Associations between risk behavior and injury and the protective roles of social environments: an analysis of 7235 Canadian school children

Epidemiology and factors associated with mortality among pediatric major trauma patients in Nova Scotia: A 17-year retrospective analysis

BACKGROUND

Major traumatic injury in the pediatric population requires further evaluation to improve patient outcomes. Relatively few Canadian studies have investigated pediatric trauma using population-based data. Our objectives were to describe the epidemiology of pediatric major trauma in Nova Scotia and identify factors associated with in-hospital mortality.

METHODS

Retrospective cohort study of pediatric major trauma patients (age <18 years) injured in Nova Scotia over a 17-year period (April 2001-March 2018). Data were collected from the Nova Scotia Trauma Registry. Characteristics were compared between patient subgroups using t-tests, chi-square analyses and Fisher's exact test. Temporal trends were evaluated using the Mann-Kendall test. Incidence and mortality rates were mapped using ArcGIS Pro. A multivariate logistic regression model was created to assess for factors associated with in-hospital mortality.

RESULTS

A total of 1258 injuries were observed over the 17-year study period. The incidence of pediatric major trauma was 41.7 per 100,000 person-years. Most patients were male (819/1258; 65.1 %) and resided in urban areas (764/1258; 60.7 %). Blunt trauma accounted for 86.2 % (1084/1258) of injuries, and motor vehicle collisions were the most common cause (448/1258; 35.6 %). Incidence and mortality rates were highest in the 15-17 year age group, with a trend towards increasing incidence among females (p = 0.011). Mortality was 17.2 % (217/1258) of patients; 10.9 % (137/1258) died pre-hospital. No trends were detected in mortality rates. The regression model showed increased odds of in-hospital mortality for every point increase in the ISS (OR 1.05; 95 % CI 1.02 to 1.09) and for every unit decrease in scene GCS (OR 0.63; 95 % CI 0.56-0.71). Rural patients were 2 times more likely to die in-hospital versus urban patients (OR 2.40; 95 % CI 1.01-5.69), and patients injured at home were 6 times more likely to die compared to those injured in other locations (OR 6.19; 95 % CI 1.01-38.11).

CONCLUSION

Pediatric trauma remains a major public health issue in Canada and beyond. Greater efforts are required to expand our understanding of trauma epidemiology and develop targeted injury prevention strategies, especially for rural inhabitants.

High peak drinking levels mediate the relation between impulsive personality and injury risk in emerging adults

BACKGROUND

Alcohol-induced injury is one of the leading causes of preventable morbidity and mortality. We investigated the relationship between impulsive personality and physical injury (e.g. falls, sports), and whether peak drinking quantity specifically, and/or risky behaviour more generally, mediates the relationship between impulsivity and injury in undergraduates.

METHOD

We used data from the winter 2021 UniVenture survey with 1316 first- and second-year undergraduate students aged 18-25 years (79.5% female) from five Canadian Universities. Students completed an online survey regarding their demographics, personality, alcohol use, risky behaviours, and injury experiences. Impulsivity was measured with the substance use risk profile scale, past 30-day peak alcohol use with the quantity-frequency-peak Alcohol Use Index, general risky behaviour with the risky behaviour questionnaire, and past 6-month injury experience with the World Health Organization's (2017) injury measurement questionnaire.

RESULTS

Of 1316 total participants, 12.9% (n = 170) reported having sustained a physical injury in the past 6 months. Mean impulsivity, peak drinking quantity, and risky behaviour scores were significantly higher among those who reported vs. did not report injury. Impulsivity and peak drinking quantity, but not general risky behaviour, predicted injury in a multi-level generalized mixed model. Mediation analyses supported impulsivity as both a direct predictor of physical injury and an indirect predictor through increased peak drinking (both p < .05), but not through general risky behaviour.

CONCLUSION

Results imply emerging adults with impulsive tendencies should be identified for selective injury prevention programs and suggest targeting their heavy drinking to decrease their risk for physical injury.

Job satisfaction has differential associations with delay discounting and risk-taking

Low job satisfaction has been associated with both negative health and negative organizational outcomes. Knowledge on which factors influence job satisfaction remains limited. This study assesses the associations between job satisfaction and three personality traits related to cognitive- and inhibitory control: delay discounting, risk-taking and sensation seeking (DRS-traits). Delay discounting and sensation seeking were inferred using self-reported behavioral data and health measurements for 80,676 participants in the UK Biobank. Multiple linear regression analysis produced beta coefficients and confidence intervals for each DRS-trait and job satisfaction. Analyses were adjusted for age, socioeconomic status and sleep quality. A combination of the three DRS-traits (CDRS) was assessed as well. Delay discounting and risk-taking were associated with, respectively, lower and higher job satisfaction in both sexes. Sensation seeking had no significant association with job satisfaction for either sex. The combined score, CDRS, was only negatively associated with job satisfaction in females but not in males. We discuss that the negative association between delay discounting and job satisfaction may be due to career related delay discounting effects, but also highlight that low job satisfaction itself may also lead to increased delay discounting. Additionally, we discuss why increased risk-taking behavior may have a positive effect on job satisfaction.

The relationship between psychosocial circumstances and injuries in adolescents: An analysis of 87,269 individuals from 26 countries using the Global School-based Student Health Survey

BACKGROUND

Over a million adolescents die globally each year from preventable or treatable causes, with injuries (intentional and unintentional) being the leading cause of these deaths. To inform strategies to prevent these injuries, we aimed to assess psychosocial factors associated with serious injury occurrence, type, and mechanism in adolescents.

