Child environmental exposures to water and sand at the beach: Findings from studies of over 68,000 subjects at 12 beaches


Swimming and recreating in lakes, oceans, and rivers is common, yet the literature suggests children may be at greater risk of illness following such exposures. These effects might be due to differences in immunity or differing behavioral factors such as poorer hygiene, longer exposures to, and greater ingestion of potentially contaminated water and sand. We pooled data from 12 prospective cohorts (n=68,685) to examine exposures to potentially contaminated media such as beach water and sand among children compared with adults, and conducted a simulation using self-reported time spent in the water and volume of water swallowed per minute by age to estimate the total volume of water swallowed per swimming event by age category. Children aged 4–7 and 8–12 years had the highest exposures to water, sand, and algae compared with other age groups. Based on our simulation, we found that children (6–12 years) swallow a median of 36 ml (90th percentile=150 ml), whereas adults aged ≥35 years swallow 9 ml (90th percentile=64 ml) per swimming event, with male children swallowing a greater amount of water compared with females. These estimates may help to reduce uncertainty surrounding routes and durations of recreational exposures and can support the development of chemical and microbial risk assessments.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Figure 1
Figure 2
Figure 3
Figure 4


  1. 1

    Collier SA, Wade TJ, Sams EA, Hlavsa M, Dufour AP, Beach MJ . Swimming in the USA: beachgoer characteristics and health outcomes at US marine and freshwater beaches. J Water Health 2015; 13: 531–543.

    Article  Google Scholar 

  2. 2

    Wade TJ, Calderon RL, Brenner KP, Sams E, Beach M, Haugland R et al. High sensitivity of children to swimming-associated gastrointestinal illness: results using a rapid assay of recreational water quality. Epidemiology 2008; 19: 375–383.

    Article  Google Scholar 

  3. 3

    Nwachuku N, Gerba CP . Health risks of enteric viral infections in children. Rev Environ Contam Toxicol 2006; 186: 1–56.

    PubMed  Google Scholar 

  4. 4

    Arnold BF, Wade TJ, Benjamin-Chung J, Schiff KC, Griffith JF, Dufour AP et al. Acute gastroenteritis and recreational water: highest burden among young US children. Am J Public Health 2016; 106: 1690–1697.

    Article  Google Scholar 

  5. 5

    U.S. EPA. Exposure Factors Handbook 2011 Edition (Final Report). U.S. Environmental Protection Agency, Washington, DC, EPA/600/R-09/052F, 2011..

  6. 6

    U.S. EPA. Exposure Factors Handbook (1997, Final Report). U.S. Environmental Protection Agency, Washington, DC, EPA/600/P-95/002F a-c, 1997..

  7. 7

    Yau VM, Schiff KC, Arnold BF, Griffith JF, Gruber JS, Wright CC et al. Effect of submarine groundwater discharge on bacterial indicators and swimmer health at Avalon Beach, CA, USA. Water Res 2014; 59: 23–36.

    CAS  Article  Google Scholar 

  8. 8

    Schets FM, Schijven JF, de Roda Husman AM . Exposure assessment for swimmers in bathing waters and swimming pools. Water Res 2011; 45: 2392–2400.

    CAS  Article  Google Scholar 

  9. 9

    Suppes LM, Abrell L, Dufour AP, Reynolds KA . Assessment of swimmer behaviors on pool water ingestion. J Water Health 2014; 12: 269–279.

    Article  Google Scholar 

  10. 10

    Wade TJ, Pai N, Eisenberg JNS, Colford JM . Do U.S. Environmental Protection Agency water quality guidelines for recreational waters prevent gastrointestinal illness? A systematic review and meta-analysis. Environ Health Perspect 2003; 111 (8): 1102–1109.

    Article  Google Scholar 

  11. 11

    Alm EW, Burke J, Spain A . Fecal indicator bacteria are abundant in wet sand at freshwater beaches. Water Res 2003; 37: 3978–3982.

    Article  Google Scholar 

  12. 12

    Byappanahalli MN, Whitman RL, Shively DA, Ting WE, Tseng CC, Nevers MB . Seasonal persistence and population characteristics of Escherichia coli and enterococci in deep backshore sand of two freshwater beaches. J Water Health 2006; 4: 313–320.

