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

项目摘要/摘要 溺水是儿童和年轻人因意外伤害而死亡的主要原因。虽然 18岁以下人群的溺水率从1999年的每10万人1.9人下降到2019年的每10万人1人，种族广泛 致命的溺水率仍然存在差距。在一些州，黑人和白人的差距几乎消失了，尽管它已经 在其他群体中扩大了，如美洲印第安人和阿拉斯加原住民。在西班牙裔中，溺水率， 在全国范围内低于白人的失业率一直在上升。国家和地区公共政策制定者的反应 地方各级已经引入了一系列干预措施，从免费的游泳学习项目到增加 泳池及救生员的规例。不幸的是，对这些政策干预和 对这些干预措施可能对溺水的种族差异产生的影响的评估仍然难以捉摸。 该项目的总体目标是更好地了解哪些公共政策应该减少溺水死亡和 伤害会起作用，对谁起作用。该提案审查了三种类型的公共政策干预，旨在减少 因溺水造成的意外死亡或受伤，发生在不同的时间和周围的不同地点 美国在过去20年里：a)地方政府和学区学习游泳的激励措施，b)游泳 泳池标准，以及c)公共和私人设施的救生员认证和人员配备要求。评估 为了确保这些政策干预措施的有效性，项目组将创建一个州和地方的国家数据库 立法、强制令、认证、法规和地方资助的干预措施，以减少或防止溺水。 该数据库将在县一级与限制使用的国家卫生统计中心合并 (NCHS)1989年至2019年从公共来源收集的死亡率数据和背景数据。合并后的 数据库将按年龄、种族、性别和民族分别绘制溺水人数的变化地图 以及在实施特定类型的公众学习游泳倡议、游泳池法规或 救生员任务或认证要求。到项目期结束时，国家和 本地政策指示符、从公共数据库获取的上下文变量以及用于链接到 受限制的NCHS数据将通过ICPSR数据档案馆公开提供。该项目有三个 具体目标：(1)确定州和地方政策干预的特点，旨在减少意外死亡或 由于溺水造成的伤害，通过描述什么被递送给谁，地点和时间。(2)隔离 目标1中衡量的公共政策干预对溺水的因果影响，按年龄组、种族、性别、 和种族。这一目标将检验两个假设：(2)政策干预的影响因群体而异 以及(2)这些干预措施缩小了溺水意外死亡的种族差距。(三)量化效果 关于致命溺水的结构性或系统性种族主义。这一探索性目标将估计将有多少人 如果没有历史上的进入障碍或种族歧视，救生员的招聘做法就会得救， 提供关于系统性种族主义可能如何影响致命溺水率方面的种族差异的见解。

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.