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Tindberg Y, Janson S, Jernbro C. Unintentional Injuries Are Associated with Self-Reported Child Maltreatment among Swedish Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5263. [PMID: 37047879 PMCID: PMC10093922 DOI: 10.3390/ijerph20075263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 06/19/2023]
Abstract
Injuries constitute a large share of childhood morbidity and mortality. This study examines whether adolescents with self-reported experiences of different types of child maltreatment more frequently reported unintentional injury events requiring health- or dental care during the last year and/or hospitalization at any time during childhood. Cross-sectional data from a Swedish national representative school survey (2016) including 4741 adolescents were used (78.5% response rate). Data were analyzed with univariate tests and multiple logistic regression. Statistically significant associations between reported experiences of physical, psychological and sexual abuse, neglect, and witnessing partner violence during childhood and reported unintentional injuries requiring health- or dental care during the last year were found (aOR:s between 1.39-1.77). The corresponding association for poly-victimization was aOR 1.91 (95% CI 1.39-2.62). Furthermore, a linear-by-linear association was seen for degree of victimization and number of episodes of unintentional injuries that required care in the last year (p = 0.000), as well as lifetime hospitalizations (p = 0.000). This study shows significant associations between child maltreatment and unintentional injuries requiring health- and/or dental care and hospitalization. To improve both injury and child maltreatment prevention, healthcare professionals need to pay particular attention to children and adolescents who repeatedly seek healthcare services due to injurious events.
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Affiliation(s)
- Ylva Tindberg
- Department of Women’s and Children’s Health, Uppsala University, 751 85 Uppsala, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, 631 88 Eskilstuna, Sweden
| | - Staffan Janson
- Division of Public Health Sciences, Department of Health Sciences, Karlstad University, 651 88 Karlstad, Sweden
| | - Carolina Jernbro
- Division of Public Health Sciences, Department of Health Sciences, Karlstad University, 651 88 Karlstad, Sweden
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Zhang L, Liu J, Tang Y, Wang L. The impact of children's temperament on recurrent unintentional injuries: the role of paternal parenting styles as a mediator. PeerJ 2022; 10:e14128. [PMID: 36248711 PMCID: PMC9559059 DOI: 10.7717/peerj.14128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/06/2022] [Indexed: 01/21/2023] Open
Abstract
Background Unintentional injuries (UIs) pose a threat to the health of children all over the world and are a major global health problem. The recurrence of UIs are influenced by the host itself or environmental factors. Children's temperament and paternal parenting styles (PPS) are important potential factors for poor health outcomes, including recurrent unintentional injuries (recurrent UIs). Therefore, exploring the relationship among these variables may help reduce the likelihood of recurrent UIs in children. Purpose To elucidate the mediating effect of PPS in the relationship of children's temperament characteristics and recurrent UIs among children. Methods By multistage random cluster sampling method, a total of 2,850 pupils in grades four and five from 10 different schools were included. The survey included the characteristics of UIs in the past year, parenting styles, and children's temperament. Structural equation modeling (SEM) was used to examine the possible mediating effect of PPS between children's temperament and recurrent UIs. Results In this study, the incidence rate of recurrent UIs was 3.8%. In temperament, children with recurrent UIs had higher mean scores than the non-recurrent UIs group (t = -3.40, -3.52, -3.45, respectively; p < 0.001) in the activity, predictability, persistence. Meanwhile, the scores of negative PPS (punishing, over-interference, rejection, and overprotection) were higher in the recurrent UIs group than in the non-recurrent UIs group (t = -5.78, -5.05, -5.56, and -3.29; p < 0.001, < 0.001, < 0.001, < 0.001, respectively). Using a stepwise binary logistic regression model, grade (OR = 0.23, 95% CI [0.12-0.41], p < 0.001), activity (OR = 1.61, 95% CI [1.14-2.26], p = 0.007) and over-interference (OR = 2.28, 95% CI [1.37-3.80], p = 0.002) had a significant independent relationship with recurrent UIs. The SEM results indicated that children's temperament was significantly related to negative PPS (β = 0.26, p < 0.001) and recurrent UIs (β = 0.11, p = 0.029). The results of the bootstrap test confirmed the significance of the mediating effect of PPS (β = 0.06, p < 0.001) between children's temperament and recurrent UIs. Conclusions These results suggest that negative PPS plays an important role in mediating children's temperament and recurrent UIs. It is essential to consider PPS when creating tailored intervention programs to reduce children's recurrent UIs.