    Article  Google Scholar 

  13. 13

    Feng F, Goto D, Yan T . Effects of autochthonous microbial community on the die-off of fecal indicators in tropical beach sand. FEMS Microbiol Ecol 2010; 74: 214–225.

    CAS  Article  Google Scholar 

  14. 14

    Zhang Q, He X, Yan T . Differential decay of wastewater bacteria and change of microbial communities in beach sand and seawater microcosms. Environ Sci Technol 2015; 49: 8531–8540.

    CAS  Article  Google Scholar 

  15. 15

    Heaney CD, Sams E, Dufour AP, Brenner KP, Haugland RA, Chern E et al. Fecal indicators in sand, sand contact, and risk of enteric illness among beachgoers. Epidemiology 2012; 23: 95.

    Article  Google Scholar 

  16. 16

    Nevers MB, Byappanahalli MN, Edge TA, Whitman RL . Beach science in the Great Lakes. J Great Lakes Res 2014; 40: 1–14.

    Article  Google Scholar 

  17. 17

    Byappanahalli MN, Shively DA, Nevers MB, Sadowsky MJ, Whitman RL . Growth and survival of Escherichia coli and enterococci populations in the macro-alga Cladophora (Chlorophyta). FEMS Microbiol Ecol 2003; 46: 203–211.

    CAS  Article  Google Scholar 

  18. 18

    Byappanahalli MN, Sawdey R, Ishii S, Shively DA, Ferguson JA, Whitman RL et al. Seasonal stability of Cladophora-associated Salmonella in Lake Michigan watersheds. Water Res 2009; 43: 806–814.

    CAS  Article  Google Scholar 

  19. 19

    Byappanahalli MN, Whitman RL, Shively DA, Ferguson J, Ishii S, Sadowsky MJ . Population structure of Cladophora-borne Escherichia coli in nearshore water of Lake Michigan. Water Res 2007; 41: 3649–3654.

    CAS  Article  Google Scholar 

  20. 20

    Schoen ME, Ashbolt NJ . Assessing pathogen risk to swimmers at non-sewage impacted recreational beaches. Environ Sci Technol 2010; 44: 2286–2291.

    CAS  Article  Google Scholar 

  21. 21

    Soller JA, Eftim S, Wade TJ, Ichida AM, Clancy JL, Johnson T et al. Use of quantitative microbial risk assessment to improve interpretation of a recreational water epidemiological study. Microbial Risk Anal 2016; 1: 2–11.

    Article  Google Scholar 

  22. 22

    Haas CN, Rose JB, Gerba CP . Quantitative Microbial Risk Assessment. John Wiley & Sons. 1999.

    Google Scholar 

  23. 23

    Ashbolt N, Reidy C, Haas C (eds). Microbial health risk at Sydney’s coastal bathing beaches. Proceedings of the 17th Australian Water and Wastewater Association Meeting, Melbourne, 1997.

  24. 24

    Craig D, Fallowfield H, Cromar N . Effectiveness of guideline faecal indicator organism values in estimation of exposure risk at recreational coastal sites. Water Sci Technol 2003; 47: 191–198.

    CAS  Article  Google Scholar 

  25. 25

    Tseng LY, Jiang SC . Comparison of recreational health risks associated with surfing and swimming in dry weather and post-storm conditions at Southern California beaches using quantitative microbial risk assessment (QMRA). Mar Pollut Bull 2012; 64 (5): 912–918.

    CAS  Article  Google Scholar 

  26. 26

    Evans O, Wymer L, Behymer T, Dufour A . An Observational Study: Determination of the Volume of Water Ingested During Recreational Swimming Activities National Beaches Conference: Niagra Falls, NY. 2006.

  27. 27

    U.S. EPA. Child-Specific Exposure Factors Handbook (2008, Final Report). U.S. Environmental Protection Agency, Washington, DC, EPA/600/R-06/096F, 2008..

  28. 29

    Colford JM, Schiff KC, Griffith JF, Yau V, Arnold BF, Wright CC et al. Using rapid indicators for Enterococcus to assess the risk of illness after exposure to urban runoff contaminated marine water. Water Res 2012; 46: 2176–2186.

    CAS  Article  Google Scholar 

  29. 30

    Colford JM, Wade TJ, Schiff KC, Wright CC, Griffith JF, Sandhu SK et al. Water quality indicators and the risk of illness at beaches with nonpoint sources of fecal contamination. Epidemiology 2007; 18: 27–35.

