Equalisation of socioeconomic differences in injury risks at school age? A study of three age cohorts of Swedish children and adolescents

Evaluating the impact of an injury prevention measure regarding different sociodemographic factors

BACKGROUND

Road traffic collisions (RTC) remain a major problem especially among young road users. Injury prevention measures and licensing systems have increasingly been developed to counteract some of the negative effects of RTCs in youth. The Prevent Alcohol and Risk Related Trauma in Youth (P.A.R.T.Y.) program is an injury prevention program that promotes prevention through reality education. In this study, the impact of the program on different sociodemographic subgroups of school students was analyzed. The aim was to find out which subgroups were influenced the most and how improvements to the program can be made.

METHODS

Evaluation was performed in a pre-post-intervention setting by means of a standardized questionnaire. The questionnaire contained three different sections with a total of 22 questions to identify students' responses regarding risk-behavior and risk-assessment. Evaluation was done at two different points on the same day (pre-and post-intervention). Data were analyzed with a focus on gender, age, residential area and level of education. Cronbach's alpha was used to check all questions for reliability. Data were analyzed using the t-test and the Wilcoxon signed-rank test with significance defined as p less than 0.05.

RESULTS

The study sample contains 193 students (range 14-17 years of age, 44% male). Female students show better results regarding risk-behavior and risk-awareness. The same applies to students of a higher educational level. And students ≥ 16 years showed significantly better results in all three sections compared to younger students.

CONCLUSIONS

Morbidity and mortality due to RTCs is a major problem in the group of young road users. Especially male road users between 14 and 17 years of age with a low educational level are at high risk to sustain road traffic injuries. Our results show that the P.A.R.T.Y. program has a stronger effect on young female students. Additionally, a significant effect was measured on students ≥ 16 years of age and on students with a higher educational level. Prevention measures need to be evaluated and further improved particularly in order to address the high-risk group of young, male road users with a lower educational status.

Are health inequalities evident at all ages? An ecological study of English mortality records

BACKGROUND

Inequalities in mortality are often presumed to exist at all ages. Here we examine whether this is true.

METHODS

We conducted an ecological study of mortality in England for 1997-99 using routinely collected public records. We used a (smoothed) single year of age rate of mortality for males and females by the multiple deprivation quintile of their ward of residence, for all and specific causes to assess if inequalities varied by age.

RESULTS

For most ages, a greater mortality risk exists for those living in the most deprived compared with the least deprived quintile of wards. However, during late adolescence there is equality. The equalization occurs at the age of 17-19 years. There is a longer period of 10 years for females and 20 years for males of convergence and then divergence centred on late adolescence and young adulthood. The equalization is driven principally through a heightened exposure to the risk of land transport accidents and a resulting higher than expected rate of mortality for the least deprived rather than a decrease in risk for the most deprived.

CONCLUSIONS

It seems likely that an increase in risk taking associated with late adolescence combined with exposure to a relatively dangerous transport environment leads to large increases in risk for young people in the least deprived parts of England. As a result mortality inequality disappears at this age.

Childhood and adolescent injuries in elementary schools in north-western Uganda: extent, risk and associated factors

Childhood injuries remain understudied in Uganda. The objective of this study was to determine the extent, nature and determinants of school-related childhood injury risk in north-western Uganda. A cohort of 1000 grade fives from 13 elementary schools was followed-up for one term. Survival and multi-level modelling techniques compared the risk rates across gender, schools and locations. Childhood injuries are common in north-western Uganda. Most of them occur during travel, breaks, practical classes and gardening, while walking, playing, learning and digging. Most injuries result from collisions with objects, sports and falls. Two-thirds of children receive first aid and hospital care. Times to injury were 72.1 and 192.9 person days (p = 0.0000). Gender differences in time to event were significant (p = 0.0091). Girls had better survival rates: cumulative prevalence of childhood injury was 36.1%; with significant gender differences (p = 0.007). Injury rate was 12.3/1000 person days, with a hazard ratio of 1.4. Compared to girls, boys had a 37% higher injury rate (p = 0.004). Rates varied among schools. Associated factors include sex and school. Rural-urban location and school differences do influence childhood injury risk. Childhood injuries are common: the risk is high, gender- and school-specific. Determinants include gender and school. Location and school contexts influence injury risk.

Time allocation between work and recreation and the associated injury risks among young people

PROBLEM

The purpose of this study was to examine the relationship between overall risk of injury and time use patterns between work and active recreation among adolescents and young adults.

METHODS

Using a representative sample of 9,795 Canadians aged 15-24 years, a multivariate logistic regression on the likelihood of any medically attended injury was conducted, including sociodemographic, individual, and time factors.

RESULTS

Young people who engaged in a combination of high work and high activity hours were twice as likely to sustain a medically attended injury compared to those who worked low hours, but did not participate in any recreational activity. Those respondents who were not in school had a 43% increase in injury risk compared to full-time students.

