Challenges to young children's swimming lesson participation in New South Wales, Australia.

BACKGROUND: Child swimming lessons are a key intervention for drowning prevention; however, participation has been severely affected by COVID-19 restrictions and cost-of-living challenges. To encourage re-engagement, the New South Wales government began providing US$100 swimming lesson vouchers. Parent/carers of eligible preschool-aged children were asked to complete a survey during voucher creation. This study aimed to examine pre-existing challenges to lesson participation among families who had not participated in the preceding 12 months. METHODS: Cross-sectional data from parent/carer surveys completed between December 2021 and June 2022 were analysed. Binary logistic models analysed associations between sociodemographic factors and answered affirmatively to one or more challenges to participation from a predefined list. RESULTS: Of 221 218 vouchers created, 79 553 parent/carers (36%) indicated that their child had not participated in swimming lessons in the last 12 months and responded to the question about participation challenges. Parent/carers of children with disabilities or residing in low socioeconomic areas had higher odds of indicating cost was a challenge while regional/remote families had over five times higher odds of indicating swim school availability difficulties. Families speaking a non-English language at home had over 2.5 times higher odds of thinking that their child was too young for swimming lessons, higher odds of thinking swimming lessons were not important and higher odds of indicating that COVID-19 had challenged participation. CONCLUSION: These findings highlight how different population groups experience challenges to participation in swimming lessons. Alleviating costs and increasing lesson availability is important.

Examining the relationship between heatwaves and fatal drowning: a case study from Queensland, Australia.

BACKGROUND: Globally, drowning is a leading cause of injury-related harm, which is heavily impacted by environmental conditions. In Australia, fatal unintentional drowning peaks in summer, yet the impact of prolonged periods of hot weather (heatwave) on fatal drowning has not previously been explored. METHODS: Using a case-crossover approach, we examined the difference in drowning risk between heatwave and non-heatwave days for the Australian state of Queensland from 2010 to 2019. Heatwave data, measured by the excess heat factor, were acquired from the Bureau of Meteorology. Incidence rate ratios (IRRs) were calculated by sex, age of drowning decedent, category of drowning incident (International Classification of Diseases-10 codes) and heatwave severity. Excess drowning mortality during heatwaves was also calculated. RESULTS: Analyses reveal increased fatal drowning risk during heatwave for males (IRR 1.22, 95% CI 0.92 to 1.61), people aged 65+ years (IRR 1.36, 95% CI 0.83 to 2.24), unintentional drowning (IRR 1.28, 95% CI 0.98 to 1.69) and during severe heatwaves (IRR 1.26, 95% CI0.88 to 1.82). There were 13 excess drowning deaths due to heatwave over the study period. DISCUSSION: The findings confirm an increased risk of fatal drowning during heatwaves. With increased likelihood and severity of heatwaves, this information should be used to inform drowning prevention, in particular the timing of public awareness campaigns and patrolling of supervised aquatic locations. CONCLUSIONS: Water safety and patrolling organisations, as well as first responders, need to prepare for more drowning deaths during heatwave conditions. In addition, drowning prevention education ahead of heatwaves is needed for recreational swimmers, and older people, particularly those with comorbidities which may be further exacerbated by a heatwave.

Hospital-admitted drowning in Victoria, Australia, before and after the emergence of the COVID-19 pandemic.

