Associations between adolescent risk behaviors and injury: the modifying role of disability

Disparities in E-Cigarette and Tobacco Use Among Adolescents With Disabilities

INTRODUCTION

In 2019, nearly 30% of US high-school students reported current (past 30 day) e-cigarette use. Adolescents with disabilities are consistently more likely to smoke cigarettes compared with their nondisabled peers, yet little is known about their use of other forms of tobacco, including e-cigarettes. We compared the prevalence of tobacco use (e-cigarettes, cigarettes, little cigars, large cigars, hookahs, and smokeless tobacco) among high school students with at least 1 disability to those without disability.

METHODS

Data were from the 2015 and 2017 Oregon Healthy Teens survey, a statewide representative sample of 11th-grade students. We estimated the prevalence of current (past 30 day) tobacco use by product type and disability status (yes or no). We used multivariable Poisson regression to estimate prevalence ratios measuring the association between disability status and current tobacco use, by product: 1) combustible products only, 2) e-cigarettes only, and 3) dual use of combustibles and e-cigarettes.

RESULTS

Students with disabilities were more likely to use a variety of tobacco products compared with their nondisabled peers, including cigarettes (12.3% vs 5.4%), little cigars (7.0% vs 5.4%), hookahs (6.2% vs 3.8%), and e-cigarettes (18.3% vs 12.3%). In adjusted models, students with a disability were more likely to report using combustibles only (adjusted prevalence ratio [aPR], 1.55; 95% CI, 1.31-1.84), e-cigarettes only (aPR, 1.36; 95% CI, 1.16-1.59), or dual use (aPR, 1.52; 95% CI, 1.29-1.80) compared with nondisabled students.

CONCLUSION

Effective tobacco control programs should target populations with the greatest burden of tobacco use. Results suggest that tobacco prevention and reduction efforts should explicitly include adolescents with disabilities and employ accommodations that support their participation in program activities.

Parent Perspectives on Health and Functioning of School-Aged Adolescents With Disabilities

BACKGROUND

Youth living with disabilities are at risk of experiencing poor health outcomes. Coordinated school health programs have an opportunity to help youth with disabilities and their families through health education, health services, and community engagement. The World Health Organization developed the International Classification of Functioning, Disability, and Health (ICF) as a framework to analyze factors related to health conditions. We used the ICF to examine parental perceptions of health and function among students with disabilities living in rural and urban areas.

METHODS

We surveyed parents (N = 71) using the parent-report versions of the Pediatric Outcomes Data Collection Instrument and Child Health and Illness Profile. From this group, parents were asked to volunteer to participate in in-depth, individual interviews (N = 18). The interviews were audio-recorded and transcribed verbatim. Researchers used the ICF linking rules to analyze and code the transcriptions. Emergent themes were assigned numerical ICF codes.

RESULTS

There were more similarities than differences among rural and urban families. Children living with disabilities face significant environmental barriers regardless of context.

CONCLUSIONS

Schools can facilitate education to improve the quality of life of parents and families of children with disabilities. School authorities should consider the many environmental barriers both urban and rural these families face in the community. The ICF can be used as a framework for program planning for community-based, health education for this population.

Disparities in injury morbidity among young adults in the USA: individual and contextual determinants

BACKGROUND

Injuries have been recognised as important public health concerns, particularly among adolescents and young adults. Few studies have examined injuries using a multilevel perspective that addresses individual socioeconomic status (SES) and health behaviours and local socioeconomic conditions in early adolescence. We offer a conceptual framework incorporating these various components.

METHODS

We test our conceptual framework using population data from the National Longitudinal Study of Adolescent Health Wave 4 when respondents were young adults and linked them to contextual level data from when they were middle-schoolers. We use logistic and multilevel regression models to examine self-reported injury risk in young adults by sex (n=14 356).

RESULTS

Logistic regression models showed that men were more likely to experience serious injuries than women (OR 1.75, P<0.0001), but SES and health behaviours operated differently by sex. In stratified models, men with lower education had consistently higher injury risk, while only women with some college had increased injury risk (OR 1.40, P=0.0089) than college graduates. Low household income (OR 1.54, P=0.0011) and unemployment (OR 1.50, P=0.0008) increased female injury risk, but was non-significant for men. Alcohol consumption increased injury risk for both sexes, while only female smokers had elevated injury risk (OR 1.38, P=0.0154). In multilevel models, significant county-level variation was only observed for women. Women living in disadvantaged neighbourhoods during adolescence had increased injury risk (OR 1.001, P<0.0001).

