The Effectiveness of Public Policy Interventions in Reducing Racial Disparities in Drowning: Lifeguard Certification, Pool Regulations, and Swimming Instruction Programs

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PROJECT SUMMARY/ABSTRACT Drowning is a leading cause of unintentional injury-related death for children and young adults. Although drowning rates fell from 1.9 per 100,000 in 1999 to 1 per 100,000 in 2019 among persons under 18, wide racial gaps persisted in fatal drowning rates. In some states, the Black-White gap has nearly vanished, while it has widened among other groups, like American Indians and Alaskan Natives. Among Hispanics, drowning rates, lower nationally than those for Whites, have been rising. The response by public policymakers at the state and local levels has been to introduce an array of interventions, from free learn-to-swim programs to increased regulations of pools and lifeguards. Unfortunately, systematic evaluation of these policy interventions and assessment of the impacts these interventions may have had on racial disparities in drowning remains elusive. This project's overarching objective is to better understand which public policies to reduce drowning deaths and injuries work and for whom. This proposal examines three types of public policy interventions designed to reduce accidental deaths or injuries due to drowning and undertaken at various times and in different locations around the U.S. over the past 20 years: a) local government and school district learn-to-swim incentives, b) swimming pool standards, and c) lifeguard certification and staffing requirements in public and private facilities. To assess the effectiveness of these policy interventions, the project team will create a national database of state and local legislation, mandates, certifications, regulations, and locally funded interventions to reduce or prevent drowning. The database will be merged at the county level with the restricted-use National Center for Health Statistics (NCHS) mortality data and contextual data collected from public sources from 1989 to 2019. The merged database will map separately by age, race, gender, and ethnicity, changes in the number of drownings before and after the implementation of specific types of public learn-to-swim initiatives, swimming pool regulations, or lifeguard mandates or certification requirements. By the end of the project period, the detailed list of state and local policy indicators, the contextual variables obtained from public databases, and the code for linking to the restricted NCHS data will be made publicly available through the ICPSR Data Archives. The project has three Specific Aims: (1) Characterize state and local policy interventions designed to reduce accidental deaths or injuries due to drowning by describing what was delivered to whom, where, and for how long. (2) Isolate the causal impacts of the measured public policy interventions from Aim 1 on drownings by age group, race, gender, and ethnicity. This aim will test two hypotheses: (2a) that the impacts of policy interventions differ across groups and (2b) that the interventions narrowed racial gaps in accidental deaths due to drowning. (3) Quantify the effects of structural or systemic racism on fatal drownings. This exploratory aim will estimate how many lives would have been saved had lifeguard hiring practices existed without historical barriers to entry or racial discrimination, providing insights into how systemic racism might affect racial disparities in fatal drowning rates.