Unintentional injuries in school-aged children and adolescents: lessons from a systematic review of cohort studies

OBJECTIVES

To critically synthesise current knowledge of the patterns of injuries and risk factors for injury in school-aged children, to summarise the evidence and support effective child injury prevention initiatives.

DESIGN

Systematic review. Selection criteria and

METHODS

Prospective cohort studies reporting unintentional injuries in healthy children aged 5-18 years were identified by searching 15 electronic databases and additional grey literature sources. A narrative synthesis was conducted of papers meeting quality criteria, with risk factors analysed at individual, family and environmental levels. Limitations of existing evidence were considered.

RESULTS

44 papers from 18 different cohort studies met the inclusion criteria. There were broad and consistent patterns of injury across time and place. Male sex, psychological, behavioural and risk-taking behaviour problems, having a large number of siblings, and a young mother were all associated with increased injury occurrence across more than one cohort and setting.

CONCLUSIONS

Descriptive epidemiology and risk factors for injury were derived from prospective cohort studies, but few studies used the full potential of their design. Opportunities to use repeated measures to assess temporal changes in injury occurrence, and the exploration of risk factors, particularly those related to the child's environment, have rarely been undertaken. Few studies were conducted in low/middle-income countries where the burden of injury is greatest. These findings should be considered when planning future research and prevention initiatives.

Child injury in a changing world

The importance of child injuries has now been recognised as a significant public health problem internationally. The World Health Organisation (WHO) and United Nations Children's Fund (UNICEF) have recently published the first world report on child injury prevention. As infectious diseases decline, the relative importance of injury has increased, but the pace of change of global processes means that absolute increases in injury may occur over the next 20-30 years. This paper examines child injury in a changing world by outlining the ways in which the forces of globalisation, urbanisation, motorisation and environmental change could have an impact on injury epidemiology and policy. We consider how those in public health and those in the injury field should respond to the changing world of injury. Child injury prevention needs to be incorporated into planning for the rapidly changing urban environments of low-income countries and strategies devised for the large numbers of people displaced by environmental change.

Fatal and non-fatal fire injuries in England 1995-2004: time trends and inequalities by age, sex and area deprivation

AIM

To examine time trends and deprivation gradients in fire-related deaths and injuries.

METHODS

A cross-sectional study and time trend analysis using data on fire casualties in England between 1995 and 2004 obtained from the Department for Communities and Local Government. Injury rates were calculated assuming a Poisson distribution. Incidence rate ratios (IRRs) were calculated to compare changes in deprivation gradients over time.

RESULTS

There were significant reductions in fatal and non-fatal fire injuries in children (fatal injuries IRR chi(2)(1) = 11.18, P < 0.001; non-fatal injuries IRR chi(2)(2) = 61.44, P < 0.001), adults (fatal injuries IRR chi(2)(1) = 15.99, P < 0.001; non-fatal injuries IRR chi(2)(2) = 183.25, P < 0.001) and older people (fatal injuries IRR chi(2)(1) = 56.88, P < 0.001; non-fatal injuries IRR chi(2)(2) = 54.09, P < 0.001) between 1995 and 2004. Adult and child fire deaths were most commonly caused by smokers' materials (e.g. cigarettes, cigars and tobacco), and cigarette lighters and matches, respectively. Cooking appliances caused most non-fatal fire injuries. Injury rates increased with increasing levels of deprivation and deprivation gradients did not change over 10 years.

CONCLUSIONS

Fire prevention interventions should promote the safe use of cooking and heating appliances and the responsible use of smokers' materials, lighters and matches, and should target those at greater risk of fire, including the socially disadvantaged.

Understanding high traffic injury risks for children in low socioeconomic areas: a qualitative study of parents' views

OBJECTIVE

To gain an in-depth qualitative understanding of parents' views about their children's exposure to road traffic injury risk in low socioeconomic areas.

DESIGN

Focus groups facilitated by a moderator with content analysis of data.

SETTING

Focus groups were conducted in 10 low socioeconomic English districts that also have high rates of child pedestrian injury. Research was conducted in community venues within each area.

