Adolescent injuries in Argentina, Bolivia, Chile, and Uruguay: Results from the 2012-2013 Global School-based Student Health Survey (GSHS)

Prevalence and correlates of unintentional nonfatal injuries among school-going adolescents in Central America

OBJECTIVES

The aim of this study is to report on the frequency of serious physical injuries (SPI) among adolescents in Central America during the previous decade, 2009-2018.

METHODS

In total, 15,807 school adolescents (14.4 years mean age; SD=1.4) from six Central American countries participated in cross-sectional Global School-based Student Health Surveys in 2009-2018 (ranging from 1,779 students in Honduras in 2012 to 4,374 students in Guatemala in 2015).

RESULTS

The prevalence of SPI was 33.8 % (22.9 % once, 7.4 % 2 or 3 times and 3.6 % 4 or more times), ranging from 31.8 % in Guatemala to 45.0 % in Belize and 45.6 % in Panama. The most frequent causes of SPI included fall (11.4 %, ranging from 6.9 % in Costa Rica to 15.6 % in Panama), and the type of SPI was fracture/dislocation (5.7 %, ranging from 4.3 % in Costa Rica to 6.7 % in Panama). In adjusted Poisson regression, male sex, food insecurity, a history of alcohol intoxication, soft drink consumption, fast food intake, truancy, multiple sexual partners, psychological distress, physical fight, physically attacked, bullied, and suicide attempt were significantly associated with a higher number of injury event counts.

CONCLUSIONS

Overall, about one in three adolescents in Central America had sustained unintentional injuries in the past 12 months and several contributing factors were identified which if addressed could aid injury prevention among adolescents.

The association between psychosocial factors, protective factors, and its associated triggers with psychological distress among Bolivian adolescents

The purpose of this study is to investigate the association between psychosocial factors, protective factors, and its associated triggers with psychological distress among Bolivian adolescents. This cross-sectional study was conducted by investigating the 2018 Bolivia global school-based student health survey (GSHS). The total number of students who participated in this survey was 7931, and the final sample was 7377. The mean age of the participants was 15.3 years (SD = 1.4). Psychological distress was assessed with a 2-item screener (loneliness and worry induced sleep disturbance). In all 22.3% of participants reported experiencing psychological distress, with 18.1% among adolescent males and 26.2% among adolescent females. In adjusted logistic regression analysis (AOR, 95% CI), there are two significant directions of association. One is the negative association, such as parental involvement as a protective factor. School adolescents who had more parental involvement were less likely to experience psychological distress. Parents understand problems or worries (0.64, 0.54-0.75, p < .001) and parents disregard privacy (0.69, 0.58-0.82, p < .001). On the other hand, many psycho-social factors are significantly positively associated with psychological distress. School adolescents who experience more psychosocial factors are more likely to experience psychological distress. Physical assault in the previous year (1.83, 1.59-2.11, p < .001), being bullied at school (1.27, 1.07-1.52, p < .01), being bullied outside of school (1.36, 1.15-1.61, p < .001), and being cyberbullied (1.60, 1.37-1.88, p < .001), were all significantly associated with psychological distress. Healthy relationships in a family, and interventions to reduce violence and bullying, should be encouraged and promoted.

Unintentional injury and its associated factors among left-behind children: a cross-sectional study

BACKGROUND

Unintentional injuries among children and adolescents are a major public health problem worldwide. These injuries not only have negative effects on children's physiology and psychology, but also bring huge economic losses and social burdens to families and society. Unintentional injuries are the leading cause of disability and death among Chinese adolescents, and left-behind children (LBC) are more prone to experience unintentional injury. The purpose of this study was to evaluate the type and incidence of unintentional injury among Chinese children and adolescents and explore the influences of personal and environmental factors by comparing the differences between LBC and not left-behind children (NLBC).

