Alcohol and drugs have been identified as key risk factors for youth (aged 15-24 years) and adult drownings in high-income countries (HIC). Whilst alcohol specific drowning prevention education programs have been developed and implemented, youth continue to be over-represented in drowning statistics, including those linked with alcohol. Therefore, this project aimed to: (i) review and assess all alcohol themed drowning prevention campaigns within HICs; (ii) determine whether the campaign had undergone evaluation for effectiveness; and (iii) provide recommendations to improve the effectiveness of future interventions. For each of the eighty-one HICs identified for the 2019 fiscal year, searches of peer-reviewed literature (through academic databases) and grey literature (through webpages and emails to organisations) were conducted. Twelve alcohol focused campaigns were identified, with only two providing limited information about program evaluation. For most campaigns identified, there was a dearth of information available and therefore assessment of campaign quality was unfeasible. This brief report highlights a lack of alcohol themed drowning prevention campaigns in HIC, and an absence of evaluations on their effectiveness. Implications associated with a lack of program evaluation are discussed and adoption of the recommendations from this brief report should enhance the quality of future research in this area.

Issue addressed: Young adults are over-represented in alcohol-related drownings in high-income countries; however, little research has investigated their behaviours and decision-making to inform prevention efforts.Methods: Semi-structured interviews were conducted with 23 young Australian adults (aged 18-24 years). Questions, informed by previous research, inquired about behavioural practices in aquatic contexts and influences on involvement in alcoholinfluenced aquatic activity. Interviews were transcribed verbatim. Thematic and interpretative phenomenological analysis followed.Results: Two main themes: personal and contextual awareness, and the impact of other people affected perceptions and involvement in alcohol-influenced aquatic activity. Perceived control of situations and self-confidence affected how these influences impacted individuals' involvement. Participants acknowledged some young adults likely overestimate their aquatic abilities. This awareness was not discussed in relation to their own capabilities. Conclusion:Drowning prevention efforts should inform young adults of the dangers of combining alcohol and aquatic activities, and make risks appear more immediate and applicable. Consideration should be given to measuring both perceived and actual aquatic abilities within various aquatic environments, to determine whether self-reported perceived competence is an accurate proxy measure for actual aquatic ability. The influence of alcohol should also be highlighted. Steps are required for a positive shift in Australian norms of alcohol use in aquatic settings and the social and cultural attitudes towards this. So what? This study provides new insight into young adults' perceptions and involvement in alcohol-influenced aquatic activity. It enhances the evidence base for drowning prevention and health promotion practitioners and should inform more focused campaigns to prevent alcohol-related drownings among young Australian adults.

Issue addressed: Alcohol-influenced drowning among young Australians (aged 18-24 years) is a prominent health concern. However, effectiveness of targeted prevention campaigns for this age group is unknown, as this information is not typically published in peer-reviewed or easily accessed grey literature. Accordingly, future campaigns cannot build on prior efforts to address this health problem.Methods: Semi-structured interviews ascertained young Australian adults' perspectives on preventing alcohol consumption in aquatic settings, and their awareness of appropriate safety strategies and Australian national and state drowning prevention campaigns. Discussions were transcribed verbatim and thematically analysed using an interpretative phenomenological approach.Results: Twenty-three individuals (mean age 20.65 years) participated in an interview. Participants had poor understanding of alcohol-focused drowning prevention campaigns and used logos and names to decipher key campaign messages. Education was recommended as the preferred method for prevention, and participants suggested preferences for delivery (eg social media, in schools, humour and shock tactics). The safety strategies discussed appeared to be transferred from strategies used in other contexts, rather than related to the specific risks of aquatic scenarios. Conclusions: Drowning prevention practitioners should ensure transparency and clarity of their campaign names and logos to enhance understanding of the messages. Practitioners should also consider using audience analysis during campaign design, delivery and evaluation, alongside best practice recommendations from literature, to enhance campaign suitability and effectiveness.So what? Water safety practitioners and policy makers should acknowledge these findings when developing campaigns which address young adults' lack of awareness of safe aquatic behaviours to encourage a sustained behaviour change.

Globally, alcohol consumption is a public health issue and a risk factor for drownings among young adults. While studies have identified a prominence of alcohol in youth drownings, little is known about the factors that influence young adults’ involvement in alcohol-influenced aquatic activity. The current study aimed to identify the predictors of young adults’ intention to participate, and past participation, in alcohol-influenced aquatic activity. A reliable and valid survey, informed by the Theory of Planned Behavior, was distributed to young adults (aged 18-24 years) educated in the UK and Australia. Cumulative odds ordinal logistic regressions with proportional odds were conducted to establish predictors. Overall, 182 participants completed the survey. Subjective norms (Wald χ2 (2) = 8.43, p = .015), cognitive attitudes (Wald χ2 (2) = 6.40, p = .041) and previous involvement (χ2 (1) = 8.98, p = .003) were significant predictors of intention, whilst the influence of friends (Wald χ2 (2) = 10.99, p = .004) and intention (Wald χ2 (2) = 10.80, p = .005) were significant predictors of behavior. Practitioners should enhance risk awareness and norm perceptions in prevention programs to encourage informed decision making in social aquatic situations.

Attitudes 3 questions containing 19 statements 22 -24 Five-point Likert Scales  Can You Swim Survey (Moran et al., 2012; Petrass et al., 2012)  Alcohol and aquatic activity surveys and research findings (Hamilton & Schmidt, 2014; Sinkinson, 2014)  Survey on young adults' attitudes towards alcohol (Midford et al., 2000) and risky driving (Delcher et al., 2013; Ulleberg & Rundmo, 2003)  Psychometric scale of risk taking (Weber et al., 2002) Knowledge 10 Questions (13 including all UK and Australian versions) -34Multiple-choice