SUBJECTS

Parents of children aged 9-14 years living in low socioeconomic areas.

RESULTS

Parents believe that children play in their local streets for the following reasons: they like playing out with friends near home; there are few safe, secure, and well-maintained public spaces for children; children are excluded from affordable leisure venues because of their costs; insufficient parental responsibility. For children that play in the street, the key sources of risk identified by parents were: illegal riding and driving around estates and on the pavements; the speed and volume of traffic; illegal parking; drivers being poorly informed about where children play; children's risk-taking behavior.

CONCLUSIONS

Intervention programs need to take into account multiple reasons why children in low socioeconomic areas become exposed to hazardous environments thereby increasing their risk of injury. Multi-agency partnerships involving the community are increasingly needed to implement traditional road safety approaches, such as education, engineering, and enforcement, and provide safe and accessible public space, affordable activities for children, and greater support for parents.

Traffic injury mortality in children in transitional Lithuania--a longitudinal analysis from 1971 to 2005

AIM

Low- and middle-income countries bear far higher road traffic injury mortality rates than high-income countries. This paper considers the changing picture of child traffic injury mortality in Lithuania over a 35-year period.

METHODS

Road traffic injury mortality data, mortality data from other causes, and population data have been used to compare the trend lines of child road deaths with injury deaths and all deaths and calculate the road traffic mortality rates for children and young people aged 0-19 years.

RESULTS

This study revealed an inverted u-shaped trend, peaking in the 1980s and with a temporary elevated level in the early 1990s, in traffic mortality for the age group 0-19. However, unlike child death by all causes, road traffic injury has not declined significantly between the beginning and the end of the study period. Traffic deaths as a percentage of injury deaths and of all deaths showed a significantly rising trend.

CONCLUSION

Road traffic injury remains a serious public health problem in children and young people in Lithuania, which requires a high priority.

Evidence into practice: combining the art and science of injury prevention

OBJECTIVES

To bring together scientific evidence of what works in injury prevention with the knowledge and experience of practitioners, using a case study of smoke alarm installation from England.

DESIGN

There is good evidence of strategies to reduce injuries but less is known about the art of translating those strategies to implementation in real-world settings. England's Health Development Agency developed a structured process applicable to many public health fields, which integrates practitioner knowledge into the evidence base and reflects local contexts. The multistep process includes convening structured field meetings with local practitioners and policy makers, which focus on a mapping exercise of strategies, policies, targets, and funding streams related to childhood injury prevention, and barriers and facilitators relating to implementation of specific interventions.

SETTING

Meetings were held in six venues across England with 98 participants from a range of professional backgrounds and sectors.

RESULTS

The collective knowledge of participants provided many local insights unlikely to emerge in conventional research. Discussion topics covered key partners and sectors to include when planning a program; national policies and programs that could be used to drive the agenda; potential sources of funding; the importance of providing and installing appropriate smoke alarms; targeting of programs; and suggestions for gaining access to hard-to-reach populations.

CONCLUSION

This methodology represents an efficient way of gaining insight necessary for successful implementation of evidence based programs. It may be particularly useful in lower and middle income countries, serving to translate evidence into the local contexts and circumstances within which practitioners operate.

UNICEF's child injury league table. An analysis of legislation: more mixed messages

This paper presents a summary table and discussion of legislation related to child injury prevention in member countries of the Organisation for Economic Cooperation and Development. The table is an expanded version of the one which appeared in the UNICEF Report Card "Child Deaths by Injury in Rich Countries" (2001). A commentary is provided on the variations in legislation between countries in terms of range and form of measures and an estimate of degree of enforcement. As legislation is generally considered a powerful tool in injury prevention, the paper examines whether those countries with the widest range of legislation and the strongest enforcement have made the most progress in reducing child injury deaths since the 1970s. It also considers whether a commitment to extensive legislation is reflected in a country's position in the UNICEF league table of injury death. The initial conclusion to these two basic issues is that no clear picture can be seen and we thus need to know far more about the relationship between legislation and societies and cultures as they vary from place to place. This paper hopes to stimulate more widespread debate about the role of legislation in different countries.