Environmental and Behavioral Risk Factors for Childhood Drowning

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.