Gender differences in injuries among rural youth

Punitive school discipline as a mechanism of structural marginalization with implications for health inequity: A systematic review of quantitative studies in the health and social sciences literature

Punitive school discipline deploys surveillance, exclusion, and corporal punishment to deter or account for perceived student misbehavior. Yet, education and legal scholarship suggests it fails to achieve stated goals and exacerbates harm. Furthermore, it is disproportionately imposed upon Black, Latinx, Native/Indigenous, LGBTQIA, and disabled students, concentrating its harms among marginalized young people. Its implications for health, however, are less clear. Using public health theories of sociostructural embodiment, we propose a framework characterizing pathways linking societal ideologies (e.g., racism) to punitive discipline with implications for health and health inequity and then present our systematic review of the punitive school discipline-health literature (N = 19 studies) conducted in accordance with PRISMA guidelines. Data were extracted on guiding theories, study characteristics, measurement, methods, and findings. This literature links punitive school discipline to greater risk for numerous health outcomes, including persistent depressive symptoms, depression, drug use disorder in adulthood, borderline personality disorder, antisocial behavior, death by suicide, injuries, trichomoniasis, pregnancy in adolescence, tobacco use, and smoking, with documented implications for racial health inequity. Using our adapted framework, we contextualize results and recommend avenues for future research. Our findings support demands to move away from punitive school discipline toward health-affirming interventions to promote school connectedness, safety, and wellbeing.

Gender Disparities in Trauma Care: How Sex Determines Treatment, Behavior, and Outcome

Trauma data bank and other research reveal sex disparities in trauma care. Risk-taking behaviors leading to traumatic injury have been associated with sex, menstrual cycle timing, and cortisol levels. Trauma patient treatment stratified by sex reveals differences in access to services at trauma centers as well as specific treatments, such as venous thromboembolism prophylaxis and massive transfusion component ratios. Trauma patient outcomes, such as in-hospital mortality, multiple organ failure, pneumonia, and sepsis are associated with sex disparities in the general trauma patient. Outcome after general trauma and specifically traumatic brain injury show mixed results with respect to sex disparity.

Body mass index and the risk of injury in adults: a cross-sectional study

OBJECTIVES

To investigate the association between body mass index (BMI) and the risk of nonfatal body injury.

METHODS

We analyzed data from 113,203 adults who participated in the Canadian Community Health Survey conducted in 2009-2010. Log-binomial models were used to estimate crude and adjusted relative risks of the association between BMI and the risk of body injury for men and women.

RESULTS

Of 113,203 adult participants, 15,194 had self-reported body injuries during the past 12 months, with a 12-month cumulative incidence of 13.7% (weighted to Canadian population). There was a significant interaction between gender and BMI in relation to the risk of body injury, and therefore, analyses were stratified by gender. For women, we found a significant association between BMI and an increased risk of body injury. Women with an increased BMI had a significant increased risk of body injuries as compared with those with normal weight (adjusted relative risk: 1.13, 95% confidence interval (CI)=1.02-1.25 for BMI 30.0-34.9 kg m(-)(2); 1.17, 95% CI=1.00-1.37 for BMI 35.0-39.9 kg m(-)(2); 1.41, 95% CI=1.16-1.69 for BMI ⩾ 40 kg m(-)(2)). A reduced risk of injury was observed in underweight women. There was no significant association between BMI and the risk of body injury for men. Obese persons of both gender were more likely to suffer injuries to the knee and lower leg, and in less demanding activities such as household chores or using the stairs.

CONCLUSIONS

We therefore conclude that increased BMI may be a risk factor for body injury in women, but not in men.

Injuries presented at a primary care setting in oman

OBJECTIVE

This study aims to measure the rate, types, and causes of injuries presented at a primary care setting in the Muscat governorate.

METHODS

A cross-sectional study was carried out where all patients who attended the Al Moabelah Health Center from the period of 1(st) January 2010 to the 31(st) December 2010 were identified from the electronic medical records. Patients identified with any type of injury were then selected for further data collection with their age and gender recorded. Details such as the type, cause and nature of the injury at the clinic were gathered from the clinical notes.