METHODS

This cross-sectional study was conducted in January and February 2019. Additionally, 2786 children and adolescents from 10 to 19 years old in Liaoning Province in China were collected in the form of self-filled questionnaires, including Unintentional Injury Investigation, Unintentional Injury Perception Questionnaire, Multidimensional Subhealth Questionnaire of Adolescent (MSQA), Negative life events, "My Class" questionnaire and Bullying/victim Questionnaire. Multiple logistic regression analysis was used to explore the factors associated with unintentional injury among children and adolescents. Binary logistic regression analysis was used to explore the factors affecting unintentional injuries between LBC and NLBC.

RESULTS

The top three unintentional injuries were falling injuries (29.7%), sprains (27.2%) and burns and scalds (20.3%) in our study population. The incidence of unintentional injuries in LBC was higher than that in NLBC. Burn and scalds, cutting injury and animal bites in LBC were higher than those in NLBC. The results show that junior high school students (odds ratio (OR) = 1.296, CI = 1.066-1.574) were more likely to report multiple unintentional injuries than primary school students. Girls (OR = 1.252, CI = 1.042-1.504) had higher odds of reporting multiple unintentional injuries. The odds of multiple injuries in children and adolescents with low levels of unintentional injury perception were higher than those in children and adolescents with high levels of unintentional injury perception (OR = 1.321, C = 1.013-1.568). Children and adolescents with a higher levels of mental health symptoms (OR = 1.442, CI = 1.193-1.744) had higher odds of reporting multiple unintentional injuries. Compared with teenagers who had never experienced negative life events, teenagers who had experienced negative life events many times (OR = 2.724, CI = 2.121-3.499) were more likely to suffer unintentional injuries many times. Low-level discipline and order (OR = 1.277, CI = 1.036-1.574) had higher odds of reporting multiple unintentional injuries. In-school adolescents who were bullied were more likely to report being injured multiple times than their counterparts who were not bullied (OR = 2.340, CI = 1.925-2.845). Low levels of unintentional injury perception, experienced negative life events and bullying had greater impacts on LBC than on NLBC.

CONCLUSION

The survey found that the incidence of at least one unintentional injury was 64.8%. School level, sex, unintentional injury perception, subhealth, negative life events, discipline and order and bullying were associated with incidents of unintentional injury. Compared with NLBC, LBC had a higher incidence of unintentional injury, and special attention should be given to this group.

Stakeholders' attitudes towards the installations of closed-circuit television cameras in reducing school violence

Purpose

While schools worldwide have employed closed-circuit television (CCTV) to discourage school violence, the literature shows that stakeholder attitudes toward adopting this technology are inconsistent across cultures. Generally, they are concerned with effectiveness, necessity, privacy, and operational transparency. Based on the Technology Acceptance Model for Video Surveillance (TAM-VS) theory, this study examined the attitudes of educational stakeholders, namely educators and students, toward adopting CCTV in Vietnam. This study aims to investigate which criteria Vietnamese stakeholders use to evaluate the necessity of CCTV and whether the concerns of Vietnam, a developing country, are similar to those of developed countries.

Methods

This study addressed these research questions by purposely sampling and interviewing 49 Vietnamese high school students, recent high school graduate students, teachers, and administrators. It employed semi-structured and in-depth interviews to gather content-rich data and applied thematic analysis to discover new insights from stakeholders under the modified TAM-VS framework. The study also followed the COREQ guidelines to improve the transparency and rigor of the data collection and analysis.

Findings

On an exploratory basis, most Vietnamese stakeholders believed that while CCTV cannot comprehensively prevent school violence, its effectiveness overshadows privacy concerns. Regarding operational transparency concerns, participants suggested that better communication, consent collection, and the right to amend school policies related to CCTV are important. From the participants’ perspective, the three criteria for evaluating the necessity of CCTV were (1) its effectiveness in controlling school violence, (2) serving other purposes to enhance overall schooling performance, and (3) insufficient existing methods.

Conclusions

This study provides context-rich insights into the perceptions of the necessity, effectiveness, privacy, and operational transparency concerns of CCTV across different stakeholders in the education and developing country context. On the practical contribution, the research identifies strategies that school administrators can employ to promote CCTV acceptance in Vietnamese high schools.

