Pediatric injury hospitalization in Hispanic children and non-Hispanic white children in southern California

The Injury Prevention Program to Reduce Early Childhood Injuries: A Cluster Randomized Trial

BACKGROUND AND OBJECTIVES

The American Academy of Pediatrics designed The Injury Prevention Program (TIPP) in 1983 to help pediatricians prevent unintentional injuries, but TIPP's effectiveness has never been formally evaluated. We sought to evaluate the impact of TIPP on reported injuries in the first 2 years of life.

METHODS

We conducted a stratified, cluster-randomized trial at 4 academic medical centers: 2 centers trained their pediatric residents and implemented TIPP screening and counseling materials at all well-child checks (WCCs) for ages 2 to 24 months, and 2 centers implemented obesity prevention. At each WCC, parents reported the number of child injuries since the previous WCC. Proportional odds logistic regression analyses with generalized estimating equation examined the extent to which the number of injuries reported were reduced at TIPP intervention sites compared with control sites, adjusting for baseline child, parent, and household factors.

RESULTS

A total of 781 parent-infant dyads (349 TIPP; 432 control) were enrolled and had sufficient data to qualify for analyses: 51% Hispanic, 28% non-Hispanic Black, and 87% insured by Medicaid. Those at TIPP sites had significant reduction in the adjusted odds of reported injuries compared with non-TIPP sites throughout the follow-up (P = .005), with adjusted odds ratios (95% CI) of 0.77 (0.66-0.91), 0.60 (0.44-0.82), 0.32 (0.16-0.62), 0.26 (0.12-0.53), and 0.27 (0.14-0.52) at 4, 6, 12, 18, and 24 months, respectively.

CONCLUSIONS

In this cluster-randomized trial with predominantly low-income, Hispanic, and non-Hispanic Black families, TIPP resulted in a significant reduction in parent-reported injuries. Our study provides evidence for implementing the American Academy of Pediatrics' TIPP in routine well-child care.

Racial Differences in Hospitalizations Due to Injuries in South Dakota Children and Adolescents

OBJECTIVES

To determine racial differences and trends in pediatric injury hospitalization rates in a rural state.

METHODS

Hospital inpatient discharge data (2009-2014) for South Dakota residents aged 0-19 years were used to calculate annual hospitalization rates due to injuries. Race-, age-, and sex-specific rates were calculated, and trends over time were determined.

RESULTS

Between 2009 and 2014, there were 3701 pediatric hospitalizations (1008 American Indian [AI]; 2303 white) due to injuries at an average rate of 269/100,000 (95% CI 260-280/100,000). Injury hospitalization rates were higher for AI than white children (532 vs. 213 per 100,000, respectively; p < 0.001). Rates for both AI and white children increased between 2009 and 2014 (both, p < 0.001). Suicide attempts were the predominant manner of injury in both the 10-14- and 15-19-year age groups, with AI adolescents having 3.5 and 3.2 times higher rates than white adolescents. Among AI adolescents aged 15 to 19 years, hospitalizations due to homicide-related injuries were 12.6 times higher than that of white children. Injury hospitalization rates among females recently exceeded that of males, due primarily to an increase in attempted suicides. Mechanism and nature of hospitalized injuries were consistent with the high rate of suicide-related admissions.

CONCLUSION

South Dakota AI children have disproportionately higher hospitalization rates due to unintentional and attempted suicide- and homicide-related injuries, and the rate differences between AI and white children are increasing over time. Injury hospitalization rates among females have increased more rapidly and recently surpassed that of males.

Factors Associated with Increased Risk for Acute Unintentional Childhood Poisoning among Children Living on the U.S.-Mexico Border

This study evaluated prevalence of unsafe storage of toxic products and evaluated the association of demographic-socio-cultural variables with risk of young-child exposure to household poisons. Interviews were conducted with 698 low-income caregivers living on the U.S./Mexico border. Multiple-ordinal regression was used to analyze associations between very unsafe storage of toxic products and household factors. At least one toxic product was accessible to children in 49.4% of households and 18.5% of these households' stored substances very unsafely in that products were accessible and stored either in non-original containers or without childproof caps. At-risk households were associated with U.S.-born caregivers who were single, employed, and live in more U.S. acculturated communities. These homes stored an increased number of toxins and were more likely to house a smoker. U.S./Mexico border childhood poisoning prevention programs should focus on potentially acculturated families with personal and household characteristics akin to the U.S. mores and customs.

