Finding your lane: experiences and beyond for adults learning to swim.

The purpose of this study was to examine experiences and impacts from participating in an adult swim instruction program. We conducted 20 semi-structured interviews with adults aged 18 + who had participated in an adult learn to swim program. Participants were interviewed through a virtual platform using a semi-structured protocol. Data were coded individually by each member of the research team for emerging thematic outcomes with final consensus among all those involved in the analysis. Participants expressed adult learn to swim programs had an effect in three areas: (a) life affordance, (b) emotional affect, and (c) interpersonal relationships. Public health experts and aquatics leaders should consider targeting programs aimed at teaching adults to learn how to swim, especially to marginalized individuals and those who did not grow up in the United States. The authors highlight how these programs can create life affordances well beyond lap swimming and even water safety.

Drowning in the United States: Patient and scene characteristics using the novel CARES drowning variables.

INTRODUCTION: Drowning results in more than 360,000 deaths annually, making it the 3rd leading cause of unintentional injury death worldwide. Prior studies examining drowning internationally have reviewed factors surrounding drowning however in the U.S. limited data exists. This study evaluated the novel drowning elements collected in the Cardiac Arrest Registry to Enhance Survival (CARES) during the first 2 years of data collection. METHODS: A retrospective analysis of the CARES database identified cases of drowning etiology for the two years 2020 and 2021. Demographics and incident characteristics were collected. Characteristics included items such as body of water, precipitating event, and who extracted patients. Survival to hospital discharge and neurological outcomes were compared between groups based on who initiated CPR using Pearson's Chi-Squared tests. RESULTS: Among 1,767 drowning cases, 69.7% were male, 47.1% white and 11.9% survived to hospital discharge. Body of water was often natural body (36.2%) or swimming pool (25.9%) and bystanders removed the patient in 42.7% of incidents. Swimming was the most common activity at time of submersion (18.6%) however in 50.2% of cases, activity was unknown or missing. When compared to EMS/First Responder initiating CPR, odds of neurologically favorable survival were significantly higher in the Bystander initiated CPR group (OR = 2.85, 95% confidence interval [CI] 2.02-4.01). CONCLUSION: In this national cohort of drowning patients in cardiac arrest, the novel CARES drowning elements provide additional detail of epidemiological factors. Bystander CPR was associated with improved neurological outcomes. Future studies utilizing the drowning elements can inform injury prevention strategies.

Campus recreational participation and COVID-19: impact on college student health and well-being.

Objective: Campus recreational sport activities impact college student health and well-being in a variety of domains. This multi-institutional study examined the participation of students in campus recreation during the pandemic and explored the relationship between student participation and their demographic markers, COVID-19 experience, and perceptions of risk, health and safety. Methods: Results from a survey of 1,815 American college students indicated the presence of statistical differences in sport participation based on Gender, Race, State, Personal COVID-19 Experience, Campus Safety Efforts, and Risk Perception Score within various areas of analysis. Results: The impact and meaning of these cross-sectional results are discussed with reference to the ongoing pandemic and student health. Recommendations are presented within the context of this vital programming area both during and beyond the current crisis. Conclusion: These results are especially important given the health benefits associated with participation in recreational sport as tools to mitigate against the unprecedented consequences of the pandemic.

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

Drowning 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.

Association between trail use and self-rated wellness and health.

BACKGROUND: Incorporating trail use into daily activity routines could be an important venue to increase a population's physical activity. This study presents important health impacts of trail use. METHODS: A cross-sectional study was conducted on 8 trails throughout the State of Indiana. A mix of urban, suburban, and rural trails were selected. Recruitment sessions were completed during four 1-week periods throughout the study in various locations and at various times of day on each trail between April and October 2017. Data were collected through online and paper surveys. For each type of physical activity, a generalized additive model for self-rated wellness and health was built adjusting for demographics, socioeconomic status, amounts of physical activity on trails, mood status, sleep pattern, diet and smoking habit. The plots of estimated smoothing spline function with 95% confidence band were pictured. All statistical analyses were conducted using R. RESULTS: The final sample size included 1299 trail users; 92% were White, 79% aged 18-65 years, 71% were married and 56% were male. Biking, walking and running were the main activities with 52, 29 and 19%, respectively. Female to male ratio was 3:2 in walkers vs. 2:3 in runners and bikers. Runners were significantly younger than the other two groups. Runners also had the highest percentage of college graduates and above, the highest rate of employment, the highest income, and the lowest percentage of being retired among the three groups. They more commonly used the trails alone than the walkers and bikers. Bikers had the highest rate of job satisfaction. They also showed a better mean score of mood than that the walkers and runners. There was a linear association between walking and self-rated wellness and health, and a curved association between running/biking and self-rated wellness and health. Running < 6.5 miles/week and biking > 14 miles/week were associated with steeper rise in self-rated wellness and health. CONCLUSIONS: Employed educated married middle-aged people had the highest prevalence of walking, running or biking. The higher the walking, the higher self-rated wellness and health. A similar association was observed for running up to 6.5 miles/week or biking > 14 miles/week.

