Occupational injury deaths of 16- and 17-year-olds in the United States

Prevalence study on self-declared work accidents in areas covered by family health strategies: a cross-sectional study

BACKGROUND

Occupational accidents are a complex phenomenon and a major public health problem. Occupational health surveillance actions are essential for prevention of injuries of this nature.

OBJECTIVE

To ascertain the prevalence of and the variables associated with occupational accidents in the city of Itajubá (MG).

DESIGN AND SETTING

A cross-sectional study with a quantitative approach, based on a household survey with random sampling, was conducted in areas covered by the Family Health Strategy (FHS) in Itajubá (MG).

METHODS

Questionnaires were applied to 292 people. The data were analyzed by means of logistic regression.

RESULTS

The prevalence of occupational accidents was 8.6%. The underreporting rate was 60.0%. The scenario for these accidents, according to the model established through the regression analysis, was most likely to involve males who declared their skin color as white and who did not have a formal employment contract.

CONCLUSION

This study makes a contribution towards unveiling the relationship between healthcare and work, and thus serve as support for the development of strategies to prevent underreporting. Lastly, the results provide the basis for future public health intervention actions and for future studies.

Occupational Safety and Health in U.S. Aquaculture: A Review

Objectives: Aquaculture encompasses a variety of species in both freshwater and marine settings and can combine elements of agriculture and fishing, two recognized hazardous occupations. Efforts are underway to expand the aquaculture sector in the United States (U.S.), and should be informed by occupational safety and health (OSH) research. The objectives of this review paper are to: i) describe the U.S. aquaculture sector, ii) summarize statistics, peer-reviewed studies, and reports focused on U.S. aquaculture OSH, and iii) describe the policy landscape specific to U.S. aquaculture OSH.Methods: Literature searches employed databases and Internet search engines to identify relevant peer-reviewed articles, reports, and other resources. Due to the expected U.S. expansion of marine aquaculture and paucity of peer-reviewed U.S.-based OSH literature in this sector, additional searches for international research on marine aquaculture were conducted.Results: The U.S. Bureau of Labor Statistics estimated high rates of illness and injury among U.S. aquaculture workers in 2014 and 2015. Peer-reviewed literature on aquaculture OSH identified numerous physical, chemical, and biological OSH risks depending on production methods and settings. Significant policy gaps exist regarding U.S. aquaculture OSH surveillance, reporting, and regulation.Conclusion: This review identifies a critical need for research, surveillance, and best practices information, specific to the major types of aquaculture in the U.S., to augment and inform worker safety and health efforts in this expanding sector.

Foundational workplace safety and health competencies for the emerging workforce

INTRODUCTION

Young workers (aged 15-24) suffer disproportionately from workplace injuries, with a nonfatal injury rate estimated to be two times higher than among workers age 25 or over. These workers make up approximately 9% of the U.S. workforce and studies have shown that nearly 80% of high school students work at some point during high school. Although young worker injuries are a pressing public health problem, the critical knowledge and skills needed to prepare youth for safe and healthy work are missing from most frameworks used to prepare the emerging U.S. workforce.

METHODS

A framework of foundational workplace safety and health knowledge and skills (the NIOSH 8 Core Competencies) was developed based on the Health Belief Model (HBM).

RESULTS

The proposed NIOSH Core Competencies utilize the HBM to provide a framework for foundational workplace safety and health knowledge and skills. An examination of how these competencies and the HBM apply to actions that workers take to protect themselves is provided. The social and physical environments that influence these actions are also discussed.

CONCLUSIONS

The NIOSH 8 Core Competencies, grounded in one of the most widely used health behavior theories, fill a critical gap in preparing the emerging U.S. workforce to be cognizant of workplace risks.

PRACTICAL APPLICATIONS

Integration of the NIOSH 8 Core Competencies into school curricula is one way to ensure that every young person has the foundational workplace safety and health knowledge and skills to participate in, and benefit from, safe and healthy work.

Adolescent workplace exposures reported to Texas poison centers

BACKGROUND

Working adolescents, with less experience and less training than adults, may take more risks and get exposed to a wide variety of toxic substances in the workplace. They may get injured when working in inadequately ventilated areas or entering areas of exposure with improper or no protective equipment.

OBJECTIVE

The purpose of this study was to describe adolescent occupational exposures reported to poison centers.

SUBJECTS

Occupational exposures reported to Texas poison centers during 2000-2015 where patients were 13-19 years in age.

METHODS

The distribution of the cases was determined for various factors.

RESULTS

There were 2430 adolescent occupational exposures. The most frequently reported major substance categories were chemicals (18%), household cleaning substances (18%), hydrocarbons (10%), and industrial cleaners (9%). Forty-five percent occurred during May-August. Males accounted for 66% of the patients; 27% were 18 years and 37% were 19 years. The most common exposure routes were inhalation (28%), dermal (27%), ingestion (26%), and ocular (24%). The patients were managed on site in 51% of the exposures. Twenty-three percent of the exposures had serious outcomes.

CONCLUSION

Adolescents involved in occupational exposures tended to be male and older. Adolescent occupational exposures were likely to involve chemicals and household cleaning substances, occur by ingestion and ocular route, and likely to be managed on site. Most were not likely to have serious outcomes.

Injury surveillance and associations with socioeconomic status indicators among youth/young workers in New Jersey secondary schools

BACKGROUND

Injuries involving career-technical-vocational education (CTE) are reported to the New Jersey Safe Schools Program online reporting system, the only U.S. State law-based surveillance data for young workers (ages twenty-one and younger), a susceptible, vulnerable adolescent sub-population.

METHODS

We examined potential associations between socioeconomic status (SES) indicators and high school student injuries reported between 12/1998-12/2013, excluding injuries acquired by staff members. Associations between DFG score-a proxy for school/district SES-and variables relating to reported injuries, including severity, injury type, injury cause, body parts injured, injury treatment setting and demographics were examined with chi square test (X(2)) for independence and logistic regression. To assess potential associations between SES and personal protective equipment (PPE), data were stratified by 2003-2008 and 2008-2013, given mandated payment by employers of PPE for employees.

RESULTS

Statistically significant associations were found between SES and injury cause [X(2) = (7, 14.74), p = 0.04] and SES and injury treatment setting [X(2) = (1, 4.76), p = 0.03]. Adjusted odds ratio suggested students from low SES schools were at a higher odds of being treated at a hospital emergency department (ED) than students from high SES schools (95 % CI 1.3-4.3, p < 0.01).