OBJECTIVES: To examine trends in hospitalisation following drowning in Victoria, Australia, before and after the emergence of the COVID-19 pandemic. DESIGN: Retrospective analysis of administrative hospital admission records. SETTING: Hospital admissions recorded in the Victorian Admitted Episodes Dataset. PARTICIPANTS: Hospital-admitted patients with ≥1 drowning-related International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification diagnosis code. MAIN OUTCOME MEASURES: Incidence and incidence rate ratios (IRR; 95% CIs) of hospital-admitted drowning that occurred before (July 2017 to June 2019), during (July 2019 to June 2021) and after (July 2021 to June 2022) the onset of the COVID-19 pandemic. RESULTS: There were 736 hospital admissions related to drowning in the study period; the incidence was 2.6 per 100 000 population pre-COVID-19 and dropped to 2.0 per 100 000 during (2019/2020-2020/2021) and after (2021/2022) the onset of the pandemic. Among Victorian residents, drowning was positively associated with younger age, male sex and regional/remote residence. Drowning was negatively associated with the onset of COVID-19 (IRR 0.76 (0.64, 0.90)) as well as the post-COVID-19 period (0.78 (0.64, 0.97)), compared with pre-COVID-19. Natural water drowning rates were consistently higher than pool or bathtub drowning rates. Pool or bathtub drowning rates decreased with the onset of COVID-19; no significant change was observed in the natural water drowning rate. CONCLUSIONS: Pool and bathtub drowning rates declined since the onset of the COVID-19 pandemic, despite more time spent at home, while natural water drowning rates remained consistently high. Hospital admissions provide a valuable data source for monitoring of drowning, which is crucial to ensure a targeted, evidence-based approach to mitigate drowning risk.

Burden of unintentional drowning in China from 1990 to 2019 and exposure to water: findings from the Global Burden of Disease 2019 study.

BACKGROUND: Drowning is an important contributor to the burden of deaths in China. Exposure to open water is a risk factor for drowning, but few studies quantify its impact on drowning. The purpose of this study was to provide an up-to-date analysis of unintentional drowning in China, including impact of exposure to open water. METHODS: Chinese provincial data from the Global Burden of Disease Study 2019 were used to describe the burden of unintentional drowning in 33 provinces and changes from 1990 to 2019. Provincial outdoor open water resource data were used to explore the relationship between outdoor open water resources and drowning burden using K-median clustering analysis. RESULTS: Between 1990 and 2019, the unintentional drowning incidence, mortality and disability adjusted life years (DALY) rates declined by 31.2%, 68.6% and 74.9%, respectively, with differences by age, sex and province. In 2019, the DALY rate for drowning was relatively higher in children under 20 year, the elderly over 80 years than other age groups and was relatively higher in men. There was no statistical difference in overall incidence rate by sex. Provincial differences in unintentional drowning burden show a positive relationship with the availability and size of outdoor open water. CONCLUSIONS: As expected availability of water increases drowning risk. There is a need to address drowning environmental risk especially among children and the elderly. Localised water safety plans which consider drowning burden and environmental risk factors are needed in China to ensure a sustained decline of unintentional drowning.

Interventions that address interpersonal violence experienced by adolescents globally: a systematic review of reviews.

Globally, adolescents experience a significant burden of interpersonal violence, impacting their health, well-being and life trajectory. To address this, decision-makers need reliable evidence on effective interventions across various contexts. OBJECTIVES: Synthesise the evidence for interventions addressing interpersonal violence experienced by adolescents aged 10-25 years. METHODS: Six electronic databases were systematically searched. Systematic reviews and meta-analyses published globally between 2010 and 2022 were included if they reported interventions addressing interpersonal violence experienced by adolescents. Results were synthesised narratively. RESULTS: 35 systematic reviews were included, of which 16 were also meta-analyses. Majority of reviews included interventions set in high income countries (71%) and implemented in educational settings (91%). Effectiveness was reported in majority of interventions measuring victimisation and/or perpetration of intimate partner violence, sexual violence, bullying and/or cyberbullying (90%), majority of interventions measuring improvements in knowledge and attitudes towards violence (94%) and all interventions measuring bystander behaviour and improvements in well-being and quality of life. However, the quality of included reviews as per Assessment of Multiple Systematic Reviews 2 and National Health and Medical Research Council was low, and equity as per PROGRESS-PLUS was seldom considered. There was also a paucity of interventions addressing interpersonal violence in low-middle income countries (12%) and none of the included interventions specifically addressed interpersonal violence perpetrated in the home such as family violence. CONCLUSION: There is some evidence of promising interventions to address interpersonal violence experienced by adolescents, however there are gaps in scope and implementation. There is a need for equity-oriented public health approaches to comprehensively address the disproportionate burden of interpersonal violence experienced by adolescents globally, including those at the highest risk of harm. PROSPERO REGISTRATION NUMBER: CRD42020218969.

