Young people's alcohol use in and around water: A scoping review of the literature.

ISSUES: The surrounding social and commercial context, including alcohol advertising, heavily influences alcohol consumption. Alcohol use is a major risk factor for both fatal and non-fatal drowning, particularly for young people. APPROACH: We conducted a scoping review to explore the peer-reviewed literature on the use of alcohol by young people (aged 15-34 years) in the context of aquatic environments. Five electronic academic databases were searched for English-language studies conducted in high-income countries and published in the last 15 years (since 2008). The MetaQAT framework was used to assess methodological quality of included studies. KEY FINDINGS: The review included a total of 24 studies, including those addressing the prevalence of and/or risk factors for alcohol use in aquatic environments among young people (n = 13); the epidemiology of alcohol-related unintentional drowning in young people (n = 9); and interventions to reduce alcohol-related harm around water (n = 3). Findings suggest that young people commonly consume alcohol around water, particularly young men. We found multiple influences on this behaviour, including the perception of risk, location of aquatic activity and presence of others, particularly peers. IMPLICATIONS: Understanding the literature addressing alcohol use around water among young people will assist in identifying and setting priorities for drowning prevention, including the need to mitigate the effects of alcohol advertising which promotes drinking in and around water. CONCLUSION: There is a clear imperative to address the use of alcohol by young people in aquatic environments. These findings have key implications for public health policy, advocacy and practice.

"I never had a thought about drowning". Exploring water safety attitudes and practices among older adults in Western Australia.

OBJECTIVES: The aim of this study was to explore factors associated with drowning among older adults aged 65 years and over in Western Australia. METHODS: This paper was concerned with illuminating older adults experience and perspectives of water safety and drowning prevention. The study used in-depth, semi-structured interviews (n = 15) to examine knowledge, attitudes, beliefs and behaviours. The interviews were analysed using a phenomenological hermeneutical interpretation whereby three steps were taken to identify common patterns of meaning from individual's lifeworld. DISCUSSION: Interviews captured the voices of those who identified as swimmers and those who identified as nonswimmers and revealed nine constitutive patterns which support a central theme of life around water. This study provides insights into perceptions and experiences of water safety as individuals' age. The findings suggest individuals who perceived themselves as strong swimmers had a decreased perception of risk, while participants who self-identified as weak swimmers were more likely to avoid risks and modified their behaviour accordingly. Findings highlighted low water safety literacy and suggest that older people not only underestimate their drowning risk, but also lack an understanding of the risk factors for drowning. SO WHAT?: The findings from this study will have a direct impact on the development of a WA health promotion program to prevent drowning among older adults.

Mobile phone use and social interactions among caregivers can reduce their ability to provide constant supervision to children at Australian public swimming pools.

ISSUE ADDRESSED: Caregivers have a crucial role to play in keeping children safe at public swimming pool facilities, with the most common factor contributing to childhood drowning being a lapse in adult supervision. METHODS: A mixed methods approach was used to collect observations (n = 301) and interviews (n = 10) with caregivers of children aged 0-10 years at two public swimming pool facilities located in the Perth metropolitan area, Western Australia (WA). RESULTS: Of the 449 children observed, children aged 6-10 years were significantly less likely to be provided with ideal supervision (26%) compared to younger children aged 0-5 years (62%). Of the caregivers who were using their mobile phone while supervising children (n = 100, 22% of children observed), none provided ideal supervision. Overall supervision levels among caregivers differed with gender, with only 44% (n = 74) of female caregivers providing ideal supervision, compared to 72% (n = 96) of male caregivers. The 10 interviews revealed several themes, including the following: caregivers' perceptions of their supervision responsibilities; barriers to supervision; and awareness and perceptions of a communications campaign designed by the Royal Life Saving WA Branch, known as Watch Around Water (WAW). CONCLUSION: Caregiver supervision at public swimming pools remains an important issue, particularly the use of mobile phones and its deleterious impact on supervision. The WAW program plays an integral role in educating caregivers of supervision responsibilities. Furthermore, this study adds to the limited evaluation of the WAW program, and thus will help guide future improvements to ensure caregiver supervision is consistent. SO WHAT?: Further research is needed to create strategies to reduce mobile phone use among caregivers, in order to provide safer swimming environments.

"A content analysis of news media coverage of drowning events in Western Australia over two summers, 2014-2016".