Alarming trends in the improper use of motor vehicle restraints in children: implications for public policy and the development of race-based strategies for improving compliance

PURPOSE

Little is known regarding the patterns of appropriate restraint use among minority children involved in motor vehicle collisions. The purpose of this study was to characterize patterns of restraint use among children hospitalized after motor vehicle collision and to examine the effects of race and socioeconomic status on compliance.

METHODS

All children admitted to our level I trauma center over a 10-year period were identified. Patterns of appropriate restraint use were compared between African American (AA) and white children. Compliance was also compared between children insured with Medicaid (as a surrogate for socioeconomic status) and those with private insurance coverage.

RESULTS

One thousand two hundred sixty-eight patients were included with an overall restraint use of 44.8% with only 20.3% restrained properly. Compared with white children, AAs were significantly less likely to be properly restrained (12.7% vs 22.2%, P < .001) or to be restrained by any means (28.8% vs 48.7%, P < .001). The greatest disparity between groups was observed in the use of car seats (16.0% vs 47.4%, P < .001). Medicaid patients were less likely to be restrained compared with those with commercial insurance (40.6% vs 48.3%, P = .022); however, race remained a significant predictor of noncompliance after controlling for the effect of insurance status.

CONCLUSIONS

These data demonstrate an alarming trend because nearly 80% of all children in our study were improperly restrained. Marked disparities in compliance were observed in the AA population even after controlling for insurance coverage. Future studies will need to further characterize the complex interplay between race and socioeconomic status with proper restraint use.

A Comparison of Nonfatal Unintentional Injuries in the United States Among U.S.-Born and Foreign-Born Persons

The objective of this research was to compare the risk of nonfatal unintentional injuries between foreign-born and U.S.-born persons. Cross-sectional, nationally representative data were used from the 2000-2003 National Health Interview Survey to compare the risk of injury between 62,267 foreign-born and 322,200 U.S.-born persons. Nonfatal unintentional injuries occurring during the three months prior to the interview were compared by age, gender, education, poverty status, region of residence, family size, and health insurance coverage status. There were a total of 7,654 injured persons with U.S.-born persons having a weighted injury prevalence of 2.3% (95% confidence interval [CI]: 2.2, 2.4) and foreign-born persons having a weighted injury prevalence of 1.2% (95% CI: 1.0, 1.3). With the U.S.-born population as the reference and while controlling for sociodemographic characteristics, the odds ratio of injury risk was 0.54 (95% CI: 0.48, 0.62) for the foreign-born population. Transportation-related injuries occurred more frequently among foreign-born persons than among U.S.-born persons (23.7%, 95% CI: 19.7, 28.3 vs. 15.0%, 95% CI: 14.0, 16.2, respectively). This research is the first step in determining the morbidity from unintentional injuries among the foreign-born population in the U.S.

Severe injury among Hispanic and non-Hispanic white children in Washington state

OBJECTIVES

The authors' anecdotal experience at a regional Level I trauma center was that Hispanic children were overrepresented among burn patients, particularly among children with burns due to scalding from hot food. This study describes injury incidence and severity among Hispanic and non-Hispanic white infants, children, and adolescents with serious traumatic injuries in Washington State.

METHODS

Data from the Washington State Trauma Registry for 1995-1997 were used to identify injured individuals aged < or = 19 years. Ratios of overall and mechanism-specific injury incidence rates for Hispanic children relative to non-Hispanic white children were calculated using denominator estimates derived from U.S. Census Bureau population data. Hispanic children and non-Hispanic white children were also compared on several measures of severity of injury.

RESULTS

In 1995-1997, serious traumatic injuries were reported to the Registry for 231 Hispanic children aged < or = 19 years (rate: 54 per 100,000 person-years) and for 2,123 non-Hispanic white children (56 per 100,000 person-years), yielding an overall rate ratio (RR) of 1.0 (95% confidence interval [CI] 0.8, 1.1). Motor vehicle crashes and falls accounted for one-third to one-half of the injuries for each group. Infants, children, and adolescents identified as Hispanic had higher rates of injuries related to hot objects (i.e., burns) (RR=2.3; 95% CI 1.3, 4.1), guns (RR=2.2; 95% CI 1.5 to 3.3), and being cut or pierced (RR=3.5; 95% CI 2.2 to 5.5). The Hispanic group had a lower injury rate for motor vehicle accidents (RR=0.7; 95% CI 0.5, 0.9). Mortality rates were similar (RR=1.1; 95% CI 0.7, 1.7). The mean length of hospital stay was 5.5 days for the Hispanic group and 8.8 days for the non-Hispanic white group (difference=3.3 days; 95% CI -0.7, 7.4).

