**1. Introduction**

Drowning is the third leading cause of injury death among adolescents 15 to 19 years in the United States (U.S.) [1]. From 2014 to 2018, the U.S. drowning death rate of adolescents ages 15 to 19 (1.1 per 100,000) was twice that of those ages 10 to 14 (0.5 per 100,000) [1]. Males were 5.3 times more likely to drown than females and Black or African American youth were 2.6 times more likely to drown compared to White or Caucasian youth [1]. In Washington State during this time period, the drowning death rate among those 15 to 19 (1.5) eclipsed other pediatric age groups [1]. Drownings in this age group in Washington State primarily involve swimming, playing, and boating in open water, like lakes or rivers [2].

High drowning rates among teens may be explained by their developmental stage. Adolescents are susceptible to peer pressure and engagemen<sup>t</sup> in risk-taking behaviors with a greater focus on rewards rather than costs and consequences [3]. In surveys and focus groups, adolescents have reported behaviors that put them at greater risk for drowning [4,5]. Risk factors such as neighborhood disorder may contribute to youth engaging in risk behaviors [6]. Fortunately, family and peer protective factors have proved e ffective in reducing risk behaviors like alcohol consumption at an early age [4]. It's unclear whether these behaviors are associated with other risk behaviors. Moreover, no studies have evaluated protective factors among adolescents with regards to drowning risk. To examine the risk and protective factors and risk-taking behaviors for drowning amongs<sup>t</sup> Washington State adolescents, we evaluated self-reported risk and protective factors and risk-taking behaviors among adolescents taking the Washington Healthy Youth Survey (HYS). The HYS is an adapted version of the U.S. nationally administered Youth Risk Behavior Surveillance System (YRBSS), which is administered by the Centers for Disease Control and Prevention (CDC). Both the YRBSS and HYS include six categories of health-related behaviors that contribute to the leading causes of death and disability among youth and adults [7]:


We conducted a preliminary study to examine risk and protective associations between risk and protective factors and risk-taking behaviors with life jacket wear and formal swimming lesson participation amongs<sup>t</sup> Washington State adolescents. Our goal was to use the HYS to better understand drowning risk and protection in the context of other adolescent risk-taking behaviors. Understanding those relationships could better identify which drowning factors might be associated with other general risk-taking and protective factors and better inform water safety promotion and drowning prevention interventions. Our objective was primarily to estimate the proportion of Washington youths who have had formal swimming lessons, wore life jackets (also known as personal flotation devices or PFDs) while boating and were comfortable in water over their head and characterize them. Additionally, we sought to evaluate risk-taking and protective factors around adolescents' wearing life jacket and having had swimming lessons.

### **2. Materials and Methods**
