Understanding the legacy of the racial/ethnic and economic segregation of pools and beaches1 is necessary as drowning disparities in the United States widen.2 Chicago’s history includes a racially motivated drowning at a segregated beach that triggered the 1919 race riots, the building of mini-pools, too shallow for swimming, in response to riots in 1966, and disinvestment in public pools into the 1980s.1 Knowing that children are more likely to swim if their parents swim,3 we hypothesized that, in Chicago, intergenerational relationships between a child’s swim skills and their parent’s swimming experiences would be impacted by race/ethnicity.
Methods
This cross-sectional survey used the Voices of Child Health in Chicago Parent Panel4 to ascertain parent and child experiences with swim lessons and swimming skills. Responses were obtained from parents in Chicago households with child(ren) <18 years of age from November 2020 to February 2021. Analyses focused on responses from parents of children ≥4 years of age, the age most children are developmentally ready for swim lessons.5 Demographic characteristics were collected. Child-level survey-weighted descriptive statistics, χ2 tests, and logistic regression analyses were performed. The regression outcome was child swim competence with 2 skills (able to float for 30 seconds and swim the length of a pool). The study was deemed exempt human subject research (IRB2019-3063).
Results
We analyzed responses from 1283 parents of 2148 children ≥4 years old. Most parents were 36 to 45 years old (42.1%) and identified as female (57.2%). They represented the racial/ethnic diversity of Chicago: 40.3% Hispanic/Latiné, 30.1% white, 21.0% Black, and 8.6% Asian, other race, or >1 race. Parents learned about swimming informally, either on their own/from family (41.9%), or formally, through community or camp swim lessons (36.7%). Racial/ethnic differences were observed in how parents learned to swim (Table 1). Overall, 35.4% (95% confidence interval [CI]: 31.5–39.2) of parents were comfortable with 3 skills assessed in the survey: (1) floating on their back, (2) swimming with their face in the water, and (3) swimming where they cannot touch the bottom, with differences by race/ethnicity. Comfort was lowest among Hispanic/Latiné parents (24.6%; 95% CI: 18.1–31.0) and highest among white parents (56.1%; 95% CI: 50.3–61.8). At the household level, 77.2% of White parents (95% CI: 72.7–81.8) and 74.9% of Asian/other parents (95% CI: 63.6–86.2) reported their child(ren) had taken swim lessons compared with 46.8% of Hispanic/Latiné parents (95% CI: 40.3–53.3) and 46.1% of Black parents (95% CI: 38.2–54.0; P <.001).
Parent and Child Swimming Experiences, by Parent Self-Identified Race/Ethnicity
| . | . | Parent Self-Identified Race/Ethnicity . | |||
|---|---|---|---|---|---|
| . | Overall . | Black . | Hispanic/Latiné . | Asian/Other . | White . |
| . | % (95% CI) . | % (95% CI) . | % (95% CI) . | % (95% CI) . | % (95% CI) . |
| Parent swim experience | |||||
| From swim lessons in my community or at a camp | 36.8 (33.0–40.5) | 43.2 (34.9–51.4) | 21.7 (16.3–27.0) | 39.7 (27.0–52.4) | 51.6 (45.7–57.5) |
