Minnesota Residents' Knowledge, Attitudes, and Practices Regarding Recreational Water Illnesses

BACKGROUND: The number of recreational water-associated outbreaks has been increasing in the US, with 70% of recreational water-associated outbreaks reported during 2009-2010 occurring in treated venues. Opportunities for recreational water exposure are numerous in Minnesota, but little is known about how aware residents are of the health risks associated with this activity. An understanding of Minnesotans’ knowledge, attitudes, and practices regarding recreational water illnesses can help guide development of new waterborne illness prevention messages for the public.

METHODS: Minnesotans ≥18 years of age were randomly recruited from a list of landline phone numbers stratified by eight health districts. A telephone survey was administered to all consenting individuals. Topics covered in the survey included swimming practices at treated (e.g., pools) and untreated (e.g., lakes) water venues in 2013, knowledge of recreational water illnesses, and demographic information. Chi-square tests were used to compare frequencies across categories using SAS 9.4.

RESULTS: Four hundred individuals were interviewed, with a participation rate of 39%. Swimming at treated and untreated recreational water venues in 2013 was reported by 38% and 31.5% of adults, respectively. Almost all participants (94%) were aware you could become ill from swimming. However, some participants reported not knowing what types of illnesses were possible; this was more commonly reported when asked about illnesses associated with treated venues (22% vs. 11%, p<0.001). For both venue types, knowledge of gastrointestinal illness was most commonly reported (57%, treated venues; 64%, untreated venues), followed by skin infections, which were more frequently reported to be associated with untreated venues (47% vs. 36%, p=0.002). Less than 10% of respondents reported knowing about other types of waterborne illness. Participants were more likely to report always showering when at treated venues, both before swimming (32% vs. 2%, p<0.001) and after swimming (63% vs. 34%, p<0.001). There were no significant differences in the frequency of participants who reported they never put their head underwater or swallowed water while swimming at treated and untreated venues.

CONCLUSIONS: While many participants were aware you can get sick from swimming, their knowledge of the range of possible illnesses was limited. Participants were less sure about the types of illnesses associated with treated venues, despite the majority of recreational water-associated outbreaks occurring in those facilities. Future outreach efforts should focus on the specific types of recreational water illness possible and methods to prevent them, particularly those associated with treated venues.