CONCLUSIONS

The study found little difference between Hispanic and non-Hispanic white infants, children, and adolescents in the burden of traumatic pediatric injury. However, burns, guns, drowning, and being pierced/cut appeared to be particularly important mechanisms of injury for Hispanic children. More specific investigations targeted toward these injury types are needed to identify the underlying preventable risk factors involved.

An ecological study of the locations of schools and child pedestrian injury collisions

Geographic studies of the incidence and prevalence of child pedestrian injury collisions in different community environments have been primarily descriptive and idiosyncratic, reflecting one or another likely determinant of the places where these injuries occur. The current study maintains that multiple determinants of child pedestrian injury collisions must be considered in evaluating the unique contributions of any one community feature to injury rates. These features include local characteristics of populations, such as rates of unemployment, and places, such as locations of schools. Schools are one stable geographic feature associated with regular, often concentrated periods of complex and congested traffic patterns. The objective of the present study was to examine annual rates of child pedestrian injury in four California communities with a focus on the unique contribution of schools to injury risk. We predicted that annual numbers of child pedestrian injury collisions (both in-school and summer combined) would be greater in communities with higher youth population densities, more unemployment, fewer high-income households, and higher traffic flow. It was hypothesized that youth population density and its interaction with the number of schools in a given area would be related to greater rates of child pedestrian collisions during in-school months. An ecological approach was taken that divided the four communities into 102 geographic units with an average of 6321 people residing in each unit. Archival data on traffic flow, number of child pedestrian injury collisions and locations of schools were obtained from state agencies. Individual-level data were obtained from a general population survey conducted in the communities. The results showed that annual numbers of injuries were greater in areas with higher youth population densities, more unemployment, fewer high-income households, and greater traffic flow. Annual numbers of injuries during in-school months were greater in areas containing middle schools and greater population densities of youth.

Assuring the health of immigrants: what the leading health indicators tell us

Over the past 20 years, the United States has experienced one of the largest waves of immigration in its history. Understanding the health status and needs of immigrants is important because of their growing numbers and their contribution to the health of the nation, but it is challenging because of gaps in national databases, the heterogeneity of immigrant populations, and uncertainty about how migration affects health. Healthy People 2010 outlines the nation's public health objectives for the current decade. It includes ten leading health indicators (LHIs) chosen because of their importance as public health issues, their ability to motivate action, and the availability of data to measure their progress. In this paper, we discuss the health of immigrants from the perspective of these LHIs, as they provide a framework for anticipating some of the future health needs of immigrants and help define priority areas for research and action.

Evaluating the utilization of a regional poison center by Latino communities

BACKGROUND

Penetrance values estimate the utilization of poison centers services. For a variety of reasons, penetrance values may vary greatly among geographic areas of population. We examined the relationship between ethnicity and penetrance in our population.

METHODS

We conducted a retrospective review of data from January 1, 2000 through December 31, 2000 from our poison center's database. Home calls to the center were evaluated by zip code, age, gender, substance, route of exposure, and outcome. These data were compared with U.S. Census 2000 geographic and community demographic data for San Diego by zip code. From this information, we identified zip code regions with substantial Latino populations (>50%), and substantial Caucasian populations (>70%). Study groups were limited to those zip codes with median household incomes of $20,000-$50,000. Aggregate total and pediatric penetrance values were calculated for each group and compared.

RESULTS

Our study group consisted of 6 zip codes with significant numbers of Latino residents, and 11 zip codes with significant numbers of Caucasian residents. Aggregate call volume for the county was 6.5 calls per 1000 population, while that for children less than age 5 was 43. Penetrance values for the study zip codes with large Latino populations were significantly lower with a mean value of 22.4 for children, and 5.0 for all ages. These values were statistically significant when compared to county data and that from the control zip codes with largely Caucasian residents (61 aggregate and 49.6 pediatric).

CONCLUSION

Penetrance values were significantly lower in zip codes with large numbers of Latino residents. Reasons for this variation are being investigated.