The burden, risk factors and prevention strategies for drowning in Türkiye: a systematic literature review.

INTRODUCTION: Drowning is a public health problem in Türkiye, as in the rest of the world. This study aims to systematically review the literature on drowning in Türkiye with a focus on data sources, epidemiology, risk factors and prevention strategies. METHODS: Literature searches were conducted using PubMed, SPORTSDiscus, Scopus, Web of Science, Turk MEDLINE, Google Scholar and Google Akademik (Turkish language). Studies (limited to original research written in English and Turkish) reporting drowning (unintentional and intentional; fatal and non-fatal) of residents and tourists in Türkiye were independently dual screened at the title and abstract and full text stages. Study quality was assessed using JBI checklists and evidence level assessed based on study design. RESULTS: From a total of 917 studies, 49 met the inclusion criteria. Most (51%) focused on unintentional fatal drowning. Included studies were most commonly analytical cross-sectional studies (n = 23) and case series (n = 20) meaning the evidence level was low or very low for 48 (98%) studies. Fifteen studies examined drowning at the national level, while sub-national studies (n = 30) focused on urban areas across three provinces: Antalya (n = 6), Istanbul (n = 6), Izmir (n = 4). There was little consensus on risk factors beyond male drowning risk, and no data reported on implemented or evaluated drowning prevention interventions. DISCUSSION: There is a need for more national-level studies to identify the causes of drowning and to guide intervention implementation and evaluation to inform policy makers and donors. Currently official data is limited in its detail, providing age and gender data only, hampering efforts to identify, and thus address, causal factors for drowning. PRACTICAL APPLICATIONS: There is currently very little evidence to inform investment in effective drowning prevention interventions in Türkiye. To improve this, data collection systems on drowning in Türkiye need to be strengthened via the development a national drowning registry. TRIAL REGISTRATION: #CRD42022382615.

'I actually thought that I was going to die': Lessons on the rip current hazard from survivor experiences.

BACKGROUND: Rip currents are strong, narrow, fast-flowing currents of water that occur on many beaches and in Australia contributing to 26 drowning deaths and several thousand lifeguard/lifesaver rescues each year. Educating the public about the rip current hazard is a primary focus of beach safety practitioners, but there has been a lack of qualitative research exploring the firsthand experiences of being caught in a rip current to assist in this regard. The aim of this study was to analyse interviews of rip current survivors to understand more about how people react when unintentionally caught in a rip current in order to help guide future public education to mitigate rip current drowning. METHODS: Semi-structured interviews were conducted with 56 individuals (primarily Australian-born) about their experience of being caught in a rip current. Interviewees were recruited via an online survey and varied in age and self-reported swimming ability. RESULTS: Thematic analysis revealed three key temporal elements to the rip current experience: Before the Rip in which lack of awareness and knowledge, complacency, over-confidence, and attitude were prevalent themes; During the Rip which identified panic and temporary inhibition of decision-making, physical response, prior experience, and relationships with other beach users as themes; and After the Rip where post-rip effects and rip safety messaging and education were key themes. The importance of experiential immersion was a prevalent thread throughout all phases of the thematic analysis. DISCUSSION: Our research shows that being caught in a rip current can be an intense and traumatic experience and that lessons learned from survivors have significant implications for improving existing and future rip current education efforts. In this regard, we provide several recommendations based on evidence-based insights gained from our interviews including the development of immersive rip current experience using virtual reality. SO WHAT: Despite the prevalence of rip currents causing drowning deaths and rescues, there has been a lack of qualitative research on firsthand experiences to aid in public education. These interviews emphasise the intense and traumatic nature of being caught in a rip current, underscoring the need for improved rip current education to aid in prevention of this, often harrowing, experience.

Evaluation of the First Lap learn to swim voucher programme: protocol.

