Health promotion and the social gradient: The free swimming initiative for children and young people in Bristol

SummaryObjectivesTo examine whether the free swimming initiative in Bristol was associated with higher uptake in more affluent areas (‘inverse use law’).Study designSecondary analysis of statistical data on free swimming session attendances in Bristol, recorded from January to June 2010. Individual postcode data were linked to lower-layer super output area (LSOA) of residence and the specific pool attended.MethodsThe dataset comprised 58,582 swims by 13,881 unique individuals between January and June 2010. The influence of age group, gender, season, distance from pool and area deprivation score (English Index of Multiple Deprivation) on swimming uptake rates was examined.ResultsHigher uptake rates were found amongst girls and older children. Higher attendance was also related to proximity to pool and warmer season. No association was found between area deprivation and uptake rate (P = 0.31). Lower uptake rates in deprived areas were more marked if they were further away from a pool and in the winter season (P-value for interactions <0.001).ConclusionsThe termination of the free swimming initiative in England may have removed an opportunity to promote physical activity across the social gradient. The evaluation of public health initiatives should examine effects across the social gradient, and clarify which aspects of interventions enhance the participation of poorer sections of society.