| On my own or from a family member | 41.9 (37.9–45.9) | 30.3 (23.0–37.9) | 45.8 (38.5–53.2) | 41.3 (27.4–55.2) | 44.8 (38.9–50.6) |
| I never learned | 21.3 (17.9–24.8) | 26.4 (19.2–33.6) | 32.5 (25.5–39.4) | 19.0 (10.2–27.7) | 3.7 (1.1–6.2) |
| Parent swim comfort | |||||
| Parent “very comfortable” with all 3 swim skills* | 35.4 (31.5–39.2) | 28.0 (19.7–36.3) | 24.6 (18.1–31.0) | 31.4 (19.0–43.7) | 56.1 (50.3–61.8) |
| Parent feels safe with this child being around water | 44.5 (41.1–47.8) | 46.9 (39.5–54.2) | 42.7 (37.1–48.2) | 32.9 (21.8–44.1) | 46.5 (41.9–51.1) |
| Child swim experience | |||||
| Any child in the family has had swim lessons in the past | 56.7 (52.8–60.5) | 46.1 (38.2–54.0) | 46.8 (40.3–53.3) | 74.9 (63.6–86.2) | 77.2 (72.7–81.8) |
| This child can float on their back for 30 s without help | 58.9 (55.6–62.1) | 46.6 (39.4–53.8) | 55.3 (49.8–60.7) | 64.2 (53.4–75.1) | 74.9 (71.2–78.6) |
| This child can swim the length of a pool without a floatation device | 48.1 (44.8–51.3) | 36.3 (29.3–43.3) | 44.6 (39.1–50.0) | 52.9 (41.2–64.7) | 63.5 (59.2–67.8) |
| Child swim competence: can float on their back for 30 s without help and swim the length of a pool without a floatation device | 43.9 (40.7–47.2) | 32.5 (25.7–39.4) | 39.8 (34.4–45.3) | 49.4 (37.7–61.2) | 59.7 (55.3–64.1) |
| . | . | Parent Self-Identified Race/Ethnicity . | |||
|---|---|---|---|---|---|
| . | Overall . | Black . | Hispanic/Latiné . | Asian/Other . | White . |
| . | % (95% CI) . | % (95% CI) . | % (95% CI) . | % (95% CI) . | % (95% CI) . |
| Parent swim experience | |||||
| From swim lessons in my community or at a camp | 36.8 (33.0–40.5) | 43.2 (34.9–51.4) | 21.7 (16.3–27.0) | 39.7 (27.0–52.4) | 51.6 (45.7–57.5) |
| On my own or from a family member | 41.9 (37.9–45.9) | 30.3 (23.0–37.9) | 45.8 (38.5–53.2) | 41.3 (27.4–55.2) | 44.8 (38.9–50.6) |
| I never learned | 21.3 (17.9–24.8) | 26.4 (19.2–33.6) | 32.5 (25.5–39.4) | 19.0 (10.2–27.7) | 3.7 (1.1–6.2) |
| Parent swim comfort | |||||
| Parent “very comfortable” with all 3 swim skills* | 35.4 (31.5–39.2) | 28.0 (19.7–36.3) | 24.6 (18.1–31.0) | 31.4 (19.0–43.7) | 56.1 (50.3–61.8) |
| Parent feels safe with this child being around water | 44.5 (41.1–47.8) | 46.9 (39.5–54.2) | 42.7 (37.1–48.2) | 32.9 (21.8–44.1) | 46.5 (41.9–51.1) |
| Child swim experience | |||||
| Any child in the family has had swim lessons in the past | 56.7 (52.8–60.5) | 46.1 (38.2–54.0) | 46.8 (40.3–53.3) | 74.9 (63.6–86.2) | 77.2 (72.7–81.8) |
| This child can float on their back for 30 s without help | 58.9 (55.6–62.1) | 46.6 (39.4–53.8) | 55.3 (49.8–60.7) | 64.2 (53.4–75.1) | 74.9 (71.2–78.6) |
| This child can swim the length of a pool without a floatation device | 48.1 (44.8–51.3) | 36.3 (29.3–43.3) | 44.6 (39.1–50.0) | 52.9 (41.2–64.7) | 63.5 (59.2–67.8) |
| Child swim competence: can float on their back for 30 s without help and swim the length of a pool without a floatation device | 43.9 (40.7–47.2) | 32.5 (25.7–39.4) | 39.8 (34.4–45.3) | 49.4 (37.7–61.2) | 59.7 (55.3–64.1) |
How comfortable are you in each of the following situations? (1) Floating on your back, (2) Swimming with your face down in the water, (3) Swimming where you cannot touch the bottom, with response options of Very Comfortable, Somewhat Comfortable, Not Comfortable.
