Author ORCID Identifier

Jason W. Marion ORCID iD icon


Environmental Health Science

Document Type


Publication Date



The growth in the number of pools to more than 7.4 million in the U.S. has been accompanied by a rise in recreational water illnesses (RWIs). Effective pool management, though, can mitigate RWI risks. Inadequate management presumably occurs more frequently where training is less formalized and/or pool operation is a minor aspect of the job of the responsible pool manager(s). During summer 2018, weekly evaluations were performed at public venues in Louisville, Kentucky. Disinfectant levels and other items were monitored and compared with venue-specific (pool or spa) criteria. Among 1,312 venue surveys, 1,173 (89.4%) met criteria and 139 (10.6%) did not meet criteria. Overall, multivariable logistic regression showed a significant association between the likelihood of a venue meeting criteria and setting type. Specifically, hotels had 120% increased odds of not meeting criteria (adjusted odds ratio = 2.2; 95% confidence interval [1.3, 3.8]) compared with other settings. Despite spas having an 80% elevated odds of not meeting criteria compared with pools in a univariate analysis, upon adjusting for setting, spas were not associated with an increased risk of not meeting criteria. Research identifying reasons for these differences in meeting criteria between settings would be beneficial for informing public health interventions for aquatic environments.

Journal Title

Journal of Environmental Health