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Lexi Benner

Drowning is the leading cause of death among children ages 1-4 in the United States, with Arizona experiencing drowning rates twice the national average. While most of Arizona’s population resides within the Phoenix metropolitan area, much of the state consists of rural communities where access to water safety education and drowning prevention resources is limited. These geographic and resource disparities highlight the need for targeted water safety interventions aimed at families living in underserved rural regions.

The Dive into Water Safety program was developed to expand access to drowning prevention education for families in rural Arizona through partnerships with local home visitors and parent educators. These professionals routinely provide guidance on child development and injury prevention, positioning them to effectively deliver water safety education within their communities.

The program was launched across multiple rural Arizona counties in June 2025. Participating sites that had previously completed water safety training were selected to receive additional instruction on program implementation and education delivery. Site enrollment continued throughout early 2026 to further expand the program’s reach across the state, with data collected from July 1, 2025, through April 30, 2026.

A brief educational video and resource materials were provided to teach families strategies for keeping children safe in and around water. Educational messaging, informed by contributing risk factors identified through the Arizona Child Fatality Review Report, emphasized active adult supervision, and layered protection strategies. Following participation, families received preventive safety items, including vest-style life jackets, door alarms, and educational handouts, to reinforce key water safety practices.

Data were collected using pre- and post-surveys administered by staff before and after participants viewed the educational video. Frequencies were analyzed to evaluate survey results. Survey measures included demographics, caregiver confidence in swimming in 6-foot-deep water, supervision practices, and life jacket use.

Through targeted outreach efforts, sites in twelve out of the fifteen Arizona counties enrolled in the program. Within the first year of implementation, 229 caregivers participated in the educational program, resulting in 200 complete data sets and the distribution of 332 life jackets.

Among the 200 complete data sets, 122 caregivers (61%) reported awareness of their child’s drowning risk and the importance of water safety practices. Reported life jacket use increased by 49% from pre- to post-surveys. Additionally, 99.5% of participants reported that they would maintain the same level of supervision while their child wore a life jacket, reinforcing the importance of active supervision alongside water safety practices.

Results demonstrated increased caregiver knowledge and confidence regarding water safety practices following participation. The educational intervention positively influenced caregiver beliefs related to supervision, life jacket use, and strategies to reduce drowning risk among young children.

Participant feedback indicated favorable reception of the educational materials and resources provided. Overall, the program demonstrated the feasibility and impact of expanding evidence-based drowning prevention education and resources to rural communities across Arizona.

1. Examine the importance and statewide need for water safety education across Arizona.
2. Describe the implementation of a community-based drowning prevention education program in rural communities.
3. Highlight a partnership model involving home visitors and parent educators to deliver and expand evidence-based drowning prevention education.

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Kristen Volz-Spessard, MS
Meghan Fish, MS
Nicholas Marinelli, MPA
Cara During, BA
Isabella Baldino, BS
Rebecca Beebe, PhD
Kevin Borrup, DrPH, JD, MPA
Steven C. Rogers, MD, MS

Suicide is the second leading cause of death among college-aged young adults with certain racial and ethnic groups experiencing higher rates. Between 2018 to 2021, the age-adjusted suicide rate among Non-Hispanic Black or African American individuals increased by 19.2%. Black youth and young adults between 10- to 24-years-old experienced a 36.6% increase overall in suicide rates – the fastest growing rate among racial groups. These trends highlight the urgent need for suicide prevention efforts tailored to this high-risk population. Fresh Check Day (FCD) is a peer-driven mental health promotion and suicide prevention program designed for college students. The program aims to reduce stigma, increase awareness of available mental health resources, and encourage help-seeking behavior through interactive booths, campus-wide collaboration, and student engagement. Historically Black Colleges and Universities (HBCUs) enroll a student body that is predominantly Black, therefore enabling FCD to effectively evaluate its impact on mental health and suicide prevention within this at-risk population. This analysis determines if post-survey key metrics differ significantly between students attending HBCUs and non-HBCUs.

Between January 2014 and May 2025, 1,517 FCDs occurred at colleges across 46 states, including 7 HBCU campuses. Following each FCD event, anonymous post-event surveys were administered to assess student perceptions, knowledge gains, and changes in attitudes toward mental health. Chi square tests for independence were conducted to examine differences between HBCU status and binary post–FCD outcomes, including awareness of suicide warning signs, preparedness to help a friend, awareness of mental health resources, likelihood of seeking help, and comfort talking about mental health and suicide.

Since 2017, 109,526 students completed the post-event survey, of which 894 students attended a HBCU. Among students attending an HBCU, 90% reported feeling more prepared to help a friend exhibiting warning signs of suicide; 90% were more aware of mental health resources available to them; 89% were more likely to ask for help if experiencing emotional distress themselves; 88% felt more comfortable talking about mental health and suicide and 85% more aware of the warning signs of suicide. Chi-square tests of independence indicated significant associations, with small effect sizes, between HBCU status and awareness of warning signs, ?²(1, N = 109,526) = 16.18, p < .001, ? = .012; preparedness to help, ?²(1, N = 109,526) = 31.97, p < .001, ? = .017; awareness of resources, ?²(1, N = 109,526) = 8.79, p = .003, ? = .009; likelihood of asking for help, ?²(1, N = 109,526) = 24.48, p < .001, ? = .015; and comfort talking about mental health and suicide, ?²(1, N = 109,526) = 20.96, p < .001, ? = .014.

Students from HBCUs demonstrated significantly higher awareness and preparedness FCD outcomes compared to students from non-HBCUs, although effect sizes suggested limited practical differences between groups. Implementing FCD on HBCU campuses may prevent suicide deaths.