CONCLUSIONS

These findings indicated low SES schools/districts have increased odds of being treated at ED, after controlling for injury severity. Future research should focus on implications such associations have on health care access and insurance for young workers and their families. With small sample sizes representing lower DFG scoring (SES) schools/districts, additional efforts should be enacted to increase injury reporting in these schools/districts.

Work-Related Injuries: Injury Characteristics, Survival, and Age Effect

Work-related injuries impose a significant burden on society. The goal of this study was to delineate the epidemiology and the effect of age on type and mortality after occupational injuries. Patients 16 years of age or older sustaining work-related injuries were identified from the National Trauma Databank 12.0. The study population was stratified into four age groups: 16 to 35, 36 to 55, 56 to 65, and older than 65 years old. The demographic characteristics, type of injury, mechanism of injury, setting of injury, use of alcohol or other illicit drugs, and mortality were analyzed and related to age strata. Overall 67,658 patients were identified. There were 27,125 (40.1%) patients in the age group 16 to 35 years, 30,090 (44.5%) in the group 36 to 55 years, 6,618 (9.8%) in the group 56 to 65 years, and 3,825 (5.7%) older than 65 years. The injury severity increased significantly with age. Elderly patients were significantly more likely to sustain intracranial hemorrhages, spinal, and other skeletal injuries. The overall mortality was 2.9 per cent (1938) with the latter increasing significantly in a stepwise fashion with progressing age, becoming sixfold higher in patients older than 65 years (OR, 6.18; 95% CI, 4.78 to 7.80; P < 0.001). Our examination illustrates the associations between occupational injury and significant mortality that warrant intervention for mortality reduction. There is a stepwise-adjusted increase in mortality with progressing age.

Young adults, mortality, and employment

OBJECTIVE

This study assessed the relationship between employment status and mortality over a 2-year period among a nationally representative sample of young adults aged 18 to 24 years (n = 121,478, representing more than 21 million US young adults).

METHODS

By using data from the 1986-2000 National Health Interview Survey and its public-use mortality follow-up through 2002, mortality after 2-year follow-up (for each individual) was regressed on employment status at baseline, controlling for gender, race, education, season, and survey design.

RESULTS

Having been employed was associated with significantly lower risks of all-cause, homicide, and "other-cause" mortality (adjusted odds ratios range: 0.51 to 0.60).

CONCLUSION

Working appears to be a factor that may prevent premature mortality among young adults; increasing unemployment may result in increased mortality risks among young adults in the future.

Characteristics of teens with and without work permits

BACKGROUND

Factors associated with the issuance of mandated work permits for teens, and their enforcement are currently unknown.

METHODS

A cross-sectional survey was administered to 1945 teens at 16 randomly selected North Carolina high schools. Predictor variables examined included teens' socio-demographic characteristics, employment patterns, and labor law knowledge.

RESULTS

One thousand and ninety-four non-working and 844 working teens participated. Seventy-seven percent of working teens worked during the school year and 39% started working younger than 16. The majority (80%) worked in retail and services. Forty-four percent worked without work permits. Factors associated with being less likely to be issued a work permit included white race, employment in a family-owned business, being a laborer, and limited or no knowledge of child labor laws.

CONCLUSIONS

Adherence to and enforcement of the work permit system is low. Interventions should specifically target teens who work in family owned businesses, in unskilled labor and in hazardous industries.

Safety or Control?: Workplace Organization and Occupational Health

Using labor process theory and epidemiologic models as a framework, this study analyzed relationships between task exposures, worker labor process control, perceived safety climate, and three dependent measures of adverse occupational health: workplace injury, exhaustion, and health status among a national sample of employed adults (n = 1,607). Multivariate analyses confirmed that task demands of heavy labor were associated with workplace injury above baseline individual and job characteristics. Consistent with previous research, results indicated worker control was associated with increased health. Reliable co-workers were associated with less exhaustion, and working fast was associated with greater exhaustion. My results implied that increased safety climate was associated with fewer injuries, less exhaustion, and increased health. Safety climate did not account for associations between task exposures, labor process control, and work place injury or exhaustion. Results suggested that part of the influence between labor process control and health status occurs through improvement in safety climate.

Teen workers' exposures to occupational hazards and use of personal protective equipment

BACKGROUND

Prior research indicates that working adolescents seek care for the toxic effects of on-the-job chemical and environmental hazard exposures.

METHODS

This cross-sectional survey of a nationally representative sample of 866 adolescent workers in the retail and service sector examines their exposures, personal protective equipment (PPE) use, and training.

RESULTS

Two-thirds of respondents were exposed to continuous, very loud noise, 55% to thermal hazards and 54% to chemical hazards. Few teens reported using any PPE, though those who had been trained reported somewhat higher usage.

CONCLUSIONS

Teens working in the retail and service sectors experience a variety of chemical, thermal, biologic and noise exposures. Efforts to eradicate such exposures need to be complemented by increased provision of PPE and appropriate training in their use by employers.

US child labor violations in the retail and service industries: findings from a national survey of working adolescents

OBJECTIVES

We investigated child labor violations among US adolescents working in the retail and service industries.

METHODS

We used interview data from a nationally representative sample of working adolescents, and investigated reports of select child labor violations (e.g., hours, equipment, and work permits). We computed weighted percentages of respondents reporting each type of discrete (and aggregated) violation.

RESULTS

Nearly 37% of respondents reported a violation of the hazardous occupations orders (i.e., prohibited jobs or use of equipment), and 40% reported a work permit violation. Fewer than 2% reported working more than the maximum weekly hours allowed during the school year, but 11% reported working past the latest hour allowed on a school night, and 15% reported working off the clock.

CONCLUSIONS

Significant numbers of US adolescents are employed in violation of the child labor laws and as a result are exposed to safety risks. Although our data did not allow for an analysis of enforcement, our findings demonstrate gaps in employer compliance with the law. We suggest that closer attention to enforcement policy and practice is needed.

Adolescent occupational injuries and workplace risks: an analysis of Oregon workers' compensation data 1990-1997

PURPOSE

Injuries to adolescents from occupational activities has been recognized as a significant public health concern. The objective of this study was to quantify adolescent injury rates, analyze risk factors, and measure the severity of injuries sustained using Oregon workers' compensation data.

METHODS

From 1990-1997, a total of 8060 workers' compensation claims, submitted by claimants 16-19 years old, were accepted by Oregon and used in these analyses. Data from the Bureau of Labor Statistics were used to derive injury rates.

