Building the evidence base for river drowning prevention
Peden, Amy (2019) Building the evidence base for river drowning prevention. PhD thesis, James Cook University.
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Abstract
Introduction: Rivers account for a significant proportion of the global burden of drowning. Rivers are the leading location for unintentional fatal drowning in Australia. Through a public health approach, this research provides a framework to develop a detailed understanding (epidemiology, risk factors and strategies for the prevention) of unintentional fatal river drowning in Australia.
Methods: A mixed methods approach was used including: a systematic literature review; epidemiological analysis of a 10‐year total population case‐series and review of coronial recommendations; a CATI survey, community surveys, breathalysing and direct observation; and a modified Delphi process to develop prevention strategies.
Results: Males (80%), adults (85%), alcohol (41%) and increasing geographical remoteness (very remote 29 times [RR= 28.8] the risk of drowning compared to major city residents) are key risk factors for river drowning. Similar numbers of males and females visit rivers, often for different activities with river visitations more likely in the afternoon, on hot days, weekends and public holidays. Adjusting for exposure, older males (75+ years) had the greatest relative risk (RR= 1.12). Blood alcohol concentrations ≥0.05% were seen among both males and females with alcohol consumption at rivers more prevalent in the afternoon and early evening. Eight percent of river drowning cases generated coronial recommendations. Prevention strategies considered more likely to be effective included: avoiding alcohol; flood‐related early warning systems; child supervision; learning to swim; lifejackets; and community‐wide rescue and resuscitation skills.
Discussion: Preventing river drowning presents is a wicked problem, where usage of such locations is encouraged, often accompanied with alcohol consumption and a lack of on‐site rescue services. Enacting legislation and subsequent enforcement are challenging due to mixed use, geographical dispersal and isolation. River drowning attracts an estimated economic burden of $318.70 million dollars per annum. Further investment in the development, implementation and evaluation of evidence‐based drowning prevention interventions is warranted. Strategies such as community wide rescue and resuscitation skills, especially in remote locations, must be considered.
Conclusion: This research, the first to specifically explore river drowning in the world, highlights the value of taking a public health approach. By building a broad evidence base of the causal factors increasing river drowning risk, the likelihood of prevention strategies being effective is enhanced. Research findings were used in the development of the 'Respect the River' and 'Don't Let Your Mates Drink and Drown' drowning prevention programs, in partnership with Royal Life Saving Society – Australia, which have contributed to an 18% reduction in river drowning to date.
| Item ID: | 60849 |
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| Item Type: | Thesis (PhD) |
| Keywords: | alcohol, Australia, behaviour change, behaviour, breathalysing, drowning prevention, drowning, epidemiology, evidence based practice, exposure, floods, health promotion theory, health promotion, injury, injury prevention, intraclass correlation coefficient (ICC), observational studies, public health, risk factors, rivers |
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| Copyright Information: | Copyright © 2019 Amy Peden. |
| Additional Information: | For this thesis, Amy Peden received the Dean's Award for Excellence 2020, which recognises excellence in Higher Degree by Research and recipients of this award are commended by independent expert examiners as having made a substantial contribution to their field of research. Eleven publications arising from this thesis are stored in ResearchOnline@JCU, at the time of processing. Please see the Related URLs field. The publications are: Chapter 2: Peden, Amy E., Franklin, Richard C., and Leggat, Peter A. (2016) Fatal river drowning: the identification of research gaps through a systematic literature review. Injury Prevention, 22 (3). pp. 202-209. Chapter 4: Peden, Amy E., Franklin, Richard C., and Leggat, Peter A. (2016) The hidden tragedy of rivers: a decade of unintentional fatal drowning in Australia. PLoS ONE, 11 (8). e0160709. pp. 1-15. Chapter 4: Peden, Amy E., Franklin, Richard C., and Leggat, Peter A. (2017) Alcohol and its contributory role in fatal drowning in Australian rivers, 2002–2012. Accidents Analysis and Prevention, 98. pp. 259-265. Chapter 4: Peden, Amy E., Franklin, Richard C., Leggat, Peter, and Aitken, Peter (2017) Causal pathways of flood related river drowning deaths in Australia. PLoS Currents Disasters, 1. pp. 1-24. Chapter 5: Peden, Amy E., Franklin, Richard C., and Leggat, Peter A. (2019) Exploring visitation at rivers to understand drowning risk. Injury Prevention, 25 (5). pp. 392-399. Chapter 5: Peden, Amy E., Franklin, Richard C., and Leggat, Peter A. (2018) Breathalysing and surveying river users in Australia to understand alcohol consumption and attitudes toward drowning risk. BMC Public Health, 18. 1393. pp. 1-18. Chapter 5: Peden, Amy E., Franklin, Richard C., Leggat, Peter A., and Lindsay, Daniel (2019) Observing patterns of river usage. Safety, 5 (4). 66. Chapter 5: Peden, A.E., Franklin, R.C., and Leggat, P. (2018) The flood-related behaviour of river users in Australia. PLoS Currents Disasters, 1. Chapter 6: Peden, Amy E., Franklin, Richard C., and Leggat, Peter (2018) Preventing river drowning deaths: lessons from coronial recommendations. Health Promotion Journal of Australia, 29 (2). pp. 144-152. Chapter 6: Peden, Amy E, Franklin, Richard C., and Leggat, Peter A. (2019) Developing drowning prevention strategies for rivers through the use of a modified Delphi process. Injury Prevention. (In Press) Chapter 6: Peden, Amy E., Franklin, Richard C., and Leggat, Peter A. (2019) Cardiopulmonary resuscitation and first‐aid training of river users in Australia: a strategy for reducing drowning. Health Promotion Journal of Australia, 30 (2). pp. 258-262. |
| Date Deposited: | 06 Nov 2019 02:40 |
| FoR Codes: | 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111712 Health Promotion @ 50% 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111706 Epidemiology @ 50% |
| SEO Codes: | 92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920409 Injury Control @ 100% |
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