Statement of purpose Drowning is the leading cause of unintentional injury-related death for toddlers within the U.S. Caregiver supervision is an important layer of protection against drowning, yet supervision is often inadequate. The aim of this study is to understand factors associated with self-reported caregiver supervision behavior at the pool when confronted with distractions.

Methods/Approach A survey was conducted using the online Amazon MTurk platform. Participants were over 18 years old and were the caregiver for a 1–4 year old. The survey asked about demographics and background, assessed drowning knowledge, and rated agreement with statements about arm’s reach supervision and distraction-related supervision behavior. Data were analyzed for 650 U.S. residents using a multivariate linear regression to identify predictors of distraction-related pool supervision behavior scores.

Results Caregivers with more drowning knowledge (p<0.001) and who showed the highest agreement with arm’s reach supervision (p<0.001) were more likely to report attentive supervision behavior. Caregivers who reported always using a flotation device for their toddler reported more attentive supervision (p=0.004). Although toddler age was not a predictor, caregivers who reported fewer swim skills for their toddler reported more attentive supervision (p<0.001). Additional characteristics related to inattentive supervision were lower income (p=0.032), having received water safety advice from a pediatrician (p=0.0001), and having reported an impairment that could limit their ability to supervise a toddler (p=0.006). Caregivers with home pools were less likely to report attentive supervision (p=0.019).

Conclusions This study offers information about factors that impact caregiver supervision behavior. The results support the usefulness of drowning education initiatives.

Significance This study highlights how water safety knowledge and perceptions are drivers of supervision behavior and subsequent drowning risk.