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Wu S, Yang T, He Y, Cui X, Luo X, Liu J. Association Between Hyperactivity Symptoms and Somatic Complaints: Mediating and Moderating Mechanisms in Childhood Trauma and Life Events Among Chinese Male Adolescents. Front Psychiatry 2021; 12:630845. [PMID: 34646169 PMCID: PMC8504436 DOI: 10.3389/fpsyt.2021.630845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 08/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Prior research has found that attention deficit/hyperactivity disorder (ADHD) - particularly hyperactivity symptoms - is associated with various somatic complaints. The present study further tests the relationship between hyperactivity symptoms and somatic complaints in Chinese male adolescents and explores the underlying moderating and mediating mechanisms. Methods: Our sample included 1,586 males (age = 12-16) recruited as part of an epidemiological study of child and adolescent mental disorders from April to July, 2014. Hyperactivity symptoms and somatic complaints were assessed with Achenbach's Child Behavior Checklist (CBCL), and the Childhood Trauma Questionnaire Short Form (CTQ-SF) and Adolescent Life Events Scale (ASLEC) were used to assess exposure to childhood trauma and recent life events. Results: Adolescents with hyperactivity symptoms experienced more emotional abuse, physical abuse, life events, and reported more somatic complaints symptoms (p < 0.0083 or p < 0.05). Linear regression analysis showed that hyperactivity, total childhood trauma score/emotional abuse and sexual abuse and ASLEC score significantly predicted somatic complaints (all p < 0.05). Emotional abuse and life events mediated the relationship between hyperactivity symptoms and somatic complaints. Furthermore, childhood trauma moderated the path between hyperactivity symptoms and ASLEC in the moderation mediation model for predicting somatic complaints (p < 0.05). Conclusions: Hyperactivity symptoms had a significant impact on somatic complaints among Chinese male adolescents. Furthermore, childhood trauma and life events affected the relationship between hyperactivity symptoms and somatic complaints. Interventions for somatic complaints in male adolescents with hyperactivity symptoms should thus consider history of childhood trauma and life events.
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Affiliation(s)
- Shuxian Wu
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Technology Institute on Mental Disorders, Changsha, China
| | - Tingyu Yang
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Technology Institute on Mental Disorders, Changsha, China
| | - Yuqiong He
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Technology Institute on Mental Disorders, Changsha, China
| | - Xilong Cui
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Technology Institute on Mental Disorders, Changsha, China
| | - Xuerong Luo
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Technology Institute on Mental Disorders, Changsha, China
| | - Jianbo Liu
- Department of Child Psychiatry of Shenzhen Kangning Hospital, Shenzhen Mental Health Center, School of Mental Health, Shenzhen University, Shenzhen, China
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Prasad V, West J, Sayal K, Kendrick D. Injury among children and young people with and without attention-deficit hyperactivity disorder in the community: The risk of fractures, thermal injuries, and poisonings. Child Care Health Dev 2018; 44:871-878. [PMID: 30039608 DOI: 10.1111/cch.12591] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/23/2018] [Accepted: 06/16/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Injuries commonly cause morbidity and mortality in children and young people (CYP). Attention-deficit hyperactivity disorder (ADHD) is the commonest neurobehavioural disorder in CYP and is associated with increased injury risk. However, large, population-based estimates of the risk of specific injuries are lacking. We aimed to provide estimates of the risk of fractures, thermal injuries, and poisonings in CYP with and without ADHD. METHODS In this population-based cohort study, we used primary and secondary care medical records from England from the Clinical Practice Research Datalink. There were 15,126 CYP with ADHD frequency-matched to 263,724 without, aged 3-17 years at diagnosis. The risk of (a) fractures, (b) thermal injuries, and (c) poisonings in CYP with ADHD was compared with those without. RESULTS The absolute rate of injury per thousand person-years at risk in CYP with versus without ADHD was fracture 28.9 (95% CI [27.5, 30.3]) versus 18.7 (95% CI [18.5, 19.0]), long bone fracture 17.7 (95% CI [16.7, 18.8]) versus 11.8 (95% CI [11.6, 12.0]), thermal injuries 4.4 (95% CI [3.9, 4.9]) versus 2.2 (95% CI [2.1, 2.3]), and poisonings 6.3 (95% CI [5.7, 6.9]) versus 1.9 (95% CI [1.9, 2.0]). Adjusting for age, sex, geographical region, deprivation, and calendar year, CYP with ADHD had 25% increase in risk of fracture (hazard ratio [HR] = 1.25; 95% CI [1.19, 1.31]), 21% increase in risk of long bone fracture (HR = 1.21; 95% CI [1.13, 1.28]), double the risk of thermal injury (HR = 2.00; 95% CI [1.76, 2.27]), and almost four times the risk of poisoning (HR = 3.72; 95% CI [3.32, 4.17]). CONCLUSIONS CYP with ADHD are at greater risk of fracture, thermal injury, and poisoning compared with those without. Paediatricians and health care professionals should provide injury prevention advice at diagnosis and reviews.