Outcome of Conventional Bystander Cardiopulmonary Resuscitation in Cardiac Arrest Following Drowning.

INTRODUCTION: The concept of compressions only cardiopulmonary resuscitation (CO-CPR) evolved from a perception that lay rescuers may be less likely to perform mouth-to-mouth ventilations during an emergency. This study hopes to describe the efficacy of bystander compressions and ventilations cardiopulmonary resuscitation (CV-CPR) in cardiac arrest following drowning. HYPOTHESIS/PROBLEM: The aim of this investigation is to test the hypothesis that bystander cardiopulmonary resuscitation (CPR) utilizing compressions and ventilations results in improved survival for cases of cardiac arrest following drowning compared to CPR involving compressions only. METHODS: The Cardiac Arrest Registry for Enhanced Survival (CARES) was queried for patients who suffered cardiac arrest following drowning from January 1, 2013 through December 31, 2017, and in whom data were available on type of bystander CPR delivered (ie, CV-CPR CO-CPR). The primary outcome of interest was neurologically favorable survival, as defined by cerebral performance category (CPC). RESULTS: Neurologically favorable survival was statistically significantly associated with CV-CPR in pediatric patients aged five to 15 years (aOR = 2.68; 95% CI, 1.10-6.77; P = .03), as well as all age group survival to hospital discharge (aOR = 1.54; 95% CI, 1.01-2.36; P = .046). There was a trend with CV-CPR toward neurologically favorable survival in all age groups (aOR = 1.35; 95% CI, 0.86-2.10; P = .19) and all age group survival to hospital admission (aOR = 1.29; 95% CI, 0.91-1.84; P = .157). CONCLUSION: In cases of cardiac arrest following drowning, bystander CV-CPR was statistically significantly associated with neurologically favorable survival in children aged five to 15 years and survival to hospital discharge.

Social Determinants of Health-Related Quality of Life: A Recreation Setting Analysis.

Objective. To determine if significant differences between park users and non-park users are associated with scores on a composite health-related quality of life (HRQoL) index. Methods. Data for this study were collected based on random intercept of a cross section of eligible Monroe County, Indiana, residents at four selected public recreational parks, as well as nonpark locations from July to December 2017. Based on data collected using validated survey items, we created a composite HRQoL index. Statistical analysis included independent-samples t test, chi-square cross-tabulation, bivariate regression, and multivariate regression. Results. Frequent park users were significantly different from nonfrequent park users in various respects. The most leisure-time physical activity (LTPA) experiences of frequent park users occurred at a park location. Body mass index and park-based LTPA were significantly positively associated with HRQoL scores in a linear regression model. Conclusion. Frequent park use was shown to be positively associated with increased park-based LTPA and HRQoL. It is therefore possible that increasing park visitation will result in more members of a community who report experiencing their LTPA at a park location. Study outcomes lend support to the validity of a composite HRQoL index for population health assessments.

Social motivation and health in college club swimming.

OBJECTIVE: Participation in recreational sport clubs on campus is a popular student activity nationwide. These sport-based organizations provide a host of benefits within recognized dimensions of health and wellness. Understanding participants' motives for engaging in these types of activities can provide insight in design and delivery and enhance participant health. This study focuses on outcomes related to the social motivations for participation in a recreational sport swim club and their potential relationship to social health. PARTICIPANTS: Current members of recreational swimming clubs were contacted for participation in the study from March-April 2016. METHODS: A Leisure Motivation Scale (LMS) survey was sent electronically to 196 collegiate swim clubs nationwide. Aggregate and multivariate analyses from 1011 responses were conducted to examine the social motivation and motivational differences of participants. RESULTS: Social motivations emerged as the predominate motivational construct, indicating important implications for social health improvement through participation. Demographically, results indicated no statistically significant differences in social motivation factors based on participant gender, and statistically significant differences within participant race, university affiliation and practice frequency. CONCLUSIONS: Impacts of these findings are important for practitioners and participants when evaluating the potential these programs have to influence participant social health.

Bystander CPR is associated with improved neurologically favourable survival in cardiac arrest following drowning.

BACKGROUND: Cardiac arrest associated with drowning is a major public health concern with limited research available on outcome. This investigation aims to define the population at risk, and identify factors associated with neurologically favourable survival. METHODS: The Cardiac Arrest Registry for Enhanced Survival (CARES) database was queried for patients who had suffered cardiac arrest following drowning between January 1, 2013 and December 31, 2015. The primary outcomes of interest were for favourable or unfavourable neurological outcome at hospital discharge, as defined by Cerebral Performance Category (CPC). RESULTS: A total of 919 drowning patients were identified. Neurological outcome data was available in 908 patients. Neurologically favourable survival was significantly associated with bystander CPR (Odds Ratio (OR)=2.94; 95% Confidence Interval (CI) 1.86-4.64; p<0.001), witnessed drowning (OR=2.6; 95% CI 1.69-4.01; p<0.001) and younger age (OR=0.97, 95% CI 0.96-0.98; p<0.001). Public location of drowning (OR=1.17; 95% CI 0.77-1.79; p=0.47), male gender (OR=0.9, 95% CI 0.57-1.43; p=0.66), and shockable rhythm (OR=1.54; 95% CI 0.76-3.12; p=0.23), were not associated with favourable neurological survival. AED application prior to EMS was associated with a decreased likelihood of favourable neurological outcome (OR=0.38; 95% CI 0.28-0.66; p<0.001). In multivariate analysis, bystander CPR (adjusted OR 3.02, 95% CI 1.85-4.92, p<0.001), witnessed drowning (adjusted OR 3.27, 95% CI 2.0-5.36, p<0.001) and younger age (adjusted OR 0.97, 95% CI 0.96-0.98, p<0.001) remained associated with neurologically favourable survival. CONCLUSIONS: Neurologically favourable survival after drowning remains low but is improved by bystander CPR. Shockable rhythms were uncommon and not associated with improved outcomes.

