescent cases, information about swimming in unguarded sites or
      drinking alcoholic beverages while in or around water will be obtained from direct interviews
      with adolescents, as parents may not have accurate information in these areas.

      The information gained from this study will provide guidance for the development of
      interventions to prevent childhood drowning.
    

Detailed description: 
      Drowning is the second leading cause of unintentional injury death among children in the
      United States. Children under five years of age are at particularly increased risk with
      drowning rates peaking among 1-2 year olds. While some preventive strategies, such as pool
      fencing, are known to be effective, the impact of other preventive strategies is unclear. For
      example, data regarding the relationship between swimming lessons or swimming ability and the
      risk of drowning are lacking, making it difficult to formulate guidelines and policies about
      enrollment of young children in swimming lessons. Information about risk and protective
      factors for childhood drownings will provide valuable guidance for the design of future
      interventions to prevent these tragic deaths.

      This study utilizes a case-control design to evaluate the relationship between swimming
      lessons, swimming ability, and other risk or protective factors on the one hand, and the risk
      of drowning on the other. The primary study hypothesis addresses the relationship between
      swimming lessons and the risk of drowning among children ages 1 to 4 years, while secondary
      hypotheses address risk and protective factors for drowning among older children. Parents or
      guardians of drowning victims and parents/guardians of age-matched controls will be
      interviewed. A short interview will also be conducted with adolescent controls, aged 14-19
      years. Interviews include questions regarding exposure to water, swimming ability,
      participation in swimming lessons, and a number of other factors that might influence the
      risk of drowning.

      Cases will be identified through a consortium of medical examiners/coroners (ME/C). As part
      of the investigation of drowning deaths, investigators from the medical examiners/coroners'
      offices routinely collect information about the circumstances surrounding the death; however,
      the format and content varies somewhat with jurisdiction. In the first phase of the proposed
      study a consortium of ME/C's will be assembled and a short abstract form will be developed to
      standardize collection of information relevant to the investigation. At the conclusion of the
      routine investigation, the investigator from ME/C office will introduce the current study to
      the parent/guardian. Case families, who have not indicated a refusal for a telephone
      interview, will be contacted by study staff for a more in-depth interview. Random digit
      dialing (RDD) will be used to identify appropriately matched control children. Study
      interviews will be conducted by telephone.
    

Keywords: Submersion; Epidemiology; Fatal; Child; Swim; Drowning; Survey