METHODS AND FINDINGS

We conducted a secondary analysis of cross-sectional survey data collected from the Global School-based Student Health Survey between 2009 and 2015. We used logistic regression to estimate associations between prevalence of serious injuries, injury type (effects of injury), and injury mechanism (cause of injury) and psychosocial factors (factors that relate to individuals socially, or their thoughts or behaviour, or the interrelation between these variables). Psychosocial factors were categorised, based on review of the literature, author knowledge, and discussion amongst authors. The categories were markers of risky behaviour (smoking, alcohol use, drug use, and physical activity), contextual factors (hunger, bullying, and loneliness), protective factors (number of friends and having a supportive family), and markers of poor mental health (planned or attempted suicide and being too worried to sleep). Models were adjusted for country factors (geographical area and income status, both using World Bank classification), demographic factors (age and sex), and factors to explain the survey design. A total of 87,269 adolescents living in 26 countries were included. The weighted majority were 14-15 years old (45.88%), male (50.70%), from a lower-middle-income country (81.93%), and from East Asia and the Pacific (66.83%). The weighted prevalence of a serious injury in the last 12 months was 36.33%, with the rate being higher in low-income countries compared to other countries (48.74% versus 36.14%) and amongst males compared to females (42.62% versus 29.87%). Psychosocial factors most strongly associated with serious injury were being bullied (odds ratio [OR] 2.45, 95% CI 1.93 to 3.13, p < 0.001), drug use (OR 2.08, 95% CI 1.73 to 2.49, p < 0.001), attempting suicide (OR 1.78, CI 1.55 to 2.04, p < 0.001), being too worried to sleep (OR 1.80, 95% CI 1.54 to 2.10, p < 0.001), feeling lonely (OR 1.61, 95% CI 1.37 to 1.89, p < 0.001), and going hungry (OR 1.61, 95% CI 1.30 to 2.01, p < 0.001). Factors hypothesised to be protective were not associated with reduced odds of serious injury: Number of close friends was associated with an increased odds of injury (OR 1.23, 95% CI 1.06 to 1.43, p = 0.007), as was having understanding parents or guardians (OR 1.13, 95% CI 1.01 to 1.26, p = 0.036). Being bullied, using drugs, and attempting suicide were associated with most types of injury, and being bullied or too worried to sleep were associated with most mechanisms of injury; other psychosocial factors were variably associated with injury type and mechanism. Limitations include the cross-sectional study design, making it not possible to determine the directionality of the associations found, and the survey not capturing children who did not go to school.

CONCLUSIONS

We observed strong associations between serious injury and psychosocial factors, but we note the relationships are likely to be complex and our findings do not inform causality. Nevertheless, our findings suggest that multifactorial programmes to target psychosocial factors might reduce the number of serious injuries in adolescents, in particular programmes concentrating on reducing bullying and drug use and improving mental health.

Serious non-fatal unintentional injuries among in-school adolescents in Sri Lanka: results from the 2016 Sri Lankan global school-based health survey

BACKGROUND

Unintentional injuries among adolescents is a major public health problem the world over. A great majority of the annual deaths among adolescents is due to unintentional injuries; it is also the leading cause of death among adolescents in the world. The aim of this study was to estimate the incidence of injuries and their associated factors among school going adolescents aged 13-17 years using data from the most recent Global School-Based Health Survey (GSHS) conducted in Sri Lanka.

METHODS

A cross-sectional survey was conducted using a self-administered questionnaire, among 3262 adolescents attending government schools. The sample was selected through a two-staged cluster sampling technique. In the first stage, 40 schools were selected using probabilities proportional to school enrollment size, from all schools in the country that have classes in grades 8-12. Then, from the selected schools, classes were selected using systematic equal probability sampling with a random start. The weighted prevalence was calculated, and logistic regression analysis was conducted in order to determine the correlates.

RESULTS

During the 12 months before the survey, 35.8% (95% CI-30.7 - 41.1) of the students reported being seriously injured one or more times. The injuries were more common among males, but were equally common among the two different age groups (13-15 age group vs 16-17 age group). The most common type of injury was cut or stab wounds (5.5%), followed by broken bones/dislocated joints (5.3%). Multivariable analysis revealed that only a few factors were associated with injury, such as being of the male sex, being bullied, being physically attacked, and/or being in a physical fight.

CONCLUSION

This study demonstrated that the prevalence of serious unintentional injuries among school going adolescents is a major public health problem in Sri Lanka. This timely and comprehensive survey would help policy makers and researchers identify the unmet needs related to adolescent injuries. Furthermore, evidence generated form the study should be given due consideration when designing school-based interventions to prevent adolescent injuries.

Building a Contextually-Relevant Understanding of Resilience among African American Youth Exposed to Community Violence

Studies consistently demonstrate that African American youth experience disproportionate levels of community violence, which is associated with negative health and well-being outcomes among these youth. The frequency and severity of community violence exposure is a unique challenge for these youth and requires tailored approaches to promote resilience after community violence exposure. However, limited research exists that operationalizes resilience after community violence based on the unique context and lived experience of African American youth. Developing a more contextually relevant understanding of resilience is critical to reducing health inequities experienced by African American youth and promoting their well-being. Five focus groups were conducted with 39 African American adolescents (ages 13-18) exposed to community violence. Participants also completed a brief survey that included questions on demographics, adverse childhood experiences, social capital, and resilience. Focus-group transcripts were independently coded by two members of the research team and analyzed using an inductive approach. Youth highlighted key indicators of resilience including the ability to persevere, self-regulate, and change to adapt/improve. Youth also described family, peer, and cultural contexts that impact how resilience is produced and manifested, highlighting trust, perceived burdensomeness, self-determination, connectedness, and mental health stigma as key factors within these contexts. Results of this qualitative study support the development of health promotion programs for African American youth exposed to community violence that address unique risks and build on existing protective factors within family, peer, and cultural contexts.

