Conclusion The strength of our study is that our meth- odology could be used by other jurisdictions that have not adopted MAHC criteria yet. If used across jurisdictions, our approach can ensure consistency in swimming pool safety grading. Future directions include evaluating if safety issues with swimming pools persist in subsequent years, investigating prevailing socioeconomic and health disparities in areas with a high concentration of pools that fail safety inspections, and developing an online platform that is available to the public that could host a map of swimming pools by safety grade. Overall, the MAHC can be applied to grade swimming pool safety in jurisdictions where it has not yet been adopted. The degree of safety violations can be spatially demon- strated (e.g., mapped) to inform injury-pre- vention measures. Acknowledgements: We gratefully acknowl- edge Kenneth Malveaux and Naomi Macias of the Commercial/Residential Pool Program within the Houston Health Department for providing us with pool inspection data and their insight on swimming pool inspections. We also acknowledge Ryan Ramphul for his help with geographical mapping of the swim- ming pools. Corresponding Author: Rohit P. Shenoi, Divi- sion of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, 6621 Fannin Street, Suite A2210, Houston, TX 77030. Email: rshenoi@bcm.edu.
FIGURE 2
Location of Swimming Pools in the City of Houston That Received F Grades
Note. Shaded area indicates the City of Houston.
aquatic bodies and permitting agencies. For example, we did not study pool violations in single-family homes, as they are not sub- ject to annual safety inspections. Second, we included only 1 year of data. It would, however, be preferable to include additional years of data to assess safety trends. Third, some swimming pools that failed safety inspection might have corrected their defi- ciencies after the routine inspection. Thus,
we were unable to determine if the safety deficiency was long-standing. It is highly likely, however, that the safety concerns were addressed in a timely manner because the property managers would want to open the aquatic facility to their clients at the earliest possible point. Finally, we can- not comment on aboveground or portable swimming pools, as they are not subject to safety inspections.
References
Allen, E.M., Hill, A.L., Tranter, E., & Sheehan, K.M. (2013). Play- ground safety and quality in Chicago. Pediatrics , 131 (2), 233–241. https://doi.org/10.1542/peds.2012-0643 Centers for Disease Control and Prevention. (2010). Violations identified from routine swimming pool inspections—Selected states and counties, United States, 2008. Morbidity and Mortality Weekly Report , 59 (19), 582–587. Centers for Disease Control and Prevention. (2018a). Model Aquatic Health Code facility inspection report (CS300555-A). https://www. cdc.gov/mahc/pdf/MAHC-Form-2019-508c.pdf Centers for Disease Control and Prevention. (2018b). 2018 Model Aquatic Health Code: Code language (3rd ed., CS288986-A). https://www.cdc.gov/mahc/pdf/2018-MAHC-Code-Clean-508.pdf
Centers for Disease Control and Prevention. (2023a). The Model Aquatic Health Code (MAHC): An all-inclusive model public swim- ming pool and spa code . https://www.cdc.gov/mahc/index.html Centers for Disease Control and Prevention. (2023b). The Model Aquatic Health Code (MAHC): An all-inclusive model public swim- ming pool and spa code—MAHC tools and training . https://www. cdc.gov/mahc/networks-tools-forms.html City of Houston. (2023). Code of Ordinances: Chapter 43—Pool and spa safety . https://library.municode.com/tx/houston/codes/ code_of_ordinances?nodeId=COOR_CH43POSPSA City of Houston Planning & Development Department. (2016a). 2016 median household income . https://www.houstontx.gov/plan ning/Demographics/docs_pdfs/2016acsd/Median-HHI.pdf
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July/August 2023 • Journal of Environmental Health
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