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Water recreation and illness severity.

Stephanie DeFlorio-Barker1, Timothy J Wade2, Mary Turyk3

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Prior studies on water recreation health focused on gastrointestinal (GI) illness. This study shows that measuring symptom severity, not just occurrence, better reflects illness burden and links it to water exposure.

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Area of Science:

  • Environmental health
  • Epidemiology
  • Public health

Background:

  • Gastrointestinal (GI) illness is a common health outcome associated with water recreation.
  • Previous studies have primarily used a dichotomous measure (presence or absence of GI illness).
  • This approach overlooks symptom severity and individuals with symptoms not meeting the strict illness definition.

Purpose of the Study:

  • To assess the utility of ordinal and semi-continuous measures for gastrointestinal symptoms in water recreation studies.
  • To evaluate the association between symptom severity and water exposure or quality.
  • To improve understanding of the health burden related to environmental exposures from water recreation.

Main Methods:

  • Utilized data from two US cohort studies involving 37,404 water recreators.
  • Employed zero-inflated negative binomial and logistic regression models.
  • Assessed symptom duration, medication use, daily activity interference, and healthcare utilization as severity metrics.

Main Results:

  • Observed individuals with high symptom severity who did not meet the case definition of GI illness.
  • Found associations between symptom severity metrics and degree of water exposure.
  • Demonstrated that severity metrics captured nuances missed by a simple dichotomous outcome.

Conclusions:

  • Considering symptom severity in addition to illness occurrence provides a more comprehensive understanding of health outcomes.
  • Ordinal and semi-continuous symptom measures offer improved insights into the burden of illness compared to dichotomous outcomes.
  • Future environmental health studies should incorporate detailed symptom severity assessments.