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Int. J. Environ. Res. Public Health 2018, 15(11), 2435;

Validation of Questionnaire Methods to Quantify Recreational Water Ingestion

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
Department of Soil, Water & Environmental Science, The University of Arizona, Gould-Simpson Building Room 611, 1040 East 4th Street, Tucson, AZ 85721, USA
Author to whom correspondence should be addressed.
Received: 8 September 2018 / Revised: 14 October 2018 / Accepted: 19 October 2018 / Published: 1 November 2018
(This article belongs to the Special Issue Recreational Water Illnesses)
PDF [638 KB, uploaded 1 November 2018]


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. View Full-Text
Keywords: pool water ingestion; recreational water; swimming pool; risk assessment pool water ingestion; recreational water; swimming pool; risk assessment

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Suppes, L.M.; Ernst, K.C.; Abrell, L.; Reynolds, K.A. Validation of Questionnaire Methods to Quantify Recreational Water Ingestion. Int. J. Environ. Res. Public Health 2018, 15, 2435.

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