Approaching the Causes of Unintentional Injuries in the School Environment: A Panel Analysis of Survey Data From Germany

BACKGROUND

Previous research on the correlates of unintentional school injuries is based on either process or cross-sectional data. This study aims at approaching the causal effects of risk-seeking behavior, mental health problems, physical activity, and exposure to bullying on unintentional injuries in the school environment by relying on longitudinal survey data.

METHODS

The data comes from a German panel survey, including more than 10,000 students. We estimate fixed-effects regression models that only take into account the variation within participants and are therefore most suitable for establishing causal inferences.

RESULTS

We find an increase in risk-seeking behavior on the individual level to yield an increase in students' likelihood to suffer injuries during physical education and on the schoolyard or in the school building. The same holds true for an increase in mental health problems. Finally, students who expand their degree of physical activity in club sports also show a higher risk of unintentional injuries.

CONCLUSIONS

Interventions aimed at reducing too risky behavior and mental health problems may help prevent unintentional injuries in the school environment. Since students who increase their activities in club sports are also more prone to school injuries, preventive efforts should include this group of adolescents as well.

Patterns of six behaviors and psychosomatic symptoms in adolescents: A six-province study in China

BACKGROUND

Psychosomatic symptoms are often related with behaviors. However, the association between different behaviors and their latent patterns and psychosomatic health status is unclear. Current study aimed to identify the patterns of six behaviors and explore the association between different patterns and psychosomatic symptoms in a school-based sample of Chinese adolescents.

METHODS

From November 2015 to January 2016, the study enrolled 22,628 students from six cities in China (15.36 ± 1.79 years). Six behaviors [unintentional injury (UI), non-suicidal self-injury (NSSI), suicidal behaviors (SB), drinking, smoking, screen time (ST)] and psychosomatic symptoms (psychological and physical symptoms) were measured by self-report validated questionnaires.

RESULTS

Six behaviors were all related to psychosomatic symptoms, among which SB was the strongest. Four patterns of behaviors were be identified as follows: low-risk pattern (64.0%), substance use pattern (4.5%), injury pattern (28.8%) and high-risk pattern (2.7%). Logistic regression analysis of psychological symptoms indicated that compared with low-risk pattern, high-risk pattern had the highest risk, followed by injury pattern, substance use pattern showed the lowest risk. Compared with low-risk pattern, the results of physical symptoms suggested the degree of risk was high-risk pattern, injury pattern and substance use pattern, respectively.

LIMITATIONS

Cross-sectional data were used in the study that could not evaluate causal relationships between six behaviors and psychosomatic symptoms.

CONCLUSIONS

Six behaviors and their latent patterns are related to psychosomatic symptoms among Chinese adolescents differently, so different intervention and prevention protocol need to be taken for different patterns of adolescents.

Prevalence and Determinants of Underweight, Overweight, and Obesity: A Cross-Sectional Study of Sociodemographic, Dietary, and Lifestyle Factors Among Adolescent Girls in Jutiapa, Guatemala

BACKGROUND

As the incidence of overweight continues to increase among children and adolescents in Guatemala, underweight remains a prominent health problem. However, the prevalence of overweight or underweight and associated risk factors has not been investigated among adolescent girls.

OBJECTIVE

To determine the prevalence of underweight and overweight/obesity and associated sociodemographic, dietary, and lifestyle factors among adolescent girls in Jutiapa, Guatemala.

METHODS

A cross-sectional study of a subsample of 392 girls aged 12 to 17 years from an agriculture-nutrition trial was conducted. Anthropometric data were obtained using standard methods. Sociodemographic, dietary, and lifestyle data were collected using a structured questionnaire. Multivariable logistic regression was conducted using underweight (body mass index [BMI] for age < 5th percentile) and overweight/obesity (BMI for age ≥ 85th percentile) as outcome variables.