1) Understand the importance of effective suicide prevention programs for HBCU campuses
2) Describe FCD HBCU students’ reported perceptions, knowledge gains, and changes in attitudes toward mental health
3) Illustrate comparisons across HBCU vs non-HBCUs in responses to key metrics

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Ben Hoffman, M.D., CPST-I, FAAP
Adrienne Gallardo, MA, CPST-I
Larisa Nefedov, MA, CPST-I
Michelle Nichols, CPST-I, STAC-I

Children and youth with special health care needs may require specialized accommodations to be safely transported in motor vehicles. Certified Child Passenger Safety Technicians (CPST) with additional training in adaptive needs transportation are best qualified to perform these assessments, in collaboration with families and medical professionals. Access to high-quality assessment to ensure safe transportation for children and youth with special health needs is limited by a number of factors: 1. Geography: Most Oregon communities lack access CPSTs with adaptive needs training. While there are statewide systems-level solutions for referral to pediatric specialty care, Oregon lacks a centralized approach for adaptive transportation assessment. 2. DME Regulation: Adaptive needs seats/vests are regulated by NHTSA, not the FDA. In practice, adaptive needs car seats fall into a gray zone between DME and “adaptive equipment,” and coverage depends on whether a given payer’s written policy chooses to include them under DME benefits. 3. Conflict of Interest: Adaptive needs seats/vests are sold/distributed by for-profit DME companies, raising concerns of bias from Medicaid payers. 4. Billing: CPSTs with adaptive needs training have not heretofore been able to bill Medicaid for assessment. This precludes a path to revenue generation and sustainability.

The Doernbecher Injury Prevention Program in Portland, OR, conducted a landscape analysis to identify access barriers to high-quality adaptive-need transportation services (Figure 1). Based on the findings, we identified structural and policy solutions, with a focus on state administrative rules, using the AAP CPTI Project Planning Tool. We then began building relationships with state governmental leaders and key staff to collaboratively address regulatory change.

Through collaboration with the Oregon Department of Transportation, we established a statewide referral system for adaptive needs transportation, including hiring a full-time CPST to perform the assessments.

We then worked with staff from Oregon Medicaid to revise state regulations to address the following: 1. Classification of NHTSA-certified adaptive needs seats/vests as DME 2. Establishing CPSTs with supplemental training in Adaptive Needs Transportation as Medicaid billing providers a. Established acceptable billing codes b. Established standards for CPST billing under a licensed independent provider who is also a CPST-I

The relevant regulations are shown in Figure 2.

Through collaboration with state Medicaid leaders and staff, Oregon became the first state to : 1. Explicitly identify adaptive needs car seats/vests as DME. 2. Establish CPSTs with adaptive needs expertise as Medicaid billing providers.

1. Discuss barriers to high-quality adaptive needs transportation assessment and resources.
2. Describe regulatory approaches to improving access to adaptive needs transportation services and supports.
3. Explain how CPSTs with adaptive needs training can bill Medicaid for services provided.

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Rohit Shenoi, MD
Laura Miranda
Shaheni Mendis
Shabana Yusuf, MD., MEd
Ned Levine, PhD

The US Water Safety Action Plan recommends evidence-informed action and evaluation, equity, intersectoral collaboration and local action when developing drowning countermeasures. Unfortunately, there are no community level drowning prevention programs existing in metropolitan Houston. We describe the efforts of the Community Advisory Group (CAG) for Water Safety to address drowning in Harris County, Texas.

In 2023-24, results from a fatal drowning data linkage project identified high-risk populations, locations, and circumstances, including events involving children with autism. Drowning in autistic children involved a predominance of pool-related incidents, lack of swimming ability, and frequent absence of secure barriers. Harris County has about 115,000 swimming pools, a major river, a major lake, two large reservoirs and many flood control structures such as bayous, creeks, canals, and ponds. In 2024, the population of Harris County was 5 million; 25% were children. The county comprised Non-Hispanic Whites (33%), African-Americans (19%), and Asians (8%). Hispanic persons were 45% of the population. A Community Advisory Group (CAG) on Water Safety in Harris County was formed in 2023 to foster safe aquatic environments in the county. The stakeholders include clinicians, community advocates, caregivers, and public health, aquatic, and injury?prevention specialists. Meetings occur virtually every month. Meeting minutes were utilized to obtain information on ongoing projects. The CAG is unfunded, but stakeholders provide in-kind resources. Undergraduate students perform project work as part of their practicum. Selected community outcome measures (Community Organization, Information, and Environmental Conditions) from the Washington State Drowning Prevention Project were utilized to develop, implement, and evaluate the project.

Based on local drowning epidemiology, the CAG focused on preparing and disseminating water safety resources to families with autistic children and sharing information about high-risk drowning locations and sub-populations with local and state departments. The CAG prepared adaptive aquatics resources, identified local sites that offer swimming and adaptive aquatics, partnered with the Texas Center for Missing Children to compile elopement prevention resources, and provided stakeholder input on drowning prevention interventions, including those relevant to autistic children. Information on high-risk drowning locations and at-risk risk groups were shared with the county water safety department, regional trauma center coordinators, county fatality review board, the local regional planning organization, Texas Water Safety Coalition, and the State Epidemiology unit in order to stimulate local drowning countermeasures. The challenges faced by the CAG include member motivation, scarce financial resources, and the absence of a governing structure. For sustainability, the CAG utilizes a core group of stakeholders to complete tasks and provides drowning resources, epidemiology, and meeting minutes to stakeholders. Future directions include strengthening current projects and pursuing a state fencing law using locally derived data.

A local drowning prevention coalition can positively impact water safety in high-risk population groups

1) Integrate local epidemiology and risk factors to craft a community-based drowning prevention program.
2) Utilize data-driven methods to evaluate community-based drowning countermeasures.
3) Understand the challenges and strengths of a community-facing drowning prevention coalition.