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Affiliation(s)
- Vibhore Prasad
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Joe West
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kapil Sayal
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Denise Kendrick
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
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Ruiz-Goikoetxea M, Cortese S, Aznarez-Sanado M, Magallón S, Alvarez Zallo N, Luis EO, de Castro-Manglano P, Soutullo C, Arrondo G. Risk of unintentional injuries in children and adolescents with ADHD and the impact of ADHD medications: A systematic review and meta-analysis. Neurosci Biobehav Rev 2017; 84:63-71. [PMID: 29162520 DOI: 10.1016/j.neubiorev.2017.11.007] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 11/08/2017] [Accepted: 11/14/2017] [Indexed: 01/01/2023]
Abstract
A systematic review with meta-analyses was performed to: 1) quantify the association between ADHD and risk of unintentional physical injuries in children/adolescents ("risk analysis"); 2) assess the effect of ADHD medications on this risk ("medication analysis"). We searched 114 databases through June 2017. For the risk analysis, studies reporting sex-controlled odds ratios (ORs) or hazard ratios (HRs) estimating the association between ADHD and injuries were combined. Pooled ORs (28 studies, 4,055,620 individuals without and 350,938 with ADHD) and HRs (4 studies, 901,891 individuals without and 20,363 with ADHD) were 1.53 (95% CI=1.40,1.67) and 1.39 (95% CI=1.06,1.83), respectively. For the medication analysis, we meta-analysed studies that avoided the confounding-by-indication bias [four studies with a self-controlled methodology and another comparing risk over time and groups (a "difference in differences" methodology)]. The pooled effect size was 0.879 (95% CI=0.838,0.922) (13,254 individuals with ADHD). ADHD is significantly associated with an increased risk of unintentional injuries and ADHD medications have a protective effect, at least in the short term, as indicated by self-controlled studies.
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Affiliation(s)
- Maite Ruiz-Goikoetxea
- Servicio de Urgencias Extrahospitalarias, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain.
| | - Samuele Cortese
- Center for Innovation in Mental Health, Academic Unit of Psychology, University of Southampton, Southampton, UK; Faculty of Medicine, Clinical and Experimental Sciences (CNS and Psychiatry), University of Southampton, Southampton, UK; Department of Child and Adolescent Psychiatry, NYU Langone Medical Center, New York, NY, USA.
| | | | - Sara Magallón
- Facultad de Educación y Psicología, Universidad de Navarra, Pamplona, Spain.
| | - Noelia Alvarez Zallo
- Servicio de Urgencias Extrahospitalarias, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain.
| | - Elkin O Luis
- Facultad de Educación y Psicología, Universidad de Navarra, Pamplona, Spain.
| | - Pilar de Castro-Manglano
- Departamento de Psiquiatría y Psicología Médica, Unidad de Psiquiatría Infantil y Adolescente, Clínica Universidad de Navarra, Pamplona, Spain.
| | - Cesar Soutullo
- Departamento de Psiquiatría y Psicología Médica, Unidad de Psiquiatría Infantil y Adolescente, Clínica Universidad de Navarra, Pamplona, Spain.
| | - Gonzalo Arrondo
- Instituto Cultura y Sociedad (ICS), Grupo Mente-Cerebro, Universidad de Navarra, Pamplona, Spain.