Characteristics and associated factors of physical activity-related injuries among university students in southern China

This cross-sectional study aimed to describe the characteristics of physical activity-related injury (PARI) and to explore its associated factors among university students in Chaoshan district. Selected from the baseline survey in March and April, 434 students graded 1-3 from two universities were interviewed face-to-face in April and May 2017. Socio-demographics, physical activity (PA) participation, risk-taking behaviors, and PARI occurrences in the past 12 months were collected. Group Lasso logistic regression was applied to identify the risk factors of PARI. Totally, 317 PARI episodes were reported by 184 subjects with an overall injury risk of 0.73 injuries/student/year (males: 1.00, females: 0.63) and an injury incidence density of 0.81 injuries per 1000 PA exposure hours (males: 1.13, females: 0.69). Most injuries involved the lower extremities and were sprains and strains. Males, sports team members, and those with high-risk rebellious and anti-social behaviors were more likely to sustain PARI compared to their counterparts. Those who participated in vigorous-intensity PA with longer duration (particularly ≥ 150 min/week) were at a higher risk for PARI. This study indicates that PARI is a health concern among university students and great efforts should be taken to prevent them from PARI when promoting a physically active lifestyle.

An Estimation of the Burden of Sports Injuries among African Adolescents

The extent to which sports injuries contribute to the burden of injury among adolescents in low- and middle-income countries (LMICs) is unknown. The goal of this study was to estimate the incidence of sports injuries among adolescents in Africa. Data from the World Health Organization Global School-Based Student Health surveys were used to estimate the annual number of African adolescents sustaining sports injuries. Gender-stratified injury rates were calculated and applied to every African country’s adolescent population to estimate country-specific and continent-wide injury totals. A total of 21,858 males and 24,691 females from 14 countries were included in the analysis. Country-specific annual sports injury rates ranged from 13.5% to 38.1% in males and 5.2% to 20.2% in females. Weighted average sports injury rates for males and females were 23.7% (95% CI 23.1%–24.2%) and 12.5% (95% CI 12.1%–12.9%), respectively. When these rates were extrapolated to the adolescent populations of the African continent, an estimated 15,477,798 (95% CI 15,085,955–15,804,333) males and 7,943,625 (95% CI 7,689,429–8,197,821) females sustained sports injuries. Our findings suggest that over 23 million African adolescents sustained sports injuries annually. Further work will help to more precisely define the burden of sports injuries in LMICs and the role that surgery can play in mitigating this burden.

Gender-Specific Risk Factors of Physical Activity-Related Injuries among Middle School Students in Southern China

This cross-sectional study was carried out to explore the potential risk factors of physical activity-related injuries (PARI) among middle-school students of different genders. Selected by the random cluster sampling method, students aged from 12 to 16 years old in grades 7-8 from six middle schools in Shantou, southern China, were recruited for this investigation in November 2017. Information about socio-demographics, physical activity (PA) exposure time, individual exercise behaviors, risk-taking behaviors, and PARI experiences in the past 12 months was collected. A multivariate logistic regression model was used to explore the risk factors of PARI. A total of 1270 students completed valid questionnaires, with an overall injury incidence of 33.6% (boys: 42.0%; girls: 25.0%), an injury risk of 0.68 injuries/student/year, and an injury rate of 1.43 injuries per 1000 PA exposure hours. For boys, living in a school dormitory, participating in sports teams, exercising on a wet floor, rebellious behavior, and having longer PA exposure time were the risk factors of PARI. For girls, those who were sports team members, whose parents were divorced or separated, and those with longer PA exposure time were more vulnerable to suffer from PARI. In conclusion, PARI was a health problem among middle school students in southern China. Boys and girls differed in PARI occurrence and were affected by different risk factors, which provides a basis for targeted gender-specific intervention programs to reduce the occurrence of PARI among middle-school students.

The influence of behavioural and socioeconomic factors on the community injury rates of adolescents assessed by the south Korean emergency medical services: an ecological approach

Background

Aim of this study is to determine if peer group risk behaviors and neighbourhood socioeconomic status (SES) would ecologically affect injury incidence according to place and gender among adolescents (aged 13–15) in South Korea.

Methods

Three variables from the Korea Youth Risk Behavior Survey (2014) were used to represent peer group risk behaviours; current alcohol consumption (cAlc), the experience of violence or bullying (VicVB), and having undergone education for injury prevention (Edu-IP). The Korea Census Data (2010) was used for neighborhood SES; the degree of urbanization, the proportion of high educational attainment, and the proportion of low residential environment. The nationwide and regional Incidence-Rates of Injury assessed by EMS (IRI-EMS) were calculated according to age and gender based on the number of injuries from EMS record (2014). A linear regression model was used to examine associations.

Results

The nationwide total and inside-school IRI-EMS were 623.8 and 139.3 per 100,000 population, respectively. The range of the regional IRI-EMS showed a maximum of about 4 times the difference from 345 to 1281 per 100,000 population depending on the region. The low residential environment had a significant effect on the increase of total IRI-EMS (β = 7.5, 95% CI 0.78–14.21). In the case of boys, the IRI-EMS inside-school was increased as the percentage of VicVB was higher (β = 17.0, 95% CI 1.09–32.91). In the case of girls, the IRI-EMS outside-school was increased in rural compared to urban location (β = 211.3, 95% CI 19.12–403.57).

Conclusion

The incidence rate of outside-school was higher than that of inside-school, and incidence rate of boys was higher than that of girls. Peer group risk behaviors were significant only in the injury of boys. Among the SES factors, rural area was a significant factor in girls, especially outside-school injury. Moreover, the rate of households not in an apartment was significant in all outside-school injury and outside-school injury of boys.