RESULTS

The prevalence of underweight and overweight/obesity was 9.9% and 15.6%, respectively. Age (15-17 years), high waist circumference, high blood pressure, father being a farmer, large family (> 5 persons), hours spent watching TV, and high red meat consumption were significantly associated with underweight. Whereas being in school, high waist circumference, high blood pressure, overweight/obese mother, unemployed father, watching TV for more than 2 hours, having soft drinks at home, and meeting fruit recommendations were significantly associated with overweight/obesity.

CONCLUSIONS

Our findings highlight the importance of concurrently addressing underweight and overweight/obesity among adolescent girls in rural Guatemala. Studies in various parts of the country are needed to confirm the results of the present study and for appropriate strategies to be implemented to reduce both underweight and overweight.

Health risk behaviours among adolescents in Argentina: trends between 2007, 2012 and 2018 national cross-sectional school surveys

Background

The aim of this study was to assess trends of various health risk behaviours among adolescents across three different surveys in Argentina.

Methods

Data from 115,697 adolescents (mean age:14.6 years, SD=1.2) that participated in three cross-sectional national school surveys in 2007, 2012 and 2018 were analysed. In all, 27 health risk behaviours were assessed through a self-administered questionnaire. Significance of a linear trend was tested by treating study year as categorical variable in logistic regression analyses, adjusted by age group and food insecurity for boys and girls separately

Results

Among both sexes, four health risk behaviours (current cigarette use, passive smoking, trouble from alcohol use, and physically attacked) significantly reduced from 2007 to 2018. Among boys five health risk behaviours (experience of hunger, parental tobacco use, current alcohol use, involvement in physical fighting, and multiple sexual partners), and among girls, inadequate physical activity significantly reduced over time. Among both sexes, the prevalence of four health risk behaviours (overweight/obesity, obesity, leisure-time sedentary behaviour and insufficient fruit intake) significantly increased among both sexes, and among girls ten health risk behaviours (not walking/biking to school, current other tobacco use, bullying victimisation, lifetime drunkenness, having no close friends, suicide plan, suicidal ideation, worry-induced sleep disturbance, loneliness, and ever sexual intercourse) significantly increased over time.

Conclusion

Nine health risk behaviours among boys and five health risk behaviours among girls decreased, and four health risk behaviours among boys and 14 health compromising behaviours among girls increased over a period of 11 years. School health programmes for adolescents should be strengthened in Argentina.

Violence and non-fatal injuries among Vietnamese in-school adolescents: national prevalence estimates and associated factors

School violence and injury are major public health problems worldwide. The data of this study were from the Viet Nam Global School-based Student Health Survey (GSHS) - a nationally representative survey conducted in 2019, with a sample size of 7690 students aged 13-17 years old. We found the prevalence of violence and non-fatal injury to be 14.5% and 21.4%, respectively. Factors related to higher odds of violence and non-fatal injuries in both sexes included smoking cigarettes, drinking alcohol, having mental health problems (loneliness, worrying and suicidal thinking), and truancy. In contrast, parental monitoring was associated with lower odds of violence, and parental respect was a protective factor of both violence and non-fatal injuries. Students who experienced violence had a higher likelihood of having non-fatal injuries in both sexes. Future policies should consider individual factors and parent-child bonding, to mitigate the burden of violence and injury among in-school adolescents in Viet Nam.

Prevalence and Correlates of Unintentional Injuries among In-School Adolescents in Ghana