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Bonander C, Beckman L, Janson S, Jernbro C. Injury risks in schoolchildren with attention-deficit/hyperactivity or autism spectrum disorder: Results from two school-based health surveys of 6- to 17-year-old children in Sweden. JOURNAL OF SAFETY RESEARCH 2016; 58:49-56. [PMID: 27620934 DOI: 10.1016/j.jsr.2016.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 05/17/2016] [Accepted: 06/21/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Injuries are one of the leading causes of death and disability among children in Sweden and attention-deficit/hyperactivity disorder (ADHD) has previously been associated with an increased risk of injury in pediatric populations elsewhere in the world. Current evidence regarding the possible link between autism spectrum disorder (ASD) and injury risk appears limited, even though some potentially risk-increasing symptoms overlap. The purpose of this study was thus to study the association between both ADHD and ASD concerning the risk of injury among Swedish schoolchildren. METHODS Two samples were used: a population-based register study containing data from 18,416 children ranging from the ages of 6-17years collected by school nurses during 2012/2014 (Survey A), and a national cross-sectional study of 3202 ninth-grade children (~15years old) collected from 92 schools in 2011 (Survey B). The data were analyzed using χ(2)-tests and log-binomial generalized linear models to obtain risk ratios (RR), comparing cases reportedly affected by ADHD or ASD to unaffected controls. RESULTS After adjusting for confounders, ADHD was associated with a 65% increased risk of injury (RR 1.65 [95% CI: 1.32-2.05] in Survey A, and a 57% increased risk of injury (RR 1.57 [95% CI: 1.27-1.95]) in Survey B. ASD was not significantly associated with any differences in injury risk (RR 0.81 [95% CI: 0.57-1.14]). CONCLUSIONS The results indicate that there is an elevated injury risk among Swedish schoolchildren with ADHD but not for children with ASD. Future studies should focus on causal mechanisms mediating the association between ADHD and injuries in order to facilitate injury prevention strategies. PRACTICAL APPLICATIONS Parents and teachers of schoolchildren with ADHD should be made aware of the elevated injury risks associated with the diagnosis. Safety experts and injury control professionals should consider the development of specialized prevention strategies in order to reduce these risks.
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Affiliation(s)
- Carl Bonander
- Department of Environmental and Life Sciences, Karlstad University, Karlstad, Sweden; Centre for Public Safety, Karlstad University, Karlstad, Sweden.
| | - Linda Beckman
- Department of Public Health Sciences, Karlstad University, Karlstad, Sweden
| | - Staffan Janson
- Department of Public Health Sciences, Karlstad University, Karlstad, Sweden
| | - Carolina Jernbro
- Department of Public Health Sciences, Karlstad University, Karlstad, Sweden
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Keyes KM, Susser E, Pilowsky DJ, Hamilton A, Bitfoi A, Goelitz D, Kuijpers RCWM, Lesinskiene S, Mihova Z, Otten R, Kovess V. The health consequences of child mental health problems and parenting styles: unintentional injuries among European schoolchildren. Prev Med 2014; 67:182-8. [PMID: 25073079 PMCID: PMC4409127 DOI: 10.1016/j.ypmed.2014.07.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 07/14/2014] [Accepted: 07/20/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Unintentional injury is the leading cause of death for schoolchildren. We assessed the association between externalizing psychopathology, parenting style, and unintentional injury in European children in the community. METHODS Data were drawn from the School Children Mental Health in Europe project and included 4517 schoolchildren across seven diverse European regions. Past-year injuries serious enough to seek medical attention were reported by mothers. Child mental health problems were assessed using validated measures and reported by the mothers, teachers, and children. Parenting styles were based on The Parenting Scale and the Parent Behaviors and Attitudes Questionnaire. RESULTS Children with attention-deficit/hyperactivity symptoms and oppositional defiant symptoms had a higher risk of injury compared to other children whether based on parent report (OR=1.47, 95% C.I. 1.2-1.9), teacher report (OR=1.36, 95% C.I. 1.1-1.7), or parent and teacher report combined (OR=1.53, 95% C.I. 1.1-2.1). Children who self-reported oppositional symptoms also had higher risk of injury (OR=1.6, 95% C.I. 1.1-2.4). Low-caring behavior of parents increased the risk of injury (OR=1.4, 95% C.I. 1.1-1.9). CONCLUSION Unintentional injury is a potential adverse health consequence of child externalizing problems. Interventions to improve parent-child relationships and prevention as well as focused treatment for externalizing problems may reduce the burden of injury.