    Article  Google Scholar 

  30. 31

    Wade TJ, Calderon RL, Sams E, Beach M, Brenner KP, Williams AH et al. Rapidly measured indicators of recreational water quality are predictive of swimming-associated gastrointestinal illness. Environ Health Perspect 2006; 114: 24–28.

    Article  Google Scholar 

  31. 32

    Wade TJ, Sams E, Brenner KP, Haugland R, Chern E, Beach M et al. Rapidly measured indicators of recreational water quality and swimming-associated illness at marine beaches: a prospective cohort study. Environ Health 2010; 9: 66.

    Article  Google Scholar 

  32. 33

    Wade TJ, Sams E, Haugland R, Brenner KP, Li Q, Wymer L et al. Report on 2009 National Epidemiologic and Environmental Assessment of Recreational Water Epidemiology Studies. U.S. Environmental Protection Agency: Washington DC, EPA/600/R-10/168, 2010..

  33. 28

    Arnold BF, Schiff KC, Griffith JF, Gruber JS, Yau V, Wright CC et al. Swimmer illness associated with marine water exposure and water quality indicators: Impact of widely used assumptions. Epidemiology 2013; 24: 845–853.

    Article  Google Scholar 

  34. 34

    Dufour A, Behymer T, Cantu R, Magnuson M, Wymer L . Ingestion of swimming pool water by recreational swimmers. J Water Health 2017; 15: 429–437.

    CAS  Article  Google Scholar 

  35. 35

    Kim SI, Kang JH, Lee DI, Jo JR, Kim HJ, Lee JB et al. Measurement of volume of a swallow for liquid swallowing in healthy young adults. J Korean Soc Clin Toxicol 2013; 11: 114–118.

    Google Scholar 

  36. 36

    Langille R, Wigmore J . The mouth alcohol effect after a “mouthful” of beer under social conditions. Can Soc For Sci J 2000; 33: 193–198.

    Google Scholar 

  37. 37

    Nilsson H, Ekberg O, Olsson R, Kjellin O, Hindfelt B . Quantitative assessment of swallowing in healthy adults. Dysphagia 1996; 11: 110–116.

    CAS  Article  Google Scholar 

  38. 38

    US EPA Human Health Recreational Ambient Water Quality Criteforia or Swimming Adviseries for Microcystins and Cylindrospermopsin, In: Office of Water (ed). U.S. Environmental Protection Agency. 2016.

  39. 39

    StataCorp Stata Statistical Software: Release 13. StataCorp LP: College Station, TX. 2013.

  40. 40

    R Core Team R: A Language and Environment for Statistical Computing. R Foundation for Statstical Computing: Vienna, Austria. 2014.

  41. 41

    Schijven J, de Roda Husman AM . A survey of diving behavior and accidental water ingestion among Dutch occupational and sport divers to assess the risk of infection with waterborne pathogenic microorganisms. Environ Health Perspect 2006, 712–717.

    Article  Google Scholar 

  42. 42

    Sne DL, Harding AK, Hope BK, Slaughter-Mason S . Exposure assessment and risk of gastrointestinal illness among surfers. J Toxicol Environ Health A 2008; 71 (24): 1603–1615.

    Article  Google Scholar 

  43. 43

    WHO Guidelines for Safe Recreational Water Environments. Volume 1, Coastal and Fresh Waters. World Health Organization: Geneva. 2003.

Download references


This study was funded in part by the National Institutes of Health (NIH; grant R03-HD076066) The research described in this article has been reviewed by the National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, and approved for publication. Approval does not signify that the contents necessarily reflect the views and policies of the Agency, nor does the mention of trade names of commercial products constitute endorsement or recommendation for use.

Author information



Corresponding author

Correspondence to Stephanie DeFlorio-Barker.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Supplementary Information accompanies the paper on the Journal of Exposure Science and Environmental Epidemiology website

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

DeFlorio-Barker, S., Arnold, B., Sams, E. et al. Child environmental exposures to water and sand at the beach: Findings from studies of over 68,000 subjects at 12 beaches. J Expo Sci Environ Epidemiol 28, 93–100 (2018).

Download citation


  • algae exposure
  • children
  • QMRA
  • recreational water
  • sand exposure

Further reading


Quick links