INTRODUCTION: Swimming skills are an evidence-based component of drowning prevention. However, in Australia, many children miss out on learn to swim education. Voucher programmes may reduce swimming lesson cost and increase participation, especially among priority populations. The First Lap voucher programme provides two New South Wales state government-funded $100 vouchers for parents/carers of preschool children to contribute to swimming lesson costs. This evaluation aims to determine the effectiveness of the programme in meeting objectives of increasing preschool-aged children participating in learn to swim programmes and building parent/carer knowledge and awareness of the importance of preschool-aged children learning to swim. METHODS AND ANALYSIS: A programme logic model was developed to explain the inputs, activities and intended outputs, and outcomes, which guided this mixed-methods evaluation design of quantitative and qualitative analysis within an impact/outcome evaluation. Baseline sociodemographic registration data will be provided by the parent/carer of each child participant and linked to swim school provider data on voucher redemption. Data will be collected on voucher use, knowledge, and attitudes to swimming lessons at registration and across two surveys. An economic evaluation will assess programme cost-effectiveness. CONCLUSION: This evaluation will determine impacts on participation rates in learn to swim programmes, particularly within priority populations. It will examine whether the programme has influenced attitudes and motivations of parents and carers toward learn to swim programmes and water safety, whether the programme has impacted or enhanced the ability of the aquatics sector to deliver learn to swim programmes and assess its cost-effectiveness.

Burden of fatal drowning in California, 2005-2019.

OBJECTIVE: To characterise risk factors for fatal drowning in California, USA to inform priorities for prevention, policy and research. METHODS: This retrospective population-based epidemiological review of death certificate data evaluated fatal drowning events in California from 2005 to 2019. Unintentional, intentional, and undetermined drowning deaths and rates were described by person (age, sex, race) and context-based variables (region and body of water). RESULTS: California's fatal drowning rate was 1.48 per 100 000 population (n=9237). Highest total fatal drowning rates occurred in the lower population density northern regions, among older adults (75-84 years: 2.54 per 100 000 population; 85+: 3.47 per 100 000 population) and non-Hispanic American Indian or Alaska Native persons (2.84 per 100 000 population). Male drowning deaths occurred at 2.7 times the rate of females; drowning deaths occurred mainly in swimming pools (27%), rivers/canals (22.4%) and coastal waters (20.2%). The intentional fatal drowning rate increased 89% during the study period. CONCLUSIONS: California's overall fatal drowning rate was similar to the rest of the USA but differed among subpopulations. These divergences from national data, along with regional differences in drowning population and context-related characteristics, underscore the need for state and regional level analyses to inform drowning prevention policy, programmes and research.

Impact of a surfer rescue training program in Australia and New Zealand: a mixed methods evaluation.

BACKGROUND: Surfers play a critical role in coastal drowning prevention, conservatively estimated to make as many rescues as beach lifeguards. The Surfer Rescue 24/7 (SR24/7) program is a coastal safety intervention in Australia and New Zealand that teaches surfers safe rescue skills and promotes prevention activities. This multi-part, mixed-methods study aimed to evaluate the impact of the SR24/7 program. METHODS: The study consisted of three parts employing quantitative and qualitative methods: a retrospective survey of course participants, in-depth interviews with course participants who had conducted rescues, and an analysis of self-reported skills confidence ratings before and after the program. RESULTS: Triangulated results from the three study components indicated that after the course, participants exhibited high levels of satisfaction with their experience in the program and would encourage others to attend, were more observant and aware of safety concerns while surfing, had a better understanding of ocean conditions and hazards, learned new rescue techniques and skills, grasped important course concepts related to their own personal safety, and improved their confidence in responding to an emergency situation. Several participants had conducted rescues in real life and indicated that the course was effective in providing them with the baseline knowledge and skills to keep safe while helping others in the ocean. This study also provides new insight on the role of surfers in coastal safety, specifically that surfers are engaged in a range of prevention activities before rescue is required. CONCLUSIONS: Despite persistent challenges in combating coastal drowning rates, the SR24/7 program is an effective intervention that helps save lives. Importantly, this study provides evidence that the course successfully equips surfers with techniques to act responsibly and safely. Expanding coastal safety focus and resources towards surfers, an often-overlooked demographic in beach safety strategies, could substantially enhance community-level capacity to prevent and respond to ocean emergencies.