ISSUE ADDRESSED: Drowning is a leading cause of death globally. Opportunities to promote drowning prevention in news media may be overlooked for attention-grabbing headlines, imagery and narrative. This study examines news media coverage of fatal drowning events in Western Australia (WA). METHODS: Coronial fatal drowning data in WA were extracted for two summer time periods (2014-2016) by date, age, gender, location and description. Corresponding print and online news articles were captured using: (i) Media Alert; (ii) Google News; (iii) Factiva. A content and frame analysis protocol was developed. A qualitative approach was taken to analyse the news angle. A subgroup analysis was undertaken for drowning focused articles. RESULTS: The final sample (n = 50) news articles matched 17 individual drowning events (T1, n = 9; T2, n = 8). Drowning stories rarely appeared on page 1 (n = 2), but were located in the first 2-10 pages (n = 20) (66.6%). In the subanalysis, one-fifth (22%) of the articles employed a news angle relating to community spirit and celebration of life. There were 32 mentions of "who was responsible for the drowning event." Environmental factors were most cited for "what was responsible" (20.4%). Experts were cited in 66.7% of articles and drowning prevention strategies were mentioned in nine of the 50 articles. CONCLUSION: Drowning was considered newsworthy; however, not the front page news. Reporting infrequently prioritised drowning prevention or discussed prevention strategies. SO WHAT?: Working closely with news outlets to embed drowning prevention messages in news stories during high-risk periods such as summer is an imperative.

What does 'Keep Watch' mean to migrant parents? Examining differences in supervision, cardiopulmonary resuscitation training and water familiarisation.

OBJECTIVES: Drowning is a public health challenge. Children of migrants may be at increased risk as parents may be unaware of local water safety issues. This study explores differences between Australian-born and migrant parents in Western Australia for: (1) swimming ability; (2) supervision; (3) water familiarisation; and (4) cardiopulmonary resuscitation (CPR) training. METHODS: A cross-sectional survey of parents and carers of children aged under 5 years residing in WA (n = 1506) captured demographics, knowledge of appropriate supervision, water safety knowledge and skills. Logistic regression was conducted. RESULTS: Migrants were significantly less likely to identify adequate supervision (p = 0.004); have participated in child water familiarisation programmes (p = 0.000); or perceived themselves as able swimmers (p = 0.000). Significantly less migrants had also undertaken CPR training (p = 0.000). CONCLUSIONS: Findings add to the small but growing body of literature highlighting the importance of tailored drowning prevention strategies for migrants in countries such as Australia with a strong aquatic culture.

Alcohol and injury risk at a Western Australian school Leavers Festival.

BACKGROUND: Leavers Festivals have become an institution for Australian youth to celebrate the completion of secondary school. Reported hazardous consumption of alcohol by leavers has focused concern on risk-taking behaviour. In response to this, campaigns such as "Don't Drink and Drown" have targeted youth to reduce alcohol consumption during aquatic activities. This research investigated intended and actual alcohol consumption, particularly during aquatic activities at a Leavers Festival located in the coastal town of Dunsborough, southern Western Australia. METHOD: In November 2016, 549 leavers aged 17 or 18 years completed a paper-based survey over a four-day period during the Festival. RESULTS: Overall, 90% of leavers reported intending to drink during the Festival, with expected average daily consumption being seven to nine standard drinks; reported daily consumption was five to six standard drinks (P < 0.001). Of the 29% of leavers who consumed alcohol around water during Leavers, 47% had done so while swimming. About 91% were aware of the campaign "Don't Drink and Drown." CONCLUSION: Awareness of the "Don't Drink and Drown" campaign and knowledge of risks associated with alcohol consumption and swimming were relatively high. Intention and actual consumption of alcohol did not correlate, with daily consumption less than anticipated. SO WHAT: Leavers appear to have a reasonable level of awareness and knowledge of the risks associated with alcohol consumption and aquatic activities, which may reflect the impact of education campaigns. However, this knowledge is not always translated into nonrisky aquatic behaviour.

This Much Water: a qualitative study using behavioural theory to develop a community service video to prevent child drowning in Western Australia.

OBJECTIVES: Drowning in children under the age of 5 is a frequently occurring, yet preventable event. This research used behavioural theory to test the suitability and appropriateness of a drowning prevention message in a community service video. DESIGN: This qualitative study used content analysis of focus groups. Constructs from the Health Belief Model guided the data analysis. SETTING: Community organisations and playgrounds in Perth, Western Australia. PARTICIPANTS: Participants were parents or carers of at least one child under 5 years residing in Western Australia. Seven focus groups (n=57) were conducted with eight participants in each group. Most participants were parents (96%), female (95%), aged between 25 and 34 years (63%) and were born in Australia (68%). RESULTS: Participants indicated the community service video was credible in communicating the message that young children were susceptible to drowning in shallow water and that various water hazards existed in and around the home. However, a range of external factors, such as the child's age, type of water hazard, presence of siblings and other environmental factors, influenced risk perceptions. Child drowning was seen as a serious issue. Controlling access to water and the role of supervision were understood to be important factors in preventing drowning. CONCLUSIONS: The lack of published drowning prevention interventions shaped by behavioural theory limits the understanding of best practice. Using constructs from the Health Belief Model, this research confirmed the perceived seriousness, devastating and unforgettable consequence of drowning; however, findings were mixed regarding cues to action. Future development of drowning prevention media messages should test strategies to increase susceptibility and self-efficacy among the target group and explore the impact of different message senders. The findings provide a valuable understanding of possible messages and their execution for use in media campaigns, as one component of an effective public health intervention to prevent child drowning underpinned by behavioural theory.