Our study suggests that among native South Korean adolescents, neighbourhood SES and peer group risk behavior have different effects depending on the injury context such as place of occurrence or gender.

Physical activity-related injuries among university students: a multicentre cross-sectional study in China

OBJECTIVES

This study aimed to investigate the epidemiological characteristics and preliminarily explore possible risk factors of physical activity-related injury (PARI) occurrences among Chinese university students via a multicentre mixed survey.

DESIGN

Cross-sectional study.

PARTICIPANTS

A total of 4758 undergraduates graded 1-3 in nine universities in three Chinese cities were enrolled via cluster random sampling and completed the self-administered online questionnaires during March and April 2017.

MAIN OUTCOME MEASURES

PARI in the past 12 months.

RESULTS

Of the 4758 participants, 1081 sustained PARI in the past 12 months, with an overall PARI incidence rate of 22.7% (27.3% (367/1343) in males and 20.9%(714/3415) in females). Around one-quarter of the injured (26.4%) suffered from PARI over at least three episodes. More than half of the injured subjects experienced physical activity (PA) absenteeism and sought medical attention. All PA indicators were significantly and positively associated with PARI, with a frequency of sports and leisure-time vigorous-intensity PA (VPA) participation being the strongest (adjusted OR: 1.079, 95% CI: 1.018 to 1.144). Moreover, males (OR=1.199), Shantou students (OR=4.239), year 1 students (OR=1.287), university and other sports team members (OR=1.717-2.360) and those with insufficient sleep time (OR=1.262-1.333) were also at a higher risk of PARI.

CONCLUSIONS

PARI is prevalent among university students in China. The frequency of sports and leisure-time VPA participation was most strongly associated with PARI among all PA indicators. These data can inform future programmes for injury intervention among university students. Safety issues should also be emphasised when promoting PA among the public to reduce PARI.

Educational Attainment at Age 10-11 Years Predicts Health Risk Behaviors and Injury Risk During Adolescence

PURPOSE

To examine the effect of educational attainment in primary school on later adolescent health.

METHODS

Education data attainments at age 7 and 11 were linked with (1) primary and secondary care injury consultation/admissions and (2) the Health Behaviour in School-aged Children survey. Cox regression was carried out to examine if attainment in primary school predicts time to injury in adolescence.

RESULTS

Pupils that achieve attainment at age 7 but not at age 11 (i.e., declining attainment over time in primary school) are more likely to have an injury during adolescence. These children are also more likely to self-report drinking in adolescence.

CONCLUSIONS

Interventions aimed at children with declining attainment in primary school could help to improve adolescent health.

Participation in organized leisure-time activities and risk behaviors in Czech adolescents

Objectives

The study aimed to assess the associations between participation in organized leisure-time activities (OLTA) and risk behaviors, and whether the associations differed by gender, age, and pattern of OLTA involvement.

Methods

Data from the 2013/2014 Health Behaviour in School-Aged Children study on 10,279 11-, 13-, and 15-year-old Czech adolescents (49.2% boys) were used. We assessed the associations between OLTA participation and risk behaviors, and modification by age and gender.

Results

OLTA participants were less likely to smoke, get drunk repeatedly, or skip school and, in contrast, more likely to get injured and fight repeatedly. The associations with lower occurrence of risk behaviors were the strongest for artists, while none was significant for adolescents participating only in team sports. Girls participating in OLTA had lower odds to smoke, get drunk, or skip school than boys, and these boys had higher odds to get injured or fight.

Conclusions

OLTA participation is associated with lower occurrence of repeated substance use and truancy and inversely with higher odds for physical fights and injuries. Girls, in general, are at lower risk when participating in OLTA than boys.

Factors associated with injuries in adolescents, from the National Adolescent School-based Health Survey (PeNSE 2012)

OBJECTIVE

To estimate the prevalence of injuries among teenagers and to examine the associated risk factors, such as sociodemographic characteristics, risk behaviors, family ties and other factors.

METHOD

The prevalence of the outcome (injury) was estimated with a 95%confidence interval. In order to verify factors associated with the injury, a bivariate analysis was made with estimated odds ratio (OR) and its respective confidence intervals. Then, a multivariate analysis was carried out, only with variables whose descriptive level was equal to or lower than 5% (p < 0.05) remaining in the model.

RESULTS

The study of injury in adolescents, based on the data from the National Adolescent School-based Health Survey (PeNSE), pointed out that 10.3% of the teenagers suffered severe injuries in the past 12 months, such as cuts or perforations, broken bones or dislocated joints. The following variables remained independently associated with "suffering severe injuries": being a male teenager; black, mulatto or indigenous race/color and working. Factors related to family ties are significant when the relations are fragile amongst members: adolescents that are injured the most are the ones who suffer most aggressions at home, who skip classes without notifying their parents, those who do not live with their parents and have low family control. The most relevant aspects of mental health are insomnia and loneliness. The factors associated to the exposure to situations of violence that remained in the model were: insecurity in school and in the route home-school; getting a ride with someone inebriated; drinking and driving motorized vehicles; not wearing the seatbelt; not wearing a helmet and being bullied. Among the factors of individual behavior, the following can be emphasized: use of alcohol, cigarettes, trying illicit drugs and early sexual intercourse.

CONCLUSION

The analysis of the determinants for suffering injuries in childhood and adolescence shows the complex relationship between associated factors, which points to the need for action towards several aspects to reduce social inequalities, strengthen family ties and prevent violent contexts and individual risk factors.

Understanding clusters of risk factors across different environmental and social contexts for the prediction of injuries among Canadian youth

BACKGROUND

Among Canadian youth, injury is the most common reason for presentation to the emergency department. Youth who commonly engage in multiple risk-taking behaviours are at greater risk for injury, but is it unknown if this phenomenon is more pronounced in different contexts. We aimed to study relationships between risk-taking behaviours and injury, and variations in such relationships between different environmental and social contexts, among youth in Canada.