RESULTS

An overall estimated claim rate of 134.2 (95% confidence interval [CI] 124.9-143.6) per 10,000 adolescent workers was found, with males having over twice the rate of females. The total average annual claim cost was $3,168,457, representing $3145 per claim. The average total temporary disability period per claim was 22.3 days. Precision production workers had the highest claim rate of 296.2 (95% CI 178.9-413.4) and highest associated costs ($8266) for all occupations, whereas those in the farming/fishing/forestry occupation had the longest average periods of indemnification with 31.6 days. Day shift workers had the highest claim rates and most severe injuries relative to other shifts.

CONCLUSION

The injury rates found among adolescent workers demonstrates that continued safety interventions and increased training are needed. Because of high claim rate and injury severity, particular attention should be focused on adolescents in food service, manufacturing, and agricultural occupations. Understanding the differences of adolescent circadian rhythm patterns in establishing work schedules and supervisory practices could also prove valuable for decreasing injury risk.

Personal protective equipment use and safety behaviors among farm adolescents: gender differences and predictors of work practices

CONTEXT

Children on farms perform work that places them at risk for acute and chronic negative health outcomes. Despite strategies for preventing and reducing the risk of disease and injury, children's use of personal protective equipment and safely equipped farm machinery has generally remained unreported.

PURPOSE

This paper reports the use of personal protective equipment, self-protective work behaviors, and selected risk exposures of children aged 14-19, who perform farm work.

METHODS

Survey results of adolescent high school students (n = 593) enrolled in agriculture class in Kentucky, Iowa, and Mississippi. Students were part of the sample that participated in the Agricultural Disability Awareness and Risk Education Project.

FINDINGS

Boys were at a significantly higher risk of exposure compared to girls, and boys engaged more frequently in risky behavior. Hearing and respiratory protection was used minimally and sporadically. Physical symptoms influenced use of hearing and respirator use, as did physician recommendation to use such protection. Of students who operated farm tractors, only half most frequently operated tractors with safety bars and seat belts. Sixty percent of the students reported using equipment with damaged or missing safety shields.

CONCLUSIONS

In addition to the usual risks of farm work, adolescents may be at even greater risk by not using personal protective equipment or not having access to machinery that is properly equipped for maximum protection. Health care providers should incorporate advice to adolescents and their parents on risk reduction, particularly on the use of personal protective equipment.

An ecological study of regional variation in work injuries among young workers

BACKGROUND

The investigation of geographic variation in occupational injuries has received little attention. Young workers 15 to 24 years are of particular concern because they consistently show elevated occupational injury rates compared to older workers. The present study sought to: (a) to describe the geographic variation of work injuries; (b) to determine whether geographic variation remained after controlling for relevant demographic and job characteristics; (c) to identify the region-level factors that correlate with the geographic variation.

METHODS

Using workers compensation claims and census data, we estimated claim rates per 100 full-time equivalents for 15 to 24 year olds in 46 regions in Ontario. A total of 21 region-level indicators were derived primarily from Census and Labour Force Survey data to reflect social and material deprivation of the region as well as demographic and employment characteristics of youth living in those areas.

RESULTS

Descriptive findings showed substantial geographic variation in young worker injury rates, even after controlling for several job and demographic variables. Region-level characteristics such as greater residential stability were associated with low work injury rates. Also, regions with the lowest claim rates tended to have proportionally fewer cuts and burns than high-claim-rate regions.

CONCLUSION

The finding of substantial geographic variation in youth claim rates even after controlling for demographic and job factors can aid in targeting prevention resource. The association between region-level indicators such as residential stability and youth work injury suggests that work injury prevention strategies can be integrated with other local economic development measures. The findings partially support the notion that work safety measures may be unevenly distributed with respect to regional socio-economic factors.

Semiparametric modeling of the spatial distribution of occupational accident risk in the casual labor market, Piracicaba, southeast Brazil

The objective of this study was to estimate the spatial distribution of work accident risk in the informal work market in the urban zone of an industrialized city in southeast Brazil and to examine concomitant effects of age, gender, and type of occupation after controlling for spatial risk variation. The basic methodology adopted was that of a population-based case-control study with particular interest focused on the spatial location of work. Cases were all casual workers in the city suffering work accidents during a one-year period; controls were selected from the source population of casual laborers by systematic random sampling of urban homes. The spatial distribution of work accidents was estimated via a semiparametric generalized additive model with a nonparametric bidimensional spline of the geographical coordinates of cases and controls as the nonlinear spatial component, and including age, gender, and occupation as linear predictive variables in the parametric component. We analyzed 1,918 cases and 2,245 controls between 1/11/2003 and 31/10/2004 in Piracicaba, Brazil. Areas of significantly high and low accident risk were identified in relation to mean risk in the study region (p < 0.01). Work accident risk for informal workers varied significantly in the study area. Significant age, gender, and occupational group effects on accident risk were identified after correcting for this spatial variation. A good understanding of high-risk groups and high-risk regions underpins the formulation of hypotheses concerning accident causality and the development of effective public accident prevention policies.

Occupational risks and risk perception among Hispanic adolescents

Although child labor laws are designed to protect youth from serious injury in the workplace, there are a number of other factors that influence the effectiveness of occupational injury prevention including adolescent risk perception, failure to understand worker rights, and lack of experience. The growing adolescent Hispanic population in the U.S. is of particular concern because cultural and economic barriers have the potential to further influence these young workers' safety. A greater emphasis on research among Hispanic adolescents is crucial to minimizing adolescent worker injury. To propose effective age and culturally appropriate intervention programs, it will be necessary to understand the knowledge, attitude and beliefs regarding occupational risks within the working adolescent Hispanic community.

Nontraditional work factors in farmworker adolescent populations: implications for health research and interventions

Agriculture has been documented to be one of the most hazardous work environments for both adults and children. Adolescents may be especially vulnerable to adverse health effects from agricultural exposures due to the rapid growth and development experienced during those years. Separating the occupational, economic, and social issues in this population is difficult. Weak regulatory protection, lack of compliance with existing regulations, and gaps in service provision characterize the working conditions of adolescent farmworkers. Although there is increasing research on the impact of work organization on mental and physical health in adult working populations, there is a scarcity of research focused on this concept in young workers--and it remains virtually unaddressed in young farmworkers. Work characteristics of the informal work sector, better delineated in international literature, should be considered when planning research or interventions in this at-risk population. Further, the population of adolescent farmworkers is diverse, and research strategies and interventions need to be targeted and tailored to the heterogeneous groups. This article addresses some of the nontraditional work factors associated with the less-than-formal work organization and environments in the farmworker adolescent population and how these factors may inform the planning of research and interventions. Specifically, mobility, cultural patterns and social networks, alternative sampling strategies, alternative delivery of health care and education, and involvement of a wide range of players in the work environment of adolescent farmworkers should all be considered when conducting research or planning programs for this population.