Injuries among adolescents pose significant public health problems. Unintentional injuries are the leading cause of adolescents’ mortality and disability with the largest burden in low-and middle-income countries. Yet, there is paucity of data in Ghana on adolescent injuries. The present study aimed to determine the prevalence and correlates of unintentional injuries among in-school adolescents in Ghana using data from the Global School-Based Health Survey. Cross-sectional data on 2058 adolescents in junior and senior high schools who randomly participated in the 2012 Global School-Based Health Survey were analyzed. Descriptive statistics were performed to determine the prevalence of unintentional injuriesacross the background characteristics of in-school adolescents. Binary logistic regression was employed to determine the factors associated with unintentional injuries. The results were presented as crude and adjusted odds ratios at a 95% confidence interval. The prevalence of one or more serious injuries in the past 12 months was 57.0%. The most commonly reported type and cause of injuries were “I had a cut or stab wound” (15.2%) and “I fell” (13.1%), respectively. In the adjusted regression, in-school adolescents aged 14–16 (aOR = 1.60, CI = 1.12–2.28) were more likely to report one or more serious injuries compared to their counterparts aged 13 or younger. In-school adolescents who participated in physical education (aOR = 1.27, CI = 1.03–1.58) had higher odds of reporting one or more serious injuries. The odds of being injured was higher among adolescents who were truant at school compared to those who were not truant (aOR = 1.42, CI = 1.14–1.77) In-school adolescents who were bullied were more likely to report being injured one or multiple times compared to their counterparts who were not bullied (aOR = 2.16, CI = 1.75–2.65). In addition, the odds of being injured once or multiple times were higher among adolescents who were physically attacked (aOR = 2.21, CI = 1.78–2.75), those that engaged in physical fighting (aOR = 1.94, CI = 1.54–2.45), and those who reported high psychological distress (aOR = 2.00, CI = 1.52–2.63) compared to their counterparts who were not. Conversely, adolescents in senior high schools were 39% less likely to be injured once or multiple times compared to those in junior high schools (aOR = 0.61, CI = 0.47–0.79). A relatively high prevalence of unintentional injuries was found among in-school adolescents in the study. The numerous factors identified in this study could be integrated into health promotion and injury prevention activities to help reduce the occurrence of injuries among in-school adolescents. Moreover, students who are susceptible to unintended injuries such as older adolescents, victims of bullying, those who participate in physical education, those who are often involved in fights, truants, and those who have psychological distress should be sensitized to take measures that will reduce their level of susceptibility. First aid treatment services should also be made available in schools to treat victims of unintended injuries.

Motor Vehicle Collisions during Adolescence: The Role of Alexithymic Traits and Defense Strategies

International literature has shown that adolescents represent the population most at risk of fatal and nonfatal motor vehicle collisions (MVCs). Adolescents’ alexithymic traits and significant use of immature defense strategies have been seen to play a key role. This study aimed to investigate the possible mediation role played by defense strategies use in the relationship between alexithymia and MVCs. Our sample consisted of 297 adolescents divided into four subgroups, based on the number of visits to the emergency department due to an MVC. We assessed adolescents’ alexithymic traits and defense strategies use through self-report instruments. Results showed that males reported a higher rate of MVCs than females. Higher rates of MVCs are associated with more alexithymic traits and maladaptive defense strategies use. Adolescents’ Acting Out and Omnipotence use significantly mediated the relationship between alexithymia and MVCs. Our findings suggest the recidivism of MVCs as an attempt to cope with emotional difficulties, with important clinical implications.

Hygiene practices among young adolescents aged 12-15 years in low- and middle-income countries: a population-based study

Background

Poor personal hygiene increases disease risk, however, the prevalence of hygiene practices among adolescents is poorly described in low- and middle-income countries (LMICs). We aimed to assess the hygiene practices among young adolescents in LMICs using data from the Global School-based Student Health Surveys (GSHS).

Methods

This population-based study analysed the GSHS data for adolescents aged 12-15 years from 75 LMICs. Data were collected between 2003 and 2015 using standardised, anonymous, self-reported questionnaires. This report focuses on hygiene related behaviours such as tooth brushing, washing hands after using the toilet, washing hands before eating and washing hands with soap. The weighted prevalence and 95% confidential intervals (CIs) for the hygiene practices, and overall and regional estimates were calculated with random-effects meta-analysis.