METHODS

Risk-taking behaviour and injury outcome data were collected from grade 9 to 10 students using the 2009-2010 (Cycle 6) of the Health Behaviour in School-Aged Children Survey (n=10,429). Principal components analysis was used to identify clusters of risk-taking behaviours. Within each identified cluster, the degree of risk-taking was categorized into quartiles from lowest to highest engagement in the behaviours. Risk ratios with 95% confidence intervals were calculated to determine the association between the risk of any injury and the degree of risk-taking behaviour specific to the cluster. Clusters were then examined across home, school, neighbourhood and sport contexts.

RESULTS

Four clusters of risk-taking behaviour were identified which were labelled as "gateway substance use", "hard drugs and weapons", "overt risk-taking", and "physical activity". Each cluster was related to injury occurrence in a graded fashion. Clusters of risk behaviour were most strongly associated with injuries sustained in neighbourhood settings, and expectedly, increasing physical activity behaviours were associated with increased risk of sport injuries and injuries occurring at school.

CONCLUSIONS

This study furthers understanding of clustered risk-taking phenomena that put youth at increasing levels of injury risk. Higher risks for injury and associated gradients were observed in less structured contexts such as neighbourhoods. In contrast, clustered physical activity behaviours were most related to school injury or sport injury and were more likely to be sustained in a supervised context. Understanding the clustered and cumulative nature of risk-behaviours, and how these vary by environmental and social context, helps to explain potential mechanisms of injury as well as modifiable factors that may be important avenues for intervention.

Is Participation in Organized Leisure-Time Activities Associated with School Performance in Adolescence?

BACKGROUND

Organized leisure-time activities (OLTA) have been identified as a context suitable for improvement of school performance. This study aimed to assess the associations between participation in OLTA and school engagement, school-related stress, academic achievement and whether these associations differ by specific pattern of OLTA participation, gender and age. Furthermore, it assessed whether OLTA participants are more likely to acquire support for schoolwork from outside the family.

METHODS

The sample concerned 10,483 adolescents (49.2% boys) aged 11, 13 and 15 from the Health Behaviour in School-aged Children data collection in 2014 in the Czech Republic. Logistic regressions adjusted for gender and age were used to analyse the associations between participation in OLTA and four education-related outcomes.

RESULTS

Participation in OLTA was associated with higher school engagement, lower levels of school-related stress and better academic achievement regardless of gender and age. The strongest associations were observed for adolescents involved in various types of OLTA concurrently, with odds ratios ranging from 1.34 (95% confidence interval (CI) 1.17-1.54) for lower school-related stress to 1.97 (95% CI 1.73-2.25) for above-average academic achievement. OLTA participants were also more likely to have a non-familial person to help them with schoolwork, though this association was weaker in 15-year-olds.

CONCLUSION

Youth involvement in OLTA is linked to general better school performance and attachment to school. Adolescents participating in more activities at the same time have the best school performance.

A systematic review of tobacco use among adolescents with physical disabilities

OBJECTIVE

To provide a systematic review of tobacco use among adolescents with physical disabilities.

STUDY DESIGN

A systematic review.

METHODS

A search was performed of English articles published prior to December 2014 in the PubMed database for studies examining smoking rates among adolescents with and without physical disabilities. Ten studies were retrieved (all cross-sectional surveys) of which six compared adolescent populations from nationally representative samples and four examined those based on convenience sampling. Pooled analyses of smoking rates by disability status were performed.

RESULTS

In studies from nationally representative samples (n = 6 studies), adolescents with physical disabilities were significantly more likely to use tobacco as compared to adolescents without (pooled analyses = 29.7% vs 23.3%). However, in studies from non-representative samples, adolescents with physical disabilities were less likely to use tobacco as compared to adolescents without (pooled analyses = 22.7% vs 39.1%).

CONCLUSIONS

Adolescents with physical disabilities may have an increased risk of tobacco use relative to those without disabilities. Tailored tobacco use prevention and cessation strategies may be appropriate for this high-risk population. Future longitudinal studies which determine factors associated with tobacco use among adolescents with different disabilities should be considered to reduce the disproportionate tobacco use in this population.

Relationships between community social capital and injury in Canadian adolescents: a multilevel analysis

Background

Characteristics of social environments are potential risk factors for adolescent injury. Impacts of social capital on the occurrence of such injuries have rarely been explored.

Methods

General health questionnaires were completed by 8910 youth aged 14 years and older as part of the 2010 Canadian Health Behaviour in School-Aged Children study. These were supplemented with community-level data from the 2006 Canada Census of Population. Multilevel logistic regression models with random intercepts were fit to examine associations of interest. The reliability and validity of variables used in this analysis had been established in past studies, or in new analyses that employed factor analysis.

Results

Between school differences explained 2% of the variance in the occurrence of injuries. After adjustment for all confounders, community social capital did not have any impact on the occurrence of injuries in boys: OR: 1.01, 95% CI 0.80 to 1.29. However, living in areas with low social capital was associated with lower occurrence of injuries in girls (OR 0.78, 95% CI 0.63 to 0.96). Other factors that were significantly related to injuries in both genders were younger age, engagement in more risky behaviours, and negative behavioural influences from peers.

Conclusions

After simultaneously taking into account the influence of community-level and individual-level factors, community levels of social capital remained a relatively strong predictor of injury among girls but not boys. Such gender effects provide important clues into the social aetiology of youth injury.