Lessons learned through the 20-year development of a national fatal drowning database in Australia.

BACKGROUND: Co-ordinated, evidence-based policy and programmatic efforts are needed to respond to complex drowning prevention problems. Comprehensive, current, and robust data are vital for agenda setting, burden and risk factor identification, intervention design and evaluation, as well as setting policy. We aim to record methods used in, and identify impacts of, the development of a national fatal drowning database (NFDD) in Australia, including lessons learned across research, policy, and practice. METHODS: We employ a case study method using process mapping and document review to explore the evolution, drivers and impacts of the NFDD. We analyse methodological approaches including those relating to data definitions, drowning case collection, and management, as well as tracking the various outputs of the NFDD. We describe a development timeline that presents impact of drowning prevention policy, and research agendas on database development, and research investments more specifically. RESULTS: Our study identified that the collected variables grew 20-fold from 2002 to 2022, reaching 259 variables, and 5,692 unique cases of fatal drowning. The NFDD employs data triangulation methodology, combining keyword and targeted searches of coronial files, media report monitoring, and organisational data provision. Database development is influenced by the Australia Water Safety Strategy, policymaker and practitioner-initiated research agendas, and identification of knowledge gaps. We identified numerous outputs spanning publications, media, intervention development, and legislative submissions. CONCLUSION: A comprehensive and robust NFDD informed by policymaker and practitioner input can enhance surveillance, policy, and intervention development for drowning prevention. Employing mixed data collection and validation methods can supplement weaknesses in official data sources. There is a need for the NFDD to continue to evolve in its application while maintaining rigorous case identification and data quality assurance processes. Despite significant investment, the outputs and influence on drowning prevention practice in Australia has been extremely valuable and contributed to sizeable reductions in Australia's fatal drowning rate.

Heatwaves and mortality in Queensland 2010-2019: implications for a homogenous state-wide approach.

Heatwaves are a significant cause of adverse health outcomes and mortality in Australia, worsening with climate change. In Queensland, the northeastern-most state, little is known about the impact of heatwaves outside of the capital city of Brisbane. This study aims to explore the impact of heatwaves on mortality across various demographic and environmental conditions within Queensland from 2010 to 2019. The Excess Heat Factor was used to indicate heatwave periods at the Statistical Area 2 (SA2) level. Registered deaths data from the Australian Bureau of Statistics and heatwave data from the Bureau of Meteorology were matched using a case-crossover approach. Relative risk and 95% confidence intervals were calculated across years, regions, age, sex, rurality, socioeconomic status, and cause of death. Heatwaves were associated with a 5% increase in all-cause mortality compared to deaths on non-heatwave days, with variability across the state. The risk of death on a heatwave day versus a non-heatwave day varied by heatwave severity. Individuals living in urban centers, the elderly, and those living in regions of lower socioeconomic status were most impacted by heatwave mortality. The relative risk of dying from neoplasms, nervous system conditions, respiratory conditions, and mental and behavioral conditions increased during heatwaves. As heatwaves increase in Queensland due to climate change, understanding the impact of heatwaves on mortality across Queensland is important to tailor public health messages. There is considerable variability across communities, demographic groups, and medical conditions, and as such messages need to be tailored to risk.

Exploring why young Australians participate in the sport of fencing: Future avenues for sports-based health promotion.

