Learning to swim: role of gender, age and practice in Latino children, ages 3–14 Rho Henry Olaisen, 1,2 Susan Flocke, 1,3 Thomas Love 1,4 ABSTRACT Objective We evaluate the effectiveness of a swim skill acquisition intervention among Latino youths, ages 3–14, a minority population at increased risk of drowning. Methods Parents were recruited through community institutions to have their children participate in group swim lessons. Each child’s swim ability was assessed at baseline, and they were then exposed to swim lessons over an 8-week period, taught by trained professionals. The swim skill curriculum focused on water safety, flotation and endurance, at five levels of increasing skill acquisition. Final swim ability was assessed on the last day of the child’s participation. Programme effectiveness was measured using direct pre–post comparisons with and without adjustment for key moderators (age and gender) and a mediator (number of practices). We also present a bias-adjusted estimate comparing low with high practice volume relying on a propensity score analysis. Results Among the 149 participating children, average acquisition was 12.3 swim skills (95% CI 10.7 to 14.1). Skill acquisition varied by age category (3–5, 6–9 and 10–14 years) and by gender. We found a strong practice intensity effect, with skill acquisition accelerated for those participating in 10 or more swimming lessons. The propensity-adjusted estimate of the impact of 10 or more compared with 9 or fewer lessons was 8.2 skills (95% CI 4.8 to 11.8). Conclusions An 8-week swim intervention is effective at building skills in a community-based sample of Latino children, ages 3–14 years. The number of swimming lessons was a far stronger correlate of skill acquisition than were age or gender. INTRODUCTION Drowning is the leading cause of death for children ages 1–4 and the second leading cause of death for children ages 5–14 in the USA. 1 Drowning is the process of experiencing respiratory impairment from submersion/immersion in water, leading to death or non-fatal events with or without complica- tions. For every death due to drowning, twice as many non-fatal events resulting from drowning are treated in emergency rooms. 1 For children (0–14) who experience drowning, swimming pools are the most common setting (47%), followed by natural bodies of water (25%), boating accidents (15%) and bathtubs (13%). 2 Drowning outcomes show pronounced health disparities in terms of race, gender, age, socio- economic status and physical setting. African American, Native American and Latino children are at two to eight times greater risk of drowning resulting in death compared with their white counterparts, 3–8 with likely under-reporting of mortality relating to Latinos, who are often classi- fied as white on death certificates. White children die disproportionately in home pools, while African American and Latino children more often drown in community pools. 15 Boys from the ages of 5–14 are at particularly high risk of drowning resulting in death. 5 9 While African Americans’ lower level of swimming skills relative to whites have been reliably documented, 1 2 less is known about the level of swimming skills of Latino chil- dren. 10 11 The rapidly expanding Latino segment of the US population, in combination with the sub- stantially greater risk of drowning resulting in death among Latino children, points to a poten- tially growing problem in this regard if left unaddressed. The incidence of drowning has in recent years been determined to be in slight decline in the USA (from 1.34 in 2005 to 1.25 per 100 000 in 2009), although this does not take into account the demo- graphic trend mentioned immediately above. To reduce drowning rates by 10% to 1.1% per 100 000 by 2020, a goal set by the Office of Disease Prevention and Health Promotion, expan- sion of evidence-based programmes in conjunction with system changes is recommended. 12 Recent studies have suggested that drowning can be effect- ively reduced through evidence-based water safety programmes, including swimming lessons and health education. 13 14 Knowing how to swim is a life-saving skill, with instruction particularly needed for minority populations, which have trad- itionally been neglected in this regard. Although there is little dispute that swimming instruction can build skills that may avert drown- ing, 1 2 12 15 there is uncertainty about the specific effects of particular interventions, as well as differ- ences in the effectiveness of interventions by age and gender. There is also uncertainty as to what minimal amount of instruction will have measur- able results. As community health interventions do not easily lend themselves to randomised controlled trials, we designed an observational study with the primary objective of measuring the relationship of age, gender and number of swimming lessons on skill acquisition by Latino immigrant children. METHODS This was an intervention study involving 149 chil- dren (age 3–14) who participated in an 8-week swimming lesson intervention between June and August 2014 held at the Hoover community pool in Redwood City, California, a municipal-owned facil- ity, approximately 50 km south of San Francisco. Participants were recruited from five community Olaisen RH, et al. Inj Prev 2018;24:129–134. doi:10.1136/injuryprev-2016-042171 129 Original article To cite: Olaisen RH, Flocke S, Love T. Inj Prev 2018;24:129–134. ► Additional material is published online only. To view please visit the journal online (http://dx.doi.org/10.1136/ injuryprev-2016-042171). 1 Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA 2 Department of Population Health and Outcomes Research Core—CTSC, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA 3 Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio, USA 4 Better Health Partnership, Cleveland, Ohio, USA Correspondence to Rho Henry Olaisen, Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH 44106-4915, USA; rho2@case.edu Received 27 July 2016 Revised 14 February 2017 Accepted 28 March 2017 Published Online First 26 April 2017 on May 29, 2020 by guest. Protected by copyright. http://injuryprevention.bmj.com/ Inj Prev: first published as 10.1136/injuryprev-2016-042171 on 26 April 2017. Downloaded from