Results

A total of 181 848 young adolescents from 75 LIMCs with available hygiene data were analysed. The overall prevalence for never washing hands were 7.4% (95% confidence interval (CI) = 4.4-10.3) for before eating, 5.9% (95% CI = 3.8-7.9) for after using the toilet, and 9.0% (95% CI = 6.2-11.8) for with soap. For tooth brushing, the overall prevalence estimates were 8.6% (95% CI = 5.5-11.7) for never brushing teeth, 80.9% (95% CI = 74.7-87.1) for 1-3 times per day, and 9.7% (95% CI = 5.8-13.6) for >3 times per day. However, the prevalence of different hygiene practices varied significantly among countries and regions (all P values <0.001). Poor hygiene status, with a prevalence >20%, was still observed in several LMICs (eg, 12 countries for never washing hands and 4 for never brushing teeth).

Conclusions

The hygiene practices of young adolescents aged 12-15 years were generally frequent, but poor status was still observed in several LMICs. These findings emphases the need for hygiene and health education targeting young adolescents in LMICs.

Percentiles for anthropometric measures in 11-18 years-old students of 73 developing countries

BACKGROUND AND AIMS

one of the health concerns for any society is to have its own standard of growth. The aim of this study was to provide the age- and sex-specific percentile values of anthropometric measures for adolescents of developing countries. The use of global percentiles in developing countries overestimates underweight and stunting while underestimates overweight and obesity.

METHODS

The data were obtained from the Global School-based Student Health Survey (GSHS). This study was conducted on school students, selected by multistage random cluster sampling from 73 developing countries. A parametric method was used for constructing age-specific reference intervals (normal ranges).

RESULTS

In general, 210,045 11-18 years-old schoolchildren (14.38 ± 1.39) from 73 developing countries between 2003 and 2014 were included in this study, among which 103,080 (49.08%) were male and 106,965 (50.92%) were female. Calculation of body mass index (BMI) percentile showed that for all BMI percentile curves of both sexes, there was a gradual increase up to the age of around 15 years, and then remain stable (except for 95th percentile). Moreover in all weight percentile curves of boys, except 90th and above, there was a slight rise until the age of 18 years. In 10th height percentile curves and above in boys, there was a sharp increase up to the age of 17, followed by a decline. Similarly, this pattern was found for 50th height percentile and above in girls.

CONCLUSION

The use of global percentiles in developing countries overestimates underweight and stunting while underestimates overweight and obesity.

The global burden of musculoskeletal injury in low and lower-middle income countries: A systematic literature review

Background:

While the global burden of musculoskeletal injury is increasingly recognized, few epidemiologic studies have specifically recorded its incidence or prevalence, particularly in low- and middle-income countries. Understanding the burden of musculoskeletal injury relative to other health conditions is critical to effective allocation of resources to mitigate the disability that results from trauma. The current study aims to systematically review the existing primary literature on the incidence and prevalence of pelvic and appendicular fractures, a major component of musculoskeletal injury, in low- and lower-middle income countries (LMICs).

Methods:

This study conforms to the systematic review and traditional meta-analysis guidelines outlined in the PRISMA-P statement. Incidence rates were calculated as the occurrence of new fracture cases per 100,000 person-years, and prevalence as total fracture cases per population sample, reported as percentages.

Results:

The literature search yielded 3497 total citations. There were 21 full-text articles, representing 14 different countries, selected for data extraction. Included studies reported a wide range of incidence and prevalence rates, with an overall mean fracture incidence ranging from 779 (95% CI: 483.0–1188.7) to 1574 (95% CI: 1285.1–1915.1) per 100,000 person-years.

Conclusion:

Better understanding the unmet burden of musculoskeletal injury in LMICs is critical to effectively allocating resources and advocating for underserved populations. To address existing gaps and heterogeneity within the literature, future research should incorporate population-based sampling with broader geographic representation in LMICs to more accurately capture the burden of disease.