ISSUE ADDRESSED: Australian sport policy calls for a diverse sector to get more individuals more active. This study contributes to an evidence base of alternative sport options that may increase physical activity levels in adolescents, as we sought to understand why Australians decide to participate in fencing when aged <18 years. METHODS: A retrospective, mixed-methods survey design was employed to measure why a participant started fencing and what participants like about fencing compared to other sports. Free-text qualitative data were analysed thematically. Quantitative data were collected to answer secondary objectives, using nonparametric tests to determine significance between the median scores prefencing and postfencing for enjoyment and frequency of participation. RESULTS: One hundred and one fencers across Australia who started fencing aged <18 years completed the survey. Respondents primarily started fencing for fun/enjoyment, followed by the desire to try something different/alternative/nonmainstream. Four themes were identified relating to why a participant decided to start fencing: (i) external motivators, (ii) influence of interest and imagination, (iii) developing the self and (iv) the supportive culture. CONCLUSIONS: Fencing may encourage adolescent participation in physical activity due to unique characteristics which attracts individuals for reasons beyond the need to be active alone, and instead affords a space for self-exploration, learning, and belonging. Further research is required to identify how fencing can engage different cohorts of adolescents, and any barriers to participation. SO WHAT?: Fencing could be utilised to promote engagement in physical activity among Australian adolescents by emphasising the creative, mental, and inclusive aspects of the sport.

Yarning about river safety: A qualitative study exploring water safety beliefs and practices for First Nations People.

ISSUE ADDRESSED: Water is vital to Australian First Nations Peoples' connection to country and culture. Despite this cultural significance, and epidemiological studies identifying elevated drowning risk among Australian First Nations Peoples, extremely limited qualitative research explores water safety beliefs and practices of First Nations Peoples. This study addressed this knowledge gap via qualitative research with Wiradjuri people living in Wagga Wagga, New South Wales. METHODS: Under Aboriginal Reference Group guidance, a local researcher recruited participants using purposive sampling for yarning circles across four groups: young people aged 18-30 years, parents of children under 5, parents of older children and adolescents and Elders. Yarning circles were audio recorded, transcribed and thematically coded using an inductive approach. RESULTS: In total, 10 First Nations individuals participated. Yarning led to rich insights and yielded five themes: families as first educators; importance of storytelling, lived experience and respect for knowledge holders; the river as a place of connection; historical influence on preference for river over pool and river is unpredictable and needs to be respected. CONCLUSIONS: This study demonstrates the importance of First Nations culture to water safety practices, particularly around the river. To reduce drowning risk among First Nations populations, knowledge holders need to be embedded in the design and delivery of community water safety education. SO WHAT?: Co-designing water safety initiatives with First Nations Peoples will have dual benefits; developing culturally appropriate and locally relevant water safety education, while also continuing First Nations culture across generations.

Lessons learned from co-designing a high school beach safety education program with lifeguards and students.

ISSUE ADDRESSED: School-based beach safety education programs are common, but best practice guidance and information on their design and development is limited. METHODS: Researchers, professional ocean lifeguards and students participated in a co-design process to inform a lifeguard-delivered, school-based beach safety education program for a coastal community in New South Wales, Australia. Lifeguards and researchers (experts) provided structured feedback about the program in a survey and facilitated workshop; students (n = 26) aged 11 to 13 years participated in focus group sessions intended to garner in-depth understanding of their experiences at the beach and knowledge of, and attitudes towards, beach safety. RESULTS AND DISCUSSION: The co-design process provided a novel and inclusive model for beach safety education program development, and valuable lessons for future efforts. Specifically, student focus groups identified several facets of pre-teens and younger teenagers' beach experience that prompted revision of the education program, primarily framing of program content and safety messages. Peers are a primary motivator for this age group and students' burgeoning independence emerged as an important theme. While knowledgeable about beach hazards and risks, students conveyed mixed safety attitudes and self-reported safety practices, highlighting the importance of designing programs to motivate behaviour and promote safe decision-making vs raising awareness alone. Findings illustrate the value of adopting co-design processes for all beach safety programs, school or otherwise. SO WHAT?: Beach safety programs may not be delivering information that is needed, wanted or useful. Structured consultation with the priority population must become standard practice in beach safety and drowning prevention education program development.

Barriers to preschool aged children's participation in swimming lessons in New South Wales, Australia.