RESULTS

A total number of 86,554 visits were recorded for the year 2010. The rate of injury visits was 24 per 1000 visits. In this study, the rate of injury visits was found to be four times more common in males (44.4 per 1000) than in females (11.5 per 1000), p≤0.001. While children aged under 12 years accounted for 41.4%, and elderly patients aged over 60 years accounted for 3.5% of the total visits emanating from injuries. The results show that home was the most common place where the majority of injuries occurred (42%), followed by playgrounds (10.2%). The most common causes of injury visits were falls, followed by cutting/piercing by sharp objects and sports injuries, which accounted for 40%, 13.4%, and 12%, respectively.

CONCLUSION

Injuries in a primary care setting with close proximity to emergency departments of secondary and tertiary hospitals may only account to less than 3% of the total visits.

Stakeholders' perspective: injury behaviour and attitude of young Asians in New Zealand

Purpose

Of the unintentional injuries sustained by 20‐25 year old Asians, one‐third have been attributed to road traffic crashes. This study seeks to examine stakeholders' perceptions of Asian youth injury prevention behaviours in Auckland, New Zealand.

Design/methodology/approach

Information was collected through face‐to‐face individual interviews, with key stakeholders who were aware of youth injury prevention and road traffic safety issues. Analysis used the statements of the discussants as the basis of describing the findings.

Findings

Risk‐taking behaviours, environment, and individual variations in attitudes influence the occurrence of injuries among Asian migrant students. Domestic injuries of students from affluent backgrounds were linked to their inexperience in domestic or kitchen work. Injuries also resulted from unprovoked race‐related street assaults by locals. Road traffic injuries may be attributed to the driving quality of some Asian youths and are influenced by traffic orientations of their country of origin. Migrant youths are often reluctant to seek medical help for their injuries due to precarious employment situations. Asian youths are reactive to minor injuries and expect robust medical procedures. Mental health and suicidal status is hard to assess due to stigma. Family pressure and limited involvement with alcohol and drugs have a protective effect against injuries.

Research limitations/implications

While some Asian family values are protective against youth injury risk behaviours, negative parental attitudes may have the opposite effect. This has implications for community‐based prevention programmes. Under‐reporting of injuries and unprovoked racial attacks on Asian youths are of great concern. Further research on mental health and suicidal behaviour of Asian students and culturally appropriate injury prevention programmes are advocated.

Originality/value

The paper explores risk behaviours and attitudes towards prevention of injuries among young Asian students, including levels of knowledge and awareness, and their risk modifying intentions, from the viewpoint of professional stakeholders.

Culture and context: buffering the relationship between stressful life events and risky behaviors in American Indian youth

The Sacred Mountain Youth Project was conducted to investigate risk and protective factors related to alcohol and drug use among American Indian youth. Findings indicated that stressful life events were positively associated with depressed mood, substance use, and risky behavior; cultural identity had no direct effects, but a secondary model showed that social support and protective family and peer influences were related to cultural identity. These findings suggest that the relationships between stressors and their negative sequelae are complex. Emphasis on protective processes that are culturally specific to American Indian youth may lead to effective alcohol and drug use prevention programs.

Injury risk in young psychiatric outpatients: an 11-year follow-up of 302 adolescents

BACKGROUND

Studies investigating the association between injuries and mental health have mainly focused on mental health sequelae of injuries. The aim of this prospective cohort study was to assess the incidence and risk factors of physical injury hospitalisation and poisoning hospitalisation among adolescent psychiatric outpatients.

SUBJECTS AND METHODS

Data on 302 consecutively referred Finnish psychiatric outpatients aged 12-22 years (mean 16) were collected at treatment entry. The end-point of the average 11-year follow-up was death or end of follow-up on 31 December 2005. The main outcome variables were physical injury hospitalisation and poisoning hospitalisation.

RESULTS

Altogether 111 physical injury hospitalisations occurred in 65 (22% of all) persons during follow-up, incidence being 27.9 (95% CI: 22.7-33.1) per 1,000 person-years. Poisoning hospitalisation occurred in 22 (7.3%) persons, altogether 50 times, incidence being 12.6 (95% CI: 9.1-16.0). Seven injury-related deaths occurred, incidence being 1.8 (95% CI: 0.5-3.1) per 1,000 person-years. The most common physical injury types were fractures (40%), followed by distortions (10%) and wounds (10%), while poisoning for drugs accounted for 72% of the poisonings. Previous inpatient care, psychotropic medication, suicidality, and major depression were associated with poisoning hospitalisation during the follow-up while only gender was associated with physical injury hospitalisation.

