Environmental Public Health Program, The University of Wisconsin-Eau Claire, 105 Garfield Avenue, Eau Claire, WI 54702, USA.
Mel and Enid Zuckerman College of Public Health, The University of Arizona, P.O. Box 245163, Tucson, AZ 85724, USA.
Int J Environ Res Public Health. 2018 Nov 1;15(11):2435. doi: 10.3390/ijerph15112435.
Swimming pool water ingestion volumes are necessary for assessing infection risk from swimming. Pool water ingestion volumes can be estimated by questionnaire or measuring a chemical tracer in swimmer urine. Questionnaires are often preferred to the chemical tracer method because surveys are less time consuming, but no research exists validating questionnaires accurately quantify pool water ingestion volumes. The objective of this study was to explore if questionnaires are a reliable tool for collecting pool water ingestion volumes. A questionnaire was issued at four pool sites in Tucson, Arizona to 46 swimmers who also submitted a urine sample for analyzing cyanuric acid, a chemical tracer. Perceived ingestion volumes reported on the questionnaire were compared with pool water ingestion volumes, quantified by analyzing cyanuric acid in swimmer urine. Swimmers were asked if they swallowed (1) no water or only a few drops, (2) one to two mouthfuls, (3) three to five mouthfuls, or (4) six to eight mouthfuls. One mouthful is the equivalent of 27 mL of water. The majority (81%) of swimmers ingested <27 mL of pool water but reported ingesting >27 mL ("one mouthful") on the questionnaire. More than half (52%) of swimmers overestimated their ingestion volume. These findings suggest swimmers are over-estimating pool water ingestion because they perceive one mouthful is <27 mL. The questionnaire did not reliably collect pool water ingestion volumes and should be improved for future exposure assessment studies. Images of the ingestion volume categories should be included on the questionnaire to help swimmers visualize the response options.
游泳池水摄入量是评估游泳感染风险所必需的。游泳池水摄入量可以通过问卷或测量游泳者尿液中的化学示踪剂来估计。由于调查不太耗时，问卷通常比化学示踪剂方法更受欢迎，但目前还没有研究验证问卷是否能准确地量化游泳池水摄入量。本研究的目的是探讨问卷是否是收集游泳池水摄入量的可靠工具。在亚利桑那州图森的四个游泳池现场向 46 名游泳者发放了问卷，并要求他们提交尿液样本以分析氰尿酸（一种化学示踪剂）。问卷中报告的感知摄入量与游泳者尿液中分析氰尿酸定量的游泳池水摄入量进行了比较。游泳者被问到他们是否吞下了（1）没有水或只有几滴，（2）一两口，（3）三到五口，或（4）六到八口。一口相当于 27 毫升的水。大多数（81%）游泳者摄入的游泳池水<27 毫升，但在问卷中报告摄入了>27 毫升（“一口”）。超过一半（52%）的游泳者高估了他们的摄入量。这些发现表明，游泳者高估了游泳池水的摄入量，因为他们认为一口水<27 毫升。问卷不能可靠地收集游泳池水摄入量，应在未来的暴露评估研究中进行改进。问卷上应包括摄入量分类的图像，以帮助游泳者直观地看到应答选项。