Adolescent internet use and its relationship to cigarette smoking and alcohol use: a prospective cohort study

The present study aims to investigate the longitudinal impact of situational Internet use on future cigarette smoking and alcohol use among male and female adolescents. A Northern Taiwanese cohort sample of adolescents with no prior use of cigarettes (n=1445) or alcohol (n=1468) was surveyed at age 16 and again 4 years later. Information regarding where, why, and length of time spent using the Internet was gathered from the 16-year-old participants. Outcome information regarding cigarette/alcohol use was gathered via a follow-up questionnaire at age 20. Multivariate regressions were used to incorporate peer, individual and family characteristics as measured at age 16 and create models of future cigarette and alcohol use at age 20. The analyses demonstrated that adolescent Internet use, particularly where such use took place, has a significant impact on future cigarette smoking and alcohol use, adjusted for conventional factors, and its relationship differs significantly by gender. Female adolescents with Internet café use appear to be especially likely to develop these two risky behaviors. The why of Internet use is also a predictor of future cigarette smoking. Finally, time spent using the Internet is significantly related to alcohol use; greater use of the Internet is associated with higher levels of drinking. The results revealed that different risky behaviors are differentially influenced by separate components of adolescent Internet use. These findings suggest that programs aimed at promoting adolescent health could potentially benefit Taiwanese adolescents by including components related to situational Internet use and taking gender into consideration.

Injury and social correlates among in-school adolescents in four Southeast Asian countries

The aim of this study was to determine estimates of the prevalence and social correlates of injury among adolescents in four Southeast Asian countries. Cross-sectional national data from the Global School-based Health Survey (GSHS) included 9,333 students at the ages from 13 to 15 years inclusive from Indonesia, Myanmar, Sri Lanka and Thailand is chosen by a two-stage cluster sample design to represent all students in grades 6, 7, 8, 9, and 10 in each country. The percentage of adolescents reporting one or more serious injuries within the past 12 months was 42.2% for all countries, ranging from 27.0% in Myanmar to 46.8% in Thailand. By major activity, “fall” (14.6%) was the leading external cause of injury, followed by playing or training for a sport (9.9%) and vehicle accident (6.1%). In multivariate regression analysis Thailand and Indonesia, being male, substance use (smoking and drinking alcohol) and psychological distress were associated with annual injury prevalence. Risk factors of substance use and psychological distress should be considered in an integrated approach to injury etiology in planning injury prevention and safety promotion activities among school children.

Injuries and risk-taking behaviours in Portuguese adolescents: Highlights from the health behaviour in school-aged children survey

AIM

Injuries in adolescence are an important public health problem and a major cause of morbidity and mortality in this age group. This study aimed to determine the behaviour profile associated to risk of injury and the differences between genders, region and ethnic origin.

METHODS

A cross-sectional study design of a nationally representative sample of 1581 adolescents of the Portuguese Health Behaviour in School-Aged Children study.

RESULTS

An occurrence of one injury-related event in the previous year was reported by 21.4% of the respondents and 5.9% referred having more than one injury-related event. Boys reported higher frequency of those events when compared to girls, and non-Portuguese subjects referred higher frequency of events. Scoring higher in violence-related behaviour and psychosomatic complaints was associated to higher chances of referring more than one injury-related event.

CONCLUSION

Gender, social background and behaviour profile are factors that seem to influence the risk of injuries. This information should guide those involved in the planning of injuries prevention programs in youth.

Sport participation, sport injury, risk factors and sport safety practices in Calgary and area junior high schools

OBJECTIVES

To examine rates of sport participation, sport injury, risk factors and sport safety practices in young adolescents.

DESIGN

Cross-sectional.

SETTING

Calgary and area junior high schools.

PARTICIPANTS

A random sample of 1466 students (aged 12 to 15 years).

OUTCOME MEASURES

Sport injury within one year prior to completing the survey.

RESULTS

Ninety-three per cent of students participated in sports in the previous year. The injury rate was 60.85 injuries/100 students/year (95% CI 58.29 to 63.35) for students reporting at least one sport injury, 29.4 injuries/100 students/year (95% CI 27.08 to 31.81) for medically treated injuries, and 12.28 injuries/100 students/year (95% CI 10.64 to 14.07) for injuries presenting to a hospital emergency department. The greatest proportion of injuries occurred in basketball (14%), soccer (12%), hockey (8.6%) and snowboarding/skiing (7.1%).

CONCLUSIONS

The rates of participation and injury in sports are high in junior high school students. Future research should focus on prevention strategies in sports with high participation and injury rates to have the greatest population health impact.

Screen time and risk behaviors in 10- to 16-year-old Canadian youth

OBJECTIVE

To examine television, computer, and video game use as possible determinants of multiple risk behaviors (MRB) among Canadian youth.

METHODS

Results are based on the Canadian 2005/06 Health Behaviour in School-Aged Children Survey. This survey included a representative cross-sectional sample of 8215 youth in grades 6-10, and a 1-year longitudinal sample of 1424 youth in grades 9-10. Total hours per week of television, video games, and computer use were calculated and participants were grouped into quartiles. Six risk behavior variables (smoking, drunkenness, non-use of seatbelts, cannabis use, illicit drug use, non-use of condoms) were combined to form a MRB score. Ordinal and repeated measure logistic regression models were used to examine associations between screen time and MRB variables.

RESULTS

High computer use (top quartile) was associated with approximately a 50% increased engagement of MRB in both samples. High television use was also associated with modestly increased engagement in MRB in the cross-sectional sample.

CONCLUSIONS

High computer use was the screen time behavior that was mostly strongly and consistently associated with engagement in MRB. Future research is needed to understand the relationship between specific screen time behaviors and adolescent health to help strengthen current screen time guidelines for youth.