Adjusting our view of injury risk: the burden of nonfatal injuries in infancy

OBJECTIVE

To describe the incidence, external cause, and types of injuries among infants treated in US emergency departments (EDs) and to compare the external cause of nonfatal to fatal injuries.

DESIGN

ED survey from the National Center for Health Statistics (NCHS) National Hospital Ambulatory Medical Care Survey for 1992-1999 and NCHS mortality data.

PATIENTS

National probability sample of patients treated in EDs; data for children <1 year old were used.

OUTCOME MEASURES

Incidence and external cause of nonfatal injury among infants. Rates were calculated using NCHS data for live births.

RESULTS

The 8-year annualized, weighted estimate of infant injuries was 426 957, a rate of 108.2 per 1000 infant years (95% confidence interval [CI]: 94.8-121.5). There were no significant differences in rates by sex, race, or ethnicity. An estimated 6% were admitted to the hospital (admission rate: 6.1 per 1000). Most injuries occurred in the home. Head trauma accounted for injuries in 12% of children (injury rate: 13.4 per 1000 per year [95% CI: 9.3-17.3]; 21% of children with head trauma had a skull fracture or an intracranial injury. An estimated 30.2 per 1000 (95% CI: 23.8-36.6) had face trauma and 23.9 per 1000 (95% CI: 18.2-29.6) had extremity injuries; open wounds or superficial injuries accounted for many of these injuries. An estimated 4% had extremity fractures (annual rate: 4.6/1000). Falls were the most frequent cause of injury (an estimated 35.1 per 1000 infant years). The rate of motor vehicle traffic injuries was 8.8 per 1000. Foreign bodies accounted for an estimated 5.2 injuries and poisonings for an estimated 3.8 injuries per 1000 infant years. A comparison with infant mortality data showed the ratio of nonfatal to fatal falls to be 8789:1. The ratio of nonfatal to fatal motor vehicle traffic injuries was 197:1. There were an estimated 1271 nonfatal poisonings for each poisoning fatality.

CONCLUSIONS

Nonfatal injuries far outnumber fatalities. Injuries from falls are very common, but they are rarely fatal. Surveillance of nonfatal injuries is essential to accurately describe and understand the burden of injury among infants. Prevention strategies must be developed to address extremely frequent, less serious injuries in infancy.

Injury related infant death: the impact of race and birth weight

OBJECTIVE

To examine the effect of race and birth weight independent of other sociodemographic factors on injury related infant death using national data.

SETTING

Infants born in the United States to mothers who were white (non-Hispanic), African American, Mexican American, and Native American.

METHODS

Linked infant birth and death data from the National Center for Health Statistics for 1989-91 were analyzed to calculate unadjusted and adjusted odds ratios for death due to homicide or unintentional injury within the first year of life. In addition to maternal race and birth weight, the risk of death was adjusted for maternal age, prenatal care, maternal education, paternal education, marital status, birth order, interval since last pregnancy, smoking during pregnancy, and alcohol intake during pregnancy.

RESULTS

Among 10.7 million births during 1989-91, 821 homicides and 2397 unintentional deaths were reported in infants. Relative to whites, African Americans were at highest risk for homicides (unadjusted and adjusted odds ratios = 3.6 (95% confidence interval = 3.1 to 4.2) and 1.6 (1.3 to 1.9), respectively) and Native Americans at highest risk for unintentional injuries (unadjusted and adjusted odds ratios = 3.8 (3.0 to 4.8) and 2.1 (1.7 to 2.6), respectively). After accounting for other sociodemographic factors, Mexican American infants appeared protected from injury (adjusted odds ratio = 0.7 (0.6 to 1.0) for homicides and 0.7 (0.6 to 0.8) for unintentional injuries). An inverse effect of birth weight was seen-as birth weight decreased, risk of homicides and unintentional injuries increased. After adjustment for the sociodemographic factors, very low birthweight babies were still at substantially increased risk of homicides with an odds ratio of 2.1 (1.4 to 3.1) and unintentional injuries with an odds ratio of 2.9 (2.4 to 3.7).

CONCLUSIONS

Using a large national data-set, the effect of race as a risk factor for fatal infant injuries was mostly explained by birth weight and other sociodemographic factors. Preventable risk factors need to be identified for African Americans and Native Americans, in particular. Birth weight is an important independent risk factor; very low birthweight babies should be monitored for both homicide and unintentional injury.