ISSUE ADDRESSED: To understand barriers to uptake of subsidised swimming lessons by children aged 3-6 years old ('preschool aged children'), including from priority populations, in New South Wales (NSW). METHODS: A thematic analysis of 4191 qualitative responses from parents/carers of preschool aged children describing barriers that resulted in their child's non-participation in subsidised swimming lessons in the past 12 months was conducted. Data, including parent/carer sociodemographic variables, were collected through registrations for the NSW Government's First Lap voucher program. RESULTS: Seven overarching barriers to participation were identified: (1) child's disability or health needs; (2) swimming lesson affordability; (3) family or personal circumstances; (4) lack of or poor availability of swimming lessons; (5) parent/carer availability, including to fulfil participation requirements; (6) COVID-19 and (7) deprioritisation of formal swimming lessons due to parent/carer perceptions relating to its importance. These may limit the uptake of swimming lessons in preschool aged children, particularly those who are Aboriginal and Torres Strait Islander, from culturally and linguistically diverse backgrounds, living with a disability, from low socioeconomic families and living in regional and remote areas. CONCLUSION: Structural barriers must be addressed to increase uptake of swimming lessons in preschool aged children, particularly in priority populations, to reduce drowning risk. SO WHAT?: Evidence-based policy initiatives, with robust evaluation, should seek to address the availability and flexibility of swimming lessons, including for priority populations; complexities associated with supervision requirements; poor awareness of parents/carers of the importance of swimming for preschool aged children and the lack of continuity of swimming for children in out of home care.

Preliminary evaluation of the impact of mandatory life jacket laws at declared high-risk rock platforms on unintentional rock fishing drowning deaths.

OBJECTIVES: To explore the impact of mandatory lifejacket wear legislation on unintentional rock fishing-related drowning fatalities at declared high-risk rock platforms in New South Wales (NSW; Australia). METHODS: Rock fishing-related drownings for the five years pre-legislation enactment (23 November 2011 to 22 November 2016) and five years post-legislation enactment (23 November 2016 to 22 November 2021) were compared. Google Earth was used to assess if drowning deaths occurred at declared areas under legislation. Binary logistic regression was used to analyse change in the number of deaths in declared areas pre-legislation/post-legislation. RESULTS: Over the 10 years, 80 rock fishing drowning deaths occurred in New South Wales; 23 in declared areas pre-legislation and 13 post-legislation (-43.5%). The odds of a rock fishing drowning death occurring in a declared area pre-legislation was 2.3 times higher (95% CI 0.942 to 5.752; p=0.067). CONCLUSION: Reductions in rock fishing deaths at declared areas were observed since the legislation's introduction, but were not significant. Greater enforcement and extension to other high-risk platforms may reduce deaths further.

Trends in drowning mortality in Portugal from 1992 to 2019: comparing Global Burden of Disease and national data.

INTRODUCTION: Imprecise data systems hinder understanding of drowning burden, even in high-income countries like Portugal, that have a well-implemented death certificate system. Consequently, national studies on drowning mortality are scarce. We aimed to explore drowning mortality in Portugal using national data and to compare these to Global Burden of Disease (GBD) estimates. METHODS: Data were obtained from the National Institute of Statistics (INE) for 1992-2019, using International Classification of Diseases (ICD)-9 and ICD-10 codes, by sex, age group and cause (unintentional; water transport and intentional). GBD unintentional drowning data were obtained online. Age-standardised drowning rates were calculated and compared. RESULTS: INE data showed 6057 drowning deaths, 4327 classified as unintentional (75.2% male; 36.7% 35-64 years; 31.5% 65+years; 15.2% 0-19 years). Following 2001, an increase in accidental drowning mortality and corresponding decrease in undetermined intent was observed, coincident with Portugal's ICD-10 implementation. GBD modelled estimates followed a downward trend at an overall rate of decrease of -0.41/decade (95% CI (-0.45 to -0.37); R2 adj=0.94; p<0.05). Conversely, INE data showed an increase in the rate of drowning deaths over the last decade (0.35/decade; 95% CI (-0.18 to 0.89)). GBD estimates were significantly different from the INE dataset (alpha=0.05), either underestimating as much as 0.567*INE in 1996 or overestimating as much as 1.473*INE in 2011. CONCLUSIONS: While GBD mortality data estimates are valuable in the absence of routinely collected data, they smooth variations, concealing key advocacy opportunities. Investment in country-level drowning registries enables in-depth analysis of incident circumstances. Such data are essential to informing National Water Safety Plans.