CONCLUSION

Injuries cause significant morbidity among psychiatric outpatients, but only poisonings seem to be related with suicidality in Finnish adolescent psychiatric outpatients. The high frequency of injuries seems to justify clinicians' attention to these aspects when assessing the need for care among young people.

Adolescents' health and health behaviour as predictors of injury death. A prospective cohort follow-up of 652,530 person-years

Background

Injuries represent an important cause of mortality among young adults. Longitudinal studies on risk factors are scarce. We studied associations between adolescents' perceived health and health behaviour and injury death.

Methods

A prospective cohort of 57,407 Finns aged 14 to 18 years was followed for an average of 11.4 years. The end-point of study was injury death or termination of follow-up in 2001. The relationships of eight health and health behaviour characteristics with injury death were studied with adjusted Cox's proportional hazard model.

Results

We identified 298 (0.5%) injury deaths, 232 (0.9%) in men and 66 (0.2%) in women. The mean age at death was 23.8 years. In the models adjusted for age, sex and socioeconomic background, the strongest risk factors for injury death were recurring drunkenness (HR 2.1; 95% CI: 1.4–3.1) and daily smoking (HR 1.7; 95% CI: 1.3–2.2). Poor health did not predict injury death. Unintentional and intentional injury deaths had similar health and health behavioural risk factors.

Conclusion

Health compromising behaviour adopted at adolescence has a clear impact on the risk of injury death in adulthood independent from socioeconomic background. On the other hand, poor health as such is not a significant predictor of injury death. Promotion of healthy lifestyle among adolescents as part of public health programmes would seem an appropriate way to contribute to adolescent injury prevention.

Pediatric sex group differences in location of snakebite injuries requiring antivenom therapy

OBJECTIVE

The objective of this study is to examine the patterns of snakebite injury in pediatric patients that require antivenom therapy and to evaluate whether and when sex group differences exist.

METHODS

We performed a nationwide, multicenter, retrospective evaluation of 24 regional poison centers from 2002 and through 2004 of data for antivenom therapy for Crotaline snakebites. Data points abstracted included the age of the victim, sex of the victim, and location of bite. We calculated contingency tables of the data with statistical significance by Fisher's exact test.

RESULTS

We evaluated 204 records that involved pediatric patients; 3 of the patients had no recorded age. In 16 of the records, the bite location was not documented (2 children and 1 unknown age) or was listed as head/neck (1 child). These records were not included in the data analysis. There were bites in 136 males and 65 females. Males were more likely than females to suffer an injury to the upper extremity (56.6% vs. 26.2%; p<0.01). Males were more likely to suffer injuries to the upper extremity in all age groups (p <0.05) except for the group aged 10 through 12 years; in the group aged 10 through 12, we did not see significant differences between the sexes (p=0.729). Males are more likely to suffer an upper extremity bite with increasing age (p=0.029), while females showed no significant change in the location of bites (p=0.223).

CONCLUSION

Male children were more likely than female children to suffer Crotaline snakebites that required antivenom therapy. In this population, significant differences between locations of snakebites were found. Males were more likely than females to be bitten in the upper extremities. This difference appears as early as 1 to 4 years of age.

Obesity and risk of nonfatal unintentional injuries

BACKGROUND

Obesity is recognized as a risk factor for multiple chronic diseases. Yet, it is unclear whether obesity is also associated with an increased risk of nonfatal unintentional injury.

METHODS

A population-based survey was conducted among adults aged > or = 18 years from January 1999 through October 2000. The relationship was investigated between body mass index (BMI), defined as weight in kilograms divided by the square of the height in meters (kg/m2), and risk of nonfatal unintentional injuries among 2575 respondents aged > or = 20 years by comparing percentage of adults between obese and nonobese respondents who had injuries. Multivariate logistic regression further examined this relationship by controlling for confounding demographics.