Physical activity levels and pattern of use for youth participants at a traditional aquatic venue.

In an effort to encourage youth to acquire recommended levels of moderate to vigorous physical activity (MVPA), we need to examine affordances available to enhance opportunities. Included for consideration should be built environments such as swimming pools which can have significant impacts through leisure service delivery to promote active lifestyles. For this study, The System for Observing Play and Recreation in Communities (SOPARC), was employed at a traditional aquatic venue during July and August in the Midwestern region of the U.S. Data was collected on three physical activity postures for youths age 4 to 18 along with variables including: (a) age, (b) gender, (c) physical activity posture, and (d) areas of participation termed target areas. A total of 3780 observations were taken into account during analysis. To detect differences among key variables, One-Way ANOVA and t-tests were performed. Descriptive results indicated that MVPA accounted for 70% of activity in the aquatic venue. Overall, female youths generated more MVPA within target areas compared to males, and youth as a single group consistently scored higher in all target areas as well as overall in MVPA. Significant differences were discovered in relation to several target areas. Findings from the study indicate that the use of a traditional aquatic venue can have positive impacts on youth physical activity and assist in meeting national standards for daily requirements of MVPA. It is also indicated that design features of an aquatic venue can play a role in determining levels of engagement and physical activity.

Beliefs about using an outdoor pool: Understanding perceptions of place in the context of a recreational environment to improve health.

Following the Reasoned Action Approach, an online survey of 74 outdoor pool users illustrates how a theory-based behavioral analysis can be used to identify people's perceptions of a place in their environment. Regression analysis of close-ended data demonstrated that intention "to use the outdoor pool next summer season" was predicted (R(2)=.636, p<.0001) from the weighted combination of attitude (ß=.663, p<.0001) and perceived control (ß=.197, p<.05). The importance of attitude suggests that use can be encouraged by addressing advantages. The content analysis of open-ended elicitation data revealed that users believed that pool use provides physical, social, and emotional advantages and could be made easier by modifying facility parameters. Implications for promoting and designing public health spaces to attract users to aquatic environments and to improve health are discussed.

Loneliness, HIV-related stigma, and condom use among a predominantly rural sample of HIV-positive men who have sex with men (MSM).

Most previous studies of the sexual behaviors of men who have sex with men (MSM) living with HIV are based on samples recruited within relatively urban and suburban areas of the United States. Using an internet-based questionnaire, we assessed HIV-related stigma, loneliness, and event-level sexual behaviors in a sample of HIV positive MSM (n = 100) residing within a largely rural area in the Midwestern United States. HIV-related stigma was correlated with loneliness (r = 0.619, p < 0.01). Loneliness was negatively associated with condom usage with the most recent partner of unknown status (p < 0.05). Namely, a 1-unit increase in the UCLA loneliness score was met with a 10% decrease in odds of condom usage. Further studies are warranted that explore loneliness, within the context of HIV-related stigma, among HIV-positive MSM residing in rural areas. More refined data will inform clinical and social service practice, as they provide much-needed information on sexual health outcomes and experiences of an often underserved and under studied population.

Experiences of HIV-positive gay, bisexual and other men who have sex with men residing in relatively rural areas.

Most previous studies of the sexual behaviour of gay, bisexual and other men who have sex with men living with HIV are based on samples of men recruited within relatively urban and suburban areas of the USA. The aim of the present study was to explore the potential challenges associated with HIV-related stigma and residing in a relatively rural area. We conducted a qualitative study based in south-central Indiana, a relatively rural area of the USA. Twenty-three HIV-positive gay, bisexual and other men who have sex with men, aged 21-48 years, were interviewed on topics regarding community engagement, perceived HIV-related stigma, relationship formation, sexual behaviour and HIV status disclosure. Findings indicate HIV-related stigma is commonly reported at the interpersonal and community levels. Because of this, men face complex situations on how and when to disclose their HIV status to members of their social and sexual networks. Although many participants reported many challenges associated with relationship formation, all expressed a desire for romantic and/or sexual connections with other men and/or women. Results suggest that new programmatic approaches are necessary to inform the work of social service and medical providers on mechanisms to intervene and combat stigma and discrimination inherent in communities, programmes and policies.