Comparative Description of Migrant Farmworkers versus Other Students Attending Rural South Texas Schools: Substance Use, Work, and Injuries

CONTEXT

Little is known about substance use, work characteristics, and injuries of youth from migrant farmworker families. Some evidence suggests that migrant youth may be at greater risk for substance use and work-related injuries than nonmigrant youth.

PURPOSE

The aim of this study is to compare substance use, employment, and injury data from migrant and nonmigrant youth residing in rural South Texas.

METHODS

Anonymous cross-sectional survey data were collected from 7,302 middle and 3,565 high school students during a regular class. Classification as a migrant student occurred if the student responded positively to: "Does your family move around the state or nation to pick fruits or vegetables for work?"

RESULTS

About 5% of South Texas middle and high school students reported belonging to a migrant family. Compared to nonmigrant students, migrant youth were more likely to report frequent substance use. Youth belonging to migrant families were less likely to work for pay on weekends but more likely to work for pay on weekday mornings before school. These youth were also more likely to have ever been injured while working than nonmigrant students.

CONCLUSIONS

These results demonstrate a need for additional interventions in this most vulnerable rural population. Specifically, targeted educational programs to enhance the occupational safety and health of migrant youth, further research into effective substance abuse treatment and prevention programs in rural areas, and enhancement of child labor laws are recommended.

Occupational injury among Rhode Island adolescents: an analysis of workers' compensation claims, 1998 to 2002

OBJECTIVES

We sought to examine occupational injuries sustained by adolescent workers during a 5-year period.

METHODS

Workers' compensation claims from Rhode Island were used to assess injuries of 15- to 19-year-old employees (n = 8321) from 1998 to 2002. Baseline employee population estimates were derived using the Current Population Survey.

RESULTS

The annual estimated adolescent claim rate was 6.6 per 100 workers (95% confidence interval = 6.1-7.1), with annual average costs of $614,182. Injury rates increased with employee age, hours worked, and for day and nightshift employees relative to evening shift workers. The highest proportion of claims by industry was in eating establishments, and the average indemnification duration was 13.0 days.

CONCLUSIONS

Specific emphasis should be placed on increasing safety training and preventative interventions for teenagers in hazardous occupations and for those working longer hours.

Age-related differences in work injuries: a multivariate, population-based study

BACKGROUND

Many population-based studies find that the rate of work injuries is higher among adolescent and young adult workers compared to older adults. The present study examines age-related differences in work injuries, with an emphasis on adjusting for the potential confounding effects of job characteristics.

METHODS

Age-related differences in work injuries were examined in a representative sample of 56,510 working Canadians aged 15 years and over. Respondents reported work-related injuries and job characteristics (e.g., occupation) in the past 12 months. Total hours worked in the past year were computed for each worker and accounted for in the logistic regressions. Analyses were stratified by gender.

RESULTS

For men, adjusting for job characteristics substantially reduced, but did not eliminate the elevated risk status of adolescent and young adult workers. For women, only young adult women showed an elevated risk of work injury with job characteristics controlled.

CONCLUSIONS

This is one of the few multivariate studies specifically examining contributors to age-related differences in work injuries in a population-based sample of workers. The substantial reduction in age-work injury association in the fully adjusted model suggests that differences in the types of jobs young workers hold play a critical role in their high-risk status.

Potential for violence against teenage retail workers in the United States

PURPOSE

To examine the working conditions of teenagers in five sites, examining the presence of factors associated with workplace violence and considering workers' concerns about safety and training to deal with violent circumstances.

METHODS

Teenage workers, aged 14-17 years, with employment experience in retail industries in five sites (North Carolina; Brockton, Massachusetts; Los Angeles, California; Oakland, California; Philadelphia, Pennsylvania) were questioned. Data in North Carolina were collected by telephone interview. Parallel data from the other sites were obtained using self-administered questionnaires in schools.

RESULTS

Teenage retail workers report experiences that include working alone, at night, and/or without supervisors present. Training about angry customers, robbery, and sexual harassment is less than complete. Yet, teenage retail workers express few concerns about safety.

CONCLUSIONS

Most teenagers work while attending high school, with over half employed in the retail trades. Those working in retail experience higher rates of workplace violence than other workers, mostly during robberies. Working alone and at night are risk factors for violent victimization. Findings indicate areas of potential improvement in child labor practices, particularly with respect to training and supervision.

Health of children working in small urban industrial shops

AIMS

To explore associations between work status and multidimensional health indices in a sample of urban Lebanese children.

METHODS

A cross-sectional survey was used to compare 78 male children (aged 10-17 years) working full time in small industrial shops, and a comparison group of 60 non-working male schoolchildren. All children lived and worked or studied in the poor neighbourhoods of three main Lebanese cities.

RESULTS

Working children reported frequent abuses. They smoked and dated more than the comparison group. They also reported a higher number of injuries (last 12 months) and recent skin, eye, and ear complaints (last two weeks). Physical examination revealed more changes in their skin and nails, but no differences in height or weight compared to non-working group. A higher blood lead concentration was detected among working children, but no differences in haemoglobin and ferritin. No differences were noted between the two groups of children regarding anxiety, hopelessness, and self-esteem. The drawings of the working children, however, revealed a higher tendency to place themselves outside home and a wider deficit in developmental age when compared to non-working children.

CONCLUSION

Significant differences were found between working and non-working children with respect to physical and social health parameters, but differences were less with regard to mental health. Future research should focus on (1) more sensitive and early predictors of health effects, and (2) long term health effects. The generality of findings to other work settings in the developing world should also be tested.

