Researchers analyzed U.S. Centers for Disease Control and Prevention data to focus on the 20 states with the highest rates and the 10 states with the lowest rates of drowning deaths among people over age 5. Open water areas are where most drownings occur among Americans over age 5.

In terms of regulations for open water swimming sites, the researchers looked at five that have been identified as critical: water quality monitoring; availability of rescue and safety equipment; presence of lifeguards; signage; and the infrastructure for surveillance and planning.

Between 2012 and 2017, nearly 11,000 people drowned at open water swimming sites in the 30 states included in the study. The highest drowning rates were in Hawaii, Alaska, Idaho and Wyoming, while the lowest rates were in Rhode Island, New York and Delaware.

Only 12 (40%) of the states in the study had any regulations for open water swim sites, and only four — Illinois, New York, West Virginia and New Jersey — had four to five regulations.

The lowest drowning rates were in states with more regulations and the highest drowning rates were in states with the fewest regulations, the findings showed.

Regulations were also associated with lower drowning rates in two groups particularly at risk: nonwhites, and children/teens up to the age of 17.

Compared with states with all five policy area regulations in place, drowning rates were three times higher among children and teens and more than four times higher among nonwhites in states with no regulations, the investigators found.

Signage and water quality were not associated with lower drowning rates, the study authors said, but surveillance and planning were associated with a 45% reduction in drowning rates, and the presence of lifeguards was associated with a 33% lower drowning rate.

The study was published online Jan. 7 in the journal Injury Prevention.

Read U.S. News