Drowning risk and climate change: a state-of-the-art review.

Drowning and climate change are both significant global health threats, yet little research links climate change to drowning risk. Research into the epidemiology, risk factors and preventive strategies for unintentional drowning in high-income and in low-income and middle-income countries has expanded understanding, but understanding of disaster and extreme weather-related drowning needs research focus. As nation states and researchers call for action on climate change, its impact on drowning has been largely ignored. This state-of-the-art review considers existing literature on climate change as a contributor to changes in drowning risks globally. Using selected climate change-related risks identified by the World Meteorological Organization and key risks to the Sustainable Development Goals as a framework, we consider the drowning risks associated with heat waves, hydrometeorological hazards, drought and water scarcity, damaged infrastructure, marine ecosystem collapse, displacement, and rising poverty and inequality. Although the degree of atmospheric warming remains uncertain, the impact of climate change on drowning risk is already taking place and can no longer be ignored. Greater evidence characterising the links between drowning and climate change across both high-income and low-income and middle-income contexts is required, and the implementation and evaluation of drowning interventions must reflect climate change risks at a local level, accounting for both geographical variation and the consequences of inequality. Furthermore, collaboration between the injury prevention, disaster risk reduction and climate change mitigation sectors is crucial to both prevent climate change from stalling progress on preventing drowning and further advocate for climate change mitigation as a drowning risk reduction mechanism.

Drowning in the Eastern Mediterranean region: a systematic literature review of the epidemiology, risk factors and strategies for prevention.

INTRODUCTION: Globally, drowning is a significant cause of preventable mortality and morbidity. The Eastern Mediterranean region (EMR) comprises 22 countries of extreme disparity in income and is a region impacted by conflict and migration. We systematically review literature published on drowning in the EMR. METHODS: Peer-reviewed literature (limited to original research) was identified using Embase, PubMed, Scopus, SportsDiscus, and Web of Science databases. Literature was independently dual screened at title/abstract and full text stages with dual data extraction (20% of included studies). Studies were included if they reported epidemiology, risk/protective factors and/or prevention strategies for drowning (unintentional and intentional; fatal and non-fatal) of residents, tourists or migrants in the EMR. Literature was assessed against the [Australian] National Health and Medical Research Council's Levels of Evidence. RESULTS: Seventy-two studies were included in this review (epidemiology 68 studies; risk/protective factor 13 studies; prevention strategies 19 studies). Iran (n = 27), Saudia Arabia (n = 11) and Pakistan (n = 10) recorded the largest number of dedicated studies. Studies predominately focused on unintentional drowning. Ninety-two percent of included studies (n = 66) were ranked as being low evidence (level IV). The majority of studies explored drowning among children and adolescents (0-19 years). All-age fatal drowning rates varied from a low of 0.48 per 100,000 (United Arab Emirates; 2002; Ministry of Health death registry data) to a high of 18.5 per 100,000 (Egypt; 2014-15; WHO mortality database). Commonly identified risk factors included being male, young age, submersion time and resident status. Common prevention strategies public education, lifeguard supervision, and cardiopulmonary resuscitation. DISCUSSION: Gaps in understanding of drowning burden in some countries within the region, as well as region-wide risk factor identification for adult drowning, intentional and migration-related drowning, impair the ability of nations to advance drowning prevention. There is a need for investment in implementation and evaluation of drowning prevention interventions in the EMR. CONCLUSION: Drowning is a significant cause of mortality and morbidity in the EMR. The recent UN declaration on global drowning prevention may provide the impetus to invest in drowning prevention research, policy, and advocacy with the aim of reducing drowning-related harms in the EMR. TRIAL REGISTRATION: Registration number: # CRD42021271215 .