Injury in children of low-income Mexican, Mexican American, and non-Hispanic white mothers in the USA: a focused ethnography

Several studies indicate that rates of serious pediatric injury are higher among Hispanics than among non-Hispanic whites in the USA. To investigate possible contributory factors, we interviewed 50 Mexican, 30 Mexican American, and 30 non-Hispanic white mothers in their own homes in the same low-income neighborhoods of Southern California. Mothers were identified via door-to-door canvassing in areas with high rates of pediatric injury. We observed household conditions and behaviors and obtained a detailed family history, including accounts of any occurrence of serious injury in a child under 5 years old, the highest-risk age group for pediatric injury. Results show that Mexican families were poorer, less educated, and lived in more hazardous and crowded conditions than did families in the other two groups. Nevertheless, they benefited from strong family bonds and a cultural tradition in which responsible older children typically supervise younger siblings. In contrast, a number of Mexican American and white mothers had been abused as children and were estranged from their own mothers; hence they lacked support and models of good parenting. There was much less self-reported smoking, drug use, and mental dysfunction among the Mexican mothers and their male partners as well as much less excessively active and/or aggressive behavior among their children. The nature of the injuries reported by the various groups seemed to reflect these differences. Appropriate interventions for each group are discussed. The study illustrates the importance of using ethnographic methods to examine the context of pediatric injury at the household level.

Relationship between socioeconomic factors and severe childhood injuries

The objective was to examine the relationship between injury rates and socioeconomic factors for children in Hamilton County, Ohio, using small-area analysis. The subjects were county residents less than 15 years old who were hospitalized or died of injuries between January 1, 1993, and December 31, 1995; they were identified through a population-based trauma registry. The census tract was the unit of analysis; the rate of injury per 100,000 population was the dependent variable. Risk factors included median income, level of education, percentage below the poverty level, percentage unemployment, percentage non-Caucasian, and percentage families headed by females. There were 2,437 children meeting the case definition; injuries per census tract ranged from 0 to 2,020.2 per 100,000 per year. Census tracts with higher injury rates had lower median incomes, more people with less than a high school education, more unemployment, more families headed by females, more people living below the poverty level, and more non-Caucasians than those with lower rates. In a regression model, percentage of people living below the poverty level, percentage of those who did not graduate from high school, and percentage unemployment were significant risk factors for injuries, P < .001. Since small-area analysis examines associations on an ecological level rather than an individual level, these studies should always be interpreted with caution because an association found at the level of the census tract may not apply at the individual level. Interventions to reduce injuries should target socioeconomically disadvantaged children living below the poverty level and those in areas with fewer high school graduates and more unemployment.

Social differences in traffic injury risks in childhood and youth--a literature review and a research agenda

OBJECTIVES

The paper reviews the scientific literature concerning social differences in traffic injuries in childhood in order to highlight the current state of knowledge and to draw the main lines of a research agenda.

METHOD

A conceptual framework is used that identifies the mechanisms through which social context, social position, and various exposures may interact in the determination of health inequalities. It is used as a frame for presenting the evidence accumulated so far concerning social differences in traffic injury in childhood, including pedestrian, cyclist, and vehicle passenger injuries.

RESULTS

For most types of traffic injuries, mortality and morbidity are often higher among children from lower social positions and in more deprived socioeconomic areas. Whether the greater occurrence of injuries in deprived areas is a phenomenon attributable to the areas themselves, or merely a reflection of a wider pattern of injuries affecting lower socioeconomic groups, is unclear. There is evidence of an interaction effect between age and gender, and also between socioeconomic status and gender.

CONCLUSIONS

The mechanisms leading to social inequalities in traffic injuries in childhood deserve greater scrutiny in future research. Further theoretical developments and empirical investigation will help define intervention needs and enable more effective targeted, long term prevention.

Latino child health: need for inclusion in the US national discourse

The "rediscovery" of poverty, as echoed in concepts of social inequality, has contributed to the goal of eliminating racial/ethnic and social class disparities in the United States. This commentary focuses on what we know about the pressing health care needs and issues relevant to Latino children and families and how extant knowledge can be linked to priority policy recommendations to ensure the inclusion of Latino health issues in the national discourse. A systematic review of the literature on Latino children and of expert opinion revealed 4 evidence-based themes focused on poverty: economic factors, family and community resources, health system factors, and pitfalls in Latino subgroup data collection. Consensus was found on 4 priority policy recommendations: (1) reduce poverty and increase access to health care coverage, (2) increase funding in targeted primary and preventive health care services, (3) provide funds needed to fully implement relevant health legislation, and (4) improve measurement and quality of data collection. If these recommendations are not instituted, the goals of Healthy People 2010 will not be achieved for the Latino population.