Collaboration between nurses and agricultural teachers to prevent adolescent agricultural injuries: the Agricultural Disability Awareness and Risk Education Model

Nearly 2 million children live or work on America's farms and ranches. Despite the increasing mechanization of production agriculture in the United States, children still constitute a considerable portion of the work force on farms and ranches. When adjusted for actual work exposure time, adolescent injury rates on agricultural establishments surpass those of adults (Castillo, D. N., Landen, D. D., & Layne, L. A. (1994). American Journal of Public Health, 84, 646-649). This project, headed by two public health nurses, developed and tested an agricultural safety curriculum [Agricultural Disability Awareness and Risk Education (AgDARE)] for use in high school agriculture classes. Students who participated in AgDARE scored significantly higher in farm safety attitude and intent to change work behavior than the control group. School and public health nurses, working together with agriculture teachers, may make an effective team in reducing injuries among teen agricultural workers.

Work-related Injury among South Texas Middle School Students: Prevalence and Patterns

BACKGROUND

Work experiences among early adolescents are largely undocumented. Our purpose was to document the prevalence of work and work-related injury among lower-income Hispanic South Texas middle school students.

METHODS

Anonymous surveys were conducted in classrooms of sixth- through eighth-grade students, and 3,008 students reported current or recent employment.

RESULTS

The prevalence of work was 56%; mean weekly work hours were 7.7. Increasing weekly work hours were significantly related to work injury (11-20 hours, odds ratio [OR], 1.5; 95% confidence interval [CI], 1.1-1.9; 21+ hours, OR, 2.4; 95% CI, 1.8-3.2, compared with 1-10 hours). The odds of injury were highest for agriculture (OR, 4.4; 95% CI, 3.3-6.0), followed by restaurant (OR, 3.8; 95% CI, 2.7-5.4), construction (OR, 3.6; 95% CI, 2.4-5.2), and yard work (OR, 1.7; 95% CI, 1.4-2.2).

CONCLUSION

Working more than 20 hours weekly increased the likelihood of injury among middle school students. Parents and professionals should monitor weekly school-year work hours.

Fatal injuries to teenage construction workers in the US

BACKGROUND

The construction industry is second only to agriculture in the annual number of fatal injuries in workers less than 18 years of age. We examined fatal injury reports for youth and adult workers to determine risk factors for injury and applicability of existing child labor regulations.

METHODS

The US Occupational Safety & Health Administration (OSHA) investigation data for fatal work injuries from 1984 through 1998 were reviewed with respect to type of event, employer characteristics, and apparent violations of existing child labor laws under the Fair Labor Standards Act (FLSA). We also examined whether the employer met exemption criteria for federal enforcement of child labor or OSHA regulations.

RESULTS

The fatality rate for teenage construction workers age 19 and younger was 12.1 per 100,000 per year, slightly less than for adult workers. Teenage workers who were fatally injured were more likely than adults to have been employed at non-union construction firms (odds ratio (OR) = 4.96, P < 0.05), firms with fewer than 11 employees (OR = 1.72, P < 0.05), and their employers were more likely to have been cited by OSHA for safety violations (OR = 1.66, P < 0.05) than for firms which were investigated because of a fatality in an adult worker. Fatalities in teenagers were more likely to occur in special construction trades such as roofing. Among fatalities in workers less than 18 years of age, approximately one-half (49%) of the 76 fatal injuries were in apparent violation of existing child labor regulations. We estimated that in 41 of the 76 cases (54%) the employer's gross annual income exceeded the $500,000 threshold for federal enforcement of child labor laws. Only 28 of 76 cases (37%) were at construction firms with 11 or more employees, which are subject to routine OSHA inspections.

CONCLUSIONS

Fatal injuries in teenage construction workers differed from those in adults in that they were more likely to be at small, non-union firms of which a substantial proportion were exempt from federal enforcement of child labor laws and from routine OSHA inspections. Safety programs for young construction workers should include small, non-union construction firms and those in special construction trades such as roofing. We did not identify specific areas for new regulation but the number of fatalities reviewed was small.

Occupational accidents among middle and high school students of the state of São Paulo, Brazil

OBJECTIVES

To estimate the prevalence of occupational injuries and identify their risk factors among students in two municipalities.

METHODS

A cross-sectional survey was conducted in public schools of the municipalities of Santo Antonio do Pinhal and Monteiro Lobato, Brazil. A stratified probabilistic sample was drawn from public middle and high schools of the study municipalities. A total of 781 students aged 11 to 19 years participated in the study. Students attending middle and high school answered a comprehensive questionnaire on living and working conditions, as well as aspects of work injuries, and health conditions. Multiple logistic regression models were fitted to estimate risk factors of previous and present occupational injuries.

RESULTS

Of 781 students, 604 previously had or currently have jobs and 47% reported previous injuries. Among current workers (n=555), 38% reported injuries on their current job. Risk factors for work injuries with statistically significant odds ratio >2.0 included attending evening school, working as a housekeeper, waiter or brickmaker, and with potentially dangerous machines.

CONCLUSIONS

The study results reinforce the need of restricting adolescent work and support communities to implement social promotion programs.

Characterization of agricultural tasks performed by youth in the Keokuk County Rural Health Study

Injury and illness among youth working on farms are important problems. The types of farm tasks performed by children and the ages at which they begin these activities have not been well characterized. This cross-sectional study characterized agricultural work performed by adolescents in a rural Iowa county to better understand the patterns and extent of exposures to agricultural risk factors. This information will help to develop prevention strategies for agriculture-related injury and illnesses for children working on farms. The Keokuk County Rural Health Study is a prospective cohort study of randomly selected households in Iowa. In Round 2, all youth, aged 12 to 17 years participating in this population-based study, were asked about their use of farm machinery, work with livestock, pesticide handling, and other farm activities. The age at which they actually began these activities, the age they believed youth should start these activities, and sources of health and safety training they received were also ascertained. Adults in the study were asked the same questions about youth. Matched parental reports and opinions were compared to their children's reports and opinions using McNemar's chi-square tests. A total of 143 youth and 684 adults with farming experience completed the interviews. There were 118 pairs of parents and youth. Fifty percent of male youth, and 18 percent of females had performed agricultural work at some time in their life. Twenty-five percent of all male youth, and 5 percent of females were currently working on farms. Close to 30 percent had driven tractors, all-terrain vehicles, and pick-up trucks. Despite the legal prohibition of hazardous work by children under age 16, several younger children reported that they had driven a self-propelled combine, worked in silos, or handled and applied fertilizers in the past 12 months. Youth began riding on tractors at a mean age of 7. The mean ages for driving tractors and all-terrain vehicles were 11 and 10, respectively. The mean age for driving a self-propelled combine was 13. Children began applying or handling fertilizers at the age of 12. There were discrepancies between parent and youth reports regarding the frequencies, starting age, and opinions relative to performing agricultural tasks. These results suggest the need for implementing guidelines, particularly for age appropriate agricultural tasks.

