The Role of Permission, Supervision, and Precipitating Events in Childhood Pool/Spa Submersion Incidents, United States, 2000–2017

dc.contributor.authorAnderson, Kristina R.
dc.contributor.authorRamos, William D.
dc.contributor.authorSchuman, James T.
dc.contributor.departmentPhysician Assistant Studies Program, School of Health and Human Sciences
dc.date.accessioned2024-07-22T10:52:39Z
dc.date.available2024-07-22T10:52:39Z
dc.date.issued2021-08-19
dc.description.abstractDrowning is a leading cause of fatality among children in the United States, and pool/spa aquatic structures represent common locations of submersion incidents. This study employed narrative case review to understand characteristics related to permission, supervision, and precipitating events in childhood submersion incidents. Retroactive analysis of 1537 fatal and non-fatal submersion incidents among children age 13 years old and younger was conducted using the U.S. Consumer Products Safety Commission In-Depth Investigations dataset from 2000–2017. Narrative descriptions were coded according to the themes of permission, supervision, and precipitating events. In most (86%) incidents, the child did not have permitted water access, and 80% of narratives indicated the child was alone at time of incident. These attributes were significantly associated with a fatal outcome (No permission: OR 11.98, 95% CI 7.97–18.06; Alone: OR 34.93, 95% CI 19.69–61.96). The average length of inactive supervision time was 15.6 min; this duration significantly differed by non-fatal (3.2 min) and fatal (16.1 min) outcomes (p < 0.001). More than half of cases occurred under the supervision type of a parent (56%), followed by grandparents (14%) and childcare provider (10%). Submersion incidents with a non-parent supervisor were two times more likely to result in a fatal outcome (OR 1.87, 95% CI 1.07–3.64). The most frequently occurring precipitating events included outdoor play (46%), a social gathering (36%), and previous water play (15%). Narrative excerpts further illustrate how tragic submersion events can unfold quickly and unpredictably. Education campaigns should target all adults that supervise children and reiterate key findings in that many submersion incidents occur (1) without permitted pool use, (2) without active supervision, and (3) when a caregiver is distracted. Multiple strategies should be utilized to add layers of projection against submersion injury.
dc.eprint.versionFinal published version
dc.identifier.citationAnderson KR, Ramos WD, Schuman JT. The Role of Permission, Supervision, and Precipitating Events in Childhood Pool/Spa Submersion Incidents, United States, 2000-2017. Int J Environ Res Public Health. 2021;18(16):8776. Published 2021 Aug 19. doi:10.3390/ijerph18168776
dc.identifier.urihttps://hdl.handle.net/1805/42352
dc.language.isoen_US
dc.publisherMDPI
dc.relation.isversionof10.3390/ijerph18168776
dc.relation.journalInternational Journal of Environmental Research and Public Health
dc.rightsAttribution 4.0 Internationalen
dc.rights.urihttps://creativecommons.org/licenses/by/4.0
dc.sourcePMC
dc.subjectSubmersion
dc.subjectDrowning
dc.subjectInjury prevention
dc.subjectSupervision
dc.subjectChildren
dc.titleThe Role of Permission, Supervision, and Precipitating Events in Childhood Pool/Spa Submersion Incidents, United States, 2000–2017
dc.typeArticle
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