Status of injuries as a public health burden among children and adolescents in China: A systematic review and meta-analysis

INTRODUCTION

Injuries among children and adolescents remain a major public health problem in China. In the present study, we undertook a systematic review and meta-analysis of the published literature of epidemiological studies investigating injuries among children and adolescents in China and aimed to describe the status of injury among children and adolescents (aged 0-19 years) in China nationwide. A random-effects meta-analysis model was used to calculate the pooled prevalence of injury with 95% confidence intervals (CIs) across studies. The potential heterogeneity moderators were identified by subgroup and sensitivity analysis. A total of 775,615 children and adolescents were included in this study. Overall, the pooled injury prevalence among children and adolescents aged 0 to 19 years was 23.0% (95% CI 20.0%-27.0%) in studies using 1996 version of injury definition, and 13.0% (95% CI 10.0%-17.0%) in studies using 2004 version of injury definition. Relevant heterogeneity moderators have been identified by subgroup analysis. Sensitivity analysis yielded consistent results.

CONCLUSION

Our study shows a moderately high injury prevalence among children and adolescents aged 0 to 19 years in China, more prevention policies and programs should be urgently developed to decrease the occurrence of child and adolescent injury.

Unintentional injuries and violence among adolescents aged 12-15 years in 68 low-income and middle-income countries: a secondary analysis of data from the Global School-Based Student Health Survey

BACKGROUND

Injuries and violence account for a substantial proportion of the global burden of disease in adolescents, especially among low-income and middle-income countries (LMICs). We aimed to compare the prevalence of unintentional injuries and violence among young adolescents in LMICs.

METHODS

We did a secondary analysis of data from the Global School-based Student Health Survey (GSHS) for adolescents aged 12-15 years from LMICs collected between 2009 and 2015. Survey data was collected using a standardised questionnaire. We used survey data to calculate the overall prevalence of serious injuries and violence (eg, physical attack, physical fighting) and bullying per country. We did a random-effects meta-analysis to calculate pooled overall and regional estimates. We also did subgroup analyses stratified by sex, age (12-13 years vs 14-15 years), and time period (2009-11 vs 2012-15). Logistic regression models adjusted for sex, weights, stratum, and primary sampling unit were used to analyse the differences in prevalence of serious injuries, violence, and bullying.

FINDINGS

We included data from 68 LMICs, including 164 633 young adolescents (77 707 [47·2%] boys; 86 926 [52·8%] girls). The overall prevalence of physical attack, physical fighting, and serious injuries during the past 12 months were 35·6% (95% CI 30·7-40·5), 36·4% (29·9-42·9), and 42·9% (39·0-46·9), respectively. Prevalence varied by WHO region and was higher among boys than girls for injuries (47·8% vs 37·5%, p=0·00094), physical attack (41·0% vs 29·4%, p=0·001), and physical fighting (45·5% vs 26·9%, p<0·0001). Fractures (22·6%, 95% CI 19·1-26·1) and cuts (21·8%, 16·8-26·8) were the most common types of serious injury, and falling was the main cause of these injuries (33·1%, 30·2-35·9). The overall prevalence of bullying at least once in the past 30 days was 34·4% (27·1-41·7), irrespective of age and sex. The most common types of bullying were physical (18·3%, 13·7-23·0), verbal-sexual (13·2%, 10·2-16·2), and racial-ethnic (11·6%, 9·2-14·0).

INTERPRETATION

The prevalence of unintentional injuries and violence remain high among young adolescents in LMICs. These countries should prioritise the development of anti-violence and anti-injury programmes to improve health in their young adolescent populations.

FUNDING

National Natural Science Foundation of China, National Key R&D Program of China, Natural Science Foundation of Zhejiang Province, Sanming Project of Medicine in Shenzhen, K.C. Wong Magna Fund in Ningbo University, and Ningbo Scientific Innovation Team for Environmental Hazardous Factor Control and Prevention.

The global school-based student health survey as a tool to guide adolescent health interventions in rural Guatemala

Background

Adolescents from rural areas in low-middle income countries face increasing physical and mental health challenges that are not well characterized or addressed due to resource limitations. We used the Global School-based Student Health Survey (GSHS) to describe adolescent health behaviors, and to inform prioritization of health promotion efforts in a resource-limited, rural, agricultural region in Guatemala.