Formative research to develop theory-based messages for a Western Australian child drowning prevention television campaign: study protocol.

INTRODUCTION: Worldwide, children under the age of 5 years are at particular risk of drowning. Responding to this need requires the development of evidence-informed drowning prevention strategies. Historically, drowning prevention strategies have included denying access, learning survival skills and providing supervision, as well as education and information which includes the use of mass media. Interventions underpinned by behavioural theory and formative evaluation tend to be more effective, yet few practical examples exist in the drowning and/or injury prevention literature. The Health Belief Model and Social Cognitive Theory will be used to explore participants' perspectives regarding proposed mass media messaging. This paper describes a qualitative protocol to undertake formative research to develop theory-based messages for a child drowning prevention campaign. METHODS AND ANALYSIS: The primary data source will be focus group interviews with parents and caregivers of children under 5 years of age in metropolitan and regional Western Australia. Qualitative content analysis will be used to analyse the data. ETHICS AND DISSEMINATION: This study will contribute to the drowning prevention literature to inform the development of future child drowning prevention mass media campaigns. Findings from the study will be disseminated to practitioners, policymakers and researchers via international conferences, peer and non-peer-reviewed journals and evidence summaries. The study was submitted and approved by the Curtin University Human Research Ethics Committee.

A Review of Drowning Prevention Interventions for Children and Young People in High, Low and Middle Income Countries.

Globally, drowning is one of the ten leading causes of child mortality. Children aged <5 years are particularly at risk, and children and young people continue to be overrepresented in drowning statistics. Accordingly, evidence informed interventions to prevent children drowning are of global importance. This review aimed to identify, assess and analyse public health interventions to reduce child drowning and investigate the use of behavioural theories and evaluation frameworks to guide child drowning prevention. Thirteen databases were searched for relevant peer reviewed articles. The systematic review was guided by the PRISMA criteria and registered with PROSPERO. Fifteen articles were included in the final review. Studies were delivered in high, middle and low income countries. Intervention designs varied, one-third of studies targeted children under five. Almost half of the studies relied on education and information to reduce drowning deaths, only three studies used a multi-strategy approach. Minimal use of behavioural theories and/or frameworks was found and just one-third of the studies described formative evaluation. This review reveals an over reliance on education and information as a strategy to prevent drowning, despite evidence for comprehensive multi-strategy approaches. Accordingly, interventions must be supported that use a range of strategies, are shaped by theory and planning and evaluation frameworks, and are robust in intervention design, delivery and evaluation methodology. This approach will provide sound evidence that can be disseminated to inform future practice and policy for drowning prevention.

Recreational Drowning Prevention Interventions for Adults, 1990-2012: A Review.

Drowning is a frequently occurring and preventable public health issue. Internationally, drowning literature has focussed on children under 5 years, however, evidence based interventions to prevent adult drowning are needed to reduce deaths on a global scale. The aim of this paper is to systematically identify and analyse the evidence for drowning interventions with an adult focus. A systematic search was undertaken for peer-reviewed articles which were published in English between 1990 and 2012, focused on adults and described a drowning intervention. After quality appraisal by expert reviewers using a purposively tailored checklist, a final total of six studies were included for review. The six studies were all conducted in high income countries. Four were drowning interventions, two were retrospective analyses. The drowning interventions duration ranged from 10 days to 5 years, the analysis studies from 6 to 21 years. Two of the studies reviewed used behaviour change theory to inform development, and two reported formative evaluation. Prevention strategies included education (n = 3), technology (n = 1) and environmental (n = 1). Positive short term effects and significant behaviour change in life jacket use was reported (n = 2). A mixed effect was observed in the six studies. The complexity of the issues surrounding drowning requires the collection of robust data and evaluation of preventative measures to support the development of targeted and tailored prevention interventions. This review reinforces the need for a genuine and sustained global approach to addressing adult drowning prevention. Drowning is a serious public health issue and should receive the same attention as other public health priorities .