Life on the farm-children at risk

BACKGROUND

More than 1 million children live, play, and work on farms, surrounded by animals and machinery. This symbiotic relationship between work and home exposes children to unique risks.

METHODS

Children presenting with a farm-related injury (November 1994 to August 2001, 82 months) were included. Trauma registry parameters included injury severity score (ISS); Glascow Coma Scale (GCS); time to presentation; season and day of injury; emergency room, intensive care unit, and total length of stay type; and mechanism of injury; and operations.

RESULTS

A total of 1,832 pediatric trauma patients were evaluated. Ninety-four children were identified with farm-related injuries. Mean age was 10.75 years. Mean ISS was 7.38. Three children died. Four children wore protective equipment. Forty-four percent of injuries occurred during summer, 31% during spring, and 55% on weekends. Average time to initial presentation was 39 minutes. A total of 177 minutes elapsed before transfer to regional trauma center. Seventy-two children required admission. LOS was 0 to 28 days, mean, 2.76 days. Twenty-six children (28%) required operations. Injuries included dislocations/fractures (52%), lacerations/avulsions (38%), concussions (31%), contusions (30%), and burns (14%). Mechanism included animals (41%), falls (34%), motor vehicles (28%), all-terrain vehicles (20%), and firearms (4%).

CONCLUSIONS

Farm injuries occur most commonly during weekends, summer, and spring months, resulting in significant morbidity. Most injuries required hospitalization. Unless unstable, initial transfer to a regional pediatric trauma center should result in the most cost-effective, prompt, and highest quality of care.

Antecedents of injury among youth in agricultural settings: a longitudinal examination of safety consciousness, dangerous risk taking, and safety knowledge

PROBLEM

Injuries are the leading cause of death for adolescents in the United States.

METHODS

This study longitudinally examined three psychological mediators of injury among 3,081 youths in agricultural settings: (a) safety consciousness, (b) dangerous risk taking, and (c) safety knowledge. These variables are examined within a nomological network of contextual variables.

RESULTS

Cross-sectional results revealed that safety consciousness and dangerous risk taking were the strongest predictors of reported injury at Time 1 and Time 2. Safety knowledge had an unexpected negative association with injury, albeit weak. As predicted, participating in safety activities was positively associated with safety consciousness, and time spent working was strongly associated with safety knowledge. Furthermore, self-esteem had both positive and negative safety outcomes, suggesting a more complex functioning. Males exhibited fewer safety cognitions than females as predicted. Longitudinal data also revealed that injury at Time 1 and dangerous risk taking were the strongest predictors of Time 2 injury.

IMPACT ON INDUSTRY

Results from this study emphasize the importance of assessing dangerous risk-taking perceptions when attempting to predict future injuries.

Fatal occupational electrocutions in the United States

INTRODUCTION

The highest proportions of fatal occupational electrocutions have occurred among those employed in the electrical trades and in the construction and manufacturing industries.

METHODS

Data from 1992 through 1999 were obtained from the Bureau of Labor Statistics Census of Fatal Occupational Injuries.

RESULTS

Occupational electrocution deaths occurred almost entirely among males, with the highest rates among those aged 20-34 and among whites and American Indians. They were highest during the summer months, in the South, and in establishments employing 10 or fewer workers. The highest rates occurred in the construction, mining, and agriculture, forestry, and fishing industries and among trades associated with these industries.

CONCLUSIONS

Electrocution continues to be a significant cause of occupational death. Workers need to be provided with safety training and employers, particularly smaller employers, persuaded of the need for safety training.

Causes, nature, and outcomes of work-related injuries to adolescents working at farm and non-farm jobs in rural Minnesota

BACKGROUND

Although there are many studies on working adolescents, information on youth who simultaneously hold jobs on both a farm and in other sectors of the economy is lacking.

METHODS

Six high schools in rural Minnesota were evaluated for adolescent work practices and injury incidence. A 20-page self-administered survey was administered to students.

RESULTS

A total of 2,250 students completed the survey, representing 92% of the student body. Students that simultaneously hold both farm and non-farm jobs have a significantly higher proportion of injuries. However, annual injury rates are highest for those working in non-farm only (26.7/100 full-time equivalents, FTEs) or farm only (25.9/100 FTEs) employment when compared with those working simultaneously in farm and non-farm jobs (21.9/100 FTEs).

CONCLUSIONS

Many rural students employed simultaneously on farm and non-farm jobs work long hours and are at significant risk of work-related injury. The annual injury rates we estimated are higher than those reported in previous studies.

Adolescent occupational exposures and pediatric-adolescent take-home exposures

Thousands of adolescents are employed and routinely incur occupational exposures as part of their work. Case reports of adolescent exposure-related fatalities and illness, coupled with observational studies of chemical and other exposures with potential health risks, create a strong case for better tracking of work-related exposures and illness, better training for all working adolescents, education of their parents about risks, more clinical involvement in the health and safety of working adolescents, and advocacy for safer adolescent work environments. Because adolescents are neither children nor adults, much research is needed to clarify exposure patterns and risks; however, existing data on adolescent occupational injury and knowledge of exposures to adults in similar work environments permit immediate interventions. The most applicable information from the growing knowledge of environmental health in young children also can be borrowed and applied, especially to younger workers, such as those on farms, who may be children rather than adolescents. Crucial to future protection of working youth from occupational exposures are application of knowledge that already is possessed about occupational risks to adults, a cultural change in the way the US population views risks of chemical exposures, and improved occupational health and safety protection for all adult workers. Improving occupational health for working adolescents may be more politically acceptable and thus feasible than starting with adults, but ultimately the two are linked inextricably. These are new realms for pediatricians, but pediatrician input is needed greatly on all of these levels.

Prevention of agricultural injuries among children and adolescents

Although the annual number of farm deaths to children and adolescents has decreased since publication of the 1988 American Academy of Pediatrics statement, "Rural Injuries," the rate of nonfatal farm injuries has increased. Approximately 100 unintentional injury deaths occur annually to children and adolescents on US farms, and an additional 22 000 injuries to children younger than 20 years occur on farms. Relatively few adolescents are employed on farms compared with other types of industry, yet the proportion of fatalities in agriculture is higher than that for any other type of adolescent employment. The high mortality and severe morbidity associated with farm injuries require continuing and improved injury-control strategies. This statement provides recommendations for pediatricians regarding patient and community education as well as public advocacy related to agricultural injury prevention in childhood and adolescence.