RESULTS

A total of 370 respondents reported injuries in the previous year. We observed a linear dose-response trend among women. An estimated 7.0% of underweight individuals (BMI <18.5) reported injuries. In contrast, 26.0% of men and 21.7% of women with a BMI > or = 35.0 reported injuries. The odds ratio of injuries for individuals with a BMI > or = 35.0 was 2.00 (95% confidence interval=1.07-3.74, p<0.05) after controlling for gender, age, education level, marital status, family poverty status, and area of residence.

CONCLUSIONS

A marginally significant association between extreme obesity and elevated risk of injuries was observed. Efforts to promote optimal body weight may reduce not only the risk of chronic diseases but also the risk of unintentional injury among overweight and obese individuals.

Identification of risk factors for non-fatal child injury in a rural area: Keokuk County Rural Health Study

OBJECTIVE

To identify risk factors for non-fatal injury among rural children.

DESIGN

Cross sectional health interview survey, 1994-98.

SETTING

A rural Iowa county, not adjacent to a metropolitan area.

SUBJECTS

Stratified, random sample of households, including all resident children and adults.

MAIN OUTCOME MEASURES

Injury episodes in the past 12 months among children aged 0-17 years and the parental and child characteristics associated with these episodes.

RESULTS

Of the 621 children in participating households, 137 or 22.1% were injured during the past 12 months. Children age 5-17 on a sports team were 1.88 times (95% confidence interval (CI) 1.07 to 3.31) more likely than other children to be injured. Children age 12-17 who binge drink were 3.50 times (95% CI 1.31 to 9.50) more likely than other children to be injured. Compared with children not on sports teams, girls on teams were 2.26 times (95% CI 1.02 to 5.13) more likely while boys on teams were 1.60 times (95% CI 0.71 to 3.68) more likely to have an injury episode. Compared with children who did not binge drink, girls binge drinking were 8.11 times (95% CI 1.52 to 43.33) more likely while boys binge drinking were 2.19 times (95% CI 0.70 to 6.84) more likely to have an injury episode.

CONCLUSIONS

Local studies such as this can provide useful clues regarding the etiology of injury. Some known and some new potential risk factors including behavioral aspects for childhood non-fatal injury in a very rural area were investigated. It is planned to address these cross sectional findings in future longitudinal follow up of this population.

A neglected risky behavior among children and adolescents: underage driving and injury in New South Wales, Australia

PROBLEM

Among different causes of injury, roads and traffic-related incidents contributed most to all child deaths. The majority of childhood and adolescent traffic-related deaths are young people killed as pedestrians or bicyclists. Underage driving is a particular risky behavior much neglected. This study aimed to describe some characteristics related to motor-vehicle crashes and crash-related injury in which the vehicle was driven by a young person who was under the legal age of obtaining a learner license in New South Wales, Australia.

METHODS

Data used in this study were made available from the Roads and Traffic Authority of NSW for the period between 1996 and 2000. Crash information was collected and reported by NSW police at the scene of these motor-vehicle crash incidents.

RESULTS

There were 526 crashes involving an underage driver recorded within the study period. The majority (79.5%) of these underage drivers were males with slightly more than half (58.0%) aged 15 years, and nearly 30% aged 14 years. Among these, 83.6% involved the driver of the vehicle being killed or injured. Among the injured or killed passengers, 128 (73.6%) were nonadult passengers under the age of 18 years. Seventy of these crashes occurred while the car was in pursuit by police. The adjusted relative risk of injury to at least one occupant in the vehicle should a crash occur for female underage drivers was two times (OR=2.01, 95% CI=1.27-3.20) as compared to male underage drivers.

DISCUSSION

Underage driving poses a serious problem in terms of crash outcomes. Experimental driving and late-night outings for adolescents should be discouraged. Well-designed studies are required to further investigate the relationship between underage driving and on road risk-taking behavior among licensed adolescents.

IMPACT ON INDUSTRY

Data obtained from this study indicate that adults, particularly parents, should discourage underage adolescents from experimenting driving and should actively cultivate a positive attitude toward driving.