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Affiliation(s)
- Katherine M Keyes
- Mailman School of Public Health, Columbia University, Department of Epidemiology, New York, United States
| | - Ezra Susser
- Mailman School of Public Health, Columbia University, Department of Epidemiology, New York, United States; New York State Psychiatric Institute, New York, United States
| | - Daniel J Pilowsky
- Mailman School of Public Health, Columbia University, Department of Epidemiology, New York, United States; New York State Psychiatric Institute, New York, United States
| | - Ava Hamilton
- Mailman School of Public Health, Columbia University, Department of Epidemiology, New York, United States
| | - Adina Bitfoi
- The Romanian League for Mental Health, Bucharest, Romania
| | - Dietmar Goelitz
- Center for Applied Sciences of Health, Leuphana University of Luneburg, Luneburg, Germany
| | | | - Sigita Lesinskiene
- Clinic of Psychiatry, Faculty of Medicine, University of Vilnius, Vilnius, Lithuania
| | | | - Roy Otten
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Viviane Kovess
- École des Hautes Études en Santé Publique, Department of Epidemiology and Biostatistics, Paris, France.
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Sandseter EBH, Kennair LEO. Children's risky play from an evolutionary perspective: the anti-phobic effects of thrilling experiences. EVOLUTIONARY PSYCHOLOGY 2011; 9:257-284. [PMID: 22947972 PMCID: PMC10630584 DOI: 10.1177/147470491100900212] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Accepted: 06/08/2011] [Indexed: 04/08/2024] Open
Abstract
This theoretical article views children's risky play from an evolutionary perspective, addressing specific evolutionary functions and especially the anti-phobic effects of risky play. According to the non-associative theory, a contemporary approach to the etiology of anxiety, children develop fears of certain stimuli (e.g., heights and strangers) that protect them from situations they are not mature enough to cope with, naturally through infancy. Risky play is a set of motivated behaviors that both provide the child with an exhilarating positive emotion and expose the child to the stimuli they previously have feared. As the child's coping skills improve, these situations and stimuli may be mastered and no longer be feared. Thus fear caused by maturational and age relevant natural inhibition is reduced as the child experiences a motivating thrilling activation, while learning to master age adequate challenges. It is concluded that risky play may have evolved due to this anti-phobic effect in normal child development, and it is suggested that we may observe an increased neuroticism or psychopathology in society if children are hindered from partaking in age adequate risky play.
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Affiliation(s)
- Ellen Beate Hansen Sandseter
- Department of Physical Education, Queen Maud University College of Early Childhood Education (DMMH), Trondheim, Norway.
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Abstract
OBJECTIVE Although an association between behavior problems and childhood injuries has been established, the majority of studies have been cross-sectional and comorbidity has not been taken into account. The purpose of this study was to prospectively assess the relationship between behavior problems and the risk of unintentional injury in a population-based sample of Canadian children aged 4 to 11 years. METHOD This prospective cohort study considered data from Cycles 1 and 2 of the Canadian National Longitudinal Survey of Children and Youth. The outcome was injury in Cycle 2 (2 years later). The exposure was the presence of behavior problems in Cycle 1, defined as children with hyperactivity only, aggression only, anxiety only, hyperactivity with aggression, hyperactivity with anxiety, aggression with anxiety, and hyperactivity with aggression and anxiety. All groups were compared to children with no behavior problems. Covariates included child-related, parental, and social-environmental factors. RESULTS The final weighted longitudinal sample included 2,209,886 children, of which 11.4% were injured in Cycle 2. None of the behavior groups were at significant risk of injury 2 years later. However, children who lived with a single/no parent and children who did not live with a biological parent had a significantly greater risk of injury. After controlling for confounders, children who lived with a single/no parent had more than twice the risk of having an injury. CONCLUSION We need to look beyond behavior problems, and possibly at family and environmental factors, to reduce the burden of injuries in the Canadian population.
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