Adolescent orofacial injury: association with psychological symptoms

Ethnic minority youth living in urban areas experience disproportionately high rates of violent intentional injuries. This study investigates the association of violent intentional injuries with psychological distress and alcohol use among adolescents treated in trauma centers for facial injuries. Interviews were conducted with 67 adolescents treated at two urban trauma centers (predominantly males [86%], and minority [Latino, 72%; African American, 19%]). Adolescents reported experiencing several different types of accidental and assault-related injuries that required medical attention in the past six months. About half (53%) reported experiencing only unintentional injuries (e.g. car accidents, falls, sports injury); 23% experienced one type of intentional injury resulting from either fighting or being attacked; and 24% experienced two types of intentional injuries resulting from both fighting and being attacked. Measures of alcohol use and psychological distress were examined in relation to these three types of injuries. Overall, 30% of study participants reported they had been drinking alcohol at the time of injury. Compared to adolescents without intentional injuries, those who experienced a physical fight and/or attack had higher levels of alcohol problems, depression, paranoia and somatic symptoms, and were more likely to have family members with alcohol problems. There is a considerable need for adolescents with intentional assault-related injuries to be screened for alcohol and mental health problems, and to be referred for appropriate treatment interventions if they score at problem levels.

Screening adolescent patients admitted to the trauma service for high-risk behaviors: who is responsible?

BACKGROUND

Trauma remains the leading cause of death for adolescents in the United States. Adolescents are a hard to access medical population, with few opportunities for providers to screen for high-risk behaviors. The trauma team has a unique opportunity to screen for concurrent risk behaviors. The objective of this study was to assess surgeon knowledge, attitudes, and current practice of screening for high-risk behaviors in injured adolescents.

METHODS

From June 2007 to September 2007, a 16-item survey was mailed to 880 trauma surgeons assess their current screening practices of their adolescent patients (14-18 years); their perception of patients' risk taking; the perceived need for additional screening; and the surgeons' willingness to add routine screening to their workup.

RESULTS

The majority of trauma surgeons believed screening for risk behaviors in their adolescent patients was an important part of the trauma admission, although most thought it was not their personal responsibility. The highest rate of screening was for substance abuse, whereas the lowest was for gun ownership and sexual behavior. The majority of surgeons (74.4%) were willing to routinely consult specialists in adolescent medicine/pediatrics to assess for and manage risk behaviors in their adolescent trauma patients.

CONCLUSION

The majority of trauma surgeons agree that risk screening is an important part of the trauma treatment for adolescent patients and are interested in involving adolescent medicine and pediatric specialists to ensure adequate screening, management, and follow-up of risk behaviors in their patients.

Associations between adolescent risk behaviors and injury: the modifying role of disability

BACKGROUND

Adolescents with disabilities are at risk for poor health outcomes including injury. The objective of this study was to examine if disability status modifies the association between risk behavior and injury among adolescents.

METHODS

The cross-sectional Health Behavior in School-Aged Children Survey was administered to a representative sample of 7235 Canadian students (grades 6-10) in 2002. Students who reported at least 1 functional difficulty due to a health condition were classified as having a disability. Engagement in up to 6 individual risk behaviors and a summative multiple risk behavior score were considered the primary exposures. Primary outcomes included medically attended injury experienced during a 12-month period.

RESULTS

Sixteen percent of students reported a disability. Almost all risk behaviors and all injury outcomes were more common among students with disabilities than in those without disabilities (eg, older age group's smoking: 17.5% vs 8.9%, p = <.01; medically attended injury: 67.4% vs 51.4%, p = <.01). Clear risk gradients were observed between engagement in multiple risk behavior and all injury outcomes. The association between multiple risk behavior and injury was accentuated by disability status among older students, particularly for students with disabilities who engaged in frequent multiple risk behavior (adjusted risk ratio 1.8, 95% CI: 1.6-1.9).

CONCLUSIONS

Canadian students with disabilities who engage in risk behaviors experience higher risks for medically attended injury than their nondisabled peers who engage in those same risk behaviors. Injury prevention programs that focus on risk-taking behavior should integrate the needs of this high-risk group of adolescents in order to prevent additional disability.

Adolescent risk taking, neighborhood social capital, and health

PURPOSE

To assess the roles of a neighborhood measure of social capital, family affluence, and risk taking on adolescent self-rated health.

METHODS

This study uses data from the 2384 Canadian students in Grades 9-10 (56.5% female) from the World Health Organization's Health Behavior in School-Aged Children Survey 2001/2002, a nationwide representative sample.

RESULTS

Using binary logistic regression models, it is found that higher levels of risk taking and lower levels of neighborhood social capital and family affluence are independently associated with worse overall perceptions of health. These influences are not found to interact with each other.

CONCLUSIONS

Neighborhood social capital, risk taking, and family affluence are important factors to consider when addressing the health of adolescents. Results are discussed in terms of possible health promoting interventions.

Healthy lifestyle behaviour decreasing risks of being bullied, violence and injury

Background

Bullying and violence are problems of aggression in schools among adolescents. Basic daily healthy practices including nutritious diet, hygiene and physical activity are common approaches in comprehensive health promotion programs in school settings, however thier relationship to these aggressive behaviours is vague. We attempted to show the advantages of these healthy lifestyle behaviours in 9 developing countries by examining the association with being frequently bullied, violence and injury.

Methodology/Principal Findings

A cross-sectional cross-national survey of 9 countries using the WHO Global School Based Student Health Survey dataset was used. Measurements included experiences of “being frequently bullied” in the preceding 30 days and violence/injury in the past 12 months. Association of risk behaviours (smoking, alcohol, sexual behaviour) and healthy lifestyle (nutrition, hygiene practices, physical activity) to being bullied, and violence/injury were assessed using multivariate logistic regression. Hygiene behaviour showed lower risks of being frequently bullied [male: RR = 0.7 (97.5CI: 0.5, 0.9); female: RR = 0.6 (0.5, 0.8)], and lower risk of experiences of violence/injury [RR = 0.7 (0.5, 0.9) for males], after controlling for risk behaviours, age, education, poverty, and country.