Trends in head injury mortality among 0-14 year olds in Scotland (1986-95)

STUDY OBJECTIVE

To examine the trends in childhood head injury mortality in Scotland between 1986 and 1995.

DESIGN

Analysis of routine mortality data from the registrar general for Scotland.

SETTING

Scotland, UK.

SUBJECTS

Children aged 0-14 years.

MAIN RESULTS

A total of 290 children in Scotland died as a result of a head injury between 1986 and 1995. While there was a significant decline in the head injury mortality rate, head injury as a proportion of all injury fatalities remained relatively stable. Boys, and children residing in relatively less affluent areas had the highest head injury mortality rates. Although both these groups experienced a significant decline over the study period, the mortality differences between children in deprivation categories 1-2 and 6-7 persisted among 0-9 year olds, and increased in the 10-14 years age group. Pedestrian accidents were the leading cause of mortality.

CONCLUSIONS

Children residing in less affluent areas seem to be at relatively greater risk of sustaining a fatal head injury than their more affluent counterparts. While the differences between the most and least affluent have decreased overall, they have widened among 10-14 year olds. The decline in head injury mortality as a result of pedestrian accidents may be partly attributable to injury prevention measures.

Gender differences in rates of unintentional head injury in the first 3 months of life

OBJECTIVES

To assess for gender differences in rates of unintentional head injury in infants less than 3 months of age, to assess the circumstances of injury in these patients, and to look for gender-related differences in these circumstances.

METHODS

Two separate databases were analyzed. 1) The National Pediatric Trauma Registry (NPTR) was queried for all patients < or = 90 days of age who had been diagnosed with unintentional head trauma between 1990 and 1999. The proportion of males was compared to the expected proportion of 51%, derived from US census data. 2) A prospective cohort of 88 infants < or = 90 days of age who had been treated for unintentional head trauma in an urban pediatric emergency department (ED) was studied. Circumstances of injury and gender-related differences in these circumstances were assessed.

RESULTS

In the NPTR database, 600 of 1072 (56%) (95% confidence interval [CI] 0.53, 0.59) infants < or = 90 days of age were boys (P =.001). In the ED cohort, 54 of 88 (62%) (95% CI 0.50, 0.72) subjects were boys (P =.06). In virtually all of the cases described, subjects appeared to be passive participants in the injury. The most commonly reported circumstances of injury were the following: "child left alone on furniture and fell" (n = 39) or "parent dropped child" (n = 27). Boys accounted for 20 (74%) of the subjects in the "parent dropped child" group (P =.04).

CONCLUSIONS

Boys outnumber girls among infants less than 3 months of age with unintentional head trauma. These young infants appear to be passive participants in their injuries, which indicates that differences in parenting practices may account for the observed gender differences.

Trauma-related hospitalizations among urban adolescents in New Zealand: priorities for prevention

PURPOSE

To: (a) determine the magnitude, characteristics, and in-patient costs of injury among hospitalized urban adolescents in New Zealand (NZ); (b) identify regional priorities for injury prevention and investigative research; and (c) compare the study findings with published data from other industrialized countries.

METHODS

The 1989-1993 files of the NZ Hospital Discharge Database were accessed to identify and analyze trauma-related admissions of adolescents residing in NZ's largest metropolitan region.

RESULTS

The estimated 9569 hospitalizations for injury accounted for one-fourth of all adolescent admissions in the region, a mean annual hospitalization rate of 1292/100,000 population and a minimum annual cost of NZ $5.8 million for in-patient care. Males and indigenous Maori youth had comparatively higher rates of hospitalizations for most major causes of injury. Falls, pedal cyclist injury, cuts, and piercing injuries were leading causes of hospitalization for trauma in early adolescence. Admission rates for motorcylist and other motor vehicle occupant trauma and self-inflicted injury increased substantially among older adolescents. Sport and recreational activities comprised at least one-sixth of injury admissions.

CONCLUSIONS

The overall rates of injury resulting in hospitalization among Auckland adolescents were comparable to those reported from Australia and France, but higher than those from the United States, Canada, and Israel. By identifying priority issues and high-risk groups, this study provides a foundation for regional injury control initiatives. It also demonstrates the utility and limitations of E-coded hospital discharge registries in defining the burden of serious nonfatal trauma.