Trends in incidence of pediatric injury hospitalizations in Pennsylvania

OBJECTIVES

This study analyzed short-term trends in pediatric injury hospitalizations.

METHODS

We used a population-based retrospective cohort design to study all children 15 years or younger who were admitted to all acute care hospitals in Pennsylvania with traumatic injuries between 1991 and 1995.

RESULTS

Injuries accounted for 9% of all acute hospitalizations for children. Between 1991 and 1995, admissions of children with minor injuries decreased by 29% (P < .001). However, admissions for children with moderate (P = .69) or serious (P = .41) injuries did not change.

CONCLUSIONS

Significant declines in pediatric admissions for minor injuries were noted and may reflect both real reductions in injury incidence and changes in admission practices over the period of the study.

Frequency and predictors of medically attended injuries in HIV-infected children

The extent to which medically attended injuries complicate the clinical course of HIV-infected (HIV+) children is unknown. In a cohort of HIV+ children delivered from 1985 to 1990 and aged less than 60 months, we determined medically attended injuries per 100 child-years, Injury Severity Scores (ISS), and predictors of medically attended injuries by using New York State Medicaid claims from 1986 to 1992 linked to birth certificates. Injury rates and ISS were compared to those of a population of black, inner city children aged less than 60 months from emergency room records. HIV+ children had slightly more injuries (19.3 vs. 16.8/100 child-years) but similar ISS (2.4 vs. 2.3). Predictors of injuries in HIV+ children included younger maternal age (24/100 child-years, p = 0.008) and delivery outside of New York City (29/100 child-years, p = 0.02). Illicit drug use and alcohol use were associated with greater ISS while cocaine use was associated with a higher rate of possibly intentional injuries. Medically attended injuries affected one in five HIV+ children in our cohort annually, slightly more than the comparison population. Specific maternal and birth characteristics such as substance abuse and younger age at delivery may help target at-risk children.

Injury hospitalizations among American Indian youth in Washington

OBJECTIVE

To determine the rate and causes of hospitalizations for injury among American Indian and Alaska Native (AI/AN) youth in the state of Washington, and to compare this with the rate of hospitalizations for injury among youth of all races.

METHODS

Subjects were aged 0-19 years and were admitted to civilian hospitals for care of an injury (International Classification of Diseases N codes 800-995) in Washington between 1990 and 1994. Deaths occurring in the prehospital setting and emergency department are not included. Using several fields of identifying information, the Washington state hospital discharge database was linked with the Indian Health Service (IHS) patient registration database to identify AI/AN youth. Denominator data included the total age specific IHS user population for American Indians and US Census derived population estimates. Incidence ratios (IRs) were calculated to compare rates of hospitalization between AI/AN youth and all youth in Washington.

RESULTS

A total of 694 and 29,048 hospitalizations for injury were identified for AI/AN youth and all races, respectively. The rate of hospitalization for injuries among AI/AN youth was 507 discharges per 100,000 youth (IR = 1.30; 95% confidence interval (CI) 1.20 to 1.40. The leading mechanism of injury was motor vehicles (IR 1.73, CI 1.49 to 2.01), followed by falls (IR 0.95, CI 0.79 to 1.15), and poisoning (IR 1.20, CI 0.80 to 1.78). The disparity was greater for intentional injuries (IR 1.71, CI 1.44 to 2.04). The highest IR for all unintentional injuries was for injuries from fire (IR 2.35, CI 1.42 to 3.87). AI/AN children aged 15-19 had the greatest disparity for rates of injury hospitalization (IR 1.4, CI 1.25 to 1.56).

CONCLUSION

AI/AN youth in Washington had a higher hospitalization rate for injury compared with all youth in the state. Disparities were greatest for injuries related to motor vehicles and assaults. When linked, hospital discharge data can be used for surveillance of AI/AN hospitalizations.

Risk taking in young Hispanic children

INTRODUCTION

The purpose of this study was to examine risk taking and daring behavior in preschool-age Hispanic children. The study sought to describe aspects of children's personality, behavior, and culture that may inform us of their propensity to take risks that lead to injuries.