Methods

In July 2015, a group of volunteers administered the GSHS to students from seven schools in four communities in the southwest Trifinio region of Guatemala. Prevalence and predictors of nutritional, mental, and sexual health behaviors were calculated from survey responses, and summarized in region- and school-level reports. Facilitated discussion of survey results with local leadership in January 2016 led to the identification of priorities for school-based health interventions.

Results

Five hundred fifty-four out of 620 (87%) students aged 12–18 years completed the survey. Prevalence of unhealthy dietary behaviors and body size was high: 61% reported high current soft drink intake, 18% were overweight, and 31% were moderate-severely stunted. In multivariable regression models, being food insecure was marginally associated with being underweight/stunted (OR = 1.95, 95%CI = 0.95–4.0). Boys were more likely than girls to report being sexually active (25% versus 6.4%, p < 0.001). Local school leadership identified food insecurity and sexual education as priority areas for intervention, and made plans for providing breakfast in schools, sexual education curriculum development and teacher training, and continued adolescent health reporting and evaluation.

Conclusions

The GSHS is a rapid, cost-efficient, useful tool for surveillance of adolescent health behaviors in vulnerable, resource-limited populations. Results of a locally-administered GSHS informed school-based interventions to decrease food insecurity, early sexual initiation, and teen pregnancy in a rural Guatemalan region.

Injuries, Violence, and Bullying Among Middle School Students in Oman

OBJECTIVES

Injuries account for a substantial proportion of the burden of disease in adolescents globally. This paper describes injury rates and associated exposures, and risk behaviors in Oman's 2010 Global School-based Student Health Survey (GSHS).

METHODS

This study used complex samples analysis to examine nationally-representative data from 1 606 students in grades eight, nine, and 10 who participated in the 2010 Oman GSHS.

RESULTS

In total, 34.0% of the students reported having at least one injury in the past year that caused at least one full day abscence from usual activities or required medical treatment. The most common injury type reported was a broken bone or dislocated joint. The most common injury cause was falling. Additionally, 38.4% of the students reported being bullied in the past month, 38.8% reported being physically attacked in the past year, and 47.6% reported being in physical fights. Both injured boys and girls reported experiencing significantly more bullying, fights, and attacks (odds ratio > 2) than their non-injured classmates, even though only 9.6% of injured students reported that their most serious injury in the past year was the result of an assault, and students reporting assaults did not have significantly higher odds of exposure to these types of peer violence. More than half of the bullied students reported that the most frequent type of peer victimization they experienced was being made fun of with sexual jokes, comments, or gestures. Sexual bullying was the most common type of bullying reported by girls and boys.

CONCLUSIONS

Promoting healthier peer relationships may help to reduce injuries in this age group as well as reducing the harmful effects of bullying.

Nonfatal Injuries and Psychosocial Correlates among Middle School Students in Cambodia and Vietnam

The aim of the study was to estimate the prevalence and psychosocial correlates of nonfatal injury among middle school students in Cambodia and Vietnam. Cross-sectional data from 7137 school children (mean age 15.5 years, SD = 1.4) who were randomly sampled for participation in nationally representative Global School-based Health Surveys (GSHS) in Cambodia and Vietnam were analyzed. The proportion of school children reporting one or more serious injuries in the past year was 22.6% among boys and 17.5% among girls in Cambodia and 34.3% among boys and 25.1% among girls in Vietnam. The most prevalent cause of the most serious injury in Cambodia was traffic injuries (4.7% among boys and 4.3% among girls) and in Vietnam it was falls (10.0% among boys and 7.0% among girls). In multinomial logistic regression analyses, experiencing hunger (as an indicator for low socioeconomic status) and drug use were associated with having sustained one injury and two or more injuries in the past 12 months in Cambodia. In addition, poor mental health was associated with two or more injuries. In Vietnam, being male, experiencing hunger, current alcohol use, poor mental health and ever having had sex were associated with having sustained one injury and two or more injuries in the past 12 months. Several psychosocial variables were identified which could help in designing injury prevention strategies among middle school children in Cambodia and Vietnam.