Ethnic and Racial Disparities in Pediatric Swimming Activities

Haley Romine
Aleena Joseph
Vinh Diep
Nouran Farag
Elizabeth A. Camp, PhD
Rohit P. Shenoi, MD

Drowning is a public health problem. Recreational water access and swim lesson participation among children are factors that can influence pediatric drowning rates. We aimed to determine factors associated with swimming lesson participation and swimming ability among children.

Parents of children aged 0-19 years who visited an urban children’s hospital emergency department between 2022-2025 completed a survey after providing informed consent. Covariates included demographics, maternal education, parental swimming ability, child’s participation in food assistance program, Head Start, or daycare, and swimming pool access. Outcomes included child swimming class participation and swimming ability (based on child’s comfort with playing in water over their head). Descriptive statistics and group comparisons by chi-squared test and logistic regression were performed.

There were 485 children selected. The median age was 6.5 years (IQR: 3,11). Subject demographics were males (54%), Hispanic (53%), non-Hispanic White (21%), Black (20%) and Asian/Other (7%). Among preschool children (?5 years old), participation in food assistance program was 35%, Head Start (19%) and daycare (31%). Forty-eight percent of school-aged children participated in a school food assistance program.

Overall, 64% of children had swimming pool access year-round or during summer. Seventy-three percent of parents could swim. Among children, 29% attended swimming classes and 38% were very comfortable playing in water over their head. Parents of Hispanic ethnicity and Black race had lower odds of swimming ability when compared to White parents. Children of Hispanic ethnicity and Black race were significantly less likely to have attended swimming classes or be comfortable when playing in water over their head compared to children of White race.

Among preschool children, significant factors associated with swimming lesson attendance were age [OR:1.8 (95%CI:1.2,2.5)], and year-round or summer pool access [OR:20 (95%CI:4,100)]. Significant factors associated with swimming lesson non-attendance were Hispanic ethnicity [OR:0.3 (95%CI:0.1,0.9)], and Black race [OR:0.1 (95%CI:0.01,0.4)]. Similarly, among preschool children, those with year-round or summer swimming pool access were >3 times more likely to be comfortable playing with water over their head compared to children without pool access after adjustment [OR:3.4 (95%CI: 1.3,8.9)].

Among school-aged children, significant factors associated with swimming lesson participation were maternal education [OR:4.7 (95%CI:2.4,9.5)], and recreation-center pool access [OR:3.0 (95%CI:1.4,6.5)]. Significant factors associated with swimming lesson non-participation were Hispanic ethnicity [OR:0.3 (95%CI:0.2,0.6)], Black race [OR:0.3 (95%CI:0.2,0.8)] or in a school food assistance program [OR:0.3 (95%CI:0.2,0.5)]. White race and parental ability to swim were factors significantly associated with a child being comfortable playing in water over the head compared to other groups.

Significant racial and ethnic disparities in parents’ swimming ability and their child’s swimming class participation and swimming ability exist. In preschool children, swimming class participation and swimming ability are significantly associated with older age, swimming pool access and non-minority race. Among school-aged children, swimming class participation and swimming ability are significantly associated with maternal education, parent’s swimming ability, swimming pool access, non-minority status, and non-participation in food assistance program.

1. Explain factors associated with swim lesson attendance in children by age group
2. Discuss reasons for disparities in swimming ability in children by age group
3. Summarize methods to improve swim lesson attendance among high drowning risk subpopulations.