Injuries among teens employed in the homebuilding industry in North Carolina

OBJECTIVE

To describe injuries of teens employed in the residential construction industry and to assess whether their injury experiences are significantly different from those of adults in this high risk industry.

METHODS AND SETTING

North Carolina homebuilders workers' compensation data for a 41 month period were analyzed. Injuries of teens were identified and described by body part injured, nature, and cause of injury. Proportionate injury ratios were used to summarize and compare the injury experience of teens with those of adult construction workers.

RESULTS

Teens had proportionately more injuries to the eye and foot and fewer injuries to the back than adults. They had more cuts and scratches and fewer sprains and strains. They also had proportionately fewer injuries from falls from elevations and overexertion, injuries that account for a significant cost burden in construction. Consistent with these findings, teens had significantly fewer injuries resulting in medical costs or lost time costs of $1,000 or more.

CONCLUSIONS

The analyses indicate that injuries of teens are less serious than those of adults. This finding may indicate that their work exposures are less dangerous than those of adults in comparable broad categories of construction. However, the data also provide documentation of injuries to teens resulting from work at heights, use of power tools, and motor vehicles with the majority of more expensive claims involving one of these exposures. Construction is dangerous work and these results add to the documentation of the need for additional measures to prevent work related injuries among all workers-teens and adults-in this industry.

Epidemiology and prevention of injuries among adolescent workers in the United States

In the United States, most adolescents are employed at some time during their teen years. Provisions of the Fair Labor Standards Act, the nation's child labor law, address some of the risks of adolescent employment; however, > 70 teenage workers are estimated to die from work-related injuries each year, with greater risk among males, whites, and older adolescents. Furthermore, the nonfatal work-related injuries of the > or = 64,000 teens who receive emergency department care each year are believed to significantly undercount actual injuries. Many of these nonfatal injuries are severe, with 15%-45% leading to work restriction or permanent disabilities. Significant methodological issues limit the ability of existing surveillance systems to monitor youth worker injury. Risk factor and intervention research is very limited, but does suggest the role of some worker characteristics, management practices, and training issues. However, these factors need more careful study. This review considers existing information about occupational injuries among adolescents and identifies needs for research and policy attention.

The downside of adolescent employment: hazards and injuries among working teens in North Carolina

Occupational injuries are major adverse outcomes of teen employment in the United States. Using data from a survey of teens employed in three different retail trade settings (food service, grocery, and other retail) in the state of North Carolina, we examine how experience, gender, work setting, and the pace of work are associated with hazard exposures and injury experiences. Multivariate analyses show that, after controlling for individual and job-level variables, perceived work-pace pressure and hazard exposure are positively associated with variation in the types of injury experiences. We emphasize the need to include characteristics of the workplace and the labor process when assessing the adverse consequences of work on adolescent well-being.

Electrical injuries: a 30-year review

INTRODUCTION

Electrical injuries currently remain a world-wide problem. This study determines whether electrical injuries at our institution have changed in the past 30 years, and identifies electrical burn complications and any high-risk groups.

METHODS

From 1967 to 1997, 185 children admitted to our institute were identified with electrical burns. Fifty-five percent of these electrical burns occurred from 1987 to 1997.

RESULTS

During the last 10 years of this study, 43% of the electrical injuries (n = 44) were from low voltage (120-240 V) and 57% (n = 58) from high voltage (>1,000 V). In 17 children, serious low-voltage burns were identified as oral commissure burns. These were treated conservatively with one to two reconstructive procedures within 2 years. High-voltage injuries were mainly identified in male children (age 11 to 18 years). Thirty-three percent of high-voltage burns required amputation, 29% had deep muscle involvement, and 24% required either escharotomy or fasciotomy. No mortalities were reported.

CONCLUSION

Although the incidence of low-voltage burns is currently on a steady decline, high-voltage injuries remain a problem, particularly in adolescent males.

Factors influencing exposure of children to major hazards on family farms

On family farms, parents are usually knowledgeable of high-risk activities, yet they allow their children to be active participants in (or bystanders to) hazardous work for reasons not well-documented. A two-phase descriptive study, based on the theory of planned behavior and using mail survey research methods, was carried out to understand factors that influence parents' decisions to expose children to major hazards on family farms. A representative sample of 1,255 Wisconsin dairy farm fathers provided data about factors that influence their decisions to expose children younger than 14 years to risks of injury. Multivariate analyses revealed that attitudes, subjective norms, and perceived control accounted for up to three-fourths of the variance in fathers' behavioral intentions. Fathers' attitudes were stronger predictors of behavioral intentions than subjective norms (i.e., perceived social pressure) or perceived control. Grandparents and mothers exerted a limited influence. Other groups, such as health care providers, 4-H, Future Farmers of America, and insurers, exerted only a modest influence on fathers' feelings of social pressure. Few demographic characteristics of the family or farm were predictive of fathers' intentions to expose children to hazards.

Adolescent occupational injuries: Texas, 1990-1996

BACKGROUND

A comprehensive surveillance system for occupational injuries to adolescents does not exist in Texas, as in most states. Therefore, the magnitude, severity, nature, and source of injuries to working adolescents have not been well described in Texas.

METHODS

The investigators used three data sources to investigate work-related injuries and deaths in Texas: (1) Texas Workers' Compensation Commission (TWCC) claims data from 1991 through April 1996; (2) 1993 TWCC/Bureau of Labor Statistics (BLS) Annual Survey of Occupational Injuries and Illnesses; and (3) work-related fatalities identified from Texas death certificates from 1990-1995.

RESULTS

There were 9,027 injuries reported to the TWCC for adolescents 14-17 years of age during slightly more than 5 years. Injuries for which indemnity payments were made (more than 7 days out of work) occurred among 21.7% of the adolescents. Based on BLS data in 1993, of 992 non-fatal injuries involving days away from work, 35% were caused by contact with objects, 27% by bodily reaction, and 24% by falls. Two-thirds of these injuries occurred while working in eating and drinking places and grocery stores. Three-quarters of the 30 deaths from 1990-1995 were accounted for equally by motor vehicle and homicide.

CONCLUSIONS

In conclusion, a substantial number of adolescents are injured or killed in the workplace each year in Texas. Although improved population-based surveillance is needed, sufficient knowledge exists to begin prevention efforts now.

Costs of occupational injuries to teenagers, United States

OBJECTIVES

This paper estimates the incidence and costs of teenage occupational injuries by severity in the United States.