CONCLUSIONS

These findings highlight the importance of investigating mechanisms that link early-life contextual conditions to early adult SES and health behaviours and their linkage to injury risk, particularly for women.

A systematic review of tobacco use among adolescents with physical disabilities

OBJECTIVE

To provide a systematic review of tobacco use among adolescents with physical disabilities.

STUDY DESIGN

A systematic review.

METHODS

A search was performed of English articles published prior to December 2014 in the PubMed database for studies examining smoking rates among adolescents with and without physical disabilities. Ten studies were retrieved (all cross-sectional surveys) of which six compared adolescent populations from nationally representative samples and four examined those based on convenience sampling. Pooled analyses of smoking rates by disability status were performed.

RESULTS

In studies from nationally representative samples (n = 6 studies), adolescents with physical disabilities were significantly more likely to use tobacco as compared to adolescents without (pooled analyses = 29.7% vs 23.3%). However, in studies from non-representative samples, adolescents with physical disabilities were less likely to use tobacco as compared to adolescents without (pooled analyses = 22.7% vs 39.1%).

CONCLUSIONS

Adolescents with physical disabilities may have an increased risk of tobacco use relative to those without disabilities. Tailored tobacco use prevention and cessation strategies may be appropriate for this high-risk population. Future longitudinal studies which determine factors associated with tobacco use among adolescents with different disabilities should be considered to reduce the disproportionate tobacco use in this population.

Unintentional injuries in children with disabilities: a systematic review and meta-analysis

Children with disabilities are thought to have an increased risk of unintentional injuries, but quantitative syntheses of findings from previous studies have not been done. We conducted a systematic review and meta-analysis to assess whether pre-existing disability can increase the risk of unintentional injuries among children when they are compared to children without disability. We searched 13 electronic databases to identify original research published between 1 January 1990 and 28 February 2013. We included those studies that reported on unintentional injuries among children with pre-existing disabilities compared with children without disabilities. We conducted quality assessments and then calculated pooled odds ratios of injury using random-effects models. Fifteen eligible studies were included from 24,898 references initially identified, and there was a total sample of 83,286 children with disabilities drawn from the eligible studies. When compared with children without disabilities, the pooled OR of injury was 1.86 (95 % CI 1.65–2.10) in children with disabilities. The pooled ORs of injury were 1.28, 1.75, and 1.86 in the 0–4 years, 5–9 years, and ≥10 years of age subgroups, respectively. Compared with children without disabilities, the pooled OR was 1.75 (95 % CI 1.26–2.43) among those with International Classification of Functioning (ICF) limitations. When disability was defined as physical disabilities, the pooled OR was 2.39 (95 % CI 1.43–4.00), and among those with cognitive disabilities, the pooled OR was 1.77 (95 % CI 1.49–2.11). There was significant heterogeneity in the included studies. Compared with peers without disabilities, children with disabilities are at a significantly higher risk of injury. Teens with disabilities may be an important subgroup for future injury prevention efforts. More data are needed from low- and middle-income countries.

Parental and practitioner perspectives on raising an adolescent with a disability: a focus group study

PURPOSE

To examine the challenges faced by parents of teenagers with a disability to determine the need for a tailored parenting program for this population.

METHOD

Focus groups were conducted with six parents and nine practitioners with experience supporting parents of teenagers with a disability.

RESULTS

An inductive thematic analysis revealed close agreement between parents and practitioners and eight understandable and relevant themes. The results indicated that parents have difficulty planning and facilitating transitions for their adolescent children, managing behavioural problems due to these problems being unique to this developmental period and because some of the parenting strategies that were useful when their children were younger were no longer applicable. High levels of stress and feelings of grief were also described.

CONCLUSIONS

These results suggest that parents of adolescents with a developmental disability could benefit from a parenting program and that an existing evidence-based parenting program should be modified. Implications for program design for this population are discussed.

IMPLICATIONS FOR REHABILITATION

Parents have difficulty supporting their teenagers' behaviour. Some parenting strategies that were useful for young children are no longer applicable. Parents may benefit from a parenting program tailored for teenagers.

Peer victimization and subjective health among students reporting disability or chronic illness in 11 Western countries

BACKGROUND

To compare the strength of the association between peer victimization at school and subjective health according to the disability or chronic illness (D/CI) status of students across countries.

METHODS

This study used data from 55 030 students aged 11, 13 and 15 years from 11 countries participating in the 2005-06 Health Behaviour in School-aged Children survey. Self-completed questionnaires were administered in classrooms. Multivariate models of logistic regression (controlled for confounding factors and countries) were used to investigate differences in the association between peer victimization and poor subjective health according to the D/CI status.

RESULTS

Overall, 13.5% of the students reported having been bullied at least two or three times a month. The percentage of victims was significantly higher among those reporting D/CI than among others in all countries studied. Victims of bullying were more likely to report poor self-rated health, low life satisfaction and multiple health complaints. However, there were no differences in the associations between peer victimization and subjective health indicators according to the D/CI status.

CONCLUSIONS

In all countries studied, students reporting D/CI were more likely to report being victims of bullying. Victims of bullying reported more negative subjective health outcomes regardless of their D/CI status. Although inclusive education is currently a major topic of educational policies in most countries, additional efforts should be made to improve the quality of the integration of students with D/CI.

Unintentional injury among low-income 5-year-olds with chronic health conditions

BACKGROUND

Growing numbers of children suffer from chronic health conditions, and initial evidence suggests chronic illness may be associated with increased child injury risk. We examined injury risk among 5-year-olds with and without chronic health conditions.

METHODS

Data from a diverse US sample of 7954 low-income 5-year-olds participating in the National Head Start/Public School Early Childhood Transition Demonstration Study were analysed. Mothers reported demographics, presence/absence of eight chronic health conditions, and whether children had experienced injuries requiring professional medical attention in the past year. Primary analyses used ordinal logistic regression.

RESULTS

Asthma, bronchitis, recurrent ear infections, hay fever/allergies and speech problems associated with increased injury risk (OR range = 1.20-1.49 in bivariate ordinal logistic regression, ps < 0.01). Children with cerebral palsy had reduced injury risk (OR = 0.37, 95% CI = 0.15-0.91, p < 0.05). Most findings held after including demographic covariates in multivariate models.

CONCLUSION

Because a range of chronic health conditions associated with increased injury risk, the causal mechanism behind relations between chronic illness and injury risk may not be disease-specific. Instead, factors related to having chronic medical conditions-not any particular condition-might contribute. Possible mediators include impaired family functioning, impaired peer relations, and familiarity with the health system/health-seeking behaviours.

Victims of bullying among students with a disability or chronic illness and their peers: a cross-national study between Ireland and France

PURPOSE

To explore bullying victimization among French and Irish students with a disability or chronic illness (D/CI), considering individual, social, and family factors. We investigated this issue in France and Ireland because of the documented differences between these two countries on relevant contextual factors.

METHODS

Data from 12,048 students aged 11, 13, and 15 years (50.1% were boys) as part of the cross-national study 2006 Health Behaviour in School-aged Children were analyzed. Self-completion questionnaires were administered in classrooms; information on socio-demographic characteristics, bullying involvement, D/CI, school participation, social network, and family were collected. Multivariate logistic regressions were performed with individual, social, and family cofactors.

RESULTS

Overall, the prevalence of bullying victimization was significantly higher in France compared with Ireland (34.2% [33.1-35.5] and 25.9% [24.5-27.4, respectively]). Youngest were more likely to report victimization; however, no gender differences were observed. In both countries, students with D/CI were significantly more likely to report that they have been bullied compared with students without D/CI, and a significant additional risk of being bullied was found when students reported D/CI with restriction in school participation. Regardless of country and D/CI status, being bullied was significantly associated with weaker social support and difficulty of communication with fathers, with even stronger associations found among students with D/CI.

CONCLUSION

Adolescents with D/CI are more likely to be victimized than their peers, with a similar risk in both countries. Besides individual, social and family factors are consistently associated to bullying victimization across countries. These results will guide future antibullying prevention programs.