METHOD

Forty-five children (4 to 5 years of age) and their parents, drawn from a primary care practice, participated in the study. Instruments completed by the families included the Acculturation Scale. Child Shyness Report, Injury Report, and the Injury Behavior Checklist. Children were interviewed about risk taking and daring behavior using a projective technique (Child Sensation Seeking Profile).

RESULTS

These children, irrespective of gender and socioeconomic status, reported similar rates of daring and risk taking behavior. Injury behaviors were not predicted by personality profiles of shyness or the child's self-report of risk taking and daring behavior. Actual injuries increased with higher levels of acculturation, but children's injury behaviors reported by parents were low in comparison with other populations. Discrepancies were observed between parental perception and report of children's injury behavior and children's expressed preferences in some domains of daring and risky behavior.

DISCUSSION

Primary care providers must consider ethnic differences in rates and causes of injury when developing interventions and injury prevention programs. PNPs can use these findings to better meet the health promotion goals of Healthy Children 2000.

Family, social, and cultural factors in pedestrian injuries among Hispanic children

OBJECTIVES

In an earlier population based surveillance study of pediatric injuries, the rate of Hispanic children injured as pedestrians was 63/100,000 compared with 17/100,000 for non-Hispanic white children. The present study was designed to examine the effect of family, social, and cultural factors on the rate of pedestrian injury in a population of Hispanic children in the southwestern US.

METHODS

A case-control study of pedestrian injuries among Hispanic children. The sample consisted of 98 children 0-14 years of age hospitalized as a result of a pedestrian injury and 144 randomly selected neighborhood controls matched to the case by city, age, gender, and ethnicity. Cases were compared with controls using conditional logistic regression; in the study design the odds ratio (OR) estimates the incidence rate ratio.

RESULTS

The following family and cultural variables were associated with an increased risk of injury: household crowding (OR = 2.8, 95% confidence interval (CI) 1.1 to 7.1 for 1.01-1.5 persons per room, compared with < or = 1.0 persons per room), one or more family moves within the past year (OR 2.2, 95% CI 1.2 to 4.1), poverty (OR 1.9, 95% CI 1.1 to 3.3), and inability of mother (OR 3.6, 95% CI 1.3 to 10) or father (OR 5.6, 95% CI 1.5 to 20) to read well. However, children in single parent households and children whose parents did not drive a car, had less education, or were of rural origin, did not have an increased rate of injury.

CONCLUSIONS

These results have implications for childhood pedestrian prevention efforts for low income, non-English speaking Hispanic populations, and perhaps for other immigrant and high risk groups. Prevention programs and materials need to be not only culturally sensitive but also designed for those with limited reading skills. In addition, environmental interventions that provide more pedestrian friendly neighborhoods must be considered.

Demographic risk factors for injury among Hispanic and non-Hispanic white children: an ecologic analysis

OBJECTIVES

To determine the effects of neighborhood levels of poverty, household crowding, and acculturation on the rate of injury to Hispanic and non-Hispanic white children.

SETTING

Orange County, California.

METHODS

An ecologic study design was used with census block groups as the unit of analysis. Measures of neighborhood poverty, household crowding, and acculturation were specific to each ethnic group. Poisson regression was used to calculate mutually adjusted incidence rate ratios (IRRs) corresponding to a 20% difference in census variables.

RESULTS

Among non-Hispanic white children, injury rates were more closely associated with neighborhood levels of household crowding (adjusted IRR 2.36, 95% confidence interval (CI) 1.22 to 4.57) than with neighborhood poverty (adjusted IRR 1.06, 95% CI 0.89 to 1.26). For Hispanic children, the strongest risk factors were the proportion of Hispanic adults who spoke only some English (compared with the proportion who spoke little or no English, adjusted IRR 1.26, 95% CI 1.04 to 1.53) and the proportion who were US residents for < 5 years (adjusted IRR 1.20, 95% CI 1.001 to 1.43). Neighborhood levels of household crowding were not related to injury among Hispanic children (adjusted IRR 0.98, 95% CI 0.89 to 1.08), but surprisingly, neighborhood poverty was associated with lower injury rates (adjusted IRR 0.89, 95% CI 0.81 to 0.97).

CONCLUSIONS

Cultural and geographic transitions, as well as socioeconomic differences, appear to contribute to differences in childhood injury rates between ethnic groups.