METHODS

Existing estimates of occupational injury costs are adapted for the teenage population. Incidence estimates are constructed using data from the US 1993 Annual Survey of Occupational Injury and Illness and the 1993 Census of Fatal Occupational Injuries combined with incidence data from the National Health Interview Survey.

RESULTS

In 1993, an estimated 371,000 teenagers were injured in the workplace, accounting for 4.2% of all occupational injuries. These injuries cost $5 billion, approximately 3% of the total of injury costs involving teenagers.

CONCLUSIONS

Teenagers appear to account for a larger share of the total number of occupational injuries relative to their presence in the employed workforce, but a lower share of the costs of such injuries.

Occupational injuries among adolescents in Washington State, 1988-1991

BACKGROUND

To characterize work-related injuries and illnesses in minors.

METHODS

We analyzed Washington State workers' compensation claims from 1988 through 1991.

RESULTS

There were 17,800 claims among adolescents from age 11 through 17 years accepted in the 4-year period, including three occupational fatalities, 22 amputations, and 464 fractures; 89% of all injuries occurred among the 16- and 17-year-olds. Claims were most frequent in restaurants, food stores, service industry, other retail and wholesale trade, and agriculture. Washington State census data were used for denominator in calculating injury rates for adolescents and adults. The crude injury rate for 16- and 17-year-olds employed at the time of the census was similar to that seen among adults (9.0 vs 10.4 per 100 workers), despite that minors work fewer hours per year. The rate among boys was almost twice that seen among girls (11.7 vs. 6.4 per 100 workers). Highest rates, per 100 workers, were in public administration (27.0), construction (21.1), agriculture (11.4), and restaurants (11.0). Using census data for those working anytime over the course of the year and adjusted for the number of hours worked, the injury rate for 16- and 17-year-olds was 19.4/100 full time equivalents compared with 10.6 of 100 full-time equivalents for adults. Most injuries were lacerations, sprains and strains, contusions, and burns.

CONCLUSIONS

Public health policy and injury prevention strategies for working adolescents should be developed and implemented.

Teens at work: a statewide study of jobs, hazards, and injuries

PURPOSE

Occupational injury is an ongoing and serious threat to American youth. However, little is known about the environments in which youth work or the hazards to which they are exposed. The purpose of this study was to document the patterns of work, exposures to hazardous equipment and situations, and work-related injury experiences of adolescents.

METHODS

We identified a statewide targeted sample of North Carolina households with teens age 14-17 years and interviewed those who had ever worked for pay or worked on a farm.

RESULTS

Five hundred sixty-two teens from 700 eligible households reported that they had worked non-farm jobs for pay. One-third were paid for work before age 14 years; two-thirds had held more than one paid job. Place of employment was most often someone's home, a retail store, or a restaurant. Common jobs were lawn care worker, cashier, and dishwasher. Common hazards to which teens were exposed included ladders or scaffolding; forklifts, tractors or riding mowers; and working around loud noises. Over half were injured at least once while working a paid job, most often from being cut or burned.

CONCLUSIONS

Work among youth is common. Teens hold a variety of jobs, mostly in the retail trade and the service sector, exposing them to hazardous equipment and situations. Injuries at work are frequent and some are serious. This study supports the need to include an occupational history and work-related safety counseling in clinical encounters with adolescents.

Occupational injury deaths of 16 and 17 year olds in the US: trends and comparisons with older workers

OBJECTIVE

To examine patterns of occupational injury deaths of 16 and 17 year olds in the United States for the three year period 1990-2, examine trends since the 1980s, and compare fatality rates with those of older workers.

METHODS

Occupational injury deaths were analyzed using the death certificate based National Traumatic Occupational Fatalities (NTOF) surveillance system. Fatality rates were calculated using estimates of full time equivalent (FTE) workers based on data from the Current Population Survey, a monthly household survey.

RESULTS

There were 111 deaths of 16 and 17 year olds for the years 1990-2. The average yearly rate was 3.5 deaths/100,000 FTE. The leading causes of death were motor vehicle related, homicide, and machinery related. All causes occupational injury fatality rates for 16 and 17 year olds were lower than for adults for 1990-2. Rates for the leading causes of death (motor vehicle related, homicide, and machinery related) were comparable or slightly higher than the rates for young and middle aged adult workers. Although rates decreased dramatically from 1980 to 1983, the decreasing trend attenuated in later years.

CONCLUSIONS

Comparisons of youth fatality rates to those of adult workers should address differences in patterns of employment, most importantly hours of work. Comparisons to narrow age groupings of adults is preferable to a single category of all workers 18 years and older. Increasing compliance with federal child labor regulations could help reduce work related deaths of youth. Other measures are needed, however, as there are many work hazards, including those associated with homicides, that are not addressed by United States federal child labor law regulations.

Occupational injuries among adolescents in Dunedin, New Zealand, 1990-1993

STUDY OBJECTIVE

In this study we describe occupational injuries among adolescents (ages 15 through 19 years) presenting at a hospital ED in Dunedin, New Zealand, 1990-1993.

METHODS

We used a new database to identify work-related injuries, as well as type of injury, cause of injury, injury site, occupation, industry, age, and sex.

RESULTS

During the 4 years of the study, 1,361 work-related injuries were treated at the ED, for an injury rate of 13.8 per 200,000 hours worked (100 full-time equivalents). Males had a rate of 20.6 injuries, females 5.8 injuries, per 200,000 hours. Compared with injury rates from other studies, rates were lower than, but reasonably comparable to, those rates estimated through more detailed surveys. Main injury sites included upper extremities (mostly hands), head (mostly eyes), and lower extremities. Laceration was the main type of injury, followed by sprain/strain and foreign body. External cause of injury was mainly cutting/piercing objects, followed by foreign body and being struck by or against an object. The rate was highest for the 16- and 17-year-olds and decreased for 18- and 19-year-olds. The rates of injuries in the construction sector were the highest of all occupational groups, at 27 injuries per 200,000 hours, followed by transportation/ communication, manufacturing (including meat and fish processing), and business and repair services. Laborers were the highest occupational risk group, with 36 injuries per 200,000 hours, followed by machine operators, precision production workers, and service workers.

CONCLUSION

These findings may be helpful in focusing prevention efforts in high-incidence areas. This study demonstrates how a well-planned data-collection system can overcome some of the previously described difficulties of getting prevention-oriented information from EDs.

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.