How safe are our schools?

OBJECTIVES

The goal of this study was to provide national estimates of the frequency and cost of school injuries.

METHODS

Six years of National Health Interview Survey data were used to estimate nonfatal injury incidence rates, multiple sources were used to estimate fatalities, and national highway crash data were used to estimate school bus injury incidence.

RESULTS

Each year, 3.7 million children suffer a substantial injury at school, resulting in an estimated $3.2 billion in medical spending and $115 billion in good health lost. Nonschool fatalities greatly exceed school fatalities; from an incidence per hour perspective, however, school hours are no safer than nonschool hours despite greater formal supervision. School bus injuries account for half of school injury deaths but less than 1% of total school injury costs.

CONCLUSIONS

Nonfatal injury is a problem in schools. The concentration of injury at secondary schools suggests that interventions there may be most cost-effective. Data on school injury causes are greatly needed.

Risk-taking behaviours in a sample of New Zealand adolescents

We surveyed the risk-taking behaviour of students aged 16 years and over in two New Zealand high schools, with a particular focus on road safety, substance use, sexual behaviour and personal safety. The questionnaire was completed by 471 students, a participation rate of 99 per cent. We found that seven out of 10 students who had ridden either a bicycle or motorcycle in the previous 12 months had not always worn a helmet; that 56 per cent had driven a car without a licence; and 23 per cent had been involved in a motor vehicle crash. A lifetime incidence of 63 per cent for cigarette smoking, 34 per cent for marijuana use and 78 per cent for alcohol use was found. Forty per cent of the students reported ever having sexual intercourse. During the previous 12 months, 49 per cent of these had not always used contraceptives and 61 per cent reported not always wearing condoms as protection for sexually transmitted diseases. Twenty-five per cent had physically harmed another person and 10 per cent reported carrying a weapon with the intent of harming someone else. This study shows that adolescents are willing to provide information on risk taking and that they are engaging in high levels of health-harming behaviour. Such information is important for designing health promotion programs to address adolescent risk taking.

Behavior and injury in urban and rural adolescents

OBJECTIVES

This study investigates the consistency of factors associated with adolescent injury in separate urban and rural samples.

SAMPLES

Adolescents, 11-17 years old, in public schools in urban and rural Maryland (n = 2,712).

METHODS

Separate bivariate and logistic regression analyses were conducted for each sample to determine individual and environmental factors associated with major and minor injuries experienced in the previous year.

RESULTS

Multivariate analyses revealed that, for both samples, the probability of a major injury was highest for boys and, among both boys and girls, for those who played several team sports. Among rural youth, other significant covariates of both major and minor injuries were a tendency to engage in risky behavior and to use alcohol. For urban youth, being white, carrying a weapon for protection, attending an unsafe school, and working for pay were also significant covariates. Interactions were important and complex.

CONCLUSIONS

The consistency of predictive factors, such as multiple sports team participation and risky and aggressive behaviors in completely different physical environments, underscores the need to address the contexts of heightened injury risk that some adolescents create wherever they live by playing sports and/or behaving in an antisocial, aggressive manner. Moreover, the perception of lack of safety in schools and neighborhoods is associated with increased injury rates, suggesting the need for policy interventions to target social environments as well as behavior.

Exploring the male-female discrepancy in death rates from bicycling injury: the decomposition method

The population-based death rate as an important indicator of health status has been widely used in injury research. Generally, the death rate from injury for males is about three times that for females. The importance of the various factors that contribute to this male-female discrepancy, however, has not been well understood. Using the innovative Decomposition Method, data from the Nationwide Personal Transportation Survey, the National Electronic Injury Surveillance System, and the National Center for Health Statistics were analyzed to explore the determinants of the male-female difference in death rates from bicycling injury. The results revealed that males have higher death rate from bicycling injury than females because they have a greater exposure rate and case fatality rate. When exposure measured by number of bicycle trips is taken into account, males are at slightly lower risk of injury than females. The relative contribution of case fatality, exposure, and risk to the 6.4-fold difference in death rates from bicycling injury between men and women is 53%, 51%, and -4%, respectively.