Objective To understand the levels of awareness of drowning and high-risk behaviors of rural left- behind and non-left-behind children in Shufu county, Xinjiang Uygur Autonomous Region, and provide scientific evidence for the intervention of drowning prevention for rural children.

Methods By random cluster sampling, 2 townships in Shufu were randomly selected in December 2021 to conduct a questionnaire survey in students from grade 1 to grade 8 in all primary and middle schools. Non-conditional logistic regression analysis and χ² test were used to analyze the risk factors associated with drowning.

Results A total of 14 543 primary and middle school students were surveyed, and 14 543 questionnaires were distributed, all the questionnaires were returned. The incidence of high-risk behaviors associated with drowning was higher in left-behind children than in non-left-behind children (χ²=8.00, P <0.05). The proportion of introvert children in left-behind children was higher than that in non-left-behind children (χ²=100.250, P <0.001), and the left-behind children usually got along poorly with parents (χ²=24.420, P<0.001) and classmates (χ²=35.420, P<0.001) compared with non-left-behind children. Open waters near school odds ratio(OR)=1.218, 95% confidence interval (CI): 1.088–1.364, with open waters near home (OR=1.893, 95%CI: 1.704–2.102), being introvert, strong curiosity (OR=1.187, 95%CI: 1.048–1.345), getting along poorly with classmate (OR=2.596, 95%CI: 2.142–3.146), poor relationship with family (OR=1.913, 95%CI: 1.575– 2.323), higher swimming level (P＜0.001) were risk factors for the high-risk behaviors associated with drowning.

Conclusion It is necessary to strengthen the health education about drowning prevention and drowning rescue training in primary and middle schools in Shufu, and give full play to the role of school education about drowning prevention and supervision of guardian, in particular, pay close attention to the mental health of left-behind children and anti-drowning monitoring.