Conclusion/Significance

Healthy lifestyle showed an association to decreased relative risk of being frequently bullied and violence/injury in developing countries. A comprehensive approach to risk and health promoting behaviours reducing bullying and violence is encouraged at school settings.

Injury among 1107 Canadian students with self-identified disabilities

PURPOSE

Students with disabilities are at risk for poor health outcomes; however, the causes and consequences of injury in this group are not well understood. The epidemiologies of injuries among students with and without disabilities were profiled and compared.

METHODS

The cross-sectional, 2002 Health Behaviour in School-aged Children Survey, was administered to a representative sample of 7235 students (grades 6-10) from Canada. Students who reported at least one functional difficulty due to a health condition were classified as having a disability. Primary outcomes were: (i) Medically attended injury; (ii) multiple injuries, and (iii) serious injury experiences during a 12-month period.

RESULTS

Some 16.3% of students reported a disability. Injuries were more common in students with disabilities compared to those without disabilities (67% vs. 51% annually, p < 0.01). Students with disabilities experienced 30% increases in the risk for medically attended injury, multiple injury, and serious injury as compared to their peers. Consistent and statistically significant associations (p < 0.05) were identified between different types of disability and all injury outcomes.

CONCLUSIONS

Canadian students who report disabilities experience higher risks for injury than their peers, perhaps due to an inability to perceive and avoid environmental hazards. Injury prevention programmes are needed to address these unique risk profiles in order to prevent additional disability or secondary conditions.

School injury and gender differentials: a prospective cohort study

This study assessed the role of certain individual characteristics in school injury among male and female adolescents. The sample included 2,398 subjects attending middle schools and high schools. Respondents completed a self-administered questionnaire at the beginning of the school year. School nurse completed a questionnaire on injury for each school injury occurred during the school year. The data was analyzed with the adjusted odds ratios (ORa) computed via the logistic models. The school injury was common (13% for both sexes). Sports/physical training injury was more frequent among girls (8.8% vs. 6.6%, P < 0.05) contrarily to the other types of injury (4.6% vs. 8.8%, P = 0.001). Sports/physical training injury was strongly associated with age <15 years (ORa 3.42) and presence of previous injury (2.63) among boys, and with age <15 years (2.02), presence of previous injury (2.94), not easily irritated (1.89), and irresponsible (1.59) among girls. The other types of injury were highly related to age <15 years (ORa 4.18), frequent use of psychotropic drugs (1.76), not living with both parents (1.65), being not calm (2.03), and presence of previous injury (1.82) among boys, and to age <15 years (2.59), obesity (3.24), and being not calm (1.84) among girls. The present study identified a number of potential risk factors for school injury among male and female adolescents. Preventive measures should be taken to make adolescents, their parents and teachers more aware of the risks and to find remedial measures.

Adolescent injuries in Canada: findings from the Canadian community health survey, 2000-2001

This article presents a description of injuries among 24312 Canadian adolescents, aged 12-24 years, based on the Canadian Community Health Survey, 2000-2001. A total of 3214 (25.6%) males and 2227 (16.5%) females reported having at least one serious injury in the past year. The leading causes of injury in adolescents were: falls; overexertion or strenuous movement; accidentally bumped, pushed or bitten; and accidentally struck or crushed by objects. The parts of the body most often affected were the ankles/feet, wrists/ hands and knees/lower legs. The most frequent locations of injuries were: sports or athletic areas; home; school, college or university areas; and the street, highway or pavement. Injuries were more often reported to have occurred during the summer months. Low socio-economic status was inversely associated with the occurrence of injury in the past year whereas risk-taking behaviour in the form of cigarette smoking and drinking alcohol was positively associated with injury occurrence.

Influence of multiple risk behaviors on physical activity-related injuries in adolescents

OBJECTIVE

The study objectives were to (1) examine the relationship between physical activity and physical activity injuries in youth, (2) determine whether this relationship is modified by the engagement in multiple risk behaviors, and (3) determine whether this relationship is modified by the setting of the injury (school versus outside of school).

METHODS

We examined associations between physical activity and multiple risk behaviors with physical activity injuries occurring at and outside of school. The study population consisted of a representative sample of 5559 Canadian youth in grades 6 through 10 who participated in the 2001/2002 Health Behavior in School-Aged Children Survey. The exposure and outcome measures were determined from a classroom-based survey.

RESULTS

Irrespective of grade, there were strong gradient relations between physical activity participation and related injuries outside of school. Conversely, there were modest relations between physical activity participation and related injuries at school. In students in grades 6 to 8, there was no relation between multiple risk behaviors and physical activity injuries at school and a curvilinear relation between multiple risk behaviors and physical activity injuries outside of school. The opposite pattern of relationships between multiple risk behaviors and injuries was observed in students in grades 9 to 10. Irrespective of grade and setting of injury, there was no significant interaction between physical activity and multiple risk behaviors on injury risk. The results were consistent by severity of injury and for structured/organized and unstructured/informal forms of physical activity.

CONCLUSIONS

The environment moderated the relation between physical activity and related injuries in that strong risk gradients only existed outside of the school setting. Unexpectedly, there were no consistent gradients between the engagement in multiple risk behaviors and physical activity injuries or any interaction effect between physical activity exposure and multiple risk behaviors. These findings suggest that optimizing the environment would be a preferred strategy for preventing physical activity injuries compared with selectively targeting youth who engage in multiple risk behaviors.