SUMMARY

Our findings suggest that injury risk was not a simple function of fatigue and cumulative exposure time. Our findings suggest the importance of considering time use and the associated injury risk tradeoffs.

IMPACT ON INDUSTRY

Relevant to state and federal work safety policy makers, our findings suggest the importance of understanding where youth might otherwise spend their time if constraint were placed on their employment opportunities, and the associated injury risk tradeoffs must be taken into consideration.

The neighbourhood socio-demographic context of teenage girls' deliberate self-harm

This study investigates whether living area characteristics relate to the commission of self-inflicted injuries and to psychiatric consultation among teenage girls. An ecological study was conducted at the parish level. Seven descriptors of the population's sociodemographic composition were selected and psychiatric health care seeking and hospitalization for deliberate self-harm (DSH) among girls aged 12-19 years were considered (years 1999-2003). For each parish characteristic, three levels of concentration were determined and health outcomes were compared between levels using rate ratios (RR). Acute psychiatric consultation was strongly associated with all parish characteristics, particularly with the concentration of female-headed households. For hospitalization for DSH, RR were significantly higher in parishes with higher concentrations of female-headed poor families, social welfare recipients and low-income people. Teenage girls' acute psychiatric consultations more than their rate of DSH injuries are affected by parish compositional characteristics. The contextual, family-related and individual mechanisms lying behind this deserve further investigation. This may have implications for prevention strategies and for the allocation of care.

Nonfatal injuries among middle-school and high-school students in Guangxi, China

OBJECTIVES

We described nonfatal injuries and calculated injury rates among middle-school and high-school students in Guangxi, China.

METHODS

Students were selected using multistage randomizing techniques, and nonfatal injuries in 1840 students from February 2002 to January 2003 were monitored with standardized injury forms. Risk factors for injury were identified in multivariate analyses.

RESULTS

The annual overall injury rate was 32.3 per 100 students. Boys had a significantly higher injury rate than the girls (34.8 vs 30.3 per 100 students), and a significantly higher proportion of injuries in boys was caused by other students (28.1% vs 19.4%). A higher proportion of injuries in girls (40.7%) occurred at home. For both boys and girls, sports were the most common activities associated with injury. Injuries from falls were the leading cause of injury, and extremities were most frequently injured. Gender, age, ethnicity, and family income levels were identified as significant risk factors for injury in multivariate analyses.

CONCLUSIONS

Nonfatal injuries in middle-school and high-school students should be recognized as a significant public health concern in China.

Education was associated with injuries requiring hospital admission

OBJECTIVES

We describe educational inequalities in the incidence of injuries resulting in hospital admission and explore the contribution of exposure variables and chronic diseases, alcohol consumption, and sedative use to the observed inequalities.

STUDY DESIGN AND SETTING

Data from the Dutch prospective GLOBE study were linked to the National Hospital Discharge Register after 7 years of follow-up.

RESULTS

Significantly higher hazard ratios (HRs) of traffic injuries in lower compared with higher educational groups were substantially reduced after adjustment for differences in the use of cars and mopeds between these groups. Significantly increased HRs in occupational, home, and sports (OHS) injuries in lower compared with higher educational groups were reduced after adjustment for higher prevalence rates of chronic diseases, very excessive alcohol consumption, and sedative use in lower educational groups.

CONCLUSION

Exposure variables, chronic diseases, alcohol consumption, and sedative use contribute to educational inequalities in traffic and OHS injuries resulting in hospital admission.

Is there equalisation in socioeconomic differences in the risk of traffic injuries in childhood? A study of three cohorts of Swedish school children

Equalisation of socioeconomic differences in injury risks at school ages is investigated, considering changes in risk inequalities over time for various categories of road users. Three national cohorts of children were followed up after their entry in different compulsory school levels (about 190,000 subjects by cohort). Subjects were attributed a household socioeconomic status in 1990 and their traffic injuries were sought over a five-year period (1990--94) in the national hospital discharge and causes of death registers. Socioeconomic inequality was measured by year and cohort for various RTI (Road Traffic Injury) diagnoses using the Relative Index of Inequality (RII). Whether equalisation arose or not was assessed considering changes in RII scores within the five-year period, measured by Chi-squared test. RII scores were generally high except for bicycle-related injuries among boys from the oldest cohort throughout the follow up. This relative equality in bicycle-injury risk benefited boys from all socioeconomic groups. Also, there was some, though short lasting, equalisation in bicycle-related injury risk for the younger cohort at the end of the first grade of compulsory school. Hence, some but limited support to the concept of equalisation was found, especially among young male bicycle riders. Population-based intervention aimed at improving safety behaviours among bicycle or motor-vehicle users should target not only suspected class-related influences, but even influences from the school, peer group and youth culture. Transitional periods in modes of transportation are a major concern.