title: Swimming in the USA: beachgoer characteristics and health outcomes at US marine and freshwater beaches.
abstract: Swimming in lakes and oceans is popular, but little is known about the demographic characteristics, behaviors, and health risks of beachgoers on a national level. Data from a prospective cohort study of beachgoers at multiple marine and freshwater beaches in the USA were used to describe beachgoer characteristics and health outcomes for swimmers and non-swimmers. This analysis included 54,250 participants. Most (73.2%) entered the water; of those, 65.1% put their head under water, 41.3% got water in their mouth and 18.5% swallowed water. Overall, 16.3% of beachgoers reported any new health problem. Among swimmers, 6.6% reported gastrointestinal (GI) illness compared with 5.5% of non-swimmers (unadjusted χ² p < 0.001); 6.0% of swimmers and 4.9% of non-swimmers reported respiratory illness (p < 0.001); 1.8% of swimmers and 1.0% of non-swimmers reported ear problems (p < 0.001); and 3.9% of swimmers and 2.4% of non-swimmers experienced a rash (p < 0.001). Overall, swimmers reported a higher unadjusted incidence of GI illness and earaches than non-swimmers. Current surveillance systems might not detect individual cases and outbreaks of illness associated with swimming in natural water. Better knowledge of beachgoer characteristics, activities, and health risks associated with swimming in natural water can improve disease surveillance and prioritize limited resources.
authors.affiliation: Centers for Disease Control and Prevention, Mailstop C-09, 1600 Clifton Road, Atlanta, GA 30333, USA E-mail: SCollier@cdc.gov.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Collier
authors.affiliation: United States Environmental Protection Agency, Office of Research and Development, Chapel Hill, NC, USA.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Wade
authors.affiliation: United States Environmental Protection Agency, Office of Research and Development, Chapel Hill, NC, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Sams
authors.affiliation: Centers for Disease Control and Prevention, Mailstop C-09, 1600 Clifton Road, Atlanta, GA 30333, USA E-mail: SCollier@cdc.gov.
authors.forename: Michele C
authors.initials: MC
authors.lastname: Hlavsa
authors.affiliation: United States Environmental Protection Agency, Office of Research and Development, Cincinnati, OH, USA.
authors.forename: Alfred P
authors.initials: AP
authors.lastname: Dufour
authors.affiliation: Centers for Disease Control and Prevention, Mailstop C-09, 1600 Clifton Road, Atlanta, GA 30333, USA E-mail: SCollier@cdc.gov.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Beach
mesh_terms: D001493:Bathing Beaches; D005618:Fresh Water; D006801:Humans; D009792:Oceans and Seas; D013550:Swimming; D014481:United States