Child swim competence was reported to be highest by white parents (59.7%; 95% CI: 55.3–64.1) and lowest by Black parents (32.5%; 95% CI: 25.7–39.4) (Table 1). Parents felt similarly safe with their child being around water, 46.5% among white parents (95% CI: 41.9–51.2) and 46.8% among Black parents (95% CI: 39.5–54.2). In an adjusted logistic regression model, clustered by household, child swim competence was higher among older children, households in which child(ren) had taken swim lessons, and among parents comfortable with swimming and lower among children of Black parents compared with white parents (Table 2).
Factors Associated With Parent Report of Child’s Swim Competence
| Variable . | Unadjusted Odds Ratio . | 95% CI . | Adjusted Odds Ratio . | 95% CI . | ||
|---|---|---|---|---|---|---|
| Child age, y | 1.22* | 1.18* | 1.26* | 1.29* | 1.24* | 1.35* |
| Any child in home has had swim lessons versus no child in home with swim lessons | 2.99* | 2.23* | 4.00* | 2.65* | 1.83* | 3.83* |
| Parent reports being very comfortable with all 3 swim skills versus not very comfortable with any of the swim skills | 3.08* | 2.31* | 4.11* | 3.44* | 2.47* | 4.80* |
| Parent female versus male | 0.62* | 0.47* | 0.83* | 1.09 | 0.75 | 1.58 |
| Parent age | ||||||
| 18–35 y | 0.49* | 0.33* | 0.73* | 1.28 | 0.81 | 2.04 |
| 36–45 y | 0.68* | 0.47* | 0.96* | 0.98 | 0.66 | 1.47 |
| 46 y and older | Referent | — | — | Referent | — | — |
| Parent race/ethnicity | ||||||
| Asian/other group | 0.66 | 0.40 | 1.09 | 0.71 | 0.41 | 1.23 |
| Black | 0.33* | 0.23* | 0.47* | 0.37* | 0.23* | 0.60* |
| Hispanic/Latiné | 0.45* | 0.33* | 0.60* | 0.68 | 0.45 | 1.04 |
| White | Referent | — | — | Referent | — | — |
| Family income % of FPL | ||||||
| <100% of FPL | 0.41* | 0.29* | 0.60* | 1.03 | 0.60 | 1.77 |
| 100%–399% of FPL | 0.50* | 0.38* | 0.66* | 0.63* | 0.43* | 0.94* |
| ≥400% of FPL | Referent | — | — | Referent | — | — |
| ≥1 public pools in neighborhood vs no pools | 0.80 | 0.60 | 1.07 | 0.81 | 0.56 | 1.12 |
| Neighborhood is along the lakefront vs inland neighborhood | 1.12 | 0.85 | 1.47 | 1.22 | 0.88 | 1.68 |
| Variable . | Unadjusted Odds Ratio . | 95% CI . | Adjusted Odds Ratio . | 95% CI . | ||
|---|---|---|---|---|---|---|
| Child age, y | 1.22* | 1.18* | 1.26* | 1.29* | 1.24* | 1.35* |
| Any child in home has had swim lessons versus no child in home with swim lessons | 2.99* | 2.23* | 4.00* | 2.65* | 1.83* | 3.83* |
| Parent reports being very comfortable with all 3 swim skills versus not very comfortable with any of the swim skills | 3.08* | 2.31* | 4.11* | 3.44* | 2.47* | 4.80* |
| Parent female versus male | 0.62* | 0.47* | 0.83* | 1.09 | 0.75 | 1.58 |
| Parent age | ||||||
| 18–35 y | 0.49* | 0.33* | 0.73* | 1.28 | 0.81 | 2.04 |
| 36–45 y | 0.68* | 0.47* | 0.96* | 0.98 | 0.66 | 1.47 |
| 46 y and older | Referent | — | — | Referent | — | — |
| Parent race/ethnicity | ||||||
| Asian/other group | 0.66 | 0.40 | 1.09 | 0.71 | 0.41 | 1.23 |
| Black | 0.33* | 0.23* | 0.47* | 0.37* | 0.23* | 0.60* |
| Hispanic/Latiné | 0.45* | 0.33* | 0.60* | 0.68 | 0.45 | 1.04 |
| White | Referent | — | — | Referent | — | — |
| Family income % of FPL | ||||||
| <100% of FPL | 0.41* | 0.29* | 0.60* | 1.03 | 0.60 | 1.77 |
| 100%–399% of FPL | 0.50* | 0.38* | 0.66* | 0.63* | 0.43* | 0.94* |
| ≥400% of FPL | Referent | — | — | Referent | — | — |
| ≥1 public pools in neighborhood vs no pools | 0.80 | 0.60 | 1.07 | 0.81 | 0.56 | 1.12 |
| Neighborhood is along the lakefront vs inland neighborhood | 1.12 | 0.85 | 1.47 | 1.22 | 0.88 | 1.68 |
FPL, federal poverty level.
Statistically significant difference, P < .05.
Discussion
In this survey of >1000 diverse parents, we found racial/ethnic disparities in parent and child experiences with swim lessons that were associated with parental comfort and child competence with select swimming skills. Child participation in swim lessons was consistently higher than their parents, yet disparities persisted across generations. Consistent with previous literature, parental comfort and child swim competence were lowest among parents who self-identified as Black or Hispanic/Latiné.3,6,7 Despite differences in child swim competence, parents across racial/ethnic groups reported similar levels of feeling safe with their child being around water, which could modify drowning risk. When educating families about layers of protection against drowning,2 pediatricians can explore parental attitudes toward swimming, which could be shaped by segregation, a fear of drowning,8 or previous negative swimming experiences.9 Culturally tailored education programs hold promise for eliminating drowning disparities.10 Our results may not generalize to other geographic areas. Swimming was impacted by coronavirus disease 2019 closures of pools and beaches. Recall bias is possible and pool length was not specified. Intergenerational swimming experiences are associated with child swim competence and should be considered in anticipatory guidance and the development of effective community-level water safety programs to address drowning inequities.
Acknowledgments
The investigators thank Rebecca Wear Robinson, MBA, MSc, for her guidance on the development of the survey items based on her expertise related to water safety and drowning prevention. The authors have a deep appreciation for Halle Quezada Rasmussen’s advocacy leading to the formation of Chicago’s Lakefront Task Force and the subsequent establishment of the Water Safety Task Force for Metro Chicago that inspired this research.
Ms Rajeh conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript; Dr Heffernan and Ms Bendelow contributed to the design of the data collection instruments, conducted the initial analyses, contributed to the interpretation of the results, and reviewed and revised the manuscript; Dr Kendi contributed to the conceptualization of the study, interpretation of the results, and critically reviewed the manuscript for important intellectual content; Ms Hill and Dr Davis contributed to the design of the data collection instruments and the interpretation of results and critically reviewed the manuscript for important intellectual content; Dr Macy conceptualized and designed the study, coordinated and supervised data collection, contributed to the interpretation of the results, and reviewed and revised the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
FUNDING: This work was supported by a Community Health Grant from the Patrick M. Magoon Institute for Health Communities. The Voices of Child Health in Chicago was supported by an anonymous family foundation dedicated to supporting research that advances community health in low-resource neighborhoods. The funders had no role in the data collection, analysis, interpretation of results, or decision to publish the findings.
CONFLICT OF INTEREST DISCLOSURES: Ms Hill receives funding from the ZAC Foundation to support her activities related to water safety. The other authors have indicated they have no